[Is it possible to extract intracranial pressure information based on the EEG activity?] / Es posible obtener informacion de la presion intracraneal a partir de la actividad electroencefalografica?

INTRODUCTION: The capability of the electroencephalography (EEG) of recording the bioelectrical activity of the brain has made of it a fundamental tool for the evaluation of the patient's neurological condition. In recent years, moreover, it has also begun to be used in obtaining information for other kind of variables, as the ones related with the cerebral hemodynamics. AIM: To study the potential relationship between the EEG activity and the intracranial pressure (ICP) in patients suffering from traumatic brain injury and subarachnoid hemorrhage, during their stay at the intensive care unit. PATIENTS AND METHODS: Twenty-one adult patients (10 women) were included in the present observational prospective cohort study. They suffered from either traumatic brain injury or subarachnoid hemorrhage, requiring continuous EEG and ICP monitoring. In every patient, Granger causality between spectral functions of the EEG and the ICP was evaluated. Temporal windows of 10 minute were used to evaluate whether a causal relationship between those variables exist or not. In all of the cases, several days of continuous recording and assessment were performed. RESULTS: In most patients and during most of the time, Granger causality turns out to be significant in the direction from the EEG to the ICP, meaning that the EEG dynamics actually leads the ICP dynamics. CONCLUSIONS: The present work provides useful information and shed light in discovering a hidden relationship between the ICP and EEG dynamics. The potential use of this relationship could lead to develop a medical device to measure ICP in a non-invasive fashion.

TITLE: Es posible obtener informacion de la presion intracraneal a partir de la actividad electroencefalografica?Introduccion. El electroencefalograma (EEG) permite obtener informacion directa de la actividad bioelectrica del cerebro y es una herramienta fundamental para la evaluacion de la condicion neurologica del paciente. En los ultimos años ha comenzado a emplearse tambien para obtener indirectamente informacion sobre la hemodinamica cerebral y las variables que intervienen en la autorregulacion del flujo sanguineo cerebral. Objetivo. Estudiar la posible relacion entre la actividad electroencefalografica y la presion intracraneal (PIC) en pacientes con traumatismo craneoencefalico y hemorragia subaracnoidea ingresados en cuidados intensivos. Pacientes y metodos. Se incluyo a 21 pacientes (10 mujeres) mayores de 18 años con traumatismo craneoencefalico o hemorragia subaracnoidea que requerian monitorizacion de la PIC y a los que se les registro el EEG de forma continua. Se determino la causalidad de Granger entre la PIC con respecto a las variables espectrales del EEG para ventanas temporales de 10 minutos durante la estancia en cuidados intensivos. Resultados. La causalidad de Granger mostro una alta correlacion entre la PIC con las bandas del EEG. En la mayoria de los pacientes existe una causalidad de Granger significativa en la direccion del EEG hacia la PIC en gran parte del tiempo de monitorizacion, de forma que las variables del EEG precedian a la PIC. Conclusiones. El presente trabajo expone la relacion temporal subyacente entre la dinamica de la PIC y la actividad bioelectrica cerebral registrada mediante EEG en pacientes con traumatismo craneoencefalico y hemorragia subaracnoidea. El potencial uso de esta relacion podria permitir estimar la PIC de manera no invasiva.

La farmacia hospitalaria en Cuba. Evolución y perspectivas / No disponible

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[Study of the brachial plexus by magnetic resonance]. / Estudio del plexo braquial por resonancia magnética.

OBJECTIVE: Magnetic resonance (MR) is considered to be the best method available at present for diagnosis of lesions of the brachial plexus. In this study we analyze our experience in patients with pathology of the brachial plexus. MATERIAL AND METHODS: Between August 1991 and March 1997 we did magnetic resonance studies on 42 patients with pathology of the brachial plexus. Our protocols included T1, T2 axial spin-echo sequences with 5 mm cuts and coronal echo of a T1-3D gradient with 2 mm cuts, together with a T1 coronal spin-echo, with cuts 2 mm in width. RESULTS: The causes found were: traumatic 16 patients (38%), pathology of bone 2 (4.7%), 19 tumours (45.2%) with breast cancer being commonest, and no obvious aetiology in 5 (11.9%). CONCLUSIONS: MR is the technique of choice for study of pathology of the brachial plexus of traumatic or tumour origin. In some patients, 11.9% in our series, no aetiology could be detected using MR.

[Self-limited steatorrhea and chronic autoimmune hepatitis type I. The Group for the Study of Viral Hepatitis and AIDS]. / Esteatorrea autolimitada y hepatitis crónica autoinmune tipo I. Grupo para el Estudio de la Hepatitis Vírica y SIDA.

Active chronic hepatitis is very infrequent in Spain. Its autoimmune pathogenesis is supported by the coexistence of autoimmune features, its usually good response to immunosuppressive treatment and the frequent coexistence of other processes of autoimmune etiology. The infrequent cases of steatorrhea observed may usually be found in the presence of severe colostasis or in association with other diseases such as celiac disease. The presence of sever anemia is also infrequent being observed on hemolysis of digestive bleeding. A case of autoimmune type I chronic hepatitis observed in a 14-year old woman presenting as acute hepatitis associated to severe anemia (Hb, 6,3 g/dl) and self-limited steatorrhea independent of the clinical course of the hepatic picture (stool fats of up to 100 g/24 h) with no evidence of hemolysis, digestive bleeding, obvious colostasis, drug ingestion or demonstrable intestinal or pancreatic disease. The coexistence of these unusual findings led the authors to report this case.

