[Candida albicans cerebral granuloma in an immunocompetent patient. A case report]. / Granulome cérébral àCandida albicans chez un patient immunocompétent. Cas clinique.

We report a case of temporal lobe granuloma caused by Candida albicans in an immunocompetent patient. This 54-year-old patient had experienced headaches and some memory disorders for two to three months before his admission to the neurosurgical department. Cerebral-computer tomography and magnetic resonance imaging showed a single right-temporal lesion with a large peritumoral edema. We operated on the patient via a temporal approach using neuronavigation and resected the lesion. The anatomopathological result and the cultures of the granuloma showed C. albicans species. The patient received antifungal therapy for three months. No predisposing factors or immunosuppression was found. After seven months, he presented an ischemic cerebrovascular accident of the brain stem and then chronic meningitis complicated by hydrocephalus. The patient's condition progressively deteriorated and he died 18 months later in an other department. C. albicans can be found even in the immunocompetent patient, but is seldom observed. Surgery can provide an accurate diagnosis and therapeutic management in the initial phase, completed by antifungal therapy.

The impact of photodynamic therapy on the viability of Streptococcus mutans in a planktonic culture.

OBJECTIVE: This study investigated the effect of photodynamic therapy (PDT) with toluidine blue O (TBO) and a light-emitting diode (LED) on the viability of Streptococcus mutans cells in a planktonic culture. BACKGROUND DATA: Growth of Streptococcus mutans is the first step in the development of tooth decay. The use of light and dyes promotes cellular death in a noninvasive way, reducing treatment time. METHODS: The LED used in this study had output power of 116 mW, its energy was 21 J, and the fluency was 2.18 J/cm(2). Samples were prepared and divided into five groups: (1) control group (-); (2) control group (+); (3) TBO; (4) LED; and (5) LED + TBO. RESULTS: One hundred percent of the bacteria were killed following irradiation with LED and TBO. The biofilm that formed on the glass surfaces was analyzed by SEM and colony count. CONCLUSIONS: It was demonstrated that PDT was efficient at killing microorganisms and preventing the formation of biofilms.

[Surgical treatment of cortical and subcortical cavernomas. General principles and personal series of 20 cases treated between 2000 and 2006]. / Traitement chirurgical des cavernomes corticaux et sous-corticaux. Principes généraux et série personnelle de 20 cas opérés entre 2000 et 2006.

The surgical treatment of cortical or subcortical hemispheric cavernomas is founded on a series of questions: Is the cavernoma located in an eloquent or non-eloquent area? Is the cavernoma tangent to the cortex and visible immediately after the dura opening or deep seated in the hemisphere? Does the cavernoma lie in the depth of a sulcus and identifiable on the pretrans-sulcal approach MRI? Will perilesional tissue have to be removed to cure the epilepsy? What is the appropriate technology for each particular case: preoperative functional MRI, angiography, preoperative stereotactic guidance, peroperative ultrasonography, neuronavigation, peroperative neurophysiology and cortical stimulation, preoperative MRI? Based on a personal series of 20 cases operated on between 2000 and 2006, we describe our personal experience.

Influence of dietary fat composition on development of insulin resistance in rats. Relationship to muscle triglyceride and omega-3 fatty acids in muscle phospholipid.

