Czechoslovak Symposium on Child Neurology

The 3rd International Symposium on Child Neurology (Prague, 18–20 June 1975) was organised by the Czechoslovak Medical Society and the Czechoslovak Society of Neurology. The main topics discussed were hypotonia in early childhood and raised intracranial pressure of non-tumorous origin.     

Apolipoprotein D is a component of compact but not diffuse amyloid-beta plaques in Alzheimer's disease temporal cortex

Apolipoprotein D (apoD) is elevated in Alzheimer's disease (AD) cortex, localizing to cells, blood vessels, and neuropil deposits (plaques). The role of apoD in AD pathology and the extent of its co-distribution with diffuse (amorphous) and compact (dense fibrillar) amyloid-beta (Abeta) plaques are currently unclear. To address this issue, we combined apoD and Abeta immunohistochemistry with ThioS/X-34 staining of the beta-pleated sheet protein conformation in temporal cortex from 36 AD patients and 12 non-demented controls. ApoD-immunoreactive, Abeta-immunoreactive, and ThioS/X-34-stained plaques were detected exclusively in AD tissue. Dual-immunolabeling showed that 63% of Abeta plaques co-localized apoD. All apoD plaques contained Abeta protein and ThioS/X-34 fluorescence. Compared to controls, AD cases showed elevated vascular and intracellular apoD immunostaining which localized primarily to cells clustered within plaques and around large blood vessels. ApoD-immunoreactive cells within plaques morphologically matched MHC-II- and CD-68-immunoreactive microglia, and did not contain the astrocytic marker GFAP, which labeled a subset of apoD-immunoreactive cells surrounding plaques. These data suggest that neuropil deposits of apoD localize only to a subset of Abeta plaques, which contain compact aggregates of fibrillar Abeta. Elevated apoD in AD brain may influence Abeta aggregation, or facilitate phagocytosis and transport of Abeta fibrils from plaques to cerebral vasculature.     

Sleep disturbances in patients treated for panic disorder

BACKGROUND AND PURPOSE: Disturbed night sleep is a common complaint of patients with panic disorder. The aim of the present study was to demonstrate whether the sleep disturbances can be successively influenced by the standard therapy for treating panic disorder. PATIENTS AND METHODS: Psychiatric examinations of 20 outpatients with panic disorder were supplemented with a study of sleep quality using standardised interviews, sleep logs and polysomnographic recordings. RESULTS: A statistical comparison of data showed that reduced anxiety after successful treatment of panic disorder was not necessarily followed by improved sleep parameters. CONCLUSION: The results suggest that the conventional therapy applied to these patients is not sufficient to treat the co-existing insomnia. Consequently, it seems to be of importance to supplement the treatment of panic disorders with specific treatment of the sleep disturbance.     

Application of transvaginal sacrospinous colpopexy in the treatment of pelvic organs prolapse

INTRODUCTION: The incidence of uterovaginal and vaginal vault prolapse appears to be higher due to the increased longevity of women. Sacrospinous ligament colpopexy is a surgery procedure which suspends the vagina up to the sacrospinous ligament and brings upper vagina over the levator plate. This technique is very useful for the primary treatment of uterovaginal prolapse in young women who want to preserve their fertility. The main aim of our study was to present the effectiveness of the us of this technique at our clinic, to investigate the possible intraoperative and postoperative complications of this technique, and to find out its effectiveness in the prevention of repeated vaginal vault prolapse. METHODS: Patients were treated with sacrospinous colpopexy with uterine conservation, vaginal hysterectomy with simultaneous sacrospinous colpopexy or obliteration of the enterocele sac, and sacrospinous colpopexy. Follow-up examinations of the patients we performed at 4 weeks, 6 months and 12 months after the surgery and yearly thereafter. RESULTS: Thirty-seven women were treated with sacrospinous ligament suspension of vaginal vault. The 5 women had vault prolapse following the hysterectomy (the 3 of then had abdominal, and the 2 vaginal hysterectomy), and another 32 women had the various degrees of uterovaginal prolapse. We obtained satisfactory results in 33 patients, in the 3 we noticed asymptomatic cystocele, and the 1 (2.7%) had partial vaginal vault prolapse six months after the surgery. With regard to postoperative complications, 3 patients had Urination disturbance, 3 patients had urinary tract infection, 2 patients had febrile temperature, and the 2 patients had low back pain. DISCUSSION: We performed sacrospinous fixation on the right side, and the postoperative results demonstrated no disturbance in vaginal axis and vault prolapse except in 1 patient. We had no intraoperative complications noted related to sacrospinous ligament colpopexy, such as the damage to the pudendal vessels and nerve, the sciatic nerve and rectum. The possibility of injury to the vessels and nearby nerves was preventid with the careful placement of suture through the sacrospinous ligament in the two fingerbreadths medial to its insertion in the ischial spine. In our series, we had 3 patients with conservation of the uterus. The 3 asymptomatic cystocele in our series were diagnosed 6 months after the operation. Our results were satisfactory, since we hade only one postoperative vault prolapse (2.7%). CONCLUSION: The results of numerous studies, as well as the results of our study, showed that transvaginal sacrospinous colpopexy could be performed along with vaginal hysterectomy and the anterior and posterior vaginal wall repair in the patients with uterovaginal prolapse because of its high success in the prevention of postoperative vaginal vault prolapse and the low intra- and postoperative complication rates. This operative technique is successful in prevention of repeated vaginal vault prolapse.     

