Expresión inmunohistoquímica de VEGFR1 en carcinomas de pulmón de células no pequeñas: La expresión inferior de VEGFR1 se asocia con el subtipo de carcinoma de células escamosas y los valores elevados en SUVmáx en PET de 18F-FDG / Immunohistochemical expression of VEGFR1 in non small cell lung carcinomas: Lower VEGFR1 expression is asociated with squamous cell carcinoma subtype and high max SUV values in 18F-FDG PET

Antecedentes: Estudiar la posible relación entre la expresión inmunohistoquímica del receptor 1 del factor de crecimiento endotelial vascular (VEGFR1) y el valor máximo de captación estandarizada (SUVmáx) de la PET 18F-FDG en pacientes con cáncer de pulmón de células no pequeñas.Material y métodos:El estudio incluyó 39 pacientes con NSCLC (24 carcinomas de células escamosas y 15 adenocarcinomas). Según el estadio clínico, los pacientes se distribuyeron de la siguiente manera: 8 en estadio I, 7 en estadio II, 15 en estadio III y 9 en estadio IV. Se estudió la expresión inmunohistoquímica del VEGFR1 mediante la técnica de la matriz tisular utilizando el dispositivo de arreglo de tejidos (Beecher Instruments, Sun Prairie, WI), utilizando el anticuerpo policlonal contra el VEGFR1 (Santa Cruz Biotechnology, California, EE. UU.).Resultados: Se observó una expresión inmunohistoquímica positiva del VEGFR1 en 23 casos (59%). El número de tumores positivos no se relacionó con el estadio clínico pero hubo una asociación estadísticamente significativa diferente (p: 0,0009) entre la positividad de VEGFR1 y el tipo histológico, correspondiendo los mayores porcentajes de resultados positivos a los adenocarcinomas (93,3%) frente a los carcinomas escamocelulares (37,5%). Asimismo, los valores SUVmáx fueron mayores (p: 0,039) en los carcinomas VEGFR1 negativos que en los tumores VEGFR1 positivos (r: 4-32,1; 16,4+/-6,4 [mediana 16,1] vs. r: 3-47; 14,5+/-8,6 [12,8]).Conclusiones: Nuestros resultados nos llevaron a considerar que en el CPCNP, la expresión inmunohistoquímica negativa de VEGFR1 se asocia significativamente con el subtipo de carcinomas de células escamosas y con valores SUVmáx más altos en 18F-FDG-PET (AU)

Background: To study the possible relation between immunohistochemical expression of vascular endothelial growth factor receptor 1 (VEGFR1) and the maximum standardised uptake value (maxSUV) of 18F-FDG PET in patients with non small cell lung cancer.Material and methods: The study included 39 patients with NSCLC (24 squamous cell carcinomas and 15 adenocarcinomas). According to the clinical stage, the patients were distributed as follows: 8 stage I, 7 stage II, 15 stage III and 9 stage IV. Immunohistochemical expression of VEGFR1 was studied through the technique of tissue-matrix using tissue arrayer device (Beecher Instruments, Sun Prairie, WI), using the polyclonal antibody against VEGFR1 (Santa Cruz Biotechnology, California, USA).Results: Positive VEGFR1 immunohistochemical expression was noted in 23 cases (59%). The number of positive tumours was not related with clinical stage but there was a different statistically significant association (p:.0009) between VEGFR1 positivity and histological type, corresponding the greater percentages of positive results to adenocarcinomas (93.3%) versus in squamous cell carcinomas (37.5%). Likewise, maxSUV values were higher (p: .039) in negative VEGFR1 carcinomas than in positive VEGFR1 tumors (r: 4-32.1; 16.4+/-6.4 [median 16.1] vs. r: 3-47; 14.5+/-8.6 [12.8]).Conclusions: Our results led us to consider that in NSCLC, the negative VEGFR1 immunohistochemical expression is associated significantly with squamous cell carcinomas subtype and with higher maxSUV values in 18F-FDG-PET (AU)

Immunohistochemical expression of VEGFR1 in non small cell lung carcinomas: Lower VEGFR1 expression is asociated with squamous cell carcinoma subtype and high SUV max values in 18F-FDG PET.

BACKGROUND: To study the possible relation between immunohistochemical expression of vascular endothelial growth factor receptor 1 (VEGFR1) and the maximum standardised uptake value (SUV max) of 18F-FDG PET in patients with non small cell lung cancer (NSCLC). MATERIAL AND METHODS: The study included 39 patients with NSCLC (24 squamous cell carcinomas and 15 adenocarcinomas). According to the clinical stage, the patients were distributed as follows: 8 stage I, 7 stage II, 15 stage III and 9 stage IV. Immunohistochemical expression of VEGFR1 was studied through the technique of tissue-matrix using Tissue Arrayer Device (Beecher Instruments, Sun Prairie, WI), using the polyclonal antibody against VEGFR1 (Santa Cruz Biotechnology, California, USA). RESULTS: Positive VEGFR1 immunohistochemical expression was noted in 23 cases (59%). The number of positive tumours was not related with clinical stage but there was a different statistically significant association (p:0,0009) between VEGFR1 positivity and histological type, corresponding the greater percentages of positive results to adenocarcinomas (93,3%) versus in squamous cell carcinomas (37,5%). Likewise, SUV max values were higher (p: 0,039) in negative VEGFR1 carcinomas than in positive VEGFR1 tumors (r: 4-32,1; 16,4+/-6,4 (median 16,1) vs r: 3-47; 14,5+/-8,6 (12,8)). CONCLUSIONS: Our results led us to consider that in NSCLC, the negative VEGFR1 immunohistochemical expression is associated significantly with squamous cell carcinomas subtype and with higher SUV max values in 18F-FDG-PET.

