The micro-structural analysis of lumbar vertebrae in alcoholic liver cirrhosis.

Although vertebral fracture is more common among alcoholic liver cirrhosis patients when compared to general population, current data on three-dimensional micro-architecture are scarce. Our study showed significant trabecular deterioration in lumbar vertebrae obtained from alcoholic liver cirrhosis donors, suggesting that they should be advised to undergo early-stage screening for osteoporosis. PURPOSE: Recent studies showed an increased incidence of vertebral fractures in alcoholic liver cirrhosis (ALC) patients, while data about vertebral micro-structure are still limited. The aim of this study was to compare trabecular and cortical micro-architecture of lumbar vertebrae between ALC patients and healthy age- and sex-matched controls. METHODS: Our study included lumbar vertebral samples of male cadaveric donors, divided into ALC (n = 20, age: 59 ± 6 years) and control group (n = 20, age: 59 ± 8 years). Following pathohistological verification of liver cirrhosis, trabecular and cortical bone micro-architecture was analyzed by micro-computed tomography (micro-CT). RESULTS: Micro-CT evaluation of the trabecular bone in lumbar vertebrae showed a significant decrease in bone volume fraction, trabecular thickness, trabecular number, and connectivity (p < 0.01). In contrast to trabecular deterioration, prominent alteration in cortical parameters was not observed in lumbar vertebrae of ALC patients (p > 0.05). CONCLUSIONS: Our data indicate that susceptibility to non-traumatic fractures in ALC patients could be explained by alterations in trabecular bone micro-architecture. Thus, we genuinely recommend osteological screening of the lumbar spine for all ALC patients in order to evaluate individual fracture risk. Graphical abstract.

Riemerella anatipestifer outbreaks in commercial goose flocks and identification of isolates by MALDI-TOF mass spectrometry.

Several outbreaks of Riemerella anatipestifer in commercial geese occurred within a short time period. A serious disease was recognized in the affected birds, mainly characterized by depression and severe neurologic disturbances. The morbidity ranged from 20 to 30% and the mortality from 5 to 20%. Generally, the clinical signs started at the age of 8 to 10 days. Post-mortem examination revealed fibrinous pericarditis, perihepatitis and airsacculitis in all birds. Some of the birds also had synovitis of the tibio-tarsal joints and oedematous swelling of the subcutaneous tissues around these joints and metatarsus. Histology revealed a characteristic severe inflammation with heterophilic granulocytes in different organs. Bacteriological investigation was made from several organs and R. anatipestifer could be isolated from all birds investigated. The identification of these clinical isolates, done for the first time by matrix-assisted laser desorption ionization-time-of-flight mass spectrometry, confirmed the aetiology. Sequence analysis showed 100% similarity between the clinical isolates, indicating a common source of infection.

Multifocal and multicentric breast cancer: is breast conserving surgery acceptable?

PURPOSE: The purpose of our study was to evaluate the significance of multifocal (MF) and multicentric (MC) breast cancer in the diagnosis and treatment of this condition. METHODS: This retrospective study was a combination of clinical and laboratory data. The patient population consisted of 274 women operated on with Madden mastectomy for breast cancer. Assessed were the following parameters: age, menstrual status, histopathological parameters, HER-2 status, estrogen receptor (ER) and progesterone receptor (PR) status, disease stage, quadrant(s) in which breast cancer was detected and axillary lymph nodes status. RESULTS: Of 274 patients 206 (85%) has unifocal disease, 41 (15%) suffered of MF (n=27; 9.9%)/MC (n=14; 5.1%) disease. MC disease was associated with metastatic axillary lymph nodes in 92.9% of the cases. MF/MC cases were primarily dependent on histology. MF/MC cancer was best related to the lobular type (85.7% of the cases), while ductal histological type was characteristic of unifocal tumors. CONCLUSION: Quadrantectomy as a form of conservative breast surgery is acceptable in cases of MF tumors, because all tumor foci can be removed. We suggest radical surgical treatment in all cases of suspected MC tumors because they are most often associated with metastasis to the axillary lymph nodes. Lobular histology characterizes MC breast cancer.

