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PubMedDate not supplied

Comparison of computed tomography and cineangiography in the demonstration of central pulmonary arteries in cyanotic congenital heart disease.

PURPOSE: To assess the diagnostic accuracy of contrast-enhanced computed tomography (CT) for central pulmonary artery pathology in patients with cyanotic congenital heart disease (CCHD) and right ventricular outflow obstruction. METHODS: We compared contrast-enhanced CT and cine pulmonary arteriography in 24 patients including hte confluence. Both investigations were interpreted by a cardiac radiologist in a double-blinded manner at an interval of 3 weeks. Angiography was used as the gold standard for comparison. RESULTS: The sensitivity for visualization of main pulmonary artery (MPA), right pulmonary artery (RPA), left pulmonary artery (LPA), and confluence on CT was 94%, 100%, 92.8%, and 92.8%, respectively. Diagnostic specificity for the same entities was 28.5%, 100%, 80% and 50%, respectively. The positive predictive value for each was 76.2%, 100%, 94.1%, and 72.2%, respectively. The low specificity of CT in the evaluation of the MPA and the confluence is perhaps due to distorted right ventricular outflow anatomy in CCHD. Large aortopulmonary collaterals in this region were mistaken for the MPA in some patients with pulmonary atresia. CONCLUSION: CT is a useful, relatively noninvasive, imaging technique for the central pulmonary arteries in selected patients. It can supplement diagnostic information from angiography but cannot replace it. LPA demonstration on axial images alone is inadequate.

Adolescent↗
PubMed2004

Single fiber electromyography in 78 patients with amyotrophic lateral sclerosis.

BACKGROUND: Single fiber electromyography (SFEMG) is a sensitive technique for detecting abnormalities in neuromuscular transmission and is mainly used in the diagnosis of neuromuscular junction disorders, such as myasthenia gravis. While the process of denervation-reinnervation in amyotrophic lateral sclerosis (ALS) can also result in immature collateral nerve terminals and instability of neuromuscular transmission, the purpose of this study was to investigate the changes and clinical values of SFEMG in patients with ALS. METHODS: Volitional SFEMG was performed on the extensor digitorum communis (EDC) of 78 patients with ALS (men 52, women 26) who had been previously diagnosed by history, clinical features, and neurophysiological studies. The mean jitter, the percentage of jitter >55 micros, the impulse blocking percentage, and fiber density (FD) were determined. These results were compared to normal controls. In addition, the SFEMG indices were analyzed for correlations with the duration of ALS, the EDC strength score on the Medical Research Council (MRC) scale, and spontaneous activity detected by EMG studies. RESULTS: SFEMG indices were abnormal in all patients with ALS. Mean jitter ranged from 30 to 178 micros (mean 80.2 micros); the percentage of jitter >55 micros ranged from 5% to 100% (mean 60.5%). In addition, the impulse blocking percentage ranged from 0% to 90% (mean 28.1%) and FD ranged from 1.4 to 4.1 (mean 2.6). Mean jitter, the percentage of jitter >55 micros, and the blocking percentage in 57 patients with definite or probable ALS were significantly higher than in patients with possible or suspected ALS. MRC scores of the EDC negatively correlated with mean jitter, the percentage of jitter >55 micros, blocking percentage, and FD. CONCLUSIONS: SFEMG is the most sensitive tool for diagnosing definite or probable ALS. Increased jitter, blocking percentage, and FD can indicate the degree of immature collateral sprouts and motor end plates resulting from the progressive denervation and reinnervation associated with ALS, and may be helpful in evaluating prognosis.

Adolescent↗
PubMed2002

Cerebral angiography and MR perfusion images in patients with ischemic cerebral vascular disease.

