Ranitidine bismuth citrate in the treatment of Helicobacter pylori infection and duodenal ulcer

STATEMENT OF PROBLEM: The existence of mandibular lateral translation and the approaches to its measurement and interpretation by using a pantograph are controversial. PURPOSE: This study evaluated the validity of using a pantograph to measure mandibular lateral translation and analyzed human pantographic tracings to determine whether they exhibited mandibular lateral translation. MATERIAL AND METHODS: A pantograph was modified by adding 2 posterior horizontal recording tables and styli at the transverse horizontal axis. Pantographic tracings of 25 human subjects were compared with the corresponding theoretically determined values for tracings that exhibited only rotation with no translation. Differences in the tracings at 2 pantographic recording table locations, relative to the transverse horizontal axis, were also compared. RESULTS: The character of the lateral component of 100 pantographic tracings all differed from the lateral component of theoretically determined values for pure rotation. In 64% of tracings, over 50% of the total mandibular lateral translation occurred by the first 1 mm of forward movement of the nonworking side condyle. In 94% of tracings, more than 50% of the translation had occurred in the first 3 mm of forward movement. For the pantographic system used, the amount of mandibular translation represented in the tracing was not changed by altering the posterior horizontal recording table position in the anterior-posterior direction, relative to the transverse horizontal axis. CONCLUSION: All subjects showed evidence of mandibular lateral translation. New definitions for timing of mandibular lateral translation are proposed. Of the tracings, 64% were classified as exhibiting early translation, 30% as intermediate, and 4% as late mandibular lateral translation.     

Evolutive study of the vectorcardiogram from the 14th day to the 6th month of life on the normal infant

With the purpose of a better evaluation of the changes of cardiac potentials during the early hemodynamic arrangement of the normal heart, the authors analyze the VCG of 10 normal children periodically recorded from the 14th day to the 6th month from birth. Rotation of QRS, T and P loops in the three planes, direction and voltage of principal planar and spatial vectors were analyzed. The QRS loop showed a balanced distribution between right and left ventricular forces in the second week and developed a leftward orientation from the 4th week to the 3rd month, as demonstrated both by the loss of clockwise rotation of horizontal QRS loop and by the progressive leftward and backward direction of intermediate vectors. The initial vectors were sketched or absent in the 14th day and increased successively until the typical Q loop. The voltage of terminal vectors did not change in the course of time, but the S loop in the horizontal plane lost its original clockwise rotation and shifted to middle posterior line. The T loop progressively shifted backward so that it was always posterior after the 30th day. The P loop in the frontal plane was similar to the adult's one while in the horizontal plane it often presented a figure-of-eight. The semeiological aspects and the electrogenic considerations of these changes were discussed.     

Visuomotor processing in unilateral neglect

The extent to which visual information on the contralateral, unattended side influences the performance of patients with hemispatial neglect was studied in a visuomotor reaching task. We replicated the well-established finding that, relative to target-alone trials, normal subjects are slower to reach to targets in the presence of visual distractors which appear either ipsilateral or contralateral to the target, with greater interference in the former condition. Six patients with hemispatial neglect showed even greater interference than did the normal subjects when the distractor appeared ipsilaterally but showed no significant interference from contralateral distractors. This pattern of performance was qualitatively similar for patients with lesions restricted to posterior regions and for patients with more extensive lesions involving both posterior and anterior brain regions. These findings suggest that, in the visuomotor domain, information on the contralateral side is processed minimally, if at all, in patients with hemispatial neglect.     

Shape-coordinate analysis of skeletal changes induced by rapid maxillary expansion and facial mask therapy

