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Introduction: The Positive and Negative Syndrome Scale (PANSS) is a widely used instrument for measuring symptomatology in patients with schizophrenia. Numerous studies have analyzed the factorial structure of this scale and have suggested a fivefactor model, namely: negative, positive, excited, anxiety/depression, and disorganized (or cognitive). The latter factor has been related to neuropsychological tests, with a view to analyzing its utility as a measure of cognitive functioning in schizophrenia, but data are inconclusive. The aim of the present study was to analyze the factorial structure of the PANSS and to assess the relationships between factors and neurocognitive tests., Material and Methods: The sample comprised 235 outpatients diagnosed with schizophrenia. To investigate the factorial structure of the PANSS, a principal component factor analysis was performed. Cognitive functioning was measured with a shortened version of the Barcelona Test., Results: Unlike previous studies, our study obtained a six-factor model, with disorganized and cognitive symptoms separated in two different factors. The cognitive factor obtained in this study was related to all subtests of the Barcelona Test. The disorganized factor, however, was only related to two of these subtests., Conclusions: Our results support the use of a six-factor model and suggest that the cognitive factor could be a valid measure of cognitive deficits in schizophrenia, although the use of a standard neuropsychological battery is advisable., (Copyright © 2009 Sociedad Española de Psiquiatría and Sociedad Española de Psiquiatría Biológica. Published by Elsevier Espana. All rights reserved.)

Objective: To evaluate the usefulness of endoscopic assisted surgery of pituitary adenomas in transesphenoidal surgery, and in surgery of craneopharyngiomas using either minimally invasive approaches to the cranial base or transventricular approaches., Material and Methods: We present our preliminary experience in eleven patients operated of sellar region tumor by endoscopic assisted resection: 6 pituitary adenoma via transesphenoidal approach, 4 craneopharyngiomas 3 through supraciliar approach and 1 by transcortical transventricular approach, and 1 suprasellar cyst., Results: By using the 30 degrees optic the use of endoscope allowed complete resection, confirmed by postoperative MRI, of all six pituitary macroadenomas providing control of resection of supraselar remnants. Complete resection was achieved in three out of four craneopharyngiomas, 2 of them being recurrences. Three were operated by using a supraciliar approach to the cranial base and in one case transcortical transventricular resection of a recurrent intraventricular craneopharyngioma was performed. In the case with partial resection remnant were let in place due to the close adherence to peritumoral structures. In the three craneopharyngiomas operated via supraciliar approach endoscope allowed better control of inferior aspect of ipsilateral optic nerve and internal carotid artery. In the case of intraventricular craneopharyngioma, the use of 30 degrees endoscope provide control of resection of the anterior part of third ventricle through the foramen of Monro with no additional opening. The suprasellar cyst was fenestrated., Conclusions: No matter which approach is going to be used in the resection of sellar tumors, endoscopy can play a crucial role in achieve complete resection with minimal morbidity by using minimally invasive procedures.

Background: Sedatives and analgesic drugs give comfort and allow adequate respiratory support to critically ill patients in mechanical ventilation (MV). Its improper use may increase the duration of MV. Clinical guidelines suggest implementation of protocols, however this is seldom done in clinical practice., Aim: To compare in MV patients, nurse-applied guided by protocol administration of sedatives and analgesic drugs (protocol: group P) with the habitual practice using physicians criteria (control: group C)., Material and Methods: Inclusion criteria was the need of MV more than 48 h. The exclusion criteria were acute neurological diseases, hepatic cirrhosis, chronic renal failure and limitation of therapeutic efforts. Midazolam and fentanyl were used in both groups. The level of sedation was monitored with the Sedation Agitation Scale (SAS). In the P group, trained nurses applied algorithms to adjust the sedative doses according to a predefined SAS goal., Results: Forty patients were included, 22 aged 65+/-19 years in group P and 18 aged 54+/-21 years in group C. Apache II scores were 16+/-8 and 19+/-8 in each group. SAS score was more frequently evaluated within goal boundaries in group P than in group C (44% and 32%, respectively p =0.001). No differences in the proportion of patients with inadequate sedation were observed between treatment groups. Midazolam doses were lower in P than in C group (0.04 (0.02-0.07) and 0.06 (0.03-0.08) mg/kg/h respectively, p =0.005)., Conclusions: The implementation of sedation protocol applied by nurses improved the quality of sedation and reduced the doses of Midazolam in mechanically ventilated patients.

Introduction: Space-occupying cerebellar infarcts (SOCI) make up a subgroup within the ischemic pathologies of the brain which are generally well tolerated clinically and usually respond well to medical treatment. Yet, in some cases, due to their volume and localisation, they can be accompanied by a progressive deterioration that requires surgical treatment. We report the clinical cases of two patients with SOCI that illustrate both therapeutic alternatives., Case Reports: We describe the case of a 65-year-old male patient with vertiginous syndrome, inability to walk and headache. Computerised axial tomography (CAT) scanning showed a SOCI in the left hemisphere that displaced the 4th ventricle, effaced the cisterns and gave rise to the hydrocephalus. The patient improved clinically with medical treatment and a week later was able to walk unaided. We also describe the case of a 75-year-old female patient with symptoms of deterioration in the level of consciousness. CAT and magnetic resonance scans showed an extensive SOCI in the right hemisphere with displacement of the 4th ventricle, effacement of the perimesencephalic cisterns and triventricular hydrocephalus. A suboccipital craniectomy was performed, along with excision of any necrotic material and duroplasty. At 24 h the patient expressed herself coherently and followed orders. She presented ataxia and dysmetry on the right-hand side following the operation, which were compensated with rehabilitating therapy., Conclusions: Our clinical case reports illustrate the alternatives available when dealing with patients with cerebellar infarct that show expanding clinical-radiological characteristics. These patients must be carefully controlled because of the risk of clinical deterioration, in which case timely surgical intervention can increase their survival.

