Histopathology of the substantia nigra in Alzheimer's disease.

Histopathologic examination of the pars compacta of the substantia nigra of 17 patients with Alzheimer's disease showed Lewy bodies in six, neurofibrillary tangles in another six and only histologic changes that did not differ from age-matched controls in five patients. Four of the six patients with nigral Lewy bodies showed severe loss of neural cell bodies, reactive astrocytosis, gliosis and neuromelanin in macrophages and in the neuropile. By contrast, the loss of neuronal cell bodies in our patients without nigral Lewy bodies regardless of whether or not they also had nigral neurofibrillary tangles was no greater than what we observed in our age-matched controls. Quantitative cell counts confirmed our histopathologic estimates of neuronal loss. Our study and the findings of others show that the substantia nigra is often abnormal in Alzheimer's disease and that the abnormalities are rarely severe without nigral Lewy bodies.

MR of benign chondroblastoma of the temporal bone.

A benign chondroblastoma of the temporal bone in an 8-year-old boy is reported. Head CT showed an expansile mass with calcifications in the center. The tumor appeared as a well-lobulated, hypointense intraosseous mass on T1-weighted brain MR; it was isointense to brain parenchyma on intermediate-weighted images and enhanced homogenously with gadolinium.

[Pulmonary aspiration puncture in the etiological diagnosis of pneumonias]. / Punción aspirado pulmonar en el diagnóstico etiológico de las neumonías.

In pneumonias, the short diagnostic results of non-invasive procedures lead frequently to use invasive techniques, among which we find pulmonary puncture aspiration (PPA). In this study, the profitability of PPA in the diagnosis of pneumonias is evaluated. One hundred and thirteen PPA were performed on 107 patients diagnosed of pneumonia. The PPA was performed with a 22-25 G needle without radioscopic control. Hemocultures were gathered in 104 cases, serological tests for productive agents of atypical pneumonia were applied in 50 cases, sputum test in 95 cases, and bronchofibroscopy with occluded telescopic brush in 25. The PPA had a specificity of 98 percent and a sensibility of 54% which rose to 73% in patients without antibiotic treatment prior to the puncture. Only 10 patients had complications with pneumothorax (9 percent) and four (3 percent) presented hemoptysic sputum. In the 53 patients with a positive PPA, knowledge of an etiological agent allowed the antibiotic treatment to be switched in 32 cases (60 percent). In addition, a decrease in the number of days of hospitalization was confirmed in the group of patients who received an etiological diagnosis while alive (p < 0.03). In conclusion, the PPA is a technique with excellent specificity, acceptable sensitivity, and a short rate of complications which allowed the treatment to be changed in 60 percent of the cases and reduced the number of days of hospitalization for patients who received a diagnosis. Thus, it constitutes a very useful technique in the etiological diagnosis of severe pulmonary infections.

Severe community-acquired pneumonia. Etiology, prognosis, and treatment.

The frequency of community-acquired pneumonia coupled with its mortality rate of 10 to 25% is of growing concern to clinicians. A prospective study of 67 patients with severe community-acquired pneumonia was carried out to determine the causative agents, the impact fore-knowledge of the etiology has on the outcome, the value of clinical and radiologic criteria in predicting the evolution, and the efficacy of empirical therapy. The study group included 45 men and 22 women (mean age: 56.8 +/- 16.6 yr), and 46.2% suffered from a concurrent debilitating disease. The cause of pneumonia was diagnosed in 32 cases, and the most common pathogens were Streptococcus pneumoniae (37.5%), Legionella pneumophila (21.8%), and gram-negative bacilli (25.0%). The fact that fungal infections were present in three patients and Pneumocystis carinii in one are worthy of note. The overall death rate was 20.8%. A fatal outcome was related to the age of the patient (p less than 0.05), the presence of debilitating disease (p = 0.026), and septic shock (p = 0.0009). Diagnosis of the causative agents did not aid in increasing the survival rate, but it did allow for better patient management. Most of the patients (85.1%) initiated on treatment with erythromycin plus tobramycin recovered, but only 68.4% of the subjects commenced on treatment with other therapeutics survived. Furthermore, it was necessary to modify the therapy of a greater percentage of the latter group (p less than 0.025). Gram-negative bacillary pneumonia was a frequent finding among the patients who did not recover, making empirical treatment with erythromycin plus third generation cephalosporins most advisable for severe cases of community-acquired pneumonia.

Successful treatment with ganciclovir of disseminated cytomegalovirus infection after liver transplantation.

Disseminated cytomegalovirus (CMV) infection in a liver transplant recipient was treated successfully by administration of ganciclovir (BW B759U) at a dosage of 7.5 mg/kg/day for 2 wk in the face of continuation of chemical immunosuppression. The spectrum of illness included symptomatic esophagitis and hepatic dysfunction associated with the appearance of CMV inclusion bodies, retinal lesions, and bone marrow suppression. Clinical improvement during therapy with ganciclovir was prompt and was paralleled by reversal of histological abnormalities. CMV was recovered from none of the cultured tissues after the start of therapy. Ten months after discontinuation of ganciclovir, the patient had no evidence of further CMV disease. The observation suggests that replicative CMV infection in organ-transplanted patients may be suppressed by relatively low dose ganciclovir, even when the patients are maintained on immunosuppressive regimens designed to prevent graft rejection.