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The primary job of the epididymis is to mature and protect the luminally transiting spermatozoa. Mounting evidence is showing that innate immune components [including Toll-like receptors (TLRs) and antimicrobial proteins, among which are β-defensins] and inflammatory mediators, under the primary influence of androgens, participate in the cellular and molecular processes that define this tissue. Here, we present an overview of the contributions of these signaling pathway components during epididymal homeostasis and discuss the hypotheses as to their involvement in epididymitis, the most common urological inflammatory condition in men, frequently impairing their fertility. Drawing primarily from rodent models, we also focus on how the distribution and functional expression of innate immune components are differentially regulated in the prenatal developing epididymis, providing new insights into the disruption of these signaling pathways throughout the lifespan. Male infertility is caused by a variety of conditions, such as congenital malformations, genetic and endocrine disorders, exposure to environmental toxicants, and inflammatory/infectious conditions. More than one-third of infertile men with an idiopathic condition cannot currently be adequately diagnosed. Thinking about the innate immunity and inflammation context of the epididymis may provide new insights and directions as to how these systems contribute to male fertility, as well as also uncover urological and andrological outcomes that may aid clinicians in diagnosing and preventing epididymal pathologies.

The primary job of the epididymis is to mature and protect the luminally transiting spermatozoa. Mounting evidence is showing that innate immune components [including Toll-like receptors (TLRs) and antimicrobial proteins, among which are β-defensins] and inflammatory mediators, under the primary influence of androgens, participate in the cellular and molecular processes that define this tissue. Here, we present an overview of the contributions of these signaling pathway components during epididymal homeostasis and discuss the hypotheses as to their involvement in epididymitis, the most common urological inflammatory condition in men, frequently impairing their fertility. Drawing primarily from rodent models, we also focus on how the distribution and functional expression of innate immune components are differentially regulated in the prenatal developing epididymis, providing new insights into the disruption of these signaling pathways throughout the lifespan. Male infertility is caused by a variety of conditions, such as congenital malformations, genetic and endocrine disorders, exposure to environmental toxicants, and inflammatory/infectious conditions. More than one-third of infertile men with an idiopathic condition cannot currently be adequately diagnosed. Thinking about the innate immunity and inflammation context of the epididymis may provide new insights and directions as to how these systems contribute to male fertility, as well as also uncover urological and andrological outcomes that may aid clinicians in diagnosing and preventing epididymal pathologies.

There has been a considerable increase in the literature devoted to innovation in the past few decades. This research area is characterized by prolific interdisciplinary connections and no single domain is able to embrace all aspects of science, technology and innovation. By analyzing nearly 60,000 references included in the 1442 articles published between 1974 and 2007 in the area's seed journal, Research Policy (RP), we have uncovered the following patterns: (1) the most important sources of knowledge are associated with “core” economics (mostly mainstream) and management sources, even though the importance of innovation-related sources has been rising; (2) the degree of autonomy of science, technology and innovation research is still weak, revealing its incipience and lack of a unified theoretical framework; (3) the most influential authors and studies follow heterodox approaches, namely the evolutionary approach (e.g. Richard R. Nelson) and the European approach to innovation (e.g. Keith Pavitt and Ch...

Background and Aims Orthotopic liver transplantation (OLT) has been the standard treatment for end-stage acute and chronic liver disease. Ischemia-reperfusion (I/R) injury is one of the major causes of poor graft function early after OLT, and adversely influencing graft and patient survivals. It is unknown whether I/R injury influences liver fibrogenesis. Materials and Methods Livers from 25 adult male Wistar rats were randomly assigned into 5 experimental groups according to the preservation solution: saline solution (SS); University of Wisconsin (UW) solution; Fructose 1, 6-biphosphate (FBP); S-Nitroso-N-Acetylcysteine (SNAC): or UW + SNAC (SNAC+UW). Aspartate aminotransferase (AST), alanine aminotransferase (ALT), and lactic dehydrogenase (LDH) were determined in preservation solution samples at 2, 4, and 6 hours. After 6 hours of cold ischemia, ex situ reperfusion was applied to the liver for 15 minutes. Serum AST, ALT, LDH, and renin levels were determined. Fresh liver slices were processed for histological studies, determination of thiobarbituric acid reactive substances, catalase, and glutathione, and expression of TGF-β1 and angiotensin II AT1 receptor. Results AST was significantly lower during cold storage with UW than with the older media ( P = .001); ALT was lower in the FBP group ( P = .023) and LDH was lower in the FBP and SNAC groups ( P = .007). After reperfusion, serum AST, ALT, LDH, and TBARS showed no significant differences among the groups. Catalase was significantly lower in the SS and FBP groups ( P = .008 and P = .006, respectively). Compared with UW, glutathione concentrations were significantly higher in SS, FBP, and SNAC 200 ( P = .004). Renin levels were significantly lower in the FBP group ( P = .022). No histological signs of preservation injury were observed in the hepatic sample. No expressions were detected of TGF-β1 or AT1 receptor. Conclusion In this experimental model of early reperfusion injury, preservation changes related to higher levels of renin, which suggest its role in fibrogenesis. FBP was associated with lower renin levels than other solutions including UW.

