bluuebunny/crossref_metadata_2025 huggingface dataset:
Walking or vitamin B for cognition in older adults with mild cognitive impairment? A randomised controlled trial
Authors: van Uffelen J G Z , Chinapaw M J M , van Mechelen W , Hopman-Rock M
Published: February 2008

Objective:

To examine the effects of aerobic exercise or vitamin B supplementation on cognitive function in older adults with mild cognitive impairment (MCI).

Design:

Randomised placebo-controlled trial.

Setting:

General community.

Participants:

Community-dwelling adults aged 70–80 with MCI.

Interventions

: The 152 participants were randomly assigned to two interventions: (1) a twice-weekly, group-based, moderate-intensity walking programme (WP, n = 77) or a low-intensity placebo activity programme (n = 75) for one year; and (2) daily vitamin pill containing 5 mg folic acid, 0.4 mg vitamin B-12, 50 mg vitamin B-6 (FA/B12/B6, n = 78) or placebo pill (n = 74) for one year.

Outcome measures:

Cognitive function, measured with neuropsychological tests at baseline and after six and 12 months.

Results:

Median session attendance at the exercise programmes (25th–75th percentile) was 63% (2%–81%) and median compliance with taking pills (25th–75th percentile) was 100% (99%–100%). Gender was an effect modifier. Intention-to-treat analysis revealed no main intervention effect for either intervention. In women in the WP, attention (Stroop combination task) improved by 0.3 seconds (p = 0.04) and memory (auditory verbal learning test) by 0.04 words (p = 0.06) with each percentage increase in session attendance. In men attending at least 75% of the sessions, the WP improved memory (β 1.5 (95% CI: 0.1 to 3.0) words).

Conclusion:

The walking programme and/or FA/B12/B6 supplementation were not effective in improving cognition within one year. The walking programme, however, was efficacious in improving memory in men and memory and attention in women with better adherence.

Trial registration:

International Standard Randomised Controlled Trial Number Register, 19227688,http://www.controlled-trials.com/isrctn/
Comparison of interdevice measurement difference of pedometers in younger and older adults
Authors: Ayabe M , Ishii K , Takayama K , Aoki J , Tanaka H
Published: February 2008

Objectives

In this study, the relationship between inter-instrument differences in regard to the daily number of steps with the intensity distribution of daily physical activity in younger and older adults was examined.

Methods

17 younger individuals and 28 older individuals wore two pedometers (Lifecorder (LC) and EC-200 (YM)) simultaneously for 7 days, in order to determine the number of steps each took. Furthermore, LC determined the time spent in light, moderate and vigorous physical activity, corresponding to <3 metabolic equivalent (METs), 3 to 6 METs and >6 METs, respectively.

Results

The LC detected a significantly larger number of steps than YM (p<0.001), yet there was a strong relationship between the two measurements (r = 0.962, p<0.001). The interdevice difference with the number of steps significantly decreased in inactive older individuals compared with the active older and younger individuals, and it was also significantly negatively correlated with the time spent in light-intensity physical activity (LPA) (r = 0.523, p<0.01).

Conclusion

This study showed that the interdevice difference with the number of steps significantly increased in older participants due to the greater length of time spent in LPAs.
Topological assessment of oatp1a1: a 12-transmembrane domain integral membrane protein with three N-linked carbohydrate chains
Authors: Wang Pijun , Hata Soichiro , Xiao Yansen , Murray John W. , Wolkoff Allan W.
Published: February 2008

Organic anion transport protein 1a1 (oatp1a1), a prototypical member of the oatp family of highly homologous transport proteins, is expressed on the basolateral (sinusoidal) surface of rat hepatocytes. The organization of oatp1a1 within the plasma membrane has not been well defined, and computer-based models have predicted possible 12- as well as 10-transmembrane domain structures. Which of oatp1a1's four potential N-linked glycosylation sites are actually glycosylated and their influence on transport function have not been investigated in a mammalian system. In the present study, topology of oatp1a1 in the rat hepatocyte plasma membrane was examined by immunofluorescence analysis using an epitope-specific antibody designed to differentiate a 10- from a 12-transmembrane domain model. To map glycosylation sites, the asparagines at the each of the four N-linked glycosylation consensus sites were mutagenized to glutamines. Mutagenized oatp1a1 constructs were expressed in HeLa cells, and effects on protein expression and transport activity were assessed. These studies revealed that oatp1a1 is a 12-transmembrane-domain protein in which the second and fifth extracellular loops are glycosylated at asparagines 124, 135, and 492, whereas the potential glycosylation site at asparagine 62 is not utilized, consistent with its position in a transmembrane domain. Constructs in which more than one glycosylation site were eliminated had reduced transport activity but not necessarily reduced transporter expression. This was in accord with the finding that fully unglycosylated oatp1a1 was well expressed but located intracellularly with limited transport ability as a consequence of its reduced cell surface expression.
Hyperemic flow heterogeneity within the calf, foot, and forearm measured with continuous arterial spin labeling MRI
Authors: Wu Wen-Chau , Wang Jiongjiong , Detre John A. , Wehrli Felix W. , Mohler Emile , Ratcliffe Sarah J. , Floyd Thomas F.
Published: February 2008

