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Abstract
SummaryWith about 4 million diabetics in germany and presumed inclination over the following years the treatment of diabetic complications like diabetic foot will become an even more important point. The management of Charcot’s foot has undergone fundamental change in the last few years. Formerly, treatment was almost exclusively limited to non surgical measures; since the late 1990’s, however, current practice has shifted to early, stage-appropriate surgical therapy. The aim of the present prospective study was to investigate the value of positron emission tomography (PET) in the pre-operative work-up of Charcot’s foot. PET were compared to magnetic resonance tomography (MRI). Patients, methods: MRI and PET imaging were used as part of the preoperative work-up in 18 patients with Type II diabetes mellitus. The diagnosis of Charcot’s foot requiring surgical treatment were made on the basis of clinical and radiologic criteria. Results: Of 46 Charcot’s lesions confirmed at surgery, 44 and 35 were detected by means of PET and MRI, respectively. PET can be used in the work-up of patients with metal implants where the MRI does not show adequate findings. PET shows the areas of detritus formation exhibit only moderately increased glucose metabolism and at visual interpretation do not usually impress as typical for acute osteomyelitis. Average SUV values stood at 1.2 (range: 0.5–2.9). Conclusions: The differentiation between Charcot’s lesions and florid osteomyelitis provides the surgeon with important additional information, which is often unavailable from MRI. Because of this important additional data, PET could be considered preferable to morphologic imaging (CT, projection radiography) in the preoperative work-up of Charcot’s foot.
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Regulation of endosome dynamics by Rab5 and Huntingtin-HAP40 effector complex in physiological versus pathological conditions. Methods Enzymol 2008; 438:239-57. [PMID: 18413253 DOI: 10.1016/s0076-6879(07)38017-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Vesicular transport of signaling molecules, specifically neurotrophins, in neurons is essential for their differentiation, survival, and plasticity. Neurotrophins such as neuron growth factor (NGF) and brain-derived neurotrophic factor (BDNF) are internalized by receptor-mediated endocytosis at synaptic terminals and loaded into endosomes for microtubule-based transport along axons to the cell body where they exert their signaling function in the nucleus. The molecular mechanisms underlying this intracellular transport are not only relevant from a basic knowledge viewpoint, but have also important implications for neurodegenerative diseases. Defects in trafficking are increasingly implicated in the pathology of Huntington's disease (HD) and other neurodegenerative disorders. The small GTPases Rab5 and Rab7 play important roles in the endocytic trafficking of neurotrophins. We have recently identified Huntingtin (Htt) and Huntingtin associated protein of 40 kDa (HAP40) as a novel Rab5 effector complex that regulates endosome motility. In HD, we detected higher HAP40 protein levels compared with normal cells. Such increase causes an augmented recruitment of Htt onto Rab5-positive early endosomes that drastically reduces their motility by "switching" these organelles from microtubules to F-actin. These findings suggest a mechanism by which impaired Rab5-mediated trafficking of neurotrophic factors may be a key event of the pathogenetic process leading to neurodegeneration in HD. To dissect the mechanisms by which Htt, HAP40, and Rab5 function in early endosome interactions with the cytoskeleton, we developed assays to investigate endosome-cytoskeleton interactions that can be applied to normal and pathological conditions. We provide here detailed protocols for, first, an assay that measures binding of early endosomes to microtubules and F-actin. Second, we describe an improved protocol for a cell-free assay that recapitulates the motility of early endosomes along microtubules in vitro. These assays provide mechanistic insights into the dysfunction of endosome motility occurring in HD as well as other neurodegenerative disorders.
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Abstract
PURPOSE Besides the use of conventional x-rays in the diagnostic work-up of initial changes in patients suffering from rheumatoid arthritis (RA), 3-phase bone scintigraphy (3P-Sz) is as well established as magnetic resonance imaging (MRI). The aim of this study was to compare the diagnostic value of ultrasound of the hands with proven methods such as conventional x-rays, low-field MRI and 3P-Sz. METHODS A total of 30 patients were studied using a 1 day protocol with ultrasound, 3P-Sz, MRI and x-ray of the hands. Images were visually assessed by two blinded nuclear medicine physicians and radiologists and classified as RA typical and non-RA typical changes. All methods were compared to the summarized findings interpreted by a rheumatologist after 2 years. RESULTS Of the 30 patients, 19 presented with clinical symptoms of initial changes due to rheumatoid arthritis. Ultrasound revealed 14/19 patients with the correct diagnosis. Conventional x-rays indicated 11/19 patients, while 3P-Sz (100%) and low-field MRI (95%) showed high sensitivity. It was possible to differentiate between inflammation and inconspicuous findings. CONCLUSIONS An experienced examiner can use ultrasound effectively for the initial diagnosis of RA. Based on its low cost, ultrasound is a valid alternative to conventional x-rays.
