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Biomedical subjects

J A Burguera

Publications and source records attributed to J A Burguera.

At least 19 recordsLinked to original sources

Unique origin and low penetrance of the 946delGAG mutation in Valencian DYT1 families.

Mutations in the DYT1 gene cause idiopathic torsion dystonia (ITD) transmitted in families as an autosomal dominant trait with incomplete penetrance. The most common mutation, 946delGAG, has been observed in populations with different ethnic and geographic origins. We have investigated 40 individuals from 22 unrelated families with ITD originating from the Land of Valencia, Spain, for the presence of this mutation and we found 5 patients and 6 unaffected subjects from 4 families who were carriers of the mutation. This finding indicates that 18% of families may be diagnosed as DYT1 and that penetrance is reduced. We detected two different geographic and linguistic origins of the Valencian families. However, by haplotype analysis using D9S1260, D9S1261, D9S63 and D9S1262 as flanking markers, we demonstrated that all affected and unaffected carriers shared a common chromosome confirming identical origin of the mutation in the four families. We postulate a unique origin for the 946delGAG mutation in the Land of Valencia and, based on linguistic criterion, we propose that the mutation might have occurred at the beginning of the second millennium. Genetic analysis of another family from Castilla-La Mancha showed a different haplotype segregating with the disease, suggesting that at least two distinct mutational events for the 946delGAG mutation have occurred in Spain.

Alleles↗

Action hand dystonia after cortical parietal infarction.

A 46-year-old patient with a pure left cortical infarct affecting mainly the gyrus postcentralis developed action dystonia in the right hand. Mechanisms involved in the genesis of focal secondary dystonia are discussed with emphasis on abnormal cortical sensory processing.

Carotid Artery, Internal↗

[Results of a program of presymptomatic diagnosis of Huntington's disease: evaluation of a 6 year period].

OBJECTIVE: To know the uptake of predictive testing of Huntington's disease, the characteristics of the applicants, as well as the consequences for them. METHODS: Prospective observational study between January of 1994 and December of 1999 of the predictive testing applicants who entered in the protocol consisted of: informative interview, psychiatric interview, blood extraction for molecular study, as well as outcome and follow-up interviews. RESULTS: There were 87 applicants with a 50% risk. The mean age of the applicants was 28 years (SD = 7). Thirty one per cent already had children in the moment of predictive testing. The application rate according to the estimate population with 50% risk for the Comunidad Valenciana is 13,4%. The rate varies depending on the access to the information of the population in risk, being of 24,7% when they have direct access and of 8,3% when they do not have it (p < 0,01). Forty per cent did not come to the post-outcome visit, the positive or negative result for the mutation not influencing over it. Only 6,8% had some adverse event in the six years of follow-up all being slight. CONCLUSIONS: The application rate is determined by the access to the information of the population in risk. The fulfilment of the protocol designed for presymptomatic diagnosis of Huntington's disease keeps the adverse events presentation to a minimum.

Access to Information↗

[Familial multiple sclerosis: a study of six families].

INTRODUCTION: Multiple sclerosis (MS) is a demyelinating disorder of the CNS, of autoimmune pathology and unknown aetiology. Several theories regarding its aetiology have been suggested, although none seems to be completely convincing. Genetically predisposed persons are affected, therefore groups of MS are seen in certain families. OBJECTIVES: To describe the family links, type of illness and evolution of 12 patients from six families with two or more members diagnosed as having MS, and to evaluate any differences from the other cases recorded in our data base. PATIENTS AND METHODS: We studied 12 patients diagnosed on the criteria of Poser, and with at least one first or second degree relation with MS. We compared clinical data, form of presentation and course with 127 patients recorded in the data base. RESULTS: We describe six families: two homozygotic twins, two families in which transmission was from father to child and three families with first degree cousins affected. We found no clinical variation in the presentation, number of attacks or evolution, as compared with the other patients. Nor was there homogeneity between the familial forms of MS. CONCLUSIONS: Familial forms make up approximately 10% of the series. We do not have any data available for early diagnosis nor for prognostic significance of familial MS.

Adult↗

[Outpatient care of patients with Parkinson disease].

INTRODUCTION: Some neurology clinics have been set up in specialist centres during the last ten years and their activities described. The group of patients with Parkinson's disease attended in the clinics of specialist centres have the distinguishing feature of where they are treated, which makes them different to other groups with the same disorder. OBJECTIVE: In this article we describe the general data of neurological attention for patients with Parkinson's disease, seen in two clinics belonging to specialist centres. PATIENTS AND METHODS: This article is based on records of patients made by neurologists of two structured centres in Hospital La Fe. RESULTS: In a period of 18 months 228 patients with Parkinson's disease were recorded out of a total case register of 5,101. Patients with Parkinson's disease made up between 4% and 5% of the patients attending the clinic. Between 30% and 50% of the patients seen in these clinics were evaluated only once during the period recorded. CONCLUSIONS: There seems to be a large number of cases recorded and these represent 70% of the estimated number of cases in the area. It seems that some patients do not keep in contact with the neurologist. Differences in function noted in clinics of specialist centres, between each other and compared with hospitals, are due to specific organizations and structures.

