bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnosis of Cerebral Venous Thrombosis with Routine Magnetic Resonance: An Update
Authors: Bianchi D. , Maeder Ph. , Bogousslavsky J. , Schnyder P. , Meuli R.A.
Published: April 2003

Magnetic resonance imaging and angiography is the technique of choice in the diagnosis and follow-up of cerebral venous thrombosis: Thrombosis appears as an absence of flow void on spin echo images and lack of signal in angiographic techniques. The thrombus signal intensity is different on T1 and T2 spin echo weighted images and evolves according to hemoglobin degradation. Recognition of pitfalls and artefacts related to the different magnetic resonance imaging techniques employed is essential to interpret dural venous sinus thrombosis. In this paper the imaging of 27 patients with cerebral venous thromboses is reviewed. We describe the type of signal abnormalities, the different types of clot- and flow-related artefacts, and the indirect signs of cerebral venous thrombosis.
Comprehensive Postictal Neuropsychology Improves Focus Localization in Epilepsy
Authors: Pegna A.J. , Qayoom Z. , Gericke C.A. , Landis T. , Seeck M.
Published: April 2003

In recent years, new techniques such as single photon emission computed tomography (SPECT), positron emission tomography (PET) and magnetic resonance imaging (MRI) have been used to improve the localization of epileptic foci during the noninvasive evaluation procedure for epilepsy surgery. Since ictal/or immediate postictal SPECT studies were shown to localize epileptic foci better than interictal SPECT, we addressed the question of whether immediate postictal neuropsychological examination would show the same effect. Neuropsychological examinations were carried out postictally and interictally using a broad range of tests. Postictal results were analyzed with regard to lateralizing and localizing information about the epileptogenic region. Seventeen patients suffering from temporal and extratemporal pharmacoresistant epilepsy were investigated postictally with a subset of tests used for the interictal neuropsychological examination. A significant improvement in focus localization was seen in comparison with interictal neuropsychology (p = 0.014). We conclude that neuropsychology can yield lateralizing and sometimes localizing information, even for extratemporal foci, if carried out during the postictal period and based on a global analysis of the clinical neuropsychological picture.
Elevated Plasma Levels of Homocysteine inParkinson’s Disease
Authors: Kuhn W. , Roebroek R. , Blom H. , van Oppenraaij D. , Przuntek H. , Kretschmer A. , Büttner T. , Woitalla D. , Müller T.
Published: April 2003

Significantly elevated plasma levels of homocysteine, but not cysteine and cysteinylglycine, were found in treated parkinsonian patients compared to controls. Elevated levels of homocysteine may be either caused by an unknown endogenous metabolic disturbance or by antiparkinsonian treatment, because no association to severity or duration of disease was found. Based on the results of this study one may speculate that homocysteine may be an independent risk factor for vascular disease in Parkinson’s disease.
NMR Studies in Demyelinating and Non-Demyelinating Experimental Allergic Encephalomyelitis
Authors: Namer I.J. , Mauss Y. , Gounot D. , Steibel J.
Published: April 2003

The spinal cords of rats, involved as part of two distinct and reproducible experimental allergic encephalomyelitis animal models, presenting inflammatory white matter lesions with and without demyelination, were studied in vitro by NMR, before and after a dehydration procedure, in order to characterize demyelination. All the parameters of the T1 and T2 relaxation times were determined, as well as the initial proportion of the very quickly decaying component of the free induction decay, and the magnetization transfer ratio. The relaxation decays were fitted with the discrete and Contin methods. Magnetization transfer ratio measurements permitted first to evaluate the magnetization transfer at the apex, and secondly to decompose the post-irradiation curves into two components: a gaussian and a lorentzian line, with their relative proportions and widths. The results presented in this study clearly demonstrate that it is not possible to evidence demyelination in fresh spinal cord preparations by NMR. Hovewer, the dehydration procedure, which was introduced with the aim of reducing the amount of free water in our samples, seems sufficient to enable the detection of demyelination from the T2 relaxation spectra and magnetization transfer data. As a conclusion, we think that the NMR properties of water protons allow to achieve tissue characterization on condition that the parameters concerning free water and its exchanges are eliminated.
Comparative Efficacy and Safety of Calcium Carbasalate plus Metoclopramide versus Ergotamine Tartrate plus Caffeine in the Treatment of Acute Migraine Attacks
Authors: LeJeunne C. , Gómez J. Pascual , Pradalier A. , Titus i Albareda F. , Joffroy A. , Liaño H. , Henry P. , Lainez J.M. , Geraud G.
Published: April 2003

