The value of dual-energy CTA for control of surgically clipped aneurysms.

OBJECTIVE: Comparison of image quality in DE-CTA with and without automatic head bone removal (BR) versus CTA with 16-detectors as a tool in postoperative evaluation of patients after neurosurgical clipping. METHODS: In this study 30 aneurysms that had undergone neurosurgical clipping were included: 18 with DE-CTA and 12 with conventional CTA. The images were further processed using the volume rendering technique (VRT) and BR. Two experienced neuroradiologists reviewed the images regarding the severity of artefacts surrounding the clip, visibility of the vessels and remnant necks. The results were compared with DSA images, if performed. RESULTS: Significantly fewer disturbances by artefacts were observed in DE-CTA versus CTA in a 16-row system. Visibility of the surrounding vessels was satisfying in both techniques and there were comparable results with DSA with only one exception. All images produced with 140 kV provided fewer artefacts than those with 80 kV. CONCLUSION: DE-CTA provides better image quality with fewer disturbances by clip artefact, a satisfying evaluation of remnant aneurysm necks and the surrounding vessels. As this method is easily performed and readily accessible with fast image post-processing using BR it provides an opportunity to avoid invasive DSA in the evaluation of suspected aneurysm rests.

Obesity and paediatric migraine.

This study investigates the influence of obesity on the severity of migraine in children. One hundred and twenty-four patients (77 female, 36 with aura; mean age 12.9 +/- 2.8 years; age range 4.0-17.0 years) were included. Headache features such as number and duration of attacks, pain severity and associated symptoms were compared between obese, overweight and normal weight patients. The percentage of obesity was 17.7. Although pain severity and duration were not different among groups, obese patients had more frequent attacks than the overweight and normal weight patients (5.3 +/- 2.4, 4.4 +/- 2.4 and 3.8 +/- 2.4 attacks/month, respectively, P = 0.018). There was also a positive correlation between relative body mass index and number of attacks (P = 0.026, r = 0.20). Obesity did not have an influence on migraine-associated symptoms including aura, phono/photophobia, nausea and vomiting. In this study, obesity appeared to be related to the frequency of headache attacks in children and adolescents with migraine.

Incidence and antibiotic resistance of Salmonella spp. in ground turkey meat.

1. The objectives of this study were to isolate Salmonella spp. by conventional culture technique from ground turkey samples, to determine the seasonal distribution of Salmonella spp., to verify the isolates by PCR using primers based on oriC gene sequence, and to determine the antibiotic susceptibility profiles of the isolates. A total of 240 packaged fresh ground turkey samples marketed in Ankara were analysed between July 2004 and June 2005. 2. One hundred and ten out of 240 (458%) samples were positive for Salmonella spp. and confirmed by PCR. The distribution of Salmonella spp. was determined as 483, 550, 633 and 166%, during spring, summer, autumn and winter, respectively. Statistical analysis showed a significant difference for the prevalence of Salmonella spp. between winter and the other seasons. 3. Of the isolates, 54 out of 110 (490%) were resistant to one or more antibiotics tested. The highest resistance was observed to nalidixic acid (254%), followed by streptomycin (172%) and tetracycline (154%). 4. In conclusion, this is a disturbing finding, both for the high prevalence of Salmonella and the extent of antibiotic resistance. Ground turkey should be produced under suitable hygienic and technological conditions and the use of antimicrobials must be controlled by governmental agencies to protect public health from salmonellosis and from the consequences of increased resistance to the antibiotics.

Congenital infiltrating lipomatosis of the face with hemimegalencephaly.

Congenital infiltrating lipomatosis of the face (CILF) is a rare disorder, causing unilateral facial asymmetry characterized by enlargement of the cheek or chin. Hemimegalencephaly is a unique malformation characterized by enlargement of a cerebral hemisphere. The association of CILF and hemimegalencephaly has rarely been reported. We present a case of unilateral facial swelling in a 1.5-year-old boy in whom magnetic resonance imaging and computed tomography revealed CILF associated with unilateral megalencephaly.

Increased risk for coeliac disease in paediatric patients with migraine.

