[Utility of coronal oblique slices in cervical spine MRI: Improved detection of the neuroforamina]. / Nutzen der halbkoronaren Schichtung im MRT der Halswirbelsäule: Verbesserte Erkennbarkeit von Neuroforamina.

BACKGROUND AND OBJECTIVES: Angulated projections are standard in conventional radiography of the cervical spine, but rarely used in magnetic resonance imaging (MRI). As neuroforaminal pathology plays an important role in the etiology of radicular syndromes and may influence an operative approach, the utility of coronal oblique slices in MRI is explored. MATERIALS AND METHODS: In a retrospective setting, 25 consecutive patients with neurologically diagnosed cervical monoradiculopathy were identified. T2-weighted sagittal, coronal oblique, and transversal slice orientations were anonymized. Two radiologists and two neurosurgeons independently assessed the cases. Criteria were site, cause, and grading of the neuroforaminal stenosis and the level of confidence on a 100-point visual analog scale (VAS). We computed interrater agreement, sensitivity, and t tests. RESULTS: Using only one slice orientation, the sensitivity in detecting the relevant neuroforamen was 0.40 for transversal, 0.68 for sagittal, and 0.64 for coronal oblique scans. A combination of the different angulations increased sensitivity and in 4 cases only the coronal oblique scans proved diagnostic. The readers felt significantly more confident in attributing the cause of the pathology on coronal oblique planes (a mean of 72 VAS points, p = 0.0003 vs 58 (sagittal) vs 64 (transversal)). Interrater agreement was significantly better for experienced (kappa 0. 48) than for inexperienced readers (0.32, p = 0.02). CONCLUSIONS: Adding coronal oblique planes in cervical spine MRI increases sensitivity and confidence in attributing the cause of neuroforaminal pathology. They are regarded as useful by all the readers.

Hippocampal cavities are not associated with cognitive impairment in transient global amnesia.

BACKGROUND: Hippocampal sulcal cavities (HSC) have been speculated to contribute to a higher vulnerability of memory pathways and might be a possible etiological factor in transient global amnesia (TGA). Therefore, we evaluated the influence of HSC on cognitive long-term outcome in TGA-patients. METHODS: Fourteen otherwise healthy patients with the clinical syndrome of TGA in their history underwent a high-resolution magnetic resolution imaging and a comprehensive neuropsychological test battery. The neuropsychological control group consisted of 15 healthy subjects and was balanced for age, sex and other risk factors as well as intellectual and social status. RESULTS: Magnetic resolution imaging and neuropsychological testing have been performed 1128 days (median) after the TGA. HSC have been detected in nine of the 14 patients and have been bilateral in eight of them. There were no differences in cognitive performance in patients with and without HSC as well as compared to healthy subjects. Even in patients with greater lesion load, only a slight visuospatial deficit was found. CONCLUSIONS: Although an increased incidence of HSCs is detected in TGA patients, cavities are not obligatorily in TGA. Moreover, even patients with hippocampal cavities achieve a full neuropsychological recovery independent of the frequency and size of the hippocampal lesions.

Light-emitting diode based on mask- and catalyst-free grown N-polar GaN nanorods.

We report on the fabrication of a light-emitting diode based on GaN nanorods containing InGaN quantum wells. The unique system consists of tilted N-polar nanorods of high crystalline quality. Photoluminescence, electroluminescence, and spatially resolved cathodoluminescence investigations consistently show quantum well emission around 2.6 eV. Scanning transmission electron microscopy and energy-dispersive x-ray spectroscopy measurements reveal a truncated shape of the quantum wells with In contents of (15 ± 5)%.

Perception and suppression of thermally induced pain: a fMRI study.

