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The high prevalence of obesity in Mexico starting from the early stages of life is concerning and represents a major public health problem. Genetic association studies have reported that single nucleotide variants (SNVs) in SIRT1, an NAD+-dependent deacetylase that plays an important role in the regulation of metabolic cellular functions, are associated with multiple metabolic disorders and the risk of obesity. In the present study, we analyzed the effect that the SNVs rs1467568 and rs7895833 of the SIRT1 gene may have on cardiometabolic risk factors in a young adult population from Mexico. A cross-sectional study was carried out with young adults between the ages of 18 and 25 who had a body mass index (BMI) greater than 18.5 kg/m2. This study included 1122 young adults who were classified into the normal weight (n = 731), overweight group (n = 277), and obesity group (n = 114) according to BMI of whom 405 and 404 volunteers were genotyped for rs1467568 and rs7895833 respectively using TaqMan probes through allelic discrimination assays. We found that the male sex carrying the G allele of rs7895833 had slightly lower BMI levels (p = 0.009). Furthermore, subjects carrying rs1467568 (G allele) showed a 34% lower probability of presenting with hyperbetalipoproteinemia where female carrying rs1467568 had lower levels of total cholesterol (p = 0.030), triglycerides (p = 0.026) and LDL cholesterol (p = 0.013). In conclusion, these findings suggest that the presence of both SNVs could have a non-risk effect against dyslipidemia in the Mexican population.

RESUMEN

Aims: In this study, we evaluated the association of sociodemographic, lifestyle and cardiometabolic factors with blood glucose levels in children and adolescents in Mexico. Methods: An analytical cross-sectional study of 642 children and adolescents aged 6 to 19 years from different educational centers located in municipalities of the state of San Luis Potosí, Mexico, was carried out. Pearson χ2 and Spearman correlation tests and multiple linear regression models were used to evaluate the associations of the variables with glycemia. Results: The prevalence of prediabetes was 8.0% in both sexes. Male participants were more likely to develop hyperglycemia than female participants (OR 2.7, 95% CI: 1.5-5.0). The variables associated with glucose levels were male sex, high socioeconomic status, inadequate diet, high blood pressure, and increased total cholesterol, LDL cholesterol, and triglycerides, which also explained up to 15.6% (p < 0.05) of the variability in glucose concentrations. Conclusion: The detection of sociodemographic, lifestyle and cardiometabolic factors in children and adolescents will contribute to the implementation of prevention strategies for cardiometabolic diseases, among which prediabetes is common.

RESUMEN

Dysbiosis has been implicated in childhood obesity. Oral intake of fermented milk containing Lacticaseibacillus casei strain Shirota preserves gut microbiota (GM) diversity in children and adults. This study was a double-blind trial involving 37 overweight or obese children aged 6-10 years. Children were followed over a 6-week intervention period in which they received different fermented milk products containing L. casei Shirota: 10 in the first group received just L. casei Shirota; 13 received L. casei Shirota with 3 g/day of inulin (L. casei+inulin); and 14 received L. casei Shirota with 3 g/day of fructans from Agave salmiana (L. casei+fructans). Principal component analysis showed the relationship between microbial abundance, GM metabolites, and other obesity-related markers. Supplementation with probiotics and synbiotics improved the HDL-cholesterol levels of overweight and obese children, although no changes in body composition were detected. We observed an increase in butyrate or propionate concentrations in the L. casei+fructans group compared to the end of the intervention (P<0.03). A diminished level of ANGPTL4 within the L. casei+fructans group (P=0.04) was also found, but no differences when lipopolysaccharide-binding protein was evaluated. The FFAR2+ cell frequency decreased between baseline and at the end of 6-week intervention in L. casei+inulin (P=0.02) and L. casei+fructans groups (P=0.04). In contrast, the percentage of CD14+FFAR3+ frequency increased in the same groups (P=0.04). The L. casei Shirota with inulin or fructans modulates GM, which improves the lipid profile and changes at a molecular level, such as expression of FFAR3 and FFAR2, ANGPTL4, propionate, and butyrate. It, therefore, could be considered an interesting therapeutic possibility for treating childhood overweight and obesity. The study was registered at ClinicalTrials.gov (ID: NCT05423015).

