Tratamiento primario con láser diodo en malformación venosa cervical de gran tamaño / Laser diode treatment of a giant lateral-neck venous malformation

No disponible

Incidencia y evolución del síndrome compartimental abdominal en aneurismas de aorta rotos tratados con endoprótesis / Incidence and outcomes of abdominal compartment syndrome after endovascular aneurysm repair in ruptured aortic aneurysms

OBJETIVO: Estudiar la incidencia, evolución y manejo del síndrome compartimental abdominal (SCA) en los aneurismas de aorta infrarrenal rotos (AAAr) tratados con endoprótesis en nuestro centro. Material y metodología: Estudio observacional retrospectivo. Analizamos todos los pacientes tratados con endoprótesis urgentes desde octubre de 2001 a diciembre de 2015. Incluimos solo pacientes con aneurismas de aorta infrarrenal rotos, excluyendo los AAA sintomáticos. Estudiamos la incidencia, evolución y tratamiento del SCA. Establecimos diagnóstico de SCA con una presión intraabdominal medida en vejiga > 20 mmHg, más el desarrollo de una nueva disfunción orgánica. Analizamos variables preoperatorias y postoperatorias para SCA. Utilizamos test exacto de Fisher y U de Mann-Whitney para el análisis estadístico. RESULTADOS: Durante el periodo analizado se implantaron 65 endoprótesis urgentes, de ellas 42 fueron por aneurismas de aorta infrarrenal rotos. La edad media fue 77 ± 8 años; el 98% fueron hombres. De los 42 pacientes estudiados, 9 (21,4%) fallecieron en quirófano. La incidencia de SCA en los 33 pacientes restantes fue 18,2% (6/33 pacientes). La mortalidad en SCA fue 66,7 frente 18,5% para los que no desarrollaron SCA (p = 0,034). Se realizó laparotomía descompresiva en 4 pacientes (4/6), siendo la mortalidad en estos pacientes del 50 frente al 100% para los que no se realizó laparotomía descompresiva (p = 0,4). Se asociaron con desarrollo de SCA la acidosis pre- y postoperatoria (57,7 vs. 7,7%, p = 0,01), coagulopatía preoperatoria (41,7 vs. 4,8%, p = 0,01), tensión sistólica <90mmHg preoperatoria (46,2 vs. 0%, p = 0,002) y administración > 3 litros de cristaloides/24 h en postoperatorio (38,5 vs. 5%, p = 0,02). Los pacientes con SCA recibieron intraoperatoriamente 8 ± 3,6 concentrados de hematíes vs. 2 ± 2,7 (p = 0,002). CONCLUSIONES: Estos hallazgos confirman que el SCA es una patología frecuente que asocia una elevada mortalidad en pacientes con AAAr tratados con endoprótesis. El compromiso hemodinámico importante y la administración de grandes cantidades de cristaloides intravenosos y politransfusión durante el manejo asocian mayor incidencia de este síndrome

OBJECTIVE: To study the incidence, evolution and management of abdominal compartment syndrome (ACS) in ruptured abdominal aortic aneurysms (RAAA) after endovascular aneurysm repair. MATERIAL AND METHODS: Retrospective observational study. We analyzed all emergency EVAR performed from October 2001 to December 2015. Only RAAA were included. Symptomatic aortic aneurysms were excluded. We studied the incidence, evolution and management of ACS. Diagnosis of ACS was established with intraabdominal pressure more than 20 mmHg plus the development of a new organic dysfunction. Preoperative and postoperative variables were analyzed for ACS. Fisher exact test and Mann-Whitney U-test were used for the statistical analysis. RESULTS: Sixty-five emergency EVAR were performed during the analyzed period, 42 were RAAA. The mean age was 77 ± 8 years; 98% were men. Nine of 42 patients (21.4%) died in the operating room. The incidence of ACS in the 33 remaining patients was 18.2% (6/33 patients). The mortality for ACS was 66.7% vs 18.5% (p = 0.034). Decompressive laparotomy was performed in 4 patients (4/6). The mortality after decompressive laparotomy was 50% vs 100% (p = 0.4). The incidence of ACS for postoperative acidosis was 57.7% vs 7.7% (p = 0.01), for preoperative coagulopathy 41.7% vs 4.8% (p = 0.01), for preoperative systolic blood pressure < 90 mmHg 46.2% vs 0% (p = 0.002). The incidence of ACS after overload of more than 3 liters of crystalloids per 24 hours in the postoperative period was 38.5% vs 5% (p = 0.02). Patients with ACS received intraoperatively 8 ± 3.6 packed erythrocytes vs 2 ± 2.7 (p = 0.002). CONCLUSIONS: These findings confirm that ACS is a common disease that is associated with a high mortality in patients with RAAA after EVAR. Patients with a compromise hemodynamic status, multiple transfusions and those with overload of intravenous crystalloids during management were associated with higher incidence of ACS

