The radiological diagnosis of frontotemporal dementia in everyday practice: an audit of reports, review of diagnostic criteria, and proposal for service improvement.

AIM: To investigate how commonly valuable diagnostic information regarding the frontotemporal dementias (FTDs) may be missed on routine radiological reporting. MATERIALS AND METHODS: The magnetic resonance imaging (MRI) examination results of a series of 39 consecutive patients in whom the diagnosis was initially thought to be a form of FTD were audited. Twenty-two patients satisfied formal diagnostic criteria for subtypes of FTD. The initial non-specialist radiological reports of the MRI examinations were compared with those of a radiologist who specifically examined the images for the possibility of atypical dementia. RESULTS: Six of the 22 original reports provided a full and accurate description of the radiological findings, while two provided a fully accurate interpretation. CONCLUSION: Valuable diagnostic information may be missed unless clinicians and radiologists jointly review and discuss brain imaging in cases of dementia. The use of standardised scales may enhance the reporting of MRI examinations for dementia.

Kingella kingae Causing Septic Arthritis of the Knee in an Immunocompetent Adult.

The bacterium Kingella kingae is a species of Gram-negative coccobacillus usually found in the oropharynx. This is an emerging pathogen reported to cause bacteraemia, endocarditis, and osteoarticular infections in children and endocarditis in the immunocompromised adult. However, there are few cases of isolated joint infections reported in the immunocompetent adult. Due to specific isolation techniques required, delay in diagnosis can compromise patient outcome. We report a rare case of septic arthritis of the knee in an immunocompetent adult caused by K. kingae.

Short-term dietary energy restriction reduces lean body mass but not performance in physically active men and women.

We studied the effect of moderate, short-term energy restriction on physical performance in physically fit men (n = 13) and women (n = 11) in a controlled clinical research setting with a metabolic kitchen, exercise testing laboratory and training facility. The experiment consisted of a 10 d baseline period followed by either 2 wk of dietary energy restriction (750 kcal/d; n = 16) or energy balance (control; n = 8). During this 24 day study, exercise energy expenditure averaged 465 +/- 5.7 kcal/d in all subjects and was accomplished through treadmill running at a self-selected pace. Body weight was maintained in the control group (-0.36 +/- 0.24kg), but energy restriction resulted in weight loss of -1.29 +/- 0.16 kg (p < 0.001). There was a trend for lean body mass to decline more in the energy restriction group (p = 0.093), accounting for 61% of the weight loss, and urinary nitrogen excretion also tended to be higher in the energy restriction vs. control group (i.e., 13.2 +/- 1.1 vs. 11.2 +/- 1.0g/d; p = 0.089). Muscle strength (leg & shoulder press; 1 repetition maximum) was maintained or increased during the energy restriction period. Muscle endurance, assessed by leg squats to fatigue, and 5 mile run time improved following two weeks of energy restriction or balance. Anaerobic capacity (Wingate Test) increased slightly in the restriction (+ 368 +/- 219 joules) but declined in the control group 649 +/- 288 joules; p<0.05). We conclude that short-term (2 weeks) moderate energy restriction (approximately 750 kcal/d) results in weight loss but does not impair performance in physically fit young men and women.

Toward solving the inferential problem in laterality research: effects of increased reliability on the validity of the dichotic listening right-ear advantage.

As noted by Satz, the prevalence of lateralized language in the general population is underestimated substantially by the proportion of people who show the typical asymmetry on a laterality task. In a series of two dichotic listening experiments with a total of 171 right-handers and 170 left-handers, we tested the hypothesis that increased reliability of measurement will lead to increased classification accuracy. Experiment 1 showed that neither the frequency nor magnitude of the right-ear advantage (REA) for fused rhyming words increased as the number of trials increased from 120 to 480. Ear-difference scores were highly reliable (r = .85), even when based on 120 trials. Experiment 2, which involved lists of dichotic word pairs, yielded similar results. Even though retest reliability of the ear-difference score for 132 word pairs was only .45, neither the incidence nor strength of the REA increased significantly when the number of pairs was increased to 528. The results indicate that the poor classification accuracy of dichotic listening tasks cannot be attributed to unreliability.

