Fragilidad, polifarmacia y riesgo de caídas en personas adultas mayores / Fragility, polypharmacy and risk of falls in older adults

Objetivo: Analizar la relación de fragilidad, polifarmacia y riesgo de caídas en las personas adultas mayores. Metodología: El diseño de estudio fue descriptivo, correlacional y transversal, conformado por 261 personas adultas mayores de Saltillo, Coahuila (México). Se utilizó una cédula de datos personales y prevalencia de polifarmacia, escala Frail y escala de Tinetti. Los datos se analizaron a través de SPSS versión 25 para Windows, se utilizaron frecuencias y porcentajes, medidas de tendencia central y dispersión. Resultados: El 19,2% de los participantes fueron frágiles, el 44,1% de las personas adultas mayores presentaron polifarmacia y el 37,5% reportó un alto riesgo de caídas. La fragilidad se correlacionó positiva y significativamente con la polifarmacia (rs = 0,274; p < 0,01) y el riesgo de caídas se correlacionó negativa y significativamente con fragilidad (rs = -0,333; p < 0,01). Conclusiones: Existe una relación entre la fragilidad y el riesgo de caídas en las personas adultas mayores, la polifarmacia no tuvo relación con el riesgo de las caídas (AU)

Objective: Analyze the relationship of frailty, polypharmacy and risk of falls in older adults. Methodology: The study design was descriptive, correlational and cross-sectional, made up of 261 older adults from Saltillo, Coahuila. A personal data card and the prevalence of polypharmacy, the Frail scale and the Tinetti scale were used. The data was analyzed through SPSS version 25 for Windows, frequencies and percentages, measures of central tendency and dispersion were used. Results: The 19.2% of participants were frail, 44.1% of older adults had polypharmacy, and 37.5% reported a high risk of falls. Frailty was positively and significantly correlated with polypharmacy (rs = 0.274; p < 0.01) and risk of falls was negatively and significantly correlated with frailty (rs = -0.333; p < 0.01). Conclusions: There is a relationship between frailty and the risk of falls in older adults, polypharmacy was not related to the risk of falls (AU)

Mode-splitting in a microring resonator for self-referenced biosensing.

Self-referenced biosensing based on mode-splitting on a microring resonator is experimentally demonstrated. A Bragg grating integrated on the surface of the ring provides coupling between the clockwise and counterclockwise travelling modes of the pristine ring resonator lifting their degeneracy. The amount of mode-splitting is directly related to the reflectivity of the grating and it is only affected by structurally modifying the grating. Environmental perturbations to the surroundings of the gratings, such as temperature and bulk refractive index variations, have a minor effect on the amount of mode-splitting. This principle allows the realization of a self-referenced sensing scheme based on the detection of variations of the mode-splitting induced by structural changes to the grating. In this work, a polymethyl methacrylate (PMMA) Bragg grating is integrated onto a ring resonator in Al2O3. It is shown both theoretically and experimentally that the amount of splitting of a resonance varies minimally under temperature or bulk refractive index perturbations. However, the structural change of attaching a layer of biomolecules inside the grating does affect its reflectivity and the amount of mode splitting present. This result represents the first proof-of-concept demonstration of an integrated mode-splitting biosensor insensitive to temperature and refractive index variations of the liquid matrix where the molecules to be detected are embedded. The reported results pave the road towards the realization of truly self-referenced biosensors.

Al2O3 microring resonators for the detection of a cancer biomarker in undiluted urine.

Concentrations down to 3 nM of the rhS100A4 protein, associated with human tumor development, have been detected in undiluted urine using an integrated sensor based on microring resonators in the emerging Al2O3 photonic platform. The fabricated microrings were designed for operation in the C-band (λ = 1565 nm) and exhibited a high-quality factor in air of 3.2 × 105. The bulk refractive index sensitivity of the devices was ~100 nm/RIU (for TM polarization) with a limit of detection of ~10-6 RIU. A surface functionalization protocol was developed to allow for the selective binding of the monoclonal antibodies designed to capture the target biomarker to the surface of the Al2O3 microrings. The detection of rhS100A4 proteins at clinically relevant concentrations in urine is a big milestone towards the use of biosensors for the screening and early diagnosis of different cancers. Biosensors based on this microring technology can lead to portable, multiplexed and easy-to-use point of care devices.

