Sexually dimorphic differences in angiogenesis markers predict brain aging trajectories.

Aberrant angiogenesis could contribute to cognitive impairment, representing a therapeutic target for preventing dementia. However, most angiogenesis studies focus on model organisms. To test the relevance of angiogenesis to human cognitive aging, we evaluated associations of circulating blood markers of angiogenesis with brain aging trajectories in two deeply phenotyped human cohorts (n=435, age 74 + 9) with longitudinal cognitive assessments, biospecimens, structural brain imaging, and clinical data. Machine learning and traditional statistics revealed sex dimorphic associations of plasma angiogenic growth factors with brain aging outcomes. Specifically, angiogenesis is associated with higher executive function and less brain atrophy in younger women (not men), a directionality of association that reverses around age 75. Higher levels of basic fibroblast growth factor, known for pleiotropic effects on multiple cell types, predicted favorable cognitive trajectories. This work demonstrates the relevance of angiogenesis to brain aging with important therapeutic implications for vascular cognitive impairment and dementia.

Tonic, phasic and cortical arousal in Gilles de la Tourette's syndrome.

This study explored the hypothesis that Gilles de la Tourette's syndrome involves a disturbance in arousal modulation. The experimental group consisted of 20 unmedicated subjects with the Gilles de la Tourette's syndrome, and the control group of 20 subjects with chronic medical illnesses (haemophilia, von Willebrandt's disease and diabetes). There were differences between groups in the manner in which log conductance level changed over time during sound and light habituation experiments involving mild levels of stimulation with the Gilles de la Tourette group showing less change in arousal level over trials than the control group. No group differences were found in measures of phasic arousal, rate of spontaneous fluctuations and performance on two tasks that have been related to cortical arousal. It is suggested that the slower change in log conductance level in the Gilles de la Tourette group during the sound and light habituation experiments indicates that reticular activity is more persistent in these patients.

Lateral eye-movements, field dependence and denial.

Conjugate lateral eye-movements can be used to classify some people into two distinct groups (left-movers and right-movers), who differ on various cognitive and personality variables reflecting stylistic reliance on the cognitive mode of a single hemisphere. In this study left-movers relied more heavily on denial as a defense. Field dependence tended to be related to both denial and left eye-movements by males but not females. The results are discussed in terms of a possible neuropsychological substrate for denial.

Level of ego development and psychotherapy outcome in phobic patients.

forty male and 86 female phobic outpatients were randomly assigned to three treatment conditions (behaviour therapy with Imipramine: behaviour therapy with placebo; and supportive therapy with Imipramine) and seen in therapy for a 26-week period. They were initially assessed for level of ego development on Loevinger's Sentence Completion measure and evaluated for initial level of pathology and therapy outcome. A stepwise multiple regression analysis, performed separately for the female and male groups, yielded results as follows: (1) patients at the preconformist level improved significantly less than the patients at the other levels; (2) an interaction between the use of medication and level of ego development was also found, with postconformist patients reporting the least benefit from the drug. These findings were significant only for the female patients.

Cecal hernia into the lesser sac.

Two cases of cecal herniation through the foramen of Winslow into the lesser sac are presented. This unusual and potentially life-threatening form of internal herniation can be diagnosed radiographically on plain abdominal radiographs and barium studies by identifying the cecum lying posterior and medial to the stomach in association with the absence of the cecum in the right lower quadrant of the abdomen. One of the described cases is unique in that the patient was asymptomatic relative to the internal hernia. The other case clearly demonstrates the importance of increased intra-abdominal pressure as a causative factor in foramen of Winslow hernia.

Comparison of oral cholecystopaques: iopronic acid vs. iopanoic acid.

A new oral cholecystopaque, iopronic acid, was compared to iopanoic acid. This was a double blind, randomized study of 260 subjects. A 4.5-G dose of iopronic acid produced a similar degree of gallbladder opacification as 3.0 g of iopanoic acid. Adverse reactions to the contrast media were generally mild, but were significantly less with iopronic acid. The present study is criticized because it was not designed to help the radiologist determine the better contrast medium under optimal clinical conditions.

Diagnosis of small bowel obstruction: the contribution of diagnostic ultrasound.

The hallmark of intestinal obstruction, whether due to a mechanical cause or to absence of peristalsis, is the intraluminal accumulation of fluid. The presence of air simply makes it easier to visualize dilated fluid-filled loops of plain radiographs. When gas is absent, secondary to vomiting or to cessation of air swallowing, the fluid-filled loops may be difficult to identify. In closed loop obstruction, air cannot enter the involved bowel, and in this situation sonography may provide important information concerning the status of the intestinal tract. In nonstrangulating obstruction, sonography offers confirmatory evidence of dilated fluid-filled loops of bowel. In some instances, ultrasonography may correctly identify the gastrointestinal tract origin of a problem thus enabling appropriate management of the patient. We describe three patients in whom ultrasound enabled prompt diagnosis of fluid-filled loops.

