Precursors of Reading Performance and Double- and Triple-Deficit Risks in Spanish.

Early literacy skills serve as the best precursors of reading success and risk indicators of the double deficit and triple deficit hypotheses according to the spelling consistency of languages. Our study analyzes the predictive value of phonological awareness, naming speed, and orthographic skills for early reading in Spanish. Participants included 362 Spanish children aged 4 to 5 years. We used data analysis to examine the relationships between these precursors and fluency through a structural equation model and investigated the risk indicators of poor reading performance according to the double deficit and triple deficit hypotheses using binary logistic analysis. Our research delimits a model for the Spanish language that emphasizes the predictive value of phonological awareness, letter-naming fluency, and knowledge of graphemes in early reading. Letter-naming fluency is the best precursor to early reading experiences, and poor early reading performance in children is explained by deficits in phonological awareness, naming speed, and visual orientation. Our findings confirm the risk indicators of the triple deficit hypothesis in the early learning of reading in Spanish.

Diagnosis and management of immunodeficiencies in adults by allergologists.

Primary immunodeficiencies (PIDs) are genetic diseases that cause alterations in the immune response and occur with an increased rate of infection, allergy, autoimmune disorders, and cancer. They affect adults and children, and the diagnostic delay, morbidity, effect on quality of life, and socioeconomic impact are important. Therapy (gamma-globulin substitution in most cases) is highly effective. We examine adult PIDs and their clinical presentation and provide a sequential and directed framework for their diagnosis. Finally, we present a brief review of the most important adult PIDs, common variable immunodeficiency, including diagnosis, pathogenesis, clinical signs, and disease management.

[Results of applying the Scientific Technical Quality Programme and Constant Quality Improvement for peritoneal dialysis]. / Resultados de la aplicación del plan de calidad científico-técnica y de mejora continua de calidad en diálisis peritoneal.

INTRODUCTION: In last time it was tried to homogenize the clinical activity and to make the decisions easier. In the field of Nephrology, the Spanish Society of Nephrology has developed different guidelines that have managed an improvement in patient s monitoring. That is the reason why the Quality Working Group in Nephrology was created, whose basic working field was haemodialysis, although its collaboration with an expert group in peritoneal dialysis (PD) has allowed the developement of a Scientific Technical Quality Programme and Constant Quality Improvement in PD. MATERIAL AND METHODS: We checked the clinical histories of all the patients in PD in the course of 2008 in the Peritoneal Dialysis Unit at our institution and we evaluated all the quality indicators that were described in the Scientific Technical Quality Programme and of Constant Quality Improvement in PD. RESULTS: During 2008 a total of 41 patients were treated in the Peritoneal Dialysis Unit at our institution, 43.9% women. Incidence was 14 (51.8%) and 21.4% were diabetics. No patients cames from transplant unit and 2 came from haemodilalysis unit (7.1%). Mean age in incident population was 60 +/- 13 years and in prevalent population was 53.9 +/- 14.4 years. Mean follow-up in PD was 25.9 +/- 19.9 months. Modified Charlson comorbility index average in incident patients was 6 and in prevalent patients was 5. 70.7% were included in transplant programme and 3 were transplanted in the year s course (10.3%). There were 19 hospital admissions (rate: 0.46 admission per patient/year in risk) with a mean stay of 7.3 days (rate: 3.4 days per patient/year in risk). During 2008 6 patients leaved PD (2 transfers to haemodialysis, 3 transplants and 1 death). 16 infective peritonitis (overall rate: 1 episode every 24 months) and 23 exit side infections were reported (rate: 1 episode every 18 months). Mean Kt/V was 2,4 +/- 0.06 (92.7% of patients achieved the stablished standards). All non-anuric patients had measured residual renal function and only 1 patient did not achieve the goal of fluid output > 1000 ml/day. No patient used 3.86-4.25% bags. Stablished standards were achieve by analitic indicators with regard to epoetin resistence index, LDL- cholesterol, phosphate, calcium-phosphate product and PTH. CONCLUSIONS: The application of the Scientific Technical Quality Programme and of Constant Quality Improvement in PD has made possible to know the current situation of our unit and to raise some matters when it is necessary to insist to get a better quality in our assistance.

