The sensory innervation of the human nipple.

Nipples represent a highly specialized skin with capital importance in mammals for breastfeeding and additionally in humans due to sexuality. The histological studies regarding this region are scarce, so 42 human nipples were studied to describe the morphology of the nipple innervation. Our results exclude the presence of a rich innervation on nipple's skin or superficial dermis, thus definitely excluding nipple skin from the concept glabrous skin. The presence of mechanoreceptors is limited to scarce Merkel cells on the epidermis and some corpuscular capsulated and non-capsulated structures in the dermis; Merkel cells progressively decrease with ageing. No Meissner corpuscles were found and the rare Pacinian corpuscles identified were close to vascular structures and embroidered in the mammary fatty tissue. The great sensitivity observed functionally on the breast and especially in the nipple can be morphologically explained by two elements; on the one hand there is a rich smooth muscle innervation present in the deep dermis; on the other hand the mammary gland demonstrate Piezo2 expression in many glandular cells, with two differentiated patterns in the ductal and in the acinar tissue of the breast. The role of Piezo2 in the normal mammary gland is discussed.

[Patterns of antidemential drug use in a group of patients from Colombia]. / Patrones de uso de farmacos antidemencia en un grupo de pacientes de Colombia.

INTRODUCTION: The benefits of pharmacological therapy with anti-dementia drugs are not yet fully demonstrated and there is even a lack of publications describing their use profile. The present work sought to determine the prescription patterns of anti-dementia drugs in a Colombian population. PATIENTS AND METHODS: Descriptive cross-sectional study. Through a systematized database of 3.5 million affiliates to the Colombian health system, patients with uninterrupted dispensing of anti-dementia drugs between August-October/2016 were selected. Sociodemographic, pharmacological and comedication variables were analyzed. The costs of the therapies were estimated from the reference price of the medicines. RESULTS: We identified 8372 patients with a mean age of 79.5 ± 8.7 years and 65.3% (n = 5471) were women. The most widely used medication was rivastigmine (69.6%), mainly in transdermal presentation, followed by memantine (31.4%). In general, the average dose administered per day was lower than the defined daily dose. Only 568 patients (6.7%) used combination therapy. 84.3% of patients (n = 7061) used some additional medication and 54.2% (n = 4535) had another neurologic medication. The cost per 1000 inhabitants/day of rivastigmine was 3.47 USD and for memantine 0.30 USD. CONCLUSION: Patients with anti-dementia drugs are using them at doses lower than those defined and they present an important frequency of comorbidities and comedications.

TITLE: Patrones de uso de farmacos antidemencia en un grupo de pacientes de Colombia.Introduccion. Los beneficios del manejo farmacologico con medicamentos antidemencia aun no estan del todo demostrados, e incluso hay carencia de trabajos que describan su perfil de utilizacion. El presente trabajo busco determinar los patrones de prescripcion de farmacos antidemencia en una poblacion de Colombia. Pacientes y metodos. Estudio descriptivo de corte transversal. Mediante una base de datos sistematizada de 3,5 millones de afiliados al sistema de salud colombiano, se selecciono a pacientes con dispensaciones ininterrumpidas de farmacos antidemencia entre agosto y octubre de 2016. Se analizaron variables sociodemograficas, farmacologicas y comedicaciones. Se estimaron los costes de las terapias a partir del precio de referencia de los medicamentos. Resultados. Se identifico a 8.372 pacientes con una edad media de 79,5 ± 8,7 años; el 65,3% (n = 5.471) fueron mujeres. El farmaco mas utilizado fue la rivastigmina (69,6%), principalmente en presentacion transdermica, seguida de la memantina (31,4%). En general, la dosis media administrada por dia fue inferior a la dosis diaria definida. Solamente 568 pacientes (6,7%) usaron terapia combinada. El 84,3% de los pacientes (n = 7.061) uso medicamentos para alguna comorbilidad y el 54,2% (n = 4.535) tenia otro neurofarmaco. El coste por 1.000 habitantes/dia de la rivastigmina fue de 3,47 dolares, y de la memantina, de 0,30 dolares. Conclusion. Los pacientes con medicamentos antidemencia los estan empleando en dosis inferiores a las definidas y presentan una importante frecuencia de comorbilidades y comedicaciones.

Ethnic rhinoplasty.

