Predictive factors of sleep quality in patients with chronic migraine.

INTRODUCTION: One of the factors contributing to transformation of migraine are sleep disorders, which can act as a trigger and/or perpetuating factor in these patients. This study's primary objective was to identify predictive factors related to sleep quality in patients with chronic migraine (CM); the secondary objective was to identify any differences in psychological variables and disability between patients with CM with better or poorer sleep quality. METHODS: A total of 50 patients with CM were included in an observational, cross-sectional study. We recorded data on demographic, psychological, and disability variables using self-administered questionnaires. RESULTS: A direct, moderate-to-strong correlation was observed between the different disability and psychological variables analysed (P < .05). Regression analysis identified depressive symptoms, headache-related disability, and pain catastrophising as predictors of sleep quality; together, these factors explain 33% of the variance. Statistically significant differences were found between patients with better and poorer sleep quality for depressive symptoms (P = .016) and pain catastrophising (P = .036). CONCLUSIONS: The predictive factors for sleep quality in patients with CM were depressive symptoms, headache-related disability, and pain catastrophising. Patients with poorer sleep quality had higher levels of pain catastrophising and depressive symptoms.

Factores predictores de la calidad del sueño en pacientes con migraña crónica / Predictive factors of sleep quality in patients with chronic migraine

Introducción: Uno de los factores contribuyentes en la cronificación de la migraña son los trastornos del sueño que pueden actuar como un factor precipitante y/o perpetuador en estos sujetos. El objetivo primario de este estudio fue identificar los factores predictores relacionados con la calidad del sueño en pacientes con migraña crónica (MC) y el objetivo secundario fue identificar si existían diferencias en variables psicológicas y de discapacidad entre los pacientes con MC que presentaban menor o mayor calidad del sueño. Métodos: Se llevó a cabo un estudio observacional, transversal, formado por 50 participantes con MC. Se registraron una serie de variables demográficas, psicológicas y de discapacidad mediante cuestionarios de autorregistro. Resultados: Se observaron correlaciones directas, moderadas-fuertes, entre las diferentes variables de discapacidad y psicológicas analizadas (p < 0,05). En la regresión, se estableció como variable criterio la calidad del sueño y las variables predictores fueron los síntomas depresivos, la discapacidad relacionada con la cefalea y el catastrofismo ante el dolor que, en conjunto, explican el 33% de la varianza. En cuanto a la comparación de los grupos de mayor y menor afectación del sueño, se encontraron diferencias estadísticamente significativas en la variable de síntomas depresivos (p = 0,016) y catastrofismo ante el dolor (p = 0,036). Conclusiones: Los factores predictores de la calidad del sueño en pacientes con MC fueron los síntomas depresivos, la discapacidad relacionada con la cefalea y, en menor medida, el catastrofismo ante el dolor. Los sujetos con peor calidad de sueño presentaron mayores niveles de catastrofismo ante el dolor y síntomas depresivos. (AU)

Introduction: One of the factors contributing to transformation of migraine are sleep disorders, which can act as a trigger and/or perpetuating factor in these patients. This study's primary objective was to identify predictive factors related to sleep quality in patients with chronic migraine (CM); the secondary objective was to identify any differences in psychological variables and disability between patients with CM with better or poorer sleep quality. Methods: A total of 50 patients with CM were included in an observational, cross-sectional study. We recorded data on demographic, psychological, and disability variables using self-administered questionnaires. Results: A direct, moderate-to-strong correlation was observed between the different disability and psychological variables analysed (P < .05). Regression analysis identified depressive symptoms, headache-related disability, and pain catastrophising as predictors of sleep quality; together, these factors explain 33% of the variance. Statistically significant differences were found between patients with better and poorer sleep quality for depressive symptoms (P = .016) and pain catastrophising (P = .036). Conclusions: The predictive factors for sleep quality in patients with CM were depressive symptoms, headache-related disability, and pain catastrophising. Patients with poorer sleep quality had higher levels of pain catastrophising and depressive symptoms. (AU)

Úlceras vulvares: un reto diagnóstico / Vulvar ulcers: A diagnostic challenge

Las úlceras vulvares son una entidad patológica relevante por su repercusión en la calidad de vida de la mujer y suponen un desafío diagnóstico dada la variedad etiológica y de presentación clínica. El diagnóstico se basa en la anamnesis, la exploración física detallada y pruebas complementarias.Presentamos el caso clínico de una paciente de 39 años con diagnóstico de úlceras vulvares graves, recidivantes, que requirió ingreso hospitalario prolongado en tres ocasiones. Se describe el proceso de identificación, los posibles diagnósticos diferenciales y el resultado del tratamiento aplicado.(AU)

Vulvar ulcers are an important pathological condition due to their impact on the quality of life of women. It is a diagnostic challenge given the aetiological variety and clinical presentation. The diagnosis is based on anamnesis, detailed physical examination, and complementary tests.The clinical case is presented of a 39-year-old patient diagnosed with severe, recurrent vulvar ulcers, and who required prolonged hospital admission on three occasions. The diagnostic process, possible differential diagnoses, and the outcome of the applied treatment are described.(AU)

Predictive factors of sleep quality in patients with chronic migraine. / Factores predictores de la calidad del sueño en pacientes con migraña crónica.

