Anatomical and radiological approach to pterygoid implants: a cross-sectional study of 202 cone beam computed tomography examinations.

The aim of this study was to define the three-dimensional angulation of the pterygomaxillary corridor in which pterygoid implants should ideally be placed. A secondary objective was to study the bone density in the tuberosity area and pterygoid plate. Two hundred and two cone beam computed tomography files of atrophic posterior maxillae were evaluated. Implant placement was guided by the individual anatomy of each patient. The mean implant angulation was 74.19±3.13° in the anteroposterior axis and 81.09±2.65° in the buccopalatal axis, relative to the Frankfort plane. Density in the tuberosity area ranged from 285.8 to 329.1DV units and density in the pterygoid plate area from 602.9 to 661.2DV units, with a 95% confidence interval. The density in the pterygoid area was 139.2% greater than in the tuberosity zone. Implant placement should be guided by the individual anatomy of each patient. Statistically significant differences were found between the tuberosity and pterygoid plate in terms of bone density. Based on the results of this study, an implant of at least 15mm long should be used in order to take advantage of the quantity and quality of the bone in this region.

Does the Pulsatile Preservation Machine Have Any Impact in the Discard Rate of Kidneys From Older Donors After Brain Death?

BACKGROUND: Donors after brain death (DBD) older than 60 years have become 46.8% of our current activity, with higher risk of renal discard rate (RDR). Assessment of kidney suitability requires complementary strategies: macroscopic evaluation, kidney biopsy score (KBS), and renal hemodynamic evaluation with the Pulsatile Perfusion Machine (PPM). METHODS: Descriptive, cross-sectional, comparative study of kidneys procured and RDR, comparing 3 time periods: 2000 to June 2004, when only KBS were used; July 2004 to 2008 (introduction of PPM and learning period); and 2009 to 2013 (experienced use of PPM). Transplantation criteria were KBS <3 and PPM renal resistance <0.4 mm Hg/mL/min and arterial renal flow >70 mL/min. RESULTS: Between 2000 and 2013, a 59.2% reduction in DBD kidneys was observed. However, older kidneys had an increase from 33.5% to 46.8%. The RDR had increased, comparing the first to the third period from 25.4% to 38.3%. However, the RDR was lower when kidneys were evaluated with PPM than those evaluated only with KBS and preserved in cold storage (CS) (21.4% versus 43.7%). There was a significant difference in cold ischemia time, because CS kidney was grafted before PPM. During the third period, more kidneys with KBS ≥4 were assigned to PPM. CONCLUSIONS: Notwithstanding the decrease in DBD-procured kidneys and the increase in older kidneys during last period, the use of PPM allowed low DR compared with CS. A bias in the results of PPM could be generated when kidneys with higher KBS were excluded from PPM. The use of KBS only to decide acceptance could preclude the use of an additional tool to evaluate suitability.

Lipoma vulvar gigante / Large vulvar lipoma

No disponible

Arrival of radionuclides released by the Fukushima accident to Tenerife (Canary Islands).

Two weeks after the accident at the Fukushima-Daichi nuclear power plant, 131I, 137Cs and 134Cs activities were measured in two different stations located in Tenerife (Canary Islands), situated at 300 (FIMERALL) and 2400 (IZAÑA) m.a.s.l, respectively. Peak measured activity concentrations were: 1.851 mBq/m3 (131I); 0.408 mBq/m3 (137Cs) and 0.382 mBq/m3 (134Cs). The activities measured at the FIMERALL station were always higher than at IZAÑA station, suggesting that the radioactive plume arrived to the island associated with low altitude air masses. Simulations of potential dispersion of the radioactive cloud (137Cs) after the nuclear accident in reactor Fukushima I show that radioactive pollution reached remote regions such as the Canary Islands in the Eastern subtropical North Atlantic. The corresponding effective dose to the local population was 1.17 nSv, a value less than one millionth of the annual limit for the general public. Therefore, there was no risk to public health.

Declining sexually transmitted infections among female sex workers: the results of an HIV and sexually transmitted infection prevention strategy in Honduras, 2006-08.

