Periodic limb movements during sleep are a frequent finding in patients with Gilles de la Tourette’s syndrome

Gilles de la Tourette’s syndrome (GTS) and restless legs syndrome (RLS) are two different neurological disorders with common features such as involuntary movements. In both disorders a disturbance of the dopaminergic system has been considered among other possible mechanisms. Since periodic leg movements (PLMS) during sleep are the predominant objective finding in RLS, the aim of this study was to investigate sleep parameters in GTS patients with particular emphasis on PLMS. Seven drug-free patients with GTS and seven age- and sex-matched healthy controls were studied polysomnographically, including superficial electromyogram (EMG) leads on all four extremities. A high number of PLMS were found in five of seven, and periodic arm movements in four of seven GTS patients. Total sleep time was significantly lower (P < 0.05) in the GTS patients than in the controls, which confirms earlier findings. The presence of PLMS in GTS might point towards evidence for a pathophysiological relationship between GTS and RLS, which, however, is not supported by the different responses to pharmacological treatments. Received: 29 February 1996 Received in revised form: 5 June 1996 Accepted: 27 June 1997     

Improved quality and information in thyroid scintigraphy

We compared rectilinear scanning, analogous gamma-camera imaging and imaging using a gamma camera interfaced to a computer in order to determine which of these techniques is superior for thyroid scintigraphy. Forty patients with and without goitre and irregular activity distribution were imaged using each of the three techniques. The sets of three scintigrams per patient were rated by seven physicians. These ratings were statistically analysed using a new distribution-free test. Thyroid scintigraphy using a gamma camera interfaced to a computer turned out to be the best method, especially for detecting circumscribed areas of increased uptake. We conclude that this was due to a combination of the following factors: a computer matrix of 128x128 pixels in combination with an acquisition zoom of 1.5, the high count density of the scintigrams, computer-controlled documentation after data acquisition and the use of a continuous grey scale for documentation. The improved quality and information content of the scintigrams obtained using a gamma-camera/computer system could improve the diagnostic value of thyroid scintigraphy, especially when the scintigrams are also evaluated quantitatively.     

The Dardik biograft in reconstructive arterial surgery: Report on a five-year experience in 94 cases

Since March 1977, there have been 94 peripheral vascular reconstructions performed using the Dardik biograft, i.e., the glutaraldehyde-tanned human umbilical vein. The indication for operation was limb salvage in 88.3%. In 74.5% only one or no crural vessels was patent. In 50 patients previous bypass grafting had failed. The distal anastomosis was placed below the knee in 91.5%, and in 53.2% a tibial or peroneal revascularization was performed. The accumulated graft patency rate at 5 years was 47.4%. Poor results were obtained when the umbilical vein was combined with other graft materials. It is concluded that the human umbilical vein cord is the graft of choice in below-knee reconstructions when the autogenous saphenous vein is not available.

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Resumen Desde marzo de 1977 se han realizado 94 reconstrucciones vasculares periféricas utilizando el Bioinjerto de Dardik, o sea la vena umbilical humana curtida con glutaraldehido. Salvamento de la extremidad constituyó la indicatión para la operación en el 88.3% de los casos. En el 74.5% se encontró patente solamente uno o ninguno de los vasos crurales; reconstrucciones previas habían fallado en 50 pacientes. La anastomosis distal fue colocada por debajo de la rodilla en el 91.5% de los casos, y en el 53.2% se realizó revascularización tribial o peroneal. La tasa acumulada de permeabilidad a cinco años fue de 47.7%. Los resultados fueron pobres cuando la vena umbilical fue combinada con otros materiales para el injerto. Se pudo concluir que la vena umbilical humana es el injerto de escogencia para las reconstrucciones por debajo de la rodilla en casos en los cuales la vena safena autógena no se encuentra disponible.

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Résumé Rupuis mars 1977, 94 reconstitutions vasculaires périphériques ont été effectuées à l'aide de la greffe de Dardik (veine ombilicale humaine traitée par le glutaraldéhyde). Dans 88,3% des cas elle fut tentée pour sauver le membre menacé. Dans 74,5% des cas, aucun ou un seul vaisseau était perméable. Chez 50 malades une intervention antérieure de court-circuit vasculaire avait échoué. L'anastomose distale fut pratiquée dans 91,5% des cas audessous du genou et dans 53,2% des cas la revascularisation tibiale ou péronière fut réalisée.Le taux de perméabilité à 5 ans atteignit 47,7%. Les mauvais résultats furent constatés lorsque la veine ombilicale avait été employée simultanément avec d'autres matériaux.On peut conclure de ces faits que la veine ombilicale de l'homme représente le greffon de choix dans les interventions reconstitutives des vaisseaux audessous du genou quand la veine saphène autogène n'est pas disponible.

