An Evaluation of a Sensor Fusion System to Improve Drivers' Nighttime Detection of Road Hazards

Objective: To determine whether combination of two spectral bands within a single sensor-fused image can improve drivers' detection of road hazards. Methods: Images were collected with visible and short wave infrared sensors, and were combined by an image fusion algorithm derived from a computational model of human retinal processing (Werblin et al., 1997). Test stimuli were single-band and fused images of a nighttime scene, collected with sensors mounted atop a vehicle and facing down a stretch of road into an opposing vehicle's headlights. The intensity of the opposing headlights was varied to produce images of low and of high glare. The subjects' task was to detect the presence of a pedestrian within each image. Results: Sensor-fused imagery reliably produced performance better than or equivalent to that produced by either format of single-band imagery. Conclusions: Sensor fusion may provide an effective method of facilitating the detection of road hazards under low visibility conditions.

Neonatal face-to-face interactions promote later social behaviour in infant rhesus monkeys

In primates, including humans, mothers engage in face-to-face interactions with their infants, with frequencies varying both within and across species. However, the impact of this variation in face-to-face interactions on infant social development is unclear. Here we report that infant monkeys (Macaca mulatta) who engaged in more neonatal face-to-face interactions with mothers have increased social interactions at 2 and 5 months. In a controlled experiment, we show that this effect is not due to physical contact alone: monkeys randomly assigned to receive additional neonatal face-to-face interactions (mutual gaze and intermittent lip-smacking) with human caregivers display increased social interest at 2 months, compared with monkeys who received only additional handling. These studies suggest that face-to-face interactions from birth promote young primate social interest and competency.

Neonatal imitation and early social experience predict gaze following abilities in infant monkeys

Individuals vary in their social skills and motivation, the causes of which remain largely unknown. Here we investigated whether an individual’s propensity to interact with others measured within days after birth, and differences in infants’ early social environment, may predict a later social skill. Specifically, we tested whether neonatal imitation—newborns’ capacity to match modelled actions—and social experience in the first months of life predict gaze following (directing attention to locations where others look), in infant macaques (Macaca mulatta; n = 119). Facial gesture imitation in the first week of life predicted gaze following at 7 months of age. Imitators were better at gaze following than non-imitators, suggesting neonatal imitation may be an early marker predicting socio-cognitive functioning. In addition, infants with rich social environments outperformed infants with less socialization, suggesting early social experiences also support the development of infants’ gaze following competence. The present study offers compelling evidence that an individual difference present from birth predicts a functional social cognitive skill in later infancy. In addition, this foundational skill—gaze following—is plastic, and can be improved through social interactions, providing infants with a strong foundation for later social interaction and learning.

Rapid assessment of postural instability in Parkinson's disease (RAPID): a pilot study

BACKGROUND

The Fahn's pull (or retropulsion) test is an item in the motor section of the Unified Parkinson's Disease Rating Scale, which is used almost exclusively to classify postural instability in Parkinson's disease (PD). However, the test is hard to standardize and is often performed incorrectly, making it hard to interpret. Moreover, it may not be safe to administer in patients who experience pain in the shoulders, neck, trunk and/or lower extremities. Identifying and grading postural instability in PD without requiring a physical challenge would not only be useful for the clinician but would assist patients and caregivers in its recognition. We propose the use of the rapid assessment of postural instability in Parkinson's disease (RAPID) questionnaire as a non-physical assessment tool.

METHODS

We determined the associations between the pull test and items on a risk-assessment questionnaire that consisted of three parts: activities of daily living, fear of falling, and frequency of falling.

RESULTS

Significant correlations were found between the pull test and the predictor variables, which ranged between 0.51 and 0.56 whilst the correlations amongst the predictor variables ranged between 0.58 and 0.70. The three parts of the questionnaire, when used in combination, produced a 96% sensitivity in the classification of postural instability.

CONCLUSIONS

The RAPID questionnaire can be used as an adjunct to the pull test or solely if the pull test is contraindicated. It may also be possible to administer the questionnaire via the telephone or Internet. It is hoped that the rapid identification of postural instability would lead to fewer falls.

Resources for genetic management and genomics research on non-human primates at the National Primate Research Centers (NPRCs)

The National Primate Research Centers (NPRCs) established Working Groups (WGs) for developing resources and mechanisms to facilitate collaborations among non-human primate (NHP) researchers. Here we report the progress of the Genome Banking and the Genetics and Genomics WGs in developing resources to advance the exchange, analysis and comparison of NHP genetic and genomic data across the NPRCs. The Genome Banking WG has established a National NHP DNA bank comprising 1250 DNA samples from unrelated animals and family trios from the 10 NHP species housed within the NPRC system. The Genetics and Genomics WG is developing SNP arrays that will provide a uniform, highly informative, efficient and low-cost method for rhesus and long-tailed macaque genotyping across the eight NPRCs. This WG is also establishing a Biomedical Informatics Research Network-based portal for shared bioinformatics resources including vital statistics, genotype and population data and information on the National NHP DNA bank.

Rhesus monkey tryptophan hydroxylase-2 coding region haplotypes affect mRNA stability

Tryptophan hydroxylase-2 (TPH2) synthesizes neuronal 5-HT and its genetic variance is associated with numerous behavioral traits and psychiatric disorders. This study characterized the functional significance of two nonsynonymous single nucleotide polymorphisms (SNPs) (C74A and G223A) in rhesus monkey TPH2 (mTPH2). Four haplotypes of mTPH2 were cloned into pcDNA3.1 and stably transfected into PC12 cells. The levels of mTPH2 mRNA and protein were assessed by quantitative real-time PCR and Western blot, respectively, while the intracellular 5-HT was measured by enzyme-linked immunosorbent assay (ELISA). The variant A-A haplotype showed significantly higher levels of mTPH2 mRNA and protein, as well as significantly higher 5-HT production than the wild-type C-G haplotype, while the other two variant haplotypes (C-A and A-G) also tended to produce more 5-HT than C-G haplotype when stably expressed in PC12 cells. Both C74A and G223A were predicted to change mRNA secondary structure, and analysis of the mRNA stability showed that the wild-type C-G haplotype mRNA degrades more quickly than mRNAs of the mutant mTPH2 haplotypes in both stable PC12 and transient HEK-293 cells. This study demonstrates that nonsynonymous SNPs in mTPH2 can affect mRNA stability. Our findings provide an additional mechanism by which nonsynonymous SNPs affect TPH2 function, and further our understanding of TPH2 gene expression regulation.

Increased signal in the subarachnoid space on fluid-attenuated inversion recovery imaging associated with the clearance dynamics of gadolinium chelate: a potential diagnostic pitfall

BACKGROUND AND PURPOSE

Hyperintense CSF in the subarachnoid space (SAS) on fluid-attenuated inversion recovery (FLAIR) imaging has been reported in numerous pathologic conditions, including subarachnoid hemorrhage, meningitis, meningeal carcinomatosis, superior sagittal thrombosis, adjacent tumors, status epilepticus, and stroke. It has also been reported in otherwise healthy patients undergoing anesthesia with supplemental oxygen. We present a series of 11 patients with hyperintense CSF signal intensity in the SAS on FLAIR imaging after previous administration of gadolinium chelate.

MATERIALS AND METHODS

Head MR images of patients who had a prior gadolinium-enhanced body, spine, or brain MR imaging and who had increased signal intensity in the SAS on FLAIR images were prospectively and retrospectively reviewed. Correlation was made with the clinical and laboratory findings.

RESULTS

Eight of the 11 patients had negative findings on lumbar punctures. Seven patients had either chronic renal insufficiency or acute renal failure, but the remaining 4 had normal renal function. Nine patients had no other significant intracranial abnormalities, and 2 patients had acute infarcts remote from the CSF hyperintensity. One patient had follow-up studies at 24 and 48 hours, documenting resolution of the CSF hyperintensities.

CONCLUSION

Given the sharp rise in volume of contrast-enhanced MR imaging studies, it is inevitable that some patients will have undergone a contrast-enhanced MR imaging 24-48 hours before an MR imaging of the brain. The neuroradiologist should be aware that previous administration of gadolinium chelate can cause increased signal intensity in the SAS on FLAIR imaging in patients with or without a history of renal insufficiency and without abnormalities known to disrupt the blood-brain barrier.