Two neuroimaging studies using functional magnetic resonance imaging (fMRI) and thermally induced pain are presented. Fifteen healthy right-handed subjects were imaged while they had to discern different levels of thermal stimuli in the first study and while they disengaged from the feeling of pain during constant stimulation in the second study. In the first experiment, during painful phasic stimuli, right-sided anterior insular activation as well as bilateral posterior insular activation could be shown regardless of stimulation side, as well as right-sided activation of sensory association areas in the superior parietal lobule. Also, activation of the ipsilateral sensorimotor cortex could be shown. In the second experiment, all subjects succeeded in suppressing the feeling of pain during previously painful levels of stimulation. During the early part of the tonic painful stimulation, bilateral activation of caudate head and dorsolateral prefrontal cortex (DLPFC) as well as insular cortex and dorsal anterior cingulated cortex (dACC) was observed. During the late part of the tonic painful stimulation, anterior insular activation as well as dACC and bilateral prefrontal cortical activation could be shown. Taken together, the activation of PFC and caudate nucleus hints at an important role in the initiation (caudate) and maintenance (PFC) of suppression of the feeling of pain. No ipsilateral sensorimotor activation could be shown in the second experiment. The possible import of unwanted sensorimotor activation due to the simultaneous rating process in the first experiment is discussed.

Can the displacement of a conservatively treated distal radius fracture be predicted at the beginning of treatment?

The aim of this study was to investigate whether the final displacement of conservatively treated distal radius fractures can be predicted after primary reduction. We analysed the radiographic documents of 311 patients with a conservatively treated distal radius fracture at the time of injury, after reduction and after bony consolidation. We measured the dorsal angulation (DA), the radial angle (RA) and the radial shortening (RS) at each time point. The parameters were analysed separately for metaphyseally "stable" (A2, C1) and "unstable" (A3, C2, C3) fractures, according to the AO classification system. Spearman's rank correlations and regression functions were determined for the analysis. The highest correlations were found for the DA between the time points 'reduction' and 'complete healing' (r = 0.75) and for the RA between the time points 'reduction' and 'complete healing' (r = 0.80). The DA and the RA after complete healing can be predicted from the regression functions.

Acute gastrointestinal bleeding: value of MDCT.

Contrast-enhanced multidetector row helical computed tomography (MDCT) scanning is establishing itself as a rapid, noninvasive, and accurate diagnostic method in suspected acute gastrointestinal bleeding. Active bleeding can be depicted as an area of focal high attenuation within the bowel lumen on arterial phase MDCT images. New MDCT technologies facilitate three-dimensional image reconstruction, and higher temporal resolution is available with new MDCT scanner generations. This allows for the acquisition of arterial- and portal-venous phase images of the whole abdomen, revealing potential bleeding sources and simultaneously depict morphological changes in the abdomen, such as intestinal tumors. This article gives an overview of available diagnostic modalities in assessing gastrointestinal (GI) tract hemorrhage, with a special emphasis on new MDCT technology.

[Complaints in the follow-up of conservatively treated distal radius fractures--predictors in the initial radiograph]. / Beschwerden im Verlauf nach konservativ behandelten distalen Radiusfrakturen--Prädiktoren aus der initialen Röntgenaufnahme.

PURPOSE: Radius fractures are frequent in adults, and the long-term results of conservative treatment remain disappointing. This study examines predictors for the clinical outcome in the initial radiograph. This will help to identify patients who will benefit from surgical treatment. MATERIALS AND METHODS: A cohort study including a standardized telephone interview (Cooney score) was used to identify all conservatively treated patients with a distal radius fracture over a five-year period. The additional selection criteria were: over 15 years old, initial X-ray available, patient reachable by phone for the follow-up interview. The following measurements were taken from the initial radiograph: radius-base angle, radial shortening, radiopalmar angle and intraarticular displacement. Correlations and a simple test to predict negative outcome were computed. RESULTS: Of the initially identified 2211 patients with distal radius fracture, 179 also fulfilled the other criteria. The patients were 56.2 years old on average (standard deviation SD = +/- 22.45 years) and 72 % were female. 60 % of the fractures were on the right side. The average follow-up was 4.3 years (SD +/- 1.66). The Cooney score results averaged 85 points (with 100 being the optimal and maximum score), indicating good or very good functional results in the long term follow-up for 61 % of patients. However, 31 % received a rating of fair or poor and therefore had an unfavorable outcome. With respect to the correlations, age and shortening of the radius (but not gender) had a significant influence on the functional result. Using an age of 75 years or above and a radial shortening of at least 4 mm to predict an unfavorable outcome, the sensitivity is only 16 %, but the positive predictive value is 73 % and the specificity is 96 %. CONCLUSION: In the analysis of the initial radiographs after distal radius fracture, age and radial shortening primarily correlate with functional results after four years after conservative treatment. Using the values age > or = 75 and radial shortening > or = 4 mm, it is possible to predict an unfavorable functional outcome with a positive predictive value of 73 %. This could aid in the indication of operative treatment.

