Long-term cognitive deficits in patients after surgery on aneurysms of the anterior communicating artery.

The long term recovery of a series of 27 patients who had undergone rupture and repair of an aneurysm of the anterior communicating artery was assessed using a number of neuropsychological measures. Testing took place 12 to 84 months post surgery. On the basis of the results from tests of intellect, memory, and conceptual learning, three subgroups of patients were identified: those with persuasive cognitive defects, those with evidence of residual frontal lobe damage and those who showed no evidence of dysfunction. The occurrence of cerebral vasospasm was the most consistent predictor of long term cognitive deficit.     

Laser-aided debonding of orthodontic ceramic brackets.

The removal of ceramic brackets from the enamel surface by means of laser heating was investigated with the use of CO2 and YAG lasers. The two bracket types investigated were polycrystalline alumina and monocrystalline alumina. The average torque force necessary to break the adhesive between the polycrystalline ceramic brackets and the tooth was lowered by a factor of 25 when the brackets were illuminated with a CO2 laser beam of 14 watts for 2 seconds. All polycrystalline brackets debonded with the CO2 laser resulted in a complete bracket detachment without bracket failure. The average torque force needed to debond monocrystalline brackets was lowered by a factor of 5.2 when illuminated with a laser setting of 7 watts. Monocrystalline brackets cracked along the bracket slot in 2 of 10 cases. Debracketing without laser heating resulted in a slightly higher incidence of bracket failure (12 of 50). Nevertheless, no visible damage to the enamel surface was observed. Advantages of the laser-aided bracket-removal techniques include the following: The heat produced is localized and controlled; the debracketing tool is essentially "cold"; and the method can be used for removal of various types of ceramic brackets, regardless of their design.     

Soluble triggering receptor expressed on myeloid cells-1 for distinguishing bacterial from aseptic meningitis in adults

The aim of the present study was to evaluate whether soluble triggering receptor expressed on myeloid cells (sTREM-1) is present in the cerebrospinal fluid (CSF) of patients with acute meningitis and if its presence can predict bacterial infection. We found elevated levels of sTREM-1 in the CSF of seven of the nine (78%) patients with culture-positive specimens and in none of 12 (0%) patients with culture-negative specimens (sensitivity: 78%; specificity: 100%). The area under the receiver operating characteristic curve for sTREM-1 in the CSF as a predictor for bacterial meningitis was 0.889. This suggests that sTREM-1 is upregulated in the CSF of patients with bacterial meningitis with high specificity and that its presence can potentially assist clinicians in the diagnosis of bacterial meningitis.     

Alterations in respiratory behavior, brain neurochemistry and receptor density induced by pharmacologic suppression of sleep in the neonatal period

