bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of Somatisers in Primary Care: Are Family Doctors Motivated?
Authors: Garcia-Campayo Javier , Sanz-Carrillo Concepcion , Yoldi-Elcid Amaya , Lopez-Aylon Rosa , Monton Carmen
Published: January 2008

Objective: The aim of this paper is to assess the attitudes of Spanish general practitioners towards somatisers and the degree of involvement that family doctors are ready to adopt in the care of these patients.

Method: A postal questionnaire on attitudes was sent to a representative sample (n = 135) of general practitioners from two health districts of the region of Aragon. Seventy (51.8%) of them returned usable questionnaires. Results: Most of the general practitioners were interested in the treatment of somatisers and considered that they should be treated at primary care level. However, when specific treatment tasks were proposed, they only accepted to act as a filter to specialised care and to care for patients with chronic functional syndromes. Additionally, they refuse to detect presenting somatisers, to prescribe psychotropic drugs or offer any psychological approach, and to avoid reinforcing abnormal illness behaviour in these patients and their families. These findings can be explained because the main emotions somatisers produce in doctors are frustration and anger. Conclusions: Family doctors need a lot more help, education and support in the management of somatisers, and psychiatrists need to provide it. Any management program for the treatment of somatisers in primary care should include methods to modify general practitioners' attitudes towards these patients.
Obsessive—Compulsive Disorder in Post-Streptococcal Infection
Authors: Monasterio Erik , Mulder Roger T. , Marshall Thomas D.
Published: January 2008

Objective: We describe the sudden onset of obsessive—compulsive symptoms fol lowing a peritoneal infection with α-haemolytic streptococci. Clinical picture: A 35–year-old woman with no past history or family history of obsessions or compulsions developed these symptoms 2 weeks after a peritoneal infection.

Treatment: The patient received 80 mg fluoxetine daily. Outcome: She responded to treatment with a progressive reduction in symptoms. Conclusions: It is suggested that these obsessions and compulsions may be related to an autoimmune response to the streptococcal infection.
Mania Associated with Codeine and Paracetamol
Authors: Orr Kenneth G.D. , Mostert Johann , Castle David J.
Published: January 2008

Objective: We describe a patient in whom a manic episode was precipitated by use of panadeine forte, a preparation containing codeine and paracetamol.

Clinical picture: The patient developed a discrete manic psychotic episode.

Treatment: The treatment consisted of cessation of the Panadeine forte and antipsychotic medication.

Outcome: The patient made a complete recovery after 1 week. Conclusions: Mania can be induced by large doses of Panadeine forte, particular ly if there is a biological predisposition.
From Consultation—Liaison Psychiatry to Psychosocial Advocacy: Maintaining Psychiatry's Scope
Authors: Smith Graeme C.
Published: January 2008

Objective: To review the status of consultation-liaison (C-L) psychiatry and the forces shaping it, and to propose strategies for dealing with the crisis in which it finds itself.

Method: A Medline search of C-L psychiatry and related terms, together with hand-searching of C-L psychiatry and psychosomatic journals and bibliographies of found articles, was used for the literature base. The experience of membership of the committees of national and international C-L psychiatry organisations and their interaction with health care administrators was used as the basis for the discussion of strategies.

Results: It is argued that patients with physical/psychiatric comorbidity and somatisation have been marginalised by application of narrow definitions of what constitutes ‘serious mental disorder’ in the public sector. Evidence is presented to support the argument that physical/psychiatric comorbidity is the most common form of psychiatric presentation in the community, that such comorbidity has serious consequences in terms of morbidity, mortality and health-care costs, and that even subthreshold psychiatric symptoms have serious implications when physical comorbidity exists.

Conclusion: It is concluded that a number of strategies, including pre-admission screening, integrated discharge planning, liaison, as well as shared care with general practitioners, advanced training in C-L psychiatry and more research to establish practice guidelines, are required if psychiatry is to remain a broad-based discipline rather than retreat to being a specialty for psychosis. Consultation-liaison psychiatrists must become the advocates for the psychosocial system.
Six-Month Outcome following a Relapse of Schizophrenia
Authors: Bergen Jenny , Hunt Glenn , Armitage Paul , Bashir Marie
Published: January 2008

Objective: To analyse clinical data on patients with schizophrenia on admission to acute care and 6 months later in order to identify factors associated with frequent hospitalisations and poor outcome.

Method: Information was collected from the medical records of 99 patients with schizophrenia consecutively admitted to acute care in hospital or by community based 24 h Crisis Teams and prospectively studied for 6 months.

Results: One-quarter of patients were being admitted to acute care within 3 months of their last hospital discharge and only 34 patients were compliant with their neuroleptic medication 3 months prior to the index admission. Twenty-one patients were managed entirely by the Crisis Teams, 27 patients received inpatient care only and the remainder ( n = 51) had both types of acute care. Six months after admission, 42 patients had been discharged and did not require further acute care, 29 patients had been re-admitted at least once and three patients had been transferred to an inpatient rehabilitation unit and, therefore, remained in hospital over the entire period. Of the remaining 25 patients, one committed suicide 2 months after discharge and the other patients were not contactable by Community Mental Health Teams at the 2 and/or 6 month follow up.

