Transcranial Sonography and I-FP-CIT Single Photon Emission Computed Tomography in Movement Disorders

Diagnosis of Parkinson's disease (PD) can be difficult in the early stages of the disease. The aim of the study described here was to assess the correlation between transcranial sonography (TCS) and ¹²³I-FP-CIT ([¹²³I]ioflupane, N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-[¹²³I]iodophenyl)nortropane) SPECT (single photon emission computed tomography) findings and the diagnosis of PD. A total of 49 patients were enrolled in the study: 29 patients with PD, 7 patients with other parkinsonian syndromes, 11 patients with essential tremor and 2 with psychogenic movement disorder. Substantia nigra echogenicity was measured using TCS. SPECT was performed using DaTSCAN ([¹²³I]ioflupane). TCS and SPECT findings were correlated in 84% of patients, with κ = 0.62 (95% confidence interval: 0.38–0.86). TCS-measured substantia nigra echogenicity and SPECT-measured striatal binding ratio were negatively correlated (r = –0.326, p = 0.003). TCS/SPECT sensitivity, specificity and positive and negative predictive values for the diagnosis of PD were 89.7%/96.6%, 60.0%/70.0%, 76.5%/82.4% and 80.0%/93.3%, respectively. Both positive TCS and SPECT findings correlated significantly with the diagnosis of PD (κ = 0.52, 95% confidence interval: 0.27–0.76, and κ = 0.69, 95% confidence interval: 0.49–0.90, respectively).     

CD4+ T-lymphocytopenia and systemic immune activation in patients with primary and secondary liver tumours

Objective. Low birthweight (LBW) has been associated with an increased risk of development of type 2 diabetes in adult life. Both type 1 and type 2 diabetes mellitus are characterized by increased oxidative stress. The purpose of this study was to investigate whether young healthy adults born with LBW showed differences in oxidative stress under normal conditions and during the added challenge of a physiological Intralipid infusion. Material and methods. Urinary excretion of DNA markers of oxidative stress were analyzed by LC‐MS/MS in 19 men (aged 19 years) with LBW and in 19 age matched, normal birthweight (NBW) controls pre‐ and post a 3‐fold increase of plasma free fatty acids. Results. Mean excretion rates of 8‐oxo‐guanine (8oxoGua), 8‐oxo‐guanosine (8oxoGuo), 8‐oxo‐2′deoxyguanosine (8oxodG), and 1,N⁶‐ethenodeoxyadenosine (εdA) did not statistically differ between subjects with LBW and NBW (66.9 versus 73.9?nmol/15?h, 17.8 versus 18.5?nmol/15?h, 11.9 versus 14.4?nmol/15?h and 44.0 versus 43.2?pmol/15?h, respectively). Furthermore, Intralipid infusion did not affect excretion of DNA adducts in LBW or NBW subjects. Statistically significant correlations were found between body mass index and urinary excretion of 8oxoGua (r = 0.64, p = 0.003) and 8oxoGuo (r = 0.64, p = 0.003) in the LBW group only. Conclusions. These findings suggest that oxidative stress may be a consequence of diabetes and is not, or at least only partly, involved in the early pathogenesis of type 2 diabetes.     

Multiple streptococcal brain abscesses successfully treated by craniotomy and needle aspiration

The successful surgical treatment of multiple brain abscesses by means of needle aspiration is reported. There is a need for aggressive surgical and antibiotic treatment, using local anesthesia and needle aspiration, when fully developed abscesses are present. The computerized tomographic scan and related surgical techniques allow for a precise localization of an abscess and its evacuation even if it is located in so-called vital areas of the brain.     

A comment on the estimation of random branching from viscosity measurements

The hydrodynamic behaviour of polydisperse branched copolymers of methyl methacrylate with a small amount of ethylene dimethacrylate was investigated in several solvents possessing different “solvent power”. It was found that with increasing degree of branching the viscometric expansion coeficient α of these copolymers decreases compared with the expansion of the linear analogs α (before the gel point α/α ≈ 0,5). This phenomenon is demonstrated to be useful in the application of viscometry as a method of estimation or determination of branching.     

Soft tissue esthetics in implant dentistry

Dental implants have been considered to be a successful treatment modality. Recently, achieving a good osseointegration is not the ultimate goal for the restorative dentist. Successful implant treatment demands the best gingival esthetic success along with stability and function of the implant. This study was performed to obtain answers to some controversial points pertaining to esthetics and function of implants in maxilla. Immediate flapless implantation into the extraction sockets in maxillary anterior zone is an emerging treatment option in dentistry--the esthetic success of which was in debate for long. The proposed study compared the esthetic success of immediate flapless implants (ILA), to immediate implants with the need for flap (ILB) and, delayed implants (DSL) in single tooth restorations, in the anterior region of the maxilla. The other aim of the study was to find out if any relation exists between the interproximal crestal bone height and papilla height. Analysis was done irrespective of treatment procedure in the same study group using periodontal sounding and radiographs to find out the relation. From the study involving 106 participants, including 21 ILA, 22 ILB and 63 DSL cases, we received highest papillary index score of 2.6 average from group ILA, followed by ILB and DSL, after 3 months of prosthetic loading. From the periodontal sounding and radiographic study it was evident that, when the distance between the base of the contact point of crowns and height of interproximal bone was less than 5, the papilla was present 100% of the time, but when the distance increased to 6 and more than 7 mm, the papilla was present only 46.5 and 24 percentage of the time respectively.     