Atomic absorption spectrophotometry is considered the method of choice for hepatic iron quantification. The objective of the present study was to perform full validation assays of hepatic iron quantification by atomic absorption spectrophotometry, using a fast sample preparation procedure, following the guidelines from the International Conference on Harmonization. The following parameters were evaluated: specificity, linearity/range, precision, accuracy, limit of detection and limit of quantification. A good linear correlation was found (0.9948) in the concentration range evaluated (20- 120 ppb). The relative standard deviations were below 15% for accuracy, and below 10% for both day-to-day reproducibility and within-days precision, and the repeatability of injections was 0.65%. Limit of detection was 2 ppb, and limit of quantification was 6 ppb. Fresh bovine liver tissue was used to evaluate the procedure of collecting samples by liver biopsies. These findings indicate that hepatic iron quantification by atomic absorption spectrophotometry can be reliably performed at the established conditions, and suggest the method is suitable for further use in clinical practice. Hepatic iron quantification by AAS is validated by the experiments performed in the present study.

Neste trabalho estudou-se a aplicabilidade do processo foto-Fenton utilizando irradiação solar no tratamento de dois efluentes (A e B) de uma indústria de tintas. Foi avaliada a influência da concentração inicial de peróxido de hidrogênio e ferro na remoção de carbono orgânico dissolvido (COD). Nos primeiros minutos de irradiação foi observada a descoloração e a remoção de odores. Para o efluente A, atingiu-se 75 % de remoção de COD durante 60 minutos de irradiação. Para o efluente B, adições múltiplas de peróxido de hidrogênio foram necessárias para aumentar a remoção de COD, 43 % em 60 minutos de irradiação. Os resultados obtidos mostram que o processo foto-Fenton solar pode ser aplicado ao tratamento dos efluentes gerados na indústria de tintas.The photo- Fenton process was evaluated for the treatment of two effluents (A and B) from ink industry. The influence of hydrogen peroxide and iron (II) concentration on the dissolved organic carbon (DOC) removal was evaluated. In the first minutes of irradiation the color and odors were removed. For the effluent A 75% of DOC removal was reached in 60 min irradiation. For the effluent B, multiple additions of H2O2 were necessary to improve the COD removal, reaching 43% of TOC in 60 min irradiation. The results obtained demonstrate that the solar photo-Fenton process can be applied for the treatment of effluents generated by ink industry.

RESUMO – Os Contaminantes Emergentes (CE) tem contribuido no aumento da poluicao ambiental, sobretudo em recursos hidricos, sendo estes caracterizados por se apresentarem em baixas concentracoes, μg.L– pg.L, porem alta persistencia e toxicidade. Dentre os CE, os Hidrocarbonetos Policiclicos Aromaticos (HPA) sao compostos orgânicos com dois ou mais aneis aromaticos conjugados, apolares, ubiquos, apresentando efeitos carcinogenicos e/ou mutagenicos para os seres vivos. No trabalho foi identificado e verificado o comportamento dos HPA e suas fontes no Riacho Algodoais, Suape-PE, onde realizou-se tres coletas. Apos extracao liquido-liquido com diclorometano como solvente, as amostras foram injetadas no CG-EM (Cromatografia Gasosa acoplada a Espectrometria de Massa). Nove HPA foram identificados e quantificados. Para Analise de Componentes Principais utilizou-se o software Statistica8, onde o comportamento e as fontes dos HPA foram estudados. Razoes diagnosticas entre o Fluoranteno e Pireno possibilitaram a identificacao das fontes. Em duas coletas as fontes se classificaram como pirogenicas, havendo discordância na terceira coleta, onde a fonte determinada foi a petrogenica, tendo esse comportamento gracas a presenca do criseno e um aumento significativo na concentracao do pireno encontrado. Faz-se necessario um monitoramento continuo do Riacho Algodoais, pois a presenca dos HPA em concentracoes significativas representa uma ameaca aos seres vivos em geral e ao meio ambiente.

