Estimulación cerebral profunda en el núcleo accumbens en pacientes con depresión resistente al tratamiento: reporte de casos / Nucleus accumbens deep brain stimulation in patients with treatment-resistant depression: report of four cases

INTRODUCCIÓN: La estimulación cerebral profunda (DBS) se ha propuesto como una alternativa terapéutica para el manejo de la depresión resistente al tratamiento (DRT). Sin embargo, existen múltiples blancos para neuroestimulación y se desconoce el punto neuroanatómico óptimo en esta patología. Como parte del circuito de recompensa, el núcleo accumbens (NAc) ha sido estudiado en modelos de depresión y anhedonia. El objetivo de este artículo fue describir la experiencia clínica de la implantación de electrodos bilaterales de DBS en el NAc. REPORTE DE CASOS: Se describe la experiencia en cuatro mujeres entre los 17 a 41 años con DRT. Los casos presentaban antecedente de múltiples hospitalizaciones e intentos de suicidio serios, a pesar de haber sido tratadas previamente con terapia farmacológica, psicoterapia y TECAR (Terapia electroconvulsiva con anestesia y relajación). A los 6 meses del inicio del DBS, se observó una mejoría de los síntomas depresivos en la escala de Hamilton y un incremento en la escala de funcionalidad global. La anhedonia y la abulia persistieron luego de la cirugía, aunque con menor intensidad. CONCLUSIÓN: La DBS del NAc puede ser una estrategia efectiva en el tratamiento de pacientes con DRT, impactando en la funcionalidad y en la disminución del riesgo suicida.

INTRODUCTION: Deep brain stimulation (DBS) has been proposed as a therapeutic alternative for Treatment-resistant depression (TRD) patients. However, there are multiple targets for neurostimulation and the optimal neuroanatomical landmark for this pathology is unknown. Nucleus accumbens (NAc) is a crucial part of the reward circuit and has been studied extensively in models of depression and anhedonia. The objective of this study was to describe our clinical experience with DBS of the NAc patients with TRD. CASE SERIES: It described the experience in four females between 17 and 41 years of age. All cases presented with a history of multiple hospitalizations and serious suicide attempts, despite having been treated with optimal pharmacological regimes, psychotherapy and ECT (Electroconvulsive therapy). Six months after the initiation of DBS, an improvement in the Hamilton Depression Scale and in the Global Assessment of Functioning Scale was observed. Anhedonia and abulia persisted after the surgery, although less severe. CONCLUSION: DBS of NAc seems to offer favorable surgical outcomes in patients with TRD, impacting functionality and suicidal risk.

Ultrasonografía Doppler-color en el diagnóstico de las anomalías vasculares de las partes blandas superficiales en pediatría / Color Doppler ultrasonography in the diagnosis of vascular anomalies of the superficial soft tissue in children

Las anomalías vasculares de las partes blandas superficiales son frecuentes en el niño y se han clasificado en hemangiomas y malformaciones vasculares, según sus manifestaciones clínicas y hallazgos histológicos. La mayoría corresponde a hemangiomas, se presenta en el recién nacido, desaparece espontáneamente con el tiempo y sólo algunos de ellos requerirán de evaluación médica. Es importante especificar el tipo de lesión vascular para definir el tratamiento, lo que en la mayor parte de los casos es posible con los hallazgos clínicos. Sin embargo, a veces es necesario recurrir a estudios de imágenes para precisar el diagnóstico y los métodos más utilizados son la Ultrasonografía (US) Doppler-color; Resonancia magnética (RM) y Angiografía. La US Doppler-color es un método sencillo, inocuo, no invasivo, que permite diferenciar las lesiones superficiales de aquellas profundas y además permite evaluar la vascularización de la lesión y, de esta manera, lograr una adecuada aproximación diagnóstica. También permite seleccionar aquellos casos que requerirán de métodos más sofisticados, como RM o angiografía. El objetivo de esta revisión es mostrar la utilidad de la US Doppler en el estudio de las anomalías vasculares de las partes blandas superficiales en el niño.

