Early constipation predicts faster dementia onset in Parkinson's disease

Constipation is a common but not a universal feature in early PD, suggesting that gut involvement is heterogeneous and may be part of a distinct PD subtype with prognostic implications. We analysed data from the Parkinson's Incidence Cohorts Collaboration, composed of incident community-based cohorts of PD patients assessed longitudinally over 8 years. Constipation was assessed with the MDS-UPDRS constipation item or a comparable categorical scale. Primary PD outcomes of interest were dementia, postural instability and death. PD patients were stratified according to constipation severity at diagnosis: none (n = 313, 67.3%), minor (n = 97, 20.9%) and major (n = 55, 11.8%). Clinical progression to all three outcomes was more rapid in those with more severe constipation at baseline (Kaplan-Meier survival analysis). Cox regression analysis, adjusting for relevant confounders, confirmed a significant relationship between constipation severity and progression to dementia, but not postural instability or death. Early constipation may predict an accelerated progression of neurodegenerative pathology.

Inflammation and fatigue in early, untreated Parkinson's Disease

OBJECTIVES

Parkinson's disease (PD)-related fatigue is a significant clinical problem, and the pathological processes that cause fatigue remain unknown. The aim of the present study was to explore the possible association of peripheral inflammation markers and fatigue in PD.

MATERIALS & METHODS

We included 47 drug naïve, newly diagnosed PD patients with low (≤3.0) or high (>5.5) fatigue levels as evaluated by the Fatigue Severity Scale (FSS). Strict diagnostic criteria were applied for inclusion. Patients with possible confounding causes for fatigue were excluded. Serum concentrations of a panel of inflammatory markers (IL-8, TNF-α, MCP1, MIP-1β, IL-6, IL-6R, p-selectin, E-selectin-1, ICAM, VCAM-1, CCL5, IL1-Ra, and TNFR1) were measured using ELISA technology in PD patients with and without fatigue to assess the potential relationships of fatigue in newly diagnosed, treatment-naïve patients.

RESULTS

Fatigued PD patients had significantly higher levels of the IL-1 receptor antagonist (IL1-Ra) (1790 pg/mL (SD1007) vs 1262 pg/mL (SD379)) and of the adhesion molecule VCAM 1 (1071 ng/mL (SD276) vs 895 ng/mL (SD229)) than non-fatigued patients. A binary logistic regression model, including high or low FSS score as the dependent variable and UPDRS motor score, MADRS, MMSE, ESS, and IL1-Ra/VCAM-1 as independent variables, showed a significant effect both for IL1-Ra and VCAM-1.

CONCLUSIONS

Higher serum levels of the inflammatory molecules IL1-Ra and VCAM-1 were associated with higher fatigue levels in patients with newly diagnosed, drug-naïve PD. These findings highlight an altered immune response as a potential contributor to PD-related fatigue, from the earliest clinical stages of the disease.

Autonomic symptoms and dopaminergic treatment in de novo Parkinson's disease

OBJECTIVES

Autonomic symptoms are present in early stages of Parkinson's disease (PD), but evidence on how they are influenced by dopaminergic treatment remains unclear. The aim of this study was to investigate the impact of dopaminergic treatment on autonomic symptoms in early PD in a population-based cohort.

METHODS

A total of 171 drug-naive patients with PD were investigated at diagnosis and 12 months later. Orthostatic blood pressure was measured, and autonomic symptoms were assessed by a preliminary version of the Movement Disorders Society-sponsored new version of the Unified Parkinson's Disease Rating Scale (range 0-4).

RESULTS

In the 82% using dopaminergic treatment after 1 year, constipation and orthostatic blood pressure drop increased. There was a tendency towards increased orthostatic dizziness and urinary dysfunction. Dysphagia scores were reduced, and this was associated with higher levodopa-equivalent daily dose.

CONCLUSIONS

Dopaminergic treatment during the first year after initiation seems to have only a minor impact on autonomic symptoms in early PD. It may increase constipation and orthostatic dizziness, while dysphagia can improve. Autonomic symptoms remained mild after 1 year of dopaminergic treatment.

White matter hyperintensities in mild lewy body dementia

Background

The objective of this study was to explore the load of white matter hyperintensities (WMH) in patients with Lewy body dementia (LBD) and compare to Alzheimer's disease (AD) and normal controls (NC).

Methods

Diagnosis of LBD and AD was made according to consensus criteria and cognitive tests were administered. MRI scans for 77 (61 AD and 16 LBD) patients and 37 healthy elderly control subjects were available for analysis. We segmented WMH from FLAIR images using an automatic thresholding technique and calculated the volume of WMH in several regions of the brain, using non-parametric tests to compare groups. Multivariate regression was applied.

Results

There were no significant differences in WMH between AD and LBD. We found a significant correlation between total and frontal WMH and Mini-Mental State Examination (MMSE) and verbal fluency scores in the AD group, but not in the LBD group.

Conclusion

The WMH load in LBD was similar to that of AD. A correlation between WMH load and cognition was found in the AD group, but not in the LBD group, suggesting that vascular disease contributes to cognitive impairment in AD but not LBD.

Parkinson disease: associated disorders in the Norwegian population based incident ParkWest study

Parkinson's disease (PD) may be associated with a number of different diseases due to common risk factors or overlapping symptomatology. We have asked for possible associated disorders in a Norwegian population of incident PD patients and controls, the Norwegian ParkWest study. The patients were diagnosed according to the Gelb criteria. 212 incident PD patients and 175 age and gender matched controls were included. PD patients and controls were asked for information on earlier medical history and family history. PD patients had a higher frequency of self-reported symptoms of depression (p = 0.003) and anxiety disorders (p = 0.004) before baseline. They tended to have a higher frequency of diabetes (p = 0.09) and had a higher frequency of prior stroke or TIA (p = 0.004).

