ABSTRACT
Gastroesophageal reflux disease (GERD) is a common disorder of the upper gastrointestinal tract which is typically characterized by heartburn and acid regurgitation. These symptoms are widespread in the community and range from 2.5% to more than 25%. Economic analyses showed an increase in direct and indirect costs related to the diagnosis, treatment and surveillance of GERD and its complications. The aim of this review is to provide current information regarding the natural history of GERD, taking into account the evolution of its definition and the worldwide gradual change of its epidemiology. Present knowledge shows that there are two main forms of GERD, that is erosive reflux disease (ERD) and non-erosive reflux disease (NERD) and the latter comprises the majority of patients (up to 70%). The major complication of GERD is the development of Barrett esophagus, which is considered as a pre-cancerous lesion. Although data from medical literature on the natural history of this disease are limited and mainly retrospective, they seem to indicate that both NERD and mild esophagitis tend to remain as such with time and the progression from NERD to ERD, from mild to severe ERD and from ERD to Barrett's esophagus may occur in a small proportion of patients, ranging from 0 to 30%, 10 to 22% and 1 to 13% of cases, respectively. It is necessary to stress that these data are strongly influenced by the use of powerful antisecretory drugs (PPIs). Further studies are needed to better elucidate this matter and overcome the present limitations represented by the lack of large prospective longitudinal investigations, absence of homogeneous definitions of the various forms of GERD, influence of different treatments, clear exclusion of patients with functional disorders of the esophagus.
Subject(s)
Disease Progression , Gastroesophageal Reflux/pathology , Adult , Barrett Esophagus/etiology , Esophagitis/etiology , Esophagus/pathology , Female , Gastroesophageal Reflux/complications , Gastroesophageal Reflux/epidemiology , Humans , Male , Middle AgedABSTRACT
Thirteen subjects with trigeminal neuralgia were treated with botulinum-A neurotoxin (BoNT/A) in an open-label pilot study. After BoNT/A, visual analog scale score, surface area of pain, and therapeutic coefficient were reduced in all patients and for all branch trigeminal nerves studied. Therefore, BoNT/A is an efficient treatment. There were no major side effects. A placebo-controlled clinical trial is needed to confirm these findings.
Subject(s)
Botulinum Toxins, Type A/administration & dosage , Trigeminal Nerve/drug effects , Trigeminal Neuralgia/drug therapy , Aged , Analgesics/therapeutic use , Anticonvulsants/therapeutic use , Blepharoptosis/chemically induced , Botulinum Toxins, Type A/adverse effects , Female , Humans , Male , Middle Aged , Neuropeptides/antagonists & inhibitors , Neuropeptides/metabolism , Neurotoxins/administration & dosage , Neurotoxins/adverse effects , Nociceptors/drug effects , Nociceptors/physiology , Pain Measurement/drug effects , Pain Threshold/drug effects , Pain Threshold/physiology , Pilot Projects , Sensory Receptor Cells/drug effects , Sensory Receptor Cells/physiology , Synaptic Transmission/drug effects , Synaptic Transmission/physiology , Treatment Outcome , Trigeminal Nerve/physiopathology , Trigeminal Neuralgia/physiopathologyABSTRACT
We evaluated 44 patients with tics and Tourette's syndrome (TS) emphasising the age of onset of symptoms, sex, classification and localization of tics, associated symptoms and signs and comorbidities. Thirty-three patients (75.2%) had TS defined criteria whereas 10 (22.7%) had chronic motor and/or vocal tics. Simple motor tics were found in 43 cases (97.7%), mainly affecting the eyes (43.2%), mouth (43.2%), face (34.1%). Simple vocal tics occurred in 33 (75%). Coprolalia was found in just 6 cases (13.6%) and copropraxia in just 2 (4.5%). Obsessive compulsive disorder and/or symptoms were found in 26 cases (59.1%) and attention deficit in 17 (38.6%). Eighteen patients (40.9%) had other disorders, such as alcoholism, tabagism, drug abuse, affective disorders, anxiety, sleep and learning disorders. The data obtained are similar to those found by other authors. We highlight the low frequency of coprolalia, as well as the associated neuropsychiatric disorders.
Subject(s)
Tics/complications , Tourette Syndrome/complications , Adolescent , Adult , Age of Onset , Attention Deficit Disorder with Hyperactivity/complications , Attention Deficit Disorder with Hyperactivity/diagnosis , Brazil/epidemiology , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Obsessive-Compulsive Disorder/complications , Obsessive-Compulsive Disorder/diagnosis , Retrospective Studies , Tics/diagnosis , Tourette Syndrome/diagnosisABSTRACT
Autosomal recessive hereditary spastic paraplegia (AR-HSP) associated with thin corpus callosum was recently described in Japan, and most families were linked to chromosome 15 q13-15. We report two patients from two different Brazilian families with progressive gait disturbance starting at the second decade of life, spastic paraparesis, and mental deterioration. One patient presented cerebellar ataxia. Magnetic resonance imaging (MRI) of the head of both patients showed a thin corpus callosum. AR-HSP with a thin corpus callosum is a rare disorder, mainly described in Japanese patients. We found only 4 Caucasian families with AR-HSP with thin corpus callosum described in the literature. Further studies including additional Caucasian families of AR-HSP with thin corpus callosum are required to delineate the genetic profile of this syndrome in occidental countries.
