Predictive value of neurochemical monitoring in large middle cerebral artery infarction.

BACKGROUND AND PURPOSE: Space-occupying brain edema is a life-threatening complication in patients with large hemispheric stroke. Early identification of patients at risk is necessary to decide on invasive therapies such as decompressive hemicraniectomy or hypothermia. To assess potential predictors of malignant brain edema by measurement of intracranial pressure (ICP) and microdialysis in patients with large hemispheric stroke and different clinical course. METHODS: In an ongoing prospective clinical study, an ICP and microdialysis probe were placed into the parenchyma of the ipsilateral frontal lobe of 10 patients. Extracellular concentrations of glutamate, lactate, pyruvate, and glycerol were measured continuously. Repeated cranial CT scans were scrutinized for size of infarction and presence of mass effect. RESULTS: The dynamics of the different substances varied in accordance with the clinical course, size of infarction, and local brain edema: Increase in ICP and in glutamate concentration and lactate-pyruvate ratio was followed by massive edema and large infarcts; generally low and stable ICP and substrate concentrations were found in patients without progressive space-occupying infarcts. CONCLUSIONS: In patients with large hemispheric infarction, bedside monitoring with microdialysis is feasible and might be helpful together with ICP recording to follow the development of malignant brain edema.

Elevation of extracellular glutamate in the final, ischemic stage of progressive epidural mass lesion in cats.

Epidural mass lesions may cause ischemia due to progressive intracranial hypertension. In order to investigate the impact of intracranial pressure on accumulation of neuroactive substances, we gradually raised intracranial pressure in five halothane anesthetized cats by inflation of an epidural balloon. We evaluated in the parietal cortex contralateral to the site of balloon inflation, alterations of extracellular glutamate and purine catabolites and of the lactate/pyruvate ratio in relation to changes of intracranial, cerebral perfusion and mean arterial blood pressure. In a complementary experiment, regional cerebral blood flow was assessed by sequential positron emission tomography. In this simplified mass lesion model, extracellular glutamate increased in all cats at a late, critical stage after tentorial herniation, when intracranial pressure had increased to more than 90 mm Hg, cerebral perfusion pressure had decreased below 40-50 mm Hg. Positron emission tomography assessments revealed that the ischemic threshold for glutamate accumulation was in the range of 15-20 mL/100 g/min. Purine catabolites and the lactate/pyruvate ratio increased somewhat earlier than glutamate, but also after reaching the critical, terminal stage. We conclude that in this model of progressive epidural compression, glutamate-mediated excitotoxic processes at sites remote from the initial focal lesion depend on processes such as delayed ischemia in combination with tentorial herniation and systemic hypotension. These processes seem to be initiated by a decrease of cerebral perfusion pressure below a threshold of 40-50 mm Hg.

Regulation of PSP/reg in rat pancreas: immediate and steady-state adaptation to different diets.

Pancreatic stone protein/reg protein (PSP/reg) is a secretory pancreatic protein of hitherto unknown function. It is precursor to a spontaneously precipitating peptide called pancreatic thread protein, which is found in protein plugs within the pancreatic ductal system. Increasing PSP/reg concentrations in pancreatic juice might augment the risk of intraductal plug formation and therefore be a condition predisposing to chronic pancreatitis. Malnutrition is associated with a high incidence of chronic pancreatitis in tropical countries. In a diet study with rats, we tested the hypothesis that protein malnutrition leads to increased PSP/reg concentrations in pancreatic juice. A highly sensitive and reliable enzyme-linked immunosorbent assay (ELISA) for rat PSP/reg was newly established. Male Sprague-Dawley rats were allocated to three nearly isocaloric experimental diets, which contained 0, 45, or 82% casein, respectively, or to a control diet (22% casein). We evaluated PSP/reg expression under these four dietary conditions on the RNA and on the protein level, performing a time-course study over a period of 28 days. Our results demonstrate that PSP/reg expression is not increased because of a protein-deficient diet if investigated under steady-state conditions. After a temporary increase in PSP/reg levels due to a carbohydrate-deficient high-protein diet, we could not find signs of a diet-dependent regulation of this protein. The regulation of PSP/reg thus differs from that of most other pancreatic secretory proteins. Our findings contradict earlier reports that had drawn conclusions based solely on messenger RNA levels.

