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11098627

[Cryptococcus species--etiological agents of zoonoses or sapronosis?].

Cryptococcus strains are doubtless the cause of a sapronosis which occurs worldwide as cryptococcosis in humans and warm-blooded animals. The etiological agent is Cryptococcus neoformans with the varieties neoformans and gattii. The infection proceeds from environmental sources and not from animals suffering from cryptococcosis. Therefore the designation as zooanthroponosis is not right. There is a correlation between the geographical distribution of the varieties of Cryptococcus neoformans in the environments and the clinical manifestation of cryptococcosis. The reservoir of var. neoformans, serotypes A and D, are worldwide pigeons and pet birds which are frequent healthy carriers. They excrete these yeasts with their excrements. Bird droppings favour the propagation of cryptococci in natural substrates. The cryptococcal infection arises from inhalation of contaminated dust. Variety gattii, serotype B, occurs mainly in tropical and subtropical climates and its environmental niche has been identified in Eucalyptus trees. Var. gattii was detected in the air and in decaying wood debris under the canopies of these trees. Serotype C was isolated once from almond trees in Colombia. Cryptococcoses in men caused by var. gattii are endemic in Australia, California, Brazil and other tropical and subtropical regions. Modern molecular typing procedures are available for studying ecological problems of cryptococci and epidemiological questions of cryptococcosis. Immunosuppressed individuals, especially HIV infected persons and AIDS patients, should avoid contact with pigeons and pet birds.

11098628

[Fourier transform infrared spectroscopy, molecular biologic methods and antimyocotic susceptibility patterns for identification and differentiation of cryptococcus species].

Molecular biological methods as well as the FTIR method allows the rapid, reliable and reproducible determination and identification of Cryptococcus species from human, veterinary and environmental origin and their serovars. The results obtained by FTIR could be verified by the molecular methods. In addition, with the PCR and FTIR fingerprinting methods it is possible to distinctly group the serovars and differentiate the different Cryptococcus strains.

11098629

[Yeasts of the genus Malassezia: taxonomic classification and significance in (veterinary and) clinical medicine].

The historical development of the taxonomic classification of Malassezia yeasts until today yielded the description of seven different species based upon molecularbiological, morphological and biochemical parameters (M. furfur, M. pachydermatis, M. sympodialis, M. globosa, M. obtusa, M. restricta, M. slooffiae). Tests like Cremophor EL assimilation, esculin degradation, catalase test, pigment production and determination of polidocanol sensitivity appear to be suitable procedures for routine identification of the different species. Their colonization of clinically healthy humans (in particular M. sympodialis, M. globosa, M. obtusa) and animals (M. pachydermatis) skin renders interpretation difficulties, when isolating Malassezia spp. from clinical specimens. Out of the seven species, in man the clinical significance of M. furfur for pityriasis versicolor and systemic infections appears to be accepted largely. In dogs and cats M. pachydermatis has been regarded as cause of otitis externa and seborrhoeic dermatitis. But, due to geno- and phenotypic variabilities described for M. pachydermatis field isolates further investigations concerning the taxonomic uniformity of the species are necessary.

11098630

[Mycologic investigation of foodstuff].

This munication presents a review on the work of the mycological laboratory of the Institute of Microbiology and Epidemics, Hannover, Germany, concerning the mycological investigation on feeding stuff. Out of the routine diagnostic work, examining more than 4000 probes in the last 10 years, some selected investigations on scientific questions will be mentioned. Different subjects as the influence of homogenisation of feeding stuff on the mycological evidence rate, the microbiological status of germinating feeding stuff for pet birds the contamination of wheat with Fusarium spp. after fungicidal treatment will be discussed. Out of the great number of diagnostic investigations the most often examined feeding stuffs, those for pigs, will be looked at more closely. The evidence rate of yeasts and moulds and the number of isolated fungi are demonstrated.

11098631

[Mycoses in fish].

Over 4 years 1.241 fish were examined mycologically. In 182 (14.7%) of them positive results were obtained. Most of the isolates belonged to the following genera: Cladosporium, Saprolegnia, Candida and Penicillium. Fungal infections were correlated with findings of Saprolegnia, Branchiomyces, Pythium, Ichtyophonus and sometimes Cladosporium. Most fungal isolates were etiologically irrelevant for diseases or death.

11098632

[Relevance of mycotoxin contaminated feed for farm animals and carryover of mycotoxins to food of animal origin].

Contaminated feed is the main source for mycotoxin infestation of farm animals. The oral intake of fungal metabolites with feed results in a negative impact on all relevant parameters of animal production. Moreover, under experimental conditions mycotoxins and/or their metabolites can be traced in meat, edible tissues, milk and eggs. However due to the high concentrations of toxins involved, such findings are rare in the daily practice. In Germany today only aflatoxins (aflatoxin M1 in milk) and ochratoxin A (in blood, meat and edible tissues from swine) are of practical relevance from the view of food hygiene and food safety. Other mycotoxins at present discussed like toxins of Fusaria (trichothecenes, zearaleone, fumonisins) and ergot alkaloids are of no importance as possible contaminants in food from animal origin although they could have a negative impact on animal production.

11098633

Radiation-induced diffuse brain injury in the neonatal rat model--radiation-induced apoptosis of oligodendrocytes.

The mechanism of radiation-induced diffuse brain injury was investigated using a model of delayed myelination in the irradiated neonatal rat brain in which the number of oligodendrocytes decreases without associated necrosis of the cerebral white matter. Immunohistochemical analysis using antibody against the large myelin-associated glycoprotein, a specific marker of oligodendrocytes at an early stage of development, showed that the number of the oligodendrocytes associated with myelination decreased in the irradiated hemisphere 1 day after irradiation and remained low until 5 days after irradiation. In situ terminal deoxynucleotidyl transferase-mediated nick end-labeling assay revealed that apoptosis mainly occurred in the cerebral white matter of the irradiated hemisphere. Three hours after irradiation, apoptotic cells were found in the subcortical white matter and the periventricular white matter. Six hours after irradiation, apoptotic cells were found in the internal capsule, and the numbers of apoptotic cells in the periventricular white matter and subcortical white matter increased. One day after irradiation, the number of apoptotic cells in the periventricular white matter decreased. Three days after irradiation, apoptotic cells were not observed in the cerebral white matter. These results suggest that the oligodendrocytes associated with myelination may be damaged via radiation-induced apoptosis, and depletion of the oligodendrocytes may cause delay of myelination.

11098634

Can continuous intraoperative facial electromyography predict facial nerve function following cerebellopontine angle surgery?

Intraoperative cranial nerve monitoring has significantly improved the preservation of facial nerve function following surgery in the cerebellopontine angle (CPA). Facial electromyography (EMG) was performed in 60 patients during CPA surgery. Pairs of needle electrodes were placed subdermally in the orbicularis oris and orbicularis oculi muscles. The duration of facial EMG activity was noted. Facial EMG potentials occurring in response to mechanical or metabolic irritation of the corresponding nerve were made audible by a loudspeaker. Immediate (4-7 days after tumor excision) and late (6 months after surgery) facial nerve function was assessed on a modified House-Brackmann scale. Late facial nerve function was good (House-Brackmann 1-2) in 29 of 60 patients, fair (House-Brackmann 3-4) in 14, and poor (House-Brackmann 5-6) in 17. Postmanipulation facial EMG activity exceeding 5 minutes in 15 patients was associated with poor late function in five, fair function in six, and good function in four cases. Postmanipulation facial EMG activity of 2-5 minutes in 30 patients was associated with good late facial nerve function in 20, fair in eight, and poor in two. The loss of facial EMG activity observed in 10 patients was always followed by poor function. Facial nerve function was preserved postoperatively in all five patients in whom facial EMG activity lasted less than 2 minutes. Facial EMG is a sensitive method for identifying the facial nerve during surgery in the CPA. EMG bursts are a very reliable indicator of intraoperative facial nerve manipulation, but the duration of these bursts do not necessarily correlate with short- or long-term facial nerve function despite the fact that burst duration reflects the severity of mechanical aggression to the facial nerve.

11098636

Ruptured aneurysm at the origin of the median artery of the corpus callosum associated with accessory middle cerebral artery--case report.

A 62-year-old male presented with ruptured municating artery (ACoA) aneurysm manifesting as severe headache associated with the bination of median artery of the corpus callosum (MACC) and accessory middle cerebral artery (MCA). Computed tomography demonstrated diffuse subarachnoid hemorrhage. Left carotid angiography demonstrated an anomalous vessel originating from the plex and passing forward in the interhemispheric fissure between the panion A2 segments. This vessel was identified as the MACC. Another anomalous vessel originated from the left A1-A2 segment and passed into the sylvian fissure. This vessel was identified as the accessory MCA. Left frontotemporal craniotomy was performed to clip the neck of the aneurysm. After identifying both A1 and A2 segments, accessory MCA, and the MACC, the aneurysm neck was occluded successfully. The plex is one of the most frequent sites of vascular anomalies. Preoperative and intraoperative care is required to identify the presence of anomalies of the plex prior to clip placement, to avoid accidental damage or clipping, which may result in severe neurological deficits.

11098635

Recovery from Duret hemorrhage: a rare complication after craniotomy--case report.

A 44-year-old female presented with Duret hemorrhage due to transtentorial herniation by extradural hematoma as plication after craniotomy for treatment of spontaneous middle cranial fossa cerebrospinal fluid leakage through the oval window. puted tomography revealed linear hemorrhage in the midbrain and the rostral pons. She awoke after 2 weeks in a, despite showing ocular bobbing and bilateral intranuclear ophthalmoplegia. She was discharged from the hospital with minimal neurological defects. Duret hemorrhage is usually fatal, but this case shows that early surgical pression is the most important factor to avoid the worst sequelae.

11098637

Endovascular treatment of basilar tip aneurysm associated with moyamoya disease--case report.

