Absence seizures in children: clinical and electroencephalographic features

The clinical and electroencephalographic (EEG) features of absence seizures in children were evaluated using EEG frequency modulation radiotelemetry and videotape monitoring. The only seizures evaluated were those with a spike-and-wave or multiple spike-and-wave duration lasting at least 3 seconds. A total of 926 absence seizures (426 typical, 500 atypical) were reviewed in 54 patients. Abnormal interictal EEGs, multiple seizure types, mental retardation, or developmental delay were more likely in patients with atypical absence seizures than in patients with typical absence seizures. Both types of absence seizures usually had a clear onset and cessation. Atypical absence seizures lasted significantly longer than did typical absence seizures. Automatisms occurred more frequently in typical absence seizures than in atypical ones, while decreases in postural tone or tonic activity occurred more frequently in atypical absence seizures. Receptive and expressive speech were retained in some patients during both types of seizures. This study demonstrates that typical and atypical absence seizures are not discrete entities but rather form a continuum. No single clinical feature can adequately distinguish the two seizure types.

The psychological impact of MND on patients and carers

Nineteen patients with Motor Neurone Disease (MND) who had been living with their partners for at least two years prior to the onset of their illness, together with their partners, completed self-report questionnaires to investigate the impact of MND on both patients and carers. Physical disability and impact of the illness on aspects of everyday functioning were related to levels of anxiety and depression in the patients; psychological coping strategies adopted depended to some extent on symptom duration. Carers also demonstrated signs of anxiety and depression, with the latter correlating with aspects of the patients' functional impairment. Perceived strain in carers over caring for the patient correlated with a loss in intimacy in their relationship, which in turn was predicted by patients' cognitive/behavioural and communication changes. Changes in patients' social performance also correlated with the extent to which carers felt that the illness was affecting other areas of their life, the extent to which their partner dominated their thoughts and the extent to which they could control their reactions when thinking about the patient. Satisfaction with formal services and the number of social groups to which carers belonged correlated with carers' self-predicted future ability to cope.

Lactoperoxidase binding to streptococci

There have been conflicting reports regarding the binding of lactoperoxidase to bacterial cell surfaces. We describe here the effects of cell-bound lactoperoxidase on acid production by suspensions of Streptococcus mutans (NCTC 10449) in the presence of hydrogen peroxide and thiocyanate. Saline suspensions of log-phase bacteria were treated with 0.1 mg of lactoperoxidase per ml and were then washed thoroughly. The addition of hydrogen peroxide and thiocyanate markedly reduced the acid production of these lactoperoxidase-treated bacteria but had no effect on the acid production of untreated controls. After a 3-h incubation in saline, the lactoperoxidase-treated bacteria produced acid in the presence of hydrogen peroxide and thiocyanate at the same rate as untreated bacteria. These observations suggest that lactoperoxidase is initially bound to the cell surface in an enzymatically active form at a concentration sufficient to inhibit acid production. The lactoperoxidase is slowly degraded or desorbed as the bacteria stand in saline suspension.

Indian childhood cirrhosis in an American child

Indian childhood cirrhosis is a fatal liver disease characterized by a striking accumulation of copper-containing granules within hepatocytes. A two-year-old American boy, the product of a third-cousin marriage, with clinical, biochemical, and histological signs of Indian childhood cirrhosis was studied. Liver biopsies at 22 and 30 months of age revealed a rapid progression from fibrosis to micronodular cirrhosis, with many of the remaining hepatocytes staining strongly for copper and copper-binding proteins. Electron microscopy showed characteristic dense granules containing copper and sulfur by electron probe analysis. Hepatic copper content was 1500 micrograms/g dry weight (normal, 20-50). Urinary copper was 3.6 mumol/d (229 micrograms/24 hours; normal, 15-20), and serum ceruloplasmin was 352 mg/L (normal, 150-320). The case suggests that both genetic and environmental components contribute to the manifestations of Indian childhood cirrhosis, and that the diagnosis of Indian childhood cirrhosis should be considered even in non-Indian infants with progressive liver disease.

