Videofluoroscopy compared with clinical feeding evaluation in children with suspected aspiration

Aim

Videofluoroscopy swallow studies (VFSS) are gold standard to diagnose aspiration in children but require resources and radiation compared with clinical feeding evaluation (CFE). We evaluated their added value for diagnosis, feeding management and clinical status.

Methods

A retrospective single‐centre cross‐sectional study of children aged 0–18 years, with respiratory morbidity, referred for VFSS at a tertiary pediatric hospital.

Results

A total of 113 children, median age (range) 2.2 years (0.1–17.9), underwent VFSS. Diagnosis included chronic pulmonary aspiration (CPA), 87 (77%); neurological, 73 (64%); gastrointestinal, 73 (64%) and congenital heart disease, 42 (37%), not mutually exclusive. Forty‐six (41%) aspirated, 9 (8%) only overtly and 37 (33%) including silent aspirations. Those with CPA or cerebral palsy were more likely to have VFSS aspiration, OR 3.2 and 9.8 respectively.

Feeding recommendations after VFSS differed significantly from those based on prior CFE, p < 0.001: The rate of exclusively orally fed children rose from 65% to 79%, p = 0.006; exclusively enterally fed children from 10% to 14%; p = 0.005. During the year after VFSS, there were significantly less antibiotic courses, total and respiratory admissions.

Conclusion

In this population with high prevalence of clinically suspected CPA, VFSS altered feeding management compared with CFE and may have contributed to subsequent clinical improvement.

Camp "Sababa" (awesome) - The world of children with burns

AIMS

Camp "Sababa" operates in Israel through the Burn Advocate Network of New Jersey, to help children with burn injuries cope with consequences of injury. The study assessed adolescents' perceptions of their participation in the camp, and its effect on their self-esteem and quality of life.

METHODS

Ten adolescents from diverse cultural backgrounds attended Camp "Sababa" in 2017. All the participants and parents signed an informed consent form, responded to a demographics questionnaire, and participated in in-depth interviews and focus groups. Phenomenological analysis revealed three themes, reflecting the chronological sequence of rehabilitation: (1) coping with emotional and physical scars, (2) formulating coping strategies, (3) belonging to a group, and (4) implications of camp experience.

RESULTS

Social participation engendered a feeling of safety and trust, enabling adolescents to share their burn experiences, and thus cope better with the physical and emotional challenges of their injuries. Participation in camp activities strengthened their confidence and social bonding; and their return to typical adolescent behaviour while at camp, and ultimately in the community.

CONCLUSIONS

The positive results suggest that burn camps should be part of the rehabilitation process of adolescents with burn injury, with emphasis on challenging, age-appropriate activities, and peer group participation.

Aerodigestive Clinics as Emerging Pediatric Care Model: The First 100 Patients in Israel

BACKGROUND

Aerodigestive clinics are run by interdisciplinary medical and surgical teams, and provide complex care coordination and combined endoscopies.

OBJECTIVES

To describe the design and patient population of the first pediatric aerodigestive center in Israel.

METHODS

A retrospective single-center cohort study was conducted describing patients followed in the aerodigestive clinic of Schneider Children's Medical Center of Israel, a tertiary pediatric hospital, between its inception in January 2017 and June 2020.

RESULTS

During the study period, 100 patients were seen at the combined respiratory and digestive (NoAM) clinic, with a total of 271 visits. Median age at first assessment was 29.5 months (range 3-216). Fifty-six patients (56%) had esophageal atresia and tracheoesophageal fistula. Thirty-nine patients had an identified genetic disorder, 28 had a primary airway abnormality, 28 were oxygen dependent, and 21 were born premature. Fifty-two patients underwent triple endoscopy, consisting of flexible bronchoscopy, rigid bronchoscopy, and gastroscopy. In 33 patients, esophageal dilatation was necessary. Six patients underwent posterior tracheopexy at a median of 6 months of age (range 5 days to 8 years) all with ensuing symptom improvement. The total mean parental satisfaction score on a Likert-type scale of 1-5 (5 = highest satisfaction) was 4.5.

CONCLUSIONS

A coordinated approach is required to provide effective care to the growing population of children with aerodigestive disorders. The cross fertilization between multiple disciplines offers a unique opportunity to develop high quality and innovative care. Outcome measures must be defined to objectively measure clinical benefit.

Serum leptin level in women with idiopathic intracranial hypertension

Leptin is a protein secreted by adipose cells which influences regulation of energy balance and body weight. Idiopathic intracranial hypertension (IIH) is recognised as a neurological disorder mainly affecting obese females. The aim of this study was to evaluate the association between IIH and serum leptin level in 15 obese patients and compare the results with those for 16 obese and 15 non-obese women. A significantly higher serum leptin level was found in patients with IIH than in controls (p<0.0001), and this did not correlate with body mass index (BMI). Serum leptin levels were significantly associated with BMI in both control groups (p<0.0006). Additional factors must therefore be involved in the phenomenon of serum leptin increase beyond weight gain. The cause can only be hypothesised, but it seems that the origin is central, probably hypothalamic.

