Rapid and Sensitive ELISA Screening Assay for Several Paralytic Shellfish Toxins in Human Urine.

Paralytic shellfish poisoning is caused by a group of paralytic shellfish toxins that are produced by dinoflagellates. Toxins in this group include saxitoxin, neosaxitoxin and gonyautoxins. A rapid diagnostic test to identify poisoning by these toxins can be helpful in guiding the appropriate treatment of victims. Additionally, quick receipt of diagnostic results can provide timely proof that shellfish harvesting should be stopped in a given area, thereby preventing additional exposures. We have developed and validated a rapid urinary enzyme-linked immunosorbent assay-based screening test to diagnose exposure to several major paralytic shellfish toxins. The lower limit of detection (LLOD) for multiple paralytic shellfish toxins was characterized as 0.02, 0.10, 0.10, 1.0, 1.0 and 15 ng/mL for saxitoxin, gonyautoxin 2,3, decarbamoyl gonyautoxin 2,3, decarbamoyl saxitoxin, neosaxitoxin and gonyautoxin 1,4, respectively. No interferences were identified in unspiked pooled urine or in specimens collected from unexposed individuals indicating that this method is specific for the paralytic shellfish toxins tested. The accuracy of this test was demonstrated in 10 individual urine specimens with osmolalities ranging from 217 to 1,063 mOsmol/kg and pHs ranging between 5.06 and 7.45. These specimens were spiked with toxins at their LLODs and the presence of toxins at these concentrations was accurately identified in all cases. These results indicate that this diagnostic test can be used to rapidly and accurately screen urine for paralytic shellfish toxins.

Two cytokine signaling molecules co-operate to promote axonal transport and growth.

The neuropoietic cytokines and their cytoplasmic signaling molecules contribute to axotomy-induced events in the nerve cell body that are beneficial to axonal regeneration. Previous studies have revealed a paradox in that, in vivo, suppressor of cytokine signaling (SOCS3) is induced in axotomized primary sensory neurons which are in a growth mode but, in vitro, SOCS3 strongly inhibits neurite growth from the same neurons. The present studies in cell lines with immuno-precipitation and western blotting, and Förstner resonance energy transfer showed that SOCS3 binds to the C terminus of C-Jun N-terminal kinase-interacting protein-1 (JIP1), increases its serine phosphorylation, and increases its binding to kinesin. Axonal transport was studied in vitro in adult rat primary sensory neurons by analyses of recovery of fluorescence after photobleaching and of the velocity and direction of movement of organelles. Over-expression of SOCS3 in addition to JIP1 had two consequences. First, recovery of fluorescence after photobleaching was more rapid and, second, JIP1-containing organelles moved more quickly and more frequently in retrograde direction. With respect to neurite outgrowth, SOCS3 alone was, as expected, strongly inhibitory but, in the presence of excess JIP1 augmented the stimulatory activity of the latter. The observations indicate that interactions between JIP1 and SOCS3 influence favorably axonal transport and growth in vitro.

Dorsally located endodermal cyst: case report and review.

Intracranial endodermal cysts are most commonly located in the posterior cranial fossa anterior to the brainstem. We report a rare case of an endodermal cyst of the posterior fossa located dorsal to the brainstem and is to our knowledge the only other such case reported in the literature.

Changes in plasma phenytoin level following craniotomy.

Phenytoin is often used to prevent postcraniotomy seizures, but is not always effective. We investigate changes in plasma phenytoin level ([phenytoin]) following craniotomy. The [phenytoin] in 28 patients who were receiving phenytoin (oral/ intravenous) and undergoing a craniotomy were prospectively measured 24 h preoperatively, immediately pre- and postcraniotomy, 24 and 48 h postoperatively. Factors examined included patients' age, sex, pathology, preoperative [phenytoin], operative duration and blood loss. Fifteen patients had [phenytoin] concentrations outside the therapeutic range. Twenty-five patients experienced a decrease in [phenytoin] immediately postcraniotomy: pre-, post- and 24 h postcraniotomy mean [phenytoin] were 13.4, 10.0 and 12.9 mg/l, respectively. Preoperative [phenytoin], operative duration and blood loss had significant correlation with the decrease in [phenytoin] (p < 0.05). In conclusion, < 50% of the patients had therapeutic preoperative [phenytoin]. In most patients, [phenytoin] decreases by 26% after craniotomy and returns to preoperative level within 24 h. These may contribute to early postoperative seizure development.

The Influence of hair shave on the infection rate in neurosurgery. A prospective study.

