History Of Difficulty Research Articles

Statistical Learning, Letter Reversals, and Reading

Reversal errors play a prominent role in theories of reading disability. We examined reversal errors in the writing of letters by 5- to 6-year-old children. Of the 130 children, 92 had a history of difficulty in producing speech sounds, a risk factor for reading problems. Children were more likely to reverse letter forms that face left, such as <d> and <J>, than forms that face right, such as <b> and <C>. We propose that this asymmetry reflects statistical learning: Children implicitly learn that the right-facing pattern is more typical of Latin letters. The degree of asymmetry that a child showed was not related to the child’s reading skill at Time 2, 2¾ years later. Although children who went on to become poorer readers made more errors in the letter writing task than children who went on to become better readers, they were no more likely to make reversal errors.

Dramatic improvement of parkinsonian symptoms after gluten-free diet introduction in a patient with silent celiac disease

Dear Sirs, Celiac disease (CD) may manifest only with neurological symptoms [5], even in advanced age [3]. No clear association has been reported to date between CD and Parkinson’s disease (PD). A 75-year-old man presented with a 1-year history of difficulty with walking, instability, and fatigability. Neurological examination showed facial hypomimia, bradykinesia, rigidity, and postural instability with a UPDRS/Part II score of 8 and a UPDRS/part III motor score of 19 (Table 1). The remaining neurological examination was unremarkable. The patient had never been treated with drugs acting on the central nervous system; in particular he had never received drugs causing parkinsonism such as neuroleptics. Brain MR revealed several nonspecific foci of hyperintensity in the frontal and parietal subcortical white matter but not in the basal ganglia. Few punctate calcifications were present in the globus pallidus bilaterally, a finding that is quite common in elderly subjects [6]. Singlephoton emission computed tomography (SPECT) after intravenous injection of 185 MBq of I-FP-CIT (DaTSCAN, G.E. Healthcare, UK) showed a pronounced decrease of radiotracer uptake in the left putamen and moderate decrease in the contralateral putamen (Fig. 1). Activity was clearly visible in the caudate nuclei of both hemispheres. Semi-quantitative analysis confirmed visual assessment of images: putamen-to-occipital cortex uptake ratios were lower than values obtained in healthy subjects, and the reduction was more pronounced on the left hemisphere. On the basis of clinical and SPECT data, a diagnosis of Parkinson’s disease was made. Laboratory studies revealed reduced serum folate level (2.8 ng/ml, n.v. 3–15) and hyperhomocysteinemia (23.4 lmol/l, n.v. 5–15), but vitamin B12 level was normal. The possibility of asymptomatic malabsortion due to a silent CD was explored. Serological screening revealed anti-gliadin antibodies, markedly elevated IgA (236 U/ml, n.v.\ 20) and IgG (86 U/ml; n.v. \ 20), anti-transglutaminase antibodies, and positive anti-endomysial antibodies. Duodenal histology was diagnostic of CD. The gastroenterologist prescribed a gluten-free diet. The patient came back to the neurological outpatient clinic only 3 months after the beginning of the gluten-free diet: during this period he had no pharmacological treatment for PD, but he reported an almost complete remission of symptoms. The improvement was confirmed by neurological evaluation, with a UPDRS/Part II score of 3 and a UPDRS/part III motor score of 8 (Table 1). Because of this improvement, we decided not to treat the patient at this stage. In order to define whether the gluten-free diet had modified striatum dopaminergic activity, we repeated the SPECT study 8 months after diet onset. SPECT confirmed the previous abnormalities and showed a further decrease in radiotracer uptake in the putamen bilaterally. Activity V. Di Lazzaro (&) F. Capone F. Ranieri Department of Neurosciences, Institute of Neurology, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128 Rome, Italy e-mail: v.dilazzaro@unicampus.it

Sporadic Burkitt's lymphoma of the parapharyngeal space in an immunocompetent adult Indian male

