Re-descemet membrane endothelial keratoplasty (DMEK) with preservation of the original graft after free roll in anterior chamber: A case report.

INTRODUCTION: Lamellar keratoplasties have had a great impact in the management of corneal edema due to endothelial dysfunction. Minimally invasive transplant techniques such as Descemet Membrane Endothelial Keratoplasty (DMEK) have helped to reduce the morbidity involved in performing penetrating keratoplasty in this type of patient. Even so, these are complex techniques that are not free of complications and require a long line of surgical learning and an even more demanding experience in postoperative management. CLINICAL CASE: An 89-year-old woman suffering from Fuchs endothelial dystrophy and undergoing combined cataract and DMEK surgery presented stromal edema predominantly inferior and sectoral detachment of the graft 24 h after the intervention. After re-bubbling in consultations and 4 days later, the graft was observed rolled and free in the anterior chamber. She underwent re-DMEK with preservation of the original graft after 24 h, with de-epithelialization to optimize visualization. The graft was stained with trypan blue and the posterior stroma was protected with air. The graft was reimplanted under intraocular maneuvers and with an air bubble. 24 h after surgery, the adhered graft was observed, with a great decrease in stromal edema. One month later, the patient had a clear cornea, persistent complete graft adhesion, and visual acuity of 0.9. CONCLUSION: The discovery of free roll in the anterior chamber after DMEK surgery constitutes the most complex form of graft detachment. Corneal edema as well as the arrangement of the different intraocular structures are conditions to be considered for the surgical resolution of this complication. In many cases, surgical repositioning of the graft is feasible, which means saving costs without the need to use new donor corneal tissues.

Traqueotomía percutánea guiada por ultrasonografía en tiempo real. Revisión de la literatura / Literature Review. Real-time ultrasonography-guided percutaneous tracheotomy

La traqueotomía percutánea por dilatación es un procedimiento que se realiza en las unidades de paciente crítico, implica la disección roma de los tejidos pretraqueales, seguida de la dilatación de la tráquea sobre la guía y la inserción de la cánula traqueal mediante la técnica de Seldinger. En las últimas décadas, la evidencia sugiere que, en manos de médicos capacitados, es al menos tan segura como la traqueotomía quirúrgica, con similar incidencia de complicaciones. La selección adecuada de pacientes y el uso de herramientas de seguridad complementarias, como broncoscopio o ultrasonido, disminuyen las tasas de falla y complicaciones. Siendo contraindicaciones absolutas para traqueotomía percutánea por dilatación una anatomía anormal, tumor maligno en el sitio de traqueostomía, coagulopatías o vía aérea difícil. La guía mediante broncoscopia permite la evaluación de la profundidad del tubo endotraqueal, confirma la posición de la aguja en el eje de la tráquea y la adecuada inserción del cable guía y dilatador. Entre sus desventajas destacan que, el sitio de punción está sujeto a sesgo y no puede guiar con precisión la aguja en la penetración de la tráquea. La traqueotomía percutánea guiada por ultrasonido es una alternativa validada en unidades, donde no se cuente con broncoscopia. Es un método rápido, seguro, que permite la identificación de estructuras anatómicas, vasculatura cervical, permite identificar el sitio de la punción y guía la inserción de la aguja en la tráquea. Esta técnica presenta altas tasas de éxito al primer intento, reduciendo significativamente el número de punciones.

Percutaneous dilation tracheostomy is a procedure performed in critical patient units. It involves blunt dissection of the pretracheal tissues followed by dilation of the trachea over the guidewire and insertion of the tracheal cannula using the Seldinger technique. In recent decades, evidence suggests that in the hands of trained physicians it is at least as safe as surgical tracheostomy, with a similar incidence of complications. The proper selection of patients and the use of complementary safety tools such as bronchoscope or ultrasound reduce failure rates and complications. Being absolute contraindications for PDT abnormal anatomy, malignant tumor at the tracheostomy site, coagulopathies, or difficult to treat airway. Bronchoscopy guidance allows evaluation of the depth of the endotracheal tube, confirms the position of the needle in the axis of the trachea and the proper insertion of the guide wire and dilator. Among its disadvantages are that the puncture site is subject to slant and cannot accurately guide the needle into the trachea. In addition, it requires Critical Patient Units with bronchoscope and trained personnel. Ultrasound-guided percutaneous tracheotomy is a validated alternative in units where bronchoscopy is not available. It is a fast, safe method that allows the identification of anatomical structures, cervical vasculature, identifies the puncture site and guides the insertion of the needle into the trachea. With high first-attempt success rates, significantly reducing the number of punctures.

