Usefulness of thermography in the diagnosis and classification of complex regional pain syndrome

INTRODUCTION

We propose a protocol for study of complex regional pain syndrome (CRPS) based on a battery of quantitative measures (skin thermography, electrochemical skin conductance and sensory thresholds) and apply such protocol to 5 representative cases of CRPS.

PATIENTS AND METHODS

5 CPRS cases (2 women/3 men) that met the Budapest criteria for the diagnosis of CRPS.

RESULTS

All patients showed spontaneous pain and allodynia. Two cases correspond to a stage I, in both the resting basal temperature was increased in the affected limb. Three cases reflect more advanced stages with a decrease in resting temperature and a delay in the recovery of the temperature when compared to contralateral limb.

DISCUSSION

These non-invasive quantitative functional tests not only improve the diagnostic accuracy of CRPS but also, they help us to stratify and understand the pathological processes of the disease.

The TIMEBASE Study: IdenTifying dIgital bioMarkers of illnEss activity in BipolAr diSordEr. Preliminary results

Introduction

Mood episodes in bipolar disorder (BD) are still identified with subjective retrospective reports and scales. Digital biomarkers, such as actigraphy, heart rate variability, or ElectroDermal activity (EDA) have demonstrated their potential to objectively capture illness activity.

Objectives

To identify physiological digital signatures of illness activity during acute episodes of BD compared to euthymia and healthy controls (HC) using a novel wearable device (Empatica´s E4).

Methods

A pragmatic exploratory study. The sample will include 3 independent groups totalizing 60 individuals: 36 BD inpatients admitted due to severe acute episodes of mania (N=12), depression (N=12), and mixed features (N=12), will wear the E4-device at four timepoints: the acute phase (T0), treatment response (T1), symptoms remission (T2) and during euthymia (T3; outpatient follow-up). 12 BD euthymic outpatients and 12 HC will be asked to wear the E4-device once. Data pre-processing included average downsampling, channel time-alignment in 2D segments, 3D-array stacking of segments, and random shuffling for training/validation sets. Finally, machine learning algorithms will be applied.

Results

A total of 10 patients and 5 HC have been recruited so far. The preliminary results follow the first differences between the physiological digital biomarkers between manic and depressive episodes. 3 fully connected layers with 32 hidden units, ectified linear activation function (ReLU) activation, 25% dropout rate, significantly differentiated a manic from a depressive episode at different timepoints (T0, T1, T2).

Conclusions

New wearables technologies might provide objective decision-support parameters based on digital signatures of symptoms that would allow tailored treatments and early identification of symptoms.

Disclosure

No significant relationships.

Lurasidone-induced mania: A case report

Introduction

Lurasidone is an atypical antipsychotic agent with potential antidepressant effects through its antagonist activity at the 5-HT7 receptor. Although treatment-emergent affective switch (TEAS) induced by second-generation antipsychotics are not frequent, several cases have been reported. To our knowledge, there is no evidence of lurasidone-induced TEAS.

Objectives

To describe a case of lurasidone-induced mania.

Methods

We describe a clinical case of a patient admitted to our psychiatric outpatient unit who developed a manic episode, presumably induced by the introduction of lurasidone. We also conduct a review of the literature on this subject.

Results

A 37-year-old man diagnosed with obsessive-compulsive disorder (OCD) and an alcohol use disorder was hospitalized due to OCD decompensation with depressive symptomatology and suicidal thoughts, and for alcohol detoxification process. Since he had a previous history of clomipramine-induced TEAS, he was started on lurasidone up to 111mg to avoid the use of antidepressants, showing a progressive improvement of depressive symptoms. Thus, the patient was discharged when alcohol detoxification process was completed. Eight days after discharge, the patient began to show manic symptoms, so he had to be readmitted. Lurasidone was discontinued and valproic acid up to 1000mg/day as mood stabilizer was added, presenting a positive remission of manic symptoms.

Conclusions

According to our experience, lurasidone may have induced an affective switch in this patient. Based on our findings, patients and psychiatrists should monitor possible lurasidone-induced mood switching. However, further research is needed in order to back-up this one case report findings.

Disclosure

No significant relationships.

Anticholinergic syndrome in a patient with schizophrenia

Introduction

Anticholinergic syndrome (AS) is a complication that can appear due to different drugs with antimuscarinic effects, such as antihistamines, alkaloids, antipsychotics, tricyclic antidepressives or anesthetics, and it is characterized by urinary retention, dry mouth and skin, mydriasis, low-grade fever, and confusion or coma.

Objectives

To describe a clinical case of AS admitted to our hospital.

Methods

We present a case report of a patient with schizophrenia who presented an anticholinergic syndrome. We also searched for previous studies of AS using a pubmed query.

Results

A 53-year-old male was admitted for a psychotic decompensation to another hospital in Barcelona. The usual treatment at home was amisulpride 1200mg/d, olanzapine 30mg/d and lormetazepam, and haloperidol 6mg/d and clotiapine 40mg/d were added to treat the decompensation. Then, the patient started to present mydriasis, mucocutaneous dryness, low-grade fever, slight hypertension and tachycardia, repeated retentions of urine, confusion, unintelligible speech and agitation, so he was referred to our hospital. Once he was admitted, haloperidol was withdrawn and support measures (bladder catheterization, fluid therapy, etc.) were applied. After a few days, most of the mentioned alterations were stabilized, but the psychotic symptoms, such as thought and behavioural disorganization, persisted and required electroconvulsive therapy, with subsequent improvement.

