Ovarian hyperstimulation caused by gonadotroph cell adenoma: a case report and review of the literature.

OBJECTIVE: We present a case of spontaneous ovarian hyperstimulation caused by pituitary gonadotroph macroadenoma, and include a review of the literature. CASE REPORT: A 27-year-old woman presented with irregular menstruation and bilateral multicystic enlargement of the ovaries. Serum estradiol (E(2)) levels were marginally elevated for the follicular phase but within the physiological range. Serum luteinizing hormone (LH) was extremely low, follicle-stimulating hormone (FSH) was normal, and prolactin (PRL) was high. Magnetic resonance imaging disclosed a pituitary macroadenoma. Immunohistochemical examination of the surgically removed adenoma showed intense reactivity for FSH and LH. After the operation, E(2), LH and PRL levels were normalized, the ovaries returned to a normal morphology, and regular menstrual cycles were resumed. CONCLUSION: A review of the literature showed that ovarian hyperstimulation caused by pituitary gonadotroph adenoma is not always accompanied by elevated FSH levels. High PRL and E(2) and low LH were reported in the majority of the cases, but E(2) may stay within the range observed in normal menstrual cycles.     

Quadro-pulse stimulation is more effective than paired-pulse stimulation for plasticity induction of the human motor cortex

OBJECTIVE: Repetitive paired-pulse transcranial magnetic stimulation (TMS) at I-wave periodicity has been shown to induce a motor-evoked potential (MEP) facilitation. We hypothesized that a greater enhancement of motor cortical excitability is provoked by increasing the number of pulses per train beyond those by paired-pulse stimulation (PPS). METHODS: We explored motor cortical excitability changes induced by repetitive application of trains of four monophasic magnetic pulses (quadro-pulse stimulation: QPS) at 1.5-ms intervals, repeated every 5s over the motor cortex projecting to the hand muscles. The aftereffects of QPS were evaluated with MEPs to a single-pulse TMS, motor threshold (MT), and responses to brain-stem stimulation. These effects were compared to those after PPS. To evaluate the QPS safety, we also studied the spread of excitation and after discharge using surface electromyograms (EMGs) of hand and arm muscles. RESULTS: Sizes of MEPs from the hand muscle were enhanced for longer than 75min after QPS; they reverted to the baseline at 90min. Responses to brain-stem stimulation from the hand muscle and cortical MEPs from the forearm muscle were unchanged after QPS over the hand motor area. MT was unaffected by QPS. No spreads of excitation were detected after QPS. The appearance rate of after discharges during QPS was not different from that during sham stimulation. CONCLUSIONS: Results show that QPS can safely induce long-lasting, topographically specific enhancement of motor cortical excitability. SIGNIFICANCE: QPS is more effective than PPS for inducing motor cortical plasticity.     

Subtle computed tomography abnormalities in cerebral deep sinus thrombosis.

A patient with cerebral deep sinus thrombosis, which was not diagnosed on the first examination, is reported. A 46-year-old woman presented with headache and vomiting. Neurological examination and a brain computed tomography (CT) scan showed no obvious abnormal findings. The patient suffered disturbed consciousness on the day after the examination, and was admitted to our emergency centre. A CT scan and magnetic resonance imaging revealed an ischaemic lesion in the left basal ganglia, suggesting deep sinus occlusion. Anticoagulant therapy was administered. One day after admission, a CT scan showed a haematoma and severe brain swelling in the same region. Cerebral angiography demonstrated a straight sinus occlusion. Intracranial pressure was not controlled with hypothermia, and the patient died 25 days after admission. Review of the initial CT scan revealed subtle, early findings of deep venous thrombosis that were missed on first examination.     

The link between contraceptive methods andChlamydia trachomatis infection

The effect of various contraceptive methods onChlamydia trachomatis (CT) infection was examined in a group of 158 women, with a mean age of 26.9 years, patients of a family planning clinic. Their symptoms were mild abdominal pain or vaginal discharge. Antibodies to CT were examined by an indirect immunoperoxidase assay, with a commercial kit. From each patient a vaginal smear was collected for bacteriologic and mycologic study.In group I, consisting of 30 married women with a mean age of 31 years, 5 (16.7%) IUD users had a positive test for CT antibodies. In group II, comprising 57 women, with a mean age of 23.3 years, 22 (38.6%) oral contraceptive (OC) users, of whom 94.7% were unmarried, had positive tests for CT antibodies. The difference between these two groups was statistically significant (p<0.05).In group III, comprising 71 women with a mean age of 28.1 years, 62% unmarried and using other contraceptive methods, 15 (21.1%) had a positive test for CT antibodies. The incidence of CT infection was not different in the 3 groups under study, when the factors of age and marital status were taken into consideration (p>0.30). Bacterial vaginal infection was found in 43.3% of the IUD users, compared with only 14% of the OC users (p<0.01).In contrast, in the OC users, candidiasis was predominant, the difference from the other groups being statistically significant (p<0.001). The women with positive antibodies also more frequently had colonies of bacterial and mycological vaginal infection. CT infection is a sexually transmitted disease (STD) related to a specific and non-monogamous sexual life style. The unmarried women in the group of OC users are the most at risk, taking into consideration that they begin sexual life at an early age and that they often change their partners.

