Background: Posterior reversible encephalopathy syndrome (PRES) is an uncommon clinical-neuroradiological syndrome with an unclear pathophysiology. Correlation between PRES and the use of immunosuppressant drugs have ...Background: Posterior reversible encephalopathy syndrome (PRES) is an uncommon clinical-neuroradiological syndrome with an unclear pathophysiology. Correlation between PRES and the use of immunosuppressant drugs have previously been described, as well as correlation between elevated blood pressure and PRES. Characteristic brain MRI manifestations include hyperintense lesions on T2 and FLAIR (fluid-attenuated inversion recovery) images. PRES is usually reversible within a short period of time after discontinuation of the presumably offending drug. Some cases of PRES might complicate with intracranial hemorrhage, refractory status epilepticus or expansive vasogenic brain edema (also regarded as “tumefactive” PRES). Methods: We present a case of a young man diagnosed with Hodgkin’s lymphoma, following a laparotomy due to cecal volvulus. The patient received glucocorticoids and elevated blood pressure values were recorded. Brain imaging studies were performed due to generalized epileptic seizures, demonstrating neuroradiological findings consistent with PRES. Neurological and neuroradiological deterioration was noted, necessitating urgent neurosurgical intervention. A complete neurological and functional rehabilitation was achieved. Conclusion: The uncommon cases of complicated PRES should be taken under consideration whenever clinical deterioration is noted following the diagnosis of PRES. Early neuroradiological evaluation should be sought, together with aggressive medical and surgical treatment in cases of life threatening mass effect.展开更多
Introduction: Gender perspectives are gradually generating great interest in health matters. Hypertension is one illness where gender considerations are important. Advancements in knowledge of pathophysiology help in ...Introduction: Gender perspectives are gradually generating great interest in health matters. Hypertension is one illness where gender considerations are important. Advancements in knowledge of pathophysiology help in better understanding of diseases and improvements in treatment. Pre-menstrual syndrome has been reported to make hypertension less responsive to treatment. This work was therefore done to see if premenstrual syndrome contributed in some way to hypertension in women. Methodology: All female hypertensives consulting the author in a private specialized hypertension clinic were questioned using the University of Carlifornia at San Diego criteria with a view to determining if they suffered from pre-menstrual syndrome. The control status was also considered for each patient. Females who consulted over the same period and were not hypertensive served as controls. Result: Pre-menstrual syndrome was found to occur more in hypertensive women than normotensive controls;to a statistically significant extent (p < 0.05). Control tended to be poorer in hypertensives with pre-menstrual syndrome than those without. The difference however did not achieve statistical significance. Discussion: There is controversy surrounding the aetiology of pre-menstrual syndrome. However, each of the models albeit inconsistent is capable of initiating and sustaining hypertension. The result here shows that in women it is likely to be one of the many factors that could produce hypertension in those predisposed. Conclusion: Pre-menstrual syndrome should arouse suspicion of future hypertension, and should be sought in all female hypertensives. Its presence should evoke deliberate action to improve outcome or remove the need for pharmacotherapy, at least for some time.展开更多
Thrombocytopenia caused by Hemolysis, Elevated Liver enzymes and Low Platelet count (HELLP) syndrome in pre-eclampsia parturients can be associated with substantial maternal and neonatal morbidity. Data on the issue o...Thrombocytopenia caused by Hemolysis, Elevated Liver enzymes and Low Platelet count (HELLP) syndrome in pre-eclampsia parturients can be associated with substantial maternal and neonatal morbidity. Data on the issue of the safety of neuraxial anesthesia with thrombocytopenia in HELLP syndrome is limited. A lower limit of 100,000 per microliter for platelet count was suggested as “safe” for performing neuraxial anesthesia, however there is no supporting data. This lower limit is challenged lately. We present a case of uneventful spinal anesthesia for urgent Cesarean section in a patient with severe pre-eclamsia, HELLP syndrome and precipitous platelet drop from 230,000 to 42,000 per microliter.展开更多
