Search

Resumen Introduccion En los ultimos anos la identificacion de anticuerpos y gammapatias monoclonales ha permitido comprender la fisiopatologia y favorecer el diagnostico y tratamiento de una multiplicidad de neuropatias inmunomediadas. Objetivo Describir los anticuerpos de mayor relevancia clinica en las neuropatias, ganglionopatias y neuronopatias inmunomediadas caracterizando en cada caso su valor fisiopatologico o diagnostico, asi como la sensibilidad y especificidad de los metodos utilizados para su determinacion. Desarrollo Se analizaran los anticuerpos identificados en 1) sindrome de Guillain-Barre; 2) polineuropatia inflamatoria desmielinizante cronica (PDIC), 3) neuropatia motora con bloqueo multifocal (NMM); 4) CANOMAD (neuropatia ataxica cronica, oftalmoplejia, proteina IgM monoclonal, aglutininas frias y anticuerpos disialosil); 5) ganglionopatias y neuronopatias y la utilidad de identificar las gammapatias monoclonales. Conclusiones Los anticuerpos y las gammapatias monoclonales son herramientas que han permitido mejorar el diagnostico y la comprension fisiopatologica de las neuropatias inmunomediadas y algunas criptogenicas, asi como orientar el tratamiento mas adecuado.

AIM: Determine the 1) effectiveness of correction for gradient-non-linearity and susceptibility effects on both QUASAR GRID(3D) and CIRS phantoms; and 2) the magnitude and location of regions of residual distortion before and after correction. BACKGROUND: Using magnetic resonance imaging (MRI) as a primary dataset for radiotherapy planning requires correction for geometrical distortion and non-uniform intensity. MATERIALS AND METHODS: Phantom Study: MRI, computed tomography (CT) and cone beam CT images of QUASAR GRID(3D) and CIRS head phantoms were acquired. Patient Study: Ten patients were MRI-scanned for stereotactic radiosurgery treatment. Correction algorithm: Two magnitude and one phase difference image were acquired to create a field map. A MATLAB program was used to calculate geometrical distortion in the frequency encoding direction, and 3D interpolation was applied to resize it to match 3D T1-weighted magnetization-prepared rapid gradient-echo (MPRAGE) images. MPRAGE images were warped according to the interpolated field map in the frequency encoding direction. The corrected and uncorrected MRI images were fused, deformable registered, and a difference distortion map generated. RESULTS: Maximum deviation improvements: GRID(3D), 0.27 mm y-direction, 0.07 mm z-direction, 0.23 mm x-direction. CIRS, 0.34 mm, 0.1 mm and 0.09 mm at 20-, 40- and 60-mm diameters from the isocenter. Patient data show corrections from 0.2 to 1.2 mm, based on location. The most-distorted areas are around air cavities, e.g. sinuses. CONCLUSIONS: The phantom data show the validity of our fast distortion correction algorithm. Patient-specific data are acquired in

Object The purpose of this study was to compare two methods of stereotactic localization in Gamma Knife treatment planning: cone beam computed tomography (CBCT) or fiducial. While the fiducial method is the traditional method of localization, CBCT is now available for use with the Gamma Knife Icon. This study seeks to determine whether a difference exists between the two methods and then whether one is better than the other regarding accuracy and workflow optimization. Methods Cone beam computed tomography was used to define stereotactic space around the Elekta Film Pinprick phantom and then treated with film in place. The same phantom was offset known amounts from center and then imaged with CBCT and registered with the reference CBCT image to determine if measured offsets matched those known. Ten frameless and 10 frame-based magnetic resonance imaging (MRI) to CBCT patient fusions were retrospectively evaluated using the TG-132 TRE method. The stereotactic coordinates defined by CBCT and traditional fiducials were compared on the Elekta 8 cm Ball phantom, an anthropomorphic phantom, and actual patient data. Offsets were introduced to the anthropomorphic phantom in the stereotactic frame and CBCT's ability to detect those offsets was determined. Results Cone beam computed tomography defines stereotactic space well within the established limits of the mechanical alignment system. The CBCT to CBCT registration can detect offsets accurately to within 0.1 mm and 0.5°. In all cases, some disagreement existed between fiducial localization and that of CBCT which in some cases was small, but also was as high as 0.43 mm in the phantom domain and as much as 1.54 mm in actual patients. Conclusion Cone beam computed tomography demonstrates consistent accuracy in defining stereotactic space. Since both localization methods do not agree with each other consistently, the more reliable method must be identified. Cone beam computed tomography can accurately determine offsets occurring within stereotactic space that would be nondiscernible utilizing the fiducial method and seems to be more reliable. Using CBCT localization offers the opportunity to streamline workflow both from a patient and clinic perspective and also shows patient position immediately prior to treatment.

