Acute cervical epidural hematoma: case report

A 74 year-old patient with a nocturnal onset of neck and chest pain was brought to an emergency clinic. Physical examination and cardiac assessment were normal. Three hours after the addmittance, a flaccid paralysis of the four limbs supervened. Suspecting of an unusual onset of central nervous system infection, a lumbar puncture was performed, yielding 20 ml of normal cerebrospinal fluid. Thirty oinutes after the puncture, the patient completely regained neurological funcion. He was then referred to a General Hospital where a computed tomography (CT) scan was done showing a large cervical epidural bleeding in the posterolateral region of C4/C5 extending to C7/Th1, along with a C6 vertebral body hemangioma. A magnetic resonance imaging revealed the same CT findings. A normal selective angiography of vertebral arteries, carotid arteries and thyreocervical trunk was carried out. Spontaneous spinal epidural hematoma (ASSEH) is a rare but dramatic cause of neurological impairment. In this article we report a fortunate case of complete recovery after an unusual spine cord decompression. We also review the current literature concerning diagnosis and treatment of ASSEH.

Pilocytic astrocytoma following radiotherapy for craniopharyngioma: case report

Administration of fractionated doses of irradiation is part of the adjutant therapy for CNS tumours such as craniopharyngiomas and pituitary adenomas. It can maximise cure rates or expand symptom-free period. Among the adverse effects of radiotherapy, the induction of a new tumour within the irradiated field has been frequently described. The precise clinical features that correlate irradiation and oncogenesis are not completely defined, but some authors have suggested that tumors are radiation induced when they are histologically different from the treated ones, arise in greater frequency in irradiated patients than among normal population and tend to occur in younger people with an unusual aggressiveness. In this article, we report a case of a papillary astrocytoma arising in a rather unusual latency period following radiotherapy for craniopharyngioma.

Screening instruments for alcohol problems: a comparison of cut points between Mexican American and Mexican patients in the emergency room

The performance of alcohol use disorder screening instruments (CAGE, BMAST, AUDIT, TWEAK) at various cut points were compared between a Mexican American emergency room (ER) sample (n = 586) and a sample of ER patients in Mexico (n = 1,417) using ICD-10 and DSM-IV criteria for alcohol dependence and harmful drinking/abuse by gender and injury status. Lowering cut points improved instrument performance substantially for females in both samples. Further research is needed to explore instrument performance by gender and level of acculturation.

Suicide attempts in a sample of patients from a general hospital

BACKGROUND

Suicide in Mexico has risen steadily in recent years, increasing by 156% in the last two decades. The study of suicide precursors, such as suicide attempts, has also become an important public health topic. The aim of this study is to establish the prevalence of suicide attempts in a general hospital setting and its association with alcohol, depression, and other factors.

METHODS

A cross-sectional survey of a sample of patients was carried out in all three service units (inpatient, outpatient, and the emergency room) of a general hospital in Mexico City. All patients were randomly selected to participate regardless of the reason for initial hospital admission. Each patient was administered a series of psychological and demographic scales including the Beck Depression Inventory, the Beck Hopelessness Inventory, the General Health Questionnaire, a suicide assessment scale, a scale for alcohol consumption, and several measurements of alcohol-related problems.

RESULTS

The final sample was made up of 1,094 patients of both genders (68% women), aged 18-65 years. A lifetime prevalence of suicide attempts of 6.1% (95% confidence interval [CI] of 4.7-7.7%) was found. Multiple logistic regression was used to obtain estimations of the association between lifetime suicide attempt and other factors. Marital status, age, depressed mood, hopelessness, Goldberg's 30-item version of the General Health Questionnaire, and high levels of alcohol consumption were all associated with the suicide attempt.

CONCLUSIONS

Prevalence of lifetime suicide attempts was mainly related to being young, divorced, or widowed, and to feeling depressed, hopeless, and under undesirable psychological distress.

