Efficacy of high dose systemic versus combined (systemic and intratympanic) corticosteroid therapy in idiopathic sudden sensorineural hearing loss: A prospective randomized trial and risk factor analysis

The pathophysiology and the proper treatment of idiopathic sudden sensorineural hearing loss (ISSNHL) are an ongoing subject of debate. Locally or systemic administered corticosteroids are the most accepted drugs of treatment in reference to ISSNHL (idiopathic sudden sensorineural hearing loss), however, no strong evidence nor guidelines regarding their effectiveness yet exists. In our prospective, randomized, controlled trial 78 participants were enrolled. Patients were randomly assigned based on the day of admission to two groups according to treatment: group SS (n = 43) received intravenous systemic methylprednisolone alone, and group CT (n = 35) received intratympanic dexamethasone + systemic methylprednisolone. The primary outcome was to compare the hearing outcomes between the treatment groups based on different, widely accepted categories (Siegel, Kanzaki, modified Siegel and PTA4 gain). In consideration of the secondary outcome, we examined the effect of the various risk factors on the hearing improvement. No differences were detected regarding hearing improvement between the two groups, based on any criteria [Siegel's criteria (p = 0.604); Kanzaki's criteria (p = 0.720); modified Siegel's criteria (p = 0.524) and PTA 4 gain (p = 0.569)]. However, several clinical factors such as vertigo (p = 0.039), or cardiovascular comorbidity (p = 0.02) and the severity of initial hearing loss (p = 0.033) were found to bear a significant impact upon the hearing outcome. To the best of our knowledge, this is the first randomized controlled trial comparing high dose systemic and combination corticosteroid therapy in ISSNHL patients. Our findings suggest coexisting cardiovascular comorbidity, vertigo and severity of the initial hearing loss may bear a significantly higher impact upon hearing improvement, than the additional intratympanic steroid administration. The presented trial was registered in the European Union Drug Regulating Authorities Clinical Trials Database (name: Combinated systemic and intratympanic steroid therapy in idiopathic sudden sensorineural hearing loss, No.: 2017-000658-20) and with the ethical approval of The National Institute of Pharmacy and Nutrition (OGYÉI) (protocol No.: 7621, on 2017.02.16.).

Decreasing suicide mortality in Hungary – What are the main causes?

Introduction

Depression and suicidal behaviour are major public health problems everywhere but particularly in Hungary where until 2000 the suicide rate was among the highest in the world.

Objectives

To analyse the possible causes of declining national suicide rate of Hungary.

Methods

Review of the scientific literature on Hungarian suicide scene published in the last 40 years.

Results

The peak of Hungarian national suicide rate was in 1985 (46/100.000) but due to a steady and continuous, year by year decline, in 2019 it was only 16/100.000, which represents a more than 65% decrease. Rate of unrecognised/untreated mood disorders, availability of health/psychiatric care, antidepressant and lithium prescription, unemployment, smoking and alcohol consumption as well as lithium and arsenic contents of drinking water were the most investigated possible determinants of suicide mortality of the country. More widespread and effective treatment of psychiatric/mood disorder patients, decreased rate of unemployment and smoking as well as the continuously improving living standards were the most important contributors to the great decline of the national suicide rate. However, in 2020 – the first year of the COVID-19 pandemic – the national suicide rate rose by 16%, which was almost totally accounted for by the increase of suicides among males.

Conclusions

Suicidal behaviour is preventable in many cases, but as it is a complex, multicausal phenomenon, its prevention should involve several medical/psychiatric, psychosocial and community interventions.

Disclosure

No significant relationships.

Nomenclature and semantic descriptions of ulcerative and inflammatory lesions seen in Crohn's disease in small bowel capsule endoscopy: An international Delphi consensus statement

BACKGROUND

In the medical literature, the nomenclature and descriptions (ND) of small bowel (SB) ulcerative and inflammatory (U-I) lesions in capsule endoscopy (CE) are scarce and inconsistent. Inter-observer variability in interpreting these findings remains a major limitation in the assessment of the severity of mucosal lesions, which can impact negatively on clinical care, training and research on SB-CE.

OBJECTIVE

Focusing on SB-CE in Crohn's disease (CD), our aim is to establish a consensus on the ND of U-I lesions.

METHODS

An international panel of experienced SB-CE readers was formed during the 2016 United European Gastroenterology Week meeting. A core group of five CE and inflammatory bowel disease (IBD) experts established an Internet-based, three-round Delphi consensus but did not participate in the voting process. The core group built illustrated questionnaires, including SB-CE still frames of U-I lesions from patients with documented CD. Twenty-seven other experts were asked to rate and comment on the different proposals for the ND of the most frequent SB U-I lesions. For each round, we used a 6-point rating scale (varying from 'strongly disagree' to 'strongly agree'). The consensus was reached when at least 80 % of the voting members scored the statement within the 'agree' or 'strongly agree' categories.

RESULTS

A 100% participation rate was obtained for all the rounds. Consensual ND were reached for the following seven U-I lesions: aphthoid erosion, deep ulceration, superficial ulceration, stenosis, edema, hyperemia and denudation.

CONCLUSION

Considering the most frequent SB U-I lesions seen in CE in CD, a consensual ND was reached by the international group of experts. These descriptions and names are useful not only for daily practice and medical education, but also for medical research.

Nomenclature and semantic description of vascular lesions in small bowel capsule endoscopy: an international Delphi consensus statement

Background and study aims  Nomenclature and descriptions of small bowel (SB) vascular lesions in capsule endoscopy (CE) are scarce in the medical literature. They are mostly based on the reader's opinion and thus differ between experts, with a potential negative impact on clinical care, teaching and research regarding SBCE. Our aim was to better define a nomenclature and to give a description of the most frequent vascular lesions in SBCE. Methods  A panel of 18 European expert SBCE readers was formed during the UEGW 2016 meeting. Three experts constructed an Internet-based four-round Delphi consensus, but did not participate in the voting process. They built questionnaires that included various still frames of vascular lesions obtained with a third-generation SBCE system. The 15 remaining participants were asked to rate different proposals and description of the most common SB vascular lesions. A 6-point rating scale (varying from 'strongly disagree' to 'strongly agree') was used successive rounds. The consensus was reached when at least 80 % voting members scored the statement within the 'agree' or 'strongly agree'. Results  Consensual terms and descriptions were reached for angiectasia/angiodysplasia, erythematous patch, red spot/dot, and phlebectasia. A consensual description was reached for more subtle vascular lesions tentatively named "diminutive angiectasia" but no consensus was reached for this term. Conclusion  An international group has reached a consensus on the nomenclature and descriptions of the most frequent and relevant SB vascular lesions in CE. These terms and descriptions are useful in daily practice, for teaching and for medical research purposes.