Primary familial brain calcification (PFBC) is identified by mineralization of the basal ganglia and other brain regions in the absence of known causes. The condition is often inherited in an autosomal dominant pattern and can manifest itself clinically with neuropsychiatric symptoms such as Parkinsonism, headaches, psychosis, and mood swings. Mutations in the SLC20A2 gene account for ~40 % of inherited cases, and this gene encodes an inorganic phosphate transporter (PiT-2), a transmembrane protein associated with Pi homeostasis. The p.Y386X mutation in SLC20A2 was identified in a patient who presented migraines, brain calcification, and mild but chronic hypovitaminosis D. SLC20A2 c.1158C > G single-nucleotide heterozygous mutation results in a premature stop codon and a putative truncated protein of 385 amino acids. Proband parents do not present the mutation, which is also not present in major public SNP databases, suggesting a de novo sporadic trait. This study describes for the first time a de novo SLC20A2 mutation in a PFBC patient with migraine and mild hypovitaminosis D. This data further reinforces the pathogenic role of SLC20A2 mutations as causal factors in PFBC physiopathology.

We previously identified a four-generation family with medullary thyroid cancer (MTC) and a germline p.Y791F RET mutation whose cancer lacked a strong genotype-phenotype correlation. The entire gene coding region of the RET gene should be sequenced when genotype-phenotype discrepancies are observed in patients with multiple endocrine neoplasia type 2 (MEN 2), even if a RET hotspot mutation has been identified.A new genetic test was performed in the index case of this family with the p.Y791F RET germline mutation. The entire coding region of the RET gene was investigated by direct sequencing of PCR products. Once a mutation was identified, the target exon was sequenced in all at-risk relatives.An additional p.C634Y germline mutation in the RET gene was identified in the reported family. The double mutation occurred in cis and segregated with the phenotype. Through the Brazilian Genetic Screening Program developed at our institution, we additionally report the combination of these two mutations (p.C634Y/p.Y791F) in the RET gene in four other unrelated families. The overall penetrance of MTC and pheochromocytoma in patients with the p.C634Y/p.Y791F mutations was 79% and 13%, respectively.Our data emphasises that a comprehensive analysis of the RET gene may reveal multiple germline mutations in MEN 2 patients who exhibit an atypical clinical course of the disease.

Hepatitis C virus (HCV) and human immunodeficiency virus (HIV) share the same transmission routes. About 30% of HIV-positive patients are co-infected with HCV. Of the various HCV-related extrahepatic events, those involving the skin may be the first sign of infection.To specify the skin presentations in patients co-infected with HIV and HCV (co-infected patients; CP) and compare them with those found in patients with HCV mono-infection (mono-infected patients; MP).This was a cross-sectional study, in which the studied population consisted of MP and CP from a tertiary hospital in the South of Brazil, who underwent complete skin examination and laboratory tests.In total, 201 patients were assessed, of whom 108 were CP, and 93 were MP. Pruritus tended to be more common in MP. MP also had significantly more dermatological conditions (mean of 5.2) than CP (mean of 4.5). In total, 104 different skin diseases were identified. There was a higher prevalence of infectious diseases and pigmentation disorders, such as verruca vulgaris and facial melasma, in CP, whereas trunk and facial telangiectasias, palmar erythema, and varicose veins were more common in MP.We found a high prevalence of skin conditions both in MP and in CP; however, the patterns of the dermatological conditions were different. CP were found to have significantly fewer skin lesions than MP, but had a higher prevalence of infectious and pigmentation disorders. By contrast, vascular conditions were more common in MP.

The aim of the Secondary School Modernisation Programme, being implemented in Portugal by Parque Escolar, EPE, is based on the pursuit of quality and makes Portuguese education a potential international benchmark. This paper discusses the strategies adopted to reorganise school spaces. It describes the conceptual model and highlights the solutions proposed for libraries, science teaching spaces and museum units.

