Balloon-assisted coiling through a single 6F guiding catheter.

The new version of the 6F Envoy guiding catheter, with its enlarged inner diameter of 0.070 inch, is capable of simultaneously accommodating both a 0.014-inch microcatheter and a balloon microcatheter for balloon-assisted coiling (BAC). We report our experience using this guiding catheter for access in BAC in 48 patients. The guiding catheter allowed for easy manipulations of 2 microcatheters, while providing sufficient quality of control angiograms during the procedure. In cases in which BAC is indicated, a larger guiding catheter (7F) or the commonly used bifemoral approach is no longer necessary, making the procedure technically simpler for the operator and less traumatic to the vessel wall.

[Epidemiologic studies of cerebellopontine angle tumors surgically treated in Maracaibo, Venezuela, in 1985-1999]. / Estudio epidemiológico de los tumores del ángulo pontocerebeloso operados en Maracaibo, Venezuela, durante el lapso 1985-1999.

OBJECTIVE: To analyze the epidemiological, clinical and neuropathological data of cases of cerebellopontine angle (CPA) tumors. MATERIAL AND METHODS: The clinical records, neuroimaging and neuropathological studies of 50 patients with diagnosis of CPA tumor operated in different hospitals of Maracaibo, Venezuela, during the lapse January 1st, 1985-December 31, 1999 were reviewed. The variables age, gender, side of the lesion and neuropathological diagnosis were analyzed. RESULTS: A 2:1 female to male ratio was observed. Median age was 48 +/- 12.7 years. Acoustic neuromas (AN) represented 48% of the cases, whereas nonacoustic neuroma tumors (NANT) made up for the rest (52%). Meningiomas were the second more commonly diagnosed lesions, they constituted 32% of the cases. Meningiomas and AN were more frequent in women, their ratios being 7:1 and 1.6:1, respectively. In 60% of the cases the signs and symptoms became eloquent in patients of the fourth and fifth decades of life. CONCLUSIONS: The difference between our results and the ones previously reported in the medical literature are due in part to the predominance of female patients in our series. Endocrinologic, genetic and biochemical factors could also be responsible; nevertheless, this does not constitute the objective of the present study.

Cystic fibrosis in Uruguay

We conducted clinical and genetic analyses of 52 cystic fibrosis (CF) patients in Uruguay, which is about half of the known affected individuals in the country. A relatively high proportion had a mild presentation, characterized by pancreatic sufficiency (28), a strong pulmonary component (97), and borderline sweat electrolyte measurements (25). Mutational analysis of CF chromosomes demonstrated a relatively low incidence of the DeltaF508 allele (40) and a large number of other cystic fibrosis conductance regulator mutations, with an overall detection rate of about 71. Fifteen different mutations were detected in our patients: DeltaF508, G542X, R1162X, G85E, N1303K, R334W, R75Q, R74W, D1270N, W1282X, DeltaI507, 2789+5G-->A, R1066C, -816C/T, R553X, as well as RNA splicing variant IVS8-5T. This group of Uruguayan CF patients has some characteristics in common with other populations of similar origin (Hispanics), as well as some unique characteristics

Estudio epidemiológico de los tumores del ángulo pontocerebeloso operados en Maracaibo, Venezuela, durante el lapso 1985-1999 / Epidemiological study of the cerebellopontine angle tumors operated in Maracaibo, Venezuela, during the lapse 1985-1999

Objetivo: Analizar los datos epidemiológicos, clínicos y neuropatológicos relacionados con los tumores del ángulo pontocerebeloso (APC).Material y métodos: Se revisaron las historias clínicas, estudios por imágenes y estudios neuropatológicos correspondientes a 50 pacientes con diagnóstico de tumor de APC intervenidos en diferentes hospitales de Maracaibo, Venezuela, entre el 1° de enero de 1985 y el 31 de diciembre de 1999. Se recabaron los datos correspondientes a las variables edad, género, lado de la lesión y diagnóstico neuropatológico. Resultados: Se observó una razón de 2:1 entre el género femenino y el masculino. La media de edad fue de 48+/-12.7 años. Los neuromas acústicos (NA) representaron el 48 por ciento de los casos y los tumores no neuromas acústicos (TNNA) el 52 por ciento. Los meningiomas fueron segundos en frecuencia, constituyendo el 32 por ciento del total. Los Meningiomas y los NA fueron mas frecuentes en mujeres a razón de 7:1 y 1.6:1, respectivamente. El 60 por ciento de los casos se presentaron en pacientes correspondientes a las décadas cuarta y quinta. Conclusiones: La diferencia entre los resultados de nuestra serie y los comunicados previamente a la literatura médica mundial en relación con la incidencia de NA y TNNA en el APC obedece en parte al predominio de pacientes del género femenino en la presente muestra y probablemente al concurso de factores endocrinos, genéticos y bioquímicos, entre otros; sin embargo ello no formó parte de los objetivos del presente estudio (AU)

