Aplicación del tranexámico intravenoso o intraarticular en el control del sangrado posquirúrgico tras una artroplastia total de cadera. Estudio prospectivo, controlado y aleatorizado / Which route of administration of acid tranexamic, intravenous or intra-articular, is more effective in the control of post-surgical bleeding after a total hip arthroplasty? A prospective, controlled and randomized study

Introducción: Una complicación frecuente tras una artroplastia total de cadera es el sangrado, y para reducirlo se utiliza el ácido tranexámico (TXA) intravenoso. Recientemente se han publicado los beneficios de su aplicación tópica. Consideramos necesario realizar un estudio que justifique qué vía de administración resulta superior. Material y método: Estudio prospectivo, controlado, aleatorizado en 2 brazos realizado entre febrero de 2017 a febrero de 2018. En el grupo A se administró 15mg/kg TXA intravenoso y en el B 2g TXA intraarticular. Se evaluó los valores de hemoglobina y hematocrito a las 24-72horas, volumen de sangre drenado, volumen de sangre perdida, transfusiones y complicaciones. Resultados: Fueron incluidos 78 pacientes, 31 con tratamiento intravenoso y 47 intraarticular. La hemoglobina descendió 3,15+/-1,64g/dl en 24horas y 3,75+/-1,56g/dl en 72horas en el grupo intravenoso, el hematocrito descendió un 10,4%+/-4,17% en 24horas y 11,85%+/-4,15% en 72horas. En el intraarticular se observó una caída de hemoglobina de 3,03+/-1,30g/dl en 24horas y de 3,22+/-1,2g/dl en 72horas y el hematocrito descendió 10,66%+/-3,6% y 12,11%+/-3,29% en 24 y 72horas (p>0,05). El drenaje medio en 24horas fue 195,80ml en el grupo A frente a 253,93ml en el grupo B (p>0,05) y a las 48horas 225,33ml en el grupo A y de 328,19ml en el grupo-B (p=0,009). En el grupo intravenoso perdieron una media de 1.505ml de sangre frente a 1.280ml del grupo intraarticular. Fueron necesarias un 5,1% de transfusiones. No tuvimos complicaciones secundarias. Conclusiones: Las diferentes vías de administración del TXA en la artroplastia total de cadera tienen un efecto similar en la reducción del sangrado postoperatorio sin evidenciar un incremento de complicaciones

Introduction: One of the most frequent complications after a total hip arthroplasty (THA) is bleeding, intravenous tranexamic acid (TXA) is used to reduce it. We considered it necessary to carry out a study to clarify which administration route is superior. Material and method: Prospective, controlled and randomized study in 2 arms carried out between February 2017 and February 2018. 15mg/kg of intravenous TXA were administered in group-A and 2gr of intra-articular TXA in group-B. The values of haemoglobin and haematocrit were evaluated at 24h-72h, blood loss volume, drained blood volume, transfusions and complications. Results: 78 patients were included, 31 with intravenous treatment and 47 with intra-articular. The decrease of haemoglobin in the intravenous group was 3.15+/-1.64g/dl in 24h and 3.75+/-1.56g/dl in 72h, the haematocrit decreased by 10.4+/-4.17% in 24h and 11.85+/-4.15% in 72h. In the intra-articular group there was a haemoglobin fall of 3.03+/-1.30g/dl in 24h and 3.22+/-1.2g/dl in 72h and the haematocrit fell by 10.66+/-3.6% and 12,11+/-3.29% in 24 and 72h (P>.05). The mean drainage in 24h was 195.80ml in group-A versus 253.93ml in group-B (P>.05) and in 48h it was 225.33ml in group-A and 328.19ml in group-B (P=.009). The intravenous group lost an average of 1,505ml of blood compared to the 11,280ml of the intra-articular group. In 5.1% of the cases, transfusions were necessary. We had no secondary complications. Conclusions: The different routes of administration of TXA in THA have a similar effect in the reduction of postoperative bleeding. There was no evidence of an increase in complications

Which route of administration of acid tranexamic, intravenous or intra-articular, is more effective in the control of post-surgical bleeding after a total hip arthroplasty? A prospective, controlled and randomized study. / Aplicación del tranexámico intravenoso o intraarticular en el control del sangrado posquirúrgico tras una artroplastia total de cadera. Estudio prospectivo, controlado y aleatorizado.

