A muscle mass in a patient with polymyalgia rheumatica.

We report the extremely uncommon case of a 77-year-old woman in whom a tumor found to be a melanotic schwannoma, arising from the right rectus abdominis muscle, was detected during investigation for a rheumatic disorder, finally identified as polymyalgia rheumatica (PMR). Tumors of this type most commonly occur in spinal nerve roots, and their clinical behavior is very difficult to predict. As far as we are aware, this is the first reported case affecting the aforementioned site. The challenging issue in this case concerns the possible link between the 2 clinical conditions, in particular the development of PMR as a paraneoplastic syndrome. Although such an association has not been reported, PMR is included among the rheumatic disorders reported to be associated with malignancies and occasionally with benign tumors. However, given that tumor resection did not result in remission of PMR and symptoms improved rapidly with prednisone, it seems likely that the above disorders might simply coexist.

Infants of depressed mothers exhibit atypical frontal electrical brain activity during interactions with mother and with a familiar, nondepressed adult.

Previous studies have shown that infants of depressed mothers exhibit atypical frontal brain electrical activity when they are interacting with their mothers. Whereas typically developing infants exhibit greater left versus right frontal brain activity, infants of depressed mothers have been found to exhibit reduced relative left frontal activity. The left frontal brain region has been associated with the expression of positive emotions. In the present study, the question of whether the atypical pattern of brain activity found in infants of depressed mothers generalizes to situations not involving mother was addressed. Brain electrical activity was recorded from 13- to 15-month-old infants of depressed (N = 59) versus nondepressed (N = 40) mothers during a baseline condition, and during several social conditions that included a playful social interaction with a familiar experiments. Infants of depressed mothers exhibited reduced left relative to right frontal activity during the baseline condition, and during interactions with their mothers and with the familiar experimenter. The present results suggest that the atypical pattern of electrical brain activity found in infants of depressed mothers generalizes to a variety of situations, including positive interactions with nondepressed adults.

Frontal brain electrical activity in infants of depressed and nondepressed mothers: relation to variations in infant behavior.

In previous studies, infants of depressed mothers have been found to exhibit reduced left frontal brain electrical activity (EEG). The left frontal region has been hypothesized to mediate social approach behaviors and positive affective expression. These findings raise important questions about the cause and nature of atypical EEG patterns in infants of depressed mothers. The present study begins to address some of these questions by examining whether or not variations in patterns of frontal brain activity in infants of depressed and nondepressed mothers are related to variations in infant behavior as observed in naturalistic situations. If such relations exist, are they specific to certain behaviors hypothesized to be mediated by the frontal region (i.e., positive approach behaviors)? Frontal and parietal brain electrical activity was recorded from 14- to 15-month old infants of depressed versus nondepressed mothers during a baseline condition and during conditions designed to elicit interest and positive affect. Infant behavior was observed in naturalistic play conditions, with and without mother, on a separate day from EEG testing. Mothers provided information on infant temperament. Infants of depressed mothers showed less affection and touching of their mothers. For infants of depressed mothers only, reduced left frontal brain activity was found to be related to lower levels of affection toward mother, but not to infant temperament. Furthermore, increased generalized frontal activation was found to be related to higher levels of negative affect, hostility, and tantrums and aggression. Relations between infant brain activity and behavior were not found for parietal EEG activity. These results suggest that infant frontal electrical brain activity is related to variations in infant behavior, especially those involved in positive affiliative behavior and the expression and regulation of negative affect. The nature and cause of atypical patterns of brain activity and question of whether such atypical patterns of frontal brain activity predispose infants to affective disorders in later life are discussed.

Large tension bronchogenic cyst in an adult mimicking the Swyer-James syndrome.

A case report of a large tension bronchogenic cyst in an adult that appeared as the Swyer-James/Macleod's syndrome is presented. Despite the thorough preoperative examinations the diagnosis was confirmed only after exploratory thoracotomy and histopathological study.

Intramural bronchogenic cyst of the oesophagus: a rare entity.

Bronchogenic cysts are congenital cystic lesions of foregut origin, usually intra-pulmonary or mediastinal in location. Peri-oesophageal bronchogenic cysts are rare, while intra-oesophageal cysts are almost always considered as enterogenous owing to their location and their composition. We report here an unusual case of a young adult with an intramural bronchogenic cyst causing dysphagia. Despite the fact that the cyst was completely embedded in the oesophageal wall, the pathological findings revealed the respiratory origin of the cyst. An extramucosal excision of the cyst was performed establishing the diagnosis and alleviating all our patient's symptoms.

Infants of depressed and nondepressed mothers exhibit differences in frontal brain electrical activity during the expression of negative emotions.

Studies have shown that infants of depressed mothers express negative emotions more frequently than infants of nondepressed mothers. The present study examined electrical brain activity during expression of negative and positive emotions in infants of depressed and nondepressed mothers. Infants, 11 to 17 months of age, were exposed to conditions designed to elicit positive and negative emotions while electroencephalographic (EEG) activity was measured from left and right, frontal and parietal regions. EEG activity was analyzed when infants were displaying prototypic expressions of emotions. Compared with infants of nondepressed mothers, infants of depressed mothers exhibited increased EEG activation in the frontal but not parietal region when expressing negative emotions (unfelt smiles and anger). The two groups of infants did not show reliable differences is brain activation during the expression of positive emotions (happiness, surprise) or neutral expressions. Compared with infants of nondepressed mothers, infants of depressed mothers exhibit greater frontal EEG activation during the expression of negative emotions.

Functional MR spectroscopy of the auditory cortex in healthy subjects and patients with sudden hearing loss.

