[Diagnostic accuracy of 64 row multidetector computed tomography for coronary artery disease assessment]

Due to technical advances, multidetector computed tomography (MDCT) allows evaluation of the coronary arteries and could in specific clinical indications provide a minimally invasive alternative to coronary angiography (CA). Recent technical advances combined with the availability of 64 row MDCT have significantly improved the evaluation of the native coronary arteries. However limitations remain for the evaluation of bypass grafts and stents. In this paper, we present a review the current literature on the diagnostic accuracy of 64 row MDCT in the assessment of coronary artery disease, and discuss the clinical implications and proposed indications of coronary CTA.

A MRI myocardial perfusion analysis tool

MRI myocardial perfusion analysis is an important element for the ischemic heart disorder assessment. The spatio-temporal analysis of the myocardial raising during the first crossing of a contrast bolus allows to identify the ischemic or hypoperfused areas. Such an analysis requires an accurate tracking of the myocardium on the whole sequence and a robust segmentation to identify pathological and healthy regions inside the myocardium. In this paper, we present a semiautomatic tracking tool and a segmentation algorithm based on statistical tests and a recent concentration theorem. We show experimental results for both the tracking step and the segmentation of hypoperfused areas to confirm the availability of this setting.

Orbital apex syndrome following inferior turbinate radiofrequency

INTRODUCTION

We report a case of orbital apex syndrome following turbinate radiofrequency.

METHODS

The clinical features, investigations (nasofibroscopy, supra-aortic and trans-cranial vessels ultrasounds, CT- and MRI-scans) are described.

RESULTS

A forty-year-old man underwent radiofrequency volumetric tissue reduction (RFVTR) for bilateral inferior turbinate hypertrophy. No particular problems were reported during the procedure under general anaesthesia. Immediately after the general anaesthesia, the patient complained of right eyelid ptosis with right monocular blindness. The patient also had ophthalmoplegia and suffered from right corneal anaesthesia and right hypoaesthesia of the cheek. The CT-scan showed right ethmoidal and maxillary sinusitis with no bone or tissue lesions. MRI-scan showed an enlarged aspect of the subarachnoid membrane of the right optic nerve. Corticosteroid treatment was prescribed but did not produce any satisfactory result. No improvement in visual acuity was observed.

CONCLUSION

Turbinate radiofrequency may result in a definitive orbital apex syndrome.

Repeated social defeat-induced depression-like behavioral and biological alterations in rats: involvement of cholecystokinin

Cholecystokinin (CCK) involvement in depression-like disorders is poorly documented. Here, we investigated whether CCKergic neurotransmission is relevant to depressive-like symptoms and antidepressant therapy using a novel preclinical model based on repeated social defeat over 4 weeks in rats. Repeated social defeat triggers changes that could be considered as behavioral and biological correlates of depressive symptoms in humans, such as a hyperactivity of hypothalamic-pituitary-adrenal (HPA) axis (increase of serum corticosterone levels and of adrenal gland weight), increased immobility time in the forced swimming test (FST), decrease of body weight and of sweet water consumption and reduction of hippocampal volume associated with a decreased cell proliferation in the dentate gyrus. In addition, in vivo microdialysis showed that cortical CCK release was tonically increased in defeated rats. Chronic imipramine treatment (16 mg kg(-1) per day for 25 days) prevented both the repeated social defeat-induced alterations of biological and behavioral parameters and the associated increase of cortical CCK release. Chronic blockade of CCK2 receptors by the specific antagonist CI-988 (1 mg kg(-1) per day for 25 days) also normalized immobility time in the FST and prevented HPA axis hyperactivity, reduction of hippocampal volume and cell proliferation and decreased sweet water intake normally evoked by repeated social defeat. These data showed that the repeated social-defeat paradigm can be considered as a suitable model of 'depression' in rats. The causal link between social defeat-evoked (1) increase in cortical CCKergic neurotransmission and (2) depression-like symptoms that we highlighted here strongly suggests that CCKergic systems may be a relevant target for novel antidepressant therapy.

Cardiac 123I-MIBG scintigraphy in heart failure

This review focuses on myocardial [(123)I]mIBG imaging in patients with cardiomyopathy and heart failure (HF). In particular, the potential role of myocardial (123)I-mIBG scintigraphy in the prediction of potentially fatal arrhythmic events is described. A growing body of evidence supports the use of cardiac sympathetic innervation imaging, specifically using (123)I-mIBG, to risk stratify patients with HF. Cardiac sympathetic imaging can help to improve understanding of the mechanisms responsible for increased sympathetic activity in HF, and how sympathetic over-activity exerts its deleterious actions. Eventually, this may result in more effective therapies and, thereby, better outcome for these patients. Assessment of cardiac sympathetic activity could also contribute to a more appropriate selection of individual patients for implantable cardioverter-defibrillators (ICD).

