Relationship between MRI and clinical findings in the acromioclavicular joint.

OBJECTIVE: To determine the relationship between the magnetic resonance (MR) appearance of the acromioclavicular (AC) joint and the physical findings. DESIGN: A total of 116 consecutive patients underwent routine MR imaging (MRI) of the shoulder over an 18-month period. All MR studies were interpreted by a blinded, experienced musculoskeletal radiologist. Eleven variables were studied: the presence of osteophytes; fluid in the joint; fluid outside the joint; high signal in the clavicle or in the acromion; fluid in the subacromial bursa; irregularity of the joint margins; bulging of the capsule; widening of the joint; the age of the patient; and the presence of a rotator cuff tear. The clinical information was supplied by an experienced shoulder surgeon blinded to the MRI findings. A control group of 23 normal volunteers was also studied. RESULTS: The only statistically significant correlation ( P=0.0249) was between high signal in the distal clavicle and degenerative changes found clinically. A weaker relationship existed between fluid in the joint and the clinical examination and between increasing degenerative changes and advancing age. Otherwise, no material relationship was found between any of the other MR abnormalities and the clinical picture. CONCLUSION: There appears to be no real correlation between the MR appearances and the clinical findings in the AC joint.

Memory dysfunction in multiple sclerosis corresponds to juxtacortical lesion load on fast fluid-attenuated inversion-recovery MR images.

BACKGROUND AND PURPOSE: MR imaging is a sensitive diagnostic tool and paraclinical marker of disease activity and prognosis in multiple sclerosis (MS), yet the role of MR imaging of MS is controversial. The aim of this study was to describe the relationship between cognitive function and MS lesion size and position, as shown on comparative images from conventional spin-echo (CSE) and fast fluid-attenuated inversion-recovery (fast FLAIR) MR studies. METHODS: CSE and fast FLAIR sequences consisted of 40 noncontiguous, 3-mm-thick axial sections matched for geometric position in 18 patients with relapsing-remitting MS. Lesions were scored for size, anatomic position, and their comparative appearance on CSE and fast FLAIR images. The neuropsychological assessment tested general psychological performance, memory, and frontal lobe executive function. RESULTS: Fast FLAIR images showed significantly more small (146 versus six) and medium-sized (18 versus four) juxtacortical lesions than did CSE sequences. Small juxtacortical lesions displayed only on fast FLAIR images had a distinctive appearance, suggestive of small areas of perivascular inflammation. The number of these lesions corresponded to reduced performance on the fifth and delayed trials of the Rey Auditory Verbal Learning memory function test. CONCLUSION: Fast FLAIR images show small lesions at the juxtacortical boundary that are not seen on CSE studies. The presence of such lesions correlates with impaired retention of information in memory tasks, which is characteristic of cognitive problems in patients with MS.

Awareness of involuntary movements in Huntington disease.

OBJECTIVE: To determine why patients with Huntington disease are apparently unaware of their involuntary movements. DESIGN: Correlative study using a subjective report questionnaire of physical symptoms and objective measures of neurologic and cognitive dysfunction. PATIENTS: Forty patients with Huntington disease attending a regional Huntington disease clinic. RESULTS: Patients were poor at reporting experiential symptoms of involuntary movements. There was no relationship between self-report of these symptoms and objective indices of motor dysfunction or severity of cognitive impairment. Patients could, however, report secondary consequences of their movement disorder, which correlated highly with nonchoreic indices of motor dysfunction. CONCLUSIONS: Patients with Huntington disease have impaired subjective experience of chorea. Denial of symptoms is likely to have a physiological basis and is not a secondary consequence of patients' cognitive impairment or a psychological defense against a debilitating disease.

The glycosylation of red cell autoantibodies affects their functional activity in vitro.

Factors governing the functional activity of red cell autoantibodies are poorly defined. Here we report the presence of qualitative differences in the glycosylation of IgG autoantibodies which affect in vitro interactions with Fc gamma RIII. The following antibodies were affinity-purified by adsorption and elution from normal red cells: IgG eluted from the red cells of 27 haemolysing or non-haemolysing patients, anti-D in sera from 11 pregnant women, and IgG1 and IgG3 human monoclonal anti-D. Monoclonal antibodies with differing levels of agalactosyl IgG were produced by culturing cell lines at high or low cell density. The % IgG with oligosaccharides lacking terminal galactose residues (agalactosyl IgG) of antibodies was designated as low, medium or high according to their reactivity with a monoclonal antibody to terminal N-acetylglucosamine. Fc gamma RIII-mediated functional activity was assessed by measuring the K-cell-mediated lysis of red cells in eluates diluted to achieve comparable levels of red cells sensitization. All eluates containing allo-anti-D were lytic (range 74-100%). In contrast, lysis by autoantibodies varied from 0 to 100%; 11/13 eluates from red cells of haemolysing patients promoted > 5% lysis compared to 2/7 eluates from red cells of non-haemolysing patients (P < 0.02). The ability of autoantibodies to promote K-cell-mediated red cell lysis correlated inversely with their level of agalactosyl IgG (r = -0.56, P < 0.01, n = 23). Further, monoclonal anti-D antibodies with very low levels of agalactosyl IgG were comparatively more lytic than the same antibodies containing more agalactosyl IgG. Analysis of the ratio of kappa:lambda light chains suggested that autoantibodies from 6/19 patients were monoclonal or oligoclonal in nature. The data indicate that IgG red cell autoantibodies from different patients are functionally heterogenous, and that this may be due, at least in part, to qualitative differences in the Fc region glycosylation reflected by differences in the proportion of agalactosyl IgG. This heterogeneity is consistent with the clonally-restricted nature of the autoantibodies in some patients.

