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PubMed2000

Parietal sinus pericranii: case report and technical note.

BACKGROUND: Sinus pericranii is a rare vascular anomaly that is defined as a group of abnormal communications between the extracranial and intracranial venous systems, usually involving the superior sagittal sinus. Different surgical techniques have been used to manage this anomaly. Surgical technique and radiologic findings are discussed. CLINICAL PRESENTATION: A case of parietal sinus pericranii is presented that was developed spontaneously. This 33-year-old woman presented with a soft fluctuant mass in the right parietal region adjacent to the midline. She complained of headache and dizziness. The preoperative radiologic findings of simple skull X-ray, computed tomography, bone scan, and direct venogram are presented. The lesion was removed completely and then multiple small vascular channels through the underlying skull were obliterated by air-powered diamond drilling. The presence of vascular endothelium in the pathologic specimen suggested a congenital origin. CONCLUSION: We think this method is very easy and useful for managing the multiple small fenestrations of the sinus pericranii without recurrence.

Adult↗
PubMed1989

Toxicology and Carcinogenesis Studies of Hydrochlorothiazide (CAS No. 58-93-5) in F344/N Rats and B6C3F1 Mice (Feed Studies).

Hydrochlorothiazide is a diuretic active at the distal convoluted tubule and collecting duct. Toxicology and carcinogenesis studies were conducted by feeding diets containing hydrochlorothiazide (USP grade, greater than 98% pure) to groups of F344/N rats and B6C3F1 mice of each sex for 15 days, 13 weeks, 1 year, or 2 years. Additional studies were performed to evaluate teratologic effects in CD(R). rats and CD(R).-1 mice. Genetic toxicology studies were performed with Salmonella, Chinese hamster ovary (CHO) cells, mouse lymphoma cells, and Drosophila. Fifteen-Day and Thirteen-Week Studies: All rats and mice lived to the end of the 15-day studies (dietary concentrations of 0 and 3,125-50,000 ppm). The final mean body weights of all dosed rat groups were 5%-11% lower than those of controls. The final mean body weights of the groups of male mice that received 6,250-50,000 ppm were 10%-14% lower than that of controls. The final mean body weights of dosed and control female mice were similar. Calculi were seen in the urinary bladder of 2/5 male and 2/5 female mice at 50,000 ppm and in 1/5 male and 1/5 female mice at 25,000 ppm. All rats lived to the end of the first 13-week studies (dietary concentrations of 0 and 3,125-50,000 ppm). Final body weights of dosed rats were 7%-16% lower than those of controls. Mineralization in the kidney was observed in all dosed rats and because of this, additional 13-week studies in rats were conducted at lower dietary concentrations. All rats lived to the end of the second 13-week studies (dietary concentrations of 0 and 250-4,000 ppm). The final mean body weights of all dosed rat groups were 5%-10% lower than those of controls. Renal mineralization was dose related and judged to be minimal to mild at the lowest dose. In the 13-week studies in mice, 7/10 males and 1/10 females that received 50,000 ppm hydrochlorothiazide died. The final mean body weights of mice that received 50,000 ppm were 11% lower than those of controls for males and females. Calculi were seen in the urinary bladder of mice that received hydrochlorothiazide at 12,500 ppm and above. Nephrosis occurred with dose-related incidences in mice receiving 12,500 ppm and above. Based on these results, 2-year studies were conducted by feeding diets containing 0, 250, 500, or 2,000 ppm hydrochlorothiazide to groups of 50 male and 50 female rats for 105-106 weeks. Diets containing 0, 2,500, or 5,000 ppm hydrochlorothiazide were fed to groups of 50 male and 50 female mice for 103-104 weeks. Ten additional rats per sex and dose group were placed on study and killed at 1 year for blood-clotting studies and histopathologic examination. Effects in the One-Year Studies: One of 10 female rats in the 1-year study group that received 2,000 ppm died with internal hemorrhage. In addition, evidence of hemorrhage was found in 11 of the 16 dosed female rats that died during the first year of the 2-year study. Hematologic analyses revealed no compound-related effects; however, activated partial thromboplastin times (APTTs) were highly variable and were lengthened in some dosed male rats. No effects on APTTs were seen for females, and no effects on prothrombin times or on the fibrinogen content of plasma were observed for dosed male or female rats. Nephropathy occurred in dosed and control rats, and the severity was judged to be greater in dosed male and high dose female rats. Increased incidences of mild focal renal mineralization were also seen in mid and high dose male rats and dosed female rats. Body Weight and Survival in the Two-Year Studies: Mean