Age and stimulus dependency of visually evoked cerebral blood flow responses

BACKGROUND AND PURPOSE: During visual stimulation, the increased metabolic demand is coupled with an increase of cerebral blood flow velocity (pCBFV) in the posterior cerebral artery (PCA). Investigation of the visually evoked flow responses (VEFR, expressed as percentage of increase from baseline pCBFV values) was suggested for different conditions of vasoneuronal disorders in the absence of any systematic investigation in healthy subjects. METHODS: We investigated VEFRs from both PCAs to various increasingly complex paradigms (diffuse light, alternating checkerboard patterns, and a color video movie stimulation; 5, 10, 20, and 30-second intervals) in 60 healthy volunteers (mean age, 41.5+/-14.9 years; range, 24 to 80 years; 28 male, 32 female) at different recording sites (P1 versus P2 segments of PCAs). RESULTS: With increasing complexity of stimulation, the VEFRs increased significantly (24.3+/-10.3%, 28.5+/-13.5%, and 43.4+/-10.7%, respectively). Twenty-second stimulation intervals yielded maximal responses (41.5+/-13.2%) compared with 5-, 10-, and 30-second intervals (22.6+/-14.1%, P=0.001; 34.4+/-11.7%, P=0.0042; and 35.5+/-9.9%, P=0.0032, respectively). Significantly higher responses were gained from P2 segments than from P1 segments (42.7+/-7.2% versus 28.2+/-7.1%). Although VEFRs tended to decrease in amplitude with age (mean, 41. 7+/-10.5% [20 to 40 years], 35+/-9.2% [40 to 60 years], and 33.9+/-8.6% [60 to 80 years]); without significant sex-related differences, only the percentage decrement of the pulsatility indices during stimulation were significant (mean, 24+/-10.7% [20 to 40 years], 20+/-7.3% [40 to 60 years], and 13+/-11.2% [60 to 80 years]). CONCLUSIONS: For optimal stimulus conditions for maximum VEFRs, a colored video stimulation of 20-second intervals should be used to combine responses not only from the primary visual projection fields (V1 and V2) but also from temporal lobe areas (V3 through V5) often supplied by the PCA.     

Functional hallux rigidus in the rheumatoid foot

Hallux rigidus results from arthritic involvement of the first metatarsophalangeal joint. The authors have observed loss of motion at this joint in patients with rheumatoid arthritis in the absence of hallux valgus or joint destruction. A hyperextension deformity of the interphalangeal joint has also been observed, with a painful callus beneath it. The first metatarsophalangeal joint appears normal on roentgenograms, and passive motion of the joint is normal when it is examined clinically. The loss of first metatarsophalangeal motion is functional, and stems from muscle spasm of the great toe intrinsic muscles in an effort to relieve pressure on the lesser metatarsal heads. The interphalangeal hyperextension may develop secondary to "functional hallux rigidus."     

Neisseria gonorrhoeae screening in pregnancy

All patients undergoing prenatal care at the U.S Naval Hospital in Yokosuka, Japan, have a gonorrhea culture performed at their intake visit. The objective of this study was to determine the prevalence of Neisseria gonorrhoeae in this military population and to propose an effective antenatal screening strategy based on the data. A retrospective 10-month review of patient data was performed. In addition, the guidelines for antenatal N. gonorrhoeae screening by the American College of Obstetricians and Gynecologists, the Centers for Disease Control and Prevention, the U.S. Department of Health and Human Services, and the World Health Organization were reviewed. During the study period, none of the screened patients (N = 518) had a gonococcal infection. The screening program at this facility will be modified based on the low-risk nature of the pregnant population. Specifically, high-risk patients will be screened selectively in the third trimester.     

