Cirugía de la patología de la arteria vertebral. Revisión / Surgery of the pathology of the vertebral artery. Revision

Se realiza una revisión sobre la patología de la arteria vertebral, valorando las repercusiones que su oclusión parcial o total desarrolla. Se analiza la clínica que ocasiona este tipo de patología a la vez que se valoran los medios diagnósticos para la detección dela lesión oclusiva. Se discuten las diferentes estrategias y procedimientos terapéuticos en los pacientes portadores de esta patología y se valoran los diferentes datos aportados en la bibliografía y que corresponden a los estudios más importantes que se han realizado. Este tipo de afección se muestra como una patología con dificultades para su detección y con unas indicaciones terapéuticas quirúrgicas muy discutibles cuando se aplican con una no muy clara evidencia científica de la pertinencia de su realización. (AU)

A review is carried out on the pathology of the vertebral artery, assessing the repercussions that its partial or total occlusion develops. The symptoms that cause this type of pathology are analyzed at the same time as the diagnostic means for detecting theocclusive lesion are evaluated. The different strategies and therapeutic procedures in patients with this pathology are discussed andthe different data provided in the bibliography and corresponding to the most important studies that have been carried out are valued. This type of condition is shown as a pathology with difficulties in its detection and with highly debatable surgical therapeuticindications when applied with not very clear scientific evidence of the relevance of its performance. (AU)

Role of Oral Nutritional Supplements Enriched with ß-Hydroxy-ß-Methylbutyrate in Maintaining Muscle Function and Improving Clinical Outcomes in Various Clinical Settings.

Aging and disease-related malnutrition are well associated with loss of muscle mass and function. Muscle mass loss may lead to increased health complications and associated increase in health care costs, especially in hospitalized individuals. High protein oral nutritional supplements enriched with ß-hydroxy-ß-methylbutyrate (HP-ONS+HMB) have been suggested to provide benefits such as improving body composition, maintaining muscle mass and function and even decreasing mortality rates. The present review aimed to examine current evidence on the effect of HP-ONS+HMB on muscle-related clinical outcomes both in community and peri-hospitalization patients. Overall, current evidence suggests that therapeutic nutrition such as HP-ONS+HMB seems to be a promising tool to mitigate the decline in muscle mass and preserve muscle function, especially during hospital rehabilitation and recovery.

[Supply medicinal products improvement in outpatient care in a hospital pharmacy service]. / Mejora de la dispensación a pacientes externos de un servicio de farmacia hospitalaria.

INTRODUCTION: Pharmaceutical care to outpatients is currently one of the main occupations of hospital pharmacy services (PEX). There are several questionnaires to measure the satisfaction of the PEX of a pharmacy service, and the results of these questionnaires can generate improvement actions that result in satisfaction. OBJECTIVES: To verify if a satisfaction questionnaire for outpatients is valid for the generation of improvements in the care provided, and if after its implementation, the same questionnaire is able to detect changes in satisfaction. MATERIAL AND METHOD: Prospective study of a single center carried out in a tertiary hospital in 2015 and 2016. A questionnaire previously validated with 16 Likert-type items was used. Demographic and classification data were collected. A descriptive analysis was performed and the internal consistency was calculated using the Cronbach's α value. RESULTS: A total of 258 questionnaires were collected in 2015 and 493 in 2016. There were no differences in the baseline characteristics of the patients and users of the service. The items with the lowest satisfaction scores in 2015 (comfort of the waiting room, dispensing privacy, drug pick-up time and medication pick-up time) guided the improvement actions to be implemented. In 2016 there was an improvement in the waiting time until collection in 12.3% (p = 0.002); in the comfort of the waiting room 4.9% (p = 0.304); business hours for medication collection, 10.7% (p = 0.013); and in the confidentiality of the dispensation 4% (p = 0.292). The remaining scores fluctuated minimally, with no statistical significance at all. A 5.1% improvement in overall satisfaction was found (p < 0.001). Satisfaction values obtained as a whole were high. CONCLUSIONS: The satisfaction questionnaire is a valid instrument for generating actions to improve the care received in an outpatient unit of a pharmacy service. This same questionnaire is a tool to monitor the changes implemented to improve the care received.

Quantification of ß-hydroxymethylbutyrate and leucine by ultrahigh performance liquid chromatography tandem mass spectrometry at different situations and stages of a rodent life.

