MR Micro-Neurography and a Segmentation Protocol Applied to Diabetic Neuropathy.

The aim of this study was to assess with MRI morphometric ultrastructural changes in nerves affected by diabetic peripheral neuropathy (DPN). We used an MR micro-neurography imaging protocol and a semiautomated technique of tissue segmentation to visualize and measure the volume of internal nerve components, such as the epineurium and nerve fascicles. The tibial nerves of 16 patients affected by DPN and of 15 healthy volunteers were imaged. Nerves volume (NV), fascicles volume (FV), fascicles to nerve ratio (FNR), and nerves cross-sectional areas (CSA) were obtained. In patients with DPN the NV was increased and the FNR was decreased, as a result of an increase of the epineurium (FNR in diabetic neuropathy 0,665; in controls 0,699, p = 0,040). CSA was increased in subjects with DPN (12,84 mm2 versus 10,22 mm2, p = 0,003). The FV was increased in patients with moderate to severe DPN. We have demonstrated structural changes occurring in nerves affected by DPN, which otherwise are assessable only with an invasive biopsy. MR micro-neurography appears to be suitable for the study of microscopic changes in tibial nerves of diabetic patients.

Endometrial lesions after tamoxifen therapy in breast cancer women.

Tamoxifen, a nonsteroidal antiestrogen with a partial estrogen-antagonist activity, is widely used as a hormonal adjuvant therapy for breast cancer in women with positive receptors for estrogens. Its prolonged administration has been associated with a series of collateral effects, among which the endometrial carcinoma is the most important. The aim of our study was to investigate an eventual correlation between a therapy with tamoxifen and the onset of endometrial lesions. We recruited 228 postmenopausal patients who had been operated on for breast cancer. They were divided into two groups according to the presence of positive or negative estrogen receptors. The group with positive receptors was subjected to hormonal adjuvant therapy by tamoxifen (20 mg/day for 5 years), while the group with negative receptors was not treated. All the patients underwent a hysteroscopic evaluation of the uterine cavity before and after treatment. The follow-up carried out 5 years later showed the presence of a statistically higher risk (p < 0.00001) of endometrial lesions, such as low glandular hyperplasia and polyps, than in the treated patients compared with untreated patients. On the other hand, because there was no onset of endometrial carcinoma, the risk of this kind of lesion turned out to be practically absent. In all the treated patients who did not evidence any endometrial lesions (n = 90) and in all those with negative receptors (n = 104) the endometrium seemed to have an atrophic aspect. In conclusion, according to these data, we believe that hormonal adjuvant therapy by tamoxifen (20 mg/day), associated with a periodic hysteroscopic evaluation, and eventually a directed biopsy of the endometrium in order to keep under control the frequent onset of benign endometrial lesions, does not absolutely seem to increase the risk of endometrial carcinoma.

5-Hydroxytryptamine modifies neuronal responses to glutamate in the red nucleus of the rat.

The effects of 5-hydroxytryptamine (5-HT) on the responses of red nucleus (RN) neurones to glutamate (glu) and its agonists were studied using a microiontophoretic technique in anaesthetised rats. Extracellular unitary recordings of RN neuronal activity showed that 5-HT application induced a significant and reversible depression of glu-evoked excitations in 85% of the RN units tested. This effect was independent of the action of the amine on background firing, which appeared enhanced in the majority of cases but was either depressed or uninfluenced in other cases. Microiontophoretic 5-HT also depressed the excitatory responses evoked in RN neurones by electrical stimulation of sensorimotor cortex. Methysergide application, which prevented the enhancing effects of 5-HT on the background firing, was scarcely effective in antagonising the depression of glu responses. In contrast, the serotonergic effects on the glu responses were reduced by the iontophoretically applied antagonist of 5-HT1A receptors, NAN-190. Microiontophoretic 5-HT was also able to influence the neuronal responses evoked by glu agonists quisqualate (quis) and N-methyl-D-aspartate (NMDA), acting on non-NMDA and NMDA receptors respectively. In fact 5-HT depressed quis-evoked excitations and induced mixed effects on NMDA responses, which were reduced in 45%, enhanced in 34% and unmodified in 21% of the units tested. These results suggest that 5-HT is able to modulate the motor glutamatergic input to RN by acting mostly on non-NMDA receptors. The modulation of non-NMDA and NMDA receptors by 5-HT in the RN appears significant and its functional meaning is discussed.

Neuronal responses in vestibular nuclei to dorsal raphe electrical activation.