Rhinoplasty is one of the main facial plastic procedures performed worldwide. Ethnic patients today are mainly mixed-race patients. Diagnosis is based on anatomical findings and surgery should be planned based on patients' needs and what they define as beautiful. Different surgical techniques are presented where a structural approach to rhinoplasty is explained. Very little tissue is resected and support structures of the nose are strengthened with sutures and grafts. A gradual approach to the nasal tip is also presented progressing from simple predictable techniques to more complex unpredictable ones. The final result should be noses with greater definition and refinement that are harmonious and blend in with patients' faces.

Estudio clínico sobre dos técnicas para la construcción de las roturas del ligamento cruzado anterior (L. C. A.): Rigid Fix(R) y Aperfix / Clinical study about two texhniques for reconstruction of anterior cruciate ligament ruptures (A. C. L.): Rigid Fix(TM) y Aperfix(TM)

Introducción y objetivos: La reconstrucción del Ligamento Cruzado Anterior (L.C.A.) es uno de los 10 procedimientos más frecuentes en Cirugía Ortopédica en U.S.A. La reparación mediante hueso tendón hueso (H.T.H.) resistiría 2977 N. El semitendinoso y recto interno, resistirían 1216 N y 838 N, respectivamente. Nuestro objetivo fue comparar clínicamente la técnica (H.T.H. Rigid Fix), con la ligamentoplastia con pata de ganso (Aperfix). Material y métodos: Estudio observacional, descriptivo y retrospectivo de 64 pacientes. Seguimiento 1-5 años. HTH: 31 casos (48.4%). Aperfix 33 casos (51.6%). Las variables analizadas fueron filiación, exploración clínica pre y postquirúrgica, RNM, escala Lysholm, aspectos quirúrgicos y complicaciones, entre otros. Los tests estadísticos empleados fueron t de Student, U de Mann Whitney y Chi Cuadrado. Análisis mediante S.P.S.S. 15.0. Resultados: Lysholm pre y postoperatorio de 14 ± 7.5 puntos y 86.7 ± 9.9 puntos, respectivamente. Hubo diferencias estadísticamente significativas, (p<0.05), a favor de H.T.H. en tiempo quirúrgico (62.7 ± 10.6 minutos Vs 79 ± 15.6 minutos), tiempo rehabilitador (115.1 ± 30.5 días Vs 139.8 ± 31.8 días), tiempo de baja (132.9 ± 20 días Vs 155.3 ± 41.4 días) o Lachmann postquirúrgico negativo (100% Vs 45% de los casos). Sin embargo, hubo mayor reducción del espacio articular con H.T.H. (9.7% Vs 0%). Conclusiones: La reparación del L.C.A. en nuestra experiencia, requeriría menor tiempo quirúrgico, rehabilitador y presentaría un Lachmann postquirúrgico menor con H.T.H. frente a Aperfix. No habría diferencias clínicas entre ambos sistemas, en la escala Lysholm

Introduction and objectives: Reconstruction of Anterior Cruciate Ligament (ACL) is one of the 10 most common procedures in orthopedic surgery in U.S.A. Repair by means of Patellar Tendon resists 2977 N. gracilis and semitendinosus, resist 1216 N and 838 N, respectively. Our objective was to compare clinical results of two surgical techniques (Bone- Patellar tendon-Bone Graft: B.P.B. Rigid Fix(TM) with hamstring tendons (Aperfix(TM)). Material and methods: Observational, descriptive and retrospective study of 64 patients. Follow up: 1-5 years. B.P.B.: 31 cases (48.4%). Hamstring tendons: 33 cases (51.6%). Variables analyzed were affiliation, pre and postoperative clinical examination, MRI, Lysholm scale, surgical aspects and complications, among others. Statistical tests used were Student t, Mann Whitney and Chi Square. Analysis by S.P.S.S. 15.0. Level IV of evidence. Results: pre and postoperative Lysholm score was 14 ± 7.5 and 86.7 ± 9.9 points, respectively. There were statistically significant differences (p <0.05), in favor of patellar tendon in operative time (62.7 ± 10.6 minutes vs 79 ± 15.6 minutes), rehabilitation time (115.1 ± 30.5 days vs 31.8 ± 139.8 days), time whithout working (132.9 ± 20 days vs 155.3 ± 41.4 days) or negative postsurgical Lachmann (100% vs 45% of cases). However, there was a greater reduction in joint space with patellar tendon (9.7% vs. 0%). Conclusions: Repair of L.C.A. in our experience, requires minor surgical time, rehabilitation time and present a lower postoperative Lachmann’s test,with B.P.B. Rigid Fix(TM). There would be no clinical differences between the two systems about Lysholm's score