The aim of this study was to evaluate maxillary and mandibular shape/size changes by means of Bookstein's shape-coordinate and tensor analysis in children with Class III malocclusions treated with rapid maxillary expansion and a facial mask in order to define optimum timing of intervention for this type of therapy. The treated group (46 subjects, 26 females and 20 males) was divided into two subgroups according to the stage of dentitional development. The early-treated group consisted of 23 subjects treated in the early mixed dentition (mean age at Time 1, 6 years 9 months +/- 7 months); the late-treated group included 23 subjects treated in the late mixed dentition (mean age at Time 1, 10 years 3 months +/- 1 year). The mean treatment period was about 11 months. The control group (32 subjects with untreated Class III malocclusion, 18 females and 14 males) also was divided into two subgroups (an early control group, 17 subjects in the early mixed dentition, and a late control group, 15 subjects in the late mixed dentition). Maxillary triangles (point T, the most superior point of the anterior wall of sella turcica, point FMN, the fronto-maxillary-nasal suture, and point A) and mandibular triangles (point Condylion, point Gonion, and point Pogonion) were digitized on cephalograms in both groups at Time 1 and Time 2. Combined facial mask and rapid maxillary expansion therapy produced a significant enhancement of the forward growth of the maxilla and significantly more upward and forward direction of growth of the mandibular condyle (leading to smaller increments in mandibular total length, Co-Pg) in the early-treated group when compared with controls and to the late-treated group. Both maxillary size and mandibular size were significantly affected by treatment in the early mixed dentition. The results of this study indicate that orthopedic treatment of Class III malocclusion induces favorable size and shape changes both in the maxilla and mandible, and that this combined treatment approach is more effective in the early mixed dentition than in the late mixed dentition.     

Loading of a unilateral temporomandibular joint prosthesis: a three-dimensional mathematical study

The load on the prosthetic side and the influence of the design on the remaining natural contralateral TMJ must be known before a unilateral temporomandibular joint (TMJ) prosthesis can be developed. The aim of the present study was to determine the maximum loading of the TMJ prosthetic side and the natural contralateral TMJ and to investigate the influence of the location of the center of rotation of the prosthesis on the maximum loading. For this purpose, a mathematical model of the mandible with a unilateral TMJ prosthesis with a fixed center of rotation (CR) was developed. The location of the CR of the TMJ prosthesis was varied from the middle of the natural mandibular condyle to 15 mm inferior to this location. Although the maximum joint reaction forces changed as a result of a unilateral TMJ prosthesis, the trend of the loading curves was similar to that of an intact mandible. A unilateral TMJ prosthesis resulted in a 50% higher loading of the prosthetic side, while the load on the natural contralateral TMJ remained within normal limits. The maximum load on the prosthetic side occurred during molar bites and could reach 100 N in the cranial direction, 30 N in the ventral direction, and 25 N in the medio-lateral direction. The location of the CR did not have a significant influence on the loading of the TMJ prosthesis and the natural contralateral TMJ.     

SEP topographies elicited by innocuous and noxious sural nerve stimulation. I. Identification of stable periods and individual differences

Scalp potential topographies evoked by innocuous and noxious sural nerve stimulation were obtained from 15 human subjects. The SEP scalp topography could be separated into 6 different stable periods (SP), that is, consecutive time points where there were no major changes in the topographic pattern. SP1 (occurring 58-90 msec post stimulus) was characterized by a contralateral frontal positivity and a central negativity oriented ipsilateral to the evoking stimulus; SP2 (92-120 msec) by a bilateral frontal positivity and a symmetrical central negativity; SP3 (135-158 msec) by a widespread negativity with a minimum at the contralateral temporo-frontal region; and SP4 (178-222 msec), SP5 (223-277 msec) and SP6 (282-339 msec) by a widespread positivity with a maximum located along the centro-parietal midline. SP4, SP5, and SP6 could be distinguished by changes in the orientation of the isovoltage contour lines and/or by changes in the location of the maximum. The stable periods had similar onset and offset latencies and the same major features across subjects. However, the topographic patterns were not identical across subjects. These individual differences are likely due to the expected variability in the orientation of the equivalent regional dipole sources generating these potentials.     

Functional magnetic resonance imaging of motor cortex: hemispheric asymmetry and handedness

A hemispheric asymmetry in the functional activation of the human motor cortex during contralateral (C) and ipsilateral (I) finger movements, especially in right-handed subjects, was documented with nuclear magnetic resonance imaging at high field strength (4 tesla). Whereas the right motor cortex was activated mostly during contralateral finger movements in both right-handed (C/I mean area of activation = 36.8) and left-handed (C/I = 29.9) subjects, the left motor cortex was activated substantially during ipsilateral movements in left-handed subjects (C/I = 5.4) and even more so in right-handed subjects (C/I = 1.3).     

