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Biomedical subjects

A Pérez-Higueras

Publications and source records attributed to A Pérez-Higueras.

At least 19 recordsLinked to original sources
PubMed2003

Vertebroplasty in the treatment of vertebral tumors: postprocedural outcome and quality of life.

The results of percutaneous vertebroplasty with polymethylmethacrylate (PMMA) of vertebral metastases were evaluated by a retrospective review of a consecutive series of 21 patients, with special reference to functional outcome. Patients complained of vertebral pain in all cases. Walking was impossible for 13 patients. Ten patients presented neurological deficit. Treatment included percutaneous vertebroplasty in all patients, radiotherapy in 15 patients and neural decompression surgery in 3 patients. Mean duration of hospitalization was 14.1 days (range 2-60 days) and the mean follow-up was 5.6 months (range 1-18 months). Preprocedural pain, measured by the visual analog scale (VAS), was 9.1, decreasing to 3.2 after the procedure and 2.8 at the last follow-up visit. Morphinics were discontinued in 7 of 14 patients following discharge from hospital. Ten out of 13 (77%) patients recovered walking capacity. Neurological status improved in three out of five patients. No further vertebral compression occurred in the vertebrae treated. Overall, 81% of the patients in this study were satisfied or very satisfied with the procedure. One patient (5%) had transitory radicular neuritis after the procedure. No major complications were observed. In conclusion, percutaneous vertebroplasty with PMMA proved to be safe and beneficial, providing significant and early improvement in the functional status of patients with spinal metastasis.

Back Pain↗
PubMed2002

Percutaneous vertebroplasty: long-term clinical and radiological outcome.

We assessed radiographic and functional outcome in 13 patients with a minimum of 5 years follow-up from a prospectively monitored series of 17 patients who underwent percutaneous vertebroplasty (PPV). A visual analogue scale (VAS) and the short McGill questionnaire (MPQ) were used to assess average symptoms. The VAS showed significant improvement after treatment: the initial score was 9.07+/-0.6 (mean+/-SD), falling to 2.07 (1.14) on the third day, 1.07 (1.07) by the third month and 2.15 (2.6) at 5 years. Pain reduction was statistically significant ( P<0.001). The MPQ showed a significant improvement after treatment ( P<0.001), but had worsened by the last follow-up. All patients were "very" or "somewhat satisfied" with the procedure. We saw no further collapse of the vertebrae injected or migration or changes in the shape of the cement. A new fracture was seen in three patients, affecting four vertebrae, only two of which were adjacent to the treated level. On CT following the procedure, there was cement in the epidural veins adjacent to the vertebra in 48% of cases, but only patient developed a transitory neuritis.

Aged↗
PubMed2001

Moyamoya disease and sagittal sinus thrombosis in a child with Down's syndrome.

A girl with Down's syndrome, moyamoya disease and sagittal sinus thrombosis is described. She was diagnosed after acute neurological deterioration by MRI and angiography. Recombinant tissue plasminogen activator (r-TPA) was injected locally to recanalise the thrombus. The patient's condition significantly improved and she was discharged. After 2 years of follow-up the child remains asymptomatic. Moyamoya syndrome and cerebral venous thrombosis should not be overlooked as a cause of acute neurological deterioration in a child with Down's syndrome. MRA appears to be a safe and accurate alternative to traditional angiography for the diagnosis of moyamoya disease. Local fibrinolysis with r-TPA is the treatment of choice for cerebral venous thrombosis due to its safety and efficacy.

Child, Preschool↗
PubMed2000

Nonhistological diagnosis of human cerebral tumors by 1H magnetic resonance spectroscopy and amino acid analysis.

