Pre-and post-surgical non-functional pituitary adenomas and their relationship with high levels of serum glucose.

OBJECTIVES: This clinical, analytical, retro-prospective, auto-controlled, not randomized, and not blinded study, aimed to investigate the association of changes in the serum glucose levels with the pre-and-post changes in the size tumor in mm3 in the Non-Functional pituitary adenomas. METHODS: Pre-and post-surgical MRI, as well as the measurements in the serum glucose levels and immunohistochemical techniques were performed in all the patients in the study, with a mean followed-up until 208.57 days. A comparison was made between the reductions in tumor size of hormonally active pituitary adenomas (HSPAs) vs NFPAs. RESULTS: Seventy-four patients were included in this study, of whom, 46 were NFPAs. The decrease in the NFPAs tumor size after surgery was statistically significant (P ≤ 0.0001). The Mean of the differences of both type of tumors in mm3 were -9552 ± 10287. Pre-surgery, the mean of the HSPAs were 8.923 ± 2.078; and the NFPAs were 14.161 ± 1.912. The differences in the tumor size were statistically significant (p = 0.039). Post-surgical, the mean of the HSPAs were 2.079 ± 971, with a (p = 0.14): and the NFPAs were 4.609 ± 1.205. After surgery of the NFPAs, most of the patients-maintained serum levels ≤ 100 mg/dL, with a statistical significance (P ≤ 0.0003). CONCLUSION: This study demonstrates for the first time the correlation between the presence of pre-and post- surgical changes in the NFPAs, with modifications in the levels of serum glucose, and the comparison, pre- and post-surgical between the tumor size of HSPAs and NFPAs.

Pre- and post-clinical-radiological and surgical evaluation of patients with pituitary adenoma and metabolic syndrome.

BACKGROUND: Pituitary adenomas are benign tumors located in the anterior hypophysis. Its appearance is associated with the development of parameters related to metabolic syndrome; therefore, surgical treatment could reduce associated morbimortality. METHODS: Pre- and post-surgical MRI, using the Hardy-Wilson and Knosp classification, and clinical data according to the American Association of Clinical Endocrinology (AACE) criteria for metabolic syndrome: all the patients were followed-up until 208.57 days were reviewed on 217 consecutive patients with pituitary surgery. RESULTS: Seventy-four patients were included in this study. There was a significant reduction in tumor size in mm3 [average pre- and post-surgery respectively: 12,362 mm3 (±12,397); 3,910 mm3 (±7,160)], (p < 0.0001). This was confirmed by the Hardy-Wilson and Knosp classification, where most patients went from grade IV C (33.7%) to grade 0 (12.1%), IA (20.2%), IIB (21.36%), and IIC (16.2%); as well as from grade 4 (24.3%) to grade 0 (45.9%), respectively. After surgery, there were statistically significant reductions in total serum levels of glucose [average pre- and post-surgery, respectively: 116 mg/dL (±26.9); 90 mg/dL (±10.2)], (p < 0.001), triglycerides [average pre- and post-surgery, 240 mg/dL (±102); 171 mg/dL (±60.5)], (p = 0.001); and HDL-c [average pre- and post-surgery, respectively: 39 mg/dL (±11.8); 44.6 mg/dL (±8.4)], (p = 0.029). The other parameters remained unchanged. CONCLUSION: This is the first study to demonstrate the relationship between the presence of pituitary adenoma and significative changes in serum glucose, triglycerides and c-HDL related to metabolic syndrome.

Multi-element contamination in soils from major mining areas in Northeastern of Brazil.

