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They are born with each a thousand minor deformity 10
April 25 the 2005
THE NEWSPAPER
The cardiopatías, as well as harelip and cracked palate, they are the most frequent congenital malformaciones among the population, she/he informed the Mexican Institute of the Public Health (IMSS).
The boss of Medical Benefits in the Zona Juárez, José Olivares Rodríguez, said that still when there is not a precision among the causes of the congenital malformaciones, in the medical literature you coincides in attributing them to nutritious situations and sectors economically more desprotegidos.
She/he added that among the claimants of the Public Health they register between 10 and 11 cases for each a thousand alive born children.
It assured that also, there is other malformaciones related with defect of closing of the tube neural among those that are births that don't have expectations of surviving as the thorn cystic bífida or mielomeningocele, syndrome of Arnold Chiari, incefalocele and anencefalia that arrive at three for each thousand in their group born.
Each one of these malformaciones in the individual thing usually has a rate of less than one for each thousand born alive but years pass without a single case is presented, like it has happened in the last times with the anencefalia that has not registered cases, it exposed.
She/he affirmed that the IMSS carried out a study on congenital malformaciones among the population claimant in Ciudad Juárez more than ten years ago and from then on the incidence was confirming of up to 11 cases for each a thousand births.
Painful Neuropatías: fisiopatología and treatment
Alberto José Mimenza Alvarado, Juan Carlos Muñiz Álvarez, Estañol Vidal, José Polishes Francisco Téllez Zenteno, Guillermo García Ramos.
Rev Neurol Vol.39 Num.04 Pág.0364
Publication date: 16/08/2004
Revisions
Objective. The present work seeks to make a revision of the diverse mechanisms fisiopatológicos involved in the genesis of the painful neuropatía, the options diagnósticas, as well as the diverse available pharmacological treatments at the present time, official statements in diverse studies. Development. Diverse pathologies usually condition painful neuropatía, .El phenomenon desencadenante is usually a damage to fabrics that harbor nervous receivers of the pain that later on they produce a liberation of molecules proinflamatorias, and they unchain a cascade of phenomenons that you/they culminated in alterations of the central and outlying nervous system (outlying and central sensitization). These alterations usually give clinical manifestations, like they are alodinia, parestesias, among other, and that in occasions they are the only manifestation of the painful neuropatía. The diagnosis of this, in occasions, is complicated, due to the affection of thin fibers that you/they can not be identified by conventional methods of studies neurofisiológicos. A wide fármacos variety used for the treatment of the painful neuropatía that you/they involve from antidepressants tricíclicos, antiinflamatorios non esteroideos also exists, analgesic opioides, antiarrítmicos and even agents of use topic. Conclusions. The diagnosis of the neuropatía of thin fibers is usually by means of the realization of a test quantitative axonal sudomotora, quantitative sensitive tests and the skin biopsy. As for the pharmacological treatment, the anticonvulsonantes of new generation, as the gabapentina, seems to have advantages on the traditional fármacos, although their cost still represents an obstacle for its use.
Effectiveness and security of the treatment with toxin botulínica in the chronic primary migraines
Michel Volcy Gómez.
Rev Neurol Vol.39 Num.04 Pág.0388
Publication date: 16/08/2004
Revisions
Introduction. The primary migraines (CP), pathologies with high prevalencia, associate with discharges morbilidad rates and inability and high costs for the system of health. Due to the partial effectiveness of treatments preservatives, especially in chronic migraines or in contraindications for prescription, the use of toxin botulínica (TXB) it arises as promissory preventive therapy. Objective. To determine the utility and the mechanism of action of TXB in CP by means of the revision of the literature. Development. The results of the recent use of TXB in CP are contradictory, and although you lacks enough studies controlled with placebo it is suggested that she/he could have level of evidence of effectiveness and security II-III, with a bigger benefit in the chronic migraine and refractory migraine type chronic tensional, with absence of the abuse of analgesic and of psychiatric illness. The probable action mechanism in CP is due to an effect outlying antinociceptivo related with the decrease of the neuropéptidos liberation and of the transmission of impulses with indirect inhibition of centers nociceptivos in the cerebral shaft, effect seemingly intensified with repeated applications. The use of TXB has been correlated with a reduction of the intensity, graveness, cefaleas/mes number, decrease of the analgésicos/mes use and reduction of total costs of handling. The adverse effects of the treatment are minimum (<1%) and transitory. Conclusion. In spite of the results that they have demonstrated effectiveness and security of TXB like therapy prophylaxis in CP, it is not still considered as preventive treatment of first election. More studies are required to establish places, dose and application outlines (fixed in front of motive), as well as a subtype of patient beneficiaries.
