Anosognosia versus unilateral neglect. Coexistence and their relations to age, stroke severity, lesion site and cognition.

The aim of this study was to examine the association between anosognosia and unilateral neglect (UN), with special focus on age, stroke severity, lesion location and pre-stroke dementia. The basis of this investigation was a population-based stroke incidence study. Anosognosia was assessed using a questionnaire, and UN using a three-item version of the Behaviour Inattention Test, the Baking Tray Task and a test of personal neglect. Stroke severity was assessed using the NIH stroke scale. Patients with anosognosia were older, and they more often had pre-stroke dementia than patients having UN only. No particular lesion localization was associated with anosognosia, while UN was strongly associated with previously defined lesion sites, often in the parietal lobe. There was a borderline significance regarding stroke severity in patients having anosognosia compared with those with UN only. Patients with anosognosia had higher mortality than patients without, but when controlled for age and stroke severity, this effect was not independent. While UN is closely associated with 'classical' lesion sites, anosognosia is a condition that more often occurs in a previously impaired brain. For anosognosia, lesion location appears to be less important. Anosognosia also tends to occur with larger strokes.

Shrinkage of desmoid tumor with interferon alfa treatment: a case report.

We report on a case with desmoid tumor sucessfully treated with low-dose interferon alfa. A desmoid tumor was diagnosed in August 1998 in the right shoulder area of a 23-year-old woman. Surgery would probably have permanently impaired muscle function in her shoulder and arm. Therefore, interferon alfa treatment (0.9 million units twice daily subcutaneously) was started in November 1998 (time = 0). The tumor volume based on magnetic resonance imaging (MRI) was initially 16 cm3. The size of the tumor decreased gradually during 12 months of treatment, and in November 1999 (time = 12 months) MRI showed no clear tumor demarcation. This treatment modality may be considered as an alternative to mutilating surgery in patients with desmoid tumor.

Epidural analgesia with bupivacaine reduces postoperative paralytic ileus after hysterectomy.

This study was undertaken to compare the effects of postoperative bupivacaine epidural analgesia with those of intermittent injections of ketobemidone (a synthetic opioid) on postoperative bowel motility in patients who had had hysterectomies. The epidural group (N = 20) received continuous epidural anesthesia with bupivacaine postoperatively for 26-30 hours and the control group (N = 20) received intermittent injections of ketobemidone for postoperative pain relief. Postoperative bowel movements and propulsive colonic motility were estimated from the first passage of flatus and feces and by following radiopaque markers by serial abdominal radiographs. In the epidural group, the times for first passing of flatus (31 +/- 22 hours; mean +/- SD) and feces (70 +/- 44 hours) were significantly shorter than in the control group (flatus 58 +/- 14 hours and feces 103 +/- 26 hours). The average position of the markers was significantly more distally in the epidural group immediately after operation and the markers continued to move forward during the first postoperative day. In the control group, the markers did not move during this period. The results demonstrate that postoperative bowel peristalsis returned earlier in the patients given epidural analgesia with bupivacaine for pain relief than in patients given a narcotic.