Symptoms and pathophysiology of cluster headache. Approach to combined occipital and supraorbital neurostimulation.

Cluster headache (CH) is included under section 3 - Trigeminal autonomic cephalalgias (TAC) of the International Headache Society (IHS) classification. It is one of the most frequent, painful and disabling primary headaches. Acute and preventive pharmacological treatments are often poorly tolerated and of limited effectiveness. Due to improved understanding of the pathophysiology of CH, neuromodulation devices are now considered safe and effective options for preventive and acute treatment of CH. In this paper, we review the information available to date, and present the case of a patient with disabling cluster headache highly resistant to medical treatment who underwent implantation of a peripheral nerve neurostimulation system to stimulate the supraorbital nerves (SON) and greater occipital nerve (GON) in our Pain Unit. We also review the diagnostic criteria for CH, the state of the knowledge on the pathophysiology of CH, and the role played by neuromodulation in treating this condition.

Clínica y fisiopatología de la cefalea en racimos. Acercamiento a la indicación de neuroestimulación combinada occipital y supraorbitaria / Symptoms and pathophysiology of cluster headache. Approach to combined occipital and supraorbital neurostimulation

La cefalea en racimos (CR) se encuadra dentro del apartado 3 de la clasificación de la Sociedad Internacional de Cefaleas (IHS), que es el reservado para las llamadas cefaleas trigémino autonómicas (CTA). Se trata de uno de los procesos de cefalea primaria más frecuentes, dolorosos e incapacitantes. Los tratamientos farmacológicos agudos y preventivos son, en muchos casos, mal tolerados y de efectividad limitada. Debido a la mejora en la comprensión de su fisiopatología de la CR, los dispositivos de neuromodulación se han posicionado como opciones seguras y eficaces de tratamiento preventivo y el tratamiento agudo de la CR. Haremos un recorrido sobre la información disponible hasta el momento y además, exponemos el caso de un paciente con CR incapacitante, muy resistente al tratamiento médico, tratado en nuestra Unidad del Dolor con el implante de un sistema de neuroestimulación de nervio periférico de nervios supraorbitario (SON) y nervio occipital mayor (GON). A continuación revisaremos los criterios diagnósticos que la definen la CR, lo datos que conocemos, a día de hoy, sobre su fisiopatología y la posición que ocupa actualmente la neuromodulación en el abordaje terapéutico de la misma. Con la descripción del caso clínico de un paciente tratado en nuestra Unidad del Dolor con una cefalea especialmente severa y resistente al tratamiento farmacológico.(AU)

Cluster headache (CH) is included under section 3 - Trigeminal autonomic cephalalgias (TAC) of the International Headache Society (IHS) classification. It is one of the most frequent, painful and disabling primary headaches. Acute and preventive pharmacological treatments are often poorly tolerated and of limited effectiveness. Due to improved understanding of the pathophysiology of CH, neuromodulation devices are now considered safe and effective options for preventive and acute treatment of CH. In this paper, we review the information available to date, and present the case of a patient with disabling cluster headache highly resistant to medical treatment who underwent implantation of a peripheral nerve neurostimulation system to stimulate the supraorbital nerves (SON) and greater occipital nerve (GON) in our Pain Unit. We also review the diagnostic criteria for CH, the state of the knowledge on the pathophysiology of CH, and the role played by neuromodulation in treating this condition.(AU)

More than a messenger: Alternative splicing as a therapeutic target.

Alternative splicing of pre-mRNA is an essential post- and co-transcriptional mechanism of gene expression regulation that produces multiple mature mRNA transcripts from a single gene. Genetic mutations that affect splicing underlie numerous devastating diseases. The complexity of splicing regulation allows for multiple therapeutic approaches to correct disease-associated mis-splicing events. In this review, we first highlight recent findings from therapeutic strategies that have used splice switching antisense oligonucleotides and small molecules that bind directly to RNA. Second, we summarize different genetic and chemical approaches to target components of the spliceosome to correct splicing defects in pathological conditions. Finally, we present an overview of compounds that target kinases and accessory pathways that intersect with the splicing machinery. Advancements in the understanding of disease-specific defects caused by mis-regulation of alternative splicing will certainly increase the development of therapeutic options for the clinic. This article is part of a Special Issue entitled: RNA structure and splicing regulation edited by Francisco Baralle, Ravindra Singh and Stefan Stamm.

