bluuebunny/crossref_metadata_2025 huggingface dataset:
CT Findings in Pulmonary Hydatid Disease
Authors: Kervancioĝlu R. , Bayram M. , Elbeyli L.
Published: October 2009

Purpose: the purpose of this study was to present the CT findings of complicated pulmonary hydatid cysts on the basis of the CT appearances.

Material and Methods: Preoperative CT examinations of 19 cases with hydatid cysts were evaluated retrospectively for the number and various features of the cysts and secondary changes in adjacent structures. the results were compared with surgical findings.

Results: While 7 patients had multiple pulmonary hydatid cysts, 12 patients had solitary cyst. the total number of the cysts was 29. Eleven of them were intact cysts. Two of the 18 complicated cysts were only ruptured, while the remaining 16 complicated cysts were ruptured and infected. the endocyst was separated from a pericyst in a local area in one ruptured cyst. Air-bubbles were seen within 14 infected cysts. Nine of the infected cysts had characteristic appearances of hydatid disease. the other 2 infected cysts showed soft tissue density.

Conclusion: CT can provide the specific diagnosis of pulmonary hydatid cysts by demonstrating the number and features of the cysts, characteristic appearances of complicated cysts, and secondary changes in adjacent structures. Whether there are characteristic signs or not, the demonstration of air-bubbles within the cyst, together with ring enhancement, are strong indicators for infected hydatid cysts.
Prospective Randomized Study for an Injection Protocol for Intravenous Contrast Media in Abdominal and Pelvic Helical CT
Authors: Gocke P. , Gocke C. , Neumann K. , Henseke P. , Langer R. , Müller R.-D.
Published: October 2009

Objective: To develop an injection protocol for intravenous administration of contrast media in abdominal and pelvic helical CT which provides optimal contrast enhancement of arterial and venous vessels.

Material and Methods: for the study on a Somatom Plus 4 unit, a standard helical CT examination procedure of abdomen and pelvis consisted firstly of a native helical examination of the liver, a second one of the liver after intravenous injection of 120 ml nonionic contrast medium with a constant start delay of 50 s, and subsequently a third helical CT of the lower abdomen and pelvis. 125 patients were randomized for examination under different protocols, varying the injection flow from 2.0–4.0 ml/s and the time delay between the second and the third helical examinations from an additional 20–40 s. the efficacy of the contrast injection was checked by region of interest (ROI) measurements of HUs in aorta, inferior vena cava, and in femoral arteries and veins. the results were compared by t-test statistics.

Results: A slow flow rate of 2.0 ml/s led to a higher contrast enhancement in the aorta than a flow rate of 3.0 and 4.0 ml/s. the difference between 2.0 ml/s and 4.0 ml/s was statistically significant. In the inferior vena cava, a flow of 3.0 ml/s caused a better contrast than a flow of 2.0 ml/s or 4.0 ml/s but the measurements did not reach statistical significance. the measurements in the femoral arteries and veins did not show any significant differences. Maximal enhancement in the pelvic vessels was achieved when the third helical examination was started immediately after the second one had ended. Adding any delay (20 s, 40 s) led to a reduced contrast in the pelvic vessels, with a significant reduction in aorta and femoral arteries.

Conclusion: for routine abdominal and pelvic helical CT, we recommend an injection of 120 ml contrast medium with a flow rate of 3.0 ml/s. Contrast-enhanced examination of the liver should be started after 50 s, and examination of the lower abdomen and pelvis region should be performed without any further delay. This gives an appropriate contrast in the major vessels.
Imaging of Abdominal Neuroblastoma in Children
Authors: Hugosson C. , Nyman R. , Jorulf H. , McDonald P. , Rifai A. , Kofide A. , Jacobsson B.
Published: October 2009

Purpose: the aims of the study were: 1) to assess the efficacy of different imaging methods for use prior to treatment; 2) to compare the surgico-histopathologically-based International Neuroblastoma Staging System (INSS) staging with the imaging results; and 3) to suggest a localisation scheme for abdominal neuroblastoma.

Material and Methods: Thirty-one children with an abdominal neuroblastoma (median age 2 years), underwent abdominal US, CT of chest and abdomen, MR imaging of abdomen and spine, chest radiography, skeletal survey, radionuclide bone scintigraphy, MIBG scintigraphy, and bone marrow biopsy.

Results: In the evaluation of local disease, CT and MR were superior to US. There was no significant difference between CT and MR in assessment of the location or size of the tumour. Evaluation of invasive growth and lymphadenopathy was uncertain irrespective of imaging modality. Intraspinal extension was more distinctly demonstrated with MR. Tissue characterization with CT and MR did not contribute in the assessment of the tumours. Contrast enhancement at CT and MR examinations both improved demarcation between tumour and kidney, and was a necessity for evaluation of vessel encasement with CT. the local disease was best assessed by either CT or MR, while metastatic disease was best revealed by CT, MR, scintigraphy or bone marrow biopsy.

Conclusion: Imaging may be a valuable basis for clinical assessment and pre-treatment staging of abdominal neuroblastoma.
Placement of a Spring Filter during Interventional Treatment of deep Venous Thrombosis to Reduce the Risk of Pulmonary Embolism
Authors: Hosaka J. , Roy S. , Kuroki K. , Xian Z. , Kvernebo K. , Enge I. , Lærum F.
Published: October 2009

Purpose: To assess the efficacy of the Spring filter during interventional treatment of deep venous thrombosis in vivo.

