[Clinical and instrumental diagnosis of Alzheimer's and multi-infarct dementia]

We investigated the possible correlation between functional and anatomical imaging techniques and clinical exams in patients with Alzheimer's and vascular dementia. We examined 24 patients affected with dementia, 16 of them with Alzheimer's disease. 7 with multiinfarct and 1 with mixed dementia. All patients were submitted to clinical, morphological (MRI, CT) and functional (SPECT, cerebral flowmetry) studies. The severity of hypoperfusion revealed by SPECT was highly correlated with cognitive impairment in Alzheimer's dementia patients. The abnormal perfusion was mostly bilateral, in the temporal-parietal region, and involved the frontal regions only in the most severe cases. CT and especially MRI showed aspecific cortical and subcortical atrophy, most evident in the medial temporal region. In the patients with multiinfarct dementia, the hypoperfused cortical regions revealed by SPECT were sometimes related to vascular lesions proved at MRI and CT. In the patients with multiinfarct dementia, MRI showed more or less apparent white matter lesions referrable to ischemic insult, besides cortical and subcortical atrophy. MRI allows a differential diagnosis between these two cerebral pathologic conditions of aging. Cerebral flowmetry by Xenon 133 inhalation showed reduced cerebral blood flow in both dementia types. In Alzheimer patients, regional flow was reduced especially in the posterior parietal regions. In multiinfarct dementia patients, flow was more diffusely reduced and asymmetrical. Brain function imaging appears to yield useful information for the differential diagnosis in the most common dementia syndromes. Since the neuropathologic data from brain biopsy are rarely available, clinical and instrumental findings must be integrated for diagnostic and pathogenetic insights of the diseases causing cognitive impairment.

Morphological evaluation of the conjunctiva and the trabecular meshwork incubated with Proline-3H

It is well known that the trabecular meshwork is a complex structure in the shape of collagen and like-elastic fibers dipped in amorfous matrix. Previous researches have been showed that in the glaucoma disease there is a sclerosis in the lamellae of the trabecular meshwork and an increase in extracellular material. In order to add informations to complex and highly organized trabecular meshwork and its role in the glaucoma disease, 12 surgical specimens of trabecular meshwork and conjunctival tissue from patients suffering from chronic simple glaucoma and undergone medical therapy have been examined. The fragments have been immediately incubated with Proline 3H for 45 minutes; after this period they have been fixed and included. The results have been showed the presence of the fibroblast cells engaged to pick up radioactive Proline. The collagen synthesis has been happened in the trabecular meshwork and in this study there is not demonstration of collagenic material coming from surrounding structures.

Validity of Ice Water Test in Diagnosis and Treatment of Neurogenic Bladders

After having illustrated the physiopathological basis of the micturition reflex to cold water (a reflex tied to specific receptors and carried by type C unmyelinated fibres) the Authors report the results in the diagnosis and treatment of neurological bladder. The Ice Water Test (IWT) was carried out on 148 patients with neurological bladder resulting from traumatic lesion for diagnostic and treatment purposes and in 130 patients with neurological bladder and multiple pathogenic disorders for diagnosis and treatment and to classify hyperactive bladders. The IWT served as an aid in performing cystographic exams in 24 patients with neurological bladder. In normal control subjects the test results are always negative. Because it is simple to perform, it is considered to be a useful complement to every urodynamic examination in patients with neurological bladder or when there is difficulty in interpreting micturitional disorders.

Intercellular adhesion molecule-1 (ICAM-1) immunoreactivity in well-differentiated thyroid papillary carcinomas

Fifty-nine cases of tumors, 51 taken from the thyroid gland including 17 well-differentiated papillary, 1 medullary and 3 follicular carcinomas, 14 follicular adenomas, 16 nodular goiters and 8 cases selected from other sites; 5 breast carcinomas; 1 melanoma; 1 Merkel cell tumor; and 1 squamous cell carcinoma of the uterine cervix, were investigated for intercellular adhesion molecule-1 (ICAM-1) expression. All cases of well-differentiated papillary thyroid carcinoma showed positivity for ICAM-1, whereas the follicular carcinomas, follicular adenomas, and all but one nodular goiters were negative. It is suggested that the occurrence of ICAM-1 on the thyroid cell surfaces in well-differentiated papillary thyroid carcinomas may contribute to the understanding of their biology and could be of potential significance for diagnostic purposes.

