Prediction of patients with idiopathic generalized epilepsy from healthy controls using machine learning from scalp EEG recordings.

Epilepsy detection is essential for patients with epilepsy and their families, as well as for researchers and medical staff. The use of electroencephalogram (EEG) as a tool to support the diagnosis of patients with epilepsy is fundamental. Today, machine learning (ML) techniques are widely applied in neuroscience. The main objective of our study is to differentiate patients with idiopathic generalized epilepsy from healthy controls by applying machine learning techniques on interictal electroencephalographic recordings. Our research predicts which patients have idiopathic generalized epilepsy from a scalp EEG study. In addition, this study focuses on using the extreme gradient boosting (XGB) method applied to scalp EEG. XGB is one of the variants of gradient boosting and is a supervised learning algorithm. This type of system is developed to increase performance and processing speed. Through this proposed method, an attempt is made to recognize patterns from scalp EEG recordings that would allow the detection of IGE with high accuracy and differentiate IGE patients from healthy controls, creating an additional tool to support clinicians in their decision-making. Among the ML methods applied, the proposed XGB method achieves a better prediction of the distinct features in EEG signals from patients with IGE. XGB was 6.26% more accurate than the k-Nearest Neighbours method and was more accurate than the support vector machine (10.61%), decision tree (9.71%) and Gaussian Naïve Bayes (11.83%). Besides, the proposed XGB method showed the highest area under the curve (AUC 98%) and balanced accuracy (98.13%) of all methods tested. Application of ML technique in EEG of patients with epilepsy is very recent and is emerging with promising results. In this research work, we showed the usefulness of ML techniques to identify and predict generalized epilepsy from healthy controls in scalp EEG studies. These findings could help develop automated tools that integrate these ML techniques to assist clinicians in differentiating between patients with IGE from healthy controls in daily practice.

Prepulse inhibition in euthymic bipolar disorder patients in comparison with control subjects.

OBJECTIVE: Deficient prepulse inhibition (PPI) of the startle response, indicating sensorimotor gating deficits, has been reported in schizophrenia and other neuropsychiatric disorders. This study aimed to assess sensorimotor gating deficits in patients with euthymic bipolar. Furthermore, we analysed the relationships between PPI and clinical and cognitive measures. METHOD: Prepulse inhibition was measured in 64 patients with euthymic bipolar and in 64 control subjects matched for age, gender, education level and smoking status. Clinical characteristics and level of functioning were assessed in all participants using Hamilton Depression Rating Scale (HDRS), Young Mania Rating Scale (YMRS) and Functioning Assessment Short Test (FAST). Cognition was evaluated using the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery (MCCB) and the Stroop test as an additional measure of executive function. RESULTS: Compared with controls, patients with bipolar disorder exhibited PPI deficits at 60- and 120-millisecond prepulse-pulse intervals. Among patients with bipolar disorder, PPI was correlated with the social cognition domain of the MCCB. PPI was not significantly correlated with other clinical, functional and neurocognitive variables in either group. CONCLUSIONS: Our data suggest that PPI deficit is a neurobiological marker in euthymic bipolar disorder, which is associated with social cognition but not with other clinical, functional or cognitive measures.

Estatus funcional de adultos mayores de Tláhuac, Ciudad de México / Functional status of senior adults in Tlahuac, Mexico City / Status funcional de idosos de Tláhuac, Cidade do México

Resumen La identificación de la capacidad de funcionalidad en el adulto mayor es una valoración conveniente. Se concibe que la funcionalidad está relacionada con lograr satisfacer sus necesidades básicas, bienestar emocional y social, significa independencia y, por lo tanto, con calidad de vida. El objetivo de este estudio fue identificar el grado de funcionalidad que presentan los adultos mayores de 60 años y mayores que asisten a consulta en 4 centros de salud ubicados en la delegación Tláhuac, Ciudad de México durante el periodo de junio a diciembre de 2014. Fue una investigación exploratoria, en una muestra por conveniencia de 754 adultos mayores; se utilizaron 5 ítems del apartado A del instrumento "Evaluación Funcional del Adulto Mayor" el cual fue aplicado en los centros de salud. Para el procesamiento de la información se utilizó estadística descriptiva. Resultados: El 82% de los adultos mayores fueron independientes y el 18% están en riesgo de dependencia. Las actividades que presentaron menor porcentaje de dependencia fueron preparar sus alimentos y realizar tareas domésticas. Conclusión: Los resultados arrojados en el presente estudio implican sensibilizar a los profesionales de los centros de salud para que incorporen en sus programas propuestas para mantener la funcionalidad en este grupo etario como son ejercicio mental y físico, hábitos alimentarios, ocupación del tiempo y el manejo de situaciones estresantes.