Conclusions

AS is a relatively frequent side effect of psychiatric medication, which diagnosis is clinical, so, we must be capable to identify it and initiate early treatment to prevent possible complications. The first step, as reflected in the case described, is to stop the causative drugs, and apply support measures. Additionally, physostigmine can be used, as it is an effective antidote.

Disclosure

No significant relationships.

Trichotillomania in adulthood, a case report

Introduction

Trichotillomania is a disorder (estimated prevalence 0.5-2.0%) with common onset in childhood, rarely seen in adulthood, characterized by the repetitive pulling out of one’s own hair leading to hair loss and functional impairment, associated with other comorbidities: major depression (39-65%), anxiety disorder (23-32%), SUDs (15-19%), OCD (13-27%).

Objectives

To present a case of late-onset trichotillomania in a 60-year-old woman.

Methods

The present study is a case report of a patient visited in outpatient psychiatry for trichotillomania. We also searched previously case reports, series and systematic reviews of clinical trichotillomania using a pubmed query.

Results

This is a 60-year-old morbidly obese woman diagnosed with dysthymia, binge eating disorder and histrionic personality disorder. She explained a worsening of anxiety associated with work problems of one year of evolution and, for six months, the beginning of the plucking of eyebrow hairs and scabs to decrease this symptom, with inability to avoid the behaviour and without eating the hairs. The mental evaluation highlighted psychic anxiety, hypothymia, low self-esteem and feelings of failure and did not suggest a delirium. We started treatment with topiramate up to 150mg/day which was not successful. After that we switched to fluoxetine up to 60mg/day associated to psychotherapy observing a slight gradual improvement.

Conclusions

The clinical presentation suggested the diagnosis of trichotillomania in the context of dysthymia. No particular medication demonstrates efficacy in the treatment of trichotillomania. Preliminary evidence suggests treatment effects of clomipramine, NAC and olanzapine based on individual trials with small sample sizes. Research findings also recommend psychotherapy based on habit reversal.

Disclosure

No significant relationships.

Usefulness of thermography in the diagnosis and classification of complex regional pain syndrome

INTRODUCTION

We propose a protocol for study of complex regional pain syndrome (CRPS) based on a battery of quantitative measures (skin thermography, electrochemical skin conductance and sensory thresholds) and apply such protocol to 5 representative cases of CRPS.

PATIENTS AND METHODS

5 CPRS cases (2 women/3 men) that met the Budapest criteria for the diagnosis of CRPS.

RESULTS

All patients showed spontaneous pain and allodynia. Two cases correspond to a stage I, in both the resting basal temperature was increased in the affected limb. Three cases reflect more advanced stages with a decrease in resting temperature and a delay in the recovery of the temperature when compared to contralateral limb.

DISCUSSION

These non-invasive quantitative functional tests not only improve the diagnostic accuracy of CRPS but also, they help us to stratify and understand the pathological processes of the disease.

Effects of 4-aminopyridine on attention and executive functions of patients with multiple sclerosis: Randomized, double-blind, placebo-controlled clinical trial. Preliminary report

BACKGROUND

A high percentage of patients with multiple sclerosis present cognitive alterations. Because 4-aminopyridine improves nerve conduction and efficient synaptic connection could improve cognitive dysfunction.

OBJECTIVE

To evaluate the efficacy on cognitive performance and safety of 4-aminopyridine administered to patients with relapsing-remitting multiple sclerosis.

METHODS

A randomized, double-blind, placebo controlled clinical trial was conducted in patients with relapsing-remitting multiple sclerosis diagnosis according to the McDonald criteria. At the beginning and at the end of the treatment different tests were used to assess cognitive performance. Subsequently, patients were randomized 1:1 to receive treatment or placebo. A bootstrap-t test was proposed to test the effectiveness of cognitive performance, considering a p-value < 0.05 as statistically significant.

RESULTS

Twenty-four patients were recruited of which 21 completed the trial, 11 with 4-aminopyridine and 10 with placebo treatment. No significant differences between groups in the initial assessments were observed. In terms of efficacy, the experimental group achieved significantly higher scores in attention span, verbal fluency, planning and graphics and constructive motion.

CONCLUSIONS

4-aminopyridine proved to be an effective treatment on cognitive aspects in patients with relapsing-remitting multiple sclerosis. Drug doses were shown to be safe with mild to moderate adverse events (ClinicalTrials.gov number, NCT02280096).

Consensus guidelines for diagnosis, treatment and follow-up of patients with pancreatic cancer in Spain

The management of patients with pancreatic cancer has advanced over the last few years. We convey a multidisciplinary group of experts in an attempt to stablish practical guidelines for the diagnoses, staging and management of these patients. This paper summarizes the main conclusions of the working group. Patients with suspected pancreatic ductal adenocarcinoma should be rapidly evaluated and referred to high-volume centers. Multidisciplinary supervision is critical for proper diagnoses, staging and to frame a treatment plan. Surgical resection together with chemotherapy offers the highest chance for cure in early stage disease. Patients with advanced disease should be classified in treatment groups to guide systemic treatment. New chemotherapeutic regimens have resulted in improved survival. Symptomatic management is critical in this disease. Enrollment in a clinical trial is, in general, recommended.

QEEG norms for the first year of life

BACKGROUND

QEEG allows a more objective evaluation of cerebral electrical activity as well as the production of topographical maps for easier comprehension. Here we have developed qEEG norms for the first year of life using methods previously published for other age ranges, including for example, regression for Gausssianity before Z transformation. These norms constitute a non-invasive and low cost tool for the functional evaluation of the infant's brain.

