Pharmacological characterization of the 6 Hz psychomotor seizure model of partial epilepsy

Originally described as a model of 'psychomotor seizures' (J. Pharmacol. Exp. Ther. (1953) 107-273), the 6 Hz corneal stimulation model was abandoned shortly after its description because of its lack of sensitivity to phenytoin. This observation is the basis for the present study designed to validate the 6 Hz seizure as a model of therapy-resistant epilepsy. The pharmacological profile of the 6 Hz seizure was determined at varying current intensities using seven established AEDs (phenytoin, carbamazepine, clonazepam, phenobarbital, ethosuximide, trimethadione, valproic acid) and five second-generation AEDs (lamotrigine, levetiracetam, felbamate, tiagabine, topiramate). The immediate early gene c-Fos was used as a marker of seizure-induced neuronal activation to help define those brain structures that were activated by 6 Hz corneal stimulation. At the current intensity required to produce a seizure in 97% of the population (CC97=22 mA), the 6 Hz seizure did not discriminate between clinical classes of AEDs tested. Increasing the current intensity by 50% (i.e. 32 mA) decreased the sensitivity of the 6 Hz seizure to phenytoin and lamotrigine. At a current intensity of 2 x CC97 (i.e. 44 mA), only two AEDs, levetiracetam and valproic acid, displayed complete protection against the 6 Hz seizure, though the efficacy of these drugs was reduced when compared to the lower stimulation intensities. Intense c-Fos staining from 6 Hz seizures induced by 22 and 32 mA stimulus intensities remained localized to the amygdala and piriform cortex. Increasing the stimulus intensity to 44 mA resulted in additional heavy staining of the dentate gyrus. This recruitment of the dentate gyrus may account for the decrease in potency of levetiracetam and valproic acid at 44 mA. The pharmacological results combined with the c-Fos immunohistochemistry suggest that the 6 Hz stimulation may provide a useful model of therapy-resistant limbic seizures.

Scintimammography in patients with minimal mammographic or clinical findings

A prospective study was made of scintimammographic findings obtained in 75 patients with minimal mammographic or physical examination findings. Patients included those with a new mammographic nodule or density (n = 33), indeterminate calcifications (n = 15), a palpable abnormality with normal mammographic findings and normal or inconclusive ultrasonographic findings (n = 13), or a new lump or mammographic change at the site of prior surgery (n = 14). A positive scintimammographic focus was defined as a discrete, rounded lesion with increased uptake and could have an intensity ranging from low to very high. Of the 30 cancers diagnosed, 27 demonstrated a positive scintimammographic focus. Eight of these foci represented occult cancers that were not identified at mammography or physical examination, and 11 were smaller than 1 cm (down to 4 mm). The overall sensitivity and specificity of scintimammography were 90% and 93.8%, respectively, which suggests that this modality may be useful in the early detection of breast cancer. It can also help distinguish postsurgical and post-radiation therapy changes from carcinoma and may be of value in certain high-risk patients. Scintimammography is a useful, noninvasive method of evaluating patients with low-suspicion or indeterminate mammographic or palpable findings and can help detect additional small tumors.

Cytokine and intracellular signaling regulation of tissue factor expression in astrocytes

There is evidence that inflammatory cytokines such as IL-1beta, TNFalpha, and IL-6 are involved in the pathogenesis of cerebrovascular disorders including stroke. One action of cytokines that contributes to diseases in peripheral tissues is upregulation of the procoagulant receptor tissue factor (TF). In the CNS, astrocytes are the primary cells that express TF; although little is known about how TF is regulated in these cells. Experiments were performed to evaluate the effect of cytokine treatment on TF activity in primary cultures of murine cortical astrocytes and in the human astrocytoma cell line (CCF). IL-1beta treatment induced a 2.5-fold increase in TF activity in the primary astrocytes and a 3-fold induction in the astrocytoma cells. TNFalpha treatment induced a 2.5-fold increase in TF activity in both the primary astrocytes and astrocytoma cells. IL-6 upregulated TF activity 2-fold in primary astrocytes, however, it had no effect on TF activity in the astrocytoma cells. The signaling pathways regulating TF expression in these cells were examined by using staurosporine, a broad spectrum inhibitor of serine-threonine protein kinases, and by examining the effects of intermediates in the sphingomyelin signaling pathway. Staurosporine inhibited IL-1beta-induced TF activity in the primary astrocytes but did not effect IL-1beta- or TNFalpha-induced TF activity in the astrocytoma cells. TF activity in the astrocytoma cells was upregulated 1.5-fold over constitutive levels by a ceramide analogue or the enzyme sphingomyelinase, however the ceramide analogue had no effect on TF activity in the primary astrocytes. These results suggest inflammatory cytokines can upregulate TF activity in astrocytes and the astrocytoma CCF cell line although the two cell types appear to utilize different signaling pathways to mediate TF expression. Further studies will be important to more completely define the signaling regulation of TF in astrocytes since alterations in brain TF levels may play a key role in CNS pathophysiology.

Dynamic MR mammography: a technique for potentially reducing the biopsy rate for benign breast disease

Thirty-five women with a total of 39 breast lesions detected at mammography and/or physical examination and who were scheduled for surgical biopsy were studied with dynamic magnetic resonance (MR) mammography. Fat-suppressed, spoiled GRASS (gradient-recalled acquisition in the steady state) sequences were performed before and after administration of gadopentetate dimeglumine. T1-weighted spin-echo and fat-suppressed T2-weighted fast spin-echo images were also obtained. By measuring percentage signal intensity change in lesions on the spoiled GRASS images after contrast agent injection, the authors achieved a sensitivity of 100% and a specificity of 83.3% in differentiating benign from malignant lesions (24 benign, 15 malignant), with biopsy results as the standard. This dynamic MR mammography technique deserves further evaluation.

MR imaging artifacts, ferromagnetism, and magnetic torque of intravascular filters, stents, and coils

Experiments were conducted in which various intravascular filters, stents, and coils were imaged using magnetic resonance (MR) spin-echo technique at 0.35 T. These devices were also evaluated for ferromagnetism (at 0.35, 1.5, and 4.7 T), magnetic torque (at 0.35 and 1.5 T), and magnetically induced migration within a plastic tube (at 0.35 and 1.5 T for the Greenfield filter [GF]). The stainless-steel GF was evaluated in vitro for its propensity to perforate canine inferior venae cavae (IVC). Magnetic force and torque at 1.5 T did not dislodge the GF or result in perforation of canine IVC by the GF. Beta-3 titanium alloy (used in a new percutaneous version of the GF) is apparently one of the best-suited metals for use with MR imaging because of its lack of ferromagnetism (up to 4.7 T) and absence of MR imaging artifacts (at 0.35 T). Devices composed of Elgiloy (Mobin-Uddin filter), nitinol, and MP32-N (Amplatz filter) alloys all created mild artifacts. Devices fashioned from 304 and 316L (GF and Palmaz stent) stainless-steel alloys created severe "black-hole" artifacts, with the 304 alloy devices also showing marked image distortion. Generally, the greater the ferromagnetism of a device, the greater its magnetic susceptibility artifact.