Microanatomy of the dysplastic neocortex from epileptic patients

Focal cortical dysplasia (FCD) is a pathology that is characterized by the abnormal development of the neocortex. Indeed, a wide range of abnormalities in the cortical mantle have been associated with this pathology, including cytoarchitectonic alterations and the presence of dysmorphic neurons, balloon cells and ectopic neurons in the white matter. FCD is commonly associated with epilepsy, and hence we have studied the ultrastructure of cortical tissue resected from three subjects with intractable epilepsy secondary to cortical dysplasia to identify possible alterations in synaptic circuitry, using correlative light and electron microscopic methods. While the balloon cells found in this tissue do not appear to receive synaptic contacts, the ectopic neurons in the white matter were abnormally large and were surrounded by hypertrophic basket formations immunoreactive for the calcium-binding protein parvalbumin. Furthermore, these basket formations formed symmetrical (inhibitory) synapses with both the somata and the proximal portion of the dendrites of these giant ectopic neurons. A quantitative analysis revealed that in the dysplastic tissue, the density of excitatory and inhibitory synapses was different from that of the normal adjacent cortex. Both increases and decreases in synaptic density were observed, as well as changes in the proportion of excitatory and inhibitory synapses. However, we could not establish a common pattern of changes, either in the same patients or between different patients. These results suggest that cortical dysplasia leads to multiple changes in excitatory and inhibitory synaptic circuits. We discuss the possible relationship between these alterations and epilepsy, bearing in mind the possible limitations that preclude the extrapolation of the results to the whole population of epileptic patients with dysplastic neocortex.

Management of leishmanial osteolytic lesions in a hypothyroid dog by partial tarsal arthrodesis

A five-year-old male boxer, previously diagnosed with leishmaniasis and hypothyroidism, had gradually become unable to bear weight on its left hindlimb. Physical examination revealed a left popliteal lymphadenopathy, mild crepitus, and severe swelling of the left tarsal joint, a radiographic examination of which revealed severe bone destruction of the talus and a periosteal reaction of the calcaneus. Laboratory findings and serological tests suggested an active leishmanial infection, and a Leishmania species was identified by direct cytology of a sample from the osteolytic area and by indirect immunohistochemistry of a bone biopsy. The dog's condition improved when it was treated with meglumine antimonate and allopurinol. Because of the large osteolytic area and the increased use of the affected leg, a partial tarsal arthrodesis was performed to prevent a fracture. Five months after the surgery, the osteolytic area had healed completely and the calcaneus periosteal reaction had disappeared.

Comparative haematology and chemistry of endangered lizards (Gallotia species) in the Canary Islands

Blood samples were taken from the ventral coccygeal vein of 15 El Hierro giant lizards (Gallotia simonyi) (seven females and eight males), six La Gomera giant lizards (Gallotia bravoana) (four males and two females) and four Tenerife giant lizards (Gallotia intermedia) (two males and two females), and 31 blood parameters were measured. Among the haematological parameters there were significant differences between the three species in heterophils, azurophils and lymphocytes, but no significant differences in red blood cell count, white blood cell count, haemoglobin, packed-cell volume, monocytes, eosinophils and basophils. In terms of blood chemistry there were significant differences between the three species in cholesterol, triglycerides, glucose, sodium, chloride, urea, uric acid, total proteins, prealbumin, albumin and gamma globulins, but no significant differences in calcium, potassium, aspartate aminotransferase, alanine aminotransferase, creatine kinase, bile acids, alpha-1 and alpha-2 globulins and beta globulins.

[The natural history of sperm cleareance after vasectomy]

OBJECTIVE

To study the time required to obtain a negative sperm analysis after vasectomy.

MATERIAL AND METHODS

We reviewed 239 consecutive vasectomies performed between september 1998 and september 1999. All of them were done in an ambulatory basis. Follow up interval was 41-853 days (mean 144, median 104). The first semen analysis was requested between 1 and 6 months after the surgical procedure. If the sample still showed spermatozoa, then a new one was requested every two months. Probability of becoming azoospermic was studied with Kaplan-Meier curves.

RESULTS

Persistent spermatozoa could be found in 31 patients (13%) at the end of follow-up. Despite having a positive semen analysis, 10 patients (4.2%) discontinued medical visits. Time required to obtain a negative sperm count ranged from 58 to 362 days (mean 133, median 99). The probability of being azoospermic 200 and 260 days after vasectomy was 80-90% respectively. A total of 328 semen analysis were requested (range 1-4, mean 1.37, median 1)

CONCLUSIONS

A minimum of 200 days (6.6 months) are needed to clear all the spermatozoa in semen after vasectomy in 80% of our patients. Requesting the first semen sample 7 months after vasectomy is cost-effective, reducing unnecesary medical visits and increasing the rentability of this test.

