Uso de ácido valproico en unidades de psiquiatría de estancia prolongada / Use of valproic acid in long stay units of psychiatry

Objetivo: El ácido valproico es utilizado frecuentemente en psiquiatría para tratar la esquizofrenia y otras afecciones fuera de indicación de ficha técnica ("off-label"). A pesar de ello, su efectividad no ha sido suficientemente demostrada y su uso no está exento de efectos adversos. El presente estudio tiene como objetivo principal conocer la frecuencia de uso de ácido valproico tanto en las indicaciones recogidas en ficha técnica, como su utilización "off-label" en pacientes psiquiátricos. Método: Se diseñó un estudio transversal el 7 de julio de 2014 con una muestra de 167 pacientes residentes en un centro psiquiátrico. Se analizaron las siguientes variables: datos demográficos, tratamiento con ácido valproico y pauta posológica, tratamiento farmacológico asociado, monitorización de los parámetros de seguridad, interacciones y concentraciones de ácido valproico. Resultados: El ácido valproico se prescribió en 1 de cada 3 pacientes del centro. Se utilizó según las indicaciones aprobadas en ficha técnica en 8 (15%) de los 53 pacientes analizados: 5 (9%) de ellos con trastorno bipolar y 3 (6%) diagnosticados de epilepsia. Otros 5 pacientes (9%) se incluyeron en la indicación extendida de trastorno esquizoafectivo. El 76% (40) de los pacientes evaluados tenían prescrito ácido valproico fuera de indicación. La media de dosis de ácido valproico fue de 1,26 Dosis Diarias Definidas/paciente/día. Se encontró una media de 6 fármacos asociados al ácido valproico. El 18% de los pacientes presentó trombocitopenia. Conclusiones: El ácido valproico se utiliza frecuentemente en pacientes psiquiátricos fuera de indicación. Debería valorarse el beneficio-riesgo en esta población (AU)

Objective: Valproic acid is often used in psychiatry to treat schizophrenia and other conditions outside of indication ("off-label"). However, its effectiveness has not been sufficiently demonstrated and its use is not exempt of adverse effects. This study's main objective is to determine the frequency of use of valproic acid in approved indications and the "off-label" use in psychiatric patients. Methods: A cross-sectional study on July 7, 2014 with a sample of 167 patients residents in a psychiatric center was designed. Demographics, valproic acid treatment, posology and associated drug treatment, monitoring safety parameters, interactions and valproic acid concentrations. Results: Valproic acid is prescribed in 1 of 3 patients of the center. It was used in the approved indications in 8 (15%) of the 53 patients analyzed: 5 (9%) of them with bipolar disorder and 3 (6%) diagnosed with epilepsy. Other 5 patients (9%) were included in the extended schizoaffective disorder indication. 76% (40) of the evaluated patients were prescribed valproic acid off-label. The mean dose of valproic acid was 1.26 Defined Daily Dose / patient / day. An average of 6 drugs associated with valproic acid was found. 18% of patients had thrombocytopenia. Conclusions: Valproic acid is often used off-label in psychiatric patients. It should be assessed the benefit-risk in this population (AU)

[Use of valproic acid in long stay units of psychiatry]. / Uso de ácido valproico en unidades de psiquiatría de estancia prolongada.

OBJECTIVE: Valproic acid is often used in psychiatry to treat schizophrenia and other conditions outside of indication ("off-label"). However, its effectiveness has not been sufficiently demonstrated and its use is not exempt of adverse effects. This study's main objective is to determine the frequency of use of valproic acid in approved indications and the "off-label" use in psychiatric patients. METHODS: A cross-sectional study on July 7, 2014 with a sample of 167 patients residents in a psychiatric center was designed. Demographics, valproic acid treatment, posology and associated drug treatment, monitoring safety parameters, interactions and valproic acid concentrations. RESULTS: Valproic acid is prescribed in 1 of 3 patients of the center. It was used in the approved indications in 8 (15%) of the 53 patients analyzed: 5 (9%) of them with bipolar disorder and 3 (6%) diagnosed with epilepsy. Other 5 patients (9%) were included in the extended schizoaffective disorder indication. 76% (40) of the evaluated patients were prescribed valproic acid off-label. The mean dose of valproic acid was 1.26 Defined Daily Dose / patient / day. An average of 6 drugs associated with valproic acid was found. 18% of patients had thrombocytopenia. CONCLUSIONS: Valproic acid is often used off-label in psychiatric patients. It should be assessed the benefit-risk in this population.

