Color Doppler US imaging during pediatric neurosurgical and neuroradiologic procedures

Experience with color Doppler imaging (CDI) during 16 pediatric intraoperative and one percutaneous neuro-radiologic procedures was reviewed to assess whether CDI increased the success rate or decreased the procedure time, thus contributing substantially to procedure performance. Intraoperative CDI was used to rapidly identify abnormal vessels or displacement of normal vessels and correlated with preoperative studies. In six cases (four vascular malformations, one mycotic aneurysm, and one hamartoma), surgical resection was altered on the basis of flow information obtained. In one case of percutaneous embolization of a Galenic malformation, CDI provided information contributing to the cessation of the procedure. In six cases (debulking of three gliomas, resection of one vascular malformation, and two biopsies of nonneoplastic conditions), information was added but did not alter the surgical approach. In the remaining four cases (three cerebrospinal fluid drainage procedures, one posterior fossa decompression), no additional information was obtained. Consultation among the ultrasound staff, neuroradiologists, and neurosurgeons before the operative procedure maximized the usefulness of CDI, thus aiding in the success of surgery.     

Anger experiences among hepatitis C patients: relationship to depressive symptoms and health-related quality of life

The authors examined anger among hepatitis C (HCV) patients and its relationship to health-related quality of life (HRQL) and depression. Eighty-seven HCV patients who received pegylated interferon-alpha(2b) and ribavirin were included. Patients' mean age was 48 years; 42% were women, and 60% were white. Patients experienced moderate anger while undergoing HCV treatment. Angry feelings increased during treatment in some domains, specifically, Control Over Anger and Angry Reaction. Greater anger was associated with more depression and poorer HRQL. Findings point to the importance for physicians to screen for a wide range of neuropsychiatric side effects of interferon, including anger.     

The spinal pathophysiology of spasticity--from a basic science point of view

Spasticity is a term, which was introduced to describe the velocity-sensitive increased resistance of a limb to manipulation in subjects with lesions of descending motor pathways. This distinguishes spasticity from the changes in passive muscle properties, which are often seen in these patients, but are not velocity-sensitive. Increased excitability of the stretch reflex is thus a central component of the definition of spasticity. This review describes changes in cellular properties and transmission in a number of spinal reflex pathways, which may explain the increased stretch reflex excitability. The review focuses mainly on results derived from the use of non-invasive electrophysiological techniques, which have been developed during the past 20-30 years to investigate spinal neuronal networks in human subjects, but work from animal models is also considered. The reflex hyperexcitability develops over several months following the primary lesion and involves adaptation in the spinal neuronal circuitries caudal to the lesion. In animal models, changes in cellular properties (such as 'plateau potentials') have been reported, but the relevance of these changes to human spasticity has not been clarified. In humans, numerous studies have suggested that reduction of spinal inhibitory mechanisms (in particular that of disynaptic reciprocal inhibition) is involved. The inter-subject variability of these mechanisms and the lack of objective quantitative measures of spasticity have impeded disclosure of a clear causal relationship between the alterations in the inhibitory mechanisms and the stretch reflex hyperexcitability. Techniques which make such a quantitative measure possible as well as longitudinal studies where development of reflex excitability and changes in the inhibitory mechanisms are followed over time are in great demand.     

Socio-demographic patterning of referral, uptake and attendance in Physical Activity Referral Schemes

BACKGROUND: Inadequate monitoring and participant profiling have so far prevented a detailed examination of who Physical Activity Referral Schemes (PARS) are accessible to and appropriate for. As a result, the nature of the role for PARS within public health is unknown. METHODS: Participants were all those referred to a countywide PARS during a three-year period (n = 3568). Participant age, gender and the deprivation level and rurality of their area of residence were compared with the average for the county population. Characteristics associated with referral uptake (attending > or =1 exercise session) and completion (> or =80% attendance), were identified using logistic regression. RESULTS: Compared with the county average, participants were older, more predominantly female (61.1 vs 51.4%) and lived in more deprived areas (p < 0.001). Referral uptake (n = 2864) was most likely in those aged 60-69 years, and least likely for residents of rural villages and the most deprived areas (all p < 0.001). For participants who took up referral, completion was most likely in men and the over-seventies (p < 0.001). CONCLUSIONS: The PARS format may be inappropriate for younger adults or people living in relative deprivation and rural areas. They appear most appropriate for adults of middle-to-old age who are more likely to require supervision, and should be targeted accordingly.     