Split cricoideo anterior posterior: una novedosa técnica para evitar la traqueotomía en parálisis cordal bilateral en pacientes pediátricos / Posterior anterior cricoid split: a cutting-edge technique to avoid tracheostomy in bilateral cordal paralysis in pediatric patients

Introducción: La parálisis cordal bilateral en aducción es la segunda causa de estridor congénito y genera una grave obstrucción de la vía aérea, debutando con estridor. La traqueotomía ha sido durante mucho tiempo el gold estándar para el tratamiento de esta afección, no exenta de complicaciones. Existen procedimientos que intentan evitar la traqueotomía, como el split cricoideo anterior posterior endoscópico (SCAPE). Objetivo: Presentar experiencia con SCAPE en pacientes pediátricos como tratamiento alternativo de parálisis cordal bilateral en aducción. Material y Método: Análisis retrospectivo de los resultados quirúrgicos obtenidos en pacientes con parálisis cordal bilateral en aducción tratados con SCAPE entre enero de 2016 y diciembre de 2019 en el Hospital Guillermo Grant Benavente de Concepción, Chile. Resultados: Siete pacientes se sometieron a SCAPE. Todos los pacientes presentaban insuficiencia respiratoria severa, cinco requirieron asistencia ventilatoria mecánica. Seis pacientes tenían el diagnóstico de parálisis cordal bilateral (PCB) congénita y uno PCB secundaria a tumor de tronco cerebral. Cuatro pacientes presentaron comorbilidad de la vía aérea: dos pacientes presentaron estenosis subglótica grado I y dos pacientes presentaron laringomalacia que requirió manejo quirúrgico. Los días promedio de intubación fueron once días. Ningún paciente requirió soporte ventilatorio postoperatorio, sólo un paciente recibió oxigenoterapia nocturna debido a hipoventilación secundaria a lesión de tronco. Ningún paciente ha presentado descompensación respiratoria grave. Un 40% ha recuperado movilidad cordal bilateral. Conclusión: Split cricoideo anteroposterior endoscópico es una alternativa eficaz para tratar el PCB en pacientes pediátricos. Nuestro estudio evidencia que es una alternativa a la traqueotomía, con excelentes resultados y menor morbimortalidad.

Introduction: Bilateral vocal fold paralysis in adduction is the second cause of congenital stridor and generates a serious obstruction of the airway. Tracheostomy has long been the gold standard for the treatment of this condition, but it has inherent complications. There are procedures that try to avoid tracheotomy, such as the endoscopic anterior posterior cricoid split (EAPCS). Aim: Present our experience with EAPCS in pediatric patients as a treatment for bilateral vocal fold paralysis in adduction. Material and Method: Retrospective analysis of the surgical results obtained in patients with bilateral vocal cord paralysis in adduction treated with EAPCS between January 2016 and December 2019 at Guillermo Grant Benavente Hospital in Concepción, Chile. Results: Seven patients underwent EAPCS. All patients had severe respiratory failure, five required mechanical ventilation assistance. Six patients were diagnosed with congenital bilateral cord palsy (BCP) and one BCP secondary to a brainstem tumor. Four patients had airway comorbidity: two patients had grade I subglottic stenosis and two patients had laryngomalacia that required surgical management. The average days of intubation were eleven days. No patient required post op invasive/non-invasive ventilation, only one patient received nocturnal oxygen therapy due to hypoventilation secondary to trunk injury. None of the patients has presented severe respiratory decompensation. Forty percent have recovered bilateral chordal mobility. Conclusion: SCAPE is a cutting-edge and effective alternative to treat PCB in pediatric patients. Our study shows that it is an alternative to tracheotomy, with excellent results and lower morbidity and mortality.

