A novel suture method to place and adjust peripheral nerve catheters.

We have developed a peripheral nerve catheter, attached to a needle, which works like an adjustable suture. We used in-plane ultrasound guidance to place 45 catheters close to the femoral, saphenous, sciatic and distal tibial nerves in cadaver legs. We displaced catheters after their initial placement and then attempted to return them to their original positions. We used ultrasound to evaluate the initial and secondary catheter placements and the spread of injectate around the nerves. In 10 cases, we confirmed catheter position by magnetic resonance imaging. We judged 43/45 initial placements successful and 42/43 secondary placements successful by ultrasound, confirmed in 10/10 cases by magnetic resonance imaging.

Follow-up of stereotaxic amygdalotomy for seizure and behavior disorders.

Stereotaxic amygdalotomy for the control of unmanageable behavior and/or intractable seizures is a controversial treatment approach with unknown risk-to-benefit ratios. Information about this subject was obtained from a retrospective follow-up study of 58 patients who received this form of treatment 1 to 11 years earlier (average 6 years). Assessments of the patients were made by invesgators external to the surgical treatment system, using structured psychiatric interviews, neuropsychological tests, and EEGs. In addition, global assessments were made, comparing pre- versus postoperative status. The objective data revealed no indication of worsening or damage with similar pre- and postoperative test scores and EEG features. Computer-scored interviews revealed considerable psychopathology in the ambulatory patients. Overall judgments of behavior, seizures, and functional levels indicated that more than a third of the group was probably improved, although the relationship of outcome to the surgery was indeterminate.

Positional oculogyric crises. Case report.

A young woman with a cystic glioma in the region of the posterior third ventricle is presented. Each time she turned to the supine position she developed immediate, forceful, conjugate upward gaze (oculogyric crises) and an inability to talk. If she turned to either side, she was alert and oriented, and could talk and lie comfortably. After stereotaxic removal of the cystic fluid, this phenomenon disappeared and did not return, even when the cyst refilled.

Alternating Horner's syndrome and hyperhidrosis due to dural adhesions following cervical spinal cord injury: case report.

Alternating Horner's sign and hyperhidrosis appeared in this patient 8 years after a spinal cord injury at C6-7. An intramedullary cyst was suspected but was not found at operation. There was a striking improvement in both symptoms after adhesions between the spinal cord and the dura mater were freed.

Arsenic speciation in marine organisms: from the analytical methodology to the constitution of reference materials.

An analytical procedure for total arsenic and arsenic species quantification in marine organisms has been developed. Fresh materials are freeze-dried and reduced to powders before analysis. Arsenic is determined either by energy dispersive X-ray fluorescence (EDXRF) directly or by inductively coupled plasma optical emission spectrometry (ICP/OES) after microwave digestion. Arsenic speciation is performed on the extracted sample using liquid chromatography coupled to ICP/OES for arsenobetaine and arsenocholine determination and to the hydride generation-quartz furnace atomic absorption spectrometric technique for arsenite, arsenate, monomethylarsonic and dimethylarsinic acids quantification. Special precautions are taken to avoid losses or contaminations as well as to prevent analytical errors during the quantification stage. Other methods are applied and the corresponding results compared for each step of the procedure. The method is finally validated by means of intercomparison studies within the Measurements and Testing Programme of the European Community (formely BCR).

Epidural lipoma simulating lumbar disc protrusion.

Spinal lipomata are usually associated with congenital anomalies. A lipoma, presenting with symptoms, signs and myelographic findings suggestive of a lumbar disc protrusion, is rare. Asymmetry of the origin of some of the scaral nerve roots may be the clue for suspecting epidural lipoma pre-operatively.

Pituitary apoplexy with intracerebral hemorrhage simulating rupture of an anterior cerebral artery aneurysm.

Pituitary apoplexy presenting with intracerebral hemorrhage into the left frontal lobe and lateral ventricle, simulating an anterior cerebral artery aneurysm rupture, is reported. No other cases of intracerebral hemorrhage caused by pituitary apoplexy have been found in a review of the English literature.

Prophylactic anticonvulsants for prevention of immediate and early postcraniotomy seizures.

Phenytoin (15 mg/kg) was administered intravenously to 189 patients shortly before their intracranial, supratentorial surgery was completed. Intravenous phenytoin of 5-6 mg/kg/day in three divided doses was administered daily for the first 3 postoperative days. Therapeutic serum levels (10-20 micrograms/mL) were achieved in 113 (59.8%) patients. An equally constituted, randomized control group of 185 patients received a placebo under identical conditions. The group receiving phenytoin had only one immediate and two early postoperative seizures. The 185 controls had four immediate and nine early postoperative seizures. None of the follow-up computed tomography scans of the patients with seizures showed postoperative hematoma. One patient had a significant tension pneumocranium, a possible cause of postoperative seizures. To avoid a decrease in the serum anticonvulsant level due to intraoperative blood loss, it is suggested that for patients who need an urgent or emergent craniotomy, prophylatic anticonvulsant medication should be given at least 20 minutes before completion of wound closure.

