Endocarditis marántica / Marantic endocarditis

La endocarditis marántica se caracteriza por la presencia de vegetaciones estériles en las válvulas cardiacas. Se asocia a estados de hipercoagulabilidad (cáncer, enfermedades autoinmunes, VIH). El ictus, el tromboembolismo pulmonar, la isquemia intestinal aguda y los infartos esplénicos, renales y hepáticos son sus principales manifestaciones. Presentamos el caso de una paciente de 57años, con antecedentes de neoplasia uterina intervenida 5años antes, que acudió al servicio de Urgencias por pérdida brusca de fuerza en hemicuerpo izquierdo. La tomografía axial computarizada mostró un ictus isquémico derecho y se sometió a reperfusión endovascular y trombectomía 3h después del inicio de la clínica. A los 4días sufrió insuficiencia respiratoria aguda, con angio-TAC compatible con tromboembolismo pulmonar. Después aparecieron fibrilación auricular paroxística e isquemia distal en el segundo dedo del pie izquierdo. Fue diagnosticada de endocarditis marántica por ecocardiograma transesofágico y falleció 72h después por fracaso multiorgánico. El diagnóstico y el tratamiento precoces con anticoagulación pueden disminuir la mortalidad de esta enfermedad, que suele ser infradiagnosticada, con un alto porcentaje de diagnóstico post mortem

Marantic endocarditis is characterized by the presence of sterile vegetations in the heart valves, and is associated with hypercoagulability states (cancer, autoimmune diseases, HIV). Its main complications are stroke, pulmonary thromboembolism, acute intestinal ischemia and splenic, renal and hepatic infarcts. We present the case of a 57-year-old patient with a history of uterine neoplasia. She went to the emergency department due to sudden loss of strength in the left side of the body. A computed tomography (CT) scan showed right ischemic stroke, and she underwent endovascular reperfusion and thrombectomy. Four days later, she suffered acute respiratory failure, with angio-CT showing pulmonary thromboembolism. Later, paroxysmal atrial fibrillation and distal ischemia in the second toe of the left foot appeared. She was diagnosed with marantic endocarditis by means of transesophageal echocardiography, and died 72h later due to multiorgan failure. Early diagnosis and treatment with anticoagulation can reduce the mortality of this disease, since it is underdiagnosed, and often only comes to light during postmortem examination

Marantic endocarditis. / Endocarditis marántica.

Marantic endocarditis is characterized by the presence of sterile vegetations in the heart valves, and is associated with hypercoagulability states (cancer, autoimmune diseases, HIV). Its main complications are stroke, pulmonary thromboembolism, acute intestinal ischemia and splenic, renal and hepatic infarcts. We present the case of a 57-year-old patient with a history of uterine neoplasia. She went to the emergency department due to sudden loss of strength in the left side of the body. A computed tomography (CT) scan showed right ischemic stroke, and she underwent endovascular reperfusion and thrombectomy. Four days later, she suffered acute respiratory failure, with angio-CT showing pulmonary thromboembolism. Later, paroxysmal atrial fibrillation and distal ischemia in the second toe of the left foot appeared. She was diagnosed with marantic endocarditis by means of transesophageal echocardiography, and died 72h later due to multiorgan failure. Early diagnosis and treatment with anticoagulation can reduce the mortality of this disease, since it is underdiagnosed, and often only comes to light during postmortem examination.

Dietary resveratrol impairs body weight gain due to reduction of feed intake without affecting fatty acid composition in Atlantic salmon.

Recent studies suggest that the use of vegetable oils at expense of fish oil in aquaculture feeds might have potential negative effects on fish redox homeostasis and adiposity. Resveratrol (RESV) is a lipid-soluble phytoalexin present in fruits and vegetables with proven in vivo antioxidant function in animals. The present study aims to assess the potential use of RESV in Atlantic salmon feeds. To this end, post-smolt salmons with an initial BW of 148±3 g were fed four experimental diets for 15 weeks. A diet low in fish oil served as a control and was supplemented with 0, 0.5, 1.5 and 2.5 g/kg of RESV, respectively. The effect of the experimental diets on animal performance, tissue fatty acid composition, and the expression of genes encoding proteins involved in antioxidant signalling, lipid peroxidation, and metabolism were studied. Resveratrol significantly reduced feed intake and final BW of the salmon. Feeding RESV did not affect the sum of saturated and monounsaturated fatty acids or total lipids in the fillet. While the content of total polyunsaturated fatty acids was not affected, the percentages of some fatty acids in the liver and fillet were changed by RESV. Furthermore, in liver, the relative expression of glutathione peroxidase 4b, nuclear factor-like 2, and arachidonate 5-lipoxygenase remained unchanged across treatment groups. In conclusion, the negative impact of dietary RESV on FI and hence reduction of the BW discourages its inclusion in low fish oil diets for Atlantic salmon.

