Acute intussusception: a classic clinical picture?

57 patients with acute intussusception were admitted to the Children's Hospital Zurich between 1972 and 1979. All were treated surgically. One died, 7 needed a bowel resection, 9 intussusceptions were difficult and 32 easy to reduce. The retrospectively reviewed data show that the classic symptomatology, beginning suddenly in a healthy male (60%) under 3 years of age (91%) with attacks of colicky pain (81%), vomiting (93%), a palpable abdominal mass (72%) and rectal bleeding (72%), appears during the course of illness or may not be present at all. This leads to misdiagnosis, wrong treatment and worsening of the pathology. Blood per rectum, the most typical symptom, was present in the first hours of illness in only 5%, vomiting in 44% and colicky pain in 33% of the patients. A high degree of awareness is therefore necessary to diagnose intussusception during the first hours of illness, and particular stress must be laid on the accuracy of the diagnosis because reducibility and resection rate depend directly on the duration of the symptoms

Prefrontal-subcortical dissociations underlying inhibitory control revealed by event-related fMRI

Using event-related fMRI, this study investigated the neural dynamics of response inhibition under fluctuating task demands. Fourteen participants performed a GO/NOGO task requiring inhibition of a prepotent motor response to NOGO events that occurred as part of either a Fast or Slow presentation stream of GO stimuli. We compared functional activations associated with correct withholds (Stops) required during the Fast presentation stream of stimuli to Stops required during the Slow presentation stream. A predominantly right hemispheric network was activated across conditions, consistent with previous studies. Furthermore, a functional dissociation of activations between conditions was observed. Slow Stops elicited additional activation in anterior dorsal and polar prefrontal cortex and left inferior parietal cortex. Fast Stops showed additional activation in a network that included right dorsolateral prefrontal cortex, insula and dorsal striatum. These results are discussed in terms of our understanding of the impact of preparation on the distributed network underlying response inhibition and the contribution of subcortical areas, such as the basal ganglia, to executive control processes