Evaluation of testicular echotexture with Ecotext as a diagnostic method of testicular dysfunction in stallions.

This study aimed to assess if Ecotext, a new software for evaluation of testicular echotexture, is a good method for diagnosis of stallions with testicular dysfunction (TD). Relationships between Ecotext parameters and sperm motility and production, testicular volume, and testicular blood flow were also studied. Ecotext provides a total of six echotexture parameters: Ecotext 1 (black pixels), 2 (white pixels) and 3 (grey pixels), and another 3 parameters related to hypoechogenic areas: Ecotext tubular density (ETD), Ecotext tubular diameter (ETd), and Ecotext tubular area (ETA). Stallions (n = 33) were assessed using proven diagnostic techniques (spermiogram, B-mode and Pulse Doppler ultrasound), and subsequent analysis with Ecotext. Animals were classified as "control stallions" (n:21, acceptable semen quality), and "stallions with TD" (n:12, poor semen quality (TM < 60%, PM < 45% and total nº of sperm with PM < 2000 × 106 spz), that were subdivided into "induced TD group" (immunized, anti-GnRH vaccine) and "acquired TD group". The acquired TD group showed differences in all Ecotext parameters in relation to controls (Ecotext 1:0.11 ± 0.17 vs 2.82 ± 2.52, Ecotext 2:1584.0 ± 575.8 vs 388 ± 368.2, Ecotext 3:134.2 ± 9.26; ETA: 2.14 ± 0.59 vs 5.40 ± 1.90; ETd: 65.66 ± 6.27 vs 86.93 ± 10.65 and ETD: 92.35 ± 11.24 vs 132.10 ± 16.35, p ≤ 0.001). Results suggest acquired TD stallions were suffering testicular degeneration with loss of architecture and function as all Ecotext parameters were altered in relation to controls. Induced TD horses only showed a reduction in ETD (116.2 ± 8.59 vs 132.10 ± 16.35, p ≤ 0.001), despite all sperm parameters being worse. These findings suggested immunized stallions probably only experience an acute loss of testicular functionality and parenchyma architecture is likely not affected since differences in Ecotext parameters with control stallions were not detected. ETD was the best parameter to identify animals with TD (AUC: 0.84, optimal cut-off value of 124.3 seminiferous tubules/cm2). Correlations were found between ETD and Doppler indices (PI: 0.60; RI: 0.47 p ≤ 0.001), total testicular volume (r: 0.48; p ≤ 0.05) and sperm motility (TM:0.51; and PM:0.54; p ≤ 0.001) and production (r:0.51; p ≤ 0.001). In summary, Ecotext could identify changes in testicular echotexture of stallions with TD. Results open the possibility for new research focused on establishing the relationship between Ecotext parameters and histomorphometry features in stallion testes.

Power Doppler can detect the presence of 7-8 day conceptuses prior to flushing in an equine embryo transfer program.

In order to determine whether differences in uterine blood flow between pregnant and non-pregnant mares can be used to predict the presence of the equine embryo prior to flushing in an embryo transfer program, power Doppler ultrasonography was used on a total of 52 mares on days 7 or 8 post-ovulation. Computer analysis of Doppler images was subsequently performed using ImageJ v1.48 software. Vascular perfusion of the endometrium was analyzed using spot meter techniques, measuring mean pixel intensity and area of blood flow. Mares with positive flushings presented a higher uterine blood flow area (one embryo: 54.01 ± 2.27 mm2 or two embryos: 61.01 ± 6.73 mm2) prior to embryo recovery compared to barren mares (21.77 ± 2.22 mm2) (p≤0.05). However, significant differences in vascular perfusion were not detected between single or twin pregnancies. Blood flow area appears to be a good predictor for differentiation between pregnant and non-pregnant mares with an AUC: 0.869; p≤0.001 and an optimal cut-off value of 37.21 mm2. Both the mare's age and day of embryo recovery caused effects on uterine vascular perfusion. According to Youden's J statistics the uterine blood flow area of young pregnant mares was greater than 25.4 mm2 on day 7 (with a sensitivity of 75% and a specificity of 87.5%) and greater than 21.02 mm2 on day 8 post-ovulation (with a sensitivity of 93.8% and a specificity of 100%). The uterine blood flow area in adult pregnant mares was greater than 41.4 mm2 on day 7 (with a sensitivity of 80% and a specificity of 85.5%) and greater than 35.55 mm2 on day 8 after ovulation (with a sensitivity of 97.2% and a specificity of 85.7%). Evaluation on day 8 is therefore considered to be more reliable. Older and middle aged pregnant mares (5-18 years old) had increased uterine vascularization compared to young pregnant mares (2-5 years old) (p≤0.001). Conversely, older barren mares showed higher endometrial vascularity (35.06 ± 2.56 mm2) than young (17.21 ± 1.26 mm2) and middle aged non-pregnant mares (23.84 ± 1.50 mm2) (p≤0.05). We hypothesized that the higher blood flow area seen in older barren mares may be a consequence of a subclinical endometritis due to repeated flushing for embryo recovery. The results of the present study indicate that power Doppler ultrasound combined with computer assisted analysis of images are reliable techniques to detect early pregnancy prior to embryo recovery.

