[Metoclopramide as a painkiller for intense migraine headache in emergency departments]. / Metoclopramida como analgésico en la cefalea migrañosa intensa en urgencias.

INTRODUCTION: Migraine headache is an uncommon but disabling clinical entity when patients go to an urgency room with a severe migraine attack and digestive symptoms. Intravenous non-steroidal anti-inflammatory drugs, paracetamol and triptans represent the first line drugs in the migraine therapy in emergency departments elsewhere however the low efficacy and the limitations of the oral way for vomiting determine a difficult situations in some migraine patients. Metoclopramide is an anti-emetic drug which indication in migraine for vomiting and as an adjunctive drug to other analgesic has been reported elsewhere but the analgesic features of this drug in monotherapy has not been largely study in the medical literature. PATIENTS AND METHODS: We report in this article the clinical features and side effects of 14 patients with severe migraine with digestive symptoms which consecutive came to our urgency department. RESULTS AND CONCLUSIONS: The patients showed a important improvement after 10 mg of intravenous metoclopramide exclusively with no other analgesic drug.

Metoclopramida como analgésico en la cefalea migrañosa intensa en urgencias / Metoclopramide as a painkiller for intense migraine headache in emergency departments

Introducción. La cefalea de tipo migrañoso es una entidad clínica poco común pero incapacitante cuando los pacientes acuden al servicio de urgencias por una crisis migrañosa grave acompañada de síntomas digestivos. Los antiinflamatorios no esteroideos intravenosos, el paracetamol y los triptanos representan los medicamentos de primera línea en el tratamiento de la migraña en los servicios de urgencias; en otras circunstancias, sin embargo, la poca eficacia y las limitacionesde la vía oral debido a los vómitos complican la situación en algunos pacientes con migraña. La metoclopramida es un antiemético cuya indicación en la migraña para los vómitos y como fármaco complementario de otros analgésicos se ha descrito anteriormente, pero las características analgésicas de este fármaco en monoterapia no se han estudiado a fondo en las publicaciones médicas. Pacientes y métodos. En este artículo, describimos el cuadro clínico y los efectos secundarios de 14 pacientesconsecutivos que acudieron a nuestro servicio de urgencias con migraña grave y con síntomas digestivos. Resultados y conclusiones. Los pacientes mostraron una importante mejoría después de la administración intravenosa de 10 mg de metoclopramida exclusivamente, sin ningún otro analgésico

Introduction. Migraine headache is an uncommon but disabling clinical entity when patients go to an urgencyroom with a severe migraine attack and digestive symptoms. Intravenous non-steroidal anti-inflammatory drugs, paracetamol and triptans represent the first line drugs in the migraine therapy in emergency departments elsewhere however the low efficacy and the limitations of the oral way for vomiting determine a difficult situations in some migraine patients. Metoclopramide is an anti-emetic drug which indication in migraine for vomiting and as an adjunctive drug to other analgesic has been reported elsewhere but the analgesic features of this drug in monotherapy has not been largely study in the medical literature. Patients and methods. We report in this article the clinical features and side effects of 14 patients with severe migraine with digestive symptoms which consecutive came to our urgency department. Results and conclusions. The patients showed a important improvement after 10 mg of intravenous metoclopramide exclusively with no other analgesic drug

Tromboendarterectomía carotídea en el paciente anciano: características clínicas de los pacientes intervenidos y resultados a corto y medio plazo / Carotid thromboendarterectomy in the elderly patient: clinical characteristics in operated patients and short and middle term results

Introducción. La tromboendarterectomía (TEA) carotídeaes el procedimiento de elección para estenosis graves,especialmente si son sintomáticas, en pacientes menores de80 años. En poblaciones ancianas hay estudios que documentanla persistencia del beneficio del procedimiento; además,otros tratamientos no han demostrado tanta eficacia o sehan acompañado de frecuentes complicaciones. Este estudiodescribe las características clínicas, resultados quirúrgicosy evolución de los pacientes mayores de 75 y 80 añosintervenidos en nuestro centro en relación con los más jóvenes.Métodos. Durante los años 2000 a 2006 fueron intervenidos86 pacientes, 8 de ellos bilateralmente. Se realizaun estudio retrospectivo que describe datos relativos a lascaracterísticas clínicas y evolución de los pacientes endarterectomizados,así como comparativo entre los distintos gruposde edad.Resultados. Fueron intervenidos 26 pacientes mayoresde 75 años, de ellos 6 eran mayores de 80 años. En los pacientesmayores el factor de riesgo fundamental fue la hipertensiónarterial, hubo menor proporción de fumadores ymayor frecuencia de estenosis grave u oclusión contralateral.Las estenosis intervenidas fueron más graves y con característicasmás agresivas. No se detectó mayor comorbilidado riesgo anestésico que en los pacientes más jóvenes.Los resultados quirúrgicos, la tasa de complicaciones perioperatoriasy la evolución a corto y medio plazo fue similaren los distintos grupos de edad (morbilidad y mortalidad inmediatapor accidente isquémico transitorio, infarto cerebralo muerte: 0% en mayores de 75 años frente a 4,41%en menores de 75 años).Conclusiones. Nuestros resultados apoyan que la edadno debe considerarse una contraindicación para la realizaciónde una TEA carotídea si existe una indicación quirúrgicaclara y una morbilidad y riesgo anestésico aceptables, comoen otros grupos poblacionales (AU)

