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Introduction: Intrahospitalary interconsultation (IC) to a neurology department is an infrastudied task within daily neurologic health care., Aims: To evaluate the IC to a neurology department., Methods: A one-year retrospective study was performed on the IC received in the Department of Neurology in the Hospital General Universitario "Gregorio Marañón" (Spain), to evaluate the reasons for consultation, the urgency of the request, concordance between initial clinical suspicion and final diagnosis, specialties involved, final diagnosis and management/deviation to the IC., Results: A total of 432 IC were analyzed. The most frequent reasons for consultation were cerebrovascular disease (19%) and control of already diagnosed neurological diseases (17%). The most frequent final diagnoses were cerebrovascular disease and acute metabolic encephalopathy (16% in both cases). With regard to management, three percent of the cases were admitted to the ward and 14% were sent to out patients for completing studies and/or follow up., Conclusions: This study underlines the importance of intrahospitalary IC within the daily tasks and health care carried out in a neurology department in relation to the number of IC undertaken during the study period. It is also an excellent method to evaluate the neurologic manifestations observed in systemic diseases and neurologically study patients with diverse pluripathy.

The disposition of propofol in the blood and brain of New Zealand rabbits was studied in three groups of six rabbits. One group received a single anaesthetic dose; a second group received a 1-h infusion; and a third group was studied after the rabbits were judged to have recovered from a 1-h infusion. There was a high concentration of propofol in the red blood cell fraction and in the brain, however, the red blood cell concentration largely exceeded the one found in the brain in all groups of animals. This is consistent with the high fat solubility of diisopropylphenol. The possible effects of propofol sequestered in red blood cells is discussed.

Recent studies have shown that a membrane p-glycoprotein, encoded by MDR1 gene, is involved in the transport of free cholesterol from the plasma membrane to endoplasmic reticulum, the site of cholesterol esterification by acyl-CoA:cholesterol acyltransferase (ACAT). Moreover, results deriving from our previous studies have shown that the rate of cell proliferation was positively correlated with cholesteryl ester levels as well as with ACAT and MDR1 gene expression. In this study, lipid content and the expression of the genes involved in cholesterol metabolism such as hydroxy-methylglutaryl coenzyme A reductase (HMGCoA-R), low-density lipoprotein receptor (LDL-R), ACAT and MDR1 have been investigated in control and atherosclerotic arteries. The results have shown that the levels of cholesteryl ester increase with the age of cadaveric donors in arteries prone to atherosclerosis (abdominal aorta, superficial femoral artery) and become predominant in advanced atherosclerotic lesions. The mRNA levels of ACAT and MDR1 showed the same age correlation, reaching the highest values in atherosclerotic specimens. These results suggest that MDR1 may be involved in the accumulation of intracellular cholesterol ester levels found in atherosclerotic lesions. Moreover, the levels of HMGCoA-R, LDL-R and ACAT gene expressions progressively increased with the age of cadaveric donors; conversely, in atherosclerotic specimens, the mRNA levels of HMGCoA-R and LDL-R drastically decreased while ACAT gene expression reached its maximum. These findings suggest a reactivation of normal homeostatic regulation of cholesterol in advanced and complicated lesions.

In the present study we examined gene expression and glucose-6-phosphate dehydrogenase (G6PD) activity in leukemic cells isolated from G6PD normal and deficient subjects. The results have shown that G6PD activity strongly increases in G6PD normal leukemic cells as well as in G6PD deficient leukemic cells when compared to peripheral blood mononuclear cells (PBMC). Higher levels of G6PD gene expression were observed in leukemic cells from G6PD deficient patients compared to G6PD normal. A similar pattern of gene expression was also observed for 3-hydroxy-3-methylglutaryl coenzyme A (HMGCoA) reductase. These results support the hypothesis that G6PD deficient cell, in order to sustain their growth, must respond to the low activity of their mutant enzyme with an increase in quantity through an induction of gene expression.