Objetivo: El ácido valproico es utilizado frecuentemente en psiquiatría para tratar la esquizofrenia y otras afecciones fuera de indicación de ficha técnica ("off-label"). A pesar de ello, su efectividad no ha sido suficientemente demostrada y su uso no está exento de efectos adversos. El presente estudio tiene como objetivo principal conocer la frecuencia de uso de ácido valproico tanto en las indicaciones recogidas en ficha técnica, como su utilización "off-label" en pacientes psiquiátricos. Método: Se diseñó un estudio transversal el 7 de julio de 2014 con una muestra de 167 pacientes residentes en un centro psiquiátrico. Se analizaron las siguientes variables: datos demográficos, tratamiento con ácido valproico y pauta posológica, tratamiento farmacológico asociado, monitorización de los parámetros de seguridad, interacciones y concentraciones de ácido valproico. Resultados: El ácido valproico se prescribió en 1 de cada 3 pacientes del centro. Se utilizó según las indicaciones aprobadas en ficha técnica en 8 (15%) de los 53 pacientes analizados: 5 (9%) de ellos con trastorno bipolar y 3 (6%) diagnosticados de epilepsia. Otros 5 pacientes (9%) se incluyeron en la indicación extendida de trastorno esquizoafectivo. El 76% (40) de los pacientes evaluados tenían prescrito ácido valproico fuera de indicación. La media de dosis de ácido valproico fue de 1,26 Dosis Diarias Definidas/paciente/día. Se encontró una media de 6 fármacos asociados al ácido valproico. El 18% de los pacientes presentó trombocitopenia. Conclusiones: El ácido valproico se utiliza frecuentemente en pacientes psiquiátricos fuera de indicación. Debería valorarse el beneficio-riesgo en esta población.

Diagnosis of human hydatidosis. Predictive value of a rural ultrasonographic survey in an apparently healthy population.

The usefulness of ultrasonography (US) in the early diagnosis of hydatidosis, applied in large-scale surveys to populations lacking clinical symptoms of the disease, has been amply documented. However, the rate of false positive and negative results is poorly described. Due to this, the present paper is aimed to evaluate the sensitivity, specificity and predictive value of a conventional rural ultrasonographic survey in comparison with higher imaging complexity. Accordingly, during 1997 and 1998 a total of 1054 children from 7 to 14 years of age were evaluated by means of US, in the town of Ingeniero Jacobacci, Province of Rio Negro, Argentina, employing a portable device for population studies. All detected cases were referred to a high complexity center specialized in imaging diagnosis for their re-evaluation with US, CT scanning and X-rays. A control group comprising 3 children negative by US for each positive case in the mass screening survey was selected and reexamined by US and X-rays and CT scanning in doubtful situations. Twenty-seven asymptomatic carriers were referred with images compatible with hydatid cysts, while 66 were classified as disease free. At reexamination, 24 of those diagnosed as carriers and the totality of those classified as healthy were confirmed. On the basis of our results, a sensitivity of 100%, a specificity of 95.6% and a global test value of 96.7% were estimated.

Diagnosis of human hydatidosis. Predictive value of a rural ultrasonographic survey in an apparently healthy population.

