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Viktor stalberg esposa disfunción sexual

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A mi familia, especialmente a mi mujer, Mercedes, por su ayuda y apoyo link este trabajo cia miccional, así como de disfunción sexual, incluyendo disfunción eréctil, eyaculación rrebroeck P, Victor A, Wein A. The standardization of terminology of lower urinary Nandedkar SD, Sanders DB, Stalberg EV.

On the shape of. médico, independientemente de la raza, credo, sexo, nacionalidad o las necesidades Viktor stalberg esposa disfunción sexual paciente, la familia y el equipo terapéutico, que.

Disfunción leve: Paresia ligera solamente objetivable a la explotación concienzuda. En Finalmente, la evolución de los restantes grupos (sexo, lado Victor 14, Martin JB. Jonsson L, Hemmingsson A, Thomander L, Bergstróm K​, Stálberg. Se estudiaron al azar 35 pacientes adultos con anemia drepanocítica (AD), de los cuales 15 (42,9 %) eran del sexo masculino y 20 (57,1 %) del femenino.

esposa Laura que ha sabido sobrellevar el trabajo, el sacrificio (que ha sido Viktor I. Sandström, estudiante de la Universidad de Uppsala (Suecia), publicó en el año casos/ habitantes-año, con predominio tanto en el sexo femenino pacientes asintomáticos tienen alguna Viktor stalberg esposa disfunción sexual renal como incapacidad.

médico, independientemente de la raza, credo, sexo, nacionalidad o las necesidades del paciente, la familia y el equipo terapéutico, que.

Tam-con sintomatologa neurolgica bin se preguntar acerca de enfermedades generales con posible repercusin sobre el sistema nervioso, como cardio- patas embolgenas, arteriosclerosis, hipertensin arterial, En neurologa, los pasos del diagnstico presentan varia- diabetes mellitus o discrasias sanguneas.

Finalmente, debeciones respecto a las otras reas mdicas, debidas funda-preguntarse por el parto y el perodo neonatal, en busca Viktor stalberg esposa disfunción sexual a que en ella existe una perfecta correlacinun posible sufrimiento fetal, convulsiones febriles y enferme-entre los sntomas y signos del paciente y las estructuras ana-dades propias de la infancia sarampin, varicela, parotidi-tmicas daadas, y a que el establecimiento del diagnsticotisde gran utilidad diagnstica en pacientes con epilepsiatopogrfico de la lesin constituye un gran avance en el re- o encefalitis.

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Por todoello, creemos de gran inters describir lo ms detalladamen-te posible algunos aspectos de la anamnesis Viktor stalberg esposa disfunción sexual exploracin f-Principales motivos de consulta en neurologasica en neurologa. Por lo general, slo con una anamne-la prctica de una adecuada exploracin fsica. En ocasiones sis adecuada el clnico podr realizar una orientacin diag-no es posible llevar a cabo la historia clnica con el propionstica inicial que le permita conocer la gravedad opaciente, bien por su estado mental demenciacin, trastor-trivialidad de la cefalea y, en caso Viktor stalberg esposa disfunción sexual ser necesario, orientarno de concienciabien por la naturaleza de la enfermedad las exploraciones que llevarn al diagnstico definitivo.

En estos casos, la anamne-Debe interrogarse minuciosamente la forma de inicio, locali-sis debe realizarse con la colaboracin de los familiares, ami-zacin, irradiacin, carcter y duracin del dolor, as comogos o personas con las que conviva el enfermo, con las limi- las maniobras que lo agravan o alivian.

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El dato ms valorabletaciones y posibilidades de error que entraa. Otras veces los es la cronopatologa de la cefalalgia. Las cefaleas agudas enpacientes refieren sintomatologa vaga y de difcil cataloga-personas sin historia previa de dolor de cabeza son graves ycin mareos, dolores mal precisadosque oscurecen laobligan a descartar hemorragia, tumor o meningitis. La croni-verdadera naturaleza del problema que aqueja. El clnico de- cidad o recurrencia Viktor stalberg esposa disfunción sexual una cefalalgia suele orientar hacia unaber recoger el relato espontneo del enfermo y, despus,etiologa vascular o psicgena.

Los datos como intensidadsin sugestionarlo, dirigir un interrogatorio adecuado que le del dolor y su relacin con los movimientos de la cabeza tie-permita precisar el sntoma gua que indique el camino a se- nen poco valor discriminativo, mientras que la alteracin delguir para llegar al diagnstico. Las polineuropatías en el curso de la AD se han relacionado con otros agentes etiológicos no directamente vinculados con la hemoglobinopatía.

Se han comunicado casos de intoxicación por plomo y por cianato en enfermos con AD y algunos autores consideran que Viktor stalberg esposa disfunción sexual enfermos con esta hemoglobinopatía son propensos a la intoxicación por plomo.

Se conoce que la isquemia produce diversas alteraciones de los nervios periféricos y que estas dependen de la severidad del daño vascular. Con los resultados de nuestra casuística puede plantearse que en la AD es frecuente la polineuropatía y que esta tiene algunas características tales como: de tipo mixta, de localización distal, secundaria a un fenómeno de desmielinización, con lesión axonal mínima, de evolución crónica y curso subclínico.

Average age in men was 31 range 16 - 44 and in women 29 range 16 - All the cases were under basal Viktor stalberg esposa disfunción sexual at the moment of the research. Symptoms and clinical signs related with a possible peripheral neuropathy were only detected in 8 Viktor stalberg esposa disfunción sexual During the nervous conduction study, a mujeres indias en vivo increase of latency and a marked reduction of the speed of conduction in the median, peroneal and sural nerves were proved in the total of patients compared with the control group.

No electrical activity was detected in the EMG of any patient at Viktor stalberg esposa disfunción sexual. No significant difference was observed in the muscular contraction potential amplitude in the EMG carried out during the voluntary contraction between the patients and the control group.

The striated muscles that had more electromyographic alterations were the anterior tibial muscle and the internal gamellus muscle. The pattern of muscular contraction of simple oscillations was not detected in any case. The findings of this study allow to state that polyneuropathy appears frequently in sickle cell anemia, since its localization is peripheral and it is of mixed type, with minimal axonal injury and a subclinical course.

Genética y Clínica de las hemoglobinas anormales. La Habana: Pueblo y Educación, Diggs LW. Sickle cell crises. Am J Clin Pathol ; Rev Cubana Hematol Inmunol Hemoter ;3 1 Beutler E. The sickle cell disease and related disorders. En Williams Hematology.

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Mononeuropathy in sickle cell anemia: Anatomical and pathophysiological Basrs for its rarity. Stevanin, F. Hentati, C.

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Auburger, Y. Agid, M. Ben Hamida, A. Brice, Clinical and genetic analysis of a Tunisian family with autosomal dominant cerebellar ataxia type 1 linked to the SCA2 locus, Neurology 44 — Cleary, C. Pearson, Replication fork dynamics and dynamic mutations: the fork-shift model of repeat instability, Trends Genet.

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Bellance, G. Buisson, H. Chneiweiss, J. Dellanave, Autosomal dominant cerebellar ataxia type I in Martinique French West Indies clinical and neuropathological analysis of 53 patients from three unrelated SCA2 families, Brain — Giunti, G.

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Frontali, N. Wood, The role of the SCA2 trinucleotide repeat expansion in 89 autosomal dominant cerebellar ataxia families frequency, clinical and genetic correlates, Brain — Harding, T. Deufel Eds. Hayes, G. Turecki, K.

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Fancellu, Scale for the assessment and rating of ataxia: development of a new clinical scale, Neurology 66 — Genotype and Phenotype in German kindreds, Arch. Bauer, T. Schmidt, T. Schulte, O. Riess, Autosomal dominant cerebellar ataxias: clinical features, genetics, and pathogenesis, Lancet 3 — Simon, K.

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Durr, M. Cook AW, Plaut M. Browder J. Spontaneous intracerebral hemorrhage: factors related to surgical results. Progression of Hypertensive intracerebral hemorrhage. Recurrent Hypertensive intracerebral hemorrhage.

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Relation between blood pressure and outcome in intracerebral hemorrhage. Di Piero V, Bastianello Viktor stalberg esposa disfunción sexual. Prognostic value of peripheral white blood cell count in. Diringer MN. Intracerebral hemorrhage: pathophysiology and management. Crit Care Med ; Surgical management of paediatric cerebral.

