Focal EEG abnormalities in Heidenhain's variant of Jakob-Creutzfeldt disease.

Serial EEGs obtained during a six-week period from a patient with Heidenhain's variant of Jakob-Creutzfeldt disease demonstrated periodic complexes confined to the occipital regions that at no time became generalized. The focal character of the discharges correlated with the site of maximal disease in the occipital cortex, suggesting that cortical damage is a necessary substrate for the production of periodic complexes in Jakob-Creutzfeldt disease.

Spinal accessory (11th) nerve palsy following carotid endarterectomy.

We report three cases of ipsilateral spinal accessory nerve palsy complicating carotid endarterectomy. Awareness of this cranial nerve injury, as a complication of this common surgical procedure, can lead to early diagnosis and avoids unnecessary investigations. This should be considered whenever such patients complain postoperatively of ipsilateral shoulder pain/weakness or "aching" about the ear, even if some time has elapsed since surgery.

Ischemic optic neuropathy: a complication of cardiopulmonary bypass surgery.

Ischemic optic neuropathy followed cardiopulmonary bypass surgery in the postoperative period in 7 of 7685 consecutive procedures. Th visual loss was unilateral in four patients and bilateral in three and there was little improvement. This ischemic infarction of the optic nerve disk was attributed to hypotension, hypothermia, and activation of certain complement factors by the bypass procedure.

Functional imaging in treatment planning of brain lesions.

PURPOSE: Explore the use of functional imaging data in radiation treatment planning of brain lesions. METHODS AND MATERIALS: Compare the treatment-planning process with and without the use of functional brain imaging for clinical cases where functional studies using either single photon emission computed tomography or magnetic resonance imaging are available. RESULTS: A method to register functional image data with planning image studies is needed for functional treatment planning. Functional volumes are not simply connected regions. One activation study may produce many isolated functional areas. After finding the functional volumes and registering the functional information with the planning imaging data, the tools used for conventional three-dimensional treatment planning are sufficient for functional treatment planning. However, the planning system must provide dose-volume histograms for volumes of interest that consist of isolated pieces. Treatment plans that spare functional brain while providing identical target coverage can be constructed for lesions situated near the functional volume. However, the dose to other areas of the brain may be increased. CONCLUSIONS: Functional imaging will make determination of dose response of eloquent areas of the brain possible when combined with volumetric dose information and neuropsychological evaluation prior to and after radiation therapy. Realizing the full potential of functional imaging studies will require improved delineation of activated volumes and determination of the uncertainties in functional volume delineation. Optimization of treatment plans by minimizing dose to volumes activated during functional imaging studies should be used cautiously, because the dose to "silent," but possibly eloquent, brain may be increased.

A study of low socioeconomic status, black teenage fathers and their nonfather peers.

Demographic background, attitude and knowledge about pregnancy and contraception, and family characteristics and dynamics of 100 teenage fathers were studied and compared with those of 100 nonfather, age-matched peers. The subjects' age ranged from 14 to 19 years with a mean age of 17.5 years. Nearly all subjects were black and were from families of low socioeconomic status. There were no differences between the two groups for age at first sexual intercourse (mean 12.5 years) and frequency of intercourse in the last year. More control subjects than fathers perceived pregnancy as disruptive of their future plans for school, job, and marriage. Teenage fathers were more likely to have mothers who were teenage parents (77% v 53%, P = .0007). In both groups, one third of their brothers and 44% of their sisters were teenage parents. Both groups had poor knowledge about the risk of pregnancy and the effectiveness of contraceptives. In both groups, negative attitudes about contraceptives represent barriers to their use. Both groups of subjects became sexually active at young ages, had poor knowledge about pregnancy prevention, and often had unprotected intercourse. Although there were many similarities between the two groups, the teenage fathers, in particular, seemed to come from an environment in which teenage pregnancy was common, accepted, and perceived to be minimally disruptive of their lives now or in the future.

Black teenage fathers: what happens when the child is born?

This study explored the changes in the lives of teenage fathers, from prenatally to 9 and 18 months postpartum, and compared them to a group of nonfather peers. At 18 months postpartum, more fathers were heads of households and fewer were still in school, although there were no differences in employment status. Although only 7.5% of the teenage parents were married, 37% lived together or had daily contact; only three had contact less often than weekly. In the 18 months since the first interview, there was a decrease in contact in 34%, an increase in contact in 19%, and no change in the frequency of contact in 46%. Two thirds of teenage fathers stayed with the mother during labor and 25% were in the delivery room. Only one father had no contact with his child 18 months later; 12% lived with the child and 25% saw the child daily. The most common reasons for not living with the child were that the baby was too young, finances, and problems in the relationship with the woman. This study demonstrates that the fathers appeared to suffer few adverse consequences of teenage pregnancy. However, the majority of fathers continued to be involved in the lives of the mother and child, and we believe they should be included in programs for teenage parents and their children.

Diagnostic testing in obstetrics and gynecology: a clinician's guide.

