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Weder-Cisneros ND, Téllez-Zenteno JF, Cardiel MH, Guibert-Toledano M, Cabiedes J, Velásquez-Paz AL, García-Ramos G, Cantú C. Prevalence and Factors Associated with Headache in Patients with Systemic Lupus Erythematosus. Cephalalgia 2016; 24:1031-44. [PMID: 15566417 DOI: 10.1111/j.1468-2982.2004.00822.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Headache is common in systemic lupus erythematosus with reported prevalence as high as 70%. The aims of this study were: to estimate the prevalence and types of headache in a sample of patients with systemic lupus erythematosus comparing it with rheumatoid arthritis, to determine clinical and serological associations. Eighty-one systemic lupus erythematosus and 29 rheumatoid arthritis consecutive patients seen in our outpatient clinic were interviewed. Headache was evaluated using the diagnostic criteria proposed by the International Headache Society. Additional evaluations were carried out in the 81 systemic lupus erythematosus patients including depression, disease activity, lupus damage, function disability, quality of life, and severity degree using a validated scales. We analysed the following autoantibodies: anti-double stranded DNA, anti-nucleosomes, anti-histones, anti-ribosomal P, anti-cardiolipin antibodies, anti-β2-glycoprotein-I (GPI), and antinuclear antibodies. Forty-one per cent of systemic lupus erythematosus and 17% of rheumatoid arthritis patients suffered from headache ( P = 0.02). No significant difference for any primary headache type between the two groups was found. Frequency of headache types in systemic lupus erythematosus patients was: migraine 24%, tensional-type headache 11%, and mixed headache 5%. In systemic lupus erythematosus patients the risk factors associated with headaches were Raynaud's phenomenon (OR 3.6; 95% CI 1.3-9.5; P = 0.009) and β2GPI antibody positivity (OR 4.5; 95% CI 1.2-16.2; p = 0.016). We conclude that headache is more common in systemic lupus erythematosus than in rheumatoid arthritis patients and was independently associated with Raynaud's phenomenon and β2GP-I antibodies.
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Affiliation(s)
- N D Weder-Cisneros
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Immunology and Rheumatology, INCMNSZ
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Sánchez-Román S, Téllez-Zenteno JF, Zermeño-Phols F, García-Ramos G, Velázquez A, Derry P, Hernández M, Resendiz A, Guevara-López UM. Personality in patients with migraine evaluated with the "Temperament and Character Inventory". J Headache Pain 2007; 8:94-104. [PMID: 17221342 PMCID: PMC3476128 DOI: 10.1007/s10194-007-0352-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2006] [Accepted: 10/26/2006] [Indexed: 11/01/2022] Open
Abstract
The objective of this study was to assess the personality profile of a sample of Mexican patients with migraine using the Temperament and Character Inventory (TCI). A cross-sectional study was performed including adult migraine patients identified from the outpatient neurology clinics of two large teaching hospitals in Mexico City. Patients were asked to voluntarily participate in the study. A physician conducted a standardised diagnostic interview adhering to the criteria of the International Headache Society (IHS). Patients were interviewed and administered the TCI. We used two healthy controls groups and a third group of non-migraine pain controls. One hundred and fortytwo subjects with migraine, 108 healthy blood donors, 269 young healthy controls and 30 patients with non-migraine pain (NMP) were included in the study. Patients with migraine had higher scores in the dimension harm avoidance (HA) and all its sub-dimensions (p<0.05) than healthy patients. Patients with non-migraine pain had high scores in HA and low scores in novelty seeking, self-directedness and cooperativeness. Blood donors had high scores in the following subdimensions: HA1, HA4 and C3 (Cooperativeness). Personality features consistent with migraine are avoidance, rigidity, reserve and obsessivity. Our study shows that patients with chronic pain share some of the personality features of patients with migraine but their TCI profile could be indicative of cluster C avoidant personality. Blood donors were shown to have more energy, with a tendency to help other people and be more optimistic. The results support serotoninergic involvement as explaining the physiopathology of migraine.
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Affiliation(s)
- S Sánchez-Román
- Department of Neurology and Psychiatry, National Institute of Medical Sciences and Nutrition "Salvador Zubirán", Vasco de Quiroga 15, Colonia Sección XVI, Delegación Tlalpan, México, DF. CP 14000, México.
