Hyperbilirubinemia, hypocarbia and periventricular leukomalacia in preterm infants: relationship to cerebral palsy

This study comprised 103 preterm infants with a gestational age less than 33 weeks who were born in Tampere University Hospital and who were followed up to two years of age. Sixty-four perinatal variables were compared to ultrasound findings in the neonatal period and neurologic handicap at the age of two years. Duration of hypocarbia (PCO2 < or = 30 mmHg) during the first 72 h and hyperbilirubinemia (the mean level of serum total bilirubin) at three days of age were independently and significantly related to periventricular leukomalacia, but not directly to cerebral palsy. The only perinatal variables related independently and significantly to cerebral palsy at two years of age were periventricular leukomalacia and ventriculomegaly. According to these results, periventricular leukomalacia was the main predictor of cerebral palsy in preterm infants. In addition to hypocarbia, hyperbilirubinemia may also be involved in the pathogenesis of extensive (severe cystic) periventricular leukomalacia.     

Steady-state evoked potentials to amplitude modulated tones in the monkey.

A frequency-specific, objective assessment of hearing thresholds is required for use in subjects unable to perform behavioural audiometry. One such method using steady-state evoked potentials (SSEPs) in response to amplitude-modulated tones was evaluated in an experimental animal, the macaque monkey. An amplitude-modulation frequency of 165 Hz was found to produce optimum response detection in the anaesthetised animal. Auditory thresholds determined by a computerised automatic response detection system accurately reflected behavioural thresholds previously described in this species.     

Translation of the Leisure Satisfaction Scale into French: a validation study

Few standardized instruments are available for clients who speak languages other than English. The purpose of the study was to present and describe the process of translating an English standardized assessment into another language. Using the translation/validation methodologies described by Haccoun (1987) and Vallerand (1989), the Leisure Satisfaction Scale (LSS) was translated into French and then statistically validated. All correlations between both language versions of the LSS were found to be significant at the 0.01 level. Confirmatory factor analysis results were positive. Study findings indicate that the Haccoun (1987) and Vallerand (1989) methodologies provide clinicians with another option for ensuring culturally sensitive and relevant evaluations. Further research is needed to globally assess the measurement properties of the French version of this instrument.     

Childhood medulloblastoma in northwest England 1954 to 1997: incidence and survival

The incidence, survival patterns, and presenting symptoms of children with medulloblastoma were studied. Data were ascertained from the Manchester Tumour Registry which is population-based and has collected data on all childhood malignancies in northwest England since 1954. Incidence rates standardized to the European standard population were calculated and Poisson regression models were used to examine temporal changes in the incidence rates during the period 1954 to 1997. Kaplan-Meier survival curves were derived and used to study changes in survival patterns. World-standardized incidence rates were 5.5 per million child years in males and 3.4 per million child years in females. Incidence rates increased from the 1950s to the 1980s but have declined recently. The 5-year survival rate has improved from 29 to 58% with similar rates for males and females. The 1-year survival rate has also improved, but females had worse survival at this point (58%) than males (75%). The type of symptom or sign at presentation is strongly affected by age, with 10 of the 22 recorded symptoms or signs showing significant age differences. The older the child is, the more likely is the presentation to show pressure features of headache, vomiting, and ophthalmic signs. Younger children present with non-specific features such as lethargy, behavioural disturbance, or increasing head size. Ataxia is seen in about 75% of children across the age range.     

Comparative effects of mirtazapine and fluoxetine on sleep physiology measures in patients with major depression and insomnia

BACKGROUND: Sleep complaints are common in patients with major depressive disorder (MDD). Both MDD and antidepressant drugs characteristically alter objective sleep measures. This study compares the effects of mirtazapine and fluoxetine on sleep continuity measures in DSM-IV MDD patients with insomnia. METHOD: Patients (N = 19) received initial baseline polysomnography evaluations over 2 consecutive nights. Subjects were randomly assigned to either fluoxetine (20-40 mg/day) or mirtazapine (15-45 mg/day) treatment for an 8-week, double-blind, double-dummy treatment trial. Single-night polysomnograms were conducted at weeks 1, 2, and 8, with depression ratings assessed at baseline and weeks 1, 2, 3, 4, 6, and 8. Statistical analysis was performed by repeated-measures analysis of variance followed by Dunnet's post hoc analyses. RESULTS: Patients receiving mirtazapine (N = 8) had significant improvement in objective sleep physiology measures at 8 weeks. Improvements in sleep latency, sleep efficiency, and wake after sleep onset were significant after only 2 weeks of mirtazapine treatment. No significant changes in sleep continuity measures were observed in the fluoxetine group (N = 11). Both groups improved clinically in mood and subjective sleep measures from baseline, with no differences between groups. CONCLUSION: These data demonstrate the differential effects of mirtazapine and fluoxetine, with significant improvement in favor of mirtazapine, on objective sleep parameters in MDD patients with insomnia.     

Altered venous function and deep venous thrombosis following proximal femoral fracture

The effect of surgery for femoral neck fracture on lower limb venous blood flow and its relationship to deep vein thrombosis was investigated in 179 patients. Blood flow was measured using strain gauge plethysmography before surgery, in the 1st week after surgery, and at 6 week review. There was a significant reduction in both venous outflow and venous capacitance, affecting both fractured and non-fractured legs but significantly greater in the fractured leg. Venous function remained significantly impaired in both lower limbs 6 weeks after surgery.There was a significant correlation between the reduction in venous function and the development of deep vein thrombosis.     

Normal fetal pelvis: important factors for morphometric characterization with US

PURPOSE: To prospectively evaluate iliac angle and iliac length in a large number of normal fetuses and to identify factors that may influence these measurements. MATERIALS AND METHODS: At antenatal ultrasonography (US) in 356 fetuses, the iliac angle and iliac length were measured at two axial levels (superior and inferior). In mixed linear models, the statistical significance and magnitude of effect on the measurement of iliac angle and iliac length were estimated for gestational age, fetal sex, maternal diabetes status, axial level, and spine position relative to the transducer. RESULTS: Statistically significant effects were found for gestational age, axial level, and spine orientation but not for fetal sex or maternal diabetes status. The iliac angle was found to decrease by 15.7 degrees from the superior to inferior portion of the pelvis, decrease by approximately 0.37 degrees /wk, and decrease by as much as 15.6 degrees when the spine is directed to the side. Iliac length was found to increase by 0.8 mm/wk from 13 weeks to term, decrease by 1.2 mm from the superior to the inferior portion of the pelvis, and increase by as much as 1.29 mm when the spine is not directly subjacent to the transducer. CONCLUSION: The axial level of measurement, gestational age, and spine orientation must be accounted for if these morphometric indexes are used to discriminate fetuses with and those without Down syndrome.