Carbohydrate antigen 125 on epicardial fat and its association with local inflammation and fibrosis-related markers.

BACKGROUND: Carbohydrate antigen 125 (CA125) is a proteolytic fragment of MUC-16 that is increased in heart failure (HF) and associated with inflammation, fluid overload, and worse adverse events. Our main objective was to study the expression of CA125 on epicardium and its association with inflammation, adipogenesis, and fibrosis. METHODS: Epicardial fat biopsies and blood were obtained from 151 non-selected patients undergoing open heart surgery. Immunohistochemistry, ELISA, or real-time PCR were used for analyzing protein or mRNA expression levels of CA125 and markers of inflammatory cells, fibroblasts, and adipocytes. Epithelial or stromal cells from epicardium were isolated and cultured to identify CA125 and its association with the adipogenesis and fibrosis pathways, respectively. RESULTS: The median age was 71 (63-74) years, 106 patients (70%) were male, and 62 (41%) had an established diagnosis of HF before surgery. The slice of epicardial fat biopsy determined a positive and colorimetric staining on the epithelial layer after incubating with the CA125 M11 antibody, providing the first description of CA125 expression in the human epicardium. Epicardial CA125 showed a strong and positive correlation with markers of inflammation and fibrosis in the epicardial fat tissue while exhibiting a negative correlation with markers of the adipogenesis pathway. This relationship remained significant after adjusting for potential confounders such as a prior HF diagnosis and plasma CA125 levels. CONCLUSION: Epicardial cells express CA125, which is positively associated with inflammatory and fibroblast markers in epicardial adipose tissue. These results suggest that CA125 may be biologically involved in HF progression (transition from adipogenesis to fibrosis).

Occult prosthetic aortic valve endocarditis caused by Propionibacterium acnes: a case report.

We present an unusual case of occult mechanical aortic valve endocarditis caused by Propionibacterium acnes (P. acnes), which occurred five years after the initial cardiac surgical procedure. The only potential source of this infection from the patient's past medical history was a gastric band removal followed by a gastric bypass surgery, which was performed two years prior to her redo cardiac procedure. The patient's main presenting symptom was progressive dyspnoea with worsening of gradients across the mechanical aortic valve. Of note, she had no cardinal symptoms of infection. The patient underwent redo bioprosthetic aortic valve replacement with aortic root replacement. Prosthetic valve cultures grew P. acnes, while blood cultures remained negative. She was started on intravenous antibiotics for six weeks and her postoperative course was uneventful. She remained symptom-free six months postoperatively. This case opens the discussion for the importance of administering antibiotics prophylaxis for endocarditis in patients with prosthetic heart valves undergoing gastric procedures.

Plasma FABP4 levels are associated with left atrial fat volume in persistent atrial fibrillation and predict recurrence after catheter ablation.

BACKGROUND: Imaging techniques have shown the association between left atrial adipose tissue (LAAT) volume and atrial fibrillation (AF) risk. PURPOSE: To analyze 1) adipokines in peripheral and atrial plasma from patients undergoing AF ablation; 2) its association with LAAT volume measured by multislice CT and 3) its predictive value for AF recurrence. METHODS: Seventy consecutive patients undergoing AF catheter ablation were screened. Blood samples were extracted from the left atrium and peripheral vein before catheter ablation. Multiplex fluorimetric immunoassay, enzyme-linked immunoassay and Western blot techniques were used for analyzing some adipokines, fatty acid binding protein 4 (FABP4), and leptin and perilipin analysis, respectively. Patients were followed up with clinical visits until one year after ablation. Generalized additive regression (GAM) was used for determining the best indicator of LAAT volume. Logistic regression analysis determined the best predictor of AF recurrence after persistent AF catheter ablation. RESULTS: Our results showed 1) differences in the levels of FABP4 between peripheral and left atrial blood samples. 2) persistent AF patients had higher LAAT volume than those with paroxysmal AF (5.12 ±â€¯2.76 vs. 3.82 ±â€¯1.81 mL; p < 0.036). FABP4 was the best adipokine associated with LAAT in persistent AF (p < 0.01) 3) and predictive value for AF recurrence after catheter ablation (AUC-ROC 0.883 with 95% CI 0.739-1.028). CONCLUSIONS: Plasma FABP4 levels, which were associated with LAAT volume in persistent AF, can be predictors of recurrence after catheter ablation. Whether persistent AF patients require more intensive management and monitoring according to FABP4 deserves further investigation.

