RESUMEN

Objective: To report our initial experience using an adult-template MAP in drug-resistant focal epilepsy in five children with apparently normal MRI. Methods: Patients selected were highly suspicious of harboring focal structural lesions and had negative brain MRI studies. MAP was performed using a locally obtained adult database as a template. Results were reviewed by two neuroradiologists. Pertinence of MAP-positive areas was confirmed by the focal epileptic hypothesis or by pathology when possible (J Neuroradiol, 39, 2012, 87). Visual analysis was performed using Mango Software. MRI studies were reanalyzed at the workstation with knowledge of the clinical suspicion to confirm or discard the possibility of FCD. Results: Five patients aged 19-48 months were studied, all with initial 3T MRI studies interpreted as normal. All had focal epileptic hypothesis with coherence of clinical seizure characterization and electroencephalographic findings. In two patients, histology showed type 1 FCD. Due to the age of our subjects, the junction map always highlighted the subcortical white matter in relationship to maturity differences. FCD was identified as asymmetric U-shaped highlighted regions in the junction map. Significance: FCD is the most frequent pathology reported in pediatric epilepsy surgery series (Epileptic Disord, 18, 2016, 240). Significant number of FCDs may be overlooked on MRIs, reducing the odds of seizure freedom after surgery (Epilepsy Res, 89, 2010, 310). MAP is an image postprocessing method for enhanced visualization of FCD; however, when using an adult template in developing brains, normal subcortical regions may be highlighted as pathological. Creating a pediatric template is difficult, due to the need for general anesthesia to acquire the MRI database. Here, we were able to show that MAP identified FCDs as asymmetric "U-" shaped highlighted regions in the junction maps of all five patients, which may indicate that obtaining childhood databases for this purpose may not be necessary and that adult ones suffice for diagnosis of FCD.

Asunto(s)

RESUMEN

PURPOSE: Inpatient Video EEG Monitoring (VEM) is the typical study performed in presurgical evaluations. It is expensive and not widely available in developing countries. Recent studies suggested that in selected patients with mesial temporal lobe epilepsy secondary to unilateral mesial temporal sclerosis (MTS), the recording of unilateral interictal epileptiform activity ipsilateral to the MTS may yield sufficient presurgical EEG data. Outpatient prolonged ambulatory EEG (AEEG) could be an alternative in these cases. The purpose of this study was to compare the post-surgical seizure outcome and costs between patients evaluated with AEEG versus VEM. METHODS: Thirty patients with TLE were included: 21 evaluated with VEM and 9 with AmbEEG and underwent surgery between 2011 and 2017. The minimum, post-surgical follow-up period was 1 year. RESULTS: Seven of nine patients who underwent AEEG had seizures ipsilateral to MTS. In two patients only unilateral interictal activity ipsilateral to the lesion was recorded. All patients were free of disabling seizures (Engel Class I) at last follow-up. The mean cost per patient of AEEG was $980 and was $4680 for VEM. CONCLUSION: AEEG may be used to identify candidates for temporal lobectomy in selected patients with unilateral lesional mesial TLE. This approach to EEG monitoring could make epilpesy surgery more affordable to some patients in developing countries.

RESUMEN

The differential diagnosis of non-convulsive status epilepticus (NCSE) is often complex due to a wide clinical variability of its presentation, including psychiatric manifestations. We report a 68 years old male with a history of depression treated with venlafaxine, mirtazapine, quetiapine and risperidone, presenting in the emergency room with confusion and generalized rigidity. A brain CT scan did not show lesions. A neuroleptic syndrome was initially suspected. At the third day the obtundation worsened and an electroencephalogram (EEG) was performed, which showed epileptiform abnormalities. Treatment with valproic acid resulted in disappearance of such abnormalities. After three weeks of mechanical ventilation, the patient was extubated and remained lucid and partially orientated in time and space.

