bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlation between Endoscopic and Angiographic Findings in Patients with Esophageal and Isolated Gastric Varices
Authors: Chikamori Fumio , Kuniyoshi Nobutoshi , Shibuya Susumu , Takase Yasuhiro
Published: April 2003

Background/Aim: The correlation between angiographic vascular patterns and endoscopic findings in portal hypertension is not sufficiently known, and knowledge of the vascular anatomy may contribute to an improvement in endoscopic embolization and transjugular retrograde obliteration procedures. We propose a new vascular map that should prove useful for this purpose. Methods: Between April 1985 and December 1997 we performed percutaneous transhepatic portography in a selected group of 75 patients (16 women and 59 men), aged 43–71 years, from whom informed consent was obtained. All patients had been diagnosed endoscopically as having either esophageal or isolated gastric varices. According to the Child-Pugh classification, class A, B, and C cirrhosis was seen in 19, 40, and 16 patients, respectively. We created a vascular map of esophageal and isolated gastric varices, based on the opacification of the portal venous collaterals on percutaneous transhepatic portography. We compared the patients in both variceal groups in terms of portal venous pressure, main blood supply, and drainage routes. Results: We found that the portal collateral system was divided into two systems: the portoazygos venous system and the portophrenic venous system. The former contributed to the formation of esophageal and cardiac varices and the latter to the formation of isolated gastric varices located at the fundus or at both the cardia and fundus. The left gastric vein participated as blood supply in 70% of the isolated gastric varices and in 100% of the esophageal varices (p < 0.01). The posterior gastric vein participated as blood supply in 70% of the isolated gastric varices and in 24% of the esophageal varices (p < 0.01). We classified the main blood drainage routes of isolated gastric varices functionally into three types: gastrorenal shunt (85%), gastrophrenic shunt (10%), and gastropericardiac shunt (5%). The portal venous pressure in patients with esophageal varices was 358 ± 66 mm H2O, whereas in patients with isolated gastric varices it was 262 ± 44 mm H2O (p < 0.01). Conclusion: We suggest that this new vascular map will be useful in endoscopic embolization and transjugular retrograde obliteration procedures for esophageal and isolated gastric varices.
Splenic Abscess after Lithotripsy of Pancreatic Duct Stones
Authors: Plaisier Peter W. , den Hoed P. Ted
Published: April 2003

We describe a case of splenic abscess following lithotripsy of pancreatic stones, for which emergency splenectomy eventually had to be performed. It is important to be aware of this complication, because splenic abscess is still a life-threatening entity.
Treatment of Adrenal Metastases after Hepatic Resection of a Hepatocellular Carcinoma
Authors: Shuto Taichi , Hirohashi Kazuhiro , Kubo Shoji , Tanaka Hiromu , Yamamoto Takatsugu , Higaki Ikko , Takemura Shigekazu , Kinoshita Hiroaki
Published: April 2003

Background: The adrenal gland is a common site of extrahepatic metastases from a hepatocellular carcinoma (HCC). However, treatment of adrenal metastases has not been well characterized. Methods: Of 562 patients who underwent hepatic resection for a HCC, 91 developed extrahepatic metastases. We reviewed the medical records of 10 patients with adrenal metastases (9 males and 1 female; mean age 63 years at the time of hepatic resection). Results: The mean diameter of the primary tumors was 5 cm, and all were located in the right lobe of the liver. The mean interval from hepatic resection to recurrence was 18 months. Seven patients underwent treatment of intrahepatic recurrence. To treat the adrenal metastases, surgical resection was performed in 4 patients, and transcatheter arterial embolization was performed in 1 patient. The patients treated had no other extrahepatic metastases. The mean diameter of the resected adrenal tumors was 6 cm. There was no hospital mortality. With surgical resection, 1 patient has been alive 63 months after recurrence. Conclusions: Adrenal metastases from a HCC were often large at the time of diagnosis. Since surgical resection was a safe procedure, and some patients could be alive for a long time, it should be performed whenever possible.
Complications and Late Outcome following Percutaneous Drainage of the Gallbladder in Acute Calculous Cholecystitis
Authors: Andrén-Sandberg Åke , Haugsvedt Trond , Larssen Trond Bjerke , Søndenaa Karl
Published: April 2003

Background: Acute septic cholecystitis (AC) remains a difficult problem in patients with coexisting severe illness, and ultrasonographically guided percutaneous puncture and drainage of the gallbladder (PTBD) may be an alternative treatment in this context. Setting: University Hospital, Norway. Methods: Retrospective study of the safety and efficacy of this approach in 86 consecutive patients treated from 1992 to 1999. Results: Five patients died. Drainage did not seem to influence the condition in these patients, who were drained for a mean of 8 days after admission compared to 4 days for the survivors (p = 0.01), and had a higher S-bilirubin on the day of the drainage, 46 and 29 µmol/l (p = 0.05), respectively. Seven patients had an intraperitoneal bile leak and 2 had worsening septicemia. One of these patients had both, and the gallbladder was removed. An open cystic duct demonstrated at catheter cholangiography was associated with a bile leak in 3 (4%) of 76 patients as opposed to 4 (40%) of 10 patients with obstruction (p = 0.001). Only 60 patients survived another 6 months because of general debility and other diseases. Twenty-seven (45%) of these were asymptomatic during follow-up. Twenty-eight (47%) of the remaining patients had at least one recurrent episode of AC. One patient who was readmitted due to AC had urgent cholecystectomy and 8 others had elective cholecystectomy during follow-up for a total cholecystectomy rate of 12%. A common bile duct stone was demonstrated in 4 patients after ERCP and indicative signs were found in another 5 (10%). Conclusions: PTBD remains a good option in patients with septic AC who have severe coexisting disease and may be too ill to undergo an operation. It may not be necessary to remove the gallbladder in 45% or more of the patients as many remain asymptomatic after PTBD.
Eosinophils as a Direct Target of the Anti-Inflammatory Effect of Salmeterol: Demonstration with Indium-111-Labeled Eosinophils
Authors: Ezeamuzie C.I. , Ziada G. , Mathew M. , Philips E. , Gopinath S. , Owunwanne A.
Published: April 2003