The ascites hepatoma Yoshida AH130 causes in the host a rapid and progressive body weight loss, associated with reduced food intake, and protein and lipid hypercatabolism. Because insulin regulates glucose as well as lipid and protein metabolism, we suggest that the observed alterations are at least in part secondary to hypoinsulinemia and/or to the increase of counterregulatory hormones in AH130-bearing rats. To verify this hypothesis, controls with free access to food (n = 4), controls with free access to food plus insulin (107 micromol. kg body wt-1. d-1) (n = 4), controls pair-fed to the tumor-bearing rats (n = 4), pair-fed controls treated with insulin (n= 4), tumor hosts (n = 9), and tumor hosts treated with insulin (n = 6) were used. The Yoshida ascites hepatoma cells ( approximately 10(8) cells/rat) were inoculated intraperitoneally. Daily food intake and body weight were measured; insulin was injected starting the day of tumor implantation for 6 d. The metabolism of both cholesterol and lipids was investigated in tumor cells, and ascitic fluid and blood serum were investigated at the end of treatment. Insulin prevented the reduction of food intake (19 +/- 0.6 vs. 13 +/- 0.4 g/d, P < 0.01; AH130 hosts treated and not treated with insulin, respectively), the loss of body weight (202 +/- 12 vs. 135 +/- 9 g, P < 0.01), lowered the circulating triglycerides (48.3 +/- 4.9 vs. 84.5 +/- 7.1 mmol/L, P < 0.01), and free fatty acids (561 +/- 47 vs. 989 +/- 54 mmol/L (P < 0.01), while corrected the decrease of adipose lipoprotein lipase activity (1,240 +/- vs. 300 +/- pmol FA, P < 0.01) observed in AH130 hosts. Moreover, insulin prevented the decrease in HDL cholesterol (13.2 +/- 0.8 vs. 9.3. +/- 0.7 mmol/L, P < 0.01) and significantly increased hepatic cholesterol synthesis as evaluated by 14C-acetate incorporation into cholesterol, in both liver (3,337 +/- 245 vs. 830 +/- 115 Bq/g, P < 0.01) and AH130 cells (11,676 +/- 1,693 vs. 4,196 +/- 527 Bq/10(6) cells, P < 0.01). Thus insulin treatment ameliorated many metabolic derangements, with a lengthening of rats survival time (7 +/- 1 vs. 11 +/- 1 d, P < 0.05) without significantly stimulating tumor growth. These data, together with our previous observations on the effectiveness of insulin on protein turnover perturbations, suggest that many metabolic alterations occurring during cancer cachexia can be avoided by the administration of this hormone.

A positive correlation between cholesterol esterification and growth rate potential was previously found in our laboratory during the growth of CEM and MOLT4 lymphoblastic cells. In the current study, we investigated whether the rates of cholesterol esters synthesis correlate with changes of acyl-CoAcholesterol acyltransferase (ACAT) mRNA levels and of other genes implied in cholesterol biosynthesis and uptake, such as 3-hydroxy-3-methylglutaryl-CoA (HMGCoA) reductase and low density lipoprotein (LDL) receptor. The results showed that the more rapid growing CEM cells had lower levels of expression of HMGCoA-reductase and LDL receptors compared to MOLT4. By contrast, ACAT mRNA levels were higher in CEM cells, further supporting the concept of a possible involvement of cholesterol esters in the regulation of cell growth and division. In this study, high levels of cholesterol esterification and of expression of ACAT gene were also associated with a markedly increased expression of multidrug resistance (MDR1) gene, suggesting that MDR1 activity might contribute to regulate the rate of cell growth and division by modulating intracellular cholesterol ester levels.

