[Venezuelan consensus guidelines on the use of magnetic resonance in diagnosis and follow up of patients with multiple sclerosis]. / Consenso venezolano para el uso de la resonancia magnetica en el diagnostico y seguimiento de pacientes con esclerosis multiple.

INTRODUCTION: The clinical use of magnetic resonance (MR) in patients with multiple sclerosis (MS) has advanced markedly over the past few years. Several groups around the world have developed consensus guidelines about the role of MR in MS at diagnosis and during follow up. However, in some regions is difficult to extrapolate the recommendations. AIM: To provide recommendations for the implementation of MR in MS patients at diagnosis and follow up in Venezuela. DEVELOPMENT: A group of experts from Venezuela that included neurologists and radiologists, by using the online surveys methodology as well as face to face meetings developed the intended consensus for the use of MR during the diagnosis and follow up of MS patients in Venezuela. Seventeen recommendations were established based on published evidence and the expert opinion. Recommendations focused on the role of conventional MR techniques and brain atrophy measurement in MS patients both at diagnosis and during follow-up. CONCLUSIONS: The recommendations of this consensus guidelines attempts to optimize the health care and management of patients with MS in Venezuela.

TITLE: Consenso venezolano para el uso de la resonancia magnetica en el diagnostico y seguimiento de pacientes con esclerosis multiple.Introduccion. El uso de la resonancia magnetica (RM) en el diagnostico y seguimiento de pacientes con esclerosis multiple (EM) se ha incrementado considerablemente durante los ultimos años. Diversos grupos de trabajo internacionales han intentado clarificar y normativizar el uso de la RM tanto en el momento del diagnostico como durante el seguimiento de los pacientes. Sin embargo, en muchas ocasiones se extrapolan datos de otras regiones que no contemplan la realidad de cada lugar o son dificiles de implementar. Objetivo. Elaborar un consenso venezolano para el uso de la RM en el diagnostico y seguimiento de pacientes con EM. Desarrollo. Un grupo de expertos de Venezuela, conformado por neurologos y radiologos, mediante metodologia de ronda de encuestas a distancia y reuniones presenciales, llevo adelante la elaboracion del consenso pretendido para el uso de la RM en el diagnostico y seguimiento de pacientes con EM en Venezuela. Se establecieron 17 recomendaciones basadas en la evidencia publicada y en el criterio de los expertos que participaron. Las recomendaciones se enfocaron en el papel de las tecnicas convencionales de RM, asi como en el de la medicion de la atrofia cerebral en pacientes con EM, tanto en el momento del diagnostico como durante el seguimiento. Conclusion. Las recomendaciones establecidas en el presente consenso permitiran optimizar el cuidado y el seguimiento de los pacientes con EM en Venezuela.

Accuracy in tunnel placement for ACL reconstruction. Comparison of traditional arthroscopic and computer-assisted navigation techniques.

The purpose of this randomized, prospective study was to compare accuracy in tunnel placement as performed with a traditional arthroscopic anterior cruciate ligament (ACL) reconstruction technique and with KneeNavTM ACL, a computer-assisted surgical navigation technique. Two surgeons experienced in ACL reconstruction, but inexperienced in computer-assisted surgical navigation technique, each randomly used traditional arthroscopic guides or KneeNavTM ACL to drill a tunnel in twenty identical foam knees. Placement of the resulting tibial and femoral tunnels was measured with a computer-assisted digitizing method and compared to traditional biplanar radiographs. Statistical analysis with Student's t-test was used to compare the distance from the ideal tunnel placement to the femoral and tibial tunnels. Accuracy of tunnel placement with KneeNavTM ACL was significantly better than that obtained with the traditional arthroscopic technique. Distances from the ideal tunnel placement to the femoral and tibial tunnels were 4.2 +/- 1.8 mm (mean +/- SD) and 4.9 +/- 2.3 mm, respectively, for the traditional arthroscopic technique, and 2.7 +/- 1.9 mm (femur) and 3.4 +/- 2.3 mm (tibia) for KneeNavTM ACL. These differences were statistically different. Tunnel placement for ACL reconstruction with KneeNavTM ACL, an image-based, computer-assisted surgical navigation device with a simple and intuitive interface, was more accurate than with the traditional arthroscopic technique.

Differential regulation of mu-opioid receptor mRNA in the nucleus accumbens shell and core accompanying amphetamine behavioral sensitization.