Tryptophan hydroxylase-2 gene polymorphisms in rhesus monkeys: association with hypothalamic-pituitary-adrenal axis function and in vitro gene expression

Tryptophan hydroxylase-2 (TPH2) is a newly identified second form of TPH responsible for serotonin synthesis in the brain and has been increasingly implicated as a contributor to the etiology of various psychiatric disorders. In this study, we have identified the constellation of polymorphisms in rhesus monkey TPH2 and investigated genotype/phenotype association as well as gene expression effects of specific polymorphisms. Genomic DNA was obtained from 247 rhesus monkeys, among which 24 had been previously examined for plasma cortisol level, dexamethasone suppression, and combined dexmethasone/ACTH challenge. Polymorphisms in all exons, splicing junctions and approximately 2 kb of the 5'-flanking region (5'-FR) of TPH2 were identified by sequencing. We identified 17 single nucleotide polymorphisms (SNPs) including two that are predictive of amino-acid change (25Pro>His and 75Gly>Ser, respectively), two mononucleotide repeats, one dinucleotide repeat, and one 159-bp insertion polymorphism. The 3'-UTR polymorphisms were significantly associated with hypothalamic-pituitary-adrenal (HPA) axis activity, especially 2051A>C, which was strikingly correlated with plasma cortisol level in the morning only (F=10.203, P=0.001). Luciferase reporter gene assays showed that the 3'-UTR polymorphisms and haplotypes had a profound effect on in vitro gene expression. Accordingly, these investigations revealed that polymorphisms in 3'-UTR of rhesus monkey TPH2 modulate HPA axis function, presumably by affecting levels of TPH2 expression.

Superficial siderosis

BACKGROUND

Superficial siderosis (SS) of the CNS is caused by repeated slow hemorrhage into the subarachnoid space with resultant hemosiderin deposition in the subpial layers of the brain and spinal cord. Despite extensive investigations, the cause of bleeding is frequently undetermined.

OBJECTIVES

To review the clinical and imaging features of 30 consecutive patients with SS and provide insights into the underlying causes of subarachnoid bleeding in this disabling disorder.

METHODS

The authors reviewed the medical records of 30 consecutive patients with clinical and MRI evidence of SS.

RESULTS

The commonest neurologic manifestations included gait ataxia and hearing impairment. A clinical history of subarachnoid hemorrhage was relatively rare. Possible predisposing conditions were identified on history in 22 patients, the commonest being a prior trauma (15 patients). In addition to the characteristic MRI findings of SS, 18 patients had abnormalities on MRI possibly related to chronic bleeding. The most common of these was the presence of a fluid-filled collection in the spinal canal seen in 14 patients.

CONCLUSIONS

A history of prior subarachnoid hemorrhage is often absent in patients with superficial siderosis (SS). A past history of trauma is common. Prior intradural surgery may be an additional risk factor. Xanthochromia or the presence of red blood cells in the CSF is a common finding. Only rarely does angiography demonstrate the bleeding source. The presence of a fluid-filled collection in the spinal canal is a common finding on MRI and is likely related to the SS. With longitudinally extensive cavities, a dynamic CT myelogram may help localize the defect and direct the site of laminectomy. Surgical repair of a dural defect, if present, should be considered. Surgical correction of bleeding should be documented by CSF examination months after surgery. Friable vessels in the dural defect are a possible source of the chronic bleeding.

Effect of housing system and boar exposure on estrus expression in weaned sows

Reproductive efficiency depends on detection of estrus, which may be influenced by housing and boar exposure. This experiment investigated the effects of housing system and boar contact on measures of estrus in weaned sows. Mixed-parity sows were randomly assigned to be weaned into gestation crates away from boars (AWC, n = 45), into pens away from boars (AWP, n = 42), or into pens adjacent to a mature boar (ADJ, n = 46). Estrus detection was initiated at approximately 0700 (0 h) and again at 0.25-, 0.5-, 1-, 2-, 4-, and 8-h intervals beginning on d 4 and continuing through d 7 following weaning. Estrus detection involved observation of the standing response after application of nose-to-nose boar exposure, backpressure, and side rubbing. For the AWC sows, a mature boar was moved to the front of the crates for a 10-min period and then removed. Sows housed in AWP were moved approximately 15 m to an empty pen adjacent to a mature boar for a 10-min period, and then returned to their pen. Sows housed ADJ were not moved and estrus detection was performed in their home pen for a 10-min period. The proportion of sows expressing estrus within 7 d from weaning was lowest for ADJ (80%, 37/46) compared with AWP (98%, 41/42) and AWC (96%, 43/45; P < 0.05). There was an effect of interval from weaning to estrus on the percentage of sows expressing estrus, but there was no interaction with treatment. Sows in AWC and AWP (4.7 d) had decreased (P = 0.01) intervals from weaning to estrus compared with ADJ (5.2 d). The duration of estrus was also shorter (P < 0.001) for ADJ (45 h) compared with AWC (58 h) or AWP (62 h). There was a treatment x interval x day of estrus effect for the percentage of sows expressing estrus. After detection of the first standing response on the first day of estrus, only 62 to 82% of sows were detected standing over the next 2 h for all treatments. However, at 4 to 8 h, this increased to 85 to 98% for the AWC and AWP sows, but <73% of the ADJ sows were detected during this period. On the second day of estrus, estrus expression was not influenced by interval for the AWC and AWP sows and was between 90 to 100% during the 8-h period, whereas ADJ sow detection rates were between 68 to 88%. These data suggest that housing sows adjacent to boars negatively affects estrus expression and detection. In addition, refractory behavior occurs in approximately 30 to 40% of sows and is influenced by housing relative to the boar, day of estrus, and interval from last boar exposure.

A mu-opioid receptor single nucleotide polymorphism in rhesus monkey: association with stress response and aggression

Variations in the human mu-opioid receptor gene have driven exploration of their biochemical, physiological and pathological relevance. We investigated the existence of variations in the nonhuman primate mu-opioid receptor gene to determine whether nonhuman primates can model genotype/phenotype associations of relevance to humans. Similar to the A118G single nucleotide polymorphism (SNP) in the human mu-opioid receptor gene, a SNP discovered in the rhesus monkey mu-opioid receptor gene (C77G) alters an amino acid in the N-terminal arm of the receptor (arginine for proline at position 26). Two mu-opioid receptor coding regions isolated from a single heterozygous (C77/G77) rhesus monkey brain were expressed in HEK-293 cells and characterized in radioreceptor assays. Paralleling the findings of increased affinity of beta-endorphin by the A118G allele in the human, the rhesus monkey mu-opioid receptor protein derived from the G77-containing clone demonstrated a 3.5-fold greater affinity for beta-endorphin than the receptor derived from the C77-containing clone. An assay developed to assess the incidence of the C77G SNP in a behaviorally and physiologically characterized cohort of rhesus monkeys (n=32) indicated that 44% were homozygous for C77-containing alleles, 50% were heterozygous and 6% were homozygous for G77-containing alleles. The presence of G77-containing alleles was associated with significantly lower basal and ACTH-stimulated plasma cortisol levels (P<0.03-0.05 and P<0.02, respectively) and a significantly higher aggressive threat score (P<0.05) in vivo. In a cohort of 20 monkeys, a trend towards an inverse correlation between aggressive threat and plasma cortisol levels was observed. The findings suggest that mu-opioid receptor haplotypes in monkeys can contribute to individual variability in stress response and related aggression. The data support the use of nonhuman primates to investigate mu-opioid receptor genotype/phenotype relations of relevance to humans.

Pseudosubarachnoid haemorrhage in subdural haematoma

Two patients with large bilateral subdural haematomas with patterns of non-enhanced brain computed tomography (CT) falsely suggesting coexistent subarachnoid haemorrhage are presented. The CT images showed marked effacement of the basal cisterns with hyperdense signal along the tentorium, sylvian fissure, and the perimesencephalic cisterns. In both cases, the suspicion of subarachnoid haemorrhage led to the performance of angiographic studies to rule out vascular lesions. Thus, recognition of this radiological feature is important to avoid unnecessary testing and treatment delay.

