bluuebunny/crossref_metadata_2025 huggingface dataset:
Treating Acute Stress Disorder and Posttraumatic Stress Disorder with Cognitive Behavioral Therapy or Structured Writing Therapy: A Randomized Controlled Trial
Authors: van Emmerik Arnold A.P. , Kamphuis Jan H. , Emmelkamp Paul M.G.
Published: January 2008

Background: Writing assignments have shown promising results in treating traumatic symptomatology. Yet no studies have compared their efficacy to the current treatment of choice, cognitive behavior therapy (CBT). The present study evaluated the efficacy of structured writing therapy (SWT) and CBT as compared to a waitlist control condition in treating acute stress disorder (ASD) and posttraumatic stress disorder (PTSD). Methods: A randomized controlled trial was conducted at an outpatient clinic. Participants (n = 125) (a) satisfied DSM-IV criteria for ASD or PTSD, (b) were 16 years or older, (c) were sufficiently fluent in Dutch or English, (d) had no psychiatric problems except ASD or PTSD that would hinder participation or required alternative clinical care, and (e) received no concurrent psychotherapy. Treatment consisted of five 1.5-hour sessions of CBT or SWT for participants with ASD or acute PTSD and ten 1.5-hour sessions for participants with chronic PTSD. Outcome measures included the Structured Clinical Interview for DSM-IV, Impact of Event Scale, Beck Depression Inventory, State-Trait Anxiety Inventory and the Dissociative Experiences Scale. Results: At posttest and follow-up, treatment was associated with improved diagnostic status and lower levels of intrusive symptoms, depression and state anxiety, while a trend was noted for the reduction of avoidance symptoms. Treatment did not result in lower levels of trait anxiety or dissociation. No differences in efficacy were detected between CBT and SWT. Conclusions: The present study confirmed the efficacy of CBT for ASD and PTSD and identified SWT as a promising alternative treatment.
Antibiotic-Impregnated Shunt Catheters for the Treatment of Infantile Hydrocephalus
Authors: Sciubba Daniel M. , Noggle Joseph C. , Carson Benjamin S. , Jallo George I.
Published: January 2008

Introduction: Antibiotic-impregnated shunt (AIS) components decrease shunt infections by preventing bacterial colonization that occurs during implantation. Despite studies showing improved efficacy in preventing infection however, concern still exists regarding using AIS components in infants, especially premature ones. In this study, clinical outcomes were assessed in infants with hydrocephalus (<1 year) following AIS placement. Methods: A prospective observational study was conducted involving pediatric patients <1 year of gestational age with hydrocephalus who underwent placement of AIS components (ventriculoperitoneal, ventriculoatrial, and cystoperitoneal) as initial treatments, shunt revision surgery, or following previous placement of a ventricular access device (VAD, Rickman reservoir). Measured outcomes included: infection, shunt revision surgery, and complications. Results: Seventy-four infants underwent 108 AIS procedures, and all were followed for over 9 months. Twenty-seven patients (36.5%) possessed previous VADs. Average weight and gestational age at birth were 1,976 g (range: 560–3,500 g) and 32.8 weeks (range: 23–41 weeks), respectively. The average age at the time of surgery was 14.6 weeks (range: 1 day to 50 weeks). Five infections occurred in 5 patients (4.6% of procedures, 6.75% of patients), 60% of which were very premature (<32 weeks). Thirty-three patients (44.6%) required shunt revision surgery, 5 (15%) for infection and 28 (85%) for malfunction. Three cerebrospinal fluid leaks occurred perioperatively without significant sequelae, and no mortalities occurred from the procedures. Conclusion: AIS systems can safely be used to treat hydrocephalus in pediatric patients <1 year old, even for those with a history of prematurity. One possible therapeutic application for such premature patients may be the incorporation of antibiotic impregnation into VADs or ventriculosubgaleal components to treat infants with hydrocephalus prior to definitive CSF shunt placement.
Epidemiology of Nervous System Tumors in Children: A Survey of 1,485 Cases in Beijing Tiantan Hospital from 2001 to 2005
Authors: Zhou Dabiao , Zhang Yuqi , Liu Hai , Luo Shiqi , Luo Lin , Dai Ke
Published: January 2008

Objective: The purpose of the present retrospective study was to describe the epidemiology of nervous system tumors in children based on the clinical data obtained from a neurosurgical center in Beijing. Patients and Methods: During a 5-year period, from January 2001 to December 2005, 1,485 primary brain and spinal tumors in children up to 17 years of age were diagnosed histopathologically according to the World Health Organization 2000 nervous system tumor classification. The sex predilection, tumor location, and histological grade in relation to age were investigated, and the epidemiological characteristics of the 5 most common brain tumors are discussed. Result: Of the 1,485 cases evaluated, brain and spinal tumors comprised 92.3% (1,371) and 7.7% (114), respectively, with a predominance of low-grade tumors (65.1 and 78.9% for brain and spinal cord, respectively). For all tumors, the overall sex ratio (male to female) was 1.6:1. 61.9% of the brain tumors were supratentorial, whereas an infratentorial location was slightly more common in the 872 brain tumors of neuroepithelial tissue (53.7%). The 5 most common brain tumors were astrocytic tumors (30.5%), craniopharyngiomas (18.4%), medulloblastomas (14.6%), germ cell tumors (GCTs, 7.9%) and ependymal tumors (5.6%). The highest preponderance of boys was observed in GCTs followed by medulloblastomas. The most common types of spinal tumors were ependymal tumors (19.3%), neurilemmomas (16.7%) and astrocytomas (14.9%). Conclusions: Based on a large hospital series of pediatric patients, the present survey revealed the histopathological diversity of childhood neurological neoplasms, and provides a reliable profile of the epidemiology of nervous system tumors in children in a developing country.
Aggressive Management of Shunt Infection: Combined Intravenous and Intraventricular Antibiotic Therapy for Twelve or Less Days
Authors: James Hector E. , Bradley John S.
Published: January 2008

