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[Color duplex sonography of the penis--examination technique and clinical results].

40 patients with suspected vasculogenic impotence were examined with color duplex sonography. Penile vascular anatomy was mapped and peak velocity was determined in both cavernosal arteries before and after intracorporeal injection of 15 mg papaverine and 0.5 mg regitine. A peak velocity exceeding 25 cm/sec was considered normal. In 20 patients the results could be compared with internal iliac angiography as the gold standard. In 18 of 20 patients, color duplex sonography and angiography led to identical evaluation of penile blood supply. Two false-negative findings were due to significant lesions of the internal iliac and pudendal artery with extensive collaterals to the penile arteries. One color dulex finding was false positive. Color duplex sonography is a sensitive and non-invasive method for evaluation of arteriogenic impotence. Only angiography, however, can delineate proximal arterial lesions. It remains indispensible if revascularisation is planned.

Adult↗

[Reconstructive surgery in complicated trauma of the thoracic and lumbar segments of the spine].

The article presents an analysis of reconstructive operations on the spinal cord in 176 patients with traumas of the thoracic and lumbar parts of the vertebral column. The operative treatment in acute period consisted in end-to-end anastomosis of the horse's tail roots, in late period of trauma disease of the spinal cord--in reconstruction of the spinal cord defects with intercostal nerves by the type of "collateral anastomosis" or free transplants from the peripheral nerve. The operations performed resulted in an improvement of sensitivity, movement, functions of pelvic organs in part of the patients.

Cauda Equina↗

[MRI and CT in diagnosis and follow-up of idiopathic (retroperitoneal) fibrosis].

Six cases of idiopathic fibrosis are presented to demonstrate the different manifestations of the disease and the efficiency of CT and MRI. In addition to the most common form, retroperitoneal fibrosis (Ormond's disease), fibrosis was seen in the mediastinum and pelvis. The inflammatory aortic aneurysm is a special variant. MRI was superior to CT in many diagnostic requirements. The extent of fibrosis was demonstrated more sensitively and MRI showed sclerosis in regions that appeared normal on CT. Occlusion of large vessels and collateral circulation were better depicted on MRI. The superior tissue contrast of MRI permitted differentiation of several stages of inflammation, which is of major significance for treatment and follow-up.

Adult↗

Hippocampal astrocytes in situ respond to glutamate released from synaptic terminals.

A long-standing question in neurobiology is whether astrocytes respond to the neuronal release of neurotransmitters in vivo. To address this question, acutely isolated hippocampal slices were loaded with the calcium-sensitive dye Calcium Green-1 and the responses of the astrocytes to electrical stimulation of the Schaffer collaterals were monitored by confocal microscopy. To confirm that the responsive cells were astrocytes, the slices were immunostained for the astrocytic marker glial fibrillary acidic protein. Stimulation of the Schaffer collaterals (50 Hz, 2 sec) resulted in increases in the concentration of intracellular calcium ([Ca2+]i) in the astrocytes located in the stratum radiatum of CA1. The astrocytic responses were blocked by the sodium channel blocker tetrodotoxin, the voltage-dependent calcium channel blocker omega-conotoxin-MVIIC, and the selective metabotropic glutamate receptor antagonist alpha-methyl-4-carboxyphenylglycine (MCPG). These results suggest that the astrocytic responses were induced by stimulation of metabotropic glutamate receptors on the astrocytes by neuronally released glutamate. The astrocytic responses to neuronal stimulation were enhanced in the presence of the K+ channel antagonist 4-aminopyridine (4-AP). Inhibition of the astrocytic responses in the presence of 4-AP required the presence of both MCPG and the ionotropic glutamate receptor antagonist kynurenic acid. These results suggest that higher levels of neuronal activity result in stimulation of both metabotropic and ionotropic glutamate receptors on the astrocytes. Overall, the results indicate that hippocampal astrocytes in situ are able to respond to the neuronal release of the neurotransmitter glutamate with increases in [Ca2+]i.

4-Aminopyridine↗

Structure-function relationships in rat brainstem subnucleus interpolaris: III. Local circuit neurons.

