Supracerebellar transtentorial approach to posterior temporomedial structures

The supracerebellar transtentorial (SCTT) approach, a modification of the infratentorial supracerebellar approach, facilitates simple and minimally invasive access to posterior temporomedial structures without requiring retraction of the temporal or occipital lobe. The SCTT approach was used in 16 patients over a 3-year period. Eleven patients harbored tumors confined to, or located mainly within, the posterior hippocampal formation, three patients harbored aneurysms (one ruptured posterior cerebral artery [PCA] aneurysm at the P2-P3 junction, one ruptured giant PCA [P2] aneurysm, and one giant basilar artery-superior cerebellar artery aneurysm), one patient had juvenile-type moyamoya disease, and one patient suffered from medically intractable epilepsy. In these patients, the SCTT approach enabled tumor removal, aneurysm clipping, and vascular bypass procedures. The authors' experience suggests that this approach can be used routinely in treating lesions in the posterior temporomedial region.

Pathophysiology of traumatic brain injury

Approximately 7 million people in the United States each year experience traumatic brain injury, the leading cause of death from injury in this country. The initial traumatic event, often described as the primary injury, and the pathophysiologic sequelae, the secondary injury, are the themes of this article. Primary injuries to the extracranial and intracranial structures will be discussed, as well as the secondary injuries that occur minutes to days after the initial insult. It is critical that the bedside nurse clinician understand these concepts to anticipate potential complications and plan appropriate interventions with the multidisciplinary team. The goal of these interventions is to prevent the devastating effects of secondary injury.

Comparison of human papillomavirus DNA testing and repeat Papanicolaou test in women with low-grade cervical cytologic abnormalities: a randomized trial. HPV Effectiveness in Lowgrade Paps (HELP) Study No. 1 Group

BACKGROUND

Results of cervical cytology screening showing atypical squamous cells of undetermined significance (ASCUS) or low-grade squamous intraepithelial lesions (LSIL) indicate risk for high-grade cervical intraepithelial neoplasia (CIN 2 or 3). In a community-based randomized trial we compared the test performance of human papillomavirus (HPV) DNA testing with that of 6-month repeat Papanicolaou (Pap) test in detecting histologically confirmed CIN 2 or 3.

METHODS

We randomly assigned 212 women aged 16-50 years with ASCUS or LSIL on cervical cytology screening to undergo either immediate HPV DNA testing or a repeat Pap test in 6 months. Cervical swabs for the HPV DNA testing and the Pap smears were obtained by their family physicians. We tested the swabs for oncogenic HPV using the Hybrid Capture II assay (Digene Corp., Beltsville, Md.). Community-based pathologists examined the Pap smears. All women were referred for colposcopy by their family physicians. Two gynecological pathologists assessed the histology findings. We calculated test performance in women who completed the trial using CIN 2 or 3 as the reference standard.

RESULTS

A total of 159 women completed the study. Compared with HPV DNA testing, which detected 87.5% (7/8) of the cases of CIN 2 or 3, repeat Pap smear showing high-grade intraepithelial neoplasia (HSIL) detected 11.1% (1/9) of cases (p = 0.004), and repeat Pap smear showing ASCUS, LSIL or HSIL detected 55.6% (5/9) (p = 0.16). Corresponding specificities were 50.6%, 95.2% (p = 0.002) and 55.6% (p = 0.61). Loss to follow-up was 17.1% in the HPV test group and 32.7% in the repeat Pap group (p = 0.009). Given the 7 cases of CIN 2 or 3 detected by HPV testing and the 5 cases detected by the repeat Pap smear, the incremental cost of HPV testing was calculated to be $3003 per additional case of CIN identified.

INTERPRETATION

HPV DNA testing was more costly but was associated with significantly less loss to follow-up. It may detect more cases of CIN 2 or 3 in women with low-grade cytologic abnormalities.