Intravenous administration of magnesium sulfate in acute stroke: a randomized double-blind study

A randomized, placebo-controlled, double-blind study was performed as a pilot study to examine the benefit of the administration of magnesium sulfate given intravenously as a protective substance during the first 24 hours following a stroke. Patients who had cortical infarction in the middle cerebral artery territory with moderate to severe neurologic deficits lasting for more than 15 minutes with onset less than 24 hours were included. The patients were treated with magnesium sulfate or placebo for 5 days and examined by a blinded investigator. Patients had follow-up for 30 days. The primary efficacy variable was the proportion of patients reaching mild to moderate neurologic deficit on the Orgogozo scale (80 points) and relative functional independence on the Barthel index (60 points). Orgogozo scale and Mathew scale values were obtained on admission and days 2, 4, 8, and 30 after stroke. Barthel activities of daily living index and Rankin disability score were obtained on day 30. Forty-one patients (22 given treatment and 19 given placebo) demonstrated significant beneficial effects on the Orgogozo scale (84 +/- 11 vs. 64 +/- 10, p < 0.0001) and (83 +/- 14 vs. 70 +/- 15, p < 0.009), respectively. At the end of 1-month follow-up, the Barthel ADL index was nonsignificantly higher and the Rankin disability score was marginally significantly lower in the magnesium-treated group (84 +/- 26 vs. 71.8 +/- 26, p < 0.143) than in control subjects (2.3 +/- 1.1 vs. 3 +/- 1.3, p < 0.077). Intravenous magnesium sulfate had significant positive effect on the outcome in patients with acute stroke. Further studies on a larger scale are needed to confirm these findings.

Acculturation attitudes and sociocultural adjustment of sojourner youth in Israel

Among 300 Jewish sojourner youth (age range: 15-18 years) from the Russian Federation, the authors investigated associations of acculturation attitudes, measures of sociocultural adjustment, and length of the encounter with the host society, Israel. All the youth were participating in a 1-3-year program of high school studies in Israel. In the light of J. W. Berry's (1997) acculturation model, the authors examined the assumptions that the participants' adjustment to Israeli society would require readiness to abandon some of their previous identity and to adopt elements of a new identity characteristic of the host society. Lower degrees of separation and higher degrees of integration were positively linked with measures of sociocultural adjustment. The adjustment scores tended to decrease over time spent in Israel.

Ultrasound imaging-guided noninvasive ultrasound thrombolysis: preclinical results

BACKGROUND

Catheter-based therapeutic ultrasound thrombolysis was recently shown to be effective and safe. The purpose of this work was to study the safety and efficacy of external high-intensity focused ultrasound thrombolysis guided by ultrasound imaging in experimental settings.

METHODS AND RESULTS

A therapeutic transducer was constructed from an acoustic lens and integrated with an ultrasound imaging transducer. In vitro clots were inserted into bovine arterial segments and sonicated under real-time ultrasound imaging guidance in a water tank. With pulsed-wave (PW) ultrasound, the total sonication time correlated with thrombolysis efficiency (r(2)=0.7666). A thrombolysis efficiency of 91% was achieved with optimal PW parameters (1:25 duty cycle, 200-micros pulse length) at an intensity (I(spta)) of >35+/-5 W/cm(2). Ultrasound imaging during sonication showed the cavitation field as a spherical cloud of echo-dense material. Within <2 minutes, the vessel lumen evidenced neither residual clot nor damage to the arterial wall. On serial filtration, 93+/-1% of the lysed clot became subcapillary in size (<8 microm). In vitro safety studies, however, showed arterial damage when an I(spta) of 45 W/cm(2) was used for periods of >/=300 seconds.

CONCLUSIONS

External high-intensity focused ultrasound thrombolysis using optimal PW parameters for periods of </=300 seconds appears to be a safe and effective method to induce thrombolysis. The procedure can be guided by ultrasound imaging, thereby allowing the monitoring of therapy.

Effects of in-group bias on planned encounters of Jewish and Arab youths

In a sample of 9th-grade Jewish (n = 118) and Arab (n = 100) students in Israel who participated in planned binational encounters, the author examined in-group biases as a function of (a) their perceptions of the encounter between the groups as interpersonal or as intergroup contact and (b) their views of the status of their respective national groups in Israel as legitimate and stable. In comparisons of the 2 encounter groups (of equal status), both groups showed in-group biases. In comparisons of the national groups at large (of unequal status), the Arab students considered their group similar to the Jewish group, whereas the Jewish students rated their group more favorably than they rated the Arab group. For the Jewish, but not the Arab, students, in-group bias was contingent on simultaneous ratings (legitimate-illegitimate; stable-unstable) of the binational situation in Israel. The data support a 2-dimensional model rather than a 1-dimensional model of intergroup-interpersonal definition of the encounter.

Mother and caregiver representations of toddlers in a kibbutz setting

Seventy-seven mother-caregiver pairs were interviewed by a 10-item instrument in order to evaluate their perception of children which they cared for, and their dyadic relationships with him or her. Children's ages ranged between 16-38 months. Results indicated that mothers presented more elaborated and more positive descriptions of their children, and perceived them as more developed as compared with caregivers. Mothers' emotional tone in describing the child was more ambivalent, namely more anxious and at the same time also more enthusiastic, as compared with the caregivers. Results are discussed in terms of the distinction between the meaning attributed by mothers and caregivers to their respective experiences of caregiving role-relations with the same child, and their different representations of the same child.

