A case of Capnocytophaga canimorsus sacral abscess in an immunocompetent patient.

We report a unique case of sacral Capnocytophaga canimorsus abscess successfully treated with surgery and antibiotics. Close contact to a dog was assumed to be the most likely source of infection. Established risk factors for invasive C. canimorsus infection such as splenectomy, alcoholism or overt immunosuppression could not be identified. The role of cigarette smoking, portal of entry and the possible relevance of altered skin microbiota as well as the diagnostic value of polymerase chain reaction are discussed in the light of the scarce literature of spinal C. canimorsus infections.

Evidence of a perceptual-encoding deficit in narcolepsy?

Body temperature, vigilance, memory, information processing and motor function were examined in 10 unmedicated narcoleptics and 10 matched controls at four different times of day. Time of day and body temperature were not related to performance. Narcoleptics displayed selective cognitive deficits in response latency, word recall, and estimation of frequency. Narcoleptics did not differ from controls in motor speed, vigilance, information processing speed or decision-making accuracy. We propose that a perceptual-encoding deficit may underlie the problems in memory and complex reaction time associated with narcolepsy.

The effects of short term flotation REST on relaxation: a controlled study.

The purpose of this study was to compare the effects of restricted environmental stimulation using a flotation tank (Flotation REST) to the effects of a normal sensory environment on relaxation. All of the subjects were first introduced to a simple relaxation program to be used during the experimental sessions. The program consisted of guided point-to-point relaxation, breathing techniques, and visual imagery techniques. Subjects were then pre-tested on measurements of electromyogram (EMG), galvanic skin response (GSR), peripheral skin temperature, and systolic and diastolic blood pressure. The experimental group experienced ten 45-minute sessions practicing the relaxation program in a Flotation REST environment. The control subjects practiced the same relaxation program in a similar body position for 45 minutes in a normal sensory environment. All subjects answered a five-question Subjective Relaxation Questionnaire on trials five through ten and were then post-tested on EMG, GSR, skin temperature, and blood pressure. The results indicated significant differences between groups from pre-test to post-test on systolic and diastolic blood pressure; the experimental group showed greater reductions. Significant differences also were observed on three of five questions on the Subjective Relaxation Questionnaire; the experimental group reported greater subjective relaxation and trends in a similar direction on the remaining two questions. The results of this study indicate that flotation REST enhances point-to-point relaxation, breathing techniques, and visual imagery techniques and, when combined with these techniques, can be an effective means of teaching normal subjects to lower systolic and diastolic pressure and heighten their subjective perception of relaxation.

Computed tomography of the postoperative intervertebral disc and lumbar spinal canal: serial long-term investigation in 19 patients after successful operation for lumbar disc herniation.

The first part of this work, published in 1988, included 25 patients who had computed tomographic (CT) scans without contrast enhancement and plain x-rays of the lumbar spine before, 1 week after, and 6 to 7 weeks after a successful operation for lumbar disc herniation. The present study extends the follow-up period to 3 years in 19 of the 25 original patients. Clinical examinations, lateral plain x-rays, and CT scans without contrast enhancement of the operated disc were repeated. The results indicate a decrease or even a disappearance of the hyperdense extradural material thought to represent fibrosis. An image suggestive of persistent disc herniation was still present in 5 of 8 patients with this finding on early postoperative CT scans. Persistent intradiscal gas was seen in nearly half of the patients. Total normalization of the posterior extraspinal structures was the rule. There was no correlation between CT appearance and residual complaints of the patients. CT scans without contrast enhancement may be sufficient to guide the surgeon in postoperative patients with massive signs and symptoms of recurrent root compression in whom a second operation is indicated on clinical grounds. In all other cases, myelography followed by CT scans is considered appropriate to investigate failed back surgery syndrome.

Human skin grafts on nude athymic mice: a light microscopic stereological study.

A morphometric procedure is presented, which allows quantitative information to be obtained from the epidermis at the light microscope level. The application of this procedure to human skin grafted to the nude mouse revealed acanthosis of the grafted epidermis compared to the original donor skin. All epidermal layers were thicker, but the increase in the granular layer was especially marked. The ratio of the basement membrane surface to the epithelial surface showed no significant change. A possible explanation for the acanthosis of the graft might be the higher mechanical stress on the nude mouse compared to the original site on the abdomen. This adaptation of the grafted epidermis does not limit the usefulness of this animal model for dermatological research, when it is assessed by objective methods, allowing statistical comparison as described here.

