GnRH antagonist administration to postpone a weekend intrauterine insemination: a large cohort study from a public center.

BACKGROUND: In Spanish public hospital Reproduction Units it is very problematic to perform programmed intrauterine insemination (IUI) on weekends, if indicated. Small previous pilot studies suggest that using a GnRH antagonist to avoid an LH weekend surge would allow to perform IUI on the following Monday, not impairing the expected pregnancy rate. METHODS: Between 1st January 2007 and 31st December 2015, 4.782 intrauterine inseminations were performed at Valladolid University Clinic, Spain, corresponding to 1.650 women. Of them, 911, corresponding to 695 women, should ideally have been performed during the weekend. If it happened that a member of the Reproduction Unit was on duty during that particular weekend, the standard protocol was not interrupted, and the IUI performed as planned (control group, 685 IUIs). If the former was not the case, the weekend gap was bridged by administering 0.25 mg GnRH antagonist (GnRHa). Ovulation was induced by means of 250 ug recombinant HCG (rHCG) 36 h prior to IUI on the following Monday (study group, 226 IUIs). RESULTS: There were no differences in the clinical pregnancy rate (13.7 cc vs. 16.2 %, p = 0.371) or in the ongoing pregnancy rate between groups (11.9 % vs. 14.9 %, p = 0.271). The multiple pregnancy rate was also comparable in both groups (14.7 % vs. 18.5 %, p = 0.77). CONCLUSIONS: Women with a planned IUI which cannot be performed at the ideal date can be offered postponement for two days with the support of GnRHa treatment, with results that are not inferior to those expected applying the regular protocol.

Estados hipertensivos del embarazo: resultados perinatales / Pregnancy-induced hypertension: Perinatal outcomes

Objetivo Analizar los resultados perinatales de las gestantes con estados hipertensivos del embarazo (EHE).Material y método Estudio de prevalencia retrospectivo. Resultados Hemos encontrado una prevalencia de EHE del 2,5%, distribuida en los siguientes grupos: hipertensión gestacional (52,30%; 12 casos/1.000 partos), preeclampsia (38,46%; 9,4 casos/1.000 partos), preeclampsia grave-eclampsia (21,53%; 0,3 casos/1.000 partos), hipertensión crónica (6,15%), y preeclampsia sobreañadida a hipertensión crónica (3,07%). Se realizó inducción del parto en el 41,5% de las pacientes. El 38,5% de los partos fueron eutócicos y el 49,1% terminó mediante cesárea. La tasa de parto pretérmino alcanzó el 28,1%. El ingreso hospitalario medio fue de 11,3 días. Se registraron 3 muertes perinatales (46,0/1.000 partos).Conclusiones Los EHE constituyen una causa de riesgo de primer orden de prematuridad, bajo peso al nacimiento y morbimortalidad perinatal, y se asocian con un incremento notable de la tasa de cesáreas y estancia hospitalaria (AU)

Objective To analyze the perinatal outcomes of women with pregnancy-induced hypertension (PIH).Material and methods A retrospective prevalence study. Results We found a prevalence of PIH of 2.5%, divided into the following groups: gestational hypertension (52.30%; 12 cases/1000 births), preeclampsia (38.46%; 9.4 cases/1000 births) severe pre-eclampsia (21.53%, 0.3 cases/1000 births), chronic hypertension (6.15%) and preeclampsia superimposed on chronic hypertension (3.07%). Labor was induced in 41.5% of the women, while 38.5% of births were eutocic. Cesarean section was performed in 49.1%. The rate of preterm birth was 28.1%. The mean length of hospital stay was 11.3 days. There were three perinatal deaths (46.0/1,000 births). Conclusions PIH is a major risk factor for prematurity, low birth weight and perinatal morbidity and mortality and is associated with a significant increase in the rate of cesarean section and length of hospital stay (AU)

Event-related evoked potential P300 in frontotemporal dementia.

There are no studies on event-related cognitive potentials in frontotemporal dementia (FTD). In order to evaluate the aptitude and usefulness of the event-related P300 potential in this disease, we prospectively examined 60 cases: 11 patients with FTD diagnosed according to the Lund and Manchester criteria and Neary consensus criteria, 33 patients with a probable Alzheimer's disease diagnosis following NINCDS-ADRDA criteria, and 16 normal controls. P300 latency, amplitude and reaction time were recorded using an auditory oddball paradigm. In this sample, P300 potential could be reliably performed by 10/11 FTD patients, notwithstanding their language or executive function deficiencies. The FTD group P300 mean latency was midway between the normal controls and the Alzheimer's disease group (ANOVA F(2, 74199) = 16.5; p = 0.00003). The latency range of the FTD patients were within normal values (average plus 1.96 standard deviation of the values of the control group), except for one case with a latency of 448 ms. Post hoc Newman-Keuls analysis showed that the P300 latencies of the control and FTD groups did not differ significantly (p = 0.15) and that the Alzheimer's disease group had a delayed P300 latency that differed significantly from that of the FTD (p = 0.002) and control group (p = 0.0002). However, there was overlapping in P300 latency values of the three groups. Despite these differences in latencies, the reaction time was significantly increased in the FTD and the Alzheimer's disease groups. These findings indicate that the P300 potential is less affected in patients with FTD than those with Alzheimer's disease. This fact could aid in FTD diagnosis, differential diagnosis with Alzheimer's disease and possibly its clinical management.

