Effect of very early treatment in rheumatoid arthritis on bone oedema and synovitis, using magnetic resonance imaging.

OBJECTIVE: To evaluate the magnetic resonance imaging (MRI) findings of hand involvement before and 1 year after treatment in patients with early rheumatoid arthritis (RA). METHOD: MRI of the dominant hand was performed in 22 patients fulfilling the new criteria for early RA. The patients were divided into three groups. Nine had very early RA (VERA; disease duration < 3 months), seven had early RA (ERA; disease duration < 6 months), and six had established RA (ESTRA; disease duration > 12 months). The MRI protocol consisted of fat-suppressed T2, and plain and contrast-enhanced T1-weighted sequences. Assessment of bone marrow oedema, synovitis, and bone erosions was performed by the OMERACT RA MRI scoring system. Patients were treated with methotrexate (MTX) 0.2 mg/kg/body weight/week and prednisone 7.5 mg/day. Clinical assessment was evaluated using the Disease Activity Score for 28 joint indices (DAS28). RESULTS: After treatment, a significant decrease was observed: (a) in DAS28 of VERA (6.2 ± 0.9 vs. 2.4 ± 1.2), ERA (5.3 ± 0.8 vs. 2.8 ± 1.0), and ESTRA patients (5.7 ± 8.0 vs. 2.7 ± 0.7; p < 0.05); (b) in bone oedema (16.77 ± 13.78 vs. 5.88 ± 6.31) and synovitis (12.44 ± 6.44 vs. 2.88 ± 3.25) of VERA patients; and (c) in synovitis (7.57 ± 6.32 vs. 1.42 ± 1.81) of ERA patients (p < 0.05). No significant difference was found in erosions in any group. CONCLUSION: Bone marrow oedema and synovitis decrease significantly when RA is diagnosed and treated early. MRI is useful in the early detection of these changes. MTX treatment resulted in a significant decrease in DAS28 score and significant improvement in bone oedema and synovitis.

Conventional MRI and magnetisation transfer imaging of the brain and optic pathway in primary open-angle glaucoma.

Neuropathological studies in experimental and human glaucoma have shown degenerative changes in the optic pathway. The purpose of the study was to evaluate, with conventional MRI and magnetisation transfer imaging, the brain and the optic pathway of patients with primary open-angle glaucoma (POAG). 26 patients, aged 67.4+/-8.6 years, and 26 control subjects were studied. The presence of white matter hyperintensities (WMH) was evaluated on fluid-attenuated inversion recovery images of the brain. The area of the optic nerves was assessed on coronal short tau inversion recovery images. Magnetisation transfer ratio (MTR) was measured in the chiasm and in the grey and white matter (CGM and CWM) of the calcarine fissure. More WMH were observed in patients (total 261, mean 10.8, standard deviation 12.7) than in control subjects (total 127, mean 4.7, standard deviation 5.7; p<0.001). The area (mm(2)) of optic nerves (10.7+/-5.7) and the MTR (%) of the chiasm (53.7+/-8.4), the CWM (60.9+/-4.2) and the CGM (53.6+/-5.6) were all lower in patients than in control subjects (13.6+/-4.3, 62.1+/-6.2, 67.6+/-8.6 and 57.0+/-4.6, respectively; p<0.05). The area of optic nerves showed significant correlation with the MTR of the chiasm (R = 0.41), the MTR of the CGM (R = 0.33), the MTR of the CWM (R = 0.34) and the cup to disc ratio (R = -0.46). POAG leads to optic nerve atrophy and degeneration of the optic pathway. The finding of an increase in the number of WMH suggests that cerebrovascular disease may play a role in the pathogenesis of POAG.

Age-related grey matter changes in preterm infants: an MRI study.

Grey matter (GM) maturation has not been previously studied in healthy preterm children. The purpose of this study was to evaluate the age dependency of GM development in 116 GM areas in preterm subjects. Sixty one preterm infants (corrected age: 13.7+/-9.92 months, gestational age: 33.4+/-1.9 weeks) with normal structural appearance on MRI were included in the study. Using a T1-weighted high resolution 3D spoiled gradient echo sequence, volumes of 116 GM areas were calculated after their segmentation using the Voxel Based Morphometry Toolboxes and the Individual Brain Atlas Statistical Parametric Mapping (IBASPM) software packages. Non linear regression analysis assessed age dependency of volume data for every GM area using the monoexponential function y=A-Bexp(-x/C). All supratentorial GM areas followed the monoexponential function model reasonably well. Cerebellar structures had a poor goodness of fit. Volume increase of the individual GM areas followed an inferior to superior and a posterior to anterior pattern. The putamen, thalamus, and caudate nucleus reached 99% of the final volume earlier than most cortical GM areas. The visual cortex and the postcentral and precentral cortices matured earlier than the parietal, frontal and temporal cortices. The fronto-occipital asymmetry or torque seen in adults was observed in the preterm infants; the left occipital areas reached maturation earlier than the right, while the right prefrontal and frontal areas matured earlier than the left. To conclude, GM development progresses in a region-specific manner coinciding with functional, phylogenetical and regional white matter (WM) maturation.

[Computerized tomography evaluation of local recurrence of operated and adjuvant radiation treated rectal carcinoma. Normal and pathological changes after operation and irradiation of rectal carcinoma in 956 CT examinations]. / Computertomographische Beurteilung von Lokalrezidiven beim operierten und nachbestrahlten Rektumkarzinom. Regelhafte und pathologische Veränderungen nach Operation und Bestrahlung des Rektumkarzinoms in 956 CT-Untersuchungen.

Colorectal carcinoma is one of the most common cancer in Germany. We want to evaluate the most reliable CT features indicating local recurrence of rectal cancer as early as possible. 232 patients suffering from rectal cancer being administered to our clinic from 1987-1998 were investigated. Criteria for inclusion: patients after surgery and radiotherapy of rectal cancer with a minimum follow-up of two years and at least 3 CT examinations. All CT examinations were analyzed standardized. The main target parameters for relapse were enlargement of a presacral mass, inhomogeneous appearance, asymmetric outlines, enlarged lymph nodes and infiltration of the surrounding structures. An unchanged appearance of the presacral space in more than three CT examinations after surgery correlated with freedom of recurrence.

Interactions of saponin with microsomal membranes isolated from vascular smooth muscle.

The effects of the plant glycosides extract, saponin, on various biochemical properties of microsomal fractions isolated from dog aortae and mesenteric arteries were investigated. These properties include binding and transport of Ca2+, ouabain-sensitive K+ activated p-nitrophenyl phosphatase (hereafter termed K+-pNPPase) and binding of radiolabelled antagonists to adrenoceptors. We found that saponin inhibited both Ca2+ binding and transport by the vascular muscle microsomes in a dose-dependent manner, but it caused marked enhancement of the K+-pNPPase activity. Saponin only slightly reduced the Bmax, but not the Kd of [125I]-iodocyanopindolol binding to the beta-adrenoceptors of the dog mesenteric artery microsomes. A similar finding on the [3H]-prazosin binding to the alpha 1-adrenoceptor in dog aortic microsomes was also observed. Our findings are consistent with the "skinning" action of saponin on the smooth muscle and provide direct evidence that saponin does not attenuate the recognition properties of the adrenoceptors in the cell membranes.