Visual hallucinations in patients with acute stroke: a prospective exploratory study.

BACKGROUND AND PURPOSE: The incidence, underlying physiopathology, features and association with lesion topography of visual hallucinations in acute stroke have scarcely been investigated. METHODS: Patients with a diagnosis of acute stroke (ischaemic or haemorrhagic) in any vascular territory, admitted within 24 h after the onset of symptoms, were consecutively included in the study. Patients with a previous history of psychosis or cognitive impairment were excluded. They and/or their caregivers answered a structured hallucination and sleep questionnaire at admission, within the first 15 days and at the clinical follow-up 3-6 months after discharge. Lesion location (IMAIOS online atlas) and leukoaraiosis (Wahlund scale) were determined by magnetic resonance imaging or computed tomography scan. Subsets of patients also underwent a neuropsychological evaluation (N = 50) and an electroencephalogram (N = 33) before discharge. RESULTS: In all, 77 patients with a mean age of 71 ± 12 years were included of whom 57.1% were men. The incidence of visual hallucinations was 16.7%. These hallucinations were mostly complex, in black and white and self-limited. The appearance of hallucinations was not influenced by age, sex, neuropsychological performance during admission or modified Rankin scale score at discharge. Visual hallucinations were associated with occipital cortex lesions (P = 0.04), and with sleep disturbances during and before admission (P = 0.041 and P = 0.03 respectively). CONCLUSIONS: Visual hallucinations are relatively frequent in patients with acute stroke and they are self-limited. Patients with occipital lesions and sleep disturbances are more likely to suffer them.

The cytologic diagnosis of breast lesions.

In view of the increasing number of patients presenting with breast lesions, cytology was used as a first step diagnostic procedure. This is the first study of its kind in Spain. Material was obtained from 660 patients, either from spontaneous nipple secretion or by fine needle aspiration. Cytologic criteria for recognition of the different cell types in the smears are discussed. The accuracy of the method was high (2.6% false negatives; 4.1% false positives). The cytologic technique for diagnosing breast lesions is simple, rapid and economic as well as harmless and painless. It therefore fulfills all requirements for an early diagnostic procedure.

Endometrial and endocervical brushing techniques with a Medhosa cannula.

A new technique for obtaining endometrial material using the Medhosa Cannula is described. This method is also useful to obtain samples from the endocervix. The Medhosa Cannula is made of flexible plastic. It is 30 cm long and has thin fins on its distal end which, guided by an introduction cone, permit endometrial and endocervical brushing. Six hundred cases are reported. Concomitant histopathological studies were performed in 40 per cent of the patients. There were two false negative cytologic reports (0.88%) and one false positive (6.66%). This is a simple, rapid, innocuous and economical technique, thus fulfilling the prerequisites for routine cytodiagnostic methods. Adequate material was always obtained.

[Bartter's syndrome. Pathophysiology in three cases (author's transl)]. / Síndrome de Bartter. Aspectos fisiopatológicos.

The primary pathologic defect in Bartter's syndrome is unknown. Three patients have been studied. In two of them, with normal intra-erythrocite sodium concentration, authors prove the existence of an impaired proximal tubular sodium reabsorption. In the last case, with a high intra-erythrocite sodium concentration, this impaired sodium reabsorption was localized in the proximal and distal tubular portions.

[Cystinolysinuric lithiasis]. / Litiásis cistinolisinúrica.

Cystinuria is a disease characterized by the excessive elimination of cystine and of dibasic amino acids (lysine, arginine, and ornithine) through urine of homozygotes. This study included 6 children complaining of abdominal pain with or without hematuria. The existence of renal radio-opaque lithiasis was confirmed in 5 of them and in the sixth, it was vesical. The clinical and analytic data were practically normal with the exception of the qualitative test of the amino acid urinary excretion that showed increase in urinary excretion of cystine. Likewise, percentages of tubular reabsorption were pathological in all the patients showing values between 35.4% and 74%. The diagnosis of systini-lysinuric lithiasis was established through amino acid excretion study in the six patients which was below normal; it fluctuated between 36% and 74%. Lysine, together with cystine, was the most frequently affected.

[Hypervitaminosis D. Review of fifteen cases]. / Hipervitaminosis D Revisión de 15 casos.

