Neuropsychological correlates of MRI temporal lobe abnormalities in schizophrenia

OBJECTIVE

The authors evaluated the neuropsychological correlates of temporal lobe abnormalities in schizophrenic patients.

METHOD

Fifteen schizophrenic patients underwent assessment of memory, by the Wechsler Memory Scale--Revised, and abstraction/categorization, by the similarities subtest of the Wechsler Adult Intelligence Scale--Revised and the Wisconsin Card Sorting Test. Neuropsychological tests of motor and constructional functions were used as control tasks. The patients also underwent magnetic resonance imaging (MRI) studies in which new neuroimaging techniques were used to derive measurements of volume and three-dimensional surface renderings of temporal lobe structures.

RESULTS

Spearman rank-order correlations indicated significant associations between poor scores on tests of verbal memory, abstraction, and categorization and reduced volume in temporal lobe structures, including the parahippocampal gyrus and posterior superior temporal gyrus (left and right). By contrast, performance on tests of visual memory and on control tasks was not correlated with MRI temporal lobe abnormalities.

CONCLUSIONS

These findings suggest a significant but modest relation between reduced volume in specific temporal lobe regions and neuropsychological deficits in abstraction, categorization, and verbal memory, all of which may reflect a dysfunctional semantic system in schizophrenia.

Epithelial implantation cysts of the upper eyelid after lid-lowering procedures

PURPOSE

Epithelial inclusion cysts are benign lesions that have been described after intraocular and intraorbital surgery or trauma. The authors determine the rate of occurrence and characteristics of epithelial implantation cysts after upper eyelid-lowering procedures using a posterior conjunctival incision.

METHOD

The records of 109 upper eyelid-lowering cases over a 9-year period that had an internal incision were reviewed retrospectively. Any cysts removed were sent for histopathologic examination.

RESULTS

The incidence of cyst development was found to be 2.75%. The cysts were small and remained under 4 mm over time. Histopathologic findings of the two epithelial cysts removed suggested a conjunctival origin. The development of cysts did not correlate with length and difficulty of the procedure.

CONCLUSION

Epithelial implantation cysts of the eyelid after posterior approach levator recession procedures are rare (2.75% incidence). However, they often require surgical excision due to their conspicuous location. Their origin is probably the conjunctival epithelium implanted while manipulating the conjunctival incision edge.

Limitations of extracorporeal shock wave lithotripsy for urinary tract calculi in young children

Despite success rates with a variety of urinary tract calculi, there is growing concern that extracorporeal shock wave lithotripsy (ESWL) has limitations and that its role needs to be redefined. We report the outcome of 28 consecutive children (age range, 6.5 months to 7 years; mean, 3.6 years) with urinary calculus disease, treated over a 5-year period. Thirteen patients had ESWL monotherapy, and 8 achieved stone clearance. The other 5 children in the ESWL monotherapy group, all with multiple calculi, required surgery to render them stone free. A further 14 patients (6 staghorn calculi, 6 multiple calculi, 1 solitary renal, and 1 child with multiple bladder calculi) were considered unsuitable for ESWL and had primary surgery. Twelve of those 14 were cleared by open surgery, one had residual fragments successfully treated by ESWL, and one still awaits adjuvant ESWL. One child had a solitary renal calculus (5 mm) which passed spontaneously. This study demonstrates that ESWL monotherapy cleared stones in only 8 of 28 patients and clearance in a further 6 was achieved with surgery. Surgery will continue to play an important role in the management of paediatric urolithiasis for large staghorn, multiple urinary tract calculi and lithotripsy failures.

