Hospitalización por insuficiencia cardíaca durante la pandemia de COVID-19 / Heart Failure hospitalization during COVID-19 pandemic

No disponible

Utilidad de la tomografía computarizada cerebral multiparamétrica en el diagnóstico diferencial de patología comicial en el código ictus. Estudio preliminar / Usefulness of multiparametric computerized tomography findings in the differential diagnosis of stroke mimics of epileptic origin: A preliminary study

Objetivo: Tras la activación del código ictus, hasta un 30% de los pacientes presentan cuadros imitadores del ictus, siendo la epilepsia el más frecuente. Evaluamos la utilidad de la TC cerebral multiparamétrica para la diferenciación de los déficit de origen comicial versus vascular. Material y métodos: Estudio observacional retrospectivo con recogida prospectiva de datos. Se revisan imágenes de TC multiparamétrica de pacientes atendidos como código ictus durante un año que finalmente fueron diagnosticados de etiología comicial. Resultados: N =11 (varones 36%, edad media 74,5 años). Tres pacientes presentaban focalidad neurológica derecha, 4 focalidad izquierda y 4 afasia aislada. El tiempo máximo desde el inicio de la clínica hasta la realización de la TC multiparamétrica fue de 8,16 h. La TC perfusión fue normal en 2 pacientes. Nueve pacientes mostraron alargamiento/acortamiento del tiempo al pico (Tmáx), siendo los mapas de flujo y volumen variables. El electroencefalograma se realizó con un tiempo máximo de evolución desde el inicio de la clínica de 47,6 h. Cuatro registros mostraron hallazgos compatibles con estatus epiléptico, 2 actividad epileptiforme focal y los 5 restantes lentificación poscrítica ipsolateral a las anomalías de la TC perfusión. Conclusión: El alargamiento del tiempo al pico en una distribución cortical multilobar en ausencia de oclusión de gran vaso y con respeto de ganglios de la base ha resultado el parámetro más sensible para la diferenciación de estas entidades en nuestra serie. Consideramos que la TC cerebral multiparamétrica es una herramienta rápida, disponible y útil para el diagnóstico diferencial de síntomas neurológicos deficitarios de inicio brusco debidos a etiología comicial que son atendidos como código ictus

Objective: Thirty percent of the patients for whom code stroke is activated have stroke mimics, the most common being epilepsy. Our purpose was to evaluate the usefulness of ultiparametric CT for differentiating between seizure-related symptoms and vascular events. Material and methods: We conducted a retrospective observational study; data were gathered prospectively during one year. We studied multiparametric CT images of patients admitted following code stroke activation and finally diagnosed with epilepsy. Results: The study included a total of 11 patients; 36% were men and mean age was 74.5 years. Three patients had right hemisphere syndrome, 4 displayed left hemisphere syndrome, and the remaining 4 had isolated aphasia. Maximum time from symptom onset to multiparametric CT study was 8.16hours. Perfusion CT results were normal in 2 patients. Nine patients showed longer or shorter times to peak (Tmax); cerebral blood volume (CBV) and cerebral blood flow (CBF) maps varied. EEG was performed a maximum of 47.6hours after symptom onset. Four patients showed findings compatible with status epilepticus, 2 displayed focal epileptiform activity, and 5 showed post-ictal slowing ipsilateral to perfusion CT abnormalities. Conclusion: The most sensitive parameter for differentiating between stroke and epilepsy in our series was increased time to peak in multilobar cortical locations in the absence of large-vessel occlusion and basal ganglia involvement. Multiparametric CT is a fast, readily available, and useful tool for the differential diagnosis of acute-onset neurological signs of epileptic origin in patients initially attended after code stroke activation

Usefulness of multiparametric computerized tomography findings in the differential diagnosis of stroke mimics of epileptic origin: A preliminary study. / Utilidad de la tomografía computarizada cerebral multiparamétrica en el diagnóstico diferencial de patología comicial en el código ictus. Estudio preliminar.

