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OBJECTIVES: A highly adaptive aspect of human memory is the enhancement of explicit, consciously accessible memory by emotional stimuli. We studied the performance of Alzheimer's disease (AD) patients and elderly controls using a memory battery with emotional content, and we correlated these results with the amygdala and hippocampus volume. METHODS: Twenty controls and 20 early AD patients were subjected to the International Affective Picture System (IAPS) and to magnetic resonance imaging-based volumetric measurements of the medial temporal lobe structures. RESULTS: The results show that excluding control group subjects with 5 or more years of schooling, both groups showed improvement with pleasant or unpleasant figures for the IAPS in an immediate free recall test. Likewise, in a delayed free recall test, both the controls and the AD group showed improvement for pleasant pictures, when education factor was not controlled. The AD group showed improvement in the immediate and delayed free recall test proportional to the medial temporal lobe structures, with no significant clinical correlation between affective valence and amygdala volume. CONCLUSION: AD patients can correctly identify emotions, at least at this early stage, but this does not improve their memory performance.

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The tools currently used to evaluate the extent of paracoccidioidomycosis (PCM) may be of limited value in detecting subclinical lesions. The aim of this study was to verify the role of gallium-67 whole-body scan in evaluating the extent of disease of 65 patients with active PCM. The (67)Ga scan findings were compared with the results of clinical evaluation, chest radiography and/or high-resolution computed tomography (CT), abdominal ultrasound (US) or CT, laryngoscopy, CT or magnetic resonance imaging (MRI) of the head, and technetium-99m methylene diphosphonate bone scan, obtained before treatment. Clinically unsuspected lesions were detected by imaging procedures in 21 patients (32%), mainly in the lungs (n=11), adrenals (n=6), and superficial (n=3) and deep lymph nodes (n=14). (67)Ga scan detected 100% of the cases with subclinical involvement in the lungs. Scintigraphy was superior to chest radiography in demonstrating lung disease (94% vs 81%). The lymphatic lesions were demonstrated by (67)Ga scan in all the clinically suspected cases and in nearly all unsuspected cases, and also revealed more extensive involvement than was clinically suspected in many of them. There was good agreement between (67)Ga scan and the other imaging procedures for the initial detection of thoracic and abdominal lymph nodes and bone involvement. (67)Ga imaging detected most cases of laryngopharyngeal disease with active inflammatory lesions found at indirect laryngoscopy. On the other hand, (67)Ga scan failed to demonstrate most of the adrenal and CNS lesions detected by abdominal US/CT and head CT/MRI. In conclusion, (67)Ga imaging is a useful tool for evaluating the location and extent of suspected and unsuspected lesions in PCM. It could serve as a screening method before the use of other diagnostic procedures, particularly in the detection of lung, superficial and deep lymph node and bone involvement.

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BACKGROUND: Contrast-enhanced color Doppler ultrasonography is a non-radiation-bearing tool that can be of value for assessment of inflammatory and vascular synovial changes in juvenile rheumatoid arthritis (JRA). OBJECTIVES: To evaluate the effect of contrast-enhanced color Doppler ultrasound (US) in the evaluation of synovial changes in the knees of children with JRA. MATERIALS AND METHODS: Sagittal color Doppler sonograms of 31 knees in 22 patients with JRA and of 10 knees in 5 control subjects were obtained before (at baseline) and after (at peak contrast phase) intravenous injection of SHU 508. Images were assessed for overall mean pixel intensity within the synovial tissue and for peak enhancement ratios [[(mean pixel intensity values at maximum contrast enhancement-unenhanced mean pixel intensity values)/unenhanced mean pixel intensity values] x 100]. The joints were classified into three groups by clinical/laboratory criteria: group A (active disease in the knee), n = 9; group B (quiescent disease with serum chemistry levels of active disease), n = 12 and group C (remission disease), n = 10. RESULTS: Mean color pixel intensity values were markedly increased by the use of US contrast agents in groups A (P = 0.004) and B (P = 0.0001), did not reach statistical significance in group C (P = 0.06) and remained essentially unchanged in the control group (P = 0.25). Enhancement ratios for the three groups of JRA patients were not different (P = 0.38) (mean +/- SD, 720% +/- 402 for group A, 731% +/- 703 for group B and 314% +/- 263 for group C). CONCLUSION: Contrast-enhanced color Doppler imaging holds promise for the detection of active synovial inflammatory disease in subclinical cases of JRA, thereby allowing earlier treatment and improved clinical outcome.

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Paracoccidioidomycosis, caused by the dimorphic fungus Paracoccidioides brasiliensis, is the most important systemic mycosis in Latin America. Imported cases have been reported in North America, Asia and Europe, in individuals who lived in endemic areas, sometimes many years before the development of clinical manifestations. The disease causes cutaneous and/or respiratory tract mucosal lesions as well as lymph node enlargement. Involvement of the oropharynx and/or the larynx, either alone or in association with pulmonary involvement, is one of the commonest clinical presentations. On MRI, the major features are mucosal lesions, usually hypointense on T1 weighted images and hyperintense on T2 weighted or fat suppressed images, affecting the oral cavity, oropharynx and larynx, with head and neck lymph node enlargement. Differential diagnosis includes other granulomatous infectious diseases, especially tuberculosis, and cancers such as squamous cell carcinoma and lymphomas.