Immunohistochemical expression of VEGFR1 in non small cell lung carcinomas: Lower VEGFR1 expression is asociated with squamous cell carcinoma subtype and high max SUV values in 18F-FDG PET. / Expresión inmunohistoquímica de VEGFR1 en carcinomas de pulmón de células no pequeñas: La expresión inferior de VEGFR1 se asocia con el subtipo de carcinoma de células escamosas y los valores elevados en SUVmáx en PET de 18F-FDG.

BACKGROUND: To study the possible relation between immunohistochemical expression of vascular endothelial growth factor receptor 1 (VEGFR1) and the maximum standardised uptake value (maxSUV) of 18F-FDG PET in patients with non small cell lung cancer. MATERIAL AND METHODS: The study included 39 patients with NSCLC (24 squamous cell carcinomas and 15 adenocarcinomas). According to the clinical stage, the patients were distributed as follows: 8 stage I, 7 stage II, 15 stage III and 9 stage IV. Immunohistochemical expression of VEGFR1 was studied through the technique of tissue-matrix using tissue arrayer device (Beecher Instruments, Sun Prairie, WI), using the polyclonal antibody against VEGFR1 (Santa Cruz Biotechnology, California, USA). RESULTS: Positive VEGFR1 immunohistochemical expression was noted in 23 cases (59%). The number of positive tumours was not related with clinical stage but there was a different statistically significant association (p:.0009) between VEGFR1 positivity and histological type, corresponding the greater percentages of positive results to adenocarcinomas (93.3%) versus in squamous cell carcinomas (37.5%). Likewise, maxSUV values were higher (p: .039) in negative VEGFR1 carcinomas than in positive VEGFR1 tumors (r: 4-32.1; 16.4+/-6.4 [median 16.1] vs. r: 3-47; 14.5+/-8.6 [12.8]). CONCLUSIONS: Our results led us to consider that in NSCLC, the negative VEGFR1 immunohistochemical expression is associated significantly with squamous cell carcinomas subtype and with higher maxSUV values in 18F-FDG-PET.

Nueva observación de la protección relativa que las enfermedades neurodegenerativas y el cáncer se confieren entre sí / New evidence of the relative protective effects of neurodegenerative diseases and cancer against each other

Introducción: El cáncer y las enfermedades degenerativas constituyen trastornos con algunos mecanismos compartidos que actúan en sentido opuesto, produciendo un fenómeno incontrolado de proliferación o pérdida de células. Observaciones diversas apuntan que los pacientes con enfermedad de Alzheimer tienen menor riesgo de desarrollar tumores y viceversa. En este artículo se expone la prevalencia de tumores (activos o superados) en pacientes de neurología cognitiva con y sin una enfermedad degenerativa demenciante. Pacientes y método: En 1.164 pacientes se analizó la frecuencia y topografía de tumores y la presencia o ausencia de enfermedad neurodegenerativa, que se clasificó en 4 grupos (enfermedad de Alzheimer, sinucleinopatía, enfermedad del complejo Pick y del complejo de poliglutamina). Se comparó la frecuencia de tumor en los subgrupos con y sin enfermedad degenerativa, y de esta en los pacientes con y sin trastorno tumoral. Resultados: Se registró proceso tumoral en el 12,1% de los pacientes con enfermedad neurodegenerativa y en el 17,3% del resto del grupo. En el grupo del estudio, un 14,8% de los que tienen antecedente tumoral fue diagnosticado de enfermedad neurodegenerativa, frente al 20,8% entre los que no tienen ese antecedente. Estas diferencias y las observadas en la comparación de subgrupos (tipo de enfermedad degenerativa y topografía del tumor) no alcanzaron significación estadística, excepto al contrastar enfermedades neurodegenerativas con tumores del sistema nervioso central y sinucleinopatías con neoplasias. Conclusiones: Las enfermedades neoplásicas y las neurodegenerativas demenciantes no son excluyentes, aunque muestran menor asociación de la esperada por su respectiva prevalencia

Background: Cancer and degenerative diseases share some pathogenic mechanisms which act in opposition to one another to produce either uncontrolled cell proliferation or cell death. According to several studies, patients with Alzheimer disease have a lower risk of neoplasia, and vice versa. This study describes the prevalence of tumours (active or successfully treated) in a series of patients with and without a dementing degenerative disease treated at a cognitive neurology unit. Patients and method: We analysed the frequency and topography of tumours and the presence or absence of a neurodegenerative disease in a group of 1,164 patients. Neurodegenerative diseases were classified in 4 groups: Alzheimer disease, synucleinopathies, Pick complex, and polyglutamine complex. We subsequently compared tumour frequency in patients with and without a degenerative disease, and prevalence of neurodegenerative diseases in patients with and without tumours. Results: Tumours were detected in 12.1% of the patients with a neurodegenerative disease and in 17.3% of the remaining patients. Around 14.8% of the patients with a history of neoplasia and 20.8% of the patients with no history of neoplasia were diagnosed with a neurodegenerative disease. Except for these differences and the differences between subgroups (type of degenerative disease and tumour location) were not statistically significant, except when comparing neurodegenerative diseases to central nervous system tumours, and synucleinopathies to neoplasms. Conclusion: Dementing degenerative diseases and neoplastic disorders are not mutually exclusive. Nevertheless, the rate of co-occurrence is lower than would be expected given the prevalence rate for each group

New evidence of the relative protective effects of neurodegenerative diseases and cancer against each other. / Nueva observación de la protección relativa que las enfermedades neurodegenerativas y el cáncer se confieren entre sí.

