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Ligament cells stretch-adapted on a microgrooved substrate increase intercellular communication in response to a mechanical stimulus.

An in vitro model was used to investigate the effect of mechanical stimuli on adaptation to load and calcium signaling in aligned medial collateral ligament cells (MCL). This model used a patterned silicone membrane to align the cells parallel with the direction of the microgrooves. Alignment created an architecture that simulated a degree of cell orientation in native ligament tissue. It was hypothesized that aligned ligament cells would be more efficient at calcium wave propagation than cells that were randomly oriented. It was further hypothesized that calcium wave propagation would be greater among cells that were both aligned and subjected to mechanical stretch compared to cells that were aligned but not stretched. Rat MCL cells were loaded with Fura-2AM, a calcium-binding dye, and mechanically indented using a micropipette tip. A ratio-imaging fluorescence technique was used to quantitate the calcium (Ca2+) response. It was concluded that stretching ligament cells prior to stimulation increased their sensitivity to load and their ability to propagate a calcium wave. However, the ability of aligned cells to propagate this wave was not significantly different when compared to nonaligned cells. Treatment of cultures with inhibitors such as apyrase and suramin significantly reduced the number of cells recruited in the calcium response. Hence, it was concluded that ATP released from mechanically stimulated cells was a principal mediator responsible for the rise in intracellular calcium in ligament cells. Further, purinoceptor activation may amplify the signal to alert and recruit more cells in a response to mechanical stimulation.

Adaptation, Physiological↗

Use of Cell Transit Analyser pulse height to study the deformation of erythrocytes in microchannels.

Information on microvascular rheology can be used to develop mathematical models of network hemodynamics in various contexts: tumor-induced angiogenesis, reaction to ischemia and collateralization, hypertension, ... The rheological method which probably most closely simulates red blood cell (RBC) flow behavior in the microcirculation is the determination of individual erythrocyte transit time and shape changes during flow through cylindrical micropores. However, these filtration experiments remain difficult to interpret in terms of cell flow properties, because the shape of the cell inside the pore is unknown. This paper uses the cell transit analyser (CTA) electrical pulse (especially the pulse height) to determine the relationship between the cell velocity and deformed shape in the pore, depending on the flow strength, suspending medium viscosity and cell membrane elasticity. As predicted by published numerical simulations for the flow of deformable particles through narrow channels, increasing pressure leads to increased deformation, but for a given pressure, increased viscosity leads to a slight increase in deformation. The sensitivity of filtration experiments to cell mechanical properties is improved when using low driving pressures and narrow and sufficiently long pores.

Blood Flow Velocity↗

Dendritic arbors and central projections of physiologically characterized auditory fibers from the saccule of the toadfish, Opsanus tau.

Neurobiotin was injected iontophoretically into saccular afferents of toadfish (Opsanus tau) after intracellular recording to examine dendritic arbors and central projections with respect to the physiological and directional response properties of the cells. Dendritic arbors of 36 afferents were examined in detail. Maximum diameter of the arbor and the number of terminal points were positively correlated with each other, but neither was predictive of spontaneous activity or sensitivity. Best azimuths were centered around 30 degrees -40 degrees, which corresponds to the angle of the saccule with respect to the fish's midline. In general, best elevations for afferents corresponded to hair cell orientations in the region innervated; unexpectedly low elevations obtained from afferents innervating the middle saccule may reflect curvature of the sensory epithelium against the otolith. Three efferent cells were filled partially. The location and large size of the efferent projections indicate that activity along the saccule could be modulated by a single efferent. All afferents projected to the dorsal zone of the descending octaval nucleus (dDON); many afferents bifurcated to terminate in the anterior octaval nucleus, and a few of those also had terminal fields in the medial zone of DON. All afferent projections into the dDON consisted of multiple axon collaterals projecting to numerous sites along the rostral-caudal extent of the nucleus. Variation in terminal field sites also was noted in the medial to lateral axis of the dDON; however, there were no consistent correlations between terminal field locations, physiology, and best directions of the saccular afferents.