Conclusions: Some of the factors associated with relapse identified in the present study were non-compliance with medication, stress, inadequate social support and substance abuse. The poor outcome in patients with frequent relapses emphasises the need to reduce the occurrences of schizophrenic symptoms to provide a better quality of life. The 25% of patients dropping out of care soon after a relapse indicates that more should be done to engage these people in long-term treatment programs.
Familial Bipolar Disorder: Preliminary Results from the Otago Familial Bipolar Genetic Study
Authors: Edmonds Liza K. , Mosley Barbara J. , Admiraal Anita J. , Olds Robin J. , Romans Sarah E. , Silverstone Trevor , Walsh Anne E.S.
Published: January 2008

Objective: This paper outlines the methodologies used, and preliminary descriptive data collected, on a cohort of familial bipolar disorder (BPD) probands and first-degree relatives taking part in a descriptive and genetic study into familial BPD in New Zealand.

Method: Fifity-five bipolar probands and 67 first-degree relatives were interviewed using the modified Diagnostic Interview for Genetic Studies (DIGS) and Family Interview for Genetic Studies (FIGS). Data was also collated from other sources. Blood samples were taken for DNA genomic analysis.

Results: New Zealand families in which BPD segregates proved willing participants in this familial based genetic research. The methodologies used were acceptable. High rates of comorbidity were found in probands (27.3% met DSM-IV criteria for panic disorder/sub-threshold panic disorder; 12.7% for phobic disorder; 1.8% for obsessive-compulsive disorder; 9.1% for alcohol-related disorders and 7.3% for an eating disorder) and relatives (major depression 34.3%; panic disorder/sub-threshold panic disorder 12.0%; phobias 11.9% and alcohol-related disorders 11.9%). The polarity of index BPD illness was related to age of onset and frequency of comorbidity. Suicidal behaviour was common.

Conclusions: Psychiatric genetic research in New Zealand families is highly feasible. Emerging trends in the familial transmission of BPD include high rates of comorbidity, illness patterns based on polarity of index episode and frequent suicidal behaviour. Such trends will be delineated further as numbers accrue, perhaps enabling identification of more homogenous phenotypic subgroups than currently produced by diagnostic schemes.
Comment
Authors: Herrman Helen
Published: January 2008

Boyce and Tobin make an important contribution to the debate about changes in State-funded psychiatry. They emphasise the variety of ways in which the role of the psychiatrist may be shaped, and encourage a reframing of questions which more commonly have had a negative connotation about the psychiatrist's place and responsibilities.
Conceptual Foundations of Schizophrenia: I. Degeneration
Authors: Barrett Robert J.
Published: January 2008

Objective: This is the first of two papers that aim to identify some of the institutional processes of 19th century European psychiatry, and some prevailing cultural themes of that era that played a role in shaping the development of schizophrenia as a disease concept.

Method: Three areas of psychiatric history are examined: the first is concerned with the key figures who coined the concept of dementia praecox; the second with the rise of the asylum; and the third is to do with the ideology of 19th century psychiatric science and its relationship to a broader intellectual milieu. These three literatures are examined for common themes.

Results: The theme of degeneration is evident in all three literatures, and denotes both a biological process (neuro-degeneration) and a moral state (degeneracy).

Conclusions: The idea of degeneration, a pervasive cultural theme of the 19th century, dominated psychiatric thinking long before schizophrenia was developed as a diagnostic category. It contributed to the ideational form-work that gave foundation, structure and shape to the concept of schizophrenia.
Attention Deficit Hyperactivity Disorder and Anxiety: Is There an Association with Neurodevelopmental Deficits?
Authors: Vance Alasdair L. A. , Luk Ernest S. L.
Published: January 2008

Objective: The co-occurrence of attention deficit hyperactivity disorder (ADHD) and anxiety is a well-established clinical observation. However, its status as a clinical construct is debated. We review the prevalence of ‘ADHD and anxiety’, its definitions, and its clinical correlates and we hypothesise that neurodevelopmental deficits may be increased in ‘ADHD and anxiety’.

Method: The authors identified empirical studies in the psychiatric and psychological literature. The search categories included hyperactivity, attention deficit hyperactivity disorder, attention deficit disorder and anxiety.

Results: ‘ADHD and anxiety’ is considerably more common in clinical than epidemiological samples. There are a range of definitions which address the situational variation in both ADHD and anxiety symptoms and the use of categorical and continuous variables to define them. Yet the nature of the anxiety is still unclear. It is associated with a poor response to psychostimulant medication treatment, and alternative pharmacotherapy approaches have been suggested. There is a controversy about whether neurodevelopmental deficits are associated with hyperactivity alone, or anxiety, or both.

