Musical hallucination associated with hearing loss / Alucinações musicais associadas a perda auditiva

In spite of the fact that musical hallucination have a significant impact on patients' lives, they have received very little attention of experts. Some researchers agree on a combination of peripheral and central dysfunctions as the mechanism that causes hallucination. The most accepted physiopathology of musical hallucination associated to hearing loss (caused by cochlear lesion, cochlear nerve lesion or by interruption of mesencephalon or pontine auditory information) is the disinhibition of auditory memory circuits due to sensory deprivation. Concerning the cortical area involved in musical hallucination, there is evidence that the excitatory mechanism of the superior temporal gyrus, as in epilepsies, is responsible for musical hallucination. In musical release hallucination there is also activation of the auditory association cortex. Finally, considering the laterality, functional studies with musical perception and imagery in normal individuals showed that songs with words cause bilateral temporal activation and melodies activate only the right lobe. The effect of hearing aids on the improvement of musical hallucination as a result of the hearing loss improvement is well documented. It happens because auditory hallucination may be influenced by the external acoustical environment. Neuroleptics, antidepressants and anticonvulsants have been used in the treatment of musical hallucination. Cases of improvement with the administration of carbamazepine, meclobemide and donepezil were reported, but the results obtained were not consistent.

Apesar das alucinações musicais causarem grandes repercussões na vida dos pacientes, sempre foram pouco valorizadas e estudadas pelos profissionais. Alguns investigadores sugerem uma combinação de disfunções periféricas e centrais como o mecanismo causador das alucinações. A fisiopatologia mais aceita entre os pesquisadores de alucinação musical associada à hipoacusia ou anacusia (causada por lesão coclear, de nervo coclear ou interrupção de informação na ponte ou mesencéfalo) é a desibinição de circuitos de memória auditiva devido à deprivação sensorial. Em relação às áreas corticais envolvidas na alucinação musical, há evidência de que um mecanismo excitatório no córtex temporal superior, como nas epilepsias, seja responsável pela alucinação musical. Finalmente, considerando a lateralidade, estudos funcionais de percepção e imagética em indivíduos normais mostraram que canções com letras levam a ativação temporal bilateral e melodias ativam apenas o lobo temporal direito. É bem documentado o efeito de aparelhos auditivos na alucinação musical através de uma melhora da perda auditiva. Neurolépticos, antidepressivos e anticonvulsivantes têm sido usados no tratamento de alucinação musical na experiência clínica, mas não há eficácia comprovada na maioria dos casos. Há casos descritos na literatura com melhora das alucinações musicais com uso de carbamazepina, meclobemide e donepezil, entretanto sem resultados consistentes.

Repetitive transcranial magnetic stimulation improve tinnitus in normal hearing patients: a double-blind controlled, clinical and neuroimaging outcome study.

BACKGROUND AND PURPOSE: Tinnitus is a frequent disorder which is very difficult to treat and there is compelling evidence that tinnitus is associated with functional alterations in the central nervous system. Targeted modulation of tinnitus-related cortical activity has been proposed as a promising new treatment approach. We aimed to investigate both immediate and long-term effects of low frequency (1 Hz) repetitive transcranial magnetic stimulation (rTMS) in patients with tinnitus and normal hearing. METHODS: Using a parallel design, 20 patients were randomized to receive either active or placebo stimulation over the left temporoparietal cortex for five consecutive days. Treatment results were assessed by using the Tinnitus Handicap Inventory. Ethyl cysteinate dimmer-single photon emission computed tomography (SPECT) imaging was performed before and 14 days after rTMS. RESULTS: After active rTMS there was significant improvement of the tinnitus score as compared to sham rTMS for up to 6 months after stimulation. SPECT measurements demonstrated a reduction of metabolic activity in the inferior left temporal lobe after active rTMS. CONCLUSION: These results support the potential of rTMS as a new therapeutic tool for the treatment of chronic tinnitus, by demonstrating a significant reduction of tinnitus complaints over a period of at least 6 months and significant reduction of neural activity in the inferior temporal cortex, despite the stimulation applied on the superior temporal cortex.

Ear and nose foreign body removal in children.

