Opportunistic and Other Infections in HIV-Infected Children in Latin America Compared to a Similar Cohort in the United States

Opportunistic and other infections have declined since the introduction of highly active antiretroviral therapy (HAART) in developed countries but few studies have addressed the impact of HAART in HIV-infected children from developing countries. This study examines the prevalence and incidence of opportunistic and other infections in Latin America during the HAART era. Vertically HIV-infected children enrolled in a cohort study between 2002 and 2007 were followed for the occurrence of 29 targeted infections. Cross-sectional and longitudinal analyses were performed to calculate the prevalence of infections before enrollment and the incidence rates of opportunistic and other infections after enrollment. Comparisons were made with data from a U. S. cohort (PACTG 219C). Of the 731 vertically HIV-infected children 568 (78%) had at least one opportunistic or other infection prior to enrollment. The most prevalent infections were bacterial pneumonia, oral candidiasis, varicella, tuberculosis, herpes zoster, and Pneumocystis jiroveci pneumonia. After enrollment, the overall incidence was 23.5 per 100 person-years; the most common infections (per 100 person-years) were bacterial pneumonia (7.8), varicella (3.0), dermatophyte infections (2.9), herpes simplex (2.5), and herpes zoster (1.8). All of these incidence rates were higher than those reported in PACTG 219C. The types and relative distribution of infections among HIV-infected children in Latin America in this study are similar to those seen in the United States but the incidence rates are higher. Further research is necessary to determine the reasons for these higher rates.

