Prevalence of antibodies to hepatitis E in two rural Egyptian communities

A population-based serosurvey in two rural Egyptian communities was used to assess age-specific prevalence of antibody to hepatitis E virus (anti-HEV). One community is in the Nile Delta (11,182 inhabitants; 3,997 participants) and the other in Upper Egypt (10,970 inhabitants; 6,029 participants). Samples were tested for anti-HEV with a commercial enzyme-linked immunoassay (ELISA) based on antigens derived from open reading frame (ORF)2 and ORF3. Although there was a clear difference in sensitivity among the lots of the commercial test used, it was still possible to determine the seroprevalence. The seroprevalence of anti-HEV exceeded 60% in the first decade of life, peaked at 76% in the second decade and remained above 60% until the eighth decade. Prevalence of this magnitude is among the highest reported in the world, with an age-specific pattern more similar to hyperendemic hepatitis A virus transmission than generally described. Lot-to-lot variation in the sensitivity of the commercial ELISA kit highlights a problem when comparing seroepidemiologic studies of different populations.

[Cognitive and emotional disorders in multiple sclerosis. Can a management strategy be envisioned?]

There is a lack of precise data concerning the natural history of cognitive disorders in multiple sclerosis (MS), but recent neuropsychological studies have demonstrated that the incidence of such disorders in MS appears to be frequent (40-65% of cases), and have shown in particular that recent memory, conceptual reasoning, attention, executive functions, visuospatial perception and information processing speed are negatively affected. In contrast, language functions, general intelligence and implicit memory appear to be relatively well preserved. Although the presence and the degree of cognitive disorders does not seem to be directly linked to disease duration or to the extent of physical disability, the relationship between cognitive decline and brain lesions detected by magnetic resonance imaging (MRI) is still a subject of discussion. The prevalence of emotional and affective disorders is difficult to estimate. Their frequency has only rarely been investigated, and the lack of data on the natural history of these disorders and those factors which they have in common (the psychosocial consequences of this chronic and disabling disease, cognitive impairment, and brain lesions) further complicate the determination of treatment strategy. The adoption of appropriate strategies could limit the negative impact of this disease on the social functioning of MS patients.

Quality control for parasitologic data

Accuracy of data is of paramount concern for all research. The task of providing objective assurances of accuracy of parasitologic data for a large, multi-center epidemiologic research project in Egypt (Epidemiology 1, 2, 3 [EPI 1, 2, 3]) presented a unique set of challenges undertaken jointly by the Ministry of Health's Qalyub Center for Field and Applied Research with technical assistance from Tulane University (New Orleans, LA). The EPI 1, 2, 3 project was part of large bilateral research program, the Schistosomiasis Research Project, undertaken jointly by the governments of Egypt and the United States. This paper describes the nature of the quality control system developed to accomplish this task, presents results and discusses the findings.

The epidemiology of schistosomiasis in Egypt: summary findings in nine governorates

Health questionnaires and parasitologic examinations of urine and stool were evaluated from a stratified random sample of 89,180 individuals from 17,172 households in 251 rural communities in 9 governorates of Egypt to investigate the prevalence of, risk factors for, and changing pattern of infection with Schistosoma sp. in Egypt. A subset, every fifth household, or 18,600 subjects, had physical and ultrasound examinations to investigate the prevalence of and risk factors for morbidity. Prevalence of S. haematobium in 4 governorates in Upper Egypt in which it is endemic ranged from 4.8% to 13.7% and averaged 7.8%. The geometric mean egg count (GMEC) ranged from 7.0 to 10.0 ova/10 ml of urine and averaged 8.1. Age stratified prevalence of infection peaked at 15.7% in the 10-14-year-old age group and decreased to 3.5-5.5% in all groups more than 25 years of age. Age-stratified intensity of infection peaked at approximately 10.0 ova/10 ml of urine in the 5-14-year-old age groups and was about half that in all groups more than 25 years of age. Males had higher infection rates and ova counts than females in all age groups. Schistosoma mansoni was rare in Upper Egypt, being consequential in only Fayoum, which had a prevalence of 4.3% and an average intensity of infection of 44.0 ova/g of stool. Risk factors for S. haematobium infection were male gender, an age <21 years old, living in smaller communities, exposures to canal water; a history of, or treatment for, schistosomiasis, a history of burning micturition or blood in the urine, and reagent strip-detected hematuria or proteinuria. The more severe grades (II and III) of ultrasonography-detected periportal fibrosis (PPF) were rare (15 of 906) in these schistosomiasis haematobia-endemic governorates. Risk factors for morbidity (ultrasonography-detected urinary bladder wall lesions and/or obstructive uropathy) were similar to those for infection, with the exception that risk progressively increased with age. Subjects with active S. haematobium infections were 3 times as likely as those without active S. haematobium infections to have urinary tract morbidity. The prevalence of S. mansoni in 5 governorates in Lower Egypt, where it is endemic, ranged from 17.5% to 42.9% and averaged 36.4%. The GMEC ranged from 62.6 to 93.3 eggs/g of stool and averaged 81.3. Age-stratified prevalence of infection peaked at 48.3% in the 15-19-year-old age group, but averaged 35-45% in all groups more than 10 years of age. The intensity of infection was highest in the 10-14-year-old age group, and showed a range of 70-85 eggs/g of stool in those > or =5 years of age. Males had higher infection rates and ova counts than females in all age groups. Schistosoma haematobium was rare in these governorates; Ismailia (1.8%) had the highest infection rate. Risk factors for S. mansoni were male gender, an age >10 years old, living in smaller communities, exposures to canal water, a history of, or treatment for, schistosomiasis or blood in the stool, detection of splenomegaly by either physical examination or ultrasonography, and ultrasonography-detected PPF. The more severe grades (II and III) accounted for 463 (13.3%) of the 3,494 having ultrasonography-detected PPF. Risk factors for morbidity (ultrasonography-detected PPF) were similar to those for infection except that inhabitants of smaller communities were not at increased risk. Active S. mansoni infection increased the odds ratio (OR) of having PPF by 1.37. In comparison with others with normal-size livers, subjects having hepatic enlargement in either the midclavicular line or the midsternal line detected by physical examination or ultrasonography had a reduced risk (ORs = 0.64-0.72) of PPF. The prevalences of lesions detected by ultrasonography were 23.7% for enlargement of right lobe of the liver, 11.3% for enlargement of left hepatic lobe, 20.6% for splenomegaly, and 50.3% for PPF. Schistosoma mansoni has almost totally replaced S. haematobium in Lower E

The epidemiology of schistosomiasis in Egypt: Qalyubia Governorate

The primary objectives of this study, carried out in Qalyubia Governorate in Egypt (south-central Nile Delta), were to continue tracking historical trends of infection prevalence of Schistosoma mansoni and S. haematobium, determine whether satellites (ezbas) of mother villages differed significantly with respect to schistosomiasis transmission, and to asses schistosomiasis-induced morbidity on a population basis using ultrasonography. Our study revealed that S. haematobium has virtually disappeared from Qalyubia governorate, and that S. mansoni prevalence continues to decline slowly (17% in 1991 compared with 19% in 1990). The prevalence of intestinal schistosomiasis was actually higher in the mother villages than in the ezbas of the same villages, indicating that prevalence based on surveys of villages alone did not (at least for Qalyubia) cause underestimates of true prevalence. (A mother village is the large village in an area that includes hamlets or ezbas. In many areas, the infection rate in ezbas is significantly higher than in the larger central village.) Ultrasonographic studies revealed that less than 3% of the population had stage 2 or stage 3 periportal fibrosis, commonly associated with chronic schistosomiasis mansoni. This low level of morbidity was consistent with earlier data from Qalyubia, which also showed a low level of S. mansoni-induced morbidity in this governorate.

