bluuebunny/crossref_metadata_2025 huggingface dataset:
Stabilization of Sewage Sludge Using Various Composting Processes
Authors: Mousty P. , Reneaume M. , Caille D.
Published: January 2008

Various sludge composting methods used in France are described and evaluated in terms of the daily and other factors. Simpte windrows with mechanical turning, aerated static piles, BAV aerated reactors and Siloda mechanically turned and aerated chambers are described. Capacities range from 0.5 to more than 50 dry tons of sludge per day.
Leaching From Land Disposed Municipal Compost: 4. Heavy Metals
Authors: Christensen Thomas H. , Tjell Jens Chr.
Published: January 2008

The leachates from 17 lysimeters containing composts of varying origin, age (3 and 12 months), and packing depths (15-50 cm) were monitored for a 2.5-year period. This paper reports on the results on heavy metals. The initial leachate concentrations exceeded the drinking water standards for all heavy metals studied (Cd, Ni, Co, Zn, Cu, Pb, Cr), but after one and half year of leaching (c.450 mm leachate) only Ni exceeded the standard. Ni was identified as the most serious heavy metal pollutant but was considered less critical than nitrogen compounds and organic matter previously reported in the leachate, The heavy metal leaching is only moderately affected by compost origin, compost age and packing depth. The first year of leaching released between 0.1% (Pb, Cr) and 1.9% (Ni) of the original compost heavy metal content.
Fluxes of Mercury in the Swedish Environment: Contributions From Waste Incineration
Authors: Lindqvist Oliver
Published: January 2008

The environmental fluxes of mercury are viewed and emissions of mercury compounds from combustion processes are discussed. Waste incineration is becoming one of the major sources of mercury releases to the atmosphere in many industrialized countries. A review of some recent studies of mercury distribution in flue gases in waste heat boilers shows that a large part of the mercury can be retained on fly ash from electrostatic precipitators or fabric filters. About 20-80% of the mercury is retained, depending on the temperature over the filter, and the time of residence of the flue gases in the temperature range below 600 °C before the filter. Preliminary tempering and leaching tests indicate that most of the filter-removed mercury is suitable for deposition.
Mercury Output From Garbage Incineration
Authors: Reimann Dieter O.
Published: January 2008

Domestic garbage normally contains 3-4 g Hg tonne-1. Slag and filter dust from garbage incineration contain only small quantities of mercury, which are difficult to leach. About 80-90% of the mercury in the flue gas can be bound in the washings at condensation temperatures of 60-70 °C from a wet scrubber operated at pH 0.5-1.0 in the presence of surplus chloride. In the following neutralization of the flue gas washings with lime c. 30-40% of the mercury can be bound as oxide; the degree of Hg precipitation can be increased to 99% or more by adding small quantities of the precipitating agent trimercapto-s-triazine—TMT 15.

The Bamberg Model for controlled depositation of residual materials containing concentrated pollutants consists of mixing the filter dust with neutralization sludge to produce a solid and only slightly permeable product.

The usual concentrations of mercury in garbage incineration plants do not present a danger for the operating personnel. The mercury concentration in the residual material and emission is clearly dependent upon the percentage of used batteries, which can account for over 50% of the total mercury.
Mercury Behaviour in Flue Gases
Authors: Bergström Jan G. T.
Published: January 2008

Mercury in the flue gas from waste incineration is predominantly in the vapour phase at temperatures down to 140 °C. Only a small portion of the mercury is metallic Hg°, most of it is oxidized, which has a high vapour pressure at these gas temperatures. Oxidized mercury is absorbed by fly ash and will be captured on fabric filters. By injecting fly ash and lime before a fabric filter a high degree of collection can be achieved, both for hydrochloric acid and for mercury.

Up to 90% of the mercury can become attached to the dust. By optimizing the operation and with efficient dust removal it is therefore possible to limit mercury emissions to less than 0.3 g ton-1 of incinerated waste.
Analysis of Inorganic Pollutants Emitted By the City of Paris Garbage Incineration Plants
Authors: Gounon J. , Milhau A.
Published: January 2008

The City of Paris has to eliminate 2 million tons of household garbage each year, mainly by incineration with heat recovery, and while doing so wishes to participate fully in the international struggle against acid rain and heavy metal pollution. The City has decided to determine precisely the atmospheric effluent emanating from present industrial plants, and to this effect a comprehensive monitoring campaign was undertaken. The analysis, unique in France because of the exhaustive nature and size of the facilities deployed for the purpose, covered many parameters.

