Computer simulation of a neurosurgical operation: craniotomy for hypothalamic hamartoma

OBJECTIVE: Analysis of the spectrum of diseases attributed to Pseudomonas aeruginosa in patients with coinfection with the immunodeficiency virus (HIV). METHODS: Retrospective study of 35 cases of coinfection with P. aeruginosa-HIV, attended from 1985 until 1995. Analysis of putative factors implicated in mortality secondary to P. aeruginosa infection. RESULTS: The spectrum of infection due to P. aeruginosa was: ORL infection (4 cases), infection of upper respiratory tract (4 cases), pneumonia (21 cases), infected bronchiectasias (one case), endocarditis (2 cases) and primary bacteremia (3 cases). Most of these infections were community-acquired ones (30 cases [85.7%]). Degree of immunodepression was variable, with 12 cases (34.3%) affecting to patients with more than 200 CD4+lymphocytes x 10(-9)/l. Radiological pattern of pneumonias consisted in alveolar consolidation (18 cases [85.7%]), necrotizing pneumonia (2 cases [9.5%]) and interstitial pattern (one case [4.8%]). More than a 80% of isolates of P. aeruginosa was sensible to ceftazidime, ciprofloxacin, aminoglycosides, ureidopenicillins and imipenem. Recidives of the P. aeruginosa infection were detected in 7 cases (20%): 4 cases of ORL infection (100%) and 3 cases of lower respiratory tract infection (13.6%). Overall mortality was a 20% (7 cases), being directly attributed to P. aeruginosa infection in every one of the cases, all of them pneumonias. Secondary bacteremia was associated to a higher mortality (odds ratio [OR] 18.67; p = 0.0207). CONCLUSIONS: P. aeruginosa affect to the HIV-infected patients, independently of their immunodepression degree, affecting to different localizations. This bacteria continues to be sensible to conventional anti-Pseudmonas treatment. Pneumonia with secondary bacteremia is associated to a higher mortality.     

Reversible dementia due to valproic acid therapy

A progressive dementia syndrome (DSM IV) with frontal-subcortical features developed in a 72-year-old woman during valproate therapy (Depakine). Discontinuation of valproate resulted in complete recovery. Drugs are a common cause of reversible dementia. The association of dementia with valproate therapy is rare. Features of a subcortical dementia are indicative of a reversible cause. In addition, the possible role of drugs should always be considered in patients with cognitive decline.     

Paradoxical response to photorefractive treatment for postkeratoplasty astigmatism

Traditionally, the procedure of implant placement requires a surgical periosteal flap to be raised. In a percentage of implant cases, there is no need for flap surgery for implant placement, or for a follow-up surgical procedure for abutment connection. In this clinical investigation, 20 maxillary and mandibular implants were placed in seven adult male patients. The sites for implant placement were prepared according to an alternative surgical technique without raising a surgical flap. Patients were recalled periodically for 2 years to evaluate healing and clinical integration of implants. The results showed normal clinical healing at the first week of reexamination in all implant sites; periodontal probing of less than 2 mm circumferentially around all healing caps at 3 months and later at subsequent recall periods; no radiolucency observed in the peri-implant zone; no sign of clinical mobility during recall examination; and no persistent or irreversible sign or symptoms of pain, infection, or necrosis. This alternative surgical technique can provide several advantages over the traditional 2-step procedure.     

Variation in response to dexamethasone of a patient with Cushing's syndrome

A patient with Cushing's syndrome due to a nonresectable chromophobe adenoma underwent external irradiation of the hypothalamic-pituitary area. The signs of Cushing's syndrome ameliorated subsequently but recurred eventually, necessitating bilateral adrenalectomy 30 months after initial presentation. Response to dexamethasone suppression testing on four occasions varied greatly. These results may reflect alterations in sensitivity of the tumour or the hypothalamic-pituitary axis to feedback inhibition by glucocorticoids.     

Adrenocortical response to hypertonic saline in rats with lateral hypothalamic lesions.

