Epilepsia partialis continua after an anterior circulation ischaemic stroke.

BACKGROUND AND PURPOSE: Although cerebrovascular disorders are the main cause of epilepsia partialis continua (EPC) in adulthood, the frequency of EPC after stroke is unknown. The aim was to prospectively ascertain its frequency 1 year after an ischaemic stroke. METHODS: This was a prospective study of consecutive acute anterior circulation ischaemic stroke patients, previously independent, with an admission National Institutes of Health Stroke Scale score ≥4, an acute ischaemic lesion on imaging and no previous epileptic seizures. During admission patients received standardized diagnostic and medical care and were submitted to a neurophysiological evaluation protocol. One year after stroke, patients were re-evaluated by an epilepsy expert neurologist and performed a video-electroencephalogram with electromyography co-registration whenever myoclonus was observed during neurological examination for jerk-locked back averaging analysis (JLBA). EPC was defined as continuously repeated fragments of epileptic seizures, with preserved consciousness, lasting at least 1 h, and representing locally restricted epileptic activity. RESULTS: In all, 151 acute anterior circulation stroke patients were consecutively included and prospectively evaluated, but 23 died in the first year. One year after stroke, from 127 patients alive, 117 (92.1%) underwent clinical and neurophysiological evaluation. In two (1.7%) patients, EPC diagnosis was made both by clinical and electroencephalographic criteria, namely JLBA. Both patients had a history of remote symptomatic seizures and one of them acute symptomatic seizures and non-convulsive status epilepticus criteria during the first 7 days after stroke. CONCLUSIONS: Despite its low frequency, the high stroke incidence makes post-stroke EPC relevant. This study draws attention to this recognizable condition with therapeutic and eventually prognostic implications.

Epileptic manifestations in stroke patients treated with intravenous alteplase.

BACKGROUND AND PURPOSE: Intravenous alteplase (rtPA) may be associated with seizures and epileptic activity in the electroencephalogram (EEG). The aim of this work was to compare the frequency of seizures and EEG abnormalities between stroke patients treated and not treated with rtPA. METHODS: This was a prospective study of consecutive acute anterior circulation ischaemic stroke patients, with 1-year follow-up. Patients were previously independent, had an admission National Institute of Health Stroke Scale score ≥4, an acute ischaemic lesion and no previous seizures. They received standardized diagnostic and medical care. A video-EEG was performed in 72 h (first EEG); during admission (daily until day 7 and after that if neurological worsening); at discharge and 1 year after stroke. RESULTS: In all, 151 patients (101 treated with rtPA) were included. The frequency of acute and remote symptomatic seizures was not significantly different between rtPA treated and non-treated patients (P = 0.726 and P = 0.748, respectively). Clinical paroxysmal phenomena during rtPA perfusion were observed in five (5%) patients. In the first EEG, rtPA treated patients more often had background diffuse slowing (43.6% vs. 26.0%, P = 0.036). This difference was no longer observed at discharge (24.0% vs. 19.1%, P = 0.517) nor 1 year after (11.8% vs. 10.0%, P = 0.765). No differences were found in the frequency of epileptiform (P = 0.867) or periodic discharges (P = 0.381). CONCLUSIONS: Intravenous alteplase is not associated with an increased risk of clinical or electroencephalographic epileptic phenomena.

Effects of prolonged ingestion of epigallocatechin gallate on diabetes type 1-induced vascular modifications in the erectile tissue of rats.

