Magnetization transfer imaging in the detection of injury associated with mild head trauma.

BACKGROUND AND PURPOSE: Most traumatic brain injuries are classified as mild, yet in many instances cognitive deficits result. The purpose of this study was to investigate possible relationships between quantitative magnetization transfer imaging (MTI) and neurocognitive findings in a cohort of patients with mild head trauma but negative findings on conventional MR images. METHODS: We examined 13 patients and 10 healthy volunteers with a standard MR protocol including fast spin-echo and gradient-echo imaging, to which was added quantitative MTI. MTI was performed with a modified gradient-echo sequence incorporating pulsed, off-resonance saturation. Both region-of-interest analysis and contour plots were obtained from the MTI data. A subgroup of nine patients was examined with a battery of neuropsychological tests, comprising 25 measures of neurocognitive ability. RESULTS: The magnetization transfer ratio (MTR) in the splenium of the corpus callosum was lower in the patient group as compared with the control group, but no significant reduction in MTR was found in the pons. Individual regional MTR values were significantly reduced in two cases, and contour plot analysis revealed focal areas of abnormality in the splenium of four patients. All the patients showed impairment on at least three measures of the neuropsychological test battery, and in two cases a significant correlation was found between regional MTR values and neuropsychological performance. CONCLUSION: Our results suggest that MTI and contour plot analysis may add sensitivity to the MR imaging examination of patients with traumatic brain injury.

Functional assessment of mild traumatic brain injury using SPECT and neuropsychological testing.

The aim of this study was to ascertain whether SPECT and neuropsychological testing provide converging evidence of normal and abnormal regional cerebral function in patients with mild traumatic brain injury (mTBI). Four patients with mTBI were evaluated with SPECT and selected neuropsychological tests with putative localizing capabilities to specific cortical regions. The performance of each patient on each test was graded as either normal or abnormal. Additionally, SPECT images were graded for normal and/or abnormal patterns of regional cerebral blood flow (rCBF) in eight regions of the cortex. These data were then used to predict outcomes from one modality to the other, i.e. rCBF patterns on SPECT were used to predict either normal or abnormal performance on specific tests and performance on specific tests was used to predict the presence or absence of rCBF abnormalities on SPECT. Statistical analysis of composite data from all four patients showed that test performance predicted SPECT findings, but SPECT findings did not predict test performance.

Raf-1 protein expression in human breast cancer cells.

BACKGROUND: The Raf-1 kinase, a 72-kDa cytoplasmic serine-threonine kinase, plays a central role as a second messenger in signal transduction. After ligand binding to a variety of transmembrane tyrosine kinase growth factor receptors including epidermal growth factor (EGF) receptor, the 72-kDa kinase is activated through phosphorylation to a 74-kDa phosphoprotein. The Raf-1 kinase is constitutively activated in many transformed cells either directly, by mutations within its amino-terminus regulatory region, or indirectly, due to overstimulation by autocrine growth factors or activated proximal oncogenes. The role of Raf-1 kinase in breast cancer has not been studied. METHODS: To investigate the role of Raf-1 kinase expression and its activation in breast cancer, we studied three human breast cancer cell lines expressing varying amounts of EGF receptor to determine the level of Raf-1 protein and the proportion expressed in the higher molecular weight form. Effects of serum starvation and stimulation with EGF on the Raf-1 protein were studied in T47D, BT474, and MDA-MB231 cells by precipitation of cell lysates with an anti-Raf-1 antibody followed by immunoblotting. [3H]Thymidine incorporation by these cells after EGF stimulation was also determined as a measure of DNA synthesis. RESULTS: In all three breast cancer cell lines studied, the Raf-1 protein was identified in a 70- and a 74-kDa form. The level of Raf-1 was similar in all three cell lines and appeared unrelated to EGF receptor expression on the cell surface. The majority of the protein was found in the 74-kDa form even after serum starvation. A minor shift from the lower to higher molecular weight form of Raf-1 was apparent in cells treated with EGF, and increased [3H] thymidine incorporation could be demonstrated in two of the cell lines after EGF stimulation. CONCLUSION: Baseline expression of the 74-kDa or activated form of the Raf-1 kinase appeared to be elevated in the breast cancer cells studied, indicating constitutive activation. Further investigation into the role of Raf-1 protein in the pathogenesis of breast cancer is indicated.

Continuous glucose for treatment of patients with type 1 glycogen-storage disease: comparison of the effects of dextrose and uncooked cornstarch on biochemical variables.

Responses to uncooked cornstarch (UCS), dextrose (Dex), and a 3:1 mixture (UCS:Dex) were determined in seven children with type 1 glycogen-storage disease (GSD-1). UCS maintained blood glucose (BG) and serum insulin concentrations between 3.5 +/- 0.3 and 4.0 +/- 0.4 mmol/L (mean +/- SEM) and 50 +/- 7 and 79 +/- 22 pmol/L, respectively, in six of the seven patients for 4 h. Only four of seven patients completed the 4-h test after UCS:Dex (BG 2.9 +/- 0.3 mmol/L): After Dex, tests had to be stopped in all patients by 150 min after initiation (BG 2.7 +/- 0.4 mmol/L). Two methods of providing dietary glucose overnight, continuous intragastric glucose infusion (COG) and intermittent UCS at 2100 and 0200, were compared by monitoring metabolites and glucoregulatory hormones. The use of UCS in amounts equal to the calculated glucose production rate is an effective method of providing a continuous dietary source of glucose overnight to patients with GSD-1.