Full-face laser resurfacing and rhytidectomy.

The Ultrapulse CO2 laser (Coherent Inc., Palo Alto, CA, USA) was used in 239 patients, from March 1996 to July 1998, for full-face laser resurfacing. In 106 (43%) of these patients rhytidectomy was performed in the same procedure. All patients submitted to laser resurfacing were prepared for 1 to 2 months beforehand with retinoic acid and hydroquinone. The procedures were done under local anesthesia controlled by an anesthesiologist. A clear film dressing impregnated with silicone gel (Silon TSR; Bio-Med Sciences, Bethlehem, PA, USA) was used for 6 to 7 days and complete healing was observed in 7 to 10 days. Complications were exclusively dermatologic, without relation to surgery. No necrosis of the cutaneous flap was observed. Skin biopsies of 10 consecutive patients undergoing the combined procedures revealed no vascular impairment to the dermis. The patients were able to resume their activities 2 weeks after the procedure.

[A phase-I/II study on the local hyperthermia of cervical N2/N3 lymph node metastases]. / Phase-I/II-Studie zur lokalen Hyperthermie zervikaler N2/N3-Lymphknotenmetastasen.

BACKGROUND: Patients with advanced lymph node metastases from head and neck tumors at stage N2/N3 (i.e. UICC IV) present a difficult therapeutic problem. Despite combined radio-chemotherapy and hyperfractionated and/or accelerated fractionation regimens, local control of these tumors remains unsatisfactory. For this reason, the value of local radio wave/microwave hyperthermia was examined for this patient group in a phase I/II study.

Halothane, but not alpha-chloralose, blocks potassium-evoked cortical spreading depression in cats.

The effects of two anesthetics, halothane and alpha-chloralose, on induction of spreading depression and on extracellular glutamate elevation after intracortical potassium administration were investigated in artificially ventilated (30% oxygen/70% nitrous oxide) cats. High potassium concentrations were achieved using either direct KCl injections (7 microliters, 150 mM via a micropipette) or microdialysis by supplementing 100, 300 or 500 mM KCl, respectively, for 10 min to the perfusion solution (Ringer's). Changes of the cortical DC potential were recorded adjacent (1-2 mm: electrode DC1) and distant (6-7 mm: electrode DC2) to the injection site. Either under halothane (0.75% in the respiratory gas mixture) or under alpha-chloralose (60 mg/kg i.v.) anesthesia, prolonged negative shifts of the DC potential reflecting the elevated potassium levels after KCl injection were measured near the injection site (electrode DC1). In contrast, spreading depressions (transient short DC deflections) were almost exclusively observed under alpha-chloralose. Spreading depressions recorded with electrode DC1 were superimposed on the prolonged negative DC shifts and they propagated frequently to the more distant site (DC2). Upon KCl administration, dose dependent elevations of extracellular glutamate were measured. These elevations were not significantly altered by the type of anesthesia. Our results suggest that in cats, spreading depression induction is affected by anesthesia, i.e., spreading depression induction is inhibited by halothane as compared to alpha-chloralose. Furthermore, factors other than glutamate or high potassium seem to contribute to spreading depression induction.

Lipid interactions of the hemagglutinin HA2 NH2-terminal segment during influenza virus-induced membrane fusion.

Fusion of influenza viruses with target membranes is induced by acid and involves complex changes in the viral fusion protein hemagglutinin (HA) and in the contact sites between viruses and target membranes (Stegmann, T., White, J. M., and Helenius, A. (1990) EMBO J. 9, 4231-4241). At 0 degrees C, in a first, kinetically distinct step, target membranes irreversibly adhere to the viruses. Fusion itself starts only after a lag-phase of several minutes (X-31 strain viruses) or after raising the temperature (PR8/34 strain viruses). We now provide evidence that the initial conformational change resulting in virus-target membrane adhesion is restricted to a (minor) subpopulation of the HA molecules. These molecules become susceptible to bromelain digestion, and they could be labeled with the photoactivatable reagent [3H]PTPC/11, a nonexchangeable lipid present in the target lipid bilayer (Harter, C., Bächi, T., Semenza, G., and Brunner, J. (1988) Biochemistry 27, 1856-1864). Only the HA2 subunit was labeled, and analyses of 2-nitro-5-thio-cyanobenzoic acid fragments derived thereof indicate that the HA2 NH2-terminal segment (fusion peptide) inserted into the target membrane bilayer. When the temperature was raised to trigger fusion of PR8/34 viruses, labeling of HA2 increased by a factor of 130. Most (74%) of that label was incorporated into the COOH-terminal membrane anchor region, but there was also a strong increase (about 30-fold) of NH2-terminal fusion peptide labeling. This suggests that fusion is preceded., or accompanied, by further changes in HA which lead to additional extensive lipid insertions of HA2 fusion peptides.

