1/16. Ultrastructural alterations in the endothelium in a patient with topical anesthetic abuse keratopathy.A 40-year-old patient frequently self-administered topical oxybuprocaine drops for approximately 7 days after bilateral ultraviolet-light keratitis. Initially, he developed bilateral chronic epithelial defects with diffuse stromal infiltration and edema. After a protracted initial healing period, the patient underwent a penetrating keratoplasty in one eye because of significant corneal scarring. Pathologically, the corneal button revealed scarring and thinning of the central stroma. Results of scanning electron microscopy showed endothelial polymorphism, focal endothelial necrosis, and numerous filamentous processes emanating from abnormally enlarged intercellular gaps. Results of transmission electron microscopy showed markedly attenuated to absent apical cell attachments at the endothelial intercellular junction. Abuse of oxybuprocaine appears to produce irreversible damage to the apical cell attachments at the level of the corneal endothelial cells.- - - - - - - - - - ranking = 1keywords = transmission (Clic here for more details about this article) |
2/16. Tuberculosis: a disease of the 1990s.In the united states, the decades preceding the 1980s were characterized by a decline in the incidence of tuberculosis. More recently, the trend has undergone a significant reversal: Case rates have been increasing by 3% to 6% annually. In 1990, more than 25,700 cases were reported to the Centers for disease Control. In a sense, tuberculosis is adapting to the '90s. The recent increase in its incidence tends to affect populations with identifiable characteristics. Among the most important of these groups are the populations at high risk for infection by the human immunodeficiency virus. The increase is also fueled by cases in populations that are medically underserved, including foreign-born persons from high-prevalence countries, persons with low incomes, and persons living in long-term-care facilities--especially persons with previous tuberculosis infection. Thus, factors such as homelessness, chronic alcohol or drug abuse, malnutrition, and crowded living conditions continue to favor development and transmission of disease. The increase in the incidence of tuberculosis appears to be greatest when subpopulations in such circumstances are also at high risk for hiv infection. Complex issues in the diagnosis and treatment of tuberculosis arise from these epidemiologic patterns. hiv infection is associated with unusual presentations of tuberculosis. Thus, the clinician must maintain a high index of suspicion for the disease in the setting of hiv infection or risk of the infection. The populations at greatest risk are likely to be mistrustful of the medical system, making the long-term administration of potentially toxic chemotherapy more difficult than it already is. Chronic substance abuse may complicate compliance and add further difficulties to the monitoring of chemotherapy. At the same time, the monitoring becomes even more important in the physician's effort to minimize adverse effects of the medications. Outbreaks of drug-resistant disease have recently occurred, complicating the selection of drugs and affecting the duration of treatment. Despite all of these problems, it is essential to establish a diagnosis and initiate treatment rapidly, both to arrest the disease process and to limit its transmission. Since mycobacterium tuberculosis is spread to uninfected persons in aerosols generated by coughing or sneezing, the infectiousness of a patient with active disease can be related, at least in part, to the number of organisms seen on sputum smears. Initiation of therapy is followed by a rapid decline in infectivity.- - - - - - - - - - ranking = 2keywords = transmission (Clic here for more details about this article) |
3/16. The development of dependence to an octapeptide somatostatin analog: contribution to the study of somatostatin analgesia.This paper reports the phenomenon of dependence to a somatostatin octapeptide analog used for the treatment of acromegaly and severe headache. The mechanism of this dependence is still unknown, but could be based on the interaction of the somatostatin analog with opioid receptors. analgesia may be at least partially supported by the opioid modulation of pain transmission, but also by general "appetitive" behavioral activation due to the effect of somatostatin on its receptors.- - - - - - - - - - ranking = 1keywords = transmission (Clic here for more details about this article) |
4/16. Substance abuse treatment modalities in the age of hiv spectrum disease.AMSAODD's Third National Forum on AIDS and Chemical Dependency presented a session about the theory and practicality of combining pharmacologic and nonpharmacologic treatment modalities to maximize the social, psychological, and physical health of patients. Synthesizing methadone maintenance for opioid dependence with abstinence modalities for cocaine dependence and alcoholism was discussed. Chronic adequate methadone treatment allows normalization of neuroendocrine function, is associated with normal natural killer-cell activity, and has proven efficacious in retaining patients in chemical dependence treatment, and thus decreasing the risk for transmission of hiv infection. Individualization of treatment is then exemplified by four clinical vignettes that were discussed by a panel of experts.- - - - - - - - - - ranking = 1keywords = transmission (Clic here for more details about this article) |
5/16. Unstable translocation t(14;21) in a man, inherited as a t(13;14) in one of his daughters.The transmission of a Robertsonian translocation was studied in a family after diagnosis of a t rob. (13;14) in a foetus, in the course of a prenatal diagnosis for maternal age. The father was found to be a carrier of a balanced t rob. (14;21) in mosaicism with a normal karyotype. The t rob(14;21) was inherited from the paternal grandfather. A second prenatal diagnosis, 1 year later, revealed a girl with the paternal t rob(14;21). Mitotic and germinal instability of the paternal t rob.(14;21) is discussed, with relation to the long period of drug addiction.- - - - - - - - - - ranking = 1keywords = transmission (Clic here for more details about this article) |