The results are that (1) the HC 1 gas concentration in smoke, about 1000 mg m-3, contributing almost one-half of the fallout, was observed at a rate of 10 μg m -3 at 5 km from the plant; and (2) the total heavy metals concentration in a modern plant is about 4 mg m-3 but, excluding Zn, less than 2 mg m-3. Analyses are given for each components Pb, Cd, Zn, Cr, Cu, Ni, Ba, Co, Ag and Hg.
The Flux of Metals Through Municipal Solid Waste Incinerators
Authors: Brunner Paul H. , Mönch Hermann
Published: January 2008

In two full scale municipal solid waste incinerators, M and B, the transfer of metals and non-metals from waste to slag, to electrostatic precipitator (ESP) dust, and to flue gas was investigated. If the input of an element into the furnace M is taken as 100%, the following partitioning was observed: carbon, slag 1.6%, ESP-dust 0.4%, flue gas 98%; sulphur 34, 26, 40; fluorine 34, 39, 27; chlorine 13, 20, 67; iron 99, 1, 0.02 ; copper 89, 10, 1; zinc 51, 45, 4; lead 58, 37, 5; cadmium 12, 76, 12; mercury 4, 24, 72. The comparison of incinerators M, B and others indicates that the fate of metals during combustion, gas cooling and gas cleaning is determined by the composition of the municipal waste, the properties of the individual metals, and the operating conditions of the incinerator. In order to improve waste incineration, it is necessary to understand better the physical-chemical processes taking place in an incinerator, and to apply this knowledge to the construction and operating of such a plant.
Collection and Transport of Solid Waste in the Federal Republic of Germany
Authors: Knoch Joachim
Published: January 2008

The most important techniques for the collection and transport of household and similar solid waste in use in the F.R.G. are presented. Graphs present relationships between weight and volume of containers, collection rate, collection cost, transport distance and number of stops per 100 metres.
Using Double Liners in Landfill Design and Operation
Authors: Schevon George R. , Damas Guy
Published: January 2008

Experience with double liners at solid waste landfills in eastern states of the U.S.A. dates back to the late 1970s. Regulatory agencies at both Federal and State levels are now mandating that landfills have primary and secondary liner systems designed to prevent migration of pollutants into adjacent soil or ground and surface waters during their active lives and before the end of the landfill post closure monitoring period. Primary liners should be at least 0.76 mm (30 mil) thick flexible synthetic membranes protected by 30 cm (12 in) minimum sand layers both above and below the liner. The lower sand layer should contain a perforated discharge pipe to serve as a leak detection system. Secondary liners at the bottom of the landfill are preferably two component systems: a flexible synthetic membrane 0.76 mm (30 mil) thick over top of 90 cm (36 in) of a low permeability soil which must achieve a hydraulic conductivity of 1 × 10-7 cm s-1 or less. Liner material selection is based upon compatibility with, or resistance to, the waste stream contained and, the configuration of the landfill and critical locational factors such as soil stability and groundwater table elevations. Quality assurance/quality control during construction are essential to insure that the liner system performs up to its design specifications. Performance of double liner systems has been successful at those landfills where adequate quality assurance/quality control were known to have been exercised.
Hydraulic Conductivity At a Hazardous Waste Disposal Site: Comparison of Laboratory and Field-Determined Values
Authors: Herzog Beverly L. , Morse Walter J.
Published: January 2008

The hydraulic conductivity of fine-grained deposits from a waste disposal site in southern Illinois was determined by both laboratory and field tests. Laboratory tests on undisturbed and recompacted samples were performed in a Harvard-type miniature permeameter. Field methods included slug tests analysed by two different methods and recovery tests. Geometric means of hydraulic conductivity determined by the three field methods were similar for each of the geologic units tested. Most average laboratory-determined values were at least one order of magnitude lower than their field counterparts.

Slug tests were also conducted on angle holes in an attempt to take into account vertical fractures. Average values from field tests of the angle holes were greater than for the vertical holes, thus leading to the tentative conclusion that the vertical fractures cause the hydraulic conductivity of material to be higher than that indicated by the results from the vertical holes.

Results of this study indicate that field tests should be used as the primary method for determining hydraulic conductivity at waste disposal facilities. Laboratory tests should be used to supplement the field tests and provide information on the variability of each material type across the site.
Methane Recovery From Municipal Landfills in the U.S.a
Authors: Berenyi Eileen B. , Gould Robert N.
Published: January 2008

A telephone survey of 75 landfill gas facilities in the U.S.A. was carried out at the end of 1983. Twenty-nine of the sites were operated at the time of the questionaire and eight were under construction, the remainder were in various stages of planning. While most existing sites were in the West more than half of the planned sites were in other parts of the country. While more than half of existing sites upgraded the heat content of the gas two thirds of the plans for new facilities call for direct use of low heat content gas, primarily to generate electricity. Although most landfills in the same survey were owned and operated by public authorities nearly all of the gas facilities (87%) are operated by private firms.
Integrated Biogas Technology in the Tropics 1. Performance of Small-Scale Digesters
Authors: Polprasert C. , Edwards P. , Rajput V.S. , Pacharaprakiti C.
Published: January 2008

Experiments were conducted with pilot small-scale biogas digesters designed for the family level in developing countries. Four 3.5 m3 ferrocement digesters equipped with manually operated mixers were fed a mixture of nightsoil, water hyacinth (Eichhornia crassipes) and rice straw and operated semi-continuously at hydraulic retention times (HRT) of 30, 50 and 70 days, corresponding to organic loadings of 1.2, 0.75 and 0.53 kg m-3 day-1 of total volatile solids (TVS), respectively. Although more biogas was produced at a HRT of 30 days with respect to the unit weight of TVS, the rates of biogas and methane production within these loading rates were similar and approximately 0.283 and 0.186 m3 (kg TVS)-1 day -1, respectively. A major operational problem was excessive scum accumulation in the digester due to the low specific gravity of the plant matter substrates. A parallel batch experiment using 20-1 aspirator glass bottles yielded biogas production rates of 0.400 and 0.406 m3 (kg TVS)-1 at the end of 30 and 50 days, respectively. Manually operated biogas plants using heterogenous substrates in which plant matter is a major component may have little potential for poor farmers in developing countries.
Industrial Waste Management At the Swedish Facility in Norrtorp
Authors: Carnes Richard A. , Bergström Jan , Aittola Jussi-Pekka
Published: January 2008

