[Alzemon: a prospective follow-up study of eslicarbazepine acetate monotherapy in patients with newly diagnosed epilepsy]. / Alzemon: estudio de seguimiento prospectivo del acetato de eslicarbacepina en monoterapia en pacientes con epilepsia de diagnóstico reciente.

INTRODUCTION: Eslicarbazepine acetate is a novel sodium channel blocker for use in the treatment of focal onset seizures. Prospective studies on its effectiveness in monotherapy in patients with newly diagnosed partial epilepsy in routine clinical practice are scarce. AIM: To evaluate the effectiveness of eslicarbazepine as initial monotherapy in patients with newly diagnosed partial epilepsy in routine clinical practice. PATIENTS AND METHODS: A prospective, multicentre, post-authorisation study. Patients with newly diagnosed partial epilepsy aged 18 years or older without previous treatment were included. The efficacy variables were: percentage of seizure-free patients, responders and reduction in monthly frequency of seizures. The safety variables analyse the 12-month retention rate and the occurrence of adverse effects. RESULTS: Fifty-three patients were included. The retention rate was 77.4%. At the end of the observation period, 83% of patients were seizure-free and 92.5% had reduced their baseline frequency by 50% or more. In addition, 68% of the patients reported some adverse effect and 7.5% of them dropped out of the study for this reason. The effectiveness analysis of the subgroup of patients aged 65 years or more showed no differences with respect to the overall population. CONCLUSION: Eslicarbazepine monotherapy in patients with newly diagnosed partial epilepsy, both in the general population and in the population over 65 years old, is effective and safe in routine clinical practice.

TITLE: Alzemon: estudio de seguimiento prospectivo del acetato de eslicarbacepina en monoterapia en pacientes con epilepsia de diagnóstico reciente.Introducción. El acetato de eslicarbacepina es un nuevo bloqueante de los canales de sodio en el tratamiento de las crisis de inicio focal. Los estudios prospectivos sobre su efectividad en monoterapia en pacientes con epilepsia parcial de reciente diagnóstico en la práctica clínica habitual son escasos. Objetivo. Evaluar la efectividad de la eslicarbacepina en monoterapia de inicio en pacientes con epilepsia parcial de reciente diagnóstico en la práctica clínica habitual. Pacientes y métodos. Estudio postautorización prospectivo y multicéntrico. Se incluyó a pacientes con epilepsia parcial de reciente diagnóstico de 18 años o más sin tratamiento previo. Las variables de eficacia fueron: porcentaje de pacientes libres de crisis, respondedores y reducción en la frecuencia mensual de crisis. Las variables de seguridad analizan la tasa de retención a los 12 meses y la aparición de efectos adversos. Resultados. Se incluyó a 53 pacientes. La tasa de retención fue del 77,4%. Al final del período de observación, el 83% de los pacientes se encontraba libre de crisis y el 92,5% había reducido en un 50% o más su frecuencia basal. El 68% de los pacientes notificó algún efecto adverso y el 7,5% de ellos abandonó el estudio por este motivo. El análisis de efectividad del subgrupo de 65 años o más no mostró diferencias respecto a la población global. Conclusión. La eslicarbacepina en monoterapia en pacientes con epilepsia parcial de reciente diagnóstico, tanto en la población general como en la población de más de 65 años, es eficaz y segura en la práctica clínica habitual.

Hipofisitis linfocitaria y paquimeningitis hipertrófica: descripción de un posible caso asociado a las patologías IgG4 / Lymphocytic hypophysitis and hypertrophic pachymeningitis: description of a possible case associated to IgG4 pathologies

