Deficient Multisensory Integration with concomitant resting-state connectivity in adult ADHD

Introduction

ADHD patients often report that they are being flooded by sensory impressions. Studies investigating sensory processing show hypersensitivity for sensory inputs across the senses. While studying unimodal signal-processing is relevant and well-suited in a controlled laboratory environment, our daily interaction with our environment does not occur merely unimodal. A complex interplay of the senses is necessary to form a unified percept. In order to achieve this, the unimodal sensory modalities are bound together in a process called multisensory integration (MI).

Objectives

In the current study we investigate MI in an adult ADHD sample accompanied by resting-state functional magnetic resonance imaging (RS-fMRI).

Methods

Twenty-five ADHD patients and twenty-four healthy controls were recruited. MI was examined using the McGurk effect, where - in case of successful MI - incongruent speech-like phonemes between visual and auditory modality are leading to a perception of a new phoneme. Mann-Whitney-U test was applied to assess statistical differences between groups. Resting-state functional MRI was acquired to realize a seed-to-voxel analysis

Results

Susceptibility to MCGurk was significantly lowered for ADHD patients (ADHD_Mdn:5.83%, Controls_Mdn:44.2%, U= 160.5, p=0.022, r=-0.34). When ADHD patients integrated phonemes, reaction times were significantly longer (ADHD_Mdn:1260ms, Controls_Mdn:582ms, U=41.0, p<.000, r= -0.56). Seeded medio temporal gyrus was negatively associated in functional connectivity to primary auditory cortex, inferior frontal gyrus, precentral gyrus, and fusiform gyrus.

Conclusions

MI seems to be deficient for ADHD patients for stimuli that need late attentional allocation. This finding is supported for higher functional connectivity from unimodal sensory areas to polymodal, MI convergence zones for complex stimuli.

Disclosure

No significant relationships.

Virtual reality-based and eye tracking-assisted attention refocusing training for adult Attention-Deficit/Hyperactivity Disorder

Introduction

Neurofeedback regimes in the treatment of adult ADHD are commonly EEG-based and have several shortcomings, including a weak signal-to-noise ratio, low transfer rates from laboratory to everyday environments and ambiguous evidence in respect to adequate brain signals of interest.

Objectives

To investigate, if an eyetracking-based real-time feedback in a virtual environment can enhance attentional performance, as measured by behavioral, EEG and eyetracking parameters.

Methods

Overall, n=18 adult patients with ADHD and n=18 healthy controls (HC) performed a continuous performance task (CPT) in a virtual seminar room, while distracting virtual events occurred. In case the participant’s gaze drifted away from the task an automated audiovisual feedback indicated the participant to refocus on the task. Three 20-minutes blocks were presented in counter-balanced order, that differed in respect to whether real feedback, sham feedback or no feedback was additionally provided.

Results

Mixed ANOVAs with within-subject factors ‘Condition’ (real feedback, sham feedback, no feedback) and ‘Phase’ (distractor phases vs. non-distractor phases) and a between-factor ‘Group’ (ADHD patients vs. HC) revealed better task performances in HC than ADHD patients in respect to omission errors (p = .023), mean reaction times (p = .042) and reaction time variabilities (p = .007; cf. Figure 1). Moreover, omission errors turned to be higher during distractor-present than distractor-absent trials (p = .007), especially in ADHD.

Figure 1.

Conclusions

While the virtual CPT turns out to discriminate well between patients with ADHD and HC, the behavioral results do not indicate an attentional performance enhancement based on the gaze-dependent feedback.

Disclosure

No significant relationships.