Intraoperative radiotherapy for the treatment of resectable locally advanced gastric adenocarcinoma: topography of locoregional recurrences and long-term outcomes

INTRODUCTION: To report feasibility, tolerance, anatomical sites of upper abdominal locoregional recurrence and long-term outcome of gastric cancer patients treated with surgery and a component of intraoperative electron beam radiotherapy (IORT). MATERIALS AND METHODS: From January 1995 to December 2010, 32 patients with primary gastric adenocarcinoma treated with curative resection (R0) [total gastrectomy (n = 9; 28 %), subtotal (n = 23; 72 %) and D2 lymphadenectomy in all patients] and apparent disease confined to locoregional area [Stage: II (n = 15; 47 %), III (n = 17; 53 %)] were treated with a component of IORT (IORT applicator size 5-9 cm in diameter, dose 10-15 Gy, beam energy 6-5 MeV) over the celiac axis and peripancreatic nodal areas. Sixteen (50 %) patients also received adjuvant treatment (external beam radiotherapy n = 6, chemoradiation n = 9, chemotherapy alone n = 1). RESULTS: With a median follow-up time of 40 months (range, 2-60), locoregional recurrence was observed in five (16 %) patients (4 nodal in hepatic hilum and 1 anastomotic). Only pN1 patients developed locoregional relapse. No recurrence was observed in the IORT-treated target volume (celiac trunk and peripancreatic nodes). Overall survival at 5 years was 54.6 % (95 % CI: 48.57-60.58). Postoperative mortality was 6 % (n = 2) and postoperative complications 19 % (n = 6). CONCLUSIONS: It is feasible to integrate IORT as a component of radiotherapy in combined modality therapy of gastric cancer. Local control is high in the radiation boosted area, but marginal regional extension (in particular, involving the hepatic hilum) might be considered as part of the anatomic IORT target volume at risk in pN+ patients (AU)

A unique aortic arterial meshwork with a major aortopulmonary collateral artery, a major arteriovenous collateral artery, and a coronary arteriovenous fistula in a young man with a bicuspid aortic valve.

This report describes a case of an asymptomatic 18-year-old boy with a grade 1/6 ejection systolic murmur in the aortic area referred for an echocardiographic study to rule out a congenital heart disease. The patient had situs solitus, levocardia, bicuspid aortic valve, dilation of the proximal portions of the right coronary artery, and arteriovenous coronary fistula of the anomalous coronary branch originating from the anterior descending coronary artery into the main pulmonary artery. In addition he had a unique aortic arterial meshwork constituted by arteries originating from the inferior and posterior aspect of the distal portion of the transverse aortic arch, intersegmentary arteries originating from the lateral and anterior aspect of the proximal portion of the descending aorta, and the true bronchial artery with a major arteriovenous collateral artery draining into the superior vena cava and the superior division of the left lower pulmonary vein as well as a major aortopulmonary collateral artery anastomosed with a bronchial artery and draining into the posterior aspect of the right pulmonary artery. The use of transthoracic two-dimensional color flow Doppler echocardiography, magnetic resonance angiography and multislice computed tomography to establish a detailed morphologic analysis and the presence of associated anomalies in patients with a bicuspid aortic valve are discussed.

Intraoperative radiotherapy for the treatment of resectable locally advanced gastric adenocarcinoma: topography of locoregional recurrences and long-term outcomes.

