Palmaris profundus: one name, several subtypes, and a shared potential for nerve compression.

The palmaris profundus is a rare, but known anatomic variation which may lead to compression of the median nerve and/or its branches. Two patients with carpal tunnel syndrome are presented in whom a palmaris profundus was discovered at operation. In these cases, median nerve compression at the wrist was attributed to the course of the extra tendon and its local mass effect on the nerve (i.e., the palmaris profundus and median nerve shared a common sheath); more commonly, the resultant decreased available space for the median nerve within the carpal tunnel due to the presence of an accessory (10th) flexor tendon is thought to be responsible. Postoperative 3 Tesla magnetic resonance imaging (MRI) was performed to demonstrate the full course of the variant muscle; despite variations in the size and longitudinal extent of the accessory musculotendinous unit, an important similarity was noted: the intimate relationship of the median nerve and the palmaris profundus. These two cases and our review of the literature highlight the fact that one name (i.e. palmaris profundus) reflects several anatomic subtypes. However, the close relationship of the palmaris profundus with the median nerve in the forearm and the palm is a common theme which emphasizes the potential pathoanatomic consequences of this relationship: nerve compression.

Repeat posterior fossa exploration for patients with persistent or recurrent idiopathic trigeminal neuralgia.

OBJECT: Patients with trigeminal neuralgia (TN) and persistent or recurrent facial pain after microvascular decompression (MVD) typically undergo less invasive procedures in the hope of providing pain relief. The outcomes and risks of repeat posterior fossa exploration (PFE) for these patients are not clearly understood. METHODS: From September 2000 to November 2006, 29 patients (14 men, 15 women) underwent repeat PFE. The mean number of surgeries per patient at the time of repeat PFE was 3.2 (range 1-6). The mean follow-up duration after surgery was 33.7 months. RESULTS: Compression of the trigeminal nerve was noted in 24 patients (83%) by an artery (13 patients, 45%), vein (4 patients, 14%), or Teflon (7 patients, 24%). Four patients (14%) who underwent operations elsewhere had incorrect cranial nerves decompressed at their first surgery. Only MVD was performed in 18 patients (62%) and a partial nerve section (PNS) was performed in 11 patients (38%). An excellent facial pain outcome (no pain, no medications required) was achieved and maintained for 80% and 75% of patients at 1 and 3 years after surgery, respectively. Patients with Burchiel Type 1 TN were pain free without medications (91% at 1 year and 85% at 3 years) more frequently than patients with Burchiel Type 2 TN (27% at both 1 and 3 years; hazard ratio = 5.4, 95% confidence interval 1.4-21.1, p = 0.02). Fifteen patients (52%) had new or increased facial numbness. Two patients (7%) developed anesthesia dolorosa; both had undergone PNS. Two patients (7%) had hearing loss after surgery. CONCLUSIONS: Repeat PFE for patients with idiopathic TN has facial pain outcomes that are comparable with both percutaneous needle-based techniques and stereotactic radiosurgery. Patients with persistent or recurrent TN should be considered for repeat PFE, especially if other less invasive surgeries have not relieved their facial pain.

Study of a Leptospirosis Outbreak in Honduras Following Hurricane Mitch and Prophylactic Protection of the vax-SPIRAL® Vaccine.

Honduras was one of the Central American countries most severely hit by Hurricane Mitch. Torrential rains and heavy flooding created conditions conducive to a leptospirosis outbreak in the country. A group of Cuban scientists studied 68 patients from the Department of Cort�s - one of the country's hardest hit areas - presenting clinical and epidemiological profiles indicative of leptospirosis. Blood and serum samples were taken from all subjects. A microscopic agglutination test (MAT) was used to identify Leptospira strains and to assess protection conferred by vax-SPIRAL® (Cuban leptospirosis vaccine) against the isolated strain. Prevalence of leptospires in the kidneys and liver was also verified. A male predominance was found in the group aged 15-49 years. Municipalities in this Department with the largest number of cases were San Pedro Sula, La Lima, and Chamelec�n. The most frequent symptoms included fever, headache, myalgia, and generalized discomfort. Over 80% of subjects reported presence of rodents in their homes, as well as contact with stagnant water and domestic animals. The strain isolated from positive blood cultures was from the Icterohaemorrhagiae serogroup, which was highly virulent in the animal model used. Protection was 100% in hamsters inoculated with vax-SPIRAL® and subsequently challenged with the Honduran strain. Additionally, macroscopic analysis of organs from immunized animals that survived the challenge showed no signs of leptospirosis infection.

