Bioconsolidation of Damaged Construction Calcarenites and Evaluation of the Improvement in Their Petrophysical and Mechanical Properties.

Bioconsolidation treatment using bacterial carbonatogenesis has been proposed as an environmentally friendly strategy for the efficient preservation of damaged stones, particularly suitable for carbonate stones. The study presented here deals with the evaluation of the performance of this treatment, applied to damaged carbonate stones in two historical buildings in Spain. The methodology applied in this research serves as a reference for future similar studies. Results showed significant improvement in the petrophysical and mechanical properties of the damaged stone following the treatment through the production of calcite and vaterite by the abundant carbonatogenic bacteria inhabiting the stone. These bacteria were able to effectively consolidate weathered areas if an adequate nutritional solution was employed, thereby augmenting the stone's resistance, as evidenced by the Drilling Resistance Measurement System (DRMS). FESEM images showed calcified bacteria and calcified exopolymeric substances (EPS) consolidating stone minerals without blocking their pores. In addition to consolidation, this biotreatment improves the stone's behavior against water absorption and increases the contact angle of water droplets without significant modifications in the pore size or diminishing vapor permeability. No color changes are observed. Overall, these results show that the application of the nutritional solution (M-3P) for in situ consolidation of different types of porous carbonate building stones is a highly effective conservation method, with no modification of the chemical composition of the treated materials.

Maritime-oriented foragers during the Late Pleistocene on the eastern costa del sol (Southeast Iberia): Cueva Victoria (Málaga, Spain).

The Mediterranean coast of Spain is marked by several clusters of Palaeolithic sites: to the south of the Pyrenees, in the area around the Ebro River, in the central part, and on the south coast, one of the southernmost regions in Europe. The number of sites is small compared with northern Iberia, but like that region, the Palaeolithic occupations are accompanied by several rock art ensembles. The archaeological material (both biotic and abiotic resources) and radiocarbon dates presented here were obtained during archaeological fieldwork of professor J. Fortea in the Late Pleistocene deposits in Cueva Victoria, located near the modern coastline and about 150 km north of the Strait of Gibraltar. In the three occupation phases, marine resources were acquired by shell-fishing (focusing almost exclusively on the clam Ruditapes decussatus), fishing, and the use of beached marine mammals. This contrasts with the limited data about the exploitation of terrestrial resources by hunting and gathering animals and plants. The study is completed by the study of artefacts (lithic and bone industry and objects of adornment) that help to understand the subsistence strategies of the cave occupants and enable a comparison with other groups inhabiting the Mediterranean coasts of the Iberian Peninsula during Greenland Interstadial 1, between ca. 15.1 and 13.6 cal BP.

Bayesian chronological analyses consistent with synchronous age of 12,835-12,735 Cal B.P. for Younger Dryas boundary on four continents.

The Younger Dryas impact hypothesis posits that a cosmic impact across much of the Northern Hemisphere deposited the Younger Dryas boundary (YDB) layer, containing peak abundances in a variable assemblage of proxies, including magnetic and glassy impact-related spherules, high-temperature minerals and melt glass, nanodiamonds, carbon spherules, aciniform carbon, platinum, and osmium. Bayesian chronological modeling was applied to 354 dates from 23 stratigraphic sections in 12 countries on four continents to establish a modeled YDB age range for this event of 12,835-12,735 Cal B.P. at 95% probability. This range overlaps that of a peak in extraterrestrial platinum in the Greenland Ice Sheet and of the earliest age of the Younger Dryas climate episode in six proxy records, suggesting a causal connection between the YDB impact event and the Younger Dryas. Two statistical tests indicate that both modeled and unmodeled ages in the 30 records are consistent with synchronous deposition of the YDB layer within the limits of dating uncertainty (∼ 100 y). The widespread distribution of the YDB layer suggests that it may serve as a datum layer.

The Usefulness of International Cooperation in the Repair of Inguinal Hernias in Sub-Saharan Africa.