OBJECTIVE: To evaluate the value of perfusion MR imaging and angiographic evidence of collateral circulation in symptomatic patients with ischemic cerebrovascular diseases (ICVD). METHODS: Cerebral angiography and perfusion MR were performed in 16 patients with symptoms of ICVD. Qualitative perfusion maps were calculated for regional cerebral blood volume (rCBV) and mean transit time (MTT). RESULTS: A total of 27 lesions were seen on the perfusion MR maps (6 infarcts and 21 ischemic lesions) and most of them (26/27) showed a prolonged MTT. MTT is sensitive to the presence of ischemic lesions, but not sufficient in distinguishing infarct from ischemia. All of the infarcts showed a decreased rCBV, while most of the ischemic lesions showed a normal or increased rCBV. When collateral circulation was identified on angiography, most ischemic lesions were not infarcts and had a normal or increased rCBV. The absence of angiographically identifiable cerebral collaterals may not always result in an infarct; 50% had decreased rCBV. Despite the absence of angiographic collaterals, the other half had normal or increased rCBV. CONCLUSION: Cerebral angiographic evidence of collateral circulation is important in identifying a favorable outcome in patients with ICVD. However, a lesion with a normal or increased rCBV suggests a sufficient collateral circulation even without angiographic collaterals. Perfusion images may be a potentially useful adjunctive tool in the prediction of the outcome of ICVD, particularly where no apparent collateral macrocirculation is seen on CA.

Adult↗
PubMed1997

Nitric-oxide-guanylyl-cyclase-dependent and -independent components of multiple forms of long-term synaptic depression.

Long-term depression (LTD) of synaptic strength is induced by glutamate-triggered increases in postsynaptic [Ca2+], through either influx or release from intracellular stores. Induction of LTD has also been reported to require release of Ca2+ from presynaptic stores and activation of presynaptic Ca2+/calmodulin-dependent protein kinase II. This finding leads to the hypothesis that the intercellular messenger nitric oxide (NO) may be a means by which postsynaptic Ca2+ triggers changes expressing LTD in presynaptic terminals. We report that bath application of the oxadiazoloquinoxalone derivative ODQ (4 microM), a selective inhibitor of NO-sensitive guanylyl cyclase (NOGC), markedly attenuated (90%) the magnitude of LTD induced by low-frequency stimulation (LFS; 1 Hz/15 min) of Schaffer collateral-CA1 synapses in hippocampal slices in vitro. Both the NO donor S-nitroso-N-acetylpenicillamine (100 microM) and the membrane-permeant cyclic guanine 3',5'-monophosphate (cGMP) analogue 8-(-4-chlorophenylthio) guanosine (8-pCPT)-cGMP (50 microM) enhanced the magnitude of LTD, which is consistent with he hypothesis that activation of NOGC plays a role in the induction of LTD. Nicotinamide (20 mM), an inhibitor of NO-activated ADP ribosyltransferase, did not impair the induction of LTD. In contrast to de novo LTD, the reversal of long-term potentiation by LFS (depotentiation) was only partially blocked (55%) by ODQ, and heterosynaptic LTD was not impaired at all, suggesting that there are both NOGC-dependent and -independent forms of LTD. Because postsynaptic intracellular infusion of ODQ (500 microM) failed to block the induction of LTD, we conclude that activation of presynaptic NOGC is a necessary step in the induction of an NOGC-dependent component of LTD.

Animals↗
PubMed1997

Visual association encoding activates the medial temporal lobe: a functional magnetic resonance imaging study.

The involvement of structures in the medial temporal lobe during the encoding of visual associations was studied with functional magnetic resonance imaging. In 11 out of 12 normal healthy volunteers this task resulted in activation in posterior portions of the parahippocampal region, close to the collateral sulcus. In seven subjects activation was encountered in the hippocampal formation. The visual association task as adapted for this study may provide a sensitive measure to study anterograde amnesia prevalent in Alzheimer's disease. Therefore, the present paradigm enables the study of individual changes in learning and memory capacities over time.

Adult↗
PubMed1992

Region-specific age effects on AMPA sensitivity: electrophysiological evidence for loss of synaptic contacts in hippocampal field CA1.