INTRODUCTION: To report feasibility, tolerance, anatomical sites of upper abdominal locoregional recurrence and long-term outcome of gastric cancer patients treated with surgery and a component of intraoperative electron beam radiotherapy (IORT). MATERIALS AND METHODS: From January 1995 to December 2010, 32 patients with primary gastric adenocarcinoma treated with curative resection (R0) [total gastrectomy (n = 9; 28 %), subtotal (n = 23; 72 %) and D2 lymphadenectomy in all patients] and apparent disease confined to locoregional area [Stage: II (n = 15; 47 %), III (n = 17; 53 %)] were treated with a component of IORT (IORT applicator size 5-9 cm in diameter, dose 10-15 Gy, beam energy 6-5 MeV) over the celiac axis and peripancreatic nodal areas. Sixteen (50 %) patients also received adjuvant treatment (external beam radiotherapy n = 6, chemoradiation n = 9, chemotherapy alone n = 1). RESULTS: With a median follow-up time of 40 months (range, 2-60), locoregional recurrence was observed in five (16 %) patients (4 nodal in hepatic hilum and 1 anastomotic). Only pN1 patients developed locoregional relapse. No recurrence was observed in the IORT-treated target volume (celiac trunk and peripancreatic nodes). Overall survival at 5 years was 54.6 % (95 % CI: 48.57-60.58). Postoperative mortality was 6 % (n = 2) and postoperative complications 19 % (n = 6). CONCLUSIONS: It is feasible to integrate IORT as a component of radiotherapy in combined modality therapy of gastric cancer. Local control is high in the radiation boosted area, but marginal regional extension (in particular, involving the hepatic hilum) might be considered as part of the anatomic IORT target volume at risk in pN+ patients.

Biopsia de ganglio centinela en pacientes con cáncer de mama y cirugía mamaria previa / Sentinel node biopsy in patients with breast cancer and previous breast surgery

Objetivo. El objetivo de este estudio fue determinar la eficacia y seguridad de la biopsia del ganglio centinela para la estadificación linfática en pacientes con cáncer de mama y cirugía previa mamaria, considerando la extensión, localización y tiempo desde el procedimiento quirúrgico anterior. Material y métodos. Realizamos biopsia de ganglio centinela a 38 pacientes con cáncer de mama precoz y algún antecedente quirúrgico mamario: biopsia escisional reciente en 22 pacientes (grupo I), tumorectomía o mamoplastia antigua en 16 (grupo II), incluyendo una cirugía conservadora por cáncer de mama (recurrencia tumoral). Se realizó linfogammagrafía tras inyección periareolar y ocasionalmente también peri-cicatricial. Tras la exéresis del ganglio centinela se practicó linfadenectomía axilar solo cuando el ganglio fue positivo (o no localizado). Resultados. La eficacia de localización gammagráfica del ganglio centinela fue 92,1%, con 15,8% de drenajes extra-axilares; la tasa de detección quirúrgica axilar fue 81,6%. La identificación resultó similar tras biopsia escisional reciente y cirugía antigua (81,8 frente a 81,2%), con mayor porcentaje de ganglios extra-axilares en el segundo grupo (9,1% frente a 25%). La localización del antecedente quirúrgico en el cuadrante supero-externo produjo más drenajes extra-axilares (27,2% frente a 11,1%); la eficacia de detección axilar fue similar al resto de cuadrantes (81,8% frente a 81,5%). La tasa actual de eventos relacionados con la enfermedad es 5,2% (2/38), sin recurrencias locorregionales (seguimiento medio tres años). Conclusión. La biopsia del ganglio centinela tras cirugía mamaria no extensa puede realizarse con seguridad. Los drenajes extra-axilares son más frecuentes cuando el antecedente quirúrgico es amplio, remoto y en el cuadrante superoexterno(AU)

Aim. The aim of this study was to establish the efficacy and safety of sentinel lymph node biopsy for lymph node staging in patients with breast cancer and prior breast surgery, considering its extension, localization and time since the previous surgical procedure. Material and methods. A sentinel lymph node biopsy was performed in 38 patients with early breast cancer and previous breast surgery: recent excisional biopsy in 22 patients (Group I), previous lumpectomy or mammoplasty in 16, including one case of cancer treated with breast-conserving surgery (tumor recurrence). Lymphoscintigraphy was performed after periareolar injection, also sometimes adding an injection near to the surgical scar. After removing the sentinel node, axillary lymph node dissection was performed when the lymph node was positive (and not localized). Results. The efficacy of the scintigraphic localization of the sentinel node was 92.1% of the patients, with 15.8% of extra-axillary drainages. Axillary intraoperative detection was 81.6%. The identification rate after recent excisional biopsy or previous surgery was similar (81.8 vs 81.2%). However, extra-axillary sentinel nodes were more frequent in Group II (9.1 vs 25%). Having a localization of previous surgical procedures in upper outer quadrant caused drainages outside of the axilla more frequently (27.2 vs 11.1%). Axillary detection rate was similar to other quadrants (81.8 vs 81.5%). The rate of breast cancer-related events was 5.2% (2/38), without axillary recurrences (mean follow-up: 3 years). Conclusion. Sentinel lymph node biopsy in patients with previous but not extensive breast surgery is safe. Extra-axillary drainages are more common when the previous surgical area was wide, especially in the upper-outer quadrant(AU)