The effects of dorsal raphe (DR) electrical stimulation on the neuronal activity of vestibular nuclei were studied in anaesthetized rats. The aim was to establish whether the central systems classically involved in nociceptive functions are able to influence vestibular secondary neurons. DR activation induced modifications of the firing in 70% of the tested neurons, the percentage being similar in the lateral (LVN), superior (SVN), and spinal (SpVN) vestibular nuclei. Three different types of responses were recorded: long-lasting modifications (generally enhancements) of the mean firing rate (43%), short-latency response patterns (14%), both (43%). Short-latency response patterns were more numerous in LVN than in SVN. Iontophoretic applications of 5-HT antagonists Methysergide and Ketanserin blocked long-lasting effects but were scarcely effective on the short-latency response patterns evoked by DR stimulation. It is concluded that DR exerts a double control on secondary vestibular neurons: a generalised excitatory influence by serotoninergic fibers and a specific action mostly targeted on LVN, by nonserotoninergic pathways.

Neuronal responses to 5-hydroxytryptamine in the red nucleus of rats.

The effects of microiontophoretic 5-hydroxytryptamine (5-HT) on the firing rate of red nucleus (RN) neurons were studied in urethane-anesthetized rats. The background discharge rate of almost all the neurons tested (97%) was modified by 5-HT, and generally increased (89%). Responses were dose dependent. Twenty-three percent of the excitatory responses were preceded by a short inhibitory phase. No significant difference in the effect of 5-HT was found between those RN neurons that project to the spinal cord and those that do not The excitatory responses to 5-HT were blocked or greatly reduced by the 5-HT antagonists methysergide and ketanserin, and were even reversed in some cases. The 5-HT2/5-HT1A antagonist spiperone, in small doses, also blocked the transient inhibitory phases in addition to the excitatory effects. In RN neurons exhibiting a short-lasting inhibition in the response to 5-HT, the 5-HT1A agonist 8-hydroxy-2(di-n-propyl-amino)tetralin (8-OH-DPAT) induced inhibitory effects. These results support the hypothesis that 5-HT exerts control throughout the RN, mostly by acting on 5-HT2 receptors. Furthermore, an influence of this amine on the electrical activity of small groups of RN neurons by 5-HT1A receptors, and eventually by different mechanisms, appears probable. The functional significance of serotoninergic control of RN neuronal activity is discussed.

Excitatory and inhibitory effects of 5-hydroxytryptamine on the firing rate of medial vestibular nucleus neurons in the rat.

The effects of microiontophoretic application of 5-hydroxytryptamine (5-HT) on the neuronal firing rate of the medial vestibular nucleus (MVN) were studied in anaesthetized rats. Ninety-three % of the units modified their background activity following 5-HT iontophoresis, enhancements of the firing rate being recorded in 42%, decreases in 38% and biphasic effects in 13%. 5-HT antagonists methysergide and ketanserin blocked the excitatory but not the inhibitory responses to 5-HT. These latter were, however, mimicked by 5-HT agonists 5-methoxy-N,N-dimethyltryptamine (5MeODMT) and 8-hydroxy-2(di-n-propyl-amino)tetralin (8-OH-DPAT). It is concluded that 5-HT can variously influence the background activity of MVN neurons and that 5-HT2 and probably 5-HT1A receptors are involved in the responses.

Effects of noradrenaline on the firing rate of vestibular neurons.

The effects of microiontophoretic noradrenaline on the firing rate of neurons located in the vestibular complex have been studied in anaesthetized rats. Eighty-five per cent of the neurons tested in all the vestibular nuclei modified their background firing rate upon noradrenaline application, generally by reducing it (86% of them). In few cases inhibitions were followed by a rebound. Responses were dose-dependent. No significant difference was found between vestibular neurons projecting to the spinal cord and those delivering their fibres to the oculomotor complex. Phentolamine, an alpha-adrenergic antagonist, blocked the noradrenaline-evoked inhibitions, whereas beta-adrenergic antagonist timolol was ineffective or enhanced them. Furthermore, responses were blocked by yohimbine, an alpha 2-adrenergic antagonist, and mimicked by clonidine, an alpha 2-adrenergic agonist, in the majority of neurons. In few cases prazosin, an alpha 1-adrenergic antagonist, was able to antagonize weak inhibitions and phenylephrine, an alpha 1-adrenergic agonist, to evoke an inhibitory effect blocked by prazosin. Isoproterenol, a beta-adrenergic agonist was totally ineffective on the neuronal firing rate. It is concluded that noradrenaline can modify the level of neuronal activity in the vestibular complex by acting mostly, but not exclusively, through alpha 2-adrenergic receptors. An influence of noradrenergic systems on the vestibular function by a direct action of noradrenaline inside the vestibular nuclei is proposed.