Abstract It is important to address the functional status of senior adults because this is an indicator of their capacities to fulfill their basic needs, as well as to have emotional and social wellbeing, and thus to live a life with quality and independence. The objective of this study was to identify the degree of functionality in seniors 60 years and older who visit four health centers in Tlahuac, Mexico City. Data were collected from June to December 2014. This was an exploratory study on a convenience sample of 754 senior adults. Five items from the section A of the instrument Senior Adult Functional Status (Evaluación Funcional del Adulto Mayor (EFAM)) were used. The questions were asked in the health centers. Descriptive statistics were performed. Results: 82% of the seniors showed being independent while 18% were at risk of being dependent. The activities which demonstrated lower percentage of dependence were preparation of their food and performing their domestic tasks, Conclusion: The findings of this study suggest that health professionals should be sensitized to incorporate proposals in their programs to help maintain the functional status of this population. These activities should focus on: physical and mental exercise, good dietary habits, adequate use of time, and stress management.

Resumo A identificação da capacidade de funcionalidade em idosos é uma valorização conveniente. Concebendo que a funcionalidade está relacionada em conseguir satisfazer suas necessidades básicas, bem-estar emocional e social, significa independência, neste conceito a qualidade de vida está considerada. O objetivo deste estudo foi identificar o grau de funcionalidade que apresentam os idosos de 60 anos e mais velhos, que assistem a consulta em quatro centros de saúde localizados no município Tláhuac, Cidade de México, durante o período de junho a dezembro de 2014. Foi uma pesquisa exploratória, em uma amostra de conveniência de 754 idosos, utilizaram-se cinco itens do apartado A do instrumento "Avaliação Funcional do Idoso" (EFAM), o qual foi aplicado nos centros de saúde. Para o processamento da informação utilizou-se estatística descritiva. Resultados: O 82% dos idosos foram independentes e o 18% estão em risco de dependência. As atividades que apresentaram menor porcentagem de dependência foram preparar seus alimentos e realizar fazeres domésticos. Conclusão: Os resultados obtidos no presente estudo procuram sensibilizar aos professionais dos centros de saúde para que incorporem nos seus programas, propostas para manter a funcionalidade neste grupo etário como são o exercício físico e mental, hábitos alimentares, ocupação do tempo e o manejo de situações estressantes.

Trastocamiento de la salud en la cotidianidad de las mujeres embarazadas con pre-eclampsia / Health Disruption in everyday life of pregnant women with preeclampsia

El presente estudio cualitativo, descriptivo, exploratorio, tiene el objetivo de describir y analizar la cotidianidad de las mujeres que presentan pre-eclampsia de una comunidad semiurbana del Municipio de Chimalhuacán del Estado de México. Esta enfermedad es un problema de salud pública en México, ha ocupado el primer lugar en muertes maternas por más de dos décadas¹ y se presenta del 5 al 10 % de todos los embarazos.² Maffesoli, Morín, Maturana, Varela, Figuereido y Boff son los autores que dieron el soporte teórico. Se realizaron entrevistas a profundidad a dieciséis mujeres usuarias del Hospital General Chimalhuacán durante el embarazo. El análisis de los datos se realizó considerando los principios de Orlandi.³ Del análisis del discurso surgieron dos categorías: Auto-eco-socio-organización de la cotidianidad y Creando Vida en la cotidianidad. La primera categoría con 3 subcategorías: Tiempo, espacio y movimiento, identidad y, solidaridad. La segunda categoría, con dos subcategorías: Corporalidad-Subjetividad y trastrocamiento de la salud. En las consideraciones finales se enfatiza que la cotidianidad de las mujeres que presentan pre-eclampsia durante el embarazo se caracteriza por ser un fenómeno complejo, autónomo: auto-organizador, auto-productor, auto-determinado, relacional, irreductible, dialógico, recursivo, hologramático, dinámico, cambiante (neguentrópico), homeostático, sinérgico; se trastoca, se vive con identidades múltiples y solidarias frente a las adversidades. Con estos hallazgos se presentan algunos indicativos importantes para construir modelos singulares, sensibles y culturalmente específicos para el cuidado de estas mujeres.

