Time-Resolved X-ray Emission Spectroscopy and Synthetic High-Spin Model Complexes Resolve Ambiguities in Excited-State Assignments of Transition-Metal Chromophores: A Case Study of Fe-Amido Complexes.

To fully harness the potential of abundant metal coordination complex photosensitizers, a detailed understanding of the molecular properties that dictate and control the electronic excited-state population dynamics initiated by light absorption is critical. In the absence of detectable luminescence, optical transient absorption (TA) spectroscopy is the most widely employed method for interpreting electron redistribution in such excited states, particularly for those with a charge-transfer character. The assignment of excited-state TA spectral features often relies on spectroelectrochemical measurements, where the transient absorption spectrum generated by a metal-to-ligand charge-transfer (MLCT) electronic excited state, for instance, can be approximated using steady-state spectra generated by electrochemical ligand reduction and metal oxidation and accounting for the loss of absorptions by the electronic ground state. However, the reliability of this approach can be clouded when multiple electronic configurations have similar optical signatures. Using a case study of Fe(II) complexes supported by benzannulated diarylamido ligands, we highlight an example of such an ambiguity and show how time-resolved X-ray emission spectroscopy (XES) measurements can reliably assign excited states from the perspective of the metal, particularly in conjunction with accurate synthetic models of ligand-field electronic excited states, leading to a reinterpretation of the long-lived excited state as a ligand-field metal-centered quintet state. A detailed analysis of the XES data on the long-lived excited state is presented, along with a discussion of the ultrafast dynamics following the photoexcitation of low-spin Fe(II)-Namido complexes using a high-spin ground-state analogue as a spectral model for the 5T2 excited state.

Donor-Acceptor Boron-Ketoiminate Complexes with Pendent N-Heterocyclic Arms: Switched-on Luminescence through N-Heterocycle Methylation.

A series of intramolecular, donor-stabilized BF2 complexes supported by phenanthridinyl-decorated, ß-ketoiminate chelating ligand scaffolds is described, along with their characterization by spectroscopy and X-ray diffraction. In solution, the relative orientation of the pendent phenanthridinyl arm is fixed despite not coordinating to the boron center, and a well-resolved through-space interaction between a phenanthridinyl C-H and a single fluorine atom can be observed by 19F-1H NOE NMR spectroscopy. The neutral compounds are nonetheless only weakly luminescent in fluid solution, ascribed to nonradiative decay pathways enabled by rotation of the N-heterocyclic unit. Methylation of the phenanthridinyl nitrogen restricts this rotation, "switching on" comparably strong emission in solution. Modeling by density functional theory (DFT) and time-dependent DFT (TDDFT) indicates that the character of the lowest energy excitation changes upon methylation, with shallow calculated potential energy surfaces of the neutral complexes consistent with their lack of significant radiative decay.

Brightly Luminescent Platinum Complexes of N∧C-∧N Ligands Forming Six-Membered Chelate Rings: Offsetting Deleterious Ring Size Effects Using Site-Selective Benzannulation.

Brightly emissive platinum(II) complexes (λemission,max = 607-612 nm) of the type RLPtCl are reported, where RL is a cyclometalated N∧C-∧N-coordinating ligand derived from 1,3-di(2-trifluoromethyl-4-phenanthridinyl)benzene (CF3LH) or 1,3-di(2-tert-butyl-4-phenanthridinyl)benzene (tBuLH). Metathesis of the chlorido ligand can be achieved under mild conditions, enabling isolation of ionic compounds with the formula [CF3LPtL']PF6 where L' = pyridine or (4-dimethylamino)pyridine (DMAP), as well as the charge-neutral species tBuLPt(C≡C─C6H4─tBu) (C≡C─C6H4─tBu = 4-tert-butylphenylacetylido). Compared with N∧N∧N-ligated Pt(II) complexes that form 5-membered chelates, these compounds all contain 6-membered rings. Expanding the chelate ring size from 5 to 6 has been previously demonstrated to enhance emission in some N∧N∧N-coordinated Pt(II) species─for example, in complexes of 2,6-di(8-quinolinyl)pyridine vs those of 2,2':6',2″-terpyridine─but in related N∧C-∧N-coordinated species, luminescence quantum yields are significantly lower for the 6-membered chelate ring complexes. Here, we demonstrate that site-selective benzannulation of the quinolinyl side-arms can offset the deleterious effect of changing the chelate ring-size and boost photophysical properties such as the quantum yield. Density functional theory (DFT) and time-dependent DFT (TD-DFT) calculations suggest that benzannulation counterintuitively destabilizes the emissive triplet states compared to the smaller π-system, with the "imine-bridged biphenyl" form of the phenanthridinyl arm helping to buffer against larger molecular distortions, enhancing photoluminescence quantum yields up to 0.09 ± 0.02. The spontaneous formation under aerated conditions of a Pt(IV) derivative (CF3LPtCl3) is also reported, together with its molecular structure in the solid state.

