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Biomedical subjects

I Fried

Publications and source records attributed to I Fried.

At least 19 recordsLinked to original sources

Human immunodeficiency virus 1 envelope proteins induce interleukin 1, tumor necrosis factor alpha, and nitric oxide in glial cultures derived from fetal, neonatal, and adult human brain.

Although microglia are the only cells found to be productively infected in the central nervous system of acquired immunodeficiency disease syndrome (AIDS) patients, there is extensive white and gray matter disease nonetheless. This neuropathogenesis is believed to be due to indirect mechanisms other than infection with human immunodeficiency virus 1 (HIV-1). Cytokines and toxic small molecules have been implicated in the clinical and histopathological findings in CNS AIDS. Previously, we have demonstrated in rodent glial cultures the presence of biologically active epitopes of gp120 and gp41 that are capable of inducing interleukin 1 and tumor necrosis factor alpha. In this study, we map the HIV-1 envelope epitopes that induce nitric oxide, inducible nitric oxide synthase, interleukin 1, and tumor necrosis factor alpha in human glial cultures. Epitopes in the carboxy terminus of gp120 and the amino terminus of gp41 induce these proinflammatory entities. In addition, we compare HIV-1 infection and pathology in glial cells derived from human brain taken at different states of maturation (fetal, neonatal, and adult brain) in an effort to address some of the clinical and histological differences seen in vivo. This study demonstrates that, in the absence of virus infection and even in the absence of distinct viral tropism, human glia respond like rodent glia to non-CD4-binding epitopes of gp120/gp41 with cytokine and nitric oxide production. Differences among fetal, neonatal, and adult glial cells' infectivity and cytokine production indicate that, in addition to functional differences of glia at different stages of development, cofactors in vitro and in vivo may also be critical in facilitating the biological responses of these cells to HIV-1.

Adolescent

The anatomy of epileptic auras: focal pathology and surgical outcome.

An aura is generally understood to be the beginning of a seizure. Yet, following successful surgery for intractable epilepsy, patients may have persistent auras even though they are otherwise seizure free. Ninety patients with intractable seizures and auras underwent resective surgery. Forty-three patients had hippocampal sclerosis and 47 had temporal or extratemporal lesions such as glial tumors or vascular malformations. The semiology of the auras was found to have value in localization but not lateralization of the pathology. Epigastric auras as well as gustatory and olfactory auras were significantly more frequent in patients with hippocampal sclerosis than in those with temporal or extratemporal lesions. Auras of vertigo or dizziness were most frequent in patients with extratemporal pathology. There was a significant difference between the pathology groups in the efficacy of resection in eliminating the auras. Of the patients with hippocampal sclerosis who were rendered seizure free, 18.9% had persistent auras, whereas only one (2.6%) of the patients with temporal or extratemporal lesions who were rendered seizure free had persistent auras. These findings suggest that for patients with hippocampal sclerosis an anatomical dissociation between seizure and aura may occur, whereas this dissociation is not present in patients with lesions. Patients suspected of having hippocampal sclerosis should be counseled preoperatively as to the significant likelihood of persistent auras even if seizures are successfully abolished.

Brain Diseases

Functional MR and PET imaging of rolandic and visual cortices for neurosurgical planning.

Magnetic resonance (MR) imaging has recently been used to demonstrate physiological activation of the human brain. This development is of considerable interest to the neurosurgeon planning procedures near brain regions involving specific functions. In the present study, rolandic and visual cortices were imaged with a conventional 1.5-tesla clinical MR imager using a spoiled gradient-recalled acquisition in the steady state sequence. Two patients, one with a right frontal astrocytoma and the other with a left parietal meningioma, underwent MR imaging of rolandic cortex while performing a repetitive finger apposition task. Two patients with complex partial seizures referable to the temporal and occipital regions underwent MR imaging of visual cortex while exposed to repetitive photic stimulation (8.3 Hz). Significant signal intensity changes up to 15% between the activation and rest conditions were observed near the surgical targets at the expected anatomical location of the rolandic and visual cortices. In two of these cases activation measured by MR was compared and found similar to the activation measured at the same plane by H2(15)O positron emission tomography (PET). These results suggest that functional MR and PET techniques can be used to obtain preoperative brain mapping in individual patients considered for neurosurgical procedures.

Adult

Mellansjö school-home. Psychopathic children admitted 1928-1940, their social adaptation over 30 years: a longitudinal prospective follow-up.