Serotonin-evoked modifications of the neuronal firing rate in the superior vestibular nucleus: a microiontophoretic study in the rat.

Microiontophoretic ejection (10-100 nA) of serotonin (5-hydroxytryptamine) into the superior vestibular nucleus induced modifications of the mean firing rate in 87% of the neurons examined. The responses to 5-hydroxytryptamine application were excitatory in 48% of the cells, inhibitory in 29%, and biphasic (inhibitory/excitatory) in the remaining 10%. The excited neurons were scattered throughout the nucleus; the units inhibited or characterized by biphasic responses were distinctly more numerous in the ventrolateral sector of the nucleus. The magnitude of both excitatory and inhibitory effects was dose-dependent. The excitatory responses to 5-hydroxytryptamine were blocked or greatly reduced by two 5-hydroxytryptamine antagonists, methysergide and ketanserin, or even reversed in many cases. Inhibitory responses were enhanced by simultaneous application of 5-hydroxytryptamine antagonists in half of the units studied. In the remaining units, ketanserin left the response unmodified, whereas methysergide reduced but never quite blocked it. The application of 5-methoxy-N,N- dimethyltryptamine, a 5-hydroxytryptamine agonist more effective on 5-hydroxytryptamine1 than on 5-hydroxytryptamine2 receptors, and of 8-hydroxy-2(di-n-propyl-amino) tetralin, a 5-hydroxytryptamine1A-specific agonist, induced a decrease in the firing rate which was unaffected by methysergide. These results support the hypothesis that 5-hydroxytryptamine exerts various functions throughout the superior vestibular nucleus by various receptors and that the inhibitory action is limited to an area of it.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of glutamate on the serotonin-induced responses of vestibular neurons.

The aim of this work was to verify whether and how spontaneous or glutamate(GLU)-induced enhancements of the neuronal firing rate modified the responsiveness of the vestibular neurons to microiontophoretic application of serotonin (5-HT). During experiments performed on anaesthetized Wistar rats the responses to 5-HT applications were studied in neurons of the lateral vestibular nucleus identified by the antidromic activation upon stimulation of the vestibulospinal tract. The magnitude (in percent) of the 5-HT induced excitatory responses decreased (hyperbolic correlation, r = 0.91) when the background mean firing rate was enhanced spontaneously or by long-lasting application of GLU. Even in high-discharging units, the response never changed its sign. The trend to a depression of the response to 5-HT in function of the background discharge was observed when either the enhancement of firing occurred spontaneously and it was induced by an application of GLU, no significant difference (F-test) being found between the two cases. It is concluded that serotoninergic afferents can exert a strong control upon the vestibular neurons when the background activity is depressed, and only a weak influence when the neuronal firing is enhanced by other excitatory afferents. It remains to verify whether the type of interference observed between GLU and 5-HT is specific or can be also detected between 5-HT and other excitatory neuromediators.

Effects of 5-hydroxytryptamine on the firing rates of neurons of the lateral vestibular nucleus in the rat.

5-hydroxytryptamine (5-HT) was delivered microiontophoretically (20-80 nA) to cells of the lateral vestibular nucleus of anaesthetized rats to test its influence on the spontaneous activity of single neurons. 5-HT increased the rate of firing of 94% of the units tested. The enhancement persisted for up to 700 s after the end of the 5-HT ejection and the maximum magnitude of the excitation (10-3400%) showed a hyperbolic correlation (rho = 0.86) with background firing. In 43% of units the enhancement was preceded by a short-lasting (less than 105 s) depression of the neuronal firing rate, the magnitude of which was unrelated to the background mean firing rate. Both components of the 5-HT response were dose-dependent. Only the excitatory responses were antagonized by metergoline, methysergide and ketanserin. The putative 5-HT agonist, 5-methoxy-N,N-dimethyltryptamine, applied microiontophoretically, depressed the background firing rate and was not antagonized by methysergide. These results demonstrate that 5-HT modifies the responsiveness of vestibular neurons and suggest that at least two mechanisms and maybe two types of receptors are activated by 5-HT in this nucleus.

Effects of motor cortex and single muscle stimulation on neurons of the lateral vestibular nucleus in the rat.

