Idiopathic Parkinson's disease: revised concepts of cognitive and affective status

Assumptions regarding increased risk of dementia in Parkinson's disease and of depression mimicking the endogenous form are reviewed and challenged from the perspectives of recent findings in both the neuropsychological and anatomical domains. Evidence suggests that depression, while frequent, behaviourally resembles the reactive variety and that selective impairment of cognitive functions considered to depend upon the integrity of the frontal lobes accompanies this disorder. In this regard, it is speculated that the cognitive alterations seen in non-demented parkinson patients are the consequences of dysfunction of the caudate nucleus which contributes significantly to the normal activities processed through the frontostriate "complex loop".     

The projection from the motor cortex to the inferior olive in the cat. An experimental study using axonal transport techniques

The cortico-olivary projection has been investigated in the cat with the methods of retrograde transport of horseradish peroxidase and wheat-germ agglutinin conjugated with horseradish peroxidase as well as autoradiographic techniques using tritium-labelled amino acids. The projection arises from cells in cortical layer V and terminates mainly ipsilaterally and less densely contralaterally. The strongest termination site is in the caudal medial accessory olive adjacent to subnucleus beta. Projections to that area originate in the medial portions of areas 4 and 6 rostral to the cruciate sulcus. Regions of the motor cortex related to axial back and neck, proximal forelimb and face musculature plus the frontal eye field are represented in largely overlapping areas of the caudal medial accessory olive. A second zone of termination is present in the rostral olive at the junction of the ventral lamella of the principal olive and the medial border of the dorsal accessory olive. Projections to that area arise from a central portion of area 4 at the border between the anterior sigmoid gyrus and the presylvian gyrus. This area contains portions of the representation of the muscle groups controlling the neck and proximal forelimb (shoulder and elbow) only. The frontal eye field, which in the cat influences both extraocular and neck musculature, is also an important direct source of input to this portion of the inferior olive. Contralateral terminations are distributed symmetrically. Combining this information with the olivocerebellar distribution, cerebellar cortical areas corresponding to this direct cortical input are defined. Taking into account that the cortico-olivary fibers appear to arise only from those portions of the motor cortex involved in the control of axial and proximal forelimb muscles, it is suggested that the cortico-olivo-cerebellar projections play a preponderant role in the cerebellar control of posture.     

A reinvestigation of the spinovestibular projection in the cat using axonal transport techniques

Summary There are numerous discrepancies within the literature concerning the sources of spinovestibular fibers and their distribution in the vestibular complex. Sources of afferents from all spinal levels were sought using the retrograde transport of wheat germ agglutinin conjugated to horseradish peroxidase. Following injections of this tracer in all portions of the vestibular complex retrograde labelling was densest at upper cervical levels, especially within the contralateral central cervical nucleus. Labelling was also observed in laminae VI (ipsilaterally), IV, V, VII, and VIII (bilaterally). At progressively more caudal levels, numbers of labelled cells decreased but were similarly distributed in these laminae. The terminal distribution of spinal efferent fibers within the vestibular complex was revealed by injecting wheat germ agglutinin conjugated to horseradish peroxidase or tritiated amino acids into various levels of the spinal cord. These studies showed that all spinal levels project to the descending vestibular nucleus and group x. The f-tail of the descending vestibular complex receives projections from upper cervical and thoracic levels. Terminations within the medial vestibular nucleus arise from both upper cervical and lumbar levels. No conclusive evidence was found supporting the presence of substantial direct spinal projections to the lateral vestibular nucleus, superior vestibular nucleus, or group z. Possible functional roles for the spinovestibular projection in posture and gaze are discussed.Abbreviations Bc brachium conjunctivum - CCN central cervical nucleus - Ce central canal - Cr restiform body/inferior cerebellar peduncle - DSCT dorsal spinocerebellar tract - DVN descending vestibular nucleus - f f-tail of DVN - tc. intercalatus - LVN lateral vestibular nucleus - MVN medial vestibular nucleus - nVII nerve of VII cranial nerve - N. cu.e. external cuneate nucleus - N.f.c. main cuneate nucleus - N.pr.V. principal nucleus of V - ph praepositus hypoglossi nucleus - RF reticular formation - SVN superior vestibular nucleus - TMB tetramethylbenzidine - Tr.sp.V. spinal trigeminal nucleus of V - VC vestibular complex - WGA-HRP wheat germ agglutinin horseradish peroxidase - X dorsal motor nucleus of cranial nerve ten - XII hypoglossal nucleus - x group x - y group y - z group z     

