EPILEPSIA, Issue 5 2005
Carlo Alberto Tassinari
Summary:,Purpose: To describe the semiologic features of aggressive behaviors observed in human epileptic seizures with particular reference to the act of biting a conspecific. Methods: We analyzed the biting behavior (BB) and other aggressive gestures occurring in a group of 11 patients retrospectively selected from >1,000 patients subjected to video-EEG/SEEG monitoring for presurgical evaluation of drug-resistant seizures. Results: Patients displaying BB showed (a) a male sex predominance, (b) heterogeneous etiologies and lesion locations, and (c) seizures involving the frontotemporal regions of both hemispheres. The act of biting was a rapid motor action, lasting ,600 ms, occurring in the context of strong emotional arousal, fear, and anger, with various bodily gestures with aggressive connotation. BB was mainly a "reflexive" behavior, in that biting acts were evoked (both during and after seizures) by actions of people in close contact with the patient. The sole intrusion of the examiner's hand in the space near the patient's face was effective in triggering BB. Rarely, self-directed or object-directed biting acts were not triggered by external stimuli. Intracranial data (SEEG) obtained in one subject showed that the amygdala/hippocampal region plus the orbitomedial prefrontal cortex had to be involved by ictal activity to observe BB. Conclusions: Anatomic and electrophysiologic data in our patients suggest that a model of dual,temporal and frontal,dysfunction could account for the occurrence of ictal/postictal BB. Behavioral data suggest also that BB and related aggressive gestures can be considered as the emergence of instinctive behaviors with an adaptative significance of defense of the peripersonal space. [source]

Bladder wall grafting in rats using salt-modified and collagen-coated polycaprolactone scaffolds: Preliminary report

INTERNATIONAL JOURNAL OF UROLOGY, Issue 10 2007
Dah-Shyong Yu
Aim: A rat model was used for the evaluation of collagen-coated and salt-modified polycaprolactone (PCL) scaffolds for bladder grafting after hemicystectomy. Methods: SD rats underwent partial cystectomy and cystoplasty with collagen-coated and salt-modified polycaprolactone scaffolds. The grafts of the regenerated bladder wall were harvested at different intervals and tissue regeneration was evaluated microscopically. Anatomic and functional characters were evaluated by cystography and urodynamics. Results: At harvesting, after 1 and 2 months, we found good preservation of the bladder shape and volume in all 16 rats receiving PCL cystorrhaphy. No stone formation was observed. Good epithelialization and ingrowth of smooth muscle cells were seen after 2 months grafting. Collagen-coated PCL scaffolds showed considerable encrustation, which appeared to be absorbed and disappear with time. The cystographic and urodynamic examinations revealed intact contour and a well-accommodated bladder with reservoir volume and contractility. Conclusions: In the rat model, we have successfully demonstrated the applicability of collagen coated and salt-modified PCL in reconstruction of the partial cystectomized bladder. [source]

Carotid artery stenting: Do procedural complications relate to the side intervened upon?,

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 1 2009
Registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK), Results From the Carotid Artery Stent (CAS)
Abstract Objectives: To determine the influence of the side intervened upon on outcomes during carotid artery stenting (CAS). Background: Anatomic and technical aspects may influence the results of CAS. The value of the side intervened upon has not been analyzed yet. Methods: We analyzed data from the Carotid Artery Stent (CAS) , Registry.Results: A total of 3,165 CAS procedures, 1,613 (51%) at the left and 1,552 (49%) at the right carotid artery were included. There was a higher proportion of patients treated for symptomatic stenoses when CAS was performed at the left carotid artery (50.1% versus 45.8%, P = 0.016) and more patients already had prior carotid endarterectomy (8.5% versus 5.8%, P = 0.003). Interventions at the left side took 3 min longer than interventions at the right side (46.6 ± 24.3 versus 43.8 ± 23.6, P = 0.003). In patients treated at the left carotid artery amaurosis fugax (0.7% versus 0.1%, P = 0.005), ipsilateral stroke (3.1% versus 1.8%, P = 0.017), and the primary endpoint of in-hospital death or stroke (4.1% versus 2.3%, P = 0.005) occurred significantly more often. Even after adjusting for confounding parameters, CAS procedures performed at the left carotid arteries remained an independent predictor of death or stroke (OR = 1.77, 95% CI: 1.15,2.72, P = 0.009). Conclusions: In current clinical practice, CAS is performed frequently at the right carotid artery as at the left carotid artery. CAS interventions have a higher in-hospital complication rate if performed at the left carotid artery. Technical improvements might help to overcome this situation. © 2009 Wiley-Liss, Inc. [source]

Patterns of motor disability in very preterm children

DEVELOPMENTAL DISABILITIES RESEARCH REVIEW, Issue 4 2002
Melanie Bracewell
Abstract Motor development in very preterm children differs in several important ways from that of children born at full term. Variability is common, although the anatomic and physiologic bases for that variability are often poorly understood. Motor patterns over the first postnatal year may depend on behaviours learned during often long periods of neonatal intensive care. The normal pattern of development may be modified by disturbances of brain function caused both by the interruption of normal brain maturation ex-utero and the superimposition of focal brain injuries following very preterm birth. Abnormal patterns of development over the first year may evolve into clear neuromotor patterns of cerebral palsy or resolve, as "transient dystonias." Cerebral palsy is associated with identified patterns of brain injury secondary to ischaemic or haemorrhagic lesions, perhaps modified by activation of inflammatory cytokines. Cerebral palsy rates have not fallen as might be expected over the past 10 years as survival has improved, perhaps because of increasing survival at low gestations, which is associated with the highest prevalence of cerebral palsy. Children who escape cerebral palsy are also at risk of motor impairments during the school years. The relationship of these impairments to perinatal factors or to neurological progress over the first postnatal year is debated. Neuromotor abnormalities are the most frequent of the "hidden disabilities" among ex-preterm children and are thus frequently associated with poorer cognitive ability and attention deficit disorders. Interventions to prevent cerebral palsy or to reduce these late disabilities in very preterm children are needed. MRDD Research Reviews 2002;8:241,248. © 2002 Wiley-Liss, Inc. [source]

