A new HLA-B allele, B*49:34, sequenced in a Spanish individual.

HLA-B*49:34 shows one nucleotide difference regarding B*49:01:01 at codon 66 (ATC>GTC, I66>V66).

Characterization of a novel HLA-DRB1 allele: DRB1*11:153.

HLA-DRB1*11:153 differs from DRB1*11:131 by one nucleotide at position 286 where C > A, (codon 67 CTC>ATC), resulting in an amino acid substitution, 67L>67I.

Alternaria toxins in wheat during the 2004 to 2005 Argentinean harvest.

The natural occurrence of Alternaria mycotoxins in Argentinean wheat from the zone 5 South during the 2004 to 2005 harvest was investigated in 64 wheat samples. All samples were highly contaminated with a wide range of fungal species. Alternaria was found as the main component of the mycota, with an infection percentage of 100%. Three mycotoxins produced by species of Alternaria were determined in wheat: alternariol, alternariol monomethyl ether, and tenuazonic acid. Alternariol was detected in 4 (6%) of 64 samples, with a range of 645 to 1,388 microg/kg (mean of 1,054 microg/kg); alternariol monomethyl ether, with a range of 566 to 7,451 microg/kg (mean of 2,118 microg/kg) in 15 (23%) of 64 samples; and tenuazonic acid in 12 (19%) of 64 samples, with a range of 1,001 to 8,814 microg/kg (mean, 2,313 microg/kg). Alternariol monomethyl ether was the predominant toxin, but tenuazonic acid was detected in higher concentrations. Alternariol was present in fewer samples and in lower levels than were the other toxins. Tenuazonic acid and alternariol monomethyl ether occurred together in four samples, while tenuazonic acid and alternariol co-occurred in one sample. This the first report of the natural occurrence of Alternaria mycotoxins in Argentinean wheat. Toxin levels were high, probably due to the heavy infection with Alternaria species found in the samples.

Mycotoxin production by Alternaria strains isolated from Argentinean wheat.

The toxigenic potential of Alternaria strains isolated from Argentinean wheat was investigated. A total of 123 strains were assayed for the production of tenuazonic acid (TA), alternariol (AOH) and alternariol monomethyl ether (AME). All but one of the isolates were able to produce at least one of the three mycotoxins. TA was produced by 72% of the strains (1-14782 mg/kg), AOH by 87% (4-622 mg/kg) and AME by 91% (7-2625 mg/kg). The average level of TA detected for all strains (1757 mg/kg) was higher than the average level of both alternariols (162 mg/kg for AOH and 620 mg/kg for AME). TA was the toxin produced at the highest concentration but in lower frequency. Most of the strains were able to synthesize more than one toxin: 74 isolates (60%) were positive for all three toxins, 30 (24%) for both AOH and AME, 5 (4%) for both TA and AME, and 2 (2%) for TA and AOH. The widespread occurrence of Alternaria in wheat and its ability to produce mycotoxins suggests the possible occurrence of its toxins in wheat naturally infected with this fungus.

Laparoscopic gastrectomy for gastric adenocarcinoma. Long-term results.

BACKGROUND: The objective of our paper is to report on the long-term results of patients with gastric cancer treated by mini-invasive surgery with "intention-to-treat" laparoscopy. PATIENTS AND METHODS: Between June 1993 and January 2006, 130 patients comprising 94 men and 36 women with gastric adenocarcinoma were prospectively selected by two surgical teams in three hospitals based on a prior agreement (CHU Charleroi, Belgium, Centre Hospitalier de Luxembourg and Zumárraga Hospital, Spain). Patients with adenocarcinoma of the cardia were excluded. Mean age of patients was 68 years (range, 37-85 years). RESULTS: Post-operative mortality within 60 days of operation was 6 patients; 109 patients were therefore properly followed up for an average of 49 months (range, 2-153 months).Average survival time for 10 non-resected patients was 4.5 months. Average survival rate for all 14 palliatively resected patients was 6.9 months. Actuarial 5-year survival rate for R0-type surgery was 35%. Global actuarial 5-year survival rate after resective surgery was 31%. CONCLUSIONS: Laparoscopic gastrectomy with any kind of lymphadenectomy is a major but safe operation with acceptable mortality and morbility rates in patients with advanced gastric cancer, usually in poor general condition. Laparoscopic gastrectomy for locally advanced cancers is equivalent to laparotomy as far as long-term oncological results are concerned.

