SYNAPSES. A European observational study to evaluate the safety and the effectiveness of safinamide in routine clinical practice: post-hoc analysis of the Spanish study population. / SYNAPSES. Estudio observacional europeo para evaluar la seguridad y la efectividad de la safinamida en la práctica clínica habitual: análisis post hoc de la población española del estudio.

INTRODUCTION: Parkinson's Disease (PD) is a progressive age-related neurodegenerative condition requiring new therapeutic alternatives. Safinamide, a novel levodopa add-on therapy, positively affects disease fluctuations by modulating both dopaminergic and glutamatergic systems. To further investigate the use of safinamide in European routine clinical practice, the present post-hoc analysis aimed to understand safinamide's safety profile within the Spanish study population. PATIENTS AND METHODS: Five hundred eleven Spanish patients with PD were evaluated at baseline, four (±1), eight (±1), and 12 (±1) months after initiating safinamide treatment. Unified Parkinson's Disease Rating Scale (UPDRS) total score and UPDRS part III score during on time were used to measure the overall severity of PD and motor complications, respectively, while the severity of adverse events was evaluated following the investigators' criteria. RESULTS: Safinamide showed a favourable safety profile within the Spanish study population, although prescription to patients with psychiatric conditions and off-label use were more frequent than in the European study population. In Spain, clinically meaningful improvements were observed in UPDRS scores when safinamide was used as the only add-on therapy to levodopa (57.4% and 53.7% of patients) and when switching from rasagiline (55.1% of patients). Motor complications were reduced from 83.2% to 63.3% after the study period. Increased safety concerns were undetected in any patient subgroup, although patients with cognitive impairment showed a slightly higher frequency of adverse events. CONCLUSIONS: This subanalysis further supports safinamide use as a safe and efficacious option for the management of motor fluctuations in different subgroups of levodopa-treated patients. However, safinamide should be used with caution in patients with cognitive impairment.

TITLE: SYNAPSES. Estudio observacional europeo para evaluar la seguridad y la efectividad de la safinamida en la práctica clínica habitual: análisis post hoc de la población española del estudio.Introducción. La enfermedad de Parkinson (EP) es una enfermedad neurodegenerativa progresiva relacionada con la edad que requiere nuevas alternativas terapéuticas. La safinamida, un nuevo tratamiento add-on a la levodopa, afecta positivamente a las fluctuaciones de esta enfermedad al modular los sistemas dopaminérgico y glutamatérgico. Para investigar más a fondo el uso de la safinamida en la práctica clínica rutinaria europea, el presente análisis post hoc tiene como objetivo comprender el perfil de seguridad de la safinamida dentro de la población española del estudio. Pacientes y métodos. Se evaluó a 511 pacientes españoles con EP al inicio, cuatro (±1), ocho (±1) y 12 (±1) meses después de iniciar el tratamiento con safinamida. Se utilizaron la puntuación total de la escala unificada de puntuación de la enfermedad de Parkinson (UPDRS) y la puntuación de la UPDRS III, durante el tiempo en on para medir la gravedad general de la EP y las complicaciones motoras, respectivamente, mientras que la gravedad de los acontecimientos adversos se evaluó siguiendo los criterios de los investigadores. Resultados. La safinamida mostró un perfil de seguridad favorable en la población española del estudio, aunque la prescripción a pacientes con enfermedades psiquiátricas y el uso para indicaciones no autorizadas fueron más frecuentes que en la población europea del estudio. En España se observaron mejoras clínicamente significativas en las puntuaciones de la UPDRS cuando se utilizó la safinamida como único tratamiento add-on a la levodopa (el 57,4 y el 53,7% de los pacientes) y cuando se venía de administrar rasagilina (el 55,1% de los pacientes). Las complicaciones motoras se redujeron del 83,2 al 63,3% tras el período de estudio. No se detectaron mayores problemas de seguridad en ningún subgrupo de pacientes, aunque los pacientes con deterioro cognitivo mostraron una frecuencia algo superior de acontecimientos adversos. Conclusiones. Este subanálisis respalda el uso de la safinamida como opción segura y eficaz para el tratamiento de las fluctuaciones motoras en diferentes subgrupos de pacientes tratados con levodopa. Sin embargo, la safinamida debe utilizarse con precaución en pacientes con deterioro cognitivo.

