Anatomical information is needed in ultrasound imaging of muscle to avoid potentially substantial errors in measurement of muscle geometry

This study validates two‐dimensional (2D) ultrasound measurements of muscle geometry of the human medial gastrocnemius (GM) and investigates effects of probe orientation on errors in these measurements. Ultrasound scans of GM muscle belly were made both on human cadavers (n = 4) and on subjects in vivo (n = 5). For half of the cadavers, ultrasound scans obtained according to commonly applied criteria of probe orientation deviated 15° from the true fascicle plane. This resulted in errors of fascicle length and fascicle angle up to 14% and 23%, respectively. Fascicle‐like structures were detectable over a wide range of probe tilt and rotation angles, but they did not always represent true fascicles. Errors of measurement were either linear or quadratic functions of tilt angle. Similar results were found in vivo. Therefore, we conclude that similar errors are likely to occur for in vivo measurements. For all cadavers, at the distal end of GM, the true fascicle plane was shown to be perpendicular to the distal aponeurosis. Using transverse images of GM to detect the curvature of the deep aponeurosis at the distal end of the muscle belly is a simple strategy to help identify the fascicle plane. For subsequent longitudinal imaging, probe alignment within this plane will help minimize measurement errors of fascicle length, fascicle angle, and muscle thickness. Muscle Nerve, 2009     

Control of prolactin-secreting macroadenomas with parenteral, long-acting bromocriptine in 30 patients treated for up to 3 years

OBJECTIVE We investigated the effect of intramuscular injections of long-acting bromocriptine in patients with macroadenomas. STUDY DESIGN AND PATIENTS Thirty patients with PRL-secreting pituitary macroadenomas were treated with repeated 4-weekly intramuscular injections of 50 or 100 mg of a long-acting, repeatable bromocriptine formulation for six to 37 injections, amounting to a total of 473 injections. Twenty patients received parenteral bromocriptine as primary therapy, ten had persisting hyperprolactinemia after previous therapies including pituitary surgery (n= 7), oral bromocriptine (7), and pituitary Irradiation (2). MEASUREMENTS A PRL day profile was obtained and the patients' clinical status and history were documented, at intervals. Detailed clinical, laboratory, and radiological (pituitary nuclear magnetic resonance or computed tomography scan) evaluations were performed at baseline, after 1 injection and every 6th injection therafter. RESULTS In all patients PRL was suppressed from a mean ± SEM pretreatment level of 32 620 ± 8680 to 4480 ± 1140 mU/l on the third day after the first injection. In 12 patients PRL levels normalized (< 400 mU/l) with the first to fourth injection, in three additional patients PRL levels normalized after 8–15 months. In 19 patients PRL was suppressed to less than 1000 mU/l. In three patients PRL did not decrease to less than 50% of pretreatment; in two of them on oral bromocriptine prior to this study there had been a comparable low efficacy. Of 28 patients with macroadenomas (median height 22 mm) tumour shrinkage was evident in 15 by nuclear magnetic resonance or computed tomography scan 28 days after the first injection, and in three additional patients after 6 months. There was further regression in seven cases after 12, 18 or 24 injections. Adenoma size (mean SEM) decreased to 66 ± 7% of the pretreatment value. The 40 adverse events noted in 20 of 30 patients during 24 hours after the first injection were similar to known side-effects of oral bromocriptine, nausea and postural hypotension being the most frequent. With repeated injections, on average 0 6 adverse events were noted per injection (mostly mild asthenia). There were no local adverse reactions at the injection site. CONCLUSION We conclude that long-acting repeatable bromocriptine in patients with macroprolactinomas offers a safe and efficacious primary treatment that ensures compliance and gives long-term control. Adverse reactions are comparable to oral bromocriptine but subside with repeated injections.     

Oral caliber-persistent artery. Unusual presentations of unusual lesions.

Two cases of oral caliber-persistent artery are reported. Both cases were different from the five previously reported oral examples of this unusual entity. One case is the first reported instance of a caliber-persistent artery not associated with spontaneous hemorrhage, inflammation, or ulceration. The clinical importance of this entity to the patient and the treating practitioner is stressed.     

