[Analysis of bone mineral density in children with celiac disease. Densitometry indications and effect of gluten-free diet]. / Densidad mineral ósea en niños celiacos. Indicaciones de estudio y efecto de la exclusión del gluten de la dieta.

INTRODUCTION: one of the main extradigestive manifestations of celiac disease is the decrease in bone mineral density (BMD). Bone densitometry performed with DXA is the method of choice for BMD assessment. Indications for its use in celiac children are controversial. OBJECTIVE: analyzing BMD and various clinical-analytical variables in celiac children when diagnosed and after a gluten-free diet. Define a profile of patients who are more likely to present BMD involvement based on several individual characteristics, to perform DXA indications. METHODS: study performed in 24 celiac children (12 boys) (age: 8.7 ± 3.3 years). Their BMD was determined at diagnosis and after a gluten-free diet using DXA. The BMD was compared in each patient in the two moments of the study and at the moment of diagnosis between groups of patients stratified according to severity criteria dependent on clinical, analytical and histological variables. RESULTS: BMD was normal in all patients studied at the time of diagnosis and after treatment, with no difference between the two moments of the analysis. Children who presented symptomatology when diagnosed with celiac disease had lower spine and femur BMD than asymptomatic ones. The calcemia had an inverse correlation with the time of evolution of the disease before its diagnosis. CONCLUSIONS: in general, in our setting, the study of bone mineralization in celiac children is not indicated, unless there has been a prolonged clinical course before diagnosis.

Densidad mineral ósea en niños celiacos. indicaciones de estudio y efecto de la exclusión del gluten de la dieta / Analysis of bone mineral density in children with celiac disease. Densitometry indications and effect of gluten-free diet

Introducción: una de las principales manifestaciones extradigestivas de la enfermedad celiaca es la disminución de la densidad mineral ósea (DMO). La densitometría ósea realizada con DXA es el método de elección para la valoración de la DMO. Las indicaciones de su uso en niños celiacos son controvertidas. Objetivos: analizar la DMO y diversas variables clínicas-analíticas en niños celiacos cuando son diagnosticados y tras realizar una dieta sin gluten. Definir un perfil de pacientes con mayor probabilidad de presentar afectación de la DMO en base a diversas características individuales, para realizar indicaciones de DXA. Métodos: estudio realizado en 24 niños celiacos (12 varones) (edad: 8,7 ± 3,3 años). Mediante DXA se determinó su DMO al diagnóstico y tras realizar dieta sin gluten. La DMO fue comparada en cada paciente en los dos momentos del estudio y al diagnóstico entre grupos de pacientes estratificados según criterios de gravedad dependientes de variables clínicas, analíticas e histológicas. Resultados: la DMO fue normal en todos los pacientes estudiados en el momento del diagnóstico y tras realizar tratamiento, sin que se apreciaran diferencias entre esos dos momentos del análisis. Los niños que presentaban sintomatología cuando eran diagnosticados de enfermedad celiaca tuvieron menor DMO en columna y fémur que los asintomáticos. La calcemia tuvo correlación inversa con el tiempo de evolución de la enfermedad antes de su diagnóstico. Conclusiones: en general, en nuestro medio, no está indicada la realización de estudio de la mineralización ósea en los niños celiacos, salvo cuando haya existido una evolución clínica prolongada antes del diagnóstico

Introduction: one of the main extradigestive manifestations of celiac disease is the decrease in bone mineral density (BMD). Bone densitometry performed with DXA is the method of choice for BMD assessment. Indications for its use in celiac children are controversial. Objective: analyzing BMD and various clinical-analytical variables in celiac children when diagnosed and after a gluten-free diet. Define a profile of patients who are more likely to present BMD involvement based on several individual characteristics, to perform DXA indications. Methods: study performed in 24 celiac children (12 boys) (age: 8.7 ± 3.3 years). Their BMD was determined at diagnosis and after a gluten-free diet using DXA. The BMD was compared in each patient in the two moments of the study and at the moment of diagnosis between groups of patients stratified according to severity criteria dependent on clinical, analytical and histological variables. Results: BMD was normal in all patients studied at the time of diagnosis and after treatment, with no difference between the two moments of the analysis. Children who presented symptomatology when diagnosed with celiac disease had lower spine and femur BMD than asymptomatic ones. The calcemia had an inverse correlation with the time of evolution of the disease before its diagnosis. Conclusions: in general, in our setting, the study of bone mineralization in celiac children is not indicated, unless there has been a prolonged clinical course before diagnosis

