Association of psychosocial traits with coronary artery calcium development and progression: The Multi-Ethnic Study of Atherosclerosis.

BACKGROUND: Coronary artery calcium (CAC) is a well-established quantifiable risk factor for cardiovascular disease (CVD). We examined the association of anger, hostility, anxiety, and depression with the development and progression of CAC. METHODS: We studied the association of these psychosocial traits with CAC among participants in the Multi-Ethnic Study of Atherosclerosis (MESA). Anger was measured using the Spielberger Trait Anger questionnaire, hostility using a modified Cook-Medley Hostility questionnaire, anxiety using the Spielberger Trait Scale, and depression using the Center for Epidemiological Studies Depression Scale (CES-D). Among the subsample of participants with CAC = 0 at the beginning of the study period, Poisson regression models were used to determine the relative risk of developing CAC>0 over the study period. In the subsample that developed CAC>0, we used linear regression models to estimate the average increase in CAC associated with a unit increase in psychosocial trait. RESULTS: Median time of follow-up was 9.4 years (range 8.0-11.4 years). Cross-sectional analyses at baseline revealed no association of any of the psychosocial traits with the presence or magnitude of CAC (anger: RR 0.98, p < 0.01; hostility: RR 1.01, p = 0.25; anxiety: RR 0.99, p < 0.01; depression: RR 0.99, p < 0.01 [not statistically significant after adjustment for covariates]). No association was detected between the traits and development of CAC (anger: RR 0.99, p = 0.23; hostility: RR 1.01, p = 0.68, anxiety: RR 1.00, p = 0.49; depression: RR 1.00, p = 0.51). We also found no association between any of the traits and progression of CAC (anger: beta -3.21, p = 0.08; hostility: beta 2.28, p = 0.43; anxiety: 3.45, p = 0.02 [not statistically significant after adjustment for covariates]; depression: beta -1.46, p = 0.11). CONCLUSIONS: We found no association between anger, hostility, anxiety, or depression and CAC, suggesting these personality traits are not independent risk factors for CVD.

Concordancia entre la PET cerebral con 18F-FDG y los biomarcadores en líquido cefalorraquídeo en el diagnóstico de enfermedad de Alzheimer / Concordance between brain 18F-FDG PET and cerebrospinal fluid biomarkers in diagnosing Alzheimer's disease

Objetivos. El hipometabolismo cortical posterior por PET con 18F-FDG (PET-FDG) y la alteración de los niveles del péptido Aß1-42 y las proteínas Tau total (tTau) y Tau fosforilada (pTau) en líquido cefalorraquídeo (LCR) son biomarcadores establecidos para el diagnóstico de la enfermedad de Alzheimer (EA). Evaluamos la concordancia y la relación entre los resultados de la PET-FDG y los biomarcadores en LCR en pacientes sintomáticos con sospecha de EA. Material y métodos. Revisión retrospectiva de 120 pacientes con deterioro cognitivo admitidos en la Unidad de Neurología Cognitiva a los que se les ha realizado punción lumbar para la determinación de biomarcadores en LCR y una PET-FDG cerebral. Para el análisis de concordancia (coeficiente Kappa), el resultado de la PET-FDG y del conjunto de los biomarcadores-LCR se clasificó en cada paciente como normal, no-concluyente, o compatible-EA. Se efectuó además una regresión logística incluyendo las variables cuantitativas Aß1-42, tTau y pTau como predictores y la PET-FDG como variable dependiente. Resultados. El coeficiente Kappa ponderado entre PET-FDG y biomarcadores-LCR fue de 0,46 (IC 95%: 0,35-0,57). En el análisis por regresión logística, la Aß1-42 y la tTau fueron en conjunto capaces de discriminar un resultado PET metabólicamente sugestivo de EA de uno no sugestivo de EA, con una sensibilidad del 91% y una especificidad del 93% aplicando la recta de corte Aß1-42=44+1,3×tTau. Conclusiones. La concordancia entre la PET-FDG cerebral y los biomarcadores-LCR es moderada, lo cual indica su valor complementario en el diagnóstico de EA. Los niveles de Aß1-42 y tTau en LCR son buenos predictores del estatus metabólico característico de EA por PET-FDG cerebral (AU)