Síndrome de encefalopatía posterior reversible y síndrome de vasoconstricción cerebral reversible: diagnóstico diferencial de cefalea en el puerperio / Posterior reversible encephalopathy syndrome and cerebrovascular constriction syndrome in the differential diagnosis of post-partum headaches

La cefalea en el periodo puerperal puede ser debida a múltiples causas. En el contexto de una paciente que ha recibido previamente analgesia epidural, la cefalea puede ser etiquetada de cefalea pospunción dural, a pesar de que sus características no sean típicas de este cuadro clínico. Presentamos el caso de una puérpera con punción dural accidental durante la realización de anestesia epidural, que desarrolló cefalea en el tercer día posparto. Se sospechó inicialmente cefalea pospunción dural, pero la aparición posterior de convulsiones y pérdida de visión hizo que se reconsiderase el diagnóstico. A propósito de este caso revisamos las características clínicas y fisiopatológicas del síndrome de encefalopatía posterior reversible y el síndrome de vasoconstricción cerebral reversible, así como el diagnóstico diferencial de la cefalea en el periodo puerperal (AU)

Postpartum headache can be due to many causes. In a patient with previous epidural analgesia, the headache can be attributed to post-dural puncture headache, even if the symptoms are not typical of this clinical entity. We report a case of a post-partum with accidental dural tap during the insertion of an epidural catheter for labour analgesia, and who referred to headaches in the third post-partum day. Initially, a post-dural puncture headache was suspected, but the subsequent onset of seizures and visual impairment meant that the diagnosis had to be reconsidered. In this case report, the clinical and pathophysiological features of posterior reversible encephalopathy syndrome and reversible cerebral vasoconstriction syndrome, as well as the differential diagnosis of post-partum headaches are described (AU)

[Posterior reversible encephalopathy syndrome and cerebrovascular constriction syndrome in the differential diagnosis of post-partum headaches]. / Síndrome de encefalopatía posterior reversible y síndrome de vasoconstricción cerebral reversible: diagnóstico diferencial de cefalea en el puerperio.

Postpartum headache can be due to many causes. In a patient with previous epidural analgesia, the headache can be attributed to post-dural puncture headache, even if the symptoms are not typical of this clinical entity. We report a case of a post-partum with accidental dural tap during the insertion of an epidural catheter for labour analgesia, and who referred to headaches in the third post-partum day. Initially, a post-dural puncture headache was suspected, but the subsequent onset of seizures and visual impairment meant that the diagnosis had to be reconsidered. In this case report, the clinical and pathophysiological features of posterior reversible encephalopathy syndrome and reversible cerebral vasoconstriction syndrome, as well as the differential diagnosis of post-partum headaches are described.

Angiosarcoma radioinducido de mama. Dos casos de una patología infrecuente / Radiotherapy-induced breast agiosarcoma. Two cases of a rare disease

El angiosarcoma radioinducido de mama es una patología poco frecuente que se da en pacientes sometidas a radioterapia después de un proceso tumoral maligno tratado con cirugía, ya sea radical con mastectomía o conservadora. Presentamos 2 casos con diferentes características. El primero corresponde a una paciente joven sometida a cirugía conservadora, radioterapia y reconstrucción, y el segundo una paciente de edad avanzada con desarrollo de angiosarcoma sobre lecho de radioterapia preoperatoria y mastectomía. En ambos casos detallamos la actitud quirúrgica llevada a cabo de forma conjunta por los Servicios de Cirugía Plástica y Cirugía General y el tratamiento adyuvante por parte del Servicio de Oncología (AU)

Radiation-induced breast angiosarcoma is a rare disease which occurs in patients submitted to radiotherapy after a malignant tumour treated with conservative surgery or mastectomy. We report 2 cases with different characteristics. The first one is a young patient with conservative surgery, radiotherapy and reconstruction. The second case is an old patient who developed an angiosarcoma after preoperatory radiotherapy and mastectomy. In both cases, the surgical attitude by the Plastic Surgery and General Surgery is detailed, and the adjuvant treatment by Oncology (AU)

Tratamiento de las arritmias cardíacas refractarias mediante bloqueo del ganglio estrellado en un paciente. Acceso por técnica clásica y ecodirigida / Treatment of a patient with refractory cardiac arrhythmias using stellate ganglion block. Access by the classical and ultrasound-guided approach

El bloqueo del ganglio estrellado es utilizado con frecuencia por anestesiólogos y otros especialistas para el tratamiento del síndromes de dolor regional complejo del miembro superior. Esta técnica interrumpe la inervación simpática cardíaca y ha sido propuesta como tratamiento de arritmias refractarias. Presentamos el caso de un paciente con arritmias refractarias a tratamiento farmacológico que fueron controladas mediante un bloqueo continuo del ganglio estrellado izquierdo. El ganglio estrellado izquierdo es clave en el manejo de las arritmias cardiacas por ser una estructura en la que se originan gran parte de las fibras simpáticas posganglionares que se encargarán de inervar preferentemente el nodo auriculoventricular, haz de His y masa ventricular, elementos fundamentales en la génesis y mantenimiento de las arritmias ventriculares (AU)

