bluuebunny/crossref_metadata_2025 huggingface dataset:
Carcinosarcoma Of The Esophagus With Osseous And Cartilagenous Production A Combined Study Of Keratin Immunohistochemistry And Electron Microscopy
Authors: Hanada Masato , Nakano Kazuo , Ii Yohei , Yamashita Hiroshi
Published: January 2011

A case of polypoid carcinosarcoma of the esophagus is presented. Histologically the bulk of the tumor consisted of a sarcomatous tissue having large foci of osseous and cartilagenous differentiation and infiltrating deeply the wall, whereas a superficially, invasive squamous cell carcinoma associated with insitu carcinoma was located at the base and luminal surface of the polypoid tumor. Intermingling of the carcinomatous and sarcomatous elements was found only in areas where they appeared to be collided. Ultrastructurally the sarcomatous portion contained cells with fibroblastic features but with no typical epithelial characteristics. Immunoperoxidase staining of the paraffinembedded histologic sections for keratin proteins revealed, however, some positive spindle cells indicative of epithelial nature in the sarcomatous area, but the great majority of the sarcoma cells were devoid of keratin. These combined findings strongly suggest that the sarcomatous component in our case of true carcinosarcoma is derived from mesenchymal transformation (metaplasia) of the squamous carcinoma cells. The findings were discussed in light of the previous pertinent literature. ACTA PATHOL, JPN. 34: 669–678, 1984.
Inhibitor of plasminogen activator in human arterial wall: I. Histochemical Study
Authors: Okamura Takashi , Nanno Shigeru , Sueishi Katsuo , Tanaka Kenzo
Published: January 2011

An inhibitor of urokinase, human urinary plasminogen activator, was found in the media of human arteries using a histochemical method (fibrin slide sandwich technique). Arteriosclerotic lesions, especially atherosclerosis, apparently contained the urokinase inhibitor. The inhibitor did not alter plasmin activity. This inhibitor of urokinase may be involved in regulation of fibrinolysis in arterial wall and thus a significant role in atherogenesis.

Acta pathol. jpn. 34: 743∼747, 1984.
Junctions between intraepithelial carcinoma and non‐neoplastic tissue of the esophagus
Authors: Takubo Kaiyo , Nishimura Hiroshi , Taniguchi Yoshiro , Sasajima Koji , Nakagawa Hitoshi , Miyamoto Hiroyasu , Fujita Kichishiro
Published: January 2011

This report describes light and electron microscopic observations in 11 patients with intraepithelial carcinomas concomitant with invasive squamous cell carcinomas of the esophagus. The junctions between the intraepithelial carcinomas and non‐neoplastic tissues were examined using an electron microscope. Vertical sections through the basal laminae revealed intraepithelial carcinomas with bulky outgrowths and simple replacement histological patterns. The bulky outgrowths contained many pseudopodial cytoplasmic projections from the tumor cells through the basal laminae, while the simple replacement patterns included rare small breaks in the basal laminae. Horizontal sections parallel to the basal laminae showed that the cells of the poorly differentiated squamous cell carcinoma were readily distinguishable from the non‐neoplastic cells in the surface layer of the esophageal epithelia and distinctly smaller and darker than the normal prickle cells. At most of the junctions, mesenchymal cells, degenerated cells, and amorphous material separated the tumor cells from the non‐neoplastic epithelial cells. However, tumor cells were occasionally attached directly to normal epithelial cells with well‐developed desmosomes. Ductal involvement of the carcinomas was found in the submucosal esophageal gland proper. The tumor cells invaded between the ductal cells and basal laminae, and neoplastic cells were also directly attached to the benign ductal cells by poorly‐developed desmosomes. The host‐tumor junctions in the intraepithelial carcinomas of the human esophagus consisted of basal laminae with hemidesmosomes and pseudopodial projections, mesenchymal cell accumulations and direct attachments with desmosomes.

Acta pathol. jpn. 34: 785∼796, 1984.
Leiomyomatosis in the pelvic lymph node and peritoneum
Authors: Horie Akio , Ishii Nobuyoshi , Matsumoto Motoko , Hashizume Yoichi , Kawakami Masao , Sato Yoichi
Published: January 2011

This paper is concerned with a rare clinical entity, i.e. leiomyomatosis of pelvic promontory lymph node in a 50−year‐old Japanese woman and leiomyomatosis peritonealis disseminata in a 41−year‐old one. Despite such daughter nodules, all of the leiomyomas showed benign histological features. Morphogenesis of the discontinuous leiomyomas was discussed in relation to pelvic endometriosis. Because of a favorable prognosis in the leiomyomatosis, no more aggressive therapy than that necessary to extirpate the tumor is recommended. Acta pathol. jpn. 34: 813∼819, 1984.
Regional lymph node involvement in benign renal angiomyolipoma
Authors: Manabe Toshiaki , Tasaka Yoshikazu , Amano Masamichi , Okunobo Takeshi
Published: January 2011

