In situ hybridization localization of choline acetyltransferase mRNA in adult rat brain and spinal cord.

The cellular distribution of choline acetyltransferase (ChAT) mRNA within the adult rat central nervous system was evaluated using in situ hybridization. In forebrain, hybridization of a 35S-labeled rat ChAT cRNA densely labeled neurons in the well-characterized basal forebrain cholinergic system including the medial septal nucleus, diagonal bands of Broca, nucleus basalis of Meynert and substantia innominata, as well as in the striatum, ventral pallidum, and olfactory tubercle. A small number of lightly labeled neurons were distributed throughout neocortex, primarily in superficial layers. No cellular labeling was detected in hippocampus. In the diencephalon, dense hybridization labeled neurons in the ventral aspect of the medial habenular nucleus whereas cells in the lateral hypothalamic area and supramammillary region were more lightly labeled. Hybridization was most dense in neurons of the motor and autonomic cranial nerve nuclei including the oculomotor, Edinger-Westphal, and trochlear nuclei of the midbrain, the abducens, superior salivatory, trigeminal, facial and accessory facial nuclei of the pons, and the hypoglossal, vagus, and solitary nuclei and nucleus ambiguous of the medulla. In addition, numerous cells in the pedunculopontine and laterodorsal tegmental nuclei, the ventral nucleus of the lateral lemniscus, the medial and lateral divisions of the parabrachial nucleus, and the medial and lateral superior olive were labeled. Occasional labeled neurons were distributed in the giantocellular, intermediate, and parvocellular reticular nuclei, and the raphe magnus nucleus. In the medulla, light to moderately densely labeled cells were scattered in the nucleus of Probst's bundle, the medial vestibular nucleus, the lateral reticular nucleus, and the raphe obscurus nucleus. In spinal cord, the cRNA densely labeled motor neurons of the ventral horn, and cells in the intermediolateral column, surrounding the central canal, and in the spinal accessory nucleus. These results are in good agreement with reports of the immunohistochemical localization of ChAT and provide further evidence that cholinergic neurons are present within neocortex but not hippocampus.

Retrospective analysis of iatrogenic Mallory-Weiss tears occurring during upper gastrointestinal endoscopy.

BACKGROUND/AIMS: This study was made to determine the incidence and natural history of iatrogenic Mallory-Weiss tears. PATIENTS AND METHODS: We retrospectively analyzed twelve cases of iatrogenic Mallory-Weiss tears identified from 2,461 consecutive upper gastrointestinal endoscopies performed at our institution over a period of twenty-two months. RESULTS: In all cases, bleeding stopped spontaneously without the need of blood transfusions, endoscopic hemostasis therapy or any other interventions. Eight patients (67%) had retching or struggling during the procedure. Hiatus hernias were noted in three patients (25%). CONCLUSIONS: Iatrogenic Mallory-Weiss tears are rare and generally have a benign course. They tend to occur mostly in patients who have experienced excessive retching or struggling during endoscopy.

Alcohol and the pancreas.

Alcoholic pancreatitis may be one of the most serious adverse consequences of alcohol abuse. Its diagnosis, as it has for many years, depends primarily on clinical acumen in interpreting properly the symptoms and signs of abdominal distress, buttressed by elevated pancreatic enzymes (amylase and lipase). More recently, the use of computerized tomography (CT) in selected situations has been both of confirmatory and prognostic value. Severity of abnormality by CT correlates reasonably well with a variety of clinical-laboratory clusters (APACHE system, Ranson's criteria, etc.) and aids in therapy. The pathogenesis of alcoholic pancreatitis is not fully defined. The ultimate picture is one of tissue autolysis by activated proteolytic enzymes. The triggers for such activation, however, are still not known. They are represented by three main theories: (1) large duct obstruction and/or increased permeability relative to pancreatic secretion, (2) small duct obstruction due to proteinaceous precipitates, and (3) a direct toxic-metabolic effect of ethanol on pancreatic acinar cells. While not mutually exclusive, we favor the last hypothesis as being most consistent with the effects of ethanol on other organ systems. The direct effects of ethanol and/or its metabolites may be mediated, at least in part, via oxidative stress or the generation of fatty acid ethyl esters. Autolysis (regardless of proximate mechanism(s)) leads to inflammation likely mediated via release of various cytokines. It also should be appreciated that "acute" pancreatitis (the topic of this chapter) likely represents an acute process within a chronic pancreatic exposure and injury from alcoholic abuse. The key question of why pancreatitis develops in only a small number of alcohol abusers is not resolved. Therapy depends on the severity of alcoholic pancreatitis, which is defined by clinical-laboratory and often CT criteria. Mild pancreatitis usually resolves acutely with alcohol abstention and supportive therapy. Severe pancreatitis has a significant morbidity and mortality, mainly related to the degree of pancreatic necrosis and infection. It requires meticulous combined medical-surgical care.

