Social avoidance and altered hypothalamic-pituitary-adrenal axis in a mouse model of anxious depression: The role of LPA1 receptor.

Anxious depression is a prevalent disease with devastating consequences. Despite the lack of knowledge about the neurobiological basis of this subtype of depression, recently our group has identified a relationship between the LPA1 receptor, one of the six characterized G protein-coupled receptors (LPA1-6) for lysophosphatidic acid, with a mixed depressive-anxiety phenotype. Dysfunctional social behaviors, which have been related to increased activation of the hypothalamus-pituitary-adrenal (HPA) axis, are key symptoms of depression and are even more prominent in patients with comorbid anxiety and depressive disorders. Social behavior and HPA functioning were assessed in animals lacking the LPA1 receptor. For these purposes, we first examined social behaviors in wild-type and LPA1 receptor-null mice. In addition, a dexamethasone (DEX) suppression test was carried out. maLPA1-null mice exhibited social avoidance, a blunted response to DEX administration and an impaired circadian rhythm of corticosterone levels, which are features that are consistently dysregulated in many mental illnesses including anxious depression. Here, we have strengthened the previous experimental evidence for maLPA1-null mice to represent a good animal model of anxious depression, providing an opportunity to explore new therapeutic targets for the treatment of mood disorders, particularly this subtype of depression.

The hilum of the lung: Two classical radiological signs to decipher it.

Assessing the hilum of the lung is a common challenge in daily practice because various structures converge in this complex anatomic region. Because chest X-rays are widely available and deliver relatively low doses of radiation, they continue to be the most common imaging test, although new imaging modalities have decreased the use of chest X-rays for differentiating between true abnormalities and superimposed lung opacities. This article reviews the literature and describes the principal anatomic relations of the lung hilum through illustrative cases to enable the two most important radiologic signs to be identified: "hilum overlay" and "hilum convergence". In the initial imaging evaluation of patients with cardiothoracic disease, knowledge of these basic principles facilitates the three-dimensional location of lesions in a single-plane image, optimizing time and resources.

El hilio pulmonar, dos signos radiológicos clásicos para descifrarlo / The hilum of the lung: two classical radiological signs to decipher it

El análisis del hilio pulmonar es un reto frecuente en la práctica diaria, por tratarse de una región anatómica compleja donde confluyen varias estructuras. La radiografía de tórax, por su alta accesibilidad y baja dosis de radiación, se mantiene como la primera técnica de imagen solicitada, pese a que las nuevas modalidades han disminuido su uso en el momento de diferenciar verdaderas anormalidades de opacidades pulmonares superpuestas. Se realizó una revisión bibliográfica que ilustra mediante casos didácticos sus principales relaciones anatómicas, lo que permite identificar los signos radiológicos que revisten mayor importancia: “sobreposición hiliar” y “convergencia hiliar”. En la valoración inicial del paciente con patología cardiotorácica, tener conocimiento de estos principios básicos facilita localizar tridimensionalmente lesiones en una imagen planar, optimizando tiempo y recursos.(AU)

Assessing the hilum of the lung is a common challenge in daily practice because various structures converge in this complex anatomic region. Because chest X-rays are widely available and deliver relatively low doses of radiation, they continue to be the most common imaging test, although new imaging modalities have decreased the use of chest X-rays for differentiating between true abnormalities and superimposed lung opacities. This article reviews the literature and describes the principal anatomic relations of the lung hilum through illustrative cases to enable the two most important radiologic signs to be identified: “hilum overlay” and “hilum convergence”. In the initial imaging evaluation of patients with cardiothoracic disease, knowledge of these basic principles facilitates the three-dimensional location of lesions in a single-plane image, optimizing time and resources.(AU)

The hilum of the lung: two classical radiological signs to decipher it. / El hilio pulmonar, dos signos radiológicos clásicos para descifrarlo.

