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Wilder Penfield was appointed as Chair of McGill University’s newly created Department of Neurology and Neurosurgery in 1930 and Director of the Montreal Neurological Institute (MNI) in 1933. The departmental structure allowed Penfield to develop his own research priorities, and the MNI’s clinics and laboratories allowed residents to train in neurosurgery and in basic science under one roof. This paper reviews the research performed by neurosurgical residents under Penfield’s direction from 1934 to 1945 and argues that their initiation to laboratory research contributed to the emergence of neuroscience following the Second World War.
This paper reviews the history of neurology and neurosurgery at McGill University from their origins within the Departments of Medicine and of Surgery at the Royal Victoria Hospital in 1894, to the creation of an autonomous Department of Neurology and Neurosurgery in 1928 at the Montreal Neurological Institute. The argument is made that the collaboration of James Stewart and James Bell and of Colin Russel and Edward Archibald in the diagnosis and treatment of neurological patients created an institutional culture that favored the integration of neurology, neurosurgery, and allied disciplines within a departmental structure and the creation of the Montreal Neurological Institute.
Psychosurgery refers to the surgical interruption of the white matter fibres joining the frontal cortex to the remainder of the cortical mantle and to the thalamus, in an attempt to mitigate the manifestations of psychosis. It reached its heyday following World War Two and was abandoned with the introduction of major tranquilisers such as chlorpromazine. Wilder Penfield, unlike most of his contemporaries, had a jaundiced view of psychosurgery. This paper addresses Penfield’s early experience with experimental, penetrating brain trauma and with the surgical resection of frontal, epileptogenic lesions, which explain his antagonism towards psychosurgery.
It remains unclear whether ST-elevation myocardial infarction (STEMI) patients transported by ambulance over long distances are at risk for clinical adverse events. We sought to determine the frequency of clinical adverse events in a rural population of STEMI patients and to evaluate the impact of transport time on the occurrence of these events in the presence of basic life support paramedics.
We performed a health records review of 880 consecutive STEMI patients transported to a percutaneous coronary intervention centre. Patients had continuous electrocardiogram and vital sign monitoring during transport. A classification of clinically important and minor adverse events was established based on a literature search and expert consensus. A multivariate ordinal logistic regression model was used to study the association between transport time (0-14, 15-29, ≥30 minutes) and the occurrence of overall clinical adverse events.
Clinically important and minor events were experienced by 18.5% and 12.2% of STEMI patients, respectively. The most frequent clinically important events observed were severe hypotension (6.1%) and ventricular tachycardia/ventricular fibrillation (5.1%). Transport time was not associated with a higher risk of experiencing clinical adverse events (p=0.19), but advanced age was associated with adverse events (p=0.03). No deaths were recorded during prehospital transport.
In our study of rural STEMI patients, clinical adverse events were common (30.7%). However, transport time was not associated with the occurrence of adverse clinical events in these patients.
The purpose of the Working Group on Ap and Related Stars (ApWG) is to promote and facilitate research about stars in the spectral type range from B to early F that exhibit surface chemical peculiarities and related phenomena. This is a very active field of research, in which a wide variety of new developments have taken place since 2009, as illustrated by the following selected highlights.
This multiple case study investigates conditions influencing the integration of the ecological approach in disease prevention and health promotion (DPHP) programs offered to older adults by local health organizations in Quebec. Scheirer’s (1981) implementation model guided the study of five Centres de Santé et Services Sociaux chosen in line with the ecological dimension of their DPHP programs. Documentary analyses were conducted along with thirty-eight semi-structured interviews among professionals and managers. Three categories of factors were explored: professional, organizational and environmental factors. Results indicate the ecological dimension of programs is influenced by organizational norms, competing priorities, team structure, external partnerships, preconceived ideas regarding DPHP for older adults, along with professional interest and training. These results provide levers for action toward optimizing services offered to the older population through disease prevention and health promotion programs.
It is well known that diets high in nuts or peanuts favourably affect plasma lipid concentrations. However, few studies have examined the effects of nut and peanut protein (PP) on body composition and skeletal muscle properties. The present study was aimed at evaluating the effect of dietary PP compared with two animal proteins, casein (C) and cod protein (CP) on body composition, skeletal muscle contractile properties and lipid metabolism in rats. Thirty-two male rats were assigned to one of the following four diets containing either C, CP, PP or C+peanut protein (CPP, 50:50) mixture. After 28 d of ad libitum feeding and after 12-h fast, blood, liver and muscle were collected for measurements of plasma and hepatic cholesterol and TAG, plasma glucose and insulin and contractile properties. Rats fed with the low-quality protein, PP, had lower body weight gain, body protein mass, soleus mass and liver weight than those fed with the high-quality dietary proteins, C and CP. PP also caused a deficit in contractile properties in soleus. Likewise, PP increased plasma cholesterol and body fat mass compared with CP. However, these elevations were accompanied with increased hepatic TAG concentrations and lowered intestinal fat excretion. These results show that PP intake alters body composition by reducing skeletal muscle mass and liver weight as well as muscle contractility and lipid metabolism. Adding a complete protein such as C might partially counteract these adverse effects.
