Minimally invasive cerebral revascularization in moyamoya disease in adult patients.

BACKGROUND: Moyamoya disease (MMD) affects young patients, is generally progressive, and results in strokes or cerebral hemorrhages for which medical management is not effective. OBJECTIVE: To determine the effectiveness of surgical management with minimally invasive cerebral revascularization in MMD. MATERIAL AND METHODS: We conducted a retrospective cohort study of patients undergoing extracranial-intracranial microsurgical revascularization surgery with mini-craniotomy, analyzing the epidemiological, clinical, neuroimaging, postoperative evolution, and complications. We describe the technique in detail. Key outcomes included graft patency, complications, and recurrence of ischemic or hemorrhagic stroke. RESULTS: From September 2017 to December 2020, 12 brain revascularization procedures for MMD were performed in eight patients (four bilateral), and all 12 grafts were classified as patent. The main complication was contralateral cerebral infarction identified by postoperative neuroimaging in a patient without clinical symptomatology. There was no case of scalp ischemia or necrosis when performing the minimally invasive approach with linear incision. CONCLUSIONS: The results of this study suggest that the minimally invasive extracranial-intracranial cerebral revascularization procedure for MMD in adults is effective, with graft patency in all cases and minimal morbidity.

Prevalencia de Incontinencia urinaria en personas mayores chilenas y su impacto en la calidad de vida: Encuesta Nacional / Prevalence of Urinary Incontinence in Chilean older people and impact on quality of life: National Survey

INTRODUCCIÓN Y OBJETIVO: La incontinencia urinaria (IU) es una patología qué por sus características epidemiológicas y fisiopatológicas, afecta en gran medida a los adultos mayores (AM); en particular en Chile, se han reportado prevalencias que van desde el 12,2 al 30% para este grupo. El objetivo de esta investigación fue evaluar la prevalencia de la IU a nivel nacional en personas mayores que viven en comunidad; analizar y describir si aquellos que presentan IU perciben una disminución en su calidad de vida evaluado a través del cuestionario SF-36, en los aspectos físicos y mentales. MÉTODOS: Estudio transversal, analítico, realizado en una muestra de personas chilenas de 60 años y más, residentes en la comunidad; con representatividad nacional, regional y urbano-rural. El análisis se realizó con el software STATA 15.0 RESULTADOS: Este estudio fue realizado en 4186 adultos mayores chilenos, se encontró una prevalencia de IU de un 12,1% siendo más frecuente en mujeres que en hombres (15,2% v/s 7,1 % respectivamente, p<0,0001). Los análisis de asociación mostraron que la IU afecta de manera negativa la autopercepcion de calidad de vida tanto en el aspecto físico como mental. La Calidad de vida, medida por SF-36 reportó una disminución en sus puntajes en personas incontinentes y de los AM que refieren una calidad de vida regular, mala o muy mala, el 50% de ellos presenta IU. CONCLUSIÓN: La IU se asocia a una percepción de disminución en la calidad de vida en las personas mayores chilenas residentes en la comunidad.

INTRODUCTION AND OBJECTIVES: Due to its epidemiological and pathophysiological characteristics, urinary incontinence (UI) is a pathology which greatly affects older adults. The reported prevalence for this group in Chile, specifically, ranges from 12.2 to 30%. The objective of this study was to evaluate, at the national level, the prevalence of UI in older people living in the community; analyze and describe whether those who experience UI perceive diminished quality of life, using the physical and mental subscales of the SF-36 questionnaire to evaluate. METHODS: Cross-sectional, analytical study conducted on a nationally, regionally and urban-rural representative sample of Chilean people aged 60 and over, who residents of the community. The analysis was performed using STATA 15.0 software. RESULTS: This study of 4,186 older Chilean adults found the prevalence of UI to be 12.1%, with higher frequency in women than in men (15.2% v / s 7.1%, respectively, p <0, 0001). Association analysis showed that UI negatively affects perceptions of the subject's own physical and mental quality of life. Quality of life, measured using SF-36, showed lower scores for incontinent people and, of the older adults who report normal, bad or very bad quality of life, 50% present UI. CONCLUSION: UI is associated with a perception of diminished in the quality of life in older Chilean people living in the community.

The phenolic profile of virgin olive oil is influenced by malaxation conditions and determines the oxidative stability.