Flow cytometric analysis of extracellular vesicle subsets in plasma: impact of swarm by particles of non-interest

Essentials Extracellular vesicles (EVs) in biological fluids are promising biomarkers for disease. Fluorescence-based flow cytometric analysis is suitable to detect low abundant EV subsets. Particles of non-interest can induce false-positive light scatter and fluorescent signals. Interference of particles of non-interest can be monitored by analyzing serial dilutions.

SUMMARY

Background Extracellular vesicles (EVs) in plasma are increasingly being recognized as potential biomarkers. EV analysis for diagnostic purposes should be robust and should allow analysis of EV subsets with a wide range of abundance and in a large number of patient samples. Flow cytometry offers possibilities to meet these criteria, as it allows multiparameter analysis of individual EVs. However, analysis of plasma EVs is challenging, because of their size and heterogeneity, and the presence of other submicrometer-sized particles in plasma that could interfere with EV analysis. Objectives To explore whether fluorescence-based flow cytometric analysis of EV subsets is suitable when the EVs of interest are present in low abundance in a background of non-labeled or differently labeled EVs and particles. Methods Fluorescently labeled EVs of interest were spiked at different ratios in full plasma, purified plasma components, or (non-)fluorescent polystyrene beads, and subsequently analyzed by flow cytometry with fluorescence threshold triggering. Results We found that light scatter detection of low-abundance or rare EV subsets during fluorescence threshold triggering was severely affected by particles of non-interest, owing to coincidence and swarming. Importantly, we show that interfering particles labeled with different fluorophores induced false-positive fluorescent signals on the particles of interest. These unwanted effects could only be discerned and controlled by performing serial dilutions and analyzing light scatter and fluorescence parameters. Conclusions We demonstrate how particles of non-interest in plasma can impact on the light scatter and fluorescence detection of low-abundance EVs of interest during fluorescence-based flow cytometric analysis, and provide a means to prevent erroneous data interpretation.

Monocyte activation drives preservation of membrane thiols by promoting release of oxidised membrane moieties via extracellular vesicles

The redox state of cellular exofacial molecules is reflected by the amount of available thiols. Furthermore, surface thiols can be considered as indicators of immune cell activation. One group of thiol containing proteins, peroxiredoxins, in particular, have been associated with inflammation. In this study, we assessed surface thiols of the U937 and Thp1 monocyte cell lines and primary monocytes in vitro upon inflammatory stimulation by irreversibly labelling the cells with a fluorescent derivative of maleimide. We also investigated exofacial thiols on circulating blood mononuclear cells in patients with rheumatoid arthritis and healthy controls. When analysing extracellular vesicles, we combined thiol labelling with the use of antibodies to specific CD markers to exclude extracellular vesicle mimicking signals from thiol containing protein aggregates. Furthermore, differential detergent lysis was applied to confirm the vesicular nature of the detected extracellular events in blood plasma. We found an increase in exofacial thiols on monocytes upon in vitro stimulation by LPS or TNF, both in primary monocytes and monocytic cell lines (p<0.0005). At the same time, newly released extracellular vesicles showed a decrease in their exofacial thiols compared with those from unstimulated cells (p<0.05). We also found a significant elevation of surface thiols on circulating monocytes in rheumatoid arthritis patients (p<0.05) and newly released extracellular vesicles of isolated CD14⁺ cells from rheumatoid arthritis patients had decreased thiol levels compared with healthy subjects (p<0.01). Exofacial peroxiredoxin 1 was demonstrated on the surface of primary and cultured monocytes, and the number of peroxiredoxin 1 positive extracellular vesicles was increased in rheumatoid arthritis blood plasma (p<0.05). Furthermore, an overoxidised form of peroxiredoxin was detected in extracellular vesicle-enriched preparations from blood plasma. Our data show that cell surface thiols play a protective role and reflect oxidative stress resistance state in activated immune cells. Furthermore, they support a role of extracellular vesicles in the redox regulation of human monocytes, possibly representing an antioxidant mechanism.

Experimental study on the mechanical interaction between silicon neural microprobes and rat dura mater during insertion

In vivo insertion experiments are essential to optimize novel neural implants. Our work focuses on the interaction between intact dura mater of rats and as-fabricated single-shaft silicon microprobes realized by deep reactive ion etching. Implantation parameters like penetration force and dimpling through intact dura mater were studied as a function of insertion speed, microprobe cross-section, tip angle and animal age. To reduce tissue resistance, we proposed a unique tip sharpening technique, which was also evaluated in in vivo insertion tests. By doubling the insertion speed (between 1.2 and 10.5 mm/min), an increase of 10-35% in penetration forces was measured. When decreasing the cross-section of the microprobes, penetration forces and dimpling was reduced by as much as 30-50% at constant insertion speeds. Force was noticed to gradually decrease by decreasing tip angles. Measured penetration forces through dura mater were reduced even down to 11±3 mN compared to unsharpened (49±13 mN) probes by utilizing our unique tip sharpening technique, which is very close to exerted penetration force in the case of retracted dura (5±1.5 mN). Our findings imply that age remarkably alters the elasticity of intact dura mater. The decreasing stiffness of dura mater results in a significant rise in penetration force and decrease in dimpling. Our work is the first in vivo comparative study on microelectrode penetration through intact and retracted dura mater.