Developmental dyslexia: atypical cortical asymmetries and functional significance

Using brain magnetic resonance imaging, we measured in 16 young developmental dyslexic adults and 14 age-matched controls cortical asymmetries of posterior language-related areas, including Planum temporale and parietal operculum cortical ribbon, and of the inferior frontal region related in the left hemisphere to speech processing. In addition, we assessed the sulcal morphology of the inferior frontal gyrus in both groups according to a qualitative method. The dyslexic subjects also performed specific tasks exploring different aspects of phonological and lexical-semantic processes. Results showed that: (1) contrary to most results reported in the literature, there is a lack of any morphological difference relative to Planum temporale asymmetry between the two groups; (2) there are significant differences between dyslexic and control subjects relative to frontal areas; (3) concerning the parietal region, there is a more asymmetrical pattern towards the left side in dyslexic subjects than in controls; and (4) relations in dyslexic subjects between parietal asymmetry coefficient and the level of performance in a phonological task have a particular reliance on verbal short-term memory, frontal asymmetry and performance in a non-word reading task. Considering these results it is suggested that phonological segmentation skills may relate to frontal lobe morphology, while phonological memory-based impairment in people with dyslexia may rather relate to parietal lobe morphology.

Pharmacokinetic-pharmacodynamic analysis of mnesic effects of lorazepam in healthy volunteers

AIMS

To describe the pharmacokinetic-pharmacodynamic modelling of the psychomotor and mnesic effects of a single 2 mg oral dose of lorazepam in healthy volunteers.

METHODS

This was a randomized double-blind, placebo-controlled two-way cross-over study. The effect of lorazepam was examined with the following tasks: choice reaction time, immediate and delayed cued recall of paired words and immediate and delayed free recall and recognition of pictures.

RESULTS

The mean calculated EC50 values derived from the PK/PD modelling of the different tests ranged from 12.2 to 15.3 ng ml-1. On the basis of the statistical comparison of the EC50 values, the delayed recall trials seemed to be more impaired than the immediate recall trials; similar observations were made concerning the recognition vs recall tasks.

CONCLUSIONS

The parameter values derived from PK/PD modelling, and especially the EC50 values, may provide sensitive indices that can be used, rather than the raw data derived from pharmacodynamic measurements, to compare CNS effects of benzodiazepines.

DNA global hypomethylation in EBV-transformed interphase nuclei

In tumors, DNA is often globally hypomethylated compared to DNA extracted from normal tissues. This observation is usually made after extraction and exhaustive digestion of DNA followed by analysis of nucleosides by chromatography or digestion with restriction enzymes, gel analysis, and hybridization. This approach provides an average value which does not give information on the various cell subpopulations included in heterogeneous samples. Therefore an immunochemical technique was set up with the aim of demonstrating, in a population of mixed cells, the possibility of detecting the presence of individual nuclei containing hypomethylated DNA, on a cell-by-cell basis. Monoclonal antibodies to 5-methylcytidine were used to label cells grown in vitro. Under appropriate fixation and permeabilization conditions, interphase nuclei were labeled. Quantitative differences in the labeling were detected between Epstein-Barr virus-transformed cells and normal peripheral blood monocytes by flow cytometry analysis. Similar differences were observed by fluorescence microscopy. Both results were confirmed by Southern transfer and hybridization of DNA fragments generated by restriction enzyme digestion. This observation, which is in accordance with the occurrence of global DNA hypomethylation in tumors as established by chromatography, opens the field for the analysis of fresh tumor samples by flow cytometry and microscopy.

[Divergent asymmetries of the temporo-parietal cortical areas: anatomo-functional correlations and evolutionary and developmental implications]

Human brains present a clear asymmetry of the postero-lateral cortical area, so called "planum temporale" (Geschwind and Levitsky). This asymmetry is on favour of the left brain. A similar asymmetry is observed on the parietal operculum. MRI studies of 37 healthy volunteers have shown a clear difference between individuals. Mixing the index of temporal and parietal asymmetry, the authors consider four types: the most frequent pattern concerns 90% of right handed. For the others, 10% there are left handed as right handed. On conclusion, planum as many asymmetry and opercular asymmetry can be divergent, and both canan to determines handedness.

Preparation and characterization of ofloxacin microspheres for the eradication of bone associated bacterial biofilm

Biodegradable polymers for localized delivery of antibiotics have emerged as an important approach to treating orthopaedic infections. In chronic forms of osteomyelitis which are thought to be associated with bacterial biofilm, localized delivery of a suitable antibiotic is desirable. This paper describes the formulation and in vitro evaluation of biodegradable ofloxacin microspheres for the eradication of bone associated bacterial biofilm infections. Ofloxacin microspheres were formulated using poly(glycolic acid-co-DL-lactic acid) (PGLA) by the emulsion solvent evaporation technique. The effects of process parameters such as phase volume, poly(vinyl alcohol) (PVA) concentration, and viscosity grade of the polymer during preparation on encapsulation efficiency (EEF) and in vitro release profiles were investigated. An increase in the phase volume or volume fraction from 21 to 35% at a constant internal phase volume resulted in an increase in EEF from 34 to 74%. Increasing PVA concentration from 0.25 to 2.5% w/v at a constant phase volume or volume fraction did not have an effect on the EEF. Ofloxacin release from the microsopheres was biphasic with an initial burst release followed by a slow release phase. An optimum slowing down of release was observed when the phase volume was 29%. Above and below this phase volume, release of ofloxacin was higher. The higher the viscosity grade of the polymer used for the preparation of microspheres, the higher the PVA concentration needed to prepare microspheres with slower release. The study indicates that various rates of ofloxacin release is possible by varying formulation conditions. This should provide a means for formulating sustained release microspheres of antibiotics for the treatment of biofilm infections associated with the bone.