BACKGROUND: Cancer and degenerative diseases share some pathogenic mechanisms which act in opposition to one another to produce either uncontrolled cell proliferation or cell death. According to several studies, patients with Alzheimer disease have a lower risk of neoplasia, and vice versa. This study describes the prevalence of tumours (active or successfully treated) in a series of patients with and without a dementing degenerative disease treated at a cognitive neurology unit. PATIENTS AND METHOD: We analysed the frequency and topography of tumours and the presence or absence of a neurodegenerative disease in a group of 1,164 patients. Neurodegenerative diseases were classified in 4 groups: Alzheimer disease, synucleinopathies, Pick complex, and polyglutamine complex. We subsequently compared tumour frequency in patients with and without a degenerative disease, and prevalence of neurodegenerative diseases in patients with and without tumours. RESULTS: Tumours were detected in 12.1% of the patients with a neurodegenerative disease and in 17.3% of the remaining patients. Around 14.8% of the patients with a history of neoplasia and 20.8% of the patients with no history of neoplasia were diagnosed with a neurodegenerative disease. Except for these differences and the differences between subgroups (type of degenerative disease and tumour location) were not statistically significant, except when comparing neurodegenerative diseases to central nervous system tumours, and synucleinopathies to neoplasms. CONCLUSION: Dementing degenerative diseases and neoplastic disorders are not mutually exclusive. Nevertheless, the rate of co-occurrence is lower than would be expected given the prevalence rate for each group.

Alucinaciones auditivas en neurología cognitiva / Auditory hallucinations in cognitive neurology

Introducción: Los tinnitus y las alucinaciones verbales o musicales (AVM) pueden deberse a lesiones neurológicas de naturaleza y topografía diversa. Método: Se han rastreado estos síntomas en 1.000 pacientes de una consulta de neurología cognitiva, anotando datos epidemiológicos y de neuroimagen. Resultados: Refirieron tinnitus el 6,9% y AVM el 0,9%. Hubo predominio femenino no significativo en el grupo con paracusias. La edad media fue menor en los pacientes con tinnitus y mayor en los que tenían AVM. La hipoacusia mostró mayor prevalencia en los enfermos con paracusias (significativo con AVM). No hubo diferencias en la prevalencia de trastorno psicótico u obsesivo-compulsivo, o de leucoaraiosis. El tratamiento con ácido acetilsalicílico mostró mayor frecuencia en el grupo con AVM, y otros analgésicos no opioides y benzodiacepinas en los pacientes con tinnitus. La presunta causa de las AVM fue demencia con cuerpos de Lewy (n = 2, uno con enfermedad vascular), enfermedad de Alzheimer (n = 2, uno con enfermedad vascular), enfermedad vascular cerebral pura (n = 3), lesión cerebral traumática (n = 1) y lesión quirúrgica en el tronco encefálico (n = 1). En los 9 casos había un elemento facilitador de la aparición de paracusias, como hipoacusia (n = 6) o medicación de riesgo (n = 9), además de polifarmacia (n = 9). Conclusiones: Los pacientes con tinnitus tomaban con frecuencia benzodiacepinas y analgésicos no opioides, y en los que tenían AVM había mayor prevalencia de hipoacusia y de tratamiento con ácido acetilsalicílico. Las causas de AVM fueron demencia con cuerpos de Lewy, enfermedad de Alzheimer y lesiones focales en mesencéfalo, protuberancia, lóbulo temporal izquierdo o claustro izquierdo (AU)

Introduction: Different types and localisations of neurological lesions can produce tinnitus and verbal or musical hallucinations (VMH). Method: These symptoms were screened for in 1,000 outpatients at a cognitive neurology clinic, and epidemiological and neuroimaging data were recorded. Results: Tinnitus was present in 6.9% of the total and VMH in 0.9%. The paracusia group was predominantly female but the difference was not statistically significant. Patients with tinnitus were younger and those with VMH were older than the rest of the sample (mean ages). Hearing loss was more prevalent in the paracusia group (difference was significant in VMH subgroup). There were no intergroup differences in the prevalence of psychotic and obsessive-compulsive disorders, or of leukoaraiosis. Treatment with acetylsalicylic acid was more frequent in the VMH group, whereas other non-opioid analgesics and benzodiazepines were more commonly prescribed to patients with tinnitus. The suspected cause of VMH was dementia with Lewy bodies (n = 2, one with vascular disease), Alzheimer disease (n=2, one with vascular disease), isolated cerebrovascular disease (n = 3), traumatic brain injury (n = 1), and surgical brainstem lesion (n = 1). All VMH cases displayed an underlying factor that might prompt this symptom, eg, hearing loss (n = 6), a predisposing drug (n = 9), and polypharmacy (n = 9). Conclusions: Treatment with benzodiazepines and non-opioid analgesics was more frequent in the tinnitus group, whereas the VMH group showed a higher prevalence of hearing loss and treatment with acetylsalicylic acid. The causes of VMH were dementia with Lewy bodies, Alzheimer disease, and focal lesions in the mesencephalon, pons, left temporal lobe, or left claustrum (AU)

Síntomas conductuales y psiquiátricos en neurología cognitiva / Behavioural and psychiatric symptoms in cognitive neurology