Análisis de efectividad del citrato de fentanilo sublingual en pacientes con dolor irruptivo: estudio Sublime / No disponible

Introducción: la literatura científica indica que dos de cada tres pacientes con dolor crónico sufren con cierta frecuencia exacerbaciones puntuales del mismo debido a diferentes causas, en ocasiones previsibles, y en otras inesperadas. Además del sufrimiento que conllevan, estos episodios constituyen un problema importante para el paciente pues generan ansiedad y añaden incapacidad funcional, lo cual se traduce en una mayor dificultad para controlar el dolor basal y una menor calidad de vida. En 1990 se acuñó en Estados Unidos el término “breakthrough pain”, para definir a las exacerbaciones transitorias de un dolor oncológico, que está bien controlado con la utilización de opioides mayores. En el año 2002, la Sociedad Española de Oncología Médica (SEOM), la Sociedad Española de Cuidados Paliativos (SECPAL) y la Sociedad Española del Dolor (SED), establecieron un documento de consenso en el que asumieron el término “dolor irruptivo”, para definir una exacerbación del dolor de forma súbita y transitoria, de gran intensidad (EVA > 7) y de corta duración (usualmente inferior a 20-30 minutos), que aparece sobre la base de un dolor persistente estable, cuando este se encuentra reducido a un nivel tolerable (EVA < 5) mediante el uso fundamental de opioides mayores...(AU)

Introduction: the scientific literature suggests that two in every three patients with chronic pain every so often suffer from transient exacerbations because of various causes, some of them predictable and some unexpected. In addition to the suffering they bring about, these episodes represent a relevant issue for patients as they trigger anxiety and add functional disability, which translates into greater difficulties in controlling baseline pain and lower quality of life. In 1990 the term “breakthrough pain” was coined in the United States to define transient cancer pain exacerbations under appropriate pain management with major opioids. In 2002, Sociedad Española de Oncología Médica (SEOM), Sociedad Española de Cuidados Paliativos (SECPAL), and Sociedad Española del Dolor (SED) defined a consensus document wherein the term “dolor irruptivo” (irruptive pain) was adopted to define sudden, transient (usually less than 20- 30 minutes), severe (VAS > 7) pain breakouts on the background of stable, persistent pain that remains tolerable (VAS < 5) under primarily major opioids. Overall, three etiologies are recognized for irruptive pain: incidental irruptive pain; idiopathic or spontaneous irruptive pain, and irruptive pain from end-of-dose medication failure. Objectives: the main goal of this work was to retrospectively study the effectiveness of sublingual fentanyl citrate in 180 patients treated for irruptive pain in Andalusian pain units during 1 month. Secondary goals included a description of the clinical indications and epidemiologic features of patients with irruptive pain under sublingual fentanyl citrate; understanding sublingual fentanyl citrate regimens for patients with irruptive pain; and a research of adverse events potentially associated with the use of sublingual fentanyl citrate in patients with irruptive pain. Material and methods: a retrospective, observational study of 180 patients, of whom 173 completed the study. Inclusion criteria (patients had to meet one of the following two) were: IP episodes with VAS > 5 during the last 12-24 hours and/or undesired side effects arising from the current therapy for irruptive pain. Within the primary goal an analysis of the results for each VAS follow-up, the number of irruptive pain events, and pain relief onset was performed. Similarly, an analysis was also performed to compare these variables in the cancer pain group versus the non-cancer pain group, and in the idiopathic pain group versus the incidental pain group. Regarding secondary goals, age, gender, patient profile (adverse effects and irruptive pain episodes), active substance for baseline pain management, percentage of patients taking an additional 100 mcg dose of sublingual fentanyl, fentanyl dose per episode, mean fentanyl dose a day, and adverse effects were also analyzed...(AU)

[Systemic autoimmune disease in patients with uveitis]. / Enfermedad autoinmune sistémica en pacientes con uveítis.

