[Polymyositis secondary to a non-Hodgkin's lymphoma]. / Polimiositis secundaria a un linfoma no Hodgkin.

TITLE: Polimiositis secundaria a un linfoma no Hodgkin.

Activation of Glutamatergic Fibers in the Anterior NAc Shell Modulates Reward Activity in the aNAcSh, the Lateral Hypothalamus, and Medial Prefrontal Cortex and Transiently Stops Feeding.

Although the release of mesoaccumbal dopamine is certainly involved in rewarding responses, recent studies point to the importance of the interaction between it and glutamate. One important component of this network is the anterior nucleus accumbens shell (aNAcSh), which sends GABAergic projections into the lateral hypothalamus (LH) and receives extensive glutamatergic inputs from, among others, the medial prefrontal cortex (mPFC). The effects of glutamatergic activation of aNAcSh on the ingestion of rewarding stimuli as well as its effect in the LH and mPFC are not well understood. Therefore, we studied behaving mice that express a light-gated channel (ChR2) in glutamatergic fibers in their aNAcSh while recording from neurons in the aNAcSh, or mPFC or LH. In Thy1-ChR2, but not wild-type, mice activation of aNAcSh fibers transiently stopped the mice licking for sucrose or an empty sipper. Stimulation of aNAcSh fibers both activated and inhibited single-unit responses aNAcSh, mPFC, and LH, in a manner that maintains firing rate homeostasis. One population of licking-inhibited pMSNs in the aNAcSh was also activated by optical stimulation, suggesting their relevance in the cessation of feeding. A rewarding aspect of stimulation of glutamatergic inputs was found when the Thy1-ChR2 mice learned to nose-poke to self-stimulate these inputs, indicating that bulky stimulation of these fibers are rewarding in the sense of wanting. Stimulation of excitatory afferents evoked both monosynaptic and polysynaptic responses distributed in the three recorded areas. In summary, we found that activation of glutamatergic aNAcSh fibers is both rewarding and transiently inhibits feeding. SIGNIFICANCE STATEMENT: We have established that the activation of glutamatergic fibers in the anterior nucleus accumbens shell (aNAcSh) transiently stops feeding and yet, because mice self-stimulate, is rewarding in the sense of wanting. Moreover, we have characterized single-unit responses of distributed components of a hedonic network (comprising the aNAcSh, medial prefrontal cortex, and lateral hypothalamus) recruited by activation of glutamatergic aNAcSh afferents that are involved in encoding a positive valence signal important for the wanting of a reward and that transiently stops ongoing consummatory actions, such as licking.

Neuropsychological syndromes in multiple sclerosis / Síndromes neuropsicológicos en la esclerosis múltiple

Background: Cognitive impairment in multiple sclerosis (MS) is common (45-65%).Deficits occur in speed of information processing (SIP), memory, attention, executive functions (EF) and visuoconstruction. Involvement of cognitive functions like language and gnosis is rare and lesser known. Our aim is to describe the cognitive function and the clinical and radiological features of five patients with MS and with neuropsychological syndromes (NPS). Method: Retrospective review of MS patients with NPS studied, using specific tests of SIP, memory, attention, EF, visuo-spatial abilities, praxis and language. Results: The sample included four women (3 relapsing-remitting MS/1 secondary progressive MS) and one man with primary progressive MS (aged between 30-55 years). Cognitive symptoms were the initial complaint in three cases. Three cases presented apperceptive agnosia and constructive apraxia, one case presented alexia with agraphia and the fifth patient presented motor aphasia. Four patients suffered cognitive dysfunction considered typical of MS. Magnetic resonance imaging (MR) in all cases showed high lesion volumes in T1 and T2- weighted sequences. A good correlation was observed between cognitive deficits and the location of the lesions in four patients. Conclusions: NPS may be the initial complaint in MS patients, often associated with other cognitive deficits, and it shows a close relationship with lesion location (AU)

Antecedentes: entre el 45-65% de los pacientes con esclerosis múltiple (EM) manifiestan déficits cognitivos en velocidad de procesamiento de la información (VPI), atención, memoria, funciones ejecutivas (FE) y visuoconstrucción. La alteración del lenguaje y la gnosis visual es infrecuente y poco reconocida. El objetivo es la descripción cognitiva, clínica y radiológica de cinco pacientes con EM con síndromes neuropsicológicos (SNPS). Método: revisión retrospectiva de pacientes de EM con SNPS estudiados mediante test específicos de atención, memoria, VPI, FE, visuoconstrucción, gnosis visual y lenguaje. Resultados: la muestra incluyó cuatro mujeres (3 EM remitente recurrente, 1 EM secundaria progresiva) y un varón con EM primaria progresiva (edades entre 30-55 años). Los déficits cognitivos fueron el síntoma inicial en 3 casos. Tres presentan agnosia aperceptiva y apraxia constructiva, uno alexia con agrafia y el quinto afasia motora. Cuatro asocian disfunción cognitiva ‘típica’ de EM. En resonancia magnética observamos alto volumen lesional en secuencias potenciadas en T1 y T2 y correlación entre los déficits cognitivos y la localización de las lesiones en 4 de ellos. Conclusiones: los SNPS pueden ser la queja inicial en la EM, con frecuencia se asocian a otros déficits cognitivos y manifiestan una estrecha relación con la localización de la lesión (AU)