body weights of dosed rats were 8%-25% lower than those of controls. Mean body weights of dosed and control mice were similar throughout the studies. No significant differences in survival were observed between rats or mice of either sex (rats-- male: control, 18/50; low dose, 16/50; mid dose, 9/50; high dose, 11/50; female: 31/50; 26/50; 30/50; 27/50; mice--male: control, 43/50; low dose, 42/50; high dose, 43/50; female: 38/50; 40/50; 35/50). Survival of all groups of male rats was low because a lar female: 38/50; 40/50; 35/50). Survival of all groups of male rats was low because a large number of animals were killed in a moribund condition late in the study. The average daily feed consumption by dosed rats was 89%-94% that by controls. The average amount of hydrochlorothiazide consumed per day was approximately 11, 23, or 89 mg/kg for low, mid, or high dose rats. The average daily feed consumption by dosed mice was 100%-105% that by controls. The average amount of hydrochlorothiazide consumed per day was approximately 280 or 575 mg/kg for low dose or high dose mice. Nonneoplastic and Neoplastic Effects in the Two-Year Studies: Nephropathy occurred in nearly all male and female rats, but the severity of this disease was greater in dosed rats, as evidenced by increases in renal cysts and epithelial hyperplasia of the renal pelvis in dosed rats shown in the following table (see page 4 of the Technical Report). Mineralization was observed at increased incidences in dosed male and dosed female rats. Changes associated with or secondary to renal injury were increased in dosed rats. These lesions included parathyroid hyperplasia, fibrous osteodystrophy of bone, and mineralization of multiple organs. Adenomas or carcinomas (combined) of the Zymbal gland in male rats occurred in 1/50 control, 1/49 low dose, 2/50 mid dose, and 4/50 high dose animals. The historical incidence of Zymbal gland neoplasms in untreated F344/N rats is 19/1,936 (1.0%), and the highest observed control group incidence is 4/50. This marginal increase was not considered to be chemically related. The incidences of fibroadenomas of the mammary gland were decreased in dosed female rats (30/50; 12/50; 11/49; 5/50). The incidence of hepatocellular neoplasms was increased in high dose male mice (adenomas or carcinomas, combined: control, 7/48; low dose, 10/49; high dose, 21/50). The historical incidence of hepatocellular adenomas or carcinomas (combined) is 609/2,032 (30%) in untreated controls. Teratology: Hydrochlorothiazide produced no teratologic effects in the offspring of CD®. rats or CD®.-1 mice after gavage administration to pregnant females on day 6 through day 15 of gestation. Genetic Toxicology: In the absence of exogenous metabolic activation, hydrochlorothiazide produced an equivocal increase in revertant colonies in Salmonella typhimurium strain TA98; no increase was observed in strains TA100, TA1535, or TA1537 with or without activation. Hydrochlorothiazide induced an increase in trifluorothymidine (Tft)-resistant cells in a mouse lymphoma L5178Y/TK+/- assay without exogenous metabolic activation; this assay was not performed with activation. In cultured CHO cells, hydrochlorothiazide induced sister chromatid exchanges (SCEs) in the presence and absence of exogenous metabolic activation but did not induce chromosomal aberrations. Hydrochlorothiazide did not increase the frequency of sex-linked recessive lethal mutations when administered by feeding or injection to adult male Drosophila melanogaster. Audit: The data, documents, and pathology materials from the 2-year studies of hydrochlorothiazide have been audited. The audit findings show that the conduct of the studies is documented adequately and support the data and results given in this Technical Report. Conclusions: Under the conditions of these 2-year feed studies, there was no evidence of carcinogenic activity of hydrochlorothiazide for male or female F344/N rats given feed containing 250, 500, or 2,000 ppm hydrochlorothiazide. There was equivocal evidence of carcinogenic activity of hydrochlorothiazide for male B6C3F1 mice, based on increased incidences of hepatocellular neoplasms. There was no evidence of carcinogenic activity for female B6C3F1 mice given diets containing 2,500 or 5,000 ppm hydrochlorothiazide. Chronic renal disease was more severe in rats administered hydrochlorothiazide, and increased incidences of secondary lesions (parathyroid hyperplasia, fibrous osteodystrophy, and mineralization in multiple organs) occurred in dosed rats. Synonym: 6-chloro-3,4-dihydro-2H-1,2,4-benzothia-diazine-7-sulfonamide 1,1-dioxide Trade Names: Aquarius; Bremil; Chlorzide; Cidrex; Dichlorosal; Dichlotride; Diclotride; Direma; Disalunil; Esidrix; Fluvin; Hidroronol; Hydril; Hydro-Aquil; Hydro-Diuril; Hydrosaluric; Hydrothide; Hypothiazide; Ivaugan; Jen-Diril; Maschitt; Nefrix; Neo-Codema; Neoflumen; Oretic; Panurin; Ro-Hydrazide; Thiaretic; Thiuretic; Urodiazin; Vetidrex

