RESUMEN
There is growing evidence that certain reactivation conditions restrict the onset of both the destabilization phase and the restabilization process or reconsolidation. However, it is not yet clear how changes in memory expression during the retrieval experience can influence the emergence of the labilization/reconsolidation process. To address this issue, we used the context-signal memory model of Chasmagnathus. In this paradigm a short reminder that does not include reinforcement allows us to evaluate memory labilization and reconsolidation, whereas a short but reinforced reminder restricts the onset of such a process. The current study investigated the effects of the glutamate antagonists, APV (0.6 or 1.5 µg/g) and CNQX (1 µg/g), prior to the reminder session on both behavioral expression and the reconsolidation process. Under conditions where the reminder does not initiate the labilization/reconsolidation process, APV prevented memory expression without affecting long-term memory retention. In contrast, APV induced amnesic effects in the long-term when administered before a reminder session that triggers reconsolidation. Under the present parametric conditions, the administration of CNQX prior to the reminder that allows memory to enter reconsolidation impairs this process without disrupting memory expression. Overall, the present findings suggest that memory reactivation--but not memory expression--is necessary for labilization and reconsolidation. Retrieval and memory expression therefore appear not to be interchangeable concepts.
Asunto(s)
Aprendizaje por Asociación/fisiología , Memoria/fisiología , Recuerdo Mental/fisiología , Retención en Psicología/fisiología , 6-Ciano 7-nitroquinoxalina 2,3-diona/farmacología , Animales , Aprendizaje por Asociación/efectos de los fármacos , Braquiuros , Reacción de Fuga/efectos de los fármacos , Reacción de Fuga/fisiología , Antagonistas de Aminoácidos Excitadores/farmacología , Reacción Cataléptica de Congelación/efectos de los fármacos , Reacción Cataléptica de Congelación/fisiología , Memoria/efectos de los fármacos , Recuerdo Mental/efectos de los fármacos , Valina/análogos & derivados , Valina/farmacologíaRESUMEN
BACKGROUND: Acute fibroid complications are rare. However, failure to recognize and treat acute complications expeditiously when they occur can lead to catastrophic, even deadly, complications. Pyomyoma is a rare but potentially fatal condition resulting from infarction and infection of a fibroid through bacterial seeding and direct, hematogenous, or lymphatic dissemination. Even though the diagnosis is established through clinical and laboratory findings, imaging is an important complementary method to support the suspected diagnosis. CASE SUMMARY: Herein, we report a case of a pyomyoma in a nulliparous woman previously diagnosed with uterine leiomyomatosis according to ultrasound findings. The patient had previously attended the emergency room due to hypogastric pain unresponsive to analgesics. After a week of persistent pain, she developed sepsis without any identifiable foci. Magnetic resonance imaging revealed findings compatible with uterine myomatosis with red degeneration, and a possible diagnosis of a pyomyoma was made according to the imaging findings along with the patient's clinical features. We decided to perform myomectomy (which is an infrequently performed surgical treatment due to the procedure's intrinsic implications) due to the patient's desire to preserve fertility. Histopathologic results revealed a uterine leiomyoma with coagulative and liquefactive necrosis, while the tissue culture showed gram-negative cocci bacteria, which were successfully treated using antibiotic therapy. The patient's health status improved after several days. CONCLUSION: The main diagnostic tools to evaluate pyomyomas are the clinical and laboratory findings as well as tissue cultures. Nonetheless, magnetic resonance imaging can help to corroborate these findings as well as to better characterize myomas with its different complications.
RESUMEN
Question mark ear deformity or Cosman ear is a very uncommon congenital alteration. The deformity includes a cleft between the posterior helix and the lobule, an increase in anterior projection, an abnormal superior third that modifies the superior crura and the scaphoid fossa, partial or complete absence of the antihelix, transposition of the lobule and antihelix (severe cases), and postauricular tags. The authors present a case of moderate question mark ear deformity treated using Mustarde sutures and two cartilage grafts to correct the support and the contour defect. Adequate correction of the deformity and symmetry was achieved for both ears. The technique described in this report is suitable for minimal to moderate defects.
