RESUMO
Aggressive behavior in patients with intellectual disability can be resistant to pharmacological treatment and have detrimental consequences to themselves, family members, and caregivers. Hypothalamic deep brain stimulation (DBS) has been used to improve this type of behavior in severe and refractory cases. Here, we present the description and analysis of DBS of the posteromedial hypothalamus (PMH) and its long-term impact as treatment to improve severe and refractory aggressive behaviors, even with previous bilateral hypothalamotomy without improvement in patients with intellectual disability. Eleven patients underwent bilateral DBS of the PMH. Their medical records were reviewed, and the impact on behavior was measured using preoperative and postoperative Modified Overt Aggression Scale (MOAS) during the last follow-up medical visit. Nine of 11 patients presented a significant decrease in the severity of aggressive behavior, with a preoperative and postoperative MOAS average value of 50.5 and 18.7, respectively. An overall improvement of 63% was seen with a mean follow-up time of 4 years. A patient who previously underwent a bilateral hypothalamotomy via radiofrequency was included in this group. During follow-up, 3 patients presented deterioration of symptoms subsequent to pulse generator depletion but made a full clinical recovery after battery replacement. We posit that DBS of the PMH may be a safe and effective in improving severe and refractory aggressive behavior in patients with long-term intellectual disability.
Assuntos
Estimulação Encefálica Profunda , Deficiência Intelectual , Agressão , Humanos , Deficiência Intelectual/cirurgia , Resultado do TratamentoRESUMO
RESUMEN: Los tumores cardíacos primarios malignos son infrecuentes en la práctica clínica. Suelen ser oligosintomáticos y de diagnóstico tardío lo que tiene como consecuencia una alta mortalidad. El caso clínico que se presenta a continuación es un ejemplo de esta patología, que debe ser especialmente considerada cuando la insuficiencia cardíaca no tiene una etiología clara. Se describen los hallazgos clínicos y de laboratorio, como también los resultados de estudios de imágenes y la histología. Se ilustra los hallazgos en la operación y la evolución clínica del paciente. Se incluye una revisión de la literatura.
ABSTRACT: Malignant primary cardiac tumors are infrequent in clinical practice. They are usually oligosymptomatic and a late diagnosis leads to a high mortality rate. The clinical case of a patient presenting with heart failure with unclear etiology is presented. Clinical and laboratory findings are described along with the results of imaging studies. Findings at the time of surgery and histopathological characteristics are illustrated. A review of the literature is included.
Assuntos
Humanos , Masculino , Idoso , Sarcoma/complicações , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Neoplasias Cardíacas/complicações , Sarcoma/cirurgia , Sarcoma/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Neoplasias Cardíacas/diagnósticoRESUMO
RESUMEN Los trastornos del control de impulsos (TCI) son complicaciones psiquiátricas de la enfermedad de Parkinson (EP), cada vez más reconocidos, pero que persisten subdiagnosticados y pueden llegar a ser muy disruptivos para la vida familiar del paciente, en especial si no son detectados a tiempo. Si bien uno de sus principales riesgos es el uso de agonistas dopaminérgicos, estos no son su única causa, se pueden ver sin relación con medicamentos o con cualquier tratamiento para la EP. Por lo tanto, se debe interrogar sistemáticamente por su presencia y educar al paciente y su familia para que sean reportados en cualquier momento. El objetivo de este capítulo es describir los diferentes tipos de TCI, sus factores de riesgo y tratamiento.
SUMMARY Impulse Control Disorders (ICD) are psychiatric complications of Parkinson's Disease (PD), increasingly recognized, but which persist underdiagnosed and can be vert disruptive to the patient's family life, especially if they are not detected in time. Although one of its main risks is the use of dopamine agonists, these are not the only cause, they can be seen without realtion to medications ot any treatment for PD, therefore it should be questioned systematically by their presence and educate the patient and his family to be reported at any time. The objective of this chapter is to describe the different types of ICD, their risk factors and treatment.
Assuntos
Mobilidade UrbanaRESUMO
BACKGROUND: Feeding modes and appetence toward certain foods are usually conditioned by the family. Obesity during adolescence usually persists during adulthood. AIM: To determine differences in family structure of adolescents according to their nutritional status. MATERIAL AND METHODS: A cross-sectional study was conducted in 60 overweight-obese and 60 normal weight adolescents. Family type was determined based on their conformation (kinship and cohabitation), development (if the mother had a remunerated job), demography (geographical area), integration (functions of the couple); life cycle stage and functionality. RESULTS: Fifty eight percent of normal weight adolescents had simple nuclear families and 47% of overweight-obese adolescents had an extended family. Thirty one and 21% of overweight/obese and normal weight adolescents lived with an overweight/obese individual, respectively. CONCLUSIONS: There are differences in the family structure of overweight/obese and normal weight adolescents.
Assuntos
Características da Família , Obesidade/epidemiologia , Adolescente , Índice de Massa Corporal , Estudos de Casos e Controles , Estudos Transversais , Comportamento Alimentar , Feminino , Humanos , Masculino , México/epidemiologia , Estado Nutricional , Sobrepeso/epidemiologia , Fatores SocioeconômicosRESUMO
Background: Feeding modes and appetence toward certain foods are usually conditioned by the family. Obesity during adolescence usually persists during adulthood. Aim: To determine differences in family structure of adolescents according to their nutritional status. Material and Methods: A cross-sectional study was conducted in 60 overweight-obese and 60 normal weight adolescents. Family type was determined based on their conformation (kinship and cohabitation), development (if the mother had a remunerated job), demography (geographical area), integration (functions of the couple); life cycle stage and functionality. Results: Fifty eight percent of normal weight adolescents had simple nuclear families and 47% of overweight-obese adolescents had an extended family. Thirty one and 21% of overweight/obese and normal weight adolescents lived with an overweight/obese individual, respectively. Conclusions: There are differences in the family structure of overweight/obese and normal weight adolescents.