This randomized, double-blind, double-dummy, multicenter, parallel-group study aimed at comparing the efficacy and safety of calcium carbasalate (equivalent to 900 mg aspirin) plus metoclopramide 10 mg (CM) with ergotamine tartrate 1 mg plus caffeine 100 mg (EC) administered in the treatment of 2 acute migraine attacks. A total of 296 patients fulfilling the International Headache Society diagnostic criteria for migraine were enrolled. In total, one or two migraine attacks were treated in 268 and 235 patients, respectively. The primary endpoint for the first treated attack was headache relief, with intensity decreasing from moderate or severe to mild or absent 2 h after drug intake. Usual secondary efficacy endpoints were assessed. A superiority of CM over EC was observed for both treated attacks for the main endpoint: success in 54 versus 36%, p = 0.003 for the first attack and 60 versus 44%, p = 0.02 for the second attack. CM was also significantly superior to EC during the first attack for complete headache relief (20 vs. 8%, p = 0.006), nausea (42 vs. 63%, p = 0.007) and willingness to take the drug again (90 vs. 80%, p = 0.043). The global efficacy evaluation, rated by the investigators, was significantly more favorable to CM for both attacks (p = 0.001 for the first attack and p = 0.02 for the second). The patients’ evaluation was significant for the first attack (p = 0.002). The global incidence of adverse events was 45% higher with EC, though not significant (32 vs. 22%, p = 0.075). They were most often unspecific and mild to moderate in intensity. Gastrointestinal side effects were significantly less frequent with CM than EC (7 vs. 21%, p = 0.001). Thus, CM is more effective and has a better gastrointestinal safety than EC in the acute treatment of migraine attacks.
Cerebrospinal Fluid Nitrate Levels in Patients with Multiple Sclerosis
Authors: de Bustos Fernando , Navarro José Antonio , de Andrés Clara , Molina José Antonio , Jiménez-Jiménez Félix Javier , Ortí-Pareja Miguel , Gasalla Teresa , Tallón-Barranco Antonio , Martínez-Salio Antonio , Arenas Joaquín
Published: April 2003

It has been suggested that nitric oxide (NO) could be implicated in the pathogenesis of multiple sclerosis (MS). Recently, two groups reported increased cerebrospinal fluid (CSF) nitrate levels (oxidation product that provides an indirect estimation of NO) in MS patients. However, another group did not confirm these findings. We studied the CSF and plasma levels of nitrate with a kinetic cadmium reduction method in 11 MS patients and 25 matched controls. The CSF nitrate levels and the CSF/plasma nitrate ratio did not differ significantly between the two study groups. Plasma nitrate levels were nearly significantly lower in MS patients. CSF and plasma nitrate levels did not correlate with age at onset and duration of the disease in the patient group. These data suggest that measurement of CSF levels of nitrate is not a marker of the activity of MS.
Neurological Complications after Autologous Stem Cell Transplantation
Authors: Guerrero A. , Pérez-Simón J.A. , Gutierrez N. , Caballero D. , Ortin F. , Gomez-Sanchez J.C. , Cacho J. , San Miguel J.F.
Published: April 2003

Introduction: Autologous bone marrow (BMT) or peripheral blood stem cell transplantation (PBSCT) are increasingly used to treat hematological malignancies and solid tumors. The reported incidence of neurological complications varies greatly among the different centers, ranging from 11 to 39%. Patients and Methods: In order to gain insight into the real incidence of early neurological complications (first 6 weeks) after autologous transplantation, we analyzed a series of 254 patients who underwent BMT/PBSCT for hematological malignancies (212 cases) or solid tumors (42 cases). Results: Seven patients died during the early posttransplant period (incidence: 2.4%), and one of these deaths was related to a neurological complication. Eight patients developed neurologic complications (incidence: 2.8%). None of the patients developed cerebral hemorrhage during the early posttransplant period, despite a rather restrictive platelet transfusion support. Two out of 13 patients diagnosed AML and 3 out of 36 patients diagnosed Hodgkin’s disease developed early neurological complications. Discussion and Conclusions: The neurological morbidity related to autologous transplantation was very low in our series of patients as compared to that reported in previous studies. This difference could be explained, at least in part, by a more restrictive definition of early neurologic complications.
Yield of Fluid-Attenuated Inversion Recovery in Drug-Resistant Focal Epilepsy with Noninformative Conventional Magnetic Resonance Imaging
Authors: Taillibert S. , Oppenheim C. , Baulac M. , Dormont D. , Marsault C. , Cabanis E.A. , Tourbah A.
Published: April 2003

Purpose: To determine the role in presurgical assessment and evaluate the yield of fast fluid-attenuated inversion recovery (FLAIR) sequences for patients with intractable partial epilepsy for whom conventional magnetic resonance imaging (MRI) was normal. Material and Methods: Forty patients were selected. Conventional MRI including spin echo T1-weighted sagittal images and fast spin echo T2-weighted axial images was normal in 33 patients and showed noninformative lesions in 7. Fast FLAIR and T2-weighted sequences were performed perpendicularly to the hippocampal long axis. Results: Additional abnormalities were found in 40%. They were correlated with electroclinical data in 13 patients (32.5%) and not correlated or doubtful in 3 (7.5%). Conclusion:  Fast FLAIR sequences brought congruent additional information in 32.5% cases and seemed useful in presurgical evaluation.
Cimetidine-Associated Optic Neuropathy
Authors: Sa’adah M.A. , Al Salem M. , Ali A.S. , Araj G. , Zuriqat M.
Published: April 2003

Two cases of optic neuropathy associated with cimetidine therapy are reported. Recovery occurred in both after drug withdrawal. Rechallenge with the same agent totally reproduced the condition in the first case. Cimetidine exerts an unequivocal toxicity on the central and peripheral nervous systems. Since its introduction in 1976, it has been used in over 100 million patients, but only 3 cases of optic neuropathy have been reported as far as we know. Although the mechanism of toxicity is still unclear, cimetidine is a well-recognized zinc chelator, and zinc deficiency has been implicated in causing optic neuropathy. Hence, it can be concluded that cimetidine produced this toxicity through its mechanism of zinc chelation. However, close ophthalmic follow-up of such patients is unnecessary, but an unexplained visual deterioration should prompt immediate drug withdrawal.
Human Parvovirus B19 Infection in Multiple Sclerosis
Authors: Nakashima Ichiro , Fujihara Kazuo , Itoyama Yasuto
Published: April 2003

