Temporal epileptogenesis: localizing value of scalp and subdural interictal and ictal EEG data.

PURPOSE: To determine the value of scalp epileptiform EEG data and subdural interictal spikes in localizing temporal epileptogenesis among patients requiring invasive recordings. For this delineation, we related such factors to site of subdural seizure origin in 27 consecutive patients. METHODS: Patients with temporal lobe epilepsy whose non-invasive lateralizing data were inconclusive and therefore required subdural electroencephalography were studied. All patients had (a) 24-h scalp telemetered EEGs, (b) adequate bitemporal subdural placements with an inferomesial line extending from a posterior burr hole anteriorly to <2.5 cm from anterior uncus and a lateral line reaching within 2.5 cm of the temporal tip, and (c) > or =2 subdurally recorded seizures. RESULTS: Three hundred one (96%) of 314 subdurally recorded clinical seizures involving all 27 patients arose from a discrete focus; 266 (85%) arose from mesial temporal regions, which was the origin of the majority of seizures in 24 (89%) patients. The majority of subdural seizures arose ipsilateral to the majority of scalp EEG spikes in 22 (81%) of 27, and most subdural seizures of 15 (75%) of 20 arose ipsilateral to scalp seizures. Lateralization of interictal subdural spikes correlated with that of subdural seizures in 74-92% of patients, depending on the method of spike compilation: for example, most subdural seizures arose from the same lobe of most consistent principal temporal spikes in 92% of patients. These indices of epileptogenesis also appeared more commonly on the side of effective (> or =90% improvement) temporal lobectomy than contralaterally in the following proportions: most consistent principal subdural spikes, 86% of patients ipsilateral vs. 9% contralateral; scalp-recorded clinical seizures, 55% vs. 18%; scalp EEG spikes, 45% vs. 9%. CONCLUSIONS: Even among patients whose scalp data are sufficiently complex to require invasive recording for clarification, lateralization of temporal scalp interictal and ictal epileptiform activity and subdural interictal spikes should be included when assessing the side of temporal epileptogenesis.

The carotenoid crocetin enhances pulmonary oxygenation.

Rabbits anesthesized with urethan and subjected to mild hypoxia (60-70 Torr arterial PO2) through a reduction of the minute volume were injected with a carotenoid compound, crocetin, or saline. The increased PO2 in the arterial blood seen subsequently with crocetin is attributed to increased diffusion through plasma. Blood flow rates remained constant and were unaffected by crocetin.

Plasma-mediated alterations of erythrocyte deformability by perfluorochemical blood substitutes.

The effect of perfluorochemical blood substitutes (eg, Oxypherol or Fluosol-DA) on red cell deformability was investigated because these emulsions are in direct contact with red cells when they are used as temporary circulatory aids. Erythrocyte deformability was assessed by a constant volumetric flow rate filtration method. The results of in vitro incubation experiments indicate that perfluorotributylamine causes the deformability of human red cells to decrease significantly in the presence of plasma. However, there is no obvious loss in the deformability when washed cells are used. Neither mean cell volume nor white cells appear to be responsible for the observed effects of perfluorotributylamine. Perfluorodecalin and perfluorotripropylamine, two perfluorochemical compounds that are widely applied clinically, do not induce significant changes in red cell deformability with or without plasma. These results indicate the need for in vitro testing in the development of perfluorochemicals as blood substitutes.

A study of function after tibial cast bracing.

103 patients with fresh unilateral fractures of the tibial shaft were reviewed clinically and radiologically to assess the results of treatment by functional bracing. At review, 84 had returned to their previous employment and all but 22 could run. All had full knee movements, 85 per cent had a normal range or a mild loss of subtalar movement, and only 11 patients had greater than 25 per cent reduction of measured ankle movement. The average shortening measured radiologically was 0.5 cm. Angulation greater than 10 degrees was present in 1 patient. Factors leading to delayed union include comminution, severe displacement, open injuries and not bearing weight. The importance of early weight bearing is discussed.

Growth of the proximal femur after varus-derotation osteotomy in the treatment of congenital dislocation of the hip.

The growth of the upper end of the femur was studied in 50 children with congenital dislocation of the hip in whom a femoral osteotomy had been carried out. All children had unilateral dislocations and had been treated by a proximal femoral varus-derotation osteotomy after closed reduction, excision of the limbus, or open reduction. The average age at osteotomy was 2.3 years. The minimum follow-up was five years (average, 11.6 years). The neck-shaft angle, CE angle, shaft-epiphysis angle, neck-epiphysis angle, diameter of the femoral head, and widths of the femoral neck and shaft were measured on the anteroposterior radiographs. Although no cases of avascular necrosis of the capital epiphysis occurred, 21 children developed deformities of the femoral head, of whom eight showed an abnormal angulation of the capital-epiphyseal plate. The neck-epiphysis angle is described as an alternative to the shaft-epiphysis angle in assessing the orientation of the capital-epiphyseal plate. The best radiographic outcome was obtained when the neck-shaft angle measured 100 degrees to 110 degrees immediately after osteotomy.