[Intermittent theta-burst transcranial magnetic stimulation for the treatment of spasticity in patients with recurring multiple sclerosis: the results of a double-blind randomised clinical trial]. / Estimulacion magnetica transcraneal theta-burst intermitente para el tratamiento de la espasticidad en pacientes con esclerosis multiple recurrente: resultados de un ensayo clinico aleatorizado doble ciego.

AIM: It has been suggested that the repetitive transcranial magnetic stimulation could be useful as a non-pharmacological treatment for spasticity. The aim of this study was to evaluate the clinical and neurophysiological effects of high-frequency intermittent theta burst stimulation (iTBS) on lower limb spasticity in patients with relapsing multiple sclerosis in a randomized, double-blind placebo controlled trial. PATIENTS AND METHODS: Seventeen patients in the remitting phase of the disease were randomly allocated to sham or magnetic therapy group and underwent iTBS over contralateral motor cortex of the most affected leg once a day for two weeks. Each session consisted of 10 bursts containing three pulses at 50 Hz repeated at 200 ms intervals (5 Hz) every 10 s for a total of 600 stimuli. The iTBS effect was assessed by using clinical (such as the Modified Ashworth Scale) and neuro-physiological (H/M amplitude ratio and cortical silent period duration) parameters. RESULTS: Two-week iTBS over motor cortex of the most affected leg did not produce any significant clinical effect on spasticity. However, it decreases the H/M amplitude ratio and increases duration of cortical silent period but not significantly, in patients with relapsing multiple sclerosis. CONCLUSION: The stimulation protocol used in this study does not have significant therapeutic effect. Therefore, we do recommend further studies as neurophysiological changes were evident.

TITLE: Estimulacion magnetica transcraneal theta-burst intermitente para el tratamiento de la espasticidad en pacientes con esclerosis multiple recurrente: resultados de un ensayo clinico aleatorizado doble ciego.Objetivo. La estimulacion magnetica transcraneal repetitiva podria ser util como tratamiento no farmacologico para la espasticidad. El objetivo de este estudio es reevaluar el efecto clinico y los cambios neurofisiologicos que produce la estimulacion theta-burst intermitente (ETBi) sobre la espasticidad de las extremidades inferiores en pacientes con esclerosis multiple recurrente en un ensayo aleatorizado, doble ciego, controlado con placebo. Pacientes y metodos. Diecisiete pacientes en la fase remitente de la enfermedad fueron aleatoriamente asignados al grupo placebo o al grupo de tratamiento activo mediante estimulacion magnetica transcraneal repetitiva con protocolo ETBi sobre la corteza motora contralateral de la pierna mas afectada. El procedimiento consistio en 10 sesiones diarias durante dos semanas. Cada sesion consistio en 10 rafagas que contenian tres pulsos a 50 Hz repetidos a intervalos de 200 ms (5 Hz) cada 10 s para un total de 600 estimulos. El efecto de ETBi se evaluo mediante el uso de parametros clinicos (como la escala de Ashworth modificada) y neurofisiologicos (ratio de amplitud H/M y duracion del periodo cortical silente). Resultados. Dos semanas de ETBi sobre la corteza motora de la pierna mas afectada no produjeron ningun efecto clinico significativo sobre la espasticidad en pacientes con esclerosis multiple recurrente. Sin embargo, aunque de forma no significativa, se observo disminucion de la ratio de amplitud H/M y un aumento de la duracion del periodo cortical silente. Conclusion. El protocolo de estimulacion utilizado en este estudio no parece tener un efecto terapeutico significativo. Sin embargo, recomendamos estudios adicionales, ya que los cambios neurofisiologicos fueron evidentes.

Multiple sclerosis following a spinal cord injury: a rare and unfortunate case.

