Critical evaluation of in situ analyses for the characterisation of red pigments in rock paintings: A case study from El Castillo, Spain.

Paint technology, namely paint preparation and application procedures, is an important aspect of painting traditions. With the expansion of archaeometric studies and in situ non-destructive analytical methods, a renewal of technological studies is being observed in rock art. In situ analyses have several limitations that are widely discussed in the literature, however. It is not yet clear whether they provide accurate information on paint technology, except under certain conditions. Here, we evaluated digital microscopic and pXRF in situ analyses for the characterisation of a large set of red and yellow paintings from the El Castillo cave, Cantabria, Spain. We have set experiments and used statistical methods to identify differences between paint components and determine factors impacting pXRF measurements. We found that the compositional heterogeneity of the paintings' environment, especially variations in secondary deposits, was responsible for most of the differences observed between the pXRF signals recorded on the paintings. We concluded that the El Castillo cave environment is not suitable for non-destructive technological studies, but that more favourable contexts might exist. Following previous works and our own results, we advocate a combination of both in situ and laboratory invasive analyses for the study of paint composition and paint technology. Our research protocol, based on the comparison of rock paintings, their substrate, experimental paintings and Fe-normalisation of the signals can improve the reliability of pXRF results. We also propose to include more systematic characterisation of rock wall heterogeneity and the use of microscopic analyses in non-destructive approaches.

Hipertensión arterial no diagnosticada en pacientes con infección por VIH que reciben tratamiento antirretroviral / Undiagnosed arterial hypertension in HIV-infected patients on antiretroviral therapy

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Looking at the Camp: Paleolithic Depiction of a Hunter-Gatherer Campsite.

Landscapes and features of the everyday world were scarcely represented in Paleolithic art, especially those features associated with the human landscape (huts and campsites). On the contrary, other figurative motifs (especially animals) and signs, traditionally linked to the magic or religious conceptions of these hunter-gatherer societies, are the predominant themes of Upper Paleolithic art. This paper seeks to present an engraved schist slab recently found in the Molí del Salt site (North-eastern Iberia) and dated at the end of the Upper Paleolithic, ca. 13,800 years ago. This slab displays seven semicircular motifs that may be interpreted as the representation of dome-shaped huts. The analysis of individual motifs and the composition, as well as the ethnographic and archeological contextualization, suggests that this engraving is a naturalistic depiction of a hunter-gatherer campsite. Campsites can be considered the first human landscape, the first area of land whose visible features were entirely constructed by humans. Given the social meaning of campsites in hunter-gatherer life-styles, this engraving may be considered one of the first representations of the domestic and social space of a human group.

The chronology of hand stencils in European Palaeolithic rock art: implications of new U-series results from El Castillo Cave (Cantabria, Spain).

The hand stencils of European Paleolithic art tend to be considered of pre-Magdalenian age and scholars have generally assigned them to the Gravettian period. At El Castillo Cave, application of U-series dating to calcite accretions has established a minimum age of 37,290 years for underlying red hand stencils, implying execution in the earlier part of the Aurignacian if not beforehand. Together with the series of red disks, one of which has a minimum age of 40,800 years, these motifs lie at the base of the El Castillo parietal stratigraphy. The similarity in technique and colour support the notion that both kinds of artistic manifestations are synchronic and define an initial, non-figurative phase of European cave art. However, available data indicate that hand stencils continued to be painted subsequently. Currently, the youngest, reliably dated examples fall in the Late Gravettian, approximately 27,000 years ago.

Phallic decoration in paleolithic art: genital scarification, piercing and tattoos.

