Maximum length sequence brainstem auditory evoked responses in term neonates who have perinatal hypoxia-ischemia

Maximum length sequence brainstem auditory evoked response (BAER) was studied within the first week after birth in 28 term neonates who had perinatal hypoxia-ischemia, or asphyxia. In the BAER recorded using conventional averaging techniques (click rate 21/s), the only abnormality was a slight increase in III-V interval, in addition to an increase in wave latencies when including those who had an elevated threshold (t test, all p<0.05). In the maximum length sequence BAER, however, both the III-V and I-V intervals in the asphyxiated infants were significantly increased at all the 91/s, 227/s, 455/s, and particularly 910/s click rates (p<0.05-0.001). The I-III interval was also increased significantly at 455/s and 910/s click rates (both p< 0.05). Wave V amplitude was significantly reduced at all the click rates used (ANOVA, p<0.05-0.001), particularly at 910/s, which sometimes was the only abnormality indicative of brain damage. Both the amplitude ratios V/I and V/III were significantly decreased at 455/s and 910/s click rates (p<0.01 or 0.001). A general trend was that BAER abnormalities after hypoxia-ischemia became more prominent as click rate was increased. Significant abnormalities occurred mainly at very high click rates (455/s and 910/s), which can be achieved using the maximum length sequence technique but not by using conventional averaging techniques. Thus, this technique, which can be used at the cribside, appears to be a better method for the early detection of brain damage after hypoxia-ischemia than using conventional averaging techniques, enhancing the diagnostic value of the BAER.

In vitro activity and fecal concentration of rifaximin after oral administration

Rifaximin showed moderately high MICs (the MIC at which 90% of the isolates tested were inhibited = 50 microg/ml) for 145 bacterial enteropathogens from patients with traveler's diarrhea acquired in Mexico during the summers of 1997 and 1998. Rifaximin concentrations in stool the day after oral administration (800 mg daily for 3 days) were high (average, 7,961 microg/g), proving the value of the drug.

Markers of enteric inflammation in enteroaggregative Escherichia coli diarrhea in travelers

As part of a traveler's diarrhea study carried out in Guadalajara, Mexico, and Goa, India, we conducted a case control study to evaluate fecal markers of enteric inflammation in three groups. Forty-five cases of enteroaggregative Escherichia coli (EAEC) diarrhea were compared to 56 controls with enterotoxigenic E. coli (ETEC) diarrhea, and 126 controls with diarrhea without identifiable pathogens. For EAEC cases we found fecal leukocytes, occult blood, and lactoferrin in 13 (28.9%), 14 (31.1%), and 27 (60.0%) patients, respectively; for ETEC controls they were 15 (26.8%), 16 (28.6%), and 15 (26.8%) respectively; and for patients without identifiable pathogens 19 (15.1%), 34 (27.0%) and 27 (21.4%) were seen for the presence of a positive fecal lactoferrin test in EAEC cases was statistically significant compared to both control groups. The study provides evidence that EAEC infection is associated with an intestinal inflammatory response.

Intestinal secretory immunoglobulin A response to enteroaggregative Escherichia coli in travelers with diarrhea

We examined stool samples from travelers for secretory immunoglobulin A (sIgA) to enteroaggregative Escherichia coli (EAEC) during episodes of acute diarrhea. Ten paired samples from 10 patients with diarrhea caused by EAEC were examined for the presence of specific sIgA by dot blot and Western blot immunoassays. Five samples were positive by dot blotting, and two samples were positive by Western blotting.