INTRODUCTION: One of the most frequent complications after a total hip arthroplasty (THA) is bleeding, intravenous tranexamic acid (TXA) is used to reduce it. We considered it necessary to carry out a study to clarify which administration route is superior. MATERIAL AND METHOD: Prospective, controlled and randomized study in 2 arms carried out between February 2017 and February 2018. 15mg/kg of intravenous TXA were administered in group-A and 2gr of intra-articular TXA in group-B. The values of haemoglobin and haematocrit were evaluated at 24h-72h, blood loss volume, drained blood volume, transfusions and complications. RESULTS: 78 patients were included, 31 with intravenous treatment and 47 with intra-articular. The decrease of haemoglobin in the intravenous group was 3.15±1.64g/dl in 24h and 3.75±1.56g/dl in 72h, the haematocrit decreased by 10.4±4.17% in 24h and 11.85±4.15% in 72h. In the intra-articular group there was a haemoglobin fall of 3.03±1.30g/dl in 24h and 3.22±1.2g/dl in 72h and the haematocrit fell by 10.66±3.6% and 12,11±3.29% in 24 and 72h (P>.05). The mean drainage in 24h was 195.80ml in group-A versus 253.93ml in group-B (P>.05) and in 48h it was 225.33ml in group-A and 328.19ml in group-B (P=.009). The intravenous group lost an average of 1,505ml of blood compared to the 11,280ml of the intra-articular group. In 5.1% of the cases, transfusions were necessary. We had no secondary complications. CONCLUSIONS: The different routes of administration of TXA in THA have a similar effect in the reduction of postoperative bleeding. There was no evidence of an increase in complications.

Lung adenocarcinoma during pregnancy: clinical case and literature review.

Lung cancer during pregnancy is a very rare disease with less than 70 cases published to date. Information about specific lung cancer as adenocarcinoma is even more limited. Genetic techniques can detect oncogene mutations which seem to be more frequent among cases of lung cancer in pregnant women and could determine both the treatment and prognosis. We present a recent case seen at our hospital and a literature review.

Toxicidad por cobalto después de la revisión a una artroplastia total de cadera posterior a fractura de cabeza cerámica / Cobalt toxicity after revision total hip replacement due to fracture of a ceramic head

La intoxicación por cobalto después de la revisión de una artroplastia total de cadera es poco común, pero una complicación potencialmente devastadora. Los síntomas incluyen: cardiomiopatía, hipotiroidismo, erupciones en la piel, alteraciones visuales, cambios en la audición, policitemia, debilidad, fatiga, deterioro cognitivo y neuropatía. Presentamos el caso de un varón de 74años que tras recambio a par cerámica-cerámica y dos episodios de luxación protésica se decidió nuevo recambio a par polietileno-metal. A los 6meses de la reintervención comenzó con clínica de intoxicación por cobalto, confirmada mediante determinación analítica, presentando niveles pico de cobalto en suero de 651,2μg/l. Tras retirada protésica y reimplante, se normalizaron los niveles de cromo y cobalto en sangre y orina, encontrándose el paciente actualmente asintomático. Recomendamos el uso de pares cerámica-cerámica en las cirugías de revisión de cadera tras rotura de componentes cerámicos para reducir al mínimo el riesgo de toxicidad por cobalto (AU)

Symptomatic cobalt toxicity from a failed total hip replacement is a rare, but devastating complication. Potential clinical findings include cardiomyopathy, hypothyroidism, skin rash, visual and hearing impairment, polycythaemia, weakness, fatigue, cognitive impairment, and neuropathy. The case is presented of a 74year-old man in whom, after a ceramic-ceramic replacement and two episodes of prosthetic dislocation, it was decided to replace it with a polyethylene-metal total hip arthroplasty (THA). At 6months after the revision he developed symptoms of cobalt toxicity, confirmed by analytical determination (serum cobalt level=651.2μg/L). After removal of the prosthesis, the levels of chromium and cobalt in blood and urine returned to normal, with the patient currently being asymptomatic. It is recommended to use a new ceramic on ceramic bearing at revision, in order to minimise the risk of wear-related cobalt toxicity following breakage of ceramic components (AU)

Cobalt toxicity after revision total hip replacement due to fracture of a ceramic head. / Toxicidad por cobalto después de la revisión a una artroplastia total de cadera posterior a fractura de cabeza cerámica.

Symptomatic cobalt toxicity from a failed total hip replacement is a rare, but devastating complication. Potential clinical findings include cardiomyopathy, hypothyroidism, skin rash, visual and hearing impairment, polycythaemia, weakness, fatigue, cognitive impairment, and neuropathy. The case is presented of a 74year-old man in whom, after a ceramic-ceramic replacement and two episodes of prosthetic dislocation, it was decided to replace it with a polyethylene-metal total hip arthroplasty (THA). At 6months after the revision he developed symptoms of cobalt toxicity, confirmed by analytical determination (serum cobalt level=651.2µg/L). After removal of the prosthesis, the levels of chromium and cobalt in blood and urine returned to normal, with the patient currently being asymptomatic. It is recommended to use a new ceramic on ceramic bearing at revision, in order to minimise the risk of wear-related cobalt toxicity following breakage of ceramic components.

Secuencia Moebius. Análisis retrospectivo de 30 pacientes / Moebius syndrome. A retrospective analysis of 30 patients.