Objective: The β2-adrenoceptor agonist salmeterol inhibits the accumulation of eosinophils at the site of allergic inflammation, but the cellular target is uncertain. This study was undertaken to determine whether eosinophils themselves are the target of this inhibitory action. Methods: Purified guinea pig peritoneal eosinophils were labeled with indium-111 oxine, pre-incubated with salmeterol or drug vehicle before being injected intravenously into guinea pigs, which have previously been immunized with ovalbumin (OA). Four hours after intradermal injection of OA or platelet-activating factor (PAF), the accumulation of labeled eosinophils at the injection sites was determined by measuring the radioactivity in punched-out skin sites. In vitro adhesion to plastic plate was also studied by measuring the eosinophil peroxidase content of adhering cells. Results: About 6% of the injected 111In-eosinophils were circulating 10 min after injection and remained relatively steady for over 4 h. In animals given vehicle-treated 111In-eosinophils an up to 3.6-fold increase in the accumulation of the labeled cells at the skin sites of OA or PAF injection was seen. Pretreatment of 111In-eosinophils with salmeterol (1 µM) – a concentration giving about 65% inhibition of in vitro adherence – had no effect on the basal (PBS-induced) skin accumulation of the injected cells. However, it inhibited the net accumulation induced by OA (0.01–1 µg/site) and PAF (0.01–1 nmol/site) by 58.8–100%. At 1 µM, salmeterol itself had no significant effect on the viability and circulation of 111In-eosinophils. Conclusion: These results provide evidence for a direct inhibitory effect of salmeterol on eosinophils and suggest that this may account for a significant part of its clinical anti-inflammatory properties.
Primary Mesenteric Venous Thrombosis in a 28-Week Pregnant Woman
Authors: Fouad Mohammad A. , Pathania A.G. , Marouf R.
Published: April 2003

Objectives and Importance: Mesenteric venous thrombosis is a very rare disorder during pregnancy. We report a 28-week pregnant woman who presented with acute abdominal pain that was proved to be due to mesenteric venous thrombosis. Clinical Presentation: A healthy, pregnant woman presented to surgical casualty with an 8-hour complaint of severe generalized abdominal pain. Clinical examination revealed a 28-week gravid uterus and a mildly distended and soft abdomen with absent bowel sounds. Sonographic findings were unremarkable. Intervention: Exploratory laparotomy revealed a gangrenous loop of the sigmoid colon, which was resected, and Hartmann’s procedure was performed. Histopathological examination of the resected bowel tissue confirmed the diagnosis of mesenteric venous thrombosis. The patient was thoroughly screened for the presence of an underlying hypercoagulable state such as a deficiency of protein C, protein S, antithrombin III, activated protein C resistance, lupus anticoagulant, factor V Leiden, and prothrombin gene mutation. No abnormalities were found. Conclusion: Exploratory laparotomy and histological examination of excised bowel tissue were used to confirm a diagnosis of mesenteric venous thrombosis in a 28-week pregnant woman. The clinicians and surgeons should be alerted to such a disease especially in the absence of a pre-existing hypercoagulable state. Exploratory laparotomy, which was diagnostic in this case, should not be delayed.
The Influence of Hair Shave on the Infection Rate in Neurosurgery
Authors: Tang K. , Yeh J.S. , Sgouros S.
Published: April 2003

Objective: To investigate whether not shaving hair in neurosurgical operations carries an increased infection rate. Methods: Taking advantage of different practices among neurosurgeons in a single institution, we embarked upon a prospective non-randomised study of 100 consecutive neurosurgical procedures involving 90 paediatric patients aged 7 days to 16.8 years. The patients were split into two groups (‘hair shave’ and ‘no hair shave’). The differences with respect to wound complications, positive microbiology on wound culture swabs and wound infection rates were analysed. Other factors considered were the cleansing solution, prophylactic antibiotic regime, duration of the operation, the surgeon’s experience and the patient’s age. Results: The only complications observed were 4 incidences of wound dehiscence (2 in the hair shave and 2 in the no hair shave group) and 3 shunt infections (2 in the hair shave and 1 in the no hair shave group). We did not find any significant difference between the two arms for any of the factors assessed. Age was a significant factor in shunt infection, as all shunt infections were seen in patients aged less than 6 months, regardless of whether the hair was shaved or not (p = 0.024, Fisher’s exact test). Conclusion: This study confirms our clinical experience that no hair shave is a good alternative to the traditional hair shaving approach, allowing patients to enjoy the psychological benefits of undisturbed body image while recovering from major surgery.
Selective Posterior Rhizotomy and Intrathecal Baclofen for the Treatment of Spasticity
Authors: von Koch Cornelia S. , Park T.S. , Steinbok Paul , Smyth Matthew , Peacock Warwick J.
Published: April 2003

