RESUMO
Subacute sclerosing panencephalitis is an infrequent central nervous system viral disease and is a late manifestation of persistent infection by a mutant form of measles virus. Since it affects mainly children and teenagers, the diagnosis in older ages is difficult. Its main clinical symptoms are cognitive impairment, behavioral disturbances and myoclonia. We report two males, aged 21 and 22 years old, presenting with the disease with atypical manifestations. One had a catatonic syndrome and the other, amaurosis. The recognition of the different presentation forms of the disease, endemic in developing countries, allows an earlier diagnosis and a more efficient treatment, when available.
Assuntos
Panencefalite Esclerosante Subaguda/diagnóstico , Adulto , Idade de Início , Humanos , Masculino , Fatores de TempoRESUMO
BACKGROUND: The high costs of adequate pharmacological treatment for Parkinson disease preclude the universal access of patients to this medication. AIM: To assess the accessibility to pharmacological treatment of Chilean patients with Parkinson disease. PATIENTS AND METHODS: An inquiry about socioeconomic stratification, medical controls, disease features and costs of pharmacological therapy, was applied to 95 patients (56 male, aged 32 to 89 years old) attending the Chilean League Against Parkinson Disease. RESULTS: Among studied patients, the disease had a mean duration of 7.9 +/- 6 years. There was a direct relationship between family income, the frequency of visits to physicians and the dose and cost of pharmacological therapy. CONCLUSIONS: The accessibility to pharmacological therapy among patients with Parkinson disease, depends on their socioeconomic level. Measures to correct this situation and improve the quality of life of these patients should be undertaken by health services.
Assuntos
Antiparkinsonianos/economia , Honorários Farmacêuticos , Acessibilidade aos Serviços de Saúde , Doença de Parkinson/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Chile , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The features of refractory epilepsies and the role of functional surgery and new antiepileptic drugs is reviewed. Among the latter, gabapentin, a drug with peculiar pharmacokinetic properties, is highlighted as a therapeutic alternative in refractory epilepsies and eventually for epileptic patients without previous treatment. A new type of relationship between the pharmaceutical industry and physicians, that privileges clinical research, is discussed.
Assuntos
Acetatos/uso terapêutico , Aminas , Anticonvulsivantes/uso terapêutico , Ácidos Cicloexanocarboxílicos , Epilepsia/tratamento farmacológico , Ácido gama-Aminobutírico , Acetatos/sangue , Chile , Ensaios Clínicos como Assunto , Resistência a Medicamentos , Epilepsia/cirurgia , Gabapentina , HumanosRESUMO
Thirty, out of 1200 patients of North Santiago Adult Epilepsy Program, were admitted to J J Aguirre Hospital due to refractory epilepsy. Looking for candidates for functional epilepsy surgery, these patients were evaluated by neurologists, psychiatrists and psychologists and with standard EEG, video monitored EEG, CAT scan, magnetic resonance imaging and SPECT. So far, four patients with temporal partial complex epilepsy have been studied, operated (anterior temporal lobectomy and amygdalo-hippocampectomy) and followed for more than one year. Of these, two are free of seizures, one has sporadic episodes and one has an important reduction. One of these patients had a postoperative amnestic syndrome of 3 to 4 weeks duration. According to these results and those reported in the literature, the rigorous selection of patients that could be benefitted by surgery is emphasized.
Assuntos
Epilepsias Parciais/cirurgia , Lobo Temporal/cirurgia , Adulto , Eletroencefalografia , Epilepsias Parciais/diagnóstico , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Psicocirurgia , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
Valproic acid is a useful antiepileptic drug, with occasional gastrointestinal side effects. Hepatotoxicity is the most serious adverse reaction and, although rare, it can be fatal. Risk factors for hepatotoxicity are an age of less than two years, polytherapy and mental retardation; it has been rarely reported in adults. We report three mentally retarded adult patients receiving polytherapy, who developed valproic acid induced hepatotoxicity. Two patients had a symptomatic hepatitis with a concomitant paradoxical increase in seizure frequency and one an asymptomatic alteration of hepatic function tests. After discontinuing the drug, the hepatitis subsided. We conclude that hepatotoxicity must be considered as a possible side effect of valproic acid and we suggest some recommendations for its early detection.