Transient global amnesia--full recovery without persistent cognitive impairment.

Transient global amnesia (TGA) is a clinical syndrome of unknown etiology characterized by sudden onset anterograde amnesia, which was thought to resolve completely. However, some authors have also suggested permanent memory impairment. It is unclear whether these results reflect a true persistent damage or a simply too short assessment interval in the context of a prolonged recovery phase after TGA. To evaluate the cognitive long-term outcome, 16 patients who had suffered from TGA at a mean of 3 years before and 15 healthy controls underwent a comprehensive neuropsychological test battery. No significant differences between patients' and controls' cognitive performance were found, irrespectively of the analyzed neuropsychological domain. Therefore we hypothesize that TGA usually does not cause persistent cognitive deficits due to a generally transient and prognostic benign character.

Schedule- and dose-intensified paclitaxel as weekly 1-hour infusion in pretreated solid tumors: results of a phase I/II trial.

Paclitaxel (Taxol; Bristol-Myers Squibb Company, Princeton, NJ) has been studied primarily on a 3-week schedule as a 3-, 24-, or 96-hour infusion at doses ranging from 135 to 250 mg/m2. The observed toxicity profile seems to be both dose and schedule dependent. Dose densification of paclitaxel given weekly over 6 weeks on a split-dose schedule for an overall increase in dose intensity was thought to improve the therapeutic index of paclitaxel in a variety of advanced malignancies and to be suitable for outpatient administration. For this study, chemotherapy consisted of a weekly 1-hour infusion of paclitaxel at a starting dose of 40 mg/m2/wk for 6 weeks, followed by a 2- to 3-week interval. Paclitaxel dosage was escalated in 10 mg/m2/wk increments in subsequent patients, to a maximum dosage of 90 mg/m2/wk. Intravenous dexamethasone, cimetidine, clemastine, and ondansetron were administered immediately before the paclitaxel infusion. Fifty patients participated in the study. The male to female ratio was 21 to 29, the median age was 53.2 years (age range, 33 to 74), and the median performance status was 1. All patients were chemotherapeutically pretreated. Overall response included five complete responses (10%), 15 partial responses (30%), 19 no change (38%), and 11 disease progressions (22%). Median dose intensity was 410 mg/m2/6 wk (range, 200 to 540 mg/m2/6 wk). Hematologic toxicity was mild, with no grade 3 or 4 toxicity up to 90 mg/m2/wk. No hypersensitivity reactions or neurologic or cardiac toxicities were documented. Dose-densified, weekly paclitaxel is concluded to be active in a variety of pretreated tumor entities. The overall low hematologic and peripheral toxicity profile suggests that further dose intensification of weekly paclitaxel and/or combination with other cytotoxic agents (eg, cisplatin/carboplatin, ifosfamide, etoposide) may be warranted. Paclitaxel can be given safely in the outpatient setting. Paclitaxel 90 mg/m2/wk is recommended for single-agent treatment. Dose-densified paclitaxel may be considered a valuable and promising alternative to standard 3-week treatment, with further options possible in combination chemotherapy.

AMPA/Zn(2+)-induced neurotoxicity in rat primary cortical cultures: involvement of L-type calcium channels.

Zn2+ is believed to be an endogenous modulator of glutamatergic excitation. It has been shown to attenuate NMDA receptor-mediated excitation and to increase AMPA-induced excitatory transmission. The dual activity of Zn2+ on ionotropic excitatory neurotransmission suggests that Zn2+ plays a role in the modulation of excitatory neurodegenerative events. Stimulation of rat primary cortical cultures with the combination of 50 microM AMPA and 300 microM Zn2+ for 30 min induced approximately 50% cell death compared with only approximately 20% cell death induced by AMPA alone. The degree of neurotoxicity 48 h after the incubation was reproducible and was attenuated by CNQX, EDTA, EGTA, diltiazem and DHP-type Ca2+ channel blockers but not by MK-801. These findings suggest that an initial depolarization induced by AMPA and a subsequent influx of Ca2+ and Zn2+ ions through voltage-operated L-type Ca2+ channels are crucial events which finally lead to neuronal death. Racemic nimodipine and its (+)- and (-)-enantiomers had remarkable in vitro neuroprotective efficacies, the IC50 values being 4 nM for the racemate, 11 nM for the (+)- and 1 nM for the (-)-enantiomer. This suggests a possible therapeutic role for Ca2+ channel blockers in neurodegenerative diseases which are characterized by a disturbance of cellular Ca2+ homeostasis.

