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Ishak Ahmed Abdi,1 Ahmed Elmi Abdi,1 Mohamed Omar Hassan,1 Said Abdirahman Ahmed,1 Mohamud Mire Waberi,1 Ahmed Shafie Aden,1 Osman Farah Dahir,1 Mohamed Ahmed Mohamud,2 Irshad Ibrahim Ali,3 Shuayb Moallim Ali Jama,4 Abdirahman Mohamed Hassan Dirie,5 Can Baba Arın6 1Department of Cardiology, Mogadishu Somali Türkiye Training and Research Hospital, Mogadishu, Somalia; 2Internal Medicine Resident, Kenyatta National Hospital, Nairobi, Kenya; 3Anesthesia and Critical Care Unit, Mogadishu Somali Türkiye Training and Research Hospital, Mogadishu, Somalia; 4Department of Radiology, Mogadishu Somali Türkiye Training and Research Hospital, Mogadishu, Somalia; 5Respiratory Medicine Department, Mogadishu Somali Türkiye Training and Research Hospital, Mogadishu, Somalia; 6Department of Cardiology, Health Science University, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, İstanbul, TurkeyCorrespondence: Ishak Ahmed Abdi, Department of Cardiology, Mogadishu Somali Türkiye Training and Research Hospital, Second Street, Black Sea, Hodan District, Mogadishu, Somalia, Tel +252618439596, Email isakabdi70@gmail.comIntroduction: Pulmonary embolism (PE) is a critical condition that can present with diverse and often non-specific electrocardiographic findings. The Aslanger pattern, identified in 2020, is an uncommon electrocardiography (ECG) finding typically associated with acute non-ST-segment elevation myocardial infarction (NSTEMI). Although this pattern is usually linked to myocardial infarction with significant coronary stenosis, we report a rare case where the Aslanger pattern was observed in a patient with acute pulmonary embolism.Case Presentation: A 52-year-old male with Parkinson’s disease presented with sudden chest pain, shortness of breath, sweating, and fatigue. Initial ECG showed Aslanger pattern, suggesting acute coronary syndrome. Despite elevated troponin I (1624 ng/mL) and normal coronary angiography, further investigation revealed right ventricular dilation and massive pulmonary embolism confirmed by CT angiography. The patient was treated with thrombolytics and anticoagulation, stabilizing over five days and discharged on rivaroxaban.Conclusion: The Aslanger pattern usually linked to myocardial infarction can also occur in acute pulmonary embolism. This case underscores the need for careful differential diagnosis and timely treatment to prevent complications associated with delayed care.Keywords: pulmonary embolism, Aslanger pattern, electrocardiogram

Diabetes mellitus affects 537 million adults around the world. Adropin is expressed in different cell types. Our aim was to investigate the cellular localization in the endocrine pancreas and its effect on modulating pancreatic endocrine hormone release in streptozotocin (STZ)-induced diabetic rats. Adropin expression in the pancreas was investigated in normal and diabetic rats using immunohistochemistry and immunoelectron microscopy. Serum levels of insulin, glucagon pancreatic polypeptide (PP), and somatostatin were measured using a Luminex ® χMAP (Magpix ® ) analyzer. Pancreatic endocrine hormone levels in INS-1 832/3 rat insulinoma cells, as well as pancreatic tissue fragments of normal and diabetic rats treated with different concentrations of adropin (10 -6 , 10 -9 , and 10 -12 M), were measured using ELISA. Adropin was colocalized with cells producing either insulin, glucagon, or PP. Adropin treatment reduced the number of glucagon-secreting alpha cells and suppressed glucagon release from the pancreas. The serum levels of GLP-1 and amylin were significantly increased after treatment with adropin. Our study indicates a potential role of adropin in modulating glucagon secretion in animal models of diabetes mellitus.