High levels of some but not all dietary fats lead to insulin resistance in rats. The aim of this study was to investigate the important determinants underlying this observation. Insulin action was assessed with the euglycemic clamp. Diets high in saturated, monounsaturated (omega-9), or polyunsaturated (omega-6) fatty acids led to severe insulin resistance; glucose infusion rates [GIR] to maintain euglycemia at approximately 1000 pM insulin were 6.2 +/- 0.9, 8.9 +/- 0.9, and 9.7 +/- 0.4 mg.kg-1. min-1, respectively, versus 16.1 +/- 1.0 mg.kg-1.min-1 in chow-fed controls. Substituting 11% of fatty acids in the polyunsaturated fat diet with long-chain omega-3 fatty acids from fish oils normalized insulin action (GIR 15.0 +/- 1.3 mg.kg-1.min-1). Similar replacement with short-chain omega-3 (alpha-linolenic acid, 18:3 omega 3) was ineffective in the polyunsaturated diet (GIR 9.9 +/- 0.5 mg.kg-1.min-1) but completely prevented the insulin resistance induced by a saturated-fat diet (GIR 16.0 +/- 1.5 mg.kg-1.min-1) and did so in both the liver and peripheral tissues. Insulin sensitivity in skeletal muscle was inversely correlated with mean muscle triglyceride accumulation (r = 0.95 and 0.86 for soleus and red quadriceps, respectively; both P less than 0.01). Furthermore, percentage of long-chain omega-3 fatty acid in phospholipid measured in red quadriceps correlated highly with insulin action in that muscle (r = 0.97). We conclude that 1) the particular fatty acids and the lipid environment in which they are presented in high-fat diets determine insulin sensitivity in rats; 2) impaired insulin action in skeletal muscle relates to triglyceride accumulation, suggesting intracellular glucose-fatty acid cycle involvement; and 3) long-chain omega-3 fatty acids in phospholipid of skeletal muscle may be important for efficient insulin action.

Evaluation of patterns of perfusion and metabolism in dobutamine-responsive myocardium.

OBJECTIVES: We investigated the patterns of perfusion and metabolism in dysfunctional myocardium whose contractility improved with dobutamine. BACKGROUND: Clinical studies have suggested that dobutamine echocardiography can identify hibernating myocardium, but laboratory studies suggest that reduced perfusion limits the response to dobutamine. METHODS: Twenty-five patients with coronary disease and ventricular dysfunction underwent low (5 and 10 micrograms/kg body weight per min) and high dose (maximum of 50 micrograms/kg per min) dobutamine echocardiography and positron emission tomography (PET) using nitrogen-13 (N-13) ammonia and fluorine-18 fluorodeoxyglucose (FDG) for imaging of perfusion and metabolism. Wall motion and tracer uptake were scored in 16 left ventricular segments. RESULTS: Perfusion and metabolism were normal in 56.4%, mildly reduced in 29.1% and mismatched (reduced perfusion, preserved FDG uptake) in 14.5% of dysfunctional segments viable on PET. Wall motion improved with dobutamine in 89 dysfunctional segments (62 at low dose, 27 only at peak dose), and 86 of these (97%) were viable on PET. Improvement in wall motion with dobutamine was more common in segments with normal perfusion and metabolism (56.5%) than in those with mildly reduced tracer uptake (28.5%, p < 0.001) and those with mismatch (32%, p = 0.03). All the segments with a biphasic response were supplied by vessels with > or = 70% stenosis, and 88% had normal perfusion and metabolism. CONCLUSIONS: The majority of viable segments with rest dysfunction had normal perfusion and metabolism, suggesting that myocardial stunning was common. Improvement of wall motion at low and high doses of dobutamine was highly correlated with myocardial viability on PET and was more common in myocardium with normal perfusion. A biphasic response to dobutamine identified segments with normal perfusion and metabolism supplied by severely diseased vessels.

[Giant extradural epidermoid cyst of the posterior fossa]. / Kyste épidermoïde extra-dural géant de la fosse postérieure.

We report an unusual case of giant extradural epidermoid cyst of the posterior fossa in a 73-year-old man. The patient presented headache and gait disturbance for 3-4 months, cerebellar ataxia, left cerebellar dysmetria, and perturbed balance. The CT-scan showed a huge posterior fossa extradural lesion with a small area of peripheral contrast enhancement. Outcome was good after total resection of the lesion via a suboccipital approach. Pathology reported an epidermoid cyst. Extradural epidermoid cyst is a rare benign tumor of the skull which sometimes can reach considerable size. It is a slow growing lesion and may cause mild neurological deficits. The goal of surgical treatment is total resection of the tumor with its capsule. The long-term prognosis is excellent after successful resection.