INTRODUCTION: One of the factors contributing to transformation of migraine are sleep disorders, which can act as a trigger and/or perpetuating factor in these patients. This study's primary objective was to identify predictive factors related to sleep quality in patients with chronic migraine (CM); the secondary objective was to identify any differences in psychological variables and disability between patients with CM with better or poorer sleep quality. METHODS: A total of 50 patients with CM were included in an observational, cross-sectional study. We recorded data on demographic, psychological, and disability variables using self-administered questionnaires. RESULTS: A direct, moderate-to-strong correlation was observed between the different disability and psychological variables analysed (P<.05). Regression analysis identified depressive symptoms, headache-related disability, and pain catastrophising as predictors of sleep quality; together, these factors explain 33% of the variance. Statistically significant differences were found between patients with better and poorer sleep quality for depressive symptoms (P=.016) and pain catastrophising (P=.036). CONCLUSIONS: The predictive factors for sleep quality in patients with CM were depressive symptoms, headache-related disability, and pain catastrophising. Patients with poorer sleep quality had higher levels of pain catastrophising and depressive symptoms.

[Does medication abuse in patients with chronic migraine influence the effectiveness of preventive treatment with topiramate?]. / ¿El abuso de farmacos en pacientes con migraña cronica influye en la efectividad del tratamiento preventivo con topiramato?

INTRODUCTION: Patients with chronic migraine (CM) and medication abuse are difficult to treat, and have a greater tendency towards chronification and a poorer quality of life than those with other types of headache. AIM: To evaluate whether the presence of medication abuse lowers the effectiveness of topiramate. PATIENTS AND METHODS: A series of patients with CM were grouped according to whether they met abuse criteria or not. They were advised to stop taking the drug that they were abusing. Treatment was adjusted to match their crises and preventive treatment with topiramate was established from the beginning. The number of days with headache and intense migraine in the previous month and at four months of treatment was evaluated. RESULTS: In all, 262 patients with CM criteria were selected and 167 (63.7%) of them fulfilled abuse criteria. In both groups there was a significant reduction in the number of days with headache/month and number of migraine attacks/month at the fourth month of treatment with topiramate. The percentage of reduction in the number of days with headache/month in CM without abuse was 59.3 ± 36.1%, and with abuse, 48.7 ± 41.7% (p = 0.0574). The percentage of reduction in the number of days with intense migraine/month in CM without abuse was 61.2%, and with abuse, 50% (p = 0.0224). Response rate according to the number of days with headache/month in CM without abuse was 69%, and with abuse, 57%. Response rate according to the number of intense migraines/month in CM without abuse was 76.8%, and in CM with abuse, 61% (p = 0.0097). CONCLUSIONS: Topiramate was effective in patients with CM with and without medication abuse, although effectiveness is lower in the latter case.

TITLE: El abuso de farmacos en pacientes con migraña cronica influye en la efectividad del tratamiento preventivo con topiramato?Introduccion. Los pacientes con migraña cronica (MC) y abuso de medicacion son dificiles de tratar y tienen peor calidad de vida que otros pacientes con migrañas. Objetivo. Valorar si la presencia de abuso de farmacos disminuye la efectividad del topiramato. Pacientes y metodos. Una serie de pacientes con MC fueron agrupados segun presentasen criterios de abuso o no abuso de farmacos. Se les aconsejo la supresion del farmaco del cual abusaban. Se ajusto el tratamiento de sus crisis y se inicio tratamiento preventivo desde el principio con topiramato. Se valoro el numero dias con cefalea y migrañas intensas en el mes previo y al cuarto mes de tratamiento. Resultados. Fueron seleccionados 262 pacientes con criterios de MC, y de ellos 167 (63,7%) cumplieron criterios de abuso. En ambos grupos hubo una reduccion significativa del numero de dias con cefalea/mes y numero de crisis de migraña/mes al cuarto mes de tratamiento con topiramato. Porcentaje de reduccion de dias con cefalea/mes en MC sin abuso, 59,3 ± 36,1%; y con abuso, 48,7 ± 41,7% (p = 0,0574). Porcentaje de reduccion de migrañas intensas/mes en MC sin abuso, 61,2%; y con abuso, 50% (p = 0,0224). Tasa de respondedores segun numero de dias con cefalea/mes en MC sin abuso, 69%; y con abuso, 57%. Tasa de respondedores segun numero de migrañas intensas/mes en MC sin abuso, 76,8%; y en MC con abuso, 61% (p = 0,0097). Conclusiones. El topiramato fue efectivo en pacientes con MC sin y con abuso de farmacos, aunque con menor efectividad en estos ultimos.

