Can we predict the response in the treatment of epilepsy with vagus nerve stimulation?

Despite the introduction of new antiepileptic drugs and advances in the surgical treatment of epilepsy, an important group of patients still remains uncontrolled by any of these methods. The relatively recent introduction of vagus nerve stimulation is yet another possible treatment for refractory epilepsy. This safe, simple, and adjustable technique reduces the number of seizures and multiple publications support its increasing efficacy and effectiveness, with few adverse effects. The goal of our study is to determine the efficacy of this procedure and the factors predicting a response, particularly in the presence of a temporal lobe discharge on the video electroencephalogram (video-EEG) and magnetic resonance imaging (MRI) lesions. We undertook a retrospective study of all the patients with refractory epilepsy who underwent implantation of a vagus nerve stimulator between 2003 and 2009, and with a minimum follow-up of 6 months. The statistical analysis was done with SPSS for Windows. The stimulator was implanted in 40 patients, of whom 38 had a minimum follow-up of 6 months. In one patient, the device had to be removed due to infection, so the series comprised 37 patients. These were divided into different groups, according to the epidemiologic, clinical, radiologic, and electroencephalographic data. In addition, an analysis of the response was performed. The efficacy of the procedure was established according to the reduction in the mean seizure frequency. The baseline value of these seizures was 80.97 ± 143.59, falling to 37 ± 82.51 at the last revision. The response rate (reduction in seizures ≥ 50 %) at 6 months was 51.4 %, with 62.2 % of the patients showing this reduction at the last evaluation. Significant differences in the response were seen for the variables: baseline frequency of seizures, temporal lobe discharge on VideoEEG and MRI lesions. The mean time to response was 10 months in patients with lower rate of seizures versus 25 months of those with the higher rate (p = 0.024), and the response at 6 months was higher (p = 0.05). Patients with temporal lobe discharge alone or in combination with discharges over other regions had a mean time to response of 11 months versus 26 months in those without temporal discharge (p = 0.037). In the analysis of the MRI, we had seen that at the last revision, 82.4 % of the patients with lesion had achieved response versus 45 % without lesion (p = 0.02). Vagus nerve stimulation reduces the frequency of seizures. A temporal lobe discharge on the video-EEG is an indicator of an early response and the presence of an MRI lesion indicates a late response. Patients with fewer rates of seizures have a better prognosis.

APPS-S: A Tool for Measuring the Attitudes Toward Prostitution and Women in Prostitution in the Spanish Population.

This study was designed with the purpose of testing the psychometric properties of the Spanish version of the Attitudes toward Prostitution and Prostitutes Scale through three studies with different samples. The first one explores the test's dimensional structure or constructs validity through confirmatory factor analysis, as well as internal consistency and test-retest reliability. The second one focuses on discriminant and criteria validity. Finally, the third one examines the scale's convergent validity and its sensitivity to detecting changes. The results support two subscales with an optimal index of internal consistency, structural stability over time, and discriminative power between groups of participants. It is, therefore, an adequate tool for adults as well as young people and teenagers, and for detecting changes in the context of intervention or awareness workshops.

[Posthemorrhagic hydrocephalus in the preterm infant: current evidence in diagnosis and treatment]. / Hidrocefalia poshemorrágica asociada a la prematuridad: evidencia disponible diagnóstica y terapéutica.

Intraventricular haemorrhage and posthemorrhagic hydrocephalus are the most important neurological complications in preterm infants during the neonatal period. The prevalence of germinal matrix intraventricular haemorrhage widely varies depending on the population of study, but it is in any case increasing due both to the higher incidence of multiple and preterm deliveries as well as the longer survival of preterm infants favoured by recent advances in perinatal care. It is therefore of the utmost convenience to be familiar with the most important clinical evidence regarding this entity. However, the available evidence is often incomplete and piecemeal. The objective of the present review is to summarise the main diagnostic and therapeutic points regarding preterm related posthemorrhagic hydrocephalus. The participants of the working-group in Pediatric Neurosurgery of the Spanish Society of Neurosurgery were asked to write these recommendations down. This hopefully represents the first step towards the definition of a clinical guide in the treatment of complications related to periventricular hemorrhage of the preterm infants.

