Activation of mossy and climbing fiber pathways to the cerebellar cortex by stimulation of the fornix in the rat

Summary The fornix of the rat was electrically stimulated with bipolar concentric electrodes to determine the properties of single unit responses in Purkinje cells of the cerebellar cortex. Both climbing (CF) and mossy fiber (MF) pathways were activated by fornix stimulation. MF responses were indicated by single or double spike responses appearing at latencies of 5–10 ms. The MF spike responses, as quantified by histogram analysis, were further identified by appearance of graded responses with increasing stimulus strength and by following at frequencies up to and greater than 20/s. CF responses were identified by characteristic complex all-or-none burst responses with latencies usually between 10 and 20 ms and with following frequencies at no faster than 10/s. Experiments which involved movement of the stimulating electrode and production of lesions around it established that the activated fiber system was within the dorsal fornix and not in adjacent areas. The results indicate that hippocampal and other limbic areas can influence the cerebellar cortex by direct mossy and climbing fiber pathways, as has been demonstrated for other afferents. It is further suggested that motor patterns linked to hippocampal activity may be regulated by this system.This work was supported by N.S.F. Grant No. 77-01174 awarded to Dr. Donald J. Woodward, and an award from the Biological Humanics Foundation     

High prevalence of vitiligo in lepromatous leprosy

BACKGROUND: Leprosy and vitiligo are common affections in the West Indies. Vitiligo frequently occurs in lepromatous patients, an observation rarely reported in the literature. METHODS: We studied the prevalence of vitiligo in patients affected by leprosy by performing a retrospective study between 1978 and 1999 in the French West Indies (Martinique). RESULTS: Eleven patients presented with vitiligo among 101 with lepromatous (multibacillary) leprosy. None presented with vitiligo among the 364 with the tuberculoid (paucibacillary) form. The mean age of the vitiligo patients was 55. 4 years at vitiligo onset. The sex ratio was 0.8. Vitiligo occurred 19 years after the diagnosis of leprosy, with a range from 3 to 42 years. The prevalence of vitiligo in lepromatous patients was 10.9%, compared to 0% in tuberculoid patients. Such an increase in prevalence compared with that in the general population (0.34%) was shown to be highly significant (P< 0.0001). CONCLUSIONS: Our data confirmed that the association of vitiligo and leprosy was not fortuitous. The physiopathology leading to this high rate of vitiligo in lepromatous leprosy is unclear, despite the fact that autoimmunity plays a major role in both diseases.     

Efferent projections of the anteromedial cortex of the rat as described by Phaseolus vulgaris leucoagglutinin immunohistochemistry

Phaseolus vulgaris leucoagglutinin (PHA-L) immunohistochemistry was used to describe the corticofugal projections of the anteromedial cortex (AMC) of rats. PHA-L was injected iontophoretically into an area of the AMC which, when stimulated electrically, is known to induce contraversive head and body movements. It was found that the AMC innervates the midbrain via three separate pathways: a dorsal transthalamic pathway terminating in the pretectum, superior colliculus, and central grey area; and a ventral transthalamic pathway and a ventral capsular-peduncular pathway projecting to the central grey and mesencephalic and pontine reticular formation. The strongest terminations were found bilaterally in the mediodorsal thalamic nucleus and nucleus caudato-putamen. The functional significance of the pathways and terminations is discussed.     

Bilateral globus pallidus internus deep brain stimulation in tardive dyskinesia: a case report.

The clinical response of a 53-year-old woman with tardive dyskinesia treated with bilateral globus pallidus interna deep brain stimulation is described. At 18 months follow-up, her Burke-Fahn-Marsden Dystonia Rating Scale score fell from 52 (preoperative) to 21 (60% improvement).     

Subthalamic nucleus deep brain stimulation for parkinson's disease after successful pallidotomy: clinical and electrophysiological observations.