Diabetes mellitus in Egypt: glycaemic control and microvascular and neuropathic complications

We performed a cross-sectional, population-based survey of persons 20 years of age and older living in Cairo and surrounding rural villages. The purpose was to describe glycaemic control and the prevalence of microvascular and neuropathic complications among Egyptians with diagnosed diabetes, previously undiagnosed diabetes, impaired glucose tolerance, and normal glucose tolerance. A total of 6052 households were surveyed. The response rate was 76% for the household survey and 72% for the medical examination. Among people with previously diagnosed diabetes, mean haemoglobin A1c, was 9.0%. Forty-two per cent had retinopathy, 21% albuminuria, and 22% neuropathy. Legal blindness was prevalent (5%) but clinical nephropathy (7%) and foot ulcers (1%) were uncommon in persons with diagnosed diabetes. Among people with diagnosed diabetes, microvascular and neuropathic complications were associated with hyperglycaemia. Retinopathy was also associated with duration of diabetes; albuminuria with hypertension and hypercholesterolaemia; and neuropathy with age, female sex, and hypercholesterolaemia. Albuminuria was as common in people with previously undiagnosed diabetes (22%) as those with diagnosed disease (21%). Mean haemoglobin A1c was lower (7.8%) and retinopathy (16%) and neuropathy (14%) were less prevalent in people with previously undiagnosed disease. Ocular conditions, blindness, and neuropathy were prevalent in the non-diabetic population. The microvascular and neuropathic complications of diabetes are a major clinical and public health problem in Egypt.

Comparative dissolution studies for mefenamic acid-polyethylene glycol solid dispersion systems and tablets

The purpose of this study was to enhance the dissolution of mefenamic acid (MFA) through the formation of solid dispersion systems, and to compare the dissolution of the unformulated dispersions with those of formulated dispersions in tablets. Solid dispersions of MFA were prepared in polyethylene glycol 3350 (PEG) as a binary system, and PEG and Tween 20 (TW) as a ternary system by the melt method. The dispersions were characterized by dissolution, scanning electron microscopy, and powder x-ray diffraction studies. A decrease in MFA composition in the binary dispersion systems from 50 to 5% w/w resulted in a 50% increase in the dissolution rate during the period of study, and this was threefold higher than that of pure MFA. Incorporation of TW in the preparation of ternary dispersion systems resulted in a further increase in MFA dissolution. A sevenfold increase in MFA dissolution was observed when the ternary system composition was MFA/PEG/TW 4.7:93:2.3 (% w/w). Scanning electron microscopy and x-ray diffraction pictures showed an increase in size and decrease in crystallinity of the dispersions, respectively. Compression of the dispersions into tablets did not have any effect on the dissolution of the drug from the dispersions. Compression of pure MFA and Avicel PH 101, which was used as a diluent and disintegrant, resulted in a threefold increase in dissolution. However, the dissolution of the uncompressed mixture was identical to that of pure MFA. Thus, further processing of the solid dispersions into tablets did not decrease the rate of dissolution of the drug in the dispersions. This may be very important in the formulation of solid dispersions as tablets, which could lead to a reduction in the dose of practically water-insoluble drugs.

[Corpus callosum disconnection syndromes and functional organization or the corpus callosum in adults]

Knowledge concerning the role of the corpus callosum derives from the study of patients with lesions of spontaneous or surgical origin. Three major aspects are defined: interhemispheric elementary transfer of symmetrically organized messages, complex transfer of asymmetrically organized information, interhemispheric transfer and complex behaviors. Symptoms are both complex and rather limited; they can be missed if they are not specifically searched for.

In situ amplification of the Epstein-Barr virus genome in cell suspensions

Epstein-Barr virus (EBV) is distributed widely throughout the world. Apart from a association with two geographically-restricted malignancies (Burkitt's lymphoma and nasopharyngeal carcinoma), EBV is thought to be implicated in the etiology of B-cell lymphoma in immunocompromised individuals. In these patients, monitoring the viral load in serum can provide useful information on the timing of the instigation of antiviral therapy, i.e. as soon as a rise is detected. PCR technology, owing to its high sensitivity, is used frequently in such situations. In order to gain further insight into the nature of the peripheral blood cells carrying the viral genome on a cell-by-cell basis, an in situ amplification technique was developed as a model using two cell lines growing in suspension, with the aim of distinguishing between EBV-positive and EBV-negative cells. Preliminary experiments were undertaken subsequently on clinical samples from patients with infectious mononucleosis and patients with lymphoma indicating that this technique might be useful clinically.

Abnormal callosal morphology in male adult dyslexics: relationships to handedness and phonological abilities

The classical notion that developmental dyslexia may somehow relate to impaired communication between hemispheres has not yet received convincing support. Sixteen dyslexic adults and 12 controls received a high resolution brain MRI scan for morphometric study of the corpus callosum. Automatized measurements of callosal area and calculation of indices defining the general morphology of the callosal mid-surface were performed. Each participant received global intelligence and reading achievement evaluation; dyslexics were further proposed specific neuropsychological tests specially designed to explore the mechanisms of reading impairment. It just appears from the group comparisons (1) that the dyslexics' corpus callosum displays a more circular and evenly thicker general shape, and (2) that the midsagittal surface is on the average larger than in controls, in particular in the isthmus. Moreover, the different morphometric characteristics of the dyslexic brain correlated with the degree of impairment on various tests exploring phonological abilities. In vivo morphometry of the corpus callosum may provide valuable hints for understanding developmental learning disorders and their consequences in adults.

Age-related decrease in the responsiveness of rat articular chondrocytes to EGF is associated with diminished number and affinity for the ligand of cell surface binding sites

The effect of age on the responsiveness of articular chondrocytes (AC) to epidermal growth factor (EGF) was examined. Cells were isolated by digesting cartilage fragments from the humeral and femoral heads of 21-day old, 8- and 14-month old rats with collagenase. The cells were cultured under standard conditions, as monolayers. DNA synthesis was measured by [3H]thymidine incorporation and cell proliferation by the DNA content of subconfluent cultures. [125I]EGF binding and the amounts of EGF and EGF-receptor mRNAs were determined using confluent cells. DNA synthesis was decreased with age of animals. EGF stimulated DNA synthesis in cultures in 1- and 8-month old rats at low serum concentrations (< 5%), and in cultures in 14-month old animals at high serum concentrations. It also increased 5-day DNA content of cultures compared to serum-treated controls but this effect was weak in cultures in 14-month old rats. The number of high affinity binding sites for [125I]EGF decreased from 37,800 in the 1-month old to 1950 in the 14-month old rat AC. The apparent dissociation constant (Kd) also decreased with age: 0.18 nmol/l in the 1-month old; 0.12 nmol/l in the 8-month old; and 0.07 nmol/l in the 14-month old cells. AC in older rats contained more EGF mRNA and less EGF-receptor mRNA. Incubation of the cells with EGF resulted in down regulation of the EGF- and upregulation of EGF-receptor mRNA expressions. These findings show the age-related quantitative and qualitative alterations in EGF and EGF-receptor which may account, at least in part, for the diminished responsiveness of senescent AC to EGF.

