[Prosody and reading: Temporal and melodic characteristics in the dyslexic child in reading and narration]

Dyslexia is widely associated to a massive phonological awareness deficit. This deficit leads to difficulties in grapheme to phoneme conversions in reading and difficulties in words and sentences productions. The origin of the phonological deficit is partially explained by the magnocellular, cerebellar and articulatory theories. Recently, an increasing number of studies demonstrated the relationship between prosody and reading and, more specifically, the potential key role of suprasegmental phonology in the healthy development of phonological representations. The aim of this study is to explore part of prosodic features in dyslexics and normal developing children in reading and narration tasks, in French. We examined reading accuracy, reading rate, pauses frequency and duration, inter-pausal units (IPUs) duration and instantaneous variations of F0. Results show correct decoding skills for all subjects but a lack of automation of this procedure for dyslexics. Differences in pauses frequency and duration, IPUS duration and F0 variations observed between dyslexics and controls confirm the link between prosodic reading and automaticity. The longer pause duration in narrative form a temporal feature of dyslexic's production. This temporal characteristic reflects the cognitive cost done by a speech generation task involving lexical selection, syntactic planning and articulatory programming processes. This result is a first step towards evidence of a suprasegmental phonological deficit in spoken language that could be an early marker of later reading difficulties.

Características físico-químicas de ácidos húmicos em diferentes etapas da vermicompostagem

Amostras de materiais coletados em diferentes estádios de vermicompostagem foram submetidas a procedimentos de extração de ácidos húmicos. Técnicas de titulação potenciométrica, termogravimetria (DTG), difração de raios X e espectrofotometria no uv/visível e no infravermelho foram utilizadas no estudo desses materiais. Os dados de titulação foram submetidos ao ajuste por regressão não-linear, determinando-se, assim, cinco valores de pKa característicos de cinco classes de grupos tituláveis. Nas curvas DTG, foram observadas duas etapas, sendo a primeira característica da separação de estruturas alifáticas e, ou, alicíclicas e a segunda, a decomposição de estruturas aromáticas. A difratometria de raios X apresentou diferenças marcantes nos resultados, principalmente nos três primeiros picos onde parecem ocorrer reorganização estrutural e polimerização ao longo do processo de vermicompostagem. Os espectros do infravermelho não apresentaram diferenciação entre os espectros. Os valores da razão E4/E6 encontrados estão de acordo com os característicos dos ácidos húmicos, mas não fornecem informações que possam contribuir para a elucidação da estrutura e formação desses ácidos.

Severe gram positive bacterial infection in an ulcerative colitis patient treated with Infliximab

Tumour necrosis factor-alpha (TNF-α) inhibitors represent an important treatment advance for a number of inflammatory conditions, including inflammatory bowel disease. Since their introduction in 1999, it has become clear that some biological therapies may be associated with an increased risk for bacterial infections. Herein we present the first case of septic arthritis and spine empyema, caused by S. aureus, in a 63 year-old patient with ulcerative colitis, who was under treatment with Infliximab and with 40mg per day of prednisolone.

A rare spontaneous osteosarcoma of the calvarium in a patient with long-standing fibrous dysplasia: CT and MR findings

A 52-year-old man with long-standing craniofacial polyostotic fibrous dysplasia (FD) and no history of prior radiation therapy developed a spontaneous right temporal bone osteosarcoma. Such spontaneous sarcomatous degeneration of FD is rare, particularly in the calvarium/skull, where, to our knowledge, only six prior cases have been reported in the literature. We report this case because it is a rare entity with well-documented CT and MR images, and to emphasize the importance of depicting imaging features of sarcomatous degeneration among the complex imaging findings of FD.

Foraminal L5-S1 disc herniation and conus medullaris syndrome: a vascular etiology?

A 56-year-old man presented with a conus medullaris syndrome lumbar magnetic resonance imaging showed only a right foraminal disc herniation at the L5-S1 level. Operative removal of the protrusion was followed by prompt neurological improvement. We postulate that the discrepancy between extent of compression shown by imaging and the neurological findings may reflect vascular compression of the artery of Desproges-Gotteron, an anatomical variant.