Receptor-receptor interactions within receptor mosaics. Impact on neuropsychopharmacology.

Future therapies for diseases associated with altered dopaminergic signaling, including Parkinson's disease, schizophrenia and drug addiction or drug dependence may substantially build on the existence of intramembrane receptor-receptor interactions within dopamine receptor containing receptor mosaics (RM; dimeric or high-order receptor oligomers) where it is believed that the dopamine D(2) receptor may operate as the 'hub receptor' within these complexes. The constitutive adenosine A(2A)/dopamine D(2) RM, located in the dorsal striato-pallidal GABA neurons, are of particular interest in view of the demonstrated antagonistic A(2A)/D(2) interaction within these heteromers; an interaction that led to the suggestion and later demonstration that A(2A) antagonists could be used as novel anti-Parkinsonian drugs. Based on the likely existence of A(2A)/D(2)/mGluR5 RM located both extrasynaptically on striato-pallidal GABA neurons and on cortico-striatal glutamate terminals, multiple receptor-receptor interactions within this RM involving synergism between A(2A)/mGluR5 to counteract D(2) signaling, has led to the proposal of using combined mGluR5 and A(2A) antagonists as a future anti-Parkinsonian treatment. Based on the same RM in the ventral striato-pallidal GABA pathways, novel strategies for the treatment of schizophrenia, building on the idea that A(2A) agonists and/or mGluR5 agonists will help reduce the increased dopaminergic signaling associated with this disease, have been suggested. Such treatment may ensure the proper glutamatergic drive from the mediodorsal thalamic nucleus to the prefrontal cortex, one which is believed to be reduced in schizophrenia due to a dominance of D(2)-like signaling in the ventral striatum. Recently, A(2A) receptors also have been shown to counteract the locomotor and sensitizing actions of cocaine and increases in A(2A) receptors have also been observed in the nucleus accumbens after extended cocaine self-administration, probably representing a compensatory up-regulation to counteract the cocaine-induced increases in dopamine D(2) and D(3) signaling. Therefore, A(2A) agonists, through antagonizing D(2) and D(3) signaling within A(2A)/D(2) and A(2A)/D(3) RM heteromers in the nucleus accumbens, may be found useful as a treatment for cocaine dependence. Furthermore, antagonistic cannabinoid CB(1)/D(2) interactions requiring A(2A) receptors have also been discovered and possibly operate in CB(1)/D(2)/A(2A) RM located principally on striatal glutamate terminals but also on some ventral striato-pallidal GABA neurons, thereby opening up a new mechanism for the integration of endocannabinoid, DA and adenosine mediated signals. Thus, A(2A), mGluR5 and/or CB(1) receptors can form integrative units with D(2) receptors within RM displaying different compositions, topography and localization. Also galaninR/5-HT(1A) RM probably participates in the transmission of the ascending 5-hydroxytryptamine neurons, where galanin receptors antagonize 5-HT(1A) recognition and signaling. Subtype specific galanin receptor antagonists may therefore represent novel antidepressant drugs. These results suggest the importance of a complete understanding of the function of these RM with regard to disease. Ultimately receptor-receptor interactions within RM that modify dopaminergic and serotonergic signaling may give new strategies for treatment of a wide range of diseases associated with altered dopaminergic and serotonergic signaling.

Cellular localization and distribution of dopamine D(4) receptors in the rat cerebral cortex and their relationship with the cortical dopaminergic and noradrenergic nerve terminal networks.

