[Fluctuations and dyskinesias as early L-dopa-induced motor complications in severe Parkinsonian's patients].

Daily fluctuations of motor performance and dyskinesias in patients with Parkinson's disease (PD) treated with levodopa represent a difficult challenge to our understanding. We report 10 patients diagnosed of severe PD (Hoehn and Yahr: III-IV/V) treated with levodopa (range of dose: 750-900 mg/day) in single drug therapy since their diagnosis (mean time of levodopatherapy: 4.8 2.

[Urodynamics foundations: contractile potency and urethral doppler].

Objectives: To calculate the bladder softening factor, elastic constant and contractile potency.

Methods: For the analysis we considered bladder behavior like that of a spring. See articles 1 and 2 published in this issue.

Tachyphylaxis following regular use of formoterol in exercise-induced bronchospasm.

Background: Formoterol is a highly effective therapeutic agent in the prevention of exercise-induced bronchospasm (EIB). Regular use of beta-adrenergic drugs may result in a reduction in the protective effect afforded by these bronchodilators against bronchoconstrictor stimuli. It is unknown whether this effect extends to formoterol and exercise.

A chimeric anti-TNFalpha monoclonal antibody (cA2) in vivo removes TNFalpha-producing cells in Crohn's disease.

Tumor necrosis factor alpha (TNFalpha) has been described as a citokine involved in gastrointestinal mucosal inflammation in Crohn's disease. A single infusion of the chimeric mouse/human monoclonal antibody cA2 anti-TNFalpha has been established as a new therapeutical procedure. The aim of these study was to determine the effect of the monoclonal antibody cA2 on lymphocyte and monocyte TNFalpha-producing cells.

[Surgical procedures of the urinary tract and male genital organs. Rates of surgical intervention: variability and its relationship with distance and income].

Objective: To valorate the existence of the variability, in surgical rates on urinary tract and masculine genital organs, between the population of Health Centres (HC) adscribed to the Hospital of Ciudad Real. It so, quantify the influence of the distance (from Health Center to Hospital) or the income have in the variability of these rates.

Material And Method: Surgical activity of the period 1996-98.

[Spinal anesthesia: a protective factor in thromboembolic disease. A retrospective cohort study of 484 arthroplasties].

Objectives: To compare general and spinal anesthesia in the context of thromboembolic disease after orthopedic surgery in patients receiving prophylactic therapy with low molecular weight heparins.

Patients And Method: Of the 484 arthroplasties studied retrospectively, 209 involved total hip prostheses, 111 partial hip prostheses and 164 total knee prostheses. Spinal anesthesia (epidural or subarachnoid) was provided in 328 cases and general anesthesia in 156.

Pulmonary actinomycosis with thoracic soft tissue mass: a rare onset form.

Actinomycosis is unusual, and rare especially when the lung and the thoracic wall are involved. It is more frequent in immunocompromised patient. US, CT, or MRI are imaging methods of diagnosis with high sensibility to recognise the disease and are able to the management.

[Motor impairment, in patients with severe Parkinson's disease, associated with dopaminergic hyperstimulation (entacapone)].

Objective: [corrected] Entacapone was given to try to improve the motor complications in eight patients with Parkinson's disease (PD) treated chronically with levodopa, with daily severe motor fluctuations and dyskinesias.

Patients And Methods: We introduced entacapone (200 mg added to every dose of levodopa) to 8 parkinsonian patients (mean age: 68.25 +/- 2.

[Falling backward: atypical sign of iodiopathic Parkison's disease. Use of intravenous apomorphine as a diagnostic test].

Introduction: The differential diagnosis of a parkinsonian syndrome is extensive and complex. In most cases, however, a detailed clinical examination will help to differentiate between idiopathic Parkinson's disease (IPD) and other causes of parkinsonism.

Patients And Methods: 10 patients with an average age of 65.

[Alpha-1-antitrypsin in early infections after hip prosthesis surgery].

