Drug allergy is associated with the development of extraintestinal manifestations in patients with ulcerative colitis.

Summary: Drug allergies are developed by antibody or cell-mediated reactions as immunologic mechanisms. It has been demonstrated that hypersensitivity reaction to certain allergens may play a role in the pathogenesis of inflammatory bowel disease (IBD) focused on food allergies. A total of 256 patients with UC were divided in two groups: 203 patients with active UC and 53 in remission UC were included in the present study. In the present study we found that 11.7% had allergy to at least one drug distributed. The most frequent drug-allergies were sulfonamides in 2.8% and penicillin in 3.1%. Sulfonamide allergy was associated with several extraintestinal manifestations such as: peripheral arthritis/arthralgia (OR = 9.06, 95% CI 1.71 - 48.00, p = 0.002); pyoderma gangrenosum (OR = 24.10, 95% CI 3.55 - 163.48, p minor 0.0001) and uveitis (OR = 15.93, 95% CI 2.55 - 99.23, p minor 0.0001). The frequency of drug allergy was 11.7% in Mexican UC patients, most frequently to sulfonamides and penicillin drugs. The presence of sulfonamide allergy was associated with the presence of several extra-intestinal manifestations.

Adaptación cultural al español del cuestionario sobre las dificultades para trabajar con esclerosis múltiple. Versión corta de 23 ítems (MSWDQ-23) / Spanish cultural adaptation of the short version of the Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ-23)

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Opiniones y creencias sobre las enfermedades mentales graves (esquizofrenia y trastorno bipolar) en la sociedad española / Opinions and beliefs of the Spanish population on serious mental illnesses (schizophrenia and bipolar disorder)

Introducción:Conocer las opiniones, creencias y preocupaciones de la población general sobre dos enfermedades mentales graves: esquizofrenia y trastorno bipolar. Material y métodos:Se construyó un cuestionario ad-hoc para encuesta. Un panel de siete expertos extrajo los contenidos. También participaron: ASAENES, ABBA, FEAFES-ANDALUCIA, AMAFE, FEMASAM y AFAEM-5. El cuestionario contenía 12 preguntas sobre: conocimiento de las patologías, dificultades diagnósticas, síntomas, desencadenantes, interferencia, tratamientos y efectividad, creencias y preocupaciones. Administrado: IV Campaña de Concienciación Social sobre la Enfermedad Mental Grave (Madrid y Sevilla, septiembre - octubre 2009). Resultados:Se recogieron 5.473 encuestas, 55,8% en Sevilla. El 66,2% de la muestra eran mujeres y la edad media 35 años (DE=14,5). El 82% conocía ambas enfermedades, pero el 51% no conocía ningún síntoma de la esquizofrenia. Otras opiniones destacables: son difíciles de diagnosticar (59%), no se diagnostican por rechazo social (27%), interfieren bastante en la vida cotidiana (49%) o impiden la vida normal (42%), los tratamientos eficaces son psicológicos (82%) y farmacológicos (72%). Las creencias refieren: rechazo social, sobrecarga familiar y sufrimiento del paciente. Las preocupaciones refieren: peligrosidad, rechazo social, falta de información y escasez de recursos. Conclusiones:Existe desconocimiento sobre la sintomatología. La mayoría desconoce síntomas específicos y resalta los negativos. Se atribuye mayor eficacia al tratamiento conjunto psicológico-farmacológico. Preocupan la estigmatización y la sobrecarga familiar y personal(AU)

Introduction:To find out the opinions, beliefs and concerns of the Spanish population on serious mental diseases: schizophrenia and bipolar disorder. Material and methods:An ad-hoc questionnaire was constructed for the survey. A panel of seven experts extracted the contents. The Societies that involved were: ASAENES, ABBA, FEAFES-ANDALUCÍA, AMAFE, and AFAEM-5 advocacy societies were also involved. The questionnaire contained 12 questions about: knowledge of the diseases, diagnostic difficulties, symptoms, triggering factors, interference, treatments and effectiveness, beliefs and concerns. The questionnaire was administered during the IV Campaign of Social Awareness about Serious Mental Illness (Madrid and Seville, September-October 2009). Results:A total of 5,473 questionnaires were collected, 55.8% in Seville. The majority (66.2%) of the sample were women, and the mean age was 35 years (SD=14.5). Both illnesses were known by 82% of the population, but 51% did not known any symptom of schizophrenia. Other notable opinions were; they are difficult to diagnose (59%), they were not diagnosed due to social rejection (27%), interfered quite a lot with daily life (49%) or prevented a normal life (42%), the effective treatments are psychological (72%). Beliefs were: social rejection, family burden, and patient suffering. Concerns included: dangerousness, social rejection, lack of information, and scarcity of resources. Conclusions:There is a lack of knowledge of the symptoms. The majority do not know about specific symptoms and highlight the negative ones. Combined pharmacological-psychological treatment is believed to be most effective. Social stigma and family and personal burden are concerns(AU)

Anxiety as a marker of severity in acute mania.

