Functional turbo spin echo magnetic resonance imaging versus tomography for evaluating cervical spine involvement in rheumatoid arthritis.

STUDY DESIGN: Comparison of findings in plain radiography and conventional tomography with findings in plain radiography and magnetic resonance imaging of the upper cervical spine in consecutive patients with rheumatoid arthritis and with known or suspected abnormalities of the cervical spine. OBJECTIVES: To determine whether plain radiography and magnetic resonance imaging provide enough information to dispense with tomography in investigations of cervical spine involvement in rheumatoid arthritis. SUMMARY OF BACKGROUND DATA: With the recent advances in magnetic resonance imaging technology and the proliferation of magnetic resonance imaging techniques for specific clinical conditions. METHODS: Twenty-eight patients with rheumatoid arthritis and with known or suspected abnormalities of the cervical spine underwent a clinical neurologic examination; plain radiography, including full flexion lateral radiography; anteroposterior and lateral tomography at C1-C2; and magnetic resonance imaging at the same level in neutral position and in flexion. Two radiologists evaluated one image set consisting of plain radiography and conventional tomographic images and another image set consisting of plain radiography and magnetic resonance images, for each patient. RESULTS: Compared with conventional tomography and plain radiography, magnetic resonance imaging and plain radiography showed cystic lesions and erosions of the odontoid process and vertical atlantoaxial subluxation more often, showed anterior subluxation as often, and showed lateral atlantoaxial subluxation less often. CONCLUSION: Magnetic resonance imaging produces sufficiently distinct images of destruction of the odontoid and subluxations for it to replace conventional tomography in investigations of upper cervical spine involvement in rheumatoid arthritis.

[2 families with meningococcal infection and a hereditary disorder of the 5th component of the complement system]. / Twee families met meningokokkeninfectie en een erfelijke afwijking van de vijfde component van het complementsysteem.

Within a period of six months, a 20-year-old female with a homozygous deficiency of the C5 component of complement developed meningococcal meningitis twice (different serogroups). Additional C5 deficiencies were not found in relatives. Homozygous deficiency of C5 was also present in another family in which a 16-year-old female and an 18-year-old sister suffered from meningococcal meningitis. Some characteristics of meningococcal disease in patients with C5 deficiency differed from meningococcal disease in patients with a normal complement system: meningitis occurred at a relatively advanced age, was associated with serogroups W-135, B and X and recurred in two of three patients.

Relationship between contrast medium dose and adverse effects in lumbar myelography.

In a prospective double-blind randomized study involving 40 patients undergoing lumbar myelography, an attempt was made to correlate adverse effects of the examination with contrast medium dosage. Metrizamide for myelography is dispensed in two dosage aliquots, 3.75 and 6.75 g. In one group of 20 patients (10 males and 10 females) the higher dose was utilized routinely, in a second similar group the lower dose. 24 h after myelography complaints of headache were noted in 9 out of 40 patients; nausea, sometimes with vomiting, in 3 out of 40, and giddiness or light-headedness in 6 out of 40. No other side effects were registered. Complaints after myelography occurred significantly more often in females than in males, but there was no correlation between the incidence of complaints and the dose of metrizamide administered.

Whole body distribution of the quaternary ammonium compound thiazinamium (N-methylpromethazine) and promethazine in monkey and mice.

The distribution of 35S-ringlabeled thiazinamium (N-methyl-promethazine) methylsulphate (35S-Th.) and its tertiary analog 35S-promethazine hydrochloride (35S-Pr.) have been studied by means of whole body autoradiography in a squirrel monkey and in mice. After infusion of 35S-Th. in the monkey until steady state condition, high accumulations of radioactivity were found in the three main organs of excretion of the drug (liver, kidneys and intestines). High concentrations of radioactivity were also observed in organs with high amounts of acetylcholine receptor such as the ganglia, skeletal muscles, myocard and ciliary bodies, and in glandular tissue such as salivary glands, thyroid gland and pancreas. On the other hand no radioactivity was seen in the central nervous system with exception of the posterior pituitary gland and the fourth ventricle. This suggests that Th.-cations cannot pass "the blood-brain barrier", except for some high permeability regions that are known to be "windows" in this barrier. 35S-Pr. was distributed significantly different. Now a high level of radioactivity was seen in the central nervous system, indicating that the tertiary amine compound can easily pass "the blood-brain barrier". Again high concentrations of radiation were found in liver, kidneys and intestines. 35S-Pr. also seemed to penetrate to acetylcholine receptor areas. Substantial accumulation in the eye was seen, as well as in glandular tissues. Essentially the same distribution patterns as described above were seen for 35S-Th. and 35S-Pr. after intramuscular injection in mice. In pregnant mice, after administration of 35S-Th. high concentration of radioactivity was found in the placenta, but only low amounts were seen in the foetus, and then only in the liver and the kidneys, which implies that Th.-cations can pass the placenta, however, to a low extent and at a low rate. With 35S-Pr. obviously placenta transfer can occur more easily and distribution in the foetus is not restricted to the liver and kidneys.

Deanol and physostigmine in the treatment of L-dopa-induced dyskinesias.

Deanol and placebo were administered to 10 parkinsonian patients with levodopa-induced dyskinesias in a double-blind, crossover fashion. Deanol and placebo did not differ significantly in their effects on dyskinesias. The reported properties of deanol seem to be attributable to a placebo effect. There was no correlation with the results of the physostigmine test. Despite these disappointing results deanol remains intriguing, because in individual cases remarkable improvements on dyskinesias are reported.