bluuebunny/crossref_metadata_2025 huggingface dataset:
Systematic Review and Meta-analysis of Therapeutic Management of Upper-Limb Dysfunction in Children With Congenital Hemiplegia
Authors: Sakzewski Leanne , Ziviani Jenny , Boyd Roslyn
Published: May 2009

CONTEXT. Rehabilitation for children with congenital hemiplegia to improve function in the impaired upper limb and enhance participation may be time-consuming and costly.

OBJECTIVES. To systematically review the efficacy of nonsurgical upper-limb therapeutic interventions for children with congenital hemiplegia.

METHODS. The Cochrane Central Register of Controlled Trials, Medline, CINAHL (Cumulative Index to Nursing and Allied Health Literature), AMED (Allied and Complementary Medicine), Embase, PsycINFO, and Web of Science were searched up to July 2008. Data sources were randomized or quasi-randomized trials and systematic reviews.

RESULTS. Twelve studies and 7 systematic reviews met our criteria. Trials had strong methodologic quality (Physiotherapy Evidence Database [PEDro] scale ≥ 5), and systematic reviews rated strongly (AMSTAR [Assessment of Multiple Systematic Reviews] score ≥ 6). Four interventions were identified: intramuscular botulinum toxin A combined with upper-limb training; constraint-induced movement therapy; hand-arm bimanual intensive training; and neurodevelopmental therapy. Data were pooled for upper-limb, self-care, and individualized outcomes. There were small-to-medium treatment effects favoring intramuscular botulinum toxin A and occupational therapy, neurodevelopmental therapy and casting, constraint-induced movement therapy, and hand-arm bimanual intensive training on upper-limb outcomes. There were large treatment effects favoring intramuscular botulinum toxin A and upper-limb training for individualized outcomes. No studies reported participation outcomes.

CONCLUSIONS. No one treatment approach seems to be superior; however, injections of botulinum toxin A provide a supplementary benefit to a variety of upper-limb–training approaches. Additional research is needed to justify more-intensive approaches such as constraint-induced movement therapy and hand-arm bimanual intensive training.
Impact of Redox Cycles on Manganese, Iron, Cobalt, and Lead in Nodules
Authors: Cornu S. , Cattle J. A. , Samouëlian A. , Laveuf C. , Guilherme L. R. G. , Albéric P.
Published: May 2009

Redox processes are responsible for Fe and Mn segregation as Fe–Mn oxide coatings or nodules. These nodules are also trace element scavengers in soils. Redox processes are of particular importance in seasonally saturated soil containing naturally high concentrations of trace metals. We investigated the dynamics of Fe–Mn nodules and two associated trace elements, Co and Pb, under controlled redox conditions in a column experiment, including five columns fed with mimicked topsoil solution that was elevated in Fe and Mn. The results show that the redox conditions reached 100 mV, which was sufficient to dissolve Mn oxides and release the associated Co, while Pb was readsorbed onto nodule surfaces. The amounts of Mn and Co released into the water were small compared with the quantities stored in the nodules (<0.1% of the initial stock stored in the nodules). The redox conditions were insufficient, however, to allow Fe oxide dissolution. On the contrary, 70 to 90% of the Fe entering the column was fixed onto the nodules. In terms of an environmental threat, these results showed that Pb would not be released from soil during nodule dissolution, whereas Co, which is less toxic, would be released.
Amelioration of the Physical Properties of Slate Processing Fines using Grape Marc Compost and Vermicompost
Authors: Paradelo Remigio , Moldes Ana Belén , Barral María Teresa
Published: May 2009

The effect of grape marc compost and grape marc vermicompost on the soil physical characteristics of slate processing fines, a waste produced during the processing of slate blocks, has been evaluated in two short‐term studies. In the first study, the slate processing fines were mixed with the composts at three rates (4, 8, and 16% dry weight, equivalent to approximately 60, 120, and 240 Mg ha−1), and incubated in the laboratory for 90 d at 25°C. The increment of organic matter, available organic C and biological activity were used to explain the effect of the treatments on the soil physical properties. The compost amendment significantly increased the consistency, water holding capacity, and aggregate size and stability of the slate processing fines (P< 0.05). Water holding capacity and consistency were positively correlated to total organic C, whereas aggregate stability was correlated to hot water‐extractable C and dehydrogenase activity. The second study was a field experiment to evaluate the effect of a grape marc vermicompost on the hydraulic properties of the slate processing fines. The fines were mixed with two rates of grape marc vermicompost (4 and 8%, equivalent to approximately 60 and 120 Mg ha−1). The moisture retention characteristic curve of the slate processing fines shifted to higher values of moisture at both rates of the amendment, but the hydraulic conductivity was only increased at the highest rate. The results of both experiments suggest that the addition of organic amendments can significantly improve the physical properties of mining wastes, producing a soil‐like material which could be of use in restoration.
Nitrous Oxide Production in an Eastern Corn Belt Soil: Sources and Redox Range
Authors: Hernandez-Ramirez Guillermo , Brouder Sylvie M. , Smith Douglas R. , Van Scoyoc George E. , Michalski Greg
Published: May 2009

