Quantitative analysis of temporal lobe white matter T2 relaxation time in temporal lobe epilepsy

The objective of this study was to assess temporal lobe white matter (WM) quantitatively using T2 relaxometry in patients with pharmacologically intractable temporal lobe epilepsy (TLE). T2 relaxometry was performed using a dual-echo sequence with 23 contiguous oblique coronal slices in 56 consecutive TLE patients and in 30 healthy subjects. Averages of six slices were chosen to calculate T2 relaxation time in the temporal lobe WM (WM-T2) and the hippocampus (Hippo-T2). Twenty-seven patients had unilateral hippocampal atrophy (HA), and twenty-nine patients had normal hippocampal volumes (NV) on volumetric MRI. Mean WM-T2 was increased ipsilateral to the seizure focus in TLE patients with HA and those with NV (P < 0.001). Contralateral mean WM-T2 was increased in left and right TLE with HA (P < 0.001) and in right TLE with NV (P = 0.001). There was a positive correlation between WM-T2 and Hippo-T2. Individual analysis showed a prolongation of WM-T2 in about 70% of TLE patients with HA and NV. In half of the patients, WM-T2 increase was bilateral and symmetric. However, in 33% of patients with NV and bilateral symmetric increase in Hippo-T2, WM-T2 provided a correct lateralization of the seizure focus. Regardless of the pattern of T2 abnormalities, that is, bilateral symmetric or ipsilateral, the majority of patients with HA became seizure-free after surgery, while those with NV did not have a favorable outcome. In patients with NV, WM-T2 measurement may provide additional lateralizing information compared to Hippo-T2.     

Estimating air-bone gaps using auditory steady-state responses

Auditory steady-state responses (ASSR) were recorded using stimuli presented both via air conduction (AC ASSR) and bone conduction (BC ASSR) in 10 normal-hearing subjects with different degrees of simulated conductive hearing losses. The ASSR-estimated ABG (air-bone gap) was compared with the ABG measured using traditional pure-tone audiometric procedures. Reproducibility of the BC ASSR electrophysiological thresholds was also assessed. Additionally, a group of five subjects with profound sensorineural hearing loss was used to establish stimulation levels in which the BC ASSR was contaminated by stimulus artifact. Results of this investigation showed that the ASSR and behavioral ABGs were strongly correlated with each other (r = .81). However, ASSR-estimated ABGs slightly overestimated the magnitude of the behavioral. Reproducibility of the BC ASSR electrophysiological thresholds was good. Data from the five subjects with profound hearing loss, however, demonstrated that the levels where stimulus artifact became problematic were relatively low. This means BC stimulation may be appropriate only for subjects with normal or mildly impaired cochlear sensitivity.     

Hospitalized psychiatric patients view the World Trade Center disaster

There is conflicting literature describing how psychiatric patients, particularly those with schizophrenia, respond to overwhelming environmental disasters, with some reports describing marked improvement in their symptoms. This view is contrary to the notion that those individuals who are most vulnerable (i.e. people with serious psychiatric illness) are at high risk for further increase in psychiatric symptoms subsequent to stressful events. Since the terrorist attack of September 11, 2001, was such a catastrophic event, the following project was undertaken to examine its consequences on a population of hospitalized and thus severely ill psychiatric patients. Medical records for 156 New York City psychiatric inpatients were examined to evaluate their psychiatric condition during the time prior to and subsequent to the September 11, 2001, terrorist attacks on the World Trade Center in New York City. We failed to find any difference between the patients who had the opportunity to directly view the disaster through windows and those who did not. However, significantly more patients with a schizophrenia spectrum diagnosis showed evidence of worsening in their symptoms than those with affective disorder or other diagnoses in response to the events of September 11.     

A neurocomputational model of analogical reasoning and its breakdown in frontotemporal lobar degeneration

Analogy is important for learning and discovery and is considered a core component of intelligence. We present a computational account of analogical reasoning that is compatible with data we have collected from patients with cortical degeneration of either their frontal or anterior temporal cortices due to frontotemporal lobar degeneration (FTLD). These two patient groups showed different deficits in picture and verbal analogies: frontal lobe FTLD patients tended to make errors due to impairments in working memory and inhibitory abilities, whereas temporal lobe FTLD patients tended to make errors due to semantic memory loss. Using the "Learning and Inference with Schemas and Analogies" model, we provide a specific account of how such deficits may arise within neural networks supporting analogical problem solving.     

Oral pemphigus vulgaris after anthrax vaccine administration: association or coincidence?

Pemphigus vulgaris is an autoimmune blistering disorder of the skin and mucous membranes. Numerous medications, ultraviolet light, and radiation have all been implicated in the etiology of the disease. We present a patient with pemphigus vulgaris whose disease developed after administration of anthrax vaccine. The histologic and immunofluorescence findings were characteristic of pemphigus vulgaris. Adverse systemic events associated with the anthrax vaccine consist primarily of flu-like symptoms. Previous cases of pemphigus vulgaris associated with anthrax vaccine administration have not been reported. Considering the recent deliberate outbreaks of anthrax and continued threats of bioterrorism, the potential exists for widespread administration of the anthrax vaccine. Accordingly, continued observation and documentation of true adverse events is needed.     

