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Search Results: 1 - 10 of 32109 matches for " Wichert-Ana "
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Ictal and interictal SPECT in patients with frontal lobe epilepsy.- This paper was awarded the ADAC Prize at the Brazilian Congress of Nuclear Medicine, Recife, Brazil, December 1998.
Wichert-Ana, Lauro.,Kato, Mery .,Terra Bustamante, Vera Cristina.,Rodrigues Velasco, Tonicarlo.
Alasbimn Journal , 1999,
Abstract: The frontal lobe seizures present variable clinical and electroencephalographic features that play some difficulties in the presurgical work-up for epilepsy. The aim of the present study is to determine the role of ictal and interictal SPECT in the localization of the epileptogenic zone in frontal lobe epilepsies. We evaluated 13 patients, 6 men and 7 women, with mean age of 16yr, and with medically intractable frontal lobe seizures. All patients were submitted to ictal SPECT and 11 also to interictal scans. Ictal SPECT studies were contributive in 54% of patients, and nonlateralized and nonlocalized, or contralateralized in the remaining patients. Interictal SPECT showed normal perfusion in 45,5% of patients, hypoperfusion localized in the suspected epileptogenic zone in 45,5%, and diffuse findings in the other 9%. We conclude that the sensitivity of ictal and interictal SPECT studies in frontal lobe epilepsies is lower than that for temporal lobe seizures, thus confirming previous data.
Hiperamonemia secundária ao uso terapêutico de ácido valpróico: relato de caso
Turcato, Marlene de Fátima;Fernandes, Regina Maria Fran?a;Wichert-Ana, Lauro;Funayama, Carolina Araújo Rodrigues;
Arquivos de Neuro-Psiquiatria , 2005, DOI: 10.1590/S0004-282X2005000200034
Abstract: valproic acid has been widely used for the treatment of epilepsy. although it is usually well tolerated, it has been associated with some side effects. a poor studied side effect is the hyperammonemia, which independs from the drug hepatotoxic action. the hyperammonemia may occurs just after the beginning or during the treatment and is characterized by vomiting, progressive impairment of consciousness, focal neurologic signs and increased seizure frequency. we report boy a 6 year-old boy who presented with hyperammonemia during the use of valproic acid within the therapeutic range. complementary investigation was negative for aminoacidopathy, organic acidemia and urea cycle disorders. the hypothesis of secondary effect to the valproic acid was reinforced by the normalization of ammonia levels after drug withdrawal. the pathogenesis of valproate-induced hyperammonemia have been discussed. we conclude that routine monitoring of ammonia blood concentration are strongly recommended in patients under valproic acid treatment.
Mortality in children with severe epilepsy: 10 years of follow-up
Terra, Vera C.;Scorza, Fulvio A.;Arida, Ricardo M.;Fernandes, Regina M.F.;Wichert-Ana, Lauro;Machado, Helio R.;Sakamoto, Américo C.;
Arquivos de Neuro-Psiquiatria , 2011, DOI: 10.1590/S0004-282X2011000600008
Abstract: epilepsy is the main neurological condition in children and adolescents. unfortunately patients with medical refractory epilepsy are more susceptible for clinical complications and death. we report a prospectively evaluated cohort of children followed for approximately 10 years. fifty-three of 1012 patients died. forty-two patients died due to epilepsy or its clinical complications and the main causes of death were pneumonia (in 16 cases), sepses (in 9 patients), status epilepticus (in 8 patients). in 11 patients cause of death was sudden unexpected death in epilepsy (sudep). mental retardation was significantly more frequent in patients who did not die from sudep. sudep may be a significant condition associated with mortality in children and adolescents with epilepsy.