Journal Article↗
PubMed1999

Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. American Academy of Pediatrics. Committee on Quality Improvement. Subcommittee on Urinary Tract Infection.

OBJECTIVE: To formulate recommendations for health care professionals about the diagnosis, treatment, and evaluation of an initial urinary tract infection (UTI) in febrile infants and young children (ages 2 months to 2 years). DESIGN: Comprehensive search and analysis of the medical literature, supplemented with consensus opinion of Subcommittee members. PARTICIPANTS: The American Academy of Pediatrics (AAP) Committee on Quality Improvement selected a Subcommittee composed of pediatricians with expertise in the fields of epidemiology and informatics, infectious diseases, nephrology, pediatric practice, radiology, and urology to draft the parameter. The Subcommittee, the AAP Committee on Quality Improvement, a review panel of office-based practitioners, and other groups within and outside the AAP reviewed and revised the parameter. METHODS: The Subcommittee identified the population at highest risk of incurring renal damage from UTI-infants and young children with UTI and fever. A comprehensive bibliography on UTI in infants and young children was compiled. Literature was abstracted in a formal manner, and evidence tables were constructed. Decision analysis and cost-effectiveness analyses were performed to assess various strategies for diagnosis, treatment, and evaluation. TECHNICAL REPORT: The overall problem of managing UTI in children between 2 months and 2 years of age was conceptualized as an evidence model. The model depicts the relationship between the steps in diagnosis and management of UTI. The steps are divided into the following four phases: 1) recognizing the child at risk for UTI, 2) making the diagnosis of UTI, 3) short-term treatment of UTI, and 4) evaluation of the child with UTI for possible urinary tract abnormality. Phase 1 represents the recognition of the child at risk for UTI. Age and other clinical features define a prevalence or a prior probability of UTI, determining whether the diagnosis should be pursued. Phase 2 depicts the diagnosis of UTI. Alternative diagnostic strategies may be characterized by their cost, sensitivity, and specificity. The result of testing is the division of patients into groups according to a relatively higher or lower probability of having a UTI. The probability of UTI in each of these groups depends not only on the sensitivity and specificity of the test, but also on the prior probability of the UTI among the children being tested. In this way, the usefulness of a diagnostic test depends on the prior probability of UTI established in Phase 1. Phase 3 represents the short-term treatment of UTI. Alternatives for treatment of UTI may be compared, based on their likelihood of clearing the initial UTI. Phase 4 depicts the imaging evaluation of infants with the diagnosis of UTI to identify those with urinary tract abnormalities such as vesicoureteral reflux (VUR). Children with VUR are believed to be at risk for ongoing renal damage with subsequent infections, resulting in hypertension and renal failure. Prophylactic antibiotic therapy or surgical procedures such as ureteral reimplantation may prevent progressive renal damage. Therefore, identifying urinary abnormalities may offer the benefit of preventing hypertension and renal failure. Because the consequences of detection and early management of UTI are affected by subsequent evaluation and long-term management and, likewise, long-term management of patients with UTI depends on how they are detected at the outset, the Subcommittee elected to analyze the entire process from detection of UTI to the evaluation for, and consequences of, urinary tract abnormalities. The full analysis of these data can be found in the technical report. History of the literature review along with evidence-tables and a comprehensive bibliography also are available in the report. (ABSTRACT TRUNCATED)