Cerebrovascular reserve capacity many years after vasospasm due to aneurysmal subarachnoid hemorrhage. A transcranial Doppler study with acetazolamide test

BACKGROUND AND PURPOSE: Vasospasm in aneurysmal subarachnoid hemorrhage results in proliferative vasculopathy. Systemic hypertension also causes vascular hypertrophy. Both of these histological changes can lead to rigidity of the cerebrovascular system, reducing its autoregulatory capacity. METHODS: Blood flow velocity (BFV) in the middle cerebral artery at rest and cerebrovascular reserve capacity (CVRC) (percent rise in BFV after acetazolamide stimulation) measured by means of transcranial Doppler sonography were studied many years after aneurysmal subarachnoid hemorrhage in patients with proven cerebral vasospasm (mean BFV > 160 cm/s). The BFV under resting conditions and the CVRC values of the ipsilateral and the contralateral hemispheres were measured in 29 patients (mean age, 43 years; mean follow-up, 4.6 years) and compared with those of control subjects. RESULTS: Persistent high BFV (> 120 cm/s) was found in three patients in the peripheral branch of the ipsilateral middle cerebral artery. In the main trunks of the arteries of the anterior circle of Willis, BFV was normal in all cases. CVRC was normal in all patients (ipsilateral, 52 +/- 21%; contralateral, 56 +/- 17%); values did not differ significantly from each other or from the control value (45 +/- 18%). The higher value of CVRC on the contralateral side was found to be statistically significant in selected groups (hypertensive patients and patients with residual infarct on late CT). CONCLUSIONS: Proliferative vasculopathy developed at the time of vasospasm must have resolved and did not reduce late vasoreactivity. Comorbidity with hypertension also did not seem to influence the late vasoreactivity toward normalization.     

Effectiveness of bupivacaine administered via femoral nerve catheter for pain control after anterior cruciate ligament repair

An 8-year-old girl presented with fibromuscular dysplasia of the intracranial vessels manifesting as ischemic stroke. Neuroimaging showed infarction of the right putamen and ipsilateral frontal white matter. Angiography revealed "string of beads" sign involving the terminal portion of the right internal carotid artery and the horizontal segment of the ipsilateral middle cerebral artery. She was treated conservatively. Magnetic resonance angiography at 2 months post ictus showed similar findings in the middle cerebral artery but improvement of the stenosis of the internal carotid artery. Her neurological deficits had almost resolved. Fibromuscular dysplasia should be part of the differential diagnosis of ischemia in children.     

Spatial coordination by descending vestibular signals. 2. Response properties of medial and lateral vestibulospinal tract neurons in alert and decerebrate cats

Spatial response properties of medial (MVST) and lateral (LVST) vestibulospinal tract neurons were studied in alert and decerebrate cats during sinusoidal angular rotations of the whole body in the horizontal and many vertical planes. Of 220 vestibulospinal neurons with activity modulated during 0.5-Hz sinusoidal rotations, 200 neurons exhibited response gains that varied as a cosine function of stimulus orientation and phases that were near head velocity for rotation planes far from the minimum response plane. A maximum activation direction vector (MAD), which represents the axis and direction of rotation that maximally excites the neuron, was calculated for these neurons. Spatial properties of secondary MVST neurons in alert and decerebrate animals were similar. The responses of 88 of 134 neurons (66%) could be accounted for by input from one semicircular canal pair. Of these, 84 had responses consistent with excitation from the ipsilateral canal of the pair (13 horizontal, 27 anterior, 44 posterior) and 4 with excitation from the contralateral horizontal canal. The responses of the remaining 46 (34%) neurons suggested convergent inputs. The activity of 38 of these was significantly modulated by both horizontal and vertical rotations. Twelve neurons (9%) had responses that were consistent with input from both vertical canal pairs, including 9 cells with MADs near the roll axis. Thirty-two secondary MVST neurons (24%) had type II yaw and/or roll responses. The spatial response properties of 18 secondary LVST neurons, all studied in decerebrate animals, were different from those of secondary MVST neurons. Sixteen neurons (89%) had type II yaw and/or roll responses, and 12 (67%) appeared to receive convergent canal pair input. Convergent input was more common on higher-order vestibulospinal neurons than on secondary neurons. These results suggest that MVST and LVST neurons and previously reported vestibulo-ocular neurons transmit functionally different signals. LVST neurons, particularly those with MADs close to the roll axis, may be involved in the vestibular-limb reflex. The combination of vertical and ipsilateral horizontal canal input on many secondary MVST neurons suggests a contribution to the vestibulocollic reflex. However, in contrast to most neck muscles, very few neurons had maximum vertical responses near pitch.     

