Roles of tandem-pore K+ channels in plants - a puzzle still to be solved.

The group of voltage-independent K(+) channels in Arabidopsis thaliana consists of six members, five tandem-pore channels (TPK1-TPK5) and a single K(ir)-like channel (KCO3). All TPK/KCO channels are located at the vacuolar membrane except for TPK4, which was shown to be a plasma membrane channel in pollen. The vacuolar channels interact with 14-3-3 proteins (also called General Regulating Factors, GRFs), indicating regulation at the level of protein-protein interactions. Here we review current knowledge about these ion channels and their genes, and highlight open questions that need to be urgently addressed in future studies to fully appreciate the physiological functions of these ion channels.

[Radioguided neurosurgery: a novel application of nuclear medicine]. / Neurocirugía radiodirigida: una aplicación novedosa de la Medicina Nuclear.

Brain tumours show uptake with Thallium-201 Chloride with high target/background rate and they would benefit from radioguided surgery. We report a patient with a brain tumor that was Thallium positive in a brain SPECT. On the next day in the operating room we injected 50 MBq of Thallium-201. At 40 minutes we confirmed tumour uptake with a gamma-probe and with a biopsy sample. After brain tumor resection was completed by conventional method, we found pathologic activity in tumoral bed with the gamma probe, that showed persistence of increased activity. After a new evaluation, residual tumor tissue was located in the pathological uptake area and was removed. Control CT showed complete resection, although the Thallium SPECT carried out after surgery showed faint uptake in the anterior pole of the surgical bed. Radioguided surgery was evaluated as a useful and promising technique by the neurosurgeon.

Diagnóstico, tratamiento y control de la infección causada por Clostridium difficile / Diagnosis, treatment and control of Clostridium difficile infection

La incidencia de la infección por Clostridium difficile ha ido aumentando progresivamente en las últimas décadas y en la actualidad se considera la primera causa de diarrea nosocomial en los países desarrollados, con grandes dificultades para su erradicación en el medio hospitalario. Los pacientes ancianos se encuentran especialmente predispuestos por los cambios asociados a la edad del aparato digestivo, junto con las características propias del envejecimiento (comorbilidad, mayor uso de antibióticos, etc.), y esta población es la principal afectada (hasta un 80% de los casos). La infección por C. difficile conlleva un aumento del gasto sanitario en relación con el aumento de la estancia hospitalaria, con una mayor morbimortalidad, con todos los aspectos diagnósticos y terapéuticos que esto implica. Los hospitales deberían desarrollar estrategias para la prevención y el control de la infección por C. difficile, que deberían incluir un adecuado uso de los antibióticos. Se expone una actualización de la infección por C. difficile con especiales referencias a la población anciana, a la vez que se desarrollan guías prácticas para su abordaje clínico hospitalario

In the last few decades, the incidence of Clostridium difficile infection has progressively increased. Currently, it is considered as the first cause of nosocomial diarrhoea in developed countries and its eradication in hospitals is extremely difficult. Elderly patients are especially predisposed because of age-related changes in the digestive system and the characteristics of ageing (comorbidity, frequent use of antibiotics, etc.) and they are the principal population group affected by this infection (up to 80% of cases). C. difficile infection increases health costs due to length of hospital stay and causes increased morbidity and mortality, with all the diagnostic and therapeutic aspects that this entails. Hospitals should develop strategies for the prevention and control of C. difficile infection, which should include appropriate use of antibiotics. We present an update on C. difficile infection with special reference to the elderly, as well as practical guides for its clinical management in hospitals

Hemorragia digestiva alta: etiología y procedimientos diagnósticos / High digestive tract hemorrhage: etiology and diagnostic approaches

Las causas más frecuentes de hemorragia digestiva alta (HDA) son la úlcera péptica y la hipertensión portal de la que no se trata en esta revisión. La úlcera péptica constituye el 37-50% de las causas, siendo más frecuente la duodenal que la gástrica. Los factores principales que influyen en su aparición son la infección por Helicobacter pylori y la administración de antiinflamatorios no esteroideos. Las lesiones agudas de la mucosa gástrica constituyen el 20% de las causas de HDA y se asocian a la toma de AINE, alcohol, o estado crítico del enfermo con ventilación mecánica, coagulopatía, lesiones neurológicas graves, politraumatizados, etc. La esofagitis, síndrome de Mallory-Weiss, lesiones vasculares, neoplasias esofagogástricas, fístula aortoentérica y hemobilia son causas menos frecuentes. Los procedimientos diagnósticos disponibles son la anamnesis y exploración física, hemograma, bioquímica, estudio de coagulación, colocación de sonda nasogástrica y lavados, panendoscopia oral, radiología baritada, angiografía, gammagrafía con sulfuro coloidal o hematíes marcados y la laparotomía exploradora. Se discute cada uno de ellos, resaltando la importancia de la panendoscopia oral (AU)

