Clival Paraganglioma, Case Report and Literature Review

Paragangliomas are rare tumors that may present with cranial neuropathies when located along the skull base. Supratentorial paragangliomas are less likely to secrete catecholamines but should be worked up, nonetheless. We highlight a case of a female in her fourth decade found to have a petroclival lesion following initial presentation that included one month of tooth pain, dysphagia, diplopia, hoarseness and right hemifacial hypoesthesia. Magnetic resonance imaging of the brain demonstrated a T2 hyperintense lesion favored to be a petroclival meningioma. Pre-operative angiography demonstrated a hypervascular tumor. She underwent a combined presigmoid craniotomy with posterior petrosectomy performed by both neurosurgery and neuro-otology. Pathology demonstrated paraganglioma. She had small volume residual tumor and is planned for continued outpatient radiotherapy. Paragangliomas should be on the differential for skull base lesions. Management paradigm involves multidisciplinary care and a combination of surgical resection and post-operative radiation. In this paper, we discuss underlying pathophysiology as well as appropriate workup and management.

Pan-cancer analysis of whole genomes

Cancer is driven by genetic change, and the advent of massively parallel sequencing has enabled systematic documentation of this variation at the whole-genome scale1-3. Here we report the integrative analysis of 2,658 whole-cancer genomes and their matching normal tissues across 38 tumour types from the Pan-Cancer Analysis of Whole Genomes (PCAWG) Consortium of the International Cancer Genome Consortium (ICGC) and The Cancer Genome Atlas (TCGA). We describe the generation of the PCAWG resource, facilitated by international data sharing using compute clouds. On average, cancer genomes contained 4-5 driver mutations when combining coding and non-coding genomic elements; however, in around 5% of cases no drivers were identified, suggesting that cancer driver discovery is not yet complete. Chromothripsis, in which many clustered structural variants arise in a single catastrophic event, is frequently an early event in tumour evolution; in acral melanoma, for example, these events precede most somatic point mutations and affect several cancer-associated genes simultaneously. Cancers with abnormal telomere maintenance often originate from tissues with low replicative activity and show several mechanisms of preventing telomere attrition to critical levels. Common and rare germline variants affect patterns of somatic mutation, including point mutations, structural variants and somatic retrotransposition. A collection of papers from the PCAWG Consortium describes non-coding mutations that drive cancer beyond those in the TERT promoter4; identifies new signatures of mutational processes that cause base substitutions, small insertions and deletions and structural variation5,6; analyses timings and patterns of tumour evolution7; describes the diverse transcriptional consequences of somatic mutation on splicing, expression levels, fusion genes and promoter activity8,9; and evaluates a range of more-specialized features of cancer genomes8,10-18.

Comprehensive, Integrative Genomic Analysis of Diffuse Lower-Grade Gliomas

BACKGROUND

Diffuse low-grade and intermediate-grade gliomas (which together make up the lower-grade gliomas, World Health Organization grades II and III) have highly variable clinical behavior that is not adequately predicted on the basis of histologic class. Some are indolent; others quickly progress to glioblastoma. The uncertainty is compounded by interobserver variability in histologic diagnosis. Mutations in IDH, TP53, and ATRX and codeletion of chromosome arms 1p and 19q (1p/19q codeletion) have been implicated as clinically relevant markers of lower-grade gliomas.

METHODS

We performed genomewide analyses of 293 lower-grade gliomas from adults, incorporating exome sequence, DNA copy number, DNA methylation, messenger RNA expression, microRNA expression, and targeted protein expression. These data were integrated and tested for correlation with clinical outcomes.

RESULTS

Unsupervised clustering of mutations and data from RNA, DNA-copy-number, and DNA-methylation platforms uncovered concordant classification of three robust, nonoverlapping, prognostically significant subtypes of lower-grade glioma that were captured more accurately by IDH, 1p/19q, and TP53 status than by histologic class. Patients who had lower-grade gliomas with an IDH mutation and 1p/19q codeletion had the most favorable clinical outcomes. Their gliomas harbored mutations in CIC, FUBP1, NOTCH1, and the TERT promoter. Nearly all lower-grade gliomas with IDH mutations and no 1p/19q codeletion had mutations in TP53 (94%) and ATRX inactivation (86%). The large majority of lower-grade gliomas without an IDH mutation had genomic aberrations and clinical behavior strikingly similar to those found in primary glioblastoma.