Phenolic compounds largely contribute to the nutraceutical properties of virgin olive oil (VOO), the organoleptic attributes and the shelf life due to their antioxidant capabilities. Due to the relevance of malaxation in the oil extraction process, we tested the effects of malaxation time on the concentrations of relevant phenolic compounds in VOO, and we evaluated the influence of performing malaxation under vacuum. An increase in malaxation time significantly decreased the concentrations of aglycone isomers of oleuropein and ligstroside but, conversely, increased the oleocanthal and oleacein contents. Additionally, malaxation under vacuum led to an increase in phenolic contents compared to standard conditions carried out at atmospheric pressure. Finally, we explored the possibility of predicting the VOO oxidative stability on the basis of the phenolic profile, and a model (R2 = 0.923; p < 0.0001) was obtained by combining the concentration of the VOO phenolic compounds and the main fatty acids.

Tricobezoar. Una causa rara de dolor abdominal con apariencia radiológica típica / Trichobezoar. A rare cause of abdominal pain with typical X-ray appearance

Un bezoar es una masa compuesta por material extraño ingerido, normalmente fibras vegetales o pelos, en el interior del tubo digestivo. Los tricobezoares son raros y aparecen normalmente en individuos con trastornos mentales. Presentamos una paciente de 16 años, con trastornos emocionales, que consulta por dolor abdominal, vómitos de dos días de evolución y masa en cuadrantes abdominales superiores. Se realiza radiografía convencional, ecografía y tomografía computarizada de abdomen que ponen de manifiesto los signos radiológicos típicos de tricobezoar gástrico. Hacemos especial hincapié en la utilidad de la tomografía computarizada en el diagnóstico preoperatorio y en la detección de posibles complicaciones. La paciente fue tratada mediante laparotomía, gastrotomía y extracción del tricobezoar. El postoperatorio discurrió sin complicaciones y actualmente está en tratamiento por psiquiatría

A bezoar is a ball of swallowed foreign material that is usually vegetable fibers or hairs, in the digestive tract. Trichobezoars are rare and normally appear in individuals with mental disorders. We present the case of a 16 year old woman with emotional disorders who consulted due to abdominal pain, two-day long vomiting and mass in upper abdominal quadrant. A plain X-ray, ultrasonography and CT scan of the abdomen were performed. They showed typical X-ray signs of gastric trichobezoar. We emphasize the utility of the CT scan in the preoperative diagnosis and in the detection of possible complications. The patient was treated by laparatomy, gastrotomy and extraction of the trichobezoar. Post-operative period was without complications and she is currently receiving psychiatric treatment

Hypomethylation of DNA and resistance to apoptosis in tonsillar hypertrophy in children.

We analyzed the hypomethylation of DNA and the sensitivity to apoptosis of tonsillar cells and peripheral blood lymphocytes (PBL) in twenty children with either recurrent tonsillitis (RT) or tonsillar hypertrophy (TH). We found no significant differences in DNA methylation of PBL obtained from RT and TH groups. Hypomethylation of DNA extracted from tonsillar tissue was higher in TH than in RT and was associated with lower spontaneous and thapsigargin-induced apoptosis. By contrast, RT showed a low level of DNA hypomethylation and was associated with high sensitivity to spontaneous and thapsigargin-induced apoptosis.

Tinnitus dopaminergic pathway. Ear noises treatment by dopamine modulation.

To date, the neurophysiological model has been used to explain the complexity of tinnitus. However from now on, the tinnitus dopaminergic pathway opens new horizons for ear noises management. Tinnitus perception takes place in prefrontal, primary temporal and temporo-parietal associative areas, as well as the limbic system. Dopaminergic neurotransmitters go through prefrontal, primary temporal, temporo-parietal associative areas and the limbic system. Tinnitus perception and dopaminergic pathway share the same cerebral structures, which control attention, stress, emotions, learning, memory and motivated behavior. Distress of tinnitus emanates from these same cerebral functions. The dopaminergic pathway can be modulated by agonists and antagonists of their receptors and can reduce the perception of tinnitus, such as sulpiride, amisulpride, olanzapine, quetiapine, ziprasidone, zuclopenthixole and aripiprazole, still under investigation, that together with sound treatment as the Sequential Sound Therapy, and a personal contact with the patient, constitute a tinnitus integral treatment.

[Auricular chondritis. Experimental model in rats]. / Condritis auricular. Modelo experimental en rata.