Peptic ulcer disease and portal hypertension are the most frequent etiology of high digestive tract hemorrhage (HDTH). Peptic ulcer disease accounts for 37-50% of all HDTH, being duodenal ulcer disease more frequent compared to gastric ulcer disease. Main determinants for the presence of HDTD are infection for Helicobacter pylori and use of non-steroidal antiinflammatory drugs (NSAID). Acute injuries of gastric mucose account for 20% HDTH and they are associated to NSAID or alcohol ingestion, critical state of the patient in mechanical ventilation, patients with coagulopathies or severe neurological and politraumatism injuries, etc. Less frequent causes of HDTD are esofagitis, Mallory-Weiss syndrome, vascular injuries, gastroesophagic cancer, aortoenteric fistula and hemobilia. The diagnostic procedures available currently are anamnesis and physical exploration, hemogram, blood biochemistry, study of coagulation, nasogastric probe and washes, oral panendoscopy, barium radiology, angiography, labelled eritrocyte or colloidal sulphur scintigraphy and exploratory laparotomy. Every approach is discussed, stressing the significance of oral panendoscopia (AU)

[Beta-cell, thyroid and celiac autoimmunity in children with type 1 diabetes]. / Autoinmunidad pancreática, tiroidea y relacionada con la celiaquía en niños con diabetes mellitus tipo 1.

OBJECTIVE: The aim of this study was to evaluate the presence of beta-cell, thyroid and coeliac autoimmunity in children with recent-onset type 1 diabetes. METHODS: We studied all children with newly diagnosed type 1 diabetes. Data were analyzed from 63 children aged 2-14 years who were treated in the Department of Pediatrics of the Virgen de las Nieves University Hospital in Granada (Spain) from 1998-2002. Antibodies to glutamic acid decarboxylase-65 (GADA), anti-insulin (AIA), thyroperoxidase (anti-TPO), thyroglobulin (anti-TG), thyroid-stimulating immunoglobulins (TSI) and endomysial antibodies (EmA-IgA) were measured and documented. A total of 55.5 % of these patients were girls and the mean age was 7.9 +/- 3.2 years. RESULTS: The prevalence rates were: GADA 65.1 %; AIA 68.3 %; anti-TPO 11.1 %; anti-TG 9.5 %; TSI 4.8 % and EmA-Ig A 3.1 %. Children with thyroid antibodies (anti-TPO1) were significantly older and developed diabetes later in life (P < 0.05) than those without antibodies. Thyroid-stimulating hormone levels, goiter and thyroid dysfunction were higher in children who were anti-TPO1 than in diabetic children without thyroid autoimmunity. CONCLUSIONS: Children with newly diagnosed type 1 diabetes show a high prevalence of thyroid and coeliac autoimmunity. In cases of positivity, additional work-up and intervention are advocated. These measures can prevent the well-known complications of diabetes and improve its clinical course.

Autoinmunidad pancreática, tiroidea y relacionada con la celiaquía en niños con diabetes mellitus tipo 1 / Beta-cell, thyroid and coeliac autoimmunity in children with type 1 diabetes

Objetivo: El objetivo de este estudio ha sido investigar en niños que presentan diabetes mellitus tipo 1 (DM1) la presencia de autoinmunidad pancreática, tiroidea y relacionada con la celiaquía. Métodos: Se incluyeron todos los niños que presentaron DM1. Se analizaron datos de 63 niños con un rango de edad de 2 a 14 años, que fueron tratados en el centro maternoinfantil del hospital universitario Virgen de las Nieves de Granada durante el período 1998-2002. Se midieron y registraron los anticuerpos antiglutamato descarboxilasa (GADA), antiinsulina (AAI), antiperoxidasa tiroidea (anti-TPO), antitiroglobulina (anti-TG), inmunoglobulinas estimulantes del tiroides (TSI) y anticuerpos antiendomisio (AAE-IgA) relacionados con la enfermedad celíaca. El 55,5 por ciento de los pacientes eran de sexo femenino, la edad media fue de 7,9 +/- 3,2 años. Resultados: El porcentaje de positividad para los distintos anticuerpos fue: GADA, 65,1 por ciento; AAI, 68,3 por ciento; anti-TPO, 11,1 por ciento; anti-TG, 9,5 por ciento; TSI, 4,8 por ciento y AAE-IgA, 3,1 por ciento. Los niños con autoinmunidad tiroidea presente eran en el momento del diagnóstico de su diabetes de mayor edad y desarrollaban su enfermedad más tarde que los niños sin autoinmunidad tiroidea. Los pacientes anti-TPO positivos presentaban niveles más elevados de hormona tirostimulante, mayor prevalencia de bocio y disfunción tiroidea que los niños sin anti-TPO. Conclusiones: Los niños que presentan DM1 presentan una alta prevalencia de autoinmunidad tiroidea y relacionada con la enfermedad celíaca. En caso de presentar estos marcadores positivos es preciso prestar especial atención a la posible asociación de otras enfermedades, completando los estudios que se precisen. Estas medidas pueden prevenir complicaciones y mejorar la evolución de la enfermedad diabética (AU)