Repeated amphetamine (AMPH) administration results in behavioral sensitization. To investigate the participation of the opioid system in this phenomenon, we examined the effects of acute and repeated AMPH administration on mu-opioid receptor (MOR) mRNA levels in the nucleus accumbens (NAc) and striatum (STR) of rats, by quantitative non-radioactive in situ hybridization. Five injections of d-AMPH (1.5 mg kg-1, i.p., once every other day), resulted in a sensitization response profile and a significant down-regulation of MOR mRNA levels in the NAc shell, whereas no change was observed in MOR mRNA levels in the NAc core compared to the saline controls. Conversely, MOR mRNA levels were up-regulated in the rostral STR of AMPH-sensitized rats compared to saline controls. No changes in MOR mRNA levels were observed after acute AMPH treatment in any of the brain regions studied. These results suggest that the opioid system participates in the neurobiological underpinnings of behavioral sensitization and that opioid receptor (OR) expression in the STR and NAc shell and core is differentially modulated by repeated AMPH exposure.

Effects of pimozide on the psychopathology of delusional disorder.

1. The effects of pimozide on the psychopathology of delusional disorder were studied. 2. After six weeks, pimozide (2-12 mg/day) administration had no effect on the Brief Psychiatric Rating Scale, or in the psychological, social and occupational functioning, as measured by the Global Assessment of Functioning Scale. 3. When the different dimensions of the delusional experience were looked upon, no modifications were observed in any of them after six weeks of pimozide treatment. 4. These data failed to support the therapeutic role of pimozide in the treatment of delusional disorder and may suggest, when compared to other disorders with prominent delusions such as schizophrenia, a different neurobiology for the illness.

The Otto Aufranc Award. Image guided navigation system to measure intraoperatively acetabular implant alignment.

There has been little clinical research to examine the effects of patient positioning and pelvic motion on the alignment of the acetabular implant during total hip replacement surgery. Until now, no tools were capable of accurately measuring these variables during the actual procedure. As part of a broader program in medical robotics and computer assisted surgery, a clinical system has been developed that includes several enabling technologies. The hip navigation system (HipNav) continuously and precisely measures pelvic location and tracks relative implant alignment intraoperatively. HipNav technology is used to gauge current clinical practice and provide intraoperative feedback to surgeons with the goal of improving the precision and accuracy of acetabular alignment during total hip replacement. This system provides surgeons with a new class of image guided measurement tools and assist devices. These tools successfully were introduced into the clinical practice of surgery with results showing the following: (1) There exist unpredictable and large variations in the initial position of patients' pelves on the operating room table and significant pelvic movement during surgery and during intraoperative range of motion testing; (2) current mechanical acetabular alignment guides do not account for these variations, and result in variable and in the majority of cases unacceptable acetabular alignment; and (3) press fitting oversized acetabular components influences the final cup orientation.

Effects of D-amphetamine administration on the release of endogenous excitatory amino acids in the rat nucleus accumbens.

1. The effects of acute D-amphetamine administration to rats on the release of endogenous excitatory amino acids from nucleus accumbens slices were studied. 2. D-amphetamine (5 mg/kg and 10 mg/kg; i.p.) significantly increased the spontaneous release of aspartate and glutamate from nucleus accumbens slices. 3. In contrast, D-amphetamine either produced no change or rather decreased K+ (40 mM)-evoked and N-methyl-D-aspartate (100 microM)-evoked release of aspartate and glutamate from the slices, respectively. 4. When D-amphetamine treated rats were pretreated with haloperidol, the effects of D-amphetamine on the spontaneous release of excitatory amino acids were not produced, whereas its effects on N-methyl-D-aspartate-evoked release remained unchanged. 5. These data suggest that amphetamine produces changes in excitatory amino acid-mediated transmission in the nucleus accumbens, that may play a role in amphetamine-induced behavioral or psychotomimetic effects.

Effects of in vitro ethanol and chronic ethanol consumption on the release of excitatory amino acids in the rat hippocampus.

In CA1-CA3 hippocampal slices, in vitro ethanol (EtOH) (10-100 mM) evoked, as a function of EtOH concentration, a differential release of aspartate (Asp) and glutamate (Glu). Omission of Ca2+ ions from the superfusion media completely abolished the EtOH-induced release of Asp but not that of Glu. In addition, at 20 mM, EtOH enhanced K(+)-evoked release only of Asp. Finally, delayed changes were observed on NMDA-evoked release of [3H]noradrenaline (NA) in the dentate gyrus (DG) after withdrawal from EtOH for 30 days.

Differential effects of haloperidol on negative symptoms in drug-naive schizophrenic patients: effects on plasma homovanillic acid.

After 5 weeks of haloperidol, positive symptoms in drug-naive schizophrenic patients substantially subsided. Negative symptoms, although with a different temporal pattern, decreased after the fifth week of haloperidol treatment; specifically, a decrease was seen in anhedonia and affective flattening, whereas avolition-apathy and attentional impairment presented no changes. Alogia showed a decrease during the third week and a trend to return to placebo scores during weeks 4 and 5. Changes in affective flattening, alogia and attentional impairment correlated with changes in positive symptoms. During placebo, plasma homovanillic acid (HVA) correlated with negative symptoms and with changes presented by negative symptoms between the first and the fifth treatment week. These data show that negative symptoms respond differentially to neuroleptics and suggest that avolition-apathy may represent a different behavioral component of the schizophrenia process.

