Wernicke's encephalopathy and dialysis: report of two cases

Wernicke encephalopathy is considered a complication of dialytic therapy, but there are few reports of this complication. We report a 57 years old man and a 45 years old woman, with grade IV renal failure, who after acute peritoneodialysis and chronic hemodialysis respectively, had a confusional syndrome that responded to the administration of thiamine. CT scans in both patients discarded abnormal blood collections or new cerebrovascular episodes. The man bad two previous cerebrovascular episodes, a severe anemia that was corrected, angina and an episode of arrhythmia during the dialytic procedure previous to the confusional episode. The woman had an acute uremic syndrome and a concomitant urinary tract infection during the confusional episode. Wernicke encephalopathy must be suspected in patients in dialysis with confusional episodes.     

Ability of pediatric residents to read critically research papers]

PURPOSE: To compare the response rates, toxicities and survival durations of elderly patients (70 years of age or more) with those of younger patients (less than 70 years of age) with non-small-cell lung cancer (NSCLC) treated with cisplatin-based chemotherapy. PATIENTS AND METHODS: We analyzed retrospectively the data of 203 assessable patients entered on a prospective randomized trial of cisplatin-based combination chemotherapy. Chemotherapy consisted of three dosage regimens: (1) vindesine and cisplatin (VP); (2) mitomycin, vindesine and cisplatin (MVP); or (3) etoposide and cisplatin alternating with vindesine and mitomycin (EP/VM). RESULTS: A greater proportion of elderly patients had localized disease and more squamous cell carcinoma than non-elderly patients. The overall response rates were 44% in the elderly group and 28% in the non-elderly group. In the EP/VM arm, the response rate was significantly better in the elderly group than in the non-elderly group. The frequency of grade 4 leukocytopenia in the MVP and EP/VM arms in the elderly group was significantly greater than in the non-elderly group (P < 0.05). No differences were found in nonhematological toxicities between the two groups. There was no difference in overall survival between the groups. CONCLUSION: Elderly patients treated with mitomycin-containing regimens have higher hematologic toxicities than younger patients. The results of this study are consistent with the previously reported pharmacologic data on mitomycin suggesting altered pharmacokinetics in elderly patients. The improved response rate in the elderly patients was probably because more elderly patients had earlier disease, squamous cell carcinoma and better performance status. Cisplatin-based chemotherapy was tolerable for most elderly NSCLC patients with good performance status.     

Low molecular weight heparins. Implications in anesthesia and resuscitation

Low molecular weight heparins are a group of drugs that have only recently been introduced in clinical practice. The are widely used for prophylaxis in thromboembolic disease and are being employed increasingly to treat established venous thrombosis. One way in which these drugs are often used is for prophylaxis in the perioperative period for patients at high risk of developing venous thromboembolism, and the anesthesiologist must therefore be familiar with the main aspects of this application. We review pharmacological characteristics of these drugs as well as the literature on low molecular weight heparins, stressing points of main interest to the anesthesiologist and intensive care recovery unit specialist, namely adverse effects (mainly bleeding) and the implications that use of low molecular weight heparin will have on choice of anesthetic (in particular the dilemma of whether to use local/regional anesthesia).     

Prevention of neutrophil apoptosis by monosodium urate crystals

The effects of monosodium urate (MSU) crystals on apoptosis of cultured peripheral blood neutrophils were investigated. MSU crystals at low concentrations decreased the rate of spontaneous apoptosis of neutrophils in a dose- and time-dependent manner. The culture supernatant of MSU crystal stimulated neutrophils also promoted a delay in neutrophil apoptosis. MSU crystals at higher concentrations rapidly caused cell lysis. These findings indicated that MSU crystals are capable of amplifying the inflammatory responses of gouty arthritis by decreasing the rates of neutrophil apoptosis at lower concentrations and inducing cell lysis at higher concentrations.     