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Macht der hochauflösende Ultraschall der Hände Magnetresonanztomographie und Projektionsradiographie in der Frühdiagnostik rheumatischer Veränderungen überflüssig? ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-977028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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[Neonatal screening for congenital hypothyreoidism in Germany. The development of concerned children in retrospect analysis using the federal state "Hessen"]. KLINISCHE PADIATRIE 2006; 219:206-11. [PMID: 16878287 DOI: 10.1055/s-2006-921579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Since widespread screenings for hypothyreosis were started in 1981 in Germany, the numbers of mental and physical handicaps due to hypothyroidism are reduced markedly. The aim of this study is to evaluate the actual efficiency of the newborn screenings in Germany using in the federal state "Hessen". METHODS/SUBJECTS All children born between 1988 and 1992 with suspicions laboratory results in the screening examination were contacted personally and statements concerning the screening itself and the physical and mental development were gathered from their parents, doctors and teachers. RESULTS 99.1% of all hessian newborns born between 1988 and 1992 were included into the screening for hypothyreosis. The incidence of congenital hypothyreosis in general was 1:3 313. An etiological classification was possible in 77% of the patients which is divided as follows: 40% athyreosis, 24% hypoplasia of the thyroid, 8% dyshormonogenesis, 5% ektopia of the thyroid. In 67% of the cases hormone substitution was initiated during the first 14 days of life. In 23.9% it was started in the third week, in 6.8% in the fourth week and only in 2.3% of the patients treatment was started later on. The physical development of the children with congenital hypothyreosis can be regarded as widely normal. The school achievement was moderately retarded even when treatment was started in the early neonatal period. CONCLUSIONS The screening for hypothyreosis is well established in Hessen concerning tracking, organisation and analysis. There are short comings concerning the follow ups of children with suspicions findings, which shall be overcome by creating a new position. The long-term-follow-up according to the guidelines of the "Arbeitsgemeinschaft Pädiatrische Endokrinologie" is of central interest. Furthermore compliance is improved by regular personal counselling with the parents.
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[Preoperative imaging of Charcot neuroarthropathy: Does the additional application of (18)F-FDG-PET make sense?]. NUKLEARMEDIZIN. NUCLEAR MEDICINE 2006; 45:15-20. [PMID: 16493510 DOI: 10.1267/nukl06010015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
UNLABELLED With about 4 million diabetics in germany and presumed inclination over the following years the treatment of diabetic complications like diabetic foot will become an even more important point. The management of Charcot's foot has undergone fundamental change in the last few years. Formerly, treatment was almost exclusively limited to non surgical measures; since the late 1990's, however, current practice has shifted to early, stage-appropriate surgical therapy. The aim of the present prospective study was to investigate the value of positron emission tomography (PET) in the pre-operative work-up of Charcot's foot. PET were compared to magnetic resonance tomography (MRI). PATIENTS, METHODS MRI and PET imaging were used as part of the preoperative work-up in 18 patients with Type II diabetes mellitus. The diagnosis of Charcot's foot requiring surgical treatment were made on the basis of clinical and radiologic criteria. RESULTS Of 46 Charcot's lesions confirmed at surgery, 44 and 35 were detected by means of PET and MRI, respectively. PET can be used in the work-up of patients with metal implants where the MRI does not show adequate findings. PET shows the areas of detritus formation exhibit only moderately increased glucose metabolism and at visual interpretation do not usually impression as typical for acute osteomyelitis. Average SUV values stood at 1.2 (range: 0.5-2.9). CONCLUSIONS The differentiation between Charcot's lesions and florid osteomyelitis provides the surgeon with important additional information, which is often unavailable from MRI. Because of this important additional data, PET could be considered preferable to morphologic imaging (CT, projection radiography) in the preoperative work-up of Charcot's foot.