Purpose Of The Study: The aim of this work was to determine whether erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and alpha-1-antitrypsin (A1AT) levels are correlated significantly with early postoperative infectious complications after hip prosthetic surgery.

Materials And Methods: This prospective study was conducted on 100 total hip replacements performed between 1994 and 1995. ESR, CRP and A1AT were obtained before surgery then at 1, 2 and 6 weeks after surgery.

[Urodynamics fundamentals. The flow curve and the isometric phase].

Objective: To analyze the cause-effect relationship of bladder dynamics and flow rate.

Methods: A theoretical study was performed using the mathematical equations obtained by other authors.

Results: We have developed equations for bladder dynamics, flow rate and the detrusor, which is considered to act like a spring from experimental studies on anesthesized animals.

[Minimally invasive parathyroid surgery with 99mTc-sestamibi scintigraphy and probe-radioguided surgery: preliminary results].

Objective: The most common pathological finding in patients with sporadic primary hyperparathyroidism is a single adenoma. The success of parathyroid surgery is determined by the identification and removal of the responsible adenoma. The aim of our study was to minimize interventional techniques, hospital stay and overall costs of patients with parathyroid adenoma who do not require a complete neck examination.

[Urodynamics rationale. The flow curve].

Objective: To describe the mathematical representation of a common phenomenon: the urinary flow curve.

Methods: The statistical adjustment for minimum squares was the method employed in the study.

Results: A mathematical expression was obtained with a goodness of fit for each flow curve and an acceptable margin of error.

[Olfactory esthesioneuroblastoma: scintigraphic expression of somatostatin receptors].

Esthesioneuroblastoma is an uncommon tumor originating in the upper nasal cavity and constitutes 3% of all intranasal neoplasms. Few references exist about the expression of somatostatin receptors in these tumors. Our case demonstrates a good correlation between the somatostatin receptor scintigraphy and magnetic resonance imaging.

Pneumomediastinum as a complication of extraperitoneal laparoscopic inguinal hernia repair.

A 52-year-old man with left indirect groin hernia was admitted for elective inguinal repair using the totally extraperitoneal (TEP) approach. After an uneventful intubation, TEP repair of the hernia was performed with three midline trocars. Immediately after extubation, the patient noted severe chest pain.

[Merkel cell carcinoma. Utility of scintigraphy with 111In-DTPA-pentetreotide].

Merkel cell carcinoma (MCC) is an unusual malignant primary skin tumor, having a high incidence of local recurrent, and regional and distant metastasis. Due to its capacity to express somatostatin receptors, it can be detected in vivo with 111In-pentetreotide scintigraphy (Ostreoscan). We present a case of a MCC whose scintigraphy revealed regional metastases of a primary frontal cutaneous tumor that had been removed previously.

[Section of the median nerve at the wrist].

Introduction: The usefulness of neurophysiological studies of peripheral nerves depends basically on an understanding of the physiopathology, especially of the evolutionary aspects of the phenomena of reinnervation.

Clinical Case: We present the case of a girl with complete section and immediate anastomosis of the two cut ends of the median nerve, at the wrist. Sixty two days later she had unmistakable signs of reinnervation (response in the thenar eminence to an electrical stimulus of 300 uV in amplitude and 42 ms in latency, with denervation and reinnervation on the EMG of the abductor pollicis brevis muscle).

[Adrenal pseudocysts. Therapeutic attitude].

Objective: Cystic tumors of the adrenal gland are uncommon, but are being increasingly more frequently diagnosed during routine radiological evaluation as "incidentalomas". We discuss the differential diagnosis, therapeutic approach and the existing controversies concerning the management of this tumor type.

Methods: Two additional cases of adrenal pseudocyst in two women aged 47 and 38 years are presented.

[Neuronopathy due to cisplatin].

Introduction: Cisplatinum is a cytotoxic agent used in the treatment of different types of cancer. It often has side-effects, including a pure sensory syndrome with conservation of pain and temperature sense which is very disabling.

Clinical Cases: We present the case of a woman with cancer of the ovary and a man with oat cell carcinoma, who were treated with cisplatinum.