An Italian kindred with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)

Vascular dementia is usually sporadic and associated with definite risk factors. Several cases also occur in a familial fashion, and may affect middle-aged or even younger subjects. Recently, an autosomal dominant inheritance was demonstrated in two unrelated French families, the members of which were affected by stroke-like episodes culminating in progressive dementia. Genetic linkage analysis assigned the disease locus to chromosome 19q12. We report an additional kindred of Italian origin in which at least 16 subjects presented leukoencephalopathic alterations. Recurrent strokes, psychiatric disturbances, dementia, and in 2 members, tetraplegia and pseudobulbar palsy were the hallmarks of this syndrome. Notably, 5 asymptomatic individuals had neuroradiological signs of leukoencephalopathy. Pathological examination of 1 subject revealed a widespread vasculopathy of the perforating arterioles, characterized by deposition of eosinophilic-congophilic material that did not immunostain with antibodies against prion protein, beta-amyloid, cystatin C, transthyretin, or heat-shock protein 70 and was similar to that described in the French families. Based on the maximum lod score, the most likely location for the disease locus was also mapped to chromosome 19q12, and found to coincide with the CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) locus. The present results confirm the existence of a nosologically distinct, autosomal dominant cerebrovascular disease, presenting with recurrent subcortical ischemic strokes independent of vascular risk factors.

Reimplantation or explantation in the treatment of septic prosthetic loosening

Indications for the surgical treatment of septic loosening of hip arthroplasty vary depending on different parameters. Explantation is indicated when patients are elderly, in generally poor condition, when there are veterate infections, particularly if these were caused by gram negative bacteria, and when there is severe skeletal injury. Reimplantation is instead indicated in patients whose general conditions are good, and who are young and motivated.

The surgical treatment of spondylolisthesis

The authors report the results obtained in 244 patients submitted to anterior interbody fusion. The method involves preoperative reduction in plaster (when necessary) and anterior surgical stabilization, facilitated by improvement in the anatomical and biomechanical conditions obtained with reduction. This method obtained excellent results in 85% of the cases, with fusion and absence of symptoms, and good results in 10% of the cases, with occasional symptoms and/or fibrous. Results were unsatisfactory in 5% of the cases because of residual radiculopathy (4 cases), non-union of the fusion (3 cases), retrograde ejaculation (2 cases), loosening of the graft (1 case) or unthreading of a screw (1 case). It is our opinion that anterior interbody fusion is the best surgical method for the stabilization of Meyerding grades III, IV and V spondylolisthesis. Posterolateral fusion is used to treat some cases with slippage equal to less than 25% (grade I) and cases where more than one level is involved.

Enhanced expression of the murine FMR1 gene during germ cell proliferation suggests a special function in both the male and the female gonad

To elucidate the function of the FMR1 gene, we applied RNA in situ hybridization to cryosections of mice from different developmental stages. The murine Fmr-1 was found transcribed in a ubiquitous manner with an expression pattern similar to glyceraldehyd phosphate dehydrogenase, Gapdh, which was used as a control gene. A significant difference in the Fmr-1 expression pattern, however, was markedly enhanced expression specifically confined to the testis and the fetal ovary. In the immature and mature testis an elevated level of Fmr-1 expression is found in type A1 spermatogonia. Expression in the testis is observed in fetal life, reaches the highest level in the immature testis, and declines early in adult life. In the mature ovary no specific Fmr-1 expression signal was found but enhanced levels were seen in the fetal ovary. At this developmental stage proliferation of oogonia takes place. It is suggested that FMR1 serves a special function during germ cell proliferation in males and females. These findings are discussed in the light of the current observation that fragile X patients produce only sperm with a premutation sized allele. Two hypotheses are put forward: (1) In males lack of FMR1 function results in a premeiotic defect preventing spermatogonia with a full mutation to reach meiosis. A fragile X mutation can be passed on to offsprings only as a premutation (selection hypothesis). (2) Transition of a premutation allele to full mutation occurs in a postzygotic stage after separation of the germ line and is restricted to soma cells (restriction hypothesis). Expression of FMR1 in proliferating germ cells is in line with both hypothesis.