The central industrial waste treatment and disposal facility located at Norrtorp, Sweden is presented. Kinds and quantity of waste, regional collection sites, path of waste through the plant, design of incinerator and operating philosophy are discussed. Emission of process water and its quality along with the continuously monitored incineration parameters is part of this paper as is a comparison of emissions from the Norrtorp operations with those from autos and other sources in the country. Start-up problems are presented along with conclusions on operations to date.
Rapid Method for Estimating Solid Wastes Generation Rate in Developing Countries
Authors: Ibiebele Dagogo D.
Published: January 2008

A rapid method for estimating the solid waste generation rate was developed and evaluated by determining the number, sizes and volumes of solid waste collection systems. For the major types of containers, a total of 480 readings at 148 locations were taken to determine the average number of days required to fill a container. The product of the determined total number of containers, their volumes, and the average density of the solid waste, divided by the product of the determined average number of days required to fill a container and the population of the study area, gave the per capita generation rate. Using this method, the generation rate in Port Harcourt, Nigeria, was 0.22 kg per person per day while the traditional, time consuming, house-to-house, volume-weight analysis methods gave 0.19 kg per person per day.
Shredded Rubber Tires as a Bulking Agent in Sewage Sludge Composting
Authors: Higgins Andrew J. , Suhr Jeffrey L. , Siddiqur Rahman M. , Singley Mark E. , Rajput Vijay S.
Published: January 2008

This study evaluated shredded rubber tires mixed with raw primary sludge to determine the optimum particle size and mix ratio for efficient composting. Of the three sizes and mix ratios tested, the 1.27-2.54 cm size and the rubber chip to sludge mix ratio of 2 : 1 were found to be optimum. Anaerobically digested and secondary biological sludges were then composted with the optimum size rubber chips. Due to their high moisture content and low C/N ratio, all three sludges required a moisture absorbing amendment and supplemental carbon. Sawdust was tested and found to be a suitable amendment. Heavy metal levels increased due to the concentrating effect as organic matter was decomposed. Rubber chips contributed zinc and iron to the finished compost. Although elevated after five cycles, the increases in zinc and iron were not high enough to limit the use of shredded rubber in composting sewage sludge.
Fate of Mutagenic Chemicals in Soil Amended Petroleum and Wood Preserving Sludges
Authors: Barbee G.C. , Brown K.W. , Donnelly K.C.
Published: January 2008

A field study using monoliths (lysimeters) of a sandy clay loam soil was conducted to assess the fate of mutagenic chemicals after refinery and wood preserving bottom sediment sludges were land treated. The Ames Salmonelialmicrosome assay* was used to determine the direct (without metabolic activation, - S9) and indirect (with metabolic activation, + S9) mutagenicity of the wastes, unamended soil, waste amended soils, and leachate. Extracts having a mutagenic ratio (MR) (MR=No. colonies from sample extract/No, colonies from DMSO solvent control) of ≥ 2 were considered positively mutagenic. Extracts of the wood preserving waste sludge without activation were non-mutagenic (MR < 2) but extracts with activation (+ S9) produced very strong indirect mutagenicity (MR = 7.9). After soil incorporation, the waste amended soil produced very strong direct (MR =8.9) and indirect (MR = 11.9) mutagenicity by day 180 and remained mutagenic (MR = 5.7, - S9; MR = 3.95, + S9) through day 350. The amount of residue in leachate from the wood preserving waste amended lysimeters was significantly greater ( P<0.05) than the unamended soil during the first 90 days after waste application, but was not different after 90 days. The leachate residue from wood preserving waste amended lysimeters in the 90-180-day period produced mutagenic responses both with (MR = 2.24 and 2.51) and without (MR = 2.29) activation. Polynuclear aromatic hydrocarbons were the main constituents identified in the leachate residues that produced a mutagenic response. Soil treatment of the refinery sludge reduced its weak indirect mutagenicity before soil incorporation (MR = 2) to non-mutagenic (MR =1.4) immediately following soil treatment. The MR of the waste amended soil increased to L7 by day 180 but by day 350 decreased to a level equal to that observed at day 0 (MR = 1.4). Leachate from the refinery amended lysimeters had significantly greater (P<0.05) amounts of organic residue than unamended lysimeters 180 to 350 days after waste application. The leachate from one refinery waste amended Ivsimeter (90-180 days after waste application) produced a mutagenic response (MR =3.16). The refinery sludge was detoxified shortly after soil treatment, but the wood preserving sludge required > 350 days to detoxify in the soil environment. The possibility exists that mobile mutagenic chemicals may leach into underlying groundwater from the treatment zone of soils amended with refinery and wood preserving sludges.
Recent Developments Using Phosphorlts-Containing Diol as a Reactive Combustion Modifier for Rigid Polyltrethane Foams-Part Iii
Authors: Lee F.T. , Green J. , Gibilisco R.D.
Published: January 2008