Asunto(s)

RESUMEN

The differential diagnosis of non-convulsive status epilepticus (NCSE) is often complex due to a wide clinical variability of its presentation, including psychiatric manifestations. We report a 68 years old male with a history of depression treated with venlafaxine, mirtazapine, quetiapine and risperidone, presenting in the emergency room with confusion and generalized rigidity. A brain CT scan did not show lesions. A neuroleptic syndrome was initially suspected. At the third day the obtundation worsened and an electroencephalogram (EEG) was performed, which showed epileptiform abnormalities. Treatment with valproic acid resulted in disappearance of such abnormalities. After three weeks of mechanical ventilation, the patient was extubated and remained lucid and partially orientated in time and space.

Asunto(s)

RESUMEN

Background: animal growth does not follow a linear pattern. Accordingly, fitted non-linear models are used to analyze the relationship between growth rate and age. Objective: to assess the ability of several mathematical models (Gompertz, Brody, and von Bertalanffy) to describe growth and development patterns of grazing Holstein males (Bos taurus). Methods: twenty eight intact Holstein steers (average weight 203.8 ± 37.5 kg) were used in the study. The animals grazed on Kikuyu grass pastures (Pennisetum clandestinum) and were supplemented with 1 kg dry matter of reconstituted grain silage until weight reached 301.9 ± 47.9 kg. Animals were weighed at the beginning of the experiment and monthly thereafter from 14 to 21 months of age. The Marquardt's iterative algorithm of PROC NLIN procedure for non-linear models available in the SAS software was used to fit the data to each model and estimate the parameters. Results: Brody model reached the highest estimated value for adult weight (1,097.6 kg) while the Gompertz model displayed the lowest value (795 kg). Bertalanffy model indicated the lowest estimate for maturity index (0.0028) while the highest estimate was obtained by Gompertz (0.0047), being statistically different (p<0.05). Conclusions: Gompertz model best described growth of intact Holstein steers under rotational grazing and feed supplementation.

Antecedentes: los animales en crecimiento no siguen un patrón lineal; así que para describir este patrón se necesitan modelos no lineales ajustados, que analicen la relación entre la velocidad de crecimiento y la edad del animal. Objetivo: evaluar los modelos matemáticos Gompertz, Brody y von Bertalanffy de acuerdo con su capacidad para describir el patrón de crecimiento y desarrollo de los machos Holstein (Bos taurus) en pastoreo. Métodos: el estudio experimental se realizó con 28 novillos enteros de raza Holstein, con peso vivo promedio de 203,8 ± 37,5 Kg. Los animales permanecieron en pastoreo rotacional de pasto kikuyo (Pennisetum clandestinum) y fueron suplementados con 1 Kg de materia seca de silo de grano reconstituido hasta alcanzar un peso promedio de 301,9 Kg. ± 47,9 Kg. Los animales fueron pesados al inicio del experimento y luego con intervalos de 30 días, obteniendo información desde los 14 hasta los 21 meses de vida. El ajuste de los datos a cada modelo y las estimativas de los parámetros se realizaron por medio iterativo del algoritmo Marquardt del procedimiento para modelos no lineales PROC NLIN de SAS. Resultados: el modelo Brody alcanzó el mayor valor estimado para el parámetro ''peso maduro'' (1097, 6 Kg) y el modelo Gompertz obtuvo el menor valor (795 Kg). El modelo de Bertalanffy presentó el menor estimativo del parámetro ''índice de madurez'' (0,0028), mientras que el mayor estimativo lo presentó el modelo de Gompertz (0,0047), mostrando diferencia significativa (p<0,05). Conclusiones: el modelo de Gompertz fue el que mejor describió el patrón de crecimiento de los machos Holstein en pastoreo rotacional con suplementación.