Synthesis of 3a,4-dihydro-3H-[1]benzopyrano[4,3-c]isoxazoles, displaying combined 5-HT uptake inhibiting and α2-adrenoceptor antagonistic activities. Part 2: Further exploration on the cinnamyl moiety

In our previous paper we have described the synthesis of a series of 3-piperazinylmethyl-3a,4-dihydro-3H-[1]benzopyrano[4,3-c]isoxazoles, as novel dual 5-HT reuptake inhibitors and alpha2-adrenoceptor antagonists. That investigation led to the identification of the cinnamyl fragment as the most suitable moiety for combined activity. This paper outlines a further optimisation programme, focused on the exploration of the aromatic ring present on the cinnamyl moiety of compounds 1, 2 and 3.

[Stage I nonsmall cell lung cancer up to 3 cm in diameter. Prognostic factors]

OBJECTIVE

To assess the prognostic value of a series of clinicopathological variables in stage I nonsmall cell lung cancer, for tumors up to 3 cm in diameter.

PATIENTS AND METHOD

The study included 271 patients. Survival was analyzed with the Kaplan-Meier method. The Cox model was used for multivariate analysis.

RESULTS

Five- and ten-year survival were 78.63% and 67.59%, respectively. Survival did not significantly depend on sex, age, extent of resection, histology, visceral pleural invasion, level of bronchial invasion or T1 versus T2. The decade in which resection was performed did affect survival (P=.0037). Five-year survival was 58% for operations between 1970 and 1980, 77% for operations between 1981 and 1990, and 84% for operations between 1991 and 2000. Tumor size also affected survival (P=.0046), which was 86% for patients with tumors of less than or equal to 2 cm in diameter and 73% for those with tumors of more than 2 cm in diameter. In the multivariate analysis both variables entered into regression, remaining predictive of survival.

CONCLUSION

We found evidence for a prognostic stage migration (Will Rogers phenomenon) according to the decade in which resection was performed and that tumor size affected survival in our population. Finally, the current system of TNM staging fails in conforming groups of patients with a homogenous prognosis.

[Psychosurgery and the neurosurgical treatment of pain: a systematic review of the experience gained in these kinds of treatment]

INTRODUCTION

Psychosurgery and the neurochemical treatment of pain (NTP) are therapeutic options restricted to patients who show resistance to medical treatments. Surgical techniques have been perfected over the last few decades.

AIMS

Our aim was to conduct a systematic review of the studies dealing with psychosurgery and NTP reported in the literature, based on the standards of quality used in evidence-based medicine.

DEVELOPMENT

Following screening and selection, nine of the 178 papers found (MEDLINE, 1990-2002) were selected for the study: three referring to the treatment of neuropathic pain and six about the treatment of obsessive-compulsive disorder (OCD). The objectives were the therapeutic results in all cases, the study of the anatomical-functional bases in three of them and the description of side effects in five. After adapting the standards of quality used in evidence-based medicine (there are no standards for papers about surgery), one was classified in group B, six in group C and two as C-D. The three papers about the treatment of pain reported a significant improvement in the pain scales in 40-77% of patients. As regards the treatment of OCD, results showed an overall improvement of the scales in 20.4-70% of the patients with an improvement above 50%. The side effects are also described.

CONCLUSIONS

Data published support the indication of psychosurgery and NTP for selected patients with neuropathic pain and OCD. The methodological limitations of the papers prevent us from drawing conclusions about the other diseases for which these techniques have been indicated.

[Treatment of a case of essential tremor with subthalamic stimulation]

INTRODUCTION

Chronic stimulation of the subthalamic nucleus (STN) has proved itself to be useful in treating Parkinson's disease and especially in dealing with the tremor suffered by patients. Yet there is very little experience to support the use of STN as an alternative therapy in non Parkinsonian tremors.

CASE REPORT

Our study considered the case of a patient who had been diagnosed as suffering from drug resistant essential tremor which was predominant in the distal region of the upper right limb and was treated by unilateral stimulation of the STN.

RESULTS

The patient's clinical state improved significantly from the first weeks onwards. After a year and a half of therapy, the patient had achieved a stable improvement of 82.4% on the tremor scale and medication was reduced by 41.7%.

CONCLUSIONS

SNT stimulation appears as a suitable target for the treatment of drug resistant essential tremor.

