Estudio controlado del ritmo del habla en la enfermedad de Parkinson / Speech rate in Parkinson's disease: A controlled study

Introducción: Las alteraciones en el habla aparecen en la mayoría de los pacientes con la enfermedad de Parkinson (EP) en el curso del trastorno. Su origen y gravedad son de interés clínico y diagnóstico. Objetivo: Evaluar los patrones de deterioro en el habla en pacientes con la EP, e identificar diferencias en la velocidad de elocución y articulación en comparación con sujetos de control, empleando un método de análisis automático en una tarea de lectura. Pacientes: Participaron 39 pacientes con la EP y 45 controles asintomáticos igualados en sexo y edad. Los pacientes con la EP, en estado on, no presentaban fluctuaciones motoras ni discinesias durante la evaluación del habla. Resultados: El grupo de pacientes con la EP muestran una significativa reducción de la velocidad de elocución y articulación. No se encontraron correlaciones significativas entre los parámetros del habla estudiados y las características de los pacientes, tales como la dosis de L-dopa, duración del trastorno, edad, ni en las puntuaciones en las escalas UPDRS III o Hoehn y Yahr. Conclusiones: Los pacientes con la EP muestran un patrón característico de deterioro del ritmo del habla. Estos resultados indican que las disfluencias en la EP son el resultado de la alteración del movimiento que afecta a la fisiología de los sistemas de producción del habla

Introduction: Speech disturbances will affect most patients with Parkinson's disease (PD) over the course of the disease. The origin and severity of these symptoms are of clinical and diagnostic interest. Purpose: To evaluate the clinical pattern of speech impairment in PD patients and identify significant differences in speech rate and articulation compared to control subjects. Speech rate and articulation in a reading task were measured using an automatic analytical method. Patients: A total of 39 PD patients in the ‘on’ state and 45 age-and sex-matched asymptomatic controls participated in the study. None of the patients experienced dyskinesias or motor fluctuations during the test. Results: The patients with PD displayed a significant reduction in speech and articulation rates; there were no significant correlations between the studied speech parameters and patient characteristics such as L-dopa dose, duration of the disorder, age, and UPDRS III scores and Hoehn & Yahr scales. Conclusion: atients with PD show a characteristic pattern of declining speech rate. These results suggest that in PD, disfluencies are the result of the movement disorder affecting the physiology of speech production systems

Speech rate in Parkinson's disease: A controlled study. / Estudio controlado del ritmo del habla en la enfermedad de Parkinson.

INTRODUCTION: Speech disturbances will affect most patients with Parkinson's disease (PD) over the course of the disease. The origin and severity of these symptoms are of clinical and diagnostic interest. PURPOSE: To evaluate the clinical pattern of speech impairment in PD patients and identify significant differences in speech rate and articulation compared to control subjects. Speech rate and articulation in a reading task were measured using an automatic analytical method. PATIENTS: A total of 39 PD patients in the 'on' state and 45 age-and sex-matched asymptomatic controls participated in the study. None of the patients experienced dyskinesias or motor fluctuations during the test. RESULTS: The patients with PD displayed a significant reduction in speech and articulation rates; there were no significant correlations between the studied speech parameters and patient characteristics such as L-dopa dose, duration of the disorder, age, and UPDRS III scores and Hoehn & Yahr scales. CONCLUSION: Patients with PD show a characteristic pattern of declining speech rate. These results suggest that in PD, disfluencies are the result of the movement disorder affecting the physiology of speech production systems.