Diabetes Mellitus type 1 is a metabolic disease that predisposes to erectile dysfunction, partly owing to structural and molecular changes in the corpus cavernosum (CC) vessels. The aim of this study was to determine the effects of early treatment with the antioxidant epigallocatechin gallate (EGCG) in cavernous diabetes-induced vascular modifications. Diabetes was induced in two groups of young Wistar rats; one group was treated with EGCG for 10 weeks. A reduction in smooth muscle content was observed in the CC of diabetic rats, which was significantly attenuated with EGCG consumption. No differences were observed among groups, neither in the expression of VEGF assayed by western blotting nor in the immunofluorescent labeling of vascular endothelial growth factor (VEGF) and its receptors (VEGFR1 and VEGFR2). VEGFR2 was restricted to the endothelium, whereas VEGF and VEGFR1 co-localized in the smooth muscle layer. With regard to the Angiopoietin/Tie-2 system, no quantitative differences in Angiopoietin 1 were observed among the experimental groups. Ang1 localization was restricted to the smooth muscle layer, and receptor Tie2 and Angiopoietin 2 were both expressed in the endothelium. In brief, our results suggest that EGCG consumption prevented diabetes-induced loss of cavernous smooth muscle but does not affect vascular growth factor expression in young rats.

Endovanilloid control of pain modulation by the rostroventromedial medulla in an animal model of diabetic neuropathy.

The involvement of transient receptor vanilloid type-1 (TRPV1) channels in pain modulation by the brain remains understudied. The rostroventromedial medulla (RVM) plays a key role in conveying to the spinal cord pain modulatory influences triggered in higher brain centres, with co-existence of inhibitory (antinociceptive) and facilitatory (pronociceptive) effects. In spite of some reports of TRPV1 expression in the RVM, it remains unknown if endovanilloid signalling plays a direct role in local pain modulation. Here we used a model of diabetic neuropathy, the streptozotocin (STZ)-diabetic rat, to study the role of endovanilloid signalling in RVM-mediated pain modulation during chronic pain. Four weeks after diabetes induction, the levels of TRPV1 mRNA and fatty acid amide hydrolase (FAAH), a crucial enzyme for endovanilloid catabolism, in the RVM of STZ-diabetic rats were higher than control. The RVM of STZ-diabetic rats presented decreased levels of several TRPV1 endogenous ligands, namely anandamide (AEA), palmitoylethanolamide (PEA) and oleoylethanolamide (OEA). Administration of capsaicin (a TRPV1 agonist) into the RVM decreased nociceptive behavioural responses in the inflammatory phase of the formalin test (phase 2). These findings suggest that diabetic neuropathy induces plastic changes of RVM endovanilloid signalling, indicating that TRPV1 may be a putative target for pain modulation in this chronic pain condition.

Inhibition of spinal 5-HT3R reverted diabetes-induced mechanical hypersensitivity in a GABAAR-mediated neurotransmission-dependent manner.

Spinal 5-HT3 receptor (5-HT3R) has been implicated in chronic pain development. The extent to which 5-HT3R contributes to spinal sensitization and diabetic neuropathic pain (DNP) remains elusive and the mechanisms subserving the effects of 5-HT3R activation on spinal pain processing during chronic pain are still unclear. In this study, we evaluated the contribution of spinal 5-HT3R to pain facilitation and spinal sensitization during DNP, exploiting the role of GABAAR-mediated neurotransmission and glial activation in the effects elicited by intrathecal administration of a 5-HT3R antagonist. Mechanical nociception was evaluated by paw pressure test in streptozotocin (STZ)-diabetic and control rats after intrathecal (i.t.) administration of a 5-HT3R antagonist (Y25130). The spinal activation of extracellular signal-regulated kinases (ERKs) pathway and the expression of 5-HT3R, glial fibrillary acidic protein (GFAP; marker of astroglia activation) and ionized calcium binding adaptor molecule 1 (IBA-1; marker of microglia activation) were evaluated at the peak maximum effect of Y25130. The involvement of GABAAR-mediated neurotransmission in the behavioral pain effect of Y25130, was assessed in STZ-diabetic animals receiving i.t. administrations of muscimol (GABAAR agonist). Intrathecal administration of Y25130 reverted mechanical hyperalgesia and decreased the activation of ERKs in STZ-diabetic rats, while no effects were observed in control animals. The spinal activation of GABAAR by i.t. administration of muscimol abolished Y25130-driven antinociception. The expression of IBA-1, GFAP and 5-HT3R was unaltered by treatment. These findings point to a GABA-mediated pronociceptive role of spinal 5-HT3R during DNP.