Neuropathology in cats experimentally infected with feline immunodeficiency virus: a morphological, immunocytochemical and morphometric study

Head flexion and extension movements near the natural head position (NHP) were analysed for the location of the mean instantaneous centre of rotation (ICR). Forty-six healthy young adults (30 women and 16 men) with sound dentitions, free from cranio-cervical disorders, performed habitual movements that were automatically detected and measured by an infrared three-dimensional motion analyser. ICR and curvature radius were calculated for each movement and subject. In both extension and flexion, ICR position changed during the motion. The movement was symmetrical in all subjects. No gender or flexion/extension differences were found for both ICR position and relevant curvature radius. On average, ICR relative to NHP soft-tissue nasion was located at about 150% of the soft-tissue nasion-right tragus distance, with an angle of about 220 degrees relative to the true horizontal. Results suggest that head flexion or extension is always performed with a combination of rotation (atlanto-occipital joint) and translation (cervical spine) even in the first degrees of motion. Moreover, NHP at rest seems to be some degree more flexed and anterior than head position during movements. These relative positions and their muscular determinants could also influence mandibular posture at rest and during functional movements.     

Disk displacement of the temporomandibular joint: correlation of magnetic resonance tomography and clinical findings

PURPOSE: To evaluate the value of magnetic resonance imaging (MRI) in symptomatic patients with different degrees of internal derangement. MATERIAL AND METHODS: We prospectively investigated 117 temporomandibular joints (TMJ) of 59 symptomatic patients and 31 asymptomatic volunteers and correlated this with clinical parameters. RESULTS: There was a positive correlation between the degree of internal derangement and deformity of the disc, maximal mouth opening, signal intensity of the posterior band, thickness of the bilaminar zone, proliferative bony changes, size of the condyle and reduced translation movement of the condyle, which in addition moved upward and backward. Patients most often complained of pain which was dependent on the degree of disc displacement and condylar changes. Clinical parameters were found to be inaccurate in predicting disc displacement. CONCLUSION: Patients with internal derangement of the temporomandibular joint may be asymptomatic. Patients history may give the only pointer to the disorder.     

Treatment response to maxillary expansion and protraction

A prospective clinical trial was conducted to determine the skeletal and dental contributions to the correction of overjet and overbite in Class III patients. Thirty patients (12 males and 18 females with a mean age of 8.4 +/- 1.7 years) were treated consecutively with protraction headgear and fixed maxillary expansion appliances. For each patient, a lateral cephalogram was taken 6 months before treatment (T0); immediately before treatment (T1); and 6 months after treatment (T2). The time period (T1-T0) represented changes due to 6 months of growth without treatment; (T2-T1) represented 6 months of growth and treatment. Each patient served as his/her own control. Cephalometric analysis described by Bj?rk (1947) and Pancherz (1982a,b) was used. Sagittal and vertical measurements were made along the occlusal plane (OLs) and the occlusal plane perpendicular (OLp), and superimposed on the mid-sagittal cranial structure. The results revealed the following: with 6 months of treatment, all subjects were treated to Class I or overcorrected to Class I or Class II dental arch relationships. Overjet and sagittal molar relationships improved by an average of 6.2 and 4.5 mm, respectively. This was a result of 1.8 mm of forward maxillary growth, a 2.5-mm of backward movement of the mandible, a 1.7-mm of labial movement of maxillary incisors, a 0.2-mm of lingual movement of mandibular incisors, and a 0.2-mm of greater mesial movement of maxillary than mandibular molars. The mean overbite reduction was 2.6 mm. Maxillary and mandibular molars were erupted occlusally by 0.9 and 1.4 mm, respectively. The mandibular plane angle was increased by 1.5 degrees and the lower facial height by 2.9 mm. Individual variations in response to maxillary protraction was large for most of the parameters tested. Significant differences in treatment changes between male and female subjects were found only in the vertical eruption of mandibular incisors and maxillary and mandibular molars. These results demonstrate that significant overjet and overbite corrections can be obtained with 6 months of maxillary protraction in combination with a fixed expansion appliance.     