Used plasma corticosterone levels to assess the response to stress induced by ip injections of hypertonic saline in 27 male albino Harlan-Sprague rats with lateral hypothalamic (LH) or sham lesions. Ss with LH lesions displayed a corticosterone response equal to that of normal Ss under basal conditions, after control injections of isotonic saline, and 20 min after injection of hypertonic saline (1.5 M, 1.0 ml/100 g of body weight). The corticosterone response of Ss with LH lesions, however, was significantly less than that of normal Ss 90 min after injection of hypertonic saline when no water was available. With access to water, normal Ss displayed substantial drinking (14.5 ml/90 min), which resulted in a reduction in plasma corticosterone concentrations to a level observed after a control injection of isotonic saline, but the little water ingested by Ss with LH lesions (2.5 ml) had no effect on the pituitary-adrenal system. It is concluded that the failure of Ss with LH lesions to drink following a hydrational challenge is not the result of an exaggerated response to stress. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

High-dose versus low-dose valproic acid as a prophylactic medication

Valproic acid has been shown to be effective in migraine prophylaxis. Its method of action is believed to be the inhibition of gamma-aminobutyric acid transaminase. The therapeutic dose needed to prevent migraine headaches has been examined in several studies, yet the optimum dose has not been found. In this case report, valproic acid was given to a 24-year-old woman with chronic headaches at 1000 mg per day. Her headaches resolved for 2 months. She tapered herself off of the medication, and her headaches returned. She was restarted at 500 mg per day of valproic acid and again, her headaches resolved. She preferred being on the lower dose which she found as effective as the higher dose. Her case makes two interesting points. The first is that lower dosages of valproic acid may be as effective as higher ones in headache prophylaxis. The second is that more studies looking at dose ranges are needed to correlate effectiveness with daily requirements.     

A super long-acting LH-RH analogue induces regression of hypothalamic hamartoma associated with precocious puberty

We treated a 1-year-old female with a hypothalamic hamartoma and precocious puberty with leuprolide acetate depot, a super long-acting hormone-releasing hormone analogue (Tap-144-SR; [D-Leu6-[des-Gly10-NH2] LH-RH ethylamide acetate). The infant's major symptoms were genital bleeding and gynaecomastia. The LH-RH analogue (30 micrograms/kg) was injected subcutaneously once every 4 weeks. Clinical and laboratory manifestations of precocious puberty showed marked improvement. A follow-up after 16 months of treatment, the size of the tumour decreased significantly and remained unchanged for 2 years of further follow-up. To the best of our knowledge, this is the first hypothalamic hamartoma case in whom a decrease of tumour size under treatment with LH-RH analogue has been documented. But, because diagnosis of hamartoma is only based on neuroradiological and not on histological examinations, the possibility of a gangliocytoma cannot be excluded with certainty.     

Gonadotrophin and prolactin secretory dynamics in girls with normal puberty, idiopathic precocious puberty and precocious puberty due to hypothalamic hamartoma

OBJECTIVE: This study was designed to test the hypothesis that hypothalamic hamartoma causes precocious puberty through a different neuroendocrine mechanism than that of normal puberty or of idiopathic precocious puberty. DESIGN AND PATIENTS: We compared the pattern of gonadotrophin secretion among 4 girls with precocious puberty due to hypothalamic hamartoma, 27 girls with idiopathic precocious puberty, and 14 girls with normal puberty. All subjects were breast stage 3 or 4. Blood samples were obtained every 20 min for 4 h during the day (1.000 hours to 1400 h) and night (22.00 hours to 0200 h). MEASUREMENTS: LH, FSH, and prolactin were measured in each blood sample. Girls also underwent LHRH-stimulation with measurement of LH and FSH before and after stimulation. RESULTS: There were no significant differences in mean LH level, LH peak amplitude, or LH or FSH peak frequency during either the day or the night among the three diagnostic groups. However, the mean +/- SD LHRH-stimulated peak LH levels were greater in girls with hypothalamic hamartoma than in girls with normal puberty or with idiopathic precocious puberty (194 +/- 142 vs 85 +/- 60 or 66 +/- 54 IU/l, respectively, P < 0.05). The LHRH-stimulated peak FSH level in girls with hypothalamic hamartoma exceeded the level for the normal pubertal girls (31 +/- 19 vs 17 +/- 7 IU/l, P < 0.05), but not the level for the girls with idiopathic precocious puberty (25 + 12 IU/l). The peak LH to peak FSH ratio in the girls with hypothalamic hamartoma exceeded the ratio for the girls with idiopathic precocious puberty (7.3 +/- 3.9 vs 2.6 +/- 3.0 IU/l, P < 0.05), but not the ratio for the normal pubertal girls (5.0 + 2.9). There were no significant differences in mean prolactin level, peak amplitude or frequency, or in the ratio of mean night to mean day prolactin, among the 3 diagnostic groups. CONCLUSIONS: We conclude that spontaneous gonadotrophin and prolactin secretion are similar among girls with hypothalamic hamartoma, idiopathic precocious puberty, or normal puberty. However, the increased LHRH-stimulated peak LH in the girls with hypothalamic hamartoma suggests subtle differences in neuroendocrine regulation that may underlie their more rapid pubertal maturation.     