Ataxia-telangiectasia-like Chinese hamster V79 cell mutants with radioresistant DNA synthesis, chromosomal instability, and normal DNA strand break repair

We have isolated three radiosensitive mutants (V-C4, V-E5, and V-G8) of the Chinese hamster V79 cell line which also show increased sensitivities to killing by bleomycin (approximately 2-5-fold) and ethyl methanesulfonate (approximately 2-fold). Genetic complementation analysis indicates that all three mutants belong to one complementation group. The mutants show a radioresistant DNA synthesis following X-ray irradiation when compared to wild-type V79 cells. Both the level and the rate of repair of DNA single- and double-strand breaks measured by DNA elution were similar to those observed in wild-type V79 cells. The level of spontaneously occurring chromosome aberrations in two of these mutants differs severalfold from the level observed in wild-type V-79 cells and in V-G8, to approximately 2- and 6-fold increase in V-E5 and V-C4, respectively. X-irradiation of the mutants resulted in consistently 3-4-fold higher levels of chromatid gaps, breaks, and exchanges than observed in wild-type V79 cells. In addition, G1 irradiation of the mutant cells yielded both chromosome and chromatid types of aberrations. The level and pattern of chromosomal aberrations induced by X-rays in V-C4, V-E5, and V-G8 are similar to those observed in ataxia-telangiectasia cells. These results indicate that our mutants represent the first rodent cell mutants which show phenotypic characteristics strongly resembling those in cells from ataxia-telangiectasia patients.     

Kernspintomographie und Vaginalsonographie in der Beurteilung des inneren Genitale

Ohne Zusammenfassung     

Der Arzt im technischen Zeitalter

Ohne ZusammenfassungVortrag der 100. Tagung der Gesellschaft Deutscher Naturforscher und Ärzte 1958 in Wiesbaden.     

Trigeminal neuralgia by an acoustic neuroma. The need of imaging

In a 43-year old female with neuralgia of the second and third branch of the trigeminal nerve, the diagnosis was made on the basis of clinical findings. After the patient was treated with 2 x 200 mg of carbamazepine, all initial symptoms resolved, which confirmed the diagnosis. To distinguish between idiopathic and secondary trigeminal neuralgia, magnetic resonance imaging was scheduled. This investigation showed an acoustic neuroma in the cerebellopontine angle. Without magnetic resonance imaging this benign tumour would be diagnosed in a much later stage and the patient would have suffered unnecessary co-morbidity. Due to the relatively high incidence of secondary trigeminal neuralgia, routine magnetic resonance imaging in patients with a trigeminal neuralgia is justifiable.     

Relation between neuroradiological findings and upper limb function in hemiplegic cerebral palsy

The relation between neuroradiological findings and upper limb function was examined in 53 children with hemiplegic cerebral palsy (CP). CT and MRI images of the children were classified into four groups (malformations, periventricular lesions, congenital cortical–subcortical lesions and postnatally acquired lesions). Additionally, each single affected neuroanatomical structure was noted. Clinical assessments included measures of activity (Melbourne Assessment of Unilateral Upper Limb Function and House Classification) and body functions (motor and sensory impairments). Comparative statistics and correlation analysis were used. Three children had a malformation, 28 a periventricular lesion, 14 a cortical–subcortical lesion and eight a postnatally acquired lesion. Children with periventricular lesions obtained the best motor functioning. Within this group, children with pure periventricular lesions performed significantly better compared to mixed lesions. The differences between congenital cortical–subcortical lesions and acquired lesions were not significant. Results further showed that middle cerebral artery infarctions and basal ganglia/thalamic lesions were significantly correlated to a worse performance. The type of lesion determined by the timing of the brain insult, and the location of the lesion distinguish children with hemiplegic CP regarding upper limb function. These insights are valuable for prognosis and may contribute to a better delineation of therapeutic interventions.