Material and Methods: A model of inferior vena cava thrombosis was used. Part I: the thrombus was treated by the pulse-spray technique (PT) (urokinase 250,000 IU; n=7) or a rotatory basket catheter, Thrombolizer (MT) (activated with compressed air at 7 atm; n=5). Part II: Following placement of a Spring filter, the animal underwent PT (n=5) or MT (n=5). Based on the results of part I, the treatment protocol was modified (PT, urokinase 500,000 IU; MT, compressed air at 8 atm). Embolus volumes trapped by the filter and found in the lungs were calculated and the filtering efficacy quantified.

Results: Part I: Pulmonary emboli (1 to 4 mm in diameter) were observed in 3 animals in the PT group and 1 animal in the MT group, respectively. Median reduction in thrombus volume was 21% and 4% by PT and MT, respectively. Part II: In the PT group, 58% and 100% of the total embolus load was trapped in 2 animals, while the filter failed to trap emboli (1 to 1.5 mm in diameter) in 1 animal. In the remaining 2 animals, no embolus was found trapped by the filter or in the lungs. In the MT group, 55–97% (median 83%) of the embolus load was trapped. Emboli found in the lungs did not exceed 4 mm in diameter.

Conclusion: Preceding interventional treatment of venous thrombosis with placement of the Spring filter reduced the embolic burden on the lungs.
Characterization of Breast Masses by Dynamic Enhanced MR Imaging
Authors: Ikeda O. , Yamashita Y. , Morishita S. , Kido T. , Kitajima M. , Okamura K. , Fukuda S. , Takahashi M.
Published: October 2009

Purpose: To identify features useful for differentiation between malignant and benign breast neoplasms using multivariate analysis of findings by MR imaging.

Material and Methods: In a retrospective analysis, 61 patients with 64 breast masses underwent MR imaging and the time-signal intensity curves for precontrast dynamic postcontrast images were quantitatively analyzed. Statistical analysis was performed using a logistic regression model, which was prospectively tested in another 34 patients with suspected breast masses.

Results: Univariate analysis revealed that the reliable indicators for malignancy were first the appearance of the tumor border, followed by the washout ratio, internal architecture after contrast enhancement, and peak time. the factors significantly associated with malignancy were irregular tumor border, followed by washout ratio, internal architecture, and peak time. for differentiation between benignity and malignancy, the maximum cut-off point was to be found between 0.47 and 0.51. In a prospective application of this model, 91% of the lesions were accurately discriminated as benign or malignant lesions.

Conclusion: Combination of contrast-enhanced dynamic and postcontrast-enhanced MR imaging provided accurate data for the diagnosis of malignant neoplasms of the breast. the model had an accuracy of 91% (sensitivity 90%, specificity 93%).
Postoperative Nerve Root Displacement and Scar Tissue
Authors: Nygaard Ø. P. , Jacobsen E. A. , Solberg T. , Kloster R. , Dullerud R.
Published: October 2009

Purpose: To investigate the association between postoperative nerve root displacement and epidural scar tissue.

Material and Methods: One hundred patients who had undergone lumbar microdiscectomy were included in a prospective cohort study with a 1-year follow-up. the patients were classified as failures or successes at the 12-month follow-up according to a clinical score. Patients with signs of recurrent disc herniation on MR were excluded from the study. All the 13 patients classified as failures were investigated with MR at the 1-year follow-up, and 40 patients classified as successes were picked at random for MR imaging; thus MR was performed in 53 patients. the MR images were independently evaluated by two neuroradiologists. the images were rated according to the presence or absence of nerve root displacement at the surgically treated disc interspace. Scar formation was rated according to two different classification systems.

Results: Nerve root displacement was observed in 13 patients. No evidence of scar formation was found in 4 patients, a small amount in 11, intermediate in 37 and extensive scar formation in 1 patient. No association between nerve root displacement and the amount of scar tissue was found.

Conclusion: Postoperative nerve root displacement seems to be an independent clinical entity not associated to postoperative scar tissue.
Power Doppler Sonography of Hepatocellular Carcinoma Treated by Transcatheter Arterial Chemoembolization
Authors: Hosoki T. , Yosioka Y. , Matsubara T. , Minamitani K. , Higashi M. , Ohtani M. , Choi S. , Mitomo M. , Tono T.
Published: October 2009

Purpose: To evaluate the usefulness of power Doppler sonography (PDS) in assessing the therapeutic effect of transcatheter arterial chemoembolization (TACE) in hepatocellular carcinoma (HCC).

Material and Methods: TACE was performed in 43 patients (48 lesions) with HCC. All patients were examined with both PDS and color Doppler sonography (CDS) to assess the therapeutic results 1 week after TACE. Follow-up hepatic angiography was performed in 39 patients 3–4 months after TACE and then CT after iodized oil reinjection was also performed 3–4 weeks after a repeat TACE; in the remaining 4 patients, hepatectomy was performed within one month after chemoembolization and histologic study was undertaken to confirm the Doppler findings.

Results: Determination of therapeutic results with PDS and CDS were in agreement with those of follow-up findings in 37 and 29 of the 48 lesions, respectively. There was a significant difference in overall accuracy ( p=0.038) between PDS and CDS results.

