Maternal dietary choline availability alters the balance of netrin-1 and DCC neuronal migration proteins in fetal mouse brain hippocampus

Alterations in maternal dietary choline availability during days 12-17 of pregnancy led to an increase in the level of immunoreactive netrin-1 and a decrease in the level of DCC protein in the developing fetal mouse brain hippocampus compared with controls. Changes in the expression of cell migration cues during development could account for some of the lifelong consequences of maternal dietary choline availability for cognitive and memory processes.     

Behavioral and hygienic characteristics of primary schoolchildren which can be modified to reduce the prevalence of geohelminth infections: a study in central Java, Indonesia

Five schools in central Java that enroll more than 500 students in grades one through six were chosen for a study of the prevalence of parasitic geohelminths and selected protozoan infections. The schools are located in regions that differ in geological features, density of vegetation and cultural and economic attributes. The prevalence of soil-transmitted helminths among children in the five schools ranged from 8.7% to 76.1%, and protozoan infections from 2.8% to 32.1%. The principal objective of the study was to identify physical, hygienic and behavioral characteristics of the children that increase the likelihood of becoming infected. Although most of the characteristics studied are considered to be contributing factors, few previous attempts have been made to rank them in order of importance in causing infection. The results of this study suggest that a systematic and sustained effort to teach children to (a) avoid certain types of behavior that favor infection, and (b) practice good personal hygiene, are the best approaches to significant and enduring reduction of the scourge of intestinal parasitism.     

Successful treatment of pure red cell aplasia associated with systemic lupus erythematosus with oral danazol and steroid

We describe a middle-aged Chinese systemic lupus erythematosus (SLE) patient developing steroid refractory and transfusion dependent red cell aplasia. Oral danazol 200 mg twice per day was started together with low-dose prednisolone therapy. There was no further recurrence of anemia 1 month after this combined therapy.     

Multidetector computed tomography of fracture-separation of the distal humeral epiphysis

A case of fracture-separation of the distal humeral epiphysis that was diagnosed using unenhanced multidetector computed tomography is reported. Fracture-separation of the distal humeral epiphysis is a rare injury of young children that is difficult to identify on routine radiographs and is frequently misdiagnosed at the time of initial evaluation.     

Intrathecal baclofen withdrawal: emergent recognition and management

Patients with severe spasticity are frequently encountered in the pediatric emergency department. Intrathecal baclofen therapy is being used increasingly to treat these patients. The purpose of this case series is to illustrate the importance of early recognition and treatment of intrathecal baclofen withdrawal, a potentially life-threatening complication of intrathecal baclofen therapy. Four cases of intrathecal baclofen withdrawal are presented.     

Long-term intrathecal baclofen therapy for severe spasticity of cerebral origin

OBJECT: The goal of this study was to ascertain the long-term effectiveness and safety of intrathecal baclofen (ITB) in the treatment of spasticity of cerebral origin in children and young adults. METHODS: A prospective, multicenter study was conducted in 68 patients who had been enrolled in the initial evaluation of ITB therapy and were willing to participate in long-term surveillance. Seventy-three percent of the patients were younger than 16 years of age at the time of study entry. The patients were examined at least every 3 months and were observed for an average of 70 months. At each follow-up visit, spasticity in the upper and lower extremities was evaluated by applying Ashworth scores. All adverse events and complications were recorded on standardized data forms. Spasticity in both upper and lower extremities decreased significantly (p < 0.005) and remained decreased up to 10 years. The dosage of ITB increased from a mean of 157 microg/day 3 months after pump insertion to 300 microg/day at 2 years postimplantation, and remained relatively stable thereafter. There were no significant differences in ITB dosage in children of different ages. Adverse events potentially related to ITB therapy occurred in 50% of patients within 2 months after pump insertion and in 50% of patients thereafter; hypotonia and lethargy were the two most common adverse events. The most common complications of surgery were catheter-related problems (31%), seromas (24%), and cerebrospinal fluid leaks (15%). CONCLUSIONS: Intrathecal baclofen provides effective long-term treatment of spasticity of cerebral origin and its effects do not appear to diminish with time. This therapy is frequently associated with adverse side effects that usually can be alleviated by adjustments in dosage.     

A genealogical assessment of heritable predisposition to aneurysms

OBJECT: This study was conducted to investigate the familial and genetic contribution to intracranial, abdominal aortic, and all other types of aneurysms, and to define familial relationships among patients who present with the different aneurysm types. METHODS: The authors used a unique Utah resource to perform population-based analysis of the familial nature of aneurysms. The Utah Population Data Base is a genealogy of the Utah population dating back eight generations, which is combined with death certificate data for the state of Utah dating back to 1904. Taking into account the genetic relationships among all aneurysm cases derived from this resource, the authors used a previously published method to estimate the familiality of different aneurysm types. Using internal, birth-cohort-specific rates of disease calculated from the database, they estimated relative risks by comparing observed to expected rates of aneurysm incidence in defined sets of relatives of probands. CONCLUSIONS: Each of the three aneurysm types investigated showed significant evidence for a genetic component. Relatives of patients with intracranial aneurysms do not appear to be at increased risk for abdominal or other lesions, but relatives of patients with abdominal aortic aneurysms appear to be at increased risk for other types of these lesions.     

Superior mesenteric artery syndrome in scoliosis surgery: weight percentile for height as an indicator of risk

A retrospective analysis of charts identified cases of superior mesenteric artery (SMA) syndrome occurring after scoliosis surgery over a 23-year period. Despite numerous reports on this potentially fatal complication of scoliosis surgery, no method exists to stratify patients for risk of developing disease after spine surgery. A study of charts was performed to identify all cases of SMA syndrome occurring after scoliosis surgery from 1972 to 1995. An upper gastrointestinal study with findings specific for the syndrome was requisite for inclusion. Patients' weight and height at the time of diagnosis of SMA syndrome were recorded. Based on standard national data tables, a percentile for weight, percentile for height, and a weight percentile for height were derived for each patient. The syndrome occurred after posterior spinal fusion in six patients (three boys, three girls). The average weight percentile for height, available in five of the six patients, was 3%, significantly different from both age-matched controls in the general population and from age-matched controls undergoing posterior spinal fusion for adolescent idiopathic scoliosis. This study, the largest reported from a single institution, suggests that a weight percentile for height of 5% is the degree of asthenia that allows compromise of the duodenum. The percentile identifies patients at risk for SMA syndrome for the purposes of increasing postoperative vigilance for gastrointestinal complaints, decreasing the threshold for diagnostic workup, and guiding perioperative dietary supplementation.