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Biomedical subjects

F Morales

Publications and source records attributed to F Morales.

At least 127 records · Page 7Linked to original sources
PubMedDate not supplied

[Acute transverse myelitis secondary to hepatitis B vaccination].

INTRODUCTION: Acute transverse myelitis is an inflammatory disorder. The pathogenesis is unclear, but the probable mechanism involves an autoimmune phenomenon. Possible causes included multiple sclerosis and parainfectious and postvaccinal events. Myelitis has rarely been reported secondary to vaccinations including hepatitis B. We present a case of acute myelitis, which seems secondary to the administration of the hepatitis B vaccine. CLINICAL CASE: A 15-years-old female presented with progressive numbness of the right arm and leg, with right leg weakness. Symptom began one week after receiving the first dose of the hepatitis B vaccine. Spinal cord magnetic resonance (MR) revealed a diffuse increased signal extending from C6 to D2. Cerebral MR and cerebrospinal fluid were normal. She was treated with high doses of methylprednisolone with a complete recovery of neurological functional. Repeat medullar cord MR was normal. There was no relapse during a four years follow up. CONCLUSIONS: Potential causal relationship between vaccination against hepatitis B and multiple sclerosis was brought to the attention and to public debate. However, no conclusive association could be made between vaccination and demyelination. In the clinical setting, the distinction between a first episode of multiple sclerosis or postvaccinal myelitis depends upon subsequent course.

Acute Disease↗
PubMedDate not supplied

[Steroid treatment of acute psychosis associated with multiple sclerosis]].

INTRODUCTION: Psychiatric disorders are common in patients suffering from multiple sclerosis (MS). Psychosis is a rare complication in this condition. We present two patients with MS and psychosis. CLINICAL CASES: Case 1. A 45-year-old man was admitted to the hospital because an acute psychosis. The diagnosis of clinical definitive MS was made two years before. Cranial magnetic resonance imaging (MRI) and single positron emission computerized tomography (SPECT) showed lesions in the left temporal lobe. He was treated with a 3-day course of high-dose corticosteroid and neuroleptic. The patient's status gradually improved within the following weeks. Case 2. A 41-year-old man with MS was hospitalized in a Psychiatric Department for acute psychosis. He was treated with high-dose of neuroleptic. Thereafter two remissions and relapses of MS have occurred. In 1998, the patient was evaluated in the Service of Psychiatric for new paranoid acute psychosis. CONCLUSIONS: Psychosis is not a prominent feature of the disease, occurring in 5% of cases. The relationship between lesions of the central nervous system and psychiatric illness has not been established although some reports have implicated the temporal lobe. The propensity of steroids to exacerbate psychosis usually argues against this option, but steroids could theoretically improve psychosis related to acute demyelination.

Acute Disease↗
PubMedDate not supplied

[Lamotrigine in refractory partial and general epilepsies].

INTRODUCTION: Lamotrigine (LTG) is a new antiepileptic drug that it has proved to be efficacious in treating patients with partial and generalized tonic-clonic seizures in adjunctive and monotherapy. It has similar efficacy in comparison with carbamazepine and phenytoin with a minor number of adverse experiences. PATIENTS AND METHODS: We report the use of LTG in adjunctive therapy in 106 adults patients with refractory epilepsy (efficacy and safety) with partial and generalized seizures, with follow-up to 3.4 years. The LTG mean doses used was 273 mg/day. RESULTS: 66% of patients experienced a > or = 50% reduction in seizure frequency, with 30% in remission. Both partial, secondarily generalized and generalized seizures showed significant reductions with LTG treatment. LTG was well tolerated in our patients. Side effects were minor. No case of rash was seen. CONCLUSION: LTG is a excellent agent for adjunctive therapy in refractory epilepsy.

Adolescent↗
PubMedDate not supplied

[Neurological alterations related to Crohn's disease].

INTRODUCTION: The incidence of alterations of the central and/or peripheral nervous system in a patient with Crohn s disease (EC) is 33.2%. Casual association may occur in 19.3% of the cases. The disorder of the nervous system may precede the diagnosis of EC. DEVELOPMENT: We review the main neurological complications of EC. The predominant cerebral vascular pathology is arterial although cases of venous thrombosis have been reported. One of the mechanisms involved is the state of hypercoagulability secondary to thrombocytosis and increase in the factors V, V111 and fibrinogen. In other cases there was confirmation of the presence of antiphospholipid antibodies and lupus anticoagulant, and therefore of an autoimmune mechanisms being involved. Other neurological features include peripheral neuropathy (axonal, demyelinating and autonomic), myopathies, pseudotumor cerebri, papilloedema, psychiatric disorders (anxiety, phobias, depression) and association with syndromes such as multiple sclerosis, Cogan s syndrome, Melkersson Rosenthal syndrome, connective tissue disorders and vasculitis. CONCLUSION: As well as hypercoagulability being one of the pathogenic mechanisms of cerebral ischaemia, there is alteration of humoral and cellular immunity in patients with EC. This justifies this and other neurological manifestations, and explains its association with other immunity disorders.

