Haemophilus influenzae and Streptococcus pneumoniae infections in children with cerebrospinal fluid shunts.

OBJECTIVE: This paper reviews the frequency of central nervous system infections due to Haemophilus influenzae and Streptococcus pneumoniae associated with cerebrospinal fluid (CSF) shunts in pediatric patients. The need for immunizations in this patient population is also evaluated. PATIENTS: All patients with cerebrospinal fluid shunts except those with brain tumors seen in our clinics. METHODS: We reviewed data in three computer databases, kept prospectively recording details of CSF shunt procedures and CSF shunt-related infections. RESULTS: 1,226 patients underwent 3,889 shunt placements between 1957 and 2007. Twelve patients had 14 episodes of Haemophilus or pneumococcal infections. CONCLUSIONS: Children with CSF shunts are at high risk for infection with H. influenzae and S. pneumoniae. Routine immunizations during infancy in addition to the 23-valent polysaccharide pneumococcal vaccine should be highly and actively encouraged by health care providers caring for children with CSF shunts. Additional expanded-coverage vaccines should be utilized if and when they become available.

Perceived first contact care for disabled children.

In a mail-back questionnaire survey, 169 mothers of myelodysplastic children were asked whom they would contact first for each of 24 health-related problems. These problems ranged from earaches to shunt obstruction to sexual counseling. All children were being followed in a comprehensive care clinic at a regional center; however, nearly half of these families lived in rural areas distant from the clinic. Eighty percent of children were said to have local physicians. Mothers tended to perceive clinic staff and specialists for first contact care according to severity of the child's motor paralysis, the greater the child's hospitalization experience, and the shorter the travel time from home to clinic. However, when travel time was controlled, there was no difference in overall perceptions for those mothers living more than 90 miles away from the clinic. In a second survey to 91 physicians designated as the "child's local doctor" and a third survey to the 27 clinic staff members, respondents were asked whom should mother contact first for each of the 24 health-related problems. The clinic staff tended to prefer itself, despite the general policy of the clinic to encourage families to utilize community resources, including their physicians. Local physicians tended to prefer themselves over clinic staff, a position consistent with the philosophy of primary care to the chronically disabled child.

Combined pressure-radionuclide evaluation of suspected cerebrospinal fluid shunt malfunction: a seven-year clinical experience.

A simple, safe radionuclide technique for evaluating the functional status of a cerebrospinal fluid shunt has been used in the clinical management of hydrocephalus in 306 patients over a seven-year period. Results of 526 studies showed greater than 99% sensitivity and accuracy in diagnosing distal shunt obstruction and 96% correct correlation with clinical outcome overall. Intrareservoir pressure measurements are especially valuable to diagnose proximal catheter shunt malfunction and to assess shunt dependency.

Gram-negative cerebrospinal fluid shunt-associated infections.

Twenty hydrocephalic children with cerebrospinal fluid (CSF) shunts over an 11-year period were seen with Gram-negative central nervous system (CNS) infections. Seventeen infections were with single organisms and three were mixed. Sixteen of 20 (80%) of the infections occurred within five months of shunt surgery. Complete shunt removal or replacement in a new site plus systemic and intraventricular antibiotics resulted in a 100% (9/9) cure rate. Systemic and intraventricular antibiotics alone or in combination with incomplete shunt removal generally were unsuccessful. Significant morbidity and mortality were associated with these infections. Of the 18 patients with follow-up data, seven (39%) died with the infection, four (22%) sustained definite CNS damage, three (17%) were retarded after infection but their preinfection status was unknown, and only four (22%) patients escaped without definite sequela. Early recognition and appropriate therapy, hopefully, will improve the current bleak prognosis

Tyrosine ameliorates a cold-induced delayed matching-to-sample performance decrement in rats.