Granulometry and the content of toxic and potentially toxic elements in vacuum-cleaner collected, indoor dusts of the city of Warsaw.

Twenty-seven sites, together with 23 household dust sample sites, representing the home environment, and four public room dust sample sites, representing working environment (mainly offices) have been described in this paper. The latter were examined to obtain an approximate reference to the home environment data. All the samples were collected between May and July 1997 by a vacuum-cleaner method, in the city of Warsaw, Poland. The granulometry of the dusts was determined by their separation into seven fractions in the range 8-500 microm. The concentrations of Cr, Ni, Cu, Zn, Pb, Br and Fe in the samples were investigated in fractions 8-32, 32-63 and 63-125 microm by the EDXRF technique. The results showed higher concentrations of these elements in finer fractions (8-32 microm). The Pb content in the household dusts was found to be unexpectedly low, ranging from 120 microg g(-1) for the 63-125 microm fraction, up to 210 microg g(-1) for the 8-32 microm fraction. Car exhausts could not be determined clearly as the main source of Pb in the indoor household dusts due to the lack of a Pb-Br intercorrelation. In these dusts, only Cr and Zn showed a remarkably high content of 90-100 and 1020-1070 (microg g(-1)), respectively. In the household dusts, strong intercorrelations were present in the three analysed fractions for the metal pairs: Pb-Zn, Pb-Cu, Fe-Cr, and Cu-Cr (weaker). The working environment rooms showed a higher degree of dustiness by 300%, as compared to the dwellings. The dusts collected in the working environment rooms showed slightly higher concentrations of Ni and by 50-100% higher concentrations of: Cu, Zn, Pb, Br than the analysed household dusts.

Single-stage rotation of arterialized scalp flaps for male pattern baldness: case report.

We used the Doppler ultrasonic flowmeter to trace the temporal artery and its branches posteriorly to their anastomosis with the occipital vessels. Then we outlined a scalp flap (one on each side) along the course of these vessels. The scalp flaps were raised and transposed to the anterior hairline in one stage, as treatment for male pattern baldness. There was complete survival of both flaps, with immediate, normal, luxuriant growth of hair--which could be combed to cover the entire scalp.

Ultrasound and the blood-brain barrier.

High intensity focused ultrasound was employed to modify the permeability of the normal feline and canine blood-brain barrier (BBB) to a circulating vital dye--Evans blue (EB). The threshold doses (W sec/cm2) for focally increasing the permeability of the BBB in white matter (WM) and gray matter (GM) were as follows: internal capsule (WM)--340 to 680; thalamus (GM)--approximately 1326; and caudate nucleus (GM)--2284 to 2952. In the presence of supralesioning doses of ultrasound, the cross sectional area occupied by the EB was consistently greater than that of the attendant nonhemorrhagic lesion--thus suggesting that BBB changes may be inducible at sublesioning doses. These findings, in conjunction with those of others, suggest that high intensity focused ultrasound may have a role in the treatment of brain tumors based on cell destruction by two mechanisms: (a) direct, by the ultrasound and (b) indirect, by an antineoplastic agent which is delivered via an ultrasonically modified BBB.

Determination of total mercury in estuary, lake and river sediments.

In order to improve the quality of the results in sediment analysis, the Community Bureau of Reference (BCR) of the European Communities has developed 3 sediment reference materials (CRM) from estuarine, lake and river origins. Certification of mercury content in these materials was achieved by 3 methods (cold vapor atomic absorption spectrometry, plasma emission spectrometry, neutron activation analysis with radiochemical separation). The values finally certified in the CRM estuarine, lake and river sediments are 1.77 +/- 0.06, 0.67 +/- 0.02, 1.03 +/- 0.13 mg/kg respectively.

[Late manifestation of alternating Horner's signs in spinal cord injury due to dura-cord adhesion (author's transl)].

It has been said that late manifestation of transient alternating Horner's signs in cases of spinal cord injury is caused by intramedullary cavity formation in which some movement of fluid stimulates the sympathetic system corresponding to their positioning. We had a patient complaining of alternating Horner's signs which became manifest 8 years after the injury. We could not find any intramedullary cavity formation, in spite of a spinal puncture at operation, but the symptoms made a striking improvement after the operation simply by making free the spinal cord from the dura mater at operation. So we suppose that late manifestation of transient alternating Horner's signs will be manifested not only in cases of intramedullary cavity, but also in cases of dense adhesion between the spinal cord and the dura mater. In addition to this, we propose the new term "Poromyelia" for the intramedullary cavity because of its resemblance to "Porencephalia" in the cerebrum, and because of the confusing usage of the word "Syringomyelia" for this condition of "Poromyelia". It has been said that "Syringomyelia" in the spinal cord is similar to "Hydrocephalia" in the cerebrum.