Primary extranodal non-Hodgkin lymphoma of the extrahepatic bile duct mimmicking Klatskin tumor.

This report describes one case of primary non-Hodgkin lymphoma of the extrahepatic biliary tree. The main symptom was obstructive jaundice. Cholangiography demonstrated stricture of the bile duct which resembled the appearance of cholangiocarcinoma.

[Digital EEG with brain mapping in Alzheimer's dementia and Parkinson's disease. A prospective controlled study].

In order to evaluate the EEG activity during wakefulness in senile dementia of the Alzheimer type (AD) and Parkinson's disease (PD), a prospective controlled study was performed. We compared 6 AD and 11 PD patients with a control group of 12 patients with mild to moderate major chronic depression (DSM-III-R, 1987). The median of the frequencies and the power of the posterior dominant activity was obtained in the three groups using spectral analysis.

[Temporal lobe epilepsy: report of an intact patient 26 years later without treatment].

We present the case of a 36 years old man with temporal lobe epilepsy since 10 years old without treatment, and daily complex partial seizures and weekly tonic-clonic seizures. The diagnosis was made by clinical aspects and electroencephalographic findings. CT scan was normal.

Rationalized polytherapy for epilepsy.

In the past, epilepsy was usually treated with polytherapy, but with little knowledge as to the interactions and side-effects of the combinations of the anti-epileptic drugs used. Adverse events and sparse clinical knowledge led to monotherapy becoming the treatment regime of choice. A new generation of drugs, which are well-tolerated and have few or predictable interactions, have enabled the reassessment of polytherapy for the treatment of epilepsy.

[Lateralization of the epileptogenic area by magnetic resonance imaging in temporal lobe epilepsy].

We studied 5 patients with medically refractory temporal lobe epilepsy using special methods of MRI, in order to localize the epileptogenic area. Coronal sequences were obtained with 5 mm sections from the posterior margin of the brainstem to the base of the frontal lobe using: "Inversion recovery T1" (TR = 2500 msec, TE = 26 msec, T1 = 600 msec) to analyse loss of internal structure and atrophy of the hippocampus, and morphology of the temporal lobe; and Spin-echo T2w (TR = 250 msec, TE = 120 msec) looking for abnormal high intensity signal. In two cases with left focal EEG the MRI showed atrophy, loss of internal structure and abnormal high intensity signal in the hippocampus, and atrophy of the anterior temporal lobe, ipsilaterally.

[Quantitative clinical and EEG measures of epileptogenesis in temporal lobe epilepsy].

In this controlled, prospective and partially blind study two groups of patients with temporal lobe epilepsy were evaluated, respectively with good and bad prognosis. Measurements of epileptogenesis were based on frequency of seizures, and on epiletogenic electroencephalographic abnormalities obtained from scalp electrodes over the temporal lobes. The results were analysed by non-parametric analysis of variance, comparison of groups and analysis of correlation.

Carbamazepine kinetics in cardiac patients before and during amiodarone.

Carbamazepine and amiodarone may often be used together, especially in countries where cardiomyopathies are common. In this study single doses of carbamazepine (400 mg) were given to patients with cardiac disease before and after one month of therapy with amiodarone, 400 mg daily. The kinetic profile of carbamazepine, its free fraction, and serum amiodarone, were measured at the two occasions.

Vigabatrin: clinical evidence supporting rational polytherapy in management of uncontrolled seizures.

Monotherapy is the policy for management of patients with epilepsy. With increasing knowledge of the biology of epilepsy and of the modes of action of antiepileptic drugs (AEDs), this concept must be reevaluated. When monotherapy fails to control seizures, subsequent treatment should be based on "rational pharmacology," taking into consideration the mode of action of the drugs, to provide improved efficacy with maintained tolerance and ease of administration.

Carbamazepine and phenytoin in epilepsies refractory to barbiturates: efficacy, toxicity and mental function.

A group of 51 patients with chronic cryptogenic or symptomatic localized epilepsy refractory to therapy with barbiturates underwent progressive substitution with phenytoin or carbamazepine, in standardized and randomized fashion. After drug changes were completed two thirds of the patients remained seizure free during a period of 6 months. A clearer effect of phenytoin and carbamazepine was seen on secondary generalized than on partial seizures.