Associations of substance use, abuse, and dependence with subsequent suicidal behavior

General population survey data are used to disaggregate the associations of substance use disorders with suicide attempts in order to evaluate a number of hypotheses about the processes leading to these associations. Data are from the US National Comorbidity Survey (1990-1992). Discrete-time survival analysis is used to study the effects of retrospectively reported temporally prior substance use, abuse, and dependence in predicting first onset of suicidal behavior. Alcohol and drug use predict subsequent suicide attempts after controlling for sociodemographics and comorbid mental disorders. Previous use is not a significant predictor among current nonusers. Abuse and dependence are significant predictors among users for three of the 10 substances considered (alcohol, inhalants, and heroin). The number of substances used is more important than the types of substances used in predicting suicidal behavior. Disaggregation shows that the effects of use are largely on suicidal ideation and nonplanned attempts among ideators. In comparison, the effects of use on suicide plans and planned attempts among ideators are not significant. Clinicians need to be aware that current substance use, even in the absence of abuse or dependence, is a significant risk factor for unplanned suicide attempts among ideators.

Thrombosis of the internal carotid artery secondary to soft palate injury in children and childhood. Report of two cases

Trauma to the soft palate is a uncommon event during childhood. Stroke following intraoral trauma is also rare, but has been well documented by the current literature as a potentially serious complication. In this article, we report 2 cases of posttraumatic internal carotid artery thrombosis depicted by imaging studies. We discuss pathogenesis, and the literature is reviewed.

Saphenous vein graft bypass in the treatment of giant cavernous sinus aneurysms: report of two cases

Two cases of giant intracavernous aneurysms treated by high flow bypass with saphenous vein graft between the external carotid artery (ECA) and branches of the middle cerebral artery (MCA) are presented. Very often these aneurysms are unclippable because they are fusiform or have a large neck. Occlusion of the internal carotid artery (ICA) is the treatment of choice in many cases. This procedure has however a high risk of brain infarction. Revascularization of the brain by extra-intracranial anastomosis between the superficial temporal artery (STA) and branches of the MCA is frequently performed. This procedure provides however a low flow bypass and brain infarction may occur. We report two cases of giant cavernous sinus aneurysms treated by high flow bypass and endovascular balloon occlusion of the ICA. Immediate high flow revascularization of MCA branches was achieved and the patients showed no ischemic events. Follow-up of 8 and 14 months after operation shows patency of the venous graft and no neurological deficits. Angiographic control examination showed complete aneurysm occlusion in both cases.

[Thrombosis of the internal artery secondary to soft palate injury: case report]

Stroke following intraoral trauma is a rare complication of a common childhood injury. In the literature these complications have been well documented, however this condition is still infrequent. In order to alert the physicians about this possible injury we report our experience with one case. Computer tomography and magnetic resonance imaging evidenced complete occlusion of the internal carotid artery. Pathogenesis of this oral trauma is discussed.

Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey

BACKGROUND

General population survey data are presented on the lifetime prevalence of suicide attempts as well as transition probabilities to onset of ideation, plans among ideators, and attempts among ideators either with or without a plan. Risk factors for these transitions are also studied.

METHODS

Data are from part II of the National Comorbidity Survey, a nationally representative survey carried out from 1990 to 1992 in a sample of 5877 respondents aged 15 to 54 years to study prevalences and correlates of DSM-III-R disorders. Transitions are estimated using life-table analysis. Risk factors are examined using survival analysis.

RESULTS

Of the respondents, 13.5% reported lifetime ideation, 3.9% a plan, and 4.6% an attempt. Cumulative probabilities were 34% for the transition from ideation to a plan, 72% from a plan to an attempt, and 26% from ideation to an unplanned attempt. About 90% of unplanned and 60% of planned first attempts occurred within 1 year of the onset of ideation. All significant risk factors (female, previously married, age less than 25 years, in a recent cohort, poorly educated, and having 1 or more of the DSM-III-R disorders assessed in the survey) were more strongly related to ideation than to progression from ideation to a plan or an attempt.

CONCLUSIONS

Prevention efforts should focus on planned attempts because of the rapid onset and unpredictability of unplanned attempts. More research is needed on the determinants of unplanned attempts.

Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey

BACKGROUND

General population survey data are presented on the lifetime prevalence of suicide attempts as well as transition probabilities to onset of ideation, plans among ideators, and attempts among ideators either with or without a plan. Risk factors for these transitions are also studied.