Mining has become one of the main factors in the global biogeochemical cycle of potentially toxic elements. Therefore, it is considered one of the anthropogenic activities with the greatest negative impact on the environment. These impacts are maximized in semiarid regions, where mining activities can lead to soil degradation and decrease in land productivity. This study aimed to assess the level of contamination in natural, urban, and agricultural soils of three important mining areas, where approximately 80,000 people live, and pollution levels have never been determined before. For this purpose, soil samples were collected around iron, uranium, and vanadium mines, as well as in the main human settlements of the region. The concentrations of 34 elements were determined by instrumental neutron analysis activation (INAA) and inductively coupled plasma optical emission spectrometry (ICP OES) techniques. Pollution indices (CF, EF, mCd, PLI, and REEP) revealed that there is a moderate to heavy level of pollution for 89% of the analyzed elements. Additionally, an extreme contamination level was observed in 78% of the samples, for at least one element. Statistical analyses were performed to identify patterns in the distribution and common sources of pollution. The results suggest that the concentrations for Al, Ba, Hf, Na, Pb, Rb, REE, Ta, Th, U, Zn, and Zr are associated with geogenic causes. However, the influence of anthropogenic sources such as agriculture and mining on the accumulation of these elements in soils should not be disregarded. In contrast, the contents of As, Br, Cd, Co, Cr, Cs, Cu, Fe, K, Mn, Ni, Sc, Ti, and V reflect the direct impact of anthropogenic sources.

HHRISK: A code for assessment of human health risk due to environmental chemical pollution.

Chemical environmental pollution is currently one of the most concerning environmental problem on a global scale, due to the high risks posed to ecological systems and human health. Risk assessment methodologies are valuable tools for preventive management and the mitigation of human health risks. However, the application of these methodological tools involves several steps and the knowledge of many variables, which can hinder its correct implementation. The main objective of this work was the development of the computational code for human health risk assessment: HHRISK (Human Health Risk). This code allows for an agile and accurate risk assessment based on the methodology established by the U.S. Environmental Protection Agency (U.S. EPA). Different from other published methods, the HHRISK code includes a new spatiotemporal matrix for the analysis of the aggregated risk (for multiple exposure pathways) and the cumulative (for exposure to multiple chemicals). HHRISK was applied to two case studies published dealing with the assessment of risk to human health through exposure to toxic metals, obtaining satisfactory results. The concordance between the average results obtained with the HHRISK and those reported by the authors confirm the validity of the implemented model. The inclusion of a greater spatiotemporal detail of the risks allowed to carry out a more accurate analysis and to propose new subsidies for a more efficient risk mitigation management by affected place and period of time.

Bioaccumulation of nickel in tomato plants: risks to human health and agro-environmental impacts.

Anthropogenic activities such as agriculture, industry, and mining have contributed significantly to the accumulation of heavy metals in the soil, which in turn cause problems to human health and to the environment. The present work aims to study the effects of nickel (Ni) on the development of tomato plants, the risks to human health associated to the consumption of contaminated tomatoes, and the consequences to the environment. The experiment was carried out in greenhouse environment for a period of 120 days, and the plants were cultivated in soils with four different concentrations of Ni: 0, 35, 70, and 105 mg kg-1. The concentration of nickel in each part (root, stem, leaf, and fruit) of the tomato plant was measured at four different stages of the cycle: 30, 60, 90, and 120 days, by inductively coupled plasma optical emission spectrometer (ICP-OES). At the end of the cycle, the concentration of certain macro- and micronutrients was also determined and related to the corresponding Ni concentration in the soil. The distribution of Ni in the parts of the plant was analyzed from the bioaccumulation factor temporal behavior. Nickel concentrations found in the fruit were too low to pose a risk to human health. As a result of this research, it was verified that soils with nickel concentrations close to 70 mg kg-1, which is the limit established by the CONAMA resolution (420/2009), may actually represent an optimum concentration value for the development of tomato plants. It also increases productivity per plant and reduces the use of resources such as water and agricultural inputs.

Cinética de degradação in situ das silagens de capim Andropogon gayanus produzidas em três idades de corte / In situ degradation kinetic of Andropogon gayanus grass silages harvested at three stages of maturity

