Spinal cord stimulation and cauda equina syndrome: Could it be a valid option? A report of two cases / Estimulación medular y síndrome de cauda equina. ¿Podría ser una opción válida? Reporte de dos casos

Spinal cord stimulation (SCS) consists of the application of electrical stimuli to the dorsal columns of the spinal cord or to the posterior nerve roots in order to modulate the pain signals carried by the ascending pain pathways to the brain. Two cases of SCS in patients with cauda equina syndrome after lumbar surgery are presented. They were treated for persistent neuropathic pain but also experienced improvement in their motor and urinary symptoms after this treatment. Although the primary indication for SCS is neuropathic pain control, its application can also lead to improvement of motor deficits, sensory disorders, and urinary incontinence, as shown in these two cases. SCS will likely play a fundamental role in rehabilitative therapies in different neurological diseases. Further investigation in the field is needed (AU)

La estimulación medular (SCS) consiste en la aplicación de estímulos eléctricos a las columnas dorsales de la médula espinal o a las raíces nerviosas para modular las señales de dolor en su vía ascendente hacia el cerebro. Se presentan dos casos del síndrome de cauda equina, secundario a cirugías lumbares. Estos fueron tratados por dolor neuropático persistente, pero también experimentaron mejoría de sus síntomas motores y urológicos con la SCS. La principal indicación de la SCS es el control del dolor neuropático; sin embargo, su uso también podría mejorar déficits neurológicos, alteraciones de la sensibilidad y la incontinencia urinaria, como se muestra en estos dos casos. La SCS probablemente jugará un rol importante en las terapias rehabilitadoras en algunas enfermedades neurológicas, aunque se necesita más investigación en este campo para estudiar dichos efectos (AU)

[Cystic nephroma. Report of two cases and bibliographic review.] / El nefroma quístico. Presentación de dos casos y revisión de la literatura.

OBJECTIVE: Multicystic nephroma (multilocular cystic nephroma, multilocular cyst) is a relatively rare benign neoplasm of the kidney. Most patients are asymptomatic and tumours are usually discovered incidentally. METHODS: Between 2010 and 2015, 2 patients with cystic nephroma at our institution were diagnosed and treated. Our study includes two new cases of cystic nephroma and a review of the literature about the differential diagnosis of a cystic renal mass. RESULTS: In this report we present two cases of multilocular cystic nephroma in a 75-year-old-female and a 33-year-old female. They were diagnosed clinically as a renal mass and surgery was performed. CONCLUSIONS: Surgery is the main treatment for cystic nephroma. The combination of clinical, biochemical and radiological features may help in lesion characterization, but only histology can provide the definite diagnosis. The differential diagnosis includes multilocular cystic renal cell carcinoma and cystic nephroblastoma.

Study by optical spectroscopy and molecular dynamics of the interaction of acridine-spermine conjugate with DNA.

We report a spectroscopic and theoretical study of the interaction between double-stranded oligonucleotides containing either adenine-thymine or guanine-cytosine alternating sequences and N1-(Acridin-9-ylcarbonyl)-1,5,9,14,18-pentazaoctadecane, or ASC, which is formed by the covalent bonding of spermine and 9-amidoacridine moieties via a trimethylene chain. Solutions containing the oligonucleotides and the conjugate at different molar ratios were studied using complementary spectroscopic techniques, including electronic absorption, fluorescence emission, circular dichroism, and Raman spectroscopy. The spectroscopical properties of ASC at both the vibrational and the electronic levels were described by means of ab initio quantum-chemical calculations on 9-amidoacridine, used as a model compound. Molecular dynamics calculations, based on the QM/MM methodology, were also performed using previously docked structures of two oligonucleotide-ASC complexes containing the A-T and the G-C sequence. Our data, taken all together, allowed us to demonstrate that conjugation of spermine to acridine modulates and gives additional properties to the interaction of the latter with DNA. As the ASC molecule has a high affinity by the polyamine transport system, these results are promising for their application in the development of new anti-tumour drugs.