Trying to figure out the secrets of the smallest cells in the brain
Scientific of UCL they have made recordings of the smallest cells in the brain, being the first work of this type that is made in the world. Their results could help to understand the secrets of the cerebelum, a center of the control important motor in the brain that, when it is damaged, it can produce disorders of the movement like ataxia and balance loss.
Paul Chadderton and their colleagues of the Instituto Wolfson for Biomedical Investigation of the UCL have used a method called " patch-clamping " to measure the activity of a single cell of the granule in an intact brain. The results are published in the last number of the noted magazine Nature.
The cells of the granule are tiny. Their size smaller –20 times that a human hair–she/he has made extremely difficult for the scientists to study them in action.
The cells of the granule constitute the layer of the entrance of the cerebelum and they receive the sensory information of the body, for example when we play with the fingers a surface.
It is thought that the cerebelum acts as a link between the senses of the body and its movements, as p.ej. to guide the finger in an easy and effective way for a surface. However, the scientists still know very little envelope the way in that the cerebelum makes its work.
The results of the group could help the investigators finally to understand more envelope the movement disorders and they could also help in the development of treatments medication " reveille " to the cerebelum, for example for the ataxia patients, a problem of coordination of movements that affects 150.000 people in the USA, and dismetria: where the patients have difficulty in regulating the speed, degree and it forces of the movement.
The group also found that the activity of cells of the granule is modulated by a mechanism of tonic inhibition". there are founded evidences that the alcohol can be added to this inhibition and, for it to affect to the functions cerebelosas, making increase the problems of uncertainty and incoordinación associated with the intoxication.
Applying the technique of the " patch-clamp " where a cellular membrane is sucked smoothly toward a glass pipette that records the small electric impulses that come from the cell, investigators of UCL they could see the granule the cellular layer when she/he works, and they confirmed this way the predictions had made more than for 30 years by neuroscientist David Marr (famous theoretical English).
Marr suggested that the layer uses an outline coding and concise to represent the entrances of the sensorial stimuli where the proportion to activate the cells is low to be able to increase to the maximum the number of models different from sensorial entrances that you/they can be represented as possible by the cerebelum. In other terms, the cells remember their activity to assure that they remain sensitive to each type of sensation that takes place in a future.
Paul Chadderton says: " We are charmed of providing the first evidence that it corroborates a theory had born for 30 years, that is: that activity in the cells of granule of the cerebelum is minimized to increase to the maximum the capacity of the brain to represent many different sensations."
"The neurociencia can advance now with this technique, only to not understand the brain well, but also to help to understand the disorders of the movement. When understanding the behavior of the signs better we will be able to design better medicines " reveille " for concrete areas of the brain.
Paul Chadderton is a student of PhD with a scholarship of Investigation in the Instituto Wolfson of UCL for the Biomedical Investigation.
Investigators from Valencia determine the keys of the cultivation of cells to regenerate injured spinal marrow
A team of investigation of Valencia has determined the keys of the cultivation of cells to regenerate injured spinal marrow, as she/he informs the Foundation The Caixa that subsidized in the year 2000 this project, directed by the Dra. Almudena Ramón, of the Institute of Biomedicina of Valencia.
This investigation project, titled Expression in the glía encircling olfatoria of molecules implied in the growth and guide axonal", she/he received a grant of 55.534 Eurus in the Convocation of Help to the Investigation in Enfermedades Neurodegenerativas of the Foundation The Caixa.
Next Thursday, the Dra. Ramón will give to know the results of his study in a scientific forum that will take place in CaixaForum, Madrid. This investigator and their team portioned of the observation that transplants of glía encircling olfatoria promoted the functional recovery of paraplegic rats and the axones regeneration in their spinal marrows". As starting point, the group thought about to characterize the molecular expression of the glía (group of cells) encircling olfatoria in rat to understand the mechanisms implied in the promotion of the axones growth (filiform continuation of a neuron).