Background: Rare pathological conditions are frequently a diagnostic challenge in intensive care. Posterior-reversible encephalopathy syndrome (PRES) is a clinical and imaging diagnosis recently individualized. It occ...Background: Rare pathological conditions are frequently a diagnostic challenge in intensive care. Posterior-reversible encephalopathy syndrome (PRES) is a clinical and imaging diagnosis recently individualized. It occurs in various conditions such as collagenosis or vasculitis of the central nervous system, electrolytic disorders and the use of cytotoxics or immunosuppressive treatment. It is responsible for non-specific neurological manifestations such as confusion, coma, convulsions or visual disturbances. The diagnosis is suggested by brain magnetic resonance imaging (MRI). The lesions correspond to vasogenic edema and are therefore generally reversible after etiologic treatment and control of blood pressure. Aim: This clinical case aims to show the diagnostic complexity of rare pathologies in the intensive care unit. Case presentation: We present a case of a 14-year-old child received in the pediatrics department for generalized tonic-clonic convulsions with tongue biting in a febrile context. Malaria was negative, with hyperleukocytosis, slightly elevated C-reactive protein, anemia and hypokliemia, lumbar puncture was performed and all cerebrospinal fluid examinations revealed nothing. The seizures were controlled by titrated cumulative doses of diazepam with a total of 12mg, antibiotic therapy with ceftriaxone, corticotherapy with dexamethasone 12mg and blood transfusion without any improvement in his condition. He was then transferred to intensive care where the clinical and paraclinical assessment highlighted a neurological deficit Glasgow coma scale of 12/15 and biological hyponatremia. Brain CT-scan was normal. Hydroelectrolytic equilibration was undertaken, antibiotics continued, anti-comital prophylaxis and general resuscitation measures were provided. He regained consciousness on the 3rd day. On the 4th day, he presented high blood pressure and on the 5th, a resumption of convulsions without any obvious biological disorder, cerebrospinal fluid control was once more non-pathological. An MRI was performed and revealed Posterior-reversible encephalopathy syndrome. Conclusion: Posterior-reversible encephalopathy syndrome is a rare disease. It is necessary to keep rare diseases in mind.展开更多
AIM: To make an electrophysiological demonstration of a possible jaw muscle afferents-oculomotor neural pathway that was proposed by our previous works on rats, which substantiates an early "release hypothesis&qu...AIM: To make an electrophysiological demonstration of a possible jaw muscle afferents-oculomotor neural pathway that was proposed by our previous works on rats, which substantiates an early "release hypothesis" on pathogenesis of human Marcus Gunn Syndrome(MGS). METHODS: Extracellular unit discharge recording was applied and both orthodromic and spontaneous unitary firing were recorded in the oculomotor nucleus(III), and the complex of pre-oculomotor interstitial nucleus of Cajal and Darkschewitsch nucleus(INC/DN), following electric stimulation of the ipsilateral masseter nerve(MN) in rats. RESULTS: Extracellular orthodromic unit discharges, with latencies of 3.7±1.3 and 4.7±2.9 ms, were recorded unilaterally in the III, and the INC/DN neurons, respectively. Spontaneous unit discharges were also recorded mostly in the INC/DN and less frequently in the III. Train stimulation could prompt either facilitation or inhibition on those spontaneous unit discharges. The inhibition pattern of train stimulation on the spontaneous discharging was rather different in the III and INC/DN. A slow inhibitory pattern in which spontaneous firing rate decreased further and further following repeated train stimulation was observed in the III. While, some high spontaneous firing rate units, responding promptly to the train stimuli with a short-term inhibition and recovered quickly when stimuli are off, were recorded in the INC/DN. However, orthodromic unit discharge was not recorded in the III and INC/DN in a considerable number of experiment animals. CONCLUSION: A residual neuronal circuit might exist in mammals for the primitive jaw-eyelid reflex observed in amphibians, which might not be well-developed in all experimental mammals in current study. Nonetheless, this pathway can be still considered as a neuroanatomic substrate for development of MGS in some cases among all MGS with different kind of etiology.展开更多
Background: This study aims to understand the relationship between menopausal status and the presence of Metabolic Syndrome in women from 40 to 65 years, as well as to describe the distribution of each component of Me...Background: This study aims to understand the relationship between menopausal status and the presence of Metabolic Syndrome in women from 40 to 65 years, as well as to describe the distribution of each component of Metabolic Syn- drome according to sample characteristics. Methods: A cross-sectional study was conducted with 551 women treated at a clinic in southern Brazil. MetS and its components were defined according to NCEP-ATP III and menopausal status as pre, peri, and post-menopause. Prevalences of menopausal status and of MetS and its components were calculated. Estimates of prevalence ratios crude and adjusted with confidence intervals of 95% were calculated by Poisson Regression with robust variance. Demographic, socioeconomic, behavioral, and reproductive characteristics were considered as potential confounding factors in multivariable models based