Long-term cerebral imaging after pre-eclampsia

OBJECTIVE

Formerly eclamptic women demonstrate cerebral white matter lesions (WMLs) several years following the index pregnancy. The pathophysiology is unclear and may be related to the predisposition for cerebrovascular/cardiovascular disease in such women and/or the occurrence of posterior reversible encephalopathy syndrome whilst pregnant. The aim of this study was to assess the presence and severity of WMLs and their relationship with the severity of the neurological symptoms during the index pregnancy and several current cardiovascular risk factors in formerly pre-eclamptic women.

DESIGN

This was a retrospective cohort study.

SETTING

The Neuroimaging Centre at the School for Behavioural and Cognitive Neurosciences, Groningen, the Netherlands.

POPULATION

Seventy-three formerly pre-eclamptic women were matched for age (37 ± 6 years) and elapsed time since index pregnancy (5.1 ± 3.7 years) with parous control women.

METHODS

Cerebral magnetic resonance imaging scans were performed on cases and controls. Scans were rated by a neuroradiologist blind to the patient category.

MAIN OUTCOME MEASURES

The presence and severity of cerebral WMLs.

RESULTS

Formerly pre-eclamptic women had WMLs significantly more often (37%) and more severely (mean, 0.11; median, 0.00; range, 0-2.34 ml) than controls (21%, P = 0.04; mean, 0.015; median, 0.00; range, 0-0.13 ml; P = 0.02). Current hypertension and a history of early-onset pre-eclampsia (<37 weeks) were independently associated with the presence of WMLs (β = 1.34, P = 0.02 and β = 1.73, P = 0.01, respectively).

CONCLUSIONS

Our findings indicate that pre-eclampsia might be a risk marker for early cerebrovascular damage. The predisposition of formerly pre-eclamptic women to later cardiovascular and cerebrovascular disease may be an important factor for the development of cerebral WMLs. Whether a history of posterior reversible encephalopathy syndrome may be an additive risk factor for the development of these lesions remains unknown.

Human brain chemical shift imaging at age 60 to 90: analysis of the causes of the observed sex differences in brain metabolites

RATIONALE AND OBJECTIVES

To assess whether differences in cerebral atrophy and white matter lesions or in the presence of lactate and lipid signals can explain the observed differences in brain choline, creatine, and N-acetylaspartate levels between healthy elderly women and men.

METHODS

In addition to standard magnetic resonance imaging of the brain, an 8 x 8 x 2-cm3 supraventricular transverse brain volume parallel to the canthomeatal line was examined by magnetic resonance spectroscopy (automated 1H chemical shift imaging) in 540 healthy elderly persons.

RESULTS

At P = 0.01, 0.001, and 0.0001, choline differed between women and men in 14, 9, and 5 of 36 voxels, respectively. On correction for cerebral atrophy (more frequent in men than in women), white matter lesions (more frequent in women), and lactate and lipid (more frequent in women), the differences in choline were reduced to 13, 6, and 3. Sex differences for creatine and N-acetylaspartate were similar but less numerous after correction.

CONCLUSIONS

Elderly women and men in the general population show differences in the levels of creatine, N-acetylaspartate, and especially choline in portions of the brain. The sex-related differences in brain metabolite levels cannot be explained by differences in cerebral atrophy or other aging-related phenomena (white matter lesions, lactate, lipid).

Reversible cisplatin ototoxicity in the albino guinea pig

Guinea pigs implanted with round window electrodes received daily doses (2.0 mg/kg) of cisplatin until a profound hearing loss occurred (> 40 dB at 8 kHz). Afterwards, pronounced recovery occurred. Recovery progressed over intervals up to 3 weeks before it saturated. Loss and recovery involved both the compound action potential and, less pronounced, the cochlear microphonics. Cochlear potentials evoked by lower frequencies recovered more fully than those evoked by higher frequencies. Loss and recovery was found also in the endocochlear potential. Outer hair cell counts did not change over the recovery period. These findings confirm our previously reported results on the reversibility of cisplatin damage. Further, they implicate the vascular stria as an important target for cisplatin in the cochlea.

Aortic atherosclerosis at middle age predicts cerebral white matter lesions in the elderly

BACKGROUND AND PURPOSE

MRI scans of the brains of elderly people frequently show white matter lesions. Clinically, these lesions are associated with cognitive impairment and dementia. A relation between atherosclerosis and white matter lesions was found in some small cross-sectional studies. However, atherosclerosis is a gradual process that starts early in life. We investigated the longitudinal association between aortic atherosclerosis assessed during midlife and late life and cerebral white matter lesions.

