Hematoma espontáneo de recto anterior del abdomen: experiencia en nuestro centro / Rectus sheath haematoma: experience in our center

Fundamento: Describir las características clínicas de los pacientes diagnosticados de hematoma espontáneo de músculo recto abdominal (HEMR), los factores predisponentes y precipitantes y el manejo terapéutico. Pacientes y métodos: Estudio descriptivo retrospectivo de 46 HEMR diagnosticados desde 2002 hasta 2016. Se analizan datos epidemiológicos, clínicos, pruebas diagnósticas y modalidad de tratamiento. Resultados: La mediana de edad fue de 81 años, 61% mujeres. Los factores desencadenantes más frecuentes fueron la tos persistente y la inyección de heparina de bajo peso molecular. El 70% estaban anticoagulados, de ellos el 57% presentaba INR en rango supraterapéutico y en el 45% se suspendió la anticoagulación de manera definitiva tras el ingreso. El 41% presentaban insuficiencia renal crónica y la creatinina en el momento del diagnóstico fue superior a la basal (p<0,001). El tratamiento fue conservador en la mayoría de casos; se realizó radiología intervencionista en tres pacientes (6,5%) y cirugía abierta en cuatro (8,7%). El tratamiento invasivo se aplicó a pacientes con hematomas de mayor tamaño y con mayores requerimientos transfusionales, y se asoció a una mayor estancia media (p<0,001). Conclusiones: El HEMR es más frecuente en pacientes ancianos, tratados con acenocumarol y en rango supraterapéutico y conlleva con frecuencia la suspensión definitiva del tratamiento anticoagulante. La insuficiencia renal aparece relacionada con la sobredosificación del tratamiento anticoagulante y con la producción del hematoma. El tamaño del HEMR y los requerimientos transfusionales son factores que parecen relacionados con mayor necesidad de tratamiento invasivo mediante embolización arterial o cirugía (AU)

Background: To describe the clinical characteristics of patients diagnosed with spontaneous abdominal rectus muscle hematoma (RSH), predisposing and precipitating factors, and therapeutic management. Method: Retrospective descriptive study of 46 RSH diagnosed from 2002 to 2016. Epidemiological, clinical, diagnostic tests and treatment were analyzed. Results: The median age of patients was 81 years, 61% were female. The most frequent triggers were persistent coughing and injection of low molecular weight heparin. Seventy percent were anticoagulated, of which 57% had INR in the supratherapeutic range, and in 45% anticoagulation was definitively discontinued after admission. Forty-one percent presented chronic renal failure; moreover, creatinine at the time of diagnosis was higher tan baseline (p <0.001). In most cases, treatment was conservative; interventional radiology was performed on three patients (6.5%) and open surgery on four (8.7%). Invasive treatment was employed with patients who had larger hematomas and higher transfusion requirements, and this was associated with a longer mean stay (p<0.001). Conclusions: RSH is more frequent in elderly patients, treated with acenocumarol and in the supratherapeutic range, and frequently entails permanent suspension of anticoagulant therapy. Renal insufficiency is related to the overdosage of the anticoagulant treatment and to the production of the hematoma. The size of RSH and transfusión requirements are factors that seem to be related to a greater need for invasive treatment through arterial embolization or surgery (AU)

[Rectus sheath haematoma: experience in our centre]. / Hematoma espontáneo de recto anterior del abdomen: experiencia en nuestro centro.

