1
|
Gleason E, Malik K, Sannar E, Kamara D, Serrano V, Augustyn M. Challenging Case: A Multidisciplinary Approach to Demystifying Chronic Sleep Impairment in an Infant with a Complex Medical and Behavioral Profile. J Dev Behav Pediatr 2024; 45:e176-e179. [PMID: 38290114 DOI: 10.1097/dbp.0000000000001251] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
CASE X is a 22-month-old White male infant with a complex medical history, including diagnoses of FBXO11 mutation, hypotonia, restrictive lung disease and mild intermittent asthma, laryngotracheomalacia, obstructive sleep apnea (OSA), feeding difficulties with a history of aspiration, gastroesophageal reflux disease (GERD), and developmental delays. X's medical presentation has resulted in multiple prior medical admissions for respiratory failure due to acute illnesses, procedures and treatments including gastrojejunostomy (GJ) tube dependence, supraglottoplasty to reshape tissues of the upper larynx, and the use of biphasic positive airway pressure (BiPAP) at night and room air during the day when he is at baseline. In addition, he has nocturnal events characterized by significant agitation, screaming, crying, body stiffening and limb movements with pauses in breathing, mouth breathing, restless sleep, and difficulty waking in the morning with concomitant daytime fatigue despite above treatments for OSA. There is no history of congenital heart disease or sudden unexplained death. Family history is noncontributory because parents are negative for the FBXO11 variant.X's sleep disruption has led to significant sleep deficits for both X and his caregivers, who spend much of the night strategizing on how to console him. X has undergone several sleep studies, starting when X was aged 4 months, at several children's hospitals across the nation to determine the cause of his chronic sleep disturbance, which yielded limited information and treatment success. As an infant, X received a medical workup and was subsequently treated with a proton pump inhibitor (PPI) for reflux. At 12 months, he was diagnosed with disordered sleep with myoclonic jerks and started on melatonin and gabapentin for involuntary movements. At 13 months, gabapentin was weaned back because of intolerance, and at 15 months, nortriptyline and clonidine were started because of worsening symptoms to target potential neuropathic pain. While most of his symptoms were at night, he had occasional daytime screaming episodes, particularly when experiencing illness. Gabapentin and clonidine were stopped because nortriptyline seemed most effective.At 17 months, the results from a sleep study led to a diagnosis of night terrors, and several clinicians agreed that X's sleep disruption was behavioral in nature. At this time, an infant mental health consultant met with a sleep psychologist on the family's behalf to support family in considering systematic desensitization therapy to increase tolerance to wearing his BiPAP mask, as well as other behavioral and sleep hygiene strategies, which were tried on several occasions and again, resulted in limited improvement in functioning.At 19 months, X's multidisciplinary team reconsidered a night terror diagnosis after a failed trial of clonazepam and pursued a differential diagnosis of periodic limb movement disorder (PLMD). X trialed gabapentin again, but this time only a nighttime dose, per sleep medicine and psychiatry recommendation. While this brought some temporary relief from nighttime distress, despite increasing to the highest dose for age and weight (15 mg/kg/dose), this became less effective, and he was weaned off at 22 months. He had been on iron supplementation since age 6 months and received an iron infusion at 22 months because of persistently low ferritin levels and PLMD in sleep.At 24 months, X was briefly trialed on levetiracetam. While no evidence for seizures on EEG was present, this medication was chosen for involuntary movements and genetic risk for seizures. However, this medication was not useful. At 25 months, an evaluation with a movement disorder physiatrist resulted in a diagnosis of nocturnal paroxysmal dystonia, and he was started on baclofen, which has provided some, but not complete relief to nighttime symptoms. Parents are reporting he has more "good nights" than "bad nights," but "bad nights" come in stretches of a few days in length with no known trigger or relief.Most recently, X was evaluated by general genetics. Whole exome sequencing (WES) was pursued which revealed a pathogenic de novo variant in FBXO11 and provides a likely cause for his neurodevelopmental phenotype. However, he has some features not explained by FBX011; thus, reanalysis of his WES was performed and revealed a de novo variant of uncertain significance in RAF1. Because pathogenic variants in RAF1 have been associated with dilated cardiomyopathy and Noonan spectrum disorder, it was recommended that X be followed periodically in a cardiac genetics clinic. Family is well connected into the FBXO11 community, including supportive Facebook groups. Parents have shared that they do not feel X's breathing issues and pain fit with the phenotype of other children with FBXO11 mutations.X is also enrolled in a medical child care program to facilitate development and social-emotional functioning and receives learning, speech, occupational, physical, and feeding therapy while in attendance. Despite periods of absence due to contracting numerous viral illnesses over the past several months, X continues to make progress across developmental therapies and happily engages when at the program.What additional diagnostic tests and treatment should be considered to better understand X's medical and behavioral presentation? What are the implications of chronic sleep deprivation and stress on the behavior and development of infant with X's profile? What are important psychosocial considerations because it relates to children with medical complexity (CMC), particularly for X and his family to support caregiver, family, and X's quality of life and overall well-being?
