Harvey Cushing's postoperative sketches of pediatric brain tumors

Harvey Cushing was a man of many talents. Not only was he a premier surgeon and scientist, but a prolific author and artist as well. In this paper, we present two postoperative sketches of pediatric brain tumors drawn by Dr. Cushing. These sketches are representative of drawings which accompany many of his operative notes at the Peter Bent Brigham Hospital. About 25% of Cushing's surgical sketches depict operations performed on children. The most commonly drawn childhood tumors were craniopharyngiomas and gliomas of the brain stem and cerebellum. These drawings reveal how Cushing maintained detailed records of his surgical experience. It is clearly evident from these records that Dr. Cushing gained substantial experience in the treatment of pediatric brain tumors.     

Methamphetamine dependence increases risk of neuropsychological impairment in HIV infected persons.

Both HIV infection and methamphetamine dependence can be associated with brain dysfunction. Little is known, however, about the cognitive effects of concurrent HIV infection and methamphetamine dependence. The present study included 200 participants in 4 groups: HIV infected/methamphetamine dependent (HIV+/METH+), HIV negative/methamphetamine dependent (HIV-/METH+), HIV infected/methamphetamine nondependent (HIV+/METH-), and HIV negative/methamphetamine nondependent (HIV-/METH-). Study groups were comparable for age, education, and ethnicity, although the HIV-/METH- group had significantly more females. A comprehensive, demographically corrected neuropsychological battery was administered yielding a global performance score and scores for seven neurobehavioral domains. Rates of neuropsychological impairment were determined by cutoff scores derived from performances of a separate control group and validated with larger samples of HIV+ and HIV- participants from an independent cohort. Rates of global neuropsychological impairment were higher in the HIV+/METH+ (58%), HIV-/METH+ (40%) and HIV+/METH- (38%) groups compared to the HIV-/METH- (18%) group. Nonparametric analyses revealed a significant monotonic trend for global cognitive status across groups, with least impairment in the control group and highest prevalence of impairment in the group with concurrent HIV infection and methamphetamine dependence. The results indicate that HIV infection and methamphetamine dependence are each associated with neuropsychological deficits, and suggest that these factors in combination are associated with additive deleterious cognitive effects. This additivity may reflect common pathways to neural injury involving both cytotoxic and apoptotic mechanisms.     

Wolff-Parkinson-White syndrome: illustrative case and brief review

The Wolff-Parkinson-White syndrome (WPWS) is a pre-excitation syndrome manifested on the 12-lead ECG by a short PR interval (less than .12 sec), a prolonged QRS interval (greater than .10 sec), and an initial slurring of the QRS complex called a delta wave. The anatomical etiology is the presence of accessory atrioventricular conduction fibers called the Kent bundle. Patients with the WPWS may present to the emergency department with a wide spectrum of symptoms, ranging from mild palpitations, to unstable tachydysrhythmias and sudden cardiac death. WPWS should be suspected in any patient presenting with a tachydysrhythmia with a rate exceeding 200/minute. Cardioversion is indicated in the unstable patient. It is impossible to predict the effect of any particular drug without prior electrophysiologic studies in a patient with WPWS. Procainamide is the safest drug for the stable WPWS patient with a tachydysrhythmia, including wide-complex and irregular rhythms. Verapamil is a useful drug in narrow-complex, regular rhythms, although complications have been reported. Atrial fibrillation may be difficult to diagnose in a very rapid tachycardia, and the use of verapamil in WPWS with atrial fibrillation is contraindicated. Electrophysiologic studies are indicated in the WPWS patient to maximize prophylactic therapy. An illustrative case as well as pathophysiology and management of WPWS are discussed.     

Distribution and origin of serotoninergic afferents to guinea pig cochlear nucleus

The distribution of serotoninergic fibers in the guinea pig cochlear nucleus was studied with serotonin immunohistochemistry. In addition, the origin of the serotoninergic fibers was determined by combining the retrograde transport of wheat germ agglutinin-apohorseradish peroxidase (gold conjugated) with serotonin immunohistochemistry. Immunoreactivity was present in varicose and nonvaricose fibers that were unevenly distributed throughout the cochlear nucleus. The fibers were most prominent in the superficial layers of the dorsal cochlear nucleus and the anterior spherical cell area of the anteroventral cochlear nucleus. Although less prominent, serotonin-positive fibers were also present in the remaining part of the anteroventral cochlear nucleus and the posteroventral cochlear nucleus. A few positive fibers were present in the auditory nerve root and the dorsal and intermediate acoustic stiae. Double-labeled cells were found throughout the rostral- caudal extent of the serotoninergic system from the caudal linear nucleus to the nucleus raphe pallidus. However, most were confined to the dorsal (52%) and median (18%) raphe nuclei. Some serotoninergic cell groups contained retrogradely labeled cells that were not serotonin immunoreactive, indicating nonauditory afferents to cochlear nucleus containing other neurotransmitter substances. Serotonin may tonically modulate auditory processing within the cochlear nucleus as well as influence certain ascending auditory pathways. Most of the serotonin in the cochlear nucleus comes from superior raphe nuclei that also project to basal ganglia motor systems and limbic strctures. Therefore, the effect of serotonin on the cochlear nucleus may be related to level of arousal or behavioral state. © 1995 Willy-Liss, Inc.     