Temporal giant cell reparative granuloma: a reappraisal of pathology and imaging features

We report a case of large temporal giant cell reparative granuloma in a 72-year-old man. MR imaging depicted a right temporal expansile multiloculated lesion, with hyper- and hypointense signal areas on T2-weighted images, heterogeneously enhancing after gadolinium administration. Cortical thinning and bone remodeling of the temporal squamous portion were better seen on CT. The patient underwent surgery, and the diagnosis was achieved by the correlation of imaging, histologic, and laboratory findings.

Diagnostic investigation and multidisciplinary management in motor neuron disease

Amyotrophic lateral sclerosis (ALS) is the most common adult-onset motor neuron disease. ALS is a progressive neurodegenerative disorder, involving motor neurons in the cerebral cortex, brainstem and spinal cord, presenting with a combination of upper and lower motor neuron signs. Etiology remains undetermined, although a multifactorial origin is widely accepted including genetic factors, auto-immunity, oxidative stress, glutamate excitotoxicity and abnormal neurofilament aggregation. The absence of specific diagnostic testing, and variable clinical presentations make the diagnosis of ALS challenging, relying upon correlation of clinical, electrophysiological and neuroimaging data. The disease is relentlessly progressive, with dysarthria, dysphagia, tetraparesis, and respiratory insufficiency due to ongoing respiratory muscle paresis. There is no specific treatment for ALS. Riluzole, a glutamate antagonist, is the only FDA approved drug for ALS, but has only a modest effect on survival. The multiplicity and progressiveness of the disabilities in ALS, highlights the need for a coordinated multidisciplinary rehabilitation program managing symptoms, respiratory care, dysphagia and nutrition, dysarthria and communication, physical and occupational therapy. The main goals are to prolong independence, prevent complications and improve quality of life.

Prevalence of bacteria in the nipple discharge of patients with duct ectasia

The aim of this study was to identify the aerobic and the anaerobic microorganisms which can be related to duct ectasia. The patients were divided into two groups. Group 1 comprised 100 patients with coloured nipple discharge (duct ectasia group), and Group 2 (the control group) was composed of 50 patients without nipple discharge. The culture media used were BHI-PRAS, blood agar, mannitol agar and MacConkey agar. There was a high frequency of bacterial growth in the two groups: 85% in Group 1 and 88% in Group 2. The most prevalent bacteria were Staphylococcus aureus and Staphylococcus epidermidis. There was a statistically significant higher rate of smokers in the duct ectasia group compared with the control group, 25 (25%) patients vs. 5 (10%), respectively (p = 0.03). These findings allow us to put forth the hypothesis that the genesis of duct ectasia may be a non-infectious inflammatory process.

Epithelioid hemangioendothelioma and multiple thoraco-lumbar lateral meningoceles: two rare pathological entities in a patient with NF-1

Epithelioid hemangioendothelioma (EHE) is a rare vascular soft-tissue tumour of intermediate malignancy. Neurofibromatosis type I (NF-1) is a genetic syndrome associated with soft tissue sarcoma and higher risk of developing neoplasia. Lateral meningoceles are uncommon entities, being mostly associated with NF-1. We report a case of a 31-year-old woman, with NF-1 and past history of right thalamic/peduncular astrocytoma WHO grade II, admitted to the Neurosurgery Department in December 2003 due to severe low back pain, irradiating to the left leg without a radicular pattern. Thoraco-lumbar magnetic resonance imaging (MRI) showed a large left posterior paravertebral expansive lesion, bilateral and multiple thoraco-lumbar lateral meningoceles and dural ectasias with scalloping of the vertebral bodies. Biopsy of the paravertebral mass lesion disclosed EHE. We present this case because of the novel association between NF-1 and EHE, and the unusual aggressiveness of the neoplasia. Additionally, we highlight the co-existence of bilateral and multiple lateral meningoceles.