Collapse
Affiliation(s)
- Erica Gleason
- Child & Adolescent Psychiatry, University of Colorado Medicine, Children's Hospital of Colorado, Aurora, CO
| | - Kristina Malik
- Department of Pulmonary and Sleep Medicine, KidStreet & Special Care Clinic, Children's Hospital of Colorado, Aurora, CO
| | - Elise Sannar
- Child & Adolescent Psychiatry, University of Colorado Medicine, Children's Hospital of Colorado, Aurora, CO
| | - Dana Kamara
- Department of Pediatrics, Pulmonary & Sleep Medicine, University of Colorado Medicine, Children's Hospital of Colorado, Aurora, CO
| | - Verenea Serrano
- Psychiatry, University of Colorado Medicine, Children's Hospital of Colorado, Aurora, CO
| | | |
Collapse
|
2
|
Margolis KL, Buchholz M, Charlot-Swilley D, Serrano V, Herbst R, Meiselman E, Talmi A. Early childhood integrated behavioral health: A promoter of equity in pediatric care. Clinical Practice in Pediatric Psychology 2022. [DOI: 10.1037/cpp0000454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
3
|
Buchholz M, Ashby B, Costello L, Ehmer A, Serrano V, von Schulz J, Wolcott C, Talmi A. From planning to implementation: Creating and adapting universal screening protocols to address caregiver mental health and psychosocial complexity. Clinical Practice in Pediatric Psychology 2021. [DOI: 10.1037/cpp0000406] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
4
|
Serrano V, Rodriguez-Gutierrez R, Hargraves I, Gionfriddo MR, Tamhane S, Montori VM. Shared decision-making in the care of individuals with diabetes. Diabet Med 2016; 33:742-51. [PMID: 27105298 DOI: 10.1111/dme.13143] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 04/13/2016] [Accepted: 04/20/2016] [Indexed: 12/01/2022]
Abstract
People with diabetes often live with other chronic conditions and lead complicated lives. Determining what is the best management decision for a patient requires consideration of each individual's personal, social and biomedical context, what he or she values, the reasons he or she has to value the available options, and the relative contribution of each option in terms of benefits, harms, costs and inconveniences. Empathic conversations between patients and clinicians to diagnose the patient situation that necessitates action and the range of evidence-based actions that best address the situation, so-called shared decision-making, are essential to the personalized care of people with diabetes. The aim of the present review was to present key elements of shared decision-making and propose three different approaches for its application. The first approach focuses on transferring information to patients so that they can make decisions. The second approach, choice, focuses on cultivating the individual's ability to give voice to which choice is best for them. The third approach, conversation, establishes an empathic conversational environment through which the individual with diabetes and their clinician think and talk through how to address the problems of living with diabetes and related illnesses. These approaches are manifest in the design of evidence-based decision aids created to support shared decision-making. In randomized trials, decision aids can efficiently improve patient's knowledge, satisfaction, risk awareness, decisional conflict and involvement. Further research, however, is needed to better understand when and how to promote the empathic conversations, patient, clinician and service and policy contexts necessary to routinely implement shared decision-making in different at scale healthcare systems. In the interim, sufficient evidence and tools exist for persons with diabetes and their clinicians to gain expertise in making decisions together.