Assessing the hilum of the lung is a common challenge in daily practice because various structures converge in this complex anatomic region. Because chest X-rays are widely available and deliver relatively low doses of radiation, they continue to be the most common imaging test, although new imaging modalities have decreased the use of chest X-rays for differentiating between true abnormalities and superimposed lung opacities. This article reviews the literature and describes the principal anatomic relations of the lung hilum through illustrative cases to enable the two most important radiologic signs to be identified: "hilum overlay" and "hilum convergence". In the initial imaging evaluation of patients with cardiothoracic disease, knowledge of these basic principles facilitates the three-dimensional location of lesions in a single-plane image, optimizing time and resources.

Infection by the semi-persistently transmitted Tomato chlorosis virus alters the biology and behaviour of Bemisia tabaci on two potato clones.

Insect-borne plant viruses usually alter the interactions between host plant and insect vector in ways conducive to their transmission ('host manipulation hypothesis'). Most studies have tested this hypothesis with persistently and non-persistently transmitted viruses, while few have examined semi-persistently transmitted viruses. The crinivirus Tomato chlorosis virus (ToCV) is semi-persistently transmitted virus by whiteflies, and has been recently reported infecting potato plants in Brazil, where Bemisia tabaci Middle East Asia Minor 1 (MEAM1) is a competent vector. We investigated how ToCV infection modifies the interaction between potato plants and B. tabaci in ways that increase the likelihood of ToCV transmission, in two clones, one susceptible ('Agata') and the other moderately resistant (Bach-4) to B. tabaci. Whiteflies alighted and laid more eggs on ToCV-infected plants than mock-inoculated plants of Bach-4. When non-viruliferous whiteflies were released on ToCV-infected plants near mock-inoculated plants, adults moved more intensely towards non-infected plants than in the reverse condition for both clones. Feeding on ToCV-infected plants reduced egg-incubation period in both clones, but the egg-adult cycle was similar for whiteflies fed on ToCV-infected and mock-inoculated plants. Our results demonstrated that ToCV infection in potato plants alters B. tabaci behaviour and development in distinct ways depending on the host clone, with potential implications for ToCV spread.

Influence of Trichomes in Strawberry Cultivars on the Feeding Behavior of Chaetosiphon fragaefolii (Cockerell) (Hemiptera: Aphididae).

Chaetosiphon fragaefolii (Cockerell) (Hemiptera: Aphididae) is the predominant aphid in strawberry (Fragaria × ananassa Duchesne) production systems in Brazil. This pest species directly damages the plants and is also responsible for spreading viruses. Further, C. fragaefolii often renders strawberry cultivation unviable, because of its high reproductive rate, as well as the large number of individuals generated through parthenogenesis. The present study aimed to (1) evaluate the feeding behavior of C. fragaefolii in four strawberry cultivars (Albion, Aromas, Camarosa, and San Andreas) and (2) identify the resistance factors associated with the number and type of trichomes in the cultivars, and also its effect on the feeding behavior of C. fragaefolii, using the electrical penetration graph (EPG) technique. The results revealed an intrinsic relationship between the number of trichomes on the cultivar and feeding behavior of C. fragaefolii. A higher number of trichomes, both tector and glandular, was observed in Albion compared to that of other cultivars, resulting in a longer no probing (Np) period per insect, and a longer Np phase. A relatively short phloem phase and ingestion time of the phloem sieve elements were also observed in Albion. These results suggest that the trichomes act as a physical barrier creating difficulties for C. fragaefolii to feed, thereby altering its feeding behavior in the four cultivars studied.

[Assessment of a Chilean Spanish version of the Patient Assessment of Chronic Illness Care Questionnaire]. / Adaptación y validación de la versión chilena del cuestionario "Evaluación de la Atención de Enfermedades Crónicas para pacientes".