Subjective sleep problems in patients with early Parkinson's disease

BACKGROUND AND OBJECTIVE

Sleep problems are common in Parkinson's disease (PD) and increasingly so with disease progression. The frequency of these problems and the influence of dopaminergic treatment on sleep in early stages of PD remain unclear. We have therefore in this study examined the subjective experience of sleep problems in drug-naïve patients with early PD and how these problems developed after 1 year on dopaminergic treatment using the Parkinson's Disease Sleep Scale (PDSS).

METHODS

In all, 138 drug-naïve patients with early PD derived from a population-based incident cohort and 138 age- and gender-matched control subjects were thoroughly assessed for Parkinsonism, cognition, depressive symptoms and sleep by structured interviews and clinical examination at the time of diagnosis and 1 year later on medication. Sleep problems were assessed using the PDSS.

RESULTS

The total PDSS score for patients with PD was lower compared with controls, 119 vs. 127 (P < 0.05) at baseline and 121 vs. 128 (P < 0.005) after 1 year on drugs. Analyses of PDSS subdomains showed more nocturnal motor off symptoms both at baseline and after 1 year (P < 0.005) and increased daytime somnolence in patients compared with control subjects (P < 0.005 at baseline and P < 0.05 after 1 year). Only minor changes in sleep scores were seen after the introduction of dopaminergic treatment.

CONCLUSION

Patients with early PD report only modestly increased subjective sleep problems at the time of diagnosis compared with control subjects and dopaminergic treatment during the first year in general only slightly changed the experienced sleep problems.

Fatigue in early Parkinson's disease. Minor inconvenience or major distress?

BACKGROUND AND PURPOSE

  Although fatigue is recognized as a common and debilitating symptom in patients with Parkinson's disease (PD), little is known on how and when this symptom emerges during disease progression. The aim of the study was to explore the presence and severity of fatigue in patients with PD at the time of diagnosis, before dopaminergic treatment has been instituted.

METHODS

  The present study is part of the Norwegian ParkWest project, a large cohort study of patients with incident PD in Norway. PD was diagnosed according to the Gelb criteria. The study population comprised 199 patients with untreated, newly diagnosed PD and 172 control subjects, matched for gender and age. Fatigue was measured by the Fatigue Severity Scale (FSS).

RESULTS

  Fifty-five percent of the patients with PD had clinical significant fatigue (FSS > 4), compared with about 20% of the controls (RR = 2.9). The mean score in patients on the FSS was 4.4 (SD 1.7) and in controls 3.1 (SD 1.3). In addition, there were highly significant differences between patients and controls in each of the nine FSS items. In a regression analysis, only the Montgomery and Åsberg Depression Rating Scale and Unified Parkinson's Disease Rating Scale-Activities of Daily Living scores were significantly associated with fatigue. There was no correlation between fatigue and cognitive impairment and hypersomnia.

CONCLUSION

  Fatigue is a common symptom in PD, also in patients with early, untreated disease, and it has a negative impact on these patients' activity of daily living. Also in early PD, fatigue is an important consideration in the management of patients with the disease.

Increased risk of leg motor restlessness but not RLS in early Parkinson disease

OBJECTIVE

This study explores the risk and correlates of leg restlessness in drug-naive patients with Parkinson disease (PD) as compared to control subjects matched for age and gender.

METHODS

A total of 200 drug-naive patients with early, unmedicated PD derived from a population-based incident cohort and 173 age- and gender-matched control subjects were assessed for leg restlessness by structured interviews, clinical examination, and blood samples. All subjects were Caucasian. Restless legs syndrome (RLS) was diagnosed according to the essential diagnostic criteria.

RESULTS

More patients (81 of 200, 40.5%) than controls (31 of 173, 17.9%) reported leg restlessness (p < 0.001). Thirty-one (15.5%) of these patients with PD and 16 (9.2%) control subjects met RLS criteria (p = 0.07). A total of 21 (12.5%) patients and 12 (6.9%) controls with RLS remained after the exclusion of potential RLS mimics and 26 patients vs 10 control subjects with leg motor restlessness (LMR), leading to a relative risk for RLS of 1.76 (95% confidence interval [CI] 0.90-3.43, p = 0.089) and 2.84 for LMR (95% CI 1.43-5.61, p = 0.001) in PD. Except for increased sleep disturbances in patients with RLS and increased Montgomery and Åsberg Depression Rating Scale scores for patients with RLS or LMR there were no other major differences in relevant blood tests, motor or cognitive function between PD with and without RLS or LMR.

CONCLUSION

LMR and not RLS occurs with a near 3-fold higher risk as compared to controls in early PD. The findings underline a need for more accurate assessments of RLS in PD and support the notion that RLS and PD are different entities.

Neurological examination of cortical function deficits

Human cortical functions have been elucidated by studies of deficits in traumatic and vascular brain damage, outcomes after elective neurosurgical procedures, studies in primates and in more recent years by imaging techniques. Cortical functions are well-defined for primary cortical areas like motor, sensory and visual functions. More complex cortical functions like language and to some degree memory are also well clarified. The associative cortical areas are more difficult to study as functions are integrated to and modulate primary cortical functions. Nevertheless, the structural basis for symptoms like neglect, apraxia and agnosia has been well established. Recent data from functional imaging indicate that large and diverse areas of the cerebral cortex are involved in planning motor tasks or coding (memory). This review focuses on the clinical neurological evaluation of cortical function deficits.

