Influence of behavioral traits in the inter-individual variability of nociceptive, emotional and cognitive manifestations of neuropathic pain.

Neuropathic pain is a complex disorder associated with emotional and cognitive deficits that may impair nociceptive manifestations. There is high inter-individual variability in the manifestations of human neuropathic pain, which largely depends on personality traits. We aim to identify the influence of different behavioral traits in the inter-individual vulnerability to neuropathic pain manifestations using behavioral, electrophysiological and genetic approaches. We first selected mice with extreme social and emotional traits and look for correlation with the spontaneous neuronal activity in the central amygdala. Neuropathic pain was induced to these mice to evaluate the influence of behavioral traits on nociceptive manifestations and gene expression profiles in the amygdala. Our results show an association of the spontaneous central amygdala neuronal activity with the sociability behavior. We demonstrate that low sociable, high anxious and low depressive phenotypes develop enhanced nociceptive hypersensitivity after nerve injury. However, greater emotional alterations and cognitive impairment are observed in high sociable, anxious-like and depressive-like mice, indicating that nociceptive, emotional and cognitive manifestations of neuropathic pain do not correlate with each other. Gene analyses identify high Pdyn and Il6 levels in the amygdala as indicative of enhanced nociceptive hypersensitivity and reveal an association between high Gadd45 expression and attenuated emotional and cognitive manifestations of neuropathic pain.

Attitudes Toward Organ Donation and Transplantation in Guanajuato, Mexico.

BACKGROUND: Chronic diseases have become a main cause of morbidity and mortality provoking function loss in organs. Quality of life is poor and expensive with replacement therapy. Transplantation offers a higher survival rate and a better life; however, the donation rate in Mexico is low, making it important to know the opinion of the population. METHODS: Six hundred forty-two people in Guanajuato, Mexico, (>15 years old) were enrolled. Demographic characteristics, education, religion, organ donation, and transplantation attitudes were evaluated. RESULTS: Donation attitudes in life or death were: very willing to donation (82.8% vs 61.5%), refuse to donate (12.7% vs 29.4%), and undecided (4.5% vs 9.1%). Reasons for donation were: altruism (63%), being useful to someone (28.6%), and empathy (7.1%). Negative causes were: personal beliefs (35.6%), fear (23.7%), and ignorance or "I don't know the recipient" (18.5%). Finally, 94.5% of the population is willing to receive a transplant if they need it. CONCLUSIONS: Guanajuato has a high tendency to donate their own organs, but less to donate from a family member. Refusal to donate has originated from lack/misinformation that people received from health professionals. Although most people are willing to donate, this is not reflected in donation rates. To be able to make this intention reality, we must create educational models for health care personnel that will allow them to transmit proper information to the population.

Fibromatosis agresiva de cabeza y cuello en la edad pediátrica. Un caso clínico y revisión de la literatura / Aggressive fibromatosis of the head and neck in pediatric age. A case report and review of the literature

Introducción. El tumor desmoide es una neoplasia mesenquimal benigna rara en la edad pediátrica, originada principalmente en el tejido conectivo de músculos y aponeurosis. Con frecuencia, es mal diagnosticada como fibromas, procesos reactivos o fibrosarcomas de bajo grado. Se caracteriza por un crecimiento lento, localmente agresiva y con una alta tasa de recurrencia sin capacidad de metastatizar. Material y método. Niña de 7 años con tumoración para mandibular derecha de un año de evolución. Se caracterizaba por un crecimiento lento e indoloro, trismus y latero-desviación mandibular a la izquierda durante la apertura oral. Las pruebas de imagen mostraban tumor departes blandas en región maseterina con una reacción perióstica en el cuerpo mandibular. La biopsia informó de tumor desmoide. Resultados. Se realizó abordaje de Risdon para la exéresis tumoral más Split de cortical externa de cuerpo mandibular sin poder preservarla rama marginal del VII par craneal (PC). La anatomía patológica informó de fibromatosis agresiva sin afectación ósea. Actualmente presenta parálisis marginal y está libre de enfermedad. Conclusiones. Los tumores desmoides de cabeza y cuello son difíciles de tratar debido a la proximidad o implicación de estructuras vitales, su naturaleza infiltrativa y la tendencia a la recurrencia local. La cirugía primaria con márgenes quirúrgicos negativos es el tratamiento de elección. Sin embargo, en muchos casos esto implica cirugías (..) (AU)

Background. Desmoid tumor is a rare benign mesenchymal neoplasmin children primarily originated in the muscle connective tissue, fascial sheaths, and musculoaponeurotic structures. It is often misdiagnosed as fibroids, reactive processes or low-grade fibro sarcomas. It is characterized by slow growth, locally aggressive nature, high recurrence rate without metastasize capacity. Material and methods. 7 year old girl with right (..) (AU)

[Use of extra-hospital emergency systems in the treatment of acute stroke in the region of Murcia. Possible repercussions on the urgent care of stroke patients]. / Utilización del sistema de emergencias extrahospitalario en el tratamiento del ictus agudo en la región de Murcia. Posible repercusión en la asistencia sanitaria urgente del ictus.