Diagnóstico y tratamiento de un caso de endoprótesis de aorta torácica infectada / Diagnosis and treatment of a case of an infected thoracic aortic endoprosthesis

No disponible

Mujer joven sin factores de riesgo cardiovascular, con clínica de claudicación intermitente / A young woman without cardiovascular risk factors with symptoms of intermittent claudication

No disponible

Peripheral autonomic nerves of human pineal organ terminate on vessels, their supposed role in the periodic secretion of pineal melatonin.

Nonvisual pineal and retinal photoreceptors are synchronizing circadian and circannual periodicity to the environmental light periods in the function of various organs. Melatonin of the pineal organ is secreted at night and represents an important factor of this periodic regulation. Night illumination suppressing melatonin secretion may result in pathological events like breast and colorectal cancer. Experimental works demonstrated the role of autonomic nerves in the pineal melatonin secretion. It was supposed that mammalian pineals have lost their photoreceptor capacity that is present in submammalians, and sympathetic fibers would mediate light information from the retina to regulate melatonin secretion. Retinal afferentation may reach the organ by central nerve fibers via the pineal habenulae as well. In our earlier works we have found that the pineal organ developing from lobular evaginations of the epithalamus differs from peripheral endocrine glands and is composed of a retina-like central nervous tissue that is comprised of cone-like pinealocytes, secondary pineal neurons and glial cells. Their autonomic nerves in submammalians as well as in mammalian animals do not terminate on pineal cells, rather, they run in the meningeal septa among pineal lobules and form vasomotor nerve endings. Concerning the adult human pineal there are no detailed fine structural data about the termination of autonomic fibers, therefore, in the present work we investigated the ultrastructure of the human pineal peripheral autonomic nerve fibers. It was found, that similarly to other parts of the brain, autonomic nerves do not enter the human pineal nervous tissue itself but separated by glial limiting membranes take their course in the meningeal septa of the organ and terminate on vessels by vasomotor endings. We suppose that these autonomic vasomotor nerves serve the regulation of the pineal blood supply according to the circadian and circannual changes of the metabolic activity of the organ and support by this effect the secretion of pineal neurohormones including melatonin.

Pharmacovigilance in children in Camagüey Province, Cuba.

PURPOSE: Our aim was to describe the adverse drug reactions (ADRs) detected following increased education about pharmacovigilance and drug toxicity in children in Camagüey Province, Cuba. METHODS: Over a period of 24 months (January 2009 to December 2010), all reports of suspected ADRs in children to the Provincial Pharmacovigilance Centre in Camagüey Province were analysed. ADRs were classified in relation to causality and severity. RESULTS: There were 533 reports involving suspected ADRs in children in the period. Almost one third of the reports received were classified as moderate (155, 29%) or severe (10, 2%). There was one fatality in association with the use of ceftriaxone. Vaccines and antibiotics were responsible for most of the ADR reports (392, 74%) and for all ten severe ADRs. After an intensive educational package, both within the community and the Children's Hospital, the number of reports increased from 124 in 2008 to 161 in 2009 and 372 in 2010. This was equivalent to a reporting rate of 879 and 2,031 reports per million children per year for 2009 and 2010, respectively. CONCLUSIONS: The incidence of ADRs in children Camagüey Province, Cuba, is greater than previously reported. An educational intervention about pharmacovigilance and drug toxicity in children can improve the reporting of ADRs.

Study of the GC-MS determination of the palmitic-stearic acid ratio for the characterisation of drying oil in painting: La Encarnación by Alonso Cano as a case study.