Arterial spin labeling (ASL) is a noninvasive magnetic resonance imaging (MRI) technique for microvascular blood flow measurement. We used a continuous ASL scheme (CASL) to investigate the hyperemic flow difference between major muscle groups in human extremities. Twenty-four healthy subjects with no evidence of vascular disease were recruited. MRI was conducted on a 3.0 Tesla Siemens Trio whole body system with a transmit/receive knee coil. A nonmagnetic orthopedic tourniquet system was used to create a 5-min period of ischemia followed by a period of hyperemic flow (occlusion pressure = 250 mmHg). CASL imaging, lasting from 2 min before cuff inflation to 3 min after cuff deflation, was performed on the midcalf, midfoot, and midforearm in separate sessions from which blood flow was quantified with an effective temporal resolution of 16 s. When muscles in the same anatomic location were compared, hyperemic flow was found to be significantly higher in the compartments containing muscles known to have relatively higher slow-twitch type I fiber compositions, such as the soleus muscle in the calf and the extensors in the forearm. In the foot, the plantar flexors exhibited a slightly delayed hyperemic response relative to that of the dorsal compartment, but no between-group flow difference was observed. These results demonstrate that CASL is sensitive to flow heterogeneity between diverse muscle groups and that nonuniform hyperemic flow patterns following an ischemic paradigm correlate with relative fiber-type predominance.
PDGF-induced human airway smooth muscle cell proliferation requires STAT3 and the small GTPase Rac1
Authors: Simeone-Penney Marina C. , Severgnini Mariano , Rozo Lilliana , Takahashi Satoe , Cochran Brent H. , Simon Amy R.
Published: February 2008

The signal transducers and activators of transcription (STAT) family of transcription factors regulates a variety of biological functions including cellular proliferation, transformation, apoptosis, and differentiation. We have previously determined that PDGF activates the STAT pathway in human airway smooth muscle cells (HASMC) and that the Jak and Src kinases are required for both PDGF-induced STAT activation and HASMC proliferation. As increased airway smooth muscle (ASM) volume is associated with airflow obstruction and disease severity in patients with asthma, it is important to elucidate the cellular and molecular pathways that regulate ASM accumulation. In this paper, we investigated the requirement of STAT3 for PDGF-induced HASMC proliferation. We demonstrate that knockdown of STAT3 expression in HASMC resulted in a significant decrease in mitogen-induced cellular proliferation. Additionally, PDGF-induced activation of STAT3 required the small GTP-binding protein Rac1, and Rac1 was also required for PDGF-induced HASMC proliferation. Furthermore, PDGF treatment induced STAT3 and Rac1 to physically associate and translocate to the nucleus, identifying one mechanism by which STAT3 is regulated in response to PDGF in HASMC. Finally, we determined that STAT3 expression is required for PDGF-mediated regulation of cell cycle targets cyclin D3 and p27. These data define a novel mitogenic signaling pathway in airway smooth muscle cells leading from PDGF to Rac1 and STAT3 and subsequent cell cycle gene regulation. Thus, targeting STAT3 may prove to be a novel therapeutic approach for patients with severe asthma and significant airway wall remodeling, as manifested by ASM accumulation.
Ultrasound assessment of popliteal vein compliance during a short deflation protocol
Authors: Young Colin N. , Prasad Raju Y. , Fullenkamp Adam M. , Stillbower Michael E. , Farquhar William B. , Edwards David G.
Published: February 2008

The purpose of the present study was to determine whether ultrasound is a useful tool to measure the venous characteristics of the lower extremity during a standard venous collecting cuff deflation protocol. To accomplish this, lower extremity pressure-cross-sectional area (CSA) and pressure-volume relationships were measured in eight (25 ± 1 yr) supine subjects. Popliteal vein CSA was assessed by using high-resolution ultrasound, while calf volume changes were simultaneously assessed by using venous occlusion plethysmography (VOP). Pressure-CSA and pressure-volume relationships were assessed at baseline, during the cold pressor (CP) test, and following sublingual nitroglycerin (NTG) administration. Relationships were modeled with a quadratic regression equation, and β1and β2were used as indexes of venous compliance. Popliteal vein regression parameters β1(8.485 ± 2.616 vs. 7.638 ± 2.664, baseline vs. CP; 8.485 ± 2.616 vs. 7.734 ± 3.076, baseline vs. NTG; both P > 0.05) and β2(−0.0841 ± 0.0241 vs. −0.0793 ± 0.0242, baseline vs. CP; −0.0841 ± 0.0241 vs. −0.0771 ± 0.0280, baseline vs. NTG; both P > 0.05) were not affected by CP or NTG. Similarly, calf regression parameters β1and β2, obtained with VOP, were not altered during either trial. Intraclass correlations for venous compliance assessed with ultrasound and VOP were 0.92 and 0.97, respectively, indicating acceptable reproducibility. These data suggest that ultrasound is a functional and reproducible tool to assess the venous characteristics of the lower extremity, in addition to VOP. Additionally, popliteal vein and calf compliance were not affected by the CP test or NTG.
Effects of Hepatitis B Virus X Protein (HBx) on Cell-Growth Inhibition in a CCL13-HBx Stable Cell Line
Authors: Kuo Chan-Yen , Wang Jing-Chyi , Wu Cheng-Chung , Hsu Shih-Lan , Hwang Guang-Yuh
Published: February 2008

