[Treatment of refractory aggressiveness by amygdalotomy and posteromedial hypothalamotomy by radiofrequency]. / Tratamiento de la agresividad refractaria mediante amigdalotomia e hipotalamotomia posteromedial por radiofrecuencia.

INTRODUCTION: Since, under certain circumstances, defensive or attacking behaviours display a pattern of motor dominance, as observed in subjects who participate in contact or fighting sports, aggressive behaviour was considered to have a dominant motor pattern. With the aim of preventing the functional problems reported with bilateral lesion procedures involving both the central nucleus of the amygdala and the posteromedial hypothalamus, the decision was made to combine them; thus, an amygdalotomy of the central nucleus of the amygdala and a posteromedial hypothalamotomy were to be performed simultaneously and unilaterally, on the basis of the motor dominance of the patient determined by means of the Edinburgh test. PATIENTS AND METHODS: This study describes the surgical experience in a series of nine patients diagnosed with refractory neuroaggressive syndrome. As part of the study protocol, a magnetic resonance brain scan was performed to rule out the presence of neoplasms, vascular diseases, infections and degenerative disorders. The degree of aggressiveness was quantified using Yudofsky's Overt Aggression Scale. Additionally, manual dominance was determined by means of the Edinburgh test. RESULTS AND CONCLUSIONS: Good control of aggressiveness was seen immediately. In some cases it was necessary to reduce the antipsychotic or benzodiazepine medication, as it was seen to increase aggressiveness. Only one case required a second surgical intervention. Follow-up was achieved in 100% of the cases at 24 months and 78% at 36 months.

TITLE: Tratamiento de la agresividad refractaria mediante amigdalotomia e hipotalamotomia posteromedial por radiofrecuencia.Introduccion. Dado que, en algunas circunstancias, las conductas defensivas o de ataque muestran un patron de dominancia motora, tal como se observa en los sujetos dedicados a los deportes de contacto o de lucha, se considero que la conducta agresiva tiene un patron motor dominante. Con el fin de evitar los problemas funcionales descritos con los procedimientos de lesion bilateral tanto del nucleo central de la amigdala como del hipotalamo posteromedial, se decidio combinarlos; es decir, realizar amigdalotomia del nucleo central de la amigdala e hipotalamotomia posteromedial de manera unilateral y simultanea, basandose en la dominancia motora del paciente mediante la prueba de Edimburgo. Pacientes y metodos. Este estudio muestra la experiencia quirurgica en una serie de nueve pacientes con el diagnostico de sindrome neuroagresivo resistente al tratamiento farmacologico. Dentro del protocolo de estudio, se les realizo resonancia magnetica cerebral para descartar la presencia de neoplasias, enfermedades vasculares, infecciones y trastornos degenerativos. El grado de agresividad se cuantifico mediante la escala global de agresividad de Yudofsky. Adicionalmente, se determino la dominancia manual a traves de la prueba de Edimburgo. Resultados y conclusiones. El buen control de la agresividad se observo de modo inmediato. En algunos casos fue necesario reducir la medicacion de antipsicoticos o benzodiacepinas, ya que aumentaban la agresividad. Solo un caso requirio una segunda cirugia. Se logro seguimiento del 100% de los casos en 24 meses y del 78% en 36 meses.

Maximization of the optical intra-cavity power of whispering-gallery mode resonators via coupling prism.

In this paper, a detailed description of the optical coupling into a Whispering Gallery Mode (WGM) resonator through a prism via frustrated total internal reflection (FTIR) is presented. The problem is modeled as three media with planar interfaces and closed expressions for FTIR are given. Then, the curvature of the resonator is taken into account and the mode overlap is theoretically studied. A new analytical expression giving the optimal geometry of a disc-shaped or ring-shaped resonator for maximizing the intra-cavity circulating power is presented. Such expression takes into consideration the spatial distribution of the WGM at the surface of the resonator, thus being more accurate than the currently used expressions. It also takes into account the geometry of the prism. It is shown an improvement in the geometry values used with the current expressions of about 30%. The reason why the pump laser signal can be seen in experiments under critical coupling is explained on this basis. Then, the conditions required for exciting the highest possible optical power inside the resonator are obtained. The aim is to achieve a highly-efficient up-conversion of a THz signal into the optical domain via the second-order nonlinearity of the resonator material.

[Radiosurgery in the treatment of brain cavernomas. Experience with 17 lesions treated in 15 patients]. / La radiochirurgie dans le traitement des cavernomes. Expérience de 17 lésions traitées chez 15 patients.