Delayed primary anastomosis for esophageal atresia: 18 months' to 11 years' follow-up

In 1977 we started treating babies with isolated esophageal atresia by delayed primary anastomosis and in 1981 reported our early experience in five cases treated between 1977 and 1979. Since 1979, 11 further consecutive cases have been managed by initial gastrostomy followed by delayed primary esophageal anastomosis. Their mean gestation was 35 weeks (range, 28 to 40 weeks) and mean birth weight was 2,040 g (range, 1,140 to 2,720 g). The esophageal gap between the two ends when assessed initially at fluoroscopy ranged from 2.2 to 4.5 cm (mean, 3.2 cm). Age at delayed primary anastomosis ranged from 6 to 20 weeks. Anastomotic leak occurred in three babies in the immediate postoperative period and all were successfully managed conservatively. Eight of the 11 patients developed anastomotic strictures; seven cases required 1 to 5 esophageal dilatations. One patient who did not respond to multiple esophageal dilatations required resection of an esophageal stricture. One patient died at 15 months of age of unrelated causes. The 10 surviving patients have been followed-up from 18 months to 11 years. At follow-up, seven patients were eating normally. Three patients had swallowing difficulties and all three were found to have esophageal strictures on barium swallow, two of them also had gross esophageal reflux and hiatus hernia. The height and weight in the 10 patients varied from 3rd centile to 75th centile. Delayed primary anastomosis is feasible in cases of isolated esophageal atresia and the patient's own esophagus is the best. A more aggressive approach should be applied to gastroesophageal reflux in these patients.

Primary hepatic tumours in children: a 26-year review

Twenty-one children were admitted to a single paediatric institution between 1964-1990 with histologically proven primary liver tumours. The diagnosis was hepatoblastoma (HBL) in 15 patients, hepatocellular carcinoma (HCA) in 2, rhabdomyosarcoma (RMS) in 2, non-Hodgkin's lymphoma (NHL) in 1, and haemangioendothelioma (HE) in 1. The common presenting clinical features were anaemia, abdominal mass, and abdominal pain. Serum alpha-foetoprotein was useful in establishing a diagnosis in HBL and in monitoring disease activity. Computed tomographic (CT) scan, ultrasound, and angiography were useful preoperative investigations for assessing site and resectability of tumour. There were no survivors in patients with malignant hepatic tumours (n = 10) who had surgery alone prior to 1981. Of 7 patients with HBL diagnosed after 1981 who had adequate surgical resection and chemotherapy, 5(72%) are currently alive and disease free between 15 months and 8 years from diagnosis. We conclude that adequate surgical resection and adjuvant chemotherapy can improve disease free survival for children with HBL. Optimal treatment has yet to be devised for other malignant hepatic tumours.

Generalized elastosis perforans serpiginosa in Down's syndrome

Elastosis perforans serpiginosa is a rare disorder of epidermal perforation characterized by the extrusion of dermal elastic tissue through the epidermis. Its aetiology is unknown, but there is histological and biochemical evidence of an abnormality of elastic tissue. Three forms of elastosis perforans serpiginosa exist. It may be either idiopathic, iatrogenic, or, in approximately one quarter of cases, associated with certain genetically determined disorders of connective tissue. Cutaneous lesions appear between the ages of 6 and 20 years, and persist for 6 months to 5 years. They may be confined to one anatomic area, or less frequently are disseminated. We review the case of a 28-year-old woman with recent onset of unusually extensive elastosis perforans serpiginosa with co-existing Down's syndrome and (secondary) sclerosing cholangitis.

Congenital diaphragmatic hernia in the newborn. Outcome in 59 consecutive cases over a ten year period (1980-1989)

A ten year review (1980-1989) of 59 neonates presenting with congenital diaphragmatic hernia (CDH) to Our Lady's Hospital for Sick Children, the main referral centre for neonatal surgery in Ireland, is presented to determine the outcome and make suggestions for improvements. CDH was more common in males (34M, 25F). The hernia was present on the left side in 47 cases and 11 cases were right sided. Overall mortality was 35.6%, with increased mortality for right-sided hernia (54.5%). Mean gestation period for survivors was 39 weeks and for non-survivors was 36 weeks. Fifty-two (88.1%) patients presented with symptoms within first six hours after birth. Nineteen of 59 patients (32%) did not have their airways secured with an endotracheal tube at the time of arrival in the hospital. Recurrent chest infections and gastro-oesophageal reflux were the most common long term complications. The prognosis was better for late presenters. A period of prolonged ventilatory stabilisation with appropriate inotropic support to help correct acidosis before surgery improved results. Surgery should be postponed until ventilatory stabilisation is established. A protocol for safe transport of patients to the referral centre is recommended. It is advisable that all patients with congenital diaphragmatic hernia be intubated as soon as the diagnosis is made and that a doctor accustomed to airway management accompanies the patient to the neonatal surgical centre.