Unilateral pallidotomy is an effective treatment for contralateral parkinsonism and dyskinesia, yet symptoms progress in many patients. Little is known about whether such patients obtain a useful response to subsequent bilateral subthalamic nucleus deep brain stimulation (STN DBS). Changes in Unified Parkinson's Disease Rating Scale (UPDRS) Motor and Activities of Daily Living (ADL) scores, medication requirements, and dyskinesias were measured. Clinical outcomes were compared to patients with de novo STN DBS. Neuronal recordings were performed. STN DBS resulted in a significant reduction in UPDRS Motor scores (42.1%; 95% confidence interval [CI], 26.9-57.4; P = 0.03), comparable with de novo STN DBS surgery (41%; 95% CI, 26-46%; P < 0.001). There was also less change in dyskinesia duration and disability scores (P = 0.017, 0.005). There were no side-to-side differences clinically or in the STN neuronal firing rates and patterns. Bilateral STN DBS is safe and efficacious in improving motor symptoms in patients with prior pallidotomy.     

Immunological and clinical differences between juvenile and adult onset of systemic lupus erythematosus.

INTRODUCTION: Systemic lupus erythematosus (SLE) in children usually follows a more severe course than in adults, but sometimes in the previous studies reported there are many confounding factors. OBJECTIVE: To analyse the immunological and clinical characteristics of SLE juvenile onset and SLE adult onset. METHODS: We studied 179 patients with SLE, 49 patients were aged 6-18 yrs at onset of disease. Anti-dsDNA antibodies were detected by radioimmunoassay and antibodies to extractable nuclear antigens (ENA): anti-nRNP, anti-Sm, anti-Ro/SS-A and anti-La/SS-B antibodies by ELISA, counterimmuno-electrophoresis and immunoblotting. RESULTS: Juvenile-onset SLE shows a higher frequency of cutaneous vasculitis (44.8% vs 27.6%; P < 0.05), seizures (18.3% vs 7.6%; P < 0.05) nephropathy (67.3% vs 48.4%; P < 0.025), and discoid lupus erythematosus (26.5% vs 13.8%; P < 0.05). The incidence of articular manifestations is lower than in adults (85.7% vs 96.1%; P < 0.025). No significant differences were found between the two groups in relation with the prevalence of antinuclear antibodies. CONCLUSIONS: Juvenile-onset SLE has more frequent neurological and renal manifestations than adult-onset SLE, but immunological markers are similar in both groups. These features suggest the most severe clinical manifestations in the juvenile-onset SLE group are not related with the presence of studied antibodies by different methods.     

Maximizing aesthetic outcome in autologous breast reconstruction with implants and lipofilling

Background

Free flap breast reconstruction is an option widely sought in postmastectomy breast reconstruction. However, the volume of autologous tissue from the patient is often not sufficient for symmetrical reconstruction. In these cases, flaps can be used in combination with implants or autologous fat injections to augment volume and achieve shape, symmetry, and contour.

Methods

A retrospective chart review was performed on patients who underwent postmastectomy free flap reconstruction with secondary augmentation using autologous fat grafting or implant from 2008 to 2011.

Results

Twenty-four patients (39 breasts) received further augmentation of autologous tissue reconstruction during this period. Sixteen patients (26 breasts) had fat graft augmentation only, four patients (eight breasts) had implant augmentation only, and three patients (five breasts) had both procedures. Among patients who had fat grafting, operative intervention was required twice for fat necrosis. Contrastingly, of patients who received implants, one patient required operative intervention for implant malpositioning. These differences were not significant (P?=?0.57). The group with both fat grafting and implant augmentation had significantly higher aesthetic scores regarding overall appearance, contour, and volume, but not projection, than the group with fat grafting only and the group with implant only.

Conclusions

Autologous fat grafting offers several contouring aesthetic advantages, including selectively augmenting areas of hollowness to improve contour and maximize symmetry. However, implant augmentation generally allows for a larger increase in projection in a single procedure, with similar rates of postaugmentation complications. Use of both autologous fat grafting and implant augmentation may allow for superior aesthetic results. Level of Evidence: Level IV, therapeutic study.     

Indications and selection of free flaps for soft tissue coverage of the upper extremity

The advantages of free flap coverage of the upper extremity following trauma or tumor resection have been acknowledged by several authors. Most importantly, these benefits include the ability to provide early coverage with composite reconstruction of all damaged or missing tissues and early mobilization to restore function. The purpose of this article is to review the indications and options for selection of free flaps for soft tissue coverage of the upper extremity.