O propósito deste trabalho foi o de investigar a remoção mecânica da placa dental pela goma de mascar isenta de açúcar. Cinqüenta crianças participaram do estudo onde se realizou inicialmente uma profilaxia oral, após o que, cada criança ficou 4 dias sem realizar procedimentos de higiene oral. Decorrido este tempo determinou-se o IHOS; e cada criança mascou 5 gomas, com um intervalo de 1 hora, sendo o tempo de mastigação foi de 15 minutos para cada goma, Em seguida foi novamente determinado o IHOS. A análise estatística demonstrou uma redução estatisticamente significante ao nível de 5% na remoção da placa dental após a mastigação da goma., this investigation was carried out to verify the mechanical efficiency of a sugar-free chewing gum on dental plaque removal. Fifty (6.12 yr old) children were used. Firstly they receveid a dental prophylaxis and were instructed to not clean their teeth for 4 days. Following this period, they were examined for the IHOS (The simplified oral higiene index) recording and received 5 chewing gum tablets to chew during 15 minutes at one hour intervals, After chewing the IHOS was again obtained. Statistical analysis of the difference of data obtained before and after chewing showed the sugar-free gum as effective for plaque removal, at a 5% significant level.

espanolEl presente articulo ofrece un analisis comparativo de tipo critico argumentativo del tratamiento conceptual y practico que cada una de las leyes organicas del sistema educativo ha efectuado de la transversalidad en el curriculo. Teniendo en cuenta los criterios de la denominacion, el uso y la aparicion en las diversas etapas educativas, la frecuencia, la perspectiva de desarrollo y concrecion, asi como la tipologia, se ha comprobado que la transversalidad curricular ha experimentado variaciones significativas. En sus inicios desde la LOGSE (1990) se vinculaba exclusivamente a aspectos del desarrollo moral y social en las etapas educativas obligatorias, pero posteriormente se ha ido desarrollando y diversificando en una amalgama de nomenclaturas y conceptos, aplicandose a mas niveles educativos y coexistiendo perspectivas de corte mas humanista con otras mas tecnicas o pragmaticas EnglishThis article provides a comparative analysis with a critical argumentative point of view of the conceptual and practical treatment that each of the organic laws of the educational system has made about the transversality in the curriculum. Taking into account the criteria of denomination, the use and appearance in the different educational levels, the frequency, perspective of development and concretion, as well as typology, it has been found that circular transversality has undergone significant variations. In its beginnings since LOGSE (1990), it was linked exclusively to aspects of moral and social development in the compulsory educational levels, but subsequently it has been developing and diversifying in a mixture of nomenclatures and concepts, being applied to more educational levels and coexisting more humanistic perspectives with others more technical or pragmatic

Resumen La enfermedad por COVID-19 se ha extendido por el mundo desde diciembre de 2019. Los sintomas neurologicos forman parte de su espectro clinico. Objetivo Conocer las manifestaciones neurologicas en pacientes infectados por COVID-19 en Argentina. Metodos Estudio multicentrico realizado en adultos, desde mayo de 2020 a enero de 2021, con COVID-19 confirmado y sintomas neurologicos. Se consignaron variables demograficas, existencia de comorbilidades sistemicas o neurologicas, la forma de comienzo de la infeccion, alteracion en estudios complementarios y el grado de severidad de los sintomas neurologicos. Resultados Se incluyeron 817 pacientes de todo el pais, 52% varones, edad promedio 38 anos. La mayoria sin comorbilidades ni patologia neurologica previa. El primer sintoma de la infeccion fue neurologico en 56,2% de los casos, predominando la cefalea (69%), luego anosmia/ageusia (66%). Tambien se reportaron mialgias (52%), alodinia/hiperalgesia (18%), astenia (6%). Un 3,2% mostro compromiso difuso del SNC como encefalopatia o convulsiones. Un 1,7% tuvo complicaciones cerebrovasculares. Los trastornos del sueno se observaron en 3,2%. Se reportaron seis pacientes con sindrome de Guillain-Barre (GBS), neuropatia periferica (3,4%), parestesias en lengua (0,6%), hipoacusia (0,4%), plexopatia (0,3%). La severidad de sintomas neurologicos se correlaciono con la edad y la existencia de comorbilidades. Conclusiones Nuestros resultados, similares a los de otros paises, muestran dos tipos de sintomas neurologicos asociados a COVID-19: algunos potencialmente incapacitantes o mortales como el GBS o la encefalitis, y otros menos devastadores, pero mas frecuentes, como cefalea o anosmia que demandan en forma creciente atencion a largo plazo.