Algorithms↗
PubMed2004

Use of intraoperative dynamic infrared imaging with detection wavelength of 7-14 microm in the surgical obliteration of spinal arteriovenous fistula: case report and technical considerations.

BACKGROUND AND OBJECTIVE: Although improvements of spatial and temporal resolution in infrared (IR) imaging have enabled intraoperative real-time acquisition of physiological and pathological information on living organs, the imaging qualities of anatomical delineation of blood vessels and functional delineation of blood flow were insufficient to serve as visual monitoring. The main reason was partly due to the lack of an appropriate IR detection IR band (formerly 3 - 5 micro m), and the broad dynamic range in previous modalities. METHODS: To make a good contrast between blood vessels and surrounding tissues, the detection wavelength was shifted to the long-wave (7 - 14 micro m) part of IR spectrum, which includes the peak IR wave from living tissue (9 - 10 micro m), and the dynamic range was confined to +/- 10 degrees C around 35 degrees C. The novel camera system (IRIS IV infrared imaging system) was used for the visual monitoring of blood flow during the obliteration of a spinal perimedullary arteriovenous fistula at Th 7 in 71-year-old male patient. The temperature resolution of camera was 0.15 degrees C, with its intensity resolution of 16 bit (320 x 240 pixels), and data were stored at a rate of 30 frames/second. High-quality delineation of blood vessels and blood flow was obtained all through the procedure without use of cold saline, which was an inevitable procedure to make contrast in the previously used thermography. However, the occasional use of an air blower was helpful to achieve adequate images in the deep and narrow area of the surgical field. The amount of shunt flow reduction was visualized by the intensity in the acquired imaging, which was also confirmed later by digital subtraction angiography. CONCLUSION: From the present experience, it is considered that this type of imaging may be able to substitute intraoperative blood vessel and blood flow monitoring in spinal and other neurosurgical disorders.

Aged↗
PubMed1993

NTP Toxicology and Carcinogenesis Studies of Polybrominated Biphenyls (CAS No. 67774-32-7)(Firemaster FF-1(R)) in F344/N Rats and B6C3F1 Mice (Feed Studies).

