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PubMed2000

A cycle of cerebrospinal fluid: supporting evidence and theoretical considerations.

An entrenched theory of cerebrospinal fluid (CSF) absorption by the arachnoid villi fails to explain observations regarding the movement of substances in the fluid. Experiments that demonstrated the arachnoid villi as the site of absorption were based on non-physiologic methods. CSF does not flow through the arachnoid villi, because villi require bulk flow and bulk flow of CSF does not exist. CSF is transported through the choroid fissure and recycled through the tela choroidae by the choroid plexus, with reentry into the ventricular system. Observed failures of the effete arachnoid villus theory can be readily explained by the cycling theory. A complete cycle of CSF is suggested to pace the 90 to 100-minute ultradian rhythms found in human physiology.

Arachnoid↗
PubMed2000

łGradation of sideropneumoconiosis.

Pathological-anatomical analyses of biopsy and autopsy samples of 43 men with anamnestically established occupational exposure to welding fumes showed in 38 specimens (88%) characteristic alterations of varying degrees of sidero pneumokonioses. Based on recurrent histological findings of increase and activation of iron storing macrophages (siderophages) and varying degrees of fibrosis, sidero pneumokonioses are classified into three grades. Intraindividually and also toporegionally different degrees may well be present. Based on morphological criteria of the three grades, seven samples were classified as grade I, 21 specimens as grade II, and 10 samples as grade III. The results show that exposure to welding fumes may well cause pulmonary alterations reaching an impairment level, depending on length, extent and special circumstances of the respective exposure. In cases of so-called welders lungs, an obliging statement in an expert's opinion on the degree of functional impairment, however, can only be given when histological findings, detailed information on the occupational history and clinical functional parameters are combined.

Autopsy↗
PubMed1994

Iron and pediatric liver disease.

As a rule, stainable iron can normally be present in the liver during the perinatal period and is normally absent from the liver during childhood and adolescence. Liver disease can be expected to develop when repeated transfusions are administered and neither phlebotomy nor chelation therapy is undertaken; in the setting of prolonged transfusional support, the source of iron overload is no mystery, and appropriate steps can be taken prophylactically to minimize the risk of iron-related liver disease. If elevated iron stores are discovered in a pediatric patient without a history of transfusion, the diagnosis of HH should be considered. Symptomatic HH is rare in childhood or adolescence, and most patients with HH in these age groups will come to medical attention because a relative with HH has been identified and family members are being screened for iron overload. It is important to initiate phlebotomy therapy in patients with HH before iron toxicity develops. To find iron in the liver of a newborn infant with liver disease is not necessarily abnormal. It is possible that iron, as an oxidant, may potentiate damage initiated by other agents, so that depletion of even physiologically normal iron stores may be of value in treatment. Most important is to remember that criteria for assessing iron overload in adults are not suited for assessing iron overload in newborn infants, and to hold back from ascribing to iron overload too large a role in whatever disease process is underway.

Child↗
PubMed1996

["Central islands"--an early postoperative complication after photorefractive keratectomy].

BACKGROUND: After myopic photorefractive keratectomy undercorrected zones in the center of the treated cornea (central islands (CI)) occur early postoperatively occasionally the reason for double-vision, halos and reduction of best corrected visual acuity. PATIENTS AND METHODS: Sixty-two eyes of 33 patients were treated with an 193 nm excimer laser for correction of myopia (range: -1.0 to -12.0 D) and an optical zone of 6.0 mm. The patients were selected consecutively regarding the follow-up examination which ranged from 1 month to 21 months after surgery. RESULTS: At 1 month after surgery the incidence of central islands was 72.6%. It rarely occurs after corrections of -3.0 D and less but may be detected in every case of correction of -6.0 D and more. The correlation between attempted correction and incidence of central islands is statistically significant (p < 0.005). Approximately 21% of the patients were steroid responders whose central islands appeared more marked. CONCLUSIONS: Central islands are an early postoperative complication with a not yet decided cause. Depending on attempted correction (D) and the follow-up the central islands disappear and/or did not result in reduction of visual acuity. In contrast, in patients with increased corticosteroid response the central islands persisted longer (15 months and more). Reoperations because of central islands should not be performed before 6 months after surgery. We describe a new form of central corneal iron deposit.