(8-Amino)quinoline and (4-Amino)phenanthridine Complexes of Re(CO)3 Halides.

In this report, we present a study on the synthesis, structure, and electronics of a series of (8-amino)quinoline and (4-amino)phenanthridine complexes of Re(CO)3X, where X = Cl and Br. In all cases, the (amino)heterocycles bind as bidentate ligands, with surprisingly symmetric modes of binding based on Re-N bond lengths. Between the complexes of (8-amino)quinolines and (4-amino)phenanthridines studied in this report, we do not observe much structural variation, and remarkably similar UV-visible absorption spectra. Expansion of the π-system in the (4-amino)phenanthridine complexes does result in an increase in the intensity of the lowest energy transitions (λmax), which computational modeling suggests are more purely MLCT in character compared with the mixed π-π*/MLCT character of these transitions in the smaller (8-amino)quinoline-supported complexes. DFT and TDDFT modeling further showed that consideration of spin-orbit coupling (SOC) is essential; omitting SOC misses the π-π* contributions to λmax and is unable to accurately model the observed electronic absorption spectra.

A Systematic Review on the Effectiveness of Active Recovery Interventions on Athletic Performance of Professional-, Collegiate-, and Competitive-Level Adult Athletes.

Ortiz Jr, RO, Sinclair Elder, AJ, Elder, CL, and Dawes, JJ. A systematic review on the effectiveness of active recovery interventions on athletic performance of professional-, collegiate-, and competitive-level adult athletes. J Strength Cond Res 33(8): 2275-2287, 2019-Active recovery (AR) is a popular approach to enhancing athlete recovery from participation through physical action, and it has a perceived benefit in the recovery of athletes' enhancement of postexertional physiological status; however, it is unclear whether these recovery techniques enhance athletic performance. The purpose of this systematic review was to examine the effects of AR interventions conducted postexertion on athletic performance among professional, collegiate, and competitive adult athletes. Articles were collected via 4 online databases restricted to publication in English between 1998 and 2014. After the evaluation of overlap among the databases and abstract review, 150 potential eligible studies remained. Twenty-six articles involving 471 subjects remained after full analysis. The primary exclusion factor was absence of AR types of interest or measures of performance. The review resulted in a wide variety of findings indicating the vagueness in AR approach and outcome measures, making it difficult to draw specific conclusions. The review demonstrated that AR interventions lasting 6-10 minutes revealed consistently positive effects on performance. The appropriate intensity level of AR sessions was inconclusive in the literature; however, blood lactate clearance rate as a recovery marker appeared unreliable. The review suggests that there are positive psychological outcomes from AR sessions, a need to determine if AR should be individualized in its application, and weak evidence regarding the efficacy of postexercise AR, particularly relating to performance. Future research is needed for reliable and accurate markers for fatigue, physiological recovery, performance, and markers of intensity and duration for AR interventions.

[Cerebrospinal fluid rhinorrhea from a transclival meningocele: A case report and literature review]. / Rinorraquia secundaria a meningocele transclival. A propósito de un caso y revisión de la literatura.