A idade ao corte é considerada o principal fator a afetar o valor nutritivo das forragens. Objetivou-se avaliar e comparar a cinética de degradação ruminal da matéria seca (MS), proteína bruta (PB) e fibra insolúvel em detergente neutro (FDN) das silagens de capim Andropogon gayanus obtidas em três diferentes idades de corte (56, 84 e 112 dias). As amostras das silagens secas e trituradas (5 mm) foram incubadas em sacos de nylon no rúmen por 0, 6, 12, 24, 48 e 72 h. Os parâmetros da cinética de degradação das silagens de cada tratamento (3 silagens) em cada animal (5 vacas) foram determinados pelo modelo: y = a + b(1 − e −c(t−L)). Os parâmetros gerados pela equação foram analisados como blocos inteiramente ao acaso, sendo que as idades de corte foram inseridas como efeito fixo e os animais como efeito aleatório (blocos). A silagem da planta aos 56 dias de rebrote apresentou maiores (P<0,05) valores de degradabilidade efetiva da MS e da FDN calculada para a taxa de passagem de 2,0%/h. Todas as silagens apresentaram baixa fração solúvel (<25,4%) e degradabilidade efetiva (<40,1%) da proteína bruta com taxa de passagem de 2%. Foi observado maior (P<0,05) tempo de colonização da FDN para as silagens realizadas com as plantas aos 84 e 112 dias de crescimento em comparação com a silagem produzida aos 56 dias. Os resultados da cinética de degradação ruminal das silagens de capim Andropogon gayanus indicam que a planta ensilada aos 56 dias de rebrote apresentou melhor valor nutricional...

Maturity is considered the primary factor affecting the nutritive value of forages. The aim of this study was to evaluate and compare dry matter (DM), crude protein (CP) and neutral detergent fiber (NDF) ruminal degradation kinetics of Andropogon gayanus grass silages harvested at three stages of maturity (56, 84 and 112 d). Dried and ground silage samples (5 mm) were incubated in nylon bags inside the rumen for 0, 6, 12, 24, 48, 72 and 96 h to estimate the kinetics of ruminal DM, CP and NDF degradation. The ruminal kinetic parameters of the silages from each treatment (56, 84 and 112 d of regrowth) in each animal (5 cows) were determined by the model: y = a + b(1 − e−c(t−L)). The parameters generated by the model were analyzed as randomized block design, with grass regrowth age as the fixed effect and animal the as random effect (blocks). The grass silage ensiled with 56 days of regrowth had the highest (P<0.05) effective degradability of DM and NDF calculated for fractional rate of particulate passage of 2%/h. All silages had low CP soluble fraction (<25.4%) and effective degradability calculated for fractional rate of particulate passage of 2%/h (<40.1%). A greater (P<0.05) NDF lag time was observed for the silages ensiled with 84 and 112d compared to the silage produced with 56d of regrowth. The ruminal degradation kinetics of Andropogon gayanus grass silages showed that the grass ensiled with 56 days of regrowth had higher nutritional value...

Cinética de degradação in situ das silagens de capim Andropogon gayanus produzidas em três idades de corte / In situ degradation kinetic of Andropogon gayanus grass silages harvested at three stages of maturity

A idade ao corte é considerada o principal fator a afetar o valor nutritivo das forragens. Objetivou-se avaliar e comparar a cinética de degradação ruminal da matéria seca (MS), proteína bruta (PB) e fibra insolúvel em detergente neutro (FDN) das silagens de capim Andropogon gayanus obtidas em três diferentes idades de corte (56, 84 e 112 dias). As amostras das silagens secas e trituradas (5 mm) foram incubadas em sacos de nylon no rúmen por 0, 6, 12, 24, 48 e 72 h. Os parâmetros da cinética de degradação das silagens de cada tratamento (3 silagens) em cada animal (5 vacas) foram determinados pelo modelo: y = a + b(1 − e −c(t−L)). Os parâmetros gerados pela equação foram analisados como blocos inteiramente ao acaso, sendo que as idades de corte foram inseridas como efeito fixo e os animais como efeito aleatório (blocos). A silagem da planta aos 56 dias de rebrote apresentou maiores (P<0,05) valores de degradabilidade efetiva da MS e da FDN calculada para a taxa de passagem de 2,0%/h. Todas as silagens apresentaram baixa fração solúvel (<25,4%) e degradabilidade efetiva (<40,1%) da proteína bruta com taxa de passagem de 2%. Foi observado maior (P<0,05) tempo de colonização da FDN para as silagens realizadas com as plantas aos 84 e 112 dias de crescimento em comparação com a silagem produzida aos 56 dias. Os resultados da cinética de degradação ruminal das silagens de capim Andropogon gayanus indicam que a planta ensilada aos 56 dias de rebrote apresentou melhor valor nutricional.(AU)

