Blepharospasm as a Manifestation of Peak of Dose Dyskinesia in Parkinson Disease.

OBJECTIVES: The aim of the study was to report 4 patients with Parkinson disease (PD) and On-period blepharospasm (BS). METHODS: We analyzed patients with PD and motor fluctuations who developed BS in several different centers in Latin America. RESULTS: Four patients had BS while in the ON periods. CONCLUSIONS: Blepharospasm in the On period in patients with PD is extremely uncommon, and our series is the only one to describe such association.

A Multicenter Comparative Study of Impulse Control Disorder in Latin American Patients With Parkinson Disease.

OBJECTIVES: Impulse control disorder (ICD) is a common adverse effect in patients with Parkinson disease who receive dopamine agonists; however, other factors are involved in its manifestations. To study the frequency and factors involved in the development of this adverse effect in a Latin American population, we conducted a cross-sectional multicenter study. METHODS: Two hundred fifty-five patients in 3 Latin American centers were evaluated by examination and application of scales (Unified Parkinson's Disease Rating Scale, Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale, Hoehn and Yahr, Clinical Impression of Severity Index for Parkinson's Disease). RESULTS: Of the patients, 27.4% had ICD, most of whom were on dopamine agonists. Other associated risk factors included a younger age at onset of Parkinson disease, moderate symptoms, a shorter evolution of the clinical manifestations, rapid eye movement (REM) sleep disorder behavior, and the consumption of tea, mate, and alcohol. CONCLUSIONS: The frequency of ICD is higher in Latin America than in Anglo-Saxon populations. Consuming tea and mate, in addition to the use of dopamine agonists, is a factor that may demonstrate a genetic link that predisposes patients to the establishment of an ICD.

Cáncer de esófago con metástasis ósea a distancia a propósito de un caso

El cáncer esofágico es la 6… causa de mortalidad por cáncer a nivel mundial. Más frecuente en hombre que en mujeres (4:1) con un rango de 50-70 años de edad. La neoplasia epidermoide representa un 50% de los cánceres esofágicos siendo el tercio medio la región mas afectada. Es frecuente la diseminación a ganglios regionales o a estructuras vecinas. Se presenta caso de masculino de 49 años que refiere disfagia progresiva, regurgitación y pérdida de peso. Examen físico: adenopatías supraclaviculares bilaterales por metástasis linfática. Endoscopia: lesión infiltrante mamelonante en 1/3 inferior con afectación a cardias. Biopsia: carcinoma epidermoide moderadamente diferenciado y ulcerado. Esofagograma: sin demostrarse fístula esofágica, hernia hiatal severa. Antecedentes familiares: madre con cáncer de vías biliares y hermano con cáncer pulmonar. Se colocó prótesis metálica autoexpansible. Durante seguimiento presentó dolor a nivel perineal y parte interna del muslo izquierdo, no calmó con analgésicos comunes. Radiografía pélvica: lesión osteoclástica en isquion izquierdo catalogada como metástasis ósea secundaria a enfermedad de base. Recibió radioterapia local disminuyendo el dolor. Se concluye que el cáncer esofágico generalmente presenta metástasis, la minoría de estas son óseas, preferentemente los arcos costales. En vista de la presentación metastásica inusual se decide presentar el caso.

Esophageal cancer is the 6th cause of mortality by cancer at a world-wide level. It is more frequent in men than women (4:1) with a range of 50-70 years of age. Epidermoid represents 50% of esophageal cancers, being the medial third the most affected region. The dissemination to regional ganglia or neighboring structures is frequent. A 49 years old male patient presents with progressive dysphagia, regurgitation and weight loss. Physical examination: bilateral supraclavicular nodules due to lymphatic metastasis. Endoscopy: a nodule-like infiltrative lesion in the inferior 1/3 with affectation of the cardia. Biopsy: moderately differentiated and ulcerated epidermoid carcinoma. Esophagogram: shows no presence of fistula, with a hiatal hernia. Family history: mother with cancer of the biliary tree and a brother with pulmonary cancer. An autoexpansible metallic endoprostheses was placed. During follow up he presented pain at the perineal area and internal part of the left thigh that did not calm with common pain relievers. Pelvic x-ray: left osteoclastic injury in the ischium catalogued as bone metastasis from the primary tumor. He received local radiotherapy that diminishing the pain. We conclude that esophageal cancer often presents metastasis; the minorities of these are to the bone, preferably to the ribs. In view of this unusual metastastic presentation we decided to present this case.