Acute post-transplantation renal failure: differential diagnosis by ultrasound

Sonograms of 35 patients with cadaveric renal allografts were reviewed. The patients included five with successful renal transplantations, seven with acute tubular necrosis, 19 with acute rejection, one with complete occlusion of the renal artery, and three with stenosis of a renal artery. During the course of acute tubular necrosis, the renal anatomy remained sonographically unaltered. During the course of acute rejection, there was a spectrum of sonographic findings including increase in renal volume, decreased amplitude of the renal sinus echoes, enlarged medullary pyramids, indistinct corticomedullary boundary, increased echogenicity of the renal cortex, areas of decreased parenchymal echogenicity, sparse cortical echoes, and perirenal fluid collections as a result of hematoma or crescentic collection of fluid around the kidney. In both arterial occlusion and stenosis, no sonographic abnormalities of renal anatomy were seen and the only finding was lack of normal post-transplantation hypertrophy. Our study encourages the use of sonography in acute post-transplantation renal failure. If serial ultrasound studies are available and correlation with clinical and laboratory data and nuclear medicine studies are obtained, the correct diagnosis may be reached without the use of invasive procedures.

Protein patterns of the cerebrospinal fluid of 30 patients with subacute sclerosing panencephalitis (SSPE)

Lumbar cerebrospinal fluid (CSF) from 30 cases of subacute sclerosing panencephalitis (SSPE) was studied for total protein and protein electrophoresis. Total CSF protein values were normal in almost all the cases, but the gamma-globulin was increased and had an oligoclonal morphology in all the cases. Absolute and relative values of some of the other electrophoretic fractions were decreased. Total protein and electrophoretic serum values in 25 cases did not differ significantly from the controls, although the gamma-globulin presented an oligoclonal morphology in 13 cases. CSF immunoglobulins were determined in 10 cases; IGG was increased in ll; IgA was traceable and slightly increased in only four cases; IgM was not found. These findings point to the intrathecal synthesis of IgG and the absence of barrier impairment. The decrease of the absolute values of some of the other CSF proteins suggests that homeostatic mechanisms for protein concentration in the CSF are maintained in SSPE.

Nerve cell fusion in a case of subacute sclerosing panencephalitis

Evidence indicating cell membrane fusion among cells and their processes where subacute sclerosing panencephalitis (SSPE) virus is present is shown in an ultrastructural study of a brain biopsy. Virus budding from plasma membrane was not seen. These rare findings reinforce the hypothesis of cell-to-cell transmission as the most likely mechanism of SSPE virus infection. The presence of fused membranes between cell processes and cell soma probably explains the rapid spread of this virus throughout the nervous system.

Two cases of rapidly progressive subacute sclerosing panencephalitis. Neuropathological findings

Two cases of rapidly progressive subacute sclerosing panencephalitis that brought about coma in less than three weeks and death in less than two months are reported. The ultrastructural observations of brain biopsy specimens from these patients found unusual neuropathological findings. These uncommon features are discussed on a cliniconeuropathological basis.

Dendritic degeneration and regrowth in the cerebral cortex of patients with Alzheimer's disease

Biopsy fragments from the frontal cortex of three patients with Alzheimer's disease were studied by electron microscopy. Electron-dense degenerating dendrites were observed in all cortical layers, but more abundantly in layers 3 and 4. Dendrites with lipid-like droplets and others filled with mitochondria were also seen in these two layers. These findings are in keeping with the abnormalities found with Golgi techniques in the dendritic trees of patients with familial forms of Alzheimer's disease, and are similar to the alterations observed in other diseases accompanied by mental changes.

Cerebral cortex dendritic degeneration in subacute sclerosing panencephalitis (SSPE)

Biopsy fragments from the frontal cortex of three patients with subacute sclerosing panencephalitis (SSPE) were studied by light- and electronmicroscopy. Special attention was given to the neuropil. Electron-dense degenerating dendrites were observed in all cortical layers, more abundantly in layers. I, II, and III. Mitochondria, with electron-dense deposits between disrupted cristae, were often recognized within these dendrites. The deposits were enzymatically extracted by pronase. These findings are in keeping with recent alterations found in dendrites of patients with other cerebral disorders, and they may be related to the mental changes seen in SSPE.

Oligoclonal gamma-globulin of cerebrospinal fluid in neurobrucellosis

The clinical manifestations and laboratory findings of two cases of neurobrucellosis are described. The cerebrospinal fluid (CSF) protein electrophoresis showed increased gamma-globulins and decreased relative values of pre-albumin and albumin, associated to high values of total CSF protein. The evidence of oligoclonal morphology of CSF gamma-globulins suggests that part of them had an intrathecal origin, in addition to an increased crossing of the damaged blood-CSF barrier. Similar oligoclonal appearance of CSF gamma-globulins was observed in two additional cases of neurobrucellosis previously reported.

