[Role of endogenous nitric oxide (NO) in pulmonary vascular adaptation to one-lung ventilation during thoracic surgery]. / Papel del óxido nítrico (NO) endógeno en la adaptación del lecho vascular pulmonar a la ventilación unilateral durante intervenciones torácicas.

To determine whether endogenous production of nitric oxide (NO) increases during one-lung lung ventilation (OLV) and to observe its possible influence on pulmonary vascular resistance (PVR). The experimental group consisted of 19 patients undergoing chest surgery with OLV, with monitoring by Swan-Ganz catheter. Hemodynamic parameters were measured and peripheral venous blood samples were taken at the start of surgery and 10 minutes after starting OLV. The control group consisted of 13 patients with comparable clinical characteristics undergoing chest surgery with conventional lung ventilation. In this group samples of peripheral venous blood were taken at the start of surgery and at a moment comparable to the sampling of the experimental group. NO was assessed by quantitative colorimetry as the concentration of nitrites in venous blood. Nitrite concentration in the experimental group was higher during OLV (12.7 +/- 10.1 muMol/ml) than initially (7.1 +/- 5.4 muMol/ml) (p < 0.05). Nitrite concentration was similar at the two moments sampled in the control group (8.7 +/- 2.8 muMol/ml at the start of surgery and 8.1 +/- 3.2 muMol/ml in the second sample taken). Mean percent increase in nitrite concentration in the experimental group was 93.7 +/- 117%; mean percent change in the control group was 3.9 +/- 23% (p < 0.001). PVR during OLV (134 +/- 45 din.s.cm-5) is lower than at the start of surgery (163 +/- 37 din.s.cm-5, p < 0.05). During OLV endogenous production of NO, measured as nitrite concentration in plasma, increases. PVR decreases, possibly because of the increase in nitrite concentration.

[Bovine cerebral cortex gangliosides in the treatment of radicular lesions (author's transl)]. / Los gangliósidos de corteza cerebral bovina en el tratamiento de las lesiones radiculares.

Bovine cerebral cortex gangliosides were given to 71 patients following surgical intervention for radicular compression of different etiologies. The extract was given for 20-25 days at daily doses of 20 mg for the first 15 days and 10 mg thereafter until completion of treatment. H reflexology was shown to be a good method for evaluating the response to therapy. Most information was gained by the use of the following parameters: AM/AH, AH/IE, and AH/number of stimulation pulses. The results have been compared with those obtained prior to surgical therapy, those collected in a series of 68 normal individuals and, finally, with those found in another series of 71 patients that were treated postoperatively with conventional measures (B vitamins, analgesics, antiinflammatory drugs, corticoids, etc.). The statistical analysis of the final data shows that the reflexologic parameters tested revert to normal quicker in the patients treated with gangliosides than in those not receiving such therapy. The authors consider the use of gangliosides of great interest in the postoperative period after surgical relief of radicular compression.

[Spinal cord compression secondary to epidural extramedullary hematopoiesis in thalassemia: a clinical case and review of literature]. / Compresión medular secundaria a hematopoyesis extramedular epidural en talasemia: caso clínico y revisión de la literatura.

INTRODUCTION: Extramedullary hematopoiesis generally occurs in a variety of hematological disorders where the normal functioning of the blood forming organs is disturbed. It is a common manifestation in thalassemia where it occurs as a compensatory phenomenon in order to combat long standing anemia. Spinal cord compression as a consequence of extramedullary hematopoiesis in the intraspinal epidural space is an extremely rare complication, though this complication has been reported more commonly in thalassemia. CLINICAL CASE: A case of spinal cord compression due to extramedullary hematopoiesis in a patient with thalassemia is reported. The patient was successfully treated with radiation therapy and blood transfusions and he made a complete clinical recovery. Development. The literature is reviewed and the efficacy of several treatments such as surgery, radiotherapy and blood transfusion therapy is discussed. Until recently surgical decompression followed by radiation therapy remained the recommended treatment. Hematopoietic tissue is particularly sensitive to the ionizing radiation and low-dose radiotherapy is enough to relieve the spinal cord compression. Blood transfusion therapy may be diagnostically and therapeutically useful in the management of this entity. CONCLUSIONS: A prompt recognition of the syndrome and early treatment with radiotherapy and blood transfusion therapy is recommended to prevent irreversible damage to the spinal cord. Surgery may be only considered in the event of progressive neurological deficit despite of radiotherapy or blood transfusion therapy.

[Intra-abdominal tumor in a young man]. / Tumor desmoide intraabdominal en un varón joven.