Representation of goodness or badness in contacts of 5-year-old children with mother and nursery school teacher

The present study assessed children's evaluation of their own 'goodness' or 'badness' in interactions with a caregiver. These assessments were derived from 5-year-olds' responses to interviews where (a) the adult takes the role of a child and addresses the child as a knowledgeable fairy (with the help of two appropriate dolls), and (b) the adult addresses the child directly. These interviews referred to positive as well as negative contacts with two different adult figures, mother and nursery school teacher; and two different child-rearing settings, town and kibbutz. The sample consisted of 72 5-year-olds drawn from both kibbutzim and towns in Israel. Results indicated that children's representation of self-goodness or self-badness, in positive as well as negative contacts, was more positive in the role of self than in the role of a fairy. The difference between these representations was larger among kibbutz children than among town peers. Statistical interactions were obtained (three-way child role by nature of contact by place of origin) for contacts with mother, and were not replicated in child contacts with the nursery school teacher. These findings suggest that the regulation of feelings of goodness or badness of 5-year-old children is facilitated and sustained by 'lived' experiences with significant other, as compared with as if relations.

Self-enhancement, generality level of self-evaluation, and emotional adjustment

Three hypotheses regarding self-concept and emotional adjustment were tested: (a) self-concept has a hierarchical structure in which self-evaluations become more positive as they become more general, (b) self-enhancement is positively associated with emotional adjustment, and (c) prediction of emotional adjustment is improved as more general levels of self-enhancement are involved. Three independent samples consisting of 708 students in 7th and 8th grades in Israel participated. The data supported Hypotheses 1 and 3, which were replicated in independent samples, for 2 different content domains of self-evaluation. Hypothesis 2 was partially supported.

Cerebrospinal fluid magnesium level as a prognostic factor in ischaemic stroke

Magnesium has been reported to have a dilatatory effect on cerebral arteries. Reduction of extracellular Mg+2 has been shown to be directly correlated with the intensity of cerebral spasm. A neuroprotective effect of magnesium in stroke has also been hypothesized. The aim of our study was to examine the Mg+2 levels in serum and cerebrospinal fluid (CSF) in the early stage of stroke and to evaluate the correlation between Mg+2 levels and the development of neurological deficits. Between 1986 and 1994, 96 patients who had a stroke of 24- to 48-h duration were enrolled in the study. Serum and CSF levels of magnesium were checked on admission, 2448 h after the onset of stroke. Using a neurological score, the neurological deficit was assessed on the 1st day, 1 and 4 weeks later. Computed tomography (CT) was performed after 1 week, and the volume and location of infarction were calculated and measured. Statistical analysis was performed for cortical and subcortical patients separately, using Spearman correlation and multiple linear and logistic regression analyses. Significant correlation was found between CSF Mg+2 and the size of the infarct (P < 0.0001). There was no correlation between serum Mg+2 and CSF Mg+2 levels. Regression analysis demonstrated an increase in the values of the Mathew Neurological Score with higher CSF Mg+2 levels. This association remained true after other factors such as age, associated heart disease, diabetes and infarction size had been taken into account by the regression model. The results confirm that there is a relationship between a low Mg+2 concentration in CSF during the first 48 h after onset of ischaemic stroke and the intensity of the neurological deficit. The therapeutic consequence of this finding may have some importance.

Friends, lovers and spouses: intimacy in young adults

Intimacy in young heterosexual adults was studied as a function of their familial roles. The 168 males and females employed represented four familial role groups: late adolescents, single adults, married people and parents. Participants were administered two forms of an Intimacy Scale (Sharabany, 1994) in which they described their desired and their obtained intimacy with a same-sex and an opposite-sex best friend. Results indicated that (a) intimacy of adults with opposite-sex partner was higher than intimacy with same-sex friend. (b) Although no direct effect of familial role on intimacy was found, the married and parent groups displayed greater intimacy towards their spouses than late adolescents and single adults towards their opposite-sex partners. (c) Women who were late adolescents and women who were married scored significantly higher than men in intimacy. However, single women expressed significantly lower intimacy than single men. (d) Higher intimacy with opposite-sex partner was associated with a concurrent lower same-sex intimacy. (e) Satisfaction with other-sex partner was higher in the married group than in the other groups.

Anterior operculum syndrome localized by SPECT

The aim of this case report was to present a patient with complete anarthria and orofacial apraxia without other relevant neurological deficit. The clinical features are compatible with anterior operculum syndrome.

METHODS

A regional brain perfusion scan was done using 99mTc-HMPAO and a SPECT gamma camera. A brain CT scan and an MRI were also performed.

RESULTS

Brain CT and MRI were not diagnostic. On brain SPECT, hypoperfusion of the left inferior area of the frontal lobe was noted.

