Lithium intoxication mimicking clinical and electrographic features of status epilepticus: a case report and review of the literature.

A 58-year-old patient who was somnolent, distractible and confused is presented. She was previously treated with lithium, and a plasma level was mildly elevated at 1.7 mmol/l (normal 0.5-1.5 mmol/l). The EEG was suggestive of electrographic status epilepticus. Following treatment with i.v. lorazepam, neither mental status nor EEG abnormalities improved. She had a full recovery of mental function and markedly improved EEG findings following discontinuation of lithium. The EEG is an effective tool for diagnosing lithium neurotoxicity in patients with normal or mildly elevated lithium plasma levels. However, caution is needed before making an assumption of status epilepticus.     

Video-EEG telemetry can be a crucial tool for neurologists experienced in epilepsy when diagnosing seizure disorders.

We retrospectively reviewed the charts of 121 patients consecutively admitted to our epilepsy-monitoring unit (VET) during the period of 01 July 2001 to 31 December 2002. We excluded patients with a confirmed diagnosis of epilepsy who were admitted for invasive pre-surgical monitoring. Medical records were reviewed to collect demographic and clinical information that lead to the initial referral for VET by neurologists with expertise in epilepsy or by an epileptologist. We identified 29 patients (24%), whose diagnosis changed after VET. Their seizure duration ranged from 1 to 46 years. A diagnosis of epileptic seizures (ES) was made in four of the patients who were initially felt to have nonepileptic seizures (NES). The diagnosis of NES was made in 22 patients who were initially felt to have ES. All of these 29 patients had failed at least two or more antiepileptic drugs (AEDs). A misclassification of epilepsy syndrome was found in three patients. Eleven of the NES patients had risk factors that would increase the likelihood of ES, including significant head injury (n=6), febrile seizures (n=2), meningioencephalitis (n=2), and tumours (n=1). Four of these 11 patients had abnormal interictal EEGs. We conclude that VET is crucial in establishing a diagnosis in patients with seizures. Without VET, patients can be misclassified or receive ineffective treatment, even when being treated by specialists in epilepsy. Thus, VET, can help facilitate the most appropriate type of therapy in difficult to control patients.     

Immunohistochemical phenotype of sensory neurons associated with sympathetic plexuses in the trigeminal ganglia of adult nerve growth factor transgenic mice

Following peripheral nerve injury, postganglionic sympathetic axons sprout into the affected sensory ganglia and form perineuronal sympathetic plexuses with somata of sensory neurons. This sympathosensory coupling contributes to the onset and persistence of injury-induced chronic pain. We have documented the presence of similar sympathetic plexuses in the trigeminal ganglia of adult mice that ectopically overexpress nerve growth factor (NGF), in the absence of nerve injury. In this study, we sought to further define the phenotype(s) of these trigeminal sensory neurons having sympathetic plexuses in our transgenic mice. Using quantitative immunofluorescence staining analyses, we show that the invading sympathetic axons specifically target sensory somata immunopositive for several biomarkers: NGF high-affinity receptor tyrosine kinase A (trkA), calcitonin gene-related peptide (CGRP), neurofilament heavy chain (NFH), and P2X purinoceptor 3 (P2X3). Based on these phenotypic characteristics, the majority of the sensory somata surrounded by sympathetic plexuses are likely to be NGF-responsive nociceptors (i.e., trkA expressing) that are peptidergic (i.e., CGRP expressing), myelinated (i.e., NFH expressing), and ATP sensitive (i.e., P2X3 expressing). Our data also show that very few sympathetic plexuses surround sensory somata expressing other nociceptive (pain) biomarkers, including substance P and acid-sensing ion channel 3. No sympathetic plexuses are associated with sensory somata that display isolectin B4 binding. Though the cellular mechanisms that trigger the formation of sympathetic plexus (with and without nerve injury) remain unknown, our new observations yield an unexpected specificity with which invading sympathetic axons appear to target a precise subtype of nociceptors. This selectivity likely contributes to pain development and maintenance associated with sympathosensory coupling.     

