bluuebunny/crossref_metadata_2025 huggingface dataset:
Acoustical Design and Noise Control in Metro Stations: Case Studies of the Ankara Metro System
Authors: Sü Zühre , Çalışkan Mehmet
Published: September 2007

The aim of this research is to demonstrate the importance of initial strategies in acoustical design of underground metro stations. The paper searches for practical design solutions by evaluating different materials for providing optimum acoustical conditions in such spaces. Acoustical designs of three metro stations on a new expansion line in Ankara including Sogutozu, Bilkent and ODTU metro stations are presented through computer simulation. Predictions of room acoustical parameters are presented for both platform and ticket office floors in terms of parameters like reverberation time (RT), speech transmission index (STI) and A-weighted sound level (SPL) distribution within spaces. Simulated reverberation times are evaluated in view of legislative requirements. The study confirms the importance of using sound absorbing materials on the ceiling and sidewalls together. The nonwoven material, used behind perforated metal suspended ceilings, has proved effective in reverberation control.
Optimum Reverberation for Speech Intelligibility for Normal and Hearing-Impaired Listeners in Realistic Classrooms Using Auralization
Authors: Yang Wonyoung , Hodgson Murray
Published: September 2007

The objective of this study was to use auralization techniques to investigate the optimal reverberation for speech intelligibility for normal-hearing and hearing-impaired adult listeners in classrooms with non-diffuse sound fields. This extended a previous study involving rooms with diffuse sound fields to more realistic rooms. Modified Rhyme Test (MRT) signals were auralized in six virtual classroom configurations with different reverberation times. Each classroom contained a speech source, a listener at a receiver position, and a noise source located between the talker and the listener. Two speech- and noise-source output-level differences (0 and +4 dB) were tested. Subjects performed speech-intelligibility tests in the virtual classrooms to identify the reverberation time that gave the best results in each case. For both normal and hearing-impaired listeners, the optimal reverberation time was generally non-zero, and increased with decreased speech-to-noise level difference. Hearing-impaired subjects apparently required more early energy than normal-hearing subjects. The optimal reverberation time for speech intelligibility in classrooms is not necessarily zero, as is commonly believed. The optimal value is generally non-zero, and varies with the room, the locations of the speech and noise sources and the listener, and the noise level.
A five-year radiostereometric follow-up of the Birmingham Hip Resurfacing arthroplasty
Authors: Itayem R. , Arndt A. , McMinn D. J. W. , Daniel J. , Lundberg A.
Published: September 2007

The early designs of hip resurfacing implants suffered high rates of early failure, making it impossible to obtain valuable mid-term radiostereophotogrammetric (RSA) results. The metal-on-metal Birmingham Hip Resurfacing arthroplasty has shown promising mid-term results and we present here the first mid-term RSA analysis of a hip resurfacing implant.

The analysis was performed in 19 hips at five years post-operatively. The mean acetabular component translation and rotation, and femoral component translation were compared with the previous RSA measurements at two and six months, and one and two years.

There was no statistical significance (t-test, p ≤ 0.05) between these consecutive movements, indicating the mid-term stability of the implant.
Microbiological cultures of allografts of the femoral head just before transplantation
Authors: van de Pol G. J. , Sturm P. D. J. , van Loon C. J. , Verhagen C. , Schreurs B. W.
Published: September 2007

Allografts of bone from the femoral head are often used in orthopaedic procedures. Although the donated heads are thoroughly tested microscopically before release by the bone bank, some surgeons take additional cultures in the operating theatre before implantation. There is no consensus about the need to take these cultures. We retrospectively assessed the clinical significance of the implantation of positive-cultured bone allografts. The contamination rate at retrieval of the allografts was 6.4% in our bone bank. Intra-operative cultures were taken from 426 femoral head allografts before implantation; 48 (11.3%) had a positive culture. The most frequently encountered micro-organism was coagulase-negative staphylococcus. Deep infection occurred in two of the 48 patients (4.2%). In only one was it likely that the same micro-organism caused the contamination and the subsequent infection.

In our study, the rate of infection in patients receiving positive-cultured allografts at implantation was not higher than the overall rate of infection in allograft surgery suggesting that the positive cultures at implantation probably represent contamination and that the taking of additional cultures is not useful.
Long-term outcome of surgically-treated habitual patellar dislocation in children with coexistent patella alta
Authors: Benoit B. , Laflamme G. Y. , Laflamme G. H. , Rouleau D. , Delisle J. , Morin B.
Published: September 2007

We retrospectively reviewed the operative treatment carried out between 1988 and 1994 of eight patients with habitual patellar dislocation. In four the condition was bilateral. All patients had recurrent dislocation with severe functional disability. The surgical technique involved distal advancement of the patella by complete mobilisation of the patellar tendon, lateral release and advancement of vastus medialis obliquus. The long-term results were assessed radiologically, clinically and functionally using the Lysholm knee score, by an independent observer.

The mean age at operation was 10.3 years (7 to 14) with a mean follow-up of 13.5 years (11 to 16). One patient required revision. At the latest follow-up, all patellae were stable and knees functional with a mean Lysholm knee score of 98 points (95 to 100). In those aged younger than ten years at operation there was a statistically significant improvement in the sulcus angle at the latest follow-up (Student’s t-test, p = 0.001). Two patients developed asymptomatic patella infera as a late complication.