Animals↗

[Fatty acid metabolic disorder detected by 123I-BMIPP SPECT shortly after elective percutaneous transluminal coronary angioplasty].

UNLABELLED: Decreased or unchanged BMIPP uptake is often observed in the repeated SPECT imaging soon after successful angioplasty, although coronary flow remarkably recovers. To evaluate clinical significance of this phenomenon, 23 patients underwent BMIPP SPECT before elective PTCA (BM-1), soon after PTCA (72 hours, BM-2), and 3 months later (BM-3). SPECT imagings were divided into 7 segments and were semiquantitatively evaluated by 2 cardiologists in the blinded fashion. Decreased uptake at BM-2 compared with BM-1 was evaluated by comparing with stress Thallium-201 SPECT performed in the same schedule but on the different date (TI-1, 2, 3), ischemic manifestation at PTCA, and wall motion change of LVG. Patients with restenosis were excluded from this study. RESULTS: BM-2 showed decreased uptake in 14 (61%), unchanged in 2 (9%), and increased in 7 (30%) patients, while stress TI showed increased perfusion in all patients. Among 91 myocardial segments correspondent to PTCA vessels, 30 (33%) showed overt uptake reduction, and only 13 (14%) segments showed increased uptake. BM-2 uptake reduction was significantly associated with the absence of collateral artery (odds ratio, OR = 3.1, p <0.01), multi vessel disease (OR = 2.0, p = 0.01), total balloon inflating time (p <0.05), ST elevation on ECG (OR = 3.6, p = 0.01), chest pain during PTCA (OR = 3.1, p <0.1), while pre-dilatation by using small size balloon catheter prevented BM-2 uptake reduction (OR = 6.0, p = 0.01). Multiple logistic regression analysis showed that chest pain, balloon inflating time and pre-dilatation were independently associated with BM-2 uptake reduction. Three months after PTCA. the segments with BM-2 reduction had stress TI uptake similar to the segments without BM-2 reduction, however, they showed poorer recovery of BM-3 uptake and LV wall motion. CONCLUSION: BMIPP uptake reduction shortly after angioplasty was associated with ischemic manifestation and poor LV motion recovery, thus, it may be a sensitive representation of the stunned myocardium.

Aged↗

Homozygous deletions of methylthioadenosine phosphorylase in human biliary tract cancers.

The p16(INK4A)/CDKN2A gene on chromosome 9p21 is a site of frequent allelic loss in human cancers, and in a subset of cases, homozygous deletions at this locus encompass the telomeric methylthioadenosine phosphorylase (MTAP) gene. The MTAP gene product is the principal enzyme involved in purine synthesis via the salvage pathway, such that MTAP-negative cancers are solely dependent on de novo purine synthesis mechanisms. Inhibitors of the de novo pathway can then be used to selectively blockade purine synthesis in cancer cells while causing minimal collateral damage to normal cells. In this study, we determine that 10 of 28 (35%) biliary tract cancers show complete lack of Mtap protein expression. In vitro analysis using a selective inhibitor of the de novo purine synthesis pathway, L-alanosine, shows robust growth inhibition in MTAP-negative biliary cancer cell lines CAK-1 and GBD-1 accompanied by striking depletion of intracellular ATP and failure to rescue this depletion via addition of exogenous methylthioadenosine, the principal substrate of the MTAP gene product; in contrast, no significant effects were observed in MTAP-expressing HuCCT1 and SNU308 cell lines. Colony formation studies confirmed that L-alanosine reduced both number and size of CAK-1 colonies in soft agar assays. Knockdown of Mtap protein by RNA interference in L-alanosine-resistant HuCCT1 cells conferred sensitivity to this agent, confirming that intracellular Mtap protein levels determine response to L-alanosine. Inhibitors of de novo purine synthesis can be a potential mechanism-based strategy for treatment of biliary tract cancers, one third of which show complete loss of MTAP function.

