Regional Gray Matter Volume Reduction Associated with Major Depressive Disorder: A Voxel-Based Morphometry

BACKGROUND AND PURPOSE: The association between the low emotional regulation and the brain structural change of major depressive disorder (MDD) has been proposed, but the voxel-based morphometry (VBM) studies on female MDD are rare. The purpose of the present study was to show the regional volume changes of gray matter (GM) in female patients with MDD by optimized VBM. METHODS: To control subjects homogeneity, twenty female MDD patients and age, sex matched 21 normal controls were included for the VBM analysis. To identify the change of regional gray matter volume (GMV), the optimized VBM was performed with T1 MRIs. The amounts of gray/white matter and intracranial cavity volumes (ICV) were measured. The analysis of covariance (ANCOVA) and partial correlation analyses covariate with age and ICV were applied for VBM. RESULTS: The age and ICV distributions were similar between the two groups. In the ANCOVA, the total GMV of MDD was smaller than that of normal controls. In the VBM, regional GMV was relatively decreased in the limbic system (amygdalae, ambient gyri, hippocampi heads, subiculum, posterior parahippocampal gyri, pulvinar nuclei, dorsal posterior cingulate gyri, and left pregenual cingulate gyrus). The lingual gyri, short insular gyri, right fusiform gyrus, and right inferior frontal gyrus were also showed decreased regional GMV. CONCLUSION: The results of this study indicate that the female MDD is mainly associated with the structural deficits of the limbic system and limbic system related cortices, which were known to the center of emotions.

Fluid-Attenuated Inversion Recovery Hypointensity of the Pulvinar Nucleus of Patients with Alzheimer Disease: Its Possible Association with Iron Accumulation as Evidenced by the T2* Map

OBJECTIVE: We hypothesized that prominent pulvinar hypointensity in brain MRI represents the disease process due to iron accumulation in Alzheimer disease (AD). We aimed to determine whether or not the pulvinar signal intensity (SI) on the fluid-attenuated inversion recovery (FLAIR) sequences at 3.0T MRI differs between AD patients and normal subjects, and also whether the pulvinar SI is correlated with the T2* map, an imaging marker for tissue iron, and a cognitive scale. MATERIALS AND METHODS: Twenty one consecutive patients with AD and 21 age-matched control subjects were prospectively included in this study. The pulvinar SI was assessed on the FLAIR image. We measured the relative SI ratio of the pulvinar to the corpus callosum. The T2* values were calculated from the T2* relaxometry map. The differences between the two groups were analyzed, by using a Student t test. The correlation between the measurements was assessed by the Pearson's correlation test. RESULTS: As compared to the normal white matter, the FLAIR signal intensity of the pulvinar nucleus was significantly more hypointense in the AD patients than in the control subjects (p < 0.01). The pulvinar T2* was shorter in the AD patients than in the control subjects (51.5 +/- 4.95 ms vs. 56.5 +/- 5.49 ms, respectively, p = 0.003). The pulvinar SI ratio was strongly correlated with the pulvinar T2* (r = 0.745, p < 0.001). When controlling for age, only the pulvinar-to-CC SI ratio was positively correlated with that of the Mini-Mental State Examination (MMSE) score (r = 0.303, p < 0.050). Conversely, the pulvinar T2* was not correlated with the MMSE score (r = 0.277, p = 0.080). CONCLUSION: The FLAIR hypointensity of the pulvinar nucleus represents an abnormal iron accumulation in AD and may be used as an adjunctive finding for evaluating AD.

Does Acupuncture Therapy Alter Activation of Neural Pathway for Pain Perception in Irritable Bowel Syndrome?: A Comparative Study of True and Sham Acupuncture Using Functional Magnetic Resonance Imaging

