11 research outputs found
Exploración posturográfica de pacientes simuladores
Introduction: An aphysiological pattern in computerized
dynamic posturography (CDP) may be produced by numerous
causes. We analyze the results obtained in this test
by a group of malingering patients.
Patients and method: This study analyzes a particular
group of 7 malingerers, ie patients simulating a false and
unreal equilibrium disorder, without any a priori awareness
of the gain expected from a pathological report. The condition
can only be identified with the very complex postural
disorder known as “continuous imbalance.” We analyze the
results of the dynamic posturography test following the
diagnostic criteria described by other authors.
Results: Of the criteria analyzed, we found Cevette’s to be
the most frequently positive for our study group.
Conclusions: The wide diversity in the criteria used makes
it necessary to apply them together, assuming a high level
of suspicion and great care in the diagnostic process
Sialoendoscopia: una nueva alternativa en el tratamiento de la patología salival. Nuestra experiencia
Objectives: Sialoendoscopy is a procedure used to visualize
the salivary ducts and their pathology. It can be used either
as a diagnostic method to rule out inflammatory processes
in the parotid and submandibular glands (diagnostic
sialoendoscopy) or to treat pathological areas (stenosis,
extract foreign bodies or sialolithiasis) through the use of appropriate
instruments (interventionist sialoendoscopy). We
attempt to prove a declining rate of salivary gland excision.
Patients and method: Sialoendoscopy was performed in
8 patients.
Results: Of these, 50 % of patients were diagnosed as having
sialolithiasis and the other 50 % had chronic sialoadenitis. In
patients with sialolithiasis, sialoendoscopy allowed the
extraction of the calculus in two patients (50 %). In the remainder,
sialoendoscopy provided confirmation of the
diagnosis in all cases.
Conclusions: Sialoendoscopy is a new technique for use in
the diagnosis, treatment and post-operative management
of sialolithiasis, sialoadenitis and other salivary gland
pathologies
Voz esofágica
El diagnóstico y tratamiento de los trastornos de la voz habitualmente
se lleva a cabo en los laboratorios de voz mediante el empleo de técnicas
instrumentales, visuales, acústicas y aerodinámicas. La voz se ha
convertido en una subespecialidad multidisciplinar, sin embargo el grupo
de pacientes que padece el trastorno de voz más radical, es decir, los
que se han sometido a una laringuectomía total habitualmente por un
cáncer de laringe son el colectivo con problemas de voz menos estudiado
y peor comprendido en cuanto a los aspectos fisiológicos y
fisiopatológicos.
Se revisan las opciones que tienen los pacientes laringuectomizados
para restituir su capacidad vocal: el desarrollo de voz esofágica o
erigmofonía; la realización de fistuloplastia fonatoria; el empleo de la
electrolaringe. Se desarrollan las bases fisiológicas y las características
acústicas y aerodinámicas de la voz esofágica y se plantean posibles
estrategias que ayuden a los pacientes a adquirir una voz esofágica más
eficaz
Técnicas digitales para la valoración laringoscópica
En 1854 con el descubrimiento del espejito laríngeo por Manuel García,
profesor de canto español, nació la laringología como especialidad. Desde
entonces han sido numerosos los avances en el terreno de la valoración
visual de la dinámica laríngea durante la fonación. En los últimos años
la tecnología digital ha permitido no sólo la obtención y registro de
imágenes de manera precisa y fiable sino que permite realizar mediciones
de fenómenos extremadamente rápidos y delicados, como son el
desplazamiento de la mucosa de las cuerdas vocales, los cambios del
área glótica durante el ciclo vocal, etc.