This qualitative, descriptive and exploratory study has the objective of describing and analyzing the everyday life of women with pre-eclampsia in a semi-urban community in the municipality of Chimalhuacán, state of Mexico. Pre-eclampsia is a public health problem in Mexico which has occupied the first place in maternal deaths over two decades, 1 and which occurs in 5 to 10% of all pregnancies. 2 Maffesoli Morin, Maturana,, Varela,, Figueiredo and Boff works provide theoretical foundations for this study. Depth interviews were conducted to sixteen women attending the Chimalhuacán General Hospital during their pregnancies. The data analysis was performed considering the principles of Orlandi. 3 From the discourse analysis, two categories emerged; Auto-eco-socio-organization of the daily life, and creating life in the everyday. The first category included three subcategories; time, space and movement, and identity and solidarity. The second category included two subcategories; corporeality-subjectivity, and health disruption. The final considerations of the everyday emphasizes women's pre-eclampsia as complex, autonomous, self-organizing, self-produced, self-determined, relational, irreducible, dialogic, recursive, hologramatic, dynamic, changing(negentropy), homeostatic, synergistic, and as living with multiple identities and endurance against adversity. The study findings can help design indicative singular, sensitive and culturally especific models for these women.

P50 sensory gating deficit is a common marker of vulnerability to bipolar disorder and schizophrenia.

OBJECTIVE: P50 gating in schizophrenia has contributed much to our understanding of the pathophysiology of the illness. We examined euthymic bipolar patients to determine if they also have a P50 gating deficit. METHOD: P50 gating was measured in 81 euthymic bipolar patients (50 with a lifetime history of psychotic symptoms), 92 stable schizophrenic patients, and 67 control subjects. RESULTS: P50 gating was significantly lower in control subjects than in bipolar patients with a lifetime history of psychosis (P = 0.001) and schizophrenic patients (P = 0.0001). In all patient groups, the percentage of patients with P50 gating was higher than in the control group (chi(2) = 30.596; P < 0.0001). There was no statistically significant correlation between P50 gating and other clinical variables. CONCLUSION: Our data suggest that P50 gating deficit is a neurobiological marker that is present in stable schizophrenic patients and euthymic bipolar patients.

[Sleeping habits and sleep disorders during adolescence: relation to school performance]. / Hábitos de sueño y problemas relacionados con el sueño en adolescentes: relación con el rendimiento escolar.

OBJECTIVE: To determine the prevalence of sleep disorders in adolescence. To describe sleeping habits of adolescents in relation to sleep disorders and associated factors. To determine the relation between sleep disorders/inappropiate sleeping habits and school performance. DESIGN: Observational, descriptive, cross-sectional study. SETTING: Secondary school of Cuenca (city in Spain). PARTICIPANTS: 1293 school children of first and fourth curses of secondary education. MAIN MEASURES: Structured questionnaire with opened and closed questions on sleeping habits during weekdays and at weekends and sleep disorders to be answered by the adolescents anonymously and on their own. Student's school performance with relation with to sleeping habits and sleep disorders were determined. RESULTS: 1155 students out of 1293 (response rate 89.33%) answered the questionnaire, 537 (45.9%) boys and 618 (54.1%) girls, 14 years old on average (between 11-18 years). On weekdays students went to bed at 23.17 h and got up at 7.46 h (average sleeping time =8 hours and 18 minutes). At weekends they went to bed at 1.02 h and got up at 10.42 h (average sleeping time =9 hours and 40 minutes). 45.4% of students said to sleep badly on Sunday night's. On average the number of subjects failed in class is higher with adolescents who complain about sleep (2.28 vs 1.91; P=.04), who are tired at waking up time (2.17 vs 1.97; P=.048) and who have morning sleepiness (2.17 vs 1.75; P=.004). CONCLUSIONS: Schools hours cause deficit sleeping time during weekdays which is partly made up for at weekend. At weekends there is an interruption of the adolescent's sleeping habits. School performance of adolescents with sleep disorders is lower.