Stellate ganglion block is a technique that is often used by anesthesiologists for the treatment of complex regional pain syndromes of the upper extremity. This technique interrupts cardiac sympathetic innervation and has been proposed as treatment for refractory arrhythmias. We present the case of a patient with arrhythmias that were refractory to pharmacological treatment, and were finally treated by continuous stellate ganglion block. Left stellate ganglion is a lynchpin of cardiac arrhythmias due to being a structure where the majority of postganglion sympathetic fibers responsible for preferentially innervating the atriventricular node, bundle of His and ventricular mass are originated, fundamentals in the origin and maintenance of ventricular arrhythmias (AU)

[Treatment of a patient with refractory cardiac arrhythmias using stellate ganglion block. Access by the classical and ultrasound-guided approach]. / Tratamiento de las arritmias cardíacas refractarias mediante bloqueo del ganglio estrellado en un paciente. Acceso por técnica clásica y ecodirigida.

Stellate ganglion block is a technique that is often used by anesthesiologists for the treatment of complex regional pain syndromes of the upper extremity. This technique interrupts cardiac sympathetic innervation and has been proposed as treatment for refractory arrhythmias. We present the case of a patient with arrhythmias that were refractory to pharmacological treatment, and were finally treated by continuous stellate ganglion block. Left stellate ganglion is a lynchpin of cardiac arrhythmias due to being a structure where the majority of postganglion sympathetic fibers responsible for preferentially innervating the atriventricular node, bundle of His and ventricular mass are originated, fundamentals in the origin and maintenance of ventricular arrhythmias.

Radiation protection in digestive endoscopy: European Society of Digestive Endoscopy (ESGE) guideline.

This article expresses the current view of the European Society of Gastrointestinal Endoscopy (ESGE) about radiation protection for endoscopic procedures, in particular endoscopic retrograde cholangiopancreatography (ERCP). Particular cases, including pregnant women and pediatric patients, are also discussed. This Guideline was developed by a group of endoscopists and medical physicists to ensure that all aspects of radiation protection are adequately dealt with. A two-page executive summary of evidence statements and recommendations is provided. The target readership for this Guideline mostly includes endoscopists, anesthesiologists, and endoscopy assistants who may be exposed to X-rays during endoscopic procedures.

Extremity and eye lens doses in interventional radiology and cardiology procedures: first results of the ORAMED project.

The main objective of WP1 of the ORAMED (Optimization of RAdiation protection for MEDical staff) project is to obtain a set of standardised data on extremity and eye lens doses for staff in interventional radiology (IR) and cardiology (IC) and to optimise staff protection. A coordinated measurement program in different hospitals in Europe will help towards this direction. This study aims at analysing the first results of the measurement campaign performed in IR and IC procedures in 34 European hospitals. The highest doses were found for pacemakers, renal angioplasties and embolisations. Left finger and wrist seem to receive the highest extremity doses, while the highest eye lens doses are measured during embolisations. Finally, it was concluded that it is difficult to find a general correlation between kerma area product and extremity or eye lens doses.

cDNA cloning, expression levels and gene mapping of photosynthetic and non-photosynthetic ferredoxin genes in sunflower (Helianthus annuus L.).

Fatty acid desaturation in plastids and chloroplasts depends on the electron-donor activity of ferredoxins. Using degenerate oligonucleotides designed from known photosynthetic and heterotrophic plant ferredoxin sequences, two full-length ferredoxin cDNAs were cloned from sunflower (Helianthus annuus L.) leaves and developing seeds, HaFd1 and HaFd2, homologous to photosynthetic and non-photosynthetic ferredoxins, respectively. Based on these cDNAs, the respective genomic sequences were obtained and the presence of DNA polymorphisms was investigated. Complete sequencing of the HaFd1 and HaFd2 genes in different lines indicated the presence of two haplotypes for HaFd2 and their alignment showed that sequence polymorphisms are restricted to the 5'-NTR intron. In addition, specific DNA markers for the HaFd1 and HaFd2 genes were developed that enabled the genes to be mapped. Accordingly, the HaFd1 locus maps to linkage group 10 of the public sunflower map, while the HaFd2 locus maps to linkage group 11. Both ferredoxins display different spatial-temporal patterns of expression. While HaFd2 is expressed at similar levels in all tissues tested (leaves, stem, roots, cotyledons and developing seeds), HaFd1 is more strongly expressed in green tissues than in all the other tissues tested. Both photosynthetic- and heterotrophic-ferredoxins are present in sunflower seeds and may contribute to fatty acid desaturation during oil accumulation. Nevertheless, the levels of HaFd2 expression during seed formation are distinct in lines that only varied in the HaFd2 haplotypes they expressed.

Síndrome de Prune-Belly / Prune-Belly syndrome

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