Exposure to cold stress has been shown to impair short-term, or working, memory which may be related to a reduction in brain catecholamines. Administration of the catecholamine precursor tyrosine may alleviate a cold-stress-induced memory impairment by preventing a deficit in brain catecholamine levels. To test this hypothesis, eight rats performed a delayed matching-to-sample (DMTS) task at an ambient temperature of either 2 degrees C (cold) or 22 degrees C, following intraperitoneal administration of saline or tyrosine (50, 100 or 200 mg/kg). Rats administered saline prior to 22 degrees C exposure demonstrated a characteristic delay gradient in which accuracy decreased as the delay interval between sample and comparison stimuli increased from 1 to 16 s. Consistent with previous research, and relative to 22 degrees C exposure sessions, matching accuracy during 2 degrees C exposure sessions was reduced, which is attributed to the effect of cold on short-term, or working, memory. In particular, during cold exposure sessions matching accuracy was significantly reduced at the longer delay intervals, relative to matching accuracy at 22 degrees C. Additional analysis of cumulative matching errors within sessions showed that during exposure to cold, errors occurred at a constant rate throughout the session, indicating rats' performance was equally debilitated by the stressor over the entire session. During cold exposure sessions, the higher doses of 100 and 200 mg/kg tyrosine significantly improved overall matching accuracy relative to saline, but did not completely reverse the effect of cold exposure, as overall matching accuracy did not increase entirely to levels obtained at 22 degrees C.(ABSTRACT TRUNCATED AT 250 WORDS)

Conditioned suppression tests of the context-blocking hypothesis: testing in the absence of the preconditioned context.

Two experiments are reported that use rats in a conditioned suppression situation. The experiments, designed to remove confounds that have complicated interpretations of prior research, tested the context-blocking hypothesis, the proposition that static apparatus cues or conditioning contexts can block conditioning to discrete conditioned stimuli (CSs). Experiment 1, like previous work, tested for conditioning to the target CS in the same context that had been preconditioned and in which target conditioning had occurred; the experiment demonstrated a context-blocking like effect. Experiment 2 tested for conditioning not only in the preconditioned context but also in a nonpreconditioned context. Evidence for context blocking appeared similar in the two test situations. This suggests that conditioned contexts block the acquisition of associative strength by discrete CSs at the time of target conditioning (e.g., Rescorla & Wagner, 1972) and not through performance factors at the time of testing (e.g., Gibbon & Balsam, 1981).

Tyrosine pretreatment alleviates suppression of schedule-controlled responding produced by corticotropin releasing factor (CRF) in rats.

Disruption of performance observed when animals are exposed to physical stressors which deplete brain catecholamines can be alleviated by pretreatment with the catecholamine precursor tyrosine. Central administration of the stress hormone corticotropin releasing factor (CRF) has been shown to affect a variety of behaviors and also to potently increase the release of central catecholamines. Since CRF-induced disruption of behavior may involve CRF-induced depletion of brain catecholamines, the present study examined whether tyrosine would alleviate suppression of schedule-controlled responding in rats resulting from ICV administration of CRF. Administration of CRF (1.0 microgram-10 micrograms) produced dose-dependent suppression of response rate and total number of earned reinforcers in rats responding on a multiple fixed-interval 60 s/fixed-ratio 20 schedule for food reinforcement. Pretreatment with 200 mg/kg tyrosine (IP) administered with ICV saline decreased response rate but did not lower total reinforcers, whereas 400 mg/kg of tyrosine decreased both. Injection of 400 mg/kg tyrosine reduced, but did not completely restore, CRF-induced suppression of behavior. The 200 mg/kg tyrosine dose was less effective in alleviating CRF-induced suppression of performance. These data indicate that pretreatment with the catecholamine precursor tyrosine can partially ameliorate performance decrements resulting from CRF administration.

Follow-up comparison of hydrocephalus with and without myelomeningocele.

A series of 454 hydrocephalic patients with and without myelomeningocele and with and without treatment is reviewed. The survival rates for hydrocephalus alone and for hydrocephalus with myelodysplasia are comparable. The authors reach the conclusion that treatment of the hycrocephalic process and its complications is the most critical therapeutic consideration. Mental retardation is the major unalterable cause for failure to develop independence; some lesser emotional causes can be modified by encouragement. Repeated reassessment of the patient's condition and adjustment are important. Before treatment is started parents or guardians should be fully informed of the child's future potential for independent life and mental development.

