Degeneration of the brainstem.

Magnetic resonance imaging (MRI) is the most sensitive imaging technique for assessing brainstem involvement in neurodegenerative diseases. An MRI can assess the degree of atrophy of the brainstem and alterations in signal intensity on T2-weighted images in the affected areas, which are the main imaging findings found in these diseases. Besides, diffusion-weighted MRI and proton MR spectroscopy are tools that play an important role in the characterization of these entities. Our purpose is to describe the neurodegenerative diseases that predominantly affect the brainstem highlighting the imaging findings most useful for diagnosis.

[Intracranial hypotension syndrome: a review of the magnetic resonance findings]. / Sindrome de hipotension intracraneal: revision de hallazgos en resonancia magnetica.

INTRODUCTION: Intracranial hypotension syndrome (IHS) is a syndrome with a variable aetiology and clinical presentation that is, in most cases, caused by leakage of cerebrospinal fluid (CSF) through the thecal sac. Orthostatic headache associated to the typical magnetic resonance imaging (MRI) findings, secondary to depletion of CSF, is the key to a correct diagnosis. AIMS: To show the imaging findings that, within a suitable clinical context, allow this condition to be identified and diagnosed. DEVELOPMENT: Decreased CSF volume plays an important role in IHS, which leads to an increase in the compensatory volume of blood, essentially dependent on the venous system. MRI is a sensitive technique in the diagnosis of IHS. Yet, separate findings are unspecific. The MRI findings include diffuse and homogeneous dural enhancement, the presence of small bilateral subdural collections, caudal displacement of the encephalic structures (pseudo-Chiari), dilatation of the cortical and medullar veins, and the recent sign of venous distension. This last sign is a highly sensitive finding of IHS, which tends to disappear following the patient's clinical improvement even before the disappearance of the pachy-meningeal enhancement, and could be used as a marker for response to treatment. CONCLUSIONS: IHS is a condition that is difficult to diagnose clinically for which several typical MRI findings have been reported; both neurologists and radiologists must be familiar with these findings.

[Isolated mesencephalic stroke related to a ruptured intracranial dermoid cyst]. / Ictus isquémico mesencefálico aislado secundario a ruptura de quiste dermoide.

Dermoids cysts are embrionary benign lesions that comprise approximately 0.04-0.25% of all intracranial tumors. Occasionally they break and spread their content into subarachnoid space and/or lateral ventricles causing several acute or delayed symptoms. Debut of this type of tumor as acute stroke is poorly reflected in literature. We present a 26-year-old woman with a isolated mesencephalic infarct secondary to spontaneous rupture of a dermoid cyst. We discuss the possible pathophysiological mechanisms for this condition and review the literature.

Ictus isquémico mesencefálico aislado secundario a ruptura de quiste dermoide / Isolated mesencephalic stroke related to a ruptured intracranial dermoid cyst

Los quistes dermoides son lesiones benignas deorigen embrionario que representan del 0.04 a 0,25%de todos los tumores intracraneales. Estos quistesocasionalmente pueden romperse diseminándose elcontenido graso intraquístico al espacio subaracnoideoy/o los ventrículos laterales. En este caso puede provocardiversas manifestaciones clínicas de forma agudao retardada. El debut de este tipo de tumor con unictus agudo está escasamente reflejado en la literatura.Presentamos el caso de una mujer de 26 años con uninfarto mesencefálico aislado secundario a la rupturade un quiste dermoide. Discutimos el mecanismofisiopatológico supuesto y realizamos una revisión delos casos recogidos en la literatura (AU)

Dermoids cysts are embrionary benign lesions thatcomprise approximately 0.04-0.25% of all intracranialtumors. Occasionally they break and spread their contentinto subarachnoid space and/or lateral ventriclescausing several acute or delayed symptoms. Debut ofthis type of tumor as acute stroke is poorly reflected inliterature. We present a 26-year-old woman with a isolatedmesencephalic infarct secondary to spontaneousrupture of a dermoid cyst. We discuss the possiblepathophysiological mechanisms for this condition andreview the literature (AU)

Florid reactive periostitis ossificans of the distal ulna.

Florid reactive periostitis is the term used to describe a benign disease characterized by aggressive periosteal reaction and benign soft-tissue inflammation. Although it is considered rare, there are numerous reports in the literature that refer to this disease with different names such as parosteal fasciitis, fasciitis ossificans, benign fibro-osseous pseudotumor, pseudomalignant osseous tumor of soft tissue, and bizarre parosteal osteochondromatous proliferation. As a result, the nomenclature is confusing, and some authors have placed florid reactive periostitis ossificans into the heterogeneous group of pseudomalignant osseous tumors of soft tissue or proliferative periosteal processes, whereas other authors place this entity in the myositis ossificans group. In the same manner, florid reactive periostitis has been considered to be a previous stage of bizarre parosteal osteochondromatous proliferations. This article presents a case of florid reactive periostitis ossificans of the distal ulna in a 13-year-old boy. The patient presented with a painful lesion in the distal ulna, and plain radiographs suggested the presence of a quickly growing periosteal lesion with associated calcification and soft tissue mass. Histologically, the appearance was that of reactive periostitis. The clinical, radiological, and histologic features of florid reactive periostitis are described.