POS0012 A NEW TNFRSF1A GENE MUTATION IN A TURKISH FAMILY WITH TNF RECEPTOR-ASSOCIATED PERIODIC SYNDROME (TRAPS)

Background

Tumor necrosis factor (TNF) receptor-1 associated periodic syndrome (TRAPS) is a rare autosomal dominant autoinflammatory syndrome caused by pathogenic variants in the tumor necrosis factor receptor 1 (TNFR1) gene (TNF receptor superfamily member 1A, TNFRSF1A). For definitive diagnosis, genetic tests are needed to show variants in the TNFR1 gene (1). Information on genotype-phenotype relationships is limited due to the rarity of the disease.

Objectives

This study presents novel R97S mutation in TNFRSF1A gene and relevant clinical findings in a patient with amyloidosis of unknown etiology and his sister.

Methods

Case; Proband 33-year-old male patient presented with swelling in the legs 9 years ago. In his history, he described muscle pain, unilateral eye redness, swelling and discharge, which occurred several times in 2-3 months and lasted for up to 2 weeks. Kidney biopsy was found to be consistent with AA amylodiosis. FMF (familial Mediterranean fever) gene mutation was detected negative. Colchicine was started at 2x0.5 mg per day.

Despite colchicine treatment in the following years, acute phase reactants remained high, proteinuria continued at nephrotic level (5060 mg in 24-hour urine), progressive deterioration of kidney functions, end-stage renal failure developed. Gene analysis was performed for other autoinflammatory diseases; R97S (Nucleotide change c.290_310dup heterozygous) mutation was detected in the TNFRSF1A gene.

Sister;31-year-old female patient was admitted to our clinic after a heterozygous mutation in the TNFRSF1A gene was detected in her brother. In her history, she described muscle pain, edema, redness and discharge around the eyes, which occurred 1-2 times a year and lasted for about 2 weeks, especially triggered by the menstrual cycle. TNF (tumor necrosis factor) receptor-associated periodic syndrome mutation was found to be heterozygous positive R97S.

Father;The father of the first two cases started having sore throat, diarrhea, muscle pain, swelling around the eyes and fever attacks starting from the age of 29. Renal biopsy revealed apple-green birefringence with congo-red stain, which was indicative of amyloidosis. When he was 32 years old, peritoneal dialysis was started first and then continued with hemodialysis due to end-stage renal disease. Three months after the start of hemodialysis, he died due to high fever, hypotension and septicemia.

Results

In this article, a novel mutation of TRAPS which has not been reported in the literature so far, is presented in a Turkish family.

Conclusion

Our patient and her sister with the R97S mutation did not have frequent clinical findings such as febrile serositis attacks and skin rashes. In addition, the incidence of conjunctivitis and periorbital edema in TRAPS cases reported in the literature is between 10-20% (1). Three members of the family presented here had periorbital edema and two had conjunctivitis. It is possible that R97S mutations in the TNFRSF1A gene are associated with the development of periorbital lesions and secondary amyloidosis.

Our country is endemic for FMF disease, a study by Bilge et al. (2) demonstrated that mutation analysis of 9% of all subjects with FMF in our country provided negative results. In our opinion genetic analysis should be performed to detect other autoinflammatory diseases in cases that classical FMF attacks are not seen, as in this case series. These and similar cases followed as FMF are likely to be associated with other autoinflammatory diseases. Diagnosing these rare diseases will provide both appropriate and effective treatment options to patients and a better definition of the clinical feature - mutation relationship.

References

[1]Nigrovic PA. Tumor necrosis factor receptor-1 associated periodic syndrome (TRAPS). In: UpToDate, Post TW (Ed), UpToDate, Waltham, MA. (Accessed on January 03, 2022).

[2]Yaşar Bilge Ş, Sari İ, Solmaz D, et al. The distribution of MEFV mutations in Turkish FMF patients: multicenter study representing results of Anatolia. Turk J Med Sci. 2019 Apr 18;49(2):472-477.

Figure 1.