Cirugía de desfuncionalización de glándulas salivales mayores en sialorrea masiva / Major salivary gland defunctionalization surgery in massive sialorrhea

Introducción: La sialorrea es la pérdida involuntaria de saliva de la boca, ya sea debido a la producción excesiva de saliva o disminución de la frecuencia de deglución. Se habla de sialorrea patológica cuando persiste más allá de los 4 años de edad. Además de las implicaciones sociales, cambios de ropa frecuentes, puede provocar neumonías por aspiración y deshidratación. El manejo de la sialorrea requiere una evaluación completa con un enfoque de equipo multidisciplinario para el tratamiento, que incluye terapias no farmacológicas, farmacológicas y quirúrgicas. Objetivo: Presentar resultados quirúrgicos y farmacológicos en el tratamiento de sialorrea masiva. Material y Método: Se realizó revisión de historias clínicas de 7 pacientes portadores de sialorrea masiva. Todos los pacientes incluidos fueron refractarios a tratamiento médico. El diagnóstico fue obtenido por un equipo multidisciplinario. Se les realizó desfuncionalización quirúrgica y farmacológica de glándulas salivales. Se les aplicó Escala de Severidad (DSS) y escala de frecuencia (DFS), previo a cirugía y posterior a procedimiento hasta el año. Resultados: Mejoría clínica subjetiva posterior a desfuncionalización quirúrgica con disminución de DSS y DFS. Disminución promedio de baberos a 10/día. Conclusión: Los resultados obtenidos son buenos, si se consideran las escalas DSS, DFS y el número de baberos al día, que son mediciones tanto subjetivas y objetivas respectivamente.

Introduction: Massive Sialorrhea is the involuntary loss of saliva from the mouth, either due to excessive saliva production or decreased swallowing frequency. We speak of pathological sialorrhea when it persists beyond 4 years old. In addition to the social implications and frequent clothing changes. It can cause aspiration pneumonia and dehydration. Treatment for sialorrhea requires a comprehensive evaluation with a multidisciplinary team approach. Including non-pharmacological, pharmacological, and surgical therapies. Aim: Presentation of the results of surgical defunctionalization of the salivary glands plus injection of Botulinum Toxin in the treatment of massive sialorrhea. Material and Method: A review of the clinical records of 7 patients with massive sialorrhea was carried out. All included patients were refractory to medical treatment. The diagnosis was obtained by a multidisciplinary team. Surgical and pharmacological dysfunctionalization of salivary glands was performed. Severity Scale (DSS) and Frequency Scale (DFS) were applied before surgery and after the procedure up to a year. Results: Subjective clinical improvement after surgical defunctionalization with decreased SHD and DFS. Average decrease in bibs to 10/day. Conclusion: The evaluated strategy presented similar benefits with respect to the literature. The SHD and DFS scales and the number of bibs per day are both subjective and objective measurements, respectively, and allow the clinical improvement and quality of life of patients undergoing surgery to be evaluated individually.

Colesteatoma de oído con complicación intracraneana en contexto de pandemia COVID-19: Reporte de caso clínico y revisión de literatura

Resumen La otitis media crónica colesteatomatosa (OMCC) complicada es una condición inusual en la época actual. Clásicamente las complicaciones se han clasificado en extracraneales e intracraneales. Estas últimas suponen un alto riesgo para los pacientes debido a la alta morbimortalidad y las secuelas neurológicas asociadas. La atención médica oportuna y derivación a otorrinolaringología junto con las medidas preventivas en edad pediátrica han disminuido la incidencia de los colesteatomas y sus complicaciones. Se presenta a continuación el caso de una paciente de 50 años, atendida en el Hospital Guillermo Grant Benavente de Concepción (Chile) por cuadro de OMCC complicada con meningoencefalitis y vasculitis infecciosa sin consulta precoz por contexto de pandemia COVID-19. Se expone metodología diagnóstica y manejo terapéutico.

Abstract Complicated chronic cholesteatomatous media otitis (CCMO) is an unusual condition nowadays. Complications have traditionally been classified as extracranial and intracranial. The last one entails a higher risk for patients due to high morbi-mortality and neurological consequences associated. Suitable medical care and otorhinolaryngological attention among with preventive measures in pediatric age have decreased the incidence of cholesteatomas and their complications. The following, is the case of a 50-year-old patient treated for CCMO at Guillermo Grant Benavente Hospital in Concepcion (Chile) complicated due to meningoencephalitis and infectious vasculitis without early diagnose due to COVID-19 pandemic. Diagnostic methodology and therapeutic management are exposed.

