Intraosseous migration of tendinous calcifications: two case reports.

Calcific tendinopathy of the rotator cuff is a common cause of shoulder pain. Inflammation of the rotator cuff tendons may be complicated by adjacent bone erosion and subsequent migration of calcific deposits within the bone resulting in marrow inflammation. Bone marrow involvement is not readily visible using X-ray and ultrasound (US) and further testing is necessary. Magnetic resonance imaging (MRI) is a highly sensitive technique that can detect a focal bone T1 and T2-weighted hypointensity with bone marrow edema-like signal and cortical erosion. These findings can mislead the radiologist by suggesting an infectious or neoplastic lesion, often requiring further evaluation with computed tomography (CT) and biopsy. We report two cases of patients with shoulder pain in which different radiological approaches were used with pathological confirmation in one of them. In the first case, MRI revealed significant bone involvement in the head of the humerus and cortical erosion of the greater tuberosity. A CT examination and a biopsy was necessary for a final diagnosis of inflammatory bone reaction from intraosseous migration of tendinous calcifications. In the second case, similar MRI findings prompted re-evaluation of imaging to make a diagnosis of intraosseous migration of tendinous calcifications, obviating the need to perform CT and biopsy. We illustrate MRI signs of this complication that we think would allow to narrow the differential diagnosis potentially avoiding biopsy and additional CT examinations.

Gist-based illusions within and across stimulus modalities in autism spectrum disorder.

Some studies have reported a low rate of false recognition (FR) in individuals with autism spectrum disorder (ASD) relative to non-autistic comparison participants (CPs). This finding, however, has not always been replicated and the source of the discrepancy remains unknown. We hypothesised that poor episodic memory functions may account for this finding. We used an adapted version of the Deese, Roediger and McDermott paradigm which presents lists of words, pictures or word-picture pairs to obtain measures of performance which reflect episodic [hits and false alarms (FAs)] and semantic (FR) memory functions. Results showed a decreased rate of FR in ASD individuals with lists of words which rose above the rate seen in non-autistic CPs with lists of word-picture pairs. This increased rate of FR in ASD was accompanied by a parallel increase in hits and a decrease in FA which reached a similar level in the two groups. Poor episodic memory functions may prevent individuals with ASD from acquiring item information which in turn precludes the formation of semantic links between items. This could render them less prone to FR.

Nitrifying bacterial biomass and nitrification activity evaluated by FISH and an automatic on-line instrument at full-scale Fusina (Venice, Italy) WWTP.

In this study, monthly variations in biomass of ammonia-oxidizing bacteria (AOB) and nitrite-oxidizing bacteria (NOB) were analysed over a 1-year period by fluorescence in situ hybridization (FISH) at the full-scale Fusina WWTP. The nitrification capacity of the plant was also monitored using periodic respirometric batch tests and by an automated on-line titrimetric instrument (TITrimetric Automated ANalyser). The percentage of nitrifying bacteria in the plant was the highest in summer and was in the range of 10-15 % of the active biomass. The maximum nitrosation rate varied in the range 2.0-4.0 mg NH4 g(-1) VSS h(-1) (0.048-0.096 kg TKN kg(-1) VSS day(-1)): values obtained by laboratory measurements and the on-line instrument were similar and significantly correlated. The activity measurements provided a valuable tool for estimating the maximum total Kjeldahl nitrogen (TKN) loading possible at the plant and provided an early warning of whether the TKN was approaching its limiting value. The FISH analysis permitted determination of the nitrifying biomass present. The main operational parameter affecting both the population dynamics and the maximum nitrosation activity was mixed liquor volatile suspended solids (MLVSS) concentration and was negatively correlated with ammonia-oxidizing bacteria (AOB) (p = 0.029) and (NOB) (p = 0.01) abundances and positively correlated with maximum nitrosation rates (p = 0.035). Increases in concentrations led to decreases in nitrifying bacteria abundance, but their nitrosation activity was higher. These results demonstrate the importance of MLVSS concentration as key factor in the development and activity of nitrifying communities in wastewater treatment plants (WWTPs). Operational data on VSS and sludge volume index (SVI) values are also presented on 11-year basis observations.

Desirable and undesirable future thoughts call for different scene construction processes.

Despite the growing interest in the ability of foreseeing (episodic future thinking), it is still unclear how healthy people construct possible future scenarios. We suggest that different future thoughts require different processes of scene construction. Thirty-five participants were asked to imagine desirable and less desirable future events. Imagining desirable events increased the ease of scene construction, the frequency of life scripts, the number of internal details, and the clarity of sensorial and spatial temporal information. The initial description of general personal knowledge lasted longer in undesirable than in desirable anticipations. Finally, participants were more prone to explicitly indicate autobiographical memory as the main source of their simulations of undesirable episodes, whereas they equally related the simulations of desirable events to autobiographical events or semantic knowledge. These findings show that desirable and undesirable scenarios call for different mechanisms of scene construction. The present study emphasizes that future thinking cannot be considered as a monolithic entity.

VATA-m: Visual-Analogue Test assessing Anosognosia for motor impairment.

