An institutional study: Does Body Mass Index influence surgical approach, surgical morbidities, and outcomes in endometrial cancer patients?

Background: Endometrial Cancer (EC), the most common genital tract malignancy in women, is recognised to be associated with a high Body Mass Index (BMI). Objective: The aim of the study was to evaluate the impact of obesity on intra and post-operative morbidity for patients treated for EC. Materials and Methods: This was a retrospective observational study including patients with EC that were surgically treated at Hospital de la Santa Creu i Sant Pau during nine consecutive years. The patients were divided in groups according to BMI: <30 Kg/m2, ≥30-<40 Kg/m2 and ≥40 Kg/m2. Demographic and pathological characteristics, surgical outcomes, perioperative complications and long-term outcomes were recorded. Results: The study included 290 patients; 164 patients with BMI <30 Kg/m2(56.5%), 107 patients with ≥30-<40 Kg/m2 36.9%) and 19 patients with ≥40 Kg/m2(6.65%). Patients with BMI ≥40Kg/m2 were younger, presented a higher percentage of endometrioid histology (84.2%, p<0.01), well-differentiated tumours (73.7%, p<0.01) and were more frequently in the initial stages at diagnosis (94.7%) compared to the other groups. A significant percentage of the patients were operated on laparoscopically (88.7%, 88.8%, 94.7% respectively). No significant differences were found in the evaluation of the surgical outcomes. The results relative to complications showed an overall tendency toward increase in the ≥40 Kg/m2 BMI group but no statistical differences were identified among the groups in terms of complications or long-term outcomes. Conclusions: There was a rising trend towards increased complications with increasing BMI in the study population, however, this was found not to be statistically significant. Therefore, the optimisation of co-morbidities and the adaptation of surgical treatment is important for the management of obese patients with endometrial cancer. What is new?: The study allows the comparison between groups with different BMI in patients with endometrial cancer. Different surgical outcomes, intra operative, early, and late complications are clearly identified, and survival outcomes are also investigated in our study.

In vitro assessment of the combined effect of letermovir and sirolimus on cytomegalovirus replication.

OBJECTIVE: Letermovir (LMV) is used for prophylaxis of cytomegalovirus (CMV) reactivation and end-organ disease in adult CMV-seropositive allogeneic hematopoietic stem cell transplant recipients (allo-HSCT). In turn, sirolimus (SLM) which displays in vitro anti-CMV activity, is frequently employed for prophylaxis of Graft vs. Host disease in allo-HSCT. Here, we aimed at assessing whether LMV and SLM used in combination may act synergistically in vitro on inhibiting CMV replication. METHODS: The antiviral activity of LMV and SLM alone or in combination was evaluated by a checkerboard assay, using ARPE-19 cells infected with CMV strain BADrUL131-Y. LMV and SLM were used at concentrations ranging from 24 nM to 0.38 nM and 16 nM to 0.06 nM, respectively. RESULTS: The mean EC50 for LMV and SLM was 2.44 nM (95% CI, 1.66-3.60) and 1.40 nM (95% CI, 0.41-4.74), respective. LMV and SLM interaction yielded mainly additive effects over the range of concentrations tested. CONCLUSIONS: The additive nature of the combination of LMV and SLM against CMV may have relevant clinical implications in management of CMV infection in allo-HSCT recipients undergoing prophylaxis with LMV.

Liposucción en Cirugía Reparadora (desengrasamiento de colgajos cutáneos y miocutáneos, exéresis de acúmulos grasos y autotransplante de grasa) / Liposuction in reconstructive surgery (undermine of cutaneous and miocutaneous flaps, exeresis of fat deposits and autologous fat transplantation)

La liposucción es una técnica quirúrgica de gran utilidad para la remodelación de acúmulos grasos y para el desgrasamiento de los colgajos cutáneos, miocutáneos o musculares. Para el desgrasamiento de los colgajos la realizamos después del año de efectuado el colgajo. También la empleamos en acúmulos grasos, en la reconstrucción mamaria postmastectomía, y acúmulos grasos periféricos en la reducción mamaria. Igualmente en el tratamiento de cicatrices deprimidas con prominencia de tejidos vecinos. En zonas deprimidas la realización del autotransplante de grasa nos ha dado buenos resultados (AU)