Nitrous oxide derived from soils is a main contributor to the greenhouse gas effect and a precursor to ozone‐depleting substrates; however, the source processes and interacting controls are not well established. This study was conducted to estimate the magnitude and source (nitrification vs. denitrification) of N2O production as affected by the form of N fertilizer, soil water content, and redox potential (Eh). Soils from continuous corn (Zea maysL.) experimental plots with a history of eight consecutive years of either side‐dressed urea–NH4NO3(UAN) or fall liquid swine manure (FM) were collected and N2O evolution was traced in both aerobic and anaerobic incubations using15N labeling. Partitioning results were highly variable but suggested that enhanced denitrification occurred after an extreme increase in soil water content (from 45 to 90% water‐filled pore space [WFPS]) while a more coupled nitrification–denitrification process drove N2O evolution at moderate water content (55% WFPS). Manured soils at high water contents registered shorter duration peaks but with higher overall N2O production rates than those observed at moderate water content (7‐d weighted average of 0.61 vs. 0.09 μg N2O kg−1soil h−1). Under anoxic conditions, manured soils showed higher N2O production rates than UAN soils (up to 336 and 145 μg N2O kg−1soil h−1, respectively) shortly after flooding, which coincided with a sharp drop in Eh (from 575 to 466 mV). Irrespective of the N source, a narrow, consistent Eh range for N2O production occurred under moderate reducing conditions (420–575 mV). These results indicate that soils receiving repeated manure application that are subject to intensive, recurrent soil rewetting events may be prone to higher N2O emissions.
Carboxyl and Phenolic Humic Fractions Affect Pinus Nigra Callus Growth and Metabolism
Authors: Muscolo Adele , Sidari Maria
Published: May 2009

A humic substance was separated into carboxyl and phenolic fractions by affinity chromatography using a weak‐base amine resin. The humic extract and its fractions were analyzed for physical and chemical characteristics. Their biological effects were compared, at concentrations of 1 and 5 mg C L−1, on the growth of callus of Pinus nigra J.F. Arnold. A higher molecular weight and a greater degree of aromaticity were observed for the unfractionated humus and carboxyl fraction than for the phenolic fraction. Spectra from 13C nuclear magnetic resonance and diffuse reflectance infrared Fourier‐transform spectroscopy showed a low content of lignin‐derived, aromatic compounds and a high amount of carboxyl C and total sugars in the carboxyl fraction. The phenolic fraction was found to contain high amounts of fatty acids as well as phenolic acids. The unfractionated humus amended only at the lower concentration (1 mg C L−1) increased the callus growth and enzyme activities. The carboxyl fraction improved the growth of calluses and increased the levels of enzymatic activities. The phenolic fraction had an inhibitory effect. Thus, the positive biological effects of the humic fractions utilized might be attributed to the relative content of specific classes of humic components, such as a high amount of peptidic, carbohydratic, and carboxylic groups, and low content of phenolic acids and fatty acids. The heterogeneity of humic substances is strongly influenced by the origin, age, and decomposition processes of parent organic materials. Therefore, the diverse amounts of chemical compounds in humus may influence the function of ecosystems in similarly diverse ways.
Abiotic Nitrate Retention in Agroecosystems and a Forest Soil
Authors: Fricks B. , Kaye J. , Seidel R.
Published: May 2009

Agricultural ecosystems are the primary source of nitrate (NO3−) pollution in many watersheds. We used a laboratory 15N tracer study with live and gamma irradiated soils to examine the role of land management in abiotic retention of NO3− in three agroecosytems and a forest soil. Nitrogen retention was defined as the quantity of 15N that remained in soil following salt extractions. Land management only affected N retention after 15 min of incubation, with forested soils retaining <4% of the added 15N and agricultural soils retaining <1%. In all four ecosystems, abiotic retention (retention in gamma irradiated soils) occurred after 1 d (15–20% of the 15N) and 21 d (up to 60% of 15N) of incubation. After 1 and 21 d, 15N retention in irradiated soils was larger than in live soils, revealing a methodological artifact associated with gamma irradiation. While our results show that abiotic reactions can occur in the laboratory, it is unlikely that such high rates of abiotic 15N retention occur in the field. Gamma irradiation appears to impart methodological artifacts that limit its use in partitioning microbial and abiotic N retention in soils.
Topsoil Properties as Affected by Tillage Systems in the Rolling Pampa Region of Argentina
Authors: Alvarez Carina R. , Taboada Miguel A. , Gutierrez Boem Flavio H. , Bono Alfredo , Fernandez Patricia L. , Prystupa Pablo
Published: May 2009