Assessment of spinal cord injury by counting corticospinal and rubrospinal neurons

This paper describes an objective, quantifiable technique for assaying the degree of severity of spinal cord injury. Twenty-one rats underwent a C₇-T₁ laminectomy: 12 received a C₈ spinal cord clip compression injury with forces of either 2.3, 16.9 or 53.0 g; 4 had cord transection at C₈, and 5 had no cord lesion. Postoperative clinical neurological assessment was performed by the inclined plane method. At 4 weeks, the spinal cord-injured rats underwent a T₁₀ transection and insertion of a Gelfoam pledget impregnated with horseradish peroxidase (HRP). HRP was similarly administered to 9 normal rats. Longitudinal sections of the spinal cord encompassing the injury site were stained with Luxol fast blue, and coronal sections from the cerebrum and midbrain were processed for HRP reactivity with tetramethylbenzidine. Labelled corticospinal and rubrospinal neurons were counted in every 6th section to derive a cortical score (CS) and a red nucleus score (RNS) for each animal. The CS reflected the extent of the pathological changes at the site of cord injury and the In CS decreased linearly with increasing injury severity (P < 0.0001). In contrast, the RNS was only reduced in animals with severe (53.0 g) cord injuries (P < 0.0006). The degree of preservation of the dorsal columns including the corticospinal tracts at the injury site correlated with the CS, whereas the RNS was related to the degree of preservation of the lateral columns. Counts of rubrospinal neurons, but not corticospinal neurons, correlated closely (r = 0.96, P < 0.001) with the inclined plane results, suggesting the importance of non-pyramidal tracts in controlling gross motor function. Thus, counting corticospinal and rubrospinal neurons is an objective, reliable test of the severity of experimental spinal cord injury.     

A novel approach to the treatment of lower extremity lymphedema by transferring a vascularized submental lymph node flap to the ankle

Objective

Vascularized groin lymph node flaps have been successfully transferred to the wrist to treat postmastecomy upper limb lymphedema. This study investigated the anatomy, mechanism and outcome of a novel vascularized submental lymph node (VSLN) flap transfer for the treatment of lower limb lymphedema.

Methods

Bilateral regional submental flaps were dissected from three fresh adult cadavers for histological study. A unilateral submental flap was dissected in another six fresh cadavers after latex injection. The VSLN flap was transferred to the ankles of seven lower extremities in six patients with chronic lower extremity lymphedema. The mean patient age was 61 ± 9.4 years. The average duration of lymphedema symptoms was 71 ± 42.2 months.

Results

There was a mean of 3.3 ± 1.5 lymph nodes around the submental artery typically at the junction with the facial artery, on the six cadaveric histological sections. Mean of 2.3 ± 0.8 sizable lymph nodes were dissected and supplied by the submental artery in six cadaveric latex-injected submental flaps. All seven VSLN flaps survived. One flap required re-exploration for venous congestion but was successfully salvaged. There was no donor site morbidity. At a mean follow-up of 8.7 ± 4.2 months, the mean reduction of the leg circumference was 64 ± 11.5% above the knee, 63.7 ± 34.3% below the knee and 67.3 ± 19.2% above the ankle.

Conclusion

The transfer of a vascularized submental lymph node flap to the ankle is a novel approach for the effective treatment of lower extremity lymphedema.     

Antiangiogenic effects of the oral administration of liquid cartilage extract in humans.

