Depth of invasion of oral squamous cell carcinoma in Nos2-knockout mice correlated to alterations in systemic inflammatory markers following 4NQO treatment

BACKGROUND

Peripheral blood analysis is a non-invasive and low-cost technique of prognostic value for several diseases, including oral cancer. Considering the role of inducible nitric oxide synthase in tumor-associated inflammation, this study purposed to evaluate the influence of this enzyme on peripheral blood parameters and systemic inflammatory biomarkers during murine oral carcinogenesis.

METHODS

A 50 μg/mL solution of 4-nitroquinoleine-N-oxide was provided to 15 C57BL/6J (Nos2+/+ ) and 16 B6.129P2-Nos2tm1Lau /J (Nos2-/- ) for 16 weeks. Animals were followed for 8 weeks after treatment. Blood samples and tongues were collected for hematological and histopathological analyses. Red blood cells, white blood cells, and platelet cell parameters were analyzed. The neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and the systemic immune-inflammation index were also calculated. The depth of invasion of all carcinomas was measured.

RESULTS

Differences were found in several blood parameters. The depth of invasion in Nos2-/- was lower than in Nos2+/+ (p = 0.009), and strong correlations were found between depth of invasion and neutrophil count (ρ = -0.68, p = 0.017), lymphocyte count (ρ = 0.72, p = 0.011), neutrophil-to-lymphocyte ratio (ρ = -0.65, p = 0.025), platelet-to-lymphocyte ratio (ρ = -0.73, p = 0.013), and systemic immune-inflammation index (ρ = -0.67, p = 0.037) in Nos2-/- mice.

CONCLUSION

Inducible nitric oxide synthase seems to have an important role in OSCC invasion and progression, which might be associated to alterations in immune-inflammatory cell dynamics evidenced by peripheral blood and systemic inflammatory biomarkers.

Quantitative electroencephalography power and coherence measurements in the diagnosis of mild and moderate Alzheimer's disease

OBJECTIVE: To evaluate the contribution of quantitative electroencephalographic (qEEG) analyses in the diagnosis of Alzheimer's disease (AD). METHOD: Thirty-five patients from the Neurology Outpatients Clinic of PUC-Campinas, diagnosed with AD according to the NINCDS/ADRDA were evaluated, and compared with a control group consisting of 30 individuals with no cognitive deficit. The procedures consisted of clinical-neurological, cognitive and behavioral analyses and the qEEG (absolute power and coherence). RESULTS: The AD group presented greater absolute power values in the delta and theta bands, greater theta/alpha indices and less frontal alpha and beta coherence. Logistic multiple regression models were constructed and those only showing variations in the qEEG (frontal alpha coherence and left frontal absolute theta power) showed an accuracy classification (72.3%) below that obtained in the mini-mental state examination (93%). CONCLUSION: The study of coherence and power in the qEEG showed a relatively limited accuracy with respect to its application in routine clinical practice.

Benign childhood epilepsy with centrotemporal spikes: an ictal EEG

Benign childhood epilepsy with centrotemporal spikes (BECTS) is common during childhood, but there are few reports in the literature recording the EEG during a seizure. We studied an 8-year-old boy with oropharyngeal seizures during wakefulness and sleep. Both his neuropsychomotor development and neurological examination were normal. While awake, the subjects's electroencephalogram (EEG) showed normal background activity and epileptiform activity characterized by spikes in the temporal regions (mid and anterior), central region of the right cerebral hemisphere and in the median central and parietal regions. During sleep, his EEG recorded an epileptic seizure that lasted 46 seconds. In the initial phase, the EEG showed an increase in the number of spikes with higher potential in the median central and parietal regions, followed by slow waves associated with the increase in slow waves in the right hemisphere. This was followed by a brief decrease in amplitude of the background activity, and then by rhythmic, diffuse discharges predominantly in the right centrotemporal region, of sharp waves at 12-13 Hz, with increasing potential. Slow waves of high amplitude then occurred for 5 seconds, and finally very high potential spikes reappeared in the central and temporal regions of the right cerebral hemisphere with normalization of the background activity. During these critical phases of the EEG, clonic lip movements and pouting could be observed with the mouth locked shut, associated with "throat noises," but there were no other motor manifestations. The child did not wake up during the seizure and there were no postictal signs or symptoms. Although there are some aspects in common in recordings of BECTS seizures, such as a reduction in amplitude followed by rhythmic discharges of increasing amplitude, differences exist that possibly correspond to the diverse characteristics of the electrical generators.