OBJECTIVE: A descriptive study was conducted on patients with uveitis to determine the frequency of associated autoimmune systemic diseases. METHODS: 64 patients with uveitis were studied. The patients were not known to have an underlying autoimmune systemic disease prior to the diagnosis of uveitis. All patients had the following immunological tests performed: serum immunoglobulins, complement components, circulating immune complexes (CIC), antinuclear antibodies (ANA), anti-neutrophil cytoplasmic antibodies (ANCA), anti-cardiolipin antibodies (ACA) and major histocompatibilty complex antigens. RESULTS: A relationship with a sub-clinical autoimmune systemic disorder could be presumed in eleven cases (17.2%). This was defined by positive autoantibodies (ANA, ANCA or ACA) in the presence of complement consumption, hyper-gammaglobulinemia or increased CIC without clinical criteria of a defined autoimmune disease. A definite association with systemic autoimmune disease was defined in four patients (6.25%). The observed autoimmune systemic diseases were Sjögren's syndrome (n=2, 3.13%), anti-phospholipid syndrome associated with lupus-like disease (n=1, 1.6%), and systemic vasculitis (n=1, 1.6%). Lupus-like disease (n=4, 6.25%) was also observed. CONCLUSION: In a significant proportion of patients with uveitis an autoimmune systemic disorder may be present and should be looked for.

Enfermedad autoinmune sistémica en pacientes con uveítis / Systemic autoimmune disease in patients with uveitis

Objetivo: La realización de un estudio descriptivoen pacientes con uveítis para establecer la frecuenciade enfermedad autoimmune sistémica asociada.Métodos: Se incluyeron en el estudio 64 pacientescon uveítis. Ninguno de los pacientes estudiadostenia una enfermedad autoinmune sistémica conocidaantes del diagnóstico de uveítis. A todos lospacientes se les realizó un protocolo diagnósticoque incluyó las siguientes pruebas inmunológicas:inmunoglobulinas séricas, factores del complemento,inmunocomplejos circulantes (ICC), anticuerposantinucleares (ANA), anticuerpos anticitoplasma deneutrófilos (ANCA), anticuerpos anticardiolipina(ACA) y antígenos del complejo mayor de histocompatibilidad.Resultados: En once casos (17,2%) se objetivóasociación con un proceso autoinmune subclínicocaracterizado por la positividad de autoanticuerpos(ANA, ANCA o ACA) en presencia de consumo decomplemento, hipergammaglobulinemia o ICC elevados, sin que los pacientes cumpliesen criteriosclínicos de una enfermedad autoinmune. Se encontróuna asociación definitiva con enfermedadautoimmune sistémica en cuatro pacientes (6,25%).Las enfermedades autoinmunes observadas fueronel síndrome de Sjögren (n=2, 3,13%), síndromeantifosfolípido asociado a enfermedad lupus like(n=1, 1,6%) y vasculitis sistémica (n=1, 1,6%).También se observó un grupo de pacientes conenfermedad lupus like (n=4, 6,25%).Conclusión: En una proporción de pacientes conuveítis puede existir un proceso autoimmune sistémicosubyacente

Objective: A descriptive study was conducted on patients with uveitis to determine the frequency of associated autoimmune systemic diseases. Methods: 64 patients with uveitis were studied. The patients were not known to have an underlying autoimmune systemic disease prior to the diagnosis of uveitis. All patients had the following immunological tests performed: serum immunoglobulins, complement components, circulating immune complexes (CIC), antinuclear antibodies (ANA), antineutrophil cytoplasmic antibodies (ANCA), anticardiolipin antibodies (ACA) and major histocompatibilty complex antigens. Results: A relationship with a sub-clinical autoimmune systemic disorder could be presumed in eleven cases (17.2%). This was defined by positive autoantibodies (ANA, ANCA or ACA) in the presence of complement consumption, hyper-gammaglobulinemia or increased CIC without clinical criteria of a defined autoimmune disease. A definite association with systemic autoimmune disease was defined in four patients (6.25%). The observed autoimmune systemic diseases were Sjögren’s syndrome (n=2, 3.13%), anti-phospholipid syndrome associated with lupus-like disease (n=1, 1.6%), and systemic vasculitis (n=1, 1.6%). Lupus-like disease (n=4, 6.25%) was also observed. Conclusion: In a significant proportion of patients with uveitis an autoimmune systemic disorder may be present and should be looked for

