Effect of a High-Intensity Tandem Bicycle Exercise Program on Clinical Severity, Functional Magnetic Resonance Imaging, and Plasma Biomarkers in Parkinson's Disease.

Rationale: The optimal modality, intensity, duration, frequency, and dose-response of exercise as a therapy for Parkinson's Disease (PD) are insufficiently understood. Objective: To assess the impact of a high-intensity tandem bicycle program on clinical severity, biomarkers, and functional MRI (fMRI) in PD. Methods: A single-center, parallel-group clinical trial was conducted. Thirteen PD patients aged 65 or younger were divided in two groups: a control group and an intervention group that incorporated a cycling program at 80% of each individual's maximum heart rate (HR) (≥80 rpm), three times a week, for 16 weeks. Both groups continued their conventional medications for PD. At baseline and at the end of follow-up, we determined in all participants the Unified Parkinson's Disease Rating Scale, anthropometry, VO2max, PD biomarkers, and fMRI. Results: VO2max improved in the intervention group (IG) (+5.7 ml/kg/min), while it slightly deteriorated in the control group (CG) (-1.6 ml/kg/min) (p = 0.041). Mean Unified Parkinson's Disease Rating Scale (UPDRS) went down by 5.7 points in the IG and showed a small 0.9-point increase in the CG (p = 0.11). fMRI showed activation of the right fusiform gyrus during the motor task and functional connectivity between the cingulum and areas of the frontal cortex, and between the cerebellar vermis and the thalamus and posterior temporal gyrus. Plasma brain-derived neurotrophic factor (BDNF) levels increased more than 10-fold in the IG and decreased in the CG (p = 0.028). Larger increases in plasma BDNF correlated with greater decreases in UPDRS (r = -0.58, p = 0.04). Conclusions: Our findings suggest that high-intensity tandem bicycle improves motor function and biochemical and functional neuroimaging variables in PD patients. Trial registration number: ISRCTN 13047118, Registered on February 8, 2018.

Motor cortex stimulation for facial chronic neuropathic pain: A review of the literature.

BACKGROUND: Facial chronic neuropathic pain (FCNP) is a disabling clinical entity, its incidence is increasing within the chronic pain population. There is indication for neuromodulation when conservative treatment fails. Motor cortex stimulation (MCS) has emerged as an alternative in the advanced management of these patients. The aim of this work is to review the worldwide literature on MCS for FCNP. METHODS: A PubMed search from 1990 to 2012 was conducted using established MeSH words. A total of 126 relevant articles on MCS focused on chronic pain were selected and analysed. Series of cases were divided in (1) series focused on MCS for FCNP, and (2) MCS series of FCNP mixed with other chronic pain entities. RESULTS: A total of 118 patients have been trialed for MCS for FCNP, 100 (84.7%) pursued permanent implantation of the system, and 84% of them had good pain control at the end of the study. Male: female ratio was about 1:2 in the whole group of studies; mean age was 58 years (range, 28-83), and mean pain duration was 7 years (range, 0.6-25). Four randomized controlled studies have been reported, all of them not focused on MCS for FCNP. The most common complication was seizure followed by wound infection. Preoperative evaluation, surgical techniques, and final settings varied among the series. CONCLUSION: MCS for FNCP is a safe and efficacious treatment option when previous managements have failed; however, there is still lack of strong evidence (larger randomized controlled multicentre studies) that MCS can be offered in a regular basis to FNCP patients.

Bilateral subthalamic deep brain stimulation after bilateral pallidal deep brain stimulation for Parkinson's disease.

BACKGROUND/OBJECTIVE: Globus pallidus internus (GPi) and subthalamic nucleus (STN) have successfully been targeted independently for deep brain stimulator (DBS) placement in medically intractable Parkinson's disease (PD). Bilateral implantation of STN DBS in a patient with preexisting, functioning GPi DBS to specifically treat motor fluctuations is, to our knowledge, yet unreported. CLINICAL PRESENTATION: We present a case of PD who had well-placed bilateral GPi DBS that controlled dyskinesia effectively and improved the motor symptoms like rigidity and akinesia. It did not improve her motor fluctuations and failed to reduce her medications. METHODS: We implanted bilateral STN DBS, which improved her 'on' time, reduced her medications and improved her motor scores. RESULTS/CONCLUSION: In this report we discuss the rationale, technical issues, programming nuances and outcome in a patient with preexisting bilateral GPi DBS who was implanted with bilateral STN DBS.