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Abstract
To compare the response of thymectomy in patients with associated conditions (PWAC) and without associated conditions (PWOAC). Comparative, retrospective. 198 patients with the established diagnosis of myasthenia gravis who had a thymectomy between 1987 and 2000, and who were folowed up for at least 3 years. We formed two groups, one with associated conditions and the second without associated conditions. The patients were divided into four groups: (i) patients in remission, (ii) patients with improvement, (iii) patients without changes, and (iv) patients whose condition worsened. Associated conditions (AC) were found in 49 patients (26%). The main associated conditions were hyperthyroidism in 16 patients (33%) hypothyroidism in seven (14%), rheumatoid arthritis in five (10%) and hypothyroidism and Sjogren syndrome in three (6%). Concerning the response of thymectomy, 13 patients WAC showed remission (27%), vs. 54 patients WOAC (39%). Twenty patients WAC showed improvement (41%) vs. 46 WOAC (33%). Thirteen patients WAC had no changes (27%) vs. 37 WOAC (26%). Finally, in three patients WAC their condition worsened (6%) vs. three WOAC (2%). The response to thymectomy was high (69%) in both groups. We did not identify significant differences.
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Affiliation(s)
- J F Téllez-Zenteno
- Department of Neurology, Instituto Nacional de Ciencias Medicas y Nutricion, Salvador Zubiran, Delegacion Tlalpan, Mexico.
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Mimenza-Alvarado AJ, Muñiz-Alvarez JC, Estañol-Vidal B, Téllez-Zenteno JF, García-Ramos G. [Painful neuropathies: their pathophysiology and treatment]. Rev Neurol 2004; 39:364-70. [PMID: 15340898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVES The purpose of this study is to review the different studies published in the literature concerning the different physiological mechanisms involved in the genesis of painful neuropathy, as well as the diagnostic options and the different pharmacological treatments currently available. DEVELOPMENT Distinct pathologies usually condition painful neuropathy, one of the main ones being diabetes mellitus. The triggering phenomenon is often some kind of damage to the tissues that contain nervous pain receptors, which later gives rise to a release of proinflammatory molecules, and triggers a cascade of phenomena that result in disorders in the central and peripheral nervous system (peripheral and central sensitisation). These disorders usually produce clinical manifestations, such as allodynia, paresthesias, among others, and these are sometimes the sole manifestation of painful neuropathy. Diagnosis of this syndrome is at times complicated due to the involvement of thin fibres, which cannot be identified by the conventional methods used in neurophysiological studies. There is also a broad range of pharmaceuticals used in the treatment of painful neuropathy that range from tricyclic antidepressants, non-steroidal anti-inflammatory drugs, opioid analgesics, antiarrhythmics and even agents for topical use. CONCLUSIONS Diagnosis of thin fibre neuropathy is usually performed by carrying out a Quantitative Sudomotor Axon Reflex Test, quantitative sensory tests and a skin biopsy. As regards the pharmacological treatment, the new generation of anticonvulsive drugs like gabapentin seems to have advantages over the traditional pharmaceuticals, although their widespread use is still largely restricted by their cost.
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Affiliation(s)
- A J Mimenza-Alvarado
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y de la Nutrición Salvador Zubirán, Mexico DF, Mexico.
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Guillermo GR, Téllez-Zenteno JF, Weder-Cisneros N, Mimenza A, Estañol B, Remes-Troche JM, Cantu-Brito C. Response of thymectomy: clinical and pathological characteristics among seronegative and seropositive myasthenia gravis patients. Acta Neurol Scand 2004; 109:217-21. [PMID: 14763961 DOI: 10.1034/j.1600-0404.2003.00209.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To identify the response to thymectomy in patients with seronegative and seropositive myasthenia gravis (SPMG). We analyzed the associated diseases, thymus histology, and the severity of symptoms between the two groups. MATERIAL AND METHODS - DESIGN: Descriptive, comparative. STUDY UNITS Fourteen patients with seronegative myasthenia gravis (SNMG) and 57 patients with SPMG who had a thymectomy between 1987 and 1997, with at least 3 years of follow-up. The patients were divided into four groups; (1) Remission, (2) Improvement, (3) No change and (4) Deterioration. RESULTS Fourteen patients (20%) were seronegative and 57 were seropositive (80%). In the group of patients with SNMG, three patients were in remission (21%), five with improvement (36%), five with no change (36%) and one with worsening (7%). In the group of patients with SPMG, 12 were in remission (21%), 17 with improvement (30%), 25 with no change (44%) and three (5%) with worsening. The patients with SNMG were older, with less associated diseases and with a lower frequency of thymomas. CONCLUSIONS The response to thymectomy was similar between the two groups. It has been suggested that seronegative patients have a better prognosis, but our results show no differences.
