Efficacy of the Therapeutic Game "Trisquel" in the Treatment of Patients With Substance-Related Disorders Randomized Clinical Study.

Substance-related disorders (SRD) have been consistently associated with alterations both in cognitive and executive functions, which affect to patients' quality of life. The main objective of this work was to test the beneficial cognitive effects on patients with SRD after the implementation of "Trisquel," an intervention program in board game format. To check the effectiveness of Trisquel program, a group of people diagnosed with SRD was randomly assigned either to the experimental group or to the control group. The experimental group performed Trisquel structured sessions twice a week during 3 months, while the control group performed routinely conventional therapeutic activities with the same frequency and duration. Neuropsychological tests were done to both groups before and after the intervention. After the 3 months of intervention the experimental group showed the following statistically significant improvements for WAIS-III subtests: number key, symbol search, arithmetic, direct digits, inverse digits, total digits, letters-numbers in the processing speed index and in the working memory index. Regarding STROOP tests, statistically significant progress was observed in the phonetic fluency letter P, phonetic fluency letter M, phonetic fluency letter R subtests, word-reading and word-color subtests. The control group only obtained improvements for WAIS-III subtests of arithmetic, letters-numbers and in the working memory index. The results of this study confirm that "Trisquel" is an effective intervention program for people diagnosed with SRD, getting improvements in processing speed (psychomotor and reading), attentional subprocesses (focused and sustained) and executive functions (updating and inhibition).

The nuclear corepressor 1 and the thyroid hormone receptor ß suppress breast tumor lymphangiogenesis.

Vascular Endotelial Growth Factors C and D (VEGF-C and VEGF-D) are crucial regulators of lymphangiogenesis, a main event in the metastatic spread of breast cancer tumors. Although inhibition of lymphangiogenic gene expression might be a useful therapeutic strategy to restrict the progression of cancer, the factors involved in the transcriptional repression of these genes are still unknown. We have previously shown that Nuclear Receptor Corepressor 1 (NCoR) and the thyroid hormone receptor ß1 (TRß) inhibit tumor invasion. Here we show that these molecules repress VEGF-C and VEGF-D gene transcription in breast cancer cells, reducing lymphatic vessel density and sentinel lymph node invasion in tumor xenografts. The clinical significance of these results is stressed by the finding that NCoR and TRß transcripts correlate negatively with those of the lymphangiogenic genes and the lymphatic vessel marker LYVE-1 in human breast tumors. Our results point to the use of NCoR and TRß as potential biomarkers for diagnosis or prognosis in breast cancer and suggest that further studies of these molecules as potential targets for anti-lymphangiogenic therapy are warranted.

Automatic Vessel Shade-Robust Segmentation of Retinal Layers in OCT Images.

Optical Coherence Tomography (OCT) is a promising imaging technique used by ophthalmologists to diagnose diseases. Since retinal morphology can be identified on these images, several image processing-based methods are emerging with the purpose of extracting their information. The first step to tackle any automatic method to extract pathological features from these images is delimiting retinal layers automatically. This is the aim of this paper, which presents an active contour-based method to segment layer boundaries in the retina. Results obtained by this method present high accuracy and robustness, even when some of these layers are low defined or vessel shades are present.

[Pelvic inflammatory disease due to Herlyn-Werner-Wunderlich syndrome]. / Enfermedad inflamatoria pélvica causada por el síndrome de Herlyn-Werner-Wunderlich.

BACKGROUND: Herlyn-Werner-Wunderlich syndrome is a congenital urogenital malformation that is associated with a uterus didelphys and a longitudinal vaginal septum, resulting in a blind hemivagina and ipsilateral renal agenesis. Clinical presentation is highly variable, delaying diagnosis and leading to important complications. CLINICAL CASE: We present the case of a 13-year-old female who was diagnosed with Herlyn-Werner-Wunderlich syndrome following an acute abdomen due to a right tubo-ovarian abscess. She had a vaginal septum giving rise to a right blind hemivagina. It was microperforated, causing intermittent genital bleeding. This hematocolpos was colonized by microorganisms that ascended to the pelvic cavity, causing right tuboovarian abscess. Nuclear magnetic resonance imaging provided theWernermost diagnostic information. We performed a vaginal septum resection, and both hemiuteros communicated with a single vagina, resulting in an asymptomatic patient. CONCLUSION: Herlyn-Werner-Wunderlich syndrome is a little known entity and can be presented atypically, resulting in diagnostic difficulty and treatment delay. It is important to be aware of this syndrome in order to avoid irreversible complications.