[Immunosuppressive treatment in multiple sclerosis].

An open, retrospective, uncontrolled study was carried out to evaluate efficacy and tolerability of immunosuppressive therapy used in the period 1982-1990 in patients with clinically definite multiple sclerosis. Of 42 patients 43% were treated with one drug, and the others with more than one. Tolerability was evaluated after at least 6 months of therapy in 6 patients on prednisone, 26 on azathioprine, 17 on methyl-prednisolone and 15 on cyclophosphamide pulses.

Phenytoin and carbamazepine decreased oral bioavailability of praziquantel.

Antiepileptic drugs, especially carbamazepine and phenytoin, are potent liver enzyme inducers. Since praziquantel, the drug used to treat neurocysticercosis, undergoes extensive liver first-pass metabolism, we carried out a prospective study to verify whether there was a decrease in oral bioavailability induced by carbamazepine and phenytoin. Carbamazepine and phenytoin significantly decreased concentrations of praziquantel, due to increased clearance secondary to induction of first pass-liver metabolism.

Cognitive functions, epileptic syndromes and antiepileptic drugs.

Cognitive function of patients on monotherapy specific for their epileptic syndrome has been studied infrequently. We evaluated 7 patients with symptomatic localised epilepsies (SEL) on phenytoin aged 30 +/- 12 (mean +/- standard deviation) years, 8 with idiopathic generalised epilepsies on sodium valproate aged 18 +/- 4 years, 16 with SEL on carbamazepine aged 28 +/- 11 years, and 35 healthy controls aged 27 +/- 11 years. All subjects were of normal intelligence, educated appropriately to age, and led productive lives in the community.

Cognitive functions of epileptic patients on monotherapy with phenobarbitone and healthy controls.

Quantitative measurements have indicated that heredity, cerebral damage, psycho-social aspects, ictal and inter-ictal phenomena and antiepileptic drugs may interfere in the cognitive dysfunction of epileptic patients. In the present study objective methods included immediate and late recall and recognition of pictures, Stroop test and auditory selection. Twenty patients with symptomatic localized epilepsy aged 17-52 years (27 +/- 10, mean +/- sd) were compared to age and socially matched healthy controls.

[Multiple sclerosis: objective criteria of diagnosis].

The frequency of multiple sclerosis in Brasil is assumed to be lower than in some geographically comparable regions, but internationally available objective diagnostic criteria are not generally used. We have reviewed a number of such criteria and applied those of Poser and colleagues to all patients who could be examined specifically for this study; who had been under our care between 1982-87; with clinically satisfactory history, physical exam, ancillary investigations and follow-up; with enough information to warrant immunosuppressive therapy with azathioprine, methyl-prednisolone or cyclophosphamide. There were 35 (88%) females and 5 (12%) males, with clinically definite (85%), probable (10%) disease according to Poser and cols, as well as 2 patients with chronic progressive disease.

[Spinal cord infarction: clinical, electrophysiologic and laboratory diagnosis].

In the international, but more so in the latin-american, medical literature infarction of the spinal cord has been rarely described except in relationship with surgery of the abdominal aorta. The objective of this report is to describe the diagnostic approach including clinical, electrophysiological, imaging and cerebrospinal fluid criteria. With these methods 17 cases were diagnosed between 1982 and 1989, one related to surgery of the abdominal aorta.

Clinical, radiological and cerebrospinal fluid presentation of neurocysticercosis: a prospective study.

The wide clinical spectrum of neurocysticercosis has led to many attempts at clinical, radiological, CSF and other classifications. Based on an objective review of the relevant literature and on a prospective study of 42 patients with active neurocysticercosis, a new classification is proposed, based on clinical, tomographic, magnetic resonance and CSF evidence of viability of cysts. The first step is to define whether the disease is active or not.

High-dose praziquantel for neurocysticercosis: serum and CSF concentrations.