FR-D, a new phosphorus-containing diol has, previously, been demonstrated to be an effective combustion modifier in producing pour-in-place rigid urethane foams meeting ASTM E-84 Class I and Class II requirements. Continued developmental efforts led to optimized Class I and Class II foams which contain significantly less amount of combustion modifiers and are thus more cost effective than those reported earlier. FR-D is also suitable for spray foam applications because of its high chemical reactivity and high hydroxy number (#OH = 460). In this paper, recently developed FR-D based Class I and Class II pour as well as spray formulations along with their processing characteristics, E-84 data and foam physicals are discussed.
The Centrality of Normative Ethical Theory to Contemporary Planning Theory
Authors: Harper Thomas L. , Stein Stanley M.
Published: January 2008

Since planning is a normative activity one would expect public planning to be based on moral foundations. Unfortunately, post-WWII mainstream planning theory became divorced from ethical theory. Ironically, this cleavage reflected an erroneous shared premise—that each discipline was technical in nature and should eschew value questions. This fallacious premise is now largely rejected. Contemporary planning theory fully recognizes the inherently normative nature of public planning processes. However, it still makes little use of normative ethical theory to illuminate the issues raised by this recognition. In this article we will present a spectrum of five normative ethical theories and show how these theories provide the underlying normative foundation for six theories of planning. Thus many debates about planning theories can be understood as debates about underlying normative ethical theories
Planning Theory Education in the 1980s: Results of a Second Course Survey
Authors: Klosterman Richard E.
Published: January 2008

This paper updates a similar survey of planning theory course-outlines conducted exactly ten years ago. The paper examines the course content, required readings, and class assignments for 67 Master's courses, 17 undergraduate courses, and 6 Ph.D. courses offered by 69 Amencan and Canadian universities during the 1989-90 academic year. Like the previous study, it reveals a remarkable diversity of views on the appropriate course content and required readings for a "planning theory" course. It also indicates that while many of the most widely used readings are extremely old, there is also an increased interest in planning history, professional ethics, and alternative perspectives.
Paroxysmal Tonic Upgaze: Physiopathological Considerations in Three Additional Cases
Authors: Spalice Alberto , Parisi Pasquale , Iannetti Paola
Published: January 2008

Paroxysmal tonic upgaze of childhood has been described as a benign distinctive syndrome of abnormal ocular movement, with or without concomitant ataxia. After the first observation of four children, a further 29 patients have been reported with a wide spectrum of neurologic abnormalities such as ataxia, unsteady of gait, learning disabilities and mental retardation at follow-up. Electroencephalograms were normal in all the subjects and magnetic resonance imaging showed deficient myelination in only one patient. Recently it has been suggested that paroxysmal tonic upgaze could be a heterogeneous syndrome, ranging from a simply age-dependent manifestation to a clinical appearance of a variety of disorders affecting the corticomesencephalic loop of vertical eye movement. Moreover, it also could be an early sign of more widespread neurologic dysfunction. We describe three patients who presented paroxysmal tonic upgaze; in one, ataxia was present; in the second child, ataxia and language disorder also were observed; and in the third patient paroxysmal tonic upgaze was associated with loss of muscle tone (drop-attack-like events). On magnetic resonance imaging, a pinealoma compressing the dorsal mesencephalic region was detected. On the basis of our observations, we suggest that any insult with periaqueductal mesencephalic gray-matter involvement could be considered the basic condition for this peculiar clinical manifestation. (J Child Neurol 2000;15:15-18).
Neurotrophin-3 Levels in Cerebrospinal Fluid From Children With Bacterial Meningitis, Viral Meningitis, or Encephalitis
Authors: Mizuno Yumi , Takada Hidetoshi , Urakami Kyoko , Ihara Kenji , Kira Ryutaro , Suminoe Aiko , Ohga Shouichi , Aoki Tomonobu , Hara Toshiro
Published: January 2008

Neurotrophin-3 levels were measured in the cerebrospinal fluid of 35 patients with bacterial meningitis, viral meningitis, or encephalitis by two-site enzyme immunoassay. Elevated cerebrospinal fluid levels of neurotrophin-3 were demonstrated in 8 of 18 patients with bacterial meningitis. Follow-up examination of the eight patients at the convalescent stage showed diminished cerebrospinal fluid levels of neurotrophin-3. In contrast, none of the 17 patients with viral meningitis or encephalitis showed an elevation of neurotrophin-3 levels in cerebrospinal fluid. No relationships were observed between neurotrophin-3 levels and cerebrospinal fluid cell numbers, cerebrospinal fluid protein levels, serum C-reactive protein concentrations, or outcome in bacterial meningitis. Since neurotrophin-3 is involved in the survival of neurons and the modulation of the immune system, neurotrophin-3 could play a neuroprotective or immunomodulatory role in bacterial meningitis. (J Child Neurol 2000;15:19-21).
The Value of Partial Sleep Deprivation as a Routine Measure in Pediatric Electroencephalography
Authors: Liamsuwan Sahas , Grattan-Smith Padraic , Fagan Elizabeth , Bleasel Andrew , Antony Jayne
Published: January 2008

