Magnetic resonance imaging in clinical therapeutic trials of multiple sclerosis.
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Brain↗
Biomedical subjects
L Jacobs
Publications and source records attributed to L Jacobs.
Lack of serum antibodies against glycoprotein E in pseudorabies virus-immune pigs infected with wild-type virus.
OBJECTIVE: To examine whether pigs with solid immunity against pseudorabies virus (PRV) could harbor latent infection with wild-type PRV without developing antibodies against glycoprotein E (gE), which is used as a marker protein to differentiate pigs that have been vaccinated from pigs infected with wild-type PRV. ANIMALS: Specific-pathogen-free pigs that were seronegative for antibodies to PRV. PROCEDURE: Oropharyngeal swab specimens were collected, and virus content was measured, Serum samples were obtained 1 week before and 2 and 4 weeks after challenge exposure. Four weeks after challenge exposure, pigs were slaughtered; various tissues were collected for virus isolation, and DNA was analyzed by polymerase chain reaction. RESULTS: Of the intranasally inoculated pigs, only 1 pig shed virus (for 1 day) but none developed antibodies directed against gE. Of the inoculated IM pigs, 3 pigs shed virus (for several days) and 5 developed antibodies directed against gE. One pig did not shed virus and did not develop detectable gE antibodies. However, variable amounts of wild-type virus DNA were detected in various tissues. CONCLUSIONS: Immunized pigs can be infected with wild-type PRV without being detected by the gE-specific ELISA, which is routinely used to discriminate between infected and vaccinated pigs. The implication for eradication programs is that these pigs might be a source of new outbreaks.
Animals↗
National Medical Association Surgical Section position paper on violence prevention. A resolution of trauma surgeons caring for victims of violence.
The epidemic of intentional injury continues to be a leading cause of premature death in America. The ravages of violence are particularly devastating within the minority community. With this position paper from the Surgical Section of the National Medical Association (the country's oldest and largest organization of minority physicians), a group of trauma surgeons and surgical intensivists resolve to focus on underused violence prevention opportunities and to extend their spheres of influence beyond the walls of their institutions and emphasize violence prevention activities.
Humans↗
An avulsion fracture of the calcaneal apophysis in a young gymnast.
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Adolescent↗
Circulating natural killer cells but not cytotoxic T lymphocytes are reduced in patients with active relapsing multiple sclerosis and little clinical disability as compared to controls.
Triple antibody flow cytometry was used to compare the populations of CD56+ effector cells in the peripheral circulation of 29 patients with relapsing multiple sclerosis (MS) and little disability who were exacerbation-free for over 2 months and 29 healthy control subjects. Populations were characterized by two panels of antibodies (CD8, CD16, CD56 and CD3, CD8, CD56), as well as by size or granularity. In the MS patients, mature natural killer (NK) cells (CD3-CD8-CD56+) of small size and low granularity were significantly reduced compared to normals (P(0.0003). The quantities of other effector cells (cytotoxic T lymphocytes, large granular lymphocytes and monocytes) were not different in MS patients compared to the control subjects. Also, we identified a previously unrecognized population of CD56+ monocytes (CD3-CD14+CD56+) in both the normal control subjects and the MS patients which would have been misclassified as NK cells using one or two antibody cytometry employed in previous studies.
Antigens, CD↗
Case report: hypoglycemia secondary to a meningioma.
Hypoglycemia secondary to a meningioma that has not metastasized to the liver has not been reported previously. A 41-year-old woman with a spinal cord meningioma first diagnosed 5 years previously with 3 recurrences in the spinal cord resulting in 4 neurosurgical procedures was admitted with a serum glucose of 23 mg/dL. Six months before the current admission, the patient was noted to have an abdominal mass of 10 cm not present on previous computed tomography. Three months later, the mass was 15.2 cm, and on the current admission, had increased to 23 cm and encased both the aorta and inferior vena cava. A needle biopsy of this mass before referral to the authors' hospital with hypoglycemia revealed that it was a meningioma. Evaluation of the etiology of the hypoglycemia, which required continuous intravenous glucose therapy, revealed that circulating insulin, C-peptide (i.e., connecting peptide), insulin-like growth factor-I (i.e., somatomedin-C) and insulin-like growth factor-II were all normal or low. Serum cortisol also was not low. Based on her endocrine evaluation, the hypoglycemia was secondary to the large mass of tumor cells, requiring a large glucose uptake to sustain its growth. After radiation therapy of 3,770 CGy to the meningioma, the patient became euglycemic without glucose supplementation.
