Emotional outbursts and post-traumatic stress disorder during intracarotid amobarbital procedure

Severe emotional outbursts (SEOs) during intracarotid amobarbital procedures (IAP) rarely jeopardize preoperative language and memory testing. Four of four patients (100%) with outbursts had experienced significant emotional trauma (three were raped and one witnessed a decapitation), compared with 26 of 546 patients (4.8%) without outbursts (chi2 = 69.8, p < 0. 0001). Evocative injections were ipsilateral to seizure focus. IAP may disrupt emotional balance in some traumatized patients. Counseling may prevent SEOs.     

Placental volume and other first-trimester outcomes: are there differences between fresh embryo transfer,frozen-thawed embryo transfer and natural conception?

Research question

Does mode of conception influence placental volume and other first-trimester outcomes?

Cognitive functioning after pallidotomy for refractory Parkinson's disease

BACKGROUND—Earlierapproaches to pallidotomy for refractory Parkinson's disease hadsignificant complication rates. More recent approaches show fewercomplications, but the effect of pallidotomy on cognition is unclear.The current study was conducted to examine the neuropsychological effects of unilateral pallidotomy.
METHODS—Neuropsychologicaltesting was performed on patients with medically refractory,predominantly unilateral Parkinson's disease at baseline andafter unilateral ventral pallidotomy (n=28)or after an equivalent period withoutsurgery in control patients (n=10).
RESULTS—Pallidotomypatients showed no significant changes from baseline to retestingrelative to the control group for any measure. Across all of the testsadministered, only five of the surgery patients showed a significantdecline, and of these five none declined on more than one test.Depression did not relate to preoperative or postoperative cognition.The pallidotomy group showed a significant improvement in motorfunctioning and activities of daily living whereas the control groupdid not. These measures were not associated with the neuropsychologicaltest scores at baseline or retest.
CONCLUSIONS—Stereotacticunilateral ventral pallidotomy does not seem to produce dramaticcognitive declines in most patients.

     

How many drinks did you have on September 11, 2001?

OBJECTIVE: This study tested the predictability of error in retrospective self-reports of alcohol consumption on September 11, 2001, among 80 Vermont light, medium and heavy drinkers. METHOD: Subjects were 52 men and 28 women participating in daily self-reports of alcohol consumption for a total of 2 years, collected via interactive voice response technology (IVR). In addition, retrospective self-reports of alcohol consumption on September 11, 2001, were collected by telephone interview 4-5 days following the terrorist attacks. Retrospective error was calculated as the difference between the IVR self-report of drinking behavior on September 11 and the retrospective self-report collected by telephone interview. Retrospective error was analyzed as a function of gender and baseline drinking behavior during the 365 days preceding September 11, 2001 (termed "the baseline"). RESULTS: The intraclass correlation (ICC) between daily IVR and retrospective self-reports of alcohol consumption on September 11 was .80. Women provided, on average, more accurate self-reports (ICC = .96) than men (ICC = .72) but displayed more underreporting bias in retrospective responses. Amount and individual variability of alcohol consumption during the 1-year baseline explained, on average, 11% of the variance in overreporting (r = .33), 9% of the variance in underreporting (r = .30) and 25% of the variance in the overall magnitude of error (r = .50), with correlations up to .62 (r2 = .38). CONCLUSIONS: The size and direction of error were clearly predictable from the amount and variation in drinking behavior during the 1-year baseline period. The results demonstrate the utility and detail of information that can be derived from daily IVR self-reports in the analysis of retrospective error.     

Metastatic osteosarcoma at diagnosis: prognostic factors and long-term outcome--the French pediatric experience

BACKGROUND: The objective of this report was to estimate long-term outcome and prognostic factors in children and adolescents who presented with metastatic osteosarcoma at diagnosis. Patients were treated in six French pediatric oncology centers with surgery and multiagent chemotherapy, mainly with high-dose methotrexate. Their medical records were reviewed retrospectively. METHODS: The medical records of patients who were treated for metastatic osteosarcoma from 1987 to 2000 were reviewed. Patients were treated with the chemotherapy regimens recommended for nonmetastatic disease in children (the French Society of Pediatric Oncology OS 87 and OS 94 protocols) or, in a few patients, with other chemotherapy regimens. Surgical excision of the primary tumor and, when possible, of all metastatic sites was performed based on a personalized assessment of each patient's situation. RESULTS: Seventy-eight patients age < 20 years were treated. Forty-six patients (59%) had only 1 metastatic site (35 to the lungs and 11 to bone). Twenty-eight patients (36%) achieved a complete remission after combination chemotherapy and surgery. The event-free survival and overall survival rates at 5 years were 14% and 19%, respectively. To date, 14 patients (18%) have remained alive with a median follow-up of 112 months. Pretreatment features associated with a shorter event-free survival in the multivariate analysis were metastasis to at least two organs and high alkaline phosphatase level. Patients with at least 1 of these poor prognostic factors had a 2.6% event-free survival rate at 5 years despite treatment. CONCLUSIONS: The survival of patients with metastatic osteosarcoma were treated with conventional chemotherapy and surgery remained very poor. Patients should be classified into different prognostic groups and treated accordingly. New therapeutic approaches are warranted to improve the prognosis for patients with the most severe disease.     

Captopril-induced eruptions: occurrence over a 3-year period

With an informatized sample of 123 patients taking Captopril and treated for a total duration of 1,321 month/patients, the frequency of the dermatological symptoms induced by the drug is related. Pruritus is found in 10,5 p. 100 and rashes in 2,4 p. 100 of cases. The results are compared with those of preceeding reports, although some authors have found a higher percentage because of highin doses of the drug. The clinical features of the rashes and the proposed mechanisms are also reported.     

The E.E.G. in non-ketotic hyperglycinaemia (author's transl)

12 cases of non-ketotic hyperglycinemia in neonates diagnosed at a time of neurological distress were studied. A characteristic tracing was observed permitting correct diagnosis in 6 cases. It consisted of a burst suppression characterized by high voltage complexes separated by low amplitude sequences. This appearance remained until the 15th day, with no electroclinical changes. In cases followed the trace closely resembled hypsarrhythmia.     

Dexmedetomidine and neurocognitive testing in awake craniotomy

Patients are selected for awake craniotomy when the planned procedure involves eloquent areas of the brain, necessitating an awake, cooperative patient capable of undergoing neurocognitive testing. Different anesthetic combinations, including neurolept, propofol with or without opioid infusions, and asleep-awake-asleep techniques, have been reported for awake craniotomy. In all these techniques, respiratory depression has been reported as a complication. In this case series dexmedetomidine, the highly selective alpha-2 adrenoreceptor agonist, was selected for its lack of respiratory depression as well as its sedative and analgesic properties. The charts of 10 consecutive patients who underwent awake craniotomy with dexmedetomidine infusion were reviewed. Five of the patients underwent "asleep-awake" technique with a laryngeal mask airway and volatile agent. Five patients received moderate to conscious sedation. All patients received a dexmedetomidine load of 0.5 to 1.0 microg/kg over 20 minutes followed by an infusion at rates of 0.01 to 1.0 microg/kg per hour. Four patients had extensive sensory and motor testing, and six underwent neurocognitive testing, including naming, reading, counting, and verbal fluency. There were no permanent neurologic deficits, except one patient who had an exacerbation of preoperative language difficulties. Dexmedetomidine appears to be a useful sedative for awake craniotomy when sophisticated neurologic testing is required.