Addenbrooke's Cognitive Examination validation in Parkinson's disease

BACKGROUND

There is a clear need for brief, sensitive and specific cognitive screening instruments in Parkinson's disease (PD).

OBJECTIVES

To study Addenbrooke's Cognitive Examination (ACE) validity for cognitive assessment of PD patient's using the Mattis Dementia Rating Scale (MDRS) as reference method. A specific scale for cognitive evaluation in PD, in this instance the Scales for Outcomes of Parkinson's disease-Cognition (SCOPA-COG), as well as a general use scale the Mini-mental state examination (MMSE) were also studied for further correlation.

METHODS

Forty-four PD patients were studied, of these 27 were males (61%), with a mean (SD) age of 69.5 (11.8) years, mean (SD) disease duration of 7.6 (6.4) years (range 1-25), mean (SD) total Unified Parkinson's Disease Rating Scale (UPDRS) score 37 (24) points, UPDRS III 16.5 (11.3) points. MDRS, ACE and SCOPA-COG scales were administered in random order. All patients remained in on-state during the study.

RESULTS

Addenbrooke's Cognitive Examination correlated with SCOPA-COG (r = 0.93, P < 0.0001), and MDRS (r = 0.91 P < 0.0001) and also with MMSE (r = 0.84, P < 0.001). Area under the receiver-operating curve, taking MDRS as the reference test, was 0.97 [95% confidence interval (CI): 0.92-1.00] for ACE, 0.92 (95% CI: 0.83-1.00) for SCOPA-COG and 0.91 (95% CI: 0.83-1.00) for MMSE. Best cut-off value for ACE was 83 points [Sensitivity (Se) = 92%; Specificity (Sp) = 91%; Kappa concordance (K) = 0.79], 20 points for the SCOPA-COG (Se = 92%; Sp = 87%; K = 0.74) and 26 points for MMSE (Se = 61%; Sp = 100%; K = 0.69).

CONCLUSION

Addenbrooke's Cognitive Examination appears to be a valid tool for dementia evaluation in PD, with a cut-off point which should probably be set at 83 points, displaying good correlation with both the scale specifically designed for cognitive deficits in PD namely SCOPA-COG, as well as with less specific tests such as MMSE.

Hyperhemolytic transfusion reaction attributable to anti-Fy3 in a patient with sickle cell disease

A case of hyperhemolytic transfusion reaction attributable to anti-Fy3 in a 30-year-oldAfricanAmerican woman with a history of sickle cell disease is reported. The patient was admitted for vaso-occlusive sickle cell crisis and received 4 units of packed RBCs secondary to worsening symptomatic anemia (Hb 5.0 g/dL). On admission, the patient's antibody screen and identification showed anti-V and anti-E, and her antibody history included anti-E,-C,-Jk(b),-N, -V,-S,-Sl(a), and a cold agglutinin with possible anti-I specificity. A DAT performed on her RBCs was negative. RBC units that lacked E, C, Jk(b), N,V, and S were transfused. Posttransfusion Hb was 8.9 g/dL. On day 10 she developed a fever of 103 degrees F, and on day 11 her Hb decreased to 6.4 g/dL. She complained of severe back pain and dark urine. In addition, she became hypertensive, tachycardic, and jaundiced. The DAT indicated the presence of IgG on the patient's RBCs. Anti-Fy3 was identified in the serum and eluate. During the next 24 hours, her Hb decreased to 2.4 g/dL. The LDH level was 1687 U/L, and her reticulocyte count was 2.6%. A delayed hemolytic transfusion reaction with hyperhemolysis secondary to anti-Fy3 was suspected and was successfully treated with IVIG and high-dose prednisone. To the best of our knowledge, this is the first published case of hyperhemolysis in sickle cell disease attributable to anti-Fy3.