Outbreaks of Streptococcus gallolyticus subsp. pasteurianus in Goslings Characterized by Central Nervous Symptoms.

The present report describes outbreaks of Streptococcus gallolyticus subsp. pasteurianus in young geese flocks in Austria. The flocks, comprising 160-1450 goslings of 2-3 wk of age, experienced increased mortalities The clinical signs were characterized by severe central nervous symptoms, namely leg paddling and torticollis. The postmortem investigation revealed hepatitis, splenitis, and a low amount of liquid fluid in the coelomic cavity. Livers were of fragile texture, with white necrotic areas. The latter were also found in spleens. No macroscopic lesions were seen in brains. Bacteriologic investigation followed by bacterial identification by matrix-assisted laser desorption time-of-flight mass spectrometry and phylogenetic analysis of the partial 16S rRNA region revealed the presence in heart, liver, spleen, and brain of S. gallolyticus subsp. pasteurianus. Histologic investigation revealed multifocal necrosis in liver and spleen samples together with infiltration of mononuclear cells and heterophilic granulocytes. Furthermore, in the lesions, coccoid bacteria could be identified. No histopathologic changes were observed in brain samples from goslings, except in one bird in which accumulation of coccoid bacteria in blood vessels of the brain samples was present. Antibiotic sensitivity tests revealed identical profiles for all strains, which were susceptible to penicillins, cephalosporins, chloramphenicol, imipenem, and tylosin. However, resistance was found against quinolones, aminoglycosides, tetracycline, and trimethoprim-sulfamethoxazole, which are commonly used to treat infections with gram-positive bacteria.

Reporte de caso­Brotes de Streptococcus gallolyticus subsp. pasteurianus en gansitos caracterizados por síntomas nerviosos centrales. El presente informe describe brotes de Streptococcus gallolyticus subsp. pasteurianus en parvadas de gansos jóvenes en Austria. Las bandadas, que comprendían entre 160 a 1450 gansos de 2 a 3 semanas de edad, experimentaron aumento de la mortalidad. Los signos clínicos se caracterizaron por síntomas severos del sistema nervioso central, incluyendo, movimientos de pataleo y tortícolis. La investigación post mórtem reveló hepatitis, esplenitis y la presencia de líquido en la cavidad celómica en poca cantidad. Los hígados presentaron textura frágil, con áreas necróticas blancas. Estos últimos también se encontraron en bazos. No se observaron lesiones macroscópicas en el cerebro. La investigación bacteriológica seguida de la identificación bacteriana mediante espectrometría de masas MALDI-TOF y el análisis filogenético de la región parcial de ARNr 16S revelaron la presencia en el corazón, el hígado, el bazo y en el cerebro de S. gallolyticus subsp. pasteurianus. La investigación histológica reveló necrosis multifocal en muestras de hígado y bazo junto con infiltración de células mononucleares y granulocitos heterófilos. Además, en las lesiones se pudieron identificar bacterias de morfología cocoide. No se observaron cambios histopatológicos en muestras de cerebro de los gansitos, excepto en un ave en la que se observó acumulación de bacterias cocoides en los vasos sanguíneos de las muestras de cerebro. Las pruebas de sensibilidad a los antibióticos revelaron perfiles idénticos para todas las cepas, que eran susceptibles a penicilinas, cefalosporinas, cloranfenicol, imipenem y tilosina. Sin embargo, se encontró resistencia contra quinolonas, aminoglucósidos, tetraciclina y trimetoprim-sulfametoxazol, que se usan comúnmente para tratar infecciones con bacterias grampositivas.

Risk factors for Toxoplasma infection in pregnant women in FYR of Macedonia.

The aim of the study was to identify risk factors for Toxoplasma gondii infection in pregnant women in FYR of Macedonia. Retrospective analysis of serological and epidemiological data in a series of 235 pregnant women from Macedonia, tested for Toxoplasma infection between January 2004 and December 2005, showed an overall prevalence of infection of 20.4%. Exposure to transmission factors significantly increased the risk of infection (RR = 1.989, 95 % CI = 1.041-3.800, p = 0.037). The single infection transmission factor that was a predictor of infection in the whole series was exposure to soil (RR = 1.946, 95% CI = 1.026-3.692, p = 0.041). Based on prevalence and the established risk factors for Toxoplasma infection in Macedonia, the health education programme as a sustainable measure for the prevention of congenital toxoplasmosis should focus on educating women of generative age to avoid contact with soil (farming, gardening), and/to adhere to strict hygienic practices afterwards.