This is a case report and review of literature with the objective report of the case of a young man with physical disability following a traumatic spinal cord injury (SCI) who was later newly diagnosed with multiple sclerosis (MS) in an inpatient SCI rehabilitation center. (Barcelona, Spain). A 24-year-old male sustained a traumatic spinal cord lesion (T9 AIS A) as the result of a motorcycle accident. He completed his rehabilitation process without complications and returned to the community having adjusted to his new disability. Two and a half years after his initial injury, he attended the clinic after experiencing 2 months of paresthesias in his left hand, progressing to his right upper limb, and difficulty with fine hand movements. An magnetic resonance imaging (MRI) was arranged and although post-traumatic syringomyelia was ruled out, demyelinating areas in the cervical spinal cord were found. A brain MRI revealed multiple demyelinating lesions suggestive of MS. The diagnosis of MS was confirmed by a neurologist and treatment was started with daily doses of glatiramer acetate. At this time the patient was still independent in transfers, activities of daily living and wheelchair management. In young patients with SCI, adequate follow-up is important to detect subsequent complications that may lead to clinical and functional deterioration with a view to uncommon causes such as MS.

Rotación de los cuerpos cavernosos para el tratamiento de la incurvación peneana congénita / Rotation of the corpora cavernosa for the treatment of congenital penile curvature

Introducción: La incurvación peneana congénita (IPC) está originada por una alteración en el desarrollo embrionario de la uretra y los cuerpos cavernosos. Condiciona dificultad para la penetración, precisando corrección quirúrgica cuando imposibilita el coito. Material y métodos: Presentamos 2 varones en la 4.ª década de la vida que presentan incurvación ventral superior a 60° de 2 años de evolución con erecciones mantenidas. Los pacientes fueron sometidos a cirugía de rotación de los cuerpos cavernosos. Tras la denudación completa del pene se realiza la liberación atérmica del paquete vasculonorvioso del pene desde la cara ventral hasta la dorsal. Una vez evidenciada la incurvación mediante una erección artificial se realiza una incisión en la albugínea de ambos cuerpos cavernosos, suturando de forma continua con monofilamento reabsorbible ambos bordes internos y externos. Posteriormente se comprueba la rectificación de la incurvación y se reconstruye el plano mucocutáneo. Resultados: El tiempo quirúrgico fue de 120 min, no existiendo complicaciones intraoperatorias. Ambos pacientes fueron dados de alta a las 24 h de la intervención. A la semana presentaban erecciones nocturnas espontáneas, pudiendo mantener relaciones sexuales al mes de la intervención. A los 6 meses la incurvación residual era inferior a 20°, el acortamiento peneano inferior al centímetro y el IIEF-5 de 25 en ambos casos. Conclusiones: La cirugía de rotación de los cuerpos cavernosos permite corregir la IPC sin acortamiento peneano significativo ni disfunción eréctil. En nuestra opinión constituye un tratamiento adecuado en pacientes con IPC, necesitándose estudios con seguimientos a largo plazo para considerarla la técnica de elección

Introduction: Congenital penile curvature (CPC) is caused by a disorder in the embryonic development of the urethra and corpora cavernosa. The condition causes difficulty for penetration, requiring surgical correction when it prevents intercourse. Material and methods: We present the cases of 2 men in their 40s who had ventral curvature greater than 60° of 2 years of evolution, with maintained erections. The patients underwent surgery for rotation of the corpora cavernosa. After the complete denudation of the penis, athermal release of the neurovascular bundle of the penis from the ventral side to the dorsal was performed. Once the curvature was verified using artificial erection, an incision was performed in the tunica albuginea of both corpora cavernosa, continuously suturing both internal and external margins with resorbable monofilament. The rectification of the curvature was then checked, and the mucocutaneous plane was reconstructed. Results: The surgical time was 120 minutes and there were no intraoperative complications. Both patients were discharged 24 h after the surgery. At 1 week, the patients experienced spontaneous night-time erections and were able to maintain sexual relations 1 month after the surgery. At 6 months, the residual curvature was less than 20°, the penile shortening was less than 1 centimeter and the International Index of Erectile Function-5 was 25 for both cases. Conclusions: Surgery for rotation of the corpora cavernosa helps correct CPC without significant penile shortening or erectile dysfunction. In our opinion, the procedure is an appropriate treatment for patients with CPC but requires studies with long-term follow-up in order to consider it the technique of choice

Rotation of the corpora cavernosa for the treatment of congenital penile curvature.

