Making the diagnosis of subarachnoid hemorrhage.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
E Flamm
Publications and source records attributed to E Flamm.
Intracranial aneurysms: detection and characterization with MR angiography with use of an advanced postprocessing technique in a blinded-reader study.
PURPOSE: To assess magnetic resonance (MR) angiography for the detection and characterization of angiographically proved intracranial aneurysms by using an advanced method of postprocessing, in a blinded-reader study. MATERIALS AND METHODS: One hundred fifty-eight vessels were examined with catheter angiography and three-dimensional time-of-flight MR angiography in 44 patients with 63 aneurysms and 15 patients with no aneurysm at catheter angiography. Postprocessing was performed off-line with an advanced multifeature-extraction, ray-tracing algorithm. MR angiograms were interpreted independently by three neuroradiologists blinded to the catheter angiographic results for presence, location, size, and morphology of the aneurysm. Proof of diagnosis was consensus reading of catheter angiograms. RESULTS: Mean sensitivity for detection of aneurysms was 75% (range, 70%-79%). As a screening tool (ie, detection of at least one aneurysm necessitating catheter angiography), mean sensitivity was 91% for all aneurysms and 95% for aneurysms larger than 3 mm. This method was not adequate for detection of lobulation or size of aneurysm. CONCLUSION: MR angiography with an advanced method of postprocessing can result in highly sensitive, specific studies for the diagnosis of intracranial aneurysms that are of sufficient size to be considered for surgical treatment, but it is inadequate for characterization of aneurysms.
Adult↗
Fetal cortical cells survive in focal cerebral infarct after permanent occlusion of the middle cerebral artery in adult rats.
Fetal rat cortical cells have been shown previously to survive at the periphery of cerebral infarction. The present study was designed to examine the ability of fetal cells to survive at the edge of the central core of ischemia. In three groups of 8 adult Sprague-Dawley rats, fetal cortical cells from ED 16 were stereotactically transplanted at 3 h, 24 h, and 7 days after unilateral middle cerebral artery occlusion. In 6 rats, fetal cells were transplanted by using the same coordinates, without arterial occlusion, for control. In the ischemic groups, overall graft survival was 85%, and in the control group, all grafts survived. Graft survival was determined by light microscopy. No significant difference was found in the survival of grafts transplanted at different intervals after middle cerebral artery occlusion. It is concluded that fetal cortical cells can survive in cerebral tissue undergoing severe ischemic change.
Animals↗
Methylprednisolone or naloxone treatment after acute spinal cord injury: 1-year follow-up data. Results of the second National Acute Spinal Cord Injury Study.
The 1-year follow-up data of a multicenter randomized controlled trial of methylprednisolone (30 mg/kg bolus and 5.4 mg/kg/hr for 23 hours) or naloxone (5.4 mg/kg bolus and 4.0 mg/kg/hr for 23 hours) treatment for acute spinal cord injury are reported and compared with placebo results. In patients treated with methylprednisolone within 8 hours of injury, increased recovery of neurological function was seen at 6 weeks and at 6 months and continued to be observed 1 year after injury. For motor function, this difference was statistically significant (p = 0.030), and was found in patients with total sensory and motor loss in the emergency room (p = 0.019) and in those with some preservation of motor and sensory function (p = 0.024). Naloxone-treated patients did not show significantly greater recovery. Patients treated after 8 hours of injury recovered less motor function if receiving methylprednisolone (p = 0.08) or naloxone (p = 0.10) as compared with those given placebo. Complication and mortality rates were similar in either group of treated patients as compared with the placebo group. The authors conclude that treatment with the study dose of methylprednisolone is indicated for acute spinal cord trauma, but only if it can be started within 8 hours of injury.
Acute Disease↗
A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study.