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Lesben porn Watch Brianna tamaño de las tetas heladas Video Sakse Video. La cronicidad o recurrencia de una cefalalgia suele orientar hacia una etiologa vascular o psicgena. Los datos como intensidad del dolor y su relacin con los movimientos de la cabeza tienen poco valor discriminativo, mientras que la alteracin del sueo, el carcter paroxstico o el aumento del dolor con la tos o la maniobra de Valsalva sugieren un cuadro de hipertensin endocraneal. En los casos de cefalea de origen intracraneal es importante valorar la edad, el sexo y la sintomatologa acompaante como forma de aura, lagrimeo, fiebre o focalidad neurolgica migraa comn, clsica o acuminada, meningitis, encefalitis, tumores, abscesos o hematomas. En las cefaleas extracraneales hay que valorar la existencia de trastornos de la visin o molestias oculares, enfermedad tica o dolores y crujidos de las vrtebras cervicales cefalalgias de origen ocular, otorrinolaringolgico o cervical. Tambin debe preguntarse acerca de la ingesta de frmacos vasoactivos, exposiciones a gas ciudad o monxido de carbono, procesos infecciosos, hipertensin arterial o trastornos pulmonares capaces de explicar un cuadro de cefalea. Finalmente, debe realizarse una valoracin psquica del paciente en busca de datos de depresin para detectar una cefalea psicgena. AnamnesisLa historia clnica de los pacientes neurolgicos no es una tarea fcil y, con frecuencia, la realizacin de una anamnesis neurolgica correcta presenta muchas ms dificultades que la prctica de una adecuada exploracin fsica. En ocasiones no es posible llevar a cabo la historia clnica con el propio paciente, bien por su estado mental demenciacin, trastorno de conciencia , bien por la naturaleza de la enfermedad que padece epilepsia, sncope. En estos casos, la anamnesis debe realizarse con la colaboracin de los familiares, amigos o personas con las que conviva el enfermo, con las limitaciones y posibilidades de error que entraa. Otras veces los pacientes refieren sintomatologa vaga y de difcil catalogacin mareos, dolores mal precisados , que oscurecen la verdadera naturaleza del problema que aqueja. El clnico deber recoger el relato espontneo del enfermo y, despus, sin sugestionarlo, dirigir un interrogatorio adecuado que le permita precisar el sntoma gua que indique el camino a seguir para llegar al diagnstico. Extended pathoanatomical studies point to a consistent affection of the thalamus in spinocerebellar ataxia type 2. Consistent affection of the central somatosensory system in spinocerebellar ataxia type 2 and type 3 and its significance for clinical symptoms and rehabilitative therapy. Brain Res Rev. Electrophysiological features in patients and presymptomatic relatives with spinocerebellar ataxia type 2. Progression markers of spinocerebellar ataxia 2. Electrophysiological study of visual processing in spinocerebellar ataxia type 2 SCA2. Electromyographic pattern in patients and asymptomatic carriers of the SCA2 mutation. Ataxin-2 intermediate-length polyglutamine expansions are associated with increased risk for ALS. Stages of sleep pathology in spinocerebellar ataxia type 2 SCA2. Disturbance of rapid eye movement sleep in spinocerebellar ataxia type 2. Subtle REM sleep abnormalities in presymptomatic spinocerebellar ataxia type 2 gene carriers. Saccade velocity is controlled by polyglutamine size in spinocerebellar ataxia 2. Saccade velocity as a surrogate disease marker in spinocerebellar ataxia type 2. Ann N Y Acad Sci. The neuroanatomical basis of slow saccades in spinocerebellar ataxia type 2 Wadia-subtype. Prog Brain Res. Oculomotor phenotypes in autosomal dominant ataxias. Olfactory dysfunction in degenerative ataxias. Olfactory dysfunction in hereditary ataxia and basal ganglia disorders. Spinocerebellar ataxia type 2 olfactory impairment shows a pattern similar to other major neurodegenerative diseases. Nuclear localization or inclusion body formation of ataxin-2 are not necessary for SCA2 pathogenesis in mouse or human. A European Community collaborative study. J Med Genet. Sequeiros J. Machado—Joseph disease: epidemiology, genetics and genetic epidemiology. In: Lechtenberg R, editor. Handbook of cerebellar diseases. New York: Dekker; Age-dependent risks in genetic counseling for spinocerebellar ataxia type 2. The role of protein composition in specifying nuclear inclusion formation in polyglutamine diseases. J Biol Chem. Amino acid sequences flanking polyglutamine stretches influence their potential for aggregate formation. Leznicki P. Aggregation and toxicity of the proteins with polyQ repeats. Postepy Biochem. Quaid KA. Presymptomatic testing for Huntington disease in the United States. Spinocerebellar ataxias caused by polyglutamine expansions: a review of therapeutic strategies. Effects of a physical training program on quantitative neurological indices in mild stage type 2 spinocerebellar ataxia patients. Chronic thalamic stimulation in a patient with spinocerebellar ataxia type 2. Subthalamic—thalamic DBS in a case with spinocerebellar ataxia type 2 and severe tremor-A unusual clinical benefit. Difference in the effects of tandospirone on ataxia in various types of spinocerebellar degeneration: an open-label study. Defining the boundaries of the response of sleep leg movements to a single dose of dopamine agonist. Periodic limb movements in sleep and periodic limb movement disorder. Type 2 spinocerebellar ataxia SCA2 is the condition most often described to date in patients with hereditary ataxia, its prevalence being 52 per , persons. In patients with SCA2 neurogenic patterns are identified by means of electrophysiological techniques. Patients and methods. A transverse study was made of 70 persons with SCA2 of different periods of duration and from different regions of the country. The control group was made up of volunteers. Electrophysiological recordings made were: conventional and quantitative electromyography, late F wave and H reflex responses. The patients with worse clinical condition were concentrated in this latter group. Significant differences were observed between Groups I, II and control and also regarding the late responses of the F wave and H reflex. Key words. F wave. H reflex. Spinocerebellar ataxia. Spinocerebellar degeneration. Aceptado: Hospital General Dr. La Habana, Cuba. Correspondencia: Dr. Hospital Docente Vladimir Ilich Lenin. El grupo control lo conformaron sujetos voluntarios. Ambos grupos consintieron en ser incluidos en el estudio tras ser informados. Los filtros entre 20 Hz y 10 kHz. Se registraron un total de 20 trazos con una frecuencia de 1 Hz. Se expresaron en ms. La tabla II muestra los resultados del electromiograma convencional. Registro de onda F en enfermo con AEC2. Figura 2. Comportamiento de la respuesta del reflejo H en un enfermo de AEC2. Trazo 1: respuesta normal en sujeto del grupo control. Trazo 2: registro con amplitud disminuida en un enfermo de AEC2. Trazo 4: ausencia de respuesta. Tabla II. Tabla III. En otros cuatro pacientes el electromiograma fue normal. Figura 3. La nube de puntos se concentra hacia la zona de amplitudes elevadas y actividad disminuida. No existen estudios en la literatura que permitan establecer confrontaciones con nuestros resultados. Estos resultados expresaron la existencia de dos tipos de respuestas anormales, una dada por latencias prolongadas con amplitudes disminuidas y la otra por la ausencia de potencial. El mismo se aplica en varios hospitales, tanto en la capital como en otras provincias. Study of 1. In Plaitakis J, ed. Neurology ; Berlin: Springer-Verlag; Autosomal dominant ataxia. Stalberg E, Dioszeghy P. Scanning EMG in normal muscle and in neunetic evidence for locus heterogeneity from a Cuban founder effect romuscular disorders. Electroencephalogr Clin Neurophysiol ; population. Am J Hum Genet ; Anticipation in spinocerebellar Stalberg E. Invited review: electrodiagnostic assessment and monitoring ataxia type 2. Nat Genet ; 1: Muscle Nerve ; Stalberg E, Masahiro S. Moderate expansion of a normally biallelic trinucleotide renate between normal and neurogenic MUPs in concentric EMG: analpeat in spinocerebellar ataxia type 2. Nat Genet ; Identification of the spinocerebellar ataxia type 2 gene using a direct Fowler JC. Electromyography and nerve conduction. In Binnie DC Jr, identification of repeat expansion and cloning technique. Nat Genet Osselton WJ, eds. Clinical neurophysiology. Newcastle: Butter; Subramony SH. Clinical aspects of hereditary ataxias. J Child Neurol Automatic analysis of the elec; Part II: findings in control subjects 7. Gispert S. Localization of the candidate gene D-Amino acid oxidase and in some neuromuscular diseases. Muscle Nerve ; 9: Am J Hum Fisher MA. H reflexes and F waves: physiology and Clinical indicaGenet ; H reflex latency in somal assignment of the second locus for autosomal dominant cerebelthe healthy elderly. Nat Genet ; 4: Denny-Brown D. Handbook of neurological examination and case re9. Bates G, Lehrach H. Trinucleotide repeat expansions and human gecording. Cambridge: Harvard University Press; Kimura J. Techniques and normal findings. In Kimura J, ed. Electrodiagnosis in diseases of nerve and muscle. Philadelphia: FA Davis; Fuglsang-Frederick A. Turns amplitude analysis of the EMG interference pattern. Methods Clin Neurophysiol ; 4: The F wave. The H reflex. Electrophysiological study in olivopontocerebellar atrophy. Electromyogr Clin Neurophysiol ; Peripheral neuropathy in spinocerebellar degenerations. Rev Cub Medic ; J Neurol Sci ; Sensory and motor peripheral neuropathy in olivopontocerebellar atrophy. Acta Neurol Scand ; Motor evoked potentials by magnetic stimulation in hereditary and sporadic ataxia. Clinical, multimodality electrophysiological study of a family with progressive cerebellar ataxia and late deafness and an autosomal recessive inheritance. Acta Neurol ; Preferential generation of recurrent responses by groups of motor neuron in man. Conventional and single unit F waves studies. Brain ; Palabras clave. Ataxia espinocerebelosa. Onda F. Reflejo H. Palavras chave. Reflexo H. All the groups showed differences in the amplitude of sensory action potentials in median and sural nerves. Sural amplitude was negatively correlated with disease duration and ataxia score. Differences among patients and controls in the mean latency and conduction velocity of sensory action potentials were found. CAG repeat and electrophysiological markers assessed were not correlative. Electrophysiological alterations in the SCA2 appeared in presymptomatic stages. These alterations are consistent markers which could be used to evaluate the progression of the disease. Introduction The autosomal dominant cerebellar ataxias ADCA are a clinically, pathologically and genetically heterogeneous group of neurodegenerative disorders caused by degeneration of cerebellum and its afferent and efferent connections. Los Alamos Avenue No. In Cuba, there are almost patients and presymptomatic relatives at risk of developing some hereditary ataxia in the next few years. The most frequent molecular form is SCA2, with a prevalence of 43 cases per , inhabitants in Holguin province, reaching cases per , inhabitants in Baguanos municipality [9]. SCA2 is characterized by progressive gait and limb ataxia, cerebellar dysarthria, dysmetria, dysdiadochokinesia, tremor and slowing of horizontal saccadic eye movements [10,11]. The gene is located on the long arm of chromosome 12 12q The unstable expansion of the polyglutamine domain within ataxin-2 is directly linked to the pathogenesis of SCA2 [13]. No existen otros síntomas. El síndrome sensitivo. El déficit motor es ligero y se evidencia en tareas manuales que requieren de habilidad como la escritura. El pronóstico es favorable. El síndrome sensitivo motor consiste en déficit motor directo y proporcional o no, asociado a una disminución homolateral de la sensibilidad parcial o total. DiaDiaDiaDiaDiagnósticognósticognósticognósticognóstico deldeldeldeldel ictusictusictusictusictus isquémicoisquémicoisquémicoisquémicoisquémico aaaaagudogudogudogudogudo. La historia clínica y el examen físico orientan al diagnóstico de la. La conferencia de consenso de Helsingborg de , recomendó la realización de una TAC en todos los pacientes sospechosos de i c t u s agudo. La TAC puede ser normal si el infarto es pequeño o se encuentra situado en el territorio posterior Figs. En el infarto embólico la TAC puede sugerir este mecanismo cuando la lesión isquémica es cortical y se encuentra en los territorios de distribución de la arteria cerebral posterior o media. Observamos imagen tomo-. La resonancia magnética nuclear RMN es la técnica de mayor sensibilidad en la enfermedad cerebrovascular; ya que posibilita el diagnóstico en los estadios iniciales del infarto cerebral y permite observar las lesiones del tallo cerebral donde la sensibilidad de la TAC es baja. El incremento de agua hística en la región afectada es el factor que posibilita el diagnóstico. Las técnicas convencionales de resonancia magnética muestran signos iniciales de infarto como son el aumento de señal en la corteza en las secuencias potenciadas en densidad protónica T2-FLAIR y la ausencia de señal de flujo en los vasos arteriales. El primero de estos signos ocurre a las 8 horas de ocurrido el infarto, mientras el segundo se evidencia de forma inmediata. Resonancia magnética. Distintas técnicas no convencionales de RM que ofrecen información sobre el grado de restricción del movimiento del agua difusión -RM , el estado metabólico espectroscopia ; y sobre la circulación a nivel microscópico RM por perfusión , permiten incrementar la sensibilidad de detección de esta técnica en las lesiones isquémicas en la fase hiperaguda del ictus, lo que la ha convertido en la técnica diagnóstica de primera elección en el estudio del ictus en su fase hiperaguda. Los estudios de difusión por RM son sensibles al movimiento microscópico aleatorio que muestran las moléculas de agua extracelular en el espacio intersticial del tejido cerebral. A partir de esta variación se puede calcular el coeficiente de difusión aparente o porcentaje neto de traslación de las moléculas de agua por segundo , que es una variable física que define la carcterística de los tejidos. En la actualidad son herramientas del diagnóstico clínico junto al lecho del paciente que realiza el neurólogo clínico. La combinación del Doppler continuo y la ecografía en modo B aumenta la sensibilidad y especificidad de estos estudios. El Doppler transcraneal se ha convertido en un examen fundamental de las lesiones arteriales intracraneales. Todo laboratorio neurovascular debe constar de esta técnica. Tiene el inconveniente de su baja sensibilidad. AnatomíaAnatomíaAnatomíaAnatomíaAnatomía patológicapatológicapatológicapatológicapatológica. El infarto cerebral pasa por 3 fases desde el punto de vista anatomopatológico: aguda, subaguda y crónica. Macroscópicamente en su fase aguda se observa como una zona de reblandecimiento, con disminución de la consistencia, rodeada de una zona de edema. Se puede observar un aumento de volumen con efecto de masa y desplazamiento de las estructuras vecinas. En la fase subaguda el edema perilesional disminuye y la zona necrosada se ha organizado con aumento de la vascularización periférica. Si el infarto es extenso se puede observar una cavidad quística. Al examen del microscopio de luz en la fase aguda en la zona central donde se ha producido la necrosis celular se observan neuronas degeneradas, retraídas y disminución o ausencia de células en las primeras 6 a 11 horas. Hacia las 24 horas se produce un infiltrado inflamatorio con predominio de polimorfonucleares, seguido de infiltración de linfocitos y monocitos con activación de la microglia en la zona perilesional alrededor de las 48 horas. En el tejido necrosado hay un exceso de agua en los primeros 4 a 5 días que disminuye en las semanas siguientes. En la fase subaguda se produce activación de los macrófagos y aumento de los astrocitos. TratamientoTratamientoTratamientoTratamientoTratamiento deldeldeldeldel ictusictusictusictusictus isquémicoisquémicoisquémicoisquémicoisquémico aaaaagudogudogudogudogudo. Hemos hecho referencia a través de todo este capítulo que el ictus es una urgencia médica y como tal debe ser tratado. De otra parte la determinación de los factores de riesgo y su importancia en el desarrollo de un ictus ha hecho que la prevención se halle en el centro del tratamiento de la ECV. Aunque en esta obra se trata del ictus isquémico en su fase aguda creemos que el imprescindible abordar los aspectos de la prevención primaria y secundaria. Tratamiento preventivo. El ictus es una enfermedad prevenible. No es posible disminuir su morbilidad y la mortabilidad sin que se realicen las acciones de prevención primaria. Educación sanitaria de la población especialmente en aquellos individuos con factores de riesgo. Control adecuado de los pacientes con hipertensión arterial a través del médico de familia vigilando por el cumplimiento del tratamiento. Pesquisaje en la población de los factores de riesgo de ECV y su control adecuado. Promover campañas educativas permanentes a través de los medios masivos de comunicación sobre calidad de vida y factores de riesgo. Dispensarizar y controlar todos los pacientes con HTA, cardiopatías isquémicas y otros factores de riesgo. Educar a todo el personal de la salud, tanto profesional como auxiliar, en que el ictus es una urgenciaurgenciaurgenciaurgenciaurgencia médica. Manejo del ictus en fase aguda. El manejo del ictus en fase aguda implica su diagnóstico preciso de forma inmediata y la puesta en marcha de medidas terapéuticas en las primeras horas. Las líneas actuales del tratamiento del ictus isquémico en fase aguda son:. Monitorización del paciente con especial atención al control de la presión arterial, la glucemia, la respiración y la temperatura, resultados que se optimizan en las Unidades de ictus UI. Recanalización precoz de la arteria obstruida en las 3 primeras horas mediante la terapéutica específica y la trombólisis. Recuperación del tejido cerebral metabólicamente comprometido y la limitación del daño por reperfusión mediante el uso de agentes neuroprotectores. Monitorización del paciente con IIA — Control de la función respiratoria. Mantener las vías aéreas libres, aspirar secreciones, controlar la frecuencia respiratoria y saturación de oxígeno. Si existe depresión respiratoria o trastornos como hipercapnia o hipoxemia severa se debe entubar al paciente. El aumento de la TA es con frecuencia una reacción fisiológica para mantener la presión de perfusión cerebral. La disminución brusca de la TA puede agravar la lesión isquémica en una zona en que se han perdido los mecanismos de autorregulación cerebral y donde la presión de perfusión cerebral depende directamente de la PAM. Recomendamos el uso de labetalol intravenoso o nitroprusiato en caso de hipertensión refractaria. El enalapril en bolo de 1 mg i. Al ingreso debe realizarse electrocardiograma y rayos X de tórax ya que existen causas frecuentes de origen cardíaco que se asocian a ictus como la fibrilación auricular, el IMA y la insuficiencia cardíaca. La fibrilación auricular no se debe tratar si el paciente no ha sido anticoagulado previamente para evitar el riesgo de embolización. La insuficiencia cardíaca y la hipotensión arterial son infrecuentes. Deben administrarse ionotrópicos de acción corta como dopamina o dobutamina, si no existe depleción de volumen. El aumento de la temperatura se observa frecuentemente en la fase aguda del ictus. La hipertermia aumenta el metabolismo cerebral y ocasiona deterioro neurológico y empeora el pronóstico. Las medidas antipiréticas para reducir la temperatura deben ser inmediatas. Tratamiento específico del ictus isquémico en su fase aguda. El tratamiento específico del IIA tiene como objetivos esenciales:. Para cumplir las metas propuestas todo paciente con un ictus isquémico agudo debe ingresar en un servicio especializado que cuente con los recursos necesarios y el personal. A este efecto han surgido las Unidades de ictus. Agentes trombolíticos. Tras la oclusión de una arteria, el tejido irrigado por esta sufre isquemia. La recanalización precoz de la obstrucción restablece el FSC y las necesidades metabólicas del tejido nervioso. El tiempo para que se produzca recuperación del tejido sometido a la isquemia recibe el nombre de ventana terapéutica y de forma general existe consenso que es de aproximadamente 3 horas. El tratamiento. Los primeros agentes utilizados fueron la estreptoquinasa, la uroquinasa y la plasmina. El estudio de estos trombolíticos tuvo serias limitaciones desde el punto de vista científico y la elevada tasa de hemorragias y muertes en pacientes tratados hicieron que su utilización fuese limitada. Los estudios de la eficacia clínica del rt-PA han sido evaluados en varias investigaciones. Los resultados no fueron concluyentes. Los estudios han concluido que sí se han cumplido los requisitos ideales; cuando la administración de T-PA se realiza por vía intraarterial por catéter, con dosis. Antiagregantes y anticoagulantes. El suloctidil, la sulfinpirazona y el dipiridamol no han demostrado su utilidad individualmente. El uso de la ASA ha demostrado su utilidad en la recurrencia del ictus. El trifusal es un inhibidor irreversible de la ciclooxigenasa y por tanto, bloquea la producción de tromboxano A y la agregación plaquetaria. Su eficacia ha sido evaluada y no resulta superior a la aspirina. Se ha empleado ampliamente los anticoagulantes en la prevención del IIA, también en la fase de progresión de este. La administración de anticoagulantes carece de valor cuando se ha completado el ictus. La necesidad de heparinización es posible en forma inmediata cuando el ictus es de origen cardioembólico. En los infartos cerebrales extensos o en aquellos que existan signos precoces en la TC donde el riesgo de hemorragia es potencialmente alto, el uso de anticoagulantes debe ser diferido unos días. Una vez definido el diagnóstico de infarto embólico el tratamiento se debe iniciar con heparina, seguido de instauración ese mismo día de tratamiento con wafarina. La heparina se administra por vía i. Es conveniente antes de iniciar el tratamiento anticoagulante estimar la actividad de la protombina y el tiempo de coagulación. El empleo se debe mantener durante 6 meses. Otra aplicación del uso de los anticoagulantes es la existencia de un estado protombótico como los déficit de proteínas C o S, el síndrome antifos- folipídico en los que se recomienda el uso de anticoagulación oral. Los agentes. Antagonistas de los canales de calcio iónico regulados mediante voltaje. Mecanismos relacionados con óxido nítrico ON. Estrategias para inhibir la cascada isquémica descendente. Depuradores y antagonistas de radicales libres. Estrategias dirigidas hacia la hiperpolarización con el objetivo de inhibir. Estrategias antiinflamatorias y anticitocinas. Efectos combinados de neuroprotección y restauración. Existen cientos de ensayos clínicos sobre el uso de agentes neuro- protectores en la isquemia cerebral aguda, no obstante, los resultados contra- dictorios, esta vía abre una esperanza en el tratamiento. Es raro que un paciente en el curso de un infarto cerebral llegue a la asistencia médica especializada en el transcurrir de minutos. EvoluciónEvoluciónEvoluciónEvoluciónEvolución yyyyy pronósticopronósticopronósticopronósticopronóstico. Cuando se observa un paciente durante la fase evolutiva de un infarto cerebral isquémico resulta muy difícil establecer un pronóstico de certeza. No existe ninguna regla que establezca con seguridad qué va a suceder en el curso del tiempo. Signos deficitarios leves pueden empeorar en horas y llevar a un estado de gravedad al paciente. En los infartos aterotrombóticos el curso clínico puede ser progresivo en los primeros días, lo que se puede deber a la extensión de la lesión o aumento del edema cerebral. En el pronóstico influyen un grupo de factores como son:. La localización de la lesión ateromatosa es un factor determinante. Si la estenosis se encuentra en la arteria cerebral media el pronóstico es peor que en los pacientes con infartos secundarios a una estenosis carotídea. Los infartos del territorio vertebrobasilar tienen mejor pronóstico que los del territorio de la circulación anterior. Si la espasticidad aparece tardíamente en un paciente con una hemiplejía la recuperación funcional es menor. El estado psíquico del paciente influye notablemente en la recuperación de estos enfermos, los pacientes deprimidos se recuperan menos. Si la recuperación no comienza en las 3 primeras semanas el pronóstico funcional es malo. Si el vaso ocluido por el émbolo es la arteria carótida interna o el tronco principal de la arteria cerebral media, generalmente se produce un infarto de gran tamaño que se acompaña de edema cerebral e hipertensión intracraneal y lleva a la muerte del individuo. Esta recuperación se observa en los infartos cardioembólicos del sistema vertebrobasilar. La evolución en los infartos embólicos guarda relación directa con sitio inicial de la oclusión y el tiempo transcurrido hasta la migración del trombo. Este riesgo es mayor en el decursar del tiempo. El pronóstico durante la etapa aguda del infarto lacunar es bueno. En los enfermos con una hemiparesia pura si el déficit es parcial el pronóstico suele ser mejor que en los pacientes con afectación motora severa. Si existe control de la hipertensión arterial el riesgo de recurrencia se reduce. El síndrome disartria mano torpe tiene un pronóstico excelente. Alvarez-Sabín J. Ictus isquémico. Acido acetilsalicílico y trifusal en la prevención del infarto cerebral aterotrombótico. AVC embólico. En: Codina Puiggrós A Ed. Tratado de Neurología. Editorial Libro del Año, Madrid ; Atherosclerotic disease of the aortic arch and the risk of ischemic stroke. N Engl J Med ; American Heart Association. Guidelines for the management of transient ischemic attacks. Stroke , American Heart Association: Heart and stroke Statitiscal update. Dallas: American Heart Association; Ameriso SF. Tratamiento de la enfermedad cerebrovascular con anticoagulantes y antiagregantes plaquetarios. Rev Neurol ; 29 12 : Antiplatelet Trialists Collaboration. Collaborative overview of randomized trials of antiplatelet therapy. Reduction in venous thrombosis and pulmonary embolism of antiplatelet prophylaxis among surgical and medical patients. Clasificación y criterios diagnósticos. En Diez Tejedor E. Guía para el tratamiento y prevención del ictus. Neurología ; 13 Suppl : Revista Clínica Española ; Clinical study of patientes with lacunar infarcts. Mortalidad en la fase aguda de la enfermedad cerebrovascular. Registro de la Alianza-Hospital Central de Barcelona. Med Clin Barc ; Auer RN, Benveniste H. Hypoxia and related conditions. Arnold, London, Sydney, Auckland ; Classification and natural history of clinically identificable subtypes of cerebral infarction. Bauer KA. Hypercoagulability : a new cofactor in the protein C as anticoagulation pathway. Prevalence of stroke in two samples rural and urban of old people in Spain. A pilot door-to-door study carried out by health professionals. Neurología ; Bogousslavsky J, Castillo V. Clasificación de la enfermedad vascular cerebral. Enfermedad vascular cerebral. En la tabla Las causas ms frecuentes son los traumatismos craneoence- Al preguntar sobre los antecedentes patolgicos de los en-flicos, por lo que siempre deben investigarse en primer lu-fermos neurolgicos es muy importante delimitar con exac-gar. Las otras causas principales son las afecciones cardio 3. Etiologa ms comn de los trastornos convulsivosde conciencia Epilepsia idioptica Traumatismos craneoenceflicos AlcoholismoEnfermedad cerebrovascular Cardiopatas Procesos expansivos intracraneales Bloqueos cardacos sndrome de Stokes-Adams, sndrome Convulsiones febriles del seno carotdeo Traumatismos Arritmias cardacas taquicardia ventricular, fibrilacinInfecciones ventricular, etc. Meningitis Cardiopatas con reduccin del volumen sistlico estenosis Encefalitis artica, miocardiopata hipertrfica, mixoma auricular, Abscesos infarto agudo de miocardio, etc. Trastornos metablicos Hipoglucemia Causas circulatorias perifricas Cuadros hiperosmolares Crisis vasovagales Hipercalcemia o hipocalcemia Ataques de tos o broncospasmo prolongado Coma heptico Sncope posmiccional Insuficiencia renal Hipersensibilidad del seno carotdeo Porfiria Ortostatismo y disautonomasEnfermedades degenerativas cerebrales Causas generales y metablicas Encefalopata hipertensiva Accidentes vasculares cerebrales transitoriosIntoxicaciones medicamentosas HipoglucemiaAtropina Epilepsia Isoniazida Hemorragias masivas Anfetamina Hiperventilacin respiratoria forzadaSndromes de abstinencia Enfermedad de Addison Alcohol FeocromocitomaBarbitricos Sndrome carcinoide Diazepxidos Causas psquicas Histeria y duracin y horario de las crisis. Tambin debe preguntarse por los fenmenos poscrticos, forma de recuperacin delvasculares, la epilepsia, la hipoglucemia y los trastornos psi-ataque y la existencia o no de causas desencadenantes,quitricos. La etiologa cardiovascular sncope es apoyada como estrs, luces intermitentes, ruidos, alteraciones del sue-por una instauracin brusca del cuadro con cada al sueloo, ingesta de alcohol e influencia de los perodos menstrua-o la existencia de palidez u otra sintomatologa vegetativa, les. Hay que interrogar, asimismo, sobre la existencia o no deantecedentes de cardiopatas previas y manifestaciones deotros tipos de crisis, tratamientos que hubiera recibido el pa-insuficiencia cardaca o embolia pulmonar. Las crisis epilp-ciente y mximo intervalo entre las crisis con tratamiento oticas suelen presentarse como prdidas bruscas del conoci- sin ste. Data from a sample of Class II cases treated with various appliances which deliver distally directed forces to the maxilla were examined to determine the frequency of absolute distal displacement of the upper first molar and of the maxilla. Analysis revealed that such distal displacement is possible and that it is, in fact, a frequent finding following treatment. Long-range stability of distal displacement was not assessed. Distal radioulnar joint: functional anatomy, including pathomechanics. The distal radioulnar joint allows the human to rotate the forearm to place the hand in a desired position to perform different tasks, without interfering with the grasping function of the hand. The ulna is the stable part of the forearm around which the radius rotates; the stability of the distal radioulnar joint is provided by the interaction between ligaments, muscles and bones. The stabilizing structures are the triangular fibrocartilage complex, the ulnocarpal ligament complex, the extensor carpi ulnaris tendon and tendon sheath, the pronator quadratus, the interosseous membrane and ligament, the bone itself and the joint capsule. The purpose of this review article is to present and illustrate the current understanding of the functional anatomy and pathomechanics of this joint. Distal Stressors and Depression among Homeless Men. Depression is a common problem among homeless men that may interfere with functional tasks, such as securing stable housing, obtaining employment, and accessing health services. Previous research on depression among homeless men has largely focused on current psychosocial resources, substance abuse, and past victimization. Fractures of the distal phalanx in the horse. Fractures of the distal phalanx are an important cause of lameness referable to the foot. Depending on the fracture configuration and articular involvement, conservative or surgical treatment may be required. Fractures of the distal phalanx have been divided into six categories based on fracture configuration. Discussion of clinical features, management, and prognosis for horses with distal phalangeal fractures is presented for each fracture type. Nonunions of the distal tibia treated by reamed intramedullary nailing. The purpose of this study is to determine the efficacy of reamed intramedullary nailing in the treatment of nonunions of the distal one-fourth of the tibia. Nonunions of the distal tibia are particularly difficult to treat given the short distal segment, the proximity to the ankle joint, and the. Management and treatment of distal ulcerative colitis. Full Text Available Ulcerative colitis UC is a chronic inflammatory condition that is confined to the colonic mucosa. Its main symptoms include diarrhea, rectal bleeding and abdominal pain. Approximately two-thirds of UC patients have disease confined distal to the splenic flexure, which can be treated effectively with topical therapy. This means the active drug can be delivered directly to the site of inflammation, limiting the systemic absorption and potential side effects. Topical treatment with aminosalicylates is the most effective approach in the treatment of these forms, provided that the formulation reaches the upper margin of the disease. Given this, the suppository formulation is the treatment of choice for proctitis and distal sigmoiditis. Thanks to their proximal spread, enemas, foams and gels represent the treatment of choice for proctosigmoiditis and for distal ulcerative colitis. Oral aminosalicylates are less effective than topical therapies in patients with active disease, while the combination of topical and oral treatment is more effective in patients refractory to topical or oral mono-therapy. Topically administered aminosalicylates play an important role in the maintenance of remission, but the long-term adhesion to therapy is poor. For this reason, the oral formulation is the first-line therapy in the maintenance of remission. Refractory patients can be treated with topical steroids or systemic steroids and TNF-alpha inhibitors in severe forms. Distal or embolic protection has intuitive appeal for its potential to prevent embolization of materials generated during interventional procedures. Distal protection devices DPDs have been most widely used in the coronary and carotid vascular beds, where they have demonstrated the ability to trap embolic materials and, in some cases, to reduce complications. Given the frequency of chronic kidney disease in patients with renal artery stenosis undergoing stent placement, it is reasonable to propose that these devices may play an important role in limiting distal embolization in the renal vasculature. Careful review of the literature reveals that atheroembolization does occur during renal arterial interventions, although it often goes undetected. The combination of platelet inhibition and a DPD may provide even greater benefit. Given the critical importance of renal functional preservation, it follows that everything that can be done to prevent atheroembolism should be undertaken including the use of DPDs when anatomically feasible. The data available at this time support a beneficial role for these devices. Evaluación, optimización y mejoramiento del sistema operativo de lagunas de estabilización de Ciudad de Dios-San Jose en el departamento de Lambayeque. Durante el año de , paralelamente a la exitosa gestión de concertación del financiamiento extremo y nacional por la ejecución del estudio definitivo para la ampliación y mejoramiento de los servicios de Agua Potable y Alcantaril OBJECTIVE: To review the literature on the role of calcium, phosphorus and trace elements in the nutrition of extremely low birth weight infants, considering their importance for metabolism, bone mineralization. Maxillary molar distalization with the dual-force distalizer supported by mini-implants: a clinical study. The objective of this prospective study was to describe the clinical effects of a bone-supported molar distalizing appliance, the dual-force distalizer. The study group included 16 patients mean age, Study models and lateral cephalograms were taken before and after the distalizing movement to record significant dental and skeletal changes Wilcoxon test. The average distalization time was 5 months, with a movement rate of 1. The average molar inclination was 5. The correlation between inclination and distalization was not significant, indicating predominantly bodily movement. The teeth anterior to the first molar moved distally also; the second premolars distalized an average of 4. The dual-force distalizer is a valid alternative distalizing appliance that generates controlled molar distalization with a good rate of movement and no loss of anchorage. Robotic distal pancreatectomy versus conventional laparoscopic distal pancreatectomy: a comparative study for short-term outcomes. Robotic system has been increasingly used in pancreatectomy. However, the effectiveness of this method remains uncertain. This study compared the surgical outcomes between robot-assisted laparoscopic distal pancreatectomy and conventional laparoscopic distal pancreatectomy. During a year period, 35 patients underwent minimally invasive approach of distal pancreatectomy in our center. Seventeen of these patients had robot-assisted laparoscopic approach, and the remaining 18 had conventional laparoscopic approach. Their operative parameters and perioperative outcomes were analyzed retrospectively in a prospective database. The mean operating time in the robotic group Both robotic and conventional laparoscopic groups presented no significant difference in spleen-preservation rate Both groups also showed no perioperative mortality. Similar outcomes were observed in robotic distal pancreatectomy and conventional laparoscopic approach. However, robotic approach tended to have the advantages of less blood loss and shorter hospital stay. Further studies are necessary to determine the clinical position of robotic distal pancreatectomy. An innovative technique to distalize maxillary molar using microimplant supported rapid molar distalizer. Full Text Available Introduction: In recent years, enhancements in implants have made their use possible as a mode of absolute anchorage in orthodontic patients. In this paper, the authors have introduced an innovative technique to unilaterally distalize the upper left 1 st molar to obtain an ideal Class I molar relationship from a Class II existing molar relationship with an indigenous designed distalizer. Clinical Innovation: For effective unilateral diatalization of molar, a novel cantilever sliding jig assembly was utilized with coil spring supported by a buccally placed single micro implant. Discussion: This appliance is relatively easy to insert, well-tolerated, and requires minimal patient cooperation compared to other present techniques of molar distalization. Moreover, it is particularly useful in cases that are Class II on one side and Class I on the other, with a minor midline discrepancy and nominal overjet. Patient acceptance level was reported to be within patients physiological and comfort limits. El mito de pristinidad y los usos efectivos del territorio de la región de Magallanes, Patagonia Chilena: Forestal, minería y acuicultura. Los métodos de clasificación de usos del suelo en regiones remotas presentan dos serias limitaciones. La primera es la mixtura conceptual de usos con coberturas que no refleja el uso efectivo del territorio. Este trabajo presenta un método para determinar los usos territoriales en la región de Magallanes en el extremo austral de Chile. To assess the effectiveness of the new anterolateral approach of the distal femur for the treatment of distal femoral fractures. Between July and December , 58 patients with distal femoral fractures were treated by new anterolateral approach of the distal femur in 28 patients new approach group and by conventional approach in 30 patients conventional approach group. The operation time, intraoperative blood loss, intraoperative fluoroscopy frequency, hospitalization days, and Hospital for Special Surgery HSS score of knee were recorded. Operation was successfully completed in all patients of 2 groups, and healing of incision by first intention was obtained; no vascular and nerves injuries occurred. The operation time and intraoperative fluoroscopy frequency of new approach group were significantly less than those of conventional approach group P 0. All patients were followed up months mean, Bone union was shown on X-ray films; the fracture healing time was The knee HSS score at last follow-up was New anterolateral approach of the distal femur for distal femoral fractures has the advantages of exposure plenitude, minimal tissue trauma, and early function rehabilitation training so as to enhance the function recovery of knee joint. Distal protection filter device efficacy with carotid artery stenting: comparison between a distal protection filter and a distal protection balloon. This retrospective study aimed to compare the effectiveness of the embolization prevention mechanism of two types of embolic protection device EPD -a distal protection balloon DPB and a distal protection filter DPF. Rates of positive findings on postoperative diffusion-weighted imaging DWI and stroke incidence were compared. Mini-implant-supported Molar Distalization. Maxillary molar distalization was planned and mini-implants were used to preserve the anterior anchorage. After 13 months of treatment, Class I molar and canine relation was achieved bilaterally and there was no anterior proclination. Thus, mini-implants provide a viable option to the clinician to carry out difficult tooth movements without any side effects. Periosteal osteoblastoma of the distal femur. Osteoblastomas located on the surface of the cortical bone, so-called periosteal osteoblastomas, are extremely rare. We report on a case of periosteal osteoblastoma arising from the posterior surface of the right distal femur in a year-old man. Roentgenographic, computed tomographic, magnetic resonance imaging, and histologic features of the case are presented. Periosteal osteoblastoma should be radiologically and histologically differentiated from myositis ossificans, avulsive cortical irregularity syndrome, osteoid osteoma, parosteal osteosarcoma, periosteal osteosarcoma, and high-grade surface osteosarcoma. Although periosteal osteoblastoma is rare, this tumor should be included in the differential diagnosis of surface-type bone tumors. Full Text Available En este trabajo se profundiza en el conocimiento de la variabilidad espacial de la precipitación, estudiando la cantidad de días con precipitación y la intensidad media diaria en milímetros por día, con énfasis en los extremos , definidos a partir de diferentes umbrales. La base de datos utilizada en este trabajo consta de 58 estaciones pluviométricas ubicadas al sudeste de Sudamérica, para la segunda mitad del siglo XX. El patrón de extremos de precipitación, por encima del percentil 75, no muestra grandes diferencias espaciales y estacionales con respecto a los del umbral 0,1mm. Sin embargo la intensidad media diaria de precipitación extrema se incrementa considerablemente con respecto al umbral 0,1mm. In this paper the climatology of the different components that composed the monthly rainfall was actualized and extended. For this purpose, we calculated the frequency of daily rainfall and the mean daily intensity for the second half of the century. In addition we calculated the climatology for the daily extreme rainfall and its intensity, defining different thresholds according to the regions. Spatial patterns and seasonal variation. Radiographic anatomy of the distal dural SAC. A radio-anatomical study was performed of the distal dural sac DS in patients subjected to myelography. In In the remaining patients the dural terminations were more distally located. The average location of the DS-termination was higher than that found in a previous anatomic study. The inference is that in patients with low-back pain and sciatica, the DS tends to terminate at a higher spinal level than in a non-selected anatomic material. The caudal reduction in sagittal diameter of the DS was less than that of the frontal diameter of the sac. The linear diminution in cross-sectional area of the DS from the level of L3 towards the lumbosacral junction was not correlated with the degree of caudal extension of the DS into the sacrum. Thus the length of the DS and its transverse diameters are independent of each other. These results supported the view that the location of the termination of the DS and hence that of the spinal cord is not related to stenosis of the central spinal canal. Maxillary molar distalization with first class appliance. Non-extraction treatment has gained popularity for corrections of mild-to-moderate class II malocclusion over the past few decades. The distalization of maxillary molars is of significant value for treatment of cases with minimal arch discrepancy and mild class II molar relation associated with a normal mandibular arch and acceptable profile. This paper describes our experience with a year-old female patient who reported with irregularly placed upper front teeth and unpleasant smile. The patient was diagnosed to have angles class II malocclusion with moderate maxillary anterior crowding, deep bite of 4 mm on a skeletal class II base with an orthognathic maxilla and retrognathic mandible and normal growth pattern. She presented an ideal profile and so molar distalization was planned with the first-class appliance. Molars were distalised by 8 mm on the right and left quadrants and class I molar relation achieved within 4 months. The space gained was utilised effectively to align the arch and establish a class I molar and canine relation. Dermal pocketing following distal finger replantation. Replantation is an ideal technique for reconstruction following fingertip amputation as it provides 'like for like' total reconstruction of the nail complex, bone pulp tissue and skin with no donor-site morbidity. However, fingertips are often not replanted because veins cannot be found or are thought to be too small to repair. Attempts at 'cap-plasty' or pocketing of replanted tips with and without microvascular anastomosis have been done in the past with varying degrees of success. We prospectively followed up a group of patients who underwent digital replantation and dermal pocketing in the palm to evaluate the outcome of this procedure. There were 10 patients with 14 amputated digits two thumbs, five index, four middle, two ring and one little who underwent dermal pocketing of the amputated digit following replantation. Among the 14 digits that were treated with dermal pocketing, 11 survived completely, one had partial atrophy and two were completely lost. Complications encountered included finger stiffness two patients and infection of the replanted fingertip with osteomyelitis of the distal phalanx one patient. Published by Elsevier Ltd. Osteoid osteoma of the distal clavicle. It was described in by Jaffe, as a tumor that affects the young adult population, with a predominance of males. This study aims to present a case of late diagnosis of a patient with osteoid osteoma of the distal clavicle region. Female patient, 44 years old, non-professional volleyball player, reported pain in the anterior and superior region of the shoulder girdle, specifically in the acromioclavicular joint, which worsened at night and had been treated for nine months as tendinitis of the rotator cuff and acromioclavicular joint arthritis. After confirming the diagnosis, the patient underwent open surgery with resection of the distal clavicle. At two years of follow-up, the patient presents without local pain. The duration of symptoms ranged from months and all of the cases had treatment failure after previous administration of corticosteroids. After a mean follow-up period of Results: At follow-up, the overall response to RT was Conclusions: Hypofractionated RT has been proven effective for treatment of severe cases of Graves ' orbitopathy in cases with a prolongated duration of symptoms. The comparison with literature data demonstrate that the results after hypofractionated RT are comparable to those obtained after conventional fractionated RT. Resolution of Graves ' disease after renal transplantation. We report a case of an adolescent boy with Down's syndrome and ESRD on hemodialysis who developed mild Graves ' disease that was not amenable to radioablation, surgery, or ATDs. After 14 months of observation without resolution of Graves ' disease, he successfully received a DDRT with a steroid minimization protocol. Thymoglobulin and a three-day course of steroids were used for induction and he was started on tacrolimus, MMF, and pravastatin for maintenance transplant immunosuppression. One month after transplantation, all biochemical markers and antibody profiling for Graves ' disease had resolved and remain normal one yr later. Nodular Graves ' disease with medullary thyroid cancer. Co-existence of thyroid nodules with Graves ' disease has been reported in various studies. Medullary thyroid cancer MTC in nodules associated with Graves ' disease is rare. On literature survey, we came across 11 such cases reported so far. We report a year-old female with Graves ' disease who also had a thyroid nodule that on fine-needle aspiration cytology and the subsequent postthyroidectomy histopathological examination was reported to be MTC. Se presenta una aproximación a su definición y los desafíos que debe afrontar el adolescente de este nivel para su formación integral sobre la base de una convivencia armónica y feliz. Graves ' disease: thyroid function and immunologic activity. Patients with Graves ' disease were studied for two years during and after a twelve-month course of treatment. These in-vivo measurements of thyroid stimulation were compared with the results of in-vitro assays of Graves , immunoglobulin TSH binding inhibitory activity - TBIA. There was no correlation between the thyroid uptake and TBIA on diagnosis. Pertechnetate uptake and TBIA both declined during the twelve months of antithyroid therapy. TBIA was detectable in sera from 19 of the 27 patients at diagnosis; in 11 of these 19 patients there was a good correlation p Graves , immunoglobulin and the thyroid uptake. Probability of recurrence can be assessed but sustained remission of Graves ' disease after treatment cannot be predicted from either measurement alone or in combination. Postoperative hypocalcemia after thyroidectomy for Graves ' disease. It is believed that patients who undergo thyroidectomy for Graves ' disease are more likely to experience postoperative hypocalcemia than patients undergoing total thyroidectomy for other indications. However, no study has directly compared these two groups of patients. The aim of this study was to determine whether there was an increased incidence or severity of postoperative hypocalcemia in patients who underwent thyroidectomy for Graves ' disease. An institutional review board-approved database was created of all patients who underwent thyroidectomy from to at the Johns Hopkins Hospital. There were a total of 68 patients with Graves ' disease who underwent surgery. Fifty-five patients who underwent total thyroidectomy were randomly selected and served as control subjects. An analysis was conducted that examined potential covariates for postoperative hypocalcemia, including age, gender, ethnicity, preoperative alkaline phosphatase level, size of goiter, whether parathyroid tissue or glands were present in the specimen, and the reason the patient underwent surgery. Specific outcomes examined were calcium levels on postoperative day 1, whether or not patients experienced symptoms of hypocalcemia, whether or not Rocaltrol was required, the number of calcium tablets prescribed upon discharge, whether or not postoperative tetany occurred, and calcium levels 1 month after discharge. Each outcome was analyzed using a logistic regression. There was a trend, though not significant, toward patients with Graves ' disease having a higher prevalence of hypocalcemia the day after thyroidectomy and 1 month later. Patients with Graves ' disease are more likely to require increased dosages of calcium as well as experience tetany postoperatively than patients undergoing total thyroidectomy for other indications. This suggests that. To evaluate the incidence of thyroid carcinoma in patients operated on for Graves ' disease, to identify criteria which may predict malignancy, and to develop a practical approach to determine the extensiveness of thyroidectomy. Retrospective study of all patients who underwent thyroidectomy for Graves ' disease between and Post-operative pathology examination revealed six cases of thyroid cancer 1. All six cases had differentiated thyroid carcinoma papillary carcinoma in 3 cases, follicular carcinoma in 2 cases and papillo-follicular carcinoma in 1 case. Five patients underwent re-operative total thyroidectomy. This study shows that while malignancy in Grave 's disease is uncommon, the presence of thyroid nodule s in patients with Grave 's disease may be considered as an indication for radical surgery. The most adequate radical surgery in this situation is to perform a total thyroidectomy. The aim of the study was to determine the blood serum sulfated glycosaminoglycans GAGs and hyaluronic acid HA concentration of Graves ' disease patients before treatment and after attainment of the euthyroid state. The study was carried out on the blood serum obtained from 17 patients with newly recognised Graves ' disease and from the same patients after attainment of the euthyroid state. Graves ' patients had not any clinical symptoms neither of ophthalmopathy nor pretibial myxedema. GAGs were isolated from the blood serum by the multistage extraction and purification using papaine hydrolysis, alkali elimination, as well as cetylpyridium chloride binding. Total amount of GAGs was quantified by the hexuronic acids assay. Increased serum concentration of sulfated GAGs in non-treated Graves ' disease patients was found. Similarly, serum HA level in untreated patients was significantly elevated. The attainment of euthyroid state was accompanied by the decreased serum sulfated GAGs level and by normalization of serum HA concentration. In conclusion, the results obtained demonstrate that the alterations of GAGs metabolism connected with Graves ' disease can lead to systemic changes of the extracellular matrix properties. Carcinomatosis peritoneal secundaria a carcinoma Lobulillar de mama. En los tres casos el diagnóstico se hizo varios años después del descubrimiento del tumor primario y en dos de ellos se ob Espondilodiscitis secundaria a anestesia peridural Spondilodiscitis secondary to peridural anesthesia. Se presenta el caso de un paciente con espondilodiscitis secundaria al uso de anestesia peridural lumbar para la resección transuretral de una hiperplasia fibroadenomatosa de la próstata. El cuadro clínico estuvo determinado por lumbalgia aguda con incremento progresivo que llevó al confinamiento en cama del paciente. En el examen físico del sistema osteomioarticular predominó la contractura paravertebral lumbar, así como en la palpación de esta región. En el examen neurológico no se encontra El Aprendizaje y servicio en educación secundaria. El artículo presenta los resultados de un estudio descriptivo-comprensivo realizado con 50 estudiantes de secundaria sobre su satisfacción con respecto a su participación en proyectos de aprendizaje-servicio. Mediante la adaptación de un modelo de satisfacción se analizan 4 dimensiones clave conocimiento e intencionalidad atribuida; valoracion de Ia utilidad atribuida; valoracion del proceso y proyección social. The onset of Graves disease during pregnancy exposes the neonate to the risk of hyperthyroidism. The newborn must be monitored and treatment modalities known to ensure early treatment of the newborn. We report on the case of an infant born at term of a mother with Graves disease discovered during pregnancy. He was asymptomatic during the first days of life, before declaring the disease. Neonatal hyperthyroidism was confirmed by hormonal assays. Hyperthyroidism was treated with antithyroid drugs and propranolol with a satisfactory clinical and biological course. Neonatal hyperthyroidism should be systematically sought in infants born to a mother with Graves disease. The absence of clinical signs during the first days of life does not exclude the diagnosis. The duration of monitoring should be decided according to the results of the first hormonal balance tests. Neonatal Graves ' Disease with Maternal Hypothyroidism. Neonatal Graves ' disease presenting as conjugated hyperbilirubinemia is a diagnostic challenge because the differential includes a gamut of liver and systemic diseases. We present a unique case of neonatal Graves ' disease in a premature infant with conjugated hyperbilirubinemia born to a mother with hypothyroidism during pregnancy and remote history of Graves ' disease. Infant was treated with a combination of methimazole, propranolol, and potassium iodide for 4 weeks. Thyroid function improved after 8 weeks of treatment with full recovery of thyroid function, disappearance of thyroid-stimulating antibodies, and resolution of failure to thrive and conjugated hyperbilirubinemia. This case provides several clinical vignettes as it is a rare, severe, presentation of an uncommon neonatal disease, signs, symptoms, and clinical history presented a diagnostic challenge for neonatologists and endocrinologists, normal newborn screen was misleading, and yet timely treatment led to a full recovery. Changes of hepatofibrosis markers in Graves ' disease. Methods: Serum levels of hepatofibrosis were measured with RIA in 40 patients with Graves ' disease CD before any treatment and 35 patients with Graves ' disease after successful anti-thyroid drug therapy as well as in 30 controls. Pancytopenia can rarely complicate Grave 's disease. It can be due to uncontrolled thyrotoxicosis or as a result of rare side effect of antithyroid medication. Pernicious anemia leading to Vitamin B12 deficiency is another rare associated cause. We report a case of a patient with Grave 's disease and undiagnosed pernicious anemia whom was assumed to have antithyroid drug induced pancytopenia. Failure to recognize this rare association of pernicious anemia as a cause of pancytopenia had resulted in delay in treatment and neurological complication in our patient. Rituximab in relapsing Graves ' disease, a phase II study. Heemstra, Karen A. Conventional therapies for Graves ' disease, consisting of medical therapy or radioiodine are unsatisfactory, because of limited efficacy and adverse events. Interventions aimed at the underlying autoimmune pathogenesis of Graves ' disease may be worthwhile to explore. We therefore performed a. Sjiele sacrifices, Odin treasures and Saami graves? Full Text Available This paper presents archaeological findings described as Saami metal deposits. The author also presents a research project dealing with prehistoric and medieval Saami graves from the south Saami area. Graves ' orbitopathy: Management of difficult cases. Management of Graves ' ophthalmopathy GO is based on three pillars: to stop smoking, to restore and maintain euthyroidism, and to treat the eye changes according to severity and activity of GO. Difficulties are frequently encountered in each of these three management issues. The advice to. These in-vivo measurements of thyroid stimulation were compared with the results of in-vitro assays of Graves , immunoglobulin TSH binding inhibitory activity--TBIA. TBIA was detectable in sera from 19 of the 27 patients at diagnosis; in 11 of these 19 patients there was a good correlation p less than 0. Isquemia aguda de miembros inferiores secundaria a ergortismo. Full Text Available Paciente de género femenino, de 21 años de edad, quien ingresó por dolor progresivo e intenso en miembros inferiores, y refirió antecedente reciente de ingestión de derivados del ergot. Al examen físico se observó ausencia de pulsos en ambos miembros inferiores. Por angiotomografia se documentó disminución severa, generalizada y bilateral, del calibre de los vasos arteriales de miembros inferiores. Se diagnosticó isquemia arterial aguda secundaria a ergotismo y se inició tratamiento con vasodilatadores y calcio-antagonistas, que resolvió los síntomas en su totalidad. Osteoporosis secundaria y Osteoporosis inducida por glucocorticoides OIG. La osteoporosis secundaria se puede producir por varias patologías y el uso de ciertos medicamentos. Diversas guías han sido propuestas por diversos grupos para el tratamiento de la OIG; desafortunadamente, las guías del tratamiento no se utilizan adecuadamente en los pacientes. Effect of I therapy on outcomes of Graves ' ophthalmopathy. Objective: To analyze the correlation between the therapeutic effect of Graves ' hyperthyroidism and the outcomes of Graves ' ophthalmopathy after I therapy, and to explore the effect of I treatment on turnout of Graves ' ophthalmopathy. Methods: Six hundreds and fifty-two patients of Graves ' disease accompanied with Graves ' ophthalmopathy, received one-time I treatment according to routine procedure. We recorded exophthalmometer readings, the signs and symptoms of eyes before therapy. Regular follow-up and appraisal of curative effect were carried out. Results: At least six months after I therapy, the effective rate of Graves ' hyperthyroidism and Graves ' ophthalmopathy were The total effective rate of hyperthyroidism with ophthalmopathy was Conclusions: The key to treat Graves ' ophthalmopathy is the cure of Graves ' hyperthyroidism through I therapy. The timely diagnosis and replacement treatment of hypothyroidism can effectively avoid the aggravation of Graves ' ophthalmopathy after I therapy. Follow up of Graves ' Opthalmopathy after radioiodine therapy. Graves ' ophthalmopathy may first appear or worsen during or after treatment for hyperthyroidism. We followed up Graves ' hyperthyroid patients treated with radioiodine of which 49 had Grave 's' ophthalmopathy during presentation in Nuclear Medicine Centre, Khulna during the period from to The aim of our study is to see the effect of radioiodine in Graves ' ophthalmopathy. All the patients received radioiodine at fixed dose regime ranged from 7 mCi to 12 mCi. None of ophthalmopathy developed among any of Graves ' hyperthyroid or disappeared after radioiodine treatment during follow up period. From the study we concluded that eye changes in Graves ' hyperthyroidism remain unchanged or exaggerated after radioiodine therapy and needs ophthalmologist care. Thyroid cancer in Graves ' disease: is surgery the best treatment for Graves ' disease? Graves ' disease is a common cause of thyrotoxicosis. Treatment options include anti-thyroid medications or definitive therapy: thyroidectomy or radioactive iodine I Traditionally, I has been the preferred definitive treatment for Graves ' disease in New Zealand. The aim of this study was to determine the rate of thyroid cancer and surgical outcomes in a New Zealand cohort of patients undergoing thyroidectomy for Graves ' disease. This study is a retrospective review of Waikato region patients undergoing thyroid surgery for Graves ' disease during the year period prior to 1 December A total of patients underwent thyroid surgery. Of these, were for Graves ' disease. Total thyroidectomy was performed in 82, near-total in 33 and subtotal in 2 patients. Recurrent thyrotoxicosis developed in one subtotal patient requiring I therapy. There were two cases of permanent hypoparathyroidism and one of permanent recurrent laryngeal nerve palsy. Eight patients 6. A low complication rate The microclimate within a Neolithic passage grave. Episodes of condensation occur on the stone surfaces in summer Soil moisture measurements above, below, and beside the grave mound indicate that rainfall on the mound is not a significant source of moisture to the chamber, whereas the ground below the sealed chamber is constantly moist. The chamber Apart from the more variable climate within the open chamber, there is also a significant penetration of ozone, which is absent in the sealed chamber..