CONCLUSIONS

The integration of genomewide data from multiple platforms delineated three molecular classes of lower-grade gliomas that were more concordant with IDH, 1p/19q, and TP53 status than with histologic class. Lower-grade gliomas with an IDH mutation either had 1p/19q codeletion or carried a TP53 mutation. Most lower-grade gliomas without an IDH mutation were molecularly and clinically similar to glioblastoma. (Funded by the National Institutes of Health.).

The somatic genomic landscape of glioblastoma

We describe the landscape of somatic genomic alterations based on multidimensional and comprehensive characterization of more than 500 glioblastoma tumors (GBMs). We identify several novel mutated genes as well as complex rearrangements of signature receptors, including EGFR and PDGFRA. TERT promoter mutations are shown to correlate with elevated mRNA expression, supporting a role in telomerase reactivation. Correlative analyses confirm that the survival advantage of the proneural subtype is conferred by the G-CIMP phenotype, and MGMT DNA methylation may be a predictive biomarker for treatment response only in classical subtype GBM. Integrative analysis of genomic and proteomic profiles challenges the notion of therapeutic inhibition of a pathway as an alternative to inhibition of the target itself. These data will facilitate the discovery of therapeutic and diagnostic target candidates, the validation of research and clinical observations and the generation of unanticipated hypotheses that can advance our molecular understanding of this lethal cancer.

The accuracy of predicting survival in individual patients with cancer

OBJECT

Estimating survival time in cancer patients is crucial for clinicians, patients, families, and payers. To provide appropriate and cost-effective care, various data sources are used to provide rational, reliable, and reproducible estimates. The accuracy of such estimates is unknown.

METHODS

The authors prospectively estimated survival in 150 consecutive cancer patients (median age 62 years) with brain metastases undergoing radiosurgery. They recorded cancer type, number of brain metastases, neurological presentation, extracranial disease status, Karnofsky Performance Scale score, Recursive Partitioning Analysis class, prior whole-brain radiotherapy, and synchronous or metachronous presentation. Finally, the authors asked 18 medical, radiation, or surgical oncologists to predict survival from the time of treatment.

RESULTS

The actual median patient survival was 10.3 months (95% CI 6.4-14). The median physician-predicted survival was 9.7 months (neurosurgeons = 11.8 months, radiation oncologists = 11.0 months, and medical oncologist = 7.2 months). For patients who died before 10 months, both neurosurgeons and radiation oncologists generally predicted survivals that were more optimistic and medical oncologists that were less so, although no group could accurately predict survivors alive at 14 months. All physicians had individual patient survival predictions that were incorrect by as much as 12-18 months, and 14 of 18 physicians had individual predictions that were in error by more than 18 months. Of the 2700 predictions, 1226 (45%) were off by more than 6 months and 488 (18%) were off by more than 12 months.

CONCLUSIONS

Although crucial, predicting the survival of cancer patients is difficult. In this study all physicians were unable to accurately predict longer-term survivors. Despite valuable clinical data and predictive scoring techniques, brain and systemic management often led to patient survivals well beyond estimated survivals.

Residency training at a crossroads: duty-hour standards 2010

In 2003, the Accreditation Council for Graduate Medical Education (ACGME) implemented a single duty-hour standard nationwide. The evidence to date suggests that this neither improved nor worsened patient outcomes. In June 2010, the ACGME proposed a new set of duty-hour standards for implementation in July 2011. The main disadvantage of this approach is that there is no ability to determine whether different standards would have worked better to reduce resident fatigue while improving patient safety. Many unanswered questions remain about how to design duty-hour standards, but relatively little evidence exists. In addition, the same approach may not work in all specialties and all hospitals. A more flexible, dynamic policy that emphasizes ongoing testing and evaluation would be more likely to achieve improvements in clinical and educational outcomes.

