Neuropsychological outcome 6 months after unilateral carotid stenting.

Percutaneous transluminal angioplasty with stenting (PTAS) has become a treatment option for severe carotid stenosis. The goal of our study was to determine prospectively neurocognitive outcome 6 months after unilateral stent-protected carotid angioplasty. Twenty consecutive patients who underwent stent-protected angioplasty for symptomatic (n=9) or asymptomatic (n=11) high-grade carotid stenosis were investigated and compared to an age and disease matched control group. Patients were administered preprocedurally and 6 months postprocedurally a battery of neuropsychological tests. We used reliable change indices methodology in order to control for practice and statistical effects unrelated to intervention. We found no cognitive change in approximately 90% of patients and cognitive improvement in approximately 10% of patients for concentration and attention variables. We further found no cognitive change in 61% of patients, cognitive improvement in 11% of patients and cognitive deterioration in 28% of patients for psychomotor speed. No cognitive change in 94% of patients and cognitive deterioration in 6% of patients was found for sustained attention; no cognitive change in 80% of patients, cognitive improvement in 15% of patients and cognitive deterioration in 5% of patients was found for verbal fluency; no cognitive change in 100% of patients was found for interference (Stroop test): no cognitive change in 95% of patients, cognitive improvement in 5% of patients was found for interference (c.I. test), respectively. Our study showed that 6 months after PTAS cognitive functioning did not change in most patients significantly. For some patients, however, significant improvement or deterioration in single neurocognitive domains can be expected. The reasons for these changes are unclear but may depend on variable type; magnitude of microemboli production; right vs. left cerebral vasculature, respectively.

Role of lipase in the regulation of postprandial gastric acid secretion and emptying of fat in humans: a study with orlistat, a highly specific lipase inhibitor.

BACKGROUND AND AIMS: To investigate the importance of lipase on gastric functions, we studied the effects of orlistat, a potent and specific inhibitor of lipase, on postprandial gastric acidity and gastric emptying of fat. METHODS: Fourteen healthy volunteers participated in a double blind, placebo controlled, randomised study. In a two way cross over study with two test periods of five days, separated by at least 14 days, orlistat 120 mg three times daily or placebo was given with standardised daily meals. In previous experiments we found that this dose almost completely inhibited postprandial duodenal lipase activity. Subjects underwent 28 hour intragastric pH-metry on day 4, and a gastric emptying study with a mixed meal (800 kcal) labelled with (999m)Tc sulphur colloid (solids) and (111In)thiocyanate (fat) on day 5. Gastric pH data were analysed for three postprandial hours and the interdigestive periods. RESULTS: Orlistat inhibited almost completely (by 75%) lipase activity and accelerated gastric emptying of both the solid (by 52%) and fat (by 44%) phases of the mixed meal (p<0.03). Orlistat increased postprandial gastric acidity (from a median pH of 3.3 to 2.7; p<0.01). Postprandial cholecystokinin release was lower with orlistat (p<0.03). CONCLUSION: Lipase has an important role in the regulation of postprandial gastric acid secretion and fat emptying in humans. These effects might be explained by lipolysis induced release of cholecystokinin.

Animating functional anatomy for the web.

The instructor sometimes has a complex task in explaining the concepts of functional anatomy and embryology to health professional students. However, animations can easily illustrate functional anatomy, clinical procedures, or the developing embryo. Web animation increases the accessibility of this information and makes it much more useful for independent student learning. A modified version of the animation can also be used for patient education. This article defines animation, provides a brief history of animation, discusses the principles of animation, illustrates and evaluates some of the video-editing or movie-making computer software programs, and shows examples of two of the author's animations. These two animations are the inferior alveolar nerve block from the mandibular nerve anesthetics unit and normal temporomandibular joint (TMJ) function from the muscles of the mastication and the TMJ function unit. The software discussed are the industry leaders and have made the job of producing computer-based animations much easier. The programs are Adobe Premiere, Adobe After Effects, Apple QuickTime and Macromedia Flash .

Spilling the beans on java 3D: a tool for the virtual anatomist.

The computing world has just provided the anatomist with another tool: Java 3D, within the Java 2 platform. On December 9, 1998, Sun Microsystems released Java 2. Java 3D classes are now included in the jar (Java Archive) archives of the extensions directory of Java 2. Java 3D is also a part of the Java Media Suite of APIs (Application Programming Interfaces). But what is Java? How does Java 3D work? How do you view Java 3D objects? A brief introduction to the concepts of Java and object-oriented programming is provided. Also, there is a short description of the tools of Java 3D and of the Java 3D viewer. Thus, the virtual anatomist has another set of computer tools to use for modeling various aspects of anatomy, such as embryological development. Also, the virtual anatomist will be able to assist the surgeon with virtual surgery using the tools found in Java 3D. Java 3D will be able to fulfill gaps, such as the lack of platform independence, interactivity, and manipulability of 3D images, currently existing in many anatomical computer-aided learning programs.