Hongos anamorfos biodegradan los libros del Área Histórica de la Universidad Central del Ecuador (UCE) / Anamorphous fungi biodegrade the books of the Historical Area from the Central University of Ecuador (CUE)

Determinamos los géneros de hongos anamorfos que contaminan los libros del área de cuarentena y limpieza, dentro del Área Histórica de la Universidad Central del Ecuador (UCE). Realizamos un hisopado aleatorio a una muestra representativa de 50 de estos libros de acuerdo a una Tabla militarizada estándar. También hisopamos como muestra preferencial a 21 libros gravemente contaminados con hongos. Los hisopados tuvieron una superficie de 5x5 cm, friccionando en la pasta, el borde y el interior de estos libros. Las 213 muestras tomadas fueron inoculadas en medio de cultivo Agar Malta. Los medios fueron incubados a una temperatura de 28°C durante 7 días. Realizamos observaciones por microscopía a 40 y 100x además de usar literatura especializada para la identificación hasta el nivel de género de hongos anamorfos. Los géneros más abundantes en este estudio fueron Penicillium (80,2%) y Mucor (8,1%). (AU)

We determined the genera of anamorphic fungi that contaminate the books in the quarantine and cleaning area, within the Historical Area of the Central University of Ecuador (CUE). We performed a random swab on a representative sample of 50 of these books according to a standard militarized Table. We also swabbed as a preferential sample 21 books seriously contaminated with fungi. The swabs had a surface area of 5x5 cm, rubbing on the paste, the edge and the interior of these books. The 213 samples taken were inoculated in Agar Malta culture medium. The media were incubated at a temperature of 28° C for 7 days. We made observations by microscopy at 40 and 100x in addition to using specialized literature for the identification down to the genus level of anamorphic fungi. The most abundant genus in this study were Penicillium(80,2%) and Mucor(8,1%). (AU)

Clinical results of radial arthroplasty in Hotchkiss' terrible triad, a case series of 47. / Resultados clínicos de la artroplastia radial en la tríada terrible de Hotchkiss, a propósito de 47 casos.

INTRODUCTION: Radial head fractures represent 33-75% of elbow fractures (30 cases/100,000 population/year). "Terrible triad's Hotchkiss" is characterized by radial head fracture, coronoid fracture and elbow dislocation. Our principal goal is to compare our results on each type of prosthesis in the context of the triad. MATERIAL AND METHODS: We conducted an observational, descriptive and retrospective study. Sample size was 47 patients. Variables analyzed were affiliation, Mason's classification, surgical aspects (moment of surgery, surgical time, prosthesis type, re-surgery), rehabilitation time, causes of prosthetic failure, complications, radiographic findings (according to van Riet), Popovic's loosening areas, MEPS and Cassebaum's scales. We performed an inter-group study, on patients treated with monopolar or bipolar prosthesis, in order to see results. RESULTS: Average age was 43.5±8.9 years. 72.7% were in highly demanding jobs. Mason's fracture type iv appeared in all the cases and Regan-Morrey's type I was the most frequent coronoid fracture (42.6%). There were 22 bipolar prosthesis and 25 monopolar prosthesis. Surgery time was about 112.3±59.1minutes. External fixation was used in 6.4%. MEPS final: 85.9±15 points. Rehabilitation time was about 4.7±2.5 months. Of the patients, 76.6% returned to work. Cassebaum's results were good-excellent in 74.5% of patients. There were 3 cases of prosthetic mobilization. Heterotopic ossification appeared in 29.8% of cases and 15.2% presented overstuffing. With regard to the inter-group study, we observed that there was less surgical time with monopolar prosthesis (P=.006), fewer second look surgeries (P=.05), less stiffness (P=.04), less heterotopic ossification (P=.004) and septic loosening (P=.005), without any influence on MEPS (P=.44). CONCLUSIONS: Results obtained in terrible triads with prostheses in our experience are good. Prosthetic type influences results, because surgical time for implantation of a monopolar prosthesis was less than for a bipolar one, although rehabilitation time was longer. With bipolar prostheses, external fixation was required, with a higher rate of reinterventions, stiffness, prosthetic mobilization, heterotopic ossification and prosthetic loosening. However, there were no differences between the 2prosthetic types in terms of clinical results, like MEPS or Cassebaum scores.