The school-home for "psychopathic" children, Mellansjö, was founded in 1928. The initiator was Alice Hellström, a teacher and physician. She was a child psychiatric pioneer in Sweden. She had no formal education in child and adolescent psychiatry but with support from Professor of Paediatrics Isaac Jundell she received education in pediatrics and from Professor of Psychiatry Bror Gadelius she was trained in psychiatry. Hellström made a study trip to Europe where she visited child psychiatry clinics. She visited Summerhill in England and professors Aichhorn and Lazar in Austria. When Hellström opened the school-home she had been influenced by a number of factors, including the ideas behind the Swedish Child Welfare Law of 1924. She was also influenced by curative education and the psychoanalysis theory. She regretted that she lacked psychoanalytical training, however. Hellström was responsible for Mellansjö during the period 1928-56. Total admissions of 387 boys and 235 girls were recorded. Hellström planned a prospective longitudinal study with support from Jundell. Her intention was to describe the outcome of the children. She collected background and follow-up data from 1928 to 1968. She was unable to complete her project before she died in 1981 at the age of 95. The study has been completed with a consistent examination and follow-up of the 242 children treated between 1928 and 1940. This can help us to understand child psychiatric patients from the 1930s and obtain knowledge about their outcome. Such knowledge is important for understanding how evolution in society can activate child and adolescent psychiatry and how new forms of treatment have something to provide beyond those that already exist. The follow-up showed that 55% of the boys and 89% of the girls had an outcome without criminality and/or alcoholism in spite of difficult adjustment problems during childhood and were considered to be "psychopaths" in the 30s. However, 45% of the boys developed criminality and/or alcoholism despite early discovery and treatment. This group of boys is characterized by heredity for mental insanity, criminality or alcoholism, low social class, word-blindness and pilfering--a special hypothesis put forward in accordance with Hellström's own intentions. "Children who have a heredity of addictions, criminality and mental disease, a vulnerability revealed in behaviour problems and learning difficulties in the absence of mental retardation run a greater risk of developing addictions and criminality."(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent

Callosal transmission time before and after partial commissurotomy.

Interhemispheric transmission time was measured in a patient, before and after partial commissurotomy sparing the splenium of the corpus callosum, using a simple reaction time paradigm with unimanual responses to lateralized flashes at 4 degrees and 8 degrees of eccentricity. Post-operative transfer time was longer than pre-operative transfer time at 8 degrees but not at 4 degrees of eccentricity. These data do not support the notion that the callosal transfer time is always faster through motor rather than visual fibers. They rather suggest that the callosal transfer time through visual fibers is longer than the callosal transfer time through motor fibers only for flashes at large eccentricities.

Adult

Dynamic magnetic resonance imaging of human Rolandic cortex.

Rolandic cortex was imaged with magnetic resonance (MR) in nine subjects while performing a motor activation task. Imaging was performed by a volumetric, T2-weighted pulse sequence in a conventional 1.5 Tesla scanner during both resting conditions and volitional toe flexion and extension of the dominant foot. Significant changes in MR signal intensity of 7.8 +/- 2.3% (mean +/- s.e.m.) were observed in the medial Rolandic cortex contralateral to the active foot. Changes were maximal in the vicinity of the central sulcus, but were also identified anteroposteriorly, across successive coronal planes. No significant changes were found in the ipsilateral Rolandic cortex or in other brain structures. Volumetric functional MRI strategies may provide an important non-invasive tool for assessment of cortical motor function.

Adolescent

Direct measurement of extracellular lactate in the human hippocampus during spontaneous seizures.

The effect of clinical, spontaneous-onset seizures on extracellular fluid lactate was investigated by the method of lactography, the in vivo on-line measurement of lactate levels using microdialysis. Studies of experimental animals have suggested that generation of extracellular lactate as measured by microdialysis is an index of local glucose utilization and is dependent on the activity of neurons under physiological conditions. Patients with medically refractory complex partial epilepsy underwent stereotactic implantation of combination depth electrode/microdialysis probes into both hippocampi for 7-16 days. During spontaneous complex partial seizures with secondary generalization, extracellular lactate levels rose by 91 +/- 32%. Moreover, this increase persisted for 60-90 min. During a unilateral hippocampal seizure that did not propagate to the contralateral hippocampus, the increase in lactate content was restricted to the side of seizure activity. Between seizures, extracellular lactate levels correlated with the frequency of interictal spikes. In summary, these data suggest that brief clinical seizures increase nonoxidative glucose metabolism significantly as measured by the generation of extracellular lactate. Furthermore, the increase in extracellular lactate levels is limited to the site of seizure activity. Lactate is transported extracellularly via a lactate/proton cotransporter, therefore, the rise in extracellular lactate level may mediate the drop in pH0 associated with seizure activity. As acidification of the extracellular compartment has an inhibitory effect on neuronal excitability, the rise in extracellular lactate content may be a mechanism of seizure arrest and postictal refractoriness. Moreover, extracellular lactate may also mediate the decreased seizure susceptibility associated with frequent interictal spikes.

