Changes in hip migration after selective dorsal rhizotomy for spastic quadriplegia in cerebral palsy.

Selective dorsal rhizotomy is increasingly used for management of spastic quadriplegic cerebral palsy but rates of hip stability following the operation have not been reported. Determining hip stability by radiographic measurement of lateral migration of the femoral head beyond a lateral edge of the acetabulum after dorsal rhizotomy allows an objective assessment of the outcome of the operation. This prospective study examined the effect of selective dorsal rhizotomy on lateral migration of the femoral head in 45 children with spastic quadriplegic cerebral palsy. The children ranged in age from 2 to 9 years (average 5 years 1 month) and were grouped according to their ages with 23 children in the 2- to 4-year-old group and 22 children in the 5- to 9-year-old group. Postoperative follow up ranged from 7 to 50 months (average 20 months). The Reimers migration percentage (MP), a measure of the lateral migration of the femoral head, was calculated from anteroposterior hip radiographs taken prior to the operation and at the last follow-up examination. Of the 90 hips involved, 9% improved, 80% remained unchanged, and 11% worsened, yielding a radiographic stability rate of 89%. The hips with postrhizotomy worsening of the MP had an average preoperative MP of 14% (range 9% to 38%) and an average postoperative increase in MP of 18% (range 11% to 37%). Of the 45 children, four subsequently underwent unilateral derotational femoral osteotomies for persistent or worsening hip subluxation. There was a significant tendency for the MP to worsen in patients with lower prerhizotomy MP values (chi 2 = 20.74, df = 4, p = 0.001), but the age of patients and their ambulatory status at the time of rhizotomy had no bearing on postoperative hip stability. The data indicate that selective dorsal rhizotomy prevents progressive lateral migration of the femoral head in the majority of children who undergo the operation for spastic quadriplegia.

Localization of gliosis in the corpus striatum of mice following cortical lesions.

Localized lesions of the medial and lateral frontal cortex were used to study gliosis, neurofilament content and changes in synaptic density in the mouse striatum. Relationships between the sites of cortical lesions and the localization of changes in different regions of the striatum were examined after 3 and 12 weeks. Independent of the location of frontal cortex lesions, glial fibrillary acidic protein (GFAP) immunoreactivity was increased throughout the entire striatum after 3 weeks. Twelve weeks after lesioning, increases in GFAP were confined to the dorsomedial (DM) striatum following medial cortical lesions, and to the dorsolateral (DL) striatum following lateral cortical lesions, suggesting persistent gliosis only in areas of striatal deafferentation. It appears, therefore, that the mechanisms which induce gliosis after short and long time periods are different.

Complete migration of peritoneal shunt tubing to the scalp.

The entire length of distal tubing from a ventriculoperitoneal shunt was found to have migrated into the subgaleal space, and resulted in a shunt obstruction. Upward migration of distal shunt catheters has rarely been reported, but probably involves patient motion that creates a "windlass" effect. Cephaled migration requires a potential space (subgaleal or ventricular) and no resistance to movement of the tubing. This complication can be prevented by securing the shunt near the site of motion.

A comparison of solid intraventricular and dissociated intraparenchymal fetal substantia nigra grafts in a rat model of Parkinson's disease: impaired graft survival is associated with high baseline rotational behavior.

It has been established that substantia nigra (SN) grafts can produce a behavioral effect in animal models of Parkinson's disease when transplanted either into the lateral ventricles as solid tissue fragments or directly into the striatum as dissociated cells. These two transplantation methods (solid-intraventricular and dissociated-intraparenchymal) were directly compared in the present study. Adult male rats received unilateral SN lesions by stereotaxic injection of 6-hydroxydopamine. Fetal ventral mesencephalon, containing the SN, was harvested from 15-day gestational rat fetuses. Equal weights of tissue were transplanted, either as solid-intraventricular or dissociated-intraparenchymal grafts. In the animals with surviving grafts, similar decreases in apomorphine-induced rotational behavior were seen in both dissociated (40.2% at 6 weeks, 29.6% at 12 weeks, N = 12) and solid (31.8% at 6 weeks, 51.0% at 12 weeks, N = 11) graft groups. Control animals receiving tectal grafts showed smaller decreases (dissociated: 12.6% at 6 weeks, 18.8% at 12 weeks, N = 20; solid: 4.1% at 6 weeks, 8.0% at 12 weeks, N = 20). There were no significant overall differences between the effects of the solid and dissociated grafts; however, in the subgroup of animals with high baseline levels of rotational behavior, the solid-intraventricular grafts produced a significantly larger effect then did the dissociated-intraparenchymal SN grafts. There was also a tendency for the effect of the solid-intraventricular grafts to increase gradually over the 12-week testing period, whereas the effects of the dissociated-intraparenchymal grafts were maximal by 6 weeks after transplantation. For both SN graft groups, there were significant correlations between decreases in rotation and numbers of surviving tyrosine hydroxylase-immunoreactive neurons in the grafts. It was also found that animals with no surviving transplanted tyrosine hydroxylase-positive neurons had higher baseline levels of rotational behavior. Therefore, in the present model, solid-intraventricular and dissociated-intraparenchymal SN grafts have similar effects on apomorphine-induced rotational behavior, except that the solid-intraventricular grafts tended to produce a larger effect in animals with high baseline levels of rotational behavior.

Liposomes as carriers of iodolipid radiocontrast agents for CT scanning of the liver.

We studied the potential of liposomes to deliver oil soluble radiocontrast agents to the liver and have developed a new preparation for CT liver scanning. The preparation consists of Ethiodol with a large amount of phospholipids. Nuclear magnetic resonance (NMR) spectroscopy was done for this lipid preparation, and the spectra show that the lipids are in the bilayer liposome configuration. Electron microscopy provides direct visualization of the liposomes. X-ray fluorescence measurements suggest that the Ethiodol is incorporated in the liposomes, and since no other particulate configurations are observed, we conclude that the Ethiodol is contained within the hydrophobic region of the liposomes. We used a GE CTT-8800 scanner and a rabbit model to study the liver uptake of the iodine from the Ethiodol. The iodine uptake in the liver was rapid and significant, and an increase in HU number of more than 40 was observed within 20 minutes after i.v. injection of 50 mg I/kg of body weight. Significant image enhancement was obtained. The iodine from the Ethiodol remained in the liver for several hours. Studies in rabbits with hepatic implants of the VX2-carcinoma show that while normal liver concentrates, areas of tumor do not concentrate the Ethiodol liposomes. Tumors not visible on ordinary scans become visible after administration of this combination. The advantages of this liposomal mode of radiocontrast agent administration are small particle size, rapid uptake in the liver, long retention times, a large increase in HU number and low iodine dose.