The correct identification of drying oils plays an essential role in providing an understanding of the conservation and deterioration of artistic materials in works of art. To this end, this work proposes the use of peak area ratios from fatty acids after ensuring that the linear responses of the detector are tested. A GC-MS method, previously reported in the literature, was revisited to its developed and validated in order to identify and quantify of eight fatty acids that are widely used as markers for drying oils in paintings, namely myristic acid (C(14:0)), palmitic acid (C(16:0)), stearic acid (C(18:0)), oleic acid (C(18:1)), linoleic acid (C(18:2)), suberic acid (2C(8)), azelaic acid, (2C(9)) and sebacic acid (2C(10)). The quaternary ammonium reagent m-(trifluoromethyl)phenyltrimethylammonium hydroxide (TMTFAH) was used for derivatization prior to GC-MS analysis of the oils. MS spectra were obtained for each methyl ester derivative of the fatty acids and the characteristic fragments were identified. The method was validated in terms of calibration functions, detection and quantification limits and reproducibility using the signal recorded in SIR mode, since two of the methyl derivatives were not totally separated in the chromatographic run. The proposed method was successfully applied to identify and characterise the most widely used drying oils (linseed oil, poppy seed oil and walnut oil) in the painting La Encarnación. This 17th century easel painting is located in the main chapel of the cathedral in Granada (Spain) and was painted by the well-known artist of the Spanish Golden Age, Alonso Cano (1601-1667).

Adverse drug reactions in children in Camagüey Province, Cuba.

OBJECTIVE: To determine the incidence of adverse drug reactions (ADRs) in children in Camagüey Province, Cuba. METHODS: A national pharmacovigilance programme has been established in Cuba and involves suspected ADRs being reported to provinces. All suspected ADRs reported to Camagüey Province during 2008 were analysed and classified in relation to causality and severity. RESULTS: Over a 12-month period, there were 124 reports of 152 suspected ADRs in children. Most ADRs were mild (98, 79%), but two were fatal and five others were severe. Antibiotics were the group of medicines most likely to be associated with ADRs. The overall report rate of suspected ADRs was 634 per million children per year, which is considerably higher than previously reported rates. CONCLUSIONS: ADRs in children are more frequent than previously reported. A successful pharmacovigilance programme can be established in lower middle income countries.

Adverse drug reactions in children in Camagüey Province, Cuba

Objective To determine the incidence of adverse drug reactions (ADRs) in children in Camagüey Province, Cuba. Methods A national pharmacovigilance programme has been established in Cuba and involves suspected ADRs being reported to provinces. All suspected ADRs reported to Camagüey Province during 2008 were analysed and classified in relation to causality and severity. Results Over a 12-month period, there were 124 reports of 152 suspected ADRs in children. Most ADRs were mild (98, 79 por ciento), but two were fatal and five others were severe. Antibiotics were the group of medicines most likely to be associated with ADRs. The overall report rate of suspected ADRs was 634 per million children per year, which is considerably higher than previously reported rates. Conclusions ADRs in children are more frequent than previously reported. A successful pharmacovigilance programme can be established in lower middle income countries(AU)

Objetivo: Determinar la incidencia de reacciones adversas a medicamentos (RAM) en los niños en la provincia de Camagüey, Cuba. Métodos Se realizó un programa de farmacovigilancia nacionales se ha establecido en Cuba y consiste en sospecha de reacciones adversas que se informa a las provincias. Todos los ADR sospechosos notificados a la provincia de Camagüey durante el año 2008 fueron analizados y clasificados en relación a la causalidad y la gravedad. Resultados Durante un período de 12 meses, había 124 informes de reacciones adversas de 152 sospechosos en los niños. La mayoría de las RAM fueron leves (98, 79 percent), pero dos de ellos mortales y otros cinco fueron graves. Los antibióticos fueron el grupo de medicamentos más probable que esté asociado a la ADR. El tipo de informe general de las ADR se sospecha fue 634 por cada millón de niños al año, que es considerablemente más alta que la publicada tarifas. Conclusiones ADR en los niños son más frecuentes que lo reportado anteriormente. Un programa de farmacovigilancia éxito se puede establecer en los países de ingreso medio(AU)

Cefalea recurrente pospunción dural en una paciente con síndrome de Chiari tipo I no conocido / Recurrent postdural puncture headache in a woman with undiagnosed Chiari I malformation