COVID-19 disease has spread around the world since December 2019. Neurological symptoms are part of its clinical spectrum.ObjectiveTo know the neurological manifestations in patients infected by COVID-19 in Argentina.MethodsMulticenter study conducted in adults, from May 2020 to January 2021, with confirmed COVID-19 and neurological symptoms. Demographic variables, existence of systemic or neurological comorbidities, the form of onset of the infection, alteration in complementary studies and the degree of severity of neurological symptoms were recorded.Results817 patients from all over the country were included, 52% male, mean age 38 years, most of them without comorbidities or previous neurological pathology. The first symptom of the infection was neurological in 56.2% of the cases, predominantly headache (69%), then anosmia / ageusia (66%). Myalgias (52%), allodynia / hyperalgesia (18%), and asthenia (6%) were also reported. 3.2% showed diffuse CNS involvement such as encephalopathy or seizures. 1.7% had cerebrovascular complications. Sleep disorders were observed in 3.2%. 6 patients were reported with Guillain Barré (GBS), peripheral neuropathy (3.4%), tongue paresthesia (0.6%), hearing loss (0.4%), plexopathy (0.3%). The severity of neurological symptoms was correlated with age and the existence of comorbidities.ConclusionsOur results, similar to those of other countries, show two types of neurological symptoms associated with COVID-19: some potentially disabling or fatal such as GBS or encephalitis, and others less devastating, but more frequent such as headache or anosmia that demand increasingly long-term care.

Pregabalin is one of the first-line treatments approved for the management of neuropathic pain (NeP). While many patients benefit from treatment with pregabalin, they are often treated with suboptimal doses, possibly due to unfamiliarity around prescribing the drug and/or side effects that can occur with up-titration. This narrative review discusses key aspects of initiating, titrating, and managing patients prescribed pregabalin therapy, and addresses concerns around driving and the potential for abuse, as well as when to seek specialist opinion. To ensure that patients derive maximum therapeutic benefit from the drug, we suggest a ‘low and slow’ dosing approach to limit common side effects and optimize tolerability alongside patients’ expectations. When requiring titration to higher doses, we recommend initiating ‘asymmetric dosing,’ with the larger dose in the evening. Fully engaging patients in order for them to understand the expected timeline for efficacy and side effects (including their resolution), can also help determine the optimal titration tempo for each individual patient. The ‘low and slow’ approach also recognizes that patients with NeP are heterogeneous in terms of their optimal therapeutic dose of pregabalin. Hence, it is recommended that general practitioners closely monitor patients and up-titrate according to pain relief and side effects to limit suboptimal dosing or premature discontinuation.

The term "mixed pain" is increasingly applied for specific clinical scenarios, such as low back pain, cancer pain and postsurgical pain, in which there "is a complex overlap of the different known pain types (nociceptive, neuropathic, nociplastic) in any combination, acting simultaneously and/or concurrently to cause pain in the same body area." Whether mixed pain is the manifestation of neuropathic and nociceptive mechanisms operating simultaneously or concurrently, or the result of an entirely independent pathophysiological mechanism - distinct from nociceptive, nociplastic and neuropathic pain - is currently unknown. At present, the diagnosis of mixed pain is made based on clinical judgement following detailed history-taking and thorough physical examination, rather than by formal confirmation following explicit screening or diagnostic criteria; this lack of formalized screening or diagnostic tools for mixed pain is problematic for physicians in primary care, who encounter patients with probable mixed pain states in their daily practice. This article outlines a methodical approach to clinical evaluation of patients presenting with acute, subacute or chronic pain, and to possibly identifying those who have mixed pain. The authors propose the use of nine simple key questions, which will provide the practicing clinician a framework for identifying the predominant pain mechanisms operating within the patient. A methodical, fairly rapid, and comprehensive assessment of a patient in chronic pain - particularly one suffering from pain with both nociceptive and neuropathic components - allows validation of their experience of chronic pain as a specific disease and, importantly, allows the institution of targeted treatment.

The photo-induced dissociative-ionization of lanthanide complexes Ln(hfac)3 (Ln = Pr, Er, Yb) is studied using intense ultrafast transform limited (TL) and linearly chirped laser pulses in a time-of-flight (TOF) mass spectrometry setup. Various fluorine and Ln-containing high-mass fragments were observed in this experiment, including the molecular parent ion, which have not been seen with previous studies relying on relatively long-duration laser pulses (i.e., ns or longer). These new high-mass observations provide important formerly missing information for deducing a set of photo-fragmentation mechanistic pathways for Ln(hfac)3. An overall ultrafast control mechanism is proposed by combining insights from earlier studies and the fragments observed in this research to result in three main distinct photo-fragmentation processes: (a) ligand-metal charge transfer, (b) CF3 elimination, and (c) C-C bond rotation processes. We conclude that ultrafast dissociative-ionization could be a promising technique for generating high-mass fragments for potential use in material science applications.