Comparison of self-collected vaginal, vulvar and urine samples with physician-collected cervical samples for human papillomavirus testing to detect high-grade squamous intraepithelial lesions

BACKGROUND

Certain types of human papillomavirus (HPV) in cervical samples are strongly associated with squamous intraepithelial lesions (SIL) and invasive cervical carcinoma. We determined and compared the test characteristics of testing for HPV with samples obtained by patients and with samples obtained by their physicians.

METHODS

In a consecutive series of women referred to a colposcopy clinic at a teaching hospital because of abnormalities on cervical cytologic screening, 200 agreed to collect vulvar, vaginal and urine samples for HPV testing. The physician then collected cervical samples for HPV testing, and colposcopy, with biopsy as indicated, was performed. Presence of HPV was evaluated using the hybrid capture II assay (Digene Corp., Silver Spring, Md.) with a probe cocktail for 13 carcinogenic types. Cervical specimens were also tested for HPV by polymerase chain reaction and hybridization with type-specific probes. Cervical smears for cytologic examination were obtained from all women.

RESULTS

High-grade lesions (high-grade squamous intraepithelial lesions [HSIL], equivalent to cervical intraepithelial neoplasia [CIN] grade 2 or 3, and adenocarcinoma) were found in 58 (29.0%) of the 200 women. Carcinogenic types of HPV were detected in the self-collected vaginal samples of 50 (86.2%) of these 58 women, in the self-collected vulvar samples of 36 (62.1%) and in the self-collected urine samples of 26 (44.8%). Carcinogenic types of HPV were detected in the cervical samples collected by physicians for 57 (98.3%) of these 58 women. The remaining 142 women (71.0%) had normal findings or low-grade squamous intraepithelial lesions (LSIL, CIN grade 1). Test results were negative or noncarcinogenic types of HPV were detected in the self-collected vaginal samples of 76 (53.5%) of these 142 women, in the self-collected vulvar samples of 89 (62.7%) and in the self-collected urine samples of 99 (69.7%). The sensitivity for self-collected samples ranged from 44.8% to 86.2%, and the specificity from 53.5% to 69.7%. For the samples collected by physicians, the sensitivity was 98.3% and the specificity 52.1%. The self-sampling methods were generally acceptable to the women: 98.4% of respondents (126/128) deemed urine sampling acceptable, 92.9% (118/127) found vulvar sampling acceptable, and 88.2% (112/127) found vaginal sampling acceptable.

INTERPRETATION

Self-collection of samples for HPV testing was acceptable to women attending a colposcopy clinic for investigation of suspected cervical lesions and shows sufficient sensitivity to warrant further evaluation as a screening test for cervical cancer prevention programs.

Use of energy color Doppler in visualizing fetal pulmonary vascularization to predict the absence of severe pulmonary hypoplasia

OBJECTIVE

The aim of our study was to determine if the assessment of pulmonary vascularization by energy color Doppler during ultrasound examination can predict the absence of pulmonary hypoplasia before birth in situations where it is a high risk.

METHODS

In a prospective study of 12 pregnancies presenting a risk of pulmonary hypoplasia (5 early and prolonged premature ruptures of the membranes, 1 diaphragmatic hernia, 1 chylothorax, 1 pulmonary sequestration, 1 omphalocele, 1 anamnios and 2 Potter's syndromes) energy color Doppler was used to visualize pulmonary vascularization.

RESULTS

In 10 cases where pulmonary vascularization could be visualized, none of the infants had pulmonary hypoplasia. In the 2 cases of Potter's syndrome where pulmonary vascularization was not visualized there was a pulmonary hypoplasia.