SYNAPSES. Estudio observacional europeo para evaluar la seguridad y la efectividad de la safinamida en la práctica clínica habitual: análisis post hoc de la población española del estudio / SYNAPSES. A European observational study to evaluate the safety and the effectiveness of safinamide in routine clinical practice: post-hoc analysis of the Spanish study population

Introducción La enfermedad de Parkinson (EP) es una afección neurodegenerativa progresiva relacionada con la edad que requiere nuevas alternativas terapéuticas. La safinamida, un nuevo tratamiento complementario de la levodopa, afecta positivamente a las fluctuaciones de esta enfermedad al modular los sistemas dopaminérgico y glutamatérgico. Para investigar más a fondo el uso de la safinamida en la práctica clínica rutinaria europea, el presente análisis post hoc tiene como objetivo comprender el perfil de seguridad de la safinamida dentro de la población española del estudio. Pacientes y métodos Se evaluó a 511 pacientes españoles con EP al inicio, cuatro (±1), ocho (±1) y 12 (±1) meses después de iniciar el tratamiento con safinamida. Se utilizaron la puntuación total de la escala unificada de puntuación de la enfermedad de Parkinson (UPDRS) y la puntuación de la UPDRS III, durante el tiempo en on para medir la gravedad general de la EP y las complicaciones motoras, respectivamente, mientras que la gravedad de los acontecimientos adversos se evaluó siguiendo los criterios de los investigadores. Resultados La safinamida mostró un perfil de seguridad favorable en la población española del estudio, aunque la prescripción a pacientes con enfermedades psiquiátricas y el uso para indicaciones no autorizadas fueron más frecuentes que en la población europea del estudio. En España se observaron mejoras clínicamente significativas en las puntuaciones de la UPDRS cuando se utilizó la safinamida como único tratamiento complementario a la levodopa (el 57,4 y el 53,7% de los pacientes) y cuando se venía de administrar rasagilina (el 55,1% de los pacientes). Las complicaciones motoras se redujeron del 83,2 al 63,3% tras el período de estudio. No se detectaron mayores problemas de seguridad en ningún subgrupo de pacientes, aunque los pacientes con deterioro cognitivo mostraron una frecuencia algo superior de acontecimientos adversos. Conclusiones ... (AU)

Introduction. Parkinson’s Disease (PD) is a progressive age-related neurodegenerative condition requiring new therapeutic alternatives. Safinamide, a novel levodopa add-on therapy, positively affects disease fluctuations by modulating both dopaminergic and glutamatergic systems. To further investigate the use of safinamide in European routine clinical practice, the present post-hoc analysis aimed to understand safinamide’s safety profile within the Spanish study population. Patients and methods. Five hundred eleven Spanish patients with PD were evaluated at baseline, four (±1), eight (±1), and 12 (±1) months after initiating safinamide treatment. Unified Parkinson’s Disease Rating Scale (UPDRS) total score and UPDRS part III score during on time were used to measure the overall severity of PD and motor complications, respectively, while the severity of adverse events was evaluated following the investigators’ criteria. Results. Safinamide showed a favourable safety profile within the Spanish study population, although prescription to patients with psychiatric conditions and off-label use were more frequent than in the European study population. In Spain, clinically meaningful improvements were observed in UPDRS scores when safinamide was used as the only add-on therapy to levodopa (57.4% and 53.7% of patients) and when switching from rasagiline (55.1% of patients). Motor complications were reduced from 83.2% to 63.3% after the study period. Increased safety concerns were undetected in any patient subgroup, although patients with cognitive impairment showed a slightly higher frequency of adverse events. Conclusions. This subanalysis further supports safinamide use as a safe and efficacious option for the management of motor fluctuations in different subgroups of levodopa-treated patients. However, safinamide should be used with caution in patients with cognitive impairment. (AU)

Palliative care management in patients with Parkinson's disease and other movement disorders in Spain. National survey of neurologists.

