ABSTRACT
This paper describes the design and development of a system for cardio rehabilitation of patients that suffered a myocardial infarction. The proposed solution focuses on exercise prescriptions and the encouragement of healthy behaviors. The innovative strategy of the design takes into account health promotion models to provide safe, assistive exercise training sessions, personalized feedbacks, and educational contents.
Subject(s)
Expert Systems , Monitoring, Ambulatory/instrumentation , Myocardial Infarction/rehabilitation , Physical Therapy Modalities/instrumentation , Self Care/instrumentation , Telemedicine/instrumentation , Therapy, Computer-Assisted/instrumentation , Equipment Design , Equipment Failure Analysis , Humans , Reproducibility of Results , Sensitivity and Specificity , User-Computer InterfaceABSTRACT
Cowden's disease is a rare genodermatosis that is characterized for multiple cutaneous and visceral hamartoma . Lhermitte-Duclos's disease is a cerebelous lesion that consists in the displasic enlargement of the cerebelous circumvolution. It's incluyed in phacomatosis and usually presents associated to Cowden's disease, tuberous sclerosis and overlap syndromes.A 56 years old man, diagnosed in Dermatology with Cowden's disease ten years ago. In the extension study, he had hamartoma intestinal polip, esophagic glucogenic acanthosis and two solid thyroid nodules. The craneal TC didn't show significant alteration. Ten years after diagnosis a cerebral magnetis resonance was performed for intense cephalea, and it was found a bad-defined mass in right cerebelous hemisphere without contrast captation, compatible with cerebelous glangliocytoma.
Subject(s)
Cerebellar Neoplasms/complications , Ganglioneuroma/complications , Hamartoma Syndrome, Multiple/complications , Cerebellar Neoplasms/diagnosis , Female , Ganglioneuroma/diagnosis , Hamartoma Syndrome, Multiple/diagnosis , Humans , Magnetic Resonance Imaging , Male , Middle AgedABSTRACT
La enfermedad de Cowden es una rara genodermatosis que se caracteriza por la aparición de multiples hamartomas tanto a nivel cutaneomucoso como visceral. Es una lesión cerebelosa que consiste en el engrosamiento displásico de las circunvoluciones cerebelosas. Se incluye dentro de las facomatosis y suele presentarse junto a la enfermedad de Cowden, la esclerosis tuberosa o síndromes de solapamiento. Presentamos un paciente de 56 años diagnosticado en la consulta de Dermatología de enfermedad de Cowden hace 10 años. En el estudio de extensión se le diagnostica de poliposis intestinal hamartomatosa, acantosis glucogénica esofágica y se encuentran dos nódulos sólidos tiroideos. A los 10 años del diagnóstico se realiza resonancia magnética nuclear cerebral por aparición de cefalea encontrando una masa mal definida en hemisferio cerebeloso derecho compatible con gangliocitoma displásico cerebeloso
Cowdens disease is a rare genodermatosis that is characterized for multiple cutaneus and visceral hamartoma . Lhermitte-Duclos´s disease is a cerebelous lesion that consists in the displasic enlargement of the cerebelous circumvolution. It´s incluyed in phacomatosis and ussually presents associated to Cowdens disease, tuberous sclerosis and overlap syndromes. A 56 years old man, diagnosed in Dermatology with Cowdens disease ten years ago. In the extension study, he had hamartoma intestinal polip, esophagic glucogenic acanthosis and two solid thyroid nodules. The craneal TC didn´t show significant alteration. Ten years after diagnosis a cerebral magnetis resonance was performanced for intense cephalea, and it was found a bad-defined mass in right cerebelous hemisphere without contrast captation, compatible with cerebelous glangliocytoma
Subject(s)
Male , Adult , Middle Aged , Humans , Hamartoma Syndrome, Multiple/complications , Intestinal Polyposis/complications , Tongue/pathology , Hamartoma Syndrome, Multiple/diagnosis , Intestinal Polyposis/diagnosis , Magnetic Resonance Spectroscopy , Tongue/injuriesABSTRACT
There are clinical difficulties to differentiate elderly-onset rheumatoid arthritis (EORA) patients from those with polymyalgia rheumatica (PMR), especially when dealing with EORA-like PMR-onset, seronegative EORA, and PMR with peripheral synovitis, which constitute the subgroups presenting the greatest difficulties. Serum samples were obtained from two groups of patients, one with EORA diagnosis and another with a PMR diagnosis. Anticyclic citrullinated peptide (anti-CCP) antibodies (enzyme-linked immunosorbent assay method) and rheumatoid factor (RF; latex technique) were determined. Of the 16 EORA patients, 9 presented anti-CCP antibodies, 4 of whom tested positive for RF. Of the 12 EORA patients who remained negative to RF, 5 were positive for anti-CCP antibodies. Eight of the EORA patients started with polymyalgic symptoms. Three of these patients showed positive titles of anti-CCP antibodies with negative RF. All PMR patients presented negative anti-CCP antibodies, except one with weak positive titles, and all were negative for RF. Of 15 patients with PMR, 7 presented oligoarticular synovitis at the onset. After a mean follow-up of 3 months, two patients developed RA. When evaluating them for RF and anti-CCP antibodies, one tested negative, while the other was positive for both antibodies. We observed a tendency to higher values of anti-CCP antibodies in patients with extraarticular manifestations, radiological damage, and disease-modifying antirheumatic drugs. When compared to the PMR group, EORA patients presented positive anticitrulline antibodies at the beginning of the disease in a statistically significant amount. One third of the seronegative EORA patients presented positive anti-CCP antibodies at the onset.
