Trigeminal neuralgia in systemic sclerosis

OBJECTIVES

Although trigeminal neuralgia (TN) has been associated with systemic sclerosis (SSc), there is a paucity of evidence and pathophysiological processes remain unknown. We undertook a nested case-control study to identify associations between TN and SSc in a large multi-centered cohort and identify possible pathophysiological links.

METHODS

Data were derived from a longitudinal cohort of 1652 SSc subjects. Cases with a physician-reported diagnosis of TN were identified at baseline visit (prevalent) and during follow-up (incident). Each case was matched on study visit to four SSc patients without TN. Sociodemographic, clinical and serological characteristics of cases and controls were compared.

RESULTS

At enrolment, 43/1652 (2.6%) subjects had a history of TN. During follow-up, an additional 36 subjects developed TN over 6193 person-years of observation (incidence rate 5.8 per 1000 person-years). Cases were identified and matched to 172 and 144 controls, respectively. Compared to controls, prevalent cases had more inflammatory myositis (24.4% versus 5.2%, p<0.001) and inflammatory arthritis (46.5% versus 30.2%, p = 0.043). Incident cases also had more inflammatory myositis (19.4% versus. 6.3%, p = 0.033) and inflammatory arthritis (50.0% versus. 16.2%, p<0.001) compared to controls. There was a trend towards more interstitial lung disease in prevalent (32.6% versus 23.8%, p = 0.241) and incident (55.6% versus 40.6%, p = 0.105) cases compared to controls.

CONCLUSION

This study provides novel evidence for a clinical association linking TN, inflammatory myositis, inflammatory arthritis and possibly interstitial lung disease. In addition to ischemia, we propose that TN in SSc could also be a consequence of inflammatory and possibly fibrotic processes.

[Coronary flow velocity reserve and collateral resistance after recanalization of chronic total coronary occlusions and periprocedural CK and cTNI elevation]

After recanalization and stenting of chronic total coronary occlusions (TCO), a reduced coronary flow velocity reserve (CFVR) and rise in collateral resistance (R(Coll)) is frequently observed. Coronary microembolization may account for these observations. In 86 patients (age 64+/-10 years; 77 men, 9 women) with TCO (duration >4 weeks), PTCA was performed with successful stent implantation in all lesions. Before PTCA, viable myocardium was detected by stress echocardiography or nuclear imaging techniques. By simultaneously measuring coronary Doppler flow velocity and pressure before and after PTCA, CFVR and R(Coll) were calculated. Over a period of 24 hours after intervention, creatine kinase (CK; upper limit of normal [ULN] for women 1.17 micromol/L/s, for men 1.33 micromol/L/s) and cardiac troponin I (cTNI; threshold 0.1 ng/mL) were studied. CFVR was <2 in 48% of all patients. A rise in R(Coll) was observed in 83% of all patients. The incidence of CK and/or cTNI elevation was only observed in 10% of all patients. These patients with CK and/or cTNI elevation did not show a significant difference of CFVR and rise in R(Coll) as compared with patients without CK and cTNI elevation. CFVR or rise in R(Coll) did not correlate with CK elevation. Coronary microembolization is not a likely cause of reduced CFVR and increased R(Coll) after PTCA of TCO. Other factors such as microvascular dysfunction and autoregulatory changes in collateral function may account for these observations.

Successful treatment of widely disseminated acanthamoebiasis

Disseminated Acanthamoeba infections are almost invariably fatal, with no universally accepted standard for treatment. Reports of acanthamoebiasis in non-human-immunodeficiency-virus infected hosts are rare. We successfully treated a lung transplant patient who had disseminated acanthamoebiasis using a combination of pentamidine, 5-fluorocytosine, itraconazole, and topical chlorhexidine gluconate/ketoconazole cream.

In-situ end labelling with bromodeoxyuridine--an advanced technique for the visualization of apoptotic cells in histological specimens

The fragmentation of nuclear DNA is considered to be a biochemical indication of programmed cell death (PCD) in various tissues. Several light microscopical approaches have been employed for the visualization of such fragmentation and have used either in-situ nick end labelling (ISEL) or in-situ nick translation (ISNT) with labelled dUTP. In the current paper, we can report a new method in which 0.5 micron Epon sections of mouse jejunum were incubated with terminal deoxynucleotidyl transferase (TdT) and 5-bromo-2-deoxyuridine (BrdU) for the in-situ tailing of fragmented DNA. Anti BrdU and the peroxidase anti peroxidase method (PAP) were used for staining the reaction product. Semithin sections of jejunum revealed high resolution images of labelled nuclei in the intestinal mucosa. An examination with confocal laser scanning microscopy indicated the differential distribution of immunoprecipitates in cellular nuclei, perhaps representing those distinct levels of DNA cleavage that may characterise the discrete stages of apoptosis. This new method is likely to offer new possibilities for the high resolution imaging of PCD, including the assessment of time courses and apoptosis statuses in histochemically characterized cells.