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Biomedical subjects

G McCarthy

Publications and source records attributed to G McCarthy.

At least 91 records · Page 5Linked to original sources
PubMed1995

MRI-based hippocampal volumetrics: data acquisition, normal ranges, and optimal protocol.

The process of producing magnetic resonance (MR) volume measurements can be divided into considerations of acquisition and postprocessing of the MR data. With careful attention to both of these, precise and reproducible measurements can be achieved. A statistical description of hippocampal measurements in normal volunteers must be available for comparison if volumetrics are employed either for clinical or research purposes. A wide range in "normal" hippocampal volume is present in the studies of normal young adults that have been reported to date. This variability is most probably due to interinstitutional differences in hippocampal boundary criteria, and in the software employed for counting pixels in a defined region of interest (ROI). Because the numeric output from the volume measurement procedure is highly technique-dependent, the statistical description of "normal" should be determined or calibrated at each institution wishing to use these techniques.

Adult↗
PubMed1995

Hippocampal MRI volumetrics and temporal lobe substrates in medial temporal lobe epilepsy.

Forty-nine consecutive patients undergoing anteromedial temporal lobe resection for medically intractable temporal lobe seizures, and averaging 2 yr (range 6 mo to 4 yr) postoperative follow-up, were selected for a retrospective study. This study correlated magnetic resonance imaging (MRI) derived hippocampal volumetrics, preoperative demographics, postoperative seizure control, and tissue analysis, including hippocampal CA (cornu ammonis) field neuronal, and glial cell counts, and immunohistochemistry (IHC) evidence for dentate sprouting and reorganization. These measures were compared in hippocampi with or without an adjacent presumptive epileptogenic temporal lobe mass. Mesial temporal sclerosis (MTS) was defined as > 50% neuronal cell loss averaged across all CA fields with NPY (neuropeptide-y) and somatostatin reorganization. These patients may or may not include granule cell sprouting as determined by dynorphin staining. Patients were divided into two groups based on CA field neuronal cell counts, one averaging > 50% cell loss and one averaging < 50% cell loss. For the MTS group (N = 38), 89% had significant volumetric atrophy of the ipsilateral hippocampus, 74% had dentate reorganization, and complete seizure control was seen in 76% of these patients. In one subgroup of the < 50% cell loss group, patients with medial temporal lobe epilepsy caused by a mass in the medial temporal lobe (mass group) (N = 6), 33% demonstrated significant volumetric atrophy of the hippocampus ipsilateral to the mass, 0% had dentate sprouting, and seizures were completely controlled in 67%. For the second subgroup of the < 50% cell loss group, patients without mass lesions (N = 5) who were classified as the paradoxical medial temporal lobe epilepsy group (paradoxical group), 20% had ipsilateral hippocampal atrophy, 0% had dentate reorganization, and complete seizure control was seen in 60% of these patients. In conclusion, for the MTS group, hippocampal atrophy proven by MRI volumetrics was highly predictive of significant neuronal cell loss and an excellent indicator of success. However, in patients who had a foreign mass, hippocampal atrophy was not necessarily indicative of significant neuronal cell loss and MRI volumetrics was not a factor in the determination of a successful outcome. Furthermore, patients without mass lesions who have normal volumetrics but demonstrate hippocampal disease through invasive electrode monitoring, are likely to have paradoxical medial temporal lobe epilepsy, seizures beginning at a later age, and a lower, but not insignificant, success rate than the classical mesial temporal sclerosis group.

Adolescent↗
PubMed1995

Enhanced adrenomedullary response and increased susceptibility to neuroglycopenia: mechanisms underlying the adverse effects of sugar ingestion in healthy children.