Conclusions: ‘ADHD and anxiety’ is important clinically because it is common and less responsive to psychostimulant medication. Important research issues include its heterogeneity which necessitates the collection of parent, teacher, and child self-reports of symptoms' presence or absence and the hypothesis that neurodevelopmental deficits may be increased in this group of children.
The Impact of Mental Health Service Integration on Systemic Function: A Staff Perspective
Authors: Le Bas James , King Robert , Block Michael
Published: January 2008

Objective: The purpose of this study was to investigate the perceptions of community staff regarding service process and quality, while a public mental health service integrated acute inpatient and continuing care components.

Methods: The study employed a naturalistic successive measures design in which community mental health staff completed a questionnaire on three occasions during the integration process.

Results: Staff perceived overall service quality to improve during the integration process with continuity of care being the area subject to greatest improvement.

Conclusions: The integration of acute inpatient and continuing care services resulted in changes to service process and outcome, which were judged by staff to be beneficial, especially with respect to continuity of patient care.
Risk Factors and Alzheimer's Disease: A Comparative Study of Two Communities
Authors: Hall Kathleen , Unverzagt Frederick W. , Hendrie Hugh C. , Gureje Oye , Gao Sujuan , Hui Siu L. , Ogunniyi Adesola , Oluwole Steve , Baiyewu Olusegun
Published: January 2008

Objective: To determine the association between demographic, lifestyle and medical history factors to Alzheimer's disease (AD), we studied samples of two community dwelling populations with significantly different prevalence rates of AD in Indianapolis, USA (6.24%) and Ibadan, Nigeria (1.4%).

Methods: The samples were drawn from African—American community dwelling residents 65 years of age and over in Indianapolis, and Yoruba community-dwelling residents 65 years of age and over in Ibadan. A two-stage epidemiological design was used in which diagnosis of AD was by National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association criteria.

Results: In Indianapolis, age (odds ratio [OR] = 1.16; 95% confidence interval [Cl] = 1.11-1.21), family history of dementia (OR = 5.40; 95% Cl = 1.99-14.62), low education (0-6 years, OR = 3.49; 95% Cl = 1.06-11.48) and rural residence (OR = 2.49; 95% CI = 1.05-5.88) were associated with a higher risk of AD. In Ibadan, age (OR = 1.15; 95% Cl = 1.12-1.18) and female gender (OR = 13.9; 95% Cl = 3.85-50.28) were associated with a higher risk of AD.

Conclusions: The remarkably similar odds ratios between age and AD between sites suggest that biological processes associated with ageing are essential elements in the development of AD but that genetic and environmental risk factors may alter age-specific rates. In our longitudinal study, we intend to investigate in more depth the interaction between these ageing, genetic and environmental factors.
Ethics, Duty of Care and Forensic Psychiatric Assessment: A Legal Perspective
Authors: Gaughwin Peter C.
Published: January 2008

Objective and Method: This article examines some of the ethical and legal issues which confront the psychiatrist who is asked to provide a forensic psychiatric assessment. Theory is explained and illustrated by way of a case study.

Results: Recent cases demonstrate a tendency by some psychiatrists to adopt an advocacy role in legal proceedings, to the potential disadvantage of not only those involved in the proceedings, but also to the wider community.

Conclusion: Ideally, there is a need for a greater collaborative effort between the College's Ethics Committee and this Country's Courts and Law Societies to establish and monitor an ethical framework in the area of expert psychiatric evidence.
Thermodynamic characterization of liquid alloys with demixing tendency: Bi–Ga
Authors: Huber Beatrix , Richter Klaus W. , Flandorfer Hans , Mikula Adolf , Ipser Herbert
Published: January 2008

The system Bi – Ga shows a pronounced miscibility gap in the liquid state ranging from 38.5 to 91.5 at.% Ga at 495 K with a maximum at 535 K at about 70 at.% Ga.

Heat capacities of liquid Bi – Ga alloys were determined by heat flow differential scanning calorimetry over the entire composition range at temperatures between 520 and 600 K. In order to optimize the differential scanning calorimetry measurements in the liquid state, the sample masses were increased to 250–400 mg and the heating and cooling rates were reduced to 10 or 5 K min−1, respectively. The experimental results show a positive deviation from the Neumann-Kopp rule in the composition range of the miscibility gap. The results are in good agreement with theoretical considerations.

Additionally, enthalpies of mixing were determined by drop calorimetry in the composition range from 30 to 100 at.% Ga at three different temperatures: 513, 573 and 673 K.
Nickel coating on some organic and carbon fibres by chemical plating
Authors: Li Fan , Kang Youngjo , Zhang Dengjun , Sichen Du
Published: January 2008

A new method was developed to produce nickel coated fibres, which could be used as a raw material for making lightweight electrodes in nickel based secondary batteries. Hydrazine was employed as the reducing agent, ammonia solution as a complexing agent, nickel sulphate as the source of nickel ions and ammonia – ammonium sulphate as the buffer system. While the experiments confirmed that the ammonia – ammonium sulphate system could be applied for plating nickel on viscose, polyester, polyamide and carbon fibres, viscose fibre was found to be the more suitable material. The suitable operating conditions were reported.
Solid inclusion cakes formed during pressure filtration tests of liquid aluminum alloys
Authors: Cao Xinjin
Published: January 2008

