Abnormal serotonin reuptake in an overtrained, insomnic and depressed team athlete.

The purpose of this report is to study serotonin reuptake of the brain in a severely overtrained athlete by using single-photon emission computed tomography (SPECT). A 26-year-old team athlete increased his training volume (by 200 %) and intensity markedly in a new high-level team. After two months, he started to feel continuous fatigue. He had tinnitus in his left ear, he felt disturbing palpitation and had pollacisuria. After four months, he started to suffer from insomnia. He still continued to play for another three months, after which he was unable to play. He could only sleep for 3 to 4 hours per night. Only minor abnormalities could be found in extensive physical and laboratory examinations. The athlete had a severe overtraining state. In the brain SPECT scans, using the specific radioligand for serotonin transporter imaging ( (123)I labelled 2beta-carbomethoxy-3beta-[4-iodophenyl]-nortropane), low activity areas were detected in the midbrain, anterior gingulus, and left frontal and temporo-occipital lobes. In a psychiatric examination, the patient was found to have signs of major depression, which he hardly recognized himself. We conclude, that that the severe overtraining state could have been related to decreased serotonin reuptake in the brain and signs of major depression.

Neural correlates of letter-string length and lexicality during reading in a regular orthography.

Behavioral studies have shown that short letter strings are read faster than long letter-strings and words are read faster than nonwords. Here, we describe the dynamics of letter-string length and lexicality effects at the cortical level, using magnetoencephalography, during a reading task in Finnish with long (eight-letter) and short (four-letter) word/nonword stimuli. Length effects were observed in two spatially and temporally distinct cortical activations: (1) in the occipital cortex at about 100 msec by the strength of activation, regardless of the lexical status of the stimuli, and (2) in the left superior temporal cortex between 200 and 600 msec by the duration of activation, with words showing a smaller effect than nonwords. A significant lexicality effect was also evident in this later activation, with stronger activation and longer duration for nonwords than words. There seem to be no distinct cortical areas for reading words and nonwords. The early length effect is likely to be due to the low-level visual analysis common to all stimulus letter-strings. The later lexicality and length effects apparently reflect converging lexico-semantic and phonological influences, and are discussed in terms of dual-route and single-route connectionist models of reading.

Category-specific occipitotemporal activation during face perception in dyslexic individuals: an MEG study.

In dyslexia, it is consistently found that letter strings produce an abnormally weak or no response in the left occipitotemporal cortex. Time-sensitive imaging techniques have located this deficit to the category-specific processing stage at about 150 ms after stimulus presentation. The typically reported behavioral impairments in dyslexia suggest that the lack of occipitotemporal activation is specific to reading. It could, however, also reflect a more general dysfunction in the left inferior occipitotemporal cortex or in the time window of category-specific activation (150 to 200 ms). As early cortical processing of faces follows a sequence practically identical to that for letter strings, both in location and in timing, we investigated these possibilities by comparing face-specific occipitotemporal activations in dyslexic and non-reading-impaired subjects. We found that both the stage of general visual feature analysis at about 100 ms and the earliest face-specific activation at about 150 ms were essentially normal in the dyslexic individuals. The present results emphasize the special nature of the occipitotemporal abnormality to letter strings in dyslexia. However, in behavioral tests dyslexic subjects were slower and more error-prone than non-reading-impaired subjects in judging the similarity of faces and geometrical shapes. This effect may be related to reduced activation of the right parietotemporal cortex at about 250 ms after stimulus onset.

Brain activation during reading in deep dyslexia: an MEG study.