The neuronal responses to stimulation of motor cortical sites and of forelimb single muscles were studied in the lateral vestibular nucleus of anaesthetized rats. Of the 228 neurons tested for response to stimulation of contralateral motor cortex, 63% responded to cortical sites controlling extensor muscles and 30% to those controlling flexors. The corresponding figures for responders to ipsilateral stimulation were 34 and 21%. Vestibulospinal units responded to cortical sites controlling extensor and flexor muscles whereas the remaining lateral vestibular nucleus neurons, very reactive to cortical sites controlling extensor muscles, responded little to contralateral and not at all to ipsilateral cortical sites controlling flexor muscles. The effects evoked by contralateral cortical sites controlling extensors varied, those induced by cortical sites controlling flexors were inhibitory in 77% of cases. The responses to ipsilateral motor cortex stimulation differed not so much by cortical sites controlling extensor or flexor muscles as by whether the neuron was in the dorsal or ventral zone of the lateral vestibular nucleus: mixed in the former, all inhibitory in the latter. Of the lateral vestibular nucleus units tested for response to stimulation of ipsilateral or contralateral forelimb distal muscles, only 11% responded. All the vestibulospinal units responsive to muscle stimulation lay in the dorsal zone of the nucleus. The remainder, dorsal or ventral, were not responsive to contralateral muscles. Single lateral vestibular nucleus cells influenced both by ipsilateral muscle and by contralateral motor cortex made up 24% of the pool, vestibulospinal and non-vestibulospinal. They fell into three groups: responsive to one or both structures but responding more strongly to combined stimulation; responsive to each of the two structures but showing a response to combined stimulation not significantly different from that evoked by the cortex alone; responsive only to combined stimulation. The lateral vestibular nucleus units included in these three groups accounted for 29% of those tested for response to extensor muscles and cortical sites controlling extensors and 15% of those tested for response to flexor muscles and cortical sites controlling flexors. Twenty-five per cent of the vestibulospinal neurons responded both to contralateral muscles and to ipsilateral motor cortex stimulation but none of the non-vestibulospinal neurons responded to both. All the responders to both were in the dorsal zone of the lateral vestibular nucleus and responded to extensor stimuli, always in the same way. These results indicate that motor cortex output exerts a major influence on lateral vestibular nucleus discharges, while the muscle afferents have a modulatory influence on the lateral vestibular nucleus responses to cortex.(ABSTRACT TRUNCATED AT 400 WORDS)

Integration of cortical and peripheral information in the lateral vestibular nucleus in the cat.

Neuronal discharges in the lateral vestibular nucleus (LVN) of the cat were studied during stimulation of a forelimb muscle and of a site in the contralateral motor cortex (area 4) capable of activating the same muscle. About one third of the LVN units were reactive to both stimulations or at least responded to one (cortex or muscle) but modified the response pattern when the other was stimulated also. The patterns evoked by a muscle were mostly enhanced on simultaneous stimulation of the cortical zone controlling the same muscle and vice versa. Only in the dorsal division the excitatory responses to muscle stimulation were depressed by simultaneous cortical stimulation. Some functional implications are proposed.

Dynamics of plasma gonadotropin and sex steroid release in polycystic ovarian disease after pituitary-ovarian inhibition with an analog of gonadotropin-releasing hormone.

To assess the dynamics of the suppression and recovery of plasma gonadotropins and sex steroids during and after inhibition of pituitary-ovarian function by a long-acting agonist GnRH-analog (GnRH-A), eight patients with polycystic ovarian disease were treated with 12 micrograms/kg X day GnRH-A for 56 consecutive days. In response to GnRH-A, these patients had a sharp and pronounced decline of their initially elevated immunoreactive LH and bioactive LH (bioLH) levels. Plasma immunoreactive FSH levels declined more rapidly than did bioLH, but the FSH decline was less sustained. Plasma testosterone, androstenedione, and estrone (E1) levels also declined during GnRH-A administration. The pattern of plasma androgen decrease resembled that of bioLH. There was a positive correlation between bioLH and the two androgens (r = 0.85; P less than 0.05, by Spearman's rank correlation, for both hormones). Cessation of GnRH-A administration was followed by prompt progressive increases in gonadotropin and androgen concentrations to pretreatment values. FSH recovered faster than bioLH. BioLH plasma concentrations reached pretreatment values by day 28. The recovery of plasma androstenedione and testosterone levels correlated positively with that of bioLH. Although plasma E1 levels were higher during the recovery period than during treatment, they never reached the concentrations found during the basal period, whereas estradiol concentrations were slightly but not significantly higher than those in the basal period. As a consequence, the E1 to estradiol ratio, very high in the basal period, approximated unity during recovery. These data indicate that hyperandrogenism in polycystic ovarian disease is gonadotropin dependent and accompanied by a relative abundance of LH bioactivity basally and during GnRH-A administration. Thus, the relative increase in bioLH secretion appears to be independent of the rate of gonadotropin secretion and the circulating sex steroid concentrations.

[Factors linked to the development of pleuro-pulmonary metastases in breast cancer. Preliminary study]. / Facteurs liés à l'évolution des métastases pleuro-pulmonaires dans le cancer du sein. Etude préliminaire.