Diabetes mellitus (DM) is a chronic illness with an increasing global prevalence. More than 537 million cases of diabetes were reported worldwide in 2021, and the number is steadily increasing. The worldwide number of people suffering from DM is projected to reach 783 million in 2045. In 2021 alone, more than USD 966 billion was spent on the management of DM. Reduced physical activity due to urbanization is believed to be the major cause of the increase in the incidence of the disease, as it is associated with higher rates of obesity. Diabetes poses a risk for chronic complications such as nephropathy, angiopathy, neuropathy and retinopathy. Hence, the successful management of blood glucose is the cornerstone of DM therapy. The effective management of the hyperglycemia associated with type 2 diabetes includes physical exercise, diet and therapeutic interventions (insulin, biguanides, second generation sulfonylureas, glucagon-like peptide 1 agonists, dipeptidyl-peptidase 4 inhibitors, thiazolidinediones, amylin mimetics, meglitinides, α-glucosidase inhibitors, sodium-glucose cotransporter-2 inhibitors and bile acid sequestrants). The optimal and timely treatment of DM improves the quality of life and reduces the severe burden of the disease for patients. Genetic testing, examining the roles of different genes involved in the pathogenesis of DM, may also help to achieve optimal DM management in the future by reducing the incidence of DM and by enhancing the use of individualized treatment regimens.

A facile and sensible spectrofluorimetric approach for the measurement of two antipsychotic medications, aripiperazole (ARP) and clozapine (CLZ), was devised and validated. The approach involves reacting the examined medicines with o -phthalaldehyde in the presence of β-mercaptoethanol in a borate buffer of pH 9.0 and pH 10 for ARP and CLZ, respectively, to produce a robustly fluorescent compound that is detected at 450 nm following excitation at 340 nm. The experimental variables influencing the performance and product stability were thoroughly investigated and optimized. Under optimal conditions, the intensity of the fluorescence was linear during a concentration range of 0.1-0.5 μg/mL, with a limit of detection (0.0391 and 0.0400 μg/mL) and limit of quantitation (0.1035 and 0.1332 μg/mL), respectively, for ARP and CLZ. The suggested approach was successful in analyzing commercialized tablets. A statistical investigation of the results produced by the suggested and standard methods showed no remarkable variation in the precision and accuracy of the two approaches. A chemical mechanism using o -phthalaldehyde was proposed.

Adropin is a novel 76-amino acid-peptide that is expressed in different tissues and cells including the liver, pancreas, heart and vascular tissues, kidney, milk, serum, plasma and many parts of the brain. Adropin, encoded by the Enho gene, plays a crucial role in energy homeostasis. The literature review indicates that adropin alleviates the degree of insulin resistance by reducing endogenous hepatic glucose production. Adropin improves glucose metabolism by enhancing glucose utilization in mice, including the sensitization of insulin signaling pathways such as Akt phosphorylation and the activation of the glucose transporter 4 receptor. Several studies have also demonstrated that adropin improves cardiac function, cardiac efficiency and coronary blood flow in mice. Adropin can also reduce the levels of serum triglycerides, total cholesterol and low-density lipoprotein cholesterol. In contrast, it increases the level of high-density lipoprotein cholesterol, often referred to as the beneficial cholesterol. Adropin inhibits inflammation by reducing the tissue level of pro-inflammatory cytokines such as tumor necrosis factor alpha and interleukin-6. The protective effect of adropin on the vascular endothelium is through an increase in the expression of endothelial nitric oxide synthase. This article provides an overview of the existing literature about the role of adropin in different pathological conditions.

Ca 2+ signaling is vital for the proper functioning of all cells, including cells of the cardiovascular system. Membrane receptors for many hormones trigger intracellular Ca 2+ signaling via the activation of phospholipase C and production of inositol-1,4,5-trisphosphate (InsP 3 ). Several research groups have demonstrated the expression of oxytocin (OXT) and oxytocin receptors (OXTR) in the heart and suggested a cardioprotective role of OXT against several pathological conditions. Here we describe the protocol for measuring the effects of oxytocin on intracellular Ca 2+ dynamics in newborn rat cardiac myocytes and cardiac fibroblasts maintained in short-term culture., (© 2022. Springer Science+Business Media, LLC, part of Springer Nature.)

Unlike other organs, the importance of VD in a normal stomach is unknown. This study focuses on understanding the physiological role of vitamin D in gastric epithelial homeostasis. C57BL/6J mice were divided into three groups that were either fed a standard diet and kept in normal light/dark cycles (SDL), fed a standard diet but kept in the dark (SDD) or fed a vitamin D-deficient diet and kept in the dark (VDD). After 3 months, sera were collected to measure vitamin D levels by LC-MS/MS, gastric tissues were collected for immunohistochemical and gene expression analyses and gastric contents were collected to measure acid levels. The VDD group showed a significant decrease in the acid-secreting parietal cell-specific genes Atp4a and Atp4b when compared with the controls. This reduction was associated with an increased expression of an antral gastrin hormone. VDD gastric tissues also showed a high proliferation rate compared with SDL and SDD using an anti-BrdU antibody. This study indicates the requirement for normal vitamin D levels for proper parietal cell functions.