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Affiliation(s)
- G R Guillermo
- Departament of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición 'Salvador Zubirán', Mexico City, Mexico.
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García-Ramos G, Téllez-Zenteno JF, Zapata-Zúñiga M, Yamamoto-Furusho JK, Ruiz-Morales JA, Villarreal-Garza C, Vargas-Alarcón G, Estañol B, Llorente L, Granados J. HLA class II genotypes in Mexican Mestizo patients with myasthenia gravis. Eur J Neurol 2004; 10:707-10. [PMID: 14641517 DOI: 10.1046/j.1468-1331.2003.00686.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Myasthenia gravis is an autoimmune, heterogeneous disorder, characterized by the presence of antibodies against acetylcholine receptors at the neuromuscular junction. There is a strong evidence that an individual's genetic composition is an important predisposing factor for the development of the disease. To correlate HLA class II genotypes with thymic pathology in Mexican Mestizo patients who had been subjected to thymectomy. HLA class II genes were analyzed in 60 patients and in 99 healthy ethnically matched controls. Thymic hyperplasia, atrophy, thymoma, and normal histology were encountered in 56, 33, 8 and 2% of patients, respectively. HLA-DR11 was significantly increased in patients with thymoma compared with healthy controls (pC = 0.001, OR = 13.35, 95% CI 3.5-51.3), compared with the subgroup of hyperplasia patients (pC = 0.005, OR = 15.5, 95% CI 2.78-95.58) and with the atrophy subgroup (pC = 0.04, OR = 10.5, 95% CI 1.75-70.95). This study provides the evidence of an association between HLA class II alleles with clinical and genetic heterogeneity in myasthenia gravis, particularly in those with thymoma (HLA-DR11).
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Affiliation(s)
- G García-Ramos
- Department of Neurology, Instituo Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, México, D.F.
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Estañol B, Sánchez-Munguia S, Corona Marco V, Elias Y, Téllez-Zenteno JF, García-Ramos G. [Effect of the graded muscle contraction on the H reflex and long latency reflexes of the thenar and hypothenar muscles to a fixed threshold stimulus]. Neurologia 2003; 18:303-9. [PMID: 12838449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
INTRODUCTION To determine the percentage of appearance of the H reflex and long latency reflexes (LLRs) in the thenar and hypothenar muscles of normal subjects to a fixed threshold mixed nerve electrical stimulus and variable degrees of muscle contraction. METHODS Fifteen subjects aged 21 to 32 years of age without any prior history of central or peripheral neurological diseases volunteered for the study. The stimulation was a constant currrent given at the wrist with the cathode positioned proximally; started at 1 mA and it was gradually increased mA by mA until the M response appeared with the subject relaxed. The intensity of the stimulation was thereafter kept constant. The contraction was an abducting movement of the thumb in the case of the thenar muscle and abduction of the digiti minimi in the case of the hypothenar muscle and was sustained throughout the study. The reflexes were elicited with a repetition rate of 3 Hz, the stimulus was a square pulse of 0.5 ms. We used a low frequency pass filter of 10 Hz and a high frequency pass filter of 10 kHz. The sweep speed was set a 10 ms per division. The responses were averaged 200 times and then smoothed. RESULTS The mean intensity of the stimulus that evoked the H response, for all subjects, was 7.5 2.8 mA. The mean latency of the H reflex elicited with stimulation of the median nerve was 26 ms 2.03 ms (std. error 0.28, maximum 28.2, minimum 22.0). The mean latency of the H reflex elicited with stimulation of the ulnar nerve was 25.1 ms 1.64 ms (std. error 0.230, maximum 28, minimum 22.3). The difference between the percentage of responses attained under a relaxed condition and with any kind of muscle contraction was highly significant statistically using the Chi square method (p < 0.001). When we compared the percentage of the H responses obtained with slight, moderate, strong contraction, and contraction against resistance, between them, we did no find a significant difference. The LLRs appeared only in the trials with strong contraction. CONCLUSIONS The H reflexes and the LLRs of the thenar and hypothenar muscle were not obtained with threshold stimulation when these muscles were relaxed. With any degree of muscle contraction the H reflex in these muscles could be obtained in 94 percent of the trials. Maximal contraction and contraction against resistance were the best conditions to elicit long latency responses.