[Sentinel node biopsy in patients with breast cancer and previous breast surgery]. / Biopsia de ganglio centinela en pacientes con cáncer de mama y cirugía mamaria previa.

AIM: The aim of this study was to establish the efficacy and safety of sentinel lymph node biopsy for lymph node staging in patients with breast cancer and prior breast surgery, considering its extension, localization and time since the previous surgical procedure. MATERIAL AND METHODS: A sentinel lymph node biopsy was performed in 38 patients with early breast cancer and previous breast surgery: recent excisional biopsy in 22 patients (Group I), previous lumpectomy or mammoplasty in 16, including one case of cancer treated with breast-conserving surgery (tumor recurrence). Lymphoscintigraphy was performed after periareolar injection, also sometimes adding an injection near to the surgical scar. After removing the sentinel node, axillary lymph node dissection was performed when the lymph node was positive (and not localized). RESULTS: The efficacy of the scintigraphic localization of the sentinel node was 92.1% of the patients, with 15.8% of extra-axillary drainages. Axillary intraoperative detection was 81.6%. The identification rate after recent excisional biopsy or previous surgery was similar (81.8 vs 81.2%). However, extra-axillary sentinel nodes were more frequent in Group II (9.1 vs 25%). Having a localization of previous surgical procedures in upper outer quadrant caused drainages outside of the axilla more frequently (27.2 vs 11.1%). Axillary detection rate was similar to other quadrants (81.8 vs 81.5%). The rate of breast cancer-related events was 5.2% (2/38), without axillary recurrences (mean follow-up: 3 years). CONCLUSION: Sentinel lymph node biopsy in patients with previous but not extensive breast surgery is safe. Extra-axillary drainages are more common when the previous surgical area was wide, especially in the upper-outer quadrant.

Ácido linoleico conjugado (ALC), metabolismo de lípidos y enfermedad cardiovascular / Conjugated linoleic acid (ALC), lipid metabolism and cardiovascular disease

High density lipoproteins (HDL) have been inversely related with the risk of cardiovascular diseases and are considered antiatherogenic factors. The vascular protective effect of HDL is associated to the reverse cholesterol transport, where the sterol is mobilized from peripheral tissues to the liver by HDL and redistributed to circulation or delivered through the bile as free cholesterol or transformed into bile acids. In the last years it has been demonstrated that conjugated linoleic acid (CLA), an omega-6 fatty acid from ruminants, which is a mixture of positional and geometric isomers of linoleic acid, has hipolipidemic and antiatherogenic properties in animal models. However, the precise effect of CLA on HDL metabolism and the mechanisms involved in these actions have yet not been elucidated. The present work reviews the scientific literature about the possible role of CLA as an antiatherogenic factor by controlling the reverse cholesterol transport.

Las lipoproteínas de alta densidad (HDL) han sido correlacionadas inversamente con el riesgo de enfermedad cardiovascular ya que se considera que constituyen un factor de protección antiateroesclerótico. El efecto protector vascular de las HDL se asocia con la vía de transporte reverso de colesterol, proceso por el cual el esterol es movilizado desde los tejidos periféricos hacia el hígado a través de las HDL plasmáticas para ser redistribuido a la circulación, o para su remoción hacia la bilis como colesterol propiamente tal o transformado en sales biliares. Por otro lado, en los últimos a±os el ácido linoleico conjugado (ALC), un acido graso derivado de la serie omega-6 proveniente de animales rumiantes y cuya mezcla está mayoritariamente formada por los isómeros geométricos y posicionales del ácido linoleico (cis 9 trans 11 y trans 10 cis 12), ha demostrado tener propiedades hipolipemiantes y antiaterogénicas en varios modelos animales. Sin embargo, su efecto preciso sobre el metabolismo de HDL y los posibles mecanismos de acción involucrados aún no ha sido dilucidado. El presente trabajo realiza una revisión de la literatura científica en relación al rol antiaterosclerótico que puede tener el consumo de ALC a través del control del trasporte reverso del colesterol.

