Where there's smoke, there's fire : the brain reactivity of chronic smokers to anti-smoking stimuli

Contexte: Plusieurs études ont démontré que les indices environnementaux associés à la cigarette peuvent provoquer des envies de consommer (« cravings ») chez les fumeurs, ce qui nuit aux efforts d’abandon de la substance et favorise le maintien du tabagisme. Un bon nombre d’études en imagerie cérébrale ont examiné les bases neurophysiologiques de cette caractéristique clinique. Le tabagisme se caractérise aussi par l’incapacité des représentations négatives de la consommation (méfaits médicaux et sociaux) d’influencer la consommation des fumeurs. Étonnamment toutefois, très peu de travaux de recherche se sont intéressés à examiner les bases neurophysiologiques de cette insouciance envers les méfaits de la cigarette chez les fumeurs. En utilisant l'imagerie cérébrale fonctionnelle, l'objectif de cette étude était: d’examiner la réponse neurophysiologique des fumeurs chroniques à des images qui illustrent les effets négatifs de la cigarette (campagne anti-tabac); d’examiner le caractère affectif de cette réactivité utilisant des conditions contrôles (c.-à-d., images aversives non-liées au tabac et appétitives liées au tabac); d'examiner la connectivité fonctionnelle durant cette tâche entre les systèmes affectifs et exécutifs (une interaction qui peut favoriser ou entraver l'impact des évènements aversifs). Méthodes: 30 fumeurs chroniques ont passé une session de neuroimagerie durant laquelle ils devaient regarder des images appétitives et aversives de cigarettes, des images aversives non-reliées au tabac et des images neutres. Résultats: Les images aversives liés au tabagisme suscitent une plus grande activation dans le cortex médial préfrontal, l'amygdale, le gyrus frontal inférieur et le cortex orbitofrontal latéral en comparaison avec les images neutres, mais une moins grande activation dans des structures médiaux / sous-corticales comparé aux images aversives non-reliés et images appétitives reliées aux tabac. L’activité du système exécutif présente une connectivité fonctionnelle négative avec le système affectif lorsque les images aversives sont liées au tabac, mais pas quand elles ne le sont pas. Conclusions: Le modèle d'activation du cerveau observé suggère qu’il y a un biais dans la réactivité des fumeurs chroniques lorsqu’ils observent des représentations négatives de la consommation du tabac. L’activité du système exécutif cérébral semble promouvoir chez les fumeurs une baisse d’activité dans des régions impliquées dans la genèse d’une réponse physiologique affective; il s’agit d’un mécanisme qui permettrait de réduire l’impact persuasif de ces représentations des méfaits de la cigarette sur la consommation des fumeurs.

Efectividad de la ketamina en depresión bipolar: revisión sistemática de la literatura

Introducción: Aunque el hallazgo clínico más distintivo del Trastorno Afectivo Bipolar es el ánimo patológicamente elevado, este no suele ser el estado de ánimo prevalente de la enfermedad. La fase depresiva del trastorno o depresión bipolar es más crónica, conlleva a un mayor deterioro de la funcionalidad y representa un reto terapéutico habitual. En la actualidad, el manejo farmacológico de la depresión bipolar suele consistir en combinaciones de al menos dos medicamentos distintos, incluyendo estabilizadores del afecto (litio y anticonvulsivantes), antipsicóticos atípicos y antidepresivos. El objetivo central de este trabajo es evaluar la efectividad de la Ketamina en la depresión bipolar. Métodos: Revisión sistemática de la literatura de artículos que proporcionen información sobre la eficacia de la Ketamina en la fase depresiva del Trastorno Bipolar. Resultados: De los 147 artículos arrojados por la búsqueda, dos cumplieron los criterios de selección (n=33). En comparación con placebo, ketamina tiene un efecto antidepresivo rápido y duradero, incluso en pacientes que han recibido más de 3 medicamentos previamente. No se reportaron efectos adversos severos durante los estudios. Discusión. La evidencia actual apunta a que la ketamina es útil para el manejo de la depresión bipolar, incluso cuando es resistente al tratamiento, es segura y puede tener cierto efecto antisuicida. Es necesario ampliar la evidencia existente.

