L-3,4-Dihydroxy-6-[F-18]fluorophenylalanine positron emission tomography demonstrating dopaminergic system abnormality in the brains of obsessive-compulsive disorder patients.

AIM: Obsessive-compulsive disorder (OCD) is a chronic disabling neuropsychiatric disorder. Current treatment modalities, such as pharmacological and behavioral methods, are sometimes unsatisfactory. The mesolimbic dopaminergic pathway is supposed to have a role in the pathogenesis of OCD. In this study, L-3,4-Dihydroxy-6-[F-18]fluorophenylalanine (F-18 FDOPA) positron emission tomography (PET) is exploited to investigate the possible abnormality of dopaminergic neuronal circuits in the brains of OCD patients in vivo. METHODS: The study subjects were recruited after psychological assessment and gave written informed consent to participate. The F-18 FDOPA PET scans were performed on five OCD patients and six healthy volunteers at 120 min after 185 MBq of F-18 FDOPA intravenous injection. The PET results were analyzed with the Statistical Parametric Mapping tool. RESULTS: Compared to the healthy subjects, the OCD brains showed increased dopaminergic metabolism in the left frontal premotor cortex (P < 0.001), along with trends toward an increase in the left posterior cingulate gyrus, the left cuneus, the left lingual gyrus, the right cuneus and precuneus, the right lingual gyrus, the right middle temporal gyrus, the left cerebellum, and the right cerebellum (P < 0.01). CONCLUSION: Our observations suggest that the increased dopaminergic neuronal function in these brain areas may be implicated in the pathogenesis of OCD.

Computed tomography findings of gossypiboma.

Gossypiboma is composed of non-absorbable surgical material with a cotton matrix. Gossypiboma is usually under-reported and is a severe medicolegal issue. Thus, we describe the computed tomography (CT) findings of gossypiboma in our institution. From January 2003 to June 2006, gossypibomas diagnosed in our institution and their data regarding sex, age, previous operation, location, the interval between the operation and the diagnosis of gossypiboma, clinical presentation, indication of CT, CT findings and further management were collected. There were 6 cases of gossypiboma, 4 men and 2 women. Three of our cases had previous chest surgery and the other 3 cases had previous abdominal surgery. The locations of 3 (50%) cases were in the left anterior subphrenic space. The mean interval between original operation and diagnosis was 24.6 +/- 33.4 months (range, 17 days to 8 years). With regard to CT findings, 3 (50%) cases had an isodense mass and 3 (50%) had a typical mass containing curvilinear opaque structures. The mean size of the gossypibomas was 62 x 62 x 67 mm. Because gossypiboma is due solely to human factors and is a severe medicolegal issue, continuous education should be considered.

Granulocyte colony-stimulating factor for acute ischemic stroke: a randomized controlled trial.

BACKGROUND: Because granulocyte colony-stimulating factor (G-CSF) has anti-inflammatory and neuroprotective properties and is known to mobilize stem cells, it may be useful in the treatment of acute ischemic stroke. We sought to examine the feasibility, safety and efficacy of using G-CSF to treat acute stroke. METHODS: We conducted a randomized, blinded controlled trial involving 10 patients with acute cerebral infarction (middle cerebral artery territory as documented by the admission MRI) who presented within 7 days of onset and whose scores on the National Institutes of Health Stroke Scale (NIHSS) were between 9 and 20. Patients were assigned to either G-CSF therapy or usual care. The G-CSF group (n = 7) received subcutaneous G-CSF injections (15 microg/kg per day) for 5 days. The primary outcome was percentage changes between baseline and 12-month follow-up in mean group scores on 4 clinical scales: the NIHSS, European Stroke Scale (ESS), ESS Motor Subscale (EMS) and Barthel Index (BI). We also assessed neurologic functioning using PET to measure cerebral uptake of fluorodeoxyglucose in the cortical areas surrounding the ischemic core. RESULTS: All of the patients completed the 5-day course of treatment, and none were lost to follow-up. No severe adverse effects were seen in patients receiving G-CSF. There was greater improvement in neurologic functioning between baseline and 12-month follow-up in the G-CSF group than in the control group (NIHSS: 59% change in the mean G-CSF group score v. 36% in the mean control group score, ESS: 33% v. 20%, EMS: 106% v. 58%, BI: 120% v. 60%). Although at 12 months there was no difference between the 2 groups in cerebral uptake of fluorodeoxyglucose in the ischemic core, uptake in the area surrounding the core was significantly improved in the G-CSF group compared with the control group. There was positive correlation between metabolic activity and EMS score following simple linear correlation analysis. INTERPRETATION: Our preliminary evidence suggests that using G-CSF as therapy for acute stroke is safe and feasible and leads to improved neurologic outcomes.

