Proportion of patients treated with thrombolysis in a centralized versus a decentralized acute stroke care setting.

Background And Purpose: Today, treatment of acute stroke consists of tissue-type plasminogen activator (tPA), admission to a stroke unit, and aspirin. Although tPA treatment is the most effective, there is substantial undertreatment. Centralized care may affect rate, timing, and outcome of thrombolysis compared to decentralized treatment in community hospitals.

Vitamin B(12) deficiency with bilateral globus pallidus abnormalities.

Objective: To describe a case of vitamin B(12) deficiency with classic and rare clinical features and novel radiographic features.

Design: Case report.

Setting: Johns Hopkins Hospital neurology service.

The influence of the CO₂ pneumoperitoneum on a rat model of intestinal anastomosis healing.

Background: The CO(2) pneumoperitoneum, which is used for laparoscopic surgery, causes local and systemic effects in patients. Concern arises about what the pressurized anoxic environment of the CO(2) pneumoperitoneum has on intestinal healing. Earlier experimental work showed a negative correlation between intestinal healing and the applied intra-abdominal pressure.

Is complete resection of the aganglionic bowel in extensive total aganglionosis up to the middle ileum always necessary?

Background/purpose: Total colonic aganglionosis is an unusual form of Hirschsprung disease, reflected by the small number of published case studies. The goal of this study was to analyze our cases of the last 22 years and report on our experience with 3 cases of extended total aganglionosis proximal to the middle ileum in which remaining aganglionic bowel was left in situ.

Materials And Methods: In a period of 22 years (from January 1988 to April 2010), we operated on 15 children with total aganglionosis.

Vertical alignment in monkeys with unilateral IV section: effects of prolonged monocular patching and trigeminal deafferentation.

We investigated monocular viewing and trigeminal (V) deafferentation on the vertical deviation (VD) in monkeys following intracranial IV section. Two monkeys wore a patch for four to six weeks, one over the paretic eye and the other over the normal eye following IV section. Two other monkeys had combined IV and V section with the paretic eye patched postlesion.

The effects of ion channel blockers validate the conductance-based model of saccadic oscillations.

Conductance-based models of reciprocally inhibiting burst neurons suggest that intrinsic membrane properties and postinhibitory rebound (PIR) determine the amplitude and frequency of saccadic oscillations. Reduction of the low-threshold calcium currents (I(T)) in the model decreased the amplitude but increased the frequency of the simulated oscillations. Combined reduction of hyperpolarization-activated cation current (I(h)) and I(T) in the model abolished the simulated oscillations.

MRI magnetic field stimulates rotational sensors of the brain.

Vertigo in and around magnetic resonance imaging (MRI) machines has been noted for years [1, 2]. Several mechanisms have been suggested to explain these sensations [3, 4], yet without direct, objective measures, the cause is unknown. We found that all of our healthy human subjects developed a robust nystagmus while simply lying in the static magnetic field of an MRI machine.

Large Genomic Deletions in CACNA1A Cause Episodic Ataxia Type 2.

Episodic ataxia (EA) syndromes are heritable diseases characterized by dramatic episodes of imbalance and incoordination. EA type 2 (EA2), the most common and the best characterized subtype, is caused by mostly nonsense, splice site, small indel, and sometimes missense mutations in CACNA1A. Direct sequencing of CACNA1A fails to identify mutations in some patients with EA2-like features, possibly due to incomplete interrogation of CACNA1A or defects in other EA genes not yet defined.

Cerebellum and ocular motor control.

An intact cerebellum is a prerequisite for optimal ocular motor performance. The cerebellum fine-tunes each of the subtypes of eye movements so they work together to bring and maintain images of objects of interest on the fovea. Here we review the major aspects of the contribution of the cerebellum to ocular motor control.

MRI shows a region-specific pattern of atrophy in spinocerebellar ataxia type 2.

In this study, we used manual delineation of high-resolution magnetic resonance imaging (MRI) to determine the spatial and temporal characteristics of the cerebellar atrophy in spinocerebellar ataxia type 2 (SCA2). Ten subjects with SCA2 were compared to ten controls. The volume of the pons, the total cerebellum, and the individual cerebellar lobules were calculated via manual delineation of structural MRI.

TMS perturbs saccade trajectories and unmasks an internal feedback controller for saccades.