Válvula Aortica bicúspide en un paciente con síndorme de Rubinstein-Taybi / Bicuspid aortic valve in a patient with Rubinstein-Taybi syndrome

El síndrome de Rubinstein-Taybi es una enfermedad infrecuente que puede acompañarse de malformaciones cardiovasculares. Se presenta el caso de un paciente adulto con síndrome de Rubinstein-Taybi intervenido bajo circulación extracorpórea por presentar una válvula aórtica bicúspide

Rubinstein-Taybi syndrome is a rare disease that may be associated with cardiovascular malformations. We report the case of an adult patient with Rubinstein-Taybi syndrome who underwent an open heart procedure due to a bicuspid aortic valve

[Achalasia in children and adolescents, a therapeutic challenge]. / La acalasia en la infancia y la adolescencia, un reto terapéutico.

INTRODUCTION: Treatment of achalasia in children is in permanent discussion. It is a rare disorder without cure, which makes its management challenging. METHODS: Retrospective review of patients under 18 years old treated for achalasia in our Hospital between 2000 and 2012, by either pneumatic dilatation (PD) or Heller myotomy (HM). RESULTS: Thirteen children were treated during this time. Mean age was 12 years (4-18), interval time between the onset of symptoms and diagnosis was 15 months (2-48) and mean follow-up was 66,8 months (4-144). Dysphagia and vomits were the main symptoms (61%). A single PD was performed in 5 patients; four were the oldest children of the series (16-18). Three girls remain asymptomatic and 2 boys suffer from moderate dysphagia. Six patients required multiple PD and, after a mean of 3 dilatations, HM was needed in all of them. The last 2 children of the series received surgery as the first treatment. In total, eight patients underwent HM and fundoplication, with 6 laparoscopic procedures. Two boys suffer from low-moderate dysphagia, but additional treatments have not been required. The mean of total hospital stay was 12,7 days (2-45) for PD and 9 days (3-30) for HM. Two patients were reoperated because of oesophagic perforation, one after PD and one after open HM. CONCLUSION: Although PD and HM could be complementary, laparoscopic Heller myotomy should be considered the first therapeutic option, specially in young boys.

Effects of Kinesio® Tape in low back muscle fatigue: randomized, controlled, doubled-blinded clinical trial on healthy subjects.

BACKGROUND: Muscle fatigue of the trunk extensor musculature plays a considerable role in chronic low back pain (LBP). The underlying physiology of fatigue is complex and not fully understood. The Kinesio® Taping (KT) supports damaged structures while allowing mobility and at the same time may influence some of the mechanisms associated with muscle fatigue such as blood flow and proprioception. OBJECTIVE: The aim of this study is to determine the influence of KT on the resistance to fatigue of the lumbar extensor musculature in a sample of young healthy subjects. METHODS: A randomized, controlled, doubled-blinded clinical trial was conducted. Ninety nine healthy subjects were randomized in to the three arms of the study Kinesio® Tape (KT), placebo (P) and control (C). Directly after application of KT we measured lumbar extensor musculature endurance with the Biering-Sorensen test. Subjects and researchers were blinded to the intervention. Time achieved (seconds) was compared between groups with one-way ANOVA with confidence intervals of 95%. RESULTS: There were significant differences between the time achieved in the KT group versus the control group (p < 0.05). The placebo group performed better than the control group but worse than the KT group, these were not significant in either case. CONCLUSIONS: KT appears to improve the time to failure of the extensor muscle of the trunk obtained using the Biering-Sorensen test. These findings suggest that KT influences processes that lead to muscle fatigue and that KT could be effective in the management of LBP.

[Design of a plan for patient safety in pediatric surgery service]. / Elaboración de un plan de seguridad del paciente en un Servicio de Cirugía Pediátrica.

