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Biomedical subjects

J F Norfray

Publications and source records attributed to J F Norfray.

18 recordsLinked to original sources

Characterization of the pigment from homogentisic acid and urine and tissue from an alkaptonuria patient.

When urine samples from alkaptonuria patients are allowed to stand, they turn black, presumably owing to the oxidation of homogentisic acid to a melanin-like substance. We report the characterization of the pigments formed by polymerization of (a) the components in the urine from a patient with alkaptonuria and (b) homogentisic acid. The absorption spectra and electron spin resonance signals of these pigments are similar to those of eumelanins. Irradiation of the pigments with nitroblue tetrazolium caused reduction of the tetrazolium; this was partially inhibited by superoxide dismutase. Irradiation of Ehrlich ascites carcinoma cells with the pigments from homogentisic acid or urine caused cell lysis. Since this lysis was inhibited by catalase, we have concluded that it was mediated by H2O2. A similar pigment was also extracted from the tissue from an alkaptonuria patient. It is suggested that the degeneration of tissue in vivo may be due to the deposition of melanin-like pigments in the tissues, probably in combination with metal ions.

Alkaptonuria

A paramagnetic agent causing ochronotic arthropathy.

Magnetic resonance imaging (MRI) identified a paramagnetic substance in the hyaline cartilage of the hips and knees in a patient with ochronosis. Chemical studies characterized the paramagnetic agent as melanin. The free radicals contained in melanin were shown to initiate cytotoxicity. The loss of cartilage in ochronotic arthropathy now can be explained at the electron level using the superoxide theory of oxygen toxicity. Inappropriate metabolism of oxygen also may explain early cartilage degeneration in hemochromatosis, hemosiderosis, and Wilson's disease.

Cartilage, Articular

MR imaging in patients with intracranial aneurysm clips.

Four patients with intracranial aneurysm clips made from a variety of alloys were studied without incidence by MR imaging at field strengths ranging from 0.35 to 0.6 T. Knowledge of the type of alloy used in the manufacturing of an aneurysm clip is important in determining whether the clip will or will not deflect in a magnetic field. Ferromagnetic clips show deflection and torque in a magnetic field and have the potential to dislodge from the aneurysm. Nonferromagnetic or weakly ferromagnetic aneurysm clips such as the Sugita (Elgiloy), Yasargil (316 LVM stainless steel), Heifetz (Elgiloy), Yasargil (Phynox), and Vari-Angle McFadden (MP35N) do not deflect or deflect weakly in the magnetic field and therefore would not be expected to dislodge during MR. The option of imaging many patients with intracranial aneurysm clips with MR extends the usefulness of the technique to a previously excluded population.

Adult

Right subhepatic abscesses detected by technetium liver scans.

A focal defect at the inferior margin of the right lobe of the liver was found in two patients with subhepatic abscesses. This defect must be differentiated from the porta hepatis and the gallbladder fossa. When technetium liver scans are obtained in patients with usspect abdominal abscesses, the inferior margin of the right lobe of the liver should be carefully scrutinized so that right subhepatic abscesses will not be overlooked.

Abdomen

Schistosomiasis of the spinal cord.

Schistosomiasis of the spinal cord is a rare presentation of a disease involving over 200 million people. A patient from an endemic area presenting as a transverse myelitis or a spinal cord tumor, and with eosinophilia, should alert the physician to the possibility of schistosomiasis of the spinal cord. Diagnosis is based on finding the characteristic eggs in the stool or urine, or if necessary, by rectal, bladder or liver biopsies. Myelography is performed to determine if decompressive laminectomy is necessary.

Adult

Ferromagnetism and MR imaging: safety of carotid vascular clamps.

Metallic extracranial carotid vascular clamps of the Selverstone, Crutchfield, Poppen-Blaylock, Salibi, Kindt, and tantalum varieties have been placed for treatment of large, giant, or inoperable intracranial aneurysms. To ascertain what adverse effect, if any, MR imaging would have on these clamps, magnetic deflection at 1.5 T was measured for various carotid clamps. Marked magnetic deflection (and torque) was displayed by stainless steel Poppen-Blaylock clamps. Relatively mild magnetic deflection was displayed by the stainless steel Selverstone, Salibi, Crutchfield, and Kindt clamps. Three patients with previously placed carotid clamps (two Selverstone, one Salibi) and one patient with a nonferromagnetic tantalum carotid clip had cranial or cervical MR studies at field strengths ranging from 0.35 to 0.60 T. No patient experienced any discomfort or neurologic sequelae as a result of MR imaging. Although the ferromagnetic clamps created severe "black-hole" artifacts and image distortion within the cervical and facial regions, no significant image degradation was apparent during spin-echo imaging of the brain. The tantalum clip created a far smaller MR artifact than did ferromagnetic clamps and allowed effective spin-echo and gradient-echo imaging in the cervical region. Our findings indicate that most patients with carotid vascular clamps (and nonferromagnetic clips) can probably be imaged safely with MR.

Adult

Visualization of brain iron by mid-field MR.

Brain iron was visualized on a mid-field (0.5 T) scanner using a spin-echo pulse sequence. Methemoglobin was hyperintense on T1- and T2-weighted images. Deoxyhemoglobin, hemosiderin, and ferritin were seen as decreased intensity on T2-weighted images. The spin-echo pulse sequences were improved for identification of deoxyhemoglobin, hemosiderin, and ferritin by prolonging the TR to 3000 msec and the TE to 80-120 msec. Phase-encoding artifacts at the level of the sylvian fissures caused increased noise, obscuring the brain iron in the lentiform nuclei with the TE of 120 msec. This artifact was substantially reduced or eliminated by lowering the TE to 80 msec, changing the phase-encoding gradient to the Y axis, or using additional pulsing in the slice and read gradients. Use of either the improved spin-echo or gradient-echo pulse sequences on a mid-field MR scanner provides improved evaluation of brain iron.

Brain Chemistry

Brain iron in patients with Parkinson disease: MR visualization using gradient modification.

In patients with Parkinson disease, improved visualization of brain iron on a mid-field-strength magnet can be obtained with T2-weighted images and elimination of phase-encoding artifacts. A long echo delay time accentuates the loss of signal from brain iron. However, the long pulse sequence creates phase-encoding artifacts from CSF pulsations at the level of the basal ganglia. These artifacts are eliminated and resolving power increased with additional pulsing in the slice-selective and read gradients. Elimination of motion artifacts enhances visualization of brain iron in three ways: (1) extrapyramidal nuclei containing iron have better definition, (2) abnormalities are better identified, and (3) pseudolesions disappear. Our findings suggest there is significant improvement in the resolving power of brain iron on MR scans made with a mid-field-strength scanner when gradient modification is used.

Adult