Outpatient lumbar myelography. Initial results in 79 examinations using a low-dose metrizamide technique

Seventy-nine patients underwent lumbar myelography on an outpatient basis, with a low (3.75 g) dose of metrizamide as the radiocontrast agent and a 25-gauge spinal needle used for lumbar puncture. No patient experienced significant neurotoxicity following the examination; 70.8% (56 of 79) experienced minimal (23%) or no (48%) side effects. Three patients (3.8%) were admitted to the hospital for management of common side effects (headache, nausea/vomiting, back pain). We obtained postmyelographic computed tomographic scans on 96% (76 of 79) of the patients. Our initial results suggest that outpatient lumbar myelography is safe and can be performed with a very acceptable incidence of side effects.     

Cerebrospinal fluid analyses in migraine patients and controls

To investigate the role of central neurotransmitters in the pathogenesis of migraine, we measured cerebrospinal fluid (CSF) levels of certain amino acids (glycine, taurine, glutamine) and metabolites of biogenic amines (5-hydroxyindoleacetic acid and homovanillic acid) in 38 migraine patients and compared them with the levels from 10 headache-free controls. The levels of taurine, glycine and glutamine were significantly higher in the migraine patients (p < 0.0001 for taurine and glycine; p < 0.0009 for glutamine); there were no significant differences among the three migraine subgroups (infrequent migraine, frequent migraine and transformed migraine). In seven patients subsequently treated with divalproex sodium, CSF taurine levels decreased significantly from pretreatment baseline values. These data support the concept that migraine is at least in part a disorder of central neurotransmission.     

Plaque accumulation on different dental filling materials

abstract — The purpose of the present study was to investigate whether some dental filling materials collect more plaque than others under standardized conditions in vitro and in vivo . Round disks of the filling materials of silicate, composite and amalgam were prepared and placed on an agar/sucrose medium or hung in liquid medium containing 5% sucrose. The mediae were inoculated with Streptococcus mutans OMZ 176 and OMZ 52–3. After 6 d the disks were rinsed in distilled water and the plaque that had accumulated on the surfaces was scraped off and measured by the orcinol method. The materials were also fitted to acrylic plates and introduced into the mouth. Six patients wore two plates each for comparison of the materials and were told to rinse their mouth every hour with 15% sucrose solution. After 8 h the plaque was scraped off and measured. Silicate disks on agar medium invariably produced inhibition zones of about 4 mm. Composites and amalgam showed no such zones. In liquid medium an insignificant amount of plaque was absorbed to the silicate disks, whereas abundant amounts were found on composite materials and some on amalgam disks. The same trend could be demonstrated in the clinical experiments.     

Rituximab as therapy for refractory polymyositis and dermatomyositis

We describe response to rituximab treatment of refractory inflammatory myopathy. Three patients with long-standing polymyositis (PM) or dermatomyositis (DM) poorly responsive to prednisone combined with several immunosuppressants were given intravenous rituximab 1,000 mg on Days 0 and 14. Prior to rituximab, each had significant proximal weakness with creatine phosphokinase (CPK) elevation to>3 times the normal upper limit (range 789-3,123 U/l). Patients were receiving prednisone plus methotrexate (MTX) or azathioprine. CPK decrease was observed 1 month post-infusion, with normalization of levels averaging 4.6 months (range 2.6-7.7 mo). Muscle strength improved in all, with strength returning to normal in 2. Average daily prednisone dose decreased from 16.7 mg (range 10-20 mg) to 4 mg (range 0-7 mg) after infusion. MTX dose was tapered by 50% in 2 patients. The third patient eventually discontinued all additional therapies. Percentage of CD19+ cells in each were suppressed at 0-1% 5 to 6 months after infusion (normal 5-21%). Elevated CPK with return of clinical symptoms occurred in 2 patients 6 and 10 months post-infusion, requiring rituximab retreatment. CD19+ cells remained suppressed at 1% in one patient, but were almost normal at 4% in the other. The third patient remains disease-free 12 months after initial treatment, even though her CD19+ cells are now normal at 8%. Thus, short-term beneficial effects with rituximab were observed in patients with DM and PM. However, the need for retreatment did not correlate with levels of CD19+ cells.     

Decrease in subunit aggregation of phosphoribosylpyrophosphate synthetase: a mechanism for decreased nucleotide concentrations in pyruvate kinase-deficient human erythrocytes

Pyruvate kinase (PK)-deficient RBCs have several unexplained metabolic abnormalities, such as decreased concentrations of total adenine nucleotides (AMP, ADP, and ATP) and total (oxidized and reduced) nicotinamide adenine dinucleotide (NAD). Because 5-phosphoribosyl-1- pyrophosphate (PRPP) is an intermediate in the synthesis of adenine nucleotides and NAD, we investigated PRPP synthetase (PRPPS), the enzyme responsible for PRPP synthesis. This enzyme is regulated, in part, by changes in its state of subunit aggregation. The proportion of aggregated PRPPS can be altered in vitro by ATP and 2,3- diphosphoglycerate (DPG). Because PK-deficient RBCs have decreased ATP and increased DPG concentrations, we examined the state of subunit aggregation of PRPPS in RBCs from normal and PK-deficient subjects, using gel permeation chromatography. Young normal RBCs have more aggregated PRPPS than do older RBCs. In contrast, due to their decreased ATP and increased DPG concentrations, PK-deficient RBCs contain less aggregated PRPPS than do RBCs of comparable age without PK deficiency. These data suggest that PRPPS should be less active in vivo in PK-deficient RBCs. This may play a key role in mediating the decreases in total adenine nucleotide and total NAD concentrations in these RBCs.