Prognostic significance of surgical margins in transoral CO2 laser microsurgery for T1-T4 pharyngo-laryngeal cancers.

Histological affected or close margin is an adverse factor in conventional surgery of larynx-hypopharynx cancer. Our objective was to analyze the relevance of the margins in transoral laser microsurgery (TLM). A retrospective study of 357 consecutive patients with cancer of the larynx and hypopharynx (T1-T4) treated with TLM.

Outcome of pregnancy in women with type 1 diabetes intensively treated with continuous subcutaneous insulin infusion or conventional therapy. A case-control study.

The aim was to evaluate and compare the outcome of pregnancies of women with type 1 diabetes (T1D) intensively treated with continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI). Twenty-nine women with T1D receiving CSII during pregnancy as intensive insulin therapy (27 started CSII during pregnancy planning while 2 started CSII during the 1st month of gestation) were matched for age, duration of T1D, White's classification, BMI before gestation, parity and HbA1c before pregnancy with 29 women treated with MDI. Metabolic control and acute complications were registered including ketoacidosis and severe hypoglycaemic episodes, and the development of hypertension induced by pregnancy and pre-eclampsia.

Eating-induced facial myoclonic dystonia probably due to a putaminal lesion.

Myoclonic dystonia is considered a form of dystonia. We present the unusual case of a 36-year-old woman with HIV infection, who developed left facial myoclonic dystonia, triggered by eating in the setting of probable progressive multifocal leukoencephalopathy involving the contralateral basal ganglia.

Isolated frontal disequilibrium as presenting form of anti-Hu paraneoplastic encephalomyelitis.

Anti-Hu encephalomyelitis is one of the most frequent paraneoplastic syndromes, classically presenting with diffuse neurological involvement. We report a 69-year-old man presenting with a three-month isolated, progressive gait disorder with normal neurological examination, except for loss of balance and gait failure reminding frontal disequilibrium, only accompanied by a very mild rigidity of his right foot. MRI of the brain showed hyperintensities in both amygdale and left putamen.

G2019S LRRK2 mutation causing Parkinson's disease without Lewy bodies.

The G2019S leucine-rich repeat kinase 2 gene (LRRK2) mutation has been identified in a significant proportion of familial and sporadic cases of Parkinson's disease (PD). Until now, information on the neuropathological changes associated with the G2019S LRRK2 mutation has been sparse. We report a 77-year-old patient who presented with a 14 year history of PD but, unexpectedly, histopathological examination disclosed mild neuronal loss in the substantia nigra without alpha-synuclein, tau or ubiquitin cytoplasmic inclusions.

[Cost-utility analysis of insulin pumps compared to multiple daily doses of insulin in patients with type 1 diabetes mellitus in Spain].

Background: The use of continuous subcutaneous insulin infusion (CSII) for treating Type I diabetes mellitus (DM1) has been related to better metabolic control compared it to daily multiple insulin injections (DMI) and thus to a lowering of the related costs. However, this therapy is now being used to a lesser extent due, at least partially, to the higher initial cost of purchase. This study is aimed at estimating the clinical and economic consequences of using CSII as compared to DMI by means of a cost-utility analysis.

Dystonia in Parkinson's disease.

Dystonia can occasionally be found in idiopathic Parkinson's disease. It is very uncommon in untreated patients and is more frequently seen as a complication of its treatment. In this review, the various types of dystonia occurring in PD, the differential diagnosis with other parkinsonian syndromes associated with dystonia and treatments available are revised.

Screening for amnestic mild cognitive impairment and early Alzheimer's disease with M@T (Memory Alteration Test) in the primary care population.

Objectives: To design and validate a new screening test for amnestic Mild Cognitive Impairment (A-MCI) and early stage Alzheimer's disease (AD).

Methods: We develop a verbal episodic and semantic memory test: the Memory Alteration Test (M@T). Discriminative validity was assessed in a population sample of 400 aged individuals from primary care population centres in Barcelona, Spain, 50 patients with A-MCI according to Petersen et al.

[Young adult onset diabetes mellitus. Clinical differences between MODY-3 and type 2 diabetes mellitus].

Background And Objective: The aim of our study was to evaluate the clinical and metabolic characteristics of type 2 diabetes diagnosed in young adults (T2DYA) and in subjects with mutations in HNF-1* gene.

Patients And Method: We included 8 subjects diagnosed of MODY-3 (3 women) at ages 25-45. They were matched (1/2) by gender and age of diagnosis with 16 (6 women) T2DYA.