Frecuencia de microcarcinomas en piezas de tiroidectomías / Frecuency of microcarcinoma in specimens of thyroidectomy

En el examen de 110 piezas quirúrgicas de tiroidectomías totales o parciales, se hallaron 8 carcinomas ocultos o microcarcinomas, según la definición de Sampson: "tumores tiroideos de 1,5cm o menos de diámetro, no sospechados clínicamente". Se hallaron más frecuentemente en tiroides que presentaron tiroiditís de Hashimoto asociada a adenoma folicular (2 casos) y en hiperplasias difusas ( 2 casos). El tamaño promedio fue de 4mm; 6 de los casos fueron de tipo papilar, los restantes de tipo folicular y medular, uno de cada uno. Dos casos fueron descubiertos después del diagnóstico de las metástasis ganglionares. Todos fueron pacientes de sexo femenino, cuyas edades variaron entre 19 y 56 años. No se encontraron diferencias histológicas significativas entre los casos con o sin metástasis. Se discuten los resultados comparándolos con las series de otros autores

Frecuencia de microcarcinomas en piezas de tiroidectomías / Frecuency of microcarcinoma in specimens of thyroidectomy

En el examen de 110 piezas quirúrgicas de tiroidectomías totales o parciales, se hallaron 8 carcinomas ocultos o microcarcinomas, según la definición de Sampson: "tumores tiroideos de 1,5cm o menos de diámetro, no sospechados clínicamente". Se hallaron más frecuentemente en tiroides que presentaron tiroiditís de Hashimoto asociada a adenoma folicular (2 casos) y en hiperplasias difusas ( 2 casos). El tamaño promedio fue de 4mm; 6 de los casos fueron de tipo papilar, los restantes de tipo folicular y medular, uno de cada uno. Dos casos fueron descubiertos después del diagnóstico de las metástasis ganglionares. Todos fueron pacientes de sexo femenino, cuyas edades variaron entre 19 y 56 años. No se encontraron diferencias histológicas significativas entre los casos con o sin metástasis. Se discuten los resultados comparándolos con las series de otros autores (AU)

Lipoma of the corpus callosum. Case report.

Lipoma of the corpus callosum is a rare intracranial condition, possibly congenital. It is often asymptomatic, but may present with headaches, seizures, hemiplegia, or dementia. An example of this disease is reported, and the condition reviewed. The radiological appearance is described, with emphasis on the value of computerized tomography in making the diagnosis. Surgery is of limited value but may be required in specially selected cases.

Unrealistic expectations of parents who maltreat their children: an educational deficit that pertains to child development.

Forty-one parents estimated when their own child and an "average" child would attain a number of different developmental milestones. These milestones and the accompanying normative data were derived from the Vineland Social Maturity Scale (Doll, 1965). Parents were divided into three groups on the basis of a prior history of child abuse, child neglect, or no previous background of abuse or neglect. Results indicate that both the abuse and neglect groups differed from the comparison group when absolute difference scores from the normative data were analyzed. When directionality of scores were analyzed (i.e., too high or too low expectations for the child), no differences were found among the groups. Implications of an education deficit model of unrealistic parental expectations were discussed.

The utility of a measure of aggression in differentiating abusing parents from other parents who are experiencing familial disturbance.

Discussed the utility of a measure of aggression using the MMPI (N = 54). Although child abusers significantly differed from a distressed and socioeconomic-status matched group on this scale, a discriminative analysis on the scale failed to adequately differentiate the groups. Results are discussed in terms of the deficiencies in the current method of separating their groups and for constructing measures that are likely to differentiate aggressive from nonaggressive populations.

Middle ear ventilation with the Castelli membrane tube.

This report evaluates the use of the Castelli type membrane tympanostomy tube in combination with adenoidectomy or adenotonsillectomy. One hundred and sixty two ears were studied. Children with mucoid or seromucoid fluid only were included. The ears were unprotected during swimming, bathing, etc. The average length of intubation was 7 months; 7 1/2 developed middle ear problems with the tubes in place and 7% developed external ear problems. All of these complications were treated without residua.

Unusual foreign bodies in the brain: A report of 2 cases.

Certain objects, such as knife blades, bullets and fragments of brick, have been found as foreign bodies within the brain. We report two cases of very unusual objects which were removed after rather bizarre injuries.

Clinicopathological conference. Case 30, part 2. Histiocytic lymphoma of the mandible.

A 77-year-old man with multiple medical problems had been treated for osteomyelitis of the left side of the mandible. Three weeks after treatment had been initiated, his condition was worse, and it was decided that more extensive surgery with the patient under general anesthesia should be done.