BACKGROUND/AIMS: Patients with irritable bowel syndrome (IBS) are characterized by abnormal central processing with altered brain activation in response to visceral nociceptive signals. The effect of electroacupuncture (EA) on IBS patients is unclear. The study is set to study the effect of EA on brain activation during noxious rectal distension in IBS patients using a randomized sham-controlled model. METHODS: Thirty IBS-diarrhea patients were randomized to true electroacupuncture or sham acupuncture. Functional MRI was performed to evaluate cerebral activation at the following time points: (1) baseline when there was rectal distension only, (2) rectal distension during application of EA, (3) rectal distension after cessation of EA and (4) EA alone with no rectal distension. Group comparison was made under each condition using SPM5 program. RESULTS: Rectal distension induced significant activation of the anterior cingulated cortex, prefrontal cortex, thalamus, temporal regions and cerebellum at baseline. During and immediately after EA, increased cerebral activation from baseline was observed in the anterior cingulated cortex, bilateral prefrontal cortex, thalamus, temporal regions and right insula in both groups. However, true electroacupuncture led to significantly higher activation at right insula, as well as pulvinar and medial nucleus of the thalamus when compared to sham acupuncture. CONCLUSIONS: We postulate that acupuncture might have the potential effect of pain modulation in IBS by 2 actions: (1) modulation of serotonin pathway at insula and (2) modulation of mood and affection in higher cortical center via ascending pathway at the pulvinar and medial nucleus of the thalamus.

Thalamic Volumes in Patients with Untreated First-Episode Schizophrenia / 신경정신의학

OBJECTIVES: Thalamic structural changes were implicated in the pathophysiology of schizophrenia by some studies. So, we investigated the differences in thalamic volumes between previously untreated patients with first-episode schizophrenia and controls. METHODS: Thalamic volumes of 24 subjects with schizophrenia and 24 controls were measured from their T1-weighted coronal magnetic resonance images using manual tracing. The thalamus was further segmented into regions that roughly reflected individual thalamic nuclei. RESULTS: Comparing to the controls, significantly smaller volumes were found in the left posterior subdivision of thalamus in patient group. Tendency of volume differences were also seen in right posterior subdivision of thalamus in patient group. These regions primarily comprised the pulvinar, a thalamic nucleus thought to be an important component of aberrant circuitry in schizophrenia. CONCLUSION: Our findings suggest the possibility of a volumetric alteration of the thalamus in patients with first-episode schizophrenia.

Fluid Attenuated Inversion Recovery (FLAIR) Imaging of the Normal Brain: Comparisons between Under the Conditions of 3.0 Tesla and 1.5 Tesla

OBJECTIVE: The aim of this study was to evaluate the differences in normal brain MRI findings between under 3.0 Tesla (T) and 1.5T MRI conditions with the use of the fluid attenuated inversion recovery (FLAIR) sequences. MATERIALS AND METHODS: Eleven normal adults underwent imaging with the use of the FLAIR sequences on both 1.5T and 3.0T scanners. Two neuroradiologists compared the signal intensity (SI) of the centrum semiovale (CS), pulvinar thalami (PT) and normal iron deposit structures (IDSs) on the 3.0T and 1.5T FLAIR images, and they evaluated three MRI findings qualitatively: high SI of CS; low SI of PT; low SI of IDS. We also evaluated signal-to-noise ratios (SNRs) for the CS, PT, red nucleus and cerebellar dentate nucleus on the FLAIR images. RESULTS: Based on qualitative analyses, the 3.0T FLAIR images showed all three MRI findings for all cases. Low SI for the PT in seven cases (64%), high SI of the CS in one case (9%) and low SI of the cerebellar dentate nucleus in one case (9%) were visualized only on 3.0T FLAIR images. The mean SNRs of the PT, red nucleus and dentate nucleus in patients where 3.0T FLAIR imaging was performed were significantly lower as compared with the SNRs on 1.5T FLAIR images. The SNR of the CS was not significantly different between under the two magnetic field strengths (p > 0.05). CONCLUSION: We have demonstrated that normal, high and low SIs of the CS, PT and IDS on 3.0T FLAIR images were depicted more frequently and more prominently as compared with those on 1.5T FLAIR images in normal adult brains.