This technique offers a satisfactory treatment for the immature patient presenting with habitual patellar dislocation associated with patella alta. If performed early, we believe that remodelling of the shallow trochlea may occur, adding intrinsic patellofemoral stability.
Ewing’s sarcoma family tumours
Authors: Bacci G. , Balladelli A. , Forni C. , Longhi A. , Serra M. , Fabbri N. , Alberghini M. , Ferrari S. , Benassi M. S. , Picci P.
Published: September 2007

Despite local treatment with systemic chemotherapy in Ewing’s sarcoma family tumours (ESFT), patients with detectable metastases at presentation have a markedly worse prognosis than those with apparently localised disease. We investigated the clinical, pathological and laboratory differences in 888 patients with ESFT, 702 with localised disease and 186 with overt metastases at presentation, seen at our institution between 1983 and 2006.

Multivariate analyses showed that location in the pelvis, a high level of serum lactic dehydrogenase, the presence of fever and a short interval between the onset of symptoms and diagnosis were indicative of metastatic disease. The rate of overt metastases at presentation was 10% without these four risk factors, 22.7% with one, 31.4% with two, and 50% for those with three or four factors. We concluded that in ESFT the site, the serum level of lactic dehydrogenase, fever, and the interval between the onset of symptoms and diagnosis are indicators of tumours having a particularly aggressive metastatic behaviour.
Should follow-up of patients with arthroplasties be carried out by general practitioners?
Authors: Haddad F. S. , Ashby E. , Konangamparambath S.
Published: September 2007

Due to economic constraints, it has been suggested that joint replacement patients can be followed up in primary care. There are clinical, ethical and academic reasons why we must ensure that our joint replacements are appropriately clinically and radiologically followed up to minimise complications. This Editorial discusses this.
Small is Beautiful? Local government reorganisation and the work of social services departments
Authors: Craig Gary , Manthorpe Jill
Published: September 2007

English

British local government is undergoing the most far-reaching reorganisation for 25 years. Government’s explicit objectives for change emphasised more local, cheaper, local government, although there were also implicit political objectives. Social services now represents the major directly-controlled local government activity; however, it was marginal in debates about reform. The impact of reform, particularly in terms of the size of the new unitary or ‘hybrid’ local authorities, may, however, be substantial. Research into the impact of reorganisation on authorities in England, Scotland and Wales raises questions about the extent to which new, smaller social services departments are sustainable.
Private, Voluntary or Public? Comparative cost-effectiveness in community mental health care
Authors: Knapp Martin , Hallam Angela , Beecham Jennifer , Baines Barry
Published: September 2007

English

Two prominent features of mental health policy in the UK in recent years have been the run-down of hospital provision and the changing of the balance between public and other provider sectors. This article examines the cost, quality of care and outcome implications. Public, voluntary and private providers of mental health care are compared, based on a long-term study of people moving out of psychiatric hospitals in London. Costs are found to be lowest in the private (for-profit) sector, and highest in the NHS and consortium (NHS and voluntary sector partnership) sectors. However, quality of care indicators suggest that the lowest cost sector is performing least well, and the highest cost sectors offer the best quality. These are associated with some differences in user outcome.
How Resource Dependency Can Influence Social Resilience within a Primary Resource Industry*
Authors: Marshall N. A. , Fenton D. M. , Marshall P. A. , Sutton S. G.
Published: September 2007

AbstractMaintaining a healthy balance between human prosperity and environmental integrity is at the core of the principles of Ecological Sustainable Development. Resource‐protection policies are frequently implemented so as to regulate the balance between resource access and use, however, they can inadvertently compromise the ability of resource users to adapt and be resilient. Resource users who are especially dependent on a resource are more seriously compromised. But how do we define and measure resource dependency? And how do we assess its ability to influence social resilience? In this study, a conceptual model of resource dependency is developed in terms of: (i) occupational attachment, (ii) attachment to place, (iii) employability, (iv) family attitude to change, (v) business size, (vi) business approach, (vii) financial situation, (viii) level of specialisation, (ix) time spent harvesting, and (x) interest in and knowledge of the environment. The model of resource dependency and its effect on social resilience are (quantitatively and qualitatively) tested and explored using the commercial fishing industry in North Queensland, Australia. Results show that occupational attachment and employability were important influences as were business size and approach. Results can be used to identify vulnerability to institutional change and guide policy development processes.
The Politics of Invasive Weed Management: Gender, Race, and Risk Perception in Rural California*
Authors: Norgaard Kari Marie
Published: September 2007

Abstract “Biological invasions” are now recognized as the cause of significant ecological and economic damage. They also raise a series of less visible social issues. Management of invasive species is often a political process raising questions such as who decides which organisms are to be managed, and who benefits or is affected by different management techniques. In a rural region of northern California, the proposed use of herbicides on spotted knapweed sparked an intense social controversy. This research uses participant observation, interviews, and archival material to understand how members of the Karuk Tribe of California, the non‐Indian community, and the U.S. Forest Service developed different perceptions of safety and risk regarding herbicide use. I describe interconnected factors that frame the interpretation of risk: institutional trust, proximity to exposure, gender, and race. Gender and race, in turn, form the basis of anti‐herbicide mobilization. The larger sociological question highlighted is, who pays the price for species invasions? Use of herbicides on invasive species is increasing. Many people who face increased exposure to herbicides are members of racial minority groups. When the poor or racial minorities face disproportionate exposure, differences in risk perception become matters of environmental justice. This paper discusses the broader social implications of differences in risk perception among communities and land managers.
Endoscopic and ultrasonographic evaluation before and after Roux-en-Y gastric bypass for morbid obesity
Authors: Teivelis Marcelo Passos , Faintuch Joel , Ishida Robson , Sakai Paulo , Bresser Adriano , Gama-Rodrigues Joaquim
Published: September 2007