Visuospatial ability of parkinsonians and elderly adults in location memory tasks

Two experiments addressed the question of the spatial deficits of Parkinson disease (PD) patients, using a spatial location task which varied the characteristics of the task along an effortful continuum. In the more effortful task, 11 PD patients, 10 elderly control subjects, and 13 young control subjects were given 3 min to learn the layout of 12 places labeled on a map and then reproduce it. In the less effortful task, 9 new PD patients, 9 new elderly control subjects, and 10 new young control subjects were given 3 min to learn the layout of 12 black dots and then asked to reproduce it. In both cases the task was repeated twice. The results showed that PD patients were less accurate than young and elderly control subjects in the less effortful task. In contrast, the performance of PD patients and elderly control subjects were equivalent in the more effortful task. These results support the idea of a specific visuospatial deficit in Parkinson's disease. Moreover, the deficit in effortful tasks seems to be due to normal aging.

Comparative studies on urethral function

Urethral pressure profiles (in vivo), opening pressures, and flow rates at opening pressure (in vitro) were determined for female, male, pregnant, ovariectomized (OVX), OVX and then estrogen-treated, and OVX and then progesterone-treated rabbits. Using the isolated whole-urethra preparation, we determined the opening pressures and flow rates as well as the effects of 250 microM phenylephrine, 250 microM bethanechol, and 120 mM KCl on the urethral opening pressure and flow rate. The results demonstrated that (1) the urethral pressure profiles were similar for male and female rabbits, (2) ovariectomy and pregnancy decreased the urethral pressure profiles, (3) estrogen therapy partially reversed the effect of ovariectomy on the urethra, and (4) progesterone therapy had little effect on the urethral pressure profile. With regard to opening pressure and flow, (1) flow at opening pressure was lower in the male than in the female; (2) the opening pressure was increased by ovariectomy; (3) phenylephrine and KCl stimulated a greater response in the male than in the female, whereas the response to bethanechol was significantly lower in the male than in the female; (4) the male had the greatest resistance to flow among all the groups; and (5) ovariectomy increased the resistance to flow and estrogen treatment reversed the effect of ovariectomy. In conclusion, ovariectomy had significant effects on urethral function that were reversed by estrogen therapy but not by progesterone therapy.

Protective effect of Tadenan on bladder function secondary to partial outlet obstruction

PURPOSE

Tadenan (DEBAT, Paris, France) is a pharmaceutical agent used in the treatment of benign prostatic hyperplasia (BPH). The specific aim of this study was to determine if pretreatment of rabbits with Tadenan reduced either the hypertrophic response of the bladder to partial outlet obstruction or the accompanying contractile dysfunction.

MATERIALS AND METHODS

Twenty-five male New Zealand rabbits (3 to 5 kg.) were separated into 5 groups of 5 rabbits each. Each rabbit in groups 1,2, and 3 received Tadenan orally at 1, 10 and 100 mg./kg./day for 3 weeks. Group 4 received vehicle only (peanut oil); Group 5 were controls. The bladders were evaluated (in vitro studies) after 2 weeks of obstruction.

RESULTS

1) Tadenan did not reduce the effect of partial outlet obstruction on bladder mass. 2) Tadenan pretreatment resulted in a significant protective effect on the contractile responses to field stimulation, bethanechol and KCl.

CONCLUSIONS

These results clearly demonstrate that Tadenan pretreatment protected the bladder from the contractile dysfunctions induced by partial outlet obstruction.

[Cognitive neuroanatomy of language: contribution of functional cerebral imaging]

This review summarizes the main results obtained to date, concerning the issue of brain/language relationships, from studies using the modern techniques of in vivo functional imaging of the brain, namely Positron Emission Tomography (PET) and, to a lesser extent, the still experimental method of functional Magnetic Resonance Imaging. These studies mostly rely on the so-called cognitive activation paradigm, which consists of recording blood flow variations as measured in PET in normal volunteers during various linguistic tasks compared to reference tasks. Since the late 80's, a great deal of literature has been accumulating, including studies of various aspects of language functions: perceptual (auditory and visual) processing of linguistic materials, expression, verbal memory, semantics... The first few results obtained have already led to challenge some previously widely held dogmas, derived from classical anatomo-clinical studies, such as the role of Wernicke's area in verbal comprehension and the role of Broca's area in language production. The involvement of the left supramarginal gyrus in some aspects of phonological processing has been directly demonstrated. At the same time, some studies have yielded unexpected results suggesting, for instance, a special role for the inferior lateral parts of the left frontal lobe in semantic and/or voluntary aspects of language processing and episodic verbal memory. Among other studies, those concerning the mechanisms of verbal short-term memory have provided interesting parallels with cognitive models. The demonstration, under certain experimental conditions, of an involvement of hitherto unsuspected cortical regions (such as the insular or the temporopolar cortices) is of potential considerable importance. Finally, with current technical improvements of the imaging methods, it will be shortly possible to take into account the important issue of interindividual variations as well as to perform activation studies in brain-damaged patients.

The timing of breastfeeding initiation and its correlates in a cohort of rural Egyptian infants

Recent data on the patterns and correlates of the timing of breastfeeding initiation in newborns are scanty for many countries including Egypt. To obtain such data in four villages in rural Bilbeis, we recruited apparently healthy, single neonates and their apparently healthy mothers within 4 days of child birth, and followed them prospectively during 1987 through 1989. All 150 neonates included in the analyses were breastfed for some duration. At the time of the first breastfeed, 36, 37, and 27 per cent of the neonates were aged < 2, 2-5, and > or = 6 hours, respectively. All neonates had received the first breastfeed by age 72 hours. In a multivariate, polytomous logistic regression model, modern birth attendants and longer ( > 8 hours) duration of labour were significantly associated with deferment of breastfeeding initiation till the neonate was aged > or = 6 hours. Breastfeeding initiation appeared to be unduly delayed in our study mothers and infants given that they were apparently healthy during the early post-partum period. Later initiation of breastfeeding was associated with indiscriminate prelacteal feeding, earlier termination of breastfeeding, and unwelcome supplementation practices. Our findings emphasize the need to initiate and/or strengthen programmes to promote appropriate breastfeeding practices in Bilbeis and other comparable areas.

[Characterization of gestural disorders in primary progressive apraxia: diagnostic and nosographic contribution]

Five cases are reported of patients with so-called primary progressive apraxia, defined as a slowly worsening disturbance of gestural abilities, without other major cognitive changes during a long period, in relation to degenerative cortical atrophy. All five cases, as other cases in the literature, share the following common features: 1) asymmetrical onset of upper limb clumsiness, more often involving the left side, later involving the contralateral side and lower limbs; 2) after a variable delay, the occurrence of symptoms suggesting subcortical involvement (akinesia, limb stiffness, various kinds of movement disorders, dystonia, paresis of vertical gaze); 3) diffuse cortical atrophy typically more pronounced in the superior parietal cortex opposite to the first side affected. The unusual nature of apraxia in all these cases is pointed out and referred to as Luria's "kinesthaesic apraxia", ascribed to a loss of "selectivity" of distal elementary movements. This pattern of symptoms and their specific outcome could represent a distinct entity.

