Biomedical subjects

A I Puente-Muñoz

Publications and source records attributed to A I Puente-Muñoz.

4 recordsLinked to original sources

PubMedDate not supplied

[Spinal tumors in infancy. A report of 48 cases].

INTRODUCTION: Spinal tumours in infancy are an infrequent oncological disorder. The clinical features, usually of insidious onset, are alterations in gait and a painful spine. OBJECTIVE: To analyze the different histological types of spinal tumours seen in infancy and their form of presentation in our series. PATIENTS AND METHODS: We reviewed the clinical histories of 48 patients with intraspinal tumours, aged under 15 years, whose reports of histological diagnosis had been sent to our centre. RESULTS: Of the patients studied, 17 were girls (35.4%) and 31 boys (64.6%) with an average age of 7.7 years. The histological diagnoses made most frequently were astrocytomas (22.9%) and lipomas (18.8%) followed by metastases (12.5%), ependymomas (8.3%) and Edwing's sarcoma (8.3%). The clinical features were present prior to diagnosis for between 1 and 6 months in 13 patients, and for less than one month in 9 patients. The presenting symptoms were alterations in gait and back pain in most patients. Exploratory tests were related to the involvement of long vias and second motor-neurone lesions. The main topographical findings were: in the axial plane the lesions were extradural (23 patients) and in the sagittal plane there was dorsal involvement (34 patients). CONCLUSIONS: Insidious, progressive alterations in gait together with continuous, nocturnal back pain are valuable data when a serious spinal disorder is to be suspected. Early diagnosis should be based on neuroimaging tests, essentially MR, in the patients in whom spinal cord involvement is considered.

Adolescent↗

PubMedDate not supplied

[Hypnic headache: a new case].

INTRODUCTION: Hypnic headache is a condition characterized by nocturnal episodes of headache which periodically waken the sleeping patient. They usually occur in persons over 55 years of age and are thought to be due to some type of disturbance of biological rhythm. CLINICAL CASE: A 70 year old woman, with no relevant past history, complained that during the previous 12-14 months she had been woken from sleep by episodes of headache. The headache was diffuse, non-pulsatile and very intense. The duration was variable, from 15 to 45 minutes and usually disappeared without requiring analgesics. The pain was not associated with autonomic or ocular disorders, nausea, vomitting or focal neurological signs. Both general and neurological examinations were completely normal. No alterations were seen on cranial CT. Treatment with lithium was started and there was marked improvement in the frequency of headaches. CONCLUSIONS: Hypnic headache is an unusual disorder characterized by episodes of holocranial, or rarely hemicranial, headache of moderate-severe intensity and periodic occurrence. Typically the headache wakes the patient whilst he is asleep ('alarm clock') and there are no autonomic or neurological alterations of any type associated with the episode. The condition usually affects persons over 55 years of age, and it has been related to changes in biological rhythms. This presumed alteration of biological pacemakers has been based on the periodicity of the episodes and the response to lithium.

Aged↗

PubMedDate not supplied

[Diagnosis of peripheral neuropathies: a clinical and neurophysiological study].

INTRODUCTION: The diagnosis of peripheral neuropathy is based on clinical and neurophysiological features. This study aims to establish the diagnostic validity of different symptoms and clinical signs, as well as its correlation with electroneurography (ENG), to determine its sensitivity (SE), specificity (SP), positive (PLR) and negative likelihood ratio (NLR) for every peripheral neuropathies type. PATIENTS AND METHODS: A sample of 108 patients with clinical suspicion of peripheral neuropathy (pain, paresthesias, loss of strength, areflexia) was studied. ENG (nerve conduction velocity and response amplitude values in 208 nerves [Median and Posterior Tibial]) was used to confirm the diagnosis, classifying the sample in axonal group (A), demyelinating (D) and normal (N). It was made descriptive statistics of this sample, studies of SE, SP, PLR and NLR of symptoms, and association (contingency tables [Chi square] and Odds Ratio) between symptoms and clinical features. RESULTS: The patients with paresthesias, loss of strength or pathologic reflexes have larger motor latency (p< 0.01). Those with paresthesias, areflexia or pain have fewer sensitive conduction velocity (p< 0.05). Symptoms's value for sensory damage's diagnosis is (SE= 0.92, SP= 0.48, PLR= 1.78, NLR= 0.14). For motor damage (SE= 0.72, SP= 0.68, PLR= 2.25, NLR= 0.41). For axonal damage (SE= 0.83, SP= 0.44, PLR= 1.49, NLR= 0.37). And for demyelinating damage (SE= 0.92, SP= 0.44, PLR= 1.66, NLR= 0.16). CONCLUSIONS: The symptoms's combination is much more sensitive and has fewer NLR than each isolated symptom in all neuropathic damage's types. Paresthesias's presence is more indicative of sensory damage and loss of strength of motor damage. Pain is the only symptom that can aim for axonal damage than demyelinating.

Cross-Sectional Studies↗

PubMedDate not supplied

[Prior authorisation to visit the neurologist from primary care may not be necessary: the findings of a prospective, controlled study].

INTRODUCTION: The system by which approval must be given by the primary care physician before a patient can visit a specialist is known as gatekeeping and is aimed at preventing the mistaken or simple referral of patients to the next stage of health care services. We present a study that compares the final diagnoses of 400 patients who used a direct access model of referral (DAM) with those of 400 patients referred by a primary care physician in a prior authorisation model (PAM). PATIENTS AND METHODS: We conducted a prospective analysis of two cohorts of patients who visited the same neurologist in a PAM system versus a DAM system. The 800 patients were evaluated following similar diagnostic criteria. The primary objective of the study was to compare the patients who were referred with a final diagnosis of 'non-neurological pathology' in the PAM and the DAM systems. Secondary aims consisted in conducting an analysis of the diagnoses by different pathologies between the two models. RESULTS: No significant differences were found between the referrals that were considered to be non-neurological in the PAM and the DAM systems (27.0% versus 26.3%; p = 0.48). A logistic regression model was performed with 'non-neurological pathology' as the dependent variable and age, sex and type of model (PAM or DAM) as the independent variables, similar results being obtained in both cases. CONCLUSIONS: Our data suggest that the role played by the primary care physician is not effective when it comes to preventing mistaken referrals to the neurologist in our area. A populational study would be needed to evaluate the rate at which resources are used and the spending on health care in the two models.

Female↗