Inferior temporal lobe atrophy and APOE genotypes in Alzheimer's disease. X-ray computed tomography, magnetic resonance imaging and Xe-133 SPECT studies.

The apolipoprotein E (APOE) gene epsilon 4 allele is known to be associated with late-onset familial and sporadic Alzheimer's disease (AD). We assessed the possible relationship between APOE genotypes and morphological or functional changes in AD brains by x-ray computed tomography (CT), magnetic resonance imaging (MRI) and Xe-133 single photon emission CT (SPECT). First, we estimated the change in size of the whole brain and total ventricular system by using two x-ray CT indices, the cerebral index (CI) and ventricular index (VI), respectively. Neither CI nor VI differed significantly among APOE genotypes. Then, we focused on the inferior temporal lobe regions by introducing new MRI indices, the inferior temporal index (ITI), temporal horn index (THI) and infero-medial temporal index (IMTI). We found a significant difference in each MRI index among APOE subgroups; ITI and IMTI were lower, while THI was higher in AD patients with at least one APOE epsilon 4 allele (epsilon 4+ group) than in those without such an allele (epsilon 4-group). Finally, we compared relative regional cerebral blood flow (rCBF) of Xe-133 SPECT among the AD subgroups. Relative rCBF in the cerebral cortex, particularly in the temporal lobe, was lower in the epsilon 4+ group than in the epsilon 4- group. These results indicate that possession, and thus expression, of the APOE epsilon 4 allele affects preferentially the inferior temporal lobe, encompassing the hippocampus and amygdala, in AD patients.

[Relationship between juxtapapillary duodenal diverticula and biliopancreatic disease--evaluation by endoscopic biliary manometry].

Endoscopic biliary manometry was performed to evaluate the motor activity of the sphincter of Oddi (SO) in 28 patients, 13 with juxtapapillary duodenal diverticula (8 with biliopancreatic disease) and 15 without diverticula (10 with biliopancreatic disease). So pressure and the rate of irregular wave pattern of phasic contraction in patients with diverticula were significantly higher than those in patients without diverticula. Especially all the patients with both diverticula and biliary stones had motor disorders of the SO. The patients with diverticula were also divided into three groups by endoscopic findings for the location of diverticular; The papilla of Vater was located close to diverticula (within about 4 cm) in group A, on the edge of diverticula in group B, in the diverticula in group C. Diverticula could have more direct effect on the motor activity of the SO in group C. Those results suggest juxtapapillary diverticula have close relationship with the motor activity of the SO and biliopancreatic disease, especially in cases which the papilla of Vater located in the diverticula. We conclude that the motor disorders of the SO might be responsible for biliopancreatic disease in patients with juxtapapillary diverticula.

[Endoscopic manometry of common bile duct and the sphincter of Oddi in patients with biliary tract stones and in controls].

Endoscopic manometry using microtransducer was applied to evaluate the motor activity of the sphincter of Oddi (SO) and common bile duct (CBD) in patients with biliary tract stones and in controls. CBD pressure, SO pressure and the incidence of irregular phasic wave pattern (IRPWP) were relatively higher in patients with biliary tract stones than those in controls. There was no significant difference in CBD and SO pressure between patients with dilated CBD and patients with non-dilated CBD, however the incidence of IRPWP was significant higher in patients with dilated CBD than that in patients with non-dilated CBD. SO pressure and the incidence of IRPWP were significant higher in patients with papillitis than those in patients without it. Patients with valvular orifice of the papilla of Vater showed high incidence of IRPWP, and in such cases it was suggested that SO had different motor functions for CBD and pancreatic duct because these ducts were seen opening onto the papilla separately according to the findings of pancreatocholangiogram. We concluded that endoscopic manometry of CBD and the SO was useful to evaluate the motor activity of SO and provided a basis for the assessment of the motor function mechanism of SO. Our results indicated the motor activity of SO had close relationship with biliary tract stones, CBD dilatation and endoscopic findings of the papilla of Vater.