The association of human parvovirus B19 (PVB19) infection with the development of several systemic autoimmune diseases has been confirmed in other studies. To determine if there is any association of PVB19 infection with multiple sclerosis (MS), we studied the prevalence of serum anti-PVB19 IgG and IgM by an enzyme-linked immunosorbent assay and PVB19-specific DNA in the cerebrospinal fluid (CSF) by the polymerase chain reaction method in a total of 46 patients during exacerbation or remission of MS. Anti-PVB19 IgG was detected in 65.8% of the patients’ sera. The percentage was significantly higher than that in age-matched healthy control subjects (40%; p = 0.019), but was not higher in patients with other neurological diseases (50%; p = 0.16). There was no correlation between serum anti-PVB19 IgG status and antinuclear antibodies or oligoclonal IgG bands in CSF. Serum anti-PVB19 IgM and PVB19 DNA in CSF were consistently negative in the patients during exacerbation of MS. Although MS patients may be commonly infected with PVB19, our results suggest that there is no active PVB19 infection during exacerbation of MS.
Gabapentin as Treatment for Hemifacial Spasm
Authors: Bandini Fabio , Mazzella Luca
Published: April 2003

Hemifacial spasm, a life-long condition characterized by involuntary unilateral contractions of the facial muscles, is a disabling disorder often resulting in patient irritation and social embarassment. Its probable etiology is neurovascular compression of the facial nerve at its root exit zone. The current medical treatment consists of either baclofen or anticonvulsant drugs, with limitation due to side effects or low efficacy. In recent years botulinum toxin injection and microvascular decompression of the facial nerve have been shown to be highly successful. However, both procedures share some complications and require special techniques. We present 5 patients affected by hemifacial spasm who responded well to the novel anticonvulsant drug gabapentin. Gabapentin was administered at a dose ranging from 900 to 1,600 mg daily, with rapid and clear improvement of spasms and absence of any remarkable adverse effects. Our findings suggest that gabapentin may be an effective treatment for patients with hemifacial spasm with a very good ratio of therapeutic effects to side effects when compared with other drugs currently used.
Hypointense and Hyperintense Lesions on Magnetic Resonance Imaging in Secondary-Progressive MS Patients
Authors: Adams H.-P. , Wagner S. , Sobel D.F. , Slivka L.S. , Sipe J.C. , Romine J.S. , Beutler E. , Koziol J.A.
Published: April 2003

Cranial magnetic resonance imaging (MRI) is widely used to monitor disease activity in clinical trials in multiple sclerosis (MS). The purpose of this study is to examine lesion burden as determined from hypointense regions on postcontrast T1-weighted scans (or black holes), and lesion burden on conventional T2-weighted scans, from a cohort of secondary progressive MS patients who participated in a placebo-controlled, randomized, double-blind cross-over trial assessing the therapeutic efficacy of cladribine. T2 lesion volumes and black hole volumes are approximately normal distributed when log-transformed, and are highly correlated (adjusted R2 = 0.63). Changes in clinical scores could be predicted with a reasonable degree of precision from baseline scores and changes in T2 lesion volumes (adjusted R2 values 0.52–0.7). Stratification schemes for clinical trials should include the acute proportion of the disease (enhancing T1 lesions), degree of permanent damage (black holes), and T2 lesion volume.
Lenticulocapsular Hemorrhages Presenting as Pure Sensory Stroke
Authors: Kim Jong Sung
Published: April 2003

Pure sensory stroke (PSS) syndrome is most often produced by a small infarct involving the lateral thalamus. Larger than lacune-sized putaminal hemorrhages have not been considered as a cause of this syndrome. The author describes 3 patients with hypertensive lenticulocapsular hemorrhage presenting with hemisensory symptoms without any other neurological deficits. In these patients, the sensory symptoms were more marked and persistent in the legs than in the other body parts. Neuroradiological data suggested that thalamocortical sensory pathways were exclusively involved. These patients highlight the heterogeneity of the vascular lesion producing PSS syndrome and illustrate that a putaminal hemorrhage should be included in the differential diagnosis of this clinical syndrome.
Coeliac Disease Presenting with Neurological Disorders
Authors: Luostarinen L. , Pirttilä T. , Collin P.
Published: April 2003

It is well known that coeliac disease may be associated with various neurological manifestations. We have had a high index of suspicion of coeliac disease during recent years in our neurological clinic. As a result 10 (7%) out of 144 of our new coeliac patients were detected because of neurological symptoms. The most common neurological manifestations were neuropathy, memory impairment and cerebellar ataxia. In these patient groups screening for coeliac disease with serological antibody tests helps to find patients who may suffer from this disease.
A Case of Hereditary Ceruloplasmin Deficiency with Iron Deposition in the Brain Associated with Chorea, Dementia, Diabetes mellitus and Retinal Pigmentation: Administration of Fresh-Frozen Human Plasma
Authors: Yonekawa Masaru , Okabe Tomohiro , Asamoto Yasumasa , Ohta Michiya
Published: April 2003

