Temperature during pregnancy influences the fetal growth and birth size.

BACKGROUND: Birth weight and length have seasonal fluctuations. However, it is uncertain which meteorological element has an effect on birth outcomes and which timing of pregnancy would explain such effect. Therefore, the purpose of this study was to examine temperature effects during pregnancy and which timing of pregnancy has effects on size at birth. METHODS: A large, randomized, controlled trial of food and micronutrient supplementation for pregnant women was conducted in Matlab, Bangladesh (MINIMat Study), where women were enrolled from November 2001 to October 2003. The fetal growth data which included the size at birth and information of their mothers were obtained (n = 3267). Meteorological data such as temperature, precipitation, relative humidity, and daily sunshine hours during pregnancy were observed at the nearest observatory site of Bangladesh Meteorological Department. RESULTS: Infants born in colder months (November-January) were shorter than those born in hot and dry, and monsoon months (mean (SD) of birth length was 47.5 cm (2.2) vs. 47.8 cm (2.1) vs. 47.9 cm (2.1) respectively; P < 0.001). Increased temperature during the last month of pregnancy was significantly related with increased birth length with adjustment for gestational weeks and the season at birth, and remained significant with further adjustments for precipitation, sex of infants, maternal early-pregnancy BMI, parity, and education status of the mother (P < 0.01). On the other hand, increased temperature at mid-gestation was associated with increased birth weight (P < 0.05). CONCLUSIONS: These findings suggest that temperature affects both birth weight and length. The more temperature increased at the last month of pregnancy, birth length became longer. For birth weight, the temperature at mid-pregnancy affected in a positive way.

Metastatic cerebellar gastrointestinal stromal tumor with obstructive hydrocephalus arising from the small intestine: a case report and review of the literature.

Gastrointestinal stromal tumor (GIST) is defined as a c-kit-positive gastrointestinal, mesenteric, or omental mesenchymal tumor that very rarely metastasizes to the brain. Metastasis to the cerebellum is particularly rare. An 80-year-old man presented with nausea and vomiting with disturbance of consciousness. Magnetic resonance imaging (MRI) revealed tumor in the cerebellar vermis causing obstructive hydrocephalus. The patient subsequently underwent midline suboccipital craniotomy, and the tumor was totally removed. Immunohistochemical analysis showed tumor cells positive for c-kit and CD34, and cerebellar metastasis of GIST was diagnosed. Postoperative radiotherapy was administered. Following surgery and radiotherapy, the patient developed ileus caused by tumor in the small intestine and underwent laparotomy for tumor removal. Following abdominal surgery, left hemiparesis and consciousness disturbance were noted. Computed tomography showed recurrent large tumor with perifocal edema in the right frontal lobe of the brain. The patient died 3 months after initial craniotomy. Intracranial metastasis of GIST is extremely rare. In cases such as the present, where the condition of the patient rapidly deteriorates and features such as rising intracranial pressure and ileus prevent the use of oral agents, molecular-targeted agents administered by intravenous infusion should be utilized.

The Indian Ocean dipole and cholera incidence in Bangladesh: a time-series analysis.

BACKGROUND: It has been reported that the El Niño-Southern Oscillation (ENSO) influences the interannual variation of endemic cholera in Bangladesh. There is increased interest in the influence of the Indian Ocean dipole (IOD), a climate mode of coupled ocean-atmosphere variability, on regional ocean climate in the Bay of Bengal and on Indian monsoon rainfall. OBJECTIVES: We explored the relationship between the IOD and the number of cholera patients in Bangladesh, controlling for the effects of ENSO. METHODS: Time-series regression was performed. Negative binomial models were used to estimate associations between the monthly number of hospital visits for cholera in Dhaka and Matlab (1993-2007) and the dipole mode index (DMI) controlling for ENSO index [NINO3, a measure of the average sea surface temperature (SST) in the Niño 3 region], seasonal, and interannual variations. Associations between cholera cases and SST and sea surface height (SSH) of the northern Bay of Bengal were also examined. RESULTS: A 0.1-unit increase in average DMI during the current month through 3 months before was associated with an increase in cholera incidence of 2.6% [(95% confidence interval (CI), 0.0-5.2; p = 0.05] in Dhaka and 6.9% (95% CI, 3.2-10.8; p < 0.01) in Matlab. Cholera incidence in Dhaka increased by 2.4% (95% CI, 0.0-5.0; p = 0.06) after a 0.1-unit decrease in DMI 4-7 months before. Hospital visits for cholera in both areas were positively associated with SST 0-3 months before, after adjusting for SSH (p < 0.01). CONCLUSIONS: These findings suggest that both negative and positive dipole events are associated with an increased incidence of cholera in Bangladesh with varying time lags.

