Active electrophysiological properties of spinal motoneurons in aged cats following axotomy. The present study was designed to examine the effects of the aging process on the response of motoneurons to axotomy. Accordingly, in aged cats using intracellular recording techniques, the electrophysiological properties of axotomized lumbar spinal cord motoneurons were compared with those of control (nonaxotomized) motoneurons. In motoneurons that were subjected to axotomy, there was a reduction in axonal conduction velocity compared to that exhibited by control motoneurons. In addition, there were a number of changes in the configuration of the action potential following axotomy. The amplitude of the spike and the overshoot increased as did the slope of the soma-dendritic spike, whereas the delay between the initial segment and the soma-dendritic spikes decreased. The duration of the action potential's afterhyperpolarization increased; its amplitude remained unaffected although the calculated afterhyperpolarization current decreased. Following the spike, most of the axotomized motoneurons exhibited hyperpolarization undershoots and delayed depolarizations. Axotomized motoneurons exhibited a small decrease in the membrane potential and a reduction in the rheobasic current compared to control cells. The changes in the frequency distribution of axonal conduction velocity, afterhyperpolarization duration, afterhyperpolarization current and rheobase measurements suggest that aged motoneurons dedifferentiated following axotomy. These results indicate that axotomy, in aged motoneurons, results in the disruption of a variety of electrophysiological parameters and that the specific patterns of the responses that occur in axotomized motoneurons of adult cats also emerge in axotomized motoneurons of aged animals.


Astroglia in Alzheimer's disease.

Astroglia in Alzheimer's disease. Amyloid deposits are characteristic of Alzheimer's Disease (AD) and there is growing evidence that amyloid may play an important role in the genesis of this neurodegenerative disease. This review discusses data which suggests that reactive astrocytes and microglia may be a necessary concomitant with amyloid to produce the neuropathology which manifests as AD. Several hypotheses and supporting data for mechanisms by which reactive astrocytes may mediate this neuropathology are presented. These include the possibility that amyloid induces excitotoxicity by interferring with astrocytic glutamate uptake, the possibility that amyloid has this effect via an action on a tachykinin-related receptor and the possibility that proteoglycans released by astrocytes may facilitate the deposition of amyloid plaques. Both symptomatic treatment to enhance cognitive function and treatment to stop the progression of AD are needed. It is hoped that answers to some of the unique questions raised here may provide new insight into the etiology and treatment of AD.


Growth hormone secretion in Alzheimer's disease: 24-hour profile of basal levels and response to stimulation and suppression studies. The 24-h growth hormone secretory pattern and GH response to growth hormone releasing hormone, the alpha 2-adrenoceptor agonist clonidine and the somatostatin-analogue SMS 201-995 were evaluated in 9 patients with Alzheimer's disease and 9 age- and body body-matched control subjects. The secretory profile did not differentiate between patients and controls. Both secreted the largest amount of GH during the early nighthours between 22.00-02.00, whereas the majority of daytime GH levels were below the assay's detection limit (0.4 ng/ml). No difference was found in GH response to GHRH between patients and controls. All subjects showed significantly enhanced GH secretion after GHRH. Dividing the patients into two groups according to age-of-onset (less than 60 years greater than), there was a trend toward larger GH responses to GHRH for the early-onset group. No other parameter differentiated the groups. GH levels after clonidine were blunted in all subjects but one AD patient, probably due to an age-dependent attenuation frequently observed in subjects over 45 years of age. Finally, the administration of the somatostatin-analogue did not render conclusive results, since spontaneous decline of GH concentration was already beginning 2 hours before the drug was given and continued steadily throughout the observation period. In conclusion, patients with only mild to moderate degree of Alzheimer's disease have no prominent changes in GH regulation.


Alteration in the pattern of nerve terminal protein immunoreactivity in the perforant pathway in Alzheimer's disease and in rats after entorhinal lesions. Neurons in layer II of the entorhinal cortex consistently develop neurofibrillary tangles in Alzheimer's disease (AD). Experimental neuroanatomical studies have shown that these neurons give rise to the perforant pathway, a major excitatory projection to the hippocampal formation, which terminates in a discrete pattern in the outer portion of the molecular layer of the dentate gyrus. The distribution of two nerve terminal associated proteins, synaptophysin and NT75, was studied in the molecular layer of the dentate gyrus in AD and control cases to determine whether Alzheimer neuronal pathology is associated with loss of synaptic markers. In parallel studies, the effect of ablation of the entorhinal cortex in rats was evaluated. In AD as compared to controls, a decrease in synaptophysin immunostaining was evident in the terminal zone of the perforant pathway. NT75 nerve terminal immunostaining was too weak to interpret in the human hippocampal formation. Both synaptophysin and NT75 immunoreactivity were found in association with some neuritic plaques. In rats, entorhinal lesions resulted in diminished immunoreactivity for both synaptophysin and NT75 in the perforant pathway terminal zone. These results suggest that nerve terminal protein loss is a concomitant feature of neuronal pathology in AD.


An evaluation of human neurophysin production in Alzheimer's disease: preliminary observations. The concentrations of human neurophysins in the cerebrospinal fluid (CSF) of nine patients with Alzheimer's disease: Preliminary observations. (AD), and one patients with Pick's disease, were determined using specific radioimmunoassays (RIAs). Concentrations of vasopressin and oxytocin were also measured. Values were compared with those from 20 age-matched mentally normal individuals who were being treated for back pain. CSF levels of vasopressin-associated human neurophysin (VP-HNP) and oxytocin-associated human neurophysin (OT-HNP) in patients with AD (22 +/- 4 fmol/ml and 104 +/- 17 fmol/ml) were only 42% and 58% of those in the control subjects (p less than 0.0001, p less than 0.0004). Vasopressin levels for these patients (3.6 +/- 0.4 fmol/ml) were also significantly reduced to 51% of controls (p less than 0.007) and oxytocin levels were marginally (p = 0.092) reduced to 70% of controls. Because neurophysins and neuropeptides are gene-related products of vasopressin-neurons and oxytocin-neurons, the data indicate that these neurons are functionally impaired in patients with AD. Plasma neurophysin values suggest this impairment is confined to neurons with centrally-directed axons. Data from the one patient with Pick's disease demonstrates that reduced CSF levels of neurophysins and hormones is not confined to Alzheimer-type dementia.


Muscarinic and nicotinic contributions to cognitive function and cortical blood flow. Muscarinic receptor blockade in humans induces a transient memory deficit claimed to mimic aspects of Alzheimer's disease (AD). AD is also strongly associated with a specific blood flow abnormality in parietotemporal cortex; we previously showed that, despite induction of a dementia-like state, scopolamine does not produce these blood flow changes. In the present study, we administered both muscarinic and nicotinic receptor blockade (using scopolamine and mecamylamine) to seven elderly healthy subjects and measured subsequent changes in cognition and cortical perfusion, using the 133Xe inhalation method to quantify regional cerebral blood flow (rCBF). Results confirmed earlier findings of scopolamine-induced memory deficit and frontal cortex flow reduction. Only mecamylamine, however, produced a perfusion deficit in parietotemporal cortex. All effects were transient and dose-dependent. These findings demonstrate the safety and feasibility of differential and combined blockade of nicotinic and muscarinic cholinergic blockade in human subjects. Furthermore, the nicotinic antagonist mecamylamine yields rCBF changes similar to those seen in AD, despite producing only minimal cognitive effects on its own. The rCBF and behavioral manifestations in AD may therefore reflect the functional loss of nicotinic receptors in addition to alterations in other receptor systems.


The role of serotonin and dopamine in brain in the antidepressant-like effect of clonidine in the forced swimming test. The effect of clonidine (0.1 mg/kg, i.p.), as a three-injection course, on behaviour in the forced swimming test was studied in rats injected intracerebroventricularly (i.c.v.) with 150 micrograms 5,7-dihydroxy-tryptamine (5,7-DHT) to destroy serotonin (5-HT) neurones or treated with 100 mg/kg (i.p.) (+/-)-sulpiride or 0.5 micrograms/0.5 microliter (-)-sulpiride in the nucleus accumbens. Clonidine significantly increased struggling and reduced floating and the effects were antagonized by both treatments with sulpiride but not by 5,7-DHT which markedly depleted 5-HT in brain. The results suggest that the mesolimbic dopaminergic system but not 5-HT neurones, plays a permissive role in the antidepressant-like effect of clonidine in the forced swimming test.


Inhibition of tryptophan hydroxylase by (R)- and (S)-1-methyl-6,7-dihydroxy-1,2,3,4-tetrahydroisoquinolines (salsolinols). The (R)- and (S)-enantiomers of salsolinol, the dopamine-derived tetrahydroisoquinolines, were found to inhibit the activity of tryptophan hydroxylase (TPH), prepared from serotonin-producing murine mastocytoma P-815 cells. Inhibition of TPH by salsolinols was found to be non-competitive with the substrate L-tryptophan. Tryptophan hydroxylase is composed of two elements with different kinetic properties in terms of cofactor (6R)-L-erythro-5,6,7,8-tetrahydrobiopterin and these two elements were inhibited by salsolinols in competitive and uncompetitive ways, respectively. Stereoselectivity of salsolinol was not observed, concerning the potency and the type of inhibition on PTH. These data indicate that salsolinols might be naturally occurring inhibitors of indoleamine metabolism.


2-Amino-3-(methylamino)propanoic acid (BMAA) bioavailability in the primate. 2-Amino-3-(methylamino)-propanoic acid (BMAA) is a low potency excitatory amino acid present in the cycad plant that has been proposed as a factor in the high incidence of amyotrophic lateral sclerosis-parkinsonism dementia (ALS-PD) in the western Pacific region. We employed stable isotopic forms of BMAA to assess the oral bioavailability of this compound in cynomolgous monkeys (n = 3). The stable isotope labeled BMAA ([15N]-BMAA) was injected i.v. at the same time that the unlabeled compound was administered orally. Both forms of BMAA were then quantified in a 48h urine sample by gas chromatography-mass spectrometry (GC/MS). Following oral dosing, 80% of the administered BMAA was absorbed into the systemic circulation; thus, oral bioavailability was high and other routes of administration could not result in significantly higher circulating levels of BMAA for a given administered dose.