Liquid metal quality has been an important topic for aluminum alloys in both industry and academic circles. Pressure filtration, or pre-concentration techniques have been among the principal methods of measuring the contents of solid inclusions. In this work, the mutual relationships between the main variables related to liquid metal quality, filter medium, filtration process, and the formed filter cake are effectively established, based on the classic filtration theories of cake mode combined with the quantitative metallurgy of the filter cake. For the first time the specific cake resistance, formation and growth dynamics of filter cakes can be quantitatively calculated. This progress will significantly help to quantitatively understand the filtration behavior during the detection of liquid metal quality. A typical example is illustrated in this work.
Performance of Ni/YSZ cermet cathode prepared by mechanical alloying for high temperature electrolysis of water vapor (steam): effect of anode and cathode thicknesses on the efficiency of hydrogen production
Authors: Lee Sungkyu , Kang Kyoung-Hoon , Hong Hyun Seon , Yun Yong Seung , Woo Sang-Kook
Published: January 2008

Ni/YSZ (Y2O3-stabilized ZrO2) composite cathode is fabricated by high-nergy ball milling of Ni and YSZ powders for high temperature electrolysis of water vapor. Composite powder composition, time and rotation speed of ball milling were optimized by trial and error for suitable performance with maximum efficiency of fabricated cathode in high temperature electrolysis of water vapor (steam) at 800°C. The composite powders thus synthesized were characterized using various analytical tools such as X-ray diffraction, scanning electron microscopy and particle size analysis, and a self-supporting planar type unit cell was prepared with Ni/YSZ composite cathode and Pt paste anode screen-printed on each side of YSZ electrolyte disk (30 mm dia.) and then sintered at 1450°C for high temperature electrolysis. X-ray diffraction and particle size analysis results showed that the Ni/YSZ composite effectively consisted of crystalline Ni and YSZ distributed on a sub-micron scale and evenly distributed without aggregation of particles. To study the effect of anode and cathode thickness on the efficiency of the hydrogen production rate, screen-printing of anode and cathode was carried out on each side of YSZ electrolyte to three different thickness values during the fabrication of a self-supporting planar type unit cell which operated quite satisfactorily during high temperature electrolysis at 800°C: a significantly higher hydrogen production rate of 13 sccm (standard cubic centimeters per minute) was reproducibly observed for triple screen-printing of anode and cathode over each side of the YSZ electrolyte disk compared to 0.5 sccm for the single screen-printed cathode under an applied direct current of 0.7 mA cm−2. Additionally, linear increase in hydrogen production was observed with applied current for triple screen-printed electrodes in contrast to single and double screen-printed electrodes.
Herophilus, Erasistratus, Aretaeus, and Galen: ancient roots of the Bell–Magendie Law
Authors: Tomey Matthew I. , Komotar Ricardo J. , Mocco J
Published: January 2008

✓Since the early 19th century, significant controversy has persisted over the competing claims of two men, Charles Bell and François Magendie, to a pivotal discovery: that the dorsal spinal roots subserve sensation, whereas the ventral spinal roots subserve motion. However, the foundations of neuroanatomy on which Bell and Magendie built their research was formed two millennia in advance. Exploration of the work of four ancient scholars—Herophilus, Erasistratus, Aretaeus, and Galen–reveals a remarkable early appreciation of the separate neural pathways (if not the correct physiology) responsible for sensory and motor control.
The neuroanatomical plates of Guido da Vigevano
Authors: Di Ieva Antonio , Tschabitscher Manfred , Prada Francesco , Gaetani Paolo , Aimar Enrico , Pisano Patrizia , Levi Daniel , Nicassio Nicola , Serra Salvatore , Tancioni Flavio , Arosio Massimo , Rodriguez y Baena Riccardo
Published: January 2008

✓Guido da Vigevano was an Italian physician and engineer who lived in the 13th and 14th centuries. He was the first scientist who used pictures to illustrate his anatomical descriptions, developing for the first time a close relationship between anatomical studies and artistic drawings. This was further developed in the Renaissance.

In his textbook Anathomia are displayed six plates showing for the first time neuroanatomical structures and techniques: dissection of the head by means of trephination, and depictions of the meninges, cerebrum, and spinal cord. On the surface of the brain painting it is possible to recognize a vague patterning of cortical convolutions. Ventricles are also described and shown. This book constituted the first attempt in the history of neuroscience to illustrate an anatomical description with schematic pictures to achieve a better understanding of such complex structures.
Cervical spine surgery in the ancient and medieval worlds
Authors: Goodrich James Tait
Published: January 2008

✓The early historical literature on cervical spine surgery lacks printed material for review, and we can rely only on pathological material from the prehistoric period that has survived as a result of anthropological investigations. After the introduction of Egyptian and early Hellenic medicine, some written material became available. This paper reviews these materials, from both books and manuscripts, in an effort to understand the development of cervical spine surgery from the perspectives of the personalities involved and the early surgical practices used. The review thus considers the following five eras of medicine: 1) prehistoric; 2) Egyptian and Babylonian; 3) Greek and early Byzantine; 4) Middle Eastern; and 5) medieval.
Spinal lipomas: clinical spectrum, embryology, and treatment
Authors: Finn Michael A. , Walker Marion L.
Published: January 2008

✓Spinal lipomas, particularly lipomas of the conus medullaris and terminal filum, are the most common form of occult spinal dysraphism and represent a wide spectrum of disease with regard to anatomy, clinical presentation, and treatment options. These lesions, however, are united by a similar embryology and pathological mechanism by which symptoms arise.

