Severe closed head injury associated with nonfracture and nonrotated atlantoaxial dislocation

This case of severe closed head injury associated with nonfracture and nonrotated atlantoaxial dislocation is reported to argue the necessity of obtaining a routine cervical CT scan for unconscious patients admitted to emergency units after severe head injury.Presented at the XIX Annual Meeting of the International Society for Pediatric Neurosurgery, Seoul 1991     

Adverse reactions of prophylactic intravenous immunoglobulin infusions in Iranian patients with primary immunodeficiency.

BACKGROUND: Although long-term intravenous immunoglobulin infusion is an effective treatment for children with antibody deficiencies, it can be complicated by systemic adverse reactions. OBJECTIVE: To evaluate the adverse reactions of intravenous immunoglobulin therapy in patients with primary immunodeficiency. METHODS: Seventy-one immunodeficient patients receiving intravenous immunoglobulin were evaluated during a 7-year period (1995-2002) at Children's Medical Center in Tehran, Iran. Immunological diagnoses were as follows: common variable immunodeficiency (31 patients), X-linked agammaglobulinemia (25 patients), IgG subclass deficiency (5 patients), hyper-IgM syndrome (2 patients), and ataxia-telangiectasia (8 patients). RESULTS: One hundred fifty-two cases (12.35%) of adverse reactions occurred following 1,231 infusions in 35 patients. The most frequent immediate adverse reactions were mild reactions (131 infusions), including chills, fever, flushing, muscle pains, nausea, headache, and anxiety. Moderate reactions, such as vomiting, chest pain, and wheezing, occurred in 19 infusions. Two patients experienced severe adverse reactions. The highest proportion (23.06%) of reaction to injection was in patients with common variable immunodeficiency. CONCLUSIONS: Intravenous immunoglobulin is a well tolerated medical agent for patients with antibody deficiency. However, to prevent occurrence of immediate adverse reactions during infusion in these patients, physicians should perform a detailed history and proper physical examination and check the titer of anti-IgA.     

Leukotrichia Developed Following Application of Intense Pulsed Light for Hair Removal

BACKGROUND: Lasers and light sources are now used worldwide for permanent or prolonged hair removal. Patients now prefer lasers and light sources for hair removal because of their noninvasiveness and fewer reported side effects. OBJECTIVE: To study and report on leukotrichia that developed following application of intense pulsed light (IPL). METHODS: From February 9, 2001 to February 14, 2002 a total of 821 patients were treated for unwanted hair. The system used was a noncoherent IPL system, with a 650 nm flashlamp filter; the parameters used varied with different Fitzpatrick skin types. The patients were treated monthly, with the rate of hair loss, measured by hair counts, and possible side effects recorded. RESULTS: Twenty-nine of 821 patients treated developed leukotrichia. Thirteen patients had no white or gray hairs before IPL therapy; the remaining 16 patients, who had few white hairs before treatment reported accelerated development of new white hairs starting after the first or second IPL therapy. Restoration of hair color occurred in 9 patients and the remaining 20 patients had no improvement or worsening of the condition within the next 2-6 months. CONCLUSION: Temporary or permanent leukotrichia may develop following IPL and laser hair removal therapy. This finding may be explained by the difference in the thermal relaxation times of melanocytes and germinative cells. The light absorbed and the heat produced by melanin may be sufficient enough to destroy or impair the function of melanocytes but insufficient to damage the hair follicle cells.     

Is the activation potential of Mahaim pathway always a fast potential? Implication for radiofrequency catheter ablation.

INTRODUCTION: Accessory pathways (AP) exhibiting Mahaim physiology are amenable to radiofrequency (RF) catheter ablation. The recording of an AP potential is an excellent guide for selection of ablation site. The purpose of this study is to determine whether the pathway potential is always a fast potential. METHODS: Ten patients (six females, mean age, 30 +/- 12 years) with preexcited tachycardias involving a Mahaim pathway underwent electrophysiological study and subsequent attempts at RF ablation. Mahaim potentials (M-potential) recorded at the site of successful ablation were reviewed and classified by at least two reviewers. RESULTS: In all patients, Mahaim pathways were characterized as atriofascicular types. The M-potential was fast in seven patients (group one), and slow in the remaining patients (group two). All group two patients had a history of prior failed ablation. Atrial electrograms were recorded closer to the QRS onset in group one. Atrium to fast M-potential (42 +/- 15 ms) was shorter than atrium to slow M-potential (83 +/- 12 ms, P = 0.03) but M-potentials were recorded with similar distance before local ventricular electrogram (P = NS). Ablation was successful in all patients with mean of 2.9 +/- 1.4 RF applications per patient. Ablation data were similar between the two groups (P = NS). No complications occurred. During 12 months of follow-up, no recurrence was observed. CONCLUSION: Our results illustrated that the activation potential of Mahaim pathways is not always a fast potential. One-third of Mahaim pathways can be mapped and ablated when the slow type of M-potential was used as a target for ablation. We also confirmed high efficacy of catheter ablation of Mahaim pathways guided by activation potentials.     