Radial approach in the treatment of supraaortic arterial lesions

SUMMARY

Radial approach (mainly right) has been used in the treatment of 67 supraaortic lesions including 56 carotid, nine vertebral and two subclavian artery stenoses. This approach offers new possibilities and solves most of the remaining technical difficulties or impossibilities encountered in the endovascular treatment of supraaortic lesions. The current technique is described. The results of this first series have been very satisfactory without complication. MR angiography allows selection of patients suitable for radial approach.

Tryptophan hydroxylase 1 knockout and tryptophan hydroxylase 2 polymorphism: effects on hypoxic pulmonary hypertension in mice

Serotonin [5-hydroxytryptamine (5-HT)] biosynthesis depends on two rate-limiting tryptophan hydroxylases (Tph): Tph1, which is expressed in peripheral organs, and Tph2, which is expressed in neurons. Because 5-HT is involved in pulmonary hypertension (PH), we investigated whether genetic variations in Tph1 and/or Tph2 affected PH development in mice. To examine the functional impact of peripheral Tph1 deficiency on hypoxic PH, we used Tph1(-/-) mice characterized by very low 5-HT synthesis rates and contents in the gut and lung and increased 5-HT synthesis in the forebrain. With chronic hypoxia, 5-HT synthesis in the forebrain increased further. Hypoxic PH, right ventricular hypertrophy, and distal pulmonary artery muscularization were less severe (P < 0.001) than in wild-type controls. The Tph inhibitor p-chlorophenylalanine (100 mgxkg(-1)xday(-1)) further improved these parameters. We then investigated whether mouse strains harboring the C1473G polymorphism of the Tph2 gene showed different PH phenotypes during hypoxia. Forebrain Tph activity was greater and hypoxic PH was more severe in C57Bl/6 and 129X1/SvJ mice homozygous for the 1473C allele than in DBA/2 and BALB/cJ mice homozygous for the 1473G allele. p-Chlorophenylalanine reduced PH in all groups and abolished the difference in PH severity across mouse strains. Hypoxia increased 5-hydroxytryptophan accumulation but decreased 5-HT contents in the forebrain and lung, suggesting accelerated 5-HT turnover during hypoxia. These results provide evidence that dysregulation of 5-HT synthesis is closely linked to the hypoxic PH phenotype in mice and that Tph1 and Tph2 may contribute to PH development.

Activation of nucleus tractus solitarius 5-HT2A but not other 5-HT2 receptor subtypes inhibits the sympathetic activity in rats

Our first aim was to elucidate the mechanisms underlying the hypotensive response elicited by 5-HT(2) receptor activation in the nucleus tractus solitarius (NTS). In pentobarbitone-anaesthetized rats, intra-NTS administration of 2,5-dimethoxy-4-iodoamphetamine (DOI), a wide spectrum 5-HT(2) receptor agonist, but not an antagonist of selective 5-HT(2B) and 5-HT(2C) receptors, produced a decrease in blood pressure and heart rate. The maximal cardiovascular changes obtained by DOI (0.5 pmol) could be almost completely abolished by prior intra-NTS microinjection (10 pmol) of MDL-100907, a selective 5-HT(2A) receptor antagonist, but not by 5-HT(2B) or 5-HT(2C) receptor antagonists. In addition, using extracellular recordings we found that the large majority of identified cardiovascular rostroventrolateral medulla (RVLM) neurons were almost totally inhibited by NTS 5-HT(2A) receptor stimulation. We then investigated whether intra-NTS administration of a subthreshold dose (0.05 pmol) of DOI, known to facilitate the cardiovagal component of the baroreflex, could also modulate the sympathoinhibitory component of this reflex. These experiments showed that neither the decrease in the activity of the cardiovascular RVLM neurons and lumbar sympathetic nerve activities produced by aortic occlusion (gain of the baroreflex), nor the hypotensive response elicited by aortic nerve stimulation, were potentiated by the microinjection of DOI under such conditions. These data show that activation of 5-HT(2A), but not 5-HT(2B) or 5-HT(2C), receptors, located on NTS neurons, elicits depressor and bradycardic responses, and that this 5-HT(2A)-mediated hypotension is produced via the inhibition of RVLM cardiovascular neurons. In addition, NTS 5-HT(2A) receptor activation facilitates the cardiac but not the sympathetic baroreflex response.