The role of the dopamine D(4) receptor in cognitive processes and its association with several neuropsychiatric disorders have been related to its preferential localization in the cerebral cortex. In the present work we have studied in detail the regional and cellular localization of the dopamine D(4) receptor immunoreactivity (IR) in the rat cerebral cortex and its relationship to the dopaminergic and noradrenergic nerve terminal networks, since both dopamine and noradrenaline have a high affinity for this receptor. High levels of D(4) IR were found in motor, somatosensory, visual, auditory, temporal association, cingulate, retrosplenial and granular insular cortices, whereas agranular insular, piriform, perirhinal and entorhinal cortices showed low levels. D(4) IR was present in both pyramidal and non-pyramidal like neurons, with the receptor being mainly concentrated to layers II/III. Layer I was observed to be exclusively enriched in D(4) IR branches of apical dendrites. Finally, mismatches were observed between D(4) IR and tyrosine hydroxylase and dopamine beta-hydroxylase IR nerve terminal plexuses, indicating that these receptors may be activated at least in part by dopamine and noradrenaline operating as volume transmission signals. The present findings support a major role of the dopamine D(4) receptor in mediating the transmission of cortical dopamine and noradrenaline nerve terminal plexuses.

Factors affecting rotation of occiput posterior position during the first stage of labor.

INTRODUCTION: Fetal occiput posterior (OP) positions account for 15 to 20% of cephalic presentations and are associated with poorer maternal and neonatal outcomes than occiput anterior (OA) positions. The aim of this study was to identify maternal, neonatal and obstetric factors associated with rotation from OP to OA position during the first stage of labor. MATERIAL AND METHODS: This secondary analysis of a multicenter randomized controlled trial (EVADELA) included 285 laboring women with ruptured membranes and a term fetus in OP position. After excluding women with cesarean deliveries before full dilatation, we compared two groups according to fetal head position at the end of the first stage of labor: those with and without rotation from OP to OA position. Factors associated with rotation were assessed with univariate and multivariate analyses using multilevel logistic regression models. RESULTS: The rate of anterior rotation during the first stage was 49.1%. Rotation of the fetal head was negatively associated with excessive gestational weight gain (adjusted odds ratio [aOR]: 0.37, 95% confidence interval [CI]: 0.17-0.80), macrosomia (aOR: 0.35, 95% CI: 0.14-0.90), direct OP position (aOR: 0.24, 95% CI: 0.09-0.65), and prelabor rupture of membranes (aOR: 0.40, 95% CI: 0.19-0.86). Oxytocin administration was the only factor positively associated with fetal head rotation (aOR: 2.17, 95% CI: 1.20-3.91). DISCUSSION: Oxytocin administration may affect rotation of OP positions during the first stage of labor. Further studies should be performed to assess the risks and benefits of its utilization for managing labor with a fetus in OP position.

Uncoupling protein 2/3 immunoreactivity and the ascending dopaminergic and noradrenergic neuronal systems: relevance for volume transmission.

Uncoupling proteins in the inner mitochondrial membrane uncouples oxidative phosphorylation from ATP synthesis. It has been suggested that these proteins are involved in thermogenesis as well as in the regulation of reactive oxygen species production in the mitochondria. The present work was conducted to investigate the localization of the uncoupling protein 2-like immunoreactivity (uncoupling protein 2/3 immunoreactivity) in the main catecholaminergic projection fields in the rat brain as well as in the areas of the dopaminergic and noradrenergic nerve cell groups. In particular, the relationships of tyrosine hydroxylase, dopamine beta-hydroxylase and uncoupling protein 2/3 immunoreactivity were assessed by double immunolabeling and confocal laser microscopy analysis associated with computer-assisted image analysis. Uncoupling protein 2/3 immunoreactivity was observed in discrete dopaminergic terminals in the nucleus accumbens and in the cerebral cortex whereas it was found in scattered noradrenergic terminals in the caudate putamen and Islands of Calleja Magna. One interesting finding was that uncoupling protein 2/3 immunoreactivity together with tyrosine hydroxylase immunoreactivity in the shell of nucleus accumbens was observed surrounding the previously characterized D1 receptor rich nerve cell column system characterized by a relative lack of tyrosine hydroxylase immunoreactivity. Moreover, in animal models of dopaminergic pathway degeneration, plastic changes in uncoupling protein 2/3 terminals have been shown in the cerebral cortex and striatum as seen from the increased size and intensity of uncoupling protein 2/3 immunoreactivity of their varicosities. Taken together, these findings open up the possibility that uncoupling protein 2/3 could play an important role modulating the dopaminergic and noradrenergic neurotransmission within discrete brain regions.