Asunto(s)

Agave , Productos Lácteos Cultivados , Obesidad Infantil , Probióticos , Niño , Adulto , Humanos , Fructanos , Agave/química , Inulina/farmacología , Sobrepeso/tratamiento farmacológico , Obesidad Infantil/tratamiento farmacológico , Propionatos , Biomarcadores

RESUMEN

BACKGROUND AND AIM: Uric acid (UA) is a product of the catabolism of purines, and its increase in blood may be related to the development of cardiometabolic diseases. Whether UA is the result or causal determinant of the appearance of risk factors for cardiometabolic disease is not yet known. UA levels among the young student population in San Luis Potosi have increased in recent years, which may be indicative of a serious future public health concern. Therefore, the objective of this study was to evaluate the association of sociodemographic, lifestyle and cardiometabolic determinants with UA levels in children and adolescents in San Luis Potosí. METHODS AND RESULTS: A total of 730 students (54.1% female and 45.9% male, 6-19 years old) participated in the study. The subjects attended one of five public schools located in San Luis Potosí. Venous blood samples were collected, blood serum was separated by centrifugation, and UA concentrations were measured with an automated analytical platform. UA was associated with most of the independent variables studied. It presented a positive correlation with body mass index (r = 0.363, p < 0.01). Male sex, socioeconomic status, total screen time, exercise, adequate sleep, systolic blood pressure, total cholesterol, and high-density lipoprotein cholesterol explained 23%-39% (p < 0.001) of the variability of plasma concentrations of UA in children and adolescents. CONCLUSION: Early detection of these determinants will prevent future diseases. Moreover, it will help with the implementation of preventive strategies that could improve the health of this population.

Asunto(s)

Enfermedades Cardiovasculares , Ácido Úrico , Adolescente , Índice de Masa Corporal , Niño , HDL-Colesterol , Femenino , Humanos , Masculino , México/epidemiología , Adulto Joven

RESUMEN

INTRODUCTION: Peroxisomal biogenesis disorders are due to mutations in the PEX genes, which code for peroxins that are required for peroxisomal biogenesis. Clinically, they are expressed as a Zellweger syndrome spectrum, and there is a wide phenotypic variety. They are diagnosed biochemically, and confirmation is molecular. The aim of this illustrative case is to highlight the importance of the clinical features and biochemical testing in the management of a peroxisomal disease. CASE REPORT: A 3-year-old boy with neonatal hypotonia, overall developmental delay and failure to thrive and a pattern of hypomyelinating leukodystrophy in brain resonance. The suspected diagnosis was a disorder affecting the biogenesis of the peroxisomes due to having found a variant with an uncertain meaning in PEX5. The clinical features, the biochemical studies and critical analysis, however, made this diagnosis unlikely. Emphasis is placed on the management that must be applied when a Zellweger syndrome spectrum is suspected. CONCLUSION: In the case reported here, a peroxisomal biogenesis disorder was suspected owing to an exome sequencing which, on being critically analysed together with the clinical features and the biochemical findings, made a peroxisomal disease very unlikely. In cases of clinical suspicion, backed up by neuroimaging, the main diagnostic management must be based on the biochemistry analysis. Although confirmation is molecular, these tests must be interpreted with caution.

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TITLE: Importancia de la semiologia y la bioquimica en el abordaje diagnostico de un trastorno de la biogenesis peroxisomica.Introduccion. Los trastornos de la biogenesis de los peroxisomas se deben a mutaciones en los genes PEX, que codifican peroxinas requeridas para la biogenesis peroxisomica. Clinicamente se expresan como un espectro del sindrome de Zellweger, y hay una amplia variedad fenotipica. Su diagnostico se realiza bioquimicamente y la confirmacion es molecular. El objetivo de este caso ilustrativo es resaltar la importancia de la clinica y de las pruebas bioquimicas en el abordaje de una enfermedad peroxisomica. Caso clinico. Niño de 3 años con hipotonia neonatal, retraso global del desarrollo y fallo de medro, con un patron en resonancia cerebral de leucodistrofia hipomielinizante, en quien se habia sospechado un trastorno de la biogenesis de los peroxisomas por encontrarse una variante de significado incierto en PEX5, pero su clinica, los estudios bioquimicos y el analisis critico de las pruebas moleculares hacian improbable este diagnostico. Se hace enfasis en el abordaje que deberia tenerse cuando se sospecha un trastorno del espectro del sindrome de Zellweger. Conclusion. En el caso descrito se sospecho un trastorno de la biogenesis de los peroxisomas por una secuenciacion exomica que, al analizarse criticamente junto con la clinica y los hallazgos bioquimicos, hacia muy poco probable una enfermedad peroxisomica. Cuando se tiene sospecha clinica y por neuroimagenes, el abordaje diagnostico principal debe partir del analisis bioquimico. Aunque la confirmacion es molecular, estas pruebas deben interpretarse con precaucion.