A 17 year old male presented with one month history of difficulty in swallowing, reduced hearing with intermittent pain in right ear, occasional nasal bleeding; slurring of speech and occasional headache with a few episodes of fainting. Clinical examination revealed right hypoglossal nerve palsy, and right lateral pharyngeal wall and tonsil were displaced medially. Right serous otitis media along with ipsilateral cervical and axillary lymphadenopathy were present. Blood biochemistry and urine examination were normal. An irregular heterogenous-enhancing mass in the right parapharyngeal space encasing the internal and external carotid arteries was evident on CT. Bone marrow biopsy was free from lymphomatous involvement. biopsy from the nasopharyngeal bulge was consistent with a submucosal malignant round cell tumour. Immunohistochemistry showed tumour cells which were CD20 and CD22 positive, and negative for CD5, Desmin, Cytokeratin (CK), CD99, and synaptophysin; with a proliferative fraction (Ki-67 index) of greater than 98%. A diagnosis of Burkitt's lymphoma of the parapharyngeal space, stage II E was made. Patient responded to chemotherapy. Sporadic Burkitt's lymphoma in an immunocompetent Indian male is being reported because of its unusual location-parapharyngeal space. Copyright © 2014, Indian Journal of Medical Specialities. Published by Reed Elsevier India Pvt. Ltd. All rights reserved.

A CASE SUPPORTING THE ROLE OF THE CEREBELLUM IN DYSTONIA

A 28 year old right handed man presented with a ten year history of difficulty in writing. He had been prescribed metoclopramide for an episode of vomiting one week prior...

Schwannoma of Tonsillolingual Sulcus: First Case Report and Review of Literature

ABSTRACTSchwannoma is a benign, encapsulated tumor that is derived from schwann's cells. The most common site is parapharyngeal space of the neck; oropharyngeal occurrence is extremely rare. Fourteen year male boy presented with a history of difficulty in swallowing, more for solids for the last 8 months. The patient also had a change of voice for the last 5 months and was muffled in character. Examination showed single lobulated mass having smooth surface, of the size of approximately 5 × 4 cm and was arising from the tonsillolingual sulcus. The fine needle aspiration cytology from the lesion, reported to be schwannoma. The mass was excised completely under general anesthesia with the help of bipolar cautery. We report first case of schwannoma of tonsillolingual sulcus and also review the literature of the rare entity.How to cite this articleVerma H, Dass A, Punia RPS. Schwannoma of Tonsillolingual Sulcus: First Case Report and Review of Literature. Int J Otorhinolaryngol Clin 2013;5(2): 98-99.

Obstructive Urolithiasis in Canine- Ultrasonographic and Radiographic Observations

Ten dogs, seven male and three female between age group of 5~7 years were brought to TVCC with the history of difficulty in urination. Dogs were not responding to medicinal treatment. The dogs were dull, depressed and dehydrated showing signs of abdominal pain on palpation. Polyethylene catheter could not be passed into the urethra. Blood examination showed mild anemia, increased T.L.C., D.L.C. and PCV values. Biochemical values indicated high creatinine, blood urea nitrogen, SGOT and SGPT. Radiographs showed presence of cystoliths and urethroliths but ultrasonogram showed presence of nephroliths, cystoliths & nephroliths. Dogs were prepared for surgery under xylazine & ketamine combination. Urethrotomy was done to remove all the calculi. Para-median cystotomy was done to remove cystoliths in males and median cystotomy was performed in females. Post-operative care was done with course of antibiotics, anti-inflammatory drugs, diuretics, B-complex & fluid therapy and daily antiseptic dressing. Skin sutures & polyethylene catheter were removed after 14 days and all dogs started passing urine normally.

Schwannoma of Tonsillolingual Sulcus: First Case Report and Review of Literature

ABSTRACTSchwannoma is a benign, encapsulated tumor that is derived from schwann's cells. The most common site is parapharyngeal space of the neck; oropharyngeal occurrence is extremely rare. Fourteen year male boy presented with a history of difficulty in swallowing, more for solids for the last 8 months. The patient also had a change of voice for the last 5 months and was muffled in character. Examination showed single lobulated mass having smooth surface, of the size of approximately 5 × 4 cm and was arising from the tonsillolingual sulcus. The fine needle aspiration cytology from the lesion, reported to be schwannoma. The mass was excised completely under general anesthesia with the help of bipolar cautery. We report first case of schwannoma of tonsillolingual sulcus and also review the literature of the rare entity.

Ectopic Thoracic Kidney and End-Stage Renal Disease in a 38-Year-Old Nigerian

This patient is a 38-year-old housewife who presented with a one-month history of difficulty, in breathing, chest pain and bilateral leg swelling and had a blood pressure of 260/150 mmHg, features of malignant hypertension and hypertensive heart disease. Chest CT scan revealed a chest location of the left kidney. She also had elevated serum urea and creatinine and proteinuria (++). The right kidney was normally located with loss of corticomedullary differentiation. She is on maintenance haemodialysis and is being worked up for possible left nephrectomy.