Task Planning For A Mobile Robot In An Indoor Environment Using Object-oriented Domain Information

For a mobile robot to be practical, it needs to navigate in dynamically changing environments and manipulate objects in the environment with operating ease. The main challenges to satisfying these requirements in mobile robot research include the collection of robot environment information, storage and organization of this information, and fast task planning based on available information. Conventional approaches to these problems are far from satisfactory due to their requirement of high computation time. In this paper, we specifically address the problems of storage and organization of the environment information and fast task planning in the area of robotic research. We propose an special object-oriented data model (OODM) for information storage and management in order to solve the first problem. This model explicitly represents domain knowledge and abstracts a global perspective about the robot's dynamically changing environment. To solve the second problem, we introduce a fast task planning algorithm that fully uses domain knowledge related to robot applications and to the given environment. Our OODM based task planning method presents a general frame work and representation, into which domain specific information, domain decomposition methods and specific path planners can be tailored for different task planning problems. This method unifies and integrates the salient features from various areas such as database, artificial intelligence, and robot path planning, thus increasing the planning speed significantly     

Protein expression profiles in human breast ductal carcinoma and histologically normal tissue

Reference two-dimensional (2-D) gels are presented for human breast ductal carcinoma and histologically normal tissue. Whole biopsy fragments were analyzed, including epithelial and nonepithelial components. Thirty-five spots have been assigned by gel matching to the human liver SWISS-2DPAGE reference map and/or to the human primary keratinocyte IPG map from the Danish Center for Human Genome. N-terminal microsequencing was applied to confirm randomly chosen matching assignments and to identify six new spots. Protein expression profiles in ductal carcinoma and in normal breast tissue appeared to be similar, except for a pattern consisting of 32 spots, which were highly expressed in all carcinoma specimens, and less intense and occasionally undetectable in normal tissue. This difference was statistically significant. Assignment has been obtained for several spots, namely GRP94, GRP78, GRP75, mitochondrial HSP60, calreticulin, protein disulfide isomerase, peptidyl-prolyl cis-trans isomerase, collagen-binding protein 2, fructose bisphosphate aldolase, glyceraldehyde-3-phosphate dehydrogenase, thioredoxin, cytochrome c oxidase VA subunit, tubulin beta isoform and macrophage migration inhibitory factor (MIF). The cancer- and tissue-specificity of the described pattern was assessed by matching to the Swiss-2DPAGE human liver, hepatoma, lymphoma, erythroleukemia reference maps. The pattern of 32 spots was found to be indicative of epithelial neoplasia.     

Simultaneous bilateral fractures of the hip following a grand mal seizure. An unusual complication

Pathological fractures as a consequence of convulsive seizures without direct trauma occur in 0.3% of cases. Some lesions such as bilateral posterior dislocation of the shoulder, fracture-dislocation of the shoulder or fracture and/or dislocation of the hip strongly suggest a seizure as the aetiology. We report on a patient with simultaneous central dislocation of one hip with fracture of the contralateral femoral neck provoked by spontaneous seizures. Unrecognized associated injuries following a convulsion may result in long-term functional disability and legal consequences.     

Selective phosphorylation of adult tau isoforms in mature hippocampal neurons exposed to fibrillar A beta

How senile plaques and neurofibrillary tangles are linked represents a major gap in our understanding of the pathophysiology of Alzheimer's disease. We characterized a hippocampal neuronal culture system in which tau undergoes maturation in vivo; rat neurons maintained in culture for more than 3 weeks replicated the splicing and phosphorylation changes that tau undergoes upon maturation in situ. Using this model system, we induced an Alzheimer-like neuritic dystrophy following the application of fibrillar beta-amyloid. The dystrophy consisted of focal distortions and swellings within the neurites and an altered phosphorylation of the adult tau isoforms. Fibrillar beta-amyloid induced the concomitant activation of MAP kinase and GSK3 beta. The aberrant activation of several signaling pathways may lead to the abnormal phosphorylation of tau and neuritic degeneration.