Uso de prótesis autoexpandibles en estenosisesofágicas en niños / Use of self-expandable prosthesis in esophageal stenosis in children

Objetivos. Las estenosis esofágicas de origen péptico o cáustico en niños precisan múltiples dilataciones, que implican un importante riesgo anestésico y de traumatismo esofágico. La colocación de prótesis esofágicas puede suponer un avance en el tratamiento de estos pacientes. El objetivo de nuestro trabajo es analizar la eficacia de las prótesis autoexpandibles para el tratamiento de estenosis esofágicas en niños. Material y métodos. Presentamos 3 casos clínicos de pacientes que han sufrido estenosis esofágicas, una secundaria a ingesta de cáusticos y dos a reflujo gastroesofágico, en los que se han colocado prótesis, en el primer caso metálica recubierta de nitinol y en los otros dos casos de material reabsorbible. Resultados. Al paciente con estenosis cáustica, tras un año de dilataciones, se le colocaron 2 prótesis metálicas consecutivas. Tras su retirada, ha precisado nuevas dilataciones con mayores periodos asintomáticos. A los dos pacientes afectos de estenosis pépticas, tras varios meses de dilataciones, les fueron colocadas prótesis (..) (AU)

Objective. Caustic or peptic esophageal strictures in children are the main cause of multiple dilations, which involve an important anesthetic risk and esophageal trauma. The placement of an esophageal stent can be an advance in the treatment of these patients. The objective of our work is to analiyze the efficacy of self-expanding stents for the treatment of esophageal strictures in children. Material and methods. Three patients with esophageal strictures, one due to caustic and two to peptic esophageal injuries have been treated with esophageal stents. Metal stent covered with nitinol has been used in the first patient, and biodegradable material stent in the rest. Results. After a year of serial (..) (AU)

[Presurgical nasoalveolar molding a child with cleft lip and palate]. / Moldeamiento nasoalveolar prequirúrgico en el niño con fisura labiopalatina.

The cleft lip and palate are among the diseases that benefit most from the creation of multidisciplinary units (paediatric surgeons, maxillofacial and plastic, orthodontist, otolaryngologist, speech therapist, psychologist, etc.). The objectives of presurgical orthodontic and orthopedic treatment are: 1.--Align the alveolar segments and reduce the width of the cleft to facilitate cheiloplasty. 2.--To guide the growth of the segments in which the jaw is divided. 3.--Improve lingual function. 4.--Shaping the nasal cartilage and the columella. We review developments in the treatment results in presurgical NAM (PNAME) in 15 patients treated in cleft lip and palate Unit Hospital Virgen de las Nieves (10 unilateral and 5 bilateral). Three patients did not complete treatment because of lack of cooperation from parents who dropped by the baby's crying. In all patients who completed a significant improvement was achieved in the alignment and spacing of the alveolar segments and in the shape of the alar cartilage. The learning curve in shaping makes each time the results are better and communication between parents of patients causes dropouts are virtually zero.

[Analysis of the medical decision in abdominal pain suggestive of acute appendicitis]. / Análisis de la decisión médica en el dolor abdominal sugerente de apendicitis aguda.