Dementia, mild cognitive impairment and quantitative EEG in patients with Parkinson's disease

The objective of this study was to evaluate relationships between quantitative EEG (qEEG) changes and cognitive disturbance (mild cognitive impairment or dementia) and the motor disturbance stage in Parkinson's disease (PD). Thirty-two PD patients (age = 67.2 +/- 10.0) and 26 normal subjects (age = 68.4 +/- 4.7) were assessed using a neurological evaluation, modified Hoehn and Yahr (HY) scale for PD, a Portuguese version of the CERAD neuropsychological battery (consortium to establish a registry for Alzheimer's disease) incorporating the Mini-mental Status Examination, Clinical Dementia Rating and an EEG analysis of absolute and relative band amplitude at rest. Four groups were compared: three with PD (7 patients with dementia, 10 with mild cognitive impairment and 15 with no cognitive disturbances) and the control group. The qEEG showed no significant differences between the control group and PD patients without cognitive disturbance. Abnormalities on the qEEG were essentially associated with the occurrence of mild cognitive impairment or dementia in patients with PD. There was an increase in the absolute and relative posterior theta amplitude in the groups with mild cognitive impairment or dementia and of the posterior absolute and relative delta amplitude in the group with dementia This study suggested qEEG as a possible physiological tool in the assessment of cognitive aspects in PD.

Radiographic assessment of Gardner's syndrome

The detection of osteomas in the maxillofacial region may be the initial clinical finding in Gardner's syndrome (GS). The most common location of osteomas is in the skull, but the lesion can also occur in the jaws. We present a case of a 47 year old male patient with GS who was referred for radiological evaluation. Extraoral examination revealed an epidermoid cyst and the patient had a history of intestinal polyps. A panoramic radiograph demonstrated numerous osteomas and diffuse sclerosis of the mandible, and compound odontomas with impacted teeth. CT scan allowed the localization and extension of the osteomas, and showed other sites in the maxillofacial region as well. CT images also revealed a different behaviour of osteoma, invading the mandibular canal.

Somatosensory evoked spikes and epileptic seizures: a study of 385 cases

We examined 385 children whose EEG showed high voltage potentials evoked by taps applied to one or both feet or hands (SES). The relationship between characteristics of SES and the occurrence of epileptic seizures and the characterization of epileptic syndromes were studied. Ninety-one children (23.6%) had epilepsy, 42 (10.9%) had only febrile convulsions and 252 children had other complaints. Epilepsy occurred in a higher proportion of cases when: SES by foot tapping were multiphasic, with high amplitude or SES were obtained by hand stimulation and there was spontaneous epileptiform activity in the EEG. The following epileptic syndromes were diagnosed: benign childhood epilepsy with centrotemporal spikes in 21 cases, benign epilepsy of childhood with occipital paroxysms in 2, benign psychomotor epilepsy in 1, "partial idiopathic others" in 43, generalized idiopathic in 8, symptomatic epilepsies in 13 and undetermined in 3 cases. In most cases SES were observed in children without evidence of cerebral organic lesion, suggesting the existence of an age-related, functional mechanism. Some characteristics of SES and the occurrence of spontaneous epileptiform activity showed a positive association with epileptic seizures. SES occurred in different types of partial and generalized epilepsies of childhood but in nearly 50% of the cases with epilepsy, there was a benign condition involving mainly the parietal lobe with versive, unilateral and sleep-generalized seizures.

[Guidelines for recording/analyzing quantitative EEG and evoked potentials. Part II: Clinical aspects]

Digital EEG (DEEG) and quantitative EEG (QEEG) are recently developed tools present in many clinical situations. Besides showing didactic and research utility, they may also have a clinical role. Although a considerable amount of scientific literature has been published related to QEEG, many controversies still subsist regarding its clinical utilization. Clinical applications are: 1. DEEG is already an established substitute for conventional EEG, representing a clear technical advance. 2. Certain QEEG techniques are an established addition to DEEG for: 2a) screening for epileptic spikes or seizures in long-term recordings; 2b) Operation room and intensive care unit EEG monitoring. 3. Certain QEEG techniques are considered possible useful additions to DEEG: 3a) topographic voltage and dipole analysis in epilepsy evaluations; 3b) frequency analysis in cerebrovascular disease and dementia, mostly when other tests have been inconclusive. 4. QEEG remains investigational for clinical use in postconcussion syndrome, learning disability, attention disorders, schizophrenia, depression, alcoholism and drug abuse. EEG brain mapping and other QEEG techniques should be clinically used only by physicians highly skilled in clinical EEG interpretation and as an adjunct to traditional EEG work.