A case of angiomyol***ipoma of the kidney with the involvement of regional lymph nodes and adjacent adipose tissue is reported. Histology of the tumor was essentially benign in either location. During three years of follow‐up period, no recurrence or distant metastasis has appeared. It was considered that the tumor was benign and that the regional lymph node involvement probably represents a multicentric hamartomatous or choristomatous growth. In such an example, it is suggested that additional treatment such as radiation or chemotherapy should be avoided until a definitive evidence of distant metastasis is obtained. Acta pathol. jpn. 34: 889∼893, 1984.
Siblings with carbamyl phosphate synthetase i deficiency
Authors: Asanuma Katsumi , Takeuchi Yutaka , Kanda Mikio , Kikuchi Yoshitomo , Yano Naoki , Kakinuma Hiroaki
Published: January 2011

This paper concerns with two autopsied cases of siblings who died from cerebral disturbances. In these patients hyperammonemia developed in the neonatal phase due to carbamyl phosphate synthetase I (CPS I) deficiency. The patient in Case 1 was admitted 2 days after birth because of oliguria and vomiting. Hyperammonemia developed and she died on the 43rd day. In Case 2 hyperammonemia developed from the 2nd day after birth and she expired on the 42nd day. In both cases the diagnosis of CPS I deficiency was established from autopsy findings of the liver. Acta pathol. jpn. 34: 901∼910, 1984.
An Immunohistochemical Study
Authors: Kakudo Kennichi , Uematsu Kunio , Suehiro Mitsuko , Fukuchi Minoru
Published: January 2011

C cell proliferation of the thyroid, which was designated as primary C cell hyperplasia (PCCH), was demonstrated in aged Fischer 344 rats in high incidence using the immunohistochemical method for calcitonin. It developed from mild to severe PCCH and resulted in nodular PCCH and tumor formation. The combined incidence of PCCH and nodular PCCH was increased with age and appeared in 60.7% of 7–15 month old group and 92.7% of 16–24 month old group possibly as a preneoplastic C cell lesion. It is almost an equivalent C cell lesion reported in the human thyroid with familial C cell carcinoma and therefore this Fischer 344 rat can provide a useful animal model to study familial C cell tumor of the thyroid.
Histopathological and Immunohistochemical Study of Neuroendocrine Tumors of the Rectum
Authors: Shimoda Tadakazu , Ishikawa Eisei , Sano Toshiaki , Watanabe Kunitake , Ikegami Masahiro
Published: January 2011

A clinicopathological and immunohistochemical study was carried out on 32 cases of neuroendocrine tumors of the rectum. Typical carcinoids consisted of 27 cases, histologically showing uniform round to columnar cells forming solid alveolar nests and ribbon‐like or trabecular arrangement. Neuroendocrine carcinomas consisted of 5 cases in which tumor cells with prominent nuclear atypism were arranged in a ribbon‐like or trabecular fashion and formed gland‐like structures. There were also small round tumor cells resembling lymphocytes. The prognosis of neuroendocrine carcinomas is very poor with marked tumor invasion of lymphatics and veins resulting in liver metastases and death within one year after operation. Thirty cases out of the 32 showed a positive argyrophil reaction, while immunohistochemistry of 29 cases revealed more than one peptide hormone in 23 cases. The most common hormone was somatostatin being present in 18 of the 23 tumors and glucagon in 16 of the 23 tumors. Gastrin/CCK and calcitonin were proven in 6 of the 23 tumors and in 4 of the 23 tumors, respectively. On the other hand, more than two hormones was present in 15 of the 23 tumors examined. Histologically, neuroendocrine tumors have a very wide spectrum. Histogenetically, typical carcinoids and neuroendocrine carcinomas are considered to be of the same origin with the former showing morphological and functional differentiation to endocrine cells and the latter being more undifferentiated.
High Incidence of Peliosis Hepatis in Autopsy Cases of Aplastic Anemia With Special Reference to Anabolic Steroid Therapy
Authors: Wakabayashi Takashi , Onda Hiroyuki , Tada Toyohiro , Iijima Moritake , Itoh Yoshio
Published: January 2011

The livers were collected from 47 autopsy cases of aplastic anemia aiming to study the correlation between the use of androgenic anabolic steroid and the formation of peliosis hepatis. Association of peliosis hepatis was found in 7 cases out of 19 cases with anabolic steroid therapy, while peliotic cavities were found only in one case out of the remaining 28 cases without anabolic steroid therapy. Out of 7 cases specified above, peliotic cavities in 5 cases were phlebectatic; phlebectatic and parenchymal types of peliotic cavities coexisted in one case, and one case was parenchymatous. Besides these cavity formations, remarkable dilatation of sinusoids often distinct at the periphery of the hepatic lobule was found in the 7 cases.
Argyrophil Cells in the Urachal Epithelium and Urachal Adenocarcinoma
Authors: Satake Tatsunari , Takeda Akihiro , Matsuyama Mutsushi
Published: January 2011

Urachal adenocarcinoma, normal urachus, and urinary bladder were studied by histochemichal methods and electron microscopy. Many argyrophil cells were found in urachal adenocarcinoma and urachal epithelium. Autofluorescence and immunoperoxidase examinations showed that the argyrophil cells possessed serotonin, glucagon, and secretin. Some of the carcinoma cells and urachal epithelial cells contained fairly large amount of mucosubstances. On the other hand, only a few argyrophil cells and very weakly PAS positive cells were observed in the urinary bladder mucosa. This study showed that there were close similarities in the histochemical and electron microscopical features between the urachal carcinoma and urachal epithelium, and suggested that the undifferentiated stem cells were able to differentiate to both glandular and endocrine cells.
Extracellular polymeric substances from Shewanella sp. HRCR‐1 biofilms: characterization by infrared spectroscopy and proteomics
Authors: Cao Bin , Shi Liang , Brown Roslyn N. , Xiong Yijia , Fredrickson Jim K. , Romine Margaret F. , Marshall Matthew J. , Lipton Mary S. , Beyenal Haluk
Published: January 2011