INTRODUCTION: The burden of disease and mortality associated with inguinal hernia in Africa, especially in sub-Saharan Africa, is very high. The purpose of this study is to show that International Cooperation work in the field of hernia repair is effective; it minimizes the delay in hernia repairs in the targeted population, and can prevent a large number of disability-adjusted life years (DALYs). MATERIALS AND METHODS: As a part of an International Cooperation program, a total of 990 black patients with inguinal hernias were studied, in whom hernioplasty was performed using polypropylene mesh. The type of hernia and surgical technique were studied. Indicators of scientific and technical quality, indicators of efficiency and of effectiveness were analyzed. The results on the usefulness of interventions were calculated as avoided DALYs. RESULTS: Surgery was performed on 926 patients with a total of 1033 hernia repairs. 87.2 % of the repairs were made with mesh. There was no mortality in the series, complications were minor, and 85.7 % of patients remained less than 24 h in the center. There was a 2.8 % of recurrence, with a follow-up 58.7 % of the patients in the first year. 5014 DALYs were avoided, and the average of the avoided DALYs per patient was of 5.41. CONCLUSIONS: Hernia repair with mesh in low development countries is a procedure with low morbidity and high effectiveness that can prevent a large number of DALYs.

Surgical treatment of endemic goiter in a nonhospital setting without general anesthesia in Africa.

BACKGROUND: Endemic goiter remains a serious public health problem and 75 % of people affected live in underdeveloped countries where treatment is difficult for various reasons. The aim of this article is to report our experience in African countries with the management and surgical treatment of endemic goiter, performed in a nonhospital setting and without general anesthesia in the context of a collaborative development project by experienced endocrine surgeons. METHODS: Fifty-six black African patients with a goiter were studied. Those in poor general health, the elderly, patients with either small goiters or clinical hyperthyroidism, and those presenting with an acute episode of malaria were excluded from the study. Cervical epidural anesthesia with spontaneous ventilation was used and a partial thyroidectomy was performed. The technique used, its immediate complications, and early and late follow-up were analyzed. RESULTS: Surgery was performed on 31 patients with grades 3 and 4 goiter without mortality and a morbidity rate of 11.9 %, with 97 % of all complications being minor. There were no instances of dysphonia or symptomatic hypocalcemia and the mean stay was 1.57 days (range 1.25-1.93). Follow-up in the first year was 71 % and no case of severe or recurrent hypothyroidism was detected. CONCLUSIONS: Surgery without general anesthesia performed in a nonhospital setting in underdeveloped countries in patients with goiter is a viable option with good results and low morbidity.

¿Muerte por malapraxis tras quemaduras de segundo grado en una menor de 2 años? / Death due to malpractice after second degree burns in child under 2 years of age?

Presentamos el caso de una menor de 2 años que falleció por bronquiolitis cuatro días después de sufrir unas quemaduras y haber sido visitada por tres equipos médicos de distintos centros. La denuncia por malapraxis formulada por los padres conllevó a la realización de autopsia médico-legal. Los resultados de la misma atribuyeron la causa de muerte a una bronquiolitis, por lo que se archivó la denuncia presentada contra los facultativos (AU)

We report the case of a child less than 2 years old who died of bronchiolitis four days after suffering burns and having being examined by three medical teams of different centres. The complaint for malpractice issued by their parents required a medico-legal autopsy. Its findings determined that bronchiolitis was the cause of death and, as a result, the complaint for medical malpraxis was discontinued (AU)

One or two types of death? Attitudes of health professionals towards brain death and donation after circulatory death in three countries.

This study examined health professionals' (HPs) experience, beliefs and attitudes towards brain death (BD) and two types of donation after circulatory death (DCD)--controlled and uncontrolled DCD. Five hundred and eighty-seven HPs likely to be involved in the process of organ procurement were interviewed in 14 hospitals with transplant programs in France, Spain and the US. Three potential donation scenarios--BD, uncontrolled DCD and controlled DCD--were presented to study subjects during individual face-to-face interviews. Our study has two main findings: (1) In the context of organ procurement, HPs believe that BD is a more reliable standard for determining death than circulatory death, and (2) While the vast majority of HPs consider it morally acceptable to retrieve organs from brain-dead donors, retrieving organs from DCD patients is much more controversial. We offer the following possible explanations. DCD introduces new conditions that deviate from standard medical practice, allow procurement of organs when donors' loss of circulatory function could be reversed, and raises questions about "death" as a unified concept. Our results suggest that, for many HPs, these concerns seem related in part to the fact that a rigorous brain examination is neither clinically performed nor legally required in DCD. Their discomfort could also come from a belief that irreversible loss of circulatory function has not been adequately demonstrated. If DCD protocols are to achieve their full potential for increasing organ supply, the sources of HPs' discomfort must be further identified and addressed.