PURPOSE: The primitive anthropological meaning of genital ornamentation is not clearly defined and the origin of penile intervention for decorative purposes is lost in time. Corporeal decoration was practiced in the Upper Paleolithic period. We discuss the existing evidence on the practice of phallic piercing, scarring and tattooing in prehistory. MATERIALS AND METHODS: We studied the archaeological and artistic evidence regarding explicit genital male representations in portable art made in Europe approximately 38,000 to 11,000 years ago with special emphasis on decorations suggesting genital ornamentation. RESULTS: Archaeological evidence that has survived to our day includes 42 phallic pieces, of which 30 (71.4%) show intentional marks to a different extent with a probable decorative purpose. Of these ornamental elements 18 (60%) were recovered from the upper Magdalenian period (11,000 to 12,700 years ago) in France and Spain, and 23 (76.7%) belong to the category of perforated batons. Decorations show lines (70% of objects), plaques (26.7%), dots/holes (23.3%) or even human/animal forms (13.3%). These designs most probably represent skin scarification, cutting, piercing and tattooing. Notably there are some technical similarities between the motifs represented and some designs present in symbolic cave wall art. This evidence may show the anthropological origin of current male genital piercing and tattooing. CONCLUSIONS: European Paleolithic art shows decoration explicitly represented in a high proportion of portable art objects with a phallic form that have survived to our day. Decorative rituals of male genital tattooing, piercing and scarification may have been practiced during Paleolithic times.

Male genital representation in paleolithic art: erection and circumcision before history.

OBJECTIVES: To report on the likely existing evidence about the practice of circumcision in prehistory, or at least a culture of foreskin retraction, and also the meaning of erection in Paleolithic minds. The origin of the ritual of circumcision has been lost in time. Similarly, the primitive anthropologic meaning of erection is undefined. METHODS: We studied the archeologic and artistic evidence regarding human representations performed during the Upper Paleolithic period, 38,000 to 11,000 years BCE, in Europe, with a focus on genital male representations in portable and rock art. RESULTS: Drawings, engravings, and sculptures displaying humans are relatively scarce, and <100 examples of male genitals are specifically represented. Some depict a circumcised penis and other represent urologic disorders such as phimosis, paraphimosis, discharge, priapism, or a scrotal mass. In addition, a small number of phalluses carved in horn, bone, or stone, with varying morphology, has survived to the present and also reveals a sustained cult for male erection and foreskin retraction not limited to a particular topographical territory. The very few noncoital human or humanoid figures with marked erection appear in a context of serious danger or death. Therefore, erection could be understood as a phenomenon related to the shamanic transit between life and death. CONCLUSIONS: The erection in Paleolithic art is explicitly represented in almost all the figures defined as unequivocally male that have survived to the present and in many objects of portable art. Circumcision and/or foreskin retraction of the penis are present in most of the works.

[The meaning of erection, genitality, and other representations of urologic topics in the paleolithic imaginary]. / El significado de la erección, la genitalidad y otras representaciones de indole urológico en el imaginario paleolítico.

The history of urology starts with written documents making express reference to procedures, practices and descriptions of morbid processes related with the male genitourinary tract. Oddly, the most recent prehistoric period, the superior Paleolithic (from approximately 40.000 years to 12.000 years ago; the longest period since our species entered the history of humanity) also has graphic documents expressing how the human being understood the physiologic phenomena and how he observed the pathologic processes of this organism. The representations with genitality expressions enable us to understand the meaning of erection from the Paleolithic perspective, and even the possible existence of a culture based on preputial retraction or rituals of circumcision. Several urologic disorders such us phimosis, paraphimosis, discharge, priapism, and even scrotal mass appear represented at that time and constitute the first sign of knowledge of what can be called primitive urologic knowledge.

[Infliximab therapy in ulcerative colitis: initial experience in two referral centers]. / Tratamiento con infliximab en la colitis ulcerosa: experiencia inicial en dos centros de referencia.