The main objective of this work was to develop a method to measure Leucine (Leu) and ß-hydroxymethylbutyrate (HMB) at basal levels in serum, urine, milk and brain microdialysates in rats. Ultrahigh performance liquid chromatography-electrospray-tandem mass spectrometry (UHPLC-ESI-MS/MS) was used as analytical technique. The sample treatment was simple and consisted of dilution with methanol and centrifugation for serum and urine, dilution with water and filtration with an Amicon filter for milk, and treatment with formic acid with no further dilution for microdialyzates. The procedures for sampling and the UHPLC-MS/MS parameters were accurately optimized to achieve the highest recoveries and to enhance the analytical characteristics of the method. For chromatographic separation, an Acquity UPLC BEH Amide column using acetonitrile-water gradient with formic acid as additive was used. The total run time was 4min. The analytical characteristics (accuracy, selectivity and sensitivity) of the proposed method were evaluated. The limits of detection (LODs) obtained ranged from 0.4 to 7ngmL(-1) and the limits of quantification (LOQs) from 1 to 22ngmL(-1). Precision, expressed as relative standard deviation (% RSD), was lower than 15% in all cases, and the determination coefficient (R(2)) was equal or higher than 99.0% with a residual deviation for each calibration point lower than ±25%. Mean recoveries were between 85 and 115%. The method was successfully applied to these matrices being able to detect significant differences between physiological situations, strains and stages of life.

Vectorial Kerr magnetometer for simultaneous and quantitative measurements of the in-plane magnetization components.

A vectorial magneto-optic Kerr effect (v-MOKE) setup with simultaneous and quantitative determination of the two in-plane magnetization components is described. The setup provides both polarization rotations and reflectivity changes at the same time for a given sample orientation with respect to a variable external magnetic field, as well as allowing full angular studies. A classical description based on the Jones formalism is used to calculate the setup's properties. The use of different incoming light polarizations and/or MOKE geometries, as well as the errors due to misalignment and solutions are discussed. To illustrate the capabilities of the setup a detailed study of a model four-fold anisotropy system is presented. Among others, the setup allows to study the angular dependence of the hysteresis phenomena, remanences, critical fields, and magnetization reversal processes, as well as the accurate determination of the easy and hard magnetization directions, domain wall orientations, and magnetic anisotropies.

Distal urethrectomy for localized penile squamous carcinoma in situ extending into the urethra: an updated series.

INTRODUCTION: The presence of squamous carcinoma in situ (CIS) of the distal penis extending into the urethral meatus is generally considered a contraindication for glans-sparing procedures. Distal urethrectomy with subsequent reconstruction can provide an alternative approach toward urethral resection while providing penile preservation in select cases. Unfortunately, long-term oncologic outcomes with this approach are ill-defined. MATERIALS AND METHODS: Between 1988 and 2012, five patients at Indiana University Medical Center underwent distal urethrectomy with reconstruction for penile squamous CIS extending into the urethral meatus. This cohort was retrospectively reviewed to evaluate functional and oncological outcomes. RESULTS: Of the five patients, four presented with glanular lesions and were initially managed with Mohs procedure in three cases, and local excision in one. The final patient presented with extensive urethral disease and was managed with primary urethrectomy. Reconstruction was performed with penile skin pedicle grafts in four patients and perineal urethrostomy in one. Final pathologic stage was T1 in one patient and Tis in the remaining four. Follow-up ranged from 6 to 96 months. One local recurrence was verified; however, it occurred outside the urethral area. This was confirmed in the pathologic analysis after the patient underwent a partial penectomy. Meatal dilation was necessary in two patients 12 and 7 months after the procedure. CONCLUSION: Distal urethrectomy for penile squamous CIS extending into the urethral meatus is a valid alternative to achieve negative surgical margins while preserving a penile function. Oncologic outcomes appear acceptable but larger series are still warranted to confirm our findings.

Short periodic orbit approach to resonances and the fractal Weyl law.

We investigate the properties of the semiclassical short periodic orbit approach for the study of open quantum maps that was recently introduced [Novaes, Pedrosa, Wisniacki, Carlo, and Keating, Phys. Rev. E 80, 035202(R) (2009)]. We provide solid numerical evidence, for the paradigmatic systems of the open baker and cat maps, that by using this approach the dimensionality of the eigenvalue problem is reduced according to the fractal Weyl law. The method also reproduces the projectors |ψ(n)(R)><ψ(n)(L)|, which involves the right and left states associated with a given eigenvalue and is supported on the classical phase-space repeller.

