Is bupropion useful in the treatment of post-stroke thalamic apathy? A case report and considerations.

Post-stroke apathy is considered to be one of the clinical consequences of lesions affecting the structures of the prefrontal cortex, basal ganglia, thalamus and limbic system. However, there is no current consensus on the treatment of post-stroke apathy, which mainly depends on the underlying etiology and comorbidities. A 62-year-old man, affected by hemorrhagic stroke in the left thalamus, presented with mood depression, anhedonia, hyporexia and marked apathy. The patient underwent clinical evaluation before and after receiving two different pharmacological therapies: escitalopram and bupropion. Only after treatment with the latter drug did the patient show changes: high motivation and willingness to pursue activities, greater interest in the external environment and social life activities, and an overall reduction of apathy. On the basis of our observations in this case, we hypothesize that the thalamic lesion resulted in disconnection of the fronto-striatal-thalamic circuits, and that loss of the dopaminergic striatal innervation caused the patient's apathetic state. The resolution of the apathetic disorder may be attributable to the action of the dopaminergic drug bupropion on the mesocortical pathway.

Quantitative evaluation of Listeria monocytogenes in fresh and processed surubim fish (Pseudoplatystoma sp) / Avaliação quantitativa de Listeria monocytogenes em surubim (Pseudoplatystoma sp) fresco e processado

L. monocytogenes is a foodborne psychrotrophic bacterial pathogen of special importance for minimally processed foods. In this work, it was enumerated in samples of surubim fish by MPN technique. The population of L. monocytogenes was estimated as < 0.012 MPN/cm² in fresh and < 0.03 MPN/g in minimally processed fish.

L. monocytogenes é um patógeno psicrotrófico transmitido por alimentos, de importância especial para alimentos minimamente processados. Neste trabalho, a bactéria foi enumerada em amostras de peixe surubim utilizando-se a técnica do NMP. A população de L. monocytogenes foi estimada como < 0.012 NMP/cm² do peixe fresco e < 0.03 NMP/g do peixe minimamente processado.

Epidemiological Survey of Listeria monocytogenes in a gravlax salmon processing line / Epidemiologia de Listeria monocytogenes em uma linha de processamento de salmão gravlax

Listeria monocytogenes is a cause of concern to food industries, mainly for those producing ready-to-eat (RTE) products. This microorganism can survive processing steps such as curing and cold smoking and is capable of growing under refrigeration temperatures. Its presence in RTE fish products with extended shelf life may be a risk to the susceptible population. One example of such a product is gravlax salmon; a refrigerated fish product not exposed to listericidal processes and was the subject of this study. In order to evaluate the incidence and dissemination of L. monocytogenes 415 samples were collected at different steps of a gravlax salmon processing line in São Paulo state, Brazil. L. monocytogenes was confirmed in salmon samples (41 percent), food contact surfaces (32 percent), non-food contact surfaces (43 percent) and of food handlers' samples (34 percent), but could not be detected in any ingredient. 179 L. monocytogenes isolates randomly selected were serogrouped and typed by PFGE. Most of L. monocytogenes strains belonged to serogroup 1 (73 percent). 61 combined pulsotypes were found and a dendrogram identified six clusters: most of the strains (120) belonged to cluster A. It was suggested that strains arriving into the plant via raw material could establish themselves in the processing environment contaminating the final product. The wide dissemination of L. monocytogenes in this plant indicates that a great effort has to be taken to eliminate the microorganism from these premises, even though it was not observed multiplication of the microorganism in the final product stored at 4ºC up to 90 days.

Listeria monocytogenes é um patógenode grande preocupação para as indústrias alimentícias, principalmente aquelas produtoras de alimentos prontos para consumo (RTE). Este microrganismo pode sobreviver às etapas de cura e defumação a frio, além de tolerar temperaturas de refrigeração. A presença de L. monocytogenes em pescados RTE com vida de prateleira longa representa um risco para a população susceptível, sendo o salmão gravlax deste tipo de produto. No presente estudo avaliou-se a incidência e disseminação de L. monocytogenes em 415 amostras de salmão gravlax obtidas de diferentes etapas de processamento de uma indústria localizada no Estado de São Paulo. A presença de L. monocytogenes foi confirmada em amostras de salmão (41 por cento), superfícies de contato (32 por cento) e não contato (43 por cento) e manipuladores (34 por cento), porém não se isolou o microrganismo em nenhum ingrediente. Do total de cepas isoladas, 179 destas foram escolhidas aleatoriamente e submetidas a sorologia e tipagem por PFGE. A maioria dos isolados pertenceu ao sorogrupo 1 (73 por cento), sendo identificados 61 pulsotipos quando se combinou os resultados de sorologia e PFGE e 6 clusters foram distribuídos em um dendrograma. O cluster A agrupou a maioria das cepas (120). Pode-se sugerir que as cepas foram introduzidas na linha de processamento por meio da matéria prima e contaminando o produto final. Estes resultados indicam que a eliminação de L. monocytogenes deste estabelecimento requer um grande esforço, ainda que o microrganismo não se multiplicou no produto final estocado a 4ºC por 90 dias.