A five-parameter logistic equation for investigating asymmetry of curvature in baroreflex studies.

Baroreceptor reflex curves are usually analyzed using a symmetric four-parameter function. We wished to ascertain the validity of assuming symmetry in the baroreflex curve and also of constraining the curves to pass through the resting blood pressure and heart rate (HR) values. Therefore, we have investigated the suitability of a new five-parameter asymmetric logistic model for analysis of baroreflex curves from rabbits and dogs. The five-parameter model is an extension of the usual four-parameter model and reduces to that model when the fitted data are symmetrical. Using 30 data sets of blood pressure versus renal sympathetic nerve activity (RSNA) and HR from six conscious rabbits, we compared the five-parameter curves with the four-parameter model. We also tested the effect of forcing these baroreflex curves through the resting point. We found that the five-parameter model reduced the unexplained variation and gave small but important improvements to the estimates of plateaus for RSNA and HR and the HR gain. Although forcing the HR curves through the resting values had little effect, this procedure, when applied to RSNA, produced a worse curve fit by increasing the unexplained variation with alteration to most of the estimated curve parameters. The mean arterial pressure-HR baroreflex relationship from six conscious dogs was also analyzed and showed clear evidence of systematic asymmetry. We conclude that the asymmetric model is a valuable extension to the symmetric logistic model when examining baroreceptor reflexes, giving improved estimates of the parameters and a new approach to examining the mechanisms contributing to baroreflex curve asymmetry. Furthermore, forcing the curves through the resting value is a statistically questionable practice when analyzing RSNA, because it affects the parameter estimates.

Frequency and amplitude of sympathetic discharges by baroreflexes during hypoxia in conscious rabbits.

Sympathetic nerve activity (SNA) from multifiber preparations exhibits two distinct components: the frequency at which discharges occur and their relative amplitude (reflecting the number of activated nerve fibers within each burst). These two components may respond independently to various afferent inputs, indicating separate central controlling processes. We examined the response in the frequency and amplitude of renal SNA to changes in baroreceptor activity and the effect of two forms of hypoxia on this relationship in nine conscious rabbits. Rabbits breathed either room air or one of two hypoxic gas mixtures (10% O2 or 10% O2 + 3% CO2) for 20 min, during which baroreflexes were stimulated by ramp increases and then decreases in arterial pressure with phenylephrine (0.5 mg/ml iv) and nitroprusside (1 mg/ml) (total arterial pressure range induced was 80 mmHg). Hypoxia with 10% O2 significantly increased the resting frequency of SNA before baroreflex modifications from 2.15 +/- 0.18 to 2.82 +/- 0.25 discharges/s and with 10% O2 + 3% CO2 to 3.20 +/- 21 discharges/s. The amplitude of sympathetic discharges was increased 44 +/- 5% over control levels during 10% O2 but was not further increased by the addition of 3% CO2. The baroreflex curve for total SNA (1-s averages of the integrated neurogram) showed a graded response to the two hypoxic stimuli, with significant increases in the upper plateau, gain, and resting point on the curves. However, the baroreflex curve for the frequency or amplitude of sympathetic discharges did not show graded responses to each hypoxic treatment. The frequency baroreflex curve was sigmoidal and not changed from air during 10% O2. During 10% O2 + 3% CO2, the gain (responsiveness) of the curve was increased although the range of frequencies occurring was unaltered. The baroreflex curve for the amplitude showed similar responses to the two hypoxic stimuli, namely, increases in the upper plateau, gain, and resting point of the curve. We conclude that the frequency and amplitude of sympathetic discharges are able to respond differentially to changes in afferent stimuli. Given that alterations in the frequency and recruitment of sympathetic fibers (amplitude) to the kidney may have differing effects, this phenomenon may provide a previously unknown level of renal hemodynamic control through the interaction of specific afferent inputs to the central nervous system.

A profile of mood in ambulatory nursing home residents.