BACKGROUND: To describe the clinical characteristics of patients diagnosed with spontaneous abdominal rectus muscle hematoma (RSH), predisposing and precipitating factors, and therapeutic management. METHOD: Retrospective descriptive study of 46 RSH diagnosed from 2002 to 2016. Epidemiological, clinical, diagnostic tests and treatment were analyzed. RESULTS: The median age of patients was 81 years, 61% were female. The most frequent triggers were persistent coughing and injection of low molecular weight heparin. Seventy percent were anticoagulated, of which 57% had INR in the supratherapeutic range, and in 45% anticoagulation was definitively discontinued after admission. Forty-one percent presented chronic renal failure; moreover, creatinine at the time of diagnosis was higher than baseline (p <0.001). In most cases, treatment was conservative; interventional radiology was performed on 3 patients (6.5%) and open surgery on 4 (8.7%). Invasive treatment was employed with patients who had larger hematomas and higher transfusion requirements, and this was associated with a longer mean stay (p<0.001). CONCLUSIONS: RSH is more frequent in elderly patients, treated with acenocumarol and in the supratherapeutic range, and frequently entails permanent suspension of anticoagulant therapy. Renal insufficiency is related to the overdosage of the anticoagulant treatment and to the production of the hematoma. The size of RSH and transfusion requirements are factors that seem to be related to a greater need for invasive treatment through arterial embolization or surgery. Key words. Spontaneous rectus sheath hematoma. Abdominal wall disease. Anticoagulant therapy. Transcatheter embolization. Abdominal pain.

[A retrospective study of 469 cases of acute appendicitis. Importance of primary care]. / Estudio retrospectivo de 469 casos de apendicitis aguda. Importancia de la atención primaria.

In the present study 469 cases of acute appendicitis, who were referred from the community and operated in the Surgery Service from the Soria Hospital, were retrospectively evaluated. The results showed an incidence of appendectomies lower than in other series (79.76 cases/100,000/year), with a higher frequency in males and in the age group between 10-30 years. No significant relation was found between symptoms and the correct diagnosis of appendicitis; however, the time of evolution influenced the number of hospital days and the degree of inflammation in the appendix. We emphasize the relevance of early diagnosis and the referral of the patient from primary care to the hospital stay and cost.

The effects of N,N-diethyl-4-methyl-3-oxo-4-aza-5 alpha-androstane-17 beta-carboxamide, a 5 alpha-reductase inhibitor and antiandrogen, on the development of baldness in the stumptail macaque.

We used a primate model of male-pattern baldness to test the efficacy of a topically applied 5 alpha-reductase inhibitor and antiandrogen (4-MA) in the prevention of baldness. Six periadolescent stumptail macaques were given daily topical applications of either 4-MA in dimethylsulfoxide or dimethylsulfoxide alone for 27 months. The three control monkeys developed varying degrees of baldness, while the three 4-MA-treated monkeys retained their juvenile pattern of hair growth. The percentage of actively growing hair follicles in the frontal scalp did not change in the 4-MA-treated group [46 +/- 6 (+/- SE) vs. 48 +/- 4], while a significant decrease occurred in the control group (63 +/- 6 vs. 25 +/- 12; P less than 0.025). Skin 5 alpha-reductase activity was reduced in the scalp of the 4-MA-treated monkeys. We conclude that topical 4-MA can prevent the development of baldness in the stumptail macaque, a primate model of androgen-dependent baldness.

Enterotropic mouse hepatitis virus infection in nude mice.

The cause of emaciation and diarrhea in athymic nude mice was found to be hyperplastic typhlocolitis resulting from infection with enterotropic mouse hepatitis virus (MHV). The disease was reproduced in experimentally-inoculated nude mice using intestinal homogenates from affected mice and cell culture-derived virus. Material derived from an experimental mouse was passed into neonatal Swiss mice and caused acute typhlocolitis. Virus failed to grow in NCTC-1469 cells and 17Cl-1 cells, which are normally permissive for MHV, but grew to low titer in a mouse rectal carcinoma cell line, CMT 93. These results show that an enterotropic strain of MHV can cause chronic enteric disease in athymic nude mice. The pattern of infection differs markedly from the more common MHV wasting syndrome in nude mice caused by non-enteric strains of MHV.

Biological and behavioural assessments of young rhesus monkeys after intrauterine exposure to high phenylalanine concentrations.

Nineteen pregnant Macaca mulatta were fed a special diet throughout the gestational period in an attempt to render them hyperphenylalaninaemic. Group C (control group) received a regular diet, group Lo was given a 'low' phenylalanine diet, group Me a 'median' phenylalanine diet, and group Hi a 'high' phenylalanine diet. Nearly all monkeys had an uncomplicated pregnancy and an uneventful delivery. Biological measurements were obtained shortly after the birth of the infants and behavioural assessments were done when the offspring were between 6 and 18 months of age. The results of the biological and behavioural evaluations revealed that there was no statistically significant difference among the respective study groups. We concluded that a combination of factors inherent in an imperfect animal model may account for the negative results of this study.