Objective: This report is limited to patients with a single cerebrospinal fluid (CSF) shunt infected by a single organism, and compares two treatment protocols. Methods: In the initial protocol (1975–1991), patients underwent removal of the shunt system and received intravenous and intraventricular antibiotics. Intraventricular antibiotics were administered twice daily to those with external ventricular drainage. When CSF was cultured 48 h off all antibiotics and found to be sterile at 24 h of incubation, a new shunt was inserted. Follow-up CSF cultures were obtained in all patients between 1–6 months following placement of the new shunt. Results: There were 25 patients (ages 1 month to 16 years; mean ± SD: 23 ± 4.0 months). CSF obtained from the shunt yielded the following: Staphylococcus epidermidis (19), Staphylococcus aureus (2), Streptococcus species (2), Serratia marcescens (1), and Propionebacterium species (1). The duration of intravenous antibiotics was 7–12 days (mean ± SD: 9.7 ± 1.3 days), and intraventricular antibiotic therapy was 6.2 ± 1.7 days. Total hospital stay was 15.2 ± 2.3 days. The follow-up period was 7.7 ± 3.6 years. Following the initial protocol in another 15 patients (1992–2004), the treatment regime was modified in that intraventricular antibiotics were administered once daily in patients with external ventricular drainage, and the CSF was cultured at 24 h off antibiotics, instead of 48 h. Results were similar to the initial protocol with respect to days of antibiotic therapy and hospital stay. Conclusion: Based on our retrospective nonrandomized series, we believe patients with a single shunt and noncompartmentalized hydrocephalus can be successfully treated without a prolonged antibiotic course and lengthy hospital stay.
Clinical Features and Treatment of Meningiomas in Children: Report of 12 Cases and Literature Review
Authors: Liu Yuguang , Li Feng , Zhu Shugan , Liu Meng , Wu Chengyuan
Published: January 2008

Objective: To study the clinical characteristics and treatment of meningiomas in children. Methods: One hundred and sixty-six meningiomas in children, including 12 cases treated in Qilu hospital and 8 series reported in the literature, were analyzed retrospectively on sex, age distribution, presenting symptoms, signs, radiological and pathological findings, treatment and prognosis. Results: The ratio of boys and girls was 2.3:1. The age ranged from 0.5 to 15 years (mean 9.9 years). Cranial nerve disorder (28%) and signs of chronic increased intracranial pressure such as headaches (62%), vomiting (53%) and papilledema (55%) were the most common symptoms. The most common location was the cerebral convexity (41%), followed by ventricles (15%), saddle areas (8%), cerebellopontine angles (8%), brain intraparenchyma (5%), parasagittal regions (4%), etc. Homogeneous density was observed in 62.3% of all cases, calcification in 14.8%, cystic components in 21.3% and intratumoral hemorrhage in 1.6%. On average, the epithelial and fibroblastic types of meningiomas took up 55% of the case, while the amount of malignant or atypical meningiomas averaged 9%. Complete tumor excision was achieved in 74%, and postoperative mortality was 3.3%. Conclusions: Compared with meningiomas in adults, meningiomas in children occur predominantly in males with a lower incidence rate of epilepsy, and are frequently associated with multiple neurofibromatosis. Meningiomas in children have a poorer prognosis than those in adults. Degree of the first tumor resection, tumor location, pathological grade and association with neurofibromatosis are the most important factors influencing the patients’ prognoses.
Intraventricular Neurocysticercus Cyst(s) in Indian Children
Authors: Kumar Raj , Kumar Kalra Samir , Mahapatra A.K.
Published: January 2008

Eleven cases of intraventricular neurocysticercosis were managed over a 10-year period. All patients presented with features of hydrocephalus. In 9 cases the cysts were blocking the cerebrospinal fluid (CSF) pathway resulting in hydrocephalus. The 4 cases of lateral ventricular cyst had communicating hydrocephalus, while 2 of these had asymmetrical ventriculomegaly. Two of 4 cases had more than one cyst. One of 4 children with lateral ventricular cyst had narrowing of the foramen of Monro causing asymmetrical hydrocephalus. Following cyst removal, CSF diversion was not required in 6 cases, while 5 required CSF diversion despite removal of their cysts in 4 of 5. One patient had a cyst at the aqueductal inlet and he was managed by shunt and albendazole therapy. Thus, we managed 6 of our cases with excision of the cysts obstructing the CSF pathway, and in 4 cases excision of cysts with ventriculoperitoneal shunt was adequate.
Pediatric Shunt Malfunction without Ventricular Dilatation
Authors: McNatt Sean A. , Kim Anthony , Hohuan David , Krieger Mark , McComb J. Gordon
Published: January 2008

Background/Purpose: Symptomatic ventriculoperitoneal shunt (VPS) malfunction can occur without progressive ventricular dilatation on imaging studies. A review of VPS revisions performed during an 18-month period was conducted to better characterize this cohort. The incidence of VPS malfunction without ventricular dilatation and the clinical features that may predispose to its occurrence have not been previously described. Methods: A retrospective review was conducted of all patients under the age of 18 who underwent VPS revision due to shunt malfunction from June 2001 to December 2002. The incidence of various factors that might correlate with the development of low compliance ventricles was examined. Results: One hundred and seventy-seven patients underwent a total of 287 VPS revisions during the study period; 16 patients (9%) had signs of raised intracranial pressure and showed no radiographic evidence of progressive ventricular dilatation. History of prior shunt-related ventriculitis positively correlated with the development of low compliance ventricles (Fisher’s exact test, p = 0.043). Conclusion: Nine percent of pediatric patients with symptomatic VPS malfunctions lack radiographic evidence of progressive ventricular dilatation on imaging studies. Patients with prior shunt infections are particularly at risk, necessitating increased vigilance when clinical signs and symptoms are apparent.
Computer-Aided Design for Three-Dimensional Titanium Mesh Used for Repairing Skull Base Bone Defect in Pediatric Neurofibromatosis Type 1
Authors: Wu Chieh-Tsai , Lee Shih-Tsen , Chen Jyi-Feng , Lin Kuang-Lin , Yen Shih-Hung
Published: January 2008

