Cognitive functioning after subthalamic nucleotomy for refractory Parkinson's disease

OBJECTIVE

To evaluate whether subthalamic nucleotomy produces adverse cognitive effects in patients with Parkinson's disease.

METHOD

Twelve patients with Parkinson's disease underwent stereotactic surgery to the subthalamic nucleus. Presurgical and postsurgical neuropsychological assessment of attention, memory, executive function, language, and verbal intellect were undertaken with a battery of tests designed to minimise potential contamination of cognitive effects by motor symptoms.

RESULTS

There was no statistically significant difference in the cognitive tests results after operation for the group as a whole. Reliable change indexes were generated for the cognitive tests. Reliable change postoperatively was found on specific tests of verbal memory, attention, and planning. Left sided operations were associated with greater incidence of deterioration postsurgery.

CONCLUSIONS

Preliminary data on the first reported cognitive changes after subthalamic nucleotomy suggested few adverse cognitive effects of the surgery although discrete neuropsychological changes were seen in some patients. These effects were consistent with current theories on the cognitive functions of the basal ganglia.

Transpedicular approaches to cervical uncovertebral osteophytes causing radiculopathy

OBJECT

The anterolateral and posterior transpedicular foraminotomies were developed to enhance the treatment of cervical spondylotic radiculopathy secondary to uncovertebral osteophytes. These novel surgical approaches may be advantageous because they allow direct decompression of the nerve root while preserving normal movement and stability of the motion segment. The use of the pedicle to obtain access to compressive uncovertebral osteophytes, without causing damage to the motion segment, has not been previously reported.

METHODS

The authors present the early outcome data obtained in 27 patients who underwent an anterolateral or posterior foraminotomy. Eighty-eight percent of patients who underwent anterolateral foraminotomy and 94% of those who underwent a posterior transpedicular procedure experienced complete or significant relief of brachialgia. Postoperatively none of the patients were symptomatically or neurologically worse.

CONCLUSIONS

The transpedicular approach is an effective and potentially improved method of treating symptomatic cervical uncovertebral osteophytes compared with techniques previously described.

Fractures of the medial humeral condyle in adults

BACKGROUND/AIM OF STUDY

Fractures of the medial condyle of humerus are uncommon in adults. The aims of this study were (i) to highlight the rarity of this injury, (ii) to focus on the problems in management of cases which present late, and (iii) to compare the results of surgical excision of medial condyle with those of internal fixation.

METHODS

Seven adult medial humeral condyle fractures were seen over a 10-year period. Four cases were surgically fixed within three weeks of the injury; one case refused operation. Two cases which presented late, one with an isolated trochlear fracture, and another Milch type I fracture comminution and compounding, were treated by excision of the condyle and supervised post excision physiotherapy.

RESULTS

All six operated cases regained good function. The two patients with excised condyle had no significant instability and had good range of movements. The results were comparable to those managed by open reduction and internal fixation.

CONCLUSIONS

Medial condyle fractures presenting early (within 3 weeks), should be managed by accurate open reduction and rigid fixation: non operative management leads to relatively poor results. In late/neglected cases, or those with extensive comminution, open reduction and fixation may lead to stiff and painful elbow, whereas excision of the condylar fragment does not lead to instability.

A novel type of RNase III family proteins in eukaryotes

The RNase III family of double-stranded RNA-specific endonucleases is characterized by the presence of a highly conserved 9 amino acid stretch in their catalytic center known as the RNase III signature motif. We isolated the drosha gene, a new member of this family in Drosophila melanogaster. Characterization of this gene revealed the presence of two RNase III signature motifs in its sequence that may indicate that it is capable of forming an active catalytic center as a monomer. The drosha protein also contains an 825 amino acid N-terminus with an unknown function. A search for the known homologues of the drosha protein revealed that it has a similarity to two adjacent annotated genes identified during C. elegans genome sequencing. Analysis of the genomic region of these genes by the Fgenesh program and sequencing of the EST cDNA clone derived from it revealed that this region encodes only one gene. This newly identified gene in nematode genome shares a high similarity to Drosophila drosha throughout its entire protein sequence. A potential drosha homologue is also found among the deposited human cDNA sequences. A comparison of these drosha proteins to other members of the RNase III family indicates that they form a new group of proteins within this family.