A Mixture of Five Bacterial Strains Attenuates Skin Inflammation in Mice.

BACKGROUND: There is a growing interest in the effects of probiotics for the prevention and treatment of skin diseases due to their immunomodulatory and antiinflammatory properties. OBJECTIVE: To assess a mixture of five bacterial strains in the prevention of chronic skin inflammation in mice. METHODS: Hairless SKH-1 mice received daily oral treatment with the probiotic mixture at the dose of 1x109 Colony-Forming Unit (CFU)/day (or vehicle) for three weeks. Chronic skin inflammation was induced by repeated applications of 12-O-tetradecanoylphorbol-13- acetate (TPA; control mice received acetone). Macroscopic and microscopic evaluations of skin lesions were performed and serum levels of interleukin (IL)-1ß, IL-6, tumor necrosis factor (TNF)-α, IL-17, IL-22, IL-10 and IL-4 measured at the end of the study. RESULTS: Treatment with the probiotic mixture significantly limited the induced chronic skin inflammation at both the macroscopic and microscopic levels. This limitation was consistent with downregulated levels of pro-inflammatory cytokines (IL-1ß, IL-6, TNF-α, IL- 17 and IL-22) and up-regulated levels of the anti-inflammatory cytokines, IL-10 and IL-4. CONCLUSION: The results suggest that the probiotic mixture tested could help in preserving skin integrity and homeostasis and that its use could be beneficial in dermatological conditions such as atopic dermatitis and psoriasis.

Lactobacillus salivarius LA307 and Lactobacillus rhamnosus LA305 attenuate skin inflammation in mice.

Oral probiotics potential for the management of dermatological diseases is vast. However, results of available studies in skin diseases, such as atopic dermatitis (AD), are inconsistent, partly because probiotic effects are strain specific. Careful selection of probiotic strains is therefore indispensable to ensure efficacy of treatment. In this study, Lactobacillus salivarius LA307, Lactobacillus rhamnosus LA305 and Bifidobacterium bifidum PI22, three strains that were previously identified for their interesting immunomodulatory properties in allergy and/or colitis models, were assessed in the prevention of chronic skin inflammation induced by repeated applications of 12-O-tetradecanoylphorbol-13-acetate in hairless SKH-1 mice. Macroscopic and microscopic evaluation of skin lesions was performed together with measurements of serum levels of interleukin (IL)-1ß, IL-6, tumour necrosis factor alpha (TNF-α), IL-17, IL-22, IL-10 and IL-4. Daily oral treatment with the three strains at the dose of 1×109 cfu/day for 3 weeks limited the development of chronic skin inflammation, the effects being strain dependent. Indeed the two Lactobacillus strains significantly limited the intensity of skin inflammation both at the macroscopic and microscopic levels. Macroscopic observations were correlated to the histological observations and the resulting microscopic score. This limitation of the development of AD-like skin lesions involved the modulation of cytokine production. Treatment with the two Lactobacillus strains induced a decrease in the serum levels of pro-inflammatory cytokines IL-1ß, IL-6, TNF-α, IL-17, IL-22 and at the opposite an increase in the production of the anti-inflammatory cytokine IL-10 and also of IL-4. Globally, B. bifidum PI22 had lower benefits. These results obtained in mice suggest that L. salivarius LA307 and L. rhamnosus LA305 could be good candidates for preserving skin integrity and homeostasis via the modulation of the gut microbiota and that their use could be beneficial in dermatological conditions such as AD.

Use of grafts in rotator cuff re-rupture. / Utilización de injertos en la reparación de rerroturas del manguito rotador.