Adult↗
Clinical nurse practitioner in a surgical team.
The role of a nurse taking on many of the duties of PRHO in a surgical team is described with the responsibilities, relationships and limitations. A nurse can carry out almost all of the elective activity of a PRHO and significantly relieve the pressure of work on others. She cannot completely substitute for PRHOs out of hours. As more consultants are appointed without additional medical members of the team, it is suggested that two consultant teams might be best served by one PRHO working with one Clinical Nurse Practitioner.
Education, Nursing, Continuing↗
Characterization of live pseudorabies virus vaccines.
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Animals↗
Conservative management of ovarian hyperstimulation syndrome.
OBJECTIVE: To evaluate the performance of a conservative treatment protocol for ovarian hyperstimulation syndrome (OHSS) that utilized low-dose dopamine, volume expanders and diuretics. STUDY DESIGN: Prospective, open trial. RESULTS: Thirteen patients met the criteria for diagnosis of severe OHSS during the study period. Two of these were in vitro fertilization (IVF) patients who did not undergo transfer and so were excluded from analysis. Of the remaining 11, 10 (91%) were pregnant. The average time for resolution of the OHSS and discharge from the hospital was 6 days (range, 2-11). Compared to levels at admission, there was no significant difference in those of sodium, potassium or creatinine after resolution of the syndrome. Hemoglobin and hematocrit, however, were significantly reduced (P < .03). There were no cases of adult respiratory distress syndrome or thrombosis. No pregnancies were interrupted. CONCLUSION: Conservative treatment of OHSS is an acceptable form of management. Risky and invasive therapies, such as paracentesis, are not warranted.
Adult↗
The lesion causing continuous facial myokymia in multiple sclerosis.
OBJECTIVE: To attempt to identify the site of the lesion causing continuous facial myokymia (CFM) in multiple sclerosis (MS) through the use of magnetic resonance imaging (MRI). DESIGN: A case series was employed. SETTING: The Baird Multiple Sclerosis Center, Millard Fillmore Hospital, and the Neurology Department, Buffalo General Hospital, Buffalo, NY. PARTICIPANTS AND MEASURES: Twelve patients with MS and CFM were examined by MRI of the brain while the CFM was present. The MRI examinations were also performed before the CFM had developed and after it had ceased in eight of the patients. Another 57 patients with MS who never had CFM but who had similar disabilities to those who did were also examined by MRI. RESULTS: In 11 of the 12 patients with MS and CFM, the causative lesion was demonstrated to involve the postnuclear, postgenu portion of the facial nerve intraaxially in the dorsolateral pontine tegmentum ipsilateral to the CFM. In the majority of patients who were studied after the CFM had stopped clinically, the lesion was observed to resolve on MRI. Seventeen percent of the patients with MS but without CFM were found to have the typical pontine tegmental lesion. CONCLUSIONS: Continuous facial myokymia in MS is caused by a pontine tegmental lesion involving the postnuclear, postgenu portion of the facial nerve. The lesion is identified by MRI in approximately 90% of patients with MS who have CFM clinically. The typical MRI lesion may also be found in a minority of patients with MS who do not have CFM clinically.
Adult↗
A brief history of the use of interferons as treatment of multiple sclerosis.
Interferons (IFNs) are a family of glycoproteins that are naturally secreted by certain cells in response to viral infection. The naturally occurring IFNs confer protection on other cells, preventing them from becoming infected, a phenomenon referred to as "virus interference" by Isaacs and Lindenmann in the first description of these proteins. In addition to their antiviral properties, the IFNs also have complex immunomodulatory, antiproliferative, and hormonelike activities, which are not completely understood.
Clinical Trials as Topic↗
Spontaneous palpebromandibular synkinesia: a localizing clinical sign.