Bioremediation of PAHs - Limitations and soultions

Introduction 1.1 Occurrence of polycyclic aromatic hydrocarbons (PAH) in the environment Worldwide industrial and agricultural developments have released a large number of natural and synthetic hazardous compounds into the environment due to careless waste disposal, illegal waste dumping and accidental spills. As a result, there are numerous sites in the world that require cleanup of soils and groundwater. Polycyclic aromatic hydrocarbons (PAHs) are one of the major groups of these contaminants (Da Silva et al., 2003). PAHs constitute a diverse class of organic compounds consisting of two or more aromatic rings with various structural configurations (Prabhu and Phale, 2003). Being a derivative of benzene, PAHs are thermodynamically stable. In addition, these chemicals tend to adhere to particle surfaces, such as soils, because of their low water solubility and strong hydrophobicity, and this results in greater persistence under natural conditions. This persistence coupled with their potential carcinogenicity makes PAHs problematic environmental contaminants (Cerniglia, 1992; Sutherland, 1992). PAHs are widely found in high concentrations at many industrial sites, particularly those associated with petroleum, gas production and wood preserving industries (Wilson and Jones, 1993). 1.2 Remediation technologies Conventional techniques used for the remediation of soil polluted with organic contaminants include excavation of the contaminated soil and disposal to a landfill or capping - containment - of the contaminated areas of a site. These methods have some drawbacks. The first method simply moves the contamination elsewhere and may create significant risks in the excavation, handling and transport of hazardous material. Additionally, it is very difficult and increasingly expensive to find new landfill sites for the final disposal of the material. The cap and containment method is only an interim solution since the contamination remains on site, requiring monitoring and maintenance of the isolation barriers long into the future, with all the associated costs and potential liability. A better approach than these traditional methods is to completely destroy the pollutants, if possible, or transform them into harmless substances. Some technologies that have been used are high-temperature incineration and various types of chemical decomposition (for example, base-catalyzed dechlorination, UV oxidation). However, these methods have significant disadvantages, principally their technological complexity, high cost , and the lack of public acceptance. Bioremediation, on the contrast, is a promising option for the complete removal and destruction of contaminants. 1.3 Bioremediation of PAH contaminated soil & groundwater Bioremediation is the use of living organisms, primarily microorganisms, to degrade or detoxify hazardous wastes into harmless substances such as carbon dioxide, water and cell biomass Most PAHs are biodegradable unter natural conditions (Da Silva et al., 2003; Meysami and Baheri, 2003) and bioremediation for cleanup of PAH wastes has been extensively studied at both laboratory and commercial levels- It has been implemented at a number of contaminated sites, including the cleanup of the Exxon Valdez oil spill in Prince William Sound, Alaska in 1989, the Mega Borg spill off the Texas coast in 1990 and the Burgan Oil Field, Kuwait in 1994 (Purwaningsih, 2002). Different strategies for PAH bioremediation, such as in situ , ex situ or on site bioremediation were developed in recent years. In situ bioremediation is a technique that is applied to soil and groundwater at the site without removing the contaminated soil or groundwater, based on the provision of optimum conditions for microbiological contaminant breakdown.. Ex situ bioremediation of PAHs, on the other hand, is a technique applied to soil and groundwater which has been removed from the site via excavation (soil) or pumping (water). Hazardous contaminants are converted in controlled bioreactors into harmless compounds in an efficient manner. 1.4 Bioavailability of PAH in the subsurface Frequently, PAH contamination in the environment is occurs as contaminants that are sorbed onto soilparticles rather than in phase (NAPL, non aqueous phase liquids). It is known that the biodegradation rate of most PAHs sorbed onto soil is far lower than rates measured in solution cultures of microorganisms with pure solid pollutants (Alexander and Scow, 1989; Hamaker, 1972). It is generally believed that only that fraction of PAHs dissolved in the solution can be metabolized by microorganisms in soil. The amount of contaminant that can be readily taken up and degraded by microorganisms is defined as bioavailability (Bosma et al., 1997; Maier, 2000). Two phenomena have been suggested to cause the low bioavailability of PAHs in soil (Danielsson, 2000). The first one is strong adsorption of the contaminants to the soil constituents which then leads to very slow release rates of contaminants to the aqueous phase. Sorption is often well correlated with soil organic matter content (Means, 1980) and significantly reduces biodegradation (Manilal and Alexander, 1991). The second phenomenon is slow mass transfer of pollutants, such as pore diffusion in the soil aggregates or diffusion in the organic matter in the soil. The complex set of these physical, chemical and biological processes is schematically illustrated in Figure 1. As shown in Figure 1, biodegradation processes are taking place in the soil solution while diffusion processes occur in the narrow pores in and between soil aggregates (Danielsson, 2000). Seemingly contradictory studies can be found in the literature that indicate the rate and final extent of metabolism may be either lower or higher for sorbed PAHs by soil than those for pure PAHs (Van Loosdrecht et al., 1990). These contrasting results demonstrate that the bioavailability of organic contaminants sorbed onto soil is far from being well understood. Besides bioavailability, there are several other factors influencing the rate and extent of biodegradation of PAHs in soil including microbial population characteristics, physical and chemical properties of PAHs and environmental factors (temperature, moisture, pH, degree of contamination). Figure 1: Schematic diagram showing possible rate-limiting processes during bioremediation of hydrophobic organic contaminants in a contaminated soil-water system (not to scale) (Danielsson, 2000). 1.5 Increasing the bioavailability of PAH in soil Attempts to improve the biodegradation of PAHs in soil by increasing their bioavailability include the use of surfactants , solvents or solubility enhancers.. However, introduction of synthetic surfactant may result in the addition of one more pollutant. (Wang and Brusseau, 1993).A study conducted by Mulder et al. showed that the introduction of hydropropyl-ß-cyclodextrin (HPCD), a well-known PAH solubility enhancer, significantly increased the solubilization of PAHs although it did not improve the biodegradation rate of PAHs (Mulder et al., 1998), indicating that further research is required in order to develop a feasible and efficient remediation method. Enhancing the extent of PAHs mass transfer from the soil phase to the liquid might prove an efficient and environmentally low-risk alternative way of addressing the problem of slow PAH biodegradation in soil.