[De novo absence status: case report]

There are few descriptions about middle-aged patients who have nonconvulsive status epilepticus, absence status. We reported the clinical case of a woman, 52-year-old, diabetic, referred to the emergency room in a confusional state. Initial electroencephalogram showed continuous typical, bilateral, symmetric and synchronous spike-and-wave discharges. Clinical and electroencephalogram normalization occurred immediately following intravenous injection of benzodiazepine. Computerized axial tomography was normal. The recognition of this entity is essential because of its similarity to psychiatric disturbance and its prompt response to proper treatment.

Reactivity of rolandic spikes

Factors influencing the frequency of rolandic spikes are rarely reported. We examined the influence of movement, tactile stimulation and cognitive test on the discharge rate of rolandic spikes. We studied 35 children with EEG rolandic spikes. Eighteen children had nonfebrile convulsions. Benign childhood epilepsy with centrotemporal spikes was diagnosed in 12 cases. Testing during the EEG included hand and tongue movements, cognitive tasks and tactile stimulation of face and hands. Rolandic spikes were counted by visual analysis in each phase of the test and the frequency expressed as mean number per min. During tongue movements there was a significantly lower discharge rate when compared to previous and subsequent rest phases. For the left hemisphere there was reduction in discharge rate during right hand movements and looking at colored spots but only when compared with the previous rest phase. The reduction in mean number of spikes/min by tongue movements occurred in patients with and without epilepsy. For patients with cerebral lesion the decrease in discharge rate during tongue movements was not significant whereas for those without cerebral lesion a significant reduction was evident. A decrease in the mean number of spikes/min of 50% or more was significantly more frequent among 29 patients without than among 6 patients with cerebral lesion. Our study showed the inhibition of rolandic spikes by tongue movements confirming the hypothesis that the localization of discharges is an important factor in determining its reactivity. The presence or not of cerebral lesion may be an important factor in the degree of reactivity.

[Occipital epileptiform activity with or without blockade with eye opening: a comparative clinico-electroencephalographic study]

Occipital epileptiform activity blocked by eyes opening (OEAB) is primarily observed in childhood epilepsy with occipital paroxysms but may be also found in cases of benign childhood epilepsy with centrotemporal spikes, cryptogenic/symptomatic partial epilepsies, idiopathic generalized epilepsies and in patients with no seizures. We studied comparatively EEG and clinical features of 20 patients with OEAB and 120 patients with occipital epileptiform activity not suppressed by eyes opening (OEA). Epileptiform activity (OEA or OEAB) was registered until the 7 years of age in 67.5% of the patients with OEA and in 45% of the patients with OEAB. Epileptic seizures began before 4 years of age in 44.4% of the cases with OEA and in 14.2% in the group OEAB. Febrile convulsions alone occurred only in the OEA group (12.5%). Developmental retardation was referred in 27 patients with OEP. The occurrence of spike and wave complexes was statistically more frequent among patients with OEAB (80.0%) as opposed to patients with OEA (17.5%). Our findings suggest clinical and electroencephalographic differences between children with OEA and OEAB.

[Epilepsy with centro-temporal spikes and parietal spikes: comparative study]

There are controversies about the existence of a benign parietal epilepsy distinct from the benign partial epilepsy with centro-temporal spikes. We studied 164 children with no neurological or neuroradiological evidence of brain damage and with epilepsy and spikes restricted to the centro-temporal (CTS) or to the parietal regions (PS). The subject's age, age at onset and type of seizures and the presence of spikes evoked by consecutive taps applied to both hands and feet were compared between 111 patients with CTS and 53 patients with PS. Age of patients and age at onset of seizures predominated until 6 years in the PS group and after 6 years in the CTS group. The occurrence of oropharyngeal or facial motor seizures was statistically more frequent among the patients with CTS (44.1%) as opposed to PS group (16.9%). In 39.5% of the children with PS and only in 3.5% of those with CTS, the EEG showed high voltage potentials, similar to the habitual spikes in clinical EEG, evoked by the stimulation of one or both feet or hands. Our findings suggest that in neurologically normal children with epilepsy, the group with PS differs from those with CTS in the age, age at onset and type of seizures and EEG reactivity to percussion of hands and feet.