Caracterización del trauma vascular periférico del hospital de Kennedy

Introducción: El trauma vascular en nuestro país es común, causando mortalidad en la población entre 15-44 años; como causa principal, las heridas por arma corto punzante en los miembros superiores lideran sobre las de arma de fuego y los miembros inferiores. En Colombia se cuenta con algunos registros de trauma vascular secundario a la guerra, por lo que con este trabajo buscamos describir la población afectada de la localidad octava como punto inicial para estudios analíticos. Metodología: revisión de la base de datos de los pacientes llevados a cirugía en el hospital de Kennedy, de los cuales se extrajeron aquellos con trauma vascular, recolección de las variables a estudiar y análisis de las mismas. Resultados: encontramos 1267 pacientes que consultaron por trauma, de ellos 32 cursaron con trauma vascular, llevados a cirugía(0,3%), el promedio de edad fue de 24 años, la mayoría de sexo masculino (84%); el 72% fueron heridas por arma blanca, 56% fueron heridas múltiples, afectando en el 41% a las extremidades superiores; las lesiones en cuello casi igualan a las heridas en miembros inferiores con un 28%, solo se presentó un caso de amputación y no se presentaron mortalidades. Discusión: en Colombia hacen falta estudios acerca de esta patología que aunque común esta subpublicada, este estudio es tan solo un paso que nos introduce en las características demográficas, y algunas característica clínicas interesantes en comparación a la literatura mundial consultada

Empirical mode decomposition: a novel technique for the study of tremor time series

Tremor is a clinical feature characterized by oscillations of a part of the body. The detection and study of tremor is an important step in investigations seeking to explain underlying control strategies of the central nervous system under natural (or physiological) and pathological conditions. It is well established that tremorous activity is composed of deterministic and stochastic components. For this reason, the use of digital signal processing techniques (DSP) which take into account the nonlinearity and nonstationarity of such signals may bring new information into the signal analysis which is often obscured by traditional linear techniques (e.g. Fourier analysis). In this context, this paper introduces the application of the empirical mode decomposition (EMD) and Hilbert spectrum (HS), which are relatively new DSP techniques for the analysis of nonlinear and nonstationary time-series, for the study of tremor. Our results, obtained from the analysis of experimental signals collected from 31 patients with different neurological conditions, showed that the EMD could automatically decompose acquired signals into basic components, called intrinsic mode functions (IMFs), representing tremorous and voluntary activity. The identification of a physical meaning for IMFs in the context of tremor analysis suggests an alternative and new way of detecting tremorous activity. These results may be relevant for those applications requiring automatic detection of tremor. Furthermore, the energy of IMFs was visualized as a function of time and frequency by means of the HS. This analysis showed that the variation of energy of tremorous and voluntary activity could be distinguished and characterized on the HS. Such results may be relevant for those applications aiming to identify neurological disorders. In general, both the HS and EMD demonstrated to be very useful to perform objective analysis of any kind of tremor and can therefore be potentially used to perform functional assessment.

Auriculo-condylar syndrome: mapping of a first locus and evidence for genetic heterogeneity

Auriculo-condylar syndrome (ACS), an autosomal dominant disorder of first and second pharyngeal arches, is characterized by malformed ears (`question mark ears`), prominent cheeks, microstomia, abnormal temporomandibular joint, and mandibular condyle hypoplasia. Penetrance seems to be complete, but there is high inter-and intra-familial phenotypic variation, with no evidence of genetic heterogeneity. We herein describe a new multigeneration family with 11 affected individuals (F1), in whom we confirm intra-familial clinical variability. Facial asymmetry, a clinical feature not highlighted in other ACS reports, was highly prevalent among the patients reported here. The gene responsible for ACS is still unknown and its identification will certainly contribute to the understanding of human craniofacial development. No chromosomal rearrangements have been associated with ACS, thus mapping and positional cloning is the best approach to identify this disease gene. To map the ACS gene, we conducted linkage analysis in two large ACS families, F1 and F2 (F2; reported elsewhere). Through segregation analysis, we first excluded three known loci associated with disorders of first and second pharyngeal arches (Treacher Collins syndrome, oculo-auriculo-vertebral spectrum, and Townes-Brocks syndrome). Next, we performed a wide genome search and we observed evidence of linkage to 1p21.1-q23.3 in F2 (LOD max 3.01 at theta = 0). Interestingly, this locus was not linked to the phenotype segregating in F1. Therefore, our results led to the mapping of a first locus of ACS (ACS1) and also showed evidence for genetic heterogeneity, suggesting that there are at least two loci responsible for this phenotype.

Increased positive thought disorder with illness duration in patients with schizophrenia

It is unclear whether the severity of positive formal thought disorder, a core clinical feature of schizophrenia, is stable or worsening through the chronic course of the illness. The neurocognitive basis for positive thought disorder also remains unclear. The aim of the present paper was to examine the relationship between thought disorder as measured by the Thought Disorder Index (TDI) and duration of illness and neuropsychological indices in 79 patients with schizophrenia. TDI scores increased in proportion to illness duration. TDI scores were not associated with verbal memory or executive functioning. These results indicate an ongoing worsening of positive thought disorder through the course of illness in schizophrenia.