Collapse
Affiliation(s)
- V Serrano
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Nutrition, Diabetes and Metabolism, Pontifical Catholic University of Chile, Santiago, Chile
| | - R Rodriguez-Gutierrez
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology, Department of Internal Medicine, University Hospital 'Dr. Jose E. Gonzalez', Autonomous University of Nuevo Leon, Monterrey, Mexico
| | - I Hargraves
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - M R Gionfriddo
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
- Mayo Graduate School, Mayo Clinic, Rochester, MN, USA
| | - S Tamhane
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - V M Montori
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
5
|
Pierart C, Serrano V, Rubio L, Ebensperger R, Foncea R. [Glucose effect in the expression of endothelial lipase in human endothelial cells and in patients with diabetes mellitus type 2]. NUTR HOSP 2012; 26:916-21. [PMID: 22470043 DOI: 10.1590/s0212-16112011000400036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Accepted: 03/04/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Endothelial Lipase (EL), enzyme that modulates HDL metabolism, is overregulated by inflammatory-cytokines. Type 2 Diabetes (DM2) has been associated with a subclinical inflammation, so it has been ruled that these patients could have high levels of EL. The objectives of the research are to determine the effect of glucose in the expression of EL in culturing cells and evaluate the relation between the levels of EL and the metabolic control in patients with DM2. METHOD During 24 hours, human endothelial cells (HUVEC) were stimulated with different concentrations of glucose (5.5, 25 and 50 mmol/L), the effect was evaluated over the expression of EL. In DM2 patients levels of EL, glucose and HbA1c were measured. We had a control group (8) to determine the levels of enzyme. EL was measured by immune transference, and the results were expressed by arbitrary units(AU). RESULTS In HUVEC cells, the expression of EL was directly proportional extracellular glucose (p < 0.05). 24 diabetic patients were evaluated (15 females and 9 males) average age from 60 ± 9,7 years old. The studied group showed levels of EL bigger than the control group (14911AU and 10250, 18AU) respectively (p < 0.05). We found no relation between glucose, HbA1c and EL. CONCLUSION In HUVEC cells there is a direct relation between extracell glucose and EL. The diabetic patients had higher levels of EL than the control group, but these was not related with glucose or HbA1c, these shows the existence of other factors that participate in the increasement of EL.
Collapse
Affiliation(s)
- C Pierart
- Departamento Nutrición, Facultad Medicina, Universidad de Chile, Santiago, Chile.
| | | | | | | | | |
Collapse
|
6
|
Goodman K, Riedel E, Serrano V, Gulati S, Moskowitz C, Yahalom J. 2584. Int J Radiat Oncol Biol Phys 2006. [DOI: 10.1016/j.ijrobp.2006.07.997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
7
|
Goodman KA, Serrano V, Riedel ER, Gulati S, Moskowitz CH, Yahalom J. Long-term outcomes of survivors of autologous hematopoietic-cell transplantation for refractory and relapsed Hodgkin’s Disease. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.6554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6554 Background: With improvements in survival among refractory/relapsed Hodgkin’s Lymphoma (HL) patients after high-dose chemo-radiotherapy and autologous hematopoietic-cell transplant (AHCT), it is important to evaluate risk of late complications in this heavily treated population. Methods: From 1985–1998, 218 refractory/relapsed HL patients were treated on high dose chemo-radiotherapy and AHCT salvage protocols. 153 (70%) surviving ≥2 years after AHCT were analyzed. All received either radiotherapy with initial therapy or total lymphoid irradiation and involved field boost with the conditioning regimen (43%). Information from surviving patients was obtained through a self-administered questionnaire. The NDI was queried to determine vital status and cause of death. Primary endpoint was non-HL mortality, defined as mortality due to cardiac causes, infection or second malignancy (SM). Competing risk methods were used to calculate cause-specific mortality rates and examine its predictors. All events were calculated from 2 years post-AHCT to date of death/last follow-up. Results: Median follow-up time was 11 years. There have been 51 deaths, 32 due to HL and 19 due to other causes. Eleven deaths were due to SM: AML (3), MDS (2), NHL (2), NSCLC (2), gastric and colon cancer. There were 8 non-SM deaths: cardiac toxicity (4), infection, aplastic anemia, suicide, unknown causes (1 each). The 10 and 15-year overall survival (OS) rates are 64% and 57%, respectively. The 10-year cumulative incidence of death from HL and from non-HL causes were 22% and 13.5% ( table ). By univariate analysis, increased risk of death due to SM was associated only with higher age at AHCT (p=0.02). Conclusions: While HL initially accounts for the majority of deaths among patients surviving high-dose therapy, the HL mortality rate plateaus and risk of death from non-HL mortality increases after 5 years. Yet, even at 15-years, SM risk does not exceed that observed in patients treated with standard regimens. [Table: see text] No significant financial relationships to disclose.