[Sentinel node localization in breast cancer. Periareolar injection of radiocolloid]. / Localización del ganglio centinela en cáncer de mama. Inyección periareolar del radiocoloide.

Traditional lymphadenectomy is being replaced by sentinel node biopsy in initial management of early stage breast cancer. The aim of this study was to validate the technique in our center, where we perform preoperative lymphoscintigraphy and intraoperative detection of sentinel node, after periareolar radiotracer and peritumoral blue dye injection. Sixty patients, breast cancer stages I and II, were included. Lymphatic mapping was performed the day before surgery, after the administration of 74 MBq 99mTc sulfur colloid in periareolar subdermal tissue. Surgical detection of sentinel node through gamma probe was followed by intraoperative and occasionally delayed biopsies. Finally, full axillary node dissection was completed. Lymphoscintigraphy identified sentinel node in 78% of the patients (47/60): 43 in axilla, 4 in internal mammary chain. Probe guided axillary detection was achieved in 88% (53/60): in every patient with axillar migration in scan, in 9/13 without imaged drainage and in 1/4 with internal mammary chain migration. Sensitivity of blue dye technique was 75% (45/60), the concordance between both procedures being high. Considering both, the overall success rate of surgical detection was 90% (54/60); if we exclude those patients who showed exclusive extraaxillar drainage, the success rate reaches 95%. Malignancy was found in 24% of sentinel nodes removed (13/54); it being the only metastatic axillary node in 4/13. No false negative sentinel nodes were found. Therefore, negative predictive value and accuracy were 100%. These results allow us to validate the technique in our center.

Localización del ganglio centinela en cáncer de mama. Inyección periareolar del radiocoloide / Sentinel node localization in breast cancer. Periareolar injection of radiocolloid

La biopsia selectiva del ganglio centinela está progresivamente sustituyendo a la linfadenectomía tradicional en el manejo inicial de las pacientes con cáncer de mama en estadios precoces. El objetivo de este estudio ha sido validar la técnica en nuestro medio, en el que realizamos linfogammagrafía prequirúrgica y detección intraoperatoria del ganglio centinela, tras inyección periareolar del radiocoloide y peritumoral de "azul patente". Se incluyeron 60 pacientes con neoplasia mamaria, estadios I y II. Se realizó linfogammagrafía el día anterior a la intervención, administrando 74 MBq. de 99mTc-sulfuro coloidal en el tejido subdérmico periareolar. Tras la detección quirúrgica mediante gammasonda, se hizo biopsia intraoperatoria, y ocasionalmente diferida del GC. Por último, se completó el vaciamiento axilar. La linfogammagrafía fue positiva en el 78 por ciento de los pacientes (47/60): 43 en axila y 4 en mamaria interna. La detección axilar con sonda se consiguió en el 88 por ciento (53/60): en todos los de migración axilar gammagráfica, en 9/13 con gammagrafía previa negativa y en 1/4 con drenaje a mamaria. La sensibilidad del colorante fue del 75 por ciento (45/60), con alta concordancia entre ambas técnicas. Combinándolas, la eficacia de la detección quirúrgica axilar alcanzó el 90 por ciento (54/60); si excluimos los tres casos con drenaje único extraaxilar, la eficacia fue del 95 por ciento (54/57). EL GC fue maligno en el 24 por ciento de los casos (13/54), siendo en 4/13 el único metastásico del vaciamiento. No existieron falsos negativos, por lo que el VPN y la exactitud diagnóstica fueron del 100 por ciento. Concluimos que estos resultados nos permiten validar la técnica en nuestro medio (AU)

Síndrome de Bouveret. A propósito de un caso / A Bouveret syndrome. A case -report

No disponible

No disponible

[Infrequent left renal pseudomass: ectopic spleen]. / Pseudomasa renal izquierda infrecuente: ectopia esplénica.