Potential target sites in peripheral tissues for excitatory neurotransmission and excitotoxicity

Glutamate receptors (GluRs) are ubiquitously present in the central nervous system (CNS) as the major mediators of excitatory neurotransmission and excitotoxicity. Neural injury associated with trauma, stroke, epilepsy, and many neurodegenerative diseases such as Alzheimer's, Huntington's, and Parkinson's diseases and amyotrophic lateral sclerosis may be mediated by excessive activation of GluRs. Neurotoxicity associated with excitatory amino acids encountered in food, such as domoic acid and monosodium glutamate, has also been linked to GluRs. Less is known about GluRs outside the CNS. Recent observations suggest that several subtypes of GluRs are widely distributed in peripheral tissues. Using immunochemical and molecular techniques, the presence of GluR subtypes was demonstrated in the rat and monkey heart, with preferential distribution within the conducting system, nerve terminals, and cardiac ganglia. GluR subtypes NMDAR 1, GluR 2/3, and mGluR 2/3 are also present in kidney, liver, lung, spleen, and testis. Further investigations are needed to assess the role of these receptors in peripheral tissues and their importance in the toxicity of excitatory compounds. Therefore, food safety assessment and neurobiotechnology focusing on drugs designed to interact with GluRs should consider these tissues as potential target/effector sites.

STANDARDIZATION OF CERVICAL/VAGINAL CYTOPATHOLOGY REPORTING: THE BETHESDA SYSTEM (TBS) FOR REPORTING CERVICAL/VAGINAL CYTOLOGIC DIAGNOSES

The complex detection system leading to the discovery and treatment of precancerous lesions and early cancers of the uterine cervix is touched upon. By far the most difficult and underestimated component of this system is the screening and interpretation of cervical smears. Emphasis on the latest system of reporting, The Bethesda system is highlighted upon. Weaker points of the previous systems and the need for a newer system for reporting are stressed upon. The classification of the precursors of invasive squamous cancers is not easy, and various groups have advocated several schemes, none is yet perfect or universally accepted. The variation in nomenclature become less significant when the cytopathologist is a full member of a team made up of a clinician, histopathologist, colposcopist, and oncologist. As long as all members speak to each other frequently and use the same language and terminology, they will be able to determine the best treatment for the patient.

Molecular cloning and biological activity of ecdysis-triggering hormones in Drosophila melanogaster

Ecdysis-triggering hormones (ETH) initiate a defined behavioral sequence leading to shedding of the insect cuticle. We have identified eth, a gene encoding peptides with ETH-like structure and biological activity in Drosophila melanogaster. The open reading frame contains three putative peptides based on canonical endopeptidase cleavage and amidation sites. Two of the predicted peptides (DrmETH1 and DrmETH2) prepared by chemical synthesis induce premature eclosion upon injection into pharate adults. The promoter region of the gene contains a direct repeat ecdysteroid response element. Identification of eth in Drosophila provides opportunities for genetic manipulation of endocrine and behavioral events underlying a stereotypic behavior.

Identification of a Manduca sexta NSF ortholog, a member of the AAA family of ATPases