Background: A new generation of highly selective short-pulsed lasers has emerged in recent years for the treatment of tattoos. Several studies (including reports by the present investigators) have proven the efficacy of each of the three commercially available, FDA approved devices; namely, the Q-switched alexandrite, Q-switched Nd:YAG and Q-switched ruby lasers. Considerable differences among the three have been reported in relation to the rate of clearing of the tattoo ink particles, tissue effects, beam profile, wound healing, and side effects., Objective: This study was primarily conducted to examine and compare the clinical response of patients with blue-black tattoos simultaneously treated with three different Q-switched lasers (alexandrite, Nd:YAG, ruby) with a focus on the percentage of tattoo lightening/clearance and the occurrence or non-occurrence of pigmentary change as a side effect., Methods: A total of forty-two blue-black tattoos seen at two laser centers (Massachusetts General Hospital Dermatology Laser Center and Laser and Skin Surgery Center of La Jolla) were simultaneously treated with three types of Q-switched lasers: a Candela Q-switched alexandrite laser (755nm 50-100 nanoseconds, 3.0 mm spot size, 6-8 J/cm2); a Continuum Biomedical Q-switched Nd:YAG laser (1064nm, 10-20 nanoseconds, 3.0 mm spot size, 5-10 J/cm2); and a Spectrum Q-switched ruby laser (694 nm, 25-40 nanoseconds, 5.0 mm spot size, 4-10 J/cm2). Paired t-tests and McNemar tests were used to compare the treatment outcome and pigmentation side effects between sites per tattoo, with each site representative of one of the three lasers. The statistical significance level was set at p < .05., Results: Overall, the Q-switched ruby laser had a significant difference in tattoo lightening versus the Q-switched Nd:YAG and Q-switched alexandrite lasers. An increase in the number of treatments paralleled a statistically significant increase in tattoo clearance for all three Q-switched lasers., Conclusion: The Q-switched ruby laser had the highest clearance rate in blue-black tattoos and the highest incidence of long-lasting hypopigmentation. The Nd:YAG had no incidence of hypopigmentation.

Introduction: We support the normal standards for two sonographic (US) signs of the posterior cranial fossa, namely the magnitude of the cisterna magna and the height of the fourth ventricle fastigium, in preterm and fullterm infants., Materials and Methods: The cisterna magna was measured as the distance between the inferior aspect of the cerebella vermis and the inner aspect of the occiput. The height of the fourth ventricle fastigium was calculated as the line drawn from the fastigium to the inner aspect of the occiput, close to the opisthion., Results: The cisterna magna was .46 +/- .13 cm in preterm infants and .45 +/- .1 cm in fullterm infants (the difference was not significant), whereas the height of the fourth ventricle fastigium was 1.7 +/- .26 cm in preterm and 1.9 +/- .16 cm in fullterm infants (the difference was significant, p < .005)., Conclusions: The finding of a cisterna magna of equal size in preterm and fullterm infants is in agreement with the concept that subarachnoid and cisternal spaces of the posterior fossa are still large at birth and start to decrease in size later in life. Our results suggest that a cisterna magna smaller than .2 cm in height and/or a fastigium closer than 1.2 cm to the basiocciput in preterm and closer than 1.6 cm in fullterm infants indicate, in a proper clinical context, an abnormally low cerebellum position (Arnold-Chiari malformation). On the other hand, cisterna magna values exceeding .72 in preterm and .65 cm in fullterm infants, as well as fastigium values exceeding 2.22 cm in both groups may suggest the presence of the Dandy-Walker complex or of an arachnoid cyst.

MRI is routinely used in the evaluation and management of patients with failed back surgery syndrome (FBSS). However, its value is unclear in the early detection of signs that can negatively affect that later course of surgical cases. The purpose of the present study is to describe the MR images of early postoperative MRI at 3 days in 30 unselected patients who underwent lumbar microdiscectomy, and to correlate the findings with follow up MRI at 8 weeks and with final outcome. The findings are correlated with literature data. Early postoperative MRI findings were consisting of pseudohernia in 24 patients (80%), annular rent in 23 patients (80%), and other non-specific postoperative findings. On the late MRI the pseudohernia persisted in 12 patients (50%), the annular rent in 4 patients (15%) and asymptomatic pseudo-spondylodiscitis was apparent in 3 patients (10%) as was a case of true spondylodiscitis. Therefore, early postoperative findings have limited value in the management of patients after surgery for lumbar disc herniation, since the images were not correlated with the immediate clinical course after surgery nor with the late radiological and clinical outcome. The evident imaging changes in the early postoperative period after lumbar disc surgery limit the accuracy of the interpretation of MRI examinations.