[Activity and motivational disorders in neurology: proposal for an evaluation scale]

Isolated disturbances of motivation and action have recently been reported following focal (anoxic, toxic or ischemic) lesions of the basal ganglia. Their postulated mechanism is thought to involve bilateral dysfunction in a cortico-subcortical loop centered on the limbic part of the striato-pallidum. Such disturbances also occur as a consequence of more diffuse brain damage, such as in vascular or degenerative dementias. Clinically, patients show dramatic decrease in spontaneous acts, whereas the same acts are correctly performed on external demand (so-called "loss of auto activation"). Moreover, they also demonstrate a special "loss of interest, affect and elan vital" which is relevant to both diagnosis and physiopathologic issues. Finally, they very often report a unique feature of decrease or absence of spontaneous thoughts, which is reversible upon external stimulation as well. In this article, the various clinical features of this syndrome are reviewed, based on the relevant literature as well as the author's personal experience. A new rating scale is proposed in order to evaluate specifically disorders of motivation and action in brain-damaged patients.

Risk factors for development of first symptomatic Giardia infection among infants of a birth cohort in rural Egypt

Giardia infection is associated with diarrheal diseases among infants and young children in both industrialized and developing countries. A study was conducted to demonstrate the predisposing factors for occurrence of the first symptomatic Giardia infection among infants in rural Egypt. The study cohort was followed from birth through the first year of life. Univariate and multivariate analyses of data revealed that infants less than six months of age were at special risk for developing their first symptomatic infection compared with infants more than six months of age. Analysis of the data, furthermore, revealed an increased risk of infant Giardia infection associated with living in a household without a latrine (relative risk [RR] = 2.63, confidence interval [CI] = 1.4-4.9, P < 0.05), a mud floor in the sleeping rooms (RR = 1.79, CI = 1.O30-3.0, P < 0.05), and household exposure to more than 10 chickens (RR = 2.5, CI = 1.13-5.56, P < 0.05). In contrast, the mother's education beyond the primary level (RR = 0.28, CI = 0.09-0.85, P < 0.05), drinking water stored in metallic containers (RR = 0.33, CI = 0.11-0.98, P < 0.05), and male sex (RR = 0.52, CI = 0.3-0.89, P < 0.05) were associated with decreased risk of Giardia infection. These data suggest that in addition to age of infants, poverty, low education, gender discrimination, and certain environmental conditions potentiated the risk for developing the first symptomatic infection.

[Athymhormic syndrome caused by bilateral striato-capsular infarction. Moyamoya disease in adults]

A 49 year-old women with no medical history suddenly presented bilateral striato-capsular infarct causing frontal-like behavioural disturbances associating inertia with loss of drive, interest and affect, and preservation of intellectual function ("athymhormic syndrome" or "loss of psychic self-activation"). Ischaemic lesions mainly affected right globus pallidus and left lentiform nucleus with no involvement of the caput of the nuclei caudati. Such changes were close to anoxic lesions known to cause the same symptomatology. Infarction was attributed to a Moyamoya disease on angiographic data. Bilateral involvement of basal ganglia, arterial borderzones or both, may explain the frequent occurrence of neuropsychological disturbances in Moyamoya disease.

Mutism and auditory agnosia due to bilateral insular damage--role of the insula in human communication

We report a case of transient mutism and persistent auditory agnosia due to two successive ischemic infarcts mainly involving the insular cortex on both hemispheres. During the 'mutic' period, which lasted about 1 month, the patient did not respond to any auditory stimuli and made no effort to communicate. On follow-up examinations, language competences had re-appeared almost intact, but a massive auditory agnosia for non-verbal sounds was observed. From close inspection of lesion site, as determined with brain resonance imaging, and from a study of auditory evoked potentials, it is concluded that bilateral insular damage was crucial to both expressive and receptive components of the syndrome. The role of the insula in verbal and non-verbal communication is discussed in the light of anatomical descriptions of the pattern of connectivity of the insular cortex.

Diverging asymmetries of temporo-parietal cortical areas: a reappraisal of Geschwind/Galaburda theory

The general theory on the biological foundations of cerebral dominance formulated in 1985 by Geschwind and Galaburda entirely relies on a postulated causal relationship between anatomical asymmetry of the planum temporale and functional lateralization of the human brain, but does not take into account asymmetry of another cortical region, the parietal operculum. In 40 normal volunteers whose handedness was specified by the Edinburgh Handedness Inventory, we assessed asymmetries of these two regions on MRI sagittal scans. For both measurements, a significantly larger leftward asymmetry was found in the 24 consistent right-handers compared to the 16 non-right-handers. Moreover, the combination, for each subject, of the two indices of asymmetry, yielded four different subtypes between which handedness distribution significantly differed. We conclude that planum temporale and parietal operculum asymmetries may be divergent and that their convergence is strongly associated with right-handedness. Functional and developmental implications of these findings are discussed by reference to the Geschwind/Galaburda theory.

Functional magnetic resonance imaging at 1.5 T during sensorimotor and cognitive task

Functional activations of the human brain cortex were observed with a standard 1.5-tesla MR imaging system using a long time echo fast low-angle shot sequence. Neural activation increases regional cerebral blood flow resulting in increased capillaries and venous blood oxygenation. Processing requires adapted algorithms because the time course of intensity signal showed fluctuations of the baseline. The use of a 'follow-up' method to generate activation maps is proposed. Brain activation was detected in striate cortex during photic stimulation and in sensorimotor areas while subjects were moving their hands. In mental imagery tasks, we observed a primary and secondary visual cortex activation during memory recall of the flashing light. Motor ideation showed an activation of the rolandic areas.

Breast-feeding in Egypt

Planning, implementation and evaluation of programmes to promote appropriate infant feeding practices require detailed, current information about these practices in the target populations. To estimate the prevalences and identify the correlates of overall breast-feeding and of exclusive breast-feeding in different age periods during infancy, a cohort of 152 apparently healthy neonates and their mothers were followed during October 1987 through April 1989 in rural Bilbeis, Sharqiya Governorate, Egypt. Feeding data were collected through twice weekly home visits thus reducing the potential for bias in our findings due to respondent recall errors. The prevalence of overall breastfeeding in the infants declined from 100% in age period 0-11 weeks to 89% in age period 36-47 weeks. Mothers with previous living children were associated with significantly higher (odds ratio [OR]: 6.53, 95% confidence interval [CI]: 1.33-32.09) and ownership of refrigerators was associated with significantly lower (OR: 0.18, 95% CI: 0.05-0.67) overall breast-feeding prevalences in age periods 24-35 and 36-47 weeks, respectively. The prevalence of exclusive breast-feeding in breast-fed infants dropped from 20% in age period 0-11 weeks to 0% in age period 36-47 weeks. After multivariate adjustment, prelacteal feeding was significantly negatively (OR: 0.12, 95% CI: 0.04-0.37) associated with exclusive breast-feeding in age period 0-11 weeks. Nearly 90% of Bilbeis infants were breast-fed at age 47 weeks, but the initiation of supplementation at 0-11 weeks in 80% of breast-fed infants is contrary to current recommendations.(ABSTRACT TRUNCATED AT 250 WORDS)

[Functional cerebral neuro-imaging at 1.5 Tesla. The results of visual, sensorimotor and auditory stimulations]

Functional activation of the cerebral cortex can be observed with a standard 1.5 Tesla MRI magnet. We used a repeated FLASH 2D one-section sequence with a long echo (TE = 60 ms) and a small passing band. Modification of regional cerebral oxygenation due to neurone activation seems to be the main source of contrast. Sensorimotor stimulation was effected by an unusual mobilization of the fingers. Visual stimulation was performed by intermittent lightings at a frequency of 8 Hz. Auditory stimulation relied on listening to speech sounds. Signal increases were localized on the cerebral cortex with precise anatomico-functional correlation. Using a clinical 1.5 Tesla magnet requires an adequate treatment of data. Thus, stimulated cerebral activity can be portrayed by MRI therapy opening a new way for anatomico-functional cerebral studies.