Stereotac Funct Neurosurg ; Cavernomas cerebrales en la infancia: presentación clínica y diagnóstico. Rev Neurol ; 34 4 : Bleeding complications in oral anticoagulant treatment. Nord Med ; Oral anticoagulants and intracranial hemorrhage.

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The treatment of spontaneous intracerebral hemorraghe: a prospective a randomized trial of surgical and conservative treatment. J Neurosurg ; Grading and the indications for treatment in ICH of the basal ganglia cooperative study in Japan. Spontaneous intracerebral hematoma: advances in diagnosis and therapy.

Springer-Verlag; Early surgical Viktor stalberg esposa disfunción sexual for hypertensive intracerebral hemorrhage. Long-term evaluation of ultra-early operation for hypertensive intracerebral hemorrhage in cases. Role of surgery in hypertensive intracerebral hematoma: a comparative study of click and surgical cases.

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Kase CS. Cerebellar hemorrhage. Intracerebral hemorrhage. Kase C. Lobar hemorrhage. Intracerebral hemorraghe. Diagnóstico y tratamiento de la hemorragia intracerebral.

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Rev Neurol. Intracerebral hemorrhage: non-hypertensive cause. Intracerebral hemorrhage and phenylpropanolamine use. Intracranial hemorrhage after coronary thrombolysis with tissue plamisnogen activador. Am J Med ; Anticoagulant-related intracerebral hemorrhage.

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Kaufman HH. Treatment of deep spontaneous intracerebral hematoma: a review. Stroke ; 24 Suppl I : I Treatment of hypertensive cerebellar hemorrhage: surgical or conservative management? Neurosurgery ; Estancia hospitalaria en hemorragias intracerebrales. Rev Neurol ; 25 : Cerebrovascular complications of https://pdf-d.website-web.site/blog-2020-06-06.php of Viktor stalberg esposa disfunción sexual crack form of alkaloidal cocaine.

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Paillas EJ, Alliez B. Surgical treatment of spontaneous intracerebral hemorrhage:. Experience with the surgical treatment of ICH Spontaneous intracerebral hematomas:.

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Heidelberg: Springer-Verlag; Piotrwski WP, Rochowanski E. Operative results in hypertensive intracerebral hematoma in patients over Gerontology ; Predictor of early deterioration and mortality in Black Americans with spontaneous intracerebral hemorrhage.

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Ropper AH. Treatment of intracranial hypertension. In Ropper AH, ed. Neurological and neurosurgical care 3 ed. New York: Raven Press; Arch Neurobiol ; N J Med ; Viktor stalberg esposa disfunción sexual A randomized trial of anticoagulants versus aspirin after cerebral of presumed arterial origin.

An Neurol ; Nontraumatic intracerebral hemorrhage in young adults. Tomonaga M. Cerebral amyloid angiophaty in the ederly. Clinical observations in 60 patients. Angiology ; Surgical treatment for hypertensive cerebellar hemorrhage: indications and characteristics of sterotaxic aspiration surgery.

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Neurol Surg ; Magnagement controversy: medical versus surgical Therapy for spontaneous intracerebral hemorrhage.

Neurosurg Viktor stalberg esposa disfunción sexual N Am ; 3: Hematomas cerebelosos. Neurocirugía ; 9: O, Saribaj O, Erbengi A. Spontaneous cerebellar strokes. Rev Neurol ; 34 8 :. Spontaneous intracerebral. Cerebral amyloid angiopathy without and with cerebral hemorrhage: a comparative histological study. Ann Neurol. A new. La hemorragia subaracnoidea HSA ocupa el cuarto lugar en frecuencia dentro del grupo de las enfermedades cerebrovasculares ECV.

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Su diagnóstico y tratamiento precoz mejora de forma espectacular las complicaciones, gravedad y pronóstico de supervivencia, lo que la convierte en una verdadera emergencia médica. Sería necesario un tratado extenso para abordar la Click to see more en todos sus aspectos, pero el objetivo de esta obra es solo Viktor stalberg esposa disfunción sexual una visión general que permita a médicos generales, internistas y otros especialistas conocer las pautas esenciales para el diagnóstico y tratamiento del paciente frente al cual sospechamos este trastorno.

El espacio subaracnoideo es, como su nombre lo indica, la cavidad que se encuentra entre la aracnoides y la superficie pial.

Las cisternas basales son expansiones de éste. Las arterias cerebrales que constituyen el polígono de Willis y las porciones proximales de este sistema anastomótico se encuentran situadas en las cisternas basales o sus prolongaciones, rodeadas de extensiones en forma Viktor stalberg esposa disfunción sexual tubos. El conocimiento de estos datos anatómicos es esencial para comprender la fisiopatología, cuadro clínico y complicaciones de las HSA. Las diferencias estructurales de los vasos sanguíneos cerebrales con los del resto del organismo.

A diferencia de los vasos de la circulación general, los intracraneales forman una extensa red sobre la superficie del encéfalo, los surcos y cisuras cerebrales. La hemorragia subaracnoidea HSA es la extravasación Viktor stalberg esposa disfunción sexual sangre en el espacio subaracnoideo ES producida por la ruptura vascular. Se denomina primaria si el sangrado se origina directamente en el espacio comprendido entre la aracnoides y la piamadre y secundaria si la sangre proviene de los ventrículos o del parénquima cerebral.

En este capítulo haremos sólo referencia a la hemorragia subaracnoidea primaria.

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En EE. En Cuba se ha calculado una incidencia anual de 30 x habitantes. La incidencia familiar de aneurismas apoya la importancia de los factores hereditarios Viktor stalberg esposa disfunción sexual la génesis de estos. También es de señalar la variabilidad de sus formas, unos son redondeados con una base ancha sin pedículos, otros se conectan con la arteria original a través de un largo pedículo mientras que otros son sólo dilataciones infundibuli- formes.

Tumores cerebrales. Discrasias sanguíneas. Infecciones: fiebre tifoidea, escarlatina.

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Intoxicaciones: monóxido de carbono. Hipertensión arterial. Disección arterial intracraneal. Tóxicos cocaína, arsénico, anfetaminas. Veneno de serpiente. La hemorragia subaracnoidea se produce por la ruptura de la pared de un vaso cuyas paredes son anormales. En ocasiones la ruptura masiva ha estado precedida por varios episodios de fisuramientos pequeños con cefaleas o signos Viktor stalberg esposa disfunción sexual transitorios.

Importancia tiene la llamada cefalea "centinela" en el diagnóstico precoz.

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Otras veces la salida de la sangre es consecuencia de la diapédesis Viktor stalberg esposa disfunción sexual través de la red capilar en una pared alterada en el transcurso de una discrasia sanguínea, traumatismo o trastornos de la coagulación de la sangre. Existen factores que favorecen la aparición de una HSA como son: la hipertensión arterial, el estrés, el coito y los traumatismos entre otros.

Como en la hemorragia intracerebral, el cuadro clínico de la Viktor stalberg esposa disfunción sexual subaracnoidea suele ser muy variable, lo que como ya apuntamos con anterioridad depende de distintos factores como son: la causa, el volumen y la localización del sangramiento.

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Otros Viktor stalberg esposa disfunción sexual no menos importantes son las cifras tensionales en el momento del sangrado, el estado de salud del individuo y la aparición de complicaciones inmediatas. En ocasiones el paciente se queja de cefalea intensísima, que se acompaña de vómitos y cae al suelo con pérdida del conocimiento.

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Si la hemorragia es masiva el paciente puede fallecer antes de llegar al hospital. En los sangramientos de menor volumen el conocimiento se puede. Somnolencia, confusión, estupor y amnesia son frecuentes.

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El paciente se encuentra envarado. En el coma intenso no aparece en ocasiones. La regla inicial es que no existen signos de focalización neurológica.

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Si hay hemiplejía, afasia, hemiparesia u otro trastorno. Estos defectos iniciales pueden desaparecer horas. La localización del sitio del aneurisma roto desde el punto de vista clínico.

La aparición de Viktor stalberg esposa disfunción sexual de extrema intensidad con preservación relativa de la conciencia, sin signos de focalización neurológica y signos meníngeos son indicativos de que ha ocurrido una hemorragia subaracnoidea. Transcurrido el período inicial, si el paciente se mantiene consciente.

Algunos pacientes pueden presentar convulsiones o hipertermia.

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Otros han tenido episodios de cefalea con anterioridad y son etiquetados de migrañosos. La Federación Mundial de Neurocirugía posteriormente creó una clasificación en la cual une la escala de coma de Glasgow a la presencia o no de defecto motor. Esta escala Viktor stalberg esposa disfunción sexual. Fisher y colaboradores.

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ComplicacionesComplicacionesComplicacionesComplicacionesComplicaciones dedededede lalalalala hemorhemorhemorhemorhemorrararararagiagiagiagiagia subaracnoideasubaracnoideasubaracnoideasubaracnoideasubaracnoidea. No neurológicas. Se debe sospechar ante cualquier déficit neurológico focal que ocurre entre el tercero y decimoquinto día. Su ocurrencia después de este período es raro. Los hallazgos en las necropsias han demostrado la presencia de infarto isquémico en ausencias de oclusión o ateroesclerosis en el vaso que tiene el aneurisma.

Este fenómeno recibe el nombre de efecto Cannon y podría ser el responsable del vasospasmo que Viktor stalberg esposa disfunción sexual produce en las horas inmediatas a la ruptura vascular. Esta teoría se basa en el efecto vasoconstrictor que poseen ciertas Viktor stalberg esposa disfunción sexual que se liberan tras la salida y degradación de la sangre tras la ruptura vascular.

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Ocurre en la etapa tardía de la. Los vasos sometidos a espasmo crónico muestran necrosis de las células musculares de la media, infiltración de leucocitos, eritrocitos y mastocitos que pueden afectar hasta la región subendotelial. Existen factores que de una forma u otra contribuyen a la aparición del Viktor stalberg esposa disfunción sexual. Antes del advenimiento del Doppler transcraneal DTC la this web page del vasospasmo requería de la angiografía para verificar el diagnóstico.

En la actualidad el DTC constituye una forma indirecta, pero segura de vigilar el calibre de los vasos por medio de la velocidad del flujo. La irrupción de gran cantidad de sangre hacia los ventrículos o hacia el espacio subaracnoideo a través de los agujeros de Magendie o Luschka es la causa. Se debe sospechar en todo paciente que muestra un Viktor stalberg esposa disfunción sexual confusional o deterioro de la conciencia.

Esta es la principal causa de muerte en la fase aguda de la enfermedad, estando relacionada con un gran volumen del sangrado, hidrocefalia o edema cerebral. Debe ser realizada con urgencia. Otros datos que aporta, son la presencia Viktor stalberg esposa disfunción sexual hemorragia o no en el interior de los ventrículos, existencia de hematoma intraparenquimatoso, otras posibles etiologías y la presencia de hidrocefalia Figs.

Se observa TAC del mismo. El LCR es generalmente hipertenso con una presión que. En las hemorragias leves el recuento de hematíes es del orden de los cientos.

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La xantocromía persiste hasta alrededor del día Las proteínas se encuentran elevadas y en ocasiones puede existir hipoglucorraquia.

Entre el 2do. Tomografía con Viktor stalberg esposa disfunción sexual intravenoso, donde se observa la silueta de un. Tomografía con contraste intravenoso, donde se observa la silueta de un aneurisma de la arteria cerebral anterior derecha.

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La resonancia magnética RM y la angiorresonancia magnética tienen valor para Viktor stalberg esposa disfunción sexual aneurismas mayores de 5 mm; pero su alta tasa de falsos negativos hacen a la angiografía cerebral el método idóneo para el diagnóstico causal. El DTC es de gran utilidad para identificar el vasospasmo en la fase aguda. La Habana.

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Otros estudios resultan de gran importancia, entre ellos se destacan:. El diagnóstico diferencial incluye las siguientes situaciones clínicas. Crisis de migraña.

Síndrome neurológico infeccioso. Absceso cerebral. Crisis epiléptica. Arteritis cerebrales.

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Tumor cerebral. Encefalopatía hipertensiva. Mielopatía aguda. Psicosis aguda. Uso de drogas.

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Si bien no es posible evitar las 2 primeras causas de HSA, es decir los aneurismas intracraneales y malformaciones vasculares, por ser 2 afecciones de origen congénito, existen algunos aspectos que nos permiten sospechar en algunos pacientes estas 2 posibilidades y tomar una conducta que contribuya a evitar la consumación Viktor stalberg esposa disfunción sexual una HSA. En otras causas menos frecuentes, como son las infecciones, el abuso de drogas y el tratamiento anticoagulante, sí es posible tomar medidas enérgicas para evitar la HSA.

Tratamiento de la HSA consumada. Tratamiento de las complicaciones. Medidas Generales. Aporte adecuado de líquidos y electrólitos. Con control del balance hidromineral.

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Control adecuado de la tensión arterial. Evitar el descenso por debajo de mm de la presión sistólica Viktor stalberg esposa disfunción sexual 90 mmHg para la presión diastólica. Usar ablandadores de las heces fecales para evitar la constipación y el esfuerzo físico. Tratamiento de la cefalea mediante medicación analgésica. Evitar el.

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Si hay agitación psicomotriz, usar haloperidol 1,5 mg i. Vigilancia estrecha de los signos neurológicos.

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Si hay Viktor stalberg esposa disfunción sexual o incontinencia urinaria, practicar sondaje vesical. La medida ideal para evitar el resangramiento consiste en operar oportunamente dentro de las primeras 36 horas a todo paciente de los grados I, II y III de la clasificación de la Federación Mundial de Neurología y a continuación incrementar el volumen intravascular, manteniendo las presiones arteriales algo por encima de lo normal.

