Brain plasticity for verbal and visual memories in patients with mesial temporal lobe epilepsy and hippocampal sclerosis: an fMRI study.

We aimed to identify the brain areas involved in verbal and visual memory processing in normal controls and patients with unilateral mesial temporal lobe epilepsy (MTLE) associated with unilateral hippocampal sclerosis (HS) by means of functional magnetic resonance imaging (fMRI). The sample comprised nine normal controls, eight patients with right MTLE, and nine patients with left MTLE. All subjects underwent fMRI with verbal and visual memory paradigms, consisting of encoding and immediate recall of 17 abstract words and 17 abstract drawings. A complex network including parietal, temporal, and frontal cortices seems to be involved in verbal memory encoding and retrieval in normal controls. Although similar areas of activation were identified in both patient groups, the extension of such activations was larger in the left-HS group. Patients with left HS also tended to exhibit more bilateral or right lateralized encoding related activations. This finding suggests a functional reorganization of verbal memory processing areas in these patients due to the failure of left MTL system. As regards visual memory encoding and retrieval, our findings support the hypothesis of a more diffuse and bilateral representation of this cognitive function in the brain. Compared to normal controls, encoding in the left-HS group recruited more widespread cortical areas, which were even more widespread in the right-HS group probably to compensate for their right mesial temporal dysfunction. In contrast, the right-HS group exhibited fewer activated areas during immediate recall than the other two groups, probably related to their greater difficulty in dealing with visual memory content.

Prognostic value of blood lactate and apache II in septic patients

Septic patients in ICU have high risk of developing multiple organ failure (MOF) and high mortality rates, in spite of modern technologies used nowdays. Various prognostic methods have been suggested in order to evaluate patient´s state and possible evolution, such as APACHE, SAPS, SOFA, blood lactate levels, intragastric mucosal pH etc

Multiple organ failure in septic patient

Multiple organ failure (MOF) is the main cause of death in ICUs, especially affecting septic patients.It is strongly related to number of systems with failure, type of system involved, risk factors such as age, previous chronic diseases, delayed or inadequate resuscitation, persistent infection, immune supression, and others. The prognoses is worse for patients rather than in elective or emergency surgical patients. The objective of this article is to provide data from our university teaching hospital ICU related to the incidence of septic patients, the distribution of MOF, and distribution of failure among each of the organs. The mortality rate, relationhip between mortality and age, and mortality and types of organs affected were evaluated. The main bacterial causes of septis were also identified. A retrospective evaluation was done of 249 patients admitted to the ICU in a 4 month period during 1999. Fifty four patients had sepsis diagnosed by ACCS/SCCM criteria. There were 37 men and 17 women; 24 medical and 30 post-surgical patients (9 after elective surgery and 21 emergency patients). APACHE II score was calculated on admission and MOF, measured for the first five days, was diagnosed using Marshall and Meakins criteria. The statistical method used was non-parametric Mann-Whitney test, p<0.05 was considered significant. The incidence of sepis was recorded in 52/249 patients (22 percent). Thirty of these 54 patients (56 percent) died. Death occurred in 2 of 11 patients with one organ failure (18 percent), in 14/27 with 2 or 3 organ failures (52 percent), and 14/16 with 4 or more organ failures (88 percent). None of the three patients 15 to 20 years years old died, 17/32 (55 percent) patients age 21-60 years, and >61 years 13/19 (68 percent), died. There were 23 patients with positive bacterial culture. The most frequent bacteria found were: Pseudomonas aeruginosa (5), multiresistant Acinetobacter baumanii (3), Streptococcus epidermidis (3), Enterobacter aerogenes (3), Klebsiella pneumoniae (2) and multiresistant Staphylococcus aureus (2). The mean value ñ SD of APACHE II (mortality risk) for survivors was 21 ñ 18 and non-survivors 42 ñ 26 (p<0.001). We conclude that MOF due to septis in an ICU is frequent, with high mortality related to the number of failing organs, age and high APACHE II.