Diagnóstico e tratamento de convulsões / Diagnosis and treatment of convulsions

As características, as causas, os cursos e os tratamentos dos vários tipos de convulsões serão aqui apresentados. Os tipos mais comuns de desordens convulsivas são: 1. grande mal, às vezes chamada tônico-clônica generalizada; 2. ausência ou pequeno mal; 3. psicomotora ou complexa parcial; 4. mioclônica ou espasmo convulsivo; e 5. febril, em crianças pequenas. Os tipos de convulsões mais raras são: status epilepticus; atônica; parcial; jacksoniana; e espasmo infantil.

The characteristics, causes, treatment and courses of various types of convulsive disorders are presented here. The most common types of convulsive disorders are: 1. great evil, sometimes called generalized tonic-clonic; 2. absence or petit mal; 3. psychomotor or complex partial; 4. myoclonic or convulsive spasm; and 5. febrile, illness in young children. The types of convulsions are rare: status epilepticus; atonic; partial; jacksonian; and infantile spasms.

Diagnóstico e tratamento de dores de cabeça / Diagnosis and treatment of headaches

Os vários tipos de dores de cabeça são: 1. cefaléias 1. cefaléias causadas por tensão na camada fina de músculos entre os ossos e o couro cabeludo; 2. enxaquecas; 3. dores de cabeça pós-traumáticas; 4. cefaleias que envolvem problemas especiais e crianças com menos de sete anos de vida; e 5. outros tipos, como cefaleias em cachos (cluster) crianças com menos de sete anos de vida; e 5. outros tipos, como cefaléias em cachos (cluster), dores produzidas por sinusite e dores de cabeça durante a gravidez ou a velhice. São apresentados os diagnósticos e tratamentos de todas estas cefaléias.

The varios kinds of headaches are: 1. headache produced by tension in thin layer o muscles between the bones and the skin of the head; 2. migraine headaches; 3. postraumatic headaches; 4. headaches involving special problems in children who are less than seven years old; and 5. miscellaneous other types such as cluster headaches, sinus infection headaches and headaches during pregnancy and old age. The diagnosis and treatment of each of these kinds of headaches are discurssed.

Precautions to be taken by radiologists and radiographers when prescribing hyoscine-N-butylbromide.

Hyoscine-N-butylbromide (Buscopan, Boehringer Ingelheim) is a widely used antispasmodic in radiological practice. There seems to be no consensus as to best practice within radiology regarding the precautions that need to be taken when prescribing Buscopan. We have performed a thorough review of the available literature and make the following recommendations to those administering Buscopan: (1) enquire whether there is an allergic history; (2) ensure patient literature warns that "in the rare event that following the examination you develop painful, blurred vision in one or both eyes, you must attend hospital immediately for assessment"; (3) warn patients to expect blurred vision and not to drive until this has worn off; (4) remind clinicians that special consideration needs to be given as to the method of investigating patients with cardiac instability, such as those recently admitted with acute coronary syndrome, recurrent cardiac pain at rest, uncontrolled left ventricular failure and recent ventricular arrhythmias.

Doença do aniversário com sintomas psiquiátricos e neurológicos / Birthday disease with psychiatric and neurological symptoms

Este caso apresenta uma doença de três semanas, com sintomas psiquiátricos e neurológicos, em uma mulher com 32 anos de idade, que exatamente no 10º aniversário da morte de sua avó, que a havia criado, teve início súbito de uma depressão severa, ansiedade e sintomas dissociativos e conversivos. Apresentou ataxia severa. Recuperou-se rapidamente quando a natureza de sua doença foi esclarecida. Ela e sua família, até então, não tinham consciência desta conexão. A literatura médica sobre a doença do aniversário será apresentada.

The case is presented of a three week illness with psychiatric and neurological symptoms of a 32-years-old woman who on exactly the 10th anniversary of the death of her grandmother, who had reared her, had the sudden onset of severe depressiveness, anxiety and dissociative and conversion symptoms. She had marked ataxia. She recovered quickly when the nature of her illness was clarified. She and her family had until this time been unaware of this connection. The medical literature on anniversary illness is revied.

A double-blind randomised, placebo-controlled trial evaluating the influence of oral long-acting muscle relaxant (Mebeverine MR), and insufflation with CO(2) on pain associated with barium enema.