Fístula broncobiliar entre un quiste hidatídico hepático y el lóbulo medio del pulmón derecho / Bronchobiliary fistulous tract between a liver hyda tid cyst and the middle lobe of the right lung

Presentamos el caso de una fístula broncobiliar entre un quiste hidatídico localizado en el lóbulo derecho hepático y el lóbulo medio del pulmón derecho, localización poco frecuente de estos trayectos fistulosos. Dado lo poco habitual de esta patología revisamos su etiopatogenia, sintomatología, diagnóstico y tratamiento. (AU)

Utilidad del pantoprazol intravenoso en Urgencias / Efficacy of intravenous pantoprazol at the Emergency Department

Los inhibidores de la bomba de protones son los fármacos disponibles más eficaces en el control e inhibición de la secreción gástrica. En España sólo existen dos para administración intravenosa: omeprazol y pantoprazol. El segundo tiene ventajas sobre el primero por la ausencia de interacciones farmacológicas, lo que le convierte en el ideal para enfermos polimedicados y con afecciones asociadas, como ocurre frecuentemente en Urgencias. La administración intravenosa consigue una inhibición más rápida y potente de la secreción ácida, o que puede ser importante en el tratamiento de la enfermedad por reflujo gastroesofágico y sus complicaciones, enfermedad ulcerosa péptica, hemorragia digestiva alta, obstrucción gástrica, síndromes de hipersecreción, profilaxis y tratamiento de la lesión por AINEs y en profilaxis de la úlcera de estrés y de la neumonía aspirativa (AU)

[Bronchobiliary fistulae between a liver hydatid cyst and the middle lobe of the right lung]. / Fístula broncobiliar entre un quiste hidatídico hepático y el lóbulo medio del pulmón derecho.

We report a case of bronchobiliary fistula between a liver hydatid cyst and the middle lobe of the right lung. It is also reviewed the etiology, pathogenesis, clinical features, diagnosis and treatment of bronchobiliary fistulas.

The role of the orthodontist in the diagnosis of Gorlin's syndrome.

Gorlin's syndrome is a relatively rare generalized disorder. Its diagnosis in childhood is usually through oral abnormalities. Some of the most frequent clinical features of this syndrome are discovered through radiographs commonly used in orthodontia. Thus, the orthodontist may be able to contribute to its diagnosis. The article shows three clinical cases that illustrate the role that the orthodontist may play in diagnosis of this syndrome.

[Marfan syndrome in childhood: cardiovascular manifestations. Echocardiographic changes]. / Síndrome de Marfan en la infancia: clínica cardiovascular. Alteraciones ecocardiográficas.

We report the cases of eight children with Marfan syndrome. Seven (87.5%) were diagnosed with cardiopathy, everyone with auscultatory findings. Electrocardiographic patterns were nonspecific. Enlargement of the aortic root was present in two of the cases as seen by thorax x-rays. Echocardiography detected the presence of mitral valve prolapse in 87.5% of the patients (7 cases) and aortic enlargement in 75% of the patients (6 cases). Echocardiography also detected the presence of aortic dysplasia, tricuspid valve prolapse and right and left ventricular hypertrophy. During the follow-up period, no case had cardiac failure. There was no mortality. The aortic enlargement was progressive and was not modified by propranolol treatment. Surgical treatment was not needed. Family history related to this condition was present in a very small percentage (37.5%). We comment on one infantile form of Marfan syndrome with its own phenotype different from that of classical Marfan syndrome.

[Coffin Lowry syndrome associated with repeated pneumonia]. / Síndrome de Coffin Lowry asociado a neumonías de repetición.

Authors described a new case of Coffin Lowry syndrome which presents a severe form, typical of males. Slight degree of affection in the mother and sister supports hypothesis of X-linked dominant trait. Authors want to underline normal appearance of the newborn period and progressive appearance of both neurological alterations and typical face of this condition. They have observed repetitive pneumonia probably produced by alimentary aspiration.