Effects of the selective metabotropic glutamate receptor agonist, L-CCG-I, on acquisition of a Morris task by rats.

L-Glutamate, a major excitatory neurotransmitter in the central nervous system, plays an important role in a variety of neuronal events associated with learning and memory, neuronal plasticity, neurotoxicity, and neurodegeneration. We assessed the effects of L-CCG-I ((2S,3S,4S)-alpha-(carboxycyclopropyl)glycine), a conformationally restricted glutamate analogue, in a standard Morris water escape task with young adult rats. L-CCG-I is considered to be a selective agonist of the metabotropic glutamate receptor. Vehicle, 5, 50, or 500 nmol L-CCG-I was injected intra-cerebroventricularly (i.c.v.) into the right lateral ventricle 30 min before the start of each of five daily acquisition sessions. The data indicate that L-CCG-I had a centrally mediated mode of action; rats treated with 500 nmol L-CCG-I were clearly impaired in acquiring the standard Morris water escape task. The no-effect dose was 5 nmol.

Glutamate-induced calcium responses in rat primary cortical cultures are potentiated by co-administration of glutamate transport inhibitors.

The effects of glutamate uptake inhibitors on the L-glutamate-induced increase in intracellular calcium concentrations were assessed in rat primary cortical cultures. The glutamate (10 microM)-induced rise in intracellular calcium concentrations was strongly and dose dependently increased and prolonged by simultaneous administration of micromolar concentrations of the reference glutamate transport inhibitors, L-trans-pyrrolidine-2,4-dicarboxylate (PDC) and D- or L-threo-beta-hydroxyaspartate. PDC in concentrations up to 10 microM showed no effect on intracellular calcium when administered alone. The anticancer drug tamoxifen, which was found to be effective as a glutamate transport inhibitor, did not increase but prolonged the cellular calcium response to glutamate, indicating that it had a different mechanism of action compared to that of standard glutamate transport inhibitors. The findings suggest that compounds which inhibit the glutamate transporter may potentiate the excitatory glutamatergic signal of cultured neurons when administered together with glutamate.

[Radial MRI of the hip joint for evaluation of degenerative changes in the young adult: a comparison of different sequences]. / Radiäre MRT des Hüftgelenks zur Abklärung präarthrotischer Veränderungen im jungen Erwachsenenalter: ein Vergleich verschiedener Sequenzen.

AIM: Femoroacetabular impingement has been shown to be an important cause for the development of osteoarthritis of the hip joint. Radial MRI of the hip has proven to be the diagnostic procedure of choice to differentiate which patient to operate. While examinations after instillation of contrast agents have been described, new papers have shown high accuracy without contrast medium. Since instillation of contrast medium is considered painful and poses the risk of infection, it is not performed for MRI evaluation of the hip at our institution. However, the question as to which sequence to use has not been settled yet. Therefore, four frequently used sequences using the same resolution were compared. MATERIALS AND METHODS: A retrospective analysis of T (1)-weighted (T (1)), T (2)-weighted (T (2)) and proton density sequences (the latter with and without fat saturation [PDfs and PD]) of 50 hips in 48 patients with femoro-acetabular impingement and developmental dysplasia of the hip was performed by two raters blinded to the clinical information. The different sequences were rated separately. Evaluated criteria were subjective imaging quality, power to differentiate acetabular from femoral cartilage as well as the labrum from the joint capsule, and localisation and characterisation of pathological changes in joint cartilage, the labrum and at the femoral head-neck junction. RESULTS: Subjective imaging quality was assessed to be similar for T (1), PDfs and PD, whereas it was significantly worse for T (2). In discriminating specific intraarticular structures, however, only PDfs and PD were superior. The differentiation of acetabular from femoral cartilage was possible in only 44% and 40% of T (1) and T (2) images, but in 79% and 76% of PDfs and PD images. Similar results were found for the differentiation of the acetabular labrum from its vicinity, especially the joint capsule (36%, 35%, 77% and 74%, respectively). Intralabral pathology was seen in a comparable extent in all sequences. An intramedullary oedema at the head-neck junction, however, was significantly more frequent in PDfs only (67% vs. 0%, 17% and 10% for PDfs vs. T (1), T (2) and PD). CONCLUSION: Despite their good subjective quality, T (1)- and T (2-)weighted sequences could not depict the acetabular labrum as efficiently as PD-weighted sequences. Concluding from our data, a PDfs sequence (possibly combined with a conventional PD sequence) is advantageous over T (1) and T (2) sequences. Intraarticular administration of contrast medium seems to be superfluous.