BACKGROUND: The Patient Assessment of Chronic Illness Care (PACIC) questionnaire is a widely used instrument to assess chronic disease care from a patient's perspective. AIM: To adapt the PACIC questionnaire to Chilean Spanish and to evaluate the psychometric properties of the translation. MATERIAL AND METHODS: Descriptive, cross-sectional design with exploratory and confirmatory factor analysis. The PACIC questionnaire was applied, throughout an external client, to 200 users who received health care at the cardiovascular program in a Family Health Center in Concepción, Chile. RESULTS: The confirmatory factor analysis did not show a good adjustment with the proposed structure in the original instrument. An exploratory factor analysis revealed five factors explaining 58% of total data variability. The distribution of the factor-items of the original questionnaire underwent some modifications, which are explained when analyzing the theoretical construct. A good reliability of the global scale was obtained (Cronbach's α 0.886). CONCLUSIONS: The PACIC questionnaire, Chilean version does not replicate the proposed structure of the original questionnaire. Therefore, further research about its validity, incorporating a higher number or diversity of participants is recommended.

Adaptación y validación de la versión chilena del cuestionario "Evaluación de la Atención de Enfermedades Crónicas para pacientes" / Assessment of a Chilean Spanish version of the Patient Assessment of Chronic Illness Care Questionnaire

Background: The Patient Assessment of Chronic Illness Care (PACIC) questionnaire is a widely used instrument to assess chronic disease care from a patient's perspective. Aim: To adapt the PACIC questionnaire to Chilean Spanish and to evaluate the psychometric properties of the translation. Material and Methods: Descriptive, cross-sectional design with exploratory and confirmatory factor analysis. The PACIC questionnaire was applied, throughout an external client, to 200 users who received health care at the cardiovascular program in a Family Health Center in Concepción, Chile. Results: The confirmatory factor analysis did not show a good adjustment with the proposed structure in the original instrument. An exploratory factor analysis revealed five factors explaining 58% of total data variability. The distribution of the factor-items of the original questionnaire underwent some modifications, which are explained when analyzing the theoretical construct. A good reliability of the global scale was obtained (Cronbach's α 0.886). Conclusions: The PACIC questionnaire, Chilean version does not replicate the proposed structure of the original questionnaire. Therefore, further research about its validity, incorporating a higher number or diversity of participants is recommended.

Análisis de las fracturas mandibulares causadas por accidentes laborales: estudio descriptivo retrospectivo / Analysis of mandibular fractures caused by work related accidents: retrospective descriptive study

El objetivo de este estudio fue evaluar la tendencia de los pacientes con fracturas mandibulares asociados a accidentes laborales. Se realizó un estudio descriptivo retrospectivo en todos los casos de fracturas mandibulares que asistieron al servicio de cirugía maxilofacial del Hospital Clínico Mutual de Seguridad C.Ch.C., Santiago de Chile en un periodo de 4 años (enero 2009 - diciembre 2012). Todas las fracturas mandibulares fueron consignadas. La información fue recopilada a través de revisión de fichas clínicas electrónicas. Entre los años 2009 al 2012 se presentaron un total de 74 pacientes incluidos en el estudio con 102 rasgos de fracturas mandibulares. La fractura más común fue la de cóndilo mandibular (35 pacientes). Se observó una tasa de complicaciones del 8%. Los resultados mostrados en este estudio están en línea con la literatura y el análisis de este reporte provee información para el diseño de planes de prevención de riesgos, especialmente para desarrollar medidas de protección facial. Nivel de Evidencia: Tipo II. Estudio descriptivo.

The objective of this study was to evaluate the tendency of patients with mandibular fractures associated with working accidents. A retrospective descriptive study was performed in all cases of mandibular fractures who attended the maxillofacial surgery service at the Clinical Hospital Mutual Seguridad C.CH.C. Santiago de Chile, in a 4-year period (January 2009 - December 2012). All mandibular fractures were recorded. The information was collected through review of electronic medical records. Between 2009 and 2012, 74 patients were included in the study with 102 lines of mandibular fractures. The most common fracture was the mandibular condyle (35 patients). The complication rate was 8%. The results shown in this study are in line with the literature and the analysis of this report provides information for the design of risk prevention plans, especially in developing measures of facial protection.