The removal of foreign bodies in children is very common in the otolaryngologist's daily routine. We present a prospective series of 187 cases of ear and nose foreign bodies removed from children aged 0-12 years old in a 6-month period--95 females (50.8%) and 92 males (49.2%); 78 children (41.71%) aged from 1 to 2 years, 66 (35.29%) from 3 to 5 years. There were 93 cases (49.73%) of ear foreign bodies, in which a bean was the most common (24.73%), and 94 cases (50.27%) of nose foreign bodies, in which sponge fragments predominated (36.17%). In 82 cases (45.85%), the removal was performed within the first 24 h after the foreign body insertion, and 86 (45.98%) of the patients had previous attempts to remove it. Thirteen cases with complications (external ear canal lacerations, tympanic membrane perforation) were observed in patients in whom these previous attempts had been made, but there were no sequelae. This corresponds to one of the largest reports of ear and nose foreign body removal in children in the literature; we conclude that younger children are more prone to insert foreign bodies, which are objects usually found at home. Complications may occur as a result of attempts to remove the foreign body without the help of specialised personnel or proper conditions.

[The effect of vasotocin and mesotocin on the suprarenal gland of the frog Rana temporaria in vivo and in vitro]. / Vliianie vazototsina i mezototsina na suprarenalovuiu zhelezu liagushki Rana temporaria in vivo i in vitro.

Biochemical and morphometric analyses have been made of the effects of nonapeptide neurohormones, vasotocin and mesotocin, on the chromaffin tissue of the adrenal gland of the frog, both in vivo and in vitro experiments. It was shown that vasotocin exerts stimulating effect on the suprarenal gland whereas mesotocin inhibits the latter. In vitro experiments revealed that adrenalin may abolish the effect of nonapeptides on the suprarenal gland.

[The effect of vasotocin, mesotocin and adrenaline on the interrenal gland in the frog Rana temporaria under in-vitro conditions]. / Vliianie vazototsina, mezototsina i adrenalina na interrenalovuiu zhelezu liagushki Rana temporaria v usloviiakh in vitro.

Morphometric studies indicate that vasotocin increases the activity of the adrenal gland in frogs, whereas mesotocin and epinephrine do not essentially affect it. Combination of epinephrine with nonapeptides in cultural medium showed that the former may abolish the effect of vasotocin on the adrenal gland.

[The effect of injections of arginine vasotocin and mesotocin on the function of the interrenal gland in the frog Rana temporaria 2 months after the removal of the anterior lobe of the hypophysis]. / Vliianie in''ektsii arginin-vazototsina i mezototsina na sostoianie interrenalovoi zhelezy liagushki Rana temporaria spustia dva mesiatsa posle udaleniia perednei doli gipofiza.

Morphometric and biochemical studies have been made on the activity of interrenal gland in the frog Rana temporaria after removal of the anterior lobe of pituitary and injections of arginine vasotocin and mesotocin. It was demonstrated that the activity of this gland after the operation decreases increasing after arginine vasotocin injections.

[The reaction of the thyroid in the frog Rana temporaria to arginine-vasotocin administration]. / Reaktsiia shchitovidnoi zhelezy liagushki Rana temporaria na vvedenie arginin-vazototsina.

Using morphometric technique, it has been shown that single and especially three successive injections of a hypothalamic nonapeptide neurohormone, arginin-vasotocin (5.10(-9) M/kg of body weight) affect functional activity of the thyroid gland in sexually mature male frogs which had been subjected to hypophysectomy 10 or 60 days before neurohormonal treatment. These data presumably confirm a hypothesis about the direct para-adenohypophysial influence of the hypothalamic nonapeptide neurohormone on the peripheral endocrine glands, particularly, the thyroid one.

[The effect of dehydration on the functional activity of the interrenal gland in adenohypophysectomized Rana catesbeiana frogs. A preliminary report]. / Vliianie degidratatsii na funktsional'nuiu aktivnost' interrenalovoi zhelezy u adenogipofizéktomirovannykh liagushek Rana catesbeiana. Predvaritel'noe soobshchenie.

A significant increase of the content of corticosterone in the blood collected from intravenous cannula or by intracardiac punction has been detected using radioimmunoassay in non-operated and adenohypophysectomized frogs Rana catesbeiana subjected to dehydration in 6.2% mannitol solution during 24 hours. The osmolality of the blood plasma of these animals also increases although less significantly than the growth of plasma corticosterone content. There is a tendency to substantial increase of plasma arginine-vasotocin level prior to the growth of corticosterone level, already after 6 hours of dehydration. Based on the present results and literature data, it is suggested that in adenohypophysectomized frogs lacking endogenous ACTH just the increase of blood arginine-vasotocin level results in a substantial activation of corticosteroid-producing cells of the interrenal gland and in the growth of plasma content of corticosterone.

[The direct stimulating effect of arginine vasotocin on the functional activity of the interrenal gland in the frog Rana temporaria]. / Priamoe stimuliruiushchee vliianie arginin-vazototsina na funktsional'nuiu aktivnost' interrenalovoi zhelezy liagushki Rana temporaria.