A 58-year-old female was admitted unconscious to a local hospital. Computed tomography demonstrated subarachnoid hemorrhage. Cerebral angiography revealed evidence of moyamoya disease and a saccular aneurysm at the tip of the basilar artery. The patient was transferred to our hospital for embolization of the basilar tip aneurysm. Endovascular embolization was performed using Guglielmi detachable coils (GDCs), and the aneurysm pletely occluded with preservation of the parent artery. No change in the patient's neurological status was seen during and after the procedure. Endovascular treatment using GDCs appears to be particularly suitable for ruptured cerebral saccular aneurysms in patients with moyamoya disease.

11098638

Correlation of magnetic resonance imaging and histological findings in a large basilar tip aneurysm after coil embolization--case report.

A 73-year-old female with a large basilar tip aneurysm underwent endovascular coil embolization with interlocking detachable coils (IDCs). The patient subsequently died of pneumonia 25 days after the embolization, and the aneurysm specimen was obtained at autopsy. Histological examination showed that the intraaneurysmal structure consisted of three layers. The outer layer was mildly organized thrombus surrounding the coils, the middle layer was disorganized clot, and the inner layer consisted of fresh blood clot. Gradient-echo magnetic resonance (MR) imaging taken before death had demonstrated a central region of high intensity and a peripheral low intensity region corresponding to the inner and middle-outer layers of the aneurysm, respectively. Intraaneurysmal placement of IDCs leads to the formation of a clot surrounding the coils. However, clot formation may be inadequate where the packing of the IDCs is plete. Comparison of the MR imaging and histological findings in this case show that gradient-echo MR imaging can assess thrombus and residual blood flow within the aneurysm.

11098639

Restoration of hearing with an auditory brainstem implant in a patient with neurofibromatosis type 2--case report.

A 25-year-old male with neurofibromatosis type 2 had hearing restored with an auditory brainstem implant (ABI) after removal of an acoustic schwannoma. The ABI allows the patient to discern many different environment sounds and is a significant adjunct to lip-reading, enabling conversation with people who have clear pronunciation without the necessity for writing.

11098640

Huge facial schwannoma extending into the middle cranial fossa and cerebellopontine angle without facial nerve palsy--case report.

A 46-year-old male presented with a huge facial schwannoma extending into both the middle cranial fossa and the cerebellopontine angle but without manifesting facial nerve palsy. Neurological examination on admission revealed no deficits except for speech disturbance. Computed tomography showed a multicystic tumor extending into the middle cranial fossa and the cerebellopontine angle, with destruction of the petrous bone. The tumor was totally grossly removed. Histological examination identified schwannoma. Total facial nerve palsy appeared postoperatively, but hearing acuity was preserved at a useful level. Facial nerve palsy is one of the most typical symptoms in patients with facial schwannoma, but is not always manifested even if the tumor extends into both the middle cranial fossa and the cerebellopontine angle.

11098641

Langerhans cell histiocytosis limited to the pituitary-hypothalamic axis--two case reports.

Langerhans cell histiocytosis rarely presents as a solitary lesion in the pituitary-hypothalamic region, and is indistinguishable from germinoma, which occurs much more frequently, especially in Japanese. A 14-year-old girl and a 9-year-old girl presented with polydipsia and polyuria as the initial symptoms. Magnetic resonance (MR) imaging demonstrated a round mass at the pituitary stalk appearing as isointense on T1-weighted imaging and hyperintense on T2-weighted imaging. Endocrinological examination revealed mild hypopituitarism with central diabetes insipidus. Both patients underwent open craniotomy. Histological examination revealed granulomatous tissue with eosinophil infiltration and frequent Langerhans histiocyte patible with the diagnosis of Langerhans cell histiocytosis. Low-dose local irradiation of 20 Gy was administered. First patient was followed up for 8 years, and her hypopituitarism gradually improved to a minimal level with only amenorrhea as the residual symptom. Recent MR imaging showed no residual mass at the region. Second patient was followed up for 15 months, and her diabetes insipidus is stable. MR imaging performed 5 months after the treatment showed marked reduction of the mass. These cases reemphasize the importance of histological diagnosis for lesions with similar neuroimaging appearances. Biopsy and low-dose irradiation are an effective treatment for this rare and essentially benign lesion, as opposed to attempting total removal of the mass.

11098642

Interhemispheric glioependymal cyst associated with agenesis of the corpus callosum--case report.

A male neonate was admitted because prenatal ultrasonography indicated central nervous system abnormalities. Neurological examination showed no abnormality except for electroencephalographic spike activities. Magnetic resonance imaging revealed a cystic lesion in the left interhemispheric fissure, agenesis of the corpus callosum, and microgyria in the left frontotemporal lobes. Cerebral blood flow (CBF) was diffusely reduced. The cyst wall was partially removed and a cyst-peritoneal shunt procedure was performed. The histological diagnosis was glioependymal cyst. The spike activity disappeared and CBF dramatically improved after the operation.

11098644

["Reading-your-baby lessons" for parents of excessively crying infants--the concept of "guided parent-infant training sessions"].

New findings indicate that persistent crying (infantile "colic") may be closely interlinked with regulatory difficulties in the organization of sleep and waking states and in sustaining prolonged episodes of uninterrupted sleep. It has been shown that munication plays a significant role in the regulation of infant states and in the prevention of infantile persistent crying. However, parents are usually unaware of these explanations, and tend to attribute the crying to inappropriate causes or have no understanding at all about why their child cries so much. Therefore, the baby's signals are not answered in an effective way. In this article "guided parent-infant-training sessions", a new treatment method for parents with excessively crying babies, will be introduced. It is the goal of this approach to help parents to improve the "reading" of their child's signals and to act according to the baby's needs. In order to provide an opportunity for training, parents are given their appointment at a time, when it is most likely for the child to cry. In the context of a therapeutic relationship they may be experiencing for the first time calming a baby they previously thought to be inconsolable.

11098645

[Early appearance and intergenerational transmission of maternal traumatization within the context of mother-infant interaction].

At the age of 9 weeks a girl was presented by her mother because of intolerable hysterical attacks' triggering maternal impulses of abuse. Maternal perception of her infant was distorted to the extent that the mother was reexperiencing encounters with her own intrusive and traumatizing mother in the face of her screaming child. She also perceived the infant's motor impulses as physical transgressions against herself and expressed intense anxieties about her daughter's future aggressive potential. The infant was viewed by her mother as extraordinarily and dangerously greedy. Even neutral infantile vocalizations were perceived as manipulating and sadistic. She tried to ward off these anxieties by employing a rigid scheme of rules and obsessively controlling the father's and grandmother's interaction with the child. The mother feared to be overwhelmed by the infant's needs if she'd yield to them in a flexible way. A background of early neglect and trauma experienced by the mother is illustrated considering recent literature about early intergenerational transmission of traumatic experiences in order to demonstrate treatment modalities in view of protective and risk factors.

11098646

[Counseling of families with two- to three-year old children].

In this paper, we present the counselling practice in parents with two- or three-year-old children. In most of the cases, the presented children are suffering from separation anxiety or behavioral disturbances. It is either a problem of infants who cling to their mothers and who avoid unfamiliar situations or of children e into conflicts with their parents because of their oppositional behavior. The basis for our diagnostic and therapeutic procedure is a model of the relationship disturbances in the parents-child-system which is concentrated on the dimensions attachment/intimacy and autonomy/differentiation. These two dimensions are to be understood as a pair of scales loaded by the parents with burdens of conscious and unconscious expectations and projections, thus influencing the balance of the two dimensions. Based on their own experiences parents may encourage or hinder attachment or autonomy in a manner which is inadequately stressing or too early. We present the typology of relationship disturbances and illustrate the diagnostic and therapeutic procedure by case examples.

11098647

[Clinical relevance of attachment theory for the psychotherapy of small children and their parents].

Since the beginning of the 1990s, the relevance of the attachment theory has gained increasing significance for psychotherapeutic practice. Due to the lack of empirical proof, the only feasible approach, for the time being, are conceptional deliberations, which, however, offer useful ideas for the practical work. Based on an case record obtained from the psychotherapeutic treatment of a 4-month-old suckling and his parents, this article attempts to discuss the incorporation of attachment-theoretical concepts into infant-parent psychotherapy. Infant-parent psychotherapy constitutes a treatment method which, on the initiative of Mechthild Papousek, founder of the "Munich interdisciplinary intervention Program", has enjoyed larger-scale dissemination and deals with regulatory disturbances in infancy. Irrespective of core symptoms and their etiology, regulatory disturbances often lead to impaired mother-child interactions and formation of secure attachment organization of the child. The observation of essential, attachment-relevant contents, such es, for instance, the child's attachment and exploratory behavior an the maternal sensitivity to signals emanating from the child gives rise to novel viewpoints regarding therapeutic interventions.

11098648

[Fathers in parent-infant psychotherapy].

This paper discusses the relative neglect of the role of the father by researchers and parent-infant psychotherapists. It goes on to describe reasons why the father's role is of developmental significance. Using clinical examples, it is suggested that it is often critical to ensure that fathers are included if the therapeutic work is to have the best chance of success. Two particular aspects of the father's contribution are considered, namely the direct influence that his own "ghosts" may exercise on the parent-infant relationship, and a slightly more indirect role that he may play as the other half of the parental couple.

11098649

[Use of video feedback in parent-infant counseling and psychotherapy].

Video-based observation and behavioral microanalyses have critically contributed to the international boom of infancy research in the early seventies. Video techniques have opened up a direct scientific access to the broad domains of intuitive behavior and thus to early integrative processes, self regulation, parenting, and munication. The exploratory potential of video based microanalyses may similarly promote innovative clinical approaches to preverbal processes and mechanisms of developmental psychopathology and disordered parent-infant relationships. The article review currently available video-based methods that are used in clinical diagnostics and parent-infant consultation and psychotherapy. The article is based on relevant international publications as well as on the Papouseks' use of behavioral microanalyses during three decades of joint basic research and almost ten years clinical experience from the Munich Interdisciplinary Research and Intervention Program for Fussy Baby's.

11098654

Diffusion of molecules in brain extracellular space: theory and experiment.