METHODS

We randomly sampled subjects between 60 and 90 years old from 2 population-based follow-up studies in which subjects had their baseline examinations in 1975 to 1978 (midlife) and in 1990 to 1993 (late life). In 1995 to 1996, subjects underwent 1.5-T MRI scanning; white matter lesions were rated in the deep subcortical and periventricular regions separately. Aortic atherosclerosis was assessed on abdominal radiographs that were obtained from 276 subjects in midlife and 531 subjects in late life.

RESULTS

The presence of aortic atherosclerosis during midlife was significantly associated with the presence of periventricular white matter lesions approximately 20 years later (adjusted relative risk, 2.4; 95% CI, 1.2 to 5.0); the relative risks increased linearly with the severity of aortic atherosclerosis. No association was found between midlife aortic atherosclerosis and subcortical white matter lesions (adjusted relative risk, 1.1; 95% CI, 0.5 to 2.3) or between late-life aortic atherosclerosis and white matter lesions.

CONCLUSIONS

The pathogenetic process that leads to cerebral periventricular white matter lesions starts already in or before midlife. The critical period for intervention directed at prevention of white matter lesions and its cognitive consequences may be long before these lesions become clinically detectable.

Protection and spontaneous recovery from cisplatin-induced hearing loss

Cisplatin [cis-diamminechloroplatinum(II)] has proved itself as a potent antineoplastic agent. However, nephrotoxicity, neurotoxicity, gastrointestinal toxicity, myelosuppression, and ototoxicity interfere with its therapeutical efficacy. Forced diuresis reduces nephrotoxicity, effectively leaving neurotoxicity and ototoxicity as the major side effects of concern, and gastrointestinal toxicity and myelosuppression as the secondary side effects. So far, attempts to reduce these side effects by developing equally potent platinum analogs have been unsuccessful. Some success has been achieved, however, by co-treatment with protective agents. Nearly all these agents are sulfur- or sulfhydryl-containing compounds (thio compounds), known as antioxidants and potent heavy metal chelators. These thio compounds may provide protection from cisplatin toxicity either (1) by direct interaction between the cisplatin and the thio moiety, (2) by displacing platinum from its site of toxic action, (3) by preventing platinum from interfering with superoxide dismutase, or (4) by scavenging of cisplatin-induced free radicals. In particular the first two protective mechanisms bear the risk of reducing the antineoplastic activity of cisplatin. Since nephrotoxicity can be controlled effectively by forced diuresis, a more specific approach of coping with ototoxicity by focusing on protection at the sensorineural level was chosen. Being familiar with the neuro-protective and neurotrophic properties of ACTH-related neuropeptides, specifically against cisplatin-induced peripheral neuropathies, it was judged expedient to test for a possible otoprotective action of these neuropeptides. The results were positive, although tainted with high interanimal variability. When testing for the possibility that the neuropeptides would merely delay cisplatin-induced ototoxicity rather than reduce it, it was discovered in control series without neuropeptide co-treatment that the ear can recover spontaneously from cisplatin-induced hearing loss. This was found both electrophysiologically and in outer hair cell (OHC) counts. Although these preliminary findings require further investigation, they strongly suggest that spontaneous recovery of cochlear injury can occur in the mature mammalian cochlea. Moreover, the otoprotective action of the ACTH-related neuropeptides suggests that it may be possible to stimulate recovery from acute hearing loss using neuropeptides.

Cisplatin ototoxicity and the possibly protective effect of alpha-melanocyte stimulating hormone

It is known that adrenocorticotrophic hormone (ACTH)-derived peptides, the so-called melanocortins, can reduce cisplatin-induced neurotoxicity. Recently, our group has found that cisplatin-induced ototoxicity can also be reduced or prevented by treatment with the synthetic melanocortin-like peptide, ORG 2766 (Hamers et al., 1994; De Groot et al., 1997). The present study was designed to investigate the possibly ameliorating effects of the physiologically more relevant naturally occurring neuropeptide alpha-melanocyte stimulating hormone (alpha-MSH) upon cisplatin ototoxicity and to compare its protective effects to those of ORG 2766. For eight consecutive days guinea pigs were treated with cisplatin at a concentration of either 1.5 mg/kg/day or 2 mg/kg/day. Animals were co-treated with either alpha-MSH (75 microg/kg/day), ORG 2766 (75 microg/kg/day), or a sham injection containing physiological saline. Electrocochleography and hair cell counts were performed. Treatment with 1.5 mg/kg/day cisplatin resulted in a large variability of the morphological and electrophysiological data, a variability that might have masked possible effects of ORG 2766 and alpha-MSH. Treatment with 2 mg/kg/day cisplatin caused less variable, severe reductions in the compound action potentials and cochlear microphonics combined with basal and middle-turn outer hair cell loss in five out of six animals. However, in the alpha-MSH co-treated groups, two out of six animals could be classified as normal, two animals as moderately affected and two animals as severely affected. In the ORG 2766 co-treated group we found three animals that were not affected and three animals that were severely affected. We conclude that the protective effects of alpha-MSH and ORG 2766 co-treatment are comparable and that alpha-MSH might be clinically useful in protecting against cisplatin-induced ototoxicity.