Characterization of enterotoxigenic Escherichia coli strains in patients with travelers' diarrhea acquired in Guadalajara, Mexico, 1992-1997

The relationship between enterotoxigenic Escherichia coli (ETEC) and travelers' diarrhea was examined in a high-risk area in 1992-1997. Toxin patterns, colonization-factor antigens (CFAs), and in vitro antimicrobial susceptibility were determined. In total, 928 US students with diarrhea acquired in Guadalajara, Mexico, were screened for enteric pathogens. Diagnosis of ETEC infection was done with oligonucleotide probes. ETEC was isolated in 19.9% of the travelers with diarrhea. CFAs were identified in 51% of the ETEC strains. The highest CFA frequency was observed among heat-stable isolates. Ampicillin, furazolidone, and sulfisoxazole resistance of ETEC increased during the study period. ETEC isolation rates and CFA patterns varied little during the 6 years of the study, which has implications for immunoprophylactic strategies. The finding that differences in the results of ribotyping and plasmid analysis change over time suggests that multiple strains of ETEC were responsible for the illness in the region studied.

Etiology of travelers' diarrhea on a Caribbean island

BACKGROUND

Between December 6, 1994 and March 10, 1996, a study of the etiology of diarrhea was carried out among 332 travelers to five all-inclusive hotels in Negril, Jamaica.

METHODS

Stool specimens were collected and sent to Montego Bay for laboratory analysis. Escherichia coli strains isolated at the Jamaican laboratory were sent to Houston for toxin testing.

RESULTS

A recognized enteropathogen was found in 118 of the 332 (35.5%) cases. Enterotoxigenic E. coli (ETEC) were the most commonly identified pathogen (87/332; 26.2%) followed by Salmonella (4.2%) and Shigella (4.2%). Clustering of etiologically defined cases was studied at each hotel. A cluster was defined as 2 or more cases with the same pathogen identified in the same hotel within 7 days. In the 3 hotels with the highest number of cases of diarrhea, enteropathogens were part of a cluster in 65 of 99 cases (65.7%) of diarrhea of which an etiologic agent was identified. In the other 2 hotels, only 4 of 20 cases (20%) occurred in clusters.

CONCLUSIONS

A total of 25 clusters of travelers' diarrhea cases was detected at the five hotels during the study period. Seventeen of 25 (68%) ETEC isolations occurred as part of a clustering of diarrhea cases. The largest outbreak of pathogen-identified diarrhea consisted of 7 cases of ETEC producing both heat-stable and heat-labile enterotoxins. In the Jamaican hotels with all inclusive meal packages most diarrhea cases occurred as small clusters, presumably as the result of foodborne outbreaks.

5-Lipoxygenase-derived oxylipins from the red alga Rhodymenia pertusa

The lipid extract of the temperate red alga Rhodymenia pertusa has yielded four eicosanoid metabolites, three of which are new natural products. Using principally NMR and MS techniques, their structures were deduced as 5R,6S-dihydroxy-7(E),9(E),11(Z),14(Z)-eicosatetraenoic acid (5R,6S-diHETE), 5R*,6S*-dihydroxy-7(E),9(E),11(Z),14(Z),17(Z)-eicosapentaenoic acid (5R*,6S*-diHEPE), 5-hydroxy-6(E),8(Z),11(Z),14(Z)-eicosatetraenoic acid (5-HETE), 5-hydroxy-6(E),8(Z),11(Z),14(Z),17(Z)-eicosapentaenoic acid (5-HEPE). The co-occurrence of these metabolites strongly suggests that R. pertusa contains a unique 5R-lipoxygenase system acting on both arachidonic and eicosapentaenoic acids.

Improved detection of enterotoxigenic Escherichia coli among patients with travelers' diarrhea, by use of the polymerase chain reaction technique

This study sought to determine whether a specific polymerase chain reaction (PCR) for enterotoxigenic Escherichia coli (ETEC) toxins after chaotropic extraction of DNA from stool would increase the detection of ETEC over that of conventional oligonucleotide probe hybridization of 5 E. coli colonies per stool sample (a standard method). By DNA hybridization, 29 (21%) of 140 patients were positive for ETEC, and 59 (42%) of 140 were positive for ETEC when PCR was used. Sensitivity of the PCR assay was confirmed through spiked stool experiments to be approximately 100-1000 ETEC colonies per sample. Specificity of the assay was determined by showing an absence of ETEC by the PCR technique in a subgroup of 48 subjects and by confirming the presence of ETEC DNA of positive samples by dot blot procedure. PCR technique detected significantly more ETEC infections in these subjects than did the hybridization method (P<.0001).

