Sources of mathematical thinking: behavioral and brain-imaging evidence.

Does the human capacity for mathematical intuition depend on linguistic competence or on visuo-spatial representations? A series of behavioral and brain-imaging experiments provides evidence for both sources. Exact arithmetic is acquired in a language-specific format, transfers poorly to a different language or to novel facts, and recruits networks involved in word-association processes. In contrast, approximate arithmetic shows language independence, relies on a sense of numerical magnitudes, and recruits bilateral areas of the parietal lobes involved in visuo-spatial processing. Mathematical intuition may emerge from the interplay of these brain systems.

The uterine carcinosarcoma - a case report.

The carcinosarcoma is a malignant mixed müllerian tumor with a highly malignant, biphasic tumor consisting of both epithelial and mesenchymal components. The presented case refers to a patient in climax with a vaginal bleeding. The Doppler echography highlights a polypoid mass, which prolapses in the cervical channel. The histopathological and immunohistochemical analysis of the surgically resected piece allowed the carcinosarcoma diagnosis. The uterine carcinosarcoma's incidence is rare, that is why this case is interesting taking in consideration the biphasic pattern of the tumor.

Diagnosis challenge of atypical spindle cells neoplasm of the spermatic cord. / Reto diagnóstico de neoplasia de células fusiformes atípicas del cordón espermático.

OBJECTIVE: To report an unusual case of softtissue neoplasm and to review the literature on this type of tumour. METHODS: We report an accidentally found tumour closely related to the spermatic cord that was diagnosed in a 70 year-old man when he was being operated on for an inguinal hernia repair. RESULTS: After thorough analysis by experienced pathologists it was not possible to determine the nature of the tumour that was removed at surgery. CONCLUSIONS: Soft tissues neoplasms of the spermatic cord may occur in an unusual way and they may be a real challenge to diagnose.

The distribution of proteoglycans of high electrophoretic mobility in cartilages from different species and of different ages.

The distribution of small proteoglycans of high relative electrophoretic mobility in cartilage of various species and of different ages was studied. Proteoglycans extracted by 4 M guanidinium chloride were purified by ion-exchange chromatography and assessed by gel electrophoresis. Proteoglycans fractionated by equilibrium density gradient centrifugation under 'dissociative' conditions were similarly purified and assessed. A rapid migrating population was found in articular cartilages of young humans, baboons, calves, pigs, rabbits, rats, chickens and in mandibular and vertebral cartilages of dog-fish. It was not detected in unfractionated proteoglycans extracted from fetal rat, pig, calf, baboon and human cartilages. In baboon and human fetal cartilages of advanced gestational age, however, small amounts of the rapid population were present being detected in the low density fractions of dissociative gradients. The rapid migrating population was not found either in unfractionated or in fractionated proteoglycans obtained from articular cartilages of humans aged over 40. It was also absent from human osteoarthritic cartilages but was detected even at advanced age in cartilages covering osteophytes.

Mental Disorders in Chronic Liver Diseases with Viral Etiology.

The study of chronic viral hepatitis represents a real challenge for modern medicine. If we also analyze this illness from the point of the mental changes involved, the complexity of the study increases. To the etiological, symptomatological polymorphism, alongside the paraclinical and conduct diagnosis, there may be easily added the multitude of mental disorders. The authors have tried, through this paper, to draw the attention upon the importance of studying certain mental disorders connected to a somatic disease, each and every representing a distinct entity, but which together may reach a remarkable complexity.

Morphological and biochemical studies of a mouse mutant (fro/fro) with bone fragility.