The aim was to determine the prevalence of coeliac disease (CD) in paediatric patients with migraine. Serum tissue transglutaminase IgA (tTGA) antibodies and IgA concentrations were measured in 73 patients with migraine (age range 6-17 years) and the control group (n = 147). Patients having positive tTGA antibodies underwent duodenal biopsy. Four patients (5.5%) from the study group and one (0.6%) from the control group had positive tTGA antibody titres (P < 0.05). Three patients with migraine had normal duodenal histology and were considered as potential CD. One patient from the study group and one from the control group declined to have biopsy. tTGA antibody is considered as a reliable indicator for the presence of CD. However, some patients with positive antibodies may have normal biopsy initially and are classified as having potential CD. Our finding of a higher prevalance of tTGA antibodies in paediatric migraine patients suggests that an association between migraine and CD might exist.

Molecular typing of Clostridium perfringens isolated from turkey meat by multiplex PCR.

AIMS: To determine the presence of toxin genes in 22 Clostridium perfringens isolated from turkey meat samples by molecular typing. METHODS AND RESULTS: For this purpose, alpha (cpa), beta (cpb), beta 2 (cpb2), epsilon (etx), iota (iA) and enterotoxin (cpe) toxin genes were analysed by multiplex PCR. All 22 turkey meat Cl. perfringens isolates were found to carry the cpa, gene but in none of the isolates cpb, etx, iap or cpe genes were detected. Results showed that all isolates represented type A and were cpe negative. CONCLUSIONS: Our results indicate that Cl. perfringens type A is the most common type in turkey meat. Also multiplex PCR is effective and rapid method for typing of Cl. perfringens. SIGNIFICANCE AND IMPACT OF THE STUDY: It is the first study about molecular typing of Cl. perfringens using multiplex PCR in turkey meat samples in Turkey.

Immunomagnetic separation and PCR detection of Listeria monocytogenes in turkey meat and antibiotic resistance of the isolates.

1. Conventional cultivation and immunomagnetic separation (IMS) cultivation methods were compared for the isolation specificity and sensitivity of L. monocytogenes from turkey meat samples. PCR was used to confirm the isolates. Disc diffusion was performed to determine the antibiotic susceptibility profiles. A total of 180 turkey meat samples collected from markets in Turkey were tested. 2. L. monocytogenes was detected in 23 samples (12.7%) by IMS and conventional cultivation. It was isolated from 16.6% (10/60), 11.6% (7/60) and 10.0% (6/60) of the meat cut, breast and leg samples, respectively. PCR assay was performed based on hlyA (LLO-listeriolysin O) gene specific primers. In all 23 (100.0%) isolates of the hlyA gene were determined. The disc diffusion test showed that 19 (82.6%) isolates were resistant to penicillin G and 17 (73.9%) to ampicillin. In addition, 8 isolates were partially resistant to erythromycin and 8 to streptomycin. 3. In conclusion, to safeguard public health turkey meat must be produced under hygienic and suitable technological conditions. Furthermore antimicrobials, as prophylactic or growth promoter agents, must be firmly controlled by governmental agencies.

Isolation of Escherichia coli O157:H7 from the gall bladder of inoculated and naturally-infected cattle.

To determine if Escherichia coli O157:H7 is capable of residing in the gall bladder of cattle, inoculation studies were conducted with O157:H7 strain 86-24 in weaned Holstein calves. Strain 86-24 was isolated from the gall bladders of five calves 36 days after inoculation. Two other calves contained the inoculation strain in the distal colon but the organism was absent in their gall bladders. A second trial in which the calves were euthanized 15 days after inoculation found strain 86-24 in six of seven inoculated calves but only in colon and/or rumen samples. In a third trial that inoculated eight calves with a four-strain cocktail of O157:H7 strains, the gall bladders from all eight animals were positive 9 days after inoculation. The colon and rumen samples from these calves were also positive. E. coli O157:H7 isolates recovered from bile samples and subtyped by pulsed field gel electrophoresis found that three of the four inoculation strains were present in one or more of the calves. Thus, residence in the gall bladder is not restricted to a single strain. Additional evidence of the ability to localize in the gall bladder of cattle was provided by testing the bile from 150 gall bladders (five collection dates, 30 samples each) obtained at an abbatoir and the isolation of E. coli O157:H7 from four samples (2.7%). This study establishes that E. coli O157:H7 can reside transiently or permanently at a low level in the gall bladder of cattle.

Prevalence of latex sensitivity in patients with malignancies.

