[Multimodal neuromonitoring in traumatic brain injury: contribution of PTiO2]. / Neuromonitorización multimodal en el TCE: aportación de la PTiO2.

The main goal of exhaustively monitoring neurocritical patients is to avoid secondary injury. In the last few years we have witnessed an increase in brain monitoring tools, beyond the checking of intracranial and brain perfusion pressures. These widely used systems offer valuable but possibly insufficient information. Awareness and correction of brain hypoxia is a useful and interesting measure, not only for diagnostic purposes but also when deciding treatment, and to predict an outcome. In this context, it would be of great interest to use all the information gathered from brain oxygenation monitoring systems in conjunction with other available multimodal monitoring devices, in order to offer individualized treatment for each patient.

The expression pattern of calcium signaling-related genes during smoltification of Salmo salar in productive conditions.

Variations in the mRNA expression of hepatic and muscle genes that are related to calcium signaling were analyzed by real-time qPCR in farmed Atlantic salmon (Salmo salar L. 1758) to determine changes in expression between parr and smolt stages. These organs were selected due to their close relationship with calcium signaling and metabolism (e.g., glycolysis, oxidative phosphorylation, muscle contraction). Differential expression between smolt and parr specimens and between organs was observed. Compared to parr specimens, smolts exhibited upregulated expression of the calcitonin receptor precursor, calcitonin receptor, calcitonin isoform, parathyroid hormone, and calmodulin in the liver. This pattern was inverse in muscle, with the exception of calmodulin, which was significantly upregulated in smolts compared to parr. Additionally, plasma calcium was decreased in the smolt condition. This study is the first to characterize the expression pattern of calcium signaling-related genes in the liver and muscle of parr and smolt S. salar. However, further functional studies are required to obtain a wider understanding about the physiological changes that accompany the productive conditions during smoltification.

[Sleep apnea-hypopnea syndrome and cardiovascular diseases]. / Síndrome de apnea-hipopnea del sueño y enfermedad cardiovascular.

Sleep apnea-hypopnea syndrome is characterised by daytime sleepiness, cognitive-behavioural, respiratory, cardiac, metabolic or inflammatory disorders, secondary to repeated obstruction of the upper airway during sleep. Numerous studies have shown that SAHS is associated with the presence of arterial hypertension and the development of cardiovascular diseases. Similarly, there is an excess of mortality associated with SAHS. An increase in the activity of the sympathetic nervous system and endothelial dysfunction are considered as mediating mechanisms, together with phenomena of oxidative stress, platelet aggregation and thrombosis.

[Nasoalveolar cyst. Five new cases]. / Quistes nasoalveolares. Presentación de 5 nuevos casos.

Nasoalverolar cyst are nonodontogenic maxillary cysts, rare and benign, which are more common in females and blacks. Their diagnosis can be established mainly on the clinical presentation, being usually asymptomatic during several years until they are large enough to cause cosmetic deformities and/or nasal obstruction, with asymmetrical alar flare. The treatment of choice is the complete surgical excision via a sublabial approach. Five cases diagnosed and treated at the Santa Maria del Rosell Hospital are reported, describing the most relevant clinican and pathological findings, so the diagnostic ant therapeutic methods.

[Schwannomas of the lingual nerve]. / Schwanoma del nervio lingual.

Schwanomas in extracranial head and neck region are an uncommon tumour, but when refered to its origin in the parasympathetic nerve fibers are extremely rare. We describe a case of schwanoma of the right submandibular gland originating from the parasympathetic branch of the lingual nerve, and we discuss about the clinical, diagnostic and therapeutic aspects of this rare tumour and a literature review of the recent cases.

[Facial mutilant basosquamous carcinoma]. / Carcinoma basoescamoso mutilante en región facial.

Basosquamous carcinoma is a rare epithelial malignant neoplasm with clinical and biological features of both basal and squamous cell carcinoma. This neoplasm has been characterized for years as a variant of basal cell carcinoma, although now it is widely accepted as a clinical entity. We report a 59-year-old male patient, homeless, who presented an ulcerated tumoral lesion from four years ago, located in left malar region, orbit and nasal pyramid. It caused an important destruction of these anatomic structures and spred out the skull base through optic nerve. The most important features of basosquamous carcinoma are its great local aggressiveness, high frequency of recurrences and its metastatic potential. Because of that, the most effective therapeutic measure is the early detection and complete removement of these tumours; although, as the case we report, it is not always possible.