Spasticity occurs in children and adults due to a wide range of conditions, including cerebral palsy, head and spinal cord trauma, cerebrovascular accidents and multiple sclerosis. Multiple treatment options have been described, including medical and surgical treatments. Medical treatments include intramuscular botulinum A toxin, oral baclofen and supportive bracing. Surgical approaches include selective posterior rhizotomy, intrathecal baclofen and orthopedic procedures to address deformities. Many reports have been published on these different treatment options, but rarely has a comparison been made between them. Therefore, this review is aimed at comparing selective posterior rhizotomy and intrathecal baclofen injection for spasticity due to cerebral palsy, especially in children.
Long-Term Follow-Up and Results of Thirty Pediatric Intracranial Hydatid Cysts: Half a Century of Experience in the Department of Neurosurgery of the School of Medicine at the University of Istanbul (1952–2001)
Authors: Onal Cagatay , Unal Faruk , Barlas Orhan , Izgi Nail , Hepgul Kemal , Turantan M. Inan , Canbolat Ali , Turker Kirac , Bayindir Cicek , Gokay Husameddin K. , Kaya Umur
Published: April 2003

A series of 30 documented cases of intracranial hydatid cyst out of 33 pediatric and 45 total patients admitted to the Department of Neurosurgery of the School of Medicine at Istanbul University within the years 1952–1996 is presented. The pediatric population consisted of 73% of the series. Twenty patients (66%) are alive and well after a follow-up period of 8–45 years (mean 21.5 years). Six patients (20%) died and 4 (13%) were lost to follow-up. There were 3 early postoperative deaths (10%), 2 being in the pre-CT era. In 4 cases (13%), brain involvement was secondary, and 2 cases (7%) had multiple intracranial hydatid cysts. Age ranged from 4 to 16 years, with a mean of 10.4. There were 5 intraventricular (17%) and 2 (7%) intracranial extradural settlements. No children with posterior fossa hydatid cyst, primary skull hydatidosis or concomitant spinal involvement were detected. One patient (3%) presented with ‘rhinorrhea’ which in fact was a hydatid fluid leak. Preoperative pseudocerebellar syndrome, convulsion and extrapyramidal signs were seen in 6 patients each (20%). Five patients (17%) had permanent visual deficits, 3 being in pre-CT era. Out of 29 patients operated on, hydatid birth with intact cyst removal was achieved in 18 cases (62%), with no other manipulation needed. This rate has increased to 70% in the CT era. Intraoperative accidental rupture occurred in 8 cases (28%), of which 7 were localized frontally or had a frontal involvement (88% of the ruptured cases). Of the patients with intraoperative rupture, 5 are dead (63%) and they were all primary. In contrast, all 3 cases alive with intraoperative rupture are secondary. Three cases were punctured on purpose (10%). Four of the operated patients (14%) required long-term antiepileptic therapy, 3 having no preoperative seizures. Only 1 patient required a shunt (3%). Four cases had recurrence, all with intraoperative cyst rupture (14%). The long-term evaluation of the results yielded an overall mortality rate of 21%. Routine use of CT after the 80s decreased the rate to 14%. With the analysis of 50 years of data, it is strongly concluded that brain involvement in pediatric hydatid disease is a primary process if delayed diagnosis and insufficient treatment of extraneural hydatidosis are prevented.
Intracranial Complications of Frontal Sinusitis in Children: Pott’s Puffy Tumor Revisited
Authors: Bambakidis Nicholas C. , Cohen Alan R.
Published: April 2003

The objective of the present study is to describe the diagnosis and treatment of intracranial complications of frontal sinusitis (Pott’s puffy tumor) in a series of pediatric patients at our institution. A rare entity, Pott’s puffy tumor has been reported in only 21 pediatric cases in the literature of the antibiotic era. The hospital records and radiographic files at Rainbow Babies and Childrens Hospital, Cleveland, Ohio, USA, over the previous 16 years were retrospectively reviewed in a search for patients with the diagnosis of Pott’s puffy tumor, defined as scalp swelling and associated intracranial infection. There were 6 male patients and 1 female patient. Ages ranged from 11 to 18 years (median 14.5 years). Intracranial infections consisted of epidural abscess in 5 patients, subdural empyema in 4 and brain abscess in 1. Intraoperative cultures grew anaerobic organisms in 1 patient, microaerophilic streptococcus in 5 patients, Klebsiella species in 1 patient and Streptococcus pneumoniae in another. All patients presented with frontal scalp swelling, and other common symptoms included headache, fever, nasal drainage and frontal sinus tenderness. Five patients were treated with antibiotics prior to their presentation. Four patients presented with neurologic decompensation characterized by varying degrees of hemiparesis, obtundation, pupillary dilatation or aphasia. All patients underwent craniotomy and evacuation of the intracranial infection. Even severely impaired patients demonstrated full neurologic recovery. Despite the widespread use of antibiotics, neurosurgical complications of sinusitis continue to occur. A high degree of suspicion, along with prompt neurosurgical intervention and the use of appropriate antibiotics, can result in favorable outcomes in even the sickest patients.
Histological Appearance of a Chronically Stimulated Vagus Nervein a Pediatric Patient
Authors: Tubbs R. Shane , Patwardhan Ravish , Palmer Cheryl Ann , Kelly David R. , Elton Scott , Blount Jeffrey P. , Bebin Martina , Grabb Paul A.
Published: April 2003