Asunto(s)

Trastorno Peroxisomal/diagnóstico , Preescolar , Humanos , Masculino , Técnicas de Diagnóstico Molecular , Trastorno Peroxisomal/genética , Fenotipo

RESUMEN

Obesity is a chronic inflammatory state with cytokines, adipokines, and miRNAs. The A2a-adenosine system decreases activation and cytokine release in immune cells. MiR-221 is upregulated in carcinogenesis and inflammatory processes, where its targets PTEN and ETS-1, negatively regulates the Akt pathway and induces the release of pro-inflammatory cytokines, respectively. However, the roles of the A2a-adenosine system and miR-221 in adipose tissue are unknown. The aim of this work was to evaluate the A2a-adenosine and miRNA pathways as immune modulators in adipose tissue. We collected aspirate of adipose tissue from patients with BMI < 25 kg/m2 (BMI < 25) and BMI ≥ 25 kg/m2 (BMI ≥ 25) who underwent liposuction; the adipose tissue was digested with collagenase, and then a Ficoll gradient was performed to obtain mononuclear cells from adipose tissue (MCAT). We evaluated the A2a levels by quantitative Retro-transcriptase Polymerase Chain Reaction (RT-qPCR) and flow cytometry and the A2a-adenosine function with a proliferation assay or cytokine levels in the presence or absence of NAD+, activators, and inhibitors of the system. We also analyzed miR-221, ETS-1 and PTEN levels by qRT-PCR. First, we detected that MCAT presented higher basal proliferation than mononuclear cells from peripheral blood; however, activation of the A2a receptor downregulated cell proliferation and cytokine release. Interestingly, while miR-221 was downregulated in MCAT from subjects with BMI ≥ 25 compared to BMI < 25, their targets ETS-1 and PTEN, were increased. In conclusion, the A2a-adenosine system is decreased in MCAT, but it maintains its function; moreover, miR-221 could participate in promoting inflammation in adipose tissue.

Asunto(s)

Tejido Adiposo/metabolismo , MicroARNs/genética , Fosfohidrolasa PTEN/genética , Receptor de Adenosina A2A/metabolismo , Adulto , Femenino , Regulación de la Expresión Génica , Humanos , Inflamación/genética , Inflamación/metabolismo , Inflamación/patología , Masculino

RESUMEN

BACKGROUND AND AIMS: An increase in plasma branched-chain amino acids is associated with a higher risk of developing type 2 diabetes and cardiovascular diseases. However, little is known about the basal plasma amino acid concentrations in young adults. Our aim was to determine the plasma amino acid profiles of young adults and to evaluate how these profiles were modified by sex, body mass index (BMI) and insulin resistance (IR). METHODS AND RESULTS: We performed a transversal study with 608 Mexican young adults aged 19.9 ± 2.4 years who were applicants to the Universidad Autónoma de San Luis Potosí. The subjects underwent a physical examination and provided a clinical history and a blood sample for biochemical, hormonal and amino acid analyses. The women had higher levels of arginine, aspartate and serine and lower levels of α-aminoadipic acid, cysteine, isoleucine, leucine, methionine, proline, tryptophan, tyrosine, urea and valine than the men. The obese subjects had higher levels of alanine, aspartate, cysteine, ornithine, phenylalanine, proline and tyrosine and lower levels of glycine, ornithine and serine than the normal weight subjects. Subjects with IR (defined as HOMA > 2.5) had higher levels of arginine, alanine, aspartate, isoleucine, leucine, phenylalanine, proline, tyrosine, taurine and valine than the subjects without IR. Furthermore, we identified two main groups in the subjects with obesity and/or IR; one group was composed of amino acids that positively correlated with the clinical, biochemical and hormonal parameters, whereas the second group exhibited negative correlations. CONCLUSION: This study demonstrates that young adults with obesity or IR have altered amino acid profiles characterized by an increase in alanine, aspartate, proline and tyrosine and a decrease in glycine.

