The Dominant Anterior Thoracic Artery of the Spinal Cord.

BACKGROUND AND PURPOSE: Dominant radiculomedullary arteries such as the artery of lumbar enlargement and the artery of cervical enlargement are well-documented. However, variability exists as to the size, number, and location of other radiculomedullary arteries contributing supply to the anterior spinal artery. The aim of this anatomic study was to document the prevalence and characteristics of the dominant anterior thoracic artery in cadaveric specimens. MATERIALS AND METHODS: Microsurgical dissection of cadaveric human spinal cord specimens (n = 50) was conducted. The artery of lumbar enlargement was injected with colored latex until the small-caliber arterial vessels were filled. The dominant anterior thoracic artery was identified, injected, and filled with diluted industrial paint. The course, diameter, and location of the dominant anterior thoracic artery, artery of lumbar enlargement, and artery of cervical enlargement were documented. RESULTS: The artery of lumbar enlargement was identified between T3 and L2 in all 50 specimens (100%), and the artery of cervical enlargement was identified in 84% of specimens (42/50). At least 1 dominant anterior thoracic artery distinct from the artery of lumbar enlargement and the artery of cervical enlargement was identified between T1 and T11 in 47 of the 50 specimens (94%). The most frequent origin of the dominant anterior thoracic artery was at the level of T4 on the left. The average size of the dominant anterior thoracic artery was 0.446 mm (range, 0.300-0.759 mm on the left and 0.270-0.569 mm on the right). CONCLUSIONS: A dominant anterior thoracic artery is present in 94% of individuals. Variations of the arterial supply to the anterior thoracic cord are of great importance due to their implications for ischemic events as well as surgical and endovascular procedures.

Efectos de la rehabilitación pulmonar sobre los síntomas asociadosa las exacerbaciones en pacientes / Effects of pulmonary rehabilitation on symptoms associated with exacerbations in patients with COPD

Las exacerbaciones de enfermedad pulmonar obstructiva crónica (EPOC) son responsables del deterioro físico de los pacientes, del ingreso y reingreso hospitalario, así como de su muerte. Esta revisión evidencia los beneficios de la rehabilitación pulmonar en la reducción de episodios de exacerbaciones en la EPOC. La metodología de búsqueda abarcó un total de 2.473 artículos, de los cuales fueron usados 14 para esta revisión según el cumplimiento de criterios establecidos. Los resultados obtenidos fueron significativos en las siguientes variables vinculadas directamente con la frecuencia de los episodios de exacerbación: disnea, saturación de oxígeno, volumen espiratorio forzado en el primer segundo, días de hospitalización, número de reingresos hospitalarios, capacidad de ejercicio, depresión y calidad de vida. La rehabilitación pulmonar mostró efectos positivos en las variables mencionadas, disminuyendo los episodios de exacerbaciones de la EPOC como las limitaciones en las actividades de los pacientes (AU)

Exacerbations of chronic obstructive pulmonary disease (COPD) are responsible for the physical deterioration of patients, hospital admission and readmission, as well as their death. This review demonstrates the benefits of pulmonary rehabilitation in reducing exacerbation episodes in COPD. A search was carried obtained a total of 2473 articles, of which 14 were used for this review according to the fulfillment of established criteria. The results obtained were significant in relation to the variables directly related to the frequency of exacerbation episodes: dyspnea, oxygen saturation, forced expiratory volume in the first second, days of hospitalization, number of hospital readmissions, exercise capacity, depression and quality of life. Pulmonary rehabilitation causes positive effects on the aforementioned variables, reducing episodes of COPD exacerbations as well as limitations in patients’ activities (AU)

Anatomy of the Great Posterior Radiculomedullary Artery.

