Residual Signs Research Articles

Semi-Parametrically Efficient Inference-Based on Signs and Ranks for Median-Restricted Models

Since the pioneering work of Koenker and Bassett (1978), econometric models involving median and quantile, rather than the classical mean or conditional mean concepts, have attracted much interest. Contrary to the traditional models where the noise is assumed to have mean zero, median-restricted models enjoy a rich group-invariance structure. In this paper, we exploit this invariance structure in order to obtain semi-parametrically efficient inference procedures for these models. These procedures are based on residual signs and ranks, and, therefore, insensitive to possible misspecification of the underlying innovation density, yet semi-parametrically efficient at correctly specified densities. This latter combination is a definite advantage of these procedures over classical quasi-likelihood methods. The techniques we propose can be applied, without additional technical difficulties, to both cross-sectional and time-series models. They do not require any explicit tangent space calculation nor any projections on these.

Antagonist‐precipitated heroin withdrawal under anaesthetic prior to maintenance naltrexone treatment: determinants of withdrawal severity

This study sought to characterize antagonist-precipitated heroin withdrawal during and immediately following anaesthesia and to identify the determinants of withdrawal severity and duration in 48 dependent heroin users. Objective withdrawal signs decreased significantly with each naloxone bolus administered under anaesthetic. The cost (amount) of the final heroin administration and the number of hours between last heroin use and commencement of anaesthesia were significant, independent predictors of the severity of withdrawal symptomatology. While 83% (40/48) of participants completed withdrawal according to objective criteria and commenced maintenance naltrexone treatment, almost half (22/48) were unable to commence naltrexone on the day of the procedure due to residual withdrawal signs. Fourteen of these 22 participants subsequently commenced naltrexone (median number of days between admission and commencement of naltrexone was 2, range 1 - 6) while eight left treatment prior to initiation of naltrexone. Significantly fewer of those with more severe withdrawal signs during anaesthesia commenced naltrexone (40% vs. 60%). While the severity and duration of withdrawal symptomatology may be moderated by encouraging participants to reduce (or cease) heroin use close to the time of withdrawal, for a substantial proportion of participants in this study, heroin withdrawal by this antagonist-precipitated procedure was neither rapid nor painless. [Ali R, Thomas P, White J, McGregor C, Danz,C, Gowing L, Stegink A, Athanasos P. Antagonist-precipitated heroin withdrawal under anaesthetic prior to maintenance naltrexone treatment: determinants of withdrawal severity.

Functional and Histological Evidence for the Protective Effect of NXY-059 in a Primate Model of Stroke When Given 4 Hours After Occlusion

NXY-059 has substantial protective effects when administered immediately after the onset of ischemia in a primate model of stroke. This study examined the efficacy of this drug when administered 4 hours after onset, a more clinically relevant time point. Before surgery, marmosets were trained and tested on a number of neurological tests, which assessed general neurological function, motor ability, and spatial awareness. Four hours after permanent middle cerebral artery occlusion (pMCAO), marmosets received a bolus of saline (n=13) or NXY-059 (n=13), and osmotic minipumps were implanted, providing 48-hour saline or drug (85 micromol/kg per hour) infusion. The monkeys were retested 3 and 10 weeks after surgery. Finally, infarct size was evaluated with histological analysis. The unbound plasma NXY-059 concentration was 200+/-9 micromol/L after 24-hour infusion, a concentration well tolerated in stroke patients. Drug treatment ameliorated the long-term motor impairment produced by pMCAO; the marmosets were better at using their contralesional, stroke-affected arm than controls at both 3 and 10 weeks. Saline-treated animals had a debilitating spatial neglect at 3 weeks with residual signs evident at 10 weeks. NXY-059 treatment substantially attenuated neglect at 3 weeks, with no deficit being seen at 10 weeks. NXY-059 reduced the overall infarct size by 28% (saline, 324+/-46 mm3; NXY-059, 234+/-30 mm3) with protection to the cortex, white matter, and subcortical structures. NXY-059 is an effective neuroprotective agent when administered 4 hours after pMCAO in a primate species, attenuating both motor and spatial neglect. The compound also substantially lessened the volume of cerebral damage.

