RESUMO
Background: Stroke is the second cause of mortality and the first cause of morbidity in Chile and worldwide. Nowadays there is a major interest in introducing new therapies applying evidence based medicine for these patients. Aim: To describe the clinical profile of patients attended after a stroke, to determine stroke subtypes and their risk factors. Material and methods: Retrospective review of clinical records of 459 patients (mean age 65±48 years, 238 female) that were admitted to our unit during a period of 37 months. Results: Sixty three percent of patients had an ischemic stroke, 14% had an hemorrhagic stroke, 15% had a transient ischemic attack, 2% had a cerebral venous thrombosis and 6% a subarachnoidal hemorrhage. The global mortality was 1%. Seventy percent of patients had a history of high blood pressure. Conclusions: The most common type of stroke is ischemic and high blood pressure is the main risk factor.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/epidemiologia , Unidades Hospitalares/estatística & dados numéricos , Distribuição por Idade , Acidente Vascular Cerebral/classificação , Acidente Vascular Cerebral/etiologia , Distribuição de Qui-Quadrado , Chile/epidemiologia , Complicações do Diabetes , Hipertensão/complicações , Estudos Retrospectivos , Fatores de Risco , Distribuição por SexoRESUMO
Pure Autonomic Failure is a progressive, adult onset, degenerative disorder of the autonomic nervous system characterized clinically by orthostatic hypotension, bladder, sexual and sudomotor dysfunction. Since there are no other associated somatic neurological deficits, this condition must be considered in the differential diagnosis of orthostatic hypotension. We report a 64 years old man with a history of seven years of autonomic dysfunction, with severe orthostatic hypotension, erectile and bladder dysfunction. Autonomic tests showed low circulating norepinephrine levels, sweating abnormalities with regional anhydrosis of the left side of the trunk and abnormal cardiovagal response, indicating generalized autonomic failure. Peripheral somatic neuropathies with autonomic involvement were excluded by normal electrophysiologic tests and the patient was diagnosed pure autonomic failure. Treatment with fludrocortisone and midodrine improved orthostatic tolerance.
Assuntos
Pessoa de Meia-Idade , Doenças do Sistema Nervoso Autônomo/diagnóstico , Diagnóstico Diferencial , Hipotensão Ortostática/diagnóstico , Sudorese , SíndromeRESUMO
BACKGROUND: Stroke is the second cause of mortality and the first cause of morbidity in Chile and worldwide. Nowadays there is a major interest in introducing new therapies applying evidence based medicine for these patients. AIM: To describe the clinical profile of patients attended after a stroke, to determine stroke subtypes and their risk factors. MATERIAL AND METHODS: Retrospective review of clinical records of 459 patients (mean age 65+/-48 years, 238 female) that were admitted to our unit during a period of 37 months. RESULTS: Sixty three percent of patients had an ischemic stroke, 14% had an hemorrhagic stroke, 15% had a transient ischemic attack, 2% had a cerebral venous thrombosis and 6% a subarachnoidal hemorrhage. The global mortality was 1%. Seventy percent of patients had a history of high blood pressure. CONCLUSIONS: The most common type of stroke is ischemic and high blood pressure is the main risk factor.
Assuntos
Unidades Hospitalares/estatística & dados numéricos , Acidente Vascular Cerebral/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Chile/epidemiologia , Complicações do Diabetes , Feminino , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Distribuição por Sexo , Acidente Vascular Cerebral/classificação , Acidente Vascular Cerebral/etiologiaRESUMO
Long-term therapy with amiodarone has been associated with a high incidence of adverse side effects, that precludes its indication for common cardiac arrhythmias. We have prospectively studied 218 patients (pts), aged 32-87 years, under chronic amiodarone therapy that were followed for 2 years and evaluated for efficacy and adverse side effects. Previous amiodarone treatment ranged from 1 to 135 months. Cardiac arrhythmias were paroxysmal AF (PAF) in 120 pts, sustained VT (SVT) in 36 pts, paroxysmal supraventricular tachycardia (PSVT) in 21 pts, unsustained VT (UVT) in 18 pts and miscellaneous in 23 pts. Amiodarone doses ranged from 500 to 4200 mg per week. Amiodarone was effective in 65% of all patients. No difference was observed between efficacy and type of arrhythmia. Dermatologic toxicity was found in 36%, neurologic toxicity in 23%, thyroid toxicity in 13.4% and pulmonary fibrosis en 2.5% of pts. Amiodarone was discontinued routinely when pulmonary toxicity was present. We conclude that amiodarone therapy is effective in a wide spectrum of arrhythmias. Although drug therapy was associated with a high incidence of adverse side effects, these did not preclude continuation of treatment.