OBJECTIVE: Eating simple sugars has been suggested as having adverse behavioral and cognitive effects in children, but a physiologic mechanism has not been established. This study was performed to address this issue. DESIGN: Metabolic, hormonal, and symptomatic responses to a standard oral glucose load (1.75 gm/kg; maximum, 120 gm) were compared in 25 healthy children and 23 young adults, and the hypoglycemic clamp, together with measurements of P300 auditory evoked potentials, was used to assess whether children are more vulnerable than adults to neuroglycopenia. SETTING: Children's Clinical Research Center, Yale University School of Medicine. RESULTS: Baseline and oral glucose-stimulated plasma glucose and insulin levels were similar in both groups, including the nadir glucose level 3 to 5 hours after oral administration of glucose (3.4 +/- 0.1 mmol/L (61 +/- 1.8 mg/dl) in children and 3.5 +/- 0.1 mmol/L (63 +/- 1.8 mg/dl) in adults). The late glucose decrease stimulated a rise in plasma epinephrine levels that was twofold higher in children than in adults (2260 +/- 289 vs 1031 +/- 147 pmol/L (407 +/- 52 vs 186 +/- 26 pg/ml), p < 0.01) and a significant increase in hypoglycemic symptom scores in children (p < 0.01), but not in adults. During control experiments, in which six of the healthy children ingested a sugar-free drink, there were no significant changes in plasma glucose levels, hormone concentrations, or hypoglycemic symptom scores. During the hypoglycemic clamp, P300 potentials did not change in any of eight adult subjects until the plasma glucose concentration was lowered to 3.0 mmol/L (54 mg/dl), whereas similar changes in P300 potentials were observed in six of seven children at glucose levels 3.6 to 4.2 mmol/L (65 to 75 mg/dl). CONCLUSION: Enhanced adrenomedullary responses to modest reductions in plasma glucose concentration and increased susceptibility to neuroglycopenia may be important contributing factors to adverse behavioral and cognitive effects after sugar ingestion in healthy children.

Adolescent↗
PubMed1995

Epidural infusion of alfentanil or diamorphine with bupivacaine in labour--a dose finding study.

Following induction of epidural analgesia with 0.375% bupivacaine, 120 healthy parturients were randomly assigned in a double blind fashion to one of eight infusion groups. All received 8 ml.h-1 of 0.125% bupivacaine either alone (control group), or with alfentanil at 133, 266 or 400 micrograms.h-1 (groups A1-A3) or with diamorphine at 133, 266, 400 or 533 micrograms.h-1 (groups D1-D4). Significantly longer top-up intervals were achieved with the two highest doses of both alfentanil and diamorphine when compared with bupivacaine alone (p < 0.01), making the minimum effective doses 266 micrograms.h-1 of alfentanil and 400 micrograms.h-1 of diamorphine. Perineal analgesia was better in all the opioid groups compared with the control group (p < 0.05). The intensity of motor block was greater in the control group (p < 0.05). The incidence of pruritus did not differ between groups. The highest dose of diamorphine caused significantly more nausea. No significant neonatal side-effects were demonstrated.

Adolescent↗
PubMed1995

Bilateral hippocampal atrophy in medial temporal lobe epilepsy.

Quantitative evidence of hippocampal atrophy has been correlated with site of seizure onset, hippocampal neuronal loss, and seizure relief after resection. Most studies have quantified hippocampal atrophy using ratios or differences between right and left hippocampal values. However, bilateral hippocampal atrophy may remain undetected by these techniques. To assess the frequency and implications of bilateral hippocampal atrophy, we studied absolute hippocampal volumes in 53 temporal lobectomy patients who had undergone intracranial electroencephalogram recordings preoperatively. Coronal images were constructed perpendicular to the longitudinal axis of the hippocampus. Atrophy was defined as > 2 SD below control values in the volume of the posterior 1.5 cm of the hippocampus. Five of 53 patients (9%) had bilateral hippocampal atrophy; four of these cases were undetected by ratios. Surgery was performed on the side of ictal onset in all five patients; four have been seizure-free for > 2 years. These results suggest that (a) mesial temporal sclerosis can be present bilaterally and may go undetected by hippocampal ratio or difference measures; (b) absolute hippocampal volume values as well as ratios are needed to detect all patients with bilateral hippocampal atrophy; and (c) temporal lobectomy is not contraindicated in patients with bilateral hippocampal atrophy, but success depends on electroencephalographic documentation of the side of predominant ictal onset.

Atrophy↗
PubMed1995

Face-sensitive regions in human extrastriate cortex studied by functional MRI.

