Malpositioned endolymphatic subarachnoid shunt causing trigeminal neuralgia: case report

A case is presented of a 64-year-old female with a fifteen year history of right facial pain. The last nine years the facial pain is described as an intense, stabbing pain in the maxillary division of the right trigeminal nerve. The patient had Meniere's Disease for which an endolymphatic subarachnoid shunt was placed fifteen years prior. The patient underwent intensive medical and several surgical therapies for pain. Some of the procedures were initially successful but none provided lasting relief. Because of severe recurrent right facial pain, the patient underwent a right open partial rhizotomy of the trigeminal nerve via a retrosigmoid approach. Intraoperative findings included the end of the endolymphatic subarachnoid shunt in association with the trigeminal nerve roots. The end of the shunt was removed at the time of surgery. Postoperatively the patient has been pain free for thirty months. It is proposed a malpositioned or migrated endolymphatic subarachnoid shunt may be a cause of trigeminal neuralgia.     

Long latency evoked potentials in a case of corpus callosum agenesia

Following monoaural stimulation, long latency auditory evoked potentials (LLAEPs) recorded from contralateral temporal areas have a shorter latency and larger amplitude than those recorded from the ipsilateral temporal areas. This observation agrees with the operational model drawn up in 1967 by Kimura, which assumes that only anatomically prevailing crossed auditory pathways are active during dichotic hearing, while direct pathways are inhibited. The inputs may then be conveyed to the contralateral cortex, from where they finally reach the ipsilateral temporal areas by means of interhemispheric commissures. It is this mechanism which may underline the right ear advantage for verbal stimuli and the left ear advantage for melodies observed when administering dichotic listening tasks. With the aim of verifying this hypothesis, we recorded temporal LLAEPs in a 21 year-old woman suffering from complex partial seizures, whose CT scan and MRI showed corpus callosum agenesia. Our data support the hypothesis that ipsilateral pathways are greatly inhibited by the contralateral pathways, and therefore auditory stimuli can be supposed to reach the contralateral auditory cortex from where they are transferred through the corpus callosum to the ipsilateral auditory cortex.     

A robust parametric estimator for single-trial movement related brain potentials

Current estimators for single-trial evoked potentials (EP's) require a signal-to-noise ratio (SNR) of 0 dB or better to obtain high quality estimations, yet many types of EP's suffer from substantially lower SNR's. This paper presents a robust-evoked-potential-estimator (REPE) facilitating high quality estimations of single movement related EP's with a relatively low SNR. The estimator is based on a standard ARX model, enhanced to support estimation under poor SNR conditions. The REPE was tested successfully on a computer simulated data set giving reliable single-trial estimations for the low SNR range of around -20 dB. THe REPE was also applied to experimental data, producing clear single-trial estimations of movement related brain signals recorded in a classic scenario of self-paced finger tapping experiment.     

The mutationally activated Met receptor mediates motility and metastasis

Mutations in Met have been identified in human papillary renal carcinomas. We have shown previously that these mutations deregulate the enzymatic activity of Met and that NIH 3T3 cells expressing mutationally activated Met are transformed in vitro and are tumorigenic in vivo. In the present investigation, we find that mutant Met induces the motility of Madin-Darby canine kidney cells in vitro and experimental metastasis of NIH 3T3 cells in vivo, and that the Ras-Raf-MEK-ERK signaling pathway, which has been implicated previously in cellular motility and metastasis, is constitutively activated by the Met mutants. We also report that transgenic mice harboring mutationally activated Met develop metastatic mammary carcinoma. These data confirm the tumorigenic activity of mutant Met molecules and demonstrate their ability to induce the metastatic phenotype.     

Stewardship: the distinguishing characteristic of not-for-profit health care

In 1995 the French Academy of Science published a report on 'Problems associated with low doses of ionising radiation'. This report aroused interest among French-speaking scientists and a translation in English was published a year later. The report pointed out that an important issue in radioprotection was not whether to accept or reject the linear no-threshold model but rather to test its validity. The aim of this review is to analyse the report and its recommendations, and to briefly indicate the progress which has been made and the questions which remain open. Three areas of the report are covered in this review: DNA repair, carcinogenesis and epidemiological data.     

Relationship between spine bone mineral density and vertebral body heights

The aim of this study was to investigate the correlation between lumbar spine bone mineral density (LS-BMD) and the vertebral body heights with advancing age and years since menopause. One hundred and sixty-three women ages 39-74 years (77 normal premenopausal, ages 39-54, and 86 normal postmenopausal, ages 46-74 years) were studied. LS-BMD was measured by dual energy X-ray absorptiometry. Vertebral heights were evaluated, using morphometry, as the sum of anterior (AHs), middle (MHs), and posterior (PHs) vertebral body heights from T4 to L5. The AHs/PHs ratio at the same level was also calculated. AHs, MHs, PHs, and AHs/PHs ratio directly correlated with LS-BMD; the correlations are AHs r = 0.80, P < 0.0001, MHs r = 0.75, P < 0.0001, PHs r = 0.76, P < 0.0001, and AHs/PHs r = 0.66, P < 0.001. Both LS-BMD and AHs are inversely correlated with age, and the regressions fit with both linear and cubic curves. The statistical significance of the correlations persists while maintaining age constant. The linear regression curve of AHs with age indicates that the spine height decrement rate is 2.12 mm/year, corresponding to 7.4 cm in 35 years. AHs decreases immediately after menopause fitting with a cubic curve model, with a decrement rate of about 3 cm in the first 5 years after menopause. We conclude that the measurement of the sum of vertebral body heights could usefully integrate LS-BMD evaluation in the clinical and epidemiological investigation of osteoporosis.     

The role of transbronchial lung biopsy in diffuse pulmonary disease

A retrospective study of 103 patients with histologically proved cutaneous malignant melanoma was made in order to assess the validity of a simple prognostic index, based upon a multivariate analysis of weighted pathological and clinical factors, in predicting the expected outcome in a given case. The results of the study were almost identical to those observed by Cochran (1968); 16 per cent of the patients with a low prognostic index (less than 20) died or developed recurrence of melanoma during the period of follow-up, in contrast to those with a high prognostic index (greater than 25) of whom 64 per cent were similarly affected. It is concluded that the predicted outcome based upon such an index is valid for the 5 postoperative years in some 90 per cent of patients with cutaneous malignant melanoma. It is suggested that the use of such an index may be of great value in selecting patients in whom the expected outcome to surgical therapy is poor and in whom adjuvant therapy may be of value.     

Prevention of acute renal failure

Acute renal failure (ARF) induced by therapeutic agents that are nephrotoxic (e.g., gentamicin, cisplatin, amphotericin, and nonsteroidal anti-inflammatory drugs) or hypotension associated with anesthesia and surgery unfortunately occur with some regularity in small animal practice. Several clinical conditions have been identified that can increase the risk of hospital-acquired ARF in dogs. Recognition of these risk factors allows the clinician to assess the risk/benefit ratio for various drugs and/or procedures. Additionally, initiating protective measures and increasing the monitoring of renal function in those patients that require potentially harmful treatment may decrease the incidence of hospital-acquired ARF.