Sry-negative XX true hermaphroditism in a roe deer.

A two-year-old roe deer was brought down in the course of a hunt in the north of Spain (Asturias). On physical examination the individual presented well-developed bared antlers, but surprisingly a female external genitalia. Several anatomical, histological and genetic analyses were performed in order to explain the observed phenotype. Necropsy evidenced ovary-like structures with follicles on the surface; histological analyses of testes evidenced positive immunolabel against testosterone in Leydig cells; genetic analyses showed that the sex of the individual was consistent with a female individual. PCR analysis failed to detect SRY sequences; no PIS deletion, which is responsible for XX sex-reversal in goats, was detected. On the basis of its presumptive normal female sexual karyotype (XX) and the presence of two functional abdominal bilateral testes and ovaries, the roe deer was finally diagnosed as possessing an XX hermaphroditism syndrome. However, as in many other cases, the specific reason for the occurrence of this case of hermaphroditism could not be determined.

El encintado como método de control del instrumental quirúrgico / Identification tape as control method for surgical instruments

El control de instrumental es una de las funciones del instrumentador quirúrgico. El objetivo, buscar el método adecuado para facilitar esa tarea y se optó por investigar con cintas adhesivas, identificatorias. Método experimental llevado a cabo en el Centro Quirúrgico del Hospital Garrahan en un período continuado de 2 meses. Se utilizaron 30 cajas y se excluyeron las que requerían proceso de esterilización por calor seco. Se procedió a identificar cada pieza con cintas adhesivas para el estudio. Grupo control conformado por dos (2) Hospitales de la Ciudad de Buenos Aires; cada uno con 15 cajas de similares características con elementos sin identificación. Se consideraron tiempos de armado de las cajas. Resultados obtenidos: Grupo experimental, cajas grandes 8', cajas medianas 2'. cajas chicas 30". Grupo control cajas grandes 12'30" cajas medianas 6'. cajas chicas 4'3". Cantidad de veces utilizadas; resultados: grupo experimental 742, Grupo control 403. Irregularidades en el uso; resultados: Grupo experimental 4, Grupo control 14: Cantidad de cajas, Grupo experimental 30. Se comprobó disminución en intercambio de piezas y una significativa reducción de tiempo en el armado de las cajas, en relación a los grupos testigos.

Spatial scaling of mountain pine beetle infestations.

1. The relationship between occupancy and spatial contagion during the spread of eruptive and invasive species demands greater study, as it could lead to improved prediction of ecosystem damage. 2. We applied a recently developed model that links occupancy and its fractal dimension to model the spatial distribution of mountain pine beetle infestations in British Columbia, Canada. We showed that the distribution of infestation was scale-invariant in at least 24 out of 37 years (mostly in epidemic years), and presented some degree of scale-invariance in the rest. There was a general logarithmic relationship between fractal dimension and infestation occupancy. Based on the scale-invariance assumption, we further assessed the interrelationships for several landscape metrics, such as correlation length, maximum cluster size, total edge length and total number of clusters. 3. The scale-invariance assumption allows fitting the above metrics, and provides a framework to establish the scaling relationship between occupancy and spatial contagion. 4. We concluded that scale-invariance dominates the spread of mountain pine beetle. In this context, spatial aggregation can be predicted from occupancy, hence occupancy is the only variable one needs to know in order to predict the spatial distributions of populations. This supports the hypothesis that fractal dispersal kernels may be abundant among outbreaks of pests and invasive species.

Prevalence of antibodies against Toxoplasma gondii in roe deer from Spain.

Roe deer (Capreolus capreolus) is an important game animal in Spain. Sera from 278 roe deer from eight areas in mainland Spain were assayed for antibodies to Toxoplasma gondii by modified agglutination test (MAT). Titers of 1:25 or higher were found in 109 (39.2%) of 278 deer. No significant differences in antibody prevalence were found between sex or age categories. In contrast, significant differences in seroprevalence between locations were evident. Roe deer from the Northern coastal habitats (high humidity and roe deer density) had the highest prevalence, compared with low prevalence in Central Spain (arid areas and low roe deer density). There was a positive correlation between antibody prevalence and mean annual rainfall (r(s)=0.85, n=8, P<0.01). These findings have environmental and/or public health implications because venison can be an important meat source of T. gondii infections for humans and feral cats.