Adolescent

Limbic and neocortical gliomas associated with intractable seizures: a distinct clinicopathological group.

The authors studied 65 patients with intractable seizures and glial tumors who were treated between 1978 and 1991. Most of the tumors were in the temporal (63%) or occipital lobe (18%) and were commonly found in limbic or perilimbic neocortical locations. The majority of these gliomas (83%) involved the gray matter of allocortex, neocortex, or transitional cortex. These tumors spanned a wide range of glial differentiation: Most (61%) were low-grade astrocytomas, but 17% were histologically malignant. However, their biological behavior was strikingly indolent, as suggested by a stable clinical history during many years of chronic seizures (mean, 15 yr). The median follow-up time since the onset of symptoms in these patients was 17.2 years, and only one patient in the entire series died from the tumor. The mainstay of the surgical treatment was resection of the gliomas to histologically confirmed, tumor-free margins. The resection was not guided by intraoperative electrocorticography. Of the 60 patients who had a postoperative follow-up of more than 1 year, 82% were seizure free. Of the 31 patients who had auras with their seizures, 87% did not retain their auras postoperatively. Of the patients who were rendered seizure free, only one patient continued to have auras. Failure in seizure control was associated with an incomplete resection of the lesion. In patients with temporal lobe tumors, seizure outcome was not significantly related to the extent of medial temporal resection. It is suggested that limbic and perilimbic gliomas associated with intractable seizures constitute a distinct clinicopathologic group of glial tumors that involve the gray matter, arise in a young host, and exhibit stable biological behavior over many years. Surgical treatment that includes complete resection of these tumors can achieve excellent seizure control.

Adolescent

Low-grade astrocytomas may arise from different astrocyte lineages.

The management of low-grade astrocytomas remains a challenge. Although the majority of these tumors have common histological features, they may have very different clinical manifestations and rates of proliferation. Because low-grade astrocytomas are composed of relatively well-differentiated neoplastic cells that closely resemble the astrocytic phenotype, it is possible that some of these lesions express antigens that characterize astrocyte lineages. The authors performed an immunohistochemical analysis of 20 low-grade astrocytomas with A2B5, a monoclonal antibody to a ganglioside found in early postnatal Type 2 (fibrillary) astrocytes, but absent in Type 1 (protoplasmic) astrocytes, and anti-glial fibrillary acidic protein to determine whether the expression of these antigens could be used to determine the histogenesis of these tumors. These findings were compared with the clinical and imaging features of these tumors. The percentages of cells positive for A2B5 and glial fibrillary acidic protein was strongly correlated with the location of the tumor within the cortex or white matter and with the length of preoperative symptoms. Tumors based in the cortex contained significantly fewer A2B5-positive and glial fibrillary acidic protein-positive cells than white matter tumors. In addition, lesions that caused a relatively short period of preoperative symptoms (< 1 year) had significantly more A2B5-positive and glial fibrillary acidic protein-positive cells than lesions responsible for a long preoperative history (mean, 12.9 years). These findings suggest that slow-growing, cortically based low-grade astrocytomas have a phenotype consistent with the Type 1 (protoplasmic) astrocyte lineage, while white matter low-grade astrocytomas express antigens consistent with the Type 2 (fibrillary) astrocyte lineage.

Adolescent

Hippocampal pathology in patients with intractable seizures and temporal lobe masses.

The authors examined hippocampal tissue removed during surgical procedures in 17 patients with intractable epilepsy who were found by preoperative magnetic resonance imaging or computerized tomography to have intra-axial masses in the temporal lobe. Neuronal densities in the cornu ammonis (CA) fields of the hippocampus and in the dentate granule cell layer were measured in hematoxylin and eosin-stained sections and were found to be lower compared to a group of 18 autopsy controls. The neuronal densities in all hippocampal fields except CA2 were related to the patient's age at seizure onset. Patients with an earlier onset of seizures had lower neuronal densities. With the exception of CA4, neuronal densities were not significantly related to the duration of the seizure disorder. Cell counts in all fields except CA2 were also related to the location of the lesion in the temporal lobe. Patients with mesial temporal lesions had lower neuronal counts. These results suggest increased vulnerability of hippocampal cytoarchitecture to proximal lesions with early ictal manifestation.

Adolescent

Encephalo-omental synangiosis in the management of moyamoya disease.

