Despite the introduction of new antiepileptic drugs and advances in the surgical treatment of epilepsy, an important group of patients still remains uncontrolled by any of these methods. The relatively recent introduction of vagus nerve stimulation is yet another possible treatment for refractory epilepsy. This safe, simple, and adjustable technique reduces the number of seizures and multiple publications support its increasing efficacy and effectiveness, with few adverse effects. The goal of our study is to determine the efficacy of this procedure and the factors predicting a response, particularly in the presence of a temporal lobe discharge on the video electroencephalogram (video-EEG) and magnetic resonance imaging (MRI) lesions. We undertook a retrospective study of all the patients with refractory epilepsy who underwent implantation of a vagus nerve stimulator between 2003 and 2009, and with a minimum follow-up of 6 months. The statistical analysis was done with SPSS for Windows. The stimulator was implanted in 40 patients, of whom 38 had a minimum follow-up of 6 months. In one patient, the device had to be removed due to infection, so the series comprised 37 patients. These were divided into different groups, according to the epidemiologic, clinical, radiologic, and electroencephalographic data. In addition, an analysis of the response was performed. The efficacy of the procedure was established according to the reduction in the mean seizure frequency. The baseline value of these seizures was 80.97 ± 143.59, falling to 37 ± 82.51 at the last revision. The response rate (reduction in seizures ≥ 50 %) at 6 months was 51.4 %, with 62.2 % of the patients showing this reduction at the last evaluation. Significant differences in the response were seen for the variables: baseline frequency of seizures, temporal lobe discharge on VideoEEG and MRI lesions. The mean time to response was 10 months in patients with lower rate of seizures versus 25 months of those with the higher rate (p = 0.024), and the response at 6 months was higher (p = 0.05). Patients with temporal lobe discharge alone or in combination with discharges over other regions had a mean time to response of 11 months versus 26 months in those without temporal discharge (p = 0.037). In the analysis of the MRI, we had seen that at the last revision, 82.4 % of the patients with lesion had achieved response versus 45 % without lesion (p = 0.02). Vagus nerve stimulation reduces the frequency of seizures. A temporal lobe discharge on the video-EEG is an indicator of an early response and the presence of an MRI lesion indicates a late response. Patients with fewer rates of seizures have a better prognosis.

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RESUMEN: El objetivo de este estudio fue determinar el riesgo de caries en la población infantil entre 7 y 34 meses, usuarios de un centro de atención primaria de salud en la ciudad de Osorno, ingresados al programa de Población en Control con Enfoque de Riesgo Odontológico (CERO) durante el año 2017. Expresándolo en alto o bajo riesgo. Se realizó un estudio observacional descriptivo, tomando una muestra de 135 pacientes, con edades dentro del rango en estudio, inscritos en el centro de salud e ingresados al programa. Se utilizaron las pautas diseñadas por el Ministerio de Salud e incluidas en el programa CERO, aplicándolas en una sesión, junto al examen clínico para determinar el nivel de riesgo de cada individuo. Posteriormente se sometieron los datos a análisis de estadística descriptiva. El 59 % de la población entre 7-34 meses tiene un riesgo de caries alto. El grupo con mayor riesgo es el de 12-23 meses con un 70 %. Los hombres tienen un 59 % de riesgo alto y las mujeres un 58 %. Al analizar en detalle cada variable, el "cepillado antes de dormir" fue el que con mayor frecuencia se encontraba en alto riesgo, con un 60 %, seguido del "momento de ingesta de alimentos azucarados" y el "uso de pasta con flúor", con un 56 % y 53 %, respectivamente.

Introduction: Neuroenteric cysts are a rare type of spinal tumors that result of anomalies during embryonic development. A case with a rare haemorrhagic presentation is reported.Case report: 42 years old male that shows an initial clinical picture consisting of cervical pain. Cervical Magnetic Resonance (MR) reveals a lesion intradural-extramedullar at level C2-C3. Findings are in correlation with hemorrhagic lesion in reabsorption phase. A surgical procedure is performed. Through a bilateral C2-C3 and partial C1 laminectomy the cyst was emptied. The rest of membranes are removed. The patient shows a progressively improvement. The hystopathological analyses find match neuroenteric cyst type A.Discussion: 58 cases of neuroenteric spinal cysts reported in literature are analyzed. Total excision was performed in about 34%. There was any finding about hemorrhagic presentation in neuroenteric cyst in these cases.