[MRI changes of Achilles tendon and hindfoot in experienced runners and beginners during training and after a (half)-marathon competition]. / MR-tomografische Veränderungen an Achillessehne und Rückfuß von Laufanfängern und Lauferfahrenen im Trainingsverlauf und nach einem (Halb-)Marathon.

BACKGROUND: Marathon running is gaining in popularity. Its benefits regarding the cardiovascular system as well as the metabolism are beyond doubt. However, whether or not there are detrimental side effects to the musculoskeletal system such as wear and tear is an unsolved question. We therefore prospectively looked at beginners and experienced runners at a city marathon during training and after the competition for lesions to the Achilles tendon (AT) or hindfoot. MATERIAL AND METHOD: 73 healthy subjects were prospectively included in our study. They were recruited from the applicants of the city marathon or half-marathon. They underwent an initial clinical orthopaedic as well as three magnetic resonance (MRI) examinations. The MRI were conducted at the time point of study enrolment, near the end of training and directly (up to 72 hours) after the run. MRI evaluation (fat saturated T (2)-weighted sagittal STIR sequence) was performed by two independent experienced radiologists blinded to the clinical context. The results were compared for subgroups of runners, also a factorial analysis was performed. Statistical results were deemed significant for p ≤ 0.05. RESULTS: 32 women and 41 men were included. In the end there were 53 finishers and 20 non-finishers; 28 seasoned runners and 25 novices. 57 runners had no foot complaints, while 14 had foot pain during training and 13 during the marathon. Mean body weight was 71.6 kg, height was 173 cm, age was 40.2 years. Mean AT diameter was 7.0 mm and showed no change during training or after the marathon. There was no significant influence of gender on other variables investigated. There was a significant and positive correlation between AT diameter and weight (r = 0.37), also AT and height (r = 0.34), while there was negative correlation between height and signal intensity of calcaneus (r = -0.50). The signal intensity of the AT decreased during training. The signal intensity of the calcaneus decreased from inclusion until after the marathon, while the mean retrocalcanear bursa volume and AT lesion volume increased. Some of the non-finishers stopped the training because of orthopaedic symptoms. These runners generally had an apparent lesion visible in their initial MRI examination. Regarding the factorial analysis of the data, there were no risk factors predicting non-finishing or development of new lesions to be detected. Interrater reliability was moderate for retrocalcanear bursa, while it was good to excellent for AT diameter and calcaneus MR signal intensity. CONCLUSION: In our sample of primarily asymptomatic German runners, the AT diameter was higher than in symptomatic American patients. The diameter did not change during training or after the marathon. Non-finishers with orthopaedic reasons generally had a lesion on MRI in the initial examination. Apart from this, no new lesions to the AT or hindfoot are to be expected during normal training. Adaptive processes seem to be the main effect of this training.

[Lateral approach to blockade of the sciatic nerve. Biometric data using magnetic resonance imaging]. / Laterale Ischiadikusblockaden. Biometrische Daten anhand magnetresonanztomographischer Untersuchungen.