Meningioangiomatosis: clinical-radiological features and surgical outcome.

Meningioangiomatosis (MA) is a rare, benign neoplastic disorder involving the cortex and leptomeninges, the sporadic form, commonly presents as refractory localization-related epilepsy, but could be asymptomatic especially in older patients. The imaging features may be entirely non-specific. Magnetic Resonance Imaging (MRI) erroneously suggests meningioma, lowgrade tumour or vascular malformations. The pathological findings are characterised by proliferation of meningothelial cells and leptomeningeal vessels and calcifications within the mass. Macroscopically there is dense thickening in the underlying cortex, often in a sharply defined area. In this article we report 3 cases of MA, neither of whom had a familiary history or stigmata of Neurofibromatosis (NF). We discuss and place particular emphasis on the clinical presentation and diagnosis imaging, as well as on the outcome. We also review the literature concerning about the aetiology, pathology findings and imaging features of MA.

[Management of hypertension and diabetes in Primary Care clinical practice: ATENCION study]. / Práctica clínica en el manejo de la hipertensión y la diabetes en Atención Primaria: estudio ATENCION.

BACKGROUND AND OBJECTIVE: Cardiovascular diseases are the main cause of death in the Spanish population. The detection and control of cardiovascular risk factors are fundamental in the prevention of cardiovascular disease. The main objectives of this study are to analyse the attitudes and therapeutic decisions of Primary Care (PC) physicians when treating hypertension (HT) and diabetes mellitus type 2 (DM2), with the aim of establishing the situation and eventually proposing improvement strategies. MATERIAL AND METHOD: A national ecological, multicentre, cross-sectional, and descriptive study was conducted in 2013. A questionnaire was used and 1,028 PC physicians took part in the study. RESULTS: A total of 92.9% of the investigators consulted have indicated that they follow the guidelines for evaluation, treatment, and diagnosis of HT, and 91.4% in the case of diabetes. The latter is diagnosed as a casual finding, while HT is diagnosed through active investigation in patients with other risk factors. Combined therapy takes more than 6 months to take effect in patients with HT, and between 8 and 9 months in diabetic patients. The percentage of non-compliance is similar (10-40%) in both pathologies. Around half the physicians questioned considered interaction with the specialist to be good or excellent (46% HT and 57.3% DM2). CONCLUSIONS: Clinical practices in PC for HT and DM2 have some basic criteria in common. The interaction with the specialist is good, but there is a considerable margin for improvement.

Molecular mass analysis of murine immunosuppressive immunoglobulin G-binding factors (IgG-BFs) produced by T-cell hybrids.

Induced and constitutive murine IgG-binding factors (IgG-BFs) have been purified by affinity chromatography from supernatants of T-cells preincubated with or without murine monoclonal IgG1 and IgG2b, respectively. IgG-BF Mr values have been studied by SDS-polyacrylamide gel electrophoresis (PAGE) after treatment with SDS under conditions which do not noticeably alter their immunosuppressive activities on the secondary in vitro IgG antibody response. Suppression was recovered at Mr values of 80000, 40000 and 20000. When induced IgG-BF was tested, the isotype-specific suppressive activity was found only at 40 kDa. The 20-kDa moiety appeared to derive from the 40-kDa component and the material found at 80 kDa exerted non-specific immunosuppressive effects. We conclude therefore that isotype-specific IgG-BF has an apparent Mr of 40000.

Epithelial cell hyperproliferation after biliopancreatic reflux into the esophagus of rats.