Base Sequence↗

Synaptic inputs of feline rubrospinal neurons from the parietal association cortex, pretectum and medial lemniscus, and their lesion-induced sprouting.

Synaptic inputs of rubrospinal (RN) neurons from the cerebral cortex, pretectal area (PRT), and medial lemniscus (ML) were investigated electrophysiologically in the cat. Stimulation of the ipsilateral parietal association cortex (PASC) and secondary sensory area (SII) produced slow-rising about 3 msec rise time monosynaptic EPSPs which were, in some cases, followed by hyperpolarizations, similar to the sensorimotor cortex (SM)-induced PSPs previously observed. Stimulation of the contralateral cerebral cortex never produced detectable PSPs. Topographical arrangement of PASC-rubral projection was found. Stimulation of the lateral part of PASC induced EPSPs predominantly in RN cells innervating the cervicothoracic spinal segments, while stimulation of the medial part of PASC produced EPSPs predominantly in RN cells innervating the lumbosacral cord. Furthermore, PASC-induced EPSPs were more frequently recorded at the rostral half of RN than at the caudal half. Monosynaptic EPSPs and multisynaptic IPSPs were induced by stimulation of the ipsilateral PRT and ML. PRT- and ML-induced EPSPs had times-to-peak of 1.0 +/- 0.4 msec (mean +/- S.D.) and 1.6 +/- 0.5 msec, respectively, which were intermediate to those of the cerebral peduncle (CP)- and nucleus interpositus of the cerebellum (IP)-induced EPSPs. Furthermore, sensitivity of amplitudes of PRT-induced EPSPs to membrane hyperpolarization was intermediate to those of CP- and IP-EPSPs, and that of ML-induced EPSPs was lower than that of IP-EPSPs. Therefore, it is likely that synapses of PRT and ML fibers are formed between the distal dendrites where CP-rubral synapses terminate and soma where IP-rubral synapses terminate. PASC-induced EPSPs after chronic IP and SM lesions had a new fast-rising component and the effectiveness of ML stimulation to induce the unit spike of RN cells was clearly increased in IP and SM lesioned cats. It was suggested that PASC-rubral fibers sprouted and formed new synapses at the proximal portions of soma-dendritic membranes of RN cells after IP and SM destructions. Collateral fibers to RN cells of the pyramidal tract were also shown to sprout new synapses following IP and ML lesions.

Animals↗

The cortically evoked secondary depolarization affects the integrative properties of thalamic reticular neurons.

Corticothalamic terminals on thalamic reticular (RE) neurons account for most synapses from afferent pathways onto this nucleus and these inputs are more powerful than those from axon collaterals of thalamocortical neurons. Given the supremacy of cortical inputs, we analysed here the characteristics and possible mechanisms underlying a secondary component of the cortically elicited depolarization in RE neurons, recorded in cats under barbiturate anesthesia. Electrical stimulation of corticothalamic axons in the internal capsule evoked fixed and short-latency excitatory postsynaptic potentials (EPSPs) that, by increasing stimulation intensity and at hyperpolarized levels (< -70 mV), developed into low-threshold spikes and spindle oscillations. The threshold for spindle oscillations was 60% higher than that required for evoking minimal EPSPs. The evoked EPSPs included a secondary depolarizing component, which appeared approximately 5 ms after the peak of the initial component and was voltage dependent, i.e. most prominent between -70 mV and -85 mV, while being greatly reduced or absent at more hyperpolarized levels. The secondary depolarizing component was sensitive to QX-314 in the recording micropipette. We suggest that the secondary component of cortically evoked EPSPs in RE neurons is due to the dendritic activation of T-currents, with a probable contribution of the persistent Na+ current. This late component affected the integrative properties of RE neurons, including their spiking output and temporal summation of incoming cortical inputs.

Anesthetics, Local↗

Gamekeeper thumb: differentiation of nondisplaced and displaced tears of the ulnar collateral ligament with MR imaging. Work in progress.