Background: Sphenoid dysplasia is a distinctive but uncommon manifestation of neurofibromatosis type 1. The absence of the sphenoid greater wing allows the temporal lobe to prolapse into the orbit resulting in temporal base encephalocele and pulsating exophthalmos. Surgical procedures are aimed at preserving vision and improving ocular movement and cosmesis. This defect can be closed using bone grafts or titanium mesh. However, the results of this procedure are often unsustainable due to bone graft resorption and graft displacement. Methods: In this report, we describe a novel surgical technique, combining computer-aided design, stereolithography and neuronavigation to repair a temporal base skull defect in a 16-year-old female patient with neurofibromatosis type 1. A three-dimensional model of the skull base defect and a template for graft were first constructed according to the image data, then transferred to a real-size stereolithographic biomodel using a rapid prototyping technique. Results: The final graft of titanium mesh, which was intraoperatively fabricated based on the biomodel, was precisely orientated and securely fixed to the surrounding bone under frameless navigation. Long-term follow-up result proved this repair to be effective and durable. Conclusion: The approach combining computer-aided design, stereolithography and surgical navigation could help managing the complex lesions in the skull base and craniofacial area requiring rigid reconstruction.
Newborn with Sebaceous Nevus of Jadassohn Presenting as Exophytic Scalp Lesion
Authors: Saedi Targol , Cetas Justin , Chang Renee , Krol Alfons , Selden Nathan R.
Published: January 2008

It is essential that various factors be considered when determining the differential diagnosis of congenital scalp lesions, including lesion size, appearance, intracranial extension, underlying medical condition and the embryological germ layer involved. We present the case of a newborn diagnosed as having a sebaceous nevus of Jadassohn scalp lesion. While a common congenital lesion, we describe the unusual presentation at birth as an exophytic nodular lesion. To our knowledge only one other case report of an exophytic congenital lesion has been published.
Cranial Fasciitis Presenting with Intracranial Mass: A Case Report
Authors: Takeda Naoya , Fujita Katsuzo , Katayama Shigenori , Akutsu Nobuyuki , Hashimoto Kimio , Kohmura Eiji
Published: January 2008

We describe a very rare case of cranial fasciitis presenting with intracranial mass in a 3-year-old girl. There was no palpable scalp mass. CT scan and MRI demonstrated an epidural mass adherent to the dura with destruction of the inner table of the skull. The tumor was extirpated completely and the resected specimens were diagnosed as cranial fasciitis. When neurosurgeons, pediatricians and radiologists encounter an epidural tumor in a pediatric patient, cranial fasciitis should be kept in mind.
Induction of Gliosarcoma and Atypical Meningeoma 13 Years after Radiotherapy of Residual Pilocytic Astrocytoma in Childhood
Authors: Jager Beatrice , Schuhmann Martin U. , Schober Ralf , Kortmann Rolf-Dieter , Meixensberger Juergen
Published: January 2008

Background: Malignant transformation of pilocytic astrocytomas in children is rare and often linked to previous radiotherapy. Methods and Results: We report a patient who underwent subtotal resection of a right temporal and insular pilocytic astrocytoma at age 8 in 1988 followed by high-dose radiation therapy. A local recurrence, grade WHO III, with signs of focal sarcomatous transformation, was subtotally resected 13 years later in 2001. A new and fast growing right frontal meningeoma, grade WHO II, was removed in 2003. In 2004 a second glioma recurrence was partially resected, this time graded gliosarcoma WHO IV. The patient was treated thereafter with repeated courses of temozolamide. Another tumor mass reduction in 2005 was followed by stereotactic radiotherapy. Nevertheless, he deceased 3 months later. Conclusion: Most of the reported cases of malignant transformation of pilocytic astrocytomas received radiation therapy beforehand. Irradiation-induced meningeomas in children are known to occur, however not following radiotherapy of low-grade hemispheric gliomas. The presented case illustrates why adjuvant radiotherapy of residual pilocytic astrocytoma in children is not recommended anymore. For children who underwent radiotherapy in the past, we recommend MRI surveillance on a yearly basis far beyond 10 years, even in those who seem to have achieved total remission.
Dural Arteriovenous Fistula of the Greater Sphenoid Wing Region in Neurofibromatosis Type 1
Authors: Cohen Jose E. , Gomori John Mose , Grigoriadis Savvas , Spektor Sergei , Rajz Gustavo
Published: January 2008

Neurofibromatosis type 1 (NF1) has been infrequently associated with different cerebrovascular conditions that may lead to either ischemic or hemorrhagic stroke. Intracranial dural arteriovenous fistulas have not been described in NF1 patients. In this paper we present a unique case of an 8-year-old child with florid NF1 that presented a greater sphenoid wing dural arteriovenous fistula draining directly through the superior ophthalmic vein and causing exophthalmos. The fistula was cured by direct trans-superior ophthalmic vein approach, by means of detachable coils. Only a few cases of dural fistulas in the lesser sphenoidal wing region have been described in the literature but a fistula of the greater sphenoid wing has not been previously described.
Acute Suppuration of the Pancreatic Duct in a Patient with Tropical Pancreatitis
Authors: Deeb Liliane S. , Bajaj Jasmeet , Bhargava Sandeep , Alcid David , Pitchumoni C.S.
Published: January 2008