BACKGROUND: Esophagogastric abnormalities are recognized prior and after bariatric procedures, but frequency and severity are debated. Liver and biliary tract findings are also of clinical importance, especially gallstones and liver steatosis. AIM: To compare pre-operative findings of hepatobiliary ultrasound and upper digestive endoscopy with post-operative results in patients submitted to open Roux-en-Y gastric bypass for morbid obesity. METHODS: A total of 80 patients were enrolled 16.8 ± 12.1 months after operation, all of them on routine follow-up program, and 8 were excluded. Retrospective analysis aimed at pre-operative clinical, endoscopic and ultrasonographic examinations and were prospectively repeated. RESULTS: Pre-operative endoscopical report was available in 42 cases, and 52 examinations were performed post-operatively. Frequency of esophagitis changed from 16.7% (7/42) to 15.4% (8/52), and of gastritis from 45.2% (19/42) to 21.2% (11/52). Gastric or gastrojejunal ulcers were initially present in 4.8% (2/42) and increased to 9.6% (5/52). Post-operatively, an unusual abnormality was silastic band erosion: 7.7% (4/52). Helicobacter pylori was present in 50.0% (21/42) before and 3.5% (2/52) after operation. Ultrasonographic study had been done before intervention in 63 subjects, and 57 were executed on follow-up. Liver steatosis occurred previously in 58.7% (37/63) and in 43.9% (25/57) later on. Only 12.7% (8/63) of the patients had undergone cholecystectomy before bariatric operation, 29.1%(16/55) suffered simultaneous resection of gallbladder because of stones during Roux-en-Y gastric bypass, and an additional 26.8% (10/36) developed gallstones post-operatively. CONCLUSIONS: Liver steatosis did not statistically improve, nor did inflammatory conditions of the upper digestive tube, despite reduction of H. pylori infections; gallbladder stones requiring intervention were common.
Prevalence of sphincter of Oddi dysfunction in patients referred to endoscopic retrograde cholangiopancreatography
Authors: Della Libera Ermelindo , Rodrigues Rodrigo Azevedo , Guimarães Ana Paula Rodrigues , Paulo Gustavo Andrade de , Geocze Stephan , Ferrari Angelo Paulo
Published: September 2007

BACKGROUND: Sphincter of Oddi manometry is the gold-standard method for sphincter of Oddi dysfunction. The prevalence of sphincter of Oddi dysfunction among patients referred to endoscopic retrograde cholangiopancreatography is largely unknown. AIM: To evaluate prospectively the prevalence of biliary sphincter of Oddi dysfunction (B-SOD) among Brazilian patients referred to endoscopic retrograde cholangiopancreatography and to study the safety of sphincter of Oddi manometry in this setting. METHODS: Biliary sphincter of Oddi manometry was intended in 110 patients referred to endoscopic retrograde cholangiopancreatography. The number of attempts to obtain deep cannulation with the manometry catheter was recorded and patients were divided into two groups: up to 5 (easy cannulation) and >5 attempts (difficult cannulation). RESULTS: Sphincter of Oddi manometry was successful in 71/110 patients (64.5%). Sphincter of Oddi dysfunction was found in 18/71 patients (25%). Endoscopic retrograde cholangiopancreatography findings were: normal in 16, biliary stones in 39, malignant biliary strictures in 9 and benign biliary strictures in 7. There was no statistical difference in sphincter of Oddi dysfunction prevalence regarding disease, gender or difficulty of cannulation. Only 2/71 patients developed post-procedure mild pancreatitis. CONCLUSIONS: We have found a high prevalence of sphincter of Oddi dysfunction in patients referred to endoscopic retrograde cholangiopancreatography. Gender, nature of disease or difficulty of cannulation did not influence the prevalence of sphincter of Oddi dysfunction among these patients. Sphincter of Oddi manometry is a safe procedure for the evaluation of sphincter of Oddi dysfunction in patients referred to endoscopic retrograde cholangiopancreatography.
Medulloblastoma: evaluation of proliferative index by monoclonal antibody Mib-1, its prognostic correlation and therapeutic implications
Authors: Ferrari Antonio Fernandes , Araújo Maria Betânia Mahler , Aguiar Paulo Henrique , Plese José Pindaro Pereira
Published: September 2007

In the past few years, the monoclonal antibody MIB-1 has been used by researchers in order to retrospectively study paraffin imbibed tumor fragments. The medulloblastoma is the most common malignant central nervous system tumor in childhood. The objectives were: determination of the mean Mib-1 LI value from these patients, as well as the prognostic value of the method.This retrospective study represents an analysis of the cellular proliferation index of posterior fossa medulloblastomas collected from 22 patients at A.C. Camargo Hospital, from January 1990 to December 1999. The histopathological diagnosis was confirmed by H&E and proliferative index (LI) was achived with Mib-1 which detects proliferating cells during G1, G2, S and M phases.The results demostrated that the mean Mib-1 was 30,1%, and ranged from 5,2% to 62,0%.In conclusion, this method has prognostic value, has to be used as routine for patients harboring medulloblastomas and the ones who have PI greater than the mean value found in this study, should be treated aggressively.
Personality features ina sample of psychophysiological insomnia patients
Authors: Carvalho Luciane Bizari Coin de , Lopes Eliane Aversa , Silva Luciana , Almeida Marilaine Medeiros de , Silva Tatiana Almeida e , Neves Afonso Carlos , Prado Lucila Bizari Fernandes do , Prado Gilmar Fernandes do
Published: September 2007