When making it, according to these sources, she/he was discovered that these rodent cells enter in senescencia to the three weeks of being in cultivation, they lose their properties and immediately later, well they enter in a cycle of cellular death or they generate varieties tumorales". This observation has taken to settle down in rodents the precise conditions of cultivation of these cells to be transplanted in animal models of lesion and it stops studies of molecular characterization. The team established a protocol that has been adopted already by diverse international groups, and that she/he sits down the bases of later studies. Parallelly, the group has characterized the encircling glía of monkeys and established the procedure that guarantees a good source of cells for its use in the therapy of the lesions of the nervous system of primates", according to the same source.
Related Webs
Institute of Biomedicina of Valencia
Cerebral hemispheres and risk of infections
A lesion in the left hemisphere of the brain like consequence of an ictus or another cause seems to increase the risk of infections, according to an article published in the electronic edition of Annals of Neurology."
Doctors of the University Hospital of Georgetown (United States), they believe that the damage in the left hemisphere dominant –el in most of people - it seems to suppress the system inmunitario, what causes that the individual is more vulnerable to the infections.
This statement is based on the study of 22 subjected patients to surgery for the epilepsy. The intervention practiced in the left side of the brain gave place to a reduction of the quantity of cells inmunitarias, while it happened the opposite if the surgery was practiced in the other cerebral hemisphere.
The Botox can help to alleviate the chronic pain of the neck
Copied article of “The health of Reuters” (24-02-04).
SOURCE: American Journal of Pain Management, January 2004.
The injections of Botox can help to alleviate the persistent pain in the later part of the neck and in the superior part of the torso when the other treatments fail, we have preliminary results of the investigations.
In the study with 25 patients whose chronic pain was resistant to other therapies, it was seen that a single shift of injections of Botox together to physical therapy supposed relief to the pain during one month.
Although its use as reducer of the lines of the frown is broadly well-known (by means of injections in the brow), the toxin botulímica type TO--well-known as Botox--it has been used in trying to reduce strong and involuntary contractions of the muscle that take place in several medical pathologies, as the cerebral paralysis and the chronic spasms of the muscles of the eye.
The Botox is a purified form of the toxin that causes the poisoning for food in the botulism. When it is injected in small dose, the toxin botulímica helps to that relax the spastic muscles preventing to the nervous cells to liberate a product that activates the muscular contractions.
The Dra. Amy M. Lang, author of the new study, said that the investigation of the laboratory suggests that the Botox can also block certain proteins promoters of the corporal pain. Besides to relax and to lengthen the contracted muscle chronically, it can attenuate the pain signs sent to the central nervous system, she/he explained in an interview.
Lang, is one specialist it prescribes in rehabilitation of Lawrenceville, Georgia, Botox has used in the suppression of the pain during the last 10 years. She/he said that it only uses it after establishing that the problem is only in the muscle and other problem articulares and mechanics don't exist, because in this case it would prove more traditional therapies as the exercise, medication for the pain and the massage therapy.
Their study, published in the American Journal of Pain Management", it included 25 patients with pain in the neck and in the superior area of the torso that had persisted three months at least, in spite of the treatment. All they received a shift of injections of Botox in their more problematic muscles, together with physical therapy.
The patients measured their pain in a scale of 10 points when beginning the study and several times during the three months of treatment. Lang vió that the scales of the patients' pain began to go down to the four weeks of treatment, and to the eight weeks almost had disappeared totally by 40 percent, for half term.
When the muscular pain, Lang appears she/he said that the benefits of Botox can last six months or even much more time. Its ability to relax and to contract the muscle can make easier for the patients to improve with physical therapy.
Lang noticed, in this experience that many patients treaties with Botox have been able to stop to take medication to combat the pain.
In this study, three patients had felt secondary effects to the treatment, as numbness in the neck and arm, pain in the place of the injection, and possible migraine.
57% said that they would want without doubting new injections of Botox for its pain, while 10% said that they would not make it.
Remzi A. Özerdemoglu, MD *; Ensor E.Transfeldt, MD
The value of primary causes that you/they were about the siringe in escoliosis associated to Syringomyelia
I design Of the Study. Retrospective letter and radiological analysis.
Objectives. To analyze the value and the risks of the procedures neuroquirúrgicos for the syringomyelia and of the procedures of the coalition for the escoliosis.
They summarize of the data of the bottom. There are few reports on the advantage of procedures neuroquirúrgicos in escoliosis, as well as the risk of the procedures of the coalition in the escoliosis related with the syringomyelia.