El uso de los bloqueadores de los canales del calcio se ha utilizado Viktor stalberg esposa disfunción sexual para reducir el vasospasmo. El nimodipino es un bloqueador selectivo de los canales de calcio, del grupo de las dihidropiridinas, que reduce la entrada del calcio extracelular al interior de las click here musculares lisas arteriales.

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La restitución de fluidos y de sodio de manera temprana con soluciones cristaloides después de la obliteración temprana del aneurisma mantiene. Se ha utilizado con resultados.

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En una etapa inicial se utilizan expansores sanguíneos y la hemodilución con el Viktor stalberg esposa disfunción sexual de incrementar el gasto cardíaco y por tanto la tensión arterial. El objetivo de la hipervolemia es lograr una presión venosa central entre 8 y 10 Viktor stalberg esposa disfunción sexual. Habitualmente esto se logra con la administración de cristaloides a una. La hemodilución hipervolémica es capaz de aumentar la perfusión cerebral.

La triple terapia H es en la actualidad el tratamiento de elección para el vasospasmo. Un método que ha tenido resultados alentadores en el tratamiento del. Entre estos se encuentran los inhibidores de la endotelina como. Side effects were more frequent and severe during immunosuppressive therapy. No side effects were found during Yun Ke treatment.

Conclusion: Yun Ke and immunosuppression appeared to be equally effective in the management of GO, but Yun Ke is safer for patients during treatment.

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Hemorragia cerebral secundaria a trombocitopenia por varicela. Su tratamiento incluyó la transfusión de plaquetas y altas dosis de esteroides.

El paciente mejoró, aunque persistieron la hemianopsia homónima izquierda y la epilepsia, tratada con medicación.

Viktor stalberg esposa disfunción sexual

Viktor stalberg esposa disfunción sexual en futuros profesores de Secundaria. Su formación es un tema tan interesante como complejo.

Si educar es ayudar al individuo a desarrollarse en plenitud, el profesor necesita una formación que le oriente en su desarrollo personal, para Viktor stalberg esposa disfunción sexual en el desarrollo profesional, en el que tiene que poner en link mecanismos de ayuda con los alumnos.

La click en valores es una necesidad hoy, pero nos preguntamos, ante todo, qué valores tienen los futuros profesores de Secundaria.

Hemos aplicado el Test de Valores a un grupo de alumnos del CAP, de cuyos resultados hemos extraído unas pocas conclusiones, y hemos dejado abiertas muchas puertas a la interpretación. Grave 's disease This brief review describes the history of Graves ' disease, starting with the original descriptions by Parry, Graves and von Basedow. The true aetiology of the disorder was uncovered in the s Viktor stalberg esposa disfunción sexual s, based on the search for a novel thyroid stimulator which turned out to be an immunoglobulin G autoantibody.

Assays for these thyroid stimulatory antibodies have been continually refined and their epitopes on the thyroid stimulating hormone receptor are increasingly well characterized. We also understand far more about the genetic and environmental susceptibility factors that predispose to disease, and even thyroid-associated ophthalmopathy has now been better defined as primarily a T-cell-mediated disease resulting from cytokine stimulation of orbital fibroblasts.

These advances should improve treatment options for Graves ' disease in the foreseeable future.

médico, independientemente de la raza, credo, sexo, nacionalidad o las necesidades del paciente, la familia y el equipo terapéutico, que.

Optimal management of Graves orbitopathy: a multidisciplinary approach. Soeters, M. Graves ' thyroid disease is a relatively common disorder in endocrinology and general internal medicine practice.

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Graves ' hyperthyroidism is mediated by circulating stimulating autoantibodies. Graves disease hyperthyroidism and glycometabolism.

The Patients with Graves disease hyperthyroidism are often accompanied by disorder of glycometabolism. The blood glycose level can become normal gradually with the recovery of Viktor stalberg esposa disfunción sexual hormone after I and antithyroid drug treatment.

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Therefore, the blood glycose level could be improved and Viktor stalberg esposa disfunción sexual could be prevented by early treatment in the patients with Graves disease hyperthyroidism accompanied with glycometabolism disorder is helpful for improving the blood glycose level.

Graves ' disease and Thyroid anaplasic carcinoma. A case of a 34 year-old patient is presented, who was diagnosed with Graves ' disease and developed a thyroid anaplastic carcinoma from a clinically detected nodular mass.

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The incidence of thyroid cancer associated with Graves ' disease is revisited. Death by suicide in Graves ' disease and Graves ' orbitopathy.

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Here we investigate the risk of unnatural death in Graves ' patients with orbitopathy GO and without GDcomp Beyond independent confirmation, reasons for this need Viktor stalberg esposa disfunción sexual be explored in order to introduce preventive measures Temporal relationship between onset of Graves ' ophthalmopathy and onset of thyroidal Graves ' disease. The temporal relationship between the onset of Graves ' ophthalmopathy and the onset of thyroidal Graves ' disease was evaluated in consecutive patients with Graves ' ophthalmopathy.

Secrets of a Mass Grave.

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This article presents a Viktor stalberg esposa disfunción sexual of study in which students examine skeletons and draw conclusions from the evidence they find in a simulated mass grave.

The activity involves the foundation of forensic anthropology--interpreting the structure of skeletal remains to determine sex, age, height, and possible cause of death.

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Working through a series of…. Medical management of Graves ' ophthalmopathy.

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In most patients with Graves more info hyperthyroidism the eye signs are self-limiting and mostly subclinical. However, about one-third of the patients have clinically relevant ophthalmopathy, which can be disabling and disfiguring. Viktor stalberg esposa disfunción sexual mechanical causes of the symptoms and signs of the eye disease are.

Biologiske behandlingsmuligheder ved Graves ' oftalmopati. The current medical treatment options for Graves ' ophthalmopathy GO are unsatisfactory. Recent treatment of GO patients with the B-lymphocyte depleting monoclonal antibody rituximab or with the anti-tumor necrosis factor-alpha agents etanercept and infliximab has shown promising results.

Thyroid surgery for Graves ' disease and Graves ' ophthalmopathy. Graves ' disease is an autoimmune disease caused by the production of auto-antibodies against the thyroid-stimulating hormone receptor, which stimulates follicular cell production of thyroid hormone.

It is the commonest cause of hyperthyroidism and may cause considerable morbidity with increased risk of cardiovascular and respiratory adverse events. Five per cent of people with Graves Viktor stalberg esposa disfunción sexual disease develop moderate to severe Graves ' ophthalmopathy. Thyroid surgery for Graves ' disease commonly falls into one of three categories: 1 total thyroidectomy, which aims to achieve complete macroscopic removal of thyroid tissue; 2 bilateral subtotal thyroidectomy, in which bilateral thyroid remnants are left; and 3 unilateral total and contralateral subtotal thyroidectomy, or the Dunhill procedure.

Recent American Thyroid Viktor stalberg esposa disfunción sexual guidelines on treatment of Graves ' hyperthyroidism emphasised the role of surgery as one of the first-line treatments. Total thyroidectomy removes target tissue for the thyroid-stimulating hormone receptor antibody. It controls hyperthyroidism at the cost of lifelong thyroxine replacement.

Subtotal thyroidectomy leaves a thyroid remnant and may be less likely to lead to complications, however a higher rate of recurrent hyperthyroidism is expected and revision surgery would be challenging.

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The choice of the thyroidectomy technique is currently largely a matter of surgeon preference, and a systematic review of the evidence base is required to source which option offers the best outcomes for patients. To assess the optimal surgical technique for Graves ' disease and Graves ' ophthalmopathy.

The date of the last search was June for all databases. We did not apply any language restrictions. Only randomised controlled trials RCTs involving participants with a diagnosis. Genetic susceptibility Viktor stalberg esposa disfunción sexual Grave 's disease.

The variety of clinical presentations of eye changes in patients with Graves ' disease GD suggests that complex Viktor stalberg esposa disfunción sexual between genetic, environmental, endogenous and local factors influence the severity of Graves ' ophthalmopathy GO. It is thought that the development of GO might https://doc-8.website-web.site/forum-2020-06-01.php influenced by genetic factors and environmental factors, such as cigarette smoking.

At present, however, the role of genetic factors in the development of GO is not known.

médico, independientemente de la raza, credo, sexo, nacionalidad o las necesidades del paciente, la familia y el equipo terapéutico, que.

On the basis of studies with candidate genes and other genetic approaches, several susceptibility loci in GO have been proposed, including immunological genes, human leukocyte antigen HLAcytotoxic T-lymphocyte antigen-4 CTLA-4regulatory T-cell genes and thyroid-specific genes.

This review gives a brief Viktor stalberg esposa disfunción sexual of the current range of major susceptibility genes found for GD.

Bullying y factores de riesgo para la salud en estudiantes de secundaria. Los docentes tienen serios problemas para hacer frente a conductas perturbadoras entre los Viktor stalberg esposa disfunción sexual agresiones verbales y físicas, consumo de drogas, etc.

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El objetivo de nuestra investigación es indagar las posibles asociaciones entre los implicados en bullying y la realización Viktor stalberg esposa disfunción sexual determinadas conductas de riesgo para la salud por ejemplo, consumo de sustancias adictivas.

Sobre una muestra de estudiantes de Enseñanza Secundaria Obligatoria, se administraron los instrumentos de evaluación siguientes: el Test BULL-S y una encuesta elaborada ah hoc sobre conductas de riesgo para la salud.

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Los resultados indican que el Entre las variables seleccionadas, los Viktor stalberg esposa disfunción sexual destacan en: consumo de tabaco y de alcohol así como en otras conductas que implican un alto riesgo para la salud. El nuevo perfil profesional de los profesores de secundaria. Full Text Available El objetivo del artículo es definir el nuevo perfil profesional de los profesores de secundaria.

Una de las debilidades del sistema educativo español es que ha cambiado el marco legal y no se ha aplicado un nuevo modelo de formación inicial a los docentes de secundaria. Se valora positivamente que el master de formación inicial del profesorado de secundaria tenga presente en su Viktor stalberg esposa disfunción sexual este nuevo perfil competencial profesional.

A partir de estas dimensiones se exploran las configuraciones políticas construidas en las instituciones escolares, entendidas como parte de la socialización política juvenil. Graves ' disease in Albanian children. Pediatric Treatment of Graves ' disease consists of anti-thyroid drugs, radioactive iodide and thyroidectomy but the optimal treatment of GD in children is still controversial.

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To review treatment outcome of pediatric Graves Viktor stalberg esposa disfunción sexual disease in Albania. Descriptive review of 15 children with Graves ' disease, diagnosed from Jan. All patients, mean age Clinical course of 15 patients link treatment with anti-thyroid drugs mainly MMI for 3. MMI was the most common first line therapy in the presented patients with Graves ' disease.

Remission rate was Remission period was 2. I and thyroidectomy were used as second line therapy in the present study.

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Antiphospholipid antibody syndrome complicated by Grave 's disease. The report describes a woman with primary antiphospholipid antibody syndrome complicated with Grave 's disease.

Developing symptoms included a small cutaneous nodule on her finger and subsequently ecchymotic purpura on the cheeks, ears, buttocks and lower legs. Histological examinations showed thrombosed vessels in the dermis Viktor stalberg esposa disfunción sexual or with hemorrhage, respectively.

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Laboratory investigation revealed positive lupus anticoagulant and immunogenic hyperthyroidism due to Grave 's disease. There is a close relationship between the cutaneous manifestation of antiphospholipid antibody syndrome and the activities of Grave 's disease and a possible link of antiphospholipid antibody syndrome with Grave 's disease was suggested both by the etiology of the disease as well as the disease activity.

Escuela secundaria Viktor stalberg esposa disfunción sexual Zurich-Suiza. Viktor stalberg esposa disfunción sexual Text Available This school complex consists of three clearly defined and independent buildings, separated by public or private gardens. The main building of the school complex is the secondary level school, with capacity for students, 24 classrooms and various rooms for complementary functions such as domestic science, art, work rooms, carpentry, storerooms, and areas for teachers, administration offices and services.

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The gymnasium has three gymnastic exercise halls, which can be converted into one large hall for sports competitions, Viktor stalberg esposa disfunción sexual first aid station, a library, workshops, bicycle parking area and complementary services.

The building to be used as a kindergarden has playrooms, dressing rooms and bathrooms. In the interior, the Viktor stalberg esposa disfunción sexual richness of the structural elements themselves has been used to the maximum advantage —concrete for the walls, columns and beams; ceramic forging; etc.

Atresia biliar: una enfermedad grave. La atresia biliar es una grave enfermedad que se manifiesta en los recién nacidos, y se desconoce su causa. La inflamación y destrucciónprogresiva de los conductos biliares conducen a la aparición de ictericia, coluria y acolia entre la segunda y sexta semana de vida.

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Epidemiology and prevention of Graves ' ophthalmopathy. Two age peaks of incidence are observed in the fifth and seventh decades of life, with slight differences between women and men. The disease is Viktor stalberg esposa disfunción sexual frequent. The aim of the study was to identify trends in presentation of GO to tertiary centres and initial management over time.

Current treatment of Graves ' disease.

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In this review we have described the Viktor stalberg esposa disfunción sexual for the appropriate treatment of patients with Graves ' disease.

Because the etiology of this disorder Viktor stalberg esposa disfunción sexual obscure, its management remains controversial. Since antithyroid drugs and radioiodine became readily available in the early s, they have been widely used for the treatment of thyrotoxicosis, and the number of cases treated surgically has markedly decreased.

However, almost four decades of experience have disclosed an unexpectedly high incidence of delayed hypothyroidism after radioiodine treatment and a low remission rate after antithyroid therapy. As a result, surgery is again being advocated as the treatment of choice.

The three modalities of treatment have different advantages and disadvantages, and selection of treatment is of importance. In principle, we believe that for most patients a subtotal thyroidectomy should be performed after the patient has been rendered euthyroid by antithyroid drugs.

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We attempt to leave a thyroid remnant of 6 to 8 gm. Radioiodine treatment of Grave 's disease.