For more than 50 years it has been known that in patients with epilepsy, sleep markedly increases the diagnostic yield of the electroencephalogram (EEG). Sleep deprivation could have an additional activating role. Many laboratories do not use these methods routinely but reserve them for a second EEG if equivocal or negative findings are present in the initial EEG. We studied a regime of routine partial sleep deprivation without the use of hypnotic agents in 396 children younger than age 17 years who were referred for EEG with a diagnosis of epilepsy or suspected epilepsy. Sleep was achieved for the EEG in 77% (96% in the 1 month to 2 year age group, 78% in the 2 to 8 year age group, and in 64% of those more than 8 years old). In a comparison group of 72 children who had not been sleep-deprived, sleep was achieved in 44% (69% of those less than 2 years old, 27% of those between 2 and 8 years of age, and 33% of those older than 8 years). The differences were highly significant. The regime was well tolerated. Routine partial sleep deprivation is a practical and effective method of obtaining sleep and thus maximizing the information obtained from a single EEG. (J Child Neurol 2000;15:26-29).
The Influence of Premorbid Language Skills and Behavior on Language Recovery in Children With Verbal Auditory Agnosia
Authors: Klein Susan K. , Tuchman Roberto F. , Rapin Isabelle
Published: January 2008

Previous studies of children with Landau-Kleffner syndrome and related language-epilepsy syndromes have focused on the relationship of seizure control to language recovery. We examined the effect of premorbid language skills and behavior, as well as some characteristics of clinical seizures and electroencephalograms, on language recovery in a retrospective study of 67 children with the severe receptive and expressive language disorder, verbal auditory agnosia. Fifty-eight percent of these children had seizures, 76% were autistic, and 24% had a history of language regression after showing previously normal language skills. The duration of language loss was not influenced by the persistence of clinical seizures. Premorbid language and behavior were more predictive of language recovery in these children. Most children with normal early language (acquired verbal auditory agnosia) had onset of language loss after age 3 years, in contrast to those with abnormal early language. Children with acquired verbal auditory agnosia were more likely to show fluctuations in language skills than those in other groups. Autistic children were more likely to begin having seizures before age 3 years, and had a longer duration of language loss and lower educational placement at time of last follow-up than those with normal behavior. This study emphasizes the importance of assessing premorbid language and behavior in predicting recovery of language skills in children with language-epilepsy syndromes. (J Child Neurol 2000;15:36-43).
Single Photon Emission Computed Tomographic Evaluation of Brainstem Release Phenomenon and Seizure in Neonates
Authors: Alfonso Israel , Papazian Oscar , Litt Richard , Meyer Keith , Paez Julio
Published: January 2008

We report the ictal brain single photon emission computed tomographic (SPECT) findings in two neonates. One neonate had hypoxic-ischemic encephalopathy, a disorganized discontinuous electroencephalogram (EEG) background, lethargy, seizures, and brainstem release phenomena. A brain SPECT was performed during a brainstem release phenomenon characterized by a 34-second sustained tonic posture of the right arm and chewing. It did not reveal focal cerebral hemisphere hyperfusion. The second neonate had hemimegalencephaly, low-voltage irregular EEG background, and seizures. A brain SPECT was performed during a seizure characterized by a 32-second sustained tonic posture of the right arm. It revealed focal hyperperfusion in the posterior region of the left hemisphere. The brain SPECT findings in these patients indicate that despite clinically similar events, brainstem release phenomena and seizures have different perfusion characteristics, and refute the theory that brainstem release phenomena are due to epileptic foci in the cerebral hemispheres undetectable by EEG. (J Child Neurol 2000;15:56-58).
Syncope as a First Sign of Seizure Disorder
Authors: Aysun Sabiha , Apak Anil
Published: January 2008

We studied the long-term follow-up of patients with the diagnosis of "syncope of unknown origin," and their progression to epilepsy to gain a better understanding of the relationship between syncope and epilepsy, and to determine whether findings of the first syncopal attack have prognostic significance in relationship to the onset of epilepsy or not. Eighteen patients with the diagnosis of syncope of unknown origin were evaluated for the possibility of becoming epileptic during a 4-year period, and four patients showed characteristic seizure disorder. There were no clinical or laboratory features that differentiated them from the nonepileptic group, except that they were all girls. The interval between the first syncopal attack and the typical epileptic seizure ranged between 7 and 19 months. Syncope of unknown origin could be the first sign of an epileptic disorder, especially in girls. Long-term follow-up extending up to 1 year is necessary to disclose the risk of becoming epileptic. (J Child Neurol 2000;15:59-61).
Acute Quadriplegic Myopathy in a 17-Month-Old Boy
Authors: Salviati Leonardo , Laverda Anna Maria , Zancan Lucia , Fanin Marina , Angelini Corrado , Meznaric-Petrusa Mija
Published: January 2008