Problemas del lenguaje en niños con parálisis cerebral / Language problems in children with cerebral palsy

La parálisis cerebral es una lesión no progresiva en las estructuras cerebrales que genera un trastorno del movimiento y de la postura. Estas lesiones también pueden afectar otras áreas responsables del desarrollo del lenguaje, tales como el sistema del habla, el sistema lingüístico o el procesamiento léxico, además de conllevar otras comorbilidades en diversas áreas. Objetivo. . Constatar el desarrollo del sistema lingüístico mediante la longitud media de los enunciados verbales y analizar el desempeño del procesamiento léxico que presentaron 142 niños mexicanos con parálisis cerebral cuyas edades comprendían de los 7 a los 13 años. Material y métodos. Mediante una elicitación de datos controlados la población debían nombrar 107 entidades clasificadas en 12 campos semánticos y contar el cuento Frog, Where are you? («Dónde está la ranita») siguiendo las imágenes de la historia para comprobar su longitud media de los enunciados verbales. Results. Solo el 16.9% de estos niños lograron nombrar más de 50 imágenes y contar el cuento que se les había mostrado. La longitud media de los enunciados verbales solo correspondió con la edad cronológica de un solo niño; el resto estuvo por debajo de lo esperado. El 83.1% de los 142 niños con parálisis cerebral evaluados no lograron emitir más de 10 palabras en ambas elicitaciones (AU)

Cerebral palsy is a non-progressive lesion in the brain structures that generates a disorder of movement and posture. These lesions can also affect other areas responsible for the language development system such as speech, linguistic or lexical retrieval system, as well as leading to other comorbidities in various areas. Objective. To observe the development of the language system using the Mean Length of Utterance and an analysis of the lexical retrieval presented in 142 Mexican children with cerebral palsy with ages ranging from 7 to 13 years. Material and methods. Using controlled data elicitation, the children with Cerebral Palsy were to name 107 entities (images) classified into 12 semantic fields and tell a story about «Frog, Where are you?», following the images of the story in order to check the Mean Length of Utterances. Results. Only 16.9% of these children were able to name more than 50 images that were shown and tell a story. The Mean Length of Utterance only corresponded with the chronological age in just one child, with the rest being lower than expected. The vast majority (83.1%) of the 142 children with palsy cerebral assessed did not exceed 10 words (AU)

Understanding the ion-induced elongation of silver nanoparticles embedded in silica.

In this work we have studied the elongation of silver nanoparticles irradiated with 40 MeV Bromine ions by means of in situ optical measurements, transmission electron microscopy and molecular dynamics simulations. The localized surface plasmon resonance of silver nanoparticles has a strong dependence on the particle shape and size, which allowed us to obtain the geometrical parameters with remarkable accuracy by means of a fit of the optical spectra. Optical results have been compared with transmission electron microscopy images and molecular dynamics simulations and the agreement is excellent in both cases. An important advantage of in situ measurements is that they yield an extremely detailed information of the full elongation kinetics. Final nanoparticle elongation depends on a complex competition between single-ion deformation, Ostwald ripening and dissolution. Building and validating theoretical models with the data reported in this work should be easier than with the information previously available, due to the unprecedented level of kinetic details obtained from the in situ measurements.

Nanoscale influence on photoluminescence and third order nonlinear susceptibility exhibited by ion-implanted Pt nanoparticles in silica.