Fighting cancer with nanoparticle medicines―The nanoscale matters

Abstract

G.P.52 A case of X-linked myopathy with excessive autophagy (XMEA) showing a VMA21 gene mutation

XMEA is a rare disorder characterised by slowly progressive muscle weakness and distinctive pathology, with autophagic vacuoles on muscle biopsy. The VMA21 gene, which encodes an essential chaperone of the vacuolar ATPase protein pump that controls pH in intracellular compartments in the cell, has recently been implicated as a cause of XMEA. In the original publication, which was later retracted, six mutations were described, all predicted to affect splicing of the gene leading to a deficiency of VMA21 protein. No other mutations in the VMA21 gene have since been described. Here we report the case of a man who presented at the age of 23years with a two year history of difficulty with stairs because of weakness of the legs. Clinical examination revealed reduced muscle mass in the legs compared to the arms, normal distal leg strength, but 4/5 weakness of hip and knee flexion and extension. Upper limbs were normal as were the deep tendon reflexes. Serum creatine kinase level was elevated (1326U/L). Muscle biopsy showed variation in fibre size, increased internal nucleation and occasional necrotic and regenerating fibres. Many fibres contained multiple small vacuoles with sarcolemmal features. Electron microscopy showed multiple membrane-lined autophagic vacuoles containing heterogeneous material and calcium deposits. There was extensive reduplication of the basal lamina associated with vacuoles of abnormal material located between sarcolemmal outpouchings. The histopathological and ultrastructural findings were those of XMEA. Sequence analysis of the entire coding region of the VMA21 gene showed the patient to be hemizygous for a A>G nucleotide change 6bp downstream from the stop codon. Given this is one of the same mutations (c.*6A>G) described in the original paper, this case report provides additional evidence in support of mutations in VMA21 being causative of XMEA.

Institutionalizing Information Literacy

There is increasing recognition that information literacy is essential for individual and community empowerment, workforce readiness, and global competitiveness. However, there is a history of difficulty in integrating information literacy with the postsecondary educational process. This paper posits that a greater understanding of the organizational functioning of different types of colleges and universities can identify targeted strategies to address this issue. It applies Birnbaum's descriptions of four models of higher education organizations and strategies for effectiveness in each to the problem of institutionalizing information literacy. It proposes strategies for the institutionalization of information literacy based on the differences in these models.

Stífkrampi - tilfelli og yfirlit

A 79 year old farmer was referred to the University Hospital with a three days history of difficulty in opening his mouth. On examination, both masseters were seen to be stiff, suggesting tetanus or jaw-subluxation. An attempt to reduce the joint was made, but failed. He subsequently developed progressive respiratory difficulties requiring intubation. The farmer had recently cut his finger on barbed wire. He had not received tetanus immunization for years and it was not clear whether primary immunization had been completed. Tetanus immunoglobulin and antibiotics were administered. He proceeded to develop autonomic instability and critical illness polyneuropathy requiring 45 days of ICU care. He was finally discharged eight months later. The farmer has gradually improved and is now living unaided at home. In this article we will review this case and the literature on tetanus.

Reduced port laparoscopic repair of Bochdalek hernia in an adult: A first report

Bochdalek hernia is a congenital defect of the diaphragm that usually presents in the neonatal period with life-threatening cardiorespiratory distress. It is rare for Bochdalek hernias to remain silent until adulthood. A 57-year-old woman presented with history of difficulty in swallowing, as well as retching. There was no history of abdominal or thoracic trauma. A chest x-ray showed the herniated stomach clearly. Computed tomography (CT) of the abdomen showed a herniated volvulus of the stomach, along with left posterolateral diaphragmatic hernia. The defect was repaired by a single incision laparoscopic technique. We present the first case of a posterolateral diaphragmatic hernia repaired by a reduced port laparoscopic technique in an adult, after an extensive literature search yielded no precedents. This report validates the feasibility of reduced port laparoscopic repair of Bochdalek hernia in an adult, and should be within the remit of the advanced laparoscopic surgeon.