Context-dependent effects of yolk androgens on nestling growth and immune function in a multibrooded passerine.

Female birds may adjust their offspring phenotype to the specific requirements of the environment by differential allocation of physiologically active substances into yolks, such as androgens. Yolk androgens have been shown to accelerate embryonic development, growth rate and competitive ability of nestlings, but they can also entail immunological costs. The balance between costs and benefits of androgen allocation is expected to depend on nestling environment. We tested this hypothesis in a multibrooded passerine, the spotless starling, Sturnus unicolor. We experimentally manipulated yolk androgen levels using a between-brood design and evaluated its effects on nestling development, survival and immune function. Both in first and replacement broods, the embryonic development period was shorter for androgen-treated chicks than controls, but there were no differences in second broods. In replacement broods, androgen-treated chicks were heavier and larger than those hatched from control eggs, but this effect was not observed in the other breeding attempts. Androgen exposure reduced survival with respect to controls only in second broods. Regarding immune function, we detected nonsignificant trends for androgen treatment to activate two important components of innate and adaptive immunity (IL-6 and Ig-A levels, respectively). Similarly, androgen-treated chicks showed greater lymphocyte proliferation than controls in the first brood and an opposite trend in the second brood. Our results indicate that yolk androgen effects on nestling development and immunity depend on the environmental conditions of each breeding attempt. Variation in maternal androgen allocation to eggs could be explained as the result of context-dependent optimal strategies to maximize offspring fitness.

Prevalencia de fracturas de cadera, fémur y rodilla en la Unidad Médica de Alta Especialidad Hospital de Traumatología y Ortopedia "Lomas Verdes" del Instituto Mexicano del Seguro Social / Prevalence of hip, femur and knee fractures at the High Specialty Medical Unit, Hospital de Traumatología y Ortopedia "Lomas Verdes", Instituto Mexicano del Seguro Social

Antecedentes: Las fracturas de la extremidad inferior ocurren más frecuentemente en los pacientes de edad avanzada con osteopenia después de una caída de baja energía y/o en los pacientes más jóvenes involucrados en traumatismos de alta energía. En la Unidad Médica de Alta Especialidad Hospital de Traumatología y Ortopedia "Lomas Verdes" se desconoce la prevalencia de fracturas de cadera, fémur y rodilla. Material y métodos: Diseño transversal, descriptivo y retrospectivo. Se revisaron los casos con fracturas de la extremidad inferior tratados durante el 01 de enero del 2012 al 31 de diciembre de 2013 en el Servicio de Cirugía de Cadera, Fémur y Rodilla de la Unidad Médica de Alta Especialidad Hospital de Traumatología y Ortopedia "Lomas Verdes". Resultados: La mayoría de los pacientes (52.2%) fueron del sexo femenino, siendo 64.1% de los pacientes mayor de 60 años de edad. La distribución de las fracturas de acuerdo al segmento afectado: 73.4% (n = 1,327) correspondieron a fracturas de fémur, 13.5% (n = 244) a fracturas de la meseta tibial y 13.2% (n = 238) fracturas de patela. En 66.8% (n = 1,209) de los pacientes tuvieron una estancia intrahospitalaria prolongada (mayor a 10 días). De acuerdo con la localización anatómica ósea más frecuente, las fracturas transtrocantéricas (49.1%) fueron las más frecuentes, seguidas por las fracturas de patela (13.2%) y las diafisarias del fémur (12.7%). Conclusiones: La prevalencia de las fracturas de la extremidad inferior en nuestro hospital corresponde con lo reportado a nivel internacional.