OBJECTIVE: Anxiety has scarcely been studied in acute mania. The aim of this study was to assess anxiety symptoms during manic episodes and their impact on clinical outcomes. METHOD: Observational, cross-sectional multicentre study. Anxiety was measured using the Hamilton Anxiety Rating Scale (HARS). Bivariate and multiple linear regression analyses were performed using the HARS score as the dependent variable. RESULTS: Two hundred and forty-two patients admitted with a diagnosis of acute manic episode according to DSM-IV TR criteria and a Young Mania Rating Scale>20 were analysed. Mean age was 43 years (SD=11.9) and 57% were women. Forty-six per cent of patients (n=104) presented moderate to severe anxiety symptoms (HARS score>14). Anxiety was significantly associated with severity of manic symptoms (P<0.0001). Patients with anxiety had 20% longer hospitalizations (mean 21 days, CI95% 19.7-23.7). CONCLUSION: An association of anxiety symptoms with greater severity in acute mania was demonstrated. The close relationship between anxiety and manic symptoms highlights the need for greater clinical attention to anxiety in this population. Further studies are necessary to determine whether effective treatment of anxiety symptoms could improve clinical and care outcomes.

Undulating toe movements in brain death.

For many years, death implied immobility. Nevertheless, there are anecdotal reports of spontaneous or reflex movements (SRMs) in patients with Brain death (BD). The presence of some movements can preclude the diagnosis of BD, and consequently, the possibility of organ donation for transplantation. McNair and Meador [(1992), Mov Dord7: 345-347] described the presence of undulating toe flexion movements (UTF) in BD patients. UTF consists in a sequential brief plantar flexion of the toes. Our aim was to determine the frequency, characteristics and predisposing factors of UTF movements in a prospective multicenter cohort study of patients with BD. Patients with confirmed diagnosis of BD were assessed to evaluate the presence of UTF using a standardized protocol. All patients had a routine laboratory evaluation, CT scan of the head, and EEG. Demographic, clinical, hemodynamic and blood gas concentration factors were analyzed. amongst 107 BD patients who fulfilled the AAN requirements, 47 patients (44%) had abnormal movements. UTF was observed in 25 (23%) being the most common movement (53%). Early evaluation (OR 4.3, CI95% 1.5-11.9) was a predictor of UTF in a multivariate regression model. The somato-sensory evoked potential (SSEPs) as well as brainstem auditory evoked potentials (BAEPs) did not elicit a cortical response in studied patients with UTF. This spinal reflex is probably integrated in the L5 and S1 segments of the spinal cord. Abnormal movements are common in BD, being present in more than 40% of individuals. UTF was the most common spinal reflex. In our sample, early evaluation was a predictor of UTF. Health care professionals, especially those involved in organ procurement for transplantation, must be aware of this sign. The presence of this motor phenomenon does not preclude the diagnosis of BD.

Time of origin of the rat pineal gland cells. A bromodeoxyuridine immunohistochemical study.

The immunohistochemical detection of bromodeoxyuridine (BrdU) was used to study the time of origin of the cells in the pineal gland of the rat. A study was made involving 17 groups of 4 rats each, administered with a single dose of bromodeoxyuridine (BrdU, 25 mg/kg) in 7 phases of the embryonic period (E15 to E21) and in 10 postnatal phases (between P0 and P30), followed by determination in each rat of the number of visible immune-labeled cells in the pineal gland 60 days after birth. The results show that approximately 60% of the pineal cells underwent the last division(s) prior to differentiation in the prenatal period between E18 and E21. The rest of the pineal cells originated after birth, particularly in the first 5 postnatal days.

Cataleptic postures in thalamic hemorrhage: case report.