Maturity is considered the primary factor affecting the nutritive value of forages. The aim of this study was to evaluate and compare dry matter (DM), crude protein (CP) and neutral detergent fiber (NDF) ruminal degradation kinetics of Andropogon gayanus grass silages harvested at three stages of maturity (56, 84 and 112 d). Dried and ground silage samples (5 mm) were incubated in nylon bags inside the rumen for 0, 6, 12, 24, 48, 72 and 96 h to estimate the kinetics of ruminal DM, CP and NDF degradation. The ruminal kinetic parameters of the silages from each treatment (56, 84 and 112 d of regrowth) in each animal (5 cows) were determined by the model: y = a + b(1 − e−c(t−L)). The parameters generated by the model were analyzed as randomized block design, with grass regrowth age as the fixed effect and animal the as random effect (blocks). The grass silage ensiled with 56 days of regrowth had the highest (P<0.05) effective degradability of DM and NDF calculated for fractional rate of particulate passage of 2%/h. All silages had low CP soluble fraction (<25.4%) and effective degradability calculated for fractional rate of particulate passage of 2%/h (<40.1%). A greater (P<0.05) NDF lag time was observed for the silages ensiled with 84 and 112d compared to the silage produced with 56d of regrowth. The ruminal degradation kinetics of Andropogon gayanus grass silages showed that the grass ensiled with 56 days of regrowth had higher nutritional value.(AU)

Qualidade da silagem de híbridos de sorgo em diferentes estádios de maturação / Silage quality of sorghum hybrids in different maturation stages

Avaliou-se a qualidade das silagens de três híbridos de sorgo, BRS 610, BR 700 e BRS 655, colhidos em três estádios de maturação da planta, grãos leitoso, pastoso e farináceo. O delineamento utilizado foi o inteiramente ao acaso, em esquema fatorial 3x3 (híbridos x estádios de maturação), com quatro repetições. Os teores de matéria seca apresentaram variação de 22,9% a 41,3%. O BR 700 apresentou maior porcentagem de matéria seca que os demais híbridos em todas as idades de corte. Os teores de proteína bruta e as frações fibrosas, fibra em detergente neutro e fibra em detergente ácido, apresentaram comportamento diferente entre estádios de maturação e entre híbridos. Os valores de lignina não foram alterados com o avanço da idade de corte. Os coeficientes de digestibilidade in vitro da matéria seca das silagens variaram de 50,7% a 55,6% e comportaram-se de forma diferente com a maturidade para cada hibrido. De acordo com os valores de pH, de nitrogênio amoniacal e de ácidos orgânicos encontrados, as silagens dos três híbridos são classificadas como de boa qualidade em todos os períodos de colheita.(AU)

The quality of silages of three sorghum hybrids BRS 610, BR 700 and BRS 655 harvested at three maturation stages, milk, soft dough and floury grains, was evaluated. A complete randomized design was used in a 3x3 factorial arrangement (hybrids x maturation stages), with four repetitions. Dry matter values varied from 22.9% to 41.3%. BR 700 had a higher percentage of dry matter than the other hybrids in all ages. The content of crude protein and fibrous fractions, neutral detergent fiber and acid detergent fiber presented different behavior between the maturation stages and between hybrids. The lignin values were not modified with the advancement of the cut age. The in vitro digestibility of silages varied from 50.7% to 55.6% and presented different behavior among each hybrid maturity. According to the pH, ammonia nitrogen, organic acids and dry matter values, the silages of the three hybrids were classified as good fermentation quality at all harvest periods.(AU)

Qualidade da silagem de híbridos de sorgo em diferentes estádios de maturação / Silage quality of sorghum hybrids in different maturation stages

Avaliou-se a qualidade das silagens de três híbridos de sorgo, BRS 610, BR 700 e BRS 655, colhidos em três estádios de maturação da planta, grãos leitoso, pastoso e farináceo. O delineamento utilizado foi o inteiramente ao acaso, em esquema fatorial 3x3 (híbridos x estádios de maturação), com quatro repetições. Os teores de matéria seca apresentaram variação de 22,9% a 41,3%. O BR 700 apresentou maior porcentagem de matéria seca que os demais híbridos em todas as idades de corte. Os teores de proteína bruta e as frações fibrosas, fibra em detergente neutro e fibra em detergente ácido, apresentaram comportamento diferente entre estádios de maturação e entre híbridos. Os valores de lignina não foram alterados com o avanço da idade de corte. Os coeficientes de digestibilidade in vitro da matéria seca das silagens variaram de 50,7% a 55,6% e comportaram-se de forma diferente com a maturidade para cada hibrido. De acordo com os valores de pH, de nitrogênio amoniacal e de ácidos orgânicos encontrados, as silagens dos três híbridos são classificadas como de boa qualidade em todos os períodos de colheita.