In the present study we examined 41 volunteers using magnetic resonance imaging to obtain biometric data of the thigh used for a planned blockade of the sciatic nerve via the lateral approach. At a needle entry point 12 cm proximal to the gap of the knee joint at the posterior border of the M. vastus lateralis, the sciatic nerve lies on average at a depth of 5.2 cm (39% of the femoral diameter at this site) with an angle of 10.9 degrees to the horizontal in a dorsal direction. Here the popliteal artery lies on average at a depth of 6.4 cm (48% of the femoral diameter) with an angle of 4.7 degrees to the horizontal in a ventral direction. At the marked point in the middle between the gap of the knee joint and the trochanter major at the posterior border of the M. vastus lateralis, the sciatic nerve is at an average depth of 6.2 cm (40% of the femoral diameter at this site) with an angle of 8.2 degrees in a dorsal direction. At a marked point 5 cm distal of the trochanter major at the posterior border of the M. vastus lateralis, the sciatic nerve is at a depth of 9.1 cm at a dorsal angle of 15.5 degrees (49% of the femoral diameter). The lateral blockade of the sciatic nerve at different sites of the thigh is a technique which is easy to plan with the presented biometric data. The popliteal artery could be reached only at the distal puncture point using a deep puncture and an angle in the ventral direction.

Glutamate transport is downregulated in the cerebral cortex of alcohol-preferring rats.

INTRODUCTION: Ethanol (EtOH) affects glutamatergic neurotransmission and this may underlie craving in alcoholics. The present study aimed to further elucidate the EtOH-induced modulation of glutamatergic neurotransmission in a model for alcoholism: the alcohol-preferring cAA rat. MATERIAL AND METHODS: Glutamate transporter binding and function was assessed in membrane and synaptosomal preparations from the cerebral cortex of alcohol-preferring cAA rats and alcohol-naive cAA rats. RESULTS: [3H]L-glutamate transport activity (Vmax) was 699 pmol.min-1.mg-1 in alcohol-naive cAA rats and 487 pmol.min-1.mg-1 in alcohol-preferring cAA rats. The specific binding sites (Bmax) for [3H]D-aspartate were markedly decreased in alcohol-preferring cAA rats (2059 pmol/mg) as compared to alcohol-naive cAA rats (4275 pmol/mg). CONCLUSIONS: We hypothesize that the reduced density and function of glutamate transporter sites in alcohol-preferring cAA rats may represent an adaptive mechanism in order to counteract suppressed glutamatergic neurotransmission during chronic EtOH exposure.

Metabolism of inositol phosphates in the protozoan Paramecium. Characterization of a novel inositol-hexakisphosphate-dephosphorylating enzyme.

Basal and stimulated levels of inositol phosphates were determined in the protozoan Paramecium labelled with myo-[3H]inositol. Under resting conditions, intracellular InsP6 (phytic acid), InsP5 and InsP4 concentrations were 140, 10 and 2 microM, respectively. InsP5 was comprised of 56% Ins(1,2,3,4,5)P5 and/or Ins(1,2,3,5,6)P5, 40% Ins(1,2,4,5,6)P5 and/or Ins(2,3,4,5,6)P5 and small amounts of Ins(1,3,4,5,6)P5 and Ins(1,2,3,4,6)P5. InsP4 was mainly Ins(1, 4, 5, 6)P4 and/or Ins(3, 4, 5, 6)P4. Other inositol phosphates were not detected at a detection limit of 50-85 nM. Using various depolarizing and hyperpolarizing stimuli, no significant changes in level of inositol phosphates were observed in vivo, indicating that in the ciliate a contribution of inositol phosphates to signal-transduction mechanisms is unlikely. In homogenates prepared from myo-[3H]inositol-labelled cells, a marked relative increase in InsP3 and InsP4 over the concentrations in vivo was observed. These inositol phosphates were identified as degradation products of endogenous InsP6. A novel separation methodology for inositol phosphates was established to allow unequivocal assignment of phosphate locations of all dephosphorylated InsP6-derived products. The dephosphorylation was catalyzed by a phytase-like enzyme with a molecular mass of 240 kDa, most likely of a hexameric structure. The enzyme had a pH optimum of 7.0 and did not require divalent cations for activity. Substrate concentrations above 300 microM were inhibitory. Dephosphorylation of InsP6 by the Paramecium enzyme differs from that of phytases from plants in that it proceeds via a sequential release of phosphate groups from positions 6, 5, 4 and 3 of the myo-inositol ring or/and positions 4, 5, 6 and 1.