Study in cerebrovascular disease: brain scanning with technetium 99m pertechnetate; clinical correlations.

A prospective brain scanning study using technetium 99m pertechnetate was performed in 84 patients with cerebral infarction. No correlation was found between vascular angiographic findings and the frequency of positive scans. A comparison with clinical motor and mental evaluation showed a good correlation between abnormal scans (58 percent) and poor initial test resutls. A half-life of 17 days characterized the time course of positive scans according to their density and abnormal radioisotopic uptake area.

Quantitative ultrasound and dual X-ray absorptiometry measurements of the calcaneus in patients on maintenance hemodialysis.

It has been suggested that quantitative ultrasound measurements (QUS), which reflect mainly bone density, could be influenced by bone micro-architecture. The aim of the study was to assess whether the relationship of QUS to dual X-ray absorptiometry (DXA) would reflect abnormalities of bone structure observed in renal osteodystrophy. QUS and bone mineral density of the calcaneus (BMDc) were measured by DXA in 30 patients on maintenance hemodialysis and 34 age- and gender-matched controls. QUS parameters and BMDc were significantly lower in hemodialysis patients than in controls (speed of sound [SOS] and broadband ultrasound attenuation [BUA], p = 0. 030; stiffness, p = 0.003; BMDc, p = 0.006). Bone measurements were not correlated with serum parathyroid hormone (PTH). The regression lines of SOS, BUA, and stiffness to BMDc were not significantly different from that of the controls. When dividing the patients into two subgroups according to their median PTH (203 pg/mL), the slopes of the regression lines of BUA to BMDc were significantly different between these two subgroups (p = 0.052). The slope of the subgroup with PTH

Resting CBF sequential study during recovery from aphasia due to ischemic stroke.

Cerebral blood flow (133Xenon inhalation method) has been studied in 30 aphasic stroke patients at 15, 30, 60 and 90 days after onset. In total aphasia the CBF values are low and the regional hypoperfused areas are extensive. In Broca's, Wernicke's and nominal aphasias, resting CBF measurements do not provide the clinician with useful additional information and clinical improvement can by no means be attributed to a resting CBF rise during the observation period.

Use of 99mTc-labeled albumin microspheres in cerebral vascular disease.

The intracarotid injection of radioalbumin microspheres (15 and 30 mum) is followed by scanning procedures that permit the description of the cerebral bloodflow distribution. The method is reproducible. Injection can be made into the internal and common carotid arteries, as well as into the aortic arch or the left ventricle. This last procedure makes it easy to examine patients with severe extracranial vascular stenosis or thrombosis and permits comparison of the two hemispheres. Most patients (88%) injected on the affected side showed one or more local vascular deficits. The method therefore is more efficient than pertechnetate scanning or arteriography.

Advances in high-throughput screening: biomolecular interaction monitoring in real-time with colloidal metal nanoparticles.

The post-genomic era is revolutionizing the drug discovery process. The new challenges in the identification of therapeutic targets require efficient technological tools in order to be properly addressed. Label-free detection systems use proteins or ligands coupled to materials of which the physical properties are measurably modified upon specific interactions. Among the label-free systems currently available, the use of metal nanocolloids offers enhanced throughput and flexibility for real-time biomolecular recognition monitoring at a reasonable cost.

Magnesium bioavailability from mineral water. A study in adult men.

OBJECTIVE: To assess magnesium enteral absorption from a magnesium-rich mineral water. DESIGN: Experimental study. SETTING: Department of Nuclear Medicine, Brugmann Hospital, Brussels, Belgium. SUBJECTS: Ten healthy male volunteers in the age range 25-42 y. INTERVENTION: Each subject completed two sessions in a random order. At one session, they received an oral load of 300 ml of water (containing 1.2 mmol Mg), traced with (28)Mg, and at the other session they received an intravenous injection of (28)Mg, in order to take into account the metabolism of endogenous magnesium. The dietary consumption was further noted on a weekly diary. RESULTS: The mean bioavailability was 59.1% (s.d.+/-13.6). Magnesium absorption and age were significantly inversely correlated (r=-0.68, P=0.035). CONCLUSION: Magnesium-rich mineral water is a reliable source of magnesium. Our observation of decreased magnesium absorption with age deserves further investigations. SPONSORSHIP: The study was sponsored by SEV, Bourg la Reine, France.