Retrieving rules for behavior from long-term memory

Human behavior is often dictated by rules or prescribed guides for action. Little is currently known regarding how these rules are stored in long-term memory or retrieved and implemented. Here, we examined the roles of ventrolateral prefrontal cortex (VLPFC) and posterior middle temporal gyrus (postMTG) in rule use. We tested two hypotheses: first, that knowledge about actions associated with abstract visual symbols is stored in postMTG, and second, that VLPFC is involved in the controlled retrieval of rule meanings. Subjects viewed a series of road signs during event-related fMRI data collection. Three types of signs were intermixed: highly familiar signs, novel signs whose meaning was explained to subjects prior to scanning, and novel signs whose meaning was not explained. Subjects were asked to think about the meaning of each sign as it was presented during scanning and then to give its meaning in a post-scan test. Left postMTG was more active when subjects viewed signs whose meaning they knew than signs whose meaning they did not know, consistent with a role in storing rule meanings. This region was not modulated by experience, in that it was equally engaged by newly trained and well-learned signs. In contrast, right VLPFC was more active for newly trained signs than for either well-learned or incorrect ones, consistent with a role in controlled retrieval. Left VLPFC was reliably engaged while subjects attempted to interpret the signs but did not differ according to knowledge or experience. These data implicate postMTG in rule storage and VLPFC in rule retrieval.     

Depression, anxiety and quality-of-life among relatives of patients with severe brain injury: The acute phase

Primary objective: To investigate the emotional well-being of relatives of patients with a severe brain injury in the acute setting, as well as risk factors associated with high anxiety and depression scores and impaired quality-of-life. Research design: Clinical convenience sample. Methods and procedures: Participants included 45 relatives of patients with severe brain injury recruited at a NICU. All relatives completed selected scales from the SCL-90-R and SF-36 ～ 14 days after injury. Data concerning the condition of the patient were also collected. Main outcome and results: Of the relatives, 51% and 69% reported anxiety and depression, respectively, as well as significantly impaired quality-of-life compared to normal reference populations. Regression analysis revealed that up to 20% of the variance in depression and anxiety scores could be explained by the CRASH 2 Mortality prediction. Conclusions: The majority of the relatives had severely impaired quality-of-life and symptoms of anxiety and depression during the patient's NICU stay. Future research is required to explore stressors and evaluate effects of psychological intervention in the acute setting.     

Prevalence of passive smoking in infancy in The Netherlands

The objective of the study was to assess the prevalence of passive smoking in infancy. This was done by self-report questionnaires completed by parents who attended the well-baby clinic in the period February-May 1996. A total of 2720 questionnaires were spread among parents with babies between 1 and 14 months: smoking and non-smoking parents. The questionnaires contained questions on smoking habits, smoking at home, smoking in presence of the baby. A total of 1702 parents filled in and returned the questionnaire (63%); 24% of the mothers and 33% of their partners smoked. In 44% of the families, one or more persons smoked; 22% of the mothers and 26% of the partners smoked at home. In 39% of the families, one or both parents smoked at home; 42% of the babies were exposed to tobacco smoke in the living-room, 8% were exposed in the car, and 4% during feeding. In cases where only the mother smoked, 13% of the infants were exposed to tobacco smoke during feeding. In the families where only the partner smoked, the babies were predominantly exposed to smoke in the car (18%). If both parents smoked, the child was most frequently exposed to tobacco smoke in the living-room (73%). It can be concluded that health workers, nurses, pediatricians and family physicians should be advised to inform parents systematically of the harmful effects of passive smoking in infancy. If parents are unable or unwilling to stop smoking, it is important to advise them to refrain from smoking in the presence of the baby.