Characterization of cholinergic regulation of seizures by the midline thalamus. This study determined the effects of injections of different cholinergic agents in the central medial intralaminar nucleus of the thalamus on seizures induced by intravenous injection of pentylenetetrazol. Injections of the cholinesterase inhibitor, neostigmine bromide, induced a stiff, tremulous state and lowered myoclonic, clonic and tonic seizure thresholds. The nicotinic agonist, tartrate, depressed arousal and facilitated all types of seizure, while its antagonist, d-tubocurarine chloride, heightened arousal and transformed pentylenetetrazol-induced convulsions, with tonic seizures occurring at a very low threshold without preceding myoclonic or clonic seizures or EEG spikes. The muscarinic agonist (+/-)pilocarpine hydrochloride, in very large doses, induced slight hyperactivity and facilitated tonic seizures but did not affect myoclonic or clonic seizures. Its antagonist, (-)scopolamine hydrobromide, slightly depressed arousal and myoclonic and clonic seizure thresholds. Injections of mixtures of agonists and antagonists (d-tubocurarine chloride + nicotine tartrate or (+/-)pilocarpine hydrochloride + (-)scopolamine) had little effect on spontaneous behavior or seizures. These results suggest that the midline thalamus regulates seizures and arousal, under the control of cholinergic neurotransmission. Nicotinic and muscarinic receptors have opposing roles in mediating these functions.


Dizocilpine (MK-801) arrests status epilepticus and prevents brain damage induced by soman. The involvement of the NMDA receptor in the neurotoxicity induced by soman, an organophosphorus compound which irreversibly inhibits cholinesterase, was studied in guinea pigs. The drug MK-801 (0.5, 1 or 5 mg/kg, i.p.) was given as a pretreatment before a convulsant dose of soman or as a posttreatment (30, 100 or 300 micrograms/kg, i.m.) 5 min after the development of soman-induced status epilepticus. Pyridostigmine, atropine and pralidoxime chloride were also given to each subject to counteract the lethality of soman. All subjects that were challenged with soman and given the vehicle for MK-801 (saline) exhibited severe convulsions and electrographic seizure activity. Neuronal necrosis was found in the hippocampus, amygdala, thalamus and the pyriform and cerebral cortices of those subjects surviving for 48 hr. Pretreatment with 0.5 or 1 mg/kg doses of MK-801 did not prevent nor delay the onset of seizure activity but did diminish its intensity and led to its early arrest. At the largest dose (5 mg/kg), MK-801 completely prevented the development of seizure activity and brain damage. Posttreatment with MK-801 prevented, arrested or reduced seizure activity, convulsions and neuronal necrosis in a dose-dependent manner. The NMDA receptor may play a more critical role in the spread and maintenance, rather than the initiation of cholinergically-induced seizure activity.


Delayed acquisition of eyeblink conditioning in aged F1 hybrid (Fischer-344 x Brown Norway) rats. We previously reported that the freely moving male Fischer-344 rat provides a useful model to demonstrate the progressive impairment of eyeblink conditioning associated with aging. However, because the youngest F-344 rats only performed at 60% of maximum, we ran the same experiment with hybrid rats and discovered most (i.e., those age 9-24 months) learned rapidly and exhibited conditioned responses on greater than 80% of trials by the end of two training sessions. In contrast, the aged rats (36 months) exhibited significantly fewer CRs on all four training days. However, unlike all ages of F-344 rats (3-30 months) which were run in our last study, these aged hybrid rats exhibited considerable improvement with extra training. These data indicate clear differences in the rate of learning between the two strains and suggest that even young F-344 rats may have deficits in the neural circuits which mediate eyeblink conditioning. Other anecdotal findings on differences between the two strains are noted.


Daytime sleepiness and performance among healthy 80 and 20 year olds. This study investigated the relationship of daytime sleepiness and performance on a vigilance test in a sample of 10 healthy men and 13 women in their 80s (mean age 83.0 +/- 3.1 years) and 18 men and 12 women in their 20s (25.0 +/- 3.1). We hypothesized that "successfully" aged healthy individuals would have more daytime sleepiness with differentially greater decrements in performance than a younger comparison group. Daytime sleepiness was measured physiologically by the Multiple Sleep Latency Test (MSLT) and through self-report by the Stanford Sleepiness Scale (SSS). Morning and evening performance was measured with the Mackworth Clock Test of vigilance. The major findings were the absence of correlation between either MSLT or SSS daytime sleepiness with performance measures, no difference in daytime sleepiness between the old and young groups and performance decrements among the healthy elderly on all parameters. Results suggest that the modest decrements in performance among the elderly cannot be attributed to daytime sleepiness.


Regional effects of aging on dopaminergic function in the Fischer-344 rat. To examine the consequences of aging on nigrostriatal (A9) and mesolimbic (A10) dopamine (DA) function, neurochemical and behavioral measurements were performed in male Fischer-344 rats 6, 12, 18, 24, and 30 months old. Regional analyses of dopaminergic overflow and uptake processes were examined using high-speed (5 Hz) in vivo electrochemical recordings and local drug application techniques. When potassium was used to elicit the presynaptic overflow of dopamine (DA) in striatal areas predominantly innervated by the substantia nigra, the amplitude of DA overflow was significantly lower in 24- and 30-month-old rats (p less than 0.05 and p less than 0.01 vs. 6 months, respectively). Furthermore, in ventral striatum (including the nucleus accumbens) which is innervated primarily by A10 DA cell bodies, potassium-evoked DA overflow release amplitudes were significantly lower in the 18, 24, and 30 month groups (p less than 0.01 vs. 6 months). In addition, age-related differences between the dorsal and ventral striatum were found in a preliminary investigation of DA diffusion and clearance. Local application of nomifensine, a DA uptake inhibitor, significantly increased (p less than 0.05 vs. control) the amplitude of the signal recorded after local application of 25-30 pmol DA in the ventral striatum of 6 month-old but not 24-month-old rats. High-performance liquid chromatography coupled with electrochemical detection (HPLC-EC) was used to analyze whole striatal DA levels, DA metabolite levels and turnover indices. However, no age-related differences in any of these variables were observed. Finally, a rod walking test was used to measure motor coordination and balance in animals prior to in vivo electrochemical recording.(ABSTRACT TRUNCATED AT 250 WORDS)


Effects of dizocilpine (MK-801) and ethanol on the EEG and event-related potentials (ERPS) in rats. Recent neurophysiological data have suggested an interaction of ethanol (EtOH) with the glutamate-NMDA receptor complex. For instance, low levels of alcohol have been found to inhibit the ion current, activated by NMDA in in vitro preparations. The present study extends these paradigms in order to evaluate the electrophysiological effects of ethanol and the nonspecific NMDA receptor antagonist, dizocilpine (MK-801) in awake, conscious rats. Twenty Wistar rats were stereotaxically implanted with electrodes, aimed at dorsal hippocampus, amygdala, thalamus and frontal cortex. Rats received the following drugs: saline (s.c.), 0.01 and 0.1 mg/kg MK-801 (s.c.); EtOH, 0.75 g/kg (i.p.); 0.75 kg EtOH plus 0.01 mg/kg MK-801; 0.75 g/kg EtOH plus 0.10 mg/kg MK-801. Five minutes of EEG was collected and event-related potentials (ERPs) recorded in response to an auditory "oddball" paradigm. Spectral analysis revealed that MK-801 (0.1 m/kg) produced significant increases in low frequency EEG components, at all sites (1-6 Hz) and decreases in higher frequencies (16-32 Hz). Whereas ethanol (0.75 g/kg) produced decreases in power in all frequency bands. The combined administration of EtOH and MK-801 produced some antagonistic effects on the EEG in the low frequency range. Evaluation of ERPs revealed that MK-801 (0.1 mg/kg) produced significant decreases in amplitude of the N1 and P2 components in the cortex, decreases in the P1 and N2 in the thalamus and a profound decrease in the P3 components in hippocampus and amygdala. Ethanol was also found to produce decreases in the N1 component in cortex. The administration of MK-801 and ethanol together did not produce significant interactions on ERPs. These studies suggest that antagonism of the NMDA receptor by MK-801 may produce some effects similar to those of ethanol, however, their combined administration did not produce synergistic effects within these dose ranges.


Actions of a series of bisquaternary compounds on nicotinic acetylcholine receptors in insects: ligand binding and electrophysiological studies. A series of bisquaternary ammoniums, with chain lengths of between 4-12 carbon atoms (C4-C12), have been tested for their ability to block acetylcholine-induced responses in the fast coxal depressor motor neurone (Df) of the cockroach (Periplaneta americana) and to displace [125I]alpha-bungarotoxin from membrane preparations of the CNS of the cockroach. The physiological studies showed that tetramethonium was inactive, whereas hexa-, octa- and dodecamethonium showed an enhanced ability to block acetylcholine-induced responses as the chain length increased. Decamethonium resulted in a slight increase in acetylcholine-induced depolarizations. Ligand binding studies showed that the ability of the compounds to inhibit the specific binding of [125I]alpha-bungarotoxin increased with size from C4-C12. The results show that neuronal nicotinic receptors in insects differ in aspects of their pharmacology from both the major subclasses of nicotinic receptors of vertebrates.


Effects of tityustoxin and ouabain on release of acetylcholine from slices of cortex from the rat brain and on the acetylcholine content of cytoplasmic and crude vesicular fractions. In this paper, the effects of tityustoxin and ouabain on the release and mobilization of ACh from cytoplasmic and vesicular stores of slices of cortex from the brain of the rat are described. Tityustoxin induced an increase of release of ACh which was time-dependent and this effect was accompanied by a concomitant decrease of the ACh, measured in cytoplasmic and crude vesicular fractions. Unlike tityustoxin, ouabain did not increase the release and synthesis of ACh during a 2 min period of stimulation but later, at 5, 10 and 15 min, ouabain increased the release and synthesis of ACh from incubated slices of cortex. After 10 min, ouabain caused a reduction of the content of ACh from cytoplasmic and crude vesicular fractions.