The most common site of CSF leakage is the floor of the anterior cranial fossa, and less commonly in the sphenoid sinus. Only 3-4% of CSF fistulas are spontaneous. The fourth case is presented of a CSF rhinorrhea due to a transclival meningocele, an extremely rare location for these lesions, and the surgical approach. The patient is a 39-year-old male with no history of trauma, and a recent history of watery rhinorrhe and meningitis. CT scan and MRI showed clival bone defect and trans-sphenoidal transclival meningocele. The defect was repaired by transclival trans-sphenoidal endoscopic endonasal approach with good results. Despite the rarity of transclival meningocele, it is recommended to consider it in the differential diagnosis of spontaneous nasal fistulas. The endoscopic endonasal approach is a direct technique that provides satisfactory results in the resolution of CSF rhinorrhea.

[Intrathoracic migration of a ventriculoperitoneal shunt catheter: a case report]. / Migración intratorácica de catéter de derivación ventriculoperitoneal: a propósito de un caso.

BACKGROUND: The intrathoracic complications from ventriculoperitoneal shunt placement are very rare. However, they are potentially serious if not treated. CLINICAL CASE: We report the case of thoracic migration of a peritoneal catheter after ventriculoperitoneal shunt and we also review the literature references with discussion of the different mechanisms of shunt-tip migration described. No case of previous sternotomy as in our patient has been found published. CONCLUSION: All reports recommend early catheter repositioning into the peritoneal cavity after diagnosing the migration described, to prevent worse complications. Moreover, it is important to keep in mind that intrathoracic migration can happen and it is necessary to palpate the catheter continuously during passage through subcutaneous tunnelling to prevent it.

Switching on emission in Zn(II) coordination complexes by tempering Namido character.

A series of four-coordinate zinc(II) complexes is presented in which the amido vs. imino character of a ligated nitrogen donor correlates to the luminescence intensity. DFT analysis points to a distinct mechanism for this trend wherein emission can be switched on by restricting non-radiative decay pathways through the resonance-induced delocalization of amido ligand lone-pairs.

[Rosette-forming glioneuronal tumor of the fourth ventricle. Case report and literature review]. / Tumor glioneuronal formador de rosetas del cuarto ventrículo. Presentación de un caso y revisión de la literatura.

INTRODUCTION: Rosette-forming glioneuronal tumor (RGNT) of the fourth ventricle is a rare tumor that has been recently characterized. RGNT was included as a new glioneuronal tumor in 2007 by the World Health Organization (WHO) in classification of tumors of the central nervous system. Within this group we found 34 documented cases. We present a new case of RGNT of the fourth ventricle with intratumoral posttraumatic bleeding and review the existing literature of this new entity. CASE REPORT: A 30-year-old patient was admitted after suffering mild traumatic brain injury (TBI) had headache, diplopia and ataxia. Studies of computed tomography and magnetic resonance imaging revealed a tumor at the fourth ventricle with intralesional bleeding and areas of calcification. She was operated performing macroscopically complete tumor resection. Pathologic examination showed a rosette-forming glioneuronal tumor of the fourth ventricle. CONCLUSIONS: The RGNT of the fourth ventricle are rare and affect young adults. The evidence shows that the prognosis is usually favorable but there is the possibility of progression and recurrence. Intratumoral hemorrhage is a very unusual presentation that involves risk to the patient's life. Surgical resection should be careful due to the location of these lesions and their extension into critical areas, all patients regardless of extent of resection achieved require a long-term monitoring of the risk of late relapse.

General LC-MS/MS method approach to quantify therapeutic monoclonal antibodies using a common whole antibody internal standard with application to preclinical studies.

Ligand binding assays (LBAs) are widely used for therapeutic monoclonal antibody (mAb) quantification in biological samples. Major limitations are long method development times, reagent procurement, and matrix effects. LC-MS/MS methods using signature peptides are emerging as an alternative approach, which typically use a stable isotope labeled signature peptide as the internal standard (IS). However, a new IS has to be generated for every candidate, and the IS may not correct for variations at all processing steps. We have developed a general LC-MS/MS method approach employing a uniformly heavy-isotope labeled common whole mAb IS and a common immunocapture for sample processing. The method was streamlined with automation for consistency and throughput. Method qualification of four IgG(2) and four IgG(1) mAbs showed sensitivity of 0.1 µg/mL and linearity of 0.1-15 µg/mL. Quality control (QC) data of these eight mAbs were accurate and precise. The QC performance of the whole molecule labeled IS was better than those of synthetic labeled IS peptides tested. The pharmacokinetic results of two mAbs (an IgG(2) and IgG(1) candidate) dosed in rats were comparable to those of LBA. The general LC-MS/MS method approach overcomes the limitations of current methods to reduce time and resources required for preclinical studies.