Influence of hormone supplementation to extended semen on artificial insemination, uterine contractions, establishment of a sperm reservoir, and fertility in swine

This study was performed to quantify the effect of hormone addition to semen using a low-fertility model to evaluate its effectiveness and mode of action. At 24 h after the onset of estrus, all gilts received a single low-dose AI (0.5 x 10(9) sperm/80 mL) with no hormone (control, C), estrogens (E, 11.5 microg), PGF2alpha (PG, 5 mg of Lutalyse), or oxytocin (OT, 4 IU), which were then evaluated for semen backflow (n = 48), oviductal and uterine sperm numbers (n = 28), uterine contractions (n = 12), pregnancy rate (PR, n = 120), and number of fetuses (n = 67). In Exp. 1, backflow of semen from the uterus was collected for 8 h after AI, whereas PR and fetuses were assessed at d 25 to 30 after AI. In Exp. 2, backflow was collected and reproductive tracts flushed to determine sperm numbers in the oviducts and the anterior segments of the uterus. In Exp. 3, sows were monitored for uterine contractions for 1 h before AI and for 2 h after AI. In Exp. 1, there was a treatment x time interaction for fluid loss (P < 0.001), but by 8 h after AI, there was no difference in the total volume (70 +/- 1 mL) of semen lost between hormone treatments (85%) compared to controls (90%). There was also a treatment x time interaction (P < 0.05) for number of sperm lost in the backflow (2.1 +/- 0.1 x 10(8)), but by 8 h following AI, there was no effect on total sperm lost for the hormone treatments (38%) compared to C (54%). There was a trend (P = 0.10) for increased numbers of sperm in the uteri of hormone-treated gilts (6.0 +/- 1.3 x 10(4)) compared with C gilts (2.2 +/- 1.3 x 10(4), but there was no effect of treatment on sperm numbers in the oviducts (3.2 +/- 1.3 x 10(4)). Within 0.5 h of AI, there was an increase in the frequency of contractions for PG compared with the other treatments (14.2 vs. 6.3/h, P < 0.005), however there was no effect on amplitude (54 mmHg) or duration (35 s) of contractions. The PR was not influenced by treatment and averaged 54% (P > 0.60), but total numbers of healthy fetuses were increased (P < 0.04) by PG (8.7) and tended (P = 0.06) to be increased for OT (8.4), but not for E (7.2) compared to C (5.8). Hormone addition to semen increased numbers of fetuses and this may be related to an alteration in the pattern of fluid and sperm loss after AI and a tendency for increased numbers of sperm in the anterior segment of the uterus. Therefore, in situations of lowered fertility, hormone addition could be a strategy to limit infertility in swine.

Effect of boar exposure at time of insemination on factors influencing fertility in gilts

The effect of boar exposure during artificial insemination (AI) on semen backflow, fertilization, and embryo quality was evaluated. Gilts (approximately 170 d) were induced into estrus with PG600, and ovulation was synchronized using hCG 72 h later. Estrus detection was initiated after PG600 and continued at 12-h intervals. At estrus, gilts were allotted to receive boar exposure (BE, n = 20) or no boar exposure (NBE, n = 20) during AI. Gilts receiving NBE were identified to be in estrus prior to AI and the boar was then removed for 1 h, whereas gilts in the BE group received 15 min of exposure during AI. Insemination occurred in crates at 12 and 24 h after onset of estrus with 3 x 10(9) sperm/80 mL. Backflow was collected continuously with samples taken at time 0, (during AI), and at 0.25, 0.5, 0.75, 1, 2, 4, and 8 h after first and second AI. The effect of treatment was evaluated for time of insemination (min), backflow (mL), and sperm in backflow samples. Oviducts were flushed 2 d after first AI to evaluate the effect oftreatment on fertilization rate, accessory sperm numbers on embryos (scored 1 to 5), and embryo quality. There was no effect of first or second AI; therefore, data were pooled. Average duration of AI was 3.7 +/- 0.2 min and was not influenced by BE (P < 0.10). However, during the initial stage of AI, BE reduced the volume of semen (18.6 vs 32.4 +/- 3 mL) and the number of sperm lost (0.8 vs 1.3 +/- 0.15 x 10(9) sperm) compared to NBE (P < 0.05). There was a treatment x time effect (P < 0.05) for volume of backflow. By 45 min, the BE gilts lost more volume (9.0 vs 3.6 mL) compared to the NBE group, but sperm loss did not differ. Between 1 and 8 h after AI, neither volume nor sperm loss was influenced by treatment. By 8 h, total leakage (65 vs 63 mL) and total sperm loss (1.6 x 10(9) vs 1.8 x 10(9) sperm) were not influenced by BE (P > 0.10). However, more accessory sperm (P < 0.01) were found on embryos for the NBE (> or = 11 sperm/embryo) compared to BE embryos (< or = 10 sperm/embryo). Despite this observation, percentages of fertilized embryos (99.5 +/- 0.5 %) and number of embryos (11.5 +/- 0.1) were not different (P > 0.10). In conclusion, AI in the presence of a mature boar did not affect total semen leakage, sperm loss, fertilized embryos, or embryo quality. The importance of boar exposure during insemination was evident from less leakage during insemination, but had no effect on fertility; this suggests that the elimination of boar exposure during AI may not be deleterious to reproductive performance.

Polymorphisms in the 3'-untranslated region of human and monkey dopamine transporter genes affect reporter gene expression

Dopamine transporter (DAT) levels vary in normal subjects and deviate from the normal range in pathological states. We investigated mechanisms by which the DAT gene may influence DAT protein expression. As the 3'-untranslated region (3'-UTR) of the DAT gene varies with regard to length and single nucleotide polymorphisms (SNPs), we addressed whether the 3'-UTR of sequence-defined DAT alleles can differentially affect the level of reporter gene expression in vitro. We first established that within individual rhesus monkeys, two alleles of the DAT gene were expressed in the substantia nigra. We then transfected HEK-293 cells with HSV-TK- and SV40-driven luciferase expression vectors harboring downstream DAT 3'-UTR segments of alleles containing polymorphisms of length (human: 9 or 10 repeat units) or SNPs within alleles of fixed length (human: DraI-sensitive (DraI+) vs. DraI-insensitive (DraI-) 10-repeat alleles; rhesus monkey: Bst1107I-sensitive (Bst+) vs. Bst1107I-insensitive (Bst-) 12-repeat alleles). Vectors containing the 3'-UTR segment of a human DAT allele containing nine tandem repeat units resulted in significantly higher levels of luciferase production than analogous vectors containing 10 tandem repeat units. Depending on the promoter used, vectors containing the human or monkey 3'-UTR segments that differed on the basis of an SNP resulted in increases or decreases in luciferase gene expression. This report provides experimental evidence that variability in the length or the sequence of the 3'-UTR of the DAT gene may influence levels of DAT protein in the brain.

Effect of frequency of boar exposure and adjusted mating times on measures of reproductive performance in weaned sows

In weaned sows, reduced reproductive performance can result from failure or delayed return to estrus or improper timing of insemination. This experiment evaluated the effect of increased frequency of boar exposure and adjusted mating times on reproductive performance. Sows of mixed parity were weaned approximately 18.7 d after parturition and allotted by genotype, parity, and lactation length to boar exposure frequency of once daily (1X, n = 66), twice daily every 12 h (2X, n = 61), or three times daily exposure at 8-h intervals (3X, n = 60). Sows were weaned into crates and boar exposure was initiated 3 d after weaning. Once estrus was detected, ultrasound was performed every 8 h to determine time of ovulation. All sows were artificially inseminated twice in the 1X group at 0 and 24 h, in the 2X group at 12 and 24 h, and in the 3X group at 16 and 32 h after onset of estrus. The weaning-to-estrus interval was not influenced by treatment and averaged 4.5 d. The percentage of sows expressing estrus in 8 d was higher (P < 0.05) for 1X (97.3%) compared with 2X (92.8%) but not the 3X group (94.0%). The percentage of sows ovulating after estrus was not influenced by treatment (P > 0.10) and averaged 96.5%. Estrus-to-ovulation interval was not affected by treatment (44.7 h) but was influenced by weaning-to-estrus interval (P < 0.0001). Length of estrus was influenced by treatment (P < 0.001), with estrus in the 1X (46.6 h) shorter than in the 2X (60.0 h) and 3X (67.0 h) treatments, and also by weaning-to-estrus interval (P < 0.001). The percentage of first inseminations occurring within 24 h before ovulation was increased (P < 0.001) in the 2X (62%) and 3X (66%) groups compared with the 1X group (28%) and was also influenced by parity (P < 0.001) and weaning-to-estrus interval (P < 0.05). The percentage of second services within 24 h before ovulation was not increased by any factor and averaged 78%. Farrowing rates were not increased (P > 0.10) for 2X (87.2%) and 3X (83.1%) treatments compared with 1X (75.0%). Total pigs born was also not affected by treatment, although 2X (11.2) and 3X (10.7) numbers were greater than 1X (10.0). It appears that once-daily estrus detection combined with delayed mating could achieve optimal reproductive performance.

