Children's color trails test: Greek normative data and clinical validity in children with traumatic brain injury and attention deficit - Hyperactivity disorder.

The Children's Color Trail Test (CCTT) is considered a culture fair equivalent of the Trail Making Test for the assessment of cognitive flexibility in pediatric populations, while others emphasize its additional validity as a measure of attention, perceptual tracking, processing speed, susceptibility to interference and inhibition. The need for standardized neuropsychological tests in Greece, especially for the pediatric population is significant. In the present study, considering the relatively good psychometric properties of the CCTT and its wide cross-cultural application, we decided that such a tool would be useful to Greek clinicians and researchers, and therefore developed norms for the Greek child and adolescent population. Additionally, we examined the clinical validity of the test, administering it to two groups of patients (children with Traumatic Brain Injury and Attention Deficit - Hyperactivity Disorder). We administered the test to 417 native healthy Greek children 6-15 years, recruited primarily from Southwestern Greece from several public schools. Linear regression analysis revealed a significant influence of age on completion time in both parts of the CCTT, whereas sex did not influence time to completion. Older children consistently completed the test faster than younger children, whereas girls and boys performed similarly on both conditions. In addition, CCTT differentiated the performance of children who have had a TBI and those diagnosed with ADHD from the performances of their typically developing peers. This study provides much needed performance and clinical utility data for the pediatric population in Greece on a promising neuropsychological tool for use in clinical and research settings.

Phonological fluency strategy of switching differentiates relapsing-remitting and secondary progressive multiple sclerosis patients.

The strategies used to perform a verbal fluency task appear to be reflective of cognitive abilities necessary for successful daily functioning. In the present study, we explored potential differences in verbal fluency strategies (switching and clustering) used to maximize word production by patients with relapsing-remitting multiple sclerosis (RRMS) versus patients with secondary progressive multiple sclerosis (SPMS). We further assessed impairment rates and potential differences in the sensitivity and specificity of phonological versus semantic verbal fluency tasks in discriminating between those with a diagnosis of MS and healthy adults. We found that the overall rate of impaired verbal fluency in our MS sample was consistent with that in other studies. However, we found no differences between types of MS (SPMS, RRMS), on semantic or phonological fluency word production, or the strategies used to maximize semantic fluency. In contrast, we found that the number of switches differed significantly in the phonological fluency task between the SPMS and RRMS subtypes. The clinical utility of semantic versus phonological fluency in discriminating MS patients from healthy controls did not indicate any significant differences. Further, the strategies used to maximize performance did not differentiate MS subgroups or MS patients from healthy controls.

Comparison of otoplasty results using different types of suturing techniques.

BACKGROUND: Prominent ears are a common congenital deformity. Numerous techniques have been developed for the treatment of protruding ears, indicating that there is no single widely-accepted procedure. Modern otoplasty techniques fall into of two main surgical categories, (1) cartilage sparing (Mustardé & Furnas), and (2) cartilage cutting (Chongchet & Stenström). This study compares an antihelixmastoid suture technique with the normal Mustardé & Furnas technique. METHODS: Within a 5-year period (between 2005 and 2009), 78 patients (mean age 27 years; range 7 to 46) underwent otoplasty performed by the senior author (in a private plastic surgery center), employing the posterior suturing technique (Mustardé & Furnas). Of these 78 patients, 44 underwent otoplasty which combined the usual posterior suturing technique with modification we have developed (antihelixmastoid sutures). Depending on the suture technique used, the patients were divided into two groups: Group 1 (Mustardé & Furnas sutures), Group 2 (Mustardé & Furnas sutures with extra modification). Patients were invited for follow-up examinations 1 month and 1 year after surgery, and all of them attended both these follow-up checks, where recurrence and suture extrusion were evaluated. RESULTS: Group 1: the clinical recurrence rate was 4.55% (3 ears). The suture extrusion rate was 7.6% (5 ears). Group 2: the clinical recurrence rate was 1.25% (1 ear). The suture extrusion rate was 7.5% (6 ears). Patients were generally satisfied with the results in terms of shape and symmetry. There were no complications such as haematoma, ear deformity and skin necrosis. CONCLUSIONS: Posterior suturing with conchomastoid and modification of Mustardé sutures is a simple operation which can be performed quickly. It appears to be effective in terms of recurrence rate (especially in the upper segment) and patient satisfaction.

Cerebellar hemorrhage after supratentorial burr hole drainage of a chronic subdural hematoma.

Cerebellar hemorrhage is an unusual, but increasingly recognized complication after supratentorial surgery. Even rarer are the cases of cerebellar hemorrhage after supratentorial burr-hole drainage of a chronic subdural hematoma (CSDH). The pathophysiology of this rare complication still remains unclear. Hypertension and overdrainage of cerebrospinal fluid seem to be causative factors of postoperative cerebellar hemorrhage. The most important key to minimize this hazardous sequel is to be aware of this potential complication and its pathogenetic mechanisms. We report our case of a 43-year old man who developed cerebellar hemorrhage after burr hole trephination for supratentorial CSDH.

