Intractable Epilepsy in a Population-Based Series of Mentally Retarded Children

Summary: Purpose: The characteristics of intractable epilepsy were analyzed in a population-based study of active epilepsy in mentally retarded children aged 6–13 years.
Methods: Diagnostic registers, EEG laboratory registers, and registers for the Education of the Subnormal were searched. Medical files were scrutinized. Clinical examinations and interviews with parents and caregivers or both were performed. EEG recordings, computed tomography (CT) and magnetic resonance imaging (MRI) of the CNS were reevaluated.
Results: Forty-five percent (44 of 98) of the children with mental retardation (MR) and active epilepsy had intractable seizures, defined as one or more seizures every day or week. The median age at onset was 0.8 years, as compared with 3.0 years for those with controlled epilepsy. Predictive factors for frequent seizures were the number of seizure types, severe MR, status epilepticus (SE) and tonic seizures. Epileptiform EEG activity was present in 91%, and focal activity in 65%. Brain lesions were detected on CT and MRI in 70%, with generalized lesions in 60%. Concurrent focal epileptiform activity and focal brain lesions on CTIMRI were detected in 26%. The percentages and prevalence rates for infantile spasms (IS) and Lennox-Gastaut syndrome (LGS) were 18% (0.25 in 1,000) and 7% (0.06 in 1,000), respectively. One of 8 children with IS had had previous neonatal seizures, 3 had SE and 1 later developed LGS.
Conclusions: Children with MR and intractable epilepsy have a high frequency of severe MR and additional major neuroimpairments. EEG recordings frequently showed focal changes despite generalized lesions in neuroradiology.     

Positron Emission Tomography with [11C]Deuterium-Deprenyl in Temporal Lobe Epilepsy

Summary: We performed positron emission tomography (PET) with [¹¹C]deuterium-deprenyl in 9 patients with temporal lobe epilepsy (TLE) undergoing evaluation for possible epilepsy surgery. Seven patients had unilateral and 2 had bilateral mesiotemporal epileptic foci based on the preoperative investigation including ictal EEG discharges and PET with 2-[¹⁸F]fluoro-2-deoxyglucose (FDG). Deprenyl is an irreversible inhibitor of mono-amine oxidase type B (MAO-B) with a very high affinity for the enzyme. In the brain, MAO-B is preferentially located in astrocytes, and a previous in vitro study showed increased binding of the ligand in sclerotic hippocampi. Dynamically acquired N-[methyl-¹¹C]-a, a-di-deutero-L-deprenyl distributions in PET images were analyzed graphically, and the focus regions were assessed visually on the PET images. In addition, the accumulation rate and distribution volume of the tracer relative to the cerebellar cortex were measured in standardized homologous temporal regions by semiquantitative methods. Uptake of [¹¹C]deuterium-deprenyl was significantly increased in the epileptogenic temporal lobes, both apparently and semiquantitatively. By calculating mean inter-lobar ratios, we identified the temporal lobe containing the epileptic focus in six unilateral cases. One case was ambiguous but was not falsely localized. The two bilateral cases were correctly identified as such. Our results suggest that PET with [¹¹C]deuterium-deprenyl might be a useful method for identification of epileptogenic temporal lobes.     

Mechanical function of intermediate filaments in arteries of different size examined using desmin deficient mice

Protein composition and mechanical function of intermediate filaments were examined in arteries of different sizes using desmin deficient mice (Des−/−) and their wild-type controls (Des+/+). Using SDS-PAGE gels and Western blots we found a gradient in desmin expression in the arterial tree; the desmin content increased from the elastic artery aorta, via the muscular mesenteric artery to the resistance-sized mesenteric microarteries ∼150 μm in diameter in Des+/+ mice. Mechanical experiments were performed on the aorta, the mesenteric artery and resistance-sized arteries using wire myographs. For aorta and mesenteric artery, no differences in passive or active circumference- stress relations were found between Des−/− and Des+/+ mice. In microarteries, both passive and active stress were lower in the Des−/− group. In conclusion, large elastic and muscular arteries contain a relatively low amount of desmin, and the desmin intermediate filaments do not seem to play a major role in the mechanical properties of these larger arterial vessels. In the microarteries, where expression of desmin is high, desmin plays a role in supporting both passive and active tension.     