The composition of extracellular polymeric substances (EPS) from Shewanella sp. HRCR‐1 biofilms was investigated using infrared spectroscopy and proteomics to provide insight into potential ecophysiological functions and redox activity of the EPS. Both bound and loosely associated EPS were extracted from Shewanella sp. HRCR‐1 biofilms prepared using a hollow‐fibre membrane biofilm reactor. Fourier transform infrared spectra revealed the presence of proteins, polysaccharides, nucleic acids, membrane lipids and fatty acids in the EPS fractions. Using a global proteomic approach, a total of 58 extracellular and outer membrane proteins were identified in the EPS. These included homologues of multiple Shewanella oneidensis MR‐1 proteins that potentially contribute to key physiological biofilm processes, such as biofilm‐promoting protein BpfA, surface‐associated serine protease, nucleotidases (CpdB and UshA), an extracellular lipase, and oligopeptidases (PtrB and a M13 family oligopeptidase lipoprotein). In addition, 20 redox proteins were found in extracted EPS. Among the detected redox proteins were the homologues of two S. oneidensis MR‐1 c‐type cytochromes, MtrC and OmcA, which have been implicated in extracellular electron transfer. Given their detection in the EPS of Shewanella sp. HRCR‐1 biofilms, c‐type cytochromes may contribute to the possible redox activity of the biofilm matrix and play important roles in extracellular electron transfer reactions.
Metabolic syndrome and leptin are associated with adverse pathological features in male colorectal cancer patients
Authors: Healy L. A. , Howard J. M. , Ryan A. M. , Beddy P. , Mehigan B. , Stephens R. , Reynolds J. V.
Published: January 2011

Aim  Metabolic syndrome (MetS) describes a clustering of factors including central obesity, hypertension and raised plasma glucose, triglycerides and high‐density lipoprotein (HDL) cholesterol. Central obesity is associated with a risk for colorectal cancer, but the impact of MetS on colorectal cancer biology and outcomes is unclear.

Method  A prospective observational study of colorectal cancer patients was carried out in an Irish population. Patients underwent metabolic and anthropometric assessment before treatment, including measurement of serum hormones and adipokines and CT measurement of visceral fat. MetS was defined according to the International Diabetes Federation definition3.

Results  One‐hundred and thirty consecutive colorectal cancer patients (66 men and 64 women) were recruited. MetS was diagnosed in 38% patients compared with the population norms reported at 21%21. Male patients had a significantly greater visceral fat area compared with female patients. MetS was associated with node‐positive disease (P = 0.026), percentage nodal involvement (P = 0.033) and extramural vascular invasion (P = 0.049) in male patients but no significant association was observed in female patients. HDL cholesterol was also significantly associated with a more advanced pathological stage (P = 0.014) and node‐positive disease (P = 0.028). Leptin was associated with nodal status (P = 0.036), microvascular invasion (P = 0.054), advanced pathological stage (P = 0.046) and more advanced Dukes stage (P = 0.042).

Conclusion  We report a high prevalence of MetS and visceral obesity in a colorectal cancer population. MetS and plasma leptin are associated with a more aggressive tumour phenotype in male patients only.
Allometric Scaling for Character Design
Authors: McGraw T. , Kawai T. , Richards J.
Published: January 2011

Geometric scaling transformations do not respect the biological processes which govern the size and shape of living creatures. In this paper, we describe an approach to scaling which can be related to biological function. We use known biological laws of allometry which are expressed as power laws to control the mesh deformation in the frequency domain. This approach is motivated by the relation between fractal biological systems and their underlying power‐law spectra. We demonstrate our approach to biology‐aware character scaling on triangle meshes representing quadrupedal mammals.
The Civilizing Process of Trust: Developing Quality Mechanisms which are Local, Professional‐led and thus Legitimate
Authors: Brown Patrick R. , Calnan Michael
Published: January 2011

‘Quality’ and ‘performance’ have become defining concepts for policymakers and health‐care systems alike. Yet whilst these principles are of fundamental importance, their practical implementation and assurance are far from straightforward. This commentary analyses the difficulties faced in enhancing quality and performance in the English NHS. Many recent initiatives have been driven through incentives and external auditing of the professionals providing health care on the frontline. Drawing on recent literature and research findings, we argue that this checking‐based ‘audit culture’ is fundamentally flawed in driving quality and performance. Many targets and measures are too crude to reflect important aspects affecting patient outcomes and therefore these frameworks lack legitimacy amongst professionals. An alternative, trust‐based model is proposed – one more capable of acknowledging the meaning, complexity and specificities inherent to professional work. Quality mechanisms developed locally by professionals are able to produce the legitimacy crucial for their effectiveness. It is argued that the normative obligation of approaches based on conditional trust is a more compelling incentive towards good practice than targets and sanctions. This governance by ‘the social’ is able to motivate a more holistically enlightened and consistent reflexivity towards practice, though it is only able to flourish in the absence of purposive‐rational systems.
Verb‐Noun Collocations in Second Language Writing: A Corpus Analysis of Learners’ English
Authors: Laufer Batia , Waldman Tina
Published: January 2011