Medialbasal hypothalamic deafferentation modulates feeding response to insulin in rats

Medialbasal hypothalamic (MBH) deafferentation induces hypothalamic obesity accompanied by hyperphagia and hyperinsulinemia. Insulin is essential in developing and maintaining obesity, but the role of insulin in food intake in hypothalamic obesity is still unclear. The present study demonstrated that exogenous insulin increased food intake dose relatedly in MBH deafferented diabetic rats without developing hypoglycemia. Insulin administrations suppressed hyperphagia in the sham-operated diabetic rats. In contrast, in the MBH deafferented diabetic rats, insulin increased food intake in sow-related manner concomitant with a greater increased body weight gain than the sham-operated diabetic rats. The blood glucose levels of the MBH deafferented diabetic rats were at all time higher than those of the sham-operated diabetic rats and were hyperglycemic throughout the insulin treatment. These data indicate that insulin action on food intake mediated through the central nervous system is modulated by MBH deafferentation. This modulated insulin action may contribute to the pathogenesis on obesity in MBH deafferented animals.     

Sustained response to interferon in a patient with common variable immunodeficiency and hepatitis C

Hepatitis C infection progresses faster in patients with hypogammaglobulinemia, often leading to death from liver failure within 10 yr of exposure. Response to interferon treatment has been poor in these patients. We report the case of a patient with common variable immunodeficiency and hepatitis C in whom a sustained biochemical and viral remission was obtained after treatment with interferon.     

Favorable response to corticoid therapy in a patient with transverse myelitis in systemic lupus erythematosus

Transverse myelitis is one of the most unusual neurologic complications of systemic lupus erythematosus. Its pathogenetic mechanisms are controversial. Several therapeutic regimens have been attempted with contradictory results. Corticotherapy appears to improve prognosis, although some authors question its beneficial effects. The case of a patient with systemic lupus erythematosus and transverse myelitis, who presented a favourable clinical course following early treatment with high-dose corticoids, is reported.     

Attitude variables associated with patient response to hospitalization.

Administered the CPH Factor Attitude Scale to 51 male veterans before and after treatment in a psychiatric ward, to assess the effects of patient attitudes toward hospitilization. A direct relationship was found between negative attitude and length of hospitalization. However, Ss' attitudes did not (a) change from admission to discharge, (b) predict response to treatment as measured by therapist ratings, or (c) correlate with educational level. In addition, Ss viewed the hospital as more authoritarian than ward personnel. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toxic effect of valproic acid on tryptophan binding to rat hepatic nuclei

This study evaluated whether valproic acid, a branched-chain fatty acid which has been used in the treatment of seizures, would influence the binding Of L-tryptophan to rat hepatic nuclei. Previous studies have indicated that binding of L-tryptophan to hepatic nuclear envelope protein was saturable, stereospecific, and of high affinity. In this study, we investigated whether valproic acid, which under certain conditions is heptatoxic, would influence L-tryptophan binding to rat hepatic nuclei as assayed by in vitro L-(5-3H)tryptophan binding. Our results indicate that the addition of valproic acid to hepatic nuclei or nuclear envelopes in vitro has little influence on their L-(5-3H)tryptophan binding. On the other hand, when valproic acid (80 mg/100 g body weight) is tube-fed 2 h before killing, the isolated nuclei show decreased specific L-tryptophan binding (total binding minus non-specific binding using unlabeled L-tryptophan (10(-4)M), at 2000-fold excess) compared with controls. Other fatty acids (oleic, palmitic or linoleic acid at 10(-4)M) when added with excess, unlabeled L-tryptophan (10(-4)M) in vitro to hepatic nuclei revealed some (but less than with valproic acid) decreased specific binding compared with controls. At high doses, valproic acid (80 mg/100 g body weight) appears to decrease tryptophan-induced stimulation of hepatic protein synthesis, probably in a hepatotoxic manner.