Reversible cholinergic changes induced by AF64A in rat hippocampus and possible septal compensatory effect. Ethylcholine aziridinium (AF64A) was injected intracerebroventricularly in rats, and the dose- and time-dependent effect of this treatment was measured on cholinergic markers in different areas of the brain. Choline acetyltransferase (ChAT) in the hippocampus was reduced by 0, 25, 40 and 50%, 4 days after administration of 0.25, 0.5, 1.0 and 2.0 nmol/side of AF64A. This effect was paralleled by a 0, 21, 38 and 48% increase in septal ChAT, at the same time and dose, respectively. Hippocampal and septal ChAT returned to normal by 14 days, following the two smaller doses of AF64A. Normal values of ChAT activity in the hippocampus were measured by 3 months post-1.0 nmol/side and by 12 months after 2.0 nmol AF64A/side. A transient secondary increase in septal ChAT was measured at 28 and 42 days after 1.0 nmol/side, after which no further changes were measured in this area. High affinity choline transport (HAChT) in the hippocampus showed a 35 and 25% decrease but only 14 and 7 days, after injection of 0.25 and 0.5 nmol AF64A/side, respectively. However, significant reductions by 45% at 14 days and by 65% at 4 days, were measured after the infusion of 1.0 and 2.0 nmol/side, respectively. This effect was significantly attenuated by 3 months and returned to normal by 12 months after treatment. Acetylcholinesterase (AChE) activity in the hippocampus was most severely affected by AF64A. Specifically, significant inhibition of 20% (by 7 days), 35% (by 7 days), 25% (by 2 days) and 30% (by 2 days) was observed at 0.25, 0.5, 1.0 and 2.0 nmol AF64A/side, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)


Regulation of amino acid uptake into cerebral microvessels. The carrier-mediated transport systems, found in cerebral endothelium, are responsible for maintaining the nutrient milieu of the CNS. The objective of this study was to identify what factors might regulate the sodium-dependent A-system of neutral amino acid transport in isolated cerebral microvessels. The uptake of amino acids into isolated microvessels was measured using methylaminoisobutyric acid (MeAIB) a nonhydrolyzable A-analog of the A-system carrier. The results indicated that stimulation of adrenergic (both alpha and beta) receptors significantly (P less than 0.05-0.02) increased the uptake of MeAIB. While the muscarinic agonist carbachol alone did not alter the uptake of MeAIB, it blocked the stimulation evoked by adrenergic agonists. Furthermore, addition of the metal ion, aluminum also significantly (P less than 0.05) increased specific uptake of MeAIB by 95%, when compared to untreated controls. These results indicate that the uptake of neutral amino acids, through the A-system, into cerebral microvessels, can be modulated by adrenergic and cholinergic receptors, as well as the metal ion aluminum. Since the A-system of amino acid transport may control appropriate levels of amino acids in brain, modulation of the uptake of amino acids by adrenergic and cholinergic receptors and by aluminum, may be associated with an imbalance of amino acids and possible neurotransmitter defects in the CNS.


[Trials of the diagnostic potentials of TPA in tumorous and nontumorous lung pathologies in 303 cases]. Serum tissue polypeptide antigen (TPA) has been determined in 271 patients with pleural or pulmonary neoplastic diseases (131) or with benign lung diseases (140). Using a cut-off of 95 U/L, TPA has a sensitivity and specificity of 65%. Therefore, TPA serum determination can suggest a diagnosis of malignancy, but its evaluation, as a single test, is not useful to differentiate between malignant or benign disease. TPA can be useful as an ancillary test in the follow-up of lung cancer therapy.


[The estimation of p50 by the algorithm proposed by Siggard-Andersen. Its experimental assessment in critical patients]. To determine the ability of O. Siggaard-Andersen algorithm in the estimation of the "in vivo" p50 and standard p50 values from a single blood sample with sO2% less than or equal to 97. comparison between measured and calculated standard p50 values. Intensive care unit. thirteen cardio-pulmonary critical ill patients. Mean age of seventy-four years (range 53-84 years). The experimental measurement of p50 standard (p50st sper) was performed tonometering the venous blood samples (60 specimens) using an IL-237 tonometer at 37 degrees C, with two different gas mixtures to obtain pCO2 at 5.33 kPa (DS = 0.06), and pO2 at levels to achieve sO2% values close to 50%. The gases's complete equilibration was not deemed important. The pO2 values were corrected to a pH of 7.40 using a Bohr factor = -0.48 and the p50 was taken by simple interpolation of points on the sO2%/pO2 diagram. Calculated standard p50 (p50st calc) and calculated "in vivo" p50 on the venous specimens (No. 60) and the correspondent arterial specimens with sO2% less than or equal to 97 (No. 40) were obtained by Siggaard-Andersen's computerized algorithm. Blood specimen analysis was performed by means of an ABL3 Radiometer gas analyzer and an OSM3 Radiometer oximeter. Statistical analysis was made by Anova test for liner regression. There was excellent correlation between the 60 experimental p50st determined by Siggaard-Andersen's oxygen dissociation curve on the same blood samples. The regression equation was: p50st sper = -0.79 + 1.21 x p50st calc, r = 0.90, R2 = 81.1%; with F = 249.5 and less than 10(-5). No good correlation was found between p50st and standards p50 calculated on arterial specimens (p50st calc art): p50 = 1.38 + 0.52 x p50st calc art, r = 0.52, R2 = 26.6%, F = 14 e P less than 10(-3). Regression of in vivo P50 calculated on correspondent venous samples (p50 ven) was: p50 ven = 0.79 = 0.77 x p50 art, r = 0.93, R2 = 87.2%, F = 256 and P less than 10(-5). Our results suggest that the curve describes the curve also at high saturation when it is not longer linear. Accurate measurement (including dishemoglobin percentage) and sO2% less than or equal to 97 are necessary. We did not perform experimental measurements of "in vivo" p50 but we postulate that as the p50st was well calculated so too would be the p50 "in vivo" at 37 degrees C.


[The diagnostic course in patients with hereditary ataxias and hereditary spastic paraparesis]. A postal questionnaire was sent to all patients affected by hereditary ataxias and hereditary spastic paraparesis resident in the province of Turin (Italy) to study their diagnostic process. A 61% response rate was obtained. The mean time interval between onset and diagnosis was 6 years (1 to 32 years). The percentage of late diagnoses dropped from 59% before 1959 to 19% after 1970, mostly because a reduction of the interval between symptom onset and the first contact with the general practitioner. The onset with dysarthria and ataxia led to earlier neurologic consultation, but the whole time requested for the diagnosis was not modified. A reduction of the time needed for the diagnostic process may be important to address the family to an early genetic counselling.


[The determination of sialic acid in cancer patients]. The availability of a new rapid and reproducible laboratory test led to an easy dosage of sialic acid (AS) serum levels in neoplastic patients. This substance, involved in tumoral transformation and metastatic spread, has been evaluated in 278 neoplastic patients: 183 patients were affected by lymphoma (96 NHL and 87 HD), 60 by breast cancer and 35 by lung cancer. All groups of patients considered showed mean values of AS higher than healthy controls and the positive percentages, compared with cut-off levels, were respectively: NHL 71%, HD 70%, breast cancer 38%, lung cancer 89%. Even if the low specificity of this marker limits its clinical validity, AS, that seems related to clinical course of disease, could be useful in the monitoring of many neoplasms.


[Hashimoto's thyroiditis, idiopathic thrombocytopenic purpura (Werlhof's disease) and Steinert's dystrophia myotonica. A clinical case]. The authors report a rare association: Hashimoto's thyroiditis, thrombocytopenic idiopathic purpura (Werlhof's disease) and Steinert's myotonic dystrophia. The authors outline the fingerprints of each disease, report particular syndromes and compare that association to data of partially reviewed literature. They suppose a suggestive pathogenetic connection among these diseases, due to the coexistence of altered genetic, endocrine and autoimmune factors and consequently impaired cell membrane permeability.


[Captopril and hydrochlorothiazide in treating arterial hypertension in the elderly patient. An enlarged case series and verification of the results]. A group of 171 hypertensive patients were treated using 100 mg captopril and 50 mg hydrochlorothiazide over a period of four months. The group was subdivided into two subgroups of 138 elderly patients and 33 patients aged under sixty all of whom had a systolic blood pressure of over 180 mmHg, or over 160 mmHg if they had undergone previous treatment using another drug. Patients were monitored after one month and at the end of hypotensive therapy. The study showed a statistically significant reduction of blood pressure in both groups. In the elderly group blood pressure diminished from a mean basal level of 198.8/104.5 mmHg to 140.4/80.5 mmHg, whereas in the adult group pressure values were reduced from 190.1/108.4 mmHg to 134.0/80.6 mmHg. These results match those of an earlier study and, in conclusion, the Authors affirm that this combinations is a suitable "geriatric drug" since it responds to the needs of elderly hypertensive patients. Using captopril and hydrochlorothiazide it is possible to improve the quality of life of elderly hypertensive patients who are otherwise notoriously difficult to treat.


[Adherence to a diet and the social aspects of patients with celiac disease]. We studied the social behaviour and dietary habits of 335 coeliacs older than 6 yrs diagnosed in our paediatric gastroenterology unit by a mailed questionnaire, 156 patients (45.2%) answered all questions; their median age was 14.7 yrs (range 6-29). We found that the disease does not compromise educational achievement and working capacity of patients. A majority of our coeliacs are students (from primary school to university) and rather successful ones since 55% of them passed their previous year examinations. Some are already employed and work as clerks, artisans, masons or skilled workers. 89.6% of our patients reported to be on a strict gluten-free diet, 9% introduce small amounts of gluten and 1.4% are on a normal diet by their own decision. Coeliac patients originating from Northern Italy have more of their gluten-free foods home made and use more gliadin free cereals (rice, maize), whereas coeliacs originating from the Southern regions consume more ready made gluten-free foods. We have assessed the amount of gluten-free products consumed monthly by our patients and their food preferences. Females eat less than males and prefer bread and flour based dishes, whereas males east more pasta and biscuits.


[The personal and familial alcohol habits in groups of young men at their first military draft exam]. In order to evaluate alcoholic consumption in a group of young men from an area in northern Italy, 834 subjects (18 years old) were examined at their first military check up. They compiled a questionnaire dealing with their own and their fathers' alcoholic consumption, social status, cultural habits, tobacco and drug abuse. 14.3% of the group examined were teetotalers. The alcoholic consumption of the youths was 31.44 +/- 48.8 DS alcohol g/a day versus their fathers' consumption of 44.52 +/- 42.12 DS alcohol g/a day. This difference is statistically significant (t = -8.1 p less than 0.001). No difference in alcoholic consumption was found between employed and unemployed subjects. Artisans and traders evidenced the highest levels of alcohol consumption (F = 2.58, p less than 0.009). The youths changed their alcoholic habits with respect to their own parents, preferring beer to wine consumption, although no change was observed in their approach to the alcoholic problems. The beer, like alcohol, remains a sociable and reassuring drink with positive connotations, even tough it is not considered a traditional Italian drink.