Polybrominated biphenyls are synthetic chemicals used as flame retardants. The technical product used in these studies, Firemaster FF-1(R)), is a mixture of brominated biphenyls. Firemaster FF-1(R)) is a known liver carcinogen in rats and mice and is one of three compounds chosen by the National Toxicology Program to investigate the potential value of perinatal exposures in assessing chemical carcinogenicity. Chronic toxicity and carcinogenicity studies of polybrominated biphenyls (Firemaster FF-1(R)) were conducted in F344/N rats and B6C3F1 mice of each sex. The studies were designed to determine: a) the effects of polybrominated biphenyls in rats and mice receiving adult ( F1) exposure only (a typical carcinogenicity study), b) the toxic and carcinogenic effects of polybrominated biphenyls in rats and mice receiving perinatal (F0) exposure only (dietary exposure of dams prior to breeding and throughout gestation and lactation), and c) the effects of combined perinatal and adult exposure to polybrominated biphenyls. STUDIES IN F344/N RATS: The exposure levels selected for F1 exposure, based on studies of polybrominated biphenyls in the literature, were 3, 10, and 30 ppm. In a preliminary study to determine the perinatal dietary concentrations for the 2-year study, female rats were administered 1 to 30 ppm polybrominated biphenyls in the feed beginning 60 days prior to breeding and continuing throughout gestation, lactation, and up to 4 weeks postweaning. The mean preweaning litter weight of the 30 ppm group was less than 80% of the mean litter weight of the control group at days 0, 4, and 12. At weaning, the mean weight of litters in this group was 80% of the control group mean. The final mean body weights (28 days after weaning) of males and females receiving 30 ppm were 13% to 19% lower than the final mean body weights of the controls. Therefore, dietary concentrations of 0, 1, 3, and 10 ppm were selected for the F0 exposure levels in the 2-year study. The eight F0 F1 exposure combinations selected for the 2-year study are shown in the following table (see page 6 of full technical report). Adult-Only Exposure The major organ affected by toxicity of polybrominated biphenyls was the liver. Rats evaluated at 9 months had decreased body weights, hepatomegaly, nonneoplastic histopathologic changes in the liver, mild anemia, increases in serum cholesterol concentrations, and decreases in serum triglyceride concentrations (males only). In rats receiving adult only exposure (F0 F1 concentrations of 0:10 or 0:30 ppm), there were no significant effects on survival. Mean body weights were significantly reduced in 0:10 and 0:30 ppm male rats and in 0:30 ppm female rats. Males and females exposed to 0:10 or 0:30 ppm had increased incidences of hepatocellular neoplasms (males: 0:0 ppm, 1/50; 0:10 ppm, 12/49; 0:30 ppm, 41/50; females: 0/50,12/50, 39/50). Increased incidences of the following nonneoplastic lesions were associated with the administration of polybrominated biphenyls: eosinophilic foci, cytoplasmic vacuolization, oval cell hyperplasia, and hypertrophy in the liver of males and females; acanthosis, inflammation, and ulceration of the forestomach in exposed males; and cystic endometrial hyperplasia of the uterus in 0:30 ppm females. Perinatal-Only Exposure For rats receiving only perinatal exposure (10:0 ppm), there were no changes in survival or body weights compared to the 0:0 ppm control groups. In female rats, there were no effects on neoplasm incidences, but perinatal exposure was associated with a marginally increased incidence of hepatocellular adenoma in male rats (0:0 ppm, 1/50; 10:0 ppm, 5/50). The incidences of nonneoplastic lesions in the liver were increased in exposed males (eosinophilic foci and cytoplasmic vacuolization) and females (eosinophilic foci). Combined Perinatal and Adult Exposure Combined perinatal and adult exposure resulted in marginally reduced survival compared to the 0:0 ppm control group for male rats in the 3:10, 10:10, and 10:30 ppm groups. No significant survival differences were obseant survival differences were observed in female rats. The final mean body weights of male and female rats receiving 3:10,10:10, or 10:30 ppm were lower than those of the 0:0 ppm controls. In male rats, there were no enhancing effects of combined perinatal and adult exposure on the incidence of hepatocellular neoplasms. However, perinatal exposure enhanced the development of liver neoplasms in female rats receiving 10 or 30 ppm adult exposure. A combined analysis of all male and female exposure groups also revealed increased incidences of mononuclear cell leukemia that were considered related to polybrominated biphenyls exposure. STUDIES IN B6C3F1 MICE: The exposure levels selected for the F1 exposure, based on studies of polybrominated biphenyls in the literature, were 3,10, and 30 ppm. In a preliminary study to determine the perinatal dietary concentrations for the 2-year study, female C57BL/6N mice were exposed to 1 to 30 ppm polybrominated biphenyls in the feed beginning 60 days before breeding to C3H/HeN males, continuing throughout gestation and lactation and up to 4 weeks postweaning. There were no clear chemical-related effects on survival or growth at any phase of the study; therefore, 0, 3,10, and 30 ppm dietary concentrations were selected for the F0 exposure levels in the 2-year