Eye movements of monkeys during discrimination learning: role of visual scanning.

Four experiments were conducted on stumptailed monkeys (Macaca arctoides) to determine whether the high levels of visual scanning (shifts in fixation from one discriminative stimulus to the other) seen during discrimination learning play a necessary role in this learning. In Experiments 1 and 2, the monkeys were given a series of two-choice, dot-pattern discrimination reversal problems. Normal visual scanning before a choice response was allowed during all but the reversal trials of half of the problems. On these latter trials, the discriminative stimuli were replaced by an uninformative stimulus after the animals made more than one visual fixation on each discriminative stimulus. Thus, on these trials, the animals were limited, in terms of the information received, to the empirically determined minimum number of scans necessary to maintain high levels of performance on such problems. In both experiments, which differed primarily in the number and type of uninformative stimuli used, the rate of reversal learning was markedly retarded by the experimental condition, with the effect persisting over a long series of problems. The magnitude of the effect was unrelated to the similarity of the uninformative stimulus to the discriminative stimuli. In Experiment 3, the monkeys were given a series of discrimination problems without reversals, during half of which the experimental condition was in effect. The results were similar to those of the first two experiments. Experiment 4 was similar to the preceding experiment except that, under the experimental condition, each trial began with the uninformative stimuli, which were replaced by the discriminative stimuli when visual scanning occurred. The uninformative stimuli had no clear-cut effect on discrimination learning in this experiment. These experiments indicate that the information provided by above-minimum levels of scanning is not necessary for discrimination learning per se, but it dose appear necessary for efficient discrimination learning.

Strength and biocompatibility of polymethacrylate-silica composite dental implant materials.

A study was made of the strength properties of several composite dental implant materials composed of silica microspheres (6%, 24%, and 48% by weight) and PMMA. Prepared specimens of the materials were tested for compressive strength and tensile strength as a function of the curing methods. Compressive strength was reduced only slightly when the 6% mixture was used, as compared to 100% PMMA, but the compressive strengths of the 12% and 24% mixtures were reduced by approximately 30% when compared to 100% PMMA. The compressive strengths of these materials were reduced even further after curing in a microwave oven, and the tensile strengths decreased to a greater degree. The 6% mixture was reduced by 38% in the heat-cured specimens and was reduced by 27% in the microwave-cured specimens. Tooth replica implants were placed in baboons and the peri-implant tissues were studied histologically after 6 months. Inflammation was minimal. Peri-implant alveolar bone was viable and active, and both connective tissue and epithelial attachment to the implant surface was evident.

Eye movements of monkeys during learning-set formation.

Eye movements of stump-tailed monkeys were measured during learning of a long series of two-choice pattern discrimination problems. The amount of scanning per trial (shifts in visual fixation from one pattern to the other) and the duration of individual fixations on the patterns increased during the course of learning-set formation and (except for the amount of scanning by some animals) remained high during the prolonged training following learning-set formation. Some of the changes in eye movements were different from those seen during the learning of single discrimination problems, a difference that possibly reflects cognitive processes specific to the learning-set task.

A vitreous carbon-polymethacrylate composite for dental implants.

A STUDY HAS BEEN CARRIED OUT ON THE STRUCTURE AND SURFACE TEXTure of a new dental implant material composed of vitreous carbon balloons (3 wt % or 6 wt %) and poly(methyl methacrylate). Tooth replica implants using this material had been successfully placed in baboons, and histologic study revealed normal alveolar bone and a peri-implant membrane with the connective tissue fibers oriented in a horizontal direction. Square wafers (10 mm X 10 mm X 1 mm) were studied, with the surface sandblasted in one-half of the specimens. Light microscopy revealed that in the 3% carbon specimens, the vitreous carbon micro-balloons were evenly spaced and often appeared to be fragmented within their spaces. S.E.M. studies revealed a finely porous surface with numerous large craters. Microballoons were often seen within the craters in the nonsandblasted specimens.