RESULTS

Developmental equations were obtained from 101 healthy infants recording at spontaneous quiet sleep stage II. Polynomial regression equations, with age as independent variable, were calculated for full Broad Band Spectral Parameters (BBSP) using the Least Squares technique. Interpolated maps of the BBSP values or their Z transformation were constructed for linked-ear reference, average reference and Laplacian montages. All montages produced similar tendency curves and Z maps of absolute and relative power, and mean frequency at all frequency bands. The norms obtained were validated against an independent group of 50 healthy infants and some pathological cases. 91-98% of cases were well classified as normal across all measures and montages. To exemplify, two pathological cases are presented of which their qEEG maps show resemblance to CT and MRI.

CONCLUSIONS

These qEEG norms are highly useful as an aid to visual interpretation and for the study of pathology further evolution as well as for assessment of infants showing brain risk factors. To our knowledge this is the first normative qEEG study for the initial year of life with such large sample and validation-group.

Bender performance and socioeconomic status in Mexican children: a cross-cultural study

Normative data are presented for Bender test performance, following the system of Koppitz, of 695 Mexican students between 5.0 and 12.1 yr. old (M = 8.7, SD = 2.01) and belonging to different socioeconomic status. The data are compared with the normative group of U.S. students used by Koppitz and with a representative sample of children from Barcelona, Spain. The results indicate that the total number of Bender errors decreased with increasing age of the children and that significant differences existed with respect to socioeconomic status. The comparison of these data with U.S. and Spanish children shows significant differences in all age groups, with the Mexican children scoring lowest. Differences in quality of schooling and in other aspects of education could explain the variability in Bender test performance.

[Enteral nutrition through long-term jejunostomy]

We present the case of a female patient suffering a peritonitis episode after subtotal gastrectomy due to gastric neoplasm in relation to lesser curvature necrosis extending to the anterior esophageal wall. This an uncommon andsevere complication that made mandatory further aggressive surgery: transection of the abdominal esophagus, transection of the gastric stump, and cervical esophagostomy with creation of a jejunostomy with a needle catheter for feeding. This digestive tube access technique is generally used during major abdominal post-surgery until oral intake is reestablished. Our patient has been 187 days with this therapy since reconstruction of the GI tract was ruled out due to tumoral infiltration of the colon and tumor recurrence at the gastrohepatic omentum. To date, there has been no complication from permanence and/or long-term use of this technique.

First Report of Celery mosaic virus Infecting Celery in Venezuela

Celery mosaic virus (CeMV) is a significant pathogen of celery (Apium graveolens) worldwide (1). In 2005, in a produce market located in Los Salias, Miranda, celery plants with mottling and leaf malformation were noticed. Electron microscopic analysis of leaf-dip preparations from three symptomatic samples revealed flexuous viral particles that were 750 nm long. Infected cells contained pinwheel inclusions typical of those associated with potyvirus infection. Inoculation of healthy celery plants with leaf extracts from four symptomatic plants produced symptoms identical to those first observed. A survey of five produce markets in Miranda was conducted to determine the prevalence of virus infection in celery using serological and molecular analyses. Mottling and malformation of celery leaflets were observed in all the markets visited. Symptoms were noted in all five markets in each of three visits during a 3-month period. A total of 125 postharvested symptomatic plants were collected from five markets on March 29, 2005 and tested for CeMV using double-antibody sandwich enzyme-linked immunosorbent assay (DAS-ELISA) with antiserum provided by F. Rabenstein, BAX, Aschersleben, Germany. Of the 125 samples collected during the survey, 53% were ELISA positive. Twenty ELISA-positive samples were also tested using reverse transcription-polymerase chain reaction (RT-PCR) with general primers for the family Potyviridae (2). All 20 samples produced an amplicon of the expected size (1.7 kbp) after RT-PCR. Amplicons from three samples were cloned into the pCR-TOPO vector (Invitrogen, Carlsbad, CA). Sequence analysis of one clone revealed more than 98% nt to a CeMV isolate from Australia (GenBank Accession No AF203532). To our knowledge, this is the first report of CeMV in Venezuela. Our results suggest that the disease may be widely spread on celery crops growing in the areas surrounding produce markets in Miranda State. References: (1) A. Brunt et al. Viruses of Plants. CAB International, Wallingford, Oxon, UK. 1996. (2) J. Chen et al. Arch. Virol. 146:757, 2001.

IgE antibodies to betalactams: relationship between the triggering hapten and the specificity of the immune response

BACKGROUND

In immunoglobulin (Ig)E-mediated responses to betalactams (BL) the antibody is directed to the hapten inducing the response. For benzylpenicillin (BP) the determinant is benzylpenicilloyl (BPO) and for amoxicillin (AX), amoxicilloyl (AXO). Because of cross-reactivity, IgE from some patients reacts to both drugs whereas others have a drug-selective recognition. After an allergic episode, there is an increase in IgE that decreases over time. We analysed the response of patients allergic to BL after penicillin administration, with emphasis on IgE cross-reactivity.

METHODS

Subjects who developed an IgE antibody response were studied. Sequential follow-up samples were obtained at different times during the response. Changes in IgE specificity were analysed by competition immunoassays using different penicillin monomeric conjugates.

RESULTS

Two patterns of response were existed: one with IgE directed to the culprit penicillin and another with IgE mainly reactive to BPO. In both, a variable cross-reactivity with the hapten triggering the boosting response was found. This pattern was maintained with no change in specificity over time, even in subjects who experienced one boosting event.

