Magnetic resonance imaging in partial complex epilepsy.

The yield of magnetic resonance (MR) imaging was investigated in 30 patients with partial complex epilepsy, and the results were compared with those of computed tomography (CT). Magnetic resonance imaging and CT disclosed focal cerebral abnormalities in 13 (43%) and eight (26%) patients, respectively. Two additional focal temporal lesions were identified by double-dose CT scanning, increasing the yield of CT to 33%. Magnetic resonance images were abnormal in all patients with focally abnormal CT scans, and in four patients (50%) they defined the extent of the temporolimbic lesions better than did the CT scans. Two of these patients had gliomas. In addition, MR images were focally abnormal in 85% of the patients in whom scalp electroencephalograms showed focal ictal discharges. These data indicate that MR imaging is more informative than CT in partial complex epilepsy.

Nifedipine for intractable hiccups.

Seven patients with intractable hiccups were treated with a calcium channel blocker, nifedipine. A daily dose of 30 to 60 mg of this drug stopped hiccups in 4 patients and improved them in a 5th patient. In 2 patients hiccups recurred within 24 hours after stopping nifedipine. Nifedipine can be effective against intractable hiccups in some patients.

Enhancement of in vitro murine embryo development by recombinant leukemia inhibitory factor.

OBJECTIVE: Human recombinant leukemia inhibitory factor (rLIF) has been shown to stimulate hatching of murine and ovine embryos in vitro. The temporal and dose-dependent effects of murine rLIF (mrLIF) and human rLIF (hrLIF) on embryo development in two different mouse strains were investigated in this work. METHODS: Two-cell embryos were recovered from the fallopian tubes of superovulated/mated females and cultured in Krebs medium plus bovine serum albumin in microdroplets under oil. RESULTS: In the B6CBF1 strain, mrLIF significantly stimulated blastocyst formation and decreased embryo fragmentation/degeneration when added simultaneously at the initiation of culture or 24 hours thereafter. Human rLIF also had a positive effect on development. In the CD1 strain (lower fecundity), mrLIF dose-dependent effects were observed, with enhanced developmental stimulation achieved with higher doses. CONCLUSIONS: These findings confirm that hrLIF stimulates mouse embryo development in vitro and that different mouse strains show distinct responses to the cytokine. In addition, mrLIF enhances blastocyst formation and decreases embryo fragmentation when added to the embryo culture as early as the two-cell stage.

Should relatives be allowed in the resuscitation room?

OBJECTIVE: To assess doctors' and nurses' views on the presence of relatives in the resuscitation room during cardiac arrest or major trauma. DESIGN: Questionnaires were sent to accident and emergency (A&E) nurses and doctors of all disciplines in a London teaching hospital. Recipients were asked if they would favour the presence of selected relatives in the resuscitation room and to give comments. RESULTS: 103 questionnaires were distributed and 81 returned, a response rate of 78.6%; 33% were senior house officers, 29% consultants, 16% senior registrars/registrars, 12% A&E nurses, and 10% house officers. Of the respondents, 63% were not in favour of relatives being present, and 37% were in favour. The likelihood of being in favour of allowing relatives to be present was high among A&E nurses; among doctors it increased with rising seniority. Most respondents felt that more resuscitation training would be necessary, in addition to counselling for staff and relatives. CONCLUSIONS: Staff with the least experience in dealing with resuscitations and distressed relatives were likely to be opposed to relatives being present in the resuscitation room. As there is evidence that the bereavement process is eased if a partner/relative witnesses the resuscitation, relatives should be offered the opportunity to witness resuscitation if staff training is geared towards the presence of relatives. ALS/ATLS training for all hospital doctors and nurses should include the management of distressed relatives observing a resuscitation.

Histological and ultrastructural features of dystrophic isocortical axons in infantile neuroaxonal dystrophy (Seitelberger's disease).

The histological and ultrastructural features of axonal swellings are described in a cerebral biopsy specimen from a 6-year-old girl with infantile neuroaxonal dystrophy. In agreement with previous reports, several swellings were identified as axonal terminals, and it is postulated that the prevailing axonal swellings in cerebral cortex represent dystrophic boutons. Microscopically, dystrophic cortical boutons are morphologically different from typical subcortical spheroids and can be easily identified in routine histological preparations. Five ultrastructural elements were present in most axonal swellings: clusters of characteristic membranous bodies, stacks of elongated membranes, mitochondria, groups of vesicles, and an amorphous matrix. In spite of widespread axonal enlargement, the cerebral cortex was not thickened, and, in fact, the gyri looked atrophic in computerized axial tomograms. These findings suggest that some normal cortical element must be deficient, but such a structure remains to be identified.

EEG and neuroimaging localization in partial epilepsy.

We have studied cortical localization provided by surface and sphenoidal electroencephalograms (EEGs) and that of computed tomography (CT), magnetic resonance imaging (MR) and single photon emission tomography (SPECT) in 58 patients with partial epilepsy. Each patient had EEG, MR and SPECT during a hospitalization period of 1-2 weeks. CT scans were obtained either during the same period or had been performed in the preceding year. EEG evaluation consisted of 3-5 days of continuous monitoring including video-telemetry and ambulatory recording as well as conventional EEGs with special electrode placements. Additionally 33 of 58 patients (55%) who were potential surgical candidates had sphenoidal recordings. All patients had an abnormal EEG which showed evidence of epileptic hyperexcitability. EEG abnormality was localized in 43 patients (74%). Neuroimaging studies were focally abnormal in 38 patients (66%); 12 CT (21%), 29 MR (50%) and 24 SPECT (41%). Thirty four of 43 patients with localized EEG had at least 1 focally abnormal neuroimaging study (79%), whereas 4 of 15 (27%) patients with non-localized EEG did so. Twenty-eight of 29 patients with focal MR (97%), 11 of 12 patients with focal CT (92%) and 20 of 24 patients with focal SPECT (83%) had a concordant focal EEG. EEG and neuroimaging localization agreed in all 15 patients in whom both MR and SPECT disclosed a concordant focal abnormality. This study demonstrates a significant (P less than 0.005) correlation between surface/sphenoid EEG and neuroimaging localization in partial epilepsy.