Optical coherence tomography detects retinal changes in hereditary cerebral amyloid angiopathy.

BACKGROUND AND PURPOSE: Investigating mutation carriers with Dutch-type hereditary (D-) cerebral amyloid angiopathy (CAA), offers the possibility to identify markers in pre- and symptomatic stages of CAA. Optical coherence tomography (OCT) has shown potential to detect retinal changes in several neurodegenerative diseases. The aim of the present exploratory study was to investigate thinning of retinal layers as a possible (early) biomarker in D-CAA mutation carriers. METHODS: Twenty-one D-CAA mutation carriers (n = 8 presymptomatic, n = 13 symptomatic, median age 50 years) and nine controls (median age 53 years) were scanned using spectral-domain OCT. Symptomatic mutation carriers were defined as having a history of ≥1 symptomatic intracerebral hemorrhage. D-CAA mutation carriers and controls were recruited from our D-CAA cohort and a healthy control cohort. Total peripapillary retinal nerve fiber layer (pRNFL) thickness, six regions of pRNFL, total macular volume (TMV), and individual macular region thickness were measured and analysed, adjusted for age. RESULTS: The overall median (interquartile range) thickness of pRNFL was lower in symptomatic, but not presymptomatic D-CAA mutation carriers compared with controls [91 (86-95) µm vs. 99 (87-108) µm; P = 0.006]. Both presymptomatic [111 (93-122) µm vs. 131 (123-143) µm; P < 0.001] and symptomatic carriers [119 (95-128) µm vs. 131 (123-143) µm; P = 0.034] had a thinner temporal-superior quadrant of the pRNFL versus controls. TMV or individual macular layer thickness did not differ between carriers and controls. CONCLUSIONS: Thinning of the retinal nerve fiber layer may be a candidate marker of disease in hereditary CAA. Further studies are needed to determine whether retinal thinning is present in sporadic CAA and estimate its value as a marker for disease progression.

The diagnosis of male breast cancer.

BACKGROUND: To review the procedural diagnosis of male breast cancer. METHODS: Medline and Google Scholar searches using the terms (male breast cancer) and (diagnosis); and (triple assessment). RESULTS: Most of the search-specific items are incorporated in more comprehensive reviews about male breast cancer in general. Relevant data was extracted in accordance with the aim of this review. RESULTS: Most of the diagnosed cases are advanced stage ductal invasive carcinomas, express hormone receptors in the great majority, and are less likely to over-express HER2-neu. They present usually as a painless retroareolar mass that requires triple assessment. The diagnosis needs a high index of suspicion primarily due to the unawareness of such a cancer in males.

Entrapment of the lateral cutaneous nerve of the calf.

Isolated lesion of lateral cutaneous nerve of the calf (LCNC), particularly due to entrapment, is rarely reported in the literature. Patients usually present with sensory symptoms in the lateral aspect of the calf. Treatment is usually by local applications or local steroid/anaesthetic injection. We report the first case of LCNC entrapment in a 35-year-old man which is documented by nerve conduction studies. The patient had a temporary improvement following a local anaesthetic/steroid injection. Owing to the recurrence of symptoms, the patient opted for surgery. About 1 year after surgery, the symptoms disappeared completely.

Pathological yawning as an ictal seizure manifestation in the elderly.

Excessive yawning has been reported in the peri-ictal period preceding or following seizures. We describe an exceptional case of an elderly man with impairment of consciousness and paroxysmal excessive yawning. We hypothesise that this can be regarded as an autonomic seizure originating from diencephalic/brainstem structures, manifesting with yawning as an ictal phenomenon.

Cervical radiculopathy: discrepancy or concordance between electromyography and magnetic resonance imaging?