Introducing nanoscaled surface morphology and percolation barrier network into mesoporous silica coatings

The advantages of surface pattern and mesoporous character of silica thin films were combined, while preserving the interconnected pore system or creating laterally separated porous volumes surrounded by nonpermeable compact zones.

Evaluation of the effect of Lake Hévíz thermal mineral water in patients with osteoarthritis of the knee: a randomized, controlled, single-blind, follow-up study

BACKGROUND

Osteoarthritis is the most frequent joint disease and is a leading cause of pain and locomotor disability in elderly people. The treatment of osteoarthritis includes non-pharmacological, pharmacological, and surgical therapies. Silver level evidence has been found concerning balneotherapy in osteoarthritis.

AIM OF THE STUDY

The aim of this study was to evaluate how Lake Hévíz thermal mineral water therapy influences pain, knee function, and quality of life in patients with knee osteoarthritis, compared to the control group.

STUDY DESIGN

randomized, controlled, single-blind, follow-up study.

SETTING

Spa Hévíz and St. Andrew Hospital for Rheumatic Diseases

POPULATION

This study included 77 outpatients between 45 and 75 years of age with mild to moderate osteoarthritis of the knee meeting the American College of Rheumatology classification criteria.

METHODS

Patients were randomized into two groups. In group I (n = 38), subjects bathed in Lake Hévíz and in group II (N.=39), patients were treated in a pool full of tap water. Water temperature was 34 °C for both groups. Participants underwent 30-minute therapy sessions, five times a week for three weeks. Outcome measures were pain visual analogue scale scores, active flexion degree, knee circumference, stair-climb time, Western Ontario and McMaster Universities osteoarthritis index (WOMAC), and EuroQoL Group 5-Dimension Self-Report Questionnaire score (EQ-5D). Study parameters were recorded at baseline, immediately after treatment, and after 15 weeks.

RESULTS

Comparison of the two groups revealed a statistically significant difference in pain visual analogue scale scores (P<0.01), active flexion degree (P<0.01), physical function components of WOMAC (P<0.05), and EQ-5D scores (P<0.05) even after 15 weeks.

CONCLUSIONS

Balneotherapy improved pain, function as well as the quality of life in patients with knee osteoarthritis.

CLINICAL REHABILITATION IMPACT

Balneotherapy is a potentially useful treatment modality for patients with knee osteoarthritis.

[Systemic sclerosis and pregnancy. A review of the current literature]

Pregnancy in women diagnosed with systemic sclerosis generally has a favorable outcome according to most recent studies. Women with systemic sclerosis who wish to become pregnant should achieve low disease activity for at least 6 months prior to conception. Regular follow-up of pregnant scleroderma patients by an interdisciplinary medical team including gynaecologists and rheumatologists is necessary to control disease activity and avoid possible complications. Severe organ involvement, early diffuse systemic sclerosis with rapid onset, and pulmonary hypertension ought to discourage patients from pregnancy, as these situations are at high risk of complications for both mother and fetus during pregnancy.

Treatment of early hepatic artery complications after adult liver transplantation: A single center experience

Introduction

Hepatic artery complication represents recognized sequel of liver transplantation that carries significant morbidity and mortality. Besides retransplantation, hepatic artery recanalization is provided surgically, or by percutaneous angioplasty and stent placement. This study provides an analysis of a single center experience comparing surgical and interventional treatments in cases of early hepatic artery complications.

Methods

In this retrospective single center study, 25 of 365 liver transplant recipients were enrolled who developed early hepatic artery complication after transplantation. Percutaneous intervention was performed in 10 cases, while surgical therapy in 15 cases. Mean follow-up time was not different between the groups (505±377 vs. 706±940 days, respectively).

Results

6 patients in the Intervention Group and 10 patients in the Surgery Group are alive. The retransplantation rate (1 and 3) was lower after interventional procedures, while the development of biliary complications was higher. The mortality rate was higher after operative treatment (2 and 5).

Conclusion

Interventional therapy is a feasible and safe technique for treatment of early hepatic artery complication after transplantation. Being less invasive it is an invaluable alternative treatment having results comparable to surgical methods.

Long-term follow-up of patients with obsessive-compulsive disorder treated by anterior capsulotomy: a neuropsychological study

BACKGROUND

For treatment-refractory Obsessive-Compulsive-Disorder (OCD) patients, anterior capsulotomy is a potential therapy. We investigated what kinds of cognitive deficits treatment-refractory patients have and how anterior capsulotomy modifies their clinical and cognitive profiles.

METHODS

Ten treatment-refractory OCD patients were examined in two groups (operated and non-operated) with 5 participants in each group, matched for symptom severity, gender, age and education. The operated group was treated with anterior capsulotomy; the non-operated group was treated only with pharmaco- and psychotherapy. The Yale-Brown Obsessive-Compulsive Rating Scale (Y-BOCS) was used to measure OCD symptoms, and ten neuropsychological tests were used to measure cognitive functioning.

RESULTS

In the operated group, the score of Y-BOCS score significantly decreased during the two-year follow-up period. Additionally, we found a significant increase in neuropsychological test scores on the Wechsler Intelligence Test (MAWI), California Sorting Test Part A (CST-A), Stroop Test Interference Score (STR-I), Verbal Fluency Test and Iowa Gambling Test. As a negative result, we observed intrusion errors in the Category Fluency Test. In the non-operated group significant improvement was found in Y-BOCS scores. At follow-up, we found significant differences between the operated and non-operated groups on three neuropsychological tests: Trail Making Test Part B, Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Attention Index and RBANS Language Index, with better performance in the non-operated group.

CONCLUSIONS

Both treatment methods (i.e. anterior capsulotomy and pharmaco- and psychotherapy) seem effective in reducing OCD symptoms and cognitive deficits, but, importantly, to different degrees. The clinical and neuropsychological improvements were more impressive in the operated group.

