Insuficiencia venosa cerebroespinal crónica y esclerosis múltiple: revisión y actualización del tema

The aetiology of multiple sclerosis remains unknown at the present time, although the most likely explanation is that it has an autoimmune inflammatory origin. During the history of this disease a vascular pathophysiology was once proposed, and it has recently re-emerged as a result of the work by Paolo Zamboni with the name of 'chronic cerebrospinal venous insufficiency'. Following this hypothesis, Zamboni puts forward a curative treatment for multiple sclerosis by means of endovascular treatment of the internal jugular vein and the azygos vein. However, several teams have attempted to replicate his findings without success. In this review, we offer a chronological description of the studies carried out by Zamboni and the later attempts to replicate his work. Our main conclusion is that, given the results we currently have available, we should be cautious and, for the time being, it would be advisable not to recommend the systematic use of this treatment for our patients

Estado epiléptico no convulsivo en el siglo XXI: clínica, diagnóstico, tratamiento y pronóstico

Non-convulsive status epilepticus is a significant issue for a neurologist because, despite its low prevalence, it mimics other pathologies, with therapeutics and prognostic outcomes. Diagnosis is based on clinical features, mainly mental status or impaired consciousness and electroencephalographic changes, so electroencephalogram is the first exploration we must perform with clinical suspicion. There are three clinical forms: generalized or absence status, with diffuse epileptiform discharges; focal, with epileptic discharges located in a specific brain area and may not affect consciousness; and subtle, with diffuse or local epileptic activity after a tonic-clonic seizure or convulsive status and limited or no motor activity. Treatment are benzodiazepines and antiepileptic drugs; anesthetic drugs are only recommended for patients with subtle status and in some with partial complex status. Prognosis is mainly determined by etiology and associated brain damage

Urgencias neurológicas y guardias de Neurología

In recent years different studies have highlighted a progressive increase in the demand for neurological care in emergency departments. To analyze the convenience of specific neurology shifts or the role that the neurologist should play in the emergency department, it is necessary to answer questions such as: What is the demand for emergency neurological care? What are the most frequent neurological emergencies? Who should attend to neurological emergencies and why? Are specific neurology shifts necessary? Neurological emergencies account for between 2.6% and 14% of medical emergencies. Stroke represents a third of all neurological emergencies, while the diagnoses of acute cerebrovascular disease, epilepsy and cephalea constitute 50% of all neurological care in the emergency department. On the basis of quality of care criteria and professional competence, the best care for patients with a neurological emergency is provided by a specialist in neurology. The implementation of specific neurology shifts, with a 24 hour physical presence, is associated with greater quality of care, better diagnostic and therapeutic orientation from the moment the patient arrives in emergency department, reduces unnecessary admissions, reduces costs and strengthens the neurology service

Breast treatments with Axxent equipment.Comparison with Mammosite for skin, lung and heart dose

Poster Session [EP-1314] Purpose or Objective We have treated 250 patients at our center from May 2015 to September 2017 for breast cancer with Axxent (Xoft Inc.) intraoperativ e radiotherapy (IORT) following the inclusion parameters of the TARGIT study, in this work we compare the doses in the skin of the first 150 patients treated with the 50 kVp source with the skin doses they would have received using the Mammosite kit using an Ir192 source. Material and Methods To the 250 patients treated in our center after removing the tumor, the appropriate balloon size is chosen to cover the tumor area with a dose of 20 Gy on the ball oon surface, the sizes used range fro m 30-65 cm3, after which it is verified that the distance to skin from the 3 closest points of the balloon i s less than 10 mm and then the treatment is carried out with an average duration of 10.3 minutes being the volumes of 30 and 35 cm3 the most used due to the inclusion criteria of the procedure. Treatment plans are previously per formed in a Brachyvision treatment planning system (TPS) (Varian Inc.) for each of the possible volumes. In tur n, another plan is calculated with the Mammosite applicator and Ir192 source, from which the skin dose of each control point is estimated, compared to our results. We present also the cases of acute dermatitis seen for these first 150 patients in a time less than 6 months after the surgical act and irradiation. Results The differences in maximum skin dose for bot h types of treatment are 8.1 ± 1.2 Gy for the case of Mammosite and 5.7 ± 1.5 Gy for patients treated with electronic source, due to the difference in the depht dos e percentage of both types of treatment (Image 1). This, in turn, explains the very few cases of acute dermatitis at 6 months (8 cases of grade 2 and 2 cases of grade 3) (Image 2) with no recurrence to date.We also show the mean and maximum doses (expressed as percentage of prescribed dose) for the left lung and heart in cases of left breast tumor for the volumes of 30 and 35 cm3, which are the most common volumes in our hospital (70% of cases): LEFT LUNG (Left Breast tratment) AXXENT MAMMOSITE Maximun Dose (%PD) 20.4% 29.9% Mean Dose (%PD) 1.0% 3.9% HEART (Left Breast tratment) AXXENT MAMMOSITE Maximun Dose (%PD) 4.1% 10.4% Mean Dose (%PD) 0.8% 3.3% Conclusion It is concluded that the IORT treatments performed with the Axxent equipment with electronic source are a good alternative to those performed with Ir192 and our 250 patients treated to date to the good results presented by other centers are joined.In additi on to the low skin toxicity, there is no recurrence in patients treated so far, which makes us very optimistic about the results