Estatus con alteraciones periictales en resonancia magnética cerebral versus encefalitis / Status with periictal changes in cerebral magnetic resonance versus encephalitis

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[Coronary stents. Results during the hospitalization phase]. / Stent coronario. Resultados en fase hospitalaria.

UNLABELLED: Between October 1991 and August 1996 two-hundred coronary stents were implanted (s) in 166 patients (pts) (1.27 s/pt). One hundred thirty-five lesions "de novo" were approached with stent, 44 because of a sub-optimal result post-angioplasty, 15 for restenosis and 17 for dissection. In thirty-six patients the indication of stenting was stable angina, in 68 unstable angina, in 37 for angina after myocardial infarction, in 11 for asymptomatic ischemia after myocardial infarction and in 14 during an acute myocardial infarction. Mean stenosis before stent implantation in all cases was 85 +/- 15%. Type of lesion in seventy cases was A, in 112 was B and 29 was C. Stents used were AVE in 146 lesions, Palmaz-Schatz in 33, Wiktor in 23, Gianturco-Roubin in 8 and Wallstent in one case. Medical treatment in 140 pts. (84.3%) after stent implantation was only with aspirin and ticlopidine. Technical success in all patients was 98.6% (208/211 pts) and primary success was 94.6% (157-166 pts). Unsuccessful procedures were because of sub-acute occlusion in three patients (1.8%), death in 3 pts. (1.8%) and urgent CABG was necessary in one pt. (0.5%). Major hematoma was a complication in 5 pts (3%). Mean residual stenosis after stent implantation in all cases was 2.2%. CONCLUSION: Stent implantation in our laboratory is a very safe procedure with a high rate of primary success with lowest complications in a great population of unstable angina.

[The DDD pacemaker implanted intravenously]. / El marcapaso DDD por vía transvenosa.

Retrospectively, we studied 66 consecutive patients in whom we implanted an intravenous DDD pacemaker. The indications were: AV block in 52 patients (79%), sick sinus syndrome in 5 patients (7.5%), both AV block and sick sinus syndrome in 4 patients (6%), and other causes in 5 (7.5%). The venous access route was by subclavian punction in 38 cases (57.5%) and by cephalic vein dissection in 28 (42.5%). With a mean follow-up of 16 months, there were complications in 11 patients (17%), in 9 of them, it was necessary a change in pacing mode different to DDD, and was possible to maintain a DDD pacing mode in 2 patients with a minimal reprogramming. The complications were: A) lost of sense and/or atrial capture in 10 patients (3 of them, had also loss of ventricular capture, one had pacemaker-mediated tachycardia, other had diaphragmatic stimulation and other had a severe infection of the pocket), B) atrial fibrillation appeared in another patient. At the implantation time there were significant differences between patients with and without complications on follow-up, the P wave amplitude was 1.86 +/- 0.75 mV in the first group vs. 3.06 +/- 1.52 mV in the latter group, p < 0.005, and the atrial pacing threshold was 1.10 +/- 1.17 microJ in the first group vs. 0.65 +/- 0.66 microJ in the latter group, p < 0.005. We consider that dual chamber stimulation is a well established form of therapy, although, it requires a more laborious implantation and specialized personal for its follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)

Transesophageal echocardiographic diagnosis of an aneurysm and thrombosis of the left anterior descending coronary artery.

An aneurysm of the left anterior descending coronary artery with thrombosis in its lumen in a 36-year-old woman who had an acute myocardial infarction is described. Although the aneurysm was detected by angiography, a transesophageal study provided new specific details of the exact site of origin of the aneurysm, as well as vascular thrombosis.

[The transcatheter closure of patent ductus arteriosus. The initial experience]. / Cierre de conducto arterioso persistente transcateterismo. Experiencia inicial.

