Relationship between anatomic lesions of the temporal lobe and temporal lobe epilepsy

A structural lesion of the brain is a frequent finding in intractable partial epileptic patients. We analyse anatomo-electro-clinical characteristics of 58 patients in which MR showed a lesion inside the temporal lobe. They are 29 males and 29 females with a mean age at surgery of 23.5 +/- 10.7 years (2.6-45.9). The mean epilepsy duration is of 13.4 +/- 8 years (1.3-35.5), with a mean seizure frequency of 28.7 +/- 43.6 per month, with a great inter-individual variability (from 3 per month to 15 a day). The minimum follow-up is 3.5 years. A video-EEG monitoring was performed in 21 cases, while a stereo-EEG investigation was judged mandatory in 26. On the basis of anatomo-electro-clinical correlations and of the results of presurgical investigations, the epileptogenic area was proved to be temporal in 49 cases, temporal but controlateral to the lesion in 1, and at least bilobar in 8 patients.     

Serotype-dependent induction of pulmonary neutrophilia and inflammatory cytokine gene expression by reovirus

Reovirus type 3 Dearing (T3D) causes a prominent neutrophil influx, substantially greater than seen with reovirus type 1 Lang (T1L) in a rat model of viral pneumonia. We sought to measure reovirus-mediated increases in chemokine mRNA expression in pulmonary cells. We found that the neutrophilia induced by T1L and T3D infection in vivo correlated directly with increased levels of chemokine mRNA expression in T3D-infected compared with those of T1IL-infected lungs. In vitro, reovirus-infected normal alveolar macrophages (AMs) and the rat AM cell line NR8383 expressed greater levels of macrophage inflammatory protein 2, KC, and tumor necrosis factor alpha mRNA. A synergism between reovirus and lipopolysaccharide was also detected for macrophage inflammatory protein 2 and KC mRNA expression. Tumor necrosis factor protein secretion was also increased to a greater extent by T3D than by T1L in primary rat AMs and the NR8383 cells. We conclude that the virus-mediated inflammatory cytokine induction suggests a role for these cytokines in the neutrophil influx observed in the rat reovirus pneumonia model.     

Hemispherectomy: a hemidecortication approach and review of 52 cases

Between 1975 and 1994, 52 hemispherectomies, of which two were anatomical and 50 hemidecortications, were performed at Johns Hopkins Medical Institutions. Eighteen patients were 2 years old or less. There were three perioperative mortalities and one patient died 9 months later from causes not related to surgery. One patient developed hydrocephalus 6 years postsurgery and has been treated effectively. Seizure control and the functional status of each patient were measured as outcome variables. Forty-six (96%) of the surviving patients were seizure free or had reduced seizures as of their last follow-up examination. Twenty-one individuals (44%) were participating in age-appropriate classes or working independently, 18 were classified as semiindependent, and nine children will likely depend on a lifetime of assisted living. The relationships between the outcome variables and the patient's age at surgery, the interval to surgery, and the etiology of the disease were compared. The authors' clinical experiences strongly suggest the importance of a multidisciplinary approach to patient selection and follow-up care. Moreover, anesthetic management of infant surgery is a major component of success.     

Effects of pregnancy on hemoglobin AIc in normal, gestational diabetic, and diabetic women

Hemoglobin AIc, a normal minor hemoglobin, has glucose linked by a Schiff base to the N-terminal end of the beta chain. The glucose interferes with the binding of 2,3 diphosphoglycerate, probably resulting in an increased affinity of that hemoglobin for oxygen. Hb AIc is increased to twice normal levels in juvenile-onset (insulin-dependent) diabetes. In the present studies, the Hb AIc, when expressed as per cent of total hemoglobin, was found to be elevated slightly in pregnany normal (m = 6.97 per cent), pregnant nondiabetic obese (m = 6.89 per cent), and gestationally diabetic subjects (m = 8.77 per cent) above that of normal females (m = 5.68 per cent). A remarkable difference was observed between the nonpregnant diabetics (m = 12.77 per cent) and the pregnant diabetics (m = 8.46 per cent). This decrease in the level of Hb AIc in diabetics who are pregnant more than 30 weeks may reflect either a better state of diabetic control and/or a compensatory mechanism to protect the fetus by facilitating oxygen exchange from mother to fetus.     