Radiofrequency ablation of an intercalyceal neoplasm in a transplanted kidney using percutaneous nephrostomy for cooling — Safety and early result

Kidney neoplasms can occur after kidney transplantation in low percentage. In this report we delineate a rare case of neoplasm in the transplanted kidney detected on screening ultrasonographic examination. Due to the intercalyceal location of the tumor percutaneous radiofrequency ablation was planned with continuous cooling the collecting system avoiding the thermal damage. To the best of our knowledge this method has never been reported applying in transplanted kidney. The two-month CT follow-up verified no residual tumor and the kidney function remained in normal range during this period. These facts imply that the method can be safely applied.

Downstaging of hepatocellular carcinoma with radiofrequency ablation on the Hungarian liver transplantation waiting list — Early results and learned lessons

Hepatocellular carcinoma, which has developed in liver cirrhosis is a disease where liver transplantation can provide a cure both for the tumour and the underlying liver damage. However, patients can only be transplanted when the tumour number and size do not exceed the Milan criteria. Tumour ablation methods — such as radiofrequency ablation — can provide a chance to make the patient eligible for transplantation. Among the 416 Hungarian liver transplanted patients there are 6 who had received different types of ablative therapy as bridging therapy in different institutions. On the basis of analysis of the patients' data we created a guideline for the treatment of cirrhotic patients with hepatocellular carcinoma with the aim of developing a uniform Hungarian approach.

Ultrasound-guided, intraglandular injection of botulinum toxin A in children suffering from excessive salivation

Background: The aim of this study was to describe the authors' minimally invasive procedure developed to significantly decrease excessive salivation in children suffering from chronic neurological diseases, using botulinum toxin A.

Objective: Ultrasound-guided, intraglandular injection of botulinum toxin blocks the parasympathetic innervation of salivary glands, resulting in a temporary decrease in saliva production and improved quality of life, lasting about three to four months.

Materials and methods: Prior to introducing the method into clinical practice, animal experiments were conducted in order to verify the lack of histological changes three months following botulinum toxin administration. Twenty-one children were included in the clinical study, with ages ranging from two and a half to 14 years.

Results: The animal studies did not reveal any histological changes three months after botulinum toxin administration. Although botulinum toxin A proved to be ineffective in a single case, the majority of the other 20 patients responded well, with a highly significant reduction of their symptoms. The parents of 18 responder children requested repeated treatment with botulinum toxin A. However, two families refused to be further involved in the study, despite good results. The protein content of saliva, regulated by sympathetic innervation, was not affected by the treatment.

Conclusion: This minimally invasive method, applied repeatedly three to four times a year, may be a viable alternative to surgical procedures such as submandibular duct relocation, duct ligature or nervus tympanicus neurectomy.

[Evaluation of diagnostic yield and clinical impact of capsule endoscopy in patients with obscure gastrointestinal bleeding]

BACKGROUND AND AIMS

The major indication of small bowel capsule endoscopy is the diagnostics of obscure gastrointestinal bleeding. The present retrospective study was aimed to analyze the diagnostic yield, positive and negative predictive values and clinical impact of capsule endoscopy in patients with obscure gastrointestinal bleeding.

PATIENTS AND METHODS

During a 36 month period at two workplaces 66 capsule endoscopy studies were performed in 62 patients with gastrointestinal bleeding who had undergone non-diagnostic upper endoscopy and colonoscopy. Capsule video recordings were evaluated by two investigators at both workplaces. Capsule endoscopy findings were divided into 3 groups according to the bleeding source: definitive bleeding source (48 patients), uncertain bleeding potential (5 patients), and negative finding (8 patient). Patients after capsule endoscopy were followed-up until a mean of 20 (1-41) months.

RESULTS

A definitive small bowel bleeding source was detected in 78.7% of the cases studied by capsule endoscopy. Definitive bleeding sources included angiodysplasia (28 cases), small bowel Crohn's disease (5 cases), small bowel tumor (5 cases), small bowel stenosis (2 cases), NSAID therapy related ulcer (1 case), non-specific inflammation (1 case) and helminthiasis (1 case) respectively. The positive and negative predictive values of capsule endoscopy studies were 95.8% and 84.6% respectively. In cases with definitive bleeding sources 72% of patients received therapy in accordance with capsule endoscopy findings (surgery in 18 patients, medical treatment modification in 16 patients, chemoembolisation in 1 patient). During the follow-up period 17.7% of the patients had rebleeding.

CONCLUSIONS

Capsule endoscopy is a useful and effective diagnostic method in cases with obscure gastrointestinal bleeding. Effective therapy may be introduced in accordance with the majority of positive capsule endoscopy results.

Topographical organisation of projections from the nucleus isthmi magnocellularis to the optic tectum of the chick brain

The anatomical connection of the magnocellular isthmic nucleus with the optic tectum was investigated with the axonal tracer biotinylated dextran amine. Following iontophoretic injection of this tracer into different areas of the chick optic tectum, neurones of both magno- and parvocellular isthmic nuclei were labelled together in a topographical arrangement. The number of labelled neurones in the parvocellular nucleus was generally higher than in magnocellular. Using different locations of the tracer injections, systematic shifts in the location of the labelled neurones were detected. The labelled axons were seen to course along the shortest possible distance between the injection site and the cells of origin, i.e., the ventral part of the tectum received projections from neurones located ventrally in the isthmic nuclei, the dorsal tectum from neurones in the dorsal part, and the lateral extension of the tectum from neurones lying midway along the nuclei. This parallel and topographic projection of the two nuclei was primarily observed in sagittal sections. After tracer injections into the magnocellular nucleus, the terminal arbours were seen to extend from the deep layers (11-12) to layer 2 of the tectum. The projections observed appeared to be topographically organised, and furthermore appeared to be parallel with and complimentary to previously described projections of the parvocellular isthmic nucleus.