The spectrum of neuropsychiatric symptoms in patients with early untreated Parkinson's disease

BACKGROUND

Neuropsychiatric symptoms are common in Parkinson's disease (PD) and have important clinical consequences for patients, caregivers and society. Few studies of neuropsychiatric symptoms in early untreated PD exist.

OBJECTIVE

To explore the range, clustering and correlates of neuropsychiatric symptoms in an incidence cohort of untreated subjects with PD.

METHODS

All cases with incident PD identified during a 22 month period in four counties of Western and Southern Norway were included. Standardised criteria were used to diagnose PD. The Neuropsychiatric Inventory (NPI) was administered to 175 PD and 166 healthy control subjects with similar age and sex distributions. Cluster analysis was used to investigate the interrelationship of NPI items.

RESULTS

The proportion with any NPI symptoms was higher in PD (56%) than in controls (22%) (p<0.001). Depression (37%), apathy (27%), sleep disturbance (18%) and anxiety (17%) were the most common symptoms. Clinically significant symptoms occurred in 27% of the PD group compared with only 3% in the control group (p<.001). Subjects with clinically significant neuropsychiatric symptoms had more severe parkinsonism than those without. Two neuropsychiatric clusters were identified, one characterised by mood symptoms and one by apathy.

CONCLUSIONS

Although the majority of patients with early untreated PD do not have clinical significant neuropsychiatric symptoms, these symptoms are more common in patients than in people without PD. Both psychological stress and brain changes associated with PD are likely to contribute to the higher frequencies.

[Hemiballismus in cerebral infarction]

BACKGROUND

Hemiballismus has traditionally been linked to lesions in the subthalamic nucleus.

MATERIAL AND METHODS

We studied six patients with hemiballismus presumably caused by ischaemic stroke. They were followed for up to two years.

RESULTS

Cerebral MRI with special projections showed that four out of six patients had ischaemic lesions in other parts of the brain than the subthalamic nucleus. Knowledge of the basalganglio-thalamocortical circuits is used to try to explain the cause of hemiballismus. Neuroleptics and benzodiazepines are the usual medical treatment for hemiballism and were helpful also in our patients. The prognosis in hemiballismus is good; four of our six patients had spontaneous recovery within nine months.

INTERPRETATION

The prognosis was not related to the site of the lesion.

Increasing mortality from amyotrophic lateral sclerosis in Norway?

OBJECTIVE

To investigate a possible increase in incidence of ALS in Norway.

METHODS

Death certificate data from all deaths in Norway in the period 1961 to 1994 for ALS, PD, and MG were obtained from Statistics Norway and related to population statistics. Data on ALS was obtained on sex, age, and place of death and compared with mortality data in PD and MG for the same period. Data were standardized using the 1990 population as standard population. Poisson regression was used to test for trends in mortality. The data from the death certificates were related to a clinical study performed on ALS in one of the counties during the same period.

RESULTS

The annual mortality of ALS almost doubled during the period studied, rising from 1.38 to 2.54 per 100,000 inhabitants at the end of the study. The increased mortality appeared solely in the population older than 60 years of age, with a peak in mortality in the age group 80 to 84 years. The increase was larger in women than in men, and the ratio between the sexes was 1.32 (men-women, age-adjusted at the end of the study). The mortality in patients with PD showed a similar increase to that seen in ALS, whereas no increase in mortality was observed in patients with a diagnosis of MG. There were considerable differences in ALS mortality in different counties, but no clear regional trends were observed.

CONCLUSION

The authors report increasing ALS mortality. Although the increase in mortality is restricted to the population aged 65 years or older, it cannot be explained by increasing age of the general population alone.

[Polyneuropathy is an early finding in primary systemic amyloidosis]

BACKGROUND

Polyneuropathy is associated with several pathological conditions. Amyloidosis is a less common cause of polyneuropathy. Amyloidosis is caused by the accumulation of insoluble protein fibrils (amyloid) in the extracellular matrix. Primary systemic amyloidosis is caused by B-lymphocyte dyscrasia. Polyneuropathy is the first sign of primary systemic amyloidosis in about 20% of the cases, and is characterised by relentless progression, painfulness, and prominent symptoms of autonomic neuropathy.

MATERIAL AND METHODS

We describe three cases of primary systemic amyloidosis that started with polyneuropathy.

RESULTS

The diagnosis of primary systemic amyloidosis is often delayed more than two years after the onset of polyneuropathy. Biopsy of rectum, fat tissue, bone marrow, or peripheral nerve are diagnostic tools.

INTERPRETATION

The survival of non-treated patients is about 18 months after the diagnosis. With chemotherapy the survival is prolonged to approximately 38 months.

[Diffusion-weighted magnetic resonance tomography--a new instrument in the diagnosis of Creutzfeldt-Jakob disease]

Creutzfeldt-Jakob's disease (CJD) is characterised by rapidly progressive dementia, ataxia, myoclonus, and several other neurological deficits. It generally affects older adults and occurs in sporadic, genetic and iatrogenic forms. Death occurs usually within one year after onset of the disease. The diagnosis is based on clinical criteria, neurophysiological and radiological findings, and confirmed by postmortal histopathology. During the last two years several cases of CJD have been reported with diffusion-weighted magnetic resonance imaging (MR) abnormalities, represented by increased signal intensity indicating reduced diffusion in basal ganglia and/or cortex cerebri. These abnormalities seem to be characteristic of CJD. We report a case of CJD in a 54-year-old woman who developed vertigo, nystagmus, ataxia, myoclonus, and dementia over a period of eight months. Diffusion-weighted magnetic resonance imaging showed increased signal intensity in corpus striatum and gyrus cinguli. The diagnosis was postmortally confirmed with histopathology.