Substantia nigra neuromelanin magnetic resonance imaging in de novo Parkinson's disease patients.

BACKGROUND: Depigmentation of the substantia nigra (SN) and locus coeruleus (LC) is a conspicuous pathological feature of Parkinson's disease (PD) and is related to the loss of neuromelanin, whose paramagnetic properties result in high signal on specific T1-weighted magnetic resonance imaging (MRI). Recent studies have suggested that neuromelanin decrease in the SN and LC of PD patients may emerge as a possible diagnostic biomarker. The SN neuromelanin signal in de novo and early stage PD patients was studied to assess its diagnostic accuracy. This is the first study based on a semi-automated MRI analysis of the neuromelanin signal in de novo PD patients. METHODS: The inclusion criteria were untreated de novo PD and a 2-5 year disease duration; in addition, age matched healthy controls were enrolled. These were studied with a high-resolution T1-weighted MRI sequence at 3 T to visualize neuromelanin. The primary outcome was SN high signal area, length and neuromelanin/midbrain ratio obtained with semi-automated methods. RESULTS: A total of 12 de novo PD patients and 10 PD patients with a 2-5 year disease duration were evaluated. The area, length of the SN T1 high signal and the SN neuromelanin/midbrain ratio were markedly decreased in the PD groups compared with age-matched controls, with a substantial overlap between the two PD groups. CONCLUSIONS: Neuromelanin-sensitive MRI techniques can discriminate PD patients from healthy individuals with high sensitivity and specificity. Our findings are consistent with recent findings showing that PD neuromelanin changes remain stable during the course of the disease.

Nociceptive spinal cord neurons of laminae I-III exhibit oxidative stress damage during diabetic neuropathy which is prevented by early antioxidant treatment with epigallocatechin-gallate (EGCG).

Spinal cord neurons located in laminae I-III respond to nociceptive stimuli and participate in the transmission of painful information to the brain. In the present study we evaluated if nociceptive laminae I-III neurons are affected by oxidative stress damage in a model of diabetic neuropathic pain (DNP), the streptozotocin-induced diabetic rat (STZ rat). Additionally, we evaluated the effects of a preventive antioxidant treatment with epigallocatechin-gallate (EGCG) in nociceptive neuronal activation and behavioural signs of DNP. Three days after diabetes induction, a treatment protocol of STZ rats with an aqueous solution of EGCG in the drinking water was initiated. Ten weeks after the onset of treatment, the spinal cords were immunoreacted against validated markers of oxidative stress damage (8-hydroxy-2'-deoxyguanosine; 8-OHdG) and of nociceptive neuronal activation (Fos). Mechanical hypersensitivity was assessed before and after EGCG treatment. Untreated STZ rats presented increased levels of 8-OHdG immunoreaction, higher numbers of Fos-immunoreacted neurons and high levels of co-localization of 8-OHdG and Fos in laminae I-III. Treatment with EGCG normalized the increase of the above mentioned parameters and ameliorated mechanical hypersensitivity. The present study shows that nociceptive neurons in spinal cord laminae I-III exhibit oxidative stress damage during diabetic neuropathy, which probably affects ascending pain transmission during DNP. The neurobiological mechanisms and translational perspectives of the beneficial effects of a preventive and sustained EGCG treatment in DNP need to be evaluated in the future.

"Hotheaded": the role OF TRPV1 in brain functions.