Hábitos de sueño y problemas relacionados con el sueño en adolescentes: relación con el rendimiento escolar / Sleeping habits and sleep disorders during adolescence: relation to school performance

Objetivo. Conocer la prevalencia de trastornos de sueño en los adolescentes. Describir los hábitos de sueño de los adolescentes y su relación con los trastornos del sueño y los factores asociados. Conocer la relación entre los trastornos del sueño y/o los hábitos de sueño inadecuados con el rendimiento escolar. Diseño. Estudio observacional, descriptivo y transversal. Emplazamiento. Institutos de enseñanza secundaria obligatoria (ESO) de la ciudad de Cuenca. Participantes. Un total de 1.293 alumnos escolarizados en primero y cuarto cursos de ESO. Mediciones principales. Hábitos de sueño en días lectivos y fines de semana y prevalencia de trastornos del sueño medidos mediante un cuestionario estructurado con preguntas abiertas y cerradas, autoadministrado y anónimo. Se determinó el rendimiento escolar de los alumnos y su relación con los hábitos y trastornos de sueño. Resultados. De los 1.293 alumnos matriculados, completaron la encuesta 1.155 (89,33%), 537 (45,9%) chicos y 618 (54,1%) chicas, con una media de edad de 14 años (rango, 11-18 años). Los días laborables se acuestan en promedio a las 23.17 y se levantan a las 7.46 (tiempo medio, 8 h y 18 min) y los fines de semana se acuestan a la 1.02 y se levantan a las 10.42 (tiempo medio, 9 h y 40 min). El 45,4% declara dormir mal la noche del domingo al lunes. El promedio de asignaturas suspendidas es mayor en los adolescentes con queja de sueño (2,28 frente a 1,91; p = 0,04), los que se levantan cansados (2,17 frente a 1,97; p = 0,048) y los que tienen somnolencia diurna (2,17 frente a 1,75; p = 0,004). Conclusiones. El horario escolar conlleva deuda de sueño durante la semana que se recupera parcialmente el fin de semana. En los fines de semana se produce una rotura en los hábitos de sueño de los adolescentes. Los adolescentes con problemas relacionados con el sueño muestran peor rendimiento escolar

Objective. To determine the prevalence of sleep disorders in adolescence. To describe sleeping habits of adolescents in relation to sleep disorders and associated factors. To determine the relation between sleep disorders/inappropiate sleeping habits and school performance. Design. Observational, descriptive, cross-sectional study. Setting. Secondary school of Cuenca (city in Spain). Participants. 1293 school children of first and fourth curses of secondary education. Main measures. Structured questionnaire with opened and closed questions on sleeping habits during weekdays and at weekends and sleep disorders to be answered by the adolescents anonymously and on their own. Student's school performance with relation with to sleeping habits and sleep disorders were determined. Results. 1155 students out of 1293 (response rate 89.33%) answered the questionnaire, 537 (45.9%) boys and 618 (54.1%) girls, 14 years old on average (between 11-18 years). On weekdays students went to bed at 23.17 h and got up at 7.46 h (average sleeping time =8 hours and 18 minutes). At weekends they went to bed at 1.02 h and got up at 10.42 h (average sleeping time =9 hours and 40 minutes). 45.4% of students said to sleep badly on Sunday night's. On average the number of subjects failed in class is higher with adolescents who complain about sleep (2.28 vs 1.91; P=.04), who are tired at waking up time (2.17 vs 1.97; P=.048) and who have morning sleepiness (2.17 vs 1.75; P=.004). Conclusions. Schools hours cause deficit sleeping time during weekdays which is partly made up for at weekend. At weekends there is an interruption of the adolescent's sleeping habits. School performance of adolescents with sleep disorders is lower

[The prevalence of sleep disorders among adolescents in Cuenca, Spain]. / Prevalencia de los trastornos del sueño en adolescentes de Cuenca, España.