Conductive hearing loss produces a reversible binaural hearing impairment

Conductive hearing loss, produced by otitis media with effusion, is widespread in young children. However, little is known about its short- or long-term effects on hearing or the brain. To study the consequences of a conductive loss for the perception and processing of sounds, we plugged the left ear canal of ferrets for 7-15 months during either infancy or adulthood. Before or during plugging, the ferrets were trained to perform a binaural task requiring the detection of a 500 Hz tone, positioned 90 degrees to the right, that was masked by two sources of broad-band noise. In one condition ("control"), both noise sources were 90 degrees right and, in the second condition ("bilateral"), one noise source was moved to 90 degrees left. Normal ferrets showed binaural unmasking: tone detection thresholds were lower (mean 10.1 dB) for the bilateral condition than for the control condition. Both groups of ear-plugged ferrets had reduced unmasking; the mean residual unmasking was 2.3 dB for the infant and 0.7 dB for the adult ear-plugged animals. After unplugging, unmasking increased in both groups (infant, 7.1 dB; adult, 6.9 dB) but not to normal levels. Repeated testing during the 22 months after unplugging revealed a gradual return to normal levels of unmasking. These results show that a unilateral conductive hearing loss, in either infancy or adulthood, impairs binaural hearing both during and after the hearing loss. They show scant evidence for adaptation to the plug and demonstrate a recovery from the impairment that occurs over a period of several months after restoration of normal peripheral function.

Brainstem auditory evoked response recorded using maximum length sequences in term neonates

Brainstem auditory evoked response (BAER) was studied in term neonates using maximum length sequences (MLS), which allows presentation of acoustic stimuli at much higher rate than possible with conventional averaging technique. The response waveforms, especially for waves III and V, were well defined at the click rates of 91-455/s. Wave latencies and interpeak intervals at various click rates were all significantly longer and wave V amplitude was smaller in the neonates than in the adults. As click rate was increased, wave latencies increased and amplitudes progressively reduced. The slopes of wave latency-rate functions were progressively steeper for the later waves. The slopes of both III-V and I-V interval-rate functions were significantly steeper in the neonates than in the adults, indicating greater rate-dependent changes in the central components of the neonatal MLS BAER. These rate-dependent changes in the neonatal MLS BAER are generally similar to those in neonatal conventional BAER, although there are some differences. The results indicate that the neonatal brainstem can process rapid acoustic stimulation up to 455/s, although this ability remains immature.

Enteroaggregative Escherichia coli as a cause of traveler's diarrhea: clinical response to ciprofloxacin

The purpose of this study was to determine the role of enteroaggregative Escherichia coli (EAEC) in the development of traveler's diarrhea and the clinical response of patients with EAEC diarrhea following treatment with ciprofloxacin. Sixty-four travelers with diarrhea and no other recognized enteropathogen were enrolled in treatment studies in Jamaica and Mexico from July 1997 to July 1998. EAEC was isolated from 29 travelers (45.3%). There was a significant reduction in the duration of posttreatment diarrhea in the 16 patients treated with ciprofloxacin, as compared with that in the 13 patients who received placebo (mean of 35.3 versus 55.5 hours; P = .049). There was a nonsignificant reduction in the mean number of unformed stools passed during the 72 hours after enrollment in the ciprofloxacin-treated group (5.6), as compared with that in the placebo group (7.5) (P = .128). This study provides additional evidence that EAEC should be considered as a cause of antibiotic-responsive traveler's diarrhea.

Lobophorins A and B, new antiinflammatory macrolides produced by a tropical marine bacterium

Two new antiinflammatory macrolides, lobophorins A and B (1 and 2), have been isolated from fermentation broths of a marine bacterium isolated from the surface the Caribbean brown alga Lobophora variegata (Dictyotales). The new compounds, distantly related to antibiotics of the kijanimicin class, are potent inhibitors of topical PMA-induced edema in the mouse ear assay when administered either topically or IP.