[Reversible primary empty sella. Case report]. / Silla turca vacía primaria reversible. A propósito de un caso.

We report the case of a 13-year-old girl with an increased hypophysis that mimicked an adenoma, who developed a partial empty sella on MRI after an acute episode of hydrocephalus. After replacement of a CSF shunt, the intracranial pressure returned to normal and the hypophysis filled up again all the sellar fossa. We discuss the possibility of the involvement by an ischemic atrophy of the adenohypophysis in the development of a primary empty sella with idiopathic chronic raised intracranial pressure that prevents the recovery of the gland volume after restoring the intracranial pressure to normal values. Restitution of empty sella may be an indicator of normal intracranial pressure in these cases.

Silla turca vacía primaria reversible. A propósito de un caso / Reversible primary empty sella. Case report

Se presenta el caso de un niña de 13 años con un aumento del tamaño de la hipófisis sugerente de adenoma que, tras un episodio de hidrocefalia aguda, desarrolló en la RM una silla turca vacía parcial.Tras la colocación de una derivación de líquido cefalorraquídeo, se normalizó la presión intracraneal y la hipófisis volvió a ocupar todo el espacio de la fosa sellar. Se discute la posibilidad de que en la silla turca vacía primaria con hipertensión intracraneal crónica idiopática, esté implicada una atrofia isquémica de la adenohipófisis que impide la recuperación del volumen glandular tras la restauración de la PIC a los niveles normales. La reversión de la silla turca vacía es un indicador de la normalización de la PIC (AU)

We report the case of a 13-year-old girl with an increased hypophysis that mimicked an adenoma, who developed a partial empty sella on MRI after an acute episode of hydrocephalus. After replacement of a CSFshunt, the intracranial pressure returned to normal and the hypophysis filled up again all the sellar fossa. We discuss the possibility of the involvement by an ischemic atrophy of the adenohypophysis in the development of a primary empty sella with idiopathic chronic raised intracranial pressure that prevents the recovery of the gland volume after restoring the intracranial pressure to normal values. Restitution of empty sell a may bean indicator of normal intracranial pressure in these cases (AU)

[Postsurgical pituitary apoplexy. Report of two cases]. / Apoplejía tumoral hipofisaria posquirúrgica. A propósito de dos casos.

We report two cases of large macroadenomas that, after a transsphenoidal partial resection, suffered necrosis and swelling of the residual tumor, with increase of its volume, compression of neighboring structures and neurological deterioration. The literature is reviewed looking for possible pathophysiological mechanism and prevention.

Apoplejía tumoral hipofisaria posquirúrgica. A propósito de dos casos / Postsurgical pituitary apoplexy. Report of two cases

Se presentan dos casos de macroadenomas nofuncionantes grandes que, tras su extirpación parcialpor vía transesfenoidal, sufrieron un infarto delresto tumoral residual, con resultado de aumento desu volumen, compresión de las estructuras vecinas ydeterioro neurológico de los pacientes. Ambos fueronreintervenidos por vía transcraneal para conseguirla extirpación completa de sus tumores. Se revisa labibliografía en busca de las claves para prevenir estacomplicación (AU)

We report two cases of large macroadenomasthat, after a transsphenoidal partial resection, sufferednecrosis and swelling of the residual tumor, withincrease of its volume, compression of neighboringstructures and neurological deterioration. The literatureis reviewed looking for possible pathophysiologicalmechanism and prevention (AU)

[Pituitary adenoma apoplexy after spinal anaesthesia. Report of two cases and review of the literature]. / Apoplejía de adenoma hipofi sario no funcionante tras anestesia espinal. A propósito de dos casos.

