Subacute and chronic electrical stimulation of the hippocampus on intractable temporal lobe seizures: preliminary report.

Recent animal experiments show that the application of an electrical stimulus to the amygdala or hippocampus following the kindling stimulus produced a significant and long-lasting suppressive effect on this experimental model of epilepsy. This is a preliminary report on the development of a surgical neuromodulatory procedure by chronic electrical stimulation of the hippocampus (CHCS) for control of intractable temporal lobe seizures in patients in whom anterior temporal lobectomy is not advisable, i.e., patients with bilateral temporal foci or a unilateral focus spreading to surrounding cerebral regions of the dominant hemisphere. This work was divided in two main consecutive stages. In the first stage, we demonstrated that subacute hippocampal stimulation (SAHCS) blocks intractable temporal lobe epileptogenesis with no additional damage to the stimulated tissue, and in a second stage, we attempt to demonstrate that CHCS may produce a sustained, long-lasting antiepileptic condition without additional undesirable effects on language and memory. In addition, taking advantage of this unique and ethically permissible situation, we attempt to determine whether or not the antiepileptic effects of SAHCS and CHCS are due to inhibition of the stimulation of hippocampal tissue by means of a number of electrophysiological, single photon computed tomography (SPECT) perfusion, and autoradiographic techniques.SAHCS during 3-4 weeks prior to anterior temporal lobectomy applied to a critical area located either at the anterior Pes hippocampus close to the amygdala or at the parahippocampal gyrus close to the entorhinal cortex abolished clinical seizures and significantly decreased the number of interictal spikes at focus after 5-6 days. Microscopy analysis of the stimulated tissue showed no evident histopathological differences between stimulated vs. non-stimulated hippocampal tissues. Additionally, CHCS persistently blocked temporal lobe epileptogenesis for 3-4 months with no apparent additional undesirable effects on short memory. Also, inhibition of the stimulated hippocampus seems to be one of the possible mechanisms underlying the beneficial antiepileptic effects of SAHCS and CHCS. This was revealed by increased threshold and decreased duration of the afterdischarges induced by hippocampal stimulation, flattening of the hippocampal-evoked response recovery cycles, SPECT hypoperfusion of the hippocampal region, and increased hippocampal benzodiazepine receptor binding. Future studies increasing the number and time of follow-up of patients under hippocampal stimulation are necessary before considering CHCS a reliable procedure for controlling intractable temporal lobe seizures.

Insulin resistance in offspring of hypertensive subjects.

OBJECTIVE: To assess whether apparently healthy subjects with a family history of systemic hypertension have a higher risk of presenting the insulin resistance syndrome. SUBJECTS: Three hundred and eighty-six subjects aged 20-65 years. SETTING: A middle socio-economic class urban community from Mexico City. METHOD: All subjects and, when necessary, their first-degree relatives, answered a questionnaire and underwent a physical examination with measurement of height, weight and blood pressure. Serum insulin, glucose, cholesterol and triglycerides were measured during fasting and 2 h after an oral load of 75 g glucose. RESULTS: A family history of systemic hypertension was present for 167 (43%) of the subjects, of whom 123 (31%) were obese. Subjects with a family history of hypertension had higher systolic blood pressures than did those without such a history (120 +/- 15 versus 115 +/- 10 mmHg). In the logistic regression model, the body mass index and age showed statistically significant effects on the fasting glucose:insulin ratio and on serum insulin levels after an oral load of glucose. When men and women were analysed separately, only in men were higher systolic and mean blood pressures and lower glucose:insulin ratios observed. In the logistic regression analysis the body mass index was a significant predictor of the glucose:insulin ratio and serum insulin levels after an oral load of glucose, especially in men. CONCLUSION: Apparently healthy male offspring of hypertensive parents have higher blood pressure levels and lower insulin sensitivities than do offspring of normotensive parents. Insulin resistance was related to obesity, but not to a family history of hypertension, as had previously been reported by other research groups.

[Decrease in the serum concentration of triiodothyronine in patients with acute edematous pancreatitis]. / Disminución de la concentración sérica de triyodotironina en pacientes con pancreatitis agudaedematosa.

Serum concentrations of triiodothyronine (T3), Thyroxine (T4) and Thyrotropine (TSH) were measured in ten patients hospitalized in an emergency way due to acute edematose pancreatitis clinically diagnosed and confirmed in the laboratory through the finding of values of amilase higher than 180 I.U. By means of venopunction 5 ml. of blood were taken from each patient in order to determine the thyroidal profile and amilasemia at the moment of internment and after 72 hours of the disease development. Results demonstrated a decrease of the values of T3, 72 hours after the patients entered the hospital, with normal values for T4 and TSH. This decrease reached levels of hypothyroidism with no clinical data of the disease.