Outcome of brain stem auditory electrophysiology in children who survive purulent meningitis

Brain stem auditory electrophysiology was assessed in children long after purulent meningitis by examining the central components of brain stem auditory evoked response (BAER) at different presentation rates of clicks. Children with peripheral hearing loss were excluded from this study to avoid any possible influence of the loss on the measurements of BAER central components. Of the 70 children who had recovered from meningitis 2 to 8 years earlier, 9 (12.9%) showed abnormalities in BAER central components--mainly a slight reduction of wave V amplitude, at the click presentation rate of 10/s. Of the remaining 61 children who did not show any obvious abnormalities in the BAER at 10/s, an abnormally prolonged I-V interval and a reduced amplitude of wave V were seen in 5 children (8.2%) at the click rate of 90/s. The total BAER abnormality rate was therefore 20.0% (14/70 cases). The results suggest that most children who survive purulent meningitis have a favorable outcome for the brain stem auditory pathway, with about 1 in 5 having mild dysfunction or a suboptimal outcome in the pathway.

Etiology of outpatient pediatric nondysenteric diarrhea: a multicenter study in the United States

BACKGROUND

Few data have been published recently on the etiology of outpatient pediatric diarrhea in the US.

METHODS

We determined the etiology of acute, nondysenteric diarrhea among 147 children between 2 and 11 years old presenting to 9 outpatient clinics in various regions of the US between August, 1991, and August, 1993. Enteropathogens were sought by conventional laboratory methods. The various diarrheagenic Escherichia coli were sought.

RESULTS

A recognized etiologic agent was detected in the stools of 89 (60.5%) children and 15 (10) patients had multiple agents detected. Rotavirus was found in 43 (29.3%) of the children, with a spring and winter peak in occurrence. Giardia lamblia was identified in 22 (15%) cases with a spring peak. HEp-2 cell-adherent E. coli were found in 15 (10.2%). Other agents found included: enteric adenovirus in 7 (4.8%); Salmonella in 5 (3.4%); enterohemorrhagic E. coli in 5 (3.4%); enteropathogenic E. coli in 2 (1.4%); enterotoxigenic E. coli in 2 (1.4%); Entamoeba histolytica in 1 (0.70%); and Campylobacter jejuni in 1 (0.7%).

CONCLUSIONS

In addition to the presence of conventional enteropathogens, diarrheagenic E. coli (HEp-2 cell-adherent E. coli, enterohemorrhagic E. coli, enteropathogenic E. coli and enterotoxigenic E. coli) were associated with endemic pediatric diarrhea in the US.

Combined carotid endarterectomy and coronary artery bypass: immediate and long-term results

Data from 213 cases of simultaneous carotid endarterectomy and coronary artery bypass grafting (CEN/CABG) were analyzed (1980-1996). There were 154 males (72.3%), and 59 females (27.7%), (mean age: 65. 6 years, range: 42-83). One hundred and thirty-two patients (62.0%) had angina, 58 (37.2%) had myocardial infarction, and 23 (10.8%) had congestive heart failure. Symptomatic cerebrovascular disease was present in 89 patients (41.7%). One hundred and twenty-two patients (57.2%) had three-vessel coronary artery disease, 41 (19.2%) had left main disease, and 27 (12.6%) had a low ejection fraction (ejection fraction </=30%). Significant (>/=75% diameter reduction) stenosis was present in 168 (78.8%) of the operated carotid arteries. The contralateral internal carotid artery was severely stenosed or occluded in 35 patients (16.4%). The hospital mortality rate was 5. 6% (12 patients). The cause of death was cardiac in ten patients (4. 6%), and neurologic in two (1%). Eleven patients (5.1%) developed a stroke postoperatively; eight strokes were ipsilateral to the operated artery, and six were permanent. Myocardial infarction occurred in five patients (2.3%). Independent predictors of early mortality were age >62 years, hypertension, and postoperative stroke (p < 0.05). Male sex was the only independent predictor of neurologic morbidity (p < 0.05). Late follow-up data were obtained for 163 (81.0%) patients (mean: 54.8 months, range: 1-168). Four (9. 3%) out of the 43 late deaths were attributed to strokes. There were three (1.8%) late ipsilateral strokes, and five (3.1%) contralateral strokes. The 5- and 10-year survival probabilities were 75 +/- 4%, and 52 +/- 6.9%. The freedom from late ipsilateral neurologic morbidity at 5 and 10 years were 97 +/- 1.7% and 90 +/- 4.0%, respectively. Taken together, the results indicate that combined carotid endarterectomy and coronary artery bypass grafting can be performed safely in this high-risk group of patients. Excellent long-term freedom from stroke can be expected.