The general pattern of local inflammation in the rat is developed in the pad of the paw. In otorhinolaryngology a model of local inflammation can be reached in the rat ear by means of the production of an auricular chondritis. For that, we have protocolized the methodology. The induction of inflammation is carried out by the substance vegetable carrageenan. It has been verified by histological studies the inflammation generated, as well as studying the action of antiinflammatory, proinflammatory and inflammatory compounds. The inflammation has been measured by nonius and by determination of the activity of the myeloperoxidase enzyme. After these studies we can validate the auricular chondritis in rat as an experimental model of local inflammation in otorhinolaryngology.

[Sequential sound therapy in tinnitus]. / Terapia sonora secuencial en acúfenos.

The sequential sound therapy is a treatment for tinnitus with white noise that has some own characteristics. We describe the methodology, as well as their differences and similarities with the Tinnitus Retraining Therapy. The sequential sound therapy has been carried out to seventeen patients assisted during the year 2002. 26 generators of sound were adapted, of them, 22 had incorporated an earphone. The results of the sequential sound therapy were compared with those of the Tinnitus Retraining Therapy in 15 patients assisted during 2000 and 2001. The percentage of satisfactory results obtained with sequential sound therapy has been a 100%, while the therapy with sounds of the Tinnitus Retraining Therapy obtained a 33%. With the sequential sound therapy 6 patients had no further tinnitus. With the sequential sound therapy no patients has abandoned the treatment. With the treatment with sounds of the Tinnitus Retraining Therapy of the patients did give up the therapy 53%.

[Sulpiride as initial treatment in tinnitus retraining therapy]. / Sulpirida como tratamiento de inicio en la terapia de rehabilitación del acúfeno.

UNLABELLED: With this study we try to find out the interaction of sulpiride in tinnitus pathology. This, could help us to control better the tinnitus through tinnitus retraining therapy. MATERIAL AND METHODS: A hundred patients with tinnitus were divided into two groups of 50. Fifty milligrams of sulpiride or placebo were administered for three months, three time per day, with monthly controls. Clinical response, audiometry, tympanometry and acufenometry were registered. RESULTS: In the first month of treatment, only 58% of patients treated with sulpiride improved, and 17% of those treated with placebo, with statistical significance. In the second month, 41% and 20% respectively, and in the third month, 42% and 17% respectively. CONCLUSION: In patients with tinnitus, treatment with sulpiride has improved more than half of them in the first month of treatment. This time is crucial to begin tinnitus retraining therapy and to obtain a greater efficacy.

[Evaluation of the morphology of stapedial reflex in otosclerosis. Provoked otosclerotic stapedial reflex]. / Evolución de la morfología del reflejo estapedial a lo largo del curso de la otoesclerosis. Reflejo estapedial otoesclerótico provocado.

Stapedial reflex is used, amongst other pathologies, for the study of otosclerosis. In this retrospective study we have collected 188 cases of patients with otosclerosis whose diagnosis has been confirmed surgically and their first line relatives. We have performed a descriptive analysis of audiometric tests, tympanometries and ipsilateral stapedial reflexes in relation with the evolutive phase of the disease. Transmission hypoacusis has been seen in 54%, mixed hypoacusis in 29% and sensorineural hypoacusis 8% of cases. On and OFF stapedial reflexes have been seen in 18%, inverted reflexes in 46% and absent reflexes in 27% of cases. The original drawings of the different types of reflexes during the evolution of otosclerosis can be seen in the four figures shown in the study: normal reflexes; ON and OFF a, b and c types; inverted a and b; and absent reflexes. The clinical evolutive phase and the audiometric and impedance tests have been correlated. Through Chi-square (p < 0.001), we have obtained a statistical significance in relation to the use of stapedial reflexes. Also it has been suggested the use of provoked stapedial reflexes in patients with sub clinical otosclerosis in order to diagnose the disease. We conclude that the knowledge of the evolutive morphology os stapedial reflexes in otosclerosis helps diagnostic capacity.

[Analysis of the relationship between chronic pharyngitis and tonsillectomy with the microbiologic study of the cavum]. / Relación de la faringitis crónica con la amigdalectomía mediante estudio microbiológico de cavum.