Summary Background No treatment has consistently shown efficacy in slowing disability progression in patients with secondary progressive multiple sclerosis (SPMS). We assessed the effect of siponimod, a selective sphingosine 1-phosphate (S1P) receptor 1,5 modulator, on disability progression in patients with SPMS. Methods This event-driven and exposure-driven, double-blind, phase 3 trial was done at 292 hospital clinics and specialised multiple sclerosis centres in 31 countries. Using interactive response technology to assign numbers linked to treatment arms, patients (age 18–60 years) with SPMS and an Expanded Disability Status Scale score of 3·0–6·5 were randomly assigned (2:1) to once daily oral siponimod 2 mg or placebo for up to 3 years or until the occurrence of a prespecified number of confirmed disability progression (CDP) events. The primary endpoint was time to 3-month CDP. Efficacy was assessed for the full analysis set (ie, all randomly assigned and treated patients); safety was assessed for the safety set. This trial is registered with ClinicalTrials.gov, number NCT01665144. Findings 1651 patients were randomly assigned between Feb 5, 2013, and June 2, 2015 (1105 to the siponimod group, and 546 to the placebo group). One patient did not sign the consent form, and five patients did not receive study drug, all of whom were in the siponimod group. 1645 patients were included in the analyses (1099 in the siponimod group and 546 in the placebo). At baseline, the mean time since first multiple sclerosis symptoms was 16·8 years (SD 8·3), and the mean time since conversion to SPMS was 3·8 years (SD 3·5); 1055 (64%) patients had not relapsed in the previous 2 years, and 918 (56%) of 1651 needed walking assistance. 903 (82%) patients receiving siponimod and 424 (78%) patients receiving placebo completed the study. 288 (26%) of 1096 patients receiving siponimod and 173 (32%) of 545 patients receiving placebo had 3-month CDP (hazard ratio 0·79, 95% CI 0·65–0·95; relative risk reduction 21%; p=0·013). Adverse events occurred in 975 (89%) of 1099 patients receiving siponimod versus 445 (82%) of 546 patients receiving placebo; serious adverse events were reported for 197 (18%) patients in the siponimod group versus 83 (15%) patients in the placebo group. Lymphopenia, increased liver transaminase concentration, bradycardia and bradyarrhythmia at treatment initiation, macular oedema, hypertension, varicella zoster reactivation, and convulsions occurred more frequently with siponimod than with placebo. Initial dose titration mitigated cardiac first-dose effects. Frequencies of infections, malignancies, and fatalities did not differ between groups. Interpretation Siponimod reduced the risk of disability progression with a safety profile similar to that of other S1P modulators and is likely to be a useful treatment for SPMS. Funding Novartis Pharma AG.

In quantum control experiments with shaped femtosecond laser pulses, adaptive feedback control is often used to identify pulse shapes that can optimally steer the quantum system toward the desired outcome. However, gaining mechanistic information can pose a challenge due to the varied structural features of the control pulses and/or the often complex nature of the associated simulations of the experiments. In this article, we introduce control pulse slicing (CPS) as an easy-to-implement experimental analysis tool that can be employed directly in the laboratory without the need for modeling, to gain mechanistic insights about control experiments, regardless of whether the pulse is optimal or chosen by other means. As an illustration, we apply CPS to dissociative ionization of CH2BrI with mass spectral detection, where two pulses with similar intensities are investigated, with each capable of distinctively controlling the ratio of Br+/CH2Br+. These two control pulses were, respectively, first identified wit...

Since 2015, edaravone is the second drug available for the treatment of Amyotrophic lateral sclerosis (ALS). In this study we analyzed the characteristics and experience of ALS patients treated with this new medication in our country. Sixteen ALS patients were treated with edaravone infusions in three ALS clinics. Most of them were male, had a spinal onset of the disease and a definite diagnosis of ALS. Mean age at first infusion was 53.5 years. Since the diagnosis of ALS, delay in starting treatment with edaravone was five times greater than that of riluzole. Edaravone therapy was usually initiated at a health care facility and was followed by domiciliary cycles. Adverse effects and the need of a special catheter for infusion were rare. Access to edaravone through health insurance was possible in only 43.8% of patients. Altogether, treatment access was limited but feasible and edaravone was well tolerated.

OBJECT: To compare the consistency of the agreement between the Convolution and TMR10 algorithms using a homogeneous phantom and to identify target characteristics that lead to large changes in target isodose coverage when the Convolution algorithm is used in GammaPlan as opposed to the TMR10 algorithm. METHODS: The IROC phantom end-to-end test was performed and RTDose for both the TMR10 and Convolution algorithm were submitted for comparison to the measurement. Treatment plans for 16 patients and 26 different targets were retrospectively re-calculated with the Convolution algorithm when originally planned with the TMR10 algorithm. Multivariate regression was used to find statistically significant predictors of loss in target prescription isodose coverage. RESULTS: Both algorithms agreed well with the IROC TLD measurement (within 1 %) and slightly better agreement was seen in the film analysis for the Convolution algorithm. After multivariate regression, small target volumes, < 1cm from air cavity, and minimum dose to target were potential predictors of large percentage loss of prescription isodose coverage (p = 0.049, 0.026, and 0.002, respectively). CONCLUSION: Convolution and TMR10 appear to be equivalent in homogeneous situations. Some target characteristics have been identified that might be indications for use of the Convolution algorithm in clinical practice.

