FR-Mesoterapia con dutasterida, una futura alternativa para el tratamiento de la alopecia androgenética / RF-Mesotherapy With Dutasteride: A Future Alternative Treatment for Androgenetic Alopecia

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Linear Scleroderma and Primary Sclerosing Cholangitis: An Undescribed Association.

Linear scleroderma (LS) is clinically characterized by the presence of sclerotic areas of skin, which develop in a linear pattern. Primary sclerosing cholangitis is a cholestatic disorder that can lead to end-stage liver disease. We present, for the first time in English literature, the case of a patient suffering from both the diseases. This highlights the fact that, even though LS has conventionally been considered to be a form of localized scleroderma, this does not necessarily imply that it is an exclusively cutaneous disease.

Mitral valve replacement in the elderly is associated with low mortality and similar survival to the general population.

BACKGROUND: With the increase in the elderly population, cardiologists and surgeons are faced with an increased incidence of mitral regurgitation. Most of these patients are denied surgery due to a misconceived perception of ominous surgical results. Our objective was to analyze early and late survival in elderly patients after mitral valve surgery in a center in which replacement is the procedure of choice. MATERIAL AND METHODS: We obtained clinical follow-up of patients older than 70 years who underwent first-time isolated replacement from January 2000 to January 2012. Observed survival was compared with expected survival in the general population of Uruguay. Independent predictors of operative mortality and survival were determined. RESULTS: A total of 127 patients were included. Global operative mortality was 9.4% (1.8% after year 2006 vs 15.3% before 2006; p<0.05). Surgery performed before 2006, preoperative hematocrit and creatinine were independent predictors for operative mortality after multivariate analysis. 6-year survival was 70.2% for females (72.4% expected survival, p=ns) and 40.1% in males (63.5% expected survival, p<0.05). Independent predictors of survival were surgery performed before 2006 (HR=3.2) and female sex (HR=0.4). CONCLUSION: Mitral valve replacement is a feasible option for elderly patients with mitral valve disease in centers with lack expertise in valve repair. Actual surgical results provide low operative mortality and similar survival to general the population (mainly in females).

Mitral valve replacement in the elderly is associated with low mortality and similar survival to the general population.

Background: With the increase in the elderly population, cardiologists and surgeons are faced with an increased incidence of mitral regurgitation. Most of these patients are denied surgery due to a misconceived perception of ominous surgical results. Our objective was to analyze early and late survival in elderly patients after mitral valve surgery in a center in which replacement is the procedure of choice. Material and Methods: We obtained clinical follow-up of patients older than 70 years who underwent first-time isolated replacement from January 2000 to January 2012. Observed survival was compared with expected survival in the general population of Uruguay. Independent predictors of operative mortality and survival were determined. Results: A total of 127 patients were included. Global operative mortality was 9.4% (1.8% after year 2006 vs 15.3% before 2006; p<0.05). Surgery performed before 2006, preoperative hematocrit and creatinine were independent predictors for operative mortality after multivariate analysis. 6-year survival was 70.2% for females (72.4% expected survival, p=ns) and 40.1% in males (63.5% expected survival, p<0.05). Independent predictors of survival were surgery performed before 2006 (HR=3.2) and female sex (HR=0.4). Conclusion: Mitral valve replacement is a feasible option for elderly patients with mitral valve disease in centers with lack expertise in valve repair. Actual surgical results provide low operative mortality and similar survival to general the population (mainly in females).

Long-term follow-up of Lambert-Eaton syndrome treated with intravenous immunoglobulin.

Recent reports have shown that patients with Lambert-Eaton myasthenic syndrome (LEMS) improve transiently after high-dose intravenous immunoglobulin (IVIG) administration. Information about the usefulness of IVIG for long-term treatment is rather scanty. Our findings demonstrate the efficacy of monthly IVIG courses at a dose of 0.4 g/kg/day for 5 days, in a 41-year-old patient with LEMS without detectable malignancy. Improvement in limb strength, peak expiratory flow rate, and electrophysiological parameters, as well as clinical signs following IVIG, was evident as early as 7 days after the first course and is still maintained at 24-months follow-up.

[Primary CNS lymphoma. Infratentorial localization and prolonged survival]. / Linfoma primario del sistema nervioso central. Localización infratentorial y prolongada sobrevida.

A case of a 35-year-old woman presenting infratentorial CNS lymphoma is reported. In 1990 she complained of diplopia, blurred vision and left horizontal nistagmus. An MRI disclosed a lesion in the medulla, pons, and cerebellar vermis and peduncles. Although no treatment was administered, a later RMI showed less extension of the tumor. One year after clinical diagnosis, she received corticosteroids; during the second year a stereotaxic biopsy of the cerebellar lesion was done showing a diffuse B cell non-Hodgkin's lymphoma. A whole brain irradiation was given (50 Gy). She did well for five years, and remains alive (79 months).

Computer interviewing of patients with epilepsy.

Epilepsy histories obtained by the computer interview were similar in substance and detail to histories recorded by house staff and attending physicians. In general, more information was obtained by the computer, and negative findings were consistently recorded by the computer. For potentially embarrassing questions, the computer may obtain more accurate information (Slack and Van Cura, 1968b). This might explain the contradictions concerning incontinence and medication. This preliminary study suggests that computer interviewing can provide a reliable method for obtaining epilepsy histories. The study also pointed out where changes in question wording and branching logic would improve the computer interview. These changes are being incorporated into the second version of the epilepsy interview. We hope computer-based interviewing will prove useful to patients and physicians in the diagnosis, treatment, and study of epilepsy.

Computers and psychiatry. Promises to keep.

The potential of computer-based psychiatric information systems is still largely undeveloped. Conceptual, technical, cost, and procedural problems have limited the impact of computers, but there are programs that have been successful or that show promise. While changes in the philosophy of psychiatric computer applications are on-going, a cost-effective, widely available clinical computer system has been developed.