Corpus callosotomy in Colombia and some reflections on care and research among the poor in developing countries.

The authors present the results of a series of corpus callosotomies (CCS) in 97 patients performed from 1989 to 1997 at the Hospital Neurologico of the Liga Colombiana Contra La Epilepsia, Cartagena, Colombia. This study demonstrates the feasibility of performing these procedures in the developing world and analyzes the outcome and cost of treatment. Patients with medically intractable secondarily generalized epilepsy, bilateral nonfocal epileptic electroencephalogram (EEG), and absence of progressive encephalopathy were accepted as candidates (patients aged 0-30 years; 62 children, 19 girls and 43 boys, with mean age at surgery of 7.9 years; 35 adults, 19 women and 16 men, with mean age at surgery of 25.8 years). Preoperatively, the mean seizure frequency was 12.1 per day, or 364 per month (range, 0.06-200 per day, 1.8-6000 per month). Before surgery, 40% of patients were classified with generalized tonic-clonic seizures of different etiologies, or cryptogenic seizures; 36% had mixed seizures; 19% had Lennox-Gastaut Syndrome; and 5% had West Syndrome. Usually, routine EEG, computed tomography, and clinical findings sufficed for the surgical decision. The standard microsurgical technique performed was an anterior two-thirds CCS by the same surgeon under general anesthesia. In five cases, an additional frontal lobe excision after electrocorticography and subdural electrode monitoring was carried out in the same session. The results were evaluated after a mean follow-up of 35 months (range, 12-28). Two thirds of patients became seizure-free or were left with none or some disabling seizures. AED medication was eased slightly after surgery. The complication rate was low. The patients underwent postoperative psychosocial studies and neuropsychological rehabilitation and showed tendencies toward improvement. The direct cost of CCS in U.S. dollars (US$) ranged between 3,137 and 3,995 depending on the preoperative studies. Thus, CCS is well suited for selected patients in developing countries. Thus far, implantation of a vagus nerve stimulator has exceeded our economic possibilities in treating similar patients. Some reflections on care and research among epilepsy patients in developing countries are discussed.

[Tooth retention in the anterior region]. / Retenciones dentarias en región anterior.

Bibliography was researched in pursuit of an improved classification of retained canine teeth that may, ideally, prove to be simpler, easy to apply in any individual case, and uncomplicated to remember. Desirably, such classification would allow establishing the location of each retention in the maxilla, mandible, or both, and its relationship with adjacent structures. Additionally, a proposal was put forth for a retained canine teeth classification that may clearly and simply outline the retention, be easily understood and remembered, and may also apply to retained dentary organs with some similarity to canines as to their shape and root number.

[Analysis for diagnosis of developmental maxillofacial anomalies in Mexico city residents]. / Análisis para el diagnóstico de las anomalías de desarrollo maxilofaciales en individuos de la Ciudad de México.

Most cephalometric analysis published to date are based on studies performed by orthodontists, focused on individuals in the growth and development stages, and based mainly on individuals with morphogenetic patterns different from those of the Latin prototype. Such studies concede little attention, if any, to the evaluation of the median (middle) third, which makes them insufficient to amply determine sites of structures found in this area of the face. In Mexico, the maxillofacial surgeon often needs to analyze individuals at the end of their growth stage, with very varied morphogenetic patterns, a result of wide ethnic interbreeding. This preliminary study aims to attain an analysis applicable to Latin individuals, whose morphogenic pattern tends toward the Caucasian prototype, and to establish standards from which to evaluate the middle third.