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Affiliation(s)
- B Estañol
- Laboratory of Clinical Neurophysiology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México.
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Téllez-Zenteno JF, Negrete-Pulido O, Nuñez M, Estañol-Vidal B, García-Ramos G. [Peripheral neuropathy during a second cycle of treatment with high doses of interferon-alpha in a patient with hepatitis C, and a review of the literature]. Rev Neurol 2002; 35:644-6. [PMID: 12389150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
INTRODUCTION Alpha interferons (IFN a) have been shown to be effective in patients with chronic active hepatitis C. IFN a treatment may be associated with neurologic complications, including peripheral neuropathy. CASE REPORT We describe a patient with active hepatitis C treated with IFN a, who developed peripheral neuropathy after a second cicle of treatment with interferon. He received a first cicle of treatment with IFN a during 22 weeks (6 MU/day 3 times a week). Afther that he did not received treatment during one year and then he received the second cycle (6 MU/day 3 times a week). After 3 months of therapy the patient complained about paresthesias of both legs. CONCLUSIONS IFN a related neuropathy is probably rare; however, some cases may be misdiagnosed. Diagnosis of IFN a related neuropathy should be considered by physicians, particularly in patients given longterm treatment and high IFN a dosage. In this case we think that the patient had an acumulative efectt of interferon though he did not received treatment with interferon during one year.
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Affiliation(s)
- J F Téllez-Zenteno
- Departamento de Neurología, Instituto Nacional de Ciencias Médicas y de la Nutrición Salvador Zubirán, Ciudad de México, México.
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Morales-Buenrostro LE, Téllez-Zenteno JF, Estañol B. [Symptomatic hemiparkinsonism with abnormal SPECT in a patient with systemic lupus erythematosus (SLE)]. Neurologia 2002; 17:391-3. [PMID: 12236961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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Mimenza-Alvarado AJ, Téllez-Zenteno JF, Cantú-Brito C, García-Ramos G. [Systemic lupus erythematosus with affection to brainstem: report of three cases]. Rev Neurol 2002; 35:128-31. [PMID: 12221623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
INTRODUCTION The frequency with which the central nervous system (CNS) is affected by systemic lupus erythematosus (SLE) varies, according to different series, between 13 and 59%, whereas the brain stem is affected in 5%. CASE REPORTS Case 1: a 33 year old male who was submitted to a Nissen funduplicature as a treatment of (hypo)incoercible hiccups. The singultus persisted and some time after a paraplegia appeared. Magnetic resonance (MRI) showed images in the medulla oblongata, and in the cervical and thoracic spine. A biopsy was also performed to examine the cervical lesions and vasculitis was diagnosed. The patient began treatment with prednisone (1 mg/kg) and two months after symptoms had begun to improve he presented an episode of bilateral optic neuritis. Until this last event, the immunological studies had been positive. Case 2: female aged 19 who had had SLE for eight months. The illness began suddenly with bilateral paralysis of the sixth cranial nerve, vertical and horizontal nystagmus, dysdiadochokinesia, truncal ataxia, 4/5 muscular strength in the upper limbs and 3/5 in the lower limbs, and left flexor plantar response, but indifferent on the right hand side. MR showed T2 hyperintensities in the pons, medulla oblongata and the junction of medulla and upper spinal cord. Case 3: female aged 31 with sudden onset of the illness, characterised by diplopy and presence of internuclear ophthalmoplegia. Brain MR showed images of T1 hypointense and T2 hyperintense in the pontobulbar region. CONCLUSION A brain stem disorder in patients suffering from SLE is one of the rarest manifestations of this pathological condition of the CNS and is probably caused by vasculitis