Reconstrucción del maxilar superior mediante transporte del proceso alveolar. Presentación de un caso / Reconstruction of the maxilla by means of transport of the alveolar process. A case report

La osteogénesis mediante distracción aplicada a la reconstrucción del proceso alveolar es una técnica sobradamente contrastada en la literatura, al igual que la utilización del transporte óseo en la reconstrucciónde defectos segmentarios mandibulares.Presentamos en este artículo un caso de reconstrucción de un defecto segmentario del maxilar superior mediante transporte de proceso alveolar y su posterior rehabilitación protésica implantosoportada. Mostramos tanto la técnica quirúrgica como el manejo de del vector de distracción utilizando elásticos de ortodoncia y tornillos de bloqueo intermaxilar (AU)

Osteogenesis by means of distraction applied to the reconstruction of the alveolar process is a well-documented technique in the literature, as is the use of bone transport in the reconstruction of mandibular segment defects.In the present article we report on a case of reconstruction of a segment defect in the maxilla using the alveolar transport process, and on the subsequent rehabilitation by means of an implant-supportedprosthesis. Both the surgical technique and the handling of the distraction vector using orthodontic bands and inter-maxillary fixation screws are shown (AU)

Infección por parvovirus B1 9 con rash petequial en un adulto / No disponible

No disponible

Linfoma primario pericárdico en la infección por VIH / Primary pericardial lymphoma in HIV infection

No disponible

Estudio multicéntrico abierto no comparativo sobre la eficacia y la seguridad del acetónido de triamcinolona -inhalador nasal- una vez al día por tres meses en los síntomas de rinitis alérgica perenne / Non operative open label multicenter study on the efficacy and security of triamcinolone acetonide -nasal inhalator- once daily for three months in the treatment of the symptoms of permanent allergic rhinitis

Objetivo: evaluar la respuesta clínica (evolución de los síntomas de rinitis y manifestaciones alérgicas) en un grupo de pacientes con diagnóstico de rinitis alérgica perenne, luego de la administración de acetónido de triamcinolona -inhalador nasal- 110 a 220 mcg/1 vez al día (según la edad y severidad de los síntomas) y describir la tolerabilidad de la medicación administrada durante 3 meses. Diseño: estudio clínico observacional, descriptivo (serie de casos)., fase IV, no comparativo, abierto. Pacientes centros: fueron incluidos en el estudio 61 pacientes evaluados en 14 centros, con diagnóstico de rinitis alérgica perenne, mayores de 4 años, sin contraindicaciones para administración de acetónido de triamcinolona. Variables de seguridad y eficacia: frecuencia de eventos adversos. Evolución de una escala de severidad de la sintomatología de rinitis en 4 dominios: congestión nasal, estornudos, prurito y secreción nasal. Evaluación global subjetiva de mejoría por parte del médico tratante y del paciente. Resultados: se reclutaron 61 pacientes, 26 hombres (42,6 por ciento) y 35 mujeres (57,4 por ciento), con edades entre 4 y 48 años (promedio: 23 años). El seguimiento planeado a 3 meses fue logrado en 52 sujetos. Se administró una dosis diaria de acetónido de triamcinolona -inhalador nasal- por un período de 12 semanas. Los pacientes fueron evaluados antes de iniciar el tratamiento y a las semanas 6 y 12. Se produjo una reducción significativa en el puntaje de severidad de la rinitis de un valor mediano de 10 antes de tratamiento a 0 a las 12 semanas (p<0,001). No se presentaron efectos adversos severos y solo un efecto leve (costras nasales) fue relacionado con la administración de acetónido de triamcinolona -inhalador nasal- , no obstante no se requirió descontinuar el medicamento. Conclusiones: el tratamiento de los síntomas de la rinitis alérgica perenne con acetónido de triamcinolona -inhalador nasal- mostró una reducción clínica y estadísticamente significativa de la sintomatología en la mayoría de los pacientes tratados y fue excelentemente tolerado

Envejecimiento y neurodegeneración:bases moleculares y celulares / Aging and neurodegeneration: molecular and cellular bases