Introducción: La secuencia Moebius se caracteriza por el compromiso congénito de los nervios motor ocular externo y facial, y se puede asociar al compromiso de otros pares craneales y a otros defectos congénitos. Su etiología es multifactorial y no bien definida, actualmente la teoría más aceptada es la disrupción vascular durante el desarrollo del romboencéfalo. Su incidencia exacta se desconoce, pero impresiona estar en aumento y asociada a la exposición prenatal a teratógenos. Objetivos: Analizar las historias clínicas de 30 pacientes con secuencia Moebius y las características de su compromiso ocular. Materiales y métodos: Estudio retrospectivo, transversal, observacional y descriptivo. Se analizaron 30 historias clínicas de pacientes con secuencia Moebius atendidos por vez primera entre el mes de Julio de 1999 y Junio de 2012 por el servicio de Oftalmología del Hospital Garrahan. Resultados: Se estudiaron 30 pacientes 15 de sexo femenino y 15 de sexo masculino, dentro de los antecedentes maternos 7 madres refirieron ingesta de misoprostol y 4 tuvieron metrorragias durante el primer trimestre de embarazo. Todos los pacientes tuvieron compromiso del VII nervio; en 20 pacientes fue bilateral y simétrico; y en los restantes asimétrico. Todos los pacientes tuvieron compromiso del VI nervio bilateral, a algunos de los cuáles se les efectuó cirugía de estrabismo otros están en plan de cirugía y unos pocos no la requirieron por presentar fijación de ambos ojos en posición primaria de la mirada. Conclusión: la secuencia Moebius es una rara patología genética y congénita multifactorial y de compromiso multisistémico que ha visto incrementada su frecuencia desde el uso de ciertos fármacos teratógenos y que obliga a una intervención quirúrgica precoz de neuroortopedistas, oftalmólogos, cirujanos plásticos y control clínico multidisciplinario para brindarles a estos niños las mejores posibilidades de desarrollo funcional y estético reparador (AU)

Introduction: Moebius syndrome is characterized by congenital palsy of the external and facial oculomotpr nerves, and may be associated with involvement of other cranial nerves and congenital defects. The etiology is multifactorial and not well defined. Currently, the most widely accepted theory is a rhombencephalic maldevelopment. The true incidence of Moebius syndrome is unknown, but it seems to be increasing associated with prenatal exposure to teratogenic factors. Objectives: To analyze the clinical charts of 30 patients with Moebius syndrome assessing ocular involvement. Material and methods: A retrospective, cross-sectional, observational study. Thirty clinical charts of patients with Moebius syndrome that were first seen at the Department of Ophthalmology of Hospital Garrahan between July 1999 and June 2012 were assessed. Results: Of the 30 patients 15 were female and 15 male. Maternal history showed seven mothers that received misoprostol and four that had metrorrhagia in the first trimester of pregnancy. All patients had VII cranial nerve involvement; the involvement was bilateral and symmetric in 20 and asymmetric in the remaining patients. All patients had bilateral VI nerve involvement, some of whom underwent surgery for strabismus, others are on the list for surgery, and a few do not require surgery because of fixation of both eyes in primary gaze position. Conclusion: Moebius syndrome is a rare multifactorial genetic and congenital pathology with multisystemic involvement and increased incidence because of the use of teratogenic drugs requiring early surgical intervention by neuroorthopedic and plastic surgeons, and ophthalmologists, and a multidisciplinary follow-up to provide these children with the best possibilities for functional development and aesthetic repair (AU)

Esophageal atresia and prenatal exposure to mycophenolate.

Mycophenolate mofetil is a widely prescribed immunosuppressive agent for transplant patients and autoimmune diseases. Potential teratogenic effects after in utero exposure to mycophenolate mofetil has been described in human clinical observations. The complete clinical pattern is still being delineated. We present four newborns with esophageal atresia and other congenital anomalies, prenatally exposed to mycophenolate mofetil during the first trimester. Two of the cases had other defects related to the embryopathy: microtia, eye abnormalities and oral clefts. Two cases did not show major craniofacial anomalies. We propose that esophageal atresia with or without tracheoesophageal fistula is a feature of mycophenolate embryopathy even without the presence of other major craniofacial anomalies. The human teratogenicity of MMF is reinforced by this report, and the current contraceptive recommendations about its use in fertile women are stressed.

Precise determination of strontium isotope ratios by TIMS to authenticate tomato geographical origin.

Thermal Ionisation Mass Spectrometry (TIMS) was applied to discriminate a total of 118 tomato samples (berries, "passata", tinned tomatoes, sauce, double and triple concentrate) coming from two different countries. The TIMS technique gave significantly different results for the (87)Sr/(86)Sr ratios and δ‰ values between Chinese and Italian tomato samples, irrespective of the treatment type. This technique proved to be a "robust" method, suitable for a precise discrimination of the two geographical origins. TIMS was able, within the Italian samples, to discriminate different geographical production areas, by virtue of different (87)Sr/(86)Sr ratios and δ‰ values. This technique could be employed in the field of food safety and quality, as a profitable tool for authenticating tomato geographical origin.

Infection and immunity for human parvovirus B19 in patients with febrile exanthema.

