Diffusion tensor imaging can localize the epileptogenic zone in nonlesional extra-temporal refractory epilepsies when [(18)F]FDG-PET is not contributive

Surgical outcome in patients with nonlesional refractory partial epilepsies could be improved by a more precise definition of the epileptogenic zone (EZ). The value of interictal FDG-PET hypometabolism, voxel-based-morphometry (VBM) and diffusion tensor imaging (DTI) is still debated. We compared the sensitivity and specificity of these noninvasive techniques in localizing the EZ with stereo-electroencephalography (SEEG) results. Twenty patients with nonlesional partial epilepsy (13 temporal lobe epilepsy (TLE) and 7 extra-temporal (extra-TLE)) underwent structural MRI, DTI and FDG-PET. FDG-PET was analyzed visually (vPET) blinded and unblinded and by statistical parametric mapping (SPM) (sPET). Individual modifications of grey matter volume and mean diffusivity increase were compared to a control group with SPM. The best sensitivity was provided by vPET unblinded (75%) and the best specificity (60%) by DTI. The sensitivity of vPET blinded (55%) was lower and those of sPET (40%) and VBM (35%) were still lower. In TLE, vPET analyzed either blinded or unblinded, performed the best and additional use of the other tools improved slightly the sensitivity. For extra-TLE, combining vPET and DTI results increased the number of pertinent abnormalities detected especially for circumscribed changes in frontal lobe epilepsy (FLE). Combining vPET and DTI was the more efficient strategy for extra-TLE, allowing the detection of pertinent abnormalities in FLE when FDG-PET alone was not contributive. Combining sPET or VBM with vPET was less useful.     

Right parietal brain activity precedes perceptual alternation during binocular rivalry

We investigated perceptual reversals for intermittently presented stimuli during binocular rivalry and physical alternation while the ongoing EEG was recorded from 64 channels. EEG topographies immediately preceding stimulus‐onset were analyzed and two topographies doubly dissociated perceptual reversals from non‐reversals. The estimated intracranial generators associated with these topographies were stronger in right inferior parietal cortex and weaker bilaterally in the ventral stream before perceptual reversals. No such differences were found for physical alternation of the same stimuli. These results replicate and extend findings from a previous study with the Necker cube and suggest common neural mechanisms associated with perceptual reversals during binocular rivalry and ambiguous figure perception. For both types of multi‐stable stimuli, the dorsal stream is more active preceding perceptual reversals. Activity in the ventral stream, however, differed for binocular rivalry compared to ambiguous figures. The results from the two studies suggest a causal role for the right inferior parietal cortex in generating perceptual reversals regardless of the type of multi‐stable stimulus, while activity in the ventral stream appears to depend on the particular type of stimulus. Hum Brain Mapp 32:1432–1442, 2010. © 2010 Wiley‐Liss, Inc.     

Congenital hypoplasia of right ventricular myocardium (Uhl's anomaly) associated with pulmonary atresia in a newborn

A third case of congenital marked hypoplasia of the right ventricular myocardium (Uhl's anomaly) associated with pulmonary valvular atresia and absent tricuspid leaflets is reported. The anatomic differences between this disease, hypoplasia of the right ventricle and Ebstein's anomaly are discussed. During the neonatal period the clinical diagnosis is difficult. Malformations like tricuspid atresia, pulmonary atresia with intact ventricular septum and Ebstein's anomaly can all give almost the same clinical picture. The prognosis of the complete form of Uhl's anomaly remains poor.     

Studies on In Vitro DNA Synthesis Purification of dna C Gene Product Containing dna D Activity from Escherichia coli

The conversion of varphiX174 single-stranded DNA to duplex DNA by extracts of E. coli requires products of the E. coli DNA replication genes. By use of this complementation system, the dna C gene product has been purified from wild-type E. coli as well as from a dna C temperature-sensitive mutant. The latter preparations are temperature sensitive when compared to the wild-type gene product. The dna C and dna D gene products copurify, have similar characteristics, are both temperature sensitive in preparations from dna C temperature-sensitive cells, and are both undetectable in preparations from dna D temperature-sensitive cells.     

Spurious scintiphotographic recurrence of pulmonary emboli

Pulmonary perfusion scintiphotographs in patients with acute, extensive pulmonary embolism have disclosed instances in which Scintiphotographic changes thought to indicate embolic recurrence were not substantiated by clinical-angiographic observations. These spurious Scintiphotographic recurrences reflected changes in the regional distribution of pulmonary vascular resistance secondary to different rates of embolic resolution or distal migration of emboli. To document the influence of changes in vascular resistance upon perfusion scintiphotographs, studies were performed in animals subjected to various sequences of pulmonary arterial obstruction by balloon catheters. Scintiphotographic changes mimicking, but not representing, recurrence of embolism were produced. Observations in both animals and man indicate that the diagnosis of embolic recurrence based on Scintiphotographic changes alone should be made with caution, particularly in patients with multiple emboli and pulmonary hypertension.     

Effect of interimplant distance (2 and 3 mm) on the height of interimplant bone crest: a histomorphometric evaluation

Background: Implants restored according to a platform‐switching concept (implant abutment interface with a reduced diameter relative to the implant platform diameter) present less crestal bone loss than implants restored with a standard protocol. When implants are placed adjacent to one another, this bone loss may combine through overlapping, thereby causing loss of the interproximal height of bone and papilla. The present study compares the effects of two interimplant distances (2 and 3 mm) on bone maintenance when bone‐level implants with platform‐switching are used. Methods: This study evaluates marginal bone level preservation and soft tissue quality around a bone‐level implant after 2 months of healing in minipig mandibles. The primary objective is to evaluate histologically and histomorphometrically the affect that an implant design with a horizontally displaced implant–abutment junction has on the height of the crest of bone, between adjacent implants separated by two different distances. Results: Results show that the interproximal bone loss measured from the edge of the implant platform to the bone crest was not different for interimplant distances of 2 or 3 mm. The horizontal position of the bone relative to the microgap on platform level (horizontal component of crestal bone loss) was 0.31 ± 0.3 mm for the 2‐mm interimplant distance and 0.57 ± 0.51 mm above the platform 8 weeks after implantation for the 3‐mm interimplant distance. Conclusions: This study shows that interimplant bone levels can be maintained at similar levels for 2‐ and 3‐mm distances. The horizontally displaced implant–abutment junction provided for a more coronal position of the first point of bone–implant contact. The study reveals a smaller horizontal component at the crest of bone than has been reported for non‐horizontally displaced implant–abutment junctions.     