The personality is the way people express themselves inside the environment they live. Sleep, quality or quantity, is a way of this physical and psychological expression of well being. Psychological factors, associated with psychophysiological insomnia (PPI) suggest an exaggerated perception of the difficulties to fall asleep. Worries, anxiety and the fear of not sleeping produce a bad sleep quality or sleep misperception. This study aims to identify personality features associated with PPI throughout Rorschach test (RT). METHOD: We studied 32 patients with PPI (22 women), between 29 and 75 years old. We excluded patients with other sleeping or psychiatric disorders. We analysed the data from PPI patients submitted to the RT and we compared our results with the standard data. RESULTS: We noticed a significant increase in global answers and a significant decrease in detailed answers; a trend of a low number of answers; great number of shape and animal answers, especially for women. CONCLUSION: The features of the PPI patient's personality were daily problems insecure and the incapability to avoid or remove them from their thought, making bedtime a time for worries to appear again and motivate insomnia.
Estudo comparativo do tono muscular na paralisia cerebral tetraparética em crianças com lesões predominantemente corticais ou subcorticais na tomografia computadorizada de crânio
Authors: Iwabe Cristina , Piovesana Ana Maria Sedrez Gonzaga
Published: September 2007

OBJETIVO: Comparar a distribuição e intensidade do tono muscular na paralisia cerebral tetraparética espástica (PC-T), correlacionando os dados clínicos com a localização da lesão no sistema nervoso central. MÉTODO: Foram incluídas 12 crianças de dois a quatro anos de idade com lesões predominantemente corticais (seis crianças) e subcorticais (seis crianças). O tono foi analisado nos membros superiores (MMSS) e inferiores (MMII) baseado no protocolo de Durigon e Piemonte. RESULTADOS: Não houve diferença significante quanto à intensidade e distribuição de tono em MMSS e MMII nos dois grupos. Comparando os MMSS e MMII de sujeitos do mesmo grupo, os MMII apresentaram mais assimetrias e maior intensidade do tono do que os MMSS. CONCLUSÃO: Neste estudo, crianças com PC devido a lesões predominantemente corticais ou subcorticais apresentam déficit semelhante na modulação de tono, ocasionando distribuição simétrica e homogênea de hipertonia que predomina em MMII.
Etiologia e a morbi-letalidade do coma agudo em crianças
Authors: Löhr Junior Alfredo , Liberalesso Paulo Breno Noronha , Luzzi Gisele Claudino Reck , Faria Antonio Carlos de , Bugallo Maria Julia Camiña , Santos Mara Lucia Schmit Ferreira
Published: September 2007

OBJETIVO: Analisou-se a etiologia e a morbi-mortalidade de 104 crianças em coma agudo, ou seja, com uma pontuação menor ou igual a 8 da escala de Glasgow, internadas na Unidade de Terapia Intensiva do Hospital Infantil Pequeno Príncipe(UTI-HIPP) no período entre março/98 e janeiro/2001. RESULTADOS: A idade variou de 2 meses a 13 anos, com média de 30,3 ± 27,4 meses e mediana de 20 meses, sendo 57 (54,8%) do sexo masculino. O tempo de permanência hospitalar variou de 1 a 114 dias, e 3 casos permaneceram em estado vegetativo persistente. Com relação à etiologia: 31 (29,8%) dos casos foram devidos a meningoencefalite, 24 (23,1%) estado de mal epiléptico, 19 (18,3%) causa tóxico-metabólica, 16 (15,4%) hipertensão intracraniana, 7 (6,7%) choque/anóxia, 4 (3,8%) etiologia indeterminada, 3 (2,9%) miscelânea. Com relação à evolução das crianças, 23 (22,1%) foram a óbito, 32 (30,8%) evoluíram sem seqüelas, 39 (37,5%) tiveram alta com seqüelas neurológicas e10 (9,6%) não informado. CONCLUSÃO: De acordo com a análise do presente estudo conclui-se que cerca de um terço dos pacientes em coma agudo falece, um terço apresenta seqüelas neurológicas na alta hospitalar e um terço evoluim sem seqüelas.
Visual function and fine-motor control in small-for-gestational age infants
Authors: Gagliardo Heloisa G.R.G. , Gonçalves Vanda M.G. , Lima Maria Cecilia M.P. , Francozo Maria de Fatima de C. , Aranha Netto Abimael
Published: September 2007

OBJECTIVE: To compare visual function and fine-motor control of full-term infants small-for-gestational age (SGA) and appropriate for gestational age (AGA), in the first three months. METHOD: We evaluated prospectively 31 infants in the 1st month; 33 in the 2nd and 34 infants in the 3rd month, categorized as full-term; birth weight less than 10th percentile for SGA and 25th to 90th percentile for the AGA group. Genetic syndromes, infections, multiple congenital malformations were excluded. The Bayley Scales of Infant Development-II were used, especially items related to visual function and to fine-motor control outcomes. RESULTS: The Motor Index Score (IS) was significantly lower in the SGA group in the 2nd month. The items "attempts to bring hands to mouth", in the 1st month and "reaches for suspended ring", in the 3rd month showed higher frequency in the SGA group. CONCLUSION: The Motor IS was lower in the 2nd month and items of fine-motor control in the 1st month and in the 3rd month showed higher frequency in the SGA group.
Myelomeningocele: a Brazilian University Hospital experience
Authors: Ulsenheimer Maria M.M. , Antoniuk Sérgio A. , Santos Lúcia H.C. dos , Ceccatto Marcos P. , Silveira Antônio Ernesto da , Ruiz Ana Paula , Egger Paulo , Bruck Isac
Published: September 2007