Family’s pedigree

Disclosure of Interests

None declared

Factors associated with all-cause mortality in patients with coronary artery chronic total occlusions undergoing revascularization (percutaneous coronary intervention or surgery) or medical treatment

Aim    Chronic total occlusion of a coronary artery (CTO) is a predictor of early and late cardiovascular mortality and poor cardiovascular outcomes in patients with coronary artery disease. The purpose of this study was to identify predictors of all-cause mortality in CTO patients that underwent invasive treatment.Material and methods    Patients between 2012 and 2018 with CTO in at least one vessel, as demonstrated by coronary angiography, were included retrospectively in the study. The patients were divided into two groups, an intervention group (percutaneous and surgical revascularization) and a medical group.Results    A total of 543 patients were studied, 152 females (28%) and 391 males (72%). The median follow-up period was 49 (26-72) mos. A total of 186 (34.2%) patients in the medical group and 357 (65.8%) patients in the invasive therapy group were followed. The 5-yr death rate was observed in 50 (26.9%) patients in the medical group and 53 (14.8%) patients in the intervention group, and it was found to be statistically higher in the medical group (p=0.001). In multivariable analysis, heart failure (odds ratio (OR): 1.92, 95% CI: 1.18-3.14; p=0.01), higher glucose levels (OR: 1.05, 95% CI: 1,02-1.08; p=0.04), lower albumin levels (OR: 0.49, 95% Cl: 0.32-0.72; p=0.001), SYNTAX score (OR: 1.03, 95% CI: 1.01-1.05; p=0.001), and CTO (≥2 occluded artery) (OR: 0.42, 95% CI: 0.22-0.72; p=0.01) were independent factors for all-cause mortality.Conclusion    In comparison to the revascularized group, there was an increase in mortality among CTO patients treated medically. Heart failure, SYNTAX score, albumin, glucose, and CTO (≥2 occluded arteries) were independent risk factors for all-cause mortality.

Comparison of propofol-remifentanil and propofol-ketamine combination for dilatation and currettage: a randomized double blind prospective trial

OBJECTIVE

The purpose of this study was to compare the propofol-remifentanil combination and propofol-ketamine combination for Dilatation and Curettage (DC) procedure.

PATIENTS AND METHODS

This prospective, double blind, and randomized study comprised 81 female patients undergoing diagnostic DC. Patients were randomly allocated to one of two groups; propofol-remifentanil (Group PR, n= 44) or propofol-ketamine (Group PK, n= 37). The level of sedation was assessed with the Ramsay Sedation Score (RSS). The patients' RSS scores were maintained at 4-5 with an additional 0.5 mg/kg bolus dose of propofol. Heart rate (HR), mean blood pressure (MBP), peripheral oxygen saturation (SpO2), and RSS were recorded. The Modify Aldrete Score (MAS) was used for postoperative recovery evaluation, and the time to reach MAS score of 10 was recorded. Total dose of propofol, procedure time, side effects, and satisfaction scores of patient and surgeon were also recorded.

RESULTS

The mean HR and MBP values of Group PR were lower than those of Group PK, at all recording times. Sedation levels were significantly higher in Group PK. The total dose of propofol consumed was significantly higher in Group PR. The recovery time of Group PK was significantly longer than that of Group PF (p<0.05). Nausea-vomiting and bradycardia were more frequent in the Group PR. There was no difference in patient and surgeon satisfaction between the two groups.

CONCLUSIONS

Ketamine-propofol combination provides better hemodynamic stability and better quality of sedation than propofol-remifentanil combination. Ketamine still seems as an advantageous and safe drug for such procedure.

Assessment of left atrial functions in cardiac syndrome X

OBJECTIVE

Cardiac syndrome X (CSX) affects left ventricular functions due to myocardial ischaemia. In this study our aim was to determine the changes in left atrial functions in patients with CSX.

PATIENTS AND METHODS

One-hundred patients (M/F; 57/43) diagnosed with CSX in whom ischaemia was detected at exercise test and myocardial perfusion scintigrapghy with normal coronary angiogram and control group of 80 subjects (M/F; 40/40) were recruited into the study. In transthoracic echocardiography and tissue doppler echocardiography, left ventricular and atrial functions were recorded.