INTRODUCTION: Palliative care in neurodegenerative diseases is useful but underused. The objective of this study is to know how palliative care (PC) is applied in Spain in order to identify limitations and unmet needs. MATERIALS AND METHODS: It is a descriptive, observational, cross-sectional study, anonymous survey type of 20 questions, directed and answered by neurologists dedicated to movement disorders (MD) in Spain. RESULTS: 58 responses were obtained from neurologists from 15 autonomous communities. 69% answered that they did not have a specialised MD nursing facility but did have a PC team in their centre (81%). No specific protocol for PC in MD was identified. All except one neurologist stated that they lacked sufficient training in PC, the main training need being the "advance directives explanation". Only 1 in 4 neurologists answered routinely explaining advance healthcare planning to their patients, recognising up to 84.5% of neurologists not knowing how to assess the patient's competence. 60.3% of those surveyed answered that between 10% and 30% of their patients would be candidates for PC, although 1 in 3 said they were not clear when to refer the patient to PC. 100% of neurologists affirmed the priority need to implement PC protocols in MD. CONCLUSIONS: Our study shows a formative deficit in PC in this area and in the care of the patient with movement disorders and their environment, and should serve as a starting point to develop consensual care protocols.

Population-based survey on menopausal symptoms and treatment use.

OBJECTIVE: This article aimed to study the use of menopausal hormone therapy (MHT) among Spanish perimenopausal and postmenopausal women, the presence of menopausal symptoms and the sources of information. METHODS: The epidemiological study using a survey included Spanish perimenopausal or postmenopausal women aged between 40 and 70 years in August 2021. RESULTS: A total of 1254 women were included. In the postmenopausal group, 86% reported one or more menopausal symptoms; the most frequent was vulvovaginal dryness (57%). Among the symptomatic women, 15.2% used some treatment. Vasomotor symptoms (p = 0.001), vulvovaginal atrophy (p < 0.001) and symptoms related to sexuality (p < 0.001) were associated with greater use of treatments; 2.5% of postmenopausal women used MHT. In the perimenopausal group, 75.1% were symptomatic, hot flashes being the most frequent. Only insomnia was related to greater use of some treatment (p = 0.021); 1.6% of perimenopausal women used MHT. The most common reason for women's rejection of MHT was the fear of side effects, especially cancer. The gynecologist was the most frequently used source of information. CONCLUSIONS: Although there is a high prevalence of symptoms, the use of MHT in Spanish perimenopausal and postmenopausal women is very low.

[Clinical experience on the management of post-traumatic bone defects of long bones treated with the membrane induction technique]. / Experiencia clínica en el manejo de defectos óseos postraumáticos de huesos largos tratados con la técnica de inducción de membrana.

INTRODUCTION: bone defects drastically alter the patient's quality of life, and can produce serious sequelae such as dysfunctional shortening, angular deformity, joint stiffness and irreversible gait disorder. OBJECTIVE: to describe the experience of managing post-traumatic bone defects of long bones treated with the membrane induction technique. MATERIAL AND METHODS: retrospective observational study of patients with bone defects greater than 3 cm in diaphyseal pseudoarthrosis of long bones, who underwent the Masquelet technique. Period taken from January 2019 to January 2021. All patients underwent vigorous debridement and stabilization of the fracture, to then place the cement spacer. Spacer removal was at 4-6 weeks. The degree of consolidation was assessed, as well as the evolution of the treatment. RESULT: 25 patients were included in the study; the mean age was 36.8 ± 8.9 years. Diameter of bone losses was 3 to 10 cm (84%) and > 10 cm (16%). Bone consolidation occurred in patients with a defect < 10 cm (16%). 32% of patients presented some complication. CONCLUSIONS: bone union was achieved only in a few patients with defects smaller than 10 cm, requiring alternative procedures in most cases. Proper selection of patients is required.

INTRODUCCIÓN: los defectos óseos alteran drásticamente la calidad de vida del paciente y pueden producir serias secuelas como acortamiento disfuncional, deformidad angular, rigidez articular y trastorno irreversible de la marcha. OBJETIVO: describir la experiencia clínica en el manejo de defectos óseos postraumáticos de huesos largos tratados con la técnica de inducción de membrana. MATERIAL Y MÉTODOS: estudio observacional, retrospectivo, de pacientes con defectos óseos mayores de 3 cm con pseudoartrosis diafisaria de huesos largos, a los que se aplicó la técnica de Masquelet. En el período de Enero de 2019 a Enero de 2021. A todos los pacientes se les realizó desbridamiento enérgico y estabilización de la fractura, para posteriormente colocar el espaciador de cemento. El retiro del espaciador fue a las 4-6 semanas. Se valoró el grado de consolidación y la evolución del tratamiento. RESULTADOS: se incluyeron 25 pacientes, la media de edad fue de 36.8 ± 8.9 años. El diámetro de las pérdidas óseas fue de 3 a 10 cm (84%) y > 10 cm (16%). La consolidación ósea se presentó en pacientes con un defecto < 10 cm (16%). Treinta y dos por ciento de los pacientes presentó alguna complicación. CONCLUSIONES: la consolidación ósea se logró sólo en aquellos pacientes con defectos < 10 cm, requiriendo procedimientos alternativos a la técnica de inducción de membrana en la mayoría de los casos. Se requiere una selección adecuada de pacientes para lograr la consolidación ósea por medio de esta técnica.