[Dolichoectasia of the intracranial arteries and stroke]

Intracranial arterial dolichoectasia is a condition related to stroke. The prevalence in patients suffering from their first cerebral infarction is estimated to be 3%. Patients with dolichoectasia are more likely to have lacunar infarctions than those without. They have a higher survival rate and better functional prognosis after first cerebral infarction, but a higher rate of stroke recurrence. The aetiology and pathogenesis of the condition is unknown. Only 0.5% of patients suffering a first cerebral infarction have dolichoectasia of both the carotid and vertebrobasilar system. We describe a case of atypical dolichoectasia affecting both circulatory systems as well as the middle and anterior cerebral arteries, with intracerebral haemorrhage.

Combined effect of alkyl-lysophospholipid and vincristine on proliferation, migration and invasion in human glioma cell lines in vitro

The aim of the present study was to investigate the combined effect of the alkyl-lysophospholipid Et-18-0-CH3 (ALP) and vincristine (VCR) on the proliferative, migratory and invasive properties of human glioma cells. Both drugs have previously been shown to act upon the locomotive apparatus of the cell. In the glioma cell lines D37MG and GaMG we found that ALP and VCR inhibited proliferation in monolayer growth as well as in multicellular spheroids in a dose-dependent manner. When combined, the two drugs had a significantly enhanced effect upon proliferation in the cell line GaMG but not in D37MG. Migration was inhibited by ALP and VCR in a dose-dependent manner in both cell lines. An enhanced effect by combining the drugs was also observed. The invasion of glioma cells into the brain cell aggregates was markedly inhibited at lower concentrations than needed for the inhibition of proliferation and migration when ALP and VCR were applied alone, without any further enhancement by combining the drugs. It is concluded that the combination of ALP and VCR have additive anti-proliferative and anti-migratory properties in human glioma cell lines.

Dynamic determination of human glioma invasion in vitro

OBJECT

The goal of this study was to evaluate whether there is any relationship between survival of patients with brain tumor and tumor proliferation or tumor invasion in vitro.

METHODS

Samples of freshly resected brain tumors from 14 patients with glioblastoma multiforme (GBM) were directly grown as three-dimensional multicellular spheroids. The tumor spheroids were cocultured with fetal rat brain cell aggregates (BCAs), used to represent an organotypical normal brain tissue model. Before the coculture, the tumor spheroids and the BCAs were stained with two different carbocyanine dyes, 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate (DiI) and 3,3'-dioctadecycloxacarbocyanine perchlorate (DiO), respectively. During the coculture, confocal laser scanning microscopy allowed a sequential analysis of tumor cell invasion by visualizing dynamic aspects of the invasive process. Single cocultures were examined at three different time points (24, 48, and 96 hours). During the observation period there was a change in the structural morphology of the cocultures, with a progressive decrease in BCA volume. Furthermore, the scanning confocal micrographs revealed a bidirectional movement of tumor cells and normal cells into brain and tumor tissue, respectively. It is also shown that there is a considerable variation in the rate of BCA destruction in cocultures of glioma spheroids generated directly from biopsy specimens. This variation is seen both between spheroids generated from the same biopsy as well as between spheroids that are grown from different biopsy specimens. Cell proliferation measured by Ki-67 immunohistochemical analysis of biopsy samples obtained in the same patients revealed a correlation between tumor cell proliferation and tissue destruction of the BCAs, as determined by a reduction in BCA volume (p = 0.0338). No correlation was found when survival was related to the same parameters (p > 0.05).

CONCLUSIONS

The present work provides a model for quick and efficient assessment of dynamic interactions between tumor and normal brain tissue shortly after surgery.

Expression of annexin II in glioma cell lines and in brain tumor biopsies

Annexin II is a calcium and phospholipid binding protein and a substrate for protein-tyrosine kinases. Increased levels of annexin II are observed in various cancer cells and tissues, and the molecule has been proposed as a marker of malignancy in vivo. Annexin II was expressed in four glioma cell lines (D-54MG, D-37MG, U251MG and GaMG), as determined by Western blot analyses, immunofluorescence staining and flow cytometric measurements. In addition, annexin II expression was also found in cryostat sections obtained from 15 consecutive brain tumor biopsies: Ten were histologically classified as glioblastomas, one as an astrocytoma, two as meningiomas and two as brain metastases. Cultured spheroids from the glioma cell lines and from three of the glioblastoma biopsies showed lower levels of annexin II, than found in the monolayers of the cell lines and in the freshly cut biopsies. The annexin II expression of the cell lines were not found to be related to their proliferative, migratory or invasive properties. These findings indicate that although annexin II may serve as a marker of malignancy in vivo, its expression can be reduced in vitro, and appear unrelated to malignant features of glioma cell lines.