Asunto(s)

Aminoácidos/sangre , Índice de Masa Corporal , Resistencia a la Insulina , Obesidad Infantil/sangre , Adolescente , Fenómenos Fisiológicos Nutricionales de los Adolescentes , Factores de Edad , Biomarcadores/sangre , Estudios Transversales , Femenino , Humanos , Masculino , México/epidemiología , Estado Nutricional , Obesidad Infantil/diagnóstico , Obesidad Infantil/epidemiología , Obesidad Infantil/fisiopatología , Prevalencia , Factores de Riesgo , Factores Sexuales , Adulto Joven

RESUMEN

Tuberculosis (TB) remains a major public health issue due to the increasing incidence of type 2 diabetes mellitus (T2DM), which exacerbates the clinical course of TB and increases the risk of poor long-term outcomes. The aim of this study was to characterize the pharmacokinetics of rifampin (RIF) and its relationship with biochemical and immunological parameters in patients with TB and T2DM. The biochemical and immunological parameters were assessed on the same day that the pharmacokinetic evaluation of RIF was performed. Factors related to the metabolic syndrome that is characteristic of T2DM patients were not detected in the TB-T2DM group (where predominant malnutrition was present) or in the TB group. Percentages of CD8(+) T lymphocytes and NK cells were diminished in the TB and TB-T2DM patients, who had high tumor necrosis factor alpha (TNF-α) and low interleukin-17 (IL-17) levels compared to healthy volunteers. Delayed RIF absorption was observed in the TB and TB-T2DM patients; absorption was poor and slower in the latter group due to poor glycemic control. RIF clearance was also slower in the diabetic patients, thereby prolonging the mean residence time of RIF. There was a significant association between glycemic control, increased TNF-α serum concentrations, and RIF pharmacokinetics in the TB-T2DM patients. These altered metabolic and immune conditions may be factors to be considered in anti-TB therapy management when TB and T2DM are concurrently present.

Asunto(s)

Antituberculosos/farmacocinética , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/metabolismo , Rifampin/farmacocinética , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/metabolismo , Adolescente , Adulto , Anciano , Antituberculosos/uso terapéutico , Linfocitos T CD4-Positivos/efectos de los fármacos , Linfocitos T CD8-positivos/efectos de los fármacos , Diabetes Mellitus Tipo 2/inmunología , Femenino , Semivida , Humanos , Interleucina-17/metabolismo , Células Asesinas Naturales/efectos de los fármacos , Masculino , Persona de Mediana Edad , Rifampin/uso terapéutico , Tuberculosis Pulmonar/inmunología , Factor de Necrosis Tumoral alfa/metabolismo , Adulto Joven

RESUMEN

SETTING: Subtherapeutic plasma isoniazid (INH) concentrations and the development of bacterial resistance may be attributed to poor quality and reduced bioavailability of fixed-dose combination (FDC) formulations. The bioavailability of INH from a generic and that of a branded FDC formulation had not been compared in the Mexican population. OBJECTIVE: To evaluate the bioequivalence of a generic three-drug FDC formulation (3FDC) in comparison with a 3FDC reference with doses of 300 mg INH in 20 healthy Mexican adults, and to generate data regarding the oral relative bioavailability of the drug in this population. DESIGN: A single-dose, randomised-sequence, open-label, two-period crossover study. RESULTS: Both formulations were well tolerated. The pharmacokinetic parameters of INH showed wide inter-individual variability. The average relative bioavailability calculated for maximum serum concentration area under the concentration-time curve (AUC), AUC(0-24h) and AUC(0-∞) of the test 3FDC formulation vs. the 3FDC reference were respectively 64.84% (90%CI 56.01-75.06), 59.05% (90%CI 50.27-69.36) and 57.26% (90%CI 46.93-69.84). CONCLUSIONS: The 3FDC test and reference formulations were not bioequivalent because the 90%CI for the geometric mean ratios did not meet the regulatory requirements for bioequivalence (range 80-125%) based on the rate and extent of absorption.