METHODS

Data are from part II of the National Comorbidity Survey, a nationally representative survey carried out from 1990 to 1992 in a sample of 5877 respondents aged 15 to 54 years to study prevalences and correlates of DSM-III-R disorders. Transitions are estimated using life-table analysis. Risk factors are examined using survival analysis.

RESULTS

Of the respondents, 13.5% reported lifetime ideation, 3.9% a plan, and 4.6% an attempt. Cumulative probabilities were 34% for the transition from ideation to a plan, 72% from a plan to an attempt, and 26% from ideation to an unplanned attempt. About 90% of unplanned and 60% of planned first attempts occurred within 1 year of the onset of ideation. All significant risk factors (female, previously married, age less than 25 years, in a recent cohort, poorly educated, and having 1 or more of the DSM-III-R disorders assessed in the survey) were more strongly related to ideation than to progression from ideation to a plan or an attempt.

CONCLUSIONS

Prevention efforts should focus on planned attempts because of the rapid onset and unpredictability of unplanned attempts. More research is needed on the determinants of unplanned attempts.

Arachnoid cyst: adversity and plasticity

We report four cases of surgically treated intracranial arachnoid cysts, one with cyst-peritoneal shunt and three with craniotomy and arachnoid membrane resection. Their classification and etiopathogeny are discussed, and especially the different methods of treatment comparing the drastic complications (adversities) with the favorable solutions in severe clinical cases (plasticity) treated at our institution.

Pilonidal cyst on the vault. Case report

Pilonidal cysts and sinuses are described as dermoid cysts which contain follicles of hairs and sebaceous glands. They clinically present as a classic case of inflammation which comes with pain, local infection and redness. The origin of pilonidal disease remains controverse. There are many hypothesis as lack of hygiene on the affected area and a penetration and growth of a hair in the subcutaneous tissue caused by constant friction or direct trauma on the damaged area. The option for clinical treatment is very frequent. However, taking into consideration the incidence and the possibility of recidive, surgical treatment is presently recommended. Complications include cellulitis and abscess formation. Pilonidal cysts are mostly found on the sacral region. In the literature is found description of pilonidal cysts on the penis, interdigital region on the hands as well as on the cervical region. We present a case of pilonidal cyst located on the vault biparietal region, without malignant degeneration.

[Alcoholic beverage consumption in the patients of the emergency services of the city of Pachuca, Hidalgo]

OBJECTIVE

Prevalence of alcohol consumption and abuse among patients with medical emergencies, accidents and violence, attending an emergency room in one of three public health hospitals in Pachuca, Hidalgo, was studied.

MATERIAL AND METHODS

Patients answered a questionnaire and their blood alcohol was measured on their first visit to the emergency room. The questionnaire gathered socio-demographic data, patterns of alcohol consumption and included scales for heavy and dependent drinkers, such as the CAGE and the alcohol use disorders identification test (AUDIT). Injured and non-injured patients were compared with the chi 2 statistics.

RESULTS

A total of 1,511 patients were evaluated. Alcohol consumption was higher in those attending for accidents or violence than in medical patients. Positive blood alcohol levels were found in 17.7% of injured patients and 15.8% reported alcohol consumption 6 hours prior to the accident. According to the CAGE, 9.2% of the patients were alcohol-dependent, and 10.9% were heavy drinkers according to the AUDIT.

CONCLUSIONS

Alcohol consumption, especially among emergency room patients attending for accidents or injuries is high. Preventive measures are indispensable to diminish social and individual costs of alcohol abuse in this population.

Alcohol consumption in emergency room patients and the general population: a population-based study

Our purpose was to obtain epidemiological measures of the association between habitual alcohol consumption, alcohol consumption before the event and alcohol abuse/dependence, and emergency room (ER) attendance compared to the general population in Pachuca-Hidalgo, a city located in the central area of Mexico. The study was a population based case-control design. Data consisted of breath samples to estimated blood alcohol concentration, as well as an interviewer-administered questionnaire, collected on a 24-hr basis, during the entire week, in each of the three main ERs of Pachuca. Cases were all patients who visited the three main hospitals ERs during the study period, classified according to their status as an injured or noninjured (medically ill) patient (n = 1511). The general population sample (n = 920) serves as a comparison group for both types of patients. Injured patients in the ER sample were significantly more likely to report high frequency/high quantity of drinking during the last 12 months than the general population [odds ratio and 95% confidence intervals = 5.55 (1.72-17.97)] and to report drinking within 6 hr before the injury. These relationships did not hold for noninjured patients. Both types of patients were more likely to report high frequency of drunkenness during the preceding 12 months, to be positive for alcohol dependence and to report drug use. We found in the city of Pachuca, a large relationship between habitual alcohol consumption and ER injuries. These findings support associations of alcohol consumption and admission to an emergency room found in ER and general population studies in other countries. Due to the increases in the risk found for abuse/dependent in both injured and noninjured patients, they both would benefit with a brief intervention strategy for reducing their alcohol consumption.