Background/Aim: Pancreatic sepsis secondary to infected necrosis, pseudocyst, or pancreatic abscess is a well-known clinical entity. Acute suppuration of the pancreatic duct (ASPD) in the setting of chronic calcific pancreatitis and pancreatic ductal obstruction with septicemia is a rare complication that is seldom reported. It is our aim to report a case of ASPD with Klebsiella ornithinolytica, in the absence of pancreatic abscess or infected necrosis. Case Report: A 46-year-old Asian-Indian man with chronic tropical pancreatitis who was admitted with recurrent epigastric pain that rapidly evolved into septic shock. A CT scan of abdomen revealed a dilated pancreatic duct with a large calculus. Broad-spectrum antibiotics, vasopressors and activated recombinant protein C were initiated. Emergency ERCP showed the papilla of Vater spontaneously expelling pus. Probing and stenting was instantly performed until pus drainage ceased. Repeat CT scan confirmed the absence of pancreatic necrosis or fluid collection, and decreasing ductal dilatation. Dramatic clinical improvement was observed within 36 hours after intervention. Blood cultures grew Klebsiella ornithinolytica. The patient completed his antibiotic course and was discharged. Conclusion: ASPD without pancreatic abscess or infected necrosis is an exceptional clinical entity that should be included in the differential diagnosis of pancreatic sepsis. A chronically diseased pancreas and diabetes may have predisposed to the uncommon pathogen. The presence of intraductal pancreatic stones obstructing outflow played a major role in promoting bacterial growth, suppuration and septicemia. Immediate drainage of the pancreatic duct with endoscopic intervention is critical and mandatory.
Naming Is Associated with Left Temporal Pole Metabolite Levels in Neurodegenerative Diseases
Authors: Rami L. , Caprile C. , Gómez-Ansón B. , Sánchez-Valle R. , Monte G.C. , Bosch B. , Molinuevo J.L.
Published: January 2008

Aim: To investigate the relationship between performance in language tests and levels of brain metabolites in two selected left temporal lobe regions. Methods: Ninety-five subjects were included: 26 controls, 30 amnestic mild cognitive impairment subjects, 27 Alzheimer’s disease and 12 frontotemporal lobar degeneration (FTLD) patients. Language was assessed by a naming test: Boston Naming Test (BNT) and by a semantic verbal fluency test. Other cognitive functions: verbal and visual memory, visual perception, attention and executive function, and praxis were also assessed. Single voxel magnetic resonance spectroscopy was obtained in the left temporal pole (L-TPOLE), and in the left posterior temporoparietal region (L-TPAR). Results: BNT scores were significantly associated with N-acetylaspartate/creatine ratios (r = 0.45; p < 0.001) and choline/creatine ratios (r = 0.33; p < 0.005) in the L-TPOLE. No significant associations were found between BNT and metabolite levels in the L-TPAR. No significant associations were found between the semantic verbal fluency test and other cognitive tests and metabolite levels either in the L-TPOLE or in the L-TPAR. Conclusion: Naming performance is related to metabolite levels in the anterior L-TPOLE.
CRTH2 Is Not Involved in the Anti-Enteropooling Effect of PGD2 in the Small Intestine
Authors: Prenn C. , Heinemann A. , Schuligoi R. , Peskar B.A.
Published: January 2008

The majority of prostaglandins (PGs) are known to induce intestinal fluid secretion (enteropooling). In contrast, PGD2 has been demonstrated to inhibit fluid secretion induced by other PGs. This study was aimed to investigate, by the use of selective agonists/antagonists, which type of PGD2 receptor mediates this inhibitory effect. The DP1 agonist BW245C dose-dependently inhibited the enteropooling effect of 16,16-dimethyl-PGE2. This inhibition was counteracted by the DP1 antagonist BWA868C. In contrast, the CRTH2 receptor does not seem to be involved in the anti-enteropooling effect of PGD2, since the selective agonists 13,14-dihydro-15-keto-PGD2 and 15(R)-15-methyl-PGD2 were without effect. Therefore, our results suggest that the inhibitory effect of PGD2 in the small intestine is mediated via activation of the DP1 receptor.
Steno-Occlusive Arterial Disease and Early Neurological Deterioration in Acute Ischemic Stroke
Authors: Ois Angel , Martinez-Rodriguez Jose E. , Munteis Elvira , Gomis Meritxell , Rodríguez-Campello Ana , Jimenez-Conde Jordi , Cuadrado-Godia Elisa , Roquer Jaume
Published: January 2008

Aim: To evaluate the influence that steno-occlusive arterial disease may have on the development of early neurological deterioration (END) in a large series of patients with acute ischemic stroke. Methods: We studied a prospective cohort of 1,093 patients admitted to a single tertiary hospital with presence of neurological symptoms in the first 24 h after stroke onset. END was defined as any increase in the National Institutes of Health Stroke Scale score ≧4 points in the first 72 h. The arterial study assessed the presence of arterial occlusion or significative stenosis in the symptomatic territory. Additionally, age, initial stroke severity, blood pressure, glucose levels, vascular risk factors, lacunar stroke and prior use of antithrombotic treatment were also analyzed in a multivariable analysis. Results: END was detected in 179 patients (16.3%). Steno-occlusive disease (adjusted OR 3.60), initial blood pressure and abdominal obesity were independently associated with END. Both arterial stenosis (adjusted OR 2.33) or occlusions (adjusted OR 3.65) were associated with END. The higher adjusted OR (5.49) was obtained for steno-occlusive arterial disease in the vertebrobasilar system. Conclusions: An early arterial study may provide key data for the selection of patients with higher risk of END after acute ischemic stroke.
Neuroprotection by Oxygen in Acute Transient Focal Cerebral Ischemia Is Dose Dependent and Shows Superiority of Hyperbaric Oxygenation
Authors: Eschenfelder C.C. , Krug R. , Yusofi A.F. , Meyne J.K. , Herdegen T. , Koch A. , Zhao Y. , Carl U.M. , Deuschl G.
Published: January 2008