Morbidity and embolic potential of left atrial cardiac tumors.

BACKGROUND: The aim of the study was to correlate cardiac tumors with implantation site, embolic potential and long-term evolution in patients undergoing surgery. METHODS: From 1981 to 2004, 78 patients underwent surgery for cardiac tumors. 64 % were female, with a mean age of 44 years. 14 % had embolic episodes (91 % CVA). The sizes of the tumors ranged from 0.4 cm to 10 cm. The most frequent tumors were myxomas (70 %), papillary fibroelastomas and fibromas. The preferential location was the left atrium (72 %). Data were analyzed using chi (2) and Student's T-tests, and the Kaplan-Meyer method and curves were compared with the log-rank test. RESULTS: Hospital mortality was 6 % and 8.2 % in the follow-up period. Myxoma was predominantly found in the left atrium ( P < 0.0001; OR = 12.8 and 4 - 41 95 % CI). Left atrial tumors showed less mortality ( P = 0.1; OR = 3 and 0.7 - 11.6 95 % CI), with a lower mortality for myxomas ( P < 0.001), fewer recurrences ( P = 0.03; OR = 8.7 and 0.8 - 89 95 % CI), and a greater embolic potential than in other locations ( P = 0.03 % OR = 0.7 and 0.6 - 0.8 95 % CI). CONCLUSION: Left atrial tumors showed greater embolic potential, fewer recurrences and less mortality.

Un nuevo caso de NEM 2B / A new case of Multiple Endocrine Neoplasia (MEN)-2B syndrome

La neoplasia endocrina múltiple es un síndrome de herencia autosómica dominante caracterizado por el desarrollo de tumores endocrinos, cuyo componente más común es el carcinoma medular de tiroides (CMT). Este síndrome se asocia a mutaciones en el protooncogén RET (cromosoma10). El cribado genético de familiares de enfermos con esta entidad es clave, ya que se trata de una entidad potencialmente mortal. Presentamos un caso de neoplasia endocrina múltiple 2B que acudió a consulta por una tumoración tiroidea y anomalías morfológicas en los labios. Destacamos la importancia de la sospecha clínica de esta enfermedad para un diagnóstico y un tratamiento adecuados (AU)

Multiple endocrine neoplasia (MEN) syndrome is an autosomal dominantly inherited disease characterized by the development of endocrine tumors. The most common component of MEN 2 is medullary thyroid carcinoma. This syndrome is associated with proto-oncogene RET (chromosome 10) mutation. Genetic screening of members of patients’ families is cruzial due to its potential severity. We describe a patient with NEM2B syndrome who presented with a thyroid tumor and morphological changes in hi slips. We highlight the importance of clinical suspicion for correct diagnosis and appropriate treatment (AU)

On the interpretation of Raman spectra of 1-aminooxy-spermine/DNA complexes.

By FT-Raman spectroscopy, we have investigated the effect of 1-aminooxy-spermine (AOSPM) on aggregation and stability of calf-thymus DNA and selected oligonucleotide chains. AOSPM is able to mimic spermine in some macromolecular interactions, but is unable to substitute polyamines to maintain cell proliferation, suggesting pharmacological applications. Raman spectra of solutions containing AOSPM and either genomic DNA or two 15mer oligodeoxyribonucleotides, with GC or AT sequences, were recorded. Precipitation was observed for calf-thymus DNA, aggregated structures and appearance of several Z marker bands were observed for the 15mer GC sequence, and no macromolecular changes were detected for the 15mer AT sequence. Specific binding sites between the aminooxy group and the base residues were also evidenced. Assignment of the AOSPM Raman bands was supported on a normal mode calculation for the molecule NH(2)-O-CH(3), as a model. The theoretical results, in combination with the analysis of the Raman bands, demonstrated that the aminooxy group played a relevant role in the AOSPM-DNA interaction. Preferential binding by the major groove was evidenced in the absence of macromolecular changes. When either precipitation or aggregation occurred, the interaction involved both the major and minor grooves. The specific interaction between AT/GC base pairs and the aminooxy group has also been theoretically investigated. The biological relevance of this work is discussed.

