Surveillance of SARS-CoV-2 in nine neighborhood sewersheds in Detroit Tri-County area, United States: Assessing per capita SARS-CoV-2 estimations and COVID-19 incidence

Wastewater-based epidemiology (WBE) has been suggested as a useful tool to predict the emergence and investigate the extent of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this study, we screened appropriate population biomarkers for wastewater SARS-CoV-2 normalization and compared the normalized SARS-CoV-2 values across locations with different demographic characteristics in southeastern Michigan. Wastewater samples were collected between December 2020 and October 2021 from nine neighborhood sewersheds in the Detroit Tri-County area. Using reverse transcriptase droplet digital polymerase chain reaction (RT-ddPCR), concentrations of N1 and N2 genes in the studied sites were quantified, with N1 values ranging from 1.92 × 10² genomic copies/L to 6.87 × 10³ gc/L and N2 values ranging from 1.91 × 10² gc/L to 6.45 × 10³ gc/L. The strongest correlations were observed with between cumulative COVID-19 cases per capita (referred as COVID-19 incidences thereafter), and SARS-CoV-2 concentrations normalized by total Kjeldahl nitrogen (TKN), creatinine, 5-hydroxyindoleacetic acid (5-HIAA) and xanthine when correlating the per capita SARS-CoV-2 and COVID-19 incidences. When SARS-CoV-2 concentrations in wastewater were normalized and compared with COVID-19 incidences, the differences between neighborhoods of varying demographics were reduced as compared to differences observed when comparing non-normalized SARS-CoV-2 with COVID-19 cases. This indicates when studying the disease burden in communities of different demographics, accurate per capita estimation is of great importance. The study suggests that monitoring selected water quality parameters or biomarkers, along with RNA concentrations in wastewater, will allow adequate data normalization for spatial comparisons, especially in areas where detailed sanitary sewage flows and contributing populations in the catchment areas are not available. This opens the possibility of using WBE to assess community infections in rural areas or the developing world where the contributing population of a sample could be unknown.

Five-week warning of COVID-19 peaks prior to the Omicron surge in Detroit, Michigan using wastewater surveillance

Wastewater-based epidemiology (WBE) is useful in predicting temporal fluctuations of COVID-19 incidence in communities and providing early warnings of pending outbreaks. To investigate the relationship between SARS-CoV-2 concentrations in wastewater and COVID-19 incidence in communities, a 12-month study between September 1, 2020, and August 31, 2021, prior to the Omicron surge, was conducted. 407 untreated wastewater samples were collected from the Great Lakes Water Authority (GLWA) in southeastern Michigan. N1 and N2 genes of SARS-CoV-2 were quantified using RT-ddPCR. Daily confirmed COVID-19 cases for the City of Detroit, and Wayne, Macomb, Oakland counties between September 1, 2020, and October 4, 2021, were collected from a public data source. The total concentrations of N1 and N2 genes ranged from 714.85 to 7145.98 gc/L and 820.47 to 6219.05 gc/L, respectively, which were strongly correlated with the 7-day moving average of total daily COVID-19 cases in the associated areas, after 5 weeks of the viral measurement. The results indicate a potential 5-week lag time of wastewater surveillance preceding COVID-19 incidence for the Detroit metropolitan area. Four statistical models were established to analyze the relationship between SARS-CoV-2 concentrations in wastewater and COVID-19 incidence in the study areas. Under a 5-week lag time scenario with both N1 and N2 genes, the autoregression model with seasonal patterns and vector autoregression model were more effective in predicting COVID-19 cases during the study period. To investigate the impact of flow parameters on the correlation, the original N1 and N2 gene concentrations were normalized by wastewater flow parameters. The statistical results indicated the optimum models were consistent for both normalized and non-normalized data. In addition, we discussed parameters that explain the observed lag time. Furthermore, we evaluated the impact of the omicron surge that followed, and the impact of different sampling methods on the estimation of lag time.

A comparison of macular ganglion cell and retinal nerve fibre layer optical coherence tomographic parameters as predictors of visual outcomes of surgery for pituitary tumours

PURPOSE

The prognostic value of optical coherence tomography (OCT) of the macular ganglion cell layer (mGGL) versus peripapillary retinal nerve fibre layers (pRNFL) following chiasmal decompression is unclear. This study is the largest comparison of the two parameters to date and aims to clarify how their performance as covariates compare in predictive models of long-term visual outcomes following pituitary or parasellar tumour surgical resection.