Study of antiphospholipid antibodies in patients treated with antiepileptic drugs.

BACKGROUND: Antiphospholipid antibodies (lupus anticoagulant and anticardiolipin antibodies) are associated with a variety of clinical situations, including drug-intake, but their relationships with antiepileptic drugs have been scarcely investigated. OBJECTIVE: To determine the prevalence of antiphospholipid antibodies in patients treated with antiepileptic drugs and the associated risk of thrombotic events. PATIENTS AND METHODS: We performed the serologic study of thirty-six consecutively prospectively recruited epileptic patients treated with diverse antiepileptic drugs during 44.38 +/- 8.08 months (mean +/- SD) in which antiphospholipid antibodies were determined using cardiolipin and a mixture of phospholipid from rabbit brain as antigen for detection of cardiolipin and lupus anticoagulant by ELISA and in addition lupus anticoagulant was carried out also using coagulometric assays. A clinical evaluation was done in order to determine the presence of thrombotic events in the following five years. RESULTS: Antiphospholipid antibodies were detected in 43% of these patients, in most of them as anticardiolipin antibodies (IgM subtype). The patients did not present thrombotic events during the time of the study. CONCLUSION: Antiphospholipid antibodies are positive in a high proportion of these patients but thrombosis were not found during the study duration. This may be explained by the fact that the profile of aCL positivity not associated to positive LA observed in these patients does not confer a risk for thrombotic events.

Estudio de los anticuerpos antifosfolípido en pacientes tratados con fármacos antiepilépticos / Study of antiphospholipid antibodies in patients treated with antiepileptic drugs

FUNDAMENTO: Los anticuerpos antifosfolípido (anticoagulante lúpico y anticuerpos anticardiolipina) se asocian con una variedad de situaciones clínicas, incluida la ingestión de medicaciones, pero su relación con los fármacos antiepilépticos no está aclarada. OBJETIVO: Determinar la prevalencia de los anticuerpos antifosfolípido en pacientes tratados con fármacos antiepilépticos y el riesgo de trombosis asociado a éstos. PACIENTES Y MÉTODOS: Estudiamos prospectivamente a 36 pacientes epilépticos seleccionados de forma consecutiva y tratados previamente con diversas medicaciones antiepilépticas durante 44,8 ñ 8,08 meses (media ñ DE). Se determinaron los anticuerpos antifosfolípido usando cardiolipina y una mezcla de fosfolípido de cerebro de rata como antígeno para la detección de los anticuerpos anticardiolipina y el anticoagulante lúpico por la técnica de ELISA y, además, mediante estudios de coagulación para este último. Se realizó un seguimiento clínico para determinar la presencia de fenómenos trombóticos en los siguientes 5 años. RESULTADOS: Se detectaron anticuerpos antifosfolípido en el 43 por ciento de los pacientes, en la mayoría anticuerpos anticardiolipina del subtipo IgM. Los pacientes no presentaron fenómenos trombóticos durante el tiempo de seguimiento. CONCLUSIÓN: Los anticuerpos anticardiolipina fueron positivos en una alta proporción de estos pacientes, pero no se asociaron a fenómenos de trombosis. Esto puede explicarse porque el perfil de positividad de anticuerpos anticardiolipina no asociado a anticoagulante lúpico positivo que se encontró en estos pacientes no confiere aumento de riesgo de trombosis. (AU)

Neuropatía trigeminal sensitiva aislada por infarto lateral pontino / Isolated sensory trigeminal neuropathy due to lateral pontine stroke

La lesión de un nervio craneal por daño vascular en la protuberancia generalmente se acompaña de afectación de los tractos nerviosos colindantes y es excepcional la presentación como mononeuropatía craneal aislada. Describimos el caso de una mujer de 57 años hipertensa, que presentó de forma brusca parestesias e hipoestesis tactoalgésica en las tres ramas del quinto nervio craneal derecho sin afectación motora y con preservación de los reflejos corneal y maseterino. La resonancia magnética craneal revelaba un pequeño infarto dorsolateral pontino en la salida del trigémino derecho. La neuropatía trigeminal sensitiva aislada es una rara forma de presentación del infarto pontino (AU)

Metástasis ovárica de un carcinoma de mama / Ovarian metastasis of a breast cancer