study. The eight F0 F1 exposure combinations selected for the 2-year study are shown in the table below (see page 7 of full technical report). Adult-Only Exposure The major organ affected by toxicity of polybrominated biphenyls was the liver. Animals evaluated at 9 months had lower body weights than the controls, hepatomegaly, and histopathologic changes in the liver. In mice receiving adult-only exposure, no males or females in the 0:30 ppm group survived to the end of the study. Neither survival nor body weights were affected in the 0:10 ppm groups. Males and females receiving 0:10 or 0:30 ppm had markedly increased incidences of hepatocellular neoplasms (males: 0:0 ppm, 16/50; 0:10 ppm, 48/49; 0:30 ppm, 48/50; females: 5/50, 42/50, 47/48). Increased incidences of nonneoplastic liver lesions including cytomegaly (hypertrophy), fatty change (cytoplasmic vacuolization), bile duct hyperplasia, eosinophilic and clear cell foci, and necrosis of individual hepatocytes were related to treatment with polybrominated biphenyls. Increased incidences and severity of chronic nephropathy in the kidney and excessive hematopoiesis in the spleen of 0:30 ppm males and females were also considered to be related to exposure to polybrominated biphenyls. Perinatal-Only Exposure There were no survival or body weight differences in mice receiving only perinatal exposure (30:0 ppm). Perinatal exposure resulted in significantly increased incidences of hepatocellular neoplasms in males and females. The incidences of nonneoplastic lesions (cytomegaly, eosinophilic foci, clear cell foci) were increased in males and females. Combined Perinatal and Adult Exposure Combined perinatal and adult exposure resulted in markedly reduced survival for females in the 30:10 ppm group; no mice receiving 30:30 ppm survived to the end of the study. In those groups receiving adult exposure of 30 ppm, mean body weights were not affected. The incidence of hepatocellular neoplasms in male and female mice was significantly increased. At the 9-month interim evaluation the incidence of hepatocellular adenomas was significantly increased in males (0:30 ppm, 1/10; 30:30 ppm, 7/10). The incidence of hepatocellular adenomas in 30:30 ppm females was similar to that of 0:30 ppm females (0:30 ppm, 0/10; 30:30 ppm, 3/10). At the end of the study the incidence of hepatocellular adenomas in males was statistically increased (0:30 ppm, 42/50; 30:30 ppm, 48/50). The incidence of hepatocellular adenomas in 30:30 ppm females was statistically decreased compared to that of 0:30 ppm females (0:30 ppm, 46/48; 30:30 ppm, 41/47). It was not possible to assess the potential enhancing effect of combined perinatal and adult exposure on hepatocellular neoplasms because adult-only exposure resulted in such high (84% to 98%) liver neoplasm incidences. CONCLUSIONS: Adult-Only Exposure Under the conditions of these 2-year, adult-only, dietary exposure studies, there was clear evidence of carcinogenic activity for polybrominated biphenyls in male and female F344/N rats and male and female B6C3F1 mice based on increased incidences of hepatocellular neoplasms. Perinatal-Only Exposure Perinatal exposure alone (through dietary administration of 10:0 ppm polybrominated biphenyls to the dams) had no effect on the incidences of neoplasms in female F344/N rats, but in male F344/N rats, perinatal exposure was associated with a marginally increased incidence of hepatocellular adenomas that may have been related to chemical administration. In male and female B6C3F1 mice, perinatal exposure to 30:0 ppm polybrominated biphenyls resulted in significantly increased incidences of hepatocellular neoplasms. The incidences of a number of nonneoplastic lesions in the liver (cytomegaly, eosinophilic focus, and clear cell focus) were increased in male and female B6C3F1 mice. Combined Perinatal and Adult Exposure Combined perinatal and adult dietary exposure to polybrominated biphenyls confirmed findings of the adult-only exposures for the increased incidences of hepatocellular neoplasms in F344/N rats and B6C3F1 mice. In male F344/N rats, there were no enhancing effects of combined perinatal and adult exposure. However, perinatal exposure enhanced the susceptibility of female F344/N rats receiving adult exposure of 10 or 30 ppm to the induction of liver neoplasms. For male and female F344/N rats, a combined analysis of the incidences of leukemia in the adult-only, perinatal-only, and combined perinatal and adult exposure groups revealed an apparent association between increasing incidences of mononuclear cell leukemia and exposure to polybrominated biphenyls. In male and female B6C3F1 mice, it was not possible to adequately assess the enhancing effects of combined perinatal and adult exposure on hepatocellular neoplasms, because adult-only exposure to 10 or 30 ppm polybrominated biphenyls resulted in high incidences (84% to 98%) of liver neoplasms. However, with increased perinatal exposure, there were increases in the numbers of B6C3F1 mice with hepatocellular carcinomas and in the numbers of B6C3F1 mice with multiple hepatocellular adenomas, which suggests an enhancement of polybrominated biphenyls-related hepatocellular carcinogenicity associated with perinatal exposure. Synonyms: PBBs; polybrominated biphenyl mixture; hexabromobiphenyl (technical grade); brominated biphenyls; polybromobiphenyls