RESULTS

As compared to control group,left ventricular diastolic functions were impaired (E/A; 0.95 ± 0.18 vs 1.11 ± 0.29 p < 0.001), left ventricular end-diastolic pressures were increased (E/Em; 8.1 ± 1.85 vs 6.9 ± 1.74 p < 0.05), and left atrial maximum volume, left atrial pre-A volume,left atrial minimum volume were increased in patients with CSX. Left atrial conduit volume was significantly decreased in patients with cardiac syndrome. Left atrial passive emptying volume (LAPEV), left atrial active emptying volume (LAAEV) and left atrial total emptying volume (LATEV) were significantly increased in patients with cardiac syndrome X. Left atrial passive ejection fration (LAPEF) was found similar between the study groups.Left atrial active ejection fraction (LAAEF) was found significantly increased (37.85 ± 11.89 vs 33.60 ± 9.21; p = 0.009) in patients with CSX. Left atrial total ejection fraction (LATEF) was increased in the group with cardiac syndrome X but it didn't reach statistical significance (60.85 ± 8.73 vs 58.36 ± 8.29; p = 0.054).

CONCLUSIONS

Left atrial active contractile pump function increase in response to impaired left ventricular diastolic functions in CSX. Increased left atrial pump function represents a compensatory mechanism in patients with CSX. These results point out the importance of maintaining sinus rythm in patients with CSX.

Critical values in hematology

INTRODUCTION

Critical values are life-threatening results that require immediate notification to the patient's healthcare provider. Accreditation bodies require laboratories to establish critical values. A survey of Ontario laboratories was conducted to determine current practice for critical values in hematology.

METHODS

The survey was sent to 182 participants questioning sources for establishing critical values, levels, review frequency, delta checks, and reporting. The survey was completed by laboratory managers, supervisors, technical specialists, senior technologists, and bench technologists working in hematology.

RESULTS

The majority of participating laboratories have established critical values limits for hemoglobin, leukocyte counts, and platelet counts. Most laboratories also include the presence of malaria parasites and blast cells. Some laboratories reported the presence of plasma cells, sickle cells, schistocytes, and spherocytes as critical values. Multiple sources are used for establishing a critical value policy. There was variability for the frequency of critical values review. Rules may differ for a first-time patient sample vs. a repeat patient sample. Delta checks are seldom used to determine whether a result should be called a critical value. Most participants require the individual taking the critical result(s) to read back and confirm that they are directly involved with the patient's care.

CONCLUSION

There is a lack of consensus for critical values reporting in hematology. As critical value reporting is crucial for patient safety, standardization of this practice would be beneficial.

Structural brain abnormalities in patients with Parkinson disease: a comparative voxel-based analysis using T1-weighted MR imaging and magnetization transfer imaging

BACKGROUND AND PURPOSE

In PD, tissue damage occurs in specific cortical and subcortical regions. Conventional MR images have only limited capacity to depict these structural changes. The purpose of the current study was to investigate whether voxel-based MT imaging could indicate structural abnormalities beyond atrophy measurable with T1-weighted MR imaging.

MATERIALS AND METHODS

Thirty-six patients with PD without dementia (9 in H&Y stage 1, thirteen in H&Y 2, eleven in H&Y 3, three in H&Y 4) and 23 age-matched control subjects were studied with T1-weighted MR imaging and MT imaging. Voxel-based analyses of T1-weighted MR imaging was performed to investigate brain atrophy, while MT imaging was used to study abnormalities within existing tissue. Modulated GM and WM probability maps, sensitive to volume, and nonmodulated maps, indicative of tissue density, were obtained from T1-weighted MR imaging. Effects seen on MTR images, but absent on density maps, were attributed to damage of existing tissue.

