Precapillary pulmonary hypertension of uncertain etiology

HISTORY AND CLINICAL FINDINGS: A 39-year-old man was hospitalized for investigation of increasing dyspnoea for 3 month. On admission he was found to have bilateral ankle oedema, an enlarged liver and loud systolic murmur over the lower sternum. INVESTIGATIONS: There were signs of right heart strain/hypertrophy on the chest radiogram and echocardiogram. After treatment of right heart failure cardiac catheterization indicated moderate precapillary pulmonary hypertension (PH) with a mean pulmonary artery pressure (PAPm) of 24 mm Hg and pulmonary vascular resistance (PVR) of 470 dyn.s.cm-5 at rest. All known causes having been excluded, the PH was classified as idiopathic. TREATMENT AND COURSE: Evidence of acute pulmonary vascular reactivity was obtained with nitric oxide (NO) inhalation and oral diltiazem, a calcium-channel blocker. The latter, at a dosage of 3 x 120 mg daily, had after 13 days achieved a persisting reduction of PVR at rest and a reduction in PAP rise during exercise. CONCLUSION: After exclusion of other causes, the acute right heart failure was found to be due to primary pulmonary hypertension. The therapeutic efficacity of diltiazem as a vasodilator can be predicted from the response to inhaled NO.     

Diagnostic laparoscopy in patients with an acute abdomen of uncertain etiology

The occurrence of multiple mating in Drosophila melanogaster is of particular interest to evolutionary biologists, as seminal fluid has some toxic effects for females. Thus, it has been predicted that the number of matings per females should be low. We have tested this prediction with seven highly polymorphic microsatellite loci in inseminated females from a Viennese D. melanogaster population. In contrast to the predicted low number of matings and previous studies in natural populations, we identified the genotypes of four to six different males fertilizing the offspring of each female tested. Potential causes and consequences are discussed.     

The relation of anxiety sensitivity to higher and lower order personality dimensions: Implications for the etiology of panic attacks.

The relation of anxiety sensitivity (AS) to personality dimensions has received little attention. In this study, 4 AS indexes were administered along with measures of personality, fears, and panic attacks to 220 undergraduates. At the higher order level, AS was positively correlated with negative emotionality (NE) but was largely unrelated to either positive emotionality or constraint. At the lower order level, AS was positively correlated with absorption and NE indexes. Most of these correlations were significant even among participants with no panic attack history. AS exhibited incremental validity above and beyond a number of personality variables, including absorption and trait anxiety, in the prediction of fears and panic attack history. These findings are consistent with the hypothesis that a propensity toward immersion in sensory experiences is a diathesis for panic attacks. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Headache in transient ischaemic attacks

In vitro studies of chlorpromazine (CPZ) a popular anti-psychotic drug has shown radiation sensitizing effects at higher celluar concentration and protective effect at a lower concentration. The present study was designed to evaluate both sensitizing and protective effects in the treatment of advanced cancer of the cervix treated with hypofractionated external radiation and intratumoural injection of chlopromazine. Twenty patients were treated with intratumoural CPZ and radiation, while, 23 patients received radiation alone. A 52.94% complete response was noted in CPZ arm while 39.1% complete response in the control. A trend towards improved response is seen in CPZ group. Similarly patients who received CPZ showed significantly low proctitis rates.     

Preoperative EEG in medically intractable epilepsy

The aim of the preoperative neurophysiological investigations is to identify the primary epileptogenic focus and its relation to functional cortical areas. The investigations include interictal and ictal extracranial (scalp) electroencephalography (EEG) and invasive methods (depth, subdural, foramen ovale electrodes and peroperative electrocorticography). If an epileptic focus is located in the anterior part of the temporal lobe by the use of scalp EEG, this is normally regarded as sufficient for an anterior lobectomy. However, because of poor spatial resolution by scalp EEG, it is difficult to separate mesial from lateral foci, identify the exact extent of posterior temporal or extra-temporal foci, identify the primary focus in patients with bilateral abnormalities and identify cases with minor scalp EEG-changes. As invasive EEG shows higher spatial resolution and gives an opportunity to evaluate functional areas, invasive EEG has significant advantages in these patients. Use of invasive EEG bears a slightly increased risk and discomfort to the patient, but is necessary in the presurgical evaluation of some patients suffering from medically intractable epilepsy.     

A case of intractable epistaxis

The surgical management of intractable epistaxis by external carotid artery ligation may become complicated if there is a high bifurcation of the common carotid artery. Occlusion of the bleeding vessels by catheter embolization is described in a patient in whom exploration of the neck had failed to locate the external carotid artery.     

Photophobia and phonophobia in migraineurs between attacks

This study investigated whether migraineurs are more sensitive to light and sound while headache-free than are healthy people. Fifty-two migraineurs (mean age 39 years) were selected using the International Headache Society diagnostic criteria for migraine. Forty-eight healthy controls were matched for age, sex, and race (mean age 36 years). Visual and auditory discomfort thresholds were measured by exposing subjects to increasing light and sound until they complained of discomfort. There were significant differences between groups in both the light discomfort threshold (P < 0.00005) and the hearing discomfort threshold (P < 0.0005). The thresholds for both were lower in the migraineurs. Overall, for both groups together, there was a significant negative correlation between light discomfort threshold and age (correlation coefficient -0.2276, P = 0.011), but not for the hearing discomfort threshold and age (P = 0.275). The results show that the migraineurs were significantly more sensitive to light and sound when headache-free than were healthy controls. The apparent increased intolerance to light in both groups together noted with increased age, did not apply to the migraine group.     