In the classical corneomandibular reflex (CMR), corneal stimulation elicits a bilateral eyelid blink and a brisk anterolateral jaw movement. We here describe 14 patients with a spontaneous palpebromandibular (eyelid-jaw) synkinesia (SPMS) in whom jaw movements, similar to those in CMR, regularly accompanied spontaneous eye blinks without an external corneal stimulus. Eleven of the patients with SPMS also had CMRs on corneal stimulation. Four patients had clinical and imaging evidence of brainstem lesions above the mid-pons, 5 patients had autopsy or imaging evidence of both bilateral cerebral and upper brainstem lesions, and 5 patients had clinical or imaging evidence of bilateral cerebral dysfunction. Topical corneal anesthesia administered to patients who had both CMR and SPMS blocked the CMR but had no effect on the SPMS. In patients with both SPMS and CMR, measurements of latency from onset of orbicularis oculi electromyographic activity to onset of lateral pterygoid EMG activity, and mandibular kinesiography of jaw velocity and direction showed that the eyelid-jaw synkinesias of CMR and SPMS had similar characteristics. We conclude that SPMS is pathophysiologically the same as the eyelid-jaw synkinesia of CMR and both synkinesias originate centrally, probably in the pons. In CMR, the jaw movement is primarily related to the blink rather than the corneal stimulus, but corneal stimulation may be necessary to overcome a higher threshold for expression of the synkinesia than in patients with SPMS. Like CMR, SPMS emerges in patients with upper brainstem or bilateral cerebral lesions and SPMS may therefore be a useful localizing clinical sign.
Adult↗
Glycoprotein E of pseudorabies virus and homologous proteins in other alphaherpesvirinae.
This paper reviews biological properties of glycoprotein E (gE) of pseudorabies virus (Aujeszky's disease virus) and homologous proteins in other alphaherpesvirinae. It focuses on the gene encoding gE, conserved regions in the gE protein and its homologs, the complex of gE and gI, biological functions of gE in vitro and in vivo, the role of gE in latency and the role of gE in the induction of humoral and cellular immune responses. Special emphasis is placed on the use of gE as a marker protein in the control and eradication of pseudorabies virus.
Alphaherpesvirinae↗
Accuracy of fatal motorcycle-injury reporting on death certificates.
This study identifies differences in motorcycle injury fatality statistics gathered from different sources. Police Accidents Reports (PARs), identifying fatal motorcycle injuries occurring in Connecticut during 1987 were matched with state death certificates. Matched death certificates were analyzed in three major areas: content, coding, and motorcycle fatality reporting. Death certificates underreported motorcycle fatalities by 38% compared to PARs. Forty percent of death certificates were missing some or all of the required information: 7 did not include the word motorcycle, 18 did not contain acceptable ICD-9 terminology for a motorcyclist, and 17 did not describe how the injury occurred. Forty-one percent of death certificates contained external cause of injury code (E-code) errors. Incomplete information on death certificates was responsible for 52% of inaccurate reporting and E-code errors for 48%. The accuracy of fatal motorcycle injury cause of death reporting on death certificates could be improved by better physician training and rapid implementation of both the computerized death certificate coding systems and upcoming ICD-10 classification system.
Accidents, Traffic↗
Abnormalities of fibrillin in acquired cutis laxa.
BACKGROUND: Degeneration of elastic tissue in acquired cutis laxa has been previously described, but microfibrils have not been adequately studied. OBJECTIVE: We determined whether the microfibrillar component of elastic tissue is affected in skin of a patient with acquired cutis laxa. METHODS: Lesional skin was examined with indirect immunofluorescence and immunoelectron microscopy with antibodies to fibrillin. RESULTS: Indirect immunofluorescence showed a reduction in the distribution of fibrillin in the papillary dermis, where there was loss of the usual pattern of microfibrils perpendicular to the epidermis. Immunoelectron microscopy showed a typical distribution of elastic microfibrils around elastin of normal skin. In skin affected by cutis laxa microfibrils appeared morphologically normal but appeared less frequently in selected sites. CONCLUSION: The microfibrillar component of elastic fibers was reduced in the papillary dermis of this patient with acquired cutis laxa.
Actin Cytoskeleton↗
Advances in specific therapy for multiple sclerosis.