BACKGROUND: Chronic reflux of duodenal contents into the esophagus of rats produces severe esophagitis and exerts a co-carcinogenic effect on the proliferating cells by enhancing the formation of nitrosamine-induced esophageal carcinomas. We investigated the effect of the different components of the duodenal reflux on the epithelial cell proliferation of the lower esophagus. METHODS: Sprague-Dawley rats underwent three surgical reflux models (biliopancreatic, pancreatic, and biliary) and a sham operation. Animals were sacrificed at 72 hours, 6 weeks, and 9 weeks after the operation. Histology and cell proliferation, determined by ornithine decarboxylase activity, polyamine (putrescine, spermidine, spermine) levels, and proliferating cell nuclear antigen labeling index of the basal and suprabasal layers, were studied in the distal esophagus. RESULTS: Both biliopancreatic and pancreatic reflux induced severe esophagitis starting on week 6. Suprabasal proliferating cell nuclear antigen labeling index significantly increased throughout the 9 weeks of the study in the biliopancreatic and pancreatic reflux groups, although this increase was earlier in the former group. Ornithine decarboxylase activity and polyamine levels were significantly increased in the biliopancreatic and pancreatic groups on week 6, decreasing on week 9. CONCLUSIONS: Increased esophageal cell proliferation after both biliopancreatic and pancreatic reflux into the lower esophagus may therefore be one mechanism by which duodenal-content reflux stimulates esophageal carcinogenesis in experimental animals.

Sinus pericranii: radiological and etiopathological considerations. Case report.

Sinus pericranii is a rare vascular anomaly involving an abnormal communication between the extracranial and intracranial circulations. A case of frontal sinus pericranii is presented which appeared to be a posttraumatic sinus because it developed 2 years after a cranial injury. However, the presence of vascular endothelium in the pathological examination and its association with a vascular anomaly (persistent trigeminal artery) suggested a congenital origin. The lesion, pericranial blood sinuses, and bone were totally removed. The computerized tomography, angiography, and magnetic resonance imaging findings are presented. The literature is reviewed and the pathogenesis of sinus pericranii is discussed.

Spinal epidermoid cysts without congenital anomalies associated. Report of two cases.

MR findings in two patients with intradural spinal epidermoid tumors without spinal anomalies are reported. In one case this tumor was congenital, the other one was considered iatrogenic. Origin and MR characteristics of this lesion are discussed.

Traumatic aneurysm of the middle cerebral artery.

The authors report a case of giant traumatic true aneurysm of the middle cerebral artery. A review of the related literature and a general revision are presented.

Successful treatment of a giant cystic craniopharyngioma. Case report.

The Authors present a case of giant cystic craniopharyngioma in a child; the tumor, diagnosed by CT scan, was completely removed. The Authors consider this cyst as the biggest one reported in the literature of the last ten years.

[Primary lymphoma of the central nervous system. Review of etiological factors]. / Linfomas primarios del sistema nervioso central. Revisión de la casuística.

INTRODUCTION: The primary lymphoma of the central nervous system are between 1 to 2% of all the brain tumors. The most important risk factor for the development of this kind of lesions is both acquired and congenital immunologic deficiency. METHODS AND RESULTS: In this paper we'll try to study the 13 cases of primary lymphomas of the central nervous system from etiological, epidemiological, clinic, diagnostic, therapeutic and outcome point of view. CONCLUSION: Besides we will discuss the bibliography founded paying special attention to diagnostic and therapeutic features.

[Intracranial collections of pus. A review of 100 cases]. / Colecciones purulentas intracraneales. Revisión de 100 casos.

INTRODUCTION: In recent decades, important scientific advances have been made, leading to modification of the diagnosis and the treatment of intracranial collections of pus (ICP). OBJECTIVES: To analyze the changes in various clinicopathological aspects of ICP during the twenty years studied. PATIENTS AND METHODS: We present a retrospective analysis of 100 cases of ICP diagnosed between 1979 and 1998 in the Hospital General de Galicia. We divided the patients into two groups: A (1979-1988) and B (1989-1998), and analyzed the similarities and differences between them. RESULTS: In these two decades, there was a predominance of men over women (4/1) ENT infections (30/100) and surgical-trauma (25/100) were the commonest causes. The diagnosis was established during the week the symptoms started in 40% of group A and 58.1% of group B. The most frequent site for abscesses was in the frontal lobes (28.5%) and temporal lobes (26.1%) and was closely related to the origin of the infection. Culture was positive in 45% of group A and in 60.3% of group B. The commonest micro-organisms found were Streptococcus (38%) and Staphylococcus (26%). More anaerobes were observed in the second decade. The most usual surgical treatment was excision (86%). Mortality was 33.3% in the first decade and 5.4% in the second. CONCLUSION: Technological improvements permit earlier, more reliable radiological and micro-biological diagnosis as well as lower morbi-mortality figures for ICP.