INTRODUCTION AND OBJECTIVES: Rotator cuff re-ruptures appear in 38-65% of cases. In order to reduce this rate, many studies have been performed using different types of biomaterial for purely mechanical aims (re-inforce the suture) and/or biological agents (growth factor transporterts). The aim of this study is to review 22 cases treated with xenografts and analyse various current alternatives. MATERIALS AND METHODS: A descriptive and retrospective study was conducted using the variables of age, sex, laterality, time of surgery, involvement in MRI, number of anchors, and final mobility results on the Constant and the University of California Los Angeles (UCLA) validated scales. RESULTS: The study included 22 patients, with a mean age of 51.7±4.6 years. A mean of 2 anchors were used and 13 patients were treated with a porcine intestinal submucosa implant, 6 with equine pericardium, and 3 with porcine dermis. Final results were: 37.6±13 points for the Constant test, and 16.9±3.9 points on the UCLA scale. The follow up was 36±10.2 months. CONCLUSIONS: In our experience, xenografts could provide good functional results and they would be a surgical alternative to tendon transfers in cases of massive tears. Further studies should be conducted with other biomaterials.

Abandono del hábito tabáquico tras un primer ingreso en el Servicio de Neumología / Smoking cessation after first admission in a respiratory unit

Some authors suggest that hospitalization is an ideal moment to stop smoking. It is unknown the outcome of smokers admitted for the first time in the pulmonology department, which interventions are carried out to achieve smoking cessation and which are the dropout rates once they are discharged. The purpose of this study is to analyze the impact of a first hospital admission in a service of Pneumology on smokers. Epidemiological variables, smoking habit, specialized interventions carried out on these subjects and rate of withdrawal after discharge were studied. It is necessary to train specialists to diagnose and treat the patient in the process, so that on every hospitalized smoker a cessation intervention should be carried out.

Algunos autores defienden que el ingreso hospitalario constituye un marco ideal para dejar de fumar. Se desconoce lo que sucede con los fumadores que ingresan por primera vez en el Servicio de Neumología, sobre las intervenciones que en ellos se lleva a cabo, así como sus tasas de abandono una vez que son dados de alta. El objetivo de este estudio es analizar el impacto que tiene un primer ingreso hospitalario en el Servicio de Neumología en sujetos fumadores. Conocer sus variables epidemiológicas, el hábito de tabáquico, las intervenciones que el personal médico especializado realiza sobre estos sujetos y las tasas de abstinencia posteriores al alta. Es necesario formar a los especialistas para diagnosticar y tratar al paciente en dicho proceso, de tal forma que sobre todo sujeto fumador hospitalizado se realice alguna intervención.

Radial head arthroplasty, 11 years experience: A series of 82 patients.

OBJECTIVES: The indications for radial head arthroplasty are essentially complex fractures with ligament damage (medial, lateral or Essex-Lopresti), and/or associated with bone damage (coronoids or olecranon). The aim of this study is to review our experience with the use of a radial head prosthesis in the context of a trauma. MATERIAL AND METHOD: An observational, descriptive and retrospective study, with a follow-up of 1- 11 years, was performed on a study group of 82 patients with a mean age of 41.6 (± 9.2) years. The inclusion criteria were: patients of working age (25-64 years) with complex radial head fractures (Mason II, III, IV), with soft tissue and bone injuries that caused instability, non-reconstructable by osteosynthesis and treated using arthroplasty. The primary variables analysed were social demographics, Mason classification, or surgical aspects such as delay, surgical time, type of prosthesis (where the bipolar prosthesis was most used, 88.6%), need of fixation or further surgery. Rehabilitation time, causes of prosthesis failure, radiological findings (according to Van-Riet), areas of loosening (according to Popovic), as well as the Mayo Elbow Performance Score (MEPS) and the Cassebaum scale. Various associated injuries were observed, such as injuries in the lateral collateral ligament of the elbow in 39% of cases, coronoid fractures in 25.6%, and an olecranon fracture in 15.9% of the series. There was one case of an Essex- Lopresti injury. The tests used for the statistical analysis were Chi squared and Fisher test for categorical variables and contingency tables. The Mann Whitney U or Kruskall Wallis tests were used for the numerical variables. Evidence level: IV. RESULTS: The mean surgical time was 100 (± 56.8) minutes. The prosthesis was fixed in 53.8% of cases. The mean score on the MEPS scale was 80.4 (± 19.3) points, being good-excellent in 71.6%. The elbow was stable in 93.7% of cases. There was moderate instability, with 10° or more in varus or valgus, and in 1.3% in the rest of the series. The rehabilitation time was lower in the fixed cases (P=.03), and there was greater rigidity (P=.03) and more sequelae (limitations in mobility, residual pain), (P<0.05) in the cases where the LCL had to be repaired (given that there were other serious injuries in these cases). When the surgical delay was less than one week, better results were obtained on the Cassebaum scale (P=.02), as well as more excellent results on the MEPS scale MEPS (P=.02). The prosthesis was removed in 11 cases (13.4%), with the main cause for removal being pain in pronosupination in 5 cases, and capitellar injuries in 4 cases, one dislocation, and one infections. The most frequent complication was rigidity (30.5%). There were 3 infections (3.7%). Popovic areas 1 and 7 had greater osteolysis. CONCLUSIONS: The presence of concomitant bone and ligament injuries determined a longer surgical time and more sequelae. Early surgery would achieve better clinical results.