Demonstration of intermediate filament proteins in the guinea pig vestibular labyrinth by a new, high-resolution cryotechnique

In order to establish the more precise localization of IFPs in the vestibular labyrinth we have developed an immunohistochemical method using semithin cryosections from guinea pig inner ear. The vestibular end organs were fixed by intralabyrinthine perfusion with formaldehyde and glutaraldehyde. Microdissection was performed, followed by decalcification in EDTA. After specimen embedding in gelatin, semithin cryosections (1 micron) were prepared. Prior to the immunohistochemical staining, a new antigen-unmasking treatment was performed. Monoclonal antibodies for cytokeratins (Cks), vimentin, neurofilament protein (NF), and glial fibrillary acidic protein (GFAP) were used and visualized with an indirect ABC method. In the guinea pig vestibular labyrinth, Cks8, 18 and 19 were present. Vimentin and NF were stained positively, GFAP negatively. These results are in accordance with our previous results in the human vestibular labyrinth except for Ck7. The high-resolution cryotechnique in combination with a new antigen-unmasking method may yield more, and more detailed information about the localization of IFPs in the vestibular region.

Glycocalyx heterogeneity in normal and hydropic cochleas of the guinea pig

The endo- and perilymphatic glycocalyx of the cochlear epithelia were investigated ultrastructurally in normal and hydropic cochleas using the electron-dense markers cationized ferritin and colloidal thorium. In the normal cochleas all epithelial surfaces showed reactivity with both markers. Using cationized ferritin, no regional differences in reactivity could be demonstrated. With colloidal thorium, however, the apical membranes of the outer hair cells reacted more intensely than either the basolateral membranes or the membranes of the supporting cells of the organ of Corti. Cationized ferritin reactivity was not affected by digestion with either neuraminidase or hyaluronidase. In contrast, colloidal thorium reactivity of the endolymphatic surfaces was greatly reduced after neuraminidase digestion. Reactivity of the cell membranes lining the perilymphatic compartments of the cochlea was less affected by neuraminidase digestion, except for the basolateral membranes of the sensory and supporting cells of the organ of Corti, which demonstrated a greatly reduced reactivity. These findings indicate that the glycocalyx of the epithelial surfaces lining the endolymphatic compartment has a high content of sialic acid. The differences that are observed in normal cochleas in regard to colloidal thorium reactivity between the apical membranes of the outer hair cells and the membranes of the Deiters' cells, could not be demonstrated in hydropic cochleas. This probably contributes to the early functional changes in outer hair cells observed in experimental hydrops.

Expression of intermediate filament proteins in the adult human vestibular labyrinth

The immunohistochemical detection of intermediate filament proteins, cytoskeletal constituents that allow the characterization of tissues, was investigated in frozen sections of the chemically fixed, nondecalcified, adult human vestibular labyrinth. Cytokeratins (CKs) were detected in all epithelia (including the sensory epithelia), although substantial differences in the degree of staining between individual cells occurred. The expression of CKs 7, 8, 18, and 19 as detected with our subunit-specific monoclonal antibodies in the vestibular epithelia is typical of "simple" epithelia and is identical to the CK subtypes found in the human cochlea. Although immunostaining for CK 7 was very weak and was limited to certain vestibular wall cells, the other CKs demonstrated a pronounced and rather uniform distribution throughout the different epithelia. All epithelia (including the sensory epithelia) displayed expression of vimentin, thus demonstrating co-expression with CKs. Vimentin was also present in the subepithelial connective tissue fibroblasts and mesothelial lining of the vestibular labyrinth. Neurofilament proteins were detected in all neuronal structures. The intense staining for CKs in the maculae and cristae implies that these sensory organs are rigid structures, a finding that may possibly be of importance in the mechanoelectrical transduction process for the sense of equilibrium.