The photo-induced dissociative-ionization of lanthanide complexes Ln(hfac)3 (Ln = Pr, Er, Yb) is studied using intense ultrafast transform limited (TL) and linearly chirped laser pulses in a time-of-flight (TOF) mass spectrometry setup. Various fluorine and Ln-containing high-mass fragments were observed in this experiment, including the molecular parent ion, which have not been seen with previous studies relying on relatively long-duration laser pulses (i.e., ns or longer). These new high-mass observations provide important formerly missing information for deducing a set of photo-fragmentation mechanistic pathways for Ln(hfac)3. An overall ultrafast control mechanism is proposed by combining insights from earlier studies and the fragments observed in this research to result in three main distinct photo-fragmentation processes: (a) ligand-metal charge transfer, (b) CF3 elimination, and (c) C-C bond rotation processes. We conclude that ultrafast dissociative-ionization could be a promising technique for generating high-mass fragments for potential use in material science applications.

Object The purpose of this study was to compare two methods of stereotactic localization in Gamma Knife treatment planning: cone beam computed tomography (CBCT) or fiducial. While the fiducial method is the traditional method of localization, CBCT is now available for use with the Gamma Knife Icon. This study seeks to determine whether a difference exists between the two methods and then whether one is better than the other regarding accuracy and workflow optimization. Methods Cone beam computed tomography was used to define stereotactic space around the Elekta Film Pinprick phantom and then treated with film in place. The same phantom was offset known amounts from center and then imaged with CBCT and registered with the reference CBCT image to determine if measured offsets matched those known. Ten frameless and 10 frame‐based magnetic resonance imaging (MRI) to CBCT patient fusions were retrospectively evaluated using the TG‐132 TRE method. The stereotactic coordinates defined by CBCT and traditional fiducials were compared on the Elekta 8 cm Ball phantom, an anthropomorphic phantom, and actual patient data. Offsets were introduced to the anthropomorphic phantom in the stereotactic frame and CBCT's ability to detect those offsets was determined. Results Cone beam computed tomography defines stereotactic space well within the established limits of the mechanical alignment system. The CBCT to CBCT registration can detect offsets accurately to within 0.1 mm and 0.5°. In all cases, some disagreement existed between fiducial localization and that of CBCT which in some cases was small, but also was as high as 0.43 mm in the phantom domain and as much as 1.54 mm in actual patients. Conclusion Cone beam computed tomography demonstrates consistent accuracy in defining stereotactic space. Since both localization methods do not agree with each other consistently, the more reliable method must be identified. Cone beam computed tomography can accurately determine offsets occurring within stereotactic space that would be nondiscernible utilizing the fiducial method and seems to be more reliable. Using CBCT localization offers the opportunity to streamline workflow both from a patient and clinic perspective and also shows patient position immediately prior to treatment.

An underdetermined linear algebraic equation system $$\mathbf{y}={\varvec{\Phi }}\mathbf{x}$$ , where $${\varvec{\Phi }}$$ is an $$m\times n (m

OBJECT Intravenous fluorescein sodium has been used during resection of high-grade gliomas to help the surgeon visualize tumor margins. Several studies have reported improved rates of gross-total resection (GTR) using high doses of fluorescein sodium under white light. The recent introduction of a fluorescein-specific camera that allows for high-quality intraoperative imaging and use of very low dose fluorescein has drawn new attention to this fluorophore. However, the ability of fluorescein to specifically stain glioma cells is not yet well understood. METHODS The authors designed an in vitro model to assess fluorescein uptake in normal human astrocytes and U251 malignant glioma cells. An in vivo experiment was also subsequently designed to study fluorescein uptake by intracranial U87 malignant glioma xenografts in male nonobese diabetic/severe combined immunodeficient mice. A genetically induced mouse glioma model was used to adjust for the possible confounding effect of an inflammatory response in the xenograft model. To assess the intraoperative application of this technology, the authors prospectively enrolled 12 patients who underwent fluorescein-guided resection of their high-grade gliomas using low-dose intravenous fluorescein and a microscope-integrated fluorescence module. Intraoperative fluorescent and nonfluorescent specimens at the tumor margins were randomly analyzed for histopathological correlation. RESULTS The in vitro and in vivo models suggest that fluorescein demarcation of glioma-invaded brain is the result of distribution of fluorescein into the extracellular space, most likely as a result of an abnormal blood-brain barrier. Glioblastoma tumor cell–specific uptake of fluorescein was not observed, and tumor cells appeared to mostly exclude fluorescein. For the 12 patients who underwent resection of their high-grade gliomas, the histopathological analysis of the resected specimens at the tumor margin confirmed the intraoperative fluorescent findings. Fluorescein fluorescence was highly specific (up to 90.9%) while its sensitivity was 82.2%. False negatives occurred due to lack of fluorescence in areas of diffuse, low-density cellular infiltration. Margins of contrast enhancement based on intraoperative MRI–guided StealthStation neuronavigation correlated well with fluorescent tumor margins. GTR of the contrast-enhancing area as guided by the fluorescent signal was achieved in 100% of cases based on postoperative MRI. CONCLUSIONS Fluorescein sodium does not appear to selectively accumulate in astrocytoma cells but in extracellular tumor cell-rich locations, suggesting that fluorescein is a marker for areas of compromised blood-brain barrier within high-grade astrocytoma. Fluorescein fluorescence appears to correlate intraoperatively with the areas of MR enhancement, thus representing a practical tool to help the surgeon achieve GTR of the enhancing tumor regions.