1. We have previously identified face-selective areas in the mid-fusiform and inferior temporal gyri in electrophysiological recordings made from chronically implanted subdural electrodes in epilepsy patients. In this study, functional magnetic resonance imaging (fMRI) was used to study the anatomic extent of face-sensitive brain regions and to assess hemispheric laterality. 2. A time series of 128 gradient echo echoplanar images was acquired while subjects continuously viewed an alternating series of 10 unfamiliar faces followed by 10 equiluminant scrambled faces. Each cycle of this alternating sequence lasted 12 s and each experimental run consisted of 14 cycles. The time series of each voxel was transformed into the frequency domain using Fourier analysis. Activated voxels were defined by significant peaks in their power spectra at the frequency of stimulus alternation and by a 180 degrees phase shift that followed changes in stimulus alternation order. 3. Activated voxels to faces were obtained in the fusiform and inferior temporal gyri in 9 of 12 subjects and were approximately coextensive with previously identified face-selective regions. Nine subjects also showed activation in the left or right middle occipital gyri, or in the superior temporal or lateral occipital sulci. Cortical volumes activated in the left and right hemispheres were not significantly different. Activated voxels to scrambled faces were observed in six subjects at locations mainly in the lingual gyri and collateral sulci, medial to the regions activated by faces. 4. Face stimuli activated portions of the midfusiform and inferior temporal gyri, including adjacent cortex within occipitotemporal sulci.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1995

MRI-based measurement of hippocampal volume in patients with combat-related posttraumatic stress disorder.

OBJECTIVE: Studies in nonhuman primates suggest that high levels of cortisol associated with stress have neurotoxic effects on the hippocampus, a brain structure involved in memory. The authors previously showed that patients with combat-related posttraumatic stress disorder (PTSD) had deficits in short-term memory. The purpose of this study was to compare the hippocampal volume of patients with PTSD to that of subjects without psychiatric disorder. METHOD: Magnetic resonance imaging was used to measure the volume of the hippocampus in 26 Vietnam combat veterans with PTSD and 22 comparison subjects selected to be similar to the patients in age, sex, race, years of education, socioeconomic status, body size, and years of alcohol abuse. RESULTS: The PTSD patients had a statistically significant 8% smaller right hippocampal volume relative to that of the comparison subjects, but there was no difference in the volume of other brain regions (caudate and temporal lobe). Deficits in short-term verbal memory as measured with the Wechsler Memory Scale were associated with smaller right hippocampal volume in the PTSD patients only. CONCLUSIONS: These findings are consistent with a smaller right hippocampal volume in PTSD that is associated with functional deficits in verbal memory.

Adult↗
PubMed1995

Trigeminal evoked potentials in somatosensory cortex of the Macaca mulatta.

Somatosensory evoked potentials (SEPs) obtained in response to stimulation of the median nerve, posterior tibial nerve, lips, tongue, palate, and pharynx were recorded in four monkeys (Macaca mulatta) under light barbiturate anesthesia. In agreement with the results of SEP recordings in humans and single-unit recordings in monkeys, there is a medial-to-lateral representation in somatosensory cortex of the hand, lips, and tongue. There is a discontinuity in the representation of the upper mouth: the tongue representation is interposed between a medial region (near the lip representation), usually representing the lateral hard palate and gum, and a lateral region (near the lateral sulcus), usually representing the central hard palate. For all types of trigeminal stimulation, root mean square (RMS) voltage maps show maxima over somatosensory cortex. Laminar recordings demonstrated that trigeminal SEPs recorded from the cortical surface are generated in somatosensory cortex in areas 1, 2, and 3b. Median nerve and posterior tibial nerve stimulation did not evoke SEPs in the surface cortex near the lateral sulcus, suggesting that the most lateral portion of the postcentral gyrus is not a part of the second somatosensory area (SII). This lateral region may contain the representation of posterior intraoral structures, but it was not possible to confirm this assumption by stimulation of the soft palate or pharynx.

Animals↗
PubMed1995

Functional magnetic resonance imaging of sensory and motor cortex: comparison with electrophysiological localization.