In the screening of patients with cervical radiculopathy, a relatively common finding is the discrepancy between normal needle electromyography (EMG) and abnormal MRI, or vice versa. We carried out a retrospective study to assess the relationship between needle EMG and MRI findings in the preoperative evaluation of patients with cervical radiculopathy. The records of 147 patients were reviewed; 58 patients (M = 32, F = 26; age 53 ± 9) were included in the study. Needle EMG examination was abnormal in 28 patients. MRI abnormalities were found in all 58 patients, showing degenerative changes not affecting the nerve root in 15 and foraminal stenosis affecting the nerve root in 43; in the latter, needle EMG was abnormal in 28 patients and normal in the remainder. Concordance between EMG and MRI level of abnormality was found in 71% of patients with non-dermatomal symptom distribution. Concordance between clinical level, EMG and MRI abnormality was found in 50% of patients with C5, in 70% with C6 and in 67% with C7 symptom distribution. When EMG and MRI level of abnormality was discordant, the EMG abnormalities corresponded to the clinical level of symptom distribution. The results of our retrospective study reveal that in the majority of cases of cervical radiculopathy, EMG and MRI level of abnormalities are concordant. When there is discordance between EMG and MRI findings, the EMG helps in the guidance of patient selection for surgical intervention because it provides evidence of nerve root lesion and offers a dynamic tool in the follow-up evaluation.

Asymmetry of visual function in migraine with aura: correlation with lateralisation of headache and aura.

BACKGROUND: Asymmetry of visual phenomena and headache is an important feature of migraine with aura. METHODS: This asymmetry was explored by assessment of visual illusions, hemifield spatial contrast detection (HCD) and hemifield pattern reversal visual evoked potentials (HVEPs) in 47 migraineurs with aura (MA), who were not taking prophylactic medications, and 62 controls with the same age range (16-59). RESULTS: Illusions were greater and HCD was poorer in MA than in controls. There were no group differences with respect to P100 amplitude. The longer the duration of migraine the poorer the HCD. When the aura was consistently unilateral it was associated with greater illusions, reduced HCD and reduced hemifield P100 amplitude. These findings were not related to the side of headache. CONCLUSION: The lateralised changes suggest that the visual dysfunction occurs at a cortical level, and the correlation with the side of the aura suggests that dysfunction is most likely to occur in an area of preexisting anomaly of neural function.

Novel 6,8-dibromo-4(3H)-quinazolinone derivatives of promising anti-inflammatory and analgesic properties.

A new series of the title compounds incorporated into diverse N and O heterocyclic moieties of pharmacoavailability as anti-inflammatory and analgesic agents, were synthesized starting with 6,8-dibromo-2-phenyl-4H-3,1-benzoxazin-4-one (I) by its fusion with p-aminoacetophenone to give the new intermediate compound, 6,8-dibromo-2-phenyl-3-(4-acetylphenyl)-4(3H)-quinazolinone (II). The one pot reaction of II with the appropriate aromatic aldehydes and anhyd. ammonium acetate in the presence of either ethyl cyanoacetate or malononitrile afforded the corresponding 2(1H)-pyridones III or 2(1H)-iminopyridines IV, respectively, while its reaction with malononitrile and aromatic aldehydes in piperidine gave 2-aminopyrans V. Also, reaction of the acetyl derivative II with aromatic aldehydes afforded the corresponding 1,3-propen-1-one derivatives VI which underwent cyclization with hydrazine to give the corresponding pyrazolines VII and with urea and/or thiourea to give the corresponding tetrahydropyrimidin-2-ones and/or tetrahydropyrimidin-2-thiones VIII. Some representative examples of the new compounds showed promising anti-inflammatory and analgesic activities in experimental animals.

Radiative electron capture to the continuum and the short-wavelength limit of electron-nucleus bremsstrahlung in 90A MeV U88 + ((1s2)(2s2))+N2 Collisions.