Acute quadriplegic myopathy is a rare condition associated with the use of nondepolarizing muscle-blocking agents and corticosteroids in the course of severe systemic illness. A 17-month-old boy underwent liver transplantation for fulminant hepatitis. He was intubated for 24 days and treated with vecuronium bromide and high-dose methylprednisolone. The child was weaned from the ventilator and presented extreme weakness in the upper limbs and total paralysis of the lower limbs. Serum creatine kinase level was normal and electromyography showed myopathic abnormalities. Muscle biopsy showed severe type-1 fiber atrophy and selective loss of myosin thick filaments was seen on electron microscopy. Scattered regenerating fetal myosin-positive fibers were present, μ calpain was absent, while m calpain was diffusely expressed. Physical therapy was immediately started and the child recovered even though corticosteroids were not discontinued. The pathogenesis of acute quadriplegic myopathy is still unknown. We suggest that it could be due to abnormal protein turnover in the muscle. Several independent factors, such as corticosteroid treatment, immobilization, or cytokines, could take part in a cascade of events that leads to an excessive yet selective degradation of proteins involving myosin thick filaments and possibly components of sarcolemma, causing muscle inexcitability. (J Child Neurol 2000;15:63-66).
Encephalopathy as the Presenting Symptom of Hashimoto's Thyroiditis
Authors: Watemberg Nathan , Willis Dale , Pellock John M.
Published: January 2008

In recent years, encephalopathy has increasingly been recognized as a complication of Hashimoto's thyroiditis. It can begin abruptly as a stroke-like event, acute seizures, or confusion, or as an insidious decline in cognitive function. Most reported cases have been on adult patients, although this encephalopathy does affect children as well. This form of encephalopathy should be considered in the differential diagnosis of children and adults with unexplained neurologic deterioration. We describe the case of a child in whom acute encephalopathy was the presenting symptom of Hashimoto's thyroiditis. (J Child Neurol 2000;15:66-69).
Intrathecal Baclofen for Management of Spastic Cerebral Palsy: Multicenter Trial
Authors: Gilmartin Richard , Bruce Derek , Storrs Bruce B. , Abbott Rick , Krach Linda , Ward John , Bloom Karen , Brooks William H. , Johnson Dennis L. , Madsen Joseph R. , McLaughlin John F. , Nadell Joseph
Published: January 2008

Intrathecal baclofen infusion has demonstrated effectiveness in decreasing spasticity of spinal origin. Oral antispasticity medication is minimally effective or not well tolerated in cerebral palsy. This study assessed the effectiveness of intrathecal baclofen in reducing spasticity in cerebral palsy. Candidates were screened by randomized, double-blind, intrathecal injections of baclofen and placebo. Responders were defined as those who experienced an average reduction of 1.0 in the lower extremities on the Ashworth Scale for spasticity. Responders received intrathecal baclofen via the SynchroMed System and were followed for up to 43 months. Fifty-one patients completed screening and 44 entered open-label trials. Lower-extremity spasticity decreased from an average baseline score of 3.64 to 1.90 at 39 months. A decrease in upper-extremity spasticity was evidenced over the same study period. Forty-two patients reported adverse events. Most common reports were hypotonia, seizures (no new onset), somnolence, and nausea or vomiting. Fifty-nine percent of the patients experienced procedural or system-related events. Spasticity in patients with cerebral palsy can be treated effectively by continuous intrathecal baclofen. Adverse events, although common, were manageable. (J Child Neurol 2000;15:71-77).
Tuberous Sclerosis Complex and Epilepsy: Prognostic Significance of Electroencephalography and Magnetic Resonance Imaging
Authors: Husain Aatif M. , Foley Catherine M. , Legido Agustin , Chandler Darryl A. , Miles Daniel K. , Grover Warren D.
Published: January 2008

Tuberous sclerosis complex is a disease that affects many organs, including the central nervous system. Nervous system involvement in the form of hamartomas often results in seizures. In this study we wanted to determine the outcome of epilepsy in tuberous sclerosis complex and determine whether interictal electroencephalograms (EEGs) and hamartoma burden as seen with magnetic resonance imaging (MRI) are predictive of degree of seizure control. The study population consisted of 30 patients. For each patient two sets of EEG and MRI data, separated by at least 12 months, and information on seizure frequency at time of data collection were obtained. Sensitivity, specificity, and positive and negative predictive values of various EEG and MRI findings were determined. Seizure control improved in 20 and worsened in 10 patients. In relation to seizure control, the specificity of an abnormal sleep EEG and the positive predictive value of normal sleep EEG were 100%. MRI and EEG background were neither sensitive nor specific for predicting seizure control. A majority of children with tuberous sclerosis complex can achieve good seizure control. The sleep EEG is helpful in predicting eventual seizure control. (J Child Neurol 2000;15:81-83).
Hot Water Epilepsy: A Benign and Unrecognized Form
Authors: Ioos Christine , Fohlen Martine , Villeneuve Nathalie , Badinand-Hubert Nicole , Jalin Claude , Cheliout-Heraut Fawzia , Pinard Jean-Marc
Published: January 2008

Hot water epilepsy is a reflex epilepsy. Seizures are provoked by hot water, and result from the association of both cutaneous and heat stimuli. Described mainly in India and Japan, the condition seems to be rare in Europe, where it occurs in young children. We report five infants aged from 6 months to 2 years. They had brief seizures during bathing with activity arrest, hypotonia, and vasoactive modification; clonic movements were observed. A simple treatment—decreasing the bath temperature—can be sufficient. Sometimes an antiepileptic drug is required. Seizure course and psychomotor development are favorable. Hot water epilepsy is a benign form of epilepsy. Its incidence could be underestimated because of confusion with febrile convulsions, vagal fits, or aquagenic urticaria. ( J Child Neurol 2000;15:125-128).
Fatality From Hepatitis A in a Child Taking Valproate
Authors: Fayad Michel , Choueiri Roula , Mikati Mohamad
Published: January 2008