Anterograde tracer study on the nucleus geniculatus dorsalis and its internal synaptic structure in chick brain

In the present study the terminals of retinal fibres and those of internal layer cells in ventral geniculate nucleus of chicks were labelled with the anterograde tracer biotinylated dextran amine. The tracer showed the connections from the internal cell layers of ventral geniculate nucleus to the medial part of the dorsal lateral geniculate nucleus. The labelled retinal terminals were located exactly in the lateral part of nucleus. The labelled terminals in the two parts of the nucleus were analysed with the electron microscope and showed a different synaptic organisation in the two parts of the dorsal lateral geniculate nucleus. In the lateral part, two kinds of synaptic glomeruli were found mostly in the vicinity of large dendrites, which are proximal dendrites of projection neurons. One type is a simple glomerulus containing a large dendrite, a large optic terminal and a large and/or series of asymmetrical synapses surrounded by glial processes. The other type is a complex synaptic unit with several pre- and postsynaptic components, among them synapses of GABA-positive axon terminals and/or dendraxons. No glomeruli were found in the medial part of the nucleus. In the medial part of the lateral geniculate nucleus, the terminals of internal layer cell axons established asymmetrical synapses with dendrites. Often, a large terminals and large dendritic profiles established serial asymmetrical synapses. GABA-positive myelinated fibres entered and ramified in both parts of the dorsal lateral geniculate nucleus, and GABA-positive terminals were seen to form synapses on the same dendrite near to the asymmetrical contacts. To our knowledge, this is the first report of the connection from ventral geniculate internal layer cells to the dorsal lateral geniculate nucleus in the chick.

The axon arbourisation of nuclei isthmi neurons in the optic tectum of the chick and pigeon. A Golgi and anterograde tracer-study

The optic tectum is reciprocally connected to the nuclei isthmi pars magnocellularis (Imc) and pars parvocellularis (Ipc), which have different modulatory effects on optic transmission. We studied the axon arbourisation of these isthmic nuclei in the optic tectum in order to differentiate between them using Golgi-impregnated preparations both in chickens and pigeons. In addition, sections from animals injected with the anterograde tracer biotinylated dextran-amine (BDA) into the Imc were examined in the bright-field and electron microscope to identify the axon arbourisations and terminals. Also, GABA immunogold stained sections were examined in the electron microscope. In Golgi preparations, slab-like (or poplar tree-like) axon terminal arbourisations of both magnocellular and parvocellular isthmic nuclei neurons were found extending to the tectal surface, with similar branching patterns, but different lengths. The axon arbourisations extending from layer 5 of the optic tectum to the surface were termed type 1, whereas those extending from the internal (12-11) layers to the tectal surface were termed type 2. Type 2 arbourisations very closely matched arbourisations observed in BDA injected material, indicating that Imc neurons gave rise to type 2 arbourisations. The two kinds of axon arbourisation in the external tectal layers were alike in both types of bird, except for the width, which was about 10 mum larger in the type 2 axon arbour. Controlling for size, there was no significant difference between chicks and pigeons. The significance of these afferents in the optic tectum is discussed.

Early effects of transplatin on oncogene activation in vivo

The aim of the study was to investigate the early effect of Transplatin (the stereo-isomer of Cisplatin) on oncogenes in inbred CBA/Ca mice. Cisplatin is commonly used for the treatment of squamous cell carcinomas of the head and neck. Cisplatin has a strong oncogene activation effect compared to the structural analogue Transplatin. Body weight equivalent amounts of a human dose of Transplatin were administered intra-peritoneally to 6- to 8-week-old, inbred, female CBA/Ca mice. Twenty-four, 48 and 72 hours after the treatment, RNA was isolated from the target organs and the expressions of c-myc, Ha-ras and p53 genes were examined. Investigation of early changes showed no significant overexpression compared to Cisplatin, which had a significant effect on oncogene expression in the "short-term" in vivo test system.

The Internal Structure of the Nucleus geniculatus lateralis ventralis in the Avian Brain: A Golgi Study and Electron Microscopic Investigation

Different types of neurons in the ventral geniculate nucleus of the thalamus of chicks were visualised by Golgi impregnation. The dendritic tree of projection neurons branched in a sphere-like territory in both the ventral and middle areas of the lamina externa. The dendrites of projection neurons in the lamina interna descended into the lamina externa and entered both the ventral and middle dendritic areas. One or two dendrites of the lamina interna neurons also emitted branches that developed a dorsal sphere-like dendritic territory. Optic terminals labelled by Golgi impregnation or injection of biotinylated dextran amine were found in these dendritic territories gathered into groups. They established synapses in these areas (synaptic islands or fields without a glial sheath) with different dendritic profiles, and a few gamma-aminobutyric acid (GABA)-positive terminals synapsed with them. No glomerulus-like synaptic complexes ensheathed by glial processes were found. Optic terminals also contacted the stem dendrites of projection neurons and GABA-positive neuron cell bodies and dendrites. Numerous synapses established by both optic and GABA-positive terminals were found on the proximal dendritic stems of the lamina interna projection neurons.

[Treatment of pancreaticopleural fistulas]

Pancreaticopleural fistulas are rare but serious complications of chronic or recurrent inflammatory pancreatic disease. Massive unilateral or bilateral pleural effusion may occur in association with rupture of pancreatic duct or pseudocyst into the pleural cavity. In the past decade we have treated 10 patients with pancreaticopleural fistulas. Eight of them had a previous history of inflammatory pancreatic disease. Diagnosis was made by finding a markedly elevated amylase level (10 pts) in the pleural fluid. US and CT examination enabled the establishment of the diagnosis of pancreatic origin, showing chronic pancreatic (9 pts) and pancreatic pseudocyst (6 pts). Pancreaticopleural fistula was successfully demonstrated by ERCP in four patients. Initial treatment was non-operative using total parenteral or jejunal nutrition and multiple thoracocentesis or thoracic drainage. Anti-secretory octreotide therapy was used in all patients. This conservative treatment was successful in three patients (3/10). Septic complication (1 pt) and unsuccessful medical therapy (6 pts) recommended surgical intervention. Decompression procedure (4 pts) and resection (3 pts) were performed. Surgery was successful in all seven patients. We lost no patients and none of them required subsequent surgical treatment.