Ectopic splenic tissue is uncommon in clinical practice, usually asymptomatic and generally unsuspected diagnosed. Interest from urological point of view is due to the possibility of mimicking left renal, adrenal and retroperitoneal tumours; as well as intrapelvic, inguinal and genital masses. We report a 42-years-old female patient with pseudotumoral upper pole left kidney mass with final diagnosis of ectopic spleen. Ethiopathogenic, diagnostic and therapeutical aspects are briefly reviewed in literature. We emphasized opportunity to include ectopic splenic tissue in differential diagnosis of left renal, adrenal and retroperitoneal masses. We recommend imaging studies as CT and MRI, complemented if necessary with liver/spleen radionuclide scan. We advocate for non-aggressive attitude in selected cases with asymptomatic extrapelvic ectopic spleen under confirmed diagnosis, deferring splenectomy in symptomatic instances or secondary portal hypertension cases.

Pseudomasa renal izquierda infrecuente: ectopia esplénica / Rare left kidney pseudomass: splenic ectopy

La presencia de tejido esplénico ectópico es una realidad clínica infrecuente, de carácter habitualmente asintomático y generalmente hallazgo incidental. El interés desde el punto de vista urológico subyace en la posibilidad de simular tumoraciones suprarrenales, renales y retroperitoneales izquierdas, así como masas intrapélvicas, inguinales y gonadales. Presentamos una paciente de 42 años con el diagnóstico de sospecha de seudotumor en polo superior de riñón izquierdo finalmente filiado como bazo ectópico. Revisamos aspectos etiopatogénicos, diagnósticos y terapéuticos en la literatura. Destacamos la oportunidad de incluir el tejido esplénico ectópico en el diagnóstico diferencial de las masas renales, suprarrenales y retroperitoneales izquierdas. Resaltamos la utilidad de los estudios de imagen como la T.A.C. y la R.N.M.; otorgando un papel complementario de elección a la gammagrafía hepatoesplénica. De igual modo, abogamos por una actitud abstencionista en casos seleccionados de bazo ectópico extrapélvico, asintomático y bajo confirmación diagnóstica, difiriendo la oportunidad de esplenectomía de presentarse clínica asociada o experimentar hipertensión portal (AU)

[Epistaxis as initial manifestation of disseminated renal adenocarcinoma]. / Epístaxis como primera manifestación de un adenocarcinoma renal diseminado.

Peculiar renal carcinoma tendency to unusual distant metastases suggest this primary neoplasm to be accounted in differential diagnosis of metastases as first clinical symptom of cancer. Renal cell carcinoma present metastases in 26-30% of cases at the time of diagnosis. Head and neck metastases from renal carcinoma are said to be present in 8% (6-15.2%) of patients, and half of them are asented on paranasal sinuses. We report a 70-years-old patient with recurrent epistaxis as first clinical sign of a nasosinusal metastases from renal disseminated carcinoma, who precised selective embolization. Epidemyologic, diagnostic and therapeutical aspects are briefly reviewed in literature. Nasosinusal metastases are uncommon in clinical practice. We emphasized the need of primary tumor investigation in the organs most often responsible for these metastasic deposits as: kidney (50%), lungs, breast, gastrointestinal tract, urogenital ridge and thyroid gland. Individualized treatment depends on leasions number and localization. On routine follow up of hipernephroma nephrectomized patients a high suspect index has to be considered as paranasal metastases can eventually occur.