In quantum control experiments with shaped femtosecond laser pulses, adaptive feedback control is often used to identify pulse shapes that can optimally steer the quantum system toward the desired outcome. However, gaining mechanistic information can pose a challenge due to the varied structural features of the control pulses and/or the often complex nature of the associated simulations of the experiments. In this article, we introduce control pulse slicing (CPS) as an easy-to-implement experimental analysis tool that can be employed directly in the laboratory without the need for modeling, to gain mechanistic insights about control experiments, regardless of whether the pulse is optimal or chosen by other means. As an illustration, we apply CPS to dissociative ionization of CH

Introduction: Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease of unknown cause, characterized by the simultaneous involvement of the upper and lower motor neurons. Epidemiological studies have estimated its annual incidence between 0.31 and 3.2 and its prevalence between 0.8 and 8.5 cases per 100,000 inhabitants. The epidemiological information in our country is limited to specialized centers. The present study presents the results of an epidemiological study in ELA performed in the Autonomous City of Buenos Aires (CABA). Methods: A multicentric retrospective study was conducted. Patients with defined and probable ALS according to the El Escorial Criteria, evaluated between January 1, 2012 and December 31, 2013, who lived in the CABA at the onset of symptoms, were included. The calculation of the incidence was based on the 2010 census. Results: We included 103 patients (55 men), with a mean age of 64 years. The onset of symptoms was in the lower limbs at 39%, upper extremities at 25% and bulbar at 26%. The initial symptom was weakness in 58% and dysarthria in 20%; 9% had dementia associated with ALS. The mean time to diagnosis was 14.5 months. Thirty new cases/patients were diagnosed between 01/06/2012 and 01/06/2013, with an incidence rate of 1.04 per 100,000 inhabitants. Conclusions: The epidemiological characteristics of ALS in CABA are similar to those reported in the universal literature. Further studies are needed to determine if these findings are applicable to the rest of the Argentine population. Introduction: Amyotrophic Lateral Sclerosis (ALS) is a neurodegenerative disease of unknown cause, characterized by the simultaneous involvement of the upper and lower motor neurons. Epidemiological studies have estimated its annual incidence between 0.31 and 3.2 and its prevalence between 0.8 and 8.5 cases per 100,000 inhabitants. The epidemiological information in our country is limited to specialized centers. The present study presents the results of an epidemiological study in ELA performed in the Autonomous City of Buenos Aires (CABA). Methods: A multicentric retrospective study was conducted. Patients with defined and probable ALS according to the El Escorial Criteria, evaluated between January 1, 2012 and December 31, 2013, who lived in the CABA at the onset of symptoms, were included. The calculation of the incidence was based on the 2010 census. Results: We included 103 patients (55 men), with a mean age of 64 years. The onset of symptoms was in the lower limbs at 39%, upper extremities at 25% and bulbar at 26%. The initial symptom was weakness in 58% and dysarthria in 20%; 9% had dementia associated with ALS. The mean time to diagnosis was 14.5 months. Thirty new cases/patients were diagnosed between 01/06/2012 and 01/06/2013, with an incidence rate of 1.04 per 100,000 inhabitants. Conclusions: The epidemiological characteristics of ALS in CABA are similar to those reported in the universal literature. Further studies are needed to determine if these findings are applicable to the rest of the Argentine population. Fil: Pérez Akly, Manuel. Sociedad Neurológica; Argentina Fil: Schiava, Marianela. Unidad Asistencial Doctor César Milstein; Argentina Fil: Melcom, Mario. Fundación para la Investigación en Neuroepidemiología; Argentina Fil: Rodríguez, Gabriel. Sociedad Neurológica; Argentina Fil: Gargiulo Monachelli, Gisella Mariana. Sociedad Neurológica; Argentina Fil: Bettini, Mariela. Sociedad Neurológica; Argentina Fil: Reisin, Ricardo. Sociedad Neurológica; Argentina Fil: Bendersky, Mariana. Sociedad Neurológica; Argentina Fil: Barroso, Fabio. Sociedad Neurológica; Argentina Fil: Brand, Patricio. Fundación para la Lucha Contra las Enfermedades Neurológicas de la Infancia. Instituto de Investigaciones Neurológicas "Raúl Carrea"; Argentina Fil: de Ambrosi, Bruno. Sociedad Neurológica; Argentina Fil: Di Egidio, Marianna. Sociedad Neurológica; Argentina Fil: Fiorotto, Luis. Sociedad Neurológica; Argentina Fil: Jáuregui, Agustín. Sociedad Neurológica; Argentina Fil: Landriscina, Paula. Sociedad Neurológica; Argentina Fil: Marchesoni, Cintia. Sociedad Neurológica; Argentina Fil: Mazia, Claudio. Sociedad Neurológica; Argentina Fil: Rey, Roberto. Sociedad Neurológica; Argentina Fil: Rugiero, Marcelo. Sociedad Neurológica; Argentina Fil: Salutto, Valeria Luján. Sociedad Neurológica; Argentina Fil: Tillard, Belén. Sociedad Neurológica; Argentina Fil: Fulgenzi, Ernesto. Sociedad Neurológica; Argentina