Objective: The known function of hepatitis B virus X protein (HBx) is to determine the fate of cells by modulating various signaling pathways. In our previous study, we demonstrated that HBx inhibits tumor formation in nude mice injected with CCL13-HBx stable cell lines; however, the mechanism underlying this inhibition is unclear. Methods: To investigate the possible mechanisms underlying HBx involvement in CCL13-HBx cells, gene profiles were initially analyzed by DNA microarray technology and subsequently confirmed by performing semiquantitative RT-PCR and Western blotting. Furthermore, the phenomenon of cell death via apoptosis was detected via DNA fragmentation, TUNEL staining, caspase-3 activity assay, and propidium iodide (PI) staining. Results: The results indicated that HBx induction downregulated Wnt-3 and β-catenin that are involved in cell proliferation. Moreover, HBx induction repressed cell growth and downregulated the expressions of cyclin D1, CDK4, cyclin E, CDK2, and cyclin B1. Furthermore, HBx induction triggered cell death via apoptosis, as determined by DNA fragmentation, TUNEL staining, caspase-3 activity assay, and PI staining. Conclusion: Most importantly, our results indicated that HBx induction in the CCL13-HBx stable cell line downregulated Wnt-3/β-catenin expression and suppressed cell growth by repressing cell proliferation or triggering cell apoptosis.
Intrafamilial Associations of Lipid Profiles and the Role of Nutrition: The Tehran Lipid and Glucose Study
Authors: Mirmiran Parvin , Mirbolooki Mohammadreza , Heydarian Peimaneh , Salehi Payam , Azizi Fereidoun
Published: February 2008

Background: The role of gene and environment in the genesis of abnormal lipid profile is still a controversial issue. Objective: To clarify the importance of certain parental risk factors associated with lipid profiles of children and adolescents. Methods: We conducted this cross-sectional population-based study in district 13 in the east of metropolitan Tehran.One hundred and thirteen eligible families comprising 455 subjects (including 229 offspring, aged 5–25 years) were enrolled into the study. Anthropometric data were measured using a standard protocol. To measure lipid profiles, venous blood was obtained in the morning after the subjects had fasted for 12–14 h overnight. Dietary intakes were assessed by means of a 2-day dietary recall questionnaire. Results: The chances of having elevated serum total cholesterol were higher in sons of fathers with high cholesterol intake (OR = 3.1; CI = 1.1–9.2) and mothers with high saturated fatty acid (SFA) intake (3.4; 1.1–10.8). Positive correlations were seen between the energy intake of fathers and serum total cholesterol of their daughters (r = 0.34, p < 0.01); between the SFA intake of fathers and serum triglycerides (TGs) of their sons (0.29, p < 0.01) and between mothers’ body mass index and daughters’ serum TGs (0.23, p < 0.03). The chances of having low serum high-density lipoprotein cholesterol were lower in sons of mothers with high carbohydrate intake (11.0; 2.8–42.8) and mothers with high serum high-density lipoprotein cholesterol (6.8; 1.7–27.0). There were higher chances of having elevated serum low-density lipoprotein cholesterol in sons with fathers having high SFA intake (4.5; 1.4–14.3), with mothers having high serum TGs (6.1; 1.3–29.0) and with mothers having high cholesterol intake (4.3; 1.2–15.2). Conclusion: The results indicate independent associations between diet contents and the lipid profiles of parents and their offspring as well as between lipid profiles and diet contents among spouses.
Interval Percutaneous Cholecystostomy Is Effective for Decompression of the Common Bile Duct in High-Risk Elderly Patients prior to Endoscopic Retrograde Cholangiopancreatography
Authors: Bar-Gil Shitrit Ariella , Braverman Dan
Published: February 2008

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is the preferred procedure for common bile duct decompression. Nevertheless, this procedure may be hazardous for high-risk elderly patients. Objective: To assess retrospectively whether interval percutaneous cholecystostomy (PC) should be considered in high-risk patients until their condition has improved and allows ERCP to be performed. Setting: Referral community teaching hospital. Patients: 8 elderly high-risk patients with acute cholangitis. Intervention: All underwent PC as a bridging procedure till performing ERCP. Results: Age ranged from 72 to 91 years (median 87). All 8 patients underwent PC. PC insertion improved their general condition and allowed us to perform an ERCP later on. Median time between PC and ERCP was 5 days. In 3 patients there was no need to perform an ERCP. All were discharged in a generally good condition and after normalization of bilirubin and liver enzymes. Median length of stay in hospital was 18 days. Conclusions: PC, as a bridging procedure to ERCP, can be an appropriate approach for selective high-risk elderly patients in whom ERCP is considered to be difficult and hazardous at the time of presentation.
Epilepsy and Dementia in the Elderly
Authors: Hommet C. , Mondon K. , Camus V. , De Toffol B. , Constans T.
Published: February 2008

Epilepsy is a frequent condition in the elderly; however, it remains a relatively understudied condition in older adults with dementia. The diagnosis of a seizure is particularly difficult and is most often based on questions to the caregiver. Epilepsy in dementia has significant consequences on the prognosis of the underlying dementia: it can result in a worsening of cognitive performance, particularly in language, as well as a reduction in autonomy, a greater risk of injury and a higher mortality rate. In this review, management strategies are recommended for the clinician. The presence of pre-existing Alzheimer’s disease does not exempt the clinician from ruling out other symptomatic causes of seizures. Anti-epileptic drugs (AED) should be started only after the diagnosis has been clearly established, when the risk of recurrence is high, and with monotherapy whenever possible. Although few data are available, the more recent AED offer significant advantages over the older medications in this context.
Pioglitazone Can Downregulate Bone Morphogenetic Protein-2 Expression Induced by High Glucose in Human Umbilical Vein Endothelial Cells
Authors: Zhang Ming , Zhou Sheng-hua , Zhao Sp , Li Xu-ping , Liu Li-Ping , Shen Xiang-Qian
Published: February 2008