Deteccion gammagrafica de lesiones venosas secundarias a cateterismo para nutricion parenteral total. Estudio prospectivo. / Gammagraphic detection of venous lesions secondary to total parenteral nutritional catheterism. A prospective study

Se efectuo un estudio prospectivo en 25 pacientes que recibieron nutricion parenteral total por via subclavia con el fin de detectar lesion venosa temprana. Se empleo tecnecio 99 con estudios dinamicos de la circulacion venosa a nivel subclavio, con tomas secuenciales en la camara de centelleo. El metodo permitio descubrir tempranamente las lesiones venosas que se observaron en 20 por ciento de los casos y son problablemente secundarias a la presencia del cateter en la luz vascular y reversibles en forma espontanea tras retirar el mismo

Niveles sericos de alfa-fetoproteina en el absceso hepatico amibiano durante la fase de regeneracion tisular. / Serum levels of alpha-fetoprotein in amebic liver abscess during the phase of tissue regeneration

Se determino por tecnica de radioinmunoensayo el nivel serico de alfa-fetoproteina (AFP) en sujetos normales y en pacientes com absceso hepatico amibiano. La concentracion en adultos normales fue media = 2,35 +/- l,56 ng/ml. En los casos con amibiasis hepatica la elevacion serica de AFP se observo a partir de la segunda semana del inicio de tratamiento antiamibiano media = 3,06 +/- 2,21 y en la mayoria persistio la elevacion hasta la septima semana (media = 5,79 +/- 2,86).Los niveles mas altos se encontraron en la tercera y cuarta semana. El aumento de AFP en los siguientes dias al inicio del tratamiento antiamibiano puede coincidir con la fase de regeneracion tisular hepatica y la variabilidad en el tiempo de resolucion centelleografica del absceso, parece estar mas en relacion con la capacidad individual de recuperacion tisular que con las dimensiones del absceso

Estado actual de la centelleografia hepatica. / Present status of liver scanning

Hasta la fecha el centelleograma hepatico es el metodo de eleccion para el diagnostico de lesiones ocupantes de espacio focalizadas. De igual forma, ofrece valiosa informacion en casos de padecimientos generalizados que repercuten en el higado. La eficiencia diagnostica del metodo es aproximadamente de 90 por ciento. Ademas, el estudio puede efectuarse cuantas veces sea necesario, por lo que encuentra amplia indicacion en el control y la valoracion de la respuesta a la terapeutica de los padecimientos que afectan al higado.El equipo electronico que se utiliza es la camara de centelleo, que en los ultimos anos se ha modificado al ser provisto con sistemas detectores de mayor tamano y con mayor numero de tubos fotomultiplicadores, factores que han hecho mas rapida y sensible la respuesta a la deteccion de eventos radiactivos, al mismo tiempo que mejoran la resolucion espacial. El radiofarmaco de eleccion para el estudio centelleografico del higado es el coloide de 99m-Tecnecio y el estudio de la vascularizacion de lesiones intrahepaticas se ha modificado al introducirse la valoracion de la poza vascular con eritrocitos marcados in vivo con 99m-Tecnecio

[Evaluation of bilio-intestinal anastomoses using radioisotope cholangiography]. / Valoración de las anastomosis bilio-intestinales mediante colangiografia radioisotópica.

In patients subjected to bilio-intestinal anastomosis as treatment of several diseases of the biliary tract and the Oddi's sphincter, with some frequency have symptoms that make suspect that the anastomosis is stenosed. The experience obtained in the evaluation of 8 cases is presented. The method used was radioisotopic cholangiography, with the administration of pyridoxiphenylalanine labeled with 99m-Technetium. Serial images were obtained in Polaroid film. In three of the eight patients, an obstruction of the principal bile duct was shown. After the operation, there was normal patency of the anastomosis. In the other cases, there was normal patency of the anastomosis, and the symptoms were due to other causes. We consider the radioisotopic cholangiography as the method of election in the study of these patients, as the results may indicate a surgical re-intervention, avoid another harmful method or make unnecessary another operation.

Valoracion de las anastomosis bilio-intestinales mediante colangiografia radioisotopica. / Evaluation of bilio-intestinal anastomosis through the radioisotopic cholangiography

Las anastomosis biliointestinales que se efectuan como tratamiento de diversos padecimientos de las vias biliares y del esfinter de Oddi, frecuentemente se acompanan en el postoperatorio tardio de sintomas que hacen sospechar que la anastomosis se ha estenosado. Se presenta la experiencia obtenida en 8 casos estudiados en el Hospital General del C.M.N. El metodo de estudio consistio en colangiografia radioisotopica, aplicando piridoxifenilalanina marcada con Tecnecio, obteniendose imagenes secuenciales en fotografia Polaroid. En tres de los ocho pacientes, se demostro que existia obstruccion de la via biliar y en el postoperatorio, se mostro permeabilidad de la anastomosis. En el resto de los casos, las anastomosis estaban permeables y los sintomas se debieron a otras causas. Consideramos que este metodo es el de eleccion en la valoracion de estos pacientes y asi como puede indicar una re-intervencion quirurgica, puede evitar un procedimiento armado o hacer innecesaria otra operacion

Advances in gastric emptying studies by means of computerized scintigraphy.

Gastric emptying studies were begun in 1833. However, as information on this phenomenon became more available it became more difficult to unify studies in order to make them more applicable for the study and treatment of functional disturbances and organic diseases. In this work an innocuous, objective and precise method is described, that consists of the study of gastric emptying in two stages in healthy individuals. In the first, basic substances of food were administered and in the second, usual 1,050 calorie meals all marked with Technetium-99 m macroaggregates, were given. Two scintillation cameras were used coupled to computerized data processing systems from where quantitative information and black and white Polaroid pictures were obtained. In the first stage, six healthy volunteers were studied who received basic food substances in different sessions. In the second stage, 10 healthy volunteers were studied who received a type of meal common in our environment. In all cases gastric emptying curves were obtained plotting radioactivity counts v.s. time. Weibull's distribution was the statistical method applied. According to the ingested substances, results showed different emptying curves of a complex exponential type. Although gastric emptying is immediate, it is parallel to the presence of plateaus in the initial part of the study; an apparently delayed phenomenon that had been overlooked and is explained in the discussion part of this paper. Results obtained have offered the possibility of an abundant volume of studies that should clarify existing doubts in the future with a wide field for clinical application.