Two cases of pituitary apoplexy occurring after spinal anaesthesia are described. Both presented with headache and III par palsy, one of them with additional visual disturbance and hyponatremia. A bibliographical review has been done, looking for early diagnostic keys. We propose the arterial hypotension as a possible pathogenetic mechanism of pituitary adenoma apoplexy.

Apoplejía de adenoma hipofi sario no funcionante tras anestesia espinal. A propósito de dos casos / Pituitary adenoma apoplexy after spinal anaesthesia. Report of two cases and review of the literature

Se presentan dos casos clínicos de apoplejía hipofisaria tras anestesia espinal, ambos con cefalea y unaparálisis del III par craneal. Uno de ellos con alteraciónvisual adicional e hiponatremia. Se revisa la bibliografíaen busca de las claves para un diagnóstico precozy se propone la hipotensión arterial como mecanismopatogénico de la apoplejía (AU)

Two cases of pituitary apoplexy occurring afterspinal anaesthesia are described. Both presented withheadache and III par palsy, one of them with additionalvisual disturbance and hyponatremia. A bibliographicalreview has been done, looking for early diagnostickeys. We propose the arterial hypotension as a possiblepathogenetic mechanism of pituitary adenoma apoplexy (AU)

[Cerebellopontine angle meningeal melanocytoma: a benign tumor?]. / Melanocitoma meníngeo del ángulo pontocerebeloso: un tumor benigno?

We report a case of a rare meningeal melanocytoma in the cerebellopontine angle. One year after tumor gross total removal, the patient suffered a sudden and devastating meningeal melanomatosis. The relevant literature is reviewed looking for the keys to establish preoperative diagnosis and to obtain information about its treatment and postsurgical management.

Melanocitoma meníngeo del ángulo pontocerebeloso, ¿Un tumor benigno? / Cerebellopontine angle meningeal melanocytoma: a benign tumor?

Se presenta un paciente con un raro melanocitoma meníngeo del ángulo pontocerebeloso que, tras su extirpación quirúrgica radical, evolucionó en el plazo de un año hacia una melanomatosis meníngea fulminante. Se realiza una revisión bibliográfica en busca de las claves para hacer una aproximación diagnóstica preoperatoria de este tipo de tumor y obtener información sobre su tratamiento y manejo postoperatorio (AU)

We report a case of a rare meningeal melanocytoma in the cerebellopontine angle. One year after tumor gross total removal, the patient suffered a sudden and devastating meningeal melanomatosis. The relevant literature is reviewed looking for the keys to establish preoperative diagnosis and to obtain information about its treatment and postsurgical management (AU)

[Primary empty sella: symptoms, physiopathology, diagnosis and treatement]. / Silla turca vacía primaria: clínica, fisiopatología y tratamiento.

Bibliographical review on the primary empty sella: concept, symptomatology, diagnosis, physiopathology and management.

[Anaesthesic management of vaginal delivery in a parturient with C1 esterase deficiency]. / Prise en charge anesthésique d'un accouchement chez une patiente atteinte d'un déficit en inhibiteur de C1 estérase.

Hereditary and acquired angioedema (HAE/AAE) are the clinical translation of a qualitative or a quantitative deficit of C1 esterase inhibitor (C1 INH). The frequency and severity of clinical manifestations vary greatly, ranging from a moderate swelling of the extremities to obstruction of upper airway. Anaesthesiologists and intensivists must be prepared to manage acute manifestations of this disease in case of life-threatening laryngeal edema. Surgery, physical trauma and labour are classical triggers of the disease. The anaesthesiologists should be aware of the drugs used as prophylaxis and treatment of acute attacks when considering labour and caesarean section. Androgens are contraindicated during pregnancy. If prophylaxis is required, tranexamic acid may be used with caution. The safest obstetric approach appears to be to administer a predelivery infusion of C1 INH concentrate. It is important to avoid manipulation of the airway as much as possible by relying on regional techniques. We report the case of a patient suffering from an HAE discovered during pregnancy. The management included administration of C1 INH during labor and early epidural analgesia for pain relief. A short review of the pathophysiology and therapeutic options follows.