Objectives. Cortical posterior hypometabolism on PET imaging with 18F-FDG (FDG-PET), and altered levels of Aß1-42 peptide, total Tau (tTau) and phosphorylated Tau (pTau) proteins in cerebrospinal fluid (CSF) are established diagnostic biomarkers in Alzheimer's disease (AD). An evaluation has been made of the concordance and relationship between the results of FDG-PET and CSF biomarkers in symptomatic patients with suspected AD. Material and methods. A retrospective review was carried out on 120 patients with cognitive impairment referred to our Cognitive Neurology Unit, and who were evaluated by brain FDG-PET and a lumbar puncture for CSF biomarkers. In order to calculate their Kappa coefficient of concordance, the result of the FDG-PET and the set of the three CSF biomarkers in each patient was classified as normal, inconclusive, or AD-compatible. The relationship between the results of both methods was further assessed using logistic regression analysis, including the Aß1-42, tTau and pTau levels as quantitative predictors, and the FDG-PET result as the dependent variable. Results. The weighted Kappa coefficient between FDG-PET and CSF biomarkers was 0.46 (95% CI: 0.35-0.57). Logistic regression analysis showed that the Aß1-42 and tTau values together were capable of discriminating an FDG-PET result metabolically suggestive of AD from one non-suggestive of AD, with a 91% sensitivity and 93% specificity at the cut-off line Aß1-42=44+1.3×tTau. Conclusions. The level of concordance between FDG-PET and CSF biomarkers was moderate, indicating their complementary value in diagnosing AD. The Aß1-42 and tTau levels in CSF help to predict the patient FDG-PET cortical metabolic status (AU)

Concordance between brain 18F-FDG PET and cerebrospinal fluid biomarkers in diagnosing Alzheimer's disease. / Concordancia entre la PET cerebral con 18F-FDG y los biomarcadores en líquido cefalorraquídeo en el diagnóstico de enfermedad de Alzheimer.

OBJECTIVES: Cortical posterior hypometabolism on PET imaging with 18F-FDG (FDG-PET), and altered levels of Aß1-42 peptide, total Tau (tTau) and phosphorylated Tau (pTau) proteins in cerebrospinal fluid (CSF) are established diagnostic biomarkers in Alzheimer's disease (AD). An evaluation has been made of the concordance and relationship between the results of FDG-PET and CSF biomarkers in symptomatic patients with suspected AD. MATERIAL AND METHODS: A retrospective review was carried out on 120 patients with cognitive impairment referred to our Cognitive Neurology Unit, and who were evaluated by brain FDG-PET and a lumbar puncture for CSF biomarkers. In order to calculate their Kappa coefficient of concordance, the result of the FDG-PET and the set of the three CSF biomarkers in each patient was classified as normal, inconclusive, or AD-compatible. The relationship between the results of both methods was further assessed using logistic regression analysis, including the Aß1-42, tTau and pTau levels as quantitative predictors, and the FDG-PET result as the dependent variable. RESULTS: The weighted Kappa coefficient between FDG-PET and CSF biomarkers was 0.46 (95% CI: 0.35-0.57). Logistic regression analysis showed that the Aß1-42 and tTau values together were capable of discriminating an FDG-PET result metabolically suggestive of AD from one non-suggestive of AD, with a 91% sensitivity and 93% specificity at the cut-off line Aß1-42=44+1.3×tTau. CONCLUSIONS: The level of concordance between FDG-PET and CSF biomarkers was moderate, indicating their complementary value in diagnosing AD. The Aß1-42 and tTau levels in CSF help to predict the patient FDG-PET cortical metabolic status.

Trends in the frequency and quality of parathyroid surgery: analysis of 17,082 cases over 10 years.