Patterns of chloroform-induced regenerative cell proliferation in BDF1 mice correlate with organ specificity and dose-response of tumor formation

Drawing arm movements in four different directions: a) upward vertical (0 degree), b) upward oblique (45 degrees), c) downward vertical (180 degrees) and d) downward oblique (135 degrees), and at two different speeds, normal and fast, were executed by eight subjects. Movements of the arm were recorded using an optoelectronic (2 TV, 100 Hz) system which allowed the computer reconstruction of joint motion. Analyses focused upon pen kinematics in the frontal plane. Velocity profiles were unimodal for all conditions. The ratio of acceleration time to total movement time changed significantly as a function of the direction and the speed of the movement. Movement time and was not affected by movement direction and consequently changes in gravitational torques, for both speeds tested. Results from this study provide indirect evidence that the CNS executes movements by taking advantage of gravitational force.     

Binaural inhibition is important in shaping the free-field frequency selectivity of single neurons in the inferior colliculus

1. We have shown previously that under free-field stimulation in the frontal field, frequency selectivity of the majority of inferior colliculus (IC) neurons became sharper when the loudspeaker was shifted to ipsilateral azimuths. These results indicated that binaural inhibition may be responsible for the direction-dependent sharpening of frequency selectivity. To test the above hypothesis directly, we investigated the frequency selectivity of IC neurons under several conditions: monaural stimulation using a semiclosed acoustical stimulation system, binaural stimulation dichotically also using a semiclosed system, free-field stimulation from different azimuths, and free-field stimulation when the ipsilateral ear was occluded monaurally (coated with a thick layer of petroleum jelly, which effectively attenuated acoustic input to this ear). 2. The binaural interaction pattern of 98 IC neurons of northern leopard frogs (Rana pipiens pipiens) were evaluated; of these neurons, there were 34 EE and 64 EO neurons. The majority of IC neurons (92 of 98) showed some degree of binaural inhibition (i.e., showing diminished response when the ipsilateral and contralateral ears were stimulated simultaneously) whether they were designated as EE or EO; these IC neurons thus were classified as EE-I or EO-I. Neurons were classified as exhibiting strong inhibition if the ILD function showed a pronounced response decrement, i.e., a decrease of > or = 50% of the response to monaural stimulation of the contralateral ear. Those neurons that showed smaller response decrements (decrease was > or = 25% but < 50%) were designated as showing weak inhibition. Most of these EE-I and EO-I neurons (n = 68) showed strong binaural inhibition. 3. In agreement with results from our earlier studies, frequency threshold curves (FTCs) of IC neurons were altered by sound azimuth. Independent of binaural interaction pattern, most IC neurons (59 of 98) showed a narrowing of the FTC as sound direction was changed from contralateral 90 deg (c90 degrees) to ipsilateral 90 deg (i90 degrees). IC neurons that exhibited the largest direction-dependent changes in frequency selectivity were typically those that displayed stronger binaural inhibition. Occlusion of the ipsilateral ear, which reduced the strength of binaural inhibition by this ear, abolished direction-dependent frequency selectivity. 4. FTCs of IC neurons that exhibited little to moderate direction-dependent effects on frequency selectivity were associated typically with neurons that displayed weak binaural inhibition. Associated with this weak binaural inhibition, central neural responses under monaural occlusion also displayed only small effects; the FTCs were only slightly broader than those derived in the intact condition, and as before, the experimental manipulation resulted in abolishment of direction-dependent frequency selectivity. 5. In contrast to most IC neurons, which showed direction-dependent narrowing of the FTC, about one-third (34 of 98) of IC neurons studied showed a broadening of the FTC when sound direction was shifted to ipsilateral azimuths. Interestingly, for 90% of these 34 neurons, monaural occlusion resulted in narrowing of the bandwidth at each azimuth instead of broadening of the FTC bandwidth. We have evidence to suggest that this direction-dependent broadening is actually a consequence of a truncation or loss of the tip of the FTC derived at c90 degrees, which results from strong binaural inhibition. 6. To compare the frequency threshold tuning in response to monaural stimulation of each ear with free-field FTCs, we measured FTCs for each of the 34 EE neurons to independent contralateral and ipsilateral stimulation. FTCs derived from ipsilateral monaural stimulation were significantly narrower than those resulting from contralateral monaural stimulation, independent of a neuron's direction-dependent changes in frequency selectivity.     