The ramifications and terminals of optic fibres in layers 2 and 3 of the avian optic tectum: a golgi and light and electron microscopic anterograde tracer study

The ramification patterns and terminals of optic fibres in layers 2 and 3 of the optic tectum were studied in Golgi-stained and immunolabelled preparations made from the brains of chicks and pigeons. The different neuronal structures of layers 2 and 3 were also examined. In Golgi preparations, two types of optic fibre were found both in chick and pigeon tectum according to their thickness and terminal branching patterns. The same types of optic fibres were also found to be present in the anterograde tracer experiments after iontophoresis of biotinylated dextran amine into the optic nerve. The varicose terminals of thin fibres mostly terminated on terminal dendritic sections of radiate and pyramidal-like neurons, contacting them on their apical dendrites. The medium-thick fibre terminals in layer 2 mainly established synapses with horizontally extending dendrites, which may therefore be contacts with inhibitory local circuit neurons. The medium-thick optic fibre bushy-like arborisation in layer 3 established synapses with larger dendrites and also stem dendrites. Their terminals formed groups with different dendritic profiles, some of which were partly covered by glial processes, and/or were located among converging dendrites. The presence of these glomerular-like synapses in layer 3 proves that the optic terminals in layer 3 also take part in the transmission of optic impulses to the nucleus rotundus.

[Capsule endoscopy in small bowel diagnostics]

INTRODUCTION

Capsule endoscopy allows for the first time total and painless imaging of the entire small bowel. The main indication for capsule endoscopy is obscure gastrointestinal bleeding which not explained by upper gastrointestinal endoscopy, colonoscopy and small bowel radiology. Capsule endoscopy has also the capacity to detect tiny small bowel manifestations of other pathologic conditions such as Crohns's disease.

METHOD AND AIMS

The GivenM2A wireless capsule endoscopy system for investigation of the whole small bowel was developed in the late 1990s. The small size swallowable capsule contains a miniature video camera, four light sources, two batteries and a radiotransmitter. This paper describes the capsule endoscopy examination method and summerizes the initial achievements from two medical centres, the Petz Aladár County and Teaching Hospital and from the Malmö University Hospital.

RESULTS

42 patients were included of whom 37 patients with obscure gastrointestinal bleeding. Pathological small bowel findings were detected in 62% of the all cases, and the source of bleeding was identified by the M2A capsule in 56.7% of the chronic bleeders. The diagnostic sensitivity of the capsule endoscopy in obscure gastrointestinal bleedings was superior both to that of push enteroscopy, 19%, and enterography, 6.7%. The capsule endoscopy was well tolerated and accepted by the patients.

CONCLUSIONS

This new diagnostic method is promising mainly for detection of a small bowel source of obscure bleedings. The availability of the method in major gastroenterological centers is strongly recommended.

Early effects of different cytostatic protocols for head and neck cancer on oncogene activation in animal experiments

In vivo investigations on oncogenes and onco-suppressor genes may provide new findings on the potential carcinogenic effects of various cytostatic protocols inducing secondary tumours of the head and neck. Further surgeries are often necessary due to regional recurrence after the Cisplatin-supplemented BVM (Bleomycin, Vincristine, Methotrexate) protocol in the treatment of human head and neck tumours. Our earlier studies have illustrated the carcinogenic and mutagenic potential of Cisplatin. The effect of Cisplatin on the alteration of different onco- and suppressor genes has also been proven. Our present study aimed at investigating the early effects of the BVM and the CFu (Cisplatin, 5-Fluorouracil) protocols on early oncogene and tumour suppressor gene expressions in mice. Body weight equivalent amounts of cytostatics were administered intraperitoneally to 6- to 8-week-old, inbred, female CBA/Ca mice. Twenty-four, 48 and 72 hours after the treatment, RNA was isolated from the target organs and the quantitative expression of c-myc, Ha-ras and p53 genes were examined. The protocols caused detectable changes. A "short-term" in vivo test, the 24-hour examination of gene expression, is suitable for detecting early effects of carcinogen exposure. The alterations of gene expression, caused by the Cisplatin-containing protocol, draw attention to the probable role of Cisplatin in the development of regional recurrence and to the possibility of prevention.

Mutational spectrum of the CHAC gene in patients with chorea-acanthocytosis

Chorea-acanthocytosis (ChAc) is an autosomal recessive neurological disorder whose characteristic features include hyperkinetic movements and abnormal red blood cell morphology. Mutations in the CHAC gene on 9q21 were recently found to cause chorea-acanthocytosis. CHAC encodes a large, novel protein with a yeast homologue implicated in protein sorting. In this study, all 73 exons plus flanking intronic sequence in CHAC were screened for mutations by denaturing high-performance liquid chromatography in 43 probands with ChAc. We identified 57 different mutations, 54 of which have not previously been reported, in 39 probands. The novel mutations comprise 15 nonsense, 22 insertion/deletion, 15 splice-site and two missense mutations and are distributed throughout the CHAC gene. Three mutations were found in multiple families within this or our previous study. The preponderance of mutations that are predicted to cause absence of gene product is consistent with the recessive inheritance of this disease. The high proportion of splice-site mutations found is probably a reflection of the large number of exons that comprise the CHAC gene. The CHAC protein product, chorein, appears to have a certain tolerance to amino-acid substitutions since only two out of nine substitutions described here appear to be pathogenic.

The intrinsic neuronal organisation of the nucleus of the basal optic root in the domestic chicken; a light and electron microscopic study using anterograde tracers and postembedding GABA-immunostaining

The intrinsic neuronal organisation in the nucleus of the basal optic root of chickens was investigated. The divergent connections with various areas and the functional complexity of the nucleus require a complex intrinsic structural arrangement. Therefore, an analysis of Golgi impregnated material, ultrastructure, GABA-immunocytochemistry and biotinylated dextran-amine anterograde tracer analysis of the nucleus was carried out. In the Golgi analysis, a characteristic dendritic ramification pattern of two types of putative projection neurons was observed. These neurons form dendritic nests with their overlapping dendritic terminal sections, that develop synaptic fields with the optic fibre terminals. These synaptic fields were confirmed by electron microscopy. GABA-immunopositive terminals synapse with distinct loci of the dendritic trees of projection neurons; they may therefore play an important role in the inhibitory-modulatory system of the nucleus of the basal optic root. The GABA-immunopositive terminals derive from small and/or elongated local circuit neurons which receive retinal afferents, and from myelinated fibres afferents to the nucleus of unknown origin.