Extracranial vertebral artery dissection causing cervical root lesion.

The authors report an unusual manifestation of extracranial vertebral artery dissection (VAD), presenting with a predominantly motor radicular manifestation. Cervical magnetic resonance imaging (MRI) revealed the intramural hematoma in the dissected vessel wall, compressing mainly the segmental motor root and, to a lesser degree, the sensory ganglion. In the digital subtraction angiography (DSA), a circumscribed narrowing of the incriminated vessel was demonstrated. Color-coded Duplex imaging (CDDI) revealed complete recanalization after a few days of anticoagulation treatment. Complete neurologic recovery was seen after 3 months. Considering the MRI data, the likely pathogenetic mechanism was compression of the nerve root by the intramural hematoma. The synopsis with similar cases in the literature points to the characteristic features, i.e., the association of neck pain with radicular motor deficit and the absence of degenerative disk disease. The respective syndrome should raise the suspicion of vertebral artery dissection, especially in young individuals.

Acute effects of alcohol on photic evoked potentials of albino rats: visual cortex and superior colliculus.

Photic evoked potentials were recorded from the primary visual cortex (VC) and superior colliculus (SC) of chronically implanted rats. Animals were given intraperitoneal injections of saline, 1.5 and 2.5 g ethyl alcohol/kg body weight on separate days. Evoked potentials were recorded at 5, 20, 40 and 60 min following injection. The amplitudes of all of the VC components except P2 (latency of 52 msec) were depressed to some extent by both doses of alcohol. In contrast, the amplitude of component P2 was increased by both alcohol doses. In the SC, the peak amplitudes of two individual components of the early positive complex were diminished by both doses of alcohol, as was a later negative component. A series of late oscillatory potentials recorded from the SC were minimally depressed by the 1.5 g/kg dose of alcohol, but showed a more prolonged depressant effect at the higher dose. Both doses of alcohol produced reliable increases in peak latency for the primary components in the VC and SC.

Do's and don'ts in stereological pathology or possibilities of stereological-biochemical correlation in uropathology.

The problems and the interpretation of combined stereological-biochemical investigations in benign prostatic hyperplasia (BPH) research are discussed. As BPH is characterized by a primary stromal enlargement the role of the smooth muscle cell (SMC) is focussed. For determination of the single cell volume of the SMC several methods are applicable leading to different results. Thus interpretation of these results has to be done with caution. Finally as an example there is a discussion of a correlation of stereological-biochemical dates of human prostatic tissue samples.

Neuropsychologic test performance in amateur boxers.

Cognitive functions of 23 amateur boxers were assessed immediately before and after an amateur boxing event. A range of cognitive measures were employed including tasks of verbal, figural, and incidental memory, motor functions, attention and concentration, and information processing speed. Compared to their prefight performance, boxers demonstrated impairments in verbal and incidental memory, but enhanced executive and motor functions postfight. There were no observed differences between winners and losers on any of the measures. The results are compared to other studies that have shown only minor changes in cognitive functions in amateur boxers compared to controls.

Identification of malingered head injury on the Halstead-Reitan battery.

Heaton et al. (1978) demonstrated that the performance of malingerers and actual head trauma patients could be distinguished on the HRB by discriminant analysis. The present study replicated Heaton et al.'s methodology on a larger sample to provide a more stable function for discriminating simulated and real head trauma. Malingerers (n = 80) were instructed to fake severe deficits without being obvious. Patients (n = 80) had documented trauma and were not litigating for compensation. Groups were matched on age, gender, and overall Impairment Index to permit comparisons between patterns of performance. A crossvalidated step-wise discriminant function correctly identified 88.75% of the groups, with 83.8% true positives and 93.8% true negatives. This function was applied to several published data sets. Both malingerer and patient groups were accurately identified in Heaton et al. (1978) and Trueblood and Schmidt (1993). Faust et al.'s (1988) adolescent malingerer and the malingered performance of three litigating patients published by Cullum et al. (1991), were also correctly classified.

Factor analysis of verbal and nonverbal clinical memory tests.