Assuntos
Doença Hepática Induzida por Substâncias e Drogas/etiologia , Epilepsia/tratamento farmacológico , Ácido Valproico/efeitos adversos , Adolescente , Adulto , Feminino , Humanos , Masculino , Ácido Valproico/uso terapêuticoRESUMO
To study the effect of old age on phenytoin pharmacokinetics, twelve young and nine old adults aged 21.7 +/- 1.8 and 71.8 +/- 4.9 years respectively, were studied. No significant differences of phenytoin indicating the drug distribution and elimination does not change with aging. After oral administration, significant differences were observed between young and old adults for absorption, measured through oral residence half time (36.89 +/- 5.07 h in young and 29.25 +/- 8.64 h in old adults p < 0.05), absorption half time (6.91 +/- 3.6 vs 3.29 +/- 2.35 h) and maximal concentration (1.45 +/- 0.37 vs 2.0 +/- 0.79 micrograms/ml). However, absolute bioavailability of the drug was not different in both age groups (72.9 and 67.6% in young and old adults respectively). It is concluded that no modifications of phenytoin dosage are necessary in elderly people.
Assuntos
Fenitoína/farmacocinética , Adulto , Fatores Etários , Idoso , Disponibilidade Biológica , Humanos , MasculinoRESUMO
Sneddon syndrome is a systemic non inflammatory arteriopathy characterized by the association of livedo reticularis, thrombotic cerebrovascular disease, coronary artery disease and hypertension. Middle age females are usually affected. It should be considered in the differential diagnosis of acute ischemic attacks in younger patients. It has been related to the antiphospholipid antibody syndrome. Treatment is based on control of hypertension and cardiovascular risk factors along with antiplatelet agents. Two cases meeting the clinical criteria outlined above are reported.
Assuntos
Síndrome de Sneddon , Adulto , Feminino , Humanos , Síndrome de Sneddon/diagnóstico , Síndrome de Sneddon/terapiaRESUMO
The bioavailability of carbamazepine from 4 commercially available products was evaluated in 12 healthy volunteers. A crossover design was used and each patients received 400 mg of each product. Plasma levels of the drug were determined periodically for 72 h using a gas-liquid chromatographic method. An open model of one compartment for first-order absorption was assumed to derive pharmacokinetic parameters. Dissolution kinetics was also evaluated in each product. Significant differences in bioavailability were shown for one product. Results correlated with the in vitro dissolution findings.
Assuntos
Carbamazepina/farmacocinética , Administração Oral , Adulto , Análise de Variância , Disponibilidade Biológica , Carbamazepina/administração & dosagem , Carbamazepina/sangue , Chile , Humanos , Masculino , Comprimidos , Fatores de TempoRESUMO
Retrospective analysis of clinical information requires easy access to reliably stored data. We developed a program running on a microcomputer and using codes from the International classification of diseases, to be used on line. The program stores diagnostic codes, medical actions and a summary for each case. It uses inexpensive hardware and is friendly to inexperienced users.
Assuntos
Sistemas Computadorizados de Registros Médicos , Doenças do Sistema Nervoso , Software , Serviço Hospitalar de Emergência , Humanos , Microcomputadores , Doenças do Sistema Nervoso/classificação , Doenças do Sistema Nervoso/diagnóstico , Encaminhamento e Consulta , Estudos RetrospectivosRESUMO
Nuclear magnetic resonance (NMR) has been proposed to be the best diagnostic test for multiple sclerosis (MS). We performed a critical analysis of 13 papers evaluating the use of NMR in MS. Out of an ideal 17 criteria for validation and reproducibility, a top of 11 (65%) was the maximum found. Foremost deficiencies were a lack of blind analysis and inadequate patient samples. Thus the claim that NMR is the diagnostic tool of choice in MS remains to be proven.