Gray matter atrophy in parkinsons disease and the parkinsonian variant of multiple system atrophy: a combined roi- and voxel-based morphometric study

OBJECTIVES: Parkinson's disease (PD) and the parkinsonian variant of multiple system atrophy (MSA-P) are distinct neurodegenerative disorders that share similar clinical features of parkinsonism. The morphological alterations of these diseases have yet to be understood. The purpose of this study was to evaluate gray matter atrophy in PD and MSA-P using regions of interest (ROI)-based measurements and voxel-based morphometry (VBM). METHODS: We studied 41 patients with PD, 20 patients with MSA-P, and 39 controls matched for age, sex, and handedness using an improved T1-weighted sequence that eased gray matter segmentation. The gray matter volumes were measured using ROI and VBM. RESULTS: ROI volumetric measurements showed significantly reduced bilateral putamen volumes in MSA-P patients compared with those in PD patients and controls (p<0.05), and the volumes of the bilateral caudate nucleus were significantly reduced in both MSA-P and PD patients compared with those in the controls (p<0.05). VBM analysis revealed multifocal cortical and subcortical atrophy in both MSA-P and PD patients, and the volumes of the cerebellum and temporal lobes were remarkably reduced in MSA-P patients compared with the volumes in PD patients (p<0.05). CONCLUSIONS: Both PD and MSA-P are associated with gray matter atrophy, which mainly involves the bilateral putamen, caudate nucleus, cerebellum, and temporal lobes. ROI and VBM can be used to identify these morphological alterations, and VBM is more sensitive and repeatable and less time-consuming, which may have potential diagnostic value.

Between the foreign and the local: French midwifery, traditional practitioners, and vernacular medical knowledge about childbirth in Lima, Peru / Entre o estrangeiro e o local: obstetrizes francesas, médicos tradicionais e conhecimento médico vernáculo sobre partos em Lima, Peru

This article examines the politics of midwifery and the persecution of untitled female assistants in childbirth in early republican Peru. A close reading of late colonial publications and the works of Benita Paulina Cadeau Fessel, a French obstetriz director of a midwifery school in Lima, demonstrates both trans-Atlantic and local influences in the campaign against untitled midwives. Cadeau Fessel's efforts to promote midwifery built upon debates among writers in Peru's enlightened press, who vilified untrained midwives' and wet nurses' vernacular medical knowledge and associated them with Lima's underclass. One cannot understand the transfer of French knowledge about professional midwifery to Peru without reference to the social, political, and cultural context.

Este artigo analisa as políticas de práticas de parteiras profissionais e a condenação de parteiras leigas nos primórdios do Peru republicano. A leitura atenta de publicações de fins do período colonial e dos trabalhos de Benita Paulina Cadeau Fessel, obstetriz francesa diretora de uma escola de parteiras em Lima, revela influência tanto transatlântica como local na campanha contra as parteiras sem titulação. Cadeau Fessel promovia seu ofício com base em debates veiculados na imprensa peruana ilustrada, que aviltavam o conhecimento tradicional de amas de leite e parteiras leigas e as associavam às classes desfavorecidas. Só é possível compreender a transferência do conhecimento francês sobre trabalho de parteiras profissionais para o Peru relacionando-a ao contexto social, político e cultural.

Síndrome de Ramsay y Hunt: reporte de un caso y revisión bibliográfica / Ramsay Hunt syndrome: a case report and review of literature

El Síndrome de Ramsay Hunt es una parálisis facial periférica (PFP) aguda asociada a otalgia y ampollas herpéticas en piel del pabellón de la oreja y del conducto auditivo externo. Debida a inflamación del nervio facial ocasionada por reactivación del virus de la varicela zoster. (VVZ). Es más frecuente en inmunodeprimidos y después de los 50 años. Enfermedad rara, autolimitada y su pronóstico es bueno. El diagnóstico es básicamente clínico. Paciente masculino de 27 años de edad, con enfermedad de dos semanas de evolución, caracterizada por debilidad, sensación de ardor en región temporal izquierda; posteriormente otalgia, aparición de eritema maculopapular, que evolucionó a vesículas en región temporo-parieto-occipital, hemicuello y hombro izquierdo. Luego presentó PFP. Antecedente de varicela a los 8 años. Se demostró VVZ a través de inmunofluorescencia directa de muestra de suero y biopsia de piel. El paciente fue tratado con: Aciclovir, Prednisona, Ketoprofeno. Nuestro caso corresponde a un síndrome de Ramsay Hunt tipo 2, consiste en PFP, dolor periauricular, lesiones herpéticas en pabellón auricular, conducto auditivo externo, cara, cuero cabelludo o cuello, sin afectación del VIII Par craneal. Para confirmar la clínica, la inmunofluorescencia directa se escogió como método diagnóstico por ser más sensible que el cultivo, de costo accesible y procesamiento rápido. El VVZ es muy lábil y d¡fícil de aislar. El paciente respondió bien al tratamiento, desapareciendo la neuralgia postherpetica y la parálisis facial completamente a los 27 días de su egreso.