Surgery of the forms is an important part of plastic surgery. Occasionally, the presence of adipose masses will interfere in certain reconstructive procedures. This is specifically true for breast surgery in reductive or reconstructive techniques. Suction lipectomy is an interesting procedure for the exeresis of fat deposits, and can also be used as an ancillary treatment in many other procedures. It is also of great use in the remodeling of skin flaps performed with a pedicle or microsurgically, as well as for myocutaneous and muscular flaps. In performing the remodeling, it is also convenient to undermine and release the edges of the flap from the peripheral scar, in order to facilitate the "lifting" procedure. The instrument set for the transplantation of autologus adipose tissue is presented. The trasnplant of fat can fill and raise depressed areas, and it must be done in an over-corrective fashion by injection into a closed preformed pouch. Thse adipose trasnplants have been followed and controlled by external assessment and biopsy, revealing a 20-30o per cent resorption of transplanted tissue, and capsule formation (AU)

Plasma effects on harmonic spectra generated from moderately relativistic laser-plasma interactions.

When intense p-polarized laser light is incident on a plasma with an electron density many times the critical density, the flux of fast electrons created by Brunel absorption excites plasma oscillations. These oscillations may in turn affect the spectrum of high harmonics by modulating the spectrum at the plasma frequency, ω(p), and by coupling to the radiation field through the steep density gradient at the plasma-vacuum interface, so generating plasma line emission (PLE) at ω(p) and harmonics of ω(p). Both aspects depend sensitively on a range of plasma and laser pulse parameters, including the initial electron density, the density profile at the plasma-vacuum interface, and the intensity, pulse shape, and pulse length of the incident laser light. These various dependences have been characterised for moderately relativistic laser-plasma interactions by means of a series of particle-in-cell (PIC) simulations.

Diagnosis of epileptic syndrome after a new onset seizure and its correlation at long-term follow-up: longitudinal study of 131 patients from the emergency room.

This study aims to demonstrate the reliability of the diagnosis of epilepsy after a new onset seizure, supported by a detailed anamnesis and the complementary tests accessible at the emergency room (ER), such as CT-scan and video-EEG. It was a prospective study including 131 adult patients (55% males, medium age 52.42 (±21.5)[16-98] years-old, follow-up 25.22 (±13.69)[12-31] months). In half of cases we could not identify any predisposing factor. Within the first 72 h, patients were included into an epileptic syndrome according to the ILAE 1989 classification, if possible. Thereafter, they were followed-up in the outpatient clinic of the Epilepsy Unit, where seizure recurrence was recorded and further diagnostic examinations were performed. 94.1% of patients initially diagnosed of epilepsy were confirmed as epileptics, and up to 57% of patients could be classified into a particular syndrome from the ER. Conversely, 44.6% of patients with the initial diagnosis of isolated seizure and one third of patients with non-epileptic seizures developed recurrence, switching their initial diagnosis to epilepsy. Both CT-scan and early EEG demonstrated its usefulness evaluating the risk of recurrence after a new onset seizure (Positive predictive value 78% and 88%, respectively). Epileptiform activity was a predictor of seizure recurrence (p<0.05), independently to the moment where the EEG was performed. According to our results, it is realistic to perform the diagnosis of epilepsy after a new onset seizure, although many patients still need further specific examinations, or seizure recurrence, to be diagnosed.

Hiperperfusión focal asociada a descargas lateralizadas periódicas epileptiformes ictales / Focal hyperperfusion associated to ictal periodic lateralised epileptiform discharges

No disponible

Bacterial community analysis of a gas-phase biotrickling filter for biogas mimics desulfurization through the rRNA approach.

The bacterial composition of a lab-scale biotrickling filter (BTF) treating high loads of H(2)S was investigated by the rRNA approach. Two 16S rRNA gene clone libraries were established 42 and 189 d after reactor startup, while fluorescent in-situ hybridization (FISH) with DNA probes was performed throughout 260d of reactor operation. Diversity, community structure and metamorphosis were studied from reactor startup to fully-established pseudo-steady state operation at near neutral pH and at an inlet H(2)S concentration of 2000 ppmv (load of 55.6g H(2)S m(-3)h(-1)). In addition, FISH was used for assessing the spatial distribution of sulfur-oxidizing bacteria (SOB) along the length of the reactor under pseudo-steady state operation. A major shift in the diversity of the community was observed with the operating time, from a well-diverse community at startup to pseudo-steady state operation with a majority of retrieved sequences affiliated to SOB of the sulfur cycle including Thiothrix spp., Thiobacillus spp., and Sulfurimonas denitrificans. Although aerobic species were predominant along the BTF, a vertical stratification was encountered, in which facultative anaerobes had a major relative abundance in the inlet part of the BTF, where the sulfide to oxygen ratio was higher. The observed changes were related to the trophic properties of the community, the DO concentration, the accumulation of elemental sulfur and the operation at neutral pH.

