Spinal arteriovenous fistulas in adults: Management of a series of patients treated at a neurology department. / Fístulas arteriovenosas espinales del adulto. Manejo de una serie de casos desde una planta de Neurología.

OBJECTIVE: Spinal arteriovenous fístulas (SAVF), a rare type of vascular malformation, account for 3% of all spinal cord lesions. Without early treatment, the associated morbidity is high; furthermore, SAVF pose a major diagnostic challenge. Our purpose was to evaluate the clinical characteristics of SAVF and review their progress after treatment to determine whether it may be too late for treatment in some cases. METHODS: We present a retrospective series of 10 patients diagnosed with SAVF and treated at a tertiary hospital during a 3-year period. RESULTS: In our sample, SAVF were found to be significantly more frequent in men (80%). Mean age in our sample was 65.4 years. The most common initial symptom was intermittent claudication/paraparesis (70%). In most patients, symptoms appeared slowly and progressively. At the time of diagnosis, the most common symptoms were motor, sensory, and sphincter disorders. Mean time from symptom onset to diagnosis was 24.3 months. Initial diagnosis was erroneous in 60% of the patients. Spinal MRI was diagnostic in 90% of these cases and arteriography in 100%. The most common location of the fistula was the lower thoracic region and the most frequent type was dural (7 cases). All patients were treated with embolisation, surgery, or both and 70% improved after fistula closure regardless of progression time. CONCLUSIONS: Diagnosis of SAVF is difficult and often delayed, which leads to poorer patient prognosis. We should have a high level of suspicion for SAVF in patients with intermittent claudication or paraparesis exacerbated by exercise. Early treatment should be started in these patients. Treatment should always aim to improve quality of life or stabilise symptoms, regardless of progression time.

Fístulas arteriovenosas espinales del adulto. Manejo de una serie de casos desde una planta de Neurología / Spinal arteriovenous fistulas in adults: Management of a series of patients treated at a neurology department

OBJETIVO: Las fístulas arteriovenosas espinales (FAVE) son excepcionales y representan el 3% de las lesiones espinales. Asocian gran morbilidad sin tratamiento precoz, pero el diagnóstico constituye un reto. Nuestro objetivo es evaluar sus características clínicas y revisar la evolución tras el tratamiento. ¿Puede ser tarde para tratar?. MÉTODOS: Presentamos una serie retrospectiva de 10 casos diagnosticados y tratados en 3 años en un hospital terciario. RESULTADOS: Se observó un predominio masculino (80%). La edad media fue de 65,4 años. El síntoma inicial predominante fue la claudicación de la marcha/paraparesia (70%). En la mayoría de los pacientes la clínica fue lentamente progresiva. Al diagnóstico, lo habitual fue la combinación de síntomas motores, sensitivos y esfinterianos. El tiempo medio desde el inicio de los síntomas hasta el diagnóstico fue de 24,3 meses. El 60% tenía un diagnóstico inicial erróneo. La RM espinal fue diagnóstica en el 90% de los casos; la arteriografía, en el 100%. La localización más frecuente fue dorsal baja y el tipo anatómico predominante fue FAVE dural (7 pacientes). Todas fueron tratadas con embolización, cirugía o con ambas y el 70% mejoró tras su cierre, independientemente del tiempo de evolución. CONCLUSIONES: El diagnóstico de las FAVE es difícil y generalmente tardío, lo que empeora el pronóstico de los pacientes. Se debe tener un alto nivel de sospecha ante síntomas de mielopatía o claudicación de la marcha exacerbadas con el ejercicio e intentar tratamiento precoz. Consideramos que el tratamiento siempre está indicado, independientemente del tiempo de evolución, al mejorar la calidad de vida o conseguir la estabilización

OBJECTIVE: Spinal arteriovenous fístulas (SAVF), a rare type of vascular malformation, account for 3% of all spinal cord lesions. Without early treatment, the associated morbidity is high; furthermore, SAVF pose a major diagnostic challenge. Our purpose was to evaluate the clinical characteristics of SAVF and review their progress after treatment to determine whether it may be too late for treatment in some cases. METHODS: We present a retrospective series of 10 patients diagnosed with SAVF and treated at a tertiary hospital during a 3-year period. RESULTS: In our sample, SAVF were found to be significantly more frequent in men (80%). Mean age in our sample was 65.4 years. The most common initial symptom was intermittent claudication/paraparesis (70%). In most patients, symptoms appeared slowly and progressively. At the time of diagnosis, the most common symptoms were motor, sensory, and sphincter disorders. Mean time from symptom onset to diagnosis was 24.3 months. Initial diagnosis was erroneous in 60% of the patients. Spinal MRI was diagnostic in 90% of these cases and arteriography in 100%. The most common location of the fistula was the lower thoracic region and the most frequent type was dural (7 cases). All patients were treated with embolisation, surgery, or both and 70% improved after fistula closure regardless of progression time. CONCLUSIONS: Diagnosis of SAVF is difficult and often delayed, which leads to poorer patient prognosis. We should have a high level of suspicion for SAVF in patients with intermittent claudication or paraparesis exacerbated by exercise. Early treatment should be started in these patients. Treatment should always aim to improve quality of life or stabilise symptoms, regardless of progression time

[Potential model for radiobiological research Stentor coeruleus (Protozoa)]. / Posible modelo para investigación radiobiológica: Stentor coeruleus (Protozoa).

The use of the ciliate Stentor coeruleus as a model to study radiosensibility after cobalt-60 irradiation is described.

Psychopathological aspects of the toxic oil syndrome catastrophe.

In May 1981 a new disease caused by widespread food-poisoning (probably with adulterated rape-seed oil) appeared in Spain. More than 20000 people were affected, and about 350 patients have died. The clinical syndrome consisted of pulmonary, neuromuscular and systemic symptoms, which evolved to produce mild or severe physical disabilities. Although the disease is not primarily a psychiatric condition, more than 6000 TOS patients have been referred to a psychiatrist: these patients show a well-defined 'reactive disaster syndrome', vulnerability being associated with female sex, low income and class, and a personal history of 'nervous' disorders. The enormous public repercussions of the disease and the specific administrative measures it provoked are discussed and evaluated. This unique experience of a specific disaster can contribute to our knowledge of the psychological and psychiatric aspects of disasters in general; and it suggests that teams of psychologists and psychiatrists should play a significant role in managing the effects of major catastrophes.

Psychopathological aspects of the toxic oil syndrome catastrophe

In May 1981 a new disease caused by widespread food-poisoning (probably with adulterated rape-seed oil) appeared in Spain. More than 20 000 people were affected, and about 350 patients have died. The clinical syndrome consisted of pulmonary, neuromuscular and systemic symptoms. which evolved to produce mild or severe physical disabilities. Although the disease is not primarily a psychiatric condition, more than 6000 TOS patients have been referred to a psychiatrist; these patients show a well-defined "reactive disaster syndrome", vulnerability being associated with female sex, low income and class, and a personal history of "nervous" disorders. The enormous public repercussions of the disease and the specific administrative measures it provoked are discussed and evaluated. This unique experience of a specific disaster can contribute to our knowledge of the psychological and psychiatric aspects of disasters in general; and it suggests that teams of psychologists and psychiatrists should play a significant role in managing the effects of major catastrophes