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Resumen El efecto de varios métodos anticonceptivos en la infección porChlamydia trachomatis (CT), fué examinado en un grupo de 159 pacientes con 26,9 años de edad media, en una clinica de planificación familiar. Sus síntomas fueron: dolor leve abdominal o flujo vaginal. Se examinaron los anticuerpos a CT mediante una prueba comercial de immunoperoxidase indirecta. Se obtuvo un extendido vaginal de eada paciente para un estudio bacteriológico y micológico.En el grupo I, constituido por 30 mujeres casadas con 31 años de edad media, 5 (16,7%) usuarias de DIU tuvieron una prueba de anticuerpos positiva a CT. En el grupo II, constituido por 57 mujeres con 23.3 aflos de edad media, siendo usuarias de anticonceptivos orales (OC) y 94,7% solteras, 22 (38,6%) tuvieron resultados positivos a anticuerpos de CT. La diferencia entre estos dos grupos fue estadísticamente significativa (p<0,05).En el grupo III, constituido por 71 mujeres con 28,1 años de edad media, siendo 62% solteras y usando otros métodos anticonceptivos, 15 (21,1%) tuvieron una prucba de anticuerpos CT positiva. La incidencia de infección de CT no fue diferente en los 3 grupos de estudio cuando se tuvieron en consideracion los factores de edad y estado civil (p>0,30). Se encontró infección bacteriana vaginal en 43,3% de las usuarias de DIU, comparado con 14% de OC (p<0,01).A diferencia, en usuarias de OC predominó la candidiasis, siendo estadísticamente significativa (p<0,001) con otros grupos. Las mujeres con anticuerpos CT positivos, mas frecuentemente tuvieron colonias de infección bacteriana y micológica. La infección CT es una enfermedad transmitida sexualmente (STD), relacionada con un grupo especifico, no monógamo de vida sexual. Las solteras en este grupo de usuarias de OC, son las que tienen el mayor riesgo considerando que empiezan su vida sexual a edad mas temprana y que cambian de pareja con frecuencia.

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Resumé L'effet de diverses méthodes contraceptives sur l'infection par laChlamydia trachomatis (CT) a été examiné sur un groupe de 158 femmes dont l'âge moyen était de 26,9 ans qui fréquentaient un clinique de planning familial. Elles présentaient comme symptômes des douleurs abdominales légères et des pertes vaginales. Les anticorps à la CT ont été examinés par un essai indirect à l'immunoperoxydase effectué au moyen d'un matériel commercial. On a procédé à un frottis vaginal sur chaque patiente aux fins d'une étude bactériologique et mycologique.Dans le groupe I, comprenant 30 femmes mariées âgées en moyenne de 31 ans, l'essai sur les anticorps à la CT, chez les 5 utilisatrices de DIU (16,7%), a donné des résultats positifs. Dans le groupe II, comptant 57 femmes d'un âge moyen de 23,3 ans, les utilisatrices de contraceptifs oraux, dont 94,7% étaient célibataires, 22 (38,6%) ont produit des résultate positifs à l'essai sur les anticorps à la CT. La différence entre ces deux groupes était significative du point de vue statistique (p<0.05).Quant au groupe III, composé de 71 femmes âgées en moyenne de 28,1 ans, dont 62% n'étaient pas mariées et faisaient appel à d'autres méthodes contraceptives, les résultats de l'essai sur les anticorps à la CT ont été positifs dans 15 cas. L'lneidence de l'infection par la CT ne différait pas dans les trois groupes étudiés lorsqu'on a tenu compte des facteurs d'âge et de statut matrimonial (p>0.30). L'infection bactérienne vaginale a été retrouvéc chez 43.3% des utilisatrices de DIU, alors qu'elle était de 14% chez les femmes qui prenaient des contraceptifs oraux (p<0.01). Par contre, chez ces dernières, la candidose était prédominante, révélant une différence statistiquement signifieative avae les autres groupes (p<0.001). En outre, les femmes ayant des anticorps positifs à la CT présentaient plus souvent des colonies d'infection vaginale bactériennes et mycologiques. L'infection par la CT est une maladie sexuellement transmissible (MST) liéc à une activité sexuelle spécifique et non monogame. Les femmes célibataires du groupe des utilisatrices de contraceptifs oraux sont les plus exposées à ces risques, compte tenu du fait que leur activité sexuelle commence tôt et qu'elles changent souvent de partenaires.

