Necrotising soft tissue infections are potentially fatal. Early recognition and prompt aggressive debridement are the keys to successful management.

of prehension. I. Posterior parietal cortex and object-oriented hand behaviors. J Neurophysiol 97: [387][388][389][390][391][392][393][394][395][396][397][398][399][400][401][402][403][404][405][406] 2007. First published September 13, 2006; doi:10.1152/jn.00558.2006. Hand manipulation neurons in areas 5 and 7b/anterior intraparietal area (AIP) of posterior parietal cortex were analyzed in three macaque monkeys during a trained prehension task. Digital video recordings of hand kinematics synchronized to neuronal spike trains were used to correlate firing rates of 128 neurons with hand actions as the animals grasped and lifted rectangular and round objects. We distinguished seven task stages: approach, contact, grasp, lift, hold, lower, and relax. Posterior parietal cortex (PPC) firing rates were highest during object acquisition; 88% of task-related area 5 neurons and 77% in AIP/7b fired maximally during stages 1, 2, or 3. Firing rates rose 200 -500 ms before contact, peaked at contact, and declined after grasp was secured. 83% of area 5 neurons and 72% in AIP/7b showed significant increases in mean rates during approach as the fingers were preshaped for grasp. Somatosensory signals at contact provided feedback concerning the accuracy of reach and helped guide the hand to grasp sites. In error trials, tactile information was used to abort grasp, or to initiate corrective actions to achieve task goals. Firing rates declined as lift began. 41% of area 5 neurons and 38% in AIP/7b were inhibited during holding, and returned to baseline when grasp was relaxed. Anatomical connections suggest that area 5 provides somesthetic information to circuits linking AIP/7b to frontal motor areas involved in grasping. Area 5 may also participate in sensorimotor transformations coordinating reach and grasp behaviors and provide on-line feedback needed for goal-directed hand movements.

No abstract

The visual outcome of 22 patients undergoing trans-sphenoidal excision of pituitary macroadenomas with intraoperative flash visual evoked potential (VEP) monitoring (Group A), was compared with a non-randomized group of 14 patients who had undergone similar operations without VEP monitoring (Group B). Tumour size, preoperative visual acuity, peripheral fields, and latencies and amplitudes of P1 and P2 were analysed to ascertain the best predictor of postoperative visual function. It was found that patients in Group A had a significantly greater improvement in field defects than those in Group B. There was no difference in postoperative improvement in visual acuity between the two groups. None of the variables analysed were good predictors of visual outcome.

Prehension responses of 76 neurons in primary somatosensory (S-I) and motor (M-I) cortices were analyzed in three macaques during performance of a grasp and lift task. Digital video recordings of hand kinematics synchronized to neuronal spike trains were compared with responses in posterior parietal areas 5 and AIP/7b (PPC) of the same monkeys during seven task stages: 1) approach, 2) contact, 3) grasp, 4) lift, 5) hold, 6) lower, and 7) relax. S-I and M-I firing patterns signaled particular hand actions, rather than overall task goals. S-I responses were more diverse than those in PPC, occurred later in time, and focused primarily on grasping. Sixty-three percent of S-I neurons fired at peak rates during contact and/or grasping. Lift, hold, and lowering excited fewer S-I cells. Only 8% of S-I cells fired at peak rates before contact, compared with 27% in PPC. M-I responses were also diverse, forming functional groups for hand preshaping, object acquisition, and grip force application. M-I activity began < or =500 ms before contact, coinciding with the earliest activity in PPC. Activation of specific muscle groups in the hand was paralleled by matching patterns of somatosensory feedback from S-I needed for efficient performance. These findings support hypotheses that predictive and planning components of prehension are represented in PPC and premotor cortex, whereas performance and feedback circuits dominate activity in M-I and S-I. Somatosensory feedback from the hand to S-I enables real-time adjustments of grasping by connections to M-I and updates future prehension plans through projections to PPC.