Bone morphogenetic protein-2 (BMP-2) plays a key role in both vascular development and pathophysiological processes. However, the effect of high glucose on BMP-2 expression remains unclear. Here we show in human umbilical vein endothelial cells that high glucose increased BMP-2 expression, associated with NF-ĸB activation, whereas pioglitazone suppressed BMP-2 expression and NF-ĸB65 activation induced by high glucose. Furthermore, the increase in MDA levels and decrease in activities of total superoxide dismutase of cell culture stimulated by high glucose were reversed by pioglitazone treatment. Our findings indicate that BMP-2 expression induced by high glucose might be closely related to NF-ĸB activation, and both effects can be suppressed by pioglitazone.
Cell Therapy for Diabetes Mellitus: An Opportunity for Stem Cells?
Authors: Soria B. , Bedoya F.J. , Tejedo J.R. , Hmadcha A. , Ruiz-Salmerón R. , Lim S. , Martin F.
Published: February 2008

Diabetes is a chronic disease characterized by a deficit in β cell mass and a failure of glucose homeostasis. Both circumstances result in a variety of severe complications and an overall shortened life expectancy. Thus, diabetes represents an attractive candidate for cell therapy. Reversal of diabetes can be achieved through pancreas and islet transplantation, but shortage of donor organs has prompted an intensive search for alternative sources of β cells. This achievement has stimulated the search for appropriate stem cell sources. Both embryonic and adult stem cells have been used to generate surrogate β cells or otherwise restore β cell functioning. In this regard, several studies have reported the generation of insulin-secreting cells from embryonic and adult stem cells that normalized blood glucose values when transplanted into diabetic animal models. Due to β cell complexity, insulin-producing cells generated from stem cells do not possess all β cell attributes. This indicates the need for further development of methods for differentiation and selection of completely functional β cells. While these problems are overcome, diabetic patients may benefit from therapeutic strategies based on autologous stem cell therapies addressing late diabetic complications. In this article, we discuss the recent progress in the generation of insulin-producing cells from embryonic and adult stem cells, together with the challenges for the clinical use of diabetes stem cell therapy.
Aggregopathy in Neurodegenerative Diseases: Mechanisms and Therapeutic Implication
Authors: Dohm C.P. , Kermer P. , Bähr M.
Published: February 2008

Many neurodegenerative diseases such as Parkinson’s, Alzheimer’s, Huntington’s and Lou Gehrig’s disease are associated with the misfolding and aggregation of proteins. While the relevance of these aggregates for neuronal degeneration and their impact on cellular function is still a matter of debate, several experimental therapeutic approaches have been aimed at interfering with protein aggregation. In this review, we want to summarize the current understanding of aggregate formation and toxicity in neurodegenerative diseases with an emphasis on Parkinson’s disease. Furthermore, we will discuss current treatment strategies in these diseases targeting aggregate formation and concurrent neuronal cell death in these diseases.
Coordinated Investigation of Cystic Astrocytomas by Nuclear Medicine and Neuroradiological Techniques
Authors: Gilday David L. , Harwood-Nash Derek C.F.
Published: February 2008

Astrocytomas are the most common intracranial neoplasm in children. It is necessary to demonstrate preoperatively the location and extent of a possible neoplastic cyst and to differentiate it from the part that is solid. This is achieved through brain scans, computer axial tomography and angiography. Though of considerable help, brain scan and computer axial tomography are insufficient in providing the neurosurgeon with the complete character and geography of the neoplasm necessary for successful surgical treatment. Demonstration of these features can only be elucidated by contrast angiography. Consequently, the coordination of these three techniques permits the precise evaluation of the presence, nature, and operative and postoperative course of cystic astrocytomas.
Cerebral Artery Aneurysms in Infancy, Childhood and Adolescence
Authors: Amacher Loren , Drake Charles G.
Published: February 2008

From this series of 16 cerebral artery aneurysms in the paediatric age group the following points can be made: (a) aneurysms in the paediatric age group may be found in unusual locations, more peripherally than usually seen in the adult population, (b) in seven patients, the aneurysm was of giant size; two of these produced symptoms by mass effect, (c) in two patients with subacute bacterial endocarditis the aneurysm was mycotic; the inflammatory fusiform dilatation of the entire circle of Willis in one case was associated with generalized candidiasis, (d) an antecedent head injury in a child may so prejudice the initial clinical assessment that the possibility of haemorrhage from aneurysm is overlooked, and (e) gradual vertebral artery ligation, to reduce the pressure-head in fusiform aneurysms, is well tolerated by the young patient, even when done bilaterally.
Follow-Up Study of Brain Stem Tumors in Children
Authors: Villani R. , Gaini S.M. , Tomei G.
Published: February 2008

In a series of 180 patients affected by brain stem tumors, 70 cases of children up to 16 years are analyzed. Diagnosis was made with clinical examinations, neuroradiological tests and, in 20 cases, with surgical explorations. A description is made concerning the clinical status with regard to site, extension and features of the tumor. Then the authors analyze statistically the survival of such patients in connection with clinical symptomatology, the radiological picture, medical treatment, radiation and/or surgical therapy either in the few cases of subtotal removal of the tumors, or in the more numerous cases of palliative procedures such as intra- and extrathecal CSF shunting.
Intracranial Tumours in Childhood
Authors: Hooper Reginald
Published: February 2008