Craniofacial adaptations induced by chincup therapy in Class III patients

The purpose of the present study is to examine the effects of an orthopedic force produced by chincup treatment in patients with Class III malocclusion. Anteroposterior maxillary and mandibular changes were examined as were changes in the vertical dimension. Further, the possibility of posterior displacement of temporomandibular joints in treated Class III subjects was evaluated. Serial lateral headfilms of 22 young females (average age, 9 years), who had received chincup therapy were compared with those of 20 skeletal Class III subjects of similar age who received no treatment during the interval studied. A computerized x-y coordinate program was applied to analyze the cephalometric landmarks and measurements. The treated group showed improvement of the skeletal Class III pattern associated with a slight increase (0.8 degrees per year) in SNA and a slight decrease (-0.7 degrees per year) in SNB and also a decreased gonial angle. The distance from the condyle to the chin (Co-Gn or effective mandibular length) increased significantly less in the treated group in comparison with controls. Increases in lower anterior facial height were not different between the treated and untreated groups. In addition, the cranial base angles N-S-Ba and N-S-Ar showed no statistical difference between groups, but these angles tended to increase with time in both groups. Basion and Articulare showed almost the same amount of backward and downward movement in both groups. The results of this study indicate that the primary effect of chincup therapy was in producing a reduction in mandibular growth increments during the period studied. Maxillary growth was not affected during treatment. Further, the results of this study fail to support the hypothesis that chincup appliance significantly induces the posterior displacement of the glenoid fossa.     

Ipsilateral oculomotor nerve palsy and contralateral downbeat nystagmus due to unilateral paramedian thalamopenduncular infarction--a case report

A case of midbrain and thalamic infarction which showed complete oculomotor nerve palsy of the ipsilateral eye and monocular downbeat nystagmus, ptosis, upward movement disturbance and adduction disturbance of the contralateral eye was reported. The patient is a 53-year-old woman who was admitted to our hospital because of sudden onset of double vision. Head magnetic resonance imaging showed unilateral midbrain and thalamic infarction. The midbrain lesion was located in the paramedian area and the bilateral ptosis, bilateral upward gaze palsy and adduction disturbance of the contralateral eye were considered to be caused by the lesion involving the unilateral oculomotor nucleus. This case is considered to be important because the association of contralateral monocular downbeat nystagmus is very rare.     

Why do we fail in aging the skull from the sagittal suture?

This study determined the variability of temporomandibular joint (TMJ) disk position in medial, central, and lateral aspects of the joint using magnetic resonance imaging (MRI). Subjects had clinical evidence of reciprocal TMJ clicking (N = 123) or restricted mandibular motion (N = 52). Eighty-nine asymptomatic volunteers provided a control group. Disk position was quantified on MRI by measuring the angle formed by a line through the middle of the condyle and perpendicular to the Frankfort plane and a line through the same midpoint of the condyle and tangential to the posterior-most aspect of the disk. The disk position in asymptomatic TMJs varied considerably with a tendency toward farther anterior placement in more lateral images. In 47 TMJs from a total of 52 TMJ5 (90%), restricted mobility was associated with anterior disk displacement (ADD) without reduction. The disk position demonstrated a mean displacement of 77 degrees without significant differences at the medial and lateral aspects of the condyle. One hundred TMJs from a total of 123 TMJs (81%) with reciprocal clicking demonstrated ADD with reduction. Tomograms revealed larger lateral displacements or rotational displacements in these joints, whereas medial images frequently showed similar ranges of disk positions as compared with asymptomatic TMJs. The results suggest that disk positions of up to +15 degrees on medial tomograms and +30 degrees on lateral tomograms should be regarded as normal variations. Furthermore, multisection analysis of all parasagittal images improved the separation between disk displacement and asymptomatic TMJs.     