Fructose-induced in vivo insulin resistance and elevated plasma triglyceride levels in rats.

Insulin action was assessed by using the hyperinsulinemic (approximately 800 pmol/L) euglycemic clamp in rats fed equal amounts of glucose or fructose (35% of calories) for 4 wk. The glucose infusion rate required to maintain euglycemia was decreased in fructose-fed animals (14.6 +/- 1.4 vs 21.8 +/- 1.1 for glucose-fed rats, p less than 0.001) with this whole-body effect contributed to equally by an impairment in hepatic insulin action and a reduction in peripheral glucose disposal in a range of tissues. There was no difference in basal glucose turnover, energy expenditure, or postprandial blood glucose and insulin responses to the diets. In the fructose-fed rats there was an increase in fasting triglyceride levels by 2 wk. Euglycemic clamp glucose disposal correlated positively and clamp hepatic glucose output correlated negatively with fasting triglyceride levels. In summary, fructose but not glucose feeding led to impaired insulin action in both the liver and peripheral tissues, effects that may depend on antecedent circulating triglyceride levels.

Sarcoidosis: the value of exercise testing.

STUDY OBJECTIVES: To evaluate exercise testing for the assessment of the extent of pulmonary disease in patients with sarcoidosis. DESIGN: Retrospective analysis of consecutive patients with sarcoidosis referred to the Pulmonary Physiology Laboratory between 1992 and 1997, who completed at least 6 min of progressive bicycle exercise. Resting and exercise pulmonary function measurements were compared to radiographic stage of disease. SETTING: Pulmonary Physiology Laboratory at Washington, DC, Veterans Affairs Medical Center. PATIENTS: Forty-eight outpatient veterans with biopsy specimen-proven sarcoidosis. RESULTS: Across all radiographic stages of sarcoidosis, total lung capacity, resting diffusing capacity, and exercise gas exchange measurements had a significant variance with radiographic stage. Across the early radiographic stage disease (stages 0 to 2), the change in alveolar-arterial oxygen pressure gradient between rest and exercise, normalized for oxygen uptake, was the most significant measurement in its variation with radiographic stage. CONCLUSIONS: Changes in gas exchange with exercise may be the most sensitive physiologic measurements to assess the extent of disease in early radiographic stages of sarcoidosis.

Periodontal adaptation following extensive extrusion and rotation of a horizontally impacted maxillary central incisor. A case report.

This report reviews the literature concerning the periodontal considerations involved in nonextraction management of impacted teeth. Further, it describes the clinical and radiographic features of periodontal tissue response to an 18-mm extrusion and 160 degree simultaneous rotation of a horizontally impacted maxillary central incisor in a 22-year-old female patient. Following surgical exposure of the unerupted incisor, an elastic thread traction was used to orthodontically move the tooth to the line of occlusion. Posttreatment evaluation of the periodontal and gingival response to a tooth movement of this complexity and magnitude was very favorable from the esthetic and functional aspects.

Lactic acidosis secondary to nucleoside analogue antiretroviral therapy.

A 53-year-old woman with newly diagnosed HIV infection was treated with the nucleoside analogue antiretroviral agents lamivudine and stavudine and the protease inhibitor indinavir. An illness characterized by severe lethargy, persistent nausea and vomiting, lactic acidosis, hyperglycemia, and microvesicular hepatic steatosis developed. Her symptoms improved gradually after withdrawal of the antiretroviral agents. The illness can be explained by mitochondrial dysfunction caused by inhibition of mitochondrial DNA (mtDNA) polymerase by the nucleoside analogues. The patient was successfully treated with nonnucleoside reverse transcriptase inhibitors, which lack affinity for mtDNA polymerase.

[Ethanol and the gastrointestinal tract]. / Etanol e o trato gastrointestinal.