420 paediatric intracranial tumour cases were admitted from an area with a 2 million population in 20 years. The incidence of various groups in Melbourne is compared to similar series in Boston, Vienna, and Tokyo. The author believes that there is a remarkable uniformity in their distribution. The greater number of ependymomas in Melbourne can be due to different pathological interpretations. The higher rate of optic gliomas can be related to a higher frequency of neurofibromatosis. Myodil ventriculography followed by immediate surgery without disturbance of the child’s position on the author’s neurosurgical wheel reduces post-operative morbidity and mortality. The author uses the anterior approach to choroidal papillomas, contralateral approach to trigone tumours and occasionally posterior fossa osteoplastic flaps. Over the years, operative mortality has decreased to less than 5 % but the overall survival rate has not greatly changed, which is possibly due to the excessive ‘growth potential’ of children.
Growing Skull Fractures of Childhood
Authors: Sato Osamu , Tsugane Ryuichi , Kageyama Naoki
Published: February 2008

Four cases of growing skull fracture are presented. Pneumoencephalography done on these cases showed a moderate to extensive degree of focal ventricular dilatation beneath the skull defect. An important factor, heretofore overlooked in explaining this focal ventricular enlargement, is our hypothesis that the force exerted on the particular area of the ventricular wall represents a pulsatile CSF movement damped in the region which is liable to yield to this compression wave in the absence of covering resistant dura mater. Because of the importance of early diagnosis in order to avoid possible delayed neurologic complications such as convulsive disorders, it is advisable to carry on repeated radiological examinations of the skull following fracture in this particular age group until the fracture heals by the progressive apposition of the bone on either side of the fractured line.
An Attempt to Treat Cerebrovascular ‘Moyamoya’ Disease in Children
Authors: Suzuki Jiro , Takaku Akira , Kodama Namio , Sato So
Published: February 2008

Moyamoya formations at the base of the brain are not congenital vascular malformations but represent collateral pathways associated with chronic progressive stenosis of the carotid fork. The authors have studied 44 personal cases, 18 children under 15 years of age, and 26 adults. In children the Moyamoya vessels change through six stages: (1) carotid fork stenosis; (2) progressive carotid stenosis with initial Moyamoya collaterals and dilatations of cerebral arteries; (3) dilatation of Moyamoya collaterals and disappearance of anterior and middle cerebral arteries; (4) thinning of Moyamoya; (5) contraction of Moyamoya and disappearance of posterior cerebral arteries; (6) intracerebral vessels perfused from the external carotid and/or vertebrae. These six stages are not observed in adults. Bilateral cervical perivascular sympathectomy (PVS) was performed in 9 children and superior cervical ganglionectomy (SCG) was added unilaterally in 4 and bilaterally in 3 cases. Angiographic follow-up studies were carried out 1–7 years following surgery. Improvement was observed in most of the cases examined within the first 2 months after surgery. This was not the case in arteriograms performed more than 6 months postoperatively. It would seem that PVS and SCG can improve the progress of Moyamoya vessels but only for a short period of time. Clinical symptoms, however, seem to continue improving over a long period of time. Cerebral blood flow improved 5 weeks following surgery in a 13-year-old boy.
Communicating Hydrocephalus in Children with Genetic Inborn Errors of Metabolism
Authors: Fowler Glenn W. , Sukoff Michael , Hamilton Ann , Williams Powell
Published: February 2008

The authors have seen eight cases of communicating hydrocephalus in children with genetic metabolic disorders, namely, one mucopolysaccharidosis I (MPS I or Hurler syndrome), one MPS II (Hunter’s disease), four MPS III (Sanfilippo syndrome) two of which were siblings, and two achondroplasias. The authors recommend surgical treatment of the latter but are doubtful about the former in which case hydrocephalus is only a contributing cause to severe dementia. In MPS hydrocephalus is due to accumulation of storage material in the piaarachnoid, as indicated by RISA cisternography carried out in six cases.
Perspectives in Paediatric Neuroradiology
Authors: Harwood-Nash Derek C.F.
Published: February 2008

At The Hospital for Sick Children, there is a sufficient number of children who require neuroradiological procedures as to warrant a separate unit for Paediatric Neuroradiology. It functions within the Department of Radiology but is mostly involved with neurosurgery and neurology. Children under 15 kg in weight demand somewhat different technical procedures. Pneumoencephalography must be performed in a specially designed chair allowing isocentric position of the head, vertical 360° rotation and side-to-side movements for tomography. Percutaneous femoral catheter cerebral angiography requires very small needles, guidewires, and catheters, so that vessels of 100 µm can be demonstrated. 2:1 magnification and subtraction are esential. Myelography is used to delineate the geography and the character of the normal and abnormal central nervous system in infants. These studies permit accurate diagnosis of most neurosurgical and neurological diseases.
Advantages of the Prone Position for Neurosurgical Procedures on the Upper Cervical Spine and Posterior Cranial Fossa in Children
Authors: Humphreys R.P. , Creighton R.E. , Hendrick E.B. , Hoffman H.J.
Published: February 2008

The authors have reviewed the charts of 107 patients undergoing 119 surgical procedures in the prone position for posterior fossa or upper cervical lesions. The intraoperative complications encountered include cardiac arrhythmia, respiratory complications, cardiac arrest, hypothermia, air embolus and technical difficulties. In all but three children the problems were minor and easily remedied. The use of controlled ventilation appears to reduce blood loss, permits excellent relaxation of the exposed tissues and had some anesthetic advantages.
Expansion of Central Arachnoid Pouches
Authors: Williams Bernard , Guthkelch Norman
Published: February 2008