Introducción. Las patologías relacionadas con la infiltración de linfocitos y células inflamatorias se clasifican, según su topografía, en patología orbitaria idiopática, paquimeningitis hipertrófica idiopática, síndrome de Tolosa-Hunt e hipofisitis linfocitaria. Presentamos a una paciente que comenzó con una hipofisitis linfocitaria hace ocho años y ha presentado varios episodios de paquimeningitis hipertrófica variables en su localización. Caso clínico. Mujer de 55 años, en seguimiento por cefalea de dos meses de evolución, que ingresó por empeoramiento clínico con parálisis del III par derecho completo, lagrimeo y rinorrea. Se realizó una resonancia magnética cerebral que demostró la presencia de una lesión sellar compatible con hipofisitis linfocitaria. Se inició tratamiento con corticoides con mejoría inicial, pero, tras dos años, la paciente presentó empeoramiento clínico con cefalea y parestesias perioculares derechas. Se repitió la resonancia, donde se observaron varias lesiones extraaxiales, siendo el resto de estudios normales, por lo que se diagnosticó paquimeningitis hipertrófica idiopática y se inició tratamiento de nuevo con corticoides. En el seguimiento posterior, la paciente presentó nuevas lesiones en diferentes localizaciones y mal control álgico, por lo que se añadió tratamiento inmunomodulador. Ante la asociación de hipofisitis linfocitaria y paquimeningitis hipertrófica, se completó el estudio con determinación de la IgG4 en el suero, que resultó negativa. Conclusiones. La asociación de hipofisitis linfocitaria y paquimeningitis hipertrófica con las patologías relacionadas con la IgG4 se ha descrito recientemente. A pesar de que en nuestra paciente no se ha confirmado el diagnóstico, se debe considerar esta relación en aquellos casos idiopáticos y, sobre todo, si se asocian otras manifestaciones sistémicas

Introduction. Pathologies related to lymphocyte infiltration and inflammatory cells are classified, according to their topography, into idiopathic orbital pathology, idiopathic hypertrophic pachymeningitis, Tolosa-Hunt syndrome and lymphocytic hypophysitis. Here we review the case of a female patient who began with lymphocytic hypophysitis eight years ago and has since presented several episodes of hypertrophic pachymeningitis in a variety of locations. Case report. Our study involves a 55-year-old female, being monitored owing to a two-month history of headaches, who was admitted to hospital as the result of a deterioration of her clinical signs and symptoms with paralysis of the whole right-side third cranial nerve, watery eyes and rhinorrhea. A magnetic resonance brain scan revealed the presence of a sellar lesion consistent with lymphocytic hypophysitis. Treatment was established with corticoids with an improvement at first, but two years later the patient’s clinical features worsened, with headaches and periocular paraesthesias on the right-hand side. Another MRI scan was performed and several extra-axial lesions were observed, the results of the other studies being normal. Idiopathic hypertrophic pachymeningitis was therefore diagnosed and treatment with corticoids was started again. In the ensuing follow-up the patient presented new lesions in different locations and poor pain control, and so immunomodulator treatment was thus added. Given the association between lymphocytic hypophysitis and hypertrophic pachymeningitis, the study was completed with determination of the IgG4 in serum, which was negative. Conclusions. The association of lymphocytic hypophysitis and hypertrophic pachymeningitis with IgG4-related pathologies have recently been reported. Although the diagnosis has not been confirmed in our patient, this relationship must be taken into account in these idiopathic cases and, above all, if they are associated with other systemic manifestations

[Lymphocytic hypophysitis and hypertrophic pachymeningitis: description of a possible case associated to IgG4 pathologies]. / Hipofisitis linfocitaria y paquimeningitis hipertrófica: descripción de un posible caso asociado a las patologías IgG4.

INTRODUCTION: Pathologies related to lymphocyte infiltration and inflammatory cells are classified, according to their topography, into idiopathic orbital pathology, idiopathic hypertrophic pachymeningitis, Tolosa-Hunt syndrome and lymphocytic hypophysitis. Here we review the case of a female patient who began with lymphocytic hypophysitis eight years ago and has since presented several episodes of hypertrophic pachymeningitis in a variety of locations. CASE REPORT: Our study involves a 55-year-old female, being monitored owing to a two-month history of headaches, who was admitted to hospital as the result of a deterioration of her clinical signs and symptoms with paralysis of the whole right-side third cranial nerve, watery eyes and rhinorrhea. A magnetic resonance brain scan revealed the presence of a sellar lesion consistent with lymphocytic hypophysitis. Treatment was established with corticoids with an improvement at first, but two years later the patient's clinical features worsened, with headaches and periocular paraesthesias on the right-hand side. Another MRI scan was performed and several extra-axial lesions were observed, the results of the other studies being normal. Idiopathic hypertrophic pachymeningitis was therefore diagnosed and treatment with corticoids was started again. In the ensuing follow-up the patient presented new lesions in different locations and poor pain control, and so immunomodulator treatment was thus added. Given the association between lymphocytic hypophysitis and hypertrophic pachymeningitis, the study was completed with determination of the IgG4 in serum, which was negative. CONCLUSIONS: The association of lymphocytic hypophysitis and hypertrophic pachymeningitis with IgG4-related pathologies have recently been reported. Although the diagnosis has not been confirmed in our patient, this relationship must be taken into account in these idiopathic cases and, above all, if they are associated with other systemic manifestations.

