Central adrenal insufficiency following traumatic brain injury: a missed diagnosis in the critically injured.

Background: High-dose steroid administration is no longer recommended in the treatment of acute traumatic brain injury (TBI) as it failed to prove beneficial in improving patients' outcome. However, a masked benefit of steroid administration in TBI management was that it provided corticosteroid replacement therapy in patients with TBI-related central adrenal insufficiency.

Case Presentation: We report the case of a 12-year-old boy who suffered a severe TBI from a motor vehicle accident that resulted in complete deficiency of anterior pituitary function.

Ophthalmological outcomes of patients treated for pineal region tumors.

OBJECTIVE The ophthalmological outcomes of children treated for pineal tumors have received limited attention in the literature. METHODS This paper reviews the outcomes of 29 children treated for pineal and posterior third ventricular tumors in the contemporary era using chemotherapy, radiotherapy, and resection as defined by the histology and/or marker profile of the tumor. RESULTS At the time of diagnosis, all patients except 1 had hydrocephalus and all had ophthalmological involvement.

Radiographic Detectability of Retained Neuropatties in a Cadaver Model.

Background: Counts are the commonest method used to ensure that all sponges and neuropatties are removed from a surgical site before closure. When the count is not reconciled, plain radiographs of the operative site are taken to determine whether the missing patty has been left in the wound. The purpose of this study was to describe the detectability of commonly used neuropatties in the clinical setting using digital technologies.

Oxygen carrying microbubbles for enhanced sonodynamic therapy of hypoxic tumours.

Tumour hypoxia represents a major challenge in the effective treatment of solid cancerous tumours using conventional approaches. As oxygen is a key substrate for Photo-/Sono-dynamic Therapy (PDT/SDT), hypoxia is also problematic for the treatment of solid tumours using these techniques. The ability to deliver oxygen to the vicinity of the tumour increases its local partial pressure improving the possibility of ROS generation in PDT/SDT.

Disruption of silicone valve housing in a Codman Hakim Precision valve with integrated Siphonguard.

Authors of this report describe 2 patients who had undergone shunt insertion for hydrocephalus and who, at 6 weeks or 9 months after their last revision, presented with symptoms of shunt dysfunction and CSF collections at the valve site. At the ensuing shunt revision in both patients, the silicone housing was fractured and the Siphonguard was disconnected from the Codman Hakim Precision flat-bottom valve. The cause of these failures was not clear since manipulation, bending, and twisting of the valves were not thought to have occurred during implantation.

Delayed visual loss from optochiasmatic arachnoiditis after resection of craniopharyngioma.

Visual loss following surgery for craniopharyngioma is usually the result of operative injury or tumor recurrence. The authors present the case of a 12-year-old boy who developed progressive visual field constriction 11 years after gross-total resection of a solid and cystic craniopharyngioma. No tumor recurrence was evident on multiple MRI studies, and it was only at surgical exploration that the diagnosis of optochiasmatic arachnoiditis was established.

Integration of psychoanalytic concepts in the formulation and management of hospitalized psychiatric patients.

Although psychoanalysis and psychodynamic psychotherapy have flourished theoretically and in practice for an increasingly widespread population of patients, the mental health professions have in recent decades experienced a hegemony of managed care, a preoccupation with pharmacological approaches at the expense of psychological approaches, and a predilection for brief symptom-focused, more easily researchable manualized psychotherapies, in spite of literature demonstrating the effective contribution of psychoanalysis and psychodynamic thought to the practice of the mental health professions. In this article a psychiatric inpatient is considered from the point of view of what psychodynamic theory can offer practically to understanding and managing her. It is not suggested that this patient might necessarily benefit from formal psychodynamic psychotherapy, but rather that incorporation of a psychodynamic understanding of her can lead to a more effective management approach, especially regarding dealing with staff reactions to disturbing patients.

Enhanced vascular permeability is hypothesized to promote inflammation-induced carcinogenesis and tumor development via extravasation of large molecular proteins into the tissue.

We propose that the growth of solid tumors is dependent, in part, on the entry of large molecular blood-borne growth regulators into the tissue and is facilitated by the highly permeable nature of tumor blood vessels. There is abundant evidence that the tumor vasculature is hyperpermeable and tumor growth is dependent on mediators that increase vascular permeability (e.g.

HMC-1 human mast cells synthesize neurotensin (NT) precursor, secrete bioactive NT-like peptide(s) and express NT receptor NTS1.

Objective And Design: To determine if mast cells synthesize the inflammatory peptide, neurotensin (NT), secrete immunoreactive and bioactive NT, and express the NT receptor NTS1.

Materials: HMC-1 cells, pleural mast cells from Sprague-Dawley rats, LAD2 mast cells, and human cord blood mast cells were used.

Treatment: HMC-1 cells were stimulated with NT, C48/80, mastoparan, or PGE(2).

Endoscopic choroid plexus cauterization versus ventriculoperitoneal shunt for hydranencephaly and near hydranencephaly: a prospective study.

Objective: To prospectively evaluate the results of endoscopic choroid plexus cauterization (ECPC) and ventriculoperitoneal shunts (VPSs) in infants with hydranencephaly or near hydranencephaly.

Methods: We prospectively collected clinical data from all untreated hydranencephalic and near hydranencephalic children from October 2006 to March 2008. All patients treated were randomly divided into 2 groups, ECPC or VPS, and submitted to either endoscopic choroid plexus cauterization or ventriculoperitoneal shunt placement.