Adult↗

Early combination of bromocriptine and levodopa in Parkinson's disease: a prospective randomized study of two parallel groups over a total follow-up period of 44 months including an initial 8-month double-blind stage.

To determine if the combination of levodopa (LD) plus bromocriptine (Br) in the early stages of Parkinson's disease (PD) permits reduction of LD dosage and consequently results in fewer motor fluctuations and dyskinesias, a double-blind, multicenter prospective study in 50 PD patients who had responded favorably to LD while under treatment with that drug for < or = 6 months was undertaken. Patients were randomized into two parallel groups (LD alone and LD plus Br). During the first placebo-controlled stage of the study lasting 8 months, association of a fixed dose of Br (15 mg/day) in the LD regimen did not allow a significant reduction in the daily LD dose. Still, in patients on combined LD plus Br, there was a tendency toward smaller daily requirements of LD as compared with those on LD alone, and the difference in LD dose between the two groups was significantly different (515.4 +/- 240 vs. 725.6 +/- 230 mg/day; p < 0.01) after 44 months of continuous treatment in the 40 patients still enrolled in the open-label stage. At that point in time, the mean dose of Br had been increased by 9.2 mg in the combined treatment group, and the mean dose of LD was 40.7% lower than in the group receiving LD alone. On subsequent evaluations, the number of patients with dyskinesias or describing wearing-off fluctuations severe enough to require changes in treatment was lower than in the group under combined therapy, the differences being significant after 20 and 44 months, respectively (36.8 vs. 9.5 and 47.3 vs. 14.2%). Our results support early combined LD-Br therapy in PD, but no conclusions can be drawn as to whether this dopamine agonist exerts a preventive effect on the late side effects of LD or has another mechanism of action.

Aged↗

[Estimate of the prevalence of Huntington disease in the Valencia region using the capture-recapture method].

INTRODUCTION AND OBJECTIVE: The objective of this study was to estimate the prevalence of Huntington's disease in order to devise a programme for diagnosis and prevention. Because of the characteristics of this disease, which is hereditary and of low incidence, few epidemiological studies have been carried out in Spain. Many studies (Medline 1990-1996) give cross-checking of registers as the key to determining the relative extent of the illness. The findings of this comparison of registers are not limited to the numerical quantification of a health problem, but are combined with active case search strategies, since there is now an approximation of probability to a previously unknown area of the disease. MATERIAL AND METHODS: Prevalence in the Valencia Region (Spain), which has a population census of 3,873,812 inhabitants, was estimated by means of the probability method known as capture-recapture. The estimated maximum probability and its confidence interval were calculated. The sources of information used were clinical histories from the regional hospitals and official figures of registered deaths during the period 1987-1992. RESULTS: It was found that there were 41 cases seen in the regional hospitals and 17 deaths recorded in the official statistics, while 4 cases coincided in both sets of statistics. Recovery of 45 cases histories enabled an analysis to be made of the relationship between the disease, sex, age of onset of symptoms, and family history. CONCLUSION: The estimated prevalence was 5.38 x 10(5). The most notable finding was that of a systematically earlier onset of symptoms in women, which was greater when the family history was on the paternal side.

Adult↗

Lithium-induced Creutzfeldt-Jakob syndrome.

a 67-year-old man with bipolar disorder developed a Creutzfeldt-Jakob like syndrome during lithium carbonate treatment. Lithium serum level was within the therapeutic range. Complete clinical-electroencephalographic recovery was achieved after lithium therapy was discontinued. Several cases of lithium-induced Creutzfeldt-Jakob syndrome have been reported to date; all of them were elderly patients and a half had "therapeutic" lithium serum levels. Patients in this age group receiving antimanic maintenance treatment should keep lithium serum levels as low as possible. Lithium neurotoxicity should be considered in Creutzfeldt-Jakob disease differential diagnosis, serial electroencephalograms being the most valuable.

Aged↗

[Sexual dysfunction in Parkinson's disease].

Sexual activity, function and libido in 50 patients with idiopathic Parkinson's disease and no signs of mental deterioration were evaluated by an estructured questionnaire. The sample included 36 men and 14 women with a mean age of 57.9 +/- 10.1 years and a mean time elapsed since onset of 7.01 +/- 3.9 years. We found decreased sexual activity in 68% and a lack of libido admitted by 26%. Although the decrease in sexual activity was found more often in women, this dysfunction was not statistically significant. Decreased sexual desire, however, was statistically significant. Erectile dysfunction was found in 38.8% and was more frequent in patients over 61 years of age.