TITLE: Hipofisitis linfocitaria y paquimeningitis hipertrofica: descripcion de un posible caso asociado a las patologias IgG4.Introduccion. Las patologias relacionadas con la infiltracion de linfocitos y celulas inflamatorias se clasifican, segun su topografia, en patologia orbitaria idiopatica, paquimeningitis hipertrofica idiopatica, sindrome de Tolosa-Hunt e hipofisitis linfocitaria. Presentamos a una paciente que comenzo con una hipofisitis linfocitaria hace ocho años y ha presentado varios episodios de paquimeningitis hipertrofica variables en su localizacion. Caso clinico. Mujer de 55 años, en seguimiento por cefalea de dos meses de evolucion, que ingreso por empeoramiento clinico con paralisis del III par derecho completo, lagrimeo y rinorrea. Se realizo una resonancia magnetica cerebral que demostro la presencia de una lesion sellar compatible con hipofisitis linfocitaria. Se inicio tratamiento con corticoides con mejoria inicial, pero, tras dos años, la paciente presento empeoramiento clinico con cefalea y parestesias perioculares derechas. Se repitio la resonancia, donde se observaron varias lesiones extraaxiales, siendo el resto de estudios normales, por lo que se diagnostico paquimeningitis hipertrofica idiopatica y se inicio tratamiento de nuevo con corticoides. En el seguimiento posterior, la paciente presento nuevas lesiones en diferentes localizaciones y mal control algico, por lo que se añadio tratamiento inmunomodulador. Ante la asociacion de hipofisitis linfocitaria y paquimeningitis hipertrofica, se completo el estudio con determinacion de la IgG4 en el suero, que resulto negativa. Conclusiones. La asociacion de hipofisitis linfocitaria y paquimeningitis hipertrofica con las patologias relacionadas con la IgG4 se ha descrito recientemente. A pesar de que en nuestra paciente no se ha confirmado el diagnostico, se debe considerar esta relacion en aquellos casos idiopaticos y, sobre todo, si se asocian otras manifestaciones sistemicas.

A comparison of early diagnostic utility of Alzheimer disease biomarkers in brain magnetic resonance and cerebrospinal fluid.

INTRODUCTION: The goals of this study were to compare the early diagnostic utility of Alzheimer disease biomarkers in the CSF with those in brain MRI in conditions found in our clinical practice, and to ascertain the diagnostic accuracy of both techniques used together. METHODS: Between 2008 and 2009, we included 30 patients with mild cognitive impairment (MCI) who were examined using 1.5 Tesla brain MRI and AD biomarker analysis in CSF. MRI studies were evaluated by 2 radiologists according to the Korf́s visual scale. CSF biomarkers were analysed using INNOTEST reagents for Aß1-42, total-tau and phospho-tau181p. We evaluated clinical changes 2 years after inclusion. RESULTS: By 2 years after inclusion, 15 of the original 30 patients (50%) had developed AD (NINCDS-ADRA criteria). The predictive utility of AD biomarkers in CSF (RR 2.7; 95% CI, 1.1-6.7; P<.01) was greater than that of MRI (RR 1.5; 95% CI 95%, 0.7-3.4; P<.2); using both techniques together yielded a sensitivity and a negative predictive value of 100%. Normal results on both complementary tests ruled out progression to AD (100%) within 2 years of inclusion. CONCLUSIONS: Our results show that the diagnostic accuracy of biomarkers in CSF is higher than that of biomarkers in MRI. Combined use of both techniques is highly accurate for either early diagnosis or exclusion of AD in patients with MCI.

[Perspective of heart transplantation in advanced congenital cardiopathy: report of a case]. / La perspectiva del trasplante cardiaco en la cardiopatía congénita avanzada: a propósito de un caso.

Heart transplantation is an infrequent treatment modality in advanced congenital cardiopathy. We present the case of a 17-years old youngster coursing with a dilated Fallot's tetralogy, in terminal stage, who was subjected to an orthotopic heart transplantation. We present the most relevant data on his management during the 53 months after the surgery and discuss the long-term perspectives, which are comparable to those expected in transplanted patients due to other cardiac disorders.

[Biatrial re-synchronization in the treatment of paroxysmal atrial fibrillation. 3- and 4-chamber pacemaker]. / Resincronización biatrial en el tratamiento de la fibrilación atrial paroxística. Marcapaso tres y cuatro cámaras.