OBJECTIVE: To perform a descriptive analysis of our experience with infliximab in the treatment of ulcerative colitis (UC). MATERIAL AND METHODS: We performed a retrospective, observational study of all patients with UC treated with infliximab and with criteria of corticosteroid resistance or dependence in two referral hospitals. The medical records of all patients treated with infliximab to December 2006 were reviewed, following the GETECCU Guidelines. Lennard-Jones and Montreal criteria were used for diagnosis and classification, respectively. Activity was defined according to Truelove-Witts criteria. Response was evaluated at 8 weeks, although most of the patients were followed-up for more than 30 weeks. RESULTS: Nineteen patients (15 steroid-dependent and four severe, steroid-resistant) were included. Of the 15 steroid-dependent patients, response to infliximab was observed in 13 (86%; 95% IC, 56-98) and complete remission was achieved in nine (60%; 32-83.7); colectomy was performed in one patient. Remission was achieved in two out of four severe, steroid-resistant patients and the remaining two patients were colectomized. Only one serious adverse event (Pseudomonas aeruginosa cavitary pneumonia) was observed in one patient, who was also receiving azathioprine and prednisone. DISCUSSION: This short-term experience suggests that infliximab can be useful in some UC patients. However, the therapeutic role of this drug should be defined more precisely in further studies.

El significado de la erección, la genitalidad y otras representaciones de índole urológico en el imaginario paleolítico / The meaning of erection, genitality, and other representations of urologic topics in the paleolithic imaginary

La Historia de la Urología comienza con documentos escritos que hacen referencia expresa a procedimientos, prácticas y descripciones de procesos mórbidos relacionados con el aparato urinario y genital masculino. Curiosamente, durante la época prehistórica más reciente, el Paleolítico superior (desde hace aproximadamente 40.000 a 12.000 años; la época más larga desde que nuestra especie entra en escena en la historia de la humanidad) tiene también documentos gráficos que expresan cómo el hombre entendía los fenómenos fisiológicos y cómo observaba los procesos patológicos de su organismo. Las representaciones con genitalidad expresa permiten inferir el significado de la erección desde la mentalidad paleolítica, e incluso la posible existencia de una cultura de retracción prepucial o de ritos de circuncisión. Patologías de índice urológico como la fimosis, la parafimosis, la supuración, el priapismo e incluso masa escrotal, aparecen representadas en dicha época y constituyen los primeros indicios de lo que podemos denominar un saber urológico primitivo

The history of urology starts with written documents making express reference to procedures, practices and descriptions of morbid processes related with the male genitourinary tract. Oddly, the most recent prehistoric period, the superior Paleolithic (from approximately 40.000 years to 12.000 years ago; the longest period since our species entered the history of humanity) also has graphic documents expressing how the human being understood the physiologic phenomena and how he observed the pathologic processes of this organism. The representations with genitality expressions enable us to understand the meaning of erection from the Paleolithic perspective, and even the possible existence of a culture based on preputial retraction or rituals of circumcision. Several urologic disorders such us phimosis, paraphimosis, discharge, priapism, and even scrotal mass appear represented at that time and constitute the first sign of knowledge of what can be called primitive urologic knowledge

Tratamiento con infliximab en la colitis ulcerosa: experiencia inicial en dos centros de referencia / Infliximab therapy in ulcerative colitis: initial experience in two referral centers

Objetivo: Describir nuestra experiencia con infliximab en el tratamiento de la colitis ulcerosa (CU). Material y métodos: Estudio observacional y retrospectivo de pacientes tratados con infliximab por CU, con criterios de corticorresistencia o corticodependencia en dos hospitales de referencia. Se revisan las historias clínicas de todos los pacientes tratados con infliximab, según la Guía de GETECCU, hasta diciembre de 2006, utilizando los criterios de Lennard-Jones, la clasificación de Montreal y los criterios de Truelove-Witts. Se evalúa la respuesta a las 8 semanas, aunque en la mayoría de los casos hay un seguimiento mayor de 30 semanas. Resultados: Se evalúan 19 pacientes (15 corticodependientes y 4 corticorresistentes). El fármaco obtuvo respuesta en 13 de 15 corticodependientes (87%; intervalo de confianza [IC] del 95%, 56-98) y remisión en 9 de 15 (60%; IC del 95%, 32-83,7). En 2 pacientes no hubo respuesta con una colectomía. Se observó remisión en 2 (50%) de los 4 corticorresistentes, y los otros 2 pacientes fueron sometidos a colectomía. Se observó sólo un efecto adverso grave: una neunomíaa cavitada por Pseudomonas aeruginosa en un paciente tratado simultáneamente con azatioprina y prednisona. Discusión: Esta experiencia sugiere que infliximab es un fármaco activo en la CU refractaria, aunque su posición en el esquema terapéutico debe definirse con nuevos estudios