In 2006, we implemented an HIV and sexually transmitted infection (STI) prevention programme for female sex workers (FSWs) in three Honduran cities. All FSW attending STI clinics underwent regular examinations and STI testing. Information on condom use with different partners was collected at each visit. After three years, we detected a significant decline in the prevalence of syphilis from 2.3% at the first screening to 0.0% at the third screening (P = 0.05), and of chlamydia, from 6.1% to 3.3% (P = 0.01). No changes were observed in the prevalence of gonorrhoea or trichomoniasis. The cumulative HIV prevalence remained constant (P = 0.44). Reports of condom use with clients increased from 93.8% to 98.9% (P < 0.001). The implementation of an HIV/STI prevention programme in FSW has contributed to increases in condom use with clients and the reduction in syphilis and chlamydia prevalence. The intervention should be strengthened and considered as part of a national health policy strategy.

Papilomatosis múltiple: presentación clínica y radiológica / No disponible

La papilomatosis múltiple (PM) de mama es una entidad poco frecuente que se ha asociado a un potencial premaligno. Se caracteriza por la presencia de proyecciones papilares con un centro revestido por células epiteliales y mioepiteliales que ocupan la luz dilatada de los ductos terminales. Puede encontrarse de manera aislada, asociada a atipia o a procesos neoplásicos. Se asocia con mayor frecuencia que el papiloma solitario a transformación maligna, en especial carcinoma ductal in situ (en algunas series hasta el 40%). Pese a este hecho, no está consensuado el manejo de esta entidad, siendo frecuente la recomendación de extirpación cuando existe algún grado de atipia en el diagnóstico histológico. Se presenta el caso de una paciente de 44 años que consulta por una historia de telorrea unilateral muy abundante de larga evolución. La realización de una galactografía puso de manifiesto un área extensa de defectos de replección pseudonodulares que ocupaba casi la mitad de la mama. Pese a tratarse de una enfermedad benigna, la opción de tratamiento propuesta fue la realización de una mastectomía(AU)

Multiple Papillomatosis (MP) of the breast is uncommon and often associated with premalignant potential. MP is restricted to papillary projections characterized by a fibrovascular core lined by epithelial and myoepithelial cells occupying the dilated lumina of terminal ductules. It is found to occur either in isolation or associated with other types of proliferative lesions such atypia, hyperplasia or malignant conditions (some series report 40% of ductal carcinoma in situ). Despite of this fact, MP is open to debate in terms of clinical management. Wide excision is often suggested when atypia is found in the pathologic tissue. We present a case of a 44-year-old woman with a long copious unilateral nipple discharge. Galactography showed an extensive replection defects area occupying almost half breast. Although this is a benign disorder, the real extent can entail the performance of a mastectomy(AU)

[Utility of heliox during treatment of upper airway obstruction secondary to bilateral vocal cord paralysis after thyroidectomy]. / Utilidad del heliox en la obstrucción de vía aérea superior secundaria a disfunción bilateral de cuerdas vocales postiroidectomía.

Helium is a noble gas whose low density decreases airway resistance. This property is utilized when a mixture of helium and oxygen (heliox) is employed in certain clinical situations, particularly in the context of airway obstruction. We report the case of a woman with severe upper airway obstruction due to bilateral vocal cord paralysis after thyroidectomy. Heliox was used temporarily to reduce respiratory effort and avoid the need for tracheal intubation while the obstruction was being treated with antiinflammatory drugs.

Utilidad del heliox en la obstrucción de vía aérea superior secundaria a disfunción bilateral de cuerdas vocales postiroidectomía / Utility of heliox during treatment of upper airway obstruction secondary to bilateral vocal cord paralysis after thyroidectomy

El helio es un gas noble que por su baja densidad disminuyela resistencia de la vía aérea. Esta propiedad,empleando una mezcla de helio y oxígeno (heliox), permiteque sea útil en determinadas situaciones clínicas,especialmente en las obstrucciones de vía aérea. Describimosel caso de una paciente que presentó un cuadro deobstrucción grave de la vía aérea superior debido a laparálisis bilateral de cuerdas vocales después de unatiroidectomía. El heliox se usó temporalmente para disminuirel esfuerzo respiratorio y evitar la intubaciónendotraqueal mientras mejoraba la obstrucción conantiinflamatorios(AU)