Desmoid tumor is a rare neoplasm with extra-abdominal location and female predilection. Anatomopatological analysis is necessary to establish the diagnosis unequivocally, but Magnetic Resonance is the no aggressive method with the best sensitivity and specificity. Surgical resection is the elective treatment yet, and prognosis is not so good as it could be expected in a benign tumor. We report a young male case without polyposis coli antecedents. When he was attended, he related only an abdominal bulk with no other symptom. An intra-abdominal mass 32 cm length per 25 cm width consistent with desmoid tumor was finally resected.

Dosage of intrathecal baclofen maintenance therapy in the spastic syndromes.

Twenty-three patients affected with severe spasticity as a result of several clinical pathologies were treated with intrathecal Baclofen and administered at a lumbar level by means of an implantable infusion system. The system allows programming of any drug dosage in a continuous infusion fashion in the subarachnoid space. The appropriate patients were selected using specific criteria and the patients were regularly reviewed regarding the level of the spasticity and functional capacity. The required daily doses were determined using a specific detailed system. The doses needed varied according to the pathologic or clinical diagnosis. The doses administered by the global method at the beginning of the treatment were 91.96 microg/day and 137.81 microg/day in the final phase. These doses were higher in patients with medullary traumatic lesion, diffuse cerebral lesion and spastic idiopathic paraparesis. Relatively mild side effects were produced by the therapeutic doses used.

[Inhalation administration of nitric oxide during selective pulmonary ventilation decreases the intrapulmonary shunt]. / La administración inhalatoria de óxido nítrico durante la ventilación pulmonar selectiva disminuye el shunt intrapulmonar.

OBJECTIVE: To assess the effects of inhaled nitric oxide (NO) on oxygenation and hemodynamics in patients undergoing lung resection surgery during one-lung ventilation (OPV). PATIENTS AND METHODS: Prospective study of 16 patients aged 62 +/- 10 years scheduled for chest surgery under combined general and epidural anesthesia. During ventilation of only one lung, NO was administered for 15 minutes. Arterial blood and mixed venous blood samples were taken for analysis of blood gases and the calculation of intrapulmonary shunt. Pulmonary and systemic hemodynamic variables were also recorded using a Swan-Ganz catheter at three times: baseline (ventilation of both lungs), OLV, and with OLV plus NO (OLV NO). RESULTS: The most relevant data consisted of a significant decrease in shunt after start of NO inhalation in comparison with the level during OLV (31.1 +/- 0.5% versus 36 +/- 0.6%; p < 0.05). Arterial oxygen pressure decreased significantly during OLV and increased after start of NO (118.9 +/- 53.6 versus 155.4 +/- 78.5 mmHg; p < 0.05). Mean pulmonary artery pressure, pulmonary and systemic vascular resistances, and cardiac index did not change with inhalation of NO. CONCLUSIONS: Inhalational administration of NO during OLV significantly improves arterial oxygenation and decreases intrapulmonary shunt during OLV, without causing hemodynamic or systemic effects.

[Comparison of ropivacaine and bupivacaine for epidural analgesia during labor]. / Estudio comparativo entre ropivacaína y bupivacaína en analgesia epidural del parto.

OBJECTIVES: To compare the analgesic efficacy and level of motor block using two local anesthetics, ropivacaine and bupivacaine, during labor. MATERIAL AND METHODS: Sixty nulliparous women were enrolled during labor after full-term pregnancies. They were randomly assigned to receive epidural analgesia with ropivacaine (group R) or bupivacaine (group B). Group R patients received 10 ml of 0.18% ropivacaine with 5 microgram/ml of fentanyl followed by continuous epidural infusion of 0.1% ropivacaine with 2 microgram/ml of fentanyl at a rate of 10 ml/h. Group B patients received 10 ml of 0.15% bupivacaine with 5 microgram/ml of fentanyl followed by continuous epidural perfusion of 0.0625% bupivacaine with 2 microgram/ml of fentanyl at the same rate. Pain intensity was assessed on a visual analog scale, motor blockade on a Bromage scale, and level of sensory block at different moments. We also recorded total doses of local anesthetic employed during continuous epidural infusion, manner of final delivery, Apgar score, degree of maternal satisfaction and side effects. RESULTS: The demographic and delivery characteristics were similar in both groups. We found no statistically significant differences between the two groups for level of motor blockade, which was nil for 29 patients (96.66%) in group R and 28 patients (93.33%) in group B. No differences in degree of pain or level of sensory block (T8-T10 in both groups) were observed. The total doses of local anesthetic used were similar at 23.7 +/- 11.6 mg in group R and 16.5 +/- 7.3 mg in group B (non-significant difference). Nor did we find differences in manner of delivery, neonatal Apgar scores, degree of maternal satisfaction or side effects. CONCLUSION: Ropivacaine and bupivacaine are equally effective for epidural analgesia during labor at the doses used and they do not cause a relevant level of motor blockade.