The quality of silages of three sorghum hybrids BRS 610, BR 700 and BRS 655 harvested at three maturation stages, milk, soft dough and floury grains, was evaluated. A complete randomized design was used in a 3x3 factorial arrangement (hybrids x maturation stages), with four repetitions. Dry matter values varied from 22.9% to 41.3%. BR 700 had a higher percentage of dry matter than the other hybrids in all ages. The content of crude protein and fibrous fractions, neutral detergent fiber and acid detergent fiber presented different behavior between the maturation stages and between hybrids. The lignin values were not modified with the advancement of the cut age. The in vitro digestibility of silages varied from 50.7% to 55.6% and presented different behavior among each hybrid maturity. According to the pH, ammonia nitrogen, organic acids and dry matter values, the silages of the three hybrids were classified as good fermentation quality at all harvest periods.

Expression of progranulin (Acrogranin/PCDGF/Granulin-Epithelin Precursor) in benign and malignant ovarian tumors and activation of MAPK signaling in ovarian cancer cell line.

It has been recently demonstrated that progranulin is overexpressed in ovarian cancer and that this protein is involved in the stimulation of cell proliferation, malignancy, and chemoresistance in ovarian cancer. The goal of the present study was to establish the differences in progranulin expression among normal, benign, and malignant ovarian tissues and to identify the signal transduction pathways activated by progranulin in an ovarian cancer cell line. Compared with benign tumors and normal ovarian tissue, progranulin mRNA and protein were overexpressed in malignant tumors. Survival analysis by the Kaplan-Meier method showed a correlation between high mRNA expression levels with poor survival outcome. Progranulin activated the MAPK-signaling pathway in NIH-OVCAR-3 cells. Progranulin expression may be potentially involved in the pathogenesis and malignant progression of ovarian cancer, and thus may represent a therapeutic target for this particular malignancy.

[Central nervous system neuromodulation for the treatment of epilepsy. II. Mechanisms of action and perspectives]. / Neuromodulation du système nerveux central dans le traitement des épilepsies. II . Mécanismes d'action et perspectives.

OBJECTIVES: Review of available evidence of the mechanisms of action underlying the anticonvulsant effect of current applied to various CNS structures. MATERIAL AND METHODS: Studies were conducted from observations of patients with drug-resistant seizures and treated with neuromodulation. Seizures originated from various cortical areas with secondary generalization or were initially generalized without a focal origin, either clinically or on EEG or SEEG. Intracranial recordings and SEEG were performed using subdural grids or depth electrodes implanted either for recordings or therapeutic deep brain stimulation (DBS). In a group of mesial temporal lobe epilepsy patients investigated with subdural or SEEG electrodes, the epileptogenic focus area was stimulated for 15 days before anterior temporal lobectomy. The surgical specimen was examined using standard and electronic microscopy and autoradiography in order to identify several neurotransmitter receptors. They also were compared to other surgical specimens from epileptic patients who had intracerebral recordings but without stimulation (epileptic controls) and to autopsy specimens from subjects with no history of epilepsy (nonepileptic controls). RESULTS: High-frequency (HF) stimulation increases the after-discharge threshold of the stimulated site and alters the cycles of potentials evoked by a test stimulation using a paradigm of coupled stimulations. HF stimulation also decreases local cerebral blood flow in the stimulated area as demonstrated on SPECT. Parahippocampal cortex HF stimulation significantly increases the GABAergic benzodiazepine receptor density in the stimulated area. In addition, centromedianum (CM) thalamic nucleus HF stimulation suppresses thalamic and cortical spike-waves, as well as secondary synchronous discharges visible on EEG. Conversely, low-frequency (3-Hz) bilateral CM stimulation induces a typical absence clinically and on EEG. CONCLUSION: High-frequency stimulation is responsible for an inhibition of local and propagated epileptogenesis. Low-frequency stimulation may trigger or enhance epileptogenesis when applied on epileptogenic regions.