[Triptans in clinical practice: effectiveness, tolerance and patient's satisfaction with medication (TRIPRACLI study)]. / Los triptanes en la practica clinica: eficacia, tolerancia y satisfaccion del paciente con los farmacos (estudio TRIPRACLI).

INTRODUCTION AND AIMS: This study was aimed determining the effectiveness, tolerance and satisfaction of patients with migraine as regards different triptans, according to the characteristics of their attacks. At the same time it sought to establish a predictive model that can be used to recommend one or another, depending on those characteristics. PATIENTS AND METHODS: Retrospective observation-based study conducted in headache units in a number of different centres. Patients included in the study were those with migraine who used the same triptan to treat their attacks. Data concerning preference, effectiveness, speed and tolerance were analysed. RESULTS: The analysis included 160 patients (88 females), with a mean age of 42.92 years. The most commonly used triptans were eletriptan, almotriptan and rizatriptan. Both patients and doctors reported a high degree of satisfaction (88% and 65%) with the triptan that was used. In the surveys on preference, patients preferred their current triptan to the previous one (83%) or to non-specific drugs. The overall score on a visual analogue scale was above 7 for all the triptans, without any differences from one to another. On analysing the use of a particular triptan depending on the characteristics of the attacks, no statistically significant differences were found. CONCLUSIONS: In this selected group of patients, triptans are a treatment that patients claim to be very satisfied with. Although there are no overall differences in the scores among different triptans, the fact that certain triptans are used more by patients after previous experiences with others suggests that they are more effective. We did not find any parameter that predicts the use of a particular triptan.

[A study to compare independent groups of patients with episodic migraine who were treated preventively with flunarizine or nadolol]. / Estudio comparativo de grupos independientes de pacientes con migrana episodica tratados preventivamente con flunaricina o nadolol.

INTRODUCTION. Flunarizine, with level of evidence A, and nadolol, with evidence level C, would be indicated as preventive treatment of migraine. Yet, no previous studies have been conducted to compare the effectiveness of the two drugs. AIM. To compare the effectiveness parameters in independent groups of patients treated preventively with one of the pharmaceuticals from the study, the same protocol being applied in both cases. PATIENTS AND METHODS. The subjects selected for the study were patients with episodic migraine (according to 2004 International Headache Society criteria) who had undergone preventive treatment for the first time, with flunarizine (5 mg/day) or nadolol (20-40 mg/day). The main effectiveness variables (reduction in the number of seizures at four months of treatment and responder rates) were analysed. RESULTS. The study included 227 patients who intended to receive treatment: 155 with flunarizine (80.5% females; mean age: 38.3 ± 12.1 years) and 72 with nadolol (63.8% females; mean age: 37.1 ± 12.0 years). The mean number of seizures prior to treatment was 6.09 ± 2.6 in the flunarizine group and 5.1 ± 1.7 in the nadolol group (p = 0.0079); at four months of treatment it was 2.61 ± 2.4 in the flunarizine group and 2.77 ± 2.4 in the nadolol group (p = NS). Percentage of reduction of migraines: 55.2% with flunarizine and 50.4% with nadolol (p = NS). The responder rate was 69% with flunarizine and 67% with nadolol (p = NS). The excellent response rate (reduction in the number of seizures by 75% or more) was 52.2% with flunarizine and 36.1% with nadolol (p = 0.0077). Percentage of adverse side effects: 48.3% with flunarizine and 25% with nadolol (p = 0.0009). The satisfaction rate was similar in both groups, 68%. CONCLUSIONS. Both flunarizine and nadolol proved to be effective in the preventive treatment of episodic migraine. Flunarizine is used more often in our milieu and was less well tolerated.

Myocardial perfusion PET/CT to evaluate known and suspected coronary artery disease.