Subject(s)
Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/epidemiology , Autoantibodies/blood , Peptides, Cyclic/immunology , Polymyalgia Rheumatica/diagnosis , Age of Onset , Aged , Aged, 80 and over , Arthritis, Rheumatoid/blood , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Rheumatoid Factor/blood , Sensitivity and SpecificityABSTRACT
INTRODUCTION: The disorders of the autistic spectrum form a collection of symptoms due to dysfunction of the central nervous system with great variations in the degree of severity. Autism is considered to be a generalized disorder of development (DSM-IV). Autism is not defined as a specific disease, since it does not have a specific aetiology. DEVELOPMENT: There are many syndromes related to autism, but most of these disorders are not selective and show a combination of autistic symptoms together with symptoms of neurological dysfunction. There is no specific aetiology, although in recent years genetics have been shown to be important. The prevalence varies between 1 and 1.2/1,000. Boys are more often affected than girls, in a proportion of 3-4 to 1. Diagnosis is clinical and is based on alterations of social interaction, problems of communication and also a restricted range of activities and interests (DSM-IV). There are anomalies associated with behaviour problems, such as delay in speaking, mental retardation, sensorial defects and motor difficulties. CONCLUSIONS: Over 75% of autistic children have mental retardation, and this proportion is higher in severe cases, especially when the children have attention deficit with hyperactivity. These children have many of the typical signs of autism: stereotyped movements, inappropriate language, obsessive behaviour with little mental flexibility, naivety and little skill in social interaction. In these cases it is difficult to draw the line between mental retardation and autism.
Subject(s)
Autistic Disorder/diagnosis , Attention Deficit Disorder with Hyperactivity/etiology , Autistic Disorder/complications , Autistic Disorder/physiopathology , Child , Communication Disorders/etiology , Female , Humans , Intellectual Disability/etiology , Male , Social Behavior , SyndromeABSTRACT
INTRODUCTION: Reflex epileptic seizures are caused by a specific sensorial stimulus which determines their classification. Photosensitive epilepsies are the commonest forms and are included with the idiopathic generalized epilepsies. DEVELOPMENT AND CONCLUSIONS: We analyze the different responses to intermittent light stimulation, in both normal and epileptic persons, and study the various epileptic syndromes in which photosensitivity is seen. The purely photosensitive (photogenic) epilepsies are characterized by seizures caused only by light as compared with the epilepsies with photosensitivity which also present spontaneous seizures. Special mention is made of seizures induced by the television screen, computer screen and video-games. The palpebral myoclonias with absences may be considered to be reflex seizures, since they are induced by eyelid closure, and include the vary rare self-induced epileptic seizures. Finally we study the epileptic seizures induced by pattern and exclusively due to intermittent light stimulation.
Subject(s)
Epilepsy, Reflex , Child , Electroencephalography , Epilepsy, Reflex/classification , Epilepsy, Reflex/physiopathology , Humans , Photic StimulationABSTRACT
INTRODUCTION: The idiopathic generalized epilepsies of childhood form a heterogeneous group of epileptic syndromes, with certain clinical and electroencephalographic characteristics in common. From the onset, the seizures affect both cerebral hemispheres with generalized clinical expression and from the start there are bilateral electroencephalographic patterns during seizures. These epilepsies have no known causes, there is a genetic predisposition and relation to the age of onset. The electroencephalographic characteristics during and between seizures have points in common: the basal electroencephalographic activity is normal in all the epilepsies of this group, the paroxystic anomalies are generalized, synchronic and symmetrical, and are formed of bilateral discharges of spikes, multiple spikes, spikes and waves and multiple spikes and waves, with discharges at a frequency of 3 Hz or more. DEVELOPMENT: In this article we review the electroencephalographic characteristics during and between seizures of the idiopathic generalized epilepsies and epileptic syndromes of childhood, with particular emphasis on childhood absences, since we consider this to be the commonest and most representative of the idiopathic generalized epilepsies of infancy. CONCLUSIONS: We consider that the electroencephalographic aspects of epilepsies and the epileptic syndromes make up a factor of great importance as a help in confirmation in diagnosis.