Improved topsoil structural quality is expected under no‐till farming, but soil physical constraints can develop under continuous no‐till. Our objectives were: to evaluate the properties of loam, silty loam, and silty clay loam soils under various management practices on a regional scale; to clarify the relationship between soil organic matter pools and soil physical properties; and to find a minimum set of topsoil properties to characterize trends established by tillage. Thirty‐nine loam, silty loam, and silty clay loam soils were sampled from cropped fields managed using conventional tillage (CT) and no‐till (NT) as well as six undisturbed soils (uncropped). The A horizon thickness did not differ among soil textural groups and was 4 cm thicker in uncropped soils. Total and particulate organic C were significantly affected by management (uncropped > CT = NT, P < 0.001). Soil structural instability of uncropped soils (0.317 mm) differed from CT soils (0.723 mm) but not from NT soils (0.573 mm). Soil structural instability was negatively related to total and particulate organic C, and no relation was found with the resistant organic C pool. Water infiltration rate was the only topsoil property affected by a significant texture × management interaction. Lower infiltration rates in NT silty soils were caused by platy structural forms with horizontal pores. Soil penetration resistance (0–5 cm) was 0.77 MPa higher in NT than in CT soils. A minimum set of topsoil properties to evaluate tillage management includes structural instability, total or particulate organic C, infiltration rate, and penetration resistance.
Accuracy and Precision Analysis of Chamber‐Based Nitrous Oxide Gas Flux Estimates
Authors: Venterea Rodney T. , Spokas Kurt A. , Baker John M.
Published: May 2009

Chamber‐based estimates of soil‐to‐atmosphere nitrous oxide (N2O) gas flux tend to underestimate actual emission rates due to inherently nonlinear time series data. In theory, this limitation can be minimized by adjusting measurement conditions to reduce nonlinearity and/or by using flux‐calculation (FC) schemes that account for the so‐called “chamber effect.” The current study utilizes gas transport theory and stochastic analysis to evaluate accuracy and precision of N2O flux determinations under specific soil and chamber conditions. The analysis demonstrates that measures taken to increase the absolute accuracy of flux estimates, including shorter deployment times, larger chamber heights, and nonlinear FC schemes, will also increase the variance in flux estimates to an extent that depends on errors associated with sampling techniques and analytical instrument performance. These effects, in the absence of any actual variation in fluxes, can generate coefficients of variation ranging from 3 to 70% depending on measurement conditions. It is also shown that nonlinear FC schemes are prone to generating positively skewed distributions. These effects decrease confidence in N2O flux estimates and inhibit the detection of differences arising from experimental factors. In general, a linear FC scheme will be more likely to detect relative differences in fluxes, although less accurate in absolute terms than nonlinear schemes. The techniques described here have been codified into an accessible spreadsheet‐based tool for evaluating accuracy and precision trade‐offs under specific measurement conditions.
Comparison of the Performance of Statistical Models that Predict Soil Respiration from Forests
Authors: Webster K. L. , Creed I. F. , Skowronski M. D. , Kaheil Y. H.
Published: May 2009

Soil respiration (Rs) is an important source of CO2 to the atmosphere, yet understanding the processes controlling the combined autotrophic and heterotrophic components has proven challenging. Numerous statistical models have been developed to explain Rs as a function of physical and chemical conditions, but there has been little effort to systematically evaluate and compare the performance of these different models. Soils in a sugar maple (Acer saccharum Marsh.) forest were monitored for Rs and its physical and chemical drivers, and the monitored data were used to fit the most common of these statistical models. Each model was fit using a repeated trials approach and the performance of the model was evaluated with a range of goodness‐of‐fit measures (RMSE, mean absolute error, r2, index of agreement, bias, and Akaike information criterion). An exponential model in which the exponent is a polynomial expression that is linear with respect to temperature (°C) and quadratic with respect to soil moisture (% by volume) explained 57% of the variance in Rs and performed well among the goodness‐of‐fit measures. Inclusion of C quantity and substrate quality (as measured by the C/N ratio) in the soils, however, increased the explanation of variance in Rs to 71%. This study shows that combining soil temperature and moisture drivers with soil C quantity and substrate quality significantly improves statistical models predicting soil respiration. Our findings support the comparison of the performance of different statistical models using a repeated trials approach coupled with a range of goodness‐of‐fit measures to identify controls on Rs within an ecosystem and to assess the generality of these controls on Rs across ecosystems.
The Importance of Trust in Organizational Change
Authors: H. Sorensen Ole , Hasle Peter
Published: May 2009

Trust is important for successful organizational change and, because change processes are
accelerating in contemporary organizations, trust and distrust are becoming increasingly important.
Furthermore, change events transform the established social relations and therefore they can become a
challenge to trust. Trust or distrust might therefore be different outcomes of change processes that will
affect how future organizational changes can be implemented. These issues have been explored in two
manufacturing firms where trust relations played a major role in the outcome of initiatives intended to
improve the psychosocial working environment. Change events initiated a decline in trust. The
management in one firm succeeded in introducing actions that were interpreted as trustworthy, thereby
stopping the decline in trust. The management and employees in the other firm were stuck in a stalemate
of distrust. Power disparity and uncertainty in change processes seem to compel the employees to make
perpetual interpretations of management actions to discover possible motives. Thereby, seemingly small
issues can be imbued with strong symbolic meanings that might threaten trust and hamper organizational
change. A theoretical model is presented that describes the relations between change, trust, and
interpretation.
Organizational Change Competence
Authors: Birgitte Gunhild , Ingstad Zeiner , Bakke Finne Live
Published: May 2009