Rifaximin: a nonabsorbed antimicrobial in the therapy of travelers' diarrhea

BACKGROUND/AIMS

Bacterial enteropathogens, the major cause of travelers' diarrhea, are customarily treated with antibacterial drugs. Rifaximin, a nonabsorbed antimicrobial was examined as treatment for travelers' diarrhea.

METHODS

A randomized, prospective, double-blind clinical trial was carried out in 72 US adults in Mexico. Patients with acute diarrhea received one of three doses of rifaximin (200, 400 and 600 mg t.i.d.) or trimethoprim/sulfamethoxazole (TMP/SMX, 160 mg/800 mg b.i.d.) for 5 days. Results were compared with data from 2 placebo-treated historical control populations.

RESULTS

The shortest duration of treated diarrhea was seen in the group receiving 200 mg rifaximin t. i.d (NS). Clinical failure to respond to treatment occurred in 6 of 55 (11%) rifaximin-treated subjects versus 5 of 17 (29%) of TMP/SMX-treated subjects (NS). Sixteen of twenty (80%) of the enteropathogens isolated from the rifaximin-treated subjects and 7 of 7 (100%) from the TMP/SMX group were eradicated by treatment (NS). Sixteen of twenty-four (67%) enteropathogens identified were susceptible to TMP and all 24 were inhibited by</=50 microgram/ml of rifaximin. Rifaximin reduced the number of unformed stools passed during the first 24 h of treatment when compared with 2 control placebo groups (3.3 versus 5.1; p = 0.008 and 0.0001) and led to a reduced duration of post-enrollment diarrhea (mean values of 43.1 versus 68.1 and 81.9 h; p = 0.001).

CONCLUSIONS

Rifaximin shortened the duration of travelers' diarrhea compared with TMP/SMX and 2 earlier studied placebo-treated groups. A poorly absorbed drug if effective in treating bacterial diarrhea has pharmacologic and safety advantages over the existing drugs.

Immaturity of electrophysiological response of the neonatal auditory brainstem to high repetition rates of click stimulation

Changes in brainstem auditory evoked response (BAER) with varying stimulus repetition primarily represent neural processes concerning the efficacy of synaptic transmission in the brainstem auditory pathway. In this study the BAER to different rates of clicks was recorded from 16 term neonates. The results were compared with those from 16 adults to examine whether the degree of maturation of synaptic transmission of the neonatal brainstem auditory pathway parallels that of general function of the pathway. All BAER wave latencies and interpeak intervals increased linearly and wave amplitudes reduced with increasing click rate. The absolute rate-dependent changes in BAER measures were much greater in the neonates than in the adults, reflecting a significant immaturity in the efficacy of synaptic transmission in the neonatal auditory brainstem and in the ability of the neonatal brainstem to process rapid acoustic stimulation. When the data obtained at higher click rates at various age groups were analyzed as percentages, using the BAER measurements at conventionally used slow rate (21/s) of clicks as the denominators, the changing rates (%), or relative changes, of most BAER measures at higher rates in the neonates were still greater than those in the adults. Therefore, the rate-dependent BAER changes in the neonates are relatively less mature than general aspects of the BAER, reflected by the BAER elicited with conventionally used slow rates of clicks. These findings suggest that synaptic efficacy in the neonatal brainstem auditory pathway is relatively less mature than general function of the pathway and thus may be more susceptible to unfavourable perinatal conditions.