CONCLUSION

The patient studied showed an uncommon case of anterior operculum syndrome of focal degenerative origin localized by SPECT. SPECT may be a useful and effective method for diagnosis of this unusual neurological deficit.

Familial dyslexia associated with cavum vergae

Three members of one family, diagnosed as dyslexic, are described. All of them have variations of midline cavity: cavum vergae or cavum septum pellucidum, diagnosed by neuroradiological examination. In contrast, the non dyslexic members of the same family have no neuroanatomical congenital variations. We raise the possibility of a functional correlation between the dyslexia and the anatomical findings in the affected members of this family.

Correlation between source asymmetry and scalp potential asymmetry in a prolate spheroid model of the head

The correlation between electric source asymmetry in the brain and potential amplitude asymmetry developed on the scalp was investigated using a computerized analytical prolate spheroid model of the head. The source was modeled by a single current dipole located in the occipital region of the brain. The potential created by the dipole was calculated using Laplace's equation with boundary conditions while allowing a quasi-static formulation and linear media. The dipole was located in the inner part of a four-compartment medium representing the scalp, the skull (with non-isotropic conduction), the cerebrospinal fluid (CSF), and the cortex. The asymmetry was modeled by a dipole located with an angle to the major axis connecting the nasion and the inion. The present study shows that source asymmetry can cause non-negligible asymmetries in the potential amplitude measured on the scalp above homotopic points of the two hemispheres. A potential asymmetry of up to 15% in the O1-O2 pair of electrodes was found when the dipole is rotated from the symmetric major axis at an angle of 10 degrees. The source asymmetry in the occipital region can be related to falx deviation, which is an asymmetry present in the majority of the population. Since this asymmetry is not related to real physiologic and psychologic sources of potential amplitude asymmetries, it should be taken under consideration when potential distribution analysis is performed.

Cerebrospinal fluid soluble interleukin-2 receptor in cerebral lupus

Cerebrospinal fluid (CSF) and serum samples of 20 young adults (mean age 41 +/- 3.4 yr) with a first episode of stroke were tested for interleukin-2 (IL-2), soluble interleukin-2 receptor (SIL-2R), tumour necrosis factor-alpha (TNF-alpha) and interleukin-1-beta (IL-1 beta) levels. The results were compared to 20 patients who had neurological symptoms without evidence of a neurological disease. Three subgroups were formed according to the aetiological source of the stroke, determined by the neurological examination and evaluation. In 13 patients, the presence of atheromatous carotid plaque or cardiac disease was found. In five of the patients, stroke was the presenting symptom of systemic lupus erythematosus (SLE), which developed during the follow-up period. In two patients, no obvious aetiology could be demonstrated. The SIL-2R level was significantly higher in the CSF of patients who later developed definite SLE (P = 0.001). Other CSF interleukins and all serum interleukin levels were not significantly different in any of the groups. No correlation between albumin quotient and CSF SIL-2R was found. The SIL-2R level in the CSF may be used as a diagnostic tool to differentiate immunologically mediated vascular processes in the CNS from stroke of other origin.

Early treatment of a single generalized tonic-clonic seizure to prevent recurrence

BACKGROUND

The question of whether to start antiepileptic treatment after a single unprovoked seizure remains controversial and has been the subject of much debate in the relevant literature.

OBJECTIVES

To determine the rate of recurrence of a second attack after a single unprovoked epileptic seizure by using 2 study groups of treated and untreated patients and, thus, to establish a treatment policy for these patients.

PATIENTS AND METHODS

A group of 91 patients with a single generalized tonic-clonic seizure were prospectively studied; 87 of these patients completed the study. The end point of the study was 36 months after the single attack or the occurrence of a subsequent epileptic attack. The patients were randomly divided into 2 groups; 45 patients who immediately received anticonvulsive treatment and 42 who remained untreated for the follow-up period. Patients in the treated group were given monotherapy with carbamazepine. The results of recurrences were statistically analyzed by using the Kaplan-Meier method.

RESULTS

Results indicated a significantly higher percentage of seizure-free patients in the treated group compared with that in the untreated group (P = .001). The treated men were proved to be less at risk for recurrent seizures compared with treated women (P < .001 vs P = .03, respectively).

CONCLUSION

Treatment after a single unprovoked seizure leads to a significant reduction in the risk of relapse of generalized tonic-clonic epilepsy.

Neurological and functional outcome in patients with supratentorial hemorrhages. A prospective study

BACKGROUND AND PURPOSE

A prospective study was performed to evaluate neurological and functional outcome after spontaneous supratentorial bleeding. The aim of the study was to determine whether clinical or neuroradiological parameters could predict the outcome of these patients during the first hours of hospitalization.

METHODS

Two hundred seventy-nine patients--52 with thalamic, 87 with putaminal, and 140 with lobar hemorrhages--were followed prospectively and examined on admission and at 2 weeks, 3 months, and 6 months after onset. The patients underwent clinical (according to the Glasgow Coma Scale) and neuroradiological examinations on admission and were scored clinically and functionally (according to Stroke Severity score and Barthel Index) on the follow-up periods. Risk factors and the correlation between findings on admission and the latest clinical and functional results were calculated with the chi 2 test, Pearson correlation test, and Student's t test. Multivariate analysis was calculated with the stepwise regression test.