Residency training at a crossroads: duty-hour standards 2010

In 2003, the Accreditation Council for Graduate Medical Education (ACGME) implemented a single duty-hour standard nationwide. The evidence to date suggests that this neither improved nor worsened patient outcomes. In June 2010, the ACGME proposed a new set of duty-hour standards for implementation in July 2011. The main disadvantage of this approach is that there is no ability to determine whether different standards would have worked better to reduce resident fatigue while improving patient safety. Many unanswered questions remain about how to design duty-hour standards, but relatively little evidence exists. In addition, the same approach may not work in all specialties and all hospitals. A more flexible, dynamic policy that emphasizes ongoing testing and evaluation would be more likely to achieve improvements in clinical and educational outcomes.

One whisker whisking: unit recording during conditioned whisking in rats

Understanding of the functional neurobiology of the rodent whisker system would be advanced by neurobehavioral studies in awake, behaving animals that combine unit recording from structures at various levels of the system with quantitative characterization of the kinematics and temporal organization of whisking. Such studies require the solution of a number of methodological problems. These include: chronic recording procedures ensuring unit isolation, stability and maximum yield, monitoring and display of unit activity and whisker movements within the same (ms) timeframe and behavioral paradigms which bring whisking movement parameters under the control of the experimenter rather than the rat. Here we describe a head-fixed rodent preparation which makes possible chronic recording of unit activity in the awake, whisking rat, combined with real-time, high resolution monitoring of whisker and pad movements in two dimensions and under behavioral control. While the head-fixed "whisking" preparation has some inherent limitations, it may be used to address a number of important neurobehavioral problems. We suggest that it should contribute significantly to understanding the functional neurobiology of the whisker system.

Topography of whisking II: Interaction of whisker and pad

The peripheral effector system mediating rodent whisking produces protraction/retraction movements of the whiskers and translation movements of the collagenous mystacial pad. To examine the interaction of these movements during whisking in air we used high-resolution, optoelectronic methods for two-dimensional monitoring of whisker and pad movements in head-fixed rats. Under these testing conditions (1) whisker movements on the same side of the face are synchronous and of similar amplitude; (2) pad movements exhibit the characteristic 'exploratory' rhythm (6-12 Hz) of whisking but their movements often have a low frequency (1-2 Hz) component; (3) Pad movements occur in both antero-posterior and dorso-ventral planes but there are considerable variations in the amplitude and topography of movement parameters in the two planes. We conclude that (a) both whisker and pad receive input from a common central rhythm generator; (b) differences in whisker and pad amplitude and topography probably reflect differences in the biomechanical properties of the structures receiving that input; (c) pad movements make a significant contribution to the kinematics of whisking behavior and (d) the two-dimensional nature of pad translation movements significantly increases the rat's flexible control of its mobile sensor.

Trilogy Image-Guided Stereotactic Radiosurgery

Full integration of advanced imaging, noninvasive immobilization, positioning, and motion-management methods into radiosurgery have resulted in fundamental changes in therapeutic strategies and approaches that are leading us to the treatment room of the future. With the introduction of image-guided radiosurgery (IGRS) systems, such as Trilogy, physicians have for the first time a practical means of routinely identifying and treating very small lesions throughout the body. Using new imaging processes such as positron emission tomography/computed tomography (PET/CT) scans, clinics may be able to detect these lesions and then eradicate them with image-guided stereotactic radiosurgery treatments. Thus, there is promise that cancer could be turned into a chronic disease, managed through a series of checkups, and Trilogy treatments when metastatic lesions reappear.