Sonographische Diagnose von Komplikationen nach Meningoenzephalitiden im Säuglingsalter

Zusammenfassung Fragestellung: Ziel dieser retrospektiven Untersuchung war es, den Stellenwert der Sonographie bei der Diagnostik von Komplikationen entzündlicher ZNS-Erkrankungen bei Neugeborenen und S?uglingen zu erarbeiten. Methode: 14 Kinder mit pr?natalen Infektionen, 81 Kinder mit eitrigen und 19 Kinder mit ser?sen Meningoenzephalitiden wurden im Zeitraum von Januar 1980 bis Dezember 1990 behandelt und mit Hilfe der zweidimensionalen Sch?delsonographie und teilweise auch der gepulsten und farbkodierten Doppler-Sonographie untersucht. Das Alter der Patienten lag zwischen 1 Tag und 1 Jahr. Ergebnisse: Sonographisch erkennbare Komplikationen waren ein Shunt-pflichtiger Hydrozephalus (26 Patienten), Erweiterungen der ?u?eren Liquorr?ume (24 Patienten), intrazerebrale, periventrikul?re und im Basalganglienbereich lokalisierte Echogenit?tsvermehrungen (11 Patienten), eine Ventrikulitis (10 Patienten), isolierte porenzephale Zysten (6 Patienten), eine multizystische Enzephalomalazie (5 Patienten) und ein Hirnabsze? (3 Patienten). Mit Ausnahme der Erweiterungen der ?u?eren Liquorr?ume waren alle Komplikationen am h?ufigsten in der Neonatalperiode zu beobachten. Schlu?folgerung: Die zerebrale Ultrasonographie ist eine sichere und genaue Methode, um die im S?uglingsalter h?ufig auftretenden Komplikationen von Meningoenzephalitiden im S?uglingsalter frühzeitig zu erfassen und entsprechend zu therapieren. Unserer Meinung nach ist eine sonographische Untersuchung innerhalb der 1. Woche nach Diagnosestellung einer Meningoenzephalitis im Neugeborenen- oder S?uglingsalter, in der 2. Woche und vor der Entlassung indiziert. Beim Auftreten von Komplikationen oder zur überprüfung der Effizienz spezieller Therapiema?nahmen sind im Einzelfall entsprechend h?ufigere sonographische Kontrolluntersuchungen angezeigt.      

Reduced levels of growth hormone, insulin-like growth factor-I and binding protein-3 in patients with shunted hydrocephalus

OBJECTIVE: Children with hydrocephalus are characterised by slow linear growth in prepuberty, accelerated physical maturation during puberty, and reduced final height. We aimed to study the possible roles of growth hormone, insulin-like growth factor-I (IGF-I), and IGF binding protein-3 (IGFBP-3) in this growth pattern. STUDY DESIGN: One hundred and fourteen patients with shunted hydrocephalus (62 males) aged 5 to 20 years, of whom 17 had spina bifida (six males), and 73 healthy controls (38 males) were studied. Anthropometric measures, body mass index, and body fat mass were assessed and the stage of puberty was determined. Serum growth hormone and plasma IGF-I and IGFBP-3 concentrations were measured. RESULTS: The patients comprised 44 (26 males) who were prepubertal and 70 (36 males) pubertal or postpubertal, while 32 of the controls (19 males) were prepubertal and 41 (19 males) pubertal or postpubertal. The prepubertal children with hydrocephalus had lower IGF-I (p = 0.002) and IGFBP-3 concentrations (p < 0.001) than the controls, and the pubertal children had four times lower basal growth hormone concentrations (p < 0.001). There was a correlation between height SD score and IGF-I levels in the total patient population (r = 0.23; p = 0.01). Peripheral IGF-I concentrations peaked at pubertal stages 2-3 in the female patients and at stage 4 in the controls. The prepubertal patients on antiepileptic treatment, carbamazepine in most cases (73%), had higher IGF-I (p = 0.01) and IGFBP-3 concentrations (p = 0.03) than those who had never been treated with antiepileptic drugs, but still lower IGFBP-3 levels than the controls (p = 0.01). CONCLUSION: Based on these findings, it can be concluded that reduced growth hormone secretion may contribute to the pattern of slow linear growth and reduced final height observed in these patients.     