RESULTS

In all of the bleeding locations, lethal outcome was significantly correlated with size of the hematoma (P < .001) and Glasgow Coma Scale score on admission (P < .001). Intraventricular blood expansion was found to have a better prognosis in thalamic bleeding (P < .007) and a worse prognosis in lobar hemorrhage (P < .01). The functional outcome after 6 months was directly correlated with the size of the bleeding area in lobar and putaminal hemorrhages. No correlation was found in thalamic bleeding. A worse functional outcome was found in putaminocapsular bleeding (P = .004) and in patients with ischemic heart disease. A limited better recovery prognosis was found in patients with lobar hematoma in the temporal lobe (P = .052).

CONCLUSIONS

The probability of lethal outcome can be calculated on admission in all patients with supratentorial bleeding and in correlation with the location and size of the bleeding area and level of consciousness. Intraventricular expansion of blood is a better prognostic factor in thalamic bleeding and a worse one in lobar hematoma. Functional outcome is correlated with size of the bleeding area and level of consciousness on admission in putaminal and lobar hemorrhages but has no correlation to thalamic hemorrhage.

Strokes mimicking peripheral nerve lesions

Sensory-motor deficit in a peripheral nerve pattern due to brain lesion is rarely documented. We report on seven patients with a clinical manifestation of sensory-motor deficit, imitating peripheral nerve involvement, due to lacunar brain infarcts verified by brain computed tomography scan. Five of the patients had an ulnar nerve-like deficit and two median nerve-like deficits. The infarcts were located in the thalamus and the corona radiata. No clinical or electrophysiological evidence for peripheral nerve involvement was found. The unusual peripheral nerve pattern of lesions caused by lacunar brain infarcts can be defined as an additional lacunar syndrome and must be taken into consideration in the clinical evaluation of peripheral nerve deficits with normal nerve conduction velocity.

Splinting therapy for congenital auricular deformities with the use of soft material

Congenital auricular deformities present serious esthetic problems. To avoid surgical correction, splinting during the early neonatal period has been attempted. We describe the results and follow-up of splinting therapy with a special soft material in 30 neonates, as compared with results in a control group of 20 untreated newborn infants. Good results were achieved in 85% of the patients and sufficient results in 15% when the treatment was continuous over the entire 4-week period. However, when treatment was partial or discontinuous, only 10% had good results. None of the infants in the control group showed spontaneous improvement during the period of study. Moreover, early initiation of treatment (first week of life) proved more effective than later treatment (second week of life). Strong parental cooperation and close follow-up are also important for success.

Correlation between skull thickness asymmetry and scalp potential estimated by a numerical model of the head

The contribution of asymmetric skull thickness to the scalp potential amplitude was investigated numerically. The model consisted of four conductive layers representing the scalp, the skull, the cerebrospinal fluid, and the cortex with a current dipole in the occipital region. The potential created by the dipole was calculated assuming quasistatic formulation and linear media. The governing equation was discretized by the finite volume method to ensure the conservation of fluxes even in regions with abrupt changes of the conductivity. The large set of the algebraic equations for the electric potential was solved iteratively by the successive overrelaxation method. The model confirmed previous experimental studies suggesting that the potential amplitude is 60% smaller on the side with the thicker bone if the asymmetry of the skull thickness exceeds 40%. The model developed suggests that skull thickness asymmetry can create nonnegligible asymmetries in the potential measured on the scalp above homotopic points of the two hemispheres.

Approach to discovering novel therapeutic agents for osteoporosis based on integrin receptor blockade

On a global scale, osteoporosis is a major and growing public health problem. In the United States, osteoporosis is present in 24 million people (mostly women) and contributes to more than 1.3 million fractures/year. Serious morbidity and mortality result from these fractures. Current therapies for osteoporosis are few, efficacy is limited, and side effects problematic. Fundamental to the pathophysiology of osteoporosis is an imbalance between the tightly coupled processes of bone resorption and bone formation that characterize normal bone remodeling. Our laboratory is engaged in a research effort focused on elucidating the role of the osteoclast integrin in bone resorption, defining the nature of ligand-integrin interactions, and developing antagonists for cell surface adhesion molecules, particularly the alpha v beta 3 vitronectin-like integrin receptor present on the surface of human osteoclasts. Peptides containing the internal arginine-glycine-aspartic acid (RGD) motif have been shown to inhibit osteoclast-mediated bone resorption in vivo. We are now designing more potent and selective inhibitors of bone resorption as a potential new mechanism-based therapeutic approach to osteoporosis based on a novel mechanism. In an effort to rapidly identify the highest affinity ligands for the human alpha v beta 3 integrin, we have generated combinatorial peptide libraries containing substantial structural diversity. For instance, based on all possible sequence combinations of extracellular matrix proteins known to bind alpha v beta 3, we recently synthesized and chemically analyzed a library of 360,000 peptides, all of which contain RGD.(ABSTRACT TRUNCATED AT 250 WORDS)

Numerical calculation of the potential distribution due to dipole sources in a spherical model of the head