The mutation fragilitas ossium (fro) was discovered in a random-bred stock of mice during an experiment aimed at detecting recessive lethal mutations after treatment of the postmeiotic germ cells of male mice with tris (1-aziridinyl)phosphine sulphide. The affected mice were moderately runted and had deformities in all four limbs. The radiological and histological findings indicate that the mutant is similar to human osteogenesis imperfecta. The ash content of long bones was lower in the mutant. A defect of type I collagen could not be detected. The electrophoretic patterns of alpha bands of type I and V collagen and CB derived peptides of type I collagen from bone and skin showed no abnormalities. The total collagen synthesis and secretion in cultures of dermal fibroblasts, as well as the gel electrophoresis of procollagen and collagen chains synthesized, and of their CB peptides, were the same as those found in the controls. The percentage of type I and type V collagen synthesized was similar; that of type III was lower in the mutants. Bone osteonectin was found to be decreased by 30% and bone sialoprotein by 5%. The mRNA level for osteonectin was decreased in the fibroblasts of the mutant by about 50%. Whether the defective expression of the osteonectin in fro/fro mice is due to a mutation in the gene itself or its regulatory site(s), or is secondary to other factors remains to be established. The fro/fro mouse may represent a model for some forms of human bone fragility without collagen abnormalities.

Homozygous achondroplasia: morphologic and biochemical study of cartilage.

We have performed histochemical, immunohistochemical, electron microscopic, and biochemical studies on the upper tibial cartilage from a case of homozygous achondroplasia. The growth zone was narrow and disorganized. Columnization was absent except for a few areas with short rows of cells. Hypertrophy was reduced to scattered clusters of cells. The provisional calcification was patchy and primary trabeculae were thick and irregularly arranged. Islands of fibrous or fibrocartilagineous tissue were found along the growth zone. The matrix did not stain with safranin O and lacked metachromasia, except for pericellular rims around the hypertrophic cell clusters. Staining with antibodies against the large proteoglycan monomers and chondroitin-4-sulfate was weakly positive. Electron microscopic examination showed that only a few cells had degenerative signs. In most areas of the matrix, proteoglycan granules were absent. Areas with dense collagen fibers were seen. In contrast to the growth zone, the cartilage of the remaining epiphyses had normal histochemical, immunohistochemical, and electron microscopic appearance. The large proteoglycan monomers had a normal composition and hydrodynamic size. Type II and XI collagen, pepsin fragments of type IX collagen, and several noncollagenous proteins extracted from cartilage had a normal electrophoretic migration. It is suggested that a mutation affecting a matrix component or a regulatory pathway present only or predominantly in the growth area of the chondroepiphysis might explain the findings.

Acromicric dysplasia.

We describe a new type of bone dysplasia, the "acromicric dysplasia," based on the study of six patients. This dysplasia is characterized clinically by mild facial anomalies, markedly shortened hands and feet, and growth retardation that is severe in most of cases. Roentgenograms of the hands are characteristic: the metacarpals and the phalanges are short and stubby, the proximal portion of the last four metacarpals are slightly pointed with an external notch on the 2nd metacarpal and an internal notch on the 5th metacarpal, similar to pseudo-epiphysis. The shape of the epiphysis and the metaphysis of the long bones is almost normal, except for a slight deformation of the femoral heads in some patients. No signs of visceral storage were found, which rules out geleophysic dwarfism. The histological, histochemical, and electron microscopical examination of the growth cartilage in two cases showed similar lesions: disorganization of the growth zone with islands of cells, some of them degenerated; abnormal organization of collagen forming thick rims around the cells and wide fibers in the interterritorial matrix; large accumulation of glycogen in most chondrocytes. Both sexes are affected; all patients are isolated cases from normal families.

Metaphyseal anadysplasia: a metaphyseal dysplasia of early onset with radiological regression and benign course.

We report on 4 boys (including 2 maternally related first cousins) with a metaphyseal dysplasia of early onset and regressive evolution. Diagnosis is possible in the first months. Distal metaphyses of long bones are very irregular. Femoral necks seem hypoplastic and the edges of the metaphyses are almost vertical; femoral shaft is bowed. Those anomalies disappear after 2 years. The main manifestations are slight shortness and a light varus deformity of the lower limbs. Stature is not affected. The upper tibial growth cartilage, studied in one case, showed wide proliferative and hypertrophic zones with an unusual appearance of the last hypertrophic cells and an abnormal zone of cartilage calcification and resorption. The name "metaphyseal anadysplasia" is suggested for this early and regressive disorder. We are aware of other forms of regressive metaphyseal dysplasia which deserve further delineation. Therefore infants whose radiological changes of metaphyseal dysplasia do not fall into one of the well-defined types should be followed and prediction of the adult height should not be made on the basis of the findings on the initial examination.