Alpha1-adrenergic receptors and their significance to chemical-induced nephrotoxicity--a brief review.

Stimulation of alpha-adrenergic receptors by cold stress or adrenergic agents has been shown to potentiate the toxicity of numerous toxicants. Several lines of evidence indicate that this interaction is dependent on glutathione depression and increased cytosolic Ca2+ concentrations produced by alpha1-adrenergic compounds. In this report, evidence is provided in support of the mechanism of adrenoreceptor-mediated potentiation of nephrotoxicity. Alpha1-adrenergic agonists are shown to potentiate the toxicity of nephrotoxicants that exert their toxic effects via glutathione conjugation or Ca2+ deregulation. This review summarizes the effects of the alpha1-adrenergic agonist, phenylephrine, at enhancing the toxicity of 2-bromohydroquinone, 1,2-dibromoethane, and cis-diammineplatinum(II) dichloride.

Extraventricular cerebral anaplastic ependymomas.

BACKGROUND: Anaplastic ependymomas are considered to be uncommon cerebral tumors by most authors. We have had the opportunity to study 34 cases of such lesions in 13 years. METHODS: 34 cases of anaplastic ependymoma operated in different hospitals of Maracaibo, Venezuela, during the period of 1983-1995 were analyzed. Cases of ependymoblastoma were excluded. RESULTS: Adult patients made up most of the present series. All patients harbored supratentorial growths in locations distant from the ventricular system. The microscopic pattern was of limited value to establish prognosis, for there was no constant correlation between the histologic features and tumor relapse; only in sporadic cases in which high cell density and conspicuous mitotic activity were maximally expressed, did tumor relapse occur shortly after removal of the lesion. CONCLUSION: This type of paradoxical behavior being the rule makes all attempts at predicting prognosis in these entities a disappointing task.

[Central nervous system infection by free-living amebas: report of 3 Venezuelan cases]. / Infección del sistema nervioso central por amebas de vida libre: comunicación de tres nuevos casos venezolanos.

INTRODUCTION: Infection of the Central Nervous System by free living amebas is an unusual event, 344 cases have been reported to date. The disease becomes evident in two different clinical fashions: Primary Amebic Meningoencephalitis (PAM) caused by Naegleria fowleri and Granulomatous Amebic Encephalitis (GAE) induced by Spp. of Acanthamoeba and Balamuthia. CLINICAL CASES: The authors report three new cases from Venezuela. Case 1. 34 years old man, with a chief complaint of general malaise, headache and fever, a diagnosis of common cold was made and the patient was treated as such, he did not improve and was admitted to the hospital with deterioration of his clinical status; the patient died 10 days after the onset of his illness which was determined to be GAE produced by Balamuthia mandrillaris. Case 2. 8 years old female admitted to the hospital because of fever, headache and generalized seizures of sudden onset; neurocysticercosis was diagnosed and following improvement the patient was discharged and readmitted on two occasions because of relapse and worsening of her illness, she died 2 months after the onset of her disease that was diagnosed by autopsy as GAE due to Balamuthia mandrillaris. Case 3. 16 years old male, previously healthy, who following immersion in a water tank was admitted to the hospital because of meningeal irritation that progressed to coma and death in a 7 day lapse; autopsy revealed PAM by Naegleria fowleri. The two cases of GAE due to Balamuthia mandrillaris occurred in apparently immunocompetent individuals, contrary to the statement that these microorganisms are opportunistic. CONCLUSION: We believe that neurological infection by amphizoic amebas is being underdiagnosed, probably due to ignorance regarding this pathology or because of a very low autopsy rate in most countries.