Biomedical subjects
Publications and source records attributed to F Villarejo.
Complex motor behaviors differing from typical automatisms were found in 12 of 502 patients with temporal lobe epilepsy. Movements involved proximal limb segments (6) or body axis (6) and were often preceded by auras and followed by automatisms. Seven of 12 patients are seizure free after surgery. The other 5 patients declined surgery.
CASE REPORT: A case of supratentorial subdural empyema extending to the superior subdural cervical space in a 14-year-old patient with systemic lupus erythematosus is presented. The presumed etiology of the empyema was an intestinal nontyphoidal salmonella infection. DISCUSSION: We review the neurological and neurosurgical complications in systemic lupus erythematosus.
The effect of positive end-expiratory pressure (PEEP) on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) has been reported by several investigators, without any consensus being reached. Acute neurological and neurosurgical patients suffer intracranial hypertension and acute lung injury with hypoxemia. Since PEEP may improve hypoxemia but elevate ICP and decrease CPP, it is important to determine the influence of varying levels of PEEP on ICP and CPP. The aim of the study was to investigate the changes in ICP and CPP associated with different levels of PEEP. Twenty patients requiring ICP monitoring and mechanical ventilation were enrolled. Patients had severe head injury (n = 10), spontaneous intracerebral haemorrhage (n = 5), and subarachnoid haemorrhage (n = 5). PEEP was raised from 5 (basal) to 15 cm H2O in steps of 5 cm H2O. After at least 10 minutes of each new PEEP setting, ICP and CPP were measured. PEEP at 10 and 15 cm H2O produced a significant (p < 0.05) increase in intracranial pressure 11.6 +/- 5.6 and 14.6 +/- 6.28 mm Hg, respectively; no significant (p = 0.819) change occurred in CPP.
OBJECTIVE: The aim of this study was to provide measurements for the defecographic diagnosis of rectal intussusception and rectal prolapse. MATERIALS AND METHODS: Four hundred thirty-seven consecutive patients with defecation and micturition disorders and gynecologic complaints were studied by means of defecography (120 patients), colpodefecography (17 patients), or cystocolpodefecography (300 patients). As a control group, 43 asymptomatic subjects underwent defecographic examination. RESULTS: Thirty-five patients were found to have rectal intussusception and 18, to have rectal prolapse. Anterior and posterior rectal wall folding thickness, intussuscipiens diameter, intussusceptum lumen diameter, and the ratio between the intussuscipiens diameter and the intussusceptum lumen diameter were measured in all patients. The findings were compared with those obtained in 13 of 43 asymptomatic subjects with rectal outline changes mimicking intussusception. Rectal folding thickness and the ratio between the intussuscipiens diameter and the intussusceptum lumen diameter were significantly greater in subjects with rectal intussusception and rectal prolapse than in asymptomatic subjects with rectal mucosa folding. CONCLUSION: Our findings suggest that dynamic evacuation radiology contributes to making a differential diagnosis between rectal intussusception and mucosal folds in the rectum.
Red cells transfusion in the patient with acute hemorrhage, must be evaluated in a risk/benefit rate context. The present tendencies appoint that the use of the hematocrit "magic" number is unsafe and uncertain to decide a red cell transfusion. We have conducted a prospective randomized and controlled trial in 60 patients with acute digestive hemorrhage without haemodynamic failure. We realized two groups: 1) control group: the target of transfusion in these patients was the hematocrit value of > or = 28%. 2) treatment group: these patients were supported with normovolemic haemodilution with crystalloid solutions until a hematocrit value of 21%. All patients have endoscopic diagnosis and they went evaluated across the study with clinic and laboratory controls. Both groups were significative differences in the hematocrit value. We did not see differences between the groups in the hospital stay neither the rate of organs failure. We find difference between the groups in the amount of red cell units (0.61 +/- 0.87 vs. 2.14 +/- 1.10; treatment and control respectively, P < 0.001). The APACHE score was greater in the treatment group. This supports that the oldest patients, who probably have least physiologic reserve, could be treated without complications. Acute hemorrhage-normovolemic haemodilution-digestive hemorrhage transfusion.
A case of tension pneumocephalus that occurred after ventriculoperitoneal shunting is presented. We have reviewed 12 cases of pneumocephalus in association with ventriculoperitoneal shunt placement. This phenomenon occurs when air is forced through the shunt or enters through the cranial base because of: iatrogenic postsurgical connection, congenital fistula, trauma, or thinning of the cranial base. Ways of preventing and treating this problem are outlined.
Diabetic ketoacidosis (DKA) involves severe volume depletion; usually a large volume of saline solution is used, but fluid reposition rate remains controversial. With the aim of properly defining fluid administration in DKA without associated illness, we performed a prospective, randomized study in 27 patients under two therapeutic regimes which differed only with regard to the repletion rate. Group 1 (14 patients) received 0.9% saline solution at a rate of 1000 ml/h, and group 2 (13 patients) at 500 ml/h. At admission to the hospital, at 2, 4, 8, 12 and 24 hours, arterial acid-base status and plasma sodium, potassium and chloride levels were measured. Both groups had similar biochemical characteristics at admission. All patients corrected the ketoacidotic disorder and there was neither mortality nor complications. We did not find any significant difference in any of the metabolic determinations among the different groups along the evolution. With regard to baseline determinations, in both groups, arterial pH increased after two hours. No changes were observed in anion gap, chloride, sodium or potassium among the therapeutic groups. We conclude that, regarding morbidity and mortality, in DKA patients without severe volume depletion it is equally effective to infuse 500 ml/h as 1000 ml/h as fluid repletion rate. Administration of modest amounts of fluids in these cases would result in reducing costs.