Non-collagenous protein screening in the human chondrodysplasias: link proteins, cartilage oligomeric matrix protein (COMP), and fibromodulin.

A gel-electrophoretic screening for link proteins, cartilage oligomeric matrix protein (COMP), and fibromodulin abnormalities was performed in fetuses, newborn infants, and children with various types of chondrodysplasia. Microdissected freeze-dried sections of upper tibial growth cartilage were extracted with 4M guanidinium chloride in the presence of proteolysis inhibitors. After dialysis against 8M urea, the extracts were submitted to stepwise ion-exchange chromatography to separate the large proteoglycans (aggrecans) from the other components. The latter were analyzed by gel electrophoresis, electrotransferred onto nitrocellulose membranes, and reacted with specific antibodies. Control samples from individuals with apparently normal growth were analyzed in the same runs. Two link protein bands with abnormal electrophoretic migration were found in a sporadic case of spondylometaphyseal dysplasia, Kozlowski type. Three link protein bands with the same migration as in the control samples were found in thanatophoric dysplasia, homozygous achondroplasia, achondrogenesis type II, hypochondrogenesis, Goldblatt syndrome, Desbuquois dysplasia, pseudoachondroplasia, and diastrophic dysplasia. In several pathologic cases with normal electrophoretic pattern of the link proteins, small link protein fragments appeared after reduction. The gel electrophoretic pattern of COMP was studied in thanatophoric dysplasia, diastrophic dysplasia, homozygous achondroplasia, fibrochondrogenesis, hypochondrogenesis, Goldblatt syndrome, and Kniest dysplasia. In all these cases the pattern was the same as in the control samples. The main band of fibromodulin had a normal migration rate in fibrochondrogenesis, Desbuquois dysplasia, Kniest dysplasia, and pseudoachondroplasia. It was delayed in diastrophic dysplasia.

Multiple epiphyseal dysplasia, Fairbank type: morphologic and biochemical study of cartilage.

We have performed histochemical, immunohistochemical, electron microscopic, and biochemical studies on the upper tibial cartilage from a case of multiple epiphyseal dysplasia, Fairbank type. Most chondrocytes had intracytoplasmic inclusions which took the stains for proteins and were resistant to microbial collagenase digestion. The electron microscopic study showed that the inclusions are dilatations of the rough endoplasmic reticulum containing a material with alternately wide electron dense and electron lucent layers. Both in optical and in electron microscopy the inclusions fixed antibodies against the core protein of the large cartilage proteoglycans (aggrecans). They didn't stain with antibodies against type II collagen. The gel electrophoretic pattern of the large proteoglycans was different from normal controls. The morphologic and biochemical alterations found in multiple epiphyseal dysplasia are similar to those already described in pseudoachondroplasia (Stanescu et al.: Eur J Pediatr 138:121-225, 1982; Stanescu et al.: J Bone Joint Surg 66A:817-836, 1984). However, the inclusions are smaller and the growth cartilage much less disorganized in multiple epiphyseal dysplasia. The similarity of morphologic and biochemical abnormalities strongly suggests that the two diseases have a similar pathogenesis and belong to the same bone dysplasia family.

Type II collagen defect in two sibs with the Goldblatt syndrome, a chondrodysplasia with dentinogenesis imperfecta, and joint laxity.