[Hypodense meningioma. A care report]. / Meningioma hipodenso. A propósito de un caso.

INTRODUCTION: Meningiomas are benign tumours which originate in the arachnoid layer and are characterized by being iso- or hyper-dense on computerized axial tomography (CAT). Hypodense meningiomas are relatively infrequent and normally behave thus because of their fat content. A hypomeningioma is almost entirely composed of adipose tissue. However, a meningiotheliomatous meningioma with fatty degeneration, which is the case being considered, is characterized by zones of meningiotheliomatous cells together with zones of adipocytes. CLINICAL CASE: We present the case of a 73 year old woman with a meningiotheliomatous meningioma with extensive fatty degeneration which on CAT scan showed as a hypodense lesion, with well-defined edges, which took up contrast heterogeneously and produced a hyperosfosant reaction. On magnetic resonance (RMN) it gave signals of heterogeneous intensities. Up to the present time, only four cases of pure lipomeningiomas have been described in the literature. CONCLUSIONS: However, meningiomas with fatty degeneration are much more frequent. In this paper we discuss aspects of the differential diagnosis of meningiomas which behave as hypodense lesions on CAT scans.

[Cystic hemangioblastoma of the spinal bulb]. / Hemangioblastoma quístico de bulbo raquídeo.

INTRODUCTION: Hemangioblastomas are histologically benign tumors that comprise 8%-12% of all posterior fossa lesions in the adult. Brain stem hemangioblastomas may be solid or cystic tumors, and surgical removal of these tumors is usually possible and is the optimal treatment. We describe a case of hemangioblastoma in the medulla oblongata diagnosed with MRI. Using microsurgery technic a total excision of this intramedullary tumor was performed. CLINICAL CASE: A 37-year-old woman with a 3-months history of progressive dysphagia and occipital headache. Neurological examination at the time of admission revealed bilateral horizontal nystagmus, paresis of cranial nerves IX, X and XII, motor weakness of the four extremities. A MRI revealed a cystic intramedullary tumor. Using a suboccipital craniectomy the tumor was totally removed. CONCLUSIONS: Cystic hemangioblastomas of the medulla oblongata represent a small segment in the spectrum of brain stem tumors. Surgical removal of these tumors can be accomplished successfully with a low risk of neurological injury.

[Cervical epidural abscess as a cause of tetraparesis]. / Absceso epidural cervical como causa de tetraparesia.

INTRODUCTION: An epidural spinal abscess is a rare clinical condition which may cause rapid, irreversible neurological deterioration. Usually, the patient presents with back pain in the affected spinal segment, but the condition is rarely considered in the differential diagnosis. CLINICAL CASE: A 57 year old man with no significant clinical history initially consulted complaining of cervicalgia. Some days later, this had worsened and he also had odinophagia, fever and general malaise. A diagnosis of retropharyngeal abscess was made. He was admitted to the Ear, Nose and Throat Department (ENT) and antibiotic treatment started with ceftazidime, vancomycin and clindamycin. Eight hours after admission he complained of paresthesia and subsequently of flaccid tetraparesia. CT and MR showed the presence of a paravertebral mass which extended to the epidural space between the fourth and seventh cervical vertebrae. On suspicion of a retropharyngeal abscess complicated by an epidural spinal abscess we proceeded to emergency operation and drained the prevertebral and epidural pus. On microbiological culture St. aureus was grown. The patient regained the mobility of his limbs. On discharge from hospital he still had paresia of the right leg, although this did not impede walking. CONCLUSIONS: It should not be forgotten that, although rare, one of the causes of spinal compression and neurological deterioration (particularly in a febrile patient) is an epidural spinal abscess. Prompt diagnosis and satisfactory surgical decompression are essential to avoid irreversible neurological sequelae.