The diversity of physical phenomena embraced by the study of Chemically Peculiar (CP) stars results in an associated research community with interests that are equally diverse. This fact became once more evident during the CP#Ap Workshop that took place in Vienna (Austria) in September 2007, and which gathered over 80 members of this research community. Besides the excellent scientific outcome of the meeting, during the workshop the community had the opportunity to discuss its organization and plans for the future. Following on those plans, the Working Group has submitted a proposal for a Joint Discussion during the IAU XXVII General Assembly, in Rio de Janeiro, which has meanwhile been accepted. Moreover, through an ApN newsletter forum, the Working Group has compiled requests from the community concerning atomic and related data. These requests have been put together and will be shared with Commission 14.
The goal of this study was to provide a general descriptive and cognitive portrait of a population with traumatic brain injury (TBI) at the time of their acute care stay.
Material and methods:
Three hundred and forty-eight TBI patients were assessed. The following data were collected for each patient: age, level of education, duration of post-traumatic amnesia, Galveston Orientation Amnesia Test score, Glasgow Coma Scale score, results of cerebral imaging, Neurobehavioral Rating Scale score, the Functional Independence Measure cognitive score and the Glasgow Outcome Scale score.
The clinical profile of the population revealed a mean age of 40.2 (±18.7) and a mean of 11.5 (±3.6) years of education. Most patients presented with frontal (57.6%) and temporal (40%) lesions. Sixty-two percent had post-traumatic amnesia of less than 24 hours. Seventy percent presented with mild TBI, 14% with moderate and 15% with severe TBI. The cognitive deficits most frequently observed on the Neurobehavioral Rating Scale were in the areas of attention, memory and mental flexibility as well as slowness and mental fatigability. Most patients had good cognitive outcome on the Functional Independence Measure and scores of 2 and 3 were frequent on the GOS. Forty-five percent of the patients returned home after discharge, 51.7% were referred to in or out patient rehabilitation and 3.2% were transferred to long-term care facilities.
Because of the specialized mandate of acute care institutions, the information provided here concerning characteristics of our TBI population is essential for more efficient decision-making and planning/programming with regards to care and service delivery.
A review of some of the most important studies of the past several decades pertaining to the study of atomic diffusion in stellar atmospheres is presented. A brief description of various studies of radiative accelerations and diffusion calculations in stellar atmospheres is given. Several physical phenomena such as ambipolar diffusion, light-induced drift and the effect of magnetic fields on diffusion are discussed. Results from recent self-consistent model atmospheres including elemental stratification are also reviewed. Particularities of radiative acceleration calculations in stellar atmospheres as well as difficulties and future challenges related to diffusion calculations in stellar atmospheres are also presented.
Spurred by recent developments in molecular neurobiology, the 1990s have seen a burgeoning of interest in the genetic aspects of cerebrovascular diseases. Many types of cerebrovascular lesions are associated with well-defined, genetically determined conditions: cerebral aneurysms accompany polycystic kidney disease; cerebral arteriovenous malformations (AVM) are a major component of hereditary haemorrhagic telangiectasia (HHT, Rendu–Osler–Weber disease); and cerebral cavernous angiomas are associated with at least two genetic mutations (Lozano & Leblanc, 1992; Putnam et al., 1996; Gunel et al., 1995). In this context the elaboration of a new neurocutaneous syndrome, hereditary neurocutaneous angiomatosis (HNA), a condition characterized by the presence of vascular lesions of the skin and brain, is of interest because its molecular characterization may shed light on the etiology of common sporadic cerebrovascular lesions such as AVMs and developmental venous anomalies (DVA) with which it is associated (Zaremba et al., 1979; Hurst & Baraitser, 1988; Leblanc et al., 1996). Most AVMs and DVA are sporadic lesions without associated cutaneous anomalies.
The clinical manifestations of the vascular nevi in HNA depend on their size and location. The lesions, including cavernous angiomas, AVMs, and venous malformations, are multiple and they can range from a few millimetres in apparent diameter to up to 1–2 cm. The color of the lesions depends on their depth, the deeper ones appearing as a flat bluish discoloration, the more superficial and larger ones as elevated, bluish or reddish, raspberry-like, blanching, compressible structures (Fig. 21.1). Palpable phleboliths are sometimes present.
Bactrocera Macquart (Diptera: Tephritidae) is a genus of nearly 500 species, the
majority of which are endemic to tropical South-East Asia and Australasia
(Drew 1989). Nearly all Bactrocera have frugivorous larvae that feed on the
fleshy fruit of tropical trees, shrubs, and vines, and some species are major
horticultural pests (White & Elson-Harris 1992). In this paper,where the term
‘fruit fly’ is used, we are referring explicitly to species of Bactrocera.