Conclusion: PDS is more effective than CDS for evaluating changes in tumor vascularity after TACE. PDS may also replace angiography in assessing the therapeutic effects of TACE for HCCs, except in deep-seated areas.
Localization of Pancreatic Insulinomas with MR Imaging at 0.5 T
Authors: Catalano C. , Pavone P. , Laghi A. , Panebianco V. , Fraioli F. , Pediconi F. , Napoli A. , Passariello R.
Published: October 2009

Objective: To determine the role of MR imaging in the localization of pancreatic insulinomas in patients with clinical and laboratory diagnosis of insulinproducing tumor.

Material and Methods: Thirty-one patients presenting with signs and symptoms of pancreatic insulinomas were prospectively included in our study. Twenty-six patients underwent surgery, and pathologic specimens were examined: 5 patients, in whom the initial diagnosis of insulinoma was excluded, were also studied and then followed up. All patients were studied with a high gradient power 0.5 T magnet. Images were evaluated by 2 radiologists blinded to previous investigations, tests and results.

Results: MR imaging correctly localized 24 of the 26 insulinomas (2 were false-negative and 1 false-positive) and was correctly negative in the 5 control patients. the interobserver agreement had a kappa value of 0.89.

Conclusion: MR imaging was accurate in localizing pancreatic insulinomas and as a consequence, patients in our institution are now submitted to surgery directly after the MR examination. Invasive methods are considered only in cases in which, despite clear biochemical results, MR imaging has not demonstrated a pancreatic focal lesion.
Radiological Demonstration of Gastroesophageal Reflux
Authors: Aksglaede K. , Funch-Jensen P. , Thommesen P.
Published: October 2009

Purpose: To correlate gastroesophageal reflux (GER), demonstrated by a radiological method using food, with the reflux events, as determined by 24-h pH monitoring.

Material and Methods: One hundred and seventeen patients with a median age of 47 years (86 male and 31 female) were examinated. In the supine left position, the patient consumed 360 ml of barium contrast. Fluoroscopy was performed with the patient in the supine right oblique position during mastication and swallowing a piece of rye bread with liver paté and barium. the test was positive if barium was observed ≥5 cm proximal to the gastroesophageal junction. An antimony pH-probe was placed 5 cm above the lower esophageal sphincter, previously determined by manometry. the position was controlled by radiography after positioning and before removal. the total time of esophageal pH<4 exceeding 5.0% was considered pathological.

Results: the radiological method had a specificity of 100% and a sensitivity of 52% compared to 24-h pH monitoring.

Conclusion: the high specificity of this radiological method justify direct therapeutic consequence of a positive test. However, a negative test still renders the problem unsolved.
Ankle Function and Sports Activity after Total Ankle Arthroplasty
Authors: Bonnin Michel P. , Laurent Jean-Raphael , Casillas Mark
Published: October 2009

Background:

The return to sporting activities after ankle arthroplasty has rarely been evaluated. The purpose of the present study was to evaluate function and return to sports after total ankle arthroplasty.

Materials and Methods:

One hundred seventy-nine Salto Total Ankle Arthroplasties (TAA) were implanted between 1997 and 2005. A self-administered questionnaire including the Foot Function Index (FFI) and Foot and Ankle Ability Measurement (FAAM) was sent to all patients. At last followup, six were deceased, 22 were not available for evaluation, and six questionnaires were incomplete. One hundred forty-five questionnaires were available. The mean age was 60.9 years and the mean followup was 53.8 months. The main indications for TAA were osteoarthritis (OA) in 100 cases and Rheumatoid arthritis (RA) in 40 cases.

Results:

15.2% of the patients said that their operated ankle was “normal”; 60.7% “nearly normal”; 20% “abnormal” and 4.1% “highly abnormal.” The FFI scores were 13.7 ± 17 for “activity limitations”, 31.7 ± 23 for “disability” and 16.9 ± 19 for “pain”. The FAAM scores were 74.9 ± 18 for activities of daily living and 48.9 ± 28 for sports activities. On a Visual Analog Scales (0 to 100 were 100 is the “pre-pathology level”) the mean rating was 70.2 ± 19.6 for Activities of Daily Living and 53.7 ± 28 for sport activities. In the OA patients, 38 regularly road bicycle, 21 perform recreational gymnastics, 58 swimming, 50 home gardening, 27 dancing, and 43 hiking. Seven patients regularly practice tennis, nine cross-country skiing, 17 downhill skiing, and six regularly run more than 500 m.

Conclusion:

This study showed that TAA improved the quality of life and that return to recreational activities was generally possible but the return to impact sport was rarely possible. Level of Evidence: III, Retrospective Case Control Study
Prospective Comparative Study of the Scarf and Ludloff Osteotomies in the Treatment of Hallux Valgus
Authors: Robinson Andrew HN , Bhatia Maneesh , Eaton C. , Bishop L.
Published: October 2009

Background:

This study compares two diaphyseal osteotomies (scarf and Ludloff) which correct moderate to severe metatarsus primus varus. This is a single surgeon, prospective cohort study with clinical and radiological follow up at 12 months.

Materials and Methods:

There were 57 patients in each group. Both groups were similar in terms of age, gender and preoperative deformity. Clinical assessment included visual analogue scale questionnaires for subjective assessment and functional activities and the American Orthopaedic Foot and Ankle Society (AOFAS) score. Standardized weight bearing radiographs were analyzed.