Background: Lower limb fractures are more frequent among older patients with osteopenia after a low energy fall and/or among young patients who sustain a high energy trauma. The prevalence of hip, femur and knee fractures at the High Specialty Medical Unit, Hospital de Traumatología y Ortopedia "Lomas Verdes" is unknown. Material and methods: Cross-sectional study, descriptive and retrospective design. Cases with low extremity fractures treated from January 1st, 2012 to December 31st, 2013 at the Hip, Femur and Knee Service, High Specialty Medical Unit, Hospital de Traumatología y Ortopedia "Lomas Verdes", were reviewed. Results: Most patients (52.2%) were females; 64.1% of patients were over 60 years of age. Fracture distribution according to the segment involved was as follows: 73.4% (n = 1,327) were femur fractures, 13.5% (n = 244) tibial plateau fractures, and 13.2% (n = 238) patellar fractures. 66.8% (n = 1,209) of patients had a long hospital stay (more than 10 days). According to the anatomical location of fractures, transtrochanteric fractures (49.1%) were the most frequent ones, followed by patellar fractures (13.2%), and femur shaft fractures (12.7%). Conclusions: The prevalence of lower limb fractures at our hospital corresponds to what has been reported internationally.

[Prevalence of hip, femur and knee fractures at the High Specialty Medical Unit, Hospital de Traumatología y Ortopedia "Lomas Verdes", Instituto Mexicano del Seguro Social]. / Prevalencia de fracturas de cadera, fémur y rodilla en la Unidad Médica de Alta Especialidad Hospital de Traumatología y Ortopedia "Lomas Verdes" del Instituto Mexicano del Seguro Social.

BACKGROUND: Lower limb fractures are more frequent among older patients with osteopenia after a low energy fall and/or among young patients who sustain a high energy trauma. The prevalence of hip, femur and knee fractures at the High Specialty Medical Unit, Hospital de Traumatología y Ortopedia "Lomas Verdes" is unknown. MATERIAL AND METHODS: Cross-sectional study, descriptive and retrospective design. Cases with low extremity fractures treated from January 1st, 2012 to December 31st, 2013 at the Hip, Femur and Knee Service, High Specialty Medical Unit, Hospital de Traumatología y Ortopedia "Lomas Verdes", were reviewed. RESULTS: Most patients (52.2%) were females; 64.1% of patients were over 60 years of age. Fracture distribution according to the segment involved was as follows: 73.4% (n = 1,327) were femur fractures, 13.5% (n = 244) tibial plateau fractures, and 13.2% (n = 238) patellar fractures. 66.8% (n = 1,209) of patients had a long hospital stay (more than 10 days). According to the anatomical location of fractures, transtrochanteric fractures (49.1%) were the most frequent ones, followed by patellar fractures (13.2%), and femur shaft fractures (12.7%). CONCLUSIONS: The prevalence of lower limb fractures at our hospital corresponds to what has been reported internationally.

Tratamiento quirúrgico de la acalasia esofágica: experiencia en 328 pacientes / Surgical treatment of achalasia: experience in 328 patients

Background: Patients with achalasia may require surgical treatment. Aim: To assess postoperative evolution, complications and mortality after surgical treatment of achalasia. Material and Methods: Analysis of 328 patients aged 13 to 80 years (51 percent females) with achalasia, operated in a period of 40 years. Open surgery was used in 165 patients and a laparoscopic modality (starting in 1994) in 163. Results: Patients subjected to open or laparoscopic surgery had similar demographic and manometric features. Mucosal injury during myotomy occurred in 20 (12 percent) and 10 (6 percent) of patients subjected to open or laparoscopic surgery, respectively (p < 0.05). Four patients operated using a laparoscopic approach had to be converted to open surgery. Two patients operated using an open approach had a postoperative leak. One patient had an abscess and one a hemoperitoneum. Conclusions: The surgical approach of choice for achalasia is laparoscopic, with a low incidence of complications.