BACKGROUND AND PURPOSE: Although considerable variability exists as to the overall caliber of radiculomedullary arteries, dominant radiculomedullary arteries such as the artery of Adamkiewicz exist. The existence of a great posterior radiculomedullary artery has attracted little attention and has been a matter of debate. The aim of this anatomic study was to determine the presence or absence of the great posterior radiculomedullary artery. MATERIALS AND METHODS: We performed microsurgical dissection on formaldehyde-fixed cadaveric human spinal cords. The artery of Adamkiewicz in the spinal cord specimens (n = 50) was injected with colored latex until the small-caliber arterial vessels were filled and the great posterior radiculomedullary artery was identified. The course, diameter, and location of great posterior radiculomedullary artery were documented. RESULTS: A great posterior radiculomedullary artery was identified in 36 (72%) spinal cord specimens. In 11 (22%) specimens, bilateral great posterior radiculomedullary arteries were present. In 13 cases (26%), a unilateral left-sided great posterior radiculomedullary artery was identified. In 11 cases (22%), a unilateral right-sided great posterior radiculomedullary artery was identified. In 1 specimen (2%), 3 right-sided great posterior radiculomedullary arteries were noted. The average size of the great posterior radiculomedullary arteries was 0.44 mm (range, 0.120-0.678 mm on the left and 0.260-0.635 mm on the right). CONCLUSIONS: A great posterior radiculomedullary artery is present in most (72%) individuals. The authors describe the microsurgical anatomy of the great posterior radiculomedullary artery with emphasis on its morphometric parameters as well as its implications for spinal cord blood supply. Variations of the arterial supply to the dorsal cord are of great importance due to their implications for ischemic events, endovascular procedures, and surgical approaches.

Sección de Neumología Pediátrica del Hospital General Universitario Gregorio Marañón / Pediatric Pneumology section of the Hospital General Universitario Gregorio Marañón

En este documento resumimos cómo entendemos que debe ser la atención sanitaria a la población pediátrica con patología respiratoria, liderada por un servicio altamente especializado que atienda adecuadamente la vertiente asistencial, y de respuesta a la demanda docente (pre y postgrado) e investigadora—innovadora propias de un centro de tercer nivel y alta complejidad; todo ello bajo estándares de calidad y controles externos como es el caso del laboratorio de función pulmonar acreditado según Norma ISO 9001 y de las Consultas externas a las que se va a ampliar el alcance de dicha certificación. Se describen la Misión, Visión y Valores; los objetivos asistenciales, sociales y de docencia e investigación y las líneas estratégicas de Gestión Clínica de la Sección de Neumología Pediátrica (Pacientes/Profesionales/Procesos/Alianzas Estratégicas/Calidad Asistencial). A continuación, se describe la Cartera de Servicios, la Estructura y los Recursos (humanos y materiales) con los que cuenta nuestra Sección, para desarrollar una actividad orientada a la humanización de todo el proceso asistencial del paciente pediátrico con patología respiratoria, siguiendo la línea estratégica del Servicio Madrileño de Salud. Por último, hacemos referencia a los Programas Específicos de Gestión — Áreas de Mejora, a medio y largo plazo, que permitan consolidarnos como una Sección de Neumología Pediátrica referente en nuestro ámbito (AU)

With this document we aim to show what we believe health care for the pediatric population who suffer respiratory pathology should be like; it should be led by highly specialized personnel Who can attend to the patients, and should be able to handle the demand for educational health-oriented work placements (pre and post—graduate) as well as the demand for investigation and innovation which are part and parcel of a highly complex and third level centre. All of this should be enveloped in high level of quality and external controls as is the case of the lung function laboratory accredited by Norma ISO 9001 and the Outpatient Clinics which will also be included by the same certificate. We outline our mission, our vision our values; the objectives for patient attendance, and as social, teaching and investigative objectives and the strategies for Clinical management within the Pediatric Pneumology Unit (Patients/Professionals/Processes/ Strategic Allíances/Healthcare Quality management). We continue by describing the full list of services we offer, in order to develop an activity which is oriented to the humanization of the attendance process for the pediatric patient with respiratory problem, in line with the Madrid Health Service Strategies. Finally, we make reference to specific Management Programmes - areas in which we can improve, in the medium to long-term, which will allow us to consolidate our position as the Pediatric Pneumology Unit of reference in our field (AU)

Effects of Neospora caninum infection at mid-gestation on placenta in a pregnant mouse model.