ANTECEDENTES: el síndrome de Herlyn-Werner-Wunderlich es una malformación urogenital congénita que asocia un útero didelfo con un tabique vaginal longitudinal que forma una hemivagina ciega y agenesia renal ipsilateral a ésta. La presentación clínica es muy variable, lo que retrasa el diagnóstico y provoca algunas complicaciones que pueden ser graves. Caso clínico: paciente femenina de 13 años de edad, con diagnóstico de síndrome de Herlyn-Werner-Wunderlich a raíz de un cuadro de abdomen agudo por un absceso tuboovárico derecho. El tabique vaginal formaba una hemivagina ciega derecha microperforada que provocaba sangrados genitales intermitentes. Este hematocolpos se colonizó con microorganismos y el ascenso de estos a la cavidad pélvica causó el absceso tuboovárico derecho. La resonancia magnética nuclear aportó mayor información para el diagnóstico. La resección del tabique vaginal comunicó los dos hemiúteros con una sola vagina y los síntomas desaparecieron. CONCLUSIÓN: el síndrome de Herlyn-Werner-Wunderlich es poco conocido y puede manifestarse de forma atípica, lo que dificulta el diagnóstico y retrasa el tratamiento. Para evitar complicaciones irreversibles es importante mantener una alta sospecha clínica.

Metástasis peritoneales en cáncer de mama / Peritoneal carcinomatosis due to metastatic spread of lobular carcinoma of the breast

El cáncer de mama lobulillar infiltrante presenta un especial tropismo sobre la cavidad peritoneal, aparato genitourinario y gastrointestinal. Describimos 2 casos de carcinomatosis peritoneal secundaria a la diseminación metastásica de un carcinoma lobulillar infiltrante de mama. El diagnóstico se hizo años después de la aparición del tumor primario. La carcinomatosis peritoneal (asociada a metástasis genitourinarias y/o gastrointestinales) en cáncer de mama es rara, siendo más frecuente en el tipo lobulillar infiltrante. Su diagnóstico es difícil dada la inespecificidad de la sintomatología y el largo periodo que, con frecuencia, ocurre desde el diagnóstico inicial del tumor mamario hasta la afectación peritoneal. La sospecha clínica y el estudio histológico-inmunohistoquímico ayudan a diferenciar entre un tumor primario de cavidad peritoneal y metástasis de carcinoma de mama. Debe individualizarse el tratamiento en cada caso (AU)

Invasive lobular breast cancer has a special tropism for the peritoneal cavity and gastrointestinal and genitourinary systems. We describe 2 cases of peritoneal carcinomatosis secondary to metastatic spread of lobular carcinoma of the breast. The diagnosis was made several years after detection of the primary tumor. The peritoneal carcinomatosis (with genitourinary or gastrointestinal metastases) in breast cancer is rare and is most frequent in invasive lobular carcinoma. Diagnosis is difficult because the symptoms are often nonspecific and there is often a long interval between the initial diagnosis of breast cancer and peritoneal involvement. Clinical suspicion and histological-immunohistochemical study help to differentiate between a primary tumor of the peritoneal cavity and the presence of metastatic breast carcinoma. Treatment should be individualized in each patient (AU)

Inversión uterina total: reposición mediante expresión manual del cuerpo uterino por vía laparotómica / Complete uterine inversion: manual repositioning after laparotomy

