Proton magnetic resonance spectroscopic imaging for discrimination of absence and complex partial seizures

We performed proton magnetic resonance spectroscopic imaging of the temporal lobes between, during, and soon after nonconvulsive seizures in 20 patients with documented temporal lobe epilepsy, 5 patients with primary generalized epilepsy, and 2 patients with secondary generalized epilepsy. Our objective was to determine whether there were metabolic changes observable by magnetic resonance spectroscopic imaging during seizures and whether these changes were specific for focal or generalized nonconvulsive seizures. We found a significant increase in lactate to creatine plus phosphocreatine (lactate/creatine) values, reflecting an imbalance in energy supply and demand or an adaptation in response to ictal neuronal discharges, during and soon after complex partial seizures, but not during or soon after absence seizures associated with generalized epilepsy. In patients with temporal lobe epilepsy, the N-acetylaspartate resonance relative to creatine plus phosphocreatine was low in one or both temporal lobes, indicating neuronal loss or damage. This was not observed in patients with primary generalized epilepsy. The regions with abnormal lactate/creatine and N-acetylaspartate/creatine values corresponded to the epileptogenic focus as defined by clinical-electroencephalographic investigation. There was no change in the N-acetylaspartate/creatine values in the temporal lobes between the interictal, ictal, or postictal states. We conclude that (1) partial seizures are associated with abnormally high lactate levels, but absence seizures are not, and (2) no short-term changes of N-acetylaspartate occur during or soon after complex partial seizures or absence seizures. These findings may be related to the lack of postictal confusion in patients with absence seizures, as well as with the more benign course of primary generalized epilepsy with nonconvulsive attacks.     

Traumatology in hang-gliding accidents. Studies based on 100 cases

The number of paragliding accidents is growing up exponentially. We review in this study 39 paragliding accidents which occurred 1985-1987 in the Val d'Illiez (Switzerland). The REGA (Swiss air ambulance) rescued 1987 61 pilots, which are also included. Most of the accidents were related to a mistake of the pilot. None is due to a failure of the material. The most severe injuries occurred immediately after taking off. The most frequent injuries occurred during landing. There is a correlation between the altitude, the wind velocity and the severity of the injuries. The lower extremities and the backbone are often injured, which is explained through the axial trauma. The pilots need a better training programme, the performance of the material should be built up and the starting places should be equipped.     

Transtemporal power- and frequency-based color-coded duplex sonography of cerebral veins and sinuses.

PURPOSETo determine the ability of transtemporal power- and frequency-based transcranial color-coded duplex sonography to aid in the assessment of cerebral veins and sinuses, as well as to provide reference data for flow direction and velocity.METHODSUsing a color duplex device equipped with a 2.0/2.5-MHz sector scan, we insonated 120 healthy volunteers and three patients with cerebral venous thrombosis.RESULTSIn subjects 20 to 59 years old, deep middle cerebral veins were identified in 88%, basal veins in 97%, straight sinuses in 60%, and transverse sinuses in 42%. The corresponding values for subjects 60 to 79 years old were 53%, 86%, 23%, and 20%, respectively. Velocities were highest in transverse and straight sinuses, slower in basal veins, and slowest in deep middle cerebral veins. Flow was directed lateromedially in the deep middle cerebral vein, rostrocaudally in the basal vein and straight sinus, and mediolaterally in the transverse sinus. Two patients with straight sinus thromboses showed reversed flow direction in the basal veins, and one patient with superior sagittal sinus thrombosis showed elevated velocities in a deep middle cerebral vein.CONCLUSIONTranstemporal power- and frequency-based color-coded duplex sonography enabled imaging and velocity measurements in deep cerebral veins in subjects 20 to 59 years old, but detection of the straight and transverse sinuses was low. In older subjects, only the basal vein was regularly assessed.     

Stimulation of insulin release is uncoupled from insulin biosynthesis in tumoral RINm5F cells.

RINm5F cells, an insulin-secreting subclone of a rat insulinoma cell line, were incubated in serum-free medium up to 24 hours in the presence or absence of glucagonlike peptide-1(7-36)amide in various concentrations, 3-isobutyl-1 methylxanthine (1 mM), choleratoxin (10 nM), carbachol (1 mM), and potassium (40 mM). Insulin release and biosynthesis were measured by the immunoreactive insulin content of the cells and the medium. Steady-state levels of insulin-specific mRNA were determined by Northern and slot blot analysis. Short-term insulin release is significantly stimulated by all secretagogues tested. A significant increase of insulin biosynthesis by any of the various secretagogues was not detectable on the peptide and mRNA level. Sodium butyrate (1 mM), a differentiating agent, increased insulin-specific mRNA levels in RINm5F cells after 72 hours. In conclusion, substances known to stimulate short-term insulin release in RINm5F cells do not stimulate insulin biosynthesis, indicating an uncoupling of insulin secretion and biosynthesis in these transformed beta cells.     

Time course of some effects of cigarette smoking on platelets.

Eight male habitual smokers smoked two cigarettes over a 20-min period following a 12-h period of abstinence. Antecubital venipuncture was performed immediately before, immediately after, and 55 min and 2 h after smoking had ceased. At these times, the mean values (+/- SD) of collagen-induced platelet aggregation were 45 +/- 5, 68 +/- 5, 59 +/- 6 and 52 +/- 5 chart units, respectively, while the corresponding values for the mean platelet aggregate ratio were 0.91 +/- 0.01, 0.82 +/- 0.03, 0.87 +/- 0.02 and 0.90 +/- 0.02, respectively. Mean collagen-induced platelet aggregation was significantly (P less than 0.005) higher immediately after, and 55 min and 2 h after smoking. The mean platelet aggregate ratio was significantly (P less than 0.001) lower immediately after and 55 min after smoking. Correlation coefficients between the concentration of nicotine in each of the 24 plasma samples obtained after smoking and the corresponding values of collagen-induced platelet aggregation and the platelet aggregate ratio were 0.41 (P less than 0.05) and -0.50 (P less than 0.02), respectively. It is concluded that when habitual smokers abstain from smoking overnight, a 20-min period of cigarette smoking may enhance platelet aggregability for as long as 2 h.