The TRPV1 (vanilloid 1) channel is best known for its role in sensory transmission in the nociceptive neurons of the peripheral nervous system. Although first studied in the dorsal root ganglia as the receptor for capsaicin, TRPV1 has been recently recognized to have a broader distribution in the central nervous system, where it is likely to constitute an atypical neurotransmission system involved in several functions through modulation of both neuronal and glial activities. The endovanilloid-activated brain TRPV1 channels seem to be involved in somatosensory, motor and visceral functions. Recent studies suggested that TRPV1 channels also account for more complex functions, as addiction, anxiety, mood and cognition/learning. However, more studies are needed before the relevance of TRPV1 in brain activity can be clearly stated. This review highlights the increasing importance of TRPV1 as a regulator of brain function and discusses possible bases for the future development of new therapeutic approaches that by targeting brain TRPV1 receptors might be used for the treatment of several neurological disorders.

Pronociceptive changes in the activity of rostroventromedial medulla (RVM) pain modulatory cells in the streptozotocin-diabetic rat.

Neuropathic pain is one of the most frequent complications of diabetes. The increased neuronal activity of primary afferents and spinal cord neurons in streptozotocin (STZ)-diabetic rats increases the recruitment of the nociceptive ascending pathways, which may affect the activity of pain control circuits in the brain. This study aimed to characterize the electrophysiological responses of neurons of the rostroventromedial medulla (RVM), a key brainstem area involved in descending modulation of nociceptive neurotransmission at the spinal cord, in STZ-diabetic rats. Spontaneous and noxious-evoked activity of ON-like cells (pain facilitatory cells) and OFF-like cells (pain inhibitory cells) in the RVM were analyzed by single cell extracellular electrophysiological recordings in STZ-diabetic rats with behavioral signs of diabetic neuropathic pain 4 weeks after diabetes induction and in age-matched non-diabetic controls (CTRL). The electrophysiological analysis revealed an increase in the spontaneous activity of RVM pronociceptive ON-like cells in STZ-diabetic rats when compared to CTRL. On the contrary, the number of active antinociceptive OFF-like cells was significantly lower in the STZ-diabetic rats and their spontaneous activity was decreased when compared with CTRL. Overall, the changes in the activity of RVM pain modulatory cells in STZ-diabetic rats point to enhancement of descending pain facilitation. Based on similar results obtained at the RVM in traumatic neuropathic pain models, the changes in the electrophysiological responses of RVM in STZ-diabetic rats may account for exacerbated pain-like behaviors in diabetic neuropathy.

α-Lipoic acid normalizes nociceptive neuronal activity at the spinal cord of diabetic rats.

AIM: To evaluate the effects of antioxidant treatment of streptozotocin (STZ)-diabetic rats with α-lipoic acid (α-LA) in neuronal and microglial activation at the spinal cord, an important relay station of nociceptive transmission. Because of the role of the potassium chloride co-transporter 2 (KCC2) in neuronal activation at the spinal cord and the influence of microglia in KCC2 expression, we also evaluated the effects of α-LA in KCC2 expression at the spinal cord. METHODS: Four weeks after STZ injection, the rats received daily intraperitoneal injections of α-LA (100 mg/kg), during 2 weeks. Mechanical nociception was evaluated before and after α-LA treatment. Spinal cords were immunoreacted against 8-OH-dG (marker of oxidative stress damage), Fos (marker of neuronal activation) and CD11b (marker of microglia). KCC2 expression was evaluated by immunohistochemistry and western blotting. RESULTS: Treatment with α-LA decreased the 8-OH-dG and Fos expressions to controls' levels, but did not affect CD11b. Treatment with α-LA alleviated mechanical hyperalgesia and partially corrected KCC2 expression. CONCLUSIONS: This study shows that neuronal hyperactivity at the spinal cord of STZ-diabetic rats can be corrected by α-LA, which may account for alleviation of mechanical hyperalgesia. These effects are probably partially mediated by KCC2, but are independent from microglia.

Minocycline completely reverses mechanical hyperalgesia in diabetic rats through microglia-induced changes in the expression of the potassium chloride co-transporter 2 (KCC2) at the spinal cord.