[A personal case report of subacute sclerosing panencephalitis in an adult]. The paper describes the case of a 37-year woman, with no past history of measles infection, who initially showed behavioral disorders, interpretative and reference deliria with a persecutory content. Extrapyramidal rigidity, bradykinesia, myoclonia, dementia, hyperpyrexia and coma with decerebrate rigidity subsequently appeared. Instrumental tests showed a spinal fluid status with intrathecal IgG synthesis and oligoclonal pattern, aspecific signs of widespread electric anomalies in the EEG. Encephalic CT and NRM were altered showing multifocal damage to the white substance. Anti-measles antibody titres were high in both spinal fluid and serum. Post-mortem histological tests confirmed the clinical hypothesis of subacute sclerosing panencephalitis. The paper reviews existing reports and pays special attention to cases of SSPE in adults and those cases with a psychiatric outcome. Lastly, the role of neuroradiological methods in the diagnostic iter is assessed.


[Autoimmune polyendocrinopathy and chronic mucocutaneous candidiasis]. A chronic mucocutaneous infection due to yeasts to the Candida genus can be part of the autoimmune polyglandular syndrome, described as APECS, APECED, SPA type I, CES. The authors describe the case of a young patient affected by mucocutaneous candidiasis, hypoparathyroidism and adrenal insufficiency. Chronic mucocutaneous candidiasis was diagnosed first in early childhood and was followed by the development of hypoparathyroidism (4 yrs) and adrenal insufficiency (5 yrs). The initial lesion of this syndrome is still unknown as the reason of the marked susceptibility to mucocutaneous candidiasis without systemic candidiasis. The treatment of mucocutaneous candidiasis has been improved by the introduction of orally active antifungal drugs as Ketoconazole, first, and fluconazole now.


[Pheochromocytoma and autoimmune hypothyroidism]. The association of multiple endocrine diseases is frequent and the coincidental involvement of the thyroid and adrenal glands is well recognized. On the contrary, two cases of hypo or hyperthyroidism have only been reported in literature: one concerning adrenal pheochromocytoma with simultaneous autoimmune hypothyroidism and another of a diffuse toxic goiter associated with pheochromocytoma. The purpose of the present report is to point out a new case of a pheochromocytoma associated with an autoimmune hypothyroidism in which the latter is florid and not biochemical.


Methodology in anti-emetic trials.

Methodology in anti-emetic trials. The most promising anti-emetic drugs are identified during preclinical testing. Phase I and II clinical studies are used to optimize doses and schedules for the various routes of administration. Most methodological issues arise in relation to phase III studies. A prospective, randomised, double-blind, parallel-subjects design is recommended. Stratification helps balance the factors influencing emesis between the 2 arms of a randomised study. The most important of these are the strength of the emetic stimulus, prior exposure to chemotherapy, age, sex and a history of chronic alcohol consumption. The evaluation of efficacy of an anti-emetic should include its efficacy in controlling acute post-chemotherapy nausea and vomiting as well as anticipatory and delayed emesis. The side effects of an anti-emetic must also be considered since they may negate any anti-emetic advantage. Patients and observers have reported successfully evaluating these parameters using both categorical and linear-analogue scales.


[The observations in a case of eosinophilic fasciitis]. We present a typical case of eosinophilic fasciitis, with transient peripheral eosinophilia, indurative swelling of the legs, perivascular infiltrates of mononuclear cells and eosinophils of the subcutis and deep fascia, increased ESR, fever, anemia, complete response to steroids. We consider the literature on this topic, particularly concerning the following question: is eosinophilic fasciitis a distinct disease entity or a variant of scleroderma?


Measurement of quality of life in clinical trials. Information on patients' quality of life (QOL) will give a more comprehensive evaluation of the treatment outcome than only measures of tumour response and survival. Psychosocial indicators have rarely been used in clinical trials. This may in part be explained by physicians' lack of familiarity with these measures, methodological insufficiency and a basic philosophical reason, i.e., most doctors tend to focus on curative treatment and not on palliative treatment. A series of QOL questionnaires has been validated in the last decade for use in cancer clinical trials. Selection of the optimal method in the given trial is important. The trial ought to be designed so the proportion of missing data is low. QOL should be used as an end point in selective trials with an optimal study design and with a study coordinator who is willing to collect QOL data.


Managing treatment-induced emesis: a nursing perspective. Patients with cancer undergoing treatment with chemotherapy or radiation therapy may experience a range of treatment-related side effects. One of the most common and most distressing side effects is treatment-induced emesis. The severity of the symptom is great enough to cause some patients to refuse treatments, delay appointments or discontinue therapy entirely. Experiencing treatment-induced nausea and vomiting can create a spectrum of issues for patients and their families and seriously influence their quality of life. Managing nausea and vomiting induced by cancer therapy is of critical importance. A team approach, inclusive of the patient, can be most effective. Nurses play a pivotal role in assessing patterns of nausea and vomiting and the usefulness of anti-emetic therapy, evaluating and updating treatment/care plans and helping the patient and family to cope with the disease and its treatment.


[Implications of acquired immunodeficiency syndrome affecting the digestive system]. Over the coming decades gastroenterology,--similarly to other branches of medicine,--will be confronted with AIDS and related disorders. In this article the gastrointestinal organ-associated symptoms are briefly reviewed with special reference to: esophagus, stomach, hepatobiliary system and the guts. Some special endoscopic problems of this field have also been mentioned.


[Molecular genetic, laboratory and clinical study of serum amyloid P]. Studying the gene polymorphism of serum amyloid P a common constituent of amyloid deposits two restriction fragment length polymorphism patterns were found among Hungarian rheumatoid arthritis (RA), juvenile rheumatoid arthritis (JRA), systemic lupus erythematosus (SLE) patients and healthy controls. Although no direct connection between DNA polymorphism and the frequency of amyloidosis in three patient groups was found, a marked predominance of the heterozygosity in all studied groups has been described. Authors found close correlation between the serum levels of SAP and CRP in juvenile rheumatoid arthritis, but failed to find the same correlation in SLE and healthy controls. Moreover, the serum level of CRP of heterozygous patients were significantly higher than that of homozygous patients within the juvenile rheumatoid arthritis patient groups.


[Erythrocyte zinc-protoporphyrin/hem ratio--screening test for the detection of iron deficiency and lead exposure. Experience with the Hemofluorometer in Hungary]. Increased zinc protoporphyrin/hem ratio (ZP) in erythrocytes caused by iron deficiency and/or lead exposure can be measured very simply and directly using a dedicated instrument, the Hematofluorometer. Clinical value of ZP test in detecting iron deficiency and lead exposure has been demonstrated by the authors in 465 females. Based on the literature and their own favourable experiences, the authors call attention to this useful screening method of preventive and diagnostic importance.


[Exclusion of Sandhoff disease (Tay-Sachs 0 variant) by chorion biopsy]. Transcervical chorionic villus sampling with ultrasound guidance at the 11-th week of pregnancy was made at a woman with the history of one lethal case of Sandhoff disease. The total hexosaminidase and the hexosaminidase A were determined. At the 16-th week amniocentesis was performed and the characteristic enzymes were determined from the amniotic cell culture. The results of the examinations made possible to advise the patient to carry out the pregnancy. The examinations after delivery confirmed the newborn to be a carrier.


Neurological and skeletal outcomes in 113 patients with closed injuries to the cervical spinal cord. Neurological and skeletal outcomes were evaluated in 113 patients for one year following closed lower cervical spinal cord injuries. The extent of neurological recovery did not depend on surgical versus nonsurgical management, or the degree of spinal angulation, vertebral displacement, spinal stenosis, or inferred mechanism of injury based on the initial plain cervical x-rays. Assessment of skeletal outcomes demonstrated significantly less vertebral angulation, more rapid stabilization, and less anterior callus formation among the patients in the surgical group. In addition, the surgical patients had marginally shorter lengths of hospitalization.


Motor vehicle crashes and spinal injury. Accident reports for 67 patients admitted to 3 spinal cord injury units in Australia in 1987 as a result of motor vehicle accidents were examined. Two thirds of the accidents occurred during the Friday-Saturday-Sunday leisure period and about 60% occurred during the November-February Australian summer holiday season. This conforms to the general Australian pattern of road trauma which is predominantly a consequence of leisure travel. The likelihood of a road traffic injury resulting in damage to the spinal cord was highest for motorcyclists whose average age was 22.7, lower than that for vehicle drivers (33.7) and vehicle passengers (38.1). However the most important finding is that most car occupants received their injuries when the motor vehicle overturned. As vehicle rollovers are relatively rare in the total spectrum of traffic crashes this distribution is thought not to have been previously reported. Some possible mechanisms of spinal cord injury are reviewed and engineering solutions to prevent future injuries are recommended. The paper also emphasises the unique opportunity for Australia to collect meaningful data on the causes of spinal injury and advocates the creation of an Australian Spinal Cord Injury Registry.


An open trial of vacuum penile tumescence: constriction therapy for neurological impotence. Sexual dysfunction is a frequent result of traumatic and non traumatic neurological disorders, including spinal cord injury, stroke, traumatic brain injury and autonomic neuropathy (for example, as may be seen in patients with diabetes mellitus). Although many methods have been suggested for the treatment of some of these problems in male patients, most are invasive and have a substantial morbidity. This is the report of a pilot trial of vacuum tumescence constriction therapy for 30 patients with chronic neurological impotence. Seventeen of these patients, following sexual counselling and training, decided to purchase such a device. At follow up, a mean of 21 months, over 50% of those who had purchased the device were still actively using it. The frequency of coitus increased from 0.3/wk to 1.5/wk (t = -5.7; p less than 0.0001). No significant morbidity was reported by patients. Vacuum tumescence constriction therapy shows promise as a noninvasive method for the treatment of neurological impotence.


Transcutaneous nitroglycerin in the treatment of erectile dysfunction in spinal cord injured. We have tested the erectile effect of penile applicated nitroglycerin plasters (Transiderm-Nitro 10 mg/24 hours) in 17 spinal cord injured men, who had responded to intracavernous papaverine injections with erections sufficient for vaginal penetration. The nitroglycerin plasters were applied on the skin of the penile shaft and a positive response was obtained in 12 men. A total of 5 men reported an erectile response sufficient for vaginal penetration after using nitroglycerin plasters at home. All 5 preferred to continue with this noninvasive treatment compared to papaverine injections. Our results indicate that men with spinal cord injury who need doses larger than 15 mg papaverine to obtain erection sufficient for vaginal penetration will not achieve this with nitroglycerin plasters. We suggest that this noninvasive treatment should be tested on spinal cord injured men before injection therapy is initiated.