We describe a multivariate analysis procedure to classify human cerebral tumors nonhistologically in vitro, combining the use of 1H magnetic resonance spectroscopy (MRS) with automatic amino acid analysis of biopsy extracts. Eighty-one biopsies were obtained surgically and classified histologically in eight classes: high-grade astrocytomas (class 1, n = 19), low-grade astrocytomas (class 2, n = 10), normal brain (class 3, n = 9), medulloblastomas (class 4, n = 4), meningiomas (class 5, n = 18), metastases (class 6, n = 8), neurinomas (class 7, n = 9), and oligodendrogliomas (class 8, n = 4). Perchloric acid extracts were prepared from every biopsy and analyzed by high resolution 1H MRS and automatic amino acid analysis by ionic exchange chromatography. Intensities of 27 resonances and ratios of resonances were measured in the 1H MRS spectra, and 17 amino acid concentrations were determined in the chromatograms. Linear discriminant analysis provided the most adequate combination of these variables for binary classifications of a biopsy between any two possible classes and in multiple choice comparisons, involving the eight possible classes considered. Correct diagnosis was obtained when the class selected by the computer matched the histological diagnosis. In binary comparisons, consideration of the amino acid profile increased the percentage of correct classifications, being always higher than 75% and reaching 100% in many cases. In multilateral comparisons, scores were: high-grade astrocytomas, 80%; low-grade astrocytomas, 74%; normal brain, 100%; medulloblastomas, 100%; meningiomas, 94.5%; metastases, 86%; neurinomas, 100%; and oligodendrogliomas, 75%. These results indicate that statistical multivariate procedures, combining 1H MRS and amino acid analysis of tissue extracts, provide a valuable classifier for the nonhistological diagnosis of biopsies from brain tumors in vitro.

Algorithms↗
PubMed1997

Gene therapy in brain tumours: implications of the size of glioblastoma on its curability.

The authors have used the thymidine kinase/ganciclovir system to block glioblastoma multiforme neoplastic cells in vivo, both in experimental animals and in two patients in which the more conventional therapies had been unsuccessful. In the Wistar rat it was found that the curability potential of the system is correlated with tumoral volume. Tumours smaller than 20 mm3 can be cured with defective retrovirus that do not carry the Herpes simplex thymidine kinase (Hsvtk) gene. While tumours smaller than 150 mm3 can regress totally by the kinase/ganciclovir system, those above that size cannot be cured by this treatment. In humans the situation seems very similar in that the authors have been unable either to reduce the tumour size of recurrent patients with tumour volumes larger than 100 cm2 applying the standard thymidine kinase/ganciclovir gene therapy or to prolong their survival time more than 8 months [7]. When a combination of size reduction by neurosurgery and gene therapy was used the survival time increased considerably. Two patients have been treated by partial surgery and repeated treatment with thymidine kinase/ganciclovir through an Ommaya reservoir connected to a catheter leading into the tumour cavity. The magnetic resonance imaging (MRI) of these patients show only a residual tumoral growth along side the tumoral bed. The procedure may be partially controlling the proliferation of cancerous cells, because, these two patients having recurrent glioblastoma, are alive 11 and 17 months after the beginning of the treatment.

Animals↗
PubMed1996

Human malignant brain tumor response to herpes simplex thymidine kinase (HSVtk)/ganciclovir gene therapy.

Growing cells from human brain tumors have been treated in vitro and in vivo with murine therapeutic retroviral producer cells. The therapeutic retrovirus carried the potential suicide gene thymidine kinase (tk) from the herpes simplex virus (HSV). After a few days, in which a large proportion of the tumoral cells had the opportunity to acquire a copy of the retrovirus, treatment with ganciclovir was initiated and considered responsible for considerable cell death both in vitro and in vivo. The in vivo experiments were performed in five adult patients who had failed standard therapy and were expected to survive only a few weeks.

3T3 Cells↗
PubMed1995

Neural migration disorders studied by cerebral ultrasound and colour Doppler flow imaging.

Cerebral ultrasound and colour Doppler flow imaging (CDFI) were used to diagnose a wide spectrum of anomalies of cell migration (17 patients): presumed lissencephaly (n = 12); schizencephaly of both fused (n = 2) and open lips (n = 2); hemimegalencephaly (n = 1); and subependymal type grey matter heterotopia (n = 12). The patients with grey matter heterotopia had irregular ventricular margins (n = 10), periventricular hyperechogenic bands (n = 12), and/or periventricular hyperechogenic nodules (n = 7). Some patients had more than one type of migration disorder as well as other central nervous system malformations. Cerebral ultrasound diagnoses were confirmed by magnetic resonance imaging (MRI) or necropsy. It is concluded that colour Doppler flow imaging is a worthwhile addition to the assessment of brain surface anomalies.