AIM: neuronal hyperactivity at the spinal cord during mechanical hyperalgesia induced by diabetes may result from a decrease in the local expression of the potassium chloride co-transporter 2 (KCC2), which shifts the action of the neurotransmitter γ-amminobutiric acid (GABA) from inhibitory to excitatory. In this study, we evaluated the effects of spinal microglia inhibition or brain-derived neurotrophic factor (BDNF) blockade on KCC2 expression, spinal neuronal activity and mechanically induced pain responses of streptozotocin (STZ)-diabetic rats. METHODS: four weeks after induction of diabetes, the STZ-diabetic rats received daily intrathecal injections, for 3 days, of minocycline (microglia inhibitor), TrkB/Fc (BDNF sequester) or saline. Behavioural responses to mechanical nociceptive stimulation of STZ-diabetic rats were evaluated by the Randall-Selitto test. The lumbar spinal cord was immunoreacted against the Fos protein (marker of neuronal activation) or KCC2, which was also quantified by western blotting. BDNF levels at the spinal cord were quantified by an enzyme-linked immunosorbent assay (ELISA). RESULTS: minocycline treatment reversed the mechanical hyperalgesia, increased Fos expression and decreased the KCC2 expression detected in STZ-diabetic rats to control levels. Treatment with TrkB/Fc was less effective, inducing moderate effects in mechanical hyperalgesia and Fos expression and only a partial correction of KCC2 expression. BDNF levels were not increased in STZ-diabetic rats. CONCLUSIONS: this study demonstrates that the microglial activation at the spinal cord contributes to mechanical hyperalgesia and spinal neuronal hyperactivity induced by diabetes, apparently by regulating the KCC2 expression. These effects do not seem to be mediated by BDNF, which is an important difference from other chronic pain conditions. New targets directed to prevent spinal microglia activation should be considered for the treatment of mechanical hyperalgesia induced by diabetes.

Diffusion Tensor Imaging in Movement Disorders: Review of Major Patterns and Correlation with Normal Brainstem/cerebellar White Matter.

The authors reviewed the diffusion tensor imaging (DTI) and tractography (DTT) of the normal brainstem and cerebellar white matter in normal volunteers, correlating it with structural magnetic resonance (MR) imaging and DTI data obtained in patients evaluated in our institution with movement disorders, including multisystem atrophy (MSA), spinocerebellar ataxia (SCA), progressive supra-nuclear palsy (PSP) and idiopathic Parkinson's disease (PD). DTI and tractography data demonstrated major white-matter fibers within the brain stem and cerebellum, including cortico-spinal tracts, transverse pontine fibers, medial lemniscus and cerebellar peduncles. Visualization of selective degeneration of these individual fibre tracts with DTI, in our cases, added qualitative data to the differential diagnosis of movement disorders.

Estudio comparativo entre el 18-FDG PET/CT y la técnica de ganglio centinela para la detección de metástasis axilares en cáncer de mama. Resultados preliminares del protocolo Roffo PET/CT 1 / Comparative study between 18-FDG PET/CT and centinela node technique for the detection of axillary metastases in breast cancer. Preliminary results of Roffo PET/CT 1 protocol