The contribution of parvovirus B19 (B19V) as a causative agent of febrile exanthema (FE) in Cordoba, Argentina, was analysed by detection of viral DNA, and specific IgM and IgG. Serum from 141 patients with FE who were negative for measles and rubella, collected during 2005-2009, plus serum from 31 healthy individuals, were assayed. B19V was the aetiological agent in 14·9% of all FE cases, and in 39·1% in an epidemic year (2007). B19V DNA was detected in 47·6% of IgM-positive FE patients, 30·2% of IgM-negative/IgG-positive FE patients, and 9·7% of healthy controls, indicating B19V long-term infection in ~10% of immunocompetent individuals. Persistent B19V DNA was significantly more frequent in children than adults and in males than females. All patients with acute B19V infection had rash and fever, 85·7% had adenopathy, and only 14·3% had arthropathy. This is the first follow-up study of markers of infection and immunity for B19V infection in Argentina.

Neutralizing antibodies in multiple sclerosis patients treated with 375 micrograms interferon-beta-1b.

BACKGROUND: Neutralizing antibodies (NAbs) to IFN-beta may have a detrimental effect on treatment response, but increasing IFN-beta dose could reduce their occurrence. The OPTimization of Interferon for MS (OPTIMS) study was a multicenter trial investigating clinical and MRI outcomes with the approved IFN-beta-1b dose (250 microg) and a higher dose (375 microg), s.c. every other day. OBJECTIVE: To analyze the occurrence of NAbs and their effect on clinical and MRI response over a long-term (4-year) follow-up using cross-sectional and longitudinal statistical analysis. METHODS: Relapses or disease progression was assessed open-label and MRI scans were performed serially during the first year of the study. Neutralizing antibodies were measured using the MxA protein production neutralization assay. RESULTS: A total of 145 patients with relapsing-remitting multiple sclerosis from 14 centers participated in the study. Neutralizing antibody frequency was negatively associated with MRI treatment response, but no detrimental effect of NAbs on the clinical response was observed. Results obtained using cross-sectional or longitudinal statistical approaches were similar. Over the 4-year period, NAb-positive patients treated with 375 microg had a significantly greater probability of NAb disappearance (hazard ratio: 3.41; 95% confidence interval: 1.78 - 6.43; p < 0.01). CONCLUSION: Use of an IFN-beta-1b dose higher than the currently approved 250-microg dose is associated with an increased probability of NAb disappearance. The OPTIMS study was registered at ClinicalTrials.gov: NCT00473213.

MRI activity and neutralising antibody as predictors of response to interferon beta treatment in multiple sclerosis.

OBJECTIVE: To prospectively validate MRI activity and neutralising anti-interferon antibody (NAb) during the first 6 months of interferon beta treatment as response indicators in multiple sclerosis (MS). METHODS: Patients with relapsing-remitting MS were followed during the first 2 years of treatment. Neurological assessments were performed every 3 months or when a relapse was suspected. MRI scans performed at baseline and at 3, 4, 5 and 6 months after the start of treatment were assessed centrally for disease activity: new T2 or gadolinium enhancing T1 lesions. NAb were assessed using the MxA protein assay; positivity was defined as two consecutive titres >or=20 NU/ml. We evaluated the predictivity of an active scan, NAb positivity, or both, during the first 6 months of treatment, on the occurrence of clinical disease activity in the following 18 months. RESULTS: 147 patients were assessed at 16 centres. Predictivity parameters (with confidence intervals) were as follows: active scan, sensitivity (SN) 52% (34-69%), specificity (SP) 80% (65-91%), negative predictive value (NPV) 73% (58-77%), positive predictive value (PPV) 62% (42-79%), p = 0.002; NAb positivity, SN 71% (45-88%), SP 66% (55-76%), NPV 92% (82-97%), PPV 29% (16-45%), p = 0.01; active scan and NAb positivity, SN 71% (38-91%), SP 86% (73-94%), NPV 94% (86-98%), PPV 50% (29-70%), p = 0.0003. CONCLUSIONS: MRI activity and NAb occurrence during the first 6 months of interferon beta treatment were reliable predictors of long term clinical response, particularly when combined. Patients with negative predictors showed a less than 10% risk of developing clinical activity. Patients with positive predictors showed a 50% risk of further clinical activity. These patients need to be followed carefully with further MRI and NAb tests.

[Usefulness of oral glucose tolerance test (OGTT) in output patients with advanced chronic renal failure (CRF)]. / importancia del test de sobrecarga oral a la glucosa (TSOG) en una consulta específica de IRC avanzada estadio IV y V.