Polytef paste injection of refluxing duplex ureters

Thirty-four children with 35 refluxing duplex ureters were treated by the endoscopic injection of polytetrafluoroethylene paste. Of the 32 patients followed, 21 ceased refluxing, 3 were unchanged and 7 had a significant reduction in the grade of reflux. One patient developed a ureteric obstruction. Concurrently, contralateral single system reflux was resolved in the 8 patients in whom it was present.

Influence of prior orchiopexy on stage and prognosis of testicular cancer

Thirty-four cryptorchid testis cancer cases were studied, of whom 9 patients had prior orchiopexy at the time of cancer diagnosis. Disease stage in this group was: stage I = 4, stage II = 1 and stages III and IV = 4 cases. Seventy-eight percent of these cases (n = 7) had non-seminomas; 4 of these patients died. In the uncorrected cryptorchidism group (n = 25), disease stage was: stage I = 12, stage II = 9 and stages III and IV = 4 cases. Of these cases, 64% (n = 16) had seminomas and 6 patients died. Orchiopexy marginally reduced the symptomatic interval for subsequent cancer and probably decreased the risk of seminoma development. Orchiopexy did not lead to a more favourable disease presentation or prognosis because of the adverse bias of advanced-stage non-seminomas in this group.

Semen analysis in patients operated on for impalpable testes

Semen analysis was performed on 48 men who had undergone orchiopexy, 40 for unilateral impalpable testes and 8 for bilateral impalpable testes. Patients with unilateral impalpable testes had varying sperm analysis; 18 (86%) of the 23 patients with unilateral impalpable canalicular testes had normal sperm analysis. All patients with bilateral impalpable testes were azoospermic. The subsequent quality of the semen is dependent upon the original anatomical positions of the undescended testes.

Do statistics lie? Suicide in Kildare--and in Ireland

This study, reporting a ten-year investigation of suicide in Kildare, found that the suicide rate based on clinical assessment of coroner's records was very close to the Central Statistics Office (CSO) figure for Kildare and for Ireland as a whole for the same period. Dublin data for 1977-1981 confirmed these findings. Since in the 1960s similar clinical assessment concluded that CSO rates underestimated suicide by a factor of two or over, we believe that changes in CSO coding procedures whereby more deaths are now coded to suicide than was the case in the past have resulted in current CSO data reflecting accurately the rate of clinical suicide. There has been more than a three-fold increase in CSO suicide rates in Ireland between 1968 and 1987. Even allowing for improved CSO practices there still remains a considerable excess of suicide deaths which indicates a doubling of 'real' suicide in Ireland over these twenty years.

Management of urinary tract infection and vesicoureteric reflux in children. 2. The case for surgery

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Kerion--clinical spectrum in nine cases

The clinical features, microbiology and outcome of nine cases of kerion are reviewed. The aetiology of this uncommon condition, and the role of various therapeutic modalities are discussed. Clinicians need to be aware of the varying presentations of inflammatory fungal disease to avoid misdiagnosis as bacterial infection.

A 40-year multinational retrospective study of 880 Swenson procedures

This report reviews the experience of pediatric surgeons in seven cities in North American and Western Europe where the Swenson procedure was performed on 880 patients. Information on the diagnosis, treatment, complications, and long-term results was collected by reviewing the hospital records, the treating physicians' office records, and by interviewing the patients in person or by telephone. A follow-up evaluation was obtained on 814 patients. The patients' ages at the time of the resection ranged from four days to 50 years. The length of follow-up averaged 10.3 years, while the longest follow-up was 39.5 years. The overall postoperative mortality was 2.4% during the entire 40 years of the study. The postoperative mortality has decreased to 1.25% for the last 20 years. Significant factors influencing postoperative mortality included Down's syndrome, the patient's age at the time of the operation, and leak of the distal colonic anastomosis. Most of the patients followed for over 5 years have normal bowel habits, report one to three bowel movements per day, and have no soiling. No patient has urinary incontinence or impotence.