CONCLUSION

The visualization of fetal pulmonary vascularization with energy color Doppler in situations with a high risk of pulmonary hypoplasia can predict the absence of severe pulmonary hypoplasia.

members only encodes a Drosophila nucleoporin required for rel protein import and immune response activation

Many developmental and physiological responses rely on the selective translocation of transcriptional regulators in and out of the nucleus through the nuclear pores. Here we describe the Drosophila gene members only (mbo) encoding a nucleoporin homologous to the mammalian Nup88. The phenotypes of mbo mutants and mbo expression during development are cell specific, indicating that the nuclear import capacity of cells is differentially regulated. Using inducible assays for nucleocytoplasmic trafficking we show that mRNA export and classic NLS-mediated protein import are unaffected in mbo mutants. Instead, mbo is selectively required for the nuclear import of the yeast transcription factor GAL4 in a subset of the larval tissues. We have identified the first endogenous targets of the mbo nuclear import pathway in the Rel proteins Dorsal and Dif. In mbo mutants the upstream signaling events leading to the degradation of the IkappaB homolog Cactus are functional, but Dorsal and Dif remain cytoplasmic and the larval immune response is not activated in response to infection. Our results demonstrate that distinct nuclear import events require different nucleoporins in vivo and suggest a regulatory role for mbo in signal transduction.

In vitro evaluation of teratogenic effects by time-varying MR gradient fields on fetal human fibroblasts

The purpose of this study was to evaluate the influence on fetal cell growth in vitro of rapidly changing magnetic gradient fields such as those produced by the gradient coils of a typical magnetic resonance (MR) imager. The static magnetic field and the radiofrequency pulses were disabled during all measurements. Human fetal fibroblasts were placed within a specially designed MR-compatible incubation system inside the magnet. Trapezoid-shaped waveforms of 500 and 75 Hz base frequency and an amplitude of 2 mT were applied for 2-24 hours. Proliferation of the cells was monitored for 3 weeks after exposure. Cell cycle analysis was performed until 24 hours after exposure to detect alterations in cell division. Tests were performed under two different conditions of growth to detect increased as well as decreased proliferation effects. None of these tests showed differences in proliferation and cell cycle distribution between exposed and nonexposed cells.

Genetic and molecular complexity of the position effect variegation modifier mod(mdg4) in Drosophila

mod(mdg4), also known as E(var)3-93D, is involved in a variety of processes, such as gene silencing in position effect variegation (PEV), the control of gypsy insulator sequences, regulation of homeotic gene expression, and programmed cell death. We have isolated a large number of mod(mdg4) cDNAs, representing 21 different isoforms generated by alternative splicing. The deduced proteins are characterized by a common N terminus of 402 amino acids, including the BTB/POZ-domain. Most of the variable C termini contain a new consensus sequence, including four positioned hydrophobic amino acids and a Cys(2)His(2) motif. Using specific antibodies for two protein isoforms, we demonstrate different distributions of the corresponding proteins on polytene chromosomes. Mutations in the genomic region encoding exons 1-4 show enhancement of PEV and homeotic transformation and affect viability and fertility. Homeotic and PEV phenotypes are enhanced by mutations in other trx-group genes. A transgene containing the common 5' region of mod(mdg4) that is present in all splice variants known so far partially rescues the recessive lethality of mod(mdg4) mutant alleles. Our data provide evidence that the molecular and genetic complexity of mod(mdg4) is caused by a large set of individual protein isoforms with specific functions in regulating the chromatin structure of different sets of genes throughout development.

[Neurodevelopmental outcome of premature infants born at less than 33 weeks of gestational age and not cerebral palsy at the age of 5 years]

AIM

To appreciate the impact of prematurity, fetal hypotrophy and familial environment on the neurodevelopmental performances of very premature infants without cerebral palsy at the age of five years.

POPULATION AND METHODS

We followed a regional cohort of 171 very premature infants (< or = 32 weeks of gestation) until they were five years of age. Cognitive functions were tested with the WPPSI test and the development quotient was assessed by the ability to draw a "bonhomme". Twenty-two premature infants suffered from cerebral palsy diagnosed before the age of two years. Another infant had a moderate diplegia at the five-year examination. We had no information for 16 prematures (9.3% of survivors). Twenty-eight premature infants were considered as having no severe disability on phone or mailed contact, and another child had a severe isolated mental retardation. We examined 104/148 infants, and 96/148 survivors without cerebral palsy passed the tests. The cognitive functions of these premature infants are compared to the performances of a control group made up of 108 children born at term > or = 37 weeks, matched for birthplace and single or twin characteristics of the pregnancy.

