Mielinólisis central pontina de curso subagudo secundario a hiperglucemias / Subacute central pontine myelinolysis secondary to hyperglycaemia

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Outcomes of Renal Allograft Recipients With Hepatitis C.

BACKGROUND: Studies on the effect of hepatitis C virus (HCV) infection showed decreased graft survival compared to HCV-negative matched patients. It was also identified as an independent risk factor for graft loss and mortality in kidney transplantation patients. OBJECTIVE: This study was designed to evaluate the 10-year graft and patient outcomes of renal allograft recipients with HCV infection at the National Kidney and Transplant Institute. METHODS: This is a retrospective study of patients who underwent renal transplantation with HCV infection and a group who were HCV-negative in the same post-transplantation period. Data were gathered from the in-patient and out-patient clinic records. RESULTS: Patient survival was significantly lower in the HCV-positive than in the HCV-negative group. The mean duration of patient survival was 154.95 (+4.95) months (12 years and 10 months) in HCV-negative patients compared to 141 (+6.52) months (11 years and 9 months) in the HCV-positive group (P = .05). Graft survival did not differ significantly between HCV-positive and HCV-negative recipients (P = .734). The mean duration of graft survival was 137 (+7.68) months (11 years and 5 months) in HCV-negative patients compared to 130 (+6.84) months (10 years and 10 months) in HCV-positive patients. Short- and long-term outcomes including biopsy-proven acute rejection, transplant glomerulopathy, chronic allograft nephropathy, renal function, and proteinuria were similar in both groups. CONCLUSION: Rejection, glomerulopathy, and renal function were similar in both groups. HCV progression was also observed in patients with detectable HCV-RNA 6 months before transplantation.

Oclusión de arteria ciliorretiniana en la hemocromatosis / Cilioretinal artery occlusion in hemochromatosis

CASO CLÍNICO: Se presenta el caso de una mujer de 31 años con pérdida brusca de visión de un ojo debido a una oclusión de arteria ciliorretiniana. En la exploración presentaba hepatomegalia y en la analítica los niveles séricos de hierro, saturación de transferrina y ferritina estaban elevados. Los perfiles de autoinmunidad y de hipercoagulabilidad fueron normales. El estudio doppler-ultrasónico de los troncos supraaórticos fue anodino, pero la ecografía cardíaca evidenció una miocardiopatía con calcificación subendocárdica. El estudio genético para la hemocromatosis fue positivo. DISCUSIÓN: La calcificación subendocárdica secundaria a hemocromatosis puede ser la causa de la oclusión embólica de la arteria ciliorretiniana. El cuadro embólico ocular fue la forma de presentación de la hemocromatosis en nuestra paciente

CLINICAL CASE: We report a case of a 31 year-old woman with a sudden visual loss due to a cilioretinal artery occlusion. The physical examinination showed hepatomegaly. Serum iron and ferritin and transferrin saturation were unusually high. The doppler scan of carotid arteries showed no relevant signs of atheromatous disease. Dilated cardiomiopaty was revealed in the B-scan with subendocardial calcium deposits. Genetic tests were positive for hemochromatosis. DISCUSSION: Subendocardial calcification due to hemochromatosis could be the embolic source in our patient. This embolic ocular disease is the first presentation of hemochromatosis in this patient

[Cilioretinal artery occlusion in hemochromatosis]. / Oclusión de arteria ciliorretiniana en la hemocromatosis.

CLINICAL CASE: We report a case of a 31 year-old woman with a sudden visual loss due to a cilioretinal artery occlusion. The physical examinination showed hepatomegaly. Serum iron and ferritin and transferrin saturation were unusually high. The doppler scan of carotid arteries showed no relevant signs of atheromatous disease. Dilated cardiomiopaty was revealed in the B-scan with subendocardial calcium deposits. Genetic tests were positive for hemochromatosis. DISCUSSION: Subendocardial calcification due to hemochromatosis could be the embolic source in our patient. This embolic ocular disease is the first presentation of hemochromatosis in this patient.