Los síntomas conductuales y psiquiátricos (SCP) son frecuentes en el enfermo neurológico, contribuyen a producir discapacidad y reducen la calidad de vida. Se ha observado, en pacientes de neurología cognitiva, la prevalencia y tipo de SCP y su asociación con diagnósticos, regiones cerebrales o tratamientos específicos. Método. Análisis retrospectivo de 843 pacientes consecutivos de neurología cognitiva, revisando SCP, diagnóstico, alteración sensorial, topografía lesional en neuroimagen y tratamiento. Se contempló el total y se comparó el grupo de pacientes con deterioro cognitivo objetivo (n = 607) y sin deterioro. Resultados. Hubo SCP en el 59,9% de los pacientes (61,3% en los deteriorados y 56,4% en el resto). Un 31,1% tenía un SCP, 17,4% dos y 11,4% más de dos. Los SCP son más frecuentes en mujeres, sobre todo depresión y ansiedad. En los mayores de 64 años predominan los síntomas psicóticos y conductuales, y en los menores de 65 la ansiedad. Las personas con alteración sensorial tienen más síntomas psicóticos. Se aprecian más síntomas conductuales y psicóticos en personas con demencia degenerativa, depresión y ansiedad en las que tienen enfermedad psiquiátrica o efecto nocivo de sustancias, labilidad emocional en relación con trastorno metabólico u hormonal, hipocondría en los síndromes dolorosos e irritabilidad en la hipoxia crónica. Hay más alteraciones de la conducta en pacientes con anomalía en lóbulos frontales o temporal o parietal derechos, y se tratan preferentemente con antipsicóticos. Aparte de los tratamientos estándar, se observó asociación de distimia con opioides, betahistina y estatinas, y síntomas psicóticos con levodopa, piracetam y vasodilatadores

Behavioural and psychiatric symptoms (BPS) are frequent in neurological patients, contribute to disability, and decrease quality of life. We recorded BPS prevalence and type, as well as any associations with specific diagnoses, brain regions, and treatments, in consecutive outpatients examined in a cognitive neurology clinic. Method. A retrospective analysis of 843 consecutive patients was performed, including a review of BPS, diagnosis, sensory impairment, lesion topography (neuroimaging), and treatment. The total sample was considered, and the cognitive impairment (CI) group (n = 607) was compared to the non-CI group. Results. BPS was present in 59.9% of the patients (61.3% in the CI group, 56.4% in the non-CI group). One BPS was present in 31.1%, two in 17.4%, and three or more in 11.4%. BPS, especially depression and anxiety, are more frequent in women than in men. Psychotic and behavioural symptoms predominate in subjects aged 65 and older, and anxiety in those younger than 65. Psychotic symptoms appear more often in patients with sensory impairment. Psychotic and behavioural symptoms are more prevalent in patients with degenerative dementia; depression and anxiety in those who suffer a psychiatric disease or adverse effects of substances; emotional lability in individuals with a metabolic or hormonal disorder; hypochondria in those with a pain syndrome; and irritability in subjects with chronic hypoxia. Behavioural symptoms are more frequent in patients with anomalies in the frontal or right temporal or parietal lobes, and antipsychotics constitute the first line of treatment. Leaving standard treatments aside, associations were observed between dysthymia and opioid analgesics, betahistine and statins, and between psychotic symptoms and levodopa, piracetam, and vasodilators

Behavioural and psychiatric symptoms in cognitive neurology. / Síntomas conductuales y psiquiátricos en neurología cognitiva.

Behavioural and psychiatric symptoms (BPS) are frequent in neurological patients, contribute to disability, and decrease quality of life. We recorded BPS prevalence and type, as well as any associations with specific diagnoses, brain regions, and treatments, in consecutive outpatients examined in a cognitive neurology clinic. METHOD: A retrospective analysis of 843 consecutive patients was performed, including a review of BPS, diagnosis, sensory impairment, lesion topography (neuroimaging), and treatment. The total sample was considered, and the cognitive impairment (CI) group (n=607) was compared to the non-CI group. RESULTS: BPS was present in 59.9% of the patients (61.3% in the CI group, 56.4% in the non-CI group). One BPS was present in 31.1%, two in 17.4%, and three or more in 11.4%. BPS, especially depression and anxiety, are more frequent in women than in men. Psychotic and behavioural symptoms predominate in subjects aged 65 and older, and anxiety in those younger than 65. Psychotic symptoms appear more often in patients with sensory impairment. Psychotic and behavioural symptoms are more prevalent in patients with degenerative dementia; depression and anxiety in those who suffer a psychiatric disease or adverse effects of substances; emotional lability in individuals with a metabolic or hormonal disorder; hypochondria in those with a pain syndrome; and irritability in subjects with chronic hypoxia. Behavioural symptoms are more frequent in patients with anomalies in the frontal or right temporal or parietal lobes, and antipsychotics constitute the first line of treatment. Leaving standard treatments aside, associations were observed between dysthymia and opioid analgesics, betahistine and statins, and between psychotic symptoms and levodopa, piracetam, and vasodilators.

Auditory hallucinations in cognitive neurology. / Alucinaciones auditivas en neurología cognitiva.

