Transcranial magnetic stimulation of motor pathways directed to muscles supplied by cranial nerves in amyotrophic lateral sclerosis.

OBJECTIVES: In amyotrophic lateral sclerosis (ALS), transcranial magnetic stimulation (TMS) detects remarkable abnormalities of central motor circuits: cortical excitability threshold, silent period (SP) duration and intra-cortical inhibition. TMS directed to cranio-facial musculature was performed in ALS patients in order: (1) to document the neurophysiological involvement of motor central and peripheral cranial pathways by evaluating changes of threshold and SP; (2) to discover a possible correlation between the clinical picture and abnormal excitability properties. METHODS: Motor evoked potentials (MEPs) were recorded from masseter, genioglossus and orbicularis oris muscles of both sides in 25 ALS patients and 25 controls, in response to TMS delivered over the face M1 area and the vertex. RESULTS: TMS gave rise to two orders of responses: bilateral MEPs during contraction represented the central responses, and motor action potentials (MAPs) during rest represented the peripheral responses. MEPs were followed by SPs, which increased linearly with increasing TMS intensity (r=0.8). At least one of the analyzed parameters was abnormal in all patients: central abnormalities (increased active threshold, delayed MEPs, reduced SP) were found in 96% of patients, alone or combined with abnormalities of the MAPs (reduced area and/or prolonged latency). The reduction of SP was linearly related to the Norris score (r=0.95). CONCLUSIONS: Our study shows that TMS is able to detect the involvement of multiple cranial muscles in ALS. This finding offers often pre-clinical information about the disease picture. Therefore, it can be employed as a valuable means for early diagnosis.

Groin hernias in adults: value of color Doppler sonography in their classification.

PURPOSE: We assessed the abilities of color Doppler and power Doppler sonography to distinguish among types of groin hernias by demonstrating the inferior epigastric artery (IEA) and its relationship with the hernia sac. METHODS: Nineteen consecutive patients (14 men and 5 women), clinically diagnosed as having groin hernias and scheduled to undergo herniorrhaphy, were prospectively enrolled in this study. Ultrasound examinations were performed preoperatively with a 6-12-MHz linear-array transducer. The IEA was identified, if possible, and its relationship to the hernia sac assessed. The sonographic diagnoses were compared with the operative findings. RESULTS: There were 15 indirect inguinal hernias, 4 direct inguinal hernias, and 1 femoral hernia; 1 patient had bilateral inguinal hernias (indirect and direct). In 18 (90%) of 20 hernia cases, the trunk segment of the IEA could be visualized. In 11 (55%) of 20 hernia cases, the origin segment of the IEA could be visualized and its relationship with the hernia sac assessed. In 9 (82%) of the 11 hernia cases, hernia types were correctly diagnosed by sonography. The overall accuracy of sonography for diagnosing the type of hernia was 45% (9 of 20 hernias). CONCLUSIONS: Color Doppler sonography can accurately differentiate types of groin hernias if the origin segment of the IEA and the hernia sac can be visualized simultaneously. However, color Doppler sonography sometimes failed to visualize this segment.

Reappraisal of intraoperative ultrasonography for pancreatobiliary carcinomas: assessment of malignant portal venous invasion.

BACKGROUND: Conventional preoperative imaging modalities are unreliable for assessing portal venous invasion by pancreatobiliary carcinoma. We evaluated the usefulness of intraoperative ultrasonography for detecting pancreatobiliary carcinoma and assessing portal venous invasion, compared with other imaging modalities. METHODS: Ninety-one patients with pancreatic carcinoma (n = 66) or bile duct carcinoma (n = 25) underwent ultrasonography, computed tomography, angiography, and endoscopic ultrasonography preoperatively. All these patients underwent tumor resection, with (n = 23) or without (n = 68) portal vein resection, after intraoperative ultrasonography. Portal venous invasion was histologically examined in all patients. RESULTS: Intraoperative ultrasonography was significantly more sensitive (100%) than ultrasonography (79%), computed tomography (81%), and angiography (54%) for detecting carcinomas, especially bile duct carcinomas and small (< or = 2.0 cm) tumors. Portal venous invasion was confirmed histopathologically in 25 patients. For diagnosing portal venous invasion, intraoperative ultrasonography was more sensitive (92%) and specific (92%) than ultrasonography (56% and 73%), computed tomography (64% and 79%), and angiography (76% and 83%), respectively. Endoscopic ultrasonography showed a 95% detectability for carcinomas and a 92% accuracy for assessing portal venous invasion. CONCLUSIONS: Intraoperative ultrasonography is a simple and accurate procedure for detection of pancreatobiliary carcinomas and assessment of portal venous invasion.

Diagnosis of portal venous invasion by pancreatobiliary carcinoma: value of endoscopic ultrasonography.