Three cases of central arachnoid pouches or cysts which are freely in communication with the subarachnoid space and cause hydrocephalus are reported. One case died; the second recovered following transtentorial opening of a huge cystic cavity located between the tentorium and the cerebellum, which opened into the cisterna magna. The patient was well although mentally retarded 6 years later. The third case was treated with a ventriculoatrial shunt and has fully recovered. In these cases, the shape and situation of the pouches are consistent with a process of upward movement of CSF. In the CSF waves, originating from constant variations of venous pressure, there is an obvious aetiological factor. Even if the hydrocephalus were primary and the pouch secondary, the pouch might contribute to the progression of the former by occasional compression of the aqueduct. This can be another example of the way hydrocephalus leads to its own exacerbation.
Cerebral Fluid Dynamics and Brain Regional Blood Flow in Experimental Hydrocephalus
Authors: Ransohoff Joseph , Dimattio Joseph , Hochwald Gerald , Epstein Fred
Published: February 2008

Cerebral blood flow was measured by the indicator fractionation technique in normal, acute hydrocephalic, chronic compensated hydrocephalic and craniectomized hydrocephalic cats. In the five normal cats the mean total brain blood flow was 136.1 ml/min/100 g dry weight. The six acute hydrocephalic animals demonstrated a relatively uniform 22% reduction in total blood flow. In eight chronic hydrocephalic cats CBF increased to the point where there was only an overall 7% decrease. In three hydrocephalic and craniectomized cats the CBF was reduced by 30.6%. In the acute phases there was a decrease in the number of blood vessels. Chronic compensated hydrocephalic brains had somewhat more vessels than the normal, whereas the craniectomized, massively hydrocephalic brain had a dramatic increase in both the number and caliber of blood vessels. These results clearly demonstrate that in acute obstructive hydrocephalus in cats, there is a significant decrease in CBF. The blood vessels revert to normal in shunted cats.
Percutaneous Third Ventriculostomy: Experience and Technique
Authors: Sayers Martin P. , Kosnik Edward J.
Published: February 2008

A series of stereotaxic percutaneous third ventriculostomies has been carried out on 46 shunt-dependent hydrocephalic children. The technique and results are presented. The advantages of this procedure over the open craniotomy type are discussed. There has been low morbidity and one mortality. The necessity of preoperative shunting to provide a ‘slack brain’ is emphasized.
Diagnosis and Management of Skeletal Metastases from Cerebellar Medulloblastoma
Authors: Lassman L.P.
Published: February 2008

Four cases of cerebellar medulloblastoma with skeletal metastases have been described. Extracranial metastases from this tumour are extremely rare but the skeleton is the site most commonly involved. The metastases did not occur after ventriculoatrial shunting, but in one of the cases, the diagnosis was made from the check X-ray taken on the day a shunt was introduced. The influence of vincristine sulphate and cyclophosphamide on the radiological appearances and management of the cases has been described. After the diagnosis of skeletal involvement was made three of the children survived over a year with cytotoxic drug treatment; the other case did not respond satisfactory and died from widely disseminated metastases of the central nervous system, 4 months after starting treatment.
Intracranial Pressure Monitoring in Reye’s Syndrome
Authors: Pizzi Francis J. , Schut Luis , Berman Wallace , Holzhapple William
Published: February 2008

Reye’s syndrome is defined as fatty degeneration of the viscera with encephalopathy. The signs are change in consciousness after recovery of a viral illness, vomiting, high fever, and progressive deterioration of the level of consciousness. Signs of brain stem involvement quickly follow. The clinical findings are: mild elevations of serum transaminases (SGOT and SGPT), normal to slightly elevated bilirubin, abnormal blood-clotting functions, normal to low blood glucose, high blood ammonia, and normal cerebrospinal fluid which may be under increased pressure. Death is due to increased intracranial pressure.
Pinealoma in Children
Authors: Sano Keiji
Published: February 2008

The author has a high incidence of pinealoma in his series of intracranial neoplasms. In order to make a diagnosis of pinealoma of the pineal region and of the chiasmal region, pneumoencephalography or ventriculography is very useful in addition to the neurological findings and the plain radiographic findings. The author emphasizes the usefulness of the Millipore filter-cell culture of the cerebrospinal fluid and of the ventriculofiberscopy for the diagnosis of pinealomas in children. The reported cases were treated by a combination of radiation and surgery.
Transient Loss of Recent Memory following Deep Midline Cerebral Operations
Authors: Amacher Loren
Published: February 2008

We have drawn attention to a post-operative complication of deep midline cerebral operations where operative manipulation occurs to structures associated with memory mechanisms. In the cases presented, the deficit was not permanent probably because the lesions were unilateral, or in conduction pathways.
Fetal Chiari’s Type III Malformation
Authors: de Reuck Jacques , Thienpont Louis
Published: February 2008

The morphological findings in a 4- to 5-month-old female fetus with Chiari’s type III malformation are described. This observation strongly supports the view that a defective closure of the roof plate is the primary cause of this malformation, and relates it to the Arnold-Chiari and Dandy-Walker syndromes.
Role of Computerized Axial Tomography in Diagnosis and Treatment of Common Neurosurgical Problems of Infancy and Childhood
Authors: Epstein Fred , Naidich Thomas P. , Chase Norman E. , Kricheff Irvin I. , Lin Joseph P. , Ransohoff Joseph
Published: February 2008