Organizations of today are often dealing with successive changes. Therefore we argue that
organizations and employees would benefit from founding what we call organizational change
competence. By organizational change competence, we mean the workers’ and organization’s ability to
handle continuous successive change processes, due to the organization’s focus on the workers’
psychological reactions through these processes.We argue that by using Armenakis and Harris’s (2002)
three strategies –management of information, persuasive communication, and active participation – in
planned organizational changes, the organization can gradually develop change competence. Building
this competence might also lead the organization into what Burns (2002) has called the ‘healthy zone’
between stability and randomness. Our idea here is that the people in the organization can handle quite a
lot of change as long as they also have some kind of stability.
Understanding the Emotional Experience of Organizational Change
Authors: Giaever Fay
Published: May 2009

Although there has been a recurring interest in exploring the role played by employees`
experiences, responses and actions in association with organizational change this paper agues that one
still lacks an in-depth understanding of emotional change-experiences. The paper attempts illustrate how
the subject of emotions has typically been dealt with in the organizational and change literature, and the
assumptions that have been made, through adopting a critical perspective on the concept of resistance in
particular. It is being argued that concepts such as resistance are too general and that the role of context is
either underestimated or ignored through assuming that employees` only experience negative emotions in
association with organizational change, that resistance is caused by innate tendencies in the individual,
that resistance occur in stages and through the adoption of a top-down managerial perspective. Hence, it
is suggested a more bottom-up and deeper insight into employees` change-experiences can be provided
through exploring their specific emotional experiences, their causes and potential consequences.
Furthermore, that the contextual emotions perspective of Lazarus and colleagues (Lazarus, 1991, Lazarus
& Folkman, 1984) may contribute to and enhance our understanding of the relationship between
employees` individual emotional experiences and events, situations and social relationships associated
with organizational change.
The Role of Norms in Organizational Change Efforts
Authors: Helland Hammer Tove
Published: May 2009

Norms are taken-for-granted beliefs about how people should think and behave. This chapter
explains the role workplace norms play in organizational change projects. It presents an analysis of how
norms emerge, are developed, and become institutionalized, describes the research that shows how norms
determine behavior by shaping employees’ perceptions and interpretations of events, and explains how
norms function to facilitate and retard the effects of organizational change.
Developing a Framework for the "Why" in Change Outcomes: The Importance of Employees’ Appraisal of Changes
Authors: Nielsen Karina , Randall Raymond , Brenner Sten-Olof , Albertsen Karen
Published: May 2009

It appears that quasi-experimental approaches to the evaluation of organizational stress
management interventions do not adequately measure, or take account of, employees’ perceptions of the
interventions themselves, or the way they are implemented. This is a problem because these perceptions
may influence intervention outcomes. As a consequence, our understanding of the why these
interventions succeed or fail is somewhat limited. In this chapter we present research that attempts to fill
this gap in the literature. In the research we used measures of employees’ perceptions of process factors
such as intervention quality and sustainability within a longitudinal intervention evaluation study. In 11
intervention projects in Denmark (n=376) three types of organizational stress management interventions
were examined: individual-focused interventions, teambuilding activities and training activities. We then
analysed the data using structural equation modelling to find out whether employees’ direct appraisals of
the change processes and the intervention itself influenced the relationship between intervention exposure
and intervention outcomes. We found that employees’ perceived influence on the content of teambuilding
and training interventions was directly linked to participation in these interventions. More importantly,
participants’ appraisals of the quality of activities within an intervention and / or their perception of the
sustainability of an intervention’s impact were found to be important in the mechanisms driving
intervention outcomes. These appraisals were shown to partially mediate the relationships between i)
exposure to all types of intervention investigated and ii) interventions employee reports of behavioural
stress and job satisfaction. We examine the implications of the findings of this research for future
research and the implementation and evaluation of interventions in organisations.
Subject Index
Authors: Oystein Saksvik Per
Published: May 2009

Full text available
A Review of the Pathophysiology, Classification, and Treatment of Foot Ulcers in Diabetic Patients
Authors: Clayton Warren , Elasy Tom A.
Published: May 2009

IN BRIEF

The development of lower extremity ulcers is a well known potential complication for patients with diabetes. This article reviews the common causes of diabetic foot ulceration and discusses methods for assessment and treatment to aid providers in developing appropriate strategies for foot care in individuals with diabetes
Congenital total absence of the pericardium: A case report
Authors: Zoroufian Arezou , Shirani Shapour , Eslami Behareh , Sahebjam Mohammad
Published: May 2009

We report the case of a 52-year-old woman who presented with a several-year history of palpitation (exacerbated by emotional stress and physical activity) and recent development of atypical chest pain. An investigation was undertaken to diagnose the patient’s problem and to recommend the best possible therapy. Transthoracic echocardiography and a computerized axial tomography scan showed evidence of complete absence of the pericardium, which is a rare congenital heart defect.
Parkinson’s disease: the most common diagnostic mistakes in Lithuania
Authors: Valeikiene Vaineta , Alekna Vidmantas , Juozulynas Algirdas , Mieliauskaite Diana , Ceremnych Jelena
Published: May 2009