Asunto(s)

Antituberculosos/farmacocinética , Medicamentos Genéricos/farmacocinética , Isoniazida/farmacocinética , Administración Oral , Adulto , Antituberculosos/administración & dosificación , Antituberculosos/sangre , Área Bajo la Curva , Disponibilidad Biológica , Estudios Cruzados , Combinación de Medicamentos , Medicamentos Genéricos/administración & dosificación , Femenino , Semivida , Voluntarios Sanos , Humanos , Isoniazida/administración & dosificación , Isoniazida/sangre , Masculino , Tasa de Depuración Metabólica , Pirazinamida/administración & dosificación , Rifampin/administración & dosificación , Equivalencia Terapéutica , Adulto Joven

RESUMEN

OBJECTIVE: Increasing overweight and obesity rates in Mexico have been associated with increases in mortality from cardiovascular disease (CVD). This study assessed changes in body mass index (BMI) and body weight over 1 year, and explored whether these were associated with changes in CVD risk factors of blood pressure and fasting glucose in a cohort of young Mexican adults. STUDY DESIGN: Longitudinal data were obtained from a cohort of young Mexican adults applying to college. METHODS: Data were collected from college applicants for the 2008 academic year who re-applied in 2009. In total, 795 college applicants aged 18-20 years, of both sexes (48% males and 52% females), were included in the study. The screen included height, weight, and systolic (SBP) and diastolic (DBP) blood pressure measurements plus a blood draw following an overnight fast for fasting glucose. RESULTS: At baseline, 31.8% of the participants were overweight or obese. The mean 1-year change in body weight and BMI were 0.80 kg and 0.35 kg/m(2), respectively. One-year changes in body weight and BMI were associated with increased SBP and DBP for both men and women (P < 0.05), independent of baseline BMI. A weight gain of 5% or more was positively associated with increases in blood pressure among women (P < 0.05), but not among men. A weight loss of 5% or more was associated with reductions in SBP among women. CONCLUSIONS: One-year changes in weight were associated with changes in blood pressure.

Asunto(s)

Presión Sanguínea , Peso Corporal , Adulto , Glucemia , Índice de Masa Corporal , Estudios de Cohortes , Femenino , Humanos , Estudios Longitudinales , Masculino , México/epidemiología , Obesidad/epidemiología , Sobrepeso/epidemiología , Factores de Riesgo , Aumento de Peso , Pérdida de Peso , Adulto Joven

RESUMEN

Brain tumours are the most common solid tumours in children and a major cause of childhood mortality. The most common paediatric brain tumours include ependymomas, cerebellar astrocytomas and medulloblastomas. These brain tumours are highly heterogeneous regarding their histology, prognosis and therapeutic response. Subtle biochemical changes can be detected in intact tissues by High-Resolution Proton Magnetic Angle Spinning Spectroscopy (HR-MAS) revealing the status of tumour microheterogeneity and metabolic alterations before they are morphologically detectable. In this study, we present metabolic profiles by HR-MAS of 20 intact tissue samples from paediatric brain tumours. Tumour types include ependymoma, medulloblastoma and pilocytic astrocytoma. The metabolic characterization of paediatric brain tumour tissue by HR-MAS spectroscopy provided differential patterns for these tumours. The metabolic composition of the tumour tissue was highly consistent with previous in vivo and ex vivo studies. Some resonances detected in this work and not previously observed by in vivo spectroscopy also show potential in determining tumour type and grade (fatty acids, phenylalanine, glutamate). Overall, this work suggests that the additional information obtained by NMR metabolic profiling applied to tissue from paediatric brain tumours may be useful for assessing tumour grade and determining optimum treatment strategies.