Prospective study of clinical epidemiology of Guillain–Barré syndrome in Harbin, China

Clinical manifestations, outcomes, prognostic indicators, and clinico-epidemiological subgroups were described based on the information of 71 patients with Guillain–Barré syndrome (GBS), who were identified from a prospective survey in Harbin, China during a 1-year period from 1 October 1997 to 30 September 1998. GBS diagnoses of the patients were validated by senior neurologists and most patients were followed up for 6 months after onset. Antecedent events, mainly respiratory infections, were found in 55 (78%) patients during the month before onset. The clinical features, like motor weakness as initial symptoms (82%) and tendon areflexia or hyporeflexia (100%), are similar to those reported from other populations. However, the proportion (70%) of patients reaching to nadir less than 7 days after onset was rather high. Intravenous human immunoglobulin and/or plasmapheresis were used in 45% of the patients and steroids in 58%. At 6 months after onset, 82% of the patients could walk without aid, 46% of the patients had no any residual signs. Four (6%) patients died within 1 month due to respiratory failure. Three subgroups with different clinico-epidemiological characteristics were identified by using cluster analysis. In conclusion, GBS patients in Harbin, China were younger, had shorter time to nadir, frequently preceded by a respiratory infection, and often treated with steroids. Clinical and epidemiological differences of GBS might exist between various populations.

Diazepam as a treatment for metronidazole toxicosis in dogs: a retrospective study of 21 cases.

The currently recommended treatment for metronidazole toxicosis is drug discontinuation and supportive therapy. Reported recovery times are 1-2 weeks. The records of 21 dogs with metronidazole toxicosis were retrospectively analyzed to determine whether diazepam improved recovery. The dosage and duration of metronidazole therapy and the response and recovery times of 13 dogs treated with diazepam were compared to those of 8 dogs receiving only supportive care. Response time was defined as the time to resolution of the debilitating clinical signs. Recovery time was the time to resolution of all residual clinical signs. The average dosage and duration of metronidazole administration for the diazepam-treated and untreated groups were 60.3 mg/kg/d for 44.9 days and 65.1 mg/kg/d for 37.25 days. The protocol for diazepam administration consisted of an initial i.v. bolus and then diazepam PO q8h for 3 days. The average dosage of both the i.v. and PO diazepam was 0.43 mg/kg. The average response time for the diazepam-treated dogs was 13.4 hours compared to 4.25 days for the untreated group. Recovery time also was markedly shorter for the diazepam-treated dogs (38.8 hours) compared to the untreated group (11 days). Results of this study showed that dogs with metronidazole toxicosis recover faster when treated with diazepam. Although the mechanism of metronidazole toxicosis or how diazepam exerts its favorable effect is not known, it is likely related to modulation of the gamma-aminobutyric acid (GABA) receptor within the cerebellar and vestibular systems.

A role of fringe pattern catalogue in the course of interferometrically based determination of residual stresses by the hole-drilling method

A further development of the technique for residual stresses determination in thick-walled structures, which is based on a combination of the hole-drilling method and reflection hologram interferometry, is presented. A plane specimen welded from two equal parts of dimensions 130×80 mm 2 in plane and thickness 12 mm is the object of investigation. Weld seam is performed along the shortest side of the specimen. Residual stress field of interest is formed by a superposition of initial welding-induced field and secondary stress field caused by plastic deformation of the specimen. A set of actual fringe patterns, which corresponds to a wide variety of residual stress components both ratio and sign, are reconstructed and presented as illustrations. A series of reference fringe patterns is simulated for the most typical cases inherent in residual stress field under study. It is shown that actual interferograms obtained belong to three main groups depending on a typical form of fringes configuration. On this base the main principles of creating the general catalogue of fringe patterns are established and the first version of this catalogue, which is related to reflection hologram interferometry, is developed. A structure of the catalogue that consists of both actual interferograms and reference fringe patterns is described. Possible ways of further catalogue completing and its direct implementing in the course of quantitative determination of residual stresses are discussed. It is shown that both experimental and numerical data aggregated into the first version of the catalogue can be effectively used for a verification of various coherent optics techniques with respect to a determination of residual stress components by means of hole drilling. An analysis of capabilities of reflection hologram interferometry in the field of residual stresses determination comparing with dual-beam speckle-interferometric techniques is presented. Superimposed residual stress field is quantitatively described in detail for both specimen sides of dimensions 260×80 mm 2. It is shown that fine nuances inherent in residual stress distributions over different specimen faces can be reliably derived from recorded fringe patterns of any type. This study serves as an example of residual stress components determination in real structure with a type of residual stress field to be investigated is unknown before the experiment.