[Psychological features and Doppler-Duplex in erectile disfunction]. / Aspectos psicológicos y Doppler-Duplex dinámico en disfunción eréctil.

OBJECTIVES: To establish a relationship between Doppler-Duplex colour ultrasound after prostaglandin intracorporeal injec tion and psychological features in patients suffering from erectile dysfunction. METHODS: Forty two patients with erectile dysfunction were prospectively evaluated with Doppler-Duplex colour ultra sonography after intracavernosal injection of 20 micrograms of E1 prostaglandin. Dynamic vascular pattern were analyzed an penile tumescence were graded in poor, moderate or good (I, II, III). All of them completed the International Index of Erectile Dysfunction, International Exam of Personality Traits (IPDE) and the Symptom Checklist (SCL-90). RESULTS: 29 patients (69.05%) showed a normal ultrasonography response (Peak Systolic Velocity >30 cm/s; Telediastolic velocity negative or less than 5 cm/s and penile tumescence grade III) and were classified as good responders with probably psy chogenic erectile dysfunction. Patients who did not show these values were classified in the group of erectile dysfunction of vas cular origin. We found significative differences between the two groups in sex desire, tumescence and paranoid personality. Th more frequent personality features were paranoid and squizoid (excentric) and ananchastic and anxious (fearful ones). Somatization and obsessive-compulsive symptoms have been outlined over the rest. We have found that paranoid personality is sixteen times more frequent in patients with normal ultrasonography. CONCLUSIONS: Psychological features and dysfunctional personality traits accompany psychogenic and organic erectile dys function, thus it is thought that mixed aetiology coexist in this patients. Doppler-Dupplex Colour ultrasound is an usefu method to exclude organic vascular factors. On de basis of our article, is more common to find psychological discomfort an dysfunctional personality traits in patients with normal ultrasound, which may help in their diagnosis and treatment.

[Purging behaviors and nutritional status in anorexia nervosa and bulimia nervosa]. / Conductas purgativas y estado nutricional en anorexia nerviosa y bulimia nerviosa.

AIMS: The aim of the study was to investigate whether the use of purgative methods in patients with eating disorders (anorexia nervosa [AN] and bulimia nervosa [BN]) could be capable of producing changes in the nutritional status of the patients. SETTING AND PATIENTS: The group under study was composed of 184 female eating disordered outpatients. One hundred and sixteen patients (63.0%) fulfilled the DSM-IV diagnostic criteria for BN (90 purging type, 26 nonpurging type). Sixty eight patients (37.0%) fulfilled the DSM-IV criteria for the diagnosis of AN (48 restricting type, 20 binging-purging type). METHODS: The assessment process included anthropometry (body circumferences and skinfold thickness) and body impedance analysis. RESULTS: The two subgroups of AN patients significantly differed from each of the BN subgroups. From a nutritional point of view, some significant differences between the two DSM-IV subtypes of AN existed, but not between the purging type and the nonpurging type of BN. CONCLUSIONS: The paper discusses the clinical significance of these findings. An alternative subtypification of AN patients is proposed: 1) restricting type [patients who control their food intake and do not purge]; 2) purging type [patient with true episodes of binging which are followed by purgative behaviors]; and 3) pseudopurging type [patients with subjective binging episodes who use purging methods].

Body mass index and some psychopathological symptoms in open community nuns.

This article examines the connections between body weight and psychopathological symptoms in a religious community. The Symptom Checklist 90-Revised was administered to 34 nuns, whose body mass index (BMI) values significantly correlated with hostility (r=0.46, p<0.01). These findings support the idea that people living in open religious communities share social values regarding weight and body size, and reveal high levels of psychological discomfort when body weight increases.

Evaluation of two retrospective active surveillance methods for the detection of nosocomial infection in surgical patients.

OBJECTIVE: To compare the sensitivity and specificity of two retrospective active surveillance methods based on review of the medical record and review of the discharge form in identfying nosocomial infection, taking the prospective surveillance method as the reference standard. DESIGN: Blind comparison of three active nosocomial infection surveillance methods. SETTING: Department of General Surgery of a tertiary-care hospital with a referral population of 266,000 people. METHODS: All operated patients admitted to the Department of Surgery for more than 24 hours and discharged from January 1, 1994, to December 31, 1994, were included. Prospective surveillance consisted of daily review of the patient's record during hospitalization. Retrospective surveillance consisted of review of the medical record and the discharge form. Sensitivity and specificity of both retrospective methods were calculated. RESULTS: Of the 1,514 patients included in the study, 1,476 (97.5%) were reviewed by means of the retrospective surveillance system. A total of 20, 8, and 4 hours per week was needed for the active prospective system, review of the medical record, and review of the hospital discharge form, respectively. The documented cumulative incidence of nosocomial infection was 21.8% for the prospective system, 19.6% for review of the medical record, and 12.6% for review of the discharge form. The overall sensitivity of review of the medical record was 88% and of the discharge form 56%, with a specificity of 99%. For review of the medical record, the highest sensitivity was 93%, for urinary tract infections; for review of the discharge form, the highest was 57%, for surgical-wound infection. CONCLUSIONS: The retrospective method of review of the medical record was the most efficient active surveillance strategy in detecting nosocomial infection in surgical patients.