Electrokinetic effect and surface free energy behavior in the adsorption process of a reactive dye onto Leacril pretreated with polyethyleneimine ion.

In a previous paper, we studied the adsorption of a polyelectrolyte, polyethyleneimine ion (PEI), onto Leacril in order to increase the amount of the reactive dye Remazol Brilliant Blue R (RBBR) taken up by these fibers. We observed that this polycation changes the fibers zeta potential sign at low concentration, ca. 0.03 g/L, and thus the RBBR adsorption onto Leacril is improved when implementing the PEI treatment. The aim of this work is to study the PEI effect related to the amount of dye adsorbed by Leacril. For this purpose, we present data on streaming potential, adsorption isotherms, and surface free energy component determination as a function of the PEI concentration used in the pretreatment, as well as a function of the RBBR concentration used in the dyeing solutions. Adsorption experimental results show that the amount of RBBR taken by the fibers increases with the PEI concentration used in the pretreatment, and this effect becomes significant at higher concentrations of RBBR solution. The zeta potential increases to positive values in the range of low concentrations of dye solution when Leacril fibers have been pretreated with the polyelectrolyte. From surface free energy component determinations it is worth noting that the electron-donor component, gamma(-), decreases with the RBBR concentration in the treatment. The results we have obtained suggest that the interaction between the amine group of the PEI previously adsorbed and the reactive beta-sulfato-ethysulfonyl group of the dye can be responsible for the improvement in dye uptake.

Rotavirus genome replication and morphogenesis: role of the viroplasm.

The rotaviruses, members of the family Reoviridae, are icosahedral triple-layered viruses with genomes consisting of 11 segments of double-stranded (ds)RNA. A characteristic feature of rotavirus-infected cells is the formation of large cytoplasmic inclusion bodies, termed viroplasms. These dynamic and highly organized structures serve as viral factories that direct the packaging and replication of the viral genome into early capsid assembly intermediates. Migration of the intermediates to the endoplasmic reticulum (ER) initiates a budding process that culminates in final capsid assembly. Recent information on the development and organization of viroplasms, the structure and function of its components, and interactive pathways linking RNA synthesis and capsid assembly provide new insight into how these microenvironments serve to interface the replication and morphogenetic processes of the virus.

Radiological clinical telesession: a cooperative working environment for sharing clinical experience over the Internet.

We describe here a six-year-long project during which groups of radiologists belonging to various hospitals in Extremadura (one of Spain's regions) shared their clinical experience over the Internet in a process of continuing medical education. We designed a set of tools based on the most familiar Internet protocols (the WWW and e-mail) that make computer-mediated communication very straightforward. Periodically, each group put forward a clinical case of interest, presenting it on a Web page. The other participating groups discussed the case (in real or deferred time), describing the radiological findings, proposing a differential diagnosis, and making suggestions concerning the case. The clinical case was subsequently resolved by the proposing group on the basis of definitive diagnostic tests, and posted for public access on the Internet as a teaching file to form part of a cases-of-interest archive. As of present, more than 65 cases have been presented and discussed, and 55 posted as teaching files. At about halfway through the project, the participants were asked to respond to a questionnaire. In their responses, they indicated a high degree of acceptance of the system, finding no special difficulties in the use of the tools. They also reported having incorporated some of the procedures (consultation of clinical cases on Internet, access to information specifically targeted at radiologists, consulting specialist literature, etc.) into their work habits.

Interpretation of colloidal dyeing of polyester fabrics pretreated with ethyl xanthogenate in terms of zeta potential and surface free energy balance.