Microsurgical Treatment of Ruptured Spetzler-Martin Grade 3 Right Hippocampal Arteriovenous Malformation: 3-Dimensional Operative Video.

We present a 14-yr-old male with a history of traumatic brain injury in March 2016, secondary to clonic tonic generalized seizures. CT scan showed hemorrhage at mesial temporal region in the body of right hippocampus, intraventricular hemorrhage at the level of lateral ventricles (right and left side) and fourth ventricle. After this the patient presented with pulsating right temporal headache of high intensity (VAS 10/10) that improved with common analgesics, dizziness, and clonic tonic generalized seizures despite taking Phenobarbital 100 mg/24 h. Neuropsychological assessment reveal major deficits regarding executive functions: working memory, verbal fluency, and planning abilities. Brain MRI and angiography showed AVM at the right level of hippocampus body. An intranidal aneurysm was also observed. Venous drainage was through the basal vein of Rosenthal. We planned for surgery and resection of the hippocampal AVM through the trans-T2 approach. Postoperatively, the patient was without medical complications. We present a 3-dimensional video of the microsurgical treatment for right hippocampal AVM performed through a trans-T2 approach. The patient signed the Institutional Consent Form, which allows the use of his/her images and videos for any type of medical publications in conferences and/or scientific articles.

Awake Craniotomy for Removal of Left Insular Cavernous Malformation.

The insula plays a crucial role in speech planning due to its connections with cortical and subcortical areas. Surgical management of cavernous malformation (CM) of the insula consists of total resection of the lesion and the surrounding gliosis to avoid or reduce seizures. When located in the dominant hemisphere, an awake craniotomy with intraoperative mapping reduces the risk of functional damage. The insula is covered by the operculum and has a relationship with the middle cerebral artery and its branches that run along its lateral surface. Therefore high expertise is required to manage the exposure of the insula and its complex anatomy. This video demonstrates the surgical management of a large left insular CM. A 29-year-old female with multiple CM and 7 years of partial seizures and recent onset of short memory loss. Neuroimaging showed a large left insular and planum polare CM with important mass effect and hemorrhage signs. The patient consented to surgery, and an awake pretemporal craniotomy was carried out with continuous motor evoked potential monitoring. No language function was localized in the superior temporal gyrus; therefore corticectomy of the middle portion was performed to expand the operative corridor. The vessel manipulation during wide opening of the sylvian fissure increased the risk of postoperative vasospasm and blood drain into the surgical field. The CM was exposed and completely removed without functional damage. The patient recovered from surgery without complications, and no seizures occurred at 2 months' follow-up. Postoperative imaging showed complete removal of the CM.

Surgical anatomy of the superior hypophyseal artery and its relevance for endoscopic endonasal surgery.

OBJECTIVE: The endoscopic endonasal approach has become a routine corridor to the suprasellar region. The superior hypophyseal arteries (SHAs) are intimately related to lesions in the suprasellar space, such as craniopharyngiomas and meningiomas. Here the authors investigate the surgical anatomy and variations of the SHA from the endoscopic endonasal perspective. METHODS: Thirty anatomical specimens with vascular injection were used for endoscopic endonasal dissection. The number of SHAs and their origin, course, branching, anastomoses, and areas of supply were collected and analyzed. RESULTS: A total of 110 SHAs arising from 60 internal carotid arteries (ICAs), or 1.83 SHAs per ICA (range 0-3), were found. The most proximal SHA always ran in the preinfundibular space and provided the major blood supply to the infundibulum, optic chiasm, and proximal optic nerve; it was defined as the primary SHA (pSHA). The more distal SHA(s), present in 78.3% of sides, ran in the retroinfundibular space and supplied the stalk and may also supply the tuber cinereum and optic tracts. In the two sides (3.3%) in which no SHA was present, the territory was covered by a pair of infundibular arteries originating from the posterior communicating artery. Two-thirds of the pSHAs originated proximal to the distal dural ring; half of these arose from the carotid cave portion of the ICA, whereas the other half originated proximal to the cave. Four branching patterns of the pSHA were recognized, with the most common pattern (41.7%) consisting of three or more branches with a tree-like pattern. Descending branches were absent in 25% of cases. Preinfundibular anastomoses between pSHAs were found in all specimens. Anastomoses between the pSHA and the secondary SHA (sSHA) or the infundibular arteries were found in 75% cases. CONCLUSIONS: The first SHA almost always supplies the infundibulum, optic chiasm, and proximal optic nerve and represents the pSHA. Compromising this artery can cause a visual deficit. Unilateral injury to the pSHA is less likely to cause an endocrine deficit given the artery's abundant anastomoses. A detailed understanding of the surgical anatomy of the SHA and its many variations may help surgeons when approaching challenging lesions in the suprasellar region.

