EEG extreme delta brush: An ictal pattern in patients with anti-NMDA receptor encephalitis.

INTRODUCTION: The anti-NMDA receptor (NMDAr) encephalitis-associated syndrome includes neuropsychiatric symptoms, impaired consciousness, seizures, autonomic instability, and hypoventilation. The electroencephalographic (EEG) activity throughout the course of the disease has still not been well documented. We reviewed electroclinical data of patients with NMDAr encephalitis to characterize their EEG and its clinical correlation. MATERIAL AND METHODS: We retrospectively identified 16 patients with NMDAr encephalitis from 8 Spanish medical centers, 15 of whom underwent video-EEG in the acute phase. RESULTS: In 15 patients (11 females, median age: 37.4, range: 14-87 years), seizures occurred in 9 (60%) and status epilepticus (SE) in 5 (33.3%). Magnetic resonance imaging (MRI) was abnormal in 10 (66.6%), and CSF (cerebrospinal fluid) was normal in 3 and abnormal in 12, with positive PCR (polymerase chain reaction) for Mycoplasma pneumoniae (1/15) and herpes simple virus (1/15). An ovarian teratoma was found in 1 patient and other malignancies (small cell lung carcinoma) in 1 patient. The EEG was abnormal in the acute phase in 14/15 (93.3%). Extreme delta brush (EDB) was observed in 5 (33.3%), and the presence of EDB was associated with SE in all cases. Rhythmic delta activity without EDB was observed in 5 (33.3%), while excessive beta activity was present in 4 (26.6%). Extreme delta brush can follow a pattern of well-characterized electroclinical seizures. CONCLUSIONS: Almost invariably, patients with NMDAr encephalitis had abnormal EEG. The presence of EDB, which can follow a pattern of well-characterized electroclinical seizures, in our patients was associated with seizures and SE. These findings suggest that EDB could be an evolutive pattern of an SE in NMDAr encephalitis. This article is part of a Special Issue entitled "Status Epilepticus".

[Infantile spasms in children with Down's syndrome]. / Espasmos infantiles en niños con síndrome de Down.

Two hundred eighty six infants with Down syndrome have been studied. Infantile spasms have been identified in nine of them, in which background, EEG pattern and its evolution, modalities of treatment and its effects, neuroimaging and development course have been revised. None of these patients had either familiar or personal pathological antecedents. The pattern in the first EEG made was hypsarrhytmic in all cases except one which showed a multifocal paroxystical activity, with intermittent and bilateral bursts of spike-waves. The treatment first used was ACTH in four cases, valproate in three cases and phenobarbital in two cases (one of these associated with nitrazepam). The ACTH treatment was effective in seven infants, either was the first or the second choice. An infant in whom the first treatment with ACTH was not successful, responded to the association with valproate+clonazepam. One patient treated initially with phenobarbital+nitrazepam, having no response to different prescriptions, responded finally to the association of carbamacepin+vigabatrin. The first treatment with valproate or phenobarbital had no effect in all patients. The EEG pattern improved in all cases just after the treatment response. Normal tracing was found for a period of two months to three years. Cranial TC was performed to three infants showing one of them a discrete ventricular dilatation and periventricular calcifications that suggested tuberous sclerosis. It is important to point out that, although the good effect of therapy and EEG pattern normalization, the development is below what had been expected in children with Down syndrome. Behavioral problems have been found in seven (77.7%) of these children.(ABSTRACT TRUNCATED AT 250 WORDS)

[Rapid method for identifying Escherichia coli and species of the Proteeae tribe in urine]. / Método rápido para identificar Escherichia coli y especies de la tribu Proteeae en orina.

