[The dementia of King Ferdinand VI and the year with no king]. / La demencia del rey Fernando VI y el año sin rey.

INTRODUCTION: Ferdinand VI was king of Spain from 1746 until 1759. His last year of reign is known as the year without a king. Over this year the king suffered a rapidly progressive deterioration of his mental health status. The clinical condition has been always attributed to a pure psychiatric disorder, generally a bipolar disorder. DEVELOPMENT: We review the sources of information in the Spanish archives and libraries, in order to find clinical information about the illness suffered by the king. We made a clinical evaluation and discussion about the disease of the king according to the information that has been obtained and the different diseases that could have caused the illness. CONCLUSIONS: Last year clinical deterioration of Ferdinand VI started with the death of his lovely wife. At first, the symptoms were similar to the symptoms of a mayor depressive disorder. Although the king had a rapidly progressive deterioration with severe changes in behavior and conduct, long stay in bed, loss of sphincters control and seizures. During the last months of his life, the king fell into a state of prostration with a marked cognitive impairment. Although it is possible that Ferdinand VI could have had a previous psychiatric disorder, there is enough information to think about a rapidly progressive dementia as the main cause of his clinical worsening and dead.

TITLE: La demencia del rey Fernando VI y el año sin rey.Introduccion. Fernando VI fue rey de España entre 1746 y 1759. Su ultimo año de reinado se conoce como el año sin rey. Durante ese año, el monarca sufrio un rapido empeoramiento de sus condiciones mentales. La enfermedad generalmente ha sido atribuida a una condicion psiquiatrica primaria, generalmente por un trastorno bipolar. Desarrollo. Se realiza un estudio de investigacion en los archivos documentales españoles y bibliotecas en busca de informacion clinica sobre la enfermedad de Fernando VI. Se realiza una evaluacion y discusion clinica de la enfermedad del rey sobre la base de la informacion obtenida. Conclusiones. El inicio del empeoramiento clinico del ultimo año de Fernando VI empezo tras la muerte de su amada esposa. Los sintomas iniciales descritos pueden ser similares a los de un episodio depresivo mayor, sin embargo, el monarca sufrio un empeoramiento rapidamente progresivo con alteraciones de la personalidad, conductuales, encamamiento, perdida de control de esfinteres y crisis epilepticas. Los ultimos meses de su vida estuvo en un estado de postracion con un estado cognitivo compatible con una demencia grave. Por todo ello, aunque es posible que Fernando VI pudiera padecer previamente algun tipo de trastorno psiquiatrico, la enfermedad que le llevo a su muerte precoz seria compatible con lo que hoy conocemos como una demencia rapidamente progresiva.

Resultados de la biopsia selectiva de ganglio centinela combinada con la localización radioguiada de tumores invasivos no palpables de mama. Técnica de SNOLL / No disponible

Objetivo: La biopsia selectiva del ganglio centinela mediante inyección intralesional de un radiocoloide, combinado con la localización radioguiada de tumores no palpables de mama en el mismo acto quirúrgico se denomina técnica de SNOLL. El objetivo de nuestro estudio es mostrar la factibilidad y sencillez para realizar la técnica en un hospital provincial de 2º nivel dotado con Servicio de Medicina Nuclear, comparando nuestros resultados con las publicaciones de referencia. Métodos: Entre enero 2007 y marzo 2008 se incluyeron 20 pacientes consecutivas diagnosticadas de carcinoma no palpable de mama. Se realizó inyección intratumoral de un nanocoloide- Tc99 de albúmina (0,2 ml, 37MBq) guiada por ecografía o estereotaxia seguida de linfogammagrafía e instilación subareolar de colorante azul patente (2 ml). Tras identificación del ganglio centinela se detectó y extirpó la lesión mamaria mediante uso de sonda detectora de rayos gamma. Se verificaron radiológicamente todos los especímenes extirpados. Resultados: Se obtuvo al menos un ganglio centinela mediante marcaje radiactivo en 19 pacientes (95%). En un paciente el ganglio centinela se detectó únicamente mediante colorante. La localización radioguiada y extirpación de la lesión primaria se consiguió en todos los casos. En dos casos (10%), los márgenes se encontraban afectos (< 2 mm) por enfermedad in situ extensa asociada. 4 pacientes presentaron ganglio centinela positivo. Conclusiones: Las conclusiones de nuestra serie se encuadran en las publicadas hasta la fecha, otorgando a la técnica de SNOLL mejores resultados que la localización con guía metálica y confirmando la factibilidad de la misma en cualquier centro con recurso a Medicina Nuclear(AU)

Introduction: The SNOLL technique results of the combination of radioguided occult lesion localization (ROLL) and sentinel node mapping with a single radiotracer injection in the management of non-palpable breast cancer. The aim of this study was to evaluate the feasibility of this technique in a second-level hospital with a nuclear medicine department and compare our results with the reference publications. Methods: From January 2007 to March 2008, lymphoscintigraphy was performed in 20 consecutive patients with non-palpable breast cancer after the intratumoral injection of albumin nanocolloid-Tc99 (0.2 ml, 37 MBq) guided by stereotaxis or ultrasound. Under general anaesthesia, a subareolar injection of blue dye was performed. After sentinel lymph node biopsy, the gamma-ray detection probe was used for radioguided removal of the breast tumor. All the breast lesions were identified on X-ray control of the surgical specimen. Results: Al least one sentinel node was removed in 19 patients (95%). In one patient, the sentinel node was only detected by blue dye. Radioguided surgery of the breast tumor was successfully achieved in all patients. In two cases (10%), in situ carcinoma was present close to the margins of the surgical specimen (< 2 mm) and further re-excision was therefore performed. Axillary dissection was accomplished in 4 patients with sentinel node metastases. Conclusions: The findings of our study are consistent with those published to date, showing the advantage of SNOLL technique over the wire-guided localization of non-palpable breast cancer and confirming its feasibility in any center with a reference nuclear medicine department(AU)

Diagnóstico precoz de una afasia progresiva primaria mediante tomografía por emisión de positrones / Early diagnosis of primary progressive aphasia by positron emission tomography

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Maxillary central incisor with two root canals: an unusual presentation.