Objetivo. Se lleva a cabo una revisión actualizada sobre las posibles causas celulares y moleculares que subyacen al proceso de envejecimiento cerebral así como a las enfermedades neurodegenerativas asociadas. Desarrollo. A partir de las lesiones morfológicas e histológicas que se detectan tanto en procesos neurodegenerativos como durante el envejecimiento fisiológico, se analizan las causas que conducen a la pérdida de neuronas y de conectividad nerviosa, así como a los procesos de reactividad glial, como base morfofuncional del deterioro de los procesos cognitivo e intelectual que caracterizan la senescencia. Se correlacionan todos estos datos con las posibles bases genéticas del proceso de envejecimiento, llevando a cabo una revisión de los hallazgos más relevantes sobre senescencia y muerte celular obtenidos en levaduras, mosca de la fruta y nematodos. Tras una breve revisión sobre gerontogenes y mecanismos de apoptosis, se analizan las causas inductoras del proceso de envejecimiento y neurodegeneración, y se interrelacionan las diferentes hipótesis que barajan las teorías más actuales sobre el tema. Finalmente se integran todos los datos celulares, bioquímicos y genéticos, a partir de la puesta en marcha de sistemas de transducción de señales que provocan la elevación de los niveles de calcio citosólico y el disparo del proceso de muerte celular. Conclusiones. Diversas causas inductoras, que pueden activar o inhibir grupos de genes, entre las que se cuentan, deficiencias de factores neurotróficos, hipoxia e hipoglucemia, excitotoxicidad, producción de radicales libres de oxígeno y de nitrógeno, desencadenan procesos de muerte neuronal responsables del envejecimiento y de las enfermedades neurodegenerativas asociadas (AU)

Enfermedades importadas 'tropicales': experiencia de una consulta especializada en un hospital general / Imported 'tropical' diseases: experience of a specialty clinic in a general hospital

Introducción. En los últimos años el incremento de viajeros, organizaciones de cooperación internacional y de inmigrantes ha originado un aumento considerable de las enfermedades importadas, y por ello la creación de unidades especializadas. Material y métodos. Se realiza un estudio de las características de los pacientes atendidos en la Unidad de Enfermedades Tropicales del Hospital de Basurto desde el inicio de su funcionamiento en marzo de 1996 hasta marzo de 1999.Resultados. En el período del estudio fueron atendidos, tras estancia en zonas tropicales, 171 pacientes. De éstos, 72 eran turistas, 50 cooperantes de Organizaciones No Gubernamentales (ONG) y 49 inmigrantes. Las áreas de procedencia fueron: África en 84 casos, Centroamérica-Caribe en 49, Sudamérica en 23 y Asia en 15. Los principales motivos de consulta fueron: fiebre (61 casos), síntomas digestivos (40 casos) y problemas cutáneos (31 casos), y los diagnósticos más frecuentes: paludismo (34), fiebre autolimitada (17), diarrea autolimitada (16), amebiasis (8), giardiasis (6), sarna (7) y larva migrañas cutánea (5).Conclusiones. La actividad asistencial ha incluido aspectos preventivos, pero fundamentalmente el diagnóstico y tratamiento de enfermedades importadas. Entre las personas atendidas se encuentran no solamente viajeros, sino una proporción importante de inmigrantes y cooperantes de ONG. Las enfermedades más frecuentes han sido el paludismo y enfermedades digestivas y cutáneas (AU)

["Tropical" imported diseases: experience of a specialized unit in a general hospital]. / Enfermedades importadas "tropicales": experiencia de una consulta especializada en un hospital general.

BACKGROUND: In the last few years a considerable increase in imported diseases has occurred as a result of an increase in the numbers of travellers, international collaborative organizations, and immigrants. Altogether, this has prompted the setting-up of specialized units. MATERIALS AND METHODS: A report is given of the characteristics of patients attended at the Tropical Diseases Unit in the Basurto Hospital, since its set-up in March 1996 to March 1999. RESULTS: A total of 171 patients were attended at this unit after staying in tropical areas. Patients were classified as tourists (72), ONG collaborators (50) and immigrants (49). The origin areas were Africa (84 cases), Central America (49 cases), South America (23 cases) and Asia (15 cases). The main complaints included fever (61 cases), digestive symptoms (40 cases), skin problems (31 cases). The most common diagnoses were malaria (34), self-limited fever (17), self-limited diarrhoea (16), amebiasis (8), giardiasis (6), scabies (7) and cutaneous larva migrans (5). CONCLUSIONS: Health care activities included preventive issues, but mainly diagnosis and treatment of imported diseases. Among the attended individuals, there were not only travellers but also a significant proportion of immigrants and ONG collaborators. The most common diseases were malaria and digestive and cutaneous conditions.