on a conceptual framework of MetS determination. Results: The prevalence of Metabolic Syndrome in the sample was 56.1% (CI95%: 51.9 to 60.2), being more common among older women (56 to 65 years), with low education, menarche 11 years old, with three or more pregnancies and in the post-menopausal period. In multivariate analysis, there was an increase of prevalence ratios when comparing perimenopause and post-menopause with pre-menopause;however, the confidence intervals include the unit. Regarding the analysis of isolated components in the sample, the most prevalent altered components were: hypertension (84.8%;CI95%: 81.7 to 87.8), waist circumference (66.4%;CI95%: 62.5 to 70.4) and HDL cholesterol (51.7%;CI95%: 47.5 to 55.9). There was a linear increase on mean blood glucose through menopausal status. Conclusions: Our study indicates variation on the distribution of MetS and each component according to menopausal status and other women characteristics. Future studies on MetS should also have foresight to use this type of approach to improve understanding and targeting of actions and programs focusing on women in this period of life.展开更多
文摘Background: Posterior reversible encephalopathy syndrome (PRES) is an uncommon clinical-neuroradiological syndrome with an unclear pathophysiology. Correlation between PRES and the use of immunosuppressant drugs have previously been described, as well as correlation between elevated blood pressure and PRES. Characteristic brain MRI manifestations include hyperintense lesions on T2 and FLAIR (fluid-attenuated inversion recovery) images. PRES is usually reversible within a short period of time after discontinuation of the presumably offending drug. Some cases of PRES might complicate with intracranial hemorrhage, refractory status epilepticus or expansive vasogenic brain edema (also regarded as “tumefactive” PRES). Methods: We present a case of a young man diagnosed with Hodgkin’s lymphoma, following a laparotomy due to cecal volvulus. The patient received glucocorticoids and elevated blood pressure values were recorded. Brain imaging studies were performed due to generalized epileptic seizures, demonstrating neuroradiological findings consistent with PRES. Neurological and neuroradiological deterioration was noted, necessitating urgent neurosurgical intervention. A complete neurological and functional rehabilitation was achieved. Conclusion: The uncommon cases of complicated PRES should be taken under consideration whenever clinical deterioration is noted following the diagnosis of PRES. Early neuroradiological evaluation should be sought, together with aggressive medical and surgical treatment in cases of life threatening mass effect.
文摘Introduction: Gender perspectives are gradually generating great interest in health matters. Hypertension is one illness where gender considerations are important. Advancements in knowledge of pathophysiology help in better understanding of diseases and improvements in treatment. Pre-menstrual syndrome has been reported to make hypertension less responsive to treatment. This work was therefore done to see if premenstrual syndrome contributed in some way to hypertension in women. Methodology: All female hypertensives consulting the author in a private specialized hypertension clinic were questioned using the University of Carlifornia at San Diego criteria with a view to determining if they suffered from pre-menstrual syndrome. The control status was also considered for each patient. Females who consulted over the same period and were not hypertensive served as controls. Result: Pre-menstrual syndrome was found to occur more in hypertensive women than normotensive controls;to a statistically significant extent (p < 0.05). Control tended to be poorer in hypertensives with pre-menstrual syndrome than those without. The difference however did not achieve statistical significance. Discussion: There is controversy surrounding the aetiology of pre-menstrual syndrome. However, each of the models albeit inconsistent is capable of initiating and sustaining hypertension. The result here shows that in women it is likely to be one of the many factors that could produce hypertension in those predisposed. Conclusion: Pre-menstrual syndrome should arouse suspicion of future hypertension, and should be sought in all female hypertensives. Its presence should evoke deliberate action to improve outcome or remove the need for pharmacotherapy, at least for some time.
文摘Thrombocytopenia caused by Hemolysis, Elevated Liver enzymes and Low Platelet count (HELLP) syndrome in pre-eclampsia parturients can be associated with substantial maternal and neonatal morbidity. Data on the issue of the safety of neuraxial anesthesia with thrombocytopenia in HELLP syndrome is limited. A lower limit of 100,000 per microliter for platelet count was suggested as “safe” for performing neuraxial anesthesia, however there is no supporting data. This lower limit is challenged lately. We present a case of uneventful spinal anesthesia for urgent Cesarean section in a patient with severe pre-eclamsia, HELLP syndrome and precipitous platelet drop from 230,000 to 42,000 per microliter.