Computerized axial tomography (CAT) is a new, highly accurate technique for studying the skull and intracranial contents. It is rapid enough to be utilized in acute emergencies and safe enough to be utilized for routine serial follow-ups and evaluation of outpatients with equivocal findings. Because CAT can delineate the ventricular system without need for contrast agent, can distinguish clearly between hematoma and edema and can differentiate cystic from solid tumors, it finds wide application in the evaluation of neurological disease.
Primary Choroid Plexus Papilloma of the Cerebellopontine Angle Presenting as Brain Stem Tumor in a Child
Authors: Hammock M.K. , Milhorat T.H. , Breckbill D.L.
Published: February 2008

A case of a primary choroid plexus papilloma of the cerebellopontine angle in an 8-year-old female is presented. The clinical features of progressive cranial nerve palsies and cerebellar signs in the absence of intracranial hypertension initially suggested an intrinsic brain stem lesion. Whereas a radionuclide brain scan demonstrated abnormal uptake in the region of the pons, vertebral angiography and pneumoencephalography were diagnostic of an angle mass. At surgery, the tumor proved to be a choroid plexus papilloma that was totally confined to the cerebellopontine angle. This patient represents the thirteenth reported case of a primary cerebellopontine angle papilloma and the first such case occurring in a child.
Intracranial Pressure and Rapid Eye Movement Sleep in Hydrocephalus
Authors: Pierre-Kahn Alain , Gabersek Victor , Hirsch Jean-François
Published: February 2008

Intracranial pressure (ICP) was monitored for 24 h in 30 hydrocephalic patients (21 infants, 9 children) representing borderline cases. The need for surgery was uncertain because their hydrocephalus seemed to be more or less arrested. In 13 cases an electroencephalogram, an electro-oculogram, an electromyogram and an actogram were simultaneously recorded. During sleep related to a period of rapid eye movement (REM) fairly regular steep-rising waves of raised ICP recurred every 50–75 min, decreasing slowly to previous levels in 25–40 min. No concomitant clinical symptoms were exhibited. The cerebral pulse wave amplitude increased during REM sleep, but might vary during one period of REM sleep. The relationship between these raised ICP waves and an increase in cerebral blood flow occurring during REM sleep is studied.
Spinal Cord Seeding from Cerebellar Astrocytomas
Authors: Shapiro Kenneth , Shulman Kenneth
Published: February 2008

Three juvenile patients with cerebellar astrocytomas which have seeded the spinal subarachnoid space are presented. Histologic verification of the similarity between the posterior fossa tumor and its spinal implant was obtained in two of the three patients. The cerebellar tumors in all cases have been benign (grade 1), and the behavior, other than their seeding has also been indolent. Review of pertinent literature discloses no similar experience with cerebellar astrocytomas. Aggressive therapy is advocated for the rare patient with subarachnoid seeding from this benign lesion.
Hydrocephalus in Infancy and Childhood
Authors: Guidetti B. , Giuffrè R. , Palma L. , Fontana M.
Published: February 2008

A surgical series of 346 children with nontumoral hydrocephalus shunted in the period January 1957 to December 1973 is presented. The etiological factors, preoperative clinical and anatomical status of the patients, their surgical career, the reasons for revision operations and causes of death, are analyzed and discussed in relation to each of the four groups constituting the series: tetraventricular communicating hydrocephalus, triventricular hydrocephalus, obstructive hydrocephalus from ventriculocisternal block and postmeningocele or postmyelomeningocele hydrocephalus. 141 patients required 218 revision operations. 16 patients died after the first operation, 27 on revision and 38 sometime later. 41 patients were lost to follow-up. A recent clinical and instrumental review of the physical, neurological and mental status of the remaining 224 patients showed that 136 (60.7%) are well or very well, 68 (30.3%) have residual deficits likely to regress with treatment and 20 (8.9%) are severely handicapped. These long-term results and the surgical aspects of the problem are discussed in the light of the literature.
Hydrodynamics of Shunt Valves
Authors: Portnoy Harold D. , Tripp Lucius , Croissant Paul D.
Published: February 2008

A study of differential pressure valves (DPV) used in the treatment of hydrocephalus was undertaken to determine their pressure-flow characteristics and compatability with the antisiphon valve (ASV). DPV could be classified into two groups: low resistance valves (LRV) and high resistance valves (HRV). The LRV maintains intraventricular pressure (IVP) near the closing pressure (CP) of the valve by permitting a high flow whenever CP is exceeded. The HRV regulates IVP by attempting to match inflow with some point on the pressure-flow curve of the valve. These characteristics were lost unless valve outlet pressure was maintained at atmospheric pressure. This could be accomplished by using a proximal DPV with an ASV at the DPV outlet, thus converting the DPV into a gauge pressure valve and preventing the ‘siphon effect’ seen with the use of a DPV alone.
Clinical and Radioisotopic Follow-Up Study of ‘Moyamoya’
Authors: Maki Yutaka , Nakada Yoshitaka , Nose Tadao , Yoshii Yoshihiko
Published: February 2008

24 children with ‘moyamoya’ had average follow-up periods of 5 years and 9 months. The following factors were noted to influence the prognosis for mental function: early onset, repeated transient ischemic attacks followed by residual neurological deficit, symptoms suggesting bilateral or dominant hemispheric lesions, and angiographically widespread occlusion. Furthermore, radioisotopic procedures could replace angiography for follow-up studies of patients with Moyamoya.
Choroid Plexus Papilloma
Authors: Milhorat Thomas H. , Hammock Mary K. , Davis Donald A. , Fenstermacher Joseph D.
Published: February 2008