This study represents an attempt to evaluate the construct validity of various verbal and nonverbal clinical memory tests. Marker variables for verbal, visual-perceptual-motor and attention-concentration abilities were employed in order to demonstrate the relative independence of these abilities from the memory measures. Subjects were 119 individuals (aged 16-74) from a combined sample of brain damaged and non-neurologic medical controls. Principal components analyses with orthogonal varimax rotations produced four factors in both Immediate and Delayed analyses: nonverbal memory and visual-perceptual-motor skills, verbal learning and memory, general verbal abilities, and attention-concentration. The inclusion of additional nonverbal memory measures helped to create a modality specific nonverbal factor but did not produce a pure nonverbal memory factor. The Wechsler Memory Quotient had modest loadings on three of the four factors.

Lateralized brain damage and performance on trail making A and B, Digit Span Forward and Backward, and TPT Memory and Location.

The present retrospective study was undertaken to determine whether Trail Making Test A and B, Digit Span Forward and Backward, and TPT Memory and Location scores are differentially sensitive to right or left hemisphere brain damage. Groups of patients with right, left, and generalized cerebral lesions and matched normal controls were compared. Results showed a relative failure for any individual measure, difference, or ratio score to reliably distinguish between right and left hemisphere lesions. Patients with diffuse lesions performed significantly worse than non-neurologic medical controls and right and left lesion groups on Trails A and TPT Memory and Location. Results are discussed in terms of specific methodological variables including chronicity of lesion, the nature of the task demands, and priming effects.

Preoperative and postoperative auditory and facial nerve function in cerebellopontine angle meningiomas.

Preoperative and postoperative facial nerve and auditory function were reviewed retrospectively in 13 cases of cerebellopontine angle meningiomas. According to their location within the posterior fossa and with special reference to the internal auditory canal, they were classified into a premeatal and a retromeatal group. All the tumors were removed by an otoneurosurgical team by use of a retrosigmoid approach. Postoperative results (1 year after operation) were compared within the two groups with respect to preservation of hearing (normal hearing in 31% and preservation of preoperative hearing in 69% of the cases) and facial nerve function (no or mild postoperative impairment in 69% of the cases). Both preoperative and postoperative impairment of facial nerve and auditory function prevailed in the premeatal group. For preservation of vital vascular and central nervous structures, subtotal resection with consecutive fractionated radiation therapy had to be performed in 30% of the cases. Our results provide substantial evidence that in cerebellopontine angle meningiomas a precise preoperative study of tumor location will assist in improving individual operative strategy and thus postoperative functional results.

[Adult syringomyelia - a syndrome of different origins]. / Die Adulte Syringomyelie - ein Krankheitsbild mit Verschiedenen Ursachen.

Syringomyelia describes an intra-medullary cyst in the spinal cord. In the adult patient, the pathology mostly results from Chiari-I-malformation or from severe spinal trauma. The clinical picture varies broadly, but symptoms often include pain and progressive neurologic deficits. During the clinical course, muscular atrophy and loss of pain and temperature sensation may develop in the affected region. Today, magnet resonance imaging helps to detect syringomyelia at an early stage. The interdisciplinary therapeutic approach includes an adequate pain treatment and physiotherapy, in selected cases a surgical intervention by an experienced surgeon. If not treated surgically, most symptomatic patients experience progressive neurologic deficits that may lead to severe paragplegia and chronic neuropathic pain.

MMPI-2 patterns in electrical injury: a controlled investigation.

The psychological consequences of electrical injury (EI) are many. Depression, posttraumatic stress disorder, anxiety, and somatic preoccupation are often concomitant with this type of injury (Kelley, Pliskin, Meyer, & Lee, 1994). The present study utilized the MMPI-2 as a tool for characterizing profiles of psychological distress in EI. We examined MMPI-2 profiles in 79 EI patients and their relationship to both injury parameters (i.e., time since injury, LOC, voltage), and extra-diagnostic factors, such as litigation status. EI patient profiles were also compared to individuals with mild traumatic brain injury (TBI), and chronic pain sufferers (CP). Results indicated that in EI, clinical elevations (T > or = 65) were found on the Hs and Hy scales, and approached clinical levels on the D scale. The injury parameter of time since injury was predictive of a distinctive profile, with individuals in the post acute phase experiencing more distress. Compared to other clinical groups, MMPI-2 scores on the Hs and Hy scales were significantly higher within the EI cohort as compared with their CP peers, with higher scores on the Pd scale for CP than EI. No statistically significant differences emerged between the EI and TBI groups. However, TBI patients showed significant elevations on Hy and D compared to CP, and EI patients endorsed more somatic symptoms than CP patients. Implications of these findings and future directions will be discussed.