Ulnar collateral ligament (UCL) injury of the first metacarpophalangeal joint (gamekeeper thumb) is common. If the UCL becomes displaced superficially to the adductor pollicis aponeurosis, surgical treatment has been advocated. Radiography cannot help differentiate between displaced and nondisplaced tears. The authors investigated the use of magnetic resonance (MR) imaging in the evaluation of UCL injury. Ten displaced and six nondisplaced UCL tears were surgically created in 16 nonembalmed cadaveric specimens. Twelve unaltered specimens served as controls. Coronal MR images were obtained and interpreted by two observers. The MR images were compared with corresponding anatomic slices. MR imaging depicted UCL displacement in all 10 specimens with displaced tears. A displaced tear was interpreted in one control specimen. Non-displaced tears were diagnosed in four control specimens. Although MR imaging was only 67% specific for all tears, it was 100% sensitive and 94% specific for depicting UCL displacement and, therefore, may be useful for evaluating gamekeeper thumb.

Adult↗

The effect of calcium removal on the suppression by adenosine of epileptiform activity in the hippocampus: demonstration of desensitization.

1. Previous work has suggested that presynaptic effects of adenosine may be dependent on divalent cations. The present study was undertaken to determine whether a similar requirement existed at postsynaptic sites. 2. Extracellular recordings were made in the CA1 pyramidal cell layer of rat hippocampal slices following orthodromic stimulation of Schaffer collateral fibres in stratum radiatum or antidromic stimulation of the alveus. In antidromic stimulation experiments, CaCl2 was omitted (calcium-free medium) or reduced to 0.24 mM (low calcium medium) and in some experiments MgSO4 was increased to 2 mM. Kynurenic acid at concentrations of 1 and 5 mM in calcium-free medium and 1 mM in low calcium medium had no effect on secondary spike size. 3. Adenosine and baclofen induced a concentration-dependent reduction in the amplitude of orthodromic potentials with maximum effects at 20 and 5 microM respectively. 4. In nominally calcium-free medium, bursts of multiple population spikes were obtained in response to antidromic stimulation. Adenosine had little effect in reducing the secondary spike amplitude. At high concentration (2 mM) an initial depression was seen which declined within 3-5 min. 5. Sensitivity to adenosine was restored in low calcium medium or by raising magnesium. Although raising the divalent cation concentration increased the inhibitory effect of adenosine, desensitization was still seen. 6. 2-Chloroadenosine (100-500 microM) and R-PIA (50 microM), which are not substrates for either the nucleoside transporters or adenosine deaminase, were inactive in the absence of calcium. S-(2-hydroxy-5 nitrobenzyl)-6-thioinosine, an adenosine uptake blocker, at a concentration 100 MicroM had no effect on secondary potential size and did not restore adenosine sensitivity in calcium-free medium.7. Thapsigargin, which discharges intracellular calcium stores, had no significant effect at 1 MicroM on the bursts of action potentials and did not change the effect of 0.5 mM adenosine in calcium-free medium.8. Unlike adenosine, baclofen concentration-dependently reduced the secondary spike size in calcium free medium and no sign of recovery was observed during maintained superfusion for up to 45 min. No cross-desensitization was seen between baclofen and adenosine.9. Applications of adenosine locally by pressure to neuronal somata or dendrites still resulted in desensitized responses in calcium-free medium.10. It is concluded that the postsynaptic sensitivity to adenosine is dependent on the concentration of divalent cations in the extracellular space implying an effect of cations on adenosine receptor activation or transduction processes.

Adenosine↗

Form and function of dorsal horn neurones with axons ascending the dorsal columns in cat.