An unusual case is presented, underlying the rarity of the presence of two canals in a maxillary central incisor associated with macrodontia.

Evolution in time of the relationship between occlusion and tooth absence.

The evolution in time of the relationship between occlusion tooth absence was studied in 204 people in Salamanca, in 1996. The data collected in an oral test (biting in maximal intercuspidation on articulating paper) were analysed using the method called expansion-contraction systems. The results show that the loss of occlusion through time is directly related to the absence of premolars and molars. Incisors and canines occlude more in elderly people. This supports the view of a polarization in the evolution of the occlusion towards canines and premolars whereas tooth absence is polarized towards molars.

Fractal structure of caries.

Between 1991 and 1993, the data of 479 clinical records were compiled about caries in the permanent teeth of subjects of both sexes, whose dental examinations were carried out in a private dental clinic in the city of Salamanca and who were distributed by age into groups of 16-65, 26-55 and 36-45 years. Using the method known as system of expansion-contraction, we showed that caries has a non-linear dynamic, whose evolution in time is difficult to predict and which has a fractal geometry. This study shows the fractal geometry of caries and to achieve this uses a little-known method which will be of great use in future research.

Fractals in restorative treatment of teeth.

Previous studies support the view that the oral medium is a dynamic system composed of several elements, among which are restorations in teeth. The author believes that the evolution in time of a restoration can be non-lineal and that it has an irregular and chaotic behaviour. To investigate the theory, the author studied, between 1991 and 1994, on their first visit to a dental clinic in Salamanca, the restorations of 583 patients of both sexes. The group results were distributed throughout three age ranges, i.e. 16-65, 26-55 and 36-45. In each group the total number of fillings in situ in each tooth was recorded using the method 'Expansion-Contraction Systems'. The results show that the restorative treatment of teeth using fillings follows a non-lineal dynamic of chaotic behaviour and irregular geometry, which suggests it is a fractal.

[The detection of acute myocardial infarct without a Q wave; indium-111-labelled antimyosin antibodies versus technetium-99m-labelled radiophosphates]. / Detección del infarto agudo de miocardio sin onda Q; anticuerpos antimiosina marcados con indio-111 frente a radiofosfatos marcados con tecnecio-99m.

In order to ascertain whether antimyosin myocardial imaging is superior to the more conventional cardiac radiophosphate scanning for the diagnosis of non Q wave acute myocardial infarction (AMI), we conducted a comparative study with the contemporary use of both tracers. Forty eight patients admitted to the coronary care unit of our centre because of non Q AMI, were included. Between two and seven days after onset, cardiac scintigraphy was performed both using 99mTc labelled diphosphonic-propane-dicarboxylic acid (99mTc-DPD) and 111indium labelled antimyosin (111In-AAM). In addition to planar imaging, tomoscintigraphy (SPECT) with 99mTc-DPD was obtained in 12 patients. 99mTc-DPD imaging was positive for AMI in 44% of the cases, while 111In-AAM in 52% (NS). In most positive cases (more than 85%) myocardial necrosis was localised in the posterolateral wall. In the subgroup of SPECT imaged patients, the percentage of positive findings was the same as the percentage using planar 111In-AAM imaging (58%). We conclude that the apparent efficacy of antimyosin for the diagnosis of non Q AMI is similar to that of 99mTc-DPD imaging. We feel that owing to its higher cost, such procedure should be saved for those cases were standard 99mTc-DPD imaging fails to detect the infarcted myocardium.

Histological study of the temporomandibular joint capsule: theory of the articular complex.

The findings of the histological study of the human temporomandibular joint confirm that the cranium and the lower jaw are jointed by two temporomandibular articular complexes (one on the left and another on the right side), each made up, in turn, of two joints--a condylomeniscal condyloarthrosis and a reciprocally fitting meniscotemporal joint. Both these joints are surrounded by short capsular bands which stretch from the condyle to the meniscus and from the latter to the temporal bone and form the true joint capsules. Longer bands which extend from the condyle to the temporal bone may be regarded as reinforcements passing over two articulations.

[The temporomandibular joint in different mammals. A new concept]. / Estudio de la articulación temporo-mandibular en diferentes animales mamíferos. Un nuevo concepto.

The gross anatomy of the temporomandibular joints from omnivorous (pigs), carnivorous (dogs and cats), and herbivorous (cows and sheeps) animals and rodents (rabbits and mice) reveals the existence of right and left temporomandibular joint complex as has been described in humans. Each articular complex includes a temporo-meniscal joint and a mandibulomeniscal joint (in all specimens a combination between a saddle joint and condylar joint). The morphological features of these joints are discussed and the similarities and dissimilitudes between those found in animals and human beings are commented on.