[Contraindications to succinylcholine in the intensive care unit. A prevalence study]. / Prevalencia de contraindicaciones a succinilcolina en unidades de cuidados intensivos.

OBJECTIVE: To determine the prevalence of contraindications to succinylcholine in patients admitted to the ICU. DESIGN: An observational study was carried out, describing the frequency of succinylcholine contraindication by stays, and associating the contraindications to population variables. SETTING: The adult general ICU of a reference hospital. PATIENTS: Clinical-surgical critically ill patients. Thirty consecutive days were analyzed. INTERVENTIONS: None. VARIABLES: Population variables: age, sex, APACHE II and SOFA scores, illness, days of hospitalization, mechanical ventilation and renal replacement therapy. CONTRAINDICATIONS: hyperkalemia, bedridden patients, rhabdomyolysis, muscle trauma, burns, infusion of neuromuscular blocking agents, acute renal failure, chronic renal failure, intraocular hypertension, intracranial hypertension, statin use, malignant hyperthermia, neuromuscular disease, spinal cord sectioning, bradycardia < 50 bpm, succinylcholine allergy, and pseudo-cholinesterase deficiency. RESULTS: A total of 102 patients were admitted, aged 60 ± 16 years (56.9% males), with the generation of 657 stays. Main diseases: elective heart surgery (33%), respiratory failure (22%) and sepsis (14%). We documented 466 stays (70.9%) with contraindications, particularly bedridden patients (n=140), neuromuscular blocking agents (n=101), acute renal failure (n=126), statin use (n=167), neuromuscular disease (n=159) and bradycardia (n=76). We recorded 74 stays (11.3%) at high risk of complications, secondary to hyperkalemic risk associated to receptor dysregulation. A high risk of complications was associated to advanced age, prolonged hospitalization, prolonged length of stay in the ICU, higher APACHE II and SOFA scores, mechanical ventilation and renal replacement therapy. CONCLUSION: Given the high prevalence of contraindications to succinylcholine observed, we discourage its use in patients admitted to the ICU.

Leptin gene therapy attenuates neuronal damages evoked by amyloid-ß and rescues memory deficits in APP/PS1 mice.

There is growing evidence that leptin is able to ameliorate Alzheimer's disease (AD)-like pathologies, including brain amyloid-ß (Aß) burden. In order to improve the therapeutic potential for AD, we generated a lentivirus vector expressing leptin protein in a self-inactivating HIV-1 vector (HIV-leptin), and delivered this by intra-cerebroventricular administration to APP/PS1 transgenic model of AD. Three months after intra-cerebroventricular administration of HIV-leptin, brain Aß accumulation was reduced. By electron microscopy, we found that APP/PS1 mice exhibited deficits in synaptic density, which were partially rescued by HIV-leptin treatment. Synaptic deficits in APP/PS1 mice correlated with an enhancement of caspase-3 expression, and a reduction in synaptophysin levels in synaptosome preparations. Notably, HIV-leptin therapy reverted these dysfunctions. Moreover, leptin modulated neurite outgrowth in primary neuronal cultures, and rescued them from Aß42-induced toxicity. All the above changes suggest that leptin may affect multiple aspects of the synaptic status, and correlate with behavioral improvements. Our data suggest that leptin gene delivery has a therapeutic potential for Aß-targeted treatment of mouse model of AD.

Prevalence of cardiovascular risk factors in an urban adult population from southern Spain. IMAP Study.

AIMS: To study the prevalence of cardiovascular risk factors in an urban population of Malaga, Spain and its relationship with educational level. METHODS: A cross-sectional study was performed with a random representative sample of 2270 individuals from the adult population (18­80 years) from a specific Health-Care Centre in Malaga City. All participants underwent a clinical interview, including social-demographical information and a physical examination. A blood sample was also drawn. RESULTS: The mean age of the participants was 43.6 ± 15.6 years and 57.6% had a low educational level. The prevalence of cardiovascular risk factors was: smoking 27.7%, hypertension 33.1%, diabetes 7.1% and dyslipidaemia 65.4%. Over 60% were either overweight or obese, and 76.7% had a sedentary lifestyle. Except for smoking and a low-HDL cholesterol, the prevalence of the other cardiovascular risk factors increased with age. A low educational level was associated with a high prevalence of cardiovascular risk factors, and this association was significant with regard to smoking, obesity, abdominal obesity and hypertriglyceridaemia. CONCLUSIONS: The population studied presents a high prevalence of cardiovascular risk factors, especially dyslipidaemia and obesity. The low academic level was associated with an increased prevalence of smoking, obesity and dyslipidaemia. People with a low socio-cultural level are a priority target for introducing policies to prevent and control cardiovascular disease.