Subject(s)
Electroencephalography , Epilepsy, Generalized/diagnosis , Adolescent , Child , Child, Preschool , Epilepsies, Myoclonic/diagnosis , Epilepsies, Myoclonic/physiopathology , Epilepsy, Absence/diagnosis , Epilepsy, Absence/physiopathology , Epilepsy, Benign Neonatal/diagnosis , Epilepsy, Benign Neonatal/physiopathology , Epilepsy, Generalized/classification , Epilepsy, Generalized/physiopathology , Epilepsy, Reflex/diagnosis , Epilepsy, Reflex/physiopathology , Epilepsy, Rolandic/diagnosis , Epilepsy, Rolandic/physiopathology , Humans , Infant , Infant, Newborn , Myoclonic Epilepsy, Juvenile/diagnosis , Myoclonic Epilepsy, Juvenile/physiopathology , Spasms, Infantile/diagnosis , Spasms, Infantile/physiopathologyABSTRACT
OBJETIVOS: Analizar la epidemiología y espectro clínico de la endocarditis infecciosa (EI) sobre válvula natural en el anciano y compararla con la que ocurre en otras edades. PACIENTES Y MÉTODOS: Se seleccionaron pacientes ancianos (edad = 65 años) diagnosticados de EI y se compararon con un grupo control de edad inferior a 60 años diagnosticados consecutivamente de EI. Se excluyeron los pacientes portadores de prótesis valvulares y adictos a drogas intravenosas. RESULTADOS: Fueron incluidos 12 pacientes ancianos con EI, con una edad media de 76,1ñ 5,1 años y 83,3 por ciento varones. Los ancianos presentaban un mayor porcentaje de comorbilidades predisponentes (75 por ciento por 20,8 por ciento), predominando las neoplasias y la diabetes mellitus. Entre las cardiopatías subyacentes en el anciano predominaron las valvulopatías degenerativas, mientras que en los controles predominó la reumática. No hubo diferencias en los hallazgos clínicos salvo un menor grado febril, mayor retraso diagnóstico y menor leucocitosis entre los ancianos. Hubo una mayor tendencia a EI por Streptococcus bovis y enterococos en el anciano. Las complicaciones fueron más frecuentes en los ancianos, sobre todo insuficiencia cardiaca (83,3 por ciento por 37,5 por ciento) y arritmias (50 por ciento por 12,5 por ciento). Hubo tendencia a una mayor mortalidad en los ancianos (33,5 por ciento por 12,5 por ciento). CONCLUSIONES: La EI es frecuente en ancianos con enfermedades debilitantes y tiende a tener un curso evolutivo más desfavorable (AU)
Subject(s)
Adult , Aged , Female , Male , Middle Aged , Aged, 80 and over , Humans , Endocarditis, Bacterial/epidemiology , Heart Valve Diseases/epidemiology , Staphylococcus , Streptococcus , Case-Control Studies , Heart Valve Diseases/microbiology , Heart Valve Diseases/mortality , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/mortality , Cohort Studies , Incidence , Spain/epidemiologyABSTRACT
Spermatic cord entrapment is an unusual complication of inguinal herniorrhaphy. The case of a 52-year-old man who presented with severe pain along the left spermatic cord and testicle, varicocele, and dyspareunia after a laparoscopic bilateral inguinal hernia repair performed elsewhere is reported. Medical treatment failed, and laparoscopic exploration showed the vas deferens and spermatic vessels entrapped by a mesh slit that was pulling the genital branch of the genitofemoral nerve. The vas deferens and spermatic vessels were released, neurotomy of the affected nerve branch was performed, and a new mesh was positioned in the residual space. The patient's pain disappeared completely after the surgery and the varicocele decreased progressively. The patient remains asymptomatic at 1-year follow-up. Laparoscopy might be the approach of choice to treat some of the complications of laparoscopic hernia repair, not only because it allows better observation of the anatomic structures, but also because the surgical therapy can be done with minimal tissue damage compared to the traditional approach.