The effects of ethanol upon the gastrointestinal tract (mouth, pharynx, esophagus, stomach, duodenum, Oddi's sphincter, small bowel, colon and rectum) were reviewed. Several studies showed that the incidence of cancer in the mouth and pharynx is increased in alcoholics as a consequence of ethanol effects and probably those of other compounds found in liquors. The gastroesophageal reflux disease may be induced by alcohol since it reduces the pressure in the lower and the upper esophageal sphincter, as well as the extent of primary peristalsis. Several studies showed a strong correlation between esophageal cancer and alcohol abuse. The risk for developing this kind of tumour is significantly increased when alcohol abuse and smoking coexist. Alcoholism predisposes patients to Mallory-Weiss syndrome as well as to bleeding of esophageal varices Ethanol may affect gastric secretion, motility, and permeability. Some drugs acting upon the gastric alcohol-dehydrogenase are able to affect gastric absorption of ethanol. Eradication of Helicobacter pylori increases the activity of alcohol-dehydrogenase in the pyloric antrum. The effects of alcohol upon the gastric mucosa include caustic damage, retrograde diffusion of H+, and cytoprotection. This agent may cause an acute gastritis but it is probably not involved in chronic gastritis. Whether alcohol is a risk factor for ulcer or not is unknown. Some studies found an increased incidence of gastric cancer associated with consumption of beer, wine and vodka. Some authors reported a decreased pressure in Oddi's sphincter while others found it increased in association with the consumption of ethanol. The acute and the chronic consumption of alcohol may affect the structure of small bowel as well as the absorption of nutrients. Several studies reported a significant correlation between colorectal cancer and the chronic consumption of ethanol.

[Intracerebellar schwannoma. Apropos of a case. Review of the literature]. / Schwannome intra-cérébelleux. A propos d'un cas. Revue de la littérature.

Intracranial schwannoma represents 8% of all primary brain tumors. It usually develops from the Schwann cells of a cranial nerve. Hemispheric intraparenchymal localisations are quite rare; 15 cases have been reported (3, 5, 12, 10, 14, 15, 18, 19, 23, 26, 28, 29) including one intraventricular localization (8). Intracerebellar localization is even by more exceptional. In 1977, one case was reported by Komminoth (16). Since then only one other case has been published in 1987 by Sarkar (25). In this paper, we report a third case.

Exner's Depression Index and the Harris-Lingoes MMPI-2 subscales for depression.

This study examined the relationship between scores on the Harris-Lingoes MMPI-2 subscales for Depression and the categories of Exner's Rorschach Depression Index (DEPI) for 53 clients of a counselling agency. Scores on the subscale Mental Dullness related to the Depression Index as a whole and to the category Blends < 4. The subscale Subjective Depression also related to the category Blends < 4.

[Intrahepatic cholestasis with situs inversus of the liver]. / Colestase intra-hepática em situs inversus do fígado.

Intrahepatic cholestasis with situs inversus of the liver has not been reported in the literature. PURPOSE--A follow-up case for approximately 14 years (by one of the authors, MM). METHODS--Clinical aspects were studied and several laboratory exams as well as three ultrasonography and one computerized tomography exams were performed. Percutaneous and endoscopic cholangiographies were attempted. RESULTS--Four days after the patient was submitted to a surgical replacement of the aortic valve (with extracorporeal circulation), she developed jaundice, severe pruritus, dark urine, and pale stools. Serum levels of bilirubin, alkaline phosphatase, gama-glutamil transferase, and cholesterol were very high. Ultrasonography and computerized tomography exams did not reveal any evidence of extrahepatic obstruction. The tomography exam confirmed the existence of situs inversus in the stomach and liver. We were not successful in performing the cholangiography exams. Clinical and laboratory data as to cholestasis returned to normal after 4 months with no recurrence or complication during the follow-up period (14 years). CONCLUSION--The differential diagnosis between intra and extra-hepatic cholestasis in patients with situs inversus of the liver may be difficult. Therefore it will be necessary to collect clinical data and various complementary exams such as endoscopic retrograde cholangiopancreatography which is very difficult to perform in these patients.

