[Anatomic and topographic models of the cerebral areas that activates during the linguistic functions]. / Modelos anatomotopográficos de las áreas cerebrales que se activan durante la función lingüística.

AIM: A brief revision was performed in order to develop a topographic model of cerebral activation during silent reading, syllable's repetition and emotional prosody, based in recent neuroimaging studies. DEVELOPMENT: It has been reported that the words are analyzed in both occipital hemispheres during silent reading, after they are 'written' in the right temporal cortex while the integration of the semantic and phonologic processes are integrated on different left temporal areas and also in the left frontal lower part. The understanding is achieved in the left-middle temporal cortex. In the other hand, activation during articulatory movements is carried out in the left supratemporal gyrus and the left motor and premotor cortex, the left putamen and part of both hemispheres of the cerebellum. Finally, recognition of the emotional prosody occurs in three stages: obtaining of the acoustic information in some areas of the right temporal lobe, representation of acoustic sequences in the right posterio-superior temporal area, and an evaluation of the emotional prosody in the lower frontal bilateral cortex, with the involvement of the basal ganglia in the emotional expression. CONCLUSIONS: The location and synchrony of the areas that activate during the language processing is lateralized toward the left hemisphere and it involves cortical and subcortical areas, except for the emotional prosody. The understanding of the language processes will open the field for to take advantage of the plastic mechanisms for the speech therapy and rehabilitation.

Modelos anatomotopográficos de las áreas cerebrales que se activan durante la función lingüística / Anatomic and topographic models of the cerebral areas that activates duringthe linguistic functions

Objetivo. Con el fin de elaborar modelos topográficos de activación cerebral asociados a los procesos de lecturasilenciosa, repetición de sílabas y prosodia emocional, se realiza una breve revisión bibliográfica de los avances recientes en estudios de neuroimagen. Desarrollo. Se ha comunicado que durante la lectura silenciosa, las palabras se analizan en amboshemisferios occipitales, después la palabra se ‘redacta’ en la corteza temporal derecha, mientras que la integración del proceso semántico y el fonológico se realiza en distintas áreas temporales izquierdas y en la parte inferior frontal izquierda. La comprensión se logra en la corteza temporal media izquierda. Por otro lado, la activación durante los movimientos articulatorios se lleva a cabo en el giro supratemporal izquierdo y las cortezas motora y premotora izquierdas, el putamen izquierdo y parte del cerebelo en forma bilateral. Finalmente, el reconocimiento de la prosodia emocional sucede en tres etapas: obtención de la información acústica en áreas del lóbulo temporal derecho, representación de secuencias acústicas en el surco temporal posterosuperior derecho y evaluación de la prosodia emocional en la corteza bilateral frontal inferior, junto con la participación de los ganglios basales en lo que respecta a la expresión emocional. Conclusiones. La localización y sincronizaciónde las áreas que se activan durante los procesos del lenguaje, con excepción de la prosodia emocional, está lateralizada preferentemente hacia el hemisferio izquierdo e implica áreas corticales y subcorticales. El entendimiento de los procesos del lenguaje abrirá el campo para el aprovechamiento de los mecanismos plásticos en la rehabilitación logopédica

Aim. A brief revision was performed in order to develop a topographic model of cerebral activation during silentreading, syllable’s repetition and emotional prosody, based in recent neuroimaging studies. Development. It has been reported that the words are analyzed in both occipital hemispheres during silent reading, after they are ‘written’ in the right temporal cortex while the integration of the semantic and phonologic processes are integrated on different left temporal areas and alsoin the left frontal lower part. The understanding is achieved in the left-middle temporal cortex. In the other hand, activation during articulatory movements is carried out in the left supratemporal gyrus and the left motor and premotor cortex, the left putamen and part of both hemispheres of the cerebellum. Finally, recognition of the emotional prosody occurs in three stages:obtaining of the acoustic information in some areas of the right temporal lobe, representation of acoustic sequences in the right posterio-superior temporal area, and an evaluation of the emotional prosody in the lower frontal bilateral cortex, with the involvement of the basal ganglia in the emotional expression. Conclusions. The location and synchrony of the areas thatactivate during the language processing is lateralized toward the left hemisphere and it involves cortical and subcortical areas, except for the emotional prosody. The understanding of the language processes will open the field for to take advantage of the plastic mechanisms for the speech therapy and rehabilitation

[Desensitization to human recombinant DNA insulin in an adolescent with insulin-dependent diabetes mellitus]. / Desensibilización a insulina DNA recombinante humana en una adolescente con diabetes mellitus insulinodependiente.