A three-dimensional spherical model of the head was investigated numerically. The model consists of four conductive layers representing the scalp, the skull, the cerebrospinal fluid, and the cortex with a dipole current source. The potential created by the dipole was calculated using quasistatic formulation and a linear medium. The volume conduction equation was discretized by the finite volume method to ensure the conservation of fluxes and efficient solution method. The large set of algebraic equations for the electric potential was solved iteratively by the successive over relaxation method. The new formulation of the volume conduction problem was validated by comparing the numerical results with two analytical solutions. The first test-case considers a homogeneous spherical model with a dipole in the center. The potential on the outer surface, as well as within the volume conductor, was calculated and very good agreement was obtained with the analytical solution. In the second test-case, the scalp potential due to a radially oriented eccentric dipole in a four concentric spheres model was compared with an analytic solution. It was found that a grid of 90 x 90 x 90 volume elements yielded accurate results on the scalp surface with errors on the order of 1%. The present numerical model can be extended to general cases with any volume conductor shape or with any distribution or orientation of the current dipoles. Compared to other numerical methods, this approach offers enhanced accuracy for given computational resources (both in CPU time and memory). The gain might be more than one order of magnitude, allowing simulation with considerably larger meshes.

Selective acalculia with sparing of the subtraction process in a patient with left parietotemporal hemorrhage

We describe a patient with left parietotemporal hemorrhage with selective acalculia for addition, multiplication, and division, but with an intact ability to subtract. There was no impairment in the ability to distinguish mathematical signs. This case suggests that different processing systems are responsible for each of the basic arithmetic operations.

Calmodulin-binding peptides interfere with melanocyte-stimulating hormone receptor activity and stimulate adenosine 3',5'-monophosphate production in M2R mouse melanoma cells

The MSH receptor belongs to a unique class of G-protein-coupled receptors, in which calcium ions control the binding affinity of MSH by a yet unknown mechanism. Possible involvement of a calcium-binding protein [e.g. calmodulin (CaM)] in the regulation of MSH receptor activity has been studied in the M2R mouse melanoma cell line. In this study, we tested the inhibitory effects of a group of calmodulin-binding peptides (CBPs) on MSH receptor activities in intact M2R cells and membrane preparations derived from them. We also report here on stimulatory effects of CBPs on cAMP production in M2R cells that could not be produced in other cell lines lacking MSH receptors. This group of CBPs includes synthetic peptides comprising the CaM-binding domains of Ca2+/CaM-dependent enzymes, cytotoxic venom peptides, and peptide hormones that have been reported to directly interact with CaM. The results show that CBPs, at micromolar concentrations, inhibit MSH binding and consequent adenylate cyclase stimulation in a specific and concentration-dependent manner, but have no effect on adenylate cyclase stimulation by prostaglandin E1. On the other hand, when MSH was omitted and forskolin (0.5-1 microM) was added instead, CBPs had the opposite effect on cAMP production, stimulating it in M2R cells, but not in other cell types tested. Thus, these peptides can be considered as antagonists of MSH receptor and partial agonists of M2R adenylate cyclase. In contrast to MSH, the stimulatory effects of CBPs were unaffected by EGTA, suggesting a Ca(2+)-independent action of these peptides. Using phospholipid vesicles and M2R cells, we recently showed that CBP activity in M2R cells may include direct partition into the lipid bilayer of the cell membrane, permitting interaction with hydrophobic lipid-inserted domains of components of the signal transducing machinery. Based on these findings, we suggest that the mechanism of action of CBPs in the M2R cells includes two major components: 1) interaction with the cell surface membrane and penetration into the lipid milieu, and 2) interaction with exposed or lipid-embedded protein epitopes intrinsically associated with the MSH-receptor system, thereby affecting the MSH receptor cascade.

Synthetic peptides corresponding to the calmodulin-binding domains of skeletal muscle myosin light chain kinase and human erythrocyte Ca2+ pump interact with and permeabilize liposomes and cell membranes

Synthetic calmodulin-binding (CaM-binding) peptides (CBPs) representing CaM-binding domains of Ca2+/CaM-dependent enzymes have been reported to interfere with the activity of the melanocyte-stimulating hormone (MSH) receptor function in melanoma cells [Gerst, J. E., & Salomon, Y. (1988) J. Biol. Chem. 263, 7073-7078]. We postulated that membrane lipids may play an important role in the mode of action of CBPs on cells. We therefore tested the ability of CBPs to interact with membrane bilayers. Using artificial phospholipid vesicles, or M2R melanoma cells and cell membranes derived therefrom, as models, we report here that synthetic peptides representing the CaM-binding domains of skeletal muscle myosin light chain kinase (M5) and the human erythrocyte calcium pump (C28W), as well as other CBPs, interact with lipid bilayers and cell membranes. Significant interactions of CBPs with the lipid bilayer were detected in both model systems. M5 and C28W were found to partition into the lipid bilayer of melanoma cell membranes and soybean lecithin vesicles, and surface partition constants obtained (for the liposome model) were in the range 10(3)-10(4) M-1. In addition, C28W and its N-modified NBD derivative were found to inhibit [125I]iodo-[Nle4,D-Phe7]alpha MSH binding to cultured M2R melanoma cells. These and other CBPs were also found to induce the release of cations and calcein from liposomes, suggesting that the interaction of CBPs with the lipid bilayer increases membrane permeability.(ABSTRACT TRUNCATED AT 250 WORDS)