[Aging and neurodegeneration: molecular and cellular bases]. / Envejecimiento y neurodegeneración: bases moleculares y celulares.

OBJECTIVE: A review about the possible cellular and molecular mechanisms of aging and related neurodegenerative diseases. DEVELOPMENT: The mechanisms involved in neuronal decrease, connectivity losses and glial reactivity, detected both in neurodegenerative (Alzheimer's disease) and physiological aging, are analyzed from the morphological and histological point of view to provide the morphofunctional base of the cognitive and intellectual alterations characterizing the senescence process. Taken together, these data are correlated to the possible genetical aspects implied in this process, reviewing the most relevant results on senescence and cellular death obtained from yeast, fruit fly and nematodes; besides this, a brief review of the molecular biology of gerontogenes was carried out, and the possible mechanisms inducing aging and neurodegenerative processes are analyzed according to the state-of-the-art related theories. Finally, cellular, biochemical and genetical data are correlated in the signal transduction way implied in the increase of the intracellular calcium level as the starting point of cell death. CONCLUSIONS: The main process implied in the neuronal cell death responsible for aging and the related neurodegenerative diseases are started by different agents such as the lacking of neurotrophic factors, hypoxia, hypoglycemia, excitotoxicity, and oxygen and nitrogen free radicals.

[Acute pancreatitis and infection with the human immunodeficiency virus]. / Pancreatitis aguda e infección por el virus de la immunodeficiencia humana.

BACKGROUND: Retrospective study of the etiology and evolution of 40 episodes of acute pancreatitis in 28 patients infected with the human immunodeficiency virus (HIV). RESULTS: AIDS criteria were met by 89.3% of patients. The likely etiology was an opportunist infection in 32.5% of episodes, drug use in 22.5%, and biliary lithiasis in 5%. AP secondary to AIDS-associated cholangitis occurred in 35.7% of episodes. Sixty percent of episodes were severe in nature. The mortality rate reached 30%. CONCLUSIONS: AP in HIV infected patients: a) is more frequent in the advanced stages of disease; b) opportunistic infections and drugs are the most frequent causes in our environment; c) in a third of patients it is probably secondary to AIDS associated cholangitis; d) biliary lithiasis seems to be less common than in the general population, and e) it is associated with a high severity and mortality.

[Primary adrenal failure and AIDS: report of 11 cases and review of the literature]. / Insuficiencia suprarrenal primaria y SIDA: descripción de once casos y revisión de la literatura.

OBJECTIVE: To know the prevalence of adrenal insufficiency (AI) in our patients with acquired immunodeficiency syndrome (AIDS) and to compare the clinical manifestations with those reported in previous series in the literature. PATIENTS AND METHODS: Retrospective study with review of clinical records of patients with AIDS diagnosed of AI (plasma cortisol after synthetic ACTH < 18 micrograms/dl) in our hospital for a period of 6 and a half years. RESULTS: Eleven out of 65 patients (17%) with the hormonal study performed were diagnosed of AI. The prevalence of AI in our patients with AIDS was 1.66%. The response of plasma cortisol to synthetic ACTH was abnormal in the 11 patients (mean increase: 1.89 micrograms/dl). Nine out of the 11 patients had a decreased basal plasma cortisol level (mean: 4.75 micrograms/dl). Basal plasma ACTH levels were increased (mean: 638.9 pg/ml) in seven out of nine patients. Patients were severely immunosuppressed (mean CD4: 21/microliter). While the clinical course was subacute (mean: 5.1 weeks), nine out of the eleven patients developed an adrenal crisis which required emergency therapy. Ten patients had an opportunist infection--M. tuberculosis (3), M. avium-intracellulare (3), Cytomegalovirus (3), histoplasmosis (1)--which could involve the adrenal glands in ten patients. All patients responded to treatment but their mean survival was 5.6 weeks. CONCLUSIONS: Although the prevalence of AI in our patients with AIDS was low (1.66%), it is important to be aware of the disease and to order a basal plasma cortisol value after synthetic ACTH, as treatment improves the life quality of patients if AI is confirmed, despite a short survival time.