[Isolated involvement of motivated behavior and basal ganglia diseases]

Focal brain lesions involving bilaterally either the globus pallidus, the corpus striatum or the deep frontal white matter, may result in a distinctive syndrome whereby patients become totally inert, with massive decrease in spontaneous behaviour, despite lack of obvious cognitive and mood disturbances. This syndrome has been variously labelled as "loss of psychic autoactivation" (Laplane et al.), "loss of action initiation and maintaining" (Ali Chérif et al.), "athymhormic syndrome" (Habib & Poncet). The most salient feature of this syndrome lies in the dissociation found between dramatic decrease in spontaneous mental (gestural, linguistic, emotional) productions, on the one hand, and almost normal productions given in response to external orders or stimulations, on the other hand. Patients are totally aware of these behavioural changes. According to their own reports, they do not suffer from these changes, they are not depressed or anxious, they do not make any plans or projects. Finally, a striking feature of their subjective experience is that they very often report an absence of spontaneous thought ("mental emptiness"). It is all though psychophysiological processes responsible for releasing and maintaining self-initiated behaviours or behaviours occurring in response to appetitive or aversive environmental stimulations, were impaired; this impairment may thus be termed a "motivational" disorder. Observations of the brain lesional substrate of this syndrome have focused on several sub-cortical neural structures, whose common feature is to be tightly connected with elements of the dopaminergic meso-limbic system, known from abundant experimental evidence to be chiefly involved in the regulation of motivated behaviour.

Covert processing of information in hemianesthesia: a case report

A 69-year-old patient with a cortical lesion of the primary sensory area showed a surprising sensorimotor control of the anesthetized arm. This observation suggested the existence of residual capacities of somesthetic information processing. This hypothesis was tested using a forced choice procedure on four tasks involving discrimination between different characteristics of the tactual-kinaesthetic stimulus. Whereas the patient was unable to identify the direction of movement or to discriminate between different letters, she could detect the occurrence of the stimulation or its dynamic quality significantly well. These results are discussed in reference to an anatomo-functional organization analogous to the one underlying the processing of visual information.

Input respiratory impedance to estimate airway hyperreactivity in children: standard method versus head generator

We previously found that a significant underestimation of respiratory mechanical impedance (Zrs) at high frequency may result from the upper airway artefact in children, when pressure is directly varied at the mouth. To determine the importance of this artefact in estimating lung response to bronchomotor agents with the forced oscillation technique, input respiratory mechanical impedance was measured using 6-32 Hz pseudorandom pressure oscillations applied directly to the mouth (standard generator (SG)) and around the subject's head (head generator (HG)) in 35 children aged 2.5-13 yrs. Changes in resistance were generally larger with HG than SG. The mean +/- SEM changes in resistance of the respiratory system (Rrs) at 20 Hz induced by acetylcholine or allergen challenge were 15 +/- 4% for SG and 67 +/- 12% for HG, and changes induced by bronchodilators were -25 +/- 2% for SG, and -46 +/- 4% for HG (p < 0.01). Challenge induced negative frequency dependence of Rrs with SG and positive frequency dependence with HG. There was significant increase in inertance after salbutamol with SG, but no significant change occurred with HG. With both methods, respiratory compliance decreased significantly after challenge. Computer simulations showed that the difference in change in Rrs induced by airway challenge with HG and SG could be explained by the effect of the upper airway wall impedance (Zuaw). Zuaw could also account for the change in inertance and compliance observed with SG, but not for the change in compliance with HG. The latter could be reproduced by simulating unequal distribution of mechanical time constants within the lung, increased peripheral lung resistance with compliant central airways.(ABSTRACT TRUNCATED AT 250 WORDS)

Association between birth weight and birth arm circumference of neonates in rural Egypt

In many developing countries including Egypt, the birth weights (BWs) of most babies go unrecorded because they are born at home. Since it is difficult to record BW in the community setting, birth arm circumference (BAC) has been used as a valid proxy for BW to identify at risk babies with low birth weight (LBW). However, the validity of BAC as an indicator of the actual BW has not been assessed fully. We did this study among neonates in rural Bilbeis, Egypt, to examine the association between BW and BAC, to assess whether BAC can serve as an indicator of the actual BW, and to determine the validity indices of 3 different cut-off levels of BAC as indicators of LBW. During 1987-88, the weights and arm circumference of 148 neonates were recorded within 2 weeks of birth. We observed a strong and highly significant positive linear correlation between BW and BAC (r = 0.6188, p = 0.0001). The BAC cut-off value of < 9.5 cm was associated with the optimal combination of sensitivity (50%) and specificity (88.4%) as an indicator of LBW. In linear regression analysis BAC was found to be a significant (p = 0.00001) predictor of BW. The means of the model predicted weights for males, females, and both genders together were identical to the corresponding means of the observed values. In contingency table analysis, for 78 (52.7%) of the 148 neonates studied the observed and predicted BW categories were identical. For another 59 (39.9%) neonates, agreement with the next lower or higher BW category was observed. We feel that BAC can be used as an indicator of the actual BW in settings where routine recording of BW is currently not practicable.

Digital image-analysis of nuclear morphometry, DNA-ploidy and AgNORs in breast-carcinoma cell imprints

A series (n = 322) of breast carcinomas was investigated from 1991 to 1993 using digital image analysis. Nuclear morphometry and DNA content, and AgNORs were evaluated on cell imprints from fresh tissue samples which were further stored frozen (-80-degrees-C). Data were correlated to morphological prognostic factors and immunocytochemical expression of cell markers assessed on frozen sections and evaluated by densitometry after image analysis processing. Nuclear morphometric parameters, DNA nuclear content and AgNORs were independent from the tumor size, histological grades, and the tumor content of immunodetectable pHER-2/neu, Cathepsin D, ER, PR, pS2, and p53. But, DNA index and hyperploidy degree correlated with the mitosis index (p < 0.01) and Ki67 immunostaining (p = 0.003, p < 0.0001) whereas the shape factor and nucleus large diameter correlated with the degree of cell anisocytosis (p < 0.01). Nuclear surface and large diameter were greater in ductal carcinomas (p = 0.028) and in comedocarcinomas (p < 0.001) than in lobular carcinomas. These results suggest that image analysis processing provides accurate data to refine histoprognostic grading and additional parameters to evaluate tumor proliferative activity.