Subject(s)
Compartment Syndromes/surgery , Hernia, Inguinal/surgery , Laparoscopy/adverse effects , Spermatic Cord , Compartment Syndromes/etiology , Follow-Up Studies , Hernia, Inguinal/diagnosis , Humans , Laparoscopy/methods , Male , Middle Aged , Reoperation , Treatment OutcomeABSTRACT
INTRODUCTION: The childhood opsoclonus-myoclonus or Kinsbourne syndrome, is a uncommon process, of acute or subacute beginning, which affects infant and children. It's course is characterized by opsoclonus, polimyoclonias and cerebellar ataxia. The disease is frequently associated to neuroblastoma (46%). MATERIAL AND METHODS: We present a retrospective study on 9 patients, emphasizing the clinical presentation and the evolution aspects. RESULTS AND CONCLUSIONS: We found changes in the EEG in three cases. Most surprising is the scarce incidence of neuroblastoma, which has been found only in a one out of nine patients. We found three cases with relapse during the treatment or on withdrawal and one of them relapsed twice again. The evolution has been variable, since 5/9 patient have presented some type of mild or moderate neuro-psychological sequelae. Out of three patient with relapses, two presented permanent neurological sequelae. A patient which suffered three relapses, is also the one which presents more serious sequelae.
Subject(s)
Cerebellar Ataxia/epidemiology , Myoclonus/epidemiology , Ocular Motility Disorders/epidemiology , Abdominal Neoplasms/complications , Abdominal Neoplasms/epidemiology , Adolescent , Adrenocorticotropic Hormone/therapeutic use , Brain Damage, Chronic/etiology , Cerebellar Ataxia/drug therapy , Cerebellar Ataxia/etiology , Child , Child, Preschool , Electroencephalography , Female , Follow-Up Studies , Ganglioneuroblastoma/complications , Ganglioneuroblastoma/epidemiology , Humans , Male , Myoclonus/drug therapy , Myoclonus/etiology , Ocular Motility Disorders/drug therapy , Ocular Motility Disorders/etiology , Recurrence , Retrospective Studies , Syndrome , Virus Diseases/complicationsABSTRACT
INTRODUCTION AND MATERIAL: Between 369 cases of benign partial epilepsy of the childhood with Rolandic spikes (BECRS) diagnosed in our hospital, we have been able to study three patients that have presented a neurophysiological and clinical presentation that was compatible with the form described by Aicardi and Chevrie in 1982. RESULTS: None of our patients had familial epilepsy precedents. There were no pathological birth or previous neurological disorders. The neurophysiological development was normal until the beginning of the clinical picture. The seizures began when the patients were 3 years and 4 months, and 5 years, with partial seizures of the same characteristic that present patients with BECRS. Two of them had generalized tonic-clonic seizures during sleep. All the patients presented throughout the evolution absences myoclonic and/or atonic seizures. The awake EEG patterns showed normal background activity and paroxysms of focal spike were complexes with diffusion to central areas. During the slow wave sleep, every cases showed paroxysms of diffuse and generalized slow spike and wave complexes practically continuous. The partial seizures were scarce, but the absences and the atonicas seizures presented several times every day, and in one case appeared in the form of a grand mal state. CONCLUSIONS: The evolution of the patients was favourable, as they were free of seizures, with a normal neurophysiological development. At the beginning, the seizures were resistant to treatment with several antiepileptics drugs (AED). The treatment with valproic acid (VPA) and clonazepam (CZP), has been very effective.
Subject(s)
Electroencephalography , Epilepsies, Partial/physiopathology , Epilepsy, Rolandic/physiopathology , Anticonvulsants/therapeutic use , Carbamazepine/therapeutic use , Child, Preschool , Clonazepam/therapeutic use , Epilepsies, Partial/classification , Epilepsies, Partial/drug therapy , Epilepsy, Absence/drug therapy , Epilepsy, Absence/etiology , Epilepsy, Absence/physiopathology , Epilepsy, Rolandic/classification , Epilepsy, Rolandic/drug therapy , Epilepsy, Tonic-Clonic/drug therapy , Epilepsy, Tonic-Clonic/etiology , Epilepsy, Tonic-Clonic/physiopathology , Humans , Male , Remission, Spontaneous , Sleep Wake Disorders/drug therapy , Sleep Wake Disorders/etiology , Sleep Wake Disorders/physiopathology , Valproic Acid/therapeutic useABSTRACT
Symptomatic epilepsy secondary to hereditary metabolic or degenerative disorders, is usually associated to neurological deterioration. Though epilepsy by itself does not induce neurological deterioration, we should remind that some epileptics encephalopathies, such as the West or Lennox-Gastaut syndromes, do actually induce limited neurological deterioration. Furthermore, in some forms of complex partial epilepsy, motor problems and behavior disorders can be observed, specially in adolescents with temporary lobe epilepsy. Other forms of epilepsy, such as the atypical benign partial epilepsy or the Landau-Kleffner syndrome, can present a certain degree of cognitive deterioration in the evolution, although they can recover later lost functions, totally or partially. The evolution of some refractory epilepsy, as patients are submitted to a multiple treatments, can make us suspect a degenerative disease. In some cases, the diagnosis of the hereditary metabolic and heredodegeneratives diseases can be made by the characteristics of the seizures but in most cases the diagnosis will be established by the symptoms of the basic disease and the lab data.