Ultrastructural changes of the neuromuscular junction in reperfusion injury

Ischemia followed by reperfusion of skeletal muscle frequently takes place in trauma surgery. Anoxia followed by reoxygenation leads to reperfusion injury, which damages the involved tissues. However, no information is available about how the neuromuscular junction is affected by ischemia-reperfusion. Tourniquet ischemia of the left hind limb was applied in the anesthetized rat for 2 h. Reperfusion lasted for 2 and 24 h and for 1, 2 and 4 weeks. The extensor digitorum longus and the soleus muscles from both legs were prepared for electron-microscopic analyses. Morphological changes of the neuromuscular junction were investigated. In all cases only the nerve endings (terminals) were affected. The postsynaptic structures were not affected. Changes can be grouped in two categories: degeneration and recovery. Degeneration consisted of the loss of synaptic vesicles, disruption of the presynaptic membrane, degeneration of the mitochondria and the development of vacuoles. It was most severe at 24 h and was still present at 4 weeks of reperfusion. Recovery started at 1 week of reperfusion and lasted at least for 4 weeks. It consisted of the slow reappearance of synaptic vesicles and mitochondria, and restoration of the presynaptic membrane with active zones. Ultrastructure of the skeletal muscle fibers did not show pathological changes. The recovery of the structures may be regulated by the Schwann cells and also by the postsynaptic membrane which is not affected by 2 h of ischemia followed by reperfusion.

The ramification and connections of retinal fibres in layer 7 of the domestic chick optic tectum: a golgi impregnation, anterograde tracer and GABA-immunogold study

Layer 7 is one of the retinorecipient layers of the avian optic tectum. However, little information is available about the neuronal organization of this layer and its implications for visual function. Golgi impregnation was used to investigate the retinal input to and the neuronal architecture of layer 7 of the chick optic tectum, which forms a narrow band between the two cell-dense layers 6 and 8. Anterograde tracers were also used to investigate the afferent and efferent connections of layer 7, in both the light and the electron microscope, together with GABA immunogold labelling. Three types of radial neuron were defined according to the origin and course of their axons. The perikarya of these neurons were situated in tectal layers 10-11. The principal dendrites of these radial neurons ascended to the tectal surface and gave rise to dendritic side-branches in layer 7. These dendritic side-branches received asymmetric synapses from the terminations of retinal fibre arborisations. Type 2 radial neurons, whose axons arose from the deep pole of the perikaryon or occasionally from a basal dendrite, were shown to project to the nucleus isthmi pars magnocellularis, which has previously been demonstrated to be GABAergic and to project to glomerulus-like complexes in tectal layers 4-5. In these layers, the dendritic branches of layer 13 neurons that project to the nucleus rotundus have previously been shown to receive retinal fibre input. Therefore, the retinal input to layer 7 may be able to modulate the transmission of information to the visual thalamus, by way of a feed-back loop to layers 4-5 of the tectum involving the nucleus isthmi pars magnocellularis.

Oral health in liver transplant children administered cyclosporin A or tacrolimus

BACKGROUND

Immunosuppression by cyclosporin A (CsA) is associated with adverse side-effects, including nephrotoxicity, neurotoxicity and gingival overgrowth. Tacrolimus (TAC/FK506) is a new immunosuppressive agent, recently approved for use in solid-organ transplants. The mode of action of TAC is similar to that of CsA and the toxicity profile of CsA is duplicated by TAC. The effect of TAC on the gingival tissue is not yet conclusive.

SAMPLE

Gingival overgrowth was assessed in 30 liver transplant children, 20 boys and 10 girls, aged 2-19 years. Seventeen children (10 boys, seven girls) were on a CsA-based immunosuppressive regimen whereas 13 children (10 boys, three girls) were on TAC for at least 1 year (mean 4.3 +/- 2.7).

RESULTS

In the CsA group, 35% of children exhibited gingival overgrowth characterized by one or more units with increased sulcus probing depth (> or = 4 mm), i.e. pseudopockets. In contrast to the CsA group, none of the children in the TAC group exhibited gingival overgrowth. The occurrence of enamel hypoplasia was observed in 11 children (36%) and enamel opacities were found in 23 children (76%). Six of the 12 children (50%) with hyperbilirubinaemia biliary atresia exhibited a marked greenish discoloration of the teeth. Caries experience (dmft/DMFT) among these children was 2.0 +/- 2.8.

CONCLUSION

No difference in caries experience or enamel defect was observed between the CsA and TAC group.

A Better Enzyme to Cope with Cold

3-isopropylmalate dehydrogenase (IPMDH) from the psychrotrophic bacterium Vibrio sp. I5 has been expressed in Escherichia coli and purified. This cold-adapted enzyme is highly homologous with IPMDHs from other organisms, including mesophilic E. coli and thermophilic Thermus thermophilus bacteria. Its molecular properties are similar to these counterparts. Whereas the E. coli and T. thermophilus enzymes are hardly active at room temperature, the Vibrio IPMDH has reasonable activity below room temperature. The thermal stabilities, conformational flexibilities (hydrogen-deuterium exchange), and kinetic parameters of these enzymes were compared. The temperature dependence of the catalytic parameters of the three enzymes show similar but shifted profiles. The Vibrio IPMDH is a much better enzyme at 25 degrees C than its counterparts. With decreasing temperature i.e. with decreasing conformational flexibility, the specific activity reduces, as well; however, in the case of the Vibrio enzyme, the residual activity is still high enough for normal physiological operation of the organism. The cold-adaptation strategy in this case is achieved by creation of an extremely efficient enzyme, which has reduced but still sufficient activity at low temperature.