There has been a growing interest in anosognosia in both clinical and research domains, yet relatively little attention has been paid to methods for evaluating it. Usually, the presence and severity of anosognosia is assessed by means of structured interviews or questionnaires. Both interviews and questionnaires can provide valuable information, but they rely heavily on self-evaluation and language, and are therefore prone to bias and pose more difficulty in the assessment of aphasic patients. The aim of this study was to develop a new tool, the VATA-m (Visual-Analogue Test for Anosognosia for motor impairment), to assess explicit anosognosia for motor impairments. The VATA-m is a questionnaire that compares a patient's self-evaluation with a caregivers' evaluation of the patient's abilities on a series of motor tasks. In addition, the test overcomes some of the limitations of the existing structured interviews and questionnaires, by enhancing reliability, improving data interpretation and diagnosis, and enabling assessment of patients with aphasia.

Cardiac magnetic resonance imaging: diagnostic value and utility in the follow-up of patients with acute myocarditis mimicking myocardial infarction.

PURPOSE: The aim of our study was to evaluate the efficacy of magnetic resonance imaging (MRI) in the differential diagnosis between active myocarditis and myocardial infarction in patients with clinical symptoms mimicking acute myocardial infarction. MATERIALS AND METHODS: Between 1 January 2006 and 30 June 2007, 23 consecutive patients (21 men and 2 women) presenting with electrocardiographic abnormalities mimicking acute myocardial infarction and a clinical suspicion of acute myocarditis (fever, chest pain and elevated troponin levels) underwent contrast-enhanced cardiac MRI within a week of admission. All patients also underwent coronary angiography, which demonstrated the absence of significant coronary artery lesions. The mean follow-up period was 2+/-4 months. RESULTS: Cardiac MRI with injection of contrast material showed late subepicardial and intramyocardial enhancement in all patients. Subendocardial late enhancement, a typical pattern of myocardial infarction, was never seen. In addition, in agreement with the literature, there was prevalent involvement of the lateral segments of the left ventricular wall. CONCLUSIONS: Cardiac MRI could be a valuable tool for the early diagnosis of acute myocarditis, as it can demonstrate specific patterns that help rule out acute myocardial infarction.

The Tbilisi paper and pencil dual-task.

One function of the central executive component of the working memory model is the coordination of two simultaneous tasks (the dual-task method). The concept of a coordination function has proved effective in identifying brain damaged patients with severe behavioural problems and in discriminating the performance of patients with mild Alzheimer's disease from that of healthy elderly. A computerised version of the dual-task method was successfully used in previous laboratory studies but it is not suited to use in a practical, clinical setting. Thus a paper and pencil version of the dual-task method was devised. The present study was aimed at refining the paper and pencil dual-task method; investigating whether or not age per se affects performance; assessing its test-retest reliability and providing norms for the Georgian population. The new paper and pencil version of the dual-task was administered to 64 young and 64 middle-age and elderly participants. A new, modified, simpler version of the paper and pencil dual-task, the "Tbilisi paper and pencil motor task" was developed. This task has high test-retest reliability and correlates with the established computerised version of the task. No age or education effects were detected.

Neuropsychological evidence for separating components of visuo-spatial working memory.

There is increasing evidence to support the idea that visuo-spatial working memory can be segregated into separate cognitive subsystems. However, the nature of these systems remains unclear. In this paper we report data from two brain injured patients suggesting that information about visual appearance is retained in a different subsystem from information about spatial location, and that this differential processing can be observed when the style of presentation (sequential or simultaneous) is controlled.

Dissociating mental transformations and visuo-spatial storage in working memory: evidence from representational neglect.

A study is reported of visuo-spatial working memory in two individuals suffering from a cognitive deficit known as unilateral spatial neglect, and seven healthy control participants. Both patients have difficulties reporting details on the left side of imaged representations, and one has an additional difficulty with perceptual input to the left of his body midline. All participants were asked to report the location and identity of objects presented in novel 2 x 2 arrays that were either present throughout or were described orally by the experimenter, with no visual input. On half of the trials, the report was to be made from the opposite perspective, requiring 180 degree mental rotation of the mentally represented array. The patients show an impaired ability to report details from the presented or the imagined left, but had no difficulty with mental rotation. Results point to a clear separation between the processes of perception and those of visuo-spatial working memory. Results also suggest that the patients might be suffering from damage to the system used for holding visuo-spatial representations rather than a difficulty with attending to elements of that representation.

Dual task effects of walking when talking in Alzheimer's disease.

Previous studies with Alzheimer Disease (AD) patients have suggested that speed and accuracy in walking can be dramatically affected by a simultaneous secondary cognitive task, such as holding a conversation. Two experiments examined the impact on AD patients and age matched elderly controls of cognitive demands while walking. In Experiment 1 walking for AD patients was more affected than it was for the normal elderly by a concurrent cognitive demand. Experiment 2 demonstrated that both groups were equally impaired under dual task conditions when the demands of the cognitive tasks were adjusted for individual levels of ability. We conclude that walking may draw on general executive resources, that walking relies more heavily on these executive resources in the elderly, and on a damaged executive system for AD patients.

Walking difficulties in patients with Alzheimer's disease might originate from gait apraxia.