During the past year, two new agents have been demonstrated to be of value in multiple sclerosis. The first agent, a form of recombinant interferon beta (Betaseron; Berlex Labs, Cedar Knolls, NJ), is effective in reducing relapses and also prevent accumulation of brain lesions over time, but has no demonstrated effect on the accumulation of disability over time. The second agent, methylprednisolone (Solumedrol; The Upjohn Co., Kalamozoo, MI), administered in megadose pulses over several days and followed by an oral prednisone taper, reduces the conversion rate of patients with optic neuritis to multiple sclerosis by approximately 50% over 2 years compared with placebo or oral prednisone alone. The mechanisms by which these agents exert their benefits are incompletely understood, but both have complex, relatively widespread effects on the immune systems. The demonstration of efficacy for both of these agents represent landmarks in the search for an effective treatment for multiple sclerosis; both agents seem to provide prophylaxis against future relapses, and methylprednisolone seems to delay the development of the disease. Their introduction into the clinical environment will undoubtedly have a profound effect on the day-to-day care of multiple sclerosis patients as well as the designs of future basic and clinical research. Other new therapies that have substantial potential for benefit in multiple sclerosis but require further definitive study include intramuscular copolymer 1 for relapsing disease and low-dose oral methotrexate and booster doses of intravenous cyclophosphamide for chronic progressive disease.
Adrenal Cortex Hormones↗
Glycoprotein gE-negative pseudorabies virus has a reduced capability to infect second- and third-order neurons of the olfactory and trigeminal routes in the porcine central nervous system.
We investigated the spread of glycoprotein gE (gE)-negative pseudorabies virus (PRV) and its rescued 'wild-type' strain into and within the central nervous system (CNS) of 3- and 10-week-old pigs. This is the first study that demonstrates PRV invasion of the porcine CNS via the synaptically linked neurons of the olfactory and trigeminal routes and that demonstrates the role of gE in this invasion. After intranasal inoculation with high doses of virus, gE-negative PRV replicated less efficiently in peripheral tissues. The titres of the gE-negative virus in the oropharyngeal mucosa, olfactory epithelium, draining lymph nodes and trigeminal ganglion were approximately 100-fold lower in 3-week-old pigs and 10-fold lower in 10-week-old pigs than titres of the 'wild-type' virus. In contrast to the 'wild-type' virus, titres of the gE-negative virus were very low or undetectable in the olfactory bulb, brain stem and other tissues of the CNS. Viral antigen of rescued 'wild-type' PRV and of gE-negative PRV was detected immunohistochemically in the olfactory epithelium and in neurons of the trigeminal ganglion, and also in the olfactory and trigeminal axons leading towards the CNS. But, in contrast to 'wild-type' virus, no viral antigen of the gE-negative virus was detected in second- or third-order neurons in the olfactory bulb or in the brain stem. We conclude that gE-negative PRV can infect first-order neurons of the olfactory and trigeminal routes and is able to spread via their axons towards the CNS. Yet, gE-negative PRV has a greatly reduced capacity to infect second- or third-order neurons. Finally, we report lateral spread of 'wild-type' PRV in the trigeminal ganglion, i.e. nonsynaptic transport from neuron to neuron. Possible mechanisms that could explain the reduced levels of the gE-negative virus in the CNS are discussed.
Aging↗
Epitope-specific antibody response against glycoprotein E of pseudorabies virus.
In this study we investigated the epitope-specific antibody response against glycoprotein E (gE) of pseudorabies virus. Epitope-specific antibody responses were investigated by enzyme-linked immunoperoxidase monolayer assays. In a vaccinated crossbred pig population, most pigs responded to antigenic domain E and to a lesser degree to antigenic domains C and D. Only few pigs responded to antigenic domains F, A, and B. Using vaccinated pigs, we investigated the influence of two different pseudorabies virus strains and the genetic background of the host on the epitope-specific antibody response. More pigs infected with the virulent NIA-3 strain had a detectable antibody response against antigenic domains C, F and A than did pigs infected with the mildly virulent Sterksel strain (P < or = 0.05; Fisher's exact test). No differences in the epitope-specific antibody responses of two genetically different pig breeding lines were observed (P > or = 0.1; Fisher's exact test). In both breeding lines the incidence of the epitope-specific antibody response was comparable to that in the crossbred pig population. In addition, we studied the epitope-specific antibody responses were strikingly different and indicated that genetic background influenced the epitope-specific antibody response. Of the serum samples of mice with C57BL and a BALB background, 40 and 17% respectively, were positive in the one of the epitope-specific immunoassays. In contrast to pigs, mice responded predominantly to antigenic domain D and to a lesser degree to antigenic domains E and B. Only few mice had a detectable antibody response against antigenic domains C and A, and none had a detectable antibody response against antigenic domain F.
Animals↗