We report a familial case of hereditary ceruloplasmin deficiency (HCD) showing an A-G transition in intron 6 of the ceruloplasmin gene. Clinical features consisted of chorea, cerebellar ataxia, dementia, diabetes mellitus, retinal pigmentation and iron deposition in the liver and brain without copper overload in those organs. The patient’s children and siblings had similar laboratory results, but did not show any neurological abnormalities. She was medicated for diabetes mellitus at 43 years of age, and neurological signs appeared when she was 52 years old. The laboratory findings were anemia, low concentrations of iron and copper in serum and of copper in urine. Ceruloplasmin was not detected in the serum. The iron and copper contents in the liver were 3,580 and 10 μg/g wet tissue, respectively. MRI of the brain showed iron deposition in the basal ganglia, dentate nucleus and thalamus. This case did not show any abnormal increase in copper in the blood and urine following CuSO45H2O oral overloading test. Following the intravenous administration of commercially available fresh-frozen human plasma (FFP) containing ceruloplasmin, the serum iron content increased for several hours due to ferroxidase activity of ceruloplasmin. In the liver, the iron content decreased more with the combined intravenous administration of FFP and deferoxamine than with FFP administration alone. Her neurological symptoms improved following repetitive FFP treatment.
Decrease in the Ciliary Neurotrophic Factor of the Spinal Cord in Amyotrophic Lateral Sclerosis
Authors: Ono Seiitsu , Imai Takashi , Igarashi Akira , Shimizu Natsue , Nakagawa Hachiro , Hu Jianguo
Published: April 2003

Ciliary neurotrophic factor (CNTF), a potent survival factor in spinal motoneurons of embryonic chick and rat, is currently being investigated in humans as a treatment for amyotrophic lateral sclerosis (ALS). However, its physiological and pathological activities in ALS remain unclear. We measured CNTF contents in the cervical enlargement of the spinal cord from 9 ALS patients and 12 age-matched control subjects using a sensitive enzyme-linked immunoassay. CNTF genotypes were determined by the polymerase chain reaction-restriction fragment length polymorphism method. In control subjects, there were 8 homozygotes and 4 heterozygotes, while in ALS patients there were 6 and 3, respectively. In both homozygotes and heterozygotes, CNTF expression in the spinal cord from ALS patients tended to decrease compared to control subjects. In homozygotes, the decrease was significant (p < 0.05). Concerning the regional concentrations of CNTF, in homozygotes, CNTF contents in the lateral corticospinal tract were markedly lower (p < 0.001) in ALS patients than in controls. The decrease in CNTF expression in the lateral corticospinal tract of the spinal cord from ALS patients may be a feature of ALS and could be related to motor neuron loss.
ELISA-Quantitation of Phosphorylated Tau Protein in the Alzheimer’s Disease Brain
Authors: Herrmann Martina , Golombowski Sidonie , Kräuchi Kurt , Frey Peter , Mourton-Gilles Chantal , Hulette Christine , Rosenberg Carolyn , Müller-Spahn Franz , Hock Christoph
Published: April 2003

A reliable, sensitive and specific sandwich ELISA for the quantitation of paired helical filament (PHF) tau in human brain was developed using well-defined monoclonal antibodies. We examined rapid-autopsy-derived brain tissue from 21 neuropathologically confirmed Alzheimer’s disease (AD) patients and 14 nondemented controls, matched for age, sex and postmortem delay times. We demonstrated significant elevations of phosphorylated tau levels in the frontal and parietal cortex as well as in the hippocampus of AD patients as compared to the nondemented controls. No difference was observed in the cerebellum. Phosphorylated tau levels measured by ELISA were significantly correlated with the presence or absence of neurofibrillary tangles.
Absence of G209A and G88C Mutations in the Alpha-Synuclein Gene of Parkinson’s Disease in a Chinese Population
Authors: Lin Juei-Jueng , Yueh Kuo-Chu , Chang Dar-Cheng , Lin Shinn-Zong
Published: April 2003

A G209A mutation in the α-synuclein gene was recently discovered in a large Italian kindred and three unrelated Greek kindreds with autosomal dominant Parkinson’s disease (PD). Subsequently, another mutation in the gene (G88C) was also identified in a German family with autosomal PD. These results indicate that the α-synuclein gene may have an important role in the pathogenesis of PD. This study was designed to screen the existence of both mutations of the α-synuclein gene among 100 Chinese patients with PD, including 80 with sporadic and 20 with familial PD. Results showed that none of our patients, both sporadic and familial PD, had either of the two mutations of this gene. We therefore conclude that although of great interest, these two mutations are not relevant for the pathogenesis of PD in a Han Chinese population.
Detection of Serum Anticerebellar Antibodies in Patients with Miller Fisher Syndrome
Authors: Inoue Atsushi , Koh Chang-Sung , Iwahashi Teruaki
Published: April 2003

We performed Western blot analysis to detect anticerebellar antibodies in the serum of patients with Miller Fisher syndrome (MFS). We studied 7 MFS patients, 6 Guillain-Barré syndrome (GBS) patients and 10 normal healthy persons as controls. Six MFS patients (86%) had IgG antibodies against mouse cerebellar protein, whereas 3 GBS patients (50%) and 4 healthy controls (40%) had antibodies. The mean number of antibodies in the serum of patient with MFS was 2.43, which was significantly more than that of GBS patients (mean 0.67) and healthy control (mean 0.70). This finding suggests variability and complexity of target in nervous systems that suffer aberrant immunity in MFS, and may also reflect the variability and heterogeneity of the pathogenesis of this syndrome.
Severe Disability at Hospital Discharge in Ischemic Stroke Survivors
Authors: Paciaroni Maurizio , Arnold Pierre , van Melle Guy , Bogousslavsky Julien
Published: April 2003