Volume transmission depends on the migration of informational substances through brain extracellular space (ECS) and almost always involves diffusion; basic concepts of diffusion are outlined from both the microscopic viewpoint based on random walks and the macroscopic viewpoint based on the solution of equations embodying Fick's Laws. In plex medium like the brain, diffusing molecules are constrained by the local volume fraction of the ECS and tortuosity, a measure of the hindrance imposed by cellular obstacles. Molecules can also experience varying degrees of uptake or clearance. Bulk flow and the extracellular matrix may also play a role. Examples of recent work on diffusion of tetramethylammonium (molecular weight, 74) in brain slices, using iontophoretic application and ion-selective microelectrodes, are reviewed. In slices, the volume fraction is about 20% and tortuosity about 1.6, both similar to values found in the intact brain. Using integrative optical imaging, results obtained with dextrans and albumins up to a molecular weight of 70,000 are summarized, for such large molecules the tortuosity is about 2.3. Experiments using synthetic long-chain PHPMA polymers up to 1,000,000 molecular weight show that these molecules also diffuse in the ECS but with a tortuosity of about 1.6. Studies with osmotic challenge show that volume fraction and tortuosity do not vary together as expected when the size of the ECS changes; a model is presented that explains the osmotic-challenge on the basis of changes in cell shape. Finally, new analytical insights are provided into plex movement of potassium in the brain.

11098696

Concepts of pain mechanisms: the contribution of functional imaging of the human brain.

Functional imaging of the conscious human brain has a solid physiological basis in synaptically induced rCBF responses. We still do not know how these responses are generated, but recent studies have shown that the rCBF response is parametrically positively correlated with functional measures of neuronal activity. Technical advances in both fMRI and PET imaging have improved the spatial and temporal resolution of imaging methods. Further advances may be expected in the near future. Consequently, we now have an important tool to apply to the study of normal and, most importantly, pathological pain. There is a tendency to expect too much of this exciting technique, but the problems we wish to address plex and will require considerable time, effort, and patience. We now know that the CNS adapts to both peripheral and central nervous system injury, sometimes in beneficial ways, but sometimes with reorganization that is maladaptive. An understanding of the pathophysiology of neuropathic pain is plicated by the new knowledge, emphasized by functional brain imaging, that pain and pain modulation is mediated, not by a simple pathway with one or a few central targets, but by a network of multiple interacting modules of neuronal activity. Simplified phrenological thinking, plete psychological functions separate and localized, is appealing, but wildly misleading. It is far more realistic and productive to apply qualitative and quantitative spatial and temporal analyses to the distributed activity of the municating human brain. This will not be quick and easy, but there is every reason for optimism in our search for a thorough and useful understanding of both normal and pathological pain.

11098718

More than cholesterol: the complexity of coronary artery disease.

There have been many recent articles published that emphasize the fact that cholesterol deposits are only one of many mechanisms through which acute coronary artery disease develops. Recently, a meta-analysis shows that only 14% of acute coronary events occur in stenotic lesions in coronary arteries that are greater than 70% occluded. The majority of acute coronary events (68%) occur in coronary arteries that have less than 50% stenotic lesions. The acute coronary syndrome is a plex and unpredictable disease. Recent information now points to the endothelium as a modulating factor in the pathogenesis of coronary artery disease through the production of nitric oxide and angiotensin-II which maintain the homeostatic environment influencing the progression of coronary artery disease. With dysfunctional endothelium there seems to be an imbalance in terms of angiotensin production with regards to the nitric oxide production. This imbalance tends to promote coronary artery disease in individuals who have multiple risk factors. Furthermore, it has been suggested that certain pounds are produced in a very dysfunctional endothelium, thereby propagating or leading to acute coronary syndromes. Specifically, this includes C-reactive protein which promotes chronic inflammation at various sites. There are also other acute phase reactants, such as fibrinogen, which may play a role in atherogenesis. Certain statin drugs, as they are called, tend to ameliorate the levels of the above acute phase reactants, while other statins do not. This reduction of coronary events by statins is independent of the LDL lowering benefits from statin drugs. This article delineates some of the beneficial effects of the different statin agents and points out that all statins are not equal in terms of their known lipid beneficial effects. For the practicing physician, choosing a particular statin agent is important. Some have more drug/drug interaction potential pared with the others because of their inability to be metabolized through the cytochrome P450 system. There are also some, because of their lipophilic and hydrophilic nature, that tend to enter cells more readily than other statin agents. The effects conferred by these subtle differences among the currently available statins tend to be beneficial in patients with low to moderate levels of LDL cholesterol.

11098720

[The assessment of episodic memory: theory and practice].

Episodic memory refers to a system which stores personally experienced events located in time and in space. It is characterized by autonoetic consciousness allowing a subject to be aware of his/her own identity throughout subjective time and to perceive the present as both a continuation of his/her past and as a prelude to his/her future. Current studies of episodic memory should take into account all these features. However, most episodic memory tests are restricted to memory performance and do not really measure episodic memory. In this article, after defining the terms of context and states of awareness, we describe two original tasks designed specially to investigate episodic memory: the 'Quoi-Où-Quand' (What-Where-When) and the 'TEMPau'. The first task allows the study of anterograde amnesia whereas the second consists of an assessment of retrograde amnesia. These two tasks include both scores of memory performance and measures of states of awareness using a procedure derived from the Remember/Know paradigm.

11098723

[Memory: a functional imaging approach].

Functional imaging permits us to tackle in a better way one of the most noble functions of the human brain: memory. First of all, it is a way to validate the wide subdivisions proposed by cognitive psychology and clinical neuropsychology such as short-term memory/long-term memory dissociation, episodic memory/semantic memory dissociation and the distinction among working memory ponents. Moreover, functional imaging yields a new perspective on the global physiology of the brain. It makes it possible to propose new relationships that are more or less reciprocal between cerebral structures and cognitive functions and raises new fundamental questions. Thus, its first goal is to answer precise questions in the framework of definite cognitive models and it offers the possibility of elaborating a new modelling conception. Finally, functional imaging is a potential tool for a predictive approach to memory functions in both normal subjects and patients.

11098721

[Working memory: a neuropsychologic and cerebral imagery approach].

The working memory model proposed by Baddeley and Hitch has frequently been used in cognitive psychology and neuropsychological studies. This model consists of several ponents, responsible for the storage and processing of the information stored in working memory. Many neuropsychological and functional imagery data are consistent with that formulation of working memory. Moreover, many cognitive tasks have been specifically designed to explore particular aspects of working memory functioning. Taken as a whole, these data confirm that the working memory model remains a useful theoretical framework to explore memory functioning both in normal subjects and in pathological conditions.

11098725

[Pharmacologic models of memory disorders in pathology].

Some drugs induce memory impairments that resemble those observed in neurological and psychiatric disorders. It has therefore been suggested that these drugs might be used as models of these disorders. The concepts and methods developed by cognitive neuropsychology to investigate memory impairments are analysed. The interest and limitations of pharmacological models are discussed and illustrated by the benzodiazepine model of organic amnesia. It is concluded that the validity of a pharmacological model has to be defined in terms of face, construct and predictive validity and assessed according to the aims of modelization.

11098722

Cellular and molecular approaches to memory storage.

There has been nearly a century of interest in the idea that information is stored in the brain as changes in the efficacy of synaptic connections on neurons that are activated during learning. The discovery and detailed report of the phenomenon generally known as long-term potentiation opened a new chapter in the study of synaptic plasticity in the vertebrate brain, and this form of synaptic plasticity has now e the dominant model in the search for the cellular bases of learning and memory. To date, considerable progress has been made in understanding the cellular and molecular mechanisms underlying synaptic plasticity and in identifying the neural systems which express it. In parallel, the hypothesis that the mechanisms underlying synaptic plasticity are activated during learning and serve learning and memory has gained much empirical support. Accumulating evidence suggests that the rapid activation of the genetic machinery is a key mechanism underlying the enduring modification of neural networks required for the laying down of memory. These advances are reviewed below.

11098724

[An animal model of human declarative (relational) memory and of its dysfunction].

The present work was aimed at determining, both at the psychological and at the neurobiological levels, aspects of rodent memory that fall into line with human declarative memory which is known to be selectively impaired in amnesic subjects and during the course of ageing. The ability pare and to contrast items in memory, and to support inferential use of memories in novel situations (flexibility), were considered to be the two key psychological features of human declarative memory that were altered by both hippocampal lesions and hippocampal dysfunction. Adult and aged mice were trained on learning tasks using two-stage paradigms, the aim of which was to assess memory performance through these two psychological aspects in the same subjects. Results suggest that ageing specifically impairs the ability to pare and contrast items in memory (declarative/relational memory based plex associations), without altering memory based on simple S-R associations (procedural memory). Hippocampal lesions in adult mice produced the same dissociation between relational memory (impaired) and procedural memory (spared). Pharmacological experiments showed that, depending on the drug used, the relational memory deficit of aged mice may be selectively reversed (i.e. without changes in procedural memory) and that the behavioural efficacy of certain treatments was shown to parallel their potency in re-establishing normal (i.e. adult) levels of hippocampal plasticity-related mechanisms. Together with previous findings, these results suggest that the storage and use of relational representations would critically depend on the plasticity of hippocampal synapses, which via their connections with cortical areas, would support the storage of associations between perceptual, behavioral and cognitive events.

11098728

[Pharmacologic treatment for cognitive disorders: an update].

Today, the memory is regarded as a network of memories which is sustained by distinct interconnected neuronal pathways. These diverse neuronal pathways are differentially impaired during cerebral ageing. Consequently, according to their molecular and cellular targets, cognitive enhancing therapies will be specifically applied to some neurodegenerative diseases or to age-related cognitive disorders. During recent decades, cognition enhancers have been devised in order to facilitate or to serve as substitutes for the effects of deficient neurotransmitters, particularly acetylcholine. These pharmacological approaches have allowed the proposition of acetylcholinesterase inhibitors and muscarinic agents. At present, these targets remain in progress but research is orientated on the discovery of nicotinic agents and acetylcholine releasers. Simultaneously, intense research activity has been undertaken around the other major systems of neurotransmission and/or neuromodulation such as the glutamatergic, monoaminergic and peptidergic pathways. Although research has always given precedence to symptomatic treatments (cognition enhancers) over organic treatments (neuroprotective agents), those are the subject of intensive research activity as they could be capable of counteracting the neuronal death and decrease of synaptic plasticity that occur during neurodegenerative diseases and ageing, respectively.