Self-Awareness of Deficits in Parkinson Disease

Anosognosia is an unawareness or denial of deficits. While it has mainly been associated with damage to cortical brain regions, anosognosia has also been reported in patients with subcortical brain disease. The present study investigated whether anosognosia is a feature of Parkinson disease. Forty-eight Parkinson disease patients with predominantly left- (N = 16) or right-sided (N = 32) motor symptoms who eventually underwent right or left pallidotomies, and 48 individuals identified as caregivers completed questionnaires rating severity of PD. There was no discrepancy in report between patients and caregivers as a function of pallidotomy side. However, as a group, patients rated themselves as significantly less impaired on 2 measures of activities of daily living, indicating that basal ganglia dysfunction may alter insight into severity of illness. Patients and caregivers in the left-symptom PD group differed significantly on selected measures of functional independence. This suggests the potential interaction of laterality and handedness. The importance of future investigations in PD patients with more severe cognitive impairment is stressed.

Mental object rotation in Parkinson's disease

Deficits in visual-spatial ability can be associated with Parkinson's disease (PD), and there are several possible reasons for these deficits. Dysfunction in frontal-striatal and/or frontal-parietal systems, associated with dopamine deficiency, might disrupt cognitive processes either supporting (e.g., working memory) or subserving visual-spatial computations. The goal of this study was to assess visual-spatial orientation ability in individuals with PD using the Mental Rotations Test (MRT), along with other measures of cognitive function. Non-demented men with PD were significantly less accurate on this test than matched control men. In contrast, women with PD performed similarly to matched control women, but both groups of women did not perform much better than chance. Further, mental rotation accuracy in men correlated with their executive skills involving mental processing and psychomotor speed. In women with PD, however, mental rotation accuracy correlated negatively with verbal memory, indicating that higher mental rotation performance was associated with lower ability in verbal memory. These results indicate that PD is associated with visual-spatial orientation deficits in men. Women with PD and control women both performed poorly on the MRT, possibly reflecting a floor effect. Although men and women with PD appear to engage different cognitive processes in this task, the reason for the sex difference remains to be elucidated.

Comparison of filter bag, cyclonic, and wet dust collection methods in vacuum cleaners

In this study, methods were developed for comparative evaluation of three primary dust collection methods employed in vacuum cleaners: filter bag, cyclonic, and wet primary dust collection. The dry collectors were evaluated with KCl test aerosols that are commonly used in filter testing. However, these aerosols cannot be used for evaluating wet collectors due to their hygroscopicity. Therefore, the wet collectors were evaluated with nonhygroscopic test particles. Both types of test aerosol indicated similar collection efficiencies in tests with dry collectors. The data show that high initial collection efficiency can be achieved by any one of the three dust collection methods: up to 50% for 0.35 microm particles, and close to 100% for 1.0 microm and larger particles. The degree of dependence of the initial collection efficiency on airflow rate was strongly related to the type and manufacturing of the primary dust collector. Collection efficiency decreased most with decreasing flow rate for the tested wet collectors. The tested cyclonic and wet collectors showed high reentrainment of already collected dust particles. After the filter bag collectors had been loaded with test dust, they also reemitted particles. The degree of reentrainment from filter bags depends on the particulate load and the type of filter material used. Thus, the overall particle emissions performance of a vacuum cleaner depends not only on the dust collection efficiency of the primary collector and other filtration elements employed, but also on the degree of reentrainment of already collected particles.

Particle emission characteristics of filter-equipped vacuum cleaners

Industrial vacuum cleaners with final high-efficiency particulate air (HEPA) filters traditionally have been used for cleanup operations in which all of the nozzle-entrained dust must be collected with high efficiency, for example, after lead-based paint abatement in homes. In this study household vacuum cleaners ranging from $70 to $650 and an industrial vacuum cleaner costing more than $1400 were evaluated relative to their collection efficiency immediately after installing new primary dust collectors in them. Using newly developed testing technology, some of the low-cost household vacuum cleaners equipped with a final HEPA filter were found to have initial overall filtration efficiencies comparable to those of industrial vacuum cleaners equipped with a final HEPA filter. The household vacuum cleaners equipped with a final HEPA filter efficiently collect about 100% of the dry dust entrained by the nozzle. For extensive cleaning efforts and for vacuum cleaning of wet surfaces, however, industrial vacuum cleaners may have an advantage, including ruggedness and greater loading capacity. The methods and findings of this study are applicable to field evaluations of vacuum cleaners.