Histological analysis of chronically stimulated human vagus nerves is lacking in the literature. In this study, we describe the first microscopic findings in a chronically stimulated left vagus nerve from a pediatric patient. Our results show many histological changes in and around the stimulated nerve with severe demyelination. Further long-term clinical and postmortem examinations of chronically stimulated vagus nerves in both children and adults are needed to ascertain whether prolonged exposure to electrical current can cause clinical dysfunction of this nerve.
Lateral Intrathoracic Meningocele Associated with a Spinal Intradural Arachnoid Cyst
Authors: Baysefer Alper , Izci Yusuf , Erdoğan Ersin
Published: April 2003

A case of lateral intrathoracic meningocele associated with a spinal intradural arachnoid cyst is reported and the cases from the literature are reviewed. Both of these lesions were detected by magnetic resonance imaging and treated surgically. Intrathoracic meningoceles are often asymptomatic and diagnosed incidentally during the evaluation of an unrelated pathology. A patient with a spinal intradural arachnoid cyst may present with paraparesis mimicking an intradural tumor, and lateral intrathoracic meningocele may seldom accompany this lesion. A comprehensive radiological examination must be conducted and a higher index of suspicion by neurosurgeons is necessary.
Cranial Birth Injuries in Term Newborn Infants
Authors: Pollina John , Dias Mark S. , Li Veetai , Kachurek Diana , Arbesman Marian
Published: April 2003

While cranial birth injuries in term infants are well recognized, to date, only small case series have been described. In an attempt to further define the spectrum of cranial birth injuries, we analyzed 41 consecutive cranial birth injuries at our institution over the period 1991–1998. The most common clinical presentations were apnea (39%) and seizures (37%). Average Apgar scores were 5.7 at 1 min and 7.3 at 5 min; 54% of infants had abnormally low Apgar scores at 1 min and 31% had abnormally low scores at 5 min. The most common intracranial lesion was subdural hemorrhage, present in 73% of infants; most had either a tentorial (57%) and/or interhemispheric (50%) location. Operative treatment was required in 5 infants (12%). Two of the 41 infants (4.8%) died. The study group was compared with a control group of 63 randomly selected births without cranial injury. Using a stepwise logistic regression model, independently significant variables included neonatal birth weight, Apgar scores at 1 and 5 min and mode of delivery. Compared with the controls, the study group had a significantly higher incidence of forceps and/or vacuum deliveries. Combining vacuum, forceps and urgent cesarean section deliveries together as ‘urgent’ and elective cesarean and spontaneous vaginal deliveries as ‘nonurgent’, we could find no significant differences between these two groups. Our data conflict with those of Towner et al. [N Engl J Med 1999;341:1709–1714], and suggest that the method of assisted delivery, rather than the urgency of the delivery or dysfunctional labor per se, is a more important variable in cranial birth injuries.
Endoscopic Treatment for a Huge Neonatal Prepontine-Suprasellar Arachnoid Cyst: A Case Report
Authors: Nakamura Yoshie , Mizukawa Katsu , Yamamoto Kazuki , Nagashima Tatsuya
Published: April 2003

A huge prepontine-suprasellar arachnoid cyst was identified by fetal sonography and magnetic resonance imaging. It was successfully treated with a two-stage operation using a neuroendoscope. The first operation during the neonatal period consisted of implantation of a cyst-peritoneal shunt. In the second operation, the cyst was fenestrated with the aid of a neuroendoscope. The cyst membrane was seen to cover the foramen magnum and to extend continuously to the ventral surface of the brain stem. At the foramen magnum, it was pulsating synchronously with the pulsation of the vertebral artery, which was suggestive of the mechanism of cyst growth. A ventriculo-peritoneal shunt was inserted to replace the cyst-peritoneal shunt. Endoscopic cyst fenestration is a less invasive alternative for the treatment of arachnoid cysts and can also be used for young children. In that case, however, special care should be taken to avoid complications, especially if the cyst exerts considerable pressure on the critical areas of the brain.
Pathology and Neuroimaging in Pediatric Temporal Lobectomy for Intractable Epilepsy
Authors: Sinclair D.B. , Wheatley M. , Aronyk K. , Hao C. , Snyder T. , Colmers W. , McKean J.D.S.
Published: April 2003

Objectives: Firstly, to study the pathology at surgery in children undergoing temporal lobectomy for intractable partial epilepsy. Secondly, to compare neuroimaging techniques (CT, MRI) in the preoperative detection of pathology. Lastly, to examine the surgical outcome in children. Methods: Forty-two pediatric patients undergoing temporal lobectomy for intractable epilepsy at the Comprehensive Epilepsy Program at the University of Alberta Hospital between the years 1988–1998 were studied. Patients had extensive preoperative investigations including CT and MRI. The pathology at surgery was reviewed and compared to preoperative neuroimaging. Charts were reviewed to determine surgical outcome. Results: Brain tumors were the most common pathology, found in 13/42 patients. Mesial temporal sclerosis (MTS) was found in 8 patients and dual pathology in an additional 5. Focal cortical dysplasia (FCD) was seen in 4 patients, 1 patient had a porencephalic cyst and 4 patients had tubers of tuberous sclerosis. Seven patients had no specific pathology detected. MRI was clearly more sensitive than CT in the detection of pathology. MRI was abnormal in 27/42 cases (64%), while CT scan was found to be abnormal in only 12/39 (31%). Surgical outcome was excellent, with 34/42 patients (80%) having an Engel class I outcome. One patient had significant improvement with an Engel class II outcome, 3 (7%) had little improvement (Engel class III) and 4 (10%) were unchanged (Engel class IV). Three patients (7%) had surgical complications. Conclusions: A wide variety of developmental pathology is seen following temporal lobectomy for intractable epilepsy of childhood. Brain tumors, FCD and MTS are common. MRI is superior to CT in the detection of pathology, which may be subtle in children. Surgical outcome is excellent, with most children being seizure free and few complications being seen.
A Case of Diastematomyelia Associated with Myeloschisis in a Hemicord
Authors: Yamanaka Takumi , Hashimoto Naoya , Sasajima Hiroyasu , Mineura Katsuyoshi
Published: April 2003