INTRODUCTION: Patient safety is a key priority in quality management for healthcare services providers. Every patient is entitled to receive safe and effective healthcare. AIMS: The aim of this study was to design a patient safety plan for a Paediatric Surgery Department. METHODS: We carried out a literature review and we established a work group that included healthcare professionals from the Paediatric Surgery Department and the Quality and Medical Records Department. The group identified potential adverse events, failures and causes and established a rating using Failure Mode Effects Analysis. Potential risks were mapped out and a plan was designed establishing actions to reduce risks. We designated leaders to ensure the effective implementation of the plan. RESULTS: A total of 58 adverse events were identified in the Paediatric Surgery Department. We detected 128 failures that were produced by 211 different causes. The group developed a proposal with 424 specific measures to carry out preventive and/or remedial actions that were then narrowed down to 322. The group designed a plan to apply the programme, which is currently being implemented. CONCLUSIONS: The methodology used enabled obtaining key information for improvement of patient safety and developing preventive and/or remedial actions. These measures are applicable in practice, as they were designed using proposals and agreements with professionals that take active part in the care of children with surgical conditions.

[Testicular cancer and cryptorchidism: myth or reality]. / Cáncer testicular y criptorquidia. Mito o realidad.

OBJECTIVE: To evaluate the previous history of cryptorchidism in patients with testicular cancer. MATERIALS AND METHODS: We carried out a study using 175 patients diagnosed with testicular cancer, in our hospital, from 1999 to 2010. We analyzed the previous history of cryptorchidism and its characteristics, testicular placing, histology and intervention age. RESULTS: 5 out of the 175 patients (2,8%) with testicular neoplasm presented a history of cryptorchidism, The average age was 31 years old, an orchidopexy was only carried out in 2 patients. The histology was different depending on the treatment chosen to battle cryptorchidism and in 2 cases it developed in the adjoining testicle. The average ratio was of 1,9. CONCLUSIONS: Our results reflect that the association of cryptorchidism with testicular neoplasm is in fact lower than in the past. A good and proper handling of cryptorchidism can prevent it from turning malignant, presenting these patients similar incidences to the rest of the population.

[Appendectomy and Crohn's disease]. / Apendicectomía y enfermedad de Crohn.

UNLABELLED: We analyzed the relationship between Crohn's disease and appendectomy in paediatric age. METHOD AND MATERIAL: We studied the patients diagnosed with Crohn's disease and appendectomy (under 20) between 1999 and 2011. We retrieved their previous medical histories and carried out an histological re evaluation of those appendix. RESULTS: 11 patients out of 137 (8,02%) had an appendectomy before the development of Crohn's disease. An average age in which the appendectomy took place and the development of Crohn's disease was diagnosed 14 (5-20 years), having 90% of the patients diagnosed in the early post-surgical stages. A patient did not develop any symptoms until a year later. There were no more appendectomies carried out in comparison with the adult population. The initial anatomopathologic diagnosis and the histological re evaluation agreed in just one case, compatible with Crohn's disease. CONCLUSION: The majority of appendectomies carried out in paediatric patients that later develop Crohn's disease are realized by a bias diagnosis of acute appendicitis and the relation between the two of them can be explained as the not yet developed Crohn's disease at the moment of the appendectomy. Appendectomies at a paediatric age are not associated with a potential development of Crohn's disease. There is no evidence of histological changes compatible with Crohn's disease in the first episode.

[Open surgery, laparoscopic Palomo varicocelectomy and embolization in children with varicocele]. / Cirugía abierta, Palomo laparoscópico y embolización en niños con varicocele.