El cáncer de mama es el tumor maligno más frecuente y la primera causa de muerte por cáncer en las mujeres. La mayoría de las neoplasias malignas son adenocarcinomas, y desde el punto de vista arquitectural la forma más frecuente es el carcinoma ductal infiltrante, seguida del lobulillar infiltrante. Ambos tipos histológicos pueden diseminarse por vía hematógena a cualquier órgano, siendo el hueso, pulmón e hígado los más afectados con más frecuencia. Otras estructuras como el peritoneo, meninges o aparato genital se afectan más raramente, y en estos casos el tipo lobulillar infiltrante es el causante de las metástasis la mayor parte de las veces. Presentamos el caso clínico de una paciente de 44 años sometida en nuestro servicio a tratamiento quirúrgico mediante mastectomía radical modificada por tumoración mamaria, cuyo resultado anatomopatológico fue carcinoma ductal con áreas de lobulillar infiltrante. En el curso del seguimiento clínico, y a los 47 meses de la intervención, se objetiva un incremento de los marcadores tumorales, así como una masa bilateral ovárica cuyo origen metastásico es comprobado tras la exéresis quirúrgica. Este caso nos sirve para hacer hincapié en la condición de enfermedad sistémica que caracteriza al cáncer de mama, y en la posibilidad de metástasis en órganos diferentes de los habituales, incluido el aparato genital, en especial si el tumor primario tiene componente lobulillar (AU)

[Isolated sensory trigeminal neuropathy caused by a lateral pontine infarct]]. / Neuropatía trigeminal sensitiva aislada por infarto lateral pontino.

Lesion of cranial nerves due to vascular damage at pontine level generally associates affectation of near nerve tracts. Isolated fifth nerve palsy due to vascular pontine lesions has been scarcely reported. We present a hypertense 57 year old woman who suffered from sudden paresthesias and hypoesthesia on the three divisions of trigeminal nerve without motor involvement and with preservation of corneal and masseter reflexes. Cranial magnetic resonance showed small dorsolateral pontine infarct over the right fifth cranial nerve entry. Isolated sensitive trigeminal neuropathy is a rare debut form of pontine infarct.

Transthyretin Tyr77 familial amyloid polyneuropathy: a clinicopathological study of a large kindred.

More than 40 point mutations (producing different clinical manifestations) have been described in diverse points of the plasma protein transthyretin (TTR). The Met30 is considered the most common mutation, the Tyr77 mutation being the second most prevalent. However, data from patients with this late mutation are scarce, and usually come from isolated case reports or tables. The Tyr77 mutation is not as well characterized as the Met30 mutation, especially with respect to such aspects as prognosis or possible treatment by liver transplantation. We therefore present the clinical and pathological features of an extensive family with the Tyr77 TTR mutation, comprising 12 affected individuals over four generations. Six living individuals were followed over a 10-year period. Retrospective data were obtained with regard to the deceased family members. We found that an initial and sometimes prolonged carpal tunnel syndrome, beginning between the 6th and 7th decades, characterizes the Tyr77 mutation. In most cases this evolved to generalized peripheral nerve involvement, restrictive cardiomyopathy, and intestinal malabsortion. Although survival is usually high, there are progressive cases that should be candidates for liver transplant, before severe impairment has developed.

Mantle cell lymphoma with amyotrophic lateral sclerosis (motor neuron disease)

We describe a previously unreported case of mantle cell lymphoma (MCL) associated to amyotrophic lateral sclerosis (ALS) in a 63-year-old woman with a 1-year history of weakness of arm and leg muscles. The both molecular-genetic and flow cytometry analysis of lymphocytes of peripheral blood (PB) demonstrated leukemic phase of MCL.

[Dorsal subdural spinal abscess after epidural anesthesia]. / Absceso subdural espinal dorsal tras anestesia epidural.

Spinal subdural empyema (SE) is a rare condition. We describe a young patient with a torathic SE after lumbar epidural anaesthesia. SE was distant from the region of manipulation. Spinal magnetic resonance was the most useful procedure for diagnosis and follow-up. Treatment with intravenous antibiotics and drainage was not enough, and she needed complete surgical excision of the lesion.

Isolated pontine infarctions with prominent ipsilateral midfacial sensory signs.

BACKGROUND: Pontine infarctions may produce combined motor, sensory, cerebellar, and cranial nerve dysfunction. Midline sensory complaints and facial pain are uncommon. CASE DESCRIPTIONS: Three patients are described with hypoesthesia and numbness of the midline facial area associated with dysarthria and contralateral hemiparesis due to pontine strokes. MRI demonstrated isolated ipsilateral ischemic infarctions of the ventral pons. CONCLUSIONS: Pontine infarctions can produce diverse sensory features. Ipsilateral midfacial sensory defect has been rarely reported. The clinicoanatomic basis for the ipsilateral midfacial sensory defect described is unknown. Involvement of the dorsal trigeminothalamic tract or fiber tracts related to central regions of the face, located in the medial part of the midbrain, could help to explain these data. The symptoms could be due to direct damage or to edema resulting from the infarct. In some patients, midfacial sensory complaints, particularly of the ala nasi, could be an early sign of major pontine deficits and may be important to determine appropriate treatment.