Hybrid microcatheter angioplasty for refractory cerebral vasospasm

Cerebral vasospasm is a significant cause of morbidity and mortality associated with aneurysmal subarachnoid hemorrhage (aSAH). Intra-arterial chemical and mechanical angioplasty, performed alone or in combination, have been shown to ameliorate cerebral vasospasm and improve patient outcomes. Few options exist for patients who fail these traditional endovascular tactics. We propose a hybrid microcatheter technique that combines the mechanical benefit of transient high pressure induced by microcatheter fluid bolus with a low-dose vasodilator infusion. Five patients with moderate to severe symptomatic vasospasm who failed medical and traditional endovascular management were treated using a hybrid microcatheter technique. All angioplasty procedures were technically successful, and the degree of vasospasm improved following angioplasty. There were no complications related to the cerebral angioplasty procedures. None of the patients required repeat endovascular intervention. Hybrid microcatheter angioplasty may be a useful complement to mechanical or pharmacological techniques in the endovascular management of intractable cerebral vasospasm after aSAH.

Hybrid microcatheter angioplasty for refractory cerebral vasospasm

Cerebral vasospasm is a significant cause of morbidity and mortality associated with aneurysmal subarachnoid hemorrhage (aSAH). Intra-arterial chemical and mechanical angioplasty, performed alone or in combination, have been shown to ameliorate cerebral vasospasm and improve patient outcomes. Few options exist for patients who fail these traditional endovascular tactics. We propose a hybrid microcatheter technique that combines the mechanical benefit of transient high pressure induced by microcatheter fluid bolus with a low-dose vasodilator infusion. Five patients with moderate to severe symptomatic vasospasm who failed medical and traditional endovascular management were treated using a hybrid microcatheter technique. All angioplasty procedures were technically successful, and the degree of vasospasm improved following angioplasty. There were no complications related to the cerebral angioplasty procedures. None of the patients required repeat endovascular intervention. Hybrid microcatheter angioplasty may be a useful complement to mechanical or pharmacological techniques in the endovascular management of intractable cerebral vasospasm after aSAH.

El uso del artículo en niños hispanohablantes con trastorno específico del lenguaje / The use of the article by spanish–speaking children with language impairment

Los niños hispanohablantes con desarrollo típico del lenguaje (DTL) y los menores con Trastorno Específico/Primario del Lenguaje (TEL/TPL) en edades escolares continúan cometiendo errores semánticos y pragmáticos que generan omisiones y sustituciones del artículo. Los artículos definidos parecen ser vulnerables a pesar de la variabilidad metodológica y de las diferencias socioculturales y lingüísticas de las investigaciones previas respecto del tema. El objetivo de esta investigación es analizar el uso de los artículos en individuos con TEL. Participaron 45 niños monolingües, hablantes de español, habitantes de México entre 4;0 y 8;0: 1) 15 niños con TEL; 2) 15 niños juntados por edad con DTL; 3) 15 niños juntados por lenguaje con DTL. La tarea experimental consistió en la presentación de juguetes organizados por clases semánticas, las que fueron acompañadas por preguntas que provocaran el uso de artículos definidos, indefinidos y sustantivos escuetos. Los niños con TEL usaron significativamente menos artículos definidos y menos funciones semánticas (roles y sustantivos genéricos) que los grupos con DTL. No se encontraron diferencias significativas en otras funciones (parte - todo o comunes). Los artículos indefinidos y sustantivos escuetos fueron usados en la misma proporción. En la discusión se explica la dificultad de ciertas funciones semánticas abstractas, en contraste con aquellas funciones ligadas a entidades concretas. Este estudio contribuye a comprender los patrones de uso de los artículos, para su inclusión en futuras pruebas de identificación del TEL en español.

Spanish-speaking children with Typical Language Development (TLD) and children with Language Impairment (LI) still commit semantic and pragmatic errors in their school years generating article omissions and substitutions. Definite articles seem to be vulnerable, despite the methodological variability, sociocultural and linguistic differences, among previous research. Forty-five monolingual Spanish-speakers living in Mexico between 4;0 and 8;0 participated: 1) 15 children with LI; 2) 15 children with TLD matched by age; 3) 15 children with TLD matched by language level with the first group. The experimental task consisted in the presentation of toys organized by semantic groups and accompanied by questions that elicit definite and indefinite articles, and bare nouns. Children with LI used significantly less definite articles and less semantic functions (roles and generic nouns) than the TLD groups. No significant differences were found in part-whole and common functions. Indefinites and bare nouns were used in the same proportion. It is explained that some abstract semantic functions carry an additional difficulty, in contrast with functions that are related to concrete entities. This study contributes to the understanding of patterns of article usage for their further inclusion in new tools that identify SLI.

DTH responsiveness of HIV-infected Thai adults.

A study was carried out in Thailand to determine the frequency of reactivity to delayed-type hypersensitivity (DTH) skin tests used for the staging of HIV patients in the United States. A four-antigen panel which included tetanus toxoid (1:10), Candida (1:10), mumps and Trichophyton antigens was assessed in 221 adult subjects from across the full immunological spectrum of HIV disease. Complete anergy was found in 38 per cent of 73 subjects with CD4 counts of 0-200 cells/ml and in 6 per cent of 78 subjects with 201-400 cells/ml. Partial anergy (response to 1 of 4 antigens) was found in 26 per cent of the 0-200 cell/ml group and decreased progressively with increasing CD4 cell count. Results suggested that a 3-member recall antigen panel would provide nearly all the clinically useful information gained by the more standard 4-member panel. In conclusion, DTH skin testing was confirmed to provide a method of assessing the integrity of cellular immune function of HIV-infected Thai adults which correlated with disease progression.

Ventilated improved pit latrines: recent developments in Zimbabwe

This paper describes recent developments in Zimbabwe in the design of ventilated improved pit latrines (VIP). Two basic designs are presented; one suitable for peri-urban areas and the other; a low-cost version of the first; for rural areas. The peri-urban VIP latrine consists of a circular pit (1.5 m diameter; 3 m deep) fully or partially lined with cement mortar and with; at its top; a brick collar on which is supported a 1.9 m diameter; 75 mm thick concrete slab precast on site. A 1.8 m high spiral shaped superstructure in construct on the cover slab in ferrocement or brick and a flat roof slab placed on top. A 150 mm diameter asbestos cement or polyvinyl chloride vent pipe with a fly screen at its top is then erected immediately adjacent to the outside of the superstructure (alternatively a brick vent pipe may be used in conjuction with a brick superstructure). A commercial kit version of this design is also described. The rural VIP latrine consitsts of a rectangular pit (1.5 m x 0.6 m x 3 m) over which are placed longitudinal and transverse wooden logs of around 100 mm diameter which are then covered with anthill soil and a thin layer of cement mortar. A spiral superstructure is then built in mud and wattle; thatch; soil or local bricks and covered with a conically shaped thatched roof. The vent pipe is made from local reeds; fitted with a fly screen and rendered with cement mortar. Both the peri-urban and rural VIP latrine designs have been found to be socially acceptable in Zimbabwe (where some 20 000 have been built) and very effective in eliminating odors and controlling fly breeding in the latrine