FACS-array gene expression analysis during early development of mouse telencephalic interneurons

DEVELOPMENTAL NEUROBIOLOGY, Issue 4 2008
Eric D. Marsh
Abstract Cortical interneuron dysfunction has been implicated in multiple human disorders including forms of epilepsy, mental retardation, and autism. Although significant advances have been made, understanding the biologic basis of these disorders will require a level of anatomic, molecular, and genetic detail of interneuron development that currently does not exist. To further delineate the pathways modulating interneuron development we performed fluorescent activated cell sorting (FACs) on genetically engineered mouse embryos that selectively express green fluorescent protein (GFP) in developing interneurons followed by whole genome microarray expression profiling on the isolated cells. Bioinformatics analysis revealed expression of both predicted and unexpected genes in developing cortical interneurons. Two unanticipated pathways discovered to be up regulated prior to interneurons differentiating in the cortex were ion channels/neurotransmitters and synaptic/vesicular related genes. A significant association of neurological disease related genes to the population of developing interneurons was found. These results have defined new and potentially important data on gene expression changes during the development of cortical interneurons. In addition, these data can be mined to uncover numerous novel genes involved in the generation of interneurons and may suggest genes/pathways potentially involved in a number of human neurological disorders. © 2008 Wiley Periodicals, Inc. Develop Neurobiol, 2008. [source]

Basic principles of MRI and morphometry studies of human brain development

DEVELOPMENTAL SCIENCE, Issue 3 2002
David N. Kennedy
Magnetic resonance imaging has undergone dramatic development in the past years. This has been paralleled by developments in the tools for extracting quantitative information from these images in support of capturing the anatomic features of brain development in living humans. This has revolutionized our expectations for current and future diagnostic and investigative work with the developing brain. This paper will cover the classes of information that are readily available in the MR image, the mechanisms for extracting quantitative results, and a sample of the application of these types of methods to developmental issues. These applications highlight tissue- and anatomic-based contrasts in the nature and rate of developmental maturation within the brain. This will be followed by a discussion of the emergent themes of developmental science as elucidated by these classes of observation. [source]

Hepatectomy for pyogenic liver abscess

HPB, Issue 2 2003
RW Strong
Background Commensurate with the advances in diagnostic and therapeutic radiology in the past two decades, percutaneous needle aspiration and catheter drainage have replaced open operation as the first choice of treatment for both single and multiple pyogenic liver abscesses. There has been little written on the place of surgical resection in the treatment of pyogenic liver abscess due to underlying hepatobiliary pathology or after failure of non-operative management. Methods The medical records of patients who underwent resection for pyogenic liver abscess over a 15-year period were retrospectively reviewed. The demographics, time from onset of symptoms to medical treatment and operation, site of abscess, organisms cultured, aetiology, reason for operation, type of resection and outcome were analysed. There were 49 patients in whom the abscesses were either single (19), single but multiloculated (11) or multiple (19). The median time from onset of symptoms to medical treatment was 21 days and from treatment to operation was 12 days. The indications for operation were underlying hepatobiliary pathology in 20% and failed non-operative treatment in 76%. Two patients presented with peritonitis from a ruptured abscess. Results The resections performed were anatomic (44) and non-anatomic (5). No patient suffered a recurrent abscess or required surgical or radiological intervention for any abdominal collection. Antibiotics were ceased within 5 days of operation in all but one patient. The median postoperative stay was 10 days. There were two deaths (4%), both following rupture of the abscess. Discussion Except for an initial presentation with intraperitoneal rupture and, possibly, cases of hepatobiliary pathology causing multiple abscesses above an obstructed duct system that cannot be negotiated non-operatively, primary surgical treatment of pyogenic liver abscess is not indicated. Non-operative management with antibiotics and percutaneous aspiration/drainage will be successful in most patients. If non-operative treatment fails, different physical characteristics of the abscesses are likely to be present and partial hepatectomy of the involved portion of liver is good treatment when performed by an experienced surgeon. [source]

Periapical radiographs overestimate root canal wall thickness during post space preparation

INTERNATIONAL ENDODONTIC JOURNAL, Issue 8 2008
E. M. Souza
Abstract Aim, To evaluate differences between anatomic and radiographic measurements of root canal wall thickness (RCWT) after each root canal preparation stage during post placement. Methodology, Twenty mandibular premolars with a single canal were decoronated and the roots embedded in resin using a teflon muffle. Roots were sectioned horizontally at a pre-established level and canals were prepared for post placement. Endodontic hand files were used for root canal preparation, followed by Gates Glidden drills and Peeso reamers. Standardized radiographs and photographs at pre-established measurement levels were taken before preparation, after root canal instrumentation, after Gates Glidden preparation and after Peeso enlargement. All images were digitized and RCWT at the mesial and distal walls measured (imagetool 3.0). Differences between radiographic and anatomic measurements were analysed with paired t- tests. anova was used to compare the percentages of radiographic distortions. Results, Regardless of the time-point evaluated, RCWT determined by radiographs were greater than the respective anatomic measurements (P < 0.05). The difference detected at each stage was similar and constant (P > 0.05). Conclusions, Throughout preparation for post placement, radiographic images overestimated the RCWT by approximately 25%, regardless of the clinical stage evaluated. [source]