11098727

[Memory, aging and risk factors. Lessons from clinical trials and epidemiologic studies].

Memory troubles associated with age justify treatment and medical attention because they lead to real disabilities in daily living even without dementia, and also because they are early predictors of dementia in Alzheimer's Disease (AD). However, the treatment of these troubles remains uncertain, badly codified and extremely variable depending on the health systems concerned. Moreover, the dominant idea of many physicians, in the general population and even in health authorities, is that it is normal to have memory troubles in the elderly. This fact explains mon attitude of therapeutic nihilism. However, recent progress in the treatment of AD demonstrates that this disease should not be considered as an irremediable phenomenon. Moreover, on the basis of the follow up of an elderly cohort, it is possible to determine subjects at high risk of dementia where preventive interventions could be undertaken.

11098730

[Rehabilitation of memory disorders: objectives, strategies and evaluation].

Memory rehabilitation can be proposed to amnesic patients with mild or moderate isolated memory deficit and with some preserved ponents. It is necessary to study memory with global psychometric tests, specific memory examination and pragmatic study, and to have definite memory aims. The facilitating effects of mental imagery and mnemonic strategies, preserved learning pensatory aids were analysed.

11098729

[Memory: therapeutic approach. Clinical evaluation].

Memory assessment in pharmaceutical trials has to date been mainly performed in Alzheimer's disease. North American and European Medical Evaluating Agencies mend guidelines. Tests need to be simple and short, and sensitive enough to assess changes over a wide range of severity to avoid floor or ceiling effect. They require inter-rater reliability and face validity. They should be at least appropriate for different languages and culture, correlate well with universally accepted estimates of a function and have several parallel forms available to avoid a training effect. Memory is assessed with sub-tests posite scales assessing a number of cognitive functions including episodic memory. The ADAS-Cog has e the standard instrument since it was used for the approval of tacrine and other cholinesterase inhibitors. Some studies have assessed more specifically different sub-systems of memory. However, autobiographical, remote or prospective memory, as well as metamemory, has not been explored in pharmaceutical trials.

11098733

[Public health networks: practical aspects and contribution to clinical research. Round table no. 2. XV].

A public health network involves several and different health professionals who work in synergy to achieve mon objective: to improve the management of a given disease. Per se, this objective could not be achieved by each of these professionals if working separately. In practice, existing public health networks ensue from very different legal frameworks e up against various impediments. They have been developed mainly for the management of chronic and serious diseases (e.g. asthma, diabetes, virus C hepatitis, Parkinson's disease, drug abuse). Public health networks can be a very valuable source of data for clinical and epidemiological research, mainly because patients are followed up over a very long period and ing from various health professionals (general practitioners, specialists, nurses, etc.) is centralized and recorded in mon database. It can also be useful for pharmacovigilance purposes (assessment of Type A and delayed reactions). In any case, the relative interest of such networks should be regularly assessed by an ad hoc methodology, e.g. an experimental or pseudo-experimental design vs. a reference. Despite the fact that there are relatively few operational networks, they can be of great interest for clinical research.

11098731

[Connectionist models of memory].

Even puter science, at its birth, had strong links with the neurosciences, it is today mainly oriented toward efficiency and robustness. For example, memory in puter has few relationships with memory in a living being. Nevertheless, some domains puter science are interested in this kind of modelling. In particular, connectionism, whose goal is to elaborate artificial neural networks, uses a formalism for its calculus inspired from calculus in the brain. Different kinds of memory that can be emulated by artificial neural networks, inspired by statistics or biology, are presented here. Their relationships with human memory are discussed together with their tentative interest for the biologist or the therapist.

11098734

[Self-medication: Is regulation needed...from whom?].

The participants attending the 1999 French Clinical Pharmacological meeting in Giens eventually reached a consensus about the necessity to set up a clear policy regarding self-medication products in France. Despite a wish by French people to take more responsibility for their own health care, self-medication products' use and development in France have been held back for many years for the reasons reported below. However, self-medication could be developed while respecting or even improving public health care by applying the following key principles: (1) the acknowledgement of a consensual definition. 'A self-medication drug is a drug (the guarantees for which are provided by marketing authorization approval and dispensation and advice of a pharmacist) specifically suitable for use without any physician's prescription'; (2) the advertising of self-medication products to the general public is authorized; (3) the safe use of self-medication products is linked to the selected indications and the relevance of the information provided to the general public; (4) the self-medication drug approval procedure could be simplified, managed by a specific AFSSAPS unit; (5) the role of the pharmacist involved, as well as suitable pharmacovigilance, is mentioned; (6) more than 1000 previously marketed drugs without any clear status, the so called 'grey zone drugs', should be taken into consideration. According to the participants at the meeting, it is possible to set up a new clear and dynamic policy for self-medication products in France in conformity with EU requirements.

11098732

[Global cardiovascular risk: definition, evaluation and management strategies. Round table no. 1. XV].

The global cardiovascular risk is the probability of developing a cardiovascular disease within a defined period of time, taking into account several risk factors simultaneously. Born 50 years ago with the analytical epidemiology of cardiovascular diseases, this concept may be considered today as a potential prevention tool integrating the multifactorial aspect of these diseases. Its implementation in clinical practice raises numerous questions related to its estimation, practical use and consequences for the health system. This new approach to cardiovascular diseases does not aim to cure plaint but to try to avoid its appearance by means of restricting measures. This will modify the relationships between physician and patient and will imply major modifications of our treatment habits. For this strategy to be effective three main prerequisites are needed: management choices will have to be the result of a deal between the patient and the physician, the responsibility for decisions will be endorsed by both of them, and the actions should be maintained over time.

11098735

[Health foods: definitions, status, public health. Round table no. 4. XV].

'Alicaments' ('ali' for 'aliment' = 'food' in French, and 'cament' for medicament = drug), is an inappropriate term to designate a developing domain: functional foods, in other words health claims in nutrition. It is not easy to delineate the frontier between foods and drugs; this results in some regulatory problems. The key question is the evaluation of health claims. In this report, we synthesize the discussions of a workshop bringing together specialists from the food industry and nutritionists, scientists and representatives of public health departments.

11098739

[Scaphoid fractures--diagnosis, classification and therapy].

Herbert's classification of scaphoid fractures provides the underlying rationale for treatment according to the fracture type. A CT bone scan in the long axis of the scaphoid is the best means of differentiating between stable and unstable fractures. This is difficult from conventional X-rays due to the particular three-dimensional anatomy of the scaphoid. To avoid long-term plaster immobilization and to diminish the risk of a nonunion, unstable fractures of type B should be fixed operatively. With headless screws such as the Herbert screw, which are now available in a cannulated shape, the majority of scaphoid fractures of type B1 and B2 can be stabilized using minimally invasive procedures. Severely displaced fractures require the classical open palmar approach. Proximal pole fractures (B3) are best managed from the dorsal approach, using the Mini-Herbert screw. Stable fractures of type A2 can be treated conservatively in a below-elbow cast or, alternatively, stabilized percutaneously, which allows early mobilization.

11098726

[Animal models of amnesia of alcoholic origin: an amnesia without memory impairment].

Our studies show that chronic alcohol consumption (CAC) in Balb/c mice induces (1) a deficit of spontaneous but not effortful retrieval processes, and (2) a itant reduction of anxiety, suggesting a potential interaction between emotional and memory disorders. We have shown that the benzodiazepine agonist, diazepam, induces memory deficits similar to those produced by CAC, whereas administering beta CCM (an inverse agonist of the benzodiazepine receptor) alleviated the memory deficits of alcohol-treated subjects. Parallel neuroanatomical studies have shown that CAC produced cell damage in the mamillary bodies, whereas no major changes were observed in the hippocampus or the frontal cortex, which is involved in long-term consolidation processes. Overall data show that CAC induced amnesia is not due to a dysfunction of the neural networks underlying memory storage processes, but rather results from a difficulty in activating the neural substrates engaged in retrieval processes which depend on emotional, motivational or environmental factors.

11098740

[Implant positioning in epiphysiolysis capitis femoris. Sequelae of poor outcome and consequences].

Which consequences can be ascribed to the intraarticular position of devices in the operative treatment of a slipped capital femoral epiphysis? Which steps are to define as a standard of a careful procedure? The clinical and radiological results of five cases of a pin or nail penetration after the operative treatment of a slipped capital femoral epiphysis are described, a possible connection of casualties is investigated. The intraarticular position of devices in most cases goes along with an unfortunate clinical e and leads to a higher risk of developing chondrolysis. Because of the radiologic overprojection with the femoral head it is possible to oversee the malposition of the pin. Any operative treatment of a slipped capital femoral epiphysis requires a careful intraoperative X-ray bined with documentation. With this procedure the bad results of an intraarticular implant position must be ascribed to the reminding risk of a fateful development.

11098737

[Drug-drug interactions: predictive in vitro models of in vivo interactions. Round table no. 6.XV].

Liver drug metabolism is a major source of drug interactions. Three major human in vitro models are employed to detect drug interactions in the preclinical phases of drug development: binant enzymes, human liver microsomes and primary human hepatocyte cell cultures. Results obtained from these models may vary during the different phases of drug development. Identification of the metabolic pathways, enzymes involved in drug metabolism (mainly cytochrome P450s), enzyme induction or inhibition allow us to detect the major pharmacokinetic drug interactions which can occur in man and to identify specific populations at risk for such interactions. In vitro models are essential to decide if and which future drug interaction studies should be performed in man. However, the clinical relevance of the potential pharmacokinetic drug interactions detected by these in vitro models remains to be determined and confirmed by human studies.

11098741

[Distal radius fracture--is non-bridging articular external fixator a therapeutic alternative? A prospective randomized study].