Acute cerebellitis presenting as tumor. Report of two cases.

A pseudotumoral presentation of acute cerebellitis is rare. The authors report two cases of children with hemicerebellar involvement, neither case being postinfectious nor vaccination related. One patient underwent biopsy sampling revealing marked parenchymal and leptomeningeal inflammation, and in the other, near-complete resolution of neuroimaging abnormalities was demonstrated. The literature is reviewed and therapy considerations are emphasized.

Brote de gastroenteritis por salmonella enteritidis entre trabajadores de maquila en Naco, Honduras / Bud of gastroenteritis by salmonella enteritidis between workers of assembles in Naco, Honduras

OBJETIVOS. Identificar los factores de riesgo, la fuente de infección y el agente causal de un brote de gastroenteritis aguda declarado en una maquila situada en Naco, Quimistán Honduras, y adoptar medidas de control inmediatas. METODOS. Se efectuó un estudio de casos y controles entre los obreros de la maquila y se efectuaron coprocultivos en 17 pacientes. Se revisó el proceso de preparación de los alimentos servidos dentro de la maquila el día del brote, y se realizaron análisis químico y bacteriológico de la fuente de agua de la maquila y de muestras de alguno de los alimentos consumidos ese día. Se realizaron inspecciones de la cocina y de la granja avícola que proveía la carne de aves de corral. RESULTADOS. En total se incluyó a 497 obreros que fueron entrevistados durante la investigación. Entre el 28 y el 30 de junio de 1999 se notificaron 281 casos, con una taza de ataque de 56.5 por ciento. La medida de edad de los casos fue de 24.2 años. En cuadro clínico predominó: cefalea(86.1 por ciento), fiebre (84.0 por ciento), dolor abdominal (82.9 por ciento) y diarrea (75.8 por ciento). La mediana del período de incubación fue de 19 horas. solamente un paciente requirió ser hospitalizado y la evolución de todos los afectados fue satisfactoria. En siete de 17 coprocultivos realizados se aisló salmonella enteritidis. Se encontró una asociación entre consumo del pollo servido en el almuerzo y la cena del día 28, con la ocurrencia de casos. [Razón de posibilidades(OR)=4.42, IC95 por ciento 1.88 a 10.21]. La inspección de la granja avícola que provenía la carne de aves de corral indicó prácticas rudimentarias de faenado que favorecían la contaminación de la carne de pollo. La revisión del manejo y la manipulación del pollo en la cocina de la maquila reveló que la refrigeración se efectuaba a una temperatura tubóptima consistente con la proliferación bacteriana. CONCLUSIONES. Los hallazgos, clínicos y epidemiológicos y laboratoriales fueron consistentes con el patrón de un brote de gastroenteritis aguda causada por salmonella enteritidis. Se sugiere normalizar un sistema de control de calidad continua en la cadena de producción de alimentos servidos en este tipo de locales

Single-neuron activity in the human supplementary motor area underlying preparation for action.

OBJECT: The supplementary motor area (SMA) is considered critical in the planning, initiation, and execution of motor acts. Despite decades of research, including electrical stimulation mapping in patients undergoing neurosurgery, the contribution of this region to the generation of motor behavior has remained enigmatic. This is a study of single-neuron responses at various stages of a motor task during depth electrode recording in the SMA, pre-SMA, and medial temporal lobe of humans, with the goal of elucidating the disparate roles of neurons in these regions during movements. METHODS: The patients were undergoing evaluation for epilepsy surgery requiring implantation of intracranial depth electrodes. Single-unit recordings were made during both the execution and mental imagery of finger apposition sequences. Only medial frontal neurons responded selectively to specific features of the motor plan, such as which hand performed the motor activity or the complexity of the sequence. Neuron activity progressively increased before the patient was given a "go" cue for the execution of movements; this activity peaked earlier in the pre-SMA than in the SMA proper. We observed similar patterns of activation during motor imagery and actual movement, but only neurons in the SMA differentiated between imagined and real movements. CONCLUSIONS: These results provide support at the single-neuron level for the role of the medial frontal cortex in the temporal organization and planning of movements in humans.

