Dopaminergic neurons associate with blood vessels in neural transplants.

Neural transplantation is an attractive strategy for diseases that result in focal neurodegeneration such as Parkinson's disease, where there is a selective loss of dopaminergic neurons in the substantia nigra of the midbrain. A major drawback to its application, however, is the poor survival of donor dopaminergic neurons. While neurons probably depend on host-derived substances delivered by either diffusion or the establishment of functional vascular connections, the relative importance of each delivery mechanism is not known.

Patency rates of femorofemoral bypasses associated with endovascular aneurysm repair surpass those performed for occlusive disease.

Purpose: To evaluate the patency rates of femorofemoral grafts performed in conjunction with aortomonoiliac or aortomonofemoral (AMI/F) endografts.

Methods: Over the past 8 years, 110 patients (98 men; mean age 77+/-7 years, range 57-90) underwent aortoiliac aneurysm repair with an AMI/F endograft. Follow-up data in these patients were prospectively collected for a mean 2.

Subclinical thyroid disease: scientific review and guidelines for diagnosis and management.

Context: Patients with serum thyroid-stimulating hormone (TSH) levels outside the reference range and levels of free thyroxine (FT4) and triiodothyronine (T3) within the reference range are common in clinical practice. The necessity for further evaluation, possible treatment, and the urgency of treatment have not been clearly established.

Objectives: To define subclinical thyroid disease, review its epidemiology, recommend an appropriate evaluation, explore the risks and benefits of treatment and consequences of nontreatment, and determine whether population-based screening is warranted.

Medical comorbidities in the treatment of epilepsy.

The treatment of epilepsy extends far beyond seizure control. Many comorbidities have a significant impact on the medical management and quality of life of patients with epilepsy. In this review, we examine interactions between epilepsy and some common medical conditions.

Characterization of Mycobacterium montefiorense sp. nov., a novel pathogenic Mycobacterium from moray eels that is related to Mycobacterium triplex.

The characterization of a novel Mycobacterium sp. isolated from granulomatous skin lesions of moray eels is reported. Analysis of the hsp65 gene, small-subunit rRNA gene, rRNA spacer region, and phenotypic characteristics demonstrate that this organism is distinct from its closest genetic match, Mycobacterium triplex, and it has been named M.

Sclerosing lymphocytic lobulitis of the breast in a patient with Graves' disease.

A 43-year-old woman presented to the endocrinologist with symptoms and signs of typical thyrotoxicosis caused by Graves' disease. Review of systems revealed that she had recently discovered a lump in her left breast. Evaluation of the left breast lesion led to a core biopsy that showed sclerosing lymphocytic lobulitis.

Primary bacterial infection of the myocardium.

Primary bacterial infection of myocardial tissue without associated endocarditis occurs only rarely. It is generally seen in the setting of overwhelming bacteremia. The most common bacterial cause of myocarditis is Staphylococcus aureus, although infections with a broad range of bacterial pathogens have been described.

Does subintimal angioplasty have a role in the treatment of severe lower extremity ischemia?

Objective: Subintimal angioplasty (SIA) has been advocated to treat long segment lower extremity arterial occlusions, but many question its value. We evaluated the role of SIA in a group of patients with severe lower extremity arterial occlusive disease.

Methods: During a 2.

Current practice of motor evoked potential monitoring: results of a survey.

Centers responding to a survey of MEP monitoring practices predominantly used transcranial electrical brain stimulation (TCES) with brief pulse trains and/or spinal cord stimulation (SCS) to elicit MEPs; transcranial magnetic stimulation and single-pulse TCES were not techniques of choice. Most centers using TCES had patient exclusion criteria (e.g.

Mechanisms of intraoperative brainstem auditory evoked potential changes.

Brainstem auditory evoked potential (BAEP) changes during intraoperative monitoring may reflect damage to or potentially reversible dysfunction of the ear, the eighth nerve, or the brainstem auditory pathways up to the level of the mesencephalon. They may also be caused by other physiologic mechanisms such as anesthesia, hypothermia, and acoustic masking from drilling noise, or they may result from technical factors that prevent proper stimulus delivery or recording of an evoked potential that is actually present. Cochlear ischemia or infarction resulting from compromise of the internal auditory artery and inner ear damage during temporal bone drilling will affect all BAEP components, including wave I.

Interrater reliability among epilepsy centers: multicenter study of epilepsy surgery.

Purpose: To measure the interrater reliability of presurgical testing and surgical decisions among epilepsy centers.

Methods: Seven centers participating in an ongoing, prospective multicenter study of resective epilepsy surgery agreed to conform to a detailed protocol regarding presurgical evaluation and surgery. To assess quality assurance, each center independently reviewed 21 randomly selected surgical cases for preoperative study lateralization and localization, and surgical decisions.

Improved dose homogeneity in scalp irradiation using a single set-up point and different energy electron beams.