Chloroform infrared multiphoton dissociation in the presence of O2 and NO2.

The infrared multiphoton dissociation (IRMPD) of CDCl3 in the presence of O2 and NO2 as acceptor gases has been studied. We have worked with both pure CDCl3 and mixtures with CHCl3. The reaction mechanism following IRMPD of CDCl3 is discussed in detail. CCl2O, CCl4 and DCl were found to be the main products. With added O2, the observed CDCl3 dissociation was larger than with nonoxygenated acceptor gases. The reaction mechanism probably involves a catalytic cycle initiated by the oxidation of CCl3. With the aim of discriminating the different CDCl3 dissociation mechanisms, the IRMPD of CDCl3 in the presence of NO2 was first studied. In order to make evident the CDCl3 dissociation produced by the catalytic cycle, we then studied the IRMPD of CDCl3 in mixtures with CHCl3 with O2 as the acceptor gas. In this case, the dissociation mechanism subsequent to IRMPD is evidenced in the competence between the two isotopic species.

Transposition of the great arteries with ventricular septal defects. Surgical considerations concerning the Rastelli operation.

We studied the anatomy of the ventricular septal defect in 20 heart specimens and eight operated patients with transposition of the great arteries regarding the feasibility of the Rastelli operation. They were divided into three groups. In Group I, comprising eight cases, creation of a left ventricle-aorta connection was not prevented by interposition of the atrioventricular valve tissue, and the ventricular septal defect was large or could be enlarged sufficiently. Thus, the Rastelli operation was feasible in all cases. In Group II, comprising 12 cases, interposition of the atrioventricular valves was not present, but the ventricular septal defect was inadequate in size for a good left ventricle-aorta connection. Small or even medium-sized ventricular septal defects were not enlargeable because of surrounding structures or inadequate septum for resection. In all cases, the ventricular septal defect was a tunnellike structure with two orifices; attempted enlargement would be more difficult at the left ventricular end (not obvious to the surgeon's view) than at the right one. The Rastelli operation was judged inadvisable in these cases. In Group III, comprising eight cases, the Rastelli operation was considered inadvisable because of interposition of atrioventricular valve tissue. The size of the ventricular septal defect and the presence of interposed atrioventricular valves can be diagnosed preoperatively. The presence of enough available space for resection, especially at the left ventricular end, should be determined preoperatively and/or intraoperatively in patients with medium-sized ventricular septal defects requiring enlargement. The anatomy of the ventricular septal defect may significantly alter the surgical approach for patients with transposition of the great arteries and ventricular septal defect.

[Aortic hypoplasia in a case of single ventricle with normally related vessels]. / Hipoplasia aórtica en un caso de ventrículo único con vasos normalmente relacionados.

In cases with double inlet left ventricle when there exists a hypoplasia of one of the great arteries, the affected vessel arises from the accessory right ventricular chamber. This is due in general to the presence of a restrictive bulbo-ventricular foramen that results in hypoplasic vessel. The case we present in this paper has unusual anatomic morphology: the hypoplasic vessel (the aorta) arises from the main ventricular chamber. We analyse the electrocardiographic findings useful for the differential diagnosis from cases of isolated aortic coarctation of hypoplasia. We review also the intraventricular anatomic malformations that may cause the presence of a hypoplasic vessel. Even if, our patient died in the neonatal period, the adequate surgical procedure for this case is reviewed.

[Aortico-left ventricular tunnel. Presentation of 2 new cases. Usefulness of non-invasive study]. / Túnel aorta-ventrículo izquierdo. Presentación de dos nuevos casos. Utilidad del estudio no invasivo.