OBJECTIVES: Our aim was to prove the outcomes in varicocele treatment during last 10 years in our institution regarding to the recurrence rate and reactive hydrocele in children and adolescents treated with open technique, laparoscopic approach or embolization. PATIENTS AND METHODS: Medical charts of patients with varicocele younger than 17 years old were reviewed. Age, weight, surgery indications, treatment (open surgery, laparoscopic Palomo varicocelectomy or embolization), location, varicocele grade, hospital stays, recurrence, postoperative hydrocele, genitofemoral nerve damage, infection, bleeding, postoperative incisional hernia and re-do varicocelectomy were collected. RESULTS: From 2000 to 2010, 98 boys with varicocele diagnosis were treated in our institution. Mean age of patients was 12 years. The varicocele location in all cases was on the left side. Grade III varicocele was found in 94 boys and grade II in 4 patients. Indications for surgery were high grade in 81, chronic pain in 16 and testicular hypotrophy in 1. Treatment approach was as follows: 12 patients underwent open surgery (Palomo or Ivanissevich technique), 32 underwent embolization and laparoscopic Palomo varicocelectomy was performed in 54. We found a global recurrence rate of 14.3% and an overall postoperative hydrocele of 24.5% Recurrence rate was higher in the embolization group than the open surgery and laparoscopic group. Three patients presented intraoperative bleeding in the laparoscopic group and there was one conversion to open surgery. CONCLUSIONS: Our retrospective review proves that laparoscopic Palomo varicocelectomy is a safe and efficient approach to treat varicocele in pediatric population, because of its low recurrence rate without any major adverse outcome. Due to our high secondary hydrocele formation, lymphatic sparing laparoscopic procedure should be taken into account in order to decrease this complication.

Tumoración en tobillo en niño de 2 años / Knee tumour in a 2-year old child

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Independent cellular effects of cold ischemia and reperfusion: experimental molecular study.

INTRODUCTION AND OBJECTIVES: There is less information available on cell cultures on the exclusive effects of either duration of cold ischemia (CI) or rewarming-reperfusion in the kidney subjected to initial warm ischemia (WI). Therefore, the goals of our work were: (1) to evaluate the consequences on tubular cellular viability of different durations of CI on a kidney after an initial period of WI, and (2) to analyze the additional effect on tubular cell viability of rewarming of the same kidney. ANIMALS AND METHODS: Sixteen mini-pig were used. All the animals were performed a right nephrectomy after 45-minute occlusion of the vascular pedicle. The kidneys were then divided into 2 groups (phase 1): cold storage in university of wisconsin (UW) solution for 3 hours (group A, n = 8) at 4°C, or cold storage in UW for 12 hours (group B, n = 8) at 4°C. Four organs of group A and four organs of group B were autotrasplanted (AT) and reperfused for 1 hour (phase 2). Nephrectomy was finally done. Biopsies were taken from all groups to perform cultures of proximal tubule epithelium cells. The biopsies were subjected to studies of cellular morphological viability (contrast phase microscopy [CPM]) and quantitative (confluence cell [CC]) parameters. RESULTS: Phase of pure CI effects (phase 1): Both CC rate and CPM parameters were significantly lower in group B compared with group A, where cell activity reached almost normal results. Phase of CI + AT (phase 2): At produced additional harmful effects in cell cultures compared with those obtained in phase 1, more evident in group B cells. CONCLUSIONS: The presence of cold storage followed by rewarming-reperfusion induces independent and cumulative detrimental effects in viability of renal proximal tubule cells. CI periods ≤ 3 hours may ameliorate the injuries secondary to reperfusion in comparison with longer CI periods.

Cirugía abierta, Palomo laparoscópico y embolización en niños con varicocele / Open surgery, laparoscopic Palomo varicocelectomy and embolization in children with varicocele

Objetivos. El objetivo del presente estudio es examinar los resultados en el tratamiento del varicocele en nuestro hospital durante los últimos 10 años, valorando la de tasa de recurrencia y de hidrocele reactivo en los niños y adolescentes tratados mediante cirugía abierta, embolización o varicocelectomía laparoscópica. Pacientes y métodos. Se revisaron las historias clínicas de los pacientes menores de 17 años intervenidos de varicocelectomía. Las variables recogidas fueron peso, edad, localización, grado de varicocele, indicación de cirugía, tratamiento, estancia hospitalaria, recurrencia, hidrocele postoperatorio, lesión de nervio genitofemoral, infección, sangrado, hernia incisional y necesidad de nueva varicocelectomía. Resultados. 98 pacientes con diagnóstico de varicocele fueron tratados en nuestra institución entre los años 2000 a 2010. La edad media fue de 12 años. Todos los casos fueron de localización izquierda. 94 pacientes tenían varicocele grado III y 4 varicocele grado II. Las indicaciones de cirugía fueron varicocele de alto grado (grado III) en 81 pacientes, dolor crónico en 16 e hipotrofia testicular en 1. Se realizó cirugía abierta en 12 pacientes, embolización en 32 casos y varicocelectomía laparoscópica en 54 pacientes. La tasa global de recurrencia fue de 14,3% y el porcentaje de hidrocele reactivo fue del 24,5% La tasa de recurrencia fue mayor en el grupo tratado con embolización, que en el de cirugía abierta y en el de laparoscopia. En el grupo de tratamiento laparoscópico, tres pacientes presentaron sangrado postquirúrgico y hubo una conversión a cirugía abierta. Conclusiones. Nuestra revisión retrospectiva indica que la varicocelectomía laparoscópica es un tratamiento seguro y eficaz en el manejo del varicocele en los (..) (AU)