Background: Several studies have attempted to identify criteria for predicting functional prognosis after stroke, but often with contradictory results. The purpose of this study was to predict the functional outcome at discharge of first-time stroke patients included consecutively in the Lausanne Stroke Registry. Methods: We studied 3,628 sequential patients with first-ever stroke who were admitted consecutively to the Centre Hospitalier Universitaire Vaudois. Functional status was evaluated using the Rankin disability scale at discharge. We studied the prognostic value of historical, clinical and instrumental variables related to functional outcome at discharge. The factors studied were age, sex, risk factors, ECG results, occurrence of transient ischemic attacks (TIAs), extension of cerebral infarction, presumed cause of stroke, clinical findings and demographic characteristics. Univariate analysis was performed on each variable by comparing the number of functionally independent with that of dependent patients at the moment of discharge. The significant variables of the univariate analysis were subjected to multivariate analysis with a backward logistic regression procedure to find those with an independent effect on the outcome. Results: A total of 3,156 patients, excluding 117 patients with ischemic stroke who died during hospitalization and 355 with brain hemorrhage, were included; 2,867 patients belonged to the nil, mild or moderate disability groups (modified Rankin score 1–4; functionally at least partially independent patients), while 291 patients belonged to the severe disability group (modified Rankin score 5; functionally dependent patients). The mean duration of stay in hospital of the severe disability group was 31.2 days (SD = 16.2). Multivariate analysis showed that impaired consciousness on admission, limb weakness, progressive worsening, infarct in the superficial and deep territory of the middle cerebral artery, ischemic heart disease and cardiac arrhythmia were predictors of severe disability at discharge. Age was not an independent predictor of poor outcome. Hypercholesterolemia was significantly related to a better outcome. Conclusions: Some prognostic indicators associated with functional outcome at discharge are available during the first few hours after onset of stroke. This is important for the management of the individual stroke patient and for organizing suitable rehabilitation planning.
Simultaneous Assessment of Brain Tissue Oxygenation and Cerebral Perfusion during Orthostatic Stress
Authors: Krakow Karsten , Ries Stefan , Daffertshofer Michael , Hennerici Michael
Published: April 2003

Simultaneous registration of cerebral tissue oxygenation parameters obtained by near infrared spectroscopy (NIRS), intracranial blood flow velocity (CBFV) measured by transcranial Doppler sonography (TCD) and basic cardiovascular parameters was carried out during a passive 80° head-up tilt table test in 15 patients with a history of orthostatic syncope and 20 control subjects. In normals, the cardiovascular parameters showed a specific course after changing to a vertical position: the heart rate increased, the mean arterial blood pressure remained unchanged, and the CBFV decreased. The NIRS measurements showed an increase in deoxyhemoglobin (HHb) and a decline in oxyhemoglobin (O2Hb) and the regional oxygen saturation (RSAT). Patients had a significantly more prominent decline in arterial blood pressure (p < 0.001), CBFV (p < 0.001) and RSAT (p = 0.04). Five patients experienced symptoms of (pre)syncope during the experiment, which were associated with a further sudden and marked (>10%) drop of O2Hb. The results indicate that the combination of TCD and NIRS increases the understanding of hemodynamic and metabolic changes during orthostatic stress, which may lead to individually suited therapeutic procedures.
A Randomized, Double-Blind Placebo-Controlled Trial of Iron in Restless Legs Syndrome
Authors: Davis Bradley J. , Rajput Alex , Rajput Michele L. , Aul Edward A. , Eichhorn Gerald R.
Published: April 2003

Background: Previous open-label trials have shown iron to be efficacious in the treatment of restless legs syndrome. We performed a randomized, double-blind, placebo-controlled trial of iron sulfate. Methods: Twenty-eight patients were randomized to receive either ferrous sulfate 325 mg b.i.d. or placebo for 12 weeks. The primary outcome measure was the dichotomous variable of improvement or no improvement in average quality of sleep as recorded by a visual analog scale nightly over a 2-week period, comparing a pretreatment 2-week baseline to weeks 13–14. Secondary outcome measures included a comparison of the quality of sleep as measured by a visual analog scale, effect of restless legs syndrome on life as a whole as measured by a different visual analog scale, and the percentage of nights patients were symptomatic. Results: No significant differences were noted between iron and placebo groups for both primary and secondary outcome measures. Responders taking iron did have a significant increase in their iron saturation compared to nonresponders taking iron. Conclusions: Iron sulfate does not appear to be an effective empiric treatment for restless legs syndrome.
Bleeding and Subsequent Anemia: A Precipitant for Cerebral Infarction
Authors: Kim Jong S. , Kang Suck Y.
Published: April 2003

Background and Objectives: The relationship between bleeding and subsequent anemia (BSA) and the occurrence of stroke has not been sufficiently studied. The purpose of the present study was to elucidate the characteristics of stroke associated with BSA. Methods: We studied 16 consecutive patients with acute stroke associated with anemia (hemoglobin level on admission ≤9.0 g/dl) and compared their stroke subtypes with those of 32 control subjects. Results: The cause of anemia was upper gastrointestinal bleeding in 11 patients (ulcers in 8; carcinomas in 2, and hemorrhagic gastritis in 1), bleeding from a hemorrhoid in 2, uterine cervical bleeding in 1, ecchymosis probably related to medication in 1, and chronic blood drainage in 1. At least 10 patients had a history of recent (<1 week), active bleeding. Clinical and imaging studies showed that all the patients had infarcts and none had intracerebral hemorrhages. Thirteen patients had infarcts in the region of the middle cerebral artery (MCA) (total MCA region in 2; partial, cortical area in 5; subcortical area in 5, and lenticulostriate artery region in 1), 2 had anterior cerebral artery (ACA) region infarction, and 1 had cerebellar infarction. All 11 patients who underwent vascular imaging studies showed significant stenosis and/or occlusion of the internal carotid artery (ICA) (n = 5), the MCA (n = 4), both the ICA and MCA (n = 1), or the ACA (n = 1). Of the different stroke subtypes (large vessel infarction (LVI), small vessel infarction, cardiogenic embolic infarction, intracerebral hemorrhage), LVI was significantly (p < 0.05) more frequent in patients with stroke associated with BSA than in the controls, even though the demographics and risk factors were similar in each group. Conclusions: The close temporal relationship between the bleeding and the onset of stroke, as well as the predominance of the LVI subtype in the BSA-associated group as compared to controls, suggest that BSA may precipitate atherothrombotic cerebral infarction. A hemodynamic alteration, enhanced thrombosis or a combination of these appears to be the pathogenic mechanism.
Increased Expression of Laminin 1 in the Skin of Amyotrophic Lateral Sclerosis
Authors: Ono Seiitsu , Imai Takashi , Shimizu Natsue , Nagao Koichi
Published: April 2003