The effects of aging on the responsiveness of hippocampal neurons to iontophoretic application of L-glutamate and AMPA were studied in vitro. There were no effects of age on neuronal responses to L-glutamate; however, CA1 pyramidal cells of old rats, but not granule cells in the fascia dentata, showed both a smaller reduction in extracellularly-recorded synaptic responses following application of AMPA (presumably mediated by depolarization), and smaller extracellular "DC" fields (measured by subtracting the DC potentials at the dendrite and soma following AMPA application in the dendrites). To examine the cellular bases of this age-related alteration in AMPA sensitivity, two additional electrophysiological approaches were used: (1) measurement of the amplitude ratios of extracellular EPSP and fiber potential components of the Schaffer collateral-CA1 response; (2) measurement of intracellularly recorded unitary EPSPs and quantal analysis of their fluctuations. The interpretations that would be placed on four hypothetical possible outcomes of such experiments are outlined and assessed in relation to the experimental data. The pattern of results obtained in the present experiments supports the following conclusions: In old rats, individual Schaffer collateral synapses do not appear to have altered AMPA receptor properties, as neither the mean size of the unitary synaptic response nor the apparent quantal size differs between age groups; however, the data do support the conclusion that there are fewer synapses per Schaffer collateral branch in old versus young CA1 pyramidal cells.

Aging↗
PubMed1986

Long-term potentiation in guinea pig hippocampal slices monitored by optical recording of neuronal activity.

Pre- and postsynaptic potential changes evoked by stimulation of the Schaffer collateral-commissural input to CA1 pyramidal neurons were optically recorded in guinea pig hippocampal slices after staining the preparation with a suitable voltage-sensitive fluorescent dye. Brief tetanic stimulation induced long-term potentiation of synaptic transmission as monitored both optically and electrically. The results demonstrate that non-invasive optical techniques can be used to study long-term changes in spatial neuronal interactions, possibly involved in learning and other higher functions of the nervous system.

Animals↗
PubMed1985

Transmural inhomogeneity of energy metabolism during acute global ischemia in the isolated rat heart: dependence on environmental conditions.

Cardiac energy metabolism is one of the earliest metabolic activities affected when either anoxia or ischemia are induced, as evidenced by the rapid decline of the tissue high-energy phosphate content of creatinephosphate (CrP) and ATP. Several reports deal with the spatial inhomogeneity of these changes and it is generally found, that the subendocardium is more sensitive to ischemia than the subepicardium. The metabolic transmural gradients observed during in vivo ischemia were attributed to both variations in wall tension and collateral flow. Lowe et al. recently presented evidence that in addition to these variations the higher vulnerability of the subendocardium to ischemia could be secondary to an increased metabolic rate.

Adenosine Triphosphate↗
PubMedDate not supplied

Anatomic relation between the medial collateral ligament of the elbow and the humero-ulnar joint axis.

The anatomic relation between the proximal attachment of the medial collateral ligament of the elbow joint and the humero-ulnar joint axis has not been clearly shown in a published study. We examined cadaveric specimens to find the exact relation between them. The medial collateral ligament was microscopically dissected to isolate specific fiber bundles. The length of each bundle was measured with a charge-coupled device camera system that faced the medial side of the elbow joint. The measurements indicated that the projected length of the deep middle bundle of the anterior oblique ligament, which is the strong cord-like part of the medial collateral ligament, is isometric during elbow flexion. The proximal end of the deep middle bundle was thus considered to be located almost on the humero-ulnar joint axis.

Cadaver↗
PubMedDate not supplied

The extraneural and intraneural arterial anatomy of the ulnar nerve at the elbow.