A systematic study has been carried out to investigate photoluminescence and third order nonlinear ultraviolet properties exhibited by platinum nanoparticles nucleated in a high-purity silica matrix. The modification in the characteristic photoluminescence spectra of the nanocomposites, ranging between 400 and 600 nm, was obtained with the assistance of a thermal annealing process that changed the average size of the platinum nanoparticles. The influence of temperature, between 200 °C-1100 °C, during the thermal treatment of the nanostructures was analyzed. UV-vis spectroscopy studies corroborated changes in the optical absorption resonances of the ion-implanted samples after annealing, which could then be correlated with the average size of the nanoparticles. The estimated average size was also corroborated by transmision electron microscopy. For temperatures below 600 °C the system is mainly composed of ultra-small photoluminescent platinum nanoparticles. Larger platinum nanoparticles were formed at higher annealing temperatures but photoluminescence quenching was observed as the typical plasmonics response of larger metal nanoparticles started to emerge. The photoluminescence emission for samples with a particle size of less than 2 nm is enhanced approximately 12 fold with respect to the samples with a particle size in the range of 3-7 nm. Differences in the resulting photoluminescence spectra were revealed by substituting the participation of argon, hydrogen or nitrogen, as environmental gases for thermal annealing. A weak PL emission, featuring 1.5 nW at a laser excitation power of 800 µW, related to larger platinum nanoparticles was observed. New emission peaks emerging from the larger platinum nanoparticles were associated with possible hydrogen adsorption on the nanoparticles' surface. Third order nonlinear ultraviolet measurements were conducted using a time-resolved two-wave mixing method with self-diffraction at 355 nm wavelength. The observed self-diffraction decay time is less than 25 ps, regardless of the average size of the nanoparticles studied. The evolution of the self-diffracted intensities derived from temperature was also linked to the mean size of the nanoparticles in the samples. Comparative two-wave mixing evaluations also validated a modification in third order nonlinear susceptibility exhibited by annealed samples. An important role of the localized surface plasmon resonance phenomena associated with the platinum nanoparticles for photoluminescence and optical nonlinearities was identified. A proposed hypothetical electronic mechanism that may explain the exceptional optical transitions related to low-dimensional platinum systems is discussed.

Valoración de la coordinación y el equilibrio en niños prematuros / Evaluation of coordination and balance in preterm children

INTRODUCCIÓN: Estudios recientes demuestran que muchos niños prematuros sin secuelas neurológicas aparentes presentan dificultades en diferentes áreas, como la coordinación o el equilibrio, durante la etapa escolar. El Movement Assessment Battery for Children-2 (MABC-2) constituye una herramienta validada para la valoración de la coordinación, mientras que la estabilometría sería la prueba gold standard para el equilibrio. Pacientes y método: Estudio de casos y controles realizado en niños prematuros de 7-10 años y controles sanos nacidos a término de la misma edad. En ambos grupos se aplicó la franja de edad número 2 del MABC-2 y se analizó el equilibrio estático mediante estabilometría. RESULTADOS: Se incluyeron 89 sujetos: 30 prematuros de peso al nacimiento ≤ 1.500 g, 29 prematuros de peso > 1.500 g y 30 controles. Los prematuros obtuvieron peores puntuaciones totales de forma global en destreza manual y equilibrio en el MABC-2, independientemente del peso al nacimiento. La menor edad gestacional supuso la obtención de peores puntuaciones en destreza manual y scores totales en el MABC-2. El equilibrio fue similar mediante la estabilometría, independientemente de la prematuridad. CONCLUSIONES: Algo más de un 10% de prematuros y controles podría tener trastornos de la coordinación o estar en riesgo de desarrollarlos empleando el MABC-2. A pesar de que la coordinación visomotriz fue similar, los prematuros podrían tener mayores dificultades en destreza manual, mientras que en ausencia de comorbilidad neurológica, el equilibrio postural parece ser equiparable al de los controles sanos de su misma edad

INTRODUCTION: Recent studies show that many preterm children without apparent neurological sequelae present some difficulties in different areas, such as coordination or balance during their school years. The Movement Assessment Battery for Children-2 (MABC-2) has demonstrated to be a useful tool to validate the coordination, while the stabilometric platform was the reference standard test for validating the balance. PATIENTS AND METHOD: Case-control study carried out on preterm children from 7 to 10 years old and healthy term infant controls of the same ages. The same age band of MABC-2 was applied and the static balance by the stabilometric platform was analysed. RESULTS: A total of 89 subjects were included, 30 preterm children ≤ 1,500 g birthweight, 29 preterm children > 1,500 g birthweight, and 30 controls. Preterm children obtained the lowest scores on an overall basis in hand dexterity and balance tests in MABC-2, regardless of their birthweight. Lower gestational age was associated with poorer outcomes in hand dexterity and total scores in MABC-2. Balance results were similar using the stabilometric platform, regardless of prematurity. CONCLUSIONS: A little more than 10% preterm and term children could have coordination disorders or be at risk of developing them using the MABC-2. Despite the visual-motor coordination being similar, preterm children could face greater difficulties in hand dexterity while, in the absence of neurological comorbidity, preterm and term children balance could be comparable

[Evaluation of coordination and balance in preterm children]. / Valoración de la coordinación y el equilibrio en niños prematuros.