Intracellular recording, electrical stimulation, receptive field mapping, and intracellular injection of horseradish peroxidase were used to assess the response properties, collateral projections, and morphology of 44 local circuit (LC) neurons in the subnucleus interpolaris (Sp Vi) of the trigeminal brainstem complex of the rat. LC neurons were defined as those with axons restricted to brainstem areas receiving trigeminal primary afferent fibers. Thus, none were antidromically activated from the thalamus, tectum, or cerebellum, and their axons could be seen terminating exclusively within the trigeminal brainstem complex or reticular formation. All neurons sampled were discharged by innocuous or noxious mechanical stimulation of a restricted portion of the face or mouth. They were classified functionally as sensitive to vibrissae (N = 22), nociceptors (N = 9), guard hairs (N = 7), hairy skin (N = 3), or periodontia (N = 3). Fifty percent of the stained neurons were vibrissa sensitive. Twenty-one of these 22 responded to deflection of only one vibrissa. The remaining functional groups also had small receptive fields. Intracellular staining revealed a consistency in vibrissa-sensitive LC morphology. Somata were small to medium in size and multipolar. Their axons had an initial transverse trajectory and gave off recurrent collaterals which arborized extensively in the region of the soma. The parent axon then bifurcated. One branch traveled rostrally to subnucleus principalis while the other branch traveled caudally to subnucleus caudalis. The branches periodically sent collaterals into regions of the trigeminal complex corresponding to the transverse position of the soma. Dendrites extended 440 +/- 140 microns rostrocaudally, forming a tree with a transverse perimeter of 459 +/- 226 microns. Distal dendrites were thin and sinuous, had few spines, and extensively arborized adjacent to the soma. They ended in multiple swellings connected by slender processes. The stereotyped morphology of vibrissa-sensitive LC neurons differed from the variable morphologies of LC neurons activated by nociceptors, guard hairs, hairy skin, or periodontia. Although no group of neurons in one of these categories displayed a distinguishing morphological characteristic, they collectively had features which distinguished them from the vibrissa-sensitive neurons. Non-vibrissa-responsive neurons generally had more expansive, but less circular, dendritic and recurrent axonal arbors; dendrites had more spines, and axons often sent endings into the reticular formation.(ABSTRACT TRUNCATED AT 400 WORDS)

Action Potentials↗

Calcium channel blockers modulate airway constriction in the canine lung periphery.

We studied the effect of two voltage-sensitive calcium channel blockers on Na2EDTA-induced bronchoconstriction in the canine lung periphery. A wedged bronchoscope technique was used to measure collateral system resistance before and after challenges with aerosolized Na2EDTA, hypocapnia, aerosolized acetylcholine, and increased flow of dry air in anesthetized mongrel dogs. Nifedipine, a dihydropyridine calcium channel blocker, reduced hypocapnia-induced bronchoconstriction by 88 +/- 6% (SE) but did not alter Na2EDTA-induced constriction. Verapamil, a phenylalkylamine calcium channel blocker, attenuated hypocapnia- and Na2EDTA-induced bronchoconstriction by 69 +/- 6 and 44 +/- 7%, respectively, but did not significantly alter responses to either acetylcholine or dry air challenge. We conclude that calcium influx through voltage-sensitive calcium channels, perhaps of the T subtype, has a limited role in the initiation of Na2EDTA-induced bronchoconstriction in the canine lung periphery.

Acetylcholine↗

Selective attention modulates extrastriate visual regions in humans during visual feature discrimination and recognition.

Positron emission tomography (PET) was used to identify regions of the human visual system which were selectively modulated by attention during feature discrimination and recognition tasks. In a first experiment, subjects were cued to the shape, colour or speed of visual stimulus arrays during a same-different match-to-sample paradigm. The psychophysical sensitivity for discriminating subtle attribute variations was enhanced by selective attention. Correspondingly, the neural activity (as measured by blood flow changes) in different visual associative regions was enhanced when subjects attended to different attributes of the same stimulus (intraparietal sulcus for speed; collateral sulcus and dorsolateral occipital cortex for colour; collateral sulcus, fusiform and parahippocampal gyri, superior temporal sulcus for shape). These regions appeared to be specialized for processing the selected attribute. Attention to a visual feature, therefore, enhances the psychophysical sensitivity as well as the neural activity of specialized processing regions of the human visual system. In a second experiment the effect of target probability (which biases attentional selection) was studied during visual search tasks involving the recognition of a single-feature (i.e. colour) or a feature-conjunction (i.e. colour x orientation) target. Target probability positively modulated neural activity of extrastriate visual regions, which were related to the single-feature or feature-conjunction processing level. These results suggest that selective attention can influence different processing levels in the visual system, possibly reflecting a facilitatory effect on different visual computations or task components.

Attention↗

Dynamic cerebral autoregulation and collateral flow patterns in patients with severe carotid stenosis or occlusion.