We analyzed 31 children with myelomeningocele born between July 1990 and July 2000. Follow-up median was 24 months (6-68months). Only 2 mothers had a known etiologic factor (diabetes mellitus). Twelve had the correct prenatal diagnosis. All children were born at term; 23 by cesarean; 13 had rupture of the membrane. Surgical correction had a 4 days median (1 to 44 days). Lumbosacral lesions were the most frequent (46%). Thirty patients were hydrocephalic, shunt was placed in 27. Meningitis was 4 times more frequent in shunted patients. Seven became epileptic (19.4%). Denver II test showed significant delay in gross motor development . Neurogenic bladder was diagnosed in 12 patients. Congenital clubfoot was the main orthopedic malformation (53%). Six infants died. Nowadays, 17 patients are being followed. A multidisciplinary approach probably helps for a better quality of life.
Intradural jugular foramen tumors
Authors: Mattos João Paulo , Ramina Ricardo , Borges Wilson , Ghizoni Enrico , Fernandes Yvens B. , Paschoal Jorge R. , Honorato Donizeti C. , Borges Guilherme
Published: September 2007

Eleven patients with jugular foramen lesions with or without extradural extension were operated at University Hospital of Campinas (UNICAMP), in Campinas, Brazil, between 1998 and 2001. Neck dissection, mastoidectomy without transposition of the facial nerve and myofascial flap reconstruction of the cranial base with an especially developed technique were carried out in 7 patients. Four patients were operated using retrosigmoid craniectomy. Total excision was accomplished in 9 cases. All patients did not show evidence of disease progression at least after 2 years follow-up. There was no mortality. New lower cranial nerve deficits occurred in 5 patients. Nine maintain or improved their preoperative status based on Karnofsky and Glasgow Outcome Scale. A complex anatomy of this region demand wide exposures for treat those tumors. For this reason, an adequate approach for curative resection of most lesions and an efficient skull base reconstruction decreasing postoperative morbidity are essential.
Influência do etanol das bebidas alcoólicas na aterosclerose em artérias carótidas extracranianas
Authors: Damiani Ibsen Thadeo , Gagliardi Rubens José , Scaff Milberto
Published: September 2007

Existem fortes evidências de menor incidência de doença cerebrovascular oclusiva, de aterosclerose coronariana e de outros vasos em indivíduos com consumo leve ou moderado de álcool. Este estudo procura analisar o efeito do etanol, em diferentes doses no comportamento da aterosclerose carotídea extracraniana. Através do ultrassom Doppler colorido, foram investigadas 328 artérias carótidas extracranianas, de homens e mulheres brancos, com mais de 35 anos de idade, normotensos, não tabagistas e sem as principais doenças que constituam fatores de risco para doenças cardiovasculares. Foram divididos de acordo com o consumo de álcool por semana (em mililitros) em abstêmios, etilistas leves (1 a 100), moderados (101 a 300) e pesados (301 ou mais). Houve menor incidência de placas de aterosclerose e de estenose naqueles que ingeriram moderada quantidade. CONCLUSÃO: O estudo sugere uma ação protetora do álcool etílico para aterosclerose carotídea, quando ingerido em moderada quantidade.
Validade preditiva do movement assessment of infants para crianças pré-termo brasileiras
Authors: Cardoso Ana Amélia , Magalhães Lívia C. , Amorim Regina Helena C. , Paixão Maria Lúcia , Mancini Marisa C. , Rossi Luciana D.F.
Published: September 2007

A validade preditiva da Avaliação do Movimento do Bebê (Movement Assessment of Infants - MAI), para detecção precoce de paralisia cerebral, foi analisada em 89 crianças brasileiras nascidas com idade gestacional < 32 semanas e peso < 1500g. O MAI foi aplicado aos 4 e 8 meses de idade corrigida e as crianças foram submetidas a avaliação neurológica entre 2 e 7 anos de idade. Foram calculadas estimativas de sensibilidade (0,61 a 1,0), especificidade (0,79 a 0,95), valor de predição positiva (0,48 a 0,73) e valor de predição negativa (0,79 a 1,0), aos 4 e 8 meses, para escores > 13 e > 10 pontos de risco. Os melhores índices preditivos foram obtidos aos 8 meses e para o ponto de corte > 13 pontos de risco. Um critério menos restritivo (> 10 pontos) pode ser útil para predição de transtornos da coordenação motora, na idade escolar.
Association between dynamic asymmetry of the newborn's head and intrauterine factors
Authors: Beuter Cláudia Regina , Pedroso Fleming Salvador , Mazetto Ricardo César , Santos Cassandra Trojahn dos , Rossi Ângela Garcia
Published: September 2007

A non-comparable, individual, observational and contemporary cross-sectional study in newborns was made to determine the dynamic lateralization in the head turning after release from the midline and its relationship with obstetric variables. From October to December of 2005, 320 newborns were admitted to the Adjacent Lodgings of the University Hospital of Santa Maria. From those, 89 were selected for assessment of the vestibular function since they have had previously fetal static control through ultrasound. Our results show that the right-sided head lateralization was significantly greater than the left-sided. The predominancy of the lateralization towards the right side also occurred in cephalic presentations and left-sided back, however these were not significant. Results corroborate with the existing literature and suggest an association between fetal static and vestibular function.
Acute bacterial meningitis in HIV, pacients in southern Brazil: Curitiba, Paraná, Brazil
Authors: Almeida Sérgio M. de , Savalla George , Gabardo Betina Mendez A. , Ribeiro Clea Elisa , Rossoni Andrea M. , Araújo Josiane M.R.
Published: September 2007