Adult↗
PubMed2003

Phthisis bulbi with a large protruding foreign body--a rare complication of penetrating injuries.

Spontaneous extrusion of a retained intraocular foreign body is a rare occurrence. An unusual case is described in a 30-year-old male, where a foreign body remained in the eye for four years and then, as phthisis set in, the foreign body gradually extruded, causing constant irritation of the upper lid. Such a situation has not been documented before. Its management along with the histopathologic features are discussed in the light of the available literature.

Adult↗
PubMed1997

Intra-alveolar pulmonary siderophages in sudden infant death: a marker for previous imposed suffocation.

Staining for iron showed previously overlooked intra-alveolar siderophages widely distributed in the lungs of two pairs of siblings, all of whom had hospital admissions for apparent life-threatening events (ALTEs) before dying suddenly at home. A mother and babysitter were convicted of their murder and manslaughter respectively. There were no siderophages in the lungs of a fifth infant whose death was included in the murder charge but who had no ALTEs. Bleeding from mouth or nose was observed during six of ten previous ALTEs suffered by these children and three unrelated infants in the same care. Such external hemorrhage is well described in imposed infant suffocation which may be one aspect of "Munchausen syndrome by proxy" child abuse. Our findings imply that there may also be intrapulmonary hemorrhage and that intra-alveolar siderophages can be a marker for previous abuse. Retrospectively we found diffusely distributed intra-alveolar siderophages in the lungs of seven of 158 infants with diagnoses of SIDS. Siderophages in such numbers demand an explanation and if this is not provided by clinical history or other necropsy findings should cause suspicion of previous imposed suffocation and infanticide and require further enquiry. The lungs should be stained for iron in all cases of sudden infant death.

Asphyxia↗
PubMed1979

Changing patterns of dietary iron overload in black South Africans.

Over the last 17 years there has been a significant reduction in the prevalence and severity of dietary iron overload in urban blacks of Johannesburg. This is attributed to a decrease in the consumption of traditionally brewed beer of high iron content over this period. A 40% reduction was found in hepatic iron concentrations measured in necropsy specimens from 248 male patients who died in 1976 as compared with 220 who died in 1959 and 1960. While hepatic iron concentrations rose with age in both groups there was no evidence of iron accumulation during the period between the two studies. Hepatic iron concentrations measured in 345 female subjects were many fold less than those of males and the 1976 group did not differ significantly from the 1959 to 1960 group. A paradoxical increase in the prevalence of portal fibrosis and cirrhosis was seen and may be due to the effects of increased ingestion of spirits and fortified wine in recent years. Iron overload was significantly greater in males with carcinoma of the esophagus and in those with idiopathic heart failure when compared to subjects who died of other causes. This suggests excessive exposure of these subjects to traditionally brewed beverages and the adulterants present in them.

Adult↗
PubMed1990

Effect of increasing storage iron on ascorbic acid metabolism in the guinea pig.

Ascorbic acid (AA) metabolism was studied in control and iron-loaded guinea pigs. All animals were fed an AA-deficient diet and given a daily intraperitoneal (ip) dose of 10 mg sodium ascorbate. The control-diet formula contained 0.10 g Fe/kg diet; the experimental diet contained an additional 3.33 g Fe/kg diet as FeSO4. After 14 wk animals were injected (ip) with 9.25 x 10(3) Bq [1-14C]L-ascorbic acid. Blood was collected for 10 d and plasma specific activity of AA was determined. All animals were subsequently killed and selected tissues were analyzed for AA and iron concentrations. In spite of marked elevation of iron concentrations in plasma, spleen, and liver in experimental animals compared with controls, no differences in AA metabolism as determined by tissue AA concentrations and AA half-life, turnover rate, and body-pool size were evident. These results demonstrate that iron loading has no effect on the rate of AA catabolism in guinea pigs.

Animals↗