Previous investigators have shown significant benefit using CO(2) for bowel insufflation. Others have suggested that the long-acting smooth muscle relaxant, Mebeverine, may be of benefit. We subjected this to a randomised double-blind trial. A total of 181 outpatients were randomised to receive either Mebeverine or placebo as pre-medication, and either air or CO(2) for bowel insufflation, thus creating four treatment groups. Visual-analogue lines were used to record pain scores before, during, and up to 8 h following the enema. All groups showed increased pain scores during the enema, with peak pain scores at the end of the examination, falling to baseline scores by 8 h. Patients receiving the combination of C0(2) and placebo had significantly lower pain scores at 1 and 4 h ( P=0.00 and P=0.014, respectively; Kruskal-Wallis test) compared with all other groups. Having Mebeverine as a pre-medication did not significantly lower pain scores compared with placebo, and decreased the amount of benefit received from the CO(2). We confirm that CO(2) is of benefit in decreasing pain during barium enema, and we recommend its routine use to improve the comfort of patients. Mebeverine is not of benefit, and its use as a pre-medication for enemas is not recommended.

Double contrast barium enema sensitivity: a comparison of studies by radiographers and radiologists.

PURPOSE: A retrospective study of histologically proven cases of colorectal cancer (CRC) was performed to assess whether the sensitivity of the radiographer-performed double contrast barium enema (DCBE) differed from that of the radiologist-performed study. MATERIALS AND METHODS: Histologically proven cases of CRC were reviewed over a 3-year period to ascertain whether: the diagnosis had been made by DCBE in the 3 years before histological diagnosis; the lesion had been correctly diagnosed; the examination had been performed by a radiologist or radiographer. RESULTS: In the 3-year period there were 478 cases with histologically proven CRC. Of these, 239 (50%) had undergone DCBE as the initial radiological investigation of the colon. Sixty-four examinations had been performed by radiographers. A correct diagnosis was made in 58 cases (90.6%), the report was equivocal in one case (1.6%), there were four false-negatives (6.25%), and one case was abandoned (1.6%). One hundred and seventy-five examinations were performed by radiologists. A correct diagnosis was made in 157 cases (89.7%), the report was equivocal in one case (0.6%), there were 16 false-negatives (9.1%), and one case was abandoned (0.6%). CONCLUSION: A sensitivity of 90.6% for radiographer-performed studies compared favourably with 89.7% for radiologist-performed studies and supports the practice of radiographers undertaking barium enemas.

Strictures of the sigmoid colon: barium enema evaluation.

PURPOSE: To assess the accuracy of radiologic interpretation, in the absence of clinical information, in the differentiation of benign and malignant sigmoid strictures at barium enema examination. MATERIALS AND METHODS: On two occasions, four independent observers retrospectively assessed examination findings in 78 patients with documented sigmoid strictures (43 benign, 35 malignant). Each stricture was graded by using a five-point scale (definitely malignant to definitely benign). RESULTS: No significant difference existed between the areas under the receiver operating characteristic curves for the two assessments with any observer. Consensus findings indicated agreement among at least three of the four observers in 68 (87%) and 66 (85%) cases at the first and second assessments, respectively. One benign stricture was called malignant at both assessments. When consensus existed, the positive predictive value for malignant strictures was 96% at both assessments (sensitivity, 63% and 66%). Nine malignant strictures were called benign, three at both assessments. When consensus existed, the positive predictive value for benign strictures was 84% and 88% at the first and second assessments, respectively (sensitivity, 88% and 86%, respectively). CONCLUSION: The differentiation between a benign and a malignant sigmoid stricture can be made in most cases at barium enema examination. When a stricture appears malignant, the diagnosis is usually correct, but caution is advised when a stricture appears benign.

Machado de Assis's own writings about his epilepsy: a brief clinical note.

Machado de Assis's own writings about his epilepsy are here given. They come from his correspondence with his friend Mario de Alencar during the last 8 months of Machado de Assis's life. These are the only places where Machado de Assis dealt clearly with his epilepsy during his entire life.