Neospora caninum is one of the more-efficient transplacentally-transmitted organisms. The goal of the present study was to investigate the pathologic and immunologic changes that occur at the materno-fetal interphase in pregnant BALB/c mice infected with N. caninum at mid-gestation. Parasite DNA was detected in feto-placentary units 3 days post-infection (PI). On day 7 PI, the DNA detection level and parasite burden were significantly higher in the placentas than in the fetuses, which may indicate that the parasite is mainly multiplying in the placenta during the initial infection. In the spleens of infected dams, we observed an increase in IFN-γ, IL-10, and IL-4. However, only IL-4 was upregulated in placentas from the infected dams; this may enhance susceptibility to N. caninum at the materno-fetal interphase and favor transmission to the progeny. Finally, an increase in TNF-α expression in nested-PCR-positive placentas combined with necrosis may compromise the viability of the fetuses.

Evaluation of ovine abortion associated with Toxoplasma gondii in Spain by different diagnostic techniques.

A total of 173 aborted ovine foetuses and seven aborted caprine foetuses, submitted from different points of north and central Spain, were analysed to determine the role of T. gondii in abortion and to compare the utility of the most widely used techniques in diagnosis of the congenital infection (histopathology, serology--IFAT and ELISA--and a nested-PCR). Parasite infection was diagnosed in 40 (23.1%; n = 173) ovine foetuses by at least one of the diagnostic techniques used. A higher percentage of foetuses were diagnosed using serological techniques (IFAT and ELISA) (28.3%; n = 106) than by histologic examination (8.7%; n = 173) or PCR (6.9%; n = 173). No significant association between infection and the foetal age categories was found (P > 0.05). In this study, 106 aborted foetuses were analysed by all of the three diagnostic techniques. When we compared serological results, perfect agreement between ELISA and IFAT was obtained. On the contrary, slight to fair agreements were observed when histology results were compared with those obtained by serology and PCR techniques. All the positive foetuses were aborted in the mid (60%) or last (40%) term of pregnancy, but no significant differences were found between ages of the infected and non-infected foetuses (P > 0.05). This report indicates that toxoplasmosis may be a common cause of small ruminant abortion and neonatal death in Spain and points out the necessity of using different and complementary techniques to increase the probability of detecting Toxoplasma infection in an aborted foetus.

Evaluation by different diagnostic techniques of bovine abortion associated with Neospora caninum in Spain.

Eighty foetuses from some of the main cattle-producing regions in Spain were analysed to investigate the participation of Neospora caninum in cases of bovine abortion. Diagnosis of the infection was determined by histopathological analysis complemented with immunohistochemistry, serology (IFAT and ELISA) and PCR tests. A total of 38.8% of the bovine foetuses analysed were considered to be infected by at least one of the diagnostic techniques used. Microscopic lesions consistent with Neospora infection in brain were identified in 31.3% of the samples, whereas only 10.7 and 15.3% were positive using serological and PCR analysis, respectively. Perfect agreement was shown between IFAT and ELISA, although there was little agreement among results of the other diagnostic techniques. Gestational age of aborted foetuses checked ranged from <3 to 9 months, with a mean of 5.9 months, and no difference in age was found between infected and non-infected foetuses (P>0.05). This study confirms the importance of N. caninum as a cause of abortion in Spain and underlines the need to use different diagnostic techniques to increase the chance to detect the infection in aborted foetuses.

[Carotid-basilar artery communication in gerbils (Meriones unguiculatus)]. / Comunicación arterial carotidobasilar en gerbos (Meriones unguiculatus).