We report a case of myeloschisis on the right hemicord in a patient with diastematomyelia. The patient was a female neonate with myeloschisis visible at birth in the upper lumbar region. Radiological examination, including three-dimensional CT and MRI, clearly revealed a bony septum as well as the myeloschisis on the right hemicord, which enabled us to make a precise preoperative diagnosis of this complex anomaly. Closure of the myeloschisis and removal of the septum were successfully accomplished in one stage to prevent subsequent infection and neurological deterioration. The presence of combined diastematomyelia and myeloschisis is consistent with the hypothesis of an ontogenic basis of development and emphasizes the importance of early imaging for diagnosis in this complex anomaly.
Moyamoya Disease Associated with Persistent Primitive Hypoglossal Artery
Authors: Katayama Wataru , Enomoto Takao , Yanaka Kiyoyuki , Nose Tadao
Published: April 2003

An 8-year-old boy presenting with a transient weakness of the left extremities had a rare association of moyamoya disease and persistent primitive hypoglossal artery (PPHA). Digital subtraction angiography demonstrated intracranial moyamoya vessels and a PPHA on the right side. There was collateral blood flow from the posterior circulation to the anterior circulation, with the PPHA functioning as a blood supplier vessel. The patient underwent multiple burr hole formation, and neovascularization via the burr holes was observed on follow-up angiography. In this case, blood flow into the posterior circulation via the PPHA, which served as the collateral vessel to the moyamoya phenomenon, may have disturbed the spontaneous closure of the PPHA. Thus, this case serves as a basis for studying important pathogenic and embryological processes that contribute to the development of these vascular abnormalities.
Eosinophilic Granuloma with Acute Epidural Hematoma
Authors: Cho Der-Yang , Liau Wen-Rei , Chiang I-Peng
Published: April 2003

The most common symptoms of eosinophilic granuloma are local tenderness and an enlarged skull mass. The presence of epidural hematoma is a very rare symptom of eosinophilic granuloma. To our knowledge, this is only the second reported case of eosinophilic granuloma with epidural hematoma. A 2-year-old boy with a soft tumor on the occipital scalp, palpable at the age of 3 months, yet with no obvious history of trauma, was admitted due to a sudden onset of loss of consciousness. A brain computed tomography scan showed a lytic lesion on the occipital skull with a large epidural and subcutaneous hematoma, causing brain compression. He underwent an emergency craniectomy with removal of both the tumor and hematoma. The patient regained consciousness and had no residual neurological damage. Pathological reports showed abnormal proliferation of Langerhans’ cells, eosinophilic cells and multinucleated cells. A whole-body bone nuclide scan revealed no other bone lesions. The patient was discharged uneventfully. The causes of hematomas are not very clear. They may be due to tumor necrosis or minor trauma. In our presented case, the cause of the epidural hematoma may have been tumor bleeding which ruptured into the epidural space. A solitary eosinophilic granuloma of the skull with acute epidural hematoma and loss of consciousness is extremely uncommon. Craniectomy with removal of the tumor and hematoma decompression may produce good results.
Spinal Sagittal Malalignment following Surgery for Primary Intramedullary Tumours in Children
Authors: Yeh John S. , Sgouros Spyros , Walsh A. Richard , Hockley Anthony D.
Published: April 2003

Background/Objective: As prior studies analysed predictive factors for various post-laminectomy spinal deformities in mixed spinal regions, age groups or pathologies, their validity and conclusions were unclear. The objective of this study was to determine predictive factors for worsened cervical or thoracic spinal sagittal alignment following laminectomy or laminotomy for primary intramedullary spinal cord tumours in children. Methods: In this retrospective study, patients treated between 1980 and 1998 were reviewed. Changes in spinal alignment at the last follow-up compared to the pre-operative state were studied. Factors analysed were age, pre-operative spinal alignment, procedure types (laminectomy or laminoplasty), number of laminae operated, surgery of C2 or T1 laminae, histological grade, presence of post-operative neurological deficit and post-operative radiotherapy. Results: There were 27 patients. The mean age was 5.6 years (range 1.3–14.0 years), and the mean duration of follow-up was 3.7 years (range 0.075–9.9 years). In the cervical-cervicothoracic surgical group (n = 12), alignment worsened post-operatively in 3 patients. The number of laminae operated upon had a statistically significant impact on the development of post-operative kyphosis (p = 0.07). In the thoracic-thoracolumbar surgical group (n = 15), alignment worsened in 9 patients. Procedure types were statistically significantly different, with laminectomy associated with an increased risk of post-operative kyphosis (p = 0.01). All 5 patients who had spinal fusion for worsened post-operative alignment were in the thoracic-thoracolumbar group; no patients in the cervical-cervicothoracic group required spinal fusion (p = 0.047). Other predictive factors did not reach statistical significance (p > 0.05). Conclusions: Worsened spinal sagittal alignment following laminectomy or laminoplasty and the need for spinal fusion is more common in the thoracic-thoracolumbar region than in the cervical-cervicothoracic region. In the cervical-cervicothoracic region, operation on a greater number of laminae tends to increase the risk of worsened alignment. In the thoracic-thoracolumbar region, laminectomy is associated with worsened alignment, while laminoplasty reduces this risk; also, pre-operative kyphotic deformity tends to increase the risk of worsened alignment post-operatively.
Early Management of Craniocerebral Injury with Avoidance of Post-Traumatic Leptomeningeal Cyst Formation
Authors: Sugiultzoglu Miltos K. , Souweidane Mark M.
Published: April 2003