Se revisa la historia de la estroboscopia, los protocolos de valoración,
las técnicas de la estroboscopia digital y sus posibilidades diagnósticas
así como sus limitaciones. Se propone así mismo dos nuevas técnicas
que han irrumpido recientemente en el panorama otorrinolaringológico
que son la videokimografía digital y la grabación en vídeo de alta velocidad
que superan las limitaciones de la estroboscopia y probablemente
se convertirán en un medio de exploración rutinario en un futuro
próximo
Sonic hedgehog inhibition reduces in vitro tumorigenesis and alters expression of GLI1-target genes in a desmoplastic medulloblastoma cell line
Medulloblastoma is one of the most frequent and aggressive tumors of childhood. The Sonic hedgehog (Shh) pathway, related to human development, is altered in most medulloblastomas: genes like Ptch, Smo, or Sufu suffer mutations in 15% to 25% of these tumors. We tested Shh inhibition in the Daoy medulloblastoma cell line by two methods: a molecular one, direct Gli1 siRNA inhibition; and a pharmacological inhibition of Smo, upstream of Gli1, by cyclopamine. Afterwards, a comparison of cellular and molecular responses was done. In general, we proved that cell viability, cell migration and cell colony formation decreased after Shh inhibition, which might confer a less tumorigenic status to Daoy cells. Moreover, we assessed the expression of different Gli1 target genes and other genes and found that Shh shows a crosstalk with oncogenes and tumor suppressor genes that have been described in numerous tumors. All these experiments give an overview of the Shh pathway in medulloblastoma, together with the demonstration of the efficacy of cyclopamine and Gli1 siRNA Shh inhibition in vitro
Exploración posturográfica de pacientes simuladores
Introduction: An aphysiological pattern in computerized
dynamic posturography (CDP) may be produced by numerous
causes. We analyze the results obtained in this test
by a group of malingering patients.
Patients and method: This study analyzes a particular
group of 7 malingerers, ie patients simulating a false and
unreal equilibrium disorder, without any a priori awareness
of the gain expected from a pathological report. The condition
can only be identified with the very complex postural
disorder known as “continuous imbalance.” We analyze the
results of the dynamic posturography test following the
diagnostic criteria described by other authors.
Results: Of the criteria analyzed, we found Cevette’s to be
the most frequently positive for our study group.
Conclusions: The wide diversity in the criteria used makes
it necessary to apply them together, assuming a high level
of suspicion and great care in the diagnostic process
Sialoendoscopia: una nueva alternativa en el tratamiento de la patología salival. Nuestra experiencia
Objectives: Sialoendoscopy is a procedure used to visualize
the salivary ducts and their pathology. It can be used either
as a diagnostic method to rule out inflammatory processes
in the parotid and submandibular glands (diagnostic
sialoendoscopy) or to treat pathological areas (stenosis,
extract foreign bodies or sialolithiasis) through the use of appropriate
instruments (interventionist sialoendoscopy). We
attempt to prove a declining rate of salivary gland excision.
Patients and method: Sialoendoscopy was performed in
8 patients.
Results: Of these, 50 % of patients were diagnosed as having
sialolithiasis and the other 50 % had chronic sialoadenitis. In
patients with sialolithiasis, sialoendoscopy allowed the
extraction of the calculus in two patients (50 %). In the remainder,
sialoendoscopy provided confirmation of the
diagnosis in all cases.
Conclusions: Sialoendoscopy is a new technique for use in
the diagnosis, treatment and post-operative management
of sialolithiasis, sialoadenitis and other salivary gland
pathologies
Técnicas digitales para la valoración laringoscópica
En 1854 con el descubrimiento del espejito laríngeo por Manuel García,
profesor de canto español, nació la laringología como especialidad. Desde
entonces han sido numerosos los avances en el terreno de la valoración
visual de la dinámica laríngea durante la fonación. En los últimos años
la tecnología digital ha permitido no sólo la obtención y registro de
imágenes de manera precisa y fiable sino que permite realizar mediciones
de fenómenos extremadamente rápidos y delicados, como son el
desplazamiento de la mucosa de las cuerdas vocales, los cambios del
área glótica durante el ciclo vocal, etc.