Studies in animals indicate that methylprednisolone and naloxone are both potentially beneficial in acute spinal-cord injury, but whether any treatment is clinically effective remains uncertain. We evaluated the efficacy and safety of methylprednisolone and naloxone in a multicenter randomized, double-blind, placebo-controlled trial in patients with acute spinal-cord injury, 95 percent of whom were treated within 14 hours of injury. Methylprednisolone was given to 162 patients as a bolus of 30 mg per kilogram of body weight, followed by infusion at 5.4 mg per kilogram per hour for 23 hours. Naloxone was given to 154 patients as a bolus of 5.4 mg per kilogram, followed by infusion at 4.0 mg per kilogram per hour for 23 hours. Placebos were given to 171 patients by bolus and infusion. Motor and sensory functions were assessed by systematic neurological examination on admission and six weeks and six months after injury. After six months the patients who were treated with methylprednisolone within eight hours of their injury had significant improvement as compared with those given placebo in motor function (neurologic change scores of 16.0 and 11.2, respectively; P = 0.03) and sensation to pinprick (change scores of 11.4 and 6.6; P = 0.02) and touch (change scores, 8.9 and 4.3; P = 0.03). Benefit from methylprednisolone was seen in patients whose injuries were initially evaluated as neurologically complete, as well as in those believed to have incomplete lesions. The patients treated with naloxone, or with methylprednisolone more than eight hours after their injury, did not differ in their neurologic outcomes from those given placebo. Mortality and major morbidity were similar in all three groups. We conclude that in patients with acute spinal-cord injury, treatment with methylprednisolone in the dose used in this study improves neurologic recovery when the medication is given in the first eight hours. We also conclude that treatment with naloxone in the dose used in this study does not improve neurologic recovery after acute spinal-cord injury.
Acute Disease↗
Management of nontraumatic vascular shunts involving the cavernous sinus.
The authors managed 38 consecutive cases of nontraumatic vascular shunts involving the cavernous sinus. Selective angiography demonstrated 12 carotid cavernous fistulas (CCFs) and 26 dural arteriovenous shunts (DAVSs). Visual disability occurred from glaucoma, venous retinopathy, optic neuropathy, or diplopia. Ten patients with slow-flow shunts and minimal dysfunction were treated medically to lower intraocular pressure (IOP) and/or instructed in manual compression of the internal carotid artery, ipsilateral to the lesion, using the contralateral hand. Percutaneous intraarterial embolization using detachable balloons, isobutylcyanoacrylate, or polyvinyl alcohol particles was successful in 16/18 DAVSs and 9/10 CCFs. The neuro-ophthalmic signs resolved in these 25 cases. Complications occurred in five patients. These included a transient hemiparesis, twelfth nerve palsy, unilateral nasal field loss, a pseudoaneurysm causing a third-nerve paresis, and temporary cavernous sinus thrombosis. Conservative therapy in mild cases and embolization in cases with visual disability or progressive signs are warranted.
Arteriovenous Fistula↗
Overproduction of Escherichia coli integration host factor, a protein with nonidentical subunits.
Integration host factor (IHF) is a small, basic protein that is needed for efficient recombination of bacteriophage lambda, as well as for other host and viral functions. We have constructed strains in which the two subunits of IHF, encoded by the himA and hip genes of Escherichia coli, are expressed under the control of the lambda rho L promoter. Separate overexpression of himA and hip led to the production of unstable and insoluble peptides, respectively. In contrast, the overexpression of both genes conjointly led to the accumulation of large amounts of active IHF. Extracts of such cells provided the starting material for a rapid purification procedure that results in milligram quantities of apparently homogeneous IHF.
Bacterial Proteins↗
Serial PET studies of human cerebral malignancy with [1-11C]putrescine and [1-11C]2-deoxy-D-glucose.