Non-amines, drugs without an amine nitrogen, potently block serotonin transport: novel antidepressant candidates?

The serotonin transporter (SERT) is a principal site of action of therapeutic antidepressants in the brain. Without exception, these inhibitors of serotonin transport contain an amine nitrogen in their structure. We previously demonstrated that novel compounds without an amine nitrogen in their structure (non-amines), blocked dopamine transport in cells transfected with the human dopamine transporter. The present study investigated whether, in the absence of an amine nitrogen, certain non-amines bind selectively to the SERT and block the transport of serotonin. At 10 microM concentration, select non-amines displayed no, or little, affinity for 9 serotonin, 5 dopamine, 7 adrenergic, 5 muscarinic cholinergic, 3 opiate and histamine receptors. The affinities of non-amines for [(3)H]citalopram binding sites on the SERT and their potencies for blocking [(3)H]serotonin transport were measured in cloned human SERT stably or transiently expressed in HEK-293. Whether oxa- or carba-based, non-amines bound to [(3)H]citalopram-labeled sites and blocked [(3)H]serotonin transport in the low nanomolar range, at values equal to or higher than those of some conventional antidepressants. A non-amine, O-1809, was 99-fold more selective for the serotonin over the dopamine transporter. As substituents on the aromatic ring of non-amines confer high affinity for the SERT, we investigated the hypothesis that aromatic-aromatic interactions may contribute significantly to non-amine/transporter association. A SERT mutant was produced in which a highly conserved aromatic amino acid, phenylalanine 548, was replaced by an alanine (F548A). Although the affinities of several non-amines were unchanged in the mutant SERT, the affinity of imipramine was decreased, revealing possible differences in amine and non-amine binding domains on the SERT. The similar affinities of non-amines and conventional antidepressant drugs for the SERT support the view that an amine nitrogen is not essential for drugs to block serotonin transport with high affinity. Non-amines open avenues for developing a new generation of antidepressants.

Clinical and radiographic features of dural arteriovenous fistula, a treatable cause of myelopathy

OBJECTIVE

To assess presentation, imaging, treatment, and outcome of patients with myelopathy due to a dural arteriovenous fistula (DAVF).

PATIENTS AND METHODS

This retrospective review identified 94 patients with DAVF surgically treated at our institution between June 1985 and December 1999. The mean ages of the 75 men and 19 women were 62.6 years and 63.0 years, respectively (range, 31-83 years). Magnetic resonance imaging was performed in 87 patients, computed tomography-myelography was performed in 37 patients, and spinal angiography was performed in all patients. Initial examination findings were retrospectively adjusted to a modified Aminoff-Logue myelopathy scale.

RESULTS

Of the 94 patients, 47 presented with symptoms that worsened with erect posture or Valsalva maneuver. As myelopathy progressed, patients' symptoms increased, and 6 patients had paraplegia at presentation. The mean time from symptom onset to diagnosis was 23 months (range, 2-120 months). Magnetic resonance imaging confirmed the diagnosis in 86 patients; computed tomography-myelography was needed to confirm the fistula in 1 patient. Spinal angiography detected the fistula in all patients. Surgical obliteration of the DAVF was successful in 93 patients; in 1 patient surgery failed because the DAVF was not localized, but acrylic endovascular embolization was successful. No patient experienced permanent morbidity or mortality. Of the 94 patients, 93 improved postoperatively 1 or 2 levels based on a modified Aminoff-Logue scale. Older patients with severe long-term deficits had poor outcomes.

CONCLUSIONS

The diagnosis of a DAVF seems to be delayed considerably because DAVF is not included in the differential diagnosis of myelopathy and because of clinicians' unfamiliarity with suggestive or revealing findings on diagnostic imaging. Neurodiagnostic imaging confirms the diagnosis, and spinal angiography localizes the fistula. Surgical intradural disconnection of the DAVF clinically reverses the pathophysiology. Additionally, surgical treatment is associated with low short-term morbidity, no permanent morbidity, and no mortality. If the diagnosis is made early and treatment initiated in such patients, they generally do well.

Liposome-encapsulated tumor necrosis factor-alpha enhances the effects of radiation against human colon tumor xenografts

Recent reports have shown that tumor necrosis factor-alpha (TNF-alpha) can augment the effects of radiation against certain tumor types. However, the high concentrations of intravenous infusion of TNF-alpha needed to cause tumor regression can induce many systemic side effects. The aims of this study were to determine if TNF-alpha encapsulated in sterically stabilized (Stealth, ALZA Corporation, Mountain View, CA), PEGylated liposomes (SL) augments the antitumor effects of radiation and to compare its efficacy and possible toxicity with free TNF-alpha in the LS174T human colon tumor xenograft model. Nude mice were injected subcutaneously (s.c.) with LS174T cells and treated intravenously (i.v.) with Stealth-liposomal TNF-alpha (SL-TNF-alpha) with and without radiation or TNF-alpha with or without radiation when tumor size was approximately 200 mm(3). In phase 1, a significant decrease (p = 0.047) in tumor growth was observed with radiation at day 21 but not with SL-TNF-alpha or free TNF-alpha alone. By the end of phase 1 (day 27) with continued treatments, the SL-TNF-alpha plus radiation group had significantly smaller tumors (p = 0.044) than those in the free TNF-alpha plus radiation group. In phase 2, where a similar tumor growth reduction pattern was observed, the addition of TNF-alpha to radiation, either as free protein or within SL, increased lymphocyte activation and natural killer (NK) cell numbers in both blood and spleen. The effect was generally more pronounced with SL-TNF-alpha. Systemic toxicity, based on hematologic analyses and body weight, was absent or minimal. Collectively, the data show that pretreatment with SL-TNF-alpha can enhance more effectively, and possibly more safely, the effects of radiation against human colon tumor xenografts than can free TNF-alpha and that the increased antitumor action may involve upregulation of lymphocytes.

MR imaging in comatose survivors of cardiac resuscitation

BACKGROUND AND PURPOSE

The prognosis of comatose survivors is determined by clinical examination. Early laboratory indicators of poor prognosis (such as evoked potentials) have low sensitivity. The role of MR imaging as a confirmatory study was investigated.

METHODS

We studied fluid-attenuated inversion recovery (FLAIR) and diffusion-weighted (DW) imaging in 10 patients comatose after cardiac arrest.

RESULTS

None of the 10 comatose patients had myoclonus status epilepticus or fixed, dilated pupils on neurologic examination, and none had abnormal somatosensory-evoked potentials. Eight patients showed diffuse signal abnormalities, predominantly in the cerebellum (n = 5), the thalamus (n = 8), the frontal and parietal cortices (n = 8), and the hippocampus (n = 9). One patient showed normal MR imaging results, and one patient had abnormalities in the thalamus and cerebellum and minimal abnormality on DW images; both later awakened. None of the patients with abnormal cortical structures on FLAIR MR images recovered beyond a severely disabled state.

CONCLUSION

MR imaging in comatose survivors may parallel the pathologic findings in severe anoxic-ischemic injury, and extensive abnormalities may indicate little to no prospects for recovery. If confirmed, MR imaging may have a role as a prognosticating test in anoxic-ischemic coma.