We investigated the role of an experimental surface coil for low field (0.2 T) MRI of prostatic gland carcinoma; the study was performed comparing MRI with US findings and with bioptic and pathologic results. To this purpose, 16 patients with prostatic cancer suspected at US and demonstrated with US-guided biopsy, were examined with low intensity field (0.2 T) MRI performed with a dedicated saddle-shaped coil and a body coil. This experimental surface coil with perineal application is used to study the prostatic gland with low field MR equipment where no transrectal probe is available. We analyzed the results of this study and found that, in all patients but one, the neoplastic lesions exhibited low signal intensity on T2-weighted images, while the normal gland was hyperintense. Six patients underwent radical prostatectomy and diagnostic imaging findings were correlated with pathologic findings obtained with whole mount specimens and serial histologic slides. The number of tumor foci, their site and size, and stromal reaction were studied on T2-weighted images; the typical low signal intensity was absent in one of 16 patients, in which case the microscopic exam of pathologic specimens showed extensive tumor spread with infiltration of perineural lymphatic vessels, with neither nodular patterns nor stromal reactions. The correlation between MR findings and the whole mount specimens (n = 6) demonstrated MR underestimation of tumor spread. In our opinion, this technique is useful for the detection and characterization of prostatic lesions, in spite of the presence of isointense lesions and the risk of underestimating the disease, especially to the prostatic capsule. To conclude, the dedicated surface coil can improve the diagnostic accuracy of low field MRI.

Fidel Pagés was born in Huesca on the 26th of January 1886. He completed his secondary studies in the same city, later receiving his degree in medicine and surgery from University of Zaragoza (1908) with high honors. The same year he joined the army medical corp, to be sent to serve in Melilla in 1909 with a rank of second medical officer. After being promoted in 1911 to first medical officer, he served in Tarragona, Toledo, Madrid (where received his doctoral degree), Ciudad Real, and once again in Madrid. In 1913 Pagés married and was destined to Mahón, only to return to work at the War Ministry in Madrid in 1915, after a brief sojourn in Alicante. The same year he placed first in competition for a staff position at Madrid's Hospital Provincial. In 1917, during World War I, he inspected POW camps in Austria and Hungary, while also serving in the military hospital in Vienna. In 1919 he became the founding editor of Revista Española de Cirugía, which published "Anestesia metamérica" in 1921, simultaneous to its publication in Revista de Sanidad Militar. In 1920 on he was assigned to Madrid's Hospital Militar de Urgencia, but was also briefly sent to Melilla in 1921 as a consequence of the military "Disaster at Annual". In 1922 he was promoted to the rank of Medical Commandant. On the 21st of September 1923, Pagés died in a traffic accident while returning to Madrid from San Sebastián. His work was soon forgotten, as can be seen from the credit long given to the Italian surgeon Dogliotti for the discovery of epidural anesthesia. Only with passing time, and through the effort of Argentinian and Spanish physicians, has the world come to recognize Pagés as the original author of this technique.

Objectives: To establish the ratio of oxygen saturation in mixed venous to that of central venous blood in patients undergoing thoracic surgery, in order to rationalize use of the pulmonary arterial catheter., Material and Methods: We compared simultaneous spectrophotometric in vivo measurements for SvO2 [Abbott Oximetrix 3/SvO2 (O)] and in vitro analysis of blood taken from the distal opening of the catheter (co-oximeter/SvO2 [CO]), with in vitro analysis of central venous blood from the superior vena cava (co-oximetry/SvcO2 [CO]) for 23 patients scheduled for lung resection by thoracotomy in lateral decubitus with single lung ventilation and the same type of monitoring and anesthesia. Measurements were taken 15 min after induction (M1), after 15 minutes in lateral decubitus (M2), 5 minutes after pleurotomy (M3), 5 min (M4) and 20 min (M5) after lung collapse, 5 min after closure of the thoracic wall (M6) and after 5 min supine (M7)., Results: SvO2(O) was higher than SvcO2 (CO) at M1, M3, M6 and M7 and the mean difference between the two concentrations was always less than 0.9%. SvcO2 (CO) was always higher than SvO2 (CO) (M1 to M7) and the mean difference was less than 1.3%. Simple linear correlation was significant (p < 0.001) for each of the measurements as well as for the whole sample. Both bias (0.2 and 0.7%) and its standard deviation (2.7 and 2.5%) between the two techniques were small and the differences between all measurements were less than 5% in 97 and 95.6%., Conclusion: For thoracic anesthesia in patients who are not good candidates for catheterization of the pulmonary artery, continuous measurement of SvO2 may be substituted for that of SvcO2 in order to monitor the balance of supply/demand.