Familial adenomatous polyposis (FAP) is associated with malignant tumors of the central nervous system, predominantly medulloblastomas and glioblastoma multiforme (Turcot's syndrome) and with craniofacial osteomas (Gardner's syndrome). This report details the occurrence of benign, intracranial tumors in two related individuals with Gardner's syndrome, an asso ciation not previously described.
Patients and Methods:
A 57-year-old woman (the propositus), her sister, two of her nieces and one of her grandnephews were previously diagnosed with Gardner's syndrome. The propositus came to neurosurgical attention because of vertigo associated with what proved to be an epidermoid cyst of the cerebellopontine angle. Her unaffected children and her relatives with Gardner's syndrome were examined and underwent computed tomography or magnetic resonance imaging.
A 39-year-old woman with Gardner's syndrome, the niece of the propositus, was found to harbor an asymptomatic left frontal meningioma.
Familial adenomatous polyposis, Gardner's syndrome, and that variant of Turcot's syndrome in which medulloblastoma predominate, are associated with a mutation of the adenomatous polyposis coli gene. The demonstration that patients with Gardner's syndrome can also have benign, nonneuroglial, intracranial tumors adds to the previously known extracolonic lesions associated with FAP. The molecular characterization of our patients should reveal if benign intracranial tumors represent a pleiotropic manifestation of the adenomatous polyposis coli gene mutation or if other genes are implicated.
To assess the feasibility and the toxicity of adjuvant high dose tamoxifen (TAM) and postoperative brain irradiation for patients with newly-diagnosed glioblastoma multiforme (GBM).
Material and Methods:
Twelve patients with histopathologically confirmed GBM entered the study. There were nine males and three females, with median age of 48.8 years (range 30-75 years). Karnofsky performance status (KPS) was 60-70% for four patients and 80-100% for eight patients. Based on the Radiation Therapy Oncology Group recursive partition analysis, there were three class III patients, six class IV, one class V, and two class VI. Eleven patients underwent partial surgical tumor resection and one patient had a near complete resection. Two weeks post surgery, the patients were started on high dose TAM (120mg/m2 P.O. BID for three months). Two weeks from date of starting TAM, external beam radiotherapy (RT) was given at a dose of 59.4 Gy/33 qd fractions/6.5 weeks. Patients were assessed weekly for toxicity during treatment. Imaging studies were done at the end of two weeks of TAM, then monthly.
Median follow-up was 40 weeks (range 22-84 weeks). In one patient, TAM was associated with significant vomiting, necessitating the TAM dose to be decreased at three weeks and then stopped at two months. One other patient had bilateral deep venous thrombosis after 51/2 weeks on TAM, although the relationship to TAM was not firmly established. There were no radiological responses after two weeks of TAM or at the end of RT. The median time to progression was 17.7 weeks (range 5.1- 43.8 weeks). Median survival time was 33.4 weeks (range 10-79.7). Actuarial survival at 48 and 74 weeks was 40% and 15%, respectively.
Our study shows that adjuvant high dose TAM is feasible and relatively well-tolerated. Furthermore, the combined use of high dose TAM and RT postoperatively was not associated with any significant increase in radiation-induced neurological toxicity. However, high dose TAM does not appear to improve treatment results.
Analyses of between-sex differences have provided a powerful starting point for evolutionarily informed work on human sexuality. This early work set the stage for an evolutionary analysis of within-sex differences in human sexuality. A comprehensive theory of human sexual strategies must address both between-sex differences and within-sex differences in evolved psychology and manifest behavior.
It is often difficult to differentiate a recurrent glioma from the effects of post-operative radiotherapy by means of conventional neurodiagnostic imaging. Proton magnetic resonance spectroscopic imaging (1H-MRSI), that allows in vivo measurements of the concentration of brain metabolites such as choline-containing phospholipids (Cho), may provide in vivo biochemical information helpful in distinguishing areas of tumor recurrence from areas of radiation effect.
Patients and Methods:
Two patients who had undergone resection and post-operative radiotherapy for a cerebral glioma became newly symptomatic. Computed tomographic (CT) and magnetic resonance imaging (MRI) performed after the intravenous infusion of contrast material, and in one case, [18F] fluorodeoxyglucose positron emission tomography (PET), could not differentiate between the possibilities of recurrent glioma and radiation effect. The patients underwent 1H-MRSI prior to reoperation and the 1H-MRSI results were compared to histological findings originating from the same locations.
A high Cho signal measured by 1H-MRSI was seen in areas of histologicallyproven dense tumor recurrence, while low Cho signal was present where radiation changes predominated.
The differentiation between the recurrence of a cerebral glioma and the effects of post-operative irradiation was achieved using 1H-MRSI in these two patients whose conventional neurodiagnostic imaging was equivocal for such a distinction. Where these two conditions are present, metabolite images from 1H-MRSI, such as that based on Cho, can be co-registered with other imaging modalities such as MRI and may also be integrated with functional MRI or functional PET within a multimodal imaging-guided surgical navigation system to assure maximal resection of recurrent tumor while minimizing the risk of added neurological damage.