Raman spectroscopy study of the interaction between biogenic polyamines and an alternating AT oligodeoxyribonucleotide.

The interaction between the 15-mer oligonucleotide d[A(TA)(7)].d[T(AT)(7)] and the three biogenic polyamines, putrescine, spermidine and spermine, under physiological conditions has been studied by Raman spectroscopy. Solutions containing 60 mM (phosphate) of the oligonucleotide and different polyamine concentrations ranging from 1 to 75 mM have been studied. Both natural and heavy water were used as solvents. Difference Raman spectra were computed by subtracting the sum of the separated component spectra from the experimental spectra of the complexes. The Raman data suggested that the interaction of biogenic polyamines with d[A(TA)(7)].d[T(AT)(7)] presents differences related with their sizes and electric charges. Preferential bindings through the oligonucleotide minor groove for putrescine and spermidine were proposed. Spermine would interact by both minor and major grooves, although interaction by the minor groove seems to be more favored. Main reactive sites were thymine-O2 and adenine-N3 atoms at the minor grooves and adenine-N7 and thymine-O4 at the major groove. Electrostatic attractions between the polyamine amino and oligonucleotide phosphodioxy groups were also proposed. Under our experimental conditions, no macromolecular effects on d[A(TA)(7)].d[T(AT)(7)] (changes on secondary or tertiary structures) were detected from Raman spectroscopy, contrary to what happened for GC sequences at the same experimental settings. This fact agrees with the role of the biogenic polyamines during the first steps of the macromolecular synthesis, which involve DNA opening in AT motifs.

Effects of aminooxy analogues of biogenic polyamines on aggregation and stability of calf thymus DNA.

The effect of a series of aminooxy analogues of the biogenic polyamines spermidine and spermine on the conformation of calf thymus DNA is studied. These new molecules are isosteric and charge insufficient analogues that are suitable to study the roles of both charge distribution and structural requirements in the molecular physiology of the biogenic polyamines. They are also evidenced as useful tools to inhibit polyamine biosynthesis and cell growth. Circular dichroism (CD) spectra of solutions containing DNA and the aminooxy analogues at different concentrations (100-1000 microM) and different pH values, (5-7.5) are recorded. We use both sonicated and highly polymerized calf thymus DNA. The CD spectra of sonicated DNA showed the formation of Psi-DNA, a highly ordered aggregated structure similar to liquid crystals, in the presence of the aminooxy analogues. Aggregation induced by an aminooxy derivative of spermine is followed by DNA collapse when increasing the polyamine concentration. The features of Psi-DNA are not detected for highly polymerized DNA. Temperature melting measurements support a high degree of structural order of the aggregates. The CD experiments indicate that dications are unable to induce major changes on the macromolecular structure of DNA. In addition, aggregation is only observed when the trimethylene moiety is present between two adjacent positive charges. The observed differences among the CD spectra of DNA solutions with different aminooxy derivatives of spermidine indicate different roles for different amino groups of this biogenic polyamine when interacting with DNA. Our results support the idea that aminooxy analogues can be used as good models in studying the physiological functions of biogenic polyamines.

Raman study of the interaction between polyamines and a GC oligonucleotide.

The interaction between the oligonucleotide d[G(CG)(7)]. d[C(GC)(7)] and the three biogenic polyamines putrescine, spermidine, and spermine under physiological conditions has been studied by Raman spectroscopy. The results indicate the formation of highly ordered aggregated structures in solution, largely stabilized by electrostatic attractions, which have been described as cholesteric phases. Aggregation seems to be preceded by a partial B --> Z conformational transition for spermidine and spermine, which would allow for a deeper oligonucleotide-polyamine interaction. Interaction with the nucleic bases has also been evidenced for aggregates. At low polyamine concentrations the preferential binding sites are similar to those proposed for their interactions with ct-DNA. With increasing the polyamine concentration, the oligonucleotide-polyamine interactions involve both minor and major grooves, which is consistent with the formation of cholesteric phases.

