Remote cerebellar hemorrhage.

Remote cerebellar hemorrhage (RCH) is a rare but benign, self-limited complication of supratentorial craniotomies that, to the best of our knowledge, has not been described in the imaging literature. RCH can be an unexpected finding on routine postoperative imaging studies and should not be mistaken for more ominous causes of bleeding such as coagulopathy, hemorrhagic infarction, or cortical vein occlusion. Cerebellar hemorrhage in the typical setting can be identified as RCH and does not require more extensive or invasive evaluation.

Chronic behavioral stress induces apical dendritic reorganization in pyramidal neurons of the medial prefrontal cortex.

Both the hippocampus and the medial prefrontal cortex (mPFC) play an important role in the negative feedback regulation of hypothalamic-pituitary-adrenal (HPA) activity during physiologic and behavioral stress. Moreover, chronic behavioral stress is known to affect the morphology of CA3c pyramidal neurons in the rat, by reducing total branch number and length of apical dendrites. In the present study, we investigated the effects of behavioral stress on the mPFC, using the repeated restraint stress paradigm. Animals were perfused after 21 days of daily restraint, and intracellular iontophoretic injections of Lucifer Yellow were carried out in pyramidal neurons of layer II/III of the anterior cingulate cortex and prelimbic area. Cellular reconstructions were performed on apical and basal dendrites of pyramidal neurons in layer II/III of the anterior cingulate and prelimbic cortices. We observed a significant reduction on the total length (20%) and branch numbers (17%) of apical dendrites, and no significant reduction in basal dendrites. These cellular changes may impair the capacity of the mPFC to suppress the response of the HPA axis to stress, and offer an experimental model of stress-induced neocortical reorganization that may provide a structural basis for the cognitive impairments observed in post-traumatic stress disorder.

Treatment of recurrent peripheral nerve entrapment problems: role of scar formation and its possible treatment.

Surgical management of peripheral nerve entrapment syndromes is usually successful, but the recurrence of symptoms after initial improvement can and does occur. Extraneural fibrosis is one possible cause of recurrent peripheral nerve problems as a result of nerve compression or tethering. Several approaches to prevent extraneural scarring after surgery have been studied, including wrapping the involved nerve with a graft, the application of various chemical compounds, and radiation. ADCON-T/N, an antiscar bioabsorbable gel device was evaluated in a retrospective clinical review. Sixty-seven percent of patients treated with ADCON-T/N after reoperation of a peripheral nerve experienced prolonged clinical improvement compared with 50% of patients who did not receive ADCON-T/N. These preliminary results suggest that ADCON-T/N may prove to be clinically useful in the surgical treatment of peripheral nerve problems. Additional more rigorous clinical studies are necessary, however.

Co-occurring psychosocial distress and substance abuse in community clients: initial validity and reliability of self-report measures.

The current study examines the self-reports of 227 community support clients using a paper and pencil questionnaire that included the South Shore Problem Inventory-revised (a brief multidimensional psychosocial distress scale), a one-item index of self-rated substance abuse (SRSA), a quantity-frequency index for alcohol consumption (QFI), and a one-item index measuring the frequency of marijuana use. Results support the factor structure and internal consistency of the SSPI-r, and show significant correlations among the substance use indices. Implications for including brief mental health and substance abuse measures are discussed within the context of routine assessment and practice evaluation.

Use of free-tissue transfer in the treatment of median sternotomy wound infections: retrospective review.

The incidence of sternal wound infection following median sternotomy is 0.4 to 5 percent. Debridement and closure of the wounds with local and regional muscles, such as a pectoralis or a pedicled rectus abdominis, have been the mainstay of surgical treatment. Often, both pectoralis major muscles and the superior portion of a rectus abdominis muscle must be used to close large sternal wounds. Loss of these major muscles can be both debilitating and cosmetically disfiguring. Free-tissue transfer can be employed to limit the amount of tissue needed to fill the sternal defect. The authors present a series of 12 free-tissue transfers used in 11 patients to close large sternal defects in this subset of patients. Total flap loss occurred in one patient. Partial loss of the skin island was noted in three patients. Two patients developed abdominal hernias after rectus abdominis free flaps. Free-tissue transfer offers the ability to close these large wounds, using one muscle, in those patients where pedicled rectus abdominis flaps are not available.