There is an extensive literature validating the use of positron emission tomography (PET) for the evaluation of regional myocardial perfusion. With PET perfusion imaging, the reported average sensitivity for detecting angiographic stenosis of >50% is 91% (range 83-100%) and the specificity is 89% (range 73-100%). While a sensitive approach for diagnosing obstructive coronary artery disease (CAD), PET (like single photon emission computed tomography) also underestimates the extent of underlying disease. However, PET's unique ability to record changes (from baseline) in left ventricular function during peak stress, as well as quantify myocardial perfusion (in mL/min/g of tissue) and derive estimates of myocardial perfusion reserve can help mitigate this limitation. Recent data suggest that PET can also provide accurate risk prediction in patients with known or suspected CAD, and that this information is additive to clinical risk prediction models. The integration of computed tomography (CT) in hybrid PET/CT scanners offers not only accurate and efficient attenuation correction, but also the possibility of providing diagnostic and prognostic information with the addition of coronary artery calcium scoring and CT coronary angiography. The combination of short lived PET radiopharmaceuticals (e.g., Rubidium-82 and N-13 ammonia) with new technology for the acquisition of the CT imaging data (e.g., prospective gating) allow a comprehensive examination of anatomy and function at a relatively low radiation dose.

Pacientes con cefalea y abuso de medicación. Indicadores de respuesta al tratamiento ambulatorio / Patients with headache and medication aubse. Indicators of response to ambulatory treatment

Introducción. Los pacientes con cefalea y abuso de medicación (CAM) son difíciles de tratar, presentan mayor tendenciaa la cronificación y peor calidad de vida que los que cursan con otras cefaleas. Objetivo. Valorar los indicadores de respuesta de estos pacientes al tratamiento ambulatorio. Pacientes y métodos. De una serie de pacientes con migraña, seleccionamos aquéllos con criterios de CAM según el apéndice de la International Classification of the Headache Disease (ICHD-2) de 2006 y que nunca habían llevado previamente tratamiento. Ambulatoriamente, se les aconsejó la supresión del fármaco del que abusaban. Se ajustó el tratamiento de sus crisis con los fármacos más eficaces y se inició tratamiento preventivo desde el principio, con topiramato o flunaricina. Se agrupó a los pacientes según persistieran con CAM o no. Se valoró el número días con cefalea en el mes previo y al cuarto mes de tratamiento y la persistencia de abuso. Resultados. Cumplieron criterios de CAM 178 pacientes (edad media: 40,9 años; 88,7% mujeres). El 68,5% (122 pacientes) respondió y dejó de cumplir criterios de CAM tras el tratamiento. En ambos grupos, los tratamientos de sus crisis (triptanes, antiinflamatorios no esteroideos, analgésicos) y preventivos utilizados (topiramato o flunaricina) fueron similares. La media de días con cefalea previa al tratamiento fue de 18,52 en el grupo que respondió y de 20,87 (p = 0,0263) en el grupo que no respondió al tratamiento. Un 7,3% abandonó el tratamiento preventivo en el grupo de respondedores frente al 35% (p = 0,0001) en los no respondedores. Conclusiones. El mayor número de días con cefalea en el mes previo al tratamiento y el abandono del tratamiento preventivo fueron indicadores de mala evolución (AU)

Introduction. Patients with headache and medication abuse (HMA) are difficult to treat, have a greater tendency owards chronification and a poorer quality of life than those with other types of headache. Aim. To evaluate the indicators showing that these patients are responding to ambulatory treatment. Patients and methods. From a series of patients with migraine, we selected those who satisfied HMA criteria according to the appendix of the 2006 International Classification of the Headache Disease (ICHD-2) and who had never previously undergone treatment. As outpatients, they were advised to stop taking the drug that they were abusing. The treatment of their seizures was adjusted with the most efficient drugs and preventive treatment was started from the outset with topiramate or flunarizine. Patients were grouped according to whether they continued with HMA or not. Comparisons were made between the number of days with headache during the previous month and after four months of treatment and the persistence of abuse. Results. HMA criteria were met by 178 patients (mean age 40.9; 88.7% females). Results showed that 68.5% (122 patients) responded and no longer met HMA criteria after treatment. The treatment used for their seizures (triptans, nonsteroidal antiinflammatory drugs, analgesics) and preventive treatment (topiramate or flunarizine) were similar in both groups. The average number of days with headache prior to treatment was 18.52 in the group that responded and 20.87 (p = 0.0263) in the group that did not respond to treatment. In the group of responders 7.3% dropped out of preventive treatment compared with 35% (p = 0.0001) in the group of non-responders. Conclusions. A higher number of days with headache during the previous month and withdrawing from preventive treatment were indicators of a bad progression (AU)

[Patients with headache and medication abuse. Indicators of response to ambulatory treatment]. / Pacientes con cefalea y abuso de medicación. Indicadores de respuesta al tratamiento ambulatorio.