Kraus e/o Shakespeare. Intertestualità in prospettiva: tradurre, citare, inscrivere

The thesis focuses on Karl Kraus’s rewritings of some Shakespeare plays and copes with the concepts of “translation” and “quotation” as commensurable forms of intertextuality. Building his Shakespeare’s Bearbeitungen as a montage of quotations of previous German translations, Karl Kraus creates a new kind of hybrid intertextuality that goes beyond the boundaries between quotation and translation. In my opinion, Karl Kraus understands quotation and translation as spatial concepts: in his rewritings he puts Shakespeare’s text into his geometrical and critical “perspective”. The thesis focuses also on the evolution of quotation and translation in Karl Kraus’s work: even maintaining their satirical and destruens function, they develop an “affirmative” role and are used in order to redefine the literary canon. The thesis investigates this form of intertextuality from a comparative point of view, referring to the translation studies (Hermans, Bassnett, Lefevere, Apel, Berman, Meschonnic), theories of intertextuality (Genette, Barthes, Worton, Orr), studies on quotation and montage (Compagnon; Möbius, Hage), and studies on Karl Kraus (Kraft, Ribeiro, Scheichl, Fischer, Timms, Canetti and the famous essay of Walter Benjamin). It also contains a survey of Theater der Dichtung’s historical framework and several comparisons between Karl Kraus’s and other early 20th translations of Shakespeare’s plays.