Fifteen cases of hypervitaminosis D in childhood are reviewed. In all of them, vitamin D was given following medical prescription. In four occasions, excessive dosage of vitamine D impaired the evolution of a previous nephropathy. The clinical, analytical, radiological and histological findings as well as the therapeutical aspects are commented. Hypercalcemia, hypercalciuria, polyuria with hypostenuria, renal failure, bone lesions and nephrocalcinosis are the most prominent features of the picture. Occasionally, arterial hypertension and glycosuria were found. Prednisone, thyrocalcitonine and phosphates were used as therapeutical means. In spite of nephrocalcinosis and renal failure generally present at diagnosis, the clinical course was rather good.

[Review of 15 cases of hypervitaminosis D]. / Revisión de 15 casos de hipervitaminósis "D".

In our experience, hypervitaminosis D, which at present should only be a historic remembrance in pediatrics, is still a frequent cause of hipercalcemia in childhood. It is easy understand that its appearance should turn out to be a complication in the treatment of hypoparathyroidisms or in vitamin D resistant rickets, but its persistance as a purely iatrogenic diseases is at present inexplicable. The frequency with which we have seen it has led us to review 15 cases where erroneous administration of high doses of vitamin D has resulted in serious clinical, biological and anatomical problems.

[Neonatal effects of adolescent pregnancy]. / Repercusión neonatal del embarazo en adolescentes.

Several maternal and fetal parameters (maternal age and prepregnancy weight, pathology and pregnancy control, parity, DIPS II amniotic fluid, modality of delivery, weeks of gestation, fetal presentation, postpartum hemorrhage and laceration, placental weight and umbilical cord, weight, length, sex and cephalic circumference of the neonate. Apgar score, mobimortality and forlorness of the newborn) were compared between a group of 171 adolescents mothers (aged 13 to 19 years) and another group of 108 adults mothers (aged 20 to 37 years) with similar socieconomics status. The adolescents mothers had worse pregnancy control (2.9 +/- 2 medical examination vs 4.7 +/- 2.3); (p less than 0.05), and greater prematurity (11.8% vs 5.3%), and smaller newborn weight (3.114.9 +/- 543.1 g vs 3.315.3 +/- 490.7 g); (p less than 0.05), and cephalic circumference (34.1 +/- 1 cm vs 35 +/- 1.9 cm); (p less than 0.05), and greater morbility (11.7% vs 2.8%); (p less than 0.05), and forlonness (8.8% vs 1.9%); (p less than 0.05) of neonate.

Studies on the site of renal sodium loss in two patients with cystinosis. Effects of hydrochlorothiazide on tubular sodium reabsorptive mechanisms.

The purpose of this study was to examine the effect of hypotonic saline diuresis on two patients with cystinosis, trying to localize the site of renal sodium loss. At the same time, we have performed the same hypotonic saline infusion under hydrochlorothiazide administration. Results seem to prove the proximal tubular localization of the salt-wasting syndrome in cystinotic patients. On the other hand, these results suggest that hydrochlorothiazide effect can be related to the hypovolemia due to the distal tubular action of hydrochlorothiazide that could inhibit the 'third' natriuretic factor, thus increasing the proximal tubular sodium reabsorption.

[Natural history of pyelonephritis (author's transl)]. / Historia natural de la pielonefritis

Natural history of pyelonephritis is reviewed through the analysis of 971 cases of urinary infaction diagnosed and treated during the last eight years.

[Jeune syndrome and fungal bronchial asthma]. / Síndrome de Jeune y asma bronquial fúngico.

A young girl suffering from asphyxiating thoracic dystrophy secondary to bronchial asthma was submitted to an allergologic evaluation. We have not found these processes associated in what some authors have called the "minor forms" of the Jeune syndrome. Osteochondrodysplasia, called in recent papers thoracic-pelvic-phalangeal dysplasia, is characterised by marked retraction of the thoracic cage associated with changes in the bones of the pelvis and extremities. We placed special emphasis on the classification of the different forms of presentation as being of greater or lesser severity from a clinical point of view, and stressed the importance of associated abnormalities (such as renal complications, as in the case of our patient) with respect to the eventual prognosis. The diagnosis of allergy is based on a detailed clinical history, positive results to cutaneous testing and the presence of specific IgE, together with the results of nasal provocation. The recording by rhinomanometre, of the temperature and pressure, and the assessment of the nasal mucosa following contact with the suspected allergen was also of help. Finally, having established the diagnosis, we advised the corresponding treatment, both from the allergic and renal viewpoints and concluded with an evaluation of the prognosis as conditioned by the renal pathology.

Vacunas profilácticas frente al virus del papiloma humano: Documento de consenso 2008* / Prophylactic human papillomavirus vaccines: Consensus Document 2008

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