Transport between intracellular compartments requires the activity of an N-ethylmaleimide-sensitive fusion protein (NSF). NSF is a member of a growing family of ATPases regulating several membrane fusion reactions. We have cloned the NSF ortholog from the moth, Manduca sexta (MsNSF). MsNSF is highly conserved in domains critical for NSF function in vertebrates. MsNSF codes for a protein of 745 amino acids, translating to a M(r) of 83kDa in vitro. MsNSF is 72% and 61% similar in amino acid sequence to Drosophila and vertebrate NSFs, respectively. We expressed the D1 ATP domain of MsNSF toward which antibodies selective to MsNSF were generated. Affinity purified alpha-MsNSF antibodies detect a 83kDa protein which is highly enriched in nervous tissues. Levels of MsNSF expression are substantially lower in other tissues examined. Anti-MsNSF antibodies are capable of inhibiting vertebrate intra-Golgi transport of a cargo protein in vitro. The identification of NSF ortholog from Manduca, whose neuroendocrine system is well studied, should facilitate isolation of complexes involved in protein trafficking from insect models. Phylogenetic analysis of NSF and related proteins suggests that the members of the AAA family arose from different ancestors, since the ingroup was not monophyletic. Proteasomal subunits and p97 homologs form two distinct subfamilies, while NSF homologs branch in to the third.

Partial purification and characterization of Bacillus thuringiensis Cry1A toxin receptor A from Heliothis virescens and cloning of the corresponding cDNA

Although extensively studied, the mechanism of action of insecticidal Bacillus thuringiensis Cry toxins remains elusive and requires further elucidation. Toxin receptors in the brush border membrane demand particular attention as they presumably initiate the cascade of events leading to insect mortality after toxin activation. The 170-kDa Cry1Ac toxin-binding aminopeptidase from the tobacco budworm (Heliothis virescens) was partially purified, and its corresponding cDNA was cloned. The cDNA encodes a protein with a putative glycosyl phosphatidylinositol anchor and a polythreonine stretch clustered near the C terminus with predicted O-glycosylation. Partial purification of the 170-kDa aminopeptidase also resulted in isolation of a 130-kDa protein that was immunologically identical to the 170-kDa protein, and the two proteins had identical N termini. These proteins were glycosylated, as suggested by soybean agglutinin lectin blot results. Cry1Ac toxin affinity data for the two proteins indicated that the 130-kDa protein had a higher affinity than the 170-kDa protein. The data suggest that posttranslational modifications can have a significant effect on Cry1A toxin interactions with specific insect midgut proteins.

Steroid induction of a peptide hormone gene leads to orchestration of a defined behavioral sequence

At the end of each molt, insects shed the old cuticle by performing preecdysis and ecdysis behaviors. Regulation of these centrally patterned movements involves peptide signaling between endocrine Inka cells and the CNS. In Inka cells, we have identified the cDNA and gene encoding preecdysis-triggering hormone (PETH) and ecdysis-triggering hormone (ETH), which activate these behaviors. Prior to behavioral onset, rising ecdysteroid levels induce expression of the ecdysone receptor (EcR) and ETH gene in Inka cells and evoke CNS sensitivity to PETH and ETH. Subsequent ecdysteroid decline is required for peptide release, which initiates three motor patterns in specific order: PETH triggers preecdysis I, while ETH activates preecdysis II and ecdysis. The Inka cell provides a model for linking steroid regulation of peptide hormone expression and release with activation of a defined behavioral sequence.

Fasciotomy for exertional anterior compartment syndrome: is lateral compartment release necessary?

The standard surgery for exertional anterior compartment syndrome is fasciotomy of the anterior and lateral compartments of the leg. We prospectively studied the necessity of lateral compartment release, which can add morbidity and extend recovery. We performed 30 anterior compartment releases in 20 patients (10 bilateral operations) with exertional anterior compartment syndrome but not lateral compartment involvement. We alternately performed only an anterior compartment release or both anterior and lateral compartment releases on 10 patients. The 10 patients who underwent bilateral surgery each had, during the same surgery, an anterior and lateral compartment release on one leg and only an anterior compartment release on the other. All were athletes involved in running sports. Overall, satisfactory outcomes were seen in 90% of the limbs--93% (14 of 15) that had anterior compartment release and 87% (13 of 15) that had release of both compartments (no statistically significant difference). For the patients who had unilateral surgery, the average time for full return to sports was 8.1 weeks after anterior release only and 11.4 weeks after release of both compartments, a statistically significant difference. The average time for full return to sports after bilateral surgery was 12.1 weeks. Among these patients, seven said that the leg with only anterior release seemed to recover faster. We concluded that when doing a fasciotomy for exertional anterior compartment syndrome alone, a lateral compartment release is not necessary.