Objectives. Our aim was to prove the outcomes in varicocele treatment during last 10 years in our institution regarding to the recurrence rate and reactive hydrocele in children and adolescents treated with open technique, laparoscopic approach or embolization. Patients and Methods. Medical charts of patients with varicocele younger than 17 years old were reviewed. Age, weight, surgery indications, treatment (open surgery, laparoscopic Palomo varicocelectomy or embolization), location, varicocele grade, hospital stays, recurrence, postoperative hydrocele, genitofemoral nerve damage, infection, bleeding, postoperative incisional hernia and re-do varicocelectomy were collected. Results. From 2000 to 2010, 98 boys with varicocele diagnosis were treated in our institution. Mean age of patients was 12 years. The varicocele location in all cases was on the left side. Grade III varicocele was found in 94 boys and grade II in 4 patients. Indications for surgery were high grade in 81, chronic pain in 16 and testicular hypotrophy in 1. Treatment approach was as follows: 12 patients underwent open surgery (Palomo or Ivanissevich technique), 32 underwent embolization and laparoscopic Palomo varicocelectomy was performed in 54. We found a global recurrence rate of 14.3% and an overall postoperative hydrocele of 24.5% Recurrence rate was higher in the embolization group than the open surgery and laparoscopic group. Three patients presented intraoperative bleeding in the laparoscopic group and there was one conversion to open surgery. Conclusions. Our retrospective review proves that laparoscopic Palomo varicocelectomy is a safe and efficient approach to treat varicocele in pediatric population, because of its low recurrence rate without any major adverse outcome. Due to our high secondary hydrocele formation, lymphatic sparing laparoscopic procedure should be taken into account in order to decrease this complication (AU)

The relation of falls to fatigue, depression and daytime sleepiness in Parkinson's disease.

OBJECTIVE: To characterize non-motor symptoms in individuals with Parkinson's disease (PD) who experience falls compared to those who do not fall. METHODS: Fifty-four individuals with PD were studied. Thirty-six were fallers and 18 were non-fallers. Fatigue was assessed by the Iowa Fatigue Scale. Excessive daytime sleepiness was assessed by the Epworth Sleepiness Scale, and depressive symptomatology was assessed by the short-form Center for Epidemiologic Studies Depression Scale. RESULTS: Compared to non-fallers, fallers had more severe disability, greater general physical fatigue (p = 0.024), lower energy levels (p = 0.042) and less productivity (p = 0.007). Fallers had more depressive symptomatology than the non-fallers (p = 0.01). Excessive daytime sleepiness was not different between the two groups (p = 0.695). CONCLUSIONS: Individuals with PD who fell had more severe motor and non-motor symptoms than those who did not fall. These non-motor symptoms included physical fatigue, energy, productivity and depressive symptomatology.