Adult neurogenesis in serotonin transporter deficient mice

Serotonin (5-HT) is a regulator of morphogenetic activities during early brain development and neurogenesis, including cell proliferation, migration, differentiation, and synaptogenesis. The 5-HT transporter (5-HTT, SLC6A4) mediates high-affinity reuptake of 5-HT into presynaptic terminals and thereby fine-tunes serotonergic neurotransmission. Inactivation of the 5-HTT gene in mice reduces 5-HT clearance resulting in persistently increased concentrations of synaptic 5-HT. In the present study, we investigated the effects of elevated 5-HT levels on adult neurogenesis in the hippocampus of 5-HTT deficient mice, including stem cell proliferation, survival, and differentiation. Using an in vivo approach, we showed an increase in proliferative capacity of hippocampal adult neural stem cells in aged 5-HTT knockout mice (approximately 14.5 months) compared to wildtype controls. In contrast, in vivo and additional in vitro analyses of younger adult 5-HTT knockout mice (approximately 7 weeks and approximately 3.0 months) did not reveal significant changes in proliferation of neural stem cells or survival of newborn cells. We showed that the cellular fate of newly generated cells in 5-HTT knockout mice is not different with respect to the total number and percentage of neurons or glial cells from wildtype controls. Our findings indicate that elevated synaptic 5-HT concentration throughout early development and later life of 5-HTT deficient mice does not induce adult neurogenesis in adult mice, but that elevated 5-HT levels in aged mice influence stem cell proliferation.

[Imaging of acute stroke]

Acute stroke patients represent an important diagnostic and therapeutic challenge. Patients with brain damage in the ischemic, but not yet infarcted, phase have the greatest potential for recovery. Here we review the most commonly employed diagnostic tools that are currently used before stroke therapy. While computed tomography is pertinent to differentiate ischemic from hemorrhagic stroke, this technique cannot be used as an etiological screening too. The ischemic origin of symptoms can be confirmed with magnetic resonance imaging which also contributes to for therapeutic decision making, prognosis assessment and etiological screening.

Cardiac baroreflex facilitation evoked by hypothalamus and prefrontal cortex stimulation: role of the nucleus tractus solitarius 5-HT2Areceptors

We previously showed that serotonin (5-HT2) receptor activation in the nucleus of the tractus solitarius (NTS) produced hypotension, bradycardia, and facilitation of the baroreflex bradycardia. Activation of the preoptic area (POA) of the hypothalamus, which is involved in shock-evoked passive behaviors, induces similar modifications. In addition, previous studies showed that blockade of the infralimbic (IL) part of the medial prefrontal cortex, which sends projections to POA, produced an inhibitory influence on the baroreflex cardiac response. Thus, to assess the possible implication of NTS 5-HT2receptors in passive cardiovascular responses, we analyzed in anesthetized rats the effects of NTS inhibition and NTS 5-HT2receptor blockade on the cardiovascular modifications induced by chemical (0.3 M d,l-homocysteic acid) and electrical (50 Hz, 150–200 μA) stimulation of IL or POA. Intra-NTS microinjections of muscimol, a GABAAreceptor agonist, prevented the decreases in blood pressure and heart rate normally evoked by IL or POA activation. In addition, we found that intra-NTS microinjection of R(+)-α-(2,3-dimethoxyphenyl)-1-[2-(4-fluorophenylethyl)]-4-piperidine-methanol, a specific 5-HT2Areceptor antagonist, did not affect the decreases in cardiovascular baseline parameters induced by IL or POA stimulation but prevented the facilitation of the aortic baroreflex bradycardia normally observed during IL (+65 and +60%) or POA (+70 and +69%) electrical and chemical stimulation, respectively. These results show that NTS 5-HT2Areceptors play a key role in the enhancement of the cardiac response of the baroreflex but not in the changes in basal heart rate and blood pressure induced by IL or POA stimulation.

Do transient ischemic attacks with diffusion-weighted imaging abnormalities correspond to brain infarctions?

BACKGROUND AND PURPOSE

Our aim was to determine whether diffusion-weighted imaging (DWI) changes associated with transient ischemic attack (TIA) are reversible or correspond to permanent tissue injury.

METHODS

Among 103 consecutive patients admitted for TIA, 36 (34.9%) had abnormalities on initial DWI (delay from TIA = 30 +/- 33 hours [mean +/- SD]). Thirty-three patients (59 DWI lesions) had an MR imaging follow-up (delay from TIA = 10.6 +/- 5 months) including fluid-attenuated inversion recovery, T2, DWI, and 3D T1-weighted sequences. For each lesion, we recorded the quantitative parameters on initial DWI (volume, apparent diffusion coefficient [ADC]) and performed a comparison between reversible and irreversible lesions.

RESULTS

MR imaging failed to detect any permanent injury in 7 patients and identified subsequent infarct in regions corresponding to the original DWI abnormalities in 26 patients (79%). Of the 59 lesions initially identified on DWI, 45 (76.3%) were associated with permanent injury on follow-up MR imaging. The DWI volume was significantly larger (0.91 +/- 1.7 versus 0.21 +/- 0.21 cm(3), P = .003) and the ADC ratio values lower (79 +/- 15% versus 91 +/- 9%, P = .001) in lesions with subsequent infarct than in those that were fully reversible.