Nódulos subcutáneos como manifestación de cisticercosis diseminada / Subcutaneous nodules as manifestation of disseminated cysticercosis

RESUMEN Antecedentes: La cisticercosis es una infección parasitaria causada por la TaeniaSolium. Puede presentar una forma diseminada con compromiso sistémico. Clínicamente, la cisticercosis diseminada puede debutar con la presencia de nódulos subcutáneos. Presentamos un caso de diagnóstico de cisticercosis diseminada con la presencia de nódulos subcutáneos y síntomas respiratorios como única fuente de sospecha de enfermedad. Caso: Se presenta el caso de un paciente varón de 76 años de edad procedente de una región del Centro del Perú que acude a emergencia por hemoptisis, baja de peso y astenia de un año de evolución. Presentaba además nódulos subcutáneos no dolorosos, móviles en miembros superiores, inferiores, tórax, abdomen, cuello y cara. En la biopsia se demostró la presencia de cisticercocelullosae. Fue tratado con albendazol 400mg cada 12 horas por 6 meses, con evolución favorable. Conclusión: La cisticercosis es una enfermedad prevalente en nuestro país. Su presentación diseminada, sin embargo, no es tan frecuente. El diagnóstico puede ser difícil y a veces permanecer oculto, pues la clínica varía de silente a formas graves, dependiendo del órgano afectado, que en una forma diseminada pueden ser múltiples los órganos afectados, como el caso de nuestro paciente. Se concluye que las presencias de nódulos subcutáneos deben hacernos pensar en la posibilidad de formas diseminadas de cisticercosis.

ABSTRACT: Cysticercosis is a parasitic infection caused by Taenia Solium. It can be present as a disseminated form with systemic compromise. Disseminated cysticercosis may clinically debut with the presence of subcutaneous nodules. We present a case of diagnosis of disseminated cysticercosis with the presence of subcutaneous nodules and respiratory symptoms as the only source of suspected disease. Case: We present the case of a 76-year-old male patient from a region of central Peru who came to emergency due to hemoptysis, low weight and asthenia of one year of evolution. It also presented subcutaneous nodules that were painless, mobile in upper and lower limbs, abdomen, neck and face, the biopsy demonstrated with the presence of cysticercuscelullosae. He was treated with albendazole 400mg every 12h for 6 months, with favorable evolution. Conclusion: Cysticercosis is a prevalent disease in our country. Its disseminated presentation, however, is not as frequent. Diagnosis can be difficult and sometimes remain hidden, as the clinic varies from silent to severe, depending on the affected organ, which in a disseminated form can be multiple, as in the case of our patient. We conclude that the presence of subcutaneous nodules should make us think about the possibility of disseminated forms of cysticercosis.

Presentación inusual de infección por HTLV-1: una caja de pandora de infecciones oportunistas / An unusual presentation of HTLV-1 infection: a pandora box of opportunist infections

HTLV-1 es un retrovirus endémico en Perú, relacionado ocasionalmente con algunas infecciones oportunistas aisladas. Presentamos el caso de un varón de 41 años, avicultor, con antecedente de TBC pulmonar tratado hace 6 meses. Ingresó a emergencia por presentar alteración de conciencia, disartria y diarrea acuosa. Al examen físico se evidenciaron placas confluentes en cavidad oral, lesiones máculo-papulares violáceas y placas costrosas; por biopsia de piel se confirmó sarcoma de Kaposi y sarna costrosa, además adenopatías cervicales que al estudio microscópico con test de Auramina mostró BAAR (++) y en el examen de heces con tinción Zielh Nielsen modificado, se evidenció ooquiste de Cystoisospora belli. Recibió trimetropin / sulfametozaxol, tratamiento antituberculoso. Se confirmó HTLV-1 por inmunofluorescencia. En el fondo de ojo se observó retinitis por citomegalovirus, recibió ganciclovir. A las tres semanas del ingreso hospitalario, falleció por insuficiencia respiratoria severa. Se discute la presencia de múltiples co-infecciones oportunistas en un paciente con inmunosupresión por HTLV-1.

HTLV-1 is an endemic retrovirus in Peru , occasionally associated with some isolated opportunistic infections. We present the case of a 41-year-old male poultry farmer with a history of pulmonary tuberculosis treated 6 months ago. He was admitted to emergency due to alteration of conscience, dysarthria and watery diarrhea; the examination revealed confluent plaques in the oral cavity, violaceous maculopapular lesions and crusted plaques. Skin biopsy confirmed Kaposi's sarcoma and crusted scabies; in addition, cervical lymphadenopathies showed evidence of BAAR (++) in the microscopic study with Auramine test, and in the examination of feces with modified Zielh Nielsen's stain, Cystoisospora belli oocyst was observed, and trimetropin / sulfametozaxol received antituberculous treatment. HTLV-1 was confirmed by immunofluorescence. In the fundus of the eye cytomegalovirus retinitis was evidenced, he received ganciclovir. At three weeks of hospital admission he died due to severe respiratory failure. We discuss the presence of multiple opportunistic co-infections in a patient with immunosuppression by HTLV-1.