In the last years the anatomic characteristics of the left aorto-ventricular tunnel and the clinical aspects of this uncommon malformation have been well described. Its evolution usually fatal without surgical procedure is in great contrast with the slight symptoms encountered by us in two new cases. This particular finding joined to the specific aspects found in the noninvasive color Doppler study, have lead us to present two new cases of left aorto-ventricular tunnel successfully operated.

[Two-dimensional and color-coded Doppler echocardiography in the diagnosis of infradiaphragmatic total anomalous pulmonary venous connection (ITAPVC) to the portal venous system]. / La ecocardiografía bidimensional y Doppler codificado en color en el diagnóstico del drenaje venoso pulmonar anómalo total infradiafragmático (DVPATI) al sistema venoso porta.

We have studied by means of 2D echocardiogram and pulsed, continuous and codified colour Doppler, 3 newborns with a total anomalous infradiaphragmatic pulmonary venous connection to the portal vein. In the right subcostal projection we have observed the abnormal venous conduit crossing the diaphragm going to an enlarged portal system. The codified colour and the pulsed Doppler showed the venous characteristics and the abnormal direction of the flow. With these techniques it was also possible to detect the anatomic and functional intracardiac abnormalities. We consider these techniques a reliable method to make a surgical correction without the practise of any other invasive diagnostic method.

[Redundancy of the interatrial septum without associated congenital cardiopathy. Its prenatal echocardiographic diagnosis and follow-up]. / Redundancia del septo interatrial sin cardiopatía congénita asociada. Diagnóstico ecocardiográfico prenatal y seguimiento.

INTRODUCTION AND OBJECTIVE: Aneurysm of the atrial septum at the level of the foramen ovale is reported commonly at the routine fetal echocardiographic examination. Cases with entire involvement of the atrial septum have been exceptionally reported. We described the data concerning the prenatal detection of a total redundancy of the atrial septum in 6 cases without congenital heart disease. METHODS: The gestational age was between 28 and 38 weeks, and none of the fetuses had evidence of heart defect. A routine fetal echocardiography was made in all the cases. Rhythm disturbances were studied by M mode. During the first three months of life, a cardiologic control was made in all the cases. RESULTS: The large displacement of the atrial septum towards the left atrium was clearly visualized in four-chambers view; by using Pulsed Doppler and Color flow mapping, the pulmonary venous return and mitral orifice flow were not impaired. Premature atrial beats were found in two fetuses and no hemodynamic disfunction was observed in all entire study group. Postnatal echocardiographic control was normal in all patients. The atrial septum becomes completely rectified with normal patency of the foramen ovale membrane in the newborn studies. The supraventricular extrasystoles were confirmed in the neonatal period. In both, the arrhythmia disappeared in a few days after delivery without treatment. CONCLUSIONS: Despite the benign follow-up in our cases, the unexpected presence of an extremely redundant atrial septum, leads to a close prenatal attention particularly in the presence of rhythm disturbance. The pathologic substrate of this anomaly might be an intrinsic alteration of the myocardial structure of the septum like seems demonstrated in the aneurysm circumscribed to area of the fossa ovalis [correction of fosa ovale]. The increase in the left atrial pressure after birth will produce a normal 2-D echo patterns in the newborn period.

[The ghost intraventricular obstruction. Its detection in the right ventricle by Doppler color]. / Obstrucción intraventricular fantasma. Su detección con Doppler color en ventrículo derecho.