OBJECTIVES: Application of the theorem of Bayes for the study of the usefulness of complementary quantitative and qualitative assessment of the effectiveness of ultrasound diagnosis in order to provide the clinician with a tool to accurately assess the effectiveness of these tests in diagnosing abdominal pain appendix subject box. METHODS: Retrospective cohort of 184 patients treated from January 2009 to June 2010 for abdominal pain suggestive of acute abdomen, of which 145 were operated. Were established as predictors of appendiceal disease abdominal exploration, ultrasonography and plasma levels of CRP and leukocytes. The statistical methodology developed by the systematic Bayesian prior determination of ROC curve and calculation of odds and post-test probability as pretest probability based on physical examination. RESULTS: The ROC analysis cut-points set of quantitative tests on the values of WBC >12,800 and CRP >1.8 mg/dl. Applying the model to the white cell count increased clinical certainty of this test in 11.3 points and 13.9 PCR. The combined use of both the index rose 32 points. The effectiveness of ultrasound method showed a statistically significant 94% and an increase in diagnostic certainty of 48 points. DISCUSSION: It is recommended to base the development of protocols and clinical guidelines in practice of test ultrasound as first, and joint determination of inflammatory markers, when that was questionable or negative. Further studies are proposed to increase the clinical certainty to reduce laparotomy white and diagnostic delays in this condition.

Moldeamiento nasoalveolar prequirúrgico en el niño con fi sura labiopalatina / Presurgical nasoalveolar molding a child with cleft lip and palate

Las fisuras labiopalatinas son una de las patologías que más se benefi cian de la creación de Unidades multidisciplinares (cirujanos pediátrico, maxilofacial y plástico, ortodoncista, otorrinolaringólogo, logopeda, psicólogo, etc.). Los objetivos del tratamiento ortodóncico y ortopédico prequirúrgico son: 1.- Alinear los segmentos alveolares y reducir la anchura de la fi sura para facilitar la queiloplastia. 2.- Guiar el crecimiento de los segmentos en que se halla dividido el maxilar. 3.- Mejorar la función lingual. 4.- Moldear los cartílagos nasales y la columela. Revisamos la evolución en los resultados en el tratamiento con moldeado nasoalveolar prequirúrgico (PNAM) en 15 pacientes tratados en la Unidad de Fisurados Labiopalatinos del Hospital Virgen de las Nieves (10 unilateral y 5 bilateral). Tres pacientes no completaron el tratamiento por falta de colaboración de los padres que lo abandonaron por el llanto del niño. En todos los pacientes que lo completaron se consiguió una importante mejoría en la alineación y separación de los segmentos alveolares así como en la forma del cartílago alar. La curva de aprendizaje en el moldeamiento hace que cada vez los resultados sean mejores y la comunicación entre los padres de los pacientes tratados hace que los abandonos sean prácticamente nulos (AU)

The cleft lip and palate are among the diseases that benefit most from the creation of multidisciplinary units (paediatric surgeons, maxillofacial and plastic, orthodontist, otolaryngologist, speech therapist, psychologist, etc.). The objectives of presurgical orthodontic and orthopedic treatment are: 1.- Align the alveolar segments and reduce the width of the cleft to facilitate cheiloplasty. 2.- To guide the growth of the segments in which the jaw is divided. 3.- Improve lingual function. 4.- Shaping the nasal cartilage and the columella. We review developments in the treatment results in presurgical NAM (PNAME) in 15 patients treated in cleft lip and palate Unit Hospital Virgen de las Nieves (10 unilateral and 5 bilateral). Three patients did not complete treatment because of lack of cooperation from parents who dropped by the baby’s crying. In all patients who completed a significant improvement was achieved in the alignment and spacing of the alveolar segments and in the shape of the alar cartilage. The learning curve in shaping makes each time the results are better and communication between parents of patients causes dropouts are virtually zero (AU)

Análisis de la decisión médica en el dolor abdominal sugerente de apendicitis aguda / Analysis of the medical decision in abdominal pain suggestive of acute appendicitis