Pituitary neuropeptide oxytocin is increasingly recognised as a cardiovascular hormone, in addition to its many regulatory roles in other organ systems. Studies in atrial and ventricular myocytes from the neonatal and adult rats have identified synthesis of oxytocin and the expression of oxytocin receptors in these cells. In cardiac fibroblasts, the most populous non-myocyte cell type in mammalian heart, the oxytocin receptors have not been described before. In the present study, we have investigated the direct effects of oxytocin on intracellular Ca 2+ dynamics in ventricular myocytes and fibroblasts from new born rats. In myocytes, oxytocin increased the frequency of spontaneous Ca 2+ transients and decreased their amplitude. Our data suggest that oxytocin receptors are also present and functional in the majority of cardiac fibroblasts. We used selective oxytocin receptor inhibitor L-371,257 and a number of intracellular Ca 2+ release blockers to investigate the mechanism of oxytocin induced Ca 2+ signalling in cardiac fibroblasts. Our findings suggest that oxytocin induces Ca 2+ signals in cardiac fibroblasts by triggering endoplasmic reticulum Ca 2+ release via inositol trisphosphate activated receptors. The functional significance of the oxytocin induced Ca 2+ signalling in cardiac fibroblasts, especially for their activation into secretory active myofibroblasts, remains to be investigated., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

In the United States, the health of a community falls on a continuum ranging from healthy to unhealthy and fluctuates based on several variables. Research policy and public health practice literature report substantial disparities in life expectancy, morbidity, risk factors, and quality of life, as well as persistence of these disparities among segments of the population. One such way to close this gap is to streamline medical education to better prepare our future physicians for our patients in underserved communities. Medical schools have the potential to close the gap when training future physicians by providing them with the principles of social medicine that can contribute to the reduction of health disparities. Curriculum reform and systematic formative assessment and evaluative measures can be developed to match social medicine and health disparities curricula for individual medical schools, thus assuring that future physicians are being properly prepared for residency and the workforce to decrease health inequities in the United States. We propose that curriculum reform includes an ongoing social medicine component for medical students. Continued exposure, practice, and education related to social medicine across medical school will enhance the awareness and knowledge for our students. This will result in better preparation for the zero mile stone residency set forth by the Accreditation Council of Graduate Medical Education and will eventually lead to the outcome of higher quality physicians in the United States to treat diverse populations.

Objective: To survey all US medical school clerkship directors (CDs) in neurology and to compare results from a similar survey in 2005., Methods: A survey was developed by a work group of the American Academy of Neurology Undergraduate Education Subcommittee, and sent to all neurology CDs listed in the American Academy of Neurology database. Comparisons were made to a similar 2005 survey., Results: Survey response rate was 73%. Neurology was required in 93% of responding schools. Duration of clerkships was 4 weeks in 74% and 3 weeks in 11%. Clerkships were taken in the third year in 56%, third or fourth year in 19%, and fourth year in 12%. Clerkship duration in 2012 was slightly shorter than in 2005 (fewer clerkships of ≥4 weeks, p = 0.125), but more clerkships have moved into the third year (fewer neurology clerkships during the fourth year, p = 0.051). Simulation training in lumbar punctures was available at 44% of schools, but only 2% of students attempted lumbar punctures on patients. CDs averaged 20% protected time, but reported that they needed at least 32%. Secretarial full-time equivalent was 0.50 or less in 71% of clerkships. Eighty-five percent of CDs were "very satisfied" or "somewhat satisfied," but more than half experienced "burnout" and 35% had considered relinquishing their role., Conclusion: Trends in neurology undergraduate education since 2005 include shorter clerkships, migration into the third year, and increasing use of technology. CDs are generally satisfied, but report stressors, including inadequate protected time and departmental support., (© 2014 American Academy of Neurology.)

