Hyperventilation response in the electroencephalogram and psychiatric problems in children with primary monosymptomatic nocturnal enuresis

OBJECTIVES: The aim of this study was to determine the frequency of an increased hyperventilation (HV) response in the electroencephalogram and to compare the results of psychometric assessments and electroencephalography (EEG) patterns in children with and without primary monosymptomatic nocturnal enuresis and in dry siblings of enuretics. We also compared the results of psychometric assessments and EEG patterns between enuretic and non-enuretic children. MATERIAL AND METHODS: The study included 89 children divided into three groups: 41 with primary monosymptomatic nocturnal enuresis, their 29 dry siblings and 19 with no history of voiding dysfunction (controls). Resting EEG changes were evaluated in all children. In addition to a psychiatric evaluation, the Maudsley Obsessive Compulsive Questionnaire, the Beck Child Depression Inventory and the State and Trait Anxiety Inventory for Children were used to assess obsessive-compulsive disorder, depression and anxiety, respectively. RESULTS: The time at which real words were first spoken occurred significantly later in enuretic children (p<0.01). The frequency of EEG abnormalities was significantly higher in the enuresis group and in their dry siblings than in the control group (p<0.01). Additionally, as an indicator of cortical dysmaturity, an increased HV response was observed more often in enuretic children and their dry siblings than in the control group (p<0.001). Anxiety scores for the enuretic children were higher than those for the controls (p<0.01). There was no significant difference in psychiatric problems between the enuresis and control groups (p>0.05). CONCLUSIONS: The increased frequency of a high-level HV response in resting-state EEG recordings and the anxiety scores suggested that delayed cortical maturity and high anxiety may be important factors in the pathogenesis of primary monosymptomatic nocturnal enuresis. The HV responses in the dry siblings of the enuretic children may emphasize the relationship between insufficient cerebral maturation and the genetic origin of nocturnal enuresis.     

Subclinical peripheral neuropathy associated with chronic obstructive pulmonary disease

Peripheral nervous system disorders in COPD (chronic obstructive pulmonary disease) have been found more frequently than usual neurologic practice. We planned this prospective clinical and electrophysiological study to determine the incidence and characteristics of neuropathy in patients with COPD. We studied 49 patients with COPD in whom other causes of polyneuropathy had been excluded. COPD patients were divided into two groups: 21 hypoxemic and 28 normoxemic. Age and sex matched, nonsmoker, 21 healthy subjects were included as the control group. We investigated the results of clinical (neurological symptom score-NSS, neurological disability score-NDS and vibration perception thresholds- VPT) and neurophysiological evaluations in COPD patients and the control group. A value over the mean +/- 2.5 SD of control group were accepted pathologic. NSS results were pathologic in 34% of COPD patients, NDS in 42% and VPT in 94%. Carpal tunnel syndrome was found in 24% of the patients, neuropathy in 55%, and polyneuropathy in 44.8%. In conclusion, the incidence of neuropathy was more than expected, the rate of axonal neuropathy was significantly higher in the hypoxemic group than normoxemic group and the severity of neuropathy was correlated with the degree of hypoxemia.     

Bilateral narrow duplicated internal auditory canal

Internal auditory canal (IAC) anomalies are rare malformations that may include alterations of shape, size or orientation of the IAC. Bilateral duplication of IAC is a very rare malformation and only one case has been described in literature. We report a case of bilateral duplicated IAC together with other inner ear anomalies.     

Withdrawal of inhaled steroids in children with non‐cystic fibrosis bronchiectasis