The application of an artificial neural network and pharmacokinetic simulations in the design of controlled-release dosage forms.

The objective of this work is to use an artificial neural network (ANN) and pharmacokinetic simulations in the design of controlled-release formulations with predictable in vitro and in vivo behavior. Seven formulation variables and three other tablet variables (moisture, particle size and hardness) for 22 tablet formulations of a model sympathomimetic drug were used as the ANN model input, and in vitro dissolution-time profiles at ten different sampling times were used as output. An ANN model was constructed by selecting the optimal number of iterations and model structure (the number of hidden layers and number of hidden layer nodes). The optimized ANN model was used for prediction of formulations based on two desired target in vitro dissolution-time profiles and two desired bioavailability profiles. For three of the four predicted formulations there was very good agreement between the ANN predicted and the observed in vitro and simulated in vivo properties. This work illustrates the potential for an artificial neural network, along with pharmacokinetic simulations, to assist in the development of complex dosage forms.

P-selectin blockade following fluid-percussion injury: behavioral and immunochemical sequelae.

Traumatic brain injury (TBI) can cause polymorphonuclear leukocyte (PMN) migration into brain parenchyma, mediating various cytodestructive mechanisms. We examined the effect of blocking leukocyte/endothelial cell adhesion molecules (CAMs) on the anatomic and behavioral sequelae in lateral fluid-percussion injury in rats. Monoclonal antibodies (MAb) directed against a functional (PB1.3) or nonfunctional (PNB1.6) epitope on endothelial P-selectin were used as treatments. Subjects were tested in the Morris water maze (MWM) at 7 and 14 days postinjury then immunohistochemistry was performed using antibodies that recognize ChAT, GFAP and OX-42. A second set of animals underwent myeloperoxidase (MPO) assay in the brain parenchyma and a third set was used to examine neutrophil migration using the MAb RP-3. Time in quadrant, but not escape latency or proximity improved with PB1.3 (p < 0.05). Similarly, PB1.3 reduced MPO levels after injury (p < 0.05), in the ipsilateral cortex. No significant difference occurred in neutrophil counts in cortex, corpus callosum, hippocampus, and thalamus between injured only rats and injured rats treated with PB1.3. Quantitative analysis of cholinergic cells in the medial septum showed a protective effect by PB1.3. Densitometry readings of GFAP and OX-42 immunolabeling revealed no discernible differences between the treated and untreated injured rats. Qualitatively, there was no difference in microglia or astrocyte response to treatment. Treatment with P-selectin blockade in brain-injured rats may reduce PMN migration into brain, help preserve cholinergic immunolabeling of medial septal nucleus neurons, and may alleviate mnemonic deficits.

The use of digital artery sympathectomy as a salvage procedure for severe ischemia of Raynaud's disease and phenomenon.

We retrospectively reviewed the effectiveness of digital artery sympathectomy as a last resort to prevent amputation in severe cases of Raynaud's disease and phenomenon. Seven patients underwent digital artery sympathectomy as a salvage procedure to prevent amputation. The patients developed cold intolerance secondary to atherosclerosis or collagen vascular disease. The results were analyzed using the criteria of ulcer healing and the prevention of amputation. In 6 of the 7 patients, the digital ulcers healed and amputation was avoided.

Adaptation of the fluid percussion injury model to the mouse.