Hiperplasia angiolinfoide con eosinofilia. Estudio clínico patológico de 9 casos / Angiolymphoid Hyperplasia With Eosinophilia: A Clinicopathologic Study of 9 Cases

La hiperplasia angiolinfoide con eosinofilia (HALE) es una enfermedad infrecuente, caracterizada por lesiones angiomatosas solitarias o múltiples que suelen localizarse en el cuero cabelludo y la cara. Presentamos un análisis retrospectivo de 9 casos de HALE. Clínicamente se manifestaban en forma de pápulas o, en algunos casos, de nódulos subcutáneos, agrupados formando lesiones múltiples localizadas en su gran mayoría en el cuero cabelludo, principalmente alrededor de la oreja. También observamos lesiones en localizaciones atípicas, como en otras áreas de la cabeza, el hombro, el cuello y el antebrazo. En estas localizaciones las lesiones adquirían una forma clínica peculiar que dificultaba su diagnóstico y que hay que tener en cuenta ante lesiones únicas, bien delimitadas, de aspecto vascular con ulceración o costra en la superficie. El tratamiento más utilizado fue la cirugía, y aunque se trate de una entidad que se engloba dentro de los procesos benignos, las recidivas fueron frecuentes

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare disease characterized by single or multiple angiomatous lesions typically located on the scalp and the face. We present a retrospective analysis of 9 cases of ALHE. The lesions appeared largely as multiple grouped papules or, in some cases, subcutaneous nodules, located mainly on the scalp, particularly around the ear. We also observed lesions in atypical locations, such as areas of the head other than the scalp, and the shoulder, neck, and forearm. At these sites the lesions had an atypical clinical appearance that made diagnosis difficult; this should be borne in mind in patients with single, well-delimited lesions with a vascular appearance and superficial ulceration or crusting. Surgery was the most common treatment in our series, and even though ALHE is considered a benign condition, recurrence was common

Angiolymphoid hyperplasia with eosinophilia: a clinicopathologic study of 9 cases.

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare disease characterized by single or multiple angiomatous lesions typically located on the scalp and the face. We present a retrospective analysis of 9 cases of ALHE. The lesions appeared largely as multiple grouped papules or, in some cases, subcutaneous nodules, located mainly on the scalp, particularly around the ear. We also observed lesions in atypical locations, such as areas of the head other than the scalp, and the shoulder, neck, and forearm. At these sites the lesions had an atypical clinical appearance that made diagnosis difficult; this should be borne in mind in patients with single, well-delimited lesions with a vascular appearance and superficial ulceration or crusting. Surgery was the most common treatment in our series, and even though ALHE is considered a benign condition, recurrence was common.

Tinea capitis en mujeres de edad avanzada: descripción de 4 casos / Tinea Capitis in Elderly Women: A Report of 4 Cases

La tinea capitis se ha considerado clásicamente como un proceso casi exclusivo de la infancia. Sin embargo, en las últimas décadas se han observado algunos cambios en su perfil epidemiológico, tanto en lo que concierne a las edades de presentación como a los agentes responsables. Se describen los casos de 4 mujeres mayores de 65 años diagnosticadas de tinea capitis. Una de ellas presentaba placas alopécicas con descamación, mientras que en las otras tres las lesiones eran inflamatorias y costrosas. Los cultivos fueron positivos para Trichophyton tonsurans (2 pacientes), Trichophyton rubrum y Trichophyton mentagrophytes. La relativa infrecuencia de la tinea capitis en la edad avanzada y, por otra parte, su frecuente atipicidad clínica condicionan un diagnóstico tardío, circunstancia que puede condicionar secuelas irreversibles e incrementa la posibilidad de contagios. El cultivo fúngico debería incorporarse en el estudio de las dermatosis del cuero cabelludo de curso atípico y persistente, especialmente en individuos de edad avanzada (AU)

Tinea capitis is a condition usually found only in children. However, its epidemiological profile has changed in recent decades, with regard to age at onset and the causative microorganisms. We report the cases of 4 women over 65 years of age diagnosed with tinea capitis. One presented plaques of alopecia with desquamation and the other 3 developed crusted inflammatory lesions. Cultures were positive for Trichophyton tonsurans (2 patients), Trichophyton rubrum, and Trichophyton mentagrophytes. The relative rarity of tinea capitis in the elderly and the frequently atypical presentation in this age group can delay diagnosis, leading to irreversible sequelae and increasing the risk of contagion. Fungal culture should be included in the study of persistent, atypical dermatoses of the scalp, particularly in the elderly (AU)

[Tinea capitis in elderly women: a report of 4 cases]. / Tinea capitis en mujeres de edad avanzada: descripción de 4 casos.