Background: To study the effects of inhaled steroid withdrawal on bronchial hyperreactivity, sputum inflammatory markers and neutrophilic apoptosis in children with non‐cystic fibrosis (non‐CF) bronchiectasis. Objectives: To evaluate the role of inhaled steroids in the treatment of children with non‐CF bronchiectasis with specific emphasis on the bronchial hyperreactivity and neutrophilic apoptosis. Methods: Twenty‐seven children with steady‐state non‐CF bronchiectasis were evaluated primarily with metacholine challenge tests and apoptotic neutrophil ratios in induced sputum and secondarily with symptom scores, pulmonary function tests and tumour necrosis factor‐alpha (TNF‐α), interleukin‐8 (IL‐8) levels and neutrophil ratios in induced sputum before and after 12‐week withdrawal of inhaled steroids. Results: There were 16 girls and 11 boys. Median (interquartile range) age was 11·4 (9·5–13·6) years, follow‐up duration was 3·5 (2–6·5) years. Symptom scores (4 vs. 3; P = 0·27), oxygen saturation (95% vs. 97%; P = 0·06), pulmonary function tests (FEV1: 82% predicted vs. 83% predicted; P = 0·73), sputum neutrophil ratios (29·9% vs. 46·8%; P = 0·20), TNF‐α (58 pg/mL vs. 44·5 pg/mL; P = 0·55) and IL‐8 (2·7 ng/mL vs. 2·4 ng/mL; P = 0·82) levels in induced sputum were similar before and after 12‐week withdrawal of inhaled steroids. However, the number of patients with bronchial hyperreactivity increased (37% vs. 63% of patients; P = 0·016) and neutrophilic apoptosis in induced sputum decreased (42·8% vs. 20·2%; P = 0·03) after withdrawal. Conclusion: In this study, 12 week‐withdrawal of inhaled steroid treatment resulted in a significant increase in bronchial hyperreactivity and decrease in neutrophil apoptosis, but no change in sputum inflammatory markers in children with non‐CF bronchiectasis was observed.     

Tauroursodeoxycholic acid and secondary damage after spinal cord injury in rats.

Greater clinical understanding of the pivotal role of apoptosis in spinal cord injury (SCI) has led to new and innovative apoptosis-based therapies for patients with an SCI. Tauroursodeoxycholic acid (TUDCA) is a biliary acid with antiapoptotic properties. To our knowledge, this is the first study in the English language to evaluate the therapeutic efficacy of TUDCA in an experimental model of SCI. Thirty rats were randomized into three groups (sham-operated, trauma only, and trauma plus TUDCA treatment) of 10 each. In groups 2 and 3, spinal cord trauma was produced at the T8-T10 level via the Allen weight drop technique. Rats in group 3 were treated with TUDCA (200 mg/kg intraperitoneal) 1 min after trauma. The rats were killed either 24 h or 5 days after injury. The neuroprotective effect of TUDCA on injured spinal cord tissue and the effects of that agent on the recovery of hind-limb function were assessed. The efficacy of treatment was evaluated with histopathologic examination and terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling (TUNEL) analysis. Histopathologic characteristics were analyzed by comparison of hematoxylin-and-eosin stained specimens. Neurologic evaluations were performed 24 h, 3 days, and 5 days after trauma. Hind-limb function was assessed with the inclined plane technique of Rivlin and Tator and the modified version of Tarlov's grading scale. Twenty-four hours after injury, there was a significantly higher number of apoptotic cells in the lesioned spinal cord group than in the sham-operated control group. Treatment of the rats with TUDCA significantly reduced the number of apoptotic cells (4.52+/-0.30 vs. 2.31+/-0.24 in group 2) and the degree of tissue injury. Histopathologic examination showed that group 3 rats had better spinal cord architecture compared with group 2 rats. Five days after injury, the mean inclined plane angles in groups 1, 2, and 3 were 65.50 degrees +/- 2.09, 42.00 degrees +/- 2.74, and 53.50 degrees +/- 1.36. Motor grading of the rats revealed a similar trend. These differences were statistically significant (p<0.05). The mechanism of neuroprotection in the treated rats, although not yet elucidated, may be related to the marked antiapoptotic properties of TUDCA. A therapeutic strategy using TUDCA may eventually lead to effective treatment of SCI without toxic effects in humans.     