[The current role of neuroradiology in evaluating malformation syndromes]

CT and MRI play complementary roles in the study of malformation syndromes in pediatric age: CT in particular is indispensable for adequately assessing the skeletal picture in subjects suffering from cranio-facial malformations, while MRI allows a morphological study and supplies informations on the maturation state of the white matter.

Alternative splicing in the fragile X gene FMR1

The FMR1 gene, associated with fragile X syndrome, has recently been cloned and the sequence of partial cDNA clones is known. We have determined additional cDNA sequences both at the 5' and 3' end. We have characterized the expressed gene by means of RT-PCR in various tissues and have found that alternative splicing takes place in the FMR1 gene, which does not seem to be tissue specific. When the different alternative splicing events are combined, 12 distinct mRNA products could result from FMR1 expression in each tested tissue. In all these transcripts the open reading frame is maintained until the same stop codon. At the 3' end alternative use of polyadenylation signals is found. The alternative splicing allows functional diversity of the FMR-1 gene. Whether all the possible proteins will be synthesized and whether they will be functionally active has to be determined.

A microdeletion of less than 250 kb, including the proximal part of the FMR-I gene and the fragile-X site, in a male with the clinical phenotype of fragile-X syndrome

A gene designated "FMR-1" has been isolated at the fragile-X locus. One exon of this gene is carried on a 5.1-kb EcoRI fragment that exhibits length variation in fragile-X patients because of amplification of or insertion into a CGG-repeat sequence. This repeat probably represents the fragile site. The EcoRI fragment also includes an HTF island that is hypermethylated in fragile-X patients showing absence of FMR-1 mRNA. In this paper, we present further evidence that the FMR-1 gene is involved in the clinical manifestation of the fragile-X syndrome and also in the expression of the cellular phenotype. A deletion including the HTF island and exons of the FMR-1 gene was detected in a fragile X-negative mentally retarded male who presented the clinical phenotype of the fragile-X syndrome. The deletion involves less than 250 kb of genomic DNA, including DXS548 and at least five exons of the FMR-1 gene. These data support the hypothesis that loss of function of the FMR-1 gene leads to the clinical phenotype of the fragile-X syndrome. In the fragile-X syndrome, there are pathogenetic mechanisms other than amplification of the CGG repeat that do have the same phenotypic consequences.

Fragile X syndrome without CCG amplification has an FMR1 deletion

We describe a patient with typical clinical features of the fragile X syndrome, but without cytogenetic expression of the fragile X or an amplified CCG trinucleotide repeat fragment. The patient has a previously uncharacterized submicroscopic deletion encompassing the CCG repeat, the entire FMR1 gene and about 2.5 megabases of flanking sequences. This finding confirms that the fragile X phenotype can exist, without amplification of the CCG repeat or cytogenetic expression of the fragile X, and that fragile X syndrome is a genetically homogeneous disorder involving FMR1. We also found random X-inactivation in the mother of the patient who was shown to be a carrier of this deletion.