Mechanical plus pharmacological prophylaxis for deep vein thrombosis in acute spinal cord injury. This pilot study assessed the effectiveness of external pneumatic compression (EPC) with gradient elastic stockings (GES) and low dose heparin (LDH) in the prevention of deep vein thrombosis (DVT) in acute spinal cord injured (SCI) patients in the first 14 days following injury. Twenty-one consecutive patients within 48 hrs of injury with acute C2 through T12 motor complete or nonfunctional motor incomplete spinal cord lesions were enrolled. 125 I fibrinogen scanning was performed daily. A positive scan was confirmed by venography. Thrombosis was demonstrated in 1/19 patients. A control group from a previous study confirmed thrombosis in 6/17 patients (p = 0.04). Comparison of extent of thrombosis demonstrated a reduction in the treated group (p = 0.02). This pilot study demonstrates that EPC with GES plus LDH may be an effective prophylactic regimen in these patients.


Return to work after spinal cord injury: the potential contribution of physical fitness. The history, physical characteristics and fitness status of 60 persons who had sustained a spinal cord injury at least 3 years previously were considered in relation to current occupation. All subjects had completed their education, 39 being gainfully employed and 21 unemployed. The general characteristics of the sample, mainly beneficiaries of the Quebec Automobile Insurance Plan, were typical of spinal cord injured individuals in North America. The working group had a significantly higher current level of education than those who were unemployed (p less than .01). In terms of physical fitness, the workers were lighter, with a lower body mass index and a higher aerobic power (p less than .05). Isokinetic testing suggested a trend toward a higher peak torque in the workers. The total work performed (Nm.kg-1) during an isokinetic endurance test (25 biphasic contraction at 180 degrees.sec-1) was significantly higher in the workers, suggesting that such muscular endurance might be even more useful than greater peak isokinetic strength during vocational activities. However, the likelihood of employment was unrelated to habitual patterns of either aerobic exercise or overall physical activity. No significant differences of physical fitness or physical activity habits were found between workers holding sedentary versus physically demanding jobs. The results verified the positive relationship between physical fitness (body composition, aerobic power, muscular endurance) and the gainful employment of paraplegics, but failed to show any significant relationship between physical fitness and the acceptance of physically demanding work by such individuals.


Maximal exercise response of paraplegic wheelchair road racers. The maximal metabolic responses of 11 paraplegic wheelchair road racers were evaluated with 2 wheelchair exercise protocols: increasing speed and increasing resistance. The maximal heart rates, minute ventilations and oxygen uptakes were similar for the 2 tests, indicating that either protocol is suitable for maximal wheelchair dynamometer exercise tests for groups. The resulting data were then compared to published data on maximal arm exercise by athletic and non athletic paraplegics and ambulatory males of the same age group. The combined mean values for both exercise tests of maximal oxygen consumption rate (VO2max = 37.4 ml/kg/min), minute ventilation (VE = 109.4 l/min), respiratory exchange quotient (RQmax = 1.18) and heart rate (187 beats/min) are in the mid range of reported data on wheelchair athletes. The mean RQ and heart rate values were similar to those achieved by ambulatory individuals performing maximal exercise tests. The mean VO2max of 37.4 ml/kg/min in our subjects is comparable to that achieved by sedentary ambulatory males of this age group. The data and the comparison to published data suggest several conclusions: in some parameters elite male paraplegic road racers have maximal values similar to those of ambulatory males, and in others they have maximal values substantially lower than might be expected; there is considerable variability among paraplegics in the metabolic responses to maximal exercise, most likely related to differences in cardiovascular fitness; and paraplegics can improve their cardiovascular fitness by training.


Symptomatic postprandial hypotension in high paraplegia. Case report. Symptomatic postprandial decrease in blood pressure has been described in patients with various autonomic disorders, but not in patients with spinal injuries. Presented herein is a 31 year old female patient with traumatic complete paraplegia under the T3 level, in whom postprandial hypotension (PPH) was observed. The PPH was preceded by an increase in insulin level and was followed by an acceleration of heart rate. Oral caffeine prevented the hypotension and alleviated the symptoms. It is suggested that the PPH might be manifested as a result of damage to an upper thoracic spinal baroreflex. Clinical investigation of PPH is recommended for patients with high paraplegia.


Recurrent dislocation of the hip in adult paraplegics. Recurrent dislocation of the hip is rare and has not previously been reported in adult paraplegics. This paper describes 3 cases. In one patient it was spontaneous, occurring 16 years after the original injury and was associated with a flexion-adduction contracture of the hip and a shallow acetabulum. One case occurred after minor trauma in a patient who experienced flexion-adduction spasms of the hip. In the third patient the condition was secondary to posterior acetabular deficiency following a conservatively treated fracture dislocation. All 3 patients experienced symptoms of disabling autonomic dysreflexia during the episodes of dislocation. The importance of recognising and adequately treating hip injuries in patients presenting with paraplegia secondary to spinal cord injury is stressed. In patients with spastic paraplegia presenting with recurrent dislocation of the hip, operative treatment combining a soft tissue repair and a bone block to augment the acetabulum is recommended.


Graves' disease complicating myelopathy. Exophthalmos, supraventricular arrhythmias, and myxedema have been noticed among patients chronically paralysed due to myelopathy. A survey was conducted to document and explain the observation. A long term care population of 77 male myelopathy patients aged 59 +/- 14 years (mean +/- 1 standard deviation), paralysed 19 +/- 11 years, were compared by exophthalmometry (Hertel instrument) with 53 male non myelopathy patients and hospital employees, aged 57 +/- 15 years, by review of electrocardiograms (EKGs) of record with 91 male non myelopathy hospital patients, aged 59 +/- 13 years, and by thyroid function tests with standard values. Abnormal ocular protrusion (greater than 22 mm) was found in 9 myelopathy patients (12%) and in none of the controls. Exophthalmos was bilateral in 7. The mean ocular protrusion was 17.2 +/- 3.6 mm for myelopathy patients and 14.9 +/- 3.9 mm for controls (p less than 0.001). Three exophthalmic patients had atrial fibrillation. Arrhythmias had been recorded in 186 of 1390 EKGs in 34 myelopathy subjects and in 63 of 377 EKGs in 25 controls. The ratios of supraventricular to ventricular arrhythmias were 2.8 for myelopathy patients and 0.7 for controls (p less than 0.02). Hypothyroidism was found in 2 of 74 patients tested, 2.7%. Exophthalmos, supraventricular arrhythmias, and myxedema are unusually common among chronic myelopathy patients. Preceding Graves' disease with residual effects can be suggested as the explanation.


The application of a modified neuroprosthetic hand system in a child with a C7 spinal cord injury. Case report. A neuroprosthetic hand system developed at Case Western Reserve University has been modified for use by an 8 year old child with an incomplete C7 spinal cord injury. This system has been adapted to accommodate voluntary thumb and finger extension, and provides stimulated finger flexion and thumb position for lateral and palmar prehension. Three months were required to develop grasp with sufficient strength and coordination for functional use. This period consisted of: implantation and immobilization of percutaneous intramuscular electrodes; stimulated exercise of the muscles of the hand and forearm; programming grasp patterns; and system training. Functional assessments show that the neuroprosthetic hand system allows the subject to perform unilateral and bilateral tasks that were otherwise impossible or were previously performed bimanually. The ability to perform activities of daily living with one hand frees the contralateral upper extremity to be used either for balance which increases the work area, or to stabilize an object allowing manipulation with the instrumented hand. Telephone interviews suggest that the hand system is used on a consistent basis at home and school. This single subject application indicates that a stimulation system designed for adults with C5-6 spinal cord injuries can enhance hand function and facilitate independence in a child with a low level cervical lesion.


How to weigh a patient who is over 350 pounds. Every so often a physician needs to weigh someone who exceeds the weight limit of the standard office scale. This short tip describes an easy and quick method of obtaining the weight of someone who is over 350 pounds.


Discitis in children.

Discitis in children. Discitis is usually a benign, self-limiting disease that is frequently misdiagnosed. The disease usually leads to spontaneous disc-space narrowing and end-plate irregularity, which require no treatment and rarely cause morbidity.


Biomechanics of the human anterior cruciate ligament. Muscle stabilization and ACL reconstruction. Several topics of debate surround the surgical reconstruction of the anterior cruciate ligament (ACL), including graft selection, reconstructive technique, and postoperative rehabilitation. The tensile properties of the human ACL and the role of this ligament in the normal kinematics of the knee have been addressed in the first part of this two-part review. This portion of the review will focus on the effects of reconstruction technique, initial graft tension, and muscular stabilization on knee kinematics.


Biomechanical considerations in intramedullary fixation of lower-extremity fracture. Since Gerhard Kuntscher's first cloverleaf design was introduced in the early 1940s, intramedullary nail geometry has become increasingly complex. Many design changes have been introduced, and these have had profound effects upon the mechanical performance of intramedullary devices, making them more versatile. The subset of long-bone fractures amenable to intramedullary fixation is expanding, largely because of these advancements in nail design. Selection of the appropriate nail and bone-nail construct for each fracture configuration requires a knowledge of basic biomechanical principles behind nail design and the implant-host interface. Appropriate clinical application of this knowledge not only ensures the best possible intramedullary fixation of long-bone fractures, but it also aids in avoiding some of the complications that may occur.


Anatomical variations of the median nerve at the wrist. A comprehensive review of reported median-nerve variations at the wrist is presented. This includes motor-branch anomalies, multiple divisions of the median nerve, neural loops, and variations in association with aberrant muscles. Inadvertent injury to the median nerve during carpal tunnel surgery can be minimized if the anatomy is understood, variations are recognized, and adequate exposure is achieved.


Clear cell sarcoma presenting as an interdigital neuroma. The incidence of malignant soft-tissue sarcomas in the general population is approximately 1.4 per 100,000. Approximately 2% of all cancer deaths are attributable to these tumors. Presented is a case history of a soft-tissue malignant neoplasm that was originally thought to be an interdigital neuroma and that eventually required a modified Chopart's amputation. A review of the literature is presented on other soft-tissue malignant tumors that have an affinity for the foot and ankle. The intention of presenting this case is to caution physicians that malignant lesions can simulate a benign process and should always be considered in the differential diagnosis of any foot mass.