We report an 8-year-old boy with complex partial seizures due to congenital stroke, treated with valproate for more than 3 years (the last 2 years were on monotherapy) with no complications during that period except for transient thrombocytopenia. His sister had uncomplicated hepatitis A. One month later, the patient became jaundiced, went into fulminant hepatic failure, and quickly became encephalopathic despite discontinuation of valproate, aggressive supportive therapy, and treatment with carnitine. He then died. He had positive hepatitis A IgM; other causes for acute hepatitis were ruled out. Liver pathology revealed distended hepatocytes with cholestasis and microvesicular changes. We could find in the literature two other articles on four cases who developed liver failure with hepatitis A while on valproate. All those cases, however, recovered. In our patient a usually benign disease became deadly, probably because of the concomitant use of a hepatotoxic medication. Immunizing, with hepatitis A vaccine, all children on valproate therapy who are living in, or traveling to, endemic areas should be considered and is probably advisable. ( J Child Neurol 2000;15:135-136).
Vigabatrin as a First-Choice Drug in the Treatment of West Syndrome
Authors: Fejerman Natalio , Cersósimo Ricardo , Caraballo Roberto , Grippo Jorge , Corral Susana , Martino Raúl H. , Martino Gabriel , Aldao Maria , Caccia Pedro , Retamero Mirta , Cristina Macat Maria , Di Blasi Marcelo A. , Adi J.
Published: January 2008

This is a prospective study designed to evaluate the efficacy and safety of vigabatrin as first-choice monotherapy in infants with West syndrome. One hundred sixteen patients with newly diagnosed West syndrome were studied in Argentina, from June 1994 to April 1998. The follow-up ranged from 17 to 40 months (mean, 23 months). Vigabatrin was administered upon diagnosis, starting with a 50-mg/kg/day dose and increasing 50 mg/kg every 48 hours to reach a maximum dose of 200 mg/kg/day. Twenty-nine percent of cases were considered to be cryptogenic or idiopathic West syndrome, while 70.7% were symptomatic. Response to vigabatrin treatment was measured according to five categories: (1) seizures free: 61.8% of cases for cryptogenic and 29.3% for symptomatic West syndrome, (2) more than 75% reduction in the number of infantile spasms: 14.7% for cryptogenic and 26.8% for symptomatic West syndrome, (3) from 50% to 74% reduction in the number of infantile spasms: 11.8% for cryptogenic and 24.4% for symptomatic West syndrome, (4) poor or null response: 11.8% for cryptogenic and 18.3% for symptomatic West syndrome, and (5) increase in the number of infantile spasms: one symptomatic case (1.2%). All seizure-free cryptogenic cases showed normal neuropsychic development. The most effective dose of vigabatrin was 150 mg/kg of body weight per day. The most frequent adverse events were somnolence in 19 cases and irritability in 15 cases, but none required treatment interruption. (J Child Neurol 2000;15:161-165).
Nocturnal Acute Laryngospasm in Children: A Possible Epileptic Phenomenon
Authors: Cohen Herman A. , Barzilai Asher , Lahat Eli
Published: January 2008

Respiratory difficulties are not uncommon during epileptic activity in all age groups. Laryngospasm, as an isolated manifestation of epileptic disorder, is a rare phenomenon described previously in only two patients. We report our experience with five children in whom nocturnal laryngospasm was the only clinical manifestation of their epileptic disorder. All children underwent extensive work-up and the diagnosis was made by sleep-deprived electroencephalography (two cases) and sleep study (three cases). All patients were treated with carbamezapine with prompt resolution of their laryngospasm. ( J Child Neurol 2000;15:202-204).
A Case of Late Infantile Neuronal Ceroid Lipofuscinosis Associated With Precocious Puberty
Authors: Aysun Sabiha , Apak R. Arul , Küçükali Türkan
Published: January 2008

Neuronal ceroid lipofuscinosis is one of the heredodegenerative diseases for which clinical and neuropathologic findings are well documented. We present a patient with late infantile neuronal ceroid lipofuscinosis with true precocious puberty; to our knowledge, this association has not been reported before. The association could be due to an underlying disturbance of hypothalamic-pituitary gonadal function, or to coincidence. ( J Child Neurol 2000;15:204-205).
Acute Pediatric Rhabdomyolysis
Authors: Watemberg Nathan , Leshner Robert L. , Armstrong Brent A. , Lerman-Sagie Tally
Published: January 2008