Incontinentia pigmenti: MR demonstration of brain changes.

PURPOSE: To describe the MR findings in eight girls and women with incontinentia pigmenti, from two families. Four had skin lesions and neurologic disease, and four had only skin lesions. METHODS: Eight patients had physical examination, family history, electroencephalogram and MR examination of the brain. MR was repeated in the two cases with more severe changes several years after the first study. RESULTS: MR revealed brain changes only in the four patients who had neurologic disease associated with the cutaneous lesions of incontinentia pigmenti. Abnormalities were located in the cerebral hemisphere contralateral to the most affected side of the body. In two cases, the MR changes were subjacent to the scalp areas where the most severe cutaneous lesions were located in the neonatal period. Hypoplasia of the corpus callosum, probably secondary to atrophy of one or both cerebral hemispheres, and abnormal signal and atrophy of the lateral regions of one of the cerebellar hemispheres also were found in all four cases. Although the changes were seen in both the T1- and T2-weighted images, they were most evident in the latter. The four patients in the fourth stage who had only cutaneous lesions without neurologic problems did not reveal any MR abnormalities. CONCLUSIONS: This study demonstrates MR signal changes and focal atrophy of the cerebrum, cerebellum, and corpus callosum in patients with incontinentia pigmenti and neurologic disorders. The MR images appear normal in patients with incontinentia pigmenti who have no neurologic abnormalities.

Hepatitis C virus infection among sexually promiscuous groups and the heterosexual partners of hepatitis C virus infected index cases.

To define the role of sexual transmission in the spread of hepatitis C virus (HCV) infection, a seroprevalence study of antibodies against HCV was performed in populations at high risk for sexually transmitted diseases. Subjects included 310 female prostitutes, 88 clients of prostitutes, 168 homosexual men and 147 stable heterosexual partners of index cases reactive for anti-HCV (98 of whom were partners of drug addicts coinfected with HCV and human immunodeficiency virus [HIV]). All subjects denied prior transfusion or intravenous drug use. Controls were 400 voluntary blood donors selected randomly from first-time donors. The prevalence of anti-HCV by enzyme immunoassay, confirmed by a second-generation recombinant immunoblot assay, was 6.4% in prostitutes, 6.8% in clients of prostitutes, 4.2% in homosexual men, 7.4% in heterosexual partners of index cases and 1.2% in random donors. However, the anti-HCV prevalence in stable heterosexual partners of HCV-positive/HIV-positive index cases was 2.2 times higher than in stable heterosexual partners of index cases reactive for anti-HCV only (9.2% vs. 4.1%), and sexual partners of index cases coinfected with HCV and HIV were almost three times more likely to be infected with HIV than with HCV (25.5% vs. 9.2%). These data suggest that HCV infection may be sexually transmitted but with low efficiency and that this efficiency could be increased in the presence of coexistent HIV infection in the index case.

[Neuroepithelial tumors in the pediatric population]. / Tumores neuroepiteliales en la población infantil.

We have studied the neuroepithelial tumors in childhood, about their epidemiological, clinical and histological aspects, the macroscopic tumoral structure and the findings obtained by magnetic resonance imaging. We stress the differential diagnosis features among the various tumoral types, based on bibliography and our own clinical experience.

[Normal myelination patterns]. / Patrones de mielinización normal.

The MR images obtained of brain during the process of myelination taking place from birth to 2 years of age are analyzed. Basically, the study focuses on the changes in signal intensity experienced by the elements of the brain in the different sequences, consisting in an increase (T1 weighted sequence) or decrease (T2 sequences) in the signal. The chronological evolution of these changes is compared with the classic myelination pattern, described prior to the development of MR, based on necropsies. Also assessed were the progressive changes in the signals of the gray and white matter, reflecting their hydric contents, throughout the period of maturation of the brain structures. It is concluded that MR imaging is presently the diagnostic method of choice in the monitoring of myelination. MR spectroscopy studies offer important perspectives for assessment and follow up of this process from the metabolic point of view.

Hepatitis C virus infection in sexually promiscuous groups.

As there is insufficient data available on the spread of hepatitis C virus (HCV) infection by sexual transmission, the prevalence of anti-HCV was determined in several sexually promiscuous groups (78 female prostitutes, 55 clients of prostitutes and 146 homosexual men) who denied intravenous drug abuse. The overall HCV infection rate was much higher in the sexually promiscuous groups (8.97%, 16.36% and 5.48% respectively) than in voluntary blood donors (0.48%), suggesting that HCV infection can be transmitted by sexual intercourse. Consequently, promiscuity may be a risk factor for this infection.

Malignant and atypical meningiomas: a reappraisal of clinical, histological, and computed tomographic features.

A series of 21 patients with atypical and malignant meningiomas is presented. Histological criteria such as high cellularity, typical and atypical mitosis, necrosis, infiltration of the underlying brain, poor differentiation, and distant metastasis define nonbenign meningiomas. Male predominance in this nonbenign group is significant when compared to a group of 205 benign meningiomas, which were also operated on. The malignant and atypical meningiomas are compared with the benign meningiomas, and special emphasis is placed on their computed tomographic features. The presence of tumor fringes (suggesting invasion of the brain substance) and intratumoral hypodense areas were both significant signs of malignancy of atypia. Radical surgical excision is still considered the treatment of choice.