Serum and CSF concentrations of praziquantel were analyzed in 8 patients with active neurocysticercosis aged 35 +/- 16 (mean +/- sd) years, in order to determine factors that may improve the therapeutic ratio. Praziquantel was given orally at 6-h intervals for 10 days at a daily dose of 100 mg/kg. Serum concentrations were determined at 1, 2 and 4 h, and CSF concentrations at 2 h after the morning dose.

[Thymectomy and immunosuppression in myasthenia gravis: a prospective study].

Between 1982 and 1988 24 women and 6 men with myasthenia gravis were included in a prospective and standardized diagnostic and therapeutic protocol. Age varied between 10 and 74 years (34 +/- 16, mean +/- standard deviation). Three patients with the ocular form were treated with pyridostigmine.

High-dose praziquantel for neurocysticercosis: efficacy and tolerability.

Standard therapeutic regimens of praziquantel for neurocysticercosis use daily doses of 50 mg/kg for 15-21 days, with prolonged remission being achieved in 60-80% patients. In this prospective study, 100 mg/kg daily was used for 10 days in 13 patients aged 32 +/- 15 years (mean +/- SD) with severe intra-, extra-parenchymal or mixed forms of neurocysticercosis. Patients were monitored with computerized tomography and cerebrospinal fluid (CSF) examination on days 1, 5 and 10.

Slowly progressive aphasia followed by Alzheimer's dementia: a case report.

Slowly progressive aphasia has been found in 8 published cases, 2 of whom progressed over a period of years to generalized dementia. Positron emission tomography demonstrated decreased glucose metabolism in the left perisylvian region in 2 cases. We describe a patient who had slowly progressive aphasia and developed generalized Alzheimer's dementia 7 years after presentation.

Oxcarbazepine and spasticity: further observations.

The previously described anti-spastic effect of oxcarbazepine and 10,11-dihydro-10-hydroxycarbamazepine was found accidentally in 2 patients undergoing a double-blind comparative study for evaluation of antiepileptic effect. In this study oxcarbazepine was given orally in doses of 300-2700 mg daily to one patient with transverse myelitis and to two patients with multiple sclerosis, all of whom had clinically disabling spasticity in the form of difficulty in walking, lower limb rigidity, spastic contractions of the lower limbs and ankle clonus. Anti-spastic effect was observed at doses between 600-1200 mg daily and consisted in a substantial decrease in the above symptoms of spasticity.

[Diabetes mellitus as a prognostic factor in ischemic cerebrovascular diseases].

As part of a prospective study about 347 cases of ischemic cerebral vascular disease (DCVI) admitted to a general hospital 36 diabetic and 36 non-diabetic patients with similar sex, age and blood pressure were evaluated with the objective of assessing the effect of diabetes mellitus on prognosis in DCVI. All patients had various types of DCVI (thrombosis, thromboembolism or cardiac embolism). The diabetic patients had statistically longer admissions (p less than 0.

[Loading-doses of carbamazepine and diphenylhydantoin: use in high-risk patients].

Loading-doses of phenytoin (1000 mg) and carbamazepine (600 mg) were given orally respectively to 10 and 6 patients with uncontrolled epileptic seizures secondary to acute neurological disorders or alcohol withdrawal. In the phenytoin group age varied between 12-73 years and serum concentrations at 2, 4, 6, 8, 12 and 18 hours after drug administration were 7.6, 8.

[Neurofibromatosis and extensive intracranial arterial occlusive disease (moyamoya disease). Report of a case].

A 33-year-old female with neurofibromatosis and intracranial vascular lesions of the Moya-Moya type is reported. Clinical and angiographic aspects of both syndromes are discussed with respect to earlier reports of this rare association, with the conclusion that it produces slow intellectual and motor deterioration in adolescents or young adults. There are no specific guidelines to therapy, and the prognosis is mixed, some patients ceasing to progress at least for a few years.

Barbiturate-refractory epilepsy: safe schedule for therapeutic substitution.

Barbiturates are considered first line antiepileptic drugs in third world countries due to traditional and economic reasons. This prospective uncontrolled study of 52 patients aged 15 to 64 years (mean 24) demonstrates that patients who become refractory to barbiturates are mainly those with partial seizures with or without generalization or with a focal EEG abnormality (71%). Seizures tend to become refractory approximately 6 years after barbiturates were started.