This study examined mood in 54 ambulatory nursing home residents. Female subjects reported significantly lower scores on the Anger-Hostility subscale than either men or normative subjects. Women also scored lower than normative subjects on the Vigor-Activity and Confusion-Bewilderment subscales, whereas men scored lower on the Fatigue-Inertia subscale. Both men and women reported below norm scores for the Tension-Anxiety subscale. Further study is needed to identify sociological factors that may explain diminished expression of mood in this vulnerable population, and to compare these findings with the mood profile of community dwelling elders.

Amount and type of dietary fat regulate pancreatic lipase gene expression in rats.

Both amount and type of dietary triglycerides regulate pancreatic lipase, but the mechanism is not fully understood. This study investigated the effects of type (safflower oil and lard) and amount [low (50 g/kg diet) or moderate (174 g/kg diet)] of fat on rat pancreatic lipase (rPL) activity and mRNA levels. Polyunsaturated safflower oil resulted in 80% greater lipase activity compared with the saturated lard at moderate levels, whereas safflower oil resulted in 50% lower lipase activity compared with lard at low levels. The rPL-3 mRNA levels were greater in rats fed the moderate safflower oil diet (163%) or the moderate lard diet (212%) than in those fed the respective low fat diets and were 45% greater in those fed safflower oil than in those fed lard. The rPL-1 mRNA levels were greater in rats fed moderate safflower oil (50%) or lard (135%) than in those fed the respective low fat diet, but these levels were not affected by type of fat, in contrast to rPL-3 mRNA levels. The amount of fat independent of its type regulates pancreatic lipase pre-translationally, because increasing dietary saturated or polyunsaturated fat resulted in parallel changes in rPL-3 and rPL-1 mRNA levels. However, type of fat may regulate pancreatic lipase at other levels such as translational or post-translational, because the 212% increase in rPL-3 mRNA in rats fed the moderate lard diet compared with the low lard diet did not result in greater pancreatic lipase activity.

In vitro evaluation of gallstone dissolution with methyl-tert-butyl ether and ultrasound energy.

Given the large number of cholecystectomies performed annually, a nonsurgical approach to gallstone therapy is of great interest. A laboratory ultrasound system has been developed to study enhancement of methyl-tert-butyl ether (MTBE) dissolution of human gallstones in vitro. A mathematical model that quantitatively characterizes the dissolution process via a rate constant has been developed. Using this model, the kinetics of 15 gallstones from a single patient were evaluated for three dissolution methods: 1) unstirred MTBE, 2) aspirated MTBE, and 3) ultrasonically enhanced MTBE. The results showed excellent fits between the model and measured dissolution rates. 195 kHz continuous-wave (CW) ultrasonically enhanced dissolution rates exhibited a 6.2 fold gain over the manually aspirated MTBE and a 49.5 fold gain over static MTBE dissolution. Investigation of 50% duty cycle pulsed mode ultrasound revealed that total power appears to be the determinant of the observed dissolution rates. Gallstone calcification showed a strong correlation with dissolution rates measured by the model.

Accelerated gallstone dissolution in methyl tert-butyl ether by sonication. An in vitro study.

OBJECTIVES: The authors tested the effect of 195 KHz therapeutic ultrasound energy on gallstone dissolution in concert with methyl tert-butyl ether (MTBE) in vitro. METHODS: Sixteen sets of three gallstones matched for weight and appearance were selected from 16 surgically resected human gallbladders. One stone from each set was analyzed for its density pattern by computed tomography (CT) and biochemically for cholesterol content. Based on CT appearance, the stones were classified into eight noncalcified, four partially calcified, and four heavily calcified sets. The three stones were subjected to dissolution with MTBE: one with simultaneous sonication via an experimental ultrasound unit, one with manual stirring, and one acted as control without added treatment. RESULTS: Sonication reduced the dissolution time of noncalcified stones by 96% (range, 94%-98%; standard deviation [SD], 2%) relative to controls, and it was three to four times more effective than manual stirring. It was similarly effective in helping to dissolve partially calcified stones, but not heavily calcified stones. CONCLUSIONS: This study demonstrates the positive effect of sonication in accelerating gallstone dissolution with MTBE in vitro for stones without heavy calcification.