Tinea capitis is a condition usually found only in children. However, its epidemiological profile has changed in recent decades, with regard to age at onset and the causative microorganisms. We report the cases of 4 women over 65 years of age diagnosed with tinea capitis. One presented plaques of alopecia with desquamation and the other 3 developed crusted inflammatory lesions. Cultures were positive for Trichophyton tonsurans (2 patients), Trichophyton rubrum, and Trichophyton mentagrophytes. The relative rarity of tinea capitis in the elderly and the frequently atypical presentation in this age group can delay diagnosis, leading to irreversible sequelae and increasing the risk of contagion. Fungal culture should be included in the study of persistent, atypical dermatoses of the scalp, particularly in the elderly.

Perfil clínico y curso evolutivo de los pacientes tratados con efalizumab tras la suspensión de su autorización por la EMEA. Estudio observacional y multicéntrico / Clinical Characteristics and Disease Course in Patients Treated With Efalizumab Following Suspension of Marketing Authorization by the European Medicines Agency: A Multicenter Observational Study

Introducción: La reciente resolución de la EMEA con respecto a la suspensión de efalizumab, ocurrida en febrero del año 2009, ha proporcionado una oportunidad única para comprobar la evolución de un grupo de pacientes en cuya selección no intervinieron los filtros ni los sesgos habituales de los estudios pivotales. El objetivo planteado fue evaluar el curso de la psoriasis tras la suspensión forzosa de efalizumab en un grupo de pacientes tratados en el ámbito clínico. Como objetivos secundarios se planteó investigar su perfil clínico, la respuesta y evolución durante el tratamiento y el curso evolutivo a las 12 y 24 semanas tras la suspensión. Pacientes y métodos: Se recogió información procedente de un grupo de pacientes tratados con efalizumab referida al perfil epidemiológico, al curso de la dermatosis durante el tratamiento y a su evolución al suspenderlo. Se llevaron a cabo estudios estadísticos con vistas a identificar variables predictivas de los distintos objetivos investigados. Resultados: Se incluyeron 147 pacientes procedentes de 12 centros hospitalarios nacionales. Durante el tratamiento un 4% de los pacientes fue diagnosticado de exacerbación inflamatoria generalizada. La mayor parte de los pacientes pudieron ser clasificados como buenos respondedores (55%) o respondedores moderados (18%). Un 30% de los pacientes presentaron rebote tras la suspensión de efalizumab. La probabilidad de rebote fue independiente del perfil clínico, la respuesta al tratamiento o la actitud terapéutica del dermatólogo al suspenderlo. Discusión y conclusiones: Se comprobó una elevada ocurrencia de fenómeno de rebote tras la suspensión de efalizumab, superior a la descrita en los ensayos clínicos pivotales y especialmente significativa si se tiene en cuenta la elevada incidencia de buenos respondedores durante el tratamiento, considerados de mejor pronóstico. Otros datos significativos son la superior perspectiva de respuesta clínica —presumiblemente condicionada por el tiempo medio de tratamiento—, y la elevada incidencia de episodios de exacerbación inflamatoria generalizada (AU)