Objectives: The lateral decubitus position, the thoracotomy and selective single-lung ventilation all cause serious changes in oxygenation. The aim of this study is to examine the usefulness of continuous monitoring of mixed venous saturation (SvO2) under these conditions., Material and Methods: Twenty-three patients scheduled for pulmonary resection by thoracotomy in lateral decubitus position with single-lung ventilation were monitored continuously for SvO2 by reflection oximetry and a fiber-optic catheter in the pulmonary artery (Abbot Oximetrix 3). Cardiorespiratory profiles were obtained 15 minutes after induction (M1), after 15 minutes in lateral decubitus position (M2), 5 min after start of pleurotomy (M3), 5 min (M4) and 20 min (M5) after lung collapse, 5 min after closure of the thoracic wall (M6), and after 5 min in supine decubitus position (M7)., Results: The decrease in SvO2 was not statistically significant. It reached its lowest level at M5 and rose significantly in M6 (p < 0.05). For all SvO2 measurements there was a significant correlation between Oximetrix 3 and Co-oximeter readings. C(a-v)O2 and O2 uptake correlated significantly at all measurements, as did those of PvO2 and Qva/Qt except at M6. VO2I correlated inversely from M1 to M5, and CI an DO2I only at M6 and M7. PaO2 and SaO2 were significantly correlated during single-lung ventilation (M4 and M5) and later (M6). The combined changes in SaO2(a-v) and CI explain the changes in SvO2 only during and after selective ventilation, and the changes are more likely to be reflected by SaO2 than by CI., Conclusions: Under the conditions studied, continuous monitoring of SvO2 is a reliable method, indicating primarily oxygenation, and cardiac output secondarily, particularly during single-lung ventilation, and also reflecting the balance of oxygen supply and demand in tissues. Given the lack of specificity, however, hemodynamic and gas measurements must be taken to diagnose the cause of any change in the supply/demand balance whenever there is a sudden drop in SvO2.

In the present study, plasma lipid concentrations were determined at different times after admission in sera from G6PD-deficient children during haemolytic crisis induced by fava bean ingestion. Reductions in total, LDL and HDL cholesterol were found in association with the maximum of bone marrow hyperplasia. A return towards normal values occurred with regression of the disease. No changes in other lipid parameters were observed. These data suggest that alterations of lipoprotein pattern, other than in experimental animals, are also present in humans with non-malignant proliferative processes. These changes appear to be a consequence of the disease, probably due to an increased utilization of cholesterol by proliferating cells.

The histochemical method for the demonstration of the L-leucyl-beta-naphtylamidase (LNAase) activity has been applied to bioptic and autoptic human prostates from very early to adult age to evaluate any correlation between sexual maturity and the appearance of this enzyme. The histochemical results indicate that in the human prostate, the LNAase activity is present at a cellular level in intrauterine life, infancy, and adulthood. This suggests that the appearance of this enzyme is genetically controlled even if different hormonal stimuli play some role in its localization and distribution.

Unilateral intranigral infusion of kainic acid (1.5 microgram) produced neuronal loss in the lateral two-thirds of the nigra while sparing axons en passage. Fink-Heimer silver impregnation revealed dense terminal degeneration in the nigra itself (both in the compacta and in the reticulata) and in areas of non-dopaminergic nigral projection such as the ventromedial (VM) nucleus of the thalamus, the superior colliculus and the reticular formation; only spare terminal degeneration was found in areas of dopaminergic projection such as the caudate and septum. In order to clarify the nature of the transmitter of the nigrothalamic and nigrocollicular neurons, the activity of glutamic decarboxylase (GAD), the marker of cholinergic neurons, was measured in the VM and ventrobasal (VB) thalamus and in the nigra of each side, 7 days after unilateral intranigral injection of kainic acid. GAD activity was reduced significantly in the VM-thalamus (-33%), in the superior colliculus (-40%) and in the substantia nigra (-18%) but not in the VB-thalamus of the lesioned side. CAT remained unchanged in these areas. Similar results were obtained in the thalamus and in the superior colliculus after electrocoagulative lesions of the nigra. The results indicate the existence of a nigrothalamic and of a nigrocollicular GABAergic pathway. This projection might play an important role in motor coordination and gaze control.

The authors comment on the signs found in utero in a case of Ebstein anomaly, by obstetrics and cross-sectional ultrasonography. They emphasize the possibilities and interest of these techniques in other prenatal diagnostic problems.