INTRODUCTION: A number of different studies have shown that there is a high prevalence of sleep disorders among adolescents. These are often cited as being due to psychological, hormonal or pubertal factors, as well as inadequate sleep habits. AIMS: The aims of this study were to determine the prevalence of sleep disorders in the adolescent population and to describe their sleep habits and the relationship between sleep disorders and daytime tiredness or drowsiness. SUBJECTS AND METHODS: We conducted an epidemiological, observational, cross-sectional study in a sample of schoolchildren studying the 1st and 4th years of compulsory secondary education by means of a self-administered anonymous questionnaire. Insomnia was diagnosed using DSM-IV criteria. RESULTS: Of a total number of 1155 children, 537 were males and 618 were females, with a mean age of 14.03 +/- 1.86 years. They sleep an average of 8 h 18 m during the week and 9 h 40 m at the weekend. Poor quality sleep was reported by 38.55%, 23.1% had difficulty in getting to sleep, 38.2% woke up during the night and 15.9% woke up too early. 17.7% reported some kind of sleep complaint plus some other insomnia-related symptom; the prevalence of insomnia was found to be 9.9%. Snoring (20.5%), talking in their sleep (45.4%) and nightmares (29.5%) were the most frequent parasomnias. 53% of them complained of excessive sleepiness during the day. Insomnia is more frequent in older adolescents, with a family history of similar disorders, among those who smoke and drink and sleep fewer hours at the weekend; those with insomnia present more symptoms of anxiety and depression, as well as more daytime drowsiness. CONCLUSIONS: A number of factors are related to the high prevalence of sleep disorders among adolescents, giving rise to their being very tired and drowsy during the day. The interruption of their normal sleep habits at the weekend and an insufficient number of hours' sleep are related to the appearance of insomnia.

[Prevalence of insomnia and use of psychodrugs among elderly in a basic health area in Cuenca]. / Prevalencia de insomnio y consumo de psicofármacos en ancianos de una zona básica de salud de Cuenca.

OBJECTIVES: Insomnia is the most common sleeping disorder, increasing as people get older, which therefore creates an increase in the use of hypnotics. The presence of insomnia in elderly people, according to different authors, ranges between 17 and 43% depending on the criteria of diagnosis used and the group of population studied. The objectives of this study are to determine the prevalence of insomnia in a population of 65 years and over in a Basic Health Area and the medical consumption related to it. DESIGN: A cross sectional study by means of an ad hoc questionnaire about sleeping habits given by medical staff, including social demographic variables, psychotropic medication consumption, cognitive assessment by means of Mini Mental Status Examination and a range of anxiety-depression of Goldberg. Hartman and DSM-IV criteria were used for the insomnia diagnosis. SETTING: Cuenca I Primary Care Center, Cuenca (Spain). PATIENTS: A random sample of 343 patients of a population of 2253, 65 years and over. MEASUREMENTS AND MAIN RESULTS: The prevalence found was 13.6% (Hartman) and 30.7% (DSM-IV) more common amongst women (p < 0.005), sufferers of psychiatric illnesses (p < 0.01) and those at the top-half of the anxiety-depression scale (p < 0.001). A 46.1% suffer from daylight hypersomniac. A 19.1% takes some kind of medication to help them sleep and the 74.6% of them take it daily. Long and short plasma half-life benzodiazepines are the most consumed, with women and insomniacs being the majority consumers. CONCLUSIONS: The prevalence of insomnia in our population is slightly inferior to that of other studies and the consumption of sleep-enhancing medication although inappropriate is similar to that referred to in literature.