Asunto(s)

Neoplasias Encefálicas/metabolismo , Glioma/metabolismo , Metabolómica/métodos , Aminoácidos/química , Análisis de Varianza , Química Encefálica , Neoplasias Encefálicas/patología , Niño , Preescolar , Ácidos Grasos/química , Glioma/patología , Humanos , Lactante , Imagen por Resonancia Magnética , Análisis de Componente Principal

RESUMEN

AIM: The effectiveness of anatomic localization of the subthalamic nucleus (EAL) was assessed and the mapping method is described here. The symmetry of contralateral nuclei (SCN) was analyzed on 11 parkinsonian patients submitted to bilateral subthalamotomy with ablative lesioning. PATIENTS AND METHODS: To assess EAL the percentage so much of first trajectory (p1) as the total of trajectories (pt) that hit the target and the rest of subthalamic nucleus average distance (d) was calculated. The anatomic localization error (epsilon) is determined as a difference between first trajectory coordinates with those of medial determined nucleus point, through electrophysiological data as to the statistical significance of this error. SCN is analyzed by contrasting equality hypothesis at the nucleus maximum height alongside a trajectory, average electrophysiological position center and spatial distribution of all intranuclear recordings found in each hemisphere in all patients. RESULTS: The pi, pt and d obtained values were 86.36%, 86.13% and 1.41 +/- 1.01 mm respectively. The epsilon value was greater in anteroposterior direction of 1.11 +/- 0.83 mm without statistical significance. The average number of recorded trajectories for the first procedure was 6.45 and 6 for the second. The asymmetry of contralateral nucleus was not significant. CONCLUSIONS: An indirect method with CT brain images and a new electrophysiological mapping method with a multiunitary recording for first and second nucleus is safe enough and it yields a high effectiveness in anatomofunctional nucleus localization. The nucleus of a same patient are symmetrical. There is little space variability among patient non related to the differences in the intercommissural distance.

Asunto(s)

Mapeo Encefálico , Técnicas Estereotáxicas , Núcleo Subtalámico/anatomía & histología , Anciano , Terapia por Estimulación Eléctrica , Electrodos Implantados , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad de Parkinson/patología , Enfermedad de Parkinson/cirugía , Núcleo Subtalámico/cirugía

RESUMEN

INTRODUCTION: A series of quantitative scales have been established internationally to evaluate the functional state of patients affected by movement disorders, such as Parkinson s disease. The values of these parameters offered by each patient, measured at different moments during his or her illness, allow us to conduct studies into their evolution as well as perform statistical studies about the casuistics. AIM. To provide a tool that enables us to study this vast amount of material in an efficient, sure and, above all, automated manner. Materials and methods. We selected the most interesting variables from the international protocols. We also designed and developed a database application for use under the Windows environment using Delphi 3.0 language and compiler and Structured Query Language. RESULTS: We designed, developed and validated a database system so as to be able to handle automatically the information on the clinical evolution of patients who had undergone functional neurosurgery. This system not only enables us to collect all relevant pre and post surgical information but also allows fast searches and selection, data processing using descriptive statistical techniques and the exportation of the data in a standard format. The system, which also allows final double blind clinical evaluation of each patient to be performed, has been used successfully in the Movement Disorders Clinic at the CIREN for over three years. CONCLUSIONS: This system allows for a considerable saving in the amount of time and effort needed for the post surgical evolution of patients, while also increasing the reliability of the results obtained.

Asunto(s)

Bases de Datos Factuales , Periodo Posoperatorio , Programas Informáticos , Técnicas Estereotáxicas , Humanos

RESUMEN

OBJECTIVES: Barrow's D type carotid cavernosa fistula (FCC) with progressive symptoms and in whom endovascular procedures have failed meet criteria for a direct approach. We report a case of this type of vascular lesion in whom partial endovascular embolization was done together with a direct approach to the FCC, using a method of localization involving a transoperative imaging guide. Digital subtraction angiography and Estereoflex stereotactic system was used. PATIENTS AND METHODS: A female patient had had a previous minor head injury. She had a progressive neurological disorder with marked visual defect, and had been diagnosed on angiography as having FCC with afferents from branches of the internal carotid artery (ACI) and external carotid artery (ACE). After failure of endovascular treatment orbito zygomatic craniotomy was done with extra intradural dissection and exposure of the antero lateral triangle of the cavernous sinus (SC). The fistula was closed completely by anterior packing with the venous component. Transoperative stereotactic angiographic checks were done to localize and control the packing. CONCLUSIONS: The Barrow's type D FCC in which embolization treatment has failed may be treated using a direct approach to the anterolateral triangle of the SC. The AC1 remained permeable, fistula was occluded and there was minimal morbidity.