L’objectif du Programme de modernisation des etablissements d’enseignement secondaire, mis en oeuvre au Portugal par Parque Escolar, EPE, est fonde sur la recherche de la qualite et fait de l’education portugaise une reference internationale potentielle. Cet article presente les strategies adoptees pour reorganiser les espaces scolaires. Il decrit le modele conceptuel et souligne les solutions proposees pour les bibliotheques, les espaces reserves a l’enseignement des sciences et les unites museologiques.

Open plan schools have been largely contested in Portugal; many teachers, administrators and even parents consider this model of schooling inappropriate and therefore a failure. Recently however the Escola da Ponte, one of the open plan schools that has survived, was recognised as one of the country’s most innovative educational facilities. Curiously, one of the main reasons for the school’s “success”, in the opinion of its teaching staff, is precisely the open space design.

Describing primary schools in a small city in Portugal is an opportunity for an overall look at the evolution of schools in general as special public buildings. A look at four of the six primary schools in the city of Caldas da Rainha shows how these public buildings have evolved, what they represent to the community, and how their architecture has corresponded to changing concepts in education and demands for flexibility over the years.

Au Portugal, les ecoles bâties sur le modele de l’open space, ou espace paysager, ont suscite de vives critiques ; nombre de professeurs, d’administrateurs et meme de parents considerent que ce modele spatial d’enseignement n’est pas adapte, et constitue a ce titre un echec. Recemment, toutefois, l’Escola da Ponte, l’une des ecoles en espace paysager a avoir survecu jusqu’a nos jours, a ete saluee comme etant l’un des centres scolaires les plus innovants du pays. Et contre toute attente, de l’avis de son personnel enseignant, c’est precisement l’architecture decloisonnee de l’etablissement qui est a l’origine de ce succes.

L’etude des ecoles primaires d’une petite ville portugaise offre, plus largement, un apercu de l’evolution des etablissements scolaires en general. Ces bâtiments publics presentent en effet de nombreuses specificites. L’observation de quatre des six ecoles primaires de la ville de Caldas da Rainha montre a quel point ces bâtiments ont evolue, tout en permettant de mieux comprendre ce qu’ils representent pour la communaute locale, mais aussi la facon dont leur architecture a evolue au fil des ans, au rythme des nouveaux concepts scolaires, notamment en reponse a l’exigence accrue de flexibilite.

African swine fever (ASF) is the most important disease that constrains pig production in Mozambique. Until 1994 it was apparently restricted to the central and northern provinces, but since 1994 outbreaks have been experienced throughout the country. ASF causes severe economic losses both in the small commercial sector and among the large numbers of small-scale producers in the family sector in rural and peri-urban areas. The history of ASF in Mozambique since its first confirmation in 1960 is briefly reviewed, recent outbreaks are reported, and the available information on the virus genotypes that have been responsible for some of the outbreaks is presented. Epidemiological factors that contribute to ASF outbreaks and strategies for limiting the negative effects of the disease in the different pig farming sectors in Mozambique, including raising farmer and community awareness, are discussed.

Leydig-cell tumors are functioning endocrine tumors that produce T autonomously leading to isosexual precocity in boys and virilization in female patients. Molecular abnormalities such as activating mutations of the luteinizing hormone receptor (LHR), a G protein-coupled receptor, and of the Gs-alpha subunit of G protein have recently been described in these tumors. Both mutations cause continuous activation of the cAMP signaling cascade, autonomous production of T and cell proliferation. We searched for activating mutations in exon 11 of the LHR gene and in exons 8 and 9 of the Gs-a gene, which contain all hot spots for those mutations, in 4 Leydig cell tumors obtained from 4 patients (one boy with LH-independent precocious puberty and 3 women with virilization). DNA was extracted from paraffin-embedded neoplastic and non-neoplastic tissues and from peripheral lymphocytes. Hot spot regions of exons 11 of LHR and exons 8 and 9 of Gs-alpha genes were amplified by PCR and the purified PCR products were directly sequenced. No LHR or Gs-alpha gene mutations were found in the 4 tumors studied. Considering the previously reported mutations found in Leydig cell tumors, the absence of activating mutations in the hot spot regions for activating mutations in these tumors indicate molecular heterogeneity among Leydig cell tumors.