Prognostic significance of the white coat hypertension in patients with type 1 diabetes mellitus.

Despite the high prevalence of white coat hypertension (WCH) in diabetes mellitus and the evidence that hypertension is a clear risk factor for the development of microalbuminuria (MA) in these patients, there is no information on the long-term prognostic significance of this condition in the diabetic population. We studied the evolution of 40 patients with type 1 diabetes mellitus (Type 1 DM). Twenty patients with WCH (office blood pressure> or =140/90mmHg associated with mean daytime blood pressure<135/85mmHg) classified as the WCH group and 20 patients with type 1 DM with a similar age and disease evolution, but who were normotensive, (office blood pressure<140/90mmHg associated with mean daytime blood pressure<135/85mmHg) classified as the normotensive control group.

Long-term quality of life after total laryngectomy.

Background: There is a perception that a total laryngectomy has a devastating effect on patients and their families, but only a few studies have addressed long-term quality of life (QOL) after laryngectomy.

Methods: A cross-sectional study of 49 patients more than 2 years since laryngectomy was performed with a general health status instrument (Short Form-12, version 2 [SF-12 v2.]) and a disease-specific QOL instrument (University of Washington Quality of Life questionnaire, version 4 [UW-QOL v4.

Regulatory issues.

Any medical decision generates consequences for the patient and for society. Medical practice should, therefore, be performed under the guidance of the following ethical principles: beneficence, nonmaleficence, autonomy, justice, integrity, dignity, and vulnerability. The overarching objective of clinical research is to develop knowledge to improve health, and the subjects who participate are the means to securing such knowledge.

Emotional reactions to predictive testing in Alzheimer's disease and other inherited dementias.

This work describes the reasons and emotional responses of healthy descendants after counseling for presenilin mutations in early-onset familial Alzheimer's disease (EOFAD), tau mutations in familial frontotemporal dementia (FTD), and prion mutations in fatal familial insomnia (FFI). A multidisciplinary protocol following Huntington's disease counseling guidelines and a post-test follow-up program were developed to counsel healthy descendants of affected families. The psychological consequences, anxiety levels, and depression status were assessed through validated scales before and after disclosing the information.

[Glycemic control and new prospects on insulinotherapy in diabetes mellitus type 1].

Except for contraindications, current treatment of DM1 is based on what we know as insulin intensive treatment. This modality includes the utilization of rapid insulins for controlling the postprandial hyperglycemic peaks, and insulins of intermediate or slow action with the objective of contributing some basal levels of insulin (bolus/basal type therapy). Although the intensive treatment does not avoid completely the appearance nor the progression of the microvascular complications, improvement of glycemic control reduces the risk of developing microvascular complications approximately between 35% and 75%, and its worsening diminishes the risk between 50% and 75%.

[Prognostic value of white blood cell count in acute myocardial infarction: long-term mortality].

Introduction And Objectives: Although traditionally an elevated white blood cell count (WBC), an indicator of systemic inflammation, has been accepted as part of the healing response following acute myocardial infarction (AMI), it has frequently been shown to be a predictor of adverse cardiovascular events. The present study was designed to assess the association between WBC and long-term mortality in AMI patients either with ST-segment elevation (STEMI) or without ST-segment elevation (non-STEMI). Patients and method.

Usefulness of quantitative intravenous myocardial contrast echocardiography to analyze microvasculature perfusion in patients with a recent myocardial infarction and an open infarct-related artery: comparison with intracoronary myocardial contrast echocardiography.

Aims: We analyzed the usefulness of quantitative intravenous myocardial contrast echocardiography to study microvasculature perfusion after infarction in comparison with intracoronary myocardial contrast echocardiography.

Methods And Results: Thirty-two patients with a first ST elevation myocardial infarction, single-vessel disease and an open artery (TIMI 3) were studied before discharge. Myocardial perfusion in the risk area was quantified with intracoronary and intravenous myocardial contrast echocardiography.

Multimarker risk strategy for predicting 1-month and 1-year major events in non-ST-elevation acute coronary syndromes.

Background: The aim of this study was to define the utility of the combined measurement of troponin I, myoglobin, C-reactive protein, fibrinogen, and homocysteine to predict risk in non-ST elevation acute coronary syndromes.

Methods: Troponin I, myoglobin, high-sensitivity C-reactive protein, fibrinogen, and homocysteine were measured in 557 consecutive patients admitted to our institution for non-ST elevation acute coronary syndrome. The risk for major events (death or nonfatal myocardial infarction) at first month and at first year follow-up was analyzed.