CONCLUSION

The IgE response can be specific to the drug inducing the reaction or cross-reactive to the classical BPO determinant. This pattern is maintained throughout the whole period of the response, even if re-exposure occurs. The stability of the type of response can be explained by the phenomenon of original antigenic sin: in the presence of antibodies, memory B cells are more easily triggered than naive B cells.

High prevalence of syphilis-HIV co-infection at four hospitals of the city of Buenos Aires, Argentina

A cross-sectional anonymous study of 261 STD (sexually transmitted diseases) outpatients and 288 outpatients from other hospital departments was conducted at four major city hospitals in Buenos Aires. High prevalence of human immunodeficiency virus (HIV) (14.5%) and syphilis (30.2%) was noted. Fifty-two persons were diagnosed with both HIV and syphilis. Of the 87 HIV cases observed, 52 (59.7%) were co-infected with syphilis. Stratified analysis by gender showed that the prevalence of HIV, syphilis and HIV/syphilis co-infection was significantly (p < 0.001) higher in men than women (HIV: 20.1% vs. 4.6%; syphilis: 39.3% vs. 17.4%; co-infection: 13.6% vs. 1.7%). Integrated HIV/STD intervention programs and more effective surveillance are required in Argentina.

Follow-up study of learning-disabled children treated with neurofeedback or placebo

This report is a 2-year follow-up to a previous study describing positive behavioral changes and a spurt of EEG maturation with theta/alpha neurofeedback (NFB) training in a group of Learning Disabled (LD) children. In a control paired group, treated with placebo, behavioral changes were not observed and the smaller maturational EEG changes observed were easily explained by increased age. Two years later, the EEG maturational lag in Control Group children increased, reaching abnormally high theta Relative Power values; the absence of positive behavioral changes continued and the neurological diagnosis remained LD. In contrast, after 2 years EEG maturation did continue in children who belonged to the Experimental Group with previous neurofeedback training; this was accompanied by positive behavioral changes, which were reflected in remission of LD symptoms.

Schizencephaly with occlusion or absence of middle cerebral artery

In a study of 160 infants with prenatal and/or perinatal risk factors for brain damage, we observed three cases of schizencephaly. All cases were unilateral, and the clefts had open lips. In two cases, magnetic resonance angiography showed occlusion or absence of the middle cerebral artery (MCA) on the affected side. Two of the patients, including one with absent flow in the MCA of the affected side, had ipsilateral cerebellar atrophy.

Open vs laparoscopic repair of secondary lumbar hernias: a prospective nonrandomized study

BACKGROUND

Lumbar hernias are uncommon defects of the posterior abdominal wall. Surgical treatment is still controversial in these cases. The aim of this study was to compare outcome and costs of the laparoscopic approach vs the open method.

METHODS

We conducted a prospective nonrandomized study of 16 patients who underwent operation for secondary lumbar hernia between January 1997 and January 2003. Nine were treated via the laparoscopic approach and seven with an open technique. The following variables were analyzed: clinical data, hospital data (operating time and length of stay), patient comfort (consumption of analgesics and time to return to normal activities), and recurrences. Hospital costs were also analyzed.

RESULTS

There were no differences between the two groups in terms of age and history, although the defects of the patients in the laparoscopic group were smaller. Mean operating time, postoperative morbidity, mean hospital stay, consumption of analgesics, and time to return to normal activities were significantly lower in the laparoscopic group (p < 0. 01). No were there any statistical differences between the two types of surgical procedure in terms of hospital costs. However, the final cost did show differences when expenses for readmissions and recurrences were taken into account (p < 0.01).

CONCLUSION

The laparoscopic approach to secondary lumbar hernia repair is more efficient and more profitable than the traditional open technique.

The diagnostic interpretation of basophil activation test in immediate allergic reactions to betalactams

BACKGROUND

Basophil activation by allergens, including drugs, has been used to determine sensitivity and to study IgE recognition and cross-reactivity.

OBJECTIVE

We sought to determine the sensitivity and specificity of a basophil activation test (Basotest) in patients with immediate allergic reactions to betalactams, with a later comparison between patients who were selective (those recognizing the culprit drug excluding benzylpenicillin (BP)) and cross-reactors (those recognizing several penicillin determinants including BP).

METHODS

Basotest to different haptens was performed in 70 patients with immediate allergic reactions to betalactams, classified into three groups: (A) skin test positive independently of CAP/RAST immunoassay value, (B) skin test negative and CAP/RAST positive, and (C) skin test and CAP/RAST negative but drug provocation test positive. Basotest was carried out by flow cytometry following the manufacturer's instructions using different betalactam determinants and results expressed as a stimulation index.

RESULTS

Of the 70 patients, 34 (48.6%) were positive to Basotest (sensitivity: 48.6%), 31 (44.3%) to CAP/RAST and 46 (65.7%) to either one or the other. Considering the different groups, Basotest was positive in 50.9% of patients in Group A, 60% in Group B and 14.3% in Group C. The specificity was 91.3%. Positivity to the haptens was 28.6% to amoxicillin (AX), 21.7% to BP, 20% to benzylpenicilloyl-poly-l-lysine, 12.5% to ampicillin and 2.2% to minor determinant mixture. In patients with cephalosporin reactions, Basotest to the culprit cephalosporin was positive in 77.7%. There were differences between the two reactor groups in the sensitivity of Basotest (selective to AX=50%, cross-reactors=28.6%; chi(2)=10.809, P=0.004) and in the CAP/RAST (selective to AX=28.6%, cross-reactors=61.9%; chi(2)=8.944, P=0.011).

