Showing papers by "British Hospital published in 2011"

Obsessive-compulsive symptoms in primary focal dystonia: a controlled study.

Abstract: Primary focal dystonia is an idiopathic neurological disorder causing involuntary muscle contraction. Its pathophysiology probably involves the basal ganglia and cortical-basal pathways. Primary dystonia appears to be associated with significant obsessive-compulsive symptoms, but evidence remains scarce and contradictory. We addressed the following research questions: (1) Do primary dystonia patients have high obsessive-compulsive symptom scores? (2) Are these symptoms more severe in dystonia than in controls with equivalent peripheral neurological disorders? and (3) Is psychopathology different in botulinum toxin-treated and -untreated dystonia patients? This work was a cross-sectional, descriptive, controlled study comprising 45 consecutive patients with primary focal dystonia (i.e., blepharospasm, spasmodic torticollis, or writer's cramp) 46 consecutive patients with hemifacial spasm, cervical spondylarthropathy, or carpal tunnel syndrome, and 30 healthy volunteers. Assessment included the DSM-IV based psychiatric interview, Symptom Checklist 90R, Yale-Brown Obsessive-Compulsive Scale and Checklist, and the Unified Dystonia Rating Scale. Dystonia patients had higher Yale-Brown Obsessive-Compulsive Symptom scores than both control groups. Dystonia patients with obsessive-compulsive symptom scores above cut-off for clinical significance predominantly developed hygiene-related symptoms. Major depression and generalized anxiety disorder were the most frequent psychiatric diagnoses in primary focal dystonia. Obsessive-compulsive disorder frequency was 6.7%. Primary focal dystonia patients have higher obsessive-compulsive symptom scores than individuals with similar functional disabilities resulting from other neurological disorders, suggesting that obsessive-compulsive symptoms in dystonia are not reactive to chronic disability. Dystonic muscle contractions and obsessive-compulsive symptoms may share a common neurobiological basis related to cortical-basal dysfunction. Psychopathology, especially obsessive-compulsive symptoms, should be actively explored and treated in primary focal dystonia.

Clinical characteristics of positional vertigo after mild head trauma.

Abstract: Conclusion: This study showed that a population with benign paroxysmal positional vertigo related to mild head trauma (BPPVAT) was younger and more frequently presented with bilateral canalithiasis...

Balance in Parkinson's disease patients changing the visual input

Abstract: The description of the postural responses in Parkinson's disease patients when visual information changes from a stable to a moving visual field analyzing the impact on balance in these patients. METHODS (CLINICAL): Limits of Stability, Body center of pressure and balance functional reserve were measured by means of the force platform in 24 Parkinson´s patients in stages 1 and 2 of the Boher classification and 19 volunteers as a control group. Both groups were stimulated with 1-Static visual field and 2-horizontal optokinetic stimulation using a virtual reality system. Postural responses were analyzed using the inverted pendulum as mathematical model. RESULTS: While the control group didn't show significant differences on the postural control between the two sensory conditions (COP p=0.0017, BFR p=0.0025), Parkinson's patients presented significant differences in the area of the center of pressure and the balance functional reserve values between static visual field and optokinetic stimulation. (COP p=0.0017, BFR p=0.0025). CONCLUSIONS: The results support the hypothesis about the influence of the changes in the visual information in triggering balance control disorders in Parkinson's patients. It is discussed the interest of these fact in the assessment and the rehabilitation programs of this disease.

Detection and molecular characterization of sporadic cases of acute human hepatitis E virus infection in Uruguay

Abstract: In developing countries, hepatitis E virus (HEV) infection is a public-health concern because it causes epidemics and waterborne outbreaks. In South America, few HEV strains have been characterized at the molecular level. We report the detection and molecular analysis of the first set of sporadic cases of autochthonous human genotype 3 HEV infection in Uruguay.

Influence of DFNB1 status on expressive language in deaf children with cochlear implants.

Abstract: ObjectiveThe objective of this study was to compare the language growth of children with connexin-related deafness (DFNB1) who received cochlear implants versus the language growth of implanted children with non-DFNB1 deafness.Study DesignA prospective longitudinal observational study and analysis.S

Syncope Caused by Huge Hiatal Hernia

Abstract: A 84-year-old white female had a brief loss of consciousness while playing bridge. A few minutes before the episode she had eaten pizza and significant amount of carbonated soft drinks. After recovery, her friends noticed that she was alert, but pale and sweating. Upon arrival at the emergency room, sitting blood pressure was 160/60 mmHg with a normal sinus rhythm. A chest X-Ray was performed, which was essential to make the diagnosis. The X-Ray showed a large retrocardiac opacity with air and liquid level compatible with a giant hiatus hernia. After a copious snack the hiatal hernia compressed the left atrium, decreasing the left cardiac output, elucidating the mechanism of the syncopal episode. In patients presenting with swallow syncope (particularly after a copious meal, validating the importance of a careful history), a chest X-Ray should be always be performed.

Commentary: The sandwich technique to preserve the hypogastric artery during EVAR.

Abstract: Compromise of the distal common iliac artery (CIA) represents a problem to the operator performing endovascular aneurysm repair (EVAR) of the abdominal aorta or/and the iliac arteries. Distal CIA landing zones need to be long enough to secure fixation and sealing. Among the most common techniques to prevent retrograde flow from the internal iliac artery (IIA) when an aortic endograft needs to be extended to the external iliac artery (EIA), coverage of the ostium or proximal embolization using coils or occluders is better tolerated than more extensive coil embolization with occlusion of the branches. The latter is accompanied by more frequent buttock claudication and other complications. Occlusion of one IIA is generally well tolerated, although some patients complain of temporary or permanent hip claudication. Bilateral IIA occlusion, however, is accompanied by higher incidences of buttock claudication and erectile dysfunction and sometimes life-threatening complications, such as colon ischemia. In a review of 634 patients in whom unilateral or bilateral hypogastric artery occlusions were performed, buttock claudication occurred in 28% of the patients and new erectile dysfunction in 17%. Differences in the incidence of complications were not statistically significant between unilateral or bilateral occlusions in this series. Every interventionist would agree that preservation of the IIAs when possible and affordable is desirable. Other methods of preserving the IIA are (1) surgical bypass or reimplantation of the IIA onto the EIA, (2) retrograde endograft implantation in the IIA from the EIA, or (3) antegrade implantation in the IIA from the proximal endograft; the latter 2 techniques need a femorofemoral bypass to restore flow to the ipsilateral common femoral artery. Placement of a side branch off the endograft in the IIA is a useful procedure but entails a somewhat complicated technique that cannot be performed in tortuous anatomy or when the CIA is ,18 mm in diameter. In addition, the device is expensive and not readily available. The technique presented by Dr. Lobato in this issue of JEVT represents a potential step forward in the preservation of IIA flow using readily available devices and a relatively simple procedure. Cost is also an issue, and the sandwich technique is less costly than a bifurcated iliac device. Cannulating the IIA from above, as needed for the sandwich technique, is relatively simple, and advancing an endograft from the upper extremity is not complicated. Sealing the commissural angles is apparently achievable using the sandwich technique as oversizing of the limbs and endografts in relation to the diameter of the main graft will produce tight apposition of the components. The 6-cm overlap of the covered stent with the limb of the aortic endograft in addition to the oversizing of the components could be enough to seal both the endograft and the covered stent. Obviously, long-term followup is needed to verify this assumption.