Short-term neurological outcome of children after surgery for brain tumors: incidence and characteristics in a pediatric intensive care unit

Purpose  

The main treatment for majority of pediatric brain tumors relies on surgery. In postoperative period, patients require monitoring in a pediatric intensive care unit (PICU). In this study, we analyzed the incidence of postoperative neurological complications and the outcome of neurological impairment in individual patients.     

Saccadic eye movements and finger reaction times of table tennis players of different levels

Building upon the finding that athletes have faster saccadic eye movements than controls (Lenoir et al., Percept Motor Skills 2000;91:546-552), the aim of this study was to compare prosaccadic and antisaccadic eye movements in table tennis players of different levels. Saccadic latency, error rate, and reaction time on a visuomotor task (key press) were measured. Saccadic latency and error rate did not decrease with an increasing level of expertise. Finger reaction times correlated positively with antisaccadic latencies, but not with prosaccadic latencies. It is concluded that in an active population, saccadic performance does not allow the discrimination between recreational, moderate, and top players because of a ceiling effect. The relation between eye and finger movements is discussed in the framework of common brain areas during movement preparation.     

Neuro-Ophthalmic Literature Review

Predominant downgaze palsy in combination with thalamic dementia were the presenting symptoms in two patients, in whom a bilateral thalamic infarct could be demonstrated on CT scan. Fourteen similar cases of vascular origin have been reported with postmortem examination. Besides a symmetrical butterfly-shaped thalamic infarct an additional bilateral paramedian mesodiencephalic involvement of the lesion including the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF) could be revealed in all cases.

This unique oculomotor/psychobehavioral syndrome is diagnostic of an ischemia in the distribution of a small thalamo-perforating artery frequently arising as one midline pedicle between the bifurcation of the basilar artery and the origin of the posterior communicating artery, thus supplying the paramedian subthalamo-thalamic region on both sides.     

Consideration of age at admission for selective screening to identify methicillin-resistant Staphylococcus aureus carriers to control dissemination in a medical ward

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) has become an increasingly important pathogen responsible for hospital-acquired infections. Our study was to evaluate the efficiency of our selective screening program for methicillin-resistant Staphylococcus aureus (MRSA) carriers at admission to nonintensive care units. METHODS: During 6 months, all patients were screened at admission to an internal medicine ward, at which time they were classified as patients at risk of carriage (PRC) and those with no known risk factor. The amplitude of cross transmission was estimated using various indicators during this universal screening period and during the same calendar period of the preceding year (selective screening). RESULTS: The prevalence of MRSA carriage at admission was 5.5%. Among the 22 carriers identified, only 10 were PRC. Age >80 years was significantly associated with MRSA carriage upon admission (OR, 3.5; P < .01). All estimation indicators of MRSA dissemination amplitude were significantly lower during universal screening (relative risks varied from 2.79 to 26.4 according to indicators), demonstrating the need to broaden our criteria defining PRC. CONCLUSION: Adding patients >80 years of age to our PRC definition would increase screening sensitivity (15 carriers identified for 128 patients sampled) and would enable early implementation of barrier precautions for the additional carriers identified.     

Double line sign: a helpful sonographic sign to detect occult fractures of the proximal humerus

The aim of this study was to describe a new sonographic sign of bone fracture and to determine if it can be helpful in decreasing the number of missed fractures of the proximal humerus. Ultrasound (US) of the shoulder was performed in 57 consecutive patients with shoulder pain and/or disability following trauma. All cases were prospectively reviewed for the presence of a humeral fracture. Sonographic signs of fractures, with special emphasis on what was termed the ‘double line sign’ (DLS), were assessed. Plain radiography was considered the standard of reference and in equivocal cases magnetic resonance imaging (MRI). Twenty-eight patients had a tuberosity complex fracture, which were all detected at US examination. Sonographic features of a fracture were periosteal elevation, corticol bone discontinuity, step-off deformity or a combination of these findings. This study showed that in 26 (93%) patients an additional sonographic feature, a DLS, could be demonstrated. The DLS is a helpful and probably reliable sonographic sign to indicate a humeral fracture. High-spatial-resolution US substantially increases the detection of fractures of the proximal humerus and should be considered as an alternative diagnostic tool prior to computed tomography (CT), MRI and arthroscopy in patients with persisting shoulder pain and/or disability following trauma.     

Evaluation of multi-exponential curve fitting analysis of oxygen-quenched phosphorescence decay traces for recovering microvascular oxygen tension histograms

Although it is generally accepted that oxygen-quenched phosphorescence decay traces can be analyzed using the exponential series method (ESM), its application until now has been limited to a few (patho)physiological studies, probably because the reliability of the recovered oxygen tension (pO₂) histograms has never been extensively evaluated and lacks documentation. The aim of this study was, therefore, to evaluate the use of the ESM to adequately determine pO₂ histograms from phosphorescence decay traces. For this purpose we simulated decay traces corresponding to uni- and bimodal pO₂ distributions and recovered the pO₂ histograms at different signal-to-noise ratios (SNRs). Ultimately, we recovered microvascular pO₂ histograms measured in the rat kidney in a model of endotoxemic shock and fluid resuscitation and showed that the mean microvascular oxygen tension, 〈pO₂〉, decreased after induction of endotoxemia and that after 2 h of fluid resuscitation, 〈pO₂〉 remained low, but the hypoxic peak that had arisen during endotoxemia was reduced. This finding illustrates the importance of recovering pO₂ histograms under (patho)physiological conditions. In conclusion, this study has characterized how noise affects the recovery of pO₂ histograms using the ESM and documented the reliability of the ESM for recovering both low- and high-pO₂ distributions for SNRs typically found in experiments. This study might therefore serve as a frame of reference for investigations focused on oxygen (re)distribution during health and disease and encourage researchers to (re-)analyze data obtained in (earlier) studies possibly revealing new insights into complex disease states and treatment strategies.