We report a case of catalepsy associated with thalamic hemorrhage. A 72 year-old hypertensive woman had acute onset of right-sided weakness and speech disturbances. She was on anticoagulants because of aortic valve replacement. When postures were imposed, the patient maintained the left upper limb raised for several minutes, even in uncomfortable or bizarre positions. A CT scan of the head revealed a left thalamic hemorrhage. Cataleptic postures have been reported in few cases with acute stroke.

Hipofonía en ictus lacunar / Hypophonia in lacunar stroke

La hipofonía ha sido definida como una disminución en el volumen del habla. Es una manifestación infrecuente de ictus que se ha relacionado con infartos profundos múltiples. Caso clínico. Mujer de 82 años, con antecedentes de hipertensión arterial, que fue admitida en nuestro hospital por presentar debilidad en hemicuerpo derecho y un bajo nivel de voz. Presentaba hipofonía y era incapaz de elevar la voz. El lenguaje era fluente sin parafasias. La resonancia magnética con sequencia de difusión reveló una lesión pequeña hiperintensa en la corona radiata izquierda. No se detectaron otras lesiones. Conclusiones. Si bien la topografía lesional precisa que explique esta sintomatología no ha sido aún claramente definida, la hipofonía también podría asociarse a infartos lacunares aislados afectando arterias penetrantes en la corona radiata. Se requieren en estudios prospectivos para poder determinar la naturaleza y el pronóstico de este fenómeno (AU)

Reconstrucción de grandes defectos de cabeza y cuello con el colgajo libre de rectoabdominal / Reconstruction of huge head and neck defects with the rectus abdominis free flap

Introducción. La utilidad del colgajo libre de recto abdominal en la reconstrucción de grandes complejos defectos tridimensionales de cabeza y cuello, oncológicos o de otra etiología, permite ofrecer una alternativa terapéutica en aquellos pacientes que, debido a la extensión de su enfermedad o al haber agotado previamente otras modalidades de tratamiento, serían desahuciados.Material y método. Se presenta un estudio retrospectivo sobre 16 colgajos realizados en el período comprendido entre 1-1-1996 y el 1-7-1999, en el Servicio de Cirugía Oral y Maxilofacial del Hospital Universitario 12 de Octubre de Madrid. Resultados. La tasa global de éxito en la transferencia tisular microvascularizada fue superior al 93 por ciento, registrándose una muy baja incidencia de complicaciones en la zona donante y en la receptora. Cerca de un 50 por ciento de los pacientes con un estadio IV en la evolución de su enfermedad siguen vivos y con un control efectivo locorregional a los 2 años de su seguimiento postoperatorio. Conclusión. La reconstrucción de grandes defectos en cabeza y cuello mediante el colgajo libre de recto abdominal es un método seguro y fiable, útil en aquellos pacientes con avanzados estadios de evolución en su enfermedad (AU)

Facial myokymia in brain death.

BACKGROUND: Brain death (BD) is the irreversible loss of all functions of the brain and brainstem. Spontaneous and reflex movements of the limbs have been described in this condition. However, facial myokymia (FM) in BD has not been previously reported. The origin of that motor phenomenon in alive patients is still uncertain, since supranuclear, nuclear and peripheral mechanisms have been proposed. OBJECTIVE: We describe the presence of FM in a patient who fulfilled the criteria for BD. A 40-year-old-man had right-sided weakness and impaired consciousness. After 14 h admission, he fulfilled the criteria for BD. A CT scan of the head showed a large putaminal hemorrhage. The EEG was isoelectric. At that time, fine spontaneous twitches of the left cheek were noticed. They consisted of repetitive and rhythmic movements in groups of 3-5 lasting for < 5 s. These movements appeared every 2-10 min during 6 h. DISCUSSION: Spinal reflexes have been described in BD. The presence of any movements other than the recognized reflexes may question this diagnosis and limit organ procurement for transplantation. The recognition of FM as an accepted movement in BD patients has practical and legal implications.

Multiple simultaneous intracerebral hemorrhages: clinical features and outcome.