La inversión uterina es una de las complicaciones más graves que pueden suceder en la tercera etapa del parto. Presentamos el caso de una gestación que finaliza en un parto eutócico, objetivando una inversión uterina total, que no se puede resolver por vía vaginal precisando abordaje laparotómico. La inversión se reduce mediante presión manual del cuerpo uterino hasta que el fondo uterino queda totalmente repuesto. La evolución posterior de la paciente es favorable. Hemos realizado una revisión de la literatura científica analizando la incidencia, factores de riesgo, clasificación, clínica y opciones terapéuticas relacionadas con dicha complicación (AU)

Uterine inversion is one of the most life-threatening obstetric emergencies that can occur during the third stage of labor. We present a case of acute complete uterine inversion following a vaginal birth. Manual vaginal manipulation was unsuccessful and surgical reduction by laparotomy was required. During the repositioning procedure, manual pressure was applied to the uterine body until the fundus reached its anatomic position. Subsequent patient outcome was favourable. A review of the literature was performed, focusing on the epidemiology, risk factors, classification, clinical findings and management of this complication (AU)

Técnica B-Lynch para el tratamiento de la hemorragia posparto / The B-Lynch technique for the treatment of postpartum hemorrhage

Objetivo Revisar la eficacia de la técnica descrita por B-Lynch en 8 casos de hemorragia posparto precoz secundaria a atonía uterina refractarios al tratamiento médico convencional. Sujetos y métodos Estudio retrospectivo descriptivo de 8 casos de atonía uterina en los que se aplicó la técnica de B-Lynch en nuestro centro entre 2004 y 2009.ResultadosEn 7 casos en los que se realizó la técnica se consiguió resolver el problema hemorrágico, excepto en uno de ellos en el que hubo que hacer una histerectomía obstétrica. Conclusiones La técnica de B-Lynch es una técnica efectiva, rápida y segura en el tratamiento de la atonía uterina, no obstante a veces hay que recurrir a la histerectomía obstétrica, como último recurso, cuando anteriormente nos han fracasado todas las técnicas, para permitir conservar la integridad uterina (AU)

Objective To review the effectiveness of the technique described by B-Lynch in 8 cases of early postpartum hemorrhage secondary to uterine atony refractory to medical treatment. Subjects and methods We performed a retrospective descriptive study of 8 cases of uterine atony treated with the B-Lynch technique in our center between 2004 and 2009.ResultsHemorrhage was resolved in 7 patients. Obstetric hysterectomy was required in the remaining patient. Conclusions The B-Lynch technique is effective, safe and rapid in the treatment of uterine atony. However, obstetric hysterectomy may be required as a last resort when all other uterine-conserving techniques have failed (AU)

Torsión anexial: experiencia en el Complejo Hospitalario Universitario de Albacete / Adnexal torsion: experience at the Albacete University Hospital Complex

Objetivo. Evaluar el manejo de las torsiones anexiales en nuestro centro durante un periodo de 10 años. Pacientes y métodos. Estudiamos los casos de torsión anexial en pacientes en edad reproductiva manejados quirúrgicamente entre los años 1997 y 2007. Analizamos retrospectivamente los hallazgos clínicos, ecográficos, quirúrgicos e histológicos, así como el tratamiento realizado y el seguimiento de dichas pacientes. Resultados. Identificamos 25 casos de torsión anexial en 24 pacientes. El 92% tenía dolor abdominal, el 32% náuseas y/o vómitos, el 4% fiebre y el 54,2% leucocitosis. El hallazgo ecográfico más frecuente fue de tumoración compleja (52,2%). Sólo sospechamos torsión en la primera valoración en el 8% de los casos y antes de la cirugía en el 36%. El 72% de las torsiones involucraron al anejo derecho y el 52% a un anejo tumoral. La sospecha de necrosis se confirmó en el 66,6% y el diagnóstico histopatológico más frecuente fue el de teratoma (28,6%). Realizamos tratamiento conservador mediante destorsión y/o quistectomía en el 40% y en estas pacientes el control posterior fue normal. Conclusiones. El síntoma más frecuente cuando existe una torsión anexial es el dolor abdominal y la sospecha clínica en la primera valoración es poco frecuente, siendo habitual el diagnóstico durante la cirugía. Cuando se torsiona un anejo tumoral suele haber un teratoma y en muchas ocasiones realizamos tratamiento conservador con buena evolución (AU)

