Shunt-responsive dementia in sarcoid meningitis: role of magnetic resonance imaging and cisternography.

The authors report a patient with progressive cognitive and gait decline in association with sarcoid meningitis. The patient had evidence of active inflammation as determined by cerebrospinal fluid examination and was steroid dependent. Magnetic resonance imaging and radionucleotide cisternography were complementary in establishing the diagnosis of communicating hydrocephalus, and suggested that the patient would be shunt responsive.

Phakomatoses. Part I: Neurofibromatosis type 1: common and uncommon neuroimaging findings.

Neurofibromatosis type I (NF-1) belongs to a family of diseases named phakomatoses, which are characterized by congenital malformations of ectodermal structures. Neurofibromatosis type I affects 1 in 3000 people, and has a diverse clinical presentation as well as an array of imaging findings. In this article the authors review the various neuroimaging findings present in NF-1, including abnormalities of the parenchyma, meninges, vessels, and associated neoplasms.

Pathophysiology of evolution and recurrence of chronic subdural hematoma.

Although the pathophysiology of the development, propagation, and recurrence of current subdural hematoma remains debatable, fundamental management strategies may be formulated to optimize outcomes. Effective drainage by whatever surgical means, removal of offending membranes when appropriate, and maximization of postoperative physiologic parameters are based on the best available current pathophysiologic information.

The cost-effectiveness of immunohistochemistry.

Objective: To evaluate the cost-effectiveness of immunohistochemistry.

Design: Using a theoretical decision analytic model, the cost-effectiveness of immunohistochemistry was evaluated in different scenarios depicting the beneficial use of immunohistochemistry. Data regarding the effectiveness of immunohistochemistry were obtained from the medical literature and costs were obtained from Allegheny General Hospital.

Arterial pseudostenosis on first-pass gadolinium-enhanced three-dimensional MR angiography: new observation of a potential pitfall.

Objective: The purpose of this study was to determine the frequency of apparent stenosis of normal aortic branches in patients on first-pass gadolinium-enhanced three-dimensional (3D) MR angiography and to reproduce the same phenomenon in a pulsatile flow phantom model.

Conclusion: Apparent stenosis of normal vessels on gadolinium-enhanced 3D MR angiography seen on the first-pass acquisition was observed in only a small proportion (approximately 2%) of our patients. The pseudostenosis was reproducible in the phantom model using rapid injection.

Gastric zygomycosis diagnosed by brushing cytology.

A 66-yr-old man with a history of squamous cell carcinoma and small cell carcinoma of the lung presented with nausea, vomiting, and abdominal pain. After passing black stools, he underwent upper endoscopy which showed gastric ulceration. A gastric brushing was performed which showed numerous nonseptate, ribbon-like hyphae with right-angle branching.

High affinity binding between lipoprotein lipase and lipoproteins involves multiple ionic and hydrophobic interactions, does not require enzyme activity, and is modulated by glycosaminoglycans.

Lipoprotein lipase (LPL) physically associates with lipoproteins and hydrolyzes triglycerides. To characterize the binding of LPL to lipoproteins, we studied the binding of low density lipoproteins (LDL), apolipoprotein (apo) B17, and various apoB-FLAG (DYKDDDDK octapeptide) chimeras to purified LPL. LDL bound to LPL with high affinity (K(d) values of 10(-12) m) similar to that observed for the binding of LDL to its receptors and 1D1, a monoclonal antibody to LDL, and was greater than its affinity for microsomal triglyceride transfer protein.

Complications of lower extremity arteriovenous grafts in patients with end-stage renal disease.

Background: More data are needed to assess lower extremity angioaccess sites for hemodialysis.

Methods: We did a retrospective review of 843 consecutive hospital records of upper and lower extremity arteriovenous (AV) fistulas from 1992 to 1996.

Results: Lower extremity grafts accounted for 16% (134/843) of patients in this series.

Uniform safety of beating heart surgery using the octopus tissue stabilization system.

Background And Purpose: Minimally invasive coronary artery bypass grafting (CABG) has been facilitated by the introduction of the Octopus Tissue Stabilization system (OTS). OTS improves exposure immobilizing the heart with minimal hemodynamic effects allowing multivessels off cardiopulmonary bypass (CPB) CABG. The purpose of this study was to compare the utilization and clinical outcome of the OTS in three geographically distinct centers.

Zaleplon improves sleep without producing rebound effects in outpatients with insomnia. Zaleplon Clinical Study Group.

The efficacy and safety of three doses of zaleplon, a novel non-benzodiazepine hypnotic, were compared with those of placebo in outpatients with insomnia in this 4-week study, using zolpidem 10 mg as active comparator. Postsleep questionnaires were used to determine treatment effects on the patient's perception of sleep, as well as any development of pharmacological tolerance during therapy or rebound insomnia or withdrawal symptoms upon discontinuation of therapy. During week 1, sleep latency was significantly shorter with zaleplon 5, 10, and 20 mg compared to placebo.

Risk factors for emergence of Stenotrophomonas maltophilia in cystic fibrosis.