Complicaciones cardiovasculares en relación con la programación fetal / Cardiovascular complications related to fetal programming

Introducción: la programación fetal ofrece nuevas perspectivas sobre el origen de las enfermedades cardiovasculares, relacionando su aparición con factores perinatales. Objetivo: exponer evidencia que vincule las alteraciones gestacionales con las enfermedades cardiovasculares en la vida adulta del feto. Metodología: búsqueda en las bases de datos EBSCO, COCHRANE, MEDLINE, PROQUEST y SciELO de los artículos de revisión e investigaciones originales en inglés publicados en los últimos diez años. Se utilizaron términos MeSH para búsqueda controlada y se evaluaron los estudios con STROBE y PRISMA según correspondía. Resultados: los hallazgos sugieren que nacer con menos de 2600 k guarda relación con diabetes mellitus (OR de 1.607 IC 95% 1.324-1.951), hipertensión arterial (OR de 1.15 IC 95% 1.043-1.288) y menor función endotelial (1.94+0.37 vs 2.68+0.41, p: 0.0001) en la adultez. La prematuridad se asocia con mayores presiones arteriales sistólicas (4.2 mmHg IC 95%; 2.8 - 5.7 p 0.001) y diastólicas (2.6 mmHg IC 95%; 1.2-4.0; p 0.001). Las alteraciones nutricionales maternas y la diabetes gestacional aumentan el riesgo de síndrome metabólico (OR 1.2 IC 95% 0.9-1.7) y sobrepeso en la edad escolar (OR 1.81 IC 95% 1.18 - 2.86). Conclusión: los resultados adversos en la gestación están relacionados con el desarrollo de enfermedades cardiovasculares en la vida adulta del feto expuesto.

Introduction: fetal programming offers new perspectives on the origin of cardiovascular diseases, relating their appearance with perinatal factors. Objective: to show the evidence associating gestational alterations with cardiovascular diseases in the offspring in adult life. Methodology: an EBSCO, COCHRANE, MEDLINE, PROQUEST and SciELO databases search of original review and research articles published in English in the last ten years was conducted. MeSH terms were used to perform a controlled search. The studies were analyzed accordingly using the STROBE and PRISMA reporting guidelines. Results:The findings suggest that a birth weight of less than 2600 kg is related with diabetes mellitus (OR = 1.607, 95% CI 1.324 to 1.951), hypertension (OR = 1.15, 95% CI 1.043 to 1.288) and impaired endothelial function (1.94+0.37 vs 2.68+0.41, p: 0.0001) in adulthood. Prematurity is related with higher systolic blood pressure (4.2 mmHg 95% CI; 2.8 to 5.7 p 0.001) and diastolic blood pressure (2.6 mmHg 95% CI; 1.2 to 4.0; p 0.001). Maternal nutritional alterations and gestational diabetes increase the risk of metabolic syndrome (OR = 1.2 95% CI 0.9 to 1.7) and overweight in school-age (OR = 1.81 95% CI 1.18 to 2.86). Conclusion: adverse results during pregnancy are related with the development of cardiovascular diseases in the exposed fetus in adult life.

Modeling the pharmacokinetic-pharmacodynamic relationship of the monoclonal anti-macaque-IL-15 antibody Hu714MuXHu in cynomolgus monkeys.