The present study examined if drug suppression of active sleep (AS) in the neonate affected the development and expression of respiratory behavior. Secondly, we assessed brain neurochemistry and receptor density in specific supra-medullary brain regions to identify coincident biochemical alterations. Sprague-Dawley newborn rat pups were randomized and divided among six rat mothers (n=10/mother/group), each mother housed separately. Two untreated control (UC) groups received either no interventions or were fed milk vehicle twice daily and were handled similarly to the drug intervention animals. Pharmacological disruption of sleep was achieved by administration (2 groups of each) of either clonidine (CLO) 100 microm/kg, or scopolamine (SCO) 800 microm/kg, given orally twice daily for the first 7 days of life. On postnatal (P) days P10 and P19 of life, pups were assessed for metabolism, minute ventilation (VE), tidal volume (Vt) and frequency (f). On P21 (14 days after the end of drug exposure), pups from each condition were sacrificed and punch biopsies of the frontal cortex, hypothalamus, and hippocampus were examined for hydroxytryptophan (5-HT), and norepinepherine (NE) by HPLC. An equal number of pups were sacrificed and brains examined for muscarinic acetylcholine (mAch), alpha2-adrenergic and I1-imidazoline receptor density. RESULTS: Both CLO and SCO exposed animals had a lower V(t) and respiratory quotient than UC animals (p<0.01). CLO animals exhibited a higher f (p<0.01) and both CLO and SCO exhibited a lower V(t) (p<0.05) than the UC groups; VE was reduced in the SCO groups, compared with CLO and UC groups (p<0.01). Pattern of breathing in response to brief hypoxia exposure was altered for CLO and SCO. The normal decline in VE during sleep was not observed in CLO rats. Both drug exposures resulted in a comparable reduction in hypothalamic NE and 5-HT levels (p<0.05), while in the frontal cortex, and the hippocampus variable changes in NE and 5-HT, occurred. In CLO and SCO rats mAch receptors were increased in cortex, and reduced in hypothalamus; I1-imidazoline receptors were increased in hypothalamus and decreased in hippocampus (p<0.05 for each). In contrast, alpha2-adrenergic receptors were increased in cortex for both CLO and SCO, decreased in hypothalamus for CLO, and decreased in hippocampus for SCO (p<0.05 for each). CONCLUSIONS: these data show that drug-induced neonatal sleep suppression will alter ventilatory pattern, metabolism, and site-specific concentrations of adrenergic neurotransmitters and in receptor density, perhaps as a result of suppression of neonatal AS.     

Vulnerology: a new term to describe the discipline of wound care

Although wound healing is probably the most critical aspect of essential medical and surgical care, it has been neglected for a long time. With the tremendous surge over the last two decades in basic research, wound healing is emerging as a well‐defined medical entity transcending existing specialties and subdivisions. In view of the multitude of health professionals interested in the field of wounds and wound healing, it seems reasonably warranted to group them under one and single appellation. We suggest ‘vulnerology’ as a new term to describe the discipline of wound care.     

Uptake of polypeptide fragments of proteins by rat intestine in vitro and in vivo

Minute amounts of intact proteins were previously shown to be taken up from the intestine into the systemic circulation of mature animals; fragments were not detected. In this study, we sought evidence for uptake of fragments in both in vitro and in vivo experiments. Polypeptide fragments produced by pepsin digestion of bovine serum albumin (ranging in molecular weight from approximately 6000 to 25,000) were labeled with 125I. Everted jejunal gut sacs prepared from rat intestine were incubated with labeled fragments. After incubation, fluid exposed to the serosal surface was applied to a Sephadex G-50 gel permeation column. Radioactivity was detected in fractions corresponding to the elution position of the fragments. Transfer of fragments from the mucosal to the serosal surface was temperature-dependent. In in vivo studies, labeled fragments were infused into the jejunum of rats. Blood samples obtained from a mesenteric vein or the portal vein contained labeled fragments. After infusion of unlabeled fragments, nanogram amounts of immunoreactive fragments were detected by radioimmunoassay of mesenteric and portal venous blood. Thus, polypeptide fragments of a potential food protein were capable of being transferred across the mucosa in vitro and in vivo. Failure to detect fragments in the systemic circulation most likely results from their rapid clearance.     

Infective endocarditis in diabetic and non-diabetic patients

We compared clinical, microbiological, and prognostic characteristics of infective endocarditis in patients with and without diabetes mellitus. In 1987--1996, 213 patients with definite or possible infective endocarditis were included, of which 39 (18%) had diabetes mellitus. Diabetic patients were older than non-diabetic (median age of 71 vs 65 y, respectively; p =0.04), had more aortic valve and less mitral valve involvement (71% vs 27%, and 21% vs 62%; p = 0.004). There was no significant difference in the frequency of Staphylococcus aureus involvement between the 2 groups (21% in diabetic vs 20% in non-diabetic group; p = ns). On multivariate analysis diabetes mellitus was not found to be an independent factor for mortality. Unlike other infections diabetes mellitus does not significantly affect clinical and microbiological features, and outcome of infective endocarditis.