CONCLUSION

By showing that most patients with DWI-positive TIAs share the same imaging outcome as stroke patients, our data provide additional support for the redefinition of TIA, which considers that all cases of transient deficit with characteristic neuroimaging abnormalities should be diagnosed as a stroke.

Listeria monocytogenes: a multifaceted model

The opportunistic intracellular pathogen Listeria monocytogenes has become a paradigm for the study of host-pathogen interactions and bacterial adaptation to mammalian hosts. Analysis of L. monocytogenes infection has provided considerable insight into how bacteria invade cells, move intracellularly, and disseminate in tissues, as well as tools to address fundamental processes in cell biology. Moreover, the vast amount of knowledge that has been gathered through in-depth comparative genomic analyses and in vivo studies makes L. monocytogenes one of the most well-studied bacterial pathogens.

[Neuroimaging characteristics of intracerebral haematoma]

The objective of brain imaging is to identify the hematoma according to its different stages and to find a potential underlying cause because of the risk of recurrence and the possibilities of treatment. In emergency, the diagnosis of hematoma is often obtained by CT scan, however today MRI has proved to be more accurate than CT to detect hemorrhage and to identify an underlying etiology. In some cases, according to the patient age, the medical history and the location of the hematoma, it may be necessary to perform a conventional angiography in order to exclude an intracranial vascular malformation. The aim of this review is to detail the different aspects of intracerebral hemorrhages according to the sequences and the temporal evolution, and to describe special findings which can help to identify an underlying etiology.

[Mechanism of thrombosis: physiopathology, role of thrombin and its inhibition by modern therapies]

Although the number of cardiological interventional procedures is in constant progression, they still carry a considerable risk of thrombotic complications. The different antithrombotic strategies in force reduce their incidence but at the price of an excess of bleeding complications. In order to improve the benefit/risk ratio, new antithrombotic drugs have been developed. The thrombin antagonists have a choice role because, in addition to its effect of fibrinogen, thrombin plays a fundamental part in the initiation and maintenance of the thrombosis, both by activating the clotting factors and by stimulating the platelets. Unfractionated heparin was the thrombin inhibitor of choice for many years in interventional cardiology but the improvement of our knowledge of the mechanisms of thrombosis has helped define its limitations. Direct inhibitors of thrombin such as bivalirudine avoid most of these disadvantages. One of their main advantages is their efficacy within the constituted clot itself, whereas heparin, in the absence of antithrombin, has a deleterious effect. The reversibility of the effect of bivalirudine probably plays a role in maintaining the haemostatic equilibrium providing an antithrombotic effect at least as effective as that of heparin but with a reduced risk of bleeding and without any specific biological surveillance. These advantages have been confirmed in the initial clinical trials but further studies aim t widen their application to patients selected with a higher risk of thrombotic events.

Deficiency of the 5-Hydroxytryptamine Transporter Gene Leads to Cardiac Fibrosis and Valvulopathy in Mice

Background— Serotonin (5-hydroxytryptamine; 5-HT) overproduction is responsible for cardiac valvular disease in patients with carcinoid tumors. Reduced 5-HT inactivation is one proposed mechanism of the valvulopathy observed in individuals treated with the appetite suppressants fenfluramine and phentermine. One key protein limiting systemic availability of 5-HT is the 5-HT transporter (5-HTT) expressed by platelets and pulmonary vascular cells; 5-HTT is responsible for 5-HT uptake and subsequent inactivation of the amine passing through the lung. Here we investigated whether 5-HTT–deficient (5-HTT-KO) mice developed structural and/or functional cardiac abnormalities and valvulopathy.

Methods and Results— Cardiac endothelial cells expressed large amounts of 5-HTT in wild-type mice. 5-HTT deficiency appeared to be associated with marked interstitial, perivascular, and valvular fibrosis as evidenced by staining of cardiac collagen in 5-HTT-KO mice. Histological analysis provided evidence for valvulopathy characterized by valvular hyperplasia and prominent fibrosis at the attachment site and base of the leaflets. Echocardiography revealed an increase in left ventricular lumen diameter and a decrease in left ventricular diameter fractional shortening. Although 5-HT 1B receptors mediated the 5-HT–induced collagen secretion by human cardiac myofibroblasts, the contribution of this receptor type to valvulopathy was ruled out because double-KO mice deficient in both 5-HTT and 5-HT 1B receptors showed the same cardiac alterations as 5-HTT-KO mice.

Conclusions— The present results establish a link between 5-HTT and the development of cardiac fibrosis and valvulopathy in vivo. 5-HTT-KO mice represent an especially relevant model for studying the mechanisms by which 5-HT induces valvulopathy.