Atypical expressions of jealousy in infants of intrusive- and withdrawn-depressed mothers

To determine whether atypical jealousy responses in infants of depressed mothers are differentiated by maternal nonoptimal interactive profiles, 12-month-old infants of intrusive-depressed and withdrawn-depressed mothers were observed with their mothers and a stranger in two contexts. In the first, infants were fully ignored in a less stressful context in which the adults focused on a picture book. In the second, infants were fully ignored in a more stressful, jealousy-inducement context, in which the adults attended to an infant-like doll. Cross-context comparisons revealed that the jealousy-inducement condition was associated with infants of intrusive-depressed mothers demonstrating greater play, and lesser proximal and distal behaviors toward their mothers. In contrast, the jealousy-inducement condition was associated with infants of withdrawn-depressed mothers directing greater proximal contacts toward the stranger. This investigation identified that as early as infancy, dysregulated expressions of jealousy are differentiated by depressed mothers' nonoptimal interactive patterns. Findings of this preliminary study call for investigative attention to this uncharted area of inquiry into mental health, and specifically, works addressing the importance of maternal characteristics to the unfolding of normative and atypical jealousy in infancy.     

Body mass index,waist hip ratio,and waist circumference: which measure to classify obesity?

SummaryObjectives: To determine the proportion of a representative population sample of adults in South Australia who have a body mass index (a measure of overall obesity) classified as normal or underweight, but who also have a waist circumference or waist hip ratio (measures of central obesity) that indicates obesity.Methods: A representative population sample of adults aged 18 years and over living in the north west region of Adelaide (n = 2523) were recruited to the study. Clinical measures of height, weight, waist and hip circumference were obtained and used to determine body mass index, waist hip ratio and waist circumference.Results: Among women with a normal body mass index, 19.0% had a high waist circumference ( 80 cm) and 8.5% had a high waist hip ratio (> 0.85). Among males with a normal body mass index, 3.4% had a high waist circumference ( 95 cm) and 0.1% had a high waist hip ratio (>1.0).Conclusions: Body mass index, waist hip ratio and waist circumference all have a role in the identification of those who are obese or overweight.

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Zusammenfassung Body-Mass-Index, Taille-Hüft-Quotient und Taillenumfang: welcher ist das richtige Mass für die Bestimmung von Þbergewicht?Zielsetzung: Die Bestimmung des Anteils an Erwachsenen in einer repräsentativen Bevölkerungsstichprobe in Südaustralien, die einen als normal oder untergewichtig geltenden Body- Mass-Index aufweisen (BMI, ein Mass zur Bestimmung von generellem übergewicht), aber gleichzeitig einen für Adipositas typischen Taillenumfang oder Taille-Hüft-Quotient (ein Mass der zentralen Adipositas) aufweisen.Methoden: Eine repräsentative Bevölkerungsstichprobe von Erwachsenen ab 18 Jahren, die im Nordwesten von Adelaide (n = 2523) lebt, wurde rekrutiert. Zur Bestimmung von BMI, Taille-Hüft-Quotient und Taillenumfang wurden Körpergrösse und -gewicht, Taillen- und Hüftumfang erfasst.Ergebnisse: Unter den Frauen mit normalem BMI hatten 19% einen grossen Taillenumfang ( 80 cm) und 8,5% hatten einen hohen Taille-Hüft-Quotient (> 0,85). Unter den Männern mit normalem BMI hatten 3,4% einen grossen Taillenumfang ( 95 cm) und 0,1% einen hohen Taille-Hüft-Quotient (> 1,0).Schlussfolgerungen: Alle Messgrössen, BMI, Taille-Hüft-Quotient und Taillenumfang müssen bei der Identifikation von übergewichtigen und adipösen Personen berücksichtigt werden.

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Résumé Indice de masse pondérale, rapport taille/hanche et circonférence de la taille: quelle est la bonne mesure de l'obésité?Objectifs: Déterminer la proportion d'un échantillon représentatif de la population adulte du sud de l'Australie ayant un indice de masse corporelle (IMC, une mesure de l'obésité générale) classé comme normal ou pas, mais qui ont aussi une circonférence de la taille ou un rapport taille/hanche (qui sont des mesures d'obésité centrale) compatibles avec une obésité.Méthodes: Un échantillon représentatif de la population adulte âgé de 18 ans et plus vivant dans la région Nord-Ouest d'Adélaide (n = 2523) a été recruté dans cette étude. Les mesures cliniques de la taille, du poids, la circonférence de la taille et des hanches ont été utilisées pour déterminer IMC et le rapport taille/hanche.Résultats: Parmi les femmes ayant un IMC normal, 19% avaient une circonférence de la taille élevée ( 80 cm) et 8,5% avaient un rapport taille/hanche élevé (> 0.85). Parmi les hommes ayant un IMC normal, 3,4% avaient une circonférence de la taille élevée ( 95 cm) et 0,1% avaient un rapport taille/hanche élevé (> 1).Conclusions: L'indice de masse corporelle, le rapport taille/ hanche et la circonférence de la taille jouent tous un rôle dans l'identification des personnes obèses ou ayant du surpoids.

     

Frontotemporal dementias: clinical features and management

This 2-part review of the frontotemporal lobar degeneration (FTLD) begins with an outline of clinical features, which differentiate FTLD from Alzheimer's disease, the more common cause of dementia. The second part describes interventions for FTLD. Although there is currently no disease-modifying therapeutic agent, symptomatic pharmacotherapy helps to control the marked mood and behavioral disturbances that may distinguish this syndrome from other causes of dementia.