The risk of death after pleuro-pulmonary metastasis was studied on a sample of 55 patients treated for breast cancer between 1954 and 1978. The women treated by tamoxifen, aminoglutethimide, or radiotherapeutic castration, at the time of the appearance of their metastasis, had a significantly lower risk of death than the women treated by other methods, or who were left untreated. The characteristics of the initial tumor, the delay between the primary tumor and the metastasis, the rhythm of systematic chest X-rays, and the use of chemotherapy did not significantly decrease this risk. The management of controlled therapeutic trials is suggested to confirm these results.

Effect of gonadotrophin-releasing hormone analogue (GnRH-A) administration on serum gonadotrophin and steroid levels in patients with polycystic ovarian disease.

A gonadotrophin-releasing hormone (GnRH) analogue, D-Ser[TBU]LRH-EA10, (GnRH-A), at a dose of 200 micrograms was given daily for 2 months to 6 women with polycystic ovarian disease (PCO). Prior to therapy the patients presented elevated LH, testosterone (T), oestrone (E1) and dihydrotestosterone (DHT) in the circulation. In response to GnRH-A, these subjects exhibited a marked decrease in circulating T, DHT and androstenedione (A) levels as measured 24 h after GnRH-A injection, by 4 weeks and onwards (P less than 0.05). After 2 weeks of daily administration, the serum LH profile, evaluated by sampling at 2, 4, 7 and 24 h after injection of GnRH-A, was not different from baseline, whereas after 4, 6 and 8 weeks the levels were significantly lower (*P less than 0.01). The profile of serum T levels was unmodified at the second week, but significantly decreased thereafter (*P less than 0.01). At the end of treatment, the E1 concentrations, elevated in pre-injection condition, were markedly decreased. These data demonstrate that in PCO subjects, GnRH-A significantly lowered the elevated levels of androgens commonly found in these patients. The close correlation observed between reduced serum LH and androgen concentrations suggests that pituitary desensitization could be responsible for the reduction in androgen levels, and may be evidence for a gonadotrophin dependence of the elevated concentrations of T in these patients.

Pyramidal input to the basal ganglia in the cat.

In cats with mesencephalic decerebration sparing the cerebral peduncles and ablation of sensorimotor cortex, changes in firing of single neurons of caudate nucleus (CD), putamen (PU), globus pallidus (GP) and entopeduncular necleus (EN) were studied following stimulation of the ipsilateral medullary pyramidal tract (MPT). Cells in CD and PU were not extensively influenced by impulses backfired from MPT (14.7% and 18.7%, respectively). Conversely, a larger number of GP cells (28.1%) and especially EN cells (46.9%) exhibited pronounced changes in their firing following MPT stimulation. The MPT-induced effects on CD and PU were either inhibition or excitations, the latter appearing at latencies greater than 11 ms. The responses observed in GP and EN cells were most frequently excitations, some of which appeared with latencies below 5 ms.

[Afferents from a single muscle of the forelimbs and fastigial neurons of the cerebellum]. / Afferenze da singoli muscoli degli arti anteriori su neuroni fastigiali del cervelletto.

Responses of neurons in the medial nucleus of cerebellum (CBM) were studied on stimulation of ipsilateral and contralateral homonymous muscles, in decerebrated cats. The aim was to find out to what extent information from homonymous muscles of the forelimbs converge on the same CBM neurons and whether the probability of such a convergence depends on location (axial, proximal, distal) or function (flexor, extensor) of the tested muscles. The analysis was limited to the neurons belonging to the rostral part of the nucleus which is known to control the ipsilateral muscle periphery. Neuronal activity was recorded extracellularly using tungsten microelectrodes (5-12 M omega) and muscle stimulation was performed by bipolar coated steel electrodes, with the exception of the tip. At least 6 pairs of homonymous muscles were generally stimulated: two axial, two proximal and two distal in both forelimbs. Care was taken that, when a muscle was stimulated, the others were not activated either directly or in a reflex way. Out of the 65 neurons studied, 60 (92%) were responsive to muscle stimulation. It was specifically observed that a high percentage of cells reacted to stimulation of distal muscles (74% to ipsilateral and 71% to contralateral ones). More than half (55%) of the neurons were responsive to activation of a pair of homonymous distal muscles and about one third of them (31%) to both the pairs of distal muscles. On the contrary the percentage of responses to proximal muscles was reduced foremost in the ipsilateral ones (23%) and only an exiquous percentage of cells (15%) received information from the homonymous proximal muscles.(ABSTRACT TRUNCATED AT 250 WORDS)