Multifocal epithelioid hemangioendothelioma in bone. The case of a 17-year-old male with multifocal, grade I epithelioid hemangioendothelioma of the right ankle and foot is presented. The major symptom was poorly localized ankle pain refractory to conservative management. Imaging studies, including roentgenograms, computed tomographic scan, and magnetic resonance imaging, revealed multiple lesions in the right distal tibia, talus, calcaneus, and first cuneiform. An open biopsy of the right talus confirmed the diagnosis, and treatment consisted of localized radiation therapy to the affected area. We review the literature of this rare neoplasm from the initial descriptions to current nomenclatures and conceptualizations of the tumor.


Metastatic renal carcinoma in the hand: treatment with preoperative irradiation and ray resection. Isolated metastatic renal-cell carcinoma of the hand is a rare disorder that requires aggressive management for pain relief, improvement of hand function, and prevention of further spread of disease. An unusual presentation of isolated, advanced metastatic renal-cell carcinoma in the left third metacarpal of the nondominant hand is presented. Localized preoperative radiation therapy was used prior to ray resection to decrease tumor bulk and vascularity. The patient is alive and disease free at 1 year postoperatively with a functional but impaired hand.


Imaging rounds. Multifocal adamantinoma of the tibia and fibula. The following is a description of the clinical and roentgenographic findings in a case exhibiting a condition of interest to the orthopaedic surgeon. Initial history, physical findings, and roentgenographic examinations are found on this page. The diagnosis and discussion of this case are presented on the following pages.


Status epilepticus in children. The acute management. Status epilepticus is a common pediatric emergency that may result in significant morbidity and mortality. This article provides a clinical update on generalized tonic-clonic status epilepticus in children and a practical approach to their initial stabilization and pharmacologic management. Only an organized approach to the initial stabilization and management of the child in status epilepticus will help prevent unnecessary complications and death.


Update in medical toxicology.

Update in medical toxicology. This article examines some current issues in toxicologic care. First there is a review of the scope of pediatric poisonings and some aspects of initial management. Then there is a discussion of the decision-making process required to properly use gastric decontamination in the management of poisonings. Each of the common methods available--emesis, gastric lavage, activated charcoal, catharsis, and whole bowel irrigation--is discussed. Finally, several new and old antidotes are reviewed, namely naloxone, glucagon, bicarbonate, dimercaptosuccinic acid, digoxin-specific fab fragments, and flumazenil.


Child abuse intervention in the emergency room. The pediatrician and other emergency room caregivers are often on the frontlines in the identification and treatment of child abuse and neglect. The ability to recognize the possibility of intentional injury is crucial because immediate intervention may be necessary to prevent further harm to the child. The evaluation requires a careful taking of history, thorough physical examination, and detailed documentation. Reporting of suspected abuse or neglect is mandated and must be made to appropriate authorities. Follow-up of medical treatment, services, and available therapy should be emphasized to assure the continued safety of the child.


Triage, initial assessment, and early treatment of the pediatric trauma patient. It should be clear from this overview of triage, assessment, and initial care that early involvement by the leader of the trauma team is essential. Because operative intervention is so often necessary, the trauma team leader should be a surgeon with specialized training in trauma. The complex decision-making process involves prioritizing approaches by emergency room physicians, pediatricians, and surgical specialties in patients with multiple injuries. Even with single-system injury a rapid and logical approach to assessment and treatment is necessary in light of an overall longer term management plan.


Management of pediatric head injury.

Management of pediatric head injury. This article on management of pediatric head injury reviews the pathophysiology and current therapy for traumatic brain injury in children. There is an emphasis on clinical protocols and algorithms that guide therapy to prevent or attenuate the deleterious effects of secondary brain injury as intracranial hypertension, hypotension, and hypoxia.


Pediatric maxillofacial trauma.

Pediatric maxillofacial trauma. The accurate diagnosis and timely, appropriate treatment of soft-tissue and bony maxillofacial injuries in children are of critical importance due to the potential adverse impact of maxillofacial trauma on subsequent facial growth and development. Guidelines are provided to assist the pediatrician in the evaluation and treatment of minor and major facial injuries.


Pediatric burns. An overview.

Pediatric burns. An overview. This article describes the management of burn injuries in children. It begins with an epidemiologic description of pediatric burns. Attention is given to emergency care, burn wound evaluation, operative management, and rehabilitative goals.


Computerized diagnostic referencing in pediatric emergency medicine. A well-qualified and dedicated pediatrician in a mid-Atlantic state recently cared for a 4-year-old child with a fever and a truncal rash. On the second visit the child was lethargic but seemed to improve with oral hydration and fever control. Twenty hours later the child's rash became petechial and the child returned moribund and died shortly thereafter. Looking for an emergency differential diagnosis on a 4-year-old child with fever and a truncal rash would have been cumbersome using traditional reference materials. With PEM-DXP, however, a nurse or secretary could have produced for the physician in 60 seconds a list of 12 emergency diagnoses to be considered. Rocky Mountain spotted fever would have appeared on that list. (Ten percent of patients with Rocky Mountain spotted fever have a maculopapular rash, and in 10% of those children the rash begins on the trunk.) This list might have prompted this physician to ask about a tick bite. A positive response would have been obtained. Possibly the tragic outcome, for both the child and the physician, could have been avoided. Children with urgent complaints are frequently cared for by physicians who are busy, tired, sleep-deprived, and stressed in many other ways. These physicians often have not read last month's medical journals in their specialty or even last year's journals. Yet the parents' expectation, and rightly so, is that their pediatrician or emergency physician has at his or her command and is bringing to bear on the care of their child the vast knowledge base of medical science as it pertains to their child's condition. It is a totally unrealistic expectation. By computerizing reference materials in ways that allow for selectively searching for and compiling information pertinent to a given presentation, however, we can move a bit closer to meeting both the parents' expectations of us and our own expectations of ourselves.


Cardiac issues in the pediatric emergency room. A great variety of problems referable to the cardiovascular system can prompt a visit to the pediatric emergency room. From the initial presentation of congenital heart disease, to the subsequent life-long management of these patients, to miscellaneous problems like Kawasaki disease and chest pain, the front-line pediatrician must be skilled in the recognition and early management of myriad complaints. This article focuses on information that can assist the emergency pediatrician in the evaluation and treatment of the cardiac patient from arrival in the emergency room until transfer of care to the pediatric cardiologist or inpatient staff.


The infant with cyanosis in the emergency room. The infant with cyanosis is a distressing medical presentation. The emergency room physician must be familiar with the diverse causes that may be underlying the event. An understanding of the pathophysiology along with a thorough history and physical examination will guide the physician toward appropriate intervention and management.


Temperature affects mechanics and stability during initial inflation-deflation of mature fetal lung. Volume-pressure (VP) curves of initial aeration of mature (0.94-0.97 term) rabbit fetuses were compared in three groups, respectively, at 37 degrees C, with maximal inflation pressure of 25 cm H2O (P25); 22 degrees C, P25; and 22 degrees C, P30. Anesthetized fetuses were delivered through uterotomy; chest was opened; trachea of fetal pulmonary liquid (FPL)-filled lungs cannulated; and lungs inflated-deflated in 5 cm H2O, 2 min steps under continuous microscopic observation. As distending pressure was increased, FPL moved peripherally with airways inflation by free gas and with saccular recruitment by free gas and bubbles. Saccular aeration continued during initial reduction of P from Pmax. At end-deflation, air was retained in saccules virtually exclusively as bubbles. Airways inflation required less P at 37 degrees C, though airways volume (V) was the same at both temperatures. Opening P was lower, and saccular aeration was larger and more rapid at 37 degrees C. The apparently higher distensibility at 37 degrees C was most likely due to temperature effects on fluid dynamics rather than on tissue elasticity. Maximal V attained during early P reduction in all groups, was total lung capacity (TLC) at 37 degrees C and less than TLC at 22 degrees C. Air retention at end-deflation, with films of near-zero surface tension, was greatest at 37 degrees C and least at 22 degrees C, P25. Lung stability, greater at 37 degrees C than at 22 degrees C, was best discriminated when V at P0 was taken into account.(ABSTRACT TRUNCATED AT 250 WORDS)


Clinical observations of nebulized flunisolide in infants and young children with asthma and bronchopulmonary dysplasia. Severe bronchopulmonary dysplasia (BPD) is frequently associated with asthma. The combination is often severe enough to necessitate corticosteroid therapy. There are no commercially available nebulizer solutions of corticosteroids for use in infants and young children. Seven infants and small children with very severe BPD and asthma aged 6-24 months, were treated with flunisolide, 187-250 micrograms q.i.d. in the form of nasal spray delivered by nebulizer. After treatment for 2.5-20 months, four patients showed clinical improvement, one initially improved but later deteriorated and died of cardiac failure, and two patients showed no improvement and died within 3 months. The number of days of hospitalization was significantly reduced from 8.4/month to 2.5/month (P less than 0.05). No side-effects were detected and it was felt that the three patients who died, did so as a consequence of very severe BPD and its cardiac consequences. The suspension remained stable for 80 min when mixed with normal saline, cromolyn sodium, albuterol, or acetylcysteine. It is concluded that nebulized flunisolide is a potentially useful treatment for infants and young children with asthma and BPD.


Diet in infancy and bronchial hyperreactivity later in childhood. Sixty-seven atopy-prone children (atopic family group, AFG) and 52 children with no family history of atopy (NAFG) were followed for 10 years. During infancy, the mothers of the newborn AFG children were advised to adjust their infants' diet, with a view toward minimizing the risk of atopy, and not to keep pets. Pulmonary function tests, methacholine inhalation challenge (MIC), and skin prick tests (SPT) were done in order to evaluate the bronchial reactivity and skin reactivity in the two groups. A pathological result in MIC was found in 20 (30%) of the AFG children and in 10 (19%) of the NAFG children. Such results of MIC were more common in the children with positive SPT results than in those without (67% vs. 24%). In regard to the diet consumed in infancy, MIC was pathological in 23% of children with and in 36% without prophylactic diet in infancy. For MIC, using the new, Spira electro 2 dosimeter equipment, the sensitivity was 75% and specificity 97%, but the predictive value for diagnosing bronchial asthma was only 25%. The important advantage of our method is that the degree of bronchial reactivity can be estimated by responses to increasing provocative doses. Our observations confirm that the new method is suitable for detecting bronchial asthma in clinical practice but it seems not to be optimal for epidemiological studies. We concluded that later bronchial hyperreactivity can not be diminished by avoiding home pets or providing a hypoallergenic diet during infancy.