Untreated Cleft Palate a Unique Surgical Contraindication in Carcinoma of the Pyriform Fossa

ABSTRACT Background/objectives Swallowing problems following total laryngectomy are significantly lesser compared to other partial laryngectomies as a permanent seperation between the trachea and esophagus is seen in the earlier. Sometimes, the patient complains of difficulty in propelling bolus through the oral cavity and pharynx as a result of the loss of hyoid bone, which is the anchor for the tongue. The increased pressure in the narrowed pharyngoesophageal segment following laryngectomy requires the tongue to move with greater force. Setting Department of Head and Neck Oncosurgery, Kidwai Memorial Institute of Oncology, Bengaluru. Case report A 52-year-old man with history of difficulty and pain while swallowing and diagnosed as squamous cell carcinoma of the right pyriform fossa extending to the pharyngoepiglottic fold. Incidently, the patient had an old untreated cleft palate. Assessment of the pharyngeal wall involvement on direct laryngoscopy proved that pectoralis major myocutaneous flap patch was needed to reconstruct the pharyngeal lumen. Cleft palate proved a contraindication for surgery as the oral swallowing phase would be affected. Conclusion Current management protocols of hypopharyngeal cancers include multifactorial assessment of anatomical and functional outcomes and rehabilitation. Even though no literature is found stating cleft palate as the contraindication for total laryngectomy, chemoradiation was preferred citing swallowing problems. How to cite this article Naik SM. Untreated Cleft Palate a Unique Surgical Contraindication in Carcinoma of the Pyriform Fossa. Int J Phonosurg Laryngol 2012;2(1):33-36.

Relação entre variáveis psicossociais familiares e desempenho em leitura/escrita em crianças

Este artigo analisa a relação entre fatores psicossociais familiares e o desempenho em leitura e escrita a partir de um estudo comparativo realizado através de entrevista semiestruturada com 29 familiares de dois grupos de alunos de 2ª série do ensino fundamental. Por meio de avaliação neuropsicológica, os estudantes foram caracterizados em: com dificuldade de leitura e escrita e leitores e escritores competentes. As análises estatísticas evidenciaram associação significativa entre o grupo com dificuldade em leitura e escrita e as variáveis presença de transporte próprio na família, percepção dos familiares de que a criança teve dificuldades para aprender a ler e no desempenho da leitura, maior índice de repetência escolar e história familiar de dificuldade na leitura. Os resultados demonstram a importância da análise de fatores psicossociais familiares para a compreensão da complexidade que envolve o desenvolvimento de habilidades de leitura e escrita em crianças.

Hepatocellular carcinoma presenting as polymyositis: a paraneoplastic syndrome

Polymyositis as a paraneoplastic syndrome associated with hepatocellular carcinoma is quite rare; only a few cases have been reported. We report a case of a 50-year-old female who presented with subacute quadriparesis, neck muscle weakness, elevated creatinine phosphokinase, a myogenic pattern on the EMG and was diagnosed as having polymyositis, a paraneoplastic syndrome associated with hepatocellular carcinoma with negative hepatic viral markers and a positive ANA. Improvement in patient symptoms and areduction in creatinine phosphokinase, which occurred after lobectomy, supports this rare association.

글로벌 해운회사의 공컨테이너 재배치 최적화

H maritime company in Korea had a long history of difficulty in obtaining enough empty containers to transport its commodities. Despite efforts to resolve the problem, the repositioning of empty containers between depots was still planned manually, which consumed much worker time. To automate the generation of reposition plans, we developed a planning system to optimize the company's reposition of empty containers between global depots with a linear programming model functioning as a key decision engine in the system. The model determines the route, volume and mode of transportation for repositioning empty containers from depots with surplus containers to those requiring containers, as well as the empty space of ships generated from the unloading or loading of full and empty containers. The system has been in operation in the company's global network since March 2008.