Bilateral choroid plexus hyperplasia: a case report and management strategies.

Introduction: Choroid plexus hyperplasia (CPH) is a rare cause of cerebrospinal fluid (CSF) overproduction and shunt-resistant hydrocephalus in infants. If treated with a ventriculoperitoneal (VP) shunt, these patients secondarily develop CSF accumulation along the shunt tract and within the peritoneum. The surgical management of this condition is not as clearly defined as in the case of a choroid plexus papilloma or carcinoma.

Formulating a web-based educational needs assessment questionnaire from healthcare competencies.

This paper by David Cochrane, Janette Palmer, Grace Lindsay, Elizabeth Tolmie, Douglas Allan and Kay Currie describes a project that led to the formulation of an online educational needs assessment tool by drawing on national healthcare competencies in coronary heart disease. It discusses the merits of web-based data collection and concludes that web-based survey systems offer distinct advantages providing researchers proceed with care.

Optic nerve sheath fenestration and bilateral expansile cranioplasty for raised intracranial pressure in craniometaphyseal dysplasia: a case report.

Introduction: Raised intracranial pressure (ICP) has been previously associated with craniometaphyseal dysplasia (CMD). To our knowledge, expansile cranioplasty has not previously been described as a treatment for raised ICP in this setting. We describe our evaluation and surgical management of a patient presenting with seizures, headaches, and CMD.

Nitric oxide inhibits metamorphosis in larvae of Crepidula fornicata, the slippershell snail.

This paper concerns the role of nitric oxide (NO) in controlling metamorphosis in the marine gastropod Crepidula fornicata. Metamorphosis was stimulated by the nitric oxide synthase (NOS) inhibitors AGH (aminoguanidine hemisulfate) and SMIS (S-methylisothiourea sulfate) at concentrations of about 100-1000 micromol l(-1) and 50-200 micromol l(-1), respectively. Metamorphosis was not, however, induced by the NOS inhibitor l-NAME (l-N(G)-nitroarginine methyl ester) at even the highest concentration tested, 500 micromol l(-1).

Regulation of neurotensin receptor function by the arachidonic acid-lipoxygenase pathway in prostate cancer PC3 cells.

Neurotensin (NT) elevates leukotriene levels in animals and stimulates 5-HETE formation in prostate cancer PC3 cells. PC3 cell growth is stimulated by NT and inhibited by lipoxygenase (LOX) blockers. This led us to test LOX blockers (NDGA, MK886, ETYA, Rev5901, AA861 and others) for effects on NT binding and signaling.

Insulin-like growth factor (IGF) induced proliferation of human lung fibroblasts is enhanced by neurotensin.

Fibroblasts are key cells in tissue repair and important contributors to the inflammatory response. Insulin-like growth factors (IGFs) have been shown to participate in growth, in immune responses and in tissue repair where they stimulate cell growth. Neurotensin (NT) has been suggested to participate in inflammation and in tissue repair and is an autocrine or paracrine growth factor for several cancer cell types.

Paraparesis caused by an angiolipomatous hamartoma in an adolescent with Proteus syndrome and scoliosis.

This 16-year-old boy with Proteus syndrome suffered acute spinal cord compression secondary to hemorrhage into an extradural paraspinal angiolipomatous hamartoma. A magnetic resonance (MR) imaging study performed 12 years earlier had revealed the presence of this tumor at the apex of a mild thoracic scoliosis, which had been stable during the intervening decade. Spinal cord neurological deficit in Proteus syndrome is rare.

The effect of neurotensin on insulin-induced proliferation of human fibroblasts.

Neurotensin has been shown to influence growth in a number of cancerous and non-cancerous cells and to enhance the proliferative effects of growth factors without itself inducing proliferation. Here we show that neurotensin potentiates the proliferative effects of insulin on IMR90 human fibroblasts in a concentration and neurotensin receptor type 1-dependent manner. This potentiating effect of neurotensin was blocked by inhibitors of phospholipase C and protein kinase C, was accompanied by an increase in the level of soluble inositol phosphates and did not involve an autocrine factor.

Polyphenolic antioxidants mimic the effects of 1,4-dihydropyridines on neurotensin receptor function in PC3 cells.

This study aimed to determine the mechanism(s) by which 1,4-dihydropyridine Ca2+ channel blockers (DHPs) enhance the binding of neurotensin (NT) to prostate cancer PC3 cells and inhibit NT-induced inositol phosphate formation. Earlier work indicated that these effects, which involved the G protein-coupled NT receptor NTR1, were indirect and required cellular metabolism or architecture. At the micromolar concentrations used, DHPs can block voltage-sensitive and store-operated Ca2+ channels, K+ channels, and Na+ channels, and can inhibit lipid peroxidation.

Critical role of mast cells in inflammatory diseases and the effect of acute stress.

Mast cells are not only necessary for allergic reactions, but recent findings indicate that they are also involved in a variety of neuroinflammatory diseases, especially those worsened by stress. In these cases, mast cells appear to be activated through their Fc receptors by immunoglobulins other than IgE, as well as by anaphylatoxins, neuropeptides and cytokines to secrete mediators selectively without overt degranulation. These facts can help us better understand a variety of sterile inflammatory conditions, such as multiple sclerosis (MS), migraines, inflammatory arthritis, atopic dermatitis, coronary inflammation, interstitial cystitis and irritable bowel syndrome, in which mast cells are activated without allergic degranulation.