Effects of insulin-induced hypoglycemia on beta 2-adrenoceptor density and proliferative responses of human lymphocytes

We studied the effects of insulin (0.1 IU/kg BW, iv)-induced hypoglycemia on lymphocyte beta 2-adrenoceptor function, lymphocyte subset distribution, and proliferative response to mitogen stimulation in 10 healthy volunteers. Thirty minutes after insulin injection plasma glucose levels were markedly decreased; concomitantly, plasma epinephrine levels had increased about 10-fold; plasma norepinephrine levels, however, increased only moderately. Lymphocyte beta 2-adrenoceptor density and the cAMP response to 10 mumol/L isoproterenol stimulation were elevated; lymphocyte Ts/c-cells had increased, whereas Th-cells had decreased, resulting in a decrease in the Th-/Ts/c-cell ratio from 1.7 to 1.0. These changes were accompanied by a significantly reduced lymphocyte proliferative response (measured as [3H]thymidine uptake) to mitogen stimulation. Two hours after insulin injection plasma catecholamines, lymphocyte beta 2-adrenoceptor function, lymphocyte subset distribution, and proliferative responses had returned to nearly preinsulin levels. We conclude that acute vigorous increases in endogenous epinephrine evoked by insulin-induced hypoglycemia are associated with increases in lymphocyte beta 2-adrenoceptor function, redistribution of lymphocyte subsets, and an (at least transiently) attenuated in vitro immune responsiveness.     

Pertussis toxin treatment of whole blood. A novel approach to assess G protein function in congestive heart failure

This study was designed to assess G protein function in mononuclear leukocytes (MNL) of patients with congestive heart failure (CHF). MNL membranes were ADP-ribosylated in vitro in the presence of pertussis or cholera toxin. The amount of pertussis toxin substrates did not differ significantly between CHF patients (6,100 +/- 224 fmol/mg, n = 23) and age-matched healthy control subjects (5,812 +/- 972 fmol/mg protein, n = 19). Among the CHF patients, no differences were observed between those with idiopathic and ischemic CHF. The amount of cholera toxin substrates also did not differ significantly between CHF patients (7,522 +/- 1,405 fmol/mg protein, n = 11) and control subjects (5,654 +/- 707 fmol/mg protein, n = 14). Moreover, basal and isoproterenol- and prostaglandin E1-stimulated cyclic AMP (cAMP) accumulation in MNL was similar in control subjects and patients. To detect more subtle alterations of the cAMP-generating system, we incubated anticoagulated blood with 250-400 ng/ml pertussis toxin for 4 hours at 37 degrees C. This treatment completely ADP-ribosylated the MNL pertussis toxin substrates. Incubation with pertussis toxin did not change basal or prostaglandin E1-stimulated cAMP generation in MNL of control subjects, but it significantly enhanced stimulated generation (443 +/- 44 vs. 643 +/- 93 pmol/10(7) cells, p less than 0.025) in MNL of CHF patients. This enhancement was most pronounced in the most severely ill patients (New York Heart Association class IV) and correlated with plasma norepinephrine levels, another marker of CHF severity (r = 0.798, n = 11, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)     

Urinary cyclic guanosine monophosphate as an indicator of experimental congestive heart failure in rats

STUDY OBJECTIVE--The aim was to investigate the relationship between urinary cyclic guanosine monophosphate (GMP) excretion and activation of the heart endocrine function in two rat models of cardiac failure. DESIGN--Left ventricular infarction and aging in spontaneously hypertensive rats (SHR) are two models that could lead to congestive heart failure. In the first the degree of failure depends on the length of the infarcted area. In the second the degree of failure depends on time. Urinary cyclic GMP, plasma atrial natriuretic factor (ANF), and degree of congestive heart failure were evaluated in both models. EXPERIMENTAL ANIMALS--31 male Wistar rats were used for myocardial infarction and sham operated controls. Spontaneously hypertensive (SHR) rats (2, 6, 12 and 24 months old, n = 10 per group) were used for the age overload studies. MEASUREMENTS AND MAIN RESULTS--In myocardial infarction, the amount of left ventricular ANF mRNA, plasma ANF concentration, and urinary cyclic GMP excretion were correlated and were proportional to the degree of cardiac failure, as assessed by the increase in right ventricular mass and the decrease in blood pressure. In male SHR (aged 6-24 months), plasma ANF and urinary cyclic GMP were correlated, increased with age, and were proportional to the heart to body weight ratio. These correlations between plasma ANF, daily urinary cyclic GMP excretion, and left ventricular hypertrophy persisted in two year old SHR. The presence of pleural extravasation in these old animals was also characterised by significant increases in both plasma ANF and urinary cyclic GMP. The plasma ANF and the daily urinary cyclic GMP excretion were negative prognostic indicators of life expectancy in two year old SHR. CONCLUSIONS--Urinary cyclic GMP excretion, correlated with the plasma ANF level, is a non-invasive indicator of congestive heart failure in two models of overloaded left ventricle in rats.