Resonancia magnética orbitaria para desenmascarar arteritis de células gigantes / Orbital Magnetic Resonance Imaging to unmask giant cell arteritis

La captación del nervio óptico es un signo visualizado en diferentes patologías; sin embargo, el realce perineural es menos frecuente. Se presenta el caso de una paciente con clínica de amaurosis bilateral en la que se sugirió el diagnóstico de arteritis de células gigantes por la captación perineural detectada en una resonancia magnética (RM) orbitaria, que se confirmó por biopsia de la arteria temporal. La clínica es, en ocasiones, inespecífica y puede presentarse con síntomas visuales, incluso ceguera si afecta a ramas de la arteria oftálmica; en estos casos, la RM orbitaria puede ser de gran utilidad para un diagnóstico precoz. Si bien los hallazgos por RM son poco frecuentes, se han descrito distintos patrones de captación de contraste, entre los que el realce perineural es el más característico. Este patrón de afectación del nervio óptico es poco conocido pero relevante, pues orienta al diagnóstico de una patología que puede conducir a la ceguera permanente

Optic nerve enhancement is a sign seen in different disease states; however, perineural enhancement is less common. This article presents the case of a patient with bilateral amaurosis in whom the diagnosis of giant cell arteritis was suggested by perineural enhancement on orbital magnetic resonance imaging (MRI) and confirmed by biopsy of the temporal artery. The clinical presentation of giant cell arteritis is occasionally nonspecific; patients can have visual symptoms, even blindness if the branches of the ophthalmic artery are affected; in these cases, orbital MRI can be very useful for early diagnosis. Although the MRI findings are uncommon, distinct patterns of enhancement have been reported, the most characteristic of which is perineural enhancement. The pattern of optic nerve involvement is relatively unknown, but important because it orients the diagnosis of a disease that can lead to permanent blindness

Orbital Magnetic Resonance Imaging to unmask giant cell arteritis. / Resonancia magnética orbitaria para desenmascarar arteritis de células gigantes.

Optic nerve enhancement is a sign seen in different disease states; however, perineural enhancement is less common. This article presents the case of a patient with bilateral amaurosis in whom the diagnosis of giant cell arteritis was suggested by perineural enhancement on orbital magnetic resonance imaging (MRI) and confirmed by biopsy of the temporal artery. The clinical presentation of giant cell arteritis is occasionally nonspecific; patients can have visual symptoms, even blindness if the branches of the ophthalmic artery are affected; in these cases, orbital MRI can be very useful for early diagnosis. Although the MRI findings are uncommon, distinct patterns of enhancement have been reported, the most characteristic of which is perineural enhancement. The pattern of optic nerve involvement is relatively unknown, but important because it orients the diagnosis of a disease that can lead to permanent blindness.

Siderosis meníngea. Estudio de un caso y revisión de la literatura médica / Meningeal siderosis. A case study and a literature review

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Prevalencia de la incontinencia urinaria en dos centros de salud urbanos / Prevalence of urinary incontinence in two urban health centres

Introducción. La incontinencia urinaria (IU) tiene importantes repercusiones para la salud y elevados costes sociales y económicos, pero a pesar de ello su prevalencia no está bien establecida y varía en distintos estudios en el mundo desde el 3 al 40% en relación con la edad y el sexo. El objetivo principal de este estudio es determinar la prevalencia global de IU en dos centros de salud urbanos (excluyendo a los pacientes que no pueden acudir a la consulta médica en el centro de salud), así como la prevalencia no conocida por el médico de atención primaria. Material y métodos. El estudio, transversal y descriptivo, se llevó a cabo durante febrero y marzo de 2010 en dos centros de salud urbanos, con pacientes de la consulta de dos médicos de familia. Se realizó un muestreo aleatorio simple, seleccionando 4 pacientes al día del total de los citados, entre los hombres y mujeres de 14 años o mayores no institucionalizados, que acudieron a la consulta por cualquier motivo. Se obtuvo una muestra total de 356 pacientes. Resultados. Se obtuvo una prevalencia global de la IU del 33%. En el 62% de los casos el diagnóstico no era conocido por el médico de atención primaria y en el 79% no había sido valorada por el especialista. El 60% refirió alguna limitación en su calidad de vida. Conclusiones. A pesar del impacto de la incontinencia urinaria, su prevalencia no está bien establecida y varía en los estudios realizados hasta la actualidad; se puede afirmar que se deben realizar nuevas investigaciones con métodos estandarizados de estudio, validados y más fácilmente comparables, así como realizar nuevos estudios estatales de su prevalencia (AU)

