Longitudinal associations between exposure to anesthesia and neurocognitive functioning in pediatric medulloblastoma.

AIM: To examine whether anesthesia exposure is associated with neurocognitive decline in pediatric medulloblastoma. METHODS: Patients were treated at St. Jude Children's Research Hospital and completed ≥2 protocol-directed neurocognitive assessments (n = 107) as part of a multisite clinical trial for pediatric medulloblastoma (NCT00085202). Patients received risk-adapted craniospinal photon irradiation, followed by four cycles of high-dose chemotherapy and stem cell rescue. Neurocognitive testing was completed at study baseline (after surgery and <2 weeks of starting radiation therapy) and annually for 5 years. Data on anesthesia exposure during treatment was abstracted from medical records. RESULTS: Patients were 10.2 years at diagnosis on average (SD = 4.5; 37% female, 73% average-risk). Mean cumulative anesthesia duration was 20.4 h (SD = 15.2; range 0.7-55.6 h). In the overall group, longer anesthesia duration was associated with greater declines in IQ (Estimate = -0.08, P < 0.001), attention (Estimate = -0.10, P < .001) and processing speed (Estimate = -0.13, P < 0.001). Similar results were shown in subgroups of patients who were <7 years at diagnosis (IQ = -0.14, P = 0.027; Attention = -0.25: P = 0.011), ≥7 years at diagnosis (Attention = -0.07, P = 0.039; Processing Speed = -0.08, P = 0.022), treated for high-risk disease (IQ = -0.09, P = 0.024; Attention = -0.11, P = 0.034; Processing Speed = -0.13, P = 0.001), or treated for average-risk disease (IQ = -0.05, P = .022; Attention = -0.08, P = 0.011; Processing Speed = -0.10, P < 0.001). CONCLUSION: Greater anesthesia exposure is a risk factor for clinically significant neurocognitive decline, in addition to factors of age at diagnosis and treatment risk arm. This result is notable as there are evidence-based strategies that can limit the need for anesthesia. Limiting anesthesia exposure, as feasible, may mitigate neurocognitive late effects, and thus, improve quality of life for survivors.

A population-based twin study of parentally reported tactile and auditory defensiveness in young children.

Some adults and children exhibit defensive behaviors to tactile or auditory stimulation. These symptoms occur not only in subsets of children with ADHD, autism, and Fragile X syndrome, but also in the apparent absence of accompanying disorders. Relatively little research explores the correlates and antecedents of sensory defensiveness. Using a population-based sample of 1,394 toddler-aged twins, mothers reported on tactile and auditory defensiveness, temperament, and behavior problems. The incidence of defensive symptoms was widely distributed, with some accumulation of cases in the extreme range. Girls were overrepresented in the extreme tactile defensiveness group. Both auditory and tactile defensiveness were modestly associated with fearful temperament and anxiety, but they were relatively distinct from other common dimensions of childhood behavioral dysfunction. Twin correlations for the full range of scores and concordance rates for the extremes suggested moderate genetic influences, with some indication that the tactile domain might be more heritable than the auditory domain.

Common risk factors seen in secondary carpal tunnel surgery.

BACKGROUND: We hypothesized that there are several common risk factors associated with secondary carpal tunnel releases. Therefore, we chose to investigate these common factors by analyzing the charts of those patients requiring a second carpal tunnel release (CTR) procedure. METHODS: A retrospective chart review was performed, and patients were identified by searching hospital medical record databases using the Common Procedural Terminology. RESULTS: Between January 1, 2000, and March 31, 2004, 2357 patients had a primary CTR, and 48 of them were found to have had a secondary CTR (of these 48, 9 had diabetes mellitus, 11 had hypertension, and 6 had gastrointestinal-related illnesses). Seven percent of those who had an open release primarily required a second CTR, while only 0.2% of those who had an endoscopic release primarily required a second CTR. CONCLUSION: A greater number of secondary CTR procedures were required for those patients with symptoms of carpal tunnel syndrome in the group that had an open release primarily versus those that had an endoscopic release primarily. Diabetes mellitus and hypertension may also contribute to the need for secondary surgery.

[Study of free living amoebae in the waters of Strasbourg. Preliminary report (author's transl)]. / Etude des amibes libres dans les eaux de Strasbourg. Résultats préliminaires

75 strains of free living amoebae were isolated from public drinking water supplies, swimming pools and official swimming ponds in Strasbourg. 42 strains were identified till now. No pathogenic strain of Naegleria fowleri was found.

Immunological studies of experimental coalworkers' pneumoconiosis.

A comparative immunological and microbiological study of experimental coalworkers' pneumoconiosis (CWP) was made in rats and mice subjected to long-term exposures of coal-mine dust aerosols. Such aerosols were realistically prepared at a concentration equal to the maximal level of respirable dust permitted by Federal standards and animals were exposed for lengths of time equal to human work contact. Among the factors studied were the production of IgA and lung reactive antibody, lung microflora and changes in pulmonary clearance. Additional experiments were concerned with the effects of passively administered lung antibody on the pulmonary clearance. It was found that both species responded immunologically in a similar manner to humans with CWP in that IgA levels were significantly elevated and lung reactive antibodies were stimulated. Coal-mine dust inhalation had little effect on the pulmonary inactivation of inhaled bacteria, but the concomitant occurrence of passively administered lung reactive antibody seemed to enhance the inactivation.