Screening systems for detecting inhibitors of cell wall transglycosylation in Enterococcus. Cell wall transglycosylation inhibitors in Enterococcus

We devised two screening systems to detect cell wall transglycosylation inhibitors. One screen utilizes a mutant of Enterococcus faecalis strain A256 that is dependent on vancomycin or moenomycin for growth. In the absence of transglycosylation inhibitors the strain fails to grow, while in the presence of inhibitors, cells are rescued. A second screening organism E. faecalis strain MDD212 utilizes a translational fusion of the lacZ gene to the vanH promoter in a derivative of E. faecalis that contains a vancomycin resistance determinant. Induction of beta-galactosidase occurs when cells are exposed to inhibitors of transglycosylation. Our natural products drug source of fungal fermentations was tested with these screens. Several cultures that produced the same family of compounds, called the thielavins, were detected. Thielavin B inhibited the formation of peptidoglycan in an in vitro assay, suggesting that these screening systems can detect compounds that interfere with cell wall transglycosylation.

Maturation of peripheral and brainstem auditory function in the first year following perinatal asphyxia: a longitudinal study

Maturation of peripheral hearing and auditory brainstem following perinatal asphyxia was investigated by longitudinal recording of brainstem auditory evoked potentials (BAEP) during the first year of life in affected infants. The general maturational course of the BAEP following asphyxia was similar to that in a control group of infants with normal births, although there were some abnormalities in the BAEP Response threshold elevation seen in a few asphyxiated infants improved significantly during the first 3 months. The interpeak intervals in the asphyxiated infants did not differ significantly from that of the control-group infants except in the first month, when the I-V and III-V intervals were significantly prolonged in the severe asphyxia group. In contrast, wave V amplitude and V/I ratio were always smaller when compared to that of the control-group infants. Amplitude reduction of wave V was more sustained than the prolonged I-V interval. Persistent hearing loss and brainstem auditory impairment were seen in 6.8% and 14.6% of the asphyxiated infants, respectively. These findings suggest that asphyxia does not interfere significantly with the maturation of the auditory system in most asphyxiated infants and that sustained peripheral hearing loss and brainstem impairment occur only in a small proportion of affected infants.

Auditory brainstem projections to the ferret superior colliculus: anatomical contribution to the neural coding of sound azimuth

The mammalian superior colliculus (SC) contains a neural map of auditory space. It is not known whether this topographic representation emerges at the level of the SC or is relayed there from other auditory areas. We have used retrograde labelling techniques in ferrets to examine the sources and pattern of innervation from auditory brainstem nuclei. After multiple injections of wheat germ agglutinin conjugated to horseradish peroxidase (WGA-HRP) into the SC, the heaviest concentrations of labelled cells were found in the nucleus of the brachium (BIN) and external nucleus of the inferior colliculus, with much weaker labelling in the nucleus sagulum, dorsal, intermediate and ventral nuclei of the lateral lemniscus, paralemniscal regions, and periolivary nuclei. The projections were predominantly ipsilateral, although labelled cells were found on both sides of the brainstem. Single injections of WGA-HRP or discrete injections of red and green latex microspheres revealed that the caudal and lateral regions of the SC receive the heaviest projections, although the majority of the retrogradely labelled neurons in the contralateral BIN project to rostral SC. On the ipsilateral side, neurons in rostral and caudal regions of the BIN were labelled primarily by the tracer injected into rostral and caudal regions of the SC, respectively. However, no clear segregation was apparent in the BIN after injections into the medial and lateral regions or in any of the other nuclei after either injection paradigm. These data suggest that converging inputs from several auditory brainstem nuclei contribute to the construction of the auditory space map in the SC, although information about sound azimuth may be conveyed to this nucleus via a spatially ordered projection from the ipsilateral BIN.