Transobturatory tension-free composite sling for urethral support in patients with stress urinary incontinence: Favorable experience after 1 year follow up

INTERNATIONAL JOURNAL OF UROLOGY, Issue 6 2006
IVAN IGNJATOVIC
Objective:, Symptomatic, anatomic and urodynamic results of a composite transobturatory tension-free sling with an absorbable middle part, in patients with stress urinary incontinence (SUI), were studied. Methods:, A prospective study in 40 women with SUI was performed. Symptoms, urodynamics and anatomical improvements were evaluated separately. Surgery was performed with the transobturatory approach. Results:, All patients had both clinically and urodynamically confirmed SUI. Clinical outcome was favorable in 36/40 (90%) patients, after 1 year. Operation improved the position of the bladder neck (2.8 cm and 1.4 cm below the pubic bone, respectively) and significantly decreased mobility of the bladder neck during abdominal straining (3.3 cm and 1.7 cm, respectively). Both symptoms and quality of life were significantly improved 1 month after the surgery. Postoperative maximum flow was lower than the preoperative one but with borderline significance (25.8 and 23.7 mL/s; P = 0.05). Pressure flow study showed unobstructed voiding both preoperatively and postoperatively. Detrusor pressure at the maximum flow was increased (20, 4 and 22, 8 cmH2O, respectively) but not significantly. Conclusion:, Our results confirmed a high objective cure rate, improvement of symptoms and quality of life, and at the same time, corrected position of the bladder neck and unobstructed voiding. [source]

Orthotopic Cardiac Transplantation: Comparison of Outcome Using Biatrial, Bicaval, and Total Techniques

JOURNAL OF CARDIAC SURGERY, Issue 1 2005
Jeffrey A. Morgan M.D.
More recently, however, bicaval and total techniques have been devised in an attempt to improve cardiac anatomy, physiology, and postoperative outcome. A bicaval approach preserves the donor atria and combines the standard left atrial anastomosis with a separate bicaval anastomosis. Total orthotopic heart transplantation involves complete excision of the recipient atria with separate bicaval end-to-end anastomoses, as well as pulmonary venous anastomoses. The aim of this study was to conduct a literature review of studies that compared the three surgical techniques (biatrial, bicaval, and total) for performing orthotopic cardiac transplantation. Numerous outcome variables were evaluated, and included post-transplant survival, atrial dimensions, atrioventricular valvular insufficiency, arrhythmias, pacing requirements, vasopressor requirements, and hospital stay. Methods: We conducted a Medline (Pubmed) search using the terms "biatrial and cardiac transplantation,""bicaval and cardiac transplantation," and "total technique and cardiac transplantation," which yielded 192 entries: 39 of these were studies that compared surgical techniques and were included in the review. Results: There was overwhelming evidence that the bicaval technique provided anatomic and functional advantages, with improvements in post-transplant survival, atrial geometry, and hemodynamics, as well as decreased valvular insufficiency, arrhythmias, pacing requirements, vasopressor requirements, and hospital stay. Conclusions: The bicaval technique was superior to both biatrial and total techniques for numerous outcome variables. To further elucidate this issue, a prospective randomized trial comparing the three techniques, with long-term follow-up, is warranted. [source]

Clinical Experience with a Single Catheter for Mapping and Ablation of Pulmonary Vein Ostium

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2009
PAOLO DE FILIPPO M.D.
Introduction: The aim of this single center study is to evaluate the safety and the efficacy of performing pulmonary vein isolation (PVI) using a single high-density mesh ablator (HDMA) catheter. Methods: A total of 17 consecutive patients with paroxysmal (10 patients) or persistent atrial fibrillation (7 patients) and no heart disease were enrolled. A single transseptal puncture was performed and the HDMA was placed at each PV ostium identified with anatomic and electrophysiological mapping. Pulsed radiofrequency (RF) energy was delivered at the targeted temperature of 58°C with maximum power of 80 watts. No other ablation system was utilized. The primary objective of the study was acute isolation of the targeted PV, and the secondary objective was clinical efficacy and safety of PVI with HDMA for atrial fibrillation (AF) prevention. Patients were followed at intervals of 1, 3, 6, and 12 months. Results: PVI was attempted with HDMA in 67/67 PVs. [Correction made after online publication October 27, 2008: PVs changed from 6/67 to 67/67] Acute success rate were: 100% (16/16) for left superior PV, 100% (16/16) for left inferior PV, 100% (17/17) for right superior PV, 100% (1/1) for left common trunk and 47% (8/17) for right inferior PV. Total procedure time was 200 ± 36 minutes (range 130,240 minutes) and total fluoroscopy time was 42 ± 18 minutes (range 23,75 minutes). During a mean follow-up of 11 ± 4 months, 64% of patients remained in sinus rhythm (8/10 paroxysmal AF and 3/7 for persistent AF). No complications occurred either acutely or at follow-up. Conclusions: PV isolation with HDMA is feasible and safe. The midterm efficacy in maintaining sinus rhythm is higher in paroxysmal than in persistent patients. [source]

