Prognostic significance of acute postoperative seizures in extra-temporal lobe epilepsy surgery

ObjectiveThis study aims to assess the prognostic value of acute postoperative seizures (APOS) in patients surgically treated for drug-resistant extra-temporal lobe (ET) epilepsy.MethodsWe studied 77 consecutive patients with ET epilepsy who underwent epilepsy surgery and were followed up for at least 2 years (mean duration of follow-up 6.2 years, range 2–14). Medical charts were reviewed to identify APOS, defined as ictal events with the exception of auras occurring within the first 7 days after surgery. Seizure outcome was determined at annual intervals. Patients who were in Engel Class I at the last contact were classified as having a favourable outcome.ResultsSeizure outcome was favourable in 47 patients (61%). The occurrence of APOS and incompleteness of resection were found to be independently associated with unfavourable outcome in a multiple regression model including all preoperative factors identified as outcome predictors in univariate analysis. Duration of illness was the only independent preoperative predictor of APOS.ConclusionsOur study suggests that APOS may predict long-term outcome in patients undergoing resective surgery for ET epilepsy. Given some study limitations, our findings should be regarded as preliminary and need confirmation from future larger, prospective, multicentre studies.SignificanceCaution may be required in the clinical management of patients experiencing APOS.     

Diagnosis, assessment and management of delusional jealousy in Parkinson’s disease with and without dementia

Patients with Parkinson’s disease (PD) may present delusional jealousy (DJ). In a previous cross-sectional prevalence study we identified 15 cognitively preserved and five demented PD patients with DJ. The current study aimed at evaluating their clinical (motor and non-motor) characteristics and the pharmacological treatments associated with DJ, and its subsequent pharmacological management. Patients were assessed by neurologists and psychiatrists using the Hoehn and Yahr scale, the Unified Parkinson’s Disease Rating Scale, the Brief Psychiatric Rating Scale, the Beck Depression Inventory, the Hamilton Anxiety Scale and the Neuropsychiatric Inventory. Efficacy of DJ management was evaluated in follow-up visits. All patients were in therapy with dopamine agonists. A subgroup of five cognitively preserved patients developed DJ after a short period of treatment of therapy with dopamine agonists, while other patients developed DJ after a longer period of dopaminergic treatment. Psychiatric comorbidities were common in cognitively preserved and in demented patients. The pharmacological management included the interruption of dopamine agonists in two patients and the reduction of dopamine agonist dose plus the use of antipsychotics in other patients. These clinical data suggest that the management of medicated PD patients should include investigation for the presence of DJ and the evaluation of clinical characteristics potentially relevant to the prevention or the early recognition of delusions.     

Comparing two types of augmentative and alternative communication systems for children with autism

This study compared acquisition and preference for two types of augmentative and alternative communication (AAC) systems in three pre-schoolers with autism. Acquisition of requesting behaviour using a picture-exchange system vs a voice-output communication aide (VOCA) was compared in an alternating treatments design. Following acquisition, both ACC systems were simultaneously available and the child could select which one of the two systems to use. There was little difference between picture-exchange and VOCA in terms of acquisition rates. Two children demonstrated a consistent preference for picture-exchange and the third showed a preference for the VOCA. Both speed of acquisition and system preference should be considered when designing AAC interventions for children with autism and related developmental disabilities.

Comparamos la adquisición y preferencia en relación a dos tipos de sistemas (AAC) de comunicación alternativa y aumentativa en 3 preescolares con autismo. Se comparó la adquisición de un comportamiento solicitado a través del uso de un sistema de intercambio de dibujos contra una ayuda de comunicación de producción de voz (VOCA), en un diseño de tratamiento alternativo. Después de la adquisición ambos sistemas AAC estuvieron disponibles en forma simultánea, y el niño podía seleccionar cuál de los dos sistemas usar. Hubo poca diferencia entre el intercambio de dibujos y VOCA en término de tasas de adquisición. Dos niños demostraron una preferencia consistente para el intercambio de dibujos y el tercero demostró una preferencia por la VOCA. Tanto la velocidad de adquisición como la preferencia por un sistema deberán ser consideradas cuando se diseñen intervenciones con AAC para niños con autismo y discapacidades en el desarrollo relacionadas.

Palabras Clave: comunicación alternativa y aumentativa, intercambio de dibujos, ayudas de comunicación de producción de la voz, adquisición, autismo.     

Hepatic encephalopathy and health-related quality of life

The impact of overt hepatic encephalopathy on health-related quality of life is well defined, but it remains to be demonstrated how much the presence of minimal hepatic encephalopathy (MHE) might impair patients' perceived health status. MHE reduces cognitive abilities, with specific impairment in manual abilities, which can lead to a depressed mood that impairs perceived health status. Therefore, all subjects with cirrhosis should be systematically screened for MHE by validated tools. Early detection and treatment is mandatory to improve the quality of life of patients with advanced cirrhosis, their social isolation, and their daily lives.     

No higher risk for colorectal cancer in atrophic gastritis-related hypergastrinemia

BackgroundAtrophic gastritis of the corporal mucosa is a frequent cause of hypergastrinemia. Hypergastrinemia is implicated in colorectal cancer development.AimTo assess whether hypergastrinemic atrophic gastritis is associated with a higher risk of neoplastic colorectal lesions.MethodsAmong 441 hypergastrinemic atrophic gastritis patients, 160 who were aged >40 and underwent colonoscopy for anaemia, diarrhoea or colorectal cancer-screening were retrospectively selected. Each patient was age- and gender-matched with a normogastrinemic control with healthy stomach. Controls had colonoscopy, gastroscopy with biopsies and gastrin assessment.Results160 hypergastrinemic atrophic gastritis patients and 160 controls were included. 28 atrophic gastritis patients and 36 controls had neoplastic colorectal lesions (p = 0.33). Patients and controls did not differ for frequency of colorectal adenomas (10.6% vs. 13.1%, p = 0.60) or cancer (6.9% vs. 9.4%, p = 0.54). Hypergastrinemic atrophic gastritis was not associated with a higher probability of developing colorectal cancer (OR 1.03, 95% CI 0.34–3.16). Age >50 years (OR 3.86) but not hypergastrinemia (OR 0.61) was associated with colorectal cancer.ConclusionsHypergastrinemic atrophic gastritis is not associated with higher risk for colorectal cancer. Atrophic gastritis-related hypergastrinemia is not associated with an increased risk of neoplastic colorectal lesions. Closer surveillance of colonic neoplasia in atrophic gastritis patients seems not appropriate.     

Penile reconstruction

During the most recent years, a variety of new techniques of penile reconstruction have been described in the literature. This paper focuses on the most recent advances in male genital reconstruction after trauma, excision of benign and malignant disease, in gender reassignment surgery and aphallia with emphasis on surgical technique, cosmetic and functional outcome.