Fluid percussion injury (FPI) is a well-characterized experimental model of traumatic brain injury (TBI) in the rat. Many pathophysiologic consequences and mechanisms of recovery after TBI rely on neurochemical pathways that can be examined in genetically altered mice. Therefore, FPI applied to mice may be a useful experimental tool to investigate TBI at the molecular level. In the present study, we establish FPI as a viable model of TBI in the mouse by characterizing acute neurological, histopathological, and behavioral changes. Right-sided parasagittal FPI or sham treatment was administered in male C57BL/6 mice. Acute neurological evaluation revealed righting reflexes in the injured animals (p < 0.001). Deficits in spatial learning and memory were observed in the Morris water maze (MWM) 5 and 6 days after injury. A novel MWM data analysis protocol is described. The injured group (n = 18) demonstrated impaired performance in the MWM during acquisition (p < 0.05) and probe trials (p < 0.025) compared to sham animals (n = 16). At 7 days postinjury, glial fibrillary acidic protein immunohistochemistry revealed intense cortical, callosal, and hippocampal gliosis. The modified Gallyas silver degeneration stain consistently labeled cell bodies and terminals throughout the ipsilateral cortex, axons in the gray matter-white matter interface above the corpus callosum and within the corpus callosum bilaterally, and terminals and fibers in the thalamus bilaterally. Additionally, the mouse FPI model described is immediately employable in labs already using the FPI rat model with no modifications to a pre-existing FPI apparatus.

Relating formulation variables to in vitro dissolution using an artificial neural network.

The purpose of this paper was to investigate the effect of several experimental variables on the ability of a neural network to predict in vitro dissolution rate as a function of product formulation changes. Neural network software was trained with sets of hypothetical and experimental data consisting of 4-15 formulations with known in vitro drug dissolution profiles and the ability of the trained model to recognize patterns was validated against similar formations not used to train the neural network. The effect of selected variables, e.g., number of hidden-layer nodes and iterations, as well as the use of replicate or mean data on the accuracy of the predictions was investigated. The importance of optimizing the number of hidden-layer nodes and iterations was demonstrated. The prediction error increased for validation data sets that were outside the range of the training data set. Accurate predictions were obtained with as few as four formulations in the training set, provided the formulations were carefully chosen, and the number of formulation variables were small. Also, limiting the validation set to one formulation was not sufficient to validate the neural network model. Increasing the size of the training set, or replication of the input and output data, also provided more accurate predictions. The neural network accurately predicted in vitro drug release provided the neural network variables were optimized, and the training and validation data sets were appropriately selected.

The role of free radicals as mediators of endothelial cell injury in hyperhomocysteinemia.

Hyperhomocysteinemia has been suggested as a potent new risk factor for premature cardiovascular disease. Homocsyteine can induce endothelial cell injury but the mechanism is not understood. The purpose of this study was to evaluate the role of free radicals as potential causes of endothelial cell injury in a case-control study of obligate heterozygotes for cystathionine beta-synthase deficiency. Firstly, free radical production as measured by neutrophil chemiluminescence in obligate heterozygotes for cystathionine beta-synthase deficiency was compared with age- and sex-matched normal subjects. Secondly, the response of the cellular antioxidant system was examined by measuring the enzymes superoxide dismutase and glutathione peroxidase, their cofactors (selenium, copper), vitamin E and vitamin A in heterozygotes and normal subjects. Analyses of neutrophil chemiluminescence, vitamin A and E, glutathione peroxidase, selenium and copper showed no difference between heterozygotes and controls. While superoxide dismutase activity was higher in heterozygotes than normal subjects, the difference did not reach statistical significance and the hypothesis of excess free radical production as a mechanism of injury was not confirmed. However, further examination of superoxide dismutase activity in a larger number of subjects would be of interest.

Interleukin-8 inhibits the induction of nitric oxide synthase in rat peritoneal neutrophils.