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Präoperative Bildgebung bei diabetisch-neuropathischer Osteoarthropathie: Vergleichende Untersuchungen mittels [F18]FDG-PET und Magnetresonanztomographie. ROFO-FORTSCHR RONTG 2005. [DOI: 10.1055/s-2005-867737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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[Diagnosis of initial changes in patients suffering from rheumatoid arthritis. Two years follow up control with a low-field magnetic resonance scanner, 3-phase bone scintigraphy and conventional x-ray]. NUKLEARMEDIZIN. NUCLEAR MEDICINE 2004; 43:195-202. [PMID: 15586215 DOI: 10.1267/nukl04060195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
UNLABELLED Besides conventional x-ray, in the diagnostic work up of initial changes in patients suffering from rheumatoid arthritis (RA), 3-phase bone scintigraphy (3P-Sz) is as well established as magnetic resonance imaging (MRI). The AIM of this study was to compare the diagnostic value of a newly developed low field MRI with proven methods such as conventional x-ray and 3P-Sz. PATIENTS, METHODS 42 patients were studied using a one days protocol with 3P-Sz, MRI, and x-ray of the hands with yearly follow up examinations. Images were visually assessed by two blinded nuclear medicine physicians and radiologists and classified as RA-typical and non-RA-typical changes. All methods were compared to the summarised findings interpreted by a rheumatologist in consideration of the Ritchie articular index as gold-standard. RESULTS 24/42 patients presented with clinical symptoms of initial changes by rheumatoid arthritis. Conventional x-ray revealed in 20/24 patients within the correct diagnosis in the study period. On the other hand 3P-Sz and low field MRI concordantly showed all 24 patients with initial changes due to RA. Time of detection showed variations with a tendency to later findings by conventional x-ray. CONCLUSIONS In the diagnostic work up of initial changes conventional x-ray should be the first choice in imaging. Our findings suggest that MRI represents an equally sensitive method for the diagnosis of initial changes due to RA in the region of the hands as compared to the 3P-Sz. The limitation of the low field MRI is the small field of view, so we prefer 3P-Sz or high field MRI in the diagnosis of patients with suspected RA.
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Frühdiagnostik rheumatischer Veränderungen der Hände: Verlaufsbeobachtungen mittels 3-Phasen-Skelettszintigraphie, Magnetresonanztomographie und Projektionsradiographie. ROFO-FORTSCHR RONTG 2004. [DOI: 10.1055/s-2004-828168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Diagnosis of initial changes in patients suffering from rheumatoid arthritis. Nuklearmedizin 2004. [DOI: 10.1055/s-0038-1623916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ZusammenfassungIn der Initialdiagnostik bei rheumatoider Arthritis (RA) werden neben der Projektionsradiographie (PR) auch die Magnetresonanztomographie (MRT) und die 3-PhasenSkelettszintigraphie (3P-SZ) eingesetzt. Ziel dieser Studie war es, bei Patienten mit Verdacht auf RA die Wertigkeit der PR, der 3P-SZ und der MRT anhand von Verlaufsbeobachtungen über 2 Jahre zu beurteilen. Patienten, Methoden: Bei 42 Patienten wurden am selben Tag je eine 3P-SZ, Niederfeld-MRT und PR der Hände im dorsovolaren Strahlengang durchgeführt. Verlaufskontrollen erfolgten im jährlichen Abstand. Alle Bilder wurden von jeweils zwei erfahrenen Radiologen/ Nuklearmedizinern befundet und in rheumatypisch und nicht rheumatypisch unterteilt. Als Goldstandard diente die abschließende klinische Diagnose des Rheumatologen unter Berücksichtigung des Ritchie-articular-Index. Ergebnisse: Bei 24/42 Patienten wurde die Diagnose einer initialen RA gestellt. In der PR konnte bei 20/ 24 Patienten im zeitlichen Verlauf die richtige Diagnose gestellt werden. Demgegenüber wurde sowohl in der 3P-SZ als auch in der MRT bei allen 24 Patienten eine beginnende RA erkannt. Lediglich im Detektionszeitpunkt gab es Variationen mit insgesamt tendenziell späterer Diagnosestellung in der PR. Schlussfolgerung: In der bildgebenden Initialdiagnostik der RA ist die PR weiterhin als Verfahren der ersten Wahl anzusehen. In der weiterführenden Diagnostik von unklaren Befunden stellt die Niederfeld-MRT ein der 3P-SZ annähernd vergleichbar sensitives Verfahren dar. Trotzdem sollten – wenn möglich – aufgrund des geringen Field-of-view neben der 3P-SZ zur weiteren Abklärung unklarer Befunde Hochfeldtomographen bevorzugt werden.