RESULTS

The values of the different quotients are significantly decreased in the preterm group. The global IQ and the performance IQ are 0.8 SD, verbal IQ is 0.5 SD and the development quotient is 0.4 SD below the values observed in the control group. A performance IQ less than -2 SD for the mean of the control group is observed three times more than in the controls (13.5% vs 3.7%, P < 0.01). Multiple linear regression shows that prematurity explains, independent of hypotrophy and socioeconomic environment, 8% of the variation of the performance IQ (P < 0.01), 2% of the variation of the verbal IQ and 2% of the development quotient (P < 0.05).

CONCLUSION

The five-year neurologic outcome of the children born prematurely in this regional study is similar to the results observed in regional studies conducted in Europe: 13.4% of the survivors have cerebral palsy, and the cognitive functions of the children with no cerebral palsy are significantly lower than the term control group. Other risk factors such as hypotrophy, which modulates the developmental quotient, and the socioeconomic status, which modulates the verbal IQ, are underlined.

The experiences of Taiwanese women caring for parents-in-law

The experiences of Taiwanese women caring for parents-in-law Using grounded theory, semistructured in-depth interviews were conducted to explore the experiences of Taiwanese women who were caregivers for their parents-in-law. Thirty-one Taiwanese women aged 23-58 participated in this study. 'Just doing' emerged as the core category and reflected the Taiwanese women caregivers' process of striving to continue to fulfil the demands of their role during the period of commitment to their parents-in-law's care. The related categories surrounding the core category in the paradigm for this study include: being called, caring for, holding up, keeping harmony, and maintaining filial piety. 'Being called' reflected the reasons that these women became caregivers to their parents-in-law under circumstances heavily influenced by cultural expectations. 'Caring for' provided the context for activities involved in providing daily comfort, keeping watch and seeking assistance when necessary. The category of 'holding up' reflected the caregiver's interpretation of her duty, the extent of the difficulties she experienced and her responses to those difficulties. A philosophy of life, which strongly emphasizes 'keeping harmony' influenced how the caregiver interpreted her caregiving role and her ability to ask for assistance or more resources to overcome difficulties posed by the situation. Maintaining filial piety was identified as a primary duty, a lifelong commitment and a desired outcome. However, striving to achieve this outcome resulted in differing caregiver perceptions, ranging from serenity to personal self-sacrifice. The findings clearly suggested that caregiving behaviours were influenced by cultural expectations when the parent-in-law was ill. This study of Taiwanese women caregivers' experiences may be beneficial in facilitating the development of a comprehensive policy for long-term care as well as suggesting possible intervention strategies for individual and family care. Recommendations for future research focus on cultural determinants of caregiving roles and coping strategies.

Determination of biokinetic parameters for ingestion of radionuclides of zirconium in animals using stable tracers

Exposure to the radioactive isotope 95Zr, as in nuclear accidents, and to stable zirconium, due to its use in industry, has increased the interest in the biokinetics of this element. Information has been derived mainly from tests performed on animals by means of radioactive tracers. Due to the fact that extrapolation from animals to humans is always open to question, there is an increasing need of a methodology which allows data to be obtained directly from humans. The use of stable tracers, being ethically justifiable, is a powerful tool for providing this information. As two tracers of the same element must be utilized in order to evaluate gut absorption, an analytical technique which is capable of distinguishing and measuring simultaneously different isotopes of zirconium in biological samples is required. Preliminary tests on laboratory animals were performed in order to assess the feasibility of the double tracer technique combined with proton activation analysis.

[For what reasons is the neurologic status of very premature infants altered between 1 and 2 years in a follow-up study? The contribution of a Frache-Comté region study]

BACKGROUND

The purpose of this population-based study was firstly to compare the neuro-developmental outcome at one and two years of very preterm infants, and secondly, to identify the risk factors for a misdiagnosis of cerebral impairment at the age of one year.

