Bajo rendimiento diagnóstico de la PET/TC con 11C-colina en la detección de metástasis hepáticas de origen prostático / Low diagnostic yield of the 11C-choline PET/CT in the detection of liver metastasis from prostate cancer

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Influence of environmental factors on the response of a natural population of Daphnia magna (Crustacea: Cladocera) to spinosad and Bacillus thuringiensis israelensis in Mediterranean coastal wetlands.

The present study was undertaken to assess the impact of a candidate mosquito larvicide, spinosad (8, 17 and 33 microg L(-1)) on a field population of Daphnia magna under natural variations of water temperature and salinity, using Bti (0.16 and 0.50 microL L(-1)) as the reference larvicide. Microcosms (125 L) were placed in a shallow temporary marsh where D. magna was naturally present. The peak of salinity observed during the 21-day observation period may have been partly responsible for the decrease of daphnid population density in all the microcosms. It is also probably responsible for the absence of recovery in the microcosms treated with spinosad which caused a sharp decrease of D. magna abundance within the first two days following treatment whereas Bti had no effect. These results suggest that it may be difficult for a field population of daphnids to cope simultaneously with natural (water salinity and temperature) and anthropogenic (larvicides) stressors.

Effects of spinosad and Bacillus thuringiensis israelensis on a natural population of Daphnia pulex in field microcosms.

Spinosad, a candidate biological larvicide for mosquito control, was evaluated for its effects on a field population of Daphnia pulex, using Bacillus thuringiensis serovar israelensis (Bti) as a reference larvicide. Microcosms (125L enclosures) were placed in a shallow temporary oligohaline marsh where D. pulex was present. Three concentrations of spinosad (8, 17 and 33 microg L(-1)) and two concentrations of Bti (0.16 and 0.50 microL L(-1)) were applied (5 replicates per concentration, including the controls). Effects of larvicides on D. pulex were evaluated after 2, 4, 7, 14 and 21d of exposure, through measurements of abundance and individual size. Dissipation of spinosad from the water phase was rapid. Four days after treatment, residue concentration represented 11.8%, 3.9% and 12.7% of the initial exposure level for the nominal concentrations of 8, 17 and 33 microg L(-1), respectively. Spinosyns A and D dissipated at similar rates. Analysis of abundance and size structure of the D. pulex population showed an impact of spinosad. Both survival and size structure were affected. However, at the lowest concentration (8 microg L(-1)), population recovered after the first week. In microcosms treated with Bti, the abundance of D. pulex was not affected but the size structure of the population changed after 21d. As compared to laboratory tests, the use of in situ microcosms improved the environmental risk assessment of larvicides, taking into account the influence of environmental factors (e.g., temperature, light, salinity) and intrinsic capacity of recovery of D. pulex under field conditions.

Nefrectomía radical abierta y laparoscópica: estudio comparativo de cuidados de enfermería y calidad de vida / No disponible

En la Fundación Puigvert se ha introducido la nefrectomía laparoscópica como innovación quirúrgica durante el año 2001. Desde enero de 2001 se emplean ambas técnicas quirúrgicas simultáneamente, disminuyendo progresivamente el número de nefrectomías abiertas en beneficio de la cirugía laparoscópica, lo cual nos exige no sólo conocer las diferencias clínicas existentes entre ambas, sino discernirlos cuidados de enfermería a proporcionar según la demanda asistencial. Como equipo de enfermería consideramos que es imprescindible poseer un cuerpo de conocimientos, habilidades y actitudes que se adapten a los cambios e innovaciones. De este modo podremos identificar necesidades de salud, planificar cuidados de enfermería adecuados, prevenir complicaciones y contribuir a la adaptación del paciente a la vida diaria fomentando la independencia en todas sus necesidades según el modelo conceptual de Virginia Henderson. El objetivo de este estudio es describir desde un punto de vista comparativo la evolución posquirúrgica de la nefrectomía radical abierta y laparoscópica durante la hospitalización y el alta domiciliaria, en función de los cuidados de enfermería requeridos según el modelo conceptual de Virginia Henderson (AU)