1. Extracellular and intracellular recordings were made from dorsal horn neurones sending their axons through the dorsal columns in cats anaesthetized with chloralose and paralysed with gallamine triethiodide. 2. Seventeen neurones were injected with horseradish peroxidase through the intracellular micro-electrode, recovered from the histological material and shown to send their axons into the dorsal columns. 3. The cells had axonal conduction velocities of 30--47 ms-1; excitatory receptive fields that usually showed multireceptive characteristics, often including input from sensitive mechanoreceptors in glabrous skin; a third of the sample had a marked subliminal fringe to the excitatory field; inhibitory fields were usually situated proximal to the excitatory field and contiguous with it. 4. The cells were located in laminae III, IV and medial V. Dorsal cells had restricted dendritic trees that ascended in an essentially cylindrical volume of tissue through lamina II and often into I; cells intermediate in depth had more primary dendrites than the others, usually dorsally directed into lamina II, and a more extensive rostro-caudal development; deep, medial cells had dendritic trees that radiated extensively from the cell body but were restricted to the transverse plane. Two cells had axons that ascended the dorsolateral funiculus for a few mm before re-entering the dorsal horn, crossing it and reaching the dorsal columns. Collaterals were given off the axons in the grey matter, in the dorsolateral funiculus and the dorsal columns. 5. The form and function of the neurones are discussed.

Animals↗

[Monitoring somatosensory evoked potentials during carotid endarterectomy].

The tromboembolic and ischemic events during carotid endarterectomy can be avoided or detected with appropriate monitoring. Median nerve somatosensory evoked potentials recorded from the parietal cortex correlate with the blood flow in the middle cerebral artery. The good evoked responses after cross-clamping of the carotid artery indicate a sufficient collateral circulation, enabling a surgery without shunt, thus minimizing the risk of embolisation. Insufficient collateral circulation after cross-camping results in an amplitude reduction of the parietal N20-P25 complex of more than 50%. In this case an ischemic event can be prevented by shunting. As a total 83 carotid endarterectomies were done. In 65 cases (78.3%) the evoked potentials showed no significant alteration, and no postoperative neurological deficit occurred. Seven patients (8.45%) needed to be operated with a shunt, because of cross-clamping ischaemia. One of them presented a transient postoperative hemiparesis, which was predicted by the long-term loss of the SEP-s, and which resolved within 4 hours. Seven further patients (8.45%)--operated primarily with shunt, and 4 patients (4.8%)--monitored with transcranial Doppler sonography, showed no postoperative neurological deficit. We found that median nerve somatosensory evoked potential monitoring during carotid endarterectomy is a simple, sensitive and reliable method.

Arteriovenous Shunt, Surgical↗

Aminophylline reduces air-flow-induced constriction in the canine lung periphery.

We examined the effect of aminophylline on air-flow-induced constriction in the canine lung periphery. A wedged bronchoscope technique was used to measure airway wall temperature (Taw) and collateral resistance (Rcs) before and after air flow was increased from a baseline flow of 200 to 500, 1,000, 1,500, or 2,000 ml/min for 2-min periods. When a sublobar segment was challenged with dry air, Taw fell during the challenge (p less than 0.05) and Rcs increased 5 min postchallenge (p less than 0.01). Pretreatment with aminophylline (20 mg/kg) reduced the fall in Taw by 31% and reduced the increase in Rcs by 53%. Aminophylline did not significantly affect either the concentrations of PGD2, TxB2, and histamine or the cell numbers and profiles obtained by bronchoalveolar lavage performed 5 min postchallenge. However, trends were consistent with the decreased physiologic responses observed. Finally, aminophylline proved ineffective in reducing the constrictor response of peripheral lung challenged directly with aerosolized histamine or PGD2. Because preaminophylline and postaminophylline peripheral lung sensitivity (as assessed by the ratio delta Rcs/delta Taw) were not significantly different, we conclude that aminophylline attenuates physiologic responses by reducing the strength of the stimulus. Aminophylline could do this by facilitating the replacement of heat and water removed during dry air challenge by increasing bronchial or pulmonary blood flow, or by reducing heat and water loss via changes in mucosal permeability.

Airway Resistance↗

Kindling increases the K(+)-evoked Ca2(+)-dependent release of endogenous GABA in area CA1 of rat hippocampus.