Intramedullary spinal cord abscess treated with antibiotic therapy--case report and review.

A 58-year-old man presented with an intramedullary spinal cord abscess (ISCA) manifesting as posterior neck pain, gait disturbance, and urinary retention, and transverse myelopathy 1 week later. Magnetic resonance imaging showed the ISCA at the C7 to T1 levels. He was treated under a diagnosis of cryptogenic ISCA with high-dose ampicillin and third- or fourth-generation cephalosporins, which resulted in complete recovery after 2 months. Review of the literature between January 1998 and August 2007 identified 26 cases of ISCA, including our patient. We also identified two additional nonsurgically treated ISCA patients reported between 1977 and 2007. The most common presentation was motor deficits in all patients, followed by fever, pain, and bladder dysfunction. The mortality rate was 1 of 26 patients, and neurological sequelae were observed in 15 of the 25 surviving patients. There was no significant difference in the frequency of neurological sequelae between surgically and nonsurgically treated patients. Mean length of the abscess in the surgically treated group was significantly larger than that in the medically treated group (5.8 vs. 2.2 vertebral bodies). All three nonsurgically treated patients with neurological sequelae had anaerobic infections and received antibiotic therapy later and for shorter periods than those with complete neurological recovery. Antibiotic treatment is comparable to surgery plus antibiotic treatment. Early broad-spectrum high-dose ampicillin and third-generation cephalosporin, covering Gram-positive, Gram-negative, and anaerobic organisms, should be the first choice of management for patients with ISCA.

The Indian Ocean Dipole and malaria risk in the highlands of western Kenya.

Epidemics of malaria in the East African highlands in the last 2 decades have often been associated with climate variability, particularly the El Niño-Southern Oscillation (ENSO). However, there are other factors associated with malaria risk and there is increased interest in the influences of the Indian Ocean Dipole (IOD), a climate mode of coupled ocean-atmosphere variability, on East African rainfall. This study explores the relationship between IOD and the number of malaria patients in 7 hospitals from 2 districts in the western Kenyan highlands, controlling for the effects of ENSO. We examined temporal patterns (1982-2001) in the number of malaria cases in relation to the dipole mode index (DMI), defined as the difference in sea surface temperature anomaly between the western (10 degrees S-10 degrees N, 50 degrees-70 degrees E) and eastern (10 degrees S-0 degrees, 90 degrees-110 degrees E) tropical Indian Ocean. We used Poisson regression models, adjusted for ENSO index Niño 3 region (NINO3), seasonal and interannual variations. The number of malaria patients per month increased by 3.4%-17.9% for each 0.1 increase above a DMI threshold (3-4 months lag). Malaria cases increased by 1.4%-10.7% per month, for each 10 mm increase in monthly rainfall (2-3 months lag). In 6 of 7 places, there was no evidence of an association between NINO3 and the number of malaria cases after adjusting for the effect of DMI. This study suggests that the number of malaria cases in the western Kenyan highlands increases with high DMI in the months preceding hospital visits.

Syringomyelia caused by intrathecal remnants of oil-based contrast medium.

Oily contrast medium had been in use since the early 19th century as a radiographic agent for detecting spinal lesions and spinal cord tumors until the late 20th century. At that point computed tomography scanning and magnetic resonance imaging, or other hydrophilic contrast medium substituted for it. Adverse effects of oil-based dye, both acute and chronic, had been reported since the middle of the 20th century. In this paper the authors report the case of syringomyelia that seemed to be caused mainly by remaining oily contrast medium for 44 years. Syringomyelia secondary to adhesive arachnoiditis caused by oily contrast medium after a long period of time is well known. In the present case, however, surgery revealed only mild arachnoiditis at the level of syringomyelia as well as both solid and liquid remnants of contrast medium. Generally, cerebrospinal fluid (CSF) blockage due to an arachnoid adhesion is considered to cause syringomyelia following adhesive arachnoiditis. The authors speculated that in the present case syringomyelia was induced by a mechanism different from that in the previously reported cases; the oily contrast medium itself seems to have induced the functional block of CSF and impaired the buffer system of the intrathecal pressure. No reports on thoracic adhesive arachnoiditis and syringomyelia caused by oil-based dye referred to this mechanism in reviewing the literature.