The antitumor effects of Angelica sinensis on malignant brain tumors in vitro and in vivo.

PURPOSE: In this study, we have examined the antitumor effects of chloroform extract of Angelica sinensis (AS-C), a traditional Chinese medicine, on glioblastoma multiforme (GBM) brain tumors in vitro and in vivo. EXPERIMENTAL DESIGN: In vitro, GBM cells were treated with AS-C, and the cell proliferation, changes in distributions of cell cycle, and apoptosis were determined. In vivo, human DBTRG-05MG and rat RG2 GBM tumor cells were injected s.c. or i.c. and were treated with AS-C. Effects on tumor growth were determined by tumor volume, magnetic resonance imaging, survival, and histology analysis. RESULTS: The AS-C displays potency in suppressing growth of malignant brain tumor cells without cytotoxicity to fibroblasts. Growth suppression of malignant brain tumor cells by AS-C results from cell cycle arrest and apoptosis. AS-C can up-regulate expression of cdk inhibitors, including p21, to decrease phosphorylation of Rb proteins resulting in cell arrest at the G0-G1 phase for DBTRG-05MG and RG2 cells. The apoptosis-associated proteins are dramatically increased and activated in DBTRG-05MG cells and RG2 cells by AS-C but RG2 cells without p53 protein expression. In vitro results showed AS-C triggered both p53-dependent and p53-independent pathways for apoptosis. In in vivo studies, AS-C not only can suppress growths of malignant brain tumors of rat and human origin but also shrink the volumes of in situ GBM, significantly prolonging survivals. CONCLUSIONS: The in vitro and in vivo anticancer effects of AS-C indicate that it has sufficient potential to warrant further investigation and development as a new anti-brain tumor agent.

Hyperintense putaminal rim sign is not a hallmark of multiple system atrophy at 3T.

BACKGROUND AND PURPOSE: Hyperintense putaminal rim (HPR) on the T2-weighted imaging, which has been observed in our daily practice while reading 3T brain images, has been described as a finding typical of multiple system atrophy (MSA). We hypothesized that the HPR sign is not an exclusive hallmark of MSA at a high magnetic field strength, but rather may be a normal finding. METHODS: Ten consecutive clinically healthy age-matched adults who showed recognizable HPR at 3T were subsequently examined on a 1.5T imaging system within 2 hours. MR examination included axial T2-weighted fast spin-echo (FSE), fluid attenuated inversion recovery (FLAIR) on a 3T scanner, and equivalent T2-weighted FSE at 1.5T. MR images were obtained parallel to the intercommissural plane. All the images were interpreted by 2 experienced neuroradiologists. RESULTS: All 10 subjects (3 men and 7 women; aged 52 +/- 6.1 years [range, 44-61 years], expressed as mean +/- SD) with the positive HPR sign on axial T2-weighted FSE at 3T had negative findings at 1.5T. Such hyperintense rim was also vague or absent on the 3T-FLAIR images. CONCLUSION: Our data suggest that the HPR at 3T scans is a nonspecific, normal finding. FLAIR may be helpful in discriminating between normal subjects and patients with MSA in case of isolated HPR at 3T.

Cough induced by ossification of the ligamentum flavum in the high cervical spine. Case report.

The authors report a very rare case of high cervical ossification of the ligamentum flavum (OLF) in a 40-year-old woman who developed an intractable cough after a traffic accident. The patient's symptoms subsided immediately after decompressive laminectomy and removal of the lesion. To the authors' knowledge, this is the first reported case of high cervical OLF in a patient who presented with a cough. The pathophysiological mechanism underlying the cough was determined to be symptomatic of high cervical spine OLF.

Primary angiosarcoma of the cranial vault: a case report and review of the literature.