Does motor subtype influence neurocognitive performance in Parkinson's disease without dementia?

The postural instability and gait difficulty (PIGD) motor subtype has been shown to represent a risk factor for development of dementia in Parkinson's disease. Whether this relationship extends to a more subtle cognitive dysfunction in patients is less clear. Therefore, we administered a battery of selected neuropsychological tests to two groups of non-demented patients with mild to moderate disease classified either as PIGD or as non-PIGD subtype and to a group of healthy controls. Groups were matched on potential confounders of neuropsychological performance. No significant differences were revealed between the two groups of patients in the performance of any of the administered neuropsychological tests. However, relative to controls there was a tendency towards a differential pattern of cognitive dysfunction. The PIGD group had slower performance in a test of psychomotor speed and cognitive flexibility, whilst the non-PIGD group performed worse in measures of verbal learning and visuo-spatial perception. In conclusion, the PIGD subtype was not associated with more severe cognitive deficits and may to a certain extent share common mechanisms of cognitive dysfunction with non-PIGD subtypes. Diverse pathological processes however may develop to account for unequal rates of dementia amongst different motor subtypes.

Effect of mifepristone (RU486) on the pituitary response to gonadotrophin releasing hormone in women.

Mifepristone interrupts folliculogenesis in women but the mechanism is not clear. Previous studies have investigated the effect of this compound on gonadotrophin secretion and have provided conflicting results. To study further the effect of mifepristone on basal and gonadotrophin-releasing hormone (GnRH)-induced gonadotrophin secretion, 12 normally ovulating women were investigated during two consecutive menstrual cycles, comprising an untreated cycle (control) and a cycle treated with mifepristone. All women were treated with mifepristone on days 2-8 at the dose of 100 mg (group 1, eight women) or 10 mg per day (group 2, six women). Two women were treated with both regimens in two different cycles. On day 8 of both cycles, the women received two GnRH pulses of 10 micrograms each 2 h apart. Blood samples in relation to the first GnRH pulse were taken at-15, 0, 30, 60, 120, 150, 180 and 240 min. In group 1, the increase in luteinizing hormone (delta LH) in response to GnRH was significantly attenuated from 30 to 180 min, while the increase in follicle stimulating hormone (delta FSH) was attenuated only in response to the second GnRH pulse. No significant decrease in delta LH and delta FSH response to GnRH was seen during treatment with the 10 mg dose (group 2). In group 1, serum oestradiol and inhibin-A concentrations after day 8 were lower than in the control cycles and the LH peak was postponed by 7 days on average. Basal LH values increased significantly on day 8 in both groups, while FSH values did not change significantly compared with the control cycles. A significant increase in serum progesterone and cortisol values occurred during the treatment only in group 1. Mid-luteal values of inhibin-A were significantly lower in cycles treated with 100 mg mifepristone than in the control cycles. We conclude that the disruption of folliculogenesis by mifepristone cannot be explained by a decrease in basal FSH concentrations during the critical period of follicle recruitment and selection. It is possible that mifepristone exerts its effect at the level of the ovary. It is also suggested that progesterone during the follicular phase of the cycle may participate in the control of the self-priming action of GnRH on the pituitary.

PIP: In the UK and Greece, clinical researchers investigated 12 normally ovulating women during two consecutive menstrual cycles (control) and a cycle treated with oral mifepristone (case) on days 2-8 to determine the role of progesterone during the follicular phase of the menstrual cycle and the possible mechanism through which mifepristone interrupts folliculogenesis in women. 7 women received 100 mg mifepristone, and the other 5 women received 10 mg mifepristone. Treatment with 100 mg mifepristone/day during the first half of the follicular phase yielded a significant increase in the timing of the luteinizing hormone (LH) response to gonadotropin releasing hormone (GnRH) from 30 to 180 minutes. In fact, the weakened LH response occurred in both GnRH pulses, suggesting that mifepristone influenced both the releasable and reserve pool of LH in the pituitary gland. Mifepristone (100 mg) also weakened the response of follicle stimulating hormone (FSH) to the second GnRH pulse. 10 mg mifepristone did not have similar effects on the LH and FSH responses to GnRH, however. 100 mg mifepristone caused a reduction in serum estradiol and inhibin-A concentrations after day 8 (p 0.05) and postponed the LH peak by 7 days on average. Mid-luteal inhibin-A concentrations were lower in cycles treated with 100 mg mifepristone than in the control cycles. Both mifepristone doses increased basal LH secretion on day 8 (p 0.05). Basal FSH concentrations throughout the treatment periods were similar to those in controls, however. This suggests that the inhibitory effect of mifepristone on either the selection or further growth of the dominant follicle occurs within the ovary. These findings suggest that progesterone during the follicular phase may contribute to the control of the self-priming action of GnRH on the pituitary.