CONCLUSIONS

The sensitivity of Basotest is similar to immunoassays (CAP/RAST). Sensitivity is improved when used in combination. Although further studies are required, Basotest results for cephalosporin allergy seem very promising. This technique does not help differentiate between selective reactors and cross-reactors.

EEG and behavioral changes following neurofeedback treatment in learning disabled children

Neurofeedback (NFB) is an operant conditioning procedure, by which the subject learns to control his/her EEG activity. On one hand, Learning Disabled (LD) children have higher values of theta EEG absolute and relative power than normal children, and on the other hand, it has been shown that minimum alpha absolute power is necessary for adequate performance. Ten LD children were selected with higher than normal ratios of theta to alpha absolute power (theta/alpha). The Test Of Variables of Attention (TOVA) was applied. Children were divided into two groups in order to maintain similar IQ values, TOVA values, socioeconomical status, and gender for each group. In the experimental group, NFB was applied in the region with highest ratio, triggering a sound each time the ratio fell below a threshold value. Noncontingent reinforcement was given to the other group. Twenty half-hour sessions were applied, at a rate of 2 per week. At the end of the 20 sessions, TOVA, WISC and EEG were obtained. There was significant improvement in WISC performance in the experimental group that was not observed in the control group. EEG absolute power decreased in delta, theta, alpha and beta bands in the experimental group. Control children only showed a decrease in relative power in the delta band. All changes observed in the experimental group and not observed in the control group indicate better cognitive performance and the presence of greater EEG maturation in the experimental group, which suggests that changes were due not only to development but also to NFB treatment.

EEG development in children with sociocultural disadvantages: a follow-up study

OBJECTIVE

The purpose of this work was to find a possible relation between psychosocial risk and any lag or alteration in CNS maturation in a group of children growing up in an economically, socially and culturally disadvantageous environment in a developing country.

METHODS

A 6 year prospective study of 42 pre-school children, growing and living under psychosocial and economic impediments, is presented. EEGs were previously recorded at different ages: 18-30 months (Int J Neurosci 79 (1994) 213), 4 years (Electroenceph clin Neurophysiol 102 (1997) 512), and 5 and 6 years (this study). The EEG developmental patterns between high- and low-risk children (HRC/LRC) are compared.

RESULTS

The EEG pattern in HRC showed higher delta and theta absolute power (AP) and relative power (RP) values in frontal leads, and less alpha AP and RP in posterior leads. The qEEG differences between HRC and LRC diminished with age, although differences in frontal theta and occipital/left temporal alpha bands persisted at 6 years.

CONCLUSIONS

We conclude that an inadequate or insufficient environmental stimulation is a major contributing factor of the developmental lag in HRC brain maturation.

SIGNIFICANCE

This is one of the very few longitudinal studies that address the issue of relating sociocultural risk to EEG maturation.

Cross-reactivity of human and bovine antibodies in striped dolphin paraffin wax-embedded tissues

This study evaluates the cross-reactivity of seven anti-human and one anti-bovine antibodies in formalin-fixed, paraffin-embedded tissue samples of liver and mesenteric lymph nodes of 13 striped dolphins (Stenella coeruleoalba). Four antibodies (CD3, IgG, lysozyme and S100 protein) reacted with striped dolphin lymph nodes in a similar pattern to that observed in the species of origin. The anti-human MHC class II mAb reacted strongly with macrophages and dendritic-like cells of striped dolphins, whereas a small number of lymphocytes were labelled with this antibody. These antibodies were used to study the immunophenotype of the inflammatory infiltrated in non-specific chronic reactive hepatitis (eight cases) and chronic parasite cholangitis (two cases) and normal liver (three cases) of striped dolphins. Non-specific chronic reactive hepatitis was composed of inflammatory infiltration of CD3+ T lymphocytes and IgG+ plasma cells in portal spaces and hepatic sinusoids. Lymphonodular aggregates observed in chronic parasitic cholangitis showed a cellular distribution similar to that found in lymph node cortex, including the presence of S100+ and MHC class II+ dendritic-like cells in lymphoid follicles and interfollicular areas. This result suggests that those inflammatory infiltrates are highly organised to enhance antigen presentation to B and T cells.

Immunophenotypic characterization of hepatic inflammatory cell infiltrates in common dolphins (Delphinus delphis)

Of 14 common dolphins, 12 showed non-specific reactive hepatitis and three chronic parasitic cholangitis with lymphoid proliferation. Non-specific reactive hepatitis was shown immunohistochemically to be associated with small clusters of CD3(+) cells in portal areas and hepatic sinusoids. Polyclonal antibody against S100 protein reacted with a variable number of lymphocytes from portal areas and hepatic sinusoids, as well as with Kupffer cells and epithelial cells of the bile ducts. The majority of plasma cells observed in portal areas and hepatic sinusoids were IgG(+). In lymphonodular lesions of chronic parasitic cholangitis, the distribution of immunoreactive cells was similar to that found in the cortex of lymph nodes. The presence of stellate cells similar to follicular dendritic and interdigitating cells expressing S-100 protein and MHC class II antigen in lymphonodular lesions suggested that these were highly organized structures developed to enhance antigen presentation to B and T cells.

