Management of hypothalamic gliomas in children: an analysis of 33 cases

The cases of 33 children with hypothalamic-chiasmatic gliomas are reviewed. Radiation therapy produced clinical or radiographic improvement in 11 (46%) of 24 patients. Progression was documented in 18 patients (54%). Overall, the median time to tumor progression was 60 months; it was 70 months in patients who received radiation therapy and 30 months in those who did not (P less than 0.05). Chemotherapy, either given initially or at the time of progression, caused the tumor to respond or to stabilize in 10 patients. Partial resection of the tumor led to improvement in 3 of 12 patients, obviating the need for a shunt in 2 of them; there were no deaths and postoperative morbidity was transient and minimal (diabetes insipidus, intraventricular hemorrhage, and left hemiparesis in one patient each). The 5- and 10-year survival probabilities were 93 and 74%, respectively. Patients with neurofibromatosis had a better prognosis.     

Scoliosis in pediatric spinal cord-injured patients

One hundred thirty children who sustained spinal cord injuries between birth and age 21 years were reviewed to determine the progression rate of paralytic scoliosis and the effects of bracing and surgery. Patients were divided into two groups: those injured before and those injured after the adolescent growth spurt. Scoliosis developed in 97 and 52%, respectively. Bracing was effective in delaying progression in the preadolescent group. The progressive paralytic spinal deformity did not appear to be related to the level of injury. The older patient is at much less risk for paralytic scoliosis, but still requires routine examination.     

Comparison of urinary bladder function in sexually mature and immature male and female rats

Although studies exist using both male and female rats, there are virtually no studies that compare male and female bladder function. In this initial study, in-vivo and in-vitro urinary bladder function was investigated in two age groups of male and female rats (sexually immature and sexually mature). These studies compare in-vivo micturition behavior (water intake, urine output, frequency and volume per micturition); and in-vitro whole bladder function (bladder volume/pressure relationships, the ability of the in-vitro bladders to generate pressure and empty in response to bethanechol and field stimulation). The results can be summarized as follows: 1) The 24 hour water intake, urine output, and volume per micturition for the mature male rats was significantly greater than that of the mature females with no significant differences among the immature females, mature females, or immature males. 2) There were no significant differences in the frequency of micturition between the 4 groups. 3) Although the average plateau pressures (cystometrograms) of the immature and mature female bladders were greater than that of the immature and mature male bladders, the compliance was similar for all groups. 4) The maximum pressure response of the mature female bladder was significantly greater than pressures generated by bladders in the other three groups; there were no age or sex related differences in the bethanechol log ED50 values. 5) There were no age or sex-related differences in the bethanechol log ED50 values or maximal expulsion responses. 6) Field stimulated bladders from mature animals generated significantly greater intravesical pressures than bladders from immature animals, but, there were no significant differences in maximal pressures attained between mature male and female bladders nor between immature male and female bladders. In conclusion, micturition behavior, and the maximal pressure response to bethanechol changed dramatically with sexual maturity. These results are consistent with the idea that estrogen and other hormones may have a marked influence on bladder function and micturition behavior.     

Patterns of Cocaine Use Among Cocaine-Dependent Outpatients

The authors systematically evaluated the frequency patterns of cocaine use in 85 cocaine-dependent outpatients and found four patterns of use: continuous (27%), intermittent patterned (35%), intermittent nonpatterned (25%), and occasional (13%). Few subjects reported consistent cycling between binges and crashes. There were no significant differences in patterns of use associated with gender, race, educational level, route of administration, or recency of heroin use. Continuous users and occasional users were older than intermittent users. Because different contingencies may control patterned vs. nonpatterned cocaine use, pattern of use may have implications for treatment, even in individuals reporting similar amounts of cocaine use.     