Acute communitarian bacterial meningitis and AIDS are prevalent infectious disease in Brazil. The objective of this study was to evaluate the frequency of acute communitarian bacterial meningitis in AIDS patients, the clinical and cerebrospinal fluid (CSF) characteristics. It was reviewed the Health Department data from city of Curitiba, Southern Brazil, from 1996 to 2002. During this period, 32 patients with AIDS fulfilled criteria for acute bacterial meningitis, representing 0.84% of the AIDS cases and 1.85% of the cases of bacterial meningitis. S. pneumoniae was the most frequent bacteria isolated. The number of white blood cells and the percentage of neutrophils were higher and CSF glucose was lower in the group with no HIV co-infection (p 0.12; 0.008; 0.04 respectively). Bacteria not so common causing meningitis can occur among HIV infected patients. The high mortality rate among pneumococcus meningitis patients makes pneumococcus vaccination important.
Evaluación de la cognición social y teoría de la mente en pacientes con enfermedad cerebelosa degenerativa aislada no dementes
Authors: Abel Carlos G. , Stein Gustavo , Galarregui Marina , Garretto Nélida , Mangone Carlos , Genovese Osvaldo , Allegri Ricardo F. , Sica Roberto E.P.
Published: September 2007

OBJETIVO: Investigar la hipótesis según la cual, el cerebelo podría participar en las alteraciones de la cognición social (CS). MÉTODO: Se administraron tests neuropsicológicos generales, de función ejecutiva (FE), de CS que evaluaban la capacidad de inferir el estado mental de otras personas y la escala de Depresión de Beck a 10 pacientes adultos con enfermedad cerebelosa adquirida aislada (GEC) y a 10 controles (GCO) apareados por edad, sexo y educación. Se analizaron los datos mediante ANOVA y correlación. RESULTADOS: El GEC obtuvo puntajes significativamente menores (p?0,05) que el grupo GCO en tareas de FE (Test de Wisconsin) y preguntas de creencia (PCr) de Teoría de la Mente (ToM). El rendimiento en las preguntas de control (PCo) de ToM fue similar en ambos grupos. El menor rendimiento en las PCr correlacionó significativamente con una menor habilidad conceptual, la severidad de la apatía (NPI) y de la ataxia estática. Las PCo correlacionaron con medidas de atención y de recuerdo diferido libre. CONCLUSÍON: El cerebelo contribuiría en el monitoreo de la conducta mediante el control de datos multimodales motores, cognitivos y emocionales.
Report of two narcoleptic patients with remission of hypersomnolence following use of prednisone
Authors: Coelho Fernando Morgadinho Santos , Pradella-Hallinan Márcia , Alves Gabriela Rodrigues , Bittencourt Lia Rita Azeredo , Tufik Sérgio
Published: September 2007

This article focuses on 2 clinical case reports of narcoleptic patients who experienced an absence of excessive sleepiness during treatment of other illnesses with 40 mg daily intake of prednisone.
Diagnostic pitfalls in Parkinson's disease: case report
Authors: Sekeff-Sallem Flávio Augusto , Barbosa Egberto Reis
Published: September 2007

Parkinson's disease (PD) is characterized by resting tremor, rigidity and bradykinesia. In 80% of cases, the disorder begins with upper limb resting tremor. However, there are some presenting atypical features that make the diagnosis even more difficult and intriguing. The disorder can have its onset below 40 years old, characterizing early-onset parkinsonism, which differential diagnosis possibilities are varied. Atypical presentations include a pure akinetic-rigid syndrome, the initial manifestations occurring in the lower limbs, and pain as the most important or sole manifestation. These atypical features are unusual, but can be seen in clinical practice. We present a 37 years old woman with early-onset parkinsonism beginning with an akinetic-rigid syndrome in the lower limbs whose first symptom was left leg pain, which diagnosis was made after 4 years of onset and after 16 referrals to several experts in different fields. We discuss these atypical features and the diagnostic pitfalls in PD.
Cluster headache attacks in a woman previously struck by lightning: pathophysiology of the latent period
Authors: Valença Marcelo Moraes , Silva Wilson Farias da , Andrade-Valença Luciana Patrízia A. , Bordini Carlos A. , Speciali José Geraldo
Published: September 2007

BACKGROUND: Cases of patients who developed cluster headache-like symptoms after different putative causes have been reported, indicating a direct relationship between brain lesion and this particular type of headache. Long term, delayed, neurological sequelae after lightning have also been described. CASE REPORT: We describe the case of a woman who, at the age of 10, was struck by lightning. Six years later she developed cluster headache-like attacks. CONCLUSION: We hypothesize that a relationship between the lightning and the cluster headache-like episodes observed in our patient. This case study may have helped throw some light into the still unknown pathophysiology of this particular type of primary headache.
Intracranial intrasellar kissing carotid arteries: case report
Authors: Pereira Filho Arthur de Azambuja , Gobbato Pedro Luís , Pereira Filho Gustavo de Azambuja , Silva Sandro Bertani da , Kraemer Jorge Luiz
Published: September 2007

Intracranial "kissing" carotid arteries are a rare variant of the carotid arteries, where both internal carotid arteries deviate medially and touch each other near the midline within the sphenoid sinus or the sphenoid bone, including the sella. This anomaly is particularly important since it may cause or mimic pituitary disease and also may complicate transsphenoidal surgery. We report a rare case of intracranial intrasellar kissing carotid arteries in a 57-years-old woman that was submitted to a computed tomography angiography during investigation of a sudden headache, and to discuss the clinical relevance of this radiological finding.
Screening for MELAS mutations in young patients with stroke of undetermined origin
Authors: Conforto Adriana Bastos , Yamamoto Fabio Iuji , Oba-Shinjo Sueli Mieko , Pinto Julio Guy C. , Hoshino Maurício , Scaff Milberto , Marie Suely Kazue Nagahashi
Published: September 2007