[Efficacy of intravenous pamidronate in osteoporosis, mineralometric evaluation]. / Efficacité minéralométrique du Pamidronate intraveineux sur l'ostéoporose dans la pratique courante.

Therapeutic efficacy of some molecules, predicted by scientific studies, is not systematically confirmed when the substance is used in general practice. In osteoporosis, certain studies show an efficacy of intravenous (i.v.) pamidronate similar to oral alendronate. These results could be a valuable alternative for non compliant patients or those suffering from digestive problems. For this reason we have studied the efficacy of i.v. pamidronate in osteoporotic patients, not available to oral alendronate. This is a retrospective study of 20 unselected osteoporotic patients from our general practice. Each patient had a bone mineral density (BMD) of less than -2.5 DS for the T-score, measured by a dual energy X-ray (DXA) densitometer at the lumbar spine and the hip. Thirty milligrams of pamidronate were administered intravenously every three months. Each patient was controlled by a DXA after eighteen months minimum. Thirteen patients had increased on average their BMD by 6.2% in the lumbar spine and by 4.7% in the hip. All patients responded at least at one site, but seven patients did not improve their BMD at both sites. We have confirmed that intermittent i.v. pamidronate given in common practice increases BMD in the lumbar spine and the hip in 2/3 of the patients. The increase in bone mass in the hip is similar to that published in the scientific literature, but less for the lumbar spine.

The effect of fat on the coherent-to-Compton scattering ratio in the calcaneus: a computational analysis.

The coherent-to-Compton scattering ratio (CCSR) is a technique that has been proposed for measuring trabecular bone mineral density (TBMD). This paper investigates the effect of fat on the CCSR and its correlation to the error in TBMD measurements. It is a computational study to determine the relationship between the magnitude of fat error and the momentum-transfer variable chi, which represents the incident photon energy and the scattering angle. Variation in fat content contributes significantly to the error in CCSR measurements. When employing a typical 241Am source (E gamma = 59.45 keV), the resulting error decreases with increasing momentum-transfer variable or angle. For example, the error ranges from +14 mg/cc at an angle of 45 degrees (chi = 18.3) to +3 mg/cc at an angle of 135 degrees (chi = 44.3) for an osteoporotic trabecular region (100 mg/cc mineral) of a calcaneus that contains 6% less fat than a calibration standard. The error is about 0.3-1.2 mg/cc less for regions containing 2-3X more bone mineral and is reduced and opposite in sign for regions containing about 7% more fat than the calibration standards (e.g., -9 mg/cc at 45 degrees and -1.5 mg/cc at 135 degrees). Others have shown that the intrinsic sensitivity of the CCSR method for measuring TBMD at a given photon energy generally increases with increasing detector angle. Thus large angles are advantageous both for reduced sensitivity to fat variation and increased sensitivity to bone mineral variation. The primary disadvantage is reduced count rates that degrade precision unless long counting lines are employed.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of hyperthermia on bone. I. Heating rate patterns induced by microwave irradiation in bone and muscle phantoms.

We describe the initial heating rate patterns generated by microwave irradiation of 915 MHz, with constant power output, in muscle-equivalent phantoms containing a freshly excised bone, and compared with those in phantoms consisting of muscle-equivalent gel only. At 1 cm depth the muscle was cooler in the centre of the field when bone was present underneath. Also, the orientation of the bone in the field had a pronounced effect on the heating rate profiles in the overlying muscle: when the long axis of the bone was parallel to E field, a hot area in the centre of the field was observed; after rotation of the applicator by 90 degrees so that the long axis of the bone was perpendicular to the E field, more homogeneous heating was obtained along most of the field. In contrast, the heating patterns obtained in the cortex of the bone at similar depth (1.3 cm) were not substantially influenced by its orientation in the field. Depending on field location, the heating rate of the cortical bone closest to the applicator was within 50-75% of the SAR in muscle at the same depth. We believe that these data may be useful for the extension of such measurements in vivo, to permit the effective application of hyperthermia, with or without radiation, in the treatment of bone lesions.

Effects of hyperthermia on bone. II. Heating of bone in vivo and stimulation of bone growth.