The present article analyzes the foundation of Escola Paulista de medicina (EPM) by discussing the role played by health sciences in the development of São Paulo's society, mainly in the 1930's. The participants in the project intended to meet the demands for universities and medical assistance by defending specialized knowledge and scientific competence as the base for social development through science, education and health. EPM was gradually created with the participation of non-academic agents and institutions that were important for the institution official and social recognition and permanence. Thus, in the beginning of the 1940's, it was decisive to build a hospital for the school--Hospital Sáo Paulo. This article also intends to contribute to the understanding of the functions science has in social organization while dealing with the constituting processes of the specific medical field.

Caroli's disease, characterized by segmental or diffuse dilation of the intrahepatic biliary ducts, is a rare disease which is difficult to treat. The course of the disorder is characterized by recurrent episodes of cholangitis and hospital stays, with a consequent loss of quality-of-life and productive capacity, often ending in death due to uncontrolled infection. Endoscopic drainage of the bile duct, percutaneously or surgically, is palliative, and presents bad results in the follow-up of these patients. Orthotopic liver transplantation appears to be an effective curative option for the treatment of patients with Caroli's disease associated to complications. The authors present the course of two cases of this disease, associated with congenital fibrosis of the liver worsened by repeated episodes of cholangitis, submitted to orthotopic liver transplantation.

The purpose of the present study is to compare postoperative analgesia offered by the simple instillation of local anesthetic on the surgical wound, its infiltration with the same local anesthetic, and the use of an intravenous opioid. Sixty patients were divided into the three analgesia groups to be studied: instillation of local anesthetic (Group I), injection of local anesthetic (Group II), and intravenous opioid (Group III). The pain was quantified using the visual analogue scale. It was observed that there was better analgesia in Groups I and II during the first 6 hours postoperatively as compared with Group III (P0.0001). At the end of the 12 hours the three modes of analgesia proved comparable. However, after 24 hours there was better analgesic development in Group I, whereas Group II had greater postoperative morbidity. We conclude that the instillation of local anesthesia provides analgesia during the immediate postoperative period comparable to local infiltration using the same anesthetic. Both regional analgesia methods are more effective analgesics during the first 6 hours than are intravenous opioids. Furthermore the simple instillation of local anesthetic allows better analgesic evolution of the surgical wound after the first 24 hours considering the lower rate of resulting complications.

Palliative treatment of advanced esophageal carcinoma by esophageal tunnelization with a prosthesis allows immediate relief of dysphagia. However, the procedure is subject to a high rate of morbidity, including gastroesophageal reflux (GER) present in all patients with a prosthesis positioned through the gastroesophageal junction, resulting in complications (pyrosis, aspiration pneumonias, sleep disorders) and reduced quality of life in these patients who already have a lower rate of survival. In an attempt to reduce GER and its complications, the authors created a surgical prosthesis coupled to an anti-reflux valve system, comparing it to the use of an esophageal prosthesis without an anti-reflux valve mechanism.Twenty-two patients were allocated to 2 tunnelization groups: esophageal prosthesis without an anti-reflux valve mechanism (group 1) and surgical prosthesis coupled to an anti-reflux valve system (group 2). The GER was quantified measuring esophageal-gastric pH, and using fluoroscopy, contrast radiographs and esophageal emptying scintigraphy. Initially, the pH of secretions in S1 (esophagus) and S2 (stomach) was determined using reagent strips after aspirating their contents with different syringes. First with the patient seated at rest in bed, later performing a Valsalva maneuver, deep breathing and forced coughing. The same procedure was performed with the patient in left lateral decubitus, right lateral decubitus, and dorsal decubitus with the head of the bed lowered to 20 degrees. After finishing these maneuvers, 15 ml of 1 molar acetic acid were infused through the catheter positioned in the antrum, and, after 5 min, S1 and S2 material sampling was repeated in the same positions as mentioned above.The pH values between the various positions and maneuvers performed in each group separately were not significantly different, but, if we compare the 2 groups, and the secretions obtained in S1 and S2, there was a significant difference in pH measures in all positions. In the patients in group 1, S1 presented a mean pH ranging from 2.87-3.62 in the initial measures, and between 2.17 and 3.5 after the infusion of 15 ml of 1 molar acetic acid. On the other hand, in group 2, the mean pH of S1 remained between 6.34 and 8.32 in the initial measures and between 4.99 and 7.33 in the presence of acid infusion. At the level of S2, the pH remained unchanged between 2 and 2.7, in both groups.The authors conclude that the association of an esophageal prosthesis with a valve system significantly reduces GER, as compared with its use alone. Furthermore, it allows marked reduction of the symptoms and resulting complications, and does not interfere clinically with esophageal emptying. It thus significantly improves the quality of life of these patients.