BACKGROUND: We evaluated the usefulness of endoscopic ultrasonography for detecting pancreatobiliary carcinoma and assessing portal venous invasion by carcinoma. METHODS: Seventy-three patients with pancreatic carcinoma (54 patients) or bile duct carcinoma (19 patients) underwent endoscopic ultrasonography, transabdominal ultrasonography, computed tomography (CT), and angiography. All patients underwent tumor resection and histological examination for portal venous invasion. Results of endoscopic ultrasonography were compared with those of other imaging modalities. RESULTS: Histopathology revealed portal venous invasion in 20 patients. Endoscopic ultrasonography was significantly more sensitive (96%) than ultrasonography (81%), CT (86%), and angiography (59%) in detecting carcinomas. On endoscopic ultrasonography, loss of the echogenic vessel-parenchymal sonographic interface or a tumor within the vessel lumen indicated portal venous invasion. For diagnosing portal venous invasion, endoscopic ultrasonography was more sensitive (95%) and accurate (93%) than ultrasonography (55% and 67%), CT (65% and 74%), and angiography (75% and 79%), respectively. CONCLUSION: Endoscopic ultrasonography is the most accurate tool for detecting pancreatobiliary carcinomas and assessing portal venous invasion.

Evaluation of antitumor activities of hyaluronate binding antitumor drugs: synthesis, characterization and antitumor activity.

To enhance the selective delivery of antitumor drugs into regional lymph nodes and cancerous tissues via a hyaluronate (HA) receptor (CD44), we synthesized HA-mitomycin C complex and HA-epirubicin complex. To investigate the specific distribution of HA into regional lymph nodes and to evaluate the HA receptor on lewis lung carcinoma cells, we also synthesized 14C-labelled HA and fluorescent HA (FR-HA). The metabolic studies of 14C-HA and HA-epirubicin complex were performed in rats. The specific distribution of both compounds to the lymph nodes were observed after sc treatment. Internalization mechanisms of HA into carcinoma cells (lewis lung carcinoma) via HA receptor was investigated using fluorescent HA (FR-HA) in vitro. Internalization of FR-HA following binding to the cell surfaces was observed. HA-Mitomycin C (MMC) exhibited potent anti-metastatic effects against lewis lung carcinoma implanted in mice at an extremely low dose (0.01 mg/kg) whereas free MMC had no effects.

Schistosome antigen gp50 is responsible for serological cross-reactivity with Trichinella spiralis.

The 50-kDa component (gp50) present in Schistosoma mansoni eggs and secretions of the various life stages of the parasite was recognized by experimentally infected mice and by humans with S. mansoni, Schistosoma haematobium, and Schistosoma japonicum infection. All sera reacting with crude S. mansoni-soluble egg antigens (SEA) also reacted strongly with gp50 in enzyme-linked immunosorbent assay. No reactivity against gp50 was seen with sera from individuals without schistosomiasis, with the exception of sera from patients with Trichinella spiralis infection. All of 10 sera from patients with trichinellosis also reacted with schistosomes by immunofluorescence essentially recognizing testes, ovaries, ootype epithelium and ducts of the reproductive system. Cross-reacting antigens were seen in T. spiralis hypodermis, stichocytes and possibly germinal primordia using anti-gp50 monoclonal antibodies and anti-gp50-positive schistosomiasis patient sera. The results suggest that the anti-gp50 antibody response constitutes a significant part of the anti-SEA antibody response in infected individuals and is a major reason for the previously recognized serological cross-reactivity between T. spiralis and schistosome species.

Antibody responses in schistosomiasis haematobium in Somalia. Relation to age and infection intensity.

Antibody responses in schistosomiasis haematobium were studied in relation to age and infection intensity in Somalia. The area is highly endemic for Schistosoma haematobium but free of S. mansoni. Antibodies of the IgG class against particulate antigens of S. mansoni adult worms were investigated by immunofluorescence (gut and somatic associated antigens) and against soluble egg and adult worm antigens by ELISA. Total IgE levels were examined by Pharmacia IgE RIA, and specific IgE against soluble adult worm antigen by enzyme immunoassay. The IgG antibody response showed a characteristic pattern with highest reactivity against both gut associated and soluble egg antigens in the age group 10-14 years, when both prevalence and intensity of the infection were highest. Reactivity against somatic associated antigen was also high in this age group, but it increased slightly and remained at high level in the older ages. It is thought that such antigen is exposed mainly after the death of the parasite and that the antigenic stimulation may remain throughout most of the life of infected individuals. On the other hand, the IgG antibody reactivity against soluble adult worm antigen was low during childhood, but it increased significantly with age. It is suggested that repeated booster effects are needed for more potent response against these antigenic components. The finding of high levels of total IgE already in the youngest age groups, together with low specific IgE response, indicates that mainly other antigens are involved in the IgE production. The specific IgE response against soluble adult worm antigen was low but increased significantly with age.

The seroreactivity against Pf155 (RESA) antigen in villagers from a mesoendemic area in Somalia.

Pf155 (RESA), a malaria antigen in the membrane of infected red cells, was recently identified as a possible future malaria vaccine candidate. In this study the seroreactivities against this antigen were compared with those against crude parasitic antigens in 195 subjects from a Somali village with mesoendemic malaria. The seroreactivities were determined with immunofluorescence. With age, there was an increased seroreactivity to both Pf155 and the crude parasitic antigens. However, the acquisition of seroreactivity was much slower against Pf155. Hence in the age group 15-24 years, only half of the subjects had detectable antibodies against Pf155.