Treatment of symptomatic arachnoid cysts is based on two procedures: cyst fenestration versus derivation of CSF. Multiseptated cysts represent a very special group. We present the case of a 75 year old woman with a symptomatic multiseptated arachnoid cyst, developing subacute bleeding in one of the cavities. Final diagnosis was obtained after MRI. CSF derivation became insufficient with clear improvement after fenestration and communication to subarachnoid space.

We report a case of a 75 year old man presenting with paraparesis, urinary incontinence and saddle anesthesia evolving after several months and severe lumbalgia and bad general status which developed fewdays before admission. CT-scan showed spondilosis with lytic lesion at L5-S1 level. MR1 was not performed because the patient had a pacemaker. A myelo-CT study was performed showing a complete stop at L4-L5 level together with L5-S1 diskytis. Laminectomy of L5 and discectomy L5-S1 was performed obtaining tissue sample diagnostic of diskytis and osteomyelitis. Our patient had two lesions at two different levels with two independent syndromic appearence. Myelo-CT played an important diagnostic role in this case because MRI study could not be obtained.

We present two rare cases of posterior fossa epidural hematoma (PFEH) due to occipital fracture and tearing of transverse sinus. One of the patients showed supratentorial and infratentorial extension, which is found in half of the PFEH cases. Both cases experienced clinical worsening within 48 h of the head injury, with control CT showing increase of haematoma volume. Both patients were elected for surgery consisting of suboccipital craniectomy, control of sinus bleeding and sealing of epidural space with dural fixation. Sources of bleeding of PFEH are, by order of frequency, transverse sinus, small dural arteries and sigmoid sinus. PFEH may cause fatal clinical outcome with less volume than supratentorial ones. PFEH have high mortality if not treated. Patients with PFEH and GCS <15 should be admitted to hospital and a control CT should be done if there is deterioration or in the first 24 hours. The treatment of choice is surgery, conservative therapy being an alternative for small PFEH and good clinical evolution.

Aims: To review the literature on cerebral neuroblastomas (CN), including their anatomopathological filiation, clinical characteristics together with those they display in imaging studies, and the different therapeutic options with their prognosis., Method: Cerebral neuroblastomas belong to the group of primitive neuroectodermal tumours (PNET), also known as cerebral meduloblastomas or supratentorial PNET. They originate in the supratentorial compartment and histologically they are in the WHO grade IV. They display unspecific clinical features and in imaging studies they behave like solid masses with a cystic or necrotic component, often with calcifications. Microscopically they are made up of undifferentiated or poorly differentiated neuroepithelial cells. CN express synaptophysin and other neuroendocrine markers, which can only be studied by performing neuronal differentiation analyses. First choice treatment is surgery performed as radically as possible associated with chemotherapy or whole brain radiotherapy. Results vary greatly according to age and the degree to which the lesion has spread. Worse prognoses have been described for children under 2 years old than for those above that age. Survival rate at 3 years of age, including paediatric patients, is 60%., Conclusions: CN are not very frequent tumours, whose clinical characteristics and those displayed by imaging techniques are unspecific. Treatment must involve radical excision associated with chemotherapy or radiotherapy.

The objective of the study is the analysis of prognostic factors observed in the evolution of 65 patients who presented chronic subdural hematoma surgically evacuated. Morbimortality ratio corresponding to our surgical technique is also presented. A retrospective statistical analysis of epidemiologic, clinic and radiologic factors was performed. Personal background of alcoholism or coagulopathy, decrease of the level of consciousness, a lower score at the Glasgow Coma Score, a maximum thickness of the hematoma superior to 2 cm, and the respiratory and neurologic complications were found to be related to a worst prognosis. Our surgical technique showed 4.6% of mortality and 1.5% of recurrence. Detection of prognostic factors may have important implications in the selection of patients for surgery. Our small craniectomy has similar clinical outcome than other surgical methods.

Objective: We discuss the diagnostic and therapeutic usefulness of the presence of somatostatin receptors (SR) in meningiomas., Development: The SR are membrane receptors, may be saturated, have great affinity and pharmacological specificity for somatostatin (SS) and its analogues. SR have been found in 100% of the meningiomas studied. The presence of a large number of SR in different tumours permits gammagraphic detection in vivo by marking SS analogues with 1-231-DTPA and subsequent visualization using a gamma camera. This study may help to differentiate between meningiomias and other tumour lines. Experiments using different SS analogues have shown different degrees of affinity of these SS analogues for the different receptors. In various animal models a potent inhibitor effect on tumour growth has been seen following SS and its analogues. Unlike in hypophyseal adenomas and endocrine gastro-entero-pancreatic tumours, neither SS nor its analogues have shown any direct inhibitory action on the growth of meningioma cell cultures. Quite the opposite occurs. A small but significant stimulation of growth was seen in the presence of SS., Conclusions: We consider the detection of SR by isotopic marking of SS analogues is useful in the differential diagnosis of meningiomas. The therapeutic usefulness of the analogues of SS for treatment of meningiomas remains controversial. Further study of the different types of receptors and analogues is necessary.