Background and objectives: The withdrawal of marketing authorization for efalizumab by the European Medicines Agency in February, 2009 provided a unique opportunity to assess the course of disease in patients who were not subject to the selection criteria and biases that were common in the pivotal trials. The aim of this study was to evaluate the course of psoriasis following forced suspension of efalizumab in a group of patients treated in normal clinical practice. As secondary objectives, we sought to assess the relationships between clinical characteristics, treatment response, and disease course during efalizumab treatment and 12 and 24weeks after suspension. Patients and methods: Information on the epidemiological profile and disease course during treatment and following suspension of the drug was collected from a group of patients treated with efalizumab. Statistical analyses were performed to identify predictive factors. Results: One hundred forty-seven patients from 12 Spanish hospitals were included in the study. During treatment, 4% of patients were diagnosed with generalized inflammatory flares. Most patients could be classified as having a good (55%) or moderate (18%) response to treatment. Rebound following withdrawal of efalizumab was observed in 30% of patients. The likelihood of rebound was independent of clinical characteristics, treatment response, or therapeutic approach used by the dermatologist following suspension. Conclusions: There was a high frequency of rebound following suspension of efalizumab, exceeding the rate reported in pivotal trials. This is particularly noteworthy given the large proportion of patients with a good response to treatment and therefore believed to have a better prognosis. Other significant findings were the higher frequency of positive treatment response than observed in previous studies (possibly influenced by the mean treatment duration) and the high frequency of generalized inflammatory flares (AU)

[Clinical characteristics and disease course in patients treated with efalizumab following suspension of marketing authorization by the European medicines agency: a multicenter observational study]. / Perfil clínico y curso evolutivo de los pacientes tratados con efalizumab tras la suspensión de su autorización por la EMEA. Estudio observacional y multicéntrico.

BACKGROUND AND OBJECTIVES: The withdrawal of marketing authorization for efalizumab by the European Medicines Agency in February, 2009 provided a unique opportunity to assess the course of disease in patients who were not subject to the selection criteria and biases that were common in the pivotal trials. The aim of this study was to evaluate the course of psoriasis following forced suspension of efalizumab in a group of patients treated in normal clinical practice. As secondary objectives, we sought to assess the relationships between clinical characteristics, treatment response, and disease course during efalizumab treatment and 12 and 24 weeks after suspension. PATIENTS AND METHODS: Information on the epidemiological profile and disease course during treatment and following suspension of the drug was collected from a group of patients treated with efalizumab. Statistical analyses were performed to identify predictive factors. RESULTS: One hundred forty-seven patients from 12 Spanish hospitals were included in the study. During treatment, 4% of patients were diagnosed with generalized inflammatory flares. Most patients could be classified as having a good (55%) or moderate (18%) response to treatment. Rebound following withdrawal of efalizumab was observed in 30% of patients. The likelihood of rebound was independent of clinical characteristics, treatment response, or therapeutic approach used by the dermatologist following suspension. CONCLUSIONS: There was a high frequency of rebound following suspension of efalizumab, exceeding the rate reported in pivotal trials. This is particularly noteworthy given the large proportion of patients with a good response to treatment and therefore believed to have a better prognosis. Other significant findings were the higher frequency of positive treatment response than observed in previous studies (possibly influenced by the mean treatment duration) and the high frequency of generalized inflammatory flares.

Assessing the reproducibility of the microscopic diagnosis of sessile serrated adenoma of the colon.

INTRODUCTION: sessile serrated adenoma (SSA) is a recently described lesion that may be related to the development of up to 15% of colorectal cancers (CRCs). OBJECTIVE: to determine the accuracy of morphological criteria for the diagnosis of SSA by assessing concordance between pathologists. MATERIAL AND METHODS: concordance between two pathologists in the diagnosis of serrated lesions of the colon was studied for 195 lesions (187 hyperplastic polyps and 7 serrated adenomas). Size, location, morphology, and sampling method were collected of each lesion. Both pathologists were unaware of the previous diagnosis, macroscopic characteristics, and location of lesions. Possible diagnoses were: SSA, traditional serrated adenoma (TSA), hyperplastic polyp (HP), serrated polyp, tubular adenoma, or mixed lesions. Diagnostic doubts had to be described. Concordance between both observers was assessed using the kappa index (ê). The influence of collected variables on concordance degree was also evaluated. RESULTS: overall agreement on the histological diagnosis was poor (ê = 0.14), and so was agreement on the diagnosis of SSA (ê = 0.23). Concordance in the diagnosis of SSA improved with size > 5 mm (ê = 0.64) and proximal location (ê = 0.43). CONCLUSION: in a real clinical setting, the existing morphological criteria for SSA identification may be difficult to use.