Introduction. Carotid thromboendarterectomy is thetechnique of choice for treating high-grade stenosis inpatients less than 80 years of age, especially if they aresymptomatic. Previous studies have also documented thepersistence of the benefit of the procedure in elderly populationsand, in addition, other treatments have notbeen demonstrated to be as effective or have been relatedto more frequent complications. This study describes theclinical characteristics, surgical results and outcome ofpatients older than 75 and 80 years old, treated by thromboendarterectomyin our center in comparison with ayounger population.Methods. Between the years 2000 to 2006, 86 patientswere treated by thromboendarterectomy, 8 of thembilaterally. A retrospective study that described the dataregarding clinical characteristics and outcome of the patientswho had undergone endarterectomy was conductedand the different age groups were compared.Results. Twenty-six patients older than 75 years old,6 of whom were older than 80, were operated on. In theelderly patients, the fundamental risk factor was highblood pressure, there was a lower proportion of smokersand a higher proportion of contralateral severe stenosisor occlusion. Stenosis treated by surgery was more severeand had more aggressive characteristics. Comorbidityand anesthetic risk were the same as in younger patients.Surgical results, perioperative complication rates andshort and long term outcome were similar in the differentage groups (immediate morbidity-mortality due totransitory ischemic accident, stroke or death: 0% in408 older than 75 vs. 4.41% in those under 75). Conclusions. Our results support that age should notbe considered a contraindication for the performance ofa carotid thromboendarterectomy if there is a clear indicationand acceptable morbidity and anesthetic risk, asin other population groups (AU)

Baclofeno intratecal en la distonía generalizada secundaria a una hipoxia cerebral / Intrathecal baclofen in generalised dystonia secondary to cerebral hypoxia

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[Carotid thromboendarterectomy in the elderly patient: clinical characteristics in operated patients and short and middle term results]. / Tromboendarterectomía carotídea en el paciente anciano: características clínicas de los pacientes intervenidos y resultados a corto y medio plazo.

INTRODUCTION: Carotid thromboendarterectomy is the technique of choice for treating highgrade stenosis in patients less than 80 years of age, especially if they are symptomatic. Previous studies have also documented the persistence of the benefit of the procedure in elderly populations and, in addition, other treatments have not been demonstrated to be as effective or have been related to more frequent complications. This study describes the clinical characteristics, surgical results and outcome of patients older than 75 and 80 years old, treated by thromboendarterectomy in our center in comparison with a younger population. METHODS: Between the years 2000 to 2006, 86 patients were treated by thromboendarterectomy, 8 of them bilaterally. A retrospective study that described the data regarding clinical characteristics and outcome of the patients who had undergone endarterectomy was conducted and the different age groups were compared. RESULTS: Twenty-six patients older than 75 years old, 6 of whom were older than 80, were operated on. In the elderly patients, the fundamental risk factor was high blood pressure, there was a lower proportion of smokers and a higher proportion of contralateral severe stenosis or occlusion. Stenosis treated by surgery was more severe and had more aggressive characteristics. Comorbidity and anesthetic risk were the same as in younger patients. Surgical results, perioperative complication rates and short and long term outcome were similar in the different age groups (immediate morbidity-mortality due to transitory ischemic accident, stroke or death: 0% in older than 75 vs. 4.41% in those under 75). CONCLUSIONS: Our results support that age should not be considered a contraindication for the performance of a carotid thromboendarterectomy if there is a clear indication and acceptable morbidity and anesthetic risk, as in other population groups.

[The effectiveness and tolerance of piribedil as adjunct therapy to levodopa in patients with Parkinson's disease: a nine month follow up]. / Eficacia y tolerancia del piribedil como terapia adjunta a la levodopa en pacientes con enfermedad de Parkinson: seguimiento de nueve meses.