Parkinson’s disease (PD) belongs to group of neurodegenerative diseases. PD diagnosis is clinical, based on these signs: tremor, rigidity, bradykinesia, akinesia or hypokinesia. The aim of the work was to determine the frequency of separate clinical forms of Parkinson’s disease and difficulties at this disease diagnosis. After examining 267 patients, foreseen clinical criterion of Parkinson’s disease correspond 202 (44.0% persons) − 115 women and 87 men and for 65 patients diagnosis of PD was not confirmed, because they did not correspond with accepted criteria of Parkinson’s disease. While analyzing clinical peculiarities of disease we ascertained that rigidity-tremor form of disease prevailed for 152 (75.2%, 86 women and 66 men) patients. The rigidity form was more rare − 28 (13.9%, 13 women and 15 men). Not very frequent was a tremor form of disease -− 22 (10.9%, 16 women and 6 men) patients. According to data of our research, for almost one fourth of patients (65, 24.3%) the diagnosis of Parkinson’s disease was not confirmed after clinical examination. These patients did not correspond with clinical criteria of PD. The data of our research maintain that for almost one fourth (one fourth of what?) (24.3%) the diagnosis was incorrect. Although these patients did not correspond with accepted criteria of PD, they had been treated with antiparkinsonic medications. The PD diagnosis for them was determined only according to separate symptoms: tremor, gait alterations or memory deterioration and behaviour alternations. It must be noted, that symptoms of Wilson’s disease, MSA or brain infarction were estimated as PD. Examining patients at home, we ascertained that not all patients use prescribed L-dopa preparations. A part of patients or their relatives stopped using of this drug independently. We also made note of the fact that urinary incontinence manifested using dopamine agonist ropinirole. This side effect became significant problem for patient himself and for his relatives.
An Artificial Vision-Based Computer Interface
Authors: Gil Ángel , Márquez Miguel , Chacón Erica , Ramirez Angélica
Published: May 2009

An Artificial Vision-Based Computer Interface

An application has been developed to assist in using software applications to individuals that have null or limited mobility of their upper limbs. The system uses a Web camera for movement patterns recognition of the user's face. The image analysis allows emulating the basic functions of the computer mouse. The face detection process is carried out through the implementation of an algorithm that uses a cascade sort key of Haar-Like type. The application was developed in C++ to be used on Windows XP platform. Tryout of the application has been performed showing excellent acceptation and short time training requirements.
Determination of Dynamic Under Keel Clearance of Maneuvering Ship
Authors: Galor Wiesław
Published: May 2009

Determination of Dynamic Under Keel Clearance of Maneuvering Ship

The safety of navigation of a ship manoeuvring within port waters mainly depends on its under keel clearance (UKC). Mainly UKC depends on water level change, squatting of moving ship and heeling and wave response. The effect of these components will be determined currently than such UKC is called as dynamic under keel clearance. The paper presents an analysis of certain components of UKC to maximise of ship draft and thus to achieve the economic benefit to port and ships owner.
Analysis of Simulation Visualizations of Shipš Traffic
Authors: Gucma Stanisław , Ślączka Wojciech
Published: May 2009

Analysis of Simulation Visualizations of Shipš Traffic

In the article the problem of comparison and compatibility of the results of simulation research have been conducted on various simulators of ship's traffic with two different methods of visualization (types of visualizations) is being examined. In both cases the similar mathematical model of ships' traffic has been applied which had been verified by the methods used in marine traffic engineering. The research have been conducting on the new designed LNG terminal in Świnoujście.
Human Reliability Model
Authors: Szpytko Janusz
Published: May 2009

Human Reliability Model

The paper is focusing on reliability model of transport devices' human operator. The presented operator model is base on operation potential approach, with taken into account his features and states helping assure of safety decision-making process. The human reliability model is important for future improvement the human - machine interfaces (HMI).
Climate as a Result of the Earth Heat Reflection
Authors: Barkāns J. , Žalostība D.
Published: May 2009

Climate as a Result of the Earth Heat Reflection

The authors show that the mean global temperature - and, therefore, climate - is determined mainly by the reflected portion of the total heat received from the Sun. The heat reflected directly by infra-red radiation is insufficient for maintenance of the temperature necessary for the Earth life, since it is limited by absorption windows created by green-house gases (mainly water molecules). The deficient heat is transported by a strong vertical convective air stream - a component of the total air circulation. This heat - limited only by Newton's law - is delivered to the upper troposphere layers not containing water molecules, from where it is dissipated, practically unlimitedly, at the infra-red radiation wavelengths corresponding to cooled media. The convection, in compliance with Newton's law, creates a negative feedback, which stabilizes the processes of temperature changes on the Earth reducing them by half.
Long-term outcome following anterior cerebral artery ligation for ruptured anterior communicating artery aneurysms
Authors: Taylor William , Miller J. Douglas , Todd Nicholas V.
Published: May 2009

✓ The long-term prognosis (15 years) was determined for 17 patients who had undergone anterior cerebral artery (ACA) ligation as the sole treatment for an anterior communicating artery aneurysm. The number of early and late rebleeds was lower than expected from previously ruptured aneurysms. Late ischemia was not a major complication while late postoperative epilepsy occurred in 19% of survivors. In a review of previously published series, ACA ligation appears to have significantly reduced the rates of both early and late rebleeding. This study helps to define the late results of “conservative” operations for ruptured aneurysms.
Intratumoral oxygen pressure in malignant brain tumor
Authors: Kayama Takamasa , Yoshimoto Takashi , Fujimoto Shunichi , Sakurai Yoshiharu
Published: May 2009