[5-year experience with a clinic for amyotrophic lateral sclerosis]

An out-patient service for patients suffering from amyotrophic lateral sclerosis (ALS), the ALS-clinic, was established at the Department of Neurology, Haukeland Hospital, in 1990. The number of ALS patients who were hospitalised during the period 1990-1995 was 59, with a mean stay in hospital of 14.8 days. Eleven of the patients died in hospital. The ALS-clinic had 127 consultations during the same period, with a mean of 2.2 consultations per patient. Speech difficulties were the dominating problem at 26 of the consultations. 32 patients experienced feeding difficulties, and a percutaneous endoscopic gastrostomy was performed in nine cases. Respiratory problems dominated in ten patients, but only two of these patients wanted a home ventilator. Various assistive devices were adapted for 16 patients.

Adhesion and migration of human glioma cells are differently dependent on extracellular matrix molecules

To analyse the interactions between glioma cells and extracellular matrix (ECM) proteins, the adhesive and migratory capacity of five human glioma cell lines (D37MG, D54MG, GaMG, U118MG and U251MG) were studied. The expression of integrins was analysed and correlated to the adhesive and migratory abilities of the cells. All cell lines were able to adhere to and migrate on the extracellular matrix proteins collagen IV, fibronectin, laminin and vitronectin. Laminin was superior in propagating adhesion and migration in all five cell lines. As analysed by flow cytometry, the expression of the integrin subunits alpha 2, alpha 3, alpha 4, alpha 5, alpha 6, beta 3, beta 4, alpha v, and integrin alpha v beta 5 proved to be uniform between the cell lines. All integrins except alpha 4, alpha 6, beta 3 and beta 4 were expressed on more than 85% of the cells. Inhibition of adhesion with synthetic peptides and antibodies directed against integrins demonstrated that adhesion on laminin was independent of integrins and the 67 kD laminin receptor. On the other hand, migration was shown to be integrin-dependent on all substrates. The results indicate that the mechanism responsible for cell adhesion in human gliomas differ from those present during migration, and that integrins play an important role in regulating these two mechanisms.

[A new variant of Creutzfeldt-Jakob disease. Do we want development of a new epidemic?]

Human spongiform encephalopathies have been receiving a lot of attention lately, because of a new variant of Creutzfeldt-Jakob disease and its possible connection to bovine spongiform encephalopathy which has reached epidemic proportions in Great Britain during the last ten years. Four different human spongiform encephalopathies have been described, the most common being Creutzfeldt-Jakob disease, which can occur in a sporadic, familial or transmissible form. The infectious agent is mainly, possibly solely, composed of a pathogenous isoform of a normal membrane-bound glycoprotein, called a prion. In animals, spongiform encephalopathies occur most frequently in sheep, as scrapie, and in cattle, as bovine spongiform encephalopathy, also known as mad cow disease. There is substantial evidence to suggest that this disease in cattle is the source of the new variant of Creutzfeldt-Jakob disease, although this has yet to be proven. An important question is whether the cases of the new variant of Creutzfeldt-Jakob disease registered so far are the start of an epidemic, as in the case of bovine spongiform encephalopathy.

[Pyuria, bacteriuria and urinary tract infections in hospitalized patients with spinal cord injuries]

Urine specimens from 15 patients with paresis of the urinary bladder following injury of the spinal cord were examined weekly for a total number of 352 weeks. Pyuria was found in 103 specimens. In more than 95% there was concordance between microscopic and chemical evaluation. Bacteriuria was found in 144 specimens, among which pyuria was found in 76. In 77 cases there was indication for antibacterial treatment, based on bacteriological and clinical parameters. The most frequent bacterium isolated was Escherichia coli. Pyuria was present in more than three of four cases that were identified as urinary tract infections. However, almost one of every two cases with bacteriuria showed no pyuria. It is concluded that clinical symptoms of urinary tract infection together with identification of pyuria call for antibacterial treatment. Bacterial examination, should always be undertaken given symptoms of infection with no presence of pyuria.

Quantification of glioma cell invasion by confocal laser scanning microscopy in an in vitro co-culture system

Malignant invasion in co-cultures of spheroids from the glioma cell line GaMg into brain cell aggregates (BA) was determined by two different techniques: by confocal laser scanning microscopy (CLSM) and by conventional light microscopic observations of semi-thin sections obtained from co-cultures. The remaining BA volumes were detected by CLSM in vital dye-fluorescent-stained co-cultures. The same specimens were fixed and embedded in Epon, and cut for histologic and morphometric analyses. The results show that CLSM can be used for continuous determination of progressive glioma invasion. Compared to the light microscopic observations, the degree of invasion appeared slightly lower when analyzed by CLSM. We conclude that the CLSM provides the possibility for continuous studies on interaction between normal and malignant cells. Therefore it considerably improves existing methods for studying tumor cell invasion in vitro.

[Prion diseases. Review of the literature on the light of two case reports of Creutzfeldt-Jakob disease]

During the last ten years the diseases scrapie in sheep and bovine spongiform encephalopathy (or mad cow disease) in cattle have received increased attention. Through the 1960s it became apparent that scrapie in sheep and kuru and later Creutzfeldt-Jakob disease in man were infectious diseases. During the last decade the appearance of mad cow disease in Great Britain has increased the fear that humans can develop Creutzfeldt-Jakob disease through their food. A special characteristic of the infectious agent, the prion, is its lack of DNA. It has been shown that the prion most probably has a pure protein structure. The prion may exist in two slightly different structural patterns, one of which induces the various prion diseases in animals and man. In 1994 two men with Creutzfeldt-Jakob disease were diagnosed at Haukeland Hospital. Their symptoms and clinical data are presented, together with a review of the literature on prion diseases in animals and man.