INTRODUCTION: Congenital penile curvature (CPC) is caused by a disorder in the embryonic development of the urethra and corpora cavernosa. The condition causes difficulty for penetration, requiring surgical correction when it prevents intercourse. MATERIAL AND METHODS: We present the cases of 2 men in their 40s who had ventral curvature greater than 60° of 2 years of evolution, with maintained erections. The patients underwent surgery for rotation of the corpora cavernosa. After the complete denudation of the penis, athermal release of the neurovascular bundle of the penis from the ventral side to the dorsal was performed. Once the curvature was verified using artificial erection, an incision was performed in the tunica albuginea of both corpora cavernosa, continuously suturing both internal and external margins with resorbable monofilament. The rectification of the curvature was then checked, and the mucocutaneous plane was reconstructed. RESULTS: The surgical time was 120minutes and there were no intraoperative complications. Both patients were discharged 24h after the surgery. At 1 week, the patients experienced spontaneous night-time erections and were able to maintain sexual relations 1 month after the surgery. At 6 months, the residual curvature was less than 20°, the penile shortening was less than 1 centimeter and the International Index of Erectile Function-5 was 25 for both cases. CONCLUSIONS: Surgery for rotation of the corpora cavernosa helps correct CPC without significant penile shortening or erectile dysfunction. In our opinion, the procedure is an appropriate treatment for patients with CPC but requires studies with long-term follow-up in order to consider it the technique of choice.

Osificación heterotópica neurógena. Veinte años después de una lesión medular traumática / Neurogenic heterotopic ossification. Twenty years after a traumatic spinal cord injury

Paciente con lesión medular cervical C8-D1 postraumática desde hace 22 años, ASIA B, que inicia de forma aguda un cuadro de eritema e induración en la cara anterointerna del muslo derecho. La exploración y las pruebas complementarias concluyen que se trata de una osificación heterotópica neurógena (OHN), aunque no presenta factores de riesgo para su desarrollo. Se inicia tratamiento con prednisona y etidronato disódico con mejoría clínica y radiológica, aunque en el último control de imagen persiste la calcificación. La OHN es una complicación común en el lesionado medular traumático durante la fase aguda o subaguda. Sin embargo, apenas se han descrito casos años después de la lesión, y los que se han publicado hacen referencia a la presencia de algún factor de riesgo predisponente. En el caso que se describe, la dificultad para un correcto diagnóstico condicionó un tratamiento tardío, aunque la evolución clínica fue favorable (AU)

The case of a patient with a post-traumatic C8-D1 spinal cord ASIA B injury that occurred 22 years ago is presented. The patient initiated with acute erythema and induration at the anteromedial aspect of the right thigh. Examination and complementary tests confirmed the diagnosis of neurogenic heterotopic ossification (NHO). However, the patient did not have risk factors for NHO development. Treatment was started with prednisone and etidronate disodium with clinical and radiological improvement. Nonetheless, calcification persisted in the last imaging control. NHO is a common complication in the acute or subacute phase of post-traumatic spinal cord injuries. However, cases have been rarely reported in the years following the injury. Those found in the literature include predisposing risk factors. In our case, the difficulty to reach a correct diagnosis led to late treatment. Even so, the outcome was favorable (AU)

Los tipos de estudios que publicamos / The types of studies we publish

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Publicación duplicada o redundante: conducta incorrecta en la actividad científica / Duplicated or redundant publication: incorrect conduct in scientific activity

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[Classification of Klebsiella strains with lectins]. / Clasificación de cepas de Klebsiella con lectinas.

Fourteen different plant seeds were used to obtain lectins which in turn were used to agglutinate 72 different serological strains of Klebsiella. The results were used to design a scheme which distinguishes 62 serotypes (91.6%) with a unique agglutination pattern with lectins. Two pairs of strains as well as two sets of three strains gave the same patterns. This procedure is useful as an alternative in the identification of strains for epidemiological purposes.