Prevalencia de insomnio y consumo de psicofármacos en ancianos de una zona básica de salud de Cuenca / Insomnia prevalence and psychotropic medication consumption in elderly population in Cuenca

Objetivos. El insomnio es el trastorno del sueño más frecuente, incrementándose a medida que avanza la edad, lo que produce un aumento paralelo en el uso de hipnóticos. En el anciano, la prevalencia de insomnio, según distintos autores, oscila en el 17-43 por ciento en función de los criterios de diagnóstico utilizados y el tipo de población a estudio. Los objetivos de este trabajo son determinar la prevalencia de insomnio en población de edad igual o mayor a 65 años de una zona básica de salud (ZBS) y el consumo farmacéutico relacionado con él. Diseño. Estudio transversal mediante cuestionario ad hoc sobre hábitos de sueño, administrado por personal sanitario, que incluye variables sociodemográficas, consumo de psicofármacos, valoración cognitiva mediante el Mini Examen Cognitivo y escala de ansiedad-depresión de Goldberg. Se utilizaron los criterios de Hartman y DSM-IV para el diagnóstico de insomnio. Emplazamiento. Centro de Salud Cuenca I. Pacientes. Muestra aleatoria de343 sujetos a partir de una población de 2.253 personas de edad mayor o igual a 65 años. Mediciones y resultados principales. La prevalencia encontrada fue del 13,6 por ciento (Hartman) y 30,7 por ciento (DSM-IV), más frecuente en mujeres (p < 0,005), en aquellos que presentan enfermedad psiquiátrica (p < 0,01) y con puntuaciones altas en la escala de ansiedad-depresión (p < 0,001). Un 46,10 por ciento refiere hipersomnolencia diurna. El 19,1 por ciento toma algún fármaco para dormir, el 74,6 por ciento a diario. Las benzodiacepinas de vida media larga y corta son los más usados, consumiendo más las mujeres y los insomnes (p < 0,01). Conclusiones. La prevalencia de insomnio en nuestra población es ligeramente inferior a la descrita en otros estudios y el consumo de fármacos para dormir, aunque inadecuado, es similar al referido en la bibliografía (AU)

[Aortic valve replacement with a pulmonary autograft (the Ross operation) in adult and pediatric patients. A preliminary study]. / Reemplazamiento valvular aórtico con autoinjerto pulmonar (operación de Ross), en pacientes adultos y pediátricos. Estudio preliminar.

INTRODUCTION AND OBJECTIVES: Aortic valve replacement with the patients own pulmonary autograft (the Ross procedure) is by now, the best surgical method for the replacement of the diseased aortic valve in certain groups of patients, this is particularly true for young adults and children or neonates with complex left ventricular outflow tract obstructions. The procedure was described by Donald Ross in 1967, and many years have passed. So in view of the accumulated experience the indications have extended to a wide group of patients which include children, neonates and young adults with formal contraindications for anticoagulation. In this publication we present our experience and our preliminary results in a group of fifteen patients which include adult and pediatric. MATERIAL AND METHODS: In six patients the etiology of lesion was congenital and in the remainder nine the valve had an acquired lesion. Two patients had an open heart procedure before this operation both of them to relieve an obstruction to the left ventricular outflow tract. In this group of patients the Ross procedure was carried out inserting the pulmonary autograft in the aortic position as a total root which was always reconstructed with cryopreserved pulmonary homograft, the mean homograft diameter was 26.1 +/- 4 mm (19-35). RESULTS: In all patients a transesophageal echocardiogram was performed in the operating room and postoperative, 1 or 2 months later. Only in one patient a mild aortic regurgitation was detected, no significant transaortic or transpulmonary gradients were detected postoperative. One patient was reoperated for bleeding in the postoperative course, there was no hospital mortality in our group and all the patients had an uneventful postoperative period. In the short term follow-up (41-155 days). All the patients are free of anticoagulant therapy, all them are in New York Heart Association Functional Class I. CONCLUSIONS: The patients presented in this publication which include adult and pediatric, are the first group of patients operated in our country with some excellent preliminary results. We hope that this procedure will become popular and that other surgical groups will adopt it as another surgical tool to replace a diseased aortic valve.

[Arousal and motor activity during sleep]. / Arousal y actividad motora en sueño.