Leptomeningeal cyst, or growing skull fracture, is a rare complication of pediatric head trauma. This entity is typically diagnosed several weeks or months following head trauma when an enlarging scalp mass is recognized. Progressive neurologic deficits (seizures, paresis) can accompany this process, which typically do not improve following conventional surgical treatment. Given that radiographic findings are highly predictive of which children are likely to develop a leptomeningeal cyst, we have adopted a policy of early management in an effort to avoid difficult surgical dissections and progressive neurologic sequelae seen with delayed intervention. The cases of two infants with skull fractures are used to illustrate our approach toward early management of post-traumatic leptomeningeal cysts.
Epidemiology of Chronic Obstructive Pulmonary Disease (COPD)
Authors: Viegi G. , Scognamiglio A. , Baldacci S. , Pistelli F. , Carrozzi L.
Published: April 2003

Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of morbidity and mortality in the industrialized and the developing countries. During 1997, COPD has been estimated to be the number four cause of death after cardiovascular diseases, tumors and cerebrovascular diseases in the United States. In 2020 COPD will probably become the third leading cause of death all over the world, following the trend of increasing prevalence of lung cancer. The impact of this respiratory disease worldwide is expected to increase with a heavy economic burden on individuals and society. In the United States direct and indirect costs of COPD were estimated at about USD24 billion in 1993. Unfortunately, there are few data on health-care utilization despite the great interest in COPD among researchers. As all chronic diseases, the prevalence of COPD is strongly associated with age. Data collected in a general population sample (living in Italy) showed a progressive increase of the prevalence of chronic bronchitis and emphysema with age, both in males and in females. COPD is determined by the action of a number of various risk factors either singly or interacting among themselves in a synergistic way. Among these, the most important is cigarette smoking, ranking at the first level for developing chronic bronchitis and emphysema. Also air pollution and some occupational exposures represent risks for developing COPD. Many epidemiological studies have indicated an association between the prevalence of chronic bronchitis and a low socioeconomic status. Furthermore, in the etiology of COPD we must consider endogenous risk factors such as gender, genetic features, presence of respiratory troubles in childhood, and family history. To date, epidemiologic studies have been of great importance for the characterization of the disease at a population level, indicating possible causes and assessing its impact on the individual and on society as a whole. Unfortunately, international standards for the diagnosis of COPD are lacking, which complicates the organization of appropriate epidemiological surveys.
Initial Bacterial Colonization in Patients Admitted to a Respiratory Intensive Care Unit:Bacteriological Pattern and Risk Factors
Authors: Drakulovic Mitra B. , Bauer Torsten T. , Torres Antoni , Gonzalez Julià , Rodríguez Maria-José , Angrill Joaquim
Published: April 2003

Background: Colonization is an important risk factor for consecutive infection, but little is known about incidence and initial pattern on admission to respiratory intensive care units (RICU). Objective: To study the bacterial colonization during the first 24 h after admission to a RICU. Methods: Endotracheal aspirates, gastric juice, and pharyngeal and rectal swabs of 55 consecutive patients were cultured (45 men, age 66 ± 14 years, APACHE II 20.1 ± 5.6, no parenchymal infection). All samples were taken within the first 24 h after admission to a RICU. Potentially pathogenic microorganisms were grouped as community (c-PPM) and hospital acquired (h-PPM), and risk factors for colonization of each body site as well as for overall colonization (all sites excluding rectum) were identified by logistic regression analysis. Results: The trachea was colonized in 18% of the intubated patients with c-PPMs and in 11% with h-PPMs. Candida spp. were the most frequent c-PPMs isolated from trachea, pharynx, and stomach (excluding rectal swabs), and Pseudomonas aeruginosa was the most frequently isolated h-PPM in trachea. The incidence of overall colonization was 49% for c-PPMs (predominantly Escherichia coli) and 18% for h-PPMs (predominantly P. aeruginosa). Admission to the hospital ≧48 h before ICU admission was an independent risk factor of colonization with h-PPMs in univariate (33 vs. 7%, p = 0.015) and multivariate analyses (odds ratio 7.2, 95% CI 1.4–38.3; p = 0.0197). Conclusions: Colonization of the trachea with c-PPMs was already present in every 5th and with h-PPMs in every 10th intubated patient during the first 24 h of RICU admission even in the absence of parenchymal infections. Hospitalization more than 48 h prior to RICU admission was a risk factor of colonization with h-PPMs.
Mechanisms of Endothelin-1 Elevation in Chronic Obstructive Pulmonary Disease Patients with Nocturnal Oxyhemoglobin Desaturation
Authors: Trakada G. , Marangos M. , Spiropoulos K.
Published: April 2003

