[Atypical Guillain-Barre syndrome clustering: is it necessary to reconsider the diagnostic criteria and microbiological protocol?] / Agrupacion de casos de sindrome de Guillain-Barre atipico: es necesario redefinir los criterios diagnosticos y los protocolos microbiologicos?

INTRODUCTION: Guillain-Barre syndrome is classically defined as a symmetrical ascending acute polyradiculoneuropathy, although there are atypical variants that make diagnosis difficult. CASE REPORTS: The medical data of six patients in our hospital area are collected during the first quarter of 2013. Lumbar punctures, imaging, neurophysiological studies, ganglioside antibodies and serologies have been proposed in all cases. We focus on the atypical features as late hyporeflexia, increased frequency of asymmetry and distal paresis and initial fever. From a neurophysiological point of view, all patients presented sensorimotor axonal forms. The most consistent datas in early studies is the F wave's alteration. A Miller Fisher variant associated with faciocervicobraquial paresis and cerebral reversible vasoconstriction syndrome has been detected. A bilateral brachial paresis and lumbar polyradiculopathy in the context of influenza A infection is other interesting case. The saltatory variant with cranial nerve involvement and lower limbs paresis has been demonstrated in one patient. Bands in cerebrospinal fluid are positive in three cases and anti-ganglioside antibodies in one patient. The syndrome of inappropriate secretion of antidiuretic hormone may explain some of the hyponatremias registered. The first line of treatment are inmunoglobulins in all patients. Plasmapheresis exchanges has been used as an additional therapy in four cases. CONCLUSIONS: These clusters of six axonal cases with atypical clinical features justifies the need for knowledge of these variants in order to achieve an early treatment. Late hyporeflexia and brachialfaciocervico, saltatory and lumbar forms should be considered in the spectrum of Guillain-Barre syndrome. The etiological study should rule out a lots of pathogens as influenza A.

TITLE: Agrupacion de casos de sindrome de Guillain-Barre atipico: es necesario redefinir los criterios diagnosticos y los protocolos microbiologicos?Introduccion. El sindrome de Guillain-Barre se define clasicamente como una polirradiculopatia aguda simetrica ascendente, si bien existen variantes atipicas que dificultan el diagnostico. Casos clinicos. Se recogen las historias clinicas de seis pacientes de nuestra area hospitalaria durante el primer trimestre de 2013. Se han realizado punciones lumbares, electroneurograma-electromiograma y analiticas con autoinmunidad en todos los casos. El conjunto de la muestra destaca por la presencia de caracteristicas atipicas, como hiporreflexia tardia, mayor frecuencia de asimetria y afectacion distal, asi como fiebre inicial. Desde el punto de vista neurofisiologico, todos los pacientes presentan formas axonales de tipo sensitivomotoras y las alteraciones de la onda F son el dato mas precoz. Se identifica una variante de sindrome de Miller Fisher asociada a paresia faciocervicobraquial y sindrome de vasoconstriccion cerebral reversible. Otro caso auna las variantes de paresia braquial bilateral y polirradiculopatia lumbar en el contexto de infeccion aguda por influenza A. La variante saltatoria ha sido demostrada en otro paciente. Todos los pacientes han recibido tratamiento con inmunoglobulinas, y en dos de ellos se sumo la plasmaferesis como terapia adicional. Conclusiones. La agrupacion de seis casos axonales con caracteristicas clinicas atipicas justifica la necesidad del conocimiento de estas variantes para lograr un diagnostico y un tratamiento precoz. La hiporreflexia tardia y las formas faciocervicobraquiales, saltatorias y lumbares deben considerarse dentro del espectro del sindrome de Guillain-Barre. El estudio etiologico debe incluir el cribado de numerosos patogenos, entre los que debe incluirse el virus influenza A.

Measurement of dental implant stability by resonance frequency analysis: A review of the literature

Dental implant treatment is an excellent option for prosthetic restoration that is associated with high successrates. Implant stability is essential for a good outcome. The clinical assessment of osseointegration is based onmechanical stability rather than histological criteria, considering primary stability (absence of mobility in bonebed after implant insertion) and secondary stability (bone formation and remodelling at implant-bone interface).The aim of this study was to review the literature on Resonance Frequency Analysis (RFA) as a methodfor measuring dental implant stability. An online search of various databases was conducted on experimentaland clinical research published between 1996 and 2008. The studies reviewed demonstrate the usefulness ofRFA as a non-invasive method to assess implant stability. Further research is required to determine whetherthis system is also capable of measuring the degree of dental implant osseointegration (AU)

[The value of diffusion magnetic resonance imaging in diagnosing infarction of the anterior spinal artery]. / Utilidad de la resonancia magnética de difusión en el diagnóstico de infarto de la arteria espinal anterior.

INTRODUCTION: The diagnosis of ischemic lesions affecting the spinal cord is sometimes difficult to confirm using conventional magnetic resonance imaging (MRI) techniques, and this makes it necessary to use those currently available to their full extent and also to search for new ones. CASE REPORT: We report the case of an 81-year-old male patient who presented symptoms of sudden onset paraparesis, secondary to lesions in the anterior spinal territory and whose diagnosis was reached using conventional spinal cord MRI, and later confirmed with the diffusion imaging technique. Diffusion MRI in the spinal cord territory, as well as in the brain territory, is a very interesting first choice technique when an ischemic pathology is suspected. Using only T2-weighted images does not allow acute ischemic lesions to be distinguished from chronic lesions; likewise, intramedullary T2 hyperintensity and standard DWI (Diffusion Weighted Imaging) is not specific to acute spinal ischemia, and the determination of the apparent diffusion coefficient in the lesion may help in the differential diagnosis of diseases affecting the spinal cord. CONCLUSIONS: Including diffusion RMI techniques in the study protocols in cases of ischemic spinal cord pathologies is indispensable today if we hope to reach a fast and correct diagnosis.