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Abstract
OBJECTIVE To compare the value of the various imaging modalities in the detection of pancreatic islet cell tumors. METHODS Analysis of the literature to compare the value of ultrasound, CT, MRI, angiography, venous sampling, scintigraphy and PET in the detection of neuroendocrine tumors of the pancreas. RESULTS For transabdominal ultrasound a sensitivity of 60% has been reported; for endoscopic ultrasound a sensitivity of more than 90%. MRI with a sensitivity of 75-100% is more sensitive compared to CT with a sensitivity of 64-82%. Angiography and venous sampling have a reported sensitivity of 66% and 76%. Somatostatin receptor scintigraphy has a sensitivity of 81-88% with significant differences between the various histological subtypes of the pancreatic islet cell tumors. PET does not play an important role in the detection of neuroendocrine tumors of the pancreas. CONCLUSION None of the various modalities is superior alone, so that it is often necessary to combine them for diagnostic imaging of pancreatic islet cell tumors.
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[Diagnosis of initial changes in the hand of patients with rheumatoid arthritis--comparison between low-field magnetic resonance imaging, 3-phase bone scintigraphy and conventional x-ray]. Nuklearmedizin 2002; 41:135-42. [PMID: 12109033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
UNLABELLED Besides conventional X-rays, in the diagnostic work up of initial changes in patients suffering from rheumatoid arthritis (RA), 3-phase bone scintigraphy (3P-Sz) is as well established as magnetic resonance imaging (MRI). The aim of this study was to compare the diagnostic value of the newly developed low field MRI with the proven methods X-rays and 3P-Sz. METHODS 65 patients (47f, 18m; 20-86 yrs) were studied on a one day protocol with 3P-Sz (550 MBq Tc-99m DPD), MRI and X-rays of the hands. Images were visually analysed by two blinded nuclear medicine physicians and radiologists and classified as a) RA-typical, b) inflammatory, non-RA-typical and c) non inflammatory changes. All methods were compared to 3P-Sz as golden standard. RESULTS In comparison to 3P-Sz, low field MRI presents with almost equal sensitivity and specificity in rheumatoid-typical and inflammatory changes. Conventional X-rays revealed in arthritis-typical changes as well as in inflammatory changes a significantly lower sensitivity and also a lower negative predictive value while specificity equals the one of MRI. Quantitative analysis of 3P-Sz using ROI-technique unveiled significantly higher values in patients with rheumatoid arthritis than in those with no inflammatory changes. CONCLUSION MRI represents an equally sensitive method in the initial diagnosis of rheumatoid-typical and inflammatory changes in the region of the hands as compared to the 3P-Sz. Besides the basic diagnosis with conventional X-rays, 3P-Sz is still the recommended method of choice to evaluate the whole body when RA is suspected. Additionally, quantitative analysis of the 3P-Sz using the ROI technique in the region of the hands reveals statistically significant results and should therefore be taken into account in the assessment of inflammatory changes.
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A newly identified chromosomal microdeletion and an N-box mutation of the AChR epsilon gene cause a congenital myasthenic syndrome. Brain 2002; 125:1005-13. [PMID: 11960891 DOI: 10.1093/brain/awf095] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Congenital myasthenic syndromes (CMSs) are frequently caused by mutations of the coding region of the acetylcholine receptor epsilon subunit (AChRepsilon) gene leading to a reduced expression of the acetylcholine receptor (AChR) at the postsynaptic membrane. Two recent observations have linked two different N-box mutations of the human AChRepsilon promoter to a clinical CMS phenotype. N-boxes are regulatory sequence elements of mammalian promoters that confer synapse-specific expression of several genes, including the AChR subunit genes. Here, we report on a novel point mutation (epsilon-154G-->A) in the N-box of the AChRepsilon promoter in a German CMS pedigree. Semiquantitative analysis of AChRepsilon mRNA levels in the patient's muscle indicated significantly impaired AChRepsilon expression. We provide additional evidence of a pathogenic role for this mutation using the mutated promoter (epsilon-154G-->A) driving a heterologous gene (luciferase) in rat skeletal muscle. We show that agrin-induced gene expression is significantly reduced by the N-box mutant (mt) compared with the wild-type (wt) promoter. Refined haplotype analysis and direct sequencing revealed maternal inheritance of the mutant AChRepsilon promoter (epsilon-154G-->A) together with paternal inheritance of a chromosomal microdeletion (Delta1290 bp) encompassing the promoter and the first two exons of the AChRepsilon gene in the index patient. In conclusion, we provide genetic and functional evidence that a mutation of the AChRepsilon subunit promoter (epsilon-154G-->A) causes CMS due to the reduction of gene expression in skeletal muscle. Moreover, this is the first report of a chromosomal microdeletion affecting an AChR gene. This type of mutation may be missed in standard screening techniques of CMS patients.