Single-center prospective, randomized analysis of conventional and eversion carotid endarterectomy.

AIM: Several studies, comparing early and long-term results of the conventional carotid endarterectomy (CEA) and eversion carotid endarterectomy (EEA), were conducted for past 10 years. Nevertheless, it still remaining difficult to choose optimal endarterectomy technique. Choice yet mainly depends of experience of attending surgeon. The aim of this study was the comparison early and long-term results of the EEA and CEA. METHODS: Randomly, 103 patients were operated on in the eversion, and 98 patients in the conventional technique; 97 (48.3%) patients were asymptomatic and 104 (51.7%) had symptomatic lesions. All patients underwent preoperative cervical duplex scanning and neurological examination. The surgical procedure was carried out under general anesthesia. In cases with retrograde blood pressure less than 20 mmHg shunt was used; 78.6% of all CEA were finished up with ''patch'' angioplasty and 21.4% by primary suture. The primary outcomes were perioperative and late mortality, perioperative and late central neurological complications, a long-term survival rate and late restenosis incidence. RESULTS: The mean follow-up was 38 months. Mortality and long-term survival rate were similar in compared groups. The perioperative central neurological complications incidence were comparable in study groups (3.9% vs 12.1% , odds ratio 3.45, 95% confidence interval 1.1-11.1; P=0.029). The late restenosis incidence was significantly lower in eversion group (0.0% vs 6.1%). CONCLUSION: EEA has an advantage over the conventional procedure. The authors recommend CEA in cases when retrograde pressure indicated the use of the intraluminal shunting.

Antiproliferative and antimicrobial activity of traditional Kombucha and Satureja montana L. Kombucha.

PURPOSE: To carry out a preliminary investigation of the biological activity of Kombucha beverages from Camellia sinensis L. (black tea) and Satureja montana L. (winter savory tea), that have consuming acidity. MATERIALS AND METHODS: Cell growth effect was measured by sulforhodamine B colorimetric assay on HeLa (cervix epithelioid carcinoma), HT-29 (colon adenocarcinoma), and MCF-7 (breast adenocarcinoma). Antimicrobial activity to bacteria, yeasts and moulds was determined by agar-well diffusion method. RESULTS: Consuming Kombuchas had the most expressive antimicrobial activity against all investigated bacteria, except Sarcina lutea, while unfermented tea samples had no activity. Traditional Kombucha showed higher activity against Staphylococcus aureus and Escherichia coli than acetic acid, while both neutralized Kombuchas had bacteriostatic activity on Salmonella enteritidis. Examined Kombuchas did not stimulate cell proliferation of the investigated cell lines. Antiproliferative activity of winter savory tea Kombucha was comparable to that of traditional Kombucha made from black tea. Furthermore, in HeLa cell line Satureja montana L. Kombucha induced cell growth inhibition by 20% (IC20) at lower concentration compared to the activity of water extract of Satureja montana L. obtained in our previous research. CONCLUSION: Presence of more active antiproliferative component(s) in Satureja montana L. Kombucha compared to Satureja montana L. water extract and antimicrobial component(s) other than acetic acid in both Kombuchas is suggested.

Comparison of the effects of continuous and pulsed mobile phone like RF exposure on the human EEG.