Rhabdomyolysis is a relatively common condition that may occur intermittently in chronic and inflammatory myopathy, muscular dystrophy, and metabolic myopathy. Rhabdomyolysis can also present acutely in otherwise healthy individuals. The list of etiologies for acute muscle cell lysis is enormous, with new causes described yearly. Series on acute pediatric rhabdomyolysis have not yet been published. This article describes a retrospective review of children admitted to the authors' institution during an 8-year period in whom rhabdomyolysis was recognized as a complication during their hospital stay. Patients with intermittent or relapsing rhabdomyolysis were excluded. Nineteen children were identified. Trauma (five cases), nonketotic hyperosmolar coma (two cases), viral myositis (two cases), dystonia (two cases), and malignant hyperthermia-related conditions (two cases) were the most common causes of rhabdomyolysis. Acute renal failure was the most frequent complication, occurring in 42% of cases. The mean age of renal failure patients was 13.9 years, compared to 8 years for non-renal failure children. Careful assessment of the initial urinalysis would have suggested a diagnosis of rhabdomyolysis in 9 of 16 patients tested. ( J Child Neurol 2000;15:222-227).
Concomitant Bihemispheric Cerebral Ganglioglioma and Hemangioma in an 18-Month-Old Child: Case Report
Authors: Kogler Andrej , Talan-Hranilovic Jasna , Bozic Boris , Kogler Jana
Published: January 2008

This is a rare case of concomitant bihemispheric cerebral ganglioglioma and hemangioma in an 18-month-old child. There were two identical processes; a combination of ganglioglioma and hemangioma was located in the parieto-occipital region of both cerebral hemispheres. The child underwent diagnostic computed tomographic and magnetic resonance imaging examinations for seizures and right-sided facial palsy, which showed the bilateral presence of parieto-occipital, oval, well-demarcated, subcortically located processes. A biparieto-occipital craniotomy was carried out and two well-demarcated abnormalities were observed and both were removed in toto. Two years after the operation, the boy had normal psychomotor development and remained free from seizures with no therapy required. Repeat magnetic resonance imaging showed no tumor recurrence. Gangliogliomas are relatively uncommon tumors in childhood, located in the supratentorial compartment and usually associated with seizures. Histopathologic and immunohistochemical analysis of the two processes found in our patient showed them to be a ganglioglioma and a hemangioma, confirming the dysontogenetic origin of these alterations and the association between malformations and tumor growth. The combination of ganglioglioma and hemangioma, especially bilateral presentation of two such identical processes in a young child, is very rare and was not found in the recent literature. ( J Child Neurol 2000;15:244-248).
Familial Idiopathic West Syndrome
Authors: Reiter Edith , Tiefenthaler Monika , Freilinger Michael , Bemert Günther , Seidl Rainer , Hauser Erwin
Published: January 2008

Two families, each with occurrence of West syndrome in two siblings, are presented. Monozygotic twins in family 1 developed infantile spasms at the age of 4 months. Two female siblings in family 2 started to have seizures at the age of 6 months, but 2 years apart. The family history; development prior to West syndrome; clinical, electroencephalographic, and neuro-radiologic findings; diagnostic work-up; and treatment are described. The outcome in family 1 (follow-up after 2 years) showed no conspicuous findings on physical and neurologic examination, and psychomotor development appropriate to cognitive, motor, and language developmental age in both twins. In family 2 (follow-up after 3 and 5 years), the older sister only was one standard deviation below mean in intellectual developmental age. Simultaneous occurrence of infantile spasms in both siblings from these two families but with variable clinical expression suggests there is a genetic susceptibility and variable phenotypic expression. Long-term follow-up will demonstrate whether these cases may be classified as "familial idiopathic West syndrome." ( J Child Neurol 2000;15:249-252).
Analgesic-Induced Headaches in a 17-Month-Old Infant
Authors: Piña-Garza Jesús Eric
Published: January 2008

This is a case report of a 17-month-old infant with 8 weeks of constant headache, which resulted from the daily ingestion of analgesics. ( J Child Neurol 2000;15:261).
Children With Stroke: Polymorphism of the MTHFR Gene, Mild Hyperhomocysteinemia, and Vitamin Status
Authors: Cardo Esther , Monrós Eugènia , Colomé Catrina , Artuch Rafael , Campistol Jaume , Pineda Mercè , Vilaseca M. Antònia
Published: January 2008

The aim of this study was to investigate a possible association among the thermolabile polymorphism, nucleotide 677 cytosine to thymidine point mutation (677 C→T) of the methylenetetrahydrofolate reductase (MTHFR) gene, hyperhomocysteinemia, serum folate, vitamins B12 and B6, and stroke in children. Allele and genotype frequencies for the 677 C→T polymorphism in 21 children with stroke and 28 healthy children of the same age were studied. No differences in allelic frequency were detected between the two populations. However, the prevalence of homozygous 677 C→T was doubled in the stroke population (28.6%) compared to the healthy group (14.3%). Total plasma homocysteine (tHcy) levels were significantly increased in children aged 2 months to 15 years with stroke compared to reference values. No association was observed between the homozygous genotype (T/T) and hyperhomocysteinemia, nor between the T/T genotype and low folate levels (below the 95th percentile) in this group of patients. Vitamin concentrations in patients were not significantly different from reference values. Significant negative correlations were found between tHcy and folate and between tHcy and cobalamin, but not between tHcy and B6 concentrations. In summary, a higher prevalence of hyperhomocysteinemia and the 677 C→T polymorphism were observed in children with stroke, but were not always associated. The systematic study of both abnormalities in children with stroke is recommended, so that hyperhomocysteinemia of any genetic origin can be corrected with vitamin supplementation. Moreover, the 677 C→T genotype is a strong factor for predisposition to hyperhomocysteinemia and recurrent risk of stroke that might also be prevented with folate supplementation. ( J Child Neurol 2000;15:295-298).