[Central nervous system neuromodulation for the treatment of epilepsy]. / Neuromodulation du système nerveux central dans le traitement des épilepsies I-Efficacité et sécurité de la méthode.

We present here a review of the work on neuromodulation - defined as application of an inhibitory or excitatory current - on intracranial structures for the treatment of drug-resistant epilepsy. Near 250 patients were treated using a neuromodulation technique of the cerebellum (paravermian cortex), the CM-pf nucleus of the thalamus, the hippocampus, epileptogenic foci, and anterior ventral nucleus of the thalamus, with a one- to 15-year follow-up. Four contact strips were used for cerebellar and functional region neuromodulation, and DBS-type depth electrodes were stereotactically implanted for CM-pf and anterior nuclei of the thalamus and hippocampal neuromodulation. Electric stimulation was cyclic in almost all trials, using low frequency (10-40 Hz) for excitation and high frequency (60-185 Hz) for inhibition. Seizure frequency reduction was variable, depending on the neuromodulation site and patient selection, although seizure duration decreased in most patients. Cerebellar neuromodulation was followed by a 78% reduction in tonic and tonic-clonic seizures, CM-pf neuromodulation by an 83% reduction in tonic-clonic seizures and atypical absence of Lennox-Gastaut syndrome, with a 17.2% seizure-free and drug-free patient rate. Hippocampal neuromodulation was followed by a 73% reduction in partial complex seizures, with a 33% seizure-free patient rate. Anterior ventral nucleus of the thalamus was followed by a 63% reduction in tonic-clonic, tonic and atonic seizures. Several prognostic factors were identified in order to improve future results. There was no mortality and morbidity was limited to skin erosion at the neurostimulator site. Seizure reduction was associated with improved neuropsychological performance and better quality of life. Neuromodulation is safe and effective for the treatment of epileptic seizures of various origins. Several targets may be associated in a single patient, especially when bilateral hippocampal seizure foci are present.

Isolation and characterizaton of Edwardsiella tarda from pacu Myleus micans / Isolamento e caracterização de Edwardsiella tarda em pacu Myleus micans

Investigaram-se as causas da mortalidade de peixes ocorrida em janeiro de 2005 na bacia do Rio São Francisco, Brasil. Edwardsiella tarda foi isolada dos rins de pacu Myleus micans. O isolado, denominado Et-LIS, caracterizado por bastonetes Gram negativos móveis, foi identificado por testes bioquímicos e confirmado pelo kit comercial Bactray. A susceptibilidade a 10 drogas das 12 testadas foi determinada pelo método de difusão de discos, enquanto as características de virulência foram avaliadas mediante inoculação experimental em Cyprinus carpio e em Oreochromis spp. Ambas as espécies desafiadas apresentaram sinais compatíveis com infecção por E. tarda. As tilápias (Oreochromis spp.) morreram 48h após a inoculação, enquanto as carpas (Cyprinus carpio) sobreviveram por 72h. Este é o primeiro relato da ocorrência de E. tarda em pacu.

Isolation and characterizaton of Edwardsiella tarda from pacu Myleus micans / Isolamento e caracterização de Edwardsiella tarda em pacu Myleus micans

Investigaram-se as causas da mortalidade de peixes ocorrida em janeiro de 2005 na bacia do Rio São Francisco, Brasil. Edwardsiella tarda foi isolada dos rins de pacu Myleus micans. O isolado, denominado Et-LIS, caracterizado por bastonetes Gram negativos móveis, foi identificado por testes bioquímicos e confirmado pelo kit comercial Bactray. A susceptibilidade a 10 drogas das 12 testadas foi determinada pelo método de difusão de discos, enquanto as características de virulência foram avaliadas mediante inoculação experimental em Cyprinus carpio e em Oreochromis spp. Ambas as espécies desafiadas apresentaram sinais compatíveis com infecção por E. tarda. As tilápias (Oreochromis spp.) morreram 48h após a inoculação, enquanto as carpas (Cyprinus carpio) sobreviveram por 72h. Este é o primeiro relato da ocorrência de E. tarda em pacu.(AU)

The role of neuromodulation of the hippocampus in the treatment of intractable complex partial seizures of the temporal lobe.