Percutaneous closure of the patent ductus arteriosus (PDA) has been recently reported to be an effective alternative in the treatment of patients with ductal shunting. We report the initial experience and results during follow-up of percutaneous ductal occlusion with the Rashkind occluder (USCI) in six patients with isolated PDA. Ages ranged from 3 to 23 years. Diagnosis was corroborated with two dimensional and Doppler echocardiography in all patients. During cardiac catheterization systolic pulmonary artery pressure oscillated between 22 and 64 mmHg and Qp/Qs ratio between 1.3 and 4.1. In two patients prosthesis of 12 mm were used and in the remaining prosthesis of 17 mm. Only one patient demonstrated total occlusion during immediate control aortography, the other patients presented central residual shunting over the occluder. In the three patients occlusion with balloon-catheter was added to the procedure, resulting in total occlusion in two and significant reduction of the shunt magnitude in one. Two technical problems were resolved satisfactorily. None of the cases presented device embolization. Mean follow-up was 23.8 months with control echocardiograms at 24 hours, 1, 4, 12 and 24 months. In all patients immediate reduction of the left atrial dimension was demonstrated. Three patients presented residual shunts in the first 24 hours. In two of them total occlusion had occurred after one month and the other patient persisted with a small residual shunt until one year after the procedure. In conclusion, in this small study group good results were obtained with percutaneous ductal closure.

[Pulmonary balloon valvulotomy. The results in 42 cases]. / Valvulotomía pulmonar con balon. Resultados en 42 casos.

The percutaneous balloon valvulotomy is nowadays the treatment of choice for isolated pulmonary stenosis. Forty two patients with congenital pulmonary stenosis underwent balloon valvulotomy at the Instituto Nacional de Cardiología "Ignacio Chávez". Ages 1 month to 24 years, mean 7.6 +/- 5.9 years, with a follow-up of 28.3 +/- 14.8 months. With an infundibular gradient of 50 mm Hg or more a treatment with propranolol was given. After valvulotomy the total basal pressure gradient decrease from 82.9 +/- 40.6 mm Hg to 31.2 +/- 27.1 mm Hg (p < 0.00001). The patient's results were divided in two groups: with and without reactive infundibular obstruction. The 31 patients without infundibular obstruction had a total initial gradient of 71.6 +/- 33.5 mm Hg, and after valvulotomy the gradient was reduced to 18.9 +/- 11.2 mm Hg (p < 0.00001). The 11 patients with infundibular obstruction had a total initial gradient of 114.8 +/- 43.2 mm Hg, and after valvulotomy the valvular gradient was 12.4 +/- 8.5, the infundibular gradient 53.4 +/- 22.9 and the total gradient 65.9 +/- 29.1 mm Hg (p = 0.002 in relation to the basal gradient). All patients with infundibular obstruction (8 treated with Propranolol) and a follow-up of 8.5 +/- 9.8 months underwent Doppler examination, showing a progressive reduction of the total gradient. By six months no one had a total gradient greater than 50 mm Hg. These data confirm that balloon valvulotomy in valvular pulmonary stenosis is safe and effective, and that restenosis is very low. Good results relay on the use of proper balloon diameters (balloon diameter/pulmonary annulus relation of 1.2 to 1.5).(ABSTRACT TRUNCATED AT 250 WORDS)

[Comparative study of 2 mechanical mitral valves]. / Estudio comparativo entre dos válvulas mecánicas en posícion mitral.

We present the long term follow-up of two groups of patients under 16 years of age in whom two different types of mitral valve prostheses were used for the treatment of mitral valve disease. Group I was formed by 74 patients with Starr-Edwards (6120) prosthesis and group II by 36 cases with Bjork-Shiley prosthesis. Group I was followed for a mean period of 11 years and group II for a mean period of 7.5 years. The clinical evolution of both groups assessed according to the New York Heart Association criteria showed improvement of the functional class (p less than 0.006). Twenty seven cases of group I and 21 of group II underwent cardiac catheterization for the evaluation of surgical results. In group I, the mean pulmonary arterial systolic pressure (PASP) decreased from 57 mmHg to 33 mmHg (p less than 0.001) and the mean pulmonary arterial wedge pressure (PAWP) from 20.8 mmHg to 12.1 mmHg (p less than 0.05). In group II, the mean PASP decreased from 59.2 mmHg to 28.5 mmHg (p less than 0.001) and the mean PAWP from 24.6 mmHg to 8.5 mmHg (p less than 0.001). There was statistically significant difference for a greater incidence of thromboembolism in group I (p = 0.037). No differences were found for bacterial endocarditis, dysfunction and death.

[Percutaneous valvulotomy for calcified aortic valve stenosis in the adult]. / Valvulotomía percutánea en la estenosis aórtica valvular calcificada del adulto.

This study describes the initial experience of the Instituto Nacional de Cardiología "Ignacio Chávez", with percutaneous aortic balloon valvuloplasty for calcified aortic valve stenosis in adults. Five patients, 4 males and a female (mean age 54 +/- 7 years), were included. All of them had poor ventricular function, and were not surgical candidates. Although it is in fact a small group, the results are promising, with a success rate of 80%, and without mortality. In only one case, the transvalvular gradient could not be modified.