Esophageal Temperature During Radiofrequency-Catheter Ablation of Left Atrium: A Three-Dimensional Computer Modeling Study

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2006
FERNANDO HORNERO M.D., Ph.D.
Introduction: There is current interest in finding a way to minimize thermal injury in the esophagus during radiofrequency-catheter ablation of the left atrium. Despite the fact that the esophageal temperature is now being monitored during ablation, the influence of different anatomic and technical factors on the temperature rise remains unknown. Methods and Results: We implemented a three-dimensional computational model that included atrial tissue, epicardial fat, esophagus, aorta, and lung, all linked by connective tissue. The finite-element method was used to calculate the esophageal temperature distribution during a procedure of constant-temperature ablation with an 8-mm electrode, under different tissue conditions. Results showed that the distance between electrode and esophagus was the most important anatomic factor in predicting the esophageal temperature rise, the composition of the different tissues being of lesser importance. The measurement of the esophageal temperature in different sites of the lumen offered differences up to 3.7°C, especially for a short electrode,esophagus distance (5 mm). The difference in the convective cooling by circulating blood around electrode and endocardium did not show a significant influence on the esophageal temperature rise. Conclusion: Computer results suggest that (1) the electrode,esophagus distance is the most important anatomic factor; (2) the incorrect positioning of an esophageal temperature probe could give a low reading for the maximum temperature reached in the esophagus; and (3) the different cooling effect of the circulating blood flow at different atrial sites has little impact on the esophageal temperature rise. [source]

Interactions Between Extracellular Stimuli and Excitation Waves in an Atrial Reentrant Loop

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 10 2003
CHAD R. JOHNSON B.S.E.
Introduction: The interactions between extracellular stimuli and excitation waves propagating in a reentrant loop are a complex function of stimulus parameters, structural properties, membrane state, and timing. Here the goal was a comprehensive understanding of the mechanisms and frequencies of the major interactions between the advancing excitation wave and a single extracellular stimulus, separated from issues of anatomic or geometric complexity. Methods and Results: A modernized computer model of a thin ring of uniform tissue that included a pair of extracellular stimulus electrodes (anode/cathode) was used to model one-dimensional cardiac reentry. Questions and results included the following: (1) What are the major interactions between a stimulus and the reentrant propagation wave, and are they induced near the cathode or near the anode; and, for each interaction, what are the initiating amplitude range and timing interval? At the cathode, the well-known mechanism of retrograde excitation terminated reentry; changes in timing or amplitude produced double-wave reentry or phase reset. At the anode, termination occurred at different cells depending on stimulus amplitude. (2) Relatively how often did termination occur at the anode? For most stimulus amplitudes, termination occurred more often at the anode than at the cathode, although not always at the same cell. (3) With random timing, what is the probability of terminating reentry? Stimulation for 5 msec terminated reentry with a probability from 0% to approximately 10%, as a function of increasing stimulus amplitude. Conclusion: A single extracellular stimulus can initiate major changes in reentrant excitation via multiple mechanisms, even in a simple geometry. Termination of reentry, phase shifts, or double-wave reentry each occurs over well-defined ranges of stimulus amplitude and timing. (J Cardiovasc Electrophysiol, Vol. 14, pp. ***-***, October 2003) [source]

Role of Structural Complexities of Septal Tissue in Maintaining Ventricular Fibrillation in Isolated, Perfused Canine Ventricle

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 1 2001
TAKANORI IKEDA M.D.
Tissue Structure and VF.Introduction: It is unclear how the patterns of wavelet propagation during ventricular fibrillation (VF) vary between structurally different tissues. We hypothesized that the structural complexities of septal tissue influence the maintenance of reentrant wavelets in the ventricle. Methods and Results: Endocardial activation patterns during VF were analyzed in the isolated, perfused canine right ventricular (RV) free wall (n = 9), interventricular septum (n = 5), and left ventricular (LV) free wall (n = 6) using a computerized mapping system (2-mm resolution) with 120-msec consecutive windows. Each tissue sample was cut progressively to reduce the tissue mass until the VF was terminated. More wavelets were seen in the septa than in the RV and LV free walls at baseline (P = 0.004), and VF in the septa displayed a shorter cycle length than in the RV and LV free walls (P = 0.017). As the tissue mass decreased, VF became successively more organized in all regions: the number of wavelets decreased and the cycle length of VF lengthened. Single and "figure-of-eight" stationary, reentrant wavelets often were mapped after tissue mass reduction in the RV free walls and rarely in the LV free walls, but they were not observed in the septa. Less critical mass was required to maintain VF in the septa than in the RV and LV free walls (P = 0.0006). Gross anatomic and histologic examinations indicated that the tissue structure of the septa is more complex than that of the RV and LV free walls. Conclusion: VF activation patterns with progressive reduction of tissue mass differ for the septum and the ventricular free walls. The structural complexities of the septal tissue influence the maintenance of fibrillation in the ventricle. [source]

Endocardial Noncontact Activation Mapping of Idiopathic Left Ventricular Tachycardia