Objetivo: Identificar el riesgo de complicaciones neurológicas de la anestesia espinal en los pacientes con un síndrome de Chiari tipo I preexistente y diferenciarlo del llamado “Chiari I adquirido” causado por un síndrome de hipotensión intracraneal, radiológicamente difícil de distinguir del anterior. Caso clínico: Mujer de 37 años, que tras recibir una punción dural durante la realización de una epidural analgésica para el parto, presentó cefalea pospunción dural (CPPD) recurrente. Se practicó resonancia magnética (RM) cerebral que puso de manifiesto malformación de Chiari tipo I (desplazamiento caudal de las amígdalas cerebelosas por el orificio magno) y engrosamiento difuso de las meninges. Aunque no lo había manifestado con anterioridad a la realización de la técnica epidural, la paciente presentaba cefaleas crónicas que se exacerbaban con las maniobras de Valsalva. La paciente fue tratada con analgésicos, cafeína y corticoides, y quedó asintomática. Tras 6 meses de seguimiento se realizó una nueva RM de control donde se observó la persistencia de los cambios anatómicos que definen el síndrome de Chiari tipo I, pero ausencia de las alteraciones meníngeas. Discusión: Tras una punción dural se puede producir el llamado “síndrome de hipotensiónin tracraneal”, motivado por la alteración del flujo y presiones del líquido cefalorraquídeo entre los compartimientos craneal y espinal. La pérdida continua de líquido cefalorraquídeo por el orificio de la punción originaría un gradiente de presión negativa que “empuja” las amígdalas cerebelosas hacia el orificio magno. ¿Es más acusado el cambio de presiones en aquellos pacientes con alteraciones previas, como el síndrome de Chiari? ¿Justifica la persistencia de una CPPD, a pesar del tratamiento? (...) (AU)

Objective: To identify the risk of neurological complications of spinal anesthesia inpatients with preexisting Chiari I malformation and to differentiate this entity from“ acquired Chiari I malformation”, caused by intracranial hypotension. These two entities can be difficult to distinguish radiologically. Case report: After undergoing dural puncture for epidural analgesia during delivery, a37-year-old woman developed recurrent postdural puncture headache (PDPH). Cerebral magnetic resonance imaging (MRI) revealed Chiari I malformation (displacement of the cerebellar tonsils into the foramen magnum) and diffuse dural gadolinium enhancement. The patient had experienced chronic headaches exacerbated by Valsalva’s maneuver before receiving epidural analgesia but had not reported these symptoms. She was treated with analgesics, caffeine and corticosteroids, which resolved the symptoms. After 6 months of follow-up, a second MRI scan revealed the persistence of the anatomical alterations characteristic of Chiari I malformation but without meningeal alterations. Discussion: After dural puncture, “intracranial hypotension syndrome” can occur, caused by alteration of cerebrospinal fluid (CSF) flow and pressure between the cranial and spinal compartments. Continuous CSF leak through the puncture site would cause a negative pressure gradient that would “push” the cerebellar tonsils toward the foramen magnum. Is the pressure change more marked in patients with prior alterations, such as Chiari malformation? Is the previous malformation the cause of the recurrent headache, despite treatment? Conclusion: Thorough clinical evaluation is required before spinal anesthesia is administered since severe neurological complications can occur in patients with undiagnosed Chiari malformations (AU)

Preliminary study of UV ageing process of proteinaceous paint binder by FT-IR and principal component analysis.

This work presents a preliminary study on the ageing process of proteinaceous binder materials used in painting under UV light. With this aim, two sets of model samples were prepared: samples prepared using a single protein material and complex samples prepared in a similar way to the sequence of layers in a real painting from lowest to highest complexity (protein, drying oils, pigment and varnish). The study focuses on acquiring information about the possible degradation process of proteinaceous binders due to ageing and how this process be affected by the presence of characteristic non-proteinaceous painting materials, such as lipids from linseed oil, terpenic compounds from varnish and inorganic pigments. Samples simulated the accelerated ageing process, as did the UV light exposition. The FT-IR spectra were recorded after 100, 500, 1000 and 1500 h of exposition. The study of the accelerated ageing process was performed by means of principal component analysis (PCA) using the FT-IR spectra obtained. Loadings from the significant principal components were analysed to find the FT-IR frequency (cm(-1)) involved in the degradation process. The study showed the lack of any relevant modification on the proteins in the single model samples. On the contrary, the complex model samples showed the ageing process. The accelerated ageing process can be explained by a principal component from PCA. The most affected IR region was 2900-3600 cm(-1), where the amide band was included.