Objetivos: Evaluar la evolución postoperatoria inmediata y morbimortalidad en 328 pacientes con acalasia sometidos a tratamiento quirúrgico en un período de 40 años. Material y Método: Se analizan 328 pacientes con acalasia, sometidos a abordaje laparotómico en 165 pacientes y laparoscópico en 163 pacientes, evaluando la morbilidad y mortalidad postoperatoria exclusivamente. Se aplicó el mismo protocolo quirúrgico en ambos grupos, variando sólo en la vía de acceso abdominal. Resultados: Ambos grupos son enteramente comparables tanto en edad, distribución por género, síntomas, duración de síntomas y estudio manométrico. Hubo significativamente más apertura de la mucosa esofágica durante cirugía laparoscópica comparada con la vía laparotómica. Hubo 2 pacientes con filtración postoperatoria con cirugía laparotómica y 1 hemoperitoneo después de abordaje laparoscópico. No hubo mortalidad operatoria. Conclusión: El abordaje laparoscópico es la técnica de elección en la actualidad en pacientes con acalasia, con una muy baja morbilidad.

Análisis cuantitativo de variables hemodinámicas de la aorta obtenidas de 4D flow / Quantitative analysis of hemodynamic variables of the aorta by 4D flow MRI

Objective: Hemodynamic parameters are critical to perform a proper diagnosis. However, due to the large number of variables that can be obtained, overall analysis may represent a complex task. To facilitate this, we propose to create a model for classifying different hemodynamic variables between those belonging to a healthy individual and to a pathological patient. For this purpose, we employed data mining techniques to identify relationships among various aortic hemodynamic parameters obtained through multi-dimensional (4D flow) MR imaging. Method: A 4D flow sequence of whole heart and great vessels was acquired using MRI in 19 healthy volunteers and 2 patients (one with aortic coarctation and one with repaired coarctation of the aorta). Retrospectively, data were reformatted along the aorta; three MRI acquisitions were performed for volunteers and 30 sequences for each patient. In each slice the aorta was segmented and various parameters were quantified: area, maximum velocity, minimum velocity, flow and volumen, with following values being calculated for last four parameters: maximum, average, standard deviation, kurtosis, skewness, proportion of time to reach the maximum value, among others. A total of 26 variables for each acquisition were obtained. In order to classify data, the CART Technique (Classification and Regression Trees) was applied. To validate the model, two extra projections were generated per each volunteer and 20 slice per each patient. Results: By using only 7 variables, the CART Technique allows discrimination between images performed either on volunteers or patients with an error rate of 14.1 percent, a sensitivity of 82.5 percent, and a specificity of 89.4 percent. Conclusions: 4D flow MR imaging provides a wealth of hemodynamic data that can be difficult to analyze. In this paper we demonstrate that by using data mining techniques it is possible to classify images from relevant hemodynamic parameters and their relationships in order...

Objetivo: Los parámetros hemodinámicos son de gran utilidad para realizar un adecuado diagnóstico. Sin embargo, debido a la gran cantidad de variables que pueden obtenerse, el análisis global de todas ellas puede ser complejo. Para facilitar esta tarea, nosotros proponemos crear un modelo que permita clasificar distintas variables hemodinámicas entre las pertenecientes a un individuo sano o a uno patológico. Para ello, usaremos técnicas de minería de datos que permitan identificar y encontrar relaciones entre distintos parámetros hemodinámicos de la aorta obtenidos a través de flujo multidimensional (4D flow) por resonancia magnética. Método: Una secuencia 4D flow de todo el corazón y los grandes vasos fue adquirida utilizando resonancia magnética en 19 voluntarios sanos y 2 pacientes (uno con una coartación aórtica y otro con una coartación aórtica reparada). Retrospectivamente, los datos fueron reformateados a lo largo de la aorta, originándose 3 cortes en los voluntarios y 30 cortes en cada paciente. En cada corte la aorta fue segmentada y distintos parámetros fueron cuantificados: área, velocidad máxima, velocidad mínima, flujo y volumen, calculándose en los cuatro últimos su valor máximo, promedio, desviación estándar, curtosis, sesgo, proporción de tiempo en alcanzar el valor máximo, entre otros. Teniendo un total de 26 variables por cada corte. Se aplicó la técnica de árboles de decisión tipo CART (por sus siglas en inglés) para clasificar los datos. Para validar el modelo, 2 cortes extras fueron generados por cada voluntario y 20 cortes por cada paciente. Resultados: La técnica CART, mediante la utilización de sólo 7 variables, puede clasificar las imágenes de los voluntarios y pacientes con una tasa de error del 14,1 por ciento, una sensibilidad de 82,5 por ciento y una especificidad de 89.4 por ciento. Conclusiones: 4D flow provee una gran cantidad de datos hemodinámicos que son difíciles de analizar. En este trabajo demostramos que al utilizar...