Dear Editor, Osteoporosis-pseudoglioma syndrome (OPPG) is an autosomal recessive disorder characterized by low bone mass and ocular globe alterations, with frequent fractures as a consequence of high skeletal fragility and severe visual deficiency [1]. Recently, Gong et al. identified mutations in the low-density lipoprotein receptor-related protein 5 gene (LRP5) that cause OPPG [2]. The LRP5 gene is located on the long arm of chromosome 11 at 11q13.4, has 23 exons, and encodes a transmembrane protein with 1,615 amino acids. This protein is a member of the low-density lipoprotein receptor (LDLR) family, the members of which have very well conserved characteristics. We had the opportunity to follow-up two brothers with clinical characteristics of OPPG, and we decided to investigate the LRP5 gene to identify any mutation that could explain the clinical features of low bone mass, fractures, and blindness. The older brother came to the hospital when he was 12 years old, (53 kg; 157 cm). At that time, lumbar bone mineral density (BMD, Hologic 4,500 A) was 0.512 g/cm (Z score −3.99). He was born blind, had a normal development until the age of 7 years, when he had lumbar pain due to the fracture of a vertebral body. At the age of 11, pain in the left leg led to the diagnosis of a tibial fracture. One month later, the same occurred in the right tibia and 2 months after that, a fracture in the right femur was detected, and he was referred to our hospital. The younger brother was 4 years old at that time and was born blind. At 2.5 years, he had a fracture of the right femur after a small fall. He was eutrophic (13 kg and 97 cm), with a lumbar BMD of 0.277 g/cm2 (Z score −5.4). Both of them had normal biochemical and hormonal parameters. Their parents were consanguineous, had normal BMD and no history of fractures or blindness, and there were no similar cases in the family. The 23 exons were analyzed and we identified an LPR5 missense mutation in the third codon of exon 8, in which an asparagine is replaced by isoleucine (N531I) in two siblings with OPPG and their consanguineous parents. The patients were found to be homozygous for this mutation, while their parents are heterozygous. This amino acid is located at the second propeller domain (YWTD repeat) in the extracellular domain of the receptor. Fifty normal participants underwent analysis of this exon, and the mutation was not present in any of them, but a polymorphism C→T (rs545382 NCBI, F549F) was found at a frequency of 1:5. According to Sidow’s program [3] of multivariate analysis of protein polymorphism (MAPP), we observed that the N531I mutant scored higher (yielding a bad amino acid substitution) and this mutation is located in the group of deleterious variants because of its high degree of evolutionary conservation. Based on these facts, we believe that this mutation is responsible for the clinical features presented in our patients and thereby define a novel mutation that causes OPPG in humans. Osteoporos Int DOI 10.1007/s00198-007-0360-x

