Trigeminal and auditory evoked responses in minor head injuries and post-concussion syndrome

Forty patients who sustained minor head trauma were investigated by brainstem trigeminal and auditory evoked potentials (BTEP, BAEP) and middle-latency auditory evoked potentials (MLAEP). The patients were evaluated within the first 48 h following their admission and at 3 months after the injury. Outcome was scored at the follow-up examination according to six complaints: failure to resume previous professional activity, headache, memory disorders, dizziness and vertigo, behavioural and emotional disturbances, and other symptoms of a neurological nature. Post-concussion syndrome (PCS) was defined by the presence of four or more of the listed features. All three evoked potential modalities showed significantly increased latencies at the initial assessment, disclosing disseminated axonal damage. Unlike the BTEPs and the BAEPs, the MLAEPs proved to correlate to outcome at 3 months, especially in its psychocognitive aspects. These findings suggest that organic diencephalic-paraventricular primary damage may account for the occurrence of PCS.     

Pattern of regional metastases from cutaneous squamous cell carcinoma of the head and neck

OBJECTIVE: To assess the pattern of regional metastases from SCC of the skin of the head and neck as a prognostic factor. STUDY DESIGN AND SETTING: A retrospective chart review of 22 patients treated in a tertiary academic center. RESULTS: Metastases could be assessed clinically in the parotid gland and the neck in 50% and 59% of the patients, respectively. Histologic examination showed metastases in the parotid gland and the neck in 68% and 45.5%, respectively. Occult disease was 36% and 20% in the parotid gland and neck, respectively. The 1st echelon for metastasis was the parotid gland lymph nodes, whereas level II lymph nodes were the 1st echelon in the neck. Metastases to both the parotid gland and neck decreased the overall survival to 0, compared with 60% for metastases to the parotid gland and 100% for the neck. CONCLUSIONS: SCC of the skin of the head and neck with regional metastases has a high incidence of occult metastases in the parotid gland and the neck. Patients with metastases in both sites have a poor prognosis.     

Two-dimensional contrast echocardiography in the detection and follow-up of congenital pulmonary arteriovenous malformations.

Pulmonary arteriovenous (A-V) malformation is frequently a manifestation of Osler-Weber-Rendu syndrome (hereditary hemorrhagic telangiectasia). We identified 14 patients (9 men and 5 women) with A-V malformation by contrast echocardiography; 10 patients with atrial right-to-left shunt served as control subjects. Agitated saline solution (10 ml) was injected through a peripheral vein during echocardiographic imaging. The delay in the appearance of microcavitations in the left atrium was measured (in number of frames) after right atrial appearance. The degree of left ventricular opacification was graded 1 to 4+ (where 4+ = intense left ventricular endocardial outline, and 1+ = minimal opacification). Results indicated patients with A-V malformation had a significant delay (p less than 0.001) in left atrial appearance of microcavitations compared with those with atrial right-to-left shunt (66 +/- 27 vs 21 +/- 7 frames, mean +/- 1 standard deviation). In the group with A-V malformation, abnormal blood gases were present in only 6 of 14 patients and chest x-ray was positive in 7. Pulmonary angiography was performed in 11 of 14 patients with positive contrast echocardiography, and all 11 had A-V malformation identified. In patients with 3 to 4+ left ventricular opacification (n = 8), large (greater than 5 mm feeding vessel) or multiple malformations were present, whereas patients with small or isolated malformation had 1 to 2+ left ventricular opacification. Balloon occlusion of malformations was performed in all 11 of these patients; repeat contrast echocardiography revealed significant diminution of right-to-left shunt in 9, and 2 required repeat embolotherapy for an additional previously undetected A-V malformation.(ABSTRACT TRUNCATED AT 250 WORDS)     

Gallbladder polyps in children: a rare condition

Although gallbladder polyps are well documented in adults, only three cases in children have been reported in the literature. We present two pediatric cases in which gallbladder polyps were detected by ultrasound, confirming this as the imaging method of choice in diagnosing gallbladder disease.     

Up-regulation of semaphorin expression in retina of glaucomatous rabbits

Background Glaucoma is a term encompassing a variety of diseases that end in the death of retinal ganglion cells (RGC). Although a variety of factors can initiate the disease onset, increased intraocular pressure (IOP) is one of the major risk factors. In our previous study we found that semaphorins were causally involved in RGC death following axotomy. Since a common feature of all retinal neuropathies is axonal damage, we hypothesized that semaphorins are involved in glaucoma-induced RGC death. The purpose of this study was to analyze the effect of increased IOP on RGC viability and to analyze semaphorin expression pattern in glaucomatous retinas.Methods Utilizing retrograde-labeled dye (4-Di-10-Asp) and hematoxylin-eosin staining, we investigated the effect of elevated levels of IOP on RGC viability. In addition, immunohistochemical analysis and western blotting were used to study the pattern of semaphorin expression in retinas of rabbits with genetically developed increased IOP and subsequently glaucoma.Results Using specific anti-semaphorin antibodies, the expression of a single protein with the size of a semaphorin protein, 110 kDa, was detected; its expression was up-regulated in glaucomatous rabbits compared with controls. Time-course analysis revealed that semaphorin expression peaked between 2 and 6 months of age and declined thereafter. Immunohistochemical analysis revealed that semaphorin expression was up-regulated specifically in the ganglion cell layer, which is a structure that is highly affected in glaucoma.Conclusion Deciphering the molecular mechanisms of glaucoma-induced death and its mediators is a crucial step towards designing new therapeutic strategies to treat this incurable disease.     

UP REGULATION OF SEMAPHORIN EX-PRESSION IN RETINA OF GLAUCOMA- TOUS RABBITS

Glaucoma is a term encompassing a variety of diseases that culminate in the death of retinal ganglion cells (RGC). Although a variety of factors can initiate the disease onset, increased intraocular pressure (IOP) is one of the major risk factors. In our previous study we found that semaphorins were causally involved in RGC death following axotomy. Since a common feature of all