OBJECTIVE: To examine trends in the frequency and quality of surgery for primary hyperparathyroidism (PHPT) in California during the period of 1999 to 2008. BACKGROUND: The quality of surgery for PHPT can be measured by the complication rate and the success rate of surgery. A fraction of patients with failed initial surgery undergo reoperation. METHODS: Data on patients undergoing parathyroidectomy (PTx) were obtained from the California Office of Statewide Health Planning and Development. Renal transplant recipients and dialysis patients were excluded. Hospitals were categorized by case volume: Very low: 1 to 4 operations annually; Low: 5 to 9; Medium, 10 to 19; High: 20 to 49; Very high: 50 or more. Complication rates and the percentage of cases requiring reoperation were analyzed. RESULTS: A total of 17,082 cases were studied. Annual case volume grew from 990 to 2746 (177% increase) over the study period, corresponding to a 147% increase in the per capita PTx rate. The proportion of cases performed by very high-volume hospitals increased from 6.4% to 20.5% (P < 0.001). The overall complication rate declined from 8.7% to 3.8% (P < 0.001). Complication rates were inversely related to hospital volume (very high volume, 3.9% vs very low volume, 5.2%, P < 0.05). Reoperation was performed in 363 patients (2.1%). The reoperation rate increased from 0.91% to 2.73% during the study period (P < 0.01). The reoperation rate was inversely and nonlinearly related to hospital volume, as described by the equation % reoperation = 100/(total hospital case volume). CONCLUSIONS: Surgery for PHPT has grown safer and more common over time. High-volume centers have lower rates of complication and reoperation.

Recurrent hyperparathyroidism and a novel nonsense mutation in a patient with hyperparathyriodism-jaw tumor syndrome.

OBJECTIVE: To present the case of a hyperparathyroidism-jaw tumor (HPT-JT) patient with a novel nonsense mutation of the CDC73 gene. METHODS: We present the case of a patient with a history of three prior maxillectomies and two prior parathyroidectomies who presented with recurrent primary hyperparathyroidism (PHPT). We also briefly review the literature pertaining to HPT-JT. RESULTS: Genetic analysis revealed a novel nonsense mutation (c.85G>T; pGlu29) in exon 1 of CDC73. The patient's son underwent genetic testing for a CDC73 mutation and was found to be negative. CONCLUSION: HPT-JT is a rare condition characterized by PHPT and benign tumors of the mandible and maxilla. Up to 15% of HPT-JT patients with PHPT have parathyroid carcinoma. HPT-JT is associated with an inactivating mutation of CDC73, a gene that codes for the tumor suppressor protein parafibromin. This report expands our understanding of the genetics underlying this rare disorder and emphasizes the importance of early detection in order to prevent hypercalcemic complications such as parathyroid carcinoma.

Endocrine surgery as a model for value-based health care delivery.

BACKGROUND: Experts advocate restructuring health care in the United States into a value-based system that maximizes positive health outcomes achieved per dollar spent. We describe how a value-based system implemented by the University of California, Los Angeles UCLA Section of Endocrine Surgery (SES) has optimized both quality and costs while increasing patient volume. METHODS: Two SES clinical pathways were studied, one allocating patients to the most appropriate surgical care setting based on clinical complexity, and another standardizing initial management of papillary thyroid carcinoma (PTC). The mean cost per endocrine case performed from 2005 to 2010 was determined at each of three care settings: A tertiary care inpatient facility, a community inpatient facility, and an ambulatory facility. Blood tumor marker levels (thyroglobulin, Tg) and reoperation rates were compared between PTC patients who underwent routine central neck dissection (CND) and those who did not. Surgical patient volume and regional market share were analyzed over time. RESULTS: The cost of care was substantially lower in both the community inpatient facility (14% cost savings) and the ambulatory facility (58% cost savings) in comparison with the tertiary care inpatient facility. Patients who underwent CND had lower Tg levels (6.6 vs 15.0 ng/mL; P = 0.024) and a reduced need for re-operation (1.5 vs 6.1%; P = 0.004) compared with those who did not undergo CND. UCLA maintained its position as the market leader in endocrine procedures while expanding its market share by 151% from 4.9% in 2003 to 7.4% in 2010. CONCLUSIONS: A value-driven health care delivery system can deliver improved clinical outcomes while reducing costs within a subspecialty surgical service. Broader application of these principles may contribute to resolving current dilemmas in the provision of care nationally.

Prevalence of rubella IgG antibodies among Syrian females of childbearing age.