Collapse
Affiliation(s)
- K. A. Goodman
- Stanford Univ, Stanford, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; Cornell Weill Medical School, New York, NY
| | - V. Serrano
- Stanford Univ, Stanford, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; Cornell Weill Medical School, New York, NY
| | - E. R. Riedel
- Stanford Univ, Stanford, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; Cornell Weill Medical School, New York, NY
| | - S. Gulati
- Stanford Univ, Stanford, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; Cornell Weill Medical School, New York, NY
| | - C. H. Moskowitz
- Stanford Univ, Stanford, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; Cornell Weill Medical School, New York, NY
| | - J. Yahalom
- Stanford Univ, Stanford, CA; Memorial Sloan-Kettering Cancer Center, New York, NY; Cornell Weill Medical School, New York, NY
| |
Collapse
|
8
|
de Arruda FF, Zhung J, Narayana A, Wolden S, Pfister DG, Serrano V, Kraus DH, Shaha A, Shah J, Lee NY. Intensity-modulated radiation therapy (IMRT) for advanced oropharyngeal carcinoma: The MSKCC experience. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.5513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - J. Zhung
- Memorial Sloan-Kettering Cancer Ctr, New York, NY
| | - A. Narayana
- Memorial Sloan-Kettering Cancer Ctr, New York, NY
| | - S. Wolden
- Memorial Sloan-Kettering Cancer Ctr, New York, NY
| | | | - V. Serrano
- Memorial Sloan-Kettering Cancer Ctr, New York, NY
| | - D. H. Kraus
- Memorial Sloan-Kettering Cancer Ctr, New York, NY
| | - A. Shaha
- Memorial Sloan-Kettering Cancer Ctr, New York, NY
| | - J. Shah
- Memorial Sloan-Kettering Cancer Ctr, New York, NY
| | - N. Y. Lee
- Memorial Sloan-Kettering Cancer Ctr, New York, NY
| |
Collapse
|
9
|
Ayala GX, Elder JP, Campbell NR, Engelberg M, Olson S, Moreno C, Serrano V. Nutrition communication for a Latino community: formative research foundations. Fam Community Health 2001; 24:72-87. [PMID: 11563946 DOI: 10.1097/00003727-200110000-00009] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Formative research techniques were used to develop a tailored health communication nutrition intervention for Latinas and their families. Members of the target community were recruited to participate in focus groups, depth interviews, and participant observations. Women, in particular, were observed preparing meals in their homes and purchasing groceries. The objective was to identify variables that could be used for targeting, segmenting, and tailoring the intervention. Results from these efforts were used to develop a theory-based intervention, which is described at the conclusion of the article.
Collapse
Affiliation(s)
- G X Ayala
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego State University, California, USA
| | | | | | | | | | | | | |
Collapse
|
10
|
Rojas A, Bah M, Rojas JI, Serrano V, Pacheco S. Spasmolytic activity of some plants used by the Otomi Indians of Quéretaro (México) for the treatment of gastrointestinal disorders. Phytomedicine 1999; 6:367-371. [PMID: 11962546 DOI: 10.1016/s0944-7113(99)80061-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The present study was performed to investigate the effect of chloroform-methanol (1:1) extracts derived from Baccharis heterophylla H. B. K (Asteraceae), Desmodium grahami Gray (Leguminosae), Dyssodia pinnata var. pinnata Rob. (Asteraceae), Gentiana spathacea H. B. K. (Gentianaceae), Loeselia mexicana Brand. (Polemoniaceae), Selaginella pallescens Spring. (Selaginellaceae) and Zornia diphylla Pers. (Fabaceae) on the spontaneous contractions of isolated rat ileum. The concentration-response curves and IC50 values were obtained and the respective relaxant potencies were compared with that of the CHCl3-MeOH (1:1) extract of Datura lanosa. The data showed that all the extracts produce a concentration-dependent inhibition of spontaneous ileum contractions. In addition, the antimicrobial activity of the extracts against pathogenic enterobacteria was tested. The pharmacological actions shown by the extracts of the selected species tend to support ethnomedical use of the plants for the treatment of gastrointestinal disorders.