Impact of local and systemic factors on the incidence of late oral implant loss

Background: This retrospective study was set to assess the influence of systemic and local bone and intra-oral factors on the occurrence of implant loss from abutment connection up to 2 years.
Materials and methods: The files of 700 patients, have been collected randomly from the total patient group treated by means of endosseous Brånemark^® system implants (Nobel Biocare, Gothenburg, Sweden) at the Department of Periodontology of the University Hospital of the Catholic University of Leuven. The end point observation was evaluating the loss of the implants 2 years after abutment installation. The study involved all implants that did not encounter early loss and implants for which it was possible to evaluate its status 2 years after abutment surgery.
Thus, data of 412 patients (240 females) provided with 1514 implants were analyzed. For each patient, the medical history was carefully checked. Data collection and analysis were mainly focused on endogenous factors such as hypertension, coagulation problems, osteoporosis, hypo- hyperthyroidism, chemotherapy, diabetes type I or II, Crohn's disease, some local factors [e.g. bone quality and quantity, implant (length, diameter, location), type of edentulism, PTV, radiotherapy], smoking habits, and breach of sterility during surgery.
Results: Radiotherapy, implant (diameter and location), and higher PTV at implant insertion and abutment connection, all affected significantly the implant loss.
Conclusion: Implant location in the oral cavity and radiotherapy seem predominant to explain the occurrence of implant loss. On the other hand, smoking and systemic health factors do not seem to be prominent players in the etiology of late implant loss.     

Pure topographic disorientation: A distinctive syndrome with varied localization

Pure topographic disorientation (TD), defined as impaired recall of routes in familiar surroundings, has been attributed to lesions of the right parahippocampus. The authors present three patients encountered consecutively with TD and compare them to previously published cases. Lesions causing TD included a right splenial/cuneus infarct, a right > left medial temporo-occipital infarct, and a left splenial infarct. TD as an isolated symptom may occur from lesion in a variety of posterior medial locations, including the parahippocampus, splenium, and retrosplenial cortex.     

Impact of local and systemic factors on the incidence of oral implant failures, up to abutment connection

Aim: The aim of this retrospective study was to assess the influence of systemic and local bone and intra‐oral factors on the occurrence of early implant failures, i.e. up to the abutment connection. Material and Methods: The surgical records of 2004 consecutive patients from the total patient population who had been treated in the period 1982–2003 (with a total of 6946 Brånemark system^® implants) at the Department of Periodontology of the Catholic University Leuven were evaluated. For each patient the medical history was carefully checked. Data collection and analysis mainly focused on endogenous factors such as hypertension, coagulation problems, osteoporosis, hypo‐hyperthyroidy, chemotherapy, diabetes type I or II, Crohn's disease, some local factors [e.g. bone quality and quantity, implant (length, diameter, location), type of edentulism, Periotest^® value at implant insertion, radiotherapy], smoking habits and breach of sterility during surgery. Results: A global failure rate of 3.6% was recorded. Osteoporosis, Crohn's disease, smoking habits, implant (length, diameter and location) and vicinity with the natural dentition were all significantly associated with early implant failures (p<0.05). Conclusion: The indication for the use of oral implants should sometimes be reconsidered when alternative prosthetic treatments are available in the presence of possibly interfering systemic or local factors.     

A New GAN-Based Approach to Data Augmentation and Image Segmentation for Crack Detection in Thermal Imaging Tests

As a popular nondestructive testing (NDT) technique, thermal imaging test demonstrates competitive performance in crack detection, especially for detecting subsurface cracks. In thermal imaging test, the temperature of the crack area is higher than that of the non-crack area during the NDT process. By extracting the features of the thermal image sequences, the temperature curve of each spatial point is employed for crack detection. Nevertheless, the quality of thermal images is influenced by the noises due to the complex thermal environment in NDT. In this paper, a modified generative adversarial network (GAN) is employed to improve the image segmentation performance. To improve the feature extraction ability and alleviate the influence of noises, a penalty term is put forward in the loss function of the conventional GAN. A data preprocessing method is developed where the principle component analysis algorithm is adopted for feature extraction. The data argumentation technique is utilized to guarantee the quantity of the training samples. To validate its effectiveness in thermal imaging NDT, the modified GAN is applied to detect the cracks on the eddy current pulsed thermography NDT dataset.