A randomised prospective study was carried out pare non-bridging external fixation using a small A0 external fixator with percutaneous Kirschner wire fixation and plaster in the treatment of distal radial fractures (A2/A3 in the A0 classification). The study involved 40 patients, 20 in each group. The advantages of the non-bridging fixation are: (1) early functional therapy of the wrist, (2) simplified reduction of the fracture, and (3) considerable less restriction of wrist mobility in day-to-day situations. Although the final examination 6 months after treatment showed almost identical functional results, the patients treated with the external fixator benefited from the fact that use of the wrist was virtually free throughout the entire treatment period.

11098742

[Traumatic sternoclavicular instability. A therapeutic alternative].

Traumatic instability of the sternoclavicular joint is a rare diagnosis. It is usually treated by different bandaging techniques without the possibility of early functional aftercare. In the period between 1 January 1996 and 31 December 1998, a total of eight patients with unstable sternoclavicular joints requiring surgical treatment were treated with Balser plates. The prised seven anterior and one posterior dislocations. The results achieved with this alternative treatment option, which offers the advantage of enabling early functional aftercare, are presented. Seven of eight patients were available for follow-up. The eighth patient moved from the area. The Constant Score ranged between 84 and 100 points (average 89 +/- 6.6).

11098743

[Mechanical behavior of Ilizarov ring fixators. Effect of frame parameters on stiffness and consequences for clinical use].

Using a mechanical testing procedure, various fixator constructs were tested in vitro. In addition, the influence of the passive soft tissue structures on the fixation stiffness was determined. An increased number of Schanz' screws or Kirschner wires led to parable increase in stiffness than that observed with an increasing screw or wire diameter. In consequence, larger diameters should be preferred over an additional screw or wire where clinically applicable. With diaphyseal telescoping rods only the axial stiffness decreased. As expected, large ring diameters as well as titanium wires reduced ponents. Bracing the outer rings caused a reduction of the overall stiffness. Asymmetric pre-tensioning of the K-wires resulted in a significant reduction of tension in the neighboring wire. Removal of the soft tissues reduced stiffness to a similar extend as experienced in a fibula defect situation. The study demonstrates the correlation between design parameters, passive soft tissues and fixation stiffness and presents guidelines for an optimized fixator design.

11098744

[5- to 8-year results of total hip endoprosthesis implantation with the Müller straight shaft prosthesis (cemented TiAlNb shaft)].

The aim of this study was to obtain mid-term results after total hip arthroplasty (THA) with cemented titanium stems. In all, 184 patients with a total of 202 THAs (cemented titanium stem) were clinically and radiologically examined after an average follow-up of 6 years (5-8). The recruitment was 86%. The Harris score was determined clinically. Radiologically, the directly postoperative radiographs pared to the control radiographs according to the mendations of Gruen et al. and Johnston et al. In 2 cases (1%) plications appeared after 2 years, which were treated in two-stage surgery. To date, revisions after loosening have been carried out in 3 cases (1.5%). This is equivalent to a revision rate of 2.5%. Three further cases showed evidence of loosening in more than 5 radiolucent lines (RLL), according to Gruen, making close-meshed controls necessary. Clinically, in all of the 6 cases of aseptic loosening, the Harris score remained above 80 points. In 36 cases, more than one pared to the postoperative radiographs, was ascertained and mainly found in zones 1, 7, 8, and 14. Substantial subsidence or varus could only be observed in one case. The clinical results in the Harris score were good or excellent in 78% and satisfactory in 20%. With an average of 75 at the time of follow-up, the age of the patients was, according to the indication that only patients above age 60 are to receive cemented-stem prostheses, clearly advanced. The body weight was significantly higher (82 kg; d = 2.4) in those 6 patients having evident RLL, than in patients without RLL. The ratio body weight to surface of the stem was especially different (1.5 kg/cm2 versus 1 kg/cm2; P < 0.005) in the two groups. This did not apply to sex or activity of the patient, size or kind of stem, Harris score, ectopic ossification, or body weight index. The biggest possible stem should be implanted. Not all cemented titanium stem prostheses are necessarily affected with a high rate of loosening at a mid-term follow-up.

11098745

[Conservative management of articular metacarpophalangeal joint fractures].

We present a splint system for a protected mobilization program after closed reduction of articular proximal phalangeal base fractures. This therapy consists of the periarticular soft tissue and functional anatomy. The soft-tissue around the base of the proximal phalanx leads to a circular stabilization effect. This so called Zancolli Complex (Metacarpophalangeal Retention Apparatus) can be used with the effect of a brace treatment. Treating 31 patients with articular fractures of the proximal phalanx way we found good functional results within a mean follow up period of 2 years after the accident.

11098746

[Arthroscopy of the upper ankle joint. A retrospective analysis of complications].

The purpose of this retrospective study was to analyse plications of our arthroscopic procedures at the ankle joint. In all patients we evaluated the treatment protocols and in 111 patients (79.3%) we also evaluated the clinical and radiologic results. All in all we have plications in 14 patients. In 4 cases we have seen a delayed wound healing, in 2 cases a superficial infection, in 3 cases a deep infection, in 3 cases a neural damage and in 2 cases a phlebothrombosis. Our study show, that plication rate could be minimized by detailed knowledge of the anatomy, exact preoperative diagnostic and planing of the operation and careful preparation of the portals. The use of a laser also shows a tendency to a plication rate.

11098736

[Evaluation of analgesics in children. Round table no. 5. XV].

Despite recent progress, childhood pain in France is still underevaluated and undertreated and its treatment very heterogeneous among clinicians and health care providers. Pain assessment is often a difficult task in this population. The ontogeny of nociceptive pathways, their maturation, and their functionality during development are pletely understood. Painful sensations primarily involve the child's own experience but can be modified, influenced by his/her parents and the psychosocial environment with their own experience of pain and anxiety. The use of analgesics cannot be precisely quantified using retail sales data. However, the 'Pediadol' survey has demonstrated that their use in children experiencing painful situations is definitely insufficient. Also, another survey conducted among pharmacists showed that at least one-third of analgesics approved for adults are not licensed for paediatric use, sometimes due to inadequate drug formulation. The situation is even more critical for young infants and neonates for whom there are even fewer available approved analgesics. A number of issues need to be addressed in order to improve pain management in children. First of all, evaluation of pain should be generalized. Auto-evaluation should be used in children over 6 years of age. Under 6 years, the initial step would be to further evaluate and validate hetero-evaluation scores. Second, analgesics should be evaluated in order to be licensed for paediatric use. When possible, data obtained in adults or older children should be used and studies in younger infants performed only when necessary. Finally it is of paramount importance to continue to increase paediatricians' and health care providers' awareness of the existence of pain in children and to train them to evaluate pain and treat it appropriately.

11098747

[Proprioception after reconstruction of the anterior cruciate ligament. Endoscopic vs. 2 tunnel technique].

ACL reconstruction with patellar tendon autograft is a standard procedure which can be performed arthroscopically with a femoral half tunnel drilled from the joint or using the two-tunnel technique with medial miniarthrotomy and additional femoral approach. The arthroscopic procedure with single incision was supposed to increase stability and to improve proprioception by earlier rehabilitation. 29 patients with ACL deficiency were included in the study. 15 patients were treated endoscopically, 14 patients by using the two-tunnel technique. Proprioception, Lysholm and Tegner scores as well as stability (KT-1000) were assessed preoperatively, 3 and 6 months postoperatively. A deficit of proprioception was assessed in either group preoperatively, which could be improved after 3 months only in the arthroscopic group. 6 months postoperatively, either group showed a restitution of proprioception near full extension and full flexion of the knee. In the mid range position, the proprioception could not be restored. There were no differences in stability and the Lysholm and Tegner scores between the groups after 6 months postoperatively. parison between the patients with acute and chronic instability shows a better proprioception in the acute group in the mid range position 6 months after the reconstruction.

11098749

[Soft tissue reconstruction after scalping injury caused by a dog bite].

The reconstruction of soft-tissue damage on the part of the head which is covered with hair is aimed not only at repairing the damage in such a way that it will withstand mechanical strain but also at the restoring the hair on the scalp. In a 5-year-old boy with a scalping injury involving second- and third-degree soft-tissue damage over an area of 20 x 12 cm after a dog bite, surgery was initially performed to transform the damage into purely second-degree damage, which was then repaired with a split skin graft. One year later, the scalp containing the hair was stretched with the aid of two skin expanders over a period of 3 months, so that the split skin graft area could be removed and the hair on the scalp restored.

11098750

[Delayed diagnosis of odontoid fracture after whiplash trauma of the cervical spine].

Fractures of the odontoid process represent about 10-20% of all diagnosed cervical spine fractures. Approximately 35% of these fractures are classified as Type II according to Anderson and D'Alonzo. They can be potentially unstable especially bined with a dens displacement of over 6 mm. In severe cervical spine trauma, these fractures do not usually cause difficulties in diagnosis. However, in whiplash injuries, which are mon and only rarely associated with such fractures, the surgical management can plicated if they are underestimated. These patients can present without significant neurological deficits or the situation can plicated due to intoxication or additional trauma. Under these circumstances in particular, the diagnosis can be delayed or missed, if no strict protocols for diagnostic effort in all whiplash injuries are employed. A case of delayed diagnosis of an odontoid fracture in a neurological asymptomatic patient after whiplash injury is presented.

11098751

[Chondroblastoma of the patella with pathological fracture].

Chondroblastoma is a rare benign bone tumor of cartilaginous origin. The typical localization of a chondroblastoma is the epiphysis of long tubular bones--the patella is a very unusual site with an estimated occurrence of 2%. We report a case of a 16-year-old patient with a chondroblastoma of the patella associated with a pathologic fracture. Partial resection of the patella was performed. This is the sixth case in the literature that associates patellar chondroblastoma with fracture.

11098758

Renal anatomy. Endourologic considerations.

The general anatomy of the kidney as applied to minimally invasive surgery is described. The kidney morphometry, the spatial planes, and the perirenal coverings are presented. The kidney's relationship with the diaphragm, ribs, pleura, liver, spleen, and colon is described in importance of intrarenal access. The intrarenal anatomy is also described, based on a large series of three-dimensional endocasts. The anatomic relationships of the intrarenal vessels (arteries and veins) with the kidney collecting system are presented and discussed with respect to intrarenal access by puncture, for endopyelotomy and for nephron-sparing operations.