OBJECTIVE: Thirty percent of the patients for whom code stroke is activated have stroke mimics, the most common being epilepsy. Our purpose was to evaluate the usefulness of multiparametric CT for differentiating between seizure-related symptoms and vascular events. MATERIAL AND METHODS: We conducted a retrospective observational study; data were gathered prospectively during one year. We studied multiparametric CT images of patients admitted following code stroke activation and finally diagnosed with epilepsy. RESULTS: The study included a total of 11 patients; 36% were men and mean age was 74.5 years. Three patients had right hemisphere syndrome, 4 displayed left hemisphere syndrome, and the remaining 4 had isolated aphasia. Maximum time from symptom onset to multiparametric CT study was 8.16hours. Perfusion CT results were normal in 2 patients. Nine patients showed longer or shorter times to peak (Tmax); cerebral blood volume (CBV) and cerebral blood flow (CBF) maps varied. EEG was performed a maximum of 47.6hours after symptom onset. Four patients showed findings compatible with status epilepticus, 2 displayed focal epileptiform activity, and 5 showed post-ictal slowing ipsilateral to perfusion CT abnormalities. CONCLUSION: The most sensitive parameter for differentiating between stroke and epilepsy in our series was increased time to peak in multilobar cortical locations in the absence of large-vessel occlusion and basal ganglia involvement. Multiparametric CT is a fast, readily available, and useful tool for the differential diagnosis of acute-onset neurological signs of epileptic origin in patients initially attended after code stroke activation.

Longitudinal studies of ischemic penumbra by using 18F-FDG PET and MRI techniques in permanent and transient focal cerebral ischemia in rats.

At present, the goal of stroke research is the identification of a potential recoverable tissue surrounding the ischemic core, suggested as ischemic penumbra, with the aim of applying a treatment that attenuates the growth of this area. Our purpose was to determine whether a combination of imaging techniques, including (18)F-FDG PET and MRI could identify the penumbra area. Longitudinal studies of (18)F-FDG PET and MRI were performed in rats 3 h, 24 h and 48 h after the onset of ischemia. A transient and a permanent model of focal cerebral ischemia were performed. Regions of interest were located, covering the ischemic core, the border that progresses to infarction (recruited tissue), and the border that recovers (recoverable tissue) with early reperfusion. Analyses show that permanent ischemia produces severe damage, whereas the transient ischemia model does not produce clear damage in ADC maps at the earliest time studied. The only significant differences between values for recoverable tissue, (18)F-FDG (84±2%), ADC (108±5%) and PWI (70±8%), and recruited tissue, (18)F-FDG (77±3%), ADC (109±4%) and PWI (77±4%), are shown in (18)F-FDG ratios. We also show that recoverable tissue values are different from those in non-infarcted tissue. The combination of (18)F-FDG PET, ADC and PWI MRI is useful for identification of ischemic penumbra, with (18)F-FDG PET being the most sensitive approach to its study at early times after stroke, when a clear DWI deficit is not observed.

Somatotroph tumor progression during pegvisomant therapy: a clinical and molecular study.

CONTEXT: There is concern that pegvisomant could be associated with a higher risk of tumor growth. The rate and possible determinants of this tumor growth are unknown. OBJECTIVE: The objective of the study was to investigate the clinical, immunohistological, and molecular factors conditioning tumor growth in patients taking pegvisomant. DESIGN AND SETTING: This was a cross-sectional study performed from 2004 to 2010 in four university hospitals in Spain. PATIENTS: Seventy-five acromegalic patients with active disease resistant to somatostatin analogs treated with pegvisomant were followed up for a mean of 29 ± 20 months. MAIN OUTCOME MEASURES: Magnetic resonance images before initiation of pegvisomant, at 6 months, and then yearly were examined in all patients. Immunohistological and molecular studies were performed in tumors that grew. RESULTS: A significant increase in tumor size was observed in five patients (6.7%). Absence of previous irradiation (P = 0.014) and shorter duration of prepegvisomant somatostatin analog therapy (P < 0.001) were associated with an increased risk of tumor growth. A stepwise multivariate linear regression analysis (R(2) = 0.334, P < 0.001) identified the duration of somatostatin analog therapy prior to pegvisomant (beta = -4.509, P = 0.014) as the only significant predictor of tumor growth. In those tumors that grew, GH expression and insulin receptor expression were higher (P = 0.033 in both cases) than in the control group. CONCLUSIONS: No previous radiotherapy, shorter duration of prepegvisomant somatostatin analog therapy, and higher tumor expression of GH and insulin receptor could be risk factors for tumor growth during pegvisomant therapy.