In the Puigvert Foundation the laparoscopic nephrectomy has been introduced as surgical innovation during 2001. From January 2001both surgical techniques are used simultaneously, decreasing progressively the number of open nephrectomies for the benefit of the laparoscopic surgery, which requires that us not only to know the existing clinical differences between both, but to discern the cares of nursing to provide according to the demand. We, as a nursing team, consider that it is essential to possess a corps of knowledge, skills and attitudes that could be adapted to changes and innovations. In this way, we will be able to identify health needs, plan adequate nursing cares, prevent complications, and contribute to the adaptation of the patient to daily life encouraging the independence in all their needs according to the conceptual model of Virginia Henderson. The goal of this study is to describe from a comparative point of view the post-surgical evolution of the open radical nephrectomy and laparoscopic during the hospitalization and the house discharge, according to the nursing cares required according to the conceptual model of Virginia Henderson (AU)

[Asystolias in the acute phase of brain stroke. Report of a case]. / Asistolias en la fase aguda del infarto cerebral. A propósito de un caso.

Brain areas involved in heart autonomic control are not well characterized. Insulae have been proposed as control centers. A lesion in these areas may induce a cardiac autonomic dysfunction (arrhythmias, atrioventricular conduction abnormalities). Asystolia has not been previously reported. A 65-year-old man suffered an acute ischemia of the right middle cerebral artery (MCA) territory. NIHSS score was 19 points. Brain CT scan was normal. Transcranial Doppler (TCD) showed occlusion of the right MCA. Fibrinolysis was initiated 135 minutes after stroke onset with TCD monitoring. Twenty minutes later he suffered cardiac arrest with asystolia trace in the ECG monitor. Fibrinolysis was stopped during resuscitation. Four minutes later, he recovered with the same NIHSS score. Aggressive resuscitation maneuvers were not necessary. A repeated brain CT scan showed infarct signs in the whole MCA territory and a new TCD did not show any change. Serial blood analyses including cardiac nzymes were normal. The patient experienced four brief cardiac arrests in the next nine hours, so a temporary cardiac pacemaker was placed for four days. He was treated with aspirin and was discharged 14 days after admission. He has not experienced recurrences during a 6-month follow-up. We could not diagnose the etiology of the cardiac arrests. All the episodes occurred in the acute stroke stage and arrhythmia, atrioventricular block, myocardial ischemia or structural lesions were not found in the cardiac study. We propose that ischemia in the right insula induced sudden and transitory interruptions of the sympathetic cardiac tone.

Asistolias en la fase aguda del infartocerebral. A propósito de un caso / Asystolias in the acute phase of brain stroke. Report of a case

Las áreas cerebrales involucradas en el control autonómico cardíaco no están bien caracterizadas. Las ínsulas han sido propuestas como centros de control. Una lesión en estas áreas puede inducir una disfunción autonómica cardíaca (arritmias, anormalidades de la conducción aurículo-ventricular). La asistolia no ha sido informada previamente. Un varón de 65 años sufrió una isquemia en el territorio de la arteria cerebral media (ACM) derecha. La escala NIHSS sumó 19 puntos, la tomografía computarizada (TC) craneal fue normal y el Doppler transcraneal (DTC) mostró una oclusión de la ACM derecha. Se inició la fibrinólisis a los 135 minutos. Veinte minutos después el paciente sufrió un paro cardiorrespiratorio (PCR) por asistolia. La fibrinólisis fue suspendida durante la reanimación. Cuatro minutos después el paciente se recuperó con la misma puntuación NIHSS, no siendo necesarias maniobras agresivas de reanimación. Una nueva TC craneal mostró signos de infarto en el territorio de la ACM y un nuevo DTC no mostró ningún cambio. Las enzimas cardíacas consecutivas fueron normales. El paciente experimentó cuatro PCR más en las siguientes 9 horas, por lo que se colocó un electrocatéter durante 4 días. Fue dado de alta y tratado con aspirina, no experimentando recurrencias durante 6 meses de seguimiento. No pudimos diagnosticar la etiología de los PCRs. Todos los episodios ocurrieron en la fase aguda de la isquemia cerebral y en el estudio cardiológico no objetivamos arritmias, bloqueos auriculoventriculares, isquemia miocárdica o lesiones estructurales. Proponemos que la isquemia en la ínsula derecha indujo repentinas y transitorias interrupciones del tono simpático cardíaco (AU)

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[Intra-arterial fibrinolysis in vertebrobasilar system]. / Fibrinólisis intrarterial en el territorio vertebrobasilar.