BACKGROUND: Angiosarcoma is a rare neoplasm. It is most likely to affect the scalp in elderly people and involvement of the cranium is uncommon. We report a case of primary malignant angiosarcoma of the cranial vault. CASE DESCRIPTION: An 82-year-old man presented with right hemiparesis, deformity of the cranium and mildly swollen scalp. Further studies disclosed bilateral parietal lesions, with destruction of the dura matter and infiltration of the brain parenchyma. Thrombocytopenia was found. Faint enhancement of the lesions was seen on magnetic resonance imaging (MRI) after i.v. administration of contrast medium with gadolinium. The tumor was excised including the affected portion of the skull and dura matter. Histologic examination revealed typical pictures of angiosarcoma with immunohistochemical evidence of factor VIII-related antigen. Postoperative radiotherapy was employed. The patient remained well at 10 months postoperative follow up. CONCLUSION: Primary angiosarcoma of the cranium is sometimes difficult to differentiate from trauma on clinical examination. We review the literature pertaining to the pathogenesis, clinical course and treatment of this condition. Determination of platelet count may be helpful in monitoring the progression of the disease. The tumor may show faint enhancement on MRI.

Imaging of renal tuberculosis in eastern Taiwan: correlation with clinical course and different communities.

Hualien, located in eastern Taiwan, is a relatively isolated district. The population is composed of different ethnic communities. Our hospital is the only medical center in eastern Taiwan, so is the most important referral hospital for epidemic diseases. After reviewing our collected cases of renal tuberculosis (TB), we observed a great diversity in staging and outcomes. The aim of this study was to classify different imaging presentations and clinical outcomes in the ethnic communities represented by these cases (non-aboriginal and aboriginal). We retrospectively reviewed 22 cases from 1991 to 2001. We reviewed laboratory data, radiologic reports, and clinical outcomes. Before TB was proved by biopsy or culture, patients were not treated with an anti-TB regimen. Roentgenography showed that 68% of patients had renal calcification, 59% had dilated calyces, 55% had lung involvement, and 41% had auto-nephrectomy. The proportion of mild and severe forms was significantly different between aboriginal and non-aboriginal groups (0.05 > p > or = 0.00409). From this series, we recommend routine plain film roentgenography, including chest roentgenography and kidney, ureter, and bladder or abdominal roentgenography, followed by intravenous urography or computerized tomography as investigative tools for renal TB. Based on the significantly different outcomes of the disease between aboriginal and non-aboriginal groups, a stronger health education program for the isolated district in eastern Taiwan is necessary.

Intracerebral implantation of autologous peripheral blood stem cells in stroke patients: a randomized phase II study.

In our previous study, intracerebral implantation of peripheral blood stem cells (PBSCs) improved functional outcome in rats with chronic cerebral infarction. Based on this finding, a randomized, single blind controlled study was conducted in 30 patients [PBSC group (n = 15) and control group (n = 15)] with middle cerebral artery infarction confirmed on a T2-weighted MRI 6 months to 5 years after a stroke. Only subjects with neurological deficits of intermediate severity based on the National Institute of Health Stroke Scale (NIHSS; range: 9-20) that had been stable for at least 3 months were enrolled. Those in the PBSC group received subcutaneous G-CSF injections (15 µg/kg/day) for 5 consecutive days, and then stereotaxic implantation of 3-8 × 10(6) CD34(+) immunosorted PBSCs. All 30 patients completed the 12-month follow-up. No serious adverse events were noted during study period. Improvements in stroke scales (NIHSS, ESS, and EMS) and functional outcomes (mRS) from baseline to the end of the 12-month follow-up period were significantly greater in the PBSC than the control group. The fiber numbers asymmetry (FNA) scores based on diffusion tensor image (DTI) tractography were reduced in every PBSC-treated subject, but not in the control group. Reduction in the FNA scores correlated well with the improvement in NIHSS. Furthermore, a positive motor-evoked potential (MEP) response by transcranial magnetic stimulation (TMS) appeared in 9 of the 15 subjects in the PBSC group. This phase II study demonstrated that implantation of autologous CD34(+) PBSC was safe, feasible, and effective in improving functional outcome.

Prevalence and characteristics of paratracheal air cysts and their association with emphysema in a general population.