[Perioperative treatment of a pregnant woman with recent cerebral infarction secondary to noncompaction cardiomyopathy]. / Tratamiento perioperatorio de una gestante con infarto cerebral reciente secundario a miocardiopatía no compactada.

Recent-onset noncompaction of the myocardium is a rare but serious entity with uncertain prognosis. Cerebral infarction is among the forms of presentation, and pregnancy and hypercoagulability increase risk. We report the case of a pregnant woman brought to the emergency department with ischemic cerebral infarction. Investigation demonstrated the cause to be cardiac embolism, and noncompaction of the myocardium was diagnosed. She was stabilized and a few days later underwent elective cesarean section under general anesthesia. Surgery and postoperative recovery were uneventful, and she was transferred for rehabilitation. Myocardial injury and progression to cerebrovascular accident must be prevented in such cases; the patient must be stabilized and antiplatelet and/or anticoagulant therapy initiated before surgery. Hemodynamic stability must be maintained throughout the perioperative period and neonatal depression avoided after delivery. Various approaches are available to be adapted to the patient's situation.

Saccade velocity as a surrogate disease marker in spinocerebellar ataxia type 2.

We measured in 82 spinocerebellar ataxia type 2 (SCA2) patients and in 80 controls maximal saccade velocity (MSV) and correlated it to polyglutamine expansion size and disease duration. MSV is strongly decreased in SCA2 patients and is influenced mostly by polyglutamine size.

[The adenoid cystic carcinoma]. / Carcinoma adenoide quístico de CAE.

The adenoid cystic carcinoma arising in the external auditory canal is a rare tumor, as other malignant neoplasias of the EAC and middle ear. The early diagnosis of these malignant tumors of the ear is very important to improve the prognosis. In this sense, the clinic experience is frequently the most useful diagnosis instrument to suspect this pathology when we have a confrontation with chronic otorrea and otalgia, common presentation form of this disease. In this report we show a new case of adenoid cystic carcinoma of external auditory canal and review the most significant medical literature existing in relationship with this pathology.

Enhanced Hippocampal Neurogenesis in APP/Ps1 Mouse Model of Alzheimer's Disease After Implantation of VEGF-loaded PLGA Nanospheres.

During adult life, hippocampus is an important brain region involved in neurogenesis. The generation and cell death of newly generated neuronal cells in this region have critical roles in brain maintenance and alterations in these processes are seen in Alzheimer's disease (AD). For the purpose of carrying out a neuroregenerative strategy, we propose a novel approach based on the encapsulation of vascular endothelial growth factor (VEGF) in poly (lactic co-glycolic acid) (PLGA) biodegradable nanospheres (NS) administered by craniotomy to stimulate the proliferation of neuronal precursors in a transgenic mouse model of AD. VEGF loaded nanospheres were prepared by double emulsion solvent evaporation technique, obtaining 200 nm nanospheres with a biphasic release profile. After demonstrating their efficacy in the proliferation and differentiation of neuronal cell cultures, in vivo studies were carried out. 3 months after VEGF-NS were implanted directly into the cerebral cortex of APP/Ps1 mice, the determination of BrdU(+) cells in the whole hippocampal region and specifically in the dentate gyrus, demonstrated a significantly enhanced cellular proliferation in VEGF-NS treated group. These results were also confirmed showing an increased number of DCX(+) and NeuN(+) cells. Hence, PLGA-VEGF nanospheres may be a potential strategy to modulate proliferative neuronal progenitors in the hippocampal region, and therefore, provide new insight for future therapeutic approaches in AD.

Trace metal concentrations and their distribution in the lobster Panulirus inflatus (Bouvier, 1895) from the Mexican Pacific coast.

The concentration and distribution of Fe, Mn, Ni, Cu, Co, Cd, Cr and Zn among the tissues of female and male lobster Panulirus inflatus from the Pacific coast of México were determined. Distinct inter-tissue and intersize differences in metal concentrations were observed. In general, highest Zn concentrations were found in viscera while highest Cu levels occurred in the gill and gonadal material. The highest Mn, Ni, Cr and Co concentrations were observed in exoskeleton and highest in eggs and gills. Cadmium was undetectable (<0.05 microg g(-1)) in most tissues, only muscle and viscera contained low but detectable amounts. A positive relationship between size and metal concentration was observed only for Zn contained in the muscle of females and males, for Zn contained in the gonad of females, for Mn contained in the gonad of males and for Cu associated with muscle of males. These results are discussed with regard to trace metal concentrations found in temperate and tropical regions.