Bangaly Fucking Watch Gameplex en citas en Bangalore Video Banglaibangla Porn. Neurol Surg ; Magnagement controversy: medical versus surgical Therapy for spontaneous intracerebral hemorrhage. Neurosurg Clin N Am ; 3: Hematomas cerebelosos. Neurocirugía ; 9: O, Saribaj O, Erbengi A. Spontaneous cerebellar strokes. Rev Neurol ; 34 8 :. Spontaneous intracerebral. Cerebral amyloid angiopathy without and with cerebral hemorrhage: a comparative histological study. Ann Neurol ;. A new. La hemorragia subaracnoidea HSA ocupa el cuarto lugar en frecuencia dentro del grupo de las enfermedades cerebrovasculares ECV. Su diagnóstico y tratamiento precoz mejora de forma espectacular las complicaciones, gravedad y pronóstico de supervivencia, lo que la convierte en una verdadera emergencia médica. Sería necesario un tratado extenso para abordar la HSA en todos sus aspectos, pero el objetivo de esta obra es solo dar una visión general que permita a médicos generales, internistas y otros especialistas conocer las pautas esenciales para el diagnóstico y tratamiento del paciente frente al cual sospechamos este trastorno. El espacio subaracnoideo es, como su nombre lo indica, la cavidad que se encuentra entre la aracnoides y la superficie pial. Las cisternas basales son expansiones de éste. Las arterias cerebrales que constituyen el polígono de Willis y las porciones proximales de este sistema anastomótico se encuentran situadas en las cisternas basales o sus prolongaciones, rodeadas de extensiones en forma de tubos. El conocimiento de estos datos anatómicos es esencial para comprender la fisiopatología, cuadro clínico y complicaciones de las HSA. Las diferencias estructurales de los vasos sanguíneos cerebrales con los del resto del organismo. A diferencia de los vasos de la circulación general, los intracraneales forman una extensa red sobre la superficie del encéfalo, los surcos y cisuras cerebrales. La hemorragia subaracnoidea HSA es la extravasación de sangre en el espacio subaracnoideo ES producida por la ruptura vascular. Se denomina primaria si el sangrado se origina directamente en el espacio comprendido entre la aracnoides y la piamadre y secundaria si la sangre proviene de los ventrículos o del parénquima cerebral. En este capítulo haremos sólo referencia a la hemorragia subaracnoidea primaria. En EE. En Cuba se ha calculado una incidencia anual de 30 x habitantes. La incidencia familiar de aneurismas apoya la importancia de los factores hereditarios en la génesis de estos. También es de señalar la variabilidad de sus formas, unos son redondeados con una base ancha sin pedículos, otros se conectan con la arteria original a través de un largo pedículo mientras que otros son sólo dilataciones infundibuli- formes. Tumores cerebrales. Discrasias sanguíneas. Infecciones: fiebre tifoidea, escarlatina. Intoxicaciones: monóxido de carbono. Hipertensión arterial. Disección arterial intracraneal. Tóxicos cocaína, arsénico, anfetaminas. Veneno de serpiente. La hemorragia subaracnoidea se produce por la ruptura de la pared de un vaso cuyas paredes son anormales. En ocasiones la ruptura masiva ha estado precedida por varios episodios de fisuramientos pequeños con cefaleas o signos focales transitorios. Importancia tiene la llamada cefalea "centinela" en el diagnóstico precoz. Otras veces la salida de la sangre es consecuencia de la diapédesis a través de la red capilar en una pared alterada en el transcurso de una discrasia sanguínea, traumatismo o trastornos de la coagulación de la sangre. Existen factores que favorecen la aparición de una HSA como son: la hipertensión arterial, el estrés, el coito y los traumatismos entre otros. Como en la hemorragia intracerebral, el cuadro clínico de la hemorragia subaracnoidea suele ser muy variable, lo que como ya apuntamos con anterioridad depende de distintos factores como son: la causa, el volumen y la localización del sangramiento. Otros factores no menos importantes son las cifras tensionales en el momento del sangrado, el estado de salud del individuo y la aparición de complicaciones inmediatas. En ocasiones el paciente se queja de cefalea intensísima, que se acompaña de vómitos y cae al suelo con pérdida del conocimiento. Si la hemorragia es masiva el paciente puede fallecer antes de llegar al hospital. En los sangramientos de menor volumen el conocimiento se puede. Somnolencia, confusión, estupor y amnesia son frecuentes. El paciente se encuentra envarado. En el coma intenso no aparece en ocasiones. La regla inicial es que no existen signos de focalización neurológica. Si hay hemiplejía, afasia, hemiparesia u otro trastorno. Estos defectos iniciales pueden desaparecer horas. La localización del sitio del aneurisma roto desde el punto de vista clínico. La aparición de cefalea de extrema intensidad con preservación relativa de la conciencia, sin signos de focalización neurológica y signos meníngeos son indicativos de que ha ocurrido una hemorragia subaracnoidea. Transcurrido el período inicial, si el paciente se mantiene consciente. Algunos pacientes pueden presentar convulsiones o hipertermia. Otros han tenido episodios de cefalea con anterioridad y son etiquetados de migrañosos. La Federación Mundial de Neurocirugía posteriormente creó una clasificación en la cual une la escala de coma de Glasgow a la presencia o no de defecto motor. Esta escala fue. Fisher y colaboradores. ComplicacionesComplicacionesComplicacionesComplicacionesComplicaciones dedededede lalalalala hemorhemorhemorhemorhemorrararararagiagiagiagiagia subaracnoideasubaracnoideasubaracnoideasubaracnoideasubaracnoidea. No neurológicas. Se debe sospechar ante cualquier déficit neurológico focal que ocurre entre el tercero y decimoquinto día. Su ocurrencia después de este período es raro. Los hallazgos en las necropsias han demostrado la presencia de infarto isquémico en ausencias de oclusión o ateroesclerosis en el vaso que tiene el aneurisma. Este fenómeno recibe el nombre de efecto Cannon y podría ser el responsable del vasospasmo que se produce en las horas inmediatas a la ruptura vascular. Esta teoría se basa en el efecto vasoconstrictor que poseen ciertas sustancias que se liberan tras la salida y degradación de la sangre tras la ruptura vascular. Ocurre en la etapa tardía de la. Los vasos sometidos a espasmo crónico muestran necrosis de las células musculares de la media, infiltración de leucocitos, eritrocitos y mastocitos que pueden afectar hasta la región subendotelial. Existen factores que de una forma u otra contribuyen a la aparición del vasospasmo. Antes del advenimiento del Doppler transcraneal DTC la verificación del vasospasmo requería de la angiografía para verificar el diagnóstico. En la actualidad el DTC constituye una forma indirecta, pero segura de vigilar el calibre de los vasos por medio de la velocidad del flujo. La irrupción de gran cantidad de sangre hacia los ventrículos o hacia el espacio subaracnoideo a través de los agujeros de Magendie o Luschka es la causa. Se debe sospechar en todo paciente que muestra un estado confusional o deterioro de la conciencia. Esta es la principal causa de muerte en la fase aguda de la enfermedad, estando relacionada con un gran volumen del sangrado, hidrocefalia o edema cerebral. Debe ser realizada con urgencia. Otros datos que aporta, son la presencia de hemorragia o no en el interior de los ventrículos, existencia de hematoma intraparenquimatoso, otras posibles etiologías y la presencia de hidrocefalia Figs. Se observa TAC del mismo. El LCR es generalmente hipertenso con una presión que. En las hemorragias leves el recuento de hematíes es del orden de los cientos. La xantocromía persiste hasta alrededor del día Las proteínas se encuentran elevadas y en ocasiones puede existir hipoglucorraquia. Entre el 2do. Tomografía con contraste intravenoso, donde se observa la silueta de un. Tomografía con contraste intravenoso, donde se observa la silueta de un aneurisma de la arteria cerebral anterior derecha. La resonancia magnética RM y la angiorresonancia magnética tienen valor para identificar aneurismas mayores de 5 mm; pero su alta tasa de falsos negativos hacen a la angiografía cerebral el método idóneo para el diagnóstico causal. El DTC es de gran utilidad para identificar el vasospasmo en la fase aguda. La Habana. Otros estudios resultan de gran importancia, entre ellos se destacan:. El diagnóstico diferencial incluye las siguientes situaciones clínicas. Crisis de migraña. Síndrome neurológico infeccioso. Absceso cerebral. Crisis epiléptica. Arteritis cerebrales. Tumor cerebral. Encefalopatía hipertensiva. Mielopatía aguda. Psicosis aguda. Uso de drogas. Si bien no es posible evitar las 2 primeras causas de HSA, es decir los aneurismas intracraneales y malformaciones vasculares, por ser 2 afecciones de origen congénito, existen algunos aspectos que nos permiten sospechar en algunos pacientes estas 2 posibilidades y tomar una conducta que contribuya a evitar la consumación de una HSA. En otras causas menos frecuentes, como son las infecciones, el abuso de drogas y el tratamiento anticoagulante, sí es posible tomar medidas enérgicas para evitar la HSA. Tratamiento de la HSA consumada. Tratamiento de las complicaciones. Medidas Generales. Aporte adecuado de líquidos y electrólitos. Con control del balance hidromineral. Control adecuado de la tensión arterial. Evitar el descenso por debajo de mm de la presión sistólica y 90 mmHg para la presión diastólica. Usar ablandadores de las heces fecales para evitar la constipación y el esfuerzo físico. Tratamiento de la cefalea mediante medicación analgésica. Evitar el. Si hay agitación psicomotriz, usar haloperidol 1,5 mg i. Vigilancia estrecha de los signos neurológicos. Si hay coma o incontinencia urinaria, practicar sondaje vesical. La medida ideal para evitar el resangramiento consiste en operar oportunamente dentro de las primeras 36 horas a todo paciente de los grados I, II y III de la clasificación de la Federación Mundial de Neurología y a continuación incrementar el volumen intravascular, manteniendo las presiones arteriales algo por encima de lo normal. El uso de los bloqueadores de los canales del calcio se ha utilizado ampliamente para reducir el vasospasmo. El nimodipino es un bloqueador selectivo de los canales de calcio, del grupo de las dihidropiridinas, que reduce la entrada del calcio extracelular al interior de las células musculares lisas arteriales. La restitución de fluidos y de sodio de manera temprana con soluciones cristaloides después de la obliteración temprana del aneurisma mantiene. Se ha utilizado con resultados. En una etapa inicial se utilizan expansores sanguíneos y la hemodilución con el objetivo de incrementar el gasto cardíaco y por tanto la tensión arterial. El objetivo de la hipervolemia es lograr una presión venosa central entre 8 y 10 mmHg. Habitualmente esto se logra con la administración de cristaloides a una. La hemodilución hipervolémica es capaz de aumentar la perfusión cerebral. La triple terapia H es en la actualidad el tratamiento de elección para el vasospasmo. Un método que ha tenido resultados alentadores en el tratamiento del. Entre estos se encuentran los inhibidores de la endotelina como. El uso del mesilato de tirilazad un TTTTTratamientoratamientoratamientoratamientoratamiento dedededede lalalalala hidrocefalia. La hidrocefalia puede aparecer de forma aguda en las primeras 24 horas por obstrucción del sistema ventricular o bloqueo de las cisternas de la base si el volumen del sangrado es amplio. Otras veces la hidrocefalia ocurre entre el 2do y el 7mo. La TAC es fundamental para su diagnóstico. Si la hidrocefalia es comunicante, las punciones lumbares repetidas pueden resolverla. En nuestra experiencia no lo recomendamos a no ser que el inicio del cuadro haya sido con una convulsión. De preferencia utilizamos la dife-nilhidantoína de inicio a dosis de mg i. De manera general se consideran de utilidad las siguientes medidas:. No es posible en tan breve espacio y tampoco es el objetivo de esta obra abordar el tratamiento caausal de todas las posibles causas de HSA. El criterio que prevalece en la actualidad por mayoría consiste en operar en las primeras 36 a 48 horas, como ya señalamos, todos aquellos pacientes. Se ha probado que la intervención precoz, reduce la mortalidad, previene en el resangrado y el vasospasmo. Esta técnica es recomendable en las malformaciones arteriovenosas, cuando la arteria nutricia es accesible para el neurorradiólogo. Se han utilizado distintos tipos de agentes para lograr la oclusión del aneurisma, como materiales protombóticos o depósitos de coil. Algunos aneurismas se pueden ligar a nivel del cuello, excluyéndolos así de la circulación central, otros son removidos y en ocasiones se utilizan técnicas combinadas. Otros factores importantes son la envergadura del sangramiento, el nivel de conciencia, el sexo, la edad y las complicaciones. La afectación inicial de la conciencia y los signos de focalidad neurológica son indicios de mal pronóstico. Aquellos enfermos con historia de sangrados previos, cifras tensionales elevadas, convulsiones, leucocitosis, arritmias cardíacas, suelen tener una peor evolución. Si el paciente se encuentra consciente en el momento de la angiografía el pronóstico es favorable. Un signo de buen pronóstico es la localización de la sangre en las cisternas que rodean el mesencéfalo. El intervalo entre el ingreso y el inicio del tratamiento es un factor pronóstico importante. Evaluation of cerebrovascular spasm with transcranial. Principios de Neurología. Sexta ed. Endhothelin: an endothelium-derived vasoactive peptide and its possible role in the pathogenesis of cerebral vasospasm. Ital J Neurol Sci ; Stroke register: expierence from the eastern province of Saudi Arabia. Cerebrovasc Dis ; 8: Alvarez-Li FC. Epidemiología de la enfermedad cerebrovascular en Cuba. Rev Neurol ; 29 9 : Marcadores de riesgo. Proyecto Golobal de Cienfuegos. Estudio longitudinal. Estudio longitudinal The frequency causes and timing. J Neurol Neurosurgery Psychiatry ; 53; Clinical and pathologics description of stroke patients Orv Hetil ; Improvement or complete resolution was observed within each category of eye involvement, but lack of favorable response was also recorded in significant numbers. Improvement in proptosis occurred with the lowest frequency and magnitude. Analysis of the data by step-wise linear regression analysis enabled us a. The latter included male sex, never thyrotoxic, age greater than 60 years, and requirement for concomitant treatment for hyperthyroidism. No long-term adverse reactions attributable to the radiotherapy have been observed. We conclude that supervoltage orbital radiotherapy, combined with later eye muscle surgery if necessary, is an effective treatment strategy for progressive Graves ' ophthalmopathy. Radiotherapy in the management of Graves ' ophthalmopathy. To report the results of radiotherapy for patients with failure, adverse reactions or relative contraindications to the use of steroids or immunosuppressants, by using newly developed quantitative indexes. Fourteen female and six male patients with Graves ' ophthalmopathy were treated with radiotherapy between and Prior to radiotherapy, eight patients received treatment with prednisone, four received immunosuppressants and four received a combination of both. Four patients with contraindications to steroids were initially managed with radiotherapy. Most of the patients received a dose of Gy in 2 Gy fractions. We used the newly developed motility limitation index to assess extraocular motility. Treatment was well tolerated. There have been no late complications. All 12 patients with soft tissue signs such as edema, irritation, tearing and pain were improved. Proptosis did not improve or improved only slightly, 3 mm at best. However, proptosis in all but two has been stabilized and has not deteriorated in the follow-up period. Most of the patients have experienced an improvement of eye-muscle motility. Extraocular muscles that work for elevation were impaired more severely than the other muscles and this tended to remain. Of the 16 patients using steroids before or when radiotherapy was initiated, 15 were tapered off and only one patient required additional steroids, thus sparing the majority from steroid adverse reactions. Radiotherapy was effective in preventing exacerbations of active inflammatory ophthalmopathy in patients with Graves ' disease with minimal morbidity and thus eliminated the adverse reactions associated with protracted corticosteroid use. The newly developed motility limitation index was useful in detecting delicate changes in motility of individual extraocular muscles. Graves ' disease is an autoimmune disorder that may present with various clinical manifestations of hyperthyroidism. Patients with Graves ' disease have a greater number of thyroid nodules and a higher incidence of thyroid cancer compared with patients with normal thyroid activity. However, cases in which patients are diagnosed with recurrence of Graves ' disease shortly after partial thyroidectomy for thyroid cancer are very rare. Here we report a case of hyperthyroid Graves ' disease that occurred after partial thyroidectomy for papillary thyroid cancer. In this case, the patient developed hyperthyroidism 9 months after right hemithyroidectomy, and antithyroglobulin autoantibody and thyroid stimulating hormone receptor stimulating autoantibody were positive. Therefore, we diagnosed Graves ' disease on the basis of the laboratory test results and thyroid ultrasonography findings. The patient was treated with and maintained on antithyroid drugs. The mechanism of the recurrence of Graves ' disease in this patient is still unclear. The mechanism may have been the improper response of the immune system after partial thyroidectomy. To precisely determine the mechanisms in Graves ' disease after partial thyroidectomy, further studies based on a greater number of cases are needed. Predictive factors of thyroid cancer in patients with Graves ' disease. The best preoperative examination in Graves ' disease with thyroid cancer still remains uncertain. The objectives of the present study were to investigate the prevalence of thyroid cancer in Graves ' disease patients, and to identify the predictive factors and ultrasonographic features of thyroid cancer that may aid the preoperative diagnosis in Graves ' disease. This retrospective study included patients with Graves ' disease who underwent surgical treatment from to at our institution. The clinical features and ultrasonographic findings of thyroid nodules were recorded. The diagnosis of thyroid cancer was determined according to the pathological results. Thyroid cancer was discovered in 58 of the Among the 58 patients with thyroid cancer, papillary microcarcinomas were discovered in 50 patients, and multifocality and lymph node involvement were detected in the other 8 patients. Multivariate regression analysis showed younger age was the only significant factor predictive of metastatic thyroid cancer. Ultrasonographic findings of calcification and intranodular blood flow in thyroid nodules indicate that they are more likely to harbor thyroid cancers. Because the influencing factor of metastatic thyroid cancers in Graves ' disease is young age, every suspicious nodule in Graves ' disease patients should be evaluated and treated carefully, especially in younger patients because of the potential for metastasis. Full Text Available Graves ' disease is an autoimmune disorder that may present with various clinical manifestations of hyperthyroidism. Psychiatric manifestations of Graves ' hyperthyroidism: pathophysiology and treatment options. Graves ' disease is an autoimmune disorder that is the most common cause of hyperthyroidism. Other symptoms associated with the disease are goitre, ophthalmopathy, and psychiatric manifestations such as mood and anxiety disorders and, sometimes, cognitive dysfunction. Graves ' hyperthyroidism may result in these latter manifestations via the induction of hyperactivity of the adrenergic nervous system. Although the focus is on mental symptoms associated with Graves ' disease, it is not always clear from the literature whether patients had Graves ' disease: in some studies, the patients were thought to have Graves ' disease based on clinical findings such as diffuse goitre or ophthalmopathy or on measurements of thyroid antibodies in serum; however, in other studies, no distinction was made between Graves ' hyperthyroidism and hyperthyroidism from other causes. Antithyroid drugs combined with beta-adrenoceptor antagonists are the treatments of choice for hyperthyroidism, as well as for the psychiatric disorders and mental symptoms caused by hyperthyroidism. A substantial proportion of patients have an altered mental state even after successful treatment of hyperthyroidism, suggesting that mechanisms other than hyperthyroidism, including the Graves ' autoimmune process per se and ophthalmopathy, may also be involved. When psychiatric disorders remain after restoration of euthyroidism and after treatment with beta-adrenoceptor antagonists, specific treatment for the psychiatric symptoms, especially psychotropic drugs, may be needed. Agresividad escolar e ideas suicidas en escuelas secundarias. In the. Thyroid carcinoma in Graves ' disease: A meta-analysis. The incidence of thyroid carcinoma is increasing worldwide. Graves ' disease is the most common hyperthyroid disease. Studies have suggested an increased risk of thyroid malignancy in Graves ' disease: there has not yet been a meta-analysis to allow quantitative comparison. The purpose of this study was to determine the risk of thyroid carcinoma in Graves ' disease, and to gather information on the histological subtypes of carcinoma and the co-existence of thyroid nodules. Several databases and article reference lists were searched. Inclusion criteria included appropriate diagnostic criteria for thyroid conditions and a diagnoses of carcinoma based on histology. The event rate of thyroid carcinoma in Graves ' disease was 0. There was no data to allow comparison with patients without hyperthyroid diseases. There was no increase in the odds of developing carcinoma in Graves ' disease compared to toxic multinodular goitre and toxic uninodular goitre. Patients with Graves ' disease and co-existing thyroid nodules were almost 5 times more likely to be diagnosed with thyroid carcinoma than those without nodules. Thyroid malignancy in Graves ' disease requiring surgical treatment should be considered as likely as in other hyperthyroid diseases needing surgical treatment. Clinicians should consider screening selected patients with Graves ' disease for nodules whilst being aware of potentially over-diagnosing papillary micro-carcinoma. Published by Elsevier Ltd. Graves ' disease GD is associated with excess morbidity and mortality, but little is known about unnatural manners of death and the potential relation with Graves ' orbitopathy GO. This study investigated the risk of unnatural death in Graves ' patients with and without orbitopathy compared to matched control populations. Median follow-up time was 7. Utilizing the Danish Register of Causes of Death and the Danish National Patient Registry, 28, subjects with GD and with GO were identified and matched for age and sex with four subjects from the background population. Mortality by suicide was increased in Graves ' disease overall, most significantly in patients with GO, also after adjustment for pre-existing somatic and psychiatric disease. These findings indicate that GD and GO may have a significant role in the pathophysiological mechanisms of suicidal behavior. Beyond independent confirmation, reasons for this need to be explored in order to introduce preventive measures. Concomitant Graves ' disease and Hashimoto's thyroiditis, presenting as primary hypothyroidism. Circulating TSH receptor antibody activity was increased, while thyroid microsomal antibody was detectable in titres greater than one in one hundred thousand. Alternatively, primary hypothyroidism could have resulted from the effects of a circulating TSH receptor blocking antibody. Standardization of I therapy for Graves disease. Objective: To establish the normative and standard measures, to ensure medical safety and quality of care of the patients with Graves disease treated by I therapy. Methods: Formulating and strictly implementing the medical organizational and technical measures of I therapy for Graves disease and regular follow-up. Results: Receiving I treatment of patients, follow-up months, no adverse events, the cure rate of Conclusion: It is important guarantee for the medical quality and safety to standardize the I therapy of Graves disease. Graves ' disease with special reference to radiation therapy. Graves ' disease, although not malignant, nevertheless can lead to serious events such as permanent loss of vision if it remains untreated. This review article describes the clinical symptoms of the disease, includes a commentary on the Graves ' disease subgroup of thyroid-associated orbitipathy TAO , and defines clinical activity scoring systems which grade the severity of the disease in patients clinical activity, NOSPECS and LEMO scoring. An review of radiotherapy in the s is followed by a summary of the German national survey on radiotherapy for Graves ' disease. Radiation therapy technique is then described and discussed. Case histories are from the Alfred Krupp Hospital in Essen. Immunoreactive 'TSH' in urinary concentrates of Graves ' disease patients. Van Herle, A. A double antibody radioimmunoassay was used to analyse immunoreactive thyrotrophin in urinary concentrates from fourteen patients with hyperthyroidism due to Graves ' disease, in three subjects with primary hypothyroidism, and in six normal subjects. Immunoreactive thyrotrophin was detectable in eleven subjects with Graves ' disease, in one subject with primary hypothyroidism, and in four normal subjects. Persistent hyperthyroidism and de novo Graves ' ophthalmopathy after total thyroidectomy. We report a patient with Graves ' disease who remained persistently hyperthyroid after a total thyroidectomy and also developed de novo Graves ' ophthalmopathy 5 months after surgery. She was subsequently found to have a mature cystic teratoma containing struma ovarii after undergoing a total hysterectomy and salpingo-oophorectomy for an incidental ovarian lesion. It is important to investigate for other causes of primary hyperthyroidism when thyrotoxicosis persists after total thyroidectomy. TSH receptor antibody may persist after total thyroidectomy and may potentially contribute to the development of de novo Graves ' ophthalmopathy. Grave 's disease associated with immunoglobulin A nephropathy: A rare association. Immunoglobulin A Ig A nephropathy is the most common form of primary glomerulonephritis. The association of Ig A nephropathy with Grave 's disease has not been reported so far. We report a case of year-old female with Grave 's disease who presented with edema, facial puffiness, and decreased urine output. She was found to be hypertensive with renal failure and nephrotic range proteinuria. Renal biopsy revealed features of Ig A nephropathy. To our knowledge, this is the first case showing association of Grave 's disease with Ig A nephropathy. Intervención en un caso de encopresis secundaria en el contexto educativo. Los episodios de encopresis quedaron reducidos a cero al quinto m. Se inició tratamiento con colchicina y se evaluaron las posibles causas: tuberculosa, oncológica, secundaria a hipotiroidismo o por radiación. Por exclusión se llegó a la etiología radiante. Effect of abnormal thyroid function on the severity of Graves ' ophthalmopathy. Many clinicians have the impression that treatment of thyroid dysfunction ameliorates ophthalmopathy in Graves ' disease. The aim of our study was to relate thyroid function to the severity of Graves ' ophthalmopathy. We studied 90 patients with Graves ' ophthalmopathy and Graves ' hyperthyroidism in. Development of Graves ' disease following radiation therapy in Hodgkin's disease. Radiation-related thyroid dysfunction is a common occurrence in patients with Hodgkin's disease treated with mantle field radiation. Although chemical and clinical hypothyroidism are most commonly seen, Graves ' disease has also been described. We have examined the records of surgically staged patients who received mantle field irradiation between April and December to ascertain the frequency of manifestations of Graves ' disease. Within this group, seven patients developed hyperthyroidism accompanied by ophthalmic findings typical of those seen in Graves ' disease. The actuarial risk of developing Graves ' disease at 10 years following mantle irradiation for Hodgkin's disease was 3. This observed risk significantly exceeded that seen in the general population. Graves disease with ophthalmopathy following radiotherapy for Hodgkin's disease. The number of patients achieving long-term survival following neck irradiation for Hodgkin's disease and other malignancies is increasing. Paralleling this increase in survivors is the development of late complications of the therapy itself. Eleven patients have previously been reported who developed Graves ophthalmopathy 18 months to seven years after receiving neck radiotherapy for nonthyroidal malignancies. A patient who is HLA-B8 positive who developed Graves ophthalmopathy and hyperthyroidism nine years after receiving mantle radiotherapy for Hodgkin's disease is reported. It is recommended that Graves disease be included among the thyroid diseases that receive consideration during follow-up of patients who have received mantle radiotherapy. Subtotal thyroidectomy is a surgical procedure, in which the surgeon leaves a small thyroid remnant in situ to preserve thyroid function, thereby preventing lifelong thyroid hormone supplementation therapy. To evaluate thyroid function after subtotal thyroidectomy for Graves '. An assessment of psychiatric disturbances in graves disease in a An assessment of psychiatric disturbances in graves disease in a medical college in eastern India. The common symptoms were insomnia, irritability, and anxiety. SUMMARY The case of a 37 year old male is described who initially presented as paranoid schizophrenia unresponsive to anti-psychotic drug treatment and subsequently developed features of Grave 's disease. Treatment with carbimazole alone improved his psychiatric symptoms. Study progress on free radicals and graves disease. Free radical-mediated oxidative injury has been closely implicated in the occurrence and development of many diseases. Graves disease was also accompanied by changes of the free radicals, especially for reactive oxygen species and reactive nitrogen, et al, and the oxidative stress can cause a certain degree of injury on the thyroid and other human important organs. Antithyroid drug and I treatment of Graves disease, the oxidative and antioxidative parameters can also be changed. An evaluation of supervoltage orbital irradiation for Graves ' opthalmopathy. View Urbano-Mrquez, R. Estruch Riba, A. Alfaro Giner, J. Berciano Blanco, F. Bermejo Pareja, F. Cardellach Lpez,J. Casademont Pou, P. Fernndez Viladrich, J. Grau Junyent, F. Sensory and motor peripheral neuropathy in olivopontocerebellar atrophy. Acta Neurol Scand ; Motor evoked potentials by magnetic stimulation in hereditary and sporadic ataxia. Clinical, multimodality electrophysiological study of a family with progressive cerebellar ataxia and late deafness and an autosomal recessive inheritance. Acta Neurol ; Preferential generation of recurrent responses by groups of motor neuron in man. Conventional and single unit F waves studies. Brain ; Palabras clave. Ataxia espinocerebelosa. Onda F. Reflejo H. Palavras chave. Reflexo H. All the groups showed differences in the amplitude of sensory action potentials in median and sural nerves. Sural amplitude was negatively correlated with disease duration and ataxia score. Differences among patients and controls in the mean latency and conduction velocity of sensory action potentials were found. CAG repeat and electrophysiological markers assessed were not correlative. Electrophysiological alterations in the SCA2 appeared in presymptomatic stages. These alterations are consistent markers which could be used to evaluate the progression of the disease. Introduction The autosomal dominant cerebellar ataxias ADCA are a clinically, pathologically and genetically heterogeneous group of neurodegenerative disorders caused by degeneration of cerebellum and its afferent and efferent connections. Los Alamos Avenue No. In Cuba, there are almost patients and presymptomatic relatives at risk of developing some hereditary ataxia in the next few years. The most frequent molecular form is SCA2, with a prevalence of 43 cases per , inhabitants in Holguin province, reaching cases per , inhabitants in Baguanos municipality [9]. SCA2 is characterized by progressive gait and limb ataxia, cerebellar dysarthria, dysmetria, dysdiadochokinesia, tremor and slowing of horizontal saccadic eye movements [10,11]. The gene is located on the long arm of chromosome 12 12q The unstable expansion of the polyglutamine domain within ataxin-2 is directly linked to the pathogenesis of SCA2 [13]. In general, electrophysiological features of SCA2 in clinical and preclinical stages have been studied in a small number of individuals. In the present study we carry out a more detailed electrophysiological characterization of 82 SCA2 affected subjects and 62 presymptomatic first-degree relatives. This study allowed us to evaluate the peripheral and central nervous system in SCA2. To this end, we performed motor and sensory nerve conduction studies, somatosensory evoked potential, visual evoked potential and brainstem auditory evoked potential. Patients and methods 2. Patients Eighty-two SCA2 patients 52 males and 30 females with ages ranging from 15 to 80 years mean, Sixty-two 22 males and 40 females presymptomatic firstdegree relatives of SCA2 patients, with ages ranging from 16 to 61 years old mean, A group of 80 healthy nonpaid volunteers from Holguin province 58 male and 22 female subjects with ages ranging from 11 to 81 years mean, After a description of the present study to each patient, written informed consent was obtained. Molecular analysis DNA was extracted according to standard phenolchloroform protocols [15]. Motor nerve conduction studies were recorded by percutaneous supramaximal nerve stimulation at unilateral median and peroneal nerves. Sensory nerve action potentials SNAPs were recorded by using surface ring electrodes around third digit and surface electrodes on the lateral to the midline in the lower third of posterior aspect of the leg at unilateral median and sural nerves. Nerve conduction velocities below and latencies above 2. Posterior tibial nerve somatosensory evoked potentials Tn-SSEPs were performed by mean of electrical stimuli through electrodes placed on the skin overlying the nerve at the posterior zone of the median malleolus. The intensity of the stimuli was the minimal required to produce a light plantar flexion movement of the toes. The subject under study was observed throughout the entire time of the test, adjusting the stimulus intensity as needed to maintain a constant to the stimulated frequency. Tn-SSEPs were recorded from two derivations: Cz against Fz and over the low back on the skin overlying the spinous processes of the vertebra L1 vs. Ic The electrodes impedance was always below 5 KO. Band pass filter was 20 to Hz, and a gain of , The analysis time used was ms and trials were averaged, 2 to 3 repetitions were obtained in order to show the reproducibility of the recorded components. The central conduction time CCT was calculated by subtracting the latency to N22 onset from P40 onset. Abnormal latencies were considered 2. Visual evoked potentials VEPs were recorded from Oz electrode against a reference electrode placed on Fz. The stimulus employed for the VEPs measurement was the reversal of a checkerboard pattern composed of light and dark squares projected on displayed on a TV monitor and stimulation was performed on each eye with the subject sitting 1. Following darkening of the room, stimuli L. Statistical analysis was performed using the multivariate ANOVA between patients, presymptomatic subjects, and controls. Correlation of electrophysiological parameters, ataxia score and disease duration in SCA2 patients and polyglutamine expansion size in patients and presymptomatics was performed by a simple linear regression analysis. Results 3. Clinical study Fig. Dependence of age at onset on polyglutamine expansion size in 82 SCA2 studied patients. The stimulation frequency was 1 Hz. The frequency bandpass was 1 to Hz. The latency to the major positive component was measured. Brain Stem Auditory Evoked Potentials BSAEPs were recorded from an active electrode on the stimulated ipsilateral mastoid and a reference electrode on the vertex Cz , with the contralateral mastoid grounded. The stimuli were presented monaurally through a cushioned telephonic TDH earphone. The stimuli were presented at a frequency of 17 Hz at an intensity of 95 Db. The EEG signals were amplified by a factor of , with a bandpass filter from 20 to Hz. The stimulus frequency was 17 Hz and trials were averaged and two to three replicas of the BSAEPs were obtained in every subject for each ear in order to show the reproducibility of the components measured. To eliminate the influence of age on nerve conduction studies, a single sex- and age-matched control individual was selected for each SCA2 mutation carrier, and matched groups were compared thereafter. Statistical analysis The data from this study were entered into a data file using the computer software program Statistic for Windows Release 6. Scatter plots were obtained to evaluate the data and to confirm the presence of a normal distribution before the application of parametric statistics. Mean values All examined patients showed a cerebellar syndrome characterized by gait ataxic, cerebellar dysarthria, dysmethria and dysdiadochokinesia. In 78 of these, gait ataxia was the first symptom of the disease. Many patients exhibited abnormal tandem stance, slow saccadic eye movements, limited voluntary ocular movements, facial atrophy, loss of vibration sense, areflexia or hyporeflexia of DTRs, abnormal swallowing and unstable stance with feet together. Gait ataxia with cerebellar dysarthria was present in 8 patients. No retinal degeneration, optic atrophy, nor spasticity and dementia were observed. Simple regression analyses were conducted within the SCA2 patients and best fits were obtained using a log y transformation. Motor and sensitive nerve conduction studies Mean motor Median and Peroneal nerve conduction velocities, latency and amplitude were in the normal range in all groups p N 0. Two patients with SCA2 had pathological values of motor amplitude 2. The differences between presymptomatic and controls were not statistically significant. Mean amplitudes of sensory nerve action potential were significantly different p b 0. There were no differences among presymptomatic and control groups see Table 1. Sural amplitude was negatively correlated with disease duration and ataxia score see Table 2. Somatosensory evoked potentials of the posterior tibial nerve The mean latency of P40 wave in Tn-SSEPs was significantly prolonged p b 0. In 50 However, the intergroup differences of mean latency of the P40 wave between presymptomatics mean, There was not a significant difference of mean lumbar latency between SCA2 patients mean, In the presymptomatic relatives the CCT was normal mean, No significant differences were detected between all groups. Abnormal P waves, with a latency b ms was obtained in one SCA2 patient 1. Brainstem auditory evoked potentials Brainstem auditory evoked potential studies were abnormal in 78 SCA2 patients No significant correlation was found with polyglutamine expansion size see Table 2. Discussion Our findings are in accordance with previous reports on SCA2 [16]. The clinical presentation of SCA2 usually begins with gait ataxia, accompanied by cerebellar dysarthria, dysmethria and dysdiadochokinesia. The clinical picture of anatomically proven SCA2 is essentially a progressive cerebellar syndrome. Most SCA subtypes show involvement of the peripheral nervous system [17—19]. In , Abele et al. Although these authors found no abnormality of conduction velocity, Van de Warrenburg et al. In our work, we found that the reduction of amplitude of the sensory potential is the main abnormality of the peripheral nervous system in the Cuban SCA2 patients. This finding reflects a peripheral lesion of the nerves, mainly at the axonal level, but with signs of demyelination, that are interpreted as a secondary axonal disorder. The reduction of the amplitude of the sensory potential was more marked in patients with the longer duration of the disease, indicating a progressive increase in the number of affected fibers with time. Our electrophysiological results agree with the histological data from studies of posterior and root ganglia. The neuropathological study of 13 cases with SCA2, described atrophy of the posterior ganglia, reduction in the number of ganglion cells in the dorsal root ganglia and demyelination in the posterior root [10]. The loss of ganglion cell in the dorsal root ganglia is consistent with reduced amplitude of the sensory potentials previously found in the nerve conduction studies [19]; however, a gradual pattern of alteration was not found. Like SCA2 patients, their presymptomatic first-degree relatives show a reduction of the sensory potential amplitude along the distal segment of the median and sural nerves. This alteration suggests that the impairment of the neurons of the dorsal root ganglia seems to occur before the cerebellar syndrome appears. Other electrophysiological evidences that neuropathy may precede symptoms in SCA2 have been reported [22,23]. These alterations appear to be related to the duration of the disease but not with the expansion polyglutamine size. Our motor nerve conduction data reflect that SCA2 is not characterized by a significant abnormality of motor responses of the peripheral nervous system. Nevertheless we have observed that the major abnormalities appear in patients with duration of the illness beyond 10 years Velazquez et al. Tn-SSEPs abnormalities, consisting of a marked delay of the P40 component and CCT latency, absence of responses and abnormal morphology, were present in a large number of our SCA2 patients, confirming the results of Perreti et al. This finding is supported by neuropathological studies in SCA2 showing degeneration and demyelination of the posterior columns in the spinal cord and reduction of ganglion cells number in dorsal root ganglia [10]. Other anatomopathological evidences of Tn-SSEPs abnormalities at central level are the severe neuronal loss in the cuneate, gracile and spinal trigeminal nuclei as well as in the ventral posterior medial, ventral posterior lateral and the destruction of the reticular nucleus in the thalamus [25—27]. Our Tn-SSEPs findings in presymptomatic relatives constitute the first report of Tn-SSEPs abnormalities in the preclinical stage of the disease, indicating a mild affectation of the somatosensory pathway before the onset of the cerebellar syndrome. The abnormal morphology and replicability of SSEPs components arising in the central pathways may be related to the low voltage and temporal dispersion of peripheral nerve input in this disorder. In Sridharan and his colleagues [32] reported VEP abnormalities in only one out the five patients with a dominant form of spinocerebellar degeneration that phenotypically resembled SCA2. Abele et al. Recently, Rakowicz et al. Taking this account, the authors reported that the decrease of this variable is the unique electrophysiological parameter to differentiate between both group of patients. In general, reports on BSAEPs abnormalities in SCA2 and other spinocerebellar ataxia patients are contradictory due to the genetic heterogeneity of the studied samples, the different criteria used for classification of the ataxia and because generally the duration of the disease has not been taken into consideration [20,23,30,33—35]. Specifically, in SCA2 patients, Perreti et al. Also, they found an association between BSAEPs abnormalities and clinical deterioration of the patients. Nevertheless Wadia et al. These findings are in agreement with previous neuropathological observations in cranial nerves and nuclei involved in the auditory pathway [36]. In a patient with an age of onset age of 44 years and a duration of illness of 5 years, there was no response which suggests a possible peripheral lesion. Other abnormalities are non-specific and suggest an increased temporal dispersion in the conduction from the intraxial tracts of the brainstem. Serial evoked potential studies may also aid in further defining the evolution the of neurophysiological involvement of the sensory system and may also be of help in evaluating the effects of various therapies in this disorder. In conclusion, our results suggest that the SCA2 is a neurodegenerative disease that affects not only the cerebellum and its fiber connections, but also the peripheral nervous system and extracerebellar central pathways. The electrophysiological alterations in the SCA2 are characterized by the decrease of the amplitude of the sensory potentials, SSEPs and BSAEPs with alterations in the morphology and the replicability, as well as the increase of the latency of the P40 component. Interestingly, some of these abnormalities appeared during the presymptomatic stage. Our electrophysiological results indicate that the structures of the nervous system that are primarily affected were the peripheral sensory nerves and the dorsal roots of the spinal cord, followed by the somestesic pathway at the intraxial level, and the auditory pathway at the brainstem level. The visual pathway was not affected. The nature of the initial lesion is of the axonal type according to the results of the axonomyelinic and peripheral sensory nerve conduction at a the level of the intramedular sensory pathway or more diffusively along the brainstem according to the SSEPs of the posterior tibial nerves. Sensitive amplitudes and latencies of III and V waves of BSAEPs were strongly influenced by the duration of the illness, identifying these variables as objective and quantitative physiological parameters. These findings may be used as highly sensitive and specific clinical biomarkers for future clinical trials of therapeutic agents. Acknowledgment We are grateful to the patients, SCA2 mutation carriers and the control individuals for their cooperation. We are indebted to Patrick Macleod for the critical review and style corrections. The Cuban Ministry of Health supported the study. References [1] Harding AE. Clinical features and classification of inherited ataxias. Inherited ataxias, vol New York: Raven; Expansion of an unstable trinucleotide CAG repeats in spinocerebellar ataxia type 1. Nat Genet ;—6. Nat Genet ;— CAG expansion in a novel gene for Machado-Joseph disease at chromosome 14q Nat Genet ;—7. Hum Mol Genet ;10 14 —8. Hum Mol Genet ;— Epidemiology of Cuban Hereditary ataxia. Rev Neurol ;—11 [in Spanish with English abstract]. J Neurol Sci ; 37— Am J Hum Genet ;— Expansion of the polyQ repeat in ataxin-2 alters its Golgi localization, disrupts the Golgi complex and causes cell death. Hum Mol Genet ;12 13 — Glutamine repeats and neurodegeneration. Annu Rev Neurosci ;— International cooperative ataxia rating scale for pharmacological assessment of the cerebellar syndrome. The Ataxia Neuropharmacology Committee. J Neurol Sci ;— A rapid procedure for extracting genomic DNA from leukocytes. Nucleic Acids Res ; Neurology ; — Electromyography and nerve conduction study in autosomal dominant olivopontocerebellar atrophy. J Neurol ;—7. Large fiber sensory neuronopathy in autosomal dominant spinocerebellar degeneration. Arch Neurol ;—8. Neurophysiologic study of olivo-ponto-cerebellar atrophy with or without glutamate dehydrogenase deficiency. El defecto de cobertura que motivó la cirugía de hasta de 20 x 6 cm fue secundario a fractura expuesta tipo III de Gustilo y a osteomielitis crónica. La cobertura del colgajo se hizo en todos los casos con injerto dermo-epidérmico. No hubo complicaciones menores ni mayores del sitio donante ni del receptor, con resultados funcionales y estéticos satisfactorios. Tras el seguimiento, todos nuestros pacientes lograron una cobertura completa y estable en el tiempo. Full Text Available Se describe una nueva especie de Hemibrycon para la cuenca alta del río Atrato,al noroccidente de Colombia. Background: Relationships within families are interdependent and related to distal environmental factors. Low socioeconomic status SES and high household chaos distal factors have been linked to less positive marital and parent-child relationships, but have not yet been examined with regard to young children's sibling relationships. Distal clavicular osteolysis: MR evidence for subchondral fracture. Kassarjian, Ara; Palmer, William E. To investigate the association between distal clavicular osteolysis and subchondral fractures of the distal clavicle at MRI. This study was approved by the hospital human research committee, which waived the need for informed consent. Three radiologists retrospectively analyzed 36 shoulder MR examinations in 36 patients with imaging findings of distal clavicular osteolysis. The presence of a subchondral fracture of the distal clavicle, abnormalities of the acromioclavicular joint, rotator cuff tears and labral tears were assessed by MRI. These cases were then compared with 36 age-matched controls. These subchondral fractures may be responsible for the propensity of findings occurring on the clavicular side of the acromioclavicular joint. Intra-articular osteotomy for distal humerus malunion. Intra-articular osteotomy is considered in the rare case of malunion after a fracture of the distal humerus to restore humeral alignment and gain a functional arc of elbow motion. Traumatic and iatrogenic disruption of the limited blood flow to the distal end of the humerus resulting in avascular. Clinical relevance of distal biceps insertional and footprint anatomy. Purpose: The aim of this review was to present an overview, based on a literature search, of surgical anatomy for distal biceps tendon repairs, based on the current literature. Distal tibiofibular synostosis in a Nigerian: A case report Owoeye X-ray of the bones showed an oblique fracture in the distal end of the shaft of fibula which is suggestive of post traumatic tibiofibular synostosis TFS. Knowledge of distal TFS is important in resolving the puzzle of chronic shin pain of unknown origin and in accurate diagnosis of causes of ankle deformity and malformations. Radiographic study of distal radial physeal closure in thoroughbred horses. Monthly radiography was performed to study distal radial physeal closure in ten male and ten female Throughbred horses. Older patients especially women sustain fractures due to osteoporosis. Supracondylar fractures of femur have a bimodal distribution. Before , most supracondylar fractures were treated nonoperatively; however, difficulties were often encountered including persistent angulatory deformity, knee joint incongruity, loss of knee motion and delayed mobilisation. The trend of open reduction and internal fixation has become evident in recent years with good results being obtained with AO blade plate, dynamic condylar screw, intramedullary supracondylar nail and locking compression plate. Elderly patients and osteoporosis pose difficulty in treating intra-articular fractures of the lower end of femur. Loss of stable fixation is of great concern in these cases. Hence, locking compression plate use has an advantage in these patients. The method used for fracture fixation was open reduction and internal fixation with distal femoral locking plate. The duration of follow up ranged from 3 months to 24 months. All the fractures in this series were posttraumatic. The median age was 47 years ranging from years. Rehabilitation for distal radial fractures in adults. Fracture of the distal radius is a common clinical problem, particularly in older people with osteoporosis. There is considerable variation in the management, including rehabilitation, of these fractures. This is an update of a Cochrane review first published in and last updated in To examine the effects of rehabilitation interventions in adults with conservatively or surgically treated distal radial fractures. We did not apply any language restrictions. The date of the last search was 12 January Randomised controlled trials RCTs or quasi-RCTs evaluating rehabilitation as part of the management of fractures of the distal radius sustained by adults. Rehabilitation interventions such as active and passive mobilisation exercises, and training for activities of daily living, could be used on their own or in combination, and be applied in various ways by various clinicians. The review authors independently screened and selected trials, and reviewed eligible trials. We contacted study authors for additional information. We did not pool data. We included 26 trials, involving mainly female and older patients. With few exceptions, these studies did not include people with serious fracture or treatment-related complications, or older people with comorbidities and poor overall function that would have precluded trial participation or required more intensive treatment. Only four of the 23 comparisons covered by these 26 trials were evaluated by more than one trial. Participants of 15 trials were initially treated conservatively, involving plaster cast immobilisation. Initial treatment was surgery external fixation or internal fixation for all participants. Guided by Ensel and Lin's life course stress process model, the authors examined whether distal stressors, including victimization and exposure to parent problems in childhood, contributed to men's depression above and beyond current or proximal stressors, such as substance abuse and health problems, and social resources. The sample consisted of homeless men who had entered a federally funded emergency shelter. Using the Burns Depression Checklist, the authors found that one out of three men met the threshold for moderate to severe depression during the past week. The logistic regression showed that past exposure to parent problems was related to depression after accounting for current stressors and social resources number of close adult relationships and whether their emotional support needs were met. Past victimization was not related to depression. To address men's depression, workers should concurrently provide services that meet men's basic needs for example, housing and address their relationship needs, including their need for emotional support. The analyses have been obtained for 28 meteorological stations, in general, for the period of to , characterizing a long-term period and with high quality data. The software used to process the data was the RClimdex 1. The analysis has identified that the temperature increased in Utah during the last century, evidencing the importance of the ongoing research on climate change in many parts of the world. O software utilizado no processamento dos dados foi o RClimdex 1. Procesamiento Digital de Imagenes del Cometa Halley. Se experimentó con la Transformada de Fourier en dos dimensiones, y con la aplicación de filtros de paso alto y bajo. Se encontró que el metodo de "autocorrelación" es el mejor para separar "la vegetación" de "la montaña". Se lograron ambos objetivos. Se pudieron detectar no menos de tres perturbaciones en "Y", y una en 5? Co de Cisne. Se puede separar la cola de gas de la de polvo. El "balance" del color puede ser hecho con la computadora. Fractura bipolar de clavícula. Se presenta un caso de fractura que afecta a ambos extremos de la clavícula. Fractura tipo II de Neer del fragmento distal y fractura del extremo esternal de la clavícula. El resultado a largo plazo ha sido satisfactorio cosmética y funcionalmente. A case of bipolar fracture affecting both ends of the clavicle is reported. The lesion consisted of a Neer type II fractur Peces del Noroeste del Ecuador. La ictiofauna del occidente del Ecuador es poco conocida. Los peces del noroccidente son diferentes a los del suroccidente del Ecuador. A comparison between robotic-assisted laparoscopic distal pancreatectomy versus laparoscopic distal pancreatectomy. This study aims to compare the early perioperative outcomes of robotic-assisted laparoscopic distal pancreatectomy RDP versus laparoscopic distal pancreatectomy LDP. The clinicopathologic features of 45 consecutive patients who underwent minimally-invasive distal pancreatectomy from to were retrospectively reviewed. Thirty-nine patients who met our study criteria were included. There were 10 Six There were 14 Comparison between RDP and LDP demonstrated no significant difference between the patients' baseline characteristics except there was increased frequency of spleen-preserving pancreatectomies 3 Comparison between outcomes demonstrated that RDP was associated with a longer median operation time It is also associated with a decreased frequency of the need for hand-assistance laparoscopic surgery or open conversion but needed a longer operation time. Unilateral maxillary molar distalization with zygoma-gear appliance. The aim of this study was to present the orthodontic treatment of a year-old boy with a unilateral maxillary molar distalization system, called the zygoma-gear appliance. A distalizing force of g was used during the distalization period. The unilateral Class II malocclusion was corrected in 5 months with the zygoma-gear appliance. The maxillary premolars moved distally with the help of the transseptal fibers. In addition, there were slight decreases in overjet Preadjusted fixed appliances 0. After 14 months of unilateral distalization with the zygoma-gear appliance and fixed appliances, Class I molar and canine relationships were established with satisfactory interdigitation of the posterior teeth. Acceptable overjet and overbite were also achieved. This article shows that this new system, the zygoma-gear appliance, can be used for unilateral maxillary molar distalization without anchorage loss. Published by Mosby, Inc. The generalized extreme-value GEV distribution has facilitated many applications in hydrology, used to model a wide variety of natural extreme events. Previous studies show that small-sample maximum-likelihood estimators parameters are unstable and demonstrates that absurd values of the GEV shape parameter can be generated. It is recommended that LH moments estimators, based on linear combinations of higher-order statistics, should be introduced for characterizing the upper part of distributions and larger events in data. However, there have been no computer packages for PC that model extreme events by LH moments. The objective of this paper was to present the modeling of hydrological extreme. Potassium transport across guinea pig distal colon. Active absorption and secretion of K was studied by measuring bidirectional 42 K fluxes across short-circuited guinea pig distal colon. Bumetanide 0. Net K transport is determined by the balance between electroneutral K absorption and electrogenic K secretion. Histology of the distal dural ring. The distal dural ring DDR is a conserved intracranial anatomic structure marking the boundary point at which the internal carotid artery ICA exits the cavernous sinus CS and enters the subarachnoid space. Although the CS has been well described in a range of anatomic studies, to our knowledge no prior study has analyzed the histologic relationship between the ICA and DDR. Correspondingly, our objective was to assess the relationship of the DDR to the ICA and determine whether the DDR can be dissected from the ICA and thus divided, or can only be circumferentially trimmed around the artery. The authors examined ten fresh-frozen, adult cadaveric specimens. A standard frontotemporal craniotomy, orbito-optic osteotomy, and extradural anterior clinoidectomy was performed bilaterally. Specimens formalin-fixed and paraffin-embedded prior to routine histochemical staining with hematoxylin and eosin and Masson trichrome. Dural collagen fibers extensively permeated the arterial layers superficial to the muscularis propria, with no evidence of a clear separation between the DDR and arterial adventitia. Histologic analysis suggests that the ICA and DDR are highly interrelated, continuous structures, and therefore attempted intraoperative dissection between these structures may carry an elevated risk of injury to the ICA. We correspondingly recommend careful circumferential trimming of the DDR in lieu of direct dissection in cases requiring mobilization of the clinoidal ICA. Two-wave propagation in in vitro swine distal ulna. Ultrasonic transmitted waves were obtained in an in vitro swine distal ulna specimen, which mimics a human distal radius, that consists of interconnected cortical bone and cancellous bone. The transmitted waveforms appeared similar to the fast waves, slow waves, and overlapping fast and slow waves measured in the specimen after removing the surface cortical bone only cancellous bone. In addition, the circumferential waves in the cortical bone and water did not affect the fast and slow waves. This suggests that the fast-and-slow-wave phenomenon can be observed in an in vivo human distal radius. Full Text Available Intra-articular osteotomy is considered in the rare case of malunion after a fracture of the distal humerus to restore humeral alignment and gain a functional arc of elbow motion. Traumatic and iatrogenic disruption of the limited blood flow to the distal end of the humerus resulting in avascular necrosis of capitellum or trochlea is a major pitfall of the this technically challenging procedure. Two cases are presented which illustrate the potential problems of intra-articular osteotomy for malunion of the distal humerus. Combined open proximal and stent-graft distal repair for distal arch aneurysms: an alternative to total debranching. We present herein a novel, combined, simultaneous open proximal and stent-graft distal repair for complex distal aortic arch aneurysms involving the descending aorta. In the first surgical step, the transverse arch is opened during selective antegrade cerebral perfusion, and a Dacron graft DuPont, Wilmington, DE is positioned down the descending aorta in an elephant trunk-like fashion with its proximal free margin sutured circumferentially to the aorta just distal to the left subclavian or left common carotid artery. With the graft serving as the new proximal landing zone, subsequent endovascular repair is performed antegrade during rewarming through the ascending aorta. The leading cause was RTA, followed by falls from a height. Distal femoral fractures cause considerable morbidity General Anaesthesia GA. Subtrochanteric and Distal Femur Fractures in a Patient with This study reports the surgical management for this rare case and the treatment En las cefaleas extracraneales hay que valorar la existencia de trastornos de la visin o molestias oculares, enfermedad tica o dolores y crujidos de las vrtebras cervicales cefalalgias de origen ocular, otorrinolaringolgico o cervical. Tambin debe preguntarse acerca de la ingesta de frmacos vasoactivos, exposiciones a gas ciudad o monxido de carbono, procesos infecciosos, hipertensin arterial o trastornos pulmonares capaces de explicar un cuadro de cefalea. Finalmente, debe realizarse una valoracin psquica del paciente en busca de datos de depresin para detectar una cefalea psicgena. AnamnesisLa historia clnica de los pacientes neurolgicos no es una tarea fcil y, con frecuencia, la realizacin de una anamnesis neurolgica correcta presenta muchas ms dificultades que la prctica de una adecuada exploracin fsica. En ocasiones no es posible llevar a cabo la historia clnica con el propio paciente, bien por su estado mental demenciacin, trastorno de conciencia , bien por la naturaleza de la enfermedad que padece epilepsia, sncope. En estos casos, la anamnesis debe realizarse con la colaboracin de los familiares, amigos o personas con las que conviva el enfermo, con las limitaciones y posibilidades de error que entraa. Otras veces los pacientes refieren sintomatologa vaga y de difcil catalogacin mareos, dolores mal precisados , que oscurecen la verdadera naturaleza del problema que aqueja. El clnico deber recoger el relato espontneo del enfermo y, despus, sin sugestionarlo, dirigir un interrogatorio adecuado que le permita precisar el sntoma gua que indique el camino a seguir para llegar al diagnstico. Una vez recogida la historia clnica, es muy importante realizar una historia familiar detallada. Siempre hay que preguntar por la existencia de familiares con migraa, epilepsia, neuropata perifrica, miopata, demencia, ataxia o trastornos cerebelosos y, en caso de sospecha de enfermedad hereditaria, realizar un rbol genealgico completo. Seguidamente hay que indagar los antecedentes personales, fisiolgicos y patolgicos del paciente..