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Téllez-Zenteno JF, Remes-Troche JM, Negrete-Pulido RO, Dávila-Maldonado L. Longitudinal myelitis associated with systemic lupus erythematosus: clinical features and magnetic resonance imaging of six cases. Lupus 2002; 10:851-6. [PMID: 11787874 DOI: 10.1191/096120301701548490] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Myelopathy is a rare central nervous system (CNS) complication associated with systemic lupus erythematosus (SLE). Acute transverse myelitis (ATM) is the most frequent form of SLE-related myelopathy. Magnetic resonance imaging (MRI) typically shows increased signal intensity in T2-weighted images and cord swelling. In the present paper, we describe six cases of SLE-related myelopathy with multiple increased signals in the T2-weighted images involving continuous levels of the cervical and thoracic spinal cord, a distinctive feature recently named 'longitudinal myelitis'. The clinical and laboratory findings are similar to those presented by ATM patients, including paraparesis, sensory level and sphincter disturbances. Four patients had positive antiphospholipid antibodies (aPL) suggesting that this could be a characteristic of longitudinal myelitis. Treatment in all cases included high doses of corticosteroids and immunosuppressive agents (intravenous (i.v.) cyclophosphamide). Anticoagulation therapy was given to one patient and two others received low doses of aspirin. The outcome was mainly unfavorable with slow improvement in only one case, no improvement in two and relapse of the myelopathy in the remaining three. In conclusion, longitudinal myelitis is an unusual form of SLE-related myelopathy, it might be associated with aPL and it has a poor prognosis.
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Affiliation(s)
- J F Téllez-Zenteno
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
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Téllez-Zenteno JF, Remes-Troche JM, García-Ramos G, Estañol B, Garduño-Espinoza J. Prognostic factors of thymectomy in patients with myasthenia gravis: a cohort of 132 patients. Eur Neurol 2002; 46:171-7. [PMID: 11721122 DOI: 10.1159/000050800] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To identify the response to thymectomy and the factors associated with a poor response, a nested case-control study was performed on 132 patients with an established diagnosis of myasthenia gravis who had had a thymectomy between 1987 and 1997 and had been followed up for at least 3 years. METHODS In order to assess the response to thymectomy, the following two points were taken into account: (a) the dose of pyridostigmine and other drugs (steroids, azathioprine) that the patient took before and after thymectomy, and (b) the Osserman classification before and after thymectomy. The patients were divided into 4 groups: (1) patients in remission; (2) patients with improvement; (3) patients with no change, and (4) patients who were worse. RESULTS 91 patients had a good response (69%) and 41 patients had a poor response (31%). The response by groups was as follows: 50 patients were found to be in remission; 41 patients had improved; 34 patients had no changes, and 7 got worse. Being more than 60 years old was associated with a poor prognosis (odds ratio 4.6, CI 1.11-20.32, p 0.01). The patients who had the disease for more than 3 years (odds ratio 2.97, CI 0.79-5.39, p 0.09) had a tendency towards a bad prognosis even though there was no statistical significance, and for those who had it for more than 4 years (odds ratio 2.58, CI 0.89-0.96, p 0.02) the bad prognosis was statistically significant. The patients who had the disease for more than 3 years between diagnosis and thymectomy (odds ratio 2.02, CI 0.69-5.90, p 0.15) and those with it for more than 4 years (odds ratio 2.53, CI 0.83-7.7, p 0.06) had a tendency towards a poor prognosis even though there was no statistical significance. In addition, having Osserman I was associated with a bad prognosis. Referring to the pathological findings, patients with thymoma (odds ratio 3.51, CI 0.43-31.5, p 0.15) and those with thymic atrophy (odds ratio 2.19, CI 0.93-5.16, p 0.04) had a poor prognosis. Finally, the use of steroids before thymectomy (odds ratio 2.26, CI 0.99-5.18, p 0.03) was associated with a worse prognosis. CONCLUSIONS The response to thymectomy was high (69%). The variables that had the most prognostic importance were age and the Osserman stage. Other variables of poor prognosis were: high doses of pyridostigmine and use of steroids before surgery; the total duration of the disease and the duration of the disease between diagnosis and the surgical procedure; history of previous thymectomy; use of plasmapheresis after surgery, and the discovery of thymic atrophy and thymoma in the histopathological result.