Modulation of hepatocyte growth factor plasma levels in relation to the dose of exogenous heparin administered: an experimental study in rats.

INTRODUCTION: Partial liver transplantation has been consolidated to be a valid treatment option. We sought to understand the factors that modulate and may be harnessed to accelerate hepatocyte regeneration. We sought to determine the impact of heparin on m-hepatocyte growth factor (HGF) plasma concentrations. MATERIALS AND METHODS: Sixteen rats were assigned to four groups of four animals each: group A, without heparin; group B, 600 IU/kg; group C, 1000 IU/kg, group D, 1400 IU/kg. Blood samples (0.5 mL) were obtained from each rat at baseline and at 30, 60, 120, and 240 minutes. After the samples were centrifuged to separate supernates from the cell phase they were stored at -20 degrees C in the m-HGF reagent and subsequently tested using enzyme-linked immunosorbent assay. Results were analyzed using SPSS 11.5 statistical software. RESULTS: Among the 16 rats, one died at 110 minutes, just prior to the last extraction. The remaining rats were sacrificed. Mean weight was: 466 +/- 64.24 g with no intergroup differences (P = .149). The comparative results (using Student t test) were: baseline A(1-4) versus A(1-4) 30 minutes: P < .05; baseline A(1-4) versus A(1-4) 60 minutes: P < .05; baseline A(1-4) versus A(1-4) 120 minutes: P = .10 (NS); baseline A(1-4) versus A(1-4) 240 minutes: P = .15 (NS). No significant differences were found among group B: baseline C(1-4) versus C(1-4) 30 minutes and 60 minutes: NS; baseline C(1-4) versus C(1-4) 120 minutes: P < .001; baseline C(1-4) versus C(1-4) 240 minutes: P < .10 (NS). Finally, the results in group D were: baseline D(1-4) versus D(1-4) 30 minutes: NS; baseline D(1-4) versus D(1-4) 60 minutes and 120 minutes: P < .05; baseline D(1-4) versus D(1-4) 240 minutes: P < .0005. When we compared group A to C and D, we detected differences (albeit not when compared to B) with P values = .01. Peak values were obtained at 120 and 240 minutes (225.21 pg/mL and 221.78 pg/mL) among groups C and D. CONCLUSION: Heparin has a positive effect to increase serum HGF concentrations among rats. The effect was dependent on the administered dose and the time elapsed.

Subpopulations of GABA neurons containing somatostatin, neuropeptide Y, and parvalbumin in the dorsomedial cortex of the lizard Psammodromus algirus.

Different subpopulations of GABA neurons containing the neuropeptides somatostatin and neuropeptide Y, and the calcium binding protein parvalbumin were studied by immunocytochemistry using light and electron microscopy in the dorsomedial cortex of the lizard Psammodromus algirus to investigate the connectivity of different subsets of GABA neurons in the lizard dorsomedial cortical circuitry and to compare cortical regions of reptiles and mammals. GABA neurons were classified into different subsets by using the peroxidase anti-peroxidase immunohistochemical method on adjacent Araldite-embedded semithin sections. GABA neurons in the dorsomedial cortex fall into three major subsets: 1) neurons with somatostatin (and neuropeptide Y), which accounted for about 44% of the GABA population; 2) neurons with parvalbumin, which accounted for about 13% of the GABA neurons; and 3) neurons without parvalbumin or neuropeptides, which represented 40% of all GABA cells. This division of GABA neurons in non-overlapping subpopulations of neuropeptide- and parvalbumin-containing cells is similar to that found in the mammalian hippocampal formation. On the basis of the nerve terminal fields, somatostatin- and parvalbumin-immunoreactive neuronal populations appear to be functionally different, acting on different portions of the projection neurons. Parvalbumin-immunoreactive neurons inhibit the pyramidal neurons at the cell body level, whereas somatostatin-immunoreactive neurons inhibit them on distal dendrites. The results of the present study add more similarities between the lizard dorsomedial cortex and parts of the mammalian hippocampus.