BACKGROUND: To evaluate the prevalence and characteristics of paratracheal air cysts and their association with emphysema and gender in a general population using low-dose computed tomography scanning of the chest. MATERIALS AND METHODS: We retrospectively enrolled a total of 924 patients (584 women, 340 men; mean age, 59.73 years; range, 37-89 years) who had received low-dose computed tomography scanning for health examination during the period January 1, 2010 to June 30, 2010. Computed tomographic images were evaluated for the presence of paratracheal air cysts. If paratracheal air cysts were identified, the lungs were reconstructed as a three-dimensional model on a commercial workstation. An emphysema index, an objective quantification of the extent of emphysematous changes on CT imaging, was defined as the percentage area of lung with attenuation values below -950 Hounsfield units. RESULTS: A total of 60 patients with paratracheal air cysts were included in this study (estimated prevalence, 6.5%; 12 men, 48 women; mean age, 59.85; range 45-89 years). Emphysema index differed significantly between genders (P<0.0001). The prevalence of paratracheal air cysts in men was significantly lower than that in women (P=0.005); however, the emphysema index in patients of both genders showed no evidence of emphysema. The majority (95%) of paratracheal air cysts were at the level of the seventh cervical to the second thoracic vertebrae. CONCLUSION: The presence of paratracheal air cysts is a common condition in general populations and should not be misdiagnosed as abnormal paratracheal free air. Paratracheal air cysts are more common in woman than in man. In our study, there is no patient with paratracheal air cysts has CT evidence of emphysema.

The natural compound n-butylidenephthalide derived from Angelica sinensis inhibits malignant brain tumor growth in vitro and in vivo.

The naturally-occurring compound, n-butylidenephthalide (BP), which is isolated from the chloroform extract of Angelica sinensis (AS-C), has been investigated with respect to the treatment of angina. In this study, we have examined the anti-tumor effects of n-butylidenephthalide on glioblastoma multiforme (GBM) brain tumors both in vitro and in vivo. In vitro, GBM cells were treated with BP, and the effects of proliferation, cell cycle and apoptosis were determined. In vivo, DBTRG-05MG, the human GBM tumor, and RG2, the rat GBM tumor, were injected subcutaneously or intracerebrally with BP. The effects on tumor growth were determined by tumor volumes, magnetic resonance imaging and survival rate. Here, we report on the potency of BP in suppressing growth of malignant brain tumor cells without simultaneous fibroblast cytotocixity. BP up-regulated the expression of Cyclin Kinase Inhibitor (CKI), including p21 and p27, to decrease phosphorylation of Rb proteins, and down-regulated the cell-cycle regulators, resulting in cell arrest at the G(0)/G(1) phase for DBTRG-05MG and RG2 cells, respectively. The apoptosis-associated proteins were dramatically increased and activated by BP in DBTRG-05MG cells and RG2 cells, but RG2 cells did not express p53 protein. In vitro results showed that BP triggered both p53-dependent and independent pathways for apoptosis. In vivo, BP not only suppressed growth of subcutaneous rat and human brain tumors but also, reduced the volume of GBM tumors in situ, significantly prolonging survival rate. These in vitro and in vivo anti-cancer effects indicate that BP could serve as a new anti-brain tumor drug.

Right nonrecurrent laryngeal nerve deforming a superior parathyroid adenoma: report of a case.

A 34-year-old patient with primary hyperparathyroidism and repeated renal stones underwent a parathyroidectomy. During operation, a right superior parathyroid adenoma was found which measured 3.5 x 1.5 x 1.0cm in size. The right nonrecurrent laryngeal nerve passed over the middle of the adenoma, and deformed the parathyroid into a dumbbell shape. Magnetic resonance angiography revealed an absence of the right innominate artery and an independent origin of the right retroesophageal subclavian and common carotid artery. The combination of the parathyroid tumor and nonrecurrent laryngeal nerve is extremely rare, especially in Asia. To avoid surgical complications, it is important to understand the possibility of a nonrecurrent laryngeal nerve developing in such patients.

ProSplicer: a database of putative alternative splicing information derived from protein, mRNA and expressed sequence tag sequence data.

ProSplicer is a database of putative alternative splicing information derived from the alignment of proteins, mRNA sequences and expressed sequence tags (ESTs) against human genomic DNA sequences. Proteins, mRNA and ESTs provide valuable evidence that can reveal splice variants of genes. The alternative splicing information in the database can help users investigate the alternative splicing and tissue-specific expression of genes.