OBJECTIVE: To investigate whether not shaving hair in neurosurgical operations carries an increased infection rate. METHODS: Taking advantage of different practices among neurosurgeons in a single institution, we embarked upon a prospective non-randomised study of 100 consecutive neurosurgical procedures involving 90 paediatric patients aged 7 days to 16.8 years. The patients were split into two groups ('hair shave' and 'no hair shave'). The differences with respect to wound complications, positive microbiology on wound culture swabs and wound infection rates were analysed. Other factors considered were the cleansing solution, prophylactic antibiotic regime, duration of the operation, the surgeon's experience and the patient's age. RESULTS: The only complications observed were 4 incidences of wound dehiscence (2 in the hair shave and 2 in the no hair shave group) and 3 shunt infections (2 in the hair shave and 1 in the no hair shave group). We did not find any significant difference between the two arms for any of the factors assessed. Age was a significant factor in shunt infection, as all shunt infections were seen in patients aged less than 6 months, regardless of whether the hair was shaved or not (p = 0.024, Fisher's exact test). CONCLUSION: This study confirms our clinical experience that no hair shave is a good alternative to the traditional hair shaving approach, allowing patients to enjoy the psychological benefits of undisturbed body image while recovering from major surgery.

Spinal sagittal malalignment following surgery for primary intramedullary tumours in children.

BACKGROUND/OBJECTIVE: As prior studies analysed predictive factors for various post-laminectomy spinal deformities in mixed spinal regions, age groups or pathologies, their validity and conclusions were unclear. The objective of this study was to determine predictive factors for worsened cervical or thoracic spinal sagittal alignment following laminectomy or laminotomy for primary intramedullary spinal cord tumours in children. METHODS: In this retrospective study, patients treated between 1980 and 1998 were reviewed. Changes in spinal alignment at the last follow-up compared to the pre-operative state were studied. Factors analysed were age, pre-operative spinal alignment, procedure types (laminectomy or laminoplasty), number of laminae operated, surgery of C2 or T1 laminae, histological grade, presence of post-operative neurological deficit and post-operative radiotherapy. RESULTS: There were 27 patients. The mean age was 5.6 years (range 1.3-14.0 years), and the mean duration of follow-up was 3.7 years (range 0.075-9.9 years). In the cervical-cervicothoracic surgical group (n = 12), alignment worsened post-operatively in 3 patients. The number of laminae operated upon had a statistically significant impact on the development of post-operative kyphosis (p = 0.07). In the thoracic-thoracolumbar surgical group (n = 15), alignment worsened in 9 patients. Procedure types were statistically significantly different, with laminectomy associated with an increased risk of post-operative kyphosis (p = 0.01). All 5 patients who had spinal fusion for worsened post-operative alignment were in the thoracic-thoracolumbar group; no patients in the cervical-cervicothoracic group required spinal fusion (p = 0.047). Other predictive factors did not reach statistical significance (p > 0.05). CONCLUSIONS: Worsened spinal sagittal alignment following laminectomy or laminoplasty and the need for spinal fusion is more common in the thoracic-thoracolumbar region than in the cervical-cervicothoracic region. In the cervical-cervicothoracic region, operation on a greater number of laminae tends to increase the risk of worsened alignment. In the thoracic-thoracolumbar region, laminectomy is associated with worsened alignment, while laminoplasty reduces this risk; also, pre-operative kyphotic deformity tends to increase the risk of worsened alignment post-operatively.

Coexistence of acanthosis nigricans and the sign of Leser-Trélat in a patient with gastric adenocarcinoma: a case report and literature review.

The association of acanthosis nigricans (AN) with the sign of Leser-Trélat (LT) and gastric carcinoma is rare. Our patient was a 69-year-old man, who presented with hematemesis; a stage-IV poorly differentiated, diffuse-type, adenocarcinoma of the gastric antrum was diagnosed. The AN was striking, with florid cutaneous papillomatosis that also involved the mucous membranes of the mouth and eyelids, and keratoderma. AN and the sign of LT predated tumor detection by 6 months and regressed after chemotherapy in parallel with reduction of the tumor load, demonstrating the dermatoses as paraneoplastic phenomena. The patient died 7 months after completion of chemotherapy. The coexistence of AN and the sign of LT should prompt a search for underlying malignancy. The pathogenesis of both dermatoses is discussed.

Primary ectopic intramuscular meningioma of the thigh.

A case of a primary ectopic intramuscular meningioma of the thigh in a 20-year-old male patient is presented. The possible histogenesis of primary ectopic meningiomas is summarized.

Paraganglioma of the cauda equina: a case report and review of the literature.

This case report describes a paraganglioma of the cauda equina in a 57-year-old man. The clinical and pathological features of the 70 cases reported to date are reviewed. The importance of total surgical removal is stressed.

Spinal intramedullary cavernous angioma in a patient with Down's syndrome.

A rare case of cervical intramedullary cavernous angioma in a 30-year-old man with Down's syndrome is presented. A review of the literature showed this to be the first reported case. Magnetic resonance imaging was diagnostic. A myelotomy was done and multiple biopsies were taken. The patient deteriorated neurologically and later died due to severe chest infection. The presentation, management and prognosis of this condition are discussed.

Wound infection with meningitis caused by Salmonella typhimurium.

We report a case of postoperative wound infection and meningitis with Salmonella typhimurium in a 66-year-old woman who had been operated on for a cerebral meningioma. The diagnostic, therapeutic and prognostic implications are discussed.