The purpose of this report was to investigate the vascular anatomy of the ulnar nerve at the elbow with a technique of combined India ink and latex injection followed by nondissection chemical debridement. Twenty-two fresh human cadaveric arms were injected with India ink to stain the intraneural microcirculation followed immediately by latex injection and chemical debridement for study of the extraneural vascularization. After clearing with a modified Spalteholtz technique, the intraneural blood supply was studied in 10 of the specimens. The findings demonstrated a consistent but segmental extraneural and intraneural vascular supply from the superior ulnar collateral, inferior ulnar collateral, and posterior ulnar recurrent arteries. No identifiable direct anastomosis was seen between the superior ulnar collateral and posterior ulnar recurrent arteries in 20 of 22 arms. The inferior ulnar collateral artery provided the only direct vascularization to the nerve in the region just proximal to the cubital tunnel. Although the clinical importance of maintaining specific arterial sources to the ulnar nerve has not been determined, these anatomic findings indicate that the arterial contribution from the inferior ulnar collateral artery may be more important than appreciated previously.

Adult↗
PubMed2001

Vascular anatomy of the gastrointestinal tract.

The blood supply of the gastrointestinal system has intramural and extramural components. The intramural vascular distribution is generally well developed with plexuses in the different layers of the bowel wall and with specializations in the liver, small intestine and gastroesophageal junction, adapted to the function of these organs. The extramural arterial supply for the oesophagus is derived from the thoracic aorta or its major branches. Blood supply to the abdominal organs is provided by three major unpaired vessels arising from the abdominal aorta, namely the coeliac trunk and the superior and inferior mesenteric arteries. The branches of these vessels form anastomotic systems that provide a rich blood supply to the adjoining organs. In many areas the systems overlap while in other regions linkages are limited. Interrelations and weak points are of significant clinical importance. As well as this, there is a great individual variability in the anatomy of the gastrointestinal vasculature.

Angiography↗
PubMed1999

Collateral methotrexate resistance in cisplatin-selected murine leukemia cells.

Resistance to anticancer drugs is a major cause of failure of many therapeutic protocols. A variety of mechanisms have been proposed to explain this phenomenon. The exact mechanism depends upon the drug of interest as well as the tumor type treated. While studying a cell line selected for its resistance to cisplatin we noted that the cells expressed a > 25,000-fold collateral resistance to methotrexate. Given the magnitude of this resistance we elected to investigate this intriguing collateral resistance. From a series of investigations we have identified an alteration in a membrane protein of the resistant cell as compared to the sensitive cells that could be the primary mechanism of resistance. Our studies reviewed here indicate decreased tyrosine phosphorylation of a protein (molecular mass = 66) in the resistant cells, which results in little or no transfer of methotrexate from the medium into the cell. Since this is a relatively novel function for tyrosine phosphorylation, this information may provide insight into possible pharmacological approaches to modify therapeutic regimens by analyzing the status of this protein in tumor samples for a better survival of the cancer patients.

Animals↗
PubMed1999

MR imaging findings of lateral ulnar collateral ligament abnormalities in patients with lateral epicondylitis.

OBJECTIVE: The purpose of this paper was to use MR imaging to determine whether a relationship exists between lateral epicondylitis and abnormalities of the lateral ulnar collateral ligament. SUBJECTS AND METHODS: The study group comprised 35 consecutive patients who were referred for MR imaging to rule out lateral epicondylitis. On MR imaging, "lateral epicondylitis" was defined as increased signal intensity of the extensor tendons close to their insertion on the lateral epicondyle. The severity of the lateral epicondylitis was graded as mild, moderate, or severe. The origin of the lateral collateral ligamentous complex was characterized, and the lateral ulnar collateral ligament was graded as normal, thickened, partially torn, or torn. Eleven patients underwent elbow surgery after the initial MR examination. RESULTS: In 15 patients, MR imaging revealed characteristics of mild lateral epicondylitis. In 13 of these patients, the lateral ulnar collateral ligament was normal; one patient showed a thickened ligament; and one patient had a thinned ligament. In 11 patients, MR imaging showed features of moderate lateral epicondylitis. In eight of these patients, the lateral ulnar collateral ligament was thickened, and in the remaining three patients the ligament was normal. All nine patients with severe lateral epicondylitis showed abnormalities of the lateral ulnar collateral ligament on MR imaging. In one of these patients the lateral ulnar collateral ligament was thickened, in three patients we saw a partial tear, and in the remaining five patients we saw a complete tear of the ligament. CONCLUSION: In our study, MR imaging features of lateral epicondylitis were often associated with thickening and tears of the lateral ulnar collateral ligament.