Objetivo: comparar al capacidad del PET y del ganglio centinela (GC) para la detección de metástasis (MTS) axilares. Evaluar la sensibilidad, especificidad, valor de predicción positivo y negativo del PET/CT. Criterios de inclusión: cáncer de mama T1 T2 N0. Pacientes con axilas clínicamente dudosas. Criterios de exclusión: carcinoma ductal in situ, carcinoma inflamatorio, biopsia reciente de mama o axila, embarazo o lactancia, diabetes. Método: el 18-FDG PET/CT se realizó 15 días antes de la cirugía. La técnica de ganglio centinela se efectuó con el método combinado (radiosótopos y azul patente). Material: fueron evaluadas 44 pacientes. Edad promedio 58 años (37-79). T1: 29 pacientes (66%); T2: 15 pacientes (34%). Tamaño tumoral entre 5 y 40mm (promedio 19mm). Axila clínicamente negativa: 38 (86%); axila dudosa 6 (14%). Estadio I: 27 pacientes (61%); estadio II: 17 pacientes (39%). Once pacientes tuvieron tumores no palpables (25%). Nueve pacientes (20%) tuvieron biopsias previas. Resultados: treinta y siete (84%) tumores fueron carcinomas ductales infiltrantes; 5 (11%) lobulillares; y 2 (5%) ductolobulillares. Doce pacientes tuvieron MTS en el GC (27%), de éstas 2 casos eran micrometástasis (17%). En 2 pacientes el PET/CT cambió la estadificación, ya que fue positivo para metástasis óseas y pulmonares. Resultados PET en mama: once negativos (FN: 20%). Tres (33%) eran carcinomas lobulillares infiltrantes; 3 eran T1a (33%). Sensibilidad 79% VPP=100%. Resultados PET en axila: en 36 pacientes el PET fue negativo (82%); 4 de éstas presentaron MTS en el ganglio centinela; 2 de ellas eran micrometástasis. Falso negativo: 33%. Sensibilidad: 66%. En 8 pacientes el PET fue positivo (18%) y el ganglio centinela presentaba MTS en todos los casos. Especificidad: 100%. VPP=100%. En 6 pacientes la axila era dudosa, de éstas sólo en una paciente el PET y el GC fueron positivos.

Aporte de 18-FDG PET/CT en el manejo de los estadios localmente avanzados de cáncer de mama. Resultados preliminares / Contribution of 18-FDG PET/CT in the Management of locally advanced breast cancer. Preliminary results

Objetivos: valorar la respuesta a la quimioterapia neoadyuvante en el cáncer de mama localmente avanzado mediante [18F]-FDG-PET/CT. Evaluar la detección de metástasis a distancia en estadios localmente avanzados mediante [18F]-FDG-PET/CT y su correlación con estudios convencionales. Material y métodos: se realizó [18F]-FDG-PET/CT en 26 pacientes antes de efectuar la biopsia de mama y antes del inicio de los tratamientos. En 23 casos se efectuó un segundo PET/CT luego del primer o segundo ciclo de quimioterapia neoadyuvante. Todas las pacientes recibieron el mismo esquema de quimioterapia con antraciclinas más paclitaxel, realizando tres cursos preoperatorios. Veintiún pacientes fueron sometidas a cirugía. Sobre éstas se compararon los hallazgos del PET/CT respecto de la patología. Se valoró el porcentaje de disminución de la SUV en el PET posquimioterapia versus el previo y se correlacionó con los hallazgos patológicos. Se valoró la detección de metástasis mediante este método y su correlación con estudios convencionales de detección de metástasis. Resultados: en 12 casos se objetivó disminución del SUV superior al 50% y en 5/12 esa disminución fue superior al 80%. En estos 5 casos se correlacionó con respuesta patológica completa (1 caso) o enfermedad residual mínima (4 casos) en la pieza operatoria. En los 7 casos restantes se halló respuesta patológica completa en 1 caso y enfermedad macroscópica en 6 casos. En 8 pacientes se observó una disminución del SUV inferior al 50%. Todas ellas mostraron enfermedad residual macroscópica en las piezas operatorias. En 3/23 pacientes se evidenció progresión de la enfermedad mediante PET/CT, ya sea a nivel local/regional o por progresión de metástasis a distancia. De ellas, 1 paciente fue operada y 2 no operadas. La operada mostró enfermedad residual macroscópica. El valor del SUV inicial se correlacionó con la respuesta.