Sleep apnea prosthesis for dentate patients.

This article describes clinical and laboratory techniques for the fabrication of a sleep apnea prosthesis for a dentate patient. The treatment objective is to posture the mandible at an increased vertical and protrusive position to diminish or eliminate the collapse of the base of tongue into the oropharynx. During fabrication of the prosthesis, cephalograms are used to evaluate spatial change between the base of the tongue and the posterior pharyngeal wall.

Stabilized record base for maxillary removable partial denture obturator.

Accurate maxillomandibular jaw relation records are enhanced by a stabilized framework used to support the occlusal rim and recording medium. Stability of the framework is often lost on the defect side because of the size of the surgical defect and/or number of missing teeth. This article introduces a technique that uses a record base stabilized with a soft resilient material that permits easy removal and replacement of the framework on the altered master cast without damage.

Septic involvement of polytetrafluoroethylene (PTFE) anastomoses producing false aneurysms: diagnosis and problems related to management.

Two patients with polytetrafluoroethylene (PTFE) grafts developed mycotic aneurysms at the suture lines. Both patients had chronic illnesses and recurrent infections. Attempts to surgically treat these aneurysms were unsuccessful. Infections involving PTFE grafts used in the management of children with congenital heart disease have not been reported. Problems related to diagnosis and management are discussed.

Acute acalculous cholecystitis in patients with acute traumatic spinal cord injury.

Acute acalculous cholecystitis (AAC) is a very serious complication which can be found in patients with multiple serious traumatic lesions ('polytrauma'). Very few patients have been reported in the literature with an acute spinal injury and associated AAC. We report seven patients with polytrauma and acute spinal cord injury who developed AAC. All had no complaint of the principal warning symptom: right upper quadrant abdominal pain. All presented with a palpable mass in this site and the laboratory results were compatible with cholestasis. The diagnosis of AAC was confirmed both by ultra sound and CT scanning. We discuss the possible precipitating factors and the treatment. One hundred and ninety one patients were admitted to the Intensive Care Unit in our Hospital with SCI over a period of 2 years, all of these in the acute stage. AAC was diagnosed in seven patients among them. Our purpose is to call attention to this clinical condition which can complicate the outcome of patients with multiple trauma and acute spinal cord injury. To date AAC in this group of patients has been infrequently described in the available literature.

Massive upper gastrointestinal hemorrhage due to cytomegalovirus infection in two patients with acquired immunodeficiency syndrome.

Massive upper gastrointestinal (GI) hemorrhage is a rare manifestation of GI cytomegalovirus (CMV) infection. A review of the English language literature yielded 21 well-documented cases of gastric ulcers due to CMV, and 7 of these 21 cases were complicated by significant GI bleeding. This report describes two cases of massive upper GI hemorrhage due to CMV infection in patients with acquired immunodeficiency syndrome (AIDS).

Morbidity and mortality in the wilderness.

The medical literature is limited regarding current wilderness morbidity and mortality statistics. Available studies concentrate on selected wilderness activities. This study retrospectively examines wilderness injuries, illnesses, and mortality based on case incident report files from eight National Park Service parks within California over a three-year period. Data were extracted regarding type of illness or injury, body area affected, age, gender, month in which the event occurred, and activity in which the victim was involved at the time of the event. The overall occurrence of nonfatal events was 9.2 people per 100,000 visits. More than 70% of all nonfatal events were related to musculoskeletal or soft-tissue injury. The most frequently involved body area was the lower limbs (38%). Seventy-eight mortalities occurred during the three years studied, resulting in an overall mortality rate of 0.26 deaths per 100,000 visits. Men accounted for 78% of the deaths. Heart disease, drowning and falls were the most common causes of death. The information and statistics on morbidity and mortality in California wilderness areas that this study provides may be used to guide future wilderness use, education, and management. A standardized, computerized database would greatly facilitate future evaluations, decisions, and policies.

Preparing teeth to receive a removable partial denture.

The success or failure of a removable partial denture is dependent on many factors. To achieve success, the practitioner must develop and sequence a sound treatment plan based on clinical and radiographic evidence. These findings must be carefully considered in prosthesis design and mouth preparation. Particular attention must be given to the proper placement of guiding planes and well-made rest seats and the use of surveyed crowns on abutment teeth. This article describes the rationale, importance, and clinical procedures for abutment preparation for removable partial dentures.