METHODS

This was a prospective, two-year, longitudinal cohort study in a single centre tertiary hospital setting. Participants with MRI evidence of pituitary or parasellar tumour compression of the optic chiasm who underwent surgical decompression, were enrolled. Associations between pre-operative OCT parameters and long-term visual outcomes were assessed using multivariable generalised linear mixed models and an age matched normative database.

RESULTS

Final analysis included 216 eyes of 108 participants with a mean age (standard deviation) of 51.6 (17.04) years, of whom 58 (49%) were female. The superior inner mGCL was the best predictor of long-term visual field recovery, with an area under the curve of 0.90, a sensitivity of 80%, specificity of 88%, positive predictive value of 86%, and negative predictive value of 83%.

CONCLUSION

mGCL performed better in predicting long-term visual field recovery post-pituitary or parasellar surgical resection. The superior inner mGCL was the best specific measure which may provide clinical utility in pre-operative counselling. In this study we clarify previously variable comparisons of mGCL and pRNFL parameters in post-operative predictive modelling.

An outbreak of gastroenteritis linked to a buffet lunch served at a Canberra restaurant

In 2013, an outbreak of gastrointestinal illness occurred following a buffet lunch at a restaurant in Canberra. An investigation was conducted to identify the cause of illness and to implement appropriate public health measures to prevent further disease. We conducted a retrospective cohort study via telephone interviews, using a structured questionnaire developed from the restaurant buffet menu. A case was defined as someone who ate the buffet lunch at the restaurant on the implicated date and developed any symptoms of gastrointestinal illness (such as diarrhoea, abdominal pain and nausea) following the consumption of food. A total of 74% (225/303) of known attendees were interviewed, of whom 56% (125/225) had become ill. The median incubation period and duration of illness were 13 and 19 hours respectively. The most commonly reported symptoms were diarrhoea (94%, 118/125) and abdominal pain (82%, 103/125). A toxin-mediated gastrointestinal illness was suspected based on the incubation period, duration of illness and the symptoms. The environmental health investigation identified a lack of designated hand washing facilities in the kitchen, an absence of thermometers for measuring food temperatures and several maintenance and minor cleaning issues. A number of food samples were taken for microbiological analysis. Multivariable analysis showed that illness was significantly associated with consuming curried prawns (OR 18.4, 95% CI 8.6-39.3, P < 0.001) and Caesar salad (OR 3.6, 95% CI 1.8-7.5, P 0.001). Enterotoxin-producing Staphylococcus aureus and Bacillus cereus were identified in leftover samples of cooked buffet food, but this food was not epidemiologically implicated. The investigation suggested that a breakdown in cleanliness, temperature control and food handling practices may have resulted in contamination of the buffet food. In order to prevent such outbreaks in the future, caterers and restaurateurs need to ensure they have the appropriate facilities and procedures in place if planning to cater for large groups.

Aluminium phthalocyanine mediated photodynamic therapy in experimental malignant glioma

The efficacy of aluminium tetrasulfonated phthalocyanine (AISPc) as a photosensitizer for photodynamic therapy (PDT) was investigated in the C6 glioma model in Wistar rats. The depth and extent of tumour necrosis was dependent on both the dosage of intravenously (IV) administered AISPc, and the dose and time post-sensitization of 675 nm light administration. There was no effect on tumour or normal brain if the sensitizer dose was less than 0.5 mg/kg. Selective necrosis of tumour was evident 6 hours post-sensitization at an AISPc dose up to 1 mg/kg and light doses up to 200 J/cm(2). Necrosis occurred in normal brain at higher doses of light and sensitizer. There was no photosensitizer effect in animals treated 24 hours post AISPc administration. The ability of AISPc to act as a selective photosensitizer causing photonecrosis provides a basis for the generation of modified AISPc species as future agents in the PDT of brain tumours, especially as these sensitizers absorb light at a higher wavelength than those that are currently available.