INTRODUCTION: The acute vertebrobasilar occlussion is usually a life-treatening disease leading to death or major disability. The treatment with heparin and the selective fibrinolysis no show good results, for this reason the local intra-arterial fibrinolysis appear as the choice treatment in patients with stroke and a agiography with basilar artery occlussion or intracranial vertebral artery occlusion. This tecnique has been proved to be effective treatment for selected patients with acute thromboembolic occlusion of the middle cerebral artery, ophthalmic artery and vertebrobasilar system, reducing the mortality in the vertebrobasilar system from 90% to 40%. CLINICAL CASE: We present a 63 years-old man with a vertebrobasilar thrombosis of a probable cardioembolic origen. He was treated with r-TPA local intra-arterial fibrinolysis, to get a recanalization of vertebrobasilar system. In the control TC we see a haemorragic sufusion in the brain stem. The follow-up see a patient with tetraparesis and palsy of the low cranial nerves and normal superior cerebral functions. CONCLUSIONS: The local intra-arterial fibrinolysis is the choise treatment in the vertebrobasilar thrombosis because the high morbimortality of this patology and the inefficacy of the others therapeutics. The result depend of many factors as the thrombo location, the neurologic state, the evolution time, the start of treatment, the colateral circulation, the nervous tissue reserve, etc, that have dificult predict the result, but it is best of the natural history of the disease. Is necesary, change the concept of emergency and the attitude front the isquemic cerebral disease at the sanitary leaders, the doctors, and the general population, for dispose of more means to cofront this pathology, which permit diminish the morbimortality and reduce the grade of incapacity.

Fibrinólisis intrarterial en el territorio vertebrobasilar / Intra-arterial fibrinolysis in vertebrobasilar system

Introducción. La oclusión vertebrobasilar aguda es una patología grave con una historia natural que suele terminar en muerte o gran incapacidad. El tratamiento médico con heparina y la fibri nólisis selectiva no han mostrado buenos resultados, por lo que la fibrinólisis local intrarterial aparece como el método terapéutico de elección en aquellos pacientes con un ictus en evolución y una angiografía que demuestra la oclusión de la arteria basilar o de ambas vertebrales a nivel intracraneal. Esta terapia ha probado su eficacia en el tratamiento de pacientes seleccionados con oclusión aguda tromboembólica de la arteria cerebral media, arteria oftálmica y sistema vertebrobasilar, reduciendo la mortalidad, en este último, de un 90 a un 40 por ciento. Caso clínico. Presentamos el caso un paciente varón de 63 años con una trombosis vertebrobasilar de probable origen cardioembólico que tratamos mediante fibrinólisis intrarterial con r-TPA, lográndose la recanalización del sistema vertebrobasilar. En la TC de control se apreció una sufusión hemorrágica en el bulbo y protuberancia. El paciente después del tratamiento quedó con una tetraparesia y afectación de pares bajos, con funciones cerebrales superiores normales. Conclusiones. La fibrinólisis local intrarterial es el tratamiento de elección en la trombosis vertebrobasilar dada la elevada morbimortalidad de esta patología y la ineficacia de otros tratamientos. Los resultados dependen de muchos factores como la localización del trombo, el estado neurológico, el tiempo de evolución, el inicio del tratamiento, la circulación colateral, la reserva del tejido nervioso, etc., que hacen difícil predecir el resultado pero que es mejor que la evolución natural de la enfermedad. Se debe realizar un esfuerzo para cambiar el concepto de urgencia y la actitud frente a la enfermedad isquémica cerebral en los dirigentes sanitarios, en los médicos y en la población general, para poder disponer de más medios para afrontar esta patología, lo que permitiría disminuir la morbimortalidad y reducir el grado de incapacidad (AU)