INTRODUCTION: Patients with headache and medication abuse (HMA) are difficult to treat, have a greater tendency towards chronification and a poorer quality of life than those with other types of headache. AIM. To evaluate the indicators showing that these patients are responding to ambulatory treatment. PATIENTS AND METHODS: From a series of patients with migraine, we selected those who satisfied HMA criteria according to the appendix of the 2006 International Classification of the Headache Disease (ICHD-2) and who had never previously undergone treatment. As outpatients, they were advised to stop taking the drug that they were abusing. The treatment of their seizures was adjusted with the most efficient drugs and preventive treatment was started from the outset with topiramate or flunarizine. Patients were grouped according to whether they continued with HMA or not. Comparisons were made between the number of days with headache during the previous month and after four months of treatment and the persistence of abuse. RESULTS: HMA criteria were met by 178 patients (mean age 40.9; 88.7% females). Results showed that 68.5% (122 patients) responded and no longer met HMA criteria after treatment. The treatment used for their seizures (triptans, nonsteroidal antiinflammatory drugs, analgesics) and preventive treatment (topiramate or flunarizine) were similar in both groups. The average number of days with headache prior to treatment was 18.52 in the group that responded and 20.87 (p = 0.0263) in the group that did not respond to treatment. In the group of responders 7.3% dropped out of preventive treatment compared with 35% (p = 0.0001) in the group of non-responders. CONCLUSIONS: A higher number of days with headache during the previous month and withdrawing from preventive treatment were indicators of a bad progression.

[The importance of chronic migraine in a general neurology service]. / Importancia de la migraña crónica en una consulta general de neurología.

INTRODUCTION: Chronic migraine is a primary headache that is difficult to treat and has an important impact on the patient's quality of life. The international headache classification recently modified the criteria for chronic migraine and therefore few studies have been conducted that analyse groups according to these new criteria. AIM. To analyse a group of patients with chronic migraine who were referred to a general neurology service. PATIENTS AND METHODS: The first 100 patients with migraine were selected. Researchers established and analysed a number of subgroups of patients with episodic, chronic or chronic migraine with probable headache due to medication abuse, in accordance with the International Headache Society (IHS) headache classification and its revised version from 2006. RESULTS: Of the total sample of 738 new patients, 100 (13.5%) suffered from migraines and of these 100 new patients with migraine 42 (5.6% of the total series) satisfied criteria for chronic migraine and 15 patients with chronic migraine met the criteria for probable headache due to medication abuse. Before visiting the neurology service, only 41% had been diagnosed as suffering from migraine, 38% had received no information about this condition, only 17% took triptans for symptomatic relief and 23% had followed some kind of preventive treatment. CONCLUSIONS: One notable finding was the importance of episodic and chronic migraine in a general neurology service, on applying the recent IHS criteria. A high percentage of patients with chronic migraine who were referred to the neurology service have not been diagnosed or given any information or proper treatment; an elevated degree of self-medication and medication abuse also exists. Preventive treatment and triptans in cases of intense migraines are still not commonly used in primary care.

Importancia de la migraña crónica en una consulta general de neurología / The importance of chronic migraine in a general neurology service

La migraña crónica es una cefalea primaria difícil de tratar que produce gran afectación de la calidadde vida del paciente. La clasificación internacional de cefaleas modificó los criterios de migraña crónica recientemente, por lo que existen pocos trabajos que analicen grupos con estos nuevos criterios. Objetivo. Analizar un grupo de pacientes con migrañacrónica remitidos a una consulta de neurología general. Pacientes y métodos. Se seleccionaron los primeros 100 pacientes con migraña. Se establecieron y analizaron subgrupos de pacientes con migraña episódica, crónica o crónica con probable cefalea por abuso de fármacos según la clasificación de cefaleas de la Sociedad Internacional de Cefaleas (IHS) y su revisión delaño 2006. Resultados. Del total de 738 nuevos pacientes, 100 (13,5%) sufrieron migrañas. De estos 100 nuevos pacientes con migraña, 42 (el 5,6% de la serie total) cumplieron los criterios de migraña crónica, y 15 pacientes con migraña crónica, los criteriosde probable cefalea por abuso de fármacos. Antes de acudir a la consulta de neurología, sólo al 41% se le había diagnosticado migraña, un 38% no había recibido información sobre esta entidad, sólo el 17% tomaba triptanes como tratamiento sintomático,y un 23% había seguido tratamiento preventivo. Conclusiones. Destacamos la importancia de la migraña episódica y crónica en una consulta general de neurología, aplicando los criterios recientes de la IHS. Los pacientes con migraña crónica enviados a la consulta de neurología siguen, en un alto porcentaje, sin haber sido diagnosticados, ni informados, ni tratados correctamente, con un alto grado de automedicación y abuso frecuente de fármacos. Los tratamientos preventivos y triptanes en migrañasintensas se siguen utilizando poco en atención primaria (AU)

