Initial experience with endoscopic third ventriculostomy in Nigeria, West Africa

Objectives Endoscopic third ventriculostomy (ETV) as an alternative to traditional shunt surgery in the management of hydrocephalus of different etiologies is new in Nigeria and West Africa, with no published data till date. This initial study was done to determine the success rate and complication among our patient population. Materials and methods This series consists of a prospective study of the clinical and radiological features and outcome of the first 25 consecutive patients who underwent ETV. ETV was considered to be successful when there was no event occurring during surgery that resulted in the procedure being aborted, postoperative neurological deficit, or adverse event that resulted in a modification of the normal postoperative care. Patients follow-up was for a minimum of 2 months. Results There were 14 males and 11 females. The median age of the patients was 6 months, ranging from 1 month to 48 years. The study included obstructive hydrocephalus because of aqueductal stenosis, Dandy Walker malformation, and pineal region tumor. ETV was successful in 23 patients. Two patients had cerebrospinal fluid leak and superficial surgical site infection. There was no mortality. Conclusion ETV in this series is safe with comparable surgical outcomes to conventional ventriculoperitoneal shunt surgery, and minimal postoperative morbidity has been observed. A commentary on this paper is available at .     

Frequency-selectivity of a thalamocortical relay neuron during Parkinson's disease and deep brain stimulation: a computational study

In this computational study, we investigated (i) the functional importance of correlated basal ganglia (BG) activity associated with Parkinson's disease (PD) motor symptoms by analysing the effects of globus pallidus internum (GPi) bursting frequency and synchrony on a thalamocortical (TC) relay neuron, which received GABAergic projections from this nucleus; (ii) the effects of subthalamic nucleus (STN) deep brain stimulation (DBS) on the response of the TC relay neuron to synchronized GPi oscillations; and (iii) the functional basis of the inverse relationship that has been reported between DBS frequency and stimulus amplitude, required to alleviate PD motor symptoms [A. L. Benabid et al. (1991) Lancet , 337 , 403–406]. The TC relay neuron selectively responded to and relayed synchronized GPi inputs bursting at a frequency located in the range 2–25 Hz. Input selectivity of the TC relay neuron is dictated by low-threshold calcium current dynamics and passive membrane properties of the neuron. STN-DBS prevented the TC relay neuron from relaying synchronized GPi oscillations to cortex. Our model indicates that DBS alters BG output and input selectivity of the TC relay neuron, providing an explanation for the clinically observed inverse relationship between DBS frequency and stimulus amplitude.     

Fine needle aspiration cytology of basal cell carcinoma of the skin: a clinical and cytopathological appraisal.

This report describes the fine needle aspiration cytologic findings of 22 cases of basal cell carcinoma of the skin. The series consisted of 17 men and 5 women with a mean age of 60.7 years (range, 35-80). All the patients were from south of Xinjiang and were outdoor workers with histories of prolonged exposure to strong sunlight. Histopathologic study was performed in all cases. Using fine needle aspiration cytology (FNAC) in evaluating basal cell carcinoma, there were no false-positive cases, but one false-negative one giving a diagnostic accuracy of 95.65%. Cytologic features suggestive of basal cell carcinoma included increased numbers of small, uniform hyperchromatic, relatively little cytoplasmic cell clusters. The peripheral cells appeared in monolayer form as a papillated outline with very strong cellular cohesion. Scattered tumor cells were seldom seen. The differential diagnosis of basal cell carcinoma in FNAC includes poorly differentiated squamous cell carcinoma, eccrine gland carcinoma, and neuroendocrine carcinoma of the skin. FNAC diagnosis of basal cell carcinoma is essential in order to ensure proper treatment.     

Corticostriatal and corticosubthalamic input zones from the presupplementary motor area in the macaque monkey: comparison with the input zones from the supplementary motor area

The presupplementary motor area (pre-SMA) is a cortical motor-related area which lies in the medial wall of the frontal lobe, immediately anterior to the supplementary motor area (SMA). This area has been considered to participate in the control of complex forelimb movements in a way different from the SMA. In an attempt to analyze the patterns of projections from the pre-SMA to the basal ganglia, we examined the distributions of pre-SMA inputs in the striatum and the subthalamic nucleus and compared them with the SMA input distributions. To detect morphologically the terminal fields from the pre-SMA and the forelimb region of the SMA, anterograde tracers were injected into such areas that had been identified electrophysiologically in the macaque monkey. Corticostriatal inputs from the pre-SMA were distributed mainly in the striatal cell bridges connecting the rostral aspects of the caudate nucleus and the putamen, as well as in their neighboring striatal portions. These input zones were located, with no substantial overlap, rostral to corticostriatal input zones from the SMA forelimb region. Corticosubthalamic input zones from the pre-SMA were almost localized in the medial aspect of the nucleus, where corticosubthalamic inputs from the SMA forelimb region were also distributed predominantly. However, the major terminal fields from the pre-SMA were centered ventrally to those from the SMA. The present results indicate that the corticostriatal and corticosubthalamic input zones from the pre-SMA appear to be segregated from the SMA-derived input zones. This implies the possibility of parallel processing of motor information from the pre-SMA and SMA in the cortico-basal ganglia circuit.     