It is not clear yet whether Global System for Mobiles (GSM) mobile phone radiation has the ability to interfere with normal resting brain function. There have been reports that GSM exposure increases alpha band power, and does so only when the signal is modulated at low frequencies (Huber, R., Treyer, V., Borbely, A. A., Schuderer, J., Gottselig, J. M., Landolt, H.P., Werth, E., Berthold,T., Kuster, N., Buck, A and Achermann, P. Electromagnetic fields, such as those from mobile phones, alter regional cerebral blood flow and sleep and waking EEG. J Sleep Res 11, 289-295, 2002.) However, as that research employed exposure distributions that are not typical of normal GSM handset usage (deep brain areas were overexposed), it remains to be determined whether a similar result patterning would arise from a more representative exposure. In this fully counterbalanced cross-over design, we recruited 12 participants and tried to replicate the modulation linked post exposure alpha band power increase described above, but with an exposure source (dipole antenna) more closely resembling that of a real GSM handset. Exposures lasted for 15 minutes. No changes to alpha power were found for either modulated or unmodulated radiofrequency fields, and thus we failed to replicate the above results. Possible reasons for this failure to replicate are discussed, with the main reason argued to be the lower and more representative exposure distribution employed in the present study. In addition we investigated the possible GSM exposure related effects on the non-linear features of the resting electroencephalogram using the Approximate Entropy (ApEn) method of analysis. Again, no effect was demonstrated for either modulated or unmodulated radiofrequency exposures.

Electroencephalographic Neurofeedback to up-regulate frontal Theta rhythms: Preliminary results.

Retrieval of positive Autobiographical Memory (AM) has been reported to increase positive emotions in healthy population. Evidence suggests that positive AM retrieval tasks are correlated with synchronisation of frontal Theta rhythms (4-8Hz). The present study has developed the Electroencephalography (EEG) based Neurofeedback (NF) protocols to promote voluntary elevation or up-regulation of positive AM retrieval related Theta rhythms over F3, Fz, F4 electrode sites (10-20 System). The protocols were evaluated with a human participant in 10-day NF training. It observed that the average amplitude of observed Theta rhythms in each NF regulation block gradually increased over days of training and most was prominent at Fz electrode site. Furthermore, a larger peak at 6Hz was present in the spectrum of the observed Theta with later trial day suggesting up-regulation of Frontal Midline Theta (FmT) rhythms.

Congenital myopathy with uniform type 1 fibers.

Congenital myopathy with uniform type 1 fibers is a rare form of nonprogressive congenital neuromuscular disease. We report a 40 year old woman with proximal muscle weakness, waddling gait and decreased deep tendon reflexes. The serum creatine kinase level was decreased. Peripheral nerve conduction velocity as well as electrocardiogram and echocardiogram were normal. The electromyogram showed myopathic changes. A biopsy specimen from the left deltoid muscle revealed a uniformity of type 1 fibers. This is the first case of congenital myopathy with uniform type 1 fibers reported in Serbia.

Serum lipids and demyelination in experimental allergic encephalomyelitis induced by the increased encephalitogenicity of myelin basic protein given with galactocerebrospide.

Cholesterol esters and free cholesterol were determined in the serum of guinea pigs with experimental allergic encephalomyelitis (EAE). EAE was induced by immunization with myelin basic protein (MBP) and galactocerebroside (GC). The results showed an increased content of cholesterol arachidonate and cholesterol linoleate during the period of clinical signs of EAE in comparison with the content of cholesterol esters in EAE induced by MBP without galactocerebroside. The content of free cholesterol was significantly reduced. Histological analyses showed intensive inflammatory lesions and demyelination which were not found in EAE induced by MBP without galactocerebroside.

Different neuronal and glial cell groups in corticomedial amygdala react differently to neonatally administered estrogen.

The percentage of labeled neurons and glial cells in the phylogenetically older corticomedial part of the amygdala was investigated in control and estrogen-treated rats using [3H]thymidine autoradiography. Newborn, three-day-old female and male Wistar rats were treated with a single dose of 1 mg of estrogen and killed at the age of 10 days. The percentage of labeled neuronal and glial cells was determined by stereological methods in the medial, cortical and central nuclei, respectively. In treated male rats, the percentage of labeled neurons and glial cells in these nuclei was significantly greater on the 10th day of life as compared to controls, except for glial cells in the nucleus centralis. In treated female rats, the percentage of labeled neurons in all three nuclei was comparable to controls, while the percentage of labeled glial cells was increased in the nucleus medialis, decreased in the nucleus centralis and unchanged in the nucleus corticalis. Our results indicate clear sex- and region-specific differences in the reactivity of both neurons and glia to neonatally administered estrogen.