[Tethered cord syndrome in the adult]. / Síndrome de médula anclada en el adulto.

INTRODUCTION: The tethered cord syndrome (TCS) is a congenital malformation with a pathologic fixation of the spinal cord in the spinal canal. It presents clinically as musculoskeletal, cutaneous, urological and neurological manifestations. The diagnosis is based on the clinical manifestations and on the MRI (Magnetic Resonance Imaging) of the lumbar spine. It is usually diagnosed in childhood, but the symptoms can appear in adult life. METHOD: We reviewed all the cases of TCS in the adult diagnosed in our hospital between 1998 and 2005. The following parameters were evaluated: mean age at onset, initial symptoms, signs, MRI findings and outcome. RESULTS: Four 22 to 72 year old patients were diagnosed. The age at onset varied from 16 to 52 years old and the diagnosis took between 2 and 20 years to be established. The most frequent initial symptoms were the muscular atrophy and the motor weakness in the lower extremities. Two patients exhibited cutaneous stigmata (one had hypertrichosis and the other one a lipoma in the sacrum area) and one a partial agenesis of the sacrum. The most frequent MRI finding was a low lying cord with a lipoma in the sacrum area. In three patients the cord was detethered surgically, but only two of them improved. CONCLUSIONS: The TCS is an uncommon disease in adult, which is usually diagnosed very late in the adult. Because of its insidious and non specific symptomatology, and of its potential surgical treatment, it should be considered in the differential diagnosis of medullar syndromes and polyneuropathies.

New lineal immunoenzymatic assay for simultaneous detection of p24 antigen and HIV antibodies.

The aim of this study was to evaluate a new lineal immunoenzymatic assay for the simultaneous detection of HIV-1/HIV-2 antibodies and p24 antigen. A total of 320 serum samples were obtained from individuals infected by HIV (HIV 1, n = 183; HIV 2, n = 2), individuals with risk factors for HIV infection (n =49), recipients of multiple transfusions (n =40), and blood donors (n = 46). The Western blot for detection of HIV antibodies and an enzyme immunoassay for detection of p24 antigen, both established techniques, were used for direct comparison. In cases of recent infection, p24 antigen was generally detected at the same time by the lineal test and the established assay. The p24 antigen sensitivity was about 200 pg of HIV antigen per milliliter. The results seem to indicate that the new test could be used with sufficient reliability for screening biological samples (sensitivity, 99.5%; specificity, 94.8%). Use of the lineal immunoenzymatic assay may shorten the amount of time needed to diagnose acute infection with HIV to approximately 2 weeks.

[Prospective study of newborn infants born to mothers infected with human immunodeficiency virus]. / Estudio prospectivo en recién nacidos, hijos de madres infectadas por el virus de la immunodeficiencia humana.

Perinatal transmission of Human immunodeficiency virus (HIV) from mother to child is at the present time the most important cause of AIDS in children. Since August 1985 we have observed 24 babies with anti-HIV antibodies born to HIV-infected mothers. Their present status is: 6 have symptomatic infection, 6 undetermined infection, 10 had became seronegative and 2 were lost for follow-up. Our results suggest that the risk of infection for the baby is high and the onset of symptoms relatively early. Follow-up studies in babies born to HIV-infected mothers are needed in order to classify the true risk of infection in them and the natural history of the disease.

Safety and efficacy of intrathecal baclofen infusion by implantable pump for the treatment of severe spinal spasticity: a spanish multicenter study.

Objective. To assess long-term efficacy, safety and functional benefit of intrathecal baclofen for severe spinal spasticity. Materials and Methods. This prospective multicenter study was performed in two stages: the first one consisted of an intrathecal bolus injection of baclofen, and the second of a continuous intrathecal baclofen infusion by means of an implantable pump. The sample consisted of 72 adult patients with severe spinal spasticity. Sixty-four were implanted and followed for 36 months. Muscular tone, spasms, and functional scales were evaluated before and periodically after administration of the drug, with a follow-up period of 36 months. Results. A very significant decrease in tone and spasms was observed in all cases (p < 0.001). Tolerance appeared during the first 12 months, increasing doses from a mean initial dose of 83.2 µg (range 25-200 µg) to a mean final dose of 270 µg (range 25-800 µg). Later on, efficacy remained stable, except in cases of mechanical problems of the infusion system.

Condensación pulmonar en adulto tras consulta con odontólogo / Pulmonary consolidation in adult after visiting the odontologist

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