Mielinolisis central pontina en trasplante hepático / Central pontine myelinolysis in a liver transplant recipient

La mielinolisis central pontina es un síndrome conocido desde hace más de 4 décadas y primariamente descrito en pacientes alcohólicos, que consiste en una desmielinización de la sustancia blanca cerebral. Su mecanismo fisiopatológico se basa en los cambios osmóticos producidos en esta estructura al corregirse de forma brusca una hiponatremia preexistente. El paciente que se somete a un trasplante hepático es, en la mayoría de las ocasiones, un cirrótico previo y en muchos casos de origen alcohólico. La hiponatremia en este grupo es la regla; es de origen multifactorial y está fundamentalmente en relación con la terapia que se les aplica para el control de la ascitis. Debemos extremar nuestros cuidados en la corrección de esta hiponatremia en el período perioperatorio del trasplante y detectar de forma temprana las alteraciones de conciencia en el postoperatorio inmediato, que deben alertarnos del desarrollo de este síndrome (AU)

Shock séptico secundario a absceso tiroideo / Septic shock secondary to thyroid abscess

El absceso tiroideo constituye una entidad infrecuente y es poco habitual que sea causa de un proceso séptico que requiera ingreso en la UCI. Son pocos los casos publicados en la bibliografía, en su mayoría relacionados con focos sépticos primarios o, más frecuentemente, con la persistencia del arco branquial, enfermedad tiroidea o en pacientes inmunodeprimidos. Presentamos el caso de una paciente con insuficiencia renal crónica y en programa de diálisis peritoneal ambulatoria sin enfermedad tiroidea previa conocida que comenzó con un cuadro séptico y edematización cervical y que evolucionó a un estado de shock séptico (AU)

Progressive multifocal leukoencephalopathy after stem cell transplantation, unsuccessfully treated with cidofovir.

We report a patient with progressive multifocal leukoencephalopathy (PML) after autologous stem cell transplantation (SCT) for non-Hodgkin's lymphoma (NHL). This is an unusual association, and to date only seven cases have been reported. This is the first case of PML after SCT treated with cidofovir, and the fifth case treated with this drug in a patient without human immunodeficiency virus (HIV) infection. In the previous four patients treated with cidofovir the outcome was discouraging, as was the case in this patient.

Edema pulmonar agudo tras embolismo aéreo venoso central / Acute pulmonary edema after central venous air embolism

Se describe el caso de un paciente que desarrolló un edema pulmonar durante el período postoperatorio de una intervención de resección de neurinoma del nervio acústico, mediante craniectomía retromastoidea en posición sedente, en la que se produjo un embolismo aéreo venoso central (EAVC).El edema pulmonar secundario a EAVC, aunque descrito ocasionalmente, parece ser una constante según hallazgos experimentales y relacionado con la distribución de burbujas gaseosas en la microcirculación pulmonar, que desencadenan una respuesta mediada por leucocitos polimorfonucleares, con aumento secundario de permeabilidad del endotelio alveolocapilar.Revisamos aspectos de la fisiopatología, tratamiento y prevención. Se requiere un diagnóstico temprano del embolismo gaseoso. En algunas intervenciones neuroquirúrgicas sería útil la monitorización conjunta mediante ETCO2 y Doppler precordial (AU)

Intraoral mandibular distraction osteogenesis: special attention to treatment planning.

PURPOSE: To demonstrate our experience using internal devices for unidirectional distraction osteogenesis in treating different mandibular hypoplasias (with or without maxillary deformities). An algorithmic table for diagnosis, and treatment planning is presented. PATIENTS AND METHODS: Twenty internal distraction devices were used in 16 patients with mandibular hypoplasia. Deficiency in length of the mandible was calculated on three-dimensional computed tomography scans. The device was activated by a transcutaneous pin on the fifth postoperative day. Distraction was achieved at rates of 0.5 mm/12 h. After a variable period of consolidation the devices were removed. Mean follow-up was 18 months. RESULTS: Successful distraction osteogenesis was achieved in all patients. No premature consolidation or pseudoarthrosis was observed. Improvement of facial aesthetics was produced in all cases. Final occlusion was excellent in those cases where no simultaneous maxillary deformity was present. Orthodontic treatment was applied in all cases. Results remained stable one year postoperatively. CONCLUSIONS: The occlusal results obtained in this series show that we can plan distraction as a definitive treatment in cases with isolated mandibular hypoplasia. When an additional maxillary deformity is present, mandibular distraction must be performed first if indicated, but a maxillary procedure will be necessary later.