Comorbidity of substance use disorders with mood and anxiety disorders: results of the International Consortium in Psychiatric Epidemiology

This article reports the results of a cross-national investigation of patterns of comorbidity between substance use and psychiatric disorders in six studies participating in the International Consortium in Psychiatric Epidemiology. In general, there was a strong association between mood and anxiety disorders as well as conduct and antisocial personality disorder with substance disorders at all sites. The results also suggest that there is a continuum in the magnitude of comorbidity as a function of the spectrum of substance use category (use, problems, dependence), as well as a direct relationship between the number of comorbid disorders and increasing levels of severity of substance use disorders (which was particularly pronounced for drugs). Finally, whereas there was no specific temporal pattern of onset for mood disorders in relation to substance disorders, the onset of anxiety disorders was more likely to precede that of substance disorders in all countries. These results illustrate the contribution of cross-national data to understanding the patterns and risk factors for psychopathology and substance use disorders.

Male drinking and violence-related injury in the emergency room

AIMS

To present epidemiological measures of associations between violence-related injuries (assaults and fights), alcohol consumption prior to the event, and drinking patterns among males attending hospital emergency rooms (ERs) in Mexico City.

DESIGN

All patients were interviewed and breath tested for alcohol consumption. The data were analyzed using a case-control design.

SETTING

Eight ERs in Mexico City that were representative of the types of emergency care systems available in that city (from public, private and social security systems hospitals).

PARTICIPANTS

Cases were males patients (n = 445) admitted to the ER because of a fight or an assault. The control group was comprised of patients (n = 320) admitted to the ER because of accidents that are less frequently reported a alcohol-related (i.e. work-place accidents, animal bites or recreational accidents excluding near drowning).

MEASUREMENTS

A breath sample to estimate BAG, as well as an interviewer-administered questionnaire were used.

FINDINGS

Alcohol consumption prior to injury was found to be a more important risk factor than usual drinking for injuries resulting from violence, while quantity of usual alcohol consumption was more predictive of violence-related injuries than frequency of drinking.

CONCLUSIONS

These data suggest the importance of using more appropriate control groups when estimating associations of alcohol and violence-related injuries so that associations will not be underestimated. More research is needed to establish unbiased estimates of alcohol-related violence.

Fears and other suspected risk factors for carrying lethal weapons among urban youths of middle-school age

OBJECTIVE

To estimate the strength of a suspected causal association between fearfulness and carrying a lethal weapon among urban middle-school students, while holding constant other suspected risk factors.

DESIGN

A prospective study of an epidemiological sample assessed at baseline in 1992 and 1 year later, with relative risk estimates derived from the conditional form of the multiple logistic regression model used to hold constant alternative explanatory variables.

SETTING

An urban environment in the mid-Atlantic region of the United States.

PARTICIPANTS

An epidemiological sample of 1131 youths enrolled in public middle schools.

MAIN OUTCOME MEASURES

Carrying a lethal weapon for protection or defense during a 1-year observation interval after the baseline assessment of fears and other suspected risk factors.

RESULTS

Of the 1131 youths, 194 (17%) reported carrying a lethal weapon for protection or defense during the 1-year interval of follow-up observation after baseline; 937 youths (83%) reported that they had not carried a lethal weapon for any reason. Self-reported fears, deviant peer affiliation, and worrying were associated with risk of starting to carry a weapon. For youths with the lowest worrying scores, the lowest neighborhood danger scores, and the least affiliation with deviant peers, self-reported fears were associated with risk of starting to carry a lethal weapon (relative risk estimate, 1.68; 95% confidence interval, 1.11-2.52; P = .01), even after holding constant age, sex, and conduct problems. However, the fear of crowded or closed-in places and the fear of leaving home alone were more salient risk factors than the fear of using public transportation or the fear of open spaces.