Idiopathic thoracic aortic aneurysm at pediatric age.

A 6-year-old-boy presented with epigastric pain and vomiting over 1 year. Chest X-ray and esophagogastric transit showed a mediastinal mass. A chest computerized tomography angiogram demonstrated a descending thoracic aortic aneurysm. Analytical determinations carried out were all negative. The aneurysm was surgically repaired using a Dacron patch. The anatomopathological study described atherosclerotic lesions with calcifications, compatible with an atherosclerotic aneurysm wall. Aneurysms are uncommon in the pediatric population. Usually, no pathogenesis can be determined, and thus, such cases are grouped as idiopathic. Direct repair with or without patch is a therapeutic alternative in pediatric aneurysms and can allow the growth of the aortic circumference.

Comparison between traditional strategies and classification technique (SIMCA) in the identification of old proteinaceous binders.

In this paper, we performed a comparison between commonly used strategies amino acid ratios (Aa ratios), two-dimensional ratio plots (2D-Plot) and statistical correlation factor (SCF) and a classification technique, soft independent modelling of class analogy (SIMCA), to identify protein binders present in old artwork samples. To do this, we used a natural standard collection of proteinaceous binders prepared in our laboratory using old recipes and eleven samples coming from Cultural Heritage, such as mural and easel paintings, manuscripts and polychrome sculptures from the 15-18th centuries. Protein binder samples were hydrolyzed and their constitutive amino acids were determined as PITC-derivatives using HPLC-DAD. Amino acid profile data were used to perform the comparison between the four different strategies mentioned above. Traditional strategies can lead to ambiguous or non-conclusive results. With SIMCA, it is possible to provide a more robust and less subjective identification knowing the confidence level of identification. As a standard, we used proteinaceous albumin (whole egg, yolk and glair); casein (goat, cow and sheep) and collagen (mammalian and fish). The process results in a more robust understanding of proteinaceous binding media in old artworks that makes it possible to distinguish them according to their origin.

[Endovascular therapy as an alternative treatment in chronic mesenteric ischemia]. / Tratamiento endovascular como alternativa terapéutica en la isquemia mesentérica crónica.

INTRODUCTION: Chronic mesenteric ischemia (CMI) is an uncommon disorder. Traditional treatment consists of open surgical (OS) revascularization. We report a case of CMI treated with percutaneous angioplasty and stenting. CASE REPORT: A 77-year-old-woman reported a history of postprandial abdominal pain, weight loss, asthenia, and anorexia. On physical examination, the only relevant sign was systolic murmur. Oral panendoscopy showed chronic atrophic gastritis and patchy intestinal metaplasia with Helicobacter pylori colonization; rectal sigmoidoscopy showed colonic diverticula. Abdominal ultrasound color-flow imaging confirmed superior mesenteric artery (SMA) stenosis > 70%. Angiography confirmed proximal SMA subocclusion and celiac trunk stenosis of 50%. Percutaneous angioplasty and stenting were carried out. The patient made an immediate recovery and remains without postprandial pain. DISCUSSION: CMI due to atherosclerotic occlusive disease was first reported in 1936 and is a relatively uncommon disorder. This entity usually occurs in patients over 60 years of age with other atherosclerotic symptoms. CMI presents with postprandial abdominal pain, anorexia due to <>, and weight loss. Despite high perioperative morbidity and mortality rates, OS revascularization has traditionally been the treatment of choice. The most frequent indications include pain relief, improvement of nutritional status, and prevention of intestinal infarction. Endovascular therapy seems to be a valid alternative, mainly in high-risk patients, with good immediate and medium-term results.

Tratamiento endovascular como alternativa terapéutica en la isquemia mesentérica crónica / ENDOVASCULAR THERAPY AS AN ALTERNATIVE TREATMENT IN CHRONIC MESENTERIC ISCHEMIA