Paroxysmal pruritus and multiple sclerosis

We report a patient who presented with paroxysmal pruritus in association with multiple sclerosis. Magnetic resonance imaging of the cervical spinal cord showed a lesion at a level corresponding to the dermatomal location of the pruritus.

Functional and magnetic resonance imaging correlates of callosal involvement in multiple sclerosis

To investigate functional and anatomical features of callosal involvement in multiple sclerosis (MS), performances of 90 patients with definite MS and 25 matched normal control subjects were compared on three tasks exploring interhemispheric transfer of auditory, sensory, and motor information: a verbal dichotic listening task, a crossed tactile finger localization task, and an alternate finger tapping task. Each patient also underwent a magnetic resonance imaging (MRI) scan (1) to appreciate the extent of white-matter changes by a semiquantitative evaluation of hemispheric brain MRI hyperintensities and (2) to measure the degree of total and regional callosal atrophy using an automatized method of partition of the midsagittal callosal area. Interhemispheric transfer and/or integration was impaired in patients with MS for all modalities explored and proportional to both degree of callosal atrophy and diffusion of white-matter lesions. Moreover, in good agreement with data obtained from partial commissurotomy studies, performance on each functional task was predominantly associated with atrophy of one part of the callosum, namely left-ear dichotic suppression with the posterior callosal region, alternate finger tapping with the anterior region, and cross-localization with midanterior and posterior regions. Finally, a subgroup of patients without MRI white-matter hyperintensities also showed significant impairment of callosal function and relative atrophy of the callosum. These findings suggest the potential clinical value of callosal involvement in MS and the usefulness of MS as a model of interhemispheric disconnection.

Community-based prevalence profile of arboviral, rickettsial, and Hantaan-like viral antibody in the Nile River Delta of Egypt

To determine the current prevalence of antibody to arboviruses, rickettsiae, and hantaan-like viruses, a survey was carried out in the Nile River Valley of Egypt, one of the principal foci of the 1977-1978 Rift Valley fever (RVF) outbreak. Blood specimens were obtained from 915 persons representing 190 study households. Enzyme immunoassay testing showed that the overall prevalence of IgG antibody was 4% to sand fly fever Sicilian (SFS), 2% to sandfly fever Naples (SFN), 15% to RVF, 20% to West Nile, and 4% to Hantaan (HTN) viruses. Antibody was demonstrated among 32% of the same study subjects to Coxiella burnetii, 58% to Rickettsia typhi, and 32% to R. conorii. The prevalence of agent-specific antibody tended to increase with age. Particularly notable was the low prevalence of RVF infection in children born after the height of the RVF outbreak. No detectable antibodies were found in the population less than seven years of age and in only 3% of those 7-12 years old. In contrast, 26% of the study population 13-19 years old, who were young children and infants at the time of the outbreak, were found to have RVF antibodies, suggesting that the level of intensity associated with transmission decreased considerably following the documented 1977-1978 outbreak. Geometric mean titers (GMT) ranged from 139 for C. burnetii to 1,305 for RVF, and did not vary significantly by age, except for high titers for RVF in the 20-49-year-old age group. A significant upward trend in GMT was also noted when antibody was detected in the specimen for more than one phlebovirus.(ABSTRACT TRUNCATED AT 250 WORDS)

[Primary progressive aphasia (Mesulam syndrome)]

Primary progressive aphasia is defined as a gradually appeared and gradually worsening disorder of speech without any major alteration of the other cognitive functions. It is regarded by some authors as a syndrome which may be due to various degenerative diseases of the cerebral cortex (notably Alzheimer's disease, owing to its frequency), while others see in it an autonomous disease related to a neuropathological process that is distinct from the main degenerative dementias. The principal clinical particularity of primary progressive aphasia is that it spares the patient's autonomy for a long time, but ultimately turns into global dementia. Despite the diversity of aphasic aspects accompanied or not, in neuroimaging, by morphological and metabolic asymmetry to the expense of the left hemisphere, a review of the autopsy cases published shows that the vast majority corresponded to a neuropathological pattern devoid of the characteristic features of Alzheimer's disease and nearer to Pick's disease. In practice, the diagnosis of Alzheimer's disease can be excluded in all patients whose clinical presentation and cerebral neuroimaging results are compatible with primary progressive aphasia. Moreover, the fact that this new clinicoanatomical entity has been individualized constitutes a definite step towards a better comprehension of degenerative dementias.

Non palpable breast carcinomas. Histological and immunohistochemical studies of 160 cases

A series of 160 impalpable breast carcinomas was collected from 1979 to 1991. Mammographs showed microcalcifications (64%), or opaque images (36%). Surgical specimens were X-rayed during the intervention in order (i) to ascertain that the lesions detected on mammographs were removed, and (ii) to guide the pathologist in sampling tissue fragment for an appropriate microscopic evaluation of the lesions. During the intervention, the peroperation histological diagnosis was correct in 63% of the cases, whereas malignancies were underscored in 37%. No false positive diagnosis was recorded. A large majority (92%) of false diagnoses stated during surgery were in situ carcinomas diagnosed as epitheliosis and invasive carcinomas diagnosed as in situ carcinomas. In 63% of the cases the axillary lymph node could be removed during the first intervention. In 91% of the cases "in sano" margins of resection were evaluated as such during the intervention. The size of tumors ranged from 1 to 60 mm (m = 10 mm - SD = 8.45), 70% measuring less than 10 mm. Carcinomas were in situ (23.75%), microinvasive (13.75%) and invasive (62.5%). Carcinomas were ductal (78.1%), lobular (18.7%) and of other types (14.2%). A majority of intraductal carcinoma (68%) were comedocarcinomas. Invasive carcinomas accounted for grade I in 37% of the cases, grade II in 56%, grade III in 7%, ductal carcinomas and for tubular carcinomas in 15%. Immunodetection could be performed on frozen sections in 78 cases. Tumors were receptor positive in 58% of the cases. The greater growth fraction (Ki-67) and higher detection of HER-2/neu oncogene product were observed in comedocarcinomas. Diploid tumors accounted for 52% of those evaluated (n = 48).

The prevalence of arboviral, rickettsial, and Hantaan-like viral antibody among schoolchildren in the Nile river delta of Egypt

A serosurvey was conducted during October and November 1989 to estimate the prevalence of selected arboviral, rickettsial, and Hantaan viral antibody among a sample of schoolchildren from 4 villages in the Bilbeis area of the Nile river delta, Egypt. Blood specimens were obtained from subjects aged 8 to 14 years. Enzyme immunoassay testing of the sera indicated that the prevalence of antibody was 9% (21/223) for Sicilian sandfly fever, 4% (8/223) for Rift Valley fever, 3% (15/437) for West Nile virus and 9% (28/315) for Hantaan (HTN) virus. Antibody was demonstrated among 22% (93/418) of the same study subjects against Coxiella burnetti, 53% (199/373) against Rickettsia typhi, and 37% (137/371) against R. conorii.