When we applied a single pulse of transcranial magnetic stimulation (TMS) to any part of the human head during a saccadic eye movement, the ongoing eye velocity was reduced as early as 45 ms after the TMS, and lasted ∼32 ms. The perturbation to the saccade trajectory was not due to a mechanical effect of the lid on the eye (e.g.

The effects and efficacy of antireflux surgery in children with gastroesophageal reflux disease: a systematic review.

Background: Antireflux surgery (ARS) for gastroesophageal reflux disease (GERD) is one of the most frequently performed major operations in children. Many studies have described the results of ARS in children, however, with a wide difference in outcome. This study aims to systematically review the efficacy of pediatric ARS and its effects on gastroesophageal function, as measured by gastroesophageal function tests.

Dynamic cyclovergence during vertical translation in humans.

When humans are accelerated along the body vertical, the right and left eyes show oppositely directed torsional modulation (cyclovergence). The origin of this paradoxical response is unknown. We studied cyclovergence during linear sinusoidal vertical motion in healthy humans.

OrbitView: Eye movement visualization software.

Measurement of eye movements often helps to diagnose ocular motor disorders in the clinic, and is also used as a research tool in ocular motor, vision and vestibular research. Eye movements, however, are usually recorded without simultaneous video recordings, making offline interpretation difficult. We developed a tool that converts the measured eye movement data into a three-dimensional (3D) movie of eye movements.

Laparoscopic repair of duodenal atresia: revisited.

Background: Since the initial reports of laparoscopic repair of duodenal atresia in neonates, further reports have been scant. Could this be because of unacceptable rates of complications, like anastomotic leakage, as mentioned in later reports? In the present study the laparoscopic repair of duodenal atresia in neonates is revisited.

Patients: Group 1 consisted of 22 patients with duodenal obstruction between 2000-2005 until the laparoscopic approach was abandoned.

Ataxia telangiectasia: a "disease model" to understand the cerebellar control of vestibular reflexes.

Experimental animal models have suggested that the modulation of the amplitude and direction of vestibular reflexes are important functions of the vestibulocerebellum and contribute to the control of gaze and balance. These critical vestibular functions have been infrequently quantified in human cerebellar disease. In 13 subjects with ataxia telangiectasia (A-T), a disease associated with profound cerebellar cortical degeneration, we found abnormalities of several key vestibular reflexes.

Pharmacotherapy of vestibular and ocular motor disorders, including nystagmus.

We review current pharmacological treatments for peripheral and central vestibular disorders, and ocular motor disorders that impair vision, especially pathological nystagmus. The prerequisites for successful pharmacotherapy of vertigo, dizziness, and abnormal eye movements are the "4 D's": correct diagnosis, correct drug, appropriate dosage, and sufficient duration. There are seven groups of drugs (the "7 A's") that can be used: antiemetics; anti-inflammatory, anti-Ménière's, and anti-migrainous medications; anti-depressants, anti-convulsants, and aminopyridines.

Barrett's esophagus in children: does it need more attention?

Background: Few studies have reported on Barrett's esophagus (BE) in children. Moreover, information on the age at diagnosis and the duration between reflux-symptoms and diagnosis is lacking.

Methods: A review of the literature was performed in PubMed, EMBASE and the Cochrane database.

Hirschsprung's disease in children with Down syndrome: a comparative study.

Background And Aim: There is controversy in the literature regarding the outcome after surgical treatment of Hirschsprung's disease in children with Down syndrome (DS). The aim of this study was to compare the outcome of our series of DS children with Hirschsprung's disease to our series of children without Down syndrome (NDS) with Hirschsprung's disease. The impact of laparoscopy within the DS group was analyzed.

Superficially located white matter structures commonly seen in the human and the macaque brain with diffusion tensor imaging.

The white matter of the brain consists of fiber tracts that connect different regions of the brain. Among these tracts, the intrahemispheric cortico-cortical connections are called association fibers. The U-fibers are short association fibers that connect adjacent gyri.

Laparoscopic treatment of gastric and duodenal perforation in children after blunt abdominal trauma.

Minimal invasive surgery has not yet gained wide acceptation for the care of patients that sustained an abdominal trauma. We describe the complete laparoscopic surgical treatment of two patients after a single blunt abdominal trauma. One patient sustained a handle bar injury and presented with a gastric perforation.