OBJECTIVE: To examine the current sero-epidemiology of rubella IgG among Syrian females of childbearing age that missed rubella vaccination. METHODS: A cross-sectional study examined healthy female students of the Pharmacy College, Kalamoon University, Deratiah, Syria. Ninety sera were collected between March and May 2008, and were subject to rubella specific IgG screening and titration using an enzyme-linked immunosorbent assay-based technique provided by Diamed Eurogen in the Microbiology Laboratory, Faculty of Pharmacy. RESULTS: The quantitative analysis for rubella IgG showed a noticeable variability in the values of antibodies that ranged between 0-363 IU/ml. A total of 77 participants were positive for rubella IgG giving a prevalence of 85.6%, and leaving a relatively high proportion of susceptibility (14.4%) among the tested group. CONCLUSION: Although most women tested were seropositive for rubella IgG, suggesting a natural virus circulation within the community, screening for protective immunity followed by vaccination to those who missed the regular vaccine program should be enforced to prevent possible rubella congenital syndrome. In addition, adding a second shot of rubella vaccine to those who were subject to the national program of vaccination is a must since the concentration of antibodies may drop below the recommended levels necessary for protection.

Estudio observacional sobre seguridad, tolerabilidad y efectividad de la galantamina en pacientes con enfermedad de Alzheimer leve a moderadamente grave / Observational study on safety, tolerability and effectiveness of galantamine in patients with mild to moderately severe Alzheimer's disease

Introducción. Ensayos clínicos controlados han demostrado la seguridad, tolerabilidad y efectividad de la galantamina en pacientes con enfermedad de Alzheimer (EA). Se presenta un estudio realizado en España, de carácter observacional y multicéntrico, con galantamina en el tratamiento de la EA leve a moderadamente grave en condiciones asistenciales reales. Métodos. Se llevaron a cabo cinco visitas durante un período de observación de 6 meses. El tratamiento con galantamina fue iniciado según la pauta estándar. Se recogieron todos los acontecimientos adversos (AA) comunicados por los pacientes, con especial atención a los considerados graves. También se exploraron las áreas cognitiva, actividades de la vida diaria, los síntomas conductuales y la calidad del sueño. Resultados. De los 723 pacientes reclutados se excluyeron 74, quedando una muestra total de 649 (71% mujeres y 29% varones). El 56.3% completó todas las visitas. La puntuación basal media del Mini-Examen Cognoscitivo (MEC) fue de 19,4 (DE: 4,7). El 29,3% de los pacientes comunicaron un total de 400 AA. Los AA más frecuentes fueron: náuseas (9,7%), vómitos (7,1), mareo (4,6%) y diarrea (4,5%). La puntuación del MEC se estabilizó a lo largo del estudio y hubo diferencias significativas favorables en la valoración de la conducta y la calidad del sueño. Conclusiones. La galantamina es un tratamiento bien tolerado en pacientes con EA leve a moderadamente grave y ha mostrado efectividad cognitiva, funcional y conductual en la práctica clínica habitual (AU)

INTRODUCTION: Several controlled clinical trials have demonstrated safety, tolerability, and efficacy of galantamine in patients with Alzheimer's disease (AD). We present an observational and multicenter study carried out in Spain. Its main objective was the assessment of the safety and tolerability of galantamine in the treatment of mild to moderately severe dementia of the Alzheimer type under real clinical conditions. METHODS: The study had five visits over a 6-month period. Titration of galantamine was performed on a standard basis. All the adverse events (AE) reported were recorded. Serious AE were particularly considered. Effectiveness was also assessed covering cognitive, functional, behavioral and sleep domains. RESULTS: 723 patients were enrolled but 74 were excluded, a sample of 649 (71% women and 29% men) remaining. A total of 56.3% patients completed all visits. Baseline Mini-Mental mean score was 19,4 (SD: 4,7). Up to 400 AEs were collected from 29.3% of the patients. The commonest AEs were: nausea (9.7%), vomiting (7.1%), dizziness (4.6%), and diarrhea (4.5%). Mini-Mental scores were stable over time and favorable and significant differences in behavioral and sleep evaluations were observed. CONCLUSIONS: Galantamine is a safe and well-tolerated treatment, and provides cognitive, functional, and behavioral benefits in patients with mild to moderately severe AD (AU)

[Observational study on safety, tolerability and effectiveness of galantamine in patients with mild to moderately severe Alzheimer's disease]. / Estudio observacional sobre seguridad, tolerabilidad y efectividad de la galantamina en pacientes con enfermedad de Alzheimer leve a moderadamente grave.