文摘Background: Rare pathological conditions are frequently a diagnostic challenge in intensive care. Posterior-reversible encephalopathy syndrome (PRES) is a clinical and imaging diagnosis recently individualized. It occurs in various conditions such as collagenosis or vasculitis of the central nervous system, electrolytic disorders and the use of cytotoxics or immunosuppressive treatment. It is responsible for non-specific neurological manifestations such as confusion, coma, convulsions or visual disturbances. The diagnosis is suggested by brain magnetic resonance imaging (MRI). The lesions correspond to vasogenic edema and are therefore generally reversible after etiologic treatment and control of blood pressure. Aim: This clinical case aims to show the diagnostic complexity of rare pathologies in the intensive care unit. Case presentation: We present a case of a 14-year-old child received in the pediatrics department for generalized tonic-clonic convulsions with tongue biting in a febrile context. Malaria was negative, with hyperleukocytosis, slightly elevated C-reactive protein, anemia and hypokliemia, lumbar puncture was performed and all cerebrospinal fluid examinations revealed nothing. The seizures were controlled by titrated cumulative doses of diazepam with a total of 12mg, antibiotic therapy with ceftriaxone, corticotherapy with dexamethasone 12mg and blood transfusion without any improvement in his condition. He was then transferred to intensive care where the clinical and paraclinical assessment highlighted a neurological deficit Glasgow coma scale of 12/15 and biological hyponatremia. Brain CT-scan was normal. Hydroelectrolytic equilibration was undertaken, antibiotics continued, anti-comital prophylaxis and general resuscitation measures were provided. He regained consciousness on the 3rd day. On the 4th day, he presented high blood pressure and on the 5th, a resumption of convulsions without any obvious biological disorder, cerebrospinal fluid control was once more non-pathological. An MRI was performed and revealed Posterior-reversible encephalopathy syndrome. Conclusion: Posterior-reversible encephalopathy syndrome is a rare disease. It is necessary to keep rare diseases in mind.
基金Supported by Natural Sciences Research Funding from Shaanxi Province(No.2009K01-74)
文摘AIM: To make an electrophysiological demonstration of a possible jaw muscle afferents-oculomotor neural pathway that was proposed by our previous works on rats, which substantiates an early "release hypothesis" on pathogenesis of human Marcus Gunn Syndrome(MGS). METHODS: Extracellular unit discharge recording was applied and both orthodromic and spontaneous unitary firing were recorded in the oculomotor nucleus(III), and the complex of pre-oculomotor interstitial nucleus of Cajal and Darkschewitsch nucleus(INC/DN), following electric stimulation of the ipsilateral masseter nerve(MN) in rats. RESULTS: Extracellular orthodromic unit discharges, with latencies of 3.7±1.3 and 4.7±2.9 ms, were recorded unilaterally in the III, and the INC/DN neurons, respectively. Spontaneous unit discharges were also recorded mostly in the INC/DN and less frequently in the III. Train stimulation could prompt either facilitation or inhibition on those spontaneous unit discharges. The inhibition pattern of train stimulation on the spontaneous discharging was rather different in the III and INC/DN. A slow inhibitory pattern in which spontaneous firing rate decreased further and further following repeated train stimulation was observed in the III. While, some high spontaneous firing rate units, responding promptly to the train stimuli with a short-term inhibition and recovered quickly when stimuli are off, were recorded in the INC/DN. However, orthodromic unit discharge was not recorded in the III and INC/DN in a considerable number of experiment animals. CONCLUSION: A residual neuronal circuit might exist in mammals for the primitive jaw-eyelid reflex observed in amphibians, which might not be well-developed in all experimental mammals in current study. Nonetheless, this pathway can be still considered as a neuroanatomic substrate for development of MGS in some cases among all MGS with different kind of etiology.
文摘Background: This study aims to understand the relationship between menopausal status and the presence of Metabolic Syndrome in women from 40 to 65 years, as well as to describe the distribution of each component of Metabolic Syn- drome according to sample characteristics. Methods: A cross-sectional study was conducted with 551 women treated at a clinic in southern Brazil. MetS and its components were defined according to NCEP-ATP III and menopausal status as pre, peri, and post-menopause. Prevalences of menopausal status and of MetS and its components were calculated. Estimates of prevalence ratios crude and adjusted with confidence intervals of 95% were calculated by Poisson Regression with robust variance. Demographic, socioeconomic, behavioral, and reproductive characteristics were considered as potential confounding factors in multivariable models based on a conceptual framework of MetS determination. Results: The prevalence of Metabolic Syndrome in the sample was 56.1% (CI95%: 51.9 to 60.2), being more common among older women (56 to 65 years), with low education, menarche 11 years old, with three or more pregnancies and in the post-menopausal period. In multivariate analysis, there was an increase of prevalence ratios when comparing perimenopause and post-menopause with pre-menopause;however, the confidence intervals include the unit. Regarding the analysis of isolated components in the sample, the most prevalent altered components were: hypertension (84.8%;CI95%: 81.7 to 87.8), waist circumference (66.4%;CI95%: 62.5 to 70.4) and HDL cholesterol (51.7%;CI95%: 47.5 to 55.9). There was a linear increase on mean blood glucose through menopausal status. Conclusions: Our study indicates variation on the distribution of MetS and each component according to menopausal status and other women characteristics. Future studies on MetS should also have foresight to use this type of approach to improve understanding and targeting of actions and programs focusing on women in this period of life.