The present study investigates the use of English verb‐noun collocations in the writing of native speakers of Hebrew at three proficiency levels. For this purpose, we compiled a learner corpus that consists of about 300,000 words of argumentative and descriptive essays. For comparison purposes, we selected LOCNESS, a corpus of young adult native speakers of English. We retrieved the 220 most frequently occurring nouns in the LOCNESS corpus and in the learner corpus, created concordances for them, and extracted verb‐noun collocations. Subsequently, we performed two types of comparisons: learners were compared with native speakers on the frequency of collocation use and learners were compared with other learners of different second‐language proficiencies on the frequency and correctness of collocations. The data revealed that learners at all three proficiency levels produced far fewer collocations than native speakers, that the number of collocations increased only at the advanced level, and that errors, particularly interlingual ones, continued to persist even at advanced levels of proficiency. We discuss the results in light of the nature of collocations and communicative learning and suggest some pedagogical implications.
Scientific Explanation and Moral Explanation*
Authors: Leibowitz Uri D.
Published: January 2011

Moral philosophers are, among other things, in the business of constructing moral theories. And moral theories are, among other things, supposed to explain moral phenomena. Consequently, one's views about the nature of moral explanation will influence the kinds of moral theories one is willing to countenance. Many moral philosophers are (explicitly or implicitly) committed to a deductive model of explanation. As I see it, this commitment lies at the heart of the current debate between moral particularists and moral generalists. In this paper I argue that we have good reasons to give up this commitment. In fact, I show that an examination of the literature on scientific explanation reveals that we are used to, and comfortable with, non‐deductive explanations in almost all areas of inquiry. As a result, I argue that we have reason to believe that moral explanations need not be grounded in exceptionless moral principles.
Spotty Scope and Our Relation to Fictions*
Authors: Button Tim
Published: January 2011

Whatever the attractions of Tolkein's world, irrealists about fictions do not believe literally that Bilbo Baggins is a hobbit. Instead, irrealists believe that, according to The Lord of the Rings {Bilbo is a hobbit}. But when irrealists want to say something like “I am taller than Bilbo”, there is nowhere good for them to insert the operator “according to The Lord of the Rings”. This is an instance of the operator problem. In this paper, I outline and criticise Sainsbury's (2006) spotty scope approach to the operator problem. Sainsbury treats the problem as syntactic, but the problem is ultimately metaphysical.
Confronting Many‐Many Problems: Attention and Agentive Control
Authors: Wu Wayne
Published: January 2011

I argue that when perception plays a guiding role in intentional bodily action, it is a necessary part of that action. The argument begins with a challenge that necessarily arises for embodied agents, what I call the Many‐Many Problem. The Problem is named after its most common case where agents face too many perceptual inputs and too many possible behavioral outputs. Action requires a solution to the Many‐Many Problem by selection of a specific linkage between input and output. In bodily action the agent perceptually selects, and in this way perceptually attends to, relevant information so as to guide the execution of specific movements. Since perceptual attention is a necessary part of solving the Many‐Many Problem, it is a necessary part of bodily action. Indeed, the process of implementing a solution to the Many‐Many Problem, as constrained by the agent's motivational state, just is the agent's performing an intentional bodily action in the relevant way.
Guillain‐Barré syndrome with severe persistent disability: relationship to hyperacute Guillain‐Barré syndrome
Authors: Palace J.A. , Hughes R.A.C.
Published: January 2011

Guillain‐Barré syndrome (GBS) is a heterogeneous condition with a variable prognosis. We studied nine patients who were unable to walk unaided 12 months after the onset of their illness to discover whether they belonged to a more homogeneous subgroup. Sis of the nine patients had symptoms of gastroenteritis shortly before the onset of their neuropathic symptoms and a hyperacute onset of weakness so that they were bed‐bound within 24 h. These patients had predominantly motor rather than sensory involvement We compared these nine poor outcome patients with 66 patients with lesser degrees of persistent disability of whom only three had both a history of prodromal gastroenteritis and a hyperacute onset (p < 0.0001). The poor and better outcome groups did not differ significantly in the severity of disability or other clinical or neurophysiological features in the acute stage. Patients with previous gastroenteritis and hyperacute onset of weakness may represent a relatively homogeneous subgroup of “hyperacute GB” in which severe axonal damage is caused by an aberrant immune response to a gastrointestinal pathogen such as Campylobacter jejuni.
Clinical course and risk factors of neurotoxicity following cisplatin in an intensive dosing schedule
Authors: Hilkens P.H.E. , Planting A.S.T. , van der Burg M.E.L , Moll J.W.B. , van Putten W.L.J. , Vecht Ch.J. , van den Bent M.J.
Published: January 2011