Eliot's Recessional: Four Quartets, National Allegory, and the End of Empire

This essay presents T. S. Eliot not as a conservative dinosaur, but as an active and imaginative participant in England's transition from imperial center to welfare state and in the conceptual revolution whereby an anthropological concept of national culture displaced a modernist concept of international art. Reading Eliot's late prose and poetry in the context of British decline, it argues that Four Quartets, in all its formal complexity, manages to absorb the residual signs of European universalism into an emergent language of cultural particularism. This interpretation moves beyond the stalled debate between "local" and "universal" readings of the poem by describing the reciprocal constitution of the local and the universal at a specific transitional moment in the history of both modernism and imperialism.

Randomised controlled study of early pulsed dye laser treatment of uncomplicated childhood haemangiomas: results of a 1-year analysis

The role of pulsed dye lasers (PDL) in the treatment of childhood haemangiomas is controversial. Our aim was to compare treatment with PDL with a wait-and-see policy. We did a prospective, randomised controlled trial in which we enrolled 121 infants aged 1-14 weeks with early haemangiomas. We assigned infants to PDL treatment (n=60) or observation (n=61), and followed them up to age 1 year. The main outcome measures assessed were proportion of lesions completely clear or with minimum residual signs, adverse reactions, including pigmentary disturbance and skin atrophy, complications such as ulceration and infection, proportion of children whose parents considered the haemangioma a problem, characteristics of the haemangioma, and an independent assessment of the haemangioma problem by a panel of five parents. Analysis was by intention to treat. All infants completed the study. The number of children whose lesions showed complete clearance or minimum residual signs at 1 year was not significantly different in the PDL treated and observation groups (25, 42%, vs 27, 44%; p=0.92). However, PDL treated infants were more likely to have skin atrophy (17, 28%, vs 5, 8%; p=0.008) and hypopigmentation (27, 45%, vs 9, 15%; p=0.001). The frequency of complications was similar between groups. The only objective measure of resolution that improved with PDL treatment was haemangioma redness. The number of children whose parents considered the haemangioma to be a problem at 1 year did not differ much between groups (11 of 60, 18%, vs 9 of 61, 15%; p=0.78). The independent parent panel validated this result. PDL treatment in uncomplicated haemangiomas is no better than a wait-and-see policy.

RESIDUAL DISABILITY AND PSYCHOSOCIAL STATUS AFTER GUILLAIN BARRÉ SYNDROME: A 3 TO 5 YEAR FOLLOW‐UP

Guillain‐Barré syndrome (GBS) is the most common cause of acute not‐traumatic neuromuscular paralysis. Even if the disease usually has a good prognosis, recovery is not always complete and residual motor or sensory signs may remain. Little is known on the incidence of disability and long term psychosocial status in GBS. We present the results of a 3 to 5 year follow‐up study of the residual signs, including fatigue, pain and psychosocial status in 75 GBS patients, aged from 20–82 years (mean 56). The functional grading at the onset and at the follow up was performed using the Hughes scale and the data about residual symptoms were obtained at the follow up by phone interview. Among the 56 patients interviewed, 44 (78%) were asymptomatic or had minimal signs of neuropathy (0–1 grade of Hughes scale), 7 (13%) remained moderately disabled (grade 2), 4 (7%) were unable to walk independently (grade 3), and one patient died. 51 (92%) were able to live independently at home while only 3 (5%) needed continuous or partial assistance. 33% of patients (18) reported fatigue in all their activities while 27% (15) had residual pain, which rarely caused restriction in daily living. 23% of patients (13) changed or temporarily or definitively suspended their job. 59% reached the maximum improvement in the first year while 21% continued to improve in the three following years. We observed that patients>40 years old were more severely impaired than the younger ones (76% vs 60% of patients had grade 4 or 5 of Hughes scale) while permanent disability was only observed in those aged>60 years (14% of patients vs none of the younger patients had grade 3). No difference was found in the outcome between patients with or without assisted ventilation. Patients reaching maximal worsening within 10 days achieved maximal improvement more quickly and remained less disabled than the others while those with>10 days plateau duration remained more severely impaired than those with a shorter duration.

Results of vulvoplasty for treatment of recessed vulva in dogs.