Objective: To perform a descriptive analysis of our experience with infliximab in the treatment of ulcerative colitis (UC). Material and methods: We performed a retrospective, observational study of all patients with UC treated with infliximab and with criteria of corticosteroid resistance or dependence in two referral hospitals. The medical records of all patients treated with infliximab to December 2006 were reviewed, following the GETECCU Guidelines. Lennard-Jones and Montreal criteria were used for diagnosis and classification, respectively. Activity was defined according to Truelove-Witts criteria. Response was evaluated at 8 weeks, although most of the patients were followed-up for more than 30 weeks. Results: Nineteen patients (15 steroid-dependent and four severe, steroid-resistant) were included. Of the 15 steroid-dependent patients, response to infliximab was observed in 13 (86%; 95% IC, 56-98) and complete remission was achieved in nine (60%; 32-83.7); colectomy was performed in one patient. Remission was achieved in two out of four severe, steroid-resistant patients and the remaining two patients were colectomized. Only one serious adverse event (Pseudomonas aeruginosa cavitary pneumonia) was observed in one patient, who was also receiving azathioprine and prednisone. Discussion: This short-term experience suggests that infliximab can be useful in some UC patients. However, the therapeutic role of this drug should be defined more precisely in further studies

[Penile leiomyosarcoma: case report and bibliographic review]. / Leiomiosarcoma de pene: presentación de un caso y revisión de la literatura.

OBJECTIVE: Primary penile leiomyosarcoma is a rare entity. Since 1930 only 30 cases have been reported in the bibliography. We wanted to add a new case to the international literature, in addition to a review of all available publications on the topic from 1957. A 54-year-old patient presented with a lobulated 8x4x3 cm lesion in the balanopreputial groove over two years; he was treated initially with partial penectomy and subsequently with total penectomy We analyze the evolution, progression and adjuvant treatments of this rare pathology. METHODS/RESULTS: We report one case with its clinical presentation, diagnostic tests performed for staging, treatment and follow-up. CONCLUSIONS: The first case of penile leiomyosarcoma was described by Levi in 1930. In 1957 Ashley and Edwards reported the first case in the British literature and in 1963 Pack reported the first in the American literature. MacKenzie et al. were the first to recognize two types of leiomyosarcoma: superficial and deep. The first develop from smooth muscle cells from the superficial dermal layers of the glans penis or distal third of the penis, they are generally asymptomatic and less malignant, rarely invading deeper structures and without involvement of the urethra on physical exam. The best prognostic predictors are type of tumor at presentation (superficial vs. deep) and treatment choice, being total penectomy more effective for failures of local resections than for primary treatment of deep tumors.

Leiomiosarcoma de pene: presentación de un caso y revisión de la literatura / Penile leiomyosarcoma: case report and bibliographic review

OBJETIVO: El leiomiosarcoma primario de pene constituye una rara entidad. Desde 1930 hasta la actualidad han sido reportados solo 30 casos en la literatura mundial. Además de revisar las publicaciones disponibles al respecto desde 1957 hasta nuestros días, nosotros como objetivo quisimos añadir un nuevo caso a la literatura internacional sobre un paciente de 54 años con una lesión lobulada, de dos años de evolución a nivel del surco balanoprepucial, de 8x4x3cm., tratado con penectomía parcial inicialmente y penectomía total posterior a la misma. Analizamos evolución, progresión y tratamientos adyuvantes de esta infrecuente patología. MÉTODOS/RESULTADOS: Presentamos un caso de un paciente masculino, detallamos la presentación clínica, los exámenes complementarios utilizados para la estadificación, el tratamiento empleado y el control evolutivo. CONCLUSIONES: El primer caso de leiomiosarcoma de pene fue descripto por Levi en 1930. Luego en 1957, Ashley y Edwards reportaron el primer caso en la literatura británica y en 1963, Pack refirió el primer caso en la literatura americana. Mc Kenzie y cols., fueron los primeros en reconocer dos tipos de leiomiosarcoma, los superficiales y los profundos. Los primeros se desarrollan desde células musculares lisas de estratos superficiales dérmicos glandelares y/o tercio distal peneano, son generalmente asintomático y de menor grado de malignidad, con escasa tendencia a invadir estructuras mas profundas, y con indemnidad uretral a la exploración. Los mejores predictores pronósticos serían el tipo tumoral a la presentación (superficial vs. profundo), y el tratamiento elegido para cada caso, donde la amputación total es más efectiva para tratamientos fracasados de resecciones locales que como tratamiento primario de los tumores profundos