Antiphospholipid Syndrome↗
PubMedDate not supplied

[Working memory and complex activities of everyday life in the initial stages of Alzheimer's disease].

INTRODUCTION: Evaluation of the working memory (WM) permits analysis of the degree of anterograde amnesia and fixation deficit present in patients with Alzheimer s disease (AD). Complex activities of everyday life (AEL) are also affected early. There is a close relation between the degree of cognitive deterioration and loss of functional competence in AEL. OBJECTIVE: To analyze the degree of memory loss and performance in carrying out complex AEL in patients with AD and mild cognitive disorder. PATIENTS AND METHODS: Evaluation of functional disorder, using Pfeffer s functional activity questionnaire (FAQ), and cognitive evaluation, using the WM examination protocol in a group of 36 patients. RESULTS: In the total MT (4.2+/-5.7) there were significant differences between patients with age associated memory impairment (AAMI) (11+/-7) and possible EA (3.2+/-4.6) and between AAMI and probable AD (2.8+/-4.8). The functional evaluation of the AEL (FAQ) gave a mean of 8.5+/-7.1. There were significant differences between probable AD (11+/-8) and possible EA (6+/-4) with the group AAMI 1+/-1.8. There was significant correlation between FAQ and total WM ( 0.70, p= 0.0001). It was found that patients with high FAQ scores had lower total WM scores. CONCLUSION: FAQ and WM have high correlation and are useful instruments for the evaluation of patients with cognitive deterioration at the initial stages.

Activities of Daily Living↗
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[Pseudotumor cerebri: analysis of our cases and review of the literature].

INTRODUCTION: Pseudotumor cerebri (PC) is a complex syndrome characterized by increased intracranial pressure in the absence of any space occupying lesion, usually self limiting, but often relapsing. Diagnosis is based on a record of intracranial pressure of over a limit of 250 mmH2O. Morbidity is basically due to possible loss of vision associated with atrophy of the optic nerve. When the aetiology is unknown this clinical condition is known as idiopathic intracranial hypertension. PATIENTS AND METHODS: We describe the principal characteristics of a series of patients who were admitted to our department with the diagnosis of PC and review the relevant literature. RESULTS: Altogether 14 patients (12 women and 2 men) were admitted with the diagnosis of PC. In 12 patients the disorder presented with headache, with or without associated symptoms of disorders of vision. The main visual symptoms were transient darkening of vision, scotomas, photopsias and reduction in visual acuity. The headache was holocranial, continuous and well tolerated or alternatively uni or bilateral, pulsatile, moderate, with or without photophobia, and with or without nausea and vomiting. Bilateral papilloedema was seen in all patients. In one case there was also bilateral facial palsy and neck rigidity. In four cases visual field measurement were abnormal (inferoneasal scotoma, bilateral concentric reduction). Progress was poor in only one case. CONCLUSIONS: In spite of being theoretically benign, and there being many forms of treatment, PC may cause considerable morbidity of vision. Therefore, early diagnosis and close follow up attention is essential.

Acetazolamide↗
PubMedDate not supplied

[Pure lower motoneurone syndrome in a series of six patients].

INTRODUCTION: Lower motoneurone syndromes (SMNI) have been defined by their clinical pattern, anomalies in nerve conduction and the presence of antiglycolipid antibodies. The possible response to immunotherapy is another characteristic which makes these syndromes interesting. PATIENTS AND METHODS: We studied the clinical and electrophysiological data, clinical progress and response to treatment of a series of six patients, with a pure lower motoneurone syndrome, with a follow up period of between 5 and 13 years. CONCLUSIONS: The clinical phenotype of our patients was: male, middle aged, the clinical topography showed only lower motoneurone involvement, predominantly or exclusively limited to the upper limbs, asymmetrical, distal rather than proximal, with a chronic course progressing initially but later becoming stable. From the electrophysiological point of view some of our cases were of SMNI. In these the conduction block was not permanent although there were signs of axon loss and multifocal demyelination. Response to treatment with intravenous immunoglobulins was seen in patients with anti GMI antibodies of IgM type and recent signs of clinical deterioration, whether there were conduction blocks present or not. In the cases which responded to this treatment there was tolerance and dependence following repeated transfusions of IV IgG.

