Evaluation Through Transcutaneous Tissue Oximetry (Near Infrared Spectroscopy) of Spinal Cord Stimulation in Patients With Complex Regional Pain Syndrome Type I.

OBJECTIVE: One of the physiopathological hypothesis behind complex regional pain syndrome (CRPS) type I involves the deep-tissue hypoxia of the affected areas. Spinal cord stimulation (SCS) appears to be effective in the treatment of these patients. We evaluated whether ESCS modifies tissue oxygen saturation (StO2 ) measured with near-infrared spectroscopy (NIRS) in the affected limbs in patients diagnosed with CRPS type I. MATERIALS AND METHODS: Nonrandomized, cross-sectional study that evaluated 16 patients with CRPS type I who were receiving SCS applied to the posterior cords. NIRS was used to evaluate baseline StO2 (primary outcome) and variations in StO2 (secondary outcome) during an ischemia-reperfusion test performed using a vascular occlusion test, comparing the hands of limbs unilaterally affected by CRPS type I with the unaffected contralateral hands. We also determined whether the variations in StO2 were related to a modification in the percentage of subjective pain improvement and in the visual analog scale score. RESULTS: The baseline StO2 of the affected hands was significantly higher than that of the unaffected hands (mean 4.7%; 95% confidence interval: 1.41, 6.7; p = 0.005). Variations in StO2 during the ischemia-reperfusion test revealed no differences between affected and unaffected hands. No significant correlations were detected between baseline StO2 values or variations in StO2 during the vascular occlusion test and the pain measurements. CONCLUSIONS: Baseline StO2 evaluated by NIRS was greater in the affected hands of patients with CRPS type I treated with SCS than in the unaffected, contralateral hands.

A single-center, long-term study of spinal dural arteriovenous fistulas with multidisciplinary treatment.

Spinal dural arteriovenous fistulas (SDAVF) are the most frequently occurring vascular malformations of the spinal cord but their optimal treatment remains contentious. We retrospectively analyzed 19 consecutive patients treated between 1996 and 2007. Endovascular embolization was considered the first treatment option for nine patients. Ten patients did not fulfill the endovascular indications and underwent surgery. Four patients required a second treatment with surgery: three following failed embolization and one following surgery. Clinical outcomes were assessed using the Aminoff-Logue disability scale (ALS). The mean follow-up time was 36 months (range=4-103 months). At follow-up, 79% of patients showed stabilization or improvement on the ALS. The overall efficacy of embolization was 55.6%, compared to 100% with surgery (p=0.03). Multidisciplinary treatment with embolization or surgery offers good long-term results. Whenever embolization does not ensure a complete closure of the venous side of the fistula, surgery should be considered as the first treatment because of its lower late recurrence rate.

Lenalidomide is effective as salvage therapy in refractory or relapsed multiple myeloma: analysis of the Spanish Compassionate Use Registry in advanced patients.

We evaluated the clinical results of lenalidomide (Len) as a compassionate salvage therapy in refractory/relapsed multiple myeloma (MM) patients. A nationwide multi-centre, retrospective research study was performed to evaluate clinical data from patients with advanced MM for which compassionate use of lenalidomide was requested. The primary endpoints were the overall response rate (ORR) and the time to progression (TTP). Secondary objectives included safety and overall survival (OS) since starting of lenalidomide therapy. Data collected from the Spanish Compassionate Use Registry included 111 patients treated in 2006-2008. The median (range) number of previous treatment lines was 3 (1-8). The median duration of lenalidomide treatment while on study was of 4.9 months (1-18). Dexamethasone was given concomitantly with Len in 89% of patients. The ORR was 66% (4% of patients had stringent complete, 11% complete and 11% very good partial responses). Median TTP and OS were 13.0 and 17.4 months, respectively. The depth of response was significantly associated with a longer OS. Toxicity, mainly myelosuppression, was predictable and manageable with Len dose adjustments and cytokine support. Lenalidomide as salvage compassionate therapy in refractory/relapsed MM showed, in this series of heavily pre-treated patients, similar efficacy to that reported in pivotal clinical trials with acceptable tolerance.