Immunobiological features of the galactoside lectin L-Lc isolated from the Argentine mistletoe Ligaria cuneifolia

Ligaria cuneifolia has been used in Argentine folk medicine and is currently employed as substitute for the European mistletoe (Viscum album) as hypotensor agent. Extracts from V. album are widely used in cancer therapy and the antineoplasic effect is attributed to their cytostatic/cytotoxic and immunomodulatory actions. When studying immunomodulatory effects of L. cuneifolia extracts (Lc extracts), they inhibited proliferation of murine mitogen-activated lymphocytes, leukaemic lymphocytes (LB) and breast tumour cells (MMT). The aim of this work was to isolate and identify lectins from Lc extracts and investigate their immunobiological actions. A galactoside lectin (L-Lc) of 57 kDa was isolated. A polyclonal antiserum obtained against Lc extract recognised both L-Lc and MLI (V. album lectin), suggesting the possibility of shared epitopes. Treatment of LB tumour cells with L-Lc (0.01 and 0.1 microg/ml) produced up to 40.0+/-6.9% inhibition of cell growth, which seems partly mediated by apoptosis (apoptosis of L-Lc treated cells 58.4+/-10.3% versus non-treated cells 38.1+/-8.8%; P<0.05), analysed by acridine orange and ethidium bromide staining. Inhibitory effect on ConA stimulated splenocyte growth was non-significant, while a mitogenic effect was observed on normal murine splenocytes and MMT cells. L-Lc in non-cytotoxic concentrations (250 ng/ml) modified mRNA expression of IL-10 but neither that of TGF-beta nor of IL-2 produced by LB cells. In addition, 43.9+/-0.5% reduction in NO production by LPS-stimulated murine macrophages was found. Finally, survival rates of LB tumour-bearing mice treated or not with Lc extract or L-Lc failed to show significant differences.

["Household items" : an alternative task to "animals" in the assessment of semantic verbal fluency: a validation study]

INTRODUCTION

The semantic verbal fluency (SVF) is usually evaluated with the task animals in 1 minute . This is a test widely applied in the screening of cognitive impairment. In our best knowledge there are not other alternatives categories for this task validated in our environment (Spanish as mother tongue, Spain).

OBJECTIVE

To validate the category households items as an alternative parallel task to animals in the assessment of SVF.

PATIENTS AND METHODS

Prospective assessment of two categories (animals and household items) in two groups: normal controls and patients with Alzheimer s disease (AD).

RESULTS

CONTROL GROUP

n= 22 (13 M, 9 W); age: 73 5 years, education: 12 5 years; MMSE MEC 35: 30 4; Animals : 15 4. Percentile distribution 10th: 11; 50th: 15; 90th: 20; household items : 17 4. Percentile distribution: 10th: 12; 50th: 17; 90th: 22. AD group: n= 24 (9 M, 15 W); age: 74 5 years; education: 11 5 years; MMSE MEC 35: 17 8; Animals : 6 3. Percentile distribution: 10th: 2; 50th: 6; 90th: 9; household items : 6 4. Percentile distribution: 10th: 1; 50th: 6; 90th: 11. It is observed a positive correlation between the two categories (Spearman s Rho: 0.83, p< 0.0001).

CONCLUSIONS

Both SVF categories had a similar distribution and a high correlation. This findings demonstrated the validity of the household items as an alternative and parallel form to animals in the assessment of SVF in patients with cognitive impairment or dementia.

Immunomodulating properties of Argentine plants with ethnomedicinal use

Five Argentine medicinal plants selected according to folk traditional or ethnomedical use, references and primary pharmacological screening; were chosen to elucidate their immunomodulating properties. Dichloromethane, methanolic and aqueous extracts of the aerial parts of Achyrocline flaccida (A. flaccida), Eupatorium arnottianum (E. arnottianum) and Eupatorioum buniifolium (E. buniifolium), leaves of Lithraea molleoides (L. molleoides) and leaves and stems of Phyllanthus sellowianus (P. sellowianus) were analyzed to disclose their effects on murine normal and tumor cell growth as well as on complement hemolytic activity. Modulation of cell growth was evaluated by tritiated thymidine incorporation while inhibition of complement activity was measured on both classical and alternative complement pathways (CP and AP respectively). The results obtained show that most of the extracts exerted inhibitory effect on tumor as well as on mitogen activated normal spleen cell growth. On tumor cells, IC50 ranged between 1-75 microg/ml for most of the extracts with the exception of dichloromethane of L. molleoides and P. sellowianus which required concentrations higher than 100 microg/ml to produce the effect. On mitogenic activated splenocytes, IC50 ranged between < 1 to 85 microg/ml with the exception of methanolic extract of E. buniifolium or P. sellowianus which were not effective on ConA or LPS stimulated splenocytes respectively. Only E. buniifolium was active on murine normal splenocytes proliferation (IC50 0.5-1.5 microg/ml). Finally, one (7%) of 15 extracts showed inhibition of complement activity on CP and 6 extracts (40%) presented moderate activity on CP. The dichloromethane extract of E. arnottianum was the most active (IC50 5 microg/ml), although remarkable effect was also obtained with dichloromethane and methanolic extracts of P. sellowianus (IC50 11.2 and 17.3 microg/ml respectively). Besides, 2 extracts (13%), dichloromethane extract of E. arnottianum and aqueous extract of P. sellowianus, showed moderate inhibition on AP.

Broad band spectral measurements of EEG during emotional tasks

Broad band spectral measurements were calculated on EEG recordings of 40 healthy male university students during emotional tasks using the emotion induction technique. Emotional stimuli were sentences with positive valence (joy of love), with negative valence (frustration) and neutral situation. Broad band measurements showed that delta and beta bands reflected better the differences by emotional state. Hemispheric differences associated to emotional states were obtained only for mean frequency data. Higher delta frequencies at left frontopolar, right frontal, parietal and temporal and higher beta frequencies at left frontotemporal and temporal were related to love. Meanwhile higher delta frequencies especially at left frontopolar and temporal regions and lower beta frequencies at midline frontal (Fz) and central (Cz) leads were associated to frustration. These findings suggest that narrow band measurements may reflect more efficiently EEG changes during emotional tasks.