6/16. nomifensine and psychological dependence--a case report.This case report indicates that nomifensine has not only a specific antidepressant profile but also a dose dependent addictive potential in patients with "addictive problems". nomifensine supports not only norepinephrine transmission, but also acts on dopamine metabolism and this may be responsible for the stimulation of motor activity. This is in contrast to more frequently used tri- and tetracyclic antidepressants. This case report further supports other observations that several patients have psychological withdrawal difficulties after long term treatment with nomifensine in high doses (400-600 mg).- - - - - - - - - - ranking = 1keywords = transmission (Clic here for more details about this article) |
7/16. Nosocomial transmission of delta hepatitis.A previously asymptomatic carrier of hepatitis b virus receiving chronic hemodialysis developed acute delta hepatitis. The patient regularly received dialysis treatments on the same machine as a parenteral drug abuser with hepatitis B surface antigen (HBsAg)-positive chronic hepatitis whose serum was strongly positive for delta antibody. The drug abuser had a major bleeding episode that caused extensive environmental contamination 3 months before onset of illness in the index patient. No other patients receiving dialysis or staff members had evidence of delta infection. A surgeon previously infected with hepatitis B from the same parenteral drug abuser also had delta antibody. Testing for delta virus is indicated for both HBsAg-positive parenteral drug abusers and patients with hemophilia receiving chronic hemodialysis. All patients who are HBsAg- and delta-positive should receive dialysis separately from patients who are HBsAg-positive and delta-negative. Susceptible patients on dialysis and staff should receive hepatitis B vaccine to protect against both hepatitis B and delta virus infection.- - - - - - - - - - ranking = 4keywords = transmission (Clic here for more details about this article) |
8/16. Acquired immunodeficiency with reversed T4/T8 ratios in infants born to promiscuous and drug-addicted mothers.A new syndrome of acquired immunodeficiency has been identified in seven children who were small for gestational age at birth and subsequently have exhibited failure to thrive, lymphadenopathy, parotitis, hepatosplenomegaly, interstitial pneumonia, and recurrent infections. All have a profound cell-mediated immunodeficiency with reversed T4/T8 ratios. Six are hypergammaglobulinemic and one has low IgG levels. The mothers of five of the seven children are sexually promiscuous and/or drug addicts. Three mothers have an immunodeficiency similar to that found in their infants. One of them died at age 33 years with a diagnosis of acquired immunodeficiency syndrome. In five of the children and in three of their mothers, there is evidence of a persistent Epstein-Barr virus (EBV) infection. We speculate that a perinatal or in utero transmission of EBV can induce an "infectious immunodeficiency." The clinical, histopathologic, and immunologic features resemble those described in adult homosexuals and drug addicts.- - - - - - - - - - ranking = 1keywords = transmission (Clic here for more details about this article) |
9/16. Acquired immune deficiency syndrome in low-risk patients. Evidence for possible transmission by an asymptomatic carrier.Two patients who contracted acquired immune deficiency syndrome (AIDS) could not be included in any of the known high-risk groups for this syndrome (ie, they were not homosexual, intravenous [IV] drug abusers, Haitian, or hemophiliacs). Patient 1, however, had regular sexual contact with her husband, an IV drug abuser who is asymptomatic despite a severe T-cell defect (T-helper cells, 33/cu mm; T-helper/T-suppressor ratio, 0.32; and a depressed lymphoproliferative response to mitogens and antigens). We hypothesize that he may be an asymptomatic carrier of an AIDS agent that he transmitted to his wife through intimate heterosexual contact. This mode of sexual transmission may provide a vector for the spread of AIDS to low-risk populations.- - - - - - - - - - ranking = 5keywords = transmission (Clic here for more details about this article) |
10/16. Callosal syndrome: implications for understanding the neuropsychology of stroke.A case is presented of callosal syndrome following cerebral hemorrhage and amphetamine abuse in a 26-year-old right-handed man. There were few hemispheric findings but a full callosal syndrome including left apraxia to verbal commands, left tactile anomia, left agraphia, right constructional apraxia, failure of blindfolded side-to-side hand replication and form-board testing showing loss of interhemispheric transmission including intermanual interference. The "draw-a-clock" test showed left inattention when drawn with the right hand but not the left, and perseveration was noted for spatial tasks done with the right hand and symbolic tasks done with the left. The patient recovered functionally almost completely but testing demonstrated continued loss of interhemispheric transmission. The case is considered of most interest for its potential in explaining phenomena observed in severe unilateral hemispheric lesions. Our findings suggest that perseveration is not a dysfunction of the damaged portion of the brain, but a phenomenon associated with intact brain attempting unfamiliar tasks. The persistence of left hemi-inattention is attributed to the inability of the left hemisphere to utilize spatial information to compensate for the phenomenon of inattention. Left-sided dyskinesia following left hemisphere lesions was attributed to the lack of symbolic information necessary to perform some movements. Dysprosody was attributed to lack of tonal information to the left hemisphere. recovery of function following severe unilateral lesions may be largely due to compensatory learning by the intact hemisphere and assertion of ipsilateral control. As our patient originally assumed an inverted left-handed writing posture, we assume the posture is controlled by the right hemisphere.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 2keywords = transmission (Clic here for more details about this article) |
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