Oesophageal function in patiensts with angina (author's transl)

Oesophageal functions were measured in 18 patients with angina, 13 healthy volunteers and 29 age-matched patients with reflux disease. Acid clearance was as abnormal in angina patients (88 +/- 46 swallows) as in those with reflux disease (97 +/- 45). The pressure in the lower oesophageal sphincter was low in patients with angina (13 +/- 8 mm Hg). The incidence of hiatal hernia, subjective symptoms during acidification of the oesophagus and results of the reflux provocation test were similar in patients with angina pectoris and healthy controls.     

Influence of inhibitors of prostaglandin synthesis on venoconstrictor responses to bradykinin

The interrelationship between prostaglandins (PGs) and bradykinin (BK) was studied in isolated canine saphenous veins. The hypothesis that PGs mediate the venoconstrictor effect of bradykinin was evaluated by determining the influence of low concentrations of indomethacin (Indo) (1 muM) or eicosa-5,8,11,14-tetraynoic acid (ETA) (3 muM), two inhibitors of PG synthesis, on cumulative concentration-response curves for BK or norepinephrine (NE). In the tissue bath, responses to BK improved with time while responses to NE did not vary. When strips were least responsive to BK, Indo and ETA enhanced these responses. When strips were most responsive to BK, neither inhibitor enhanced the responses. Neither Indo nor ETA altered responses to NE. Phentolamine (10(-8) M) did not alter responses to BK. These data suggest that endogenous PGs act to attenuate, rather than mediate, the venoconstrictor response to BK. Progressive enhancement of responses to BK of untreated saphenous vein strips is associated with a decreased ability of inhibitors of PG synthesis to enhance those responses also. Thus, there may be a time-related decrease in the ability of this preparation to synthesize PGs. From the present results, it cannot be determined whether saphenous veins in vivo are highly responsive or relatively unresponsive to the peptide. However, these data do suggest that PGs are a determinant of venous responsiveness to BK.     

Resuscitation equipment board for nurseries and delivery rooms

A resuscitation equipment board for mounting in delivery rooms and nurseries facilitates orderly and effective resuscitation of asphyxiated neonates.     

Noninvasive myocardial imaging with potassium-43 and rubidium-81 in patients with left bundle branch block

Noninvasive myocardial imaging with potassium-43 and rubidium-81 has been used successfully to identify areas of infarction and exercise-induced ischemia as regions of decreased radioactivity. The image defects observed are believed to be due to a decreased radionuclide uptake in regions of myocardial scar or to heterogeneous myocardial accumulation of tracer as a result of regional ischemia. Of 27 patients with left bundle branch block studied with noninvasive imaging at rest and during exercise, 25 manifested at rest reduced radioactivity in the region of the interventricular septum. This pattern is similar to that seen in patients with anteroseptal myocardial infarction. Sixteen of the 27 patients underwent diagnostic coronary arteriography and left ventriculography. Only five of these patients had evidence of either previous infarction or significant obstructive coronary artery disease as assessed with clinical or angiographic criteria, or both. Although the image defect was routinely demonstrated at rest in patients with left bundle branch block, this defect was generally normalized or less distinct with exercise in patients with no anatomic heart disease. In contrast, a larger, more distinct or new image defect with exercise correctly identified the presence of significant obstructive coronary artery disease in patients with left bundle branch block. In the clinical application of noninvasive myocardial imaging, these image defects observed at rest can lead to the false pasitive radionuclide interpretation of anteroseptal myocardial infarction.