The results of vulvoplasty were evaluated in 34 dogs that underwent surgery at the University of Wisconsin Veterinary Medical Teaching Hospital between 1987 and 1999. Case records were evaluated, and clients were interviewed by telephone. The most common clinical signs of a juvenile or recessed vulva at initial examination were perivulvar dermatitis in 59% (20/34) of dogs and urinary incontinence and chronic urinary tract infection (UTI), each present in 56% (19/34) of dogs. Other common complaints included pollakiuria, irritation, and vaginitis. Most dogs developed clinical signs before 1 year of age. All dogs except one bichon frise were medium to giant breeds, suggesting that vulvar conformation may be related to growth rate or body conformation; prior ovariohysterectomy did not appear to be an influencing factor. Eighty-two percent of owners rated the outcome of the surgery as at least satisfactory. The incidence of urinary incontinence was reduced by vulvoplasty; however, it remained the most common residual sign after surgery, suggesting a multifactorial etiology. The incidences of UTI, vaginitis, and external irritation were greatly reduced after surgery.

A Simple Algorithm for Sequentially Incorporating Gravity Observations in Seismic Traveltime Tomography

The geologic structure of the Earth's upper crust can be revealed by modeling variation in seismic arrival times and in potential field measurements. We demonstrate a simple method for sequentially satisfying seismic traveltime and observed gravity residuals in an iterative 3-D inversion. The algorithm is portable to any seismic analysis method that uses a gridded representation of velocity structure. Our technique calculates the gravity anomaly resulting from a velocity model by converting to density with Gardner's rule. The residual between calculated and observed gravity is minimized by weighted adjustments to the model velocity-depth gradient where the gradient is steepest and where seismic coverage is least. The adjustments are scaled by the sign and magnitude of the gravity residuals, and a smoothing step is performed to minimize vertical streaking. The adjusted model is then used as a starting model in the next seismic traveltime iteration. The process is repeated until one velocity model can simultaneously satisfy both the gravity anomaly and seismic traveltime observations within acceptable misfits. We test our algorithm with data gathered in the Puget Lowland of Washington state, USA (Seismic Hazards Investigation in Puget Sound [SHIPS] experiment). We perform resolution tests with synthetic traveltime and gravity observations calculated with a checkerboard velocity model using the SHIPS experiment geometry, and show that the addition of gravity significantly enhances resolution. We calculate a new velocity model for the region using SHIPS traveltimes and observed gravity, and show examples where correlation between surface geology and modeled subsurface velocity structure is enhanced.

Evaluation of the treatment of clubfeet with the Diméglio score.

Between January 1994 and November 1997, 17 children with 25 clubfeet were treated and evaluated. This group was divided into a group of only conservatively treated feet (group A, n=13) and a group of feet which had conservative treatment and complementary operative treatment (group B, n=12). Both groups were evaluated according to the Diméglio classification method in which the objective clinical evaluation is scored only. This was performed for the starting-point (at presentation until 2 weeks after birth), with the necessary information received from the patient's files where all the passive limitations were recorded in a standardized way and also for the end-point (at the time of the follow-up). After comparing these results to each other, all 25 feet had improved after treatment and the operative group had improved more than the conservative group, however the end result was equal, because the operated feet were more severely deformed before the treatment. After treatment, the results were considered acceptable in 92% of the feet, comparable to 93%, 75-85%, 88%, 77%, and 96% in other studies. Moreover, the forefoot adduction was the most common residual sign in the treated feet, confirmed by results in other studies. We conclude that the Diméglio method is an appropriate tool for the follow-up of clubfeet from birth to the end of treatment.

Evaluation of the Treatment of Clubfeet With the Diméglio Score

Between January 1994 and November 1997, 17 children with 25 clubfeet were treated and evaluated. This group was divided into a group of only conservatively treated feet (group A, n=13) and a group of feet which had conservative treatment and complementary operative treatment (group B, n=12). Both groups were evaluated according to the Diméglio classification method in which the objective clinical evaluation is scored only. This was performed for the starting-point (at presentation until 2 weeks after birth), with the necessary information received from the patient's files where all the passive limitations were recorded in a standardized way and also for the end-point (at the time of the follow-up). After comparing these results to each other, all 25 feet had improved after treatment and the operative group had improved more than the conservative group, however the end result was equal, because the operated feet were more severely deformed before the treatment. After treatment, the results were considered acceptable in 92% of the feet, comparable to 93%, 75-85%, 88%, 77%, and 96% in other studies. Moreover, the forefoot adduction was the most common residual sign in the treated feet, confirmed by results in other studies. We conclude that the Diméglio method is an appropriate tool for the follow-up of clubfeet from birth to the end of treatment.