[Neurophysiological diagnosis of lumbosacral radicular compression syndrome from late responses]. / Diagnóstico neurofisiológico del síndrome compresivo radicular lumbosacro a través de las respuestas tardías.

INTRODUCTION: Lumbosacral radicular compression syndrome is a disorder that can affect anyone at some moment in their lives, regardless of their sex, age and profession. It appears more frequently in specific groups of people. Late responses constitute neurophysiological studies that allow evaluation of the functional state of the proximal portions of the peripheral nervous system, which are affected to a greater or lesser extent in the course of this pathological state. AIMS. To determine the usefulness of the F wave and H reflex in lumbosacral compressive radiculopathies at L5 and S1. PATIENTS AND METHODS: We examined 100 patients who had been clinically and imagenologically diagnosed as suffering from lumbosacral compressive radiculopathy, which was classified as being L5 and S1. Late responses (F wave and H reflex) were performed and they were compared with a group made up of 74 normal subjects. RESULTS: In patients with L5 radiculopathy, the F wave was abnormal in 66.6% of the cases, where a reduction in the percentage of waves obtained from patients and prolonged minimum, average and maximum latencies predominated. In the case of patients with S1 lumbosacral compressive radiculopathies, 77.5% presented H reflex alterations and the main abnormalities were detected as being the prolongation of reduced amplitude latencies and the absence of response. CONCLUSIONS: The F wave and H reflex are useful tools for evaluating patients with compressive radiculopathies at L5 and S1, respectively.

[Quantitative evaluation of disorders of coordination in patients with Cuban type 2 spinocerebellar ataxia]. / Evaluación cuantitativa de los trastornos de la coordinación en pacientes con ataxia espinocerebelosa tipo 2 cubana.

INTRODUCTION: Implementation of quantitative techniques to study disorders of coordination of movements in hereditary ataxias permits an objective description of the disease. OBJECTIVES: To make an objective evaluation of the main disorders of coordination in patients with ataxia and compare healthy persons with those affected. PATIENTS AND METHODS: We made a prospective transverse study of 43 normal persons and 50 patients with type 2 spinocerebellar ataxia (SCA2). In all cases we made a qualitative examination of Romberg's sign in two stages to increase the sensitivity. We observed how long the person could keep his balance or whether he swayed and fell. The finger-nose test and diadochokinesia were also quantitatively analyzed using a specially designed system connected to a computer which permitted quantitative analysis. RESULTS: We showed that the patients with SCA2 swayed when standing upright. However, they swayed and fell more when the test became more sensitive. This showed loss of postural sense. The maximum variables of the period and standard deviation were increased, whilst the effectiveness was significantly reduced in the group of patients (finger-nose test). Quantitative examination of diadochokinesia showed increased values for the maximum period, standard deviation and integral. CONCLUSIONS: The techniques developed allow measurement of the main disorders of coordination in patients with SCA2, help to differentiate affected persons from healthy ones and are useful for the detection of moderate changes in severity during progression of the disorder.

[Economic management of institutional pharmacies of the city of Rosario. Quality indicators proposal]. / Gestión económica en establecimientos asistenciales de la ciudad de Rosario. Propuesta de indicadores de calidad.

OBJECTIVE: To compare structures, procedures and results of the pharmaceutical management of institutional pharmacies in the city of Rosario (Argentina), to define the current situation and thus recommend changes. METHOD: Descriptive study, using a questionnaire and quality indicators of an Accreditation Program of Hospital Pharmacies. Evaluated dimensions: selection, acquisition, reception, storage and stock control of drugs and medical devices. Data was collected for a one-year-period in order to obtain indicators. After tabulation, data was discussed in meetings with all the pharmacists that participate in this study, in order to evaluate the situation and propose changes for the Pharmacies, as well as to evaluate the Program based on usefulness of these indicators. RESULTS: The general results illustrate how each institution has different health policies. 43.2% of indicators were answered, 67.6% reached standard values. CONCLUSIONS: This work allowed for an exhaustive analysis of the current situation. The pharmacists made proposals and unified criteria in order to obtain an improved use of the economic resources of each institution.