Recently, the treatment of these lesions has generated much controversy, with some physicians advocating surgical treatment for all patients regardless of symptoms and others proposing that surgery be withheld until symptoms develop. The authors discuss lumbosacral spinal lipomas, with particular attention to the theories of their origin, anatomical and pathological features, and treatment options, including a review of current controversies.
Spinal cord transection for definitive untethering of repetitive tethered cord
Authors: Blount Jeffrey P. , Tubbs R. Shane , Wellons John C. , Acakpo-Satchivi Leslie , Bauer David , Oakes W. Jerry
Published: January 2008

✓ In certain highly selected circumstances, division of a distally nonfunctional or dysfunctional cord can be a means of definitive untethering that spares and protects more rostral neurological function and results in definitive untethering. The authors reviewed their institutional experience with such cases and evaluated the limited literature. Based on their experience, treatment can be effective in carefully selected patients who undergo spinal cord transection, and the rate of repetitive tethered spinal cord can be decreased. Although uncommon, spinal cord transection appears to be an effective therapy in carefully selected patents with symptoms of repetitive cord tethering.
Pathogenesis of Chiari malformation: a morphometric study of the posterior cranial fossa
Authors: Nishikawa Misao , Sakamoto Hiroaki , Hakuba Akira , Nakanishi Naruhiko , Inoue Yuichi
Published: January 2008

To investigate overcrowding in the posterior cranial fossa as the pathogenesis of adult-type Chiari malformation, the authors studied the morphology of the brainstem and cerebellum within the posterior cranial fossa (neural structures consisting of the midbrain, pons, cerebellum, and medulla oblongata) as well as the base of the skull while taking into consideration their embryological development. Thirty patients with Chiari malformation and 50 normal control subjects were prospectively studied using neuroimaging. To estimate overcrowding, the authors used a "volume ratio" in which volume of the posterior fossa brain (consisting of the midbrain, pons, cerebellum, and medulla oblongata within the posterior cranial fossa) was placed in a ratio with the volume of the posterior fossa cranium encircled by bony and tentorial structures. Compared to the control group, in the Chiari group there was a significantly larger volume ratio, the two occipital enchondral parts (the exocciput and supraocciput) were significantly smaller, and the tentorium was pronouncedly steeper. There was no significant difference in the posterior fossa brain volume or in the axial lengths of the hindbrain (the brainstem and cerebellum). In six patients with basilar invagination the medulla oblongata was herniated, all three occipital enchondral parts (the basiocciput, exocciput, and supraocciput) were significantly smaller than in the control group, and the volume ratio was significantly larger than that in the Chiari group without basilar invagination.

These results suggest that in adult-type Chiari malformation an underdeveloped occipital bone, possibly due to underdevelopment of the occipital somite originating from the paraxial mesoderm, induces overcrowding in the posterior cranial fossa, which contains the normally developed hindbrain. Basilar invagination is associated with a more severe downward herniation of the hindbrain due to the more severely underdeveloped occipital enchondrium, which further exacerbates overcrowding of the posterior cranial fossa.
Classification of previously unclassified cases of craniosynostosis
Authors: Chumas Paul D. , Cinalli Giuseppe , Arnaud Eric , Marchac Daniel , Renier Dominique
Published: January 2008

Cases of craniosynostosis usually fall into well-demarcated categories: those related to a syndrome or identified by a combination of suture involvement and morphological appearance. Between 1976 and 1995, 53 (3.6%) of 1474 cases in the craniofacial databank were assessed and designated as nonsyndromic but unclassifiable. The records and radiological studies obtained in these patients were retrospectively analyzed and comparisons were made with patients classified in the databank as having simple craniosynostoses.

It proved possible to divide the formerly unclassifiable cases into two groups: those with “two-suture disease” (Group A) and a “complex” group (Group B) in which more than two sutures were affected. Group A consisted of 36 cases (68%) of patients presenting with clear evidence of simultaneous involvement of two sutures but with no progression over time to suggest a more diffuse pansynostosis. Suture involvement was as follows: 17 of 36 sagittal plus one coronal; seven of 36 sagittal plus metopic; six of 36 sagittal plus one lambdoid; and six of 36 metopic plus one coronal. The only significant difference between the Group A cases and the cases of simple craniosynostoses was in the percentage requiring a second operation (24% vs. 5%, p < 0.0001).