Evolutionary patterns in life histories of Oxyurida

The Oxyurida comprises some 850 known species that occur in the intestine of arthropods and vertebrates (one species in annelids). Important arthropod hosts include Diplopoda, Blattodea, Gryllotalpoidea, Passalidae, Scarabaeida and Hydrophilidae. The major vertebrate hosts are lizards, tortoises, primates, rodents and lagomorphs. An underlying characteristic of the group is haplodiploid reproduction and like many haplodiploid groups, pinworms tend to have life histories that involve high levels of inbreeding. Unlike Strongylida, Ascaridida and Spirurida, which have diversified in tissue site and life cycle as well as hosts, pinworms show little variation in these features and have radiated only across host groups. Two explanations are advanced for this. Haplodiploidy and its concomitant inbreeding may act to canalise evolutionary change, although diverse groups such as the Hymenoptera belie this. Alternatively, Strongylida, Ascaridida and Spirurida are presumed to have arisen from skin-penetrating ancestors that were forced to undergo a tissue migration before reaching their primitive tissue site, the gut. This migration demanded they adapt to a variety of tissue sites and thus acted as a preadaptation to further diversification. The Oxyurida, in contrast, probably arose using oral contaminative transmission. The lack of exposure to other tissue sites may therefore have relegated pinworms to their position in the posterior gut.

Enzyme activity of salivary lactoperoxidase adsorbed to human enamel

Human saliva was incubated with human enamel powder, and the lactoperoxidase activity of the saliva was measured before and after incubation. Liquidphase lactoperoxidase activity was reduced in direct proportion to the weight of enamel powder added. Lactoperoxidase molecules were adsorbed to the enamel surface in an enzymatically active conformation, and this enamel-bound lactoperoxidase activity was also measured. The adsorption of lactoperoxidase was irreversible and produced at least a 40% increase in the concentration of lactoperoxidase in the enamel surface phase as compared with its concentration in the liquid phase. Enamel-bound lactoperoxidase, as well as the free enzyme, was capable of inactivating the key glycolytic enzyme hexokinase. The implications of the adsorption phenomenon for bacterial colonization are discussed.

From the Other Side of the Door: Patient Views of Seclusion

1. Patient participants viewed seclusion as a form of punishment that maintains physical, and at times, psychological control over the secluded person. 2. A seclusion episode should serve a greater function than simply containment or preserving safety. During this period of crisis for the patient, they felt an even greater need for a therapeutic intervention. 3. Environmental, procedural, and attitudinal changes were emphasized by the patients in this study as a means to enhance the therapeutic potential of seclusion.

Lactoperoxidase and thiocyanate protect bacteria from hydrogen peroxide

Lactoperoxidase and thiocyanate were shown to protect Escherichia coli and three oral streptococcal species from the bactericidal effect of hydrogen peroxide under aerobic conditions. Lactoperoxidase in the absence of thiocyanate was also protective for two of the bacterial species in a dilution medium but potentiated hydrogen peroxide toxicity for the other two under the same conditions. The products of the reaction between hydrogen peroxide and thiocyanate in the presence of lactoperoxidase were not bactericidal except in the case of E. coli, and then only under special conditions. The results demonstrate the effectiveness of lactoperoxidase and thiocyanate in protecting living cells from hydrogen peroxide toxicity. Although the effect on human cells was not examined in this study, extrapolation of these results to the cells of the oral mucosa would suggest an important protective role of lactoperoxidase and thiocyanate against the toxic effects of hydrogen peroxide in the oral cavity.

The fracture toughness (KIC) of amalgam

The fracture toughness (KIC) has been measured (at 1 week) for a selection of sixteen amalgam products. This included low copper (i.e. Cu less than 6%) and high copper (both single component and admixed) products in milled and spherical powder forms. The results have shown that the fracture toughness decreases progressively as the copper content increases. The admixed high copper products possess superior fracture toughness to those containing a single component powder. These results have been attributed to differences in the microstructures produced by changes in composition and form in which the copper addition is made.