Silla turca vacía primaria: clínica, fisiopatología y tratamiento / Primary empty sella: symptoms, physiopathology, diagnosis and treatement

En este artículo se revisa el concepto, clínica,fisiopatología y manejo de la silla turca vacía primariay los distintos problemas que plantea, a la luz de labibliografía que se ha considerado más relevante sobreel tema (AU)

Bibliographical review on the primary empty sella:concept, symptomatology, diagnosis, physiopathologyand management

Abscesos cerebrales: análisis de factores pronóstico e influencia del tratamiento antibiótico protocolizado en su evolución / Brain abscess. Evaluation of prognostic factors: does the use of antibiotic prescribing protocols improve outcome?

Objetivos: Analizamos los factores pronósticos asociados a mortalidad en pacientes con absceso cerebral (AC) y la influencia del tratamiento antibiótico protocolizado (PA). Pacientes y Métodos: estudio observacional en un hospital universitario (1975-2005). El tratamiento antibiótico empírico se realizó sin PA (Periodo I -PI-, 1975-1983; n = 33) y de acuerdo a PA diseñado por los Servicios de MI-Infecciosas y Neurocirugía a partir de 1983 (Periodo II -PII-; n = 71); valoramos la influencia del Protocolo Terapéutico en la curación de los enfermos. Resultados: se evaluaron 104 pacientes (edad media 45 años; rango12-86); el origen del AC se identificó en 89% y en 76% hubo confirmación microbiológica. Mortalidad, 16,3% (17/104); se asociaron de forma estadísticamente significativa a mayor mortalidad: edad > 40 años, enfermedad de base últimamente fatal, situación clínica inicial crítica-mala, presencia de alteración del estado de conciencia y tratamiento empíricono adecuado. No hubo diferencias estadísticamente significativas en las características epidemiológicas, clínicas, radiológicas o microbiológicas de los pacientes correspondientes al PI y al PII, excepto en edad (> 40años, 36% en PI y 62% en PII); si hubo diferencias en curaciones, 60% vs 77% (p < 0,05); recidivas 21 vs. 7% (p < 0,05) y mortalidad 18 vs.15,4% (p > 0,05) en PI y PII, respectivamente. Conclusiones: La edad, enfermedad de base últimamente fatal, gravedad clínica inicial, presencia de alteración del nivel de conciencia y el tratamiento antibiótico empírico inadecuado son los principales factores pronósticos asociados a mayor mortalidad en pacientes con AC. La prescripción del tratamiento empírico de acuerdo con un PA consensuado se asoció con mayor porcentaje de curaciones y menor número de recidivas

Background: the aim of this study was to evaluate prognostic factors in brain abscess (AB) and influence of management with antibiotic prescribing protocols (APP). Patients and Methods: observational study of a cohort of non-paediatric patients with BA admitted at a 944-bed hospital (1976-2005). Data collection from clinical records has been done according to a standard protocol. We analysed epidemiological, clinical, radiological, microbiological and laboratory data associated with mortality. From1976 to 1983 (Period I), antibiotic treatment was not done according toany internal APP; from 1983 (Period II), antibiotic management was done according to a APP designed by infectious diseases specialists and neurosurgeons. Predictors of mortality were identified by univariate analysis. The influence of the use of APP in outcome was assessed. Results: 104 patients with BA were included (mean age 45 years;range 12-86); presumed primary pathogenic mechanism of BA was identified in 89%; microbiologic diagnosis was made in 76%. Overall mortality was 16.3%. Factors statistically associated with higher mortality were: age > 40 years, ultimately fatal underlying disease, acute severe clinical condition at the onset of BA, altered mental status and inadequate empirical treatment; 33 patients were treated in Period I and 71 in Period II; no statistically significant differences were found between epidemiological, clinical, radiological or microbiological characteristics of the groups except for mean age (> 40 years in 36% and 62% respectively in Period I and II). Rates of resolution of BA were 60 vs. 77.4% (p <0.05); relapses 21 vs. 7% (p < 0.05) and mortality 18 vs. 15.4% (p >0.05), in Period I and II respectively. Conclusions: main prognostic factors associated with mortality in patients with BA are age, rapidly fatal underlying disease, acute severe clinical condition at the onset of BA, altered mental status and inadequateempirical treatment. Empiric treatment according to APP was associated with greater resolution and lower relapse rates