Intracytoplasmic sperm injection improves in vitro embryo production from poor quality bovine oocytes.

The objective was to use subzonal sperm injection (SUZI) to understand sperm penetration patterns and to use intracytoplasmic sperm injection (ICSI) to improve production of bovine embryos using poor quality gametes. In experiment 1, poor versus good quality oocytes were fertilized with sperm from two bulls, A and B, with poor and good sperm vigor, respectively. The blastocyst rate was higher for good versus poor quality oocytes (23.3% vs. 11.1%, P < 0.05), regardless of the bull used. There was no significant difference in blastocyst rate for bull A (low vigor) regardless of oocyte quality, and for bull B (high vigor), blastocyst rate was better for good versus poor quality oocytes (25.7% vs. 9.2%, P < 0.05). In experiment 2, poor quality oocytes were subjected to SUZI. The oocyte penetration rate was lower for bull A than for bull B (29.6% vs. 53.8%, P < 0.05), when SUZI was performed within 1 hour after sperm processing. However, when SUZI was performed 2 to 3 hours after sperm processing, penetrating capacity was similar between bulls, but for bull B, penetrating capacity significantly decreased after 3 hours of sperm processing. In an attempt to overcome sperm penetrating disorders, poor and good quality oocytes were subjected to ICSI (experiment 3). Irrespective of the bull or of the oocyte quality grade, there were no differences in cleavage or blastocyst rates. Both bulls had distinct IVF embryo production rates, which we inferred were because of particular individual sperm characteristics. In conclusion, ICSI was an effective means to achieve in vitro production of bovine embryos with gametes of variable quality.

[Cerebrovascular disease as an initial finding in childhood tuberculosis meningoencephalitis]. / Enfermedad cerebrovascular como síntoma inicial de meningoencefalitis tuberculosa en la infancia.

INTRODUCTION: The prevalence of tuberculosis in developing countries, such as Brazil, remains high with important morbidity and mortality rates among children. Neurological complications are frequent and tuberculous meningo-encephalitis (TBM) is the most dreaded of them in infancy. CASE REPORT: Our case involves a 7-year-old white female patient who was previously in good health. Over a period of two weeks she suffered from high temperatures and vomiting and was given amoxicillin. She later suffered an attack of focal seizures. Electroencephalogram studies showed a temporary double focus and lesions in the left hemisphere. A cranial computerised tomography (CT) scan revealed a periventricular haemorrhage on the left side. The control CT (carried out 20 days later) showed a reduction in the haemorrhage and localised hypodensity. Owing to the suspected existence of an abscess, the patient was administered vancomycin. A new cranial CT scan (40 days after the first) showed gliosis alongside the basal nuclei with impregnation in the carotid trifurcation, which led us to suspect that we were dealing with a case of vasculitis or a granuloma. All the microbacterial cultures were negative and there was no history of contact with tuberculosis. The adenosine deaminase (ADA) value in the sample of cerebrospinal fluid (taken seven weeks after the first) was found to be 21.2 UI. Treatment was started with tuberculostatic compounds. Two weeks later the fever disappeared. The control CT scan showed decreased hypodensity and impregnation. The patient was discharged from hospital, with a slight monoparesis in the upper right limb. DISCUSSION: The presentation of a cerebrovascular disease within a context of TBM, like the case reported here, is relatively rare in the literature. We concluded that the uncommon initial symptoms of TBM, associated with the negative cultures, contributed to the delay in reaching a diagnosis. A cerebrovascular accident must be included in the clinical picture of TBM and this disease has to be taken into account when dealing with a case of cerebrovascular accident.

[Spastic tetraparesis as a sequela of bacterial meningitis]. / Tetraparesia espástica como secuela de meningitis bacteriana.

AIMS: The aim of this study is to demonstrate the incidence of spastic tetraparesis (ST) in meningitis patients in the paediatric ICU, together with the associated variables, and establish comparisons with the existing literature. PATIENTS AND METHODS: We reviewed the medical records of patients who presented symptoms of meningitis and required hospital treatment in the Paediatric ICU at the Hospital de Clínicas de Porto Alegre, between January 1985 and June 2001. In addition to the diagnosis of meningitis and the incidence of ST as a complication, we also examined the aetiological agent, sex, age at the moment of hospital admittance, length of time spent in hospital and treatment given in each case. RESULTS AND DISCUSSION. An incidence of 15.1% was found for cerebral palsy in the 112 cases of bacterial meningitis that were followed up clinically. In the patients with ST, the time spent in hospital was longer, and the frequency of seizures, intracranial hypertension and the protein concentration levels in CSF were higher (p<0.05).

Follow-up of patients with vertically-acquired HIV infection who are more than 9 years old.

The aim of this study was to assess the influence of biological markers of infection and antiretroviral therapy on the survival rate and quality of life in children with vertically-acquired HIV infection. This retrospective study was performed between August and October 2000. Outcome measures were presence of neurological disease, CD4 cell count, cranial computerized tomography (CT), electroencephalogram (EEG), use of antiretroviral agents, and mortality. The presence of neurological disease and of pathological findings in cranial computed tomography, and the lack of biological monitoring are associated with poor prognosis. Follow-up of this population should continue to allow long-term assessment of the social and biological impact of vertically-transmitted HIV.

[Devic disease: a case report] / Doença de Devic: um relato de caso.