     

Presynaptic dopamine D1 receptors attenuate excitatory and inhibitory limbic inputs to the shell region of the rat nucleus accumbens studied in vitro.

1. Intracellular recordings were made from the shell region of the nucleus accumbens in an in vitro slice preparation. The mean resting membrane potential, input resistance, and action potential amplitude of these neurons were -76 +/- 1 mV, 87 +/- 5 M omega and 94 +/- 2 mV (N = 108), respectively. A sample of these neurons (N = 18) was identified as medium spiny neurons with the use of the biocytin-avidin labeling technique. 2. Electrical stimulation of the fornix, subcortical fibers, or neuropil within the nucleus accumbens shell itself elicited a depolarizing postsynaptic potential (PSP). Dopamine (10-100 microM) attenuated PSPs elicited by stimulation of all of these sites. In a paired-pulse stimulation protocol, dopamine was observed to enhance the facilitation of the test response with respect to the conditioning response. 3. The suppressive effect of dopamine was mimicked by the D1 receptor agonist SKF 82958 (10-30 microM), whereas the D2 receptor agonist quinpirole (10-30 microM) was ineffective. The action of dopamine was antagonized by the D1 receptor antagonist Sch 23390 (10-30 microM), but not by the D2 receptor antagonist sulpiride (10-50 microM) or various adrenergic receptor antagonists. 4. The PSP was usually composed of an excitatory postsynaptic potential (EPSP)-inhibitory postsynaptic potential (IPSP) sequence. Dopamine equally attenuated the excitatory and inhibitory component of the synaptic response. The attenuation of both EPSP and IPSP did not depend on membrane potential. 5. Dopamine effects on the resting membrane potential and input resistance were variable and did not correlate with changes in the PSP. Two further indications were found in favor of a presynaptic locus of dopaminergic modulation. First, the time course of the PSP was not altered during dopamine application. Second, dopamine did not attenuate depolarizations induced by bath-applied L-glutamate. In extracellular recordings, it was found that dopamine reduced the population spike but not the presynaptic fiber volley. 6. These findings strongly indicate that dopaminergic modulation of synaptic responses in neurons located in the accumbens shell region is mediated by presynaptic D1 receptors. Notably, dopamine does not exert a purely inhibitory effect on synaptic excitability in the nucleus accumbens, because it suppresses both the excitatory and inhibitory component of the synaptic response.     

Neonatal impact of leukemia inhibitory factor on neurobehavioral development in rats

Cytokines have been implicated in the etiology or pathology of various psychiatric diseases of developmental origin such as autism and schizophrenia. Leukemia inhibitory factor (LIF) is induced by a variety of brain insults and known to have many influences on mature and immature nervous system. Here, we assessed the neurobehavioral and pathological consequences of peripheral administration of LIF in newborn rats. Subcutaneous LIF injection induced STAT3 phosphorylation in many brain regions and increased glial fibrillary acidic protein (GFAP) immunoreactivity in the neocortex, suggesting that LIF had direct effects in the central nervous system. The LIF-treated rats displayed decreased motor activity during juvenile stages, and developed abnormal prepulse inhibition in the acoustic startle test during and after adolescence. They displayed normal learning ability in active avoidance test, however. Brain neuronal structures and startle responses were grossly normal, except for the cortical astrogliosis during neonatal LIF administration. These results indicate that LIF induction in the periphery of the infant has a significant, but discrete impact on neurobehavioral development.     

A new approach to spike sorting for multi-neuronal activities recorded with a tetrode--how ICA can be practical

Multi-neuronal recording with a tetrode is a powerful technique to reveal neuronal interactions in local circuits. However, it is difficult to detect precise spike timings among closely neighboring neurons because the spike waveforms of individual neurons overlap on the electrode when more than two neurons fire simultaneously. In addition, the spike waveforms of single neurons, especially in the presence of complex spikes, are often non-stationary. These problems limit the ability of ordinary spike sorting to sort multi-neuronal activities recorded using tetrodes into their single-neuron components. Though sorting with independent component analysis (ICA) can solve these problems, it has one serious limitation that the number of separated neurons must be less than the number of electrodes. Using a combination of ICA and the efficiency of ordinary spike sorting technique (k-means clustering), we developed an automatic procedure to solve the spike-overlapping and the non-stationarity problems with no limitation on the number of separated neurons. The results for the procedure applied to real multi-neuronal data demonstrated that some outliers which may be assigned to distinct clusters if ordinary spike-sorting methods were used can be identified as overlapping spikes, and that there are functional connections between a putative pyramidal neuron and its putative dendrite. These findings suggest that the combination of ICA and k-means clustering can provide insights into the precise nature of functional circuits among neurons, i.e. cell assemblies.     