CONCLUSIONS

In this study, youths with fears were at greater risk of carrying a lethal weapon for protection or defense, even when alternative explanatory variables were taken into account. Pending confirmation by other investigators, this new finding could point out a useful target for public health interventions to reduce the carrying of weapons and associated violence in urban America.

Cerebral aneurysms. Assessment of 50 cases operated on and comparison with previous series

A retrospective analysis of 50 patients who suffered subarachnoid hemorrhage (SAH) treated at UNICAMP between April 1988 and March 1992 is made, distributed as 34% in Hunt & Hess grade I, 38% in grade II, 16% in grade III, and 12% in grade IV. Males were predominant (66.6%), and patients age varied around 47 +/- 12.13 years old. Only 13 patients (26%) were admitted within the first 24 hours after bleeding, with an overall average of 20.45 days of delay. From all cases only one had a rebleeding, survived and was submitted to surgery. Four patients died after surgery (8%). Timing of operation and prognostic chances were available, being 27.30 days after SAH for Hunt & Hess group I. It is analyzed also the timing for diagnosis-which responded for the most delay, and treatment for the other groups, and a historical comparison with previous series since year 1956 of the same Hospital were documented. Good results were observed in 38 cases (76%). The overall results in terms of mortality and morbidity is, in comparison, in accordance with the literature, and is ameliorated from the past series due to technical improvement, despite worsen difficulties in managing admittance, diagnosis and treatment faster, which is required to deal with the disease.

Suicide attempts and alcohol consumption in an emergency room sample

OBJECTIVE

The aim of this study was to obtain an epidemiologic measure of association between suicide attempts and alcohol consumption in eight emergency room (ER) hospitals.

METHOD

All patients were interviewed and breath tested for alcohol consumption. The data were analyzed using the case-control methodology. Cases were patients (N = 40; 21 male) admitted to ER because of a suicide attempt. The control group comprised patients (N = 372) admitted to ER because of accidents that are less frequently reported as alcohol related (i.e., workplace accidents, animal bites, and recreational accidents, except drowning).

RESULTS

The proportion of suicide attempts under the effects of alcohol was significantly higher than that of the control group. The bivariate odds ratios (and 95% confidence intervals) for self-report of alcohol consumption in the 6 hours prior to the suicide attempt were: abstainers (baseline); 0.001-100 g of alcohol = 2.01 (0.44, 7.85); > 100 g = 31.11 (10.13, 98.61). For habitual alcohol consumption; abstainers (baseline); 0.001-100 g of alcohol = 0.67 (0.25, 1.77); > 100 g = 1.10 (0.44, 2.75). For Alco-Sensor: < or = 9 mg of alcohol/100 ml of blood (baseline); 10.99 mg/100 ml = 8.21 (2.81, 23.73); > or = 100 mg/100 ml = 2.97 (0.42, 15.95). Multiple logistic models did not change these findings.

CONCLUSIONS

Alcohol consumption prior to the suicide attempt is a more important risk factor than the habitual alcohol consumption pattern. New research should emphasize life events and psychiatric variables and find explanations for differences between the self-reported and the Alco-Sensor estimates.

[Epidemiology of suicide in Mexico, 1970-1984]

OBJECTIVE

This paper reports data of suicide as a cause of death in Mexico from 1970 to 1994.

MATERIAL AND METHODS

Death certificates and census data were used as the main sources for this study.

RESULTS

In 1970 554 suicide deaths were reported for both genders. In 1994 there were 2 603 deaths. During this period the suicide death rate increased from 1.13 per 100 000 inhabitants to 2.89 per 100 000 inhabitants, which represents an increase of 156% in 24 years. Nevertheless, a higher increase was seen among males; 169% for this period as compared to 98% among females. In 1970 the proportional suicide mortality rate was 0.11% of total deaths; in 1994, an increase to 0.62% was observed. During the study period, the highest increase in the suicide rate was seen in the older groups (65 years and over). Nevertheless, an increase was also seen among the younger population (those aged under 19 years). In 1994, the last year of the series, the highest rates were found among males, especially among those aged 65 and over. Differences were found also in the suicide rates among the states of the Mexican Republic. In 1994 the State of Tlaxcala and the State of Mexico reported the lowest rates. The highest rates were found in Tabasco and Campeche. Thus, the highest suicide rates were seen in the southeast and the lowest rates in the central part of the country.