Autopsy↗
PubMed1993

Encapsulated intracerebral hematomas: a defined entity. Case report.

Encapsulated intracerebral hematoma is an interesting and not widely appreciated entity. It can be defined as an intraparenchymal hematoma found in normotensive patients, usually caused by histologically confirmed vascular malformations, characterized by a gradual clinical onset, and presenting a well-defined capsule at operation. One case is presented and 25 previously reported cases are reviewed, all reflecting the above-mentioned characteristics. The hematomas reviewed here occurred in relatively young patients with a mean age of 35 years and a clear male predominance (19 males, seven females). A ring of contrast enhancement around a lesion of variable density, usually with mass effect and perifocal edema, is the most relevant feature on computerized tomography. Findings on magnetic resonance images are described for the first time in the reported case. A vascular malformation was the most frequent cause found on histological examination (12 of the 26 total cases). No proven cause was found in the remaining 14 cases, although a small vascular malformation, destroyed or thrombosed after rupturing and bleeding, is the most likely etiology in these patients.

Adult↗
PubMed1992

Stroke in neonates with cardiac right-to-left shunt.

Neonatal focal cerebral arterial infarction has been rarely reported in the literature, in contrast to the watershed infarctions, which are common entities among asphyxiated infants. In neonatal postmortem series, thromboembolism was the commonest cause of cerebral arterial occlusion; the source of emboli was associated to different risk factors. Our four cases are the first alive patients reported with congenital heart disease and right-to-left shunt, who suffered a cerebral infarct with its clinical neurological correlates in the neonatal period. We assume that the most probable mechanism was paradoxical embolism, once pulmonary filter is obviated as a result of the altered hemodynamics in these patients. Our data demonstrate the value of ultrasound scanning for assessment of focal cerebral ischemic lesions. Thus, although abnormal neurological signs in this particular group of infants could be attributed to hypoxemia or specific treatments as prostaglandins, we suggest routine cerebral ultrasounds in neonates with congenital heart disease and neurological disabilities, as early complications could be not so infrequent.

Cerebrovascular Disorders↗
PubMed1992

Simultaneous multiple intracranial and spinal meningiomas.

We report on the case of a 50-year old woman with two intracranial meningiomas and two spinal ones. All were diagnosed at the same time and there were no signs of neurofibromatosis. Multiple meningiomas in different neural spaces are extremely rare, and even rarer is the simultaneous diagnosis of separate coincident lesions. The literature in this regard is reviewed.

Brain Neoplasms↗
PubMed1990

Unusual CT image of a cerebral hydatid cyst.

We report an unusual case of cerebral hydatid cyst which was found with CT. Unenhanced CT showed a hyperdense, not calcified, ring surrounding the cyst cavity. This has never been reported before. We propose a possible explanation for such abnormal behaviour.

Brain↗
PubMed1987

Arteriovenous malformation of the spinal cord in the neonate.

A newborn baby boy with a high-flow arteriovenous malformation (AVM) of the dorsal spinal cord is reported. The baby was born paraplegic. The myelogram suggested an increased vasculature, showing irregular worm-like radiolucent lesions of the dorsal spinal cord. Spinal angiography showed a huge arteriovenous angioma of the dorsal spinal cord with an intra-spinal aneurysmal sac. The vascular supply was decreased after two embolizations. This was followed by complete surgical resection of the aneurysmal sac.

Arteriovenous Malformations↗
PubMed1987

Serum CPK-BB isoenzyme in the assessment of brain damage in asphyctic term infants.

Serum creatine phosphokinase-BB activities were measured at 4 and at 10 hours of life in 33 asphyctic full-term infants. The infants were followed for a mean period of 16 months. Enzyme activities at 4 hours of life were significantly higher in those neonates who died of severe hypoxic-ischemic encephalopathy or developed neurological sequelae than in those who did not present neurological abnormalities during the follow-up time. The specificity of the enzyme assay in order to predict the neurological outcome was inferior to that of cranial computed tomography or a combined clinical-electroencephalographic evaluation. It appears that the presence of elevated serum creatine phosphokinase-BB activity can be a sensitive indicator of conspicuous brain damage, but it is of limited value to predict the neurological outcome after neonatal asphyxia.

Asphyxia Neonatorum↗