Cranial neuronavigation-a step forward or a step aside in modern neurosurgery

Neuronavigation is a result of the introduction and integration of high technologies into modern neurosurgery. The method is becoming increasingly available, and more than ever, its ＂fashionable＂, ungrounded application （literally, in each neurosurgieal procedure） requires objective evaluation of its real usefulness. The aim of the present survey was to analyze the use of neuronavigafion in the general fields of modem cranial neurosurgery. The reliability of the classical method of brain lesion localization was compared to neuronavigated localization. We studied the neuronavigation assisted interventions in tumor surgery, skull-base surgery, biopsies, neuroendoseopy,functional neurosurgery, vascular neurosurgery and surgical procedures in the proximity of functionally important cortical zones. We showed the modem tendencies in neuronavigation and outlined the social and economic aspects of neuronavigation-assisted neurosurgery.     

Trends in caesarean delivery by country and wealth quintile: cross-sectional surveys in southern Asia and sub-Saharan Africa

Objective

To examine temporal trends in caesarean delivery rates in southern Asia and sub-Saharan Africa, by country and wealth quintile.

Methods

Cross-sectional data were extracted from the results of 80 Demographic and Health Surveys conducted in 26 countries in southern Asia or sub-Saharan Africa. Caesarean delivery rates were evaluated – as percentages of the deliveries that ended in live births – for each wealth quintile in each survey. The annual rates recorded for each country were then compared to see if they had increased over time.

Findings

Caesarean delivery rates had risen over time in all but 6 study countries but were consistently found to be lower than 5% in 18 of the countries and 10% or less in the other eight countries. Among the poorest 20% of the population, caesarean sections accounted for less than 1% and less than 2% of deliveries in 12 and 21 of the study countries, respectively. In each of 11 countries, the caesarean delivery rate in the poorest 40% of the population remained under 1%. In Chad, Ethiopia, Guinea, Madagascar, Mali, Mozambique, Niger and Nigeria, the rate remained under 1% in the poorest 80%. Compared with the 22 African study countries, the four study countries in southern Asia experienced a much greater rise in their caesarean delivery rates over time. However, the rates recorded among the poorest quintile in each of these countries consistently fell below 2%.

Conclusion

Caesarean delivery rates among large sections of the population in sub-Saharan Africa are very low, probably because of poor access to such surgery.     

Salazopyrin in the treatment of scleroderma

Following reports of successful treatment of various forms of scleroderma with salazopyrin, 13 selected patients were treated, 8 with acrosclerosis, one with sclerodermatomyositis and four with generalized morphoea. No effect was observed except in two cases of generalized morphoea which were in the acute stage of spreading to involve most of body surface. These two were more or less cured. This observation seems to warrant further trials with salazopyrin in this rare but serious form of scleroderma.     

A Study of single nucleotide polymorphism fragments of the aur gene metalloprotease strains of Straphylococcus aureus isolated from the skin of patients with atopic dermatitis

Studying the heterogeneity of internal fragments of the aur gene coding a proteolytic enzyme aureolysin in strains of Staphylococcus aureus with different enzymatic activity isolated from the affected skin of patients with atopic dermatitis was the aim of this study. The study included 125 patients from 1 to 35 years old diagnosed with atopic dermatitis. One hundred clinical strains of Staphylococcus aureus were studied in monoculture. Identification of the strains was performed by standard classical methods and obtained results were confirmed by specific biochemical microtests using a set of APIs Staph 20 (bioMerieux SA, France). Reference strains of S. aureus ATCC 29213 and NCTC 8325 were used in the work. Specific aur loci were detected by the method of multiplex polymerase chain reaction. Proteolytic ability of supernatants was determined by the ability to split the substrates (human IgG, Sigma) into fragments using as inhibitors of metalloproteases 0.01–0.1 M solutions of sodium EDTA. Sequencing of the amplified fragments of aur gene, including preliminary stages of separation and purification of DNA, was performed by Syntol (Moscow). Different strains of the conservative plot amplicon fragment of aur gene contain up to nine polymorphic nucleotides. The index of nucleotide diversity for proteolytic active strains was less (Pi = 0.04) than for proteolytic inactive (Pi = 0.07), p < 0.05. It should be noted that all proteolytically active strains were isolated from the skin of patients with high and moderate severity of atopic dermatitis (67.8 ± 5.4 points on the SCORAD scale) with erythematous form of the disease. The inactive strains were allocated in elderly patients with reduced severity of atopic dermatitis (with the dry form of skin lesions).     

The effect of major depression on participation in preventive health care activities

Background  

The objective of this study was to determine whether major depressive episodes (MDE) contribute to a lower rate of participation in three prevention activities: blood pressure checks, mammograms and Pap tests.     