Results:

There was no statistically significant difference between the two groups at 6 and 12 months in subjective satisfaction, AOFAS score, improvement in functional activities and range of movements. The improvement in pain (at best) and transfer lesions at 12 months was significantly better in the scarf group ( p < 0.05). The radiological results at 6 and 12 months including intermetatrsal angle ( p < 0.001), hallux valgus angle ( p < 0.01), distal metatarsal articular angle and seasmoid position ( p < 0.05) were significantly better in the scarf osteotomy group. There were three cases (5%) of delayed union in the Ludloff group. Two of these healed with dorsiflexion malunion. One patient in the Ludloff osteotomy group developed a complex regional pain syndrome. There were two wound complications in the scarf group.

Conclusion:

Overall the patients who had a scarf osteotomy had a superior outcome at 6 and 12 months. Level of Evidence: II, Prospective Comparative Study
Treatment of Brachymetatarsia of the First and Fourth Ray in Adults
Authors: Lee Woo-Chun , Suh Jin-Soo , Moon Jeong-Seok , Kim Ji Yeong
Published: October 2009

Background:

The purpose of this study was to review our results of treatment for brachymetatarsia involving the first and fourth ray.

Materials and Methods:

This study includes 47 feet of 30 patients who have been treated for brachymetatarsia of the first and fourth rays. The average age of patients was 26.4 (range, 20 to 36) years. The second and third metatarsals were shortened in 44 feet. In 41 feet, the fourth metatarsals were lengthened at one stage with resected bones from the second and third metatarsals. The lengthening or shortening of each metatarsal was recorded. American Orthopaedic Foot and Ankle Society score and subjective satisfaction were obtained for the clinical evaluation.

Results:

The average amount of shortening in the second and third metatarsal was 8.9 ± 2.8 mm and 7.2 ± 2.6 mm respectively. The average amount of lengthening in the fourth metatarsal was 10.3 ± 4.1 mm. Postoperative AOFAS score was 83.2 ± 7.6. Stiffness of the fourth metatarsophalangeal joint was the most common cause of functional deficit. All except three patients were satisfied with some reservation. Additional operations were performed on eleven feet.

Conclusion:

Most adult patients with the first and fourth ray brachymetatarsia have been subjectively satisfied with the treatment with some loss of function mostly due to stiffness of the metatarsophalangeal joints. Level of Evidence: IV, Retrospective Case Series
Sensitivity Mapping of the Human Foot: Thresholds at 30 Skin Locations
Authors: Hennig Ewald Max , Sterzing Thorsten
Published: October 2009

Background:

Mechanoreceptors in the skin provide sensory input for the central nervous system about foot placement and loading. This information is used by the brain to actively control or regain balance and is important to establish memory traces for subsequent movement. A sensitivity map of the human foot could help to understand the mechanisms of the foot as a sensory organ for movement adjustment and balance control.

Materials and Methods:

Touch and vibration perception threshold values from 30 plantar and dorsal foot locations were determined in more than 40 women and men between 20 and 35 years. Semmes Weinstein monofilaments and a vibrotactile neurothesiometer were used for skin sensitivity threshold detection.

Results:

Large sensitivity differences were present between the 30 different foot sites. Gender effects were not present for touch but women had better sensitivities for vibration ( p < 0.01), especially on the dorsal aspect of the foot. Age, in our cohort of 20- to 35-year-olds, did not have an influence on vibration or touch sensitivity. The heel had the highest detection thresholds for touch but was very sensitive for vibration stimuli. Compared to the dorsum, the plantar foot was substantially more sensitive, especially for vibration detection.

Conclusion:

The results suggest that primarily the fast adapting plantar mechanoreceptors are important in assisting balance control during human locomotion.

Clinical Relevance:

The sensitivity map of the foot will help in understanding the function of the foot as a sensory organ and could be useful in creating footwear for better balance control and for the design of comfortable shoes.
Quantitative Analysis of Bacteria in Forefoot Surgery: A Comparison of Skin Preparation Techniques
Authors: Cheng Kenneth , Robertson Hannah , St. Mart Jean Pierre , Leanord Alistair , McLeod Ian
Published: October 2009

Background:

Currently a lack of consensus exists on the optimum solution and preparation methods needed to decrease bacteria present during forefoot surgery. We therefore compared the effect of povidine-iodine and chlorhexidine gluconate on lowering bacterial load and to study any additional benefits gained by pre-treatment with the use of a bristled brush.

Materials and Methods:

Fifty consecutive patients undergoing forefoot surgery were recruited into the study and randomized to receive one of two surgical skin preparations (Povidine-iodine 1% with isopropyl alcohol 23% or Chlorhexidine gluconate 0.5% with isopropyl alcohol 70%). In addition to the skin preparation of the foot with the randomized solution, the subjects other foot was also scrubbed with a sterile surgical bristled brush for three minutes and then painted with the same solution. Swabs were taken from three sites and analyzed via qualitative and quantitative analysis before and after prepping.

Results:

All four preparation methods significantly decreased ( p < 0.001), in all three sites, the number of colony forming units. Using two-way analysis of variance, no significant interaction was observed between preparation method and number of colony-forming units, suggesting that no difference in bacterial inhibition between preparation methods.