Test methods for evaluating the filtration and particulate emission characteristics of vacuum cleaners

The overall filtration efficiency of a vacuum cleaner traditionally has been tested by placing the vacuum cleaner in a test chamber and measuring aerosol concentrations at the chamber inlet and outlet. The chamber test method was refined and validated in this study. However, this chamber test method shows an overall filtration efficiency of close to 100% for most of the industrial vacuum cleaners and for most of the newly developed household vacuum cleaners of midprice range or higher because all these vacuum cleaners have a high-efficiency particulate air (HEPA) or other highly efficient filter installed at the exhaust. A new test method was therefore developed through which the vacuum cleaner was probed in various internal locations so that the collection efficiency of the individual components could be determined. For example, the aerosol concentration upstream of the final HEPA filter can thus be measured, which permits one to estimate the life expectancy of this expensive component. The probed testing method is particularly suitable for field evaluations of vacuum cleaners because it uses compact, battery-operated optical particle size spectrometers with internal data storage. Both chamber and probed tests gave the same results for the aerosol filtration efficiency. The probed testing method, however, also gives information on the performance of the individual components in a vacuum cleaner. It also can be used to determine the dust pickup efficiency and the degree of reaerosolization of particles collected in the vacuum cleaner.

Changes in vocal intensity in Parkinson's disease following pallidotomy surgery

The present study was designed to examine changes in vocal intensity following unilateral posteroventral pallidotomy (PVP) in a large sample of speakers with Parkinson's disease (PD) that exhibited a range of hypokinetic dysarthria. Twenty-five persons with PD were recorded using a variety of speech tasks, once prior to and once following PVP. The pre-PVP vocal SPL was subtracted from the post-PVP vocal SPL to derive a relative change in vocal SPL. Mildly dysarthric participants had significantly greater relative increases in vocal SPL following PVP than either moderately or severely dysarthric participants who had reduced vocal SPL following PVP. If future results follow those observed in the present data, mildly dysarthric Parkinson's patients may benefit most from unilateral PVP perhaps due to less overall destruction of the basal ganglia sensorimotor control circuits involved in oral facial functions, thus increasing the chances to observe improvements postsurgery.

Particle settling after lead-based paint abatement work and clearance waiting period

This study investigated the evolution of airborne particle concentration and size distribution following abatement work in a controlled environment utilizing direct real-time particle monitoring and used it to project potential lead loadings as those particles settle. An 860 ft3 environmental test chamber with sophisticated ventilation and air purifying systems was built. Wooden doors with lead-based paint were dry sanded or scraped to generate the highest feasible airborne lead concentrations. Size-fractional airborne particle concentrations decreased exponentially with time in all tests, even with no air exchange, consistent with the stirred model of constantly mixed air, which predicts longer settling than for tranquil settling. Very low levels of air mixing generated by temperature gradients and initial room air turbulence affected particle settling. About 90% of airborne lead mass settled within 1 hour after active abatement, before final cleaning began. During the second waiting period of 1 hour, which followed cleaning of the floor, additional dust settled so that the additional potential lead loading from remaining airborne lead was less than 20 microg/ft2. For this worst case scenario, the underestimate of the lead loading done by the clearance sampling did not exceed about 30%. For more realistic conditions, the underestimates are projected to be much lower than the new 40 microg/ft2 Housing and Urban Development (HUD) clearance standards for floor dust lead. These results were obtained for the first waiting period (between the end of active abatement and the beginning of cleaning) of 1 hour, as recommended by HUD guidelines. Thus, this study demonstrates no need to increase either the first or second waiting period.