CONCLUSIONS

Suicide is a growing problem in Mexico, mainly occurring among male older adults. Nevertheless, growing rates among young adults call for suicide prevention and care programs.

[Brainstem hemorrhage after surgical removal of arachnoid cyst of the Sylvian fissure: a case report]

The authors report a case of a hemorrhage of the brainstem after craniotomy for resection of a huge arachnoid cyst of the sylvian fissure on the left hemisphere. The previous simptomatology included clinical signs of increased intracranial pressure, and the computerized tomography showed midline shift. Some factors may contribute to brain hemorrhage post-operatively: cerebral edema, ipsilateral changes in the venous reflux and blood perfusion, although the physiopathology remains obscure. A more careful approach is suggested in such cases with intracranial hypertension.

The growth of conduct problem behaviors from middle childhood to early adolescence: sex differences and the suspected influence of early alcohol use

OBJECTIVE

This study investigates the levels and rates of growth of conduct problem behaviors over time in an urban sample of American youth. Our hypotheses focused on differences between the sexes and between youths with and those without early use of alcohol without parental permission.

METHOD

Data for this study are from an ongoing epidemiologic study of urban public school students, recruited originally at the time of their entry into Grades 1-2 between 1985 and 1987. Each spring, from 1991 to 1993, a total of 1,212 students were interviewed privately for this study. A total of 408 (54.2% female, 84.7% black) respondents met study criteria as either an "early unsanctioned alcohol user" or an "abstainer." These youths constitute the analytic subsample.

RESULTS

Estimates from longitudinal growth modeling analyses showed that boys and girls had different initial levels of conduct problem behaviors, but similar rates of growth. Both the initial level of conduct problem behaviors and the rates of growth were greater for early unsanctioned alcohol users as compared to abstainers. In a combined analysis the difference between early unsanctioned alcohol users and abstainers seemed to offset the initially observed sex difference.

CONCLUSION

Early alcohol use without parental permission was associated with higher levels of conduct problem behaviors by the ages of 10-12 years and higher rates of growth in those behaviors during the transition from late childhood to early adolescence for both boys and girls, although the levels differed by sex. It may be that unsanctioned early alcohol use puts youths on an accelerated pathway of conduct problem behaviors and development of conduct disorder in adolescence.

Casualties in Acapulco: results of a study on alcohol use and emergency room care

This article reports the results of an emergency room study carried out in 1987 in three hospitals in Acapulco, Mexico. All patients were interviewed and breath tested for alcohol consumption. The data were analyzed using the case-control methodology. Cases were falls, motor vehicle accidents, fights and assaults, and home accidents. The control group included patients for whom accidents are less frequently reported as alcohol related, i.e., those reporting work place accidents, animal bites and recreational accidents. For positive breathalyzer readings (> or = 10 mg/100 ml of blood alcohol), the odds ration and 95% confidence intervals were statistically significant for falls, 3.45 (1.23-9.66); motor vehicle accidents, 3.85 (1.21-12.01); and fights and assaults, 5.23 (2.36-12.95). The association was non-significant for home accidents, 0.78 (0.20-2.98). Possible biases of this approach are discussed and recommendations are made for selecting better controls for future emergency room studies.

Alcohol consumption, low birth weight, and preterm delivery in the National Addiction Survey (Mexico)

In 1988 the Mexican General Directorate of Epidemiology and the Mexican Institute of Psychiatry carried out the first National Addiction Survey that provided prevalence estimates at national and regional levels of alcohol consumption, tobacco smoking, and several other drugs use. In addition, a questionnaire included questions regarding alcohol consumption during pregnancy and adverse outcomes. According to the results of logistic regression, women classified as suffering from Alcohol Dependence Syndrome had a very high risk of low birth weight and/or preterm delivery: Odds ratio = 12.1 with a 95% confidence interval of (1.3, 108.9) and p = .026. After controlling for several confounding variables, the findings remained basically the same.