Seguimiento de las lesiones escamosas intraepiteliales de alto grado (H-SIL) tras conización con asa diatérmica / Follow-up of high risk intraepithelial lesions after loop excision

Objetivo: Establecer el porcentaje de persistencias de las lesiones escamosas intraepiteliales de alto grado (H-SIL) tras realizar la conización con asa diatérmica, así como el momento del diagnóstico tras la intervención. Material y método: Revisión de los casos de conización por H-SIL en un período de 5 años en nuestra unidad de patología cervical. Analizamos el informe anatomopatológico de la pieza, las persistencias de H-SIL, la presencia de carcinomas y el número de curaciones, así como las pérdidas de seguimiento y la correlación de los márgenes afectados con la persistencia de H-SIL y con la presencia de carcinoma. Resultados: Nuestro porcentaje de curaciones es similar a las cifras publicadas. Hay diferencia significativa entre la existencia de carcinomas en las piezas de H-SIL cuando ambos márgenes están afectados y cuando los márgenes están libres. El momento de detección de la persistencia o recidiva de la lesión siempre fue en el primer control, excepto en un caso. Conclusiones: El seguimiento de las pacientes con conización por H-SIL es importante para detectar la persistencia de H-SIL

Objective: To evaluate whether the surveillance schedule for patients treated with loop excision for high-grade squamous intraepithelial lesions (H-SIL) could be improved. Material and method: We reviewed patients followed-up after loop excision of H-SIL in our unit over a 5-year period. We analyzed histologic confirmation of lesion, risk of recurrence of high-grade dysplasia, the presence of carcinomas, the number of patients with complete resolution, losses to follow-up, and the correlation between margin status and H-SIL recurrence and the presence of carcinoma. Results: The cure rate in this study was similar to rates reported in the literature. A significant difference was found between the presence of carcinoma in H-SIL surgical specimens when both margins were involved compared with disease-free margins. In all but one patient, recurrence was detected in the first follow-up examination. Conclusions: An optimal surveillance schedule for women treated for high-grade dysplasia with loop excision is important to detect and treat recurrent disease

Epidemiological assessment of levodopa use in Cuba: 1993-1998.

PURPOSE: The purpose of this study is to describe and evaluate the use of levodopa in Cuba in order to provide a basis for intervention aimed at improving pharmacological treatment of individuals presenting with Parkinson's disease (PD). METHODS: We studied the amount of levodopa, both plain and combined, distributed by the central laboratory to hospital and community pharmacies in Cuba in the period 1993-1998. An internationally established drug-classification system and a reported method for epidemiological assessment of levodopa sales were applied. Sweden in 1994 served as the reference population. RESULTS: National crude rates of levodopa use basically remained stable since 1994, and in 1998 stood at 0.11 defined daily dose (DDD) per 1000 inhabitants/day, approximately 15 times lower than the corresponding figure for the reference population. Annual provincial use of levodopa showed considerable geographical variation, with the lowest rates in the eastern provinces and the highest rates in Havana City (Ciudad de La Habana). Adjustment for age reduced such differences by approximately 50%. CONCLUSIONS: Levodopa use in Cuba is low and consistent with the reported low prevalence of the diagnosis of PD. Results suggest that the diagnosis and treatment of PD can be improved, with emphasis on better detection of PD.

Evaluación de la calidad de comunicación entre niveles asistenciales mediante el documento interconsulta / Evaluation of the quality of communication between care levels through the inter-consultation document

Objetivos. Evaluar la calidad y mejora de cumplimentación de los documentos de interconsulta en el equipo de atención primaria (EAP). Diseño. Ciclo completo de calidad. Emplazamiento. Atención primaria (AP).Componentes de la evaluación. Dimensión estudiada: calidad científico-técnica. Sujetos: todos los documentos de interconsulta (DI-1) dirigidos por los médicos de AP del centro de salud de Irún Centro a atención especializada durante 15 días, 223 DI-1 para la evaluación en abril de 1998 y 287 para la reevaluación en octubre 1998. Tipo de evaluación: retrospectiva. Fuente de datos: documentos interconsulta e historias clínicas. Criterios: explícitos y normativos. Medidas correctoras: educativas (discusión de resultados en reunión del EAP).Resultados. En la reevaluación se observó una mejoría estadísticamente significativa: datos de filiación (91,5-96,8 por ciento), legibilidad (86-92,7 por ciento), antecedentes y/o medicación habitual (35,9-50 por ciento) y sintomatología (77,8-87,2 por ciento). Por niveles de calidad se ha pasado en los buenos del 20,6 al 42,5 por ciento y en los malos del 40,8 al 33,4 por ciento. Obtuvimos respuesta en un 22,2 por ciento de nuestras derivaciones. La falta de respuesta se produce en un 34 por ciento por no haber informe del especialista, un 47,8 por ciento se atribuyen al paciente o al circuito y el 18 por ciento de los pacientes está pendiente de pruebas. Conclusiones. La información proporcionada en los DI-1 ha mejorado significativamente después del ciclo de calidad. Conocer nuestra práctica habitual de trabajo sirve como estimulo de mejora. Los criterios que peor cumplimos son: referencia a antecedentes personales y/o medicación habitual, exploración física y medidas terapéuticas empleadas. Gran perdida de información en la respuesta a nuestras derivaciones (AU)