An intensive weekly regimen of cisplatin was administered to 66 patients with solid cancer in doses varying from 70 to 85 mg/m2. The occurrence of sensory neuropathy was prospectively examined by assessment of neuropathic signs and symptoms and measurement of vibration perception threshold (VPT). Evaluation was performed before initiation of therapy and during follow‐up until 3–12 months after the last cycle of cisplatin. A mild or moderate neuropathy developed in 47% of patients at 2 weeks after treatment This neuropathy continued to deteriorate until approximately 3 months after cessation of chemotherapy leading to a mild or moderate neuropathy in 71% of patients and a severe neuropathy in 9% of patients. Thereafter we observed a gradual but incomplete recovery. The high incidence of neuropathy we found may be explained by the prolonged observation period compared with earlier reports. The only factor correlated with severity of neuropathy was the cumulative dose of cisplatin, while there was no association with either pre‐treatment VPT, age, sex, tumor type or co‐treatment with etoposide. The progressing course up to approximately 3 months after the end of treatment underscores the need for prolonged follow‐up in future studies on cisplatin neuropathy.‐
The relevance of clinical subtypes for disease course, family history and epidemiological variables in Parkinson's disease
Authors: Röhl A. , Friedrich H.‐J. , Ulm G. , Vieregge P.
Published: January 2011

Clinical outcome and relevance of genetic and epidemiological factors were evaluated in 161 patients with idiopathic Parkinson's disease (PD) with regard to onset symptoms [tremor (T) vs non‐tremor (NT)], to clinical classification into tremor‐dominant (TD), alkineto‐rigid (AR), and equivalent (EQ) subtypes, and to disease onset before the 45th year of age (EO) and after age 69 (LO). Patients were investigated by questionnaire‐based personal interview and clinical examination. Allegedly symptomatic first‐degree relatives were examined personally or had sufficient medical documentation to allow neurological diagnosis. Disease course was more favorable in T than in NT, in TD than in AR or EQ, and in EO compared with LO. Among EO and LO patients, clinical subtypes TD, AR and EQ were not differently distributed. Frequency of first‐degree relatives with PD or essential tremor and any epidemiological variable tested were not elicited differently between TD, AR and EQ patients, with the exception that TD reported more frequent premorbid travelling. EO patients reported higher frequencies of premorbid head trauma and rural living than LO patients. The more favorable disease prognosis of patients with predominant tremor at presentation and of patients with early disease onset is corroborated. Clinical subgroups do not differ in genetic and epidemiological factors.
Vertical saccade palsy: a presenting sign of Niemann‐Pick type IIS
Authors: Shawkat F.S. , Carr L. , West P. , Taylor D.S.I. , Surtees R. , Harris C.M.
Published: January 2011

An 8 year old sister of a patient undergoing investigations for Niemann‐Pick type IIS was observed to have mild difficulties in making downward saccades. She had no other symptoms apart from longstanding mild learning difficulties. Detailed eye movement assessment, using horizontal and vertical electro‐oculography and video monitoring, revealed normal horizontal but abnormal vertical eye movements. Vertical downward saccades were absent and could only be achieved by mobilizing the bead to allow for headthrusts. Upward saccades were present at initial presentation, however a subsequent recording after 10 months revealed an inability to make upward saccades unless accompanied by blinks. Vertical optokinetic nystagmus was absent, although vertical smooth pursuit and vestibular ocular reflex were present. Cultured skin fibroblasts showed defective cholesterol esterification which confirmed the diagnosis of Niemann‐Pick type IIS (previously known as type C). Vertical saccade palsy has been described as part of the neurological deficits, however it has not been previously reported as the presenting sign of Niemann‐Pick type IIS.
Chronic paraparesis associated with human T‐lymphotropic virus type I beginning after dental extraction
Authors: Jiménez‐Jiménez F.J. , García‐Albea E. , Cabrera‐Valdivia F. , Ayuso‐Peralta L. , Tejeiro J. , Vaquero A.
Published: January 2011

We report a patient with a chronic paraparesis associated with human T‐lymphotropic virus I infection (HTLV‐I antibodies were present in blood and CSF), which began after a dental extraction. We suggest the possible relation of the dental procedure with the triggering of the disease.
Diagnostic problems in “clinically definite” multiple sclerosis patients with normal CSF and multiple MRI abnormalities
Authors: Fieschi C. , Gasperini C. , Ristori G. , Bastianello S. , Girmenia F. , Leuzzi V. , Buttinelli C. , Pozzilli C. , Rasura M.
Published: January 2011

Among patients who underwent cerebrospinal fluid (CSF) and magnetic resonance imaging (MRI) examination during a 5‐year period, we found 18 patients at the multiple sclerosis center of the University of Rome and clinically definite multiple sclerosis, MRI white matter abnormalities, normal CSF examination, a disease duration of at least 1 year and an upper age of < 45 years at onset These patients were examined again with a variety of tests screening for different diseases mimicking multiple sclerosis. Alternative diagnoses reached after laboratory tests were: Lyme disease, two cases of vasculitis, mitochondrial encephalomyopathy, multiple ischemic lesions caused by atrial septum aneurysm and olivopontocerebellar atrophy. Hence, six of these 18 patients had a final diagnosis other than multiple sclerosis, while 12 remained with a final diagnosis of “MS with normal CSF”. Our study suggests that in patients with a clinical picture of multiple sclerosis and disseminated white matter MRI lesions but no CSF abnormalities, the classical clinical criteria may not be sufficiently specific, unless confirmed by a very prolonged clinical history with repeated MRI.
Bilateral thalamic damage, cortical hypometabolism and behavioural disturbances
Authors: de Falco F.A. , Soricelli A. , Majello L. , Modafferi A. , Grossi D.
Published: January 2011