Collapse
Affiliation(s)
- A Rojas
- Facultad de Quimica, Universitiad Autónoma de Querétaro, Centro Universitario, México
| | | | | | | | | |
Collapse
|
11
|
Chicharro JL, Serrano V, Ureña R, Gutierrez AM, Carvajal A, Fernández-Hernando P, Lucía A. Trace elements and electrolytes in human resting mixed saliva after exercise. Br J Sports Med 1999; 33:204-7. [PMID: 10378074 PMCID: PMC1756161 DOI: 10.1136/bjsm.33.3.204] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [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: 11/04/2022]
Abstract
OBJECTIVES Exercise is known to cause changes in the concentration of salivary components such as amylase, Na, and Cl. The aim of this investigation was to evaluate the effect of physical exercise on the levels of trace elements and electrolytes in whole (mixed) saliva. METHODS Forty subjects performed a maximal exercise test on a cycle ergometer. Samples of saliva were obtained before and immediately after the exercise test. Sample concentrations of Fe, Mg, Sc, Cr, Mn, Co, Cu, Zn, Se, Sr, Ag, Sb, Cs, and Hg were determined by inductively coupled plasma mass spectrometry and concentrations of Ca and Na by atomic absorption spectrometry. RESULTS After exercise, Mg and Na levels showed a significant increase (p < 0.05) while Mn levels fell (p < 0.05). Zn/Cu molar ratios were unaffected by exercise. CONCLUSIONS Intense physical exercise induced changes in the concentrations of only three (Na, Mg, and Mn) of the 16 elements analysed in the saliva samples. Further research is needed to assess the clinical implications of these findings.
Collapse
Affiliation(s)
- J L Chicharro
- Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | | | | | | | | | | | | |
Collapse
|
12
|
Gil-Néciga E, Alberca R, Moreno A, Cayuela A, Serrano V, Garzón F. 1-12-25 Behavioral symptoms in Alzheimer's disease. J Neurol Sci 1997. [DOI: 10.1016/s0022-510x(97)84923-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
13
|
Gil-Néciga AE, Garzón F, Moreno A, Serrano V, García D. 2-12-03 Asymmetric cortical degenerative syndrome with predominant visuoperceptual symptoms and asymmetric parietoccipital subcortical atrophy. J Neurol Sci 1997. [DOI: 10.1016/s0022-510x(97)85253-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
14
|
Moreno-Rojas AJ, Casado JL, Gil-Néciga E, Jarrín S, Serrano V, Madrid A. [Plus-minus eyelid syndrome of vascular origin]. Rev Neurol 1996; 24:94-5. [PMID: 8852010] [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: 02/02/2023]
Abstract
The association of unilateral ptosis and contralateral palpebral retraction named as "palpebral plus-minus syndrome" by Gaynard et al is an infrequent finding. Most cases described are of peripheral origin and secondary to muscle pathology or neuromuscular union. Cases secondary to central lesions are exceptional. We present the case of a female patient who developed palpebral plus-minus syndrome as a result of a vascular lesion with presumably mesencephalic localization.
Collapse
Affiliation(s)
- A J Moreno-Rojas
- Servicio de Neurología, Hospital Universitario Virgen del Rocío, Sevilla
| | | | | | | | | | | |
Collapse
|
15
|
Moreno Rojas AJ, Romero J, Serrano V, Madrid A, Jarrín S, Casado JL. [Intradural extramedullary cavernoma of cauda equina]. Rev Neurol 1995; 23:1228-30. [PMID: 8556624] [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: 01/31/2023]
Abstract
Cavernous angiomas are comparatively rare vascular malformations in the central nervous system. Their location at the spinal level is rare, being but 3 to 16% of such vascular malformations. Among spinal intradural cavernous malformations most are intramedullar, the extramedullar type being less frequent. We have only came across five cases in the literature of intradural extramedullar cavernous angiomas affecting the cauda equina. We present a new such case with acute onset and later chronic evolution affecting the cauda equina through an intradural cavernous malformation at the level.