Light quanta modulated characteristics of Ni uptake by Brassica juncea seedlings: the interdependence of plant metal concentration and biomass

The relationships between the concentration of metal in the growth medium, Cs, the concentration of metal absorbed by the plant, Cp, and the total biomass achieved, M, all of which are factors relevant to the efficiency of metal uptake and tolerance by the plant, have been investigated via the physiological response of Brassica juncea seedlings to Ni stress. The factorial growth experiments treated the Ni concentration in agar medium and the diurnal light quanta as independently variable parameters. Observations included the evidence of light enhancement of Ni toxicity in the root, as well as at the whole-plant level. The shoot mass index possibly is an indicator of the amount of shoot metal sequestration in B. juncea, as are the logarithmic variation of Cp with Cs and the power-law dependence of M on Cp. The sum total of these observations indicates that, for the Ni accumulating plant B. juncea, the overall metabolic allocation to either growth or metal tolerance of the plant is important. Neither a rapid biomass increase nor a high metal absorbed concentration favored the removal of high metal mass from the medium. Rather, the plants with a moderate rate of biomass growth and a moderate absorbed metal concentration demonstrated the ability to remove the maximum mass of metal from the medium. The implication of these results as related to the extant model of phyoextraction efficiency is discussed.

Does Body Mass Index Affect Outcome After Reconstruction of Orthotopic Neobladder?

OBJECTIVES

To evaluate the impact of body mass index (BMI) on outcome after orthotopic neobladder (NB) reconstruction.

METHODS

We performed a retrospective analysis of patients who underwent radical cystectomy and NB from 1992 to 2004. The patients were categorized according to BMI into group 1, BMI less than 25 kg/m2; group 2, BMI 25 to 29.9 kg/m2; and group 3, BMI greater than 30 kg/m2. The relationships among the BMI categories, the predominant complications (eg, urinary tract infection [UTI]; pyelonephritis; ureteral, bladder neck, and urethral stricture), other complications, and continence were analyzed.

RESULTS

Of the 343 patients who underwent radical cystectomy, 116 had an NB. The patient characteristics among the BMI groups were similar. Group 1 had fewer complications compared with the other groups (P <0.012). The principal complications observed were UTI, stricture, and pyelonephritis. The incidence of UTI, pyelonephritis, and wound infection were less in group 1 than in the other groups, with statistically significant differences (P = 0.001, P = 0.04, and P = 0.04, respectively). At the last follow-up visit, only 10% of the patients required clean intermittent catheterization to empty the NB, and no statistically significant differences were found in the continence status and voiding pattern among the groups.

CONCLUSIONS

An increased incidence of UTI, pyelonephritis, and wound infection was found in patients with increased BMI. However, they were transient and not life threatening. The continence and voiding patterns were relatively similar. Hence, an NB can be offered to patients with an increased BMI, and they should be formally counseled.

Metastatic adenoid cystic carcinoma to the kidney in a young woman

The incidence of an adenoid cystic carcinoma on major salivary glands is low, constituting only about 10% to 15% of all parotid malignancies. Cases of delayed metastasis have been reported, but reports of specific renal involvement have not been extensively found. We present the case of a 21-year-old woman with a left renal metastasis from an adenoid cystic carcinoma of the parotid gland that had been surgically treated 7 years previously. The patient underwent successful left radical nephrectomy. During follow-up, the patient developed pulmonary nodules that were metastatic adenoid cystic carcinoma and were surgically excised. At last follow-up, the patient was doing well with no evidence of disease.

Orthotopic ileal neobladder reconstruction for bladder cancer: is adjuvant chemotherapy safe?

OBJECTIVE

We examined our database of patients undergoing radical cystectomy (RC) with orthotopic neobladder (NB) to determine whether adjuvant chemotherapy in this group is safe.

MATERIALS AND METHODS

We performed a retrospective analysis of patients who underwent radical cystectomy and urinary diversion between 1992 and 2004. Relevant clinical and therapeutic data were entered into a database. High-risk bladder cancer patients who underwent NB were identified. They were stratified into 2 groups, those who received adjuvant chemotherapy and those who did not. The incidence of complications between the 2 groups was analyzed and compared.