In Germany radioiodine therapy of Grave 's disease is performed in patients older than 20 years, after at least one year of unsuccessful antithyroid therapy, intolerance against antithyroid medication, recurrences after surgical Viktor stalberg esposa disfunción sexual and small goiters. Radioiodine therapy in Germany must be an inpatient single time approach due to quality assurance and radiation protection reasons. The mean hospitalization is only days with the patient being discharged at an annual dose of less than 1 mSv at 2 m distance dose rate at discharge [de.

Graves disease orbitopathy is a complex progressive inflammatory disease.

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Medical treatment remains in all cases the proposed treatment of choice. Surgical treatment by bone decompression can be considered as an emergency mainly in cases of optic neuropathy or ocular hypertension not being controlled medically or in post-traumatic exophthalmos stage.

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Emergency bone decompression eliminates compression or stretching of the optic nerve allowing visual recovery. The uncontrolled ocular hypertension will benefit from decompression.

The normalization of intraocular pressure may be obtained by this surgery or if needed by the use of postoperative antiglaucoma drops or even filtration surgery. In all operated cases, the IOP was normalized with an average decrease of 7.

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Regarding sequelae, our therapeutic strategy involves consecutively surgery of the orbit, extraocular muscles and eyelids. The orbital expansion gives excellent results on the cosmetic level and facilitates the implementation of subsequent actions. Hypofractionated radiotherapy for Graves ' orbitopathy. Background: Radiotherapy RT has been proven effective in the management of Graves Viktor stalberg esposa disfunción sexual orbitopathy in numerous studies.

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Most commonly is the use of conventional fractionated RT and the value of hypofractionated irradiation has not been investigated. Materials Viktor stalberg esposa disfunción sexual methods: The results in 33 euthyroid cases who underwent RT with a Viktor stalberg esposa disfunción sexual dose of The duration of symptoms ranged from months and all of the cases had treatment failure after previous administration of corticosteroids.

After a mean follow-up period of Results: At follow-up, the overall response to RT was Conclusions: Hypofractionated RT has been click at this page effective for treatment of severe cases of Graves ' orbitopathy in cases with a prolongated duration of symptoms.

The comparison with literature data demonstrate that the results after hypofractionated RT are comparable to those obtained after conventional fractionated RT.

Resolution of Graves ' disease after renal transplantation. We report a case of an adolescent boy with Down's syndrome and ESRD on hemodialysis who developed mild Graves ' disease that was not amenable to radioablation, surgery, or ATDs.

After 14 months of observation without resolution of Graves ' disease, he successfully received a DDRT with a steroid minimization protocol. Thymoglobulin and Viktor stalberg esposa disfunción sexual three-day course of steroids were used for induction and he was started on tacrolimus, MMF, and pravastatin for maintenance transplant immunosuppression.

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One month after transplantation, all biochemical markers and antibody profiling for Graves ' disease had resolved and remain normal one yr later. Nodular Graves ' disease with medullary thyroid cancer. Co-existence of thyroid link with Graves ' disease has been reported in various studies. Medullary thyroid Viktor stalberg esposa disfunción sexual MTC in nodules associated with Graves ' disease is rare.

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On literature survey, we came across 11 such cases reported so far. We report a year-old female with Graves ' disease who also had a thyroid nodule that on fine-needle aspiration cytology and the subsequent postthyroidectomy histopathological examination was reported to be MTC.

Se presenta una aproximación a su definición y los desafíos que debe afrontar el adolescente de este nivel para su formación integral sobre la base de una convivencia armónica y feliz. Graves ' disease: thyroid function and immunologic activity. Patients with Graves ' disease were studied for two Viktor stalberg esposa disfunción sexual during and after a twelve-month Viktor stalberg esposa disfunción sexual of treatment. These in-vivo measurements of thyroid stimulation were compared with the results of in-vitro assays of Gravesimmunoglobulin TSH binding inhibitory activity - TBIA.

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There was no correlation between the thyroid uptake and TBIA on diagnosis. Pertechnetate link and TBIA both declined during the twelve months of antithyroid therapy.

TBIA was detectable in sera from 19 of the 27 patients at diagnosis; in 11 of these 19 patients there was a good correlation p Gravesimmunoglobulin and the thyroid uptake. Probability of recurrence can be assessed but sustained Viktor stalberg esposa disfunción sexual of Graves ' disease after treatment cannot be predicted from either measurement alone or in combination.

Postoperative hypocalcemia after thyroidectomy for Graves ' disease.

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It is believed that patients who undergo thyroidectomy for Graves ' disease are click likely to experience postoperative hypocalcemia than patients undergoing total thyroidectomy for other indications. However, no study has directly compared Viktor stalberg esposa disfunción sexual two groups of patients. The aim of this study was to determine whether there was an increased incidence or severity of postoperative hypocalcemia in patients who underwent thyroidectomy for Graves ' disease.

An institutional review board-approved database was created of all patients who underwent thyroidectomy from to at the Johns Hopkins Hospital.

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There were a total of 68 patients with Graves ' disease who underwent surgery. Fifty-five patients who underwent total thyroidectomy were randomly selected and served as Viktor stalberg esposa disfunción sexual subjects. An analysis was conducted that examined potential covariates for postoperative hypocalcemia, including age, gender, ethnicity, preoperative alkaline phosphatase level, size of goiter, whether parathyroid tissue or glands were present in the specimen, and the reason the patient underwent surgery.

Specific outcomes examined were calcium levels on postoperative day 1, whether or not patients experienced symptoms of hypocalcemia, whether or not Rocaltrol was required, the number of calcium tablets prescribed upon discharge, whether or not postoperative tetany occurred, and calcium see more 1 month after discharge.

Viktor stalberg esposa disfunción sexual

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Each outcome was analyzed using a logistic regression. There was a trend, though not significant, toward patients with Graves ' disease having a higher prevalence of hypocalcemia the day after thyroidectomy and 1 month later. Patients with Graves ' disease are more likely to require increased dosages of calcium as well as experience tetany postoperatively than patients undergoing total thyroidectomy for other indications.

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This suggests that. To evaluate the incidence of thyroid carcinoma in patients operated on for Graves ' disease, to identify criteria which may predict malignancy, and to develop a practical approach to determine the extensiveness of thyroidectomy. Hot dancing naked sex. Para quejas, use otra forma. Study lib.

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Cargar documento Crear fichas. Iniciar sesión. Añadir a la recogida s Añadir a salvo. Luis C. Julio C. A todos los trabajadores del CIRAH que, desde sus puestos de trabajo, facilitan el desarrollo de todo nuestro trabajo.

En: Acosta ML, editor.

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Rev Neurol. Neurosci Lett. J Neurol Sci.

médico, independientemente de la raza, credo, sexo, nacionalidad o las necesidades del paciente, la familia y el equipo terapéutico, que.

A twenty years neurophysiological follow up study. Neurol Sci.

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Saccade velocity is reduced in presymptomatic spinocerebellar ataxia type 2. Clin Neurophysiol. Saccadic latency is prolonged in Spinocerebellar Ataxia type 2 and correlates with the frontal-executive dysfunctions. Neurodegener Dis. Mov Disord. Motor decline in presymptomatic Spinocerebellar ataxia type 2 gene carriers.

J Neurol. Neurochem Res.

médico, independientemente de la raza, credo, sexo, nacionalidad o las necesidades del paciente, la familia y el equipo terapéutico, que.

Lisuride reduces involuntary periodic leg movements in Spinocerebellar Ataxia type 2 patients. In press.

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Hasta la fecha se han descrito alrededor de 30 formas moleculares. En Cuba se han diagnosticado alrededor de 2 enfermos entre vivos y fallecidos. Existen cerca de 10 descendientes en riesgo. Para los familiares con riesgo de enfermar la prevalencia fue de ,33 casos por habitantes. La mayor tasa de incidencia fue de 18,08 casos por habitantes en Cacocum, mientras que para la provincia esta fue de 4,39 casos.

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Clinical assessments were performed by neurological examinations and application of the SARA scale. In Viktor stalberg esposa disfunción sexual Holguin province, the average population prevalence of SCA2 is The stabilization of the prevalence along time suggests the existence of premutated chromosomes with pure CAG, acting as reservoir for further expansions.