N-Methyl-D-aspartate receptors and release of newly-synthesized [3H]dopamine in nucleus accumbens slices and its relationship with neocortical afferences.

1. The effects of excitatory amino acid agonists on the release of newly-synthesized [3H]dopamine was examined in slices of nucleus accumbens of the rat. 2. L-glutamate and N-methyl-D-aspartate stimulated the release of newly-synthesized [3H]dopamine, which was completely inhibited by physiological concentrations of magnesium and by the selective and non-competitive antagonist MK-801. 3. Other ligands for excitatory amino acids subtype receptors, such as AMPA and kainic acid, had no effect of newly-synthesized [3H]dopamine release. 4. Frontal cortical ablation produced a significant increase on the N-methyl-D-aspartate-stimulated release of [3H]dopamine. 5. These data suggest that dopaminergic function in the rat nucleus accumbens is modulated by N-methyl-D-aspartate receptors, the sensitivity of which is determined, at least in part, by glutamatergic and/or aspartergic afferents from the frontal cortex.

[Munchausen's syndrome: a study of 6 cases]. / Síndrome de Munchausen: estudio de 6 casos.

We report 6 patients with Munchausen syndrome, a fictitious disorder with physical symptoms. There were 4 females and 2 males, the age ranged from 21 to 29 years. Abdominal pain (2), hemoptysis, shock and hypoglycemia were the presenting symptoms. The diagnosis was made after a prolonged and costly hospital course, including invasive and non invasive diagnostic procedures. Two patients were ill enough to be at risk of death. An early diagnosis may help prevent unnecessary or risky procedures in these patients.

[Biotechnological aspects in "loco" larvae]. / Aspectos biotecnológicos en larvas de "loco".

The biology of planktotrophic larvae of Concholepas concholepas is the main bottleneck towards developing biotechnologies to rear this muricid. Data concerning planktonic larvae development, diets and environmental signals triggering larval settlement and recruitment is scarce. We have begun the study of the molecular and cell biology of embryos, larvae and recruits having as a final goal, the development of appropriate biotechnologies to rear this gastropod. First, an inverse ratio between BuChE and AChE enzyme activities was established. This ratio may be a precise developmental marker for this species. Second, for the first time a phosphoinositide related regulatory pathway is reported in a muricid, opening a new approach to the biotechnological management of larvae. Third, the relation between sulfate in sea water and larval motility was studied. Concentrations below 125 microM sulfate decreases larval motility. The sulfate is incorporated in proteoglycans which participate in different developmental phenomena. Lastly, a genomic Concholepas concholepas DNA sequence, similar to that of a human growth hormone probe was detected. This is very interesting since growth factors are key molecules during development, growth and are involved in food conversion rates in fish and also, in a variety of marine invertebrates.

Circadian variation of plasma homovanillic acid levels is attenuated by fluphenazine in patients with schizophrenia.

Plasma homovanillic acid (HVA) levels were measured hourly for a 24-hour period in 10 patients with schizophrenia during treatment with placebo and fluphenazine. Ten age- and sex-matched normal volunteers were similarly studied. Diet and activity were carefully controlled and monitored in both patients and controls. A circadian rhythm of the plasma HVA level was found in controls with a nadir in the afternoon and peak values in the early morning hours; when the patients were free from drugs, they showed a similar rhythm with lower amplitudes. Fluphenazine treatment significantly reduced the plasma concentrations of HVA and abolished the 24-hour rhythm. These data suggest that a 24-hour rhythm of the plasma HVA level exists in humans and that the amplitude of this rhythm may be less pronounced in patients with schizophrenia. Treatment with neuroleptic drugs reduces both the absolute levels and the normal circadian rhythm of the plasma HVA level.

A central 6-hydroxydopamine lesion prevents fluphenazine-induced increase in plasma homovanillic acid.

