Dipole density of low-frequency and spike magnetic activity: a reliable procedure in presurgical evaluation of temporal lobe epilepsy.

Conventional visual analysis and dipole density analysis of magnetoencephalographic data for both spike and low-frequency magnetic activity were compared for presurgical evaluation in temporal lobe epilepsy (TLE) in a sample of 26 drug-resistant operated TLE patients. A series of logistic regression analyses were performed. Dipole density sensitivity was superior to visual localization analysis. Three separated logistic models were calculated for interictal spikes, low-frequency magnetic activity, and the combination of both measures. A combined interictal spike/low-frequency magnetic activity model predicted correctly the operated temporal lobe in all patients. Clear-cut criteria for the probability model are proposed that are valid for 92.3% of cases in the sample. The quantitative approach proposed by this study is an evidence-based model for presurgical evaluation of temporal lobe epilepsy, which improves previous magnetoencephalographic investigations and establishes working clinical criteria for patient evaluation in TLE.     

Comparison of the effects of calmidazolium, morphine and bupivacaine on N-methyl-d-aspartate- and septide-induced nociceptive behaviour

We have recently shown that spinal calmodulin inhibitors (W-7 and calmidazolium) dose-dependently inhibit the nociceptive reaction (biting, scratching, licking, BSL) evoked by intrathecal N-methyl-d-aspartate (NMDA) and septide, an agonist of the neurokinin (NK) NK₁ receptor. To compare this effect with that induced by standard analgesics, we now report a study of the effects of calmidazolium (14–420 nmol), bupivacaine (29–582 nmol) and morphine (26–260 nmol) when coadministered intrathecally with either NMDA (4 μg) or septide (0.5 μg). Calmidazolium had the highest potency for inhibiting septide-induced nociceptive behaviour, acting over a dose range of 34–130 nmol (dose eliciting a half-maximal response, ED₅₀, 67 nmol) lower than that of bupivacaine [ED₅₀ 234 (115–475) nmol]. Only the highest dose of morphine (260 nmol) inhibited septide-evoked BSL [ED₅₀=133 (69–255) nmol]. Higher doses of morphine could not be tested due to the appearance of an excitatory aversive reaction. Both calmidazolium [ED₅₀=232 (138–388) nmol] and bupivacaine [ED₅₀=123 (59–256) nmol] dose-dependently reduced NMDA-induced BSL reaching an almost maximal inhibition at the highest doses assayed (420 and 291 nmol, respectively). In contrast, morphine had less effect on NMDA-induced behaviour, inducing only a partial reduction of BSL even with the highest dose assayed (260 nmol). Overall, it can be concluded that the calmodulin inhibitor calmidazolium inhibits septide- and NMDA-evoked nociceptive behaviour with a potency and efficacy at least as high as those of morphine and bupivacaine. Received: 1 April 1998 / Accepted: 4 September 1998     

Aplicación del método de Gail de cálculo de riesgo de cáncer de mama a la población valenciana

Background

The objective of this study was to verify whether the method defined by Gail is applicable and predictive in a population of women in Valencia (Spain).

Population and methods

Of the 685 patients diagnosed with breast cancer and attended-to in 2000–2001, 186 incident cases were identified. The variables studied were obtained from a specific questionnaire which included characteristics of reproductive history, number of biopsies and contraceptive pill consumption prior to the diagnosis. Using the model of the National Surgical Adjuvant Breast and Bowel Project (NSABP), an adaptation of the Gail model, the risk of developing breast cancer at 5 years was estimated.

Results

Only 40% of those women diagnosed as having breast cancer would have been identified as a high-risk patient by the Gail method. With our population group, the method detected the elderly women with a medical history of breast cancer who developed advanced stage disease.

Conclusions

The Gail method does not adapt well to the study population of Valencia. It would be necessary to add other risk-factors to the Gail method so as to identify more patients in our area.     

Nutcracker or left renal vein compression phenomenon: multidetector computed tomography findings and clinical significance

The use of multidetector computed tomography (MDCT) in routine abdominal explorations has increased the detection of the nutcracker phenomenon, defined as left renal vein (LRV) compression by adjacent anatomic structures. The embryology and anatomy of the nutcracker phenomenon are relevant as a background for the nutcracker syndrome, a rare cause of hematuria as well as other symptoms. MDCT examples of collateral renal vein circulation (gonadal, ureteric, azygous, lumbar, capsular) and aortomesenteric (anterior) and retroaortic (posterior) nutcracker phenomena in patients with no urologic complaint are shown as well as studies performed on patients with gross hematuria of uncertain origin. Incidental observation of collateral veins draining the LRV in abdominal MDCT explorations of asymptomatic patients may be a sign of a compensating nutcracker phenomenon. Imbalance between LRV compression and development of collateral circulation may lead to symptomatic nutcracker syndrome.     

Non-alcoholic Steatohepatitis (NASH) and Hepatocellular Carcinoma

Non-alcoholic fatty liver disease (NAFLD) is characterized by an excessive accumulation of fatty acids and triglycerides within the cytoplasm of the hepatocytes of non-alcohol users. The natural history varies according to the initial histological diagnosis. A current consideration is that cryptogenic cirrhosis may be representative of a late stage of non-alcoholic steatohepatitis (NASH), which has lost its features of necroinflammatory activity and steatosis in up to 80% of patients. Since NASH is able to progress to cirrhosis, hepatocellular carcinoma (HCC) development may be an end-stage of this disease. We report below two clinical cases of patients diagnosed with NASH who developed HCC. The relationship between NAFLD and HCC is reviewed.