RESULTS

Over the 12-year period, 136 patients underwent RC and NB construction for bladder cancer. Of these, 83 patients were at high risk for recurrence. Nineteen patients received adjuvant chemotherapy and 64 did not. The complication rate in the adjuvant chemotherapy group was 53% and it was 23% in those who did not receive chemotherapy. There were no perioperative or treatment related death. There were 2 patients with grade 4 toxicity in the adjuvant chemotherapy group. There was a statistical difference between these two groups with regard to the incidence of complications. However, none of these complications was life-threatening, required only conservative treatment and caused no long-term disability.

CONCLUSIONS

Adjuvant chemotherapy is a safe treatment for patients undergoing RC and NB substitution. Hence, the option of orthotopic NB should not be denied in selected bladder cancer patients with high risk for recurrent disease.

Adrenocortical carcinoma with tumor thrombus in the right hepatic vein

Adrenocortical carcinoma is an unusual neoplasm with very poor prognosis. Patients present with an abdominal mass often exceeding 5 cm or as a functional tumor. Computed tomography is effective to demonstrate the neoplasm as an inhomogeneous adrenal lesion with irregular margins, and magnetic resonance imaging is helpful to visualize invasion into large vessels as well. Reported herein is a case of large adrenocortical carcinoma with tumor thrombus extending into the right hepatic vein.

Is adjuvant chemotherapy for bladder cancer safer in patients with an ileal conduit than a neobladder?

OBJECTIVE

To assess the safety of adjuvant chemotherapy in patients with neobladder reconstruction in comparison to ileal conduit, as radical cystectomy and urinary diversion is an effective curative surgical treatment for muscle-invasive and high-risk superficial bladder cancer, and adjuvant chemotherapy is usually considered for patients with clinical stage > T2 and nodal metastasis.

PATIENTS AND METHODS

We analysed retrospectively patients who had had a radical cystectomy and urinary diversion between 1992 and 2004. Patients with high-risk disease who had adjuvant chemotherapy were identified and stratified based on the type of urinary diversion (ileal conduit or neobladder). The chemotherapy regimen, complications from the adjuvant chemotherapy and other relevant data were analysed.

RESULTS

Overall, 343 patients had radical cystectomy, 40 had adjuvant chemotherapy; 25 had an ileal conduit and 15 had a neobladder. Patient characteristics including age, stage and follow-up were similar. In all, 55% of patients had grade 1 toxicity, 23% grade 2, 18% grade 3, and 13% grade 4. No patients had serious organ toxicity and none died. There were no significant differences in the toxicity among the two groups.

CONCLUSIONS

Adjuvant chemotherapy appears to be safe in patients with a neobladder and equally safe in patients with an ileal conduit. Hence neobladder reconstruction should not be denied to patients with bladder cancer who are at high risk of recurrence and who might require adjuvant chemotherapy.

Search for exotic baryons in 800 GeV pp-->pXi+/-piX reactions

We report the results of a high-statistics, sensitive search for narrow baryon resonances decaying to Xi-pi-, Xi-pi+, Xi+pi-, and Xi+pi+. The only resonances observed are the well known Xi0(1530) and Xi0(1530). No evidence is found for the states near 1862 MeV, previously reported by NA49 [Phys. Rev. Lett. 92, 042003 (2003)]. At the 95% confidence level, we find the upper limit for the production of a Gaussian enhancement with sigma=7.6 MeV in the Xi-pi- effective mass spectrum to be 0.3% of the number of observed Xi0(1530)-->Xi-pi+. We find similarly restrictive upper limits for an enhancement at 1862 MeV in the Xi-pi+, Xi+pi-, and Xi+pi+ mass spectra.