Estudio comparativo entre el 18-FDG PET/CT y la técnica de ganglio centinela para la detección de metástasis axilares en cáncer de mama. Resultados preliminares del protocolo Roffo PET/CT 1 / Comparative study between 18-FDG PET/CT and centinela node technique for the detection of axillary metastases in breast cancer. Preliminary results of Roffo PET/CT 1 protocol

Objetivo: comparar al capacidad del PET y del ganglio centinela (GC) para la detección de metástasis (MTS) axilares. Evaluar la sensibilidad, especificidad, valor de predicción positivo y negativo del PET/CT. Criterios de inclusión: cáncer de mama T1 T2 N0. Pacientes con axilas clínicamente dudosas. Criterios de exclusión: carcinoma ductal in situ, carcinoma inflamatorio, biopsia reciente de mama o axila, embarazo o lactancia, diabetes. Método: el 18-FDG PET/CT se realizó 15 días antes de la cirugía. La técnica de ganglio centinela se efectuó con el método combinado (radiosótopos y azul patente). Material: fueron evaluadas 44 pacientes. Edad promedio 58 años (37-79). T1: 29 pacientes (66%); T2: 15 pacientes (34%). Tamaño tumoral entre 5 y 40mm (promedio 19mm). Axila clínicamente negativa: 38 (86%); axila dudosa 6 (14%). Estadio I: 27 pacientes (61%); estadio II: 17 pacientes (39%). Once pacientes tuvieron tumores no palpables (25%). Nueve pacientes (20%) tuvieron biopsias previas. Resultados: treinta y siete (84%) tumores fueron carcinomas ductales infiltrantes; 5 (11%) lobulillares; y 2 (5%) ductolobulillares. Doce pacientes tuvieron MTS en el GC (27%), de éstas 2 casos eran micrometástasis (17%). En 2 pacientes el PET/CT cambió la estadificación, ya que fue positivo para metástasis óseas y pulmonares. Resultados PET en mama: once negativos (FN: 20%). Tres (33%) eran carcinomas lobulillares infiltrantes; 3 eran T1a (33%). Sensibilidad 79% VPP=100%. Resultados PET en axila: en 36 pacientes el PET fue negativo (82%); 4 de éstas presentaron MTS en el ganglio centinela; 2 de ellas eran micrometástasis. Falso negativo: 33%. Sensibilidad: 66%. En 8 pacientes el PET fue positivo (18%) y el ganglio centinela presentaba MTS en todos los casos. Especificidad: 100%. VPP=100%. En 6 pacientes la axila era dudosa, de éstas sólo en una paciente el PET y el GC fueron positivos.(AU)

Aporte de 18-FDG PET/CT en el manejo de los estadios localmente avanzados de cáncer de mama. Resultados preliminares / Contribution of 18-FDG PET/CT in the Management of locally advanced breast cancer. Preliminary results

Objetivos: valorar la respuesta a la quimioterapia neoadyuvante en el cáncer de mama localmente avanzado mediante [18F]-FDG-PET/CT. Evaluar la detección de metástasis a distancia en estadios localmente avanzados mediante [18F]-FDG-PET/CT y su correlación con estudios convencionales. Material y métodos: se realizó [18F]-FDG-PET/CT en 26 pacientes antes de efectuar la biopsia de mama y antes del inicio de los tratamientos. En 23 casos se efectuó un segundo PET/CT luego del primer o segundo ciclo de quimioterapia neoadyuvante. Todas las pacientes recibieron el mismo esquema de quimioterapia con antraciclinas más paclitaxel, realizando tres cursos preoperatorios. Veintiún pacientes fueron sometidas a cirugía. Sobre éstas se compararon los hallazgos del PET/CT respecto de la patología. Se valoró el porcentaje de disminución de la SUV en el PET posquimioterapia versus el previo y se correlacionó con los hallazgos patológicos. Se valoró la detección de metástasis mediante este método y su correlación con estudios convencionales de detección de metástasis. Resultados: en 12 casos se objetivó disminución del SUV superior al 50% y en 5/12 esa disminución fue superior al 80%. En estos 5 casos se correlacionó con respuesta patológica completa (1 caso) o enfermedad residual mínima (4 casos) en la pieza operatoria. En los 7 casos restantes se halló respuesta patológica completa en 1 caso y enfermedad macroscópica en 6 casos. En 8 pacientes se observó una disminución del SUV inferior al 50%. Todas ellas mostraron enfermedad residual macroscópica en las piezas operatorias. En 3/23 pacientes se evidenció progresión de la enfermedad mediante PET/CT, ya sea a nivel local/regional o por progresión de metástasis a distancia. De ellas, 1 paciente fue operada y 2 no operadas. La operada mostró enfermedad residual macroscópica. El valor del SUV inicial se correlacionó con la respuesta.(AU)

