Acute bulbar palsy due to myelomeningocele and Chiari II malformation

We describe a case of a 10-year-old girl with myelomeningocele and type II Chiari malformation. She presented with an acute bulbar palsy requiring mechanical ventilation. Surgical decompression of the brainstem was performed and, because of a phrenic nerve palsy, surgical plication of the right diaphragm was also required. The patient s evolution was favourable. We discuss the various forms of clinical presentation of this pathology as well as its management. The importance of early diagnosis and surgical correction are also stressed as a key factor for favourable evolution.     

Growth and determinants of access in patient e-mail and Internet use

OBJECTIVES: To measure the rate of access to and use of the Internet and e-mail, to determine sociodemographic predictors of access, and to measure the change in Internet and e-mail access over a 1-year interval. DESIGN: Survey study. Comparison of data with those from a similar survey from 1998. SETTING: Emergency department of a large urban pediatric teaching hospital. PARTICIPANTS: Primary caretakers of pediatric patients or the patients themselves if aged 16 years or older. MAIN OUTCOME MEASURES: Use of and access to the Internet or e-mail. RESULTS: We surveyed 214 individuals: 72.8% use or have access to the Internet, e-mail, or both, an increase from 52.2% in the 1998 survey (P<.001), and 48.5% regularly use the Internet or e-mail, compared with 43.1% in 1998 (P = .32). Outside the home, access is primarily at work (52.2%), schools (8.9%), public libraries (11.5%), and friends' and relatives' houses (16.7%). Internet use and access are linearly correlated with income (r = 0.43; P<.001). White patients are more likely to have access (odds ratio, 2.6; 95% confidence interval, 1.3-5.4; P<.001) than black or Asian patients, whereas those of Hispanic ethnicity are less likely to have access (odds ratio, 0.20; 95% confidence interval, 0.09-0.43; P<.001). However, after adjustment for race and Hispanic ethnicity, only income was a significant predictor of family access to the Internet and e-mail. CONCLUSIONS: During the past year, many patients have gained access to the Internet and e-mail, although rates of regular use have remained steady. This access is often from outside the home. Furthermore, access is directly related to income and is unevenly distributed across racial and ethnic groups.     

The use of helium-oxygen mixture in the ventilation study of children with chronic obstructive lung disease

OBJECTIVE: To study the distribution of Tc-99m DTPA radioaerosol when heliox or oxygen are used in the nebulization of children and adolescents with chronic obstructive pulmonary disease during pulmonary ventilation scintigraphy. MATERIAL AND METHODS: Clinical randomized and controlled trial. Patients with chronic obstructive pulmonary disease (5 to 18 years old) who required pulmonary scintigraphy between March 1996 and September 1998 were included. Obstruction of the lower airway was measured by spirometry. Patients were randomized into two groups according to the gas used for nebulization during scintigraphy: heliox (80% helium and 20% oxygen) or oxygen. Scintigraphy studies were expressed as slope of the cumulative pulmonary radioactivity uptake curve and as the maximal cumulative radioactivity in the lung. The mean diameter of the Tc-99m DTPA particles generated by heliox and oxygen was measured by laser diffraction. RESULTS: Ten patients were allocated in each group. There were no statistical differences (P>0.05) in terms of gender, main diagnosis, signs of malnutrition, mean values of weight, height, body area, or spirometry results. The mean slope in the heliox group (5,039-/+1,652) was significantly different (P=0.018) from the mean slope of the oxygen group (3,410-/+1,100). The mean slope of patients with severe airflow obstruction in the heliox group was statically different (P=0.017) from the mean slope of patients with airflow obstruction in the oxygen group. In both groups, patients without evidence of airflow obstruction were similar in terms of mean slopes (P=0.507) and mean cumulative radiation in the lung (P=0.507). The mean diameter of heliox-generated Tc-99m DTPA particles was 2.13 m (-/+0.62). This was statistically different (P=0.004) from the mean diameter of oxygen-generated particles (0.88-/+0.99 m). CONCLUSIONS: Nebulization with heliox was more efficacious than nebulization with oxygen for distribution and dispersion of Tc-99m DTPA radioaerosol in the lungs of children and adolescents with chronic obstructive pulmonary disease submitted to ventilation scintigraphy. The benefits of heliox over oxygen are more evident in the presence of lower airway obstruction. Without airway obstruction, we did not observe any difference in the distribution and dispersion of radioaerosol in the lungs. Although the mean diameter of the Tc-99m DTPA particles generated by heliox and oxygen was significantly different, the particles generated by both gases were still within the recommended range (between 1 and 5 m). Therefore, this difference does not account for the effects of heliox observed in this study.     

Horizontal appendicular dysmetria in four patients with a typical Wallenberg's syndrome

During the acute stage of a Wallenberg's syndrome ipsilateral appendicular dysmetria is frequently seen. The dysmetria is more apparent in the ipsilateral upper extremity. These patients also have a peculiar type of dysmetric eye movements that are characterized by hypermetric saccades toward the side of the lesion and hypometric saccades to the opposite side. We examined four patients with acute Wallenberg's syndrome and found horizontal dysmetria of the affected extremity. Hypermetric arm and hand movements were present to the side of the lesion and hypometric movements toward the opposite side. This type of dysmetria is probably related to the same patophysiological mechanism that underlies dysmetric eye movements in the Wallenberg's syndrome. The dysmetria tends to disappear with time although it continues to be present in some patients six months after the ischemic damage.     

Synthesis of new N-(4-pyridyl)-1-aminopyrazoles and their muscarinic and adrenergic properties

The synthesis of new N-(4-pyridyl)-1-aminopyrazoles is described. Their binding properties were tested for muscarinic and other neurotransmitter receptors, together with their acetylcholinesterase inhibitory activity. The series derived from 3,5-dimethyl-1H-pyrazole showed moderate activities in both muscarinic and adrenergic receptor binding tests.