Clarificación y delimitación de la psicopatología. Respuesta a Villagrán / Clarifying and delimiting psychopathology. An answer to Villagrán

Aprovechando una llamada a la discusión en psicopatología, en este artículo se pretende clarificar y delimitar su concepto, tal y como los autores la entienden. Clarificar su postura y delimitarla frente a otras posiciones hegemónicas, al menos en el orden efectivo de las adhesiones. Se quiere así contribuir, de buen grado y de forma escueta, a la posibilidad de que las posturas queden lo más nítidamente establecidas y, en sucesivos encuentros, si ha lugar, no remachen sobre el mismo clavo de forma contumaz. De ello se deriva, así lo creemos, una aportación directa a la discusión psicopatológica y una mutua aclaración conceptual de las partes, que en cualquier caso debe resultar beneficiosa

In answering a call for debate in psychopathology, about the sense of revising phenomenology, this article tries to clarify and delimit its concept from the authors point of view. As brief and clearly as possible, the authors try to defend their own conception from the dominant positions, asserting the difference between psychopathology and semiology, rescuing the value of psychopathology as a technique and conceiving the psychiatric symptom as a mediation unit, more than a semiotic basic category. Subjective experience is recalled as the empirical ground for psychopathology

[Prevalence and factors associated with suicidal thinking among university students]. / Prevalencia y factores asociados a ideación suicida en estudiantes universitarios.

OBJECTIVES: To quantify the prevalence of suicidal ideation in a population of university students, to characterize groups in connection with ideation and suicidal behavior, and to determine the variables associated with suicidal ideation and suicide attempts. METHODS: Observational, analytic and cross-sectional study of a probabilistic sample of the population studied. An instrument for measuring suicide risk and associated variables was applied to this sample. RESULTS: The prevalence of the current suicidal ideation was 3.6%, and 18% in the last year. Both suicidal ideation and history of suicide attempts were higher among female students. Rape history, being alone more than eight hours a day, and female gender were the factors more strongly related to suicidal ideation. A relationship suicidal ideation and awareness of the suicide of others was not found in this sample. CONCLUSION: A history of rape, remaining alone for more than eight hours during the day, and being a woman should alert the clinician about the possibility of suicidal ideation. It is recommended to explore and assess suicidal ideation in all people with these factors.

Long-lasting enhancement of rapid eye movement sleep and pontogeniculooccipital waves by vasoactive intestinal peptide microinjection into the amygdala temporal lobe.

STUDY OBJECTIVES: The effect of a vasoactive intestinal peptide (VIP) microinjection into the amygdaloid central (CN) and basal nuclei (BN) on sleep organization and on the number and pattern of occurrence of pontogeniculooccipital (PGO) waves was analyzed. DESIGN: One group of 8 cats was studied in baseline conditions and after the microinjection of two doses of VIP applied into the CN and BN. SETTING: Sleep research laboratory. PARTCIPANTS AND INTERVENTIONS: Eight cats were prepared with sleep-recording electrodes and with guide tubes in both amygdalae for saline and VIP microinjections. Neuropeptide doses of 0.10 microg/1 microl (30 microM) and 0.33 microg/1 microl (99.24 microM) were employed. MEASUREMENTS AND RESULTS: Once the microinjection was applied, 23-hour polygraphic sleep recordings were performed for 5 consecutive days. Concomitantly the PGO waves were tape-recorded on each day and computationally analyzed. Results show that the 0.10 microg/1 microl microinjection produced no change. Unilateral VIP 0.33 microg/1 microl injection into the CN provoked a significant and lasting increase in the percentage of slow-wave sleep with PGO waves. Bilateral application of VIP increased the percentage of slow-wave sleep with PGO waves and rapid eye movement sleep for 5 days. Bilateral microinjection of the neuropeptide into the BN only enhanced the percentage of slow wave sleep with PGO waves. For both amygdaloid nuclei, we observed that VIP increased the number and modified the PGO wave pattern of occurrence during slow-wave sleep with PGO waves and during rapid eye movement sleep. CONCLUSIONS: The VIP microinjection into both the CN and BN induces increased amounts of rapid eye movement sleep, PGO waves, and slow-wave sleep with PGO waves, having a more robust effect on all of these three variables when applied into the CN.