INTRODUCTION: Since 1966 when Levine and Payan observed that the Mongolian gerbil (Meriones unguiculatus) was unusually susceptible to cerebral infarction following occlusion of one or both common carotid arteries, the model has been used for the experimental study of cerebral ischemia. OBJECTIVE: To assess the presence of anterior-posterior arterial communication in the Mongolian gerbil (Meriones unguiculatus). MATERIAL AND METHODS: 26 animals were used and divided in the following groups: 1. Bilateral carotid ligation (n = 10); 2. Unilateral left carotid ligation (n = 5); 3. Unilateral carotid right carotid ligation (n = 5); and 4. Control group without carotid ligation (n = 6). RESULTS: Postmortem intra-aortic dye injection demonstrated communication between anterior and posterior cerebral arteries in 30% of gerbils that previously were subjected to bilateral common carotid artery occlusion. A number of vessels, between 8.95-11.35 microns in diameter, were linking the basilar artery with the posterior cerebral artery. In the remaining animals, the absence of communication was confirmed. CONCLUSION: Communicating carotid-basilar in lower number of cases and anastomosis the smallest diameter to give the gerbil advantage on others species as model of experimental regional ischemia.

Comunicación arterial carotidobasilar en gerbos (Meriones unguiculatus) / Carotid-basilar arterial communication in gerbils (Meriones unguiculatus)

Introducción. El modelo en gerbos para la investigación de la isquemia cerebral por oclusión bilateral y unilateral de la arteria carótida común ha sido empleado desde 1966, cuando Levine y Payan lo describieron como susceptible de desarrollar infarto cerebral y signos de daño neurológico por variantes de la circulación anastomótica cerebral. Objetivo. Demostrar la presencia de comunicaciones arteriales entre la circulación cerebral anterior y posterior. Material y métodos. La muestra la forman 26 gerbos que fueron anestesiados para exponer y ocluir las arterias carótidas comunes: 1. Grupo bilateral (n= 10); 2. Carótida izquierda (n= 5); 3. Carótida derecha (n= 5); 4. Sin oclusión (n= 6). Posteriormente se sacrificaron para perfusión intraórtica, inicialmente con solución salina (0,9 por ciento) y paraformaldehído (4 por ciento), y finalmente con colorantes para teñir las arterias. Los cerebros fueron extraídos 24 horas después y posfijados una semana más, para estudiar la circulación arterial cerebral, su distribución y la medición de diámetros de los vasos principales y secundarios, especialmente de los vasos terminales del tronco vertebrobasilar y de la arteria cerebral posterior. Resultados. Se encontró, en 30 por ciento de los animales con oclusión bilateral, pequeños vasos comunicantes posteriores de diámetro variable, entre 8,95 y 11,35 µm. En los restantes animales examinados no se encontró comunicación entre el sistema vertebrobasilar y el sistema carotídeo. Conclusión. La comunicación carotidobasilar, en menor número de casos y con anastomosis de diámetro pequeño, le dan al gerbo ventaja sobre otras especies como modelo de isquemia regional (AU)

Malignant fibrous histiocytoma (giant cell type) associated with a malignant mixed tumor in the salivary gland of a dog.

A 12-year-old male Boxer dog presented with a 5 x 5 x 7-cm partially encapsulated mass in the right mandibular salivary gland. Histologically, the mass was composed of neoplastic epithelial and mesenchymal cells. The mesenchymal component consisted of two cell populations arranged in different patterns: coalescing nodules of neoplastic mononuclear cells with rare osteoid and numerous osteoclastlike giant cells; and sheets of neoplastic spindle cells intermingled with neoplastic epithelial cells and containing osteoid and well-formed bone trabeculae lined by osteoblasts and few osteoclastlike giant cells. On the basis of these histological features, two malignant salivary tumors were diagnosed: a malignant fibrous histiocytoma (giant cell type) and a malignant mixed tumor. Immunohistochemical studies demonstrated keratin 5 and 8 expression by the neoplastic epithelial cells, indicating a probable salivary ductal origin, and vimentin expression by all mesenchymal elements, suggesting a fibroblastic line of differentiation.