[Syndrome owing to aberrant nervous regeneration. Frey and Bogorad syndrome]. / Síndromes por regeneración nerviosa aberrante. Síndrome de Frey y de Bogorad.

Two cases of anomalous nervous regeneration seen lastly in our Department suggest us this brief reconsideration specially on the physiopathology of these group of malaties triggered during the development of salivary reflex.

[Clinical course and treatment of sphenoid mucocele. Report of a case]. / Clínica y tratamiento de los mucoceles esfenoidales. A propósito de un caso.

Endoscopic surgical technique minimaly invasives employed in the therapy of paranasal sinuses pathology are imposing up little by little to the external approach procedures, as specialists get experienced and outcomes can be assessed in middle/long term. In this paper we record the case of a woman enduring a sphenoidal mucocele non-complicated, optimal stage for the indication of endoscopic surgery minimally invasive, because in this condition the best postoperative functional results are attainable and in addition recurrence failures are reduced at minimum. The discovery of the illness in an earle stage, thanks to a greater availability of diagnostic means like TC or RMN, allow us the broadening of indications of this surgery and consequently improve the postoperative results.

[Childhood nasal sinus mucoceles. Review and report of a new case]. / Mucoceles nasosinusales infantiles. Revisión y aportación de un nuevo caso.

The appearance of mucoceles of paranasal sinuses during infancy is very rare. In relation with a patient, 11-year-old, enduring an ethmoidal mucocele treated in our Department we benefit it in order to realize a review of the published cases in medical literature. We also discuss on the etiopathogenesis, clinic and differential diagnostic aspects in pediatric age in comparison of those verified in grown-up.

[Retro-inframandibular approach to tumors of the deep parotid lobe]. / Abordaje retroinframandibular en los tumores del lóbulo profundo de la parótida.

Two cases of pleomorphic adenoma of the parotid deep lobe are presented. Both of them were removed through back-submandibular approach. We favor this procedure as the best for tumors of the parapharyngeal space, whereas the mandibulotomies are indicated when dealing with strong adhesions, reoperations or malignancies.

[Sarcoma of the larynx. Report of two cases]. / Sarcomas de laringe. A propósito de 2 nuevos casos.

In relation with other laryngeal neoplasms, sarcomas are uncommon tumours. With the object to put in knowledge one chondrosarcoma and one liposarcoma located in the larynx seen in our hospital in a small period of time, we decided to do this publication, discussing the differential clinical aspects of these laryngeal cancers.

[Angioneurotic edema secondary to antihypertensive therapy]. / Edema angioneurótico secundario al tratamiento con antihipertensivos.

Secondary angioneurotic oedema due to antihypertensive drugs of the angiotensin-converting enzyme inhibitors type, is an uncommon entity which must be remembered when dealing with differential diagnosis of this type of oedema. We have reviewed the subject following 2 of our own cases.

[Infantile dyspnea due to pyogenic laryngeal granuloma]. / Disnea infantil por "granuloma piogénico" laríngeo.

Two appearances are outstanding in this case report. First is the clinical picture of chronic laryngeal stridor of a child due to an acquired haemangioma. And that the anatomopathologic subtype of angioma is a pyogenic granuloma noteworthy, as we shall see, the use of the term "pyogenic granuloma" based only on anatomopathological findings in order to circumscribe this lesion.

[The role of heredity in the genesis of idiopathic peripheral facial paralysis. A case report]. / Papel de la herencia en la génesis de la parálisis facial periférica idiopática. A propósito de un caso.

After a study of a family with 9 members who had one or more episodes of idiopathic facial palsy at some point in life, we reviewed the literature for the role of heredity as an etiopathogenetic factor in peripheral facial palsy. Differential criteria for the most controversial aspects were considered, such as incidence and the type or mechanism of transmission which conditions the appearance of peripheral facial palsy in patients with possible genetic factors.

[Congenital cysts of the nasopharynx. Report of a case]. / Quistes congénitos de nasofaringe. Presentación de un caso.

Congenital nasopharyngeal cysts are uncommon and usually located on the lateral wall of the nasopharynx. The literature groups lateral and medial cysts although they have different origins. A congenital nasopharyngead cyst in a 67-year-old man was diagnosed and treated. His only symptom was right hearing loss caused by secretory otitis. After cyst excision using a transpalatine approach, his hearing loss resolved within 4 days. Nasopharyngeal cyst types and their histological and anatomic differentiation are discussed. Therapeutic options and approaches are considered, and the need for total exeresis of the cyst with its capsule is noted.