UNLABELLED: A pathological Oral Glucose Tolerance test (OGTT) is early marker of peripheral insulin resistance. Nevertheless, its utility in nondiabetic patients with CRF stage IV-V is undetermined. AIM: We wanted to detect, in a population of non diabetic patients with CRF, the presence of carbohydrates metabolism anomalies, by means of the OGTT and to relate it with metabolic, anthropometric, cardiovascular parameters and renal function. We studied 45 non diabetic patients with advanced CRF (stage IV-V), 26 men, mean age 66.5 years, with average Cockroft-Gault of 23.6 ml/min. We measured weight, height, waist and BMI. BIOCHEMICAL: glucose, insulin, OGTT, C peptide, lipid profile, HbA1C and Hto. Cardiovascular comorbidity, mean proteinuria and systolic and diastolic blood pressure (6 months pre and post analytical measure) were measured. Pulse pressure was also calculated. RESULTS: 47% of the patients presented normal fasting glucose, whereas 53% had isolated impaired fasting glucose (IFG). After the OGTT, 36% of the patients presented impaired glucose tolerance (IGT) and 14% diabetes (>200 mg/dl). Of the patients with normal fasting glucose, 38% had IGT after OGTT and 5% diabetes. Patients with abnormal OGTT were older (71+/-13.6 versus 60+/- 18.8 years, p=0.03), had greater HbA1C (5.6+/-0.5 versus 5.2+/-0.3%, p=0.02), total cholesterol (193+/-37.7 versus 169.8+/-44.9 mg/dl, p=0.03), pulse pressure (63.4+/- 14.5 versus 52.3+/-9.7 mmHg, p=0.0001) and greater prevalence of ischemic heart disease (28% versus 5%, p=0.05). Creatinine Clerance negatively correlated with the OGTT (r=-0.39, p=0.01) and plasma creatinine positively with fasting insulin (r=0.33, p=0.02) and C-peptide (r=0.42, p=0.006). Urinary Proteins were correlated with fasting glucose (r=0.30, p=0.04), C-peptide (r=0.52, p=0.001), triglycerides (r=0.36, p=0.01) and with the HOMA-IR index (r=0.30, p=0.05). CONCLUSION: Fasting Glucose did not predict OGTT results in patients with CRF. For this reason, we think that the OGTT can be very usefull tool to identify states of "prediabetes" and diabetes in patients with CRF, specially in those whose present an elevated Pulse Pressure, age greater than 65 years, hyperlipidaemia and HbA1C above 5.2%. The early detection of these metabolic anomalies, may lead to intensify dietetic and pharmacological measures directed to delay or to attenuate the appearance of diabetes and its serious complications in a population in which the cardiovascular risks factors are very elevated.

Importancia del test de sobrecarga oral a la glucosa (TSOG) en una consulta específica de IRC avanzada estadio IV y V / Usefulness of oral glucose tolerance test (OGTT) in output patients with advanced chronic renal failure (CRF)

Un TSOG patológico es un marcador precoz de resistencia periférica a la insulina. Objetivos: Identificar, en una población de pacientes no diabéticos con IRC avanzada marcadores clínicos asociados a un TSOG patológico, para reconocer a cuáles de nuestros pacientes debemos realizarle dicha prueba. Material y métodos: Estudiamos 45 pacientes no diabéticos, 26 varones, 66,5 años, con IRC avanzada estadio IV y V. Se midió peso, talla, cintura, IMC, glucosa, insulina, TSOG, péptido C, lípidos, HbA1C y Hto. Comorbilidad cardiovascular, proteinuria y presión de pulso medias (6 meses). Resultados: 47% de los pacientes presentó una glucemia basal normal (GBN) y 53% glucemia basal anómala (GBA). Tras el TSOG, un 36% de los pacientes presentó intolerancia oral a la glucosa (IOG) y un 14% una glucemia mayor de 200 mg/dl (DM). De los pacientes con GBN, 38% tuvieron IOG tras el TSOG y el 5% DM. De los pacientes con GBA (n = 24), 33% presentó IOG y 21% DM. Los pacientes con TSOG patológico tenían más edad (71 ± 13,6 vs 60 ± 18,8 años, p = 0,03), mayor HbA1C (5,6 ± 0,5 vs 5,2 ± 0,3%, p = 0,02), mayor colesterol total (193 ± 37,7 vs 169,8 ± 44,9 mg/dl, p = 0,03), mayor presión de pulso (63,4 ± 14,5 vs 52,3 ± 9,7 mmHg, p = 0,0001) y mayor prevalencia de cardiopatía isquémica (28% vs 5%, p = 0,05). El GFR se correlacionó negativamente con el TSOG (r = -0,39, p = 0,01) y la proteinuria con la glucemia basal (r = 0,30, p = 0,04), péptido C (r = 0,52, p = 0,001), triglicéridos (r = 0,36, p = 0,01) e índice de HOMA (r = 0,30 p = 0,05). Tras el modelo de curvas COR, la edad, la HbA1C, el colesterol total y la Presión de Pulso, tuvieron un área bajo la curva significativa para predecir TSOG patológico. Conclusión: La glucemia basal en ayunas no predijo un TSOG patológico en pacientes con IRC avanzada, por ello, creemos que la realización del TSOG puede ser muy útil para identificar estados de «prediabetes» y diabetes en estos pacientes, especialmente en aquellos que presentan una Presión de Pulso elevada, una edad mayor de 65 años, dislipemia y HbA1C mayor de 5,2%