Cerebral blood flow and sources of abnormal EEG activity (VARETA) in neurocysticercosis

OBJECTIVES

To compare two different functional procedures in the assessment of brain ischemia in patients with neurocysticercosis (NCC): (1) electroencephalography (EEG) evaluated by brain maps and EEG current sources in the frequency domain using variable resolution electromagnetic tomography and (2) blood flow analyzed by computerized tomography assessed with stable Xe (Xe-CT).

METHODS

Eleven patients with NCC at different evolution stages were studied. CT and Xe-CT scans, as well as quantitative electroencephalography with source calculation in the frequency domain, were obtained. All patients showed cysts and in 6 of them there were also vascular complications: two of them presented calcifications of the middle cerebral artery, two other subjects showed calcifications of the vessels in the circle of Willis and the remaining two had brain infarctions.

RESULTS

In the cyst areas important hypoperfused zones were observed, as intense as those observed in infarcted areas. Damage to the blood-brain barrier was originated by parasites in colloidal phase (final cysticerci stage) producing large areas of edema and hypoperfusion. Abnormal delta EEG activity was observed in very large lesions, probably generated by partial cortical deafferentation; and abnormal theta activity was mainly related to the presence of edema.

CONCLUSIONS

Sources of abnormal EEG activity were very similar in topography to the hypoperfused areas.

Intracranial metastases from an ovarian dysgerminoma in a 2-year-old dog

A 2-year-old, intact female rottweiler was presented for signs of lethargy. A mass was ultrasonographically observed, cranial and lateral to the left kidney. Exploratory laparotomy revealed a mass in the left ovary that was diagnosed histopathologically as an ovarian dysgerminoma. Two weeks after surgery, the dog was readmitted with signs of peripheral vestibular disease that progressed to central vestibular disease. Magnetic resonance imaging of the brain revealed the presence of a mass in the caudal fossa. The histopathological diagnosis of the mass was metastases from the ovarian dysgerminoma.

[Working memory and complex activities of everyday life in the initial stages of Alzheimer's disease]

INTRODUCTION

Evaluation of the working memory (WM) permits analysis of the degree of anterograde amnesia and fixation deficit present in patients with Alzheimer s disease (AD). Complex activities of everyday life (AEL) are also affected early. There is a close relation between the degree of cognitive deterioration and loss of functional competence in AEL.

OBJECTIVE

To analyze the degree of memory loss and performance in carrying out complex AEL in patients with AD and mild cognitive disorder.

PATIENTS AND METHODS

Evaluation of functional disorder, using Pfeffer s functional activity questionnaire (FAQ), and cognitive evaluation, using the WM examination protocol in a group of 36 patients.

RESULTS

In the total MT (4.2+/-5.7) there were significant differences between patients with age associated memory impairment (AAMI) (11+/-7) and possible EA (3.2+/-4.6) and between AAMI and probable AD (2.8+/-4.8). The functional evaluation of the AEL (FAQ) gave a mean of 8.5+/-7.1. There were significant differences between probable AD (11+/-8) and possible EA (6+/-4) with the group AAMI 1+/-1.8. There was significant correlation between FAQ and total WM ( 0.70, p= 0.0001). It was found that patients with high FAQ scores had lower total WM scores.

CONCLUSION

FAQ and WM have high correlation and are useful instruments for the evaluation of patients with cognitive deterioration at the initial stages.

EEG changes during word and figure categorization

OBJECTIVE

To analyze whether the EEG changes observed during figure and word categorization are compatible with either the dual, the common amodal, or the alternative model (modality-specific codes for words and pictures, where meaning is represented for both in a higher-order amodal system) for semantic knowledge.

METHODS

EEG was recorded during word and figure categorization of animals or non-animals in a group of 28 children 8-10 years old. Computation of EEG sources in the frequency domain using variable resolution electrical tomography (VARETA) and their statistical evaluation by statistical parametric mapping were carried out.

RESULTS

At all frequencies, there were significant changes between EEG segments prior to the presentation of the stimuli and EEG segments recorded after the stimuli. Post-segments showed more power from 1.56 to 7.02 Hz, and less power than pre-segments from 8 to 12.48 Hz. EEG changes were only observed in the word task at: 3.9 (left occipital), 4.68, 5.46, and 6.24 Hz (temporo-occipital regions). These changes may be associated with visual encoding of words. Frequencies 7.8 and 17.94 Hz increased in prefrontal, anterior cingulate, and anterior temporal regions only during figure categorization. The prefrontal region may be related to object working memory. Thus, these frequencies might be related to figure codification. No significant differences between tasks were observed at 3.12 and 7.02 Hz in very wide brain areas (all lobes except occipital), suggesting that the amodal semantic system storage could be the model compatible with figure and word categorization.

CONCLUSIONS

Thus, our results support the modified amodal semantic hypothesis, which advocates that the meanings of both kinds of stimuli are represented in a conceptual memory that receives input from the logogen and iconogen systems.