Asunto(s)

Fístula del Seno Cavernoso de la Carótida/terapia , Duramadre/irrigación sanguínea , Duramadre/diagnóstico por imagen , Adulto , Malformaciones Arteriovenosas/diagnóstico por imagen , Malformaciones Arteriovenosas/terapia , Fístula del Seno Cavernoso de la Carótida/diagnóstico por imagen , Fístula del Seno Cavernoso de la Carótida/cirugía , Angiografía Cerebral , Terapia Combinada , Embolización Terapéutica/métodos , Femenino , Humanos , Microcirugia , Procedimientos Neuroquirúrgicos/métodos , Técnicas Estereotáxicas

RESUMEN

Se emplea el análisis espectral de orden superior para detectar la presencia de no-gaussianidad en señales eléctricas de estructuras profundas del cerebro de pacientes parkinsonianos operados en el CIREN. Fueron procesados un total de 800 señales agrupadas por tipo de estructura en 8 grupos diferentes (100 por grupo) en un total de 100 pacientes. Las señales fueron registradas con semimicroelectrodos, filtradas en una gama de frecuencias entre 100-1000Hz, evitando la contaminación con cualquier artefacto externo y la interferencia de cualquier otro estimulo durante el registro. Se comparan los resultados de la función de bicoherencia de señales patrones con la calculada para las señales y se aplica laprueba estadística de Hinich sobre la base de dicha función para contrastar la hipótesis de normalidad en la dis tribución de las mismas. Como resultado los valores máximos (0.036± 0.0418) del cuadrado de la función de bicoherencia de las señales se corresponden con señales distribuidas normalmente y se obtienen valores de probabilidad promedio de estar errados al aceptar la hipótesis de la presencia de no-gaussianidad de p=0.986± 0.0110. Se concluye que en las señales registradas conmicroelectrodos en estructuras profundas del cerebro en pacientes parkinsonianos no aparecen no-gaussianidadessignificativas y que por ende la estadística de dicho proceso puede ser evaluada a partir de información brindada por los procedimientos que emplean la función de autocovarianza y el espectro de potencia(AU)

Asunto(s)

Análisis Espectral , Cerebro , Enfermedad de Parkinson

RESUMEN

INTRODUCTION: The Neurosurgical Deep Recording System (NDRS) using a personal computer takes the place of complex electronic equipment for recording and processing deep cerebral electrical activity, as a guide in stereotaxic functional neurosurgery. It also permits increased possibilities of presenting information in direct graphic form with automatic management and sufficient flexibility to implement different analyses. OBJECTIVE: This paper describes the possibilities of automatic simultaneous graphic representation in three almost orthogonal planes, available with the new 5.1 version of NDRS so as to facilitate the analysis of anatomophysiological correlation in the localization of deep structures of the brain during minimal access surgery. MATERIAL AND METHODS: This new version can automatically show the spatial behaviour of signals registered throughout the path of the electrode inside the brain, superimposed simultaneously on sagittal, coronal and axial sections of an anatomical atlas of the brain, after adjusting the scale automatically according to the dimensions of the brain of each individual patient. This may also be shown in a tridimensional representation of the different planes themselves intercepting. RESULTS: The NDRS system has been successfully used in Spain and Cuba in over 300 functional neurosurgery operations. The new version further facilitates analysis of spatial anatomophysiological correlation for the localization of brain structures. CONCLUSION: This system has contributed to increase the precision and safety in selecting surgical targets in the control of Parkinson s disease and other disorders of movement.