Epilepsy and primary cerebral tumours

Although the association of epilepsy with cerebral tumours is well recognized, the reported incidence of seizures and relationship to tumour pathology varies significantly. This study assessed retrospectively the incidence of seizures, relationship to tumour pathology, natural history of epilepsy and prognostic significance of presentation with a seizure in 120 consecutive adults with histologically proven primary cerebral hemisphere tumours including meningiomas. 52% had a seizure and most were at presentation. Seizures were more common with anaplastic astrocytoma (AA) (18 23 ) than glioblastoma multiforme (21 56 ) (p = 0.001) and seizure occurrence was associated with cortical invasion. 52% of meningioma patients had a seizure. Seizures recurred in 34%, more frequently with glioma (19 of 46) than meningioma (1 of 15) (p < 0.05). Patients with AA presenting with a seizure had a longer survival (28 months) than patients without seizure (8 months) (p = 0.05 one sided). In conclusion, seizures are a common complication of cerebral tumours, usually at presentation and correlate with tumour pathology. A seizure at presentation in AA correlates with longer survival.

Rapidly progressive Whipple's disease of the central nervous system

We describe a patient with rapidly progressive Whipple's disease confined to the central nervous system (CNS). The diagnosis was made pre-mortem following stereotactic and open brain biopsis and confirmed at autopsy. Despite appropriate antibiotic treatment, the disease ran a fulminant course to death after nine weeks.

ADAM22, expressed in normal brain but not in high-grade gliomas, inhibits cellular proliferation via the disintegrin domain

OBJECTIVE

To study the expression and function of the brain-specific proteinase deficient disintegrins, ADAM11 and ADAM22 (a disintegrin and metalloproteinase).

METHODS

Specimens of low- and high-grade gliomas and normal brain were analyzed for ADAM11 and ADAM22 expression using Western blotting. The effects of overexpression of ADAM11 and ADAM22 in glioma cells on growth were analyzed using bromodeoxyuridine incorporation linked to immunocytochemistry. Similarly analyzed were the effects on cell proliferation of bacterially expressed glutathione S-transferase fusion proteins with the disintegrin domain of ADAM11 and ADAM22.

RESULTS

ADAM22 is expressed in normal brain and some low-grade gliomas, but not in high-grade gliomas, whereas ADAM11 is expressed in all low- and high-grade gliomas. In vitro, ADAM22 inhibits cellular proliferation of glioma derived astrocytes. The growth inhibition appears to be mediated by interactions between the disintegrin domain of ADAM22 and specific integrins expressed on the cell surface. This growth inhibition can be avoided by over-expression of integrin linked kinase.

CONCLUSION

ADAM22, a brain-specific cell surface protein, mediates growth inhibition using an integrin dependent pathway. It is expressed in normal brain but not in high-grade gliomas. A related protein, ADAM11, has only a minor effect on cell growth, and its expression is unchanged in low- and high-grade gliomas.

Epilepsy Surgery for Pathologically Proven Hippocampal Sclerosis Provides Long‐term Seizure Control and Improved Quality of Life

PURPOSE

To examine long-term seizure and quality-of-life outcome in a homogeneous group of patients after temporal lobectomy with pathologically proven hippocampal sclerosis (HS). Previous research has had limited follow-up (generally <2 years) and has grouped patients across multiple pathologies.

METHODS

Fifty consecutive patients were identified as having had a temporal lobectomy for the treatment of temporal lobe epilepsy at Royal Melbourne Hospital with pathologically proven HS and >or=2 years' follow-up. All patients were sent a postal survey concerning seizure activity, quality of life (QOLIE-89), and antiepileptic drug (AED) use. The mean follow-up was 5.8 years (range, 2-9.2).

RESULTS

The rate of complete postoperative seizure freedom was 82% at 12 months, 76% at 24 months, and 64% at 63 months (no further seizure recurrences observed after this time). A class I seizure outcome was achieved by 83.3% of patients. Patients with better seizure outcome had significantly better quality of life (Kendall's tau =-234, p < 0.01). Seizure recurrence was associated with a reduction in AED intake or absorption in five (29%) of 17 cases, including three of the five patients with a first seizure recurrence after 24 months after surgery.

CONCLUSIONS

Temporal lobectomy provides continued long-term seizure control in the majority of patients with HS. However, patients remain at risk of seizure recurrence >or=2 years after surgery. Long-term quality of life is dependent on seizure outcome.