Lactoperoxidase-catalyzed inactivation of hexokinase

The enzymatic activity of hexokinase (ATP : D-hexose 6-phosphotransferase, EC 2.7.1.1) decreased rapidly when the enzyme was exposed to the lactoperoxidase antimicrobial system (consisting of lactoperoxidase, H2O2 and SCN-). Inactivation did not begin until the reaction of one sulfhydryl group per hexokinase monomer was completed. Loss of enzyme activity accompanied the reaction of at least one additional sulfhydryl group per monomer. Covalent incorporation of 14C-labeled SCN- into hexokinase increased as the inactivation reaction progressed. The rate of the hexokinase activity loss dependent on temperature, pH and the presence of glucose and phosphate ion. When H2O2 and SCN- were applied to a Sepharose column bearing covalently attached lactoperoxidase, the column eluate inactivated hexokinase. This demonstrated that the lactoperoxidase molecule itself need not be in contact with hexokinase in order to catalyze hexokinase inactivation. The sulfhydryl-reactive oxidation product of SCN- which is generated by the column is sufficient. The results are consistent with a two-stage reaction in which the exposed, non-essential sulfhydryl groups on the hexokinase molecule react first to produce an enzymatically active but unstable form of hexokinase. This modified form of hexokinase then undergoes a spontaneous, temperature-dependent structural change, which allows reaction of previously shielded, essential sulfhydryl groups. The phenomenon described here suggests a possible mechanism for the antimicrobial effects of the lactoperoxidase system.

Outcome following bypass, and proximal and distal ligation of popliteal aneurysms

Background

The aim of this study was to describe early and late results of proximal and distal ligation for popliteal aneurysm (PA), combined with bypass, with particular reference to the fate of the excluded aneurysm.

Methods

Of a cohort of 116 patients with PAs, 66 were treated with bypass and ligation. Graft patency was determined by duplex surveillance. In addition, 17 patients with bypassed PAs underwent a total of 33 duplex scans to determine flow within the aneurysm and change in size.

Results

For initially patent PAs, 3-, 5- and 8-year primary bypass graft patency was 78, 78 and 51 per cent respectively. These rates were not statistically significantly different from those following bypass for thrombosed PA, 3- and 5-year primary patency being 72 and 65 per cent respectively. No PA produced further symptoms after bypass and ligation. No flow was seen in any aneurysm at follow-up. Only one showed an increase in size.

Conclusion

Proximal and distal ligation with bypass produced satisfactory long-term patency with good exclusion of the PA.

MR spectroscopy for assessment of memantine treatment in mild to moderate Alzheimer dementia

OBJECTIVES

Magnetic Resonance Spectroscopy (MRS) may provide a precise and reliable assessment of the extent and severity of neural tissue loss caused by various diseases. In particular, the N-Acetyl Aspartate (NAA) and Creatine (Cr) ratio has been found to be an indicator of the degree of neuronal loss in Alzheimer's disease (AD). Memantine is thought to benefit the AD brain by stabilizing the NMDA receptors on neurons in turn reducing excitotoxicity. Despite its effectiveness in treating moderate to severe AD, memantine has not had similar success in the treatment of mildly demented AD patients. The objective of this study was to test whether memantine would slow or prevent the loss of neurons in mild to moderate AD patients.

METHODS

A double-blind placebo-controlled study was designed to measure the effect of a year-long course of memantine in patients with a probable AD diagnosis with mild to moderate dementia. The primary outcome measure was stipulated to be change in MRS NAA/Cr ratio in inferior parietal cortex in memantine relative to the placebo treatment condition. The secondary outcome measures were changes in cognitive and function scale scores.

RESULTS

This pilot study failed to demonstrate a benefit of memantine on the primary outcome measure, the inferior parietal NAA/Cr ratio, or the secondary outcome measures.