Bacteriemia por leuconostoc citreum en trauma craneoencefálico grave por proyectil de arma de fuego / Leuconostoc citreum bacteremia in severe head trauma by firearm missile

Se presenta el caso de un paciente con trauma craneoencefálico grave por proyectil de arma de fuego a quien se le documentó en el curso de su enfermedadbacteriemia por Leuconostoc citreum. Se presenta y se discute la evolución del paciente y su manejo antibiótico. Se discute la probable vía de entrada del germen al torrente sanguíneo y se revisa la literatura mundial. Lo inusual del caso motivó a los autores a publicarlo.

A case of severe head trauma by firearm missilesis presented; bacteremia by Leuconostoc citreumwas documented in the course of the disease. Theclinical course of the patient and the antibiotictreatment are presented and discussed. The pro-bable route of contamination and the entrance ofthe bacteria into the blood stream are discussedand the worldwide literature is reviewed. Therarity of this case encouraged the authors topublish it

Sui generis head trauma: a case with intracerebral phalanges.

In times of conflict, physicians can encounter all types of trauma, even uncommon trauma. The case we present is one of those cases. A 30-year-old, male, Army sergeant suffered polytrauma caused by fragmentation missiles and the shock wave from an antipersonnel mine in combat; the amputated fingers of the right hand produced ocular trauma, with loss of the right eyeball. The patient also suffered facial injuries and mild head trauma. Computed tomographic scans demonstrated intracerebral osseous objects. The patient underwent cranial wound debridement and dural repair, and several osseous objects, which corresponded to the victim's phalanges, were found in the cerebral parenchyma. In shock wave accidents, body parts from the victim can serve as missiles and can cause the same or greater damage, compared with conventional missiles. This is the first case of this kind of trauma published in the worldwide literature.

Oxigenoterapia hiperbárica en el tratamiento de la Cistitis hemorrágica posradioterapia: experiencia en el Hospital Militar Central / Hyperbaric oxigen therapy in treatmen post-radiotherapy hemorrhagic cystitis. Experience of Hospital Militar Central in Bogotá

El objetivo del trabajo fue describir el curso de la cistitis hemorrágica posradioterapia pélvica con la terapia de oxígeno hiperbárico (OTHB). Se hizo un estudio descriptivo retrospectivo, en el que se revisaron las historias de diez pacientes atendidos en el Servicio de Medicina Hiperbárica del Hospital Militar Central de Bogotá, remitidos del Servicio de Urología de la misma institución con el diagnóstico de cistitis hemorrágica postradioterapia, en un período comprendido entre enero de 2001 a febrero de 2007. Los resultados se tabularon con las variables preestablecidas y se procesaron en Excel. El 70 por ciento de los pacientes fueron hombres, la edad promedio fue 74,3 años (63-88), el 70 por ciento tuvo cistitis y proctitis posradioterapia y el restante sólo cistitis. Todos los hombres fueron irradiados por cáncer de próstata y las mujeres por cáncer de cérvix. El 40 por ciento recibió braquiterapia y el promedio de sesiones de OTHB fue de doce, en un rango entre siete y quince. El tiempo promedio de inicio de los síntomas fue de 16,4 meses y el de seguimiento después de iniciada la OTHB fue de 1,6 años. Al final del seguimiento todos los pacientes estuvieron asintomáticos, lo que permite concluir que la del OTHB es una alternativa útil y segura en el tratamiento de los pacientes con cistitis hemorrágica posradioterapia.

Carcinoma escamocelular intracerebral originario de un quiste epidermoide: reporte de un caso / Sgnamous carcinoma arising in a intracerebral epidermoid cyst

La frecuencia del quiste epidermoide es baja, su transformación maligna lo es aún más. Se presenta el caso de un quiste epidermoide parcialmente resecado que ocho años mas tarde cursó como carcinoma escamocelular