Current medical educational theory encourages the development of competency-based curricula. The Accreditation Council for Graduate Medical Education's 6 core competencies for resident education (medical knowledge, patient care, professionalism, interpersonal and communication skills, practice-based learning, and systems-based practice) have been embraced by medical schools as the building blocks necessary for becoming a competent licensed physician. Many medical schools are therefore changing their educational approach to an integrated model in which students demonstrate incremental acquisition and mastery of all competencies as they progress through medical school. Challenges to medical schools include integration of preclinical and clinical studies as well as development of learning objectives and assessment measures for each competency. The Undergraduate Education Subcommittee (UES) of the American Academy of Neurology (AAN) assembled a group of neuroscience educators to outline a longitudinal competency-based curriculum in medical neuroscience encompassing both preclinical and clinical coursework. In development of this curriculum, the committee reviewed United States Medical Licensing Examination content outlines, Liaison Committee on Medical Education requirements, prior AAN-mandated core curricula for basic neuroscience and clinical neurology, and survey responses from educators in US medical schools. The newly recommended curriculum provides an outline of learning objectives for each of the 6 competencies, listing each learning objective in active terms. Documentation of experiences is emphasized, and assessment measures are suggested to demonstrate adequate achievement in each competency. These guidelines, widely vetted and approved by the UES membership, aspire to be both useful as a stand-alone curriculum and also provide a framework for neuroscience educators who wish to develop a more detailed focus in certain areas of study., (© 2014 American Academy of Neurology.)

Valproate-associated hyperammonemic coma in adults is a rare complication of valproate therapy and has been previously reported to occur in few days to years after initiation of therapy. We present a case of hyperammonemic coma induced within hours of initiating valproate therapy in a patient with plasma carnitine deficiency.

We describe the first studies of a simple and sensitive spectrofluorimetric and spectrophotometric methods for the analysis of nalbuphine (NLB) in dosage form and biological fluids. The spectrofluorimetric method was based on the oxidation of NLB with Ce(IV) to produce Ce(III) and its fluorescence was monitored at 352 nm after excitation at 250 nm. The spectrophotometric method involves addition of a known excess of Ce(IV) to NLB in acid medium, followed by determination of residual Ce(IV) by reacting with a fixed amount of methyl orange and measuring absorbance at 510 nm. In both methods, the amount of Ce(IV) reacted corresponds to the amount of NLB and measured fluorescence or absorbance were found to increase linearly with the concentration of NLB, which are corroborated by correlation coefficients of 0.9997 and 0.9999 for spectrofluorimetric and spectrophotometric methods, respectively. Different variables affecting the reaction conditions such as concentrations of Ce(IV), type and concentration of acid medium, reaction time, temperature, and diluting solvents were carefully studied and optimized. The accuracy and precision of the methods were evaluated on intra-day and inter-day basis. The proposed methods were successfully applied for the determination of NLB in pharmaceutical formulation and biological samples with good recoveries., (Copyright © 2012 John Wiley & Sons, Ltd.)

Simple, reliable, sensitive, and accurate spectrofluorimetric and spectrophotometric methods were proposed for the determination of two selected analgesic drugs, namely tramadol and morphine, in pharmaceuticals and biological fluids. The proposed methods were based on the oxidation of the studied drugs by Cerium (Ce)IV in an acidic medium. The spectrofluorimetric method is based on measuring the relative fluorescence intensity of Ce(III) arising from Ce(IV) at 350 nm with an excitation wavelength at 250 nm. The spectrophotometric method involves on addition of a known excess of Ce(IV) to the studied drugs in an acid medium, followed by the determination of residual Ce(IV) by reacting with a fixed amount of methyl orange and measuring the absorbance at 510 nm. Different variables affecting the reaction conditions, such as the concentrations of Ce(IV), type and concentration of the acid medium, reaction time, temperature, and the diluting solvents, were carefully studied and optimized., (© 2013 American Academy of Forensic Sciences.)