Introduction. Urinary incontinence (UI) has significant repercussions for health and has high social and economic costs. In spite of this, its prevalence is not well established and varies, according to different studies around the world, from 3 to 40% depending on age and sex. The principal aim of our study is to determine the prevalence of urine incontinence (UI) in two urban health centres (excluding the patients unable to come to the clinic) as well as the prevalence unknown to the Primary Care doctor. Material and methods. A cross-sectional descriptive study was carried out during February and March, 2010 in two urban health centres, with patients attending two family doctor clinics. Simple random sampling was used, selecting four patients each day during the period of the study, from non- institutionalised males and females age 14years and over, who came to the clinic for another reason. A total sample of 356 patients was obtained. Results. An overall prevalence of UI of 33% was obtained. Of these, 62% of the cases diagnosed were not known by the Primary Care doctor, and 79% had not been assessed by specialist. It caused some limitation in the quality of life in 60% of the cases. Conclusions. In spite of the impact of the urinary incontinence, its prevalence is not well established well and varies in the studies conducted up to the present time. This confirms that further studies should be performed using standardised, validated and easy to compare methods in order to determine its prevalence nationwide (AU)

In-hospital cardiopulmonary resuscitation. 5 years' incidence and survival according to the Utstein template.

BACKGROUND: Direct comparison of survival rates from in-hospital cardiopulmonary resuscitation (CPR) remains difficult. The objective of this study was to report outcome according to the Utstein template for in-hospital cardiac arrest and to evaluate the Utstein template itself as applied to a retrospective material. METHODS: The hospital (900 beds, 37,000 annual admissions) has no established do-not-resuscitate (DNR) order policy. CPR outside the Intensive- or Coronary Care Units (ICU/CCU) is performed by an emergency medical team consisting of an anaesthesiologist, a medical resident and a nurse anaesthetist. CPR attempts during 5 years (1990-1994) were analysed retrospectively. Patient survival, cerebral and overall performance category (CPC/OPC) score of the survivors was determined. The Utstein template was evaluated in terms of clinical relevance and data availability. RESULTS: During 5 years, 4927 patients died as in-patients. CPR outside the CCU/ICU was attempted 244 times. CPR was primarily successful on 83 occasions (34%), and 42 patients (17%) were finally discharged with CPC 1 or 2. Survival from primary ventricular fibrillation (VF) or ventricular tachycardia was 40%, pulseless electrical activity 3%, asystole 11% and of rhythm undetermined 6%. Age or sex effects were not observed. CONCLUSION: More than 90% of in-hospital deaths in this hospital are handled without CPR being initiated. Overall survival was 17%, and almost all survivors made a favourable outcome. The Utstein template for in-hospital cardiac arrest performed acceptably as a framework for reporting outcome in this retrospective study.

Out-of-hospital cardiopulmonary resuscitation: a population-based Norwegian study of incidence and survival.

