RESUMEN
AIM: In high-risk hypertensive subjects (HTs) with incidental unilateral renal artery stenosis (RAS), the effectiveness of percutaneous revascularization with stent (PR-STENT) on blood pressure (BP) and glomerular filtration rate (GFR) is not established. METHODS: Eighteen HTs aged 65.7 ± 9.2 years with angiographically diagnosed unilateral RAS (≥ 60%) were randomized to receive PR-STENT (N=9) or to NO-STENT (N=9). BP (mercury sphygmomanometer) and GFR (99mTc-DTPA clearances during renal scintigraphy) were evaluated yearly for three years. Echo-Doppler of renal arteries was performed to verify the anatomic patency and flow velocities of the reperfused artery. Analysis of variance compared BP and GFR values changes from baseline to the follow-up; differences for continuous variables were evaluated between groups with the Tukey's post hoc test after adjustment for age, change of BP between baseline and at the follow-up, GFR and body mass index (BMI). RESULTS: Baseline systolic BP and GFR values were not different between groups. The significantly greater GFR increase observed in PR-STENT than in NO-STENT at univariate analysis at the end of follow-up (62.5 ± 19.2 vs. 42.24 ± 17.6, P<0.02) disappeared after adjustment for confounding factors. However, systolic BP remained significantly lower in PR-STENT than in NO-STENT (140.1 ± 4.6 vs. 170.0 ± 8.3, P<0.0001) also after adjustment for age, GFR and BMI. CONCLUSION: PR-STENT reduces systolic BP without improving GFR. Due to the strong association between high BP and renal damage, this study raises the question on whether PR-STENT should be performed in all HTs with unilateral and incidental RAS.
Asunto(s)
Angioplastia de Balón , Tasa de Filtración Glomerular , Hipertensión/fisiopatología , Hipertensión/terapia , Obstrucción de la Arteria Renal/fisiopatología , Obstrucción de la Arteria Renal/terapia , Stents , Anciano , Algoritmos , Análisis de Varianza , Presión Sanguínea , Determinación de la Presión Sanguínea , Femenino , Estudios de Seguimiento , Humanos , Hallazgos Incidentales , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Cintigrafía , Obstrucción de la Arteria Renal/diagnóstico por imagen , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , UltrasonografíaRESUMEN
Brown-Vialetto-Van Laere syndrome is a rare disease of unknown origin commonly considered as part of the large group of motor neuron diseases. The course is quite variable: it may be quickly fatal or protracted, with relapsing phases followed by periods of arrest and even partial improvement. We describe a case of Brown-Vialetto-Van Laere syndrome with strong family history for sensorineural hearing impairment. The patient came to our medical attention for severe respiratory failure and leg weakness. The clinical conditions partially improved with recovery of spontaneous respiration and mild increase in muscle strength. The neurophysiological studies performed on our patient showed evidence of nerve damage with subsequent improvement. Our study raises the possibility that the disorder is due to primary nerve damage, which can better justify the intermittent course of the disease, the partial clinical regression and the neurophysiological improvement, never detected in typical motor neuron disorders.
Asunto(s)
Enfermedades de los Nervios Craneales/fisiopatología , Pérdida Auditiva Sensorineural/fisiopatología , Enfermedad de la Neurona Motora/fisiopatología , Enfermedades de los Nervios Craneales/complicaciones , Salud de la Familia , Femenino , Estudios de Seguimiento , Lateralidad Funcional , Humanos , Persona de Mediana Edad , Conducción Nerviosa/fisiologíaAsunto(s)
Esclerosis Amiotrófica Lateral/etiología , Miastenia Gravis/tratamiento farmacológico , Fármacos Neuroprotectores/uso terapéutico , Riluzol/uso terapéutico , Esclerosis Amiotrófica Lateral/genética , Electrofisiología , Humanos , Masculino , Persona de Mediana Edad , Fármacos Neuroprotectores/efectos adversos , Riluzol/efectos adversosRESUMEN
Short-latency somatosensory evoked potentials by the stimulation of the median nerve at the wrist, were recorded in six patients (four with cerebral tumors and two with post-trauma lesions). The electrodes were placed on the scalp following the 10-20 International System. A reference electrode was placed on earlobe contralateral to the site of the stimulation. Eleven normal subjects were used as control (mean age 64.4 +/- 12.05). We used the Brain-Surveyor-Basis Trade system which allowed us to elaborate the results by coloured mapping through linear interpolation of signal amplitudes. The following parameters were investigated: peak latencies of the N13, N20, P22, N30 waves; amplitudes of the post-rolandic P14-N20, N20-P25, pre-rolandic P22-N30 components and the central conduction time N13-N20 (CCT). The evaluation of latencies was not significant in determining the lesion site. On the contrary, the evaluation of amplitudes revealed expressive asymmetry, though it did not define the nature of alteration (increase or decrease due to lesion), and the correlation between these variations and the site of the lesion. The authors discussed the possibility that amplitude abnormalities in patients with tumors were related either to the tumors and/or drug effects.