AIM: To examine the use of extra-hospital emergency systems in the urgent care of stroke patients in our region and their influence on the time required to reach hospital, the time needed to perform an urgent computerised axial tomography (CAT) scan and the delay in receiving attention from the specialist. PATIENTS AND METHODS: Samples were collected from 232 stroke patients out of the total number admitted to our hospitals. Data about the stroke were collected prospectively, and included the arrival time, the time required to perform the CAT scan and the time the specialist devoted to attending the patient. Data were also gathered about the different extra-hospital transport and emergency systems. A statistical analysis was performed to determine the effect of using the extra-hospital emergency procedures on the different variables. RESULTS: A total of 53.6% of patients arrived within the first three hours. 38.7% went straight to hospital, 25% visited extra-hospital Emergency Services first, and 18.5% made a prior visit to Primary Care. 51.5% found their own way to the hospital and 46.7% arrived by ambulance. Mean time taken to perform an urgent CAT scan: 190.4 minutes; mean time required for specialist attention: 25.65 hours. The only statistically significant relation was the use of extra-hospital emergency systems and health care transport according to the type of stroke: both were more likely to be used in cases of haemorrhagic stroke. CONCLUSIONS: In hospitals in the Murcia region, the use of the extra-hospital emergency system and the means of transport utilised do not affect the time stroke patients take to reach hospital or the time needed to perform an urgent CAT scan or the delay in receiving attention from a specialist; the aetiology of the stroke does, however, influence the use of such services.

Utilización del sistema de emergencias extrahospitalario en el tratamiento del ictus agudo en la región de Murcia. Posible repercusión en la asistencia sanitaria urgente del ictus / Use of extra-hospital emergency system in the treatment of acute stroke in the region of murcia. Possible repercussions on the urgent care of stroke patients

Objetivo. Utilización en nuestra región de los sistemas de urgencias extrahospitalarias en la atención urgente del ictus y su influencia en el tiempo de llegada al hospital, el de realización de la tomografía axial computarizada (TAC) urgente y demora de la atención por el especialista. Pacientes y métodos. Se recogieron muestras de 232 pacientes con ictus del total de los ingresados en nuestros hospitales. Prospectivamente se recogieron datos sobre el ictus, con inclusión de los tiempos de llegada, tiempo de realización de la TAC y tiempo de atención por el especialista. Se recogió el uso delos distintos sistemas de urgencias y transporte extrahospitalarios. Estadísticamente se analizó la influencia del uso de los dispositivos de urgencia extrahospitalarios en las distintas variables recogidas. Resultados. 53,6% de los pacientes llegaron en las tres primeras horas. 38,7% acudieron directamente al hospital, el 25% acude primero al Servicio de Urgencias extrahospitalarias y 18,5% consulta previamente con Asistencia Primaria. El 51,5% llegaron por sus propios medios y el 46,7% en ambulancia. Tiempo medio de TAC urgente: 190,4 minutos; tiempo medio de atención por el especialista:25,65 horas. La única relación estadísticamente significativa fue el uso del sistema de urgencias extrahospitalarias y transporte sanitario según el tipo de ictus, con más tendencia a utilizarlos en los ictus hemorrágicos. Conclusiones. En los hospitales de Murcia, el uso del sistema de urgencias extrahospitalarias y el medio de transporte empleado no influyen en el tiempo de llegada del ictus al hospital, en el tiempo de realización de TAC urgente ni en la demora de atención por el especialista, y sí influye en la utilización de dichos servicios la etiología del ictus (AU)

Aim. To examine the use of extra-hospital emergency systems in the urgent care of stroke patients in our region and their influence on the time required to reach hospital, the time needed to perform an urgent computerised axial tomography(CAT) scan and the delay in receiving attention from the specialist. Patients and methods. Samples were collected from 232stroke patients out of the total number admitted to our hospitals. Data about the stroke were collected prospectively, and included the arrival time, the time required to perform the CAT scan and the time the specialist devoted to attending the patient. Data were also gathered about the different extra-hospital transport and emergency systems. A statistical analysis was performed to determine the effect of using the extra-hospital emergency procedures on the different variables. Results. A total of 53.6% of patients arrived within the first three hours. 38.7% went straight to hospital, 25% visited extra-hospital Emergency Services first, and 18.5% made a prior visit to Primary Care. 51.5% found their own way to the hospital and 46.7% arrived by ambulance. Mean time taken to perform an urgent CAT scan: 190.4 minutes; mean time required for specialist attention: 25.65hours. The only statistically significant relation was the use of extra-hospital emergency systems and health care transport according to the type of stroke: both were more likely to be used in cases of haemorrhagic stroke. Conclusions. In hospitals in the Murcia region, the use of the extra-hospital emergency system and the means of transport utilised do not affect the time stroke patients take to reach hospital or the time needed to perform an urgent CAT scan or the delay in receiving attention from a specialist; the aetiology of the stroke does, however, influence the use of such services (AU)