PURPOSE: It has been suggested that mitochondrial disease may be responsible for a substantial proportion of strokes of indetermined origin. We have preliminarily screened for MELAS (mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes) mutations in young patients with cryptogenic strokes. METHOD: The mitochondrial mutations A3243G and T3271C were investigated in 38 subjects aged less than 46 years. Group 1: 15 patients with cryptogenic strokes; Group 2: 3 patients with diagnosis of MELAS syndrome, including stroke-like episodes; Group 3: 20 healthy subjects. RESULTS: The A3243G mutation was absent in all subjects in Groups 1 and 3 but was present in all subjects in Group 2. CONCLUSION: Our results do not support screening for these mutations to diagnose oligosymptomatic forms of MELAS in cryptogenic strokes in the absence of other features of the syndrome. We suggest that clinical findings should guide mitochondrial genetic testing.
Ketogenic diet for the treatment of refractory epilepsy: a 10 year experience in children
Authors: Freitas Alessandra , Paz José Albino da , Casella Erasmo Barbante , Marques-Dias Maria Joaquina
Published: September 2007

Ketogenic diet (KD) is a high fat and low carbohydrate diet, which controls refractory epilepsy. We analyzed the KD effects on 54 children of the Children's Institute of the University of São Paulo. Efficacy, tolerability, and adverse effects were studied. Response to KD was effective (E) if seizure control was >75%, good (G) when 50-75%. When possible, we correlated the results with the epileptic syndrome and patient's age. By the second month on diet, 57.4% of the patients had E response and 31.4% G results. At the 6th month, 63.8% had E response and 25.5% G. At the 12th month, 71.8% had E and 25.6% G. At the 24th month, 62.1% had E and 37.9% G. Antiepileptic drugs have been reduced, and generalized epilepsy was the most sensitive. Age-related differences were not observed. Adverse effects were rarely observed. In conclusion, KD proved to be an effective treatment for refractory epilepsy.
Evaluation of the "spasticity of conjugate gaze phenomenon" in unilateral cerebral lesions
Authors: Maranhão Eliana Teixeira , Maranhão-Filho Péricles , Lima Marco Antonio
Published: September 2007

The spasticity of conjugate gaze phenomenon (SCG) is a subtle motor ocular sign that usually indicates unilateral acute cerebral lesion. We analyzed the sensitivity of this sign in a prospective blinded study using 57 patients. All patients had monohemispheric brain lesions without resting deviation of the eyes and no motor complaints. Fourteen individuals without cerebral lesions were included as controls. Patients and controls were submitted to a brain magnetic resonance image. We observed SCG in just 1/57 (sensitivity of 1.7%), while all controls had a normal Bell's phenomenon. We speculate that SCG may disappear over time and is not useful to diagnose a long-lasting unilateral brain lesion.
Qualidade de vida em portadores de esclerose múltipla
Authors: Morales Rogério de Rizo , Morales Nívea de Macedo Oliveira , Rocha Fernando Coronetti Gomes da , Fenelon Sheila Bernardino , Pinto Rogério de Melo Costa , Silva Carlos Henrique Martins da
Published: September 2007

A esclerose múltipla (EM) é doença crônica que pode causar repercussões importantes na vida dos pacientes. Medidas tradicionais de evolução na EM não consideram os efeitos da doença na qualidade de vida relacionada à saúde (QVRS). O objetivo deste estudo é avaliar o impacto da EM na QVRS de portadores residentes em Uberlândia - MG. O SF-36 foi aplicado em 23 portadores de EM e em 69 doadores de sangue. Os portadores de EM apresentaram escores mais baixos que a população geral, principalmente nos domínios de função física. Pacientes com EDSS <3,5 apresentam escores maiores em quatro domínios do SF-36 que aqueles com EDSS >4,0, e menores em todos os domínios em relação ao grupo controle. Sintomas depressivos e intolerância ao calor mostram correlação com domínios e componentes do SF-36. Concluindo, a EM provoca impacto negativo significante em todos os domínios do SF-36, comparados à população geral, mesmo nas fases de menor incapacidade.
Síndrome de crouzon: fatores envolvidos no desenvolvimento neuropsicologico e na qualidade de vida
Authors: Yacubian-Fernandes Adriano , Ducati Luis Gustavo , Silva Mateus Violin , Abramides Dagma Venturini Marques , Perosa Gimol B. , Palhares Aristides , Gabarra Roberto C. , Giglio Alcir , Portela Luis , Marinello João Luiz P. , Plese José Píndaro P. , Zanini Silvio Antonio
Published: September 2007

A síndrome de Crouzon é caracterizada por deformidade craniana, alterações faciais e exoftalmia. O retardo no desenvolvimento neuropsicomotor é observado em alguns casos. Este estudo tem como objetivo analisar a influência do momento da cirurgia, da classe sócio-econômica associada ao nível educacional dos pais e da ocorrência de malformações do sistema nervoso central no desenvolvimento cognitivo destes pacientes correlacionando estes achados à qualidade de vida deles e de suas famílias. Foram estudados 11 pacientes com diagnóstico de síndrome de Crouzon com idade entre um ano e quatro meses e treze anos. A avaliação multidisciplinar dos pacientes incluiu, avaliação social, avaliação cognitiva, estudo do encéfalo por ressonância magnética e avaliação da qualidade de vida. O quociente de inteligência variou de 46 a 102 (m=84,2) e foi correlacionado de forma inversa com o Fator 4 do Questionário de Recursos e Estresse Simplificado (incapacidade da criança); não se correlacionou com as alterações encefálicas, com a condição sócio-econômica dos pais e nem com o momento do tratamento neurocirúrgico.
Multiple system atrophy: clinical-radiological correlation. Report of two cases
Authors: Albuquerque Adolfo V. de , Freitas Marcos R.G. de , Cincinatus Daniel , Harouche Maria Beatriz B.
Published: September 2007

