Facial Nerve Monitoring under Neuromuscular Blockade

The characteristics of facial nerve electromyography at various levels of neuromuscular blockade are unclear. Partial blockade is well known to facilitate anesthetic safety and management. However, the use of neuromuscular blockage in many skull base procedures is avoided to allow intraoperative facial nerve monitoring.We studied the influence of various levels of neuromuscular blockade on facial nerve stimulation in the New Zealand white rabbit. The facial nerve was exposed in the middle ear of six rabbits. Using electromyographic-type facial nerve monitor, we recorded the facial electromyography signals in these rabbits at increasing levels of vecuronium-induced neuromuscular blockade. All animals demonstrated reliable facial electromyography response at all levels of partial neuromuscular blockade (P < .02). Five of the six animals could be monitored throughout complete blockade. These results clearly demonstrate that rabbit facial electromyography monitoring is possible under neuromuscular blockade. The effect of neuromuscular blockers on facial electromyography monitoring deserves further study, as partial blockade would greatly facilitate the management of anesthesia in otologic, neurotologic, and skull base surgery.     

The role of convexity in perceptual completion: beyond good continuation

Since the seminal work of the Gestalt psychologists, there has been great interest in understanding what factors determine the perceptual organization of images. While the Gestaltists demonstrated the significance of grouping cues such as similarity, proximity and good continuation, it has not been well understood whether their catalog of grouping cues is complete--in part due to the paucity of effective methodologies for examining the significance of various grouping cues. We describe a novel, objective method to study perceptual grouping of planar regions separated by an occluder. We demonstrate that the stronger the grouping between two such regions, the harder it will be to resolve their relative stereoscopic depth. We use this new method to call into question many existing theories of perceptual completion (Ullman, S. (1976). Biological Cybernetics, 25, 1-6; Shashua, A., & Ullman, S. (1988). 2nd International Conference on Computer Vision (pp. 321-327); Parent, P., & Zucker, S. (1989). IEEE Transactions on Pattern Analysis and Machine Intelligence, 11, 823-839; Kellman, P. J., & Shipley, T. F. (1991). Cognitive psychology, Liveright, New York; Heitger, R., & von der Heydt, R. (1993). A computational model of neural contour processing, figure-ground segregation and illusory contours. In Internal Conference Computer Vision (pp. 32-40); Mumford, D. (1994). Algebraic geometry and its applications, Springer, New York; Williams, L. R., & Jacobs, D. W. (1997). Neural Computation, 9, 837-858) that are based on Gestalt grouping cues by demonstrating that convexity plays a strong role in perceptual completion. In some cases convexity dominates the effects of the well known Gestalt cue of good continuation. While convexity has been known to play a role in figure/ground segmentation (Rubin, 1927; Kanizsa & Gerbino, 1976), this is the first demonstration of its importance in perceptual completion.     

Hypozincaemia in febrile convulsion

To understand further the role of trace elements in the pathogenesis of febrile convulsions, serum zinc (Zn), copper (Cu), magnesium (Mg) and CSF Zn, Cu, Mg and protein levels were measured by spectrometry in patients with febrile convulsion (n=19), bacterial meningitis (n=9), viral CNS infection (n=16) and in the control groupn=10) which consisted of children with signs of meningeal irritation due to upper respiratory tract infection but normal CSF findings. Samples were obtained within 6 h after admission to hospital. Mean serum and CSF Zn levels in the febrile convulsion group were significantly lower than in the other groups (for serum Zn: 0.66±0.03 mg/l vs 0.98±0.07 mg/l, 1.06±0.08 mg/l, 1.05±0.09 mg/lP<0.05; for CSF Zn: 22.96±1.62 g/l vs 75.47 ±6.9 g/l, 50.32±5.235 g/l, 39.85 ±2.81 g/lP<0.05). A linear relationship was established between serum Zn and CSF Zn levels (P<0.001). Mean CSF Zn, Cu and protein levels in the bacterial meningitis group were significantly higher than in the other groups (for CSF Cu 63.94±6.33 g/l vs 38.77±2.70 g/l, 35.84±3.48 g/l, 33.86±2.88 g/lP<0.05; for CSF protein 0.80 ± 0.12 g/l vs 0.22±0.02 g/l, 0.53±0.08 g/l, 0.19±0.01 g/lP<0.05). In children with meningitis, the elevation of the mean CSF Zn and Cu levels may result from the breakdown of the blood-brain barrier and subsequent leakage of trace elements and protein from serum to CSF. There was no significant difference between the four groups in terms of mean serum Mg and mean CSF Mg levels.Conclusion Serum and CSF Zn levels are decreased in children with febrile seizures. Zinc deprivation may play a role in the pathogenesis of febrile seizures.     