Biological Behavior and Partial Molecular Characterization of Six Chilean Isolates of Plum pox virus

Plum pox virus (PPV) strain D was first detected in Chile in 1992 infecting Prunus trees including peaches, nectarines, apricots, and plums. Since then, quarantine efforts have included periodic surveys in the central zone of the country, the main region for stone fruit production. This work describes the characterization of six PPV isolates from this area of Chile, using biological and molecular approaches. PPV isolates were introduced into Prunus tomentosa and Nicotiana benthamiana hosts by grafting and mechanical inoculation, respectively. Symptoms were evaluated by following the appearance of circular necrotic spots and mosaic in leaves of P. tomentosa and mosaic and some leaf deformation in N. benthamiana. Molecular analysis was carried out using reverse transcription-polymerase chain reaction, allowing the cloning and sequencing of 1.34-kb fragments corresponding to the 3' region of the replicase gene, the complete coat protein (CP) gene, and the 3' nontranslated region of the PPV genome. Evolutionary distance analysis of these nucleotide sequences and their deduced coat protein amino acid sequences grouped the six Chilean isolates among strain D isolates, with closest genetic distances to those of Central Germany and Poland. Representative sources of these isolates suggest that strain D could be the only type of PPV currently present in Chile.

Lambda(0) polarization in 800-GeV/cpp --> p(f)(Lambda0K+)

We report results from a study of Lambda(0) polarization in the exclusive reaction pp --> p(f)(Lambda0K+) at 800-GeV/c. We observe a dependence of the polarization on the Lambda0K+ invariant mass with large (+71%) positive polarization at small mass (1.63-GeV/c(2)) and large (-43%) negative polarization at large mass (2.75-GeV/c(2)). This observation confirms the result of the CERN ISR R608 experiment and extends the range over which the effect is observed. The strong dependence of the polarization on the Lambda0K+ invariant mass suggests that the origin of the polarization is closely related to the production dynamics of the diffractively produced Lambda0K+ system.

Diffractively produced charm final states in 800-GeV/c pp collisions

We report the first observation of diffractively produced open charm in 800-GeV/c pp collisions of the type pp-->pD*X. We measure cross sections of sigma(diff)(D*+) = (0.185+/-0.044+/-0.054) (mu)b and sigma(diff)(D(*-)) = (0.174+/-0.034+/-0.029) (mu)b. Our measurements are based on 4.3x10(9) events recorded by FNAL E690 in the fixed-target run of 1991. We compare our results with previous fixed-target charm experiments.

Bilateral tonic-clonic epileptic seizures in non-benign familial neonatal convulsions

We report an electroclinical pattern considered characteristic of benign familial neonatal convulsions (BFNC) in two neonates without BFNC. Both neonates were products of uncomplicated pregnancies, labor, and deliveries. The cause of the seizures was not established. There was no family history of seizures or epilepsy. Seizures started on the second and third days after birth. Ten seizures were captured by continuous video-EEG telemetry. The electroclinical events began with generalized tonic posturing coinciding with the appearance of diffuse attenuation of the EEG activity. After several seconds, bilateral clonic movements accompanied by bilateral repetitive sharp waves or spikes occurred in the EEG. One patient had normal development; the other became autistic. We conclude that the electroclinical pattern occurring in BFNC can occur in other types of neonatal seizures.

Effect of age, malnutrition and renutrition on free secretory component and IgA in secretions

The development of free secretory component (FSC) was studied in the tears of normal infants, children and adults. The level of FSC in tears was higher in older adults than in children. Free secretory component was also measured in the tears of normal, moderately and severely malnourished Colombian children. Children suffering from kwashiorkor, combined protein-calorie malnutrition or marasmus were studied before and after renutrition. No change was detected in the concentration of FSC in tears of moderately malnourished (Grade I and II) children. There was a significant difference between normal and severely malnourished children which improved with renutrition. The levels of tear IgA were decreased in the moderately malnourished children. These results indicate that reduction in secretory IgA levels in moderate malnutrition may not be explained by a lack of available free secretory component in tears, but that severe malnutrition may impair the S-IgA system by significantly reducing the availability of free secretory component.

Enzootic Brugia infection in a two-year-old Colombian girl

Mature male and female filarial worms were present in a lymphatic vessel near a retro-auricular lymph node removed from a 2-year old Colombian girl. Although apparently mature microfilariae were present in the uterus of the female, none was detected in blood samples (Knott's) of peripheral blood taken during day or night. The identification of the worms as a species of Brugia is suggested by their location in a dilated lymphatic vessel, morphology of adults, and the distribution pattern of tail nuclei of the microfilariae. This case is similar to another Colombian case reported from the Departamento del Santander del Sur, and suggests that zoonotic filarial infections may not be uncommon in Colombia.