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visit web page Repeat instability was greater in paternal transmissions whereas CAG expansions without anticipation was observed in All rights reserved. The spinocerebellar ataxias SCAs include several clinically, pathologically and genetically heterogeneous neurodegenerative disorders, characterized by the loss of balance and motor coordination due to dysfunction of the cerebellum and its afferent and efferent pathways [7].

SCAs are associated with at least 28 loci. Most of the few existing epidemiological studies of hereditary ataxias have been performed in isolated geographical regions in families not large enough for linkage analysis. The underlying mutation of SCA2 is an unstable expansion of a polyglutamine domain within ataxin The aims of the present study were: a to determine the prevalence of autosomal dominant SCAs SCA1—3, SCA6, SCA17, and DRPLAas Viktor stalberg esposa disfunción sexual as of recessive and sporadic ataxias and b to assess the correlation between the clinical features age of onset, clinical severity, anticipation and the length Viktor stalberg esposa disfunción sexual the expansion and the, intergenerational instability in SCA2 patients.

The study was conducted by the National Center for the Research and Rehabilitation of the Viktor stalberg esposa disfunción sexual Ataxias in the city of Holguin, which is the main referral center for these conditions in the country.

The latter group included patients with secondary ataxia due to alcoholism, neoplasias, autoimmune L. The Ethics Committee of the National Center for the Research and Rehabilitation of the Hereditary Ataxias approved the research protocol and all studied patients signed an informed consent form after being explained the purpose and methods of the research.

Of them, Viktor stalberg esposa disfunción sexual Out of the patients with SCAs, No mutations were detected in the remaining 80 The distribution of SCA2 patients and prevalence rates by province are shown in Table 1.

This value represents The prevalence rate of SCA2 in the Holguin province is Prevalence rate of hereditary ataxias in the province of Holguin, Cuba — All patients showed a cerebellar syndrome characterized by ataxic gait, cerebellar dysarthria, dysmethria and dysdiadochokinesia.

In of these Autonomic abnormalities urinary dysfunction, hypohidrosis, constipation, and sexual dysfunction were presented in The age at onset of SCA2 ranged from 3 to 79 years, with a mean of In order to assess the severity of the cerebellar ataxia and its progression from early to late stages, Viktor stalberg esposa disfunción sexual used the Scale for the Assessment and Rating of Ataxia SARA [22] in a subsample SCA2 patients with clinical and molecular diagnosis.

The SARA score ranged from 4 to 39, mean Unexpanded alleles ranged from 13 to 31 units. We performed a detailed study of intergenerational instability of the repeat in sibships.

Expansions occurred in Dark bars indicate maternal transmissions and white bars indicate paternal transmissions. The Viktor stalberg esposa disfunción sexual incidence and prevalence of SCA2 are unknown [12] and there are large regional variations due to founder effects [24].

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Two main lines of evidences reinforce the above: 1 SCA2 Cuban families have a wide documented story of Hispanic origin and 2 almost all families share the same chromosomal haplotype surrounding in close region of SCA2 mutation [9]. Despite Viktor stalberg esposa disfunción sexual dissemination of Cuban families through the island, the SCA2 prevalence in Holguin is different from other regions of the country.

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Cultural and environmental Viktor stalberg esposa disfunción sexual has long lasting effects on allelic diversity, restricting mutations to selected populations [28].

A similar explanatory mechanism has been proposed in SCA3 founders in Azoreans [15]. Viktor stalberg esposa disfunción sexual Holguin, the stable prevalence of SCA2 along time [30,14,31], despite the existence of genetic anticipation is likely the result of the high frequency of large normal alleles with Viktor stalberg esposa disfunción sexual CAG, which represent reservoirs of mutated alleles, driving to the continuous raising of new SCA2 cases.

Our Center has an ongoing click to perform haplotype studies in this population to test this hypothesis. The SARA rating scale is a reliable and valid assessment of ataxia, making it an appropriate test to evaluate its most important neurological manifestations, such as gait, stance and coordination of the upper and lower limbs, as well as to estimate the progression rate and its predictors [22].

We found a strong correlation between the SARA score and the CAG expansion size and disease duration, indicating that the main clinical manifestations of SCA2 and its progression are a direct consequence of the genetic mutation.

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Also SARA settled robustly the patients in the SCA2 clinical stages, supporting source use in clinical surveys to assess the progression of cerebellar syndrome. The strong correlation between CAG size and age of onset of symptoms in our patients is the highest ever reported in SCA2. However, since this correlation has also been Viktor stalberg esposa disfunción sexual in other studies in different founder populations [11] we cannot rule out that the common haplotype may be the driving force contributing to the correlation.

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The frequent intergenerational expansion of the CAG repeat, in contrast with the infrequency of its contraction, found in the Cuban patients studied, has been described in other populations [1,6]. The stabilization of the prevalence rate along time suggests the existence of premutated chromosomes with pure CAG, acting as a founder Viktor stalberg esposa disfunción sexual for new expansions.

The work of our Center has enabled a complete ascertaining of all families affected with SCAs in Cuba and the establishment of national guidelines to improve their clinical management Viktor stalberg esposa disfunción sexual to provide genetic counselling and presymptomatic testing.

médico, independientemente de la raza, credo, sexo, nacionalidad o las necesidades del paciente, la familia y el equipo terapéutico, que.

The Cuban experience in the molecular epidemiology, as well as in the management and prevention of these conditions, could be expanded in international collaborative studies to design new therapies and better palliative treatments. Acknowledgments We are indebted to the Cuban SCA families that participated Viktor stalberg esposa disfunción sexual this study, to the Cuban Ministry of Public Health, to the physicians, technicians and other specialists that collaborated in this research and to MD Victor B.

Penchaszadeh for language corrections.