Effects of dehydroepiandrosterone treatment in rats with diet-induced obesity

Previous studies showed that administration of dehydroepiandrosterone (DHEA) to lean and genetically obese Zucker rats reduced body weight. In the present experiments, the effect of DHEA treatment in rats with diet-induced obesity was evaluated. In experiment 1, male Sprague-Dawley rats (300 g) were fed a nonpurified diet (reference group) or a condensed milk-corn oil nonpurified diet [diet-induced obese (DIO) rats] for 7 wk. Then, 0.6% DHEA was included in the food of one-half of the DIO rats (DIO + DHEA rats). After 6 wk, DIO rats weighed 23% more and had greater fat pad weights, cell size and cell number than reference and DIO + DHEA rats. Brown fat mitochondrial respiration was similar in all groups. DIO rats had higher serum cholesterol and triacylglycerol concentrations than reference and DIO + DHEA rats. DIO + DHEA rats had lower serum insulin levels than DIO and reference rats. In experiment 2, male Sprague-Dawley rats (460 g) were fed either the nonpurified diet or the condensed milk diet for 8 wk. Condensed milk-fed rats were then divided into DIO and diet-resistant groups. One-half of the rats in each group were fed 0.6% DHEA for 2 wk. Body weights and serum glucose, insulin, triacylglycerol and triiodothyronine levels were lowered by DHEA treatment in all groups. Liver mitochondrial state 3 respiration rates per gram and per liver and peroxisomal beta-oxidation were higher in DHEA-treated than in control rats. In DIO rats, DHEA treatment appears to interfere with hyperplastic adipose tissue growth. In this strain of rats, DHEA appears to have hypolipidemic and hypoinsulinemic effects.     

Nicotine interactions with dopamine agonists: Effects on working memory function

Nicotine has been found to improve memory performance in a variety of tests including the radial-arm maze. Nicotine may have effects mediated by promoting the release of dopamine. The present study was conducted to determine the interactions of nicotine with D₁ and D₂ agonists. Rats were acutely administered nicotine, the D₁ agonist SKF 38393, and D₂/D₃ agonist quinpirole, and nicotine together with each of these agonists. Nicotine significantly improved choice accuracy in the radial-arm maze. The D₁ agonist SKF 38393 significantly impaired choice accuracy. Nicotine was effective in reversing this effect. The D₂/D₃ agonist quinpirole showed a trend toward potentiating the improvement in choice accuracy caused by 0.2 mg/kg (0.43 μmol/kg) of nicotine. These data show that, as with the nicotinic antagonist mecamylamine, there are significant interactions of dopamine systems with nicotine effects. © 1994 Wiley-Liss, Inc.     

The comparison of trends in perinatal mortality in small areas

Year to year changes in perinatal mortality rates for small populations are difficult to interpret. Because local rates are based on small numbers of events, they are subject to apparently large fluctuations. A technique for analysing trends in mortality, for detecting changes in trends and comparing variations in trends between areas is described. It is illustrated by an analysis of perinatal mortality rates for Area Health Authorities in the West Midlands Region of England from 1974-1981, but the same techniques could be used to analyse trends at other times and in other places.     

Turf wars in radiology: introduction

Turf wars over medical imaging have become ubiquitous. At many centers, radiologists already have lost access to important technologies and their applications. A combination of decreasing revenues in other specialties and a growing attachment to imaging further threatens radiologists’ practices in the future. This is the first of an extended series of articles that will address the phenomenon of self-referral—its motivations, extent, and the threats it poses to radiologists. Each article will focus on a specific aspect and provide advice on how radiologists can deal with self-referral in their locales.     

Reduction of bacterial adherence to catheter surface with heparin

Despite many advances in catheter design and use, the most common cause of hospital-acquired infections is catheterization of the urinary tract. In the present investigation the adherence of bacteria to catheters coated with heparin was studied. Since heparin itself does not coat the plastic catheter surface, a complex of heparin with tridodecylmethylammonium chloride (TDMAC) was used which results in hydrophobic association of hydrocarbon chains of the TDMAC with the catheter leaving the quaternary ammonium moiety of TDMAC exposed to the surface forming ionic bonds with the highly anionic sulfate groups of heparin. Coating latex catheter material with TDMAC without heparin resulted in 3.6-fold higher adherence whereas coating with the TDMAC-heparin complex reduced adherence to less than 10% of control untreated latex. TDMAC-heparin also significantly reduced bacterial adherence to teflon coated latex (Bardex) and vinyl catheter material. Less than 30% of the original heparin was removed after wash periods of up to one week. These results indicate that TDMAC-heparin coating of urethral catheters reduces bacterial adherence and thereby may delay the acquisition of catheter associated urinary tract infection.