We report on a syndrome of spondylo-epimetaphyseal dysplasia, dentinogenesis imperfecta, and ligamentous hyperextensibility in two sibs born to nonconsanguineous parents. This chondrodysplasia was characterized by severe shortness of stature and an osteoporosis without fractures. Electron microscopic examination of the cartilage documented large vacuoles of dilated rough endoplasmic reticulum within the cytoplasm of chondrocytes. Gel electrophoresis of pepsin-soluble collagen extracted from cartilage demonstrated the presence of type II collagen chains with an abnormal mobility. Prolyl and lysyl hydroxylations were slightly increased. The abnormal molecules melted at a higher temperature than the normal ones. CNBr peptide mapping of type II collagen showed an altered electrophoretic migration of peptides CB 11, CB 8, and CB 10,5 whereas CB 9,7 looked normal. In addition, two small non-collagenous proteins isolated from cartilage were not found in an age-matched control individual but were detected in a normal newborn infant. The quantitation of proline-labelled collagen synthesized by dermal fibroblasts demonstrated a 50% reduction of total collagen. This decrease essentially affected the amount of extracellular type I collagen, which was secreted less efficiently than in control cells. Nevertheless, type I collagen chains behaved normally on 5% polyacrylamide gels. The reduced mRNA levels of alpha 1I and alpha 2I chains might reflect either a transcriptional defect or a decreased stability of mRNA transcripts. We suggest that the association of both pathological chondrocytes producing altered collagen type II and decreased synthesis of type I could be responsible for this peculiar phenotype. The overmodification of alpha 1II CNBr peptides is consistent with the presence of a single-base substitution in the COL2A1 gene. Whether there is a direct causal relationship between the type II collagen defect and the underexpression of type I collagen will require clarification.

Opsismodysplasia: a new type of chondrodysplasia with predominant involvement of the bones of the hand and the vertebrae.

The name opsismodysplasia is proposed for a new chondrodysplasia, which was studied in three patients. Clinically, the condition is recognized at birth on the basis of shortness, short hands, and facial abnormalities with a short nose and a depressed bridge of nose. The most characteristic radiographic signs are: very retarded bone maturation; marked shortness of the bones of the hands and of the feet with concave metaphyses; and thin, lamellar vertebral bodies. The growth cartilage studied in one case showed a wide hypertrophic area containing thick connective tissue septa, irregular provisional calcification, and vascular invasion. Type I collagen was detected in the hypertrophic area by immunohistochemical and microchemical tests. The transmission of opsismodysplasia is probably autosomal recessive.

Labeling of articular cartilage surface with cationized ferritin: aged human normal and osteoarthritic cartilage.

The labeling of the articular surface with cationized ferritin (CF), an electron-dense marker, visualizes the anionic sites and may disclose abnormal penetration of the large CF molecule into the subsurface layers. Various areas of cartilage selected by unaided eye examination were taken from femoral heads excised in three cases of osteoarthritis and two cases of hip fracture. The fragments were examined by optical microscopy and by electron microscopy after labeling with CF. The labeling with and the penetration of CF were correlated with the morphological features of the surface. The surfaces belonging to the erosion border were disrupted and the CF penetrated approximately 2 microns into the matrix along the collagen fibers and in areas containing a patchy dense material. Prefixation with Karnovsky's fixative prevents CF penetration. The fragments taken at a distance from the erosion border showed at electron microscopical examination either an intact appearance of the surface that was labeled without penetration or a disrupted surface with penetration of the label. The osteophytes and the regeneration buds surface were labeled showing little or no penetration. The fragments from cartilage of hip fractures had either an intact surface regularly labeled or a slightly or moderately disrupted surface with moderate penetration of CF. The penetration of large molecules of CF in damaged cartilage demonstrates important permeability changes that may be significant for the pathogenetic mechanism of osteoarthritis. Similar permeability changes were previously shown in mice femoral heads treated in vitro with collagenase or trypsin and labeled with CF.

False-negative diffusion-weighted MR findings in acute ischemic stroke.