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Diagnosis of initial changes in patients suffering from rheumatoid arthritis. Nuklearmedizin 2002. [DOI: 10.1055/s-0038-1623889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ZusammenfassungZur Diagnostik initialer Veränderungen bei rheumatoider Arthritis (RA) werden neben der Projektionsradiographie (PR) im bilddiagnostischen Stufenkonzept die 3-Phasen- Skelettszintigraphie (3P-Sz) und die Magnetresonanz- Tomographie (MRT) eingesetzt. Ziel dieser Studie war es, die neu entwickelte Niederfeld-MRT mit den etablierten Verfahren (PR, 3P-Sz) in der Initialdiagnostik der RA an der Hand zu vergleichen. Methode: Bei 65 Patienten (47 w, 18 m; 20-86 Jahre) wurden an einem Tag 3P-Sz (550 MBq Tc-99m DPD), Niederfeld-MRT und PR der Hände durchgeführt. Alle Bilder wurden von zwei erfahrenen Nuklearmedizinern/Radiologen geblindet befundet und unterteilt in a) rheumatypische, b) entzündliche, nicht rheumatypische und c) nicht entzündliche Veränderungen sowie der 3P-Sz als Goldstandard gegenüber gestellt. Ergebnisse: Im Vergleich zur 3P-Sz zeigt die Niederfeld-MRT bei nahezu gleicher Sensitivität gegenüber rheumatypischen und entzündlichen Veränderungen nur eine gering niedrigere Spezifität. Bei der PR war sowohl bei rheumatypischen als auch bei entzündlichen Veränderungen die Sensitivität vermindert bei gleicher Spezifität wie die Niederfeld-MRT. Die quantitative Auswertung der 3P-Sz mittels ROI-Technik ergab signifikant höhere Werte bei rheumatypischen Veränderungen. Schlussfolgerung: Die Niederfeld-MRT stellt ein der 3PSz vergleichbar sensitives Verfahren in der Initialdiagnostik zum Nachweis rheumatypischer und entzündlicher Veränderungen im Bereich der Hände dar. Neben der Basisuntersuchung der PR empfiehlt sich die 3P-Sz durch Erhebung eines Ganzkörperstatus sowie quantitativer ROI-Technik für die weiterführende Diagnostik bei Verdacht auf RA.
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[SAPHO syndrome--results of 2-phase bone scintigraphy]. Nuklearmedizin 2001; 40:N48-50. [PMID: 11727631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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[Chronic pain in both thighs. Chronic recurrent multifocal osteomyelitis (CRMO)]. Radiologe 2001; 41:701-4. [PMID: 11552386 DOI: 10.1007/s001170170122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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The distribution of aminoacylase I among mammalian species and localization of the enzyme in porcine kidney. Biochimie 2000; 82:129-37. [PMID: 10727768 DOI: 10.1016/s0300-9084(00)00191-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Aminoacylase I (Acy-1, EC 3.5.1.14) is found in many mammalian tissues, with highest activities occurring in kidney. The enzyme hydrolyzes a variety of N-acylated amino acids; however, the physiological role and the exact cellular localization of Acy-1 are still a matter of debate. The comparison of Acy-1 activities in kidney and liver homogenates of 11 mammalian species showed that the enzyme is most abundant in true herbivores such as sheep and cattle as well as in omnivores, while activities were very low in both rodents and the cat. Acy-1 activity was not detected in livers of dogs of five different breeds. Using in situ hybridization of porcine kidney sections with DIG-labeled RNA probes, Acy-1 mRNA was shown to be evenly distributed throughout the tubular system, while glomeruli and the interstitium were free of stain. During subcellular fractionation, porcine Acy-1 behaved like a typical cytosolic enzyme. Commonly, Acy-1 is thought to catalyze hydrolytic reactions, i.e., the formation of free amino acids from acylated derivatives. Based on the present results and literature data, we propose a novel hypothesis, i.e., that Acy-1 catalyzes the synthesis (rather than the hydrolysis) of hippurate that is formed as a detoxification product of aromatic compounds.
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