Bilateral Thalamic Ischemic Injury : A case report

Thalamic infarction is frequently bilateral due to the nature of the vascular supply to the thalamic region, and is usually caused by cardiogenic embolism or emboli originating from the proximal basilar or vertebral artery. But there have been no reported case of bilateral thalamic ischemic injury. A 25-year old man was in coma after committing suicide, hanging his neck. MRI showed bilateral pulvinar ischemic injury. He showed disturbance in recent memory, calculation, and had bilateral hemianopsia, transcortical motor aphasia, intentional tremor, proprioceptive sensory dysfunction. He was treated with progressive physical therapy for ambulation, repeated stimuli with TENS for proprioception, given donepezil 5 mg and cognitive training for improvement of cognition. After discharge, he was able to walk independently at outdoors, and could do all activities of daily living by himself. All motor and sensory functions of upper and lower extremities were recovered except tremor and dynamic standing balance dysfunction.

The Statistical Parametric Mapping Analysis between Pre- and Post-Operative FDG-PET Images in Patients with Mesial Temporal Lobe Epilepsy / 대한간질학회지

BACKGROUND: To investigate postoperative changes in the cerebral glucose metabolism of patients with mesial temporal lobe epilepsy (MTLE), statistical parametric mapping (SPM) analysis was performed on pre- and post-operative 18F-fluorodeoxy glucose positron emission tomographic (FDG-PET) images. METHODS: We included 28 patients with MTLE who had under-gone surgery and had been seizure free postoperatively (16 had left MTLE and 12 right MTLE). All patients showed hippocampal sclerosis by pathology or brain MRI. FDG-PET images of the 12 right TLE patients were reversed to lateralize the epileptogenic zone to the left side in all patients. RESULTS: Application of the paired t-test in SPM to pre- and postoperative FDG-PETs showed that the postoperative glucose metabolism decreased in the caudate nucleus, pulvinar of thalamus, fusiform gyrus, lingual gyrus, and in the posterior region of the insular cortex in the hemisphere ipsilateral to resection, whereas postoperative glucose metabolism increased in the anterior region of the insular cortex, temporal stem white matter, midbrain, inferior precentral gyrus, anterior cingulate gyrus, and supramarginal gyrus in the hemisphere ipsilateral to resection. No significant postsurgical changes of cerebral glucose metabolism occurred in the contralateral hemisphere. Subtraction between pre- and postoperative FDG-PET images in individual patients produced similar findings to the SPM results. CONCLUSION: This study suggests that brain regions showing a postoperative increase in glucose metabolism appear to represent the propagation pathways of ictal and interictal epileptic discharges in MTLE while a postoperative decrease in glucose metabolism may be related to a permanent loss of afferents from resected anterior-mesial temporal structures.

El espectro clínico e histopatológico de la epidermolisis ampollar adquirida: reporte de tres casos / Clinical and pathologic spectrum of epidermolysis bullosa acquisita: report of three cases

La epidermolisis ampollar adquirida (EAA) es una enfermedad ampollar subepidérmica, crónica, poco frecuente, caracterizada por la presencia de anticuerpos circulantes y/o tisulares tipo IgG dirigidos contra el colágeno tipo VII de las fibrillas de anclaje de la unión dermo-epidérmica. Su aspectro clínico e histopatológico es variable y se han definido tres presentaciones: la forma clásica similar a una porfiria cutánea tarda o a una epidermolisis ampollar distrófica, la forma tipo penfigoide ampollar y la forma tipo penfigoide cicatricial. El diagnóstico definitivo se establece mediante la inmunofluorescencia directa con piel perilesional separada con NaCI 1 molar o mediante la inmunomicroscopía electrónica. En nuestro medio, es una enfermedad poco frecuente o no detectada ya que plantea dificultades diagnósticas con otras enfermedades ampollares. En este estudio presentamos tres casos catalogados como EAA recolectados con la consulta de enfermedades ampollares de nuestro centro, que ilustran la diversidad clínica e histológica de esta entidad

Immunocytochemical Study on the Monoaminergic Innervation of Diencephalic Visual Structures in the Squirrel Monkey