INTRODUCTION: Several controlled clinical trials have demonstrated safety, tolerability, and efficacy of galantamine in patients with Alzheimer's disease (AD). We present an observational and multicenter study carried out in Spain. Its main objective was the assessment of the safety and tolerability of galantamine in the treatment of mild to moderately severe dementia of the Alzheimer type under real clinical conditions. METHODS: The study had five visits over a 6-month period. Titration of galantamine was performed on a standard basis. All the adverse events (AE) reported were recorded. Serious AE were particularly considered. Effectiveness was also assessed covering cognitive, functional, behavioral and sleep domains. RESULTS: 723 patients were enrolled but 74 were excluded, a sample of 649 (71% women and 29% men) remaining. A total of 56.3% patients completed all visits. Baseline Mini-Mental mean score was 19,4 (SD: 4,7). Up to 400 AEs were collected from 29.3% of the patients. The commonest AEs were: nausea (9.7%), vomiting (7.1%), dizziness (4.6%), and diarrhea (4.5%). Mini-Mental scores were stable over time and favorable and significant differences in behavioral and sleep evaluations were observed. CONCLUSIONS: Galantamine is a safe and well-tolerated treatment, and provides cognitive, functional, and behavioral benefits in patients with mild to moderately severe AD.

The mechanism of glucose-induced catecholamine stimulation.

Catecholamines are important hormones for maintaining homeostasis and may be secreted in response to several different stimuli. A report by Robertson and Porte in 1974 made the unexpected observation that acute administration of hypertonic glucose stimulates catecholamine secretion. Our study reassessed this observation by measuring individual catecholamines, explored its potential mechanism, and quantitated it relative to exercise and hypoglycemia-stimulated catecholamine secretion. We hypothesized that the mechanism of glucose-induced catecholamine secretion was related to an acute increase in plasma osmolality, which we tested with the nonmetabolizable hexose mannitol. In 56 studies, 14 normal adults underwent 4 partially randomized studies. The 4 study conditions consisted of the following: (1) rapid intravenous injection of 20 g of glucose; (2) rapid intravenous injection of 20 g of mannitol; (3) acute exercise (80 J/kg); and (4) insulin-induced hypoglycemia. Our results demonstrate that a significant increase in plasma catecholamine concentration occurs following each of the above stimuli, but its composition differs relative to the magnitude of epinephrine versus norepinephrine secretion. We conclude that the mechanism of glucose-induced catecholamine stimulation is the acute elevation in plasma osmolality induced by glucose, and that its stimulation is less than that which occurs following exercise for norepinephrine and less than that which occurs following hypoglycemia for epinephrine.

Familial atypical progressive supranuclear palsy associated with homozigosity for the delN296 mutation in the tau gene.

Heterozygous missense and splice-site mutations in the tau gene have been previously identified in familial frontotemporal dementia with autosomal dominant inheritance. Here we report a Spanish kindred in which two brothers born from a third-degree consanguineous marriage were both affected with atypical progressive supranuclear palsy. A homozygous deletion at codon 296 (delN296) was identified in one of the affected siblings. Among the heterozygous carriers, two members with probable Parkinson's disease were identified, but none of heterozygotes developed atypical parkinsonism. The delN296 mutation lies in the sequence corresponding to the second tubulin-binding repeat of tau protein and affects one asparagine residue absolutely conserved in other species. This finding indicates that homozygous mutations in the tau gene may also cause hereditary tauopathies.

Development of formulations of biological agents for management of root rot of lettuce and cucumber.