11098759

Renal physiology. Laparoscopic considerations.

Oliguria is a ponent of the physiologic effect of increased intra-abdominal or retroperitoneal pressure. The cause is multifactorial, emanating from vascular and pression, and is associated with systemic hormonal effects. Ureteral obstruction does not play a significant role. These changes are pressure-dependent and are usually not apparent until pressures reach 15 mm Hg or more. This effect is not associated with any histologic pathology or evidence of renal tubular damage. After the release of the pneumoperitoneum or pneumoretroperitoneum, the renal function and urine output return to normal with no long-term sequelae, even in patients with pre-existing renal disease. The entire operative team must understand the physiologic effects of CO2 insufflation, which allows appropriate intraoperative monitoring and management and minimizes intraoperative and plications.

11098760

Renal calculi. Percutaneous management.

Percutaneous nephrolithotomy has established indications and is performed with high success and minimal morbidity. Patients who have large or hard stones or stones associated with urinary obstruction are candidates for a percutaneous procedure. When the certainty of the final result is important, the patient should have a PNL. In general, the best treatment for SWL failure is not more SWL; such patients usually should have an endoscopic procedure.

11098761

Ureteropyeloscopic treatment of ureteral and intrarenal calculi.

Endoscopic lithotripsy is an essential part of the armamentarium at plete stone treatment center. It is first-line therapy plicated upper urinary tract calculi and for patients who fail primary extracorporeal shock wave lithotripsy. In the presented series, ureteroscopy is defined as a safe and particularly effective treatment for upper urinary tract calculi. Endoscope miniaturization, the Holmium laser, and refined surgical technique have positive results. Complications are less frequent today, even with in the plex large stone burdens being addressed in a retrograde ureteroscopic way.

11098763

Calyceal diverticula. Ureteroscopic management.

In selected cases, RIRS management of calyceal diverticula and its related problems has been shown to be more efficacious than ESWL monotherapy and avoids the plications and fort of percutaneous and laparoscopic procedures. The advent of the Holmium laser energy source, with innovations such as the flexible ureteroscope and the tipless stone basket, have expanded the role of RIRS in the management of calyceal diverticula and associated problems. Presently, RIRS is the initial treatment choice for the management of low to moderate stone burdens that are contained in calyceal diverticula or trapped behind any narrowed intrarenal segment (e.g., infundibular stenosis). If repair of the stenotic segment is not successful, thereby excluding stone treatment, then under the same anesthesia, the patient undergoes a percutaneous antegrade renal surgery. The authors feel that the percutaneous approach as a first choice is more suitable for posteriorly located diverticula with a large stone burden. In selected cases of anteriorly located diverticula with large stone burdens, the laparoscopic approach is more expedient.

11098762

Percutaneous management of caliceal diverticula.

The diagnosis of a caliceal diverticulum may be serendipitous or established owing to patient symptoms. Once the decision to treat a diverticulum has been made, a percutaneous approach should be considered. If stones are plete stone removal and obliteration of the diverticulum should be the goals of surgery. The authors prefer the direct puncture technique whenever possible to limit the risk for bleeding and to facilitate stone removal. Use of a percutaneous approach in properly selected patients affords high success rates and results in plications.

11098765

Renal cystic disease. Laparoscopic management.

Laparoscopy offers a safe and efficacious means of ablating symptomatic simple renal cysts while conferring the usual benefits of shorter hospital stay, quicker convalescence, and reduced postoperative pain, although no parison with open surgery has been performed. For plex renal cysts, laparoscopic exploration may spare the patient a morbid open operation to assess a cystic lesion of indeterminant risk. Although laparoscopic removal of kidneys with ADPKD remains a technically challenging exercise, centers of laparoscopic expertise have demonstrated the safety and feasibility of the procedure, thereby expanding the benefits of laparoscopic surgery to patients traditionally relegated to open surgical management.

11098764

Caliceal diverticulum and hydrocalyx. Laparoscopic management.

Laparoscopic treatment of caliceal diverticula or hydrocalyces is an excellent choice for anterior cavities without significant overlying renal parenchyma that are large or that have an endoscopically inaccessible neck and either a narrow neck or large stone burden.

11098766

Ureteropelvic junction obstruction. Retrograde endopyelotomy.

The modern day treatment of UPJO with retrograde endopyelotomy continues to evolve as experience and knowledge progress. Use of the straight lateral incision and selective use of spiral CT angiogram has refined treatment decisions with retrograde endopyelotomy further. The authors' decision-oriented approach offers guidelines for the practicing urologist. Ultimately, it is up to the urologist and the patient to select the best approach for each clinical scenario.

11098767

Percutaneous endopyelotomy.

Percutaneous endopyelotomy, introduced over 15 years ago, is a well-established alternative to open operative pyeloplasty for management of ureteropelvic junction (UPJ) obstruction. Although several variations of the technique have been described, the goal in all cases is to develop a full thickness incision though the obstructing proximal uretra that extends out to the peripyeloureteral fat and heals over an internal stent. Though a percutaneous endopyelotomy can be considered for almost any patient with primary or secondary UPJ obstruction, it is particularly valuable in the setting of upper tract stones that can then be managed simultaneously. This article reviews the indications, techniques, and es of percutaneous endopyelotomy.

11098768

Laparoscopic pyeloplasty.

Laparoscopic pyeloplasty must pared with open surgery in terms of efficacy and with endopyelotomy in terms of morbidity. All of the series published so far show that the results of laparoscopic pyeloplasty equal those of open surgery. Laparoscopy is associated with a lower morbidity; therefore, it is preferable to open surgery. The morbidity of endopyelotomy is also low, at least when it is performed in a retrograde fashion. The results of endopyelotomy are poor if UPJ obstruction is caused by crossing vessels. In addition, endopyelotomy in this clinical setting carries the risk of hemorrhage. Most adults with symptomatic UPJ obstruction present with crossing vessels at the UPJ. These patients benefit from laparoscopy, and endopyelotomy should be reserved for patients with true intrinsic stenoses. For this reason, preoperative investigation using contemporary imaging techniques is of crucial importance to be able to select the most appropriate surgical method for a given patient. Laparoscopic dismembered pyeloplasty is technically feasible but difficult. The authors prefer nondismembered techniques that yield equally good results in selected patients. Nondismembered pyeloplasty as described by Fenger is easy to perform and well suited for laparoscopy.

11098769

Laparoscopic radical nephrectomy for cancer.

Laparoscopic radical nephrectomy is a rapidly emerging technique for the treatment of renal cell carcinoma. Surgeons at multiple institutions have reported excellent technical results with this procedure, with encouraging safety and efficacy data and plication parable with the rates in open radical nephrectomy. Although debate continues regarding the pros and cons of the transperitoneal versus retroperitoneal approach and regarding morcellation versus intact specimen extraction, laparoscopic radical nephrectomy is beginning to approach standard-of-care status at select institutions for tumors less than 8 cm in size. Although generally accepted indications for laparoscopic radical nephrectomy include T1-T2N0M0 tumors, increasing experience and operator confidence have allowed expansion of these indications to include select patients with nodal disease, preoperatively staged level I renal vein thrombus, cytoreductive surgery before immunotherapy protocols, and the rare patient with a laterally directed locally invasive (pT4N0M0) renal cell carcinoma.

11098770

Laparoscopic partial nephrectomy. The European experience.

Laparoscopic partial nephrectomy is technically difficult but oncologically effective. The operation should be performed in centers with expertise. Hemostasis can be achieved using bipolar coagulation and fibrin glue-coated cellulose. Further studies will determine whether less invasive alternatives (focused ultrasound, cryotherapy) will meet the high standard of open (or laparoscopic) nephron-sparing surgery for small renal cell carcinoma.

11098771

Primary percutaneous approach to upper urinary tract transitional cell carcinoma.

The optimal approach to upper tract TCC remains to be redefined. A routine nephroureterectomy for every filling defect in the upper urinary system, even in the case of a normal contralateral kidney, constitutes an unnecessary mutilation in more than two thirds of the cases. Nephroureterectomy does not reduce the need for a long-term cystoscopic follow-up because of the high rate of bladder tumor recurrence that may happen years later after nephroureterectomy. Relying solely on radiography and cytology, lacking sensitivity and specificity, to mend a nephroureterectomy is against the principles of oncologic surgery, especially now that preoperative histologic proof is easy to obtain endoscopically promising cancer control. Ureteroscopy, rigid and flexible, provides plete assessment of the upper urinary system. Biopsy specimens taken with ureteroscopy may be sufficient for grading but less adequate for staging of the tumor. The authors reserve ureteroscopy for ureteral tumors and small (< 1.5 cm) single tumors of the renal pelvis. They approach large or multiple tumors of the renal pelvis percutaneously, in which a full histologic assessment is possible along with plete resection of the tumor. The decision on the therapeutic approach is made only after the final pathologic report is reviewed. Grade I and grade II superficial disease (Ta, T1) can be treated endoscopically with minimal morbidity and with an parable with the standard more invasive nephroureterectomy (Table 5). The indications for endourologic treatment in these cases can be extended safely beyond a solitary kidney or a high surgical risk to include any healthy individual with a normal contralateral kidney who is willing mit to a rigorous lifelong follow-up. Patients with grade II T1 lesions require a more vigilant follow-up. For grade III Ta disease, more caution should be exercised in selecting these patients for elective endourologic management. When criteria of good prognosis are found, such as absence of carcinoma in situ, presence of diploidy, low p53 expression and a single-tumor, endoscopic management can be offered [table: see text] with a closer follow-up and resorting always to immediate nephroureterectomy at the first evidence of upstaging. Because of the high incidence of recurrence and progression, elective endourologic management for grade III T1 tumors is not mended. Endoscopic conservative surgery still can be offered in the cases of a solitary kidney or chronic renal insufficiency or for poor surgical candidates. Patients with localized stages (T2, T3) TCC should be offered immediate nephroureterectomy. The authors do not expect adequate endoscopic extirpation with muscle invasive tumors. Although the tissue removed may include deep layers, deep resection is precluded by the thin renal pelvic wall and the associated risk for perforation. Patients with more extensive disease (T3, T4) have a bad prognosis regardless of the form of therapy. Achieving local control percutaneously while preserving as many nephrons as possible for the future chemotherapy can be a reasonable option.

