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Allen L. Ho, Anne-Mary N. Salib, Arjun V. Pendharkar, Eric S. Sussman, William J. Giardino and Casey H. Halpern

% ethanol with water until intake stabilized. Bilateral DBS leads were then implanted in either the shell or the core of the NAc, and DBS was delivered for 5 minutes prior to ethanol access and then continued for 30 minutes, during which the volume of consumption was measured. Ethanol consumption was significantly reduced with increasing intensities of DBS, but there was no significant difference in consumption between those rats receiving NAc core or shell DBS. 35 TABLE 1. Summary of animal studies of DBS for alcoholism Authors & Year Animal EtOH Procedure DBS

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Sascha Mann, Michael Schütze, Steffen Sola and Jürgen Piek

Object

Pyogenic vertebral osteomyelitis is of special interest to neurosurgeons because it often results in acute neurological deterioration and requires a combination of adequate surgical and conservative treatment. The aim of the current study was to evaluate the strategy of a primary surgical approach to this disease.

Methods

A group of 24 patients with the clinical and radiological signs of acute pyogenic spondylodiscitis was prospectively followed from 1998 to 2004. Of these, 20 had underlying diseases such as diabetes mellitus, chronic alcoholism, and liver cirrhosis. The main causative organism was Staphylococcus aureus. Most infections were localized in the thoracic or lumbar spine (10 cases each); 15 infections were associated with epidural abscesses. Because of a delay in diagnosis, 13 patients presented with neurological deficits on admission.

Patients with a complete or rapidly progressing neurological deficit underwent immediate surgery. In patients with minor or no deficits or in a stable neurological condition, surgery was delayed for 3 to 5 days. This group was treated with immobilization and intravenous antibiotic drugs before surgery. Surgical procedures included ventral, dorsal, and combined approaches in one- or two-stage operations. Antibiotic treatment included the use of broad-spectrum antibiotic drugs delivered intravenously for at least 10 days, followed by orally administered antibiotics for 3 months.

Twenty patients were independent on follow-up review, 15 with no or minor handicaps. Severe septicemia and multiorgan failure developed in two patients, and these two died of their disease. Major complications were mainly due to long-term antibiotic therapy.

Conclusions

Surgical treatment is the modality of choice in patients with acute spinal osteomyelitis. It is especially indicated in patients with progressive or severe neurological deficits and spinal deformity. In experienced hands, surgery is safe and offers the advantages of spinal cord decompression, immediate mobilization, and correction of spinal deformity. The decision whether an anterior or posterior approach should be used must be made on an individual basis.

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Michael B. Henderson, Alan I. Green, Perry S. Bradford, David T. Chau, David W. Roberts and James C. Leiter

thought to approximate many features of alcoholism found in patients with a genetic predisposition toward alcoholism. 25 For this reason, DBS, which is already effective and approved for use in humans in other settings, may be a beneficial therapy in patients with severe alcoholism resistant to other forms of therapy. If DBS proves to be effective at reducing the salient effect of alcohol in abstinent drinkers, it may also decrease the risk of relapse. 28 Thus, DBS may serve as a solitary or an adjunctive therapy in patients resistant to current treatments for

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Stephan Dützmann, Florian Geßler, Gerhard Marquardt, Volker Seifert and Christian Senft

substitution was anticipated based on patient history in the vast majority. The rate of unexpectedly elevated PTs that do not affect the bleeding tendency would be strongly diminished if testing were focused on elective patients with a higher pretest probability for PT abnormalities only—patients with current or previous anticoagulation medication, liver disease including alcoholism, or longer-lasting inflammatory or malignant illnesses. Subsequent studies might reveal specific conditions in which PT testing remains mandatory. Likewise, Ng et al. 26 have suggested that the

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Tony R. Wang, Shayan Moosa, Robert F. Dallapiazza, W. Jeffrey Elias and Wendy J. Lynch

ameliorated by NAc DBS. 33 This provides further evidence that the PFC may play a pivotal role in impulse control in drug addiction. Moreover, this result supports animal work in which NAc DBS was found to antidromically activate the PFC. 63 Neuroimaging has also demonstrated the critical role of the PFC in addiction. In 1 study, PET scans were performed during a gambling task in both the on and off stimulation state (the patient was blinded to the stimulation status during the testing) 2 years after the placement of NAc DBS for alcoholism. Testing revealed that the

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Toba Niazi, Alfredo Quinoñes-Hinojosa and Meic H. Schmidt

-old woman with a history of alcoholism and cocaine dependency presented to the University of Utah emergency room after a motor vehicle collision complaining of cervical spine tenderness and having experienced transient left-arm paresthesias immediately after the accident. Examination On examination, the patient was alert, awake, oriented, and hemodynamically stable, with no deficits in motor or sensory function. The results of a trauma work up were unremarkable with the exception of findings on the CT and CT angiograms of her cervical spine. These studies

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Brian P. Walcott, Jean-Valery C. E. Coumans and Kristopher T. Kahle

effective in correcting the neurological manifestations of copper deficiency. 22 , 27 , 35 Other nutrient and vitamin deficiencies, such as vitamin B12 and folate deficiency, have characteristic effects on the posterior and lateral columns of the spinal cord. 3 , 53 Symptoms of weakness, paresthesia, impaired proprioception, and impaired vibratory sensation can mimic spinal cord disease, especially severe myelopathy, as the condition progressively worsens. These deficiencies can be secondary to poor absorption and malnutrition in the setting of alcoholism 12 , 18 , 69

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Bradley A. Gross, Stefan A. Mindea, Anthony J. Pick, James P. Chandler and H. Hunt Batjer

level is equal in efficacy to midnight salivary cortisol levels in terms of sensitivity and specificity for the diagnosis of Cushing syndrome. 41 Hence, a more convenient “bedtime” 11 p.m. cortisol can be measured. It is generally advisable to collect at least three late-night salivary cortisol samples on 3 different days. Indeed, equivocal results one evening may occur in the setting of pseudo-Cushing states such as depression, sleep apnea, polycystic ovarian syndrome, high physical stress, and chronic alcoholism. Interestingly, normal salivary cortisol levels

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D. L. Marinus Oterdoom, Gertjan van Dijk, Martijn H. P. Verhagen, V. Carel R. Jiawan, Gea Drost, Marloes Emous, André P. van Beek and J. Marc C. van Dijk

addictive behavior related to alcohol 31 , 35 and cocaine. 64 Some clinical evidence indicates a favorable outcome of DBS with regard to compulsions in patients with obsessive-compulsive behavior. 18 Furthermore, beneficial effects were reported in a case series with positive effects on alcoholism. 65 Current Evidence for DBS of the NAC in Obesity From a theoretical point of view the NAC makes a suitable target for DBS in the treatment of obesity, especially the forms related to food addiction. There are, however, only 5 animal experimental papers actually testing this

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Louis De Beaumont, Luke C. Henry and Nadia Gosselin

relatively poor specificity of these ERP components, although they are highly sensitive to the effects of sports concussions. For instance, alterations in P3 components have been found in various clinical populations including those with schizophrenia, alcoholism, depression, attention deficit disorders, epilepsy, Alzheimer disease, and others. 55 The poor ERP component specificity is particularly problematic for concussed athletes whose P3 components alterations are not tied to observable or reported cognitive difficulties, as one might argue that factors extraneous to