[Evolution of the epidemiological characteristics of tuberculosis in Navarra (1994-2003)]. / Evolución en las características epidemiológicas de la tuberculosis en Navarra (1994-2003).

AIM: To describe the changes in the incidence and the epidemiological profile of tuberculosis in Navarra. METHODS: The cases of tuberculosis in the 1994-2003 period were analysed. Cases reported to the system of obligatory notifiable diseases, completed with the microbiological diagnoses and the cases collected in other health registers. RESULTS: The incidence of tuberculosis fell from 21 per 100,000 inhabitants in the five-year period 1994-1998 to 16 per 100,000 in 1999-2003. In both periods the number of cases in men doubled that in women, and the maximum incidence occurred in the age groups from 25 to 44 and over 65 years of age. The diagnoses of tuberculosis in persons with HIV infection fell from 15.1% to 6.6% and those in immigrants rose from 2.2% to 21.3%. Somewhat over 3% of the cases had received prior anti-tuberculosis treatment and about 6% showed resistance to some medicine, without significant differences between periods. The proportion of potentially transmissible tuberculosis (73%) underwent no significant changes, nor did that of those with positive sputum bacilloscopy. The number of outbreaks (groupings of two or more cases) rose from 18 to 26 and the percentage of cases secondary to another recent case rose from 3.6% to 10.1% (p<0,001). In the 1999-2003 period, pulmonary localisation occurred in isolated form in 67.7% of the patients, and in combination with other localisations in another 5.1%. The isolated pleural form appeared in 9.9% and the meningeal form in 1.5%. CONCLUSION: There has been an advance in the control of tuberculosis although its incidence is still high with respect to other European countries. Control of imported cases is one of the challenges to be faced in coming years, without neglecting control measures in the autochthonous population.

Spatial Inhibition of Return promotes changes in response-related mu and beta oscillatory patterns.

The possible role that response processes play in Inhibition of Return (IOR), traditionally associated with reduced or inhibited attentional processing of spatially cued target stimuli presented at cue-target intervals longer than 300 ms, is still under debate. Previous psychophysiological studies on response-related Electroencephalographic (EEG) activity and IOR have found divergent results. Considering that the ability to optimize our behavior not only resides in our capacity to inhibit the focus of attention from irrelevant information but also to inhibit or reduce motor activation associated with responses to that information, it is conceivable that response processes are also affected by IOR. In the present study, time-frequency (T-F) analyses were performed on EEG oscillatory activity between 2 and 40 Hz to check whether spatial IOR affects response preparation and execution during a visuospatial attention task. To avoid possible spatial stimulus-response compatibility effects and their interaction with the IOR effects, the stimuli were presented along the vertical meridian of the visual field. The results differed between lower and upper visual fields. In the lower visual field spatial IOR was related to a synchronization in the pre-movement mu band at bilateral precentral and central electrodes, and in the post-movement beta band at contralateral precentral and central electrodes, which may be associated with an attention-driven reduction of somatomotor processing prior to the execution of responses to relevant stimuli presented at previously cued locations followed by a post-movement deactivation of motor areas. In the upper visual field, spatial IOR was associated with a decrease in desynchronization around response execution in the beta band at contralateral postcentral electrodes that might indicate a late (last moment) reduction of motor activation when responding to spatially cued targets. The present results suggest that different response processes are affected by spatial IOR depending on the visual field where the target is presented.

Bioprosthetic mitral valve thrombosis: clinical profile, transesophageal echocardiographic features, and follow-up after anticoagulant therapy.

Cardiac bioprosthetic valve thrombosis is frequently found on pathologic examination, but preoperative diagnosis is rarely performed. Four hundred six patients with mitral porcine xenograft bioprostheses were examined by transthoracic echocardiography. Transesophageal echocardiography (TEE) was performed in 161 of the patients, with clinical or echocardiographic criteria of prosthetic malfunction. Fairly homogeneous and echodense masses, attached to the ventricular surface of the mitral bioprosthetic cusps, were detected by TEE in 15 patients. Only 10 patients, in whom diagnosis of bioprosthetic thrombosis was confirmed, are included in this study. After TEE, two patients underwent prosthetic replacement and eight patients received anticoagulants. A new TEE was performed 85.6 +/- 29.8 days after anticoagulation in these eight patients. Clinical follow-up was continued for 13.6 +/- 8.6 months, and one additional patient underwent surgery during the follow-up. Pathologic examination of removed grafts (three cases) identified these masses as being thrombotic tissue. TEE examination after therapeutic anticoagulation demonstrated complete disappearance of the echogenic masses on bioprosthetic cusps and normal mobility of all leaflets in six cases. In the other two cases, cusp masses were notably reduced, but partially restrictive mobility of affected leaflets persisted, suggesting incomplete resolution of thrombi. Mitral valve prosthetic mean gradient decreased from 11.8 +/- 4.5 to 7.6 +/- 3.7 mm Hg (p < 0.001), and mitral valve area increased from 1.13 +/- 0.3 to 1.72 +/- 0.6 cm2 (p < 0.001). Long-term symptomatic improvement after anticoagulation was obtained in seven patients. Thus this study shows that mitral bioprosthetic thrombosis is a relatively frequent cause of valve dysfunction, TEE is useful for detecting thrombus in relation to mitral bioprosthetic valves, and oral anticoagulation is effective in resolving thrombosis on bioprostheses.

