ABSTRACT
BACKGROUND: Arachnoid cysts are extra-axial cerebrospinal fluid (CSF) collections surrounded by a membrane. Occasionally, hydrocephalus is associated due to a change in CSF circulatory dynamics. Neuroendoscopic treatment has been recommended for patients who develop symptoms resulting from the cyst location. METHODS: We retrospectively evaluate the results in our series of 9 patients with hydrocephalus associated to midline arachnoid cysts treated endoscopically. Success was rated on a scale of five degrees of neuroendoscopical success. RESULTS: We performed endoscopic third ventriculostomy (ETV) in three cases; ETV was associated to ventriculocystostomy (VC) in three cases; ETV, VC and septostomy (SPT) were performed in one patient; neuroendoscopic Monro foraminoplasty (NEFPMO) plus SPT were associated in one case; last patient was performed ETV, VC and cystocysternostomy (CC). For first procedures, 6 patients completed permanent Success (grade I). In one case success was transitory (grade II) and required a second procedure (ETV). In one patient VC success and ETV failure implied partial success (grade III). One patient's early failure (grade V) required a second procedure (ETV + NEFPMO). Success in second procedures was grade I in both patients. Follow-up period was over 12 months and altogether success was grade I in 8/9 patients and grade III in 1/9 patients. Shunt independency went over 88%. CONCLUSIONS: Endoscopy allows a solution avoiding the implantation of cerebrospinal fluid shunt devices. When possible, we likely approach both, hydrocephalus and arachnoid cyst, with different endoscopic maneuvers in a single procedure. It is important to expand the usage of success classifications for combined procedures.
Subject(s)
Arachnoid Cysts/surgery , Hydrocephalus/surgery , Neuroendoscopy/methods , Ventriculostomy/methods , Arachnoid Cysts/complications , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Hydrocephalus/etiology , Infant , Male , Retrospective Studies , Treatment OutcomeABSTRACT
BACKGROUND: The purpose of this study was to determine the prevalence of substance use disorders (substance abuse or substance dependence: SA/SD) in a large sample of Bipolar Type I (BPI) patients drawn from the Costa Rican population and to describe the effects of SA/SD on the course of their bipolar disorder. METHOD: 110 subjects from two high-risk (for BPI) Costa Rican pedigrees and 205 unrelated Costa Rican BPI subjects were assessed using structured interviews and a best estimate process. Chi(2) and survival analyses were performed to assess the effect of gender on comorbidity risk, and the effect of comorbidity on the clinical course of BPI. RESULTS: SA/SD (primarily alcohol dependence) occurred in 17% of the BPI patients from the population sample and 35% of the BPI patients from the pedigree sample. Comorbid SA/SD was strongly associated with gender chi(2) = 16.84, P = 0.00004). In comorbid subjects, alcohol dependence tended to predate the first manic episode (chi(2) = 6.54, P < 0.025). History of SA/SD did not significantly alter the prevalence of psychosis or age of onset of mania in BPI subjects. CONCLUSIONS: These results suggest that SA/SD comorbidity rates are lower in this type of population than in BPI patient populations in the US. Gender is a strong predictor of comorbidity prevalence in BPI patients from this population. Although SA/SD may be a risk factor for precipitating BPI in those at risk, in this population comorbid BPI subjects do not have a different onset or course of BPI in comparison to BPI patients without comorbidity.
Subject(s)
Bipolar Disorder/genetics , Substance-Related Disorders/genetics , Bipolar Disorder/complications , Bipolar Disorder/ethnology , Comorbidity , Costa Rica/epidemiology , Costa Rica/ethnology , Female , Humans , Male , Middle Aged , Pedigree , Prevalence , Risk Factors , Sex Factors , Substance-Related Disorders/complications , Substance-Related Disorders/ethnologyABSTRACT
Genomewide association studies may offer the best promise for genetic mapping of complex traits. Such studies in outbred populations require very densely spaced single-nucleotide polymorphisms. In recently founded population isolates, however, extensive linkage disequilibrium (LD) may make these studies feasible with currently available sets of short tandem repeat markers, spaced at intervals as large as a few centimorgans. We report the results of a genomewide association study of severe bipolar disorder (BP-I), using patients from the isolated population of the central valley of Costa Rica. We observed LD with BP-I on several chromosomes; the most striking results were in proximal 8p, a region that has previously shown linkage to schizophrenia. This region could be important for severe psychiatric disorders, rather than for a specific phenotype.
Subject(s)
Bipolar Disorder/genetics , Chromosome Mapping , Chromosomes, Human, Pair 8/genetics , Linkage Disequilibrium/genetics , Costa Rica , Female , Genetic Markers , Genome, Human , Haplotypes/genetics , Humans , Male , Pedigree , Polymorphism, Single Nucleotide/geneticsABSTRACT
Sin embargo, no que los tres o cuatro años de entrenamiento va a hacer solamente ese tipo de trabajo. Debe promediarse, de acuerdo a posibilidades del lugar de adiestramiento y del interés personal, del residente, todas las otras actividades formativas y áreas del conocimiento psiquiátrico señaladas al principio de esta exposición. Si creo que la Psiquiatría Social, de Comunidad, las acciones en pro de la salud mental debe ser del interés del entrenando, pero para que ocurra un verdadero aprendizaje en esta orientación, para que esto ocurra, las estructuras asistenciales donde se va a tomar deben corresponder, existiendo y funcionando de acuerdo a este modelo del ejercicio médico psiquiátrico.