Combined spinal-epidural for labor analgesia.

Since the introduction of the combined spinal-epidural technique in the early 1980s it has gained increasing popularity for analgesia and anesthesia in labor and delivery. The benefit of the rapid onset of analgesia from the intrathecal injection, coupled with the flexibility of an epidural catheter that can provide a long duration of labor analgesia or conversion to an anesthetic when operative delivery is necessary, has made combined spinal-epidural the labor analgesic of choice in many obstetric anesthesia practices.

Neuropsychological profiles associated with subcortical white matter alterations and Parkinson's disease: implications for the diagnosis of dementia.

Despite the emergence of a number of new classification systems, the diagnosis of cerebrovascular dementia remains controversial. Also controversial is the significance of periventricular and deep white matter alterations (WMA) as seen on magnetic resonance imaging (MRI). To further clarify this issue, MRI scans were used to regroup patients clinically diagnosed with Alzheimer's disease (AD) or subcortical ischemic vascular dementia (IVD) into cohorts presenting with either little versus significant WMA on MRI.

Neuropsychological technologies in rehabilitation.

Objective: To provide an introduction and a conceptual context for the articles presented in this special edition of the Journal of Head Trauma Rehabilitation on neuropsychological technologies.

Summary: Many clinical assessments in neuropsychology are metamorphosing from a psychometric search for a lesion to a functional image of the working brain. Behavioral probes increasingly employ technology to provide more ecologically valid stimuli to elicit diagnostically relevant responses.

Neurosteroid effects on GABAergic synaptic plasticity in hippocampus.

We have previously reported that short-term (48-72 h) exposure to the GABA-modulatory steroid 3alpha-OH-5alpha-pregnan-20-one (3alpha,5alpha-THP) increases expression of the alpha4 subunit of the GABA(A) receptor (GABAR) in the hippocampus of adult rats. This change in subunit composition was accompanied by altered pharmacology and an increase in general excitability associated with acceleration of the decay time constant (tau) for GABA-gated current of pyramidal cells acutely isolated from CA1 hippocampus similar to what we have reported following withdrawal from the steroid after chronic long-term administration. Because GABAR can be localized to either synaptic or extrasynaptic sites, we tested the hypothesis that this change in receptor kinetics is mediated by synaptic GABAR.

Spontaneous nontraumatic hemoperitoneum due to a bleeding arteriovenous malformation on the serosal surface of the transverse colon: a case report.

Arteriovenous malformations of the gastrointestinal tract are a very common entity and a frequently cited cause of lower gastrointestinal bleeding in adults. They are characteristically found in the mucosa or submucosa of the bowel wall, and the vast majority do not cause any symptoms. We discuss the rare case of an extraluminal arteriovenous malformation of the transverse colon in an elderly woman who presented to the emergency department in hypovolemic shock after collapsing at home.

Immediate radiographic assessment following laparoscopic antireflux operations is unnecessary.

Background: Laparoscopic antireflux operations (LAP) have become increasingly common for the treatment of gastroesophageal reflux disease (GERD). We sought to determine if routine postoperative barium contrast studies following LAP were clinically efficacious in identifying technical problems and life-threatening complications related to the surgical intervention.

Methods: From January 1996 to December 1997, 112 barium studies were performed following 112 LAP procedures (47 male/65 female patients; mean age, 51 years) (group I).

Fine needle aspiration diagnosis of lipoblastoma of the parotid region. A case report.

Background: Lipoblastomas are rare tumors of embryonal fat that occur in infants and children. They are usually located in the extremities and trunk. Two cases in the parotid region have been described.

Beta-amyloid, neuronal death and Alzheimer's disease.

Alzheimer's disease (AD) is a common neurodegenerative disease that affects cognitive function in the elderly. Large extracellular beta-amyloid (Abeta) plaques and tau-containing intraneuronal neurofibrillary tangles characterize AD from a histopathologic perspective. However, the severity of dementia in AD is more closely related to the degree of the associated neuronal and synaptic loss.

Intrathecal gadolinium-enhanced MR cisternography in the evaluation of clinically suspected cerebrospinal fluid rhinorrhea in humans: early experience.

In this prospective multicenter study, the authors evaluated the utility of magnetic resonance (MR) cisternography after intrathecal administration of gadopentetate dimeglumine in 15 patients clinically suspected of having cerebrospinal fluid (CSF) rhinorrhea. By means of lumbar puncture, a single dose of 0.5 mL of gadopentetate dimeglumine was injected into the lumbar subarachnoid space.

Alpha-synuclein in familial Alzheimer disease: epitope mapping parallels dementia with Lewy bodies and Parkinson disease.