Serial PET measurements of [1-11C]putrescine ([11C]PUT) uptake and glucose metabolic rate (GMR) using [1-11C]2-deoxy-D-glucose ([11C]2DG) were made on eight human subjects with a radiological and, in most cases, pathological diagnosis of primary or metastatic brain tumor. Blood-to-brain influx constants (Ki) were calculated for [11C]PUT. Tumor uptake of 11C after [11C]PUT injection was unidirectional peaking at 15 min. The mean +/- s.d. Kis for [11C]PUT for tumor and normal brain tissue were 0.78 +/- 0.045 and 0.024 +/- 0.007 ml cc-1 min-1, respectively (average of ratio, 3.11) whereas the ratio of GMR for tumor and normal brain tissue was 1.2 +/- 0.5. The mean Ki for four active, high grade astrocytomas was 0.098 +/- 0.030 in contrast to 0.027 +/- 0.008 ml cc-1 min-1 for two patients with low grade astrocytoma. Active high grade astrocytomas also showed marked CT contrast enhancement and regional glucose hypermetabolism. In one subject with brain metastases, both [11C]PUT and GMR correlated with a declining clinical picture in repeated studies over a 4-mo period. PET studies with [11C]PUT provide a better signal:noise ratio than GMR measurements, are useful for locating small glycolytically hypometabolic tumors and, when used in longitudinal studies in a single subject, appear to provide an index of degree of malignancy.
Adult↗
Neuroophthalmologic abnormalities and intravascular therapy of traumatic carotid cavernous fistulas.
Traumatic fistulas were successfully embolized using various transvascular approaches in 33 of 34 lesions. Complete superselective angiographic demonstration of the exact site of the shunt and possible collaterals was necessary to choose the appropriate embolization techniques. Improvement in the signs of orbital congestion was seen in all cases. Embolization, which directly occludes the fistula, precludes recurrences via collateralization and restores the normal arteriovenous gradient to the eye and optic nerve.
Adult↗
An Escherichia coli mutant unable to support site-specific recombination of bacteriophage lambda.
We report the isolation of mutations in, and the characterization of, an Escherichia coli gene, hip, that is required for site-specific recombination of phage lambda. hip mutants are recessive and are located near minute 20 on the linkage map. The gene product is not vital to bacterial growth, since deletion mutants are viable. The absence of hip product reduces lambda integration to barely detectable levels and also reduces prophage excision, but less drastically. Certain mutations in the lambda int gene partially restore integration and excision in hip- hosts. Homologous recombination promoted by recA does not require hip function. In addition to their defect in site-specific recombination, hip mutants are unable to support lytic growth of phage Mu or of certain lambda mutants. Their pleiotropic phenotype closely resembles that of himA mutants, but complementation, mapping and DNA sequencing show that hip and himA are different genes.
Bacterial Proteins↗
Primate mammary development. Effects of hypophysectomy, prolactin inhibition, and growth hormone administration.
The pituitary gland has been found to be an important factor in mammary development in primates. Hypophysectomy in 12 sexually immature monkeys caused significant inhibition of estradiol (E2)-induced mammary growth and development. A histological index of mammary development in sexually immature hypophysectomized animals was lower (0.82) than in intact E2-treated controls (3.4; P less than 0.008). Hypophysectomy also inhibited growth of the mammary gland as judged by a size index. Despite the hypophysectomy, E2 stimulated some, albeit blunted, mammary growth and development, which may have been due to incomplete hypophysectomy. Selective inhibition of prolactin by ergot drugs in intact animals did not prevent full mammary development, suggesting that there may be pituitary mammogens other than prolactin, or that very low or unmeasurable concentrations of prolactin were sufficient to synergize with E2 to cause full acinar development. The mean histological index was 3.08 in E2-treated animals and 3.16 in animals treated with E2 plus pergolide. There was also no difference in the size of the glands. We evaluated the effect of growth hormone on mammary development by treating three hypophysectomized animals with pure 22,000 mol wt human growth hormone (hGH) (Genentech, Inc., South San Francisco, CA). We found that physiological or slightly supraphysiological concentrations of hGH in animals with unmeasurable prolactin were incapable of restoring the capacity of E2 to induce full mammary growth. These findings suggest that, if growth hormone is a mammary mitogen, that physiological concentrations are insufficient to synergize with E2 to induce full mammary growth or that other forms of hGH are mammogenic. Our studies suggest that the role of the pituitary gland in mammary mitogenesis in primates is more complicated than previously thought. They also raise the possibility that heretofore unidentified pituitary substances may be mammogenic.
