Hyperintense subcortical brain alterations in anorexia nervosa.

OBJECTIVE: The results of past research have identified changes in brain structure in anorexia nervosa. We observed previously unreported MRI alterations in two cases of anorexia nervosa. METHOD: For both cases, we reviewed the clinical history, MRI scans and conducted a pertinent literature review. RESULTS: The MRI brain scans of two patients with the diagnosis of anorexia nervosa revealed evidence of subcortical hyperintense changes on T2-weighted images. DISCUSSION: No previous reports of these findings have been described in the literature on anorexia nervosa to date. Clinical and pathologic correlates associated with these brain observations in anorexia nervosa are discussed.

SPECT brain imaging abnormalities in attention deficit hyperactivity disorder.

SPECT using N-Isopropyl I-123 IMP was performed, as part of a neuropsychiatric evaluation, on 10 patients with the DSM III-R diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) and 6 patients from a non-ADHD mixed psychiatric group used as controls for comparison. Mean regional I-123 IMP SPECT region of interest (ROI) count ratios (left to right) demonstrated that the ADHD patients had greater overall hemispheric I-123 IMP uptake asymmetry with less activity in the left frontal and left parietal regions in comparison to control patients. Both groups demonstrated similar I-123 IMP uptake asymmetry in the temporal regions. These findings are consistent with previous studies of brain physiology in ADHD implicating regional cortical perfusion and metabolism abnormalities in areas which are involved in the control of attentional processes.

Tc-99m HMPAO SPECT imaging of the central nervous system in tuberous sclerosis.

Tc-99m HMPAO was used to evaluate cerebral perfusion in a patient with tuberous sclerosis. The SPECT images demonstrated reduced HMPAO uptake in regions corresponding with MRI-confirmed locations of cortical tubers. These results indicate that the lesions are characterized by vascular perfusion deficits and support the hypothesis that cortical tubers result from developmental abnormalities of the embryonic central nervous system.

Brain imaging: evoked potential, quantitative EEG and SPECT abnormalities in schizophrenia.

The case of a nineteen-year-old female with a three-year history of psychiatric symptomatology clinically consistent with the DSM-III-R diagnosis of schizophrenia is presented. Neurophysiologic assessment using topographic brain mapping demonstrated auditory evoked potential P300 asymmetry with left temporal inactivation and increased latency, while EEG frequency analysis was remarkable for left hemispheric slow wave predominance as well as increased left temporal beta activity. Single photon emission computed tomography (SPECT) using hexamethylpropyleneamine oxime (HMPAO) in the same patient revealed radionucleide uptake reductions in the frontotemporal cortical regions. The clinical presentation of schizophrenia in the context of these imaging correlations is reviewed.

Somatic complaints in childhood tic disorders.

Twenty-six children diagnosed with chronic tic disorders (18 with Gilles de la Tourette syndrome and 8 with chronic motor tic disorder) were studied for unexplained physical complaints. Compared to normal controls, an excess of somatic complaints was found in the tic disorders group; this was similar to an excess of somatic complaints in a mixed psychiatric clinic group. Medication produced no significant effect on somatic complaints for patients in the tic and psychiatric clinic groups. Within the tic disorders group, no significant correlation was found between the increased somatic complaints and the severity of anxiety, dysphoria, or movement disorder.

A versatile phage lambda expression vector system for cloning in Escherichia coli.

By integrating fragments from the expression plasmids pJK2 and pJK4 into a derivative of the bacteriophage lambda, we constructed the phage expression vectors lambda JK2 and lambda JK4, which allow efficient cloning of genomic or cDNA either into the 5' end or the 3' end of the lacZ gene of Escherichia coli. Expression of barrier-free DNA in phase may lead to fusion proteins consisting of active beta-galactosidase (beta Gal) plus an additional polypeptide encoded by the inserted DNA. Analysis of distinct recombinant clones is quick and easy, due to the reversible integration of the plasmid into the genome. As an example, we constructed an expression library of genomic Plasmodium falciparum DNA in lambda JK2. We polymerised (amplified) and expressed a synthetic DNA fragment, which codes for a potential antigenic determinant of the 11-1 gene of Plasmodium falciparum as a fusion to the N terminus of active beta Gal. We demonstrate that such chimeric molecules can be affinity-purified and that polypeptides can be separated from the beta Gal part by cleavage with the protease factor Xa.

The 11-1 gene of Plasmodium falciparum codes for distinct fast evolving repeats.