Thermal stress modulates temporal patterns of responding on a multiple DRL-FR schedule.

To investigate temporal changes in behavior induced by moderate cold temperatures, rats performing on a multiple differential-reinforcement-of-low-rate (DRL) fixed-ratio (FR) schedule were exposed to ambient temperatures of 2, 8, 16, and 24 degrees C. DRL response rates markedly increased with decreasing cold temperatures, while FR response rates remained unchanged. In addition, as ambient temperatures decreased, the interresponse time (IRT) distribution of DRL responses shifted toward shorter times and short IRT bursts increased. Compared with cold effects, exposure to 38 degrees C heat induced decreases in both DRL and FR response rates which were associated with increases in long IRTs. Decreases in reinforcement frequency was associated only with the DRL schedule in cold, and with both DRL and FR schedules during heat exposures. The distinct effects of cold and heat on both DRL and FR responding suggest that the increases in DRL response rates and shifts in IRT distribution are unique to cold, and are not due to general effects of nonspecific thermal change in the ambient environment.

The effects of diisopropyl phosphorofluoridate (DFP) on time perception in rats.

The hypothesis that DFP alters circadian rhythms by altering the output of an "internal clock" which is also used to time events in behavioral tasks was tested. Since any clock has a mean rate (ticks/unit time) and an associated variance (changes in the rate across time), measures of time perception which depend upon both the mean clock rate and its variance (discriminability, A'), or only the mean clock rate (Bisection Point) were examined. In Experiment 1, two groups of rats were trained to discriminate between a standard duration and six comparison durations of a light. Six weeks following three injections of DFP (1.0 mg/kg/week) or vehicle (saline and 5% alcohol), the discriminability (A') between the standard and comparison durations was reliably reduced for the DFP-treated animals. In Experiment 2, rats were trained to perform on a temporal bisection task. Relative to performance during the weeks following vehicle (peanut oil) treatments, discriminability (A') during the weeks following treatment with DFP (1.0 mg/kg/week) was reliably degraded but measures of the Bisection Point were unaffected. Since Experiments 1 and 2 both used a light duration as a discriminative stimulus, Experiment 3 examined the possibility that DFP treatments produced a change in visual function rather than clock function. Two groups of rats were trained to discriminate between light-on and light-off periods in a standard free-operant successive discrimination paradigm. No changes in discriminability or response rates were evident following two injections of DFP (1.0 mg/kg/week) or vehicle (peanut oil).(ABSTRACT TRUNCATED AT 250 WORDS)

Circadian variations in time perception in rats.

The hypothesis that time perception is determined by an internal clock's rate, which is sensitive to physiological circadian changes was examined. This hypothesis suggests that when body temperature and activity increase, clock rate increases causing overestimations of time and a decrease in time interval production. The following experiments examine this hypothesis with rats. Since rats are nocturnal, and body temperature is highest at night, time estimation should be longer and time production shorter than during the day. All experiments were run 24 hr a day under a 12:12 light:dark cycle. In the first experiment, rats discriminated among stimulus durations. Consistent with the hypothesis, both rats reliably judged standard durations as "longer" during the night than during the day. In Experiment 2, fixed-interval (FI) schedules of 60, 120 and 180 sec were used to examine circadian variations in time production. All seven rats produced longer postreinforcement pause (PRP) durations as FI length increased, and shorter PRP durations at night than during the day. However, absolute differences in PRP durations between day and night did not increase as FI duration increased, suggesting the PRP durations alone do not directly characterize proportional changes in internal clock rate. To more directly examine circadian variation in clock rate and the production of shorter intervals (i.e., between 1 and 16 sec) Experiment 3 used a lever holding procedure. Since this procedure requires the measured lever hold duration to meet or exceed the required hold duration, it more accurately characterizes the timing process.(ABSTRACT TRUNCATED AT 250 WORDS)

Perceptual bisection in rats: the effects of physostigmine, scopolamine and pirenzepine.