[Hepatotoxic substances in Brazilian rum]. / Substâncias hepatotóxicas em pingas nacionais.

The purpose of this study was to investigate whether Brazilian "pingas" (liquor distilled from sugar cane) contain toxic agents other than ethanol at levels which might risk consumers health, especially regarding liver damage. We have studied 8 different "pingas" in which the levels of iron, copper and zinc were measured through an atomic absorption method, and the levels of ethanol, acetaldehyde, n-propanol, ethyl acetate, isobutane, and isoamylic alcohol were measured through gas chromatography and mass spectrometry. Iron levels were higher than those allowed in two liquors, samples 1 and 8 (respectively 0.57 mg/L and 0.38 mg/L). Such levels may be considered deleterious to health if these liquors are consumed in great amounts and during large periods, especially if a synergistic interaction between alcohol and iron exists, as accepted by some authors. Our findings warrant that further studies be performed.

[Bicortical reconstruction of a large calvarial bone defect with Hydroset® osteoconductive cement and titanium mesh. A preliminary study]. / Reconstitution bicorticale de grande taille de l'os calvarial par ciment ostéoconducteur Hydroset® associé à une grille en titane. Étude préliminaire.

INTRODUCTION: Bi-cortical calvarial bone loss is a very frequent issue for neurosurgery and craniofacial surgery. Several techniques can be used to reconstruct the skull, with variable difficulty and costs. The purpose of our study was to assess the use of Hydroset® osteoconductive cement for large size bicortical cranioplasties. MATERIALS AND METHODS: Three patients presented with extensive loss of calvarial bone bi-cortical substance (>25 cm(2)), between 2010 and 2012. The 3 patients underwent cranioplasty with Hydroset® osteoconductive cement and titanium mesh. RESULTS: The esthetic results were very satisfactory, especially for the skull dome, with a completely invisible and non-palpable cement/native skull junction. Scalp adherence to the cement was natural with maintenance of skin mobility. DISCUSSION: Bicortical calvarial bone reconstruction with Hydroset® cement is technically easy to perform, gives very good results, with an uneventful outcome, and induces lower costs.

Human endothelial lecitin-like oxLDL receptor-1 (LOX-1) expression is not associated with impairment of endothelium-dependent vasoreactivity in conduit vessels.

UNLABELLED: The cellular uptake of oxidized low density lipoprotein (LDL) is mediated through the oxidized LDL receptor-1, LOX-1. We investigated whether circulating factors link LOX-1 expression in endothelial cells and impaired endothelium-dependent vasoreactivity (EDVR) as functional indicator of atherogenesis. EDVR was measured as flow-mediated dilation (FMD) of the brachial artery in 27 patients with a known history of cardiovascular disease. Human umbilical vein endothelial cells (HUVEC) were incubated with bradykinin or prostacyclin in the presence of tumour necrosis factor-alpha (TNF-α) or with serum of each patient for four hours. Total mRNA and protein extracts were analysed for LOX-1 and eNOS expression relative to the expression in medium-treated cells and corrected for GAPDH expression. RESULTS: Prostacyclin and bradykinin did not modulate LOX-1 basal expression but were able to prevent significantly the up-regulation of LOX-1 expression by TNF-α, in HUVEC in vitro. Impaired EDVR was associated significantly with reduced endothelial nitric oxide synthase (eNOS) protein expression in HUVEC (r=0.788, P<0.001), diabetes (P=0.024), and smoking status (yes/no, P=0.047). In contrast, no such association was established with LOX-1 mRNA (r=0.292, P=0.138) or with LOX-1 protein expression in HUVEC (r=0.201, P=0.312). CONCLUSIONS: Using a combination of in vitro experiments with in vivo measurements, we found no evidence that endothelial LOX-1 expression and EDVR mediated through circulating factors were associated.