Abnormalities of collagen and glycosaminoglycans of skin have been reported in patients with amyotrophic lateral sclerosis (ALS). However, little is known concerning laminin in ALS. The aim of this study is to evaluate laminin 1 immunohistochemistry of skin in ALS patients. We studied laminin 1 immunoreactivity of skin from 17 patients with ALS, 17 patients with other neurological or muscular diseases (control group A) and 10 patients without neurological or muscular disorders (control group B). The dermis, the epithelial basement membrane of the epidermal layer and the basement membrane of skin appendages and blood vessels of skin in ALS patients were significantly higher than in control groups A and B, and showed a significant positive correlation with the duration of illness in the optical density for laminin 1 immunoreactivity. In addition, there was an appreciable positive relationship in the laminin 1 immunoreactivity between the dermis and the basement membrane in ALS patients. These data suggest that alterations of laminin 1 in the skin of ALS patients could be related to the pathogenesis of ALS and may contribute to changes in the mechanical properties of the skin, resulting in the absence of bedsores in ALS patients.
Relative Frequencies of CAG Expansions in Spinocerebellar Ataxia and Dentatorubropallidoluysian Atrophy in 116 Italian Families
Authors: Filla A. , Mariotti C. , Caruso G. , Coppola G. , Cocozza S. , Castaldo I. , Calabrese O. , Salvatore E. , De Michele G. , Riggio M.C. , Pareyson D. , Gellera C. , Di Donato S.
Published: April 2003

Two hundred and forty-eight patients from 116 Italian families with dominant ataxia were studied for CAG expansion within SCA1, 2, 3, 6, 7 (spinocerebellar ataxia) and DRPLA (dentatorubropallidoluysian atrophy) genes. Fifty-six percent of the families originated from Southern, 19% from Central and 25% from Northern Italy. SCA2 was the commonest mutation, accounting for 47% of the families, followed by SCA1 (24%), SCA6 (2%), SCA7 (2%) and DRPLA (1%). No SCA3 family was found. Twenty-four percent of the families carried a still unidentified mutation. When occurrence of mutations was evaluated according to the geographic origin, SCA1 was the commonest in Northern (72%), whereas SCA2 was prevalent (63%) in Southern Italy. The number of CAG repeats in SCA1 normal alleles was higher in Northern than in Central-Southern Italy.
Remote Effects of Chronic Botulinum Toxin Treatment: Electrophysiologic Results Do Not Indicate Subclinical Remodelling of Noninjected Muscles
Authors: Fertl Elisabeth , Schnider Peter , Schneider Barbara , Auff Eduard
Published: April 2003

This study investigates the remote effects of botulinum toxin injections by examining the motor unit architecture of noninjected distant muscles. In 21 dystonia patients treated with botulinum toxin (n = 11, mean cumulative dose = 815 mU; n = 10, mean cumulative dose = 7,207 mU) and 10 control individuals, a blinded single-fiber electromyography of the vastus lateralis muscle was performed. The main outcome measure was fiber density (FD), thus measuring the effect of different cumulative doses on remote reinnervation. FD was normal in all patients treated with botulinum toxin. FD did not differ between the three groups studied. No relationship was found between FD and cumulative dose. Therefore, in this specific patient population, muscles remote to the site of injection showed no FD change months after the injection. We conclude that there was no evidence of remote reinnervation and remodelling of motor units with cumulative chemodenervation.
Cytomegalovirus Meningoencephalitis with Paroxysmal Course in Immunocompetent Adults: A New Nosographical Entity
Authors: Devetag F. Chalaupka , Boscariolo L.
Published: April 2003

An immunocompetent adult developed cytomegalovirus (CMV) meningoencephalitis with paroxysmal neurologic symptoms of a self-limited nature and with a favourable outcome. Consistent with known cases in the clinical literature, two clinical forms of CMV meningoencephalitis will be identified: a monophasic form and a paroxysmal form. The clinical, diagnostic and therapeutic aspects of the two types will be analysed, and a pathogenetic hypothesis for the paroxysmal type will be proposed.
Lipid Peroxidation Products and Antioxidant Capacity in Portal Venous and Systemic Arterial Plasma during Gradual Intestinal Ischemia and Reperfusion in Pigs
Authors: Juvonen P.O. , Paajanen H.E.K. , Heino A.A. , Koski E.J. , Merasto M. , Hartikainen J.E.K. , Kosma V.M. , Alhava E.M. , Takala J.A.
Published: April 2003