Adult↗
PubMed1992

Presynaptic inhibition of excitatory synaptic transmission by adenosine in rat hippocampus: analysis of unitary EPSP variance measured by whole-cell recording.

We have utilized the favorable signal-to-noise ratios provided by whole-cell recording, combined with variance analysis, to determine the pre- or postsynaptic actions of a variety of manipulations on unitary EPSPs evoked by low-intensity stimulation of afferents to CA1 pyramidal neurons in slices of hippocampus. Estimates of quantal content (mcv) were determined by calculating the ratio of the squared average unitary EPSP amplitude (determined from 150-275 responses) to the variance of these responses (M2/sigma 2), while quantal amplitudes (qcv) were estimated by calculating the ratio of the response variance to average EPSP size (sigma 2/M). Estimates of mcv were highly correlated with those determined using the method of failures (mf). With paired stimulation (50 msec interpulse interval) there was a significant facilitation of the second unitary EPSP, accompanied by an increase in mcv, but not qcv, suggesting that this facilitation was of presynaptic origin. Superfusion of hippocampal slices with various concentrations of adenosine, the A1-selective adenosine receptor agonist cyclohexyladenosine, or the Ca2+ channel blocker cadmium significantly reduced average unitary EPSP amplitudes and mcv, without significantly altering qcv, suggesting a presynaptic locus for this inhibition. The 50% effective concentration for the apparent presynaptic action of adenosine on mcv in the present study (5.7 microM; 95% confidence limits = 4.2-7.7 microM) was significantly lower than its EC50 for reducing conventional, large EPSPs (33 microM; recorded with high-resistance microelectrodes), or extracellular field EPSPs (29 microM), as previously reported by this laboratory. The glutamate receptor antagonist 6,7-dinitroquinoxaline-2,3-dione (DNQX) reduced average unitary EPSP amplitudes; in contrast to the above manipulations, it had no effect on mcv, but significantly altered qcv, which is consistent with its presumed postsynaptic mechanism of action. We conclude from these data that adenosine presynaptically reduces synaptic strength at Schaffer collateral-commissural synapses in the hippocampus by diminishing the number of quanta released, not by reducing the size of these individual quanta or postsynaptic sensitivity to excitatory neurotransmitter. These results suggest that the mechanism by which adenosine inhibits synaptic transmission in the hippocampus is similar, if not identical, to the mechanism by which it inhibits synaptic transmission at the neuromuscular junction.

Adenosine↗
PubMedDate not supplied

[Doppler pulsed and color echography of the inferior vena cava].

B mode real time echotomography associated with duplex and colour doppler makes possible a complete investigation of the lower vena cava. The ilio-cava fossa is difficult to explore because of gas and digestive superpositions. Diagramatically, it is possible to distinguish five levels of investigation. 1) Iliac veins and ilio-cava convergence. 2) Sub-renal LVC. 3) Inter-renal LVC and communications with renal veins. 4) Retro-hepatic LVC: communications with liver and supra-hepatic veins. 5) Thoracic LVC and termination in the right atrium. Sector-based probes provide a 60 to 110 degrees sector thanks to which it is possible to obtain a sufficient exploration field for a very limited acoustic fenestra. Duplex and colour doppler assess the venous flow and its variations during the respiratory cycle and during the operations of compression or Valsalva's experiment. Colour doppler detects more precisely slow, collateral or repermeation flows. The recent complete thrombosis leads no duplex and colour doppler signal but an increase of the vein diameter associated with a collateralitis syndrome. In case of partial thrombosis, the vein is partially compressible as colour doppler fits thrombus closely round and visualizes the remaining lumen. In the ilio-cava fossa, compressions (either tumorous, ganglial or aneurysmal) which are often associated are diagnosed in the meanwhile. It is important to know the change of diameter and the abnormalities of the LVC position when a cava blocking is advised. A LVC whose diameters exceed 28 mm (mega-cava) contra indicated filter because of the risk of migration. Colour doppler makes easier the supervision of the blocking.

