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Hospital de Órbigo, Spain

Alvarez Garcia de Quesada L.I.,Hospital Universitario Quiron | Nunez Giralda A.,Pediatra. CS Guayaba
Pediatria de Atencion Primaria | Year: 2011

Idiopathic scoliosis is a reason for consultation in both Primary Care and in Specialized Care because of the connotations that implies both orthopaedic and surgical treatment. It is defined as the coronal plane deformity greater than 10 degrees. It has a prevalence of approximately 2%. The most recent studies speak in favour of a genetic predisposition in the development of the curves. The scoliosis screening programs for diagnosis have proved expensive and ineffective. An adequate knowledge of basic exploration and natural history of the disease prevents excessive radiation exposure to children. Idiopathic scoliosis is most common in the adolescent. We need to pay special attention to the exploration of children aged 10-11. The treatment is very standardized, taking into account the type and magnitude of the curve, sex and skeletal maturity of the patient. Given these factors, an indication of the back brace is for immature curves 25 to 45 and surgery for curves that exceed 45 degrees. Current instrumentation systems allow surgery before skeletal maturity. Source

Lopez-Martin S.,Autonomous University of Madrid | Albert J.,Autonomous University of Madrid | Albert J.,Complutense University of Madrid | Fernandez-Jaen A.,Hospital Universitario Quiron | Carretie L.,Autonomous University of Madrid
Psychological Medicine | Year: 2015

Background Although both emotion and response inhibition are thought to be important in attention-deficit/hyperactivity disorder (ADHD), little is known about the neural mechanisms that underlie the interaction between these two processes in patients with this disorder. This study aimed at examining how emotional contexts affect inhibitory control in children with ADHD. Method A total of 24 ADHD children and 24 healthy comparison subjects performed a modified go/no-go task during three different emotionally laden contexts: negative, neutral and positive. To explore the timing and the underlying neural substrates of emotion-modulated response inhibition, event-related potentials were measured and further analysed both at the scalp and at the voxel level. Results Patients with ADHD showed greater activation of inhibition-related neural mechanisms (i.e. no-go P3 amplitudes and orbitofrontal cortex activity) to maintain a similar level of performance as healthy comparison subjects, especially during the emotionally arousing contexts (negative and positive). Conclusions This study provides plausible neural mechanisms for the difficulty that ADHD children have in controlling their behaviour in highly emotional situations. Such emotional contexts might increase the need for top-down inhibitory control and put ADHD children at greater risk for impulsive behaviours and emotional dysregulation. © 2015 Cambridge University Press. Source

Bermejo C.,Gabinete Medico Velazquez | Martinez-Ten P.,Delta Ultrasound Diagnostic Center in Obstetrics and Gynecology | Recio M.,Hospital Universitario Quiron | Ruiz-Lopez L.,Gabinete Medico Velazquez | And 2 more authors.
Ultrasound in Obstetrics and Gynecology | Year: 2014

Objectives To investigate the accuracy of three-dimensional ultrasound (3D-US) with respect to magnetic resonance imaging (MRI), and compared to clinical examination, in the assessment of cervix and vagina in women with uterine malformations. Methods In this prospective study, 16 patients diagnosed with uterine malformation with cervical involvement underwent 3D-US examination. The acquisition of cervical volumes was transvaginal, with four cases repeated in the peri-ovulation period, while vaginal volumes were acquired by transperineal imaging following filling of the vagina with gel. MRI was performed in 13 patients using endovaginal gel. All cases underwent clinical examination, comprising bimanual gynecological examination and speculoscopy. Diagnostic concordance of each of the methods with the gold standard was calculated. Results 3D-US cervical examinations revealed 12 cases of duplicate cervix, two of complete septate cervix and two of incomplete septate cervix. Images of the cervical canal in the peri-ovulation period were judged subjectively to be better in quality, but did not lead us to change any diagnosis. 3D-US vaginal examinations revealed four cases with a vaginal dividing wall and two with a blind hemivagina. None of the 3D-US findings contradicted the clinical findings of the cervix; however, clinically we observed two cases with vaginal dividing wall that had not been diagnosed with 3D-US. MRI diagnosed nine cases of duplicate cervix, three of complete septate cervix, one of incomplete septate cervix, five of vaginal dividing wall and two of blind hemivagina. One case diagnosed as complete septate cervix was in fact a duplicate cervix on 3D-US and on clinical examination. Compared with the gold standard, both 3D-US and MRI were highly efficient in the diagnosis of anomalies of the cervix and vagina. The overall diagnostic concordance of 3D-US with clinical examination (kappa, 0.84; 95% CI, 0.62-1) was slightly inferior to that of MRI with clinical examination (kappa, 0.9; 95% CI, 0.72-1), but this difference was not statistically significant. Conclusions The acquisition of isolated cervical volumes, without including the uterus, defines the extent of the ectocervix and the limits of the cervical canal in uterine malformations. The use of endovaginal gel makes possible the diagnosis of associated vaginal anomalies with 3D-US. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd. Source

Attention deficit hyperactivity disorder (ADHD) is a remarkably heterogeneous neurobiological disorder. This characteristic is aetiologically mediated by genetic and environmental factors. Numerous studies have shown that different genes play a moderate but complex role in the aetiology of ADHD. Significant associations have been identified with several candidate genes for this disorder, including DAT1, DRD4, DRD5, 5HTT, HTR1B or SNAP25. The neurocognitive models of ADHD have been largely based on the findings from neuroimaging studies conducted in patients with ADHD, when establishing hypotheses capable of explaining the clinical features that are observed. From a neurobiological point of view, the genetic architecture of these patients or the interaction of the above-mentioned genes should at least partially account for the neuroanatomical and neuropsychological findings observed, which explains the axiomatic antithesis in the title. Nevertheless, the results of studies into the relationship between the genotyping and the neuroimaging or psychological findings are scarce and contradictory. The methodological differences in the volumetric analyses, the sizes of the populations studied, the neuropsychological batteries that are used, the presence of previous pharmacological treatment or comorbidity could account for these results. Source

Abejon D.,Hospital Universitario Puerta Of Hierro Majadahonda | Abejon D.,Hospital Universitario Quiron | Abejon D.,Medtronic | Parodi E.,Hospital Universitario Of Mostoles | Del Saz J.,Medtronic
Pain Physician | Year: 2014

Background: Despite recent developments in implantable neurostimulation devices, the adjustment of stimulation levels to the patient's postural changes has remained a problem so far. Objective: This study was conducted with the newest rechargeable devices, in order to compare its results with the ones published from conventional systems. Study Design: It is a prospective study. Setting: In 46 patients implanted with rechargeable constant current stimulation systems we measured impedance, stimulation thresholds, therapeutic range, as well patients' satisfaction and sensation in 7 different body postures. Results: Data analysis was performed in 46 patients, whose most frequent pathologies were failed back surgery syndrome (FBSS) and complex regional pain syndrome (CRPS). The lowest amplitude needed to reach the different thresholds was always scored in the supine decubitus position, with no significant changes in the therapeutic range and impedance. For all stimulation thresholds, there is always a difference between the supine position and all other postures. No statistically significant differences with regard to patients' satisfaction and sensation were found for the different postures. Limitations: Sample sample size. Conclusion: The findings of the present work are similar to those described in previous publications that showed the relationship between postural changes and several stimulation thresholds and pulse energy. The posture which requires lower energy - and whose corresponding therapeutic range (TR) is narrower - is supine decubitus. Source

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