The neuroprotective effect of oxygen after acute stroke in rats has been shown previously. However, the question of optimal dosing still remains unanswered. Thus, we investigated the use of oxygen at different concentrations by either normobaric oxygenation (NBO) or hyperbaric oxygenation (HBO) at different pressures in a model of transient ischemia/reperfusion in rats. Animals underwent 90 min of middle cerebral artery occlusion (MCAO) followed by 90 min of reperfusion before oxygen treatment. Oxygen was applied either by NBO (100% O2; 1.0 absolute atmosphere, ATA) or HBO (100% O2; 1.5, 2.0, 2.5 or 3.0 ATA) for 1 h. Primary endpoints were infarct volume and clinical outcome measured 24 h and 7 days following the MCAO. A statistically significant and long-lasting reduction in infarct volume was seen in the HBO 2.5 ATA and 3.0 ATA groups over a period of 7 days. The reduced infarct volume was accompanied with a statistically significant improvement in clinical outcome in the high-dose oxygen-treated groups. The presented data indicate that oxygen is a highly neuroprotective molecule in transient focal cerebral ischemia in rats, when applied early and at high doses. The effect is dose dependent and shows a superiority of HBO over NBO, when the primary endpoints infarct volume reduction and clinical outcome are analyzed. These data are important for the development of new acute stroke treatment studies in humans.
Blood Pressure and Antihypertensive Therapy as Predictors of Early Outcome in Acute Ischemic Stroke
Authors: Keezer Mark R. , Yu Amy Y.X. , Zhu Bin , Wolfson Christina , Côté Robert
Published: January 2008

Background: The clinical impact of blood pressure (BP) and of antihypertensive therapy (AHT) in acute ischemic stroke remains uncertain. Methods: We reviewed the charts of patients admitted to the Montreal General Hospital between April 1, 2002 and October 15, 2005. Ischemic stroke was considered severe if the Canadian Neurological Scale at presentation was ≤7. Poor outcome at 10 days after onset was defined as a modified Rankin Scale >3. Acute change in BP was defined as the percent difference between the mean 24-hour mean arterial pressure (MAP) and the baseline MAP. AHT was considered present if administered ≧5 days during the first week after stroke onset. The association between predictors and outcome was assessed using unconditional multivariable logistic regression. Covariates used included age, stroke severity, diabetes mellitus, coronary artery disease, atrial fibrillation, premorbid hypertension and hyperlipidemia. Results: Three hundred and sixty-four patients were included. Compared to patients with intermediate baseline BP, those with a MAP >130 mm Hg [OR = 2.47 (95% CI, 1.04–5.85)] or a MAP <90 mm Hg [OR = 2.94 (95% CI, 1.28–6.77)] were found to have an increased risk of poor outcome after covariate adjustment. A 15% increase in MAP was associated with an increased risk of poor outcome [OR = 5.34 (95% CI, 1.18–24.3)] while AHT in the first week after stroke onset was found to result in a decreased risk [OR = 0.39 (95% CI, 0.17–0.90)]. However, neither of these findings remained significant after adjustment for the described covariates. Conclusions: Both high and low MAP at presentation are associated with worse short-term outcome after ischemic stroke.
Longitudinal Investigations on the Anterograde and Retrograde Degeneration in the Pyramidal Tract following Pontine Infarction with Diffusion Tensor Imaging
Authors: Liang Zhijian , Zeng Jinsheng , Zhang Cuimei , Liu Sirun , Ling Xueying , Xu Anding , Ling Li , Wang Fang , Pei Zhong
Published: January 2008

Background: Secondary degeneration following supratentorial stroke has been detected by some studies using diffusion tensor imaging (DTI), but the anterograde and retrograde degeneration in pyramidal tract after pontine infarction and its potential clinical significance are not well understood. Methods: Fourteen patients with a recent pontine infarct underwent three DTIs at week 1, week 4, and week 12 after onset. Fourteen age- and gender-matched controls underwent DTI once. Mean diffusivity and fractional anisotropy (FA) were measured. Neurological deficit, motor deficit and life independence were assessed with the NIH Stroke Scale, Fugl-Meyer scale and Barthel index, respectively, 2 h before each DTI examination. Results: FA values at the ipsilateral medulla and the proximal portion of the pyramidal tract, including centrum semiovale, internal capsule and cerebral peduncle, significantly decreased progressively from week 1 to week 12 (p < 0.01). The NIH Stroke Scale decreased; Fugl-Meyer scale and Barthel index increased significantly over the time points (p < 0.01). The absolute values of percent reduction of FA value at the ipsilateral medulla and the proximal portion of pyramidal tract correlated negatively with the absolute values of percent reduction of the NIH Stroke Scale and percent increase of the Fugl-Meyer scale. Conclusions: Progressive anterograde and retrograde degeneration in pyramidal tract revealed by DTI may hinder the process of neurological recovery after a pontine infarct. To confirm the clinical significance, future studies with a longer observation period and a larger sample size of patients with more homogeneous pontine infarcts are still needed.
Display of Dural Sinuses with Time-Resolved, Contrast-Enhanced Three-Dimensional MR Venography
Authors: Meckel Stephan , Glücker Thomas M. , Kretzschmar Martin , Scheffler Klaus , Radü Ernst-Wilhelm , Wetzel Stephan G.
Published: January 2008