Group B consisted of 17 cases in which the patients presented at a slightly earlier age (mean 1 year) with severe morphological changes and multiple suture involvement. At the time of surgery, six of 17 patients showed large areas of lacunae within the cranial vault, making craniectomy the only option. In Group B, 10 of 17 patients displayed bilateral lambdoid plus sagittal suture involvement resulting in marked occipital recession posteriorly, whereas anteriorly in six of these 10 patients there was a massive frontal bone associated with posteriorly located coronal sutures. In contrast, there were also four patients in Group B with bilateral coronal plus metopic involvement resulting in a small frontal bone. There was a trend toward a lower intelligence quotient and a worse morphological outcome in the patients in Group B, but again the only result attaining statistical significance when compared to the databank was the rate of second operation (37.5 vs. 5%, p < 0.0001).

“Two-suture synostosis” is a relatively straightforward condition and is treatable with standard craniosynostosis techniques. However, possibly as a result of surgical compromise when two sutures are involved, the rate of reoperation is far higher than in simple suture cases. In contrast, patients in the “complex” group presenting with severe multisuture involvement require a more tailor-made approach to their management that often entails a second procedure.
Occipital flattening in the infant skull
Authors: Lin Kant Y. , Polin Richard S. , Gampper Thomas , Jane John A.
Published: January 2008

Occipital plagiocephaly caused by lambdoid synostosis is rare. Positional flattening is more common and will most often respond to conservative measures. Surgical correction of a flat occiput is warranted if the deformity is profound. Skull molding devices may be effective for treating mild abnormalities but are ineffective in the more severe cases. An operative procedure is described that uses a microplate-reinforced median bar to provide a rigid scaffold to maintain the occipital correction. Seventy-three consecutive patients were evaluated over a 3-year period for occipital plagiocephaly. Of these individuals, only one had true lambdoid synostosis and six required surgery. There were no operative complications and cranial length was increased from 84 to 94% of age-matched controls after surgery. The need for operative intervention is rare; however, it should be based on the severity of the posterior deformity, especially when accompanied by compensatory frontal bossing, and not on the etiology of the flattening.
Carboplatin and vincristine chemotherapy for children with newly diagnosed progressive low-grade gliomas
Authors: Packer Roger J. , Ater Joanne , Allen Jeffrey , Phillips Peter , Geyer Russell , Nicholson H. Stacy , Jakacki Regina , Kurczynski Elizabeth , Needle Michael , Finlay Jonathan , Reaman Gregory , Boyett James M.
Published: January 2008

The optimum treatment of nonresectable low-grade gliomas of childhood remains undecided. There has been increased interest in the use of chemotherapy for young children, but little information concerning the long-term efficacy of such treatment. Seventy-eight children with a mean age of 3 years (range 3 months-16 years) who had newly diagnosed, progressive low-grade gliomas were treated with combined carboplatin and vincristine chemotherapy. The patients were followed for a median of 30 months from diagnosis, with 31 patients followed for more than 3 years. Fifty-eight children had diencephalic tumors, 12 had brainstem gliomas, and three had diffuse leptomeningeal gliomas. Forty-four (56%) of 78 patients showed an objective response to treatment. Progression-free survival rates were 75 ± 6% at 2 years and 68 ± 7% at 3 years. There was no statistical difference in progression-free survival rates between children with neurofibromatosis Type 1 and those without the disease (2-year, progression-free survival 79 ± 11% vs. 75 ± 6%, respectively). The histological subtype of the tumor, its location, and its maximum response to chemotherapy did not have an impact on the duration of disease control. The only significant prognostic factor was age: children 5 years old or younger at the time of treatment had a 3-year progression-free survival rate of 74 ± 7% compared with a rate of 39 ± 21% in older children (p < 0.01). Treatment with carboplatin and vincristine is effective, especially in younger children, in controlling newly diagnosed progressive low-grade gliomas.
Neuropsychological functioning before and after unilateral thalamic stimulating electrode implantation in Parkinson's disease
Authors: Tröster Alexander I. , Fields Julie A. , Wilkinson Steven B. , Busenbark Karen , Miyawaki Edison , Overman John , Pahwa Rajesh , Koller William C.
Published: January 2008

One theoretical advantage of chronic thalamic stimulation compared with thalamotomy for the treatment of refractory Parkinson's disease (PD) entails the avoidance and reversibility of potential cognitive morbidity. Support for the cognitive safety of thalamic stimulation remains largely anecdotal; empirical data are limited to the neuropsychological findings published for one small series of patients. The purpose of this study was to supplement those published findings that pertain to the mean changes in neuropsychological test scores and to extend previous findings by evaluating cognitive changes in individual cases from preoperative baseline to 4 months after electrode implantation. Nine patients with tremor-dominant, refractory PD underwent unilateral implantation of a deep brain stimulating electrode in the ventralis intermedius thalamic nucleus (five patients on their left and four patients on their right sides). A neuropsychological test battery was administered to each patient to evaluate attention, language, memory, and visuoperceptual and executive functions during their best “on” state before surgery, while on a medication regimen, and with the stimulator turned on after surgery. As a group, the patients attained significantly higher scores on word list recognition (discriminability) and delayed recall of prose passages after surgery than before surgery. In addition, there was a trend toward higher scores on a visual confrontation naming test after surgery. Examination of individual patient data indicated gains and losses in test scores exceeding two standard deviations to be very rare. Changes of one standard deviation were also relatively rare, but gains were more likely to occur than losses. These observations provide preliminary support for the cognitive safety of thalamic stimulation for PD.
Flash visual evoked potential monitoring of optic tract function during macroelectrode-based pallidotomy
Authors: Bonaroti Eugene A. , Rose Robert D. , Kondziolka Douglas , Baser Susan , Lunsford L. Dade
Published: January 2008