Purpose: The electronic health record (EHR) is an important advancement in health care. It facilitates improvement of health care delivery and coordination of care, but it creates special challenges for student education. This article represents a collaborative effort of the Alliance for Clinical Education (ACE), a multidisciplinary group formed in 1992. ACE recognizes the importance of medical student participation in patient care including the ability of documentation. This article proposes guidelines that can be used by educators to establish expectations on medical student documentation in EHRs., Summary: To provide the best education for medical students in the electronic era, ACE proposes to use the following as practice guidelines for medical student documentation in the EHR: (a) Students must document in the patient's chart and their notes should be reviewed for content and format, (b) students must have the opportunity to practice order entry in an EHR--in actual or simulated patient cases--prior to graduation, (c) students should be exposed to the utilization of the decision aids that typically accompany EHRs, and (d) schools must develop a set of medical student competencies related to charting in the EHR and state how they would evaluate it. This should include specific competencies to be documented at each stage, and by time of graduation. In addition, ACE recommends that accreditation bodies such as the Liaison Committee for Medical Education utilize stronger language in their educational directives standards to ensure compliance with educational principles. This will guarantee that the necessary training and resources are available to ensure that medical students have the fundamental skills for lifelong clinical practice., Conclusions: ACE recommends that medical schools develop a clear set of competencies related to student in the EHR which medical students must achieve prior to graduation in order to ensure they are ready for clinical practice.

Antiepileptic drugs (AEDs) are commonly used for prevention of migraine headaches. Bone loss is a known complication, particularly associated with use of older AEDs. Topiramate is a newer AED, widely used for migraine prevention, but no evidence is currently available on its effect on bone metabolism. In a clinic-based pilot study, we evaluated bone health by examining biochemical and radiological markers of bone metabolism, in women with migraine. Osteopenia was noted in 53% of the patients and was associated with the duration of exposure to topiramate (P = .04)., (© 2011 American Headache Society.)

Objective: The objective of the study was to evaluate the efficacy of vagus nerve stimulator (VNS) therapy and identify factors associated with reduction of seizures. The VNS is an accepted therapeutic option for patients with refractory partial epilepsy. There are, however, limited data regarding efficacy in any specific group of patients with epilepsy., Methods: This is a retrospective review of patients with epilepsy on VNS therapy initiated between January 2000 and December 2007 at a university medical center. Information collected included demographics, epilepsy type and duration, antiepileptic drug usage, stimulation parameters, and seizure frequency at baseline, 3months, 6months, 1year, 2years, and 3years after VNS therapy initiation. Seizure frequency at different follow-up intervals was compared with baseline frequency. Patients were stratified into three subsets based on VNS response. Relationships between VNS response and factors including demographics, location of seizure focus, type or duration of epilepsy, and VNS settings were examined as a whole as well as in subsets., Results: Fifty-four patients were implanted with VNSs over a period of 7years. Four patients were excluded. A total of 50 patients (31 men, 19 women) with mean age 39years and on VNS therapy were included in this study. Average duration of VNS therapy was 4.5years. Baseline average frequency was 10 seizures per month. Significant decreases in median seizure frequency were noted at 3months (P<0.001), 6months (P<0.001), 1year (P=0.004), 2years (P<0.001), and 3years (P<0.0001). Seventy-two percent of the patients reported a decrease in seizure frequency within the first 3months, which increased to 80% by the end of 3years. Overall, the percentage reduction in seizure frequency was 64% at 3months and increased to 86% at the end of 3years. In the subset of patients who responded to VNSs, reduction in seizure frequency improved from 80 to 89% by the end of 3years. There were no correlations between seizure frequency and specific VNS settings, epileptic focus, or duration or type of epilepsy, in the group as a whole or in its subsets. Data suggest a favorable VNS response in patients with higher baseline seizure frequency., Conclusions: Significant reductions in seizure frequency were noted with VNS therapy over a 3-year follow-up period with a possible cumulative effect. Lateralization or localization of epileptic focus or epilepsy subtype did not correlate with response to VNSs., (Copyright 2010 Elsevier Inc. All rights reserved.)

Bariatric surgical procedures are increasingly common. In this review, we characterize the neurologic complications of such procedures, including their mechanisms, frequency, and prognosis. Literature review yielded 50 case reports of 96 patients with neurologic symptoms after bariatric procedures. The most common presentations were peripheral neuropathy in 60 (62%) and encephalopathy in 30 (31%). Among the 60 patients with peripheral neuropathy, 40 (67%) had a polyneuropathy and 18 (30%) had mononeuropathies, which included 17 (94%) with meralgia paresthetica and 1 with foot drop. Neurologic emergencies including Wernicke's encephalopathy, rhabdomyolysis, and Guillain-Barré syndrome were also reported. In 18 surgical series reported between 1976 and 2004, 133 of 9996 patients (1.3%) were recognized to have neurologic complications (range: 0.08-16%). The only prospective study reported a neurologic complication rate of 4.6%, and a controlled retrospective study identified 16% of patients with peripheral neuropathy. There is evidence to suggest a role for inflammation or an immunologic mechanism in neuropathy after gastric bypass. Micronutrient deficiencies following gastric bypass were evaluated in 957 patients in 8 reports. A total of 236 (25%) had vitamin B(12) deficiency and 11 (1%) had thiamine deficiency. Routine monitoring of micronutrient levels and prompt recognition of neurological complications can reduce morbidity associated with these procedures.