Background: Time-resolved (TR) contrast-enhanced 3D MR angiography has recently received considerable attention for the workup of cerebrovascular diseases, foremost dural arteriovenous fistula and arteriovenous malformation, and potentially for the evaluation of dural sinus thrombosis. Thereby, the dynamic visualization of cerebral vessels is enabled similar to the principle of digital subtraction angiography. Yet, its voxel size is relatively large due to an inherent trade-off between the desired spatial and temporal resolutions. The goal of this study was to evaluate whether the limited spatial resolution of TR MR venography (MRV) is sufficient to visualize dural venous sinuses. Methods: The prospective study included 20 patients without compromise of cerebral venous outflow. Two neuroradiologists independently graded the quality of visualization of 11 predefined dural venous sinuses on images of fast TR contrast-enhanced MRV (1.5 s/dataset; voxel size, 2 × 2 × 2.2 mm; acquisition time, 37.5 s) in comparison to time-of-flight (TOF) MRV (voxel size, 0.8 × 0.8 × 4 mm; acquisition time, 3 min 51 s) and steady-state contrast-enhanced 3D (VIBE) MRV (voxel size, 1.1 × 0.9 × 1.5 mm; acquisition time, 2 min 46 s). Results: The torcular Herophili (p < 0.001), left (p < 0.001) and right (p < 0.01) transverse sinus, and right jugular bulb (p < 0.05) were visualized better at TR MRV than at TOF MRV. For visualization of the small inferior sagittal sinus, TR MRV was inferior to VIBE (p < 0.001) and TOF (p < 0.05) sequences. The visibility of all other dural sinuses was equal. Conclusion: Despite the inferior spatial resolution, TR MRV depicted some large dural sinuses more clearly than TOF MRV. To overcome the visualization of smaller venous structures, TR MRV can be applied complementarily with high-resolution steady-state contrast-enhanced MRV.
Major Vascular Events after Transient Ischaemic Attack and Minor Ischaemic Stroke: Post Hoc Modelling of Incidence Dynamics
Authors: Atanassova Penka A. , Chalakova Nedka T. , Dimitrov Borislav D.
Published: January 2008

Background: Only few follow-up studies have compared the long-term risk of such major vascular events (MVE) as myocardial infarction (MI) and/or stroke following transient ischaemic attack (TIA) or minor ischaemic stroke (MIS). Estimates of relative risk and cumulative long-term occurrence of MVE may provide better information and contribute to the optimization of treatment decisions. Methods: In the current post hoc modelling study with unique data from Bulgaria, we analysed 183 consecutive patients with TIA (n = 89) or MIS (n = 94), aged >40 years, who were prospectively followed over 36 months for non-fatal or fatal MVE. The cumulative survival, hazard and risks (with 95% confidence intervals) for MVE (combined or by stratification) were calculated by Kaplan-Meier analysis and adjusted (age, sex) by multivariate Cox proportional hazard models. A set of regression models was then applied to MVE incidence (per 100 patients; 4-month intervals). Results: Median follow-up was 36 months (interquartile range 30.8–36.0); no differences by age or sex were found (p > 0.05). The risk of non-fatal or fatal MVE was approximately 28% (stroke 19.7%, MI 8.2%). The adjusted cumulative risk of stroke was 0.21 versus 0.10 for MI. The odds ratio of TIA versus MIS was 0.75 (95% CI 0.43–1.32), i.e. lower for stroke (0.63, 0.31–1.25) than for MI (1.12, 0.40–3.14). The risk of non-fatal MVE was higher in MIS than in TIA (pBreslow = 0.0497), especially for non-fatal stroke (p = 0.0325). Time series regression models provided best estimates of the different outcome dynamics in TIA versus MIS (R2TIA = 0.969 with bpower = 1.04 vs. R2MIS = 0.989 with blinear = 0.84; p1-tailed = 0.04) over the study period. Conclusions: The age- and sex-adjusted cumulative 36-month hazard of MVE is higher after MIS than after TIA, but MVE fatality was higher after TIA than after MIS. Although stroke incidence was higher (up to 3 times that of MI), with the highest difference between months 8 and 18, MI fatality was always higher in absolute, relative or adjusted terms. The above alarming patterns and increasing, diverging tendencies for MVE indicate a higher long-term cumulative risk after MIS compared with TIA. These results confirm our hypothesis of a differential risk of TIA versus MIS and, at least, point toward equal importance of therapies aimed at preventing MVE in both types of preceding conditions (TIA or MIS) and the increased fatality after MI, in particular in patients with TIA.
Extremely Early Computed Tomography Signs in Hyperacute Ischemic Stroke as a Predictor of Parenchymal Hematoma
Authors: Okazaki Shuhei , Moriwaki Hiroshi , Minematsu Kazuo , Naritomi Hiroaki
Published: January 2008