Aged↗

[Mortality from Parkinson's disease in Spain (1980-1985). Distribution by age, sex and geographic areas].

An approximation of Parkinson's disease in Spain was carried out based on the data of mortality by this disease over the period 1980-1985. The annual number of deaths by Parkinson's disease as well as its distribution by sex, age groups and Spanish provinces was obtained from information published annually by the National Institute of Statistics in the Natural Movement of the Spanish Population. The global mortality rate during the period studied was of 2.14 per 100,000 inhabitants. The specific mortality rate by Parkinson's disease in males was slightly higher than that of females. A specific mortality rate was also observed by age groups being higher in the older age groups. From the point of geographical distribution, higher rates were observed in the northern provinces with respect to the south and in rural areas compared to provinces capitals. Following the analysis of the results obtained and upon comparing the findings published in other countries it was concluded that place of residence may be related to the development of Parkinson's disease. From these data new epidemiological studies are required oriented to the identification of the environmental factors which may play a role in the etiology of this entity.

Age Factors↗

[Oculographic findings in the Arnold-Chiari malformation type I].

The paper deals with 5 adults carriers of this syndrome diagnosed by means of nuclear magnetic resonance (NMR). Neither the conventional radiography nor the plain computerized tomography showed indicative clues of the deformity. However electronystagmography prove in all cases a vertical down beating nystagmus. In one instance the nystagmus become rotatory at lateral glance. In all cases appeared an altered smooth pursuit and a lack of suppression fixation of the vestibular nystagmus. The AA. emphasize the diagnostic value of the electronystagmography (which tracings could spare several other, sometimes expensive, examinations) and suggest a prompt MRI.

Adult↗

Blood serum selenium in the province of Mérida, Venezuela, related to sex, cancer incidence and soil selenium content.

Blood serum selenium levels were measured in healthy subjects of six districts located throughout the province of Mérida, Venezuela. There were either high (87-115 micrograms/L) or low (58-72 micrograms/L) serum selenium-containing districts. Serum selenium in males from three districts were statistically significantly lower (p less than 0.001) than in females. There was a general tendency for serum selenium to increase with age. On the average, a reduction in cancer was observed in the districts with high serum selenium content. Further, serum selenium was lower in male patients from the Mérida district with cancer disease. Association between selenium in soil and in the blood serum of healthy subjects has been observed.

Adolescent↗

[Laryngeal stridor caused by Gerhardt's syndrome in olivopontocerebellar atrophy and a probable striatonigral degeneration].

Communication about 2 Gerhardt's syndromes following two multisystemic diseases of N.C.S. One case produced by an strio-nigrica degeneration, the other one by a degenerative olivo-pontocerebellar process. The AA. underline the importance of the laryngoscopy because of the nocturnal dyspnea present, with its vital high risk. For this reason they recommend the surgery in order to reestablish as soon as possible the airway.

Apnea↗

[Findings of computed tomography in the acute form of Marchiafava-Bignami disease].

We report a case of Marchiafava-Bignami's disease with acute evolution. Pathological examination was carried out and a cavitary lesion with discontinuous longitudinal extension was found throughout the corpus callosum. CT had shown a narrow hypodense area symmetrically localized just anterior to the frontal horns of the lateral ventricles, corresponding to the genus of the corpus callosum. The literature is reviewed, the anatomical-radiological correlations are discussed, and the possibility of the diagnosis of this condition during life is commented.

Acute Disease↗

[Wilson's disease: difficulties in diagnosis and therapeutic management in our country].

The clinical analytical and therapeutic results of a retrospective study of 11 cases of Wilson's disease carried out in "La Fe" Hospital in Valencia are presented. The disease had a neurological onset in 5 cases, an hepatic onset in 4 cases (3 acute hepatitis and 1 chronic hypertransaminemia), 2 cases started as an acute hemolytic anemia; one of the outbreaks occurred during a period of treatment interruption. Diagnosis showed some difficulty in one case since the disease was associated with positive hepatitis B markers, positive anti HIV antibodies and initially normal ceruloplasminemia values. The diagnostic difficulties derived from the interpretation of ceruloplasminemia, and blood and urine copper levels are pointed out as well as the difficulties encountered in our environment to determine intrahepatic copper levels and to perform a kinetic study with radioactive copper both of which are of vital importance to confirm doubtful cases. Two patients became pregnant in the course of the disease having normal pregnancies and deliveries, without any apparent abnormalities in the newborns. Treatment with D-Penicillamine was started in 9 cases, observing a low to moderate intolerance in 7 cases; there was one case of severe intolerance for which treatment had to be interrupted. The new therapeutical approaches based on the use of trientine (not available in our country) are discussed, together with the expectations of liver transplant in this disease.

Adolescent↗