Tratamiento conservador de las fracturas del cóndilo mandibular. Parte II / Conservative management of condylar fractures. Part II

La estadística del Servicio de Cirugía Oral y Maxilofacial del Hospital Carlos Haya de Málaga muestra un 9 por ciento de fracturas condileas mandibulares dentro del total de fracturas maxilofaciales, 28 por ciento de las fracturas mandibulares. La distribución por décadas de las fracturas simples condileas es predominantemente infantiljuvenil (39,1 por ciento) con un tratamiento quirúrgico en un 6,4 por ciento. Las fracturas combinadas son predominantes en adultos jovenes (36,3 por ciento) siendo la asociación más frecuente con otra fractura mandibular (39 por ciento) estando el otro cóndilo afectado en total en un 45,3 por ciento (30,3 por ciento del otro cóndilo +15 por ciento del segundo condilo más una tercera fractura) de las fracturas multiples. El tratamiento quirurgico es la osteosíntesis de la fractura asociada en un 48 por ciento y osteosíntesis del cóndilo en un 6 por ciento únicamente frente a un 15 por ciento de los casos con dislocación condílea mayor de 90° del eje longitudinal que lo indica. Las complicaciones de defectos de oclusión o apertura no son significativas. La osteosíntesis condílea más favorable debe ser con dos mini/microplacas en líneas de tensión y compresion, ya sea con ayuda endoscópica o no para evitar las complicaciones de los abordajes preauriculares y subangulomandibulares. La fisioterapia con activadores miofuncionales con guía condílea es esencial para la correcta rehabilitación (AU)

Role of factor XIII Val 34 Leu polymorphism in patients with migraine.

At present, it is contradictory to determine if the combination of certain prothrombotic polymorphisms and migraine increases the risk to develop ischaemic cerebrovascular disease. Recently, the common Val34Leu polymorphism of the A-chain factor XIII gene, associated with variations in factor XIII activity, has been suggested to play a significant role in the development of arterial and venous thrombotic disorders. We analysed the prevalence of this polymorphism in 17 patients with coexisting ischaemic cerebrovascular disease and migraine (5 with aura, and 12 without aura), 89 patients with migraine (43 with aura, and 46 without aura), 116 patients with ischaemic cerebrovascular disease, and 467 healthy Caucasian controls from the South of Spain. Genomic PCR amplification, using a mutated oligonucleotide, and allele-specific restriction assays were used for genotyping. The factor XIII Leu 34 variant was present in 47.1; 40.5; 34.9; and 35.1% of patients with coexisting ischaemic cerebrovascular disease and migraine, ischaemic cerebrovascular disease, migraine, and control subjects, respectively. These data suggest that the factor XIII Leu 34 allele does not play a protective role against these disorders in our population.

Charles Bonnet syndrome and Parkinson's disease.

We present two cases of Charles Bonnet syndrome in comorbidity with Parkinson's disease. Patients developed visual hallucinosis before starting any antiparkisonian treatment. We briefly discuss the possible physiopathological mechanisms involving low visual acuity and Parkinson's disease with visual hallucinosis.

[Emotional facial paresis as a symptom of a spontaneous carotid dissection]. / Paresia facial emocional como síntoma de una disección espontánea de carótida: a propósito de un caso.

Emotional facial paresis consists of the absence of facial movements during emotional stimulus, as laughing, with a normal voluntary facial mobility. The anatomic ways responsible for the emotional facial mobility have been already studied. We present a case of emotional facial paresis caused by a striatum-capsular infarct secondary to a spontaneous dissection of the internal carotid artery.

[Herpes zoster ophthalmicus with contralateral hemiplegia]. / Herpes zoster oftálmico con hemiplejia contralateral.

A 57-year-old patient nonimmunosuppressed who had zoster ophthalmicus associated to contralateral hemiplegia is presented. We noticed on the CT scan an infarction of left caudate nucleus, as well as in the angiography signs of vasculitis. We comment on the clinical and diagnosis features and suggest possible benefit effects of the treatment with acyclovir.