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Affiliation(s)
- J F Téllez-Zenteno
- Department of Neurology, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico.
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Austrich Senosian E, Téllez-Zenteno JF, García-Ramos G, Corona R. [Klippel-Feil syndrome. Three-dimensional tomographic images]. GAC MED MEX 2001; 137:609-11. [PMID: 11766467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
Klippel-Feil syndrome (KPS) is characterized by congenital vertebral fusion believed to result from faulty segmentation along the embryo's developing axis. The hallmark phenotypic findings of low hairline, short neck, and limited range of motion of the neck are found as al triad in < 50% of patients. Congenital musculoskeletal and systemic anomalies are commonly found. These include, but are not limited to elevation of the scapula, scoliosis and renal and cardiac abnormalities. Here, we present the three-dimensional images by computed tomography of a 9-year-old boy with multiple fusion of the cervical vertebraes.
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Affiliation(s)
- E Austrich Senosian
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, Colonia Sección XVI, 14000 Tlalpan, México, D. F
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Téllez-Zenteno JF, Jacinto-Tinajero JC, Avila-Funes A, García-Ramos G, Negrete-Pulido O, Sentíes-Madrid H. [Guillain-Barre syndrome. Experience in a third level hospital]. Rev Invest Clin 2001; 53:311-4. [PMID: 11599477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
INTRODUCTION Acute peripheral neuropathy represents a medical emergency. The causes of it are diverse and plentiful. The most common cause of acute paralytic peripheral neuropathy is the Guillain-Barré syndrome (GBS). As many as 85% of those affected can be expected to make an excellent recovery. OBJECTIVE To describe the principal risk factors associated, clinical manifestations, treatment, evolution and complications of 28 cases of Guillain-Barré syndrome (GBS) in the "Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán". METHODS We search in our computer records all files under diagnostic of GBS, during the last ten years. We found 28 cases that were available to study. RESULTS Mean age was 37 years old (SD 17.2). Fifteen patients were female (54%) and 13 were male (46%). Nine patients (32%) were preceded by a superior via infection, 5 (18%) by a diarrhea illness and 14 patients had not a predisposing factor. The duration of symptoms before diagnostic has a median of 7 days (2-15). Twenty-six patients (93%) had an ascending paralysis and 18 had paresthesias (64%). The most frequent subtype was acute inflammatory-demyelinating polyneuropathy (AIDP) in 18 patients (64%), acute motor-sensory axonal neuropathy (AMSAN) in 5 (18%), acute motor axonal neuropathy (AMAN) in 3 (11%) and 2 patients (7%) had the Fisher-Miller syndrome. Fifteen patients (54%) developed respiratory involvement requiring mechanical ventilation. Twenty-four patients (86%) had cerebrospinal fluid proteins elevated. Twenty patients (72%) had a total recovery, 6 (21%) had a partial recovery and 2 had not any response (7%). DISCUSSION GBS is a particularly highstakes illness in that its onset is sudden and paralysis is frequently extreme (requiring assisted respiration), however, as many as 85% of those affected can be expected to make an excellent recovery. In our study the majority of patients (54%) develop respiratory involvement requiring mechanical ventilation but in this group the majority had a favorable outcome (71%).