Heterogeneic modulation of malignant behavior in human glioma cells in defined and serum-containing media

Malignant features in three glioma cell lines were studied in four defined media of various complexity. The cell lines D37MG, D54MG, and GaMG were able to grow in monolayer culture in all media examined, and as multicellular tumor spheroids in the two most nutrient-rich media. In the defined media, none of the cell lines were able to migrate in a migration assay on poly-D-lysine-coated plastic surfaces. Flow cytometric analysis of the GaMG cell line demonstrated no medium-dependent selection of subclones of glioma cells in spheroids cultured for 30 d. Morphological diversity of spheroids varied according to the supplementation of the media. The capacity of glioma cells to invade cellular rat brain aggregates was intact in the media examined. However, glioma migration was severely inhibited by the lack of specific serum components. This study demonstrates that glioma growth and invasion was heterogeneously preserved in the defined media used. Depending on the assay to be used in the study of glioma cell behavior, the degree of medium supplementation has to be considered.

Thymomas express epitopes shared by the ryanodine receptor

Myasthenia gravis (MG) patients with thymoma have antibodies against ryanodine receptor (RyR) of skeletal and heart muscle. In this study, thymomas were examined for reactivity with a panel of polyclonal rabbit antibodies against various short peptides of RyR. An antibody against peptide C2 in the transmembrane region of RyR stained thymoma epithelial cells in cryosections of 17/23 thymomas, and detected a 40-kDa peptide in Western blotting of a thymoma membrane fraction. The other RyR antibodies did not react with thymoma tissue. The anti-C2 RyR antibody did not react with normal thymus, tonsil or carcinoma of colon. The results strongly indicate that epithelial thymoma cells express an epitope shared by the transmembrane region of skeletal and cardiac muscle RyR.

Development and reversion of methionine dependence in a human glioma cell line: relation to homocysteine remethylation and cobalamin status

We investigated the biochemical changes which accompanied the development and reversion of methionine dependence in a human glioma cell line GaMg. This cell line attained a higher proliferation rate and more malignant morphology with increasing passages in vitro. Early passages (P10, P25, and P45) were able to grow in a methionine-deficient medium supplemented with homocysteine (Met-Hcy+), while a later passage (P60) had lost this ability, i.e., it had become methionine-dependent. From P60 cells, a methionine-independent revertant (P60R) was established by exposing the cells to 5-aza-2-deoxycytidine, followed by culture in a Met-Hcy+ medium. In these genetically related cell lines, we investigated homocysteine remethylation and the functional state of cobalamin-dependent methionine synthase, the enzyme responsible for remethylation of homocysteine to methionine. The methionine synthase activity in cell extracts was similar in all cell sublines. Intact cell methionine biosynthesis and nitrous oxide-dependent homocysteine export reflect homocysteine remethylation in cells cultured in a Met-Hcy+ and methionine-containing (Met+Hcy-) medium, respectively. Both of these parameters, as well as the cellular content of the substrate 5-methyltetrahydrofolate, and the cofactor methylcobalamin, in addition to adenosylcobalamin, were high in P10, declined progressively in P45 and P60, and were restored in P60R. P25 cells had some unique features among the methionine-independent phenotypes because both homocysteine remethylation and the level of 5-methyltetrahydrofolate were low in Met+Hcy- medium. The maximal homocysteine export rate in the presence of nitrous oxide, which reflects the overall transmethylation rate, was high in P60 and even higher in P60R compared to the lower passages. The basis for development of methionine dependence during culture of this glioma cell line seems related to the combined effects of reduced methionine biosynthesis and an increased overall transmethylation rate. The single parameter which most closely correlated to the ability to use homocysteine for growth was methylcobalamin. These data support a model for methionine dependence, which implies impaired provision of cobalamin to methionine synthase.

[Varicella zoster infections and neurologic complications]

We describe three patients who suffered from neurological complications to varicella-zoster virus infections. One had polyradiculoneuritis, another myelitis, and a third suffered from focal encephalitis. These patients were all treated with acyclovir, and showed good recovery within a few days. The diagnosis must be based on clinical characteristics, together with virological and immunological tests. The indications for antiviral treatment are discussed.

Anti-cardiac ryanodine receptor antibodies in thymoma-associated myasthenia gravis

Sera from myasthenia gravis (MG) patients with thymoma were examined in Western blot for the presence of antibodies to proteins in the sarcoplasmic reticulum (SR) of cardiac muscle. Fourteen of 30 MG thymoma sera had IgG antibodies to a protein with the same electrophoretic mobility as cardiac muscle ryanodine receptor (RyR). Anti-cardiac RyR antibodies were not detected in any of the 45 sera from MG patients without thymoma. The same 14 MG thymoma sera, but none of the others, bound to RyR from skeletal muscle as well. Neutralization experiments showed that the anti-RyR antibodies in MG patient cross-reacted with cardiac and skeletal muscle RyR. Since skeletal and cardiac muscle RyRs are antigenically different, our findings may indicate that autoantibodies to RyR in MG originate by sensitization to a peptide shared by cardiac and skeletal muscle RyR, rather than to the complete native RyR.

