Rupture of the airways after blunt chest trauma in two children.

Rupture of the airways after blunt chest trauma is exceptional in children. Two recent cases are reported, in a 3-year-old boy and in a 12-year-old girl. Both had longitudinal tears, of the trachea for Patient 1, and of the main left bronchus for Patient 2 with many associated lesions for this patient. Diagnosis of rupture of the airways must always be referred to the mechanisms of the accident. Bronchoscopy is mandatory, in order to define the lesions, and to guide the treatment. Immediate surgery is not always necessary if the chest roentgenogram demonstrates a good reexpansion, with a well tolerated and decreasing air leakage. Even in case of a delayed surgery, it is possible to perform a local reconstruction.     

The care of the limb deficient child in north Africa

The surgical and prosthetic treatment of longitudinal lower limb deficiency is described and discussed, in the light of cultural and social requirements. Those with upper limb deficiencies are not fitted with prostheses.     

Restoring the sense of touch with a prosthetic hand through a brain interface

Our ability to manipulate objects dexterously relies fundamentally on sensory signals originating from the hand. To restore motor function with upper-limb neuroprostheses requires that somatosensory feedback be provided to the tetraplegic patient or amputee. Given the complexity of state-of-the-art prosthetic limbs and, thus, the huge state space they can traverse, it is desirable to minimize the need for the patient to learn associations between events impinging on the limb and arbitrary sensations. Accordingly, we have developed approaches to intuitively convey sensory information that is critical for object manipulation—information about contact location, pressure, and timing—through intracortical microstimulation of primary somatosensory cortex. In experiments with nonhuman primates, we show that we can elicit percepts that are projected to a localized patch of skin and that track the pressure exerted on the skin. In a real-time application, we demonstrate that animals can perform a tactile discrimination task equally well whether mechanical stimuli are delivered to their native fingers or to a prosthetic one. Finally, we propose that the timing of contact events can be signaled through phasic intracortical microstimulation at the onset and offset of object contact that mimics the ubiquitous on and off responses observed in primary somatosensory cortex to complement slowly varying pressure-related feedback. We anticipate that the proposed biomimetic feedback will considerably increase the dexterity and embodiment of upper-limb neuroprostheses and will constitute an important step in restoring touch to individuals who have lost it.Although it has been shown that percepts can be elicited with intracortical microstimulation (ICMS) of primary somatosensory cortex (S1) (1–7), a major challenge in developing approaches to convey sensory feedback using ICMS in animal models is to assay the evoked sensations (8). One way to circumvent this obstacle is to train animals to discriminate sensory stimuli along a dimension of interest, and then to assess whether the animals can perform the task when physical stimuli are replaced with ICMS (2, 3). In this approach, ICMS regimes are designed to mimic the patterns of neuronal activation that encode the relevant sensory dimension. In the context of upper-limb neuroprostheses, contact location, pressure, and timing are three of the most basic cutaneous signals that mediate object grasping and manipulation (9). In somatosensory cortex of intact primates, the neural coding of stimulus location (i.e., which parts of the hand are contacting the object) presumably relies on somatotopic organization: The population of activated neurons within the body representations in S1 (one each in areas 3a, 3b, 1, and 2) determines where on the body the sensation is projected (10). We can attempt to convey information about contact location by targeting ICMS on populations of neurons with specific receptive field (RF) locations. The neural coding of contact pressure might rely on two mechanisms: (i) as the pressure exerted on the skin increases, the neuronal population with RFs under the stimulus becomes more active, and (ii) neurons with adjacent RFs will become activated so the size of the activated population will increase (11). We might thus convey information about pressure by increasing the amplitude of ICMS—thereby increasing both the strength of activation of neurons near the electrodes and the size of the activated population (12). The neural coding of contact timing—which signals when contact with an object is initiated and terminated—is thought to rely on the on and off responses produced in S1 neurons at the onset and offset of contact and lasting on the order of 50–100 ms (13). These temporally precise responses are relatively insensitive to object properties (14) and critical in guiding the dexterous manipulation of objects (9). We might convey information about contact timing by delivering phasic ICMS at the onset and offset of object contact. Our experimental approach consists in mimicking natural patterns in the brain and assessing whether the animal spontaneously interprets these induced patterns correctly.     

Effect of cimetidine on the pharmacokinetics of theophylline

1. The effect of the therapeutic doses of cimetidine (400 mg/twice daily) on theophylline metabolism in Jordanian volunteers was studied. 2. The administration of the above therapeutic cimetidine dose did not alter theophylline clearance and elimination half-life. 3. Cimetidine administration also failed to alter the elimination of theophylline metabolites in urine.     

In vitro activities of new 2-substituted quinolines against Leishmania donovani

A series of 9 quinolines and 18 styrylquinolines was evaluated for the drugs' in vitro antileishmanial activities and cytotoxicities. The 7-aroylstyrylquinoline scaffold appeared to be the most promising one, with the most interesting compound, no. 35, exhibiting a 50% inhibitory concentration (IC(50)) of 1.2 μM and a selectivity index value of 121.5. Compound 35 was 10-fold and 8-fold more active than miltefosine and sitamaquine, the reference compounds, with selectivity indexes 607-fold and 60-fold higher, respectively.     