BACKGROUND AND PURPOSE: Lesions associated with acute stroke are often missed by diffusion-weighted imaging (DWI), suggesting that the sensitivity of this technique for detecting acute ischemic stroke may not be as high as initially thought. Our aim was to estimate the rate of false-negative DWI studies in patients with persistent neurologic deficit due to an ischemic stroke and to identify which stroke lesions are most likely to be missed by DWI. METHODS: We reviewed MR images obtained within 48 hours after stroke onset in 139 patients admitted for symptoms consistent with ischemic stroke in whom the deficit lasted more than 24 hours. Cases of negative initial DWI findings with an ischemic lesion visible on follow-up MR studies and a final diagnosis of arterial ischemic stroke were analyzed in terms of delay between onset of symptoms and initial DWI (MR latency), size and vascular distribution of the lesions, and relationship to findings in patients with positive initial DWI results. RESULTS: We found eight cases (5.8%) of false-negative initial DWI studies, of which four were positive on initial fluid-attenuated inversion recovery (FLAIR) imaging. Follow-up FLAIR/DWI showed a hyperintensity matching clinical presentation in all eight patients. The mean size of the lesion was 0.19 +/- 0.16 cm3. False-negative studies occurred more often in cases of stroke in the posterior (19%) than in the anterior (2%) circulation or when DWI was obtained within 24 hours after symptom onset. Of the six false-negative vertebrobasilar stroke lesions, five were located in the brain stem. In all, 31% of patients with vertebrobasilar ischemic stroke had a false-negative initial DWI study during the first 24 hours. CONCLUSION: A false-negative DWI study is not uncommon during the first 24 hours of ischemic stroke. Vertebrobasilar stroke should therefore not be ruled out on the basis of early negative DWI, especially when symptoms persist and are suggestive of this diagnosis.

Colloid cysts of the third ventricle: are MR imaging patterns predictive of difficulty with percutaneous treatment?

BACKGROUND AND PURPOSE: Colloid cysts of the third ventricle are rare benign brain tumors. The purpose of this study was to correlate their patterns on MR images with the probability of success of percutaneous treatment. METHODS: Nineteen patients underwent endoscopic treatment for colloid cysts of the third ventricle. The cases were divided into two groups based on difficulty of the aspiration procedure. We reviewed CT scans and MR images and divided cysts into groups based on their signal intensity on the MR images and their density on CT scans. Intensity and density were correlated with difficulty of aspiration during the endoscopic procedure. RESULTS: The aspiration procedure was difficult in 63% of the cases. Eighty-nine percent of hyperdense cysts on unenhanced axial CT scans were categorized as difficult, and 75% of hypodense cysts were categorized as easy. On T2-weighted MR sequences, 100% of low-signal cyst contents were difficult and nearly 63% of high-signal lesions were easy. There was a significant correlation between the T2-weighted sequences and the CT scans regarding the difficulty of the aspiration procedure. CONCLUSION: T2-weighted MR sequences are useful for predicting difficulty of aspiration during stereotactic or endoscopic procedures. A T2-weighted low-signal cyst is correlated with high-viscosity intracystic contents.

Pathogenic mechanisms in osteochondrodysplasias.

UNLABELLED: We performed histochemical, immunohistochemical, electron-microscopic, and microchemical studies on cartilage growth plates from sixty-eight patients with nineteen different forms of human osteochondrodysplasia. Cartilage biopsies were obtained during orthopaedic procedures. Postmortem specimens were obtained within a short time after death. The combined morphological and biochemical studies revealed specific abnormalities suggestive of a particular biochemical defect in several chondrodysplasias. In pseudoachondroplasia, non-collagenous protein accumulated in the rough endoplasmic reticulum of chondrocytes and a proteoglycan species that normally is present in the extracellular matrix was not detected by gel electrophoresis. The accumulated material was stained with antibodies against the core protein of proteoglycan. This strongly suggested that in this syndrome an abnormal core protein of a proteoglycan species is not properly transferred to the Golgi system. In Kniest syndrome, intracytoplasmic accumulation of metachromatic material, dilatation of rough endoplasmic reticulum, and an abnormal gel-electrophoretic pattern of cartilage proteoglycans suggested an abnormality of cartilage proteoglycan metabolism. Abnormalities that probably are related to degradative lysosomal processes of proteoglycans in chondrocytes were found in spondylometaphyseal dysplasia of the Kozlowski type. An abnormal organization of type-II collagen was found in fibrochondrogenesis. In diastrophic dysplasia, an abnormal organization of collagen was found in areas of interterritorial matrix and around many degenerated cells, but also in the lacunae of cells without ultrastructural signs of degeneration. The segment-long-spacing form of collagen prepared from cartilage of three patients with diastrophic dysplasia showed an abnormal cross-striation pattern in a portion between bands 42 and 45, corresponding to the position of the alpha 1(II) cyanogen-bromide-derived 10,5 peptide. This suggested that in this syndrome there is a structural alteration of the type-II collagen molecule. There was an accumulation of intracellular lipid in pyknodysostosis and in hypochondrogenesis, and of glycoproteins in several atypical cases of spondyloepiphyseal dysplasia. In a pair of twins with an atypical form of spondyloepiphyseal dysplasia, the presence of many multinucleated chondrocytes suggested a primary impairment of cell division. CLINICAL RELEVANCE: A knowledge of the pathogenic mechanisms in osteochondrodysplasias might improve the classification; aid in diagnosis, prognosis, and genetic counseling; and contribute to the understanding of normal endochondral growth.(ABSTRACT TRUNCATED AT 400 WORDS)