[Prevention of postoperative nausea and vomiting in gynecologic surgery with 3 fixed doses of metoclopramide, droperidol or placebo]. / Prevención de las náuseas y vómitos postoperatorios en cirugía ginecológica mediante tres dosis fijas de metoclopramida, droperidol o placebo.

OBJECTIVES: To compare the efficacy and side effects of three doses of metoclopramide, droperidol or placebo administered every 8 h to prevent nausea and vomiting during the first 24 h after surgery. MATERIAL AND METHODS: Prospective, double blind study of 104 patients scheduled for major intraabdominal gynecological surgery under general anesthesia. The patients were randomly assigned to three groups: group M received 10 mg of metoclopramide, group D received 1.25 mg of droperidol and group P received a saline solution. The patients were premedicated with oral diazepam. All patients were anesthetized using similar techniques, with fentanyl, thiopental, vecuronium, oxygen/nitrogen protoxide and isoflurane. Muscle relaxation was reversed with atropine and neostigmine. Postoperative analgesia was given with endovenous morphine and metamizol. Immediately after surgery each patient received an endovenous dose of the assigned antiemetic drug. Patients were monitored for 24 h and observations were recorded every hour on the following scale: 0, for no emetic symptoms, 1 for nausea and 2 for vomiting. RESULTS: Fifteen patients (42.9%) in group D, 21 (60% in group M and 19 (54.3%) in group P experienced nausea during the 24 h after surgery, with no significant differences. However, the incidence of vomiting was significantly lower in group D, with 7 patients (20%) vomiting in group D versus 11 patients (31.43%) in group M and 17 (50%) in group P. Side effects were mild and required no treatment. CONCLUSIONS: Droperidol at a dose of 1.25 mg every 8 h is effective and safe for preventing postoperative nausea and vomiting and has minimal side effects. Metoclopramide at a dose of 10 mg every 8 h, in our study, was no better for the same purpose than placebo.

Fourier transform Raman study of the structural specificities on the interaction between DNA and biogenic polyamines.

Biogenic polyamines putrescine, spermidine, and spermine are essential molecules for proliferation in all living organisms. Direct interaction of polyamines with nucleic acids has been proposed in the past based on a series of experimental evidences, such as precipitation, thermal denaturation, or protection. However, binding between polyamines and nucleic acids is not clearly explained. Several interaction models have also been proposed, although they do not always agree with one another. In the present work, we make use of the Raman spectroscopy to extend our knowledge about polyamine-DNA interaction. Raman spectra of highly polymerized calf-thymus DNA at different polyamine concentrations, ranging from 1 to 50 mM, have been studied for putrescine, spermidine, and spermine. Both natural and heavy water were used as solvents. Difference Raman spectra have been computed by subtracting the sum of the separated component spectra from the experimental spectra of the complexes. The analysis of the Raman data has supported the existence of structural specificities in the interactions, at least under our experimental conditions. These specificities lead to preferential bindings through the DNA minor groove for putrescine and spermidine, whereas spermine binds by the major groove. On the other hand, spermine and spermidine present interstrand interactions, whereas putrescine presents intrastrand interactions in addition to exo-groove interactions by phosphate moieties.