Vascular anomalies of superficial soft tissues are frequent in children and have been classified in hemangiomas and vascular malformations, depending on clinical and histological findings. Most correspond to hemangiomas, present in the newborn period, which disappear spontaneously with time and only some may require an imaging evaluation. It is important to specify the type of vascular anomaly in order to define management, which in most cases is possible with just clinical findings. Nevertheless, some cases may require imaging studies to define diagnosis, and the most utilized methods are Doppler ultrasonography (US), magnetic resonance Imaging (MRI) and angiography. Doppler US is a non invasive, harmless and simple method which allows to differentiate between deep and superficial lesions. It also permits to evaluate vascularization and in this manner; achieve an adequate diagnosis and select those cases that will require more sophisticated methods like MRI or angiography. The main objective of this review is to show the role of Doppler US in the study of superficial soft tissue vascular anomalies in children.

Estudio radiológico simple en el diagnóstico del tumor de células gigantes en población pediátrica: correlación anatomoradiológica / Plain radiological study in giant cell tumor (GCT) diagnosis among pediatric patients: anatomo-radiological correlation

Background. Giant cell tumor (GCT) is an uncommon primary bone neoplasm in pediatric patients. Plain radiograph of the affected area is the first diagnostic approach in most cases. Objective. To show radiographic features that could allow the radiologist to suspect the diagnosis of GCT through plain radiological study. Methods. Records from the National Bone Tumor File between 1959 and 1999 were retrospectively analyzed. Twenty-nine cases of patients under 20 years with biopsy proven diagnosis of GCT were found. The radiological study was available in 14 cases. Results. From a total of 29 patients, 83 percent were females and 17 percent males. Age ranged from 7 to 19 years, with an average of 16.3 years. In cases with radiological study, 93 percent of them presented epiphyseal involvement of long bones. Osteolytic lesions with metaphyseal extension were the most frequent radiological pattern. One case showed malignancy with metastases. Conclusions. GCT is regarded as an infrequent occurrence in pediatric patients and its diagnosis can be suspected based on plain radiographic findings.

El tumor de células gigantes es un tumor óseo primario, poco frecuente en población pediátrica. En la mayoría de los casos, la radiografía simple es la primera aproximación diagnóstica, por lo que nuestro objetivo es mostrar las características radiológicas que permiten sospechar el diagnóstico del tumor de células gigantes en el estudio radiológico simple. Se analizó retrospectivamente los datos del Registro Nacional de Tumores Óseos, entre los años 1959 y 1999, encontrando 29 casos de tumor de células gigantes histológicamente confirmados en menores de 20 años; en 14 se dispuso de estudio radiológico. El 83 por ciento (24/29) correspondió a mujeres y 17 por ciento (5/29) a hombres, con edades entre 7 y 19 años (promedio = 16.3 años). Radiológicamente, el 93 por ciento mostró compromiso epifisiario de huesos largos y el patrón más frecuente fue osteolítico con extensión metafisiaria.

Estudio radiológico simple en el diagnóstico de condroblastoma epifisiario benigno: correlación anatomo – radiológica / Radiographic study in benign epiphyseal chondroblastoma diagnosis: anatomoradiological correlation