First insight into plastics ingestion by fish in the Gulf of California, Mexico.

Plastic particle occurrence in the digestive tracts of fishes from a tropical estuarine system in the Gulf of California was investigated. A total of 1095 fish were analysed, representing 15 species. In total 1384 particles of plastic debris were recovered from the gastrointestinal tracts of 552 specimens belonging to 13 species, and all consisted of threads, the majority of which were small microplastics (0.23 to 1.89), followed by large microplastics (2.07 to 4.49), and few mesoplastics (5.4 to 19.86). Plastic particles were identified using ATR-FTIR spectroscopy. The mean frequency of occurrence of plastics in the gastrointestinal tracts of fishes from this system was 50.5%, which is higher than frequencies reported in similar systems in other areas. The polymers identified by ATR-FTIR were polyamide (51.2%), polyethylene (36.6%), polypropylene (7.3%), and polyacrylic (4.9%). These results show the first evidence of plastic contamination for estuarine biota in the Gulf of California.

Inflammatory response in human alveolar epithelial cells after TiO2 NPs or ZnO NPs exposure: Inhibition of surfactant protein A expression as an indicator for loss of lung function.

The increasing use of metal oxide nanoparticles (MONPs) as TiO2 NPs or ZnO NPs has led to environmental release and human exposure. The respiratory system, effects on lamellar bodies and surfactant protein A (SP-A) of pneumocytes, can be importantly affected. Exposure of human alveolar epithelial cells (A549) induced differential responses; a higher persistence of TiO2 in cell surface and uptake (measured by Atomic Force Microscopy) and sustained inflammatory response (by means of TNF-α, IL-10, and IL-6 release) and ROS generation were observed, whereas ZnO showed a modest response and low numbers in cell surface. A reduction in SP-A levels at 24 h of exposure to TiO2 NPs (concentration-dependent) or ZnO NPs (the higher concentration) was also observed, reversed by blocking the inflammatory response (by the inhibition of IL-6). Loss of SP-A represents a relevant target of MONPs-induced inflammatory response that could contribute to cellular damage and loss of lung function.

Identifying and managing patient–ventilator asynchrony: An international survey / Identificación y manejo de la asincronía paciente-ventilador: encuesta internacional

Objective To describe the main factors associated with proper recognition and management of patient–ventilator asynchrony (PVA). Design An analytical cross-sectional study was carried out. Setting An international study conducted in 20 countries through an online survey. Participants Physicians, respiratory therapists, nurses and physiotherapists currently working in the Intensive Care Unit (ICU). Main variables of interest Univariate and multivariate logistic regression models were used to establish associations between all variables (profession, training in mechanical ventilation, type of training program, years of experience and ICU characteristics) and the ability of HCPs to correctly identify and manage 6 PVA. Results A total of 431 healthcare professionals answered a validated survey. The main factors associated to proper recognition of PVA were: specific training program in mechanical ventilation (MV) (OR 2.27; 95%CI 1.14–4.52; p=0.019), courses with more than 100h completed (OR 2.28; 95%CI 1.29–4.03; p=0.005), and the number of ICU beds (OR 1.037; 95%CI 1.01–1.06; p=0.005). The main factor influencing the management of PVA was the correct recognition of 6 PVAs (OR 118.98; 95%CI 35.25–401.58; p<0.001). Conclusion Identifying and managing PVA using ventilator waveform analysis is influenced by many factors, including specific training programs in MV, the number of ICU beds, and the number of recognized PVAs. (AU)

