Anti-NMDA receptor encephalitis with associated catatonia during pregnancy.

Anti-NMDA-R encephalitis has been described as a cause of acute psychosis in young females. It is rare during pregnancy. We describe a primigravida 32-year-old woman with acute onset psychosis during the first trimester. Eight weeks after becoming pregnant, the patient became psychotic with associated catatonia and autonomic disturbance. Serum anti-NMDA-R antibodies were found. She responded to plasma exchange. At caesarean section, a healthy baby boy was born and a benign mature cystic teratoma was removed from the left ovary. Catatonia associated with psychosis may occur in pregnancy secondary to anti-NMDA-R encephalitis. Prompt and aggressive treatment can lead to a good outcome for both baby and mother.

Brachial neuritis masquerading as acute coronary syndrome.

BACKGROUND: Brachial neuritis is a frequently misdiagnosed condition which can present to many medical or surgical specialties. OBJECTIVE: To report a case of brachial neuritis with bilateral phrenic nerve involvement and diaphragmatic weakness. CASE DESCRIPTION: A 63-year-old man presented with acute-onset proximal upper extremity pain and weakness. He also developed severe orthopnoea. Examination revealed proximal upper limb wasting and dramatic paradoxical breathing. Cardiac investigations were unremarkable. Electromyographic studies were consistent with a C5 radiculopathy. Phrenic nerve studies were abnormal bilaterally and Sniff test was positive. A diagnosis of brachial neuritis with predominant C5 and bilateral phrenic nerve involvement was made. His symptoms resolved spontaneously over 3 months. CONCLUSIONS: Brachial neuritis can mimic an acute coronary syndrome and is a rare cause of bilateral phrenic neuropathy. Phrenic nerve palsy should be considered in patients presenting with shortness of breath without any underlying respiratory or cardiovascular illness.

Metastatic meningioma: positron emission tomography CT imaging findings.

The imaging findings of a case of metastasing meningioma are described. The case illustrates a number of rare and interesting features. The patient presented with haemoptysis 22 years after the initial resection of an intracranial meningioma. CT demonstrated heterogeneous masses with avid peripheral enhancement without central enhancement. Blood supply to the larger lesion was partially from small feeding vessels from the inferior pulmonary vein. These findings correlate with a previously published case in which there was avid uptake of fluoro-18-deoxyglucose peripherally with lesser uptake centrally. The diagnosis of metastasing meningioma was confirmed on percutaneous lung tissue biopsy.

Positive data in sativex® phase IIb trial: support advancing into phase III development in cancer pain

No disponible

No disponible

Characterization of the major immunogen in the excretory-secretory products of exsheathed third-stage larvae of Trichostrongylus colubriformis.

The excretory-secretory products of exsheathed third-stage larvae of Trichostrongylus colubriformis conferred some protection to guinea pigs against homologous challenge. A glycoprotein with an apparent molecular mass of approximately 94 kDa was the dominant immunogen in post-exsheathment products. Immunoblots revealed IgG antibodies to this glycoprotein in sera from multiply-infected guinea pigs and some sheep, and in sera of guinea pigs after three truncated infections which had been restricted by anthelmintic treatments to development of the third parasitic stage. IgA antibodies to this protein were also found in intestinal lymph of a naturally infected sheep. Fluorescent antibody studies indicated that this 94 kDa component was associated with cells in the central body cavity of third-stage larvae, but was absent from fourth-stage larvae or adult worms. Fractionation and protection assays in guinea pigs revealed that while the native and aggregated 94 kDa protein conferred some host protection, it was not the only protective component of the excretory-secretory products of exsheathed third-stage larvae of T. colubriformis.

A novel host-protective antigen from Trichostrongylus colubriformis.

The detergent-soluble fraction from Trichostrongylus colubriformis third-stage larvae contained a simple set of antigens, one of which (molecular weight 41,000) induced 43-51% protection in guinea pigs following immunization. Isolation and partial amino acid sequence analysis of this protective antigen showed it was parasite tropomyosin.

Molecular vaccines against parasites.

Prophylactic vaccines can be expected to be one of the major practical outputs of parasitology research. Various groups within Australia have pursued the vaccine objective for several years, with particular emphasis on blood-stage falciparum malaria in man, intestinal helminths of sheep and cattle, cutaneous myiasis (blowfly strike) in sheep, cysticercosis in sheep and cattle, bovine babesiosis, and cattle ticks. Other vaccine programmes are concerned with giardiasis, filariasis, toxoplasmosis, fascioliasis, coccidiosis in poultry, cutaneous leishmaniasis and schistosomiasis japonica. For many years, the only available vaccine against a parasite in Australia has been the attenuated Babesia bovis vaccine produced by the Tick Fever Research Centre of the Queensland Department of Primary Industries. Strategies for achieving molecular vaccines are generally similar within the various research groups. They involve analysis of the immunology and immunochemistry of a model or in-vitro system; development of functional monoclonal antibodies; analysis of antibody specificities in clinically and/or functionally defined polyclonal sera; screening of cDNA or genomic expression libraries; peptide synthesis; identification of an appropriate vaccination schedule involving adjuvants or new recombinant DNA-based antigen delivery systems. Outlined below are five of the major vaccine programmes.