Adenotonsillectomy for upper airway obstruction carries increased risk in children with a history of prematurity. To define better the clinical presentation and perioperative outcome in children undergoing adenotonsillectomy (T&A) for relief of upper airway obstruction (UAO), we reviewed the hospital records of 60 consecutive, otherwise normal children aged 12 years or younger. Seven patients with trisomy 21, neurologic impairments, or preoperative cor-pulmonale were excluded. Intraoperative and postoperative complications were experienced by 15 (34%) and 13 (25%), respectively, of the 53 children with preoperative UAO. The most severe complications comprised pulmonary edema and prolonged postoperative oxyhemoglobin desaturation. Multivariate logistic regression analysis found a history of prematurity and/or low birth weight to be the most significant risk factors related to the occurrence of complications. Twenty-eight % of the study population had a history of prematurity and they had approximately 85% of the perioperative complications seen in children with UAO undergoing T&A. Other significant risk factors included adenoidal facies and evidence of respiratory distress at the time of surgery. It appears that T&A poses significant risk for children with UAO who were born prematurely and have evidence of abnormal facial development or respiratory distress preoperatively.


Noninvasive breathing analysis: repetitive chloral hydrate in neonatal guinea pigs. A noninvasive method was used to record neonatal breathing, heart rate (HR), and the electroencephalogram (EEG) in guinea pig pups. Neonates were randomly assigned at birth to chloral hydrate (CH) or placebo (PLA) treatment. Treatments were administered 30 min before each study on days 1, 3, 5, 7, 14, and 21 after birth. Animals were studied while they breathed room air followed by air with 5% CO2 and 30% O2. CH decreased breathing frequency (f) and inspiratory minute volume (VI), but not tidal volume (VT) during the first week (P less than 0.05), and reduced the rate of growth throughout the study (P less than 0.01), whereas breathing of CO2 increased f, VT, VI, HR, and the relative power in the delta frequency band of the EEG. The percent change in VI induced by CO2, however, was not affected by drug treatment. There was a significant day of life effect on all breathing parameters and HR. CH has cumulative effects on breathing and growth that should be considered when it is used as a sedative for repeated neonatal studies in guinea pigs.


Effect of rapid thoracic compression on the cerebral blood flow-velocity patterns of small infants. We measured the middle cerebral artery (MCA) flow-velocities of 12 small infants (mean weight, 2,882 +/- 602 g) before, during, and after the rapid thoracic compression (RTC) maneuvers of partial forced expiratory flow-volume studies. Cerebral flow-velocities were measured using transcranial Doppler ultrasonography. RTC increased MCA end diastolic flow-velocities and Pourcelot indices of all infants (P less than 0.001). These values returned to baseline immediately after the release of chest compression. We also measured the MCA flow-velocities of several preterm infants during their normal daily activities. The changes in flow-velocity patterns observed during normal daily life were similar to those observed during RTC. These findings demonstrate that RTC produces real, but likely not pathologic, changes in cerebral blood flow-velocities.


Snoring in French preschool children.

Snoring in French preschool children. The prevalence of habitual snoring and its associations with respiratory symptoms, personal and familial risk factors, ear, nose, and throat (ENT) abnormalities, and its influence on ventilatory function were studied in a sample of 190 children aged 5 to 6 years from nine kindergartens in Nancy (northeastern France). Nineteen (10%; 95% CI 5.7-14.3%) of the children were habitual snorers; the prevalence was the same in boys and girls. In univariate analysis habitual snoring was significantly associated with a personal history of exercise-induced bronchospasm [relative risk (RR) 4.50]; a history of adenotonsillectomy (RR, 2.56); a personal history of allergy (RR, 2.83); a sibling history of atopy (RR, 2.39); and doctor-assessed tonsillar hypertrophy (RR, 2.51). These factors were entered into a logistic regression model that retained as independent determinants exercise-induced asthma, personal history of allergy, sibling history of allergy, and tonsillar hypertrophy. The height-adjusted peak expiratory flow rate was slightly, non-significantly lower in habitual snorers as compared to non-snorers (2.01 +/- 0.32 vs 2.10 +/- 0.38 L/s/m2). Due to the limited numbers in the sample, the increased risk for paternal (RR, 1.8) and maternal (RR, 1.6) smoking at home remained nonsignificant.


Comparison of 2-channel and 4-channel pneumograms. To determine whether the addition of air flow and O2 saturation (SaO2) channels improves sensitivity of the pneumogram in identifying cardiorespiratory pattern abnormalities, 2- and 4-channel pneumograms (PG-2 and PG-4) were simultaneously recorded in 91 consecutive infants. Forty-one infants (45%) had cardiorespiratory symptoms, and 50 were asymptomatic. Pneumograms were considered abnormal for any of the following: apnea greater than or equal to 20 seconds, heart rate less than 80 bpm for greater than 5 seconds in preterm and less than 60 bpm in full-term infants (bradycardia), shorter apnea with bradycardia or desaturation, periodic breathing greater than 7% of total sleep time in preterm and greater than 4% in full-term infants, or SaO2 less than 85% for greater than 5 seconds. Both recordings were normal in 72% of infants and abnormal in 24%. In only 4% were the PG-4 abnormal when the PG-2 were normal, in all instances due to minimum SaO2 levels of 77-84% for 5-19 seconds associated with central apnea of intermediate duration (three infants) or with mixed apnea. The difference in frequency of abnormal results between the PG-2 and PG-4 recordings was not statistically significant (X2). In conclusion, although PG-4 do increase the scope of physiological information obtained in infants with cardiorespiratory events, this short-term study does not establish whether this increase results in any long-term benefits. Further, at least in this number and these types of at-risk infants, PG-4 do not improve the sensitivity of cardiorespiratory recordings for detecting abnormalities.


Comparison of helium dilution and nitrogen washout measurements of functional residual capacity in infants and very young children. In infants and very young children, functional residual capacity (FRC) is the lung volume most frequently measured and gas dilution techniques are most frequently used to measure FRC. We compared measurements of FRC by helium dilution (FRCHe) and nitrogen washout (FRCN2) in a lung model of known volumes (20, 40, 60, 80 mL) in 8 normal infants (NL), 8 infants with acute respiratory illness (ARI), and 7 infants with chronic lung disease (CLD). In the model lung, measurements of FRCHe had a significantly greater coefficient of variation compared to FRCN2 (6.5 vs 1.5%, P less than 0.02), but there was no such difference in the results from all infants combined (6.5 vs 6.2%). In the model lung, the difference between known volumes and the measured values was significantly different from zero only for FRCHe at 20 mL (-4.4 mL, P less than 0.02). For both FRCHe and FRCN2, the slopes of the regression equations were 0.99 and the intercepts not significantly different from zero. We conclude that techniques for measuring FRCHe and FRCN2 yield accurate, reproducible, and comparable results in normal, healthy infants and very young children, and in those with respiratory disease.


Aplasia of respiratory tract cilia.

Aplasia of respiratory tract cilia. We report on ciliary aplasia of the respiratory tract, a rare disorder of the mucociliary apparatus, that is insufficiently recognized as a distinct entity. A culture method for ciliogenesis was developed by our laboratory and offers the advantage of studying cilia free of secondary changes associated with infection. Three cases of primary ciliary aplasia were documented histologically in direct biopsy specimens and also in biopsy specimens cultured specifically for ciliogenesis. Primary ciliary aplasia should be differentiated from secondary ciliary aplasia in which basal bodies are present and ciliogenesis takes place in specific culture. Only hereditary ciliary abnormalities are expressed in cell cultures. We critically review the cases of ciliary aplasia reported to date.


Cerebral contusional tears as a marker of child abuse--detection by cranial sonography. A series of 6 infants subjected to child abuse is presented in whom contusional tears of subcortical white matter were detected during life by intracranial sonography. The sonographic appearances of this highly pathognomonic marker of shaking injury are described for the first time and their significance discussed. On the basis of our experience we suggest that high resolution cranial sonography is an extremely valuable part of the diagnostic work up in cases of suspected non-accidental injury.


Cerebrovascular resistive index assessed by duplex Doppler sonography and its relationship to intracranial pressure in infantile hydrocephalus. Duplex Doppler sonography and direct intracranial pressure (ICP) measurement were performed on 18 patients with infantile hydrocephalus. ICP was measured through a frontal reservoir or ventricular tap using a nondisplacement pressure transducer. The Pourcelot Resistive Index, RI = (peak systolic-end diastolic)/peak systolic velocity was obtained from pulsed-wave Doppler measurements of blood flow velocity in the anterior (ACA) and/or the middle cerebral (MCA) arteries. There was a statistically significant positive correlation between ICP and RIs in the MCA and ACA. Paired RI measurements in 7 patients with raised ICP decreased significantly from a mean of 0.90 pre-tap to 0.75 post-tap. Our results suggest that the RI provides a reliable measure of cerebrovascular resistance in hydrocephalus. Duplex Doppler ultrasonography thus is a useful noninvasive means of monitoring cerebrohaemodynamic change with simultaneous imaging of ventricular size in infantile hydrocephalus.


Iodine-123 scintigraphy in the evaluation of pediatric thyroid disorders: a ten year experience. Few studies have been published that describe the role of scintigraphy in the evaluation of the spectrum of pediatric thyroid disorders. Between 1978 and 1987, we studied 280 children with iodine-123 (123I) scintigraphy. Clinical information and follow-up were available in 246. We analyzed the indications for referral and determined whether the information obtained with this technique was useful in subsequent management. Indications for scintigraphy included hypothyroidism, neck masses, hyperthyroidism, and miscellaneous reasons. Scintigraphy was helpful in distinguishing anatomic from functional causes of hypothyroidism. It reliably identified the location of the thyroid gland in patients with neck masses. The functional status of thyroid nodules was readily assessed and was important in directing further treatment. Scintigraphy added little to the management of children with post-irradiation hypothyroidism without a palpable nodule, patients with Hashimoto thyroiditis or Graves disease when the clinical diagnosis was straightforward.


Melnick-Needles syndrome. Four new cases. Melnick-Needles syndrome is a rare connective tissue disorder producing somatic abnormalities with characteristic radiographic features. There are less than 35 documented cases reported to date. We present four new cases of Melnick-Needles Syndrome, one of which is the first reported Asian-ancestry patient. Two girls are daughters of one of Needle's original patients from family #2. Two others, from unrelated non-affected families, probably represent new mutations. All have characteristic radiographic features of the disorder.