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Téllez-Zenteno JF, Torre-Delgadillo A, Uscanga-Domínguez LF. [Descriptive analysis of 41 patients with a pyogenic hepatic abscess]. Rev Invest Clin 2001; 53:218-22. [PMID: 11496708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
OBJECTIVE To identify the clinical, laboratory and imaging characteristics of 41 patients with a pyogenic hepatic abscess. RESEARCH DESIGN Retrospective, descriptive. SETTING Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán. STUDY UNITS 41 patients with a pyogenic hepatic abscess. MAIN MEASUREMENTS The measurement of the following variables was carried out: previous background, period of evolution, symptoms, signs, laboratory studies, imaging, treatment, complications and evolution. RESULTS 41 patients were evaluated. The average age of the group was 52.5 years (SD = 14.3) and 30 (73%) were male. The most frequent associated disease was diabetes mellitus which was found in 15 patients (37%). The most frequent clinic data were: fever in 38 patients (93%), chills in 26 (63%) and pain in the upper right quadrant in 25 (61%). The most common source of the formation of the abscess was of biliary origin in six patients (15%) and the serum amoeba test was positive in 10% of the cases. The localization of the abscess in our series was as follows: 33 cases (81%) were from the right lobe, five (12%) from the left lobe, three (7%) from both lobes and 87% were solitary. The germ found more frequently was E. coli in five patients (15%). As for the treatment, puncture by computed tomography was carried out in 25 patients (61%), four patients had a surgery and the rest were treated only with antibiotics. Regarding mortality, only one patient died (2%) due to a septic shock. CONCLUSIONS An association with diabetes mellitus was identified and the most frequent origin was biliary, these data have already been reported in other studies. On the other hand, mortality and morbidity rates in our study were low.
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Affiliation(s)
- J F Téllez-Zenteno
- Departamento de Gastroenterología, INCMN Salvador Zubirán Vasco de Quiroga Núm. 15, Tialpan 14000 México, D.F
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Téllez-Zenteno JF, Torre-Delgadillo A, Garduño-Espinosa J. [Radiation myelitis]. GAC MED MEX 1999; 135:201-2. [PMID: 10327757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
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Téllez-Zenteno JF, Hernández-Ronquillo L, Tapia-Rangel B, Garduño-Espinosa J. [A fibrolamellar variety of hepatocarcinoma in a young woman 17 years old]. GAC MED MEX 1999; 135:83-7. [PMID: 10204316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
We report here the case of a 17-year-old female with typical fibrolamellar hepatocellular carcinoma, no hepatitis B or C viral infection and a normal, non-cirrhotic liver. Computed tomography and magnetic resonance imaging revealed a solid tumor with a central fibrous scar. A fibrolamellar hepatocellular carcinoma is an uncommon malignancy of unknown etiology, without cirrhosis, usually without an increase in tumor markers, and rarely associated with hepatitis B virus. It occurs mainly in young patients. This tumor presents a high resectability rate (48-100%), a good prognosis and a mean survival of 68 months. This tumor is an important differential diagnosis of space occupying lesions in younger adults.
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Garduño-Espinosa J, Téllez-Zenteno JF, Hernández-Ronquillo L. [Frequency of depression in patients with diabetes mellitus type 2]. Rev Invest Clin 1998; 50:287-91. [PMID: 9830315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE To determine the prevalence of depression in Mexican adult diabetics and to identify factors associated to the depression. RESEARCH DESIGN Prolective survey. SETTING Four Mexico City hospitals (Clinica San Pedro de los Pinos IMSS, Centro Medico Nacional Siglo XXI IMSS, Hospital Gea González SSa and Centro de Salud Margarita Chorne SSa). STUDY UNITS 79 patients with diabetes mellitus type 2. MAIN MEASUREMENTS The Beck Depression Inventory was used as a measure of depression. We used sociodemographic variables (age, gender, marital status, religion, education, occupation, socioeconomic status) and disease variables (years of diagnosis, other chronic medical conditions and compliance with therapeutic regimens) as the independent variables of depression. RESULTS Mean age was 59 +/- 11 years (SD) and 58 (73%) were females. The frequency of depression was 46%. Factors associated to depression were: females (OR = 3.67, CI = 1.07-13.3, p = 0.03) and years of diagnosis above 15 (OR = 3.08, CI = 0.91-10.8, p = 0.07). CONCLUSIONS Frequency of depression was high (46%). Gender and years of diabetes diagnosis were factors associated to depression.
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Affiliation(s)
- J Garduño-Espinosa
- Unidad de Investigación Médica en Epidemiología Clínica, Hospital de Pediatría, CMN Siglo XXI, IMSS, México, D.F
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