Data are presented on the adsorption of the colloidal dye Disperse Blue 3 onto polyester fabric (Dacron 54, Stile 777), the fabric being pretreated with different amounts of the surfactant potassium ethyl xanthogenate (PEX). This study has been made by means of both the evolution of the zeta potential of the fiber/dye interface and the behaviour of the surface free energy components of the above systems. The kinetics of adsorption of the process of dyeing, using 10(-4) M of PEX in the pretreatment of the fabric, shows that increasing temperature of adsorption decrease the amount of colloidal dye adsorbed onto the fabric. This fact shows that the principal mechanism involved in this adsorption process is physical in nature. The adsorption isotherms of the colloidal dye onto polyester pretreated with different amounts of PEX, shows that the adsorption of the dye is favored with the increase in the concentration of the surfactant used in the pretreatment. This fact shows that the pretreatment with PEX is a very interesting aspect of interest in textile industry. The zeta potential of the system fabric/surfactant shows that this parameter is negative (about -25 mV) for the untreated fiber and decreases in absolute value for increasing concentration of the surfactant on the fiber, the value of the zeta potential of the system being -5 mV for 10(-2) M of PEX. This behavior can be explained for the chemical reaction nucleophilic attack between the carboxyl groups of polyester, ionized at pH 8, and the thiocarbonyl group of the xanthogenate ion. On the other hand, the zeta potential of the system polyester pretreated with PEX/Disperse Blue 3 at increasing concentrations of the surfactant and the dye shows that this parameter increases its negative value strongly with increasing concentration of the surfactant used in the treatment. This can be explained for the hydrogen bonds between the hydroxy groups of the dye and the S- ions of the thiocarbonyl group of the surfactant preadsorbed onto the fiber.

Electrokinetic and thermodynamic analysis of the adsorption process of N-cetylpyridinium chloride on polyester fabric.

An electrokinetic and thermodynamic analysis of the adsorption process of N-cetylpyridinium chloride on polyester fabric is described in the present work. The electrokinetic study was performed by means of electrophoretic mobility measurements of the polyester-surfactant system. The most significant result is the increase in electrokinetic potential, zeta, toward more positive values as the surfactant concentration in the dispersion medium is raised. Given the molecular structure of N-cetylpyridinium chloride (N-CP-Cl), which contains a pyridinium group, positively charged, it is feasible that such increase in |zeta| is due to the electrostatic attraction between the carboxyl groups of polyester, ionized at pH 8.5, and the pyridinium group of the surfactant. The uptake of N-CP-Cl by the fiber is experimentally determined at four temperatures: the strong increase in the amount of the surfactant incorporated onto the fiber as the initial concentration of N-CP-Cl is larger shows that the electrostatic attraction between the fiber and the surfactant is the main mechanism of the adsorption of the surfactant onto the fiber. The obtained data on the kinetics and thermodynamics of adsorption of N-cetylpyridinium chloride onto the polyester, standard free energy, enthalpy, and entropy related to the process of adsorption are in accordance with our hypothesis on the mechanisms of adsorption. From a different point of view, the efficient coverage of polyester by N-CP-Cl is also demonstrated by the changes experienced by the surface free energy of polyester upon treatment with N-CP-Cl.

Electrokinetic and Thermodynamic Analysis of the Dyeing Process of Polyamide Fabric with Mordant Black 17.

An electrokinetic and thermodynamic analysis of the dyeing process of polyamide 6.6 (nylon 6.6) by the dye Palatine chrome black (PCB) is described in the present work. The electrokinetic study was performed by means of electrophoretic mobility measurements on bare and dyed fiber. The most significant result is the increase in electrokinetic potential, zeta, toward more negative values as the dye concentration in the dispersion medium is raised. Given the molecular structure of PCB, which contains a sulfonate group per molecule, it is feasible that such increase in |zeta| is due to the adsorption of the negatively charged, dissociated dye entities. The uptake of PCB by the fiber is experimentally determined at two temperatures: the strong increase in the amount of dye incorporated into the fiber as the initial concentration of PCB is larger, and also the fact that higher temperatures favor the dyeing process is an indication of the existence of strong interactions between both interfaces. From a different point of view, the efficient coverage of Nylon by PCB is also demonstrated by the changes experienced by the surface free energy of Nylon upon treatment with PCB. Copyright 2001 Academic Press.