The Swenson operation in the treatment of Hirschsprung's disease

A review of the clinical features, postoperative course and long-term follow up of a series of 40 patients having a Swenson pull-through procedure for Hirschsprung's disease is presented. The immediate postoperative recovery and long term bowel function was generally satisfactory and compared well with other operations used in this condition. Most of the residual problems with regard to functional outcome were in the younger age group who would be expected to gain more control with time. The provision of a covering colostomy in the post operative period, improvements in chemotherapeutics and in the intensive care management of these patients in recent years are discussed with regard to the avoidance of septic complications and mortality related to the operation.

Current management of bladder exstrophy: a BAPS collective review from eight centres of 81 patients born between 1975 and 1985

The British Association of Paediatric Surgeons (BAPS) agreed to collect information on bladder exstrophy from its members. Data were obtained on 81 patients from eight centres. Twenty-one patients had other congenital abnormalities. Three died within the first year of life, and one was lost to follow-up in the early neonatal period--leaving 77 for further analysis. Forty patients had bladder closure without permanent urinary diversion. Ten were able to stay dry for two hours or longer, and 16 were constantly wet. Of the remaining 14, some were too young to assess, while others were dry for from 30 minutes to two hours. Thirty-seven had undergone diversions; fourteen had ureterosigmoidostomy, nine underwent ileal loop conduit, nine had colon loop conduit, and five had cutaneous ureterostomy. Seventeen of these diversions had been carried out before the patients were 2 years of age.

Surgery for neonatal necrotising enterocolitis in Ireland 1980-1985

Forty-seven infants were operated on for necrotising enterocolitis (NEC) in Ireland in a 6-year-period from 1980 to 1985. Incidence for surgical NEC in Ireland is 1/8733 live births. 44/47 patients were operated on during the acute phase and 3 patients had elective resection of strictures following conservative management. Indication for surgery in the acute phase was pneumoperitoneum in 37 infants. The initial procedure was: drainage alone in 10 patients, laparotomy and defunctioning enterostomy in 18, resection of the necrotic segment and proximal enterostomy in 15. 27/44 acute patients survived giving an overall mortality of 38.6% for acute NEC but mortality directly related to NEC was 31.8%. There was an inverse relationship between mortality and age at surgery. Medical treatment included total parenteral nutrition (TPN) in all patients for a mean time of 20.5 days.

Semen analysis of patients who had orchidopexy at or after seven years of age

Semen analysis was performed in 142 men who had undergone orchidopexy at age 7-13 1/2 years, 119 for unilateral cryptorchidism and 23 for bilateral cryptorchidism. Fertility potential was related to the original position of the testes: most men who had had unilateral cryptorchidism or bilateral undescended testes in the superficial inguinal pouch produced normal or acceptable semen, whereas those who had had bilateral canalicular or abdominal testes were azoospermic.

Technical refinements in endoscopic correction of vesicoureteral reflux

Subureteral polytetrafluoroethylene (Teflon) injection (the Sting) was used for endoscopic correction of vesicoureteral reflux in more than 400 patients since March 1984. The basic principle involves injection of 0.2 to 0.8 ml. of polytetrafluoroethylene paste the intravesical portion of the affected ureter. The refinements of the technique and the various types of equipment used are described. A protocol for followup is outlined.

Endoscopic correction of grades IV and V primary vesicoureteric reflux: six to 30 month follow-up in 42 ureters

Between March 1984 and March 1986, 31 children with 42 ureters with grades IV and V primary vesicoureteric reflux were treated by endoscopic subureteric injection of Polytef paste. Reflux ceased after a single injection in 28 ureters, after the second in six, after the third in three and after the fourth injection in one. Two ureters showed improvement to grade II reflux after two injections and no further treatment was given. Two ureters showed no change in grade of reflux after three and four injections, respectively. Twenty-seven children with successfully treated ureters have now been followed up for periods ranging from 6 to 30 months. All 38 ureters had a negative micturating cystogram following endoscopic correction. At follow-up there was no reflux in 32 (84%) ureters and recurrence in six (16%). The procedure is simple to perform and without significant complications. The follow-up results show that the endoscopic treatment is reliable and effective in correcting higher grades of vesicoureteric reflux.