Reconstrucción en un tiempo del pabellón auricular en amputación parcial traumática con preservación del pedículo inferior: revisión de la literatura y presentación de dos casos / One-stage auricular replantation in traumatic partial ear amputation with inferior pedicle preservation: review of the literature and presentation of two cases

La amputación parcial traumática del pabellón auricular con preservación del pedículo inferior corresponde a una patología infrecuente. Su reconstrucción incluye el uso de diversas técnicas quirúrgicas. Presentamos dos casos de reimplante inmediato, sin uso de microcirugía, con resultados favorables y sin necesidad de reintervenciones, junto a una revisión de la literatura. La revisión bibliográfica realizada apoya el uso de esta técnica, basándose en la preservación del puente cutáneo bajo el tragus que incluye una rama de la arteria temporal superficial y que sería responsable de la irrigación del reimplante.

Partial auricle amputation with preservation of the inferior pedicle is an unusual pathology. The reconstruction in these cases includes many surgical techniques. We present two cases of immediate replantation, without the use of microsurgery, with favorable outcomes and without need of new interventions. The revision of the literature supports this technique based in the preservation of the cutaneus bridge under the tragus that includes a branch of the superficial temporal artery that is responsible of the perfusion of the reimplant.

Presentación atípica de la enfermedad en el anciano. Un caso de fiebre de origen desconocido / A typical presentation of disease in the elderly. A case of fever of unknown origin

Presentamos el caso de un paciente de 88 años aquejado de febrícula de 30 días de evolución. Aunque no se cumplieran de forma estricta los criterios clínicos de fiebre de origen desconocido (FOD), se procedió a estudiarlo como tal, dada la falta de diagnóstico y respuesta al tratamiento antibioterápico tras una semana de ingreso. El objetivo de la presentación es comentar un caso que recuerda cómo la patología del paciente de edad avanzada suele presentarse de forma atípica y poco específica.Se recuerda brevemente las principales causas de FOD en el anciano (AU)

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Kainate-induced seizures alter protein composition and N-methyl-D-aspartate receptor function of rat forebrain postsynaptic densities.

The postsynaptic density is a highly dynamic structure, which is reorganized in an activity-dependent manner. An animal model for temporal lobe epilepsy, i.e. kainate-induced limbic seizures in rats, was used to study changes in postsynaptic density composition after extensive synaptic activity. Six hours after kainate injection, the protein content of the postsynaptic density fractions from rats that developed strong seizures was increased three-fold compared to saline-treated controls. Immunoblot analysis revealed that the relative amounts of metabotropic glutamate receptor 1alpha, N-ethylmaleimide-sensitive fusion protein, protein kinases C, Fyn and TrkB, as well as the neuronal nitric oxide synthase, were significantly higher in seizure-developing than in control rats. In contrast, the relative contents of the kainate receptor KA2 subunit, beta-actin, alpha-adducin and the membrane-associated guanylate kinase homolog SAP90/PSD-95 were decreased. The relative amounts of additional postsynaptic density proteins, including alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionate and N-methyl-D-aspartate receptor subunits, calcium/calmodulin-dependent kinase type II, casein kinase 2, tubulin, microtubule-associated protein 2B, the membrane-associated guanylate kinase homolog SAP102, and proline-rich synapse-associated protein 1/cortactin binding protein 1/Shank2 remained essentially unchanged. To assess possible changes in postsynaptic performance, postsynaptic densities were isolated from control and epileptic rats, incorporated into giant liposomes and N-methyl-D-aspartate receptor currents were recorded. A significant reduction in the mean conductance was observed in patches containing postsynaptic densities from animals with high seizure activity. This was due to the presence of reduced conductance levels in each membrane patch compared to control postsynaptic density preparations. From these data, we suggest that intense synaptic activity associated with seizures modifies the composition of postsynaptic densities and has profound consequences on the function of the N-methyl-D-aspartate receptors present in them. This rearrangement may accompany impairment of synaptic plasticity.