[Evaluation of the quality of communication between levels of care through the inter-consultation document]. / Evaluación de la calidad de comunicación entre niveles asistenciales mediante el documento interconsulta.

OBJECTIVES: To evaluate the quality and improvement of compliance in the inter-consultation documents of the primary care team (PCT). DESIGN: Entire care cycle. SETTING: Primary care (PC). MEASUREMENTS: Dimension studied: scientific-technical quality. SUBJECTS: all the inter-consultation documents (ID-1) sent by PC doctors from Irun Health Centre to specialist clinics over a 15-day period. 223 ID-1 for evaluation in April 1998, and 287 for re-evaluation in October 1998. Type of evaluation: retrospective. SOURCE OF DATA: inter-consultation documents and clinical records. CRITERIA: explicit and standard. Corrective measures: educational (discussion of results in meeting of the PCT). RESULTS: A statistically significant improvement was found at the re-evaluation: basic personal details (91.5%-96.8%), legibility (86%-92.7%), medical history and/or customary medication (35.9%-50%) and symptoms (77.8%-87.2%). Good quality levels rose from 20.6% to 42.5%; and bad quality levels fell from 40.8% to 33.4%. 22.2% of our referrals received a reply. 34% of the lack of replies was because of no report from the specialist, 47.8% were attributed to the patient or circuit, and 18% of the patients were awaiting test results. CONCLUSIONS: The information supplied in the ID-1 improved significantly after the quality cycle. Knowing our habitual working practice can serve to stimulate improvement. The criteria we complied with least were: reference to personal antecedents and/or habitual medication, physical examination, and therapeutic measures employed. There was a huge loss of information in the replies to our referrals.

Controlling chaos in ecology: from deterministic to individual-based models.

The possibility of chaos control in biological systems has been stimulated by recent advances in the study of heart and brain tissue dynamics. More recently, some authors have conjectured that such a method might be applied to population dynamics and even play a nontrivial evolutionary role in ecology. In this paper we explore this idea by means of both mathematical and individual-based simulation models. Because of the intrinsic noise linked to individual behavior, controlling a noisy system becomes more difficult but, as shown here, it is a feasible task allowed to be experimentally tested.

[Parkinson disease in Spain: evidence of under-diagnosis and starting points for its reduction]. / Enfermedad de Parkinson en España: evidencias de infradiagnóstico y puntos de partida para su reducción.

INTRODUCTION: Parkinson's disease (PD) has been found in all surveys focusing on frequent neurological disorders. In general, sparse geographical variation of PD prevalence was found. OBJECTIVE: Since preliminary data suggest considerable PD underdiagnosis, 69%, 67%, 52%, 29%, we studied potential differences of PD prevalences in Spain. MATERIAL AND METHODS: We obtained age-specific prevalences of PD from scientific media and publications from professional meetings and compared them using stratified analysis. RESULTS: The geographical variation of prevalences at ages 60-89 years was small except among those aged 80-89, being twofold in Cantalejo, Segovia, and approximately 1/3 in Lower Aragón, Teruel. The Cantalejo (door-to-door, 67% de novo diagnoses) versus Lower Aragón (medical services) prevalence ratio was 4/1. CONCLUSION: PD might be considerably underdiagnosed in Spain.

[Motoneuron disease in Spain: differential epidemiological features]. / Enfermedad de motoneurona en España: rasgos epidemiológicos diferenciales.