Helium is a noble gas whose low density decreasesairway resistance. This property is utilized when amixture of helium and oxygen (heliox) is employed incertain clinical situations, particularly in the context ofairway obstruction. We report the case of a woman withsevere upper airway obstruction due to bilateral vocalcord paralysis after thyroidectomy. Heliox was usedtemporarily to reduce respiratory effort and avoid theneed for tracheal intubation while the obstruction wasbeing treated with antiinflammatory drugs(AU)

An Early Pleistocene hominin mandible from Atapuerca-TD6, Spain.

We present a mandible recovered in 2003 from the Aurora Stratum of the TD6 level of the Gran Dolina site (Sierra de Atapuerca, northern Spain). The specimen, catalogued as ATD6-96, adds to the hominin sample recovered from this site in 1994-1996, and assigned to Homo antecessor. ATD6-96 is the left half of a gracile mandible belonging to a probably female adult individual with premolars and molars in place. This mandible shows a primitive structural pattern shared with all African and Asian Homo species. However, it is small and exhibits a remarkable gracility, a trait shared only with the Early and Middle Pleistocene Chinese hominins. Furthermore, none of the mandibular features considered apomorphic in the European Middle and Early Upper Pleistocene hominin lineage are present in ATD6-96. This evidence reinforces the taxonomic identity of H. antecessor and is consistent with the hypothesis of a close relationship between this species and Homo sapiens.

Optimización de la precisión del puntaje de Gleason con el uso de esquemas ampliados en biopsias prostáticas por punción / Optimization of the precision of Gleason score with the use of amplified schemes in needle prostate biopsies

El puntaje de Gleason de la biopsia por punción es un factor pronóstico independiente en el cáncer de próstata, por lo cual constituye un antecedente fundamental en la elección del tratamiento. Existe sin embargo una significativa sub y supraetapificación con respecto al puntaje de la pieza de la cirugía radical en las biopsias por sextantes. Evaluamos en forma prospectiva el rendimiento de biopsias con esquemas ampliados en la predicción del puntaje final, comparándose la concordancia con la del esquema de punción clásico. 92 pacientes fueron sometidos a prostatectomía radical entre octubre 2001 y julio 2005. En 51 casos el diagnóstico fue efectuado mediante el esquema clásico (6 muestras) y a partir de marzo de 2003 en 41 pacientes mediante esquemas ampliados (10-12 muestras). Se analizaron correlaciones entre los especímenes efectuándose estudios de asociación. Los grupos fueron comparables en cuanto a las características clínicas e histopatológicas. La concordancia de la suma de puntajes entre la biopsia por punción y la biopsia de la prostatectomía radical fue de 31,4 por ciento (n=16) para el esquema clásico por sextantes y de 53,7 por ciento (n=22) para los esquemas con mayor número de muestras (p=0,021). Al analizar el puntaje primario por separado se establecieron concordancias de 49 por ciento y 78 por ciento, respectivamente (p=0,005). Esta diferencia fue más significativa en muestras con puntaje de Gleason <7 (p=0,018). Se observó subetapificación en 30 casos (58,8 por ciento) del esquema clásico y en 15 casos (36,6 por ciento) de las biopsias con esquemas ampliados (p=0,038). Se objetivó un incremento en la precisión del puntaje de Gleason a partir de la implementación de esquemas ampliados en las biopsias prostáticas por punción. La adición de mayor número de muestras, junto con aumentar en forma significativa la tasa de detección de tumores, permite asimismo optimizar el valor predictivo de la muestra. De esta manera se dispone de mayores antec...