Methods. They subdivided the 105 patients that had escoliosis and syringomyelia in three groups: (i) 59 patients without escoliosis or congenital myelomeningocele, (ii) 20 patients with escoliosis and congenital syringomyelia, and (iii) 26 patients with the myelomeningocele and the syringomyelia. The study evaluated: (1) the effect of any deviation craniectomy or direct suboccipital in the siringe, the bend, and the neurological state; (2) the neurological risk of
the surgery of the coalition of the escoliosis; and (3) the state of the curve after the surgery of the coalition.
Results. In group I (patient without escoliosis or congenital myelomeningocele), craniectomy suboccipital given place to the improvement of the curve in seven, getting worse in three, and any change in two, while the one
direct deviation of the siringe gave the improvement of the curve in any, it curves that gets worse in seises, and any change in two. In groups II and III, no patient had improvement of the curve after the neurosurgery. The group III had the highest index in the subsequent neurosurgery (50%). The subsequent neurosurgery was almost always craniectomy suboccipital or the detethering of the rope.
Three of 38 patients (8%) they had neurological worsening when the surgery of the coalition of the escoliosis was made without the decompression previous of the siringe.
Conclusions. In patient without myelomeningocele or congenital escoliosis, but with the malformación and the syringomyelia of Arnold-Chiari, craniectomy suboccipital gave the best occasion for the reduction of the siringe and the improvement of the escoliosis, particularly in younger children 10 years old. The deviation of the siringe didn't improve
any of the scolioses. For the siringes in patient with escoliosis or congenital myelomeningocele, none of the two procedures neuroquirúrgicos gave place to the improvement of the curve, as other causes of the escoliosis (anomalies, paralysis of the vertebra) they continued being untreated. The patients with the myelomeningocele require to multipronged surgical approach to treat all the causes of the siringe, this way reducing to the minimum
the potential necessity of the neurosurgery of the repetition. The correction of the escoliosis without the decompression previous of the siringe takes a high neurological risk
Operative technique adapted for the type malformación of Chiari of using the color Doppler Ultrasonography of Intraoperative
Thomas H. Milhorat, M.D.; Paolo A. Bolognese, M.D.
Department of the neurosurgery, the institute of Chiari, hospital of the north of the university of the bank, Jewish system of the health of the long island, Manhasset, department of New York of the neurosurgery,
OBJECTIVE: We describe an operative technique for the type malformación of Chiari of I that uses the ultrasonography of Dopplerdel color like guide to carry out later decompressions patient-especi'ficas of the grave. The technique has been used from 1999 in more than 300 operations.
METHODS: In base of anatomical and physiologic measures in real time, the following goals of the surgery were supervised: 1)descompresión appropriate of the joint cervicomedullary; 2) creation of a space retrocerebellar volume of 8 at 10 cm3; and 3) establishment of the good cerebrospinal flowing flow among those
cranial and spinal compartments
RESULTS: The size of the craniectomy was adapted to conform to with the area of the impaction cerebeloso according to that demarcated by the spaces compressed subarachnoid. A laminectomy was not carried out unless the tonsils cerebelosas was herniated under C1.
Before opening the hard one, the projection of image of the ultrasonography of Doppler of the color was invaluable in the operative's of the planning strategies. A simple duraplasty without additional steps is opposing to be treatment adapted in patient occasional with the herniation minimum tonsillar (58 millimeters). In the rest of the cases, necessary era to carry out an internal decompression that included lysis of the arachnoid and of the contraction of the tonsils cerebelosas to reach the goals of the surgery. The good cerebrospinal liquid crosses the double bottle of the hole in anesthetized patients, prone it was opposing to have the following characteristics: a maximum speed of 3 to 5 cm/s, of the bidirectional movement, and in a wave way that exhibits
vascular and breathing variations. The achievement of surgical goals was confirmed in most of the patients by postoperative neuroimaging.
Conclusion: The projection of image of the ultrasonography of Doppler of the color is an important technological advance that allows the neurosurgeon to adapt the steps of the surgery of Chiari according to variables you patient-specify. The success of this technique depends on the master of a new and sophisticated supervision modality.
Thomas H. Milhorat, M.D.; Paolo A. Bolognese, M.D.
Department of the neurosurgery, the institute of Chiari, hospital of the one north of the university of the bank, Jewish system of the health of the long island, Manhasset, department of New York of the neurosurgery, the institute of Chiari, hospital of the north of the university of the it borders, Jewish system of the health of the long island, Manhasset, New York