Brain distribution and kinetics of 11C-chlorpromazine in schizophrenics: positron emission tomography studies.

The positron emitter 11C (20 minutes half-life) permits the labeling of chlorpromazine (CPZ) and the study of its distribution in humans by external counting. Trace amounts of 11C-CPZ were injected intravenously into 22 schizophrenic patients all untreated for several months with neuroleptics. The brain uptake was 6.04 +/- 1.6% of the injected dose 15 minutes after the injection, and it remained constant for 45 minutes. By positron emission tomography, the drug distribution was shown to be in the gray matter, and such structures as the cortex, caudate nucleus, thalamus and putamen could be identified. This new methodology will be helpful in studying specific receptors in humans in a noninvasive way.

A 'made in one piece' skeleton in a 22-year-old man suffering from sickle cell anaemia.

A 22-year-old African male with known sickle cell anaemia was referred by a Congolese medical centre with a request to improve his poor physical condition. He was unable to walk, stand or sit because his large joints and his spine were either ankylosed or very rigid. Radiographs showed joint fusion from the third to the fifth cervical vertebrae, of both hips, of the left knee, and a bilateral osteonecrosis of the humeral head. There was no scintigraphic evidence for an active osteomyelitis (99mTc-MDP (methyldiphosphonate) bone scan, Tc monoclonal antigranulocyte scan and 99mTc sulphur colloid scan). To improve his mobility the right femoral head was resected in June 1997; 14 days later the left femoral head was resected. Four months after the resection of the right hip, a right uncemented total hip prosthesis was implanted on this side. One month later the same type of hip arthroplasty was performed on the left side. During the postoperative rehabilitation period the patient regained autonomy. We have found no previous reports of such severe and multiple joint complications in a single patient suffering from sickle cell anaemia.

Predictors of the variation of the ejection fraction during exercise in patients with and without coronary heart disease.

The aim of this study was to determine the factors influencing the different response of the ejection fraction (EF) of the left ventricle at exercise observed in patients with and without significant coronary heart disease. We have studied 98 patients referred for coronary angiography (82 men, 16 women), of whom 49 patients had a previous myocardial infarction and 71 patients had significant coronary heart disease. Exercise testing was performed and combined with a cardiac blood pool imaging at equilibrium. The variation of the EF between rest and peak exercise (delta EF) was measured. Twelve clinical, exercise-related, isotopic, and coronary arteriographic variables were examined in a linear univariate and statistical analysis. In the univariate regression, seven variables were significant regressors on the delta EF. In the multivariate regression, only four variables were significant regressors on the delta EF. Three independent predictors were found: the rate-pressure product, the ST depression, and the occurrence of a previous myocardial infarction. These three independent predictors reflect the myocardial functional reserve.

Type I interferons induce proteins susceptible to act as thyroid receptor (TR) corepressors and to signal the TR for destruction by the proteasome: possible etiology for unexplained chronic fatigue.

In some patients complaining of chronic fatigue such as those suffering from the chronic fatigue syndrome (CFS), no underlying physical cause can be clearly identified and they typically present a normal thyroid function. Several studies indicate a dysregulation in the type I interferons (IFN-alpha/beta) pathway in CFS resulting in a sustained upregulation of 2('),5(')-oligoadenylate synthetases (2-5OAS). Likewise, patients treated with IFN-alpha/beta usually complain of severe fatigue as a limiting side effect. Beside the 2-5OAS, IFN-alpha/beta induce also the expression of three closely related proteins of unknown function termed the 2-5OAS-like (2-5OASL) proteins. The amino acid sequences of the 2-5OASL proteins display 96% identity with the partial sequence of the thyroid receptor interacting protein (TRIP) 14, further contain two typical thyroid hormone receptor (TR) coregulator domains and feature two ubiquitin C-terminal domains. From these observations, we raise the hypothesis that the 2-5OASL proteins are TRIPs capable of, respectively, repressing TR transactivation and/or signaling the receptor for destruction by the proteasome. Such molecular mechanisms could explain the development of a clinical hypothyroid state in presence of a normal thyroid function.