11098772

Ureteroscopic management of patients with upper tract transitional cell carcinoma.

Endoscopic therapy for the management of upper urinary tract TCC is mainly indicated for patients with an anatomically or functionally solitary kidney, renal insufficiency, bilateral tumors, or severe orbidity. It may be a reasonable alternative to distal ureterectomy with bladder-cuff resection in individuals with low-grade superficial distal ureteral tumors. Although use of this approach has been suggested for treating standard patients with low-grade, low-stage collecting system tumors, this mendation should not be embraced until more supporting evidence is generated. The efficacy of adjuvant therapy for the prevention of recurrent or progressive disease needs to be defined. If current adjuvant strategies prove ineffective, alternative ones will need to be developed. It is anticipated that advancements in endoscopic technology will facilitate the performance of this type of surgery in the future.

11098773

Laparoscopic nephroureterectomy. A new standard for the surgical management of upper tract transitional cell cancer.

Laparoscopic nephroureterectomy for upper tract TCC still remains somewhat controversial. Unlike laparoscopic radical nephrectomy, which has e widely accepted, LNU is still in its earliest stages. Although there are obvious benefits for the patient who has LNU--less plications, less postoperative fort, a shorter hospital stay, a better cosmetic result, and a brief convalescence--there are significant concerns. The longer operative time creates a negative financial and professional inducement to learn this technique. Operative times need to fall into the 4-hour range or less to make the procedure cost-effective. Analysis of the efficacy of laparoscopic nephroureterectomy as a curative treatment modality is important. In the short-run, LNU seems to provide similar results to open nephroureterectomy for upper TCC. Although concerns over port site seeding, bladder recurrence, and intraperitoneal seeding have been voiced, these problems have not occurred. The higher incidence of local recurrence noted in the authors' series, however, is of concern and remains an unsettled issue. Despite these local recurrences, the overall cancer survival for a given grade and stage of upper tract TCC seem to be similar to survivals recorded after open nephroureterectomy. Still, the number of LNU cases remains small, and follow-up is brief. These patients need to be monitored closely, with follow-up CT scans over the next decade. The authors believe that there are still several significant hurdles standing in the path of LNU before it can e a widely accepted procedure. Issues of cost, training, and long-term efficacy must be answered definitively. To obtain these types of data, it will be necessary to create a multi-institutional, cooperative study to obtain sufficient numbers of patients with a more than 5-year follow-up on which to base future mendations.

11098774

Renal transplantation: laparoscopic live donor nephrectomy.

Laparoscopic nephrectomy is now performed at many centers worldwide. This technique for organ harvesting offers less postoperative pain, quicker convalescence, and an optimal cosmetic result pared with the traditional open approach. With experience, the laparoscopic technique is plished promise to donor safety or allograft function, plications parable with the rates in open historic series. Longer operative times and the need for disposable equipment result in greater hospital costs; however, the quicker convalescence permits patients to resume activity sooner, allowing marked cost savings for patients and employers. The laparoscopic technique is associated with a steep learning curve. Launching a successful laparoscopic living donor program requires a dedicated coordinated effort involving physicians, nurses, and hospital administration. The ultimate impact of this technique on the willingness of individuals to donate has not yet been determined.

11098775

Renal transplant complications. Minimally invasive management.

Advancements in endourology, laparoscopic urology, and interventional radiology continue to influence the contemporary management of renal plications. The successful implementation of these minimally invasive therapies significantly relies on careful patient selection; not all renal plications are suitable or amenable for this form of management--true for transplant plications and less so for other plications. With such a strategy, renal plications can be managed efficiently and effectively with these minimally invasive modalities to minimize further recipient morbidity while also minimizing potential risk to the recipient and for the renal allograft.

11098776

Renal surgery in the new millennium.

In the not too distant future, the minimally invasive renal surgeon will be able to practice an operation on a difficult case on a three-dimensional virtual reality simulator, providing all attributes of the real procedure. The patient's imaging studies will be imported into the simulator to better mimic particular anatomy. When confident enough of his or her skills, the surgeon will start operating on the patient using the same virtual reality simulator/telepresence surgery console system, which will permit the live surgery to be conducted by robots hundreds of miles away. The robots will manipulate miniature endoscopes or control minimally or noninvasive ablative technologies. Endoscopic/laparoscopic footage of the surgical procedure will be stored digitally in optical disks to be used later in telementoring of a surgery resident. All this and more will be possible in the not so distant third millennium.

11098777

Laparoscopic cryoablation of renal masses.

Laparoscopic cryoablation seems to be an effective treatment modality for small peripheral renal tumors. The technique is minimally invasive, has a rapid learning curve, results in minimal blood loss and morbidity, and, to date, has demonstrated precise reliable ablation of small renal neoplasms. Long-term follow-up is necessary to confirm the absence of local tumor recurrence or distant or port-site metastases.

11098778

Public health consequences among first responders to emergency events associated with illicit methamphetamine laboratories--selected states, 1996-1999.

Methamphetamine, a central nervous system stimulant, is manufactured in illicit laboratories using over-the-counter ingredients. Many of these ingredients are hazardous substances that when released from active or abandoned methamphetamine laboratories can place first responders at risk for serious injuries and death. In 16 states, the Agency for Toxic Substances and Disease Registry maintains the Hazardous Substances Emergency Events Surveillance (HSEES) system to collect and analyze data about the morbidity and mortality associated with hazardous substance-release events. Based on events reported to HSEES during 1996-1999, this report describes examples of events associated with illicit methamphetamine laboratories that resulted in injuries to first responders in three states, summarizes methamphetamine-laboratory events involving injured first responders, and suggests injury prevention methods to protect first responders.

11098779

Progress toward poliomyelitis eradication--Eastern Mediterranean Region, 1999-September 2000.

In 1988, the Regional Committee for the Eastern Mediterranean Region (EMR) of the World Health Organization (WHO) adopted a resolution to eradicate poliomyelitis from the region by 2000. Since then, substantial progress has been made in vaccination and surveillance and, by the end of the year, 19 of the 23 EMR countries are expected to have interrupted poliovirus transmission. This report summarizes progress toward this goal from January 1999 through September 2009.

11098780

Shortage of tetanus and diphtheria toxoids.

A temporary shortage of adult tetanus and diphtheria toxoids (Td) in the United States has resulted from two coincident situations: 1) a decrease in the number of lots released by Wyeth Lederle (Pearl River, New York), and 2) a temporary decrease in inventory of vaccine following routine maintenance activities at the production facilities by Aventis Pasteur (Swiftware, Pennsylvania) that lasted longer than anticipated. Approximately one half of the usual number of Td doses has been distributed this year. Although there have been no decreases in production of tetanus toxoid (TT), availability is low because of increased use during the Td shortage. On the basis of information provided by Aventis Pasteur, the Public Health Service expects vaccine supplies to be restored early in 2001. Until then, Aventis Pasteur will be limiting orders to assure the widest possible distribution of available doses.

11098781

Ischemic bandage injuries: a case series and review of the literature.

To determine the prognosis and distribution of ischemic injuries caused by inappropriate bandaging of the lower limb in dogs and cats.

11098783

Definition and determination of acetabular component orientation in cemented total hip arthroplasty.

To describe the spatial orientation of the cemented ponent in cemented total hip arthroplasty, based on a ventrodorsal and lateral radiographic projection of the pelvis.

11098782

Ureteral obstruction after ureteroneocystostomy in dogs assessed by technetium TC 99m diethylenetriamine pentaacetic acid (DTPA) scintigraphy.

To use technetium Tc 99m diethylenetriamine pentaacetic acid (99mTc-DTPA) renal scintigraphy to monitor ureteral obstruction after ureteroneocystostomy in a canine model of partial ureteral obstruction.

11098786

Ventral surgical approach to the caudal brain stem in dogs.

To develop a safe neurosurgical procedure that accessed the ventral pons and medulla of the dog primarily for the removal of brain stem neoplasms.

11098789

Realignment of the radius in canine antebrachial growth deformities treated with corrective osteotomy and bilateral (type II) external fixation.

To identify factors affecting radial alignment after oblique corrective osteotomy stabilized with a type II external fixator and to evaluate the results of this treatment for antebrachial growth deformities.

11098784

Acetabular component orientation as an indicator of implant luxation in cemented total hip arthroplasty.

To determine the sensitivity and specificity with which ponent angles of inclination and version could be used, alone or bination, to predict luxation of cemented total hip arthroplasties (THA).

11098787

Fertility of mares after unilateral laparoscopic tubal ligation.

To develop a technique for laparoscopic tubal (oviductal) ligation and to evaluate pregnancy rates for mares that ovulated ipsilateral or contralateral to the ligated oviduct.

11098785

Evaluation of risk factors for luxation after total hip replacement in dogs.

To identify risk factors for luxation after canine total hip replacement (THR).

11098788

The effects of methylprednisolone on normal and monocyte-conditioned medium-treated articular cartilage from dogs and horses.

To study in vitro (1) the dose-response relationships between proteoglycan metabolism in normal and corticosteroid-treated articular cartilage; (2) long-term proteoglycan metabolism after treatment of articular cartilage with corticosteroids; and (3) the effect of corticosteroids on proteoglycan metabolism in articular cartilage treated with monocyte-conditioned medium (MCM).

11098793

Disturbed functional brain interactions underlying deficient tactile object discrimination in Parkinson's disease.