CONCLUSIONS

More studies are needed to determine the effect of memantine on regions of the brain significantly affected by AD pathology.

The relationship of age, gender, and exercise practices to measures of health, life-style, and self-esteem

A study of 478 adults from a rural-urban region was conducted to determine differences in health and life-style measures based on age, gender, and exercise involvement that would provide data to incorporate in healthy-living programs. Pender's Health Promotion Model provided the framework for the study. Significant results related to age, gender, exercise, and initiation and maintenance of health-promoting practices were found.

Attributions, strain and depression in carers of partners with MND: a preliminary investigation

Further examination of the data of Goldstein et al. (J Neurol Sci 160 (1998) S114) on the impact of MND in their spouses/partners on 19 caregivers investigated whether carers' depression and strain scores could be related to their attributional style. Contrary to expectations, carers' scores on a measure of depressed mood were not correlated with measures of internal/external, stable or global attributions. However, perceived strain was greater in carers who viewed their partners' illness as having a more global impact on their lives, and was related to self-perceived control over their thoughts about their partner. Female carers anticipated experiencing less strain and distress in the following year than male carers, even though they did not differ in current strain levels. Male and female carers received similar numbers of formal services. The availability of informal support (family and friends) was associated with reduced anticipation of future strain and distress and with reduced perception of the pervasive impact of their partners' MND on their lives.

Metallothionein synthesis and degradation in Indian childhood cirrhosis fibroblasts

Indian childhood cirrhosis (ICC) is a fatal liver disease characterized by the accumulation of copper-sulfur aggregates. We demonstrated that cultured fibroblasts from a patient with ICC contain vesicular aggregates, fibrillar whorls, and crystalloids along with dilated rough endoplasmic reticulum filled with flocculent material. Although the copper content of the fibroblasts was normal, both basal and metal-induced metallothionein (MT) synthesis was reduced in the ICC cells. The lower MT synthesis in ICC cells was seen at copper concentrations of 100, 200, and 400 microM, zinc concentrations of 50 and 100 microM, and a cadmium concentration of 2 microM. The lower MT synthesis in ICC cells was not due to failure of the cells to take up copper because 67Cu uptake kinetics were normal in the mutant cells. MT degradation was also normal in the ICC cells. The size of human MT IIA mRNA was normal in the ICC cells, but its amount was reduced under both basal and metal-induced conditions. The MT IIA gene, which is the predominant MT gene in human beings, showed no sequence alterations in any of its exons, introns, or promoter region in the ICC cells compared with normal cells. These studies demonstrate that this case of ICC represents a genetic disease with some level of expression in cultured fibroblasts; the basic defect may involve insufficient MT mRNA and protein synthesis for the copper load present. However, it remains to be determined whether reduced MT synthesis is a primary or secondary phenomenon.

[Survey on Schistosomes of man and livestock in Senegal using specific identification given by chetotaxy of cercaria. I. New arguments for the validation of S. curassoni Brumpt, 1931, parasite of man and domestic Bovidae]

Study of Senegal cercariae emitted by naturally infected snails or by snails experimentally infected using eggs from human urine or from sheep liver, and study of the corresponding eggs. The relative position of the dorsal sensillae of cercariae is described by an "AD index" and the ratio length/width of eggs by an "L/l index." At the present time, we have not finished the epidemiological studies, certain experiments are imperfect and the isoenzyme analysis of the corresponding adults is incomplete. Nevertheless information given by the indices AD and L/l agree and lead us to admit the existence of a Schistosome different to mattheei, haematobium and bovis and which, following Brumpt and Gretillat we refer to as Schistosoma curassoni. If one relies on the indices, the study indicates that: a) S. mattheei has not been found in Senegal, b) S. bovis is quite rare, c) S. haematobium apparently exists in pure infections in Casamance and in mixed infections with S. curassoni in man in the north and in the east, d) S. curassoni is apparently the dominant species in domestic ruminants and in man in the north and in the east, e) Bulinus umbilicatus is the principal vector of S. curassoni and S. haematobium.