Cerebral blood flow in just detoxified alcohol dependent patients. A 99 m Tc-HMPAO-SPECT study.

Chronic alcohol abuse is responsible for several organic brain disorders. However, even the most characteristic of them are largely underdiagnosed by routine procedures. Therefore, there is need for sensitive, noninvasive and low-cost diagnostic procedures. 99m-Tc-HMPAO-SPECT could be an interesting candidate in this indication, because it estimates the distribution of the cerebral blood flow and the metabolic activity of the brain with a good resolution. We used this technique in 17 healthy volunteers and in a sample of 50 patients dependent on alcohol, without other major physical or mental disorder. SPECT was performed during the attendance of these patients in an inpatient detoxification program. We observed abnormal SPECT in 34 patients, but only in 2 volunteers (p < 0.001). The main abnormality was heterogeneity of the distribution of the tracer. SPECT abnormalities appear to be due nor to withdrawal syndrome, nor to medication. On the contrary, they are correlated with stigmata of heavy alcoholism. Furthermore, a genetic vulnerability to alcohol was suspected because SPECT abnormalities are more frequent in patients with an history of drinking problems in their relatives.

[Techniques for the diagnosis of cerebral ischemia (author's transl)]. / Moyens instrumentaux de diagnostic dans l'insuffisance circulatoire céébrale.

The various techniques for the diagnosis of cerebral ischemia are reviewed. The methods for investigating the large cervical arteries are considered (angiography, ultrasonic Döppler technique, carotid compression test) as well as those concerned with intracranial circulation. The latter are divided in "functional" methods (Rheoencephalography cerebral blood flow measurements with Xenon or with microspheres) and "morphological" methods (Brain scintigraphy and CAT scan). The respective values of the various methods are estimated in a personal series of patients.

[First detection of sentinel node in adenocarcinoma of Bartholin's gland]. / Premier cas de recherche du ganglion sentinelle dans un adénocarcinome de la glande de Bartholin.

We report the first case of detection of sentinel node in a 54 year-old woman presenting an adenocarcinoma of Bartholin's gland. Primary carcinoma of Bartholin's gland is rare and represents 2-7% of vulvar malignant lesions; this could explain the lack of consensus about treatment. The best attitude could be vulvectomy and inguinal lymphadenectomy. Pelvic lymphadenectomy is not required when no pelvic sentinel node is observed or when no metastatic inguinal node can be detected.

[Left ventricular function in obstructive chronic bronchopneumopathy]. / Etude de la fonction ventriculaire gauche en cas de bronchopneumopathie chronique obstructive.

Left ventricular (LV) function was studied, using echocardiography, radionuclide angiography and right catheterization, in 20 patients (mean age 60.9 +/- 1.5 years) with severe stable chronic obstructive pulmonary disease (COPD) and without known heart disease. The diagnosis of LV failure, suspected on clinical grounds in 8 of these patients, was confirmed by raised pulmonary capillary wedge pressure (PCWP) in only one patient. Nineteen subjects had normal PCWP and LV ejection fraction (LVEF) values, radionuclide LVEF and end diastolic LV dimension being the most powerful discriminators between the single abnormal patient and the others. Echocardiograms of sufficient quality were obtained in 11 out of the 19 normal patients and constantly showed LV dimensions in the lowest part of the normal range. The stroke volume index (SVI) - cardiac output being measured by thermodilution - was found to be decreased in 9 of 14 patients with normal LVEF values. We conclude that in patients with severe COPD (1) LV failure is quite unfrequent and the empirical use of digitalis should not be recommended, (2) radionuclide angiography is the most useful procedure for routine evaluation of LV function and (3) a decreased SVI is frequently found in patients with a small LV cavity and a normal LVEF, suggesting some degree of diastolic dysfunction of the left ventricle.