Intervertebral disc space infection caused by Aspergillus fumigatus

The authors describe the case of a 53-year-old woman who suffered from an Aspergillus fumigatus infection of the L2/3 intervertebral disc space unrelated to previous operations on her lumbar spine. After surgical debridement combined with amphotericin therapy she died on the 23rd postoperative day from a fulminant bacterial sepsis of pulmonary origin. Although she had intermittently used steroids for bronchial asthma, this is an unusual case of fungal infection of the lumbar spine in an apparently immunocompetent patient.

Urinary retention and space-occupying lesions of the frontal cortex

The authors present 2 cases in which urinary retention was related to supratentorial cortical lesions. These cases support the presence and function of a supratentorial center involved in control of the voiding reflex loop and indicate that lesions affecting this center can result in urinary retention rather than the syndrome of incontinence, urgency, and increased urinary frequency that is generally attributed to dysfunction of this system. In such cases, a clinical presentation of urinary retention in the absence of associated remarkable neurological deficits renders clinical evidence as a localizing sign.

Intracranial pressure and cerebral perfusion pressure in severe head injury

Monitoring and management of intracranial pressure (ICP) are fundamental to modern neurotraumatology. Although never formally proven to independently improve outcome in prospective, randomized, placebo-controlled trials, there is such a predominance of indirect support for this modality that most neurotrauma protocols are impossible with-out its inclusion and ethical considerations virtually preclude placebo-controlled trials of its efficacy. In addition to the question of improving outcome, ICP monitoring is also useful in guiding the use of potentially harmful treatment modalities such as hyperventilation, mannitol, and barbiturates, and also provides important prognostic data. ICP monitoring provides information on the likelihood of cerebral herniation and allows calculation of the cerebral perfusion pressure (CPP). Although there is no constant threshold for herniation, the most commonly used treatment threshold is 20 to 25 mm Hg. In addition, ICP trends are indispensable in providing the earliest possible indication of critical intracranial mass effects when combined with other clinical indicators. CPP is the difference between mean arterial pressure and ICP. CPP is an important clinical indicator of cerebral blood flow (CBF). Cerebral autoregulation generally remains at least partially preserved after severe head injury, although the CPP value at which it is activated appears to be shifted upward. Therefore, maintaining adequate CBF appears to require using an elevated minimal CPP threshold when treating the injured brain. A generally accepted value of 70 mm Hg is suggested.

Variability of vascular territory in stroke. Pitfalls and failure of stroke pattern interpretation

BACKGROUND AND PURPOSE

We investigated the efficacy and feasibility of determining infarction mechanisms and underlying embolic or hemodynamic pathologies from topographical patterns of ischemic damage seen on computed tomography or magnetic resonance imaging.

METHODS

Infarction patterns from 22 patients with ipsilateral severe, hemodynamically relevant carotid stenosis (n = 6) or occlusions (n = 16) were superimposed, using two matching algorithms, onto maps showing the variability of the cerebral vascular territories as determined from recent cadaver studies. These images were used to classify the infarctions as border-zone or territorial for the two conditions of minimal and maximal middle cerebral artery distribution.

RESULTS

Classification of infarction patterns resulting from carotid stenosis was independent of the territorial extension map chosen: 83% were classified as territorial. Classification of patterns due to carotid occlusion, however, varied highly; 81% of infarctions were considered territorial when the maximal middle cerebral artery distribution map was used, whereas only 19% were when the minimal territorial extension map was used.

CONCLUSIONS

The current concept that stroke mechanisms can be inferred from the interpretation of stroke patterns seen on computed tomography scans or magnetic resonance imaging is significantly confounded by the demonstrated variability in intracranial vascular distributions. Stroke pattern interpretation appears to be highly dependent on the in vivo vascular tree of the individual, which is unknown to the examiner. This calls into question the reliability of classifying infarction patterns as border-zone or territorial. Determination of true underlying stroke mechanisms requires a comprehensive approach and cannot be based solely on stroke pattern interpretation.

Intracranial pressure. Monitoring and management

Monitoring of ICP from the subarachnoid, intraparenchymal, or ventricular spaces can be accomplished easily and reliably. The risks and benefits of each approach should be considered when choosing the monitoring technique. The goal of ICP management is to prevent herniation and to optimize cerebral perfusion. Even transient episodes of post-traumatic cerebral ischemia due to inadequate CPP can quickly nullify all resuscitative efforts. The provision of sufficient CBF is complicated by the varying degree of disruption of pressure autoregulation commonly resulting from head trauma. Post-injury, there is a need to provide a CPP which is elevated to some extent with respect to that sufficient in uninjured brains. This generally requires a CPP of at least 70 mm Hg, which must be accomplished by maintaining an adequate MAP while controlling ICH. Although ICH can generally be controlled using methods commonly employed, the majority of these techniques have potential complications. Additionally, there is increasing evidence that significant variation exists in the pathologic processes driving ICH in individual patients. Therefore, goals such as the desired CPP and conditions such as the relative contribution of edema, cerebral hypervolemia, and ischemia to ICH should optimally be considered in a patient-specific fashion and allow a targeted approach to therapy.

Emergence of orientation selective simple cells simulated in deterministic and stochastic neural networks

The processing of visual data in area 17 of the mammalian cortex is mainly performed by cells with receptive fields which are tuned to different orientations of input stimuli. The mechanisms underlying the emergence of receptive field properties of orientation selective cells are not well understood up to now. Recently, some models for the prenatal development of the receptive fields of orientation selective simple cells have been proposed, which emerge in neural networks trained by Hebb type unsupervised learning rules. These models, however, use different network architectures and are restricted to the case of identical input neurons. In this work, a biologically motivated neural network model with a general architecture is presented. It is trained with a Hebb type updating rule and with uncorrelated input. The input neurons are identified with retinal ganglion cells and exhibit mature Mexican hat type receptive fields. If the receptive fields of the input neurons have identical properties (deterministic model), a set of parameter domains is found, which characterize different kinds of receptive field maturation behaviour of the network. Results obtained by other authors with similar models are contained in this description as special cases. In addition, the more general and rarely investigated stochastic model, where random variations of the parameters describing the receptive fields of the input neurons occur, is investigated. A high sensitivity of the network against these random variations is obtained. In case of large variations of receptive field parameters of the ganglion cells, a qualitatively new kind of maturation behaviour appears. A significant part of the synaptic connections from ganglion cells to the cortical cell is removed and small simple cell receptive fields with only few lobes emerge. The stochastic model is found to provide a better description of the size, scatter and structure of receptive fields present in biological systems, than the deterministic model.

Physical-chemical limits for the stability of biomolecules

Water is an indispensable prerequisite for the existence of life. Only in an aqueous environment can biomolecules take up their native, tertiary structure and organize themselves into higher aggregates like multienzyme complexes or cell-organelles. In most of these processes interactions between biomolecules and water play an important role. The influence of pressure and temperature upon intramolecular interactions of biopolymers and biopolymer-water interactions are discussed. Because of fast hydrolysis biomolecules should be unstable at T > or = 500 K. Hydrostatic pressure leads to an accelerated hydrolysis. The p,T-dependence of hydrophobic interactions suggest an even lower upper boundary around T approximately 400 K. In the model system t-butanol/water compression weakens hydrophobic interactions. However, within the modest pressure range p < or = 120 MPa observed on earth hydrostatic pressure does not seem to limit the stability of biomolecules at temperatures below 400 K severely.