Secondary generalized epilepsy in childhood: EEG patterns and correlation with responsiveness to benzodiazepines or ACTH (preliminary note)

Secondary generalized epilepsy in childhood, characterized by absences or minor motor seizures, occurs in the forms of various syndromes, as defined by current classifications. EEG often shows continuous or subcontinuous paroxysmal activity associated with partly reversible psychomotor or mental regression. The paroxysmal activity can exhibit one of two distinct patterns: "organized" or "disorganized," although intermediate forms are common. The two patterns differ not only morphologically but also in the responsiveness to drug or hormone therapy, reactivity to stimuli, sleep changes and frequency of disordered slow rhythms. These features are illustrated by means of a survey of 10 cases.     

Somatosensory evoked potentials following nerve and segmental stimulation do not confirm cervical radiculopathy with sensory deficit.

Twenty eight patients with unilateral cervical radiculopathy were studied by somatosensory evoked potentials (SEPs) from nerve stimulation at the wrist and from skin stimulation at the first, third or fifth finger depending on the root involved. In order to evaluate the reliability of various "radicular SEP patterns" as described in the literature, absolute latencies and side-to-side differences of the brachial plexus component from the supraclavicular fossa (N9), the medullary component (N13) from the cervical vertebra Cv7, and the primary cortical component (N20, P25) were assessed. Side-to-side differences of the amplitudes of N20/P25 and of the conduction times across the intervertebral fossa (interval N9-N13) were analysed. After nerve stimulation, 68% of the patients had false negative findings on the symptomatic, while 36% had positive findings on the asymptomatic side. After segmental stimulation, 72% of the patients had false negative findings on the symptomatic, while 22% had positive findings on the asymptomatic side. It is concluded that SEPs following nerve and segmental stimulation do not reliably confirm clear-cut already established diagnoses of unilateral radiculopathy with sensory and motor deficit. Therefore, they will not be helpful in the electrophysiological investigation of cervicobrachialgias of unknown origin.     

Reverse targeting of preventive care due to lack of health insurance

We analyzed patterns of receipt of preventive services among middle-aged women, with particular attention to health insurance coverage, based on data from the National Health Interview Survey. Lack of insurance was most prevalent among socioeconomically disadvantaged women at high risk for disease and was the strongest predictor of failure to receive screening tests. The relative risk of inadequate screening for uninsured compared with insured women was 1.60 (95% confidence interval [Cl], 1.40 to 1.83) for blood pressure checkups, 1.55 (95% Cl, 1.43 to 1.68) for cervical smears, 1.52 (95% Cl, 1.41 to 1.63) for glaucoma testing, and 1.42 (95% Cl, 1.33 to 1.51) for clinical breast examination. Controlling for demographic and health status variables did not diminish the effect of insurance coverage. We conclude that inadequate insurance coverage leads to "reverse targeting" of preventive care--that is, populations at highest risk are least likely to be screened. This compromises both the effectiveness and the cost-effectiveness of screening.     

Laser welded vascular anastomosis

Summary A comparative study was undertaken to investigate the application of a specially adapted microsurgical Neodymium Yag Laser system with a wavelength of 1,319 m and a CO₂ laser system for laser assisted microvascular end-to-end anastomosis (LAMA) of the rat femoral artery. Conventionally sutured anastomoses served as controls. Postoperative investigations included patency tests, light microscopy and tensile strength measurements. Both laser systems seem to be equally suitable for LAMA: The patency rates do not differ from those of sutured anstomoses and formation of microscopically small aneurysms occurred predominantly in control animals and only once in laser groups. The clamp time needed for LAMA was half the time that was needed for sutured anastomoses. Wound healing in all groups was similar with less fibrotic reactions and less foreign body granulomas in laser groups. At all intervals tensile strength was significantly higher for sutured anastomoses while differences between the CO₂- and the ND: Yag-laser groups were not statistically significant. Potential applications in urology include microvascular anastomoses in erectile dysfunction, pediatric and reconstructive urology.Contains parts of a dissertation     

Ultrasound screening for hip dysplasia in neonates

In a pilot study, hip development in 615 newborn children was assessed sonographically. Distinct dysplasia was found in 2.3%, and an intermediate "physiologically immature" hip development was noted in 13%. The number of controls and expenses would greatly increase if all physiologically immature hips were followed until they reached maturity. To reduce the number of unnecessary control and to facilitate assessment, we propose the use of "cut-off values" in a screening program for newborns.     

Activation of inflammatory systems during cardiopulmonary bypass

"Whole body inflammation" induced by cardiopulmonary bypass may play a role in the pathogenesis of postoperative complications after open-heart surgery. The inflammatory response, in terms of complement activation and release of granular proteins from neutrophil granulocytes, was investigated in six patients undergoing aortocoronary bypass surgery. Complement activation was demonstrated as well as substantially increased plasma levels of lactoferrin and myeloperoxidase--two granulocyte factors. The activation of inflammatory systems probably takes place on the artificial surfaces of the extracorporeal device. The biocompatibility of these components therefore should be further studied.     