Background: Nonapneic, oxyhemoglobin desaturation associated with sleep has been described in patients with chronic obstructive pulmonary disease (COPD). Hypoxemia stimulates endothelin-1 (ET-1) secretion. Once released, ET-1 can act locally to elicit sustained pulmonary artery vasoconstriction, bronchoconstriction and activation of alveolar macrophages. Objective: The aim of this study was to examine a possible correlation between ET-1 levels and nocturnal, nonapneic, oxyhemoglobin desaturation during sleep, in patients with COPD. Methods: We examined 48 COPD patients with formal polysomnography (EEG, ECG, airflow, respiratory muscle movement, oximeter) to detect the presence of nocturnal, nonapneic, oxyhemoglobin desaturation. Twelve of them were disqualified because of inadequate sleep or sleep apnea syndrome. Nineteen of them desaturated below a baseline sleep saturation of 90% for 5 min or more, reaching a nadir saturation of at least 85%. We collected arterial samples to measure ET-1 levels, after 5 min of the first period of desaturation, in each of the 19 patients. We also collected arterial samples in the morning, before the study, to measure baseline ET-1 levels in all patients. Results: Baseline arterial ET-1 levels during the day were very significantly higher in ‘desaturator’ COPD patients (2.058 ± 0.252 pg/ml) compared to ‘non-desaturator’ COPD patients (1.382 ± 0.159 pg/ml; p < 0.001). Also in ‘desaturator’ COPD patients ET-1, levels during the night were significantly higher (4.297 ± 1.107 pg/ml) compared to those during the day (p ≤ 0.001) and a significant negative correlation was observed between ET-1 levels and degree of desaturation (p < 0.0001, r = 0.9305). Conclusions: According to our study we can conclude that (1) ET-1 levels are significantly higher in ‘desaturator’ COPD patients both during the day and during the night, and (2) ET-1 levels correlate negatively significant with the degree of the oxyhemoglobin desaturation. These findings are consistent with the hypothesis that ET-1 plays a very important role in the pathophysiological manifestations of COPD patients.
Reproducibility of a Standardized Titration Procedure for the Initiation of Continuous Positive Airway Pressure Therapy in Patients with Obstructive Sleep Apnoea
Authors: Wiest G.H. , Fuchs F.S. , Harsch I.A. , Pour Schahin S. , Lampert S. , Brueckl W.M. , Hahn E.G. , Ficker J.H.
Published: April 2003

Background: Manual titration of continuous positive airway pressure (CPAP) under polysomnographic control is the method most commonly employed to establish the minimal effective pressure (Peff) for the treatment of the obstructive sleep apnoea syndrome (OSA). To date, however, the reproducibility of Peff titrated in this way has not been investigated in any detail. Objectives: The present study aims to establish the reproducibility of Peff determined by manual titrations of CPAP under polysomnographic control in the sleep lab. Methods: In a group of 50 patients (5 women), with a mean (SD) apnoea-hypopnoea index of 39.3 (21.8), apnoea index of 28.1 (20.9) and oxygen desaturation index of 39.3 (22.6), with newly diagnosed OSA, manual titration of CPAP was performed on two consecutive nights using the following standard titration protocol: starting at 4 mbar, CPAP was increased by steps of 1 mbar at intervals of at least 5 min, until no signs of airway obstruction could be seen, and arousals were no longer elicited. When no airway obstruction was detected over a period of 30 min, the pressure was lowered once during the night in steps of 1 mbar at intervals of at least 10 min, until obstructive events reappeared, whereupon the pressure was again increased as described above, until, once more, no signs of airway obstruction and no arousals occurred. The second titration was carried out in a blind manner, that is the lab technician did not know the results of the first pressure titration. Results: The mean (SD) Peff for all titrations was 8.1 mbar (2.9). A high level of correlation was found between the Peff titrated on the first night and that titrated on the second night (Spearman correlation coefficient = 0.89). In a few individual cases, however, differences of up to 3 mbar were found between Peff on the first night and Peff on the second night. On average, the Peff measured on the second night was 0.5 mbar (SD = 1.3, range: –2.0 to 3.0 mbar) higher than that of the first night. Conclusions: With standardization of the manual titration of CPAP, Peff is readily reproducible. In individual cases, however, a difference of as much as 3.0 mbar between the two titrations is possible.
Usual Interstitial Pneumonia: Idiopathic Pulmonary Fibrosis versus Collagen Vascular Diseases
Authors: Nagao Taishi , Nagai Sonoko , Kitaichi Masanori , Hayashi Michio , Shigematsu Michio , Tsutsumi Takeo , Satake Norio , Izumi Takateru
Published: April 2003

