Perinatal Asphyxia II: Clinical Management of Multisystemic Sequelae

This paper discusses the management of multisystemic sequelae of perinatal asphyxia. Appropriate intrapartum and subsequent adequate neonatal monitoring are an absolute necessity for the early detection of systemic dysfunctions. Prophylactic and therapeutic measures applicable to the various organ malfunctions are described.     

Detection of human T-cell leukemia/lymphoma virus type I in a transfusion recipient with chronic myelopathy

A white man with a progressive spastic paraparesis that began 15 months after sustaining severe trauma in a motor vehicle accident was positive for antibodies to human T-lymphotropic virus type I (HTLV-I) by enzyme-linked immunosorbent assay. Serum antibody to HTLV-I was confirmed by Western blot and radioimmunoprecipitation assay. We detected specific proviral DNA in peripheral blood lymphocytes by the polymerase chain reaction. Because the incidence of HTLV-I is generally restricted to Southern Japan and Caribbean black populations, the most likely source of HTLV-I infection in this patient was multiple intraoperative blood transfusions. The relatively short interval between transfusion and development of HTLV-I-associated myelopathy is consistent with the more rapid evolution of this clinical syndrome compared with adult T-cell leukemia.     

An autoradiographic study of the efferent connections of the ventral lateral geniculate nucleus in the albino rat and the cat

The efferent connections of the ventral lateral geniculate nucleus (LGN_v) of the albino rat and the cat have been studied using the autoradiographic method for tracing axonal pathways. Following the injection of ³H-proline or ³H-leucine into the LGN_v of the rat, label transported in the rapid phase of axonal flow was found bilaterally in the olivary pretectal nuclei, the lateral terminal nuclei of the accessory optic system, and the ventral portion of the suprachiasmatic nuclei of the hypothalamus, and ipsilaterally in the rostrolateral portion of the superior colliculus. Since these regions are known to receive a direct projection from the retina, comparisons have been made of the distribution of silver grains in autoradiographs of each region following injections of ³H-proline into the eye and into the LGN_v; in every nuclear region except the superior colliculus the grain distributions were found to overlap precisely and, in the suprachiasmatic nuclei there also appears to be a similarity in the relative intensity of the input to the nuclei on the two sides. In the superior colliculus, the retinal fibers end mainly within the more superficial laminae, whereas those from the LGN_v are distributed mainly to the deeper layers where they overlap the projection from the striate and peristriate cortex. The LGN_v has also been found to project to the zona incerta on the same side and to the contralateral LGN_v, In the cat a similar set of projections to the lateral terminal nuclei of the accessory optic tract, the suprachiasmatic nuclei, and the pretectal areas of both sides has been found, together with a projection to the ipsilateral superior colliculus and the zona incerta of both sides. No evidence could be found in either species for a projection from the LGN_v to the visual cortex.     

Evaluation of QUADAS, a tool for the quality assessment of diagnostic accuracy studies

Background  

In clinical trials, both unequal randomization design and sequential analyses have ethical and economic advantages. In the single-stage-design (SSD), however, if the sample size is not adjusted based on unequal randomization, the power of the trial will decrease, whereas with sequential analysis the power will always remain constant. Our aim was to compare sequential boundaries approach with the SSD when the allocation ratio (R) was not equal.     

Sensory stimulation induces local cerebral glycogenolysis: demonstration by autoradiography.

Brain glycogen stores are localized primarily to glia and undergo continuous utilization and resynthesis. To study the function of glycogen under normal conditions in brain, we developed an autoradiographic method of demonstrating local-glycogen utilization in the awake rat. The method employs labeling of brain glycogen with 14C(3,4)glucose, in situ microwave fixation of brain metabolism, and anhydrous tissue preparation. With this technique, tactile stimulation of the rat face and vibrissae was found to accelerate the utilization of labeled glycogen in brain regions known to receive sensory input from face and vibrissae: the contralateral somatosensory cortex and the ipsilateral trigeminal, sensory and motor nuclei. These findings demonstrate a link between neuronal activity and local glycogen utilization in mammalian brain and suggest that, like other tissues, brain may respond to sudden increases in energy demand in part by rapid glycolytic metabolism of glycogen. As cerebral glycogen is restricted primarily to glia, these observations also support a close coupling of glial energy metabolism with neuronal activity.     

Multiple sclerosis: serum-induced demyelination in vitro. A light and electron microscope study

Primary demyelination has been documented in organotypic cultures of mouse spinal cord exposed to 25% myelinotoxic sera from 2 patients with multiple sclerosis (MS). Between 10% and 90% of the original population of myelinated axons were involved. Younger cultures were more severely affected than older ones. Myelin degeneration was seen to involve the transformation of the regular 12 nm periodicity into smudged areas with an amorphous or finely-lamellated structure. The myelinolysis was accompanied by an active overgrowth of oedematous astrocytic processes which surrounded affected fibres and phagocytosed the degenerating myelin. This progressed until naked axons, invested by swollen astrocytic cytoplasm, remained. A number of oligodendrocytes in each MS serum-exposed culture underwent either acute or subacute destruction. The former occurred during the first few hours of exposure. The latter began after about 4 hr and was completed by 72 hr. Affected oligodendrocytes were phagocytosed following their ensheathment by astrocytic processes. Neurons and astrocytes did not degenerate. The myelin and oligodendrocyte lesions produced by MS serum in vitro are essentially identical to those effected by EAE serum from animals inoculated with whole white matter, except that the phenomena are slower and less widespread. The findings have been compared with patterns seen in human MS plaques and in animal demyelinating conditions.     

Evaluation of the pituitary. Patients with suspected prolactin-producing tumors

We have reviewed our experience in the radiographic and ophthalmologic evaluation of 1001 patients with symptoms suggesting the presence of a pituitary, prolactin-secreting adenoma. Twenty-seven patients had abnormal or suspicious radiographic examination of the sella turcica. Twenty-two of those had hyperprolactinemia. In only one instance was an abnormality noted on polytomography that was not seen on a conventional four-view study of the skull. Based on these findings, a four-view plain conventional radiographic assessment of the skull suffices as a screening procedure in patients with amenorrhea, galactorrhea, or both. Thin section tomography should be reserved to more thoroughly evaluate those patients with elevated serum prolactin concentrations and/or abnormal conventional radiographs. We found visual field testing to be of little value as an initial screening procedure in these patients.