Platelet monoamine oxidase activity in schizophrenia: Relationship to family history of the illness and neuroleptic treatment

Platelet monoamine oxidase (MAO) activity was determined in a large population of drug-free and haloperidol-treated schizophrenic patients and healthy controls and, in a second study, in a sample of schizophrenics after a wash-out period and at different times during treatment with haloperidol. Enzyme activity was significantly decreased in both acute and chronic haloperidol-treated schizophrenics, but not in drug-free schizophrenics, compared with normal controls. No significant difference was observed between drug-free schizophrenics with a family history of the illness and those without such history, and between healthy relatives of schizophrenic patients and normal controls without a family history of schizophrenia.MAO activity was significantly reduced after 14 and 21 days of haloperidol treatment, and such reduction did not correlate with response to treatment. These data strongly support the idea that neuroleptic intake may, at least in part, explain low MAO values repeatedly reported in schizophrenics.     

Perceived parental rearing behaviour and psychopathology in epileptic patients: a controlled study

Memories of parental rearing behaviour were assessed by the EMBU in 61 epileptics and 151 healthy controls. The occurrence of the first crisis during the childhood was an inclusion criterion for patients. Epileptics, as compared with controls, rated their fathers and mothers as less stimulating, their fathers as less performance oriented and affectionate, and their mothers as more tolerant. Moreover, the score on the subscale 'favouring subject' for both fathers and mothers was higher in epileptics. As patients with and without interictal psychopathological features were compared, the scores on the subscales 'overprotective' and 'favouring subject' for mothers and 'abusive' and 'depriving' for fathers were higher in the former subgroup, whereas that on the subscale 'performance oriented' for fathers was higher in the latter. No significant difference was observed among patients suffering from the various subtypes of epilepsy. These results are consistent with the idea that parents of epileptics tend to encourage passivity in their children, have low expectations as regards their ability to operate effectively, and treat them in a more indulgent way because of their disability. Furthermore, they are in line with the reported association between maternal overprotectiveness and problem behaviour in epileptics.     

A horseradish peroxidase study of the olfactory system of the frog, Rana esculenta

The olfactory system of the frog Rana esculenta was studied by using horseradish peroxidase (HRP) tracing of axonal pathways. Injections of HRP were made in the main olfactory bulb (MOB), accessory olfactory bulb (AOB), anterior olfactory nucleus (AON), the amygdala (AMY), and in a zone of the leteral wall of the telencephalic hemisphere immediately posterior to the AOB. Projections from these sites are described and are generally similar to those obtained by degeneration methods. However, HRP reveals more extensive olfactory connections than previously reported. Ipsilateral, contralateral, and bilateral projections are described. The MOB, AOB, and AON have ipsilateral connections to each other. The MOB and AOB have very different projections. The MOB and AON project via the habenular commissure (HC) to the contralateral medial wall of the telencephalon. Ipsilateral MOB fibers also terminate in this cell-free zone where the medial forebrain bundle (MFB) originates. The AOB projects to the lateral cortex of the contralateral telencephalic hemisphere via the HC and also to the ipsilateral AMY and lateral forebrain bundle (LFB) from where some fibers project contralaterally. HRP injections in the AMY retrogradely fill cells in the ipsilateral AOB, two nuclei of the ipsilateral hypothalamus and a nucleus of cells caudal to the ipsilateral nucleus isthmi. Fibers are also labeled that project to the contralateral AMY. Few fibers were observed to decussate in the interpeduncular nucleus or optic chiasma. No olfactory fibers were found to project to the habenular nuclei, and no labeled neurons were found to project to the olfactory bulbs. No morphological asymmetry was observed qualitatively in the distribution of olfactory fibers in the two halves of the brain.     

Implementing psychiatric reform in southern Italy: the case of Campania

The implementation of the 1978 psychiatric reform in Campania, the most populated region of Southern Italy, is surveyed, by referring to currently available empirical data. Emphasis is laid on the incomplete development of psychiatric wards within general hospitals and of mental health services, on the lack of residential structures, on the failure to implement comprehensive departments for mental health care, on the increase in the number of admissions to private clinics and on the fact that more than three thousand patients are still in mental hospitals. Moreover, some characteristics of the new services clearly betraying the spirit of the law are pointed out.     

Conditional associative learning in drug-free schizophrenic patients

The performance on spatial and nonspatial associative learning tasks was tested in a sample of male drug-free DSM III-diagnosed schizophrenic patients and in a closely matched normal control group. Schizophrenics showed a worse performance on both versions of the task, but especially on the nonspatial one. A significant correlation was observed between some indices of the nonspatial task and the scores on two subscales (affective flattening and anhedonia) of the scale for the assessment of negative symptoms by Andreasen. These results are consistent with the hypothesis of a dysfunction of dorsolateral prefrontal cortex in schizophrenia and with the postulated linkage between such dysfunction and negative schizophrenic symptomatology.