PURPOSE: To use MR spectroscopy to study the biochemical changes produced by auditory stimuli in patients with sudden sensorineural hearing loss and to compare these findings with the biochemical changes seen in healthy volunteers. METHODS: Single-voxel MR spectroscopy was used to study biochemical changes in the auditory cortex in 11 control subjects and 19 patients with sudden sensorineural hearing loss. MR spectroscopic signals were measured during three different sound conditions (scanner noise, music, and sirens). RESULTS: A lower MR spectroscopic lactate signal was observed in control subjects during the music stimulus than during the other sound conditions. This music-induced lactate change was not observed in patients with hearing loss. The other proton metabolites (choline, creatine, N-acetylaspartate [NAA]) remained stable during the different auditory stimuli. However, the NAA/creatine ratio was higher in the auditory cortex of patients than in the control subjects, and was not dependent on the sound condition. CONCLUSION: The detection of stimulus-induced and stable biochemical MR spectroscopic changes in patients with hearing loss may be useful in assessing disease activity.

Infants of depressed mothers exhibit atypical frontal brain activity: a replication and extension of previous findings.

The left frontal brain region is specialized for expression of positive emotions (e.g. joy) whereas the right frontal region is specialized for negative emotions (e.g. sadness). Depressed adults have been found to exhibit reduced left frontal electroencephalographic activity. In this study, baseline frontal and parietal EEG activity was measured in 13-15-month-old infants of depressed and nondepressed mothers who were of middle income with no other major psychiatric problems. Compared to infants of nondepressed mothers, infants of depressed mothers exhibited reduced left frontal EEG activity. Infants of mothers with major depression exhibited lower levels of left frontal EEG activity than those of mothers with subthreshold depression.

Subgroups of autistic children based on social behavior display distinct patterns of brain activity.

Two questions were addressed in the present study: (1) Do autistic and normally developing children exhibit regionally specific differences in electroencephalographic (EEG) activity? (2) Do subgroups of autistic children classified according to Wing and Gould's (1979) system which emphasizes degree of social impairment exhibit distinct patterns of EEG activity? Twenty-eight children with autism (5 to 18 years of age) and two groups of normally developing children (one matched on chronological age and the other on receptive language level) participated. EEG was recorded from left and right frontal, temporal, and parietal regions during an alert baseline condition. Compared to normally developing children, autistic children exhibited reduced EEG power in the frontal and temporal regions, but not in the parietal region. Differences were more prominent in the left than the right hemisphere. Furthermore, subgroups of autistic children based on Wing and Gould's system displayed distinct patterns of brain activity. Compared to autistic children classified as "active-but-odd," "passive" autistic children displayed reduced alpha EEG power in the frontal region.

Case report on primary and secondary aortoenteric fistula in patient.

A rare case is reported of a 77-year-old male with secondary aortoenteric fistula after earlier ligation of infrarenal aorta without any prosthetic grafting in the abdomen. The patient was admitted into our Clinic suffering from haematemesis and melaena. The combination of our patient's medical history, the endoscopic picture and MRI arteriography indicated the likelihood of a secondary aortoenteric fistula. Three years before this our patient had been successfully operated on for a primary aortoenteric fistula having an aneurysmectomy, ligation of the infrarenal aorta and an axillobifemoral bypass performed on him while the duodenum was sutured and patched with omentum. The choice of this surgical procedure was unavoidable because our patient had been operated on for a duodenal ulcer perforation 3 days before this. With the diagnosis of a secondary aortoenteric fistula very possible an urgent laparotomy was performed revealing a fistula between the third duodenal portion and the aortic stump. The duodenum was separated from the aortic stump to which a dacron patch, posterior peritoneum and omentum were sewn. Postoperatively the patient required respiratory support in intensive care for 4 days and was discharged within 8 days. Today, two years later, he continues to be in excellent condition.

The role of frontal lobe functioning in the development of infant self-regulatory behavior.

In the last two decades, there has been tremendous growth in two fields of study related to human infant development: (1) the development of neural processes during the early postnatal years and (2) the development of self-regulatory behavior. In an attempt to stimulate research on the relation between early brain development and self-regulatory processes, several hypotheses pertaining to the role of frontal lobe functioning in the development of emotion regulation during infancy are proposed. The results of a study of the relation between frontal electroencephalographic (EEG) activity and emotional behavior of 21-month-old infants are reported. It was found that increases in frontal lobe activation were associated with increases in emotional arousal, while EEG activity recorded from the parietal region showed either a reciprocal pattern of activation or did not change as a function of level of emotional arousal. These results provide evidence for the specialized role of the frontal lobe in mediating emotional behavior during infancy.

Frontal lobe activity and affective behavior of infants of mothers with depressive symptoms.

Studies of adults and infants indicate that the left frontal brain region is specialized for approach emotions, such as joy, whereas the right frontal region is specialized for withdrawal emotions, such as distress. Furthermore, depressed adults have been found to show reduced brain activity in the left frontal region. In this study, frontal and parietal electroencephalographic (EEG) activity was recorded from 27 infants aged 11-17 months (13 of whose mothers reported elevated depressive symptoms) during baseline and emotion-eliciting conditions. Compared with infants of nonsymptomatic mothers, infants of symptomatic mothers exhibited reduced left frontal brain activity during playful interactions with their mothers and failed to exhibit the typical pattern of greater right frontal activity during a condition designed to elicit distress (maternal separation). Infants of symptomatic mothers also showed less distress during maternal separation; however, no group differences in behavior were found during the playful condition. Group differences were evident in the frontal region, but not in parietal brain activity.