INTRODUCTION AND OBJECTIVES: Little data has been published in Spain on motor neurone disease or amyotrophic lateral sclerosis. This study reports data on incidence and mortality in Cantabria and incidence in Segovia. It discusses and compares them emphasizing certain characteristic features of the epidemiology of the disease in Spain. RESULTS: The incidence of motor neurone disease is higher in males, increases with age, reaches a peak between 70 and 79 years but then drops after the age of 80. There is little difference between incidence and mortality. The incidence of mortality varies greatly with time. CONCLUSIONS: The incidence of motor neurone disease in Spanish studies is average. The mortality is similar to that of other countries, although the pattern varies with age. There was a striking drop in this disease in the 1960s, but since 1970 it has been increasing.

Lactantes con ascaridiasis en vesícula biliar / Ascaridiasis of the gallblader in an infant

Se denomina ascaridiasis en vesícula biliar a la presencia de los parásitos intestinales denominados Ascaris lumbricoides en la vesícula biliar, debido a la migración de éstos por via ascendente desde el yeyuno y ileón hacia el duodeno y luego a través de la ampolla de Vater hacia la via biliar principal y vesicula. Se describe el caso de una lactante de un año y nueve meses de edad, con ascaridiasis en vesícula biliar, atendido en el Servicio de Pediatria del "Hospital Santa Cruz", Caja Petrolera de Salud. El parásito se detecta ecograficamente; el mismo es eliminado espontaneamente de la vesícula biliar, a las 24 horas de efectuarse el diagnostico. La infestación masiva, la gran movilidad del parásito y la administración previa de mebendazol a la paciente (en otro centro hospitalario),explicarian la localización del áscaris,el cual prococá dolor localizado en hipocondrio derecho y fiebre en la lactante.

[Selective intra-arterial embolization in spontaneous rupture of hepatocarcinoma]. / Embolización selectiva intraarterial en ruptura espontánea de hepatocarcinoma.

We present the case of a patient with no previous history of liver disease, who required urgent medical care due to dizziness and hypotension. A diagnosis of hemoperitoneum was made by means of ultrasound and fine needle aspiration. The hemoperitoneum source was the spontaneous rupture of a liver tumor whose CT axial scan appearance was suggestive of hepatocarcinoma. The hemorrhage was controlled using intraarterial selective embolization. The rupture of a hepatocarcinoma is a surgical emergency with high mortality. Its early detection using an adequate diagnostic sequence, allows the surgeon to establish a therapeutic procedure as soon possible. Selective intraarterial embolization with alcohol has proved to be an effective procedure in the management of this kind of hemorrhage with a minimum surgical preparation, and allows further surgical interventions. Nevertheless mortality is still high due to the severity of the clinical entity.

Clinical and experimental evidence for the use of hypothermia in decompression sickness.

During construction of the Coxwell sewer tunnel and subway in Toronto, a number of patients with decompression sickness failed to respond completely to repressurization alone. After the addition of hypothermia, significant improvement occurred. These observations stimulated an experimental study in which 36 rabbits were exposed to 60 or 70 p.s.i. for 1 h. After sudden decompression over 70 s, they were either observed, cooled in air at 0 degrees C, or cooled in water at 3 degrees C. Immersion in water significantly reduced the mortality rate, while cooling in air did not. These experimental results supported the clinical observations that hypothermia was an effective therapeutic adjunct in the treatment of decompression sickness.

Informe preliminar sobre el uso de la cola de fibrina en cirugia ortopedica.Reporte de 11 casos. / Preliminary report on the use of fibrin adhesive in orthopedic surgery. Report of 11 cases

Se reporta el uso de la "cola de fibrina" como coadyuvante en la cirugia ortopedica en 11 casos con diversas patologias. La finalidad de este trabajo es reportar el uso del sello de cola de fibrina usado por primera vez en Venezuela

Clinical evaluation of Rho(D) immune globulin (human) in Canada.

-During 1966, clinical trials were conducted in three Canadian centres to determine the safety and efficacy of Rh(0)(D) immune globulin (human) in preventing isoimmunization by the Rh(0)(D) antigen in Rh-negative women delivering ABO-compatible Rh-positive infants.The candidates were randomly divided into control and treated groups; the treated mothers received an intramuscular injection of 300 mug. of anti-Rh(0)(D) within 72 hours of delivery. Follow-up antibody screening tests were conducted on the sera of all patients six to nine months post partum.Of the 175 control patients, 11 or 6.2% became actively immunized to the Rh antigen, whereas complete protection against maternal Rh immunization was observed in the 191 treated patients.