Naltrexone augmentation of neuroleptic treatment in alcohol abusing patients with schizophrenia

Objective Alcohol abuse in patients with schizophrenia is associated with psychiatric and social complications. While two medications have been approved by the Federal Drug Administration (FDA) for the treatment of alcoholism: disulfiram and naltrexone, no medications have been approved for individuals with alcohol dependence and comorbid schizophrenia. The purpose of this study was to evaluate the efficacy of naltrexone in alcohol-abusing schizophrenic patients.Method Thirty-one patients with schizophrenia and comorbid alcohol abuse or dependence were treated for 12 weeks in an outpatient study using naltrexone or placebo in a randomized, double-blind fashion in addition to their neuroleptic medication. Patients also participated in a weekly therapy using cognitive-behavioral drug relapse prevention strategies combined with skills training. Outcomes included drinking measured by the time line follow-back method, craving using the Tiffany Craving Questionnaire, psychotic symptoms using the Positive and Negative Symptoms Scale (PANSS), side effects and a measures of abnormal involuntary movements.Results There were no significant differences in treatment exposure or medication compliance between groups. Naltrexone treated patients had significantly fewer drinking days, heavy drinking days (>5 drinks) and reported less craving compared to the placebo treated patients. Naltrexone did not affect symptoms of schizophrenia, such as psychosis. The medication was well tolerated and there were no group differences in side effects.Conclusions These data suggest that naltrexone may be an effective medication for individuals with comorbid alcohol dependence and schizophrenia. Given the widespread problems associated with alcohol misuse in this population, and the lack of effective pharmacotherapies, these findings represent an exciting clinical development.An erratum to this article can be found at Preliminary results from this study were presented at the Society of Biological Psychiatry 57th Annual Scientific Convention, Philadelphia, Pa., USA in May 2002. The VA Naltrexone Study Collaboration Group: West Haven: Diana Congdon, Ned Cooney, Roberto Gil, Kathy Keegan, Debra Miles, Alison Oville, Barbara Peluse, Louis Trevisan; Northampton: Lynn Gordon, John Reino, Wayne Costello, Christopher Cryan; Bedford: Nitigna Desai, Marylee Losardo, Doreen Farrell, Barbara E. Rofman. W. Costello is deceased.     

Prevalence and clinical relevance of the morphological substrate of ventricular arrhythmias in patients without known cardiac conditions detected by cardiovascular MR

Objective

Cardiac MR (CMR) identifies the substrate of ventricular arrhythmia (VA) in cardiomyopathies and coronary heart disease. However, little is known about the value of CMR in patients with VA without previously known cardiac disorders.

Methods

76 patients with VA (Lown ≥2) without known cardiac disease after regular diagnostic work-up were studied with CMR, and findings were correlated with electrocardiogram (ECG) and electrophysiological stimulation (EPS). Structural abnormalities matching the VA origin as defined by ECG and/or EPS, or a CMR-detected cardiac condition known to cause arrhythmia were defined as VA substrate. CMR findings were defined as clinically relevant, if resulting in a new diagnosis, change of treatment or additional diagnostic procedure.

Results

44/76 patients demonstrated pathological CMR findings. In 24/76 patients, the pathology was detected by CMR and not by echocardiography. CMR-based diagnoses of cardiac disease were established in 20/76 patients, and all were morphological substrates for VA. In seven patients, the location of the CMR finding (scar) directly matched the VA origin. CMR findings resulted in a change of treatment in 21 patients and/or additional diagnostics in 8 patients.

Conclusion

Undetected cardiac conditions are frequent causes of VA. This is the first study demonstrating the value of CMR for detection of morphological substrate and/or underlying cardiac disorders in VA patients without known cardiac disease.

Advances in knowledge

The high incidence of clinically relevant CMR findings which were not detected during initial diagnostic work-up strongly supports the use of CMR to screen VA patients for underlying heart disease.Although the value of cardiac MR (CMR) for the diagnosis of cardiac diseases such as myocarditis is undisputed, CMR is also predictive of patients at high risk for ventricular arrhythmias (VAs) with conditions such as hypertrophic cardiomyopathy (HCM) and coronary heart disease (CHD).^1–3 Recent studies have demonstrated the ability of CMR to identify the anatomical correlate of VA in those patients. This anatomical correlate has been characterized by CMR as a structural abnormality (e.g. fibrosis or peri-infarct region), which may go undetected using other non-invasive imaging modalities.^4,5 A number of studies have been undertaken, or are ongoing, to further elucidate the added value of CMR in patients with known cardiac conditions, to improve risk stratification for VA and to optimize therapy.^1,6–8 However, little is known to date regarding the added value of CMR for detection of an arrhythmogenic substrate or underlying cardiac condition in patients who present with VAs without known cardiac disease.Thus, the purpose of this study was to investigate the added value of CMR in patients with VAs for detection of underlying heart disease and an arrhythmogenic morphological substrate, and also to investigate the clinical relevance of CMR in those patients with positive findings.