Posteroventral pallidotomy (PVP) has received renewed interest as an ablative procedure for the symptomatic treatment of Parkinson's disease. In previous reports, the proximity of the optic tract to the lesion target in the globus pallidus internus has resulted in the occurrence of visual field deficits in as much as 14% of patients. The authors have used intraoperative visual evoked potentials (VEPs) during PVP to reduce this risk. All procedures were performed in awake patients. Flash stimuli were delivered to each eye via fiberoptic sources. Baseline flash VEPs were recorded at O1/Cz (left visual cortex to vertex), Oz/Cz (midline visual cortex to vertex), and O2/Cz (right visual cortex to vertex) for OS, OU, and OD stimulation. Epochs were acquired before and after localization, after macroelectrode stimulation, after temporary thermal lesioning, and after permanent thermal lesioning. Forty-seven patients underwent a total of 59 procedures. Visual evoked potentials were recorded reproducibly in all patients. In 11 procedures, VEP changes were reported, including six amplitude changes (10-80%), six latency shifts (3-10 msec), and one report of “variability.” In four procedures, VEP changes prompted a change in target coordinates. One false-positive and one false-negative VEP change were encountered. The only confirmed visual deficit was a superior quadrantanopsia, present on formal fields, but clinically asymptomatic. The authors conclude that VEPs may be useful for procedures performed in the awake patient because of the lack of anesthetic-induced variability. The 1.7% visual morbidity reported here (one in 59 patients) compares favorably with other series using microelectrodes. Visual evoked potentials may be a useful monitoring technique to reduce the incidence of clinically significant visual morbidity during pallidotomy, especially during formal lesioning of the ventral pallidum adjacent to the optic tract.
Cerebral abscess as an unusual complication of coil embolization in a dural arteriovenous fistula
Authors: Zurin Adnan Abd. Rahman , Ushikoshi Satoshi , Houkin Kiyohiro , Kikuchi Yoichi , Abe Hiroshi , Saitoh Hisatoshi
Published: January 2008

This 63-year-old man presented with a right temporoparietal cortical infarction. A dural arteriovenous fistula involving the right transverse sinus was diagnosed on cerebral angiography. Transvenous embolization using detachable coils was performed; however, postembolization angiograms demonstrated retrograde filling of a cortical draining vein that was not seen on initial angiography. The patient subsequently developed a cerebral abscess in the region of the previous cortical infarction 2 months after the embolization. The abscess was successfully treated with drainage and antibiotic therapy. The authors report this case to illustrate an unusual complication associated with this procedure and the possible contribution of the cortical draining vein in the pathogenesis of the cerebral abscess.
Factors associated with survival in patients with meningioma
Authors: McCarthy Bridget J. , Davis Faith , Freels Sally , Surawicz Tanya S. , Damek Denise , Grutsch James , Menck Herman R. , Laws Edward R.
Published: January 2008

Factors affecting the survival rate in patients with meningiomas were explored using the National Cancer Database (NCDB), which includes tumors from approximately 1000 hospitals participating in the American College of Surgeons tumor registry program. Analysis included over 9000 cases diagnosed from 1985 to 1988 and 1990 to 1992. Survival estimates were computed and prognostic factors were identified using a proportional hazards model. The overall 5-year survival rate was 69% and it declined with age. This rate was 81% in patients aged 21 to 64 and 56% for patients 65 years of age or older. When patients were grouped by the histological type of their tumors, those with benign tumors had an overall 5-year survival rate of 70%, whereas the overall 5-year survival rates in patients with atypical and malignant meningiomas were 75% and 55%, respectively. Prognostic factors for benign tumors included age at diagnosis, tumor size, whether treated surgically, hospital type, and radiation therapy; for malignant tumors, age at diagnosis, whether treated surgically, and radiation therapy were statistically significant. The 5-year rate for recurrence of symptoms (regardless of the method of treatment) was 18.2% for those with benign tumors and 27.5% for those with malignant tumors. In patients whose benign tumor had been completely removed, the 5-year rate of tumor recurrence was 20.5%. Although not population-based, the NCDB has the potential for providing pertinent information regarding patient characteristics and methods of treatment for benign, as well as malignant, brain tumors.
Prognostic variables in surgery for skull base meningiomas
Authors: Lefkowitz Michael A. , Hinton David R. , Weiss Martin H. , Giannotta Steven L. , Couldwell William T.
Published: January 2008