Background: In acute ischemic stroke, thrombolysis with intravenous recombinant tissue plasminogen activator is more effective when given within 90 min of onset compared to that given later than 90 min. However, the significance of early CT signs (ECTs) during such early periods has not yet been fully clarified. We investigated the usefulness of ECTs within 90 min for predicting parenchymal hematoma (PH) in patients without thrombolysis. Methods: We evaluated 212 consecutive patients with initial ischemic stroke in the anterior cerebral circulation who underwent the first CT within 6 h of onset. The patients were divided into 3 groups according to the interval from onset to CT: within 90 min (group A, n = 90), 91–180 min (group B, n = 76) and 181–360 min (group C, n = 46). Patients who had received thrombolytic therapy were excluded. ECTs were evaluated according to the Alberta Stroke Program Early CT Score (ASPECTS). The relationships between ECTs and the subsequent development of PH were compared among the groups. Results: In patients with ASPECTS values between 0 and 7, PH was developed more frequently in group A (35%) than in groups B (14%) or C (15%) (group A vs. B: p = 0.036, group A vs. C: p = 0.094). In group A, atrial fibrillation, elevated pretreatment blood pressure and ASPECTS ≤7 were independent predictors of PH. Conclusions: The manifestation of ECTs as represented by ASPECTS ≤7 within 90 min after stroke appears to indicate a high risk of PH.
Reliability and Sensitivity of Visual Scales versus Volumetry for Evaluating White Matter Hyperintensity Progression
Authors: Gouw A.A. , van der Flier W.M. , van Straaten E.C.W. , Pantoni L. , Bastos-Leite A.J. , Inzitari D. , Erkinjuntti T. , Wahlund L.O. , Ryberg C. , Schmidt R. , Fazekas F. , Scheltens P. , Barkhof F.
Published: January 2008

Background: Investigating associations between the change of white matter hyperintensities (WMH) and clinical symptoms over time is crucial for establishing a causal relationship. However, the most suitable method for measuring WMH progression has not been established yet. We compared the reliability and sensitivity of cross-sectional and longitudinal visual scales with volumetry for measuring WMH progression. Methods: Twenty MRI scan pairs (interval 2 years) were included from the Amsterdam center of the LADIS study. Semi-automated volumetry of WMH was performed twice by one rater. Three cross-sectional scales (Fazekas Scale, Age-Related White Matter Changes Scale, Scheltens Scale) and two progression scales (Rotterdam Progression Scale, Schmidt Progression Scale) were scored by 4 and repeated by 2 raters. Results: Mean WMH volume (24.6 ± 27.9 ml at baseline) increased by 4.6 ± 5.1 ml [median volume change (range) = 2.7 (–0.6 to 15.7) ml]. Measuring volumetric change in WMH was reliable (intraobserver:intraclass coefficient = 0.88). All visual scales showed significant change of WMH over time, although the sensitivity was highest for both of the progression scales. Proportional volumetric change of WMH correlated best with the Rotterdam Progression Scale (Spearman’s r = 0.80, p < 0.001) and the Schmidt Progression Scale (Spearman’s r = 0.64, p < 0.01). Although all scales were reliable for assessment of WMH cross-sectionally, WMH progression assessment using visual scales was less reliable, except for the Rotterdam Progression scale which had moderate to good reliability [weighted Cohen’s ĸ = 0.63 (intraobserver), 0.59 (interobserver)]. Conclusion: To determine change in WMH, dedicated progression scales are more sensitive and/or reliable and correlate better with volumetric volume change than cross-sectional scales.
Immunomodulatory Effect of Gatifloxacin on Mouse Peritoneal Macrophages in vitro and in Models of Endotoxin-Induced Rat Conjunctivitis and Rabbit Bacterial Keratitis
Authors: Wada Tomoyuki , Kida Tetsuo , Inoue Takateru , Tokushige Hideki , Naka Hiroaki , Sakaki Hideyuki
Published: January 2008

Aim: To determine the anti-inflammatory activity of gatifloxacin in ophthalmic use. Methods: The following 3 experiments were carried out. (1) Rabbits were inoculated intracorneally with methicillin-resistant Staphylococcus aureus and topically treated with gatifloxacin or levofloxacin. The severity of infection and viable bacterial count were assessed. (2) Thioglycollate-elicited mouse peritoneal macrophages were stimulated by Pseudomonas lipopolysaccharides (LPS) in the presence of graded concentrations of fluoroquinolones, and macrophage-derived tumor necrosis factor α (TNF-α) was assessed. (3) The effects of fluoroquinolones on TNF-α production were compared in an LPS-induced rat conjunctivitis model. Results: In the rabbit keratitis model, the ocular inflammation was significantly reduced by gatifloxacin as compared to levofloxacin but there was no significant difference between the groups in the number of viable bacteria. Gatifloxacin and levofloxacin suppressed TNF-α production in mouse macrophages in a concentration-dependent manner, and the effect of gatifloxacin was more potent than that of levofloxacin. Moxifloxacin exhibited no effect in this condition. In the rat conjunctivitis model, the tissue TNF-α level was significantly reduced only in the group instilled with gatifloxacin ophthalmic solution. Conclusion: These results indicate that gatifloxacin has not only antibacterial activity but an anti-inflammatory action caused by at least inhibiting TNF-α production at the doses used in topical ophthalmic therapy.
Direct Image-Creating Aspheric Lens for Indirect Ophthalmoscopy
Authors: Chalam Kakarla V. , Brar Vikram S. , Agarwal Swati
Published: January 2008

Aims: To describe a compact handheld optical lens that creates a real, upright image of the fundus with indirect ophthalmoscopy. Methods: The compound lens consists of three double aspheric lenses of variable dioptric power mounted coaxially in a plastic housing mount. Lens A and B are separated by a distance of 30.96 mm while lens B and C are 19.38 mm apart. The length of the optical system is 79.63 mm. Results: The lens design provides an upright aerial image of the fundus between the lens and the observer compared to the real inverted image formed by conventional indirect lenses during indirect ophthalmoscopy. Conclusions: The direct image-creating aspheric lens provides an upright image of the fundus with binocular indirect ophthalmoscopy, thus eliminating the need for mental reorientation of an inverted image.
Retinal Findings in Chinese Patients with HIV Infection
Authors: Wang Jian , You Qisheng , Yang Hua , Li Haiying , Wu Hao , Xu Liang , Jonas Jost B.
Published: January 2008