Outcome of moderate carotid artery stenosis in patients who are asymptomatic

PURPOSE: The incidence rate of disease progression and stroke after the diagnosis of a moderate (50% to 79%) carotid stenosis was determined by means of color-flow duplex scanning. METHODS: During a 4-year period, 344 male veterans with moderate internal carotid artery stenoses, on one or both sides, were examined at regular intervals for a mean period of 25 months. Carotid color-flow scans were obtained semiannually. Clinical follow-up was performed to determine the incidence rate of amaurosis fugax, transient ischemic attacks, nonhemispheric symptoms, and strokes. RESULTS: New neurologic symptoms developed in 75 patients (21.8%). Fifty-one (14.8%) had ipsilateral symptoms during follow-up: 18 amaurosis fugax (5.2%), 14 transient ischemic attacks (4%), 5 nonhemispheric symptoms (1.4%), and 14 strokes (4%). Twenty-four patients (6.9%) had contralateral symptoms: 20 strokes (5.8%) and 4 transient ischemic attacks (1.2%). Life-table analysis showed that the annual rate of ipsilateral neurologic events was 8.1%, and the annual rate of stroke was 2.1%. Seventy-five patients (22%) died in the follow-up period. Disease progression to 80% to 99% stenosis or occlusion occurred in 71 of 458 vessels (15.5%). The internal carotid arteries that showed evidence of disease progression had a significantly higher initial peak systolic velocity (251 vs 190 cm/s; P <.0001) and end diastolic velocity (74 vs 52 cm/s; P < 0.0001). Black patients and patients with ischemic heart disease were at a higher risk for disease progression. We could not identify any atherosclerotic risk factors that reliably predicted patients in whom future ipsilateral neurologic symptoms were more likely to develop. However, there was an increased risk of stroke associated with progression of disease. CONCLUSION: Patients who are asymptomatic and who have moderate carotid stenoses are at significant risk for neurologic symptoms and death, but have a relatively low incidence rate of ipsilateral events. The initial flow characteristics in the stenotic vessel are predictive of future disease progression, but they are not helpful in identifying patients in whom symptoms will develop.     

Bilateral reductions in hippocampal volume in adults with epilepsy and a history of febrile seizures

OBJECTIVES: To examine the degree and frequency of reductions in hippocampal volume in patients with temporal lobe epilepsy with and without a history of febrile seizures. METHODS: In vivo measures of hippocampal volume were computed from three dimensional gradient echo (FLASH) images in 44 patients undergoing comprehensive evaluations for epilepsy surgery. Twenty one patients (48%) reported a history of febrile seizures. The volumes from these patients were compared with those from 23 patients without a history of febrile seizures and 34 healthy controls. RESULTS: The febrile seizure group had significant reductions in volume, both ipsilateral (30% decrease) and contralateral (15% decrease), to the EEG seizure focus. Twelve of 18 patients with febrile seizures exhibited clinically significant ipsilateral volume reductions, defined as volumes falling 2 SD below the mean obtained from the control sample. Only four of 19 patients without febrile seizures exhibited this degree of reduction. No significant correlations were found between seizure variables (for example, duration of epilepsy, seizure frequency) and ipsilateral reductions in volume. However, a significant inverse correlation (r=-0.45, P<0.05) between seizure frequency and the volume of the hippocampus contralateral to the seizure focus was found in the febrile seizure group. CONCLUSION: These results suggest that a history of febrile seizures is associated with the finding of a smaller hippocampus on the side ipsilateral to the subsequent temporal lobe focus whereas chronic factors seem to be be related to pathology contralateral to the seizure focus.