[Reflections on the clinical reports «minimum data set¼]. / Reflexiones sobre el «conjunto mínimo de datos¼ de los informes clínicos.

Royal Decree 1093/2010 (3 September 2010) establishes the minimum data set that the clinical reports of discharges and outpatient visits elaborated in the facilities of the National Health System should contain, among others. Until then, the Ministerial Order 221/1984, that only required the drawing up of a discharge report for patients seen in a hospital-regime health care establishment, was in force. In spite of the importance of these documents, their quality is far from that desired, especially that of the reports on visits, which, among other things, are not performed in a high percentage of the cases. Recently the Sociedad Española de Medicina Interna (SEMI) (Spanish Society of Internal Medicine), in collaboration with other scientific societies, issued some recommendations for the drawing up of the discharge reports. In this present work, a series of thoughts are made on the implications of the new decree, especially in the case of the reports of the outpatient clinics.

Preventive antioxidant effects of cocoa polyphenolic extract on free radical production and cognitive performances after heat exposure in Wistar rats.

The preventive effects of ACTICOA powder (AP), a cocoa polyphenolic extract, on free radicals produced by leucocytes in rats after heat exposure (HE) and its protective effects on subsequent cognitive impairments were assessed. AP or vitamin E, the antioxidant reference, was orally administered to rats for 14 d before HE at 40 degrees C temperature during 2 h. The day after HE, free radical production by leucocytes in rats treated with AP or vitamin E was significantly reduced as compared to control. Unlike controls, AP- and vitamin E-treated rats discriminated between active lever and inactive levers in a light extinction paradigm. In the Morris water maze, escape latencies before reaching the hidden platform by AP- and vitamin E-treated rats decreased throughout testing. The daily oral administration of AP or vitamin E protected rats from cognitive impairments after HE by counteracting the overproduction of free radicals.

Y chromosome sequences in Turner's syndrome: association with virilization and gonadoblastoma.

UNLABELLED: The presence of Y chromosome fragments in patients with Turner's syndrome is known to increase the risk of gonadoblastoma and virilization. Y chromosome material is detected in up to 6% of patients with Turner's syndrome by karyotype. By DNA analysis, Y chromosome sequences have been reported in 0-60% of patients. The putative gonadoblastoma gene has been mapped to the pericentromeric region of the Y chromosome increasing the interest in studying these sequences. AIMS: 1. To determine the frequency of occult Y chromosome sequences in patients with Turner's syndrome. 2. To analyze the clinical implications of Y sequences detected by karyotype and occult Y sequences. STUDY DESIGN: Cross-sectional study of 58 patients with Turner's syndrome (30 45,X; two with structural anomalies; 26 mosaic [two of whom were 45,X/46,XY]). SRY, TSPY and DYZ3 sequences were amplified by PCR using genomic DNA from peripheral blood. RESULTS: All three Y chromosome sequences were found in one out of 56 patients whose karyotype was not suggestive of having Y chromosome material and in one patient with 45,X/46,Xr(X) karyotype. The patients with the ring chromosome and 45,X/46,XY karyotype underwent surgery and were found to have a gonadoblastoma and dysgerminoma. The four patients with Y chromosome material had non-virilized female genitalia. CONCLUSIONS: Analysis by PCR was more sensitive in detecting Y chromosome sequences than conventional karyotype. The presence of Y material was not associated with virilization. We confirmed the association of Y fragments and gonadoblastoma at an early age.