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2000
JASBIR SRA M.D.
Mapping of Idiopathic Ventricular Tachycardia. Idiopathic left ventricular tachycardia with a right bundle, left-axis deviation is thought to originate from posterior fascicles. Recently, there has been considerable interest in the anatomic and mechanistic basis of this arrhythmia. We report our experience with a 26-year-old man in whom new noncontact mapping technology was used to acquire detailed data from the left ventricle, identify the mid-diastolic potential and part of the ventricular tachycardia circuit, and perform successful ablation. This information helped define the physiologic aspects of this unique tachycardia. [source]

Superiority of a functional leukocyte adhesiveness/aggregation test over the white blood cell count to discriminate between mild and significant inflammatory response in patients with acute bacterial infections

JOURNAL OF CLINICAL LABORATORY ANALYSIS, Issue 4 2002
Ori Rogowski
Abstract Electronic cell counters may underestimate the white blood cell count (WBCC) in the presence of aggregated leukocytes. In the present study we focused on the possibility of using a functional, as opposed to an anatomic, count to circumvent this eventual underestimation. A model of bacterial infection was used because of the importance of leukocytosis in the physician's clinical decision-making process. There were 35 patients with low C-reactive protein (CRP) concentrations (0.5,4.9 mg/dL), 45 with intermediate (5,9.9 mg/dL), and 120 with relatively high (>10 mg/dL) CRP concentrations. A significant (P=0.008) difference was noted between the state of leukocyte adhesiveness/aggregation in the peripheral blood of individuals with low CRP concentrations (3.5%±4.3%) and those with high CRP concentrations (7.4%±8%), while there was no significant difference in the respective number of WBCs per cubic millimeter (cmm) (11,600 ± 5,500 and 14,000 ± 7,200, respectively). We raise the possibility that a functional test might be superior over an anatomic count in patients with acute bacterial infection and a significant acute phase response. © 2002 Wiley-Liss, Inc. [source]

Diagnosis of arterial occlusive disease of the upper extremities: Comparison of color duplex sonography and angiography

JOURNAL OF CLINICAL ULTRASOUND, Issue 8 2003
Muharrem Tola MD
Abstract Purpose The aim of this study was to assess the abilities of color duplex sonography (CDUS) to detect and characterize arterial occlusive disease of the upper extremities. Methods We prospectively compared the results of CDUS with those of intra-arterial digital subtraction angiography, which were considered definitive, in patients with symptomatic arterial occlusive disease of the upper extremities. In each extremity, we visualized 9 arterial segments, which were each evaluated for stenoses and occlusions. Each segment was categorized on each imaging modality as not significantly narrowed (narrowed by <50%), significantly narrowed (narrowed by ,50% but <100%), or occluded (100%). Results We examined a total of 578 segments in 57 patients (34 men and 23 women) with a mean age of 50 years (range, 20,74 years). CDUS had a sensitivity, a specificity, a positive predictive value, a negative predictive value, and an accuracy of 98%, 99%, 97%, 99.5%, and 99%, respectively, for detecting occluded lesions and 79%, 100%, 100%, 99%, and 99%, respectively, for detecting hemodynamically significantly stenotic lesions. Notably, the sensitivity of CDUS for diagnosing significantly stenotic lesions (79%) was lower than that for diagnosing occlusive disease (98%). Conclusions With high sensitivity and accuracy rates, CDUS is a reliable screening method for detecting arterial occlusive disease of the upper extremities. This modality efficiently provides anatomic and hemodynamic data that are useful in cases of such disease. © 2003 Wiley Periodicals, Inc. J Clin Ultrasound 31:407,411, 2003 [source]

The Science of Communicating the Art of Esthetic Dentistry.

JOURNAL OF ESTHETIC AND RESTORATIVE DENTISTRY, Issue 3 2000
Part I: Patient-Dentist-Patient Communication
ABSTRACT Many contemporary restorative procedures are primarily esthetically driven, and patients have high expectations. It is imperative for the restorative dentist to understand patients' desires and expectations prior to initiating irreversible therapy. It is equally important for patients to understand the anatomic and technical limitations inherent with restorative therapy. CLINICAL SIGNIFICANCE This article describes several relatively straightforward techniques that can assist in dentist-patient-dentist communication and allow the patient to visualize a reasonable facsimile of the definitive result prior to initiation of irreversible therapy. By using these techniques where indicated, the frustrating cycle of rejection and failure may be avoided. [source]

Recurrent pregnancy loss: A disease of inflammation and coagulation

JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 4 2009
Joanne Kwak-Kim
Abstract Recurrent pregnancy loss (RPL) is one of the most common obstetrical complications. Multiple etiologies, such as endocrine, anatomic, genetic, hematological and immunological causes have been reported for this devastating disease. However, over half of the cases remain unexplained. Thrombotic/inflammatory processes are often observed at the maternal-fetal interface as the final pathological assault in many cases of RPL, including those of unexplained etiologies. In the present paper, cellular immune responses (T, natural killer [NK], natural killer-T [NKT], regulatory T [Treg] cells and their cytokines) and autoimmune abnormalities of women with RPL are reviewed. In addition, metabolic diseases and hematological conditions which often lead to thrombotic/inflammatory conditions are discussed in association with RPL. Finally, current therapeutic options for RPL are reviewed. [source]

Chronic Ethanol Administration Alters Immunoreactivity for GABAA Receptor Subunits in Rat Cortex in a Region-Specific Manner