Comparison of histological measures of skin photoaging.

BACKGROUND: Dermal elastosis is considered the histological 'gold standard' for evaluation of skin photoaging, but the relation of the level of dermal elastosis to other histological indicators of photoaging is not clear. OBJECTIVE: To investigate how various proposed histological measures of photoaging compare with the level of dermal elastosis. METHODS: Prospective, community-based study in Southeast Queensland, Australia, among 89 participants aged 40-82 years. Quantitative histology was used to evaluate 8 biomarkers of photoaged skin, and associations between grades of dermal elastosis and each of the other 7 biomarkers were analysed using ordinal logistic regression models with proportional odds assumption, using histological grades of elastosis as the outcome. RESULTS: Older age, male sex and high outdoor exposure levels were confirmed as predictors of high levels of dermal elastosis. After adjustment for age and sex, the only significant positive association with increasing elastosis grades was the proportion of p53-positive cells. Epidermal thickness, interdigitation index proportion of surface covered with melanin (% Fontana-Masson staining) and glycosaminoglycan content were not associated with elastosis in either crude or adjusted models. CONCLUSIONS: Among a range of suggested biomarkers of photoaged skin, only p53-positive cells appear to be strongly associated with the level of dermal elastosis.

Edema agudo pulmonar por obstrucción de la vía aérea en el periodo postanestésico inmediato / Acute pulmonary edema due to airway obstruction during postanesthetic recovery

Se comunica una complicación postanestésica no reportada en la literatura médica, en un paciente de 22 años de edad, estado físico ASA 1, programado para osteotomía sagital de rama mandibular y colocación de injerto paranasal, bajo anestesia general balanceada que presentó al despertar edema agudo de pulmón. Se discute el papel de la obstrucción de la vía aérea que puede generar una elevada presión negativa intratorácica y subsecuentemente un edema agudo pulmonar, así como el diagnóstico diferencial acerca de las posibles causas de un edema agudo pulmonar durante el periodo postanestésico inmediato. La evolución postoperatoria fue satisfactoria(AU)

We report a postanesthetic complication that has not been described in the literature. A 22-year-old man (ASA 1) developed acute pulmonary edema on awakening from balanced anesthesia for scheduled sagittal mandibular ramus osteotomy and implantation of a paranasal graft. We discuss the role of airway obstruction, which can generate high intrathoracic negative pressures and lead to acute pulmonary edema. We also review the differential diagnosis of possible causes of acute pulmonary edema during the postanesthetic recovery. The postoperative course in this case was good(AU)

Ectasia piélica en diagnóstico prenata / Pyelic ectasia in prenatal diagnosis

La ecografía gestacional demuestra que el 1,4% de los fetos presentan algún grado de hidronefrosis, aunque en el 50%, dicha ectasia habrá desaparecido en el nacimiento. El desconocimiento que aún existe con respecto a las diferentes etapas del desarrollo fetal hace que sea difícil distinguir entre aquellas situaciones fisiológicas y las que son patológicas. La medición de los diámetros de la pelvis renal a lo largo de la gestación y la cantidad de líquido amniótico son datos importantes para establecer un pronóstico. Las válvulas de uretra posterior son las responsables de un buen número de casos de hidronefrosis gestacional significativa. Es importante diagnosticarlas y proceder a su tratamiento para evitar daño renal. Se presenta un caso clínico y se realiza una revisión sobre el tema proponiendo un algoritmo de actuación clínica (AU)

