Hypertrophic osteodystrophy in dogs.

Hypertrophic osteodystrophy is an uncommon orthopaedic disease that affects young, growing dogs. Aetiology is currently unknown; however, several unproven etiologies have been theorised in the literature including canine distemper virus, previous vaccination, hereditary causes and auto-immune disorders. Affected animals often present with varying degrees of lameness, lethargy, pyrexia and/or distal metaphyseal swelling of affected limbs. An index of suspicion is based on clinical signs. Confirmation is obtained with radiographs of the affected limb(s) by the presence of a "double physis," or a radiolucent line that is parallel to the physis. Treatment varies depending on degree affected, but generally consists of anti-inflammatory steroids, pain medications, gastrointestinal support, nutritional management and appropriate supportive care. Critically affected patients require intensive monitoring and more aggressive supportive care for prevention of life-threatening sequalae. Prognosis is very favourable with mildly and moderately affected patients, but good to guarded in severely affected patients.

Development of an expert system for differentiating tension type headaches from migraines.

We created a program, written in the CLIPS language for expert systems, to distinguish migraines from headaches. The system can be web-based, takes seconds to input data and quickly converges to the correct diagnosis. Over time such an application can result in enormous savings to doctors, patients, and health care institutions.

Comparing Nafion and ceramic separators used in electrochemical purification of spent chromium plating solutions: cationic impurity removal and transport.

This study focuses on the electrolytic regeneration of spent chromium plating solutions. These solutions contain a significant amount of chromium and a lesser amount of other heavy metals, which makes them a significant environmental concern and an obvious target for recycling and reuse. The type of separator used is extremely critical to the performance of the process because they are the major resistance in the transport-related impurity (Cu(II), Ni(II), and Fe(III)) removals from contaminated chromic acid solutions. A Nafion 117 membrane and a ceramic diaphragm separator traditionally used in the industry were tested for comparison. It was found that the mobilities of Cu(II) and Ni(II) were similar and higher than that of Fe(III) using both separators. The mobility of each cation was smaller in the Nafion membrane than in the ceramic diaphragm. The measured conductivity of the ceramic diaphragm was slightly higher than that of Nafion membrane. However, the Nafion membrane was much thinner than the ceramic diaphragm resulting in the system using the Nafion membrane having higher impurity removal rates than the system using the ceramic diaphragm. The removal rates were approximately equal for Cu(II) and Ni(II) and lowest for Fe(III). Both current and initial concentration affected the removal rates of the impurities. Modeling results indicated that a system using a Nafion separator and a small catholyte/anolyte volume ratio was better than a system using a ceramic separator for removing impurities from concentrated plating solutions if the impurities transported into the catholyte are deposited or precipitated.

Home polysomnography norms for children.

Home polysomnography (PSG) by means of ambulatory monitoring systems has distinct advantages over sleep laboratory recordings, especially for children. However, normative data have been lacking. Norms for conventional PSG variables were compiled for 60 children age 5-16 years using the Oxford Medilog ambulatory monitoring system. Recordings were confined to a single night in view of previous demonstrations that the sleep on the first night is not significantly affected by the recording procedure. The results are presented in 5 age subgroups. Broad comparisons with published laboratory PSG norms for children of the same ages suggest that in home recordings sleep duration is longer, and slow wave sleep is much more pronounced with a commensurate reduction in stage 2 NREM sleep. That is, sleep quality and quantity appears better at home even when adaptation to the laboratory situation has been promoted. These new normative data are considered valuable for both clinical and research purposes where physiological sleep studies in children are required.

[Pituitary tumors: clinical presentation and evaluation of transphenoidal surgical treatment]. / Tumores de hipófisis: presentación clínica y evaluación del tratamiento por cirugía transesfenoidal.

The clinical manifestations and the surgical treatment results of 280 patients (179 female), undergoing a total of 319 operations at the Asenjo Institute of Neurosurgery were retrospectively analyzed. The surgical approach for the first operation was transphenoidal in 89.3% of patients and transcraneal in the rest. Tumors were non-secretory in 169 (60.4%) patients, prolactinomas in 75 (27.8%) and produced acromegalia in 29 (10.4%) and Cushing syndrome in 7 (2.5%) patients. There was extraselar extension in 42% of women and 71% of men. The surgical treatment of prolactinomas corrected endocrine alterations in 25 of 29 and visual alterations in 18 of 27 patients assessed. Surgical treatment of acromegalia improved endocrine alterations in 11 of 13 and visual alterations in 4 of 10 patients assessed. Treatment of non secretory tumors corrected visual alteratons in 38 of 64 patients assessed. The principal complication of transphenoidal surgery was transient diabetes insipidus in 6.8% of patients. Overall mortality was 2.3% for transphenoidal surgery and 5.6% for transcraneal surgery. It is concluded that transphenoidal surgery is effective for the management extraselar complications of pituitary tumors and endocrine management of selected cases.

Peritoneal catheter insertion using laparoscopic guidance.