Effect of moderate malnutrition on immediate hypersensitivity and immunoglobulin E levels in asthmatic children

Dermal reactions and IgE levels were compared in 51 asthmatic Colombian children identified on the basis of anthropometric measurements as nutritionally normal (25) or mildly (16) or moderately (10) undernourished. Twenty-five nonatopic children served as controls. Total serum IgE concentrations were significantly elevated in the asthmatic group as a whole. Moderately malnourished (grade II) asthmatic children had more than twice as much serum IgE as normal or mildly malnourished (grade I) asthmatic subjects and seven times more than nonatopic children. Intestinal parasitism did not appear to contribute to these differences in IgE levels. Serum levels of IgA and IgD were similarly elevated in grade II asthmatics. Concentrations of serum IgG, IgM, and C3 and C4 complement were unaffected by nutritional or allergic status. Eosinophilia in nasal mucus was significantly reduced in grade I and grade II malnourished asthmatic children. Among asthmatics, the most frequent dermal reactions were to mite antigens (96%), house dust (67%), and grass pollens (35%). Significant levels of specific IgE were detected by the RAST to two species of mites in nearly all atopic children. There was no apparent influence of nutritional status on the distribution of reactivity or specific IgE assay. The clinical significance of hyperimmunoglobulin E in atopic, moderately malnourished children remains to be elucidated.

Effect of renutrition on humoral and cell-mediated immunity in severely malnourished children

Forty-three Colombian children suffering from either kwashiorkor (21), combined protein-calorie malnutrition (11), or maramus (11) were hospitalized and provided a high protein, high calorie diet for 4 to 5 wk. Improvement in clinical and nutritional status was accompanied by significant increases in levels of serum immunoglobulins G and M and C3 complement and by significant decreases in serum immunoglobulin A concentrations, especially in infants with kwashiorkor. Skin test reactions to purified protein derivative and candidin improved during renutrition. Lymphocyte blastogenesis after stimulation in vitro with phytohemagglutinin and pokeweed mitogen increased rapidly during hospitalization. After 1 yr posttreatment, cell-mediated immune responses, both in vivo and in vitro, had diminished. These results indicate that some aspects of the immune response are affected to a different degree in kwashiorkor, maramus, and combined malnutrition. Short-term nutritional rehabilitation has a differential effect on the long-term restoration of various aspects of immunity.

Pancreatic and salivary amylase activity in undernourished Colombian children

Amylase activities were quantitated in secretions of marginally and severely malnourished Colombian children. In young children with a mean age of 21 months, the relative pancreatic and salivary amylase isozyme activities of urine were significantly changed in marginally malnourished children compared to normal children. There was a relative increase in salivary and decrease in pancreatic amylase activity in the undernourished children and total amylase activity was somewhat decreased. Amylase activity in saliva and tears was significantly lower in these malnourished children. Older children who were more severely malnourished had significantly lower amylase activity in their sera and tears. Thus marginal and severe malnutrition affects the production of amylase by the pancreas and salivary glands of young children distinctly. It significantly suppresses amylase activity in tears, saliva, and serum.

Etiology of respiratory tract infections in children in Cali, Colombia

One hundred eighty children hospitalized for acute respiratory disease were studied in Cali, Colombia. In the majority of patients, pneumonia was the reason for hospitalization and remained the final diagnosis. Fifty-one cases of pneumonia of indeterminate etiology comprised the largest single diagnostic category, followed by 38 cases of pneumonia associated with measles, and 22 cases assocaited with serologic evidence of infection with other viral agents or Mycoplasma pneumoniae. Etiologic diagnosis could be assigned with a reasonable degree of confidence in 116 of the 180 patients (64%). The laboratory procedure found most likely to provide the etiologic diagnosis in this series was paired sera specimens for demonstration of rise in antibody titer against the common viral respiratory pathogens. Those most frequently implicated serologically as etiologic agents in the cases studied were, in order of decreasing frequency, measles, influenza, parainfluenza, and adenoviruses.