BACKGROUND: To evaluate the possibility of using the determination of beta-glucuronidase and phenylalanine deaminase activity directly from urine samples for rapid detection (2 hours) of the presence of Escherichia coli and species of the Proteeae tribe. METHODS: To detect beta-glucuronidase activity methyl-umbelipheryl-beta-D-glucuronic was used as a substrate. The presence of fluorescence after incubation at 37 degrees C for 2 hours indicated a positive reaction. While phenylalanine was used as a substrate for detecting phenylalanine deaminase activity, FeCl3 was added after incubation at 37 degrees C for 2 hours with a greenish color being observed indicating phenylalanine deaminase activity. RESULTS: The detection of Escherichia coli by beta-glucuronidase activity presented sensitivity and specificity of 0.91 and 0.99, respectively. The positive predictive value was 0.96 and the negative predictive value was 0.98, whereas the determination of the phenylalanine deaminase activity with the aim of detecting species of the Proteeae tribe presented the following results; sensitivity 0.92, specificity 0.99, positive predictive value 0.94 and negative predictive value 0.99. CONCLUSIONS: The determination of beta-glucuronidase and phenylalanine deaminase activities directly from urine sediment has been demonstrated as a rapid and specific test for detecting the presence of Escherichia coli and species of the Proteeae tribe, therefore it must be considered as a useful test in early diagnosis of urinary infection thereby facilitating the administration of appropriate antibiotic treatment.

[Acute gastroenteritis: a prospective study of 445 cases]. / Gastroenteritis aguda: estudio prospectivo de 445 casos.

Four hundred and fourty-five adult patients suffering acute gastroenteritis (AG) seen at the emergency ward of two hospitals in Barcelona, have been studied. The aim of this work was to analyze the cause of AG in our community and to evaluate the utility of the biologic and clinical criteria chosen as indicators of bacteremia or of AG produced by invasive microorganisms. Stool culture was positive in 157 patients (35%) of which 140 were Salmonella sp. The most frequently isolated serotype was S. enteritidis. Eight patients (7.8%) presented Salmonella sp. bacteremia. Presence of an underlying disease, dehydration, shivers, fever, presence of occult blood in stools, septic hemogram and the history of AG in other family members were more common in patients with a positive stool culture (p less than 0.05). Patients with bacteremia presented dehydration with a significantly higher frequency than nonbacteremics. The rest of the parameters studied were similar in both groups. We conclude that Salmonella sp. is the most frequently encountered microorganisms responsible for adult AG in our community. It is possible to identify patients with AG due to Salmonella sp. based on clinical and biological parameters. On the contrary, it is necessary to perform a wider study in order to determine the parameters that may allow the identification of patients with bacteremia.

[Spontaneous regression of a heart rhabdomyoma in tuberous sclerosis. Apropos of a case]. / Regresión espontánea de un rabdomioma cardíaco en la esclerosis tuberosa. A propósito de un caso.

A case of cardiac rhabdomyoma diagnosed during the neonatal period is presented. The condition remitted spontaneously, as was observed by monitoring its course both clinically and by echocardiography. Surgical treatment of this rare condition should be assessed with care, both because of the risk involved in surgery and because of the possibility of a spontaneous cure in rhabdomyomas, which are usually grouped together, as in our case, in a general picture of tuberous sclerosis.

[Acute enteritis caused by Salmonella: effect of mecillinam and cotrimoxazole on the clinical course and fecal carrier state]. / Enteritis aguda por Salmonella: influencia del mecillinam y del cotrimoxazol en el curso clínico y en el estado de portador fecal.

In a prospective randomized study we have evaluated the influence of co-trimoxazole and mecillinam on the clinical outcome and the fecal Salmonella sp carrier status in 134 adult patients with acute non-typhi Salmonella sp enteritis. The patients were distributed in three groups on the basis of predefined clinical and biological criteria, depending on their risk of bacteremia or severe complications of it, or on the enteroinvasive character of the causative organism. The inclusion in any group determined the treatment. Seventy-six patients received mecillinam (1.200 mg/day p.o.), 36 co-trimoxazole (1.600 mg/day p.o.), both during five days, and 22 only diet. The patients were investigated after 1, 3 and 6 weeks until stool culture was negative. The isolated Salmonella strains, either in stool or blood culture, had a sensitivity of 98.3% to mecillinam and 96.9% to cotrimoxazole. Resistance did not develop during therapy. All patients had a favorable outcome, including the six with bacteremia. No differences were found regarding clinical features (diarrhea, abdominal pain, fever) or the rate of positive stool cultures in the three therapeutic groups in any of the follow-up controls. It was concluded that the administration of mecillinam or co-trimoxazole to patients with Salmonella sp enteritis is not associated with a prolongation of the state of fecal carrier or with the development of resistant strains.