Asunto(s)
Oído Externo/anomalías , Oído Externo/cirugía , Niño , Femenino , Humanos , Procedimientos de Cirugía PlásticaRESUMEN
INTRODUCTION AND OBJECTIVES: Myxomas are the most common type of primary cardiac tumors. The aim of this study was to analyze the clinical forms of presentation of cardiac myxoma, the postoperative evolution, and the possibility of recurrence and tumoral embolism. PATIENTS AND METHOD: From July 1992 to March 1999, 31 patients with myxoma were studied. Cell cycles (ploidy pattern of the tumoral DNA) were studied in 12 patients to evaluate the risk of recurrence and tumoral embolism. RESULTS: The most frequent clinical manifestations were constitutional symptoms (74%), dyspnea (45%), and embolism (41%). Smaller-diameter myxomas correlated independently with tumoral embolism (45%). The in-hospital mortality was 3.2%, no deaths were observed during follow-up (mean: 4.8 years). No patients had clinical or echocardiographic signs of tumoral recurrence. Patients with tumoral embolism (n = 8) were compared with patients without embolism (n = 4). Patients who suffered embolism had higher S phase > 7 and/or DNA index > 1.2 (4/4 patients [100%], p= 0.061) than patients without embolism (2/8 patients [25%]). Cytometry of the only recurrent tumor (second operation) revealed a diploid tumor with a significantly more frequent S phase (10%) than in sporadic myxomas (4.27 2.32%, p = 0.039). CONCLUSIONS: Constitutional symptoms, dyspnea, and tumor embolism were the most frequent clinical manifestations. Clinical and anatomopathologic characteristics and the cell cycle were not significantly related to tumoral embolism, but there was a tendency toward a higher proportion of cells in S phase and a higher DNA index in tumors associated with embolism. The S phase was significantly more frequent in the only case of recurrent myxoma and could be a potential marker of recurrence.
Asunto(s)
Neoplasias Cardíacas/cirugía , Mixoma/cirugía , Adulto , Anciano , ADN de Neoplasias/química , Femenino , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/patología , Humanos , Masculino , Persona de Mediana Edad , Miocardio/patología , Mixoma/diagnóstico , Mixoma/patología , Células Neoplásicas Circulantes/patología , Recurrencia , Estudios RetrospectivosRESUMEN
INTRODUCTION AND OBJECTIVES: The aim of this study was to describe the predictors of hospital mortality found in patients admitted for infective endocarditis (IE) to a cardiovascular surgery ward. Patients and method. Prospective study of 186 patients with IE treated in our hospital between 1992 and 2001. RESULTS: One hundred fourteen patients (61.3%) had native valve endocarditis and 72 (38.7%) had prosthetic valve endocarditis (early in 28 patients [up to 12 months after surgery] and late in 44 [later than 12 months]). Blood cultures were positive in 82%. The predominant organism was Streptococcus viridans (36%) in native valve endocarditis and Staphylococcus aureus (33%) in prosthetic valve endocarditis. The hospital mortality was 22.6%. Severe sepsis (4.8%) produced a high mortality rate (88%) and was caused by Staphylococcus aureus in 60%. One hundred nineteen patients (64%) required surgery, 79 (66.4%) of them urgently. Negative blood cultures predicted need for surgery in native valve endocarditis (p < 0.05). The surgical mortality was 21.8% and was related to NYHA III-IV class (p = 0.014) and emergency surgery (p = 0.009) in patients with native valve endocarditis. This last factor also predicted higher surgical mortality in patients with early prosthetic valve endocarditis (p < 0.001). CONCLUSIONS: The hospital mortality of this group of patients with infective endocarditis treated in a tertiary medical center was high. The presence of severe sepsis, although infrequent, had a somber prognosis. Severe heart failure in native valve endocarditis and urgent surgery in native and prosthetic valve endocarditis increased surgical mortality.