Vagus nerve stimulation (VNS) is an important therapeutic option for individuals with refractory epilepsy who have failed multiple antiepileptic drugs (AEDs). The intricate relationship of the vagus nerve to cardiac function raises concern that vagal stimulation may affect cardiac rhythm and function. Previous pre- and postmarketing studies have not shown this to be a significant problem, with the incidence of bradyarrhythmias reported to be about 0.1%. We review three cases of ventricular asystole with complete heart block that occurred during intraoperative lead tests. The purpose of these case reports is to identify the specific type of cardiac abnormality associated with vagus nerve stimulation and to identify individuals at risk.

There is a growing interest in recognizing the association between antiepileptic drugs and reduced bone mineral density. Although the literature regarding this association has been available for more than three decades, the management of this complication remains unclear. We review the relevant literature regarding antiepileptic drugs and reduction in bone mineral density with the aim of developing some guidelines for practical management of this problem. This review focuses on the mechanism of antiepileptic drug-induced bone loss, its recognition, and its management.

A 69-year-old male on colchicine 0.6 mg twice a day for more than a year developed subacute onset of painless proximal muscle weakness with significant elevation of creatine phosphokinase (CPK) levels. He also experienced numbness and tingling in the extremities. Nerve conduction studies revealed a mild axonal neuropathy affecting the arms and legs while needle electromyography was unremarkable. He refused a muscle biopsy. After withdrawal of colchicine, muscle strength and serum CPK levels returned to normal over a period of 4 months. Neuromyopathy is a well documented side effect of colchicine, and impaired renal function has been the major risk factor in previously reported cases. In our patient, neurological toxicity occurred in the presence of normal renal function. The neuromyopathy is generally reversible on withdrawal of the drug. Colchicine is to be used with caution in patients with impaired renal function, and even if kidney function is normal, muscle strength must be monitored and serum CPK levels checked if myopathy is suspected.

Periodic lateralized epileptiform discharges (PLEDs) are typically associated with encephalitis, cerebral abscess, cerebral infarct, and status epilepticus. There is considerable debate as to whether this pattern is ictal or interictal when seen in association with status epilepticus. We present a patient with complex partial status epilepticus who developed PLEDs and remained comatose despite optimal drug therapy. Technetium 99m single-photon emission computed tomography (SPECT) showed hyperperfusion that resolved with further aggressive antiepileptic drug therapy, indicating that this pattern may indeed be ictal. Further studies are needed to define the significance of PLEDs in patients with status epilepticus. The role of SPECT in differentiating PLEDs as an interictal or ictal pattern also requires further study.

Central pontine myelinolysis (CPM), a neurologic disorder caused most frequently by rapid correction of hyponatremia, is characterized by demyelination that affects the central portion of the base of the pons. There are no inflammatory changes, and blood vessels are normal. Clinical features usually reflect damage to the descending motor tracts and include spastic tetraparesis, pseudobulbar paralysis, and the locked-in syndrome. Magnetic resonance imaging of the brain, the imaging procedure of choice, shows an area of prolonged T1 and T2 relaxation in the central pons, which may have a characteristic shape. Recovery varies, ranging from no improvement to substantial improvement. To avoid CPM, correction of serum sodium in patients with hyponatremia should not exceed 12 mEq/24 h. We describe a case of CPM in a hyponatremic patient who presented with a cerebellar syndrome with no pyramidal tract involvement and in whom the rate of correction of serum sodium was within the recommended limits.