Memantine: targeting glutamate excitotoxicity in Alzheimer's disease and other dementias.

The management of dementia has changed since the development of new antidementia drugs. The benefits observed in Alzheimer's disease (AD) with selective cholinergic transmission treatments are mainly symptomatic, without clear evidence of neuroprotection. The hypothesis that glutamate-mediated neurotoxicity is involved in the pathogenesis of AD is finding increasingly more acceptance in the scientific community.

[Study of post-infarction coronary perfusion using quantitative analysis of myocardial echocardiography with intravenous injection of contrast].

Introduction And Objectives: After a myocardial infarction, damage to the microcirculation indicates a worse prognosis. We compared the usefulness of the quantitative analysis of myocardial contrast echocardiography with intravenous injection of contrast (MCE-iv) with intracoronary injection (MCE-ic) for analyzing coronary perfusion.

Patients And Method: We studied 42 patients with a first ST-elevation myocardial infarction, single-vessel disease and a patent artery (TIMI 3, stenosis < 50%).

Risk stratification in non-ST elevation acute coronary syndromes: predictive power of troponin I, C-reactive protein, fibrinogen and homocysteine.

Introduction: In acute coronary syndromes, myocardial damage markers and acute-phase reactants predict adverse cardiac events. The aim of this study was to define the fitted prognostic value of the most widely used variables of necrosis and inflammation as well as of homocysteine.

Methods And Results: Troponin I, high-sensitivity C-reactive protein, fibrinogen and homocysteine were measured in 515 consecutive patients admitted to our institution for non-ST elevation acute coronary syndrome.

Clinical characteristics, beta-cell function, HLA class II and mutations in MODY genes in non-paediatric subjects with Type 1 diabetes without pancreatic autoantibodies.

Objective: To study clinical characteristics, beta-cell function, HLA typing and mutations in the hepatocyte nuclear factor (HNF)-1alpha and HNF-4alpha genes in Type 1 diabetes mellitus (T1D) patients without pancreatic autoantibodies.

Design And Methods: Twenty patients without pancreatic autoantibodies (Ab neg) and 20 with autoantibodies (Ab pos), age/gender matched, were included (age 17-34 years). Islet cell, glutamic acid decarboxylase, tyrosine phosphatase and insulin autoantibodies, basal and stimulated C-peptide were measured.

[An invasive strategy in non-ST-segment elevation acute coronary syndromes. From large trials to the real world].

Introduction And Objectives: We report the impact on prognosis of an invasive strategy used at our center for non-ST-segment elevation acute coronary syndrome.

Patients And Method: We analyzed 504 consecutive patients with typical chest pain, electrocardiographic changes or increased troponin I serum values, who were divided into 2 cohorts: a) conservative group, 272 patients admitted between October 2001 and September 2002 and managed with a conservative strategy, and b) invasive group, 232 patients admitted between October 2002 and September 2003 for whom an invasive strategy was recommended. We recorded major events (death or reinfarction) and minor events (readmission or need for postdischarge revascularization) within a 12-week follow-up period.

CO2 laser surgery: a larynx preservation alternative for selected hypopharyngeal carcinomas.

Background: Transoral CO2 laser surgery (TLS) has demonstrated good oncologic results and low morbidity in the treatment of selected laryngeal carcinomas, but experience in hypopharyngeal carcinomas (HC) is limited. The aim of this study was to evaluate the usefulness of TLS in the treatment of selected HC.

Methods: Twenty-eight patients with HC were treated with TLS and neck dissection.

[Prognostic value of Charlson comorbidity index at 30 days and 1 year after acute myocardial infarction].

Introduction And Objectives: The Charlson comorbidity index (CCI), an indicator of comorbidity, has been used as an adjusting variable in multivariate models. Because of its prognostic value per se for cardiovascular complications after acute myocardial infarction (AMI), we sought to determine the predictive value of the CCI for all-cause mortality and recurrent AMI 30 days and 1 year after the index event.

Patients And Method: We analyzed 1035 consecutive patients admitted with the diagnosis of AMI (ST elevation=508 and non-ST elevation=527).

[Coronary risk assessment in subjects with type 2 diabetes mellitus. General population-based scores or specific scores?].

Coronary risk in patients with type 2 diabetes mellitus can be calculated using population-based scores or diabetes-specific scores. Our objective was to compare the results with both scores in a group of patients with type 2 diabetes and no history of cardiovascular disease. We analyzed the results for 101 patients aged 40 to 65 years with type 2 diabetes and no prior cardiovascular disease.