Infratentorial hygroma secondary to decompressive craniectomy after cerebellar infarction

We present a case of expansive CSF collection in the cerebellar convexity. The patient was a 74 years old lady who one month before had suffered a cerebellar infarct complicated with acute hydrocephalus. She had good evolution after decompressive craniectomy without shunting. Fifteen days after surgery, the patient started with new positional vertigo, nausea and vomiting and a wound CSF fistula that needed ventriculoperitoneal shunt (medium pressure) because conservative treatment failed. After shunting, the fistula closed, but the patient symptoms worsened. The MRI showed normal ventricular size with a cerebellar hygroma, extending to the posterior interhemispheric fissure. The collection had no blood signal and expanded during observation. A catheter was implanted in the collection and connected to the shunt. The patient became asymptomatic after surgery, and the hygromas had disappeared in control CT at one month. This case shows an infrequent problem of CSF circulation at posterior fossa that resulted in vertigo of central origin. A higroma-ventricle-peritoneal shunt solved the symptoms of the patient

Monitorización con vídeo-EEG y ECG simultáneo para el diagnóstico diferencial de trastornos de conciencia transitorios. A propósito de un caso

We present the case of a 36 year-old woman, with history of transient consciousness disorders with vegetative state, interpreted as epileptic crises and treated with valproate for two years. After nine asymptomatic years, they reappeared associated with migraine, vomiting and some generalized convulsions. Electroencephalogram and cerebral magnetic resonance turned out normal, and treatment with zonisamide was started, without beneficial results. Later cardiological studies objectified a blockage of the left branch that coincided with dizziness. The study was completed with Video-EGG monitoring, where there was an episode that showed temporary right epileptiform activity, with a diagnosis established of focal epilepsy of unknown cause. At present, she remains asymptomatic with oxycarbazepine

Toxicity results after treatment with Electronic Brachytherapy in patients with endometrial cancer

Poster Session [EP-2226] Purpose or Objective To analyse the toxicity outcomes after treatment with Electronic Brachytherapy (XB) in postsurgical endometrial cancer patients treated at our medical centre. Material and Methods Prospective study in which we selected 94 patients, between September/2015 and September/2017, that received treatment with XB administered twice a week after endometrial cancer surgery, with IMRT planificati on. The patients were divided in two groups: Group 1 (57/94) considered high risk received external beam radiotherapy (46Gy) followed by XB (15Gy in 5Gy fractions) and group 2 (37/94) considered intermediate risk received exclusive XB (25Gy in 5Gy fraction s). We analysed the median dose in bladder, rectum and sigmoid D2cc, V50, V35 with XB comparing the doses with Ir192. The vaginal mucosa, gastrointestinal (GI) and genitourinary (GU) toxicities were analysed with the Common Terminology Criteria for Adverse Events (CTCAE 4.0) scale. Results The median dose in bladder with XB vs. Ir192 was: 2cc 62.9 vs. 69.9%, V50 7.1 vs. 12.6Gy, V35 15 vs. 28.1. In rectum XB vs. Ir192 was: D 2cc 64.01% vs. 67.7%, V50 7.8 vs. 10.9Gy, V35 16.5 vs. 31.8Gy. In sigmoid XB vs. Ir 192 was: D 50.37%vs. 58.0%, V50 8.8 vs. 16.2Gy, V35 21.2 vs. 37.5Gy. The median follow- up was 11 months (range 1 - 23, 9 months). In group 1, acute vaginal mucositis (G1) was observed in 35.08% of the patients, GI toxicity (G1) in 5.26% and GU toxicity (G1) in 10.52%. In group 2, we observed acute vaginal mucositis G1 in 45% of the patients and G2 in 10.81%, GI toxicity (G1) occurred in 2.7% and GU toxicity (G1) was present in 16.21%. There was no grade 3 or greater toxicity in any of the groups. Late toxici ty was observed in only 4 patients: Mucositis (G1) in 3 patients and GU toxicity (G1) in 1 patient. Conclusion The dose received by the organs at risk with the XB is less compared to Ir192, with a good coverage of the PTV. The greater toxicity was observe d immediately after the treatment was finished with an important reduction of the symptoms after 6 months. This technique shows excellent results as for toxicity