INTRODUCTION: Different types and localisations of neurological lesions can produce tinnitus and verbal or musical hallucinations (VMH). METHOD: These symptoms were screened for in 1,000 outpatients at a cognitive neurology clinic, and epidemiological and neuroimaging data were recorded. RESULTS: Tinnitus was present in 6.9% of the total and VMH in 0.9%. The paracusia group was predominantly female but the difference was not statistically significant. Patients with tinnitus were younger and those with VMH were older than the rest of the sample (mean ages). Hearing loss was more prevalent in the paracusia group (difference was significant in VMH subgroup). There were no intergroup differences in the prevalence of psychotic and obsessive-compulsive disorders, or of leukoaraiosis. Treatment with acetylsalicylic acid was more frequent in the VMH group, whereas other non-opioid analgesics and benzodiazepines were more commonly prescribed to patients with tinnitus. The suspected cause of VMH was dementia with Lewy bodies (n=2, one with vascular disease), Alzheimer disease (n=2, one with vascular disease), isolated cerebrovascular disease (n=3), traumatic brain injury (n=1), and surgical brainstem lesion (n=1). All VMH cases displayed an underlying factor that might prompt this symptom, eg, hearing loss (n=6), a predisposing drug (n=9), and polypharmacy (n=9). CONCLUSIONS: Treatment with benzodiazepines and non-opioid analgesics was more frequent in the tinnitus group, whereas the VMH group showed a higher prevalence of hearing loss and treatment with acetylsalicylic acid. The causes of VMH were dementia with Lewy bodies, Alzheimer disease, and focal lesions in the mesencephalon, pons, left temporal lobe, or left claustrum.

Prescripciones inconvenientes en el tratamiento del paciente con deterioro cognitivo / Inappropriate treatments for patients with cognitive decline

Introducción: Algunos fármacos resultan inconvenientes en pacientes con deterioro cognitivo. Se analiza su uso en 500 pacientes y se revisa la bibliografía. Desarrollo: Las benzodiacepinas producen dependencia y reducen la atención, memoria y agilidad motora. Pueden inducir desinhibición o agresividad, facilitan los episodios confusionales e incrementan los accidentes y la mortalidad en mayores de 60 años. En mayores de 65, la presión sistólica baja se asocia a deterioro cognitivo. Es recomendable mantenerla en 130-140 mmHg (145 en ≥ 80 años). La colesterolemia < 160 mg/dl se asocia a mayor morbimortalidad, agresividad y suicidio, y el colesterol unido a las lipoproteínas de alta densidad (c-HDL) < 40 mg/dl empeora la memoria y aumenta el riesgo vascular y la mortalidad. La edad avanzada predispone para que los opioides produzcan alteración cognitiva y confusión. En demencias no Alzheimer y no asociadas a Parkinson, deterioro cognitivo ligero y enfermedades psiquiátricas, los efectos adversos de anticolinesterásicos y memantina probablemente superan al beneficio. La alteración cognitiva por anticolinérgicos de acción preferentemente periférica también es posible. Hay que conocer la demencia o psicosis por corticoides, y saber que la polifarmacia facilita el síndrome confusional. El 70,4% de 500 pacientes con disfunción cognitiva analizados recibía polifarmacia y el 42%, benzodiacepinas. Los que compartían ambas situaciones representaron el 74,3% de los casos en los que se sospechó iatrogenia. Conclusiones: En personas con edad avanzada o deterioro cognitivo, es necesario evitar la polifarmacia innecesaria y tener presente que las benzodiacepinas, los opioides y los anticolinérgicos producen frecuentemente alteraciones cognitivas y conductuales. Además, deben evitarse la presión sistólica < 130 mmHg, el colesterol < 160 mg/dl y el colesterol HDL < 40 mg/dl

Introduction: Some treatments are inappropriate for patients with cognitive decline. We analyse their use in 500 patients and present a literature review. Development: Benzodiazepines produce dependence, and reduce attention, memory, and motor ability. They can cause disinhibition or aggressive behaviour, facilitate the appearance of delirium, and increase accident and mortality rates in people older than 60. In subjects over 65, low systolic blood pressure is associated with cognitive decline. Maintaining this figure between 130 and 140 mm Hg (145 in patients older than 80) is recommended. Hypocholesterolaemia < 160 mg/dl is associated with increased morbidity and mortality, aggressiveness, and suicide; HDL-cholesterol < 40 mg/dl is associated with memory loss and increased vascular and mortality risks. Old age is a predisposing factor for developing cognitive disorders or delirium when taking opioids. The risks of prescribing anticholinesterases and memantine to patients with non-Alzheimer dementia that is not associated with Parkinson disease, mild cognitive impairment, or psychiatric disorders probably outweigh the benefits. Anticholinergic drugs acting preferentially on the peripheral system can also induce cognitive side effects. Practitioners should be aware of steroid-induced dementia and steroid-induced psychosis, and know that risk of delirium increases with polypharmacy. Of 500 patients with cognitive impairment, 70.4% were on multiple medications and 42% were taking benzodiazepines. Both conditions were present in 74.3% of all suspected iatrogenic cases. Conclusions: Polypharmacy should be avoided, if it is not essential, especially in elderly patients and those with cognitive impairment. Benzodiazepines, opioids and anticholinergics often elicit cognitive and behavioural disorders. Moreover, systolic blood pressure must be kept above 130 mm Hg, total cholesterol levels over 160 mg/dl, and HDL-cholesterol over 40 mg/dl in this population

Bradycardia in frontotemporal dementia.