Os autores apresentam dois casos de polineuropatia carencial (PC) entre os índios Xavantes, em que o arroz era o alimento exclusivo no caso 1 e quase exclusivo no caso 2. O arroz consumido por esses índios era o beneficiado ou despolpado. A intoxicação pelo cianeto da mandioca ou de outros vegetais foi afastada. RELATO DOS CASOS. Foram observados em suas aldeias dois índios com 18 e 25 anos, com história progressiva de fraqueza, diminuição da força muscular e emagrecimento. Removidos ao Hospital São Paulo, notou-se, no exame neurológico do caso 1, atrofia da musculatura distal dos membros superiores e inferiores, déficit motor distalmente com grau zero na musculatura flexora, reflexos profundos abolidos, reflexo cutâneo plantar sem resposta bilateralmente, sensibilidade táctil, dolorosa e palestésica diminuída distalmente nos membros inferiores. No exame neurológico do caso 2, notou-se hiporreflexia proximal nos membros superiores, arreflexia nas porções distais dos membros superiores e inferiores, hipoestesia táctil e dolorosa nos pés, hipoacusia à direita. As eletroneuromiografias mostraram anormalidades compatíveis com polineuropatia sensitivo-motora simétrica, de padrão axonal desmielinizante no caso 1 e de predomínio desmielimizante no caso 2. Os exames de líquor foram normais. DISCUSSÃO. A polineuropatia foi caracterizada pela história clínica, pelos exames neurológicos, eletroneuromiográficos e líquor. O diagnóstico de PC ficou estabelecido pela história clínica e pelos exames eletroneuromiográficos sugestivos de polineuropatia periférica de causa nutricional. Esta PC não se enquadra nas mieloneuropatias como a neuropatia atáxica tropical, a paraparesia espástica e a neuropatia de Cuba. CONCLUSÃO. A PC dos Xavantes deve-se à deficiência da tiamina (vitamina B1), sendo o beribéri seco, tendo como causa o consumo do arroz beneficiado industrialmente como alimento exclusivo ou quase exclusivo. A polineuropatia dos Xavantes é diferente da neuropatia verificada entre os índios Kreen-Akrore e a observada entre os adolescentes índios do Parque do Xingu. The authors present two cases of polyneuropathy deficiency among Xavante indians where the sole food was rice in case 1 and almost so in case 2. The rice consumed by these indians was processed or hulled. Intoxication by cyanide from maniot or other vegetables was excluded. CASE REPORT - Two indians aged 18 and 25 years with a progressive history of weaness, decrease in muscular force and thinning were observed in their villages. On removal to the Hospital São Paulo, atrophy of the distal musculature of the upper and lower limbs, motor deficit distally with zero degree in the flexor musculature, abolished deep reflexes, plantar cutaneous reflex without response bilaterally, decreased tactile, painful and pallesthetic sensitivity distally in the lower limbs were noted on neurological examination of case 1. On neurological examination of case 2 proximal hyporeflexia in the upper limbs, areflexia in the distal portions of the upper and lower limbs, tactile and painful hypoesthesia in the feet, right hypoacousis were noted. Electromyography showed abnormalities compatible with symmetric sensorimotor polyneuropathy with an axonal demyelination pattern in case 1 and predominantly demyelinizing in case 2. Cerebrospinal fluid tests were normal. DISCUSSION - Polyneuropathy was characterized by the clinical history and by neurological, electromyographic and cerebrospinal fluid tests. The diagnosis of polyneuropathy deficiency was established by the clinical history and by electromyography suggesting peripheral polyneuropathy of nutritional origin. This neuropathy deficiency does not fit myeloneuropathies such as ataxic tropical neuropathy, spastic paraparesis and Cuba neuropathy. CONCLUSION - The Xavante polyneuropathy deficiency is caused by thiamine (vitamin B1) deficiency, that is dry beriberi, owing to consumption of industrially processed rice as sole or almost sole food. The Xavante polyneuropathy is different from the neuropathy observed among Kreen-Akrore indians and from that of adolescent indians in the Xingu Park. Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina UNIFESP, EPM SciELO

Background: Periodic paralyses and paramyotonia congenita are rare disorders causing disabling weakness and myotonia. Mutations in sodium, calcium, and potassium channels have been recognized as causing disease. Objective: To analyze the clinical phenotype of patients with and without discernible genotype and to identify other mutations in ion channel genes associated with disease. Methods: The authors have reviewed clinical data in patients with a diagnosis of hypokalemic periodic paralysis (56 kindreds, 71 patients), hyperkalemic periodic paralysis (47 kindreds, 99 patients), and paramyotonia congenita (24 kindreds, 56 patients). For those patients without one of the classically known mutations, the authors analyzed the entire coding region of the SCN4A , KCNE3 , and KCNJ2 genes and portions of the coding region of the CACNA1S gene in order to identify new mutations. Results: Mutations were identified in approximately two thirds of kindreds with periodic paralysis or paramyotonia congenita. The authors found differences between the disorders and between those with and without identified mutations in terms of age at onset, frequency of attacks, duration of attacks, fixed proximal weakness, precipitants of attacks, myotonia, electrophysiologic studies, serum potassium levels, muscle biopsy, response to potassium administration, and response to treatment with acetazolamide. Conclusions: Hypokalemic periodic paralysis, hyperkalemic periodic paralysis, and paramyotonia congenita may be distinguished based on clinical data. This series of 226 patients (127 kindreds) confirms some clinical features of this disorder with notable exceptions: In this series, patients without mutations had a less typical clinical presentation including an older age at onset, no changes in diet as a precipitant, and absence of vacuolar myopathy on muscle biopsy.