Epidemiological Survey of Listeria monocytogenes in a gravlax salmon processing line.

Listeria monocytogenes is a cause of concern to food industries, mainly for those producing ready-to-eat (RTE) products. This microorganism can survive processing steps such as curing and cold smoking and is capable of growing under refrigeration temperatures. Its presence in RTE fish products with extended shelf life may be a risk to the susceptible population. One example of such a product is gravlax salmon; a refrigerated fish product not exposed to listericidal processes and was the subject of this study. In order to evaluate the incidence and dissemination of L. monocytogenes 415 samples were collected at different steps of a gravlax salmon processing line in São Paulo state, Brazil. L. monocytogenes was confirmed in salmon samples (41%), food contact surfaces (32%), non-food contact surfaces (43%) and of food handlers' samples (34%), but could not be detected in any ingredient. 179 L. monocytogenes isolates randomly selected were serogrouped and typed by PFGE. Most of L. monocytogenes strains belonged to serogroup 1 (73%). 61 combined pulsotypes were found and a dendrogram identified six clusters: most of the strains (120) belonged to cluster A. It was suggested that strains arriving into the plant via raw material could establish themselves in the processing environment contaminating the final product. The wide dissemination of L. monocytogenes in this plant indicates that a great effort has to be taken to eliminate the microorganism from these premises, even though it was not observed multiplication of the microorganism in the final product stored at 4°C up to 90 days.

Aggressive behaviour of cherubism in a teenager: 4-years of clinical follow-up associated with radiographic and histological features.

Cherubism is a rare hereditary fibro-osseous childhood disease characterized by bone degradation and fibrous tissue replacement at the angles of the mandible and at the tuberosity areas of the maxilla that leads to prominence of the lower face and an appearance reminiscent of the cherub's portrayal in Renaissance art. This disease has an autosomal dominant hereditary characteristic. The purpose of this report is to analyse laboratory tests, clinicopathological and radiographic features of cherubism and its intraoral manifestations in a patient during 4-years of follow-up, correlating the features observed in this case with those of the literature. Also discussed is the atypical and aggressive behaviour of this case during puberty.

Quantificação de Listeria monocytogenes em salames fatiados embalados a vácuo / Occurrence of Listeria monocytogenes in pre-sliced vacuum-packaged

There is scarce information in Brazil and other South American countries about the occurrence of Listeria monocytogenes in food, mainly refrigerated ready-to-eat products. The consumption of sliced vacuum-packaged meat products has increased in the last few years. Nevertheless, a complete assessment of the risk associated with L. monocytogenes in these products is still necessary. Because of the production and storage characteristics of these products, they can be considered potential vehicles for L. monocytogenes to humans, mainly immunocompromised, elderly, and pregnant women. The objectives of this study was to evaluate the population of L. monocytogenes in salami, a ready-to-eat meat product with extended shelf life, acquired in retail stores in São Paulo-Brazil. The three-tube most probable number technique was used and the methodology was that from Health Canada. Strains were biochemically identified and serotyped. Among the 45 samples, 3 (6.7 per cent) harboured 9.2 MPN/g of L. monocytogenes and the others < 0.3 MPN/g. All the strains belonged to serotypes 1/2a and 1/2b, the most frequent serotypes found in food everywhere. Even being low, the population of L. monocytogenes found in this product could be a cause of concern to public health authorities as it can pose a threat to population at risk. This contamination highlights the importance of implementing systems like HACCP to assure safe products to consumers.

Total reconstruction of the auricle after traumatic amputation.