The psychophysiological specificity problem in panic attacks

Traumatic intrusion of permanent teeth is a relatively infrequent but serious type of dental injury, due to the complicated picture it involves. Various treatment approaches have been suggested, so far, regarding management of intrusive luxation. Techniques aiming to reposition the intruded tooth include observation for spontaneous reeruption, surgical as well as orthodontic repositioning. However, development of complications such as pulp necrosis, inflammatory root resorption, replacement resorption and ankylosis and loss of marginal bone support makes selection of the most favorable technique controversial. In this paper, a critical review of the existing treatment modalities is attempted and treatment approaches based on diagnostic parameters that are indicative of the severity of an intrusive injury are presented. Recommendations are made after taking into consideration experimental and clinical study findings and observations from other author's and our own clinical experience. Two cases of intrusive luxation in children are presented and management of the dental injuries as well as the complications which occurred are being discussed.     

Surgical management of intractable epilepsy in patients with ganglioglioma

Long-standing intractable seizures are common manifestation of cerebral gangliogliomas. There is much controversy regarding the most appropriate surgical treatment (lesionectomy vs resection of the epileptogenic cortex with the lesion) for patients with intractable epilepsy associated with gangliogliomas. We reported 2 cases, in which the favorable seizure outcome was obtained following lesionectomy alone. (Case 1) Nine-year-old female developed attack of abnormal sensation in her left upper limb followed by motor seizure in her left limbs since 5 years old. MRI revealed hyperintense tumor in the right medial frontal lobe. Chronic invasive subdural recording showed that ictal onset zone was located in the hand motor area. Following lesionectomy alone, she became free from seizures. (Case 2) Eight-year-old girl had intractable generalized seizure since 6 years old. MRI revealed a cystic tumor in the right parietal lobe. She had multiple spike foci on electroencephalography and magnetoencephalography, and intraoperative electrocorticography failed to reveal the paroxysm. Following lesionectomy, she had good relief with less than one minor seizure per 1-3 months. Thus, lesionectomy, even without resection of the epileptogenic cortex, may improve seizure outcome in patients with ganglioglioma-associated epilepsy.     

Psychophysiology of relaxation-associated panic attacks.

Physiological changes preceding and accompanying panic attacks were observed serendipitously in 2 female anxiety-disordered patients (aged 33 and 34 yrs) who were relaxing during physiological assessment. Both Ss showed decreases in heart rate and frontalis EMG during relaxation, followed by sudden increases on both measures at the onset of panic. Hand-surface temperature showed a similar but less intense pattern of response. Possible mechanisms involved in this phenomenon are discussed, including involvement of the parasympathetic system or through proprioceptive or interoceptive conditioning. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping with intractable symptoms in collagen diseases--Behcet''s disease

OBJECTIVE: To determine associations between subclinical Mycobacterium paratuberculosis infection and milk production, milk components, and somatic cell counts of dairy cattle. DESIGN: Cross-sectional epidemiologic survey. ANIMALS: 23 dairy herds in Wisconsin containing 1,653 adult cows were studied. The herds had above average milk production and a history of bovine paratuberculosis in the herd within the previous 12 months. PROCEDURE: All adult cows in the herds were tested for paratuberculosis by use of an absorbed ELISA. Milk yield, fat, protein, and somatic cell count data were retrieved electronically from Dairy Herd Improvement Association records. RESULTS: 147 ELISA-positive and 1,506 ELISA-negative cows were identified. ELISA-positive cows had a mature-equivalent milk production of 376 kg (829 lb)/lactation less than that for ELISA-negative herdmates. Significant difference was not found in lactation average percent-ages of fat and protein, or somatic cell count linear score. When comparing ELISA-positive and -negative cow's current mature equivalent milk with all previous lactations, significant difference was found only from the immediate-preceding lactation. When this difference was examined by parity group, significant difference was confined to cows in the second lactation. CLINICAL IMPLICATIONS: Subclinical paratuberculosis infections, as determined by ELISA, are associated with a 4% reduction in milk yield and add to the already substantial costs of clinical M paratuberculosis infection in the dairy industry.     

Viral etiology of intussusception in Taiwanese childhood

The T-agglutination types were determined for a diverse collection of 1531 group A streptococci for which the 5' M protein gene (emm) sequences had been analysed. The majority of the T-agglutination types correlated with previously seen M/emm/T-type associations; however, several new associations were found. Analysis of a subset of this collection -- which included 1157 clinical isolates with multiply encountered emm types -- found that emm amplicon restriction profiles of isolates sharing identical T types and opacity factor phenotypes are useful for detecting groups of isolates with identical emm genes. Many emm genes of known 5' sequence display a highly conserved restriction pattern amongst clinical isolates widely separated both geographically and temporally.