OBJECTIVE: Primary penile leiomyosarcoma is a rare entity. Since 1930 only 30 cases have been reported in the bibliography. We wanted to add a new case to the international literature, in addition to a review of all available publications on the topic from 1957. A 54-year-old patient presented with a lobulated 8x4x3 cm lesion in the balanopreputial groove over two years; he was treated initially with partial penectomy and subsequently with total penectomy. We analyze the evolution, progression and adjuvant treatments of this rare pathology. METHODS/RESULTS: We report one case with its clinical presentation, diagnostic tests performed for staging, treatment and follow-up. CONCLUSIONS: The first case of penile leiomyosarcoma was described by Levi in 1930. In 1957 Ashley and Edwards reported the first case in the British literature and in 1963 Pack reported the first in the American literature. MacKenzie et al. were the first to recognize two types of leiomyosarcoma: superficial and deep. The first develop from smooth muscle cells from the superficial dermal layers of the glans penis or distal third of the penis, they are generally asymptomatic and less malignant, rarely invading deeper structures and without involvement of the urethra on physical exam. The best prognostic predictors are type of tumor at presentation (superficial vs. deep) and treatment choice, being total penectomy more effective for failures of local resections than for primary treatment of deep tumors

[The rupture of the renal graft]. / Rotura del riñon trasplantado.

OBJECTIVES: The renal graft rupture (RGR) was first described in 1968; it is a severe situation, generally appearing in the immediate post-operative period. OBJECTIVES: To retrospectively analyze the incidence of renal graft rupture in the population of patients who underwent kidney transplant in the Renal Transplant Department of the Angerich Hospital. METHODS: 492 kidney transplants were performed from 1-1-1992 to 7-31-2005. 422 (85.7%) cadaver donor transplants and 70 (14.3%) live related donor transplants. RESULTS: 11 renal ruptures were observed, with a clinical picture characterized by sudden pain in the graft area, hypotension, and hematocrit descent. CT scan confirmed the diagnosis. Seven patients underwent transplant nephrectomy (one of them 24 hours after surgical repair), another two were surgically repaired successfully, and for the other two patients a conservative management with watchful waiting also resulted in graft preservation. All cases where cadaver donor drafts. CONCLUSIONS: 1) The renal graft rupture is a rare (2.8% in our series) severe complication characterized by hemodynamic instability, with no diagnostic doubts about its presentation in most cases. We use ultrasound as the diagnostic test. 2) In our series we were able to preserve 40% of the kidneys with low morbidity. 3) This complication appeared in cadaver donor kidneys in all cases (11/386; 2.8%).

[Wilms tumor in an adult patient: case report]. / Tumor de Wilms en paciente adulto presentación de un caso.

Nephroblastoma or Wilms tumor is the most common renal neoplasia in children, representing 1/5 of the malignant tumors in this group. Nevertheless, the incidence of such tumor in adults is much rarer with less than 250 cases reported. Due to the low-frequency of this pathology in adults there is not a world widely accepted treatment modality. Currently, the therapeutic options derive from the National Wilms Tumor Study (NWTS). We report a new case with the radiological images, histologic findings, outcomes and follow-up.