Background: The aim was to determine the prevalence of retinal lesions in patients infected by the human immunodeficiency virus (HIV) in China. Methods: The study included 105 consecutive patients with an HIV infection that underwent general and ophthalmologic examinations. In none of the patients was any systemic opportunistic infection found. The CD4+ T lymphocyte count determined in 89 patients revealed that 77 patients (87%) had a CD4+ lymphocyte count of >200 × 106/l. Results: Retinal microvascular abnormalities were found in 12 subjects (11%) and local retinal nerve fiber layer defects in 13 patients (12%). Patients with fundus abnormalities compared to those with a normal fundus had a significantly (p = 0.013) lower CD4+ T cell count (166 ± 67) × 106/l vs. 482 ± 33 × 106/l) and did not vary significantly in visual acuity. Conclusions: In these HIV-positive Chinese patients attending a hospital for infectious diseases, retinal microvasculopathy and retinal nerve fiber layer defects were the most common fundus lesions, which were found in about 10% of the patients and which were inversely associated with the CD4+ T cell count, without marked effect on visual acuity.
Low-Grade Endometrial Stromal Sarcoma with Florid Intravenous Component
Authors: Lo Keith Wing-Kit , Yu Mei-Yung , Cheung Tak-Hong
Published: January 2008

A case of low-grade endometrial stromal sarcoma (LGESS) with striking involvement of pelvic veins is reported. The pattern of vascular involvement resembled that seen in intravenous leiomyomatosis. The report illustrated that the possibility of venous involvement should always be considered in the management of LGESS. Search for tumor involvement of the venous system at the time of diagnosis of metastasis or recurrence is essential. Surgical management of extensive venous recurrence of LGESS is feasible.
Uncomplicated Acute Renal Failure and Post-Hospital Care: A Not So Uncomplicated Illness
Authors: Fischer Michael J. , Brimhall Bradley B. , Parikh Chirag R.
Published: January 2008

Background: Although uncomplicated acute renal failure (ARF) is associated with significant hospital resource utilization, its health care requirements following hospital discharge are not well understood. The goal of this study was to characterize the post-hospital care requirements incurred by patients with uncomplicated ARF and to determine its important influencing factors. Methods: We obtained hospital case mix data sets for a 2-year period (1999–2000) from the Massachusetts Division of Health Care Finance and Policy. Utilizing DRG and ICD-9-CM codes from 23 Massachusetts hospitals, we identified 2,128 adult patients whose primary reason for hospitalization was uncomplicated ARF. Post-hospital care was defined as the receipt of extended facility care or home health care following hospital discharge. Results: Nearly 50% of patients hospitalized with uncomplicated ARF required some type of post-hospital care, of whom 27% underwent extended facility care while 22% received home health care. The post-hospital care requirements for uncomplicated ARF were similar to those for serious medical conditions (e.g. heart failure) and exceeded those of many common illnesses (e.g., bronchitis). Advancing age, worsening severity of illness, female gender, and emergency room admission were independently associated with receipt of post-hospital care (p < 0.05). A trend existed between less frequent post-hospital care requirements and hospitalization at academic medical centers compared with non-academic hospitals. Conclusions: Uncomplicated ARF is frequently associated with prolonged care following hospitalization. As the health care utilization for ARF becomes better characterized, these post-hospital care resources should not be overlooked.
Residual Perception of Moving Objects: Dissociation of Moving and Static Objects in a Case of Posterior Cortical Atrophy
Authors: Midorikawa Akira , Nakamura Katsuki , Nagao Takehiko , Kawamura Mitsuru
Published: January 2008

Background/Aims: Several studies have reported specific cognitive deficits of posterior cortical atrophy (PCA) starting in the early stage; however, these characteristics have not been demonstrated as arising in the middle or late stage of the disease. We report a patient with PCA who exhibited atypical symptoms after the middle stage. Methods: We observed and examined the patient for more than 10 years in clinical and everyday situations. Results: With increasing symptoms, the patient gradually showed blind-like behavior. He could not find a static object even when it was in front of him, but he could see and catch a tossed ball very well. In addition, he could walk and pick up scattered golf balls without colliding with obstacles. Magnetic resonance imaging and single photon emission computed tomography indicated severe degeneration in the white matter of the parietal lobe and lateral occipital region, whereas the primary visual cortex was relatively intact. Conclusion: Several studies have reported specific cognitive deficits in PCA; however, the present results support the conclusion that not only the initial stage but also the middle and late stages of the disease have the potential to disturb specific cognitive systems.
Open-Label Trial of Anti-TNF-α in Dermato- and Polymyositis Treated Concomitantly with Methotrexate
Authors: Hengstman G.J.D. , De Bleecker J.L. , Feist E. , Vissing J. , Denton C.P. , Manoussakis M.N. , Slott Jensen H. , van Engelen B.G.M. , van den Hoogen F.H.J.
Published: January 2008

Background/Aims: To determine the efficacy of infliximab combined with weekly methotrexate in drug-naive recent-onset dermatomyositis and polymyositis. Methods: A multicentre open-label controlled trial was conducted. Disease activity was assessed using patient’s and physician’s disease activity assessment, manual muscle testing (MMT), handheld dynamometry, and serum CK. The primary objective was to assess the efficacy using MMT after a period of 26 weeks. Results: The study was terminated prematurely because of a low inclusion rate and a high drop-out rate due to disease progression and the occurrence of an infusion reaction. The few patients who did reach the primary endpoint showed improvement in all aspects studied. Conclusion: Infliximab combined with weekly methotrexate might be safe and well tolerated in a small subgroup of patients with drug-naive recent-onset myositis. At present, we do not advocate the use of this treatment because treatment response cannot be predicted beforehand.