Objetivos. Aplicación del teorema de Bayes al estudio de la utilidad de las pruebas complementarias cuantitativas, y valoración cualitativa de la efi cacia del diagnóstico ecográfi co, con objeto de dotar al clínico de una herramienta para evaluar con exactitud la efectividad de dichas pruebas en el diagnóstico del dolor abdominal susceptible de cuadroapendicular. Método. Cohorte retrospectiva de 184 pacientes atendidos desde enero 2009 a junio 2010 por dolor abdominal sugestivo de abdomen agudo, de los que 145 fueron intervenidos. Se fijaron como variables predictoras de enfermedad apendicular la exploración abdominal, la ecografía y los valores plasmáticos de PCR y leucocitos. La metodología estadística se desarrolló según la sistemática bayesiana, previa determinación de curva ROC, y cálculo de momios y probabilidades postprueba, según la probabilidad preprueba basada en la exploración física. Resultados. El análisis ROC fi jó los puntos de corte de las pruebas cuantitativas en valores de leucocitos >12.800 y PCR >1,8 mg/dl. La aplicación del modelo al contaje leucocitario aumentó la certidumbre clínica de esta prueba en 11,3 puntos y de la PCR en 13,9. El uso combinado(..) (AU)

Objectives. Application of the theorem of Bayes for the study of the usefulness of complementary quantitative and qualitative assessment of the effectiveness of ultrasound diagnosis in order to provide the clinician with a tool to accurately assess the effectiveness of these tests in diagnosing abdominal pain appendix subject box. Methods. Retrospective cohort of 184 patients treated from January2009 to June 2010 for abdominal pain suggestive of acute abdomen, of which 145 were operated. Were established as predictors of appendice aldisease abdominal exploration, ultrasonography and plasma levels of CRP and leukocytes. The statistical methodology developed by the systematic Bayesian prior determination of ROC curve and calculation of odds and post-test probability as pretest probability based on physical examination. Results. The ROC analysis cut-points set of quantitative tests on the values of WBC >12,800 and CRP >1.8 mg/dl. Applying the model to the white cell count increased clinical certainty of this test in 11.3points and 13.9 PCR. The combined use of both the index rose 32 points. The effectiveness of ultrasound method showed a statistically significant (..) (AU)

[Use of self-expandable prosthesis in esophageal stenosis in children]. / Uso de prótesis autoexpandibles en estenosis esofágicas en niños.

OBJECTIVE: Caustic or peptic esophageal strictures in children are the main cause of multiple dilations, which involve an important anesthetic risk and esophageal trauma. The placement of an esophageal stent can be an advance in the treatment of these patients. The objective of our work is to analiyze the efficacy of self-expanding stents for the treatment of esophageal strictures in children. MATERIAL AND METHODS: Three patients with esophageal strictures, one due to caustic and two to peptic esophageal injuries have been treated with esophageal stents. Metal stent covered with nitinol has been used in the first patient, and biodegradable material stent in the rest. RESULTS: After a year of serial dilations, we placed two consecutive metal stents in one patient with caustic stricture. After its withdrawal, new dilations have been needed, but with longer asymptomatic period. The other two patients had peptic strictures; biodegradable stents were placed after months of serial dilations, before performing antireflux surgery. None of them needed further dilation. CONCLUSIONS: Esophageal stent placement has solved the problem without further dilation in peptic esophageal strictures. Asymptomatic period was significantly increased in caustic stricture. The results obtained with self-expanding stents are promising.

Aging-induced alterations in female rat colon smooth muscle: the protective effects of hormonal therapy.

Aging is associated to oxidative damage and alterations in inflammatory and apoptotic pathways. Aging impairs secretion of several hormones, including melatonin and estrogens. However, the mechanisms involved in aging of smooth muscle are poorly known. We have studied the changes induced by aging in the colonic smooth muscle layer of female rats and the protective effect of hormonal therapy. We used young, aged, and ovariectomized aged female rats. Two groups of ovariectomized rats (22 months old) were treated either with melatonin or with estrogen for 10 weeks before sacrifice. Aging induced oxidative imbalance, evidenced by H(2)O(2) accumulation, lipid peroxidation, and decreased catalase activity. The oxidative damage was enhanced by ovariectomy. In addition, aged colonic muscle showed enhanced expression of the pro-inflammatory enzyme cyclooxygenase 2. Expression of the activated forms of caspases 3 and 9 was also enhanced in aged colon. Melatonin and estrogen treatment prevented the oxidative damage and the activation of caspases. In conclusion, aging of colonic smooth muscle induces oxidative imbalance and activation of apoptotic and pro-inflammatory pathways. Hormonal therapy has beneficial effects on the oxidative and apoptotic changes associated to aging in this model.