Multiple system atrophy (MSA) is a sporadic, neurodegenerative disorder, clinically characterized by parkinsonian, autonomic, cerebellar and pyramidal signs. We describe two patients showing different presentations of the same disease. The patient on case 1 presents features of MSA-C or olivopontocerebellar atrophy with the pontine "cross sign" on brain MRI. The second case reports a patient presenting MSA-P or striatonigral degeneration and the brain MRI shows lenticular nucleus sign alteration. We think that brain MRI might increase the accuracy diagnostic of MSA.
Temporal pole signal abnormality on MR imaging in temporal lobe epilepsy with hippocampal sclerosis: a fluid-attenuated inversion-recovery study
Authors: Carrete Junior Henrique , Abdala Nitamar , Lin Kátia , Caboclo Luís Otávio , Centeno Ricardo Silva , Sakamoto Américo Ceiki , Szjenfeld Jacob , Nogueira Roberto Gomes , Yacubian Elza Márcia Targas
Published: September 2007

OBJECTIVE: To determine the frequency and regional involvement of temporal pole signal abnormality (TPA) in patients with hippocampal sclerosis (HS) using fluid-attenuated inversion-recovery (FLAIR) MR imaging, and to correlate this feature with history. METHOD: Coronal FLAIR images of the temporal pole were assessed in 120 patients with HS and in 30 normal subjects, to evaluate gray-white matter demarcation. RESULTS: Ninety (75%) of 120 patients had associated TPA. The HS side made difference regarding the presence of TPA, with a left side prevalence (p=0.04, chi2 test). The anteromedial zone of temporal pole was affected in 27 (30%) out of 90 patients. In 63 (70%) patients the lateral zone were also affected. Patients with TPA were younger at seizure onset (p=0.018), but without association with duration of epilepsy. CONCLUSION: Our FLAIR study show temporal pole signal abnormality in 3/4 of patients with HS, mainly seen on the anteromedial region, with a larger prevalence when the left hippocampus was involved.
Prevalence of seizures and associated factors in children under five living in a deprived municipality of southern Brazil
Authors: Abib Cheple Roberto , Mendoza-Sassi Raúl A. , Bech-Nappi Jaime , Stein Airton Tetelbom
Published: September 2007

OBJECTIVE: To determine the frequency and distribution of seizure in children under five, living in a deprived community. METHOD: This was a cross-sectional study, conducted in a probabilistic sample of 487 children aged 5 or less, resident in the rural and urban areas of São José do Norte, a poor municipality in southern Brazil, during the period 1998-99. Children were identified as having this disorder after the application of the three subsequent instruments, the screening questionnaire for epileptic seizures (SQES), the neurological diagnostic interview for epilepsy (NDIE) and the EEG. Statistical analysis included a multivariate analysis using Poisson regression. Prevalence ratios (PR) and 95% confidence intervals (CI) were calculated. RESULTS: Diagnosis of epileptic seizures was confirmed in 22 children. Prevalence of seizure was 45.2/1000 (CI 2.9-6.8). Absence of tap water (PR 2.86; IC 1.15-7.10), and precarious housing (PR 2.50; CI 1.01-6.18) were significantly associated with the outcome. CONCLUSION: Prevalence of seizure in this deprived population is extremely high and related to socio-economic conditions.
Massaging over the greater occipital nerve reduces the intensity of migraine attacks: evidence for inhibitory trigemino-cervical convergence mechanisms
Authors: Piovesan Elcio Juliato , Di Stani Fabrizio , Kowacs Pedro André , Mulinari Rogério Andrade , Radunz Victor Hugo , Utiumi Marco , Muranka Eder B , Giublin Mario Luiz , Werneck Lineu César
Published: September 2007

Activation of the trigemino-cervical system constitutes one of the first steps in the genesis of migraine. The objective of this study was to confirm the presence of trigemino-cervical convergence mechanisms and to establish whether such mechanisms may also be of inhibitory origin. We describe a case of a 39-years-old woman suffering from episodic migraine who showed a significant improvement in her frontal headache during migraine attacks if the greater occipital nerve territory was massaged after the appearance of static mechanical allodynia (cortical sensitization). We review trigemino-cervical convergence and diffuse nociceptive inhibitory control (DNIC) mechanisms and suggest that the convergence mechanisms are not only excitatory but also inhibitory.
Lexical semantic memory in amnestic mild cognitive impairment and mild Alzheimer's disease
Authors: Balthazar Marcio L.F. , Martinelli José E. , Cendes Fernando , Damasceno Benito P.
Published: September 2007

OBJECTIVE: To study lexical semantic memory in patients with amnestic mild cognitive impairment (aMCI), mild Alzheimer's disease (AD) and normal controls. METHOD: Fifteen mild AD, 15 aMCI, and 15 normal control subjects were included. Diagnosis of AD was based on DSM-IV and NINCDS-ADRDA criteria, and that of aMCI, on the criteria of the International Working Group on Mild Cognitive Impairment, using CDR 0.5 for aMCI and CDR 1 for mild AD. All subjects underwent semantic memory tests (Boston Naming-BNT, CAMCOG Similarities item), Rey Auditory Verbal Learning Test (RAVLT), Mini-Mental Status Examination (MMSE), neuropsychological tests (counterproofs), and Cornell Scale for Depression in Dementia. Data analysis used Mann-Whitney test for intergroup comparisons and Pearson's coefficient for correlations between memory tests and counterproofs (statistical significance level was p<0.05). RESULTS: aMCI patients were similar to controls on BNT and Similarities, but worse on MMSE and RAVLT. Mild AD patients scored significantly worse than aMCI and controls on all tests. CONCLUSION: aMCI impairs episodic memory but tends to spare lexical semantic system, which can be affected in the early phase of AD.