The authors have retrospectively analyzed selected surgical and pathological observations made among a group of 20 patients harboring recurrent cranial base meningiomas in an attempt to reveal which factors may be important in predicting tumor recurrence. This cohort was compared with a group of 34 patients with cranial base meningiomas that underwent primary resection and in whom tumor recurrence has not been demonstrated over a median follow-up period of 33 months. Features analyzed included brain, cranial nerve, carotid artery, or muscle invasion as well as tumor cellularity, nucleolar prominence, cellular pleomorphism, and percentage of cells staining positive for the Ki-67 antigen. As expected, increased cellularity and tumor necrosis were relatively more prevalent in recurrent tumors. With regard to tumor type, atypical and anaplastic tumors were more common in the group of patients with recurrent tumor compared with the primary group (p < 0.02). As expected, increased cellularity was relatively more prominent in recurrent tumors. Invasion of muscle and bone (72%) was more frequently associated with recurrent tumors, suggesting that these characteristics may be important features of recurrent skull base meningiomas.
Cerebral arteriovenous oxygen difference: a predictor of cerebral infarction and outcome in patients with severe head injury
Authors: Le Roux Peter D. , Newell David W. , Lam Arthur M. , Grady M. Sean , Winn H. Richard
Published: January 2008

Jugular bulb oxygen monitoring can be used to estimate the adequacy of cerebral blood flow to support cerebral metabolism after severe head injury. In the present study, the authors studied the cerebral arteriovenous oxygen difference (AVDO2) before and after treatment in 32 head-injured patients (Glasgow Coma Scale scores ¾ 8) to examine the relationships among AVDO2 and cerebral perfusion pressure (CPP), delayed cerebral infarction, and outcome. Fifteen patients (Group A) underwent craniotomy for hematoma evacuation and 17 (Group B) received mannitol for sustained intracranial hypertension (intracranial pressure > 20 mm Hg, > 10 minutes). Radiographic evidence of delayed cerebral infarction was observed in 14 patients. Overall, 17 patients died or were severely disabled. Cerebral AVDO2 was elevated before craniotomy or mannitol administration; the mean AVDO2 for all patients before treatment was 8.6 ± 1.8 vol%. Following craniotomy or mannitol administration, the AVDO2 decreased in 27 patients and increased in five patients (mean AVDO2 6.2 ± 2.1 vol% in all patients; 6 ± 1.9 vol% in Group A; and 6.4 ± 2.4 vol% in Group B). The mean CPP was 75 ± 9.8 mm Hg and no relationship with AVDO2 was demonstrated. Before treatment, the AVDO2 was not associated with delayed cerebral infarction or outcome. By contrast, a limited improvement in elevated AVDO2 after craniotomy or mannitol administration was significantly associated with delayed cerebral infarction (Group A: p < 0.001; Group B: p < 0.01). Similarly, a limited improvement in elevated AVDO2 after treatment was significantly associated with an unfavorable outcome (Group A: p < 0.01; Group B: p < 0.001). In conclusion, these findings strongly indicate that, despite adequate cerebral perfusion, limited improvement in elevated cerebral AVDO2 after treatment consisting of either craniotomy or mannitol administration may be used to help predict delayed cerebral infarction and poor outcome after traumatic brain injury.
Facial nerve palsy produced by plasma cell granuloma
Authors: Rubio Guillermo , Guijo C. Garciá , Baez J. M.
Published: January 2008

There are many causes for peripheral facial nerve palsy, such as an isolated phenomenon occurring in a healthy person (Bell's palsy), a manifestation of a systemic illness, or a component of a more widespread neurological disease. Plasma cell granuloma is the proliferation of polyclonal, nonneoplastic plasma cells. Several cases have been reported in the literature in which plasma cell granulomas have affected the brain, lungs, gastrointestinal tract, kidneys, salivary glands, and skin. We report a case of peripheral facial nerve palsy produced by a plasma cell granuloma that was confirmed by histological and immunohistochemical studies.
Postoperative management following carpal tunnel release surgery: principles of rehabilitation
Authors: Degnan Gregory G.
Published: January 2008

The patient with an unsatisfactory result following carpal tunnel release is fortunately the exception rather than the rule. The vast majority of appropriately selected and treated patients will recover uneventfully without the need for extensive therapy. Although uncommon, the dissatisfied patient presents an extremely difficult management problem. Inasmuch as there are a number of factors that may potentially contribute to a poor result, failure to recognize and treat excessive edema and stiffness in the early postoperative period are responsible for a significant percentage of poor results. Patients with a poor result present with three basic signs or symptoms, which may occur in combination or alone. These signs and symptoms include excessive edema, stiffness, and hypersensitivity. If left untreated, these are the patients who will go on to develop persistent median nerve symptoms, stiffness, and possibly even reflex sympathetic dystrophy or sympathetically mediated pain. If identified early and placed in an appropriate therapy program, most of these patients will receive the proper treatment and will ultimately be satisfied with their result. The author presents here a protocol for the postoperative management of the patient who has undergone carpal tunnel release surgery, with emphasis on the recognition and treatment of those patients at risk for a poor result.