Prevención de las náuseas y vómitos postoperatorios en cirugía ginecológica mediante tres dosis fijas de metoclopramida, droperidol o placebo / Three fixed doses of metoclopramide, droperidol or placebo to prevent postoperative nausea and vomiting in gynecological surgery

OBJETIVOS. Comparar la eficacia de tres dosis administradas cada 8 h, de metoclopramida, droperidol o placebo, sobre la incidencia de náuseas y vómitos postoperatorios durante las primeras 24 h y valorar sus efectos secundarios. MATERIAL Y MÉTODOS. Estudio prospectivo, doble ciego sobre 104 pacientes programadas para cirugía ginecológica mayor intraabdominal bajo anestesia general. Las pacientes fueron asignadas de forma aleatoria en tres grupos: grupo M (10 mg de metoclopramida); grupo D (1,25 mg de droperidol), y grupo P (suero fisiológico). Las pacientes fueron premedicadas con diazepam por vía oral. Todas las pacientes fueron anestesiadas de forma similar con: fentanilo, tiopental, vecuronio, oxígeno/protóxido de nitrógeno e isoflurano. La relajación muscular se revirtió con atropina y neostigmina. La analgesia postoperatoria se realizó con morfina intravenosa y metamizol. Inmediatamente después de la intervención cada paciente recibió una dosis intravenosa del fármaco antiemético asignado. Las pacientes fueron controladas durante 24 h y las observaciones se recogieron cada hora según la siguiente escala: 0, ausencia de síntomas eméticos; 1, náuseas, y 2, vómitos. RESULTADOS . En las 24 h del postoperatorio tuvieron náuseas 15 pacientes (42,9 por ciento) del grupo D, 21 (60 por ciento) del grupo M y 19 (54,3 por ciento) del grupo P, sin que las diferencias fueran significativas. Sin embargo, la incidencia de vómitos fue significativamente menor en el grupo D, 7 pacientes (20 por ciento), respecto a los otros grupos, 11 pacientes (31,43 por ciento) en el grupo M y 17 (50 por ciento) en el grupo P. Los efectos secundarios fueron leves y no requirieron tratamiento. CONCLUSIONES. El droperidol a dosis de 1,25 mg cada 8 horas es un fármaco útil y seguro en la prevención de las náuseas y vómitos postoperatorios con mínimos efectos secundarios. La metoclopramida a dosis de 10 mg cada 8 h, en nuestro estudio, no demostró ser superior al placebo en la prevención de las náuseas y vómitos postoperatorios (AU)

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Parallel segmentation and rendering using clusters of PCs.

Clinics have to deal currently with hundreds of 3D images a day. 3D Medical Images contain a huge amount of data, and thus, very expensive and powerful systems are required in order to process them. The present work shows the features of a software parallel computing package developed at the Universidad Politécnica de Valencia, under the European Project HIPERCIR. http:¿hiperttn.upv.es/hipercir. Project HIPERCIR is aimed at reducing the time and requirements for processing and visualising 3D images with low-cost solutions, such as networks of PCs running standard operating systems (Windows 95/98/NT). This project is being developed by a consortium formed by medical image processing and parallel computing experts from the Universidad Politécnica de Valencia (UPV), experts on biomedical software and radiology clinic experts.

P-glycoprotein, metallothionein and NM23 protein expressions in breast carcinoma.

Cellular drug resistance and increased metastatic potential are the major obstacles in the successful treatment of cancer with chemotherapy. The aim of this study was to investigate whether the immunohistochemical expression of two proteins implicated in drug resistance (P-glycoprotein and metallothionein) and the product of the suppressor gene nm23 could be related to prognosis in breast cancer. Seventy-two patients with palpable or occult breast carcinoma, not treated with chemotherapy or endocrine therapy, were examined. Immunohistochemical methods were used to determine the expression of P-glycoprotein (PG), metallothionein (MT), nm23, as well as the estrogen receptor (ER), the p53 status, and the Ki67 index. The results were correlated with clinical and morphological features. Cytoplasmic and membrane-specific immunostainings of PG were seen exclusively in tumor cells and identified in 14 of 72 cases (19.4%). Only a statistically significant association with metastases, (p = 0.06) and recurrences (p = 0.1) was observed. MT-positive reaction was identified in the cytoplasm of the tumor cells in 47 (65.3%) cases. Statistical significance was associated with metastases (p = 0.07), but not with death or recurrences. Specific immunostaining of nm23 protein was seen only in the cytoplasm of tumor cells. A positive reaction was observed in 55 of 72 (89.3%) cases. Although a significant association between nm23 protein expression and other morphologic and immunohistochemical variables did not exist, we observed a higher morbidity in patients with the MT-positive/nm23-negative tumor phenotype. Univariate analysis for survival selected the following variables: histologic grade (p = 0.001), ER (p = 0.002), mitotic index (p = 0.005), Ki 67 index (p = 0.068), MT (p = 0.046) and PG (p = 0.085). The Cox model provided the following independent variables: histologic grade (p = 0.021) and metallothionein (p = 0.03). These data confirm the prognosis observed in patients with PG or metallothionein expression as well as the independence of these two variables. It also suggests that nm23 is not necessarily involved in the development of an invasive phenotype.