[Cervical intramedullary neurofibroma]. / Neurofibroma intramedular cervical.

Spinal neurofibromas make up a third of all tumours of the medulla. They are usually found to be intradural and extramedullary. Exceptionally they may be intramedullar. We describe the case of a patient with signs of slowly progressive compression of the medulla, who was operated on surgically for an intramedullary neurofibroma, after imaging studies. We review the previously published cases and analyse the different histogenic theories concerning this tumour.

Práctica clínica en el manejo de la hipertensión y la diabetes en Atención Primaria: estudio ATENCION / Management of hypertension and diabetes in Primary Care clinical practice: ATENCION study

Fundamento y objetivo. Las enfermedades cardiovasculares constituyen la principal causa de muerte en la población española. La detección y control de los factores de riesgo cardiovascular es fundamental para prevenirlas. Este estudio tiene como objetivos fundamentales analizar la actitud y las decisiones terapéuticas de los médicos de Atención Primaria (AP) ante la hipertensión arterial (HTA) y la diabetes mellitus tipo 2 (DM2), con el fin de conocer la realidad y proponer estrategias de mejora para su correcto manejo. Material y método. Estudio ecológico de encuesta, descriptivo, transversal y multicéntrico, de ámbito nacional, con participación de médicos de AP, realizado en 2013. Se solicitó la participación en el estudio a 1.028 médicos. Resultados. El 92,9 y el 91,4% de los investigadores consultados sigue las guías para la evaluación, el tratamiento y el diagnóstico de HTA y DM2, respectivamente. Esta última se diagnostica sobre todo casualmente, y la HTA por búsqueda activa en pacientes con otros factores de riesgo. La terapia combinada tarda más de 6 meses en instaurarse en pacientes hipertensos y entre 8-9 meses en diabéticos. El porcentaje de incumplimiento es similar (10-40%) en ambas dolencias. Aproximadamente la mitad de los encuestados consideran buena o excelente la interacción con el especialista (46 y 57,3% en HTA y DM2, respectivamente). Conclusiones. La práctica clínica en AP en HTA y DM2 tiene criterios básicos comunes. La interacción entre la AP y el especialista es buena. No obstante, existe margen de mejora en el tratamiento de estos factores de riesgo, particularmente en lo relativo a intensificar la terapia precozmente (AU)

Background and objective. Cardiovascular diseases are the main cause of death in the Spanish population. The detection and control of cardiovascular risk factors are fundamental in the prevention of cardiovascular disease. The main objectives of this study are to analyse the attitudes and therapeutic decisions of Primary Care (PC) physicians when treating hypertension (HT) and diabetes mellitus type 2 (DM2), with the aim of establishing the situation and eventually proposing improvement strategies. Material and method. A national ecological, multicentre, cross-sectional, and descriptive study was conducted in 2013. A questionnaire was used and 1,028 PC physicians took part in the study. Results. A total of 92.9% of the investigators consulted have indicated that they follow the guidelines for evaluation, treatment, and diagnosis of HT, and 91.4% in the case of diabetes. The latter is diagnosed as a casual finding, while HT is diagnosed through active investigation in patients with other risk factors. Combined therapy takes more than 6 months to take effect in patients with HT, and between 8 and 9 months in diabetic patients. The percentage of non-compliance is similar (10-40%) in both pathologies. Around half the physicians questioned considered interaction with the specialist to be good or excellent (46% HT and 57.3% DM2). Conclusions. Clinical practices in PC for HT and DM2 have some basic criteria in common. The interaction with the specialist is good, but there is a considerable margin for improvement (AU)

Interference of Fano-Rashba conductance dips.

We study the interference of two tunable Rashba regions in a quantum wire with one propagating mode. The transmission dips (Fano-Rashba dips) of the two regions either cross or anti-cross, depending on the distance between the two regions. For large separations we find Fabry-Perot oscillations due to the interference of forwards and backwards propagating modes. At small separations overlapping evanescent modes play a prominent role, leading to an enhanced transmission and destroying the conductance dip. Analytical expressions in scattering matrix theory are given and the relevance of the interference effect in a device is discussed.