Bilateral parafalcine subdural abscess secondary to frontal sinusitis

Subdural empyema or abscess is a rare complication of frontal sinusitis in the modern era of antibiotics. We described two interesting cases where the pus was confined in the interhemispheric fissure. Early treatment preferably craniotomy limits the otherwise high mortality.     

Volunteerism and Shriners Hospitals for Children

Shriners Hospitals for Children exemplifies the spirit of volunteerism and the remarkable effectiveness of this spirit in providing orthopaedic and burn care to thousands of children around the world. The voluntary efforts of Shriners have included fund raising, hospital planning and development, governance, identification of patients in need, and patient transportation. Until the 1980s, orthopaedic surgeons received little or no remuneration for their work in caring for children in Shriners hospitals. Subsequently, numerous factors have caused a conversion of a part-time voluntary medical staff to full-time and contracted part-time staff. Even so, many Shriners hospitals' medical staff members continue to volunteer their own time in caring for children in less fortunate countries, and as a corporation, Shriners Hospitals for Children has provided volunteer medical teams during times of major international disasters.     

Genetic and pharmacological demonstration of a role for cyclic AMP-dependent protein kinase-mediated suppression of protein phosphatases in gating the expression of late LTP

Protein kinases and phosphatases play antagonistic roles in regulating hippocampal long-term potentiation (LTP), with kinase inhibition and phosphatase activation both impairing LTP. The late phase of LTP (L-LTP) requires activation of cAMP-dependent protein kinase (PKA) for its full expression. One way in which PKA may critically modulate L-LTP is by relieving an inhibitory constraint imposed by protein phosphatases. Using mutant PKA mice [R(AB) transgenic mice] that have genetically reduced hippocampal PKA activity, we show that deficient L-LTP in area CA1 of mutant hippocampal slices is rescued by acute application of two inhibitors of protein phosphatase-1 and protein phosphatase-2A (PP1/2A) (okadaic acid and calyculin A). Furthermore, synaptic facilitation induced by forskolin, an adenylyl cyclase activator, was impaired in R(AB) transgenics and was also rescued by a PP1/2A inhibitor in mutant slices. Inhibition of PP1/2A did not affect early LTP (E-LTP) or basal synaptic transmission in mutant and wildtype slices. Our data show that genetic inhibition of PKA impairs L-LTP by reducing PKA-mediated suppression of PP1/2A.     

Safety, tolerability, and pharmacokinetics of remacemide in children

Eleven patients (nine males, two females), 9–14 years of age, received adjunctive therapy with remacemide in an open ascending-dose study at two residential centers in the United Kingdom. Children taking enzyme-inducing drugs were given remacemide twice daily, starting at approximately 4 mg/kg per day and doubling the dose at two weekly intervals to a target dose of approximately 16 mg/kg per day. Children not taking enzyme-inducing drugs (n = 5) received half of these doses. After the dose-escalation phase, remacemide was slowly withdrawn over 2 weeks except in two children who, because of apparent benefit, entered a continuation phase. Remacemide generally was well tolerated in doses up to 13.5 mg/kg per day. Adverse events were similar to those reported in adults, with central nervous system and gastrointestinal events being the most common. One patient died after a suspected seizure, which was unlikely to have been related to remacemide treatment. No adverse effects on neuropsychologic functioning were observed; effects on vital signs and laboratory variables were not clinically significant. The pharmacokinetic profile for remacemide and its desglycinyl metabolite in children is similar to that seen in adult patients. Plasma concentrations of remacemide and the desglycinyl metabolite are reduced in the presence of concomitant antiepileptic drugs with hepatic enzyme-inducing activity.     

Glenohumeral mechanics: a study of articular geometry, contact, and kinematics

Stereophotogrammetry was used to investigate the functional relations between the articular surface geometry, contact patterns, and kinematics of the glenohumeral joint. Nine normal shoulder specimens were elevated in the scapular plane by using simulated muscle forces in neutral rotation (NR) and starting rotation (SR). Motion was quantified by analyzing the translations of the geometric centers of the humeral head cartilage and bone surfaces relative to the glenoid surface. In both NR and SR, the ranges of translations of the center of the humeral head cartilage surface were greatest in the inferior-superior direction (NR 2.0 +/- 0.7 mm, SR 2.9 +/- 1.2 mm). Results of this study also show that joints with less congruence of the articular surfaces exhibit larger translations, and elevation in SR yields greater translations than in NR. Kinematic analyses with the humeral head bone surface data yielded larger values of translation than analyses that used the cartilage surface data, suggesting that similar overestimations may occur in radiographic motion studies. Results of this study demonstrate that small translations of the humeral head center occurred in both SR and NR. The proximity of the origin of the helical axes to the geometric center of the humeral head articular surface confirmed that glenohumeral elevation is mainly rotation about this geometric center with small translations.     

The Northwestern University multihospital twin study: IV. Duration of gestation according to fetal sex

Recently MacGillivray has observed that the average duration of male twin gestations is shorter than that of either female twin or male/female twin gestations. The data from 562 twin gestations from the Northwestern University multihospital twin study were used to test this observation. Male twin gestations were slightly but significantly shorter than other twin gestations as measured by pediatric examination (p < 0.005). Approaching significance at the 0.05 level were findings that male twin gestations were shorter than other twin gestations when measured by dates, and that the male twins were slightly shorter and lighter than other twins. No significant differences were found between male/female twin gestations and female twin gestations. No relationship could be found between twin sex combinations and a variety of maternal and obstetric factors. Taken together, the results suggest that male twin gestations differ in some distinctive biologic sense from other twin gestations.