Optimización de esquemas para detección de cáncer de próstata en rebiopsias: estudio prospectivo / Optimization of schemes to detect prostatic cancer in rebiopsiaes: prospective study

El manejo de pacientes con sospecha de cáncer y con biopsias prostáticas previas negativas representa un desafío para el urólogo. En la literatura no existe consenso en cuanto a número y zonas a biopsiar en este procedimiento. Efectuamos un estudio prospectivo evaluando la sensibilidad de distintos esquemas de punción, con el fin de generar una estrategia óptima en términos de detección y número de muestras. Se incluyeron 35 pacientes sometidos a re-biopsia de próstata. Se aplicó un esquema de 12 muestras incluyendo 2 de la zona de transición. Se calculó el rendimiento de cada foco en forma separada, analizándose diversas combinaciones y comparándose con pruebas no paramétricas. El 28,6 por ciento de los pacientes presentó cáncer en la biopsia. El esquema clásico por sextantes diagnosticó sólo 50 por ciento de los tumores. Los pacientes sometidos previamente a biopsia por sextantes presentaron una mayor tasa de detección (32 por ciento) que aquellos sometidos previamente a biopsia ampliada (20 por ciento). Las muestras de la zona de transición no representaron un aporte. La densidad del APE fue el único parámetro significativamente mayor en pacientes diagnosticados con cáncer (p=0,029). La biopsia ampliada (10-12 muestras) presenta mayor rendimiento que el esquema por sextantes en re-biopsias, siendo más efectivo en pacientes sometidos, previamente, a biopsias por sextantes.

Different morphologies of silver nanoparticles as catalysts for the selective oxidation of styrene in the gas phase.

Silver nanoparticles of different morphologies were prepared using the polyol process and then dispersed on alpha-alumina. Catalysts were tested for the selective oxidation of styrene in the gas phase. Activity and selectivity were strongly dependent on the morphology of the silver nanoparticles.

Optimización de esquemas de punción en biopsia ecodirigida para la detección del cáncer de próstata / Optimization of puncture schedule in transrectal ultrasound guided prostate biopsy in prostatic cancer

El esquema clásico de biopsias por sextantes ha demostrado ser insuficiente en el diagnóstico del cáncer de próstata. Sin embargo, aún no existe consenso en cuanto a número y zonas a biopsiar durante este procedimiento, existiendo numerosas propuestas al respecto en la literatura. Los estudios han descrito un mayor rendimiento con biopsias dirigidas hacia la zona lateral. Efectuamos un estudio prospectivo comparando la sensibilidad de los distintos focos en forma individual, evaluándose diversas combinaciones de éstos con el fin de generar una estrategia óptima en términos de detección y número de muestras. Se incluyeron 110 pacientes consecutivos sometidos a biopsia de próstata. Se registró edad, APE, volumen prostático, Gleason, tacto rectal y morbilidad derivada del procedimiento. Además de la biopsia rutinaria por sextantes en ubicación parasagital, se agregaron dos muestras laterales a cada lado, en la base y en la zona media. En próstatas > 50 cc se agregaron dos muestras de la zona de transición. Se calculó el rendimiento de cada foco de biopsia en forma separada, analizándose varios esquemas derivados de distintas combinaciones, comparándose con pruebas no paramétricas. Treinta y nueve (35,5 por ciento) de los pacientes presentó cáncer en la biopsia. Estos pacientes eran de mayor edad (p=0,056), tenían próstatas más pequeñas (p=0,028) y APE más elevados (p=0,0003). El esquema clásico por sextantes detectó sólo el 69,2 por ciento de los cánceres en comparación con el esquema de 10 muestras (p=0,001), este rendimiento se mantuvo al eliminar la muestra de la base de la zona lobular media, obteniéndose de esta manera una combinación óptima compuesta por 8 muestras. Esta tendencia se mantuvo al analizar según APE, volumen prostático y tacto rectal, siendo significativa en próstatas < 50 cc (p=0,008), en pacientes con TR negativo (p=0,003) y con APE < 10 ng/ml (p=0,004). Se constató una morbilidad baja, no diferenciándose significativamente de la publicada en series con 6 muestras. La biopsia ecodirigida debiera incluir al menos 8 muestras, incluyéndose la zona lateral basal y media, el ápex y la media de la zona lobular media. El mayor número de muestras no implica una mayor morbilidad.

Laser in situ keratomileusis and photorefractive keratectomy for residual refractive error after phakic intraocular lens implantation.

