Abnormal sensorimotor integration is related to disease severity in Parkinson's disease: a TMS study.

Hyperexcitability of the motor system has been reported in Parkinson's disease (PD). We evaluate how cutaneous afferents modulate motor excitability in PD patients and whether abnormal modulation is correlated to parkinsonian symptoms. Digital stimulation causes abnormal enhancement of motor responses in patients. This effect may be one of the features of motor hyperexcitability in PD. Cutaneomotor hyperexcitability correlates with clinical scores, suggesting that abnormal processing of cutaneous inputs might contribute to the pathogenesis of parkinsonian symptoms.     

Mechanisms of tolerance during treatment with nitroglycerin patches for 24 h

Objective: We examined the relationship between tolerance development, counterregulatory responses and arterial vasodilating effects evaluated by digital pulse plethysmography. Methods: Twenty patients with stable angina pectoris were exercise tested before, after 2 and after 24 h of open nitrate patch treatment. Results: The effects observed after 2 h of treatment on exercise duration, ST-segment depression, blood pressure and heart rate were lost in most individuals after 24 h. In contrast, the effects on the arterial pulse curves persisted after 24 h, with a mean change from baseline of 29%, compared to 33% at 2 h. After 24 h, a significant decrease in haematocrit and an increase in body weight were observed. The haematocrit changes correlated with the loss of clinical efficacy (r =0.57 for ST-segment depression, and r =0.54 for exercise duration). Conclusion: Clinical nitrate tolerance may be observed despite maintenance of the arterial vasodilating effects, and tolerance is more related to plasma volume expansion as a counterregulatory mechanism. Received: 28 February 1996/Accepted in revised form: 5 July 1996     

Gadoteridol dose dependence in MR imaging of a liver abscess model

A necrotic liver abscess model was studied with magnetic resonance (MR) imaging at 1.5 T before and after intravenous administration of gadoteridol at doses of 0.1, 0.25, and 0.5 mmol/kg in 24 rabbits. Enhancement characteristics and lesion delineation were assessed with both breath-hold and non-breath-hold imaging techniques. Lesion delineation, as assessed both by signal intensity measurements and evaluations by two image readers blinded to imaging technique, was greatest on high-dose (0.5 mmol/kg) breath-hold images. Lesion rim enhancement was seen consistently only on postcontrast images obtained at a dose of 0.5 mmol/kg and progressed with time after injection of contrast material.     

Prophylactic use of chlorpromazine to improve survival of random skin flaps in pigs

On the basis of earlier success in rat studies, chlorpromazine was evaluated as a probable agent for improving survival of random skin flaps in pigs. The aim was to exclude the possibility that the effect of the chlorpromazine is species specific and to find out if it is dose dependent. One hundred and five dorsally-based 12×4 cm flaps were raised unilaterally on the backs of 15 pigs. The animals were divided into three groups using 15 mg/kg chlorpromazine, 7.5 mg/kg chlorpromazine, and a saline-treated control group. Flaps in the control group averaged 40.57±3.17% necrosis, while flaps in the 15 mg/kg and 7.5 mg/kg chlorpromazine-treated groups averaged 31.53±4.77% and 11.47±2.22% necrosis respectively. These results demonstrate dose dependent beneficial affects of chlorpromazine and the survival of random skin flaps in the pig. Although ideal dose levels are still to be determined, flap survival improved with the prophylactic use of chlorpromazine at the lower 7.5 mg/kg dosage.     

益母草防治初发期急性肾小管坏死的实验研究

ＳＤ成年雄性大鼠，禁止１６小时，肌注甘油引起急性肾小管坏死（ＡＴＮ），于其初发期给予不同药液，观察到益母草组３、２４及４８小时Ｂｃｒ升高值，２４及４８小时ＢＵＮ升高值均明显低于自来水组和单纯禁水组，而与校正对照异搏停组近似，肾组织损伤程度亦明显减轻。结果表明，益母草对初发期急性肾小管坏死（ＩＡＴＮ）有一定的防治作用。     

肺癌侵犯中央肺动脉继发肺低灌注的CT与DSA对照研究

目的　探讨肺癌侵犯中央肺动脉继发肺低灌注的CT特征及其诊断价值。方法　对2 0例手术及病理证实的肺癌侵犯中央肺动脉 (cancerousinvasionofcentralpulmonaryarteriesinlungcancer,CICPA)患者术前肺血管DSA及增强螺旋CT(含高分辨率CT ,即HRCT)征象行前瞻性对照研究。根据DSA和CT胸膜下末梢肺动脉分布和数量变化 ,即肺血管征、肺毛细血管充盈度和肺实质强化后密度及时间 密度曲线变化 (即肺实质征 ) ,行两者间的盲法对照 ,统计学分析CT与DSA征象及其一致性 ,评估CT对CICPA继发肺低灌注的诊断价值。结果　 2 0例手术病理证实的CICPA病例中 ,共3 0支肺叶动脉受累 ,DSA显示 90 % (2 7/3 0 )出现肺叶低灌注征象 ,CT诊断肺低灌注敏感度为 78%(2 1/2 7) ,特异度 10 0 % (3 /3 ) ,准确度 80 % (2 4/3 0 )。肺低灌注与CPA狭窄程度无明显相关性 (rs=0 40 ,P =0 0 73 )。CT与DSA的肺血管征一致性较好 (Kappa =0 69,P <0 0 0 1) ,而肺实质征一致性稍差 (Kappa =0 3 7,P =0 0 11)。结论　肺低灌注是肺癌侵犯中央肺动脉的常见表现 ,CT对其定性诊断具有重要价值 ,而定量判断有一定限度     