Thomsen-Friedenreich antigen expression in gastric carcinomas is associated with MUC1 mucin VNTR polymorphism

Aberrant glycosylation of mucins is a common phenomenon associated with oncogenic transformation. We investigated the association between expression of the tumor-associated antigens T, Tn, and sialyl-Tn and polymorphism in the length of the MUC1 mucin tandem repeat in a series of gastric carcinomas. We further evaluated the relevance of MUC1 tandem repeat length on the expression of these tumor-associated carbohydrate antigens (TACAs) using a gastric carcinoma cell line model expressing recombinant MUC1 constructs carrying 0, 3, 9, and 42 repeats. Gastric carcinomas showed a high prevalence of Tn and sialyl-Tn antigens, whereas T antigen was less frequently expressed. The expression of T antigen was significantly higher in gastric carcinomas from patients homozygous for MUC1 large tandem repeat alleles. No significant associations were found for Tn and sialyl-Tn antigens. This novel association was reinforced by the gastric carcinoma cell line model experiments, where de novo expression of T antigen was detected in clones transfected with larger VNTR regions. Our results indicate that polymorphism in the MUC1 tandem repeat influences the expression of TACAs in gastric cancer cells and may therefore allow the identification of subgroups of patients that develop more aggressive tumors expressing T antigen.

Discord in the family Sparidae (Teleostei): divergent phylogeographical patterns across the Atlantic-Mediterranean divide

The Strait of Gibraltar has been proposed to be the divide between two marine biogeographical regions, the Mediterranean Sea and the Northeast Atlantic. Intraspecific studies have shown, for several of the examined species, a reduction of gene flow between the two basins. The present study examines genetic variation at nuclear and mitochondrial loci in five marine teleost species belonging to the family Sparidae. Four samples for each species were analysed spanning the Northeast Atlantic and the Mediterranean. For all individuals 17 allozyme loci were scored and a combined single strand conformation polymorphism-sequencing approach was used to survey approximately 190 bp of the mitochondrial DNA (mtDNA) D-loop region. All five species share similar biological features. For three species, namely Lithognathus mormyrus, Spondyliosoma cantharus, and Dentex dentex, large mtDNA divergence was observed between Atlantic and Mediterranean samples. Little or no mtDNA differentiation was found in the other two species, Pagrus pagrus and Pagellus bogaraveo. Allozyme data revealed strong differentiation when comparing Atlantic and Mediterranean samples of L. mormyrus and D. dentex, moderate for P. pagrus, and no differentiation for P. bogaraveo and S. cantharus. These results provide evidence for a sharp phylogeographical break (sensu Avise) between the Atlantic and the Mediterranean for two (or possibly three) sparid species of the five investigated. At the same time, the obtained results for the other two species raise the question on which ecological/historical factors might have caused the observed discrepancy in the geographical distribution of genetic variation among otherwise biologically similar species.

[Relationships between the coronal suture and the sulci of the lateral convexity of the frontal lobe: neurosurgical applications]

An anatomical study of the relationships between the coronal suture and the sulci of the convexity of the frontal lobe was accomplished in seven cephalic segments. The pre-central and central sulci are, respectively, 26,5 mm and 40,5 mm behind the bregma and 15,0 mm and 35,5 mm behind the pterion. The use of the coronal suture as point of reference, and especially, its relationship with the sulci of the lateral surface of the frontal lobe, allows to determine the projection on the cranium of the superficial cerebral lesions with the purpose to delimit the surgical access and to guide the approach to the cerebral convexity.

[Cranioencephalic relationships between Trolard and Labbé veins: neurosurgical applications]

We accomplished an anatomic study of the anastomotic veins of Trolard and Labbé in seven human cephalic segments with the objective to accurate its stretch and references to facilitate its preservation during surgical procedure. The relationship between the Trolard vein and motor cortex was also studied.