     

Significance of retinoblastoma and mdm2 gene expression as prognostic markers for soft-tissue sarcoma

The growth regulatory function of the retinoblastoma protein (RB) can be suppressed by mdm2 via RB/mdm2 interaction by perturbation of the RB suppression of the E2F function. The goal of this study was to examine the clinical value of immunohistochemical (IHC) RB detection and its relationship to mdm2 overexpression in a cohort of 198 adult primary soft-tissue sarcomas (STS). RB overexpression reveals, multivariately, a correlation with survival (RR = 1.59, P = 0.037) as well as mdm2 positivity (RR = 2.32, P = 0.0035). Stratification of RB results to mdm2 staining shows a prognostic graduation in four levels. Patients with positivity for both antibodies have the highest risk (RR = 3.30, P = 0.002) and the poorest prognosis (projected 5-year survival rate, 18.6%); those with negativity for both antibodies show the most favourable prognosis (projected 5-year survival rate, 63.4%). Intermediately, an isolated RB overexpression (projected 5-year survival rate, 46.1%) is more favourable than an isolated mdm2 positivity (projected 5-year survival rate, 33.5%). To sum up, this study proves that RB and mdm2 overexpression have an individual and also an additive effect on prognosis in STS. Received: 3 June 1997     

Induction of hepatic mrp2 (cmrp/cmoat) gene expression in nonhuman primates treated with rifampicin or tamoxifen

The multidrug resistance protein 2 (Mrp2) also called canalicular multidrug resistance protein (cMrp) or canalicular multispecific organic anion transporter (cMoat) is a transmembrane export pump located at the canalicular domain of hepatocytes. Mrp2 transports a broad spectrum of organic anions including glucuronides, glutathione conjugates, and organic sulphates into bile. Based on previous observations in rat hepatocytes, the inducibility of mrp2 gene expression in primate liver was investigated in rhesus monkeys treated with tamoxifen or rifampicin. It was found that treatment with tamoxifen (25 mg/kg per day; over 7 days) or rifampicin (15 mg/kg per day; over 7 days) leading to an induction of cytochrome P450 3A4, resulted in a strong increase in mrp2 mRNA in the liver of male and female rhesus monkeys. On the protein level, tamoxifen also was a highly effective inducer, while rifampicin showed some inducing effect in a female and was inactive in a male monkey. In sections of paraffin-embedded liver tissue, immunofluorescence staining confirmed the results of Western blot analysis. Induced Mrp2 was localized to the canalicular domain of the hepatocytes. In conclusion, our data show inducibility of mrp2 gene expression in the liver of primates which may represent an adaptive response aimed at the enhanced biliary elimination of the inducing drugs and/or their metabolites. Received: 8 June 1998 / Accepted: 7 September 1998     

Orientation-dependent changes in MR signal intensity of articular cartilage: a manifestation of the “magic angle” effect

Objective: To study magnetic resonance (MR) imaging pattern of normal hyaline articular cartilage in the knee joint with regard to the contribution of the “magic angle” effect to the MR signal. Design. Thirty-two healthy volunteers were imaged in a standard supine position in a 1.5-T unit using spin echo and gradient echo sequences. Nine volunteers were reimaged with the knee flexed. The signal behavior of the hyaline cartilage of the femoral condyles was evaluated qualitatively and quantitatively. The extended and flexed positions of the nine volunteers were compared. Results. A superficial and a deep hyperintense layer and a hypointense middle cartilage layer were observed. Segments of increased signal intensity were visible along the condyles; a magic angle effect on signal intensity was evident in the hypointense middle layer with both gradient echo and spin echo images. Conclusion. The MR signal behavior of hyaline cartilage is influenced by the alignment of the collagen fibers within the cartilage in relation to the magnetic field. Failure to recognize this effect may lead to inaccurate diagnosis.     

Anti-IgE and anti-FcRI autoantibodies in clinical allergy

Autoantibodies recognizing critical effector molecules of type I allergic reactions have been identified. Anti-IgE autoantibodies occur at high frequencies not only in atopic diseases but also in healthy individuals and, depending on their epitope specificities, may promote or prevent the elicitation of allergic symptoms. In contrast, anti-FcRI autoantibodies with basophil/mast cell activating properties were selectively found in patients with chronic urticaria, a condition characterized by the continuous degranulation of mast cells. Thus, humoral anti-FcRI autoreactivity defines a distinctive subset of chronic urticaria and may well be the causative and pathogenetic principle in this disease.     

Histopathologic features of spontaneous periodontitis in adult Macaca fascicularis monkeys

In the general absence of histopathologic data on spontaneous periodontitis in non-human primates, the present study was performed using a group of 6 M. fascicularis monkeys (1 female, 5 males) about 8 to 10 years of age. Four animals were given one intraveneous injection of ³H-proline 24 h prior to death. The perfusion-fixed jaws were processed for serial ground sectioning of the posterior teeth. Sections cut mesio-distally or horizontally were examined by lightmicroscopy, polarized light, roentgenography and radioautography. It was shown that, (1) supra- and subgingival plaque and calculus were omnipresent interdentally, (2) chronic established gingivitis was most common, (3) incipient to moderate periodontitis occurred in 3 animals, primarily around maxillary premolars and molars, (4) characteristic histopathologic features allowed differentiation between inactive and postactive lesions, (5) moderate periodontitis could be associated with intensive new bone formation, and. (6) high protein synthetic activity was characteristic for the healthy periodontal ligament, a chronically inflamed gingiva, and the trabecular bone of the alveolar process with signs of peripheral bone loss. Severe periodontitis was seen in 1 animal only, and it also suffered from periodontogenic infections of the face, and from emaciation.