RESULTS

Contrary to T1-weighted MR imaging, MT imaging was sensitive to the progression of brain pathology of the neocortex and paraventricular WM. MTR images and T1-based volume images, but not density images, showed a progression of disease in the olfactory cortex, indicating the occurrence of atrophy as well as damage to existing tissue in this region. MTR images revealed bilateral damage to the SN, while T1-weighted MR imaging only showed left-sided abnormalities.

CONCLUSIONS

The findings suggest that voxel-based MT imaging permits a whole-brain unbiased investigation of CNS structural integrity in PD and may be a valuable tool for identifying structural damage occurring without or before measurable atrophy.

Diagnostic approach to reveal retroperitoneal injury during lumbar discectomy

For decades, lumbar discectomy has been one of the most common surgical practices performed by neurosurgeons. Although it has proved to be an effective and safe surgical procedure, life threatening complications may occur in rare cases, including iliac artery and/or vein injuries, superior rectal artery injury, common iliac artery aneurysms, iliac arteriovenous fistula, intestinal injuries, and ureteral injuries. Ureteral damage during the lumbar L4-5 microdiscectomy was reported in a slim 50 year-old male patient. Because of a small amount of bleeding occurred during the surgery as soon as the patient came out of anesthesia, an angio-computed tomography (CT) of the abdomen was performed. It showed no hematoma and no major vascular injury, but air bubbles were seen in the retroperitoneal region, indicating that perforation had occurred. The patient was then monitored carefully for immediate and possible subsequent injuries, in this way; ureteral damage was found and repaired. This is perhaps the first such case report in the literature of the early detection of ureteral damage using an angio CT scan. If there is a suspicion of perforation of the anterior annulus fibrosus and anterior longitudinal ligaments but no indication for an emergency laparotomy, an abdominal angio CT done immediately after the surgery and an abdominal non-contrast CT 4 hours later will give sufficient information concerning the potential occurrence of nearly all the major complications associated with lumbar discectomy.

Quantum dots for terahertz generation

Nanostructures made of semiconductors, such as quantum wells and quantum dots (QD), are well known, and some have been incorporated in practical devices. Here we focus on novel structures made of QDs and related devices for terahertz (THz) generation. Their potential advantages, such as low threshold current density, high characteristic temperature, increased differential gain, etc, make QDs promising candidates for light emitting applications in the THz region. Our idea of using resonant tunneling through QDs is presented, and initial results on devices consisting of self-assembled InAs QDs in an undoped GaAs matrix, with a design incorporating a GaInNAs/GaAs short period superlattice, are discussed. Moreover, shallow impurities are also being explored for possible THz emission: the idea is based on the tunneling through bound states of individual donor or acceptor impurities in the quantum well. Initial results on devices having an AlGaAs/GaAs double-barrier resonant tunneling structure are discussed.

Direct observation of polarons in electron populated quantum dots by resonant Raman scattering

The general problem of the pairing of strongly interacting elementary excitations producing new quasiparticles such as polarons arises in many areas of solid state physics. Recent interest in polaron formation in semiconductor quantum dots has been motivated by the need to understand the physical nature of the carrier relaxation processes and their role in quantum-dot based devices. We report on the direct observation of polarons in InAs/GaAs self-assembled quantum dots populated by few electrons where the polarons are strongly coupled modes of quantum dot phonons and electron intersublevel transitions. The degree of coupling is varied in a systematic way in a set of samples having electron intersublevel spacing changing from larger to smaller than the longitudinal optical phonon energy. The signature of polarons is evidenced clearly by the observation of a large (12-20 meV) anticrossing for both InAs and GaAs-like quantum dot phonons using resonant Raman spectroscopy.

Effect of bonded restorations on the fracture resistance of root filled teeth

AIM

To evaluate the fracture resistance of root filled maxillary premolars restored with different techniques.