Objetivo Describir los factores asociados al correcto reconocimiento y manejo de la asincronía paciente-ventilador (APV). Diseño Estudio analítico transversal. Ámbito Estudio internacional realizado en 20 países mediante una encuesta a través de Internet. Participantes Médicos, terapeutas respiratorios, enfermeras/os y fisioterapeutas que trabajan actualmente en unidades de cuidados intensivos (UCI). Principales variables de interés Se utilizó un análisis uni y multivariado para describir la asociación entre todas las variables (profesión, formación en ventilación mecánica, tipo de programa de formación, años de experiencia y características de la UCI en la cual trabajan los profesionales) con la correcta identificación y manejo de 6 APV. Resultados Un total de 431 profesionales respondieron una encuesta validada previamente. Los factores asociados a una correcta identificación de 6 APV fueron: haber completado un programa de formación específico sobre ventilación mecánica (OR: 2,27; IC 95%: 1,14-4,52; p=0,019), programa de formación con más de 100h (OR: 2,28; IC 95%: 1,29-4,03; p=0,005) y el número de camas de UCI (OR: 1,037; IC 95%: 1,01-1,06; p=0,005). El principal factor asociado a un adecuado manejo de la APV fue la correcta identificación de 6 APV (OR: 118,98; IC 95%: 35,25-401,58; p<0,001). Conclusiones La identificación y el manejo de la asincronía paciente-ventilador, mediante el análisis de las curvas del ventilador está influenciada por programas de formación, específicos sobre ventilación mecánica, el número de camas de la UCI y el número de asincronías identificadas. (AU)

Early production of table olives at a mid-7th millennium BP submerged site off the Carmel coast (Israel).

We present here the earliest evidence for large-scale table olive production from the mid-7th millennium BP inundated site of Hishuley Carmel on the northern Mediterranean coast of Israel. Olive pit size and fragmentation patterns, pollen as well as the architecture of installations associated with pits from this site, were compared to finds from the nearby and slightly earlier submerged Kfar Samir site. Results indicate that at Kfar Samir olive oil was extracted, while at Hishuley Carmel the data showed that large quantities of table olives, the oldest reported to date, were prepared. This process was most probably facilitated by the site's proximity to the Mediterranean Sea, which served as a source of both sea water and salt required for debittering/pickling/salting the fruit, as experimentally demonstrated in this study. Comparison of pit morphometry from modern cultivars, wild-growing trees and the archaeological sites, intimates that in pit morphology the ancient pits resemble wild olives, but we cannot totally exclude the possibility that they derive from early cultivated trees. Our findings demonstrate that in this region, olive oil production may have predated table olive preparation, with each development serving as a milestone in the early exploitation of the olive.

Identifying and managing patient-ventilator asynchrony: An international survey.

OBJECTIVE: To describe the main factors associated with proper recognition and management of patient-ventilator asynchrony (PVA). DESIGN: An analytical cross-sectional study was carried out. SETTING: An international study conducted in 20 countries through an online survey. PARTICIPANTS: Physicians, respiratory therapists, nurses and physiotherapists currently working in the Intensive Care Unit (ICU). MAIN VARIABLES OF INTEREST: Univariate and multivariate logistic regression models were used to establish associations between all variables (profession, training in mechanical ventilation, type of training program, years of experience and ICU characteristics) and the ability of HCPs to correctly identify and manage 6 PVA. RESULTS: A total of 431 healthcare professionals answered a validated survey. The main factors associated to proper recognition of PVA were: specific training program in mechanical ventilation (MV) (OR 2.27; 95%CI 1.14-4.52; p=0.019), courses with more than 100h completed (OR 2.28; 95%CI 1.29-4.03; p=0.005), and the number of ICU beds (OR 1.037; 95%CI 1.01-1.06; p=0.005). The main factor influencing the management of PVA was the correct recognition of 6 PVAs (OR 118.98; 95%CI 35.25-401.58; p<0.001). CONCLUSION: Identifying and managing PVA using ventilator waveform analysis is influenced by many factors, including specific training programs in MV, the number of ICU beds, and the number of recognized PVAs.

Association of leptin receptor expression in placenta and peripheral blood mononuclear cell with maternal weight in birth outcomes.