Release of lead-containing particles from a wall enclosure

The 1995 Department of Housing and Urban Development (HUD) Guidelines for the Evaluation and Control of Lead-Based Paint Hazards in Housing discusses using interior and exterior wall enclosures for lead hazard control. Leaded dust may be aerosolized inside enclosures and released through gaps and cracks into a room. The effects of airflow and mechanical disturbances on dust release were studied using a laboratory wall enclosure model with dust collected from homes with lead-based paint hazards. Airflows relevant to residences were blown down the enclosure and out a 4-, 6-, or 8-mm horizontal gap at its bottom, simulating potential enclosure failure. Then, low-frequency mechanical vibrations also were applied to the enclosure. No significant dust release was found when blowing air down the enclosure even at 37 cm/sec (representing extremely high flow); release occurred only with this high flow and 3 Hz mechanical disturbances. Dust was released primarily from the floor area immediately adjacent to the enclosure gap; the release rate fluctuated over time. Most dust initially settled near the enclosure. Dust release for 1 hour at extreme conditions (high airflow with vibration) yields lead loading above the 1995 HUD clearance level of 100 microg/ft2 only within 3-4 cm of the wall; for the HUD standard (1 ft2) sampling area, the lead loading does not exceed 30 microg/ ft2. Redistributing dust over the room's 16 m2 floor space yields average extreme-condition loading rate of 2 microg/ft2/hour. At less-than-extreme conditions, dust would have to be released for years without cleaning to yield a hazard.

Cognitive and vestibulo-proprioceptive components of spatial ability in Parkinson's disease

Visual-spatial deficits are often associated with Parkinson's Disease (PD). Recent theories suggest that frontal-basal ganglionic dysfunction affects cognition in PD. Although this hypothesis does not entirely explain spatial deficits in PD, the inappropriate utilization of cues associated with executive dysfunction may induce spatial deficits. Alternatively, the vestibular system is also involved in spatial cognition, and vestibular dysfunction may affect visual-spatial ability in PD. To test these hypotheses, we administered the Water Jar Test, while perturbing vestibulo-proprioceptive input. Non-demented PD patients were significantly less accurate than controls in judging horizontal, and appeared to inappropriately utilize cues. No group effect was found for head tilt. These findings suggest the visual-spatial difficulties seen in PD are related to executive dysfunction that is associated with a disruption of the frontal-basal ganglionic and frontal-parietal systems.

Voice and speech characteristics of persons with Parkinson's disease pre- and post-pallidotomy surgery: preliminary findings

Pallidotomy surgery, lesioning the globus pallidus internal, has been performed to alleviate Parkinsonian symptoms and drug-induced dyskinesias. Improvements in limb motor function have been reported in recent years following pallidotomy surgery. The purpose of this preliminary study was to determine the effect of pallidotomy surgery on select voice and speech characteristics of 6 patients with Parkinson's disease. Acoustic measures were analyzed pre-pallidotomy surgery and again at 3 months following surgery. Preliminary findings indicated that all participants demonstrated positive changes in at least one acoustic measure; 2 of the participants consistently demonstrated positive changes in phonatory and articulatory measures, whereas 3 participants did not consistently demonstrate positive changes postsurgery. The results are discussed relative to the differential effects observed across participants.

Rapid accurate entry of microbiology results

OBJECTIVE

To develop techniques to improve efficiency and accuracy of data entry in microbiology, using a commercially available laboratory information system that is keystroke-intensive.

DESIGN

A combination of technologies, including bar-coded phrase sheets, keyboard macros, and bar-coded specimen labels, are used to automate the entry of commonly used keystroke sequences and combinations of culture findings.

SETTING

An acute care hospital laboratory.

PARTICIPANTS

Laboratory technologists.

OUTCOME MEASURES

Feasibility, report error rates, and technologist time.

RESULTS

Qualitative: implementation of all three technologies proved feasible and practical. Quantitative: a 25-fold decrease in misreported cultures, as well as a 50% saving in reading time for new urine cultures.

CONCLUSIONS

This set of technologies for keystroke reduction would be of general applicability to laboratories with a variety of different laboratory information systems.