pathological Oral Glucose Tolerance test (OGTT) is an early marker of peripheral insulin resistance. Nevertheless, its utility in nondiabetic patients with CRF stage IV-V is undetermined. Aim: We wanted to detect, in a population of non diabetic patients with CRF, the presence of carbohydrates metabolism anomalies, by means of the OGTT and to relate it with metabolic, anthropometric, cardiovascular parameters and renal function. We studied 45 non diabetic patients with advanced CRF (stage IV-V), 26 men, mean age 66.5 years, with average Cockroft- Gault of 23.6 ml/min. We measured weight, height, waist and BMI. Biochemical: glucose, insulin, OGTT, C peptide, lipid profile, HbA1C and Hto. Cardiovascular comorbidity, mean proteinuria and systolic and diastolic blood pressure (6 months pre and post analytical measure) were measured. Pulse pressure was also calculated. Results: 47% of the patients presented normal fasting glucose, whereas 53% had isolated impaired fasting glucose (IFG). After the OGTT, 36% of the patients presented impaired glucose tolerance (IGT) and 14% diabetes (> 200 mg/dl). Of the patients with normal fasting glucose, 38% had IGT after OGTT and 5% diabetes. Patients with IFG (n = 24), 33% presented IGT and 21% diabetes. Patients with abnormal OGTT were older (71 ± 13.6 versus 60 ± 18.8 years, p = 0.03), had greater HbA1C (5.6 ± 0.5 versus 5.2 ± 0.3%, p = 0.02), total cholesterol (193 ± 37.7 versus 169.8 ± 44.9 mg/dl, p = 0.03), pulse pressure (63.4 ± 14.5 versus 52.3 ± 9.7 mmHg, p = 0.0001) and greater prevalence of ischemic heart disesase (28% versus 5%, p = 0.05). Creatinine Clerance negatively correlated with the OGTT (r = -0.39, p = 0.01) and plasma creatinine positively with fasting insulin (r = 0.33, p = 0.02) and C-peptide (r = 0.42, p = 0.006). Urinary Proteins were correlated with fasting glucose (r = 0.30, p = 0.04), C-peptide (r = 0.52, p = 0.001), triglycerides (r = 0.36, p = 0.01) and with the HOMA-IR index (r = 0.30 p = 0.05) Conclusion: Fasting Glucose did not predict OGTT results in patients with CRF. For this reason, we think that the OGTT can be very useful tool to identify states of «prediabetes» and diabetes in patients with CRF, specially in those whose present an elevated Pulse Pressure, age greater than 65 years, hyperlipidaemia and HbA1C above 5.2%. The early detection of these metabolic anomalies, may lead to intensify dietetic and pharmacological measures directed to delay or to attenuate the appearance of diabetes and its serious complications in a population in which the cardiovascular risks factors are very elevated

Every-other-day interferon beta-1b versus once-weekly interferon beta-1a for multiple sclerosis (INCOMIN Trial) II: analysis of MRI responses to treatment and correlation with Nab.

BACKGROUND: In RRMS, clinical exacerbations are usually associated with different types of active lesions at MRI, including: hyperintense lesions on T1-weighted post-gadolinium sequences; new hyperintense lesions or enlarging old lesions on PD/T2-weighted scans; or new hypointense lesions on T1-weighted pre-Gd sequences. OBJECTIVE/METHODS: Primary outcome was the occurrence of patients with at least one active MRI lesion of the different types indicated above during treatment with 250 microg every other day (EOD) interferon beta (IFNbeta)-1b or 30 microg once weekly (OW) IFNbeta-1a in outpatients with RRMS (INCOMIN Trial). RESULTS: The number of patients with at least one 'active' lesion, evaluated over the two-year follow-up, was significantly (P = 0.014) lower in the EOD IFNbeta-1 b arm (1 3/76, 17%) then in the OW IFNbeta-1a arm (25/73, 34%). NAb frequency over two-year follow-up was 22/65 (33.8%) in the EOD IFNbeta-1b arm and 4/62 (6.5%) in the OW IFNbeta-1a arm, significantly greater in the EOD IFNbeta-1b arm. CONCLUSIONS: The development of MRI active lesions is strongly reduced by EOD-IFNbeta-1b compared with OW-IFNbeta-1a, indicating that EOD-IFNbeta-1b is more effective than OW-IFNbeta-1a in reducing ongoing inflammation and demyelination in MS. Logistic regression showed that NAb status did not affect the risk of MRI activity.

[Intrathecal baclofen and Botulinum toxin in infantile cerebral palsy]. / Baclofén intratecal y toxina botulínica en la parálisis cerebral infantil.

INTRODUCTION: Infantile cerebral palsy is considered to be a motor disorder affecting both posture and movement. It is the manifestation of a cerebral lesion that took place during the maturing process of the brain. Spastic cerebral palsy is the most frequent variety. The spasticity presented by these patients strongly influences their functioning and gives rise to several complications that affect their quality of life. AIMS AND DEVELOPMENT: The main aim of this study is to determine a set of suitable and effective therapeutic steps that can be used to improve patients' spasticity and to prevent the complications that stem from them, such as contractures, deformities, surgery, etc. Multiple treatments were used, including physiotherapy, rehabilitation and oral pharmacotherapy, with few satisfactory results. At present there are two very promising therapeutic alternatives for patients with infantile cerebral palsy: Botulinum toxin, which we already have a great deal of experience with, and intrathecal treatment with baclofen. We report on a series of 10 patients aged between 8 and 15 years who had had an intrathecal baclofen infusion pump implanted. To date (maximum follow-up: 12 months), their clinical course has been satisfactory in most cases, with no severe complications related to the surgical technique, except in one individual who presented a fistula that resolved spontaneously. CONCLUSIONS: Intrathecal baclofen seems to be a very useful alternative in the treatment of spasticity to improve the quality of life of these patients and those around them.