Collateral Circulation↗
PubMed2001

[Transcranial Doppler imaging: state of the art].

Initially introduced in the early 1980's, transcranial Doppler followed by transcranial Doppler sonography were used in neurosurgical units for management and follow-up of intracranial vasospasm in patients with subarachnoid hemorrhage. This imaging technique, more sensitive and less invasive than catheter angiography, also proved to be of value for diagnosis of intracranial atherosclerosis, management of patients with head trauma, and evaluation of collateral flow through the circle of Willis. Doppler US would also allow prediction of the risk of symptomatic embolic events through monitoring of HITS. Evaluation of the middle cerebral arteries during carotid occlusion testing is useful for evaluating the need for particular revascularization techniques. Finally, Doppler imaging is useful to assess patients with possible brain death. A recent advance in Doppler imaging is the ability to provide a three-dimensional projection (3D Doppler) of the intracranial arteries enabling improved detection and evaluation of stenoses involving the circle of Willis and improved characterization of intracranial aneurysms. These new applications benefit from the use of US contrast agents and harmonic US imaging.

Brain Death↗
PubMed2002

Assessment of coronary artery disease with second harmonic myocardial perfusion contrast echocardiography.

OBJECTIVE: To assess the relationship between myocardial regional perfusion using second harmonic myocardial contrast echocardiography (MCE) by venous injection of Levovist and coronary artery stenosis detected by coronary angiography to determine whe ther MCE can be used to detect coronary artery disease (CAD) and its sensitivity and specificity for detecting CAD. METHODS: Thirty-six patients who underwent coronary artery angiography and MCE formed the study groups. Ten myocardial segments (5 each in the apical two- and four-chamber views) from the images were scored for detecting myocardial perfusion as follows: 1, normal perfusion; 2, decreased perfusion; and 3, perfusion defect. The arteries were classified as normal or diseased. The diseased arteries were classified into three groups according to the perfusion scores. RESULTS: There were significant differences in coronary diameter stenosis among the different perfusion score groups (P < 0.001). There were 10 total occluded arteries, and the myocardial perfusion scores were different because of different collateral circulation. In the normal perfusion group (Group A), the coronary diameter stenosis was 65% +/- 12%, and the myocardial perfusion score index was 1 +/- 0.00. In the decreased perfusion group (Group B), the average coronary diameter stenosis was 82% +/- 8%, and the myocardial perfusion score was 1.93 +/- 0.16. The diameter stenosis was less than 85% in 63% of the coronary arteries (including diameter stenosis < or = 75% in 12% of the vessels). The diameter stenosis was 85%-90% in 22% of the coronary arteries and > 90% in 15% of the arteries. In the perfusion defect group (Group C), the average diameter stenosis was 90% +/- 6%, and the myocardial perfusion score index was 2.89 +/- 0.24. The diameter stenosis was > or = 85% in 94% of the coronary arteries, and the diameter stenosis was < 85% and > 75% only in 6% of the coronary arteries. The overall sensitivity and specificity of MCE in identifying angiographic coronary diameter stenosis was 67% and 100%, respectively. The false negative rate was 32.6% for the 108 coronary arteries. Further subdivided analysis showed the sensitivities in Groups A, B and C were 0, 100%, and 100%, respectively. The sensitivity increased with increased lumen diameter stenosis of coronary arteries. CONCLUSIONS: There is a close relationship between coronary artery stenosis and MCE perfusion scores. MCE with venous injection of new generation contrast can define the presence of CAD and lesion graded classifications. Some disagreements between perfusion score and coronary diameter of stenosis may indicate other factors such as different collateral circulation, which should be further investigated. As artery stenosis increases, the sensitivity of MCE is increased.

Adult↗