Magnetoencephalographic (MEG) changes in cortical activity were studied in a chronic Finnish-speaking deep dyslexic patient during single-word and sentence reading. It has been hypothesized that in deep dyslexia, written word recognition and its lexical-semantic analysis are subserved by the intact right hemisphere. However, in our patient, as well as in most nonimpaired readers, lexical-semantic processing as measured by sentence-final semantic-incongruency detection was related to the left superior-temporal cortex activation. Activations around this same cortical area could be identified in single-word reading as well. Another factor relevant to deep dyslexic reading, the morphological complexity of the presented words, was also studied. The effect of morphology was observed only during the preparation for oral output. By performing repeated recordings 1 year apart, we were able to document significant variability in both the spontaneous activity and the evoked responses in the lesioned left hemisphere even though at the behavioural level, the patient's performance was stable. The observed variability emphasizes the importance of estimating consistency of brain activity both within and between measurements in brain-damaged individuals.

Neurophysiology of fluent and impaired reading: a magnetoencephalographic approach.

This article reviews a series of magnetoencephalographic (MEG) experiments aimed at identifying cortical areas and time windows relevant or even critical for fluent reading. The approach was to compare single-word processing in fluent and dyslexic readers. The activations which differed between the two groups were then studied in more detail to determine their functional roles. In fluent reading, overall visual feature processing occurs about 100 milliseconds (ms) after seeing a word, in the posteromedial extrastriate cortex bilaterally. This activation does not differentiate between letters and symbols. The first reading-specific signal is detected about 150 ms after word onset, when the left inferior occipitotemporal cortex responds preferentially to letter strings. After 200 ms, the left superior temporal cortex, in particular, is engaged in semantic processing of single words and their integration with connected text. While visual feature processing seems to be within normal limits in dyslexic subjects, reading is disrupted during the first 200 ms after seeing a word, at the letter-string specific stage. The subsequent activations are weak and delayed as compared with those in fluent readers. Also presented is a case of deep dyslexia, where the same tools were used to demonstrate that reading comprehension was still subserved by the left hemisphere despite severe damage.

Dynamics of letter string perception in the human occipitotemporal cortex.

The inferior occipitotemporal brain areas, especially in the left hemisphere, have been shown to be involved in the processing of written words and letter strings. This processing probably occurs within 200 ms after presentation of the letter string. It has also been suggested that this activation may differ between fluent and dyslexic readers. Using whole-head magnetoencephalography, we studied the spatiotemporal dynamics of brain processes evoked by visually presented letter strings in 12 healthy adult subjects. Our achromatic stimuli consisted of rectangular patches in which single letters, two-letter syllables, four-letter words, or symbol strings of equal length were embedded and to which variable noise was added. This manipulation dissociated three different response patterns. The first of these patterns took place approximately 100 ms after stimulus onset, originated in areas surrounding the V1 cortex and was distributed along the ventral visual stream, extending laterally as far as V4v. This response was systematically modulated by noise but was insensitive to the stimulus content, suggesting involvement in early visual analysis. The second pattern took place approximately 150 ms after stimulus onset and was concentrated in the inferior occipitotemporal region with left-hemisphere dominance. This activation showed a preference for letter strings, and its strength and timing correlated with the speed at which the subjects were able to read words aloud. The third pattern also occurred in the time window approximately 150 ms after stimulus onset, but originated mainly in the right occipital area. Like the second pattern, it was modulated by string length, but showed no preference for letters compared with symbols. The present data strongly support the special role of the left inferior occipitotemporal cortex in visual word processing within 200 ms after stimulus onset.

Semantic cortical activation in dyslexic readers.