Animals↗
Transvascular treatment of giant aneurysms of the cavernous carotid and vertebral arteries. Functional investigation and embolization.
Functional angiographic investigation and percutaneous embolization using detachable balloons in nine carotid cavernous aneurysms, three petrous aneurysms, one vertebral artery aneurysm, and one posterior inferior cerebellar aneurysm are reported. A double-lumen balloon catheter is used to evaluate acute tolerance to occlusion of the carotid or vertebral arteries. Occlusion is tested under systemic heparinization. Local perfusion of heparinized saline, proximal as well as distal, to the balloon occlusion is used. The procedure was successful in all but one cavernous aneurysm. The arterial lumen was sacrificed in all cases. Clinical improvement occurred in all successful cases. Retro-orbital pain was relieved in all. Ocular cranial nerve palsies improved or resolved in most. One delayed ophthalmic episode that improved represents the only complication. No such embolic problems occurred in any case in which the cavernous carotid artery was occluded by balloon trapping. The delayed embolic complications after carotid artery occlusion are related to the collateral vessels to the C-4 and C-5 segments of the artery. Balloon trapping decreases the length of the thrombosed segment and prevents retrograde filing of the aneurysm.
Adult↗
Visual evoked potentials in chiasmal gliomas in four adults.
Visual evoked potentials (VEPs) were recorded from four patients with surgically verified chiasmal gliomas. Despite good visual acuity, 6/12(20/40) or better in each eye, these patients showed substantially reduced VEP amplitudes to a diffuse flash stimulus and hardly detectable responses to a highly textured checkerboard-pattern stimulus. The dissociation between evoked electrical activity and visual acuity is noteworthy; this differs from previously reported findings in patients with extrinsic compressing lesions of the chiasm or with lesions of demyelinating disease, which usually reduce VEP amplitude and increase conduction time in rough proportion to a loss of visual acuity.
Adult↗
lambda altSF: a phage variant that acquired the ability to substitute specific sets of genes at high frequency.
We report the isolation of lambda altSF, a variant of Escherichia coli phage lambda that substitutes sets of genes at high frequency. Two forms of the variant phage have been studied: lambda altSF lambda, which exhibits the immunity (repressor recognition) of phage lambda, and lambda altSF22, which exhibits the immunity of Salmonella phage P22. Lysates made from single plaques of lambda altSF lambda contain 10-30% phage of the P22 form. Similarly, lysates from single plaques of lambda altSF22 contain as much as 1% phage of the lambda form. Heteroduplex analyses reveal the following features of the lambda altSF chromosomes: (i) each form has the immunity genes appropriate to its immune phenotype, (ii) the substituted segments include genes involved in regulation and replication, and (iii) the alt phages have unusual additions and substitutions of DNA not normally found associated with either immunity region. In the case of lambda altSF lambda, there is a small insertion in the region of the cI gene. Because revertants that lose this inserted DNA concomitantly lose the ability to substitute, we conclude that the insertion plays a role in the substitution process. In the case of change from lambda altSF lambda to lambda altSF22, the substituting P22 genes are derived from the E. coli host. We have identified a set of Salmonella phage P22 genes in a standard nonlysogenic strain of E. coli K-12 that is apparently carried in a silent form. The reason for this lack of expression is not obvious, because this P22 material includes structural genes and associated promoters and is potentially active. When this set of genes substitutes for the analogous set of genetic material on the genome of lambda altSF lambda, the P22 genes are expressed in a normal manner.
Bacteriophage lambda↗
Spinal cord regeneration.
Explore the source record for details and available documents.
Action Potentials↗
Planned intracranial revascularization before proximal ligation for traumatic aneurysm.
Explore the source record for details and available documents.
Adult↗