Differential regional and cellular distribution of dopamine D2-like receptors: an immunocytochemical study of subtype-specific antibodies in rat and human brain.

Dopamine D2-like receptors (D2, D3, and D4) are major targets for action of typical and atypical neuroleptics, commonly used in the treatment of schizophrenia. To understand their individual functional contribution, subtype-selective anti-peptide antibodies were raised against D2, D3, and D4 receptor proteins. The antibodies were shown to be specific on immunoblots of rat brain membranes and immunoprecipitated the solubilized native dopamine receptors in an antibody concentration-dependent manner. In addition, they also bind selectively to the respective recombinant D2, D3, and D4 receptor membrane proteins from cDNA transfected cells. Immunolocalization studies show that the D2-like receptor proteins had differential regional and cellular distribution in the cerebral cortex, hippocampus, basal ganglia, cerebellum, and midbrain, thus providing anatomical substrate for area-specific regulation of the dopamine neurotransmission. In cortical neurons, D4 receptor protein was found in both pyramidal and nonpyramidal cells, whereas D2 and D3 seem to be mostly associated with nonpyramidal interneurons. In rat hippocampus, the expression pattern of D2-like receptors (D4>D3>D2) mirrored that obtained with immunoprecipitation studies. D2 and D4 receptor immunolabeling was observed in the thalamic reticular nucleus, which was negative for the D3 subtype. Species differences were also observed; for example, the D4 subtype receptor is the most highly expressed protein in the rat cortex, whereas it is significantly less in human cortex. Differential patterns of D2, D3, and D4 receptor expression in rat and human brain should shed light on the therapeutic actions of neuroleptic drugs and may lead to the development of more specifically targeted antipsychotic drugs.

Distribution of neuropeptide Y (NPY) in the cerebral cortex of the lizards Psammodromus algirus and podarcis hispanica: co-localization of NPY, somatostatin, and GABA.

The aim of the present study was to analyze the distribution and characteristics of NPY immunoreactive structures in the cerebral cortex of lizards and to investigate the degree of co-existence of this neuropeptide with somatostatin and GABA. The immunoperoxidase method was applied to vibratome sections as well as to semithin sections. NPY neurons are multipolar or fusiform and were unevenly distributed throughout the brain cortex. Within the medial, dorsomedial and dorsal cortices, most NPY perikarya were located in the plexiform layers, especially in the deep one. This suggests that these cells could be regarded as interneurons. In the lateral cortex, NPY neurons were found throughout all layers. The dorsomedial cortex displayed the highest NPY cell density. Here, neuronal perikarya projected many immunoreactive processes toward two distinct zones: the deep plexiform layer of the medial cortex and the superpositio medialis. The NPY neurons of the dorsomedial cortex differed from the other NPY cortical immunoreactive cells in that the latter displayed very few immunoreactive processes. A high degree of co-existence among NPY, somatostatin, and GABA (approx. 80%) was found. This co-existence rate is very similar to that reported in mammals and suggests that co-localization is a phylogenetically ancient phenomenon.

Dopamine D5 receptors of rat and human brain.

In contrast to dopamine D1 receptors, the anatomical distribution of D5 receptors in the CNS is poorly described. Therefore, we have studied the localization of dopamine D5 receptors in the brain of rat and human using our newly prepared subtype-specific antibody. Western blot analysis of brain tissues and membranes of cDNA transfected cells, and immunoprecipitation of brain dopamine receptors suggest that this antibody is highly selective for native dopamine D5 receptors. The D5 antibody labeled dopaminergic neurons of mesencephalon, and cortical and subcortical structures. In neostriatum, the D5 receptors were localized in the medium spiny neurons and large cholinergic interneurons. The D5 labeling in caudate nucleus was predominantly in spines of the projection neurons that were frequently making asymmetric synapses. Occasionally, the D5 receptors were also found at the symmetric synapses. Within the cerebral cortex and hippocampus, D5 antibody labeling was prominent in the pyramidal cells and their dendrites. Dopamine D5 receptors were also prominent in the cerebellum, where dopamine innervation is known to be very modest. Differences in the localization of D5 receptors between both species were generally indistinguishable except in hippocampus. In rat, the hippocampal D5 receptor was concentrated in the cell body, whereas in human it was also associated with dendrites. These results show that D5 receptors are localized in the substantia nigra-pars compacta, hypothalamus, striatum, cerebral cortex, nucleus accumbens and olfactory tubercle. Furthermore, the presence of D5 receptors in the areas of dopamine pathways suggests that this receptor may participate actively in dopaminergic neurotransmission.