Hu714MuXHu is a recombinant chimeric murine-human monoclonal antibody directed against interleukin-15 (IL-15), a proinflammatory cytokine associated with memory CD8+ and natural killer (NK) T-cell activation and implicated in the pathogenesis of inflammatory diseases. A pharmacokinetic-pharmacodynamic (PK/PD) model was developed to describe the NK cell count reduction in cynomolgus monkeys after treatment with Hu714MuXHu. Cynomolgus monkeys were dosed with Hu714MuXHu in three studies: as a single dose at 0.1 or 1 mg·kg(-1) i.v.; weekly for 5 weeks at 0, 30, 60, or 150 mg·kg(-1) i.v. or 150 mg·kg(-1) s.c.; weekly for 13 weeks at 0, 5, 30, or 150 mg·kg(-1) s.c. Serum Hu714MuXHu concentration-time data were analyzed using noncompartmental analysis and the PK/NK cell count relationship was assessed via simultaneous PK/PD modeling. Hu714MuXHu PK was approximately dose-proportional between 0.1-150 mg·kg(-1) for i.v. and 5-150 mg·kg(-1) for s.c. administration with an elimination half-life of 12.7-18 days. Hu714MuXHu administration resulted in rapid and marked reductions in NK cell counts after the first dose which recovered fully after the serum Hu714MuXHu concentrations approached 0.1 µg·mL(-1) (assay limit of quantification). PK/PD modeled Hu714MuXHu effects on NK cells had an EC 50 of 0.09 µg·mL(-1). In summary, weekly i.v. or s.c. doses with Hu714MuXHu for up to 3 months in cynomolgus monkeys demonstrated linear PK and significant NK cell count reduction, which was described using PK/PD modeling. This approach may be used to guide investigative product dose selections for inflammatory diseases where NK cell count alterations are quantifiable.

Simultaneous analysis of multiple monoclonal antibody biotherapeutics by LC-MS/MS method in rat plasma following cassette-dosing.

We have recently developed a general liquid chromatography-tandem mass spectrometric (LC-MS/MS) method using a stable isotope-labeled (SIL) monoclonal antibody (mAb) as an internal standard (IS) for single-analyte quantification of mAb (Li et al. Anal Chem 84(3):1267-1273, 2012). The method offers an advantage over ligand binding assay in reducing the time and resources needed for bioanalytical support in preclinical stages of drug development. In this paper, we report another marked increase in assay efficiency for multi-analyte bioanalysis using unique surrogate peptides for each analyte and the strategic choice of the SIL-IS peptide. The method was qualified for the simultaneous determinations of four mAbs in rat plasma and applied to samples from discrete- and cassette-dosed rats. The pharmacokinetic parameters of the four mAbs of cassette dosing were comparable to those of discrete dosing and of enzyme-linked immunosorbent assay results. Although there may be limitations and special considerations for cassette-dosing of biologics, these results demonstrate the robust performance of the multi-analyte LC-MS/MS method allowing cassette-dosing that would ultimately reduce animal use and improve efficiency.

Ligand-binding mass spectrometry to study biotransformation of fusion protein drugs and guide immunoassay development: strategic approach and application to peptibodies targeting the thrombopoietin receptor.

The knowledge of in vivo biotransformation (e.g., proteolysis) of protein therapeutic candidates reveals structural liabilities that impact stability. This information aids the development and confirmation of ligand-binding assays with the required specificity for bioactive moieties (including intact molecule and metabolites) for appropriate PK profiling. Furthermore, the information can be used for re-engineering of constructs to remove in vivo liabilities in order to design the most stable candidates. We have developed a strategic approach of ligand-binding mass spectrometry (LBMS) to study biotransformation of fusion proteins of peptides fused to human Fc ("peptibodies") using anti-human Fc immunoaffinity capture followed by tiered mass spectrometric interrogation. LBMS offers the combined power of selectivity of ligand capture with the specificity and detailed molecular-level information of mass spectrometry. In this paper, we demonstrate the preclinical application of LBMS to three peptibodies, AMG531 (romiplostim), AMG195(linear), and AMG195(loop), that target the thrombopoietin receptor. The data show that ligand capture offers excellent sample cleanup and concentration of intact peptibodies and metabolites for subsequent query by matrix-assisted laser desorption ionization time-of-flight mass spectrometry for identification of in vivo proteolytic points. Additional higher-resolution analysis by nanoscale liquid chromatography interfaced with electrospray ionization mass spectrometry is required for identification of heterogeneous metabolites. Five proteolytic points are accurately identified for AMG531 and two for AMG195(linear), while AMG195(loop) is the most stable construct in rats. We recommend the use of LBMS to assess biotransformation and in vivo stability during early preclinical phase development for all novel fusion proteins.