Immunochemical localization of the metabotropic glutamate receptors in the rat heart

The localization of the glutamate receptor outside of the central nervous system is becoming more evident. These receptors have been implicated in brain function and pathology. It can also be envisioned that they play a vital role in the physiology of other organs and systems. We recently reported the presence of ionotropic glutamate receptors in the rat heart. These were distributed differentially in specific cardiac structures, including nerve terminals, ganglion cells, and the conducting system. In this study, we investigated the presence and localization of the metabotropic glutamate receptors (mGluRs) in the rat heart by immunohistochemistry. The experimental data show that the mGluR 1alpha, mGLuR 2/3, and mGluR 5 are present in the rat heart. Their preferential localization includes nerve terminals, ganglion cells, and elements of the conducting system. The mGluR 5 was the only receptor located in the intercalated disks of the cardiac muscle and in the endothelial lining of the blood vessels. This preferential localization to the different components of the conducting system and cardiac neural structures suggest that they play a role in the physiology of the heart.

Odontoid process and C1-C2 corrective osteotomy through a posterior approach: technical case report

OBJECTIVE AND IMPORTANCE

To demonstrate a new posterior approach to the anterior elements of the atlas and the axis including the odontoid process.

CLINICAL PRESENTATION

A 36-year-old woman presented with ankylosing spondylitis and severe flexion deformity of the cervical spine. She had sustained a trauma 5 years previously, causing the inability to look forward or to open the jaw adequately. An examination demonstrated fixed flexion and rotation of the cervical spine, with no neurological deficit. Radiologically, there was fusion of C1, C2, and the clivus.

TECHNIQUE

The upper cervical vertebrae were exposed via a midline posterior incision, the posterior arch of C1 was excised, and the vertebral arteries were mobilized. A wedge osteotomy was performed through the lateral masses of C1 and subsequently through the odontoid. The head was repositioned, and C1-C2 lateral mass screws and a Ransford loop were inserted.

CONCLUSION

It is possible to gain sufficient surgical access to the odontoid process via a posterior approach. The technique described is of benefit when the alternative anterior approaches to the upper cervical spine are technically difficult or impossible.

Gastrointestinal mucormycosis--an uncommon isolated mucormycosis

BACKGROUND

Isolated mucormycosis of the gastrointestinal tract is uncommon, with only two case reports from India.

OBJECTIVES

To study the clinicopathologic features of gastrointestinal mucormycosis in Indian patients.

METHODS

Eight cases of isolated gastrointestinal mucormycosis, seen over six years (1992-97) are reviewed.

RESULTS

Five of the patients were premature babies or infants, one was a 12-year-old boy, and two were middle aged. Symptomatology included vomiting, bloody diarrhea, upper gastrointestinal bleeding, abdominal lump and abdominal distention. All the neonates presented with intestinal perforation. The duration of symptoms was ten days or less in six cases. Mucormycosis was not suspected clinically in any patient. In six cases the diagnosis was established antemortem from resection or biopsy material. Only two patients received antifungal therapy and only one patient responded.

CONCLUSIONS

Isolated gastrointestinal mucormycosis is not uncommon in India. Early diagnosis may be helpful in reducing the high mortality.

Arteriovenous malformation of knee masquerading as juvenile arthritis

This is a rare case of involvement of knee joint by an arteriovenous malformation. A nine year old girl had recurrent monoarticular pain and swelling of long duration and had been treated as juvenile rheumatoid arthritis. Angiographic and histological features suggested an arteriovenous malformation of lower thigh with knee joint involvement.

Adrenal lipoma. A case report

Lipoma of the adrenal gland is an extremely uncommon tumor detected incidentally at postmortem or during life when the patient undergoes investigations for other reasons. All tumors reported in the literature were very small in size. We report a case of lipoma of the adrenal gland in a 45-year-old male patient who was hypertensive and presented with pain in the abdomen. The symptomatic presentation, large size, laparoscopic removal and rarity of this tumor merit documentation in the literature.