[Importance of the early intravenous administration of streptokinase in acute myocardial infarct]. / Importancia del inicio precoz en la administración de estreptoquinasa intravenosa en el infarto agudo del miocardio.

To evaluate the importance of early initiation of fibrinolytic therapy with intravenous streptokinase (IVSK), we studied 34 consecutive patients, within less than six hours of the onset of acute myocardial infarction, who were treated with 1.5 million units of intravenous streptokinase. All the patients had coronary angiograms in the first seventy two hours. We correlated the angiograms with the time of onset of the IVSK. The patients were divided into 3 groups: Group num. 1: From zero to two hours (twelve patients); Group num. 2: From two to four hours (13 patients); and Group num. 3: From four to six hours (nine patients). We had angiographic reperfusion in twenty-four patients (70.2%) P less than 0.05. We observed reopening in the patients of group num. 1 (83.3%); in group 2, nine patients (69%) and in group num. 3, five patients, (55.5%), with statistical significance only in group num. 1 (p less than 0.05). We also demonstrated the utility of the electrocardiographic and enzymatic criteria to predict reperfusion. No mortality was related to the procedure. We concluded that a higher percentage of reperfusion is obtained the sooner intravenous streptokinase therapy is initiated.

Late results of mitral valve replacement with the Björk-Shiley prosthesis in children under 16 years of age.

The late results of isolated mitral valve replacement were evaluated in 37 children under 16 years of age receiving a Björk-Shiley prosthesis for the treatment of rheumatic mitral lesions. Three patients died, one during the operation and the others 2 months postoperatively. Of the latter two, one had a cerebral hemorrhage and the second had septicemia. The survivors were followed up for a mean of 4.7 years (range 2.8 to 8.9 years). After the operation, all patients were placed on a strict anticoagulant regimen with acenocoumarol. The actuarial survival rate was 92% at the end of the follow-up period. Before valve replacement two patients were in New York Heart Association Class I, 15 in Class II, 18 in Class III, and two in Class IV. After treatment 33 were in Class I and one in Class II. No instances of thromboembolism or infective endocarditis were observed in the survivors. Twenty-one patients underwent cardiac catheterization 2 to 7 years after the operation for evaluation of surgical results. The mean pulmonary artery systolic pressure decreased significantly after operation (p = 0.001), and the mean pulmonary artery wedge pressure decreased to normal values (p = 0.001). A mild mean diastolic gradient across the mitral valve at rest was found after the operation (4.9 +/- 2.4 mm Hg). During isometric exercise this gradient increased to 6.5 +/- 4.6 mm Hg. In two patients a discrete paravalvular leak was demonstrated by cineangiography, but the pulmonary wedge pressure was normal in both. The overall results with the Björk-Shiley prosthesis are encouraging in patients in whom reconstructive operations cannot be performed.

[Double-outlet left ventricle]. / Doble camara de salida del ventriculo izquierdo.

Two cases of double-outlet left ventricle with ventricular septal defects and pulmonic stenosis are described. Both had atrial situs solitus, one with concordant and another with discordant atrioventricular connections. Considering the clinical behaviour of the malformation, the diagnosis is difficult. Although the echocardiographic findings suggest the abnormality, angiocardiography is the best procedure for the accurate diagnosis.

[Left ventricular hypertrophy. Correlation of ventriculographic findings in ischemic cardiopathy]. / Hipertrofia ventricular izquierda. Estudio correlativo de los hallazgos ventriculográficos en la cardiopatía isquémica.

In order to analyze the angiographic characteristics associated with left ventricular hypertrophy in patients with coronary insufficiency, the left ventriculography was used to calculate the ventricular volumes, the ejection fraction (EF) and the ventricular mass (LVM) in 31 patients with clinical diagnosis of ischemic heart disease. Patients were divided into three groups: A) Those with normal coronaries and (EF), B) Those with coronary lesion and EF greater than 50% and C) Those with coronary lesions and EF less than 50%. The following results were obtained for the telediastolic volume (ml/m2), the EF (%) and the LUM (g/m2): Group A = 85 +/- 19, 73 +/- 7 and 41 +/- 13. Group B = 102 +/- 25, 61 +/- 8 and 50 +/- 9. Group C = 154 +/- 27, 39 /+- 7 and 74 +/- 17 respectively. Comparing the FEV with the LVM in the patients studied, a negative correlation was found with an r index of -0.7894 (p less than or equal to 0.001). The correlation index for the diastolic volume and the LVM was r = 0.6806; and -0.6991 for the EF and the telediastolic volume. These findings suggest that hemodinamic changes, especially an increase in the ventricular volume and subsequently in the tension of the ventricular wall, act as a stimulus in initiating a metabolic chain leading to ventricular hypertrophy. This process is compensatory in the initial phases of the disease (groups A and B) but insufficient in the advanced stage (group C).