Subject(s)
Epilepsy/diagnosis , Nervous System Diseases/diagnosis , Adolescent , Brain Diseases/complications , Brain Diseases/diagnosis , Brain Diseases/genetics , Child , Child, Preschool , Cognition Disorders/diagnosis , Cognition Disorders/etiology , Diagnosis, Differential , Disease Progression , Electroencephalography , Epilepsy/etiology , Epilepsy/genetics , Humans , Infant , Infant, Newborn , MERRF Syndrome/complications , MERRF Syndrome/diagnosis , Metabolism, Inborn Errors/complications , Metabolism, Inborn Errors/diagnosis , Metabolism, Inborn Errors/genetics , Nervous System Diseases/complications , Nervous System Diseases/genetics , Seizures/diagnosis , Seizures/etiology , Spasms, Infantile/diagnosis , SyndromeABSTRACT
INTRODUCTION AND CLINICAL CASE: We present a male patient which presented distal muscular stiffness, from the first hours of the life. At this time, he also presented episodes of generalized muscular hypertonia with cyanosis and apnoea, started by somato-sensorial stimuli. Those episodes were terminated by passive flexion of the extremities and the head. Later, dream myoclonic jolts appeared. EEG tracings during hypertonic episodes showed an initial artefact potential followed by bursts of rhythmic and repetitive acute potentials in the bilateral fronto-central regions, at a 20-22 Hz frequency, similar to an epileptiform spike-wave burst. The EMG showed a continuous muscular activity, suppressed by rest and the administration of diazepam. Treatment with oral diazepam has been very effective. Now, the patient is four years old, is asymptomatic and continues treatment with oral diazepam. If the dose is decreased, the child starts unstable march, startle response on somatosensory stimuli with falls, and above all nocturnal myoclonia. The patient does not have familiar antecedents of hyperekplexia, even in its minor form. CONCLUSION: Clinical picture suggests us a not familiar form of hyperekplexia.
Subject(s)
Stiff-Person Syndrome/diagnosis , Electroencephalography , Electromyography , Humans , Infant , Male , Stiff-Person Syndrome/physiopathology , Terminology as TopicABSTRACT
INTRODUCTION: The Adie tonic pupil is an intrinsic, isolated and benign ophthalmoplegia producing defective accommodation and anisocoria. The affectation is unilateral in the 90% of cases and can appear at any age. If associated to patellar tendinous reflexes abolition, constitutes Holmes-Adie syndrome. CLINICAL CASE: We present a 6 years old girl. She suffered a right temporal trauma with cephalea and vomiting for a few hours. After two months, she presented right mydriasis. There were no familiar antecedents. After a year evolution, she has not presented clinical changes. CONCLUSION: We comment the process's physiopathology.
Subject(s)
Adie Syndrome/diagnosis , Anisocoria/diagnosis , Child , Female , Humans , Reflex, Pupillary/physiologyABSTRACT
For many years, Rifampicin has been used empirically for the treatment of hemophilic chronic synovitis with encouraging results. A study was performed in which Rifampicin was shown to reduce the inflammation of joints affected by hemophilic synovitis. A clinical study was performed on 48 hemophilic patients (48 joints). Seventeen elbows, eight knees, and 23 ankles were treated. The mean age of the patients was 6 years (range, 4-23 years) and the mean followup was 29 months (range, 24-53 months). Overall, 40 excellent results and eight good results were obtained. The average number of weekly injections of Rifampicin was 3.06 (range, 1-10 injections). Eight patients experienced pain on the first injection, which subsided gradually with the subsequent procedures. Synoviorthesis with Rifampicin seems to be a good method for the treatment of hemophilic synovitis, especially in small joints (elbows and ankles) and in younger children.