La troponina I como predictor de morbilidad tras cirugía cardíaca con circulación extracorpórea / Troponin i for prediction of morbidity after cardiac surgery with cardiopulmonary bypass

Fundamento. La troponina I es un marcador específico y muy sensible del daño miocárdico. El infarto de miocardio perioperatorio tiene implicaciones pronósticas en la evolución del postoperatorio. El objetivo de nuestro estudio fue determinar la utilidad de la troponina I como predictor de morbilidad, así como de la estancia prolongada en la unidad de cuidados intensivos (UCI) en los pacientes sometidos a cirugía cardíaca. Material y método. Estudio prospectivo, observacional, analítico de cohortes. Se analiza la utilidad de la determinación de la troponina I en 217 pacientes intervenidos de cirugía cardíaca con circulación extracorpórea, en los días primero y cuarto del postoperatorio, estableciéndose mediante curvas ROC un punto de corte para obtener el mayor poder predictivo de morbilidad y estancia prolongada en UCI. Resultados. El valor de la troponina I a las 24 h en los pacientes que desarrollaron morbilidad fue de 20,8 (DE 17,8) ng/ml, frente a 8,7 (8,8) ng/ml en los pacientes que no la presentaron (p 4 días) para el mismo punto de corte presentó una sensibilidad del 64 por ciento y una especificidad del 67 por ciento. Conclusiones. La determinación de la troponina I sérica en el primer día del postoperatorio de cirugía cardíaca con circulación extracorpórea es un buen predictor de morbilidad y de estancia prolongada en UCI (AU)

[Bullous emphysema and neurofibromatosis]. / Enfisema bulloso y neurofibromatosis.

Clinical and image findings in a 43 year-old smoker man with advanced lung bullous emphysema and von Recklinhausen's neurofibromatosis are presented. Bullous emphysema and subpleural neurofibromas were detected in a chest computed tomographic study. The possible association or independence of these two conditions is discussed.

Enfisema bulloso y neurofibromatosis / Bullous emphysema and neurofibromatosis

Se describen los hallazgos clínicos y de imagen en un varón fumador de 43 años de edad con enfisema bulloso avanzado y neurofibromatosis de von Recklinghausen. El enfisema bulloso y los neurofibromas subpleurales se detectaron en una tomografa computarizada (TC) de tórax. Se discute la posible asociación o independencia de estas dos entidades (AU)

[Daily defined doses of parkinsonian drugs in Alcoi]. / Dosis diarias definidas de fármacos antiparkinsonianos en Alcoi.

BACKGROUND: Some authors have suggested that the use of DDD (defined daily doses) of L-dopa may be useful as an indicator of the frequency of Parkinson's disease. AIM: To determine the measurement for L-dopa and selegiline in Alcoi. MATERIAL AND METHODS: We have obtained the intakes for L-dopa and selegiline between January and December, 1990 and we have calculated the DDD/1,000 inhab/day. RESULTS: During the study period, we have found that the mean intakes were 18,000.969 mg and 53,800 mg for L-dopa and selegiline, respectively. And so, the L-dopa intake in Alcoi was 0.60 DDD/ 1,000 inh, and the selegiline intake was 0.21 DDD/1,000 inh. DISCUSSION: Comparing the other data of the literature, specially in scandinavian countries, the obtained intake for L-dopa was low, and that could indicate that the frequency of the disease in Alcoi was lower.

Schinzel-Giedion syndrome: report of two sibs.

We report on two further cases, a sister and a brother, with Schinzel-Giedion syndrome. Both presented the following manifestations: "coarse face" with midface retraction, agenesis of corpus callosum, bilateral hydronephrosis, and typical skeletal anomalies. Patient 1 had a malignant sacrococcygeal teratoma. This is the third case of malignancy in this syndrome. Patient 2 died shortly after birth.

Cardiovascular reflexes in Parkinson disease.

We have investigated the autonomic function of 95 patients with Parkinson disease (PD) by testing their cardiovascular reflexes and compared the results with those of 53 healthy volunteers. 51.1% of the patients were on antiparkinsonian therapy. The patients showed a smaller heart rate response to deep breathing with a mean exhalation-inspiration difference of 87.73 +/- 7 (p: 0.0005), a smaller heart rate response to standing with a mean 30: 15 index of 1.18 +/- 0.25 (p: 0.01), and a smaller blood pressure rise to handgrip with a mean rise of 9.53 +/- 8.76 mmHg (p: 0.005). We found a higher percentage of patients with established sympathetic lesion (41% vs 34%) or atypical patterns of global autonomic function involvement (33% vs 26%), but the percentage of subjects with parasympathetic lesion was similar in both, patients and controls (16% vs 15%). We found no significant difference on cardiovascular performance between treated and untreated patients. The patients with autonomic impairment were older than the patients with normal autonomic function. Our findings suggest that patients with PD have a true autonomic dysfunction.