[Emergencies in oncological gynaecology]. / Urgencias en ginecología oncológica.

This article describes the signs for suspecting neoplasia that lead the patient to come to the Accident and Emergency Service, concentrating on genital bleeding, pelvic mass and vulvar pruritus. Patients can also come due to processes resulting from complications of the disease, such as urethral obstruction, carcinomatosis, ascites, thromboembolic processes, haemorrhages, constipation, nausea and vomiting, intestinal obstruction and pain. Finally, we describe complications that are secondary to the treatment, such as abdominal and inguinal lymphocele and post-radiotherapy enteritis and proctitis.

[Infections of the central nervous system in emergency department]. / Infecciones del sistema nervioso central en urgencias.

Infections of the central nervous system are frequent diseases in emergency care. They can have a bacterial, parasitic or viral origin. Initial symptoms can be non-specific, which can complicate and delay diagnosis, hence the extreme importance of all the information that can be obtained through anamnesis and physical exploration, with frequent complementary explorations. In the last hundred years, with the introduction of antibiotic drugs, there has been a significant fall in mortality secondary to meningoencephalitis, but in spite of that they continue to provoke high morbidity and mortality. Other phenomena, such as vaccination campaigns, migratory movements, infection by HIV and other states of immunosuppression, have given rise to important epidemiological changes such as the virtual disappearance of some infections or the appearance of others that rarely existed previously. The list of potential infections of the central nervous system is extensive, which is why in this review we set out, from the clinical, diagnostic and therapeutic point of view, those that are most frequent in our environment and some that, although very infrequent, might require emergency attention due to their severity.

[Variation of Mini-Mental-State examination scores due to age and educational level. Normalized data in the population over 70 years of age in Pamplona]. / Variación de las puntuaciones en el Mini-Mental-State con la edad el nivel educativo. Datos normalizados en la población mayor de 70 años de Pamplona.

The Mini-Mental-State Examination (MMSE) is widely used as a screening tool for dementia in epidemiological studies. Its applicability in population-based studies is nevertheless limited by its low specificity. The effect of age and educational level have been usually ignored when cut-off scores have been selected. The aim of this study was to evaluate the effect of age and educational level on the MMSE scores in a representative sample of subjects older than 70 and provide adjusted normalised data according to these two variables, after excluding subjects with dementia or cognitive decline. Population-based, cross-sectional and longitudinal study of a representative cohort of 1367 subjects older than 70. All subjects with suspected dementia or cognitive decline received a neurological evaluation where clinical and etiological diagnosis were established. Normal MMSE scores, as defined by the 10th percentile, varied significantly across age and educational level groups. Exclusion of demented or cognitively declined patients from the reference population reduced the variability and "range of normality", but this remained excessively high in the older and less educated groups. The use of different cut-off points for each age and educational level groups may improve the specificity and applicability of the MMSE in population-based epidemiological studies. However, the wide amplitude of the range of normality suggests that different approaches, other than this vibariate analysis, may prove more adequate in the selection of cut-off scores for the MMSE.

[Standardization of the Alzheimer's Disease Assessment Scale in a Spanish population]. / Estandarización en una población española de la escala ADAS (Alzheimer's Disease Assessment Scale).

We describe a Spanish adaptation and standardization of the Alzheimer's Disease Assessment Scale (ADAS) carried out as part of a prospective, coordinated study performed simultaneously in two Spanish health centers. Three diagnostic groups were defined: 21 healthy volunteers (normal group); 22 patients with cognitive deterioration but no dementia (CDND group); and 20 patients with Alzheimer type dementia (ATD group). The subjects were examined at the start of the study and after 3 and 6 months. The mean cognitive ADAS scores were significantly different in the 3 groups (F = 67.2, p = 0.0001), as follows: normal group, 7.6 +/- 2.1; CDND group, 12.4 +/- 4.5; and ATD group, 21.0 +/- 4.7. Likewise, the ADAS proved sensitive to the course of deterioration in the ATD group, while the other groups' scores improved. We conclude that the ADAS, and in particular the cognitive subscale, is useful for evaluating ATD patients, especially in the early phases of deterioration. It discriminates between ATD and CDND patients well.

Prevalence of Alzheimer's disease and other dementing disorders in Pamplona, Spain.

We investigated the prevalence of dementing disorders in the city of Pamplona, Spain, using a door-to-door two-phase approach. We first administered the Cambridge Examination of Mental Disorders of the Elderly (CAMDEX) to all survivors, as of March 1, 1991, of a probability sample of the total population identified in 1989 (n = 1,127). Using specified diagnostic criteria, the study neurologists extensively investigated those subjects who screened positive on CAMDEX. We found 194 subjects affected by dementia, 119 had Alzheimer's disease; 51 vascular or mixed dementia, and 16 secondary dementia. The prevalence of both dementia and Alzheimer's disease increased steeply with advancing age and was consistently higher in women. The prevalence of combined vascular and mixed dementia increased less rapidly with age, and was generally higher in men. Alzheimer's disease was the most common type of dementia. Our prevalence figures for dementia and Alzheimer's disease are similar to those previously reported in Europe.

Abnormal muscle and skin mitochondria in family with myoclonus, ataxia, and deafness (May and White syndrome).

A mother and two of her daughters had deafness and cortical reflex myoclonus; the mother also had mild truncal ataxia. Muscle and skin biopsy specimens revealed abundant ragged-red fibres and abnormal mitochondria. The son of one of the daughters had sensorineural deafness. Three other grandchildren were asymptomatic. The two daughters also had diabetes mellitus, hypertension and cardiomyopathy. Another daughter died of renal failure. The mother lost her hearing in her 70s, one daughter in her 30s, and the other daughter and the grandson in their 20s. The mother has had transient episodes (24-48 hours) of temporal disorientation, severe action myoclonus, and ataxia for about eight years. This is the first reported family with inherited deafness, myoclonus, and ataxia with mitochondrial pathology.

Cortical mechanisms mediating asterixis.

We describe a patient with chronic renal failure who suffered multifocal action-induced jerks. Electromyography (EMG) recorded the typical silence of asterixis. Back-averaging the EEG activity preceding the EMG silent periods in the forearm showed a biphasic wave antedating the asterixis by 23 ms. Somatosensory evoked potentials (SEPs) after median nerve stimulation were pathologically enlarged on both hemispheres. Brain-mapping of the biphasic wave preceding asterixis and the giant SEPs indicated a common origin in the sensorimotor cortex. This observation provides further documentation of a cortical origin for some types of asterixis in humans.