Preoperative evaluation for temporal lobe surgery

Temporal lobe epilepsy (TLE), the most common form of partial epilepsy in adults is often refractory to medical treatment and in these patients epilepsy surgery is considered. Successful surgery is dependent on accurate localisation and lateralisation of the epileptogenic zone. The preoperative evaluation involves a series of assessments and investigations including detailed clinical history, interictal EEG, video-EEG monitoring, MRI, PET, SPECT, and neuropsychology and neuropsychiatric assessment. The role of each of these investigations and assessments in the preoperative evaluation is discussed. Advanced MR techniques including magnetic resonance spectroscopy, MR diffusion and MR perfusion have recently been assessed and are likely to enhance the pre-surgical evaluation of patients with TLE.The surgical outcome and preoperative investigations performed of 80 consecutive patients who underwent temporal lobe surgery between 1993 and 2002 at Royal Melbourne Hospital were reviewed. All patients had MRI, video-EEG monitoring and neuropsychology assessment and 56% a PET scan. During a mean follow-up of 5.9 years 75% had Class 1 outcome, 22% non-Class 1 outcome and 3% were lost to follow-up. The results of preoperative investigations were correlated with outcome. For interictal EEG, seizure semiology, ictal EEG, PET and neuropsychology assessment the surgical outcome of patients in whom results were concordant to side of surgery was compared with those discordant or non-lateralising. There was no significant difference. In 78 of 80 patients MRI revealed mesial temporal sclerosis or a foreign tissue lesion. The outcome was no different between these two groups. Results suggest that in patients with unilateral temporal lobe lesion on MRI and where ictal EEG is either concordant or non-lateralising, other investigations including PET, provide little additional prognostic information.

Emotional and social dysfunction in patients following surgical treatment for brain tumour

Patients following brain surgery for tumour were assessed using the Emotional and Social Dysfunction questionnaire on a self-rating and partner version of the questionnaire. Analyses were performed on those patients who had self-ratings following surgery for astrocytoma (n=13), meningioma (n=26), neuroma (n=13) and pituitary adenoma (n=17). Patients with astrocytoma were rated highest when compared to the other tumour groups, although all groups of patients performed more poorly on some of the individual scales compared to a matched control group of extra-cerebral neurosurgery patients and terminally ill cancer patients. A malignant (n=48) and benign (n=33) classification similarly showed a higher partner and self-rating of malignant tumour patients. Both diagnosis and location of lesion determined outcome independently. Some differences in profile and severity between patient self-ratings and partner ratings indicate the need to survey both perspectives. This study shows a broader based emotional dysfunction in these patients which includes such prominent features such as anger, helplessness, fatigue, emotional dyscontrol, indifference, and maladaptive behaviour. These results are discussed in terms of follow-up therapeutic care and the need to further explore the relationship between lesion location and emotional profile.

The ESDQ: a new method of assessing emotional and social dysfunction in patients following brain surgery

The Emotional and Social Dysfunction Questionnaire (ESDQ) has been designed to overcome some of the difficulties of inappropriately applying psychiatric based questionnaires to brain-damaged populations. Two-hundred and twenty-five patients were assessed following brain surgery (BS) using a self-rating patient version of the ESDQ and 211 of these patients were rated by their partner. A factor analysis using a varimax rotation and principal components analysis found the partner results to show eight factors including, Anger, Helplessness, Emotional Dyscontrol, Indifference, Inappropriateness, Fatigue, Maladaptive behaviour, and Insight. The analysis of the Self-rating questions revealed a similar profile, Anger, Emotional Dyscontrol, Helplessness, Inertia, Fatigue, Indifference, Inappropriate, and Euphoria. The scales based on the factors were subjected to discriminant analysis in which the BS patients were compared with a combination control group of neurosurgical outpatients and terminally-ill cancer patients, all of which were without cerebral complaints. The brain surgery results for the partner-rated and the Self-rated version of the ESDQ were compared with control ratings of 42 partners and 54 self-ratings, respectively. The analysis showed a significant discrimination for the Partner-rated version on each of the eight scales individually with an overall significant overall separation (Wilks Lambda=.903, chi=21.1, df=8, p=<.005). The Self-rated version showed less separation on an individual scale basis the Emotional Dyscontrol scale failing to show a significant separation. The overall difference on the Self-rating version was significant [Wilks Lambda=.908, chi=26.2, df=8, p=<.001). The levels of internal consistency of the questionnaire scales were found to be satisfactory (Alpha,.78 -.94). Also the relationship between ESDQ scales and standardised measures of aggression, anxiety, depression, and vigour (STAXI, HADS, and POMS) gave an indication of acceptable levels of concurrent validity.

