[A cerebral infarct as the initial manifestation of hypertrophic cardiomyopathy in a young patient].
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Biomedical subjects
Publications and source records attributed to J Escudero.
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The antihypertensive efficacy of amlodipine was studied in 22 patients (16 female, six male) with mild-to-moderate hypertension. Following an initial two-week placebo run in, patients with a sitting diastolic blood pressure in the range 95-115 mmHg (12.7-15.3 kPa) began the 12-week active treatment phase with amlodipine at a dose of 5 mg once daily. If the sitting diastolic blood pressure was not reduced to less than or equal to 90 mmHg (12.0 kPa) after four weeks' treatment, the amlodipine dose could be adjusted to 10 mg once daily. The final four weeks of active treatment comprised of a maintenance phase during which the dose, which had produced the desired therapeutic response in each patient, remained constant. At the end of the trial, 18 patients (85.7%) were classified as therapeutic successes (reduction in diastolic blood pressure to less than or equal to 90 mmHg [12.0 kPa] with a greater than or equal to 5 mmHg [0.7 kPa] from baseline values or a greater than or equal to 10 mmHg [1.3 kPa] decrease from baseline). Of these patients, 16 received the 5 mg dose throughout the study and only two required an increase to 10 mg once daily. Patients generally tolerated amlodipine treatment well.
We report the case of a woman with short nocturnal attacks of peri- and retro-orbital pain, diplopia, ptosis, rhinorrhea and lacrimation of five months evolution. Neurological examination was normal between attacks. The latter presented with partial third nerve palsy, which finally became complete and permanent. Brain CT showed a sellar and supraseller tumor with parasellar extension to the right side. We stress the atypical clinical presentation and evolution of this case, and discuss its pathophysiology.
Peripheral nervous system (PNS) involvement in the form of different neuropathies in human immunodeficiency virus (HIV) infection is increasingly more common. We present a series of 20 HIV + patients subjected to neurophysiological study. The most commonly observed neurological disorder was a slight axonal-type sensitivo-distal polyneuropathy that predominantly affected the lower limbs during the early stages of infection. As HIV infection evolves, the polyneuropathy worsens and becomes a sensitivo-motor polyneuropathy with a more important axonal component. Secondary demyelinization is observed, with additional involvement of the upper limbs in the final stages of infection. The most frequent neurophysiological finding was a decrease in somatosensory evoked potential (SEP) and conduction velocity (CV) of the sural nerve.
Vacuolar myelopathy is the most frequent spinal syndrome in patients infected with the human immunodeficiency virus, presently considered to be related to a direct action of the virus. The authors review the historical, clinical, pathological and etiopathogenetic aspects of this new entity, stressing the difficulties posed by its differential diagnosis and its scarce therapeutic possibilities.
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Enalapril was used to treat five patients with pulmonary arterial hypertension secondary to congenital cardiopathy, three with ventricular septal defect, one with arterial septal defect, and one with patent ductus arteriosus. The dose of enalapril was 20 mg/day. All patients underwent pretreatment and posttreatment cardiac catheterization. It was concluded that enalapril may be a useful drug in the treatment of pulmonary arterial hypertension secondary to congenital cardiopathy.
A clinical trial in 24 patients with essential arterial hypertension (14 women and 10 men, mean age 47.5) was conducted on a double-blind basis using a placebo, 240-mg verapamil and 100-mg atenolol daily. The total duration of the trial was 12 weeks: a 2-week washout period on placebo, a 4-week period on one of the trial drugs, a second 2-week weaning period and a further 4-week treatment period on the other trial drug. Stabilization of the hypertension was obtained in 80% of the patients on verapamil and 71% of the patients on atenolol both in the supine and upright positions; there was no significant difference between the 2 drugs. A moderate decrease in heart rate was obtained. Sinus bradycardia was observed in 3 patients on verapamil and 4 patients on atenolol. No instances of atrioventricular block were observed on electrocardiogram. No adverse effects were reported with verapamil and in only 1 patient taking atenolol. Adequate stabilization of hypertension appears possible in most patients with both verapamil and atenolol.
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At present there are no reliable statistics on the relative prevalences of sexually transmitted diseases (STDs) in Spain. In a report of the first three years' experience in an STD diagnostic centre between 1977 and 1979 a total of 879 patients (534 men adn 345 women) were seen. They mainly consisted of university students and the mean age was 22 years in 1977 and 23 years in the following two years. All the patients were examined for syphilis and all women for gonorrhoea and trichomoniasis. Investigations for Chlamydia trachomatis, Mycoplasma hominis, Ureaplasma urealyticum, Candida albicans, and Herpesvirus hominis infections were carried out according to the presenting symptoms. Non-specific genital infections occurred most commonly (25.7%); chlamydia were isolated from 30% of the patients with non-gonococcal urethritis (NGU). The second commonest infection was candidosis (13.5%). Gonorrhoea, which was found in 10.6% of the patients, was diagnosed more frequently in men (13.5%) than in women (6%). No strains of beta-lactamase-producing Neisseria gonorrhoeae were detected and all were sensitive to penicillin. Syphilis was diagnosed in 4.4% of patients (2% women and 5% men). Condylomata acuminata were diagnosed in 2.8% of patients and more frequently in men (4%). Herpes genitalis and venereophobia were uncommon (1.9% and 1.2% respectively) and were diagnosed only in men.
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Transcranial magnetic stimulation method permits the study of the facial nerve in all its aspects (motor cortex-alpha moto-neurone-facial muscle) in an non invasive and painless way. We studied 12 patients using two levels of stimuli, the first was at an occipital level and the second at the primary motor cortex in the frontal lobe. We compared the results of this technique with those obtained by electric stimulation of the nerve.
A retrospective study of 35 non-hypertensive intraparenchymal brain hematomas (NHBH) is made to evaluate their etiopathogenesis and the therapeutic approaches employed. A comparison is made with the hypertensive hematomas seen during the same period. Among the NHBH there were 5 vascular malformations (VM (14%), 5 hematomas secondary to brain tumors (14%), 2 amyloid angiopathies (6%), 2 cases of coagulation dysfunction (6%), 3 hematomas secondary to anticoagulation therapy (9%), and one hematoma in an intravenous drug abuser (3%). No etiological diagnosis was established in the remaining 17 cases (48%). The NHBH were predominantly lobar (43%), and incidence was greater among young patients. Mortality was 20%. All cases were diagnosed by brain CT, the latter suggesting pathology underlying the hematoma in 3 tumoral hematomas, in 2 VM confirmed arteriographically, and in one patient with suspect VM not confirmed by angiography. A total of 22 angiographies were performed: the latter were diagnostic in all VMs and negative in the tumor hematomas, amyloid angiopathies and in those hematomas of unknown etiology where angiography was performed. Fifteen patients were operated on. We recommend that in patients with brain hematomas but without antecedents of arterial hypertension or with an atypically situated hematoma, a careful examination should be carried out to discard all possible causes of brain hemorrhage, together with the early performing of contrasted CT scans and posterior angiography. If the latter prove negative, the patient should undergo a clinico-radiological follow-up, together with an histological study of the blood clot if operated on.