Migración intratorácica de catéter de derivación ventriculoperitoneal: a propósito de un caso / Intrathoracic migration of a ventriculoperitoneal shunt catheter: a case report

Introducción: Las complicaciones intratorácicas secundarias a la colocación de una derivación ventriculoperitoneal son infrecuentes, aunque se asocian a graves consecuencias si no son tratadas de forma adecuada. Caso clínico: Describimos un caso de migración intratorácica de un catéter peritoneal tras derivación ventriculoperitoneal y se revisan las escasas referencias en la literatura, con discusión de los posibles mecanismos de penetración en la cavidad torácica. En ninguno de los artículos publicados se describe la presencia de un paciente con estereotomía previa como en nuestro caso. Conclusión: Es recomendable que tras el diagnóstico de la migración descrita, se proceda a un tratamiento precoz de reposicionamiento del catéter que evite complicaciones posteriores de mayor relevancia. Asimismo, durante la colocación de una derivación ventriculoperitoneal destacamos la importancia de la palpación permanente del catéter durante la tunelización subcutánea para evitar la migración intratorácica del mismo

Background: The intrathoracic complications from ventriculoperitoneal shunt placement are very rare. However, they are potentially serious if not treated. Clinical case: We report the case of thoracic migration of a peritoneal catheter after ventriculoperitoneal shunt and we also review the literature references with discussion of the different mechanisms of shunt-tip migration described. No case of previous sternotomy as in our patient has been found published. Conclusion: All reports recommend early catheter repositioning into the peritoneal cavity after diagnosing the migration described, to prevent worse complications. Moreover, it is important to keep in mind that intrathoracic migration can happen and it is necessary to palpate the catheter continuously during passage through subcutaneous tunnelling to prevent it

Rinorraquia secundaria a meningocele transclival. A propósito de un caso y revisión de la literatura / Cerebrospinal fluid rhinorrhea from a transclival meningocele: a case report and literature review

El lugar más común de fístulas de líquido cefalorraquídeo (LCR) es el suelo de la fosa craneal anterior, menos comúnmente el seno esfenoidal. Solo el 3-4% de fístulas de LCR son espontáneas. Nosotros presentamos el cuarto caso clínico de rinorraquia secundaria a meningocele transclival, lugar muy poco común de asiento de estas lesiones, y discutimos la vía de abordaje. Varón de 39años, sin antecedentes de traumatismo previo, historia reciente de salida de líquido transparente a través de las ventanas nasales y cuadro de meningitis. La tomografía computarizada y la resonancia magnética mostraron el defecto óseo clival y meningocele transclival. El defecto fue reparado mediante abordaje endonasal endoscópico transesfenoidal transclival con resultado favorable. A pesar de la rareza del meningocele transclival, se recomienda considerarlo en el diagnóstico diferencial de las fístulas nasales espontáneas. El abordaje endonasal endoscópico es una técnica directa que ofrece resultados satisfactorios en la resolución de rinorrea de LCR

The most common site of CSF leakage is the floor of the anterior cranial fossa, and less commonly in the sphenoid sinus. Only 3-4% of CSF fistulas are spontaneous. The fourth case is presented of a CSF rhinorrhea due to a transclival meningocele, an extremely rare location for these lesions, and the surgical approach. The patient is a 39-year-old male with no history of trauma, and a recent history of watery rhinorrhe and meningitis. CT scan and MRI showed clival bone defect and trans-sphenoidal transclival meningocele. The defect was repaired by transclival trans-sphenoidal endoscopic endonasal approach with good results. Despite the rarity of transclival meningocele, it is recommended to consider it in the differential diagnosis of spontaneous nasal fistulas. The endoscopic endonasal approach is a direct technique that provides satisfactory results in the resolution of CSF rhinorrhea