The effect of various carrier formulations of Bacillus subtilis and Pseudomonas putida were tested on germination, growth, and yield of lettuce and cucumber crops in the presence of Pythium aphanidermatum and Fusarium oxysporum f.sp. cucurbitacearum, respectively. Survival of B. subtilis and P. putida in various carriers under refrigeration (about 0 degree C) and at room temperature (about 22 degrees C) was also studied. In all carrier formulations, B. subtilis strain BACT-0 survived up to 45 days. After 45 days of storage at room temperature (about 22 degrees C), populations B. subtilis strain BACT-0 were significantly higher in vermiculite, kaolin, and bacterial broth carriers compared with other carriers. Populations of P. putida were significantly higher in vermiculite, peat moss, wheat bran, and bacterial broth than in other carriers when stored either under refrigeration (about 0 degree C) or at room temperature (about 22 degrees C) for 15 or 45 days. Germination of lettuce seed was not affected in vermiculite, talc, kaolin, and peat moss carriers, but germination was significantly reduced in alginate and bacterial broth carriers of B. subtilis compared to the non-treated control. Germination of cucumber seed was not affected by any of the carriers. Significantly higher fresh lettuce and root weights were observed in vermiculite and kaolin carriers of B. subtilis compared with P. aphanidermatum-inoculated control plants. Lettuce treated with vermiculite, and kaolin carriers of B. subtilis, or non-inoculated control lettuce plants had significantly lower root rot ratings than talc, peat moss, bacterial broth, and P. aphanidermatum-inoculated control plants. Growth and yield of cucumber plants were significantly higher in vermiculite-based carrier of P. putida than the other carriers and Fusarium oxysporum f.sp. cucurbitacearum-inoculated plants.

A prospective study of hepatitis C viremia in renal allograft recipients.

In an attempt to study the impact of HCV viremia on renal transplant clinical course and outcome, we prospectively followed 133 HBsAg-negative end stage renal disease (ESRD) patients, in whom HCV-RNA-PCR results were available, from the pre- to post-transplant period. Eighty (60%) ESRD patients tested PCR-positive, of these, 12 (15%) were anti-HCV negative by second generation ELISA. The viremic patients had a longer time on dialysis (p < 0.001), received more blood units (p < 0.001) and had a higher frequency of pre-transplantation liver disease (p < 0.001). Further, 41% of PCR-positive patients gave a history of antischistosomal treatment compared with 23% of PCR-negative ones (p = 0.048). Recipients with and without HCV viremia were followed for a mean of 31.8 +/- 5.8 (range 6-42) months and 29.8 +/- 9 (range 6-41) months respectively, p = 0.14. While the prevalence of HCV viremia increased from 60 to 64% at the last follow-up, the anti-HCV seroprevalence decreased from 63 to 61%. PCR-positive patients had higher rates of both acute (p = 0.005) and chronic (p < 0.001) liver disease after transplantation compared with PCR-negative patients. However, none of our HCV RNA positive recipients developed a fulminant liver disease or hepatic failure until the last follow-up. Stepwise logistic regression analysis identified pre-transplant liver disease (Odds ratio = 2.4; p = 0.07) and a cumulative corticosteroid dose in excess of 15 g at the last follow-up (Odds ratio = 3; p = 0.03) as independent predictors of post-transplant hepatic dysfunction in PCR-positive patients. Azathioprine was discontinued due to hepatic dysfunction in a significantly (p = 0.005) higher proportion of viremic patients compared with the non-viremic ones. There were no significant differences between PCR-positive and -negative patients in terms of frequencies and individual causes of graft and patient losses. Our results demonstrate that HCV infection is extremely prevalent in Egyptian hemodialysis patients and is responsible for most hepatic dysfunctions after transplantation. Although HCV viremia did not negatively affect graft or patient outcome until 31 months post-transplantation, the authors would recommend that a viremic patient should have a liver biopsy before transplantation and be immunosuppressed with caution post-transplantation. A longer follow-up may be required to exclude increased rates of HCV-induced hepatic mortalities.

Undetected neuropsychophysiological sequelae of khat chewing in standard aviation medical examination.

BACKGROUND: Khat (Catha edulis Forsk) is a plant whose leaves contain cathinone, a natural amphetamine. Its leaves are chewed for their effect of central nervous system stimulation and sympathomimesis. METHOD: We examined 25 regular (daily) khat chewing flight attendants (RC), 39 social (occasional) khat-chewing flight attendants (SC), and 24 non-khat-chewing aircrew members (NC) who presented for FAA medical examinations, using electroencephalographic (EEG) frequency analysis and 4 psychometric tests measuring perceptual-visual memory and decision-speed. RESULTS: Memory function test scores were significantly lower in khat chewers than NC's, and in RC's than SC's. They correlated significantly negatively with both duration and quantity of khat abuse in both khat-chewing groups. While EEG analysis revealed a statistically significant shift towards fast frequency bands in RC's compared to SC's or NC's, it did not significantly correlate with, or influence, any of the tested memory functions. CONCLUSION: The results suggest an adverse effect of khat chewing on perceptual-visual memory and decision-speed regardless of EEG frequency changes, and are discussed in relation to aviation safety and standard FAA Aviation Medical Examination.