Parasol and midget ganglion cells of the human retina.

Golgi-impregnated ganglion cells were studied in two flat-mounted human retinas. A number of different morphologic forms were observed, and those showing a thickly branching dendritic field with terminals that stratified within a narrow zone of the inner plexiform layer were selected for further investigation. When the dendritic field diameter of these cells was plotted against distance from the fovea, the scatter diagram showed two distinct clusters. At any given eccentricity, there was no overlap between the cell group with large dendritic fields and the group with small dendritic fields. Those with the larger dendritic fields also tended to have larger somas and thicker axons than the group with the smaller dendritic fields. The dendritic fields of both groups tended to be elongated, and the orientation and degree of this elongation were quantified by determining the best-fitting ellipse for each dendritic field. The degree of elongation was independent of eccentricity. The orientation of the dendritic field (major axis of the ellipse) of a cell did not appear to be independent of its position on the retina. To test whether the major axes tended to be directed toward any particular point on the retina, the positions of the cells on the retinal flat mount were transformed to relative positions on the retinal hemisphere, and the orientations of the dendritic fields were expressed in a spherical coordinate system for this hemisphere. A search was made for the position on the hemisphere which minimized the mean square deviation of the orientations from this point. The group with the large dendritic fields showed a significant tendency to be radially oriented toward a specific location on the retinal hemisphere, and that location lay within a few degrees of the fovea. Leventhal and Schall ('83) have reported a similar finding for ganglion cells of the cat retina. For the group with small dendritic fields, the retinal location that minimized the mean square deviation was also near the fovea; however, the set of orientations showed no greater tendency for mutual alignment than did a randomized set. The cell group with the large dendritic fields appears to correspond to Dogiel's (1891) type II cells, to Polyak's ('41) parasol cells, to the A cells of the monkey retina described by Leventhal et al. ('81), observed following HRP injection to the magnocellular layer of the LGN, and to the P alpha cells of the monkey retina, observed by Perry and Cowey ('81), following HRP uptake by cut axons of the optic nerve.(ABSTRACT TRUNCATED AT 400 WORDS)

Overlap of retinal and prestriate cortical pathways in the primate pretectum.

Connections between the pretectum and prestriate visual cortex were examined following injection of HRP into area V4 of Macaca nemestrina monkeys. Orthograde label was found in nucleus olivarius (NO) and the sublenticular (SL) regions while retrogradely labeled neurons were present in the nucleus of the optic tract (NOT). Following injection of [3H]proline into one eye, 3 pretectal zones of retinal input were seen: NO, SL and the posterior pretectal region (PPR). These results indicate that NO and SL may be sites for retinal and cortical pathway interaction in primate pretectum.

Hypertrophy of neurons in dorsal lateral geniculate nucleus following striate cortex lesions in infant monkeys.

Monkeys whose left striate cortex had been removed in infancy received bilateral injections of horseradish peroxidase (HRP) into the prelunate gyrus (PLG) prestriate cortex. Scattered large neurons in the dorsal lateral geniculate nucleus were retrogradely labeled in both hemispheres. On the lesioned side, the HRP-labeled cell bodies were 58% larger in area, showing an overall increase in soma size and complexity of dendritic field, suggesting a hypertrophy of the geniculate-PLG pathway following a neonatal striate cortex lesion.

Alterations of retinal inputs following striate cortex removal in adult monkey.

The morphology of the retina and central retino-recipient nuclei was studied in two monkeys that had undergone total bilateral striate cortex removal as adults. These animals had been behaviorally tested for two years after lesioning and had demonstrated significant recovery of pattern vision. Light and electron microscopy and autoradiography were done on the central retino-recipient nuclei following a monocular intravitreal injection of 3H-proline. Light microscopic analysis of retinal ganglion cell number showed a 30% loss in the parafoveal retina due to retrograde trans-synaptic degeneration. The most striking central change in retinal axon distribution was in the dorsal lateral geniculate nucleus (dLGN) where the parvocellular but not the magnocellular region showed a marked reduction in retinal input. Despite the loss of almost all dLGN neurons through retrograde degeneration, at the EM level both parvocellular and magnocellular regions contained islands of neuropil made up of retinal and several other types of synaptic terminals as well as small dendrites and pale unidentified processes. Approximately equal numbers of retinal terminals were identified by EM autoradiography in both regions of dLGN, which did not explain the apparent differences in labeling between the two regions seen in the light microscope. A second change in central retinal pathways was found in the olivary pretectal nucleus where a significant loss of retinal input also occurred. A third change, but in the opposite direction, was found in the pregeniculate nucleus (PGN) where the area of retinal terminals appeared enlarged. The remaining central retino-recipient nuclei had the same distribution of retinal input as the control animals.