We have measured the continuum momentum distribution for radiative electron capture to the continuum (RECC) cusp electrons in 90A MeV U88+ + N2-->U88+ + N2 +* + ecusp(0 degrees ) + hnu (RECC) collisions. We demonstrate that x rays coincident with RECC cusp electrons originate from the short-wavelength limit of the electron-nucleus bremsstrahlung and explain the asymmetric cusp shape by comparison with theory within the relativistic impulse approximation.

The value of neurophysiological and imaging studies in predicting outcome in the surgical treatment of cervical radiculopathy.

It is not always easy to predict the degree of symptomatic improvement to be expected in a patient undergoing surgery for cervical disc herniation and radiculopathy. Here we investigate whether preoperative electromyography (EMG) can help select those most likely to benefit from intervention. We prospectively evaluated 20 patients whose required operative level was unclear after clinical examination and MRI scan alone. The surgical procedures was anterior cervical interbody fusion with the AcroMed carbon fibre cage. Clinical assessment employed using validated scoring systems (Prolo functional and economic scoring system). Patients underwent MRI preoperatively, and were assessed pre and postoperatively with neurophysiological studies (NPS) including nerve conduction studies and concentric needle EMG. Patients with preoperative evidence of cervical nerve root involvement on EMG (group A, n = 8) had better outcome (P = 0.001) following discectomy and anterior fusion than patients who had no evidence of nerve root damage on EMG (group B, n = 12). Prolo mean score +/- SEM for group A was 7.375 +/- 0.3750 and for group B was 5.583 +/- 0.2876. Thus, NPS are a valuable tool in selecting patients in this subgroup for cervical surgery.

Procedure for the assessment of liquefaction of hidraulic fill coal refuse disposal facilities

A rational procedure for the investigation and assessment of potential liquefaction and the stability of hidraulic fill coal refuse disposal impoundments under seismic loading is outlined. Fiel and laboratory testing as applied to several sites in the Appalachian coalfields are summarized (AU)

Supporting cancer care in the developing countries: role of IAEA/WHO.

Cancer management can be expensive and constitutes a major problem in many developing countries where management standards are poor due to many factors, including non-availability of sufficient funds, equipment, and trained personnel. The incidence of cancer is rising worldwide. This is more so in the developing countries, many of whom are less equipped to deal with the problems. Radiation therapy is one of the major treatment modalities for cancer, and it is estimated that about 60% of all cancer patients require this treatment at one time or another during the course of their disease. Unfortunately, radiotherapy facilities are lacking or grossly inadequate in many developing countries. Over the past 8 years the IAEA and WHO have shown more interest in the problem and treatment of cancer in the developing countries. This paper reviews the role of these international organizations, with emphasis on research activities, education (seminars, workshops, training courses), and technical assistance programs. These include establishment or upgrading of radiotherapy facilities, provision of experts, etc. Scientific papers are published with a view to disseminating current information and research findings in the developing countries. The achievements up to date are assessed and discussed.

An overview of the situation in radiotherapy with emphasis on the developing countries.

Radiotherapy services are closely linked to the level of medical care which, in turn, is an important component of the overall health care program, with its development related to social, economic, and educational factors. As a basis for understanding the situation regarding adequate coverage of the population by radiotherapy services, general information about the world population (currently 5 billion), age distribution, frequency of cancer occurrence, and causes of death is presented. For an appreciation of the obstacles that must be overcome, the situation with regard to Gross National Product (GNP), transfer of economic resources, and per capita expenditures for health services is shown. For example, in the developing world, most countries spend less than 5% of their GNP for health, and on a macro scale at least 20 billion U.S. dollars per year are being transferred from the poor nations of the southern hemisphere to the northern hemisphere. Information about the wide range of population coverage with radiotherapy resources and the trend regarding high-energy radiotherapy machines is presented. For example, in North America (USA) there are six high-energy machines for each one million persons, and each machine is used to treat about 230 new patients per year. In other parts of the world, such as large areas of Africa and South-East Asia, there may only be one high-energy radiotherapy machine for 20 to 40 million people, and one machine may be used to treat more than 600 new patients per year. Many cancer patients have no access to radiotherapy services. When estimates of the need for radiotherapy services in the developing world as a consequence of cancer incidence are compared with the current health expenditures, it is concluded that a combined effort of national authorities, donor and financial institutions, professional and scientific societies, and international organizations is required. The knowledge, skills, and technology are available in many excellent radiotherapy centers throughout the world. The key issues are priority and the commitment of sufficient resources.