Epistaxis during a generalized seizure leading to an atypical ictal SPECT finding at the skull base
Wichert-Ana, Lauro;Ferruzzi, Emerson Henklain;Alexandre Jr, Veriano;Velasco, Tonicarlo Rodrigues;Bianchin, Marino Muxfeldt;Terra-Bustamante, Vera Cristina;Kato, Mery;Santos, Antonio Carlos;Azevedo-Marques, Paulo Mazzoncini de;Oliveira, Lucas Ferrari de;Sakamoto, Américo Ceiki;
Journal of Epilepsy and Clinical Neurophysiology , 2006, DOI: 10.1590/S1676-26492006000700007
Abstract: introduction: generalized tonic-clonic seizures (gtcs) are among the most dramatic types of epileptic seizures and may be accompanied by rising blood pressure and pulse rate, physical injuries from falling, muscular convulsions, tongue biting, or aspiration pneumonia. epistaxis is an uncommon complication of generalized seizures and investigations should exclude local or systemic disorders. objective: we aim to report a 29-year-old male patient with medically intractable right temporal lobe epilepsy whose ictal spect showed a conspicuous high extracerebral accumulation of the tracer at the skull base. methods: the tracer 99mtc-ecd was injected during a gtcs complicated by simultaneous epistaxis during a long term video-electroencephalographic monitoring. results: initially, spect images showed an unexpected hot spot at the skull base suggesting pharyngeal or pituitary tumors. clinical history disclosed chronic sinusitis and rare episodes of epistaxis. white and red cells blood count, platelet count, serum biochemistry, coagulation tests, and rest arterial blood pressure were normal. computed tomography and mri excluded sinusoidal expansive or vascular lesions, head trauma, fractures or acute infections. subtracted spect disclosed a focal high concentration of the radiotracer within the left sphenoid sinus, probably related to the nose bleeding. conclusion: this is a singular case of a brain spect artifact secondary to a nasal bleeding during a generalized seizure that was misinterpreted as neoplastic disease. also, this case raises concerns about the pathophysiological relationship among epileptic seizures, nasal bleedings and chronic sinusitis.
Neurovascular coupling and functional neuroimaging in epilepsy
Becker Junior, Valesio;Wichert-Ana, Lauro;Silva, Rhelen Piantino Leit?o Ferreira da;Abud, Daniel Giansante;Escorsi-Rosset, Sara;Romcy-Pereira, Rodrigo;Leite, Jo?o Pereira;
Journal of Epilepsy and Clinical Neurophysiology , 2009, DOI: 10.1590/S1676-26492009000100007
Abstract: introduction: the neural regulation of the microcirculation is done by the functional neurovascular unit that is composed of vascular, astroglial and neuronal cells. the neurovascular unit represents the interface between the central nervous system and the vascular system. objective: this paper reviews the literature on functional neuroimaging with a particular focus on the mechanisms of the neurovascular coupling. conclusions: functional neuroimaging techniques as functional mri, spect and pet distinguish metabolic and physiological processes underlying normal and abnormal events, based on neurovascular coupling. although these techniques still have limitations in temporal and spatial resolution, they have considerably reduced the need for intracranial electrodes or invasive functional tests in the presurgical evaluation for intractable epilepsy. recently, new techniques as optical approaches (measurement of intrinsic optical signals and near infrared spectroscopy) have increased both temporal and spatial resolutions. the use of such techniques in animal models has yielded experimental evidence for a neurovascular coupling in normal and epileptic conditions.
Variable fMRI activation during two different language tasks in a patient with cognitive delay
Escorsi-Rosset, Sara;Wichert-Ana, Lauro;Bianchin, Marino Muxfeldt;Velasco, Tonicarlo Rodrigues;Sakamoto, Américo C.;Leite, Jo?o Pereira;Santos, Antonio Carlos;Araújo, Dráulio Barros de;
Arquivos de Neuro-Psiquiatria , 2007, DOI: 10.1590/S0004-282X2007000600012
Abstract: functional mri produces a more accurate localization of the language areas for epilepsy surgery purpose, but requires the patient cooperation. we report a 34 years-old woman with mental retardation who underwent two different verbal fluency tasks, category and word naming. we found a strong activation of the broca?s area in the most difficult task. we suggest that a multi-task fmri study could be successful in patients with cognitive delay.
Tratamento farmacológico das psicoses na epilepsia
Guarnieri, Ricardo;Hallak, Jaime Eduardo Cecílio;Walz, Roger;Velasco, Tonicarlo Rodrigues;Alexandre Júnior, Veriano;Terra-Bustamante, Vera Cristina;Wichert-Ana, Lauro;Sakamoto, Américo Ceiki;
Revista Brasileira de Psiquiatria , 2004, DOI: 10.1590/S1516-44462004000100014
Abstract: epilepsy is one of the main causes of functional disability, and it is usually associated to psychiatric comorbidity, such as psychosis of epilepsy (poe). poe requires more careful pharmacological treatment, considering the propensity of the antipsychotics (ap) to provoke seizures and the risk of pharmacokinetic interaction with anti-epileptic drugs (aeds). we discussed the classification and the main types of poe, as well as some characteristics of ap typical and atypical, its potential to decrease the epileptogenic threshold (et) and possible interactions between ap and aed. atypical ap, except clozapine, disclosed smaller influence on et than typical ap. regarding pharmacokinetic interactions, aeds are related with a significant increase of the ap metabolism. therefore, in spite of the risk for ap induced convulsions be dose-dependent, higher doses of ap can be necessary in the treatment of poe.
