OBJECTIVE: To determine the nature (clonal type and antibiotic resistance pattern) of methicillin-resistant Staphylococcus aureus (MRSA) strains recovered from the largest teaching hospital in Portugal and to detect temporal trends in clonal types during three consecutive surveillance periods in 1992--93, 1994--95 and 1996. METHODS: MRSA strains were characterized by chromosomal SmaI macrorestriction patterns using pulsed-field gel electrophoresis (PFGE) and by DNA fingerprints---applied to ClaI digests---capable of probing two specific areas of the staphylococcal chromosome: (1) the vicinity of the mecA gene, and (2) the attachment site(s) and copy number of transposon Tn554. The combination of these methods can generate 'clonal types' useful for epidemiological tracking of MRSA strains. RESULTS: During the 1992--93 collection period, 65% of MRSA strains carried the mecA polymorph I, Tn554 pattern E and PFGE pattern A (I::E::A)---a clonal type that was used to define the 'Iberian MRSA', which is widely spread throughout southern Europe. The representation of this clone decreased to 42% in 1994--95 and to 20% in 1996. At the same time, a second multiresistant MRSA strain carrying mecA polymorph XI, Tn554 type B and PFGE pattern B (XI::B::B)---a clonal type characteristic of the so-called 'Brazilian MRSA'---increased from 5% in 1992--93 to 36% in 1994--95 and 29% in 1996. CONCLUSIONS: Throughout the four years of surveillance, the Iberian and Brazilian MRSA types and their single subtype variants together have been responsible for the overwhelming majority (close to 90%) of all MRSA infections in the largest teaching hospital of Portugal. The mechanism of epidemicity of these two multiresistant international MRSA clones remains to be elucidated.

Background and purpose We evaluated two methods to identify mesial temporal sclerosis (MTS): visual inspection by experienced epilepsy neuroradiologists based on structural magnetic resonance imaging sequences and automated hippocampal volumetry provided by a processing pipeline based on the FMRIB Software Library. Methods This retrospective study included patients from the epilepsy monitoring unit database of our institution. All patients underwent brain magnetic resonance imaging in 1.5T and 3T scanners with protocols that included thin coronal T2, T1 and fluid-attenuated inversion recovery and isometric T1 acquisitions. Two neuroradiologists with experience in epilepsy and blinded to clinical data evaluated magnetic resonance images for the diagnosis of MTS. The diagnosis of MTS based on an automated method included the calculation of a volumetric asymmetry index between the two hippocampi of each patient and a threshold value to define the presence of MTS obtained through statistical tests (receiver operating characteristics curve). Hippocampi were segmented for volumetric quantification using the FIRST tool and fslstats from the FMRIB Software Library. Results The final cohort included 19 patients with unilateral MTS (14 left side): 14 women and a mean age of 43.4 ± 10.4 years. Neuroradiologists had a sensitivity of 100% and specificity of 73.3% to detect MTS (gold standard, k = 0.755). Automated hippocampal volumetry had a sensitivity of 84.2% and specificity of 86.7% (k = 0.704). Combined, these methods had a sensitivity of 84.2% and a specificity of 100% (k = 0.825). Conclusions Automated volumetry of the hippocampus could play an important role in temporal lobe epilepsy evaluation, namely on confirmation of unilateral MTS diagnosis in patients with radiological suggestive findings.

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We present a 36 year-old male patient complaining from progressive sensory loss on both hands and sensation of chest and abdominal tightness, lasting for five weeks. Neurological examination revealed a mild tetraparesis, glove and sock hyposthesia, C2 to T11 sensory impairment, vibratory anesthesia and proprioceptive errors of lower limbs. Cerebellar tests were normal. Romberg, Babinski and Lhermitte signs were absent. Laboratory tests revealed Hb 14.3 g/dL, mean corpuscular volume 104 fL. Renal and hepatic functions, iron study, copper levels and angiotensin conversion enzyme, and folic acid were normal. Vitamin B12 level was <82 pg/mL (189-883 pg/mL). Serum immunology, virology and bacteriology were negative. CSF study and brain MRI were unremarkable. Cervical spine MRI showed hyperintense spinal cord signal on T2-weighted images affecting mainly dorsal, but also lateral, columns between medulla oblongata and T11 levels, with subtle contrast enhancement (Fig A-C). Basing on clinical and laboratory examinations, the patient was evaluated for extensive myelopathy due to VBD, and it was performed an upper gastrointestinal examination which revealed an atrophic mucosa; histological examination showed chronic atrophic gastritis and intestinal metaplasia, excluding Helicobacter pylori infection. Anti-parietal cells were negative, but anti-intrinsic factor antibodies were positive. Treatment was performed with IM cyanocobalamin replacement, 1,000 μg IM daily for a week, then weekly for four weeks and monthly afterwards. Three months later, there was a significant clinical recover, only remaining hypoesthesia of hand fingers. MRI performed at this time showed an exuberant improvement (Fig D).Subacute combined degeneration (SCD) refers to degeneration of the posterior and sometimes lateral columns of the spinal cord usually as a result of VBD, which effects may not be appreciated until several years, since there is a significant body store of vitamin B 12 1,2 . Its absorption occurs via the ileal microvilli after binding to the intrinsic factor 3 , and malabsorption

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