Impulses and resting membrane properties of small cultured rat hippocampal neurons

1. The impulses and resting membrane parameters of small (soma diameter less than 10 microM) cultured hippocampal neurons from rat embryos were studied with the tight-seal whole-cell recording technique. 2. Mean resting potential was -47 mV, mean input resistance 3.3 G omega, mean capacitance 11 pF, and mean time constant 33 ms. 3. Rectangular suprathreshold current steps elicited regenerative potential responses. The amplitude and time course of the responses were clearly stimulus dependent: stronger current steps caused impulses of larger amplitude. 4. The current threshold was very low: rheobase current was less than 15 pA. 5. The potential response depended on the preceding holding potential, responses from more negative potentials showing sharper peaks than those from more positive potentials. 6. Spontaneous impulses with pre-potentials similar to synaptically induced events were recorded from several cells. The amplitude of the spontaneous impulses varied similarly to that of the stimulus-induced responses.

[Value of radioimmunoscintigraphy compared to computed tomography in the diagnosis and follow-up of primary ovarian carcinoma]

In this prospective study the diagnostic merit of radioimmunoscintigraphy (RIS) was compared with computed tomography (CT) and operation in the primary diagnostic procedure and follow-up of women with suspected ovarian cancer. In primary diagnosis, sensitivity, specificity, and diagnostic accuracy was 100%, 60% and 90% for RIS. In follow-up, sensitivity for local recurrence was slightly higher in CT than in RIS. It was possible to detect peritoneal carcinosis in the pelvis and lower abdominal region better with RIS, but in the upper abdominal region, peritoneal carcinosis was detected better with CT. If no differentiation between benign or malignant lesion, is possible with CT, differentiation will in many cases be possible with RIS.

Electrophysiological evaluation of the patient with acute spinal cord injury

This article reviews basic principles, equipment and techniques, and clinical applications of electrophysiologic monitoring in patients with spinal cord injuries. Four groups of electrophysiologic measurements are considered: Somatosensory evoked potentials (SEPs); motor evoked potentials (MEPs); electromyography (EMG) and nerve conduction studies; and late responses, including H reflex, M response, and F wave. Reports of SEP recordings in spinal cord injury, as drawn from the literature, are tabulated in detail.

[Immunohistochemical localization of pregnancy-specific beta 1-globulin in placentas at various ages]

In the study reported here the dispersion of pregnancy-specific beta 1-globulin (SP1) in placentas from the 6th to the 40th week of pregnancy was determined by means of the peroxidase-anti-peroxidase method; cytophotometric quantification of the stain reaction was also carried out. SP1 was only identified in syncytiotrophoblasts. Cytotrophoblasts, villous stroma and vascular endothelia were free of SP1. Within the syncytiotrophoblast SP1 was found in particularly large quantities in proliferation buds. Weaker reactions were obtained in the following order for: nucleated villous epithelium, non-nucleated epithelial squama, including the syncytiocapillary membranes, epithelial nodules with nuclear pyknosis and regressively changed villous epithelium associated with stromal fibrosis. Spectrophotometry of the extinction at the wave-length of the DAB-peroxidase product revealed, in relation to the age of the placenta, a relatively uniform intensity of reaction during the entire duration of pregnancy, with only a moderate rise up to the 24th week and a slight decrease until term.

Release of luteinizing hormone in prepubertal and middle-aged ovariectomized rats

Concentrations of circulating LH were determined in conscious, free-moving ovariectomized rats. All of the animals had been ovariectomized at 24 days of age. Between 30 and 90 days there was an increase in mean blood LH concentrations; a more vigorous pulsatile release of LH characterized by an increase in amplitude and frequency of LH release; and an elevated responsiveness to LHRH administration. Rats which had been ovariectomized for 1 year still had elevated blood LH levels but had episodic pulses of reduced amplitude and a decrease in responsiveness to LHRH. These data suggest that important alterations occur with age in the neuroendocrine mechanisms responsible for the release of LH.

Management of premature infants with patent ductus arteriosus

Images

Posterior compartment syndrome of the thigh with a sciatic palsy

✓ The authors describe a posterior compartment syndrome of the thigh and sciatic nerve palsy following a traumatic hematoma, and discuss its treatment.