[Mandibular distraction osteogenesis in patients with craniofacial malformation]. / Distracción mandibular osteogénica en pacientes con malformaciones craneofaciales.

Craniofacial malformations (Pierre-Robin sequence, Treacher-Collins syndrome, Nager syndrome, etc.) are frequently associated to severe mandibular hypoplasia, which can cause upper airway obstruction by retroposition of the base of the tongue in the posterior pharyngeal space. Most of the patients respond to postural treatment. In prone decubitus position, it may be necessary to monitor oxygen saturation, insert a nasopharyngeal tube and even an endotracheal one. In more severe cases with prolonged and frequent pauses of apnea, tracheostomy may be necessary, but it is associated with high morbidity and sometimes mortality. In the last two years, in the Multidisciplinary Cleft Lip and Palate Unit of the Hospital Virgen de las Nieves, 4 children with severe obstructive apnea secondary to severe mandibular hypoplasia have been treated with mandibular distraction osteogenesis, this procedure being effective in the resolution of the condition. It has avoided tracheostomy, it has lengthened the jaw in a period of 2-3 weeks. During this time, the obstructive respiratory problems and also swallowing problems have disappeared. The esthetic results were excellent and the complications, for the moment, minimum.

Identification of histamine receptors and effects of histamine on murine and simian colonic excitability.

BACKGROUND: Inflammatory responses can include recruitment of cells of hematopoietic origin to the tunica muscularis. These cells can secrete a variety of factors which can reset the gain of smooth muscle cells (SMC) and influence motor patterns. Histamine (H), a major mediator in inflammation, is released by mast cells and exerts diverse effects in SMC by binding to H receptors. The profiles of H receptor expression in animal models used to study inflammatory diseases are unknown. METHODS: Histamine receptor expression and electro-mechanical responses to H were tested in simian and murine colonic smooth muscle using qualitative and quantitative PCR, isometric force measurements, microelectrode recordings and patch clamp techniques. KEY RESULTS: H1, H2, and H4 receptor transcripts were expressed at similar levels in simian colonic tissue whereas only the H2 receptor transcript was detected in murine colonic tissue. Stimulation of simian colonic muscles with H caused depolarization and contraction in the presence of tetrodotoxin. Histamine activated non-selective cation channels in simian SMC. In contrast, H caused hyperpolarization and inhibited contractions of murine colon. The hyperpolarization was inhibited by the K(ATP) channel blocker, glibenclamide. Histamine-activated K(+) currents were inhibited by glibenclamide in murine colonic SMC. CONCLUSIONS & INFERENCES: Histamine receptor expression in simian SMC was similar to that reported in humans. However, H receptor profile and responses to H were considerably different in mice. Thus, monkey colon may be a more suitable model to study how inflammatory mediators affect the gain of smooth muscle excitability.

Distracción mandibular osteogénica en pacientes con malformaciones craneofaciales / Mandibular distraction osteogenesis in patients with craniofacial malformation

Las malformaciones craneofaciales (secuencia de Pierre Robin, síndrome de Threacher Collins, síndrome de Nager, etc.) con frecuencia van asociadas a hipoplasia mandibular severa, que puede causar obstrucción de la vía aérea superior por retroposición de la base de la lengua dentro del espacio faríngeo posterior. La mayoría de los pacientes responden al tratamiento postural; ende cúbito prono puede ser necesario monitorizar la saturación de oxígeno ,insertar un tubo nasofaríngeo e incluso endotraqueal. En casos más severos con pausas prolongadas y frecuentes de apnea la traqueostomía puede ser necesaria, pero se asocia a una alta morbilidad y ocasional mente mortalidad. En los últimos dos años, en la Unidad Multidisciplinar de Labio y Fisura Palatina del Hospital Virgen de las Nieves, se ha tratado a 4 niños con apnea obstructiva grave secundaria a hipoplasia mandibular severa mediante distracción mandibular osteogénica, mostrándose este procedimiento eficaz en la resolución del problema. Ha evitado la traqueostomía, se ha elongado la mandíbula en el plazo de 2-3 semanas, en este tiempo han desaparecido los problemas respiratorios obstructivos y también de la deglución, siendo los resultados estéticos obtenidos excelentes y las complicaciones, por el momento, mínimas (AU)