Pendular nystagmus in progressive ataxia and palatal tremor

Pendular nystagmus (PN) is an involuntary ocular oscillation that can be found in congenital or acquired visual or central nervous system diseases [1, 2]. We describe the case of a patient with PN associated with progressive cerebellar ataxia and palatal tremor (PAPT). The PN has been registered and analyzed with video-oculography. A 55-year-old man complained of a 2-year history of progressive difficulty with running and walking accompanied by unsteadiness. Over this time, he described transient oscillopsia. In retrospect, he reported a long history of difficulty in biking and subtle visual disturbances and tinnitus (but no ear click). There was no relevant family and past medical history. Examination revealed wide-based and unsteady gait, impossible tandem walk and marked dystasia at the single leg stance test (Video 1). The other cerebellar tests were normal (Video 2). Tendon reflexes were brisk at four limbs. The nystagmus was almost invisible at eye (Video 3, part 1), although it could be easily demonstrated by video-oculography (Video 3, part 2), as well as the palatal tremor at the oropharyngeal inspection (Video 3, part 3). The PN had a frequency of about 0.5–1 Hz. It mainly developed on the vertical and the horizontal axis with a secondary rotatory counter-clockwise component (Fig. 1). Best-corrected visual acuity was 20/20. Dynamic visual acuity test was normal. Brain MRI showed mild cerebellar atrophy, more prominent in the lateral part of the hemispheres and signal abnormalities in both inferior olives, which appeared enlarged, and in the decussation of the dentatorubral tracts (Fig. 2). Laboratory tests, including thyroid hormones, antibodies anti-gliadin, -endomysium, transglutaminase, -glutamic acid dehydrogenase, -voltage-gated calcium channel, and -cerebellum were within normal range or negative. Needle biopsy of the quadriceps showed a mild increase in lipid content without morphological and histoenzymatic abnormalities. Genetic tests for POLG1, SCA1, SCA2, SCA6, and FXN (Friedreich ataxia) mutations were negative. Diagnosis of sporadic PAPT can be made in the presence of non-familiar degenerative progressive ataxia and palatal tremor [3]. Ocular oscillations typically coexist in the form of vertical PN [4]. Due to the absence of brainstem morphological abnormalities and of dentate calcifications, adult-onset Alexander’s disease [5, 6] and spinocerebellar ataxia type 20 [7] seem unlikely. Electronic supplementary material The online version of this article (doi:10.1007/s00415-011-6007-z) contains supplementary material, which is available to authorized users.

Epidermoid Cyst of the Tongue Causing Airway Obstruction

Epidermoid cyst occurring within the tongue is rare. The aim of this article is to discuss the management of an adult patient who presented with respiratory obstruction due to this congenital epidermoid cyst within the tongue. A 32-year-old male patient who was brought to the accident and emergency department of the University of Port Harcourt Teaching Hospital, Port-Harcourt, Rivers State, Nigeria was presented. He came with a history of difficulty in breathing as a result of a slow growing swelling of the tongue which started from birth. There was associated pain, difficulty in speech and mastication as the swelling increased in size. Detailed physical examination, sonographic imaging and histopathology were carried out. On examination, patient was acutely ill-looking, in severe respiratory distress, febrile, mildly pale and dehydrated but anicteric. Extra-oral examination revealed mildly protruded upper and lower dento-alveolar arch as well splaying and recession of the anterior and posterior teeth of the upper arch. Intra-oral examination revealed moderately tender, fluctuant and grossly enlarged tongue obstructing the oro- and nasopharyx. A diagnosis of dermoid cyst was made and the patient was booked for surgery after resuscitation. Excision of the cyst was done under general anaesthesia/naso-tracheal intubation by an intra-oral approach. Ultrasound was able to give a thorough assessment of the cystic nature of the swelling while post-operative histopathology was used to confirm the specific type of teratoma. The relationship of the cyst to the intrinsic and extrinsic muscles of the tongue and mylohyoid muscle was relevant to the surgical approach to the lesion.

P02-283 - Psychological status of patients undergone myocardial infarction: presentation of a case myocardial infaction (MI)

In myocardial infarction, as well as psychological problems many serious physical problems may appear in individuals who experience a disease which will be a threat for death or bodily image.PresentationMr. H’ cardiac disorder had onset in 2001. When Mr. H. who was discharged after placement of stent due to myocardial infarction has returned to polyclinic for control a psychosocial orientation scale was applied. His compliance to disease was fairly good.There were anxiety, lack of social support, reduced income level and various psychosocial factors which progress up to fear. Mr. H. is a 54-year old married man and he is a secondary school graduate, and is working in a restaurant since his present financial situation is not efficient. He demonstrated behaviors of anxiety, panic, uneasiness, gabbing and restlessness and an increase in tendency toward violence, irritability, isolation from society and timid behaviors were observed. Patient had a history of difficulty in establishing friend-relationships and there was an anxiety caused by gabbing and difficulty in expressing himself. During interview his actions were restless and just like he wanted to leave right away. He had fears of being disgraced in front of strangers. He said he was afraid of being ostracized from public because he was stammering. Nurses taking place in health team to arrange training programs related to issues such as appropriate diet toward MI, regular intake of medications, quitting smoking, reducing weight, increasing social support, coping with stress and anger control facilitate individuals who undergone MI compliance to disease and decrease their anxiety.