Serious infections caused by Bacillus species

Thirty-eight patients with serious infections caused by organisms belonging to the genus Bacillus are described. Our experience, and that reported in the literature, indicates that, in most cases, isolated Bacillus bacteremia is not a particularly serious disease. Therefore, under most circumstances, empiric antibiotic therapy designed specifically for treatment of Bacillus is probably not necessary. Endocarditis can occur, but apparently follows bacteremia only infrequently. When these bacteria cause localized infection such as pneumonia, pan-ophthalmitis, visceral abscess, or musculoskeletal infections, tissue necrosis and profound morbidity are the rule. The frequency of these complications following bacteremia appears to be low but cannot be estimated from our experience or that reported in the literature reviewed. The role of intravascular devices and trauma as predisposing factors is emphasized. Immunocompromised hosts and intravenous drug abusers appear predisposed, but intravascular devices in the former group may play an important role in the pathogenesis of Bacillus infections. Antibiotics which appear especially useful in the treatment of Bacillus infections are clindamycin and vancomycin, to which the vast majority of strains are susceptible in vitro. Beta-lactam antibiotics, including the new cephalosporins and penicillins, are of little value in this setting.     

Tactile intensity and population codes

An important question in neuroscience is how different aspects of a stimulus are encoded at different stages of neural processing. In this review, I discuss studies investigating the peripheral neural code for perceived intensity in touch. One of the recurrent themes in this line of research is that information about stimulus intensity is encoded in the activity of populations of neurons. Not only is information integrated across afferents of a given type, but information is also combined across submodalities to yield a unified percept of stimulus intensity. The convergence of information stemming from multiple submodalities is particularly interesting in light of the fact that these are generally thought to be parallel sensory channels with distinct sensory functions and little cross-channel interactions. I discuss implications of a recently proposed model of intensity coding for psychophysical functions and for the coding of intensity in cortex. I also briefly review the peripheral coding of intensity in other sensory modalities.     

Repetitive transcranial magnetic stimulation for the treatment of negative symptoms in residual schizophrenia: rationale and design of a sham-controlled,randomized multicenter study

Current meta-analysis revealed small, but significant effects of repetitive transcranial magnetic stimulation (rTMS) on negative symptoms in patients with schizophrenia. There is a need for further controlled, multicenter trials to assess the clinical efficacy of rTMS on negative symptoms in schizophrenia in a larger sample of patients. The objective of this multicenter, randomized, sham-controlled, rater- and patient-blind clinical trial is to investigate the efficacy of 3-week 10-Hz high frequency rTMS add on to antipsychotic therapy, 15 sessions per 3 weeks, 1,000 stimuli per session, stimulation intensity 110% of the individual motor threshold) of the left dorsolateral prefrontal cortex for treating negative symptoms in schizophrenia, and to evaluate the effect during a 12 weeks of follow-up. The primary efficacy endpoint is a reduction of negative symptoms as assessed by the negative sum score of the positive and negative symptom score (PANSS). A sample size of 63 in each group will have 80% power to detect an effect size of 0.50. Data analysis will be based on the intention to treat population. The study will be conducted at three university hospitals in Germany. This study will provide information about the efficacy of rTMS in the treatment of negative symptoms. In addition to psychopathology, other outcome measures such as neurocognition, social functioning, quality of life and neurobiological parameters will be assessed to investigate basic mechanisms of rTMS in schizophrenia. Main limitations of the trial are the potential influence of antipsychotic dosage changes and the difficulty to ensure adequate blinding.

     

Ventilatory function test values of health adult Jordanians.

A sample of 144 male, and 117 female healthy adults was selected to determine the normal ventilatory functions for Jordanians. Forced vital capacity, FEV1, and FMF 25-75% were determined using a dry bellows spirometer. Linear regression curves and nomograms were constructed for predicted values. Jordanian values for FVC and FEV1 were similar to those of Caucasians living in the western hemisphere.     

Pott's paraplegia

Summary Two hundred and twenty patients with active spinal tuberculosis were seen at the Orthopaedic Centre, Tunis, between 1965 and 1975. Fifty adults and 11 children were paraplegic, this being particularly associated with infection of the mid-thoracic spine and with marked kyphosis. The number of diseased vertebrae ranged up to 7, the average kyphosis measuring 53° and the worst being 140°. Patients had been paralysed for an average of 4 months before seeking treatment. Thirty seven patients were treated by chemotherapy alone and 26 with the addition of anterior decompression and grafting. The selection of treatment was arbitrary. The average follow up was nearly three years. Sixty eight per cent of the medical group had complete neurological recovery and 19% partial recovery, against 38% and 31% respectively for the surgical group. Mortality in the medical group was 5% compared with 23% after surgery. Patients in either group who showed no sign of improvement within six months of the beginning of treatment failed to recover. The prognosis was better in children and in patients with partial paraplegia but was not influenced by the duration of paraplegia.This review was conducted while one of the authors (J. V. F.) was Senior Medical Officer with Care-Medico in Tunisia