Primate antisaccade. II. Supplementary eye field neuronal activity predicts correct performance.

Neuronal activities were recorded in the supplementary eye field (SEF) of 3 macaque monkeys trained to perform antisaccades pseudorandomly interleaved with prosaccades, as instructed by the shape of a central fixation point. The prosaccade goal was indicated by a peripheral stimulus flashed anywhere on the screen, whereas the antisaccade goal was an unmarked site diametrically opposite the flashed stimulus. The visual cue was given immediately after the instruction cue disappeared in the immediate-saccade task, or during the instruction period in the delayed-saccade task. The instruction cue offset was the saccade gosignal. Here we focus on 92 task-related neurons: visual, eye-movement, and instruction/fixation neurons. We found that 73% of SEF eye-movement-related neurons fired significantly more before anti-saccades than prosaccades. This finding was analyzed at 3 levels: population, single neuron, and individual trial. On individual antisaccade trials, 40 ms before saccade, the firing rate of eye-movement-related neurons was highly predictive of successful performance. A similar analysis of visual responses (40 ms astride the peak) gave less-coherent results. Fixation neurons, activated during the initial instruction period (i.e., after the instruction cue but before the stimulus) always fired more on antisaccade than on prosaccade trials. This trend, however, was statistically significant for only half of these neurons. We conclude that the SEF is critically involved in the production of antisaccades.

Brote de gastroenteritis por salmonella enteritidis entre trabajadores de maquila en Naco, Honduras / Bud of gastroenteritis by salmonella enteritidis between workers of assembles in Naco, Honduras

OBJETIVOS. Identificar los factores de riesgo, la fuente de infección y el agente causal de un brote de gastroenteritis aguda declarado en una maquila situada en Naco, Quimistán Honduras, y adoptar medidas de control inmediatas. METODOS. Se efectuó un estudio de casos y controles entre los obreros de la maquila y se efectuaron coprocultivos en 17 pacientes. Se revisó el proceso de preparación de los alimentos servidos dentro de la maquila el día del brote, y se realizaron análisis químico y bacteriológico de la fuente de agua de la maquila y de muestras de alguno de los alimentos consumidos ese día. Se realizaron inspecciones de la cocina y de la granja avícola que proveía la carne de aves de corral. RESULTADOS. En total se incluyó a 497 obreros que fueron entrevistados durante la investigación. Entre el 28 y el 30 de junio de 1999 se notificaron 281 casos, con una taza de ataque de 56.5 por ciento. La medida de edad de los casos fue de 24.2 años. En cuadro clínico predominó: cefalea(86.1 por ciento), fiebre (84.0 por ciento), dolor abdominal (82.9 por ciento) y diarrea (75.8 por ciento). La mediana del período de incubación fue de 19 horas. solamente un paciente requirió ser hospitalizado y la evolución de todos los afectados fue satisfactoria. En siete de 17 coprocultivos realizados se aisló salmonella enteritidis. Se encontró una asociación entre consumo del pollo servido en el almuerzo y la cena del día 28, con la ocurrencia de casos. [Razón de posibilidades(OR)=4.42, IC95 por ciento 1.88 a 10.21]. La inspección de la granja avícola que provenía la carne de aves de corral indicó prácticas rudimentarias de faenado que favorecían la contaminación de la carne de pollo. La revisión del manejo y la manipulación del pollo en la cocina de la maquila reveló que la refrigeración se efectuaba a una temperatura tubóptima consistente con la proliferación bacteriana. CONCLUSIONES. Los hallazgos, clínicos y epidemiológicos y laboratoriales fueron consistentes con el patrón de un brote de gastroenteritis aguda causada por salmonella enteritidis. Se sugiere normalizar un sistema de control de calidad continua en la cadena de producción de alimentos servidos en este tipo de locales