We present the results of chronic electrical stimulation of the hippocampus (ESH) in 9 patients with complex partial seizures and at least 18 months follow-up. The magnetic resonance imaging (MRI) scan was normal in 5 while in 4 patients it showed hippocampal sclerosis. The seizure frequency ranged from 10 to 50 seizures per month. All patients were submitted to implantation of diagnostic 8-contact bilateral hippocampal depth electrodes to determine the location of epileptic foci. Once the focus was located, the diagnostic electrodes were replaced by deep brain stimulation (DBS) electrodes. Following DBS, all patients improved. With respect to outcome, patients were divided in two groups, one seizure-free (5 patients) and the other with residual seizures (4 patients). Both groups shared similar clinical features. However, the patients who were seizure free had normal MRI scan while those who had residual seizures were being stimulated on a sclerotic hippocampus. We conclude that electrical stimulation of the epileptic hippocampal formation can control mesial temporal seizures. Best results are obtained if we stimulate a hippocampus which does not show sclerosis in the MRI. In these cases, seizures are stopped and the recent memory tests improve even in patients with bilateral foci. This result is of extreme importance to patients who have either intractable seizures and normal MRI or bilateral epileptogenic foci, are excluded as candidates for temporal lobectomy and are left with no other alternative.

Deep brain stimulation for treatment of the epilepsies: the centromedian thalamic target.

Electrical stimulation (ES) of the thalamic centromedian nucleus (CMN) has been proposed as a minimally invasive alternative for the treatment of difficult-to-control seizures of multifocal origin and seizures that are generalized from the onset. ES intends to interfere with seizure propagation in a non-specific manner through the thalamic system. By adopting a frontal parasagittal approach and based on anterior-posterior (AC-PC) commissure intersection, deep brain stimulation (DBS) electrodes are stereotactically inserted. Electrophysiologic confirmation of electrodes position is accomplished by eliciting cortical recruiting responses and direct current (DC) shifts by low- and high-frequency stimulation through the electrodes. Cycling mode of bipolar stimulation has been used at 60-130 Hz, 0.45 msec, 2.5-3.5 V, 1 min ON in one side 4 min OFF, 1 min ON in the other side and 4 min OFF forward and back for 24h. ES of CMN significantly decreases generalized seizures of cortical origin and focal motor seizures. Best results are obtained in non-focal generalized tonic clonic seizures and atypical absences of the Lennox-Gastaut syndrome. Experience has indicated that the most effective target for seizure control is the thalamic parvocellular centromedian subnucleus.

Neuromodulation of the inferior thalamic peduncle for major depression and obsessive compulsive disorder.

Neuromodulation of the inferior thalamic peduncle is a new surgical treatment for major depression and obsessive-compulsive disorder. The inferior thalamic peduncle is a bundle of fibers connecting the orbito-frontal cortex with the non-specific thalamic system in a small area behind the fornix and anterior to the polar reticular thalamic nucleus. Electrical stimulation elicits characteristic frontal cortical responses (recruiting responses and direct current (DC)-shift) that confirm correct localization of this anatomical structure. A female with depression for 23 years and a male with obsessive-compulsive disorder for 9 years had stereotactic implantation of electrodes in the inferior thalamic peduncle and were evaluated over a long-term period. Initial OFF stimulation period (1 month) showed no consistent changes in the Hamilton Depression Scale (HAM-D), Yale Brown Obsessive Compulsive Scale (YBOCS), or Global Assessment of Functioning scale (GAF). The ON stimulation period (3-5 V, 130-Hz frequency, 450-msec pulse width in a continuous program) showed significant decrease in depression, obsession, and compulsion symptoms. GAF improved significantly in both cases. The neuropsychological tests battery showed no significant changes except from a reduction in the perseverative response of the obsessive-compulsive patient and better performance in manual praxias of the female depressive patient. Moderate increase in weight (5 kg on average) was observed in both cases.