As we enter a new era of health care in the United States with limited economic resources, there will be an increasing demand for thoughtful and critical evaluation of the diagnostic tests used in clinical medicine. To interpret the clinical utility of diagnostic tests, the physician must understand the fundamental concepts of sensitivity, specificity, and predictive values. The purpose of this paper is to define these terms, demonstrate the use of receiver operating characteristic curves and Bayes' theorem, and provide clinical examples in obstetrics and gynecology to illustrate their use. Practitioners must be able to interpret the results of diagnostic tests to provide accurate information to their patients.

Polymerase chain reaction amplification of herpes simplex virus DNA from clinical samples.

The polymerase chain reaction was used to amplify herpes simplex virus (HSV) DNA from 79 clinical specimens from the female genital tract, and the results were compared with cell culture. Combining the polymerase chain reaction with visualization of amplified products using a direct gel analysis, HSV DNA was detected in 38 specimens, six of which were negative for virus by cell culture. Hybridization of the amplified products detected HSV in three other specimens. One specimen was positive for HSV by cell culture but negative for viral DNA by polymerase chain reaction. Specimen purification before the polymerase chain reaction improved the detection of viral DNA. Restriction endonuclease cleavage of amplified DNA seen by direct gel analysis, used to differentiate HSV-1 from HSV-2, was correct in each case. The analysis time using the polymerase chain reaction was 8-10 hours, making this technique potentially valuable in the clinical setting of parturition.

Repositioning accuracy of a noninvasive head fixation system for stereotactic radiotherapy.

We report on the repositioning accuracy of patient setup achieved with a noninvasive head fixation device for stereotactic radiotherapy. A custom head mask which attaches to our stereotactic radiosurgery head ring assembly is fabricated for each patient. The position and orientation of a patient in the stereotatic space at the time of treatment are determined from analyzing portal films containing images of radio-opaque spheres embedded in a custom mouthpiece. From analysis of 104 setups of 12 patients, we find that the average distance between the treated isocenter and its mean position is 1.8 mm, and that the standard deviations of the position of the treated isocenter in stereotactic coordinate space about its mean position are less than 1.4 mm in translation in any direction and less than 1 degree of rotation about any axis.

Mucormycosis presenting as positional nystagmus and hydrocephalus. Case report.

A case of mucormycosis presenting with signs of positional nystagmus and obstructive hydrocephalus is described. The authors believe that this presentation of Mucor is unique.

Horner's syndrome secondary to angiogram negative, subadventitial carotid artery dissection.

A 59-year-old man presented with the acute onset of paresthesias and pain in the left neck, face, and forehead. On subsequent investigation he was found to have a subadventitial type of carotid artery dissection, producing an ipsilateral Horner's syndrome with normal carotid angiography. MRI imaging of the neck structures, using fat saturation technique, showed the subadventitial dissection, sparing the vessel lumen. MRI offers a non-invasive method of diagnosis and follow-up for carotid artery dissection.

Multiresidue method for the analysis of pesticide residues in fruits and vegetables by accelerated solvent extraction and capillary gas chromatography.

An analytical procedure using accelerated solvent extraction and capillary gas chromatography with electron capture and flame photometric detections was developed to simultaneously determine residues of different pesticides in fruits and vegetables. Single laboratory validation of the method was carried out for 28 compounds selected from eight pesticide classes, in blank and fortified samples of fresh pear, cantaloupe, white potato, and cabbage. The method had to meet specific established validation criteria for regulatory purposes applicable to our laboratory. At each of the two fortification levels studied, 24 of the 28 pesticides gave recoveries of more than 70% with a coefficient of variation of less than 10%. With respect to existing procedures, the method showed acceptable limits of detection (from 0.0019 to 0.14 microg/g depending on the pesticide and matrix) while minimizing environmental concerns, time, and labor.

Clinical evaluation of cervical radiculopathy and myelopathy.

This article considers the entities of cervical radiculopathy and myelopathy. Beginning with a brief historical note and neuroanatomy review of the cord and nerve roots, the discussion proceeds with analysis of symptoms and signs of cervical root disease and then compressive cervical myelopathy. A discussion of diagnostic testing and a differential diagnosis follows. A brief review of conservative medical therapy concludes the article.

The effect of integrating substance abuse treatment with prenatal care on birth outcome.

OBJECTIVE: To determine whether engaging pregnant substance abusers in an integrated program of prenatal care and substance abuse treatment would improve neonatal outcomes. STUDY DESIGN: The subjects were women who voluntarily enrolled in Project Link, an intensive outpatient substance abuse treatment program at Women and Infants Hospital, Providence, RI. A total of 87 women received substance abuse treatment in conjunction with their prenatal care; the comparison group of 87 women received equivalent prenatal care but did not enroll in the substance abuse treatment program until after they delivered. The two groups of women were similar demographically and socioeconomically and had similar substance abuse histories. Univariate and multivariate analyses were performed. The key outcomes were gestational age at delivery, birth weight, preterm delivery, Apgar scores, and neonatal intensive care admission rate. Factors controlled in the multivariate models included demographics, socioeconomic status, parity, and prenatal care. RESULTS: Infants born to women who enrolled prenatally were 400 gm heavier (p < 0.001), and their gestational age was 2 weeks longer (p < 0.001) than infants of mothers enrolled postpartum. In addition, they were approximately one-third as likely to be born with a low birth weight (p < 0.01) and approximately one-half as likely to be admitted to the neonatal intensive care unit (p < 0.05). CONCLUSION: Neonatal outcome is significantly improved for infants born to substance abusers who receive substance abuse treatment concurrent with prenatal care compared with infants born to substance abusers who enter treatment postpartum.