Left atrial dissection: pathogenesis, clinical course, and transesophageal echocardiographic recognition.

Left atrial dissection is an uncommon entity. It is generally associated with mitral valve replacement, but other predisposing factors should be considered in pathogenesis. We discuss a series of 11 patients with pathologically confirmed left atrial dissection who had been diagnosed previously by transesophageal echocardiography. Predisposing factors and surgical or pathologic findings were reviewed to identify the pathogenic mechanism and to explain the clinical course, hemodynamic disorder, and echocardiographic features. Dissection of the coronary sinus secondary to retrograde cardioplegia, endocarditis, cardiac rupture after myocardial infarction, and blunt chest trauma also could be related to its development. Transesophageal echocardiography identified a mobile intimal flap of the atrial wall that was creating a false chamber and allowed accurate diagnosis of prosthetic mitral valve function, endocarditis complications, and a left ventricular pseudoaneurysm after acute myocardial infarction. Color flow Doppler was particularly useful in identifying complications: communication between the false chamber and true left atria, permitting mitral regurgitation through the periannular route; development of atrial shunts; and severe tricuspid regurgitation caused by disruption of the anterior papillary muscle.

Epidemiology of urticaria in Spain.

BACKGROUND: In spite of the frequency of chronic urticaria there are very few epidemiological studies of its prevalence and distribution. OBJECTIVE: We wanted to approach the real prevalence of chronic urticaria in a population-based study and to depict demographic distribution and personal perception of the disease. We also wanted to describe the frequency of acute urticaria episodes in the population studied. METHODS: We conducted a population-based study among adults in Spain. We questioned 5003 individuals after calculating a sample size for a maximum variability (conservative approach p=q=0.5). RESULTS: We found a 0.6% (95% CI: 0.4-0.8) prevalence of chronic urticaria. The prevalence is significantly higher in women than in men with a OR=3.82 (95%CI 1.56-9.37). Chronic urticaria is a self-limited disease, yet in 8.7% of cases chronic urticaria lasts from one to 5 years and in 11.3%, for more than 5 years. The average age of onset is 40 years. CONCLUSIONS: We offer large epidemiology study data on the prevalence of chronic urticaria. The prevalence of chronic urticaria has not yet been defined in an adult population-based study. With this work we offer such data to describe the prevalence and features of this disease.

[Aortic pseudocoarctation complicated by a giant pseudoaneurysm]. / Seudocoartación de aorta complicada con seudoaneurisma gigante.

Pseudocoarctation of the aorta is an infrequent anomaly caused by the elongation and the congenital kinking of the aorta. We present a case of pseudocoarctation of the aorta with saccular aneurysm complicated with a large pseudoaneurysm. Both, magnetic resonance and aortography showed an aneurysm of the aortic isthmus that extended/progressed as pseudoaneurysm towards the neck. The patient was asymptomatic but due to the high risk of rupture, she underwent surgical reparation. The revision of the literature and our experience with this case show that pseudocoarctation of the aorta is not always a benign pathology and that surgical reparation should be performed in all those cases that are complicated by aneurysm.

[Prosthetic endocarditis and splenic abscess caused by Clostridium clostridiformis]. / Endocarditis protésica y absceso esplénico causados por Clostridium clostridiformis.