Cytochemical localization of ouabain-sensitive, potassium-dependent p-nitrophenylphosphatase in the guinea pig inner ear. Evaluation of the cerium-based method vs. the lead-based method

The cytochemical localization of ouabain-sensitive, potassium-dependent p-nitrophenylphosphatase in the guinea pig inner ear was studied using both the lead-based method and the cerium-based method. The influence of primary fixation and incubation time was investigated under both incubation conditions. A high p-NPPase activity was observed in the basolateral infoldings of the stria vascularis in the cochlea and the dark cells in the vestibular labyrinth. The stromal cells of the spiral prominence only showed a weak reaction with the lead-based method. No specific enzyme activity was found in the endolymphatic sac. The results of the present study are discussed with emphasis on the cation transport mechanisms of the inner ear.

Differential immunohistochemical detection of cytokeratins and vimentin in the surgically removed human endolymphatic duct and sac

Immunohistochemical detection of intermediate filament proteins and different subgroups of cytokeratins (Cks) was used to characterize the epithelium of the surgically removed adult human endolymphatic duct (ED) and sac (ES). The epithelium of the ED and ES demonstrated immunostaining for Cks 7, 8, 14, 17, 18 and 19, a pattern typical of so-called "complex" or "mixed" epithelia. This is a remarkable finding, since this pattern differs strikingly from previously reported data on the adult human cochlea and vestibular labyrinth that demonstrated a Ck pattern typical of "simple" (or single-layered) epithelia. Furthermore, the epithelium of the ED and ES demonstrated co-expression of Cks and vimentin. The present data indicate that the epithelium of the ED and ES exhibits another type of epithelial differentiation and demonstrates a higher degree of complexity than the other epithelia in the adult human inner ear.

Early ultrastructural effects of gentamicin cochleotoxicity

Ultrastructural changes in the cochlear hair cells during the early stages of gentamicin intoxication were investigated after tri-aldehyde primary fixation and OSO4/K4Ru(CN)6 post-fixation. In cochleas treated for 5, 10 and 15 days with gentamicin the individual outer hair cells (OHC1, OHC2 and OHC3) were randomly affected. Degeneration of the inner hair cells was not observed at this stage. Ultrastructurally, the earliest identifiable changes were an increase in lysosomes, proliferation of the endoplasmic reticulum, and formation of Hensen's bodies. This was followed by dilatation of the endoplasmic reticulum and the nuclear envelope, giving rise to extensive cytoplasmic vacuolation. These results demonstrate that gentamicin-induced changes primarily involve the cell's synthetic apparatus. All further intracellular changes occur at a much later stage and are therefore to be considered secondary events.

Ultrastructure of the organ of Corti in experimental hydrops

The early ultrastructural changes of the organ of Corti in the guinea pig after obliteration of the endolymphatic sac and duct were examined in a time-sequence study. Initial loss of outer hair cells was followed by inner hair cell degeneration, both starting at the apical part of the cochlea. Morphological changes of the sensory cells were found to start at the endolymphatic surface and were characterized by a variety of sterociliary pathologies, distortion of the cuticular plate and a less prominent contrast-staining of glycocalyx. Further degeneration was marked by pathological changes of intracellular organelles and the afferent and efferent nerve endings. Details of the ultrastructural changes in the organ of Corti are discussed with regard to the pathophysiology of experimental hydrops.

Pathological findings in the human auditory system following long-standing gentamicin ototoxicity

The clinical, audiovestibular and histopathological findings in a patient who suffered from a long-standing gentamicin-induced deafness are reported. In both temporal bones, the organ of Corti was completely absent, with only a few nerve fibres remaining in the apical part of the cochlea. Regenerative ingrowth of nerve fibers into the area of the degenerative organ of Corti was present apically in both ears. The stria vascularis exhibited considerable degeneration in all turns and loss of microvasculature was found in the basilar membrane. The spiral ganglion cells, the cochlear nerve and the central auditory pathways and nuclei appeared to be unaffected.

Testing ciliary activity in patients with chronic and recurrent infections of the upper airways: experiences in 68 cases

The clinical use of various tests of ciliary activity is uncertain and the purpose of this study is to assess the practical significance of the most current methods. Therefore, biopsy specimens of the nasal mucosa were investigated by means of phase contrast microscopy in 68 patients with chronic and recurrent infections of the upper airways. In 19 cases an absent or extremely weak ciliary activity could be demonstrated. Ultrastructurally, a characteristic pattern of defective dynein arms as observed in primary ciliary dyskinesia, was evident in only 3 out of these 19 patients. Measurements of the mucociliary transport velocity by means of intranasal Tc 99m labeled particles appeared to be unreliable in cases of severe nasal obstruction. In this study, phase contrast microscopy of biopsy material from the nasal respiratory epithelium appeared to have the most advantages: It is a practical and rather simple screening test in the assessment of ciliary activity.