INTRODUCCIÓN: La isquemia mesentérica crónica es una enfermedad cuyo tratamiento tradicional es la revascularización quirúrigica. Presentamos un caso de isquemia mesentérica crónica tratada con angioplastia y stent. CASO CLÍNICO: Mujer de 77 años de edad, con clínica de dolor abdominal posprandial, pérdida de peso, anorexia y astenia. En la exploración física destacaba un soplo sistólico abdominal. La panendoscopia puso de manifiesto una gastritis crónica atrófica con zonas de metaplasia intestinal colonizadas por Helicobacter pylori, y la colonoscopia, divertículos colónicos. Se realizó una eco-Doppler color abdominal, que confirmó la sospecha de estenosis > 70% de la arteria mesentérica superior (AMS). Una angiografía confirmó la existencia de una suboclusión proximal de la AMS y una estenosis del 50% en el tronco celíaco. Se le realizó una angioplastia con stent. La paciente experimentó una mejoría clínica inmediata, y permanece sin dolor posprandial. DISCUSIÓN: La isquemia crónica secundaria a una enfermedad aterosclerótica oclusiva es una enfermedad relativamente infrecuente, descrita como entidad en 1936. Normalmente, se presenta en las personas mayores de 60 años con manifestaciones ateroscleróticas en otras localizaciones. Los síntomas característicos incluyen dolor abdominal posprandial, anorexia por «miedo a comer» y pérdida de peso. La revascularización quirúrgica ha sido el tratamiento de elección, a pesar de la elevada morbimortalidad perioperatoria. Las indicaciones de tratamiento incluyen alivio del dolor, mejora del estado nutricional y prevención del infarto intestinal. El tratamiento endovascular parece ofrecer una alternativa válida, con un buen resultado inmediato y a medio plazo, principalmente en pacientes con alto riesgo quirúrgico

INTRODUCTION: Chronic mesenteric ischemia (CMI) is an uncommon disorder. Traditional treatment consists of open surgical (OS) revascularization. We report a case of CMI treated with percutaneous angioplasty and stenting. CASE REPORT: A 77-year-old-woman reported a history of postprandial abdominal pain, weight loss, asthenia, and anorexia. On physical examination, the only relevant sign was systolic murmur. Oral panendoscopy showed chronic atrophic gastritis and patchy intestinal metaplasia with Helicobacter pylori colonization; rectal sigmoidoscopy showed colonic diverticula. Abdominal ultrasound color-flow imaging confirmed superior mesenteric artery (SMA) stenosis > 70%. Angiography confirmed proximal SMA subocclusion and celiac trunk stenosis of 50%. Percutaneous angioplasty and stenting were carried out. The patient made an immediate recovery and remains without postprandial pain. DISCUSSION: CMI due to atherosclerotic occlusive disease was first reported in 1936 and is a relatively uncommon disorder. This entity usually occurs in patients over 60 years of age with other atherosclerotic symptoms. CMI presents with postprandial abdominal pain, anorexia due to «fear of food», and weight loss. Despite high perioperative morbidity and mortality rates, OS revascularization has traditionally been the treatment of choice. The most frequent indications include pain relief, improvement of nutritional status, and prevention of intestinal infarction. Endovascular therapy seems to be a valid alternative, mainly in high-risk patients, with good immediate and medium- term results

Abordajes alternativos a la arteria poplítea y su trifurcación / Alternative approaches to the popliteal artery and its trifurcation

Objetivo. Describir las vías de abordaje alternativas a la arteria poplítea (AP) y a su trifurcación, con exclusión de las vías medial y posterior, consideradas clásicas. Detallar qué ventajas e inconvenientes tienen y cuáles son sus indicaciones más importantes. Desarrollo y conclusiones. Las vías alternativas comprenden la vía lateral supra o infragenicular con o sin resección del peroné, la vía medial total y la vía medial de la arteria tibial anterior (ATA) proximal. Se utilizan poco en general, ya que por técnicas endovasculares o por vía media y posterior somos capaces de resolver la mayoría de las situaciones. Las indicaciones más importantes de abordaje por vía lateral de la AP serían la infección, la radioterapia, las reintervenciones o extensas cicatrices en la cara medial. La necesidad de explorar la segunda porción de AP indicaría la vía medial total, y las indicaciones para la vía media de la ATA proximal serían la escasa longitud del injerto, bypass secuenciales e infección del compartimiento tibial anterior. Como inconvenientes principales destacan la posible lesión del nervio peroneo común, inestabilidades de la rodilla y el menor conocimiento de estas técnicas alternativas