Study of the Leacril Dyeing Process by a Cationic Dye from an Emulsion System.

Adsorption studies of a cationic dye, Rhodamine B, from an emulsion phase on Leacril fabric at different temperatures were conducted. The emulsion phase consisted of n-hexadecane emulsified by isopropyl alcohol (1 M) and stabilized by tannic acid. In the alcohol solution Rhodamine B was dissolved. The kinetics of its adsorption and desorption is discussed. The changes in Leacril surface free energy components in the dyeing process were also determined. The adsorption data show that the presence of an emulsion increases the dye adsorption at room temperature (293 K) and at 313 K, while at 333 K it is smaller than that from Rhodamine solution alone. However, Rhodamine desorbs more when adsorbed from the solution. Surface free energy components differ for the Leacril samples dyed at different temperatures, and the most hydrophobic surface was obtained for the samples dyed at 333 K, where the electron-donor component is the lowest one. In general, the work of water spreading is close to zero, except for the above sample for which it is relatively highly negative. Possible mechanisms of the dye adsorption are discussed. Copyright 2001 Academic Press.

MRI features of epidural extramedullary hematopoiesis.

A case of beta-thalassemia intermedia with spinal cord compression due to extramedullary hematopoiesis, which was successfully treated by blood transfusion, is presented. Emphasis was made on the MRI appearance of extramedullary hematopoiesis on different pulse sequences. The theories that aimed to explain the involvement of the epidural space by extramedullary hematopoiesis are discussed.

Comparison of lansoprazole-based triple and dual therapy for treatment of Helicobacter pylori-related duodenal ulcer: an Asian multicentre double-blind randomized placebo controlled study.

BACKGROUND: [corrected] In Asian countries with limited resources, clarithromycin-based triple therapy may not be readily available. There are also few direct comparisons of different regimens in Asia. AIM: To compare two lansoprazole-based non-clarithromycin triple therapies and one dual therapy in a prospective double-blind placebo-controlled study of Helicobacter pylori eradication and duodenal ulcer healing. METHODS: Fourteen centres in Asia participated in this study. Patients with acute duodenal ulcer who were H. pylori-positive were recruited. They were randomized to receive: (a) lansoprazole 30 mg b.d., amoxycillin 1 g b.d. and metronidazole 500 mg b.d. for 2 weeks (LAM-2 W), or (b) LAM for 1 week and placebo (LAM-1 W), or (c) lansoprazole 30 mg b.d., amoxycillin 1 g b.d. and placebo for 2 weeks (LA-2 W). Upper endoscopy was repeated at week 6 to check for duodenal ulcer healing. Symptoms and side-effects were recorded. RESULTS: A total of 228 patients were recruited, and two patients took less than 50% of the drugs. H. pylori eradication rates (intention-to-treat) were 68 out of 82 (83%) with LAM-2 W, 55 out of 71 (78%) with LAM-1 W and 43 out of 75 (57%) with LA-2 W. There were significant differences (P=0. 001) in eradication rates when comparing either LAM-2 W or LAM-1 W with LA-2 W. The eradication rate in patients with metronidazole resistant H. pylori strains were significantly lower than those with metronidazole sensitive strains (P=0.0001). The duodenal ulcer healing rates at week 6 were 85%, 85% and 72% in LAM-2 W, LAM-1 W and LA-2 W, respectively (P=0.065). Side-effects occurred in 13%, 11% and 9% in LAM-2 W, LAM-1 W and LA-2 W, respectively. H. pylori eradication and initial ulcer size were factors affecting duodenal ulcer healing. CONCLUSIONS: This Asian multicentre study showed that 1-week lansoprazole-based triple therapy without clarithromycin has similar efficacy in H. pylori eradication and ulcer healing compared with a 2-week regimen. Both triple therapies were significantly better than dual therapy in H. pylori eradication. Therefore, 1-week lansoprazole-based triple therapy is as safe and effective as 2-week therapy in eradication of H. pylori infection and healing of duodenal ulcer in these Asian centres.