Organic Solvents Activate Human Platelets Through the Inositol Lipid-linked Signal Transduction System

It has recently been proposed that occupational exposure to organic solvents in vivo may lead to platelet activation and this has been substantiated by exposure of platelets to solvents in vitro. The present work was undertaken to study the effects of organic solvents on the platelet inositol lipid signal transduction system. Human platelets that had been prelabelled with [(32)P] P, were exposed to a saturated atmosphere of the organic solvents toluene, xylene or hexane. Extracts were analyzed for metabolites of the polyphosphoinositide cycle and ATP. All solvents studied induced a decrease in radioactivity in phosphatidylinositol 4,5-bisphosphate together with an increase in radioactivities in phosphatidylinositol 4-phosphate and phosphatidic acid. This is compatible with solvent-induced activation of the cells through the inositol lipid pathway. In cells exposed to toluene or xylene we could detect an increased level in inositol trisphosphates at 3 min of exposure. The solvent-induced changes in metabolic ATP could not explain the solvent-induced effects on the inositol lipid metabolism. It is concluded that the organic solvents toluene, xylene and hexane can activate human platelets through the inositol lipid-linked transmembrane signal system.

Hydrophobic organic solvents activate human platelets in vitro

The purpose of this study was to investigate blood platelet function during exposure to the hydrophobic organic solvents toluene, p-xylene and n-hexane. Human blood platelets were exposed for 30 min at 37°C to a saturated atmosphere of p-xylene, toluene or n-hexane. All three solvents, and the aromatics in particular, induced a decrease in the number of single platelets (61-88%) together with an increase in the extracellular levels of ATP plus ADP (45-65% of total) and serotonin (67-100% of total). Passive leakage of [(14)C] adenine-labelled nucleotides from the metabolic pool, due to platelet lysis, was minor or delayed. Electron microscopy of platelets exposed to p-xylene revealed aggregation. The platelets were spherical without pseudopods. Our results indicate that the hydrophobic solvents n-hexane, p-xylene and toluene induce platelet aggregation and dense granule secretion.

Prognostic factors and survival in amyotrophic lateral sclerosis

This study of clinical outcome in amyotrophic lateral sclerosis (ALS) evaluated 148 patients (93 men and 55 women) diagnosed in Hordaland county, Norway, during the period 1970 to 1990. In addition to evaluation of clinical data, data were available on sex, age at diagnosis, time from appearance of symptoms to diagnosis, family history, EMG and spinal fluid. Sixty-nine cases were bulbar ALS and 79 were spinal ALS. Median survival from diagnosis was 16.5 months, 26.0 months in the spinal and 12.1 months in the bulbar form. The survival time decreased with increasing age at the start of disease. A brief interval from start of symptoms to diagnosis was also a poor prognostic factor. Cases with mainly spastic clinical appearance had longer survival than those with marked atrophy. Sex, appearance of familial cases, increased protein level in the spinal fluid, or disease confirmed or not by EMG had no influence on the prognosis. The importance of the prognostic variables was assessed simultaneously using a proportional hazards model. To test the validity of the prognostic factors, a binary survival outcome was established and a predictive rule determined by logistic regression. The data were applied on 11 ALS cases collected outside Hordaland county. Only 1 out of 7 patients with a predicted probability of living more than 1 year actually died within this time period. Two out of 4 patients in the poor prognostic group were dead within a year from the time of diagnosis.

Differential effects of 12-O-tetradecanoyl-13-phorbol acetate (TPA) on growth, migration and invasion of a human glioma cell line

To evaluate the effects of protein kinase C (PKC) activation on a human glioma cell line (GaMG), this study examined the effects of the phorbol ester 12-O-tetradecanoyl-13-phorbol acetate (TPA) on the tumor properties proliferation, migration and invasion. GaMG monolayer growth was reduced by 30% (p < 0.05) in the presence of TPA and, concomitantly, cells accumulated in the G2M phase of the cell cycle as determined by flow-cytometric analyses. In studies of directional migration of cells from GaMG spheroids, low concentrations of TPA increased the area of migration by 60% (p < 0.005). The effects at higher concentrations of the phorbol ester were still present but less pronounced. Glioma invasion was assessed with a glioma spheroid/brain aggregate co-culture technique and revealed TPA-induced enhancement of the invasive process (p < 0.005) at low concentrations of the phorbol ester. Down-regulation of PKC by passaging the cells in a TPA containing medium significantly decreased the migratory response to TPA. Moreover, the PKC inactive phorbol ester 4-alpha-phorbol-12,13-didecanoate had no effect on the migratory response of GaMG cells. It is concluded that metabolic pathways under the control of PKC may play an important role in the control of glioma growth, migration and invasion. The effects of PKC activation are probably dependent on the growth conditions. Studies on PKC activation under different culture conditions in three-dimensional systems are required to evaluate further the role of PKC in glioma biology.

IgG subclass distribution of ryanodine receptor autoantibodies in patients with myasthenia gravis and thymoma

Patients with myasthenia gravis (MG) and thymoma often have autoantibodies to the ryanodine receptor (RyR), a ligand-gated Ca(2+)-release channel in the sarcoplasmic reticulum of striated muscle. Using an ELISA, we studied the Ig isotype and IgG subclass distribution of RyR autoantibodies in sera from 30 MG patients with thymoma. RyR IgG antibodies were detected in 16/30 sera. 14/30 sera had IgG1 RyR antibodies, and 15/30 sera had IgG3 RyR antibodies. All sera with IgG1 RyR antibodies also contained IgG3 antibodies. A small number of sera had low amounts of IgG2, IgG4, IgA or IgM RyR antibodies. The RyR autoantibodies are therefore mainly expressed in the IgG1 and IgG3 subclasses. The RyR autoantibodies may be of pathogenic significance by interfering with the mechanism of excitation-contraction coupling in striated muscle.