Atypical fibroxanthoma. A study of 14 cases emphasizing the presence of Langerhans' histiocytes with implications for differential diagnosis by antibody panels

Fourteen consecutive cases of atypical fibroxanthoma (AFX) seen during a 4-year period were studied histologically; of these, 12 were further examined for the presence of immunocytochemically detectable cytokeratin (CK), vimentin (VIM), S-100 protein, melanocyte-associated antigen (MAA), muscle-specific actin (MSA), alpha-1-antitrypsin (A1AT), alpha-1-antichymotrypsin (A1ACT), and ferritin (FER). In four cases, electron microscopy was also performed. Tumor cells were nonreactive with antibodies directed against CK and MAA, strongly reactive with anti-VIM, and variably reactive with A1AT, A1ACT, MSA, and FER. Our findings are consistent with the current notion that these tumors are "fibrohistiocytic". However, in 11 of 12 cases studied, a subpopulation of cells with features of Langerhans' histiocytes (LH) was also identified. These were dendritic cells within the substance of the tumor that were strongly reactive with S-100 antibody and uniformally nonreactive with MAA antibody; ultrastructurally, they were seen to contain typical Birbeck granules. LH characteristically comprised no more than 5% of the overall cell population of the tumor; however, in restricted portions of some lesions, they sometimes accounted for up to 80% of tumor cells. The occurrence of LH in AFX, although previously reported, has not generally been emphasized. Awareness of their presence as an expected and sometimes extensive component of AFX can be important when interpreting differential immunocytochemical panels applied to malignant spindle cell tumors of skin.     

Objective and subjective effects of remoxipride, alone and in combination with ethanol or diazepam, on performance in healthy subjects

Effects on human performance of remoxipride (RX), an antipsychotic drug of substituted benzamide structure, were studied in a randomized double-blind crossover trial where 12 young healthy volunteers took at 1 week intervals single oral doses of placebo or remoxipiride 100 mg both alone and in combination with 15 mg diazepam (DZ) or 0.8 g/kg ethanol (EtOH). Objective (digit symbols, tracking, choice reaction, flicker fusion, Maddox wing, body balance, memory) and subjective (visual analogue scales, questionnaire) tests were administered at baseline and 1.5, 3, 4.5 and 6 h post-treatment.     

Non-Hodgkin's lymphomas in 137 patients aged 70 years or older: a retrospective European Organization for Research and Treatment of Cancer Lymphoma Group Study

The results of a European Organization for Research and Treatment of Cancer (EORTC) retrospective study on non-Hodgkin's lymphoma (NHL) in elderly patients (greater than or equal to 70 years of age) seen in Europe in 1984 are reported. A precodified form was sent to 55 European institutes in order to evaluate the incidence of NHL in the elderly with regard to natural history, treatment-related toxicity, response, and survival. Thirteen institutes participated in the study. One hundred thirty-seven cases of NHL were observed in the elderly during 1984, making up 28% of the total number of NHL seen in those institutes. The median age was 77 years; 21% of the patients had favorable (low-grade) and 73% unfavorable (intermediate- and high-grade) histology, according to the Working Formulation. Stage at presentation was localized (I and II) in 60% and advanced in 37% of the patients. Most of the physicians used standard therapy regimens at reduced doses, from the beginning of the treatment. Sixty patients (44%) underwent a "conservative" treatment (one or two antineoplastic drugs or local field radiotherapy) and 77 (56%) an "aggressive" treatment (polychemotherapy regimens or extended field radiotherapy). Response was similar between the two treatment groups, but severe and lethal toxicity was significantly higher among patients treated with aggressive therapy. Prospective randomized studies are clearly needed to define the optimal treatment in elderly patients with advanced unfavorable NHL.     

Differences in DNA-fingerprints between remission and relapse in childhood acute lymphoblastic leukemia

DNA "fingerprint" (DNA-F) analysis, based on the polymorphism caused by numeric variations in the tandem repeats of minisatellite areas of the human genome, has a potential capacity to reveal even minor genomic changes. In this study we have applied DNA-F to the detection of residual disease in leukemia. In order to identify normal and leukemic cell populations, we used two molecular probes: Jeffrey's minisatellite probes and M13 wild type phage probe, which detect different sets of polymorphic fragments in the human genome. Comparison of varying minisatellite fragments between remission and relapse was performed by Southern blot hybridization in seven patients with acute lymphoblastic leukemia (ALL). The results suggest that Southern hybridization with DNA "fingerprint" probes can prove to be a sensitive method in the detection of minimal residual disease in ALL.