Conjunctival keratoacanthoma

Keratoacanthoma is a rapidly growing skin neoplasia that may stabilize or regress spontaneously. We describe here a case of conjunctival keratoacanthoma and comment about the clinical signs and symptoms and pathological findings.

Compression of the peripheral branches of the sciatic nerve by lipoma

The authors report two female patients with chronic sensitive and motor findings in lower limbs caused by compression of distal branches of sciatic nerve by lipoma. Similar eases were not described on literature. Nerve conduction studies allowed to localize the exact site of compression. At surgery, lipomas compressing the deep peroneal nerve (case 1) and the posterior tibial nerve (case 2) were observed. Histologic studies of tumors confirmed the diagnoses.

Metacarpophalangeal pattern profile in Marfan syndrome and Marfan-like patients

Marfan syndrome (MFS) is an autosomal dominant trait due to mutations in the fibrillin gene (FBN1). The MFS expressivity is variable, and its diagnosis relies completely on clinical criteria. Atypical cases and Marfan- like (marfanoid) clinical presentations are commonly found. The metacarpophalangeal pattern profile (MCPP), a radiological method in which the 19 tubular hand bones are assessed, has been used in the diagnosis of various syndromes. To investigate whether the MCPP was adequate to discriminate between MFS and Marfan-like subjects, we studied 38 patients who were referred to our service because they had an MFS diagnosis, diagnostic hypothesis, or differential diagnosis or had arachnodactyly with dolichostenomelia. Two groups were formed: 1) MFS: 21 patients with a mean age of 18.3 (10.8 S.D.) years and 2) Marfan-like syndromes: 16 patients who did not meet the current criteria, with a mean age of 14.6 (4.6 S.D.) years. The MCPP was performed in each case following the classical technique, and a characteristic mean profile was obtained for group I (MFS), with Z scores ranging from 0.69 to 2.73 (1.80 ± 0.50; mean ± S.D.). In group I, three cases had no correlation with the typical MFS pattern. In group II, three cases had an MFS pattern. The correlation with the mean MCPP of MFS permitted the differential diagnosis of MFS and marfanoid syndromes with 86% sensitivity, 81% specificity, and 86% positive and 81% negative predictive values. The results suggest that MCPP can be used effectively as an auxiliary tool in the nosology of these conditions and, because there is no change in MCPP with age, can be helpful in early diagnosis.

Rinolitiase: Atualizacao e relato de caso

Rhinoliths are rares and, in general, develop in response to foreign body lodged in the nose. This study briefly comments the clinics features of one case of rhinolithiasis that occurred during two years period. The etiology of rinoliths, differencial diagnosis and a review of the literature are also included. The authors concluded that the presence of calcified stones must be considered in cases of sinusitis or rhinitis not responding to medical therapy.

Human sporotrichosis: Transmitted by feline

The authors present two cases of human sporotrichosis, the lymphangitic and the fixed cutaneous form, observed in the owners of an infected domestic cat. Feline sporotrichosis has been related with higher frequency and shows zoonotic significance due to inter and intraspecies transmission risk. This is thought to occur as consequence of the high number of fungi in cutaneous lesions of this animal species.

Clonal chromosome abnormalities found in three non-neoplastic proliferative brain lesions

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Cytologic diagnosis of vaginal metastasis from renal cell carcinoma: A case report

BACKGROUND: Metastasis of renal cell carcinoma to the vagina is rare, although it may be the first evidence of the existence of the primary tumor. CASE: A metastatic deposit of renal cell carcinoma in the vagina was diagnosed by cytology as clear cell adenocarcinoma, which was confirmed by biopsy. Radiographic and ultrasound examinations confirmed the renal site of origin, which was corroborated by immunohistochemistry of the biopsy specimen. CONCLUSION: When a cytologic diagnosis of vaginal clear cell adenocarcinoma is made, metastasis of renal cell carcinoma should be considered in the differential diagnosis.

Optic neuropathy in sheep associated with overdosage of closantel

This report describes clinical and pathological findings in 2 flocks in Brazil where blindness and deaths in sheep occurred after closantel overdosage. Depression, weakness, and blindness affected 37 animals and 17 died in 2 flocks of 190 animals. Two animals submitted for ophthalmic examination showed no inflammation in the anterior segment of both eyes; posterior segment evaluation by indirect ophthalmoscopy suggested retinal degeneration. One postmortem evaluation local spongy vacuolization was in several regions of the brain and the optical nerves had severe axonal degeneration.