Thalamic damage could be responsible for reduced metabolism in anterior cortical areas. In order to investigate an anatomical lesion and impairment of regional blood flow (rCBF) in distant cortical areas, we studied by magnetic resonance imaging (MRI) and single photon emission computed tomography (SPECT) a patient with bilateral thalamic infarction, who presented with sudden consciousness impairment, drowsiness, gaze paralysis, dysphagia and bilateral Babinski sign. Three weeks later the neurological symptoms disappeared, but a severe mental deterioration was evident MRI showed thalamic bilateral damage of posterior and medial areas, involving part of the pulvinar, more evident for the right thalamus. A 99mTc‐HMPAO SPECT showed a decrease of rCBF over frontal and parietal regions, more evident for the right hemisphere. Six months later a severe memory impairment was still evident and MRI and SPECT picture were unchanged. The persistent memory defect could be related to a loss of cortical activation following the thalamic damage. The absence of primary lesions of cortical regions on CT scan and MRI and the neuroanatomical considerations on the diffuse projections running from medial nuclei and pulvinar to large parts of anterior neocortex supported this hypothesis.
Neurosonographic findings in dementia
Authors: Ni X.S. , Horner S. , Schmidt R. , Augustin M. , Niederkorn K.
Published: January 2011

We performed neurosonographic examinations in 19 patients with vascular dementia (VD) and compared these findings with those in 21 patients with dementia of the Alzheimer type (DAT) and in 20 controls. There were no significant differences in age and sex among these three subject groups. The severity of dementia quantified by the Mini‐Mental State Examination and Mattis Dementia Rating Scale did not reveal significant differences between VD and DAT. We found that carotid stenosis > 50% or occlusion was more frequent in VD compared to controls. The mean flow velocities of both the middle cerebral artery (MCA) and the basilar artery (BA) were decreased in VD and DAT compared with controls. This decrease was statistically significant for left MCA, but not for right MCA and BA. However, we did not find any significant differences between VD and DAT for the mean flow velocities of both MCA and BA.
Central motor conduction as a measure of disease progression in early multiple sclerosis
Authors: Ravnborg M. , Sørensen P. Soelberg , Christiansen P. , Blinkenberg M.
Published: January 2011

We monitored disease progression in 27 patients with clinically or laboratory‐supported definite multiple sclerosis by means of clinical assessments [expanded disability status scale (EDSS), and the neurologic rating scale (NRS)] repeated at 6 month intervals for 2 years. Each clinical assessment was accompanied by evoked potentials (EP; visual, brain stem auditory, and somatosensory evoked potentials), motor evoked potentials elicited by magnetic stimulation, and magnetic resonance imaging of the brain and brain stem. Central conduction indices were calculated for each central pathway. According to the EDSS 18 patients deteriorated, eight were unchanged and one improved. The central motor conduction index (CMCI) was the only conduction parameter which correlated significantly with both EDSS and NRS at baseline [rho=0.51 (EDSS); ‐0.65 (NRS)], at final investigation, and when individual changes from baseline to final investigation were addressed (rho=0.38; ‐0.38). Individual deteriorations or improvements of the CMCI during the 2 years correlated with changes in both EDSS and NRS (rho = 0.51; ‐0.38). The MRI parameters did not correlate with the clinical scores. The concordance between MRI and CMCI in detection of disease activity was 63%. We conclude that the CMCI stands out as an objective, accurate and easily obtained outcome parameter.
Muscle activity changes in spasmodic torticollis after botulinum toxin treatment
Authors: Marin C. , Martí M.J. , Tolosa E. , Alvarez R. , Montserrat L. , Santamaria J.
Published: January 2011

We assessed electromyographic (EMG) activity in neck muscles before and after botulinum toxin injections in 28 patients with spasmodic torticollis (ST) to investigate possible changes in muscle activation after treatment. A six‐channel EMG with surface electrodes was used to record activity of sternocleiodomastoid, trapezius and splenius capitis bilaterally. Objective benefit (>25% reduction in Tsui's score) occurred in 22 patients (78%). Of the 168 muscles studied before botulinum toxin injections, 90 presented EMG activity. Sixty‐eight of these muscles were injected and a decrease in EMG activity occurred in 44 (65%) of them. A decrease in EMG activity was also detected in 15 (68%) of those which were not injected. On the other hand, 70 of the 78 muscles without pre‐botulinum toxin EMG activity were not injected. However, after treatment, EMG activity increased in 37 (52%) of these muscles. These changes involved 18 patients and occurred without concomitant change in the main direction of head deviation despite the improvement observed in most cases. These results suggest that in ST head turning results from an abnormal central motor program which results in non‐specific neck muscle activation.
Clinical intra‐ and interfamilial variability of cluster headache
Authors: Russell M.B. , Andersson P.G.
Published: January 2011