Persistence of Cajal-Retzius cells in the adult human cerebral cortex. An immunohistochemical study.

The presence of Cajal-Retzius cells in the adult human prefrontal and visual cortices has been demonstrated with calcium binding protein immunocytochemistry and NADPH-diaphorase histochemistry. These cells expressed parvalbumin, calbindin and calretinin calcium binding proteins and displayed NADPH-diaphorase enzyme activity. The three basic morphological profiles-horizontal, pyriform and multipolar-were observed. The morphologies of labelled cells resembled those of neurons observed in Golgi studies of the human cerebral cortex. The presence of calcium binding proteins and NADPH-diaphorase in these cells suggests a possible inhibitory role as GABAergic neurons. The persistence of Cajal-Retzius cells in the adult cerebral cortex supports the idea that they undergo developmental dilution rather than postnatal degeneration.

A tangential neuronal migration in the olfactory bulbs of adult lizards.

Tritiated thymidine ([3H]thymidine) autoradiography at different times after experiments showed that postnatally generated neurones in the adult lizard olfactory bulbs are not generated in a local germinative zone but in the ventricular zone (VZ) of the cerebral hemispheres, which is a long distance from the olfactory bulbs. The new cells originating in the VZ of rostral telencephalon migrate to both main and accessory olfactory bulbs through the olfactory peduncle, along a highly restricted pathway orthogonal to the orientation of radial glial fibres. Our results suggest that the olfactory bulb interneurones of adult lizards may follow a tangential migration route from their germinative zone, as is the case in mammals.

Immunocytochemical localization of somatostatin in the cerebral cortex of lizards.

The distribution of somatostatin-like immunoreactivity in the cerebral cortex of two lizards has been studied. Results are similar in both species. Somatostatin-positive neurons show variable morphology; they are bipolar, multipolar or pyramidal cells. Their distribution within the cerebral cortex is not homogeneous: they tend to be found in the innermost cortical layer, the deep plexiform layer, where they constitute a constant population in the region of the dorsomedial cortex. All immunoreactive processes observed in the cerebral cortex belong to somatostatin cortical neurons since no immunoreactive fiber is found to reach or leave the telencephalic cortex. Most of the dendrites are smooth or sparsely spinous. Axons are abundant in the deep plexiform layer; in the dorsomedial cortex a prominent terminal field appears in the outermost region of the superficial plexiform layer, which may arise from the neuronal somatostatin immunoreactive population found deeper in the same cortex.

Serotonin innervation of the cerebral cortex in lizards.

The serotonin (5-HT) innervation of the cerebral cortex in two species of lizards has been studied. Results show no differences between both species. Most of the cerebral cortex of these lizards is innervated by serotoninergic fibers, which are fine and varicose. Their density varies greatly from one cortical region to another: the areas with higher density of serotoninergic fibers and terminals are parts of the medial and dorsal cortices. There is a laminar pattern of distribution of serotoninergic fibers. In the medial cortex, 5-HT fibers are found preferentially in both plexiform layers just above and below the cellular layer. In the dorsomedial cortex, there is an immunoreactive plexus in the outermost third of the superficial plexiform layer and another in the depth of the layer, whereas 5-HT fibers are distributed evenly in the deep plexiform layer of this cortex. In the pars medialis of the dorsal cortex, serotoninergic fibers are abundant in all layers, whereas in the pars lateralis, fibers are found predominantly in the external third of the superficial plexiform layer. The lateral cortex is almost devoid of immunoreactive fibers. These results show a different organization of the cortical serotonin innervation between lizards and turtles.