Adult↗
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[Cerebral gliomatosis. A report of three cases and review of the literature].

INTRODUCTION: Cerebral gliomatosis is an infiltrating, non destructive process of glial type, with a diffuse growth pattern and great clinical variation in the initial symptoms. Confirmation of the diagnosis requires histological study of the lesion showing infiltration by well differentiated mature astrocytes (atypical forms are rare). We report three cases diagnosed by our department over the past five years. CASE REPORTS: Case1. A 64 year old man presented with olfactory crises and right homonymous hemianopsia. On cerebral MR there was an extensive left occipital cortico subcortical lesion infiltrating the genum of the corpus callosum, with irregular uptake of contrast material. CASE REPORT 2: A 68 year old woman was admitted complaining of paresia of her right arm which had worsened over the past two months. On MR there was an extensive left paraventricular subcortical lesion, involving the anterior temporal and capsulo lenticular regions. Case 3. A 63 year old woman complained of staggering gait and headache. On examination she had a right facial palsy and intention tremor of her right arm. All the patients died. In all cases stereotactic biopsy confirmed the diagnosis of cerebral gliomatosis. CONCLUSIONS: Cerebral gliomatosis is an infiltrating glial disorder with a poor prognosis. The clinical diagnosis is suggested on cerebral MR studies and confirmed on histological studies.

Aged↗
PubMedDate not supplied

[The maternal comparison in Cuba. Benefits and education].

About 300 years ago, admitting children in hospitals started to be done and the complicated problems derived from this fact started as well. Those who followed the school of the psychological and even organic benefit and the evolution of the pathological process of the small patient when he received the family warmth and particularly his mother's, found many opposers. In Cuba, before the Revolution triumph in 1959, due to the great amount of illiteracy, inculture and misery of most of the people, a great deal of our children, when they became ill, were delivered in to hands of babblers or ignorants who gave them decoctions of herbs, and witch treatments, all this accompanied by the lack of medical establishments and staff, especially in the provinces, as well as the low standard of life of most of the people who could not afford the stay in the few existing medical centers which did not offer sanitary education or preventive measures either. After the triumph of the Revolution, a deep change in the social, economical and cultural structures took place in the country giving priority to education and people's health. In this last field, health programs, including food and other material cares, were given to the mother in the hospital during the whole day. The advantages of the mother near the child while he was in the hospital are outlined in the present paper, in addition to the education for health that the Cuban mother receives when she is in the hospital with her child, as well as under other circumstances. Significant achievements reached with this program are equally outlined and thus we find the total eradication of severe diseases for childhood, and among the indicators, the fact of having the lowest children mortality rate in Latin America.

Child Care↗
PubMedDate not supplied

[8-year experience in 40 patients with an axillary-femoral graft].

The 8 years (1967-1975) experience with axillary-femoral and femoro-femoral grafts in 40 patients is presented; 6 females and 34 males, between 50 and 90 years of age, with arteriosclerosis, all complicated by chronic illnesses. The results have been satisfactory, as the grafts are functioning from 2 months to 80 months (6 years, 8 months), most of them being more than 12 months old. Twenty eight of the 40 patients operated are alive. Four patients (10%) had infection of their grafts. In 6 (15%) the graft closed because of severe progresive distal obstruction. Three patients (7.5%) died in the first 32 post-operative days. In 9 (22.5%) the deaths were not related to surgery. The indications for placement of axillary-femoral and femoro-femoral grafts is established.

Aged↗
PubMedDate not supplied

[Standardization of the Alzheimer's Disease Assessment Scale in a Spanish population].

We describe a Spanish adaptation and standardization of the Alzheimer's Disease Assessment Scale (ADAS) carried out as part of a prospective, coordinated study performed simultaneously in two Spanish health centers. Three diagnostic groups were defined: 21 healthy volunteers (normal group); 22 patients with cognitive deterioration but no dementia (CDND group); and 20 patients with Alzheimer type dementia (ATD group). The subjects were examined at the start of the study and after 3 and 6 months. The mean cognitive ADAS scores were significantly different in the 3 groups (F = 67.2, p = 0.0001), as follows: normal group, 7.6 +/- 2.1; CDND group, 12.4 +/- 4.5; and ATD group, 21.0 +/- 4.7. Likewise, the ADAS proved sensitive to the course of deterioration in the ATD group, while the other groups' scores improved. We conclude that the ADAS, and in particular the cognitive subscale, is useful for evaluating ATD patients, especially in the early phases of deterioration. It discriminates between ATD and CDND patients well.

Aged↗