The combined temporal and spatial resolution of MEG (magnetoencephalography) was used to study whether the same brain areas are similarly engaged in reading comprehension in normal and developmentally dyslexic adults. To extract a semantically sensitive stage of brain activation we manipulated the appropriateness of sentence-ending words to the preceding sentence context. Sentences, presented visually one word at a time, either ended with a word that was (1) expected, (2) semantically appropriate but unexpected, (3) semantically anomalous but sharing the initial letters with the expected word, or (4) both semantically and orthographically inappropriate to the sentence context. In both subject groups all but the highly expected sentence endings evoked strong cortical responses, localized most consistently in the left superior temporal cortex, although additional sources were occasionally found in more posterior parietal and temporal areas and in the right hemisphere. Thus, no significant differences were found in the spatial distribution of brain areas involved in semantic processing between fluent and dyslexic readers. However, both timing and strength of activation clearly differed between the two groups. First, activation sensitivity to word meaning within a sentence context began about 100 msec later in dyslexic than in control subjects. This is likely to result from affected presemantic processing stages in dyslexic readers. Second, the neural responses were significantly weaker in dyslexic than in control subjects, indicating involvement of a smaller or less-synchronous neural population in reading comprehension. Third, in contrast to control subjects, the dyslexic readers showed significantly weaker activation to semantically inappropriate words that began with the same letters as the most expected word than to both orthographically and semantically inappropriate sentence-ending words. Thus, word recognition by the dyslexic group seemed to be qualitatively different: Whereas control subjects perceived words as wholes, dyslexic subjects may have relied on sublexical word recognition and occasionally mistook a correctly beginning word for the one they had expected.

Native language, gender, and functional organization of the auditory cortex.

Whole-head magnetoencephalography was employed in 40 normal subjects to investigate whether the basic functional organization of the auditory cortex varies with linguistic environment. Robust activations of the bilateral supratemporal auditory cortices to 1-kHz pure tones, maximum at about 100 ms after stimulus onset, were studied in Finnish and German female and male subject groups with monolingual background. Activations elicited by the tones were mutually indistinguishable in German and Finnish women. In contrast, German men showed significantly stronger auditory responses to pure tones in the left, language-dominant hemisphere than Finnish men. We discuss the possibility that the prominent left-hemisphere activation in German males reflects higher frequency resolution required for distinguishing between German than Finnish vowels and that the clear effect of native language in male but not in female auditory cortex derives from more pronounced functional lateralization in men. The present data suggest that the influence of native language can extend to auditory cortical processing of pure-tone stimuli with no linguistic content and that this effect is conspicuous in the male brain.

Dissociation of normal feature analysis and deficient processing of letter-strings in dyslexic adults.

Neuroimaging studies have revealed that the functional organization of reading differs between developmentally dyslexic and non-impaired individuals. However, it is not clear how early in the reading process the differences between fluent and dyslexic readers start to emerge. We studied cortical activity of ten dyslexic adults using magnetoencephalography (MEG), as they silently read words or viewed symbol-strings which were clearly visible or degraded with Gaussian noise. This method has previously been used to dissociate between analysis of local features and pre-lexical word processing in fluent adult readers. Signals peaking around 100 ms after stimulus onset and originating in the postero-medial extrastriate cortex were associated with increasing local luminance contrast in the noise patches. These early visual responses were similar in dyslexic and non-impaired readers. In contrast, the letter-string-specific responses peaking around 150 ms predominantly in the left inferior occipito-temporal cortex in fluent readers were undetectable in dyslexic readers. Thus, while the early visual processing seems intact in dyslexic adults, the pattern of cortical activation starts to differ from that of fluent readers at the point where letter-string-specific signals first emerge during reading.

Non-impaired auditory phase locking in dyslexic adults.

Dyslexic adults have profound difficulties in discriminating rapidly presented sound sequences. To test whether these deficits might be caused by impaired neuronal phase locking to the envelopes of the sound stimuli, 20 normal-reading and 13 dyslexic adults discriminated pitches of pure tones at approximately 1 kHz (producing spectral pitch due to place coding in the cochlea) and of approximately 80 Hz amplitude modulations of white noise (producing periodicity pitch based on temporal information only). We proposed that a specific deficit in phase locking would result in a worse ability to discriminate periodicity than spectral pitch. The dyslexics were significantly less accurate than the control subjects in discriminating both spectral and periodicity pitch stimuli but their performance was not disproportionally worse in the periodicity pitch task. Thus it seems that impaired neuronal phase-locking cannot explain the problems dyslexics face in processing of rapid sound sequences.

Auditory stream segregation in dyslexic adults.