A strategy for the selection of transcribed sequences in the Xq28 region

As an essential step towards an exhaustive analysis of the coding potential of large regions of the genome, we have developed a protocol allowing the rapid isolation of transcripts defined by overlapping clone libraries. The method is based on the hybridisation of cDNA inserts, which had been amplified by PCR from cDNA libraries, to biotinylated DNA from cosmids or cosmid pools. Nonspecific hybrids are then removed, the selected cDNAs are eluted and reamplified by PCR. Using a cosmid containing part of the FMR-1 gene as test, we were able to demonstrate an eighty thousand fold enrichment of cDNAs for this gene after two rounds of selection-amplification. The technique was applied to the analysis of transcripts from two cosmid contigs, together encompassing a region of 900 kb in Xq28. These experiments have thus far resulted in the identification of 81 cDNA clones, of which 54 clones were mapped back to the cosmid contigs. Of the 54 clones placed on the contig maps, 12 cDNA clones can be shown to belong to two genes which have been previously reported (L1CAM and QM).

[A therapeutic protocol with cefoperazone in bronchopneumopathy in mucoviscidosis]

Cystic fibrosis, a hereditary chronically evolving disease, is characterized by special predisposition to bronchial infections, especially by Pseudomonas strains. In the present open noncomparative study, the therapeutic efficacy of cefoperazone in respiratory infections by Pseudomonas aeruginosa in 25 children suffering from cystic fibrosis has been evaluated. Results were favorable, since both the specific symptoms of the infection and the general condition of the patients was markedly improved although the eradication of Pseudomonas was not achieved.

Origin of aneuploidy in relation to disturbances of cell-cycle progression. I. Effects of vinblastine on mouse bone marrow cells

Vinblastine (VBL) was tested in the mouse for induction of chromosome malsegregation in bone marrow cells. The occurrence of aneuploidy and polyploidy was correlated with cell-cycle kinetics measured by DNA labelling with bromodeoxyuridine (BrdUrd). Sister-chromatid exchanges (SCE) were also detected. A dose-dependent lengthening of the cell cycle was induced in the dose range of 0.9-4.5 mg/kg body weight, up to a complete inhibition of cell-cycle progression (100% of metaphases were arrested before completion of the first mitotic division following a recovery time of 18 h, compared with 8% in the controls). Both aneuploidy and polyploidy were induced. Aneuploid metaphases were grouped into 2 classes, those with no more than 2 extra chromosomes and those with 3-10 extra chromosomes. The frequencies of cells with severe aneuploidy and polyploidy increased considerably when second-generation cells were sampled at a recovery time of 24 h. This observation suggested that gross chromosome imbalances occur preferentially after a period of mitotic arrest, probably as a consequence of multipolar spindles or failure of proper spindle assembly. Non-disjunction of single chromosomes arises independently of the mitotic block. A slight increase in SCE frequency was observed only at a recovery time of 18 h. This study may provide information on the kinetics and mechanisms of origin of VBL-induced numerical aberrations in vivo.

Magnetic resonance imaging in the malformative syndromes with mental retardation

We reported on thirteen children affected with malformative syndromes associated with mental retardation. MRI examination showed in all of them different types of anomalies; agenesis of corpus callosum, ventricular dilatation and cerebral matter alterations were the most frequent findings. The authors give a brief description of the clinical reports and of the anomalies observed with MRI; they conclude that MRI seems to be a valuable tool especially for the study of the alterations of the cerebral matter and their correlation with mental retardation.

[Crohn disease of the colon with acute onset at the 17th week of pregnancy. Description of a clinical case]

A case of Crohn's disease of the colon onsetting at 17 weeks gestation and observed at the 22 weeks when the disease presented severely and concomitant to serious maternal malnutrition, is reported. The patient was treated with NPT for 4 weeks in association with corticosteroids and sulphasalazine therapy continued to term (36 weeks). The newborn (weight 2480 g, Apgar of 9 at 5') developed moderately serious postnatal icterus resolved with phototherapy; at twelve months he presented normal growth and neurological development conditions. Stress is laid on the fortunate outcome of this gestation and the role of NPT in the correction of maternal malnutrition and the maintenance of foetal growth.