Craniofacial malformations (Pierre-Robin sequence, Treacher-Collins syndrome, Nager syndrome, etc.) are frequently associated to severe mandibular hypoplasia, which can cause upper airway obstruction by retroposition of the base of the tongue in the posterior pharyngeal space. Most of the patients respond to postural treatment. In prone decubitus position, it may be necessary to monitor oxygen saturation, insert a nasopharyngeal tube and even an endotracheal one. In more severe cases with prolonged and frequent pauses of apnea, tracheostomy maybe necessary, but it is associated with high morbidity and sometimes mortality. In the last two years, in the Multidisciplinary Cleft Lip and Palate Unit of the Hospital Virgen de las Nieves, 4 children with severe obstructive apnea secondary to severe mandibular hypoplasia have been treated with mandibular distraction osteogenesis, this procedure being effective in the resolution of the condition. It has avoided tracheostomy, it has lengthened the jaw in a period of 2-3 weeks. During this time, the obstructive respiratory problems and also swallowing problems have disappeared. The esthetic results were excellent and the complications, for the moment, mínimum (AU)

Melatonin, a potential therapeutic agent for smooth muscle-related pathological conditions and aging.

Increases or decreases in the contractile response of smooth muscle underlie important pathological conditions such as hypertension, incontinence and altered gastrointestinal transit. These disorders are also frequently encountered in the aged population. Oxidative stress and inflammation are key features in the initiation, progression, and clinical manifestations of smooth muscle disorders. Melatonin, the major secretory product of the pineal gland, has free radical scavenging and antioxidative properties and protects against oxidative insult. Recently, widespread interest has grown regarding the apparent protective effects of melatonin on smooth muscle dysfunction. "In vitro" studies have shown that melatonin decreased vascular tone of vascular beds from control, hypertensive or aged animals, through the reduction of adrenergic contraction and the increase in acetylcholine-induced relaxation. "In vivo", melatonin also attenuates sympathetic tone by direct activation of melatonin receptors, scavenging free radicals or increasing NO availability in the central nervous system. In the gastrointestinal tract, melatonin treatment improves age-related impairments in gallbladder contractility and prevents deleterious effects of cholecystitis on smooth muscle and the enteric nervous system through suppression of oxidative stress. In addition, melatonin improves colonic transit time in constipation-predominant IBS patients. Melatonin is also able to restore impaired contractility of the detrusor muscle from old animals through normalization of Ca(2+) dependent and independent contraction, mitochondrial polarity, neuromuscular function and oxidative stress, which would explain the effects of melatonin counteracting cystometric changes in senescent animals. It also reverses bladder damage following ischemia/reperfusion. In conclusion, melatonin may be a promising candidate for future research of agents that modulate smooth muscle motility.

Spontaneous calcium oscillations in urinary bladder smooth muscle cells.

Although spontaneous phasic activity of detrusor muscle plays an important role in urinary bladder function there is little information regarding myogenic [Ca(2+)](i) signals in this tissue. We have studied spontaneous, unstimulated [Ca(2+)](i) signals in fura-2 loaded detrusor cells isolated from newborn (10-13 days old) guinea-pig urinary bladder. In newborn guinea pigs 35% of studied muscle cells displayed spontaneous [Ca(2+)](i) oscillations with several kinetic patterns (from irregular to highly paced cycles). The oscillations were inhibited by external Ca(2+) removal, treatment with L- and T-type Ca(2+) channel blockers and by the hyperpolarizing drug pinacidil. Ca(2+) stores were necessary to maintain oscillations, as indicated by the inhibitory effects of thapsigargin, ryanodine and 2-APB. Oscillations were also inhibited by folimycin, an inhibitor of acidic Ca(2+) stores. Treatment with the selective inhibitors iberiotoxin and NPPB indicated that the oscillatory signal is also modulated by Ca(2+) -activated K(+) channels (inhibitory) and Ca(2+) -activated Cl(-) channels (stimulatory). Our results indicate that detrusor cells from newborn guinea-pigs develop spontaneous [Ca(2+)](i) oscillations due to Ca(2+) influx through T- and L-type Ca(2+) channels modulated by intracellular stores, including acidic pools. This activity could underlie the myogenic activity of urinary bladder during early stages of development.