ALCOHOLISM, Issue 8 2000
A. Chistina Grobin
Background: Chronic ethanol administration has a plethora of physiological effects. Among the most consistently observed findings is a change in the expression pattern of ,-aminobutyric acid type A (GABAA) receptor subunits in the rat brain cortex. These findings led to the hypothesis of "subunit substitution" to account for changes in receptor function without changes in receptor number. Methods: We used subunit (,1 and ,4) specific antibodies and a combination of immunohistochemistry and immunoblotting to examine subregions of cortex (prefrontal, cingulate, motor, parietal, and piriform) for their response to 2 weeks of forced ethanol administration. Results: Overall, cortical immunoreactivity for the ,1 subunit was decreased and for the ,4 subunit increased whether measured immunohistochemically or by immunoblotting. Piriform cortex exhibited a bidirectional change in GABAA receptor ,1 and ,4 immunoreactivity, similar to that previously observed in preparations of whole cortex. However, in parietal cortex, declines in ,1 immunoreactivity (55 ± 12% control value [CV] and 88.3 ± 4.3% CV; immunohistochemistry and immunoblotting, respectively) were not accompanied by concomitant increases in ,4 immunoreactivity (104 ± 8% CV and 116 ± 9.3% CV; immunohistochemistry and immunoblotting, respectively). Conversely, ,4 immunoreactivity increased in cingulate cortex (210 ± 30% CV and 134 ± 9.5% CV; immunohistochemistry and immunoblotting, respectively) without a decline in ,1 immunoreactivity (90 ± 4% CV and 91.3 ± 3.9% CV; immunohistochemistry and immunoblotting, respectively). Prefrontal and motor cortex exhibited GABAA receptor subunit peptide alterations, but these changes varied with the method of analysis. Conclusions: These findings demonstrate that ethanol dependence results in nonuniform changes in GABAA receptor subunit peptide levels across the rat brain cortex and suggest that mechanisms which subserve functional changes in receptor activity may vary in accordance with anatomic or cellular differences within the cortex. [source]

The distal superficial femoral arterial branch to the sartorius muscle as a recipient vessel for soft tissue defects around the knee: Anatomic study and clinical applications

MICROSURGERY, Issue 6 2009
Fernando A. Herrera M.D.
Complex wounds surrounding the knee and proximal tibia pose a significant challenge for the reconstructive surgeon. Most of these defects can be managed using local or regional flaps alone. However, large defects with a wide zone of injury frequently require microvascular tissue transfers to aid in soft tissue coverage and closure of large cavities. We describe a unique recipient vessel for microvascular anastomosis for free flap reconstruction involving the knee and proximal tibia through anatomic and clinical studies. © 2009 Wiley-Liss, Inc. Microsurgery 2009. [source]

Anatomical and functional brain imaging using high-resolution echo-planar spectroscopic imaging at 1.5 Tesla

NMR IN BIOMEDICINE, Issue 4 2005
Weiliang Du
Abstract High-resolution echo-planar spectroscopic imaging (EPSI) of water resonance (i.e. without water suppression) is proposed for anatomic and functional imaging of the human brain at 1.5,T. Water spectra with a resolution of 2.6,Hz and a bandwidth of 333,Hz were obtained in small voxels (1.7,×,1.7,×,3,mm3) across a single slice. Although water spectra appeared Lorentzian in most of the voxels in the brain, non-Lorentzian broadening of the water resonance was observed in voxels containing blood vessels. In functional experiments with a motor task, robust activation in motor cortices was observed in high-resolution T maps generated from the EPSI data. Shift of the water resonance frequency occurred during neuronal activation in motor cortices. The activation areas appeared to be more localized after excluding the voxels in which the lineshape of the water resonance had elevated T and became more non-Lorentzian during the motor task. These preliminary results suggest that high-resolution EPSI is a promising tool to study susceptibility-related effects, such as BOLD contrast, for improved anatomical and functional imaging of the brain. Copyright © 2005 John Wiley & Sons, Ltd. [source]

Results after surgical treatment of transtectal transverse acetabular fractures

ORTHOPAEDIC SURGERY, Issue 1 2010
Xi-gong Li MD
Objective:, To retrospectively evaluate the results of operative treatment of transtectal transverse fractures of the acetabulum. Methods:, From May 1990 to July 2006, 40 patients with displaced transtectal transverse fracture of the acetabulum were treated surgically. A mean postoperative follow-up of 88.6 months' (range, 16,121 months) was achieved in 37 patients. Final clinical results were evaluated by a modified Merle d'Aubigné and Postel grading system. Postoperative radiographic results were evaluated by the Matta criteria. Fracture and radiographic variables were analyzed to identify possible associations with clinical outcome. Results:, Fracture reduction was graded as anatomic in 31 patients, imperfect in 4 and unsatisfactory in 2. Two hips were diagnosed to have subtle instability by postoperative radiography. The clinical outcome was graded as excellent in 16 patients, good in 14, fair in 4 and poor in 3. The radiographic result was graded as excellent in 14 patients, good in 15, fair in 4 and poor in 4. There was a strong association between the final clinical and radiographic outcomes. Variables identified as risk factors for unsatisfactory results included residual displacement greater than 2 mm, comminuted fracture of the weight bearing dome, postoperative subtle hip instability and damage to the cartilage of the femoral head. Conclusion:, The uncomplicated radiographic appearance of transtectal transverse fracture belies its complexity. Comminuted fracture of the weight bearing dome, unsatisfactory fracture reduction, subtle hip instability and damage to the cartilage of the femoral head are risk factors for the clinical outcome of transtectal transverse fracture of the acetabulum. [source]

