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The objective of this study was to evaluate sleep macrostructure and sleep disturbance in a group of 39 patients with temporal lobe epilepsy (TLE). Patients completed questionnaires to evaluate their sleep and subjective daytime sleepiness (Epworth Sleepiness Scale [ESS]) and undergone Polysomnography and Multiple Sleep Latency Test (MSLT). Daytime sleepiness was the most frequent complaint (85%), followed by wakefulness during sleep, history of seizures during sleep (75%) and initial insomnia (26%). Parasomnias (67%), obstructive sleep apneas (13%), restless legs syndrome (15%) and periodic limb movements (5%) were the most frequent sleep disorders. The most frequent changes of sleep patterns were: sleep architecture fragmentation (100%), decreased amount of REM sleep (92%) and increase in time awake after sleep onset (77%). There were significative correlations between the ESS and the MSLT (p<0,05). In conclusion, TLE patients have fragmented sleep with increased sleep stages shifts, increased number of awakenings and in time awake after sleep onset. REM sleep was decreased. Daytime sleepiness was the most frequent complaint in TLE patients.

Purpose: Hippocampal atrophy (HA) and signal changes, detected at magnetic resonance imaging, have been associated with intractable seizures. Such a relation has been established by tertiary centers, where the prevalence of more severe cases tends to be higher. We evaluated the clinical and imaging variables that may have relevance to seizure control in patients with mesial temporal lobe epilepsy (MTLE) and HA., Methods: MTLE patients from the outpatient clinic of University of São Paulo School of Medicine at Ribeirão Preto were evaluated with protocols for the temporal lobe. Patients were considered to have good seizure control (GC; n = 42) if they had three of fewer seizures per year. Patients with pharmacoresistance and who did not fit the criteria for GC were considered to have poor seizure control (PC; n = 44). We made group comparisons and correlations of clinical data and hippocampal volume (HV) with seizure frequency., Results: No statistical differences were observed between the GC and PC groups in the following parameters: age at the time of study, age at the time of the initial precipitating injury (IPI) or first epileptic seizure, epilepsy duration and follow-up, and family history of epilepsy. No differences were found in HV between GC (male, 2.04 +/- 0.60 cc; female, 2.00 +/- 0.70 cc) and PC (male, 2.26 +/- 0.47 cc; female, 2.15 +/- 0.48 cc) groups. Regression analysis indicated no correlation between seizure frequency and HV (p = 0.33)., Conclusions: These findings suggest that the intensity of HA does not have a direct correlation with seizure frequency in patients with MTLE with HA and that the detection of HA in MTLE patients does not mean an unequivocal indication of intractability.

Objective: To establish the seroprevalence of Helicobacter pylori infection in children and to identify risk factors for seropositivity.\par, Methods: A cross-sectional study established the seroprevalence of infection by Helicobacter pylori and afterwards a comparative study was performed amongst seropositive and seronegative children. A group of 228 children were cared for at the outpatient clinic of Instituto Materno Infantil de Pernambuco, from May to July 1999. Age, sex, indicators of environmental, social and economic conditions, health and nutritional status as well as children living in contact with dwellers with history of gastrointestinal pain or peptic disease were evaluated. All data was obtained through an interview with children's parents or caretakers. Nutritional status was evaluated by anthropometric index. \par, Results: Seroprevalence of infection caused by Helicobacter pylori was found in 32% (95% CI 26% - 38%); 25.8% (95% CI 17.8% - 33.8%) in preschool children and 39.4% (95% CI 30.4% - 48.4%) in school age children. Analysis of environmental variables demonstrated higher frequency of seropositivity in children living in houses without toilets or sanitary flush toilet facilities (p = 0.008), overcrowded (p = 0.05), lower family income (p = 0.03) and poor maternal education (p = 0.002). There were no statistically significant differences between the groups regarding health indicators, anthropometric indexes and children living with dwellers with history of gastritis or peptic ulcer.\par, Conclusion: Seroprevalence of Helicobacter pylori infection was high in the studied population, being even higher among the school age group. A positive association between seropositivity and less favorable environmental variables was detected.

A retrospective study was performed in order to evaluate the frequency of abnormalities found by computed tomography (CT) scan of the head in 78 patients with migraine or tension-type headache. In the present study CT scan was normal in 61.5% of the patients with migraine or tension-type headache. A number of abnormalities were encountered in more than one third of the patients studied, including inflammatory sinus disease (19.2%), cysticercosis (3.9%), unruptured cerebral aneurysm (2.6%), basilar impression (2.6%), intracranial lipoma (2.6%), arachnoid cyst (2.6%), empty sella (2.6%), intracranial neoplasm (2.6%), and others (2.6%). None of these lesions were symptomatic or responsible by the headache picture, therefore, considered incidental findings. In conclusion, the fortuitous encounter of some abnormalities on CT scan of the head is often higher than what we could predict in patients suffering migraine or tension-type headache. We briefly discuss clinical, epidemiologic, and practical management of some of the abnormalities detected by CT scan as well as the indication to request a neuroimaging investigation.

Object: The authors report their experience in the treatment of 12 symptomatic patients with intradural spinal neurocysticercosis., Methods: The mean age of the 12 patients was 33 years. There were eight female and four male patients. Cysticercosis was present in association with hydrocephalus in nine cases. In nine of 12 patients the spinal lesion was confined to the thoracic or lumbar spinal cord, and in three the cysticerci occupied the cervical region. In all patients with hydrocephalus nerve root symptoms developed seven to 48 months later (mean 27.6 +/- 15.5 months). In one patient hydrocephalus was absent, but he presented with cysticercal meningitis 24 months before spinal cord compression developed. Presenting symptoms suggesting spinal cysticercosis included muscular weakness (67%), pain (67%), and sphincter disturbance (25%). Neurological examination demonstrated a motor deficit in nine patients, sensory deficit in four, and radicular pain in three. The prognosis was worse in patients with moderate-to-severe arachnoiditis and spinal cord compression compared with those with isolated nerve roots involvement in whom outcome was favorable. Ten patients underwent laminectomy, after which neurological status improved in 44%, remained unchanged in 33%, or worsened in 22.2%., Conclusions: The authors discuss their findings in these cases. Additionally they briefly review the literature, pathophysiology, and therapeutic and/or surgical strategies involved in this disease.

A 48-year-old man submitted to surgical excision of a left atrium leiomyosarcoma. The patient had a node close to the right suprarenal gland. The tumor was a casual echocardiographic finding as part of the cardiologic investigation, since the patient had shortness breath. Leiomyosarcomas of the heart are uncommon, and often the diagnosis is performed during postmortem examinations. Methods of diagnosis, specially the echocardiogram, were emphasised. Treatment and prognostic aspects on basis in a wide review of the literature were also emphasised.

The authors present a case of massive, nonocclusive intestinal ischemia and necrosis after surgery for correction of interatrial communication with cardiopulmonary bypass in a 22-year-old woman. This is an extremely serious complication that generally occurs in older patients. The literature mentions its occurrence in patients subjected to aortic valve replacement who have low cardiac output and in patients undergoing myocardial revascularization. Its occurrence in a young person with simple congenital cardiopathy is rare.

A case of nonfunctioning paraganglioma of the posterior mediastinum in a 20-year-old white man is presented. The diagnosis of aorticosympathetic paraganglioma (Glenner-Grimley classification) was established by histologic examination after surgical removal of the tumor.