Our recent description of a 17‐ and 2‐fold increased risk of cluster headache among first‐ and second‐degree relatives, respectively, strongly suggests that cluster headache has a genetic cause. Eighteen families with familial occurrence of cluster headache according to the criteria of the International Headache Society were included. Clinical intra‐ and interfamilial variability of cluster headaches was analyzed in 44 cases (31 males and 13 females) from 18 families. None of the families showed a distinctive pattern of symptoms except for the two families with chronic cluster headache. Their affected male relatives had a high number (1–8) of attacks per day in their cluster periods. Children had a significantly lower age at onset than parents (p = 0.018), but it is uncertain whether this is a real phenomenon or caused by memory bias. However, the possible existence of anticipation is important in the search for the gene. Co‐occurrence of migraine with and without aura was not increased in familial cases of cluster headache compared with the prevalence of migraine with and without aura in the Danish population, implying different etiologies. Our results suggest that episodic, chronic and chronic cluster headaches evolved from episodic have a common etiology and genetic heterogeneity is unlikely on clinical grounds.
Hereditary juvenile parkinsonism with pyramidal signs and mental retardation
Authors: Quinn N.P. , Goadsby P.J. , Lees A.J.
Published: January 2011

We describe two patients who developed, in the first and second decades of life, mental retardation, some limitation of up gaze, poorly levodopa‐responsive parkinsonism and pyramidal signs. Recessive inheritance is suggested by the fact that they were subsequently found to be first cousins from consanguineous unions. A number of different possible diagnoses were considered, but despite extensive investigation these patients, who are both still living, thus far appear to be unique. In particular, unlike most cases of alleged “pallido‐pyramidal disease” in the literature, we do not feel it justifiable to use this denomination in the absence of either pathological or in vivo imaging evidence of pallidal involvement
Intracranial pressure is a fraction of arterial blood pressure
Authors: Gustafsson O. , Rossitti S.
Published: January 2011

The relation between cerebrospinal fluid pressure (pcsf) and arterial blood pressure (pa) was studied in pigs and in rabbits before and after an ischemia‐induced impairment of the cerebral autoregulation, in order to predict the effect of changes of pa on the pcsf. Before the ischemic brain episode no clear correlation between pa and pcsf was found. A close dependence emerged after the ischemic episode, and after each change in pa the pcsf assumed immediately a new stationary level. The results suggest that intracranial pressure is at any moment a fraction of arterial blood pressure quantitatively determined by the coordinated action of cerebrovascular resistance, i.e. arteriolar resistance Ra, regulated by vasomotor tonus, and venous resistance Rv, which is mechanically passive in the same manner as a Starling resistor device. The relation is given by pcsf = pa[1 + (Ra/pv)]−1. Induced changes in pa have different effects on pcsf. However, this effect may be predicted to some extent because the relation between pcsf and pa may be represented mathematically as a rectangular hyperbola. This observation may be of relevance in neurological intensive care. Changes in arterial blood pressure are known to influence intracranial pressure in patients with deranged intracranial dynamics, as in the case of severe head injury. In clinical practice, both raising systemic arterial blood pressure in order to preserve cerebral perfusion pressure and induced arterial hypotension to reduce hydrostatic capillary pressure with consequent reduction of brain edema have been used in the management of patients with severe brain injury. While theoretical models of biological systems often have a limited value in practice because of inability to measure the relevant parameters from clinical data, the ratio of cerebrovascular resistances may be calculated at the bedside.
Prognosis of ischaemic stroke — a multivariate analysis
Authors: Misra U.K. , Kalita J. , Srivastava M. , Mandal S.K.
Published: January 2011

Paucity of studies on the prognosis of ischaemic stroke prompted this study. Sixty‐seven patients with CT‐proven infarction were studied after a mean duration of 9 days to evaluate the role of a number of clinical, CT scan and evoked potential parameters in predicting the prognosis. Their mean age was 53 (range 22–82) years and 16 were females. Four of these patients died and 20 had poor recovery. Out of 24 clinical, CT scan and evoked potential parameters analysed by univariate analysis, 11 variables were found to be significant These were Canadian Neurological Scale, Glasgow Coma Scale (GCS), Motoricity Index, muscle tone, tendon reflex, incontinence, sensations, motor area involvement on CT scan, size of infarction, motor evoked potential and somatosensory evoked potential. Multivariate logistic regression analysis was employed to study the combined effect of different variables on the outcome. The best model included past history of stroke, GCS, pulse pressure and involvement of motor area on CT scan. The model proposed by us is simple and useful for predicting 3 month outcome of ischaemic stroke. A larger study is recommended to confirm these findings.‐
Post‐stroke pathological crying: frequency and correlation to depression
Authors: Andersen G. , Vestergaard K. , Ingeman‐Nielsen M.
Published: January 2011

While pathological crying has classically been described as a disturbance of the motor concomitants of emotional affect that is unrelated to mood, recent studies indicate that there may in fact be a correlation. We therefore undertook a study of post‐stroke pathological crying in relation to mood score/depression and lesion site in an unselected stroke population the first year following stroke. The study population comprised 211 patients with first ever stroke (median age 69 years, range 25–80). The patients were included in the study within 7 days of the onset of stroke, and follow‐up examinations were made at 1 month, 6 months and 1 year. Computerized tomography brain scans were obtained on Days 5–10. The frequency of pathological crying was 14% at 1 month, 10% at 6 months and 11% at 1 year. The overall 1 year incidence was 19%. Pathological crying correlated significantly to mood score and post‐stroke depression (p < 0.005), as well as to lesion size (p < 0.05), Barthel Index (p < 0.05), Motricity Index (p < 0.005) and intellectual impairment (p < 0.05), but not to lesion location, sex, age, history of stroke or depression, predisposing disease or social distress before the stroke incident Post‐stroke pathological crying was common and persistent in 11% of patients at 1 year and correlated strongly to mood score and post‐stroke depression. The indication for treatment of pathological crying is therefore further strengthened.
Clues about the functional neuroanatomy of verbal working memory: a study of resting brain glucose metabolism in Parkinson's disease
Authors: Marié R.M. , Rioux P. , Eustache F. , Travère J.M. , Lechevalier B. , Baron J.C.
Published: January 2011