We report the first case of Clostridium clostridiformis endocarditis in a 71 year old man with an aortic prosthetic valve. He was febrile with left upper quadrant pain and left lower lobe infiltrate in chest X ray. The diagnosis was made by gram-positive bacilli grown from three blood cultures. Transthoracic and transesophageal echocardiogram showed a paraaortic abscess. A computed tomographic scan of the abdomen revealed a large splenic abscess. He received penicillin G 4 million units every 4 hours intravenously. A successful percutaneous drainage guided computed tomographic scan was performed. The patient remained febrile and a new computed tomographic scan of the abdomen revealed residual splenic abscess. A splenectomy was performed. The patient defervesced on the second day of surgery and remained afebrile during the remainder of his hospitalization. He has returned for medical follow-up and two years later the patient is asymptomatic.

[Acute pericarditis as the initial presentation of a primary cardiac angiosarcoma. The anatomicoclinical correlations]. / Pericarditis aguda como presentación inicial de un angiosarcoma primario cardíaco. Correlaciones anatomoclínicas.

We report the clinic and postmortem pathologic examination of a 38-years-old man with a primary angiosarcoma of right atrium and many widespread metastatic. Both his presentation, a clinical course of acute pericarditis self-limited, as the negatives complementary examination, give at case unusual characteristics, for his high malignancy.

[Lipomatous hypertrophy of the interauricular septum, fibrosis of the bundle of His and calcification of the mitral annulus associated with multiple rhythm and conduction disorders. The anatomicoclinical correlations]. / Hipertrofia lipomatosa del septo interauricular, fibrosis del haz de His y calcificación del anillo mitral asociadas a múltiples trastornos del ritmo y de la conducción. Correlaciones anatomoclínicas.

We present the case of a 72 years old female with multiple episodes of atrial fibrillation, interatrial block and different degrees of atrioventricular block, that died because of stroke. Postmortem pathologic examination showed a lipomatous hypertrophy of the interatrial septum (previously suspected on echocardiogram), his bundle and right branch degeneration as well as mitral annular calcification extended to conduction system. According to these pathologic findings, rhythm and conduction disturbances are correlated with the two levels (atrial and atrioventricular) where anatomic abnormalities were found.

[Bilateral pelvic ectopic kidney]. / Riñón ectópico pelviano bilateral.

OBJECTIVES: A case of bilateral ectopic pelvic kidney is presented whose clinical symptoms were hypogastric pain and cloudy urine. The few cases reported in the world medical literature are briefly reviewed. METHODS: Patient evaluation included intravenous urography, selective right renal arteriography and transoperative left antegrade pyelography. A left nephrectomy was performed. RESULTS: All symptoms disappeared after nephrectomy. CONCLUSIONS: Bilateral ectopic pelvic kidneys are uncommon as shown by the few cases reported in the literature. To our knowledge, the present case is the first case reported in the Spanish literature.

[Solitary pelvic kidney and vaginal agenesia]. / Riñón pelviano solitario y agenesia vaginal.

OBJECTIVE: To present a case of solitary pelvic kidney with congenital absence of the vagina. METHODS: A patient with solitary pelvic kidney and vaginal aplasia is described. Patient evaluation included hematological, hormonal, cytogenetic, laparoscopic and imaging studies. RESULTS: Blood, hormone and cytogenetic studies were normal. Laparoscopy showed absence of the uterus and both tubes and ovaries, which was confirmed by pneumopyelography. IVP showed absence of renal shadows and a solitary pelvic kidney. CONCLUSIONS: Congenital absence of the vagina should be suspected in a patient with a pelvic solitary kidney consulting for primary amenorrhea.

[Transverse testicular ectopia. A review of the literature and a case report]. / Ectopía testis transversa. Revisión de la literatura y presentación de un caso.

OBJECTIVE: To describe a case of crossed testicular ectopia that was diagnosed in a 52-year-old patient who had consulted for infertility associated with a genital anomaly. METHODS: Patient evaluation included hematological, hormonal, cytogenetic and imaging studies. An exploratory operation was also performed. RESULTS: The hematological, hormonal and cytogenetic studies gave normal results. There were no urinary tract abnormalities in the intravenous urography; retrograde urethrography disclosed a narrow duct behind the urethra that ascended towards the left inguinal duct and divided into two epididymides after reaching the scrotum. Surgical exploration showed two testes in the left scrotal pouch that were biopsied. Histological examination revealed an almost complete hyalinization of the tubular wall with no germ cells within the tubules. CONCLUSIONS: Crossed testicular ectopia is one of the most uncommon testicular anomalies and is often associated with other disorders such as inguinal hernia, hypospadias, pseudohermaphroditism and scrotal abnormalities. Like all dysgenetic testes, progression to malignancy is relatively frequent. The foregoing should be remembered when dealing with these patients.