INTRODUCTION: Recent studies show that many preterm children without apparent neurological sequelae present some difficulties in different areas, such as coordination or balance during their school years. The Movement Assessment Battery for Children-2 (MABC-2) has demonstrated to be a useful tool to validate the coordination, while the stabilometric platform was the reference standard test for validating the balance. PATIENTS AND METHOD: Case-control study carried out on preterm children from 7 to 10 years old and healthy term infant controls of the same ages. The same age band of MABC-2 was applied and the static balance by the stabilometric platform was analysed. RESULTS: A total of 89 subjects were included, 30 preterm children≤1,500g birthweight, 29 preterm children>1,500g birthweight, and 30 controls. Preterm children obtained the lowest scores on an overall basis in hand dexterity and balance tests in MABC-2, regardless of their birthweight. Lower gestational age was associated with poorer outcomes in hand dexterity and total scores in MABC-2. Balance results were similar using the stabilometric platform, regardless of prematurity. CONCLUSIONS: A little more than 10% preterm and term children could have coordination disorders or be at risk of developing them using the MABC-2. Despite the visual-motor coordination being similar, preterm children could face greater difficulties in hand dexterity while, in the absence of neurological comorbidity, preterm and term children balance could be comparable.

Encuesta perinatal de la Sociedad Gallega de Obstetricia y Ginecología 2010-2011 / Perinatal survey of the Galician Society of Obstetrics and Gynecology 2010-2011

Objetivo. Obtener y evaluar los datos de la asistencia perinatal en Galicia. Material y métodos. Estudio descriptivo, retrospectivo y multicéntrico. Se solicitó la colaboración de todos los centros sanitarios gallegos con asistencia al parto para la realización de la base de datos perinatales de los años 2010 y 2011. Resultados. Realizamos el estudio estadístico epidemiológico de 29.254 nacimientos acontecidos en nuestra comunidad en el bienio 2010-2011, lo cual representa el 67,2% del total de nacimientos de Galicia en ese periodo. Analizamos las siguientes variables: edad materna, estática fetal, amenorrea en el momento del parto, tipo de parto, indicaciones de cesáreas, y mortalidad perinatal y materna (AU)

Objective. To obtain and evaluate information on perinatal care in Galicia (Spain). Material and methods. We performed a descriptive, retrospective, multicenter study. All centers in Galicia involved in deliveries were requested to collaborate in the perinatal database for 2010 and 2011. Results. We performed a statistical, epidemiological study of 29,254 births in our region in the 2-year period from 2010 to 2011, representing 67.2% of all births in Galicia in this period. The following variables were analyzed: maternal age, fetal statics, amenorrhea at delivery, type of delivery, indications for cesarean section, and perinatal and maternal mortality (AU)

Renal effects of levosimendan: a consensus report.

Renal dysfunction is common in clinical settings in which cardiac function is compromised such as heart failure, cardiac surgery or sepsis, and is associated with high morbidity and mortality. Levosimendan is a calcium sensitizer and potassium channel opener used in the treatment of acute heart failure. This review describes the effects of the inodilator levosimendan on renal function. A panel of 25 scientists and clinicians from 15 European countries (Austria, Finland, France, Hungary, Germany, Greece, Italy, Portugal, the Netherlands, Slovenia, Spain, Sweden, Turkey, the United Kingdom, and Ukraine) convened and reached a consensus on the current interpretation of the renal effects of levosimendan described both in non-clinical research and in clinical study reports. Most reports on the effect of levosimendan indicate an improvement of renal function in heart failure, sepsis and cardiac surgery settings. However, caution should be applied as study designs differed from randomized, controlled studies to uncontrolled ones. Importantly, in the largest HF study (REVIVE I and II) no significant changes in the renal function were detected. As it regards the mechanism of action, the opening of mitochondrial KATP channels by levosimendan is involved through a preconditioning effect. There is a strong rationale for randomized controlled trials seeking beneficial renal effects of levosimendan. As an example, a study is shortly to commence to assess the role of levosimendan for the prevention of acute organ dysfunction in sepsis (LeoPARDS).

Second-order nonlinear response of composites containing aligned elongated silver nanoparticles.

We present second-harmonic generation (SHG) measurements and simulations from a silica matrix containing randomly distributed but aligned elongated silver nanoparticles (NPs). The composites were produced by a double ion-implantation process of silver nanoparticles followed by an irradiation with Si ions. It is demonstrated that one can model the experimental results by considering the sub-micrometric composite layer as a nonlinear media containing rod NPs for which the hyperpolarizability tensor is cylindrically symmetric along the NP long axis. The second-order macroscopic susceptibility of the composite originates from the coherent summation of the hyperpolarizabilities associated to each NP. We obtain analytical expressions for the p- and s-polarized effective susceptibility tensor as a function of experimental variables, such as the fundamental beam input polarization and sample orientation, and fitting parameters relating the cylindrically shaped hyperpolarizability. In addition, coherent SHG measurements on spherical nanoparticles resulting from the first ion-implantation process are also presented showing an isotropic polar behavior for the total SHG intensity where the p-polarized SHG intensity resulted to be the main contribution.

