Continuous unilateral epileptiform discharge and language delay: effect of functional hemispherectomy on language acquisition.

PURPOSE: To assess the efficacy of functional hemispherectomy in promoting language acquisition in a child with severe language delay and continuous left hemispheric epileptiform discharge in the absence of clinical seizures. We report a 6-month-old girl who initially presented with a right hemiparesis secondary to a lesion of probable prenatal origin in the distribution of the left middle cerebral artery. Weeks later, she developed infantile spasms. At 1.5 years of age, because of intractable seizures, the patient had fenestration of the left porencephalic cyst and anterior temporal lobectomy. The seizures ceased; however, language development remained limited to 35 words at 3.5 years of age. The EEG showed almost continuous epileptiform activity over the left hemisphere with no independent epileptiform potentials contralaterally. She underwent a functional left hemispherectomy. METHODS: Imaging, electroencephalographic investigation, pre- and postoperative psychological and speech assessment were carried out. RESULTS: Considerable language, speech, and behavior improvement was noted within 2 months of surgery. CONCLUSIONS: Interictal epileptiform discharges can interfere with the development of contralateral hemispheric function in the absence of clinical seizures. Early functional hemispherectomy may have a role in promoting optimal language development in appropriately selected patients. Although the primary indication for functional hemispherectomy is to control intractable seizures, a secondary proposed indication is to reduce functional impairment of the other hemisphere by electrical interference.

A review of selected microstomia prevention appliances.

Perioral burns may occur due to electrical, thermal, or chemical agents. The resultant contracture of the facial tissue during healing causes limited oral access, compromised esthetics, and other related problems. This article presents various microstomia prevention appliances used by dentists and hospital burn centers. These appliances reflect different treatment concerns, ease of fabrication, age appropriateness, and cost effectiveness. An understanding of these factors and available appliances will aid the clinician in selecting or developing the best appliance for burn patients.

Genomic structure and chromosomal mapping of the mouse nov gene.

The nov gene encodes a cysteine-rich protein that is overexpressed in avian nephroblastomas. It is a member of the CCN family of proteins, all of which are involved in cell growth. Genomic and cDNA clones encompassing the mouse nov gene have been isolated and characterized. The mouse nov gene is highly conserved with the human and chick nov genes at the level of nucleotide sequence and genomic organization. The exon structure reflects the modular organization of the NOV protein in a number of structural domains. These are highly conserved with other members of the CCN family, as is the distribution of 38 of its 40 cysteine residues. The nov gene maps to chromosome 15, between D15 Mit 153 and D15 Mit 183, in a region of conserved synteny with human chromosome 8.

Sickle cell anemia: a review of the dental concerns and a retrospective study of dental and bony changes.

This paper is a review of the medical concerns pertinent to dental care and a preliminary study of dental findings of the sickle cell anemia (SS) patient. The dental characteristics observed in 21 dental patients with SS are described. Radiographic findings included "stepladder" trabeculae pattern (70%), enamel hypomineralization (24%), calcified canals (5%), increased overbite (30-80%), and increased overjet (56%). Comparisons are made with other studies of the sickle cell patient, and the need for further study is suggested.

Transport of Ca2+ by diltiazem across the lipid bilayer in model liposomes.

The calcium channel antagonist diltiazem was examined for its ability to translocate Ca2+ from an aqueous medium to the nonpolar lipid milieu. We monitored the spectral changes caused by the drug-mediated cation transport at 37 degrees C in unilamellar vesicles made of dimyristoyl phosphatidylcholine (DMPC) and containing the calcium-sensitive dye arsenazo III trapped inside. Vesicle leakage or membrane fusion caused by diltiazem was assessed by the use of vesicles containing fluorescent indicators. These effects were, however, found to be insignificant compared with ion transport. The transport was negligible at temperatures below the liquid crystalline to gel transition temperature of DMPC indicating a carrier mechanism of ion transport. A quantitative analysis of the transport kinetics indicated that a 1:2 Ca(2+)-drug complex is formed inside the lipid. The calcium ionophoretic ability of diltiazem, combined with other related data, suggests a possible role for Ca2+ in the conformation of the drug in the lipid membrane milieu and in its interaction with the calcium channel.

Beneficial effect of brief pre-transfusion incubation of platelets at 37 degrees C.

The effects of brief warming of stored platelet concentrates were assessed in 15 children undergoing transfusion for stable thrombocytopenia due to chemotherapy (n = 13) or aplastic anaemia. Half of a pool of platelet concentrates stored at 22 degrees C was incubated at 37 degrees C for 1 hour and the other half at room temperature. Each patient received one bag of warmed and one of unwarmed cells transfused in random order 2 h apart. Platelet warming improved transfusion efficacy, as assessed on the basis of corrected platelet count increments (CCIs) and platelet morphology. Compared with unwarmed bags, warmed bags had a higher morphology score (p = 0.0001) and a higher CCI (adjusted for the transfusion order) at 1 h (n = 11; p = 0.014) and at 2 h (n = 15, p = 0.006) post transfusion. Thus, with platelets stored at room temperature bags warmed before transfusion to 37 degrees C for 1 h provide a larger number of circulating platelets after transfusion than do unwarmed bags.

Management of behavioral symptoms in disturbed elderly patients: comparison of trifluoperazine and haloperidol.

This double-blind trial compared the efficacy of trifluoperazine 1 mg b.i.d. and haloperidol 0.5 mg b.i.d. as initial doses in the treatment of behavioral symptoms associated with chronic brain syndromes and senile psychoses in 54 institutionalized elderly patients. Forty-four of the patients were followed through the entire 6-week trial. Improvement in symptoms as measured by Clinical Global Impressions (CGI) scores was observed in 86% (N = 19) of those who received trifluoperazine and 90% (N = 20) of those given haloperidol. Twenty-seven percent (N = 6) of the trifluoperazine patients were rated at least moderately improved on the CGI, whereas only 9% (N = 2) of those treated with haloperidol exhibited such improvement. Marginally significant trends favoring trifluoperazine over haloperidol were observed in the ratings obtained on the Brief Psychiatric Rating Scale, the Nurses' Observation Scale for Inpatient Evaluation, and the Sandoz Clinical Assessment-Geriatric. The type and incidence of adverse reactions were similar for the two treatments, with sedation being the most common complaint. None of the patients developed any extrapyramidal motor symptoms.