Eficácia e tolerabilidade das substâncias calorigênicas: ioimbina, triiodotironina, aminofilina combinada a efedrina e fenilpropanolamina no tratamento da obesidade a curto prazo

Objetivo: Determinar a eficácia e tolerabilidade de 4 substâncias calorigênicas: ioimbina, triiodotironina (T3), combinação efedrina-aminofilina e fenilpropanolamina (FPA). Material, Métodos e Desenho da Pesquisa: 103 mulheres obesas (30 < BMI < 40kg/m²), de 18 a 55 anos, foram submetidas a estudo cego comparativo das 4 substâncias associadas a uma dieta com 1.200 calorias (55% HC, 30% gordura e 15% proteínas). As doses utilizadas foram 8mg de ioimbina, 25mcg de T3, 100mg de aminofilina + 25mg de efedrina e 25mg de FPA. Foi ainda incluído um grupo placebo. Os 4 medicamentos e o placebo foram dados 3 vezes ao dia, antes do desjejum, do almoço e do jantar. O estudo se realizou num período de 12 semanas, para cada paciente e no início e o fim do mesmo foram avaliados peso, composição corpórea por bioimpedância, metabolismo de repouso (por calorimetria), pulso e pressão arterial e eventos adversos. Resultados: Houve perda de peso em todos os grupos, mas o único que perdeu peso significativamente em relação ao grupo placebo foi o que recebeu FPA (p < 0,05). Não houve diferença quanto à composição corpórea e metabolismo de repouso entre os 5 grupos. Conclusão: Em nossa amostra, a FPA se revelou mais eficaz, embora este fato não possa ser atribuído a uma maior queima energética em repouso, já que não houve diferença apreciável no metabolismo de repouso entre os grupos.

[DNA ploidy and dysplasia in ulcerative colitis--interim analysis of a prospective study]

DNA ploidy and cell cycle phases were evaluated by flow cytometry in colonic biopsy specimens from 107 patients with ulcerative colitis in order to analyse the prevalence of DNA aneuploidy as an indicator of numerical chromosomal aberrations and the cell proliferation in all forms of ulcerative colitis. Whereas G2/M-phase fractions in ulcerative colitis and in controls were comparable (2.7 +/- 1.1% vs. 2.8 +/- 1.1%), S-phase fractions in ulcerative colitis exceeded those of controls (7.5 +/- 3.2% vs. 6.5 +/- 2.3%; p < 0.01). In 28 control patients, only diploid DNA histograms existed. Single or multiple aneuploid stem lines were detected in 10 patients with ulcerative colitis (9.3%). Aneuploidy was nearly exclusively associated with pancolitis. Dysplasia was present in 13 patients (indefinite: 8; low-grade: 5), of whom 5 patients also showed DNA aneuploidy. 5 patients with non-dysplastic mucosa exhibited DNA aneuploidy. Because dysplasia and DNA aneuploidy can be discordant and might therefore identify different subgroups at risk, flow cytometry might play a role as a valuable complement to histological examination in surveillance programs of ulcerative colitis.

[Surgical therapy of peptic stenosis of the esophagus in adults]

One hundred and one patients with reflux esophagitis and strictures, submitted to different kinds of surgical solutions over the last 16 years, were revised. Seventy seven patients had dilatable stricture and the lower esophageal sphincter mechanism could be brought intra-abdominally in 70. In 36 there was radiographic evidence of hiatal hernia and 8 had a Barrett esophagus. The surgical technique employed in these cases was transgastric dilatation of the stricture, and Nissen fundoplication in 63 and partial fundoplication in 13 patients with peptic stricture post BI or BII6, gastroenterostomy or pyloromyotomy and vagotomy and post Heller myotomy. The post-operative mortality was 2.6% (2 in 77 patients) and morbidity 14.3%. Results after 5 years of follow-up have been classified as good to excellent in 88.3%. Six out of 9 remaining patients needed more than 3 dilatations in the first year after surgery and 3 of these were reoperated. Twenty four patients had a fixed stricture: In 22 of them, the area of esophagogastric stenosis was resected with replacement of the esophagus by colon interposition in 6, jejunum in 14, and a gastric tube with cervical anastomosis in 2. In two patients of advanced age and with respiratory problems a retrosternal by-pass with colon was performed. In this group the post-operative mortality was 12.5% (3 in 24 patients) and the morbidity 25%. The most common problems after one year of surgery were diarrhea (4 patients) and gastric fullness in 2. Eleven patients remained asymptomatic after 5 years (9 with jejunum interposition and 3 with colon) and 3 with jejunum were alive after 10 years.(ABSTRACT TRUNCATED AT 250 WORDS)

