Morbidity associated with the use of foramen ovale electrodes

PURPOSE: The identification of the epileptic zone in patients with mesial temporal lobe epilepsy sometimes requires intracranial recordings, for example, with foramen ovale electrodes (FOE). This paper reviews and analyzes the resulting complications in a series of patients studied with bilateral FOE for presurgical evaluation. METHODS: The clinical records of 331 consecutive FOE implantations in 329 patients were reviewed. Complications related to FOE were divided into two groups: those that were non-life-threatening or not directly attributable to FOE, or life-threatening complications and those clearly related to FOE. RESULTS: The mean length of hospital stay in the v-EEG unit with FOE was 5.8 +/- 0.2 days (range 1-19) following a bimodal distribution (peaks at 4 and 8 days). Complications were observed in 6.64% of patients, but in 4.83% of cases, complications were non-life-threatening (moderate disaesthesia, cheek bleeding, FOE expulsion). Complications were only severe in 1.81% of patients (clotting or intracranial hemorrhage). One patient died more than 20 days after FOE removal and after several episodes of status epilepticus. Patients suffering from life-threatening complications were more likely to be female (83.3%) than patients experiencing no complications or non-life-threatening complications. Patients with life-threatening complications had a more prolonged stay in the v-EEG unit during monitoring with FOE (8.2 +/- 0.7; n = 6) than the group without complications (5.7 +/- 0.2; n = 309; p < 0.01; Kruskal-Wallis test). DISCUSSION: FOE is a reasonably safe intracranial technique for v-EEG monitoring with low rates of potentially severe complications, but its indication should be carefully evaluated, especially if monitoring for more than 8 days is expected.     

Selective disbalances of peripheral blood T lymphocyte subsets in human CD3γ deficiency

The selection of T lymphocytes in the thymus and their activation upon the encounter with foreign antigens in the periphery require the aggregation and signals of the Tcell receptor (TcR)/CD3 complex and several surface molecules termed coreceptors (notably CD4 or CD8 and CD45). The spatial arrangement and interactions of the different molecules in the resulting multimolecular recognition structure are mostly unknown. Here we report, from studies on a healthy human CD3γ deficiency, that the lack of the CD3γ component of the TcR/CD3 complex is associated with a long-term severe defect of peripheral blood CD4⁺CD45RA⁺ and CD8+ lymphocytes, whereas CD4⁺CD45RO⁺, B and natural killer lymphocytes are unaffected. These results suggest that the CD3y site of the TcR/CD3 complex is required for the peripheral representation of certain Tcell types.     

Predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion

There has been no agreement among different authors on guidelines to specify the situations in which arthrodesis is justified in terms of results, risks and complications. The aim of this study was to identify preoperative predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion. A prospective observational study design was performed on 203 consecutive patients. Potential preoperative predictors of outcome included sociodemographic factors as well as variables pertaining to the preoperative clinical situation, diagnosis, expectations and surgery. Separate multiple linear regression models were used to assess the association between selected predictors and outcome variables, defined as the improvement after 1 year on the visual analog scale (VAS) for back pain, VAS for leg pain, physical component scores (PCS) of SF-36 and Oswestry disability index (ODI). Follow-up was available for 184 patients (90.6%). Patients with higher educational level and optimistic preoperative expectations had a more favourable postoperative leg pain (VAS) and ODI. Smokers had less leg pain relief. Patients with better mental component score (emotional health) had greater ODI improvement. Less preoperative walking capacity predicted more leg pain relief. Patients with disc herniation had greater relief from back pain and more PCS and ODI improvement. More severe lumbar pain was predictive of less improvement on ODI and PCS. Age, sex, body mass index, analgesic use, surgeon, self-rated health, the number of decompressed levels and the length of fusion had no association with outcome. This study concludes that a higher educational level, optimistic expectations for improvement, the diagnosis of “disc herniation”, less walking capacity and good emotional health may significantly improve clinical outcome. Smoking and more severe lumbar pain are predictors of worse results.     

Large cell neuroendocrine carcinoma of the lung with atypical evolution and a remarkable response to lutetium Lu 177 dotatate

Large cell neuroendocrine carcinoma of the lung (LCNEC) is a high-grade, poorly differentiated tumor that typically does not express somatostatin receptors. Thus, it does not benefit from treatment with somatostatin analogs and peptide receptor radionuclide therapy (PRRT). The current study objective was to demonstrate that treatment with PRRT may be a valid option in neuroendocrine carcinomas with high expression of somatostatin receptors. This is a case report of a 58-year-old man who was diagnosed with LCNEC and received chemotherapy treatment with little benefit. Extensive hepatic and bone metastasis was detected on ¹¹¹In-pentetreotide scintigraphy following high uptake of the radionuclide by the tumors. The patient benefitted from neuroendocrine treatment initially and from lutetium Lu 177 dotatate subsequently. A significant clinical and radiological response was observed, along with an improvement in quality of life. The use of PRRT is a valid alternative to chemotherapy in patients with LCNEC involving the expression of somatostin receptors.     

Effects of the use of oral contraceptives on hip and knee kinematics in healthy women during anterior stair descent

Purpose

Our aim was to evaluate the effects of the use of oral contraceptives (OC) on the hip and knee kinematics of healthy women during anterior stair descent.