Tratamiento mediante electroterapia de una epicondilalgia de origen miofascial / Electrotherapy of a myofascial triggered epicondylalgia

Objetivo. Mostrar el resultado del tratamiento mediante corriente de Träbert y neuroelectroestimulación transcutánea (TENS) en una paciente con dolor epicondíleo de origen miofascial. Paciente y métodos. Mujer de 35 años que acude a consulta diagnosticada de epicondilitis. Tras comenzar el tratamiento para la epicondilitis y no obtener una mejoría clara del dolor, se localizó un punto gatillo miofascial (PGM) activo en el músculo supinador corto. Después de probar un tratamiento manual mediante técnicas compresivas y estiramientos y no obtener mejoría clara, se prueba con un tratamiento electroterápico consistente en corriente de Träbert durante 15 min y TENS por ráfagas durante 10 min. Resultados. El tratamiento electroterápico consiguió una remisión del dolor en tres sesiones. Esto permitió la aplicación de una pauta cinesiterápica de prevención para evitar recidivas. Al año de terminar el tratamiento no se ha producido ninguna recaída. Conclusiones. La pauta de tratamiento propuesta podría ser una opción terapéutica en aquellos pacientes en los que no se consiguen resultados con las técnicas manuales previa a la aplicación de fisioterapia invasiva

Objective. To show the result of the treatment with Träbert current and transcutaneous electrical nerve stimulation (TENS) in a patient affected by an epicondylalgia of myofascial origin. Patient and methods. A 35-year old woman who came to medical office diagnosed with epicondylitis. After beginning treatment with no clear improvement in the pain, an active myofascial trigger point (MTP) in supinatus muscle was found. After trying manual treatment consisting in compressive techniques and stretching, again with no clear improvement, electrotherapeutic treatment consisting in Träbert current for 15 minutes and burst TENS for 10 minutes was used. Results. Pain improvement was achieved in three sessions by the electrotherapy. This allowed the application of a prevention kinesitherapeutic guideline to avoid relapses. At one year of treatment completion, no relapse has occurred. Conclusions. The treatment guideline proposed could be a therapeutic option in those patients in whom manual techniques do not produce successful results prior to applying invasive physical therapy

Quilotórax espontáneo en una lactante de 16 meses / Spontaneous chylothorax in a 16-month-old child

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Aportaciones del análisis molecular al diagnóstico y conocimiento de la Distrofia Muscular de Duchenne / Contributions of the Molecular Analysis to the diagnosis and Knowledge of the Duchenne Muscular Dystrophy

Objetivo: Revisar las técnicas de análisis molecular que se están empleando actualmente en el estudio de la DMD y los avances conseguidos en el diagnóstico y conocimiento de esta patología.Material y métodos: Se ha realizado una búsqueda bibliográfica de los últimos cinco años en las bases de datos PUBMED, OMIM y GENETEST mediante las palabras clave Duchenne Muscular Dystrophy and molecular analysis además de una búsqueda libre según la bibliografía localizada en dichas bases de datos, artículosy libros consultados.Resultados: se han localizado 73 referencias en las bases de datos de las cuales se han empleado 39 en la revisión, de la búsqueda libre se han utilizado un total de 10 referencias. Los mayores avances se han producido tanto en el reconocimiento de pequeñas mutaciones que pasaban desapercibidas mediante los análisis tradicionales y en la detección de portadoras de la enfermedad.Conclusiones: El análisis molecular ha facilitado el reconocimiento de numerosas mutaciones implicadas en la DMD así como las frecuencias de cada una de ellas. Se ha producido un gran avance en el diagnóstico y conocimiento de la DMD facilitando su abordaje diagnóstico y terapéutico aunque aún no se hayaencontrado un tratamiento resolutivo de la misma

Objective: To review the molecular analysis techniques those are being used nowadays in the study of DMD disease and the successful advances in the diagnosis and knowledge of this disease.Material and methods: It has been made a bibliography search in last five years on PUBMED, OMIM and GENETEST databases using the key words «Duchenne Muscular Dystrophy» and «molecular analysis» and a free search according to the references localized in that databases, articles and consulted books.Results: There have been localized 73 references in the databases, being employed 39 of them in the review. It has been used a total of 10 references from the free search. The greatest advances have been produced in the recognition of little mutations that gone unnoticed by means of traditional analysis and by the detection of female carriers.Conclusions: Molecular analysis has provided the recognition of numerous mutations involved in DMD just as each one frequency. A great advance has been produced in the diagnosis and knowledge of DMD, avoiding its diagnosis and therapeutics approaching although it has not been found a definitive treatment of this disease yet