Plasma and brain levels of the dopamine metabolite, homovanillic acid, were measured in rats after acute and chronic treatment with fluphenazine. After acute administration, homovanillic acid levels were increased in the whole frontal cortex, caudate nucleus, nucleus accumbens, anterior cingulate (supragenual) cortex, prefrontal cortex and plasma. Following chronic administration, the effects of single doses of fluphenazine in increasing homovanillic acid were markedly attenuated in the caudate nucleus, nucleus accumbens, the whole frontal cortex, anterior cigulate cortex and plasma, but not in the prefrontal (anteromedial) cortex. Following fluphenazine administration plasma homovanillic acid levels were correlated with homovanillic acid concentrations in whole frontal cortex (r = 0.63, p less than 0.01) and caudate nucleus (r = 0.51, p less than 0.05). Further, prior intracerebroventricular administration of 6-hydroxydopamine prevented the fluphenazine-induced increase in plasma homovanillic acid. These data suggest that in the rat, plasma and brain (caudate nucleus and whole frontal cortex) homovanillic acid levels change in a similar fashion during acute and chronic neuroleptic administration.

Acute stress enhances the activity of the GABA receptor-gated chloride ion channel in brain.

The effect of acute swim stress on the functional activity of the gamma-aminobutyric acid (GABA) receptor/chloride ion channel was studied using an assay to measure 36chloride (36Cl-) uptake into rat brain synaptoneurosomes. Muscimol-stimulated 36Cl- uptake in cerebral cortex, hippocampus, but not cerebellum, was enhanced (increased potency and efficacy) in rats subjected to 10 min of swimming, compared to non-stressed, control rats. The effect of swim stress on the activity of the GABA receptor/Cl ion channel was prevented by adrenalectomy.

Autoradiographic visualization and characterization of [3H]ouabain binding to the Na+,K+-ATPase of rat brain and pineal.

Ouabain binds to the catalytic subunit of Na+,K+-ATPase and specific [3H]ouabain binding can be used as a measure of the number of active enzyme molecules present in a given tissue. Specific [3H]ouabain binding can be demonstrated in frozen, cryostat sections from rat brain and pineal and these sites have the characteristics of Na+,K+-ATPase. Incubations carried out in the absence of ATP or the presence of excess unlabeled ouabain reduces specific binding by greater than or equal to 98%. The addition of K+ or omission of Mg2+ also result in a decrease in specific binding. Strophanthidin, digoxin and digoxigenin displace [3H]ouabain binding with IC50 values of 0.73, 0.48 and 1.4 microM, respectively. Scatchard analyses of specific [3H]ouabain binding in brain sections shows a single class of non-interacting binding sites with an apparent affinity (Kd) of 339 nM and a maximal binding capacity (Bmax) of 34.9 pmol/mg protein. [3H]Ouabain binding is unevenly distributed throughout the brain with the olfactory nuclei, superior colliculus, dentate gyrus, pontine nuclei and pineal gland having a relatively high density of binding sites. The outer layers (1-3) of the cerebral cortex show more labeling than the inner layers (4-6) and most other brain areas have intermediate levels of [3H]ouabain binding sites, whereas white matter has virtually no specific binding. Computer-assisted densitometry was used to measure changes in specific [3H]ouabain binding after kainic acid injection into the caudate nucleus. An initial increase in [3H]ouabain binding was observed at 1 and 24 h after lesioning and a decrease in [3H]ouabain binding was evident by 9 days after lesioning.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical and biochemical effects of verapamil administration to schizophrenic patients.

We administered verapamil hydrochloride, a calcium channel antagonist, to seven chronically ill schizophrenic patients for five weeks under double-blind, placebo-controlled conditions. No therapeutic effect was noted. Worsening in hostile and uncooperative behaviors and a syndrome of heightened emotional tone was observed during verapamil treatment and during the postverapamil placebo period. Verapamil produced significant increases in cerebrospinal fluid (CSF) and plasma levels of homovanillic acid and in plasma levels of prolactin, as well as significant decreases in plasma levels of 3-methoxy-4-hydroxyphenethyleneglycol. Verapamil and its active metabolite, norverapamil, were partitioned into CSF with CSF/plasma ratios of 0.06 and 0.04, respectively. The lack of therapeutic effects of verapamil in schizophrenic patients differs from earlier reports of its usefulness in treating manic patients. The biochemical and clinical data from our study suggest the possibility that verapamil exerts behaviorally relevant central nervous system activity in schizophrenic patients.

Neurotransmitter-stimulated inositol phosphate accumulation in hippocampal slices.

The agonist-induced accumulation of [3H]IP in the presence of lithium represents a sensitive method for studying a number of receptor-mediated events in brain. In the presence of lithium, receptor-mediated [3H]IP3 formation in brain is difficult to demonstrate. It is possible that lithium itself may prevent the formation if IP3 and, thus, the presence of lithium in the incubation may account for such a discrepancy. It is likely that the effects of lithium on the PI cascade are more complex then previously envisioned. The recent identification of the inositol polyphosphates, myo-inositol 1,3,4-trisphosphate and myo-inositol 1,3,4,5-tetrakisphosphate, indicates that other inositol phosphates need to be considered in future studies of receptor-mediated PI metabolism.