Prospective randomized comparison of pefloxacin and ampicillin plus gentamicin in the treatment of bacteriologically proven biliary tract infections

One hundred and eighty-nine patients with acute cholecystitis or cholangitis requiring antibacterial therapy and surgery were randomly allocated in a prospective open study to receive either iv or oral pefloxacin (800 mg per day) or a combination of iv or oral ampicillin (4 g per day) and gentamicin (240 mg per day im). Ninety-two patients had to be withdrawn from the efficacy analysis, mainly because of negative baseline culture, but occasionally because of isolation of bacteria resistant to the study drugs. In the 97 evaluable patients (90 with cholecystitis and 7 with cholangitis) the clinical cure rates were excellent and similar for both groups: 49/50 (98%) for pefloxacin and 45/47 (95.7%) for the combination; the respective bacteriological success rates were 100% and 91.5%. Three patients in the pefloxacin group and six patients in the ampicillin-gentamicin group reported mild and transient side effects.

[Roux-en-Y gastrectomy. A 12 years' experience]

A review of 161 patients who underwent Roux-en-Y biliary diversion and truncal vagotomy from 1978 to 1989 is performed under the double perspective: clinical and functional (using radionuclide semi-solid and liquid gastric emptying (GE) studies). In 46 patients this solution was adopted to treat different kinds of post-gastrectomy syndromes and in 115 to solve the esophageal-duodeno-gastric peptic disease. Some technical details are considered very important to prevent the nominated post Roux-en-Y Syndrome in relationship with the gastroparesis and gastric retention. The overall operative mortality was 2.5%. Five patients were reoperated: two, to complete vagotomy; 2, to solve gastric retention and one with sub-occlusion due to jejunal stricture. Forty one patients with 7.4 +/- 1.3 years after surgery were graded Visick I or II in 82.9% of the cases and 17.1% Visick III or IV. Gastric emptying studies demonstrated that the problems of gastric fullness detected in the immediate post operative period are quite similar to those observed after other kinds of sub-total gastrectomies. After 6 months, the gastric emptying change to a more rapid pattern in the large majority of patients. In the late post operative period is quite common to have no agreement between gastroparesis complains and the objective measurements of the GE, in symptomatic patients. Roux-en-Y gastrectomy solve the problems of post gastrectomy syndromes in 80% of the cases and in our experience, is a method that can be used with advantage to treat the ulcerative peptic disease resistant to the medical treatment in patients with less than 50 years.

[Surgical therapy of reflux esophagitis in patients with normal lower esophageal sphincter pressure]

In a group of 12 patients with reflux esophagitis resistant to the medical treatment and normal LES pressure, gastric emptying and bile-gastric (B.G.) reflux (HIDA-CCK test) were determined. All of the patients had delayed gastric emptying associated in seven with high levels of B.G. reflux. Two of the patients had an unsuccessful fundoplication two years ago and five have been cured of duodenal 3 or gastric 2 ulcer with antacids. Although there was an evolution to an ulcer scar in all of these patients the abdominal post-prandial pain persisted and some of them maintained occasional bilious vomiting. Deep gastritis with dysplasia and metaplasia of the gastric mucosa was demonstrated in all of these five patients. The esophagitis was an isolated phenomenon in 3 patients, one had a peptic esophageal stricture above de cardia, and another one a Barrett esophagus. A proximal gastric vagotomy (PGV) and pyloroplasty was performed in patients with delayed gastric emptying without BG reflux. The other 7 patients with concomitant high BG reflux were treated by a duodenal diversion to a Roux-en-Y loop and P.G.V. Esophageal and gastric symptoms disappeared soon after surgery. Esophageal biopsies were normal six months after surgery and the intense gastritis changed to a less serious form of superficial gastritis. It is concluded that delayed gastric emptying associated or not with high values of BG reflux can be the most important pathogenic factor that cause reflux esophagitis in this group of patients. The improvement of gastric emptying and elimination of BG reflux can be the proper method to treat these situations.