Dose and dose rate effects of whole-body gamma-irradiation: II. Hematological variables and cytokines

The goal of part II of this study was to evaluate the effects of gamma-radiation on circulating blood cells, functional characteristics of splenocytes, and cytokine expression after whole-body irradiation at varying total doses and at low- and high-dose-rates (LDR, HDR). Young adult C57BL/6 mice (n = 75) were irradiated with either 1 cGy/min or 80 cGy/min photons from a 60Co source to cumulative doses of 0.5, 1.5, and 3.0 Gy. The animals were euthanized at 4 days post-exposure for in vitro assays. Significant dose- (but not dose-rate-) dependent decreases were observed in erythrocyte and blood leukocyte counts, hemoglobin, hematocrit, lipopolysaccharide (LPS)-induced 3H-thymidine incorporation, and interleukin-2 (IL-2) secretion by activated spleen cells when compared to sham-irradiated controls (p < 0.05). Basal proliferation of leukocytes in the blood and spleen increased significantly with increasing dose (p < 0.05). Significant dose rate effects were observed only in thrombocyte counts. Plasma levels of transforming growth factor-beta 1 (TGF-beta 1) and splenocyte secretion of tumor necrosis factor-alpha (TNF-alpha) were not affected by either the dose or dose rate of radiation. The data demonstrate that the responses of blood and spleen were largely dependent upon the total dose of radiation employed and that an 80-fold difference in the dose rate was not a significant factor in the great majority of measurements.

Administration of p.g. 600 to sows at weaning and the time of ovulation as determined by transrectal ultrasound

This study determined whether the interval from estrus to ovulation was altered by giving P.G. 600 to sows at weaning. Mixed-parity sows received P.G. 600 i.m. (n = 72) or no treatment (n = 65) at weaning (d 0). Beginning on d 0, sows were observed for estrus twice daily. At the onset of estrus and thereafter, ultrasound was performed twice daily to determine the average size of the largest follicles and time of ovulation. Weaning age (20.1+/-0.4 d) did not differ (P > 0.10) between treatments. More P.G. 600 sows expressed estrus within 8 d (P < 0.01) than controls (94.4% vs 78.4%, respectively). Parity was associated with expression of estrus (P < 0.02), with 78% of first-parity and 93% of later-parity sows exhibiting estrus. However, no treatment x parity effect was observed (P > 0.10). The interval from weaning to estrus was reduced (P < 0.0001) by P.G. 600 compared with controls (3.8+/-0.1 d vs 4.9+/-0.1 d). Follicle size at estrus was not affected by treatment (P > 0.10). The percentage of sows that ovulated did not differ (P > 0.10) for P.G. 600 and control sows (90.3% vs 81.5%, respectively). Time of ovulation after estrus was not affected by treatment and averaged 44.8 h. However, univariate analysis indicated that the interval from weaning to estrus influenced the interval from estrus to ovulation (r = 0.43, P < 0.0001). Further, multivariate analysis showed an effect of treatment on the intervals from weaning to estrus, weaning to ovulation (P < 0.0001), and estrus to ovulation (P < 0.04). Within 4 d after weaning, 81% of the P.G. 600 sows had expressed estrus compared with 33% of controls. However, this trend reversed for ovulation, with only 35% of P.G. 600 sows ovulating by 36 h after estrus compared with 40% of controls. The estrus-to-ovulation interval was also longer for control and P.G. 600 sows expressing estrus < or = 3 d of weaning (45 h and 58 h, respectively) than for sows expressing estrus after 5 d (39 h and 32 h, respectively). Farrowing rate and litter size were not influenced by treatment. However, the interval from last insemination to ovulation (P < 0.02) indicated that more sows farrowed (80%) when the last insemination occurred at < or = 23 to > or = 0 h before ovulation compared with insemination > or = 24 h before ovulation (55%). In summary, P.G. 600 enhanced the expression of estrus and ovulation in weaned sows but, breeding protocols may need to be optimized for time of ovulation based on the interval from weaning to estrus.

Cloning of dopamine, norepinephrine and serotonin transporters from monkey brain: relevance to cocaine sensitivity

We used RT-PCR to clone monoamine transporters from Macaca mulatta, Macaca fasicularis and Saimiri sciureus (dopamine transporter; DAT) and Macaca mulatta (norepinephrine transporter; NET and serotonin transporter; SERT). Monkey DAT, NET and SERT proteins were >98% homologous to human and, when expressed in HEK-293 cells, displayed drug affinities and uptake kinetics that were highly correlated with monkey brain or human monoamine transporters. In contrast to reports of other species, we discovered double (leucine for phenylalanine 143 and arginine for glutamine 509; Variant I) and single (proline for leucine 355; Variant II) amino acid variants of DAT. Variant I displayed dopamine transport kinetics and binding affinities for various DAT blockers (including cocaine) versus [3H] CFT (WIN 35, 428) that were identical to wild-type DAT (n=7 drugs; r(2)=0.991). However, we detected a six-fold difference in the affinity of cocaine versus [3H] cocaine between Variant I (IC(50): 488+/-102 nM, SEM, n=3) and wild-type DAT (IC(50): 79+/-8.2 nM, n=3, P<0.05). Variant II was localized intracellularly in HEK-293 cells, as detected by confocal microscopy, and had very low levels of binding and dopamine transport. Also discovered was a novel exon 5 splice variant of NET that displayed very low levels of transport and did not bind cocaine. With NetPhos analysis, we detected a number of highly conserved putative phosphorylation sites on extracellular as well as intracellular loops of the DAT, NET, and SERT, which may be functional for internalized transporters. The homology and functional similarity of human and monkey monoamine transporters further support the value of primates in investigating the role of monoamine transporters in substance abuse mechanisms, neuropsychiatric disorders and development of diagnostic and therapeutic agents.

Implant placement in the vertically enhanced ridge--a surgical and restorative interdisciplinary approach

A diagnostic and therapeutic approach is offered to enable the surgeon and restorative dentist to successfully install endosseous implants into the vertically enhanced ridge. The strategy involves the use of diagnostic and surgical templates to aid in the creation of positive osseous architecture followed by the vertical orientation of the endosseous implant(s). This effort provides optimal hard-tissue and soft-tissue form for the creation of the most favorable crown profiles for implant-supported prostheses.

Single nucleotide polymorphisms distinguish multiple dopamine transporter alleles in primates: implications for association with attention deficit hyperactivity disorder and other neuropsychiatric disorders

The human dopamine transporter (DAT) gene contains a variable number tandem repeat (VNTR; 40 bases/3 to >11 repeats) in the 3'-untranslated region (3'-UTR), resulting in multiple alleles categorized by length. The 10-copy allele has been associated with attention deficit hyperactivity disorder (ADHD), yet it accounts for only a small proportion of symptom variance. We investigated whether the rhesus monkey DAT gene contains a repeat sequence similar to the human and whether this region differs in the five most hyperactive and the five most sedate animals selected from a behaviorally characterized cohort (n = 22). A fixed number tandem repeat (FNTR; 39 bases/12 repeats) was observed in all animals. Accordingly, this FNTR is unbefitting an association of DAT transcript length with hyperactivity. However, sequence analysis revealed potential single nucleotide polymorphisms (SNPs), one of which affects a Bst1107I restriction site. We screened the entire cohort, confirmed that all the rhesus monkeys had repeat regions of the same length, and demonstrated that digestion with Bst1107I was sufficient to distinguish two distinct FNTR alleles. Bst1107I genotype was suggestive but not predictive of hyperactive behavior. Based on these data, we speculated that SNPs may exist in human DAT VNTR alleles. To support this hypothesis, we cloned a portion of a novel 10-repeat allele from the human gene containing an SNP that abolishes a DraI restriction site. We conclude that SNPs create a diversity of DAT alleles between individuals that may be greater than previously identified based solely on the length of the VNTR region, and that alleles of specific sequence may contribute to dopamine-related disorders.