This study was for investigating relations between distributions of monoamines-norepinephrine, serotonin, and dopamine-on the visual system and their functions. Distributions of these monoamines in the lateral geniculate body, pulvinar, lateral posterior nucleus, and suprachiasmatic nucleus were investigated. Brain of a squirrel monkey was removed and frozen sectioned. Immunocytochemical study was performed for the tissue of the brain. Results showed that the anterior part of the lateral geniculate body contained more monoamines than the posterior part. More serotonins were distrbuted at the magnocellular part, and more dopamines were found at the parvocellular part. In pulvinar, more norepinephrines were distributed at the medial part, while serotonins were evenly distributed at all parts. In lateral posterior nucleus and suprachiasmatic nucleus, three kinds of monoamines were distributed with high density. Among the three, density of the serotonin showed the highest value. The lateral geniculate body relates with visual perception such as visual acuity, form and color perception, and stereopsis, while the pulvinar relates with visual functions, such as visual attention, sensory integration, and differentiation. Since norepinephrine and serotonine are distributed with high density in the pulvinar than in the lateral geniculate body those two monoamines are expected to playa major role for visual functions. Inferior part of the pulvinar relates with visual imagination, and the lateral posterior nucleus relates with integration of visual sensory. Relatively high distribution of dopamine in these two parts means that dopamine may playa major role for visual imagination and integration. As suprachiasmatic nucleus relates with controlling biorhythm, dense distribution of monoamines in suprachiasmatic nucleus implies that the monoamines may work for controlling biorhythm.

Arthrography in Congenital Dislocation of the Hip / 대한정형외과학회잡지

Arthrography is an invaluable procedure in critically verifyging the concentricity of closed reduction and the optimum position of stability. And it is known to be the most accurate and certain way of demonstrating lesser degrees of incongruity. It can visualize the intrinsic obstructive fractors, such as capsular attachment, the labrum, the psoas tendon and its relationship to the joint, the pulvinar, ligamentum teres, the inferior transverse ligament, and the shape of the femoral head and acetabulum. We analyzed 20 cases of congenital dislocation of the hip in 17 patients, which had been evaluated by arthrography. The results are as follows: 1. We found the inferior approach very efficient among many kinds of arthrographic techniques. 2. Among 20 cases, 12 cases could be treated with closed reduction and 8 cases were treated by open reduction such as capsuloplasty, partial limbusectomy, and removal of space occupying lesion in acetabulum, including 2 cases of Salter's innominate osteotomy and 1 case of derotational osteotomy. 3. Among the intracapsular obstructive factors which played major role in hindering closed reduction, capsular constriction was shown in 8 case, inverted or hypertrophic limbus in 5 cases, and other space occupying lesions in 2 cases. 4. We performed combined operation including bone and soft tissue for severe extra- and intracapsular lesions and closed reduction for mild to moderate extra- and intracapsular lesions. 5. Arthrography of the hip joint was indispensable in evaluating the intracapsular osstructive lesions as well as detecting the subtle incongruent reduction.

Response of Hypothalamic Hypophyseal Hormones to Stimulation and Lesion in the Thalamus and Hypothalamus

Plasma levels of growth hormone(GH), luteinizing hormone(LH) and cortisol were determined by radioimmunoassay following radiofrequency(RF) stimulation or coagulation of various nuclei in thalamus and hypothalamus. RF stimulation or coagulation of many nuclei in thalamus and hypothalamus consisted of pulvinar and dorsomedial nucleus in thalamus and anterior and posterior hypothalamic nuclei in hypothalamus. Anterior thalamic stimulation resulted in highly significant increase of plasma LH, GH, cortisol and TH levels. However thalamic stimulation resulted no change in the level of various plasma hormones. Hypothalamic lesion produced significantly decreased plasma LH, GH and cortisol levels. Plasma cortisol and LH levels were highest 2 hours after stimulation while GH levels did not increased until 6 hours and TH until 72 hours respectively after stimulation. The significant difference in latency for beginning of hormone secretion suggests that GH, cortisol and LH may be controlled by several separate neuronal networks. Plasma GH and cortisol levels were lowest 72 hrs after coagulation of the anterior hypothalamic area, while GH, cortisol and LH levels did not change following stimulation or coagulation of posterior hypothalamic nucleus and thalamic nucldi. It was also noted that the anterior hypothalamic stimulation or coagulation caused increased or decreased in GH, cortisol, and LH than that observed from stimulation or coagulation of other hypothalamic and thalamic nuclei respectively.