[Voltage sources analysis in studies with foramen ovale electrodes]

INTRODUCTION

Paroxysmal activity in medial temporal lobe epilepsy is originated in either hippocampal or parahippocampal regions. This activity can be directly recorded by foramen ovale electrodes. That paroxysmal activity will start from irritative or ictal areas. However, anatomo-functional relations between both regions are still debated.

OBJECTIVE

We describe a new physical very simple model which allows to directly analysis the anatomo-physiological relations between sources for interictal and ictal areas.

RESULTS

1) The mathematical model allows to fit with minimum error and great precision the voltage sources originated from monopoles. 2) We can obtain this degree of precision with a matrix using an internodal distance of 0.1 mm (300x200 nodes) 3) Triplets of potentials with double sources with equal or specially with inverse charges have bigger error than monopolar charges. 4) Fitting real data obtained from a patient shows an error of 0.29 +/- 0.17% for interictal and 0.54 +/- 1.22% and 2.84 +/- 3.00% for two seizures (mean +/- SD).

CONCLUSIONS

This model allows directly to know the relative anatomo-physiological relations between interictal and ictal sources in MTLE, which have a very important implications so for patho-physiological as therapeutics and outcome implications.

Synthesis of 3a,4-dihydro-3H-[1]benzopyrano[4,3-c]isoxazoles, displaying combined 5-HT uptake inhibiting and alpha(2)-adrenoceptor antagonistic activities: a novel series of potential antidepressants

The synthesis of a series of novel 3-piperazinylmethyl-3a,4-dihydro-3H-[1]benzopyrano[4,3-c]isoxazoles as novel dual 5-HT reuptake inhibitors and alpha(2)-adrenoceptor antagonists is described. Their affinity at the three different human alpha(2)-adrenoceptor subtypes and the 5-HT transporter site is reported. The in vivo activity of the compounds was measured in two different assays: (1). inhibition of pCA-induced excitation, which evaluates the ability to block the central 5-HT transporter, and (2). inhibition of xylazine-induced loss of righting, which evaluates the ability to block central alpha(2)-adrenoceptors.

[Emergency lung transplantation]

INTRODUCTION

Lung donors are scarce and lung transplantation resources limited, leading to a need to look at transplants in terms of efficiency. Because emergency transplants (C-0) are assumed to yield poor results, most countries do not perform them on a regular basis. Spain, however does accept the concept of emergency lung transplantation for patients who are on waiting lists. We assess outcome for our patients who have received scheduled and emergency transplants.

MATERIAL AND METHOD

The survival of patients receiving lung transplants in our service from 1992 through 2001 was studied using, Kaplan-Meier, Cox regression and chi-squared statistical analyses. We compared outcome and perioperative mortality (over 30 days) for scheduled versus C-0 procedures, analyzing the influence of certain variables (age, sex, emergency status, type of transplant, mechanical ventilation and use of extracorporeal membrane oxygenation).

RESULTS

Eleven of 183 lung transplants were C-0 and 172 were scheduled. Forty-one were single-lung and 142 were double-lung transplants. Perioperative mortality was 36.4% for emergency procedures and 8.7% for scheduled procedures (p = 0.0035). Survival was significantly better for scheduled patients than for C-0 patients (p = 0.0032), although outcome was similar when perioperative mortality was not taken into account (58.16% vs. 57.14% at 5 years for scheduled and C-0 patients, respectively).

CONCLUSIONS

Long-term survival after lung transplantation shows that the procedure is effective and efficient in C-0 patients, in spite of perioperative risk, provided the patient has been adequately monitored.

Isolated primary Langerhans' cell histiocytosis of central nervous system

Solitary eosinophilic granuloma that involves the CNS is an uncommon lesion and most frequently affects the hypothalamus. We report a new and rare case of solitary eosinophilic granuloma of the left temporal lobe in a patient without systemic disease. The diagnosis was confirmed by electron microscopy and immuohistochemical techniques. The treatment of choice is surgical resection. There is a better prognosis in comparison with cases accompanied by systemic disease.

[Biophysical foundations of magnetoencephalograhy]

OBJECTIVE

It is sought to expose in a simple but rigorous way the physical, neurobiological and methodological foundations of the magnetoencephalography (MEG).

DEVELOPMENT

We start from the basic properties of the classical electromagnetism, analyzing in detail the concepts of electric and magnetic fields, the Maxwell s equations and the multipolar development of potentials. All these tools are very important to know the peculiarities of the MEG studies. Later on, they are reviewed very briefly the different types of potentials generated by the neurons and their implication in the MEG. Lastly, some necessary technical characteristics will be commented for detection of the very weak neuromagnetic fields. It is shortly exposed the concept of tunnel effect, in one that detection systems used at the present time are based (SQUID).