Using radioimmunoassay it has been detected that both nonoperated and hypophysectomized, lacking endogenous ACTH, frogs injected one or three times with arginine vasotocin (5.10(-9) M/kg b. w.) show a statistically significant increase of plasma corticosterone level as compared with that in control animals and frogs injected with Ringer solution. The level of 11-hydroxycorticosteroids (fluorometric determination) in the interrenal gland decreases significantly only in animals three times injected with arginine vasotocin. It is assumed that arginine vasotocin produces a direct stimulatory effect on corticosteroid-producing cells of the frog interrenal gland.

[The effect of serotonin on the hypothalamic structures that participate in the regulation of the hypophyseal-adrenal cortex system]. / Vliianie serotonina na gipotalamicheskie struktury, uchastvuiushchie v reguliatsii gipofizarno-adrenokortikal'noi sistemy.

The activation of the 11-hydroxycorticosteroids secretion by 5-hydroxytryptophan was confirmed in intact rats as well as in those with isolated mediobasal hypothalamus. Deafferentation of the medial basal hypothalamus did not prevent an increase of corticoliberin and vasopressin content in the external median eminence after adrenalectomy and led to an opposite response after 5-hydroxytryptophan injection in these rats. The activation of the vasopressinergic cells and increase of portal vessels' lumen occurred under the 5-hydroxytryptophan effect, particularly in rats subjected to deafferentation combined with adrenalectomy.

[Morphofunctional research on the interrenal gland of the frog Rana temporaria following arginine vasotocin administration]. / Morfofunktsional'noe issledovanie interrenalovoi zhelezy liagushki Rana temporaria posle vvedeniia arginin-vazototsina.

Studies have been made of the effect of injections of hypothalamic nonapeptide neurohormone, arginine vasotocin, on functional condition of the interrenal gland in mature frogs. In unoperated, sham-operated and in animals 10 days after hypophysectomy, single and especially three subsequent injections of arginine vasotocin (5 x 10(-9) M per 1 kg of the body weight) result in evident activation of glandular cells of the interrenal gland which is manifested in the increase of the volume of their nuclei and cytoplasmic area, as well as in the dilatation of the blood vessels. Activation of the interrenal gland in hypophysectomized frogs, which lack endogenous ACTH, indicate the direct para-adenohypophyseal influences of nonapeptide hypothalamic hormones on the activity of glandular cells in the peripheral endocrine glands, in particular, the interrenal gland of the grass frog.

[Age-related dynamics of the response of the hypothalamo-hypophyseal neurosecretory system in rats to a change in corticoid levels of the blood]. / Vozrastnaia dinamika reaktsii gipotalamo-gipofizarnoi neirosekretornoi sistemy krys na izmenenie urovnia kortikoidov v krovi.

Hypothalamic vasopressin- and corticoliberinergic neurosecretory cells are able to change their activity after true or shame adrenalectomy in respect to the level of corticoids even in 10-day old rats. Vasopressin and corticoliberin accumulate in the nerve fiber terminals of the median eminence external zone a few days after surgery in young rats as opposed to the accumulation within 2-3 weeks usually observed in adults. The underdifferentiation of neurovascular relations in the neurohaemal area seems to be the reason for [areactivity] of the hypothalamo-hypophyseal system in young rats.

[Characteristics of neurosecretory centers of the rat hypothalamus associated with the regulation of adrenal cortex function]. / Kharakteristika neirosekretornykh tsentrov gipotalamusa krys, sviazannykh s reguliatsiei funktsii korkovogo veshchestva nadpochechnikov.

The reaction of neurosecretory cells of some hypothalamic centers of rats of different age to experimental change of the blood level of corticoids to elucidate their role in the regulation of function of the hypophyseoadrenocortical system was studied. Immunohistochemical methods revealed corticoliberin- and vasopressinergic cells in the hypothalamic paraventricular nucleus and vasopressinergic cells in the anterocommissural group of neurosecretory cells and in the supraoptic nucleus. The number of revealed corticoliberin-immunoreactive cells and the value of nucleoli of vasopressinergic cells served an indicator of the intensity of synthesis of neurohormones. In accordance with literature data there was an increase in the number of corticoliberin-immunoreactive cells after adrenalectomy. Vasopressinergic cells of the anterocommissural group were activated after true adrenalectomy. They responded by lowered activity to sham adrenalectomy. Small cell vasopressinergic elements of the paraventricular nucleus and, to a lesser degree, large cell elements responded by a rise of activity to true and sham adrenalectomy. It was assumed that vasopressinergic elements of the anterocommissural group were sensitive to the content of peripheral blood corticoids and were involved in the system of long negative feedback. Vasopressinergic elements, mostly small cells of the paraventricular nucleus, appeared to be responsible via the system of short negative feedback for maintaining the hypophyseal ACTH level.