Cloning of the V-ATPase B subunit cDNA from Culex quinquefasciatus and expression of the B and C subunits in mosquitoes

The V-ATPase B subunit cDNA isolated from the midgut and Malpighian tubules of Culex quinquefasciatus larvae has a 1476 bp ORF encoding a 492 amino acids protein with a predicted mass of 54.8 kDa. Northern blot analysis reveals the presence of 1.8 and 4.2 kb transcripts in larvae and a 3.0 kb transcript in pupae. A single 57 kDa protein band is detected in immunoblot analysis of protein extracts from C. quinquefasciatus and A. aegypti larvae. Using antibodies to the B subunits we demonstrate high-level expression of these subunits in ion-transporting cells of caeca and anterior midgut, and in Malpighian tubules and rectum. High V-ATPase expression was also observed in the larval salivary glands, central nervous system neurophile, the thoracic endocrine complex and in imaginal discs.

Molecular and immunochemical characterization of the ionotropic glutamate receptors in the rat heart

Excitatory amino acids (EAA) and glutamate receptors (GluRs) play a fundamental role in the central nervous system (CNS). Ionotropic glutamate receptors (iGluRs) are coupled to ion channels, which are classified according to their most selective agonists. These ligand-gated channels are permeable to Na+, K+, and Ca+. Interaction of EAA receptor is linked to Ca+2/Na+ influx. Influx changes lead to an action potential, which in the heart is transmitted along the cardiocyte membrane. Furthermore, the heart has a rich innervation and specialized conduction system for rapid conduction and regulation of cardiac rhythmicity. Availability of EAA receptors in the heart might be important for cardiac function. The following GluRs were cloned by isoform-specific RT-PCR from rat heart ribonucleic acid (RNA): GluR 1, GluR 3, GluR 4, GIuR 7, Ka 1, and Ka 2. Expression in cardiac tissue was confirmed by western (for anti-GluR 2/3) and northern blots (for GluR 3, NMDAR 1, and Ka 2). The anatomical distribution was investigated by immunohistochemistry. Antibodies to GluR 2/3, GluR 5/6/7, Ka 2, and NMDAR 1 showed the strongest signals. These signals were specifically localized to cardiac nerve terminals, ganglia, conducting fibers, and some to myocardiocytes particularly in the atrium. Each antibody had a specific pattern of distribution. This anatomical localization suggests that they might play a role in cardiac electrophysiology and pathology.

Surgical experience with an implanted artificial cervical joint

OBJECT

To assess the effectiveness of Cummins' artificial cervical joint, the authors reviewed the cases of 20 patients in whom the joint had been placed.

METHODS

A review of patients' medical records and reexamination of 18 patients were performed. The review of the surgical experience with the implantation of movable stainless-steel joints in 20 patients treated for cervical myelopathy (16 patients), cervical radiculopathy (three patients), and severe pain (one patient) indicated that the procedure is safe and well tolerated and does preserve cervical joint motion in most patients over an extended period of observation. To date, adjacent segmental symptomatic degenerative changes leading to further surgical treatment have been avoided. The joint has been placed in patients with advanced congenital and acquired cervical fusion and has been demonstrated to be stable, mobile, and biomechanically and biochemically compatible; it has shown no subsidence into adjacent bone. Wear debris has not occurred.

CONCLUSIONS

The use of stainless steel in the cervical spine appears to be suitable for this joint replacement design.