Sunao Tawara: A Father of Modern Cardiology

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 1 2001
KOZO SUMA
SUMA, K.: Sunao Tawara: A Father of Modern Cardiology. Knowledge of the conduction system of the heart was greatly advanced by Tawara's work carried out in Aschoff's laboratory in Marburg at the beginning of this century. In his monograph, The Conduction System of the Mammalian Heart, published in 1906, Tawara indicated that the treelike structure of specific muscle fibers comprising the atrioventricular node, His bundle, bundle branches, and Purkinje fibers served as the pathway for atrioventricular conduction of excitation in the mammalian heart. From his own anatomic and histological findings of the conduction system, he assumed precisely that the conduction velocity of excitation in the system, except in the atrioventricular node, would be fast and that contraction as the result of excitation would take place at the various sites of the ventricles almost simultaneously. According to Tawara, a long pathway to each contracting unit and a fast conduction velocity of excitation would be a prerequisite for the effective contraction of the ventricles. Tawara's findings and assumptions provided Einthoven the theoretical basis for interpreting the electrocardiogram, resulting in rapid popularization of electrocardiography. This century has witnessed the rapid progress of cardiology, including cardiac pacing and its related sciences. This progress has its roots in the discovery of the conduction system and the development of electrocardiography that took place almost in the same period at the beginning of this century. Tawara's pioneering work on the conduction system still serves as an invaluable reference for basic and clinical research. [source]

Morphology and Anatomy of Shoot, Root, and Propagation Systems in Hoffmannseggia glauca

PLANT BIOLOGY, Issue 6 2007
T. A. Kraus
Abstract: Hoffmannseggia glauca is a perennial weed that has tubers and root-borne buds. Some authors only consider root tubers without mentioning root-borne buds, while others consider that more anatomic studies become necessary to determine the origin of these structures and to interpret their behaviour. The objectives are: to study the growth form of the plant in order to analyze the ontogeny of its propagation organs, and to study its shoot and root anatomical characters that affect water conductivity. Hoffmannseggia glauca was collected in Argentina. Development of its shoot and root systems was observed. Shoots and roots were processed to obtain histological slides. Macerations were prepared to study vessel members. Primary and lateral roots originate buds that develop shoots at the end of the first year. In winter, aerial parts die and only latent buds at soil surface level and subterranean organs remain. In the following spring, they develop innovation shoots. Roots show localized swellings (tuberous roots), due to a pronounced increase of ray thickness and parenchymatous proliferation in the root center. Root vessel members are wider than those of aerial and subterranean shoots. Early development of an extensive root system, presence of root borne buds, anatomic and physiological specialization of innovation shoots, capability of parenchymatous rays to originate buds and tuberous roots, and high water transport efficiency in subterranean organs lead Hoffmannseggia glauca to display higher colonization potential than other species. [source]

Multifactorial dysphagia: Diffuse idiopathic skeletal hyperostosis and eosinophilic esophagitis,

THE LARYNGOSCOPE, Issue 1 2010
Grace Nimmons MD
Abstract Swallowing is a complex, multistage event with oral, pharyngeal, and esophageal phases. A thorough clinical examination for swallowing complaints begins to differentiate whether the problem is due to anatomic, mechanical, or neurologic etiologies. Based on the clinical suspicion, additional tests may be beneficial, including fluoroscopic and direct imaging methods, and electrophysiologic measurements. A multidisciplinary approach may also be advantageous, as in this case of dysphagia from diffuse idiopathic skeletal hyperostosis and eosinophilic esophagitis, which incorporated care from otolaryngology, speech pathology, orthopedic surgery, and gastroenterology. Laryngoscope, 2010 [source]

Endoscopic endonasal surgery for petrous apex lesions

THE LARYNGOSCOPE, Issue 1 2009
Adam M. Zanation MD
Abstract Background: Endoscopic endonasal approaches to the ventral skull base are categorized based on their orientation in coronal and sagittal planes. For all of these approaches, the sphenoid sinus is the starting point, and provides orientation to important vascular and neural structures. Surgical approaches to the petrous apex include 1) a medial approach, 2) a medial approach with internal carotid artery (ICA) lateralization, and 3) a transpterygoid infrapetrous approach (inferior to the petrous internal carotid artery). The choice of a surgical approach depends on the relationship of the lesion to the internal carotid artery (medial or inferior), degree of medial expansion, and pathology. The purpose of this paper is to discuss the anatomic and technical features of endoscopic surgical approaches to the petrous apex, provide a new classification for approaches that focuses on the relationship of the lesion to the petrous internal carotid artery, and provide outcomes data on our first 20 endoscopic petrous apex approaches. Methods: A retrospective clinical outcome study of endoscopic petrous apex surgeries was performed at the University of Pittsburgh Medical Center. The medical records from patients with endoscopic endonasal approaches to isolated petrous apex lesions were reviewed for demographics, diagnoses, presentation, endoscopic approach, and clinical outcomes. Patients with lesions that extended into the petrous apex but were not isolated to the petrous apex were excluded (e.g., clival chordoma with extension into the petrous apex). Results: Twenty patients were included in the analysis: 13 inflammatory cystic lesions (9 cholesterol granulomas and four petrous apicitis) and 7 solid lesions. Chondrosarcoma was the most common solid petrous apex lesion in our series. Twelve of 13 cystic lesions were drained endoscopically (one surgery was aborted early in the series). All drained patients had resolution of presenting symptoms. One patient had closure of the outflow tract without return of symptoms and one patient had revision endoscopic drainage due to scarring and neo-osteogenesis and return of unilateral headache. No carotid injuries and no new cranial neuropathies occurred perioperatively. The advantages and limitations of the medial transsphenoidal approaches (with and without carotid mobilization) and the transpterygoid infrapetrous approach are discussed. Conclusions: The endoscopic endonasal approach to petrous apex lesions is safe and effective for appropriately selected patients in the hands of experienced endoscopic skull base surgeons. If offers advantages of removing the hearing and facial nerve risks from the transtemporal/transcranial approaches and allows for a larger and more natural drainage pathway into the sinuses. Laryngoscope, 119:19,25, 2009 [source]