[Induced visual crisis and non-ketotic hyperglycemia: a case report]

In a 47-years-old male patient, partial visual seizures triggered by movement was an early symptom of nonketotic hyperglycemia. Seizures were resistant to conventional anticonvulsivant therapy. During seizures, EEG showed discharges over the right hemisphere. CT was normal. A search for reflex seizures and hyperglycemia should be routinely carried out in patients with repeated focal visual seizures, as shown in the case reported.

[Psychosocial evaluation in epilepsy: experience with a version of WPSI]

Epilepsy has frequently been associated with important psycho-social problems. Washington Psychosocial Seizure Inventory is a inventory developed to identify the psycho-social problems in epilepsy. In this study we applied a WPSI version for a psychosocial evaluation of Brazilian patients: 54 epileptic patients answered a questionnaire in a period of 7 months. The application of WPSI showed difficulties in the scales: adjustment to seizures, financial status, vocational adjustment, emotional and interpersonal adjustment. The scores of problems were lower in the scales of family background, medicine and medical management. Level of schoolarity, employment status, seizure type, duration of epilepsy, control of seizures were factors influencing WPSI results. Difficulties were noticed in the comprehension of some words by the illiterate patients, and in high scores for validity scales. Our initial results were comparable to the literature. However, it should be necessary an adaptation of some language aspects and validity scales, and a further application in a larger number of epileptic patients to validate our WPSI version.

[Occipital paroxysms before eye closure. Clinico-electroencephalographic correlations in 24 cases]

Paroxysms of high-amplitude spike-waves or sharp waves recurring rhythmically on the occipital areas when the eyes are closed (POEC) are primarily observed in childhood epilepsy with occipital paroxysms (CEOP). An association of this electroencephalographic (EEG) pattern with idiopathic epilepsy has been disputed. We studied EEG and clinical features in 24 patients (age ranging from 3 to 25 years) with POEC. The EEG showed generalized discharges in 8 cases, rolandic spikes in 4 and background abnormalities in 4 cases. Eighteen (75%) patients manifested epileptic seizures. The nonfebrile seizures (16 cases) were partial (9 cases), generalized (6 cases) and unclassified (one patient). Two children had neurological examination or computed tomography abnormalities. Clinical and EEG data allowed for the following epileptic syndromes diagnosis: CEOP, 7 cases; benign childhood epilepsy with centrotemporal spikes, one case; CEOP or benign childhood epilepsy with centrotemporal spikes, one case; partial symptomatic/cryptogenic epilepsy, 4 cases; generalized idiopathic, 2 cases; febrile convulsions, 2 cases. We conclude that POEC may be observed in cases with different types of idiopathic partial, cryptogenic/symptomatic and idiopathic generalized epilepsies and may also occur in patients with no seizures.

[Hemiballismus as initial manifestation of acquired immunodeficiency syndrome: a case report]

There are few descriptions of movement disorders as an initial presentation of acquired immunodeficiency syndrome (AIDS). The authors report the case of a 54-year-old man who presented with hemiballismus of gradual onset. The computed axial tomographic scan showed a deep seated enhancing lesion with mass effect. Investigation revealed AIDS and a probable toxoplasmosis. It is concluded that AIDS must be considered in the aetiological diagnosis of patients with movement disorders.

Epileptic syndromes in children with somatosensory evoked spikes

We studied 186 children with frequent EEG paroxysms evoked by tapping of the feet or hands (ES). Seventy-five (40.3%) patients had a history of epileptic seizures. Febrile convulsions alone occurred in 31 (16.7%) of the children and nonfebrile in 44 cases (23.7%). Non-febrile seizures occurred in a greater proportion among patients with ES than in a control group with normal EEG. Spontaneous epileptiform activity was recorded in 39.6% of the patients without epileptic seizures but in a great percentage of the children with seizures (85.3%). The non-febrile seizures were partial in 26 cases and generalized in 18. In 39 of these cases the EEG also showed spontaneous focal spikes, which occurred predominantly in the parietal regions in 24 cases. ES were observed in different types of partial and generalized epilepsies of childhood. Our findings also suggest that in an important proportion of cases there is a benign condition of a functional nature that is age-dependent, involving mainly the parietal lobe but in which seizure type does not so easily permit definition as a clearly characterized epileptic entity compared to other recognized idiopathic partial childhood epilepsies.