Some differences between men and women who commit suicide.

Men have persistently had a several-fold higher suicide rate than women. In this study of 204 consecutive suicides, the authors examined three areas in which the men differed from the women. Men used more violent, immediately lethal methods of suicide, were almost three times more likely to be substance abusers, and were more likely to have economic problems as stressors. The authors conclude that while the difference in suicide rate between men and women is complexly determined, the weight of the evidence suggests that more men than women intend to commit suicide.

Impaired proteolytic processing of lysosomal N-acetyl-beta-hexosaminidase in cultured fibroblasts from patients with infantile generalized N-acetylneuraminic acid storage disease.

Cultured skin fibroblasts from patients suffering with infantile generalized N-acetylneuraminic acid (NeuAc) storage disease accumulate free NeuAc in a population of lysosomes less dense than those observed in normal fibroblasts (1.035 vs. greater than 1.07 mean density), as assessed by the distribution of lysosomal enzyme activities and NeuAc on Percoll gradients after subcellular fractionation. In the present study, normal and affected fibroblasts were labeled with [35S]methionine, and cell homogenates or subcellular fractions from Percoll gradients were immunoprecipitated with polyclonal antibodies to lysosomal N-acetyl-beta-hexosaminidase (Hex); immunoprecipitated polypeptides were analyzed by SDS-polyacrylamide gel electrophoresis. The synthesis and initial processing of Hex polypeptides were comparable in normal and affected fibroblasts, but mature polypeptides were quantitatively localized in "buoyant" lysosomes of affected cells, along with Hex activity; moreover, mature alpha-chain of Hex was approximately 2 kDa larger than that observed in normal cells. The molecular weight difference was apparently due to impaired proteolytic processing of alpha-chain in affected fibroblasts, since treatment of immunoprecipitated alpha-chain from normal and affected cells with neuraminidase and endo-beta-N-acetylglucosaminidase H failed to resolve the molecular weight difference. The impaired processing was observed to be persistent (after a chase of up to 200 h), but had no apparent effect on the turnover or activity of Hex in affected fibroblasts. The observed proteolytic processing defect may be primary or secondary in infantile NeuAc storage disease.

Psychopharmacologic approaches to the borderline patient.

Five case examples are presented to illustrate the role of psychopharmacology in the treatment of patients diagnosed as Borderline Personality Disorders. The cases range from organic through affective and schizophrenic syndromes which are not infrequently at the "border" of personality disorders, and which often respond to specific pharmacologic interventions. The importance of looking for and recognizing drug treatable syndromes within the wide array of patients who satisfy DSM-III criteria for Borderline Disorders is discussed.

Worldwide trends and developments in social security, 1983-85.

This article highlights the major developments and trends in social insurance programs that are presented in detail in the 1985 edition of Social Security Programs Throughout the World. The data in that reference book reflect the fact that as countries have adapted to the slow economic growth in recent years, increased emphasis has been placed on the cost effective use of social security funds. Some industrialized countries have restructured benefit provisions and reallocated resources among programs and beneficiaries to target benefits for specific groups. In the developing nations, the introduction of additional programs and expanded benefits continued on a limited scale amidst widespread concern about maintaining the real value of benefits after years of high inflation.

Digital subtraction angiography: principles and potential applications in emergency medicine.

Digital subtraction angiography (DSA) is a new computer-assisted process which enables visualization of arterial structures after intravenous injection of contrast material. Technical requirements of the process mandate total patient cooperation during the filming sequence, which generally lasts five to ten seconds. Because of lower spatial resolution compared with conventional angiography, and difficulty with vessel overlap as a result of nonselective opacification, DSA has not supplanted conventional angiography in evaluation of traumatic vascular injuries. The technology of DSA, currently accepted uses, and potential future uses of DSA are discussed. Future improvements in DSA promise to make it more amenable to the evaluation of traumatic vascular injuries.