OBJECTIVE: To report a case of Devic disease, emphasizing its diagnosis, in addition to reviewing the medical literature. DESCRIPTION: Male, six-year-old patient suddenly developed weakness in lower limbs, with resolution during hospital stay. However, as the weakness disappeared, loss of vision occurred. The symptoms were reverted after the use of prednisone. COMMENTS: The diagnostic and therapeutic approach was similar to that used in other cases reported by different reference centers. In other words, clinical diagnosis and prednisone therapy were used, with the complete improvement of symptoms. However, there is still some controversy surrounding its etiology and relationship with other demyelinating diseases, such as multiple sclerosis.

[Aids neurologic manifestations in childhood]. / Manifestaciones neurológicas del SIDA en la infancia.

INTRODUCTION: Children with AIDS get infected mainly by vertical transmission. DEVELOPMENT: That was what happened in 90% of the cases in a series of 340 HIV+ children followed at Hospital de Clínicas de Porto Alegre, Brazil. Currently, after the use of prophylactic treatment during pregnancy and the six first weeks of life, our transmission rate is 3% to 4%. The incidence of neurologic complications in the vertical transmission group was 49% in our prospective series, and due either to immunosuppression or primary neurological disease. Neurologic changes secondary to HIV constitute a complex syndrome, manifested by various degrees of cognitive, motor and behavioral delay. Encephalopathy can be either progressive or static. In our series, encephalopathy occurred in 32.5% of cases, developmental delay in 42.5%, seizures in 6%, speech delay in 5%, headaches in 2.5% and behavioral disorders in 2%. Central nervous system infections happened in 33.8% of our cases: acute bacterial infections in 11%, cytomegalovirus in 6.8%, toxoplasmosis in 5.9%, cryptococcal in 5%, tuberculous in 3.8% and syphilis in 1.3%. Hemorrhagic cerebrovascular accidents were seen in 2.5% of our cases, and peripheral neuropathy in 5%. Seventy percent of our cases had abnormalities in the CSF, 75% in brain CT scans and 45% in EEGs. CONCLUSIONS: Treatment of children with AIDS and neurologic manifestations was based on specific drugs aimed at controlling viral replication. Best response was obtained with combined use of AZT and other anti-retroviral neuro-protective.

Evolutional neurologic evaluation of seven year-old children born prematurely.

A sample of 51 children aged 7 with a history of prematurity was compared to 44 age-matched children who were born at term at the HCPA. The premature children had had gestational ages up to 37 weeks and 6 days and were born weighing less than 2,500 g. The control group consisted of children born with gestational age between 38 and 42 weeks and weights above 2,500 g. The evaluation criteria were clinical examination, neurological examination and the evolutional neurological evaluation (ENE). The results pointed out that impulsiveness, aggressiveness, disorganization and enuresis were prevalent symptoms of developmental disturbances in the sample of prematures. Alterations at neurological examination did not discriminate between the two groups, although cerebral palsy occurred only in the group of prematures. The ENE functions which differentiated the two groups studied were dynamic balance, appendicular and trunk-limb coordination and motor persistence.

[Comparison between the EEG of natural sleep and the induced by chloral hydrate in relation to paroxysmal changes and baseline rythm]. / Comparação entre o eletrencefalograma de sono natural e o induzido por hidrato de cloral em relação às alterações paroxísticas e ao ritmo de base.

EEG changes associated with the use of chloral hydrate (50 mg/Kg) to induce sleep were evaluated in 50 epileptic children (ages 1 to 12 years), either taking no anticonvulsants or on monotherapy. It was observed that chloral hydrate was capable of inducing sleep without side effects and was capable of modifying the sleep EEG, improving organization of sleep spindles and generalized paroxysms.

Comparaçäo entre o eletrencefalograma de sono natural e o induzido por hidrato de cloral em relaçäo às alteraçöes paroxísticas e ao ritmo de base / Comparison between the EEG of natural sleep and the induced by chloral hydrate in relation to paroxystic changes and baseline rythm

Estudo das variaçöes do EEG paroxístico provocadas pelo uso do hidrato de cloral a 20 por cento, na dose de 50mg/Kg, na induçäo do sono em 50 crianças epilépticas de 1 a 12 anos de idade, em monoterapia ou sem anticonvulsivantes. Foi observado que o hidrato de cloral é capaz de induzir o sono sem efeitos colaterais e é capaz de modificar o EEG em sono, melhorando a organizaçäo dos fusos de sono e diminuindo os paroxismos generalizados

[Nifedipine as a coadjuvant drug in the treatment of uncontrolled epilepsy: a preliminary report]. / Nifedipina como droga coadjuvante no tratamento de epilepsias de difícil controle: Nota preliminar.

The authors report the use of nifedipine as a coadjuvant drug in the treatment of three patients with uncontrolled epilepsy.

[Börjeson-Forssman-Lehmann syndrome: report of a case]. / Síndrome de Börjeson-Forssman-Lehmann: relato de um caso.

We present a case of Börjeson-Forssman-Lehmann syndrome characterized by the presence of hypogonadism, grotesque facies, microcephaly, large ears, obesity and convulsions. In addition to these findings, which were detected also in the other patients described in the literature, the present patient showed hyperglycemia and aminoaciduria. In our opinion, the presence of these alterations and the poor evolution of the patient, with death occurring during the first year of life, may contribute to the amplification of the phenotypic spectrum of the Börjeson-Forssman-Lehmann syndrome.