Aphysiologic performance on dynamic posturography in work-related patients.

It has been suggested that malingering should be suspected in patients suffering from dizziness or imbalance and who had a potential gain associated with insurance and worker's compensation claims. This study aimed to assess and compare the prevalence of aphysiologic performance on computerized dynamic posturography (CDP) in patients with the potential for secondary gain using a retrospective review of two groups of patients: work-related patients referred for dizziness and/or imbalance (Group 1) were compared against a group of patients with complaints of dizziness or imbalance, who had no history of work-related injury, or litigation procedures (Group 2). CDP and videonystagmography (VNG) were carried out in all patients. The Sensory Organization Test summaries were scored as normal, aphysiologic, or vestibular using the scoring method published by Cevette et al. in Otolaryngol Head Neck Surg 112:676-688 (1995). 24 out of 88 (27%) patients had aphysiologic CDP in Group 1 and 9 out of 51 (18%) in Group 2 but these differences were not significant (p > 0.05). Definite signs of vestibular dysfunction were found in 12 out of 24 (50%) of patients with aphysiologic performance in Group 1 although the presence of VNG abnormalities was significantly higher (p = 0.005) in Group 2. The hypothesis that the occupational group could show a significantly higher rate of aphysiologic results than a control group is not confirmed. Furthermore, VNG abnormalities were found in 50% of the work-related cases with non organic sway patterns. These results suggest that patient's complaints should be considered genuine in work-related cases and due caution exercised when evaluating aphysiologic CDP patterns.

[Tobacco brand-related headache]. / Cefaleas relacionadas con marcas de tabaco.

INTRODUCTION: Tobacco smoking has been considered a risk factor for headache by some authors, while others disagree because of contradictory data. PATIENTS AND RESULTS: We describe the clinical aspects of eleven patients (four men and seven women) who presented to us with tobacco brand-related headaches. Clinical history help us to discover that headache of each patient was directly related with certain cigarette brands smoking. The cigarette brands implicated were diverse and different for each patient. Headaches were migraine-like in seven cases, cluster-like in three, and non-specific in the other one. They disappeared after switching brand or stopping smoking. CONCLUSIONS: In our patients, headaches were clearly related to smoking certain brands of cigarettes, which has never been reported before. This type of headache has characteristics that suggest that it could be a particular form of chemical odour intolerance, previously described. The number of possible responsible substances is large. More studies will be necessary in order to discover the mechanism leading patients to tobacco brand-related headache. It is important to ask our patients which cigarette brand they smoke, so it is possible to solve the problem.

[Epidemiology of ambulatory neurological diseases at the Baix Camp]. / Epidemiología de la patología neurológica ambulatoria en el Baix Camp (Tarragona) durante 1999.

BACKGROUND: Studies analyzing the incidence of ambulatory neurological diseases are scanty. INTRODUCTION: To describe the first prospective study of incidence of ambulatory neurological diseases at the Baix Camp (Tarragona). PATIENTS AND METHODS: This is a prospective study of a cohort of consecutive, first visited-patients at the neurology clinic of the Sant Joan Universitary Hospital of Reus. Demographic and clinical variables were analyzed. RESULTS: There were 1330 first visits, but 52 were excluded as they were diagnosed and treated previously at another medical center. So, the final study group included 1278 patients; 790 (61.8%) were woman and 488 (38.2%) men. Mean age was 48.7 years. The incidence ratio was 10.3 new neurological outpatients by 1000 hab./year. Headache was the most frequent symptom (36.5%), followed by focal symptoms and transitory loss of consciousness. The most frequent diagnoses were, by order of frequency, non-tumoral headaches (35.8%), followed by anxiety and depression, neuropathies and epilepsy. Cranial CT and MRI were the complementary exams more solicited. CONCLUSIONS: This epidemiological study corroborates that the most frequent neurological diseases were non-tumoral headaches, neuropathies and epilepsy. The need for specialized assistance could be reduced by better identification of certain diseases from primary medical assistance. This analysis will be actualized every five years.

Desinfección de los conductos radiculares / Root canals disinfection

Las soluciones irrigadoras son el principal auxiliar de la preparación biomecánica. las analizaremos en sus distintas alternativas