Increasing breastfeeding rates to reduce infant illness at the community level

OBJECTIVE: Although breastfeeding is associated with lower rates of a variety of infant illnesses, skeptics have suggested that much of the association is attributable to confounding, even after appropriate statistical adjustment. This article utilizes a novel design to investigate changes in infant illness at the community level after a successful breastfeeding promotion program. METHODS: In this population-based cohort study, the medical records of all infants born in one Navajo community the year before a breastfeeding promotion program (n = 977) and the year during the intervention (n = 858) were reviewed. Outcomes assessed include changes after the intervention in: proportion breastfeeding and/or breastfeeding exclusively; incidence of common infant illnesses in the first year of life; and feeding-group specific incidence of illness. RESULTS: The proportion of women breastfeeding exclusively for any period of time increased from 16.4% to 54.6% after the intervention. The percent of children having pneumonia and gastroenteritis declined 32. 2% and 14.6%, respectively, after the intervention. Feeding-group specific rates of these illnesses were unchanged, indicating that the decline observed was attributable to the increased proportion of infants breastfeeding. In contrast, rates of croup and bronchiolitis increased after the intervention among those fed formula from birth, suggesting a viral epidemic which was limited to those never exclusively breastfed. Finally, sepsis declined in both formula-fed and breastfed infants after the intervention, suggesting that other factors affected this illness outcome after the intervention. CONCLUSIONS: Increasing the proportion of exclusively breastfed infants seems to be an effective means of reducing infant illness at the community level. The experimental design suggests that the increased incidence of illness among minimally breastfed infants is causally related to lack of breast milk, rather than being attributable to confounding.     

Sonographische Befunde bei Neugeborenen mit Mekoniumperitonitis

Zusammenfassung Fragestellung: Welchen Stellenwert hat die Ultraschalluntersuchung des Fetus und Neugeborenen bei der Diagnosestellung und Therapieplanung einer Mekoniumperitonitis. Patienten und Methode: Wir berichten über die sonographischen Befunde von 8 Kindern mit einer Mekoniumperitonitis und beschreiben die Korrelationen zwischen den sonographischen Befunden und der zugrundeliegenden Darmerkrankung bzw. dem klinischen Verlauf. Ergebnisse: Bei 7 Patienten wurde die Diagnose bereits pr?natal vermutet. Sonographische Befunde zum Zeitpunkt der Geburt waren Mekoniumpseudozysten (n=6), diffuse intraabdominale Verkalkungen (n=4), ein Polyhydramnion (n=6), ein Aszites (n=3), dilatierte Darmschlingen (n=5) und multiple intrahepatische Mekoniumzysten (n=1). Polyhydramnion und dilatierte Darmschlingen waren immer mit einer intestinalen Stenose bzw. Atresie assoziiert. Schlu?folgerung: Neugeborene mit einer Mekoniumperitonitis zeigen ein charakteristisches Spektrum an sonographischen Befunden, welche neben dem klinischen und radiologischen Befund für die postnatalen therapeutischen überlegungen wichtig sind.      

PCR-SSCP快速检测耐多药结核分枝杆菌

目的:了解本地区结核病耐药基因突变情况,探讨PCR-SSCP作为新的分子药敏试验方法在临床的应用价值。方法:通过提取耐INH、RFP、SM的肺结核患者痰中结核分枝杆菌DNA,进行PCR-SSCP分析,检测结核分枝杆菌rpoB、katG、rpsL基因是否存在突变,并与传统L-J药敏实验对照。结果:30株耐多药株中,耐RPF、INH、SM基因突变阳性率为90%(27/30)、63%(19/30)、53%(16/30)。3个基因联合突变共8株(26.7%),2个基因联合突变共18株(60%),即26株(86.7%)。单基因突变共2株,2株无基因突变。结论:通过PCR-SSCP方法可检测出绝大部分耐多药结核病的耐药基因,rpoB、katG、rpsL基因突变与本地区结核杆菌对RFP、INH、SM耐药性有关。与传统L-J药敏实验对比,PCR-SSCP是一种敏感、快速的指导临床用药的先进检测方法。     

Female circumcision (female genital mutilation): a problem for brachytherapy in cervical cancer

Female circumcision is a traditional practice common in African countries. It involves partial or total removal of external female genitalia. It has led to many complications, in particular, the scarring of the external genitalia. The consequence is a very narrow introitus making the intracavitary brachytherapy treatment component difficult when these women develop cancer of cervix. We present two such cases from our institution. Our aim is to make the radiation and gynecological oncologists, both in developed and developing countries, aware of this practice and the problems they can encounter in the management of such cases. Intracavitary brachytherapy is an important component in the potentially curative role of radiation therapy for cervical cancer. Every effort should be made to ensure that the sequelae of genital mutilation does not deprive these women of the same standard of care as the general population.