Treatment of acute heart failure using levosimendan for a patient with dilated cardiomyopathy, chronic renal failure, and hypertension.

The clinical and hemodynamic effects of compassionate therapy with levosimendan were evaluated in a 14-year-old patient with end-stage renal disease and arterial hypertension secondary to glycogenosis type Ia. The patient previously had normal heart function but experienced acute development of severe myocardial dysfunction resistant to diuretic therapy and inotropic support. Levosimendan administration was followed by a marked clinical and echocardiographic improvement. The authors believe that levosimendan may be useful for cases of resistant acute heart failure with arterial hypertension. Although administration of levosimendan is not recommended for patients with chronic renal disease, no adverse effect was observed. Therapeutic action for these patients seems to last longer than for patients with a normal kidney.

Ablation and optical third-order nonlinearities in Ag nanoparticles.

The optical damage associated with high intensity laser excitation of silver nanoparticles (NPs) was studied. In order to investigate the mechanisms of optical nonlinearity of a nanocomposite and their relation with its ablation threshold, a high-purity silica sample implanted with Ag ions was exposed to different nanosecond and picosecond laser irradiations. The magnitude and sign of picosecond refractive and absorptive nonlinearities were measured near and far from the surface plasmon resonance (SPR) of the Ag NPs with a self-diffraction technique. Saturable optical absorption and electronic polarization related to self-focusing were identified. Linear absorption is the main process involved in nanosecond laser ablation, but non-linearities are important for ultrashort picosecond pulses when the absorptive process become significantly dependent on the irradiance. We estimated that near the resonance, picosecond intraband transitions allow an expanded distribution of energy among the NPs, in comparison to the energy distribution resulting in a case of far from resonance, when the most important absorption takes place in silica. We measured important differences in the ablation threshold and we estimated that the high selectiveness of the SPR of Ag NPs as well as their corresponding optical nonlinearities can be strongly significant for laser-induced controlled explosions, with potential applications for biomedical photothermal processes.

Anisotropic linear and nonlinear optical properties from anisotropy-controlled metallic nanocomposites.

High-energy metallic ions were implanted in silica matrices, obtaining spherical-like metallic nanoparticles (NPs) after a proper thermal treatment. These NPs were then deformed by irradiation with Si ions, obtaining an anisotropic metallic nanocomposite. An average large birefringence of 0.06 was measured for these materials in the 300-800 nm region. Besides, their third order nonlinear optical response was measured using self-diffraction and P-scan techniques at 532 nm with 26 ps pulses. By adjusting the incident light's polarization and the angular position of the nanocomposite, the measurements could be directly related to, at least, two of the three linear independent components of its third order susceptibility tensor, finding a large, but anisotropic, response of around 10(-7) esu with respect to other isotropic metallic systems. For the nonlinear optical absorption, we were able to shift from saturable to reverse saturable absorption depending on probing the Au NP's major or minor axes, respectively. This fact could be related to local field calculations and NP's electronic properties. For the nonlinear optical refraction, we passed from self-focusing to self-defocusing, when changing from Ag to Au.

Determination of the size distribution of metallic nanoparticles by optical extinction spectroscopy.

A method is proposed to estimate the size distribution of nearly spherical metallic nanoparticles (NPs) from optical extinction spectroscopy (OES) measurements based on Mie's theory and an optimization algorithm. The described method is compared against two of the most widely used techniques for the task: transmission electron microscopy (TEM) and small-angle x-ray scattering (SAXS). The size distribution of Au and Cu NPs, obtained by ion implantation in silica and a subsequent thermal annealing in air, was determined by TEM, grazing-incidence SAXS (GISAXS) geometry, and our method, and the average radius obtained by all the three techniques was almost the same for the two studied metals. Concerning the radius dispersion (RD), OES and GISAXS give very similar results, while TEM considerably underestimates the RD of the distribution.

Large optical birefringence by anisotropic silver nanocomposites.