Introduction: A chondroblastoma is a rare, usually benign, tumor of bone that accounts for approximately 1 percent of all bone tumors, which mainly affects the growing skeleton. Local pain is the most common presenting symptom, and for some patients it implies functional involvement due to its periarticular site. Chondroblastoma most commonly affects the epiphysis of long bones, specially occuring on the lower extremities. Usually, radiography is the first diagnostic imaging technique to be performed and its relatively characteristic findings may cause alarm or lead to misdiagnosis. Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) are complementary studies that best show the lesion, its extension, and soft tissue involvement. Objectives: To present the most frequent manifestations of chondroblastoma in radiographies, establishing the anatomoradiological correlation of lesions. Material and Methods: Thirty-six patients with histologically proven chondroblastoma, who were registered in the National Register of Bone Tumors, between 1959 and 2004, were retrospectively investigated under clinical and radiological viewpoints. Results: Thirty-six patients (26 male, 10 female) whose ages ranged from 5 to 19 years (mean age 14.5 years) were studied. In all cases, biopsy results confirmed the diagnosis of chondroblastoma. Bone lesions were sited as follows: long bones of lower extremities in 22 patients; long bones of upper extremities, 8 cases; feet bones, 3 patients; pelvis, 3 cases, and rib cage in 1 case. Lesions, which were unique in all cases and involved epiphyseal region, were predominantly osteolytic in 30 patients. Metaphyseal extension was found in 28 patients. Eccentric bone lesions were seen in 27 cases, while calcifications were present in 18 patients and 9 cases were found to have soft tissue extensions. Conclusions: Benign epiphyseal chondroblastoma is an unusual bone lesion occuring in young patients, with well-characterized and constant...

Introducción: El condroblastoma es una lesión ósea benigna poco frecuente (1 por ciento - 4.7 por ciento de los tumores óseos primarios), que afecta principalmente al esqueleto en crecimiento. Se manifiesta por dolor local de larga evolución y en algunos pacientes, compromiso funcional por su localización periarticular. Tiene predilección por las epífisis de los huesos largos o su equivalente epifisiarío, especialmente en extremidades inferiores. La radiografía simple es generalmente el primer examen y los hallazgos son relativamente característicos, pudiendo alarmar e inducir a error. Tomografía computada (TC) y resonancia magnética (RM) son complementarias y muestran mejor la lesión, extensión dentro del hueso y compromiso de partes blandas. Objetivos: Mostrarlas manifestaciones más frecuentes del condroblastoma en radiografías, estableciendo correlación anátomo-radiológica de las lesiones. Material y Métodos. Se analizaron retrospectivamente las características clínicas y radiológicas de 36 pacientes con condroblastoma confirmado por histología, incluidos en Registro Nacional de Tumores Óseos (RENATO), entre los años 1959 y 2004. Resultados. Se estudiaron 36 pacientes, 26 varones y 10 niñas, de 5 a 19 años (promedio = 14.5 años). Biopsia compatible con condroblastoma en todos los pacientes y su localización: huesos largos de extremidades inferiores(22), huesos largos de extremidades superiores(8), huesos del pie(3), pelvis(3) y parrilla costal(1). Las lesiones fueron únicas en todos los casos, predominantemente osteolíticas(30). La totalidad comprometía la epífisis; se observó extensión hacia la metáfisis(28), lesión ósea excéntrica(27), calcificaciones(W) y extensión hacia partes blandas(9). Conclusión. El condroblastoma epifisiario benigno es una lesión poco frecuente, de pacientes jóvenes, con manifestaciones radiológicas relativamente constantes y características, lo que puede permitir al radiólogo sospechar el diagnóstico en la radiografía simple ini...

Anomalías vasculares de partes blandas: imágenes diagnósticas / Vascular anomalies of soft tissues: diagnostic images

Vascular anomalies include different pathologies as hemangiomas and vascular malformations, however they usually are reported together and confusion is created. Mülliken and Glowacki proposed a classification posteriorly, modificated, adapted and actually in use. Unfortunately is not sufficiently known for our radiologist. Classification and imaging correlation of soft-tissue vascular anomalies are revised, since a exact diagnosis is a great value for appropriate treatment and prognosis.