EGF receptor modifies cellular responses to hyaluronan in glioblastoma cell lines

Cell contact with the extracellular matrix component, hyaluronan, plays a pivotal role in glioma cell invasion and proliferation. Although it is well established that glioma cells can bind hyaluronan to their surface via the expression of CD44, the cellular responses following ligand-receptor interaction remain poorly understood. Given that a large proportion of human high grade gliomas over express the epidermal growth factor receptor (EGFR) and ErbB2, this study aimed to investigate whether an interaction exists between CD44 and these receptor tyrosine kinases. Here we present evidence that CD44 co-immunoprecipitates with EGFR and ErbB2 in the glioma cell lines U87MG and SMA560. Hyaluronan treatment mediated the rapid and transient phosphorylation of extracellular signal regulated kinases 1 and 2 (ERK1 and ERK2) in glioma cell lines. This response to hyaluronan was augmented by the co-expression of EGFR. EGFR also differentially modified the hyaluronan induced expression of a number of genes associated with cellular invasion and proliferation. Northern blot analysis demonstrated that genes encoding urokinase type plasminogen activator (uPA), urokinase type plasminogen activator receptor (uPAR), plasminogen activator inhibitor-1 (PAI-1), tissue inhibitor of metalloproteinases (TIMP-1) and c- myc were up-regulated in response to hyaluronan. Furthermore, zymographic analysis revealed increased levels of uPA in the conditioned medium of hyaluronan stimulated cells. These results indicate a novel functional relationship between CD44 and EGFR in glioma cell lines. The capacity of CD44 to form stable complexes with receptor tyrosine kinases may provide a versatile system for the regulation of cellular invasion and proliferation that allows hyaluronan to activate signal transduction pathways and modulate gene expression via an EGFR-dependent manner. These findings provide new insights into the mode by which hyaluronan regulates the malignant phenotype and also suggest a role for EGFR-CD44 interactions in glial tumorigenesis.

Imaging and quantitation of the hypoxic cell fraction of viable tumor in an animal model of intracerebral high grade glioma using [18F]fluoromisonidazole (FMISO)

We have demonstrated that FMISO uptake is significantly higher in tumor tissue in the C6 intracerebral glioma rat model compared to normal brain, and that there is persisting hypoxia in gliomas independent of tumor size. FMISO uptake was observed homogeneously throughout viable glioma tissue in tumor sizes ranging from 2mm to almost 1cm. Quantitation of uptake of FMISO showed a tumor/brain ratio of 1.9 and a tumor/blood ratio of 2.6 at 2 hours post injection.

Estrogenic and antiproliferative properties of glabridin from licorice in human breast cancer cells

There is an increasing demand for natural compounds that improve women's health by mimicking the critical benefits of estrogen to the bones and the cardiovascular system but avoiding its deleterious effects on the breast and uterus. The estrogenic properties of glabridin, the major isoflavan in licorice root, were tested in view of the resemblance of its structure and lipophilicity to those of estradiol. The results indicate that glabridin is a phytoestrogen, binding to the human estrogen receptor and stimulating creatine kinase activity in rat uterus, epiphyseal cartilage, diaphyseal bone, aorta, and left ventricle of the heart. The stimulatory effects of 2.5-25 microg/animal glabridin were similar to those of 5 microg/animal estradiol. Chemical modification of glabridin showed that the position of the hydroxyl groups has a significant role in binding to the human estrogen receptor and in proliferation-inducing activity. Glabridin was found to be three to four times more active than 2'-O-methylglabridin and 4'-O-methylglabridin, and both derivatives were more active than 2',4'-O-methylglabridin. The effect of increasing concentrations of glabridin on the growth of breast tumor cells was biphasic. Glabridin showed an estrogen receptor-dependent, growth-promoting effect at low concentrations (10 nM-10 microM) and estrogen receptor-independent antiproliferative activity at concentrations of > 15 microM. This is the first study to indicate that isoflavans have estrogen-like activities. Glabridin and its derivatives exhibited varying degrees of estrogen receptor agonism in different tests and demonstrated growth-inhibitory actions on breast cancer cells.