Conclusion:

We suggest that either povidone - iodine with no more that 23% isopropyl alcohol or chlorhexidine gluconate with 70% isopropyl alcohol be used for surgical preparation in forefoot surgery. No additional benefit in reduction in bacterial load was gained by scrubbing the foot with bristles prior to painting.
Falling Weight Deflectometer Testing to Determine Relative Damage in Asphalt Pavement Unbound Aggregate Layers
Authors: Donovan Phillip , Tutumluer Erol
Published: October 2009

Falling weight deflectometer (FWD) testing is a nondestructive pavement structural evaluation technique routinely performed on highway and airfield pavements to estimate pavement layer properties from measured deflection basins. This paper presents a methodology based on analyzing FWD test data between trafficked and nontrafficked lanes to determine the degradation and rutting potential of flexible pavement unbound aggregate layers in comparison to the subgrade damage. The validity of the approach is demonstrated by analyzing the heavy weight deflectometer (HWD) data obtained from the FAA's National Airport Pavement Test Facility (NAPTF) flexible airport pavement test sections built with substantially thick unbound aggregate base–subbase courses. The modified base damage index and base curvature index defined from HWD pavement deflection basins were used to determine relative base-to-subgrade damage, which clearly showed evidence of the increased base damage induced in the NAPTF airport pavement layers during trafficking partly due to the applied aircraft gear load wander. This was in accordance with both the individual pavement layer recovered and unrecovered (inelastic or residual) deformation trends identified from analyzing the multidepth deflectometer data collected during trafficking and the post-traffic forensic analysis results, which indicated that a majority of the permanent deformation occurred in the unbound aggregate layers and not in the subgrade. The methodology presented for the detailed analyses of the FWD (or HWD) test data between trafficked and nontrafficked lanes can be effectively used in flexible pavements to detect unbound aggregate layer deterioration and the pavement damage potential due to that deterioration.
Water as the Key to Expansion of Ettringite in Cementitious Materials
Authors: Nair Syam , Little Dallas
Published: October 2009

Damage in sulfate-bearing soils and aggregate systems stabilized with additives containing lime, including lime and portland cement, has drawn considerable attention over the past two decades. Researchers and practitioners have made considerable contributions to the understanding of the problem, including the mechanisms involved in the formation of the two minerals, ettringite and thaumasite, that are most often associated with this damage. This paper provides a case history analysis of the expansion history compared with the ettringite growth history of three controlled low-strength mixtures containing fly ash with relatively high sulfate contents. Samples were subjected to three curing conditions: a dry cure, in which only mixing water was available for curing; a moist cure, in which an external source of water was available for curing; and a sulfate cure, in which an external source of sulfate-bearing water was made available for the duration of cure. Ettringite was quantified by using both differential scanning calorimetry and X-ray diffraction; the resulting volume changes in the samples were measured. Results suggested that sorption of water by the ettringite molecule was at least part of the reason for expansion. The importance of sorption was based on the fact that although expansion increased in moist cure compared to dry cure systems, the quantities of ettringite formed under each regime were about the same and remained about the same throughout the experiments. As expected, samples exposed to sulfate cure responded with the greatest expansion, which was concomitant with continued ettringite crystal growth due to a supply of the limiting reagent, sulfate.
Carbon Dioxide Emissions due to Highway Subgrade Improvements
Authors: Rogers Christopher D. F. , Thomas Andrew M. , Jefferson Ian , Gaterell Mark
Published: October 2009

Improving poor subgrades is essential to facilitate highway construction and ensure long-term stability. Improvements include enhanced load distribution by using crushed rock “capping” layers or increasing the sub-base thickness if the bearing capacity of the subgrade remains unchanged, and lime stabilization of soft clay subgrades improves the subgrade stiffness and strength to reduce or remove the need for additional crushed rock. However, the relative sustainability of subgrade improvement options as determined by indicators such as carbon dioxide (CO2) emissions is not immediately apparent. If capping is used, the relative depth requirements, together with variations due to different aggregates, make the lowest emissions option unclear. Lime production incurs far greater CO2 emissions than aggregates production, but it is used in smaller quantities and the quantity truly required, as opposed to that commonly specified, requires consideration. To address these decision-making dilemmas, a methodology is presented that allows the relative sustainability, according to CO2 emissions, to be evaluated. This methodology is illustrated through analysis of available improvement options for a typical low California bearing ratio clay subgrade by using capping, subbase thickening and lime stabilization, or a combination of these solutions. It is concluded that analysis of the relative sustainability of subgrade improvements can be informed by emissions calculations and that the lowest emissions option is heavily dependent on associated highway haulage vehicle movements. However, wider appreciation of financial, social, and environmental factors and a fundamental understanding of the role of lime stabilization are necessary if road foundations are to be constructed sustainably.
Endoscopic third ventriculostomy to treat hydrocephalus associated with macrocephaly-cutis marmorata telangiectatica congenita
Authors: Mitha Alim P. , Bullivant Kelly J. , Lauzon Julie L. , Hader Walter J.
Published: October 2009

Macrocephaly-cutis marmorata telangiectatica congenita is a rare overgrowth syndrome commonly associated with hydrocephalus. Although the pathophysiological characteristics of the hydrocephalus in this syndrome is not fully known, previous reports have described its treatment with ventriculoperitoneal shunt placement. The authors describe 2 cases of macrocephaly-cutis marmorata telangiectatica congenita successfully treated for progressive hydrocephalus with endoscopic third ventriculostomy. Both patients experienced clinical and radiographic stabilization following treatment, and these findings offer insight into the pathophysiology of the hydrocephalus and its ideal management.
The motor-evoked potential threshold evaluated by tractography and electrical stimulation
Authors: Kamada Kyousuke , Todo Tomoki , Ota Takahiro , Ino Kenji , Masutani Yoshitaka , Aoki Shigeki , Takeuchi Fumiya , Kawai Kensuke , Saito Nobuhito
Published: October 2009

Object

To validate the corticospinal tract (CST) illustrated by diffusion tensor imaging, the authors used tractography-integrated neuronavigation and direct fiber stimulation with monopolar electric currents.