Intestinal ischemia may evoke an inflammatory response and eventually multiple organ failure. We investigated whether intestinal ischemic injury induces systemic lipid peroxidation and changes in the plasma antioxidant capacity in a pig model. Together with cardiovascular parameters, arterial and portal venous blood of 7 pigs were measured for thiobarbituric acid-reactive material diene conjugates, fluorescent chromolipids and plasma antioxidant capacity during graded occlusion of superior mesenteric artery and reperfusion. Plasma levels of lipid peroxidation products did not change significantly during graded ischemia and reperfusion. Portal venous plasma antioxidant capacity increased slightly during reperfusion (from 96.16 ± 3.91 to 142.49 ± 12.01 µmol/l, p < 0.05). Although elevated levels of free radical reaction products have been found in ischemia-reperfusion, we found no evidence of systemic lipid peroxidation in our intestinal ischemia model.
Perioperative Lavage Promotes Intraperitoneal Adhesion in the Rat
Authors: van Westreenen M. , van den Tol P.M. , Pronk A. , Marquet R.L. , Jeekel J. , Leguit P.
Published: April 2003

This study was designed to study the effect of peritoneal lavage solutions on postsurgical adhesion formation in rats undergoing laparotomy and standardized ischemic injury to the lateral peritoneum with sutures. This reproducible model enabled semiquantitative scoring of adhesion formation. Adhesions were induced in 33 adult female Wistar rats. The solutions RPMI medium, NaCl (0.9%), Viaspan® and both povidone-iodine (1%) and chlorhexidine (0.02%) in dilution were evaluated. In the control group that was operated upon (without peritoneal lavage), a mean adhesion percentage of 22.5% was scored. All solutions used for abdominal lavage in this rat model induced significantly (p = 0.0001) more adhesions (40.6–70.8%). Not all solutions induced an equal effect. The results found in the present in vivo study correlate with observations in previous in vitro experiments i.e. exposure of peritoneal areas to lavage solutions enhances peritoneal activation and thus promotes intra-abdominal adhesion formation.
Liver Ischemia Modifies the Concentration of Plasmatic Catecholamines after Reperfusion in the Rat
Authors: Zonta F. , Barbieri Annalisa , Frattini P. , Pettenazza P. , Gaspari Annalisa , Maestri M.O. , Zonta A.
Published: April 2003

Pulmonary hypertension is one of the most frequent and severe consequences of liver ischemia. The aim of this study is to evaluate the presence of humoral vasoactive mediators, generated during liver ischemia, which could be able to determine the onset of pulmonary hypertension. Thus, we evaluated the plasmatic concentration of catecholamines (adrenaline, noradrenaline, dopamine) during the immediate reperfusion period. Wistar rats were used. Animals (n = 89) were divided into four groups. Group 1 served as control (sham-operated). In group 2 animals underwent 60 min of left hepatic exclusion. In group 3 animals underwent to bilateral adrenectomy. In group 4 animals had both bilateral adrenectomy and liver ischemia. Ischemia in group 2 and 4 was induced by interrupting the vascular supply to the left and median lobes, so avoiding the use of a portal shunt. Blood samples were collected from the suprahepatic inferior caval vein immediately after reperfusion. Strips of the main pulmonary artery were put into an isolated organ bath and tested for the response to noradrenaline, adrenaline and plasma samples. Plasma samples collected after ischemia caused a significantly greater (p < 0.01) contraction of the pulmonary artery compared to controls. Plasma samples collected after adrenectomy caused a weak contraction which was not different from that obtained in the adrenectomy + ischemia group. Plasma concentrations of catecholamines after liver ischemia were significantly increased in the control group (p < 0.01). In adrenectomized rats only the adrenaline level was greatly reduced. However ischemia did not increase plasma catecholamines as it occurred in sham-operated rats.
Increased Production of Cytokines and Growth Factors by Aortic Allografts: A Possible Explanation for Myointimal Hyperplasia Formation
Authors: Sterpetti A.V. , Cucina Alessandra , Randone B. , Guglielmi M.B. , Fragale Alessandra , Cavallaro A.
Published: April 2003

Accelerated myointimal hyperplasia is a major complication of arterial allografts. The aim of our study was to analyze the role of growth factors in the genesis of myointimal hyperplasia in arterial allografts. Two groups of experiments were performed: Isografts and Allografts. The Isograft group consisted of 18 inbred Lewis rats in which a 1-cm long segment of aorta was inserted as abdominal aortic interposition graft. The aortic segments were obtained from syngeneic Lewis rats. The Allograft group consisted of 18 inbred Lewis rats, in which a 1-cm long segment of aorta was interposed at the level of the abdominal aorta. The aortic segments were obtained from allogeneic Brown-Norway rats. No immunosuppression was used. The animals were sacrificed 4 weeks after surgery and the aortic grafts were analyzed by light, electron microscopy (n = 3 for each group) and immunohistochemistry (n = 3 for each group). In addition, aortic segments (n = 12 for each group) were put in an organ culture to assess production of growth factors. All allografts showed evidence of severe myointimal hyperplasia, which was minimal in isografts. PDGF, bFGF and TGF-β1 production, generally considered to be the cause of myointimal hyperplasia, was not increased in allografts, whereas IL-1, TNF-α and GM-CSF production was increased in allografts and probably lymphocytes were the source of these cytokines (p < 0.001). We conclude that myointimal hyperplasia in aortic allografts is associated with an increase of IL-1, TNF-α and GM-CSF produced by lymphocytes.
Development of a Model for Measurement of Adhesion Strength of Fibrin Sealant to Human Tissue
Authors: Kjaergard H.K. , Velada J.L. , Pulawska T. , Ellensen V.S. , Larsen S.S. , Hollingsbee D.A.
Published: April 2003