Gestational ultrasound shows that 1.4% of the fetuses have some degree of hydronephrosis, although in 50% renal ectasia will have disappeared at birth. The ignorance that still exists in the different stages of fetal development makes it difficult to distinguish between those situations that are physiological or pathological condition. Measuring the diameter of the renal pelvis throughout pregnancy and amniotic fluid are important data for establishing a prognosis. Posterior urethral valves are responsible for a number of significant cases of gestational hydronephrosis. It is important to diagnose it and provide treatment to prevent kidney damage. We present a case report and a review is made on the issue and we propos an algorithm for clinical intervention (AU)

Actualización en el tratamiento médico del carcinoma renal avanzado / Update on the medical treatment of advanced kidney cancer

El tratamiento quirúrgico del cáncer de células renales (CCR) avanzado se ve reforzado por la aplicación de fármacos con capacidad citorreductora. La inmunodependencia del CCR lo hace sensible a terapias como la Interleukina e el Interferón, aunque los resultados son discretos. Nuevas terapias médicas han conseguido mejores resultados. Dentro del grupo de los inhibidores de las multiquinasas, el Sunitinib bloquea los receptores del VEGF, PDGFR, C-Kit, FLT-3 tirosina quinasa que juegan un papel en la carcinogénesis del CCR; y el Sarafenib bloquea VEGFR-2 y PDGFR por inhibición de RAF-1. Por su parte de anticuerpos anti-VEGF, como el Bavicizumab neutralizan la actividad de VEGF-A. Los inhibidores de mTOR, como el Tensirolimus, y el Everolimus, inhiben a la rapamicina-quinasa, responsable de la proliferación y la hipoxia celular. Se presenta un caso de CCR avanzado con buena respuesta al tratamiento médico (AU)

Surgical treatment of renal cell cancer (RCC) is reinforced by the application of drugs with cytoreductive capacity. The CRC inmunomodulation makes it amenable to therapies such as interleukin and interferon, although the results are discrete. New medical therapies have better results. Within the group of the multi-kinase inhibitors, Sunitinib blocks the receptors of VEGF, PDGFR, C-kit and FLT-3 tyrosine kinase that plays a role in carcinogenesis soft RCC, while Sorafenib blocks VEGFR-2 and PDGFR through inhibition RAF—1. Anti-VEGF antibodies such as Bevacizumab neutralize the activity of VEGF-A. MTOR inhibitors, such as Tensirolimus and Everolimus, inhibits rapamycin-kinase responsible for proliferation and cellular hypoxy. A case of advanced RCC with good response to treatment is presented (AU)

Botox, mucho más que arrugas / Botox, much more tan rides

El primer tratamiento para los pacientes con vejiga inestable son los fármacos anticolinérgicos, que, sin embargo, pueden ser inefectivos o producir efectos adversos. Se han buscado otros tipos de tratamiento como son la neuromodulación o el tratamiento intravesical con toxina botulínica (Botox). Existe una evidencia creciente acerca de la utilidad de la inyección de toxina botulínica en el detrusor para el tratamiento de la hiperactividad vesical. Existen diferentes indicaciones en urología para el Botox aunque no están aceptadas oficialmente: el detrusor hiperactivo neurógeno e idiopático, la disinergia vésico-esfíteriana, cistopatía intersticial y dolor prostático crónico. Presentaremos dos casos clínicos para revisar las diferentes aplicaciones de Botox en urología (AU)

The first treatment for patients with unstable bladder are anticholinergics drugs, however, may be ineffective or cause side effects. Has been sought other types of treatment such as neuromodulation or intravesical treatment with Botulinic Toxine (Botox). There is growing evidence of the usefulness of botulinum toxin injection into the detrusor for the treatment of overactive bladder. There are different indications for Botox in urology but are not officially accepted: neurogenic and idiopathic overactive detrusor, the detrusor-sphincter, interstitial cystitis and chronic prostatic pain. We present two cases to review the various applications of Botox in urology (AU)