The 11-1 gene of Plasmodium falciparum has been investigated by DNA sequence analysis. It begins at the 5' end with a putative miniexon coding for a polypeptide which has the characteristics of a signal sequence. The miniexon is followed by a small intron. This again is followed by a large exon consisting of 9-, 18- and 27-bp repeats embedded in unique DNA. Specific antibodies isolated by affinity chromatography on a purified recombinant fusion protein expressing the three- and six-amino acid repeats were used to identify the product of the 11-1 gene. In exhibits size variations from 260 to 350 kd in different strains. Southern blot analysis with synthetic DNA as probe demonstrates that the 18-bp repeat is absent or drastically altered in two strains whereas the other repeats are present in all seven strains investigated. The unusual preference for G in the third position of some codons of the repeats but not in the unique sequences indicates rapid evolution of the repeats. Slippage during replication, unequal crossing over and selection are discussed as possible mechanisms leading rapidly to extreme diversity.

Chairing the academic occupational therapy department: a job analysis.

The role of department chair is one of the most important roles in academia, yet chairs are rarely formally prepared for it. A modified job analysis format can be used to examine the role of the chair. In addition to administrative responsibilities, the chair, who is usually selected from the faculty, has teaching, research, and service responsibilities. Administrative functions include dealing with data (finances and programs), people (students, faculty, support personnel, the dean, and other administrators), and things (department reports, space, equipment, and materials). There is a high attrition rate of department chairs. Occupational therapy students and therapists must be taught to see the academic chair position as an opportunity for a challenging career encompassing academia and administration.

Pitfalls in the diagnosis of tricuspid atresia: report of a new angiocardiographic sign.

Two patients with the classical clinical, angiographic, and echocardiographic signs of tricuspid atresia are reported, where the correct diagnoses were made at operation; one child had cor triatriatum dexter, the other child total anomalous systemic venous drainage to the left atrium. The literature on cor triatriatum dexter and total anomalous systemic venous drainage is discussed and a new angiographic sign for the differentiation from tricuspid atresia is reported: nonopacification of the right atrial appendage with right atrial angiocardiography.

[Echocardiographic diagnosis of a thrombus in the pulmonary artery following a banding operation]. / Echokardiographische Diagnose eines Thrombus in der Pulmonalarterie nach Banding-Operation.

In an infant with univentricular heart and banding of the pulmonary artery a thrombus developed in the pulmonary artery distal to the banding. The diagnosis was made at first by two-dimensional echocardiography and confirmed by angiography. The pathogenetic factors and the clinical relevance of this rare observation are discussed.

[Echocardiographic pressure-dimension analysis following anatomically corrective operation of d-transposition of the great arteries]. / Echokardiographische Druck-Dimensions-Analyse nach anatomischer Korrekturoperation der d-Transposition der grossen Arterien.

The major theoretical advantage of anatomic correction of transposition of the great arteries compared with intraatrial repair is that the left ventricle becomes the systemic pump. In 10 patients we analysed 5-12 months after anatomic correction the left ventricular echocardiographic pressure-dimension loop, meridional wall stress and left ventricular stiffness from the simultaneous recordings of the left ventricular pressure and M-mode echocardiogram. The low left ventricular diameters, left ventricular hypertrophy in 4 patients, and increased peak meridional wall stress in 3 patients indicate that left ventricular adaption to systemic impedance is still incomplete 5-12 months after anatomic correction. The cycle efficiency was reduced in 2 patients, indicating incoordinate left ventricular contraction and relaxation. In one of these patients the left ventricular stiffness was severely increased, while in another patient there was a slight increase in left ventricular stiffness. In all patients the right ventricular internal diameter was increased due to the long-standing preoperative pressure and volume overload.

[Left-ventricular thrombosis in hypoplastic left heart syndrome: echocardiographic diagnosis]. / Linksventrikulärer Thrombus bei hypoplastischem Linksherzsyndrom: echokardiographische Diagnose.

Because of its fatal prognosis the hypoplastic left heart syndrome has to be distinguished from operable lesions with similar clinical presentation. In most cardiological centers the diagnosis is made solely by echocardiography. Additional diagnostic studies are performed only if echocardiographic findings are not standard. We report the echocardiographic findings in a case of hypoplastic left heart syndrome (aortic atresia, coarctation, mitral stenosis, hypoplastic left ventricle) where a thrombus formed inside the left ventricle in the third month of life.