Crustacean peptidergic neurons in culture show immediate outgrowth in simple medium.

The survival and outgrowth of neurons in culture has usually required conditioning factors. We now report that crustacean neurons, taken from the peptidergic neurosecretory system of the eyestalk of crabs (Cardisoma carnifex) and lobsters (Panulirus marginatus), show immediate outgrowth, sustained for a week or more, in defined medium as simple as physiological saline with glucose and glutamine. The neurons show peptide hormone immunoreactivity that is prominent at growth cones, exhibit differences in form correlated with their immunoreactivity, release peptides to the medium, and have voltage-dependent currents, including a well-sustained Ca current. Cd blocks secretion, growth, and the Ca current. Peptidergic secretory neurons may be able to utilize existing membrane from their store of granules and already active synthetic, transport, and secretory mechanisms for immediate outgrowth.

Differentiation between cortical and subcortical lesions following focal ischemia in cats by multimodality evoked potentials.

Regional ischemia was induced in cats by occluding the middle cerebral artery. Evoked and spontaneous electrical activity as well as regional cerebral blood flow (rCBF) were recorded with platinum depth macroelectrodes in three primary cortical areas: the auditory cortex (A, middle ectosylvian gyrus) and the front and hind limb somatosensory cortex (SF and SH, lateral and medial posterior sigmoid gyrus). To distinguish among the various evoked potentials after click, median or tibial nerve stimulation, electrical field interactions had to be eliminated using a multiplex stimulation and analysis system. Spontaneous electrocortical activity was evaluated by power spectral analysis. In all areas, evoked potentials were abolished 10 min after arterial occlusion. However, rCBF behaved differently in these regions: it was severely reduced in A, decreased moderately in SF and remained unchanged in SH. The graded reduction of rCBF in the three cortical areas was related to changes in electrophysiological activity during the first minutes of ischemia. In A, auditory potentials were abolished within 3 min after occlusion, whereas in SH, the decrease of somatosensory responses started after about 5 min. In SF, two components of the EP changes were found: an early decrease immediately and a later decrease about 5 min after occlusion. The different rates of EP impairment possibly correspond to two types of ischemia. The fast EP abolishment seems to be caused by local cortical damage whereas the delayed EP decrease probably reflects impairment of subcortical white matter structures. Thus, this method may be useful for distinguishing between gray and white matter ischemia.

Influence of spinal and hypothalamic warming on metabolism and sleep in pigeons.

Animals were prepared with electrooculogram (EOG), cortical electroencephalogram (EEG), and electromyogram (EMG) electrodes and with spinal and/or hypothalamic thermodes. Experiments were run at a cold and a neutral ambient temperature (Ta) during the dark portion of a 24-h light-dark cycle. Metabolic rate, temperatures, EEG, EMG, and EOG were measured continuously for 4-h periods with hypothalamic or spinal temperature unmanipulated or warmed to the level measured during the light. The cold Ta increased metabolic rate over the neutral Ta, but did not influence total sleep time (TST) or rapid-eye-movement sleep (REM) as percent TST. At the cold Ta, spinal warming resulted in reduction in REM as a percent TST. Spinal warming frequently caused a fall in body temperature (Ta). A plot of REM as a percent TST vs. the fall in Tb, including data for all animals and all conditions, revealed a clear correlation between fall in Tb and reduction in REM. Hypothalamic warming had no influence on metabolic rate, Tb, or distributions of arousal states. Cold thermal stimuli caused by a fall in Tb can inhibit REM in birds as it can in mammals independently of thermoregulatory drive.