Factors affecting intellectual outcome in pediatric brain tumor patients

A prospective study utilizing repeated intellectual testing was undertaken in 73 children with brain tumors consecutively admitted to Childrens Hospital of Los Angeles over a 3-year period to determine the effect of tumor location, extent of surgical resection, hydrocephalus, age of the child, radiation therapy, and chemotherapy on cognitive outcome. Forty-three patients were followed for at least two sequential intellectual assessments and provide the data for this study. Children with hemispheric tumors had the most general cognitive impairment. The degree of tumor resection, adequately treated hydrocephalus, and chemotherapy had no bearing on intellectual outcome. Age of the child affected outcome mainly as it related to radiation. Whole brain radiation therapy was associated with cognitive decline. This was especially true in children below 7 years of age, who experienced a very significant loss of function after whole brain radiation therapy.     

Physical properties of proprietary light-cured lining materials.

Physical parameters of four photopolymerized lining materials were evaluated for comparative purposes and to contribute to the understanding of these novel materials. Properties investigated included compressive, diametral and flexural strength, modulus of elasticity, fluoride and calcium release for four weeks, and pH values for 24 hours. In general Cavalite and TimeLine were significantly stronger than Vitrabond and XR-lonomer and were essentially neutral in pH. All the materials exhibited a yield upon compressive strength testing. The fluoride release was intermediate for TimeLine and negligible with Cavalite. Vitrabond and XR-lonomer released significant amounts of fluoride at all time periods. XR-lonomer was the only material investigated to have significant calcium release, and this may have been related to its visible dissolution in water. This material also showed a low initial pH of 2.2. It, along with Vitrabond, demonstrated a gradual increase in pH over time. The behavior of TimeLine and Cavalite is therefore more consistent with that of a modified composite resin, whereas Vitrabond and XR-lonomer are similar in nature to glass-ionomer liners.     

Detection of colonic polyps on single-contrast barium enema study: emphasis on the elderly

A systems approach was employed to improve results of the single-contrast barium enema examination for detection of colonic polyps. Improvements were made in each of the following areas: radiographic-fluoroscopic equipment, fluoroscopic-television images, screen-film combinations, barium suspensions, examination techniques, imaging sequences, and quality controls. Radiologic-endoscopic correlation was undertaken for 137 colonic polyps seen endoscopically in 91 patients. The average age of the patients was 69 years. The sensitivity of the single-contrast examination for detection of all polyps was 80%. Polyps 5-9 mm in size were detected with 66% sensitivity, while 94% of polyps 10 mm or larger were detected. The results indicate that the sensitivity of a suitably performed single-contrast barium enema examination may approach that of the double-contrast study for the detection of colonic polyps, even in an elderly and infirm patient population.     

INFLUENCE OF EXPERIMENTAL DIABETES ON THE MICROCIRCULATION OF INJURED PERIPHERAL NERVE - FUNCTIONAL AND MORPHOLOGICAL ASPECTS

Regeneration of diabetic axons has delays in onset, rate and maturation. It is possible that microangiopathy of vasa nervorum, the vascular supply of the peripheral nerve, may render an unfavorable local environment for nerve regeneration. We examined local nerve blood flow proximal and distal to sciatic nerve transection in rats with long-term (8 month) experimental streptozotocin diabetes using laser Doppler flowmetry and microelectrode hydrogen clearance polarography. We then correlated these findings, using in vivo perfusion of an India ink preparation, by outlining the lumens of microvessels from unfixed nerve sections. There were no differences in baseline nerve blood flow between diabetic and nondiabetic uninjured nerves, and vessel number, density, and area were unaltered. After transection, there were greater rises in blood flow in proximal stumps of nondiabetic nerves than in diabetic animals associated with a higher number, density, and caliber of epineurial vessels. Hyperemia also developed in distal stumps of nondiabetic nerves but did not develop in diabetic nerves. In these stumps, diabetic rats had reduced vessel numbers and smaller mean endoneurial vessel areas. Failed or delayed upregulation of nerve blood flow after peripheral nerve injury in diabetes may create a relatively ischemic regenerative microenvironment.     

THE ETIOLOGY OF ACUTE UPPER RESPIRATORY INFECTION (COMMON COLD)

Experimental upper respiratory infections similar to "common colds" were transmitted singly and in series through two and four passages in nine out of fifteen persons, by intransal inoculations with bacteria-free filtrates of nasopharyngeal washings obtained from individuals ill with natural "colds." These observations conform with those reported by previous workers and lend further support to the view that the incitant of the "common cold" is a filtrable virus.     

Erosion of the left ventricle by the epicardial patch of an automatic implantable cardioverter defibrillator

A 56 year old man with an implantable cardioverter defibrillator was admitted with chest pain and collapse. Erosion of the left ventricle by an epicardial patch was confirmed by thoracotomy, but surgical repair was impossible. This rare complication should be considered in patients with a history of cardioverter defibrillators implanted by thoracotomy.     

Dentatorubro-pallidoluysian atrophy of the myoclonus epilepsy type with posterior column degeneration

Dentatorubro-pallidoluysian atrophy (DRPLA) has a variable clinical presentation but the pathology is routinely confined to cerebellifugal and pallidofugal systems. We present a case of DRPLA of the myoclonus epilepsy type in which prominent posterior column degeneration was added to the pathological picture. This case illustrates the concept that the neurodegenerative diseases can be a continuum of both clinical and pathological presentations.