Display Caotico. Mutazioni nell'arte del mostrare dagli anni Sessanta ad oggi

La mostra è diventata un nuovo paradigma della cultura contemporanea. Sostenuta da proprie regole e da una grammatica complessa produce storie e narrazioni. La presente ricerca di dottorato si struttura come un ragionamento critico sulle strategie del display contemporaneo, tentando di dimostrare, con strumenti investigativi eterogenei, assumendo fonti eclettiche e molteplici approcci disciplinari - dall'arte contemporanea, alla critica d'arte, la museologia, la sociologia, l'architettura e gli studi curatoriali - come il display sia un modello discorsivo di produzione culturale con cui il curatore si esprime. La storia delle esposizioni del XX secolo è piena di tentativi di cambiamento del rapporto tra lo sviluppo di pratiche artistiche e la sperimentazione di un nuovo concetto di mostra. Nei tardi anni Sessanta l’ingresso, nella scena dell’arte, dell’area del concettuale, demolisce, con un azzeramento radicale, tutte le convenzioni della rappresentazione artistica del dopoguerra, ‘teatralizzando’ il medium della mostra come strumento di potere e introducendo un nuovo “stile di presentazione” dei lavori, un display ‘dematerializzato” che rovescia le classiche relazioni tra opera, artista, spazio e istituzione, tra un curatore che sparisce (Siegelaub) e un curatore super-artista (Szeemann), nel superamento del concetto tradizionale di mostra stessa, in cui il lavoro del curatore, in quanto autore creativo, assumeva una propria autonomia strutturale all’interno del sistema dell’arte. Lo studio delle radici di questo cambiamento, ossia l’emergere di due tipi di autorialità: il curatore indipendente e l’artista che produce installazioni, tra il 1968 e il 1972 (le mostre di Siegelaub e Szeemann, la mimesi delle pratiche artistiche e curatoriali di Broodthaers e la tensione tra i due ruoli generata dalla Critica Istituzionale) permette di inquadrare teoricamente il fenomeno. Uno degli obbiettivi della ricerca è stato anche affrontare la letteratura critica attraverso una revisione/costruzione storiografica sul display e la storia delle teorie e pratiche curatoriali - formalizzata in modo non sistematico all'inizio degli anni Novanta, a partire da una rilettura retrospettiva della esperienze delle neoavanguardie – assumendo materiali e metodologie provenienti, come già dichiarato, da ambiti differenti, come richiedeva la composizione sfaccettata e non fissata dell’oggetto di studio, con un atteggiamento che si può definire comparato e post-disciplinare. Il primo capitolo affronta gli anni Sessanta, con la successione sistematica dei primi episodi sperimentali attraverso tre direzioni: l’emergere e l’affermarsi del curatore come autore, la proliferazione di mostre alternative che sovvertivano il formato tradizionale e le innovazioni prodotte dagli artisti organizzatori di mostre della Critica Istituzionale. Esponendo la smaterializzazione concettuale, Seth Siegelaub, gallerista, critico e impresario del concettuale, ha realizzato una serie di mostre innovative; Harald Szeemann crea la posizione indipendente di exhibition maker a partire When attitudes become forms fino al display anarchico di Documenta V; gli artisti organizzatori di mostre della Critica Istituzionale, soprattutto Marcel Broodhthears col suo Musée d’Art Moderne, Départment des Aigles, analizzano la struttura della logica espositiva come opera d’arte. Nel secondo capitolo l’indagine si sposta verso la scena attivista e alternativa americana degli anni Ottanta: Martha Rosler, le pratiche community-based di Group Material, Border Art Workshop/Taller de Arte Fronterizo, Guerrilla Girls, ACT UP, Art Workers' Coalition che, con proposte diverse elaborano un nuovo modello educativo e/o partecipativo di mostra, che diventa anche terreno del confronto sociale. La mostra era uno svincolo cruciale tra l’arte e le opere rese accessibili al pubblico, in particolare le narrazioni, le idee, le storie attivate, attraverso un originale ragionamento sulle implicazioni sociali del ruolo del curatore che suggeriva punti di vista alternativi usando un forum istituzionale. Ogni modalità di display stabiliva relazioni nuove tra artisti, istituzioni e audience generando abitudini e rituali diversi per guardare la mostra. Il potere assegnato all’esposizione, creava contesti e situazioni da agire, che rovesciavano i metodi e i formati culturali tradizionali. Per Group Material, così come nelle reading-room di Martha Rosler, la mostra temporanea era un medium con cui si ‘postulavano’ le strutture di rappresentazione e i modelli sociali attraverso cui, regole, situazioni e luoghi erano spesso sovvertiti. Si propongono come artisti che stanno ridefinendo il ruolo della curatela (significativamente scartano la parola ‘curatori’ e si propongono come ‘organizzatori’). La situazione cambia nel 1989 con la caduta del muro di Berlino. Oltre agli sconvolgimenti geopolitici, la fine della guerra fredda e dell’ideologia, l’apertura ai flussi e gli scambi conseguenti al crollo delle frontiere, i profondi e drammatici cambiamenti politici che coinvolgono l’Europa, corrispondono al parallelo mutamento degli scenari culturali e delle pratiche espositive. Nel terzo capitolo si parte dall’analisi del rapporto tra esposizioni e Late Capitalist Museum - secondo la definizione di Rosalind Krauss - con due mostre cruciali: Le Magiciens de la Terre, alle origini del dibattito postcoloniale e attraverso il soggetto ineffabile di un’esposizione: Les Immatériaux, entrambe al Pompidou. Proseguendo nell’analisi dell’ampio corpus di saggi, articoli, approfondimenti dedicati alle grandi manifestazioni internazionali, e allo studio dell’espansione globale delle Biennali, avviene un cambiamento cruciale a partire da Documenta X del 1997: l’inclusione di lavori di natura interdisciplinare e la persistente integrazione di elementi discorsivi (100 days/100 guests). Nella maggior parte degli interventi in materia di esposizioni su scala globale oggi, quello che viene implicitamente o esplicitamente messo in discussione è il limite del concetto e della forma tradizionale di mostra. La sfida delle pratiche contemporanee è non essere più conformi alle tre unità classiche della modernità: unità di tempo, di spazio e di narrazione. L’episodio più emblematico viene quindi indagato nel terzo capitolo: la Documenta X di Catherine David, il cui merito maggiore è stato quello di dichiarare la mostra come format ormai insufficiente a rappresentare le nuove istanze contemporanee. Le quali avrebbero richiesto - altrimenti - una pluralità di modelli, di spazi e di tempi eterogenei per poter divenire un dispositivo culturale all’altezza dei tempi. La David decostruisce lo spazio museale come luogo esclusivo dell’estetico: dalla mostra laboratorio alla mostra come archivio, l’evento si svolge nel museo ma anche nella città, con sottili interventi di dissimulazione urbana, nel catalogo e nella piattaforma dei 100 giorni di dibattito. Il quarto capitolo affronta l’ultima declinazione di questa sperimentazione espositiva: il fenomeno della proliferazione delle Biennali nei processi di globalizzazione culturale. Dalla prima mostra postcoloniale, la Documenta 11 di Okwui Enwezor e il modello delle Platforms trans-disciplinari, al dissolvimento dei ruoli in uno scenario post-szeemanniano con gli esperimenti curatoriali su larga scala di Sogni e conflitti, alla 50° Biennale di Venezia. Sono analizzati diversi modelli espositivi (la mostra-arcipelago di Edouard Glissant; il display in crescita di Zone of Urgency come estetizzazione del disordine metropolitano; il format relazionale e performativo di Utopia Station; il modello del bric à brac; la “Scuola” di Manifesta 6). Alcune Biennali sono state sorprendentemente autoriflessive e hanno consentito un coinvolgimento più analitico con questa particolare forma espressiva. Qual è l'impatto sulla storia e il dibattito dei sistemi espositivi? Conclusioni: Cos’è la mostra oggi? Uno spazio sotto controllo, uno spazio del conflitto e del dissenso, un modello educativo e/o partecipativo? Una piattaforma, un dispositivo, un archivio? Uno spazio di negoziazione col mercato o uno spazio di riflessione e trasformazione? L’arte del display: ipotesi critiche, prospettive e sviluppi recenti.