✓ Oxygen pressure (pO2) in brain tumors, pO2 in brain cortex surrounding the tumors, and PaO2 were measured simultaneously during total resection in 16 patients with previously untreated brain tumors in order to detect hypoxic regions within the tumors. When the inhaled O2:N2O ratio was 1:3 under enflurane anesthesia, mean PaO2 was 109.2 ± 5.8 mm Hg, a rather high value when compared with that obtained when air is inhaled under atmospheric pressure. The simultaneously measured intratumoral pO2 and pO2 in brain cortex surrounding the tumor were 15.3 ± 2.3 and 59.8 ± 6.5 mm Hg, respectively. Each intratumoral pO2 value was significantly lower than that of pO2 in brain cortex surrounding the tumor (mean < 30 mm Hg, Wilcoxon signed rank test, p < 0.005) and influenced the oxygen effects on radiation. These results appear to confirm that there are hypoxic regions within human brain tumors. A comparison between intratumoral pO2 and either the angiographic or contrast-enhanced computerized tomography scans of the tumor vasculature disclosed no correlation.
Iopamidol myelography: morbidity in patients with previous intolerance to iodine derivatives
Authors: Ebersold Michael J. , Houser O. Wayne , Quast Lynn M.
Published: May 2009

✓ The records of 1005 patients who underwent iopamidol myelography between January and September, 1988, were reviewed. In this group, 50 patients had histories suggestive of untoward sequelae associated with iodine intake, contact, or administration. The charts of these patients were carefully reviewed, and none of them had any reactions or sequelae suggestive of toxicity or an allergic response after iopamidol myelography. It is concluded that, even in patients with a previous history suggestive of intolerance to iodine administration, iopamidol myelography is generally a safe procedure.
Shunt surgery for hydrocephalus in tuberculous meningitis: a long-term follow-up study
Authors: Palur Ravi , Rajshekhar Vedantam , Chandy Mathew J. , Joseph Thomas , Abraham Jacob
Published: May 2009

✓ Hydrocephalus is a common complication of tuberculous meningitis. Case studies of 114 patients with tuberculous meningitis and hydrocephalus, who underwent shunt surgery between July, 1975, and June, 1986, were reviewed to evaluate the long-term outcome and to outline a management protocol for these patients based on the results. Seven factors were studied in each case: 1) age at admission; 2) grade on admission (I to IV, classified by the authors: Grade I being the best and Grade IV being the worst); 3) duration of alteration of sensorium; 4) cerebrospinal fluid (CSF) cell content at initial examination; 5) CSF protein levels at initial examination; 6) number of shunt revisions required; and 7) the necessity for bilateral shunts. During a long-term follow-up period ranging from 6 months to 13 years (mean 45.6 months), the mortality rate was 20% for patients in Grade I; 34.7% for patients in Grade II; 51.9% for patients in Grade III; and 100% for patients in Grade IV. Only the grade at the time of admission was found to be statistically significant in determining final outcome (p < 0.001). Based on these results, the authors advocate early shunt surgery for Grade I and II patients. For patients in Grade III, surgery may be performed either if external ventricular drainage causes an improvement in sensorium or without selection. All patients in Grade IV should undergo external ventricular drainage and only those who show a significant change in their neurological status within 24 to 48 hours of drainage, should have shunt surgery.
Pediatric spinal epidural metastases
Authors: Klein Steven L. , Sanford Robert A. , Muhlbauer Michael S.
Published: May 2009

✓ A total of 2259 children with solid malignant tumors were treated at St. Jude Children's Research Hospital between the years 1962 and 1987. Of these, 112 (5%) developed spinal epidural metastasis with spinal cord compression during the course of their disease process. Metastatic epidural spinal cord compression was caused most commonly by Ewing's sarcoma and neuroblastoma, followed by osteogenic sarcoma, rhabdomyosarcoma, Hodgkin's disease, soft-tissue sarcoma, germ-cell tumor, Wilm's tumor, and (rarely) hepatoma. There was no significant difference in outcome between patients with small-cell tumors (neuroblastoma, Hodgkin's disease, and germ-cell tumors) who received only chemotherapy and/or radiation therapy and the patients with similar lesions who received a decompressive laminectomy alone or prior to chemotherapy and/or radiation therapy. Patients with spinal cord compression from metastatic sarcoma (Ewing's sarcoma, soft-tissue sarcoma, osteogenic sarcoma, and rhabdomyosarcoma) showed a significant improvement with decompressive laminectomy alone or before medical therapy, compared to those who received radiation therapy and/or chemotherapy without posterior decompression.