Aims. The aim of this study was to describe the surgical approaches that can be used as alternatives to the popliteal artery (PA) and to its trifurcation, excluding the medial and posterior paths, which are considered to be classical procedures. It also outlines the advantages and disadvantages of each approach and their most important indications. Results and conclusions. The alternative paths include the above- or below-the-knee lateral path with or without resection of the fibula, the total medial path and the medial path of the proximal anterior tibial artery (ATA). They are not generally used very often because most situations can be resolved by means of endovascular techniques or by medial and posterior approaches. The most important indications for a lateral approach to the PA would be infection, radiotherapy, re-interventions or extensive scarring on the medial side. The need to examine the second part of the PA would indicate the total medial path and indications for the medial path of the proximal ATA would be an insufficient length of the graft, sequential bypasses and infection of the anterior tibial compartment. The most notable disadvantages include possible injury to the common peroneal nerve, instability of the knee and the fact that less is known about these alternative techniques

Noradrenaline transporter and its turnover rate are decreased in blood lymphocytes of patients with major depression.

Lymphocytes possess transporters of serotonin and dopamine, and also contain monoamines. The objective of this work was to determine the presence of noradrenaline transporters, the turnover rate of noradrenaline and serotonin in lymphocytes of major depression patients, and to correlate the biochemical parameters with the severity of the disorder. Lymphocytes from peripheral blood were isolated by Ficoll/Hypaque, and noradrenaline transporter was studied by binding of [3H]nisoxetine: control group (29, age 31.52+/-1.08, 7 men) and major depression patients (35, age 36.68+/-1.69, 6 men), Hospital Vargas de Caracas. Diagnostic was done by criteria of the American Psychiatric Association and severity by Hamilton Scale for Depression. Levels of noradrenaline, serotonin, 3-methoxy-4-hydroxyphenylglycol and 5-hydroxyindoleacetic acid were determined by HPLC. Turnover rate was evaluated by the ratios of monoamines and metabolites. Correlations were done between the biochemical parameters and the severity of depression. The score of Hamilton for Depression was 22.77+/-0.51. There was a reduction in the number of transporters in lymphocytes of patients, 0.95+/-0.27 versus 4.06+/-1.67 fmol/10(6) cells. Levels of monoamines and metabolites did not significantly differ between patients and controls. However, there was a higher monoamine/metabolite ratio in lymphocytes of patients, indicating a reduction of metabolic turnover rate. Also there was a relative greater concentration of noradrenaline than serotonin in the lymphocytes of the patients, as indicated by the ratio noradrenaline/serotonin. Noradrenergic and serotonergic turnover is decreased in blood peripheral lymphocytes of major depression patients; the reduction in noradrenaline transporter could be related to changes in intracellular levels, and these modifications could result in functional changes of the immune system.

The system of cerebrospinal fluid-contacting neurons. Its supposed role in the nonsynaptic signal transmission of the brain.