Tumor de Wilms en paciente adulto. Presentación de un caso / Wilms tumor in an adult patient: case report

El nefroblastoma o tumor de Wilms, es la neoplasia renal más común en niños y representa actualmente la quinta parte en tumor malignos en este grupo. Sin embargo la incidencia de dicho tumor en el adulto es mucho más rara con tan sólo menos de 250 casos reportados en la literatura. Debido a la baja frecuencia de esta patología en adultos no existe una modalidad en el tratamiento aceptada mundialmente. Actualmente las opciones terapéuticas se desprenden del National Wilms Tumor Study (NTWS). Presentamos a continuación un nuevo caso con las imágenes radiográficas, hallazgos histológicos, evolución y seguimiento

Nephroblastoma or Wilms tumor is the most common renal neoplasia in children, representing 1/5 of the malignant tumors in this group. Nevertheless, the incidence of such tumor in adults is much rarer with less than 250 cases reported. Due to the low-frequency of this pathology in adults there is not a world widely accepted treatment modality. Currently, the therapeutic options derive from the National Wilms Tumor Study (NWTS). We report a new case with the radiological images, histologic findings, outcomes and follow-up

Rotura de riñón trasplantado / The rupture of the renal graft

La rotura del injerto renal (RR) descripta por primera vez en 1968, es una situación grave que se produce habitualmente en el postoperatorio inmediato. OBJETIVO: Analizar retrospectivamente la incidencia de rotura renal ( RR) en la población de pacientes transplantados por el Servicio de Transplante Renal del Hospital Argerich. MÉTODOS: Desde el 01-01-92 al 31-07-05 se realizaron 492 transplantes renales. 422 (85,7%) de dador cadavérico y 70 (14,3%), de dador vivo relacionado. RESULTADOS: Se observaron 11 RR, estando el cuadro clínico caracterizado por dolor brusco en el área de injerto, hipotensión, descenso del hematocrito. La ecografía renal fue de utilidad al mostrar un hematoma perirrenal y retroperitoneal. La tomografía computada corroboró estpos hallazgos. Se realizaron 7 nefrectomías, (una a las 24 hs. de una reparación quirúrgica), otros 2 fueron reparados quirúrgicamente en forma exitosa y en los restantes dos pacientes se adoptó una conducta expectante que también resulto en la preservación del injerto. En todos los casos el injerto renal fue proveniente de dador cadavérico. CONCLUSIONES: 1) La rotura del injerto renal es una complicación grave, infrecuente (2 8% de nuestra población), caracterizada por compromiso hemodinámico, no ofreciendo dudas diagnósticas su presentación clínica en la mayoría de los casos. Utilizamos la ecografía como método diagnóstico complementario . 2) en nuestra casuística hemos logrado conservar el 40 % de los riñones con una baja morbilidad. 3) En todos los casos, esta complicación se presentó en pacientes que recibieron riñones provenientes de dadores cadavéricos (11/386; 2.8%)

OBJECTIVES: The renal graft rupture (RGR) was first described in 1968; it is a severe situation, generally appearing in the immediate post-operative period. OBJECTIVES: To retrospectively analyze the incidence of renal graft rupture in the population of patients who underwent kidney transplant in the Renal Transplant Department of the Angerich Hospital. METHODS: 492 kidney transplants were performed from 1-1-1992 to 7-31-2005. 422 (85.7%) cadaver donor transplants and 70 (14.3%) live related donor transplants. RESULTS: 11 renal ruptures were observed, with a clinical picture characterized by sudden pain in the graft area, hypotension, and hematocrit descent. CT scan confirmed the diagnosis. Seven patients underwent transplant nephrectomy (one of them 24 hours after surgical repair), another two were surgically repaired successfully, and for the other two patients a conservative management with watchful waiting also resulted in graft preservation. All cases where cadaver donor drafts. CONCLUSIONS: 1) The renal graft rupture is a rare (2.8% in our series) severe complication characterized by hemodynamic instability, with no diagnostic doubts about its presentation in most cases. We use ultrasound as the diagnostic test. 2) In our series we were able to preserve 40% of the kidneys with low morbidity. 3) This complication appeared in cadaver donor kidneys in all cases (11/386; 2.8%)