Fine needle aspiration in the pre-operative diagnosis of melanotic neuroectodermal tumour of infancy.

A case of melanotic neuroectodermal tumour of infancy is described. The pre-operative diagnosis was made on cytological material obtained by fine needle aspiration. The patient was a three-month-old male infant with a rapidly growing maxillary tumour mass that also involved the pterygomaxillary fossae and the floor of the orbit. In addition to the typical clinical presentation, the cytology is also distinctive showing a dual population of small neuroblastic cells and large melanin-containing epithelial cells. Histological, immunohistochemical and electron microscopic examination of the excised mass confirmed the initial diagnosis. The pre-operative distinction of this tumour from other small round cell tumours of infancy (rhabdomyosarcoma, neuroblastoma, melanoma and lymphoma), is essential in order to plan the most complete resection therefore reducing the possibilities of tumour recurrence. This tumour belongs to a field of pathology with which many otolaryngologists may not be familiar.

Blood group antigens in differentiated thyroid neoplasms.

Alteration of cell-surface blood group antigens during malignant transformation is a well-known phenomenon that has not yet been sufficiently investigated in thyroid gland neoplasms. We evaluated 50 normal thyroid glands and 141 differentiated thyroid neoplasms (29 follicular adenomas, 30 follicular carcinomas, 56 papillary carcinomas, and 26 medullary carcinomas) both by the immunoperoxidase technique, using monoclonal antibodies against blood group antigens (A, B, H, Le(a), Le(b), Le(x), and Le(y)) and precursor substances (T, Tn, and sTn), and by affinity to the lectin from Arachis hypogea, to determine the usefulness of these antigens as tumor markers and prognostic factors. Neoplastic tissues showed immunostaining with concordant and nonconcordant expression of ABH antigens. There were statistically significant differences between normal and neoplastic tissues but not among the different neoplasms. Statistically significant differences in Lewis antigen expression were noted between normal and neoplastic tissues and between benign and malignant tumors. Tn and sTn antigen expression showed statistically significant differences between normal and neoplastic tissues. In conclusion, blood group antigens are tumor markers that are expressed more frequently in malignant than in benign neoplasms. The presence of metastases was correlated with enhanced peanut lectin receptors and a loss of A or B antigens.

DNA-chlorpheniramine interaction studied by spectroscopic techniques.

It was previously studied that the antihistaminic chlorpheniramine elicits a biphasic response on cell growth and regulates polyamine metabolism, as described for polyamines. In part, polyamine effects on macromolecular synthesis and cell growth are attributed to nucleic acid:polyamine interactions. In this work, we have tested the hypothesis of a DNA:chlorpheniramine interaction, using fluorometry, FTIR and Raman spectroscopic techniques. The results indicate that DNA:chlorpheniramine interaction occurs inducing conformational changes in the macromolecule by affecting both phosphodiester bonds and bases. Results open new perspectives for characterization of action mechanisms of natural or synthetic diamines with pharmacological or physiological importance.