Utilizing a ventricular perfusion technique, the rate of CSF formation was determined in a 2-year-old child before and after removal of a 74 g choroid plexus papilloma from the left lateral ventricle. Preoperatively, the CSF formation rate was 1.05 + SD 0.01 ml/min (1,656 ml/day). Postoperatively, the CSF formation rate was reduced fivefold to 0.20 + SD 0.01 ml/min (288 ml/day). Whereas these data are regarded as conclusive evidence of CSF overproduction by a choroid plexus papilloma, the pathogenesis of generalized ventricular enlargement in this case was due in part to obstruction of the subarachnoid pathways.
Choroid Plexus Papilloma
Authors: Milhorat Thomas H. , Davis Donald A. , Hammock Mary K.
Published: February 2008

An electron-microscopic study of a choroid plexus papilloma from the lateral ventricle of a child revealed fine structural features typical of normal choroid plexus tissue. Utilizing the Ernst technique for demonstrating ouabain-sensitive, potassium-dependent phosphatase activity, Na-K-ATPase was localized along the basal and lateral plasmalemmas of the tumor epithelium but not along the ventricular surface (apical plasmalemma). This localization is similar to that found in normal choroid plexus epithelium of all species studied to date.
Correlation of the Response of the Flushing Device to Compression with the Clinical Picture in the Evaluation of the Functional Status of the Shunting System
Authors: Osaka Kunihiko , Yamasaki Shun , Hirayama Akihiko , Sato Noriko , Ohi Yoshiyuki , Matsumoto Satoshi
Published: February 2008

The functional status of cerebrospinal fluid shunting systems provided with flushing devices has commonly been assessed by the response of the flushing device to digital compression and a review of the clinical status of the patient. In order to study the reliability of the response of the flushing device as an indicator to shunt function, 47 hydrocephalic children with implanted shunts were studied. In 40% of these children, the flushing device was pumping well at the time of shunt obstruction, and in 50% it was not, although the patient’s clinical status was perfectly normal. Accordingly, we conclude that the flushing device is a very poor indicator of shunt functioning.
Focal Seizure Disorder Secondary to Multiple Shunt Revisions
Authors: Finney Lee , Arlant Pedro A.
Published: February 2008

A case of focal seizure disorder secondary to multiple ventricular shunt revisions is presented. The literature reviewed indicates this complication of shunting is probably due to low grade infections or bleeding at the puncture site at the time of shunt revisions.
Gamma-Encephalography in the Diagnosis of Subdural Effusions in Infancy and Childhood
Authors: Basauri L. , Zuleta A. , Palma A. , Claure H.
Published: February 2008

The results of the use of gamma-encephalography (GEG) as a diagnostic tool in a group of 28 patients with subdural effusions and 46 membranes confirmed at surgery are presented. 27 patients were submitted to bilateral surgical explorations and 1 was unilaterally explored. Positive GEG: membranes were present in 34, in 8 the test was nonconclusive and there were 4 false-negatives. Negative GEG: membranes were absent in 6, 1 case was nonconclusive and 2 were false-positive tests. Therefore, from 28 patients with 46 membranes the GEG was correct in two thirds of the cases, it was nonconclusive in 9 cases and the image did not confirm the surgical findings in 6 cases (false-positive or false-negative). The results suggest that the presence of a medium or thick membrane almost always results in a positive image, whereas the presence of a thin membrane leads to a nonconclusive result or in some cases a false-negative one. The general data from the literature correlates well with the present series.
Role of Computerized Axial Tomography in Diagnosis, Treatment and Follow-Up of Hydrocephalus
Authors: Epstein Fred , Naidich Thomas , Kricheff Irvin , Chase Norman , Lin Joseph , Ransohoff Joseph
Published: February 2008

The authors have summarized their experience in the application of computerized axial tomography to the overall management of hydrocephalus.
Growing Skull Fracture of Childhood
Authors: Ito Hiroshi , Miwa Tetsuro , Onodra Yoshihisa
Published: February 2008

It is recognized that the presence of a dural tear is essential in the development of a growing skull fracture. We present nine cases of growing skull fracture, stressing the importance of parenchymal injury beneath the skull and dural defects as pathogenic factors, and two cases which showed pathological conditions similar to those of growing skull fracture. According to our clinical analysis, all of these cases followed head trauma in the first year of life. The area of cranial defect varied in size among the individual cases but was progressive in all instances. Convulsions were the most frequent symptom. With both radiological examinations and operative findings, it is recognized that dural tears and local cerebral injury are usually severe, and various localized ventricular enlargements are always found beneath the fracture. In many cases fibrous granulation was found filling in the bone defect and adhering to the contused cortex. The mechanism of the enlarged bone defect can be explained by classifying the lesions into three groups according to the type of tissue present: (1) granulation type; (2) cyst type, and (3) mixed type. Each type prevents the bone edge from spreading out, offering a suitable means to transmit mechanical pulsations of brain and cerebrospinal fluid. The formation of granulation tissue and dense scarring is an important factor in the growing skull fracture.
Intracranial Arterial Aneurysms in Infancy and Childhood
Authors: Almeida Gilberto M. , Pindaro J. , Plese P. , Bianco Eduardo , Shibata Milton K.
Published: February 2008

Eleven cases of intracranial arterial aneurysms in patients under 15 years of age, treated from 1959 to 1976, are presented. The preponderance of aneurysms at the internal carotid artery bifurcation and the peculiarities of the defects in this location are remarkable.