Recent investigations confirm the importance of nonsynaptic signal transmission in several functions of the nervous tissue. Present in various periventricular brain regions of vertebrates, the system of cerebrospinal fluid (CSF)-contacting neurons seems to have a special role in taking up, transforming and emitting nonsynaptic signals mediated by the internal and external CSF and intercellular fluid of the brain. Most of the CSF-contacting nerve cells send dendritic processes into the internal CSF of the brain ventricles or central canal where they form terminals bearing stereocilia and a 9+0-, or 9+2-type cilium. Some of these neurons resemble known sensory cells of chemoreceptor-type, others may be sensitive to the pressure or flow of the CSF, or to the illumination of the brain tissue. The axons of the CSF-contacting neurons transmit information taken up by dendrites and perikarya to synaptic zones of various brain areas. By forming neurohormonal terminals, axons also contact the external CSF space and release various bioactive substances there. Some perikarya send their axons into the internal CSF, and form free endings there, or synapses on intraventricular dendrites, perikarya and/or on the ventricular surface of ependymal cells. Contacting the intercellular space, sensory-type cilia were also demonstrated on nerve cells situated in the brain tissue subependymally or farther away from the ventricles. Among neuronal elements entering the internal CSF-space, the hypothalamic CSF-contacting neurons are present in the magnocellular and parvicellular nuclei and in some circumventricular organs like the paraventricular organ and the vascular sac. The CSF-contacting dendrites of all these areas bear a solitary 9 x 2+0-type cilium and resemble chemoreceptors cytologically. In electrophysiological experiments, the neurons of the paraventricular organ are highly sensitive to the composition of the ventricular CSF. The axons of the CSF-contacting neurons terminate not only in the hypothalamic synaptic zones but also in tel-, mes- and rhombencephalic nuclei and reach the spinal cord as well. The supposed chemical information taken up by the CSF-contacting neurons from the ventricular CSF may influence the function of these areas of the central nervous system. Some nerve cells of the photoreceptor areas form sensory terminals similar to those of the hypothalamic CSF-contacting neurons. Special secondary neurons of the retina and pineal organ contact the retinal photoreceptor space and pineal recess respectively, both cavities being embryologically derived from the 3rd ventricle. The composition of these photoreceptor spaces is important in the photochemical transduction and may modify the activity of the secondary neurons. Septal and preoptic CSF-contacting neurons contain various opsins and other compounds of the phototransduction cascade and represent deep encephalic photoreceptors detecting the illumination of the brain tissue and play a role in the regulation of circadian and reproductive responses to light. The medullo-spinal CSF-contacting neurons present in the oblongate medulla, spinal cord and terminal filum, send their dendrites into the fourth ventricle and central canal. Resembling mechanoreceptors of the lateral line organ, the spinal CSF-contacting neurons may be sensitive to the pressure or flow of the CSF. The axons of these neurons terminate at the external CSF-space of the oblongate medulla and spinal cord and form neurohormonal nerve endings. Based on information taken up from the CSF, a regulatory effect on the production or composition of CSF was supposed for bioactive materials released by these terminals. Most of the axons of the medullospinal CSF-contacting neurons and the magno- and parvicellular neurosecretory nuclei running to neurohemal areas (neurohypophysis, median eminence, terminal lamina, vascular sac and urophysis) do not terminate directly on vessels, instead they form neurohormonal nerve terminals attached by half-desmosomes on the basal lamina of the external and vascular surface of the brain tissue. Therefore, the bioactive materials released from these terminals primarily enter the external CSF and secondarily, by diffusion into vessels and the composition of the external CSF, may have a modulatory effect on the bioactive substances released by the neurohormonal terminals. Contacting the intercellular space, sensory-type cilia were also demonstrated on nerve cells situated subependymally or farther away from the ventricles, among others in the neurosecretory nuclei. Since tight-junctions are lacking between ependymal cells of the ventricular wall, not only CSF-contacting but also subependymal ciliated neurons may be influenced by the actual composition of the CSF besides that of the intercellular fluid of the brain tissue. According to the comparative histological data summarised in this review, the ventricular CSF-contacting neurons represent the phylogenetically oldest component detecting the internal fluid milieu of the brain. The neurohormonal terminals on the external surface of the brain equally represent an ancient form of nonsynaptic signal transmission.

Traumatismo por arma de fuego en la arteria femoral superficial / Firearm wound in the superficial femoral artery

Introducción. En nuestro país, los traumatismos vasculares en los miembros inferiores (MMII) suponen un 38 por ciento de todos los traumatismos vasculares. Frecuentemente, los causados por armas de fuego producen fístulas arteriovenosas asociadas o no a pseudoaneurismas. A la técnica quirúrgica convencional de reparación de la fístula mediante disección cuidadosa, ligadura y reparación de la arteria y la vena se han sumado otras opciones de la mano de las técnicas endovasculares. Caso clínico. Varón de 21 años remitido al Servicio de Urgencias por una herida por arma de fuego en el muslo derecho, sin signos de inestabilidad hemodinámica ni de hemorragia externa; en la exploración presentaba ausencia de pulsos poplíteo y distales, palidez y frialdad del pie y soplo en el tercio medio del muslo derecho. Al sospechar una lesión en la arteria femoral superficial, se realizó una arteriografía de urgencia, en la que se diagnóstico de fístula arteriovenosa. Al paciente se le intervino de forma urgente y se le colocó una endoprótesis recubierta de 8 × 50 mm en la lesión de la arteria femoral superficial. La evolución durante el posoperatorio fue satisfactoria, y el paciente recuperó los pulsos distales, con una correcta perfusión de la extremidad, sin déficit neurológico ni lesión venosa asociada. Conclusión. Las técnicas endovasculares pueden suponer una alternativa de reparación en el traumatismo vascular más segura y sencilla en casos seleccionados, pero la ausencia de series largas y protocolos adecuados de actuación aconseja ser prudentes en sus indicaciones. No obstante, es una opción más para el cirujano, y el tiempo y los estudios decidirán qué papel desempeñarán en el futuro (AU)