Delayed P300 during Sternberg and color discrimination tasks in poor readers

The P300 ERP component was studied in poor and normal readers, using Sternberg and color discrimination (Spaceships) tasks. During the first one, subjects must decide if a probe item belongs or not to a set of digits previously presented. In the second one, the participants must shoot violet spaceships with one key and other than violet spaceships with another key. There were no significant differences between groups with respect to reaction times, but a larger proportion of errors was observed in poor readers. Longer P300 latencies were recorded for poor readers than controls in both tasks. P300 amplitudes showed topographical differences between the two groups: Poor readers' P300 is larger frontally during the Sternberg task, but smaller at posterior sites during the Spaceships task. These results suggest that poor readers may have deficiencies during the early processing stage, such as visual stimulus evaluation. Poor readers also appear to have deficits for classifying and memorizing visual stimuli.

Sources of abnormal EEG activity in brain infarctions

EEGs from 16 patients with stroke in three different stages of evolution were recorded. EEG sources were calculated every 0.39 Hz by frequency domain VARETA. The main source was within the delta band in 2 out of 4 chronic patients, and in 67% of the patients in the acute or subacute stages when edema (cytotoxic or vasogenic) was present. Moreover, all patients showed abnormal activity in the theta band. Sources of abnormal activity in cortical or corticosubcortical infarcts were located in the cortex, surrounding the lesion. At the site of the infarct, a decrease of EEG power was observed. Sources of abnormal theta power coincided with edema and/or ischemic penumbra.

Specific EEG frequencies at specific brain areas and performance

In this study it was shown that in adults, the frequency characteristics of EEG preceding stimuli that were followed by incorrect responses were different from the characteristics of EEG preceding stimuli that were followed by correct responses. In the recording during three different tasks that explore different neuronal networks, higher values of current preceding incorrect performance in those areas directly related to the task were found in frequencies within the delta (1.56 and 3.12 Hz) and beta bands (13.26, 14.04, 14.82, 15.6, 17.16 and 17.94 Hz), suggesting that these frequencies signal inhibition. Frequencies within the alpha band (9.36 and 12.48 Hz) showed greater energy preceding correct responses in task-specific areas, supporting previous results observed in children.

Auditory event-related potentials in poor readers

Although poor readers (PR) are considered the major group among reading-disabled children, there are not event-related potentials (ERP) studies reported of PR on the subject. In this study, attentional and memory processes were studied in an auditory oddball task in PR and normal controls. ERP to auditory stimuli were recorded in 19 leads of the 10/20 system, using linked earlobes as references, in 20 normal children (10 female) and 20 PR (10 female) of the same age (10-12 years old). Two pure tones (1000 and 3000 Hz) were used in an oddball paradigm. No significant differences were observed in the amplitudes and latencies of N100 between the groups. However, N200 to frequent stimuli and P200 to both frequent and infrequent stimuli were of higher amplitude in poor readers than in normal children. There were no differences between groups in the latency and amplitude of P300. The results suggest that PR use more attentional resources in the components occurring before P300 to both frequent and infrequent stimuli than the normal children, and this finding is particularly marked for PR girls.

Primary task demands modulate P3a amplitude

Auditory event-related brain potentials (ERPs) were recorded from 10 subjects in two different conditions: (1) subjects were required to reorder five visually presented letters in order to form a word and provide a verbal response (task condition); (2) subjects were presented with a control stimulus with the same physical characteristics as the experimental stimulus, but containing just one type of letter (i.e., AAAAA). Subjects had to verbally respond to such stimuli by saying "A" (control condition). Tones of 1000 Hz (standard) and 1050 Hz (deviant) were also presented to the subjects in a 85%-15% probability paradigm 2 s before, during and 8 s after the presentation of the visual stimuli. Recordings were obtained from Fpz, Fz, Cz and Pz vs. linked ears. Auditory ERPs to the auditory stimuli after the presentation of the visual letter string and during the performance of the task were averaged for the standard and deviant tones in both conditions. Only correct responses were considered for the averages. The N100 was affected by stimulus type (standard vs. deviant) but not by condition (task vs. control); however, larger P3a waves were observed during the control than during the task condition. No significant differences between conditions were observed in the mismatch negativity (MMN) latency range. These results suggest that primary task demands modulate involuntary attention processing.

[The assessment of working memory by Mini-Mental State Examination]

INTRODUCTION

Delayed recall items of the Mini-Mental State Examination (MMSE) and the Mini Cognitive Examination are based on a simultaneous processing of the storage of the material to be remembered while other test's items are executed. This function is probably mediated by the working memory (WM) system.

OBJECTIVE

A new protocol of WM assessment during the Mini Cognitive Examination application is presented.

PATIENTS AND METHODS

The standard Mini Cognitive Examination is modified with two new items of registration and recall. Criteria to introduce three new words in registration 2 and 3 is a complete recall of the three previous words. The score of the three recall trials, until a 27 points maximum, represents WM. A sample of 44 patients with probable Alzheimer's disease (AD), 19 with possible AD, 39 patients with cognitive impairment without dementia and 14 control subjects were evaluated.

RESULTS

Patients with probable AD and possible AD showed the minimum WM scores and the greatest percentage of words repetitions (WM 3.2 +/- 3.6 and 7 +/- 6, with 91 and 83% of repetitions, respectively); control subjects scored a WM of 22 +/- 6 with 14% of repetitions; patients with cognitive impairment without dementia scored a WM of 11 +/- 4 and 50% of repetitions.

CONCLUSIONS

We propose that delayed recall items of the MMSE and the Mini Cognitive Examination are an index of WM capacity. This new method reinforces the assessment of delayed recall during Mini Cognitive Examination or MMSE application, and can facilitate an early detection of anterograde amnesia.