METHODOLOGY

One hundred and twenty single-rooted maxillary premolar teeth were divided randomly into six groups of 20 teeth and subjected to the following procedures: group 1: intact teeth. Group 2: endodontic access cavities prepared. Group 3: MOD cavities were prepared, root canals were filled and no restoration was placed. Group 4: teeth were prepared as group 3 and restored conventionally with amalgam. Group 5: teeth were prepared as group 3 and restored with amalgam using a bonding material. Group 6: teeth were prepared as group 3 and restored with composite resin using the same bonding material. Teeth were embedded in acrylic resin and the loads for fracture strength were applied vertically with a constant speed of 1 mm min(-1). Data were evaluated statistically with anova and Tukey's tests.

RESULTS

The mean force of fracture values were 1191.41, 599.86, 233.03, 494.72, 962.81 and 856.48 N for groups 1, 2, 3, 4, 5 and 6, respectively. The fracture resistance of group 5 was similar to group 1 (P > 0.05). The mean force at fracture of group 5 and group 6 was not significantly different. The fracture resistance of groups 5 and 6 was significantly higher than group 4 (P < 0.001).

CONCLUSIONS

The group, restored with conventional amalgam, had the weakest resistance to fracture when compared with the bonded restorations. No statistically significant differences were found between the bonded amalgam and composite resin groups.

Multilocular echinococcosis in humerus: a case report

Hydatid cysts caused by E. multilocularis are less common than those caused by E. granulosus (Pintilie et al., 1996). Infection in the bones is rare, accounts to 0.9-2% of all hydatid cysts (Wirbel et al., 1997). A thirty-five-year old female was presented with a four month history of pain and swelling in her humerus. Plain radiography (Fig. 1) and ultrasonography revealed partial destruction of bone. Laboratory investigations revealed Hb, 15.2 gm, ESR, 11 1st hr and WBC, 10,000. Indirect haemagglutination test using hydatid antigen was positive (1/16,000) and ELISA (IgG) was positive (1/4096). Lung, liver and brain scans were normal. Endosteal-sarcoma was considered and a biopsy was performed. Histopathological examination of bone tissue, showed many cysts (Fig. 11). On surgical operation, a huge number of cysts were found, and removed. The patient was given Albendazole in the recommended dose (Mazyad et al., 1998), and followed up. Six months later, all symptoms and signs regressed. Again three months more, the serological levels markedly decreased and X ray was normal.

Prognostic significance of angiogenesis in rectal cancer: a morphometric investigation

BACKGROUND

Neo-angiogenesis is crucial for tumor growth and metastasis and has been proposed as an independent prognostic factor for survival in patients with solid tumors. In this study the quantitative expression of angiogenesis was investigated by direct stereologic assessment of the vascular surface density in rectal carcinoma to determine the possible correlation of angiogenesis with clinicopathological factors and prognosis.

PATIENTS AND METHODS

Sections from formalin-fixed paraffin-embedded tissue blocks of 29 primary rectal carcinomas were resected and immunostained for endothelial cell factor-VIII-related antigen. The vascular surface density (VSD), number of vessels per square mm (NVES), maximum NVES (NVESmax) according to the three maximum values of NVES and number of vessels in the unit area (N) were assessed by means of morphometry. The results were related to the main prognostic variables and the survival of patients.

RESULTS

There were no significant differences between survivors and non-survivors in terms of the angiogenesis parameters that were investigated. The overall survival rate was not significantly different for sex, age, tumor size and differentiation, extrahepatic metastasis, depth of invasion and the mode of adjuvant therapy. However, a significantly lower overall survival rate was observed in patients with liver metastatic disease (p<0.001), lymph node involvement (p=0.04) and incomplete resection (p<0.001). Multivariate analysis indicated that only the number of vessels in the unit area (HR = 1. 028, p = 0. 04), hepatic metastases (HR=14.94, p=0.007) and type of resection (HR=23.81, p=0.004) predicted overall survival.