Organophosphate pesticide dichlorvos-induced increase in the rate of lipid peroxidation in the different regions of the rat brain: supporting ultrastructural findings

Commonly used organophosphate pesticide dichlorvos is known to cause neurologic lesions. However, the exact mechanism of its neurotoxicity is, as yet, unclear. Using dose-dependent inhibition of acetylcholinesterase activity as an index of its neurotoxicity, effects of three different doses of dichlorvos (0.6 mg, 1.5 mg, and 3.0 mg/kg body weight i.p. daily for 10 days) have been observed on the rate of lipid-peroxidation in the cerebrum, cerebellum and brain stem of albino rats. Simultaneously, electron microscopic study of the dichlorvos intoxicated rat cerebellum was also carried out. Dose-dependent increase in the rate of lipid peroxidation was found in all the brain regions, and increased incidence of lipofuscin-like pigment granules was discernible in the Purkinie cells of the cerebellar cortex.     

Population-based studies of childhood disability in developing countries: rationale and study design

Infant mortality level has been used for decades to indicate the health and socioeconomic status of populations. Given the relative availability of necessary data, this indicator has proved most viable. As the more glaring aspects of underdevelopment fade into history in some countries, other health status indices should be considered. Childhood disability is proposed as 1 such indicator. Disability is neither subsumed by nor necessarily correlated with declining infant mortality, and may thus be used to help identify solutions for both short- and longterm problems. To employ this indicator, one needs to know how various types of disabilities are spread through populations as well as the correlated risk factors. Methodology must be developed which is capable of rapidly identifying cases and assessing risk factors. A 2-stage method, comprised of screening and clinical evaluation, is described.     

Pigmented liver cell adenoma in two male patients

We report two cases of hepatocyte neoplasia with extensive deposition of Dubin-Johnson-like pigment in men without Dubin-Johnson syndrome. This pigment has previously been described in hepatocellular carcinoma but not in liver cell adenoma. The tumors of both patients showed some atypical cytologic features, but no frank histologic evidence of malignancy. Long-term follow up for several years showed no evidence of recurrence after limited surgical excision. We conclude that tumors with this structure may be cured by limited surgical excision and should be considered as pigmented liver cell adenomas.     

Differentiation-specific increase in ALA-induced protoporphyrin IX accumulation in primary mouse keratinocytes.

A treatment regimen that takes advantage of the induction of intracellular porphyrins such as protoporphyrin IX (PPIX) by exposure to exogenous 5-amino-laevulinic acid (ALA) followed by localized exposure to visible light represents a promising new approach to photodynamic therapy (PDT). Acting upon the suggestion that the effectiveness of ALA-dependent PDT may depend upon the state of cellular differentiation, we investigated the effect of terminal differentiation upon ALA-induced synthesis of and the subsequent phototoxicity attributable to PPIX in primary mouse keratinocytes. Induction of keratinocyte differentiation augmented intracellular PPIX accumulation in cells treated with ALA. These elevated PPIX levels resulted in an enhanced lethal photodynamic sensitization of differentiated cells. The differentiation-dependent increase in cellular PPIX levels resulted from several factors including: (a) increased ALA uptake, (b) enhanced PPIX production and (c) decreased PPIX export into the culture media. Simultaneously, steady-state levels of coproporphyrinogen oxidase mRNA increased but aminolaevulinic acid dehydratase mRNA levels remained unchanged. From experiments using 12-o-tetradecanoylphorbol-13-acetate, transforming growth factor beta 1 and calcimycin we demonstrated that the increase in PPIX concentration in terminally differentiating keratinocytes is calcium- and differentiation specific. Stimulation of the haem synthetic capacity is seen in primary keratinocytes, but not in PAM 212 cells that fail to undergo differentiation. Interestingly, increased PPIX formation and elevated coproporphyrinogen oxidase mRNA levels are not limited to differentiating keratinocytes; these were also elevated in the C2C12 myoblast and the PC12 adrenal cell lines upon induction of differentiation. Overall, the therapeutic implications of these results are that the effectiveness of ALA-dependent PDT depends on the differentiation status of the cell and that this may enable selective targeting of several tissue types.