A large optical birefringence of oriented Ag nanoellipsoids embedded in silica was measured using an ellipsometric technique. The two main surface plasmon resonances associated with the axes of the ellipsoid were tuned, allowing us to quantify the light transmission through the samples when placed and rotated between crossed and parallel polarizers. This birefringence can be physically associated with the selective optical absorption of one component of the linear polarization of the incident light with respect to the anisotropic axis of the sample, depending on the wavelength used to perform the measurement.

Propuesta metodológica de evaluación de la ejecución del proceso docente educativo en el policlínico universitario / Evaluative methodological proposal in the performance of the teaching learning

Fundamento: El policlínico universitario se debe convertir en un centro de excelencia en la atención a la población y modelo para la formación básica y postgraduada de los profesionales de la salud. Objetivo: Proponer una metodología para evaluar la calidad de la ejecución del proceso docente educativo en el nuevo modelo de formación del médico general integral básico. Métodos: Se realizó el diagnóstico de las variables y los indicadores de calidad a tener en cuenta, así como los instrumentos que se proponen utilizar para la evaluación de la ejecución del proceso docente educativo en el nuevo modelo pedagógico. La metodología de evaluación diseñada se centra en el conocimiento de cómo se desarrolla la planificación, ejecución del proceso, aspectos organizacionales y funcionales, el clima organizacional, y la satisfacción de los estudiantes, docentes y directivos en los nuevos escenarios de formación. Resultados: La propuesta metodológica elaborada es integradora y tiene enfoque sistémico, basada en un paradigma de evaluación mixta con un modelo holístico, dirigido hacia la dimensión de eficacia; las variables a evaluar se consideran en los niveles de análisis institucional, de grupo e individual. Conclusiones: La estrategia proporcionará una información acerca de la calidad y los factores que pueden estar influyendo en la eficacia del proceso docente educativo, mediante el análisis y la operacionalización de los indicadores propuestos(AU)

Background: The university policlinic should become into a center of remarkable health assistance to the population and a model for the basic and post graduated formation of the health professionals. Objective: To propose a methodology to assess the quality in the implementation of the teaching learning process of the new model in the formation of the general comprehensive doctor. Method: The diagnosis of the variables as well as the quality indicators to be taken into account was carried out. The instruments to be used for the evaluation of the implementation in the teaching learning process of this new pedagogical model were proposed. The methodology of the designed evaluation is focused on the knowledge of how planning, execution of the process, functional and organizable aspects, organizable environment, as well as satisfaction of professors, students, leaders are developed in these new places of formation. Results: The elaborated methodological proposal is integrated and has a systemic approach based on a paradigm of mixed evaluation with a holistic model directed to the dimension of efficacy. The variables to assess are considered within the levels of institutional, group, and individual analysis. Conclusions: The strategy will provide information about the quality and the factors that can be influencing the efficacy of the teaching learning process throughout the analysis and operation of the proposed indicators(AU)

Oftalmopleía cambiante en el curso del carcinoma de las paratiroides / Changing ophtaloplegia in the course of parathyroid carcinoma

Se presenta el caso de una mujer de 62 años de edad, cuya enfermedad se manifestó inicialmente con una oftalmoparesia con toma de los nervios motor ocular común y externo. Se confirma mediante examen clínico, los complementarios y los estudios hísticos que la enferma padecía de un carcinoma de paratiroides con un hiperparatiroiodismo primario. Se indica la baja incidência de esta neoplasia en los pacientes con disfunción de paratiroides y la rareza de que su expresión inicial sea con manifestaciones neurológicas. Se señalan los mecanismos posibles en la génisis de estas alteraciones neurológicas y se recomienda tener presente esta posibilidad en los pacientes con neuropatías de pares craneales, sobre todo si ocurren con una expresión clínica cambiante (AU)

Oftalmopleía cambiante en el curso del carcinoma de las paratiroides / Changing ophtalmoplegia in the course of parathyroid carcinoma

Se presenta el caso de una mujer de 62 años de edad, cuya enfermedad se manifestó inicialmente con una oftalmoparesia con toma de los nervios motor ocular común y externo. Se confirma mediante examen clínico, los complementarios y los estudios hísticos que la enferma padecía de un carcinoma de paratiroides con un hiperparatiroiodismo primario. Se indica la baja incidência de esta neoplasia en los pacientes con disfunción de paratiroides y la rareza de que su expresión inicial sea con manifestaciones neurológicas. Se señalan los mecanismos posibles en la génisis de estas alteraciones neurológicas y se recomienda tener presente esta posibilidad en los pacientes con neuropatías de pares craneales, sobre todo si ocurren con una expresión clínica cambiante