Monte Carlo calculations of energies in the erbium region

We investigate the validity of the method of computing ground-state energies, at a given angular momentum, with Monte Carlo methods applied to the functional integral formulation containing pairing fields. Calculations have been performed for several erbium isotopes and a few dysprosium isotopes. It is found that some residual sign fluctuations, which seem to be associated with a small neutron number above the $N=82$ shell closure, are present, but that they do not affect the feasibility of the calculations. Such sign fluctuations disappear as the neutron number is increased. Also, an efficient improved method for the computation of the functional integral in the case of an odd number of particles is presented. The Monte Carlo method of Metropolis et al. [J. Chem. Phys. 21, 1087 (1953)] is used in the evaluation of expectation values.

Long-term sensory deficit after Guillain-Barré syndrome

In order to document the sensory deficit still present several years after onset of Guillain-Barré syndrome (GBS) and to determine if the sensory residua have a disrupting effect on daily life, 122 patients were asked to cooperate in a neurological examination and to complete a questionnaire three to six years after onset. On functional assessment 84 patients had no or only minor neurological symptoms or signs, 24 patients showed moderate recovery and 14 patients were left with severe residual signs. On neurological examination, residual sensory deficit was found in the arms of 38 % of the patients and in the legs of 66 % of the patients. Sensory disturbance was experienced as moderate to severe in the arms of 27 % of the patients and in the legs of 40 % of the patients. Muscle aches and cramps were still present in 48 %. There was a statistically significant relation between muscle aches and cramps and objective residual sensory deficit but not with residual weakness. Furthermore, in the group of patients with a pure motor GBS, significantly fewer people suffered from muscle aches and cramps than in the remaining patients (p=0.04). Twenty-five percent of patients changed jobs after their illness, and 44% gave up some leisure activities. It can be concluded that many patients still suffer from sensory deficit, and a considerable number experience these as moderately to seriously disruptive, especially in the legs. Muscle aches and cramps seems to be related to sensory rather than motor dysfunction.

Community-Acquired Pneumonia

We initiated a prospective study with a group of practitioners to assess the etiology, clinical presentation, and outcome of community-acquired pneumonia in patients diagnosed in the outpatient setting. All patients with signs and symptoms suggestive of pneumonia and an infiltrate on chest X-ray underwent an extensive standard workup and were followed over 4 weeks. Over a 4-year period, 184 patients were eligible, of whom 170 (age range, 15-96 yr; median, 43 yr) were included and analyzed. In 78 (46%), no etiologic agent could be demonstrated. In the remaining 92 patients, 107 etiologic agents were implicated: 43 were due to "pyogenic" bacteria (39 Streptococcus pneumoniae, 3 Haemophilus spp., 1 Streptococcus spp.), 39 were due to "atypical" bacteria (24 Mycoplasma pneumoniae, 9 Chlamydia pneumoniae, 4 Coxiella burnetii, 2 Legionella spp.), and 25 were due to viruses (20 influenza viruses and 5 other respiratory viruses). There were only a few statistically significant clinical differences between the different etiologic categories (higher age and comorbidities in viral or in episodes of undetermined etiology, higher neutrophil counts in "pyogenic" episodes, more frequent bilateral and interstitial infiltrates in viral episodes). There were 2 deaths, both in patients with advanced age (83 and 86 years old), and several comorbidities. Only 14 patients (8.2%) required hospitalization. In 6 patients (3.4%), the pneumonia episode uncovered a local neoplasia. This study shows that most cases of community-acquired pneumonia have a favorable outcome and can be successfully managed in an outpatient setting. Moreover, in the absence of rapid and reliable clinical or laboratory tests to establish a definite etiologic diagnosis at presentation, the spectrum of the etiologic agents suggest that initial antibiotic therapy should cover both S. pneumoniae and atypical bacteria, as well as possible influenza viruses during the epidemic season.