OBJECTIVE: To describe different types of motor activity which occur during sleep in relation to episodes of arousal and sleep disorder. DEVELOPMENT: During sleep, normal motor activity should be distinguished from paroxystic episodes: parasomnias; abnormal movements such as nocturnal paroxystic dystonia, which is very similar to epilepsy of frontal origin; nocturnal epileptic crises and especially periodic movements of the limbs and the restless legs syndrome, which is related to it. Physiological cyclical fluctuations of sleep are common to all these conditions and due to cortico-subcortical changes in excitability. CONCLUSION: We review diagnostic, clinical and neurophysiological criteria and aspects of physiopathology and treatment.

Operative management of a persistent sciatic artery aneurysm.

A 60-year-old man with a painful pulsatile mass approximately 8 cm in diameter in the right buttock was diagnosed using angiography as having a complete unilateral persistent sciatic artery aneurysm. The lesion was obliterated by proximal and distal ligation of the sciatic artery at the pelvis and the adductor magnus canal. A femoropopliteal bypass was performed with inverted autologous saphenous vein. The residual mass was subsequently drained because of persistent symptoms. Postoperative recovery was good.

Early open mitral commissurotomy: long-term results.

It has frequently been suggested that early mitral commissurotomy could improve long-term results in patients with severe mitral stenosis. However, the real advantages of this procedure have yet to be demonstrated. To evaluate this hypothesis, we retrospectively studied 397 patients who underwent operation for mitral stenosis in our unit between 1978 and 1988. Forty of these patients (group I) fulfilled the criteria for early mitral commissurotomy: being young (average age 33 years), being asymptomatic or showing few symptoms, and being in sinus rhythm. The remaining 357 patients who underwent operation during the same period of time served as control (group II). Mitral valve replacement (p < 0.05) and associated tricuspid annuloplasty (p < 0.05) occurred less frequently in patients from group I than it did in patients from group II. Survival after 11 years for patients with early mitral commissurotomy was 100%, 90% of whom were in functional class I, were in sinus rhythm, and were receiving no medication whatsoever. Ninety-six percent of these patients were free of complications after 11 years, compared with 73% of patients in group II (p < 0.05). In our opinion, these results support the use of early mitral commissurotomy for young patients in sinus rhythm, who are symptom free, who are and who have a mitral valve area is 1.3 cm2 or less.

Adolescent idiopathic scoliosis and joint laxity. A study with somatosensory evoked potentials.

To assess the existence of disturbances in proprioception in adolescent idiopathic scoliosis and an hypothetical relationship with generalized joint laxity, a blind comparative study of short-latency somatosensory evoked potentials by posterior tibial nerve stimulation was designed. One hundred twenty-one subjects were included: fifty-two were diagnosed as having adolescent idiopathic scoliosis, thirty-two met criteria for generalized joint laxity, twenty-one had curvatures with Cobb angles less than 10, and twenty-eight were matched control subjects; twelve subjects were initially seen with both adolescent idiopathic scoliosis and generalized joint laxity. We failed to find alterations in somatosensory evoked potentials in patients with adolescent idiopathic scoliosis that could suggest proprioceptive disturbances as a causative factor; however, in a subgroup of thoracolumbar curvatures we were able to demonstrate a functional alteration in somatosensory evoked potentials that could represent a neurologic basis for some curves considered as idiopathic thus far; generalized joint laxity seems to be implicated in this situation.

Aberrant right subclavian artery associated with common carotid trunk. A rare cause of vascular ring.

We have reviewed four cases of incomplete vascular rings caused by the presence of a common carotid trunk from which arose both carotid arteries associated with an aberrant right subclavian artery. The patients were aged between 3 and 9 months. All patients presented with recurrent respiratory tract infections. Three patients showed signs of malnutrition and failure to thrive caused by episodes of bronchial aspiration from extrinsic compression of the oesophagus. One patient presented with dyspnoea induced by feeding and another had stridor. A common carotid trunk associated with an aberrant subclavian artery was confirmed in all cases. No other associated anomaly was observed in any patient. Ligature and section of the anomalous right subclavian artery was performed in all patients. The low incidence of this type of vascular ring, its physiopathological mechanism and surgical management are discussed.