INTRODUCTION: Numerous regions of the brain, such as the medial frontal cortex, orbitofrontal cortex, insula, and amygdala, participate in the autonomic control of cardiovascular functions such as heart rate. The degenerative process in frontotemporal dementia (FTD) involves the listed anatomical structures and may therefore produce dysautonomic cardiovascular symptoms. AIM: To observe whether or not non-cardiogenic bradycardia was more frequent in a group of patients with FTD than in subjects with mild cognitive impairment or dementia of a different aetiology. PATIENTS AND METHOD: Once patients with primary cardiac arrhythmia were excluded, we registered the heart rates of 258 patients with cognitive symptoms (36 with FTD, 22 with Alzheimer disease, 23 with vascular dementia, 10 with other dementias, and 167 with non-dementia cognitive impairment). RESULTS: Bradycardia (<60 beats/minute) was significantly more frequent in patients with FTD. This difference remained significant after excluding subjects undergoing treatment with a potentially bradycardic effect. Bradycardia was more prevalent in behavioural FTD cases than in cases of the aphasic variant, and we detected a trend toward higher frequency among patients with more pronounced right hemisphere atrophy. Moreover, mean systolic blood pressure in FTD patients was lower than in other participants, and systolic hypotension (<120 and <100mm Hg) was more prevalent. CONCLUSION: Bradycardia was more frequent in the FTD sample than in other patients with cognitive symptoms. Further investigations will be necessary before we may consider bradycardia to be a sign supporting diagnosis of FTD or its behavioural variant.

Inappropriate treatments for patients with cognitive decline.

INTRODUCTION: Some treatments are inappropriate for patients with cognitive decline. We analyse their use in 500 patients and present a literature review. DEVELOPMENT: Benzodiazepines produce dependence, and reduce attention, memory, and motor ability. They can cause disinhibition or aggressive behaviour, facilitate the appearance of delirium, and increase accident and mortality rates in people older than 60. In subjects over 65, low systolic blood pressure is associated with cognitive decline. Maintaining this figure between 130 and 140 mm Hg (145 in patients older than 80) is recommended. Hypocholesterolaemia < 160 mg/dl is associated with increased morbidity and mortality, aggressiveness, and suicide; HDL-cholesterol<40 mg/dl is associated with memory loss and increased vascular and mortality risks. Old age is a predisposing factor for developing cognitive disorders or delirium when taking opioids. The risks of prescribing anticholinesterases and memantine to patients with non-Alzheimer dementia that is not associated with Parkinson disease, mild cognitive impairment, or psychiatric disorders probably outweigh the benefits. Anticholinergic drugs acting preferentially on the peripheral system can also induce cognitive side effects. Practitioners should be aware of steroid-induced dementia and steroid-induced psychosis, and know that risk of delirium increases with polypharmacy. Of 500 patients with cognitive impairment, 70.4% were on multiple medications and 42% were taking benzodiazepines. Both conditions were present in 74.3% of all suspected iatrogenic cases. CONCLUSIONS: Polypharmacy should be avoided, if it is not essential, especially in elderly patients and those with cognitive impairment. Benzodiazepines, opioids and anticholinergics often elicit cognitive and behavioural disorders. Moreover, systolic blood pressure must be kept above 130 mm Hg, total cholesterol levels over 160 mg/dl, and HDL-cholesterol over 40 mg/dl in this population.

Análisis de costes directos, indirectos e intangibles de la epilepsia / Analysis of direct, indirect, and intangible costs of epilepsy

Introducción: Se ha realizado una estimación económica de los costes de epilepsia en adultos.Métodos: Estudio observacional prospectivo realizado durante 6 meses, en pacientes epilépticos mayores de 14 años. Se excluyeron los pacientes con enfermedades concomitantes que pudieran influir en la evolución de la epilepsia. Los costes directos incluyeron: tratamiento administrado, número de consultas en Neurología, Atención Primaria, y Urgencias, número de días de ingreso hospitalario, número y tipo de pruebas diagnósticas, uso de los medios de transporte al hospital y desde el hospital, y los apoyos psicopedagógicos y sociales por epilepsia. Los costes indirectos se analizaron en función de la pérdida de productividad laboral de los pacientes, con consideración de los familiares cuando los pacientes necesitaban supervisión a causa de la epilepsia. Los costes totales se derivaron de la suma de los costes directos e indirectos. Los costes intangibles se evaluaron según el cuestionario QOLIE-10. Resultados:La media de los costes directos por paciente fue de 1.055,2 €. El gasto económico medio en los costes indirectos ascendió a 1.528,8 € por paciente. El total de los costes asociados a la epilepsia supuso una media de 2.584 € por cada paciente, derivados sobre todo de la pérdida de productividad laboral (p<0,05). En los costes intangibles, según la escala QOLIE-10, la media obtenida fue de 77,8. Conclusiones: El mayor porcentaje de los costes asociados a la epilepsia corresponde a la pérdida de productividad laboral de los pacientes. Los costes del sufrimiento psicológico y social en epilepsia provocan deterioro de la calidad de vida (AU)

Introduction: A financial estimate has been made of the costs of epilepsy in adults. Methods: A prospective, observational study, over a period of 6 months, on epileptic patients over 14 years-old. Patients with concomitant diseases that could influence the outcome of the epilepsy were excluded. The direct costs included: treatment received, number of visits to neurology, primary care, and emergencies, number of days admitted to hospital, number and type of diagnostic tests, use of transport to and from hospital, and psychopedagogic and social support due to the epilepsy. The indirect costs were analysed according to, loss of work productivity of the patients, taking into account families where the patient needed supervision due to epilepsy. The total costs were derived from the sum of the direct and indirect costs. The intangible costs were calculated according to QOLIE-10 questionnaire.Results: The mean direct cost per patient was 1,055.2 €. The mean indirect financial costs came to 1,528.8 € per patient. The total cost associated to epilepsy was a mean of 2,584 € for each patient, mainly arising from loss of work days (p<.05). For intangible costs according to the QOLIE-10 scale a mean of 77.8 was obtained.Conclusions: The greatest percentage of costs associated to epilepsy is due to the work productivity loss by the patients. The costs of psychological and social suffering in epilepsy lead to a deterioration in the quality of life (AU)

Analysis of direct, indirect, and intangible costs of epilepsy.