Objective: To report a case of acute neurologic adverse effects related to fluorouracil administration and to review the neurotoxicity of this agent., Case Summary: A 73-year-old white man with a history of esophageal carcinoma was treated with fluorouracil 1,500 mg iv daily for four days. After completing treatment, he presented with sudden onset of confusion, cognitive disturbances, a cerebellar syndrome, and repeated seizures. A magnetic resonance image of the brain showed no structural abnormalities, and cerebrospinal fluid examination was normal; none of the other laboratory tests provided an explanation for his symptoms. The patient was treated with anticonvulsants, and the cognitive changes resolved in 72 hours. The cerebellar signs, however, did not resolve completely and persisted when the patient was examined two weeks after discharge., Discussion: Fluorouracil can cause both acute and delayed neurotoxicity. Acute neurotoxicity manifests as encephalopathy or as cerebellar syndrome; seizures, as seen in our patient, have rarely been reported. Acute neurotoxicity due to fluorouracil is dose related and generally self-limiting. Various mechanisms for such toxicity have been postulated, and treatment with thiamine has been recommended. Delayed neurotoxicity has been reported when fluorouracil was given in combination with levamisole; this form of subacute multifocal leukoencephalopathy is immune mediated and responds to treatment with corticosteroids., Conclusions: Clinicians should be aware of the adverse neurologic effects of fluorouracil and should include them in the differential diagnosis when patients receiving the drug present with neurologic problems.

Purpose: We wished to assess organ transplant recipients, who incur a significant risk for seizures., Method: We reviewed 85 lung transplants performed in 81 patients at the University of North Carolina hospitals between 1991 and 1994. All patients were reviewed for age, reason for transplant, detailed description of seizures, neurological examination, medications, and laboratory results, including cyclosporine level, EEG, and brain imaging., Results: Eighteen of 81 (22%) patients experienced seizures. Patients aged < 25 years had the greatest risk of seizures and 15 of the 18 patients had cystic fibrosis. Sixteen of the 18 (89%) patients, by history, had partial-onset seizures. Eleven of the 18 (61%) patients had seizures < or = 10 days after initiation of intravenous methylprednisolone for allograft rejection. Two patients had seizures associated with sustained hypertension: 1 of these patients was simultaneously being treated for rejection. Four patients had strokes (1 before transplant) and seizures. Two patients were receiving imipenem. Magnetic resonance imaging (MRI) of the brain demonstrated areas of increased T2 signal in 8 of 9 patients., Conclusions: Our findings demonstrate multiple etiologies for seizures in our transplant recipients. However, we believe that patients, especially those aged < 25 years, being treated with intravenous methylprednisolone for rejection may be at increased risk of seizures. We hypothesize that the focal loss of blood-brain barrier (BBB) may play a significant role in the development of partial seizures in lung transplant recipients.

To overcome the problems of restricted visibility and surgical mobility, as well as those posed by anatomical features oif the canine subfrontal sinus region and associated dura mater, aggravated by hazards of infection from potentially infected frontal sinuses, of uncontrollable haemorrhage and post-operative brain compression, a radical approach was devised, combining invasion of the frontal sinus with a lateral rostrotentorial craniotomy. This offers adequate surgical manoeuvring space, excellent visualisation of the rostral cranial fossa and its contents, proper asepsis, minimal haemorrhage and no untoward after-effects. The technique lends itself to diverse neurosurgical applications in the rostral cranial fossa of the dog. Particulars of instrumentation, and pre-operative, operative and post-operative procedures, done on 3 Beagles with excellent results, are described.

The effects of selenium on the emergence of aflatoxin B1 (AFB1)-induced enzyme-altered foci were studied in male Sprague-Dawley rats. Animals were fed a selenium-deficient diet and supplemented with 5.0, 2.0, and 0.2, or 0 ppm selenium in drinking water for 3 weeks prior to initiation with 2.0 mumol/kg AFB1. After a 1-week period of selenium normalization, the animals were placed on a diet of ordinary rat chow, and were administered a promoting regimen of 500 ppm phenobarbital in drinking water for 1 week, after which time each rat received a two-thirds partial hepatectomy. The promoting regimen of phenobarbital in tap water was then reduced to 100 ppm and continued for 7 weeks. Subsequently, the rats were sacrificed, their livers excised, and fresh frozen sections prepared and stained histochemically to demonstrate areas of gamma-glutamyl transpeptidase (GGT) activity. Selenium supplementation was observed to diminish the induction of GGT-positive foci, especially at the 5.0-ppm level. These data suggest that selenium is able to protect against the hepatocarcinogenic effects of AFB1 in the rat, and that the enzyme-altered foci bioassay may be a useful technique in assessing the interaction of selenium on the process of hepatocarcinogenesis.