The quality of collateral blood supply in carotid disease is pivotal for the resulting hemodynamic compromise. However, the interrelation between different patterns of collateral blood flow and actual impairment of cerebral autoregulation (CAR) has not been analyzed so far. Dynamic CAR was assessed noninvasively by the phase shift between respiratory-induced 0.1-Hz oscillations of arterial blood pressure (ABP) and cerebral blood flow velocity (CBFV) in 101 patients with severe unilateral carotid stenosis (> or = 75%) or occlusion. CO(2)-vasomotor reactivity was assessed via inhalation of 7% CO(2). Spontaneously activated collaterals via primary (anterior/posterior communicating artery, type I, n = 65) and secondary (ophthalmic artery / leptomeningeal with or without primary pathways, group II, n = 24) pathways were assessed by transcranial Doppler/duplex sonography. Signs of functional stenosis in the anterior collateral pathways were subsumed under type III (n = 12). Best dynamic CAR (phase shift) on affected sides was observed for type I (n = 65), in which values did not differ significantly from contralateral sides. Reduced phase shift values were present in type II; poorest values were observed for type III. CO(2)-reactivity differed mainly between type I and the other types. A less distinct differentiation of autoregulatory impairment was found when dividing patients into groups of different degrees of stenosis. Symptomatic patients (previous TIA/stroke) were significantly less frequent in the group with type I collateral flow and had significantly lower phase shift and CO(2)-reactivity values. In conclusion, we found that dynamic CAR is substantially impaired if secondary collateral pathways are activated or if functional stenosis in the activated anterior collateral pathway is present. These hemodynamic constellations are also associated with a higher proportion of clinically symptomatic patients. Determination of dynamic CAR by transfer function analysis represents a convenient, sensitive method for detection of cerebral hemodynamic compromise in obstructive carotid disease.

Blood Flow Velocity↗

Release of norepinephrine by electrical field stimulation of collateral arteries from the hindlimb of the dog.

Studies were conducted comparing the electrical field-stimulated contractile response and endogenous norepinephrine overflow of developing collateral arteries to that of branch arteries from normal extremities. Norepinephrine overflow was measured by radioenzymatic assay. Experiments on collateral arteries were undertaken 6 weeks after occlusion of the femoral artery. Collateral arteries had a lesser contractile response at lower voltages of stimulation with a greater direct smooth muscle component. This occurred despite previously reported greater sensitivity to alpha-adrenergic agonists. Stimulated norepinephrine overflow was significantly greater despite a lower norepinephrine content. These findings may reflect alterations in local control of adrenergic neuronal transmission. The results also suggest an inefficient innervation of vascular smooth muscle by adrenergic nerve endings. Lack of difference between anterior tibial artery from unoccluded (normotensive) and occluded (hypotensive) extremities excluded the possibility that differences between collateral and normotensive branch arteries were due to hypotension alone.

Animals↗

Intraoperative measurement of graft blood flow--a necessity in liver transplantation.

Portal venous and hepatic arterial flow was measured intraoperatively in the 70 most recent patients undergoing liver transplantation in our institution. Impaired graft flow due to vascular abnormalities was detected in six patients. One patient suffered from arterial steal due to stenosis of the recipient celiac trunk with blood shunting from the hepatic to the splenic artery. Ligation of the recipient hepatic artery restored the arterial graft flow. In two patients we found reduced portal venous flow due to large portosystemic collaterals. The collaterals accountable for the impaired portal flow were identified and ligated, which restored portal venous graft flow. Excessive sensitivity of the portal venous flow to the position of the graft was found in a 6-month-old boy. Portal venous flow varied considerably, depending upon the position of the graft, and intraoperative flow measurement allowed the best position of the graft to be identified. Two patients developed arterial thrombosis in the early postoperative course. Immediate laparatomy with thrombectomy resulted in good, palpable pulsation in the graft artery in both patients. Intraoperative flow measurement demonstrated satisfactory arterial flow in one patient, whereas there was no net flow in the other patient's graft artery. Pulsation in this patient was caused by blood oscillating in and out of the liver. In conclusion, we find that causes of primary graft dysfunction due to technically flawed reperfusion of the graft can be identified and alleviated by intraoperative measurement of the flow in the graft vessels.

Adult↗

An anatomic study of the popliteofibular ligament.

Our study was prompted by the varied reports in literature about the existence of the popliteofibular ligament as an integral part of the posterolateral corner of the knee. We performed 25 formalinised cadaveric knee dissections and identified the popliteofibular ligament. It was on an average 11.06 (5-16) mm in width and 11.8 (6-16) mm in length. Our study did not include a functional evaluation. We found the ligament to be a constant structure of the posterolateral knee complex, and recommend its repair in acute injuries as well as reconstruction in chronic injuries of the posterolateral corner of the knee.

Cadaver↗

Pitfalls in sonography of the Gamekeeper's thumb.