Background: Alpha-synuclein is a major component of Lewy bodies (LBs) in Parkinson disease and dementia with LBs and of glial cytoplasmic inclusions in multiple system atrophy. However, epitope mapping for alpha-synuclein is distinctive in different neurodegenerative diseases. The reasons for this are poorly understood but may reflect fundamental differences in disease mechanisms.

Mechanisms of atherosclerotic plaque stabilization for a lipophilic calcium antagonist amlodipine.

Coronary artery disease (CAD) is the result of atherosclerosis, a vascular disorder characterized by abnormalities in vasoconstriction and endothelial function, ultimately leading to partial or complete vessel occlusion. Because the atherosclerotic plaque is marked by changes in calcium regulation, there has been interest in a potential antiatherosclerotic role for calcium antagonists. In support of this hypothesis, a recent clinical study demonstrated in patients with CAD that treatment with the lipophilic dihydropyridine-type calcium antagonist amlodipine resulted in significantly fewer cardiovascular procedures and events.

Peripheral vascular disease intervention in patients with end-stage renal disease: few complications in those treated with peritoneal dialysis.

Background: We assessed the results of peripheral vascular surgery in patients with end-stage renal disease (ESRD) who were being treated with peritoneal dialysis.

Methods: Sixty-seven ESRD patients on peritoneal dialysis who had peripheral vascular surgery were assessed retrospectively for preoperative risk factors, primary and secondary patency rates, and mortalitv. The study group had 48 proximal femoral-popliteal bypasses, 12 distal femoral-popliteal bypasses, and 7 distal femoral-tibial and/or peroneal revascularizations.

Automating psychiatric tasks: taking quality to the next level.

Advances in information technology have allowed the creation of databases and decision support systems for behavioral health care as well as other areas of medicine. The authors describe the state of the art in automating behavioral health care tasks and how automated information analyses provided in real time can measurably improve patient outcomes.

A novel use of ultrasound in pulseless electrical activity: the diagnosis of an acute abdominal aortic aneurysm rupture.

We report a case of a patient who presented to the Emergency Department with pulseless electrical activity. A rapid diagnosis of ruptured abdominal aortic aneurysm was made by Emergency Medicine bedside ultrasonography. On arrival, the patient was without palpable pulses and bradycardic.

Contemporary Approaches to the Management of Neurosurgical Complications of Infective Endocarditis.

Infective endocarditis can often involve the nervous system, resulting in stroke, intracerebral hemorrhage, infectious aneurysm formation, cerebral abscess, and spinal epidural infection. Many of these problems require neurosurgical attention. Modern advances in neuro- surgical critical care, computerization, instrumentation, and radiologic imaging have affected the treatments available to patients with neurosurgical manifestations of infective endocarditis.

Effective normalization of complexity measurements for epoch length and sampling frequency.

The algorithmic complexity of a symbol sequence is sensitive to the length of the message. Additionally, in those cases where the sequence is constructed by the symbolic reduction of an experimentally observed wave form, the corresponding value of algorithmic complexity is also sensitive to the sampling frequency. In this contribution, we present definitions of algorithmic redundancy that are sequence-sensitive generalizations of Shannon's original definition of information redundancy.

Current assessment of thromboembolic disease and pregnancy.

This study was undertaken to assess incidence of deep venous thrombosis and pulmonary emboli in an inner-city pregnant population. Thromboembolic disease is believed to occur in 0.05 to 0.

Modification of a choledochoscope for extraction of difficult biliary stones.

Cholelithiasis is a common problem in the United States, affecting 10 to 15 per cent of the population. Although only one per cent of these patients have intrahepatic gallstones their discovery intraoperatively may present a technical challenge for the surgeon. This paper describes a simple method for dislodging difficult intrahepatic biliary stones: modification of a rigid choledochoscope to permit use of a biliary Fogarty catheter and Segura basket under direct visualization.

Hemicricoidectomy for voice rehabilitation following hemilaryngectomy with ipsilateral arytenoid removal.

The purpose of this article is to describe an approach to reconstruction of the larynx after vertical partial laryngectomy with removal of the ipsilateral arytenoid cartilage. This method addresses the problem of postoperative posterior glottal incompetence (aphonia with or without aspiration). The technique involves resection of the ipsilateral half of the cricoid cartilage, use of an inferiorly based strap muscle flap for vocal fold reconstruction, and placement of a customized stent.

Viral encephalitis associated with reversible asystole due to sinoatrial arrest.

We report a case of sinoatrial node block associated with syncopal episodes that required a temporary pacemaker. Magnetic resonance imaging (MRI) of the brain showed lesions of both temporal lobes consistent with viral encephalitis, presumably due to herpes simplex virus (HSV). The patient quickly recovered with intravenous acyclovir (Zovirax) therapy.