Chronic migraine is a primary headache that is difficult to treat and has an important impact on the patient’s quality of life. The international headache classification recently modified the criteria for chronic migraine and therefore few studies have been conducted that analyse groups according to these new criteria. Aim. To analyse a group of patients with chronic migraine who were referred to a general neurology service. Patients and methods. The first 100 patients with migraine were selected. Researchers established and analysed a number of subgroups of patients with episodic, chronic or chronic migraine with probable headache due to medication abuse, in accordance with the International Headache Society (IHS) headache classification and its revised version from 2006. Results. Of the total sample of 738 new patients, 100 (13.5%) suffered from migraines and of these 100 new patients with migraine 42 (5.6% of the total series) satisfied criteria for chronic migraine and 15 patients with chronic migraine met the criteria for probable headache due to medication abuse. Before visiting the neurology service, only 41% had been diagnosed as suffering from migraine, 38% had received no information about this condition, only 17% took triptans for symptomatic relief and 23% had followed some kind of preventive treatment.Conclusions. One notable finding was the importance of episodic and chronic migraine in a general neurology service, on applying the recent IHS criteria. A high percentage of patients with chronic migraine who were referred to the neurology service have not been diagnosed or given any information or proper treatment; an elevated degree of self-medication and medication abuse also exists. Preventive treatment and triptans in cases of intense migraines are still not commonly used in primary care (AU)

Diagnóstico prenatal de triploidías / Prenatal diagnosis of triploids

Estudio retrospectivo de los casos de triploidía diagnosticados en el período comprendido desde enero de 2000 a enero de 2008, revisando los hallazgos ecográficos, la edad gestacional, el diagnóstico, los marcadores bioquímicos y el cribado de aneuploidía

Retrospective study of the cases of triploidy diagnosedin the period from January 2000 to January 2008. Areview was made of the ultrasound findings, gestationalage, diagnosis, biochemical markers and aneuploidy screening5 (AU)

Gestación gemelar bicorial biamniótica con un feto vivo y una mola parcial del otro gemelo / Bichorial bioamniotic twin pregnancy with one live fetus and a partial hydatiform mole

La gestación gemelar con una bolsa con feto vivo y una segunda bolsa con una mola parcial embrionada es un caso extremadamente infrecuente. En nuestro caso se trata de una paciente nulípara, de 22 años de edad, con gestación espontánea, que ingresó en la semana 16 por hiperemesis gravídica resistente al tratamiento habitual. En la ecografía se detectó una gestación gemelar bicorial biamniótica con un primer feto vivo y otro feto sin frecuencia cardíaca con una biometría de 12-13 semanas y una placenta de aspecto molar. Se realizó una biopsia corial que confirmó el diagnóstico. La paciente decidió continuar con el embarazo y fue controlada en la consulta de alto riesgo hasta la semana 38, en que se indujo el parto por elevación de la presión arterial, con buen resultado perinatal. La evolución de la paciente fue favorable y en la actualidad permanece asintomática (AU)

Twin pregnancy with one sac containing a live fetus and a second sac containing a partial embryonic mole is an extremely rare entity. A 22-year-old nulliparous woman was admitted to our hospital at 16 weeks’ gestation due to persistent hyperemesis unresponsive to the usual medication. Ultrasound examination revealed a bichorial biamniotic twin pregnancy with one live fetus and another fetus with absent fetal heart rate and a biometry of 12-13 weeks. The placenta of the second fetus showed signs of diffuse molar changes. The diagnosis was made with chorionic villus sampling biopsy. The patient wanted to continue with the pregnancy and was followed-up as a high risk pregnancy. Labor was induced at 38 weeks’ gestation due to preeclampsia. Outcome was favorable and the patient remains asymptomatic (AU)

[Topiramate in chronic daily headache due to migraine]. / Topiramato en cefalea crónica diaria por migraña.