Methods

Forty volunteers aged from 18 to 26 years were divided into two groups: 1—Group of women who had used OC for at least 3 months prior to evaluation (n = 20) and 2—Group of women who did not use OC (n = 20). The knee flexion/extension and abduction/adduction, hip flexion/extension, abduction/adduction and medial/lateral rotation excursions (degrees) were calculated for the dominant (supporting) limb during anterior stair descent. T tests for independent samples were used to compare the kinematic differences between the groups (α = 0.05).

Results

No significant difference was verified between the groups regarding the maximum excursion of knee flexion (n.s.) and abduction (n.s.) or hip flexion (n.s.), adduction (n.s.) and medial rotation (n.s.). When considering the knee flexion at 50°, no significant difference was verified between the groups regarding the excursion of knee abduction (n.s.) or hip flexion (n.s.) adduction (n.s.) and medial/lateral rotation (n.s.).

Conclusion

These results suggest that the use of OC does not influence the hip and knee kinematics during anterior stair descent. Therefore, the role of this medication as a protective factor against anterior cruciate ligament injuries remains questionable.

Level of evidence

III.     

Clinical and CN-SFEMG evaluation of neostigmine test in myasthenia gravis

Neostigmine test (NT) is a pharmacological test, demonstrating a clinical improvement in patients affected by myasthenia gravis (MG). We aim to compare clinical evaluation and neurophysiological recordings by concentric-needle single-fiber electromyography (CN-SFEMG) in response to acute administration of neostigmine in ocular and generalized MG patients. Twenty-three MG patients (10 with ocular MG and 13 with generalized MG) were evaluated before and after 90 min neostigmine 0.5-mg administration. Clinical responsiveness was assessed by MG composite (MGC) scale. Neurophysiological evaluation by CN-SFEMG considered analysis of mean value of consecutive differences (MCD), single-pair jitter, and blocks. MGC scores significantly improved after NT in generalized MG patients (MGC 11.1?±?7.6 vs 9.1?±?6.7, p?=?0.02), whereas the improvement was not significant in the ocular group. CN-SFEMG recordings significantly improved after NT in generalized MG patients (MCD 58.9?±?18.8 vs 45.9?±?23.2 μs, p?=?0.003; single-pair jitter 49.8?±?26.9 vs 24.1?±?26.7%, p?=?0.0001; blocks 6.2?±?9.5 vs 2.6?±?7.4%, p?=?0.03) as well as in ocular MG patients (MCD 50.8?±?22.7 vs 40.1?±?22.9 μs, p?=?0.01; single-pair jitter 35.9?±?23.7 vs 20.0?±?25.1%, p?=?0.001). CN-SFEMG is a reliable tool to evaluate responsiveness to acute administration of neostigmine in MG. Moreover, neurophysiological modifications to NT could show subclinical improvement in ocular MG better than that of the clinical scale.     

Neuroprotective effect of dapsone in patients with acute ischemic stroke: a pilot study

OBJECTIVES: In a previous study of brain ischemia in rats, dapsone (4,4'-diamino-diphenylsulfone) was associated with a neuroprotective effect. As dapsone is safe and relatively free of adverse reactions, we conducted a pilot clinical trial to assess the possibility of using this drug in patients with a cerebral infarction. METHODS: A double-blind, placebo-controlled, pilot clinical trial of dapsone was conducted from January 1999 to January 2000. Thirty patients with a CT or MRI documented ischemic stroke in the territory of the middle cerebral artery were included. Patients with >4 points of the National Institute of Health Stroke Scale (NIHSS) were randomly allocated to receive either a single dose of 200 mg dapsone or placebo. For follow-up, NIHSS on days 0, 2, 7 and 60, modified Rankin scale and Barthel index at day 60 were applied. Adverse reactions were also recorded. The main cut point was considered when a patient obtained a variation of 2 points for modified Rankin scale and 17 points for Barthel index. RESULTS: Fifteen patients received dapsone and 15 received placebo. Twenty-nine were followed up for 60 days and one patient in the treatment group died during follow-up. Favorable scores were achieved for treated patients by all different measures; NIHSS (p=0.032), Barthel (p=0.049) and Rankin scale (RR=0.182, 95% CI: 0.04 and 0.86). Best results were obtained when treatment started within the first 8-10 hours after stroke. No adverse reactions related to medication were reported. DISCUSSION: Dapsone appears as a useful and safe drug for the treatment of stroke patients. Results of this pilot trial are promising and support further research to define the role of dapsone as a neuroprotective drug.     

Associations between COMTVal158Met polymorphism and cognition: direct or indirect effects?

BACKGROUND: Previous work suggests that reaction time variability (RTV) in attentional tasks, as a measure of cognitive stability, is associated with degree of Val loading in COMT Val(158)Met genotype, and that this association may be relevant for the aetiology of schizophrenia. This study examined (i) to what degree RTV pertaining to tasks of varying cognitive complexity would be associated with increased risk for schizophrenia and (ii) to what degree this would be mediated by Val loading. METHODS: COMT genotyping was investigated in a sample of 23 patients with schizophrenia, 33 first-degree relatives, and 21 controls. All participants performed the Flanker continuous performance test. RESULTS: Schizophrenia liability was associated with number of correct trials of the Flanker test, but not with RTV, and this association was not mediated by COMT Val(158)Met genotype. Similarly, Met loading was associated with number of correct trials and with RTV, but this was not mediated by schizophrenia liability. CONCLUSIONS: Associations between COMT Val(158)Met genotype and RTV do not appear to reflect transmission of schizophrenia liability in families. Differential associations with Val and Met alleles across studies suggest indirect effects through gene-gene interactions or the influence of a functional polymorphism near COMT Val(158)Met.