BACKGROUND: The simultaneous occurrence of intracerebral hemorrhages in different arterial territories is an uncommon clinical event. Its predisposing factors and pathophysiological mechanisms are not clearly defined. OBJECTIVE: To analyze the frequency, risk factors, clinical features, neuroimaging findings, and outcome of multiple simultaneous intracerebral hemorrhages (SIHs). PATIENTS AND METHODS: We studied all patients with acute stroke admitted to our hospital from July 18, 1997, through December 18, 1999. Multiple SIHs were defined as the presence of 2 or more intracerebral hemorrhages affecting different arterial territories with identical computed tomographic density profiles. Patients with a history of traumatic brain injury were excluded from this study. Diagnostic investigation included routine blood and urine tests, coagulation studies, a chest radiograph, electrocardiogram, 2-dimensional transthoracic echocardiography, and computed tomography of the head without contrast medium. Disability was assessed using the National Institutes of Health Stroke Scale and Modified Rankin Scale. RESULTS: Among 142 patients with hemorrhagic stroke, we found 4 (2.8%) with SIHs. All 4 patients had a history of uncontrolled arterial hypertension. We excluded other potential causes of multiple SIHs by using appropriate diagnostic tests. The most common clinical manifestations were headache and weakness. Localization of hematomas was supratentorial, except for one patient who had both infratentorial and supratentorial hemorrhages. The mean National Institutes of Health score on admission was 15 and the Modified Rankin Scale score was higher than 4 at 3 months. CONCLUSIONS: In our study, all patients with multiple SIHs had arterial hypertension and a poor outcome. Additional analytic studies, including new imaging techniques, can help to elucidate the association between arterial hypertension and multiple SIHs, risk factors, and underlying mechanisms of this clinical condition.

[Hypophonia in lacunar stroke]. / Hipofonía en ictus lacunar.

INTRODUCTION: Hypophonia has been defined as a reduction in speech volume. It is an uncommon finding in acute stroke, mainly related to multiple deep infarcts. CLINICAL CASE: An 82 year old hypertensive woman was admitted to our hospital presenting acute right sided weakness and low speech volume. She was hypophonic and unable to yell. Language was fluent without paraphasic errors. A diffusion weighted magnetic resonance showed a small hyperintense lesion in the left corona radiata. No other lesions were detected. CONCLUSIONS: Although, the precise anatomic area involved in the brain has not been clearly precised yet, hypophonia may be also due to isolated lacunar affecting the penetrating arteries in the corona radiata. Further studies are necessary to better understand the nature and the prognosis of this phenomenon.

Fluctuación en infarto talámico bilateral: estudio con difusiónpor resonancia magnética / Fluctuation in bilateral thalamic infarct: a magnetic resonance diffusion study

Introducción. Los infartos talámicos paramedianos bilaterales son infrecuentes. Se caracterizan por disminución aguda del nivel de conciencia, alteraciones oculomotoras y trastornos cognitivos. La evolución clínica fluctuante no ha sido previamente referida. Caso Clínico. Mujer de 66 años, con antecedentes de hipertensión y diabetes insulinodependiente, que presentó cuatro episodios fluctuantes de deterioro del nivel de conciencia y alteración en la mirada conjugada vertical. Entre cada episodio, el examen neurológico era normal. La difusión por resonancia magnética evidenció lesiones hiperintensas en la región paramediana de ambos tálamos. Conclusión. Los infartos talámicos paramedianos bilaterales pueden presentarse como episodios fluctuantes del nivel de conciencia. La causa más frecuente es la oclusión ateromatosa del ostium de la arteria tálamo-subtalámica. Los hallazgos del examen neurológico y de las imágenes por difusión contribuirían a definir la extensión y mecanismo etiopatogénico subyacente de este tipo de ictus isquémico (AU)

Cell proliferation in the developing rat pineal gland. A bromodeoxyuridine immunohistochemical study.

The immunohistochemical detection of bromodeoxyuridine (BrdU) was used to study the cell proliferation in the developing rat pineal gland, from the appearance of pineal primordium in the embryonic day 15 (E15) until 30 days after birth. The results showed three different proliferative phases. From E15 to E21, the pineal gland shows a phase of rapid proliferation. The second phase corresponds to the first postnatal week, in which the number of labeled cells per surface unit decreases suddenly to values between 20% to 10% of those of embryonic period. From the second postnatal week onwards, the number of BrdU-positive cells progressively decreases.

Spontaneous and reflex movements in brain death.

Spontaneous and reflex movements may be found in patients with brain death (BD). The authors prospectively evaluated their frequency using a standardized protocol. Among 38 patients who fulfilled criteria for BD, the authors found 15 (39%) with spontaneous or reflex movements. The most common movement was finger jerks. Undulating toe flexion sign, triple flexion response, Lazarus sign, pronation-extension reflex, and facial myokymia also were seen. These movements may be more common than reported and do not preclude the diagnosis of BD.