Seizure frequency and duration of epilepsy are not risk factors for postoperative seizure outcome in patients with hippocampal sclerosis

PURPOSE

Despite accurate localization of the seizure focus, not all patients are seizure free after temporal lobectomy. This study determined risk factors for seizure recurrence in patients with proven hippocampal sclerosis.

METHODS

The outcome from surgery was assessed in 56 consecutive patients with proven hippocampal sclerosis. The age at surgery, duration of epilepsy, history and age of febrile seizures, age of onset of epilepsy, sex ratio, laterality of seizure focus, and seizure frequency were compared between patients seizure free and those not seizure free, and those seizure and aura free and those with seizure recurrence including auras.

RESULTS

During a mean follow-up of 38 months, 48 (86%) of 56 are seizure free. The mean age at surgery (37 vs. 36 years), duration of epilepsy (26 vs. 22 years), age (1.6 vs. 1.1 years), and occurrence (58 vs. 75%) of febrile seizures, age of onset of epilepsy (11 vs. 14 years), sex ratio (50 vs. 75% female), laterality of seizure focus (42 vs. 50% left), greater than weekly seizures (40 vs. 38%), and a history of (69 vs. 75%) and frequency of (2.10 vs. 2.38 per year) secondarily generalized seizures did not differ significantly between the two groups. Similarly there was no significant difference between patients seizure and aura free and those with seizure recurrence including auras.

CONCLUSIONS

Clinical factors such as seizure frequency and duration of epilepsy are not risk factors for postoperative seizure recurrence.

Responses to propofol in the pulmonary vascular bed of the rat

BACKGROUND

Although a great deal is known about responses to propofol, controversy remains about its mechanism of action. The present study was undertaken to investigate the direct effects of 2,6-diisopropyl phenol, disodium edetate, and its intralipid emulsion in the rat pulmonary vascular bed and to better understand the mechanisms involved in propofol-mediated responses.

METHODS

The effects of N omega-l-nitro-l-arginine benzyl ester (L-NABE), an inhibitor of nitric oxide synthase, of the cyclooxygenase blocker, meclofenamate, and the K + ATP channel antagonist, U-37883A, an ATP-sensitive potassium channel antagonist, on responses to propofol, acetylcholine, nitroglycerin, and isoproterenol were investigated in the isolated blood-perfused rat lung under low tone and high steady-state tone.

RESULTS

Propofol produced a dose-dependent decrease in pulmonary arterial perfusion pressure. L-NABE significantly reduced vasodilator responses to acetylcholine, whereas the nitric oxide synthase inhibitor had no significant effect on responses to propofol. Meclofenamate significantly reduced vasodilator responses to arachidonic acid without effecting responses to propofol. Responses to propofol were not significantly changed in the presence of U-37883A, whereas U-37883A reduced vasodilator responses to levcromakalim. Additionally, 2,6-diisopropylphenol in a pure preparation as well as an intralipid preparation similar to propofol emulsion had no significant effect while disodium edetate had a dose-dependent depressor effect under high steady-state tone.

CONCLUSION

Propofol has significant vasodilator activity in the pulmonary vascular bed of the rat but responses to propofol are not mediated or modulated by the release of nitric oxide, opening of K + ATP channels, or the release of vasodilator cyclooxygenase products.

Non-invasive investigations successfully select patients for temporal lobe surgery

OBJECTIVES

There is controversy regarding the need for invasive monitoring in the preoperative assessment of patients with temporal lobe epilepsy. The use of a series of non-invasive investigations in identifying the seizure focus is reported in 75 consecutive adults referred for epilepsy surgery.

METHODS

All had video-EEG monitoring using scalp electrodes, high resolution MRI, and neuropsychology assessment. Other investigations included volumetric MRI, PET, and ictal and interictal SPECT. The seizure focus was localised and surgery offered if MRI disclosed unilateral hippocampal atrophy or a foreign tissue lesion and other investigations were either concordant or not discordant.