Background: Bronchoalveolar lavage fluid (BALF) lymphocytosis was found in patients with usual interstitial pneumonia (UIP) associated with collagen vascular diseases (CVD) other than diffuse systemic sclerosis (SSc), but it was not found in patients with idiopathic pulmonary fibrosis (IPF), a disease histologically diagnosed as UIP. This difference could be partly due to variations of UIP spectrums between IPF and interstitial pneumonia associated with CVD. Methods: We scored histopathological findings of lung specimens obtained from 31 cases (16 IPF, 9 CVD other than SSc and 6 SSc) using a semiquantitative scoring method. All cases were diagnosed as UIP by surgical lung biopsy. None of the patients were current smokers. Results: Compared with IPF and SSc cases, CVD patients without SSc presented decreased scores of fibrosis (p < 0.01) and alveolar space cellularity (severity, p < 0.05). Lymphocytes were mainly localized in the alveolar walls and the majority of cells in the alveolar spaces were macrophages. On the other hand, other scores such as cellularity and alveolar wall cell infiltrate did not vary among these three groups. Conclusion: Fewer macrophages in the alveolar spaces and a decrease in the degree of fibrosis may contribute to BALF lymphocytosis more in patients with UIP/CVD non-SSc than in patients with IPF/UIP and UIP-SSc.
A Case-Controlled Study with Dornase Alfa to Evaluate Impact on Disease Progression over a 4-Year Period
Authors: Shah Pallav L. , Conway Steven , Scott Sandra F. , Rainisio Maurizio , Wildman Martin , Stableforth David , Hodson Margaret E.
Published: April 2003

Background: Chronic endobronchial sepsis and profuse airway secretions dominate pulmonary disease in cystic fibrosis. Recombinant human DNase I (dornase alfa) reduces the viscoelasticity of airway secretions and hence may improve clearance of airway secretions. Objectives: To evaluate the long-term influence of dornase alfa on disease progression by performing a case-controlled study with dornase alfa over a period of 4 years. Methods: A cohort of patients with cystic fibrosis who have been treated with dornase alfa were matched with a control group of patients with cystic fibrosis who had not received treatment with dornase alfa. The patients were matched by pulmonary function, age, and then sex. All available measurements of forced expiratory volume in one second (FEV1), height, weight and sputum bacteriology were collected for periods when the patients were free from respiratory exacerbations. Results: Thirty-eight patients were matched. Slopes of median changes in FEV1 were –2.19 (–3.32, –1.06) in the control group and –0.75 (–1.87, 0.36) in the dornase alfa-treated group (p = 0.076). There were more infective exacerbations per patient year in the control group [3.13 (1.25–4.25)] in comparison to the dornase alfa group [1.25 (0.63–3.0), p = 0.035] over the 4-year treatment period. Antibiotic requirements were also greater with a median 43.75 (17.5–60.0) days of intravenous antibiotic use per patient year in the control group and 16.25 (8.5–44.0) days in the dornase alfa group (p = 0.034). Conclusions: The trends suggest that dornase alfa may have some influence on disease progression but in view of the limitations of the current study the need for further long-term studies in larger cohorts of patients is emphasised.
Inhibition of Lung Natural Killer Cell Activity by Smoking: The Role of Alveolar Macrophages
Authors: Takeuchi M. , Nagai S. , Nakajima A. , Shinya M. , Tsukano C. , Asada H. , Yoshikawa K. , Yoshimura M. , Izumi T.
Published: April 2003

Background: It is known that natural killer (NK) cell activity in the lung of smokers (SM) is lower than in non-smokers (NS). However, little is known about the underlying mechanisms. Objective: The purpose of this work was to investigate the mechanisms of the inhibition of NK cell activity by alveolar macrophages (AM) in SM. Methods: Lung effector cells and AM were obtained using bronchoalveolar lavage. The NK cell activity was assayed by 51Cr release method after incubation of 4 and 24 h, using K562 as target cell. AM were added at a concentration of 25% to effector cells. Results: Following 24-hour culture, NK cell activity significantly increased in the NS but not in the SM. Lung NK cell activity was significantly augmented by interleukin-2 in the NS but not in the SM. Addition of AM to the NK cell preparation from SM exerted a significantly greater suppressive effect on autologous blood NK cell activity than in the NS. Indomethacin, catalase or thiourea did not prevent AM-mediated suppression of NK cell activity, in contrast to superoxide dismutase. Conclusions: These results suggest that the suppression of NK cell activity by AM in SM may be caused by O–2 release rather than by prostaglandins, H2O2 or OH release from AM.
Addition of ATP and MgCl2 to the Preservation Solution Attenuates Lung Reperfusion Injury following Cold Ischemia
Authors: Hirata Toshiki , Fukuse Tatsuo , Ishikawa Shinya , Miyahara Ryo , Wada Hiromi
Published: April 2003

Background: In lung transplantation, reperfusion injury following cold ischemia is one of the crucial problems for recipients. Objective: We evaluated the protective effect of adding a combination of ATP and MgCl2 to the preservation solution against lung reperfusion injury following cold ischemia. Methods: Using an isolated rat lung perfusion model with fresh rat blood as the perfusate, the rats were divided into five groups (n = 6). In the fresh group, the study lungs were flushed with phosphate-buffered saline (PBS), then immediately reperfused for 120 min. In the control group, the study lungs were flushed with PBS, then cold ischemia was induced for 9 h (4°C), after which reperfusion was performed. In the other three groups, the protocols were the same as for the control group except that ATP and/or MgCl2 were added to the PBS: ATP group (100 µM ATP), MgCl2 group (100 µM MgCl2) and ATP + MgCl2 group (100 µM ATP + 100 µM MgCl2). Results: In the ATP + MgCl2 group, the intrapulmonary shunt fraction, peak airway pressure and wet to dry lung weight ratio were significantly lower than those in the control group. No improvement was observed in the ATP or MgCl2 groups. Histological examination supported these physiological results. In all groups, flush time and lipid peroxide levels in the lungs after cold ischemia did not show any significant differences. Conclusion: The addition of ATP and MgCl2 to the preservation solution attenuated reperfusion injury following cold ischemia in rat lungs.