The effects of cholinergic drugs on three different perceptual bisection tasks were studied in rats. Physostigmine (0.056-0.56 mg/kg), a reversible anticholinesterase, produced dose-dependent decrements in discriminability (A'), but did not affect the bisection point (BP) in visual duration, auditory duration, and auditory intensity bisection tasks. This finding is consistent with results previously obtained in an auditory duration bisection task with an irreversible anticholinesterase, diisopropyl phosphofluoridate. Scopolamine (0.075-0.422 mg/kg), a muscarinic cholinergic-receptor antagonist, produced dose-dependent decrements in both A' and BP in visual and auditory duration bisection tasks. The behavioral antagonism between physostigmine (0.56 mg/kg) and scopolamine (0.075-0.237 mg/kg) was studied in the visual and auditory duration bisection tasks. The BP was not affected by physostigmine alone or in combination with scopolamine, except at the largest dose of scopolamine, which produced a reliable decrement in the BP. A', however, was equally decreased by physostigmine alone and all combinations of physostigmine and scopolamine. Pirenzepine (1, 3 and 10 mg/kg), a selective high-affinity M1 muscarinic antagonist, had no effect on A' or the BP in the duration bisection tasks, suggesting changes in perception produced by muscarinic antagonists do not involve the M1 receptor subtype. The similar drug effects in different sensory modalities (visual and auditory) and perceptual systems (subjective duration and loudness) suggest that cholinergic drugs may affect perceptual mechanisms responsible for sensory coding, such as the output of a neural generator.

Loudness bisection and masking in the rat (Rattus norvegicus).

The bisection method of animal psychophysical scaling was examined as a measurement procedure. The critical assumptions of bisection scaling, as described by Pfanzagl (1968), were tested to determine if a valid equal-interval scale could be derived. A valid scale was derived in which loudness for the rat (Rattus norvegicus; n = 13) was a power function of sound pressure for 4-kHz tones. Masking noise reduced the discriminability of tonal stimuli but did not affect the bisection point. This result is consistent with an interval scale representation of loudness and demonstrates scale meaningfulness. Loudness bisection data that have been reported in the literature for 3 species (humans, rats, and pigeons) are in substantial agreement with our results.

Orthopaedic management of high-level spina bifida. Early walking compared with early use of a wheelchair.

To determine whether it is worth while to encourage patients who have high-level spina bifida to walk at an early age, we compared the cases of thirty-six patients who had participated in a walking program with those of thirty-six patients for whom a wheelchair had been prescribed early in life. The patients in the two groups were matched for age, sex, level of the lesion, and intelligence. Only twelve of the patients who had been able to walk at an early age were still able to do so effectively at the time of this study, when their ages ranged from twelve to twenty years, but still these patients fared somewhat better than the other patients did. The patients who walked early had fewer fractures and pressure sores, were more independent, and were better able to transfer than were the patients who had used a wheelchair from early in life. However, during childhood and early adolescence, the patients who had always used a wheelchair had spent fewer days in the hospital than did those who had participated in the walking program. There were no major differences between the two groups with regard to skills of daily living, function of the hands, and frequency and severity of obesity.

Tyrosine reverses a cold-induced working memory deficit in humans.