The usefulness of ultrasonography (US) in the early diagnosis of hydatidosis, applied in large-scale surveys to populations lacking clinical symptoms of the disease, has been amply documented. However, the rate of false positive and negative results is poorly described. Due to this, the present paper is aimed to evaluate the sensitivity, specificity and predictive value of a conventional rural ultrasonographic survey in comparison with higher imaging complexity. Accordingly, during 1997 and 1998 a total of 1054 children from 7 to 14 years of age were evaluated by means of US, in the town of Ingeniero Jacobacci, Province of Rio Negro, Argentina, employing a portable device for population studies. All detected cases were referred to a high complexity center specialized in imaging diagnosis for their re-evaluation with US, CT scanning and X-rays. A control group comprising 3 children negative by US for each positive case in the mass screening survey was selected and reexamined by US and X-rays and CT scanning in doubtful situations. Twenty-seven asymptomatic carriers were referred with images compatible with hydatid cysts, while 66 were classified as disease free. At reexamination, 24 of those diagnosed as carriers and the totality of those classified as healthy were confirmed. On the basis of our results, a sensitivity of 100

, a specificity of 95.6

and a global test value of 96.7

were estimated.

Porcentaje de luxaciones en artroplastía total de cadera: 24 años de experiencia en el Hospital ABC / Rate o dislocation in total hip arthroplasty; 24 years of experience in ABC Hospital

Una de las complicaciones de la artrosplastía total de cadera es la luxación la cual tiene una frecuencia que varía de 0.16 por ciento a 3 por ciento según lo reportado. La etiología es multifactorial, y el tiempo de presentación es variable. Se realizó una revisión de 859 artroplastías totales valorando la experiencia en el manejo de las luxaciones de artroplastías totales de cadera y buscando valores que determinaran los factores de riesgo de esta complicación. Se obtuvieron 28 luxaciones predominando el sexo femenino, con un tiempo de presentación entre la cirugía y la luxación en un rango entre 3 meses a 18 años. La inclinación de la copa acetabular varió entre 45º a 90º. El 80 por ciento fueron revisadas quirúrgicamente siendo el tratamiento definitivo. Como causas mecánicas encontramos la orientación a más de 55º de la copa acetabular ya sea por posición inicial o por migración por desgaste o aflojamiento; los demás factores son coadyuvantes, la osteotomía del trocánter mayor, el acortamiento del componente femoral, anteroversión o retroversión y la edad son factores asociados a la luxación. El tiempo de presentación de la luxación es variable. Las causas mecánicas son importantes factores de luxación de la artroplastía total de cadera

Síndrome doloroso acetabular posthemiartroplastía de cadera / Painful hip after hemi arthroplasty by femoral component of Thompson or Austin-Moore prosthesis

Existe un grupo de pacientes con hemiartroplastía de cadera, siendo el principal síntoma el dolor, en los que no existen infección. Hemos observado cambios en el cartílago articular del acetábulo durante las cirugías de recambio de prótesis de Thompson o de Austin Moore, estando el cartílago reblandecido, fragmentado y con la presencia de una membrana de color negro, pudiendo ser la causa de dolor, a la que hemos llamado condrólisis. Se operaron 20 paciente con recambio de prótesis monopolar a prótesis total cementada tipo Charnley. La edad promedio fue de 70 años 9 meses. Todas eran del sexo femenino, con un peso corporal promedio de 59 kg. El tiempo desde la hemiartroplastía a la colocación de la prótesis total varió de 5 meses hasta 17 años. Durante la operación se tomaron muestras del cartílago acetabular para estudio histopatológico con luz polarizada. La valoración clínica pre y postoperatoria fue de acuerdo a Merle D'Aubigné y Postel. Se llevaron a cabo, ya que en 8 caderas no existía cartílago necrótico con fibrosis y partículas metálicas que se observaron en el microscopio de luz polarizada. El dolor que inicialmente sumaban 59, pasó a 112, la marcha de 68 a 113 y la movilidad de 73 a 124. La condrólisis acetabular posthemiartroplastía de cadera es causa de dolor, y se debe a la presión que el componente femoral ejerce sobre el cartílago articular necrosándolo, este mecanismo se ve aumentado por las partículas de metal que se desprenden de la prótesis, como el tamaño inadecuado de la cabeza protésica

Hemiartroplastia con prótesis integral Lazcano. Informe preliminar / Hemiarthroplasty with integral Lazcano prothesis. A preliminary report