INTRODUCTION: The pregnancy period represents the most intense period of growth and development. Pre-pregnancy weight influences weight gain during pregnancy. Leptin is a hormone mainly derived from white adipose tissue, during pregnancy leptin is also produced by the placenta. It has been suggested that the effects of placental leptin on the mother may contribute to endocrine-mediated alterations in energy balance; a dysregulation in leptin levels or its receptors may lead to poor birth outcomes. Therefore, the main goal of the present study was to analyze the differences in birth outcomes by maternal weight with the expression level of leptin receptor in maternal peripheral blood mononuclear cell (PBMC) and placental tissue. METHODS: Women with full-term gestation and its offspring were enrolled. Total RNA from maternal PBMC and placenta was obtained to perform the analysis of expression of the leptin receptor (LEPR) gene trough real-time PCR technique. Data were analyzed using one-way ANOVA or Mann-Whitney u test when applicable. Pearson correlation coefficient was used to determine the relationship between continuous variables (Stata v.13); p ≤ 0.05 was considered statistically significant. RESULTS: No statistically significant differences were found between LEPR expression level and the BMI studied groups in maternal PBMC and placental tissue. Interaction between gestational weight gain (GWG) and LEPR in maternal PBMC explain in a 32% the variability of the newborn weight. CONCLUSIONS: LEPR expression level in maternal PBMC correlates with newborn measurements independent from sex. GWG can affect fetal development by increasing fetal birth weight.

Fatal Disseminated Infection by Trichosporon asahii Under Voriconazole Therapy in a Patient with Acute Myeloid Leukemia: A Review of Breakthrough Infections by Trichosporon spp.

INTRODUCTION: Cases of invasive Trichosporon infections have increasingly emerged; it is now the second leading cause of yeast bloodstream infections after Candida spp., particularly in the immunosuppressed population, where it often causes breakthrough fungemia with high mortality. METHODS: We present a case report of a breakthrough Trichosporon asahii infection in a patient with acute myeloid leukemia and review all of the cases of breakthrough Trichosporon spp. infections published in the literature to date. RESULTS: We extracted 68 cases of breakthrough Trichosporon spp. infections, wherein 95.5% patients had hematological malignancy, 61.8% of them occurred in the presence of echinocandins, 22% of triazoles, 13.2% of amphotericin and 3% of other combinations of antifungals. The most prevalent manifestation was fungemia (94%); 82.8% of these were associated with the presence of a central venous catheter. The overall mortality was 68.7%; the patients who survived recovered from the neutropenic event. CONCLUSIONS: Invasive trichosporonosis is an acute fatal condition that occurs in immunosuppressed patients, usually under antifungal selective pressure. Typically, neutropenia and its underlying diseases are associated with adverse outcomes.

Hallazgo casual al realizar una broncoscopia: tuberculosis endobronquial / Casual findings after a bronchoscopy: endobronchial tuberculosis

La tuberculosis continúa siendo un problema de salud a nivel mundial. Existe una gran variabilidad clínica de esta entidad dependiendo, entre otros factores, del lugar del organismo donde se asiente el bacilo. Existe una entidad específica de tuberculosis, denominada Tuberculosis Endobronquial (EBTB), que se define como una infección tuberculosa del árbol traqeuobronquial con evidencia microbiológica y/o histopatológica. Ésta puede presentarse sola o junto con afectación parenquimatosa. Las manifestaciones clínicas de esta entidad son inespecíficas, lo cual dificulta el diagnóstico. Para este es fundamental la realización de una TC de tórax y una broncoscopia. Ésta última nos permitirá observar las características del árbol traqueobronquial y tomar muestras para poder hacer el diagnóstico de certeza. El tratamiento es similar al de la tuberculosis pulmonar y el objetivo fundamental de este es erradicar el bacilo y prevenir complicaciones, siendo la más frecuente la estenosis bronquial

Tuberculosis continues to be a health problem worldwide. There is a large degree of clinical variability for this disease which depends, among other factors, on the part of the organism where the bacillus settles. There is a specific type of tuberculosis, called endobronchial tuberculosis (EBTB), which is defined as a tuberculous infection of the tracheobronchial tree with microbiological and/or histopathological signs. It can present on its own or alongside parenchymal involvement. The clinical manifestations of this disease are non-specific, which makes diagnosis difficult. That is why performing a chest CT and bronchoscopy is essential. The latter will allow the characteristics of the tracheobronchial tree to be seen and samples to be taken in order to make an accurate diagnosis. Treatment is similar to that of pulmonary tuberculosis and the main objective is to eradicate the bacillus and prevent complications, the most frequent of which is bronchial stenosis

[Thoracoabdominal primary endodermal sinus tumor: a case report]. / Tumor primario de seno endodérmico en pared toracoabdominal: reporte de un caso.