Autobiographical experience and word meaning.

The role of current personal experience in understanding of word meaning was investigated in a patient, WM, who suffers from semantic dementia. The study was prompted by the observation that WM, despite being severely impaired on formal tests of word comprehension and naming, retained a range of vocabulary pertaining to her daily life. If autobiographical experience has a general facilitatory effect, then this should affect which concepts are retained and which lost, but not influence the quality of that conceptual knowledge. Conversely, if personal autobiography has a direct role in investing concepts with meaning, then WM's understanding of nominal terms that she uses spontaneously in conversation ought not to be normal, but should be constrained by the autobiographical context in which she uses those terms. WM could define nouns and noun phrases drawn from her conversational vocabulary, but her definitions had a markedly autobiographical quality. Moreover, WM was extremely impaired in her ability to define new noun phrases, constructed by combining words from her conversational vocabulary (e.g. "dog licence", constructed from "driving licence" and "dog"; "oil field" constructed from "oil" and "field"). It was concluded that WM does not have normal conceptual understanding of nouns and noun phrases that she uses appropriately in conversation. Her understanding is narrow and autobiographically constrained. The findings, which suggest an interactive relationship between autobiographical and semantic memory, have implications for understanding of the progressive breakdown of semantic knowledge.

The biological activity of human monoclonal IgG anti-D is reduced by beta-galactosidase treatment.

The contribution to IgG effector function of exposed galactose residues on the oligosaccharide chains in IgG has been tested experimentally. We studied a human monoclonal antibody (BRAD-5) to the Rh D blood group antigen. The preparation used contained a very low percentage of agalactosyl IgG (3.6%). After digestion with beta-galactosidase there was an increase in terminal GlcNAc indicating an increase in % agalactosyl IgG to approximately 30%. Comparison was made of the Fc receptor-(Fc gamma R)-mediated functional interactions of the two glycoforms of BRAD-5 in assays which measured the recognition and destruction of sensitised erythrocytes by various effector cells. After beta-galactosidase treatment, there was a slight reduction in Fc gamma RI-mediated adherence of erythrocytes to U937 cells and phagocytosis of erythrocytes by monocytes. Fc gamma RII-mediated binding of erythrocytes to K562 cells was also reduced. However there was little difference in adherence of erythrocytes to either Daudi cells (via Fc gamma RII) or NK cells (via Fc gamma RIII). There was a consistent reduction in lysis of erythrocytes mediated through Fc gamma RIII on K cells with the beta-galactosidase treated anti-D. Overall the results showed that reduced levels of galactose on IgG anti-D were associated with reduced biological activity in these assays, but the experiments failed to cast light on the physiological role of the agalactosyl glycoform of IgG.

The functional activity of human monocytes passively sensitized with monoclonal anti-D suggests a novel role for Fc gamma RI in the immune destruction of blood cells.

The role of Fc gamma RI in the immune destruction of blood cells is uncertain as serum IgG levels are sufficient to competitively inhibit interactions between this high-affinity receptor and sensitized red cells. In the current study, it is proposed that, rather than functioning as a receptor for opsonized red cells, Fc gamma RI might, under appropriate conditions, mediate the passive sensitization (or 'arming') of human macrophages with IgG antibodies resulting in the in vivo destruction of unsensitized cells expressing the corresponding antigen. To examine this hypothesis, Fc gamma RI-bearing human monocytes and U937 cells were first passively sensitized by incubation in vitro with human monoclonal anti-D, and then incubated with D-positive red cells. The uptake of monoclonal anti-D by U937 cells was rapid and, in the presence of 2.5 micrograms/ml IgG1 or IgG3 anti-D, was almost complete after 5 min at 37 degrees. Subsequent incubation of passively sensitized U937 cells in an IgG-free medium for 1 hr at 37 degrees resulted in the loss from the cell surface of approximately 50% cell-bound IgG; the remaining cell-bound IgG was lost more slowly despite repeated washing. In functional assays, passively sensitized monocytes (M-IgG) mediated adherent, phagocytic and chemiluminescent (CL) responses to D-positive red cells. After incubation of M-IgG in 50% v/v fresh normal human serum (FNHS) for 2 hr, sufficient anti-D remained bound to monocytes to promote the adherence of red cells. The adherence and phagocytosis of red cells by M-IgG was enhanced by the simultaneous addition of 50% FNHS, probably owing to the binding of low levels of C3bi to red cells. In contrast, phagocytic and CL responses of unsensitized monocytes to anti-D-sensitized red cells (E-IgG) were abrogated in the presence of 0.25% v/v FNHS, presumably owing to blocking of Fc gamma RI by IgG. It is considered that in vivo, Fc gamma RI may mediate the passive sensitization of macrophages in close proximity with antibody-secreting cells in the reticular network of the splenic cords. Once 'armed' in this way, macrophages may destroy cells expressing the appropriate antigen.