Se revisa la historia de la estroboscopia, los protocolos de valoración,
las técnicas de la estroboscopia digital y sus posibilidades diagnósticas
así como sus limitaciones. Se propone así mismo dos nuevas técnicas
que han irrumpido recientemente en el panorama otorrinolaringológico
que son la videokimografía digital y la grabación en vídeo de alta velocidad
que superan las limitaciones de la estroboscopia y probablemente
se convertirán en un medio de exploración rutinario en un futuro
próximo
Mathematical methods for measuring the visually enhanced vestibulo-ocular reflex and preliminary results from healthy subjects and patient groups
Background: Visually enhanced vestibulo-ocular reflex (VVOR) is a well-known bedside clinical test to evaluate visuo-vestibular interaction, with clinical applications in patients with neurological and vestibular dysfunctions. Owing to recently developed diagnostic technologies, the possibility to perform an easy and objective measurement of the VVOR has increased, but there is a lack of computational methods designed to obtain an objective VVOR measurement.
Objectives: To develop a method for the assessment of the VVOR to obtain a gain value that compares head and eye velocities and to test this method in patients and healthy subjects.
Methods: Two computational methods were developed to measure the VVOR test responses: the first method was based on the area under curve of head and eye velocity plots and the second method was based on the slope of the linear regression obtained for head and eye velocity data. VVOR gain and vestibulo-ocular reflex (VOR) gain were analyzed with the data obtained from 35 subjects divided into four groups: healthy (N = 10), unilateral vestibular with vestibular neurectomy (N = 8), bilateral vestibulopathy (N = 12), and cerebellar ataxia, neuropathy, and vestibular areflexia syndrome (CANVAS) (N = 5).
Results: Intra-class correlation index for the two developed VVOR analysis methods was 0.99. Statistical differences were obtained by analysis of variance statistical method, comparing the healthy group (VVOR mean gain of 1 ± 0) with all other groups. The CANVAS group exhibited (VVOR mean gain of 0.4 ± 0.1) differences when compared to all other groups. VVOR mean gain for the vestibular bilateral group was 0.8 ± 0.1. VVOR mean gain in the unilateral group was 0.6 ± 0.1, with a Pearson's correlation of 0.52 obtained when VVOR gain was compared to the VOR gain of the operated side.
Conclusion: Two computational methods to measure the gain of VVOR were successfully developed. The VVOR gain values appear to objectively characterize the VVOR alteration observed in CANVAS patients, and also distinguish between healthy subjects and patients with some vestibular disorders
Relevance of artifact removal and number of stimuli for video head impulse test examination
Objective: To evaluate the effect of artifacts on the impulse and response recordings with the video head impulse test (VHIT) and determine how many stimuli are necessary for obtaining acceptably efficient
measurements.
Methods: One hundred fifty patients were examined using VHIT and
their registries searched for artifacts. We compared several variations
of the dataset. The first variation used only samples without artifacts,
the second used all samples (with and without artifacts), and the rest
used only samples with each type of artifact. We calculated the relative
efficiency (RE) of evaluating an increasingly large number of samples (3
to 19 per side) when compared with the complete sample (20 impulses
per side).
Results: Overshoot was associated with significantly higher speed
(p = 0.005), higher duration (p < 0.001) and lower amplitude of the
impulses (p = 0.002), and consequent higher saccades’ latency (p =
0.035) and lower amplitude (p = 0.025). Loss of track was associated
with lower gain (p = 0.035). Blink was associated with a higher number
of saccades (p < 0.001), and wrong way was associated with lower saccade latency (p = 0.012). The coefficient of quartile deviation escalated
as the number of artifacts of any type rose, indicating an increment of
variability. Overshoot increased the probability of the impulse to lay on
the outlier range for gain and peak speed. Blink did so for the number
of saccades, and wrong way for the saccade amplitude and speed. RE
reached a tolerable level of 1.1 at 7 to 10 impulses for all measurements
except the PR score.
Conclusions: Our results suggest the necessity of removing artifacts
after collecting VHIT samples to improve the accuracy and precision of
results. Ten impulses are sufficient for achieving acceptable RE for all
measurements except the PR score