Factors predicting protracted improvement after pallidal DBS for primary dystonia: the role of age and disease duration

In many patients, optimal results after pallidal deep brain stimulation (DBS) for primary dystonia may appear over several months, possibly beyond 1 year after implant. In order to elucidate the factors predicting such protracted clinical effect, we retrospectively reviewed the clinical records of 44 patients with primary dystonia and bilateral pallidal DBS implants. Patients with fixed skeletal deformities, as well as those with a history of prior ablative procedures, were excluded. The Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) scores at baseline, 1 and 3 years after DBS were used to evaluate clinical outcome. All subjects showed a significant improvement after DBS implants (mean BFMDRS improvement of 74.9% at 1 year and 82.6% at 3 years). Disease duration (DD, median 15 years, range 2-42) and age at surgery (AS, median 31 years, range 10-59) showed a significant negative correlation with DBS outcome at 1 and 3 years. A partition analysis, using DD and AS, clustered subjects into three groups: (1) younger subjects with shorter DD (n = 19, AS < 27, DD ? 17); (2) older subjects with shorter DD (n = 8, DD ? 17, AS ? 27); (3) older subjects with longer DD (n = 17, DD > 17, AS ? 27). Younger patients with short DD benefitted more and faster than older patients, who however continued to improve 10% on average 1 year after DBS implants. Our data suggest that subjects with short DD may expect to achieve a better general outcome than those with longer DD and that AS may influence the time necessary to achieve maximal clinical response.