Epístaxis como primera manifestación de un adenocarcinoma renal diseminado / Epistaxis as first clinical sign of a nasosinusal metastases from renal diseminated carcinoma

La peculiar tendencia del carcinoma renal a metastatizar en localizaciones poco usuales hacen de este proceso oncológico un tumor primario a tener en cuenta en el diagnóstico diferencial de la metástasis como primera manifestación de un proceso neoplásico. El carcinoma de células renales presenta metástasis en el 26-30 per cent de los casos en el momento de su diagnóstico. La incidencia de metástasis en cabeza y cuello del carcinoma renal está presente en el 8 per cent (6-15,2 per cent) de los pacientes; y de ellas la mitad asienta en los senos paranasales. Presentamos un paciente de 70 años con epístaxis recidivante que precisó embolización selectiva, secundaria a una metástasis nasosinusal como primera manifestación de un adenocarcinoma renal diseminado. Revisamos aspectos epidemiológicos, diagnósticos y terapéuticos en la literatura. Las metástasis nasosinusales son una realidad clínica infrecuente, por ello destacamos la necesidad de realizar una búsqueda del tumor primario en las ubicaciones más comúnmente implicadas: riñón (50 per cent), pulmón, mama, tracto gastrointestinal, tracto génito-urinario y glándula tiroidea. El tratamiento será individualizado en función del número y localización de las lesiones. De igual modo, resaltamos la necesidad de un alto índice de sospecha ante la presencia de epístaxis en el seguimiento del paciente nefrectomizado por hipernefroma; dada la eventual posibilidad de una metástasis en senos paranasales (AU)

Laparoscopic repair of Bochdalek's hernia with gastric volvulus.

Bochdalek's hernia is the most common congenital diaphragmatic hernia in newborns, but it is an uncommon clinical feature in adults. In most cases, there are no symptoms or only minor gastrointestinal problems. Rarely, it may manifest as an acute abdomen due to viscus strangulation, requiring emergency surgery. We report the case of a 52-year-old man with herniation of the colon and a volvulated stomach through a Bochdalek's hernia. The patient was operated on via a laparoscopic approach and had an uneventful recovery. We recommend the laparoscopic approach as an alternative to open surgery in cases of noncomplicated Bochdalek's hernia.

Diethyl 2-[cyano(toluene-4-sulfinyl)methylene]propanedioate and its Diels-Alder adduct with cyclopentadiene.

The thermal Diels-Alder cycloadditon reaction of diethyl 2-[cyano(toluene-4-sulfinyl)methylene]propanedioate, C(16)H(17)NO(5)S, with cyclopentadiene gave the pure racemates of two of the four possible diastereomers, with a complete pi-facial selectivity and a high (80:20) endo/exo-sulfinyl selectivity. X-ray diffraction studies of diethyl 2-[cyano(toluene-4-sulfinyl)methylene]propanedioate and the major isomer of the cycloaddition product, namely diethyl 3-cyano-3-(toluene-4-sulfinyl)bicyclo[2.2.1]hepta-5-ene-2,2-dicarboxylate, C(21)H(23)NO(5)S, reveal that the conformation of the substituents on the acrylonitrile moiety produces both steric and electronic effects, which affect the stereoselectivity of the reaction.

[Metachronous contralateral Leydig cell tumor of the testis: conservative treatment]. / Tumor testicular de células de Leydig contralateral metacrónico: tratamiento conservador.

Leydig cell tumors are the primary nongerm cell tumors of the testis, comprising approximately 1 to 3% of all testicular neoplasms. These tumors are bilateral in 5 to 10% of cases. Hypoechoic testicular nodule associated to a child virilising syndrome or adult gynecomastia with negative testis tumor markers (AFP, B-HCG) show a high index suspicion for this entity. We report a case of metachronous contralateral Leydig cell tumor in a 32 years old man with a 9 year interval between presentations, in which we performed local excision of the lesion. Diagnostic an therapeutic aspects are reviewed in literature. Since preoperative diagnosis of Leydig cell tumors in difficult and clinical course unpredictible, radical orchiectomy has been the standard treatment. Emphasis is made on conservative management opportunity in patients with only one testis, small tumors (less than 2.5 cm) with biopsies from tumor bed negative and wishes to remain fertile and/or refuses androgen supplementation. Follow-up is mandatory by performing scrotal ultrasounds. CT scan, Chest X-Ray, tumor markers and hormone determinations (testosterone, estradiol, progesterone, LH and FSH).