The Trondheim region's (315 km2, population 154,000) emergency medical service (EMS) provides advanced cardiac life support (ACLS) with combined paramedic and physician response. This EMS system is commonly employed in Norway, yet no population based study of outcome in cardiac arrest has been published to date. This retrospective study reports incidence and outcome from every attempted out-of-hospital cardiopulmonary resuscitation (CPR) during 1990 through 1994 according to the Utstein template. Information on the patient's pre-morbid conditions and final outcome was obtained from hospital records. The incidence of cardiac arrest and CPR from all causes was 68 per 100,000 per year, with 83% primary cardiac aetiology. The median alarm to patient arrival interval for ambulance and emergency physician was 8 minutes and 11 minutes, respectively. The presenting rhythm was ventricular fibrillation or tachycardia in 51%, asystole in 34%, pulseless electrical activity in 8% and undetermined in 8%. Definite return of spontaneous circulation occurred in 211 patients (40%, 27 per 100,000 per year) and 57 patients (11%, 7.4 per 100,000 per year) survived to discharge. Most patients made a favourable cerebral outcome, although nine were severely disabled. This is the first population-based Norwegian study of outcome from out-of-hospital cardiac arrest in this combined paramedic/physician staffed EMS. Incidence, survival and neurological outcome are comparable with results obtained in other EMS systems.

UDP-N-acetylhexosamines and hypotaurine in human glioblastoma, normal brain tissue and cell cultures: 1H/NMR spectroscopy study.

NMR spectroscopy was used to analyse perchloric acid extracts of normal human brain, murine brain cell cultures, glioblastoma tissue and the glioblastoma cell line U-87. 1H NMR spectra revealed the presence of elevated levels of UDP-N-acetylglucosamine and UDP-N-acetylgalactosamine in glioblastoma extracts and the glioblastoma cell line U-87, in comparison with normal brain tissue and primary cell cultures of neurons and astrocytes. UDP-N-acetylhexosamines appear to accumulate in cells that are unable to differentiate. Furthermore, it was found that the culture medium had an effect on the concentration of UDP-N-acetygalactosamine in the glioblastoma cell line. Hypotaurine, previously only associated with oligodendrocytes, has been identified in astrocyte cultures and in cerebellar granule cells. In normal brain it was not observed by NMR spectroscopy, but was easily detectable in glioblastoma tissue extracts. UDP-N-acetylhexoseamines and hypotaurine might be useful markers for brain pathology and play a role in cell differentiation and cell division.

Ramsay-Hunt syndrome and high-resolution 3DFT MRI.

A case of Ramsay-Hunt syndrome has been studied with pre- and postcontrast MR imaging, using a three-dimensional Fourier transform fast imaging with steady precession sequence with axially oriented sections and coronal reformatted images. A clear demonstration of the abnormal enhancement of the labyrinth and of the intratemporal cranial nerves was obtained. This demonstration assisted us in establishing the diagnosis of Ramsay-Hunt syndrome.

Mrs evaluation of brain-metabolites in extracts from cell-cultures, human tumors and normal tissue from brain - cholesteryl ester, choline containing compounds and creatine as markers for development, differentiation and pathology.

A multi stage extraction procedure which gives the possibility to analyze both water soluble and lipid components stemming from the same specimen has been developed in our laboratory. Metabolites from brain cancer biopsies have been compared to metabolites in normal human brain, developing mouse brain and primary mouse cell cultures of neurons and astrocytes from cerebral cortex and cerebellum. Extraction with perchloric acid (PCA) dissolves water.soluble components such as choline containing compounds, creatine, amino acids, carbohydrates and high energy phosphates. The water insoluble fraction left after the PCA treatment was extracted with chloroform/methanol, 2/1 (vol/vol). C-13 and H-1 NMR spectra showed characteristic lipid resonances identified as those from long chain saturated and unsaturated fatty acids and cholesterol. Only glioblastomas contained detectable amounts of cholesteryl ester suggesting this compound as marker for brain pathology. It was shown that cholesterol but not cholesteryl ester is present in cultures of neurons either alone or together with astrocytes. H-1 NMR spectra of PCA extracts from biopsies showed that the creatine/choline containing compounds (Cr/Cho) ratios decreased and the N-acetylaspartate/Cho ratios decreased in glioblastomas as compared to normal brain. Cell cultures retain the Cr/Cho ratio characteristic of the developmental stage of the tissue they were prepared from.