INTRODUCTION: Chronic daily headache (CDH) includes primary headaches that last more than four hours with a frequency equal or superior to 15 days a month over the last three months. It has a prevalence of 4-5% in the general population and is a frequent reason for visiting the physician in headache units. AIM: To evaluate the effectiveness of topiramate, as the primary drug, in CDH due to probable chronic migraine with or without medication abuse. PATIENTS AND METHODS: From the 447 patients with migraine in our database, we selected those: a) satisfying Silberstein criteria for CDH; b) that had not followed prior prophylactic treatment; and c) who were treated with topiramate as the primary drug. The mean number of days with headache and bouts of severe migraine in the fourth month of treatment using topiramate as compared to the month preceding treatment, as well as the percentage of responses and the rate of respondents in the fourth month were all analysed. RESULTS: Eighty-three patients (88% females) with a mean age of 38.0 +/- 14.13 years were selected. Medication abuse was reported in 44% of cases. At the fourth month of treatment, the mean number of days with headache dropped significantly from 20.8 to 7.9 (p < 0.0001) and the mean number of bouts of severe migraine diminished from 4.4 to 1.7 (p < 0.0001). The rate of respondents was 72%. Medication abuse continued in 14% of cases. Side effects were produced in 58% of patients and the dropout rate was 24%. CONCLUSIONS: Topiramate proved to be effective in the treatment of CDH due to probable chronic migraine and with probable medication abuse in de novo migraine patients.

Topiramato en cefalea crónica diaria por migraña / Topiramate in chronic daily headache due to migraine

La cefalea crónica diaria (CCD) incluye aquellas cefaleas primarias de más de cuatro horas de duracióny frecuencia igual o superior a 15 días al mes en los últimos tres meses. Presenta una prevalencia del 4-5% entre la población general y es un motivo frecuente de consulta en las unidades de cefaleas. Objetivo. Valorar la efectividad de topiramato, como primer fármaco, en la CCD por probable migraña crónica con o sin abuso de fármacos. Pacientes y métodos. De nuestra base de datos de 447 pacientes con migraña se seleccionaron aquellos: a) con criterios de Silberstein de CCD, b) queno habían llevado un tratamiento profiláctico previo, y c) tratados con topiramato como primer fármaco. Se analizaron la media de días con cefalea y crisis de migraña intensa en el cuarto mes de tratamiento con topiramato en relación con el mes previoal tratamiento, los porcentajes de respuesta y la tasa de respondedores en el cuarto mes. Resultados. Se seleccionaron 83 pacientes (88% de mujeres) con una edad media de 38,0 ± 14,13 años. El 44% abusaba de fármacos. Al cuarto mes de tratamiento, la media de días con cefalea disminuyó significativamente de 20,8 a 7,9 (p < 0,0001) y la medía de crisis de migrañaintensa, de 4,4 a 1,7 (p < 0,0001). La tasa de respondedores fue del 72%. Un 14% continuó abusando de los fármacos. Se produjeron efectos adversos en el 58% de pacientes y hubo un 24% de abandonos. Conclusión. El topiramato se mostró efectivo en el tratamiento de la CCD por probable migraña crónica y con probable abuso de fármacos en pacientes migrañosos de novo

Chronic daily headache (CDH) includes primary headaches that last more than four hours with afrequency equal or superior to 15 days a month over the last three months. It has a prevalence of 4-5% in the general population and is a frequent reason for visiting the physician in headache units. Aim. To evaluate the effectiveness of topiramate, as theprimary drug, in CDH due to probable chronic migraine with or without medication abuse. Patients and methods. From the 447 patients with migraine in our database, we selected those: a) satisfying Silberstein criteria for CDH; b) that had not followed prior prophylactic treatment; and c) who were treated with topiramate as the primary drug. The mean number of days with headache and bouts of severe migraine in the fourth month of treatment using topiramate as compared to the monthpreceding treatment, as well as the percentage of responses and the rate of respondents in the fourth month were all analysed.Results. Eighty-three patients (88% females) with a mean age of 38.0 ± 14.13 years were selected. Medication abuse was reported in 44% of cases. At the fourth month of treatment, the mean number of days with headache dropped significantly from20.8 to 7.9 (p < 0.0001) and the mean number of bouts of severe migraine diminished from 4.4 to 1.7 (p < 0.0001). The rate of respondents was 72%. Medication abuse continued in 14% of cases. Side effects were produced in 58% of patients and thedropout rate was 24%. Conclusions. Topiramate proved to be effective in the treatment of CDH due to probable chronic migraine and with probable medication abuse in de novo migraine patients

Tongue-base suspension in conjunction with uvulopalatopharyngoplasty for treatment of severe obstructive sleep apnea: long-term follow-up results.