Signaling mechanisms controlled by melanocortins in melanoma, lacrimal, and brain astroglial cells

Melanocortins appear to be involved as regulators in an ever growing number of physiological processes in cells and tissues of diverse functions. While such trends are apparent also in the case of other peptide hormones, it appears that melanocortin receptors can be regarded as unique among G-protein-linked receptors due to their special need for extracellular Ca2+ which may relate to some, yet undetermined selectivity of their actions. The physiological role that Ca2+ may be playing and the diverse signaling mechanisms regulated, as well as the nature of the cell-specific responses elicited in melanocortin-sensitive cells/tissues, have yet to be elucidated. Likewise, it will be of interest to establish the relationship of melanocortins to processes like growth and differentiation of cells, as well as to higher, more complex processes such as those regulated in the CNS.

Giant axonal neuropathy with predominant central nervous system manifestations

The authors describe a 25-year-old woman with giant axonal neuropathy (GAN) and severe CNS involvement. She had been admitted to hospital with generalized seizures, and had gait disturbances followed by progressive mental deterioration since childhood. Neurological examination revealed mental retardation, scanning speech, cerebellar dysfunction, pyramidal signs, mainly in the lower extremities, and peripheral sensory neuropathy. Sensory nerve conduction velocity was decreased; brain CT and MRI showed diffuse demyelination. Sural nerve biopsy revealed characteristic signs of GAN. The patient's older sister had died at the age of 23, after having had similar neurological disturbances since childhood. This case illustrates an unfamiliar presentation of GAN, characterized by mild sensory neuropathy and serve CNS involvement, including seizures.

Weight gain, increased appetite, and excessive food intake induced by carbamazepine

Four young patients who developed weight gain induced by carbamazepine therapy are described. The patients received the carbamazepine as anticonvulsant treatment, and soon after starting the drug, abruptly developed an increase in appetite with a concomitant increase in food intake. During a period of 2 months the patients' weights rose by between 7 and 15 kg. Dietary restriction during the carbamazepine treatment was ineffective in promoting weight loss, and loss of the excess weight was achieved only when the drug was discontinued. These patients demonstrate an as yet unpublished adverse effect of carbamazepine. In carbamazepine-induced weight gain, overeating and fat deposition must be taken into consideration as a differential diagnosis to the hitherto described water retention and edema.

Autosplenectomy complicating pneumococcal meningitis in an adult

We present a rare complication of pneumococcal meningitis. A 56-year-old female patient with pneumococcal meningitis developed acute hyposplenism. Left-sided hypochondriacal pain accompanied by a marked thrombocytosis developed during the convalescent period. Abdominal radionuclide and computed tomographic scans demonstrated damage to the spleen. The findings were compatible with autosplenectomy.

Alkaline phosphatase level in CSF in various brain tumors and pulmonary carcinomatous meningitis

Twenty-six patients with various brain tumors or carcinomatous meningitis were examined for alkaline phosphatase (ALP) in the cerebrospinal fluid. ALP enzyme levels were compared with the respective levels in control groups of 75 patients with epilepsy, stroke, bacterial and viral meningitis and intervertebral disc prolapse. Extremely high ALP levels in CSF (9516 mu/l, 1425 mu/l, and 871 mu/l) were found in patients with pulmonary carcinomatous meningitis. Among all other patients with brain tumors, ALP levels in CSF were in the normal range. Examination of ALP in serum yielded normal results in all patients. In patients with pulmonary carcinomatous meningitis, the enzyme level in CSF was examined during various stages of radiotherapy and chemotherapy. Decreased ALP enzyme level was found during treatment followed by recurring rising levels a month after the treatment coinciding with clinical relapse. No correlation was found between the level of ALP enzyme and the biochemical and cellular content of the CSF during the various stages of treatment.

LDH isoenzymes in cerebrospinal fluid in various brain tumours

This study examined the isoenzymatic pattern of LDH in the cerebrospinal fluid (CSF) as well as the ratio between the five fractions of LDH among patients with various brain tumours, carcinomatous meningitis and control groups. LDH 1/LDH 2 less than 1 was found significant for carcinomatous meningitis (p less than 0.001) and brain metastases (p less than 0.001). LDH 1/LDH 2 ratio was found to be significantly lower in carcinomatous meningitis than in brain metastases (p less than 0.05). No LDH 1/LDH 2 ratios smaller than 1 were found in the other groups. The LDH 1/LDH 2 ratio smaller than 1 was found in the early stage of carcinomatous meningitis without other evidences of the involvement of the leptomeninges. Examination of LDH 1/LDH 2 can be found as an adjunctive method to identify brain metastases and carcinomatous meningitis at the initial stage.