The use of laparoscopic guidance for abdominal puncture and introduction of ventriculoperitoneal shunt peritoneal catheters using a peritoneal split trocar is proposed. The technique permits location of the catheter in the right parietocolic space or its relocation if trapped within the omentum. Cerebrospinal fluid flow is certified. Since the submission of the paper 6 selected cases have been operated upon without complications.

Intracranial arachnoidal cysts.

Twenty-eight cases of intracranial arachnoidal cysts diagnosed during the period 1978-1990 are analyzed. All cases were investigated with computed tomography (CT), 5 with magnetic resonance imaging (MRI) and 5 with ultrasonography (US). Seventeen were located in the middle cranial fossa, 3 in the quadrigeminal cistern, 2 were parasagittal, 3 suprasellar and 3 were located in the posterior fossa. Twenty-three of the 28 patients were treated surgically, craniotomy with fenestrations was used in 3 cases. Different varieties of shunts were inserted in 8 cases and in the last 15 patients the only surgical treatment was the insertion of cysto-peritoneal (CP) drainage (without a valve) with excellent results. MRI and/or CT follow-up revealed disappearance of the cyst in 13 out of 22 cases and 7 experienced a marked reduction. In 2 patients the cyst showed little change. There were no cases of infection and no deaths.

Review article: the medical management of trigeminal neuralgia.

Trigeminal neuralgia results from disturbances in the trigeminal root entry zone which generate repetitive action potentials. Drugs which relieve the pain of trigeminal neuralgia depressed these potentials. Anticonvulsants which exert this or related effects, and which have been demonstrated to be efficacious in trigeminal neuralgia, include carbamazepine, phenytoin, clonazepam, and valproic acid. Baclofen may act by facilitating segmental inhibition of the trigeminal complex. The mechanism of action of pimozide for treating trigeminal neuralgia is not known. Carbamazepine is suggested as the drug of first choice; baclofen or clonazepam could be added if carbamazepine monotherapy is ineffective. When these fail, monotherapy with phenytoin, pimozide, or valproic acid would be a reasonable next step.

Technique for the replacement of a peritoneal catheter.

A simple method for the replacement of a peritoneal catheter is described. The old catheter is disconnected from the valve and exteriorized from the peritoneal cavity, using a straight connector. The new catheter is anchored to the cranial or peritoneal end of the old catheter. A gentle traction allows the new catheter to follow the previous subcutaneous tunnel.

Peripheral neuropathy in Crohn's disease patients treated with metronidazole.

Thirteen pediatric patients with Crohn's disease, aged 12-22 yr, were studied to assess the prevalence of peripheral neuropathy due to oral metronidazole. After 4-11 mo of therapy, 11 of 13 patients (85%) had a sensory peripheral neuropathy, determined by abnormal neurologic examinations or reduced nerve conduction velocities, or both. Only 6 of the 11 patients were symptomatic. Nine of 11 patients with peripheral neuropathy had their metronidazole discontinued and 2 had the dose reduced to less than 10 mg/kg X day. Follow-up evaluations of the 9 patients whose metronidazole had been discontinued 5.5-13 mo earlier demonstrated complete resolution of the peripheral neuropathy in 5, improvement in 3, and no change in 1. In the 2 patients whose metronidazole dose was reduced, 1 showed worsening and 1 showed complete resolution of the neuropathy after 10-12 mo of continued therapy.

Moderate grade astrocytoma presenting in a 4-month-old child with a family history of von Recklinghausen's neurofibromatosis spanning four generations: a case report.

Intracranial gliomas are found in association with von Recklinghausen's neurofibromatosis. However, few truly neonatal lesions have been identified and studied. This case report concerns a 4-month-old child who was found to have a massive thalamic glioma of moderate grade. Four paternal generations had suffered from different manifestations of this transmissible autosomal-dominant (Ad) phakomatosis.

Adenoma of the middle ear.

Benign adenoma of the middle ear emerged as a distinct entity following a review of 20 cases as reported from the Armed Forces Institute of Pathology in 1976. We report 4 additional cases and note that the pathologic diagnosis is not so clear cut. Benign primary adenoma may be confused with adenocarcinoma, ceruminoma, and glomus tumor. The otologic surgeon must take a hard look at the clinical signs and symptoms to determine if they are compatible with the diagnosis of primary middle ear adenoma. While middle ear adenoma has recently been implicated as a cause of facial paralysis (including a case herein), bone destruction should never be found in concert with this neoplasm.

Nonconvulsive epileptiform activity appearing as ataxia.

Ataxia may be the result of otherwise silent epileptiform activity. We studied three patients, between 3 and 5 years of age, whose initial complaint was unsteadiness of gait. Each one of the patients had an epileptiform EEG with bursts of slow spike and wave activity. Each had normal results of diagnostic studies for other causes of ataxia. Specifically, none had anticonvulsant drug levels in the toxic range. Modification of the anticonvulsant regimen resulted in dramatic clinical and EEG improvement. Nonconvulsive epileptiform activity has been called pseudoataxia in the scant literature on this subject. This process should be considered in the evaluation of ataxia in children.