Journal Article↗
PubMed1990

Technical workshop report: Working Group I: Occupational health and safety strategies for agriculture.

The six workshops in this subgroup--Injuries, Respiratory Diseases, Acute Chemical Toxicity, Cancer, and Health Surveillance--competently outlined the principal health and safety issues in agriculture, documenting the increased and unacceptable morbidity and mortality in farmers and their families. It became evident that although research knowledge is just now unfolding, sufficient data exist to permit comprehensive program planning for research and prevention. It is necessary that farmers and their families be considered an occupational grouping and that specific programs aimed at ongoing risk assessment and early diagnosis are important. At the same time, a more broadly based approach to rural family life enhancement is essential, including the following: 1) education; 2) prevention; 3) family life enhancement; and 4) research. Because of the scope and nature of the problem, program development should include a multidisciplinary approach that involves the local community, state government, university (professional) resources, farm/organizations, and industry.

Agricultural Workers' Diseases↗
PubMed1996

Transcingulate approach to lateral ventricle tumors. Technical case report.

Surgical experience with treatment of two lateral ventricle tumors using the anterior transcingulate approach demonstrate that this route provides an excellent approach to tumors attached to the lateral wall of the anterior ventricle, without causing gross neurologic deficits. This approach deserves attention as an alternative to the transcallosal approach in selected patients.

Adolescent↗
PubMed2002

Dynamic changes during evacuation of a left temporal abscess in open MRI: technical case report.

We demonstrate the usefulness of "near real-time" neuro-navigation by open MRI systems for guidance of stereotactic evacuation of intracranial abscesses. A 70-year-old patient was referred to our institution with an intracranial left temporal abscess. He presented with headache, senso-motor aphasia and mild right hemiparesis. The abscess (35 x 25 mm) was stereotactically evacuated under MRI guidance, and a recurrence of a daughter abscess was again evacuated on the 9th postoperative day. "Near real-time" imaging showed an indentation of the abscess wall of 11 mm along the trajectory. A thermosensitive MRI protocol demonstrated a higher temperature around the abscess capsule than in the brain tissue more distant to the capsule, demonstrating the inflammatory process. The patient had 6 weeks of antibiotic therapy for gram-negative bacteria and was discharged with improved clinical symptoms 5 weeks after admission. Follow-up CT 2 months postoperatively showed a complete resolution of the abscess. Open MRI-guided interventions with "near real-time" imaging demonstrate the anatomical changes during an ongoing procedure and can be accommodated for enhancing the overall precision of stereotactic procedures. Thermosensitive MRI protocols are capable of revealing temperature gradients around inflammatory processes.

Aged↗
PubMed2005

Overlapping stent-supported coil embolization of wide-neck basilar tip aneurysm: technical case reports.

We report two cases in which wide-neck basilar aneurysms were treated with overlapping stent-supported coil embolization. This overlapping technique ensures complete stent interface with the aneurysm neck and likely improves long-term outcomes. We demonstrated the feasibility of this novel technique and suggest its application for other bifurcation aneurysms requiring stent-supported coil embolization.

Adult↗
PubMed2006

Placement of a Neuroform2 stent into the parent vessel by navigating it along the inner wall of the aneurysm sac: a technical case report.