UNLABELLED: An increased frequency of allergic reactions to latex have been reported in specific populations with chronic latex exposure (e. g., children with spina bifida, health-care workers, rubber and doll-manufacturing workers). However, latex sensitization occurs in adult patients with no known risk factors. This study investigated hypersensitivity to latex in patients with malignancies. MATERIAL AND METHODS: We studied 70 adult patients (40 females, 30 males) with a standard questionnaire, skin prick tests (SPTs) with latex, common aeroallergens and fruits to all of the subjects. In addition, specific IgE concentrations for all of these allergens were measured in serum with the Pharmacia UniCAP system. RESULTS: The prevalence of latex sensitization was found to be 11.4% (n = 8). Both SPTs and anti-latex IgE antibodies of these patients were positive in the sera. Latex sensitization was related to the personal history of allergic diseases (p = 0.02), the duration of disease (p = 0.01), and the number of invasive procedures (p = 0.04). DISCUSSION: This study shows that latex hypersensitivity is present in patients with malignancies. From our results latex sensitization must be kept in mind while dealing with this susceptible patient group.

Autoimmune encephalitis in children.

Autoimmune encephalitis is a heterogeneous group of disorders characterized by cognitive and behavioral decline due to an immune reaction against neuronal antigens. There is increasing evidence that autoimmune encephalitis represents a significant subgroup of encephalitis in children, which are defined by the presence of antibodies against important proteins involved in neurotransmission. The distinction between the different causes of autoimmune encephalitis is important for the patient, as there is a marked difference in therapeutic response; specifically, autoimmune encephalitis associated with the classical onconeuronal antibody is unresponsive to treatment, while autoimmune encephalitis in association with antibodies against surface proteins may respond to immunomodulation. Autoimmune encephalitis may be classified into forms with prevalent involvement of the grey matter (polioencephalitis), white matter (leucoencephalitis), or endothelial cells (vasculitis). The subject of this review includes polioencephalitis, which encompasses syndromes in which there is a loss and/or alteration of neuronal function and in which autoantibodies can be detected in the serum or CSF.

Demyelinating disease of central and peripheral nervous systems associated with a A8344G mutation in tRNALys.

We describe a patient with acute combined demyelinating disease of the central and peripheral nervous systems associated with the A8344G mutation in the mitochondrial tRNA lysine gene. A 7-year-old boy presented with acute onset of palpitations, tinnitus, ataxia, bilateral sixth nerve palsy, and flaccid quadriparesis. Serum creatine kinase and lactate were mildly increased. Electromyography showed demyelinating sensory and motor polyneuropathy. Brain magnetic resonance imaging demonstrated demyelination in the left thalamus and magnetic resonance spectroscopy revealed a lactate peak corresponding to this lesion. Histologic analysis of the muscle showed cytochrome c-oxidase-deficient fibers and ragged red fibers. Respiratory chain analyses revealed deficiencies of complexes I and IV. Molecular genetic analyses of the muscle showed an A8344G (MERRF) mutation in mitochondrial tRNA lysine. To the best of our knowledge, this is the first description of this mutation associated with acute combined demyelinating disease of the central and peripheral nervous systems.

Foramen magnum meningiomas: clinical outcome after microsurgical resection via a posterolateral suboccipital retrocondylar approach.

OBJECTIVE: We analyzed a consecutive series of patients operated for a foramen magnum (FM) meningioma located on the ventral aspect of the medulla oblongata via a posterolateral suboccipital retrocondylar approach with regard to long-term surgical outcome. METHODS: Clinical data in a consecutive series of 25 patients experiencing a meningioma attached to dura of the anterior or anterolateral FM rim were retrospectively reviewed. RESULTS: The most common symptoms of the 19 women and six men (mean age, 59.2 yr) was cervico-occipital pain (72%) and gait disturbance (32%). Clinical examination revealed gait ataxia in 48% of the patients. As depicted from preoperative magnetic resonance imaging (MRI), dural attachment of the meningioma at the FM rim was anterior in 36% and anterolateral in 64% of cases. Tumor removal was accomplished via a posterolateral suboccipital retrocondylar approach in all patients. A Simpson Grade 2 resection was achieved in 96% of the patients. Permanent surgical morbidity and mortality rates were 8 and 4%, respectively. No tumor recurrence was observed after a mean follow-up period of 6.1 years (range, 1-14 yr) with clinical and MRI examination, and 80% of the patients have regained full daily activity. CONCLUSION: Anterior and anterolateral FM meningiomas that displace the medulla/spinal cord can be safely and completely resected via a posterolateral suboccipital retrocondylar approach. A tumor remnant should be left on critical neurovascular structures in cases with poor arachnoid dissection planes.