Developmental dyslexia is often associated with problems in phonological processing based on, or accompanied by, deficits in the perception of rapid auditory changes. Thirteen dyslexic adults and 18 control subjects were tested on sequences of alternating tones of high (1000 Hz) and low (400 Hz) pitch, which at short stimulus onset asynchronies (SOAs) led to perceptual separation of the sound sequence into high- and low-pitched streams. The control subjects perceived the tone sequence as connected down to SOAs of 130 ms, with segregation of the streams at shorter SOAs; in dyslexic subjects the segregation occurred already at 210 ms. Auditory stream segregation has previously been shown to impair the detection of phoneme order in segments of speech sounds. The observed aberrant segregation of sound streams in dyslexic subjects might thus contribute to their difficulties in achieving awareness of phonemes or phoneme order and in the acquisition of literacy.

Prolonged low-back pain in young athletes: a prospective case series study of findings and prognosis.

We investigated the prognosis of low-back pain and the association of clinical symptoms and anatomic findings among young athletes. Consecutive patients, aged between 12 and 18 years, who had low-back pain that had interfered with their training for at least 4 weeks were included in the case series. All the patients participated in a standardized interview and clinical examination, and plain radiographs and magnetic resonance images were also obtained. Most patients also participated in technetium bone scan examination. In 15 out of 19 subjects there were anatomic abnormalities that corresponded with the location and type of clinical symptoms. Twelve subjects had changes in the disk-vertebral end plate complex and eight had a positive bone scan indicative of posterior vertebral arch stress reaction. Six out of eight boys and two out of 11 girls had stress reaction (P = 0.043). Restriction of painful activities was recommended to all subjects, restriction of activities and the use of a dynamic low-back brace for the first 3 months was recommended to patients with posterior vertebral arch stress reaction. The self-reported intensity of low-back pain (scale 0-100) among all the patients was 69 +/- 16 (mean +/- SD) at baseline and 18 +/- 21 at the 1-year follow-up (P < 0.0001). In conclusion, the reasons for prolonged back pain among young athletes are usually established by imaging studies. A knowledge of anatomic abnormalities may help in tailoring training programmes and avoiding the progression of changes during growth. Simple restriction of painful activities usually leads to good recovery.

An MEG study of picture naming.

The purpose of this study was to relate a psycholinguistic processing model of picture naming to the dynamics of cortical activation during picture naming. The activation was recorded from eight Dutch subjects with a whole-head neuromagnetometer. The processing model, based on extensive naming latency studies, is a stage model. In preparing a picture"s name, the speaker performs a chain of specific operations. They are, in this order, computing the visual percept, activating an appropriate lexical concept, selecting the target word from the mental lexicon, phonological encoding, phonetic encoding, and initiation of articulation. The time windows for each of these operations are reasonably well known and could be related to the peak activity of dipole sources in the individual magnetic response patterns. The analyses showed a clear progression over these time windows from early occipital activation, via parietal and temporal to frontal activation. The major specific findings were that (1) a region in the left posterior temporal lobe, agreeing with the location of Wernicke"s area, showed prominent activation starting about 200 msec after picture onset and peaking at about 350 msec (i.e., within the stage of phonological encoding), and (2) a consistent activation was found in the right parietal cortex, peaking at about 230 msec after picture onset, thus preceding and partly overlapping with the left temporal response. An interpretation in terms of the management of visual attention is proposed.

Distinct time courses of word and context comprehension in the left temporal cortex.

The time course and cortical basis of reading comprehension were studied using magnetoencephalography. The cortical structures implicated most consistently with comprehension were located in the immediate vicinity of the left auditory cortex, where final words totally inappropriate to the overall sentence context evoked enduring activation starting approximately 250 ms and lasting up to 600 ms after word onset. Contextually appropriate but unexpected words produced weaker activation which terminated earlier. Highly anticipated words totally failed to activate this area, suggesting that the conceptual network became involved only if unexpected information was detected during the primary word identification process. We propose that the point in time (350 ms after word onset) where the response to appropriate but unexpected endings started to diverge from those to contextually inappropriate endings reflects the boundary between understanding a single word and the meaning of a whole sentence.