Vascular alterations of the colonic mucosa in schistosomiasis and portal colopathy.

BACKGROUND/AIM: Portal colopathy, the occurrence of vascular-ectasia like lesions has been observed in patients with portal hypertension of variable etiology. Schistosomiasis is a major cause of liver damage and portal hypertension. In colonic schistosomiasis, vascular alterations are commonly observed. It is therefore possible that schistosomiasis may induce portal colopathy in addition to inflammatory changes directly induced by oviposition. MATERIALS AND METHODS: In order to examine this possibility, we reviewed the endoscopic data obtained in 100 consecutive patients with established bilharziosis. In addition, endoscopic biopsies from all patients were examined for the presence of inflammation, parasite eggs, granulomas and mucosal vascular congestion. The latter was assessed using immunohistochemical staining for Ulex Europaeus. RESULTS: Endoscopic abnormalities were observed in 66/100 patients. The main lesions were abnormalities in vascularisation of the mucosa, especially hyperemia, defined as the presence of numerous, prominent and irregular vessels (62%) and telangiectasia (4%). The mucosal biopsies revealed prominent vascularisation in 60% of the cases. Positivity for ulex staining was significantly correlated with the finding of hyperemia during endoscopy and with the presence of ova. No good correlation was found with the clinical presentation. The lesions were not well correlated with the presence of an increased cellular infiltrate in mucosal biopsies. CONCLUSIONS: This observation suggests that portal colopathy may explain some of the endoscopic lesions observed in the colon of patients with Schistosomiasis.

Small arterial granular degeneration in familial Binswanger's syndrome.

A 55-year-old mildly hypertensive woman died after having developed a subcortical dementia during the past 9 years, with focal neurological signs. She presented at the age of 46 years with short episodes of dizziness and diplopia, suggesting that transient ischemic attacks involved the posterior fossa structures. Over the next 8 years, she developed difficulty in walking, urinary incontinence and seizures. On examination in 1989, she was severely demented. There was tetraparesis, bilateral arm and leg spasticity with hyperreflexia and bilateral Babinski signs. She showed epilepsia partialis continua involving the eyes, left hemiface and limbs. CT showed hypodensity of the white matter and lacunes in the basal ganglia and centrum semiovale, moderate hydrocephalus with cerebellar and cortical atrophy. Clinical and radiological features were similar to those of Binswanger's disease. Similar cases had occurred in the family affecting the patient's grandfather, father and two brothers, suggesting an autosomal dominant hereditary disease. Postmortem examination disclosed a Binswanger type of leukoencephalopathy caused by a peculiar microangiopathy characterized by a slightly basophilic small arterial granular degeneration of the medial sheath associated with the presence of ballooned smooth muscle cells with clear cytoplasm. Electron microscopic study revealed degenerative changes in the parietal vessels with notable increase of basal-membrane-type material and electron-dense granular deposits. These lesions could correspond to a specific familial pathology of the small arteries of the brain. They are identical to those reported in some patients with autosomal dominant inheritance. For other patients with similar clinical features and the same familial pattern, reported as "hereditary multi-infarct dementia'' and "chronic familial vascular encephalopathy'', there are no sufficient objective pathological facts to consider that they have the same disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Nephropathy in asymptomatic patients with active Schistosoma mansoni infection.

In this study 240 patients with active Schistosoma mansoni infection with no symptoms suggestive of glomerular disease were subjected to investigation. All were evaluated clinically and their urine was examined for proteinuria. Out of the 240 patients 48 (20%) had proteinuria as detected by the dipstick test. All these patients were found to be free of any secondary cause other than schistosomiasis which could explain their proteinuria. Out of these 48 patients, 15 agreed to be subjected to kidney biopsy. When examined by light microscopy and immunofluorescent microscopy, kidney biopsies showed positive findings in 8 cases. These were mainly focal mesangial proliferation and immunofluorescent deposits which were mainly IgM and C3. We have concluded that early kidney lesions could be detected in 20% of this particular group of patients.