INTRODUCTION: The Color Doppler echocardiography is a method of choice to detect the regional acceleration of flow in the left ventricle. The color study confirm it also in the right ventricle of infants with diseases other than hypertrophic cardiomyopathy. MATERIAL: We centered our attention in this finding observed in 16 infants with a mean age of 2.5 months (3 of whom were neonates) with several congenital heart malformations: 9 immediately after surgical ventricular septal defect closure (A-V canal type in 6, and isolated in 3); 2 with pulmonary atresia+intact septum+reconstruction of right ventricular-pulmonary artery connection; 2 with severe aortic stenosis; 1 with a double outlet right ventricle+pulmonary band; 1 with Jatene operation; finally 1 after balloon pulmonary valvuloplasty. RESULTS: The phenomenon consisted in a late Doppler systolic signal in the right ventricular apex whose velocity ranged between 1.5 and 2.9 m/s. The jet was directed towards the tricuspid orifice, with a normal pulmonary flow. The turbulence was easily viewed in the apical four chambers and subcostal sagittal plane of the right ventricle, the spectral signal showed a morphology with left side concavity. An erroneous diagnosis of apical ventricular septal defect was suggested in 2 cases in whom the left ventricular angiogram performed before treatment excluded the lesion. CONCLUSION: The dynamic nature of the jet suggest that an asynchronous order of myocardial contraction in hypertrophic right ventricule play a role in its genesis. With the increasing use of Doppler color technique, this finding can be observed with greater frequency in neonates and infants with operated or unoperated heart diseases and right ventricular hypertrophy. Apical ventricular septal defect will be included in the differential diagnosis.

[Divided left atrium: operative results and follow-up in the cor triatriatum]. / Aurícula izquierda dividida: resultados quirúrgicos y seguimiento en el cor triatriatum.

INTRODUCTION AND OBJECTIVES: A divided left atrium because of cor triatriatum is a relatively rare cardiac anomaly requiring corrective surgery. We describe here our clinical and surgical experience with this congenital heart defect as well as the different medium and long term diagnostic, surgical and evolution aspects. PATIENTS AND METHODS: From 1981 to 1999, 15 children with cor triatriatum without complex associated cardiovascular defects underwent surgery at a mean age of 13 months (excision of the obstructive membrane). The surgical reports were reviewed and the clinical and echocardiographic data were analyzed before and after the intervention; six of these patients (40%) were referred to operating room only with the 2-D echo Doppler technique and color flow mapping information. The follow-up period ranged from 8 months to 19.3 years. RESULTS: Diagnosis was confirmed during the surgical procedure. One 9 month old patient died 60 days after a successful corrective surgery because of sepsis (7%). No late deaths or reoperations were found in the follow-up period. All 14 patients who survived the operation have a functional class I (NYHA), and they are asymptomatic in the follow-up. The overall survival rate was 93% (70% CI: 87-90). CONCLUSIONS: Corrective surgery with excision of the obstructive membrane dividing the left atrium restores normal anatomic, hemodynamic and clinical status in children with cor triatriatum without complex associated defects.

[Non-surgical treatment of aortic coarctation and recoarctation]. / Tratamiento no quirúrgico de la coartación y recoartación de aorta.

OBJECTIVES: To analyze the results of nonsurgical treatment of aortic coarctation and recoarctation by evaluating the results of each technique, and its complications and outcome. PATIENTS AND METHODS: The results were as follows: 51 children underwent balloon dilatation due to recoarctation (86.5 %); two underwent dilation of a native coarctation (3.3 %) and six underwent stent implantation for recoarctation (10 %). Age ranged from 2 to 236 months (109 +/- 63.45 months) with a follow-up of between 1 and 156 months (38.87 +/-32.96 months). RESULTS: The mean predilatation gradient in children with recoarctation was 34 +/- 11.62 mmHg, which decreased to 11 +/- 5.38 mm Hg (p < 0.0001). In 12 patients (20.3 %) effective dilatation was not achieved. The size of the stenosis was 6.7 +/- 2.35 mm predilatation, which increased to 9.3 +/- 3.10 mm (p < 0.0001) after dilatation with a percentage increase of 50.97. There were very few complications. Six children required subsequent redilatation. The experience with stent showed a mean gradient of 32.83 +/- 10.62 mm Hg, which decreased to 7.3 +/- 3.8 mm Hg (p < 0.0001) with a balloon/stenosis ratio of 1.94. CONCLUSIONS: We conclude that the interventionist technique is highly effective in both native coarctation and recoarctation in the short term, as well as subsequently, with very few complications. The stent technique produces equally good results in older children, which is promising for the future.

Fístula carótido-cavernosa tras traumatismo craneoencefálico / Development of carotid cavernous fistula after traumatic brain injury

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