3-Hydroxy-3-methylglutaryl-coenzyme A lyase deficiency: initial presentation in a young adult.

3-Hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) lyase deficiency is a rare inborn error affecting leucine catabolism and ketogenesis, usually presenting in the neonatal period. Late forms of the disease have been detected in infancy and childhood, but not in adults. We report a case of HMG-CoA lyase deficiency with initial presentation in a 29-year-old adult with no prior history of the disease, which to our knowledge is the first case described with presentation at this age.

C-fos expression at the spinal dorsal horn of streptozotocin-induced diabetic rats.

BACKGROUND: Pain during diabetic neuropathy is associated with peripheral nerve damage but recent evidences suggest the occurrence of central effects. We used the activation of the c-fos protooncogene to study the activity of spinal dorsal horn neurons in streptozotocin (STZ)-induced diabetic rats in the absence of stimulation or in response to innocuous or noxious stimuli. METHODS: Four weeks after saline or STZ (50 mg/kg) injection, rats were anaesthetized and either not further manipulated or submitted to innocuous (gentle touch), noxious mechanical (pinching) or noxious thermal (radiant heat) stimulation of the hindlimb skin. In each experimental situation, the numbers of Fos-immunoreactive (Fos-IR) neurons occurring in the superficial (laminae I-II) or deep (laminae III-V) dorsal horn were compared. RESULTS: In the absence of stimulation, STZ-injected rats presented significantly higher numbers of Fos-IR neurons than controls, both in the superficial and deep dorsal horn (DDH). In comparison with the respective baseline levels, innocuous stimulation did not induce a significant increase in the numbers of Fos-IR neurons in controls or STZ-rats. Noxious mechanical and noxious thermal stimuli increased the numbers of Fos-IR neurons, both in control and STZ-rats, but in a more pronounced manner when diabetic rats were subjected to noxious mechanical stimulation. CONCLUSIONS: The present study demonstrates that the responses of spinal cord neurons are strongly affected during diabetes. The higher baseline neuronal activity probably underlies the spontaneous pain detected during diabetes since the spinal dorsal horn is the major relay station in the ascending transmission of nociceptive input to the brain.

Interobserver agreement in the magnetic resonance location of cerebral vein and dural sinus thrombosis.

The interobserver variation in the magnetic resonance (MR) location of cerebral vein and dural sinus thrombosis (CVT) has not been previously reported. Four independent observers rated a convenience sample of 40 MR/MR angiographies to assess whether or not each dural sinus and major cerebral veins were occluded. Interobserver reliability was measured using kappa statistics. Interobserver agreement was comparable between the six pairs of raters. Agreement was excellent for thrombosis of the deep cerebral venous system (kappa = 1.00), cerebellar veins (kappa = 1.00), superior sagittal sinus (kappa range: 0.82-1) and right jugular vein (kappa range: 0.84-0.95); good to excellent for the right transverse/sigmoid sinus (kappa range: 0.75-0.90) and the left jugular vein (kappa range: 0.65-0.85); moderate to excellent for the left lateral sinus (kappa range: 0.59-0.78) and the straight sinus (kappa range: 0.59-0.92); poor to good for the cortical veins (kappa range: 0.02-0.65). Agreement between observers varies with the location of CVT. It is good or excellent for most of the occluded sinus and veins, except for the cortical veins. This study suggests that information on the location of CVT can be reliably collected and used in multicentre studies.