Homogeneous irradiation of the entire or a large portion of the superficial scalp poses both technical and dosimetric challenges. Some techniques will irradiate too much of the underlying normal brain while other techniques are either complex and involve field matching problems or may require sophisticated linear accelerator (linac) add-ons such as intensity modulated radiation therapy (IMRT)/electron multileaf collimation. However, many radiotherapy facilities are not equipped with such treatment modalities.

Ankle impingement syndromes.

The term "ankle impingement" encompasses a broad range of conditions that are typically post-traumatic and often chronic. Various forms of mechanical impingement can result from synovial proliferation, bone spur formation, or ligamentous scarring and hypertrophy. Since symptoms and physical findings can mimic a variety of disorders, accurate diagnosis may remain elusive, and proper effective therapy may be delayed.

Differential diagnosis of osteoporosis.

Background: Dual x-ray absorptiometry (DEXA) is widely used to identify persons at increased risk for osteoporotic fractures. It does not, per se, give us any diagnostic information that is necessary to determine the best therapeutic approach in an individual case.

Objective: Identify conditions and tests that may impact on the diagnosis and the treatment of subjects with low bone densitometry scores.

Laryngopharyngeal dysmotility in multiple sclerosis.

This study investigated the swallowing physiology of 13 patients [age 27-69 years (mean = 45 years)] with multiple sclerosis (MS) who had Kurtzke Extended Disability Status Scale (EDSS) scores ranging from 2 to 9 (mean = 6) and who complained of difficulty swallowing. Videofluoroscopic recordings of the patients' calibrated liquid and paste bolus swallows were analyzed and compared with published normative data. Results showed that swallowing physiology was disordered in the 13 MS patients with severity level ranging from mild to severe.

Repeated bleeding scintigraphy may reveal that stationary foci of activity represent sites of active hemorrhage.

The goal of bleeding scintigraphy is to localize the site of origin of a hemorrhage to within general regions of the large or small bowel. Activity is typically seen to extravasate from the blood pool into the lumen, and the collection of activity then moves on sequential images, as a result of the cathartic action of blood. Sometimes, bleeding studies show a stationary focus of activity without subsequent movement.

Limited role for IVUS in the endovascular repair of aortoiliac aneurysms.

Background: To determine the need for routine versus selective intraoperative IVUS during endovascular aortoiliac aneurysm (AIA) repair.

Methods: One-hundred and eighty-eight endovascular AIA repairs performed over a 5-year period were reviewed and included in the study. Surgeon-made aorto-uni-femoral grafts (n=78) and industry-made bifurcated or tube grafts (n=110) were used.

The plantar plate of the lesser metatarsophalangeal joints: potential for injury and role of MR imaging.

This article reviews the normal anatomy of the plantar plate and surrounding support structures at the lesser metatarsophalangeal joints, and demonstrates degenerative change and rupture using high resolution MR imaging of the forefoot. The etiology of plantar plate and collateral ligament degeneration and rupture, most commonly occurring at the second metatarsophalangeal joint, is discussed as it relates to chronic synovitis and instability. Both conservative and surgical treatment options are discussed.

Interferon-mediated fatigue.

Fatigue is a common side effect of interferon (IFN) therapy, reported in 70-100% of patients treated with IFN. The etiology of IFN-mediated fatigue (IMF) is multifactorial, with endocrine failure, neuropsychiatric disturbance, autoimmunity, and cytokine dysregulation potentially being contributors. Thyroid dysfunction, associated with the development of autoantibodies, is seen in 8-20% of patients receiving IFN-alpha.

Increasing incidence of midterm and long-term complications after endovascular graft repair of abdominal aortic aneurysms: a note of caution based on a 9-year experience.

Objective: To analyze the late complications after endovascular graft repair of elective abdominal aortic aneurysms (AAAs) at the authors' institution since November 1992.

Summary Background Data: Recently, the use of endovascular grafts for the treatment of AAAs has increased dramatically. However, there is little midterm or long-term proof of their efficacy.

The incidence of tuberculosis in drug users with small tuberculin reaction sizes.

Setting: In persons infected with the human immunodeficiency virus (HIV), a decreased tuberculin reaction cut-point of > or = 5 mm induration is recommended.

Objective: To determine tuberculosis risk in non-anergic HIV-infected persons with 5-9 mm tuberculin reactions.

Design: A prospective study with semi-annual tuberculin and anergy testing, HIV antibody and T cell subset assays, and active surveillance for tuberculosis.

PACS and RIS: approaches to integration.

PACS and RIS have traditionally been discrete information systems with separate databases. Maintaining more than one database containing identical data sets creates the potential for outdated information being used in parallel with accurate information. Today, because of increased implementation of PACS and improved Web technology, this problem must be solved.

Group A streptococcal appendicitis in a patient with AIDS.

A man with AIDS developed appendicitis and bacteremia caused by Group A streptococcus, neither of which is considered an opportunistic infection. Group A streptococcus is rarely implicated in appendicitis in children and has not previously been reported in an adult. Immunodeficiency might have predisposed the patient to this unusual infection.