Tratamiento endovascular de aneurisma de aorta abdominal asociado a riñón en herradura: a propósito de dos casos y revisión de la literatura / Endovascular treatment of abdominal aortic aneurysm associated with horseshoe kidney: a presentation of two cases and a review of the literature

El riñón en herradura (RH) es una de las malformaciones congénitas renales más frecuentes, cuya incidencia se sitúa en torno al 0,25%, siendo infrecuente su asociación con aneurisma de aorta abdominal (AAA). Presentamos los resultados del tratamiento endovascular (EVAR) en dos casos de AAA asociado a RH (AAA-RH). Caso 1: varón de 60 años, con antecedentes de obesidad, dislipemia y RH asintomático, diagnosticado casualmente de AAA de 62mm de diámetro asintomática. Caso 2: mujer de 71 años, con antecedentes de hipertensión arterial y artritis reumatoide, diagnosticada mediante angio TC en el contexto de abdominalgia inespecífica, de AAA infrarrenal de 50mm de diámetro sin signos de rotura asociado a RH. En ambos casos se realizó EVAR mediante endoprótesis bifurcada Zenith®. No se registraron endofugas ni oclusión de arterias renales en angiografías de control. No hubo complicaciones perioperatorias. La búsqueda realizada en Medline/Pubmed/Scopus mediante la introducción de los términos horseshoe, kidney, aneurysm, endovascular y EVAR identificó 19 casos descritos en la literatura desde 1991 en los que se empleó EVAR para tratar AAA-RH(AU)

Horseshoe kidney (HSK) is one of the most common kidney malformations, the incidence is around 0.25%, but its association with abdominal aortic aneurysm (AAA) is uncommon. We present the results of endovascular treatment in two cases of AAA associated with HSK (AAA-HSK). Case 1. 60-year-old male with a history of obesity, dyslipidaemia, and asymptomatic HSK, incidentally diagnosed with an, also symptomatic, AAA of 62mm in diameter. Case 2. 71-year-old woman with a history of hypertension and rheumatoid arthritis, diagnosed by angio-CT with an infrarenal AAA 50mm in diameter with no signs of rupture associated with HSK in the context of non-specific abdominal pain. Both patients underwent endovascular repair (EVAR) by Zenith® endoprosthesis. There were no endoleaks or occlusion of renal arteries on angiography. There were no perioperative complications. The search in Medline/Pubmed/Scopus by introducing the terms «horseshoe», «kidney», «aneurysm», «endovascular» and «EVAR», identified 19 cases described in literature since 1991, which was used to treat AAA EVAR-HSK(AU)

The rs5743836 polymorphism in TLR9 confers a population-based increased risk of non-Hodgkin lymphoma.

Non-Hodgkin lymphoma (NHL) has been associated with immunological defects, chronic inflammatory and autoimmune conditions. Given the link between immune dysfunction and NHL, genetic variants in toll-like receptors (TLRs) have been regarded as potential predictive factors of susceptibility to NHL. Adequate anti-tumoral responses are known to depend on TLR9 function, such that the use of its synthetic ligand is being targeted as a therapeutic strategy. We investigated the association between the functional rs5743836 polymorphism in the TLR9 promoter and risk for B-cell NHL and its major subtypes in three independent case-control association studies from Portugal (1160 controls, 797 patients), Italy (468 controls, 494 patients) and the US (972 controls, 868 patients). We found that the rs5743836 polymorphism was significantly overtransmitted in both Portuguese (odds ratio (OR), 1.85; P=7.3E-9) and Italian (OR, 1.84; P=6.0E-5) and not in the US cohort of NHL patients. Moreover, the increased transcriptional activity of TLR9 in mononuclear cells from patients harboring rs5743836 further supports a functional effect of this polymorphism on NHL susceptibility in a population-dependent manner.

Tratamiento endovascular de la isquemia mesentérica. Revisión y puesta al día / Endovascular treatment of the mesenteric ischemia

La isquemia mesentérica continúa representando una enfermedad con elevada morbimortalidad a pesar de los recientes avances que han mejorado los resultados de la mayoría de las patologías quirúrgicas en las últimas décadas. La cirugía abierta ha sido considerada el tratamiento de elección durante las últimas décadas, pero el intenso desarrollo del tratamiento endovascular durante los últimos años ha facilitado su instauración en gran parte de los centros hospitalarios. Revisamos las generalidades, indicaciones y resultados de los procedimientos endovasculares en el tratamiento de la isquemia mesentérica aguda y crónica (AU)

Mesenteric ischemia continues to be a disease with high mortality despite recent advances that have improved the results of most surgical pathologies in recent decades. Open surgery has been considered the treatment of choice during the last decades, but the intense development of endovascular treatment in recent years has facilitated its establishment in most of the hospitals. We review the general indications and results of endovascular procedures in the treatment of acute and chronic mesenteric ischemia (AU)

Toxicity of chromated copper arsenate: a study in mice.