The gamekeeper's or skier's thumb is a very common injury. Nondisplaced tears of the ulnar collateral ligament of the thumb (UCL) may be treated conservatively. For that reason an accurate diagnosis is mandatory for choosing the correct therapy. Ultrasound is able to depict the position of the torn UCL correctly in approximately 90 % of cases. Sonographic pitfalls can be caused by a dislocation of the palmar joint capsule to the ulnar joint space, by a scalloping of the adductor aponeurosis due to the displaced UCL, and by scar tissue or technical mistakes. It is important to know about those pitfalls because conservative treatment of displaced UCL tears leads to instability. Therefore, the use of MRI is recommended whenever a nondisplaced UCL tear is suspected by US and a conservative therapy is suggested. Splitting the diagnostic pathway between US and MRI and preferring conservative therapy in nondisplaced UCL tears should help to save money in this field.

Collateral Ligaments↗

Electrophysiological effects of aconitine in rat hippocampal slices.

The electrophysiological effects of aconitine were investigated in the rat hippocampal slice and compared with those of veratridine. Both alkaloids are known to bind at site 2 of sodium channels and to block its inactivation. Extracellular recordings revealed that aconitine and veratridine exert inhibitory effects on neuronal excitability. Aconitine slowly and reversibly decreased the population spike recorded in the CA1 pyramidal cell layer. The reduction of the spike amplitude was similar whether orthodromically or antidromically activated. The aconitine-induced inhibition did not differ from that of veratridine. However, following washout of aconitine, the amplitude of the antidromic spike was increased compared to the control amplitude. The veratridine-induced inhibition was only partially reversible. This inhibition was also observed during suppression of synaptic transmission by a low Ca2+/high Mg2+-medium, indicating an inhibition of axonal conductance. The results show that in the absence of synaptic transmission the antidromic (alvear) spike is more sensitive to the inhibitory action of aconitine than the presynaptic fiber spike elicited by stimulation of the Schaffer collaterals. Furthermore, it is shown that aconitine acts in an activity-dependent manner, in that the latency of onset of the inhibition is prolonged when the stimulation frequency is decreased. Field excitatory postsynaptic potentials were also suppressed by aconitine, whereas excitatory postsynaptic currents recorded by the patch clamp technique were not influenced by aconitine when cells were held at -60 mV.

Aconitine↗

pH transients evoked by excitatory synaptic transmission are increased by inhibition of extracellular carbonic anhydrase.

Excitatory synaptic transmission has been associated with a rapid alkalinization of the brain extracellular space. These pH shifts are markedly increased by acetazolamide, an inhibitor of carbonic anhydrase. Although this effect can be readily explained by inhibition of extracellular carbonic anhydrase, this enzyme has been considered strictly intracellular in the central nervous system. To determine whether these alkaline shifts are regulated by extracellular carbonic anhydrase, we studied the effects of a membrane impermeant, dextran-bound inhibitor of this enzyme. Extracellular alkaline transients, measured with pH-sensitive microelectrodes, were generated in the CA1 region of rat hippocampal slices by repetitive electrical stimulation of Schaeffer collateral fibers or by local ejection of glutamate. More direct alkalinizations were elicited by focal ejection of NaOH in the vicinity of a pH microelectrode. These pH transients were reversibly enhanced by addition of the dextran-bound inhibitor. We conclude that there is significant carbonic anhydrase activity in the extracellular space of the brain. We postulate that this enzyme functions in the regulation and modulation of extracellular pH transients associated with neuronal activity.

Acetazolamide↗

Arterial injury of the axilla: an unusual case after blunt trauma of the shoulder.

The lesion of an axillary artery after a shoulder dislocation without bone fractures is very rare. The most common lesion is the subtotal transection of the vessel. Vascular injuries may be associated with nervous lesions whose incidence ranges from 27 to 44%. The nervous lesions are highly invalidating. The symptoms which recur most frequently are motor and sensitive deficiencies and a distal ischemia which, in some cases, may not be noted owing to the extensive collateral network. Whenever these symptoms are covered or absent, as in this case report, an angiography of the upper limb becomes essential for correct diagnosis and treatment.

Accidental Falls↗

Role of MR imaging in the management of "skier's thumb" injuries.

"Skier's thumb" is an acute rupture of the ulnar collateral ligament (UCL) of the metacarpophalangeal (MCP) joint of the thumb. As the method of choice in evaluating soft tissue injuries, MR imaging is useful in evaluating UCL injuries. This article reviews current concepts regarding the rupture of the UCL, including a study of 34 UCL injuries in which MR imaging was used as the main diagnostic tool. When correlated with surgical findings, MR imaging resulted in identifying UCL tears with 96% sensitivity and 95% specificity.

Adult↗