Acute exposure to cold stress has been shown to impair short-term, or working, memory, which may be related to reduction in, or disruption of, sustained release of brain catecholamines. Administering a supplemental dose of the catecholamine precursor tyrosine may alleviate cold stress-induced memory impairments by preventing cold-induced deficits in brain catecholamine levels. The present experiment determined whether administration of tyrosine would prevent a cold-induced working memory deficit, using a computer-based delayed matching-to-sample (DMTS) memory task. Eight male volunteers performed the DMTS task for 30 min at an ambient temperature of either 4 degrees C (cold) or 22 degrees C following a 30-min preexposure period and 2 h after ingesting 150 mg/kg of L-tyrosine or placebo. Subjects demonstrated a decline in matching accuracy on the DMTS task as delay interval increased, such that matching accuracy following a 16-s delay between sample and comparison stimuli was lower than that following a delay of 2 or 8 s. Consistent with previous research, and relative to 22 degrees C exposure sessions, matching accuracy during 4 degrees C exposure sessions was reduced significantly following placebo administration, which is attributed to the effect of cold exposure on short-term, or working, memory. Administration of tyrosine significantly improved matching accuracy at the longest delay interval most affected by cold exposure, such that matching accuracy in the cold following tyrosine was at the same level as matching accuracy following placebo or tyrosine administration at 22 degrees C. Tyrosine administered prior to 22 degrees C exposure had no effect on DMTS performance.(ABSTRACT TRUNCATED AT 250 WORDS)

Developmental guidelines for children with myelodysplasia.

A new inventory of 166 milestones and developmental tasks was designed and given to parents of 173 children with myelodysplasia to use over a 2 1/2-year period to record their children's development. The inventory included items in the categories of self-help (including independent toileting), personal-social development, and gross motor development. The children were placed in one of four subgroups according to their level of paralysis. For each motor-level group, the percentage of those performing each item at various ages was calculated. The ages of routine performance of selected self-help and personal-social items are reported for 20, 50, and 80 percent achievement for the children for whom the data were known. There was a tendency for the less paralyzed children to learn skills more quickly than their more paralyzed peers. However, the wide age ranges within groups for learning individual skills indicate that factors other than the level of paralysis affect the rate of development, and these factors need to be identified. The data provided represent a reasonable estimate of when children with varying degrees of paralysis can first be expected to perform developmental tasks. The tables can be used to establish learning objectives and programs so that more children with myelodysplasia can learn independence at an earlier age.

The natural history of hip deformity in myelomeningocele.

We studied 1061 children with myelomeningocele, reviewing 3184 pelvic radiographs from 802 patients. Hip dislocation had occurred by the age of 11 years in 28% of children with a thoracic neurosegmental level, 30% of those with an L1/2 level, 36% of L3, 22% of L4, 7% of L5 and only 1% of those with sacral levels. Hip dislocation was not inevitable even when there was maximal muscle imbalance about the hip. The average hip flexion contracture in children aged 9 to 11 years was significantly greater in those with thoracic (22 degrees) and L1/2 (33 degrees) levels than in those with L4 (9 degrees), L5 (5 degrees) or sacral (4 degrees) levels. Our findings indicate that muscle imbalance is not a significant factor in the production of flexion deformity or dislocation of the hip; both are commonly seen in the absence of imbalance. The restoration of muscle balance should no longer be considered to be the principal aim of the management of the hip in children with myelomeningocele.

Epidemiology, etiologic factors, and prenatal diagnosis of open spinal dysraphism.

The caudal neural tube closes late in the first month after fertilization and failure of it results in myelomeningocele. Epidemiologic studies have shown differences in prevalence at birth based on ethnic-racial backgrounds and geography. Etiologic factors include the drug valproic acid or carbamazepine. Periconceptional folic acid supplementation appears to decrease the prevalence of neural tube defects. Numerous modalities allow for prenatal diagnosis of myelomeningocele. A cesarean section, before rupture of amniotic membranes and onset of labor, decreases the degree of paralysis.

A behavioral economic analysis of the relative persistence of behavior: comment on Meisch (2000)

This commentary examines and reinterprets the concept of relative persistence in drug self-administration studies, described by R. A. Meisch (2000), in behavioral economic terms. Over the past several years, investigators in the behavioral sciences have successfully applied consumer demand theory to the study of drug abuse and addiction. The economic concept of demand elasticity (i.e., the changes in the amount of a commodity demanded as a function of changes in price) and the concept of unit price are described in detail, and this commentary shows these concepts provide an alternative interpretation to the relative persistence of behavior. The application of the behavioral economic approach to understanding abuse potential of putative drugs of abuse, in development of medications for drug addiction and in characterizing the transition from drug use to drug addiction, is discussed.