STUDY DESIGN: Dorsal spinal cord compression caused by amyloid tissue deposits in the posterior vertebral arch and epidural space of the T6-T7 region in a 29-year-old woman is reported. RESULTS: Studies did not show any primary cause of amyloidosis. CONCLUSIONS: This case can be classified as primary localized tissue because other causes and amyloid deposits were not discovered. This patient was the youngest person reported to have dorsal spinal cord compression caused by amyloid tissue deposits, and the spinal cord compression was localized in the thoracic region, which occurred in six of the seven cases reported.
The authors review eight cases of thalamic tumors in children. Radical surgery was performed in seven cases. All cases were diagnosed by computed tomographic scanning, and histological diagnosis showed seven benign astrocytomas and one malignant astrocytoma. All patients are still alive. The treatment of these tumors is discussed.
Thirty-eight cases of Dandy-Walker malformation (DWM) are presented. A female predominance of 3:1 was found. Thirty-two cases (84%) were diagnosed within the 1st year of life. Of these, 17 cases (44.7%) were diagnosed at birth. Ten (26%) were delivered by cesarean section. Thirteen infants (34%) had a birth weight below 3000 g. Several associated malformations were observed, the most frequent being capillary angioma (6 cases); cardiac malformations, ophthalmic anomalies, agenesis of the corpus callosum, malformed limbs, and occipital meningocele were also seen. These observations indicate that DWM represents a disorder of the midline central nervous system indicative of marked genetic and etiologic heterogeneity with the possibility of showing clinical and pathological alterations intra- and extracranially. Macrocephaly was the most frequent physical finding, appearing in 31 cases (82%). Seventeen (44.7%) patients died, 11 before 6 months of age, 3 between 6 and 12 months, and 3 after 1 year. Postmortem studies were performed in 13 patients. Three cases have been lost to follow-up. Mental retardation (IQ below 70) was found in 11 cases (58% of survivors), low intellect (IQ between 70 and 85) in 4, and only 2 patients showed normal intellectual development (IQ more than 85). The high incidence of malformations having several genetic and environmental origins, as well as the high early mortality of patients with DWM, indicate the complexity of this syndrome, which involves the midline developmental field structures. It is not an isolated malformation of the posterior fossa in most cases.
Monozygotic twins sisters with optic glioma "in mirror image" (one with involvement of the left optic nerve and the other with the right optic nerve) and hydrocephalus secondary to progressive stenosis of the aqueduct have been found in a series of 128 cases below 14 years of age with neurofibromatosis. The optic glioma was diagnosed in each of the twins at 2 years of age. In one twin the tumor involved only the optic nerve but in the other the glioma affected the optic nerve and spread to the homolateral zone of the optic chiasm. First symptoms of hydrocephalus appeared at 8 years and 11 years of age respectively but ventriculo-peritoneal shunting procedures were performed to relieve intracranial hypertension at 11 years and 15 years of age respectively. At 2 years of age both twins had pneumoencephalography which demonstrated normal air passage through the aqueduct and cerebral ventricles of normal size and morphology. Posterior studies with CT-scan demonstrated progressive obstruction of the aqueduct with very slow progression of the hydrocephalus in each twin, although it was not observed simultaneously. The increased intracranial pressure was tolerated for many years in each twin without obvious symptoms which could be attributed to the slow progression of the aqueduct obstruction.
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A case of a calcified aneurysm of the posterior cerebral artery is reported. Frequency, aetiology, pathology, diagnosis and treatment of these aneurysms are discussed.
The authors describe a 5-year-old boy with a spinal neurenteric cyst without associated vertebral or other congenital malformation, causing compression of the spinal cord at C 6-7 level. He was twice treated surgically with good recovery. The pertinent literature is reviewed with reference to 43 similar reported cases.
Fourteen children less than 2 years old with choroid plexus papilloma (CPP) were studied. Of these patients nine had the tumor in the lateral ventricles (LV), three in the fourth ventricle (4th V), one in the third ventricle (3rd V) and one in the third and left lateral ventricle (LLV). Ten cases showed benign CPP, three cases malignant CPP, and one case had a venous malformation of the choroid plexus (VMCP). Computed tomography (CT) was the best method for neuroradiological study, although a very small CPP in the 3rd V was not detected in an early study. Malignant and benign CPP can be differentiated with CT, especially if the study is performed with contrast media. Pneumoencephalography must be rejected because it is very dangerous and may be the cause of death in some cases. The follow-up of patients with CPP showed a poor prognosis, even after correctly removing the tumor and inserting a shunt.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.