PURPOSE: To determine the visual and refractive outcome of photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) in eyes with prior posterior chamber phakic intraocular lens implantation for high myopia. METHODS: We studied a series of 37 consecutive eyes of 31 patients who underwent LASIK or PRK for residual refractive error following collamer posterior chamber intraocular lens (IOL) (Staar Surgical Implantable Contact Lens) implantation into a phakic eye. Twenty-eight eyes had LASIK and nine eyes had PRK. Mean follow-up was 8.1 +/- 4.7 months after laser ablation (range, 3 to 18 mo). RESULTS: The preoperative mean spherical equivalent refraction prior to phakic posterior chamber IOL implantation was -17.74 +/- 4.89 D (range, -9.75 to -28.00 D). Following phakic IOL implantation and prior to LASIK or PRK, mean spherical equivalent refraction was -2.56 +/- 2.34 D (range, -0.25 to -8.75 D). One month following LASIK or PRK, mean spherical equivalent refraction was -0.24 +/- 0.52 D (range, -1.50 to +1.50 D), 3 months following LASIK or PRK, mean spherical equivalent refraction was -0.19 +/- 0.50 D (range, -1.50 to +1.00 D). The refraction was within +/-1.00 D of emmetropia in 36 eyes (97.2%) and within +/-0.50 D in 31 eyes (83.7%). Three eyes developed anterior subcapsular opacities several weeks after laser ablation, one eye developed macular hemorrhage 4 weeks after laser ablation, and one eye had corticosteroid induced ocular hypertension. CONCLUSIONS: LASIK or PRK can be used to treat the residual refractive error following posterior chamber phakic IOL implantation.

Bitoric laser in situ keratomileusis for the correction of simple myopic and mixed astigmatism.

OBJECTIVE: To evaluate the safety and efficacy of bitoric laser in situ keratomileusis (LASIK) for the correction of simple myopic and mixed astigmatism. DESIGN: Retrospective, single-center, and noncomparative case series. PARTICIPANTS: Eighty-six eyes of 56 patients were analyzed for this study. Six-month and 1-year follow-up data were available on 86 eyes and 72 eyes, respectively. Eyes were divided in two groups according to the type of astigmatism: myopic astigmatism with low sphere (< -2 diopters) and mixed astigmatism. The range of astigmatism was 1.25 to 7.5 diopters. INTERVENTION: LASIK was performed using the Automated Corneal Shaper (ACS) microkeratome (Bausch & Lomb, Claremont, CA) to create a cornea flap using the 130- or 160-micron thickness plate. A bitoric mid-stromal ablation was performed using the Nidek EC-5000 excimer laser (Nidek Company, Gamagori, Japan). MAIN OUTCOME MEASURES: Uncorrected visual acuity, manifest refraction, and best spectacle-corrected visual acuity were the parameters measured preoperatively and at months 1, 3, 6, and 12. RESULTS: At the last visit, an uncorrected visual acuity of 20/20 or better was achieved in 77% and 68% of the myopic and mixed astigmatism groups, respectively. Ninety-two percent of all eyes had a mean spherical equivalent within +/- 0.50 diopter of emmetropia. A mean decrease in the vectorial magnitude of the astigmatism of 94% and 91% was achieved for those eyes with myopic and mixed astigmatism, respectively. There was no loss of best spectacle-corrected visual acuity. In two eyes, the axis of the positive cylinder was misaligned. CONCLUSION: Bitoric LASIK is an effective procedure to correct myopic and mixed astigmatism. Eighty-five percent of the eyes achieved an uncorrected visual acuity of 20/25 or better and had a final cylinder of 0.5 diopter or less. It is a safe operation, because no eyes lost any lines of best spectacle-corrected visual acuity. Longer follow-up may be needed to assess these results.

Swelling-induced K(+) fluxes in vascular smooth muscle cells are mediated by charybdotoxin-sensitive K(+) channels.

