Occipitotranstentorial approach for lesions of the superior cerebellar hemisphere: technical report

OBJECTIVE: The occipitotranstentorial approach is well accepted for lesions of the pineal region, superior cerebellar vermis, or mesencephalon. Although evidently suitable, this approach has not, to our knowledge, been reported for lesions of the superior cerebellar hemisphere in adults. Experience with this approach is reported. METHODS: Four patients underwent surgery between August 1995 and March 1997. The findings obtained are evaluated. RESULTS: All lesions were situated in the quadrangular lobules (one extending into the vermis), and all were completely removed. Postoperative deficits, especially visual field deficits, did not occur. CONCLUSION: Lesions of the superior cerebellar hemispheres are easily approached by an occipitotranstentorial route. The major advantages over a supracerebellar approach are that the surgical route is nearly perpendicular to the lesion and to the tentorium instead of parallel, and wide exposure is thereby possible.     

Chest radiographic data acquisition and quality assurance in multicenter studies

Dorsal fusion with the internal fixator has become the standard treatment of instabilities and deformities of the thoracolumbar spine. With our new device, the modular spine fixator (MSF), which has been specially designed for short-distance instrumentations, we have increasingly been treating unstable injuries of the thoracolumbar spine by one-level stabilization. Prerequisite is an accurate evaluation of the indication, including CT and MRI to assess the involvement of the intervertebral disc and the ligamental structures. The operative technique differs in some details from the procedure in more-multi-level instrumentations, especially concerning the application of the pedicle screws. The instrumentation is always combined with posterior allogenic bone grafting. Since the beginning of 1993 we also perform anterior autogenic transpedicular bone grafting. Between January 1991 and July 1995, 57 one-level stabilizations with the MSF were performed. Of the 57 patients operated on 39, 27 men and 12 women, with an average age of 41 years, have had a clinical and radiographic follow-up examination so far, on average, 27 months after the accident. Seventeen patients were completely free of pain and 17 patients (were only) sensitive to weather changes or had minor pain during great physical stress. Five patients had pain even during slight physical stress or at rest. The preoperatively measured Cobb angle was 15.1 degrees on average, after the operation 5.2 degrees, and at the time of the follow-up examination amounted to 8.1 degrees. The patients' range of motion was normal. Only five minor complications have been seen. No implant fatigue failure has been noted in this series. We derive from these results that, for correct indications, one-level stabilization can be performed successfully and should be firmly established in the operative treatment of unstable fractures of the thoracolumbar spine.     

Induction by leptin of uncoupling protein-2 and enzymes of fatty acid oxidation

We have studied mechanisms by which leptin overexpression, which reduces body weight via anorexic and thermogenic actions, induces triglyceride depletion in adipocytes and nonadipocytes. Here we show that leptin alters in pancreatic islets the mRNA of the genes encoding enzymes of free fatty acid metabolism and uncoupling protein-2 (UCP-2). In animals infused with a recombinant adenovirus containing the leptin cDNA, the levels of mRNAs encoding enzymes of mitochondrial and peroxisomal oxidation rose 2- to 3-fold, whereas mRNA encoding an enzyme of esterification declined in islets from hyperleptinemic rats. Islet UCP-2 mRNA rose 6-fold. All in vivo changes occurred in vitro in normal islets cultured with recombinant leptin, indicating direct extraneural effects. Leptin overexpression increased UCP-2 mRNA by more than 10-fold in epididymal, retroperitoneal, and subcutaneous fat tissue of normal, but not of leptin-receptor-defective obese rats. By directly regulating the expression of enzymes of free fatty acid metabolism and of UCP-2, leptin controls intracellular triglyceride content of certain nonadipocytes, as well as adipocytes.     

The in vitro uptake of albumin by adult Haemonchus contortus is altered by extracorporeal digestion

FITC (fluorescein isothiocyanate)-labeled albumin was used as a substrate to further characterize the digestion of host blood proteins by adult Haemonchus contortus. Isolated H. contortus intestine degraded FITC-albumin; degradation was completely inhibited by E-64, a specific inhibitor of cysteine proteases. The in vitro uptake and degradation of FITC-albumin by parasites was also evaluated. Uptake of fluorescence was demonstrated; greater than 50% of the fluorescence was associated with degraded FITC-albumin. However, both the uptake and degradation of FITC-albumin were reduced by about 85%. Additionally, when parasites were incubated in the presence of specific inhibitors of cysteine proteases, degradation of FITC-albumin was shown to occur rapidly in the media during in vitro incubation. This degradation was blocked completely by the presence of cysteine protease inhibitors. These results indicate that the rapid extracorporeal digestion of FITC-albumin (mediated by secreted cysteine proteases) produce relatively high concentrations of low molecular weight FITC-labeled fragments and alters the kinetics of uptake of fluorescence by the parasite. These fragments rather than FITC-albumin are rapidly taken up by the parasites. Thus in vitro demonstration of a definitive role for the cysteine proteases as intestinal digestive enzymes in H. contortus is compromised by the enzyme's extracorporeal activity. This extracorporeal cysteine protease activity may represent the enzyme's predominant activity.     