Contribution of MRI in supracardiac total anomalous pulmonary venous drainage. A case of supracardiac total anomalous pulmonary venous drainage (TAPVD) in an infant aged 2 1/2 months is presented. Diagnosis was established non invasively by magnetic resonance image (MRI). Not only did MRI precisely depict the anomalous venous pathway but it moreover securely excluded pulmonary venous obstruction.


Plain film and CT observations in prostaglandin-induced bone changes. Prostaglandin E1 intravenous infusion is used in infants with ductal-dependent congenital heart disease to maintain ductal patency and prolong life until palliative or corrective surgery is feasible. Complications of prostaglandin administration include fever, diarrhoea, hypotension, apnoea, bradycardia, pseudowidening of the cranial sutures, underossification of the calvarial bones, periostitis, and skin edema [1-3]. This paper presents dramatic plain radiographic features of prostaglandin-induced bone disease, including periosteal proliferation and the unusual bone-within-bone appearance, and provides the previously unpublished CT correlation.


Oto-palato-digital syndrome type II. Report of two related cases. Two cases with major features of bowed long bones, hypertelorism, mandibular hypoplasia and hand and foot abnormalities with early neonatal death due to respiratory failure are presented. The radiologic and clinical findings are in keeping with oto-palato-digital syndrome type II and differ significantly from other causes of bowed long bones such as campomelic and kyphomelic dysplasias.


Bronchiolitis obliterans-organizing pneumonia (BOOP) in children with malignant disease. Four patients who had completed chemotherapy for malignant disease are presented. Unexpected findings of pulmonary infiltrates on chest radiographs of two patients and solitary and/or confluent nodules on CT in all four led to open lung biopsy. Histologic diagnosis in each case was bronchiolitis obliterans-organizing pneumonia (BOOP). This usually innocuous disorder can be differentiated histologically from the more severe pure bronchiolitis obliterans and should be considered in the differential diagnosis of pulmonary lesions associated with malignant disease.


The olive on end: a useful variant of the "shoulder" sign in the barium X-ray diagnosis of idiopathic hypertrophic pyloric stenosis. We describe a radiographic sign of infantile hypertrophic pyloric stenosis. This sign, elicited during firm compression of the barium-coated pyloric region, is a round or avoid filling defect caused by the hypertrophied pyloric muscle protruding en face into the gastric lumen. This filling defect typically reveals a barium-containing central depression or stellate indentation, representing the proximal end of the obstructed pyloric channel. This sign, like the closely related "shoulder sign", appears to establish the diagnosis of hypertrophic pyloric stenosis without need for filling of the pyloric channel or for additional radiographic maneuvers.


Fetal meconium peritonitis without sequelae. Meconium peritonitis is a chemical peritonitis usually resulting from antenatal bowel rupture. Prenatal ultrasound findings include ascites, intraabdominal masses, bowel dilatation and the development of intraabdominal calcifications [1-5]. The most common bowel disorders which lead to meconium peritonitis in utero are those resulting in bowel obstruction and perforation, such as small bowel atresias, volvulus and meconium ileus [1-5]. Meconium ileus is associated with cystic fibrosis in most cases, although extraluminal abdominal calcifications are usually scarce in cases of cystic fibrosis [1, 6]. Postnatal outcome for infants with meconium peritonitis depends on the etiology for bowel rupture and underlying disease.


An unusual case of meconium peritonitis associated with perforated hydrocolpos. Meconium peritonitis results from intestinal wall perforation with meconium spillage into the peritoneum during intrauterine life. Anal atresia is associated with meconium peritonitis and is also associated with cloacal malformation. A female neonate presented with a distended abdomen, anal atresia, and meconium peritonitis as diagnosed by calcification in the peritoneal cavity on abdominal radiograph. Sonography and cystography demonstrated a cloacal malformation with perforation of the hydrocolpos and resultant spillage of meconium into the peritoneum. There was no evidence of further perforation of bowel at surgery. This unusual case of meconium peritonitis is reported.


Focal fatty infiltration of the liver in a healthy child. Fatty infiltration of the liver may occur in healthy children. The ultrasonographic, CT, and MRI findings are identical to those already described in the adult population.


Intrahepatic biliary stones in children. Intrahepatic biliary stones in seven non-Oriental patients were studied in all by sonography, in four patients by computed tomography and in four patients by percutaneous transhepatic cholangiography. For patients had extrahepatic biliary atresia treated with portoenterostomies, one patient had undergone partial liver transplantation and of the remaining two, one had cystic fibrosis and the other immunodeficiency syndrome. All sonograms were abnormal and showed echogenic foci within the liver, with or without associated signs of biliary tract dilatation. CT confirmed the biliary tract dilatation yet calculi were identified in one patient only. PTC was particularly helpful in the patient with immunodeficiency in whom features typical of sclerosing cholangitis were found. This report emphasizes the variable radiological appearance of bile stones which to our knowledge have rarely been described in children with entities other than Oriental cholangitis.


Fluoroscopic placement of jejunal feeding tubes. Over a two-and-one-half year period, 50 children underwent placements of jejunal tubes through a nasal route (NJ, n = 47) or through an existing gastrostomy site (GJ, n = 119). There were four attempted placements (98% success rate). The NJ tubes remained in place an average of 13 days, and the GJ tubes remained in place an average of 37 days. Fluoroscopic time for placement of an NJ tube averaged 6 min (29 cases), and for a GJ tube 8 minutes (91 cases). In spite of the limited retention time, fluoroscopic time, and availability of alternative methods, fluoroscopically placed jejunal feeding tubes are still playing an active role in this institution.


Paediatric myelography with iohexol.

Paediatric myelography with iohexol. 32 paediatric patients requiring myelography were studied with iohexol 210 mgI/ml (n = 15) and iohexol 180 mgI/ml (n = 17). Visualization was good or excellent in over 90% of the group receiving the higher concentration and in over 83% of the lower. There were no side effects in either group and vital signs were not significantly altered during the procedure. In the majority of patients (14/18) who had CT, additional diagnostic information was obtained. Iohexol 180 mgI/ml is preferred for routine use, but 210 mgI/ml may give superior visualization with no apparent added risk. Procedural technique and good communication with the patients and their families may have contributed to the absence of side effects.


Multiple myeloma in an adolescent.

Multiple myeloma in an adolescent. The radiographic findings of a 15-year-old Brazilian male with diagnosis of multiple myeloma are described. He presented with claudication and recent onset of tender painful swelling of the right mid leg. Radiographs showed wide spread "soap bubble" lesions of the skull, long bones, spine, pelvis, ribs, shoulders, and clavicles. The diagnosis was confirmed by the presence of a plasmacytoma on tissue biopsy (femur), serum IgG gammopathy and Bence-Jones proteinuria.


Sonography of intrascrotal hematomas simulating testicular rupture in adolescents. Four cases of intrascrotal hematoma simulating testicular rupture were noted in teenagers. Careful sonographic technique allowed for the discovery of the normal testicle in a more peripheral location in the scrotum. Duplex doppler aided in confirming a normal testis in one case.


Bubble gum simulating abdominal calcifications. CT examination of the abdomens of two children demonstrated sites of high attenuation in the stomach, which were revealed to be bubble gum. Investigation of the CT appearance of samples of chewing gum showed that it consistently has high attenuation (178-345 HU). The attenuation of gum base, which contains calcium carbonate, was 476 HU. In addition, examination of a volunteer who had swallowed bubble gum confirmed the CT appearance.


Diagnosis of peanut inhalation by MRI.

Diagnosis of peanut inhalation by MRI. A peanut is a commonly inhaled foreign body during childhood. Some cases are difficult to diagnose especially in cases without a clear history of inhalation. We describe a 16-month-old boy presenting with stridor and fever. The chest x-ray suggested inhalation of a foreign body but there was no history of this. A high spot on a T1-weighted chest MRI was due to a peanut which was seen to have moved from the right main bronchus to the left inferior bronchus, between the two MRI studies. MRI can provide information on position and size of the peanut, the conditions of the surrounding tissues and may be also useful in treatment. We consider MRI to be a valuable new method for the diagnosis of peanut inhalation.


MR demonstrates cartilaginous megaepiphyses of the hips in Kniest dysplasia of the young child. MR imaging of a 2-year-old girl with Kniest dysplasia revealed abnormally large cartilaginous femoral heads. Although ossification of the femoral head is delayed in Kniest dysplasia, it is nonetheless also a megaepiphyseal growth center with respect to the cartilage model.


Extracorporeal shock wave lithotripsy and xanthine calculi in Lesch-Nyhan syndrome. We report a case of Lesch-Nyhan syndrome (LNS) with urinary xanthine calculi. At eight years of age calculi in the renal pelvis were successfully disintegrated by extracorporeal shock wave lithotripsy (ESWL) without any complications. Follow-up sonography is very useful for management of patients with LNS, particularly when they are on allopurinol therapy.


Isolated intrathoracic spleen presenting as an enlarging chest mass. CT and MRI findings. We present the first reported case of an isolated intrathoracic spleen. This presented as an enlarging chest mass in a 6-month-old infant. The lack of symptoms and absence of herniated bowel caused an interesting diagnostic problem which was elegantly solved by a combination of imaging modalities.


Cystic mesenchymal hamartoma of the liver. Two cases of multicystic mesenchymal hamartoma of the liver in children are described. In both cases noninvasive imaging techniques (ultrasound, CT or MR, radionuclide scan) showed a bulky cystic mass suggesting a correct preoperative diagnosis, while selective arteriography defined the operability of the tumor.


Intraabdominal calcifications in the newborn: an unusual case with anorectal malformation and other anomalies. Intraabdominal calcifications are an unusual radiographic finding in the newborn and can easily be misinterpreted as meconium peritonitis. The authors refer to a patient with anorectal malformation (ARM), intraluminal calcifications and other anomalies. Careful differentiation of the type of intraabdominal calcifications can suggest the possibility of other initially unsuspected anomalies.


Bilateral subdural effusion (hygromas) in non-immune hydrops fetalis. In addition to body edema fluid accumulation in serous cavities is a component of non-immune hydrops fetalis. A case with bilateral symmetrical subdural effusion is reported. Fluid accumulation in this space appears to be a part of this entity.


Sonographic findings in spontaneous renal transplant rupture. A post-transplant kidney became acutely swollen during a rejection episode. The hemoglobin level and pulsitility index fell. Sonographic examination demonstrated extrarenal and subcapsular collections due to spontaneous renal transplant rupture.