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The early diagnosis of herpes simplex encephalitis (HSE) is essential because early introduction of antiviral therapy can significantly reduce the mortality of this disease. Herpes simplex virus (HSV) DNA detection in cerebrospinal fluid (CSF) samples is a rapid, noninvasive, specific, and highly sensitive method for HSE diagnosis. Neurodiagnostic methods have also been studied for noninvasive diagnosis of HSE. Magnetic resonance imaging (MRI) seems to be the most sensitive of them but it has not been compared to PCR in terms of efficacy for HSE diagnosis. In this study, 17 patients with focal encephalitis were prospectively evaluated by PCR analysis of CSF samples and MRI examination. MRI lesions involving the inferomedial region of one or both temporal lobes were observed in all PCR-positive patients but one. No PCR-negative patient presented with the same pattern of MRI lesions. MRI was also important for the establishment of an alternative diagnosis in three of eight PCR-negative patients. Both methods should be routinely applied in the evaluation of presumed HSE cases.

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This article describes the observations collected from the dissection of 10 nonformalinized cadavers analyzed in respect to the anatomical relation variations between the external jugular vein, the great auricular nerve, and the posterosuperior border of the platysma muscle.

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Tuberculosis of the central nervous system is still an important cause of death or significant neurologic disability. Prompt diagnosis and early treatment are extremely important to reduce its morbidity and mortality. The main forms of intracranial tuberculosis are represented by tuberculous meningitis, meningeal or parenchymal tuberculomas, and tuberculous abscess formation. Sequelae consist of hydrocephalus, calcifications, and areas of encephalomalacia. Less frequent manifestations include tuberculous osteitis of the skull and tuberculous otomastoiditis. Although MR imaging is in general somewhat more sensitive to the detection of cranial tuberculosis, CT is the diagnostic imaging mainstay in many clinical settings to demonstrate the various aspects of cranial tuberculosis on initial presentation and to monitor the evolution of the disease and response to therapy.

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Abdominoplasty is a common procedure in plastic surgery. Reviewing 150 patients who underwent abdominoplasty, it has been observed that 72% of the patients already had an abdominal scar. How to deal with abdominoplasty in an abdomen with a previous scar is discussed in this article.

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Secondary rhytidoplasty has become a very popular procedure. Of the 100 most recent patients presenting for rhytidoplasty, 19% asked for a second face-lift. In this article, we discuss particulars of second face-lifts.

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The advantages of fat filling for hand rejuvenescence are discussed. Seventy-two patients treated by this method are presented, including their follow-up, complication rate, and details of combined operations. Preference is given to local anesthesia when no other major surgeries are associated with the method. A highly satisfactory rate was obtained (98.62%) with a low complication rate (4.15%).

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Taking advantage of anatomical knowledge, in this report we suggest the benefits of an ample superficial musculoaponeurotic system undermining reaching the insertions of platysma muscle in the cutaneous muscles of the mouth and chin. This dissection is followed by an upward pull of the superficial musculoaponeurotic system-platysma on the face and a posterosuperior pull on the neck. The described procedure is recommended for patients presenting with drooping chin and lateral gravity bags. The method was performed in 84 of 148 patients, with excellent results.

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The purpose of this paper is to study the alterations produced by pregnancy in women who submitted to breast reduction. We studied a group of 50 women younger than 32 years of age who submitted to this operation and had an incidence of pregnancy of 22%. The alterations of ponderable weight and increased breast volume had no relation to pregnancy. Breast ptosis was twice as frequent in the group of women who became pregnant than in the group of women who did not become pregnant. Breast-feeding was normal. We found a large percentage of women were gratified by the results of the operation (92%), and those not fully satisfied did not report any disturbances in their sexual life.

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Sideburn elevation, tragus elimination, earlobe dislocation, and visible scars in front of the ear are common mistakes in facelift operations. The presence of just one of these flaws spoils the result of rhytidoplasty. Surgical procedures for optimizing the preauricular scar and the location of the sideburns in the facelift procedure are discussed in this article.

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A study of 10 patients who underwent a unilateral dissection of the superficial musculoaponeurotic system (SMAS) is discussed. According to the different postoperative results, the patients were grouped into three classes, with either major, minor, or no obvious benefit from the SMAS dissection. The indications for and value of SMAS treatment in face lift are discussed, based on the results observed.

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The advantages of non-prefixed marking for breast reduction are discussed in this paper. The authors use a curved incision modification of the Pitanguy technique, stressing the value of changing the demarcation depending on the skin-gland relationship of each patient.

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Platysma muscle was studied in 50 cadavers. The principal anatomic variation concerned the medical fibers. In 75 percent of the cases, the fascicles are separate in the suprahyoid region but interlace with those of the opposite side, 1 to 2 cm below the chin. In 15 percent, the fascicles come together at the level of the thyroid cartilage, like a single muscle in the suprahyoid region. In 10 percent of the cadavers, the fibers were separate, but inserted in the subcutaneous muscles of the chin without decussating. The posterosuperior fibers of the platysma always pass behind the angle of the jaw and over important structures, the most significant being the mandibular branch of the facial nerve.

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The results in 50 patients who had had mammaplasties done 3 years ago are described--both as regards the patients' opinions and the surgeon's assessments. The alterations that occur in breasts after reduction mammaplasty were studied, and also changes that may occur when the patient's weight increases or decreases.

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