Pituitary macroadenomas can invade the cavernous sinus and rarely cause occlusion of the internal carotid artery (ICA). Most patients with symptomatic obstruction of the ICA by a pituitary tumor have been reported as a result of apoplexy. The authors review the literature about this condition and report a 48-year-old man who presented with transient ischemic attacks leading to a stroke. Imaging studies demonstrated complete occlusion of the left ICA and critical narrowing of the right ICA at the level of the clinoid processes, most likely due to macroadenoma mass effect. There was no radiologic evidence of apoplexy. Surgical resection of the tumor and ICA decompression via the transsphenoidal route resulted in prevention of further symptoms. Histopathologic analysis confirmed a nonfunctioning pituitary adenoma without evidence of hemorrhage or intratumoral infarction. This patient, to the authors' knowledge, is the first documented patient with symptomatic carotid compression by a pituitary adenoma without evidence of apoplexy.

Surgical options for pediatric patients with marked dysfunction of a single epileptogenic hemisphere have evolved over time. Complications resulting from highly resective operations such as anatomical hemispherectomy, including superficial siderosis and secondary hydrocephalus, have led to the development of less resective and more disconnective functional hemispherectomy. Functional hemispherectomy has recently given rise to hemispherotomy, the least resective operation primarily aimed at disconnecting the abnormal hemisphere. Hemispherotomy is effective in decreasing seizure frequency and most likely decreases the risk of postoperative complications when compared with its predecessors. Hemispherotomy is a technically challenging operation that requires a thorough understanding of 3D cerebral anatomy to ensure adequate hemispheric disconnection without placing important structures at risk. The details of germane operative anatomy are not currently available because of the difficulty in exposing this operative anatomy adequately in cadavers to prepare detailed instructive illustrations. Using 3D graphic models, the authors have prepared 2D overlay illustrations to discuss the relevant operative nuances for a modified form of this procedure. Through hemispherotomy, experienced surgeons can effectively treat patients with unilateral epileptogenic hemisphere dysfunction while limiting potential complications.

Resumen En los ultimos anos la informacion cientifica sobre el tratamiento farmacologico del dolor neuropatico (DN) ha aumentado considerablemente. Estudios aleatorizados, controlados, metaanalisis, guias, recomendaciones y revisiones ofrecen al medico una gran posibilidad de lectura, gran parte de ella en ingles. Consideramos util ofrecer al neurologo no especialista de habla hispana un resumen actualizado en espanol de las guias y recomendaciones sobre el tratamiento farmacologico del DN. En la presente revision consideramos 4 grupos de farmacos clasificados de acuerdo a su sitio y mecanismo de accion:a) receptores perifericos (farmacos de uso topico: lidocaina, capsaicina); b) fibras perifericas (bloqueantes de canales del sodio: carbamazepina, oxcarbacepina);c) moduladores espinales del dolor (bloqueantes de la subunidad alfa 2 delta de los canales de calcio voltaje dependiente: gabapentin, pregabalina); y d) moduladores de la inhibicion central descendente (inhibidores de la recaptacion de aminas) (antidepresivos triciclicos y selectivos «duales»: amitriptilina, duloxetina) y agonistas de receptores opioides (opioides, tramadol). Diferentes autores coinciden en que la primera eleccion en el tratamiento del DN esta compuesta por amitriptilina, gabapentina y pregabalina; como segunda opcion duloxetina; como tercera opioides, tramadol y farmacos de aplicacion topica y finalmente, como cuarta opcion, otros farmacos antiepilepticos y antidepresivos. En circunstancias especiales algunos farmacos pueden considerarse como primera eleccion: polineuropatia diabetica dolorosa pregabalina y duloxetina; neuralgia del trigemino: carbamazepina y oxcarbacepina. DN agudo: opioides, tramadol y DN localizado con alodinia (neuralgia postherpetica): lidocaina topica.

