Superior temporal gyrus in schizophrenia: a volumetric magnetic resonance imaging study

The left superior temporal gyrus (STG) has been reported to be smaller in patients with schizophrenia. The volume of the STG has been found to correlate negatively with severity of hallucinations and thought disorder. In this study, we measured the STG volume of 20 normal controls and 20 patients with schizophrenia using 3 mm contiguous coronal T1 magnetic resonance images. We found that patients had a significantly smaller left anterior STG, and that the volume of this region negatively correlated with the severity of hallucinations. The left posterior STG was not significantly smaller in patients than in controls, but its volume negatively correlated with severity of thought disorder. We also found that the left anterior STG was smaller than the right STG in patients but not in controls. The STG has at least three histologically distinct areas, each with different connections to the rest of the brain. These data are consistent with the proposition that dysfunction of the primary auditory cortex in the anterior and middle STG and auditory association cortex in the posterior STG may play a role in the production of auditory perceptual abnormalities and poor organization of thought respectively.     

Respiratory failure and intraoperative oxygenation following oesophagectomy

Respiratory complications are a major cause of morbidity andmortality following oesophagectomy.¹ We hypothesized that patientswho develop postoperative respiratory failure would have anunstable intraoperative course. Two stage oesophagectomy requiresa period of one lung ventilation (OLV) and one measure of intraoperativeinstability is desaturation during OLV. We therefore studiedthe relationship between Sa_O2 during OLV and postoperative course.Previous work has focused on preoperative factors associatedwith postoperative complications.² There is little informationon intraoperative factors that may influence outcome. We performed a retrospective analysis of all elective oesophagectomiesperformed between January 1998 and August 1999. Seventy-sevenpatients had a 2-stage sub-total oesophagectomy requiring OLV.Oxygen saturation recorded on the anaesthetic chart during OLVwas plotted on a fixed linear scale of 0–100% againsttime for each patient. The area above the curve was calculated,as a measure of intraoperative oxygenation during OLV. Thiswas standardized by dividing the area by the OLV duration, thusobtaining the Area Per Unit Time (APUT). The postoperative courseof each patient was recorded including outcome, total durationof ITU stay and the worst Pa_O2/F_O2 ratioattained. ARDS was defined using the American-European ConsensusConference on ARDS criteria. Twenty-one patients had a prolongedITU stay (>48 h) and all had a persistent Pa_O2/F_O2<27. Thirteen patients (17% of the total) fulfilled the ConsensusConference criteria for ARDS and seven of these died in hospital. Total OLV time was not significantly different between the groupsbut patients who developed ARDS had significantly greater intraoperativehypoxaemia as measured by the APUT (Table 17). We conclude thatintraoperative hypoxaemia is associated with respiratory failurefollowing oesophagectomy.     

Fulminant radiation-induced necrosis after stereotactic radiation therapy to the posterior fossa. Case report and review of the literature

The problem of radiation-induced necrosis of normal brain surrounding the target area has been a major catalyst for the development of stereotactically focused radiation therapy. According to current opinion, the effects of stereotactic irradiation are confined to the region targeted. The authors present a case in which the administration of a conventional dose of stereotactically focused irradiation for treatment of a pilocytic astrocytoma produced fulminant necrosis that necessitated a combination of intensive surgical and medical management, after which the patient improved over the course of 1 year. Concomitant with his improvement, the initially remarkable findings on magnetic resonance imaging gradually resolved. In this presentation the authors emphasize the need to evaluate alternatives carefully before a decision is made to administer therapeutic irradiation. Furthermore, they explore the roles that target, host, and dosage factors play in hypersensitivity to radiation injury, the detection of these factors before treatment, and the administration of radioprotective agents. With the growing use of stereotactically focused irradiation as a primary treatment modality for a variety of neurosurgical conditions, it is important to be cognizant of its uncommon but potentially lethal side effects. A cooperative multicenter database in which the outcomes and morbidity following stereotactic irradiation are recorded is essential to the detection of relatively uncommon but severe complications such as those observed in this case.     

Comparative evaluation of marginal integrity of two new fissure sealants using invasive and non-invasive techniques: a SEM study

In this era of preventive dentistry, many dental materials used for prevention of dental diseases are available. Since last few decades efforts are being directed towards prevention of dental caries which is one of the major dental diseases tormenting mankind. The main avenues available are plaque control, use of systemic and local fluorides and use of fissure sealants. There are many factors that contribute towards a successful sealant restoration such as properties of enamel, duration of etching, acid used for etching, manipulative variables. However, one of the prime factors governing the efficacy and life expectancy of a sealant is the marginal adaptability. This study was carried out on a total of 40 intact premolar teeth, which were divided in four main groups and subjected to evaluation under Scanning Electron Microscope. The parameters checked were the width and the number of marginal gaps. The results obtained showed that Teethmate had better marginal integrity and favored the use of invasive technique over non-invasive technique.     

Surgical considerations in malignant neoplasia of nose and paranasal sinuses

Most recurrences of cancers of the nose and paranasal sinuses are attributed to inadequate local control of disease. Since such tumours are usually advanced a standard maxillectomy procedure is inadequate Nevertheless batter local control is obtainable by modifying palatal zygomatic or superior bone cuts (cranifacial resection) or including an appropriate part of the septum in the specimen. This paper describes 78 such cases undergoing surgicad ablation. Uses of CT and modifications of standard surgical techniques adapted for various tumour extensions are described.     

Clinical course of isolated ventricular septal defect: An Indian experience

To define the clinical course of ventricular septal defect, 410 consecutive patients with isolated ventricular septal defect were evaluated over a period of 13 years. Their age ranged from 12 days to 24 years at the time of first visit to the hospital. Patients with less than 2 years follow-up period were excluded. One hundred and fifty seven patients were one year of age or less. The left to right shunt size remained the same in 52.4% of cases. In 34.4% the shunt size decreased, with complete closure of ventricular septal defect in 8.8%. Closure of ventricular septal defect was observed even in patients who had initially presented with large left to right flow, and congestive heart failure in infancy. Right ventricular outflow tract obstruction developed in 8.5% of patients usually between 2 and 10 years of age. Murmur of aortic regurgitation appeared in 8.9% on follow-up. Infective endocarditis developed in 6 cases. The unfortunate complication of Eisemenger's complex was seen in 3 patients; they had not returned for follow up for a long period of time. Hence, our data show that the left to right shunt across the ventricular septal defect decreases in about one-third of patients. However, a regular follow up is essential to prevent development of Eisenmenger's complex and for early detection of other complications like aortic regurgitation and right ventricular outflow tract obstruction.     

Hypophosphatemic rickets : Easy to diagnose, difficult to treat

Hypophosphatemic rickets (HR) has generated a lot of interest in recent times. There is need to recognize this disorder and differentiate it from the more common nutritional rickets because the therapy is different. It is also important to emphasize that a detailed clinical examination with pedigree analysis and easily available biochemical tests are adequate to establish the diagnosis in most cases. This report presents three families with hypophosphatemic rickets. Interestingly, many of these patients had a mixed picture of HR and nutritional rickets. Their important features are described with special emphasis on early initiation of treatment with oral phosphate and stringent monitoring of renal functions to prevent development of irreversible renal insufficiency.