Molecular and regional targets of cocaine in primate brain: liberation from prosaic views

Abstract The neurochemical processes underlying initial exposure to and reinforcing effects of cocaine are not fully understood. An enduring hypothesis of cocaine addiction is based on an underlying premise that dopamine is the acute mediator of the rewarding effects of cocaine and this nefarious role extends through each phase of addiction. Cocaine is an effective inhibitor of the dopamine transporter, thereby increasing extracellular dopamine levels. Euphoria is attributed to the cocaine-induced inundation of extracellular dopamine and the withdrawal and craving for cocaine after cessation of drug use are attributed to neuroadaptive processes to dampen dopaminergic transmission. Nevertheless, our understanding of the role of dopamine transporter blockade in cocaine addiction is not fully understood. The objectives of this laboratory are to investigate the primary targets of cocaine in the brain, those associated with the initial phase of cocaine use and that can provide leads for investigating neuroadaptive processes that may trigger addiction. Two prosaic views of the neurobiology of cocaine addiction are examined in this review. The first is based on the assumption that the dopamine transporter contributes significantly to the stimulant and reinforcing effects of cocaine, and focuses on how stimulant drugs of abuse such as cocaine bind to the dopamine transporter. We present evidence that the widespread assumption that dopamine transporter blockers require an amine nitrogen in their structure is incorrect as non-amines are effective blockers of transporters. The second prosaic view, based on the assumption that the dopamine transporter fulfills a paramount role in cocaine addiction, is assessed in view of mounting evidence that the transporter may not account for the full spectrum of cocaine's effects. Other targets of cocaine, which may be relevant to the acute and chronic effects of cocaine, are presented.

Absent pachymeningeal gadolinium enhancement on cranial MRI despite symptomatic CSF leak

CSF leak is recognized to cause orthostatic headaches and diffuse pachymeningeal gadolinium enhancement (DPMGE) on MRI. We report six patients with typical symptoms and documented CSF leaks without DPMGE. Two had normal meninges from the onset; one initially had normal meninges, but subsequently DPMGE developed. In three, the initially noted DPMGE resolved while they were still symptomatic with documented continued CSF leaks. Absent DPMGE does not rule out CSF leak. When clinical manifestations suggest this disorder, additional diagnostic studies should be pursued.

Suspected non-small cell lung cancer: incidence of occult brain and skeletal metastases and effectiveness of imaging for detection--pilot study

PURPOSE

To estimate the incidence of occult metastases to the brain and skeleton in patients suspected of having non-small cell lung cancer (NSCLC) (stage higher than T1Nomo) with surgically resectable disease, to assess the accuracy of screening magnetic resonance (MR) imaging and radionuclide bone scanning for help in identifying occult metastases, and to determine the effectiveness of a high dose of MR contrast material.

MATERIALS AND METHODS

Twenty-nine patients suspected of having NSCLC localized to the lung or to the lung and regional nodes underwent preoperative MR imaging with contrast material enhancement and radionuclide bone scanning for detection of brain or skeletal metastases. Patients were followed up for 12 months to determine the incidence of clinical metastatic disease.

RESULTS

Eight (28%) patients had occult metastatic disease to the brain or skeleton. Brain metastases were identified on MR images in five of six patients. Bone metastases were identified on MR images in four of five patients and on bone scans in three of five patients. MR imaging was no more accurate than bone scanning for skeletal evaluation. A high dose of MR contrast material allowed detection of more metastases and of small lesions.

CONCLUSION

Contrast-enhanced MR imaging of the brain is indicated for the exclusion of brain metastases in patients with clinically operable known or possible NSCLC and a large (> 3-cm) lung mass. Skeletal imaging may be indicated if an isolated brain metastasis is detected.

Juxtafacet cysts of the cervical spine

OBJECTIVE

We report a retrospective series of 13 patients who presented with symptoms and signs caused by cervical juxtafacet cysts. Clinical findings, radiographic features, surgical management strategies, and possible causes are reported and discussed.

METHODS

We reviewed clinical histories, radiographic studies, surgical notes, and pathological records of all 13 patients who underwent surgery for subaxial cervical juxtafacet cysts from 1984 to 1997 at the Mayo Clinic in Rochester, MN. During the summer of 1997, surgical outcomes were assessed by direct or telephone interview.

RESULTS

Nine patients were men and four were women. The average age at the time of presentation was 66 years. One patient had undergone a previous anterior cervical fusion below the level of the cyst. Ten patients presented with radiculopathies. Two patients presented with myeloradiculopathies. One patient presented with a cervical myelopathy. Computed tomographic myelography and magnetic resonance imaging were essential in establishing a preoperative diagnosis. The cysts were located at C7-T1 in nine patients, at C4-C5 in two patients, at C6-C7 in one patient, and at C3-C4 in one patient. All patients underwent posterior laminectomy or hemilaminectomy, excision of the cyst, and decompression of the thecal sac and/or nerve root. Two patients underwent concurrent posterior fusion procedures for instability. All patients experienced good to excellent relief of their radicular pain. All three myelopathies stabilized after surgery. There were no major complications or recurrences.

CONCLUSION

Juxtafacet cysts seem to be a degenerative change of the cervical spine rather than a traumatic event. Similar to their counterparts in the lumbar spine, they tend to arise in segments with increased mobility. Surgical treatment is effective.

MR imaging in pretruncal nonaneurysmal subarachnoid hemorrhage: is it worthwhile?

BACKGROUND AND PURPOSE

The cause of pretruncal (perimesencephalic) nonaneurysmal subarachnoid hemorrhage is not known. MRI of the brain or spine is often performed to exclude any other vascular abnormalities. Its diagnostic value is not known.

METHODS

We used MR imaging of the brain with routine sequences, gadolinium enhancement, and additional thin T1-weighted axial sections following a triple dose of contrast.

RESULTS

We performed MR imaging of the brain in 18 patients with a pretruncal nonaneurysmal subarachnoid hemorrhage. The focal nature of the subarachnoid hemorrhage exclusively in front of the brain stem was confirmed in 14 patients studied within 7 days of the ictus. No vascular abnormalities were found in 17 cases, including 14 patients with gadolinium enhancement. An incidental capillary telangiectasia was found in 1 patient. Fluid-attenuated inverse recovery MR additionally documented blood in the sulci due to cerebrospinal fluid recirculation of blood. Five patients underwent MR imaging of the spine, and no arteriovenous malformations were found.

CONCLUSIONS

MR imaging did not reveal a source of pretruncal subarachnoid hemorrhage. The cost of MR imaging probably outweighs the benefit in the evaluation of this variant of subarachnoid hemorrhage.

Pretruncal nonaneurysmal subarachnoid hemorrhage

OBJECTIVE

To review the diagnostic evaluation and the clinical course of patients with pretruncal nonaneurysmal subarachnoid hemorrhage.

MATERIAL AND METHODS

The study population consisted of a consecutive series of patients with a pretruncal nonaneurysmal subarachnoid hemorrhage encountered at Mayo Clinic Rochester during a 6-year interval. We reviewed the clinical manifestations, the neuroimaging characteristics, and the appropriate management.

RESULTS

The 15 male and 9 female patients with a pretruncal nonaneurysmal subarachnoid hemorrhage ranged from 3 to 72 years of age (median, 45). Of the 24 patients, 18 had a sudden explosive headache at the time of initial assessment. Ventricular shunting for acute hydrocephalus was indicated in one patient. Neuroimaging studies demonstrated that the center of the hemorrhage was prepontine, and it extended into the interpeduncular or premedullary cisterns. In two patients, a small focal hemorrhage was not noted on an admission computed tomographic scan but was identified on repeated study. A second four-vessel cerebral angiogram, obtained in most patients, showed normal findings in four patients who had had cerebral vasospasm on the first study. In one patient, moderate cerebral vasospasm was found on the second angiogram. No patient had rebleeding. One patient had transient dysphasia associated with cerebral vasospasm after cerebral angiography. Two patients had a family history of aneurysmal subarachnoid hemorrhage.

CONCLUSION

The excellent outcome in patients with pretruncal nonaneurysmal subarachnoid hemorrhage is in distinct contrast to the overall somber outcome associated with aneurysmal subarachnoid hemorrhage. A ruptured aneurysm of the posterior circulation may mimic a pretruncal nonaneurysmal subarachnoid hemorrhage and should be excluded on the basis of a technically satisfactory cerebral angiogram.

Evidence of posterior fossa hypoplasia in the familial variant of adult Chiari I malformation: case report

OBJECTIVE AND IMPORTANCE

A case of familial Chiari I malformation and a review of the literature are presented. Recent posterior fossa morphological studies suggest that the sporadic variant of adult Chiari I malformation may be caused by occipital dysplasia and overcrowding of posterior fossa contents. This analysis was applied retrospectively for two of the three members of this familial variant.