INTRODUCTION: Piribedil is a D2 D3 dopamine agonist, which has been shown to be well tolerated and to improve Parkinsonian symptoms, particularly tremor. However, few studies have been published about this Dopamine Agonist as an adjunct to levodopa therapy in patients with Parkinson's disease (PD). This placebo controlled, parallel group study was undertaken to investigate the effects of piribedil in PD patients insufficiently controlled with levodopa in a nine months follow up. PATIENTS AND METHODS: We included 62 PD patients insufficiently controlled with levodopa and needed an increase in dopamine stimulation. Patients were randomized in two similar groups, one of them taking Piribedil and levodopa and the other group taking a placebo and levodopa. The primary efficacy measures were the items II and III of the UPDRS. The patients were evaluated prior to the start of therapy, and 3, 6 and 9 months after the start of the study. RESULTS: Patients taking Piribedil showed an average of improvement of 37,8% (p < 0.01) in the part II and 63,2% (p < 0.01) in the part III of the UPDRS at the end of the study. At 9 month evaluation, tremor at rest showed an average improvement of 68,6%, rigidity, fingers taps and legs agility improved substantially in their respective items of the UPDRS at the end of the study. CONCLUSIONS: We concluded that PD patients with functional worsening while on stable levodopa doses exhibit a steady improvement of the UPDRS part II and III with the adjunction of Piribedil 150 mg mean daily dose for 9 months.

Eficacia y tolerancia del piribedil como terapia adjunta a la levodopa en pacientes con enfermedad de Parkinson: seguimiento de nueve meses / The effectiveness and tolerance of piribedil as adjunct therapy to levodopa in patients with Parkinson's disease: a nine-month follow-up

Introducción. El piribedil es un agonista dopaminérgico (AD) D2-D3, eficaz en el control de síntomas parkinsonianos, particularmente el temblor. Sin embargo, hay pocos estudios publicados con seguimientos mayores de tres meses sobre este AD como terapia adjunta a la levodopa en pacientes con la enfermedad de Parkinson (EP). Este estudio se diseñó para investigar los efectos del piribedil en pacientes con EP, tratados con levodopa y con deterioro funcional (DF) en un seguimiento de nueve meses. Pacientes y métodos. Incluimos 62 pacientes con EP sin complicaciones atribuibles a la levodopa y con DF y motor. Los pacientes se distribuyeron de una manera aleatoria en dos grupos similares, levodopa más piribedil o levodopa más placebo. La eficacia se valoró con las partes II y III de la escala unificada para la valoración de la EP (UPDRS) y la tolerancia se valoró con un cuestionario para detectar efectos adversos. Se hizo una valoración basal y a los 3, 6 y 9 meses posteriores al inicio de la terapia. Resultados. Los pacientes que tomaron piribedil mostraron un porcentaje diferencial de mejoría de 37,8 por ciento (p < 0,01) en la parte II del UPDRS y 63,2 por ciento (p < 0,01) en la parte III del UPDRS. Mostraron una mejoría del 68,6 por ciento en el ítem `temblor de reposo' al final del protocolo; también hubo una mejoría notable en el resto de los síntomas cardinales parkinsonianos. Conclusión. Los pacientes de este estudio, con EP y DF, mostraron una mejoría progresiva y sostenible en las partes II y III de la UPDRS durante nueve meses al agregarse 150 mg/día de piribedil, como terapia adjunta a la levodopa. Los efectos adversos fueron similares a los comunicados por otros AD (AU)

Introduction. Piribedil is a D2-D3 dopamine agonist, which has been shown to be well tolerated and to improve Parkinsonian symptoms, particularly tremor. However, few studies have been published about this dopamine agonist as an adjunct to levodopa therapy in patients with Parkinson’s disease (PD). This placebo controlled, parallel group study was undertaken to investigate the effects of piribedil in PD patients insufficiently controlled with levodopa in a nine months follow up. Patients and methods. We included 62 PD patients insufficiently controlled with levodopa and needed an increase in dopamine stimulation. Patients were randomized in two similar groups, one of them taking piribedil and levodopa and the other group taking a placebo and levodopa. The primary efficacy measures were the items II and III of the UPDRS. The patients were evaluated prior to the start of therapy, and 3, 6 and 9 months after the start of the study. Results. Patients taking piribedil showed an average of improvement of 37,8% (p < 0.01) in the part II and 63,2% (p < 0.01) in the part III of the UPDRS at the end of the study. At 9-month evaluation, tremor at rest showed an average improvement of 68,6%, rigidity, fingers taps and legs agility improved substantially in their respective items of the UPDRS at the end of the study. Conclusions. We concluded that PD patients with functional worsening while on stable levodopa doses exhibit a steady improvement of the UPDRS part II and III with the adjunction of piribedil 150 mg mean daily dose for 9 months (AU)