Methods

Forty patients with brain lesions adjacent to the CST were studied. During the operation, the motor responses (motor evoked potential [MEP]) elicited at the hand by the cortical stimulation to the hand motor area were continuously monitored, maintaining the consistent stimulus intensity (mean 15.1 ± 2.21 mA). During lesion resection, direct fiber stimulation was applied to elicit MEP (referred to as fiber MEP) to identify the CST functionally. The threshold intensity for the fiber MEP was determined by searching for the best stimulus point and changing the stimulus intensity. The minimum distance between the resection border and illustrated CST was measured on postoperative isotropic images.

Results

Direct fiber stimulation demonstrated that tractography accurately reflected anatomical CST functioning. There were strong correlations between stimulus intensity for the fiber MEP and the distance between the CST and the stimulus points. The results indicate that the minimum stimulus intensity of 20, 15, 10, and 5 mA had stimulus points ~ 16, 13.2, 9.6, and 4.8 mm from the CST, respectively. The convergent calculation formulated 1.8 mA as the electrical threshold of the CST for the fiber MEP, which was much smaller than that of the hand motor area.

Conclusions

The investigators found that diffusion tensor imaging–based tractography is a reliable way to map the white matter connections in the entire brain in clinical and basic neuroscience applications. By combining these techniques, investigating the cortical-subcortical connections in the human CNS could contribute to elucidating the neural networks of the human brain and shed light on higher brain functions.
Resolution of hydrocephalus-associated sensorineural hearing loss after insertion of ventriculoperitoneal shunt
Authors: Sammons Vanessa J. , Jacobson Erica , Lawson John
Published: October 2009

The authors present a pediatric patient with severe hearing loss due to communicating hydrocephalus. This is the first clearly documented case of de novo sensorineural deafness caused by hydrocephalus, with subsequent improvement in hearing after shunt insertion.

The patient initially presented with otitis media and was found to have hearing loss. After reporting ongoing headaches, he received a diagnosis of communicating hydrocephalus, which was treated with the insertion of a ventriculoperitoneal shunt. Formal hearing tests showed dramatic improvement postsurgery; his hearing was normal at 2 months. At 3 years postsurgery the patient's hearing remains within normal limits.

Hearing loss is a rare complication of hydrocephalus. Based on this case, the authors suggest that the diagnosis of hydrocephalus be considered as a cause of unexplained hearing loss, and conversely, that patients with hydrocephalus might benefit from hearing assessment.
Efficacy of antibiotic-impregnated shunt catheters in reducing shunt infection: data from the United Kingdom Shunt Registry
Authors: Richards Hugh K. , Seeley Helen M. , Pickard John D.
Published: October 2009

Object

In recent years CSF shunt catheters impregnated with rifampicin and clindamycin have been introduced to the United Kingdom (UK) market. These catheters have been shown to be effective in vitro against cultures of Staphylococcus epidermidis. The authors used data collected by the UK Shunt Registry to assess the efficacy of antibiotic-impregnated catheters (AICs) against shunt infection by using a matched-pair study design.

Methods

The UK Shunt Registry contains data on nearly 33,000 CSF shunt-related procedures. The authors identified 1139 procedures in which impregnated catheters had been used, and accurate information was known about diagnosis, number of revisions, sex, and age in these cases. The database was ordered chronologically and searched forward and backward for cases with these same characteristics but involving conventional catheters. Matches were found for 994 procedures.

Results

Among the 994 procedures in which AICs had been used, 30 shunts were subsequently revised because of shunt infection. Among the 994 controls, 47 were subsequently revised for infection (p = 0.048, chi-square test).

Conclusions

The UK Shunt Registry does not collect data on causative organisms, and the surgeon is relied on entirely for the diagnosis of infection. However, with the large number of matched pairs evaluated, the authors attempted to reduce bias to a minimum. Their data suggest that AICs have the potential to significantly reduce shunt infections.
Modified orbitozygomatic craniotomy for craniopharyngioma resection in children
Authors: Golshani Kiarash J. , Lalwani Kirk , Delashaw Johnny B. , Selden Nathan R.
Published: October 2009

Object

In this study, the authors evaluated the efficacy and safety of modified orbitozygomatic craniotomy for resection of craniopharyngioma in children.

Methods

A prospective, institutional review board–approved database was retrospectively reviewed for pediatric patients undergoing craniopharyngioma resection performed by a single surgeon.