Asunto(s)
Endocarditis Bacteriana/mortalidad , Mortalidad Hospitalaria , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Procedimientos Quirúrgicos Cardíacos/mortalidad , Ecocardiografía , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/cirugía , Femenino , Prótesis Valvulares Cardíacas/efectos adversos , Prótesis Valvulares Cardíacas/microbiología , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/mortalidadRESUMEN
Se presentan los resultados de 123 pacientes sometidos a cirugía de revascularización miocárdica utilizando conductos arteriales: arterias mamarias y arteria radial. La mamaria izquierda casi siempre es empleada para revascularizar el territorio de la arteria descendente anterior y generalmente in situ, mientras que con la derecha se revascularizó las áreas dependientes de coronaria derecha y circunfleja; finalmente la arteria radial se destinó a los territorios del ramo diagonal, circunfleja y a veces de la descendente posterior. La arteria radial estuvo disponible para realizar anastomosis múltiples debido a su extensión aproximada de 20 cm. Asimismo el empleo combinado de estos tres conductos arteriales permite una revascularización arterial exclusiva en la mayoría de los pacientes operados con una baja morbimortalidad temprana y alejada
Asunto(s)
Humanos , Adulto , Persona de Mediana Edad , Arterias Mamarias/cirugía , Arteria Radial/cirugía , Revascularización Miocárdica/métodos , Cirugía Torácica , Angiografía , Diltiazem , Diltiazem/uso terapéutico , Complicaciones PosoperatoriasRESUMEN
Introducción y objetivos. El objetivo de este estudio es intentar reconocer los predictores de mortalidad hospitalaria de los enfermos con endocarditis infecciosa ingresados en un servicio de cirugía cardiovascular. Pacientes y método. Estudio prospectivo de 186 casos de endocarditis infecciosa en pacientes tratados desde 1992 hasta 2001.Resultados. Se trataron 114 casos de endocarditis infecciosa sobre la válvula nativa y 72 casos (38,7 por ciento) sobre la válvula protésica (28 tempranas [hasta 12 meses poscirugía] y 44 tardías [posteriores a este período]). Los hemocultivos fueron positivos en el 82 por ciento, predominando Streptococcus viridans (36 por ciento) en las válvulas nativas y Staphylococcus aureus (33 por ciento) entre las protésicas. La mortalidad hospitalaria global fue del 22,6 por ciento. En los pacientes no operados, la sepsis grave (4,8 por ciento, un 60 por ciento por Staphylococcus aureus) fue la causa del 88 por ciento de mortalidad (p < 0,001). En total, 119 pacientes (64 por ciento) requirieron cirugía (urgente en el 66,4 por ciento). En la endocarditis nativa, la presencia de hemocultivos negativos resultó predictora de necesidad quirúrgica (p < 0,05). La mortalidad quirúrgica fue del 21,8 por ciento y se relacionó, en las válvulas nativas, con la clase funcional III-IV de la New York Heart Association (NYHA) (p = 0,014) y la urgencia (p = 0,009). Este último factor predijo también mayor mortalidad entre las protésicas tempranas (p < 0,001).Conclusiones. La mortalidad hospitalaria de los pacientes con endocarditis infecciosa tratados en un centro de derivación terciaria es elevada. La sepsis grave, aunque poco frecuente, tiene un pésimo pronóstico. En las endocarditis nativas y protésicas tempranas, la urgencia en la indicación aumenta la mortalidad quirúrgica. Esta última se encuentra incrementada en las endocarditis nativas en presencia de insuficiencia cardíaca grave (AU)
Asunto(s)
Persona de Mediana Edad , Adolescente , Adulto , Anciano de 80 o más Años , Anciano , Masculino , Femenino , Humanos , Mortalidad Hospitalaria , Infecciones Estafilocócicas , Estudios Prospectivos , Pronóstico , Ecocardiografía , Endocarditis Bacteriana , Procedimientos Quirúrgicos Cardíacos , Prótesis Valvulares Cardíacas , Valor Predictivo de las PruebasRESUMEN
Con el fin de evaluar la posibilidad de diagnosticar rechazo en los pacientes con trasplante cardíaco a través de la ecocardiografía Doppler, se analizaron 40 pacientes con 290 eco-Doppler realizados en el mismo día de la biopsia y se compararon los resultados obtenidos. Mostraron buena correlación con el rechazo las variables de función diastólica, la velocidad anterógrada pulmonar y la presencia de derrame. Las variables de función sistólica también se correlacionaron en algunos casos pero en forma tardía. El bajo número de biopsias con alto grado de severidad avala la búsqueda de métodos incruentos para el seguimiento de los pacientes con rechazo