Evaluación de la reproducibilidad del diagnóstico microscópico del adenoma serrado de sésil de colon / Assessing the reproducibility of the microscopic diagnosis of sessile serrated adenoma of the colon

Introducción: el adenoma serrado sésil (ASS) es una lesión descrita recientemente y que puede estar relacionada con el desarrollo de hasta un 15% de los cánceres colorrectales (CCR). Objetivo: determinar la eficacia de los criterios morfológicos para el diagnóstico del ASS evaluando el grado de acuerdo entre patólogos. Material y métodos: se estudió la concordancia entre dos patólogos para el diagnóstico de las lesiones serradas de colon en 195 lesiones (187 pólipos hiperplásicos y 7 adenomas serrados). De cada lesión se recogió el tamaño, la localización, la morfología y la forma de obtención de la muestra. Los dos patólogos eran desconocedores del diagnóstico inicial, las características macroscópicas y la localización de las lesiones. Los posibles diagnósticos fueron: ASS, adenoma serrado tradicional (AST), pólipo hiperplásico (PH), pólipo serrado, adenoma tubular o formas mixtas. Las dudas diagnósticas debían describirse. La concordancia entre los dos observadores se evaluó mediante el índice kappa (k). También se evaluó la influencia de las variables recogidas de las lesiones en el grado de acuerdo en el diagnóstico. Resultados: el acuerdo global para el diagnóstico histológico fue pobre (k = 0,14). También lo fue el acuerdo para el diagnóstico de ASS (k = 0,23). La concordancia para el diagnóstico de ASS mejoró con el tamaño > 5 mm (k = 0,64) y para la localización proximal (k = 0,43). Conclusión: en un contexto clínico real, los criterios morfológicos existentes para la identificación del ASS pueden ser de difícil aplicación(AU)

Introduction: sessile serrated adenoma (SSA) is a recently described lesion that may be related to the development of up to 15% of colorectal cancers (CRCs). Objective: to determine the accuracy of morphological criteria for the diagnosis of SSA by assessing concordance between pathologists. Material and methods: concordance between two pathologists in the diagnosis of serrated lesions of the colon was studied for 195 lesions (187 hyperplastic polyps and 7 serrated adenomas). Size, location, morphology, and sampling method were collected of each lesion. Both pathologists were unaware of the previous diagnosis, macroscopic characteristics, and location of lesions. Possible diagnoses were: SSA, traditional serrated adenoma (TSA), hyperplastic polyp (HP), serrated polyp, tubular adenoma, or mixed lesions. Diagnostic doubts had to be described. Concordance between both observers was assessed using the kappa index (k). The influence of collected variables on concordance degree was also evaluated. Results: overall agreement on the histological diagnosis was poor (k = 0.14), and so was agreement on the diagnosis of SSA (k = 0.23). Concordance in the diagnosis of SSA improved with size > 5 mm (k = 0.64) and proximal location (k = 0.43). Conclusion: in a real clinical setting, the existing morphological criteria for SSA identification may be difficult to use(AU)

El difícil diagnóstico de la ruptura de los implantes de mama. Caso clínico / No disponible

No disponible

Comportamiento de la cefalea postpunción dural en pacientes quirúrgico. Dos años de estudio

La cefalea postpunción dural es una complicación postoperatoria que se describe con relativa frecuencia, variando su presentación según determinados factores de riesgo, por lo que se define como objetivo de la investigación identificar el comportamiento de la cefalea postpunción dural en pacientes intervenidos quirúrgicamente durante 2 años en el Hospital General de Trinidad, para ello se realizó un estudio descriptivo, prospectivo, que incluyó 940 pacientes intervenidos quirúrgicamente.(AU)

[Multiple enterolithiasis, coexisting with bladder and gallbladder lithiasis, associated with colon adenocarcinoma]. / Enterolitiasis múltiple, coexistiendo con litiasis biliar y vesical, asociada a adenocarcinoma de colon.