Baclofén intratecal y toxina botulínica en la parálisis cerebral infantil / Intrathecal baclofen and botulinum toxin in infantile cerebral palsy

Introducción. La parálisis cerebral infantil se considera un trastorno motor que afecta tanto a la postura como al movimiento. Constituye la manifestación de una lesión cerebral que tuvo lugar durante el proceso madurativo del cerebro. La parálisis cerebral espástica es la variedad mas frecuente. La espasticidad que presentan estos pacientes interfiere de forma muy importante en la funcionalidad del mismo, produciendo diversas complicaciones que afectan a su calidad de vida. Objetivo y desarrollo. El objetivo principal es lograr unas medidas terapéuticas adecuadas y eficaces para mejorar la espasticidad y evitar las complicaciones que de ella se derivan: contracturas, deformidades, cirugía, etc. Se han utilizado múltiples tratamientos, como fisioterapia, rehabilitación y farmacoterapia oral, con escasos resultados satisfactorios. Actualmente existen dos alternativas terapéuticas muy a tener en cuenta en pacientes con parálisis cerebral infantil: la toxina botulínica, de la que ya tenemos amplia experiencia, y el tratamiento intratecal con baclofén. Se presenta una serie de 10 pacientes, de edades comprendidas entre 8 y 15 años, a los que se les ha implantado una bomba de perfusión intratecal de baclofén. Hasta el momento actual (seguimiento máximo: 12 meses), la evolución ha sido satisfactoria en la mayoría de los casos, sin encontrarse graves complicaciones en relación a la técnica quirúrgica, excepto en un caso que presentó una fístula que se resolvió espontáneamente. Conclusión. El baclofén intratecal se considera una alternativa muy a tener en cuenta en el tratamiento de la espasticidad para la mejora de la calidad de vida de estos pacientes y su entorno (AU)

Introduction. Infantile cerebral palsy is considered to be a motor disorder affecting both posture and movement. It is the manifestation of a cerebral lesion that took place during the maturing process of the brain. Spastic cerebral palsy is the most frequent variety. The spasticity presented by these patients strongly influences their functioning and gives rise to several complications that affect their quality of life. Aims and development. The main aim of this study is to determine a set of suitable and effective therapeutic steps that can be used to improve patients’ spasticity and to prevent the complications that stem from them, such as contractures, deformities, surgery, etc. Multiple treatments were used, including physiotherapy, rehabilitation and oral pharmacotherapy, with few satisfactory results. At present there are two very promising therapeutic alternatives for patients with infantile cerebral palsy: Botulinum toxin, which we already have a great deal of experience with, and intrathecal treatment with baclofen. We report on a series of 10 patients aged between 8 and 15 years who had had an intrathecal baclofen infusion pump implanted. To date (maximum follow-up: 12 months), their clinical course has been satisfactory in most cases, with no severe complications related to the surgical technique, except in one individual who presented a fistula that resolved spontaneously. Conclusions. Intrathecal baclofen seems to be a very useful alternative in the treatment of spasticity to improve the quality of life of these patients and those around them (AU)

Choanal atresia associated with prenatal methimazole exposure: three new patients.

We report three patients with bilateral choanal atresia in children prenatally exposed to methimazole (MMI) in order to define a MMI embryopathy clinical pattern. The combination of choanal atresia and other specific malformations strongly resembles previously reported patients exposed to MMI in utero. At present, propylthiouracil is considered the best treatment in pregnancies. However in Argentina and some other countries MMI is the only antithyroid drug, possibly posing a significant risk to the unborn fetus.

[Unusual forms of clinical presentation of attention deficit hyperactivity disorder]. / Formas clinicas inhabituales de presentacion del trastorno por deficit de atencion con hiperactividad.

INTRODUCTION AND DEVELOPMENT: Attention deficit hyperactivity disorder (ADHD) is one of the most frequently observed processes in our Neuropaediatric unit, and in recent years has become one of the leading reason for visits, together with headaches. On occasions, the diagnosis that should be made, in accordance with the criteria included in the DSM IV, is more difficult because initially they are patients who visit because of some other problem that becomes the centre of our clinical attention. Headaches, in our experience, are the main reason for visiting in these cases. A careful review of the patient's history and a physical examination, together with their observation during the interview, lead us to suspect a genuine case of ADHD underlying the problem that presents with other non specific symptoms. These patients are mainly boys and, less frequently, girls who see how the chances of academic and social failure increase and then become worried to such an extent that they start suffering from important tension type headaches. Concentrating the study and the therapy on just solving the problem of the headaches sometimes gives rise to therapeutic failure, which occasionally goes on for months. Other symptoms, such as tics, unspecific dizziness, pains in the abdomen and visual disorders, can also be the reason that brings ADHD patients to visit. CONCLUSIONS: When faced with these symptoms we should always bear in mind (mainly in the case of headaches) the possibility referred to above and special care must be taken not to diagnose ADHD in excess, and always base our judgment on objective proof that meets the criteria required for its diagnosis. Therapy based on pharmacological treatment and a suitable psychopedagogical intervention solves the problem in these cases and significantly reduces the symptomatology that led to the visit.

