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A Tellería-Díaz

Publications and source records attributed to A Tellería-Díaz.

At least 19 recordsLinked to original sources
PubMed1998

[Apnea testing to establish death based on brain criteria].

INTRODUCTION: The apnea test provides one of the most important criteria for the diagnosis of death by brain criteria, nevertheless although the absence of spontaneous respiration is a crucial point in the diagnosis of the death, we must point out, that still, there are not standardized criterion to perform this test. DEVELOPMENT: The lack of uniformity at the moment of carrying out this test in our country is due to the use of time as an indirect estimate of the PCO2 levels instead of the actual measurement of the blood level of this gas. This paper reviews the recommendations about this procedure published in the medical literature. It also remarks the most interesting physiopathological aspects related to this test. CONCLUSIONS: At present, the literature does not provide evidence to favor one method over the other however, it seems generally accepted that a positive apnea test requires a level of PCO2 equal or greater than 60 mmHg. Optionally, it is possible to consider 20 mmHg above the starting arterial PCO2 level. It seems clear that this aspect is more important than the duration of the test. The fears about hypoxemic damage during the apnea test are not support by the information found in the literature. It seems that the respiratory like movements do not exclude the diagnosis of death by brain criteria.

Apnea↗
PubMed1998

[Intensive neurology. Past, present, and future].

Although the neurological intensive care, seem have originated at the ends of 40s, during the epidemic of acute poliomyelitis that flogged Europe, it must be indicated that the growth and expansion of this subspecialty, has been a remarkable fact only in the course of the two last decades. Despite the fact that the neurological intensive care units (Neuro-ICU) are expensive; multiple have been the benefits derived from their creation; so much for patients, hospitals, as well for medical teaching. This is the current panorama of these units, mainly in developed countries, however, unfortunately this is not the situation in others, especially the underdeveloped ones. Many of the dilemmas that today confronts neurology in our countries are due to the nonexistence of these units. Undoubtedly, the neurocritical patients results more benefitted, when receives attention from the neurointensivists; thus the medical care that it receives becomes defragmented. The creation of the Neuro-ICU in our countries should not be made in a generalized way, but strategically, in addition, would be very convenient the incorporation of neurointensivists in the polyvalent intensive care units or intermediate care units. For the future, it will have to keep in mind the fact, that certain novel procedures that today emerge for the management of certain neurocritical conditions, will have to be assimilated by neurointensivists, since they will be the personnel disposed to implement them in any moment, and what is more important, it is the competent personnel prepared to treat any complication that emerge upon applying these.

Case Management↗
PubMed1997

[Physiopathology of amyotrophic lateral sclerosis: the contribution from transcranial magnetic stimulation].

INTRODUCTION/OBJECTIVE: The introduction of the technique of magnetic stimulation for the study of motor disorders has led to a better understanding of the pathophysiological mechanisms involved in amyotrophic lateral sclerosis (ALS). MATERIAL AND METHODS: Thirty two patients with ALS were studied in order to describe the behaviour of the variables: central conduction time (CCT), amplitude ratio (Ar) and motor threshold (MT) evaluated by means of motor evoked potentials (MEP). RESULTS: Analysis of these variables showed the great sensitivity of MEP for the detection of abnormalities in the corticospinal tract with 95% of the results being abnormal. Subclinical abnormalities were detected in 22.4% of recordings. Axonal degeneration was the commonest kind of conduction disorder seen. A significant lineal relationship between the evolution time and the variables MT, Ar and CCT (p < 0.05) was demonstrated. This suggests that there is a progressive deterioration of the voluntary motor pathway which begins with an excitotoxic mechanism at the onset of the disease and ends with the death of motor neurones. CONCLUSIONS: The electrophysiological results discussed, together with observations on isolated cases provide evidence in favour of the hypothesis of degeneration of the upper motor neurone. Although it is recognized that this alone does not explain the whole degenerative phenomenon of the motor system which occurs in ALS.

Adult↗
PubMed1997

[Status epilepticus].