Functional magnetic resonance (MR) imaging was performed using a 1.5-tesla MR system to localize sensorimotor cortex. Six neurologically normal subjects were studied by means of axial gradient-echo images with a motor task and one or more sensory tasks: 1) electrical stimulation of the median nerve; 2) continuous brushing over the thenar region; and 3) pulsed flow of compressed air over the palm and digits. An increased MR signal was observed in or near the central sulcus, consistent with the location of primary sensory and motor cortex. Four patients were studied using echo planar imaging sequences and motor and sensory tasks. Three patients had focal refractory seizures secondary to a lesion impinging on sensorimotor cortex. Activation seen on functional MR imaging was coextensive with the location of the sensorimotor area determined by evoked potentials and electrical stimulation. Functional MR imaging provides a useful noninvasive method of localization and functional assessment of sensorimotor cortex.

Adult↗
PubMed1995

Language-related field potentials in the anterior-medial temporal lobe: I. Intracranial distribution and neural generators.

Field potentials were recorded from intracranial electrodes in humans to study language-related processing. Subjects viewed sentences in which each word was presented successively in the center of a video monitor. Half of the sentences ended normally, while the other half ended with a semantically anomalous word. The anomalous sentence-ending words elicited a large negative field potential with a peak latency near 400 msec, which was focally distributed bilaterally in the anterior medial temporal lobe (AMTL), anterior to the hippocampus and near the amygdala. Subdural electrodes positioned near the collateral sulcus just inferior and lateral to the amygdala recorded a positive field potential at the same latency. This spatial distribution of voltage suggested that this language-sensitive field potential was generated in the neocortex near the collateral sulcus and anterior fusiform gyrus. Additional task-related field potentials were recorded in the hippocampus. The AMTL field potential at 400 msec shares characteristics with the N400 potential recorded from scalp electrodes that has been associated with semantic processing.

Action Potentials↗
PubMed1995

Language-related field potentials in the anterior-medial temporal lobe: II. Effects of word type and semantic priming.

Field potentials were recorded from intracranial electrodes in humans to study the role of the anterior medial temporal lobe (AMTL) in language-related processing. Subjects viewed lists of words in which orthography and word type varied, or in which words were primed by semantic associates. Large negative field potentials were elicited within the AMTL by isolated words. The amplitude and intracranial distribution of these AMTL field potentials were consistent with those in our previous study in which anomalous sentence-ending words were used as stimuli (McCarthy et al., in press). The neocortex, in the region of the collateral sulcus and anterior fusiform gyrus, was identified as the likely neural generator of this field potential. The AMTL field potential was diminished by semantic priming, and was larger for words with semantic content than for words serving grammatical function. Orthographically illegal nonwords did not elicit this field potential. The N400 scalp event-related potential (ERP) has been shown to respond in the same manner to these task manipulations (Nobre and McCarthy, 1994), and, thus, the AMTL field potential was proposed to contribute to the generation of N400. The possible roles in language processing reflected by the AMTL field potential were considered.

Action Potentials↗
PubMed1994

Word recognition in the human inferior temporal lobe.

Studies of primates and of patients with brain lesions have shown that the visual system represents the external world in regions and pathways specialized to compute visual features and attributes. For example, object recognition is performed by a ventral pathway located in the inferior portion of the temporal lobe. We studied visual processing of words and word-like stimuli (letter-strings) by recording field potentials directly from the human inferior temporal lobe. Our results showed that two discrete portions of the fusiform gyrus responded preferentially to letter-strings. A region of the posterior fusiform gyrus responded equally to words and non-words, and was unaffected by the semantic context in which words were presented. In contrast, a region of the anterior fusiform gyrus was sensitive to these stimulus dimensions. These regions were distinct from areas that responded to other types of complex visual stimuli, including faces and coloured patterns, and thus form a functionally specialized stream within the ventral visual pathway.

Adult↗
PubMed1994

Functional magnetic resonance imaging of human prefrontal cortex activation during a spatial working memory task.