POPULATION AND METHODS

The preterm cohort included 203 infants born between 25 and 32 weeks of gestational age in the region of Franche-Comté (France) during a two-year period. The control group included 196 full-term infants born in the same maternity wards. Neuro-developmental assessments were performed by pediatricians or physicians, both at one and two years of age, on 94% (161/171) surviving preterms and 89% (173/195) full-terms.

RESULTS

There is a fair correlation between the two neurological evaluations of the control group (170/173, 98% have the same classification at the age of one and two). There is a weak correlation (kappa = 0.37) between the two neurological evaluations of the preterm group. Sixteen preterms (10%) had been classified more abnormal at one year than they were at two years. The presence of a broncho-pulmonary dysplasia, linked to male sex and extreme prematurity, was statistically linked to this first kind of misclassification. Seventeen preterms (10%) had been considered more normal at one year than they were at two years. The presence of a diplegia, family precariousness and the examination at one year of age by a general practitioner were statistically linked to this second kind of misclassification.

CONCLUSION

This prospective population-based study identifies structural situations (bronchopulmonary dysplasia linked to extreme prematurity) and environmental situations (family precariousness, examiner's qualifications) linked to a misclassification of the neurological status of one-year-old former preterm infants.

Internal dose for ingestion of molybdenum radionuclides based on a revised biokinetic model

Recent investigations with human volunteers showed that the model recommended by ICRP for the description of the biokinetics of molybdenum radionuclides is not able to describe some characteristic features, like the clearance from the transfer compartment and the urinary excretion profile. Therefore, a revision of the model was presented in a previous paper. In the current work, dose coefficients for ingestion of radionuclides of molybdenum from members of the public have been calculated according to the ICRP guidelines, but using the revised biokinetic model. The results obtained for the effective dose do not differ remarkably from the ICRP estimates. However, considerable deviations are observed for the equivalent dose to some individual organs; for example, the dose coefficient for colon after ingestion of 99Mo in solid form is about 7 times higher than the ICRP value, whereas for other organs the new estimates are about one tenth of the ICRP ones. This fact could be of importance with respect to deterministic effects to particularly radiosensitive organs.

Internal biokinetic behaviour of molybdenum in humans studied with stable isotopes as tracers

Although molybdenum is considered to be an essential trace metal for humans, the knowledge about its metabolism is rather limited. The present study was aimed at the assessment of biokinetics following intravenous injection of trace amounts of 95Mo or 96Mo into five healthy volunteers. In a total of 11 investigations, the plasma clearance up to eight hours and the urinary excretion for at least three days after the injection were evaluated. The tracer concentrations were determined by proton nuclear activation analysis in blood plasma and by thermal ionization mass spectrometry in urine samples respectively. In all subjects, the plasma clearance is much faster than expected from the literature. The data obtained for the plasma clearance of the tracer can reasonably be fitted by a two exponential equation. The half times of the fast component range between 4 and 70 minutes and for the slow component between 3 and 30 hours. The urinary excretion of the injected tracer seems also to be faster than expected and the fractions lost are higher for larger doses administered. For the smallest dose given, 34% of the injected tracer were excreted within one day whereas for the four times larger dose about 60% were lost. These findings on urinary excretion are in agreement with recently published results.

Fluorescent neoglycoproteins: antibody-aminodextran-phycobiliprotein conjugates

New, highly amino-substituted dextran or aminodextran (hereafter denoted Amdex) of various sizes between about 20 and 1000 kDa molecular mass and degrees of amino-substitution between 7 and 40% were prepared and characterized by elemental analyses and polyacrylamide gel electrophoresis. These aminodextrans together with others commercially available were shown by static light scattering, viscosity, and refractive index measurements to adopt a globular structure in aqueous salt solutions. Antibody and fluorescent protein dye, phycoerythrin, or its tandems with cyanin 5. 1 and TEXAS RED, were covalently conjugated to the aminodextrans. The conjugates contained multiple dye molecules and were shown by dynamic light scattering and scanning electron microscopy to assume either globular structure or aggregates thereof. Streptavidin could be substituted for antibody to prepare streptavidin-aminodextran-PE conjugates, which were then used with biotinylated antibody to label subpopulations of white blood cells. The conjugates yielded up to 20-fold amplification of fluorescence intensity over direct antibody-dye conjugates in labeling white blood cells for flow cytometry.