Phenotype analysis of tumour-infiltrating lymphocytes and lymphocytes in peripheral blood in patients with renal carcinoma

INTRODUCTION: When checking tumour growth, a number of observations indicate that the immune system plays a significant role in patients with renal cell carcinoma (RCC). Infiltration by lymphocytes (tumour infiltrating lymphocytes, TILs) is more prevalent in RCC than any other tumours. T lymphocytes are the dominant population of TIL cells. Views concerning the role of T lymphocytic subpopulations, B lymphocytes and NK cells in an anti-tumour response are not established. AIM: The aim is to determine the phenotype and activation of T and B lymphocytic subpopulations and NK cells and to compare their representation in tumour stroma and peripheral blood lymphocytes (PBL) in patients with RCC. MATERIAL AND METHODS: Samples of peripheral blood taken from the cubital and renal veins and tumour stroma cells were obtained from 44 patients in the course of their surgeries carried out due to primary RCC. TILs were isolated from mechanically disintegrated tumour tissue. Immunophenotype multiparametric analysis of PBL and TILs was carried out. Their surface and activation characteristics were determined by means of flow cytometer. RESULTS: CD3+ T lymphocytes (69.7%) were the main population of TILs. The number of CD3+/CD8+ T lymphocytes was significantly higher in TILs, 42.6% (p < 0.01), while CD4+ T lymphocytes were the majority population in peripheral blood, 41.35% (p < 0.001). The representation of CD3+/69+ T lymphocytes was significantly higher in TILs, 32.9%, compared to PBL (p < 0.001). On the contrary, the numbers of CD3+/CD25+, CD8+/57+ and CD4+/RA+ (naive CD4+ T lymphocytes) were higher in PBL (p < 0.001). The differences in representation of (CD3-/16+56+) NK cells and CD3+/DR+ T cells in TILs and PBL were not significant. CONCLUSION: The above-mentioned results prove that the characteristics and intensity of anti-tumour responses are different in compared compartments (tumour/PBL). CD3+/CD8+ T lymphocytes are the dominant lymphocytic population of TILs. The knowledge of the phenotype and functions of effector cells, which are responsible for anti-tumour response, are the basic precondition for understanding the anti-tumour immune response and the cause of its failure.     

A prospective randomized comparison of conventional mechanical ventilation and very early high frequency oscillatory ventilation in extremely premature newborns with respiratory distress syndrome

Objective: To compare the effectiveness and safety of very early high-frequency oscillatory ventilation (HFOV) with conventional mechanical ventilation (CMV) in treatment of the respiratory distress syndrome (RDS) and to evaluate their impact on the incidence of chronic pulmonary disease and early and late morbidity of very low-birthweight neonates. Design: A prospective randomized clinical trial. Setting: Tertiary neonatal intensive care unit in the Perinatology Center in Prague. Patients: 43 premature newborns, delivered in the Department of Obstetrics in the Perinatology Center, were randomly divided into two groups (HFOV and CMV) immediately after delivery; 2 patients in each group died, 2 fulfilled crossover criteria from CMV to HFOV, and 2 were excluded because of congenital malformations. Nineteen patients treated with HFOV were therefore compared with 18 infants in the CMV group. Methods: The two contrasting modes of ventilation were introduced immediately after intubation. Maintenance of optimal lung volume in HFOV to optimize oxygenation and the therapeutic administration of surfactant after fulfilling defined criteria are important points of the strategy and design of the study. Measurements and main results: Except for a higher proportion of males in the HFOV group (p < 0.02), the basic clinical characteristics (gestational age, birthweight, Apgar score at 5 min, umbilical arterial pH), the two groups were similar. In the acute stage of RDS, infants treated with HFOV had higher proximal airway distending pressure with HFOV for 6 h after delivery (p < 0.05). For a period of 12 h after delivery lower values for the alveolar-arterial oxygen difference (p < 0.03) were noted. The number of patients who did not require surfactant treatment was higher in the HFOV group (11 vs 1, p < 0.001). In the HFOV group the authors found a lower roentgenographic score at 30 days of age (p < 0.03) and a lower clinical score in the 36th postconceptional week (p < 0.05), using these two scoring systems for assessing chronic lung disease according to Toce scale. The incidence of pneumothorax, pulmonary interstitial emphysema, intraventricular hemorrhage and retinopathy of prematurity in both groups was the same. Conclusions: HFOV, when applied early and when the clinical strategy of maintenance of optimal lung volume is used, improves oxygenation in the acute stage of RDS, reduces the need of surfactant administration, and can decrease the injury to lung tissue even in extremely immature newborns to whom surfactant is administered therapeutically. Received: 3 December 1997 Final revision received: 31 August 1998 Accepted: 1 September 1998