Thalidomide neuropathy: clinical, electrophysiological and neuroradiological features.

OBJECTIVE: Thalidomide is a promising therapy for multiple myeloma. Sensory neuropathy is a side effect of thalidomide and resulted to be partially reversible in 50% of cases, suggesting a sensory ganglionopathy. Spinal cord magnetic resonance imaging (MRI) was found to be useful in the diagnosis of sensory ganglionopathies and we use it to determine if thalidomide neuropathy has features of a ganglionopathy. MATERIAL AND METHODS: Six patients with multiple myeloma developed thalidomide-induced polyneuropathy. Nerve conduction studies, somatosensory-evoked potentials (SEPs) and cervical and dorsal spinal cord MRI were obtained in all. RESULTS: All patients had a sensory neuropathy, with clinical or electrophysiological abnormalities involving all four limbs. Spinal cord MRI showed high signal intensity in the posterior columns in only one patient, with abnormal central conduction time at SEPs. CONCLUSION: Our results suggest that thalidomide can induce either an axonal length-dependent neuropathy or, less frequently, a ganglionopathy.

Formas clínicas inhabituales de presentación del trastorno por déficit de atención con hiperactividad / Usual forms of clinical presentation of attention déficit hyperactivity disorder

Introducción y desarrollo. El trastorno por déficit de atención con hiperactividad (TDAH) es uno de los procesos que observamos más frecuentemente en nuestra consulta de neuropediatría, y ha pasado a ocupar en los últimos años uno de los primeros puestos, junto con las cefaleas. El diagnóstico que debe hacerse, siempre según los criterios recogidos en el DSM IV, en ocasiones, se hace más difícil, ya que inicialmente son pacientes que consultan por otra problemática que adquiere el protagonismo clínico. Las cefaleas, en nuestra experiencia, son el motivo de consulta principal en estos casos. Una anamnesis cuidadosa y la exploración de los pacientes, y su observación durante la entrevista, hacen sospechar el contexto de un auténtico TDAH que subyace en el problema que se presenta con otra sintomatología no específica. Principalmente, se trata de niños (menos frecuente), que ven como sus expectativas de fracaso escolar y social aumentan y les preocupan hasta tal punto que se inicia una cefalea tensional importante. A veces, si se centra únicamente el estudio y la terapéutica exclusivamente en solucionar la cefalea, se produce el fracaso terapéutico, que a veces se ha prolongado durante meses. Otros síntomas como tics, mareos inespecíficos, abdominalgias y trastornos visuales, también pueden ser motivo de consulta en pacientes con TDAH. Conclusiones. Ante la consulta de esta sintomatología, debe tenerse siempre en cuenta /principalmente con las cefaleas) la posibilidad referida y tener especial cuidado en no diagnosticar en exceso el TDAH, y siempre basándonos en pruebas objetivas que reúnan los criterios exigidos para su diagnóstico. La terapia dirigida al tratamiento farmacológico y una intervención psicopedagógica adecuada resuelven en estos casos el problema y disminuyen significativamente la sintomatología motivo de consulta (AU)

Introduction and development. Attention deficit hyperactivity disorder (ADHD) is one of the most frequently observed processes in our Neuropaediatric unit, and in recent years has become one of the leading reason for visits, together with headaches. On occasions, the diagnosis that should be made, in accordance with the criteria included in the DSM IV, is more difficult because initially they are patients who visit because of some other problem that becomes the centre of our clinical attention. Headaches, in our experience, are the main reason for visiting in these cases. A careful review of the patient’s history and a physical examination, together with their observation during the interview, lead us to suspect a genuine case of ADHD underlying the problem that presents with other non-specific symptoms. These patients are mainly boys and, less frequently, girls who see how the chances of academic and social failure increase and then become worried to such an extent that they start suffering from important tension-type headaches. Concentrating the study and the therapy on just solving the problem of the headaches sometimes gives rise to therapeutic failure, which occasionally goes on for months. Other symptoms, such as tics, unspecific dizziness, pains in the abdomen and visual disorders, can also be the reason that brings ADHD patients to visit. Conclusions. When faced with these symptoms we should always bear in mind (mainly in the case of headaches) the possibility referred to above and special care must be taken not to diagnose ADHD in excess, and always base our judgment on objective proof that meets the criteria required for its diagnosis. Therapy based on pharmacological treatment and a suitable psychopedagogical intervention solves the problem in these cases and significantly reduces the symptomatology that led to the visit (AU)