Los modelos de hemiartroplastias de cadera de una pieza tipo Austin-Moore y Thompson no son ideales para usarse con cemento acrílico ya que fueron diseñados antes de que éste saliera al mercado. Las prótesis bipolares, que también se utilizan para tratar las fracturas subcapitales de fémur, después de un tiempo funcionan como monopolares, pero tiene un costo elevado. Hemos diseñado un nuevo modelo de prótesis monopolar basado en la experiencia de 22 años con artroplastia de cadera tipo Charnley en México. Para lograrlo, se evaluaron estudios antropométricos en fémures de cadáveres de mexicanos y también se elaboraron análisis transoperatorios y radiográficos. Esta hemiprótesis integra varios conceptos: El tallo femoral de Charnley, una ceja en el collar cervical anterior que ha sido recomendada por Harris y un ángulo diafisocefálico de 140º. Se operaron 32 caderas, de las cuales se estudiaron 20 que tenían un máximo de evolución de dos años y un mínimo de un año. La edad promedio de los pacientes fue de 77 años. Dieciocho correspondieron al sexo femenino. Un paciente fue reoperado por infección postoperatoria tardía. No se observaron datos radiográficos de aflojamiento ni de erosión acetabular. Este nuevo modelo de prótesis permite una colocación fácil al momento de la intervención quirúrgica, además de un cementado perfecto al aplicar presión entre el cuello femoral y la ceja posterior protésica. El tamaño es adecuado para la población mexicana y latinoamericana. El resultado funcional es igual al de las prótesis bipolares y su costo es menor. Es necesario un estudio de por lo menos 10 años para dar un resultado más definitivo del implante

Morphometric and neurosecretory changes in supraoptic neurons after D-amphetamine treatment.

Several morphological and immunochemical characteristics of the neurosecretory neurons of the supraoptic nucleus (SON) have been studied of rats treated for 1 month with D-amphetamine sulfate (AMP) (8 mg/kg weight, daily). An increase of SON volume (11%) has been observed as a consequence of the growth of the dorsoventral axis. Neurosecretory neurons increased their nucleolar area (11.4%), their nuclear area (8.3%), and their cytoplasmatic area (18.3%). Vasopressin immunoreaction did not show any differences between treated and control animals, but oxytocin immunostaining displayed an important increase (23.7%) in the neuronal cytoplasm of the treated rats. The SON hypertrophy of the AMP-treated rats corresponded to the hypertrophy/hyperfunction of its oxytocinergic neurons, and could be considered as a new mechanism of the action of the AMP. The results are discussed in relation to the plastic features of the SON and its central (neuronal) and peripheral (hormonal) function.

Morphometric study on the development of magnocellular neurons of the supraoptic nucleus utilising immunohistochemical methods.

Vasopressin (VP)- and oxytocin (OXY)-producing neurons, components of the rat supraoptic nucleus, have been located with immunohistochemical methods, with the purpose of studying their morphofunctional characteristics during different phases of life (embryonic, juvenile, adult and senile). To carry out this study, an IBAS I (Kontron) computerised image analyser has been utilised. The hormone VP is first detected in the neuronal cytoplasm of 21 days old rat embryos and the hormone OXY appears in the neuronal cytoplasm later, in the newborn phase. The neuronal area with a positive reaction for the two neurohormones has been evaluated and it has been found that the quantity of reaction substance is proportional to the age. In the adult period, VP neurons possess a reaction area (198 microns 2) greater than that of OXY neurons (153 microns 2). In the SON, there are two neuronal shapes, fusiform and round; these shapes coexist in both hormonal types of neurons. Until Day 15 of postnatal development, the SON neurons are intermixed in the interior of the nucleus but in this period a neuronal redistribution is initiated. In the adult phase, OXY neurons are situated preferentially in the anterior, posterior and dorsal parts and VP neurons in the ventral and posterior parts, with both neurons being present in the intermediate part of the SON.

Morphometric changes between one-day-old and adult chicken neurons of the nucleus isthmi.