INTRODUCTION: The Neuroform2 stent has proven to be a very helpful device in the stent-assisted coiling of wide-necked cerebral aneurysms particularly because of its high navigability. We describe the case of a 33-year-old man with a ruptured anterior cerebral artery aneurysm that was successfully embolized and a wide-necked unruptured middle cerebral artery (MCA) aneurysm that required stent-assisted coiling. METHODS: All attempts to catheterize the parietal branch of the MCA in order to deploy the stent were unsuccessful since various guidewires followed a circular path inside the aneurysm sac. Based on our experience on the flexibility of the Neuroform2 stent, and since the aneurysm was unruptured, we decided to follow the circular path of the wire inside the aneurysm with the stent microcatheter. RESULTS: The stent navigated easily into the parietal branch where it was correctly deployed and the aneurysm was uneventfully embolized. CONCLUSION: This maneuver might pose the risk of aneurysm puncture in ruptured aneurysms but might prove helpful in unruptured wide-necked calcified or partially thrombosed aneurysms.

Adult↗
PubMed2001

Combined surgery and endovascular stenting for basilar artery stenosis refractory to balloon angioplasty: technical case report.

The authors report a case of symptomatic basilar artery stenosis treated by stenting via the surgically exposed C1 vertebral artery. This case was initially treated by percutaneous transluminal angioplasty via a transfemoral route but resulted in unsatisfactory dilatation. Stenting via a transfemoral route also resulted in failure because of the coiling of the proximal vertebral artery. Direct puncture of the vertebral artery beyond the coiling portion was tried but a stent could not be delivered beyond the C2 vertebrae. Finally, the vertebral artery was surgically exposed between C1 and the occipital bone and a stent was introduced into the lesion from this portion under fluoroscopic control. The basilar artery was fully opened by stenting without new neurological deficits. Stenting of the basilar artery via a transfemoral route is not always possible even with newer generation stents if the vertebral artery has elongated tortuous curves. Combined surgery and endovascular stenting is one of the alternatives in such cases including our case.

Aged↗
PubMed1985

Malathion and malaoxon: histopathology reexamination of the National Cancer Institute's carcinogenesis studies.

In the early 1970s the National Cancer Institute (NCI) studied malathion and the oxygen analog, malaoxon, for possible carcinogenicity in rats and mice. The results from these long-term studies were reported in three NCI Technical Reports with the conclusions that neither chemical was shown to be carcinogenic in rodents. In response to the renewed public health interest and concern about the increasing use of malathion in agriculture and especially its use to eliminate Mediterranean fruit fly infestations in California and Florida during the 1980s, the National Toxicology Program (NTP) in consultation and agreement with the NCI reevaluated the histopathology of the NCI studies of malathion in Osborne-Mendel and Fischer 344 rats and of malaoxon in Fischer 344 rats. The NTP histopathology reexamination confirmed the original NCI interpretative conclusions that malathion was not carcinogenic. For the malaoxon study, the only difference between the original and subsequent interpretations was for C-cell neoplasms of the thyroid gland, in that the NTP concluded there was equivocal evidence of carcinogenicity for male and female F344 rats.

Animals↗
PubMed2005

Protection of the C1 posterior arch in atlantal lateral mass fixation: technical case report.

Screw fixation of the C1 lateral mass is a relatively new technique designed to allow for C1/C2 fixation in scenarios where transarticular screw fixation is not safe or possible. In order to place the screw at the base of the C1 arch, it has been recommended to drill at the junction of the C1 posterior arch and the lateral mass of C1, to accommodate the screw head. This may, however, weaken the C1 arch, making it prone to fracture. In this new technique, we describe a modification to the current technique to allow placement of this screw without compromising the C1 arch. A case of atlantoaxial instability secondary to os odontoideum is described. C1 lateral mass fixation is achieved by selecting a screw 10 mm longer than required and placing the screw 10 mm above the bony entry point, for easier placement of the rod and avoidance of drilling at the base of the C1 arch. Adequate and safe C1/C2 fixation was achieved. Sublaminar wiring was performed around the C1 arch with no weakening or fracture of the arch. We believe that in order to place reasonable C1 lateral mass screws, it is inadvisable to drill the base of the junction between the C1 posterior arch and lateral mass as this may lead to arch weakening and failure. Easier instrumentation can be performed and the integrity of the C1 arch maintained using this alternate technique.

Adolescent↗