平板式全数字心血管造影机在周围血管及非血管介入中的应用

目的 :评价平板式全数字心血管造影机在周围血管及非血管介入中的应用价值。方法 :对平板探测器(FPDD)X线成像与影像增强器 电视 (IITV)X线成像在动态范围、成像均匀性、对比度线性、对比分辨率等图像质量指标的检测及比较。随机选择上述两机型在周围血管及非血管介入诊疗病例图像资料各 6 0例 ,由三名高年资医师对其图像质量进行综合评价 ,记录评价结果 ,并进行比较。结果 :FPDD成像在动态范围、成像均匀性、对比度线性、对比分辨率等图像质量指标均优于IITV成像 ;在人体各部位周围血管及非血管介入诊疗中的图像综合评价结果也优于IITV成像。结论 :平板式全数字化心血管造影机不仅适用于心血管介入 ,同时能满足全身各部位周围血管及非血管介入诊疗的需要。     

Prevalence of elevated serum prostate-specific antigen in rural Nigeria

BACKGROUND: Recent hospital and cancer registry data show increasing prostate cancer incidence in Nigeria, which was previously regarded as a low incidence region. This study investigates the prevalence of prostate cancer risk in a previously unscreened cohort of rural Nigerians. METHODS: Rural Nigerian men, 40 years and older, were screened by serum prostate-specific antigen (PSA) and digital rectal examination (DRE) and those with PSA >/= 4 ng/mL and/or abnormal DRE were referred for prostate biopsy. RESULTS: Of 200 consecutive men invited, 151 (75.5%) presented for screening, the mean age was 56.45 + 15.1 and 95 (61.6%) were >/= 50 years of age. Of the 140 who consented to a blood test, PSA correlated with age (r = 0.3, P < 0.01), 14 (10.0%) had abnormal PSA >/= 4 ng/mL, increasing from 3 (3.6%) in men < 60 years to 4 (50%) in men >/= 80 years. The rate was 13 (15.7%) for men >/= 50 years and there was no evidence of increased incidence of prostatitis in the community. Mean (median) PSA in ng/mL increased from 1.17 (0.60) in the youngest to 13.75 (4.45) in the oldest cohort. Of those who accepted DRE, 38 (29.0%) had an enlarged prostate, including two who had nodular prostate, one-third with symptoms, increasing from 4 (5.4%) in those < 50 years to 6 (75.0%) in men >/= 80 years. The proportion of men with PSA >/= 4 ng/mL among those with enlarged vs normal prostate is 27.0 to 3.4%, P < 0.001, and the pattern was similar for men >/= 60 years and those < 60 years of age. The 40 (32.0%) men referred for prostate biopsy defaulted mainly because they did not fully understand the need for further investigation because they were symptom free or afraid of the possible side-effects of the procedure or diagnosis of cancer. CONCLUSION: The proportion of men with PSA >/= 4 ng/mL is comparable to that of previously unscreened populations with high incidence of prostate cancer such as African-American men. A larger study is required to confirm these findings and intensify efforts to determine the prostate cancer detection rate by biopsy in this population. A prostate cancer awareness and education campaign will be useful in this community.     

Le sommeil de l’analyste

The state of “nodding off” which the psychoanalyst may experience during therapy is a phenomenon that requires further investigation into its nature, causes, and effects. Even if it occurs only sporadically and is a physiological necessity, it nevertheless has a certain effect and can present certain advantages. This introduction of resistance in the form of sleep can sometimes provide an opportunity in the development of sensorimotor functions for the patient to verbalize his experience, and in any case this phenomenon should not be taken lightly. Recourse to current knowledge regarding sleep can improve our understanding of this phenomenon, and we should be prepared to take the risk of examining psychoanalysis on the basis of a non-analytical approach, i.e. primarily psychobiological and cognitive. This also permits a link to be made between the psychoanalyst’s therapeutic activity and the contextual phenomena which influence cerebral activity and its level of vigilance which is expressed by specific types of verbalization. The pertinence of this risk-taking should also be examined, and a distinction made between physiologically necessary somnolence and other causes. It appears that in the present context, the induction of a state of somnolence is caused by the narcissistic characteristics of a transferential relation that is in the process of development; that is to say, the “positive aspects’’ of narcissism, which are an integral part of psychic growth. However, we should also bear in mind that these narcissistic characteristics can also be expressed in the form of resistance.     

The progressive outer retinal necrosis syndrome

The progressive outer retinal necrosis (PORN) syndrome is a recently described clinical variant of necrotizing herpetic retinopathy in patients with the acquired immunodeficiency syndrome (AIDS). It is caused by varicellazoster virus infection of the retina. Its course and clinical features distinguish it from the acute retinal necrosis syndrome and CMV retinopathy. Early disease is characterized by multifocal deep retinal opacification. Lesions rapidly coalesce and progress to total retinal necrosis over a short period of time. Despite aggressive therapy with intravenous antivirial drugs, prognosis is poor; disease progression and/or recurrence is common, and the majority of patients develop no light perception vision. Total retinal detachments are common. Prophylaxis against retinal detachment using laser retinopexy has not been useful in most cases. PORN syndrome is an uncommon, but devastating complication of AIDS.