Psychological distress in chronic obstructive pulmonary disease patients

Stress is defined as the exposure of an individual to a threatening stimulus or overwhelming event. Increased rates of psychological distress have been established in patients with chronic diseases compared to healthy individuals. The objective of the present study is to assess the indicators and correlates of psychological distress in chronic obstructive pulmonary disease (COPD) patients. We evaluated the stress exposure (stressful events that COPD patients and control subjects had been exposed) by a life events checklist and psychological distress by General Health Questionnaire in 74 COPD patients and 30 control subjects. Serum adrenocorticotropic hormone (ACTH) and cortisol levels were measured as biochemical indicators of stress. Distress score was higher in COPD group compared to age‐matched controls, although the stress exposure score were not statistically different; indicating that COPD itself is a source of distress. 92% of COPD patients and 87% of control subjects had varying degrees of distress. Severe distress was more frequent in COPD group. Distress score was further increased in patients with severe COPD and severe hypoxemia.There was no significant difference in serum ACTH and cortisol levels of COPD patients and control subjects and distress scores were not correlated to serum ACTH and cortisol levels. However, serum cortisol was higher in patients with severe hypoxemia. These findings support the importance of screening for psychological distress symptoms in COPD outpatients. Since high degree of distress contributes to impaired quality of life and added morbidity, patients with COPD need a comprehensive care including a psychological evaluation. Copyright © 2008 John Wiley & Sons, Ltd.     

Exteroceptive suppression patterns of masseter and temporalis muscles in central and peripheral headache disorders

The objective of this study was to compare the exteroceptive suppression patterns of masseter and temporalis muscles in patients with primary and secondary headache disorders originating from peripheral joint dysfunction. We accomplished the temporalis and masseter exteroceptive suppression in 28 patients with migraine, 25 patients with chronic tension-type headache (CTH), 22 patients with temporomandibular joint (TMJ) dysfunction and 18 healthy controls. The onset latencies and duration of the first suppression period (S1) was not significantly different between the patients and controls. The duration of the second suppression period (S2) was shorter in patients with CTH, migraine (analysed during attack) and TMJ dysfunction than those obtained from controls. A distinctive finding was significantly prolonged onset latency in patients with TMJ over those obtained from patients with CTH and migraine. We concluded that the onset latency of the S2 period is a useful parameter in the differential diagnosis of primary and peripheral headache disorders.     

Circulating leptin and body composition in chronic obstructive pulmonary disease

Nutritional depletion and weight loss are two features of chronic obstructive pulmonary disease (COPD), and the association between low body mass index (BMI) and poor prognosis in patients with COPD is a common clinical observation. Mechanisms of weight loss are still unclear in COPD. Excessive energy expenditure partly due to increased work of breathing was shown, but other mechanisms have been searched for. Leptin is a hormone secreted by adipocytes that plays an important role in energy homeostasis and regulates body weight through control of appetite and energy expenditure. The aim of this study was to evaluate the association of circulating leptin levels and measures of body composition in COPD patients. Thirty male COPD outpatients (mean age 66.3 +/- 8.4) and 20 controls (mean age 65.9 +/- 10.8) were included in the study. After standard spirometry and body composition measurements, serum leptin concentration was measured by ELISA assay. COPD patients were grouped according to BMI. Mean BMI was 19.01 +/- 2.26 kg/m2 in group 1 (COPD patients with low BMI), 26.85 +/- 4.51 in group 2 COPD (COPD patients with normal/high BMI) and 27.64 +/- 2.75 kg/m2 in healthy controls (group 3). Mean serum leptin concentration was 1.41 +/- 1.86 ng/ml in group 1, 2.60 +/- 1.38 ng/ml in group 2 and 2.82 +/- 1.46 ng/ml in group 3 (p = 0.002). Leptin correlated to not only BMI but also body weight, waist circumference, triceps and biceps skinfold thickness and body fat percent (p < 0.05 for all). Results of this study suggest that the cause of weight loss is not increased circulating leptin in COPD. Instead, leptin remains regulated in COPD and further decreased in patients with low BMI, probably as a compensatory mechanism to preserve body fat content, which should be evaluated in further studies.     

Normal values of cervical vertebral measurements according to age and sex in CT

Introduction

Atlantodental interval (ADI), basion-dental interval (BDI) and the thickness of prevertebral soft tissue (TOPST) measured in lateral cervical radiographs were reported to be useful indicators and indirect signs of underlying cervical spine injuries. However, cervical computed tomography (MDCT) is the first method of imaging used in all trauma patients and upper normal limits (UNLs) of cervical distances according to age and sex are undetermined. Therefore, we aimed to calculate these metrics.