The reason for multisite pacing is to correct atrial and ventricular electrical and mechanical asynchrony found in paroxysmal atrial fibrillation (PAF) and dilated cardiomyopathy. We report the first two cases in Mexico treated with biatrial pacing for PAF. The first was treated with a three chamber pacemaker and the other with a four chamber pacemaker. The first patient was a young man with uncontrolled ventricular rate in whom the atrioventricular conduction was modified with radiofrequency energy to control ventricular rate during atrial fibrillation. The second patient was a woman with corrected transposition of the great arteries, left ventricular ejection fraction (LVEF) of 30% and complete heart block. The pacing modalities were DDD for the first patient and DDDR for the second, both with sleep rate and auto mode switching. The atria were paced in right appendage and the left through the coronary sinus. PAF episodes were, found only in the first patient but were decreased in number and duration. The LVEF and functional class improved in the patient with biatrial and ventricular resynchronization. We conclude that biatrial pacing is effective in PAF.

[Trichamber pacing in dilated myocardiopathy. TTDR pacing?]. / Estimulación tricameral en la miocardiopatía dilatada. Modo de estimulación TTDR?

This article describes the first case in Mexico city that received a three chamber pacing system. A 40 year-old man with dilated cardiomyopathy with variant cardiac rhythm and bradycardia. The three leads were introduced by right subclavian approaches. The right chamber leads were placed in atrial's appendage and in the right ventricular outflow tract and the last one was placed in the great cardiac vein. The two ventricular lead were connected a Y-connector to the ventricular channel of a standard bipolar DDDR pacemaker. The right ventricular lead was connected to the distal pole (anode) and the left ventricular lead to the proximal pole (cathode). Eight days later, the patient's clinical status improved, his functional class improved from IV to II and his left ventricular ejection fraction increased from 30% to 35% by conventional ventriculography. In this type of patients the improvement in cardiac output is this result an of increase in left ventricular filling, reduced mitral and tricuspid regurgitation a better synchronization of ventricular contraction. Multisite pacing has added a mayor complexity to contemporary pacing and a modification of the standard pacer-maker code should be considered to accommodate multisite pacing. The letter in the first and second position might be T (three) or F (four) according to number of pacing chamber and also the letter "t" may be suitable to designate trigger in the third position. We conclude that implant of three chamber pacing in patients with dilated cardiomyopathy is technically feasible. An improvement in the patient's condition may be obtained and a modification in standard pacemaker code is necessary.

[Anomalous connection of inferior vena cava to left atrium: infrequent entity that can be a diagnosis and surgical challenge]. / Conexión anómala de la vena cava inferior a la aurícula izquierda: entidad poco frecuente que puede plantear un reto diagnóstico y quirúrgico.

This is the diagnostic experiences as well as the surgical mode of treatment used in a 31 years old women suffering diversion of the inferior vena cava into the left atrium associated with atrial septal defect. The patient had been previously studied and operated thrice under conventional circumstances at different institutions in order to solve the septal defect. The hemodynamic solution had not been reached due to a missing pathological definition. The cineangiogram through the saphenous vein specified the left atrium form the inferior vena cava. Some considerations are made on the surgical methods used for the fourth operation, and in regard of the fact that the patient refused blood transfusion because of religious convictions (Jehova Witness).

Cambios en la reserva coronaria con el uso de dipiridamol oral y su correlacion angiografica. / Changes in coronary reserve with the use of oral dipyridamole and its angiographic correlation

Por metodo doble ciego se estudiaron 40 pacientes con insuficiencia coronaria, administrando a la mitad de ellos 75 mg de dipiridamol tres veces al dia y a la otra mitad placebo durante tres meses consecutivos. Los pacientes que recibieron dipiridamol mostraron un aumento en la tolerancia a la prueba de esfuerzo en la banda sinfin, asi como una recuperacion electrocardiografica mas rapida al suspender esta prueba. Durante un segundo periodo de tres meses se administro en estudio abierto, a treinta de estos cuarenta pacientes, 75 mg de dipiridamol tres veces al dia.Los pacientes que inicialmente habian recibido placebo, mostraron un notable incremento en la tolerancia a la prueba de esfuerzo y en el tiempo de recuperacion electrocardiografica. Los pacientes que recibieron dipiridamol, durante los dos periodos de estudio, tambien mejoraron en los parametros estudiados, pero en menor intensidad en este segundo periodo de tratamiento. El estudio angiografico coronario practicado en catorce pacientes revela que el dipiridamol ejerce un efecto terapeutico mas intenso en aquellos en que la funcion contractil ventricular esta mas comprometida