Assuntos
Amiodarona/administração & dosagem , Arritmias Cardíacas/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Amiodarona/efeitos adversos , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Ha habido importantes avances en el conocimiento del metabolismo del triptofano, la síntesis de serotonina y los receptores serotoninérgicos encefálicos. Se ha determinado la efectividad terapéutica del 5-hidroxitriptofano en la depresión, insomnio, dolor crónico, mioclonías, etc. Eso sí, ha surgido inquietud al establecerse, como efecto adverso del tratamiento con L-triptofano, la producción del síndrome de mialgia-eosinofilia con compromiso importante de las fuerzas debido a una polineuropatía
Assuntos
Humanos , 5-Hidroxitriptofano/farmacologia , Receptores de Serotonina/fisiologia , Triptofano/farmacologia , Transtorno Depressivo/tratamento farmacológico , Mioclonia/tratamento farmacológico , Serotonina/síntese química , Síndrome de Eosinofilia-Mialgia/induzido quimicamente , Distúrbios do Início e da Manutenção do Sono/tratamento farmacológicoRESUMO
En una paciente de 12 años de edad, aparentemente sana hasta los 9 años, con epilepsia progresiva, deterioro mental, acidosis láctica y déficit neurológicos que simulaban accidentes cerebrovasculares, la biopsia muscular demostró fibras rojas desflecadas y acúmulos de mitocondrias anormales, confirmando el diagnóstico de encefalomiopatía mitocondrial. Conviene pensar en este grupo de enfermedades en pacientes escolares con cefalea periódica, epilepsia mioclónica que responde mal al tratamiento, hipoacusia sensorioneural y deterioro mental. Las manifestaciones musculares pueden ser frecuentemente tardías
Assuntos
Criança , Humanos , Feminino , Encefalomielite/patologia , Mitocôndrias Musculares/ultraestrutura , Encefalomielite/diagnóstico , Síndrome , Tomografia Computadorizada por Raios XRESUMO
A 12 year old girl with mitochondrial myopathy, encephalopathy, lactic acidosis and stroke like episodes (MELAS) is reported. After a normal childhood, at 9 years of age she developed generalized and hemilateralized seizures. Posteriorly, these episodes became more frequent and were accompanied by headache, homonimous hemianopsia, ataxia, vomiting, photophobia, left hemiparesis, slurred speech and even convulsive status. Laboratory tests evidenced lactic acidosis, brain lucencies at CT Scan and ragged skeletal muscle fibers at muscle biopsy.
Assuntos
Encefalomielite/patologia , Mitocôndrias Musculares/ultraestrutura , Acidose Láctica/etiologia , Criança , Encefalomielite/complicações , Encefalomielite/diagnóstico , Feminino , Humanos , Doenças Musculares/patologia , Síndrome , Tomografia Computadorizada por Raios XRESUMO
The relation between resistance to fatigue and intramuscular pH was studied in fast muscles (anterior tibialis and extensor digitorum longus) from rats treated with 2,4-dichlorophenoxyacetic acid (2,4-D) to induce myotonia. Fatiguability was studied in muscles indirectly stimulated at 30 Hz (330 ms/s; 1 train/s) for 2 min. The resistance to fatigue decreased significantly 1 h after drug treatment and remained low 24 h later. The intramuscular pH was lower than normal in resting muscles from 2,4-D-treated rats. After 2 min of stimulation the pH decreased in both control and drug-treated muscles. However, this decrement was reduced in the experimental muscles. The pH of control and of 2,4-D-treated muscles were similar after the stimulation period, but only the drug-treated muscles were fatigued. Therefore, a decrease in intramuscular pH would not be the cause of the observed decrease in muscle resistance to fatigue after 2,4-D treatment. The reduced endurance of drug-treated muscles could not be attributed to impaired neuromuscular transmission.
Assuntos
Contração Muscular , Músculos/fisiopatologia , Miotonia/fisiopatologia , Resistência Física , Ácido 2,4-Diclorofenoxiacético , Potenciais de Ação/efeitos dos fármacos , Animais , Eletromiografia , Concentração de Íons de Hidrogênio , Contração Muscular/efeitos dos fármacos , Relaxamento Muscular/efeitos dos fármacos , Miotonia/induzido quimicamente , Resistência Física/efeitos dos fármacos , Ratos , Ratos EndogâmicosRESUMO
En los ultimos anos ha ido adquiriendo creciente importancia el registro de las respuestas evocadas visuales, auditivas y somatosentitivas. Mediante este metodo es posible pesquisar lesiones en el Sistema Nervioso Central que aun no han dado manifestaciones clinicas. Entre las diversas aplicaciones que tiene destaca su contribucion al diagnostico de Esclerosis Multiple donde estan alteradas aproximadamente en un 90% de los casos