银杏叶提取物对豚鼠腹腔神经节细胞生物电的影响

目的通过观察银杏叶提取物(EGb)对交感神经节细胞生物电的影响,为进一步探讨EGb调节包括血管运动在内的内脏功能活动的机制提供依据.方法细胞内生物电记录技术和灌流给药法.结果 EGb(50～500 mg/L)可使75.0%的腹腔神经节(CG)细胞产生去极化反应,幅度(5.58±0.79) mV,时程(240.7±50.3) s,且表现剂量依赖性;12.5%的细胞超级化;6.3%出现先超级化再去极化的双相反应;另有6.3%的细胞在相同的灌注条件下,于不同的时间内,分别出现超级化和去极化两种反应.去极化反应的细胞其膜电阻表现为降低(33.8%)、增大(26.2%)和不变(40.0%).此去极化反应可被低钙/高镁克氏液部分阻断,但不被胆碱和肾上腺素受体阻断剂所阻断.EGb尚可抑制外源性Ach引起的去极化电位.结论 EGb可能通过影响肽类递质的释放,进而影响豚鼠CG细胞生物电活动.     

Motor dysfunction in HIV-infected patients without clinically detectable central-nervous deficit

Summary Motor tests were performed in 50 HIV-infected patients in all stages according to the current CDC classification, but without any clinically evident central nervous system deficit, and the results compared with an age-matched control group. Patients were excluded from the study if there was alcohol or drug abuse, fever and/or opportunistic cerebral infection. The parameters tested were postural tremor of the outstretched hands, most rapid voluntary alternating index finger movements (MRAM) and rise time of most rapid index finger extensions (MRC). Whereas tremor peak frequencies did not differ significantly in the patients and controls, MRAM and rise times of MRCs showed significant slowing in the patient group. Morphologically, the motor test performance of the HIV-infected patients was similar to that of patients with manifest basal ganglia disease (Parkinson's, Huntington's and Wilson's diseases). MRI scans of all patients were normal. It is concluded that in HIV-infected patients there is a very early subclinical central nervous system affection, especially of the basal ganglia, which is detectable with appropriate, quantitative motor function tests. These functional abnormalities precede the structural alterations in the MRI scans.Preliminary results were presented at the Congress of the International Medical Society of Motor Disturbances (ISMD), Rome, 1988     

基底节区脑脓肿并发脑疝手术治疗的方法及预后

目的:探讨基底节区脑脓肿并发脑疝手术治疗的方法及预后。方法:回顾性分析2002年1月至2007年6月收治的11例基底节区脑脓肿并发脑疝患者的手术方法及其预后。结果:11例基底节区脑脓肿并发脑疝患者接受开颅去骨瓣减压加脓肿穿刺抽出术,其中10例治愈,且肢体功能都恢复正常;1例基底节区脑脓肿并发脑疝同时破入脑室患者,行开颅去骨瓣减压加脓肿穿刺抽出术的同时行脑室外引流术,术后10d死亡。结论:去骨瓣减压加脓肿穿刺抽出术是治疗基底节区脑脓肿并发脑疝有效的方法,且避免了基底节区重要结构(如内囊)的损伤。一旦脓肿破入脑室,则预后较差。     

“Squeezing Eyes.” A Clinical Pathological Conference

The case of a 55-year-old man with severe spasm of the upper and lower eyelids is presented. The differential diagnosis of essential blepharospasm is discussed, as are the various treatment modalities. The importance of careful ophthalmic and neurological examination is emphasized, as, in some instances, blepharospasm is associated with basal ganglia dysfunction.     

含降钙素基因相关肽的脊神经节细胞分支分布至股神经和腰背肌的研究

目的 探讨腰背痛伴下肢痛和下肢肌痉挛的化学神经机制。方法 应用荧光双标记法结合免疫组化及ＰＡＰ法对１７只豚鼠进行了研究，将碘化丙啶注入股神经干，双苯甲亚胺注入腰背肌，结果：发现在Ｌ３～５节段脊神经节中存在着荧光双标记细胞，荧光双标记细胞的出现率为３．４％，约４３．７％的荧光双标记细胞含降钙素基因相关肽，含降钙基基因相关肽的荧光双标记细胞均中，中小和小型细胞，结论：在腰背肌与股神经之间存在着脊神经节     

Basal cell carcinoma on the dorsum of the hand: report of 11 cases

BACKGROUND: Basal cell carcinoma (BCC) is the most common cutaneous malignancy, although the appearance on the dorsum of the hand appears to be rare. OBJECTIVES: The purpose of this study was to identify and describe patients with BCC of the dorsum of the hand in a large cohort of BCC patients and to provide a review of the literature. METHODS: Eleven patients with a BCC on the dorsum of the hand were identified. Information on age at diagnosis, sex, treatment and follow up, presence of additional malignancies, etc., was gathered from medical records. RESULTS: Between January 1985 and December 1995, 2990 BCCs were registered, of which 11 were located on the dorsal aspect of the hand (0.37%). Nine patients were male and most patients had a history of multiple skin malignancies. Most of the BCCs were nodular or had a nodular component. Solar elastosis was frequently seen. The percentage of 0.37% compares well with BCC located on the dorsum of the hand in other studies, but also with other parts of the body per skin surface area (except the face and neck area). CONCLUSIONS: The density of BCC on the dorsum of the hand is much lower than in the face and neck area but compares well with other parts of the body.