Chronic pharyngitis is an usual process with difficult treatment. It has been related to tonsillectomy. This study collected 224 patients suffering from chronic pharyngitis, 55 tonsillectomies and 169 without operation. Bacteriological culture was done from nasopharynx in the different seasons. Microorganisms more frequent were Staphylococcus aureus, Corynebacterium sp and Aspergillus. The time between the tonsillectomy and this study has been of more than 17 years. No relationship has been found between chronic pharyngitis and tonsillectomy, considering types of microorganisms, seasons, numbers of microorganisms isolated per culture, Gram stain, and age of the patients.

[Lymphocytes of patients with auto-immune deafness present type II collagen hyporeactivity in the presence of the pineal hormone melatonin]. / Linfocitos de pacientes con sorderas autoinmunitarias presentan hiporreactividad a colágeno tipo II en presencia de la hormona pineal melatonina.

A study was made of the behavior of peripheral blood lymphocytes in healthy controls and patients with various types of hearing loss. Hearing loss of auto-immune origin was studied in the presence and absence of melatonin, activated or not by concanavalin A. In patients with auto-immune hearing loss, lymphocytes showed hyporeactivity to type II collagen in terms of proliferative activity in the presence of concavalin A. Hyporeactivity was especially relevant in melatonin-incubated cells. In different nosologic entities, lymphocyte hyporeactivity to type II collagen was similar in bilateral sensorineural hearing loss, Ménière's disease and otosclerosis. We conclude that the lymphocytes of patients with autoimmune hearing loss showed hyporeactivity to type II collagen when compared to lymphocytes from control subjects. This hyporeactivity was revealed when lymphocytes were activated in the presence of melatonin.

Oral vaccine in otosclerosis.

Otosclerosis is a genetically based disease in which the development of autoimmune mechanisms can lead to its clinical expression. Anti-type II collagen antibodies have been found in otosclerotic patient serum. The first clinically unexpressive phase of the disease can be diagnosed from a family history and ON-OFF stapedial reflexes with evidence of an autoimmune disorder. The use of antigenic oral hyposensitization is accepted, based on autoimmune pathogenesis. Hyposensitization should be initiated during this subclinical period of otosclerosis with a type II collagen oral vaccine.

Ototoxicity caused by cisplatin is ameliorated by melatonin and other antioxidants.

The mechanism of the ototoxicity caused by cisplatin is based in the generation of reactive oxygen species, which interferes with the antioxidant protection of the organ of Corti. Conversely, the protection of the cochlea with antioxidants ameliorates the ototoxicity by cisplatin. The ototoxicity produced by cisplatin can be reversible or persistent, depending on the age of the patient, cumulative doses, number of chemotherapy cycles, history of noise exposure, and deteriorating renal function. We have obtained in rats an ototoxic chart utilizing cisplatin (10 mg/kg body weight injected intraperitoneally, once only). Together with this treatment, the animals were treated with melatonin in the drinking water (10 mg/L) or injected subcutaneously (250 microg), and with an antioxidant mixture, injected subcutaneously, composed of 0.25 mg alpha-tocopherol acid succinate, 3 mg ascorbic acid, 1 mg glutathione, and 60 mg N-acetylcysteine. The distortion product otoacoustic emissions were determined for a prolonged period of time for each animal. The ototoxicity produced by cisplatin was maximal from days 7 to 10 post-treatment, returning to normal values in a month. When melatonin and the antioxidant mixture were present, the recovery was between days 10 and 15 post-treatment, independent of the means of administration of the pineal product. We conclude that the ototoxicity caused by cisplatin is ameliorated by melatonin and other antioxidants.

Brain tumors in Mexico: characteristics and prognosis of glioblastoma.

BACKGROUND: Frequency and clinical characteristics of brain tumors have been studied in several populations from different genetic backgrounds; their peculiarities in the Mexican mestizo population shed light on the descriptive and comparative epidemiologic analysis of the genetic participation in brain tumors. METHODS: To analyze the frequency of intracranial neoplasms at the National Institute of Neurology and Neurosurgery of Mexico between 1987 and 1994, demographic, clinical, surgical, and neuropathological records were reviewed and compared with other reports. Glioblastoma cases were followed to investigate survival and prognostic factors. RESULTS: In a seven-year period 1,776 patients with brain tumors were treated; 419 (24%) had pituitary adenoma; 586 (33%) had glioma. Of the latter, 165 had glioblastoma multiforme, representing 28% of all gliomas and 9% of all neoplasms. Mean survival for glioblastoma was 16 months and the longest mean survival was obtained in patients with radical neurosurgical resection plus radiotherapy and chemotherapy. Cumulative analysis showed that 41% of patients survived less than one year, 39% from 1 to 2 years, 12% from 2 to 3 years and 8% more than three years. Factors that showed prognostic significance were age, therapeutic approach, tumor size, and pre- and postoperative clinical status (p < 0.05). CONCLUSIONS: This study comprises the largest series on the frequency of brain tumors in a Latin American population. When compared with other studies, the proportion of glioma and glioblastoma among brain neoplasms was low whereas pituitary adenoma was high. Mean survival for glioblastoma was similar to other reports; in these patients, the overall therapeutic response is still far from satisfactory.