High-speed magnetic resonance (MR) imaging was used to detect activation in the human prefrontal cortex induced by a spatial working memory task modeled on those used to elucidate neuronal circuits in nonhuman primates. Subjects were required to judge whether the location occupied by the current stimulus had been occupied previously over a sequence of 14 or 15 stimuli presented in various locations. Control tasks were similar in all essential respects, except that the subject's task was to detect when one of the stimuli presented was colored red (color detection) or when a dot briefly appeared within the stimulus (dot detection). In all tasks, two to three target events occurred randomly. The MR signal increased in an area of the middle frontal gyrus corresponding to Brodmann's area 46 in all eight subjects performing the spatial working memory task. Right hemisphere activation was greater and more consistent than left. The MR signal change occurred within 6-9 sec of task onset and declined within a similar period after task completion. An increase in MR signal was also noted in the control tasks, but the magnitude of change was less than that recorded in the working memory task. These differences were replicated when testing was repeated in five of the original subjects. The localization of spatial working memory function in humans to a circumscribed area of the middle frontal gyrus supports the compartmentalization of working memory functions in the human prefrontal cortex and the localization of spatial memory processes to comparable areas in humans and nonhuman primates.

Color Perception↗
PubMed1994

Functional NMR imaging using fast spin echo at 1.5 T.

Functional NMR imaging of the brains response to a simple visual task has been performed using a fast spin echo (FSE) imaging sequence at 1.5 T. The FSE method refocuses dephasing effects induced by large-scale susceptibility variations, and permits imaging in regions where macroscopic field gradients produce artifacts in gradient echo sequences. At 1.5 T, gradient echo (GRE) sequences are sensitive to the effects of brain activation, but relatively large effects may arise from large vessels and veins, and these may dominate the effects produced by smaller capillaries. Spin echo (SE) sequences with short echo times are relatively immune to large vessel effects and emphasize the susceptibility induced losses from small capillaries, but the imaging time for these sequences is prohibitive for most functional brain studies. We demonstrate that multislice functional brain imaging may be performed in reasonable imaging times at 1.5 T using an FSE imaging sequence. The FSE sequence with short echo spacing but long effective TE is sensitive to susceptibility induced effects at the capillary level. It is not sensitive to larger scale inhomogeneities such as those found in veins and can be used in regions near tissue/air boundaries. Results are shown comparing conventional GRE and FSE images in activation of the visual cortex and these are supported by theoretical calculations and phantom experiments.

Body Water↗
PubMed1994

Bilateral rotatory subluxation of the scaphoid.

We describe the case of a 17-year-old girl, who presented to our Accident and Emergency (A&E) department following minor trauma to her forearm. Initial x-rays were misread as normal. Radiographs demonstrated classical features of rotatory subluxation of the scaphoid, which was found to be bilateral.

Adolescent↗
PubMed1994

Face recognition in human extrastriate cortex.

1. Twenty-four patients with electrodes chronically implanted on the surface of extrastriate visual cortex viewed faces, equiluminant scrambled faces, cars, scrambled cars, and butterflies. 2. A surface-negative potential, N200, was evoked by faces but not by the other categories of stimuli. N200 was recorded only from small regions of the left and right fusiform and inferior temporal gyri. Electrical stimulation of the same region frequently produced a temporary inability to name familiar faces. 3. The results suggest that discrete regions of inferior extrastriate visual cortex, varying in location between individuals, are specialized for the recognition of faces. These "face modules" appear to be intercalated among other functionally specific small regions.

Adolescent↗
PubMed1993

Echo-planar magnetic resonance imaging studies of frontal cortex activation during word generation in humans.

Nine subjects were studied by high-speed magnetic resonance imaging while performing language-based tasks. Subjects were asked either to repeat or to generate verbs associated with nouns read by an experimenter while magnetic resonance images were obtained of the left inferior frontal lobe. The echo-planar imaging sequence was used with a gradient echo time of 70 ms to give an apparent transverse relaxation time weighting (T2* that is sensitive to local hemoglobin levels. Images were acquired every 3 s (repetition time) in series of 32. In plane resolution was 6 x 4.5 mm and slice thickness was 10 mm. An increase in signal accompanied performance of the tasks, with significantly more activation for verb generation than for repeating. The activation effect occurred within 3 s after task onset and could be observed in single images from individual subjects. The primary focus of activation appeared in gray matter along a sulcus anterior to the lateral sulcus that included the anterior insula, Brodmann's area 47, and extending to area 10. Little or no activation of this region was found for a passive listening, covert generation, or mouth-movement control tasks. Significant activation was also found for a homologous region in the right frontal cortex but not for control regions in calcarine cortex. These results are consistent with prior studies that have used positron emission tomography imaging with 15O-labeled water as a blood flow tracer.

Brain Mapping↗