CLINICAL PRESENTATION

A family is described in which symptomatic Chiari I malformation occurred in two generations: monozygotic twin sisters and the daughter of one sister. The monozygotic twins developed symptoms within 1 year of each other, and both had associated syringomyelia. The daughter of one of the twins presented with symptomatic tonsillar herniation alone at a young age.

INTERVENTION

All three family members underwent surgical decompression of the craniovertebral junction, with or without syringosubarachnoid shunting, with good results.

CONCLUSION

Cases of familial Chiari I malformation are rare, although they are probably under-reported. An evaluation of posterior fossa morphology in these patients suggests that occipital dysplasia and overcrowding of posterior fossa contents may be the substrate for both familial and sporadic cases of Chiari I malformation and suggests a unifying concept of origin.

Acquired Chiari I malformation secondary to spontaneous spinal cerebrospinal fluid leakage and chronic intracranial hypotension syndrome in seven cases

OBJECT

Spontaneous spinal cerebrospinal fluid (CSF) leakage with development of the intracranial hypotension syndrome and acquired Chiari I malformation due to lumbar spinal CSF diversion procedures have both been well described. However, concomitant presentation of both syndromes has rarely been reported. The object of this paper is to present data in seven cases in which both syndromes were present. Three illustrative cases are reported in detail.

METHODS

The authors describe seven symptomatic cases of spontaneous spinal CSF leakage with chronic intracranial hypotension syndrome in which magnetic resonance (MR) images depicted dural enhancement, brain sagging, loss of CSF cisterns, and acquired Chiari I malformation.

CONCLUSIONS

This subtype of intracranial hypotension syndrome probably results from chronic spinal drainage of CSF or high-flow CSF shunting and subsequent loss of brain buoyancy that results in brain settling and herniation of hindbrain structures through the foramen magnum. Of 35 cases of spontaneous spinal CSF leakage identified in the authors' practice over the last decade, MR imaging evidence of acquired Chiari I malformation has been shown in seven. Not to be confused with idiopathic Chiari I malformation, ideal therapy requires recognition of the syndrome and treatment directed to the site of the spinal CSF leak.

Defining the cross-sectional anatomy important to interscalene brachial plexus block with magnetic resonance imaging

BACKGROUND AND OBJECTIVES

Interscalene brachial plexus block is a useful technique to provide anesthesia and analgesia for the shoulder and proximal upper extremity. The initial needle direction at the interscalene groove has been described as being "perpendicular to the skin in every plane" (1). A cross-sectional (axial) approach may offer a more easily conceptualized directed needle placement. The purpose of this study is to define the cross-sectional anatomy and idealized needle angles important to interscalene brachial plexus block.

METHODS

Following IRB approval, 50 patients were studied. Cross-sectional volume coil T1-weighted magnetic resonance images (MRI) were obtained from 50 patients undergoing cervical region imaging for other reasons. At the interscalene groove, a simulated needle path to contact the ventral rami or trunks of the brachial plexus was approximated at the level of C6 or C6-C7 interspace. The angle of this needle path intersecting the sagittal plane was recorded for each patient.

RESULTS

The mean angle of the simulated needle path relative to sagittal plane was determined to be 61.1 +/- 6.1 degrees (range, 50-78 degrees). In 13 of 50 (26%) MRI scans, the cervical nerve roots were not visualized at the level of C6 and were measured at the C6-C7 level.

CONCLUSIONS

These findings suggest initial needle placement at the interscalene groove should be angled less perpendicularly relative to the sagittal plane than is often observed. A cross-sectional approach enables more practical visualization of initial needle placement. A more accurate initial needle placement may minimize the number of needle passes necessary to contact the nerve roots, thereby more efficiently obtaining a successful block.

Posterior vertebral body erosion by arachnoid diverticula in cauda equina syndrome: an unusual manifestation of ankylosing spondylitis

Cauda equina syndrome is an uncommon complication of longstanding ankylosing spondylitis. It is associated with dorsal arachnoid diverticula, which may erode the lamina and spinous processes of the bony lumbosacral spine. We describe a patient who developed cauda equina syndrome associated with the unusual finding of erosion of the posterior aspect of 2 vertebral bodies by arachnoid diverticula. This was clearly revealed by magnetic resonance imaging of the spine.

What nature's knockout teaches us about GnRH activity: hypogonadal mice and neuronal grafts

The hypogonadal mouse is one of "nature's knockouts," bearing a specific deletion in the gene for gonadotropin-releasing hormone (GnRH), with the result that no GnRH peptide is detectable in the brain. The lack of reproductive development after birth provides an animal model that has proved fruitful in clarifying the role of GnRH in reproductive behavior and physiology. Behavioral studies with hypogonadal mice convincingly demonstrate that although GnRH may facilitate the appearance of sexual behavior, this peptide is not essential for either male or female sexual behavior in the mouse. Administration of GnRH to hypogonadal mice with regimens mimicking GnRH pulsatility initiates reproductive development. Surprisingly, continuous exposure to GnRH stimulates remarkable ovarian and uterine growth and increased FSH release, although pituitary content of LH and FSH remains unchanged. In contrast, when brain grafts of normal fetal preoptic area (POA), containing GnRH cells, are implanted in the third ventricle of adult hypogonadal mice, both pituitary and plasma gonadotropin levels increase. Grafted GnRH neurons innervate the median eminence of the host and support pulsatile LH secretion in the majority of animals with graft-associated gonadal development. Studies of hypogonadal mice with POA grafts demonstrate that distinct components of reproductive function are dissociable: hosts may demonstrate reflex but not spontaneous ovulation; others may show positive but not negative feedback. Activation of grafted GnRH cells in response to sensory input to the host, as revealed in Fos expression studies, is an example of the integration of the graft with the host brain that underlies such capabilities. A goal of these studies is to elucidate the specific connectivity underlying discrete aspects of reproductive function.

Syndrome of orthostatic headaches and diffuse pachymeningeal gadolinium enhancement

OBJECTIVE

To characterize clinical and imaging features, biopsy findings, etiologic factors, and outcome in the syndrome of intracranial hypotension, headaches, and diffuse pachymeningeal gadolinium enhancement on magnetic resonance imaging (MRI).

MATERIAL AND METHODS

We describe our experience with 26 consecutive patients with orthostatic headaches and diffuse pachymeningeal gadolinium enhancement, for all of whom clinical, imaging, and follow-up data were available. For 10 patients who had undergone meningeal biopsy, slide material was also reviewed.

RESULTS

The 15 men and 11 women ranged from 24 to 76 years of age. All 26 patients had postural headaches; in 22 patients, the headaches were completely alleviated by recumbency. Nausea or emesis, neck pain, horizontal diplopia, changes in hearing, photophobia, upper limb pains or paresthesias, visual blurring, or dysgeusia was noted in some of the patients. Cardinal MRI features were diffuse pachymeningeal gadolinium enhancement (100%), subdural collections of fluid (69%), and evidence of descent of the brain (62%) that sometimes resembled type I Chiari malformation. Cerebrospinal fluid (CSF) opening pressures were 40 mm or less in only 46%. In three patients, CSF pressures were consistently no less than 90 and as high as 130 mm of water. A variable pleocytosis of 5 or more cells/mm3 was noted in 15 patients (more than 40 cells/mm3 in 4 patients). A variable increase in CSF protein was noted in at least one spinal tap in 23 patients. Six patients had overdraining CSF shunts; CSF leak was documented in another 11 patients. Shunt revision or ligation and surgical correction of the leak led to a resolution of the clinical and MRI abnormalities in all cases thus treated. Improvement occurred with epidural blood patch in four patients. Three of the 12 patients treated supportively have remained symptomatic. Histologically, a thin subdural zone of fibroblasts and thin-walled vessels was noted in an amorphous matrix. Two patients with prolonged symptoms had a more pronounced proliferative reaction.

CONCLUSION

The syndrome of low-pressure headaches and pachymeningeal gadolinium enhancement is being recognized with increasing frequency. The source of the CSF leak can be demonstrated in many patients. Meningeal abnormalities are likely attributable to decreased CSF volume and hydrostatic CSF pressure changes. The prognosis is typically good.