Dystonic movement disorders and spinal degenerative disease

The occurrence of degenerative spinal disease subsequent to dystonic movement disorders has been neglected and has received more attention only recently. Spinal surgery is challenging with regard to continuous mechanical stress when treatment of the underlying movement disorder is insufficient. To characterize better the particular features of degenerative spinal disease in patients with dystonia and to analyze operative strategies, we reviewed the available published data. Epidemiologic studies reveal that degenerative spinal disorders in patients with dystonia and choreoathetosis occur much earlier than in the physiological aging process. Dystonic movement disorders more often affect the spine at higher cervical levels (C(2-5)), in contrast to spinal degeneration with age which manifests more frequently at the middle and lower cervical spine (C(5-7)). Degenerative changes of the cervical spine are more likely to occur on the side where the chin is rotated or tilted to. Various operative approaches for treatment of spinal pathologies have been advocated in patients with dystonic movement disorders. The available data do not allow making firm statements regarding the superiority of one approach over the other. Posterior approaches were first used for decompression, but additional anterior fusion became necessary in many instances. Anterior approaches with or without instrumented fusion yielded more favorable results, but drawbacks are pseudarthrosis and adjacent-level disease. Parallel to the development of posterior fusion techniques, circumferential surgery was suggested to provide a maximum degree of cord decompression and a higher fusion rate. Perioperative local injections of botulinum toxin were used initially to enhance patient comfort with halo immobilization, but they are also applied in patients without external fixation nowadays. Treatment algorithms directed at the underlying movement disorder itself, taking advantage of new techniques of functional neurosurgery, combined with spinal surgery have recently been introduced and show promising results.

Chemokines indicate allergic bronchopulmonary aspergillosis in patients with cystic fibrosis

RATIONALE: Allergic bronchopulmonary aspergillosis (ABPA) is characterized by a Th2 immune response. Mouse models suggest a critical role for the Th2 chemokines thymus- and activation-regulated chemokine (TARC) and macrophage-derived chemokine (MDC) in ABPA. OBJECTIVES: To determine whether serum levels of TARC and MDC characterize ABPA in patients with cystic fibrosis (CF) and to examine longitudinally if levels of TARC and MDC indicate ABPA exacerbations in patients with CF. METHODS: Levels of TARC and MDC and levels of Th1 (IL-12 and IFN-gamma) and Th2 (IL-4, IL-5, and IL-13) cytokines were analyzed in serum of 16 patients with CF with ABPA, six non-CF patients with asthma with ABPA, 13 patients with CF colonized with Aspergillus fumigatus, six patients with CF sensitized to A. fumigatus, 12 atopic patients with CF, and 13 non-CF atopic control subjects by ELISA. The longitudinal course of TARC, MDC, and IgE levels was assessed during ABPA episodes. RESULTS: Patients with ABPA had significantly higher serum levels of TARC compared with the other patient groups. Cytokine levels did not differ among the patient groups. Longitudinally, levels of TARC indicated ABPA exacerbations in patients with CF more clearly than IgE levels. In patients with CF and ABPA, levels of TARC correlated positively with specific IgE to A. fumigatus and rAsp f4. CONCLUSIONS: Serum levels of TARC differentiate patients with CF or patients with asthma with ABPA from patients with CF colonized with or sensitized to A. fumigatus, atopic patients with CF, and atopic control subjects. Longitudinally, levels of TARC indicate ABPA exacerbations, suggesting TARC as a marker for identification and monitoring of ABPA in patients with CF.

Cleavage of CXCR1 on neutrophils disables bacterial killing in cystic fibrosis lung disease

Interleukin-8 (IL-8) activates neutrophils via the chemokine receptors CXCR1 and CXCR2. However, the airways of individuals with cystic fibrosis are frequently colonized by bacterial pathogens, despite the presence of large numbers of neutrophils and IL-8. Here we show that IL-8 promotes bacterial killing by neutrophils through CXCR1 but not CXCR2. Unopposed proteolytic activity in the airways of individuals with cystic fibrosis cleaved CXCR1 on neutrophils and disabled their bacterial-killing capacity. These effects were protease concentration-dependent and also occurred to a lesser extent in individuals with chronic obstructive pulmonary disease. Receptor cleavage induced the release of glycosylated CXCR1 fragments that were capable of stimulating IL-8 production in bronchial epithelial cells via Toll-like receptor 2. In vivo inhibition of proteases by inhalation of alpha1-antitrypsin restored CXCR1 expression and improved bacterial killing in individuals with cystic fibrosis. The cleavage of CXCR1, the functional consequences of its cleavage, and the identification of soluble CXCR1 fragments that behave as bioactive components represent a new pathophysiologic mechanism in cystic fibrosis and other chronic lung diseases.