Successful Pregnancy in the Didmoad Syndrome (Diabetes Insipidus, Diabetes Mellitus, Optic Atrophy, Deafness)

Summary: A case of successful pregnancy in a patient with the complete DIDMOAD syndrome is described. Attention is drawn to the need to monitor fluid balance carefully during and after pregnancy in this condition. The current literature in the area is reviewed.     

Voices from different places: but why a medical school faculty?

Interdisciplinary collaboration between nursing and medicine is a valued goal, but one which is difficult to achieve. Two nurses who are faculty members in medical schools reflect on their unique roles and how these encompass interdisciplinary research, teaching, and practice.     

Bilaterality in anterior cruciate ligament injuries: associated intercondylar notch stenosis

Nonsimultaneous, bilateral ACL injuries are not uncommon. We studied a group of patients with these injuries to determine possible predisposing factors that could aid in early detection and prevention of contralateral ACL injury. Retrospective analysis of 1,120 patients with ACL ruptures who were treated between 1983 and 1987 revealed 45 patients with bilateral ruptures. Complete follow-up data were available for 41 of these patients. We examined age at initial injury, sex, interval between initial and contralateral ACL injury, mechanism of injury, activity at injury, medical and family histories, treatment of initial injury, and radiographic measurement of intercondylar notch width. The overall incidence of bilaterality was 4.01% in the 28 male and 13 female patients. Their average age was 19 years and 10 months. The average interval between initial and contralateral injury was 47 months. A noncontact cutting maneuver was the most common mechanism of injury. We devised a method to measure and compare intercondylar notch widths on plain radiographs. We compared the mean notch width index (NWI) of the bilateral group to the mean NWI of a group of 50 consecutive patients with "normal" knees and to the mean NWI of 50 consecutive patients with acute ACL ruptures. The mean NWI for the normal group was .2338, for the acute ACL group, .2248, and for the bilateral group, .1961. We noted a statistically significant difference when we compared the bilateral group to the normal and acute groups (P less than 0.0001, respectively). There was no statistically significant difference between the NWI of the normal and acute ACL groups.(ABSTRACT TRUNCATED AT 250 WORDS)     

Real-time NMR beam-directed velocity mapping. V-mode NMR.

BACKGROUND. Currently available noninvasive techniques for measuring blood flow velocities are constrained by limited view orientations (Doppler ultrasound) or limited time resolution (magnetic resonance imaging, MRI). We describe an MRI technique for measuring flow velocities in real time at arbitrary orientations within a cylindrical volume or "beam": V-mode nuclear magnetic resonance (NMR). METHODS AND RESULTS. The technique was implemented on a standard 1.5-T clinical NMR imager with no special hardware and was tested on phantoms and human volunteers. The beam can be fired at rates up to 60 times per second, allowing measurements on a time scale that is appropriate for ungated cardiac studies. In phantoms, steady flow velocities were measured with the beam aligned along the direction of flow, and the measured velocities correlated well with the actual velocities (r > 0.99). The radial distribution of velocities in phantoms under constant flow conditions was also determined. In humans, flow of blood in the descending aortas of normal and aortic insufficiency subjects was measured. Distinctive backflow of blood because of aortic insufficiency was readily apparent. CONCLUSIONS. The V-mode NMR technique is capable of acquiring clinically relevant real-time blood flow information from any desired angle of view with no attenuation at bone or air-tissue interfaces.     

An association between variants in the IGF2 gene and Beckwith-Wiedemann syndrome: interaction between genotype and epigenotype

Beckwith-Wiedemann syndrome (BWS) is a fetal overgrowth disorder involving the deregulation of a number of genes, including IGF2 and CDKN1C, in the imprinted gene cluster on chromosome 11p15.5. In sporadic BWS cases the majority of patients have epimutations in this region. Loss of imprinting of the IGF2 gene is frequently observed in BWS, as is reduced CDKN1C expression related to loss of maternal allele-specific methylation (LOM) of the differentially methylated region KvDMR1. The causes of epimutations are unknown, although recently an association with assisted reproductive technologies has been described. To date the only genetic mutations described in BWS are in the CDKN1C gene. In order to screen for other genetic predispositions to BWS, the conserved sequences between human and mouse differentially methylated regions (DMRs) of the IGF2 gene were analyzed for variants. Four single nucleotide polymorphisms (SNPs) were found in DMR0 (T123C, G358A, T382G and A402G) which occurred in three out of 16 possible haplotypes: TGTA, CATG and CAGA. DNA samples from a cohort of sporadic BWS patients and healthy controls were genotyped for the DMR0 SNPs. There was a significant increase in the frequency of the CAGA haplotype and a significant decrease in the frequency of the CATG haplotype in the patient cohort compared to controls. These associations were still significant in a BWS subgroup with KvDMR1 LOM, suggesting that the G allele at T382G SNP (CAGA haplotype) is associated with LOM at KvDMR1. This indicates either a genetic predisposition to LOM or interactions between genotype and epigenotype that impinge on the disease phenotype.