Objective. To evaluate the management of adnexal torsion in our center during a 10-year period. Patients and methods. We studied cases of adnexal torsion in patients of reproductive age treated surgically between 1997 and 2007. The clinical, ultrasonographic, surgical and histological findings, as well as the treatment and follow-up of these patients, were retrospectively analyzed. Results. We identified 25 cases of adnexal torsion in 24 patients. Abdominal pain was present in 92%, nausea and/or vomiting in 32%, fever in 4% and leucocytosis in 54.2%. The most frequent echographic findings were complex tumors (52.2%). Torsion was suspected in the first evaluation in only 8% of the cases and before surgery in 36%. Most (72%) of the torsions involved the right adnexa and 52% a tumoral adnexa. Suspicion of necrosis was confirmed in 66.6% and the most frequent histopathological diagnosis was teratoma (28.6%). Conservative treatment was performed through detorsion and/or cystectomy in 40% and in patients whose subsequent clinical course was normal. Conclusions. When an adnexal torsion is present, the most frequent symptom is abdominal pain. Clinical suspicion in the first evaluation is infrequent, and diagnosis is usually made during surgery. When a tumoral adnexa is torsioned, a teratoma is usually present. Conservative treatment is often performed with good results (AU)

Recurrencia del tumor ovárico de las células de la granulosa / Recurrence of ovarian granulosa cell tumor

Presentamos el caso de una mujer de 79 años, con antecedentes de un supuesto fibroma ovárico, que comienza con un cuadro de dolor en fosa ilíaca izquierda y leucocitosis, siendo diagnosticada de diverticulitis. Durante el estudio, incidentalmente se descubre una masa en la pared abdominal anterior que resultó ser una recidiva de un tumor de células de la granulosa. Realizamos una revisión bibliográfica de esta patología centrándonos, fundamentalmente, en sus aspectos clínicos y terapéuticos. Se trata de una neoplasia muy poco frecuente, sobre la que hay pocos estudios, que se caracteriza por su larga historia natural y su tendencia a recurrir años después del diagnóstico (AU)

We present the case of a 79-year-old woman who was misdiagnosed with an ovarian fibroma 5 years previously. The patient presented with pain in the right iliac fossa with leukocytosis and was diagnosed with diverticulitis. A mass was incidentally found in the anterior abdominal wall, which was later confirmed as metastasis from a granulosa cell tumor of the ovary. We provide a literature review, focussing on the clinical findings and treatment of this tumor. Few reports have been published of this uncommon entity, characterized by a long natural history and tendency to recur years after the initial diagnosis (AU)

Morbimortalidad materna y fetal en pacientes con preeclampsia grave / Morbidity and maternal and fetal mortality in patients with severe preeclampsia

Objetivo. La presencia de preeclampsia, combinación de hipertensión y proteinuria tras la 20 semana de gestación aumenta de una manera notoria el riesgo de mortalidad y morbilidad perinatal y materna. Sujeto y métodos. El objetivo del estudio realizado es conocer los resultados perinatales y la morbimortalidad materna en las mujeres que presentaron una preeclampsia grave en el Complejo Hospitalario de Albacete. Conclusiones. Analizando nuestros resultados, hemos observado que en nuestra muestra la mortalidad, tanto materna como fetal, fue menor que la observada por otros autores y los neonatos de las mujeres que desarrollaron preeclampsia grave que ingresaron en la unidad de cuidados intensivos con eclampsia o síndrome de HELLP tuvieron una mayor morbilidad(AU)

Objective. The presence of preeclampsia, combination of hypertension and proteinuria after 20 weeks of gestation, would noticeably increase the risk of maternal and fetal morbi-mortality. Subject and methods. The objective of the study is to determine the perinatal outcome and maternal morbidity and mortality in women with severe preeclampsia at Albacete hospital. Conclusions. Analyzing our results we observed in our sample both maternal and fetal mortality was lower than that observed by other authors and infants of women who develop severe preeclampsia admitted to the ICU, with eclampsia or HELLP syndrome had a higher morbidity(AU)