INTRODUCTION: A financial estimate has been made of the costs of epilepsy in adults. METHODS: A prospective, observational study, over a period of 6 months, on epileptic patients over 14 years-old. Patients with concomitant diseases that could influence the outcome of the epilepsy were excluded. The direct costs included: treatment received, number of visits to neurology, primary care, and emergencies, number of days admitted to hospital, number and type of diagnostic tests, use of transport to and from hospital, and psychopedagogic and social support due to the epilepsy. The indirect costs were analysed according to, loss of work productivity of the patients, taking into account families where the patient needed supervision due to epilepsy. The total costs were derived from the sum of the direct and indirect costs. The intangible costs were calculated according to QOLIE-10 questionnaire. RESULTS: The mean direct cost per patient was 1,055.2 €. The mean indirect financial costs came to 1,528.8 € per patient. The total cost associated to epilepsy was a mean of 2,584 € for each patient, mainly arising from loss of work days (p<.05). For intangible costs according to the QOLIE-10 scale a mean of 77.8 was obtained. CONCLUSIONS: The greatest percentage of costs associated to epilepsy is due to the work productivity loss by the patients. The costs of psychological and social suffering in epilepsy lead to a deterioration in the quality of life.

Características clínicas y pronóstico de la insuficiencia cardíaca de origen isquémico e hipertensivo / Clinical characteristics and prognoses of ischemic and hypertensive heart failure

Objetivos. Nos propusimos evaluar las características clínicas y la supervivencia de pacientes con insuficiencia cardíaca de origen isquémico o hipertensivo que requirieron ingreso hospitalario. Métodos. Analizamos las características clínicas de 229 pacientes con insuficiencia cardíaca en clase III-IV debida a cardiopatía isquémica o hipertensión arterial (en este grupo se excluyeron los hipertensos con lesiones coronarias o manifestaciones clínicas de cardiopatía isquémica, así como los casos debidos a otras cardiopatías) que requirieron ingreso hospitalario entre el 1 de enero de 1991 y el 31 de diciembre de 1994. Su situación vital se evaluó mediante consulta o contacto telefónico en los meses de abril y mayo de 1998, con un período medio de seguimiento de 4 años. Se obtuvieron datos de 144 pacientes con insuficiencia cardíaca de origen isquémico y 69 pacientes de etiología hipertensiva. La edad media del grupo total era de 70 ñ 11 años, 70 ñ 9 de los 69 pacientes incluidos en el grupo hipertenso y 69 ñ 11 años en el isquémico. Resultados. El 49 por ciento de los isquémicos era también hipertenso. El 72 por ciento de los hipertensos y el 73 por ciento de los isquémicos se encontraban en clase IV en el ingreso hospitalario. La presencia de edema (periférico y pulmonar) era significativamente más frecuente en los pacientes con insuficiencia cardíaca hipertensiva, 49 por ciento frente al 20 por ciento; p = 0,0001, así como la existencia de cardiomegalia en radiografía de tórax: 97 por ciento frente al 84 por ciento, p = 0,01. También la hipertrofia ventricular izquierda en ECG (58 por ciento frente al 31 por ciento; p = 0,0001) y la fibrilación auricular (47 por ciento frente al 19 por ciento; p = 0,0001) eran significativamente más frecuentes en el grupo hipertenso. La disfunción sistólica de ventrículo izquierdo (FE < 50 por ciento) fue más frecuente, aunque no de forma significativa, en los pacientes que tenían cardiopatía isquémica (82 por ciento frente al 68 por ciento; p = 0,057). No se observaron diferencias en la supervivencia de ambos grupos con una supervivencia a 3 años del 58,5 por ciento y 58,6 por ciento de los pacientes incluidos en el grupo hipertenso e isquémico y a los 5 años del 47,7 por ciento y 45,9 por ciento, respectivamente. Conclusiones. El grupo de pacientes con insuficiencia cardíaca de etiología isquémica ingresados en nuestro hospital presenta, a largo plazo una elevada mortalidad similar a la del grupo hipertensivo, siendo la supervivencia a cinco años menor del 50 por ciento en ambos grupos (AU)

Trismus and pain after removal of a lower third molar. Effects of raising a mucoperiosteal flap.

OBJECTIVE: To investigate the effect of raising a mucoperiosteal flap on trismus and pain after extraction of an impacted lower third molar. STUDY DESIGN: We studied a consecutive series of 218 patients, all of whom underwent removal of an impacted lower third molar. Of the 218 patients, 52 (group A) underwent simple extraction without raising a mucoperiostal flap, 17 (group B) underwent extraction with raising of a mucoperiostal flap but without ostectomy, and 149 (group C) underwent extraction with both raising of a mucoperiostal flap and ostectomy (C). Trismus was evaluated as maximum interincisal distance (MID), determined before surgery and 1 and 5 days after surgery (MID0, MID1 and MID5 respectively). Pain was evaluated on the basis of reported analgesic use, likewise 1 and 5 days after surgery. RESULTS: In group A (no flap), there was no significant diference between MID0 and MID5; however MID1 was significantly lower than MID0. In groups B and C (flap), the difference between MID0 and MID1 was more marked, and in addition MID5 remained significantly lower than MID0. Neither MID0 nor MID5 differed significantly between group B (flap, no ostectomy) and group C (flap plus ostectomy). The proportion of group A subjects reporting analgesic use was significantly lower than the corresponding proportions in groups B and C on both day 1 and day 5, and again there were no significant differences between groups B and C.