Pediatric tumors invade the spinal canal via the neural foramen, compressing the spinal cord in a circumferential manner, allowing decompressive laminectomy (posterior approach) to be an effective surgical approach. Sixty-six percent of children who had no evidence of motor or sensory function below the level of the compression became ambulatory after surgical decompression and medical treatment, regardless of tumor type.
Dopamine distribution and behavioral alterations resulting from dopamine infusion into the brain of the lesioned rat
Authors: Kroin Jeffrey S. , Kao Li Chiung , Zhang Tie Jin , Penn Richard D. , Klawans Harold L. , Carvey Paul M.
Published: May 2009

✓ In an effort to verify the “dopamine secretion hypothesis” as the mechanism responsible for the antiparkinsonian efficacy of adrenal medullary transplants into the brain, the effects of dopamine infusion into the brains of rats with unilateral substantia nigra lesions were examined. The apomorphine-induced rotation, characteristic of this animal model, was diminished after 7 days of continuous dopamine infusion (10 µg/hr) into the ipsilateral striatum, whereas intraventricular infusion was without effect. Chromatographic analysis of the dopamine distribution after 10 days of infusion into either region revealed that ipsilateral delivery of dopamine did not result in contralateral increases in dopamine content. Examination of the adjacent striatum following ipsilateral intraventricular delivery indicated that dopamine had only penetrated 1 mm. Even with intrastriatal delivery, there were still parts of the infused striatum which had below-normal levels of dopamine. The fact that striatal tissue presents a significant barrier to the penetration of dopamine is discussed in relation to adrenal medullary and fetal nigral transplants.
Pseudopsammomatous meningioma with elevated serum carcinoembryonic antigen: a true secretory meningioma
Authors: Louis David N. , Hamilton Allan J. , Sobel Raymond A. , Ojemann Robert G.
Published: May 2009

✓ A sphenoid-wing meningioma in a 60-year-old woman was accompanied by elevated serum carcinoembryonic antigen (CEA) levels, which returned to normal after removal of the tumor. Light microscopic examination revealed a secretory meningioma containing numerous pseudopsammoma bodies and a prominent vascular pattern. Immunohistochemical analysis showed the tumor cells and pseudopsammoma bodies to be CEA-positive. This case illustrates the possibility that secretory meningioma may be associated with clinically detectable secretion of CEA. The report also documents the rare occurrence of elevated serum CEA in a primary benign intracranial tumor.
Occlusion of an “accessory” distal anterior cerebral artery during treatment of anterior communicating artery aneurysms
Authors: Gibbons Kevin , Hopkins Leo N. , Heros Roberto C.
Published: May 2009

✓ Two cases are presented in which clip occlusion of a third distal anterior cerebral artery segment occurred during treatment of anterior communicating artery aneurysms. Case histories, angiograms, operative descriptions, and postmortem findings are presented. The incidence of this anomalous vessel is reviewed. Preoperative and intraoperative vigilance in determining the presence of this anomaly prior to clip placement is emphasized.
Tension pneumocephalus: treatment with controlled decompression via a closed water-seal drainage system
Authors: Arbit Ehud , Shah Jatin , Bedford Robert , Carlon Graziano
Published: May 2009

✓ The successful treatment of a patient with tension pneumocephalus by controlled decompression via external drainage is described. The advantage of the technique includes the immediate release of high pressure and the capability of maintaining constant low pressure to enable and facilitate sealing of dural tears. The method has been used in three other patients, leading to resolution of the tension pneumocephalus without recurrence or other complications.
The fastigial pressor response
Authors: Elisevich Kost , Redekop Gary
Published: May 2009

✓ A distinct vasomotor and cardioregulatory response first identified experimentally was elicited intraoperatively in a 6-year-old girl by local mechanical stimulation in the vicinity of the fastigial nucleus of the cerebellum. These findings are discussed in the light of current experimental knowledge of the anatomy and physiology of the fastigial pressor response.
Coaptation of the anterior rami of C-3 and C-4 to the upper trunk of the brachial plexus for cervical nerve root avulsion
Authors: Yamada Shokei , Peterson Gordon W. , Soloniuk Donald S. , Will A. Douglas
Published: May 2009

✓ No surgical procedure has been available to repair cervical nerve root avulsion inside the spinal canal. Results with peripheral neurotization of denervated muscles have been discouraging. The authors have performed bridge-graft coaptation in three patients with C-5 and C-6 nerve root avulsion. The components of the coaptation included the anterior primary rami of C-3 and C-4 as the donor material, the entire upper trunk as the recipient, and the sural nerve graft as the bridge. This procedure resulted in restoration of motor function in the biceps and shoulder-girdle muscles and produced improved sensation. Stimulation of the C-3 and C-4 nerve roots elicited electrical responses in the biceps and deltoid muscles that indicated nerve growth through the graft and the brachial plexus into these muscles. This reconstructive procedure is effective and should stimulate development of new approaches to treatment of cervical nerve root avulsion and proximal brachial plexopathy.
A variant of arteriovenous fistulas within the wall of dural sinuses. Results of combined surgical and endovascular therapy
Authors: Barnwell Stanley L. , Halbach Van V. , Dowd Christopher F. , Higashida Randall T. , Hieshima Grant B. , Wilson Charles B.
Published: May 2009

✓ Dural arteriovenous (AV) fistulas are thought to be acquired lesions that form in an area of thrombosis within a sinus. If the sinus remains completely thrombosed, venous drainage from these lesions occurs through cortical veins, or, if the sinus is open, venous drainage is usually into the involved sinus. Among 105 patients with dural A V fistulas evaluated over the the past 5 years, seven had a unique type of dural AV fistula in the superior sagittal, transverse, or straight sinus in which only cortical venous drainage occurred despite a patent involved sinus; the fistula was located within the wall of a patent dural sinus, but outflow was not into the involved sinus. This variant of dural AV fistulas puts the patient at serious risk for hemorrhage or neurological dysfunction caused by venous hypertension. Three patients presented with hemorrhage, one with progressive neurological dysfunction, one with seizures, and two with bruit and headaches. A combination of surgical and endovascular techniques was used to close the fistula while preserving flow through the sinus.
Management of hemorrhagic complications from preoperative embolization of arteriovenous malformations
Authors: Purdy Phillip D. , Batjer H. Hunt , Samson Duke
Published: May 2009