INTRODUCTION: Status epilepticus (SE) is a condition in which epileptic discharges are sufficiently prolonged or repeated so as to cause persistent changes in neurological function. DEVELOPMENT: At the present time the classification of SE seems to be incomplete and therefore provisional. However the broad subdivision into convulsive SE and non-convulsive SE is still useful in clinical practice when emergency treatment is required. The neuropathological changes are largely determined by the nature (excitory or inhibitory) and the duration of the event which originated the crisis. Tonic-clonic SE is only one of many variants of SE. However, unlike many others, it is a medical emergency which if not suitably treated may lead to permanent neurological damage. Neurone damage and death are the result of a series of parallel processes occurring at a systemic and neuronal level. Outstanding amongst the latter is the activation of a complex neurotoxic cascade. Better understanding of the physiopathological mechanisms occurring in SE would set the stage for a more logical use of treatment. CONCLUSIONS: With advances in the treatment of SE in recent years the prognosis of these patients has improved considerably. However, we should now consider the use of conventional anticonvulsant drugs alone to be insufficient, and that this should give way to polytherapy with neuroprotector agents.

Anticonvulsants↗
PubMed1997

[Clinical characteristics of Cuban epidemic neuropathy].

INTRODUCTION: At the beginning of 1992 an epidemic neuropathy was seen in Cuba. MATERIAL AND METHODS: To determine the clinical characteristics we studied the clinical and neurological features, cerebrospinal fluid, and did neurophysiological investigations and sural nerve biopsies. RESULTS: Sixty patients were studied. Of these, 42 (70%) had polyneuropathy which was predominantly peripheral and 18 (30%) had combined forms. Most patients had asthenia and weight loss. The polyneuropathic effects were mainly in the legs. In 33.3% of the patients there were distal autonomic effects and sphincter disorders. Only 7 patients had hypoacusia. However, subclinical neurosensorial hypoacusia was seen in 33.3%. Optic neuropathy affected central vision bilaterally and symmetrically with temporal pallor of the papilla in half the cases. In 3 patients there was loss of ganglionar nerve fibres of the papillo-macula bundle. The contrast sensitivity visual test was abnormal in some patients with peripheral polyneuropathy, showing subclinical optic neuropathy in these cases. Sensory neuroconduction suggested axonal neuropathy in 30 patients, demyelinating neuropathy in 5 patients, while the remainder were normal. Motor neuroconduction was normal in most patients. Sural nerve biopsy of 27 patients showed axon damage in 96.2% of cases. CONCLUSIONS: The clinical picture is similar to that seen in nutritional deficiencies and toxic processes.

Adolescent↗
PubMedDate not supplied

[Antisense targeting in neurology].

INTRODUCTION: Antisense targeting refers to the use of synthetic short lengths of single stranded DNA, or RNA with base sequences complementary to a specific gene or its mRNA. Commonly, synthetic oligonucleotides are designed to hybridize to specific mRNA and thus preventing its translation in a specific protein. DEVELOPMENT: The use of this technology as research tool is well known since two decades ago, but it has been in the last few years, when it has been proposed as a promising tool for the development of a new generation of drugs with high specificity, relative ease of production and low rate of toxicity. Antisense therapeutics is currently being evaluated in clinical trials for cancer, inflammation, and viral diseases. In the field of Neuropharmacology, it has become in a very valuable tool to block the expression of specific genes in vitro as well in the living brain. In this article, we review the contributions of this technology in the field of the Neurosciences, and also give an overview concerning the advances of the antisense strategy in the design of possible new treatments for certain neurological disorders. Other clinically relevant information regarding molecular biology, pharmacokinetics, mechanism of action, and side effects of antisense oligonucleotides has been collected and summarized. CONCLUSIONS: In the neuropharmacological area is the Neurooncology the most intensively researched; nevertheless, the lack of oligos that cross the blood-brain barrier in sufficient amount continues being one of the main difficulties for the successful application of this technique on the central nervous system.

Alzheimer Disease↗
PubMedDate not supplied

[Guillain Barre syndrome].

OBJECTIVE: To review about this disorder, with emphasis on the intensive care of severe Guillain Barr syndrome (GBS). DEVELOPMENT: GBS is an acute immune mediated inflammatory polyneuropathy that may lead to quadriparesis, ventilatory failure, and autonomic dysfunction but also to many general medical problems that have great bearing on outcome. Therefore severe GBS patients require admission into an intensive care unit (ICU), where in addition to the disorders mentioned before, other complications can arise. The neurologist who plans to deal comprehensively with these patients must be familiar with therapy for infections, nutrition, fluid management, and selected aspects of pulmonary medicine as well as the indications for and complications of plasma exchange and gammaglobulin infusion. CONCLUSIONS: With modern intensive care support, the outcome is excellent (>80% recovery), although in many cases a persistent residual paresis occurs. Because GBS is largely self limited, the skill daily cares of these patients in an ICU contributes as much, or more, to the overall outcome of an individual patient as do specific immune therapies.

Critical Care↗