Absolute zero: a man who doubts his own love

In this paper the author explores the relationship, first formulated by Freud, between depression and the experience of losing one's feeling of being able to love. She emphasises the narcissistic organisation underlying depression and depressive anxieties, and argues that the defences used to protect against such anxieties frequently produce the very states of mind they are supposed to be defending against. Using clinical material from a patient in analysis, she describes the way in which a combination of idealisation and a subtle, pervasive contempt for objects creates a brittle, sham relationship with the analyst, and that when this sham relationship is threatened, the patient can feel a catastrophic sense of desolation. Such events threaten the analysis, and often create correspondingly great anxiety in the analyst. At such times the analyst may be tempted to return the analytic relationship to the earlier, seemingly less disturbing state. The author argues that this would be a mistake, because it perpetuates the patient's despair about being able to engage only in fraudulent, ultimately empty relationships, and his fear that the analyst is unable to recognise this despair and to help him with it.

Enhanced airborne radioactivity during a pine pollen release episode

A single episode of pine pollen release in the highly contaminated area of Novozybkov, Russian Federation, which led to enhanced atmospheric concentrations of 137Cs is discussed. The pollen grains were sampled by a rotating arm impactor and analysed by gamma-spectrometry for 137Cs activity and by image analysis for their size. In the vicinity of a forest, a maximum concentration of 4.5+/-0.4 mBq m(-3) was measured, and a mean activity per pollen grain of 260+/-80 nBq was determined. The emission rate of the Novozybkov mixed pine forest was estimated to be approximately 400 Bq m(-2) per year. Because of the large size of pine pollen grains (about 50 microm) and the short emission period of 5-8 days per year, the estimated potential annual inhalation doses are very low. Biological emissions including pollen release may be a source of increased airborne radionuclide concentrations at larger distances from the source areas as well.

Visceral and vascular complications resulting from anterior lumbar interbody fusion

OBJECT

The literature on abdominal and general surgery-related complications following anterior lumbar interbody fusion (ALIF) is scant. In this retrospective review of 60 patients in whom ALIF was performed at their institutions between 1996 and 1998, the authors detail the associated complications and their correlation with perioperative factors. The causes, strategies for their avoidance, and the clinical course of these complications are also discussed.

METHODS

The study group was composed of 31 men and 29 women whose mean age was 42 years (range 29-71 years). The preoperative diagnosis was discogenic back pain in 33 patients (55%); failed back syndrome in 11 (18.3%); pseudarthrosis in five (8.3%); postlaminectomy syndrome in four (6.6%); spondylolisthesis in three (5%); burst fracture in two (3.3%); and malignancy in two (3.3%). A retroperitoneal approach to the spine was used in 57 of the 60 patients. One interspace was exposed in 28 patients (46.6%), two in 28 (46.6%), and three in four (6.6%). Discectomy and interbody fusion in which the authors placed titanium cages or bone dowels was performed in 56 patients and corpectomy with instrumentation in four. Seven (11.6%) of 60 patients had undergone previous abdominal surgery and 29 (48.3%) had undergone previous spinal surgery. The follow-up period averaged 12+/-4 months (mean+/-standard deviation). Twenty-four general surgery-related complications occurred in 23 patients (38.3%), including sympathetic dysfunction in six; vascular injury in four; somatic neural injury in three; sexual dysfunction in three; prolonged ileus in three; wound incompetence in two; and deep venous thrombosis, acute pancreatitis, and bowel injury in one patient each. There were no deaths. The incidence of complications was not associated with underlying diagnosis (p>0.1), age (p>0.5), previous abdominal or spinal surgery (p>0.1), or the number of levels exposed (p>0.1).