Drug action on articular cartilage surface. An in vitro study using mouse femoral heads labeled with cationized ferritin.

The direct effects on the cartilage articular surface of three anti-inflammatory drugs (Diclofenac, Pirprofen and acetyl-salicylic acid) and of a polysulfated glycosaminoglycan (Arteparon), were studied using an in vitro system in which BALB-c mouse femoral heads were incubated with the drugs. After incubation and labeling of the negative charges of the articular surfaces with cationized ferritin, the femoral heads were examined by electron microscopy. In addition, the effect of the drugs on the aggressive action of collagenase on the articular surface was tested using the same in vitro system. Diclofenac, Pirprofen and the polysulfated glycosaminoglycan did not alter the structure or the charge properties of the surface. Acetyl salicylic acid produced a slight disruption of the articular surface. The drugs studied had no effect on the disruptive action of collagenase.

[Diffusion MRI and cerebral ischemia. When to calculate the coefficient of diffusion?]. / IRM de diffusion et ischémie cérébrale. Quand calculer le coefficient de diffusion?

INTRODUCTION: There are two types of diffusion images: so-called "diffusion-weighted" images (DWI) and apparent diffusion coefficient (ADC) images. For certain authors, ADC mapping is crucial for interpreting diffusion images while for others the ADC map adds no further sensitivity or specificity compared with diffusion weighted images. The objective of this work was to determine those situations where ADC mapping modifies image interpretation. MATERIAL AND METHODS: T2-weighted and diffusion-weighted (DIF) MRI sequences were acquired in 197 patients with suspected cerebral ischemia (< or = 48 hr). For each lesion (239 lesions in the 197 patients), we analyzed MRI interpretation with and without ADC mapping and compared the interpretations with the final diagnosis established on clinical data and complementary explorations. RESULTS: We observed 3 groups. In group A (36% of the lesions), ADC mapping did not change image interpretation. This group was subdivided into 3 subgroups. A1: T2 and DIF weighted images are normal: no lesions and normal ACD map (n = 38 patients); A2: High intensity signal on T2 and low intensity signal on DIF: ischemic sequelae, ADC always increased (n = 32 lesions); A3: T2 normal and high intensity signal on DIF: hyper acute ischemia and ADC always decreased (n = 16 patients) In group B (high intensity signal on T2 and DIF, 54.5% of the lesions), ADC mapping changed the MRI interpretation: there was acute ischemia if the ADC was decreased (n = 113) and "pseudo-ischemic" lesions if the ADC was normal or increased (n = 17 patients). Group C was comprised of 23 lesions with a false negative ADC (9.5%). These lesions were always small recent ischemic lesions (< or = 5 mm) with a high intensity signal on DIF and a strictly normal ADC map. CONCLUSION: ADC mapping was found to be useful in 54.5% of the lesions and should not be considered as solely a research tool but also as a useful tool for routine clinical practice.

[Cellular aspects of chondrodysplasia]. / Aspects cellulaires des chondrodysplasies.

Studies of growing cartilage in cases of chondrodysplasia have demonstrated chondrocytic abnormalities, in particular the presence of abnormal inclusions. The histochemical and microchemical analysis of these inclusions provide valuable information concerning the pathophysiology of these diseases, which involves a variety of mechanisms: disorders of the metabolism of proteoglycans and glycosaminoglycans, collagen, lipids, glycoproteins, disorders of cell division.