Cerebral cortex involvement in Machado-Joseph disease.

BACKGROUND AND PURPOSE: Machado-Joseph disease (MJD/SCA3) is the most frequent spinocerebellar ataxia, characterized by brainstem, basal ganglia and cerebellar damage. Few magnetic resonance imaging based studies have investigated damage in the cerebral cortex. The objective was to determine whether patients with MJD/SCA3 have cerebral cortex atrophy, to identify regions more susceptible to damage and to look for the clinical and neuropsychological correlates of such lesions. METHODS: Forty-nine patients with MJD/SCA3 (mean age 47.7 ± 13.0 years, 27 men) and 49 matched healthy controls were enrolled. All subjects underwent magnetic resonance imaging scans in a 3 T device, and three-dimensional T1 images were used for volumetric analyses. Measurement of cortical thickness and volume was performed using the FreeSurfer software. Groups were compared using ancova with age, gender and estimated intracranial volume as covariates, and a general linear model was used to assess correlations between atrophy and clinical variables. RESULTS: Mean CAG expansion, Scale for Assessment and Rating of Ataxia (SARA) score and age at onset were 72.1 ± 4.2, 14.7 ± 7.3 and 37.5 ± 12.5 years, respectively. The main findings were (i) bilateral paracentral cortex atrophy, as well as the caudal middle frontal gyrus, superior and transverse temporal gyri, and lateral occipital cortex in the left hemisphere and supramarginal gyrus in the right hemisphere; (ii) volumetric reduction of basal ganglia and hippocampi; (iii) a significant correlation between SARA and brainstem and precentral gyrus atrophy. Furthermore, some of the affected cortical regions showed significant correlations with neuropsychological data. CONCLUSIONS: Patients with MJD/SCA3 have widespread cortical and subcortical atrophy. These structural findings correlate with clinical manifestations of the disease, which support the concept that cognitive/motor impairment and cerebral damage are related in disease.

[Diagnostic hysteroscopy]. / Histeroscopia diagnóstica.

Six hundred and six diagnostic hysteroscopies were conducted between April of 1991 and November of 1994 and retrospectively analysed; 544 of these were made in routine outpatient clinic with paracervical anaesthesia in 438 (72%) of the cases. Mean hospitalisation was for a period of six hours. The patient's mean age was 48.7 years and the most frequent indications were, abnormal uterine bleeding (220 cases-35%) and post menopausal metrorrhagia (176 cases-29%). Our cases showed a morbidity rate of 1.9%. We found a positive correlation between the hysteroscopic findings and the histological study in 428 examinations (71%). The hysteroscopic procedure allowed us to make a precise and early diagnosis of many gynecologic pathologies, a proper therapeutical approach and provided an endometrial cancer screening tool. These aspects are very important in our region because our female population some risk factors for that endometrial cancerous or precancerous lesions.