Carbamazepine and phenytoin in epilepsies refractory to barbiturates: efficacy, toxicity and mental function

A group of 51 patients with chronic cryptogenic or symptomatic localized epilepsy refractory to therapy with barbiturates underwent progressive substitution with phenytoin or carbamazepine, in standardized and randomized fashion. After drug changes were completed two thirds of the patients remained seizure free during a period of 6 months. A clearer effect of phenytoin and carbamazepine was seen on secondary generalized than on partial seizures. The frequency of severe side effects decreased after the change to phenytoin and carbamazepine. The group on carbamazepine improved in immediate and late recall, and in immediate and late recognition of pictures. The group on phenytoin improved significantly in the Stroop test. Patients changed to phenytoin, but not those changed to carbamazepine, became significantly more aggressive, anxious and depressive than when on phenobarbital, as measured by subjective scales. The results indicate that patients should not be considered refractory to antiepileptic drug therapy while on barbiturates. Cognitive dysfunction and mood changes observed in epilepsy may be temporary and dependent on the presence of seizures and/or on use of barbiturates.

[Partial motor seizures induced by movement in diabetic patients]

Three elderly patients with partial motor seizures triggered by movement of posture of an extremity are presented. They had a history of diabetes mellitus. Two of them had nonketotic hyperglycemia. Hemiparesis was present in the three patients, which resolved in two. In the other patient, hemiparesis resulted from a previous stroke. All patients had transitory parietal syndrome. During seizures, EEG showed discharges in the parieto-occipital area in two cases and in the mid-temporal area in one. Seizures were resistant to conventional anticonvulsant therapy, and ceased only after treatment of metabolic disturbances. A search for reflex seizures and hyperglycemia should be carried out routinely in the elderly with repeated spontaneous focal motor seizures. This may be important for treatment and prognosis.

[Evoked parietal spikes in the electroencephalogram and febrile convulsions]

In a population of 2307 children, 69 (2.99%) showed in the EEG high-voltage evoked potentials (evoked spikes) elicited by tapping on the feet or hands. Febrile convulsions were mentioned in 226 cases, and 13 of them showed the evoked spikes in the EEG and were otherwise neurologically and psychologically normal. Association between febrile convulsions and evoked spikes was observed, mainly when EEG showed also epileptiform activity of parietal localization. These EEG features are probably of functional rather than organic nature, and with possible genetic mechanisms involved. Longitudinal studies of children with febrile convulsions and evoked spikes in the EEG are necessary to verify a possible high risk of developing epilepsy not predicted on clinical data.

[Electroenecephalogram in cranio-cerebral injuries]

The 551 electroencephalograms of 387 patients with head injury are analysed. The electroencephalographic findings are correlated to the following clinical data: age, time after the trauma, duration of unconsciousness, presence of localizing neurological signs, existence of open wounds or hematoma, bloody cerebrospinal fluid and post-traumatic epilepsy. The autor came to the following conclusions: 1--there is a clear correlation between the electroenecephalographic abnormalities and the degree of cerebral injury characterized by the duration of unconsciousness, presence of localizing neurological signs, presence of bloody cerebrospinal fluid and post-traumatic epilepsy; 2 - slow wave activity over the parieto-occipital area is more frequent in the age group up to 10 years; 3 - the proportion of abnormal electroencephalograms decreases particularly after the 1st month post-trauma; 4 - diffuse or focal slow activity decreased principally after the 1st month post-trauma; 5 - paroxysmal abnormalities increase proportionaly after the 6th month post-trauma; 6 - patients with intracranial hematoma present great proportion of abnormalities, particularly depressions. This study demonstrates the importance of electroencephalographic tracings as a complementation to the clinical evaluation of head injury cases, chiefly early, and late follow-up tracings.