Enteroliths are calculi primarily formed in the intestine. Enterolithiasis is a rare condition frequently associated with intestinal stasis. Usually it causes no symptoms in most cases, but it can be an important diagnostic clue in patients presenting intestinal occlusive symptoms. We report a case of multiple enterolithiasis, very infrequent pathology, coexisting with bladder and gall bladder lithiasis in a patient with colon adenocarcinoma. Diagnosis was made by X-rays and CT images. Calculi were analysed by several methods: chemical, infrared spectroscopy, stereoscopic microscopy and atomic emission spectroscopy; they showed that caluli are made up of organic material and whilokita (calcium and magnesium ortophosphate). No risk factors for lithogenesis were found in this patient excluding the intestinal stasis caused by intestinal narrowing as a result of adenocarcinoma. Genetic factors are suggested as main contributors to hyperlithogenesis observed in this patient. The physiopathological conditions were studied in depth and literature about this subject reviewed.

Enterolitiasis múltiple, coexistiendo con litiasis biliar y vesical, asociada a adenocarcinoma de colon / Multiple enterolithiasis, coexisting with bladder and gall bladder lithiasis, associated with colon adenocarcinoma

La enterolitiasis, cálculos formados primariamente en el intestino, es una rara enfermedad asociada, generalmente, con estasis intestinal. Suele cursar sin síntomas en la mayoría de los casos, pero puede presentar oclusión intestinal y debe ser tenida en cuenta como posible causa de la misma. Presentamos, un caso de enterolitiasis múltiple, patología muy infrecuente, que coexiste con litiasis biliar y vesical en un paciente con adenocarcinoma de colon. El diagnóstico fue realizado por imágenes de Rx y TC. El análisis de los cálculos: químico, por espectroscopia infrarroja, microscopía estereoscópica y espectrometría de emisión atómica, mostró una composición basada en materia orgánica y whilokita (ortofosfato de calcio y magnesio). No se encontraron factores de riesgo para la litogénesis, exceptuando la estasis intestinal ocasionada por la estenosis provocada por el adenocarcinoma. Se sugiere que los factores genéticos podrían ser los principales contribuyentes a la hiperlitogénesis observada en este caso. Profundizamos en el proceso fisiopatológico y revisamos la literatura al respecto

Enteroliths are calculi primarily formed in the intestine. Enterolithiasis is a rare condition frequently associated with intestinal stasis. Usually it causes no symptoms in most cases, but it can be an important diagnostic clue in patients presenting intestinal occlusive symptoms. We report a case of multiple enterolithiasis, very infrequent pathology, coexisting with bladder and gall bladder lithiasis in a patient with colon adenocarcinoma. Diagnosis was made by X-rays and CT images. Calculi were analysed by several methods: chemical, infrared spectroscopy, stereoscopic microscopy and atomic emission spectroscopy; they showed that caluli are made up of organic material and whilokita (calcium and magnesium ortophosphate). No risk factors for lithogenesis were found in this patient excluding the intestinal stasis caused by intestinal narrowing as a result of adenocarcinoma. Genetic factors are suggested as main contributors to hyperlithogenesis observed in this patient. The physiopathological conditions were studied in depth and literature about this subject reviewed

El contrato de gestión en los centros de Atención Primaria / The gestion agreement in Primary Health Care Centers

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Reflux nephropathy: a clinico-pathological study of 16 cases.

The pathologic features of 16 nephrectomy specimens obtained from patients with a radiological diagnosis of reflux nephropathy were analyzed. Chronic pyelonephritis was diagnosed in 7 cases, renal dysplasia in 5 and segmental atrophy in 4. Clear correlations between pathologic pictures and pathogenic mechanisms involved in the development of renal lesions in kidneys with reflux are difficult to establish. These results show, however, that 'reflux nephropathy' is a broad term, which encompasses both congenital and acquired renal lesions.