Pegvisomant: uso clínico en pacientes con acromegalia

Contexto: el manejo de los pacientes con acromegalia actualmente incluye cirugía, radioterapia y terapia farmacológica. Aunque la cirugía es el tratamiento de primera línea, un gran porcentaje de pacientes van a requerir manejo adicional con radioterapia y farmacoterapia. Objetivo: revisar las características farmacológicas y los estudios clínicos de pegvisomant. Metodología: se revisaron las bases de datos electrónicas como Medline y Pubmed con el término pegvisomant y se analizaron los estudios clínicos y los datos relevantes de este medicamento en el manejo de acromegalia. Resultados: los análogos de somatostatina constituyen el tratamiento farmacológico de primera línea indicado en las guías de práctica la de esta entidad, no obstante, estudios recientes han reportado niveles muy variables de control de la enfermedad. Para lograr un mejor control se introdujo el pegvisomant, un análogo de la hormona de crecimiento que se une al receptor pero no induce cambios conformacionales para la transducción de señales y, por tanto, no inhibe la secreción de la hormona de crecimiento, sino sus efectos fisiológicos en los tejidos diana. Hasta la fecha, ha demostrado eficacia para normalizar los niveles séricos del IGF-1 tanto en monoterapia como en terapia combinada. Conclusiones: si no logramos el control de la enfermedad a pesar de estos medicamentos, debemos considerar terapias de segunda línea como pasireotide o pegvisomant. Las características clínicas individuales del paciente permitirán elegir cuál es la mejor opción para nuestros pacientes. El pegvisomant es un medicamento eficaz para el control del paciente con acromegalia

The five preferences for post-traumatic SAH

Acute traumatic brain injury is a worldwide public health crisis. Post-traumatic subarachnoid hemorrhage (SAH) is a finding that is present at a frequency of 40% according to data from American TCDB (1,2). Among the mechanisms that have been implicated as causes of post-traumatic SAH is the cortical bleeding through the subarachnoid space. It is estimated that the incidence of post-traumatic SAH is 11% to 60% in patients with traumatic brain injury. The brain CT is considered a technique with good sensitivity, economical and available in many hospitals worldwide. We have reviewed the literature and found some imaging characteristics of post-traumatic subarachnoid hemorrhage. We have called “the five preferences for post-traumatic SAH”

Causas genéticas de acromegalia: revisión narrativa

Contexto: La acromegalia es causada en la gran mayoría de los casos por tumores hipofisiarios productores de hormona de crecimiento. Estos tumores suelen ocurrir de manera esporádica y raramente de forma hereditaria. En los últimos años se ha explorado el panorama de las mutaciones y síndromes familiares asociados a la acromegalia y al gigantismo. Objetivo: Esta revisión se concentra en el conocimiento actual de las bases genéticas causantes de la acromegalia familiar. Metodología: Se revisaron las bases de datos electrónicas y textos guías de endocrinología y se resumen las enfermedades genéticas asociadas a acromegalia. Resultados: Las causas genéticas de acromegalia son el complejo de Carney, la neoplasia endocrina múltiple tipo 1, los adenomas pituitarios aislados familiares (FIPA), el acrogigantismo ligado al X (XLAG), la asociación de feocromocitoma/paraganglioma/adenoma pituitario familiar (3P), el síndrome de McCune-Albright (SMA) y la neurofibromatosis tipo 1. Conclusiones: Se debe buscar activamente neoplasia endocrina múltiple en los pacientes con acromegalia mediante la medición de calcio y hormona paratiroidea. Además, siempre debe preguntarse por antecedentes familiares buscando FIPA y en casos muy jóvenes o con manifestaciones asociadas sospechar una causa genética

Postraumatic pneumorrhachis: Report of three cases and classification proposal

The Pneumorrhachis is the presence of air at the level of the spinal canal. It can have several causes among which are: traumatic, iatrogenic among others. Clinical Cases: We present three cases of male patients handled by our neurosurgery service with traumatic pneumorrhachis patients, which were managed in a conservative manner, with control images. Conclusions: pneumorrhachis has traditionally been classified as internal if air is present in the subdural or subarachnoid space and external if the air is located at the epidural level. We propose a classification in degrees (Moscote-Agrawal-Padilla) which is more practical from the clinical and radiological point of view

Association of abnormal metopic suture causing hypertelorism, interfrontal encephalocele with craniofacial cosmetic deformity associated with myelomeningocele: Management literature review

Myelomeningocele may be associated with other neural and extraneural anomalies. Authors present association of metopic suture abnormality, an interfrontal encephalocele with widening of metopic suture and abnormal shape frontal bones in the forehead in those associated with hydrocephalus. Authors describes two neonates with interfrontal encephalocele, representing first series reporting in neonate. Management and pertinent literature is briefly discussed

Management of subdural chronic hematoma in Colombia: National survey

Chronic subdural hematoma is a growing neurological pathology, especially in older people. Thus, describing how this entity is approached in Colombia is of great importance because it allows to evaluate and contrast this approach with that of other countries, comparing the techniques used, therapeutic management and additional measures. In this study, this comparison was carried out using a self-administered survey with 16 multiple-choice items. The results were evaluated in Microsoft Excel, determining measures of central tendency accompanied by frequencies and percentages. As an initial management, 75.5% preferred to use 1Burr Hole and, in cases of recurrence, craniotomy is the choice in 50% of cases. Regarding the placement of drainage, its use was estimated to be 83.3%, especially the subdural system closed to external drainage, with a preference of 85.2%, and without use of corticosteroids as adjuvant therapy in 88.9 % of respondents. These data are consistent with the results of studies in other countries regarding the management of this pathology

Antioxidant therapies in traumatic brain injury: A review

Oxidative stress constitute one of the commonest mechanism of the secondary injury contributing to neuronal death in traumatic brain injury cases. The oxidative stress induced secondary injury blockade may be considered as to be a good alternative to improve the outcome of traumatic brain injury (TBI) treatment. Due to absence of definitive therapy of traumatic brain injury has forced researcher to utilize unconventional therapies and its roles investigated in the improvement of management and outcome in recent year. Antioxidant therapies are proven effective in many preclinical studies and encouraging results and the role of antioxidant mediaction may act as further advancement in the traumatic brain injury management it may represent aonr of newer moadlaity in neurosurgical aramamentorium, this kind of therapy could be a good alternative or adjuct to the previously established neuroprotection agents in TBI

Intradural spinal neurocysticercosis: Case presentation

Introduction: Neurocysticercosis (NCC) is a common parasitic infection of the central nervous system caused by the larvae of the Taenia solium. Spinal cord involvement is very uncommon. Clinical case: A female patient with a history of NCC presented with chronic and recurrent headache associated with motor and sensory deficit, which develops tonic-clonic convulsion, with spatial disorientation. She also had intracranial hypertension syndrome, meningitis syndrome, and pyramidal sygns suggestive of spinal NCC. Conclusions: Neurocysticercosis usually occurs in developing countries and should be considered as a differential diagnosis of neurological diseases. Early diagnosis and treatment are mandatory, as well as education to the community to primary prevention

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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