This study examines the relative contributions of K-Cl cotransport and K(+) channels to swelling-induced K(+) fluxes in vascular smooth muscle cells (VSMC). DIOA known as a potent inhibitor of erythrocyte K-Cl cotransport exerts diverse side-effects on VSMC and can not be used to analyze the role of this carrier in swelling-induced K(+) fluxes. Other inhibitors of K-Cl cotransport (furosemide, okadaic acid and calyculin A) did not affect K(+) fluxes in VSMC triggered by swelling. Swelling-induced K(+) fluxes in VSMC were also not affected by K(+) channel blockers such as TEA, glibenclamide and apamin, but were blocked by Ba(2+) and charybdotoxin (ChTX), a potent inhibitor of Ca(2+)- and voltage-gated K(+) channels. Swelling-induced K(+) influx in VSMC was diminished in Ca(2+)-free medium and in cells loaded with Ca(2+) chelator BAPTA, but was not accompanied by detectable elevation of [Ca(2+)](i). In contrast to Ca(2+)-induced hyperpolarization of erythrocytes triggered by activation of intermediate conductance Ca(2+)-gated K(+) channels (IK(Ca)), neither clotrimazole nor calmodulin antagonists (R24571, trifluoroperazine, fluphenazine) affected swelling-induced K(+) influx in VSMC. In conclusion, K(+) fluxes triggered in swollen VSMC are mediated by Ba(2+)- and ChTX-sensitive K(+) channels. These channels are distinct from IK(Ca) expressed in erythrocytes. Their molecular origin and systems involved in the swelling-induced Ca(2+)(i)-independent signal transduction pathway need further investigation.

The Pleistocene site of Gran Dolina, Sierra de Atapuerca, Spain: a history of the archaeological investigations.

Gran Dolina is part of an archaeological and paleontological complex located in the Sierra de Atapuerca karstic system (Burgos, Spain). The Trinchera del Ferrocarril sites were discovered as a consequence of the construction of a railway for the transport of minerals at the end of the nineteenth century. The systematic excavation of the upper Gran Dolina levels was initiated in 1981. In 1993, a 6 m(2)biostratigraphic survey pit was started, reaching level TD6 in 1994. This level was excavated during four consecutive years, yielding human fossils, identified as Homo antecessor, in association with lithic and faunal remains, dating to more than 0.78 m.y.a.

The TD6 level lithic industry from Gran Dolina, Atapuerca (Burgos, Spain): production and use.

Technological analysis of lithic artefacts recovered at the Aurora stratum of Atapuerca-TD6 shows that this Lower Pleistocene assemblage is similar to Mode I Technology (=Oldowan tradition) documented at many African sites. Diachronic comparison of the different levels of Gran Dolina allows us to conclude that this particular form of early European technology lacks the production of big flakes to manufacture large tools such as bifaces and cleavers. Rather, it is characterized by the presence of small artefacts, including flakes, denticulates, notches, and side-scrapers, many of which bear use-wear traces of butchery and woodworking. The dominant production technique is orthogonal, which is also reflected in the core recovered at the slightly older level of TD4. The raw materials also found in the Middle Pleistocene occupations at Atapuerca, though with significant proportion differences, have a local origin and include varieties of flint, quartzite and sandstone as well as limestone and quartz. TD6 small artefacts were made from most of these, although the retouched pieces seem to have been preferentially made of the best quality flint, i.e., Cretaceous flint, pointing to the existence of differential use of lithic material, and therefore, some degree of planned knapping behaviour. Most of the "chaînes opératoires" or reduction sequences took place inside the cave, although some artefacts, elaborated on Cretaceous flint, seem to have been retouched off site, possibly near the supply sources.

The TD6 (Aurora Stratum) hominid site. Final remarks and new questions.

The study of the faunal and lithic assemblage (including almost a hundred human fossil remains) recovered from the Aurora stratum-TD6 level of the Lower Pleistocene cave site of Gran Dolina (Sierra de Atapuerca, Spain) has allowed us to answer some important questions concerning the debate about the earliest evidence for human occupation of Europe. However, it has also started new discussions about some geographical, ecological, and economic aspects of this earliest occupation. The nature (definitive or ephemeral) of the first occupation, as well as the model for the arrival of the Acheulean (Mode 2) in Europe are also issues for discussion.