In addition to motor impairment, non‐demented patients with Parkinson's disease (PD) exhibit a variable degree of cognitive impairment which could indicate dysfunction in the central executive of working memory. In this study, we have employed positron emission tomography measurements of resting brain glucose metabolism (CMRglc) to investigate the neural substrates underlying this dysfunction, taking PD as a model disease to assess, within the framework of Alexander's striato‐pallido‐thalamo‐cortical cognitive circuits the functional neuroanatomy of the central executive. We studied central executive performance in 17 non‐demented, highly selected PD patients, by means of the Brown‐Peterson paradigm (BPP), and correlated the BPP performance according to various response delays (from 0 to 18 s) with local cerebral metabolic rates of glucose. We document for the first time that the BPP performance in PD is heterogeneous not only across delays (with PD patients selectively impaired for the 0 and 3 s delays, compatible with impaired attention and central executive, respectively), but also from subject to subject; a multiple correspondence analysis was able to distinguish two patient subgroups according to short delay BPP performance. The correlational analysis with PET data evidenced a limited number of significant correlations, most of which were consistent with our working hypothesis. Notably, a positive correlation between lateral frontal relative metabolism and BPP performance for short delays, and a negative one between these scores and mediodorsal (MD) thalamic nucleus metabolism, would fit the way in which caudate dopamine denervation would alter in opposite directions frontal cortex and MD nucleus synaptic activity and in turn affect central executive function. The results from this study lend further support to the role of altered thalamo‐prefrontal interplay as the basis for central executive dysfunction in PD.
Oromandibular dystonia associated with fluoxetine
Authors: Segovia J.G. , Alvarez‐Cermeño J.C.
Published: January 2011

A 66 year old patient with major depression treated with fluoxetine developed persistent oromandibular dystonia and mild akathisia. She improved significantly after discontinuation of the drug and treatment with biperiden. The temporal relationship between the use of fluoxetine and the occurrence of dystonia and akathisia suggests that fluoxetine may have induced tardive dystonia in this patient possibly due to a serotonergically mediated inhibition of striatal dopaminergic neurotransmission. We believe that this is the first reported case of persistent or tardive dystonia associated with fluoxetine treatment
Co‐existence of Lambert‐Eaton myasthenic syndrome and subacute cerebellar degeneration in a patient with rheumatoid arthritis
Authors: Kalita J. , Choudhury N. , Singh M.K. , Jha S. , Misra U.K.
Published: January 2011

A 38 year old woman with rheumatoid arthritis had a rare co‐existence of Lambert‐Eaton myasthenic syndrome and subacute cerebellar degeneration. She had mild but transient improvement in muscle power following plasmapheresis, which correlated with the degree of increment on high rate repetitive nerve stimulation (RNS). Her cerebellar signs did not improve, however. This differential therapeutic response may be due to different mechanisms of injury and tissue susceptibility.
Neuralgic amyotrophy and infectious mononucleosis: a case report
Authors: Esmonde T. , Gamble W. , Patterson V.
Published: January 2011

A 27 year old man developed neuralgic amyotrophy of the right upper limb 5 weeks after an acute febrile illness which was proven serologically to be caused by Ebstein‐Barr virus. The weakness developed in a limb that had been used to perform heavy manual labour. A parallel with a similar phenomenon described in association with paralytic poliomyelitis is noted.‐
Acute sensory neuropathy: 2 year follow‐up of sensory conduction
Authors: Baba M. , Okushima T. , Kan‐Nari K. , Ozaki I. , Matsunaga M.
Published: January 2011

Following flu‐like illness a 75 year old man developed pure sensory neuropathy that reached a peak at 3 weeks. Cerebrospinal fluid protein was elevated with no increase in cell count The sensory deficits started to improve 4 months later, and were completely resolved 12 months later. Compound sensory nerve action potential, which had been absent initially, became detectable 8 months after the onset The revived sensory potentials progressively increased their size during the 2 year period. A variant of acute inflammatory demyelinating polyneuropathy may be part of a syndrome of acute sensory neuropathy.
Current issues in neurology
Authors: Bates D.
Published: January 2011

Current Issues in Neurology was the title of a meeting for UK neurologists held at the Gloucester Hotel in London, on the 25/26th May. This is the fourth annual symposium organised by Glaxo Pharmaceuticals designed to meet some of the managerial training needs of the neurologist, whilst additionally looking at new and innovative research in associated fields of science. Dr David Bates (Consultant Neurologist, The Royal Victoria Infirmary, Newcastle‐upon‐Tyne) attended the symposium and has summarised the proceedings in the following paper.