Isolated trigeminal neuropathy due to trigeminal nerve root hemorrhage.

BACKGROUND: Isolated trigeminal neuropathy is uncommon; causes include trauma, inflammation, or neoplasm. METHODS: We report a patient who fell and struck his head during a myocardial infarction, was treated with streptokinase, and developed symptoms and signs of an isolated trigeminal sensory neuropathy. RESULTS: Imaging showed hemorrhage in the trigeminal nerve root; follow-up imaging showed resolution of the hemorrhage, but no underlying structural lesion. CONCLUSION: A combination of head trauma plus thrombolysis resulted in an isolated trigeminal neuropathy.

The various MRI patterns of pituitary apoplexy.

The aim of this study was to describe the various MRI features, in correlation to surgical and pathological findings, in patients who presented with pituitary apoplexy (PA). Eleven patients presenting with PA, were evaluated with various MR protocols including spin-echo (SE) T1-weighted sequences in 9 of 11 patients, post gadolinium SE T1-weighted sequences in only 8 of 11 patients, and with T2-weighted SE sequences in 2 of 11 patients. All patients had transsphenoidal pituitary surgery after MR studies. The severity of presenting symptoms ranged from headaches to coma. Ten patients had pituitary macroadenoma; one had a non-hemorrhagic metastatic lesion into a non-adenomatous pituitary gland. Of the 11 patients, one was studied at the acute stage of PA (1 day after onset), 9 at the subacute period (3-15 days after onset), and one at the late stage (5 months after onset). Images compatible with intratumoral hemorrhage were found in all macroadenomas, whereas the metastatic pituitary lesion did not show evidence of bleeding. All gadolinium-enhanced studies showed partial tumoral enhancement. The SE T2-weighted studies demonstrated areas of low and high signal intensities in keeping with the presence of blood degradation contents. Pituitary apoplexy present with different MR features, including hemorrhagic and non-hemorrhagic characteristics on T1-weighted images. Gadolinium-enhanced images do not provide complementary diagnostic information when the presence of blood is assessed on plain images.

Trigeminal nerve hypertrophy in chronic inflammatory demyelinating polyradiculoneuropathy.

An unusual clinical manifestation of nerve hypertrophy in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is described. A patient with a 13-year history of CIDP developed diplopia and proptosis. Imaging of the neuraxis showed marked bilateral trigeminal nerve hypertrophy and lumbosacral nerve root hypertrophy. Biopsy of the right infraorbital nerve revealed inflammatory infiltrates and extensive onion bulb formation, consistent with CIDP.

Final results of a study of escalating doses of hyperfractionated radiotherapy in brain stem tumors in children: a Pediatric Oncology Group study.

PURPOSE: In September 1984, the Pediatric Oncology Group began accrual to a Phase I/II study designed to assess the efficacy and toxicity of sequentially escalated doses of hyperfractionated (twice daily) radiotherapy in children with poor-prognosis brain stem tumors. Pediatric Oncology Group Study #8495 closed in June 1990 with a total of 136 patients on study. We report here the outcome of patients treated at the third and final dose level (75.6 Gy), and compare the results to those obtained at the 66 and 70.2 Gy dose levels. METHODS AND MATERIALS: Patients eligible for study were those between 3 and 21 years of age with previously untreated tumors arising in the midbrain, pons or medulla. Histological confirmation of diagnosis was not mandatory provided that the clinical and radiological findings were typical for brain stem glioma. Treatment consisted of radiotherapy delivered to local fields. At the third dose level, fraction sizes of 1.26 Gy were given twice daily, with a minimum interfraction interval of 6 hr to a dose of 75.6 Gy in 60 fractions over 6 weeks. Between 5/89 and 6/90, 41 patients were accrued to the study. Two were excluded from analysis leaving 39 evaluable patients, 21 male and 19 female, whose ages ranged from 3 to 15 years (median 7.5 years). RESULTS: Following treatment, neurological improvement was reported in 30/39 (77%) of the patients. On central review of imaging studies in 29 patients, one patient was found to have had a complete response to radiotherapy, five a partial (> 50% response), and only three had non-responding or progressive disease. The median time to disease progression was 7 months; median survival time was 10 months; survival at 1 year was 39.9% (SE 8.3%) and at 2 years, 7% (SE 4.8%). The pattern of failure was local in all patients; in addition six had evidence of leptomeningeal seeding. Morbidity of treatment included an enhanced skin reaction (21%), otitis media and/or externa (26%), and steroid use > 3 months (62%). Intralesional necrosis was a frequent finding (45%) on imaging studies performed at a median time of 6 weeks post treatment. CONCLUSION: The results of treatment in terms of progression-free survival and overall survival are not significantly different (at p = .55 and p = .46, respectively) from those obtained at the two previous dose levels. There is no evidence that higher doses of hyperfractionated radiotherapy given as in this study improve the outlook of patients with poor-risk brain stem gliomas.