Cervical epidural anesthesia for combined neck and upper extremity procedure: a pilot study

In a prospective pilot study, we evaluated the possibility of performing a total parathyroidectomy with parathyroid gland implantation into the forearm (a combined neck and upper extremity procedure) under cervical epidural anesthesia (CEA) at C6-7 level using ropivacaine. The indication for CEA was the patient's choice or a previous procedure on the neck with unilateral vocal cord paralysis. Anesthesia was induced by 10 mL of 0.75% ropivacaine plus 10 mug of sufentanil in 2 mL. Block onset time, success rate, analgesia, sensory block extent, changes in respiratory and hemodynamic variables, complications, and length of hospital stay were assessed. All 15 procedures were successfully performed under CEA. Sensory block was registered in the range C2-T10, with a lower median of T3. The upper margin of sensory block was C2 in all patients. Of the respiratory variables, the only significant decrease was observed in forced vital capacity; none of the patients developed clinically significant respiratory insufficiency. We conclude that combined procedures involving the neck and upper limbs can be performed using CEA with ropivacaine. CEA allows verbal communication with patients and early detection of vocal cord paralysis.     

Linear extragenital lichen sclerosus with underlying bony atrophy

We describe a 21-year-old male patient with linear extragenital lichen sclerosus. The lesions are confined to the left side of his body and consist of 3 long bands running along the left leg and several patchy and linear lesions on the left side of his trunk. An associated finding is a smaller diameter of the distal part of his left lower leg caused by bony atrophy of the underlying portion the tibia. This is the fifth reported case of linear lichen sclerosus.     

Psychiatric comorbidity and inpatient treatment history in bulimic subjects

Bulimia nervosa (BN) is often associated with other forms of psychopathology. There is a need to clarify which specific factors of psychopathology are linked with the referral to psychiatric or psychotherapeutic inpatient treatment. This study examined which factors of psychopathology are linked with the referral of BN patients to inpatient treatment while controlling for history of suicide attempts and history of underweight. 126 females with a current diagnosis of BN purging type were assessed with the Structured Clinical Interview for DSM-IV and interviewed about their history of treatment for the BN, history of weight, and history of suicide attempts. Logistic regressions were conducted to examine whether psychiatric comorbidity, suicide attempts, and underweight were associated with inpatient treatment history. Axis I comorbidity in general, but no specific axis I disorder, was associated with inpatient history. Axes II comorbidity, especially Cluster B disorders and to a lesser degree depressive/negativistic personality disorders, was associated with a history of inpatient treatment. History of suicide attempts was also linked with inpatient experience, but history of underweight was not. The results showed that BN patients with specific types of comorbidity are more likely to be hospitalized than others.     

A review of multi-threat medical countermeasures against chemical warfare and terrorism

The Multi-Threat Medical Countermeasure (MTMC) hypothesis has been proposed with the aim of developing a single countermeasure drug with efficacy against different pathologies caused by multiple classes of chemical warfare agents. Although sites and mechanisms of action and the pathologies caused by different chemical insults vary, common biochemical signaling pathways, molecular mediators, and cellular processes provide targets for MTMC drugs. This article will review the MTMC hypothesis for blister and nerve agents and will expand the scope of the concept to include other chemicals as well as briefly consider biological agents. The article will also consider how common biochemical signaling pathways, molecular mediators, and cellular processes that contribute to clinical pathologies and syndromes may relate to the toxicity of threat agents. Discovery of MTMC provides the opportunity for the integration of diverse researchers and clinicians, and for the exploitation of cutting-edge technologies and drug discovery. The broad-spectrum nature of MTMC can augment military and civil defense to combat chemical warfare and chemical terrorism.