Moyamoya disease is a chronic occlusive cerebrovascular disorder characterized by stenosis of the intracranial internal carotid artery often accompanied by stenosis of the anterior and/or middle cerebral arteries. This results in cerebral ischemia, which manifests clinically as transient, repetitive episodes of hemiplegia, dysarthria, and involuntary movements. This case report documents a patient in whom an initial extracranial-intracranial bypass (superficial temporal-middle cerebral artery) failed to alleviate the ischemic symptoms. In a subsequent procedure, a pedicle graft of omentum was created and through a subcutaneous tunnel was placed on the right cerebral cortex. Over a 2 1/2-year period, this has resulted in a dramatic resolution of the patient's symptomatology. The report delineates the condition and reviews other therapeutic options.

Adult

Functional organization of human supplementary motor cortex studied by electrical stimulation.

The presence of somatotopic organization in the human supplementary motor area (SMA) remains a controversial issue. In this study, subdural electrode grids were placed on the medial surface of the cerebral hemispheres in 13 patients with intractable epilepsy undergoing evaluation for surgical treatment. Electrical stimulation mapping with currents below the threshold of afterdischarges showed somatotopic organization of supplementary motor cortex with the lower extremities represented posteriorly, head and face most anteriorly, and the upper extremities between these two regions. Electrical stimulation often elicited synergistic and complex movements involving more than one joint. In transitional areas between neighboring somatotopic representations, stimulation evoked combined movements involving the body parts represented in these adjacent regions. Anterior to the supplementary motor representation of the face, vocalization and speech arrest or slowing of speech were evoked. Various sensations were elicited by electrical stimulation of SMA. In some cases a preliminary sensation of "urge" to perform a movement or anticipation that a movement was about to occur were evoked. Most responses were contralateral to the stimulated hemisphere. Ipsilateral and bilateral responses were elicited almost exclusively from the right (nondominant) hemisphere. These data suggest the presence of combined somatotopic organization and left-right specialization in human supplementary motor cortex.

Adolescent

Electrocorticographic (ECoG) correlates of language. I. Desynchronization in temporal language cortex during object naming.

The electrocorticogram (ECoG) was recorded during a language task, silent naming, from sites identified as essential for naming by electrical stimulation mapping and from surrounding cortex of left dominant temporal cortex at craniotomies under local anesthesia. The ECoG was analyzed quantitatively for a reduction in spectral density in 7-12 Hz frequencies indicating 'desynchronization.' These measurements were made on the averaged ECoG in 3 subjects and on individual ECoG segments in 4. Statistically significant increases in desynchronization were identified during silent naming at most sites essential for language, most often in the epoch from 700 to 1200 msec after presentation of the item to be named. During silent naming, there was a greater degree of desynchronization at those sites than in surrounding cortex. At several sites essential for language in several subjects, significantly less desynchronization was evident during a spatial task using physically identical stimuli. Thus, localized desynchronization in temporal cortex is an ECoG change with temporal, anatomic, and sometimes behavioral specificity to a language task. This finding provides insights into cortical physiologic mechanisms active during human language.

Adult

Dendritic organization of the anterior speech area.

Golgi studies revealed significant differences in dendritic patterns between neurons of the left and right opercular regions of the frontal lobe (Broca's speech area on the dominant side) and between cells of the left and right precentral areas (the orofacial motor zones) just behind. Although total dendritic length of the basilar dendritic array seemed characteristic of an area independent of side, a larger proportion of the length on the left (dominant) side was made up of higher order (4, 5, 6) dendrite branches, and lower order (1, 2, 3) segments predominated on the right. The pattern was partially reversed in non-right-handed patients. These findings can be interpreted as indicating an early preponderance of dendrite growth in the non-speech-gifted hemisphere followed by enhanced dendrite growth in the dominant hemisphere coincident with the beginning of conceptualization and speech function.

Aged

Scanning electron microscopy of the central nervous system. II. The hippocampus.

This study has presented cells, fibers and non-neuronal elements as seen in 3 dimensions using the SEM. Our discussion on possible artifacts which can occur with this method is offered in the hope that others will develop better techniques of dissection and specimen preparation. With the picture of normal tissue in mind, the investigator can undertake studies to determine the effects of various interventions on the structures of interest. Such treatments could include deafferentation or the use of macromolecular probes bound to cell surfaces. We anticipate that improvements in tissue preparation techniques by ourselves and others will open the way to intensive investigation of the nervous system using this powerful tool.

Animals

Structural correlates of seizure behavior in the mongolian gerbil.

Hippocampi of seizure-sensitive and seizure-resistant Mongolian gerbils were examined in search of structural correlates of seizure behavior. In animals with well-established seizure histories, differences were found in both presynaptic and postsynaptic structures. Seizing animals had less dense dendritic spines, a greater proportion of mossy tuft area devoted to presynaptic vesicles, and a smaller proportion devoted to spines. The possible relationship of these findings to epilepsy is discussed.

Animals