Previous studies in vitro have shown that it is possible to achieve comparable temperature distribution in bone and the adjacent soft tissues, under appropriate experimental conditions. The objective of the present work was to determine the effects of hyperthermia on bone in vivo. In order to obtain direct temperature measurements in bone, catheters were surgically installed on top of and inside the medullary cavity of the femur of normal rabbits. The thighs were irradiated with 915 MHz microwaves for 45 min, once or twice a week. The temperatures on and inside the bone were maintained between 42.5 and 44.0 degrees C; the resulting temperatures in the muscle were within 1.0 degrees C at depths equidistant from the applicator. After four to six treatments the femora were excised for histopathological examination. New trabecular bone was deposited around the catheters; most bone components including periosteum, osteoid, and fully calcified matrix could be seen. Large numbers of osteoblasts and osteoclasts lined the trabecular surfaces, and numerous cement lines were visible, running in all directions, indicating extensive bone deposition and remodelling. In contrast, control bones (catheters installed--no hyperthermia) showed much less ossification, with many areas of thin incomplete osteoid. Further, bones treated with hyperthermia only (no surgical trauma) showed no such changes. Thus, it appears that following an initial insult, hyperthermia promotes bone deposition.

Subtalar arthrodesis in children with cerebral palsy: results using iliac bone plug.

Twenty-six extra-articular subtalar arthrodeses were performed on 15 patients with flexible planovalgus feet due to cerebral palsy. Following muscle balancing procedures, an iliac bone plug was used to stabilize the sinus tarsi. A review of the results up to 12 years, average 6.8, is presented. Overall satisfactory results were achieved in 88.4% of the patients, unsatisfactory in 11.6%. All children were immobilized in short-leg walking casts for 6 to 8 weeks. The surgical technique is described. The procedure gave good stability to the subtalar joint and was found to be reliable. Graft acquisition was simple and there were no complications.

Pedal polydactyly. A case report.

Polydactyly is a common pedal deformity with great variation in clinical presentation. There is a tendency toward a higher incidence in previously affected families, but the actual occurrence rate of the different forms of polydactyly has not been agreed upon in the literature to date. Most authors agree that the isolated deformity is an expression of an autosomal dominant gene with varied penetrance. Syndromatically associated polydactyly is inherited as an autosomal recessive trait. Surgical intervention should be attempted as early as possible. Correction should be undertaken only after a thorough clinical and radiographic evaluation has been performed. The patient's postoperative goals should always be considered. It is not necessary to remove the supernumerary digit if it does not interfere with the foot's function and comfort. Cosmesis should not be the chief consideration. The surgeon should strive to return the foot to a more normal contour while maintaining or improving foot function.

Three-point fixation walking spica cast: an alternative to early or immediate casting of femoral shaft fractures in children.

A retrospective review of 28 children treated for middle and proximal femoral shaft fractures was undertaken. Following preliminary traction, a modified pantaloon walking spica, utilizing the principle of total contact and three-point fixation molding, was applied, followed by immediate ambulation. The mean anterior bow was 5 degrees varus/valgus, 6.5 degrees angulation, and 1.2 cm shortening. There were no significant differences in the results when age groups or proximal to mid-shaft fractures were compared. No further shortening or angulation occurred with ambulation. The advantages of early ambulation and better control of proximal shaft fractures are discussed.

Spontaneous cortical DC-potential shifts: modulation stereotypy; relationships to higher EEG-frequencies.

A description of scalp-recorded, spontaneous, cerebral DC-potential shifts is given independent of other variables (shift stereotypy), in relationship to higher frequencies (theta, alpha 1, alpha 2: 4-13 Hz) and as analyzed pairwise across the median sagittal line (Fz, Cz, Pz) separately according to frequency and condition (relaxation and moderate mental load). Spontaneous DC-shifts are shown to behave unpredictably. Whether measured jointly (up to triads) or as dyad and triad context entropy, the frontal DC-shifts are calculated as being random, whereby their definition as such within the context of the Principle Component Analysis is supported by the analysis of longitudinal registrations. Cross-correlation analysis of the cerebral slow potential's relationship to each of the higher frequencies (theta, alpha 1, alpha 2) reveals it to be highly independent, the highest correlation accounting for merely 11% of the common variance, the average being 9% (R congruent to 0.3). By matching the conjoint activity of the DC-potential between Fz-Cz, Cz-Pz, and Fz-Pz to that of theta, alpha 1, alpha 2 at the same paired sites, the DC-activity is shown to be operating at higher levels of synchronous activity than the higher frequencies, regardless of pairing and/or condition, although the general level of synchronous activity (DC, theta, alpha 1, alpha 2) is remarkably high along the median sagittal line, 75% of the correlation averages of all analysis-pairings being above 0.60.