INTRODUCTION: Endodermal sinus tumor is a malignant germ cell tumor that generally involves the gonads. Extra-gonadal localization out of midline organs is rare. We report a case of endodermal sinus tumor in the thoracoabdominal wall. CASE REPORT: We discuss the case of an infant presenting an abdominal mass detected after a fall from his own height. Studies revealed anemia with abundant intraabdominal fluid and elevated alpha-fetoprotein. During surgery, a left thoracoabdominal wall-dependent tumor was identified, with involvement of the diaphragm and the costal cartilage. Complete resection was performed. Pathology report informed of an endodermal sinus tumor. DISCUSSION: Abdominal wall location of endodermal sinus tumor is rare. Pathophysiology has not been completely outlined, however, it is presumed to be a consequence of aberrant migration patterns of the primordial cells. Pre-surgical diagnosis remains a challenge due to the low incidence.

INTRODUCCION: El tumor del seno endodérmico es un tumor maligno de células germinales con compromiso primario a nivel gonadal principalmente. La localización extragonadal por fuera de la línea media es infrecuente. Describimos un caso de tumor del seno endodérmico en la pared toracoabdominal. CASO CLINICO: Presentamos el caso de un lactante con masa abdominal, detectada tras una caída de su propia altura. Los estudios revelaron anemización con abundante líquido intraabdominal y alfafetoproteína elevada. Durante la cirugía se identificó un tumor dependiente de pared toracoabdominal izquierda, con compromiso de diafragma y cartílago costal. Se realizó resección completa. El estudio histológico reveló tumor del seno endodérmico. COMENTARIOS: La presentación del tumor de seno endodérmico en estructuras por fuera de la línea media es rara. La fisiopatología es aún desconocida, pero se presume que corresponde a un patrón aberrante de migración de las células primordiales. El diagnóstico prequirúrgico constituye un reto por la baja frecuencia de presentación.

[Paraganglioma of Zuckerkandl's organ. Report of two pediatric cases]. / Paraganglioma del órgano de Zuckerkandl: reporte de dos casos pediátricos.

INTRODUCTION: Pheochromocytoma is an infrequent neuroendocrine tumor, originated from neural crest cells. 10% of them are extra adrenal, located at sympathetic nodules and are known as paragangliomas. The most common place is the Zuckerkandl organ, 10 to 26% are malign and has a mortality around de 26% of the cases. CASE REPORT: We present two cases of teenagers with Zuckerkandl's organ paraganglioma, who debut with high blood pressure, diaphoresis and dyspnea. Complete tumor resection was performed in both cases, during which they presented hipertensive crisis and, after vascular pedicle ligation, hypotension. CONCLUSIONS: Zuckerkandl's organ paraganglioma is a rare pathology in pediatric population, therefore represents an important diagnostic and therapeutic challenge. Surgery differs from other tumors because of catecholamine secretion that produces hemodynamic changes and demands prompt and accurate management from surgeon and anesthetist.

INTRODUCCION: El feocromocitoma es un tumor neuroendocrino infrecuente. El 10% son extraadrenales en los ganglios simpáticos, conocidos como paragangliomas. El sitio más común es el órgano de Zuckerkandl. Son malignos en un 10 a 26% con una mortalidad del 26%. REPORTE DE CASOS: Presentamos dos casos de paraganglioma del órgano de Zuckerkandl en adolescentes, que debutan con hipertensión arterial, diaforesis y disnea. Se realizó resección completa del tumor; durante ambas cirugías presentaron crisis hipertensiva y posterior a la ligadura del pedículo vascular del tumor presentaron hipotensión, con normalización progresiva de las cifras tensionales en el postoperatorio. CONCLUSIONES: El paraganglioma del órgano de Zuckerkandl es una patología infrecuente en la población pediátrica, representa un importante reto diagnóstico y terapéutico. La cirugía difiere de las de otros tumores ya que la secreción de catecolaminas genera cambios hemodinámicos transoperatorios que exigen al cirujano y anestesiólogo un manejo rápido, eficaz y oportuno.