Results

Ten patients underwent craniopharyngioma resection surgery between July 2000 and January 2006 (4 girls and 6 boys, ages 1.5–17 years). Nine patients presented to the authors' institution, and 1 patient was referred after surgery and radiation therapy were administered elsewhere. Nine patients presented with visual field deficits (2 with unilateral or bilateral light perception only) and 5 with endocrine dysfunction. Eight patients had large tumors that significantly displaced the optic chiasm and hypothalamus. All patients underwent a modified frontotemporal orbitozygomatic osteotomy in a single piece. The lamina terminalis was opened in 4 patients with third ventricular extension. One patient required a staged transsphenoidal operation to remove residual tumor in the sella turcica, and 1 patient underwent a contralateral subtemporal approach to resect a daughter lesion in the prepontine cistern. Complete radiographic resection was achieved in all patients. Follow-up averaged 55 months (range 12–95 months). Vision was improved in 8 patients and remained stable in 2. All patients had postoperative endocrine dysfunction. One patient experienced transient cranial nerve IV palsy and 1 suffered a small caudate stroke 5 months after surgery without sequelae. Two patients experienced polyphagia and weight gain without other symptoms of hypothalamic dysfunction. There were no other new neurological deficits.

Conclusions

Modified orbitozygomatic craniotomy provides excellent exposure of the suprasellar region with minimal brain retraction, allowing complete resection of craniopharyngiomas with good visual and neurological results.
Hemispherotomy: efficacy and analysis of seizure recurrence
Authors: Limbrick David D. , Narayan Prithvi , Powers Alexander K. , Ojemann Jeffrey G. , Park Tae Sung , Bertrand Mary , Smyth Matthew D.
Published: October 2009

Object

Hemispherotomy generally is performed in hemiparetic patients with severe, intractable epilepsy arising from one cerebral hemisphere. In this study, the authors evaluate the efficacy of hemispherotomy and present an analysis of the factors influencing seizure recurrence following the operation.

Methods

The authors performed a retrospective review of 49 patients (ages 0.2–20.5 years) who underwent functional hemispherotomy at their institution. The first 14 cases were traditional functional hemispherotomies, and included temporal lobectomy, while the latter 35 were performed using a modified periinsular technique that the authors adopted in 2003.

Results

Thirty-eight of the 49 patients (77.6%) were seizure free at the termination of the study (mean follow-up 28.6 months). Of the 11 patients who were not seizure free, all had significant improvement in seizure frequency, with 6 patients (12.2%) achieving Engel Class II outcome and 5 patients (10.2%) achieving Engel Class III. There were no cases of Engel Class IV outcome. The effect of hemispherotomy was durable over time with no significant change in Engel class over the postoperative follow-up period. There was no statistical difference in outcome between surgery types. Analysis of factors contributing to seizure recurrence after hemispherotomy revealed no statistically significant predictors of treatment failure, although bilateral electrographic abnormalities on the preoperative electroencephalogram demonstrated a trend toward a worse outcome.

Conclusions

In the present study, hemispherotomy resulted in freedom from seizures in nearly 78% of patients; worthwhile improvement was demonstrated in all patients. The seizure reduction observed after hemispherotomy was durable over time, with only rare late failure. Bilateral electrographic abnormalities may be predictive of posthemispherotomy recurrent seizures.
Pus and free bone flaps
Authors: Widdel Lars , Winston Ken R.
Published: October 2009

Object

The goal of this investigation is to describe the results of a vigorous attempt to preserve contaminated free bone flaps and avoid the problems associated with the traditional and common practice of discarding the flap, administering a course of antibiotics, and after several months, performing a cranioplasty.

Methods

Patients with clearly contaminated, free cranial bone flaps, including so-called high risk cases, were treated by meticulous debridement of the surgical bed, scrubbing, soaking, and then replacing the bone flap in its normal position, and administering a course of intravenous antibiotics.

Results

Fourteen patients with contaminated avascular cranial bone flaps were treated using this technique. All bone flaps were able to be preserved.

Conclusions

Patients with bacteriologically contaminated, free bone flaps can be treated successfully without discarding the flaps. Success is dependent upon aggressive surgical debridement and persistence.
Neurophysiological basis of direct cortical stimulation and applied neuroanatomy of the motor cortex: a review
Authors: Kombos Theodoros , Süss Olaf
Published: October 2009

Intraoperative electrical stimulation of the motor cortex is a sensitive method for intraoperative mapping and monitoring of this region. Two different stimulation techniques have been established, the bipolar and monopolar techniques. Controversy exists regarding the most suitable method. Both methods have advantages and disadvantages and different electrophysiological backgrounds. The present study is a review of the electrophysiological basis of direct cortical electrical stimulation of the motor cortex. Both methods are discussed and their field of application is presented.
Impact of anesthesia on transcranial electric motor evoked potential monitoring during spine surgery: a review of the literature
Authors: Wang Anthony C. , Than Khoi D. , Etame Arnold B. , La Marca Frank , Park Paul
Published: October 2009

Object

Transcranial motor evoked potential (TcMEP) monitoring is frequently used in complex spinal surgeries to prevent neurological injury. Anesthesia, however, can significantly affect the reliability of TcMEP monitoring. Understanding the impact of various anesthetic agents on neurophysiological monitoring is therefore essential.

Methods

A literature search of the National Library of Medicine database was conducted to identify articles pertaining to anesthesia and TcMEP monitoring during spine surgery. Twenty studies were selected and reviewed.

Results

Inhalational anesthetics and neuromuscular blockade have been shown to limit the ability of TcMEP monitoring to detect significant changes. Hypothermia can also negatively affect monitoring. Opioids, however, have little influence on TcMEPs. Total intravenous anesthesia regimens can minimize the need for inhalational anesthetics.