Asunto(s)

Encéfalo/patología , Encéfalo/fisiología , Técnicas Estereotáxicas , Electrofisiología , Humanos

RESUMEN

INTRODUCTION: The combination of stereotaxic techniques, advances in neuroimaging and the creation of continually improving software has permitted stereotaxic biopsy of cerebral lesions at the most varied sites. Improvement in the method of permanent interstitial radiation (brachytherapy) improves the precision with which the radioactive sources may be inserted, releasing a maximum dose of radiation to the tumour with minimum radiation to the surrounding tissue. PATIENTS AND METHODS: We treated 237 patients (aged 1 to 78 years) with intracranial lesions, all included in the protocol of our centre. Stereotaxic systems of Leksell, Riechert-Mundinger, Micromar and Estereoflex were used. The procedure was in three stages: acquisition of the image, surgical planning and surgical operation. The imaging guide was the computerized axial tomography (CAT). RESULTS: Stereotaxic biopsy guided by CAT images was done in 153 patients. These were divided into three groups, taking the biopsy findings as the reference: group A (primary tumors, 128), group B (metastatic tumors, 15) and group C (non-malignant lesions, 10). Ninety six permanent implants of 192Ir were inserted, with a low dose of 4-7 cGy/h and a total dose of 80-120 Gy. CONCLUSIONS: Stereotaxic biopsy is a very effective procedure with a significantly low range of complications. The permanent implant with a low dose rate, well situated and using a source of 192Ir is a safe, simple, effective method for the treatment of primary and recurrent glial tumours, and non-glial tumours which fulfil criteria for this type of brachytherapy.

Asunto(s)

Braquiterapia , Neoplasias Encefálicas/radioterapia , Radioisótopos de Iridio/uso terapéutico , Técnicas Estereotáxicas , Adolescente , Adulto , Biopsia/métodos , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo

RESUMEN

INTRODUCTION: The microsurgical techniques for resection of intracranial lesions are limited where anatomical references do not exist or cannot be used as guides in the dissection of deeply located lesions or in more superficial eloquent areas. The stereotaxic guide, guided by imaging gives precise volumetric and geometric definition in intracranial lesions. Its application in the resection of intracranial tumors has special characteristics due to their biological condition and varied localization. OBJECTIVES: Spatial orientation during surgery is essential. We show this application of stereotaxic surgery in the Centro Internacional de Restauración Neurológica (CIREN) in La Havana, Cuba, between May 1994 and February 1988, describing 65 microsurgical operations done using stereotaxis in 62 patients with intracranial cerebral tumors. PATIENTS AND METHODS: The procedure was divided into three stages: acquiring an image, computerized axial tomography and surgical planning, with the STASSIS planning system and microsurgical procedures, including systems of stereotaxis: Leksell, Micromar and Estereoflex. RESULTS: Of the total, 27 of these patients had glial tumors, 33 non-glial tumors and only 2 had non-neoplastic lesions of different sites and sizes. A total of 30 resections were done. Surgical morbidity was minimal and there was no surgical mortality. CONCLUSIONS: The main advantages of this method are: exact localization of the site for craniotomy, easy spatial orientation and ease in distinguishing the delimitation between the tumour and the healthy tissue. It has been shown that Estereoflex may be used in cerebral microsurgery.

Asunto(s)

Neoplasias Encefálicas/diagnóstico , Neoplasias Encefálicas/cirugía , Microcirugia , Técnicas Estereotáxicas , Terapia Asistida por Computador , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad

RESUMEN

This paper describes the automatic three-dimensional (3D) graphic possibilities that are supplied by the Neurosurgical Deep Recording System (NDRS) to facilitate anatomic-physiological targeting during stereotactic and functional neurosurgery using depth recording. This software has been developed to substitute the complex electronic equipment ordinarily used for deep brain electrical recording, display and processing by a personal computer. It may also help to improve on-line graphic analysis, automatic management of the recorded information and flexibility to implement different forms of signal analysis. It can automatically show a 2D or 3D representation of the electrode track, with the electrophysiological findings superimposed as well as the corresponding sagittal, coronal and axial views of a brain atlas using automatic scaling. The NDRS has already successfully been applied during more than 300 neurosurgeries in Spain and Cuba, enabling improved targeting accuracy and safety.

Asunto(s)

Imagenología Tridimensional/instrumentación , Microcomputadores , Modelos Anatómicos , Modelos Neurológicos , Procedimientos Neuroquirúrgicos/instrumentación , Técnicas Estereotáxicas/instrumentación , Mapeo Encefálico/instrumentación , Mapeo Encefálico/métodos , Computadores , Imagenología Tridimensional/métodos , Monitoreo Intraoperatorio/instrumentación , Monitoreo Intraoperatorio/métodos , Procedimientos Neuroquirúrgicos/métodos