Chromated copper arsenate (CCA) was widespread used as a chemical wood preservative with application in the construction of playground equipment, fences, jetties, and naval. Environmental protection agency (EPA) had limited the use of CCA-treated wood on 2002, due to probable implications on both human and environmental health. Although this fact, several industries pursue the use of this product within their manufactories. In addition, the durability of this wood for 60 years, makes these treated products an hazard to the public health. In the present work, studies were explored exposing mice to CCA, during 14, 24, 48, and 96 h for the assessment of acute toxicity of CCA. Kidney and liver were removed, prepared for histology and for metalloid, and copper content evaluation by high resolution inductively coupled plasma mass spectroscopy. The histological results evidenced apparently normal structures for control animals and group exposed to As2O5. On the contrary, the renal sections of the animals treated with CCA revealed epithelium cells desquamation, hyaline, and granular casts in renal tubules lumen. Furthermore, high levels of arsenic were detected in the kidney of animals treated with CCA over 14 and 48 h, being significantly greater than controls. Although this approach underlines the potential hazard of CCA on some vital organs, further testing may be required to establish the impacts on other functions.

Quantum chaotic resonances from short periodic orbits.

We present an approach to calculating the quantum resonances and resonance wave functions of chaotic scattering systems, based on the construction of states localized on classical periodic orbits and adapted to the dynamics. Typically only a few such states are necessary for constructing a resonance. Using only short orbits (with periods up to the Ehrenfest time), we obtain approximations to the longest-living states, avoiding computation of the background of short living states. This makes our approach considerably more efficient than previous ones. The number of long-lived states produced within our formulation is in agreement with the fractal Weyl law conjectured recently in this setting. We confirm the accuracy of the approximations using the open quantum baker map as an example.

[Follow-up of the first case of Mycobacterium ulcerans infection documented by PCR, genotyping and culture in the Republic of Congo-Brazzaville]. / Suivi du premier cas d'infection à Mycobacterium ulcerans confirmé par culture, PCR et génotypage République du Congo-Brazzaville.

This article presents follow-up data from the first patient in whom Mycobacterium ulcerans infection (MUI) was documented by PCR, genotyping and culture in the Republic of Congo-Brazzaville. Findings show the importance of regular clinical and microbiological evaluation for the disseminated form of the disease. The patient was probably infected in Pointe Noire where MUI has been described but never documented. Culture of specimens collected before antibiotic treatment showed that the bacterium was sensitive to the antibiotics being administered (streptomycin and rifampin) and was identical to isolates from Atlantic-coast regions of West Africa where MUI is endemic. The patient was treated with streptomycin and rifampin for 12 weeks in association with surgery. During treatment clinical examination was performed every day and microbiological analysis every two weeks. The duration of follow-up from the end of specific antibiotic treatment was 26 months. Medical treatment failed to prevent bone involvement and fistulae that were treated by surgery. However medical treatment may have limited dissemination of the disease. Serial microbiological evaluation was useful to detect bone involvement in this patient, but persistent positive gene amplification is not a proof of active disease. This study confirms that MUI is still endemic in the region of Pointe Noire. This finding underlines the need to optimize epidemiologic surveillance, laboratory diagnostic capabilities, and therapeutic management in the Republic of Congo-Brazzaville.

Developments on drug delivery systems for the treatment of mycobacterial infections.

The clinical management of tuberculosis and other mycobacterial diseases with antimycobacterial chemotherapy remains a difficult task. The classical treatment protocols are long-lasting; the drugs reach mycobacteria-infected macrophages in low amounts and/or do not persist long enough to develop the desired antimycobacterial effect; and the available agents induce severe toxic effects. Nanotechnology has provided a huge improvement to pharmacology through the designing of drug delivery systems able to target phagocytic cells infected by intracellular pathogens, such as mycobacteria. Liposomes and nanoparticles of polymeric nature represent two of the most efficient drug carrier systems that after in vivo administration are endocytosed by phagocytic cells and then release the carried agents into these cells. This article reviews the relevant publications describing the effectiveness of the association of antimycobacterial agents with liposomes or nanoparticles for the treatment of mycobacterioses, particularly for Mycobacterium tuberculosis and M. avium infections. The increased therapeutic index of antimycobacterial drugs; the reduction of dosing frequency; and the improvement of solubility of hydrophobic agents, allowing the administration of higher doses, have been demonstrated in experimental infections. These advantages may lead to new therapeutic protocols that will improve patient compliance and, consequently, lead to a more successful control of mycobacterial infections. The potential therapeutic advantages resulting from the use of non-invasive administration routes for nanoparticulate systems are also discussed.