Thalamic stimulation for tremor. Subtle changes in episodic memory are related to stimulation per se and not to a microthalamotomy effect

The aim of this study was to investigate the impact of unilateral deep brain stimulation (DBS) of the ventrointermediate (Vim) thalamic nucleus on neuropsychological functioning comparing stimulation-on with stimulation-off conditions. Nine patients [five patients with Parkinson's Disease (PD), two patients with essential tremor (ET) and 2 patients with multiple sclerosis (MS)] underwent comprehensive neuropsychological testing for cognitive functions, including general mental impairment, aphasia, agnosia, executive and constructional abilities, learning, memory, cognitive processing speed and attention as well as depression. The neuropsychological assessments were performed at least 6 months postoperatively (mean 9 months). Testing in the stimulation-on and stimulation-off condition was obtained within a period of 3 to 4 weeks. Unilateral DBS resulted in improvement of tremor in all patients. There were no significant differences between the stimulation-on and the stimulation-off condition with the exception of a decrement of word-recall in the short delay free-recall subtest of the Rey Auditory-Verbal Learning Test (RAVLT). Subgroup analysis indicated that the impairment in word-recall was related to left-sided thalamic stimulation. Our study confirms that chronic unilateral DBS is a safe method with regard to cognitive function. The subtle changes in episodic memory are related to stimulation per se and not to a microthalamotomy effect.

Chronic stimulation of the globus pallidus internus for treatment of non-dYT1 generalized dystonia and choreoathetosis: 2-year follow up

OBJECT: The authors studied the long-term efficacy of deep brain stimulation (DBS) of the posteroventral lateral globus pallidus internus up to 2 years postoperatively in patients with primary non-DYT1 generalized dystonia or choreoathetosis. The results are briefly compared with those reported for DBS in DYT1 dystonia (Oppenheim dystonia), which is caused by the DYT1 gene. METHODS: Enrollment in this prospective expanded pilot study was limited to adult patients with severely disabling, medically refractory non-DYT1 generalized dystonia or choreoathetosis. Six consecutive patients underwent follow-up examinations at defined intervals of 3 months, 1 year, and 2 years postsurgery. There were five women and one man, and their mean age at surgery was 45.5 years. Formal assessments included both the Burke-Fahn-Marsden dystonia scale and the recently developed Unified Dystonia Rating Scale. Two patients had primary generalized non-DYT1 dystonia, and four suffered from choreoathetosis secondary to infantile cerebral palsy. Bilateral quadripolar DBS electrodes were implanted in all instances, except in one patient with markedly asymmetrical symptoms. There were no adverse events related to surgery. The Burke-Fahn-Marsden scores in the two patients with generalized dystonia improved by 78 and 71% at 3 months, by 82 and 69% at 1 year, and by 78 and 70% at 2 years postoperatively. This was paralleled by marked amelioration of disability scores. The mean improvement in Burke-Fahn-Marsden scores in patients with choreoathetosis was 12% at 3 months, 29% at 1 year, and 23% at 2 years postoperatively, which was not significant. Two of these patients thought that they had achieved marked improvement at 2 years postoperatively, although results of objective evaluations were less impressive. In these two patients there was a minor but stable improvement in disability scores. All patients had an improvement in pain scores at the 2-year follow-up review. Medication was tapered off in both patients with generalized dystonia and reduced in two of the patients with choreoathetosis. All stimulation-induced side effects were reversible on adjustment of the DBS settings. Energy consumption of the batteries was considerably higher than in patients with Parkinson disease. CONCLUSIONS: Chronic pallidal DBS is a safe and effective procedure in generalized non-DYT1 dystonia, and it may become the procedure of choice in patients with medically refractory dystonia. Postoperative improvement of choreoathetosis is more modest and varied, and subjective ratings of outcome may exceed objective evaluations.