Pathological findings in one of two siblings with Sjögren-Larsson Syndrome

The clinical features of 2 new cases of Sjögren-Larsson syndrome are described. Histopathological examination of the skin in 1 of the cases revealed an ichthyosis vulgaris, which does not agree with the clinical and genetic classification. In the same case, a neuroblastoma was the cause of death, and neuropathological examination showed a symmetrical demyelination of some ascending and descending long tracts in the medulla and spinal cord.

Immunologic dysfunction in Sickle cell anaemia

Selected cellular immune parameters were studied in 20 patients with sickle cell anaemia (SCA). A moderate absolute lymphocytes was observed in SCA patients compared with the control group. There was no significant difference between patients and controls in the mean E-rosette percentage and absolute number. PHA transformation was decreased in 50% of SCA patients, and some of them showed cutaneous anergy. It was suggested that imparied cell-mediated immunity is another factor to be included among defective SCA host-defense mechanism.

Neurofibrillary changes in the cerebral cortex of a patient with subacute sclerosing panencephalitis (SSPE)

Biopsy fragments from the frontal cortex of one patient with SSPE were studied with ultrastructural methods. Special attention was given to the presence of neurofibrillary tangles observed in all cortical layers. These tangles were composed either of filaments with a diameter of 10 -- 12 nm or of paired helical filaments 22 -- 24 nm at their widest and periodically reduced to 10 nm about every 80 nm. These tangles were observed in all cortical layers, while those formed by single filaments were only visualized in layer 3. The simultaneous appearance of both types of tangles in the same patient suggests that they may be chemically related, which is in keeping with recent chemical data concerning the nature of the neurofilament protein subunit.

Nuclear bodies in nerve cells of two patients with normal-pressure hydrocephalus

Biopsy specimen fragments from two patients with normal-pressure hydrocephalus were studied using ultrastructural methods. Simple nuclear bodies were found in all layers of the cortex and white matter, whereas complex ones were only seen in the fifth and sixth layers and in the underlying white matter. There may be a relationship of these nuclear bodies, either to the neuroglial proliferation observed in both patients or to the existence of a viral infection of the CNS.

Multivesicular bodies in cortical dendrites of two patients with Alzheimer's disease

Biopsy fragments from the frontal cortex of 2 patients with Alzheimer's disease were studied with ultrastructural and cytochemical methods. A great number of light and dark, acid phosphatase positive, multivesicular bodies were observed in dendrites and their spines, in all cortical layers, being more abundant in layers 3 and 4. A close topographic relationship between these organelles and post-synaptic membranes was found. It is postulated that these findings might be related to the neurite formation of the senile plaques and to the synaptic involvement in Alzheimer's disease.

Synaptic vesicles and other organelles of human mossy fibre endings. A morphometric study

The mossy fibre ending organelles of 6 men were studied, using morphometric methods. The numerical densities of agranular, coated and dense core vesicles, as well as the number of agranular vesicles per micrometer2 of the synaptic surface and per synapse were calculated.

Tetanus antibody production in serum and cerebrospinal fluid in the rabbit and correlated histopathological features of the central nervous system

The histopathological features in the central nervous system (CNS) developing during the active phase of tetanus antibody formation in the cerebrospinal fluid (CSF) as induced in 15 rabbits were studied. The measurement of antibody titres in serum and CSF by electroimmunodiffusion and histological examination were done sequentially at the 1st, 3rd, 5th, 7th and 9th days after cisternal secondary inoculation with fluid tetanus toxoid. Tetanus antibodies appeared in serum after the 1st and in CSF after the 5th day. Decreasing values of CSF total protein were found. The meaning of an elevated Q ratio as observed in this situation of strong antibody formation in the CSF was enhanced. The histopathological features in the central nervous system consisted of perivascular inflammatory infiltration, at first polymorphic and then composed almost exclusively of mononuclear cells with a predominantly leptomeningeal and subpial localization, which might represent the origin of CSF tetanus antibodies. The localization was related to the contact zone between the antigen- and antibody-containing compartments, respectively the subarachnoid space and vascularized structures of the brain and spinal cord. Four control rabbits presented neither tetanus antibodies in the CSF nor perivascular inflammatory infiltration in the CNS. Similarity between the present experimental results and the immunopathological features of the primary demyelinating diseases provides some useful information about the immunological inflammatory events in these diseases.