We report a technique of auricular replantation used in a case of traumatic amputation. The principal difficulties encountered in this type of replantation are mentioned, and ways of avoiding them are suggested. All the skin of the ear was removed except for that of the anterior surface of the conch. At this site, the cartilage received small, multiple perforations to allow for nutrition of the corresponding skin. The remainder of the auricular cartilage was covered by a skin flap undermined from the mastoid region. Three months later, the retro-auricular region was freed and covered with a total skin graft taken from the right supraclavicular region. On the basis of the satisfactory results obtained, we discuss the intention and the technical details of the method and possible contraindications.

[Chromo-colposcopic images during oral contraception]. / Immagini cromocolposcopiche in corso di contraccezione orale.

The Authors report chromocolposcopic pictures with AZEA (Azure 2 + alcohol-soluble eosine + ethanol) and related histologic pictures in six women under oral contraception. Columnar epithelium develops violet or blue-violet areas histologically corresponding to endocervicitis. Aceto-white epithelium develops reddish color in case of medium-mature metaplasia, brown-violet in case of mature metaplasia, lilac in case of superficial koilocytosis on metaplasia. Native epithelium appears dark brown, or yellow-brown in case of koilocytosis.

Lower eyelid repair utilising triangular skin flaps with subcutaneous pedicles.

Fifty-four patients were studied during the period from 1984 to 1989. The lower eyelid was repaired in 55 cases utilising a triangular flap with a subcutaneous pedicle. Repair was achieved in 39 cases with a triangular flap only and in 16 it was necessary to use a chondromucosal graft of nasal septum as well. The method is described and is feasible for repairs ranging from the simplest to the most complex in different locations of the lid.

Retinal manifestations of neurofibromatosis. Diagnosis and management.

Five patients presented with vision-threatening retinal tumors and systemic signs of neurofibromatosis, including neurofibromatosis type 1 (four patients) and familial cafe-au-lait spots (one patient). These tumors included large retinal astrocytic hamartomas, multiple retinal capillary hemangiomas, and combined hamartomas of the retina and retinal pigment epithelium, which resulted in rubeotic glaucoma, vitreous hemorrhage, and retinal detachment. Surgical therapy included retinal cryopexy, xenon and argon photocoagulation, scleral buckling, and pars plana vitrectomy with excisional retinal biopsy. Retinal tumors may result in marked visual loss in patients with neurofibromatosis, and vitreoretinal surgery may restore useful vision in some of these patients.

Erbium-YAG laser surgery on experimental vitreous membranes.

We used a pulsed erbium-YAG laser emitting in the midinfrared region (2.94 microns) to cut experimental vitreous membranes in rabbits via an intraocular fiberoptic delivery system. Thirty-four membranes were cut at distances of 500 to 3600 microns from the retina. All 34 of the membranes treated were effectively cut. Sixteen cases had no evidence of retinal injury, including one in which the membrane was only 800 microns from the retina. Retinal injuries in the remaining cases consisted of small (less than 300 microns) retinal burns and hemorrhages. In 94% of the cases with retinal injury, the fiberoptic was within 2000 microns of the retina. We conclude that a pulsed erbium-YAG laser allows near tractionless cutting of vitreous membranes and may have potential for clinical use if further studies show it to be efficacious and safe near the retina.

Leiomyosarcoma of the orbit. A case report and review of the literature.

Leiomyosarcoma has been rarely encountered in the orbit. Leiomyosarcoma may arise as a primary tumor in the orbit, metastasize from distant sites to the orbit, extend into the orbit from the paranasal sinuses, or appear after radiation therapy to the orbit. The 43-year-old female patient described in this paper underwent excision of a leiomyosarcoma in the subcutaneous tissue of the buttock. Seven years later, a leiomyosarcoma in the medial orbit was removed. The clinical course of this patient's disease was similar to that of other subcutaneous leiomyosarcomas documented in the literature. Gynecological history was remarkable for a leiomyoma of the uterus, an interesting association found in at least one other case in the literature. This was the third documented case of metastatic leiomyosarcoma in the orbit.

Enxerto composto de pele e cartilagem auricular no tratamento de estenose traqueal. / Composite graft of skin and auricular cartilage in the treatment of tracheal stenosis. Apropos of a case

Os autores usaram enxerto composto de pele e cartilagem auricular autogena no tratamento de um caso de estenose traqueal recidivada apos resseccao de cinco aneis cartilaginosos, com boa evolucao pos-operatoria. A tecnica usada e descrita e proposta como uma opcao de tratamento