CONCLUSION

MEG is a very promising recent technique that is used in epilepsy studies, evoked potentials and other functional pathologies. Its utility in clinic continues being even controversial. However, it is fundamental to know the mechanisms that justify their use in order to know better their benefits and limitations.

Survival and risk model for stage IB non-small cell lung cancer

BACKGROUND

The aim of this work is to estimate the prognostic value of a set of clinical-pathological factors in patients resected for non-small cell lung cancer (NSCLC) and classified as stage IB, in order to create a prognostic model for establishing risk groups, and to validate that model.

METHODS

Among 637 patients resected and classified as stage IB, we analyzed sex, age, symptoms, location, type of resection, cell type, histology, and tumor size. The Kaplan-Meier method was used to estimate the survival. The results were compared using the log-rank test. All the significant variables from this univariable method were then included in a multivariable method of estimation of the proportional risk for survival data developed by Cox, using the variables selected, a regression model was developed for accurately predicting survival. To validate the predictive capability of the regression model, we randomly divided our patients into training and test subsets, containing 322 and 315 cases, respectively.

RESULTS

The overall 5-year survival rate of the series was 60%. The cell type, the squamous or non-squamous and the tumor size showed a significant influence on survival in the univariable analysis, while, according to the Cox model, only the tumor size and the squamous or non-squamous type entered into regression. Hazard rates were calculated for each patient. The mean risk was 0.87 +/- 0.25 (range 30-1.94). The series was divided into three risk groups (low, intermediate, and high risk) according to the fitted hazard rates, using cut-off points (one standard deviation from the mean). The 5-year survival rates were 85, 59, and 44%, respectively. To validate the model, we repeated the analysis for training and test subsets. Only the tumor size had a significant influence on survival in the univariable analysis. Using the Cox model, also the tumor size entered into regression. The mean risk was 0.79 +/- 0.29 (range 0.09-2.12). Cut-off points were 0.50 and 1.08 for the low, intermediate, and high-risk groups. The 5-year survival rates were 83, 58, and 40%, respectively. We validated the regression model obtained in the training subset by demonstrating its capacity in identifying risk groups in the test subset. The 5-year survival rates were 83, 61, and 49.5% for the low, intermediate, and high-risk groups, respectively (P = 0.0104).

CONCLUSIONS

Stage IB does not succeed in configuring a group of patients with a homogeneous prognosis, as there is a wide variability in a 5-year survival. The estimation of prognosis derived from a multivariable analysis can obviate the limitations of the actual staging system for NSCLC.

Magnetic resonance imaging in the diagnosis of Fournier's gangrene

Magnetic resonance imaging and ultrasound are the imaging modalities recommended in the early diagnosis of Fournier's gangrene. Because of the high mortality of this inflammatory disease early diagnosis is essential to initiate adequate surgical and medical treatment. In the clinical literature only a handful of cases, in which diagnosis of Fournier's gangrene is based on MRI findings, have been reported; therefore, we report another case which shows the ability of MRI especially to determine the point of origin and extension of disease.

[Single-lung transplant and primary graft failure]

OBJECTIVE

To quantify primary graft failure (PGF) and its impact on perioperative and early mortality in single-lung transplant (SLT).

METHOD

We analyzed 35 SLT procedures performed using similar techniques. PGF was defined as a PaO2/FiO2 coefficient lower than 200 mmHg during the first 72 hours or ventilation assistance lasting longer than 5 days attributable to primary lung dysfunction. We defined perioperative mortality as occurring within 30 days of surgery and early mortality within 90 days.

RESULTS

Twenty-five men and 10 women received lungs, 22 for pulmonary fibrosis and 13 for emphysema; the mean age was 53.26 10.77 years. Twenty right SLTs were performed and 15 left SLTs. Twenty-nine donors were men and 6 were women, with a mean age of 29.31 12.33 years. Twenty-six died from cranial trauma, 8 from stroke and 1 from a brain tumor. The mean time of intubation was 1.69 1.35 days. The mean PaO2 was 470.71 70.82 mmHg. The mean time of ischemia was 201.77 62.64 minutes. Four patients (11.42%) developed PGF and 3 died during the perioperative period. Two additional patients died within the early postoperative period. Survival was 91.4% at one month and 85.5% at three months. The cause of donor death was the only variable that influenced the development of PGF.

CONCLUSION

We observed a low incidence of PGF and of perioperative and early mortality, with one and three month survival rates similar to those reported internationally.