Collapse
Affiliation(s)
- A J Moreno Rojas
- Servicio de Neurologia, Hospital Universitario Virgen del Rocio, Sevilla
| | | | | | | | | | | |
Collapse
|
16
|
Moreno A, Serrano V, Casado JL, Arenas C, Alberca R. [Sumatriptan and cluster headache]. Neurologia 1995; 10:76-80. [PMID: 7695947] [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: 01/26/2023] Open
Abstract
Double-blind studies have demonstrated the efficacy of sumatriptan for the treatment of cluster headache (CH) but little is known about its use on a daily basis. The open trial reported here analyzed the efficacy, tolerance and appropriateness of subcutaneous administration of sumatriptan; the results are compared with findings for other treatments of CH. Sumatriptan was used in 232 attacks suffered by 16 patients and its effect was very rapid. Pain began to diminish a mean 9 minutes after injection and the most intense had disappeared in less than 15 minutes. All the patients preferred sumatriptan to other treatments. No serious side effects were recorded and the patients were satisfied with subcutaneous injection. Sumatriptan was considered the first choice medication for treatment of CH symptoms, although its high cost is a drawback that had to be taken into account.
Collapse
Affiliation(s)
- A Moreno
- Servicio de Neurología, Hospital Universitario Virgen del Rocío, Sevilla
| | | | | | | | | |
Collapse
|
17
|
Casado JL, Arenas C, Serrano V, Moreno Rojas A, Gil-Néciga E, Gil-Peralta A. [Complete recovery from transient coma in bilateral paramedian thalamic infarctions]. Rev Neurol 1995; 23:151-2. [PMID: 8548613] [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: 01/31/2023]
Abstract
Bilateral paramedian thalamic infarcts (BPTI) can begin clinically with transient coma, after which symptoms of fluctuating hypersomnolence, irrational behaviour, or amnesic states may be observed. We present two patients with BPTI who began with coma, recovering spontaneously in under eight hours, with no accompanying symptoms.
Collapse
Affiliation(s)
- J L Casado
- Servicio de Neurología, Hospital Universitario Virgen del Rocío, Sevilla
| | | | | | | | | | | |
Collapse
|
18
|
Alberca R, Casado JL, Arenas C, Moreno A, Serrano V, Madrid A, Jarrin S. [Cluster headache and trigeminal nerve]. Neurologia 1995; 10:19-25. [PMID: 7893508] [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: 01/27/2023] Open
Affiliation(s)
- R Alberca
- Servicio de Neurología, Hospital Universitario Virgen del Rocío, Sevilla
| | | | | | | | | | | | | |
Collapse
|
19
|
Alberca R, López JM, Aguilera JM, Casado JL, Arenas C, Serrano V, Moreno A. [Chronic cluster headache: course and outcome of treatment]. Neurologia 1994; 9:379-86. [PMID: 7811488] [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: 01/27/2023] Open
Abstract
We analyze the results of treatment and the course of disease in 20 patients suffering from chronic cluster headache. Patients were followed for an average of 5 years. Sumatriptan provided the most effective relief of symptoms in those who used that medication. The results of surgical and medical prophylaxes were poor. The disease either remitted or changed to an episodic variety after several months or years in most patients. There is no evidence to suggest that these changes were related to any particular treatment.
Collapse
Affiliation(s)
- R Alberca
- Servicio de Neurología, Hospital Universitario Virgen del Rocío, Sevilla
| | | | | | | | | | | | | |
Collapse
|
20
|
Alberca R, Aguilera JM, Casado JL, López JM, Arenas C, Moreno A, Serrano V. [Cluster headache with a familial presentation]. Neurologia 1994; 9:22-4. [PMID: 8161463] [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: 01/29/2023] Open
Abstract
Four out of 190 patients suffering from cluster headache (CH) were of familial presentation. In three families the affected relative was either the brother or the father of the proband. In the other family the disorder affected the father, two brothers, and perhaps the grand mother of the patient. The prevalence of the disease seems to be higher among relatives of CH patients compared to general population. It is unclear whether this familial aggregation depends up on genetic factors.