[Adenosine triphosphatase activity in the osmoregulatory organs of vertebrates]. / Aktivnost' adenozintrifosfataz v osmoreguliruiushchikh organakh pozvonochnykh.

Studies have been made on the activity of cation- and anion-stimulated ATPases, as well as succinic dehydrogenase in homogenates and subcellular fractions from osmoregulatory organs of marine (elasmobranch and teleost) and freshwater (teleost) fishes, amphibians, reptiles, birds and mammals. The activity of Na+, K+-ATPase was found to be rather similar in almost all osmoregulatory organs of the species investigated. The highest level of Cl-stimulated ATPase was found in microsomal fraction of the kidneys from birds and mammals. Succinic dehydrogenase activity is significantly higher in the renal tissue of mammals, both in total homogenates and in mitochondrial fraction.

[Ultrastructure of the neurosecretory cells of the anterior commissural nucleus of the hypothalamus in rats]. / Ul'trastruktura neirosekretornykh kletok perednekomissural'nogo iadra gipotalamusa krys.

The ultrastructure of neurosecretory cells of the anterior commissural nucleus of rat hypothalamus is similar to that of the supraoptic nucleus and of the "magnocellular" part of the paraventricular nucleus. The only difference is a less expressed granular endoplasmatic reticulum and a smaller diameter of elementary neurosecretory granules (80-150 nm in diameter). Such elementary granules are characteristic of neurosecretory terminals located in the external zone of the median eminence. It is suggested that neurosecretory cells of the anterior commissural nucleus project to this neurohemal region.

[Relationship between the spawning process and quantitative ultrastructural analysis of the neurosecretory elements of the neurohypophysis of female Acipenser güldenstädti sturgeon]. / Kolichestvennyi ul'trastrukturnyi analiz neirosekretornyk élementov neirogipofiza samok osetra Acipenser guldenstadti v sviazi s protsessom neresta.

Quantitative studies have been made on functional condition of neurosecretory terminals in the neurohypophysis of sturgeon females during upstream migration, soon after spawning and 3 or more weeks after the latter. Electronmicroscopically, within each of the 3 types if neurosecretory terminals (A1, A2, B) certain forms were distinguished which correspond to separate phases of the secretory cycle; relative amounts of these forms were determined. Functional correlation in the activity of peptide- (A1, A2) and monoaminergic (B) terminals was observed which reveals itself in synchronous increase of the activity of peptidergic and the decrease in the activity of monoaminergic terminals immediately after spawning. At later stages, inactivation of all the 3 types of terminals takes place. Functional significance of this correlation is discussed in relation to double (peptide- and adrenergic) control of the activity of visceral organs during realization of protective and adaptive reactions of the organism under such natural stress conditions, as spawning.

[Median eminence of the hypothalamus in hypophysectomized rats: its structure and ultrastructure]. / Sredinnoe vozvyshenie gipotalamusa gipofizéktomirovannykh krys: struktura i ul'trastruktura.

The median eminence of the hypothalamus of intact and hypophysectomized rats has been studied by means of light and electron microscopy. Paraldehyde-fuchsin (PAF)-positive material is revealed in the external zone of the median eminence in 2-5 days after the operation. The PAF-positive material is also accumulated in the neurosecretory fibres localized around subependymal blood vessels. A2 fibres containing granules of 100-150 nm in diameter and B type fibres with granules up to 100 nm in diameter are seen in the external zone of the median eminence in intact rats. Besides, A1 fibres with granules of 120-200 nm in diameter are found near hypophyseal portal vessels in hypophysectomized animals. All type terminals make contact with blood vessels in the subependymal zone of the median eminence of hypophysectomized rats. It is suggested that terminals of the neurosecretory fibres of types A2 and B permanently make contact with the primary portal capillaries in the external zone of the median eminence, while A1 fibres ingrow in the median eminence in the course of postoperative reparation.

Ultrastructure of the sturgeon neurohypophysis. / O nekotorykh osobennostiakh ul'trastruktury neirogipofiza osetra

Three types of nerve fibres and their terminals have been revealed in the sturgeon neurohypophysis. Peptidergic A1 and A2 type fibres contain granules 120--200 and 100--160 nm in diameter, resp. Monoaminergic B type fibres have granules 80-100 nm in diameter. Terminals of A2 type predominate in the sturgeon neurohypophysis, A1 and B type terminals are a rarer occurrence. Different stages of exocytosis of the neurosecretory granule content were seen in the A1 and A2 type terminals. It is suggested that neurosecretory granules are the carriers of arginine-8-vasotocin and oxytocin-like polypeptide in A2 and A1 fibres, resp.