Intubación con tubo de doble luz mediante laringoscopio Airtraq® en dos pacientes despiertos con vía aérea díficil prevista / Double lumen tube insertion in awake patients through the AirTraq laryngoscope in 2 cases of expected difficult airway

La posibilidad de hallar un paciente con vía aérea difícil (VAD) en cirugía torácica aumenta por la coexistencia de patología oncológica faringo-laríngea asociada. El uso de tubos de doble luz para el aislamiento pulmonar supone una dificultad añadida en estas situaciones. Diversos dispositivos ópticos diseñados en los últimos años, aportan nuevas soluciones disponibles para el manejo de estos casos. Presentamos dos pacientes con VAD conocida, programados para resección pulmonar, en los que se utilizó con éxito el laringoscopio Airtraq® para la inserción de tubo de doble luz con el paciente despierto. Este laringoscopio no requiere desplazamiento de la lengua, ni tracción de la vallécula, lo que facilita su tolerancia en pacientes despiertos(AU)

The likelihood of difficult airway in thoracic surgery increases in the presence of associated cancer of the pharynx or larynx. The difficulty is greater when a double lumen tube must be inserted in these conditions, and various newly developed optical devices offer solutions for managing such cases. We report on 2 patients with expected difficult airway who were scheduled for lung resection. In both cases, intubation was accomplished through the AirTraq laryngoscope while the patient remained awake. Awake patient tolerance is facilitated by this laryngoscope, because the tube can be inserted without changing the position of the tongue or placing pressure on the vallecula(AU)

The phylogeographical history of the Iberian steppe plant Ferula loscosii (Apiaceae): a test of the abundant-centre hypothesis.

The geology and climate of the western Mediterranean area were strongly modified during the Late Tertiary and the Quaternary. These geological and climatic events are thought to have induced changes in the population histories of plants in the Iberian Peninsula. However, fine-scale genetic spatial architecture across western Mediterranean steppe plant refugia has rarely been investigated. A population genetic analysis of amplified fragment length polymorphism variation was conducted on present-day, relict populations of Ferula loscosii (Apiaceae). This species exhibits high individual/population numbers in the middle Ebro river valley and, according to the hypothesis of an abundant-centre distribution, these northern populations might represent a long-standing/ancestral distribution centre. However, our results suggest that the decimated southern and central Iberian populations are more variable and structured than the northeastern ones, representing the likely vestiges of an ancestral distribution centre of the species. Phylogeographical analysis suggests that F. loscosii likely originated in southern Spain and then migrated towards the central and northeastern ranges, further supporting a Late Miocene southern-bound Mediterranean migratory way for its oriental steppe ancestors. In addition, different glacial-induced conditions affected the southern and northern steppe Iberian refugia during the Quaternary. The contrasting genetic homogeneity of the Ebro valley range populations compared to the southern Iberian ones possibly reflects more severe bottlenecks and subsequent genetic drift experienced by populations of the northern Iberia refugium during the Pleistocene, followed by successful postglacial expansion from only a few founder plants.

Conservation genetics of the endangered Iberian steppe plant Ferula loscosii (Apiaceae).

Ferula loscosii (Lange) Willk (Apiaceae) is a threatened endemic species native to the Iberian Peninsula. The plant has a narrow and disjunct distribution in three regions, NE, C and SE Spain. Genetic variability within and among 11 populations from its natural distribution was assessed using allozymes. Intermediate levels of genetic diversity were detected in F. loscosii (P(99%) = 36.83; H(E) = 0.125; H(T) = 0.152). However, the highest genetic diversity (58%) corresponded to the threatened populations from SE and C Spain (H(T) = 0.169) rather than the more abundant and larger populations from NE Spain (Ebro valley) (H(T) = 0.122). Low to moderate levels of genetic structure were found among regional ranges (G(ST) = 0.134), and several statistical spatial correlation analyses corroborated substantial genetic differentiation among the three main regional ranges. However, no significant genetic differentiation was found among the NE Spain populations, except for a northernmost population that is geographically isolated. Outcrossing mating and other biological traits of the species could account for the maintenance of the present values of genetic diversity within populations. The existence of an ancestral late Tertiary wider distribution of the species in SE and C Spain, followed by the maintenance of different Quaternary refugia in these warmer areas, together with a more recent and rapid post-glacial expansion towards NE Spain, are arguments that could explain the low genetic variability and structure found in the Ebro valley and the higher levels of diversity in the southern Iberian populations.

[Alterations in calcium metabolism in patients with active tuberculosis]. / Alteraciones del metabolismo del calcio en pacientes con tuberculosis activa.