Antecedentes: os animais no seu crescimento não seguem um patrão lineal, pelo qual são necessários modelos matemáticos não lineais, que estudem a relação entre a taxa de crescimento e a idade do animal. Objetivo: avaliar os modelos Gompertz, Brody e von Bertalanffy na sua capacidade para descrever o crescimento de machos inteiros da raça holandês em condições de pastejo. Métodos: o estudo foi realizado com 28 animais não castrados da raça holandês, cujo peso vivo ao inicio do experimento foi de 203,8 ± 37,5 Kg. Os animais foram mantidos em um sistema de pastejo rotacionado com capim kikuyu (Pennisetum clandestinum) e suplementados com 1 Kg de matéria seca de silagem de grão reconstituído até atingir um peso médio de 301,9 ± 47,9 Kg. Todos os animais foram pesados ao inicio do experimento e depois a intervalos de 30 dias, obtendo informação entre os 14 e 21 meses de vida. O ajuste dos dados a cada modelo e as estimativas dos parâmetros foram realizadas com o procedimento PROC NLIN do SAS. Resultados: o modelo Brody atingiu o maior valor estimado para o parâmetro ''peso à maturidade'' (1097,6 Kg) e o modelo Gompertz obteve o menor valor (795 Kg). O modelo von Bertalanffy apresentou a menor estimativa do parâmetro ''índice de maturidade'' (0,0028) entanto que o maior valor foi encontrado no modelo Gompertz (0,0047) (p<0,05). Conclusões: o modelo Gompertz foi o que melhor descreveu o crescimento de machos da raça Holandês mantidos em condições de pastejo rotacionado com suplementação.

RESUMEN

El síndrome de déficit de atención e hiperactividad (ADHD) es un trastorno neurológico /conductual que se inicia en la infancia. Se ha propuesto que el zinc tendría un potencial rol como terapia adjunta para el ADHD. Nuestro objetivo fue evaluar el efecto de la suplementación con zinc sobre la conducta, como terapia complementaria al metilfenidato, en niños con ADHD. En un estudio controlado, doble ciego, se seleccionaron 40 pacientes con criterios clínicos y psicométricos de ADHD, (31 niños, 9 niñas, 7-14 años de edad). Ellos fueron seleccionados aleatoriamente para recibir ya sea metilfenidato 0,3 mg/kg/d + placebo (sacarosa) (grupo placebo, GPL), o metilfenidato 0,3 mg/kg/d + zinc (sulfato) 10 mg/d (grupo Zn, GZN) por 6 semanas; se excluyeron 4 niños. Se tomó una muestra de 3 mL de sangre en el tiempo 0 y a las 6 semanas para el análisis de Zn plasmático; se aplicó en ambos tiempos a padres y profesores la escala abreviada de Conners para ADHD. Entre los resultados, El Zn plasmático fue normal en el tiempo 0 en ambos grupos, disminuyendo después de 6 sem., especialmente en el grupo GPL (GPL: 95,9 ± 21,5 a 77,9 ± 15,5; GZN: 90.3 ± 9.1 a 85,0 ± 12,0 μg/dl, NS). El test de Conners aplicado por los profesores mostró una aparente mejoría en GZN: GPL: 18 (9-28) a 16 puntos (2-26); GZN: 19 (6-24) a 11 puntos (3-23) (p= 0,07), sin mejoría en el Conners aplicado por los padres: GPL: 19 (7-25) a 13 (3-22); GZN: 19 (7-25) a 11 (2-19). Se concluye que se observa una disminución en las concentraciones plasmáticas de Zn en ambos grupos, pero mayor en el grupo placebo. Con el suplemento de zinc se observa una aparente mejoría en los síntomas de ADHD, de acuerdo con la evaluación de Conners aplicada por profesores. Se requiere avanzar en el estudio de esta probable interacción entre zinc y metilfenidato.