The effect of interleukin(IL)-8 and leukotriene B4 (LTB4) on the induction of nitric oxide (NO) synthase in rat peritoneal neutrophils (PMN) ex vivo was studied. IL-8, but not LTB4, caused concentration-dependent inhibition of the induction of a Ca(2+)-independent NO synthase ex vivo. The effect of IL-8 was not attributable to the synthesis of an inhibitor of this enzyme. These findings suggest complex regulatory control of the induction of NO synthase by cytokines.

Induction of nitric oxide synthase in rat peritoneal neutrophils and its inhibition by dexamethasone.

Rat peritoneal polymorphonuclear leukocytes (PMN) elicited with oyster glycogen contain a Ca(2+)-independent nitric oxide (NO) synthase which is induced in vivo in a time-dependent manner. When washed PMN containing low levels of enzyme activity were cultured ex vivo further expression of NO synthase was observed. This was inhibited by cycloheximide indicating that de novo synthesis of the enzyme occurred during the ex vivo incubation. Enzyme activity was enhanced by interferon (IFN)-gamma, but not by tumor necrosis factor (TNF)-alpha when added ex vivo. However, IFN-gamma and TNF-alpha synergized to increase further the expression of NO synthase. Treatment of rats with dexamethasone inhibited the induction of NO synthase in elicited PMN. This treatment reduced the accumulation of PMN by approximately 30%, without affecting cell viability. Dexamethasone also inhibited the induction of the NO synthase ex vivo in a concentration-dependent manner. Furthermore, the enhanced enzyme activity following treatment of PMN with cytokines was also inhibited by dexamethasone. Once induced, dexamethasone did not affect enzyme activity. These data indicate that PMN elicited in the rat peritoneum with oyster glycogen express an NO synthase in vivo and ex vivo. The induction of the enzyme can be further stimulated ex vivo with IFN-gamma and TNF-alpha and inhibited by dexamethasone. The inhibition of the induction of NO synthase in the PMN by dexamethasone may contribute to the anti-inflammatory activity of this and other glucocorticoids.

Identification of N-iminoethyl-L-ornithine as an irreversible inhibitor of nitric oxide synthase in phagocytic cells.

1. The synthesis of nitric oxide (NO) from L-arginine by rat peritoneal neutrophils (PMN) and the murine macrophage cell-line J774 and the inhibition of this synthesis by N-iminoethyl-L-ornithine (L-NIO), NG-monomethyl-L-arginine (L-NMMA), NG-nitro-L-arginine (L-NNA) and its methyl ester (L-NAME) were investigated. 2. L-NIO was the most potent inhibitor in both types of cells while L-NMMA was less active. L-NNA and L-NAME had no significant effect in PMN and L-NNA produced only approximately 40% inhibition of the generation of NO in the J774 cells at the highest concentration tested (300 microM). 3. The inhibitory effect of L-NIO was rapid in onset, requiring 10 min pre-incubation to achieve its full inhibitory activity, while the other compounds required 20-60 min pre-incubation to achieve their full effect. 4. The inhibitory effect of L-NIO (10 microM) on intact cells could not be reversed by L-arginine (300 microM) but could be prevented by concomitant incubation with this compound (300 microM), while the effect of the other inhibitors could be reversed by a 3-5 fold molar excess of L-arginine. 5. The NO synthase from both PMN and J774 cells was cytosolic and NADPH- but not Ca2(+)-dependent, with Km values for L-arginine of 3.3 +/- 0.8 and 4.2 +/- 1.1 microM respectively. 6. L-NIO was the most potent inhibitor of the neutrophil and J774 enzymes with IC50 values of 0.8 +/- 0.1 and 3 +/- 0.5 microM respectively. Furthermore, the effect of L-NIO was irreversible. The other three compounds were less potent, reversible inhibitors. 7. The inhibitory effects of all these compounds were enantiomerically specific. 8. These data indicate that L-NIO is a novel, potent, rapid in onset and irreversible inhibitor of NO synthase in phagocytic cells. The rapid uptake of L-NIO compared with the other compounds indicates that phagocytic cells have different uptake mechanisms for L-arginine analogues.