HEp-2 cell-adherent Escherichia coli and intestinal secretory immune response to human immunodeficiency virus (HIV) in outpatients with HIV-associated diarrhea

HEp-2 cell-adherent Escherichia coli and the human immunodeficiency virus (HIV) itself have recently been incriminated as causes of chronic HIV-associated diarrhea. This study sought to determine the prevalence of these two agents among HIV-infected patients with diarrhea in an outpatient setting in the United States and to compare their prevalence to that of other commonly recognized enteropathogens known to be present in this population. HEp-2 cell-adherent E. coli was found in 20 of 83 (24.1%) patients with diarrhea. A diffuse pattern of adherence was the most common, found in 14 of 20 (70%) patients, followed by a localized adherence pattern (6 of 20; 30%). An intestinal secretory immune response against the p24 antigen of HIV was found in 9 of 34 (27.5%) patients with HIV-associated diarrhea. The following pathogens or products were also detected in lower frequencies: Cryptosporidium spp. (10.8%), Clostridium difficile toxin (8.8%), microsporidia (6%), Isospora belli (3.6%), Blastocystis hominis (2.4%), Giardia spp. (1.2%), Salmonella spp. (1.2%), and Mycobacterium spp. (1.2%). The role of HEp-2 cell-adherent E. coli and HIV enteric infections in patients with HIV-associated diarrhea deserves further study.

Sources of subcortical projections to the superior colliculus in the ferret

We have identified brainstem and other subcortical afferents to the superior colliculus (SC) in the ferret, by examining the pattern of retrograde labelling that resulted from unilateral injections of red and green fluorescent latex microspheres or of wheat germ agglutinin conjugated to horseradish peroxidase into different regions of this midbrain nucleus. Labelled neurons were found in many structures, including somatosensory, visual and auditory nuclei. These subcortical inputs are almost all bilateral, although most are primarily ipsilateral. Despite some differences in organization, the subcortical projections to the ferret SC broadly resemble those described in other species. Following injections of red and green microspheres in either the rostral and caudal or the medial and lateral regions of the SC, double-labelled cells usually accounted for less than 10% of the total number of retrogradely labelled cells, indicating that most of the subcortical neurons project to discrete regions of the SC. Many of these afferents show some topographic organization, which is much more evident along the rostrocaudal axis of the SC than in the medial-lateral dimension. The intercollicular projection is restricted mainly to the rostral SC and demonstrates a point-to-point organization. Most of the subcortical structures caudal to the central region of the SC were labelled mainly by the tracers injected in caudal SC, while those rostral to this region, including the zona incerta and the pretectal nuclei, were labelled largely by injections in rostral SC. These findings suggest that projections originating from nuclei posterior to the central region of the SC terminate principally in caudal SC whereas afferents from structures anterior to the central region project largely to rostral SC.

Continuous electroencephalographic monitoring and selective shunting reduces neurologic morbidity rates in carotid endarterectomy

PURPOSE

The role of continuous electroencephalographic (EEG) monitoring during carotid endarterectomy was evaluated in this retrospective review.

METHODS

We analyzed data from 902 consecutive carotid endarterectomy procedures performed with vein patch angioplasty. In 591 operations from 1980 to 1988 we did not use intraoperative EEG monitoring or shunting (non-EEG group). Continuous intraoperative EEG monitoring and selective shunting were used in 311 procedures from 1988 to 1994 (EEG group). The patients' mean age was higher in the EEG group (68.8 years; range, 41 to 87 years) than in the non-EEG group (66.2 years; range, 34 to 90 years; p < 0.001). There was also a significantly higher incidence of hypertension (56.2% vs 41.9%) and redo operations (5.4% vs 2.54%) in the EEG group than in the non-EEG group (p < 0.05). The operative technique was identical in both groups. We defined a significant EEG change as a greater than 50% reduction of the amplitude of the faster frequencies, a persistent increase of delta activity, or both.