Estudio de las intoxicaciones etílicas agudas en un servicio de urgencias / A stude of the acute ethanol intoxication at the emergency room

Objetivo: Conocer la frecuencia de las intoxicaciones etílicas agudas en nuestro servicio, así como sus características epidemiológicas, clínicas, y problemas asociados. Método: Se estudiaron una serie de variables en los pacientes mayores de 14 años que fueron atendidos en urgencias por intoxicación etílica, separándolos en dos grupos de edad. Resultados: Se atendieron 472 casos (0,55 porciento de los motivos de consulta), siendo hombres el 84,1 porciento y un 40 porciento 25 años, la distribución semanal es más homogénea y hay un mayor número por las tardes. La relación con traumatismo cráneo-encefálico es menor en el grupo de los jóvenes. No hubo diferencias significativas en el número de accidentes de tráfico. El porcentaje de ingresos fue del 17 porciento en los >25 años frente al 5 porciento en los menores de esta edad. No se obtuvieron variaciones con significación estadística en cuanto al número de agresiones, intentos de autolisis, sobredosis o asociación a otras sustancias tóxicas. Conclusiones: Las intoxicaciones etílicas muestran unas características diferenciadas según ocurran en jóvenes (25 años). En los primeros se trata fundamentalmente de la consecuencia de una conducta "recreativa de las noches del fin de semana", mientras que en los segundos hay una mayor asociación a traumatismos e ingresos sin que éstos se justifiquen por una mayor incidencia de accidentes de tráfico (AU)

[Acute ethanol intoxication at an emergency room]. / Estudio de las intoxicaciones etílicas agudas en un servicio de urgencias.

OBJECTIVE: To know the frequency of the acute ethylic intoxications in our service, as well as their epidemiologic, clinical characteristics, and associate problems. METHOD: A series of variables in patients older than 14 years were studied. These patients were assisted at the emergency room by ethylic intoxication, and they were separated in two age groups. RESULTS: 472 cases were assisted (0.55% of the consultation reasons). 84.1% were men and 40% < 26 years. Most of the intoxications in this age group happened during the weekends, fundamentally at night, while in the > 25 years, the weekly distribution is more homogeneous and there is a bigger number in the afternoons. The relationship with traumatic brain injury is smaller in the group of the youths. There were not significant differences in the number of traffic accidents. The percentage of admissions was 17% in the > 25 years opposite to 5% in people younger than this age. Variations with statistical significance were not obtained if we consider the number of aggressions, parasuicides, overdoses or association with other toxic substances. CONCLUSIONS: The ethylic intoxications show some different characteristics depending on the age of the patient (< 26 years old vs. > 25 years old). In the young people ethylic intoxication is the consequence of a "recreational behaviour at weekend's night" fundamentally, and in the adults there is a stronger association with traumatisms and admissions and we can't say that these one are justified for a bigger incidence of traffic accidents.

[Most common cardiovascular diseases and sleep apnea syndrome. A general population study]. / Enfermedades cardiovasculares más frecuentes y síndrome de apnea del sueño. Un estudio en población general.

BACKGROUND: The sleep apnea syndrome (SAS) is a frequent disease associated with significant morbidity. The aim of our study was to investigate diseases associated with the sleep apnea syndrome (SAS) in general population. METHODS: We selected a random sample of 110 people from the electoral census. These people were invited to the clinic where medical history, physical examination and monitoring for sleep-disordered breathing was done. RESULTS: Twenty two subjects were diagnosed of SAS. The prevalence of arterial hypertension in the SAS group was 36.4%, and coronary artery disease 13.6%. CONCLUSIONS: Although the prevalence of this diseases was increased in the SAS group, we do not see significant association with this disease.

Trismus and pain after removal of impacted lower third molars.

PURPOSE: This study evaluated trismus and pain after removal of impacted lower third molars and investigated whether these responses were related to difficulty of surgery. PATIENTS AND METHODS: A consecutive series of 104 patients, all of whom underwent removal of an impacted lower third molar under local surgery, was studied. Difficulty of surgery was evaluated on a modified version of the Parant scale: I, extraction with forceps only; II, extraction by ostectomy; III, extraction by ostectomy and coronal section; IV, complex procedures. Trismus was evaluated in terms of maximum interincisal distance (MID) 1 and 5 days after surgery. Pain was evaluated on the basis of reported analgesic use 1 and 5 days after surgery. RESULTS: Among group I subjects, mean day 1 MID did not differ significantly (P > .05) from mean presurgery MID, whereas mean day 1 MID in groups II, III, and IV was significantly lower than before surgery. In groups II, III, and IV, mean day 5 MID remained lower than before surgery. The proportion of group I patients using analgesics was significantly lower on both days 1 and 5 than the proportion of patients using analgesics in groups II, III, and IV. In all groups, the proportion of patients using analgesics dropped significantly between days 1 and 5. CONCLUSION: Trismus is less severe after simple (forceps-only, grade I) extractions than after surgical extractions (grades II to IV). However, trismus severity after surgical extraction does not depend on difficulty of surgery. Pain, as revealed by reported analgesic use, is likewise less severe after simple extractions. Regardless of extraction type, pain declines between days 1 and 5 postsurgery.