Isolation of the V-ATPase A and c subunit cDNAs from mosquito midgut and Malpighian tubules

Using conserved amino acid sequences for the design of oligonucleotide primers, we isolated cDNA clones for two subunits of the V-ATPase from the midgut and Malpighian tubules of Aedes aegypti larvae. The 3.1 kb cDNA of the A subunit of the peripheral catalytic V1 sector codes for a protein of 68.6 kDa. The protein contains conserved motifs, including an ATP/GTP binding site, found in all other A subunits. Southern analysis using the A subunit as a probe suggests the presence of only a single copy of gene in the Aedes aegypti. The 0.85 kb cDNA of the c subunit of the membrane H+ conducting V0 sector codes for a protein of kDa. This protein has four transmembrane domains and contains a conserved glutamic acid that serves as the binding site for dicyclohexylcarbodiimide. Southern analysis using the c subunit as a probe suggests the presence of more than one related gene in the genome of Aedes aegypti. Pileup analysis of various A and c subunits shows that these subunits fall into distinct clusters, including one in which all arthropod proteins are clustered.

A glucose-regulated protein, GRP58, is down-regulated in C57B6 mouse liver after diethylhexyl phthalate exposure

Diethylhexyl phthalate (DEHP) is a widely used plasticizer that induces peroxisome proliferation in rodents. Prolonged exposure to DEHP results in a variety of toxic effects, the most significant of which appears to be an increased incidence of liver cancer and male reproductive toxicity in rodents. Accompanying these toxic effects is the induction of a number of genes within the liver, particularly those genes involved in peroxisomal fatty acid beta-oxidation and members of the cytochrome P450 family, CYP4A. In order to explore which additional genes may be altered by DEHP exposure, mRNA differential display was performed using total liver RNA from male C57B6 mice that were treated with either O or 2% DEHP in their diet for 7 days. In doing so, a number of partial cDNAs representing messages that are potentially differentially expressed have been isolated. One of these cDNAs was found to be similar to the previously cloned gene, GRP58. Analysis by RNase protection assay and North hybridization have shown that the transcript for GRP58 is down-regulated in the liver after DEHP exposure. Analysis of dose-response exposures to DEHP by reverse transcription (RT)-PCR confirm these results and also shows that GRP58 is not altered in kidney or testis. Immunoblot analysis using GRP58-specific antibodies also shows a decrease in GRP58 protein levels in DEHP-treated mice. Moreover, exposure of mice to another peroxisome proliferator, clofibrate, results in a slight down-regulation of GRP58 at the highest dose, 0.5%. Thus, it appears as if DEHP and clofibrate can use different pathways to affect gene expression.

Molecular cloning and characterization of a novel mosquitocidal protein gene from Bacillus thuringiensis subsp. fukuokaensis

A novel mosquitocidal protein gene, cry20Aa, was cloned from Bacillus thuringiensis subsp. fukuokaensis (H-3a: 3d: 3e). The gene product, Cry20Aa, was naturally truncated and had a molecular mass of 86,138 Da. The Cry20Aa protein possessed five conserved sequence blocks, as do most other insecticidal Cry toxins. However, an amino acid comparison of Cry20Aa with other mosquitocidal toxins, including Cry4A, Cry4B, Cry10A, Cry11A, and Cry11B, demonstrated that Cry20Aa was quite different from other toxins except for the conserved blocks. The N terminus of Cry20Aa was, however, homologous to the N termini of Cry4A and Cry10A. Interestingly, an inverted repeat (IR1) sequence in the open reading frame of the cry20Aa gene caused incomplete expression of Cry20Aa. When this internal IR1 sequence was altered with no change of amino acid sequence, acrystalliferous B. thuringiensis cells transformed with cry20Aa gene dramatically produced crystal inclusions. However, the intact 86-kDa Cry20Aa protein is highly labile, and it is rapidly degraded to polypeptides of 56 and 43 kDa. To increase expression of the cry20Aa gene, the p20 chaperonelike protein and the cyt1Aa promoter were utilized. While p20 did not increase Cry20Aa expression or stability, chimeric constructs in which the cry20Aa gene was under control of the cyt1Aa promoter overexpressed the Cry20Aa protein in acrystalliferous B. thuringiensis. The expressed Cry20Aa protein showed larvicidal activity against Aedes aegypti and Culex quinquefasciatus. However, the mosquitocidal activity was low, probably due to rapid proteolysis to inactive 56- and 43-kDa proteins.