It is crucial for the surgeon to know the physical properties of a surgical sealant. Current test methods of fibrin sealant involving animal testing or in vitro testing of sealant using artificial substrates have little clinical relevance. Most of these test methods also lack accuracy and reproducibility. A new model was developed for testing strength and in vitro adhesion of fibrin sealant to vital human tissue using fresh vein leftover from coronary artery bypass grafting. The vein leftover was cut into samples and fastened in a tensiometer linked to a computer. Patient-derived fibrin sealant (0.1 ml) was applied to the tissue, and the surfaces of the tissue samples were held together for 5 min, and then automatically pulled apart by the tensiometer. Data were generated in a load cell and recorded and analysed by the computer. The reproducibility for the adhesion strength was 6.6%, adhesion energy 9.8%, and elongation at break 8.4%. The method has been considered ethical and has good reproducibility. The method can be used for standardised measurements and comparison of different types of fibrin sealant without the sacrifice of animals.
Gastrectomy in the Rat Using Two Modifications of Esophagojejunal Anastomosis
Authors: Wojtyczka A. , Górka Z. , Bierzynska-Macyszyn G. , Rümenapf G. , Jonderko K. , Schwille P.O.
Published: April 2003

Gastrectomy (GX) was carried out in the male rat according to the Longmire and the Roux-en-Y procedure. The focus of the postoperative investigations was to evaluate the influence of post-GX morphological changes occurring at the site of two types of end-to-end esophagojejunal anastomosis (with and without invagination), in particular food intake, body weight gain, food efficiency, hematocrit and bone density. GX failed to alter food intake, fasting blood glucose, α-amino nitrogen, or free fatty acids, but led to uniformly decreased body weight, food efficiency and serum gastrin, and increased serum osteocalcin, indicating high turnover osteopenia. However, irrespective of the type of (digestive tract) reconstruction (Longmire or Roux-en-Y), the invagination anastomosis was associated with lower mortality, fewer complications, less early postoperative weight loss, less intensive tissue changes at the anastomotic site, and improvement of bone density and hematocrit. Bivariate and multivariate regression analysis revealed that bone density was negatively influenced by epithelial hyperplasia of the anastomotic tissue, while hematocrit was positively influenced by bone density. In contrast, food intake appeared to have no influence. It was concluded that (1) the histological status of the esophagointestinal anastomosis varies depending on the surgical technique applied and (2) the type of anatomical reconstruction of the digestive tract (Longmire vs. Roux-en-Y) and food intake may be of minor importance for the bone and hematological status of GX rats. Future investigations are justified to clarify whether esophagojejunal proinflammatory tissue factors may contribute to the GX-mediated damage of bone mineral and bone marrow, thereby leading to low body weight.
Effect of Artificial Valves on Intestinal Adaptation in the Short-Bowel Syndrome: An Integrated Study of Morphological and Functional Changes in Rats
Authors: Willis S. , Klosterhalfen B. , Titkova S. , Anurov M. , Polivoda M. , Max M. , Öttinger A.P. , Schumpelick V.
Published: April 2003

Two-third-resections of the proximal or distal small bowel with and without artificial valves were performed in rats. Intestinal adaptation led to a significant increase in bowel diameter, villus height and villus diameter and consequently in absorptive mucosal surface area per unit of serosal area. Additional artificial valve construction did not affect the calculated mucosal surface area after proximal resection, while it significantly decreased the absorptive area by the occurrence of large, plump villi after distal resection. There was no change in small-intestinal absorption of water, glucose and electrolytes per unit mucosa with valve construction. DNA cytometry showed that artificial valves led to mucosal hyperplasia without hypertrophy. These morphological changes coincided with a significant increase in basal and stimulated gastrin release. The body weight was unchanged or even worse in the valve groups than after resection alone, despite a significantly prolonged transit time. Therefore, in our study, artificial valves did not result in functional improvements after small intestinal resections.
Three-Dimensional Ultrasonographic Visualization of Multiple Pregnancy
Authors: Hata Toshiyuki , Aoki Showa , Miyazaki Kohji , Iwanari Osamu , Sawada Kohji , Tagashira Toshihiro
Published: April 2003

Our purpose was to describe interrelationships and contacts between twins in utero by use of three-dimensional ultrasonography with a specially developed abdominal three-dimensional transducer. Thirteen twin pregnancies (3 monochorionic and 10 dichorionic pairs) and one triplet pregnancy (trichorionic triplet) from 9 to 36 weeks of gestation were studied with a specially developed abdominal three-dimensional transducer (3.5 MHz). This imaging system can provide conventional two-dimensional ultrasonography images and can also generate within seconds high-quality three-dimensional images in the surface and transparent mode with no need for an external workstation. Interrelationships and contacts between twins or triplets are described. Various types of contacts (head/body/arm/leg) and interrelationships were clearly visualized. Crowding of in utero twin fetuses increased with advancing gestation. Sometimes two placentas and dividing membrane were beautifully depicted. In one triplet pregnancy, the interrelationships among 3 fetuses and dividing membranes were easily recognized. Three-dimensional ultrasonography provides a novel means of visualizing multiple pregnancies in utero. These results suggest that three-dimensional ultrasonography has the potential to be a supplement to two-dimensional ultrasonography and would be useful in evaluating the interhuman contacts and crowdings of twin and triplet fetuses in utero.