Resumen Si bien el dolor neuropatico (DN) es conocido desde la antiguedad y puede presentarse en numerosas entidades, muchos profesionales en nuestro medio consideran que la formacion medica durante la etapa del pregrado en el tema es insuficiente. Para evaluar la opinion que tienen los medicos de su capacitacion en DN en el pregrado y en el posgrado en nuestro pais, los autores realizaron una encuesta a 440 medicos durante el ano 2010. Se consulto a los profesionales si habian recibido educacion de pregrado y de postgrado en DN y si se sentian capacitados para tratarlo. La mayoria de los medicos refirio no haber recibido educacion de pregrado en dolor y DN (53%) y no se sentian capacitados para tratarlo (62%). Gran parte de los medicos adquiria formacion en actividades de posgrado y estaban interesados en continuar su formacion en DN.

Resumen La fibromialgia (FM) es una entidad que ha sido aceptada por la OMS en 1992. Los criterios diagnosticos han sido postulados inicialmente en 1990 y modificados recientemente. El cuadro clinico se caracteriza por dolor cronico osteoarticular, muscular y del tejido celular subcutaneo, con fluctuaciones a lo largo del tiempo; se asocia a patologias cronicas dolorosas y trastornos del sueno, atencion y del estado de animo. Suele llevar varios anos de evolucion en el momento del diagnostico, provocando disminucion de las capacidades funcionales y conflictos psico-sociales. Afecta entre el 2 y 4,7% de la poblacion entre los 20 y 60 anos y en un 80% al sexo femenino. Los pacientes perciben dolor con estimulos de menor intensidad que la mayoria de los individuos. Si bien no se ha detectado un parametro biologico indicador de FM, estudios con resonancia magnetica funcional detectan imagenes que se correlacionan con una mayor percepcion del dolor y se postulan factores geneticos y fallos en el sistema nervioso central, en los circuitos inhibitorios del dolor. Estos fenomenos son criticados por investigadores que postulan factores psicogenos de mala adaptacion al dolor. El tratamiento debe contemplar farmacos: pregabalina, duloxetina y milnacipram combinados con tratamiento educacional, psicoterapeutico y ejercitacion fisica controlada. En esta revision se plantea una vision critica de la FM dirigida al neurologo que en su practica diaria asiste a pacientes con FM.

Resection of hemangioblastomas can be challenging due to their high vascularity and intimate association with neighboring cerebrovascular structures. The authors present their intraoperative findings using fluorescein angiography and fluorescence for removal of hemangioblastomas in an attempt to improve the safety and extent of resection.From April through August 2012, four patients were diagnosed with hemangioblastomas, 3 in the cerebellum and 1 in the medulla oblongata. Low-dose (4 mg/kg) sodium fluorescein was injected intravenously immediately before microdissection. The area of interest was inspected through a microscope-integrated fluorescent module.In three superficially located tumors, the vascular pattern of feeding and draining vessels could be easily identified with fluorescein angiography. The resection of the tumors was guided using real-time fluorescence mode. For each patient, histopathologic examination of the lesion confirmed the diagnosis of hemangioblastoma. All samples of fluorescent tissue resected were confirmed to contain tumor. No patient experienced any complication.Low-dose sodium fluorescein used in conjunction with a microscope-integrated fluorescence module is a potentially useful tool for localization, vascular characterization, and resection of hemangioblastomas.

Fluorescent technology has recently become a valuable tool in the surgical management of neoplastic and vascular lesions. The availability of microscope-integrated fluorescent modules has facilitated incorporation of this technology within the microsurgical workflow. The currently available microscope integrated modules use 5-aminolevulinic acid (5-ALA) and indocyanine green (ICG) as fluorophores. Fluorescein sodium is a fluorescent molecule that has been used specifically in ophthalmology for the treatment of retinal angiography. A new microscope-integrated fluorescent module has been recently developed for fluorescein. We employed this technology to maximize resection of tumors and perform intraoperative angiography to guide microsurgical management of aneurysms and arteriovenous malformations. Fluorescein fluorescence allows the surgeon to appreciate fluorescent structures through the oculars while visualizing non-fluorescent tissues in near natural colors. Therefore, the operator can proceed with microsurgery under the fluorescent mode. We present three representative cases in which the use of fluorescein fluorescence was found useful in the surgeon’s decision making during surgery. The applications of this new microscope-integrated fluorescent module are multiple, and include vascular and oncologic neurosurgery. Further clinical investigations with large patient cohorts are needed to fully establish the role of this new technology.