A discrete, stochastic model for microbial filter feeding: a model for feeding of ciliated protists on spatially uniform, nondepletable suspensions.

Suspension-feeding ciliates, either bacteriovorous or planktonic, are adapted to feed on particulate food matter of size much smaller than their own size. These microorganisms collect their prey by generating water currents that draw prey toward their capture surfaces. Under such conditions food particles are treated in bulk, and captures of individual food particles from a suspension by individual single-celled organisms are discrete events that occur at random intervals of time. Each such event is followed by a sequence of additional events that also occur at random intervals of time. This sequence culminates in the incorporation of the digestible portion of the food particle into the cell's cytoplasm and the expulsion of the indigestible portion from the cell. In theory, the rate of the overall ingestion-digestion process can be limited by the passage of particles through any stage of this sequence of events. In this paper, we assume that only the initial events in the sequence, those that occur in the oral region of the cell, limit the rate of the ingestion-digestion process, and we develop a discrete, stochastic model of filter feeding based on that assumption. We use the model to show how advanced instrumentation, such as flow cytometry, can be used to measure parameters of the model and also to answer a number of important questions about the mechanism of filter feeding. We show also how the model can be applied to nonhomogeneous cell populations for which parameters of the model are distributed.

Immune reactivity in Bell's palsy.

Although the pathogenesis of acute facial (Bell's) palsy is probably multifactorial, some investigators believe that the disorder results from autoimmune demyelination and is perhaps related to previous viral infection. The purpose of this study was to identify immune mechanisms which might contribute to Bell's palsy. The lymphocyte transformation test and immunofluorescence were evaluated with a soluble homogenate of unrefined peripheral nerve antigens. Three antigen-nonspecific tests were also studied. Results in 14 patients with Bell's palsy were compared with those in 21 controls. To be eligible for study, patients with Bell's palsy had to be seen within 10 days of onset of weakness. The control group included 5 patients with facial nerve dysfunction from other causes and 16 normal volunteers. No patient or control had previously received steroids. Five patients with Bell's palsy and one normal volunteer had abnormal lymphocyte transformation (p less than .05). Virtually all other tests were normal. These results. suggest that some instances of Bell's palsy result from cell-mediated immunity against peripheral nerve antigens. They also encourage further research in steroid and other immunotherapy.

Parkinson's disease: managing symptoms and preserving function.

Two strategies of drug therapy for Parkinson's disease (PD) are neuroprotective and symptomatic. In early PD, selegiline may delay need for symptomatic treatment, but whether this represents a delay in disease progression remains controversial. The decision to begin symptomatic therapy depends on how disabling or troublesome symptoms are to the patient. Anticholinergics are often used as monotherapy for alleviation of early tremor. When levodopa is added, it may be reasonable to begin with the controlled-release form. The variety of dopamine agonists used as adjunctive agents is increasing. Research continues on surgical therapies and fetal tissue transplantation.

Comparison of CT-based treatment planning and retrograde urethrography in determining the prostatic apex at simulation.

In 20 consecutive patients who underwent treatment planning, localization of the prostatic apex with CT-based techniques at simulation was compared to location of the apex as defined by retrograde urethrography. In addition, the location of the urethrogram-defined prostatic apex was compared with the bottom of the ischial tuberosities, which is often recommended as the inferior margin of the field. In 15% of the patients there was agreement between the CT-defined apex and the urethrogram-defined apex; in 85% there was discordance. In a majority of patients with discordance, the urethrogram apex was located caudad to the CT-defined apex (71%) with a median difference of .65 cm. In 29% of the patients the urethrogram apex was located superior to the CT-defined apex. Overall, 75% of the patients had discordance between the urethrogram apex and the CT apex of 0.5 cm or greater; 30% had an absolute difference of 1.0 cm or greater. Comparing the location of the prostatic apex with the bottom of the ischial tuberosities revealed that in 15% of the patients the apex was 1.0 cm or less from the bottom of the tuberosities and in 45% it was less than 1.5 cm. This would place the apex of the prostate in the penumbra region of the field and risk undertreatment of the prostate if the bottom of the ischial tuberosities was the inferior margin of the field. Measuring the location of the prostatic apex from the top of the symphysis pubis revealed that a distance of 4.9 cm encompassed the apex in all 20 patients.(ABSTRACT TRUNCATED AT 250 WORDS)