Increased serum IgE in acute type A, B and delta hepatitis.

Serum IgE levels have been documented in patients of acute type B hepatitis. There are very few studies on serum IgE in acute type A hepatitis and, to our knowledge, there are no data on serum IgE in acute delta hepatitis patients. The purpose of this study was to measure total IgE levels in 38 patients with acute A, B and delta hepatitis and in 181 controls in order to determine the possible existence of changes in this parameter in the course of these infections. Our results showed a relevant increase in IgE levels in the three groups (hepatitis A, B and delta) with respect to the control group. Moreover, the hepatitis B group showed increased total serum IgE levels with respect to the hepatitis delta group.

[Hyperlipidemia in liver transplanted patients]. / Hiperlipemia en los pacientes trasplantados hepáticos.

Hyperlipemia is frequent in liver transplanted patients and has been related with the existence of cholestasis, renal insufficiency, obesity, diabetes, and especially with immunosuppressant treatment. Although there are no studies that show a relationship between post-liver transplant hyperlipemia and the development of cardiovascular disease, there are data that indicate that liver transplanted patients should control their cholesterol levels to reduce the incidence of this disease. When post-transplant hyperlipemia is present, hygienic-dietary measures should be established and treatment should be carried out with the minimum dose of cyclosporine needed to maintain the graft stable. Corticoids should be discontinued as soon as possible. Treatment with some statins (Lovastatin and Pravastatin) has shown to be safe and efficacy in the liver transplanted patients with hypercholesterolemia.

[Effects of total gastrectomy on the nutritional status]. / Efectos de la gastrectomía total sobre el estado nutricional.

In this study, we have analyzed a series of 88 patients who underwent total gastrectomy followed by two different reconstructive procedures, Roux-en-Y jejunal interposition (57%) and interposition of a jejunal limb between the oesophagus and the duodenum (38%) (Henley procedure). We examined diet, intestinal transit, symptoms of dumping syndrome and body weight curves. Patients with Roux-en-Y reconstruction presented post-prandial sweating more often (48%) than patients with the Henley procedure (21%). Forty percent patients with Roux-en-Y reconstruction suffered post-prandial nausea whereas this finding was not associated with patients after the Henley procedure. The reconstructive method has to be chosen considering the age and general condition of the patient, stage of the neoplasia and its curability. We currently favor Roux-en-Y esophagojejunostomy. However, in selected patients the Henley procedure may prove useful in order to prevent reflux and dumping symptoms.

[Horner's syndrome following epidural analgesia for labor]. / Síndrome de Horner tras analgesia epidural para el trabajo de parto.

Horner's syndrome is a disorder of the sympathetic nerve supplying the eye. Infrequently, Horner's syndrome can arise as a complication of epidural anesthesia, but its clinical course is favorable. The incidence increases when epidural analgesia is used in obstetrics because of physiological and anatomic changes in obstetric patients that favor spread of the local anesthetic. We report the case of a 31-year-old woman requiring epidural analgesia for labor. She received 10 mL of 0.15% ropivacaine with a bolus dose of 50 microg of fentanyl, followed by epidural catheter infusion of 0.15% and 0.001% fentanyl at a rate of 10 mL/h. Two hours after starting the infusion, the patient's right eye presented a contracted pupil, a drooping eyelid, and enophthalmos, accompanied by flushing on the same side of the face. Horner's syndrome was diagnosed. Signs resolved over the next hour without treatment. The literature contains reports of widely differing incidences of Horner's Syndrome ranging from 1.3% to 75%. The case we report was the only one in our hospital over a period of 4 years during which 12,796 epidural procedures were performed. These data suggest to us that Horner's syndrome often passes undetected because clinical manifestations are not remarkable. Nevertheless, the diagnosis should be kept in mind so that unnecessary treatment is avoided, given that the clinical course is favorable with spontaneous resolution.