CONCLUSIONS

This report provides a detailed analysis of the general surgery-related complications following ALIF. Although many of these complications have been recognized in the literature, the significance of sympathetic dysfunction appears to have been underestimated. The high incidence of complications in this series likely reflects the strict criteria. Many of these complications were minor and resolved over time without long-term sequelae.

[Prenatal ultrasonic measurements of the eye and the interorbital distance]

OBJECTIVES

The two-fold objective of this study was to ascertain whether the antero-posterior diameter of the fetal eye is comparable to the transversal diameter and to establish nomograms based on the measurements obtained for ocular diameter (OD), mean interorbital distance (MIOD) and the MIOD/biparietal diameter (BPD) ratio related to gestational age. TYPE: A prospective monocentric study based on 398 sonographic fetal eye measurements.

RESULTS

The antero-posterior and transverse ocular diameters of the fetal eye remain comparable throughout pregnancy (R = 0.997, p < 0.0001). They were related to gestational age and BPD. The MIOD/BDP ratio decreased with gestational age. The OD/BPD ratio remained nearly constant. Nomograms were established for OD, MIOD and the MIOD/BPD ratio related to gestational age.

DISCUSSION AND CONCLUSION

The fetal eye can be measured on any diameter provided the sonographic scan for the measurement is flawless. Nomograms and values are given. Hyper- and hypotelorism and microphthalmia can be found in numerous malformative syndromes. Previously published tables are not well-suited to the French population.

Posterior circulation aneurysms. Technical strategies based on angiographic anatomical findings and the results of 60 recent consecutive cases

Ninety-eight patients with aneurysms of the posterior circulation were admitted to our department from 1993 to 1997. Sixty of them underwent microsurgical treatment, mostly in the acute stage of subarachnoid hemorrhage. Peri- and intraoperative management were carried out according to a structured treatment strategy. Special aspects of surgical technique included extradural selective anterior clinoidectomy for basilar head aneurysms, lateral suboccipital craniotomy and partial condylectomy without laminectomy for aneurysms of the vertebral artery or posterior inferior cerebellar artery, and a trans-Sylvian approach, as used in selective amygdalohippocampectomy, for aneurysms of the posterior cerebral artery. A careful angiographic evaluation of the aneurysms in relation to the neighboring important arteries and bony structures was essential for optimal surgical planning. Forty-nine patients (82%) made a good recovery by 3 months after surgery. The mortality was 7%.

Some risk factors for cerebral palsy in very premature infants: importance of premature rupture of membranes and monochorionic twin placentation

OBJECTIVE

To delineate the perinatal risk factors of neurodevelopmental disabilities in very preterm birth applying logistic regression analysis.

DESIGN

This prospective, geographically defined collaborative study was carried out in the Franche-Comté region of France.

SUBJECTS

From October 1, 1990 to September 30, 1992, perinatal and follow-up data were collected on 203 consecutive live-born singleton or twin non-malformed infants with strictly ascertained gestational ages of less than 33 weeks.

MAIN OUTCOME MEASURE

The rate of cerebral palsy and/or severe mental retardation as diagnosed by a family physician or pediatrician with a screening-skill test performed at 2 years of age.

RESULTS

167/171 (98%) survivors were evaluated. Twenty-two of the 167 examined infants (13%) showed signs of cerebral palsy, and 10 of these had severe cerebral palsy or mental retardation. Risk factors for disabilities were selected by a multivariate approach: premature rupture of membranes >/=48 h (OR 4.3, 95% CI 1.6-11.8); monochorionic twin placentation (OR 6.0, 95% CI 1.7-21.3), and respiratory distress syndrome (OR 2.8, 95% CI 1.1-7.1).

CONCLUSION

This geographically defined prospective study gives epidemiological data and highly suggests that there is a link between prenatal events (premature rupture of membranes, monochorionic twin placentation), postnatal events (respiratory distress syndrome), and neurological disabilities in former preterm infants.