RESUMO
INTRODUCTION: Deep brain stimulation (DBS) is a surgical technique used to manage aggression in patients who do not improve despite the use of appropriate drug treatment. OBJECTIVE: The objective of this study is to assess the impact of DBS on aggressive behavior refractory to the pharmacological and behavioral treatment of patients with Intellectual Disabilities (ID). METHODS: A follow-up was conducted on a cohort of 12 patients with severe ID, undergoing DBS in posteromedial hypothalamic nuclei; evaluated with the Overt Aggression Scale (OAS), before the intervention, at 6, 12, and 18 months of medical follow-up. RESULTS: After the surgical procedure, there was a significant reduction in the aggressiveness of patients in the follow-up medical evaluation at 6 months (t = 10.14; p < 0.01), 12 months (t = 14.06; p < 0.01), and 18 months (t = 15.34; p < 0.01), respect to the initial measurement; with a very large effect size (6 months: d = 2.71; 12 months: d = 3.75; 18 months: d = 4.10). From 12 months onward, emotional control stabilized and is sustained at 18 months (t = 1.24; p > 0.05). CONCLUSION: DBS in posteromedial hypothalamic nuclei may be an effective treatment for the management of aggression in patients with ID refractory to pharmacological treatment.
Assuntos
Estimulação Encefálica Profunda , Deficiência Intelectual , Humanos , Criança , Deficiência Intelectual/terapia , Estimulação Encefálica Profunda/métodos , Hipotálamo , Resultado do Tratamento , Agressão/fisiologia , Agressão/psicologiaRESUMO
OBJECTIVES: The aim of this study was to analyze the impact of deep brain stimulation (DBS) of the posteromedial hypothalamus (pHyp) on seizure frequency in patients with drug-resistant epilepsy (DRE) associated with intractable aggressive behavior (IAB). METHODS: Data were collected retrospectively from nine patients, who received bilateral stereotactic pHyp-DBS for the treatment of medically intractable aggressive behavior, focusing on five patients who also had DRE. All patients were treated at the Colombian Center and Foundation of Epilepsy and Neurological Diseases-FIRE (Chapter of the International Bureau for Epilepsy), in Cartagena de Indias, Colombia from 2010 to 2014. Each case was evaluated previously by the institutional ethical committee, assessing the impact of aggressive behavior on the patient's family and social life, the humanitarian aspects of preserving the safety and physical integrity of caregivers, and the need to prevent self-harm. Epilepsy improvement was measured by a monthly seizure reduction percentage, comparing preoperative state and outcome. Additional response to epilepsy was defined by reduction of the antiepileptic drugs (AEDs). Aggressive behavior response was measured using the Overt Aggression Scale (OAS). RESULTS: All the patients with DRE associated with IAB presented a significant decrease of the rate of epileptic seizures after up to 4 years follow-up, achieving a general 89.6% average seizure reduction from the state before the surgery. Aggressiveness was significantly controlled, with evident improvement in the OAS, enhancing the quality of life of patients and families. SIGNIFICANCE: In well-selected patients, DBS of the pHyp seems to be a safe and effective procedure for treatment of DRE associated with refractory aggressive behavior. Larger and prospective series are needed to define the pHyp as a target for DRE in different contexts.
Assuntos
Agressão/psicologia , Estimulação Encefálica Profunda , Hipotálamo Médio/fisiologia , Hipotálamo Posterior/fisiologia , Convulsões/psicologia , Convulsões/terapia , Adolescente , Adulto , Agressão/fisiologia , Estimulação Encefálica Profunda/tendências , Epilepsia/complicações , Epilepsia/psicologia , Epilepsia/terapia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Convulsões/complicações , Resultado do Tratamento , Adulto JovemRESUMO
En 53 pacientes intervenidos entre los años 1979 y 1997, se practicaron un total de 55 anastomosis de colon. En su gran mayoría se utilizó la técnica descrita por Goligher en su libro de texto, complementada con estudios radiológicos para asegurar la permeabilidad del colon, preparación preoperatoria del colon y utilización de suturas no reabsorbidas. No se presentaron complicaciones inherentes a la técnica
Assuntos
Humanos , Masculino , Feminino , Vitamina K/administração & dosagem , Vitamina K/uso terapêutico , Radiografia , Cefalosporinas/administração & dosagem , Cefalosporinas/uso terapêutico , Colo/patologia , Enema , Anastomose CirúrgicaRESUMO
Diez pacientes menores de 15 años, con el diagnóstico de tumores mediastinales, fueron atendidos en los Departamentos de Cirugía Pediátrica y Pediatría del Hospital Militar "Dr. Carlos Arvelo", entre los años 1983 y 1993. Los autores efectúan una revisión de la estadística, los métodos de diagnóstico utilizados y la histología de estos tumores
Assuntos
Criança , Adolescente , Humanos , Masculino , Feminino , Histologia , Neoplasias do Mediastino , MediastinoRESUMO
La estenosis del meato es una complicación común de la circuncisión en el recién nacido; sin embargo, su frecuencia exacta es difícil de establecer. El propósito del presente trabajo es analizar los casos de estenosis adquirida del meato, tratados en el Servicio de Cirugía Pediátrica del Hospital Militar "Dr. Carlos Arvelo", en el período comprendido desde enero de 1976 hasta diciembre de 1986, y estudiar su relación con la operación de circuncisión previa
Assuntos
Recém-Nascido , Lactente , Pré-Escolar , Humanos , Masculino , Feminino , Circuncisão Masculina/complicações , Obstrução da Artéria Renal/complicaçõesRESUMO
El quiste mesentérico es una patología rara. El ultrasonido permite sospechar el diagnóstico prenatal, el cual es corroborado al nacer el paciente, con la ayuda del ultrasonido y los otros procedimientos diagnósticos. El diagnóstico diferencial debe establecerse con todas las otras masas abdominales y retroperitoneales. El tratamiento debe ser quirúrgico en todos los casos