Neuropatía por disulfiram: comunicación de tres casos clínicos / Disulfiram neuropathy: report of 3 cases

Disulfiram is widely used for aversive treatment of alcoholism. Although it is well tolerated in most patients, one in 15,000 patients will develop peripheral neuropathy every year, which is frequently misdiagnosed as alcoholic neuropathy. Disulfiram neuropathy can be mild or severe, depending on diverse factors such as time of exposure and the dosage. Most patients will present with a motor-sensory neuropathy of the lower limbs, which tends to improve as disulfiram administration ceases, however some cases may remain with permanent sequelae. We report the clinical, laboratory and electrophysiological features of three patients who developed disulfiram neuropathy during treatment of alcoholism. Recovery was incomplete at 8 weeks after treatment cessation in all of them. No other findings justified the clinical features described in these patients. Considering the incidence of alcoholism and the wide use of disulfiram treatment in Chile, we suggest that disulfiram neuropathy is being underdiagnosed. We also stress the fact that disulfiram neuropathy could be avoided by using lower doses

Prevalencia de la ateromatosis carotídea en pacientes con enfermedad cerebro vascular oclusiva / Prevalence of carotid atherosclerosis among patients with ischemic stroke

Background: Hispanics have a greater incidence of stroke and prevalence of intracranial atherosclerosis than whites. Aim: To study the prevalence of extracranial atherosclerosis among patients admitted to a hospital with an ischemic stroke. Material and methods : A prospective study in stroke patients admitted to a Neurology ward in a University Hospital. All were subjected to a CT scan, carotid duplex-Doppler ultrasonographic examination with Doppler measurement of blood flow velocity, permeability and plaques. Cardiac emboli were searched with transthoracic and transesophagic echocardiography. Results: One hundred ten patients (39 women), aged 67.5ñ11.4 years old were studied. Stroke was atherothrombotic in 46 (41.8 percent), embolic in 30 (27.3 percent), lacunar in 27 (24.6 percent) and of other type in 7 (6.4 percent). Ninety two patients (84.4 percent) had high blood pressure, 38 percent had high cholesterol levels, 35 percent had a cardiac disease and 26 percent were smokers. Thirty five subjects (31.8 percent) had a normal carotid ultrasonography, 46 (41.8 percent) had mural plaques, 16 (14.5 percent) had multiple plaques without occlusion, 13 (11.8 percent) had a partial occlusion and 7 (6,4 percent) had a total occlusion. Logistic regression analysis disclosed no significant relationship between stroke types and carotid atherosclerosis. Age was the only significant predictor for carotid atherosclerosis. Conclusions: The prevalence of severe carotid atherosclerosis in this group of stroke patients was less than expected

Aplicaciones de la musicoterapia en la medicina / Medical uses of musical therapy

Music therapy is a science that has been applied since many centuries ago, but it has been organized as a profession during the past century. This science studies the therapeutic effects of music in human beings. Profesionals who practice this science are called "music therapists" and they must be trained not only in music theory and performance, but also in psychology, anatomy, research techniques, and other subjects. Today, we can find music therapy research in many areas such as the effects of music in children with autism, adults with psychiatric illnesses, elderly with Alzheimer and Parkinson disease, people with brain injuries, among others. Numerous studies demonstrate the functionality of music therapy in patients with neurological disorders. These studies show that music helps patients to gain control over their walking patterns after a brain injury, stimulates long and short term memory in patients with Alzheimer disease, and increase self esteem and social interaction in elders

Talleres de estimulación cognitiva en adultos mayores: experiencia preliminar / Cognitive stimulation in old age: preliminary report

Objective: to test the utility of cognitive stimulation in a group of healthy older people. Design: a pilot study in 11 healthy women from Conchali council. All of them were evaluated before and after stimulation using Minimental State Examination of Folstein (MM), Memory Wechsler Scale (MW) and Geriatric Depression Scale (GDS). Participants: were selected from a group of regularly participants in center for seniors, aged 60 years or more (mean 66,6 years old), able to read and write (mean scholarship 5,3 years). Intervention: 16 workshop of 90 minutes, twice a week during 2 months. They had motivation pantomime plays, memory activities and so on. Result: Wilcoxon signed rank pre and post workshop for MM was -2.633 (p= 0.008), for MW was -2.938 (p= 0.003) and for GDS was -2.943 (p= 0.03) Conclusions: cognitive stimulation could be useful in older people. It is necessary to increase the sample

Fibrinolisis en el infarto cerebral / Fibrinolysis in brain infarction

Hasta hace poco años atrás no existía una terapia espececífica para el tratamiento del infarto cerebral (IC), sin embargo en los últimos treinta años la trombolisis constituyó un campo activo de la investigación terapéutica orientada a solucionar esta deficiencia en el tratamiento del IC. Actualmente la trombolisis es la única terapia específica disponible para casos seleccionados de IC. En este artículo presentamos una revisión de la literatura relacionada a la terapia fibronolítica como tratamiento IC y entregamos una pauta de criterios para el uso de fibronolítico con las prepaciones comerciales disponibles actualmente. Las recomendaciones dada en este trabajo están respaldadas por evidencia científica demostrada

Niveles de colesterol y accidente vascular hemorrágico: un estudio de casos y controles en Chile / Blood cholester level and hemorrhagic stroke: a case control study in Chile

Objetivo: estudiar el colesterol sérico como factor de riesgo en el accidente vascular encefálico hemorrágico. Diseño: es un estudio de casos y controles, asumiendo un riesgo relativo de 2, un Alfa de 0,20, 15 por ciento de prevalencia de colesterol alto en los controles,la muestra mínima fue de 112 casos y 112 controles. Pacientes: corresponden a pacientes prospectivos al hospital J.J. Aguirre, de la Universidad de Chile entre agosto de 1992 y julio de 1994. Todos ellos tenían tomografía cerebral. Los controles fueron pacientes ingresados a otras unidades del Hospital Clínico, sin el diagnóstico de hemorragia cerebral y fueron pareados por edad y sexo con los casos. Otras variables estudiadas fueron: diabetes, alcohol, enfermedad hepática, uso crónico de medicamentos. Se analizó utilizando STATA 3.1 empleando análisis pareado y análisis de regresión logística condicional

Estudio de los efectos neurotóxicos del bromuro de metilo sobre trabajadores expuestos / Study of neurotoxic effects of methyl bromide over exposed workers

We studied prospectively 15 male middle age workers before and after a fumigation period with methyl bromide, that lasted 2 to 4 weeks. According to the initial assessment, 5 of these subjects had a chronic exposure to the chemical. As controls, 10 non exposed workers matched for age, sex and working conditions were studied in 2 occasions. The evaluation included the Who Neuro Behavior Core Test Battery, dynamometric and vibrator assessment of peripheral nerve function, the Nothingham test for psychological functioning and Titmus test for visual acuity. Methyl bromide levels were measured in blood and irine. Blood methyl bromide levels increased from 13.3 to 30 mg/dl after headache, paresthesiae, mood changes and loss of memory and concentration. In these subjects, the threshold for the Vibration test increased from 2.4 to 2.85 sec, dynamometry the score fro negative auto-perception in the Nothingham test from 11.2 to 13.6. No deterioration in these tests were observed in unexposed workers. Acute and chronic methyl bromide exposure causes important psychological and neurological derangement