✓ Endovascular embolization procedures have undergone dramatic evolution and improvement in recent years. Despite these advances, controversy remains regarding the optimal role of these procedures in treating cerebral arteriovenous malformations (AVM's) and whether their purpose should be as a presurgical adjunct or as primary therapy. This controversy risks fragmentation between disciplines in the broader efforts to improve management of cerebrovascular disorders.

The authors report seven cases of life-threatening hemorrhages that occurred during staged invasive therapy for AVM's which illustrate the value of a unified team approach to optimize patient care. Each patient underwent at least one embolization procedure using polyvinyl alcohol particles, followed in two cases by the occlusion of proximal feeding vessels by platinum microcoils and in one case by the attempted detachment of an endovascular balloon. In three patients, catheter penetration into the subarachnoid space resulted in subarachnoid hemorrhage. One patient suffered rupture of a large feeding vessel during balloon inflation. The final three patients sustained intracranial hemorrhage 2 hours, 8 hours, and 5 days, respectively, following embolization. All but two patients underwent emergency craniotomy at the time of the complication. These cases underscore the advantages of interdisciplinary management optimizing decision-making and providing expeditious care when life-threatening complications develop.
Acute subdural hematoma: morbidity, mortality, and operative timing
Authors: Wilberger Jack E. , Harris Mark , Diamond Danial L.
Published: May 2009

✓ Traumatic acute subdural hematoma remains one of the most lethal of all head injuries. Since 1981, it has been strongly held that the critical factor in overall outcome from acute subdural hematoma is timing of operative intervention for clot removal; those operated on within 4 hours of injury may have mortality rates as low as 30% with functional survival rates as high as 65%. Data were reviewed for 1150 severely head-injured patients (Glasgow Coma Scale (GCS) scores 3 to 7) treated at a Level 1 trauma center between 1982 and 1987; 101 of these patients had acute subdural hematoma. Standard treatment protocol included aggressive prehospital resuscitation measures, rapid operative intervention, and aggressive postoperative control of intracranial pressure (ICP). The overall mortality rate was 66%, and 19% had functional recovery. The following variables statistically correlated (p < 0.05) with outcome: motorcycle accident as a mechanism of injury, age over 65 years, admission GCS score of 3 or 4, and postoperative ICP greater than 45 mm Hg. The time from injury to operative evacuation of the acute subdural hematoma in regard to outcome morbidity and mortality was not statistically significant even when examined at hourly intervals although there were trends indicating that earlier surgery improved outcome. The findings of this study support the pathophysiological evidence that, in acute subdural hematoma, the extent of primary underlying brain injury is more important than the subdural clot itself in dictating outcome; therefore, the ability to control ICP is more critical to outcome than the absolute timing of subdural blood removal.
Endoscopic ventricular fenestration using a “saline torch”
Authors: Heilman Carl B. , Cohen Alan R.
Published: May 2009

✓ The fiberoptic endoscope has never gained popularity among neurosurgeons although it is ideally suited for navigating within the cerebral ventricles. Recent advances in optics and miniaturization make the application of endoscopy in neurosurgery more practical. The authors report eight children who underwent ventriculoscopic fenestration of symptomatic loculated cerebrospinal fluid (CSF) collections. These CSF collections were either isolated ventricular cysts or trapped lateral ventricles secondary to obstruction at the foramen of Monro. Cyst wall dissection was carried out with a “saline torch” dissector which was introduced through a working channel in the ventriculoscope. The torch was used to coagulate vessels and to sculpt large windows in cyst walls or in the septum pellucidum. Ventriculoscope-guided cyst fenestration can be performed safely and easily under direct vision. The technique may permit simplification of shunt systems in some patients and elimination of shunts in others.
Intraoperative monitoring of the facial nerve during decompressive surgery for hemifacial spasm
Authors: Haines Stephen J. , Torres Fernando
Published: May 2009

✓ In 11 consecutive patients, intraoperative electromyographic (EMG) recordings were made from the facial muscles during microvascular decompression for hemifacial spasm. In one patient, recordings could not be obtained for technical reasons, and two patients had no abnormality. In the remaining eight patients, the abnormal response resolved before decompression in two, resolved immediately at the time of decompression in five, and failed to resolve in one. All patients were relieved of their hemifacial spasm. In the five patients whose abnormalities resolved at the time of decompression, there was a precise intraoperative correlation between decompression of the nerve and disappearance of the abnormal EMG response. In three cases, this was a useful guide to the need to decompress more than one vessel. These results confirm the findings of Mailer and Jannetta, support the use of this technique for intraoperative monitoring of facial nerve decompression procedures, and provide strong circumstantial evidence that vascular cross-compression is an important etiological factor in hemifacial spasm.