Immunocytochemical detection of the carbohydrate antigen, Sialyl Lewisx, in normal human skin and during irritant contact dermatitis

Abstract Sialys Lewis^x (SLex) is a ligand for the E-selectin and the interaction of E-selectin on the endothelium and SLe^x on T cells may be important for T-cell migration into the skin. We investigated the expression of SLe^x on Langerhans cells (LC) in normal skin and on LC repopulating epidermis deprived of LC due to a preceding irritant contact dermatitis. SLe^x was visualized by fluorescence and light microscopic immunocytochemistry using the monoclonal antibody. CSLEX-1. The results showed that about 40% of LC in normal epidermis express SLe^x. In the repopulation phase, most of the epidermal cells were CDla⁺/SLe^x+. We suggest that SLe^x is present on epidermal LC that have recently immigrated from the dermis.     

Preterm birth and low birthweight among children of Swedish and immigrant women between 1978 and 1990

Summary. The aim of the study was to estimate the occurrence of low birthweight (LBW) and preterm birth among immigrant and Swedish women in Sweden. Eligible for analysis were all 1270407 singleton births in Sweden between 1978 and 1990 to mothers aged between 15 and 44 years, whose own country of birth was known. The mothers of the children were born in Sweden (88.2%), or had immigrated from Finland (4.4%), other Scandinavian countries (1.2%), Western Europe or North America (1.3%), Eastern Europe (1.8%), the Middle East and North Africa (1.7%), Central and South America (0.6%), Asia and the Pacific Islands (0.6%), or Sub-Saharan Africa (0.2%). Multiple logistic regression was used to model LBW and preterm birth categorical outcomes. Each immigrant group was compared with the Swedish group. Odds ratios (ORs) for LBW were 1.13 (95% CI 1.04,1.22) for Asia and the Pacific Islands, 1.21 (1.05,1.38) for Sub-Saharan Africa and 0.89 (0.86-0.93) for Finland. Odds ratios for preterm birth were 1.15 (1.08-1.23) for immigrants from Asia and the Pacific Islands and 1.08 (1.04,1.13) for immigrants from Eastern Europe. Remarkably small differences were found between immigrant women and native Swedish women.     

Malassezia furfur in Infantile Seborrheic Dermatitis

Abstract: Malassezia furfur is important in the pathogenesis of a number of dermatologic diseases including seborrheic dermatitis in adults. It has also recently been suggested that M. furfur might be the etiologic agent in infantile seborrheic dermatitis (ISD). We studied the presence of M. furfur in 21 children with the clinical diagnosis of infantile seborrheic dermatitis. Laboratory analyses showed aberrant patterns of essential fatly acids (EFA) in serum characterized by elevated levels of 18:1w9 and 20:2w6. Samples for M. furfur were taken from the foreheads and chests of children with infantile seborrheic dermatitis at the time of diagnosis, directly after treatment to complete healing, and after 1 year with no signs of infantile seborrheic dermatitis. All the patients were treated topically with borage oil containing 25% gammalinolenic acid (GLA). No reduced growth of M. furfur was seen on contact plates prepared with borage oil. The growth of M. furfur seems not to be related to the clinical symptoms in ISD.     

The mini bottle brush ‐ a new fastening device in cancellous bone

A new design for bone implants, the bottle brush. was recently presented in a pilot study on marrow cavities in the femur of rabbits. In this study, the concept is further evaluated on a mini bottle brush. The fixture, 5x7 mm, with an implant shaft made of CP‐titanium and bristles of nylon coated with sputtered titanium, was inserted into the cancellous bone of the medial femoral condyle in 15 adult rabbits. The titanium fixture was compared with a similar brush without the titanium sputtered surface. The animals were sacrificed after 4 months and the quantity and quality of bone integration were evaluated with pull‐out tests and histological examination. In both parameters, the values were significantly higher for the titanium‐sputtered brushes, with removal forces similar to titanium cylinders of the same size and with a bone‐to‐metal contact area of about 50%.     