Cognitive and Surgical Outcome in Mesial Temporal Lobe Epilepsy Associated with Hippocampal Sclerosis Plus Neurocysticercosis: A Cohort Study
Marino M. Bianchin, Tonicarlo R. Velasco, Erica R. Coimbra, Ana C. Gargaro, Sara R. Escorsi-Rosset, Lauro Wichert-Ana, Vera C. Terra, Veriano Alexandre, David Araujo, Antonio Carlos dos Santos, Regina M. F. Fernandes, Jo?o A. Assirati, Carlos G. Carlotti, Jo?o P. Leite, Osvaldo M. Takayanagui, Hans J. Markowitsch, Américo C. Sakamoto
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0060949
Abstract: Background Where neurocysticercosis (NCC) is endemic, chronic calcified neurocysticercosis (cNCC) can be observed in patients with mesial temporal lobe epilepsy associated with hippocampal sclerosis (MTLE-HS). Considering that both disorders cause recurrent seizures or cognitive impairment, we evaluated if temporal lobectomy is cognitively safe and effective for seizure control in MTLE-HS plus cNCC. Methods Retrospective cohort study of neuropsychological profile and surgical outcome of 324 MTLE-HS patients submitted to temporal lobectomy, comparing the results according to the presence or absence of cNCC. Findings cNCC occurred in 126 (38.9%) of our MTLE-HS patients, a frequency higher than expected, more frequently in women than in men (O.R. = 1.66; 95% C.I. = 1.05–2.61; p = 0.03). Left-side (but not right side) surgery caused impairment in selected neuropsychological tests, but this impairment was not accentuated by the presence of cNCC. Ninety-four (74.6%) patients with MTLE-HS plus cNCC and 153 patients (77.3%) with MTLE-HS alone were Engel class I after surgery (O.R. = 1.16; 95% C.I. = 0.69–1.95; p = 0.58). However, the chances of Engel class IA were significantly lower in MTLE-HS plus cNCC than in patients with MTLE-HS alone (31.7% versus 48.5%; O.R. = 2.02; 95% C.I. = 1.27–3.23; p = 0.003). Patients with MTLE-HS plus cNCC showed higher rates of Engel class ID (15.1% versus 6.6%; O.R. = 2.50; 95% C.I. = 1.20–5.32; p = 0.012). Interpretation cNCC can be highly prevalent among MTLE-HS patients living in areas where neurocysticercosis is endemic, suggesting a cause-effect relationship between the two diseases. cNCC does not add further risk for cognitive decline after surgery in MTLE-HS patients. The rates of Engel class I outcome were very similar for the two groups; however, MTLE-HS plus cNCC patients achieved Engel IA status less frequently, and Engel ID status more frequently. Temporal lobectomy can be safely performed in most patients with MTLE-HS plus cNCC without affecting cognitive outcome. Long-term surgical seizure control in MTLE-HS plus cNCC is still satisfactory, as long as selected patients remain under medication.
Pl doyer für eine Fortentwicklung der medizinischen Ausbildungsordnung im Spannungsfeld zwischen systematischer und praktischer Ausbildung [Pro and Cons for the development of medical education by incorporating more systematic teaching into the curriculum vs. small group education with patients ]
von Wichert, Peter
GMS Zeitschrift für Medizinische Ausbildung , 2008,
Abstract: [english] This paper deals with current medical education in Germany which is thought to be too much directed to so-called practical aspects. Particularly learning in small groups is unproductive, because the teaching personnel is not experienced enough to guarantee a high level of education. The author puts forward that it is much more important to teach the scientific foundations of medicine to prepare physicians for the developments of medical science in the future. [german] Der Beitrag befasst sich mit der gegenw rtigen Approbationsordnung für rzte, die nach Auffassung des Autors nicht genügend systematische und wissenschaftliche Aspekte der Medizin beachtet, und zu gro en Wert auf eine praktische Ausbildung in Kleingruppen legt. Im Gegensatz zu einer sog. praktischen Ausbildung setzt eine wissenschaftliche, systematische Ausbildung die sp teren rzte in die Lage zukünftige Entwicklungen der Medizin kritisch in ihr Wissen zu integrieren, und ist durch die Erziehung zum kritisch-wissenschaftlichen Denken ein direkter Sicherheitsfaktor für die Patienten.
The Relation Between Acausality and Interference in Quantum-Like Bayesian Networks
Catarina Moreira,Andreas Wichert
Computer Science , 2015,
Abstract: We analyse a quantum-like Bayesian Network that puts together cause/effect relationships and semantic similarities between events. These semantic similarities constitute acausal connections according to the Synchronicity principle and provide new relationships to quantum like probabilistic graphical models. As a consequence, beliefs (or any other event) can be represented in vector spaces, in which quantum parameters are determined by the similarities that these vectors share between them. Events attached by a semantic meaning do not need to have an explanation in terms of cause and effect.
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