The attention-deficit/hyperactivity disorder (ADHD) is a neurological/behavioral disorder which begins in childhood. Zinc has a potential role as an adjuvant therapy for ADHD. The objective was to evaluate the effect of Zn supplementation on behavior, as a complementary therapy to metylphenidate, in pediatrics patients with ADHD. In a controlled, double blind design, 40 patients with clinical criteria of ADHD (DSMIV) and psychometric evaluation (WISC-R), were selected (31 boys and 9 girls, 7-14 years of age). They were randomized to receive methylphenidate 0.3 mg/kg/d + placebo (sucrose) (group placebo, GPL) or methylphenidate 0.3 mg/kg/d + zinc (sulfate) 10 mg/d (group Zn, GZN) for 6 weeks. A blood sample was drawn at time 0 and 6 weeks, for plasma Zn analysis. The teacher and parent ADHD rating scale (Conners` global index, CGI) was applied at both times. Among the results, plasma Zn was normal at time 0, decreasing especially in the GPL after 6 weeks (GPL: 95.9 ± 21.5 to 77.9 ± 15.5; GZN: 90.3 ± 9.1 to 85.0± 12.0 μg/dL; NS). The CGI by teachers showed a non-significant improvement with Zn: GPL: 18 (9- 28) to 16 points (2-26); GZN: 19 (6-24) to 11 points (3-23) (p=0.07); no significant difference in the CGI by parents by groups was found: GPL: 19 (7-25) to 13 (3- 22); GZN: 19(7-25) to 11(2-19). We conclude that a decrease in plasma Zn levels in both groups was found, greater in the placebo group. An apparent improvement in ADHD signs in children was observed with the Zn supplementation, according to the Conners global index by teachers.

Asunto(s)

RESUMEN

The attention-deficit/hyperactivity disorder (ADHD) is a neurological/behavioral disorder which begins in childhood. Zinc has a potential role as an adjuvant therapy for ADHD. The objective was to evaluate the effect ofZn supplementation on behavior, as a complementary therapy to metylphenidate, in pediatrics patients with ADHD. In a controlled, double blind design, 40 patients with clinical criteria ofADHD (DSM-IV) and psychometric evaluation (WISC-R), were selected (31 boys and 9 girls, 7-14 years of age). They were randomized to receive methylphenidate 0.3 mg/kg/d + placebo (sucrose) (group placebo, GPL) or methylphenidate 0.3 mg/kg/d + zinc (sulfate) 10 mg/d (group Zn, GZN) for 6 weeks. A blood sample was drawn at time 0 and 6 weeks, for plasma Zn analysis. The teacher and parent ADHD rating scale (Conners' global index, CGI) was applied at both times. Among the results, plasma Zn was normal at time 0, decreasing especially in the GPL after 6 weeks (GPL: 95.9 +/- 21.5 to 77.9 +/- 15.5; GZN: 90.3 +/- 9.1 to 85.0 +/- 12.0 microg/dL; NS). The CGI by teachers showed a non-significant improvement with Zn: GPL: 18 (9-28) to 16 points (2-26); GZN: 19 (6-24) to 11 points (3-23) (p = 0.07); no significant difference in the CGI by parents by groups was found: GPL: 19 (7-25) to 13 (3-22); GZN: 19(7-25) to 11(2-19). We conclude that a decrease in plasma Zn levels in both groups was found, greater in the placebo group. An apparent improvement in ADHD signs in children was observed with the Zn supplementation, according to the Conners global index by teachers.

Asunto(s)

RESUMEN

Se presenta el primer caso de un transplate simultaneo renal y pancreatico realizado en Colombia el 26 de Marzo de 1988 en un paciente de 36 anos, que desde los 17 sufria una diabetes mellitus tipo 1 y quien en los ultimos tiempos tenia una insuficiencia renal terminal por sindrome nefrotico. Habia presentado varios episodios de coma diabetico. Una vez realizado el transplante se observo desde un comienzo como el rinon transplantado no funcionaba, lo que dificulto su tratamiento. Permanecio practicamente insulino independiente por mas de tres semanas. Como el pancreas se coloco en situacion extraperitoneal, se presento necrosis de los musculos de esta zona debido a la formacion de un hematoma y se produjo pancreatitis superficial. Hacia la 4 semana hubo compromiso severo de el estado general e inconciencia, y fue necesario extraerle el pancreas transplatado. Fallecio el 21 de abril de 1988, 26 dias despues de la cirugia.

Asunto(s)

RESUMEN

Se describen tres pacientes con angiomiolipomas o hemartomas del rinon, uno de ellos asociado a esclerosis tuberosa. Se destaca la importancia del ultrasonido y mas especificamente de la tomografia axial computarizada (TAC), en el diagnostico. Igualmente se revisa la terapia actual, en la que la embolizacion arterial juega papel predominante sobre los procedimientos quirurgicos.

Asunto(s)