Somatosensory discrimination of cuboid objects was studied in a group of healthy volunteers and patients with Parkinson's disease using regional cerebral blood flow (rCBF) measurements obtained with positron emission tomography (PET) and 15O labeled water [H2 15O]. A 6-[18F]-fluoro-L-dopa (FDOPA) PET scan demonstrated that the patients may be grouped into those with normal and those with abnormally lowA FDOPA uptake in the caudate nucleus. The categorical parisons revealed that task-induced rCBF increases were deficient in bilateral motor and sensory cortical areas in the Parkinson patients. Moreover, deficient rCBF increases were evident in the mesial and right dorsolateral prefrontal cortex for patients in a more advanced disease state, who showed low FDOPA uptake in the caudate nucleus. A ponent analysis (PCA), performed on the rCBF data, identified three patterns ponents, PCs) that differentiated patients from normals. The first PC represented a right-hemisphere dominant, bilateral group of brain areas known to be involved in tactile exploration. A second PC reflected a cortical-subcortical pattern of functional prising cortical areas important for working memory processes. The third group-differentiating PC revealed a pattern of functional interactions involving bilateral temporo-parieto-occipital association cortices, which was consistent with a hypothesized supramodal network necessary for object discrimination. In an additional subgroup analysis, greater expression of the third PC pattern predicted greater caudate FDOPA uptake in patients. Our neuroimaging data revealed a disturbance of distinct patterns of brain functional interactions related to the sensorimotor deficit in Parkinson's disease and to deficits of cognitive information processing deficits in the more advanced stage of Parkinson's disease.

11098790

Screw fixation in lag fashion of equine cadaveric metacarpal and metatarsal condylar bone specimens: a biomechanical comparison of shaft and cortex screws.

pare acute fixation stability and insertion effort of cortex bone screws with and without a shaft inserted in lag fashion in equine metacarpal (metatarsal, MC(T)III) bone.

11098791

Use of pelvic flexure biopsies to predict survival after large colon torsion in horses.

To determine if morphologic evaluation of intraoperative biopsies of the large colon could be used to accurately predict e in horses with large colon torsion.

11098794

What have Klingon letters and faces in common? An fMRI study on content-specific working memory systems.

Neuroimaging studies show that prefrontal, premotor, and parietal cortical regions are part of a working memory network that supports the active retention of information. In two experiments we used fMRI to examine whether prefrontal and posterior cortical areas are organized in a content-specific way for object and spatial working memory. Subjects performed a delayed matching-to-sample task modified to allow the examination of content-specific retention processes, independent of perceptual and decision-related processes. In Experiment 1, either unfamiliar geometrical objects (Klingon letters from an artificial alphabet unknown to the participants) or their spatial locations had to be memorized, whereas in Experiment 2, either unfamiliar faces or biological objects (butterflies) were actively memorized. All tasks activated a similar cortical network including posterior parietal (banks of the intraparietal sulcus), premotor (banks of the inferior precentral sulcus) and prefrontal regions (banks of the inferior frontal sulcus), and the presupplementary motor area (pre-SMA). For geometrical objects and faces for which strategic semantic processing can be assumed, this activation was larger in the left than in the right hemisphere, whereas a bilateral or right dominant distribution was obtained for butterflies and spatial locations. The present results do not support the process-specific or content-specific view of the role of the prefrontal cortex in working memory task. Rather, they suggest that the inferior prefrontal cortex houses nonmemonic strategic processing systems required for response selection and task management that can flexibly be used across a variety of tasks and informational domains.

11098796

Individual cortical current density reconstructions of the semantic N400 effect: using a generalized minimum norm model with different constraints (L1 and L2 norm).

Event-related brain potentials were recorded to study whether verbs and nouns activate topographically distinct cortical generators. Fifteen subjects performed a primed lexical decision task with verb/verb and noun/noun pairs. The relatedness between prime and target items was varied in three steps (unrelated, moderately, and strongly related) and the EEG was recorded from 124 scalp electrodes. The topography of cortical sources of the N400 effect was evaluated by standardized differences scores and by cortical current source estimates which were constrained by the individual MRI-determined cortex anatomy. A behavioral priming effect and a substantial N400 effect was found for both word categories. However, the topography of the grand average N400 effect of verbs and nouns did not differ, neither for raw nor for standardized amplitudes. Cortical current source estimates of the N400 effect revealed a very broad and scattered distribution of active locations with pronounced interindividual differences. Cortical current source estimates obtained with the L1-norm and L2-norm model, respectively, differed in the distribution of sources over the cortex but converged on the same "hot spots." The data give no indication that the N400 effect is generated by word category-specific networks which have a different topography. The marked individual differences are discussed with respect to the involved processes and the current source estimation procedures.

11098797

Evaluation of octree regional spatial normalization method for regional anatomical matching.

The goal of regional spatial normalization is to remove anatomical differences between individual three-dimensional (3D) brain images by warping them to match features of a standard brain atlas. Processing to fit features at the limiting resolution of a 3D MR image volume putationally intensive, limiting the broad use of full-resolution regional spatial normalization. In Kochunov et al. (1999: Neuro-Image 10:724-737), we proposed a regional spatial normalization algorithm called octree spatial normalization (OSN) that reduces processing time to minutes while targeting the accuracy of previous methods. In the current study, modifications of the OSN algorithm for use in human brain images are described and tested. An automated brain tissue segmentation procedure was adopted to create anatomical templates to drive feature matching in white matter, gray matter, and cerebral-spinal fluid. Three similarity measurement functions (fast-cross correlation (CC), sum-square error, and centroid) were evaluated in a group of six subjects. bination of fast-CC and centroid was found to provide the best feature matching and speed. Multiple iterations and multiple applications of the OSN algorithm were evaluated to improve fit quality. Two applications of the OSN algorithm with two iterations per application were found to significantly reduce volumetric mismatch (up to six times for lateral ventricle) while keeping processing time under 30 min. The refined version of OSN was tested with anatomical landmarks from several major sulci in a group of nine subjects. Anatomical variability was appreciably reduced for every sulcus investigated, and mean sulcal tracings accurately followed sulcal tracings in the target brain.

11098795

Brain processing of visual sexual stimuli in human males.

Despite its critical sociobiological importance, the brain processing of visual sexual stimuli has not been characterized precisely in human beings. We used Positron Emission Tomography (PET) to investigate responses of regional cerebral blood flow (rCBF) in nine healthy males presented with visual sexual stimuli of graded intensity. Statistical Parametric Mapping was used to locate brain regions whose activation was associated with the presentation of the sexual stimuli and was correlated with markers of sexual arousal. The claustrum, a region whose function had been unclear, displayed one of the highest activations. Additionally, activations were recorded in paralimbic areas (anterior cingulate gyrus, orbito-frontal cortex), in the striatum (head of caudate nucleus, putamen), and in the posterior hypothalamus. By contrast, decreased rCBF was observed in several temporal areas. Based on these results, we propose a model of the brain processes mediating the cognitive, emotional, motivational, and ponents of human male sexual arousal.

11098798

Quantification of fMRI artifact reduction by a novel plaster cast head holder.

In light of artifact-induced high variability of activation in fMRI repeat studies, we developed and tested a clinically useful plaster cast head holder (PCH) with improved immobilization, repositioning, fort. With PCH, there were considerably lower levels of translational and rotational head pared to head fixation with conventional restraining straps (CRS). ponents cannot be pensated by realignment and lead to "false activations." In addition, task-correlated head motion, which highly increases the risk of artifacts, was considerably reduced with PCH, especially in a motion prone subject. Compared with PCH, head motion was 133% larger with CRS in a highly cooperative subject. With a motion prone subject, head motion range was increased by 769% (PCH: 0.9 mm, CRS: 7.8 mm), which may indicate the usefulness of PCH for restless patients. In functional activation maps, PCH alone yielded fewer residual motion artifacts than CRS + image registration. Subject tolerance of the head holder during the long measurement times of up to 2.5 hr was good, and slice orientation on different days confirmed the quality of repositioning.

11098800

Detecting bilateral abnormalities with voxel-based morphometry.

In this article we describe a new method, using SPM99, that searches explicitly for bilateral structural abnormalities. Children with bilateral pathology have a poorer prognosis than children with unilateral damage. After brain injury or disease in childhood, it is thought that rescue of function is only possible if the neuronal substrates of that function are preserved and operational in at least one hemisphere [Vargha-Khadem and Mishkin, 1997]. If this is the case, the detection of bilateral abnormalities would greatly facilitate more accurate prognosis in children with brain injury or developmental disorders. We have therefore developed a technique to detect bilateral abnormalities that uses conjunction analysis with voxel based morphometry. It is illustrated using a group of patients with bilateral hypoxic-ischaemic damage to the hippocampus. The approach is shown to have enhanced specificity and sensitivity relative to conventional unilateral characterisations.

11098799

The impact of increased mean airway pressure on contrast-enhanced MRI measurement of regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV), regional mean transit time (rMTT), and regional cerebrovascular resistance (rCVR) in human volunteers.

Contrast-enhanced magnetic resonance imaging (MRI) measurement of cerebral perfusion is a diagnostic procedure increasingly gaining access to clinical practice not only in spontaneously breathing patients but also in mechanically ventilated patients. Effects of increased mean airway pressure on cerebral perfusion are entirely possible. Therefore, the present study used continuous positive airway pressure (CPAP) (12 cm H2O) to study the effects of increased mean airway pressure on cerebral perfusion in volunteers. CPAP significantly reduced regional cerebral blood flow (rCBF) and regional cerebral blood volume (rCBV) but increased regional mean transit time (rMTT) and regional cerebrovascular resistance (rCVR). Active vasoconstriction (e.g., arterial) and/or pression of capillary and/or venous vessel areas are the most likely underlying mechanisms. The number of interhemispheric differences in rCBF, rCBV, rMTT, and rCVR found at baseline rose when mean airway pressure was increased. These results, although obtained in volunteers, should be taken into consideration for the interpretation of contrast-enhanced MRI perfusion measurements in mechanically ventilated patients with an increased positive airway pressure.

11098802

Autism and Asperger syndrome: coexistence with other clinical disorders.

: To provide a clinically useful analysis of the extent to which autism and Asperger syndrome coexist with other disorders.

11098804

Assessment of dysfunctional working models of self and others in schizophrenic patients: a summary of data collected in nine nations. International Research Group.

To investigate the cross-cultural feasibility of a new scale for assessing dysfunctional working models of self and others, and to evaluate its discriminative power.

11098805

Progressive deterioration of soft neurological signs in chronic schizophrenic patients.

Neurological signs are found to be increased in schizophrenia in cross-sectional studies. Whether they progress with time is an important issue in addressing the course of the illness.