The most important parameters of the neuronal soma of neurons of the chicken nucleus isthmi have been analyzed, with photo and morphometric techniques, in order to quantify the morphological variations present during the first months of the life to determine if the developmental changes of both neuronal populations of the nucleus are similar or different. The study was carried out on neurons of the parvicellular part and magnocellular part of the Nucleus Isthmi in one day and four month-old chickens. The soma shape did not change during this time interval in parvicellular neurons. The magnocellular neurons became more fusiform. In-one-day old chickens, the section shapes of the neuronal soma and optical density, are similar in both the magnocellular and parvicellular parts of the nucleus. The area and the maximum and minimum diameters do not present significant differences between magnocellular and parvicellular neurons. In adults, the maximum diameter, neuronal area and optical density are higher in magnocellular neurons than in parvicellular neurons. In summary, magnocellular neurons of the nucleus Isthmi of adults are bigger, darker and more elongated than the ones that constitute the parvicellular territory.

Topographical development of the supraoptic nucleus of the rat.

Topographical changes in the development of the principal part of the supraoptic nucleus (SON) of the rat were studied by analyzing its tridimensional images, from the intrauterine to the senescent stage. Evaluation of the growth rate of the SON was also made possible by this procedure. From the onset of the appearance of the SON, changes in its spatial orientation were marked by a progressive increase in the antero-posterior and medio-lateral dimensions. The ventro-dorsal one increased up to 6 months of age and then began to decrease progressively. These changes were accompanied by a ventral displacement that became indistinct at 6 months, whereas the lateral migration persisted. No rostro-caudal displacement was recognized. Possible reasons for these changes are briefly discussed.

Development of the chicken oculomotor nucleus: a quantitative study of cresyl violet and colloidal iron stained neurons.

The characteristics of new-born chicken oculomotor neurons have been studied comparatively with adults (four-months), applying both, the Cresyl Violet and Colloidal Iron stain methods. A cytophotometric study has been performed on the neurons, obtaining optical density maps. Afterwards, a statistical study on the nuclear and somatic parameters, and the optical density values, were made. The existence of two nerve-cell types has been proved: clear ones-big, eggshape with nucleus and an obvious nucleolus; and darker ones-smaller, fusiforms, with nucleus and a less perceptible nucleolus. These characteristics of the neuronal-cells are present in new-born and four-month old animals. The ratio is different for each stage: in younger chickens there is a bigger proportion of clear nerve-cells (70%) than dark ones (30%); and in four-month old chickens there is a bigger proportion of dark nerve-cells (95%) than clear ones (5%). During postnatal development, oculomotor nucleus nerve-cells increased the neuronal area 28% in the clear cells and 30% in the dark cells. The optical density histograms for clear cells of one-day old animals and four-month old animals were similar, as were the histograms for both developmental stages of the dark cells. Glycosaminoglycans were shown with the colloidal Iron, there being strong positive reactions on the cell periphery, prolongations, and Golgi apparatus of four-month old specimens. But in the nex-born animals the reaction was weaker, with the maximum intensity on the pericaryon periphery.

The in vitro cultivation of Taenia pisiformis to sexually mature adults.

Taenia pisiformis was cultivated from a cysticercus to a non-fertile adult in a diphasic medium. This medium was composed of coagulated bovine serum, as a solid phase, and CMRL 1066, modified by the addition of fetal calf serum, yeast extract, glucose and KCl, as a liquid phase. The medium was gassed with 10% O2 and 5% CO2 in N2. Evidence of morphogenesis with proglottid formation occurred after 7-8 days of culture, and genital pores were formed after 22 days. Some worms showed signs of teratological changes with two or three genital pores.

Dipiridamol/acido acetilsalicilico en la prevencion de tromboembolismo en artroplastia total de cadera. / Dipyridamole/acetylsalicylic acid in the prevention of thromboembolism in total hip arthroplasty.

A 525 pacientes sometidos a artroplastia total de cadera, tipo Charnley, se les administro dipiridamol y acido acetilsalicilico como tratamiento profilactico de la tromboembolia. Se suspendio el tratamiento a 91% de estos pacientes en vista de presentar gastritis por la administracion de acido acetilsalicilico y a 12% por presentar cefalea consecutiva a causa del dipiridamol. Se observo trombosis venosa profinda en 7.97% de los pacientes; 5.07% presento embolia pulmonar con 0.24% de mortalidad.