The release of endogenous amino acids from hippocampal CA1 subslices under basal conditions and the release evoked by high potassium (50 mM K+) depolarization was studied during kindling epileptogenesis. Emphasis was put on the release of the amino acid neurotransmitters gamma-aminobutyric acid (GABA) and glutamate. Kindling was induced by tetanic stimulation of the Schaffer-collaterals/commissural fibers of the dorsal hippocampus of the rat. The calcium-dependent GABA release in the presence of high K+ was significantly increased (40-46%) in fully kindled animals, 24 h after the last seizure, in comparison to controls. At long-term, 28 days after the last seizure, the calcium-dependent GABA release was still significantly increased (45-49%). An increased release of GABA in kindled animals was still found when GABA uptake was blocked by nipecotic acid. In contrast, no significant alterations were encountered in the basal or high potassium induced release of the excitatory amino acids aspartate and glutamate. These results suggest that kindling epileptogenesis is accompanied by a specific and long-lasting enhancement of GABA exocytosis which may lead to a desensitization of the GABA receptor, and thus determine the increase of seizure sensitivity.

Animals↗

Clinical evaluation of lymphoscintigraphy with a new technetium compound for metastatic cervical lymphadenopathy.

OBJECTIVES: To evaluate the potential usefulness of lymphoscintigraphy for the detection of metastatic cervical lymphadenopathy. METHODS: Dynamic and static lymphoscintigraphy with 99Tcm-HSA-D was performed in 23 patients with malignant oropharyngeal tumors. The internal jugular nodes were excised and examined pathologically. The results of the lymphoscintigraphy were compared with the pathological examination and clinical palpation for accuracy. RESULTS: All cases showed abnormal findings on lymphoscintigraphy. The accuracy on dynamic scintigraphy was 69% for asymmetric drainage, 69% for delayed drainage and 100% for inverse drainage. The overall accuracy for each side was 71%. With static scintigraphy, the accuracy was 69% for asymmetry, 86% for fitting defect, 67% for mottled-patchy appearance, 70% in swelling and 100% for collateral pathway. The overall accuracy for each side was 74%. The agreement between lymphoscintigraphy and palpation was 44%. CONCLUSIONS: Lymphoscintigraphy with 99Tcm-HSA-D was superior to palpation. The method is useful as a supplementary modality for the evaluation of metastatic cervical lymphadenopathy because of its relatively high accuracy and a low false-negative rate.

Adult↗

Calcium-induced long-term potentiation in the hippocampus.

The effect of a transient increase in extracellular calcium concentration on the Schaffer collateral-commissural evoked excitatory postsynaptic potential and population spike responses of CAI pyramidal neurons was investigated using the rat in vitro hippocampal slice preparation. Brief exposure of slices (5-10 min) to twice the normal concentration of calcium (4 mM) induced a marked potentiation of both the excitatory postsynaptic potential and population spike that could persist for at least 3 h. No long-term changes were observed in either the presynaptic fiber volley of antidromically evoked CAI population spike, indicating that the potentiation could not be attributed to an increase in the number of fibers activated or a generalized increase in cellular excitability. The response of CAI pyramidal neurons to the iontophoretic application of L-glutamate in the apical dendritic zone was also unaffected after exposure to high calcium perfusate, suggesting a lack of alteration in membrane excitability or receptor sensitivity restricted to the region of synaptic input. In addition, total intracellular calcium content of individual slices, measured by atomic absorption spectrophotometry, was significantly increased for at least 1 h following return to the control medium. These data indicate that brief exposure of in vitro hippocampal slices to a high extracellular calcium concentration results in a long-term increase in synaptic efficacy which is similar in many respects to long-term potentiation induced by tetanic stimulation of hippocampal excitatory afferents. The results further suggest that the mechanisms underlying calcium-induced long-term potentiation may reside in presynaptic components and involve an enhanced transmitter release.

Afferent Pathways↗

Postsynaptic contributions to hippocampal network hyperexcitability induced by chronic activity blockade in vivo.