Equilibrium and kinetic studies of iron(II) and iron(III) complexes of some alpha (N)-heterocyclic thiosemicarbazones. Reduction of the iron(III) complexes of 2-formylpyridine thiosemicarbazone and 2-acetylpyridine thiosemicarbazone by cellular thiol-like reducing agents

PURPOSE: To examine the association between communication with parents and self-harm in 14-19-year-old adolescents. METHODS: A total of 36 female and 16 male adolescents presenting to the accident and emergency department of a general hospital; 52 hospital-based controls were interviewed and studied using the following scales: Parent-Adolescent Communication Scale, Family Adaptability and Cohesion Evaluation Scale, Adolescent-Family Inventory of Life Events and Changes Scale, Children's Depression Index, and Nowicki-Strickland Locus of Control Scale. RESULTS: The absence of a family confidant was very strongly associated with adolescent self-harm. Despite controlling for a wide range of possible causal factors, poorer parent-adolescent communication remained strongly associated with self-harm. The effect of poorer communication on self-harm was strongest in the group with and internal locus of control. CONCLUSIONS: Impairment of communication between adolescents and their parents may be important in the origins of adolescent self-harm.     

Regulation of cGMP-dependent current in On bipolar cells by calcium/calmodulin-dependent kinase

PURPOSE/OBJECTIVE: A review of available head and neck quality of life (QOL) instruments reveals them to inadequately address important radiation related side effects, or to be too cumbersome for routine use. The purpose of this study was to develop a head and neck disease specific module as a companion to the previously developed quality of life - radiation therapy instrument (QOL-RTI). The goal was to create a more complete, yet concise, head and neck site-specific module geared toward patients receiving radiation therapy for head and neck cancer. METHODS AND MATERIALS: This exploratory study included 34 consecutive patients undergoing definitive radiotherapy over a 6-7 week course (60-79.8 Gy). We developed and administered a 14-item questionnaire to all eligible patients treated with radiotherapy for head and neck cancer who were not already registered in another research study assessing quality of life (e.g., RTOG). During the treatment period, the QOL-RTI general tool and the head and neck (H&N) module were administered as follows: at baseline, at week four (for test-retest), and at the end of the treatment period. For validation purposes the QOL-RTI/H&N was compared to the functional assessment cancer tool head and neck (FACT-H&N) questionnaire. The FACT-H&N was administered one time at week 4, on the same day as the QOL-RTI/H&N. This report includes the treatment phase of the study (during the course of radiation). RESULTS: Mean age was 62 years (range 40-75). Internal consistency of the module was satisfactory (Chronbach's alpha = 0.85). Test-retest yielded a correlation coefficient of 0.90 (p < 0.001). Concurrent validity, established by comparing the module to the FACT/H&N , yielded a correlation coefficient of 0.85. Significant changes in quality of life scores during a course of radiation was noted for both general quality of life tool and the site specific module. For the head and neck module, the difference in the mean baseline (7.17) and end of treatment scores (4.20) was 2.94, or 42% change (p < 0.0001). A smaller, yet still significant, difference in scores was seen in the general QOL tool (22 % change, p = 0.001). Item analysis of the module revealed statistically significant (p < 0.05) worsening in quality of life scores in the following areas: pain in throat, swallowing difficulty (meat/bread and liquids), changes in mucous and saliva, changes in taste, difficulty chewing, trouble with coughing, and speech difficulties. Items that were not significant were pain in the mouth, and appearance. CONCLUSION: These initial results suggest that the H&N companion module to the QOL-RTI is a valid and reliable tool that is responsive to changes in QOL during a course of H&N radiation therapy. This tool differs from existing H&N tools by including specific assessments of mucous, saliva, taste, cough, and local pain in a concise format. Significant changes in QOL scores were noted in all of these items. Evaluation of the tool in the post-treatment period (follow-up) is ongoing.     

Evaluation of a "lexically assign, logically refine" strategy for semi-automated integration of overlapping terminologies

Visually evoked potentials (VEPs) measured under conditions of retinal image stabilization that minimized the influences of visual masking and smearing were averaged from electroencephalographic records measured from striate cortex of three cats. The amplitudes of the VEPs increased around saccade initiation. The grating-evoked potentials obtained at different times relative to the saccade exhibited changes in waveform shape that could be attributed to a saccade-evoked potential. The changes in the shape of the waveform were reasonably accounted for by the summation of the grating-evoked potential (produced when the cat did not make a saccade) and an appropriately timed saccade-evoked potential. The fundamental amplitudes of the residual potentials were computed and found to vary across the time course of the saccade. These observations suggest that there are other influences besides visual masking that are exerted early in the visual pathway to modulate visual processing during saccadic eye movements. A corollary discharge process is the most likely candidate to exert these influences.     

Anti-C1q receptor/calreticulin autoantibodies in patients with systemic lupus erythematosus (SLE)

We report a case of acute glomerulonephritis associated with acute Q fever. An abattoir worker with a nonspecific febrile illness and pneumonia and abnormal liver function test results developed hematuria, proteinuria, and acute renal failure that resolved with appropriate antimicrobial therapy. Renal biopsy demonstrated diffuse proliferative and exudative glomerulonephritis. Serological tests confirmed recent infection with Coxiella burnetii, with a fourfold rise in the titer of phase II antibody, positive phase II IgM antibody, and negative phase I antibody. Other known causes of glomerulonephritis were excluded. Most reports of renal complications of C. burnetii infection describe glomerulonephritis associated with endocarditis due to chronic Q fever. Renal involvement in patients with acute C. burnetii infection has been rarely described. Glomerulonephritis should be recognized as a complication of acute C. burnetii infection and endocarditis due to chronic Q fever.