Field dependence and short-term memory.

This study examined the relationship between field dependence and short-term memory. It was predicted that relatively field-independent individuals would perform better on short-term memory tests in which a large amount of interference is assumed to be present than would individuals who are more field-dependent. Subjects' appraisals of their own attentional facility, as well as their thoughts and feelings about the experimental tasks, were also elicited, and were looked at in terms of their relationship to field dependence and short-term memory.

Relationship between agoraphobia and field dependence.

In recent years agoraphobia has been viewed by clinicians as etiologically distinct from other phobic disorders, with conflicts over the developmentally early issue of separation and individuation (self-other differentiation) playing a central role. In an effort to adduce quantitative evidence for this clinical observation, three groups of phobic patients (totaling 166 outpatients in all) were distinguished on the basis of their symptomatology (agoraphobia, simple phobias, and mixed phobias) and were individually administered the Group Embedded Figures Test as a measure of field dependence, a cognitive style dimension that according to Witkin is, at least in part, a manifestation of self-other differentiation. A one-way analysis of variance, performed separately for men and women for differences among the three phobic groups on field dependence, showed significance (rho less than .05) for the females, with the famale agoraphobic being more field dependent than the female simple phobic groups, but not for the males. Implications for the understanding of agoraphobia are discussed.

Large mucosal bridges: an unusual roentgenographic manifestation of ulcerative colitis.

An unusual case of colonic mucosal bridges in a patient with ulcerative colitis was demonstrated by double-contrast barium enema and confirmed at colonoscopy. We believe this to be the first report of this entity in the radiologic literature. The probable etiology of this uncommon manifestation of chronic inflammatory bowel disease is discussed.

Angiographic aspects of experimental nonocclusive intestinal ischemic injury.

An experiment was designed to fulfill the following aims: (1) to develop a model of nonocclusive intestinal ischemic injury compatible with survival for several days; (2) to determine the accuracy of angiography in diagnosing the presence and extent of intestinal ischemic injury; and (3) to determine the therapeutic and diagnostic value of intraarterial papaverine infusion. Experimental shock models were developed in the dog, and efficacy of the hypovolemic and normovolemic models was confirmed by gross and histologic evidence of intestinal injury in surviving dogs. No reliable angiographic signs of intestinal mucosal injury could be elicited. Angiographic abnormalities associated with the experiment were attributable to the shock itself and disappeared with the relief of shock. Infusion of papaverine into the superior mesenteric artery within 2 hr of the onset of shock prevented or ameliorated intestinal injury.

Transcatheter embolization for treatment of diverticular hemorrhage.

Two patients underwent transcatheter embolization for control of massive diverticular hemorrhage after vasopressin infusion had failed to control the bleeding. The role of angiography in the management of diverticular bleeding is discussed. If surgery is being considered, angiography should be utilized to localize the bleeding site and to permit limited colonic resection. Transcatheter embolization is proposed as an alternative to operative intervention.

Growth rates of small abdominal aortic aneurysms.

A policy of utilizing B-mode ultrasound scan measurements of abdominal aortic aneurysms to help determine operability in poor-risk patients with small asymptomatic aneurysms has been pursued for the past 6 years. Indications for surgery in such patients have included enlargement to 6 cm. in any transverse diameter, the development of symptoms, or evidence of leak or rupture. In addition, patients treated nonoperatively have been followed by serial B-mode echo scans, permitting the accumulation of aneurysm growth rate data. Such data indicate that small aneurysms grow an average of 0.4 cm. per year, but that dramatic increases in aneurysm size may occur unexpectedly in asymptomatic patients. These data appear to have value in both individual decision making and as a baseline for weighting the various risk factors in the poor-risk patient with a small asymptomatic abdominal aortic aneurysm.

Immune-related renal vein thrombosis in a renal allograft.

A patient developed a renal venous thrombosis 15 months after renal transplantation. In contrast to other cases described in the literature, the thrombosis was not related to vascular surgical trauma, but was immune-complex mediated. The patient's renal function stabilized and the nephrotic syndrome improved over 18 months follow-up during continuous oral anticoagulant therapy.

Catheter exchange in tortuous vessels during selective cerebral angiography.

Inability to advance double-curved catheters beyond the origin of tortuous arch vessels in a common problem in femorocerebral angiography in the aged or hypertensive patient. The authors describe a simple technique involving the use of an exchange guide wire and straight catheter which has proved to be safe and successful in such circumstances.