The aim of this study is to assess the efficiency of radiosurgery (RS) in the treatment of brain cavernomas. The series included intra-axial 17 lesions in 15 patients, 10 women and 5 men. Eleven were infratentorial lesions (brain stem and cerebellum) and 6 supratentorial (thalamus, hippocampus, brain cortex and paraventricular region). Fifteen lesions bled once or twice. Two lesions revealed by focal epilepsy displayed a rim of hemosiderin on MRI. RS was performed for all 17 lesions. The risk of morbidity was considered too high for surgery in 13 patients and 2 patients wished to be treated by RS. RS was delivered by a 6 MeV linear accelerator with a conic collimators device. Stereotactic localization and dosimetry were carried out with STP system 3.O (Fischer-Liebinger TM, Germany). Doses ranged between 16 and 23 Gy, the lower doses being delivered to brain stem lesions. All the lesions received a single fraction isocentric radiation. Lesion volumes ranged between 0.7 and 4.7 cm(3). Twelve lesions disappeared on MRI, the volume reduced (50-80%) in 3 lesions, and did not change in 2 lesions. Volume reduction was significant (P<0.01, P<0.001). In the follow up, 4 patients experienced bleeding, 1 of them died. Edema diagnosed in 2 patients at 3 and 13 months was treated by corticosteroids. The risk of hemorrhage without treatment in this group of patients was estimated about 34.45% a year. Hemorrhage incidence observed after RS was 7.17% (significant with P<0.01, P<0.001). At the end of follow up, 12 patients were symptom-free, 2 had sequels from bleeding, 1 patient died. Radiosurgery is an efficient treatment of cavernomas leading to a total disappearance of 70% of the lesions and significantly reducing the risk of new hemorrhages.

[Botulin toxin as treatment for spasticity and dystonia in infantile cerebral paralysis]. / Toxina botulínica como tratamiento de la espasticidad y distonía en la parálisis cerebral infantil.

UNLABELLED: Treatment of spasticity and dystonía in PCI with Botulinum toxin A. BACKGROUND: Botulinum-A (NxTxBoA) toxin produce neuromuscular blockade, it has been effective with therapeutic purposes in strabismus, focal dystonias and spasticity. OBJECTIVE: Evaluate the therapeutically effects off NxTxBoA in cerebral palsy (CP) spastic and/or dystonic in children. Prospective study. MATERIAL AND METHODS: 12 CP patients (8 spastic and 4 spastic/dystonic) were treated with NxTxBoA in affected muscles at least for 2 doses by up 12 months. The indication was: improve limb function, to avoid surgical correction or improve hygienic or dressing. Ashworth Spasticity Scale (ASS), functional scale for Dystonic Sindou-Millet (SMS) and O'Brien Global Assessment Scale (OGAS) were used to evaluate improvement. STATISTICAL METHODS: No parametric tests, Wilcoxon's rang's test and sign test were used with p < 0.05. RESULTS: Total doses session was 3-10 U/kg. AAS showed muscle spasticity improvement in two grades in 8 patients, and one grade in the rest (p = 0.004). SMS showed the muscle dystonic improve up 60% in two patients improve 50% in others (p = 0.006). OGAS demonstrated a good correlation. Mean treatment effect during 4.8 months (rank 4 to 10 m). Two patients had side effects, general weakness, instability, and focal haematoma. CONCLUSIONS: Botulinum toxin type A proved a highly useful adjuvant therapy and conservative management in CP.

Specific inhibition of Photobacterium phosphoreum extends the shelf life of modified-atmosphere-packed cod fillets.

Inhibition of the specific spoilage organism, Photobacterium phosphoreum, was studied in model substrates and in modified-atmosphere-packed cod fillets. The objective was to determine how inhibition of this organism influenced spoilage. The spoilage reactions limiting shelf life were studied rather than the development of a new product. In naturally contaminated modified-atmosphere-packed cod fillets, 500 ppm Na2CaEDTA reduced the growth rate of P. phosphoreum by 40% and shelf life was increased proportionally by 40%, from 15 to 17 days to 21 to 23 days at 0 degree C. In aerobically stored cod fillets other microorganisms were responsible for spoilage and Na2CaEDTA had no effect on shelf life. The extension of the shelf life of modified-atmosphere-packed cod therefore was a result of the reduced growth of P. phosphoreum and no other microbial or nonmicrobial spoilage reactions limited shelf life. These results confirmed P. phosphoreum as the specific spoilage organism in modified-atmosphere-packed cod and showed the organism to have an extensive spoilage domain. Consequently, any preservation procedure able to reduce growth of P. phosphoreum is likely to extend shelf life of packed cod. However, the effect of different inhibitory compounds in model systems as well as results from packed cod indicated the need to include product studies in the screening of antimicrobials and in the development of preservation procedures.