Morphological study of the tegmental pedunculopontine nucleus, substantia nigra and subthalamic nucleus, and their interconnections in rat organotypic culture

The morphological organization of the tegmental pedunculopontine nucleus, midbrain extrapyramidal area, substantia nigra and subthalamic nucleus and their interrelationships were studied in rat organotypic culture using immunohistochemistry and NADPH-diaphorase histochemistry. Three coronal sections, one containing the tegmental pedunculopontine nucleus/midbrain extrapyramidal area, another with the substantia nigra and the third with the subthalamic nucleus, were obtained from postnatal 1-2-day-old rats. These sections were co-cultured for 3-4 weeks using the roller-tube technique. In the tegmental pedunculopontine nucleus/midbrain extrapyramidal area, the distribution pattern of cholinergic neurons was similar to that found in the in vivo study. We could, therefore, identify the subdivisions of the tegmental pedunculopontine nucleus (i.e., pars compacta and pars dissipata) and the midbrain extrapyramidal area. As in the in vivo situation, glutamate immunoreactive neurons were also located in these areas. Approximately 10% of NADPH-diaphorase positive neurons in the tegmental pedunculopontine nucleus, were glutamate immunoreactive. In the substantia nigra, as in the in vivo, tyrosine hydroxylase immunoreactive (putative dopaminergic) neurons were identified predominantly in the substantia nigra pars compacta, and parvalbumin immunoreactive neurons (putative GABAergic) mainly in the substantia nigra pars reticulata. The subthalamic nucleus was ladened with glutamate immunoreactive neurons. NADPH-diaphorase stained axons originating from the tegmental pedunculopontine nucleus were traced into the substantia nigra and subthalamic nucleus. They were often in close apposition to tyrosine hydroxylase immunoreactive neurons in the substantia nigra. Parvalbumin immunoreactive fibers from the substantia nigra projected heavily to the midbrain extrapyramidal area, but only sparsely to the tegmental pedunculopontine nucleus and the subthalamic nucleus. These findings indicate that the tegmental pedunculopontine nucleus/midbrain extrapyramidal area, substantia nigra and subthalamic nucleus in the organotypic culture have retained a basic morphological organization and connectivity similar to those seen in the in vivo situation. Therefore, this preparation could be a useful model to conduct further studies to investigate functional circuits among the structures represented.     

Personality of seasonal affective disorder analyzed by Tri-dimensional Personality Questionnaire

BACKGROUND: Although there have been numerous reports in personality of mood disorders, there have been few reports in regard with personality of winter seasonal affective disorder (SAD). Furthermore, no reports have been published concerning summer SAD personality characteristics. Thus, this study was conducted to assess the personality of winter and summer SAD using Tri-dimensional Personality Questionnaire (TPQ) that have been used in a variety of mental disorders. METHODS: A total of 6135 Japanese were evaluated with TPQ, the Seasonal Pattern Assessment Questionnaire (SPAQ) and the Self-rating Depression Scale (SDS). Winter, summer and non-SAD groups were classified by SPAQ. We compared the difference of personality trait among these three groups in consideration of gender, age and SDS score influence. RESULTS: Winter SAD demonstrated higher "Novelty Seeking" and "Harm Avoidance"; summer SAD showed higher "Harm Avoidance" than the non-SAD group. "Harm Avoidance" in both SAD groups was re-analyzed using SDS score as a covariate, and "Novelty Seeking" in winter SAD using age as a covariate. As a result, the significance of high "Novelty Seeking" and high "Harm Avoidance" in winter SAD was excluded. However, "Harm Avoidance" remained the significant difference between summer and non-SAD. LIMITATION: SAD was diagnosed only by SPAQ and not by interview. The state-dependency of "Harm Avoidance" was not confirmed in identical patients over lapse of time. CONCLUSION: Patients with winter SAD have high "Harm Avoidance" dependent on the depressive state that is in accordance with non-seasonal depression. Patients with summer SAD have high "Harm Avoidance" possibly independent from the depressive state.     

Effect of evaluative observation during mental tasks on cardiovascular responses

The effect of evaluative observation on cardiovascular responses was assessed in 20 female undergraduate students. All participants performed a mental arithmetic (MA) task, and a mirror drawing (MD) task, with or without evaluative observation. Heart rate, blood pressure (BP), admittance plethysmography, and task performance were recorded for each task. Both tasks increased blood pressure, but the hemodynamic response patterns were distinct. The MA task induced enhanced cardiac response, whereas the MD task induced a vascular dominant response. Evaluative observation substantially increased BP during both tasks, but it always enhanced cardiac output and reduced total peripheral resistance. The hemodynamic responses changed significantly from vascular dominant to cardiac dominant, particularly during the MD task. The similarity of responses during evaluative and competitive situations is discussed. The significance of interpersonal factors in psychophysiological studies is emphasized.