Neuromodulation of prelemniscal radiations in the treatment of Parkinson's disease.

In patients with Parkinson's disease (PD), tetrapolar electrodes were implanted in the prelemniscal radiations (RAPRL) to treat tremor, rigidity and bradykinesia. Fifteen patients were implanted unilaterally and five patients bilaterally and followed-up for one year. The selection criteria included the presence of unilateral pronounced tremor and rigidity in patients implanted unilaterally or bilateral symptoms including severe bradykinesia in patients implanted bilaterally. In the operating room, the tremor decreased significantly or was abolished following the insertion of the electrode in the RAPRL. This effect was temporary and subsided when the stimulation was off. However, when the stimulator was turned on, the severity of the symptoms and signs decreased significantly. The post-implantation MRI confirmed that the electrode contacts used for stimulation were inserted in RAPRL, a group of fibers located between the red nucleus and subthalamic nucleus, above the substantia nigra, medially to the zona incerta and below the thalamus. The patients were evaluated using the UPDRS part III, before implantation and every 3 months during the first year. Global scores decreased significantly. The pre- and postoperative median values (range in round brackets) were as follows: tremor improved from 3 (2-16) to 1 (2-3) (p<0.001); rigidity was either abolished or decreased markedly from 2 (1-16) to 0 (0-4) (p< 0.001); bradykinesia improved from 2 (0-4) to 1 (0-2) (p<0.001). We conclude that RAPRL, an area anatomically different from STN, is a good target for electrical stimulation in order to treat effectively all the main symptoms of PD.

Cuadro clínico de inicio de la diabetes tipo 1 en el niño / Clinical picture at the onset of type 1 diabetes mellitus in children

Background: Type 1 diabetes mellitus (DM1) is a disease of increasing incidence among children. The time elapsed between the beginning of symptoms and the diagnosis of the disease is, in most cases, very extended. Aim: To report the clinical picture at onset and laboratory features of children with DM1. Material and methods: Retrospective review of all medical records of patients admitted to the hospital with a DM1 of recent onset. Results: Sixty three males aged 95±47 months and 34 females aged 109±51 months, were studied. Males were significantly younger than females (p <0.05). The lapse between symptoms onset and the diagnosis of the disease was longer in girls than in boys (46±46 and 26±26 days respectively, p <0.02). There was an inverse correlation between plasma glucose and the lapse between symptoms onset and the diagnosis of disease. The most common clinical picture of the disease was the classical symptoms of diabetes (polyuria, polydipsia, weight loss), in 60 percent of cases. Thirty seven percent had developed ketoacidosis at the time of the diagnosis. Ketoacidosis was more common between 1988 and 1995, as compared with the period 1996-2003 (50 percent and 28.8 percent, respectively). The onset of symptoms occurred between April and August (Winter in the Southern Hemisphere) in 38 percent of cases. Conclusions: DM1 is a disease of increasing incidence among children, whose diagnosis is delayed, even though symptoms are evident. The lower incidence of ketoacidosis in our patients between 1996 and 2003 is encouraging.

Barrera intestinal del paciente crítico: realidades y tendencias / Gut barrier in the critically ill patient: facts and trends

The disturbances of gut barrier in critically ill patients may influence their outcome and prognosis. Experiments in animals show that fasting and stress collaborate to produce intestinal atrophy and translocation of microorganisms and toxins. This fact is one of the main arguments to promote the use of early enteral feeding in critically ill patients. However, the intestinal barrier behaves differently in humans than in animals. The human enteral cells have a good tolerance to fasting and stress, mucosal atrophy is mild and it is not always associated with changes in intestinal permeability. Moreover, the relationship between intestinal permeability with sepsis and bacterial translocation is controversial. This last phenomenon also happens in normal subjects and may be a mechanism to build immunological memory. One of the most important factors that influence bacterial translocation is the microorganism, that under stress conditions can adhere to the intestinal cell and penetrate the intestinal barrier. Splanchnic ischemia and reperfusion is one of the main pathogenic factors in the failure of intestinal barrier. Finally, the fact that the small bowel is an inflammatory target of extra intestinal injuries, explains several clinical situations. The pathophysiology of the intestinal barrier definitely requires more research.