RESULTS

In 68 patients the seizure focus was localised and three patients were inoperable. Sixty five patients have been offered surgery and 50 have undergone temporal lobe surgery and have a follow up of at least 12 months (mean 24 months). All had pathology: hippocampal sclerosis 34, dysembryoblastic neuroepithelial tumour six, cavernoma four, dysplasia two, low grade glioma two, ganglioglioma two. Thirty nine patients (78%) are seizure free postoperatively, 29/34 with hippocampal sclerosis and 10/16 with a foreign tissue lesion. Of the 11 patients with postoperative recurrent seizures, eight have a >90% reduction in seizure frequency and three have <90% reduction in seizure frequency but a worthwhile improvement.

CONCLUSIONS

Non-invasive investigations successfully select most patients for temporal lobe surgery.

Analysis of vancomycin in the hindlimb vascular bed of the rat

Previously, studies have demonstrated that the effects of both a laboratory-produced vancomycin and a clinically available vancomycin were mediated, in part, by activation of both H(1) and H(2) receptors; however, other mechanisms may play a role in the vascular changes associated with vancomycin, since neither H(1) and H(2) receptor blockade has completely abolished the vasodilator responses to vancomycin in any model system. To study the mechanisms of vancomycin interactions in the hindlimb vascular bed of the rat, responses of two types of vancomycin preparations were studied. Vancomycin prepared for either clinical or laboratory use produced an initial short-lived period of vasoconstriction followed by a prolonged period of vasodilation in the hindlimb vascular bed. Responses to both the vancomycins and histamine on systemic arterial vasodilation were significantly decreased after administration of both the H(1)-receptor antagonist diphenhydramine and the H(2)-receptor antagonist famotidine. Verapamil, an L-type calcium channel blocker, significantly reduced the vasopressor responses to clinical vancomycin but not the vasopressor responses to laboratory vancomycin. Enalaprilat, and angiotensin-converting enzyme blocker, significantly reduced the vasodilator responses but not the vasoconstrictor responses of clinical vancomycin and significantly reduced the vasoconstrictor responses but not the vasodilator responses to laboratory vancomycin. Meclofenamate, a cyclo-oxygenase inhibitor, and N(omega)-L-nitro-L-arginine methyl ester (L-NAME), a nitric oxide synthetase inhibitor, had no significant effect on the biphasic responses with either vancomycin preparations. Atropine, an anticholinergic-antimuscarinic receptor antagonist, and propranolol, a beta adrenergic blocker, had no significant effect on vancomycin responses. Finally, ondansetron, a serotonin receptor blocker, and HOE 140, a bradykinin receptor blocker, also had no significant effect on vancomycin responses. These data suggest that both vancomycin preparations (clinically available and laboratory prepared) caused biphasic responses that differed from the dose-dependent vasodilation elicited by histamine. Both vancomycin preparations' vasodilator responses appear to be modulated, in part, by a histamine receptor--sensitive mechanism, while vancomycin-induced vasoconstrictor responses appear to be modulated, in part, by angiotensin-converting enzyme and L-type calcium channel--sensitive mechanisms in the rat hindlimb vascular bed. These data also suggest that the vascular responses of vancomycin are preparation dependent.

Malignant granular cell tumour of the sciatic nerve

A case of malignant granular cell tumour of the sciatic nerve is presented. Computed tomography demonstrated isodensity with muscle and minimal enhancement. Magnetic resonance demonstrated T1 isointensity with muscle with marked enhancement, and isointensity with fat on proton and T2 images. Pathological evidence is presented for its probable Schwann cell histogenesis.

Reconstruction of posttraumatic and congenital facial deformities with three-dimensional computer-assisted custom-designed implants

The principles, method, and benefits of combining three-dimensional computed tomography (CT) and computer-aided design/computer-aided manufacture (CAD/CAM) technology for development of custom-designed prostheses are applied in the repair of posttraumatic and congenital facial contour deficiencies. Each prosthesis is generated to fit the bone defect exactly, with external contours adjusted to compensate for overlying soft-tissue disparities. Three representative case reports from a series of 17 demonstrate the applications and advantages of using this technique. Some patients had residual defects after primary repair of posttraumatic deformities. Others had defects after orthognathic relapses for congenital deformities. Without a relatively minor surgery and a high degree of predictability, many of these patients would not have pursued further treatment. All but one of the surgeries were performed on an outpatient basis, providing an accurate, simple, and cost-effective method of contour restoration with limited morbidity and reduced operative time.