Long-term prognosis of reactive salmonella arthritis.

OBJECTIVES: Reactive joint complications triggered by salmonella gastroenteritis are increasingly reported, but the outcome and long term prognosis of the patients is incompletely known. This study looked at the prognosis of salmonella arthritis in patients hospitalised in 1970-1986. METHODS: Hospital records from two hospitals in southern Finland were screened for patients with the discharge diagnosis of salmonellosis or reactive, postinfectious arthritis or Reiter's disease. For the patients with confirmed diagnosis of reactive salmonella arthritis, data about the acute disease were collected from the hospital records. A follow up study was performed. RESULTS: There were 63 patients (28 women, 35 men, mean age 36.5 years) with salmonella arthritis. Urethritis occurred in 27%, eye inflammation in 13%, and low back pain in 44% of the patients. HLA-B27 was present in 88%. More men than women were HLA-B27 positive. HLA-B27 positive patients had higher erythrocyte sedimentation rate (mean 80.9 v 46.5 mm 1st h, p = 0.0180). Also, extra-articular features and radiological sacroiliitis were seen only in HLA-B27 positive patients. A follow up study was performed on 50 patients mean 11.0 (range 5-22 years) later. Twenty patients had recovered completely. Ten patients had mild joint symptoms, 11 patients had had a new acute transient arthritis, and five acute iritis. Eight patients had developed chronic spondyloarthropathy. Radiological sacroiliitis was seen in six of 44 patients, more frequently in male than in female patients (32% v 0%; p = 0.0289). Recurrent or chronic arthritis, iritis or radiological sacroiliitis developed only in HLA-B27 positive patients. CONCLUSION: Joint symptoms are common after reactive salmonella arthritis. HLA-B27 contributes to the severity of acute disease and to the late prognosis.

Epidemiology and traumatology of injuries in elite soccer: a prospective study in Finland.

A prospective study of male soccer injuries among 12 teams playing at the highest competition level was carried out in Finland in 1993. Overall, two out of three players were injured during the whole season. The injury incidence per 1000 playing hours among injured players and all players during games was higher than during practice, 14.2 vs. 11.3 and 2.3 vs. 1.8, respectively. The lower extremity was involved in 76% of the injuries. Thigh injuries were most frequent (22%), whereas overuse injuries were scarce (6%). Eighteen per cent of the injured players needed surgery and in most cases (58%) the reason for surgery was a knee injury. Sixteen per cent of all injured players were absent from soccer for more than 1 month after the injury. The mean absence time was 17 days for all and 84 days for operatively treated players.

High frequency of silent inflammatory bowel disease in spondylarthropathy.

OBJECTIVE: To search for an association between gut infection, gut inflammation, and spondylarthropathies. METHODS: Ileocolonoscopy was performed in 118 patients with various inflammatory and noninflammatory joint diseases and in 24 patients with uncomplicated acute bacterial gastroenteritis. RESULTS: Endoscopic lesions were more frequent in patients with spondylarthropathy (44%) compared with those with other inflammatory arthritides (6%; P = 0.001). Ileal changes were observed only in patients with spondylarthropathy (20% versus 0%; P = 0.01). Inflammatory bowel disease was the endoscopic diagnosis in 19% of the arthritis patients. Possible or definite Crohn's disease was diagnosed in 26% of patients with chronic spondylarthropathy, and ulcerative colitis in 1 patient with rheumatoid arthritis and in 1 with chronic uroarthritis. Histologic evidence of inflammation differed less distinctly than endoscopy findings between patients groups. There was no association of gut lesions with the use of nonsteroidal antiinflammatory drugs or with the presence of HLA-B27. CONCLUSION: Gut inflammation is frequent in patients with spondylarthropathy, and one-fourth of the patients who have chronic disease have early features of Crohn's disease.