Intensive care unit discharge to the ward with a tracheostomy cannula as a risk factor for mortality: A prospective, multicenter propensity analysis

To analyze the impact of decannulation before intensive care unit discharge on ward survival in nonexperimental conditions. DESIGN: Prospective, observational survey. SETTING: Thirty-one intensive care units throughout Spain. PATIENTS: All patients admitted from March 1, 2008 to May 31, 2008. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: At intensive care unit discharge, we recorded demographic variables, severity score, and intensive care unit treatments, with special attention to tracheostomy. After intensive care unit discharge, we recorded intensive care unit readmission and hospital survival. STATISTICS: Multivariate analyses for ward mortality, with Cox proportional hazard ratio adjusted for propensity score for intensive care unit decannulation. We included 4,132 patients, 1,996 of whom needed mechanical ventilation. Of these, 260 (13%) were tracheostomized and 59 (23%) died in the intensive care unit. Of the 201 intensive care unit tracheostomized survivors, 60 were decannulated in the intensive care unit and 141 were discharged to the ward with cannulae in place. Variables associated with intensive care unit decannulation (non-neurologic disease [85% vs. 64%], vasoactive drugs [90% vs. 76%], parenteral nutrition [55% vs. 33%], acute renal failure [37% vs. 23%], and good prognosis at intensive care unit discharge [40% vs. 18%]) were included in a propensity score model for decannulation. Crude ward mortality was similar in decannulated and nondecannulated patients (22% vs. 23%); however, after adjustment for the propensity score and Sabadell Score, the presence of a tracheostomy cannula was not associated with any survival disadvantage with an odds ratio of 0.6 [0.3-1.2] (p=.1). CONCLUSION: In our multicenter setting, intensive care unit discharge before decannulation is not a risk factor

Neutrino Democracy, Fermion Mass Hierarchies And Proton Decay From 5D SU(5)

The explanation of various observed phenomena such as large angle neutrino oscillations, hierarchies of charged fermion masses and CKM mixings, and apparent baryon number conservation may have a common origin. We show how this could occur in 5D SUSY SU(5) supplemented by a ${\cal U}(1)$ flavor symmetry and additional matter supermultiplets called 'copies'. In addition, the proton decays into $p\to K\nu$, with an estimated lifetime of order $10^{33}-10^{36}$ yrs. Other decay channels include $Ke$ and $K\mu$ with comparable rates. We also expect that BR$(\mu \to e\gamma)\sim$BR$(\tau \to \mu \gamma)$

Dense carbon monoliths for supercapacitors with outstanding volumetric capacitances

A commercially available dense carbon monolith (CM) and four carbon monoliths obtained from it have been studied as electrochemical capacitor electrodes in a two-electrode cell. CM has: (i) very high density (1.17 g cm−3), (ii) high electrical conductivity (9.3 S cm−1), (iii) well-compacted and interconnected carbon spheres, (iv) homogeneous microporous structure and (v) apparent BET surface area of 957 m2g−1. It presents interesting electrochemical behaviors (e.g., excellent gravimetric capacitance and outstanding volumetric capacitance). The textural characteristics of CM (porosity and surface chemistry) have been modified by means of different treatments. The electrochemical performances of the starting and treated monoliths have been analyzed as a function of their porous textures and surface chemistry, both on gravimetric and volumetric basis. The monoliths present high specific and volumetric capacitances (292 F g−1 and 342 F cm−3), high energy densities (38 Wh kg−1 and 44 Wh L−1), and high power densities (176 W kg−1 and 183 W L−1). The specific and volumetric capacitances, especially the volumetric capacitance, are the highest ever reported for carbon monoliths. The high values are achieved due to a suitable combination of density, electrical conductivity, porosity and oxygen surface content.Financial support from projects MAT2011-25198, MP1004 and PROMETEO/2009/047 is gratefully acknowledged. V.B. thanks MINECO for R&C contract