Neuronal activity is thought to play an important role in refining patterns of synaptic connectivity during development and in the molecular maturation of synapses. In experiments reported here, a 2-week infusion of tetrodotoxin (TTX) into rat hippocampus beginning on postnatal day 12 produced abnormal synchronized network discharges in in vitro slices. Discharges recorded upon TTX washout were called 'minibursts', owing to their small amplitude. They were routinely recorded in area CA3 and abolished by CNQX, an AMPA receptor antagonist. Because recurrent excitatory axon collaterals remodel and glutamate receptor subunit composition changes after postnatal day 12, experiments examined possible TTX-induced alterations in recurrent excitation that could be responsible for network hyperexcitability. In biocytin-labelled pyramidal cells, recurrent axon arbors were neither longer nor more highly branched in the TTX infusion site compared with saline-infused controls. However, varicosity size and density were increased. Whereas most varicosities contained synaptophysin and synaptic vesicles, many were not adjacent to postsynaptic specializations, and thus failed to form anatomically identifiable synapses. An increased pattern of excitatory connectivity does not appear to explain network hyperexcitability. Quantitative immunoblots also indicated that presynaptic markers were unaltered in the TTX infusion site. However, the postsynaptic AMPA and NMDA receptor subunits, GluR1, NR1 and NR2B, were increased. In electrophysiological studies EPSPs recorded in slices from TTX-infused hippocampus had an enhanced sensitivity to the NR2B containing NMDA receptor antagonist, ifenprodil. Thus, increases in subunit protein result in alterations in the composition of synaptic NMDA receptors. Postsynaptic changes are likely to be the major contributors to the hippocampal network hyperexcitability and should enhance both excitatory synaptic efficacy and plasticity.

6-Cyano-7-nitroquinoxaline-2,3-dione↗

Influence of magnetic resonance imaging on indications for arthroscopy of the knee.

In a prospective study, magnetic resonance imaging was performed before arthroscopy for all patients (n = 121) with a meniscal tear (n = 125). Criteria of the study were stable cruciate and collateral ligaments, absence of pathologic radiographic findings, and absence of prior surgical interventions of the involved knee joint. In 43 knees (34%), the clinical diagnosis of a meniscal tear was discarded because of the results of the magnetic resonance imaging examination. Synovitis was diagnosed in 16 patients (13%), articular cartilage damage in 10 patients (8%), bone bruise injuries in 10 patients (8%), osteochondritis dissecans in 3 patients (2%), disruption of the inner layer of the medial collateral ligament in 3 patients (2%), and osteonecrosis in 1 patient. The use of magnetic resonance imaging in establishing diagnosis of disorders of the knee joint altered treatment in a significant proportion of patients. Magnetic resonance imaging should be done before arthroscopy of the knee in all cases in which the clinical diagnosis has been reduced to a suspected meniscus injury.

Adult↗

New perspectives for perfusion imaging in echocardiography.

The rapid injection into the coronary circulation of solutions containing microbubbles produces an ultrasonic contrast effect in the myocardium. The time-intensity curves generated by sequential videodensitometric analysis of contrast intensity, which is corrected for myocardial background intensity, resembles the curves used in indicator dilution techniques. Studies done in vitro have demonstrated a direct relation between contrast intensity and amount of microbubbles. In animal studies, measurements derived from these curves correlated with changes in myocardial blood flow assessed by microspheres but with varying controversial results. Differences between investigators in technique of injection and size of microbubbles injected are among the list of factors that will alter the time-intensity curve and explain some of the differences in results between investigators. Several factors limit the application of myocardial contrast echocardiography (MCE) to the quantitation of myocardial blood flow. Nevertheless, the results from multiple investigations suggest that the technique is sensitive to changes in perfusion and may be applicable to the evaluation of regional coronary reserve and assessment of the results of revascularization procedures. Peak intensity and area under the time-intensity curve have provided consistent results between investigators; therefore, these measurements have been used to assess regional coronary reserve in experimental studies and patients with coronary artery disease. Although the results are encouraging, they cannot distinguish well between normal and mild impairments in coronary reserve and are subject to larger reproducibility errors.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