Rifabutin encapsulated in liposomes exhibits increased therapeutic activity in a model of disseminated tuberculosis.

Tuberculosis (TB) is a leading cause of death amongst infectious diseases. The low permeation of antimycobacterial agents and their difficult access to infected macrophages necessitate long-term use of high drug doses. Liposomes preferentially accumulate in macrophages, increasing the efficacy of antibiotics against intracellular parasites. In the present work, several rifabutin (RFB) liposomal formulations were developed and characterised and their in vivo profile was compared with free RFB following intravenous administration. With the RFB liposomal formulations tested, higher concentrations of the antibiotic were achieved in liver, spleen and lungs 24h post administration compared with free RFB. The concentration of RFB in these organs was dependent on the rigidity of liposomal lipids. The liposomal RFB formulation prepared with dipalmitoyl phosphatidylcholine:dipalmitoyl phosphatidylglycerol (DPPC:DPPG) was the most effective and was selected for biological evaluation in a mouse model of disseminated TB. Compared with mice treated with free RFB, mice treated with the DPPC:DPPG RFB formulation exhibited lower bacterial loads in the spleen (5.53 log(10) vs. 5.18 log(10)) and liver (5.79 log(10) vs. 5.41 log(10)). In the lung, the level of pathology was lower in mice treated with encapsulated RFB. These results suggest that liposomal RFB is a promising approach for the treatment of extrapulmonary TB in human immunodeficiency virus co-infected patients.

Intestinal toxicity induced by 5-fluorouracil in pigs: a new preclinical model.

BACKGROUND: The goal of this study was to develop an animal model of intestinal injury induced by 5-fluorouracil (5-FU) in pigs. METHODS: Six domestic pigs were used as control (healthy group) and another 6 malnourished pigs orally received 5-FU (treated group). After 4 weeks of treatment, pigs were sacrificed and jejunum, ileum and colon were isolated for histological, immunological and biochemical analyses. RESULTS: 5-FU caused a decrease in the intestinal mass. Disaccharidase, and phosphate alkaline activities, and glutathione redox cycle were disrupted by 5-FU. Histopathological alterations in the crypts and villous were greater in the small intestine than in the colon. 5-FU decreased the number of peripheral and intestinal leukocytes, promoting an increase in T-cytotoxic cells and a decrease in T-helper and B cells. CONCLUSION: This pig model of intestinal dysfunction closely mimics the common side effects of cancer chemotherapy in humans, and provides a useful tool for evaluating novel antimucotoxic agents.

Newborn screening: a national public health programme in Brazil.

The newborn screening programme started in Brazil (1976) through isolated initiatives, without governmental directions and/or policies. According to Health Ministry (2000) data the coverage was 55% and unevenly distributed. Only 17 out of 27 Brazilian states had more than 30% coverage. Public budgets covered only diagnostic examinations. There were no official data about assistance, patient follow-up or detected disorders. The creation of the National Programme (2001) has provided new perspective for newborn screening (NBS) in the public health system. It has provided important official data and established management and care units for each state: Reference Services in Newborn Screening. The programme screened about 13 million newborns from October 2001 to December 2005. The coverage increased to 80.2% (2005) and 74% of the states presented coverage of over 70%. Within 34 accredited Reference Services in 27 Brazilian states, all provide screening for PKU and CH. Ten of them provide screening for haemoglobinopathies as well, and three of them provide also for CF. The Reference Services altogether count on at least 170 health professionals, such as paediatricians, endocrinologists, nutritionists, psychologists and social workers. They are qualified to assist positive cases, within the policies established by the National Programme. There has been significant increase in NBS coverage and follow-up assuredness, including detected cases before the National Programme (10,935 positive cases) mostly in those regions where the programme did not exist. There has been significant evolution in the Newborn Screening as a Public Health Program in Brazil due to the government's commitment (federal and each component state).

Tratamiento endovascular de la aorta torácica / No disponible

No disponible

Age and sex-related serum changes in nitric oxide: correlations with serological markers.

Serum nitric oxide levels, systematically determined in 200 men and women from 18 to 65 year-old, undergo age and sex changes that strongly correlate with serological markers such as those related with cardiovascular functions and lipid profile.