BACKGROUND: The antiangiogenic properties of shark cartilage extracts have been demonstrated in animal models but there are no data in human subjects. MATERIALS AND METHODS: A placebo or one of two doses of a liquid shark cartilage extract was orally administered daily, from Day 1 to Day 23 of the study protocol, to 29 healthy male volunteers randomized into three groups. On Day 12, a polyvinyl alcohol sponge threaded in a perforated silicone tubing was inserted subcutaneously on the anterior side of the arm and removed on Day 23. Evaluation of endothelial cell density, with factor VIII immunostaining, an indirect measurement of angiogenesis, was performed on histological sections of the implant using a semiquantitative numerical scale ranging from 1 (low density) to 5 (high density). The hydroxyproline content of the sponges was measured by HPLC. RESULTS: The mean endothelial cell density was significantly lower in groups that had received the liquid cartilage extract: grades 2.24 +/- 0.10, 2.47 +/- 0.10, and 3.15 +/- 0.11 for 7 and 21 ml liquid cartilage extract and placebo, respectively (P < 0.01 for both comparisons). No grade 1 was observed in the placebo group, whereas 9 treated subjects received a grade 1. Hydroxyproline content of the sponges did not differ between groups and there was no significant correlation between hydroxyproline content and endothelial cell density in the sponges. CONCLUSIONS: These results demonstrate that the liquid cartilage extract contains an antiangiogenic component bioavailable in humans by oral administration. This is the first report of an inhibition of wound angiogenesis in healthy men.     

Risk Assessment of Deoxynivalenol by Revisiting Its Bioavailability in Pig and Rat Models to Establish Which Is More Suitable

Due to its toxic properties, high stability, and prevalence, the presence of deoxynivalenol (DON) in the food chain is a major threat to food safety and therefore a health risk for both humans and animals. In this study, experiments were carried out with sows and female rats to examine the kinetics of DON after intravenous and oral administration at 100 µg/kg of body weight. After intravenous administration of DON in pigs, a two-compartment model with rapid initial distribution (0.030 ± 0.019 h) followed by a slower terminal elimination phase (1.53 ± 0.54 h) was fitted to the concentration profile of DON in pig plasma. In rats, a short elimination half-life (0.46 h) and a clearance of 2.59 L/h/kg were estimated by sparse sampling non-compartmental analysis. Following oral exposure, DON was rapidly absorbed and reached maximal plasma concentrations (C_max) of 42.07 ± 8.48 and 10.44 ± 5.87 µg/L plasma after (t_max) 1.44 ± 0.52 and 0.17 h in pigs and rats, respectively. The mean bioavailability of DON was 70.5% ± 25.6% for pigs and 47.3% for rats. In the framework of DON risk assessment, these two animal models could be useful in an exposure scenario in two different ways because of their different bioavailability.     

Surgical management of cubital tunnel syndrome: a comparative analysis of outcome using four different techniques

Background

Various options exist for the surgical management of cubital tunnel syndrome. The goals of this study were to compare the outcome of four different surgical techniques: (1) simple decompression, (2) endoscopic decompression, (3) anterior subcutaneous transposition, and (4) anterior sub-muscular transposition for the treatment of cubital tunnel syndrome.

Methods

One hundred ten patients (117 cases) with cubital tunnel syndrome were reviewed from 1986 to 2000. Parameters measured included signs and symptoms, medical comorbidity, other nerve compressions, and anatomical pathology. Severity was evaluated using the Dellon classification and the symptom severity score (SSS). SSS included evaluation of pain, clawing, the Froment sign, and the Wartenberg sign. Bishop's rating was measured at final follow-up. Statistical analysis included ANOVA, Kruskal–Wallis tests, and Spearman's Rho for correlation.

Results

Correlation between severity of nerve compression and symptom duration was not statistically significant. A significant weak positive correlation existed between Dellon score and SSS. Bishop's rating was 46.5 % excellent, 39.5 % good, 7.9 % fair, and 6.1 % poor overall. A significant weak negative correlation existed between the Dellon score and Bishop's rating. The average Bishop score was 1.74?±?0.85, and no significant difference existed when comparing each surgical technique to one another. No significant association was found between the severity of compression (Dellon) and the surgery type performed. A weak negative correlation existed between severity of ulnar nerve compression and clinical outcome. No significant differences were found between the type of surgeries performed in regard to outcome and Dellon score.

Conclusions

We found patients with the most severe compressive symptoms benefited the least from operative intervention regardless of surgical technique used. However, for mild to moderate disease, performing any of the purposed surgical techniques in accordance with the physician’s experience and comfort level is adequate in treating ulnar nerve compression at the elbow joint. Level of Evidence Level IV, therapeutic study