CT and MR imaging findings in adults with cerebellar medulloblastoma: comparison with findings in children.

The goal of this study was to determine if certain imaging features suggest the diagnosis of cerebellar medulloblastoma in adults and to determine how often the classic CT appearance seen in children is present in adults. The study included 28 adult patients with proved cerebellar medulloblastoma. The tumor was located in the cerebellar vermis in 14 patients and in a cerebellar hemisphere in 14 patients. Thirteen patients had unenhanced CT of the brain, all patients had contrast-enhanced CT, and eight patients had unenhanced MR imaging. The imaging features in adults were compared with those in children, as described in the literature. In our adult patients, all tumors were hyperdense compared with gray matter on unenhanced CT and showed a slight to moderate increase in density after injection of contrast medium. Thirteen lesions had well-defined margins, and 15 had poorly defined margins. Low-density areas consistent with cystic and necrotic degeneration were detected in 23 (82%) of the 28 tumors. By comparison, in children, medulloblastoma usually originates in the vermis. As in adults, the mass is hyperdense on unenhanced CT, but enhances markedly and homogeneously after injection of contrast medium. Usually no evidence of cyst formation or necrosis is seen, and the tumor margins are well defined. This classic CT appearance of medulloblastoma in children was identified in only three (11%) of the 28 adult patients. Medulloblastoma has a variable MR appearance in both children and adults. On T2-weighted images, lesions are hypo-, iso-, or hyperintense compared with normal gray matter. The CT findings of medulloblastoma in adults usually differ from those of medulloblastoma in children. The tumor has a variable and nonspecific appearance in adults and should always be considered in the differential diagnosis of a mass in the posterior fossa.

Low-grade myxoid chondrosarcoma of the base of the skull: CT, MR, and histopathology.

A retrospective CT, MR, and histopathologic study was performed in five patients with histologically verified low-grade myxoid chondrosarcoma of the base of the skull. In four patients, the tumor originated off the midline and was associated with bone destruction at the petrous apex near the petrooccipital fissure. Tumor extent included the cerebellopontine angle in three patients and the parasellar area in two patients. The fifth tumor originated on the midline and was associated with destruction at the dorsum sellae. Three tumors contained calcifications, whereas two lesions were mostly isodense with brain on CT scan. All tumors were hypointense on T1-weighted MR images and very intense on T2-weighted images except for areas of signal void consistent with calcifications. Light microscopy revealed islands of mature hyaline cartilage in an abundant myxoid ground substance. Histology and immunocytochemical analysis were consistent with a low-grade myxoid chondrosarcoma. The CT and MR features of low-grade myxoid chondrosarcoma are comparable with those of chordoma. Chordoma usually arises from the midline, but cases with origin from the lateral portion of the clivus or the petrous apex have been described. Low-grade myxoid chondrosarcoma has distinct histologic and immunocytochemical features and includes lesions formerly called "chondroid chordomas."