Conclusions

In general, selecting the appropriate anesthetic regimen with maintenance of a stable concentration of inhalational or intravenous anesthetics optimizes TcMEP monitoring.
Intraoperative neurophysiological monitoring during spine surgery: a review
Authors: Gonzalez Andres A. , Jeyanandarajan Dhiraj , Hansen Chris , Zada Gabriel , Hsieh Patrick C.
Published: October 2009

Spinal surgery involves a wide spectrum of procedures during which the spinal cord, nerve roots, and key blood vessels are frequently placed at risk for injury. Neuromonitoring provides an opportunity to assess the functional integrity of susceptible neural elements during surgery.

The methodology of obtaining and interpreting data from various neuromonitoring modalities—such as somatosensory evoked potentials, motor evoked potentials, spontaneous electromyography, and triggered electromyography—is reviewed in this report. Also discussed are the major benefits and limitations of each modality, as well as the strength of each alone and in combination with other modalities, with regard to its sensitivity, specificity, and overall value as a diagnostic tool. Finally, key clinical recommendations for the interpretation and step-wise decision-making process for intervention are discussed.

Multimodality neuromonitoring relies on the strengths of different types of neurophysiological modalities to maximize the diagnostic efficacy in regard to sensitivity and specificity in the detection of impending neural injury. Thorough knowledge of the benefits and limitations of each modality helps in optimizing the diagnostic value of intraoperative monitoring during spinal procedures. As many spinal surgeries continue to evolve along a pathway of minimal invasiveness, it is quite likely that the value of neuromonitoring will only continue to become more prominent.
Eosinophils Oxidize Damage-Associated Molecular Pattern Molecules Derived from Stressed Cells
Authors: Lotfi Ramin , Herzog Gloria Isabelle , DeMarco Richard Anthony , Beer-Stolz Donna , Lee James Joseph , Rubartelli Anna , Schrezenmeier Hubert , Lotze Michael Thomas
Published: October 2009

Eosinophils (Eos) are found at increased numbers within necrotic areas of tumors. We show that necrotic material from cell lysates containing damage-associated molecular pattern molecules induce eosinophil degranulation (release of major basic protein and eosinophil peroxidase) and enhance their oxidative burst while the stimulatory capacity of cell lysates is significantly diminished following oxidation. High mobility group box 1 (HMGB1), a prototypic damage-associated molecular pattern molecule, released following necrosis but not apoptosis, induced a similar effect on Eos. Additionally, we demonstrate that HMGB1 enhances eosinophil survival and acts as a chemoattractant. Consistently, we show that Eos express an HMGB1 receptor, the receptor for advanced glycation end product, and that anti-receptor for advanced glycation end product could diminish the HMGB1-mediated effects. Of all tested biologic activities, Eos respond most sensitively to the presence of necrotic material including HMGB1 with generation of peroxide. We postulate that Eos “sense” necrotic cell death, migrating to and responding to areas of tissue injury/necrosis. Oxidation of cell lysates reduces their biologic activity when compared with native lysates. We postulate that eosinophil-associated modulation of immunity within tumor and other damaged tissues may be primarily by promoting oxidative degradation of necrotic material. Novel therapeutic strategies may be considered by advancing oxidative denaturation of released necrotic material using Eos or other aerobic strategies.
Costimulatory Pathways in Multiple Sclerosis: Distinctive Expression of PD-1 and PD-L1 in Patients with Different Patterns of Disease
Authors: Trabattoni Daria , Saresella Marina , Pacei Michela , Marventano Ivana , Mendozzi Laura , Rovaris Marco , Caputo Domenico , Borelli Manuela , Clerici Mario
Published: October 2009

T lymphocytes costimulatory molecules, including CD80, CD86, CD28, CTLA4, PD-1, PD-L1, and B7-H3, are associated with the preferential production of pro- or anti-inflammatory cytokines. We analyzed the expression of these molecules and myelin basic protein (MBP)-specific IL-10 and IFN-γ production in patients with multiple sclerosis (MS) with relapsing-remitting acute (AMS, n = 40) or stable (SMS, n = 38). Twenty-two patients successfully undergoing therapy with glatimer acetate (n = 12) or IFNβ (n = 10) were also analyzed. MBP-specific and PD-1-expressing T lymphocytes, PD-L1-expressing CD19+ cells, and PD-L1+/IL-10+/CD14+ and CD19+ cells were significantly augmented in SMS patients. Additionally, MBP-specific and annexin V-expressing CD4+ and CD8+ (apoptotic) T lymphocytes were augmented and pAkt-positive (proliferating) cells were decreased in SMS compared with AMS patients. PD-1 ligation resulted in the increase of pAkt+ lymphocytes in AMS patients alone. B7-H3 expression and IFN-γ production were comparable in all individuals but the PD-L1+/IL-10+ over B7-H3+/IFN-γ+ ratio was significantly lower in AMS compared with SMS patients. Finally, PD-L1 expression on immune cells was reduced in treated patients, suggesting that therapy-induced disease remission is not associated with the modulation of the expression of this molecule. The PD-1/PD-L1 pathway plays an important role in modulating immune functions in MS patients; monitoring and targeting these proteins could offer diagnostic and therapeutic advantages.