Patrones de comorbilidad en pacientes psiquiatricos ambulatorios / Comorbidity patterns in psychiatric outpatients

En el presente estudio se determinaron patrones de comorbilidad en pacientes psiquiátricos ambulatorios en la Unidad de Salud Mental del Hospital San Juan de Dios (Bogotá). Se revisaron 3.028 historias clínicas de los pacientes atendidos en el servicio de consulta externa de Psiquiatría durante 1997, de estas se analizaron 1.127. Las variables que se tuvieron en cuenta fueron: edad, género y diagnóstico psiquiátrico en el eje I, II y III. Dada la naturaleza categórica de la mayor parte de las mediciones, se analizaron los datos mediante métodos multivariados de correspondencia múltiple. Los resultados mostraron la conformación de cuatro ejes: eje I mujeres, deprimidas, ansiosas, con comorbilidad cardiovascular y síndrome mental orgánico (SMO) y por otro lado hombres, psicosis, trastorno de personalidad o retardo mental. Eje II hombres con comorbilidad neurológica, SMO y trauma y por otra parte mujeres con comorbilidad endocrinológica y trastornos afectivos. En el eje III hombres con abuso de sustancias, trastornos de personalidad y diagnósticos relacionados con trauma o enfermedad cardiovascular. Por otro lado mujeres con patología endocrinológica, neurológica y retardo mental, sin diagnóstico en eje I. El eje IV recoge pacientes ansiosos, con trastornos de personalidad y alteraciones gastrointestinales o endocrinológica y por otra parte pacientes con trastorno bipolar o SMO y trauma

Acido Folico y depresion / Folic acid and major depressive disorder

La asociación entre deficiencia de ácido fólico y trastornos psiquiátricos ha sido estudiada y debatida desde el descubrimiento de esta vitamina en la década del 40. La relevancia clínica de esta deficiencia continúa siendo motivo de permanente investigación y ha sido inferida a partir de observaciones clínicas y de un mejor entendimiento del rol del folato en las vías metabólicas cerebrales. Este artículo hace una breve descripción de las características del acido fólico y su metabolismo, especialmente a nivel cerebral, así como una revisión de la literatura médica sobre la relación del ácido fólico y varios trastornos psiquiátricos, haciendo énfasis en el trastorno depresivo mayor

Trastorno de ansiedad en los niños

La ansiedad es una de las sensaciones experimentales con mayor frecuencia por el ser humano; semiológicamente es un continuum que va desde la ansiedad existencial cotidiana, pasando por la ansiedad experimentada ante eventos traumáticos y terminando en estados francamente patológicos no correlacionados con eventos ambientales externos. Su sintomatología generalmente tiene elementos mixtos somáticos y psicológicos. En los niños se encuentran algunos trastornos de ansiedad específicos como el trastorno de ansiedad de separación, el trastorno de ansiedad excesiva y el trastorno por evitación en la infancia y de la adolescencia; también comparten algunos trastornos con los adultos como el trastorno de pánico, el trastorno de estrés post-traumático y el trastorno de adaptación con afecto ansioso. Desde el punto de vista etiológico y terapéutico se hace un enfoque biopsicosocial lográndose un adecuado control en la mayoría de los pacientes.

Habituation to bearable experimental pain elicited by tooth pulp electrical stimulation.

Stimulation (1/10 sec, 1-2 msec) of the tooth pulp of volunteers was carried out for 120 min at an intensity that produced bearable pain. Cortical evoked potentials, electroencephalographic activity, electromyograms of the superciliary and masseter muscles and galvanic skin response were recorded. Every 30 min, without suspending the stimulation, the subjects were questioned with respect to the sensations accompanying the stimuli. A progressive decrease in all polygraphic responses was observed which coincided with a decrease in the reported sensation of pain. This effect could be reversed by applying heterosensorial stimulation (questioning). It is suggested that this is a phenomenon of habituation to pain since dishabituation, potentiation of habituation, and habituation to dishabituation were found.