Machado de Assis's own writings about his epilepsy: a brief clinical note

Machado de Assis's own writings about his epilepsy are here given. They come from his correspondence with his friend Mario de Alencar during the last 8 months of Machado de Assis's life. These are the only places where Machado de Assis dealt clearly with his epilepsy during his entire life

Gastroduodenal obstruction from ovarian cancer: imaging features and clinical outcome.

OBJECTIVE: The purpose of this study was to describe the imaging features and clinical significance of gastroduodenal obstruction from ovarian cancer. MATERIALS AND METHODS: Eleven women with symptomatic gastroduodenal obstruction were identified over a 3-year period of prospective clinicoradiological review of cases managed in a specialist gynaecological oncology unit, during which period 438 women with ovarian cancer were managed. Imaging features were verified by surgery, intervention and clinicoradiological follow-up for a minimum of 12 months or until death. Management and outcome were independently reviewed by a medical oncologist not involved in primary care. RESULTS: The frequency of gastroduodenal obstruction was 2.5% (11 of 438 women). Disease stages of these women at initial diagnosis were: stage II (four women), stage III (six), stage IV (one). Histology was grade 3 in eight of the 11 women. Symptomatic gastroduodenal relapse occurred at 9-103 months after initial diagnosis (median 20 months). There were five cases of predominant involvement of the gastric body and six of the gastric outlet and duodenum. In six cases, focal mass disease resulted in obstruction, in two cases there was diffuse gastric invasion, and in three cases encysted malignant ascites in the lesser sac caused gastric compression/obstruction - the 'squashed stomach syndrome'. Diagnosis of obstruction was with CT in 10 of 11 cases. Palliative interventional procedures relieved symptoms in these three cases, surgery was performed in three cases and the remainder were treated with chemotherapy and other palliative measures. Two women are alive and well at 16 and 38 months who had loculated ascitic disease. Otherwise median survival was 5 months after symptomatic gastroduodenal involvement. CONCLUSIONS: Gastroduodenal obstruction is rare in women with ovarian cancer. Identification and drainage of encysted lesser sac ascites as its cause may be associated with long term survival, otherwise the prognosis is poor. CT accurately demonstrates the level and cause of obstruction and gives information about the wider extent of recurrent disease.

The use, value and safety of herniography.

AIMS: To assess the safety, sensitivity and specificity of out-patient herniography when used to diagnose hernias in the presence of a normal or equivocal physical examination. MATERIALS AND METHODS: This retrospective study reviewed the symptoms, clinical findings, radiological findings, surgical findings and clinical outcome of 112 patients referred for herniography over a 5-year period. RESULTS: No significant complications were encountered. Thirty hernias were diagnosed. There was one false-positive and one false-negative examination giving herniography a sensitivity of 96.6% and a specificity of 98.4%. CONCLUSION: Herniography is a sensitive, specific, safe and reliable investigation which should be available to and used by all surgeons who perform hernia repair operations.

Uso e abuso de EEGs / Use and abuse of EEGs

Médicos no Brasil e também nos Estados Unidos adquirem, durante seus anos de treinamento, conhecimentos adequados sobre eletrocardiogramas, exames de raio X, tomografia computadorizada, ultra-sonografia e outros exames. Em geral, eles não obtêm informações semelhantes da natureza, uso e limitações de eletroencefalogramas (EEGs). Este artigo trata de algumas das falhas mais comuns de médicos não-especialistas em Neurologia e Psiquiatria: 1. EEGs não dão informações sobre as personalidades e os estados emocionais e intelectuais dos pacientes; 2. EEGs podem ser úteis na avaliação e tratamento de pacientes com dores de cabeça somente se o médico enfatiza que a maioria das cefaléias não está relacionada ao cérebro, mas tem as suas causas nas tensões das camadas musculares da cabeça e em outras estruturas não-cerebrais da cabeça; 3. EEGs são de muito valor no diagnóstico de ausências (epilepsia pequeno mal) mas para obter este valor o médico tem de entender bem a natureza deste tipo de convulsão; 4. EEGs têm utilidade no diagnóstico de epilepsia grande mal, mas eles possuem limitações neste campo; 5. EEGs são úteis no tratamento de pacientes com traumatismo craniano leve, mas neste caso eles também têm de ser utilizados nos contextos da situação total da vida do doente, e o significado do seu traumatismo craniano deverá ser explicado. O artigo trata ligeiramente de outros assuntos semelhantes