A SEVERE COMPLICATION OF RETROPERITONEOSCOPIC NEPHRECTOMY

A 58-year-old woman was admitted to the hospital with left hydronephrosis due to a 3 cm. obstructive calculus of the renal pelvis. She had undergone diskectomy 2 months earlier for symptomatic median disk herniation at L4/5. Postoperative followup revealed no residual neurological signs. A Double-J* catheter was inserted. Renal mercaptoacetyltriglycine-3 scintigraphy 14 days later demonstrated complete failure of the left kidney. Retroperitoneoscopic nephrectomy was scheduled. After preparation of the ureter and kidney, the hilus was removed laterally. Bleeding occurred and an endoscopic gastrointestinal anastomosis clip was positioned with limited visibility in the hilar region. Bleeding stopped and after cutting the ureter the left kidney was removed. Postoperatively the patient immediately complained of severe back and leg pain, partial loss of sensibility and weakness in both legs with paresis of the right foot levator muscle. Neurological and electromyographic examinations proposed an intraoperative pressure lesion of the right peroneal nerve. Computerized tomography of the abdomen and transbrachial aortography demonstrated a clip obstructing the aorta (figs. 1 and 2). The aorta was collapsed for 2 cm. and refilled by collaterals. Aortal clip closure was confirmed at reoperation. Preparation of the clipped aortic stump and right renal artery was not possible due to extensive scarring. A polytetrafluoroethylene tube graft was inserted with an end-to-side anastomosis from the supraoeliac aorta to the distal aortic stump maintaining perfusion to the right renal artery. Duplex sonography demonstrated normal perfusion of the renal and distal extremity arteries. The neurological disorders resolved completely. DISCUSSION Difficult dissection in retroperitoneoscopic nephrectomy due to bleeding or anatomy can cause severe complications. It is important to identify carefully the hilar vessels because the aorta and vena cava may be pulled into the operative field.

Clinical epidemiology of Guillain-Barré syndrome in adults in Sweden 1996-97: a prospective study.

We described clinical manifestations, outcomes, prognostic indicators and clinico-epidemiological subgroups for 53 adult patients with Guillain-Barré syndrome (GBS) in Sweden during the period 1996-97. These patients were identified from a population of 2.8 million inhabitants and prospectively followed up for one year by a network of neurologists. An additional 10 cases, of whom five were adults who had not been prospectively followed up, were not included in the analyses. At 6 months after onset 80% of the patients could walk without aid, while at 1 year 46% were fully recovered, 42% had mild residual signs or symptoms, 4% had moderate and 6% severe disabilities, and 2% had died. Intravenous human immunoglobulin or plasmapheresis were used in 72% of the patients. The sum of the Medical Research Council (MRC) score at nadir was found as the only significant predictor for residual signs at 1 year in a multivariate model. Three subgroups, with different clinico-epidemiological characteristics, were identified by using cluster analysis. In conclusion, GBS in Sweden is frequently preceded by a respiratory infection, is often treated with immunomodulatory therapies, and exhibits a high recovery rate and a low fatality rate.

MR imaging and (1)H spectroscopy of brain metabolites in hepatic encephalopathy: time-course of renormalization after liver transplantation.

To evaluate changes in hydrogen 1 magnetic resonance (MR) spectroscopic findings in overt or subclinical hepatic encephalopathy (HE) after liver transplantation and to compare these changes with clinical outcomes and basal ganglia high signal intensity (BGH). Twenty-two patients scheduled for liver transplantation and 17 healthy control subjects were examined with (1)H MR spectroscopy and standard nonenhanced MR imaging. Eight patients underwent complete MR imaging and (1)H spectroscopic examinations before liver transplantation and at 3-4-week, 12-28-week, and 10-12-month follow-up after liver transplantation. Before liver transplantation, typical (1)H spectroscopic changes-decreased myo-inositol (mI)/creatine (Cr) and choline (Cho)/Cr ratios and an elevated glutamine and glutamate (Glx)/Cr ratio-were found in 21 patients. Eighteen patients had BGH at T1-weighted imaging. Three to 7 months after liver transplantation, the mI/Cr and Glx/Cr ratios were within the normal range in five of eight and eight of eight patients, respectively, without any residual signs of subclinical or overt HE; however, at MR imaging, seven patients still had BGH. After successful liver transplantation, renormalization of HE-specific brain metabolite changes is detected at (1)H spectroscopy and precedes the disappearance of BGH. The neuropsychologic signs of subclinical or overt HE follow the changes seen at (1)H spectroscopy rather than those seen at MR imaging.

Congenital ocular motor apraxia with autosomal dominant inheritance

PURPOSE: To document congenital ocular motor apraxia in five first-degree relatives. METHODS: Case series. Five family members with a history of horizontal head thrusting had neuro-ophthalmologic evaluation. Magnetic resonance imaging of the brain was obtained in the proband. RESULTS: Four siblings (one boy and three girls) had congenital ocular motor apraxia. The father had head thrusting as a child and displayed residual signs of the disorder. Magnetic resonance imaging disclosed no central nervous system abnormalities in the father. CONCLUSION: Congenital ocular motor apraxia can be inherited as an autosomal dominant trait.