Upper Airway Mucin Gene Expression: A Review

THE LARYNGOSCOPE, Issue 5 2007
Mahmoud S. Ali MSc
Abstract Introduction: The gel-like properties of mucus depend primarily on its content of mucins. The protein backbones of mucins are encoded by mucin genes. Of the currently known 20 mucin genes that encode protein backbone of mucins, 16 have been identified in the airways. Method: We explored the current knowledge about upper airway mucin expression in health and disease conditions using a Medline search. We have also studied upper airway mucin gene expression and compared our results with the results from other studies. Results: MUC5AC, MUC5B, and MUC2 are the principal gel-forming mucins secreted in the airway. However, the spectrum of mucin expression in chronic upper airway diseases such as nasal polyps, chronic sinusitis, middle ear effusion, and cystic fibrosis is generally wide and variable. Discussion: The wide spectrum of upper airway mucin expression is possibly caused by various anatomic and histologic features as well as physiologic and pathologic variables. These variables have not been fully explored yet, and the majority of airway mucin expression studies used small numbers of samples. Conclusion: Studies including adequate numbers of samples (patients) are more likely to reveal a clearer profile and more precise expression patterns. Generating a clear profile of mucin expression patterns in health and disease requires the analysis of different variables, which can alter that expression. It is also essential to understand the various molecular mechanisms controlling mucin gene and protein expression. This could lead to the invention of novel therapeutic modalities to treat upper airway diseases. [source]

Focal Atrial Fibrillation in Dextrocardia

ANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 3 2009
Takumi Yamada M.D.
A 49-year-old woman with dextrocardia and situs inversus underwent catheter ablation of paroxysmal atrial fibrillation (AF). During the electrophysiologic study, AF triggered by frequent premature atrial contractions (PACs) with a short coupling interval exhibiting a "P on T" pattern occurred. Pulmonary vein mapping revealed that those PACs originated from right-sided (anatomic left) or left-sided (anatomic right) pulmonary veins. In this case with mirror-image dextrocardia, the P-wave morphologies in leads I and aVL and the II/III ratio of the P-wave amplitude were helpful for predicting a right- or left-sided pulmonary vein origin. [source]

Faecal incontinence after lateral internal sphincterotomy is often associated with coexisting occult sphincter defects: A study using endoanal ultrasonography

ANZ JOURNAL OF SURGERY, Issue 10 2001
Joe J. Tjandra
Background: Troublesome faecal incontinence following a lateral internal sphincterotomy (LIS) is often attributed to faulty surgical techniques: division of excessive amount of internal sphincter or inadvertent injury to the external sphincter. The aim of the present paper was to assess the anatomic and physiological factors that may contribute to faecal incontinence following a technically satisfactory lateral internal sphincterotomy by a group of colorectal specialists. Methods: Fourteen patients (nine women, five men; median age: 38 years; range: 23,52 years) who developed troublesome postoperative faecal incontinence were evaluated by clinical assessment, endoanal ultrasonography and anorectal physiological studies (manometry, pudendal nerve terminal motor latency) by two independent observers. The Cleveland Clinic continence score (0,20; 0, perfect continence; 20, complete incontinence) was used to quantify the severity of faecal incontinence. Fourteen continent subjects after a LIS (nine female patients, five male patients; median age: 36 years; range: 20,44 years) were also evaluated as ,continent' controls (continence score , 4). Results: In the incontinent group, the median postoperative Cleveland Clinic continence score was 9 (range: 6,13) compared with a preoperative score of 1 (range: 0,3). On assessment by endoanal ultrasonography the site of the internal sphincterotomy was clearly identified. There were additional coexisting defects, on endoanal ultrasonography, of the external anal sphincter in seven female patients, of the internal sphincter in two female and two male patients; and a defect of both the external and internal sphincters in a male patient who had had a prior fistulotomy. The pudendal nerve terminal motor latency (PNTML) was prolonged in two female patients on the side contralateral to the lateral internal sphincterotomy. In two of five male patients there was no evidence of any occult sphincter injuries. In the continent controls a defect of the distal portion of the external sphincter was noted in one female patient. None of the patients had a prolonged PNTML. The maximum voluntary contraction was significantly lower in the female subjects than in the female continent controls (92 mmHg vs 140 mmHg; P < 0.05), while the resting anal canal pressures and length of the high pressure zone were similar between the study subjects and the continent controls. Conclusion: Troublesome faecal incontinence after a satisfactorily performed lateral internal sphincterotomy is often associated with coexisting occult sphincter defects. [source]