Optimization of nuclear medicine procedures for the diagnosis and management of thyroid disorders: report of a research coordination meeting held in Vienna, 15-17 December 1986 under the auspices of the International Atomic Energy Agency.

The third and final meeting of a coordinated research programme on the diagnosis and management of thyroid disorders was held in Vienna from 15 to 17 December 1986. The participants were from Czechoslovakia, Egypt, Israel, Malaysia and Thailand. Each participant had studied between 500 and 1000 patients for thyroid function evaluation by performing T3, T4 and TSH radioimmunoassays. Each had also used the newly available supersensitive immunoradiometric (IRMA) assay in a group of patients to compare the efficiency of the new assay with that of the conventional assay. A microcomputer was provided to each participant for data analysis. Internal quality control was studied by establishing precision profiles and external quality control was on the basis of pooled standard sera in different ranges. Recommendation for the strategy suggested T4 RIA as the test of first choice in each category of thyroid function. IRMA TSH was suggested as a second test in borderline cases.

Study of eosinophilia in relation to serum IgE level and cell mediated immunity (CMI) to soluble egg antigen (SEA) in human schistosomiasis mansoni.

Eosinophil count, delayed intradermal test and lymphoblast transformation test (LTT) using SEA, have been used to study the correlation of eosinophilia with CMI in patients with schistosomiasis mansoni. Only a weak positive correlation was found between the eosinophil count and both in vivo and in vitro manifestations of CMI. When IgE serum level was correlated with eosinophil count, a positive correlation was only found in cases with hepato-splenic disease (those with increased CMI).

The optimization of nuclear medicine procedures for the diagnosis and management of thyroid disorders in developing countries.

Thyroid disease is common in developing countries and its management is based on the measurement of thyroid function and the investigation of thyroid masses. This report discusses techniques and outlines a strategy for the measurement of thyroid function using radioimmunoassays of thyroid-related hormones in the blood. It makes proposals for the evaluation of thyroid morphology using echography, pertechnetate imaging and fine needle biopsy. Note is taken of the difficulties facing laboratories in developing countries and the International Atomic Energy Agency is concerned with the practical assessment of these recommendations and of any alternative proposals in this field.

Study of cell mediated immune responsiveness to soluble egg antigen and phytohaemagglutinin using the lymphoblast transformation test in human schistosomiasis mansoni in Egypt.

Antigeno soluvel de ovo e fitohemaglutinina foram usados para medir a resposta imunologica celular dos pacientes com esquistossomose mansonica atraves do teste de transformacao linfoblastica. Antigeno soluvel de ovo mostrou resposta maior nos casos com hepatosplenomegalia quando comparados com as formas intestinais simples, as respostas mais altas sendo reencontradas nos grupos etarios mais jovens. Fitohemaglutinina mostrou resposta menor nos casos de esquistossomose intestinal simples e resposta maior nos grupos etarios de media idade. Esses resultados corroboram a importancia da resposta imunologica de tipo celular do hospedeiro nas varias manifestacoes da esquistossomose

Cell mediated immune (CMI) responsiveness to soluble egg antigen (SEA) and its relation to the occurrence of schistosomal hepatosplenic disease in patients with schistosomiasis mansoni.

The delayed intradermal test and migration inhibition tests were used to assess the delayed hypersensitivity in patients with BHF and simple intestinal bilharziasis using SEA. All bilharzial patients gave a positive intradermal test. The specificity of the intradermal test using SEA is demonstrated clearly by the negative response in all control groups.