Prelacteal infant feeding practices in rural Egypt

Data collected during a prospective cohort study of infant feeding and health in rural Bilbeis, Egypt, were analysed to define prelacteal infant feeding practices, identify their determinants, and assess whether these practices were predictive of breastfeeding and supplementation patterns and diarrhoea incidence during infancy. Sixty per cent (89/149) of study infants were prelacteally fed sugar-water, teas, or both. Lack of milk in the mother's breast (74 per cent), and maternal exhaustion or illness following labour (29 per cent) were the two most commonly stated reasons for prelacteal feeding. After multivariate adjustment, significantly higher incidence of prelacteal feeding was associated with childbirth during the warmer months [odds ratio (OR): 2.4; 95 per cent confidence interval (CI): 1.1-5.1], birth attendants with modern training (OR: 5.5; 95 per cent CI: 1.7-17.5), and labour lasting > 8 hours (OR: 2.3; 95 per cent CI: 0.1-4.9). Prelacteally fed infants were significantly less likely to be exclusively breastfed in age periods 0-3, 4-7, and 8-11 weeks. Diarrhoea incidence was higher among prelacteally fed infants in age periods 0-11, 12-23, and 36-47 weeks. Indiscriminate practice of prelacteal feeding and early supplementation of breastfeeding need to be discouraged.

Kufs' disease presenting as progressive dementia with late-onset generalized seizures: a clinicopathological and electrophysiological study

A 32-year-old woman presented with increasing motor difficulties and memory disturbances. Neurological examination only showed mild cerebellar and extrapyramidal symptoms, whereas neuropsychological evaluation disclosed severe cognitive changes consistent with dementia. Her motor and mental status progressively deteriorated until death, which occurred 5 years after the first admission. One year before death, while she was almost bedridden, symptoms of myoclonic epilepsy first appeared, with frequent generalized seizures and generalized myoclonus, occurring especially upon sensory stimulation or passive joint movements. Pathological examination showed neuronal inclusions typical of Kufs' disease. This case, with primary progressive dementia and late-onset myoclonic epilepsy, differs from previously reported cases. Three special electrophysiological features were abnormal, "giant", evoked potentials; unusually marked photosensitivity; and seizure induction by any sensory stimulation.

Competition binding studies with biotinylated echovirus 11 in cytofluorimetry analysis

Competition binding studies between viruses are usually performed with radiolabelled probes. In this report, a cytofluorimetric method using biotinylated echovirus (EV) 11 is described for the study of competition of enteroviruses for a common cell receptor site. An N-hydroxysuccinimide ester biotin spacer arm was used for biotinylation of CsSO4-purified EV 11. Biotinylation did not change the infectivity of the virus (attachment to and replication in susceptible cells). With the exception of EV 22 and EV 23, all the echovirus serotypes and also coxsackievirus A9 (CA 9) were able to inhibit the absorption of biotinylated EV 11 onto cells. The taxonomic implications of these findings are discussed.

The role of home environment in infant diarrhea in rural Egypt

In 1982 and 1983, a descriptive environmental survey was conducted in 317 households with newborn infants in rural Bilbeis, Egypt. The incidence of infant diarrhea in these households was ascertained by twice-weekly home visits for a 1-year period (1981-1982). Using univariate and multivariate analyses, the authors identified household factors that were statistically associated with infant diarrhea incidence, including number of children in the house under 4 years of age; number of persons per household; incidence of diarrhea in other family members; having a dirt (vs. concrete) dining room floor; having multiple living areas in the house; having a house or roof in need of repair; using well water rather than tap water for cooking or bathin; the absence of a sewer for waste bathwater; food being left out at room temperature between meals; and having many rodents in the house. Two practices involving interaction with the environment appeared to be protective: butchering of cattle by the family for home consumption, and protection of the infant from flies by a veil during napping. The combined household variables explained 25% of the variance in the total incidence of diarrhea. Categories of variables that accounted for most of the total variance explained by environmental factors are, in decreasing order: house structure (28%); water usage (24%); toilet and bathing area (12%); animal management (11%); food preparation area (10%); hygiene (8%); and wastewater management (6%). This approach may be useful in identifying environmental characteristics whose change would reduce diarrheal illness among infants.

[Changes in personality and hypertension. The "athymhormic" syndrome]

In 3 hypertensive patients, aged 57 to 66, profound behavioral and personality changes occurred rather abruptly, characterized by total loss of spontaneous activity and initiative, apathetic behavior, passivity, lack of drive and motivation, loss of interest for any of previous occupations and hobbies, and total flatness of affect. Neurological examination was normal or only showed mild extra-pyramidal signs. Neuropsychological evaluation was only remarkable for mild intellectual impairment suggestive of frontal lobe dysfunction. None of the 3 patients fulfilled criteria for dementia or severe depression. This neurobehavioral syndrome has been coined "athymhormic syndrome" (Habib & Poncet, 1988), a term emphasizing the specific defect in drive ("horme") and affect ("thumos"). Electrical and clinical heart examination was unremarkable. Blood pressure was always found within normal limits during hospitalization, including 24-hour monitoring in one case. However, all patients were known as hypertensive in the past, with repeated bouts of high blood pressure (up to 270 mmHg systolic in one case). X-ray CT-scan was usually normal or showed non-specific white matter changes (so-called "leukoaraiosis"). In all 3 cases, a brain MRI scan showed multiple small infarcts mainly involving deep subcortical structures (caudate nuclei and/or adjacent periventricular white matter) of both hemispheres, consistent with the definition of lacunes.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of handedness and sex on the morphology of the corpus callosum: a study with brain magnetic resonance imaging

In view of conflicting data in the existing literature, we examined 53 normal subjects using a handedness questionnaire and callosal area measurements obtained from midsagittal MRI images. The callosum was found to be significantly larger in nonconsistent right-handers (NCRH), especially in its anterior half and especially for males. A significant hand x sex interaction, favoring consistent right-handed (CRH) females, was also found for the posterior midbody, a region known to house interhemispheric fibers connecting the right and left posterior association cortices. These results (1) confirm Witelson's (1985) first findings on postmortem specimens; (2) validate a dichotomy between CRH and NCRH rather than simply considering the writing hand, as was the case in most other similar studies; and (3) suggest that at least two different sex-related--probably hormonal--factors may be acting during the callosal development, one explaining the larger anterior half in NCRH males and the other the larger posterior midbody in CRH females.

[Neurologic sequelae of the neuroleptics-lithium combination: role of hyperthermia]

The combination of lithium carbonate and neuroleptic is frequently used in the treatment of bipolar disorders. Four patients exhibited permanent neurological sequelae including cerebellar, pyramidal and extra-pyramidal signs after a long-term therapy with this association. Fever, stupor and pulmonary event were initially present. Neuropathological findings in one case only showed selective degeneration of cerebellar Purkinje cells, also noted as a characteristic feature in heat stroke and malignant hyperthermia. Lithium carbonate may be the main factor of neurotoxicity but hyperthermic states are probably involved in determinating brain damage, particularly cerebellar lesions.