MR imaging of progressive downward herniation of the diencephalon

Some clinicians have challenged the clinicopathologic correlation in patients with brain herniation from acute mass lesions. Earlier studies have questioned the significance of downward displacement of the brainstem in supratentorial herniation. Using recent generation MRI, we studied a patient with an acute hemorrhagic infarction. MRI demonstrated significant compression of the diencephalon with downward displacement of the midbrain and hyperintensity on T2-weighted sequences in the lateral mesencephalon during progression from early diencephalic stage to midbrain upper pons stage of herniation. This is the first intra vitam documentation of diencephalic herniation by MR imaging and confirms rostrocaudal deterioration usually found at autopsy.

Polarization states and output powers of a CO(2) laser with an electro-optic phase retarder

We study the power output and polarization state of a CO(2) laser that contains both passive polarization-sensitive elements (Brewster plates) and an active phase-retarding electro-optic modulator (CdTe crystal). The theoretical threshold condition (i.e., the retardation required to extinguish the laser) is obtained from a cavity round-trip Jones matrix. We show that adding extra Brewster plates may be counterproductive in that the required retardation voltage increases. We calculated the output power, which depends on the saturated gain properties of the active media, by iterative modeling, with the elliptically polarized light propagated repeatedly around the cavity. We compare the theory with results from a folded rf-excited waveguide CO(2) laser (Laser Ecosse Model CM3500). Theory and experiment are in fair agreement for low powers. As expected, at high powers there are extra difficulties in modeling the cavity behavior, probably because of distortions induced in and by the crystal.

Multiple sclerosis of the spinal cord: magnetic resonance appearance

OBJECTIVE

To determine the MR appearance of spinal cord multiple sclerosis (MS) plaques in patients presenting with myelopathy by using a high-field (1.5 T) imager.

MATERIALS AND METHODS

We studied 119 patients who underwent high-field (1.5 T) MR studies of the spinal cord for evaluation of myelopathy. All 119 patients were thought to have possible findings of spinal cord MS at the time of the MRI interpretation.

RESULTS

Sixty-four plaques were studied in 47 patients with clinically definite MS and adequate quality MRI. Of these patients 68% had a single spinal cord plaque, 19% had two plaques, and 13% had three or more plaques. Sixty-two percent of the plaques occurred in the cervical spinal cord and most frequently involved the posterior (41%) and lateral (25%) aspects of the spinal cord. None of the 64 lesions involved the entire thickness of the spinal cord. The lesion length varied from 2 to 60 mm, with 84% of the lesions < 15 mm in length. The spinal cord diameter was unchanged in 84% of plaques, enlarged at the level of the lesion in 14%, and atrophic in 2%. Just over half (55%) of the plaques enhanced with intravenously administered gadolinium. Of the patients who received synchronous head and spinal cord examinations on the same day, 24% had normal findings on the MR study of the head. Follow-up spinal cord studies were available in nine patients. New lesions developed in two patients, while previously described lesions resolved. In three patients only new lesions developed. In four patients no change occurred in the existing number of cord plaques.

CONCLUSION

Spinal cord demyelinating plaques present as well-circumscribed foci of increased T2 signal that asymmetrically involve the spinal cord parenchyma. Knowledge of their usual appearance may prevent unnecessary biopsy. An MR examination of the head may confirm the imaging suggestion of spinal cord demyelinating disease, because up to 76% of patients have abnormal intracranial findings. In the remaining 24% of cases in which the clinical diagnosis is not certain and MR findings in the head are negative, a follow-up spinal cord study is recommended, because these lesions evolve and change over time.

Gonadotropin-releasing hormone messenger RNA expression in gonadotroph tumors and normal human pituitary

Gonadotroph tumors predominantly secrete FSH or free gonadotropin hormone subunits and rarely LH. In contrast to normal gonadotrophs, a subset of tumors synthesize FSH beta-subunit (SU) in excess of alpha-SU, and the cause of gonadotropin hormone-SU biosynthetic defects in these tumors is unknown. Gonadotropin-releasing hormone (GnRH) is known to modify gonadotropin hormone-SU biosynthesis and secretion and may be an important determinant of gonadotroph tumor hormone regulation. Data in experimental animals have demonstrated that endogenous expression of GnRH may occur in the pituitary. We therefore determined whether 1) the GnRH gene is expressed in gonadotroph tumors and normal pituitaries using reverse transcriptase (RT)-PCR; 2) the GnRH receptor gene is co-expressed in gonadotroph tumors; 3) an alternative upstream transcriptional start site on the GnRH gene is utilized; and 4) media from primary cultures of gonadotroph tumors have detectable GnRH immunoreactivity by RIA. GnRH messenger RNA (mRNA) was detected in 10/10 gonadotroph tumors, eight of which expressed GnRH-Receptor mRNA. Both mRNAs were detected in all normal pituitaries studied (n = 6). Six of 10 gonadotroph tumors and 3/6 normal pituitaries had GnRH transcripts derived from the upstream transcriptional start site (5'GnRH). GnRH immunoreactivity was detected in overnight media from 3/3 primary gonadotroph tumor cultures (range: 1.89-5.86pg/mL; limit of detection (LD) = < 1.58pg/mL) but was not detectable in control media. This is the first study to demonstrate endogenous GnRH gene expression in human pituitary adenomas and normal human pituitary tissue. The presence of both GnRH and GnRH-Rc suggest that GnRH may be a paracrine/autocrine regulator of cell function in the pituitary and may affect gonadotroph tumor hormone phenotype.

Butterfly vertebra

A 41-year-old man with low back pain and lumbar disc disease was found to have L-3 butterfly vertebra on imaging studies as an incidental finding. This uncommon congenital anomaly of the vertebral column is usually asymptomatic and of no clinical significance. Awareness of this deformity and its imaging features is important diagnostically.

Meningeal biopsy in intracranial hypotension: meningeal enhancement on MRI

Intracranial hypotension is a cause of diffuse enhancement of the pachymeninx with gadolinium, which often is associated with subdural fluid collections. We reviewed the results of meningeal biopsy in six patients with intracranial hypotension and diffuse pachymeningeal enhancement to correlate the MRI findings with histopathologic observations and to explain the abnormalities seen on MRI. Grossly, the dura mater was unremarkable in all patients, as were the leptomeninges, except for one patient with prolonged (18 months) intracranial hypotension in whom the arachnoid was thickened and opaque. Microscopically, the dura mater was entirely normal on its epidural aspect; however, a fairly thin zone of fibroblasts and thin-walled small blood vessels in an amorphous matrix was noted on the subdural aspect. In the patient with longstanding symptoms, diffuse benign arachnoidal cell proliferation was also noted, probably a reaction triggered by longstanding changes in the subdural area, as noted in the five other patients. There was no evidence of inflammation, infection, or metastatic neoplasia. These findings suggest that in intracranial hypotension, the dural-meningeal abnormalities probably represent reactive secondary phenomena, likely related to hydrostatic changes in the CSF, and not a primary meningeal process.

Cervical disk prolapse

OBJECTIVE

To correlate the findings on computed tomographic myelography (CTM) with surgically and pathologically proven prolapsed cervical disks, mention other pertinent cross-sectional imaging studies, and note the clinical relevance of certain CTM features.

DESIGN

We retrospectively reviewed the medical and radiologic records of Mayo patients with suspected degenerative cervical disk disease during a 4-year period.

MATERIAL AND METHODS

Between January 1986 and December 1989, 734 patients with possible cervical disk disease underwent assessment by CTM. An extruded disk was noted in 297 of these patients. In this study group, magnetic resonance (MR) imaging was also done in 28 patients and plain computed tomography was performed in 14, and we summarized those findings.

RESULTS

Of the 297 study patients, 280 had a cervical radiculopathy and 17 had a myelopathy. CTM identified more than 90% of the extruded cervical disks. CTM could not distinguish between an osteophytic cartilaginous cap and a disk, and CTM could not identify the source of a cervical radiculopathy in 102 patients. Although only a few imaging studies other than CTM were performed, those modalities were less sensitive in the detection of prolapsed disks.

CONCLUSION

Imaging of cervical disk prolapse continues to be difficult, and the results are not always specific. CTM is the most sensitive imaging examination, but the number of MR studies in the current series of patients was insufficient for a reasonable comparison between the two modalities.