Tumor primario de seno endodérmico en pared toracoabdominal: reporte de un caso / Thoracoabdominal primary endodermal sinus tumor: a case report

Introducción: El tumor del seno endodérmico es un tumor maligno de células germinales con compromiso primario a nivel gonadal principalmente. La localización extragonadal por fuera de la línea media es infrecuente. Describimos un caso de tumor del seno endodérmico en la pared toracoabdominal. Caso clínico: Presentamos el caso de un lactante con masa abdominal, detectada tras una caída de su propia altura. Los estudios revelaron anemización con abundante líquido intraabdominal y alfafetoproteína elevada. Durante la cirugía se identificó un tumor dependiente de pared toracoabdominal izquierda, con compromiso de diafragma y cartílago costal. Se realizó resección completa. El estudio histológico reveló tumor del seno endodérmico. Comentarios: La presentación del tumor de seno endodérmico en estructuras por fuera de la línea media es rara. La fisiopatología es aún desconocida, pero se presume que corresponde a un patrón aberrante de migración de las células primordiales. El diagnóstico prequirúrgico constituye un reto por la baja frecuencia de presentación

Introduction: Endodermal sinus tumor is a malignant germ cell tumor that generally involves the gonads. Extra-gonadal localization out of midline organs is rare. We report a case of endodermal sinus tumor in the thoracoabdominal wall. Case report: We discuss the case of an infant presenting an abdominal mass detected after a fall from his own height. Studies revealed anemia with abundant intraabdominal fluid and elevated alpha-fetoprotein. During surgery, a left thoracoabdominal wall-dependent tumor was identified, with involvement of the diaphragm and the costal cartilage. Complete resection was performed. Pathology report informed of an endodermal sinus tumor. Discussion: Abdominal wall location of endodermal sinus tumor is rare. Pathophysiology has not been completely outlined, however, it is presumed to be a consequence of aberrant migration patterns of the primordial cells. Pre-surgical diagnosis remains a challenge due to the low incidence

Paraganglioma del órgano de Zuckerkandl: reporte de dos casos pediátricos / Paraganglioma of Zuckerkandl’s organ. Report of two pediatric cases

Introducción: El feocromocitoma es un tumor neuroendocrino infrecuente. El 10% son extraadrenales en los ganglios simpáticos, conocidos como paragangliomas(1,2). El sitio más común es el órgano de Zuckerkandl. Son malignos en un 10 a 26%(4) con una mortalidad del 26%(5). Reporte de casos: Presentamos dos casos de paraganglioma del órgano de Zuckerkandl en adolescentes, que debutan con hipertensión arterial, diaforesis y disnea. Se realizó resección completa del tumor; durante ambas cirugías presentaron crisis hipertensiva y posterior a la ligadura del pedículo vascular del tumor presentaron hipotensión, con normalización progresiva de las cifras tensionales en el postoperatorio. Conclusiones: El paraganglioma del órgano de Zuckerkandl es una patología infrecuente en la población pediátrica, representa un importante reto diagnóstico y terapéutico. La cirugía difiere de las de otros tumores ya que la secreción de catecolaminas genera cambios hemodinámicos transoperatorios que exigen al cirujano y anestesiólogo un manejo rápido, eficaz y oportuno

Introduction: Pheochromocytoma is an infrequent neuroendocrine tumor, originated from neural crest cells. 10% of them are extra adrenal, located at sympathetic nodules and are known as paragangliomas(1,2). The most common place is the Zuckerkandl organ, 10 to 26% are malign(4) and has a mortality around de 26% of the cases(5). Case report: We present two cases of teenagers with Zuckerkandl’s organ paraganglioma, who debut with high blood pressure, diaphoresis and dyspnea. Complete tumor resection was performed in both cases, during which they presented hipertensive crisis and, after vascular pedicle ligation, hypotension. Conclusions: Zuckerkandl’s organ paraganglioma is a rare pathology in pediatric population, therefore represents an important diagnostic and therapeutic challenge. Surgery differs from other tumors because of catecholamine secretion that produces hemodynamic changes and demands prompt and accurate management from surgeon and anesthetist