OBJECTIVES/HYPOTHESIS: To evaluate the usefulness of tongue-base suspension (TBS) in addition to uvulopalatopharyngoplasty (UPPP) in the treatment of obstructive sleep apnea syndrome (OSAS). STUDY DESIGN: Long-term prospective case series. SETTING: University tertiary care medical center. METHODS: Fifty-five consecutive patients with severe OSAS (apnea-hypopnea index [AHI] 52.8+/-14.9 events/hr) with multilevel upper airway obstruction who refused treatment with continuous positive airway pressure underwent UPPP plus TBS with the Repose system. All patients were evaluated before surgery by clinical history, Epworth Sleepiness Scale (ESS), fiberoptic nasopharyngoscopy with Müller maneuver, and nocturnal polysomnography (PSG). After 3 years of surgery, all patients were re-evaluated at the clinic and had ESS test and full PSG. Surgical success was defined when the ESS dropped bellow 11, and the AHI decreased below the threshold of 20 events per hour of sleep and at least 50% from the preoperative value RESULTS: There were 42 (78%) patients in which the AHI score decreased more than 50%, the AHI was lower than 20 events/hr in the PSG, and the ESS was lower than 11 after 3-years of follow-up (surgical success index). Logistic regression analysis demonstrated that body mass index at baseline was the only variable with significant statistical power to predict surgical success (odds ratio 0.85; 0.73-0.95, 95% confidence interval, P<.01) CONCLUSION: When associated with UPPP, the TBS technique performed with the Repose system demonstrates a surgical success of up to 78% for patients with severe OSA who refused nasal continuous positive airway pressure.

Evaluación económica del tratamiento de la crisis aguda de migraña con triptanes en España. Respuesta / Economic evaluation of acute migraine attack treatment with triptans in Spain. Response

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Allogeneic stem cell transplantation in children with acute lymphoblastic leukemia after isolated central nervous system relapse: our experiences and review of the literature.

The prognosis of patients with acute lymphoblastic leukemia (ALL) and central nervous system (CNS) relapse has historically been very poor. Although chemo-radiotherapy has improved outcomes, some patients still have a poor prognosis after CNS relapse. Therefore, allogeneic hematopoietic stem cell transplantation (allo-SCT) has recently become an option for treatment of CNS leukemia; however, information, particularly on the long-term outcome of transplant recipients, is limited. We performed allo-SCT in eight pediatric patients with ALL (n=7) or T-cell type non-Hodgkin's lymphoma (n=1), who had isolated CNS relapse. All patients survived for a median of 70.5 (range, 13-153) months after SCT. Sequelae developed late in some patients: mental retardation (IQ=47) in one patient, severe alopecia in two patients, limited chronic graft-versus-host-disease in three patients, and amenorrhea and/or hypothyroidism in three patients. Except for a pre-school child with post transplant CNS relapse, six out of seven patients show normal school/social performance. Our results clearly indicate a high cure rate of isolated CNS relapse by allo-SCT in pediatric lymphoid malignancies; however, there needs to be further studies to determine which are the appropriate candidates for transplantation and what is the best transplant regimen to achieve high cure rate and maintain good quality of life.

[Topiramate or flunarizine in the preventive treatment of migraine. A comparative study of two series of cases]. / Topiramato o flunaricina en el tratamiento preventivo de la migraña. Estudio comparativo de dos series de casos.

INTRODUCTION: Both flunarizine and, more recently, topiramate have proved to be effective in the prophylaxis of migraine. AIM: To compare two independent groups of patients with similar clinical and demographic characteristics who were treated with flunarizine or topiramate as the preferred drug in the prevention of their migraines and to evaluate effectiveness and safety according to the medication they received. PATIENTS AND METHODS: All the patients reported more than four episodes a month and/or transformed migraine according to Silberstein's criteria, and had never received prophylactic treatment. Data determined: the number and average number of migraines in the previous month and at the fourth month of treatment, and the rate of respondents. RESULTS: A total of 125 patients were included in each group. No significant differences were found between the groups as regards mean age or the average number of migraines in the previous month. With both drugs there was a significant decrease (0.0001) in the mean number of episodes in the fourth month of treatment, but with no significant difference between them: topiramate (5.88 +/- 3.7 to 2.1 +/- 2.5) and flunarizine (5.24 +/- 3.2 to 2.3 +/- 2.7). The mean reduction in the number of migraines at the fourth month was 58.2 +/- 38.2% with topiramate, and 55.4 +/- 37.5% with flunarizine. The respondent rate was 71% with topiramate and 67% with flunarizine. The percentage of dropouts with topiramate (28%) was higher than with flunarizine (11%) (0.0013). With topiramate 69 patients reported side effects and 53 patients reported them with flunarizine (0.0427). CONCLUSIONS: Both drugs showed a high degree of effectiveness when used as the preferred drug in the preventive treatment of migraine. Topiramate offered better results as far as effectiveness is concerned, but also more side effects, none of which were serious.