Frequency of the R3500Q mutation of the apolipoprotein B-100 gene in a sample screened clinically for familial hypercholesterolemia in Hungary

Familial hypercholesterolemia (FH) and familial defective apolipoprotein B-100 (FDB) cause early onset of coronary heart diseases (CHD). According to the recommendations of the international MEDPED program, we tried to find FH cases. We analyzed 73 FH probands and their 304 first-degree relatives. A total of 39 probands were found from the 21000 subjects screened (1:538) from family doctors' registers recording all citizens, while the remaining 34 were derived from screened patients from lipid clinics. In our FH probands, four cases of FDB (R3500Q mutation) were diagnosed with allele-specific PCR, and the mutation was also detectable in five cases out of seven living family members. In the remaining 69 FH families, 156 people were diagnosed clinically with FH, and 31.8% of the males (against 13% of the not clinically diagnosed FH males, P<0.01), and 32.4% of the females (against 13.5% of the not clinically diagnosed FH females, P<0.01) suffered from early onset CHD. The plasma total cholesterol level of the FDB patients, especially in the younger patients, was very close to normal values. Therefore, the FDB patients seem to be under-represented in this type of survey. Because FDB is one of the independent causes of early onset CHD, the R3500Q mutation should be considered in families with a high frequency of cardiovascular diseases.

Surgical closures of oropharyngocutaneous fistulas

Of the 146 patients undergoing surgery for oropharyngeal cancer in our institution, 12 (8.2 percent) developed fistulas. As a first line of therapy, conservative measures were used, which consisted of debridement, Xeroform gauze packing, and nasogastric feeding. Seven fistulas closed after conservative treatment. Of the five patients who required surgery for fistula closure, three had large (more than 20 mm) and two had mid-size (5- to 20-mm) fistulas. In all cases, internal flaps were prepared from the healthy viable tissues surrounding the fistula, and sternocleidomastoid-trapezius-platysma myocutaneous flaps were used for external closure. None of the closures failed, and we obtained good functional and aesthetic results.

Mechanism of volatile compound production during storage of sunflower Oil

Volatile compounds formed in the course of the thermal decomposition of hydroperoxides during storage of sunflower oil were analyzed by headspace solid-phase microextraction sampling followed by gas chromatographic separation and mass spectral detection. The determining role of alkoxyl radicals in the process has been proven by electron spin resonance spectroscopic measurements. On the basis of analytical results, the reaction networks and mechanisms were constructed by computer modeling to describe the formation of volatile products of radical decomposition of hydroperoxides. We established that off-flavor aliphatic aldehydes are originated from only the alkoxyl radicals derived from trigliceride of linoleic acid. To find a specific additive, which redirects the formation of these radicals toward production of more stable species, is suggested.

[Randomized study of cisplatin-based combination chemotherapy for the treatment of planocellular cancer of the head and neck region]

Between January 1996 and November 1998 38 patients were treated with induction chemotherapy. Patients were distributed in two randomized groups, 19-19 patients in each, receiving (group N) either bleomycin, vincristine and methotrexate (BVM) or the previous medication plus cisplatin (BVCM) chemotherapy (group C). Side effects were low and reversible during the treatments. The clinical regression rate (RR) of the cases was 87% including complete regression 24%. There was no difference between the two groups. There was no difference in the pathological macroscopic regression, however group C was better in microscopic regression. During the 27.5 months of average follow-up time, group N had a significantly better result in the tumor-free survival, with a lower rate of metastatic recidives (N/C = 2/9). There was no significant difference in the overall survival rate, due to the radical neck dissections of recidive metastases. According to our experience we recommend the use of cisplatin in conjunction with neck radiotherapy.

[Double flap reconstruction of extended facial defects]

The authors report the reconstruction of large facial defects remaining after resection of two advanced facial cancer cases. In both cases double flap closures were carried out. In the first case the internal flap was created from the remaining part of the oral mucosa membrane, while in the second a forearm fascio-cutan free flap was used. For external closure in both cases platysma based transpositional flaps were used, prepared from the neck. On the basis of excellent aesthetic results and safe applicability the authors recommend the more frequent use of this method.

Diagnostic test meal in childhood enteropathy using simultaneous carbohydrate and fat loading

The diagnostic value of a combined test meal consisting of glucose, D-xylose and dairy cream was studied in 230 infants and children with gastrointestinal symptoms. The simultaneous absorption of the three compounds was rated according to their serum concentrations at different times 0-240 min after intake and compared to the histological changes of jejunal biopsy specimens.

CONCLUSION

The results showed that the simultaneous loading test had higher specificity and sensitivity than D-xylose alone in patients with subtotal villous atrophy.

Fatal deterioration of neurological disease after orthotopic liver transplantation for valproic acid-induced liver damage

We describe a 12-year-old girl with an early onset neurologic disease of slow progressiveness and electro-encephalography showing epileptic activity. The girl developed fulminant liver failure 5 months after the start of valproic acid treatment. Repeated mitochondrial assays failed to prove a mitochondrial disorder, but muscle biopsies were slightly pathological. Liver histology indicated acute-on-chronic liver disease. Six weeks after a successful orthotopic liver transplantation her neurological condition deteriorated rapidly, soon leading to generalized cortical disease and death. Post-mortem brain examination showed advanced central nervous destruction. We suggest that this is a late-onset Huttenlocher variant of Alpers' syndrome, where fulminant liver failure can be triggered by valproic acid, and orthotopic liver transplantation can subsequently trigger a fatal neurologic deterioration. Our case illustrates that when a referral center receives a previously unknown patient with hepatocellular insufficiency, it might be impossible to differentiate between fulminant vs. acute-on-chronic liver failure, and the decision whether to perform a liver transplantation or not would become difficult.

Adaptive systems in speckle-pattern interferometry

The concept of adaptivity in television holography is discussed, and various realizations of adaptivity are presented. In one possible variation, functions of the components of the optical arrangement may be changed to adapt them to measurement conditions. An additional peculiarity of the technique is that reference waves are produced by holographically reconstructed virtual images. A method, believed to be new, is introduced for synthesizing the phase front of the master object beam that is produced by a simple holographic optical element and is used as a smooth or a speckled reference beam in the electronic speckle-pattern interferometer. An adaptive interferometer is presented as a measuring device for various measuring tasks. Selected applications are shown, demonstrating different aspects of adaptivity.