A genetic study of idiopathic focal dystonias.

The inheritance of focal dystonias was investigated in 43 families containing 43 index cases with torticollis (n = 21), blepharospasm (n = 18) and writer's cramp (n = 4). They generated a potential population of 235 first-degree relatives, and 168 out of 179 living first-degree relatives were examined. Ten relatives with dystonia were identified in ten families. Another two parents from two of the same group of ten families were affected according to the family history. The majority of the secondary cases (six patients, five siblings, and one child) were not aware of any dystonia. The tendency for affected relatives to have the same type of dystonia as index patients was observed only for torticollis. Overall, 23% of index patients had relatives with dystonia. Segregation analysis suggested the presence of an autosomal dominant gene or genes with reduced penetrance underlying focal dystonia.

The levels of free cholesterol and cholesterol esters in serum before, during and after the induction of experimental allergic encephalomyelitis in the guinea-pig.

Cholesterol esters and free cholesterol were determined in the serum of guinea-pigs with experimental allergic encephalomyelitis (EAE). EAE was induced by immunization with myelin basic protein (MBP). The results showed a marked decrease in cholesterol esters (CHE) 4 days after immunization. Seven days after immunization the values of esters increased and reached a maximum during the period of manifest clinical signs of EAE. After the cessation of clinical signs, after 2 weeks, the values of esters returned to the initial or somewhat lower values. The level of cholesterol was inverse to the values of cholesterol esters. Histological analyses showed characteristic changes in the brain and spinal cord. A possible correlation between the changes in cholesterol esters and cholesterol of the brain and serum in EAE is suggested.

Unusual association of multiple sclerosis and tomaculous neuropathy.

We describe two cases in which multiple sclerosis (MS) occurred in association with tomaculous neuropathy, presenting as chronic, distal sensorimotor polyneuropathy. In Case 1, monoclonal gammopathy of undetermined significance with monoclonal IgG lambda reactive against GM1 ganglioside, was also detected. The diagnosis of tomaculous neuropathy was established after sural nerve biopsy. Teased fibers examination revealed focal 'sausage-like' thickenings of the myelin sheaths in intact fibers and in fibers with segmental demyelination. Electron microscopy showed them to be due, mostly, to multiple windings of redundant myelin and concentric apposition of numerous lamellae, in contact with an intact myelin sheath. These are the first reported cases of tomaculous neuropathy in patients with MS. Whether the combination of the two conditions is purely coincidental or suggests the possible causal relation between MS and tomaculous neuropathy, is not certain.

Solitary intracranial plasmacytomas.

We present two cases of an unusal localised extramedullary plasmacytoma with a long survival period: a 42-year-old woman with left temporal and a 25-year-old woman with left parietal intracranial plasmacytoma. The tumor masses were totally removed in both patients and their histological, histochemical (PAS and methyl green pyronin positive granules) and immunohistochemical (positive light chains mostly lambda, and negative stains for GFAP, NSE and S-100 protein) properties showed that the tumor tissues consisted of monoclonal population of plasma cells. Our cases were diagnosed as solitary cerebral plasmacytomas since the presence-of underlying multiple myeloma has been ruled out by the clinical, laboratory, radiographic and immunological investigations. Postoperatively the patients were given 40 Gy to the whole cranium and additional 20 Gy focused on the tumor site. Complete remissions were achived 7.5 and 5.5 years, respectively.

In vitro cytogenetic analysis of the effects of oxytocin on human peripheral blood lymphocytes.

The purpose of this study was to determine possible genotoxic and cytotoxic (or mitogenic) effects of high concentrations of oxytocin, active component of Syntocinon in cultures of human peripheral blood lymphocytes. Two test systems were used: (1) analysis of numerical and structural chromosome aberrations, and (2) the in vitro sister chromatid exchange (SCE) test. On the basis of the results obtained it can be concluded that oxytocin does not express any genotoxical properties. Furthermore, the mitotic index did not change significantly.

Association of Krabbe leukodystrophy and congenital fiber type disproportion.