BACKGROUND: Abnormalities in phosphocalcic and vitamin D metabolism may develop in patients with active tuberculosis (TB). Their incidence and relationship with the disease is not well known, particularly in our area. We have prospectively evaluated 40 patients with TB [(30 with localized TB (LTB) and 10 with disseminated TB (DTB)]. METHODS: After stabilizing the diet during 4 days, the calcium, phosphorus, magnesium and creatinine balances, blood ionic calcium, plasma intact PTH, 25-hydroxy vitamin D [25(OH)D] and serum 1.25 dihydroxyvitamin D [1.25(OH)2D] were measured. RESULTS: Hypercalcemia was not found in any patient, but 25% had hypercalciuria (HC). The 24-hour urinary excretion of calcium was higher in patients than in controls (3.2 +/- 1.7 mg/kg or 0.10 +/- 0.06 mg/100 ml of GFR vs 2.3 +/- 0.7 mg/kg or 0.08 +/- 0.03 mg/100 ml of GFR, p less than 0.05), basically at the expense of patients with DTB (4.4 +/- 1.8 mg/kg or 0.14 +/- 0.06 mg/10 ml of GFR, p less than 0.005). These had a lower PTH than patients with LTB and controls (12.8 +/- 7.7 vs 18.5 +/- 6.9 vs 19.5 +/- 6.0 pg/ml, p less than 0.05). Independently from the extent of the disease, the patients with HC had a lower PTH (12.6 +/- 6.8 vs 18.5 +/- 6.9 pg/ml, p less than 0.01) and higher serum 1.25(OH)2D (34.5 +/- 10.1 vs 25.0 +/- 7.2 pg/ml, p less than 0.01) than patients without HC. The levels of 25(OH)D were lower in patients with TB than in controls (11.2 +/- 6.0 vs 20.0 +/- 7.0 ng/ml, p less than 0.05), independently from the extent of the disease and the presence or absence of HC. CONCLUSIONS: Patients with tuberculosis may have hypercalcinuria with inadequately high levels of 1.25(OH)2D and low intact PTH. This abnormality appears to be correlated with the extent of the disease.

[Changes in serum and urinary levels of phosphorus in pregnant women, induced by effect of milk supplementation]. / Modificaciones de los niveles séricos y urinarios de fósforo en mujeres gestantes, por efecto de la suplementación láctea.

It was studied the levels of phosphorus in serum and urine in two groups of pregnant women. One group was advised to follow their usual intake and the other to supplement the diet with 750 ml of milk. A control group of healthy non pregnant women were conformed to the same protocol. Pregnant women that followed their usual intake had the same levels of serum phosphorus and maximum phosphate transport as controls. Pregnant women who had taken milk supplement showed in the second and third trimester of pregnancy significantly lower serum phosphorus and maximum phosphate transport levels than controls and also with respect to pregnant women in the first trimester. It suggests a possible influence of diet on these parameters. Both groups of pregnant women showed hyperphosphaturia through the three trimesters.

[Serum levels and urinary excretion of magnesium in pregnancy. Effect of milk intake]. / Niveles séricos y excreción urinaria de magnesio en la gestación. Influencia de la ingesta láctea.

Magnesium levels in serum, as well as 24-hr urine and 2-hr post-fasting urine levels, were studied in 107 pregnant women, who were later separated into two groups. One group was advised to follow their usual intake, and the other, to supplement the diet with 750 cc of milk. The control group (30 healthy non-pregnant women) underwent the same protocol. Magnesium intake in pregnant women was much lower than that recommended for gestation. In both groups of pregnant women, serum magnesium levels were lower than those of the controls, in the second and third trimester of pregnancy. Urinary magnesium in 24-hr urine was higher in each trimester of pregnancy than the controls. Hypomagnesemia and hypermagnesuria not influenced by milk intake was observed.

Acute antihypertensive effect of nifedipine on high and low salt diet.

To examine the influence of sodium balance in the acute response to nifedipine, we studied 10 untreated essential hypertensive patients aged 29 to 43 years. Blood pressure was recorded with the patients fasting and lying in the supine position, and 10 mg nifedipine was administered sublingually. Blood pressure was recorded again 3 h after nifedipine. Patients were studied after 1 week on both their unrestricted usual diet (NaU 206 +/- 29 mmol/day) and a low salt diet (NaU 66 +/- 8 mmol/day). The maximum hypotensive effect of nifedipine was observed at 90 min. The decrease of blood pressure tended to be greater and longer on high salt than low salt diet. Our results suggest that the acute antihypertensive effect of nifedipine is enhanced by sodium administration.