Ototoxicity caused by aminoglycosides is ameliorated by melatonin without interfering with the antibiotic capacity of the drugs.

The production of free radicals seems to be involved in the mechanisms of ototoxicity. Aminoglycosides produce ototoxicity, which can be determined through distortion product otoacoustic emissions (OAEs) that measure the activity of the outer hair cells of the organ of Corti. An ototoxic chart was obtained in rats using gentamicin or tobramycin. Together with this treatment, the animals ingested melatonin in the drinking water, or melatonin was injected subcutaneously or intramuscularly. The distortion product OAEs were determined over a prolonged period of time for each of the groups. The effect of melatonin on the antibiotic capacity of the aminoglycosides used was also studied. Antibiograms inoculated with Escherichia coli or Pseudomonas aeruginosa and treated with gentamicin or tobramycin in the presence or absence of melatonin at quantities from pharmacological to physiological doses were performed. The ototoxicity produced by gentamicin and tobramycin was maximal from days 3 to 5 post-treatment, returning to normal values in 2 wk. When melatonin was present, the recovery was at day 5 post-treatment, independently of the means of administration of the pineal product. The antibiograms showed that melatonin had no effect on the antibiotic capacity. It is concluded that the ototoxicity caused by gentamicin and tobramycin is ameliorated by melatonin and that the pineal hormone does not interfere with the antibiotic capacity of these antibiotics.

Autoimmune deafness is not related to hyperreactivity to type II collagen.

The pathogenic role of anti-type II collagen was analysed in a variety of hearing losses, in age-matched controls and in different autoimmune diseases. The immune reactivity of peripheral blood lymphocytes to type II collagen was studied by the degree of proliferation measured as the incorporation of bromodeoxyuridine in cultured lymphocytes. The anti-type II collagen antibodies showed a very low incidence in the hearing loss group. Lymphocytes of otosclerosis, Meniere's disease and other sensorineural deafness patients proliferated in response to concanavalin A and to type II collagen to a lower extent than peripheral blood lymphocytes from healthy controls. Nonetheless, these differences were not statistically significant. The immune hyperreactivity to type II collagen cannot explain the autoimmune mechanism of hearing losses. Humoral and cellular hyperreactivities to inner ear proteins different from type II collagen, could explain the autoimmune mechanism of deafness.

Microalbuminuria as renal marker in recurrent acute tonsillitis and tonsillar hypertrophy in children.

Raised levels of microalbuminuria pointing out glomerular abnormality and indicate renal damage. Glomerulonephritis is caused by immune reaction leading to the formation of circulating immune complexes that are deposited on the basal membrane of the glomerulus. The time course and the appearance of antibodies against infectious agents both play very important roles in its clinical presentation. Antibodies against streptococci have not a protective role, but offers a useful marker of the presence or absence of recent infection. This work studies the presence of microalbuminuria and circulating anti-streptococcal antibodies, namely, anti-streptolysin O and anti-deoxyribonuclease B antibodies in ninety children which underwent tonsillectomy due to infectious and obstructive tonsillar pathology. These children were divided in recurrent acute tonsillitis (n= 34), recurrent tonsillitis with tonsillar hypertrophy (n = 26), and tonsillar hypertrophy (n = 30). It was found in recurrent acute tonsillitis a moderate correlation between microalbuminuria and anti-streptolysin O, and a weak correlation between microalbuminuria and anti-deoxyribonuclease B antibodies. It was also found significant differences of the levels of anti-streptococcal antibodies between the three groups of pathologies. It is proposed the determination of microalbuminuria, an inexpensive and harmless test, as an indicator of possible renal damage in recurrent acute tonsillitis.