[Statistical analysis of repetitive nerve stimulation test]

INTRODUCTION

Statistical properties of Repetitive Nerve Stimulation test (RNS) are studied for different variables (forth to first potentials ratio of CMAP) together with two new variables (trends of area and amplitude for series of CMAP) OBJECTIVE: To compare the variables commonly used, in order to define the best statistical properties and, in the other hand, investigate if the new variables (trends in area and amplitude) could be useful for the study of neuromuscular transmission pathology.

SUBJECTS AND METHODS

Statistical properties of voltage (V4/V1(V)), area of CMAP (V4/V1(a)) and slopes of regression lines of voltage (m(V)) and area (m(a)) measures are determined for runs of 3, 10, 15 and 20 Hz series of stimuli in 13 men and 17 women healthy volunteers.

RESULTS

1) The sample fits well to a normal distribution; 2) The variables that measure tendencies in CMAP series, can be reasonably fitted to linear regression functions; 3) Differences between sex and age have been not found; 4) Variables measuring tendencies have been the most stables, specially m(a); 5) The variable that fits better to normal distribution is m(V); 6) All variables behave linearly with respect frequency of stimulation.

CONCLUSIONS

1) Neuromuscular transmission is a particularly stable physiologic function; 2) The most used variable in clinical neurophysiology laboratories, V4/V1(V) have the worst statistical properties, showing a very significant variability; 3) Trends measures (m(a)) and m(V)) show very satisfactory statistical properties; this implies that these could be very useful for the study of neuromuscular transmission diseases.

Changes in peripheral blood leukocyte populations in pigs with natural postweaning multisystemic wasting syndrome (PMWS)

The objective of the present study was to analyze, by flow cytometry, changes in PBMC subsets in pigs having postweaning multisystemic wasting syndrome (PMWS), a new condition associated to porcine circovirus type 2 (PCV2) infection. Thirteen acutely PMWS affected pigs were selected from a farm seronegative to porcine reproductive and respiratory syndrome virus (PRRSV) and to Aujeszky's disease virus (ADV); 11 clinically healthy pigs were selected from a high health farm with no history of PMWS and free of the major swine pathogens, and used as a control group. All pigs were necropsied, and tissue samples were fixed in formalin; blood with EDTA anticoagulant was used to perform the flow cytometric analysis. PBMC were incubated with mAb against porcine CD3, CD4, CD8, CD25, CD45, IgM, SWC3, and SLA-Class II. Flow cytometric analysis showed substantial changes in leukocyte subsets in the peripheral blood of PMWS-affected pigs, which were characterized by an increase of monocytes, a reduction of T (mainly CD4(+)) and B-lymphocytes, and the presence of low-density immature granulocytes. Altogether, these changes would suggest an inability of acutely PMWS-affected pigs to mount an effective immune response.

[Model of mortality risk in stage I non-small cell bronchogenic carcinoma]

OBJECTIVE

To develop and validate a mortality risk model for patients with resected stage I non-small cell bronchogenic carcinoma (NSCBC).

PATIENTS AND METHOD

Tumors from 798 patients with diagnoses of NSCBC were resected and classified in stage I. The Kaplan-Meier method and Cox's proportional hazard model were used to analyze the influence of clinical and pathologic variables on survival.

RESULTS

Univariate analysis revealed that age (p = 0.0461), symptoms (p = 0.0383), histology (p = 0.0489) and tumor size (p = 0.0002) and invasion (p = 0.0010) affected survival. Size (p = 0.0000) and age (p = 0.0269) were entered into multivariate analysis. Each patient's risk was estimated by applying the regression equation derived from multivariate analysis; the mean was 1.47 +/- 0.31 (range 0.68 to 2.92). The series was divided into three groups by degree of risk (low, intermediate and high), establishing the cutoff points at 1.16 and 1.78 (standard deviation of the mean). Five-year survival rates were 85%, 62% and 46%, respectively (p = 0.0000). To validate the model's predictive capacity, the series was divided randomly into two groups: the study group with 403 patients and the validation group with 395. Age (p = 0.0295), symptoms (p = 0.0396), tumor size (p = 0.0010) and invasion (p = 0.0010) affected survival in the univariate analysis. Size (p = 0.0000) and age (p = 0.0358) were entered into Cox's model. Mean risk was 1.94 +/- 0.36 (range 0.98 to 3.32). The series was divided into three risk groups, with cut-off points established at 1.58 and 2.30. Five year survival rates were 90%, 62% and 46% for the low, intermediate and high risk groups, respectively (p = 0.0000). The same model proved able to identify risk when applied to the validation group, in which five-year survival rates were 78%, 61% and 48%, respectively (p = 0.0000).

CONCLUSIONS

Risk models can identify patient subgroups, potentially influenced by co-adjuvant treatment, as well as facilitate comparison of patient series.