[The significance of radiologically diagnosed brain concussion for the outcome after head injury]

The early and late outcome was evaluated in head injury patients who presented brain contusion(s) on the cranial CT scan and in patients hospitalized for concussion. There was a high degree of concurrence between mortality and CT findings. Late complaints were common among cases of concussion of the brain. However, the frequency of impaired memory and concentration, speech problems, paresis and epileptic seizures was increased in cases where the CT scan showed brain contusion. Adaptive and social functioning was most impaired in cases with multifocal contusions in both hemispheres.

Ryanodine receptor autoantibodies in myasthenia gravis patients with a thymoma

Sera from patients with myasthenia gravis were examined by Western blot for the presence of antibodies to proteins of the sarcoplasmic reticulum from rabbit skeletal muscle. Fourteen of 30 patients with myasthenia gravis and a thymoma had IgG autoantibodies to the calcium release channel of the sarcoplasmic reticulum (the ryanodine receptor), which plays a crucial role in the mechanism of excitation-contraction coupling in striated muscle. Ryanodine receptor autoantibodies were not detected in any of the 45 sera from patients with myasthenia gravis without a thymoma. Ryanodine receptor autoantibodies may have pathogenetic relevance in thymoma-associated myasthenia gravis.

Early and late outcome in head injury patients with radiological evidence of brain damage

This study examined the early and late outcome in head injury patients with focal or multifocal (unilateral or bilateral) brain contusions revealed by computerized tomography (CT) scanning. The outcome was also evaluated in patients hospitalized due to brain concussion. Three months after the injury (the early outcome) 43% of the 86 cases with multifocal contusions on the CT scan were dead. As evaluated by the Glasgow Outcome Scale, all the 57 patients with a focal brain contusion, as well as the 117 cases with brain concussion, made a good recovery or were moderately disabled. The late outcome (1 to 5 years after injury) was evaluated in 78 cases with brain contusion and in 85 cases with brain concussion, and revealed that complaints and impaired adaptive functioning were frequent in both the contusion and concussion group. The occurrence of headache, dizziness and sleep problems did not significantly differ among the various head injury groups. However, focal or multifocal brain contusions on the CT scan increased the frequency of impaired memory, impaired concentration, speech problems, weakness in arms or legs and seizures with loss of consciousness. Cognitive deficits and speech problems were particularly common in patients with a focal contusion in the temporal lobe. The late adaptive and social functioning were most markedly impaired in cases with multifocal bilateral contusions.

Activation of blood platelets in workers exposed to organic solvents

Organic solvents probably exert their clinical effects through distortion of cellular membrane structure and function. Blood platelets represent an easily available membrane system. This study describes an evaluation of mean platelet volume (MPV) and total platelet count (TPC) in a group of workers exposed to a mixture of organic solvents in paint factories. We have found a correlation between decreased MPV and present exposure. The reduction was reversed within an exposure-free interval of 3 weeks. The intracellular adenosine triphosphate/adenosine diphosphate (ATP/ADP) ratio was significantly increased in exposed workers, compatible with dense granule secretion. A quantitative study of the phosphoinositide cycle in the platelets revealed an increased concentration of the phosphatidic acid, indicating an increased turnover. These findings are consistent with a solvent-induced activation of circulating platelets.

Myasthenia gravis patients with a thymoma have antibodies against a high molecular weight protein in sarcoplasmic reticulum

Our purpose was to investigate whether components of the sarcoplasmic reticulum (SR) are relevant antigens in myasthenia gravis (MG). Using enzyme-linked immunosorbent assay (ELISA), 75 MG sera and 120 control sera were examined for IgG antibodies against SR prepared from rabbit skeletal muscle. 16/30 thymoma MG patients had IgG antibodies that reacted with SR. 1/30 MG patients with thymic hyperplasia and 3/15 MG patients with thymic atrophy had SR antibodies in low concentrations. Control sera were negative. Using immunoblot, SR antibodies were detected in the thymoma group only. 14/30 sera from thymoma patients reacted with a protein of 320 kDa relative molecular weight. The only reported SR protein with similar electrophoretic mobility is the subunit of the spanning protein which links junctional SR to sarcolemma and functions as a calcium-release channel.

[Peripheral facial paresis as a symptom of Borrelia burgdorferi infection]

Infection with the tick-borne Borrelia burgdorferi can lead to a variety of neurologic symptoms, the most frequent being a radicular pain syndrome due to meningitis. General symptoms such as asthenia or headache are also frequent, however, and serious neurologic complications such as dementia or spastic paresis may occur. At an early stage, Borrelia infections can be easily treated with antibiotics, which makes it important to recognize the symptoms and make the correct diagnosis. A common feature of borreliosis is facial palsy, and in the article is described the case of a 14 year-old boy with borreliosis and bilateral facial palsy. The frequency of facial palsy from borreliosis is probably high. The authors discuss the indications for performing lumber puncture in patients with apparent idiopathic facial palsy (Bell's palsy).

[Amyotrophic lateral sclerosis. Occurrence and prognosis]

The epidemiology of amyotrophic lateral sclerosis in Hordaland county, western Norway, was studied during the period 1979 through 1988. Average annual incidence was 1.60 per 100,000 habitants and the male/female ratio was 1:26. The maximal age-adjusted annual incidence was 8.12 and occurred in the age-group 61-65 years. The mean age at start of symptoms was 60.9 years. The prevalence of amyotrophic lateral sclerosis in Hordaland as per 1 January 1989 was 3.67 per 100,000. The mean survival from onset of disease was 28 months, distributed as 24 months in patients with bulbar onset of symptoms and 40 months in patients with spinal onset symptoms.