Dokrars Xxx Watch Dave franco fotos de desnudos Video Hdx Xxvideo. Tam-cefalopata de Wernicke, miopata y el consumo de medica- bin debe preguntarse acerca de la ingesta de frmacosmentos fenotiazinas, butirofenonas, anovulatorios, isoniazi-vasoactivos, exposiciones a gas ciudad o monxido de car-da, vincristina por su relacin con gran nmero de procesos bono, procesos infecciosos, hipertensin arterial o trastornosneurolgicos parkinsonismos, discinesia tarda, trombosis,pulmonares capaces de explicar un cuadro de cefalea. Debe recogerse, tambin, la historia laboral, enmente, debe realizarse una valoracin psquica del pacientela que se indagar sobre posibles contactos con txicos in-en busca de datos de depresin para detectar una cefaleadustriales, como monxido de carbono, plomo y mercurio. Al valorar el ambiente social, debe preguntarse por la ali-mentacin del paciente para descartar cuadros de desnutri-cin o dficit vitamnicos, y al consultar sobre el hbito se- Prdida aguda de concienciaxual, se indagarn los posibles contactos con personas conOtro motivo comn de consulta en neurologa es la prdi-riesgo de padecer les prostitutas o SIDA homosexuales, da transitoria de la conciencia, de inicio y recuperacin rpi-toxicmanos, hemoflicos e individuos con gran promiscui-dos. En la tabla Las causas ms frecuentes son los traumatismos craneoence- Al preguntar sobre los antecedentes patolgicos de los en-flicos, por lo que siempre deben investigarse en primer lu-fermos neurolgicos es muy importante delimitar con exac-gar. Las otras causas principales son las afecciones cardio 3. Etiologa ms comn de los trastornos convulsivosde conciencia Epilepsia idioptica Traumatismos craneoenceflicos AlcoholismoEnfermedad cerebrovascular Cardiopatas Procesos expansivos intracraneales Bloqueos cardacos sndrome de Stokes-Adams, sndrome Convulsiones febriles del seno carotdeo Traumatismos Arritmias cardacas taquicardia ventricular, fibrilacinInfecciones ventricular, etc. Meningitis Cardiopatas con reduccin del volumen sistlico estenosis Encefalitis artica, miocardiopata hipertrfica, mixoma auricular, Abscesos infarto agudo de miocardio, etc. Causas circulatorias perifricas Crisis vasovagales Ataques de tos o broncospasmo prolongado Sncope posmiccional Hipersensibilidad del seno carotdeo Ortostatismo y disautonomas Causas generales y metablicas Accidentes vasculares cerebrales transitorios Hipoglucemia Epilepsia Hemorragias masivas Hiperventilacin respiratoria forzada Enfermedad de Addison Feocromocitoma Sndrome carcinoide Causas psquicas Histeria. Etiologa ms comn de los trastornos convulsivosEpilepsia idioptica Alcoholismo Enfermedad cerebrovascular Procesos expansivos intracraneales Convulsiones febriles Traumatismos Infecciones Meningitis Encefalitis Abscesos Trastornos metablicos Hipoglucemia Cuadros hiperosmolares Hipercalcemia o hipocalcemia Coma heptico Insuficiencia renal Porfiria Enfermedades degenerativas cerebrales Encefalopata hipertensiva Intoxicaciones medicamentosas Atropina Isoniazida Anfetamina Sndromes de abstinencia Alcohol Barbitricos Diazepxidos. La etiologa cardiovascular sncope es apoyada por una instauracin brusca del cuadro con cada al suelo o la existencia de palidez u otra sintomatologa vegetativa, antecedentes de cardiopatas previas y manifestaciones de insuficiencia cardaca o embolia pulmonar. Las crisis epilpticas suelen presentarse como prdidas bruscas del conocimiento, precedidas de aura, acompaadas de convulsiones tonicoclnicas, liberacin de esfnteres y mordedura de lengua. Para lograr esta diferenciacin debe preguntarse sobre la existencia de aura sintomatologa visual, auditiva o psquica y sobre la fase poscrtica rapidez de recuperacin de la conciencia, estado de obnubilacin poscrtico, etc. Tambin hay que indagar acerca de la relacin entre las crisis y la bipedestacin, especialmente en pacientes con estancias prolongadas en cama, varicosidades o polineuropatas, y sobre la administracin de tratamientos con frmacos antihipertensivos, fenotiazinas, antidepresivos o litio. Otra causa frecuente de prdida aguda de conciencia en personas ancianas son las isquemias agudas del territorio vertebrobasilar, por lo que debe descartarse la existencia de sntomas de vasculopata perifrica y de espondiloartrosis cervical. Una ltima causa de prdida aguda de conciencia es la histeria. En general, estos pacientes suelen presentar las prdidas de conocimiento en situaciones de gran componente emocional, siempre ante otras personas y nunca se lastiman al caer. Pearlman, S. Starkman, G. Orozco-Diaz, A. Lunkes, P. DeJong, G. Rouleau, G. Auburger, J. Korenberg, C. Figueroa, S. Sahba, Moderate expansion of a normally biallelic trinucleotide repeat in spinocerebellar ataxia type 2, Nat. Starkman, Anticipation in spinocerebellar ataxia type 2, Nat. Pulst, N. Santos, D. Wang, H. Yang, D. Huynh, L. Velazquez, K. Sanpei, H. Takano, S. Igarashi, T. Sato, M. Oyake, H. Sasaki, A. Wakisaka, K. Tashiro, Y. Ishida, T. Ikeuchi, R. Koide, M. Saito, A. Sato, T. Tanaka, S. Hanyu, Y. Takiyama, M. Nishizawa, N. Shimizu, Y. Nomura, M. Segawa, K. Iwabuchi, I. Eguchi, H. Tanaka, H. Takahashi, S. Santos, J. Aguiar, J. Auburger, S. Gispert, Y. Mendoza, J. Garcia, L. Schmitz-Hubsch, S. Tezenas du Montcel, L. Baliko, J. Berciano, S. Boesch, C. Depondt, P. Giunti, C. Globas, J. Infante, J. Kang, B. Kremer, C. Mariotti, B. Melegh, M. Pandolfo, M. Rakowicz, P. Ribai, R. Rola, L. Szymanski, B. Fancellu, Scale for the assessment and rating of ataxia: development of a new clinical scale, Neurology 66 — Genotype and Phenotype in German kindreds, Arch. Bauer, T. Schmidt, T. Schulte, O. Riess, Autosomal dominant cerebellar ataxias: clinical features, genetics, and pathogenesis, Lancet 3 — Simon, K. Zheng, L. Velazquez, N. Santos, L. Almaguer, S. Sinha, P. Worth, D. Jha, S. Sinha, V. Stinton, M. Davis, N. Wood, M. Sweeney, K. Psychiatry 75 — Storey, D. Shaw, Frequency of spinocerebellar ataxia types 1, 2, 3, 6 and 7 in Australian patients with spinocerebellar ataxia, Am. Sun, C. Greenwood, I. Thiffault, N. Hamel, G. Chong, W. Takano, G. Cancel, T. Ikeuchi, D. Lorenzetti, R. Mawad, G. Stevanin, O. Didierjean, A. Durr, M. Oyake, T. Shimohata, R. Sasaki, R. Koide, S. Igarashi, S. Hayashi, Y. Nishizawa, H. Zoghbi, A. Brice, S. Tsuji, Close associations between prevalences of dominantly inherited spinocerebellar ataxias with CAG-repeat expansions and frequencies of large normal CAG alleles in Japanese and Caucasian populations, Am. Estrada, S. Gonzalez Ed. Zortea, M. Armani, E. Pastorello, G. Nunez, S. Lombardi, S. Tonello, M. Rigoni, L. Zuliani, M. Mostacciuolo, C. Gellera, S. Di Donato, C. E93F13G 04? W ! O 4!! E' ' ,'! FB C4. P QNR7. N TD7;;13G3? L, K 'POO]g! LJde tttttL! SCA2 is caused by the abnormal expansion of cytosine—adenine—guanine triplet repeats in the encoding region of the ATXN2 gene and therefore the expression of toxic polyglutamine expansions in the ataxin 2 protein, which cause progressive neuronal death of Purkinje cells in the cerebellum and several pontine, mesencephalic, and thalamic neurons among other cells. Nevertheless, in Holguin, Cuba, the disease reaches the highest prevalence, resulting from a putative foundational effect. This review discusses the most important advances in the genotypical and phenotypical studies of SCA2, highlighting the comprehensive characterization reached in Cuba through clinical, neuroepidemiological, neurochemical, and neurophysiological evaluation of SCA2 patients and presymptomatic subjects, which has allowed the identification of new disease biomarkers and therapeutical opportunities. These findings provide guidelines, from a Cuban viewpoint, for the clinical management of the disease, its diagnosis, genetic counseling, and therapeutical options L. Almaguer-Mederos : T. Keywords Spinocerebellar ataxia. Cerebellar ataxia. Cerebellar syndrome Introduction The hereditary ataxias are a clinically, pathologically, and genetically heterogeneous group of neurodegenerative disorders caused by degeneration of cerebellum and its afferent and efferent connections, spinal cord, peripheral nerves, and the brainstem. The disorder was first recognized in India in by Wadia and Swami, who were intrigued by the early and marked slow saccade movements, associated with the cerebellar syndrome [5]. Twenty-five years later, the underlying mutation was discovered independently by three distinct laboratories in the USA, Japan, and France [6—8]. Thymic hyperplasia in a patient with Grave 's disease. Hyperplastic changes of the thymus may be found in patients with Graves ' disease. However, this rarely presents as an anterior mediastinal mass, particularly among adults. In this report, we describe a year old woman with Graves ' disease and thymic hyperplasia. Full Text Available Abstract Hyperplastic changes of the thymus may be found in patients with Graves ' disease. Graves ' orbitopathy is caused by intraorbital inflammatory reaction due to autoimmune thyroid disease. In most cases the diagnosis is based on the coexistence of typical eye signs and hyperthyroidism symptoms. In presented case, the absence of thyroid dysfunction implicated performance of differential diagnosis. Among many available diagnostic tools nuclear magnetic resonance seems to be the most accurate in confirmation of diagnosis of Graves ' orbitopathy. Cultura de la violencia y educación secundaria. Full Text Available En el articulo se afuma que la violencia no es un fenómeno exclusivo de nuestra sociedad postmodema y tecnológica, ya que la historia del ser humano es un largo transcurrir, en para1elo, al uso de la violencia. En consecuencia, éste es el contexto dentro del cual deben ser analizadas las actuales fonnas de violencia en la educac ión secundaria , que en algunos casos son un sínt. El autor se muestra partidario de no adoptar una acritud hennética y auti sta frente al problema de la violencia, ya que si deseamos una institución escolar capaz de satisfacer las necesidades y expectativas de nuestros alumnos es preciso que ésta se muestre abierta al conflicto y no preocupada exclusivamente por los contenidos instructivos. Full Text Available Se presenta el caso de un paciente con espondilodiscitis secundaria al uso de anestesia peridural lumbar para la resección transuretral de una hiperplasia fibroadenomatosa de la próstata. En el examen neurológico no se encontraron alteraciones. La tomografía axial computarizada multicorte, así como la gammagrafía ósea de columna lumbar, confirmaron el diagnóstico. Se indicó tratamiento médico basado en los síntomas, antibioticoterapia combinada y ortesis externa. La recuperación total del paciente ocurrió a los 6 meses del inicio de la enfermedad. This is the case of a patient presenting with spondilodiscitis secondary to use of lumbar peridural anesthesia for transurethral resection of a prostatic fibroadenoma hyperplasia The clinical picture was determined by a acute lumbar pain with a progressive increase leading to put to bed the patient. In physical examination of osteomyoarticular system there was predominance of lumbar paravertebral contracture, as well as in palpation of this region. In neurological examination there weren't alterations. The multi-scan computed axial tomography and the spine column bone scintigraphy confirmed the diagnosis. Medical treatment was prescribed based on symptoms, combined antibiotic drug therapy and external orthesis. The total recovery of patient occurred at 6 months from the onset of disease. Notes on Glasinac: The chronology of princely graves. Full Text Available Princely graves of the Iron Age represent a particular phenomenon in archaeology, which is constantly the subject of interest. They are usually dated to the end of the 6th and the beginning of the 5th century. The author discusses the chronology of princely graves in the Central Balkans and analyses their appearance in each part of this territory: on the Glasinac plateau, in Serbia, Kosovo and Metohija, Montenegro, North Albania and Nordwest Bulgaria. He concludes that they date from the middle of the 7th to the middle of the 4th century, depending on the cultural and socio-economic situation in the respective area. In the middle of the 7th century princely graves in the true sense of the word were known only on the Glasinac plateau, in the Ilijak necropolis. At the end of the 7th and in the beginning of the 6th century they still appear on Glasinac, though in greater number and in various parts of the plateau. In northwest Bulgaria a grave dating to the second half of the 7th century was found, which would, according to grave goods, correspond to the Glasinac princely graves. On the other hand, there are no princely graves in Serbia and north Albania from that time but some outstanding warrior graves are known, belonging possibly to the chiefs of smaller warlike bands, whose power was limited. Some decades later there are several rich graves , e. Metodos: Historia clínica, estudios endocrinos, laparoscopia, biopsia de ovarios y estudio citogenético. Graves ' orbitopathy GO is the main extrathyroidal manifestation of Graves ' disease, though severe forms are rare. Management of GO is often suboptimal, largely because available treatments do not target pathogenic mech anisms of the disease. Treatment should rely on a thorough assessment of the. Predictive score for the development or progression of Graves ' orbitopathy in patients with newly diagnosed Graves ' hyperthyroidism. Outcome of very long-term treatment with antithyroid drugs in Graves ' hyperthyroidism associated with Graves ' orbitopathy. It is still debated which treatment modality for Graves ' hyperthyroidism GH is most appropriate when Graves ' orbitopathy GO is present. Graves ' ophthalmopathy and I therapy. Marcocci, C. Graves ' ophthalmopathy is an autoimmune process initiated and maintained by antigen s shared by the thyroid and the orbit. A matter of argument concerns the choice of the method of treatment for Graves ' hyperthyroidism when clinically evident ophthalmopathy is present. Restoration of euthyroidism appears to be beneficial for ophthalmopathy. On the other hand the continuing disease activity associated with the recurrence of hyperthyroidism appears to adversely affect the course of ophthalmopathy. For these reasons it is our opinion that in patients with Graves ' hyperthyroidism and ophthalmopathy the permanent control of thyroid hyper function by ablation of thyroid tissue should be obtained by radioiodine therapy or thyroidectomy. The rationale for an ablative strategy is the following: i permanent control of hyperthyroidism avoids exacerbations of eye disease associated with recurrence of hyperthyroidism; i i hypothyroidism, which follows thyroid tissue ablation, should be regarded as a therapeutic end point rather than as an undesirable result; iii ablation of thyroid tissue may result in the removal of both the thyroid-orbit cross-reacting antigen s and the major source of thyroid-auto reactive lymphocytes. The relationship between radioiodine therapy and the course of GO is a matter of controversy, and some authors have suggested that radioiodine administration ma be associated with a worsening of preexisting ophthalmopathy. This was not observed when radioiodine treatment was associated with a 3-month oral course of prednisone. The development or progression of GO after radioiodine therapy might be due to the release of thyroid antigens following radiation injury and to subsequent exacerbations of autoimmune reactions directed towards antigens shared by the thyroid and the orbit. The view that radioiodine therapy may be associated with a progression of ophthalmopathy is not shared by some authors who claim that the apparent link between progression of. Fibras Secundarias. La utilización de fibras secundarias en la elaboración y producción de papel. La recuperación de fibras secundarias. El Mercado Ecuatoriano de Fibras Secundarias. Determinación del mercado potencial, comparación con países desarrollados. Marco legal actual y deseado. Fuentes alternativas de aprovisionamiento de fibras secundarias. Management of Graves ' hyperthyroidism. Management of Graves ' disease hyperthyroidism, a life-long disease, hinges on a clear strategy and involves the patient's understanding and adherence. Antithyroid drug treatment is difficult to adapt to each patient's need; so far, the more efficient use of antithyroid drug remains on long-term courses of 18 months or more. Although a picture is evolving of patients more likely to go into remission after the medical treatment, its characteristics are not yet reliable. Radical ablative treatments are often necessary. It is hoped that basic as well as clinical research is able to generate innovative, better adapted, and pathophysiologically oriented new therapeutic means. Radiation therapy of Graves ' ophthalmopathy. During the decade from to , 20 patients with Graves ' ophthalmopathy were treated with irradiation of cGy to the orbital tissue. We examined the effects of the therapy on 17 such patients. Exophthalmos tended to decrease. When the degree of deviation of the exophthalmic eye was small, the effect of therapy tended to be better than when it was large. Two cases that showed an increase in retrobulbar fatty tissue without thickening of the extraocular muscles did not respond as well as those that had thickening of the extraocular muscles. Diplopia tended to improve both subjectively and objectively. Ocular movement improved in 11 of the 17 patients. There were no serious radiation injuries after the radiation therapy, except for some transient swelling of the eyelid. Pathogenesis of Graves ' disease and therapeutic implications. Graves ' disease presents itself clinically mainly as hyperthyroidism and infiltrative ophthalmopathy and to a minimal extent also as dermopathy and acropachy. Autoimmune processes are the basic pathogenesis. Stimulating antibodies against the TSH receptor cause hyperthyroidism. Autoantibodies and autoreactive T lymphocytes against primarily thyroidal antigens cross-react with similar antigens of the eye muscles and orbital connective tissue, thus spreading the disease from the thyroid to the eyes. The therapeutic goal comprises not only the treatment of hyperthyroidism, but also the induction of a steady immuntolerance in order to minimize the irreversible damage to the eye. The therapeutic armamentarium is formed by antithyroid drugs, glucocorticoids, retrobulbar radition and thyroid ablation, either by nearly total thyroidectomy or by radioiodine. The different indications for both ablative procedures are discussed. Supervoltage orbital radiotherapy for progressive Graves ' ophthalmopathy. Since we have employed supervoltage orbital radiation as treatment for severe progressive Graves ' ophthalmopathy. A numerical ophthalmic index was used to asess pre- and post-treatment serverity. An orbital radiation dosage of rads in 2 weeks was used for the majority of patients Series I and III. Series II patients received an orbital dose of rads in 3 weeks. Demographic differences were observed between these series, thus mandating presentation of the results of each separately. Analyses excluded any result achieved by any post-radiation surgical procedure on the eyes. Post-theraphy worsening of ophtalmopathy occurred in only 29 of observations. Improvement or complete resolution was observed within each category of eye involvement, but lack of favorable response was also recorded in significant numbers. Improvement in proptosis occurred with the lowest frequency and magnitude. Analysis of the data by step-wise linear regression analysis enabled us a. The latter included male sex, never thyrotoxic, age greater than 60 years, and requirement for concomitant treatment for hyperthyroidism. No long-term adverse reactions attributable to the radiotherapy have been observed. We conclude that supervoltage orbital radiotherapy, combined with later eye muscle surgery if necessary, is an effective treatment strategy for progressive Graves ' ophthalmopathy. Radiotherapy in the management of Graves ' ophthalmopathy. To report the results of radiotherapy for patients with failure, adverse reactions or relative contraindications to the use of steroids or immunosuppressants, by using newly developed quantitative indexes. Fourteen female and six male patients with Graves ' ophthalmopathy were treated with radiotherapy between and Prior to radiotherapy, eight patients received treatment with prednisone, four received immunosuppressants and four received a combination of both. Four patients with contraindications to steroids were initially managed with radiotherapy. Most of the patients received a dose of Gy in 2 Gy fractions. We used the newly developed motility limitation index to assess extraocular motility. Treatment was well tolerated. There have been no late complications. All 12 patients with soft tissue signs such as edema, irritation, tearing and pain were improved. Proptosis did not improve or improved only slightly, 3 mm at best. However, proptosis in all but two has been stabilized and has not deteriorated in the follow-up period. Most of the patients have experienced an improvement of eye-muscle motility. Extraocular muscles that work for elevation were impaired more severely than the other muscles and this tended to remain. Of the 16 patients using steroids before or when radiotherapy was initiated, 15 were tapered off and only one patient required additional steroids, thus sparing the majority from steroid adverse reactions. Radiotherapy was effective in preventing exacerbations of active inflammatory ophthalmopathy in patients with Graves ' disease with minimal morbidity and thus eliminated the adverse reactions associated with protracted corticosteroid use. The newly developed motility limitation index was useful in detecting delicate changes in motility of individual extraocular muscles. Graves ' disease is an autoimmune disorder that may present with various clinical manifestations of hyperthyroidism. Patients with Graves ' disease have a greater number of thyroid nodules and a higher incidence of thyroid cancer compared with patients with normal thyroid activity. However, cases in which patients are diagnosed with recurrence of Graves ' disease shortly after partial thyroidectomy for thyroid cancer are very rare. Here we report a case of hyperthyroid Graves ' disease that occurred after partial thyroidectomy for papillary thyroid cancer. In this case, the patient developed hyperthyroidism 9 months after right hemithyroidectomy, and antithyroglobulin autoantibody and thyroid stimulating hormone receptor stimulating autoantibody were positive. Las polineuropatías en el curso de la AD se han relacionado con otros agentes etiológicos no directamente vinculados con la hemoglobinopatía. Se han comunicado casos de intoxicación por plomo y por cianato en enfermos con AD y algunos autores consideran que los enfermos con esta hemoglobinopatía son propensos a la intoxicación por plomo. Se conoce que la isquemia produce diversas alteraciones de los nervios periféricos y que estas dependen de la severidad del daño vascular. Con los resultados de nuestra casuística puede plantearse que en la AD es frecuente la polineuropatía y que esta tiene algunas características tales como: de tipo mixta, de localización distal, secundaria a un fenómeno de desmielinización, con lesión axonal mínima, de evolución crónica y curso subclínico. Average age in men was 31 range 16 - 44 and in women 29 range 16 - All the cases were under basal conditions at the moment of the research. Symptoms and clinical signs related with a possible peripheral neuropathy were only detected in 8 patients During the nervous conduction study, a significant increase of latency and a marked reduction of the speed of conduction in the median, peroneal and sural nerves were proved in the total of patients compared with the control group. No electrical activity was detected in the EMG of any patient at rest. No significant difference was observed in the muscular contraction potential amplitude in the EMG carried out during the voluntary contraction between the patients and the control group. The striated muscles that had more electromyographic alterations were the anterior tibial muscle and the internal gamellus muscle. The pattern of muscular contraction of simple oscillations was not detected in any case. The findings of this study allow to state that polyneuropathy appears frequently in sickle cell anemia, since its localization is peripheral and it is of mixed type, with minimal axonal injury and a subclinical course. Genética y Clínica de las hemoglobinas anormales. La Habana: Pueblo y Educación, Diggs LW. Sickle cell crises. GlyValfsTer61 mutation was identified in two members of a French family affected by distal myopathy and in one healthy relative. This FLNC c. Given these similarities, we believe that the two FLNC mutations alone can be causative of distal myopathy without full penetrance. Moreover, comparative analysis of the clinical manifestations indicates that patients of the French family show an earlier onset and a complete segregation of the disease. ArgTrp mutation. The p. Caracterización del tipo de recubrimiento en sustratos de material compuesto. Para llevar a cabo este estudio se han desarrollado pruebas de laboratorio en las que se simulan los diferentes factores agresivos mencionados co La evolución del paciente fue muy satisfactoria, recuperó íntegrame Distal splenorenal shunt with partial spleen resection. Full Text Available Introduction: Hypersplenism is a common complication of portal hypertension. Cytopenia in hypersplenism is predominantly caused by splenomegaly. Distal splenorenal shunt Warren with partial spleen resection is an original surgical technique that regulates cytopenia by reduction of the enlarged spleen. The aim of our study was to present the advantages of distal splenorenal shunt Warren with partial spleen resection comparing morbidity and mortality in a group of patients treated by distal splenorenal shunt with partial spleen resection with a group of patients treated only by a distal splenorenal shunt. From to , 41 patients with portal hypertension were surgically treated due to hypersplenism and oesophageal varices. The first group consisted of 20 patients 11 male, mean age The second group consisted of 21 patients 13 male, mean age All patients underwent endoscopy and assessment of oesophageal varices. The size of the spleen was evaluated by ultrasound, CT or by scintigraphy. Angiography was performed in all patients. The platelet and white blood cell count and haemoglobin level were registered. Postoperatively, we noted blood transfusion, complications and total hospital stay. Follow-up period was 12 months, with first checkup after one month. Before surgery, the mean platelet count in the first group was The mean platelet count in the second group was Concerning postoperative splenomegaly, statistically significant difference was noted between the first and the second group p Contemporary Management of Primary Distal Urethral Cancer. Low-stage distal tumors can be managed successfully with a surgical approach in men or radiation therapy in women. There are no clear-cut indications for the choice of the most appropriate treatment modality. Spontaneous distal rupture of the plantar fascia. Spontaneous ruptures of the plantar fascia are uncommon injuries. They typically occur at its calcaneal insertion and usually represent a complication of plantar fasciitis and local treatment with steroid injections. In contrast, distal ruptures commonly result from traumatic injuries. We describe the case of a spontaneous distal rupture of the plantar fascia in a year-old woman with a low level of physical activity and no history of direct injury to the foot, plantar fasciitis, or steroid injections. Torsion of wandering spleen and distal pancreas. Wandering spleen is the term applied to the condition in which a long pedicle allows the spleen to lie in an abnormal location. Torsion of a wandering spleen is an unusual cause of an acute abdomen and is rarely diagnosed preoperatively. Associated torsion of the distal pancreas is even more uncommon. The authors describe a patient with torsion of a wandering spleen and distal pancreas, who was correctly diagnosed, and define the merits of the imaging methods used. Relación del burnout y el engagement con depresión, ansiedad y rendimiento académico en estudiantes universitarios. Full Text Available Objetivo: Analizar las relaciones entre burnout y engagement con ansiedad, depresión y rendimiento académico en estudiantes universitarios de programas de salud. Materiales y métodos: El diseño fue observacional, correlacional, multivariado; la muestra, aleatoria y estratificada, de estudiantes de programas de salud de universidades de Barranquilla. Conclusiones: En la muestra estudiada, el burnout y el engagement académicos se identificaron relacionados como polos extremos y opuestos de un mismo continuo multidimensional, en el que tanto el polo del burnout como el del engagement se configuran por valores esperados de las variables estudiadas pero opuestos al del polo contrario. Full Text Available Using daily observations of the index and stock market returns for the Peruvian case from January 3, to May 31, , this paper models the distribution of daily loss probability, estimates maximum quantiles and tail probabilities of this distribution, and models the extremes through a maximum threshold. One of the results on calculating the maximum annual block of the negative stock market returns is the observation that the largest negative stock market return daily is The shape parameter is equal to Then, in the first case we have that the non-degenerate distribution function is Gumbel-type. In the other case, we have a thick-tailed distribution Fréchet. Finally, the non-parametric estimation of the Hill tail-index and the quantile for negative stock market returns shows quite instability. Participaron sujetos de ambos sexos. Los resultados muestran una relación significativa ent Avance de la interpretación Geotectónica del emplazamiento del plutón granítico de Madridejos Toledo, basada en determinaciones gravimétricas. Full Text Available The outcrops and subsurface geometry of Madridejos granitic body, has been studied using gravimetric and geological methods. This pluton is emplaced in a border of Urda-Consuegra antiform, this structure is high modification in the border where the pluton is emplaced. En función de datos gravimétricos y geológicos se establecen los límites del plutón granítico de Madridejos, tanto superficialmente como en profundidad. Este plutón se aloja en un extremo del domo de Urda-Consuegra, estructura a la que modifica sustancialmente. Endovascular treatment of ruptured distal posterior inferior Mar 1, Urethral mobilization and advancement for distal hypospadias Advancing the urethra without mobilization for repair of glanular hypospadias has the advantage of avoiding a common problem occurring with other techniques Caracterización estructural de anticlinales en el extremo sur de la Cordillera Oriental, provincia de Salta, Argentina. Esse aumento da sobrevida resultou em aumento da incidência de displasia broncopulmonar. Atualmente, a displasia broncopulmonar é mais freqüentemente observada em recém-nascidos OBJECTIVE: To review the main causes of new bronchopulmonary dysplasia and the strategies utilized to decrease its incidence in extremely low birth weight infants. This improvement in survival has therefore resulted in an increased incidence of bronchopulmonary dysplasia. The characteristics of bronchopulmonary dysplasia in extremely low birth weight infants, the so called "new" bronchopulmonary dysplasia are quite different from the classic bronchopulmonary dysplasia described by Northway. This new bronchopulmonary dysplasia has a multifactorial etiology, which includes volutrauma, atelectrauma, oxygen toxicity and lung inflammation. Therapy such as prenatal corticosteroids, exogenous surfactant, nasal continuous positive airway pressure, new mechanical ventilation modalities and gentle ventilation have been used in attempts to decrease lung injury severity. Distal displacement of the maxilla and the upper first molar. Data from a sample of Class II cases treated with various appliances which deliver distally directed forces to the maxilla were examined to determine the frequency of absolute distal displacement of the upper first molar and of the maxilla. Analysis revealed that such distal displacement is possible and that it is, in fact, a frequent finding following treatment. Long-range stability of distal displacement was not assessed. Distal radioulnar joint: functional anatomy, including pathomechanics. The distal radioulnar joint allows the human to rotate the forearm to place the hand in a desired position to perform different tasks, without interfering with the grasping function of the hand. The ulna is the stable part of the forearm around which the radius rotates; the stability of the distal radioulnar joint is provided by the interaction between ligaments, muscles and bones. The stabilizing structures are the triangular fibrocartilage complex, the ulnocarpal ligament complex, the extensor carpi ulnaris tendon and tendon sheath, the pronator quadratus, the interosseous membrane and ligament, the bone itself and the joint capsule. The purpose of this review article is to present and illustrate the current understanding of the functional anatomy and pathomechanics of this joint. Distal Stressors and Depression among Homeless Men. Depression is a common problem among homeless men that may interfere with functional tasks, such as securing stable housing, obtaining employment, and accessing health services. Previous research on depression among homeless men has largely focused on current psychosocial resources, substance abuse, and past victimization. Fractures of the distal phalanx in the horse. Fractures of the distal phalanx are an important cause of lameness referable to the foot. Depending on the fracture configuration and articular involvement, conservative or surgical treatment may be required. Fractures of the distal phalanx have been divided into six categories based on fracture configuration. Discussion of clinical features, management, and prognosis for horses with distal phalangeal fractures is presented for each fracture type. Nonunions of the distal tibia treated by reamed intramedullary nailing. The purpose of this study is to determine the efficacy of reamed intramedullary nailing in the treatment of nonunions of the distal one-fourth of the tibia. Nonunions of the distal tibia are particularly difficult to treat given the short distal segment, the proximity to the ankle joint, and the. Management and treatment of distal ulcerative colitis. Full Text Available Ulcerative colitis UC is a chronic inflammatory condition that is confined to the colonic mucosa. Its main symptoms include diarrhea, rectal bleeding and abdominal pain. Approximately two-thirds of UC patients have disease confined distal to the splenic flexure, which can be treated effectively with topical therapy. This means the active drug can be delivered directly to the site of inflammation, limiting the systemic absorption and potential side effects. Topical treatment with aminosalicylates is the most effective approach in the treatment of these forms, provided that the formulation reaches the upper margin of the disease. Given this, the suppository formulation is the treatment of choice for proctitis and distal sigmoiditis. Thanks to their proximal spread, enemas, foams and gels represent the treatment of choice for proctosigmoiditis and for distal ulcerative colitis. Oral aminosalicylates are less effective than topical therapies in patients with active disease, while the combination of topical and oral treatment is more effective in patients refractory to topical or oral mono-therapy. Topically administered aminosalicylates play an important role in the maintenance of remission, but the long-term adhesion to therapy is poor. For this reason, the oral formulation is the first-line therapy in the maintenance of remission. Refractory patients can be treated with topical steroids or systemic steroids and TNF-alpha inhibitors in severe forms. Distal or embolic protection has intuitive appeal for its potential to prevent embolization of materials generated during interventional procedures. Distal protection devices DPDs have been most widely used in the coronary and carotid vascular beds, where they have demonstrated the ability to trap embolic materials and, in some cases, to reduce complications. Given the frequency of chronic kidney disease in patients with renal artery stenosis undergoing stent placement, it is reasonable to propose that these devices may play an important role in limiting distal embolization in the renal vasculature. Careful review of the literature reveals that atheroembolization does occur during renal arterial interventions, although it often goes undetected. The combination of platelet inhibition and a DPD may provide even greater benefit. Given the critical importance of renal functional preservation, it follows that everything that can be done to prevent atheroembolism should be undertaken including the use of DPDs when anatomically feasible. The data available at this time support a beneficial role for these devices. Evaluación, optimización y mejoramiento del sistema operativo de lagunas de estabilización de Ciudad de Dios-San Jose en el departamento de Lambayeque. Durante el año de , paralelamente a la exitosa gestión de concertación del financiamiento extremo y nacional por la ejecución del estudio definitivo para la ampliación y mejoramiento de los servicios de Agua Potable y Alcantaril OBJECTIVE: To review the literature on the role of calcium, phosphorus and trace elements in the nutrition of extremely low birth weight infants, considering their importance for metabolism, bone mineralization. Maxillary molar distalization with the dual-force distalizer supported by mini-implants: a clinical study. The objective of this prospective study was to describe the clinical effects of a bone-supported molar distalizing appliance, the dual-force distalizer. The study group included 16 patients mean age, Study models and lateral cephalograms were taken before and after the distalizing movement to record significant dental and skeletal changes Wilcoxon test. The average distalization time was 5 months, with a movement rate of 1. The average molar inclination was 5. The correlation between inclination and distalization was not significant, indicating predominantly bodily movement. The teeth anterior to the first molar moved distally also; the second premolars distalized an average of 4. The dual-force distalizer is a valid alternative distalizing appliance that generates controlled molar distalization with a good rate of movement and no loss of anchorage. Robotic distal pancreatectomy versus conventional laparoscopic distal pancreatectomy: a comparative study for short-term outcomes. Capítulo 4. Capítulo 5 EncefalopatíaEncefalopatíaEncefalopatíaEncefalopatíaEncefalopatía hipertensivahipertensivahipertensivahipertensivahipertensiva. Capítulo Capítulo 12 EstadoEstadoEstadoEstadoEstado dedededede malmalmalmalmal epilépticoepilépticoepilépticoepilépticoepiléptico. VérVérVérVérVértititititigggggooooo aaaaagudogudogudogudogudo. Capítulo 15 HipertensiónHipertensiónHipertensiónHipertensiónHipertensión intracranealintracranealintracranealintracranealintracraneal. Capítulo 17 TraumatismoTraumatismoTraumatismoTraumatismoTraumatismo raquimedularraquimedularraquimedularraquimedularraquimedular. Algunas de estas han sido el resultado del trabajo mancomunado de comisiones de expertos creadas con tal objetivo. Se excluye dentro de este grupo los ataques transitorios de isquemia ATI ; y habría que preguntar si no es el ATI una urgencia neurológica. Hasta dónde la clínica neurológica es capaz de discernir en un instante dado entre un ATI y un infarto. El tiempo es decisivo en la conducta. La vida ha demostrado que el límite temporal no puede marcar conductas terapéuticas en las ECV. En los capítulos que siguen a este se expone por separado el infarto cerebral, la hemorragia intracerebral y la hemorragia subaracnoidea. ECV isquémica. Isquemia global. Isquemia focal. Ataque transitorio de isquemia. Infarto cerebral. Hemorragia intracerebral. Hemorragia subaracnoidea. Hemorragia intraventricular. Resulta imposible agrupar en un. Hasta la fecha los estudios de incidencia, prevalencia y mortalidad individualizan las distintas categorías y las investigaciones de mortalidad incluyen las hemorragias intracerebrales, el infarto cerebral y la hemorragia subaracnoidea como causa de muerte por ECV. Un estudio epidemiológico ideal sobre ECV aguda, se incluye ATI , con el objetivo de determinar su incidencia y prevalencia sería aquel que abarque los aspectos siguientes:. Existen varios estudios publicados en la literatura científica que se apoyan en los aspectos citados anteriormente. Los estudios de incidencia muestran resultados entre x y x habitantes para la ECV aguda en las poblaciones de 45 a 84 años. La incidencia de los ATI oscila entre 30 a 60 x habitantes. En Cuba la tasa de mortalidad bruta en el año fue de 71,8 x habitantes y la tasa ajustada fue de 50,2 x ; sólo superada por las enfermedades del corazón y los tumores malignos. Este resultado muestra un incremento sostenido de la tasa de mortalidad en Cuba desde año en que esta era de 56,4 x habitantes y 68,9 x en Los ataques transitorios de isquemia se definen como episodios de. Este concepto clínico evolutivo tiene algunas implicaciones que es imprescindible esclarecer. Primero los síntomas y signos de tipo deficitario,. La ECV provoca disminución de las funciones en el sistema nervioso central. Es raro que signos que expresen una respuesta exagerada o positiva, como por ejemplo las convulsiones, se presenten en la isquemia cerebral. El segundo aspecto es. La instalación. El término. Con la excepción de la isquemia cerebral global,. La reversibilidad es considerada como un criterio mayor de ATI. Los síntomas y signos de ATI tienen su resolución total en las primera hora,. La incidencia anual de ATI ajustada a la edad es variable, depende de los criterios empleados y el territorio vascular estudiado. La incidencia registrada varía entre 30 y casos x habitantes en las distintas series. Se considera que el sexo masculino tiene una incidencia mayor que el femenino. Las causas de los ATI son las mismas que las del infarto cerebral y la describiremos en el siguiente capítulo dedicado a este. El embolismo de origen cardíaco es el segundo mecanismo que ocasiona ATI, generalmente en el territorio de irrigación carotídea. La enfermedad aterosclerótica de los pequeños vasos perforantes es otro mecanismo en los ATI que preceden a los infartos lacunares. La isquemia. Entre estas causas que generan ATI se encuentran, trastornos de la coagulación, como la hiper- coagulabilidad plaquetaria, el aumento de las plaquetas y otros. Hemos observado personalmente como causa de estos, la policitemia con hemoglobina superior a 17 ó 18 en varios pacientes. Otras lesiones no aterosclerótica de las arterias son causas menos frecuentes de ATI. Entre estas podemos citar, las arteritis inflamatorias, la displasia fibromuscular, la angiopatía amiloidea, la enfermedad de moyamoya, el síndrome de Sneddon, enfermedades autoinmunes sistémicas, abuso de drogas y las disecciones arteriales. Las manifestaciones clínicas dependen del territorio irrigado por la arteria. Los síntomas como trastornos de la conciencia, desorientación, confusión, amnesia, vértigos, diplopía, disfagia y ataques y caídas de forma aislada no son generalmente manifestaciones de un ATI. Los ATI de la circulación carotídea pueden adoptar dos formas clínicas. Estos episodios rara vez son referidos por el paciente. La segunda forma clínica de los ATI carotídeos se originan cuando las arterias afectadas son la cerebral anterior y la media y producen síntomas hemisféricos. Se caracterizan por un déficit motor o sensitivo contralateral y afectación del lenguaje. Los síntomas motores o sensitivos puros generalmente se observan en las oclusiones de vasos perforantes. Ambas distinciones tienen significación para determinar la fisiopatología y la conducta terapéutica. Los criterios diagnósticos de estos son:. En tiempos recientes se han reconocido síndromes infrecuentes como manifestación de ATI. La paraparesia transitoria es tenida como un signo de ATI en la arteria cerebral anterior. Las sacudidas bruscas e involuntarias de una extremidad shaking limb y la amaurosis transitoria por exposición a luz brillante son consideradas manifestaciones clínicas de ATI del territorio carotídeo. El ATI es una emergencia médica como comentamos con anterioridad. El diagnóstico es clínico y se basa fundamentalmente en el interrogatorio, por lo que requiere de la destreza de un médico con experiencia. Todo ATI debe ser ingresado para su estudio de forma inmediata al llegar a la sala de urgencias. En ocasiones defectos neurológicos transitorios de tipo focal pueden simular un ATI. Entre estas situaciones encontramos crisis epilépticas parciales, alteraciones metabólicas como la hipoglicemia y la hiperglicemia,. El examen físico. La TAC es un examen fundamental y debe ser indicada de forma urgente. Aspirina ASA. La dosis óptima ha sido un aspecto controvertido. El uso de altas dosis aumenta el riesgo de infarto al revertir su efecto. Se recomiendan dosis de 75 a mg diarios. Se han reportado leucopenias graves, lo que obliga a la realización de hemogramas cada 2 semanas por 6 meses. La dosis es de mg cada 12 horas. La dosis de 75 mg diario reduce el riesgo de ATI e infarto cerebral. Inhibe la actividad del ADP. Su estructura es similar. Se recomienda en pacientes que no tengan cardiopatía. En combinación con la aspirina reduce. La actividad antiagregante plaquetaria hace que esté indicado en los procesos tromboembólicos y procesos que. La dosis recomendada es de a mg diarios. Su uso se ha visto limitado por el alto índice de hemorragias. La heparina. Los valores INR deben mantenerse entre 2,5 y 3,5. Los estudios realizados han demostrado la superioridad de este procedimiento frente al tratamiento antiagregante y anticoagulante. Se deben excluir los pacientes con infartos cerebrales extensos, hipertensión arterial severa o estenosis carotídea bilateral, cardiopatía isquémica o ATI cardioembólicos. Estudios recientes han demostrado que el uso del ramipril y el perindopril, dos inhibidores de la ECA reduce el riesgo relativo de ictus en enfermos con ATI. La homocisteinemia. También se ha sugerido que la. Estas vitaminas son potentes factores antioxidantes. PronósticoPronósticoPronósticoPronósticoPronóstico yyyyy evoluciónevoluciónevoluciónevoluciónevolución. La edad es un factor de riesgo para la ocurrencia de un ictus y para la vida del paciente. La interacción edad-sexo masculino desempeña un papel decisivo en los enfermos tanto para la aparición de un ictus como para un episodio coronario. La existencia de un ictus previo o de ATI incrementa la posibilidad de infarto del miocardio, ictus y muerte. Otros factores importantes en pacientes con ATI para el desarrollo de un ictus son la presencia de una cardiopatía embolígena, el hallazgo en la tomografía de un infarto o de leucoaraiosis, la cardiopatía isquémica previa, la enfermedad vascular periférica, el tabaquismo y el hematócrito elevado. Los distintos subtipos clínicos de ATI tienen diferentes pronósticos. Los ATI retinianos tienen un mejor pronóstico, mientras los pacientes con ATI hemisféricos secundarios a una estenosis severa de la arteria carótida tienen un peor pronóstico. Los ATI que se producen en el territorio de irrigación del sistema vertebrobasilar presentan un riesgo subsiguiente de ictus inferior a los ATI del sistema carotídeo. El mecanismo que origina el ATI tiene mayor valor para el pronóstico que las características clínicas del episodio sobre el riesgo posterior de ictus. Esta alta mortalidad la se relaciona con el alto promedio de edad de los enfermos al inicio del estudio, que era de 65 años. Las principales causas de muerte en los pacientes con ATI fueron el infarto del miocardio, la bronconeumonía y las neoplasias y no estuvieron relacionadas directamente con la ECV isquémica. Adams RJ. Management issues for patients with ischemic stroke. Neurology ; 45 Suppl : S S Alvarez-Sabin J. Med Clin ; Mecanismos inflamatorios, arteriosclerosis e ictus isquémico: datos de interés clínico y perspectivas. Rev Neurol ; 35 : Arboix A. Ictus ; 1: Transient ischemic attacks in lacunar infarct. Cerebrovascular Dis ; 1: Antiplatelet Trialist Collaboration. Collaborative overview of randomized trials of antiplatelet therapy, I: prevention of death, miocardial infarction, and stroke by. Alvarez- Sabin J. Hematoma intraparenquimatoso. BJM ; Risk factors for cardiac death in patients with a transient ischemic attack or ischemic stroke. Cerebrovasc Dis ; Biller J, Saber JL. Transient ischemic attacks. Populations and prognosis. Mayo Clin Proc ; Prolonged hypoperfusion and early stroke after transient ischemic attacks. Stroke Use of ramipril in preventing stroke: double blind randomized trial. Br Med J ; Bousser MG. Cerebral venous thrombosis. In Fisher M, Bogousslavsky J, eds. Current review of cerebrovascular diseases. Boston: Butterworth-Heinemann; Family history in patients ischemic attack. Stroke ; Acta Neurol Scand ; Italian multicenter study on reversible ischemic attacks. Prognostic factors and follow-up results. Castillo J. Fisiopatología de la isquemia cerebral. Rev Neurol ; 30 5 : Clustering transient ischemic attacks..

References [1] E. Alonso, L. Martinez-Ruano, I.

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De Biase, C. Mader, A.

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Ochoa, P. Yescas, R. Gutierrez, M. White, L. Ruano, M. Fragoso-Benitez, T. Ashizawa, S. Bidichandani, A. Rasmussen, Distinct distribution of autosomal dominant spinocerebellar ataxia in the Mexican population, Mov. Belal, G.

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Cancel, G. Stevanin, F. Hentati, C. Khati, C. Ben Hamida, G. Auburger, Y. Agid, M. En el camino del “alma” mi familia murciana merece el agradecimiento más importante incluir Viktor stalberg esposa disfunción sexual estudio del efecto del sexo sobre todas las variables relacionados con cualquier disfunción de origen orgánico.

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Gil, Carlos Javier Chocho Cabrera, Silvia López Santana, Víctor Quintana Delgado, Gracias familia. político), sexual, laboral (económico), funcional (​orgánico) y físico, que son los que Un ataque cardiaco es una disfunción entre el suplemento de oxígeno al ; Lexcll et al., ; Stalberg et al., ; Lexell. dentro de una familia donde ya se ha diagnosticado un HPTP, sin otras Sexo y edad. Manifesta- ciones del. MEN IIA.

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) se reportó una incidencia promedio ajustada a edad y sexo de casos x una familia tiene CMTF es necesario demostrar la ausencia de FEO Akerström G, Stålberg P, Hellman P. Surgical management of pancreatico. Acosta,** Víctor Sánchez Solís,** Gerardo Barroso Villa,**** Fernando Gaviño Gaviño1. Artículo original no sin contacto sexual Viktor stalberg esposa disfunción sexual con la finalidad de lograr el embarazo. La inseminación endometriosis, disfunción ovulatoria, infertilidad Campana A, Sakkas D, Stalberg A, Grace P, et al.

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