Intranigral administration of kainic acid results in loss of pars reticulata neurons without damage to axons traversing or terminating within the nigra. Unilateral nigral lesions with kainic acid result in an ipsilateral turning upon administration of apomorphine, a dopamine (DA)-receptor agonist and in contralateral turning upon administration of haloperidol, a DA-receptor blocker. Destruction of post-synaptic structures in the striatum of the side contralateral to that injected with kainic acid results in a drastic reduction, abolition or even reversal of the turning effects elicited by apomorphine and haloperidol. Unilateral intranigral microinjection of nanogram amounts of the GABA-receptor antagonists picrotoxin and bicuculline elicits ipsilateral circling upon apomorphine administration. Kainic-induced lesion or microinjection of picrotoxin or bicuculline in the nigra ipsilateral to a 6-OHDA-lesion of nigro-striatal DA-neurons results in reduction, abolition or reversal of the contralateral circling produced by apomorphine. The results indicate that the nigra pars reticulata is a station for dopaminergic impulses originating from the striatum and suggest that the turning behavior in response to striatal DA-receptor stimulation is due to a GABA-mediated inhibition of ipsiversive pars reticulata neurons.

DNA synthesis, cholesterogenesis and the enzymes of the hexosemonophosphate (HMP) shunt pathway were investigated in liver of diabetic rats treated with insulin and in fasted/re-fed rats. Both insulin and refeeding were found to induce liver cell proliferation, accompanied by a remarkable increase in cholesterogenesis. An enhancement of glucose-6-phosphate dehydrogenase (G6PD) and 6-phosphogluconate dehydrogenase (G6PD) activities was also found in insulin-treated diabetic rats and in re-fed rats, supporting the concept that these two enzymes are involved in the proliferative process. Since insulin did not exert the same biochemical effects in a non replicating cell population, such as in insulin-treated normal rats, these studies provide new evidence of a close correlation between DNA, cholesterol synthesis and HMP shunt enzymes during cell proliferation.

The ontogeny of muscarinic cholinergic receptors has been studied in different regions of the human fetal brain. For a comparison, the same study has been carried out on newborn and premature brain. Regarding on the areas examined (frontal cortex, cerebellum, hippocampus, thalamus and basal ganglia) either an increase or a decrease of receptor density during gestation was observed. Thus, the ontogeny of the receptors follows a different pattern in areas which differ in function, cholinergic innervation and embryological origin. However, in all the regions the affinity of the binding site for the ligand [3H]quinuclidinyl benzilate [3H]QNB was very similar to that reported for muscarinic receptors from adult mammalian brain. Data obtained from agonist binding (acetylcholine and carbachol) revealed the presence of a high (H)- and a low-affinity binding site (L) from 10 weeks of gestation. The selective antagonist pirenzepine (PZ) also distinguished two different muscarinic receptor subtypes, which however had higher affinity than that seen in adult brain. In conclusion, during ontogeny, the muscarinic acetylcholine receptor shares some but not all of the pharmacological properties shown in the adult brain.

Long-term (20 days) treatment with methyl mercury (MeHg) increases the total number of benzodiazepine binding sites and decreases essentially the content of cyclic GMP in the cerebellar cortex. In contrast, this treatment fails to modify the content of GABA and cyclic AMP, GAD activity and GABA binding sites in the same brain area. The changes in cyclic GMP and benzodiazepine binding sites in the cerebellar cortex are discussed in relation to the motor disturbances associated with MeHg intoxication.

Heterogeneity of muscarinic cholinergic receptors was investigated in chick embryo retina throughout development and in chicks immediately after hatching. The presence of a homogeneous receptor population was evidenced by antagonist binding. The affinity of antagonists increased up to day 14 of incubation, when synaptogenesis occurs. After this stage, it remained substantially unchanged. The number of receptors increased in embryos until hatching. On the contrary, agonists, such as acetylcholine and carbachol, bound to two (high- and low-affinity) binding sites. Through development, the affinity of both significantly increased until day 14, further substantiating the hypothesis of a maturation of the receptor pattern which precedes synapse formation. Muscarinic cholinergic binding seems to identify 3 critical steps in retinal neuronal development. The first is between 7 and 9 days of incubation, the second when synaptogenesis occurs and the third after initiation of function.