RESULTS

In the EEG group, acute EEG changes occurred in 40 patients (12.8%); 31 (77.5%) unilateral and ipsilateral to the operated carotid artery, and nine (22.5%) bilateral. In five patients (12.5%) the changes correlated with an intraoperative episode of hypotension, and after normal blood pressure was restored the EEG returned to normal. In 35 procedures (87.5%) a carotid shunt was inserted. In 33 of those patients the EEG returned to baseline, in one patient there was a significant improvement, and in one patient the EEG changes persisted. Postoperative hospital strokes occurred in one patient (0.32%) in the EEG group and in 13 patients (2.19%) in the non-EEG group (p < 0.05). All strokes (n = 14) were ipsilateral to the operated carotid artery. Of the 13 strokes in the non-EEG group nine were major and four were minor. The one stroke in the EEG group was embolic in origin and occurred before carotid cross-clamping; it was associated with profound EEG changes that did not reverse after placement of a shunt. In the total group (n = 902), intraoperative EEG monitoring was inversely associated with postoperative stroke (p < 0.05).

CONCLUSION

The overall neurologic morbidity rate was significantly lower in the EEG group than in the non-EEG group, therapy demonstrating the value of intraoperative EEG monitoring in carotid endarterectomy.

Novel oxylipins from the temperate red alga Polyneura latissima: evidence for an arachidonate 9(S)-lipoxygenase

The oxylipin chemistry of the temperate red alga Polyneura latissima has been investigated. The structures of three novel oxylipins, 8-[1'(Z),3'(Z),6'(Z)-dodecatriene-1'-oxy]- 5(Z),7(E)-octadienoic acid, 7(S*)-hydroxy-8(S*),9(S*)-epoxy-5(Z),11(Z),14(Z)-eicosatrienoic acid, 7(R*)-hydroxy-8(S*),9(S*)-epoxy-5(Z),11(Z),14(Z)-eicosatrienoic acid, together with two known eicosanoids, 9(S)-hydroxy-5(Z),7(E),11(Z),14(Z)-eicosatetraenoic acid, and 9,15-dihydroxy-5(Z),7(E),11(Z),13(E)-eicosatetraenoic acid, were elucidated by spectroscopic methods and chemical degradation. The oxygenation pattern of these oxylipins suggests that P. latissima metabolizes polyunsaturated fatty acids via a 9(S)-lipoxygenase.

Topographic organization of projection from the parabigeminal nucleus to the superior colliculus in the ferret revealed with fluorescent latex microspheres

Unilateral, discrete injections of red and green fluorescent latex microspheres or injections of wheat germ agglutinin conjugated to horseradish peroxidase (WGA-HRP) were made into the ferret's superior colliculus (SC) to characterize the topographic organization of the projection from the parabigeminal nucleus (PBN). Retrograde labelling in the PBN revealed that this nucleus projects bilaterally to the SC, although the heaviest projection arises from the ipsilateral PBN. The PBN-SC projection demonstrates a highly ordered organization along the rostral-caudal axis; rostral PBN projects to rostral SC and caudal PBN projects to caudal SC. The caudoventral and rostrodorsal areas of the PBN project mainly to the ipsilateral and contralateral SC, respectively. The ipsilateral pathway terminates principally in the caudal region of the SC, while the contralateral projection terminates predominantly in rostral SC. Ipsilaterally, there are slightly more neurons, located mainly in the ventral PBN, that project to the lateral SC than those, located largely in the dorsal part of the nucleus, that target the medial SC. The contralateral PBN mainly projects to the rostrolateral quadrant of the SC. These results indicate that each quadrant of the SC is innervated principally by a restricted part of the PBN: the caudolateral quadrant, which receives the heaviest ipsilateral input, and the caudomedial quadrant are targeted predominantly by the ventral and dorsal portions, respectively, of the ipsilateral PBN; the rostrolateral quadrant by the contralateral PBN, and the rostromedial quadrant, which receives the weakest input, by the dorsal portion of the nucleus on both sides. These findings suggest that activity in the PBN is relayed to distinct regions of the SC in the form of a highly ordered topographic projection. The adjacent lateral tegmentum (ALT) also projects heavily to the SC, principally on the ipsilateral side. The ALT projection to the ipsilateral SC appears to be organized in a less orderly fashion, and terminates principally in caudal SC, particularly the caudolateral quadrant. No topography was apparent for the contralateral projection.