Las anomalías vasculares han sido tradicionalmente tratadas en conjunto aun cuando engloban patologías tan diferentes como hemangiomas y malformaciones vasculares. La clasificación dada a conocer por Mülliken y Glowacki, modificada posteriormente, no es suficientemente conocida ni usada en nuestro medio. Se revisa la clasificación actual y la correlación con imágenes de aquellas anomalías vasculares situadas en partes blandas, dada la importancia que tiene un correcto diagnóstico para la terapéutica y pronóstico de los pacientes con estas lesiones.

Development and characterization of a murine monoclonal antibody specific for the P1.15 PorA proteins from vaccine strain B:4,7:P1.19,15 of Neisseria meningitidis.

Neisseria meningitidis isolates are conventionally classified by serosubtyping, which characterizes the reactivities of the PorA outer membrane protein variable-region epitopes with monoclonal antibodies (MAbs). New murine hybridomas, secreting specific MAbs against PorA of N. meningitidis serogroup B, were generated using conventional hybridoma procedures. Using outer membrane protein as antigen, we obtained two positive clones, and one of them we characterized. This MAb reacted, on whole-cell enzyme-linked immunosorbent assay (ELISA) and immunoblotting, only with strain subtype P1.15 and its IgG2b isotype. This MAb demonstrated bactericidal activity against the homologous strain in the presence of human complement.

[Identification, by Western blot, of Fasciola hepatica immunogens recognized by the sera of experimentally infected rats]. / Identificación, mediante western blot, de inmunógenos de Fasciola hepatica, reconocidos por los sueros de ratas infectadas experimentalmente.

This paper was aimed at identifying the main components present in the excretory-secretory antigens of adult parasite which are recognized by the sera of rats experimentally infected with metacercariae of Fasciola hepatica, by using the Western Blot technique. The cynetics of antibodies was also determined with and indirect ELISA. The results obtained allowed to find 31 components with approximate molecular weights from 11 to 136 kD. The predominant fractions were the following: 11-13 kD, 14-16 kD, 23-33 kD, 55-57 kD, 65-71 kD, and 86-136 kD. Antibodies were detected from the 2nd. week of infection in 80% of the animals and from the 3rd. week in 100% of them. There were no antibodies during the first week. The identification of these antibodies may contribute to a better understanding of the mechanisms of immunity linked with the infection by F. hepatica.

Partial characterization of the epitope on excretory-secretory products of Fasciola hepatica recognized by monoclonal antibody ES78.

This report contains a partial characterization of the epitope recognized by monoclonal antibody (MAb) ES78 produced against excretory-secretory (ES) antigens of Fasciola hepatica. ES78 is currently used for the detection of ES antigens in serum and stool samples of cattle and humans with fasciolosis, using a highly sensitive and specific sandwich enzyme-linked immunosorbent assay (ELISA). The epitope was characterized by periodate oxidation, alkaline borohydride reduction, trichloroacetic acid precipitation, beta-mercaptoethanol treatment, and enzymatic proteolysis. These results, together with those of the 2-site ELISA, lectin immunoassays, and beta-galactosidase digestion, showed that MAb ES78 reacts with a partly protein/partly carbohydrate antigenic determinant that is found on several ES molecules of adult specimens of F. hepatica and contains at least 1 disulfide bond and beta-galactose probably as galactose-beta(1-3)-N-acetylgalactosamine disaccharide.

Echocardiography shows persistent thickness of the wall of the right ventricle in infants at high altitude.

We have applied M-mode and two-dimensional echocardiography to infants living at high altitude in La Paz, Bolivia (3800m) and infants living at low altitude in Santa Cruz, Bolivia (400m). At low altitude, the thickness of the anterior wall of the right ventricle decreases during the first month of extrauterine life to a dimension which remains constant for the rest of infancy. At high altitude, the thickness of the anterior wall of the right ventricle at birth is similar to that found at low altitude but does not decrease in the succeeding twelve months. The ratio of the diameter of the aorta to that of the pulmonary artery was higher at low altitude in all age-groups. The observations are consistent with the persistence of a high pulmonary arterial pressure during infancy at high altitude.