BACKGROUND: Adverse reactions to drugs have increased in the last years, about 15% of all side effects are thought to be immune mediated according to the Coombs and Gell classification they can be type I (immediate) hypersensitivity, type II (cytotoxic) type III (immune complex mediated) or type IV (delay). Allergy to insulin is defined as an immunological response type I, and type II or III to exogenous insulin solutions occurring the 0.1% and 0.2% of the patients. PATIENTS: A 13 year old female with a 4-year history of insulin-dependent diabetes mellitus who presented hypersensitivity against recombinant DNA (rDNA) insulin manifested with urticaria and itching. We used a premedication therapy without good response and impossibility to use alternative therapy for her metabolic control, so she needed desensitization with insulin. METHODS: Skin prick testing with rapid insulin preparations 1:10 W/V dilution were positive. IgE antibodies to insulin weren't presented. IgE serum values were normal. We began the desensitization with a rapid 1:1000 UI insulin solution by intradermal route, than by subcutaneous route until reaching the accumulated doses necessary per day. During the process it appeared a papular rash and itching which were treated with an intravenous antihistaminic without troubles. RESULTS: The patient tolerated the desensitization procedure very well. For the past 14 months she has been treated uneventfully by subcutaneous administration of rDNA insulin. DISCUSSION: The desensitization against drugs is not a frequently process it only has to be used when it is impossible to substitute the treatment. Our patient showed probably hypersensitivity type 1 to insulin. However, we have to take into account the cytotoxic reaction caused by IgG or IgM antibodies or by immune complex. The desensitization finally was tolerated, 14 months after our patient accepts correctly her daily dose of human recombinant insulin.

[Changes in the mass and function of the left ventricle after renal transplantation]. / Modificaciones de la masa y función del ventrículo izquierdo después de trasplante renal.

We undertook a study of cardiac function in 13 patients with end-stage renal disease with conventional echocardiography. Measurements in systolic and diastolic function were assessed before and after renal transplantation. Improvement in left ventricular mass was observed (mu +/- SD) from 362.4 +/- 150.2 to 178.4 +/- 62.4 (p less than 0.001), also in left ventricular mass index (left ventricular mass/body surface) from 229 +/- 86.3 to 115.6 +/- 41.3 (p less than 0.001), ejection fraction from 0.44 +/- .196 to 0.64 +/- .165 (p less than 0.01) and velocity of circumferential fiber shortening (mu +/- SD) from 19.5 +/- 11.04 to 31 +/- 11.6. Renal transplantation procedure induce favorable modifications in left ventricular functions. If cardiac dysfunction is present in a end stage renal disease patient, it should be not considered a contraindication for transplantation. We were unable to demonstrate that hemoglobin values play an important role in the development or maintenance left ventricular dysfunction. A prospective, larger and longer trails are needed to clarify the risk factors associated with cardiovascular morbid event.

[Hereditary thrombocytopathic thrombocytopenia. Report of 2 cases transmitted with dominant character]. / Trombocitopenia trombocitopática hereditaria. Presentación de 2 casos transmitidos con carácter dominante

Hereditary thrombocytopathic thrombocytopenia is reported in a family (mother and son) and is transmitted with dominant character of moderate to severe intensity (platelets fluctuated from less than 5,000 per mm-3 to 20,000 with sporadic higher rises), normal survivorhship, larger than normal diameter and abnormal platelet 3 factor. Comments are made on its resemblance to idiopathic thrombocytopenic purpura and stress is placed on the importance of its identification through the decision of splenectomy with negative results in these patients.