Collapse
Affiliation(s)
- R Alberca
- Servicio de Neurología, Hospital Universitario Virgen del Rocío, Sevilla
| | | | | | | | | | | | | |
Collapse
|
21
|
Alvarado-Díez MA, Márquez-Enriquez LM, Troconis-Trens G, Serrano V, Vásquez-Gutiérrez E, Rivera-Rebolledo JC, Villegas-Silva R. [Experience in the use of central venous catheterization via subclavian puncture in a pediatric hospital]. Bol Med Hosp Infant Mex 1993; 50:394-8. [PMID: 8517934] [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: 01/31/2023] Open
Abstract
OBJECTIVE To assess the frequency and type of complications during central venous catheter installation by subclavian puncture, and during its use in children admitted to an ICU. PATIENTS AND METHODS Patients from one month to 15 years of age, admitted to the Intensive Care Unit of the Hospital de Pediatría Centro Médico Nacional, Siglo XXI, who underwent a percutaneous infraclavicular subclavian puncture for central venous catheter complications were included. Clinical features, diagnosis, complications and indications for the procedure were registered. RESULTS 92 patients and 102 subclavian punctures were included for analysis. Effectively index was 88.3%. Main diagnosis was infectious diseases in 29.4% and neoplasia in 22.5%. Hemodynamic monitoring was the more frequent indication for the procedure (44%). Of the catheter 45% were successfully installed at first intent. The complication in the installation appear in 11.7%. Was arterial subclavian puncture (6.8%), hematoma (2.9%), without hemodynamic deterioration no any case. The mean time of permanence was 8.8 days. The late complications was present in average 7.3 days, in 18.6% of the cases. Predominance infection in entrance place of catheter. CONCLUSIONS Installation of venous central catheter by subclavian puncture prove a great utility in our patients, with a few complications and a high effectively. For experimental personal the central venous catheterization by subclavian puncture in pediatric patients to be importance in the first place in critical ill children.
Collapse
Affiliation(s)
- M A Alvarado-Díez
- Unidad de Terapia Intensiva, Hospital de Pediatría, Centro Médico Nacional, Siglo XXI, Instituto Mexicano del Seguro Social, México, D. F
| | | | | | | | | | | | | |
Collapse
|
22
|
Jalil R, Vaccarezza A, Jara A, Lira P, Vial S, Serrano V. [Human recombinant erythropoietin (rH-EPO) in chronic hemodialysis patients]. Rev Med Chil 1990; 118:629-34. [PMID: 1775783] [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: 12/28/2022]
Abstract
We studied 7 patients on chronic hemodialysis before and after 12 weeks of therapy with human recombinant erythropoietin. The drug was administered intravenously, 3 times a week at doses increasing from 50 to 125 U/kg. Dialysis was performed for 4 hr, 3 times a week and no blood transfusions were used during the study. An increased tolerance to daily physical activities was observed in all patients. Hematocrit increased from 19 +/- 3.4 to 28 +/- 4.1 and hemoglobin from 6.7 +/- 1.3 to 9.4 +/- 1.5, p less than 0.01. No changes were detected in blood pressure, weight, liver function tests and nutritional values. No patient developed either absolute (ferritin less than 30 ng/ml) or relative iron deficiency (transferrin saturation less than 20%) during the study. Efficiency of dialysis remained unaltered. No secondary effects from the drug were observed. Thus, this study confirms the clinical usefulness of human recombinant erythropoietin in patients with chronic renal failure and anemia on chronic dialysis.
Collapse
Affiliation(s)
- R Jalil
- Departamento de Nefrourología, Pontificia, Universidad Católica de Chile, Santiago de Chile
| | | | | | | | | | | |
Collapse
|
23
|
Calatayud J, Manso FJ, Serrano V, Zapata T. [Routine aspiration and dental anesthesia. Study of 1,018 cases]. Av Odontoestomatol 1988; 4:293-6. [PMID: 3273159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
|
24
|
Calatayud J, Manso FJ, Azanza JR, Serrano V. [Study of vasoconstrictors in dental anesthetic solutions]. Arch Odonto Estomatol 1987; 3:339-54. [PMID: 3136745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
|
25
|
Calatayud J, Manso FJ, Serrano V, Kaiser C. [Methods for making local anesthesia more comfortable]. Rev Actual Estomatol Esp 1987; 47:43-5. [PMID: 3483466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
26
|
Ruiz Ruiz M, Serrano V, Padilla P, Pena JM. The public image of suicide: attitudes toward suicide and mental illness. Crisis 1986; 7:84-8. [PMID: 3780278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
27
|
Marin A, Bellido F, Domínguez F, Marin V, Sánchez de Vega, Serrano V. [Gastric leiomyoma]. Rev Esp Enferm Apar Dig 1978; 53:555-62. [PMID: 725190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|