OBJECTIVES: To investigate whether gait apraxia is a possible cause for some of the walking abnormalities shown by patients with Alzheimer's disease. METHODS: 60 patients with Alzheimer's disease, selected as being free from overt extrapyramidal impairment or other potential causes of walking deficits, were assessed with a new test evaluating aspects of walking and related movements. Norms for this test were collected from a sample of 182 healthy volunteers. RESULTS: 40% of the Alzheimer group performed below the cut off score on this test, and half performed poorly. Performance of the Alzheimer group in the walking skills test correlated highly with scores in a test assessing limb apraxia and with dementia severity. CONCLUSIONS: Gait apraxia may be the cause of walking disorders found in a subgroup of patients with Alzheimer's disease. Its detection is made easier by the use of a standardised test, but still relies heavily on the exclusion of other causes of walking deficits. It is a recognisable and independent form of apraxia.

Pantomimes are special gestures which rely on working memory.

The case of a patient is reported who presented consistently with overt deficits in producing pantomimes in the absence of any other deficits in producing meaningful gestures. This pattern of spared and impaired abilities is difficult to reconcile with the current layout of cognitive models for praxis. This patient also showed clear impairment in a dual-task paradigm, a test taxing the co-ordination aspect of working memory, though performed normally in a series of other neuropsychological measures assessing language, visuo-spatial functions, reasoning function, and executive function. A specific working memory impairment associated with a deficit of pantomiming in the absence of any other disorders in the production of meaningful gestures suggested a way to modify the model to account for the data. Pantomimes are a particular category of gestures, meaningful, yet novel. We posit that by their very nature they call for the intervention of a mechanism to integrate and synthesise perceptual inputs together with information made available from the action semantics (knowledge about objects and functions) and the output lexicon (stored procedural programmes). This processing stage conceived as a temporary workspace where gesture information is actively manipulated, would generate new motor programmes to carry out pantomimes. The model of gesture production is refined to include this workspace.

How many camels are there in Italy? Cognitive estimates standardised on the Italian population.

OBJECTIVE: We provided the standardisation of a new Cognitive Estimation Task (CET). PARTICIPANTS: the test was administered to 175 healthy subjects. RESULTS: performance on the Cognitive Estimation Task (CET) is associated with gender (where women show poorer performance than men) and education (where more highly educated individuals show better performance compared to individuals with lower levels of education). However,CET performance is not associated with age. DISCUSSION: the lack of age effects on the CET may be explained by the task dependence on "crystallised intelligence", which is less affected by healthy adult ageing than "fluid intelligence".

Object recognition and object orientation in Alzheimer's disease.

There are a wide variety of neuropsychological deficits in Alzheimer's disease (AD), among which are disorders of visual perception and spatial cognition. The present study investigated the ability of 20 mildly to moderately deteriorated patients with AD (and 174 age- and education-matched controls) on tasks that required them to visually identify, provide the canonical orientation of, and mentally rotate common objects. Some 85% of the AD patients performed poorly on all tasks. The authors were able to identify a small number of individual patients whose pattern of performance represented double dissociations between recognizing objects and knowing their canonical orientation. These findings are interpreted in the context of previous findings, especially as to whether information relating to an object's orientation and identity is independently coded.

Gait apraxia after bilateral supplementary motor area lesion.

OBJECTIVES: The study aimed at addressing the issue of the precise nature of gait apraxia and the cerebral dysfunction responsible for it. METHODS: The case of a patient, affected by a bilateral infarction limited to a portion of the anterior cerebral artery territory is reported. The patient's ability to walk was formally assessed by means of a new standardised test. RESULTS: Due to an anomaly within the anterior cerebral artery system, the patient's lesion was centred on the supplementary motor regions of both hemispheres. He presented with clear signs of gait apraxia that could not be accounted for by paresis or other neurological deficits. No signs of any other form of apraxia were detected. CONCLUSIONS: The clinical profile of the patient and the analysis of 49 cases from previous literature suggest that gait apraxia should be considered a clinical entity in its own right and lesions to the supplementary motor areas are responsible for it.

Memory-driven movements in limb apraxia: is there evidence for impaired communication between the dorsal and the ventral streams?

Memory-driven reaching and grasping movements were analysed in patients with left cerebral hemispheric damage and impaired gesture imitation. The dorsal and ventral streams of the visual pathway model of Milner and Goodale (Milner and Goodale, The Visual Brain in Action, 1995) are thought to operate relatively independently. However, cross-connections between the areas of each pathway are likely to enable interactions essential for higher-level praxis. Apraxic errors such as seen in gesture imitation can possibly be understood as arising from a disconnection of the two visual pathways. If the integrated action of the perceptual and visuomotor systems in patients with apraxia is compromised, then we would expect to find indications of impaired motor programming and misreaching in these patients when making movements driven by stored representations. Such a pattern, however, was not found in our sample of apraxic patients. Patients with limb apraxia produced normal movement kinematics and normal end-point accuracy when making memory-driven reaching movements with or without visual guidance of movement. Furthermore, perceptual information about object size and object distance were incorporated as normal in memory-driven grasping movements of these patients.