Cystitis as a correlate of female urinary incontinence

The objectives of the research were to study the association between prevalent urge and stress urinary incontinence (UI) and a history of cystitis in adult females. A cross-section of the adult female population, aged 30–59 years, in the Municipality of Aarhus, Denmark, was studied, using self-reported data based on postal questionnaires. The sample consisted of 3114 women, out of whom 2613 (84%) delivered the information requested. The main outcome measures were period prevalence in 1987 of episodes of UI provoked by physical stress and UI associated with a feeling of urge, prevalence of experience of episodes of cystitis and UI related to cystitis in adult life, and prevalence of relative risks, as indicated by odds ratio (OR), of UI conditional on cystitis experience. Results indicated that the 1987 period prevalences of UI provoked by physical stress and UI associated with a feeling of urge were 15% and 9%, respectively. Forty-five per cent reported a history of cystitis and 10% of UI during episodes of cystitis. Both UI provoked by stress and UI associated with a feeling of urge were significantly correlated to cystitis (OR 2.1, P<0.0001, and 1.8, P<0.0001, respectively) and to UI during episodes of cystitis (OR 7.1, P<0.0001, and 5.7, P<0.0001, respectively). When corrected for the stress aspect, UI being associated with a feeling of urge showed no association of its own to a history of cystitis. However, stress and urge aspects were both correlated to the experience of UI during episodes of cystitis. The prevalence of experience of cystitis increased with increasing number of urologic (per operation OR 2.1, P<0.0001) and gynecologic operations (per operation OR 1.5, P<0.0001), e.g. curretage (per operation OR 1.2, P<0.001), but not with the number of abdominal operations or the number of childbirths. It was concluded that cystitis may be an important component of UI etiology. Stress and not urge UI seems to be the key type related to a history of cystitis in general. The experience of UI during cystitis is connected to both stress and urge UI. A history of cystitis may possibly itself by initiated by surgery.     

Clinical safety of enamel matrix derivative (EMDOGAIN®) in the treatment of periodontal defects

Abstract The aim of the present clinical trial was to test tolerability during 2 treatments with EMDOGAIN® in a large number of patients. An open, controlled study design in 10 Swedish specialist clinics was chosen, with a test group of 107 patients treated with EMDOGAIN® in connection with periodontal surgery at 2 surgical test sites per patient. The procedures were performed 2 to 6 weeks apart on one-rooted teeth with at least 4 mm deep intraosseous lesions. A control group of 33 patients underwent flap surgery without EMDOGAIN® at I comparable site. In total 214 test and 33 control surgeries were performed. Serum samples were obtained from test patients for analysis of total and specific antibody levels. 10 of the patients had samples taken before and after the first surgery. 56 other samples were taken after one treatment with EMDOGAIN®, and 63 after 2 treatments. None of the samples, not even from allergy-prone patients after 2 treatments, indicated deviations from established baseline ranges. This indicates that the immunogenic potential of EMDOGAIN® is extremely low when applied in conjunction with periodontal surgery. Comparison between the test and control groups demonstrated the same type and frequency of post-surgical experiences, i.e., reactions caused by the surgical procedure itself. Clinical probing and radiographic evaluation was performed at baseline and 8 months postsurgery. About half of the patients (44 test and 21 control) were also evaluated after 3 years. There was a significant difference between the test and control results at 8 months post surgery. and this difference had increased further at the 3 year follow-up. The 2.5–3 mm increase in attachment and bone level after treatment with EMDOGAIN® was of the same magnitude as seen in the studies with split-mouth design aiming for lest of effectiveness of EMDOGAIN®.