Hypotonia and weakness developed in a 12-month-old boy whose psychomotor development had previously been normal. The muscle biopsy demonstrated a disparity in the mean diameters of type 1 and type 2 fibers and satisfied major histologic criteria for diagnosis of congenital fiber type disproportion (CFTD). However, deterioration of motor and mental function, which developed subsequently, strongly suggested progressive encephalopathy. Examination of leukocyte cerebral enzymes at 15 months of age revealed a complete lack of galactosylceramide-beta-galactosidase. Selective type 1 fiber atrophy with type 1 fiber predominance has been observed in various conditions, including Krabbe disease. We report an additional case of Krabbe leukodystrophy associated with CFTD. The finding on the molecular level will resolve the dilemma of whether CFTD is a congenital myopathy or whether these patterns of disproportion may result from a number of different processes that interfere with the maturation of the developing motor unit.

Neoplastic angioendotheliomatosis (NAE) of the CNS in a patient with AIDS subacute encephalitis, diffuse leukoencephalopathy and meningo-cerebral cryptococcosis.

A 12-year-old, hemophilic boy died with acquired immune deficiency syndrome (AIDS) after a clinical course characterized by progressive psycho-organic syndrome and opportunistic infections. Postmortem neuropathological examination revealed a cerebral form of neoplastic angioendotheliomatosis (NAE), leukoencephalopathy, giant cell encephalitis and meningo-cerebral cryptococcosis. The most unusual finding was the presence of proliferated neoplastic cells within lumina of some blood vessels throughout the central nervous system (CNS). These cells displayed cytologic features of malignancy and stained positively for common leukocyte antigen. Coronal sections showed diffuse cerebral and cerebellar leukoencephalopathy with most pronounced loss of myelin and axons in deep white matter, while the subcortical arcuate fibers and the corpus callosum were partially spared. In these areas numerous small foci of severe myelin loss were present. Microglial nodules and distinctive multinucleated giant cells (MGC) were numerous. Intracytoplasmic and intranuclear acidophilic inclusions were found in a few multinuclear and mononuclear cells. Close contact between mononuclear and multinuclear cells suggesting their fusion was also observed. As far as we know this is the first case of NAE encountered in AIDS, one of the rare primary cerebral forms and the youngest reported case of NAE up to now. This case could be considered as one proof more that NAE is a special form of malignant lymphoma.

The modulatory effect of estradiol benzoate on superoxide dismutase activity in the developing rat brain.

The sensitivity of copper,zinc (CuZn)- and manganese (Mn)-superoxide dismutase (SOD) to exogenous estradiol benzoate (EB) was investigated in Wistar rats during postnatal brain development. Enzyme activities were measured in samples prepared from brains of rats of both sexes and various ages between 0 and 75 days, treated sc with 0.5 micro g EB/100 g body weight in 0.1 ml olive oil/100 g body weight, 48 and 24 h before sacrifice. In females, EB treatment stimulated MnSOD activity on days 0 (66.1%), 8 (72.7%) and 15 (81.7%). In males, the stimulatory effect of EB on MnSOD activity on day 0 (113.6%) disappeared on day 8 and on days 15 and 45 it became inhibitory (40.3 and 30.5%, respectively). EB had no effect on the other age groups. The stimulatory effect of EB on CuZnSOD activity in newborn females (51.8%) changed to an inhibitory effect on day 8 (38.4%) and disappeared by day 45 when inhibition was detected again (48.7%). In males, the inhibitory effect on this enzyme was observed on days 0 (45.0%) and 15 (28.9%), and then disappeared until day 60 when a stimulatory effect was observed (38.4%). EB treatment had no effect on the other age groups. The sensitivity of MnSOD to estradiol differed significantly between sexes during the neonatal and prepubertal period, whereas it followed a similar pattern thereafter. The sensitivity of CuZnSOD to estradiol differed significantly between sexes during most of the study period. Regression analysis showed that the sensitivity of MnSOD to this estrogen tended to decrease similarly in both sexes, whereas the sensitivity of CuZnSOD showed a significantly different opposite tendency in female and male rats. These are the first reports indicating hormonal modulation of antioxidant enzyme activities related to the developmental process.