Cerebrospinal fluid lactate dehydrogenase levels in early stroke and transient ischemic attacks

We examined the concentrations of lactate dehydrogenase in the cerebrospinal fluid of 25 patients with strokes and 15 patients with transient ischemic attacks less than or equal to 8 hours after the onset of the vascular event and in a control group of 21 patients. We found significantly higher concentrations in the stroke patients (40.9 +/- 14.5 units/l) than in the transient ischemic attack patients (11.8 +/- 2.9 units/l, p less than 0.001) and the controls (11.2 +/- 6.7 units/l, p less than 0.001). Among the stroke patients, we found a significantly higher lactate dehydrogenase concentration in those with cortical strokes (n = 12, 50 +/- 12.3 units/l) than in those with lacunar white matter infarcts (n = 5, 26.4 +/- 6.5 units/l; p less than 0.001) and those with basal ganglia infarcts (n = 8, 36.37 +/- 11.7 units/l; p less than 0.05). Our study offers a supplementary examination for diagnosing cortical or subcortical infarction during the early stage of the event, with the possibility of distinguishing precisely stroke from transient ischemic attack during the first hours after onset of the event.

Chloral hydrate in intractable status epilepticus

Five adult patients were admitted to the neurological department in a state of status epilepticus. All were treated unsuccessfully with IV diazepam and diphenylhydantoin. Administration of sodium valporate or phenobarbital also was ineffective. However, after treatment with intrarectal chloral hydrate, all seizures ceased. The excellent effect of this drug was proved both clinically and electrodiagnostically. Discussed is the possibility of using chloral hydrate to treat patients with status epilepticus in whom conventional treatment has failed.

Glioblastoma multiforme with bone metastase and cauda equina syndrome

Remote metastases, leptomeningeal dissemination and spreading of the tumor by infiltration are rare complications of glioblastoma multiforme. The existence of different forms of spreading simultaneously is very rare. We present a case of a young patient with glioblastoma multiforme who was operated and subsequently received radiation therapy and cytotoxic treatment. Eight months following the operation, the patient developed cauda equina syndrome. Bone metastases of vertebrae and ribs, and direct infiltration of the recurrent tumor mass into the ethmoidal and frontal sinuses were found. The described patient demonstrates a very rare combination of all forms of spreading metastases in glioblastoma multiforme. The infiltration of the tumor mass into the sinuses and the direct permeation of the meningeal and dural venous system and of the leptomeninges, may explain the mechanism of the development of distant metastases and leptomeningeal dissemination in glioblastoma multiforme.

Individualised instruction, congruent authority structure and student outcomes

Measures of formal and informal authority structure were employed in order to assess academic and non-academic outcomes of individualised instruction. A sample of 386 fourth and fifth-grade elementary school children studying in nine individualised and 10 traditional classes was employed. Thus academic outcomes of either method of instruction were found to be contingent on the congruence between formal and informal authority structure: higher achievement scores were obtained when individualisation as school policy was accompanied by teacher sharing of authority with pupils at the informal classroom level. Achievement in less individualised classes was higher when teacher did not extend decision-making opportunities to pupils. Non-academic pupil outcomes were generally unrelated to either formal or informal authority structure. Similarities and differences between these results and former findings are discussed in light of cross-cultural differences in classroom individualisation.

Characterization of the binding of alpha-bungarotoxin to bacterially expressed cholinergic binding sites

Bacterially expressed cDNA fragments of the alpha-subunit of the nicotinic acetylcholine receptor previously have been shown to bind alpha-bungarotoxin (Gershoni, J. M. (1987) Proc. Natl. Acad. Sci. U. S. A. 84, 4318-4321). Here, a novel system has been developed in which totally synthetic alpha-bungarotoxin binding sites are expressed in Escherichia coli transformants. The amino acid sequences, alpha 184-200 and alpha 184-196 of the Torpedo californica alpha-subunit of the nicotinic acetylcholine receptor were expressed as trpE fusion proteins via the expression vector pATH2 and a method for the enrichment of these fusion proteins is described. Quantitative analysis of toxin binding to the recombinant binding sites demonstrates that they bind toxin with affinities of KD = 2.5 X 10(-7) and 4.7 X 10(-6) M, respectively. Furthermore, the pharmacological profile of alpha 184-200 qualitatively reflects that of the intact receptor. These data not only indicate that the area of alpha 184-200 is an essential element of the cholinergic binding site but that residues alpha 197-200 contribute a point of contact between the receptor and alpha-bungarotoxin.

5-Hydroxytryptamine in platelets of torsion dystonia patients

In an effort to explore possible changes in 5-hydroxytryptamine (5-HT) metabolism in idiopathic torsion dystonia (ITD), platelets from patients were studied. Platelet 5-HT concentrations did not differ from those in matched controls. 5-HT uptake by the platelets was also studied, and the results demonstrated significantly higher Km values, but Vmax values were normal among patients. Inhibition by imipramine of 5-HT uptake by platelets taken from ITD patients was also normal. The therapeutic implications of the low affinity of 5-HT to its platelet receptors are discussed.

Circling behavior induced by phencyclidine in mice and its inhibition by naloxone

Phencyclidine (PCP), when given to mice, induces general hyperactivity and rapid circling, similar to that caused by morphine. These effects are partially antagonized by naloxone.