[Coupling of immunomagnetic separation and polymerase chain reaction for the rapid detection of salmonellae in minced meat and chicken giblets]. / Kopplung von immunomagnetischer Separation und Polymerase-Kettenreaktion zum Schnellnachweis von Salmonellen in Hackfleisch und Geflügelinnereien.

Coupling of immunomagnetic separation and polymerase chain reaction was used after preenrichment for the rapid detection of salmonellae in minced meat and chicken giblets. The primers used are specific to the origin of DNA replication (oriC) on the Salmonella chromosome and produce a 163 bp DNA fragment. The method allowed a screening of Salmonella free samples within 24 hours. It detected 5 serovars when inoculated in minced meat at a contamination level of 1 to 4 cfu/g. Compared with the method L 00.00-20 of the Official Collection of Methods of Analysis according to section 35 of the German Law on Food and Commodities it showed a sensitivity of 94% and a specificity of 87.5% for the examination of chicken giblets (n = 45) and a specificity of 100% for the examination of minced meat (n = 63).

Characterization of Escherichia coli O157:H7 from downer and healthy dairy cattle in the upper Midwest region of the United States.

While cattle in general have been identified as a reservoir of Escherichia coli O157:H7, there are limited data regarding the prevalence and clonality of this pathogen in downer dairy cattle and the potential impact to human health that may occur following consumption of meat derived from downer dairy cattle. In the present study, conducted at two slaughter facilities in Wisconsin between May and October of 2001, we established a higher prevalence of E. coli O157:H7 in fecal and/or tissue samples obtained aseptically from intact colons of downer dairy cattle (10 of 203, 4.9%) than in those from healthy dairy cattle (3 of 201, 1.5%). Analyses of 57 isolates, representing these 13 positive samples (one to five isolates per sample), by pulsed-field gel electrophoresis, revealed 13 distinct XbaI restriction endonuclease digestion profiles (REDP). Typically, isolates from different animals displayed distinct REDP and isolates from the same fecal or colon sample displayed indistinguishable REDP. However, in one sample, two different, but highly related, REDP were displayed by the isolates recovered. Antimicrobial susceptibility testing indicated that 10 of the 57 isolates, recovered from 2 (1 downer and 1 healthy animal) of the 13 positive samples, were resistant to at least 1 of 18 antimicrobials tested. However, there was no appreciable difference in the frequency of resistance of isolates recovered from downer and healthy dairy cattle, and not all isolates with the same REDP displayed the same antimicrobial susceptibility profile. Lastly, it was not possible to distinguish between isolates recovered from downer and healthy cattle based on their XbaI REDP or antimicrobial susceptibility. These results indicate that downer cattle had a 3.3-fold-higher prevalence of E. coli O157:H7 than healthy cattle within the time frame and geographic scope of this study.

A novel passive functional MRI paradigm for preoperative identification of the somatosensory cortex.

The purpose of this study was to assess the feasibility of a novel passive functional magnetic resonance imaging (fMRI) paradigm for activation analysis of the somatosensory cortex utilizing a specifically designed conductor for electrical stimulation of the median and tibial nerves. Thirteen healthy volunteers underwent electrical stimulation of these nerves with defined frequencies and intensities in a block-designed fashion. Electrical stimuli were applied by two custom-designed magnetoelectrically protected coaxial leads, taking into account the technical difficulties of the application of electrical current in the fMRI environment. Activation effects were analysed in real-time mode and validated by statistical parametric mapping. The shielded conductors suppressed electromagnetically derived artefacts nearly completely. The measurements revealed maximum cortical activation when applying a stimulation frequency of 3 Hz and an intensity of 3 mA above motor threshold. Simultaneous stimulation of both the median and tibial nerves enhanced identification of the central region significantly. A standardized setup for the clinical environment was evolved. With this passive paradigm, the identification of the somatosensory cortex was possible in all evaluated cases. The presented technical setup and paradigm is a reliable and fast method for preoperative identification of the somatosensory cortex and may represent a feasible paradigm for generation of pre- and intraoperative fMRI in functionally disabled patients.