Time- and dose-dependent volume decreases in subcortical grey matter structures of glioma patients after radio(chemo)therapy.

Background and purpose: Radiotherapy (RT) is an adjuvant treatment option for glioma patients. Side effects include tissue atrophy, which might be a contributing factor to neurocognitive decline after treatment. The goal of this study was to determine potential atrophy of the hippocampus, amygdala, thalamus, putamen, pallidum and caudate nucleus in glioma patients having undergone magnetic resonance imaging (MRI) before and after RT. Materials and methods: Subcortical volumes were measured using T1-weighted MRI from patients before RT (N = 91) and from longitudinal follow-ups acquired in three-monthly intervals (N = 349). The volumes were normalized to the baseline values, while excluding structures touching the clinical target volume (CTV) or abnormal tissue seen on FLAIR imaging. A multivariate linear effects model was used to determine if time after RT and mean RT dose delivered to the corresponding structures were significant predictors of tissue atrophy. Results: The hippocampus, amygdala, thalamus, putamen, and pallidum showed significant atrophy after RT as function of both time after RT and mean RT dose delivered to the corresponding structure. Only the caudate showed no dose or time dependant atrophy. Conversely, the hippocampus was the structure with the highest atrophy rate of 5.2 % after one year and assuming a mean dose of 30 Gy. Conclusion: The hippocampus showed the highest atrophy rates followed by the thalamus and the amygdala. The subcortical structures here found to decrease in volume indicative of radiosensitivity should be the focus of future studies investigating the relationship between neurocognitive decline and RT.

Endemicity and inter-city spread of Burkholderia cepacia genomovar III in cystic fibrosis.

OBJECTIVES: We sought to determine whether the same Burkholderia cepacia complex strain has persisted as the dominant clonal lineage among patients in a large cystic fibrosis (CF) treatment center during the past 2 decades. STUDY DESIGN: The inter-city spread of B cepacia through transfer of a colonized patient and the impact of infection control measures in containing inter-patient transmission were investigated. We analyzed all available B cepacia complex isolates recovered from 1981 to 1987 and from 1996 to 2000 at one large CF treatment center (Center A) and from 1997 to 2000 at another center (Center B). Incidence of B cepacia complex infection and infection control measures in both centers were assessed. RESULTS: Seventeen (81%) of 21 Center A patients from whom B cepacia complex bacteria were recovered between 1981 and 1987 and 40 (97%) of 41 patients culture-positive between 1996 and 2000 were infected with the same genomovar III strain. Transfer of a colonized patient from Center A to Center B was associated with an increase in B cepacia complex infection in Center B, all of which was with the Center A dominant strain. This strain, designated PHDC, lacks both B cepacia epidemic strain and cblA markers. CONCLUSIONS: B cepacia complex strains may remain endemic in CF treatment centers for many years. Responsible bacterial and host factors and optimal infection control measures to prevent inter-patient spread remain to be identified.

Inhaled corticosteroids in childhood asthma: growing concerns.

Inhaled corticosteroids (ICS) are an established treatment for asthma in childhood. Recent data bring to light growing concerns that ICS may have significant effects on growth velocity in children. The Food and Drug Administration (FDA) recently convened a joint meeting to review these data, and to release new class labelling for ICS that notes this potential adverse effect. Additional concerns regarding ICS are also discussed, including other potential adverse effects, difficulty of use, noncompliance, and patient and parental concerns with the safety of ICS. The aim of this article is as follows: to describe the rationale for the use of ICS in children with asthma; to delineate the association of ICS with potential growth suppression in children; to discuss recent FDA class labelling for use of ICS in children; to describe other potential long term effects of ICS in children; and to detail compliance issues in children with asthma treated with ICS.

Effects of nimodipine on the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced depletions in the biogenic amine levels in mice.

In view of the calcium hypothesis the effect of nimodipine (Bay e 9736, CAS 66085-59-4) on the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced depletions in dopamine and serotonin were investigated in C57-BL/6 mice. Oral treatment with nimodipine (5 mg/kg and 20 mg/kg b.i.d., respectively, for 9 days) prior to, during and following administration of MPTP appeared to attenuate MPTP-induced neurochemical changes in a dose-related manner. The results suggest that nimodipine reduces MPTP-induced damages, especially in the serotoninergic system, through its calcium antagonistic effects.

[Laser treatment for tightening the trabecular meshwork in open-angle glaucoma (trabeculoplasty)]. / Laserbehandlung zur Straffung des Trabeculum corneosclerale bei Offenwinkelglaukom (Trabekuloplastik).

Forty eyes with medically uncontrolled open-angle glaucoma underwent argon laser therapy through 360 degrees of the trabecular meshwork. The mean pressure change in the treated eyes after two weeks showed a decrease of 9.95 mmHg. Thirty-five eyes (87.5%) were clinically controlled (tension less than or equal to 20 mmHg) either by laser treatment alone (25 eyes) or by continuation of previous therapy (10 eyes) over the various follow-up periods ranging from one to ten months (means = 3.31). Laser therapy showed no hypotensive reaction in five eyes. Increased pressure immediately after therapy seems to be the most severe side effect, which was of short duration in all cases but two.

[The effect of neural mediation on the immediate rise in intraocular pressure in glaucomatous eyes after cyclocryotherapy (author's transl)]. / Der Einfluss der neuralen Reizübertragung auf den postoperativen Druckanstieg in Glaukomaugen nach Zyklokryokoagulation.

As a rule, there is a transient rise in intraocular pressure following cyclocryotherapy. The preoperative administration of retrobulbar anaesthesia to a group of patients significantly reduced intraocular pressure after cyclocryotherapy in this group as compared with a control group without anaesthesia. These results imply that the temporary rise in intraocular pressure after cyclocryotherapy is mediated by a neural pathway.

Metastatic calcification to the peripheral fundus in chronic renal failure.

Report on massive deposition of calcium hydroxypatite in the eye of a 20-year-old woman who died as a result of chronic renal failure. Massive accumulation of this material within the previtreal space lead to an unusual finding in the peripheral fundus.