The number of patients with cystic fibrosis (CF) whose sputum culture has yielded Stenotrophomonas maltophilia has increased in the last 5 years at St. Christopher's Hospital for Children. We conducted a case-control study to determine risk factors for recovery of S.

Fluoroquinolones.

The fluoroquinolone class of antimicrobial agents has expanded dramatically in the last 5 years and will continue to grow over the next decade. This article discusses the newer fluoroquinolones in detail, including pharmacokinetics, pharmacodynamics, safety, and drug interactions, and the spectrum of in vitro activity. Newer agents are compared and contrasted with the older ones, particularly ciprofloxacin and ofloxacin, and problems with liver toxicity and trovafloxacin are described.

Cephalosporins, carbapenems, and monobactams.

Nonpenicillin beta-lactams exhibit a variable spectrum of antimicrobial activity, have a wide range of clinical uses and a favorable safety profile. Cefepime's twice-daily dosage and increased activity against Enterobacteriaceae may offer some advantages over older cephalosporins. The carbapenems offer a broad antimicrobial spectrum, and meropenem has an improved safety profile compared with imipenem.

Antibacterial agents in infections of the central nervous system.

Experimental animal models have provided information applicable to antimicrobial therapy of infections of the central nervous system. The efficacy of an antimicrobial agent in the therapy of bacterial meningitis depends on its ability to penetrate the blood-brain barrier, its activity in purulent cerebrospinal fluid, and a demonstration of rapid bactericidal activity against the offending pathogen. The recent emergence of resistant pathogens is challenging the therapy for bacterial meningitis.

Use of antibacterial agents in renal failure.

This article provides information on the pharmacokinetics of antibacterial agents in patients with normal renal function and those with impaired renal function. Specific discussion includes the use of serum levels, dosage adjustments in dialysis, new strategies for cefazolin dosages in dialysis patients, and antibiotic toxicity in renal failure, and tabular data is presented for determining appropriate dosages for varying degrees of renal failure.

Pharmacodynamics of antibacterial drugs.

Pharmacodynamics of antibacterial agents relates the time course of drug concentration to its antimicrobial effects at the infection site. Antibacterial agents can be divided into three groups based on pharmacodynamic characteristics: agents that exhibit concentration-dependent bactericidal activity over a range of drug concentrations (e.g.

Principles of selection and use of antibacterial agents. In vitro activity and pharmacology.

The selection of an antimicrobial treatment regimen is based on many factors, including the nature of the infection, the identity and susceptibility pattern of the infecting organisms, and the pharmacokinetics and pharmacodynamics of the antibacterial drugs. This article discusses principles of susceptibility testing, pharmacology, and monitoring of therapy.

Management and care of the newly diagnosed patient with cystic fibrosis.

Cystic fibrosis is the most common autosomal recessive fatal disease among whites. Life expectancy is now at 31 years of age. The major cause of morbidity and mortality is chronic progressive lung disease.

Miller Fisher syndrome: an uncommon acute neuropathy.

The syndrome of ophthalmoplegia, ataxia, and areflexia was first described in 1956 by Miller Fisher. This syndrome has long been believed to be a variant of Guillain-Barré syndrome (GBS), mainly because of its areflexia, cerebrospinal fluid findings, and its postinfectious presentation. The case of an 11-year-old male with Miller Fisher syndrome (MFS) is described.

Linear ablation lesions for control of unmappable ventricular tachycardia in patients with ischemic and nonischemic cardiomyopathy.

Background: Conventional activation mapping is difficult without inducible, stable ventricular tachycardia (VT).

Methods And Results: We evaluated 16 patients with drug refractory, unimorphic, unmappable VT. Nine patients had ischemic and 7 had nonischemic cardiomyopathy.

Cerebral herniation after lumbar puncture in sarcoid meningitis.

A patient with chronic meningitis due to neurosarcoidosis became comatose within minutes of a lumbar puncture and died 24 h later. The diagnosis of neurosarcoidosis was made post mortem. Development of cerebral herniation may have been exacerbated by lumbar puncture.

Afferent roles in hindlimb wipe-reflex trajectories: free-limb kinematics and motor patterns.

The hindlimb wiping reflex of the frog is an example of a targeted trajectory that is organized at the spinal level. In this paper, we examine this reflex in 45 spinal frogs to test the importance of proprioceptive afferents in trajectory formation at the spinal level. We tested hindlimb to hindlimb wiping, in which the wiping or effector limb and the target limb move together.

Transneuronal labeling from the rat distal colon: anatomic evidence for regulation of distal colon function by a pontine corticotropin-releasing factor system.

Neural circuits that are positioned to regulate rat distal colon function were identified by immunohistochemical detection of pseudorabies virus (PRV) and corticotropin-releasing factor (CRF). The distribution of PRV-immunoreactive neurons was examined in spinal cord and brain at increasing times (72-118 hours) after distal colon injection. At 72-80 hours, PRV-labeling was confined to the spinal cord, in the parasympathetic preganglionic column in the lumbosacral spinal cord and in the intermediolateral column of the thoracic spinal cord.