CONCLUSION

These findings suggest that increased tumoral vascularity, consistent with previous studies, adversely affects survival in rectal cancer patients. Liver metastatic status and completeness of the surgical resection were the most powerful criteria to predict the final outcome of these patients. Thus, neo-angiogenesis is indeed an important and key step in tumorigenesis, but it may not be the single overwhelming factor that determines recurrence and metastasis in rectal carcinoma.

Moyamoya syndrome with protein S deficiency

Moyamoya disease is a cerebrovascular disease with progressive occlusion of both internal carotid arteries and of their branches and formation of a new vascular network at the base of the brain. Because of the angiographic appearance, it is named as moyamoya. The clinical features are cerebral ischaemia, recurrent transient ischaemic attacks, sensorimotor paralysis, convulsions and migraine-like headaches. A 10-year-old child who acutely developed hemiparesis, weakness and aphasia was found to have moyamoya disease and heterozygous protein S deficiency. This case shows us that during the thromboembolic events the coexistence of protein S deficiency and moyamoya should be investigated.

Arteriovenous malformation of the choroid plexus

A case of a 55-year-old female with arteriovenous malformation (AVM) of the choroid plexus within the right ventricle is reported. Arteriovenous malformation of the choroid plexus is a rare occurrence. The MR findings of this malformation are discussed.

Acute endophthalmitis outbreak after cataract surgery

PURPOSE

To evaluate the source of organisms causing an epidemic of postoperative endophthalmitis and to emphasize the importance of prompt intervention with an early diagnosis.

SETTING

S.B. Ankara Hospital Eye Department, Ankara, Turkey.

METHODS

Thirteen patients who had surgery on the same day and developed acute postoperative endophthalmitis were evaluated. Clinical patterns were observed and intraocular cultures and stains performed in 10 eyes. Broad-spectrum intravitreal antibiotics were injected on an empirical basis.

RESULTS

Intravitreal cultures showed Pseudomonas aeruginosa in four cases and coagulase-negative staphylococci in three cases; three cases were culture negative. P. aeruginosa were also isolated from irrigation solutions used on the same day. Two patients with P. aeruginosa had a visual acuity of 20/200 and 20/300, respectively.

CONCLUSION

The different culture results were probably related to the amount of inoculation, individual risk factors, and the subconjunctival antibiotic injection given at the end of surgery. That one patient with P. aeruginosa endophthalmitis retained a visual acuity of 20/200 shows the importance of rapid intravitreal antibiotic treatment.

Evaluation of congenital Brown's syndrome with magnetic resonance imaging

The magnetic resonance (MR) findings in congenital Brown's syndrome were investigated. Sixteen involved eyes of 12 patients were compared with 20 eyes of 10 controls. An enlargement of the tendon-trochlea complex was observed in congenital Brown's syndrome. In addition, the appearance of the tendon-trochlea complex was irregular in shape and of intermediate signal intensity. The MR appearances in patients with a satisfactory or poor response to surgery did not show any significant differences from each other or from those in patients who had not undergone surgery. This was also the case for the patient with spontaneous improvement. The MR examination in congenital Brown's syndrome suggested that the abnormality was located at the tendon-trochlea complex but clinically it does not give a clue about the outcome of the disease.

Cloning and expression of a haloacid dehalogenase from Pseudomonas sp. strain 19 S

A dehalogenase gene specifying the utilization of a variety of haloacids by Pseudomonas sp. Strain 19S has been cloned and expressed in E. coli. Our cloning strategy employed specific amplification of a fragment homologous to Pseudomonas dehalogenase gene by Polymerase Chain Reaction (PCR). The PCR amplicon successfully acted as a probe to detect the dehalogenase gene in the Southern Blot of the digested Pseudomonas total DNA. Corresponding fragments were cloned into pUC 18 vector and amplified in E. coli MV 1190. One clone with a substantial dehalogenation activity carried a recombinant plasmid containing a 5.5 kb insert.