Anomalies in universal intensity scaling in ultrarelativistic laser-plasma interactions.

Laser light incident on targets at intensities such that the electron dynamics is ultrarelativistic gives rise to a harmonic power spectrum extending to high orders and characterized by a relatively slow decay with the harmonic number m that follows a power law dependence, m(-p). Relativistic similarity theory predicts a universal value for p=8/3 up to some cutoff m=m*. The results presented in this Letter suggest that under conditions in which plasma effects contribute to the emission spectrum, the extent of this contribution may invalidate the concept of universal decay. We report a decay with the harmonic number in the ultrarelativistic range characterized by an index 5/3 < or approximately p < or approximately 7/3, significantly weaker than that predicted by the similarity model.

The effects of liposuction removal of subcutaneous abdominal fat on lipid metabolism are independent of insulin sensitivity in normal-overweight individuals.

BACKGROUND: Abdominal fat (both visceral and subcutaneous) accumulation is associated with an increased risk of developing insulin resistance. The latter stands as the basis upon which diabetes, hypertension, and atherogenic dyslipidemia tend to build up. Hence, abdominal liposuction (AL) could theoretically hold metabolic benefits. We undertook the present study to assess the effects of AL on carbohydrate and lipid metabolism. METHODS: This is a prospective study including 20 healthy volunteers (M2/F18) aged 39.6 +/- 7.7 years old (24-52), body mass index (BMI) = 25.3 +/- 4.7 kg/m(2) (19.8-36) who underwent AL. Before and 4 months after AL, we measured glucose and insulin concentrations, HOMA index [glucose (mM) x IRI (microUI/l)/22.5], free fatty acids (FFA), glycerol, total cholesterol and triglycerides, high-density lipoprotein (HDL)-cholesterol (HDL-c), low-density lipoprotein (LDL)-cholesterol (LDL-c), very low-density lipoprotein (VLDL)-cholesterol (VLDL-c) and apolipoproteins (apo) B, AI and AII, adiponectin (Adp), and ultra-sensitive C-reactive protein (CRP). RESULTS: Lipo-aspirate averaged 5.494 +/- 5.297 cc (600-19.000). Weight, BMI, and waist circumference decreased significantly 4 months after surgery by 4.6, 4.6 and 5.9%, respectively. There were significant decrements in FFA (-35%, p < 0.0001), glycerol (-63%, p < 0.0005), VLDL-c (-15.2%; p < 0.001), and triglycerides (-21.3%, p < 0.002), an increase in HDL-c (+10%, p < 0.03), Apo AI (+10.1%, p < 0.02), and Apo AII (+11.8%, p < 0.001). Total cholesterol, LDL-c, ApoB, and the LDL-c/ApoB ratio raised by +15% (p < 0.0005), +27.3% (p < 0.000), +15.1% (p < 0.008) and +2.76% (p < 0.008), respectively. Glucose, insulin, the HOMA index, Adp, and CRP were not significantly altered after AL. CONCLUSION: AL in healthy normal weight or slightly overweight subjects improves the major lipoprotein components of obesity-associated dyslipidemia. This improvement occurs independent of insulin sensitivity.

Intravascular large B-cell lymphoma presenting with neurological syndromes: clinicopathologic study.

Intravascular lymphoma or intravascular lymphomatosis (IVL) is an uncommon extranodal lymphoma, which gives rise to exclusively intravascular tumor growth. In 1/3 of the reported cases the disease debuts with involvement of the nervous system, which is particularly susceptible. Over the clinical course of the disease, 2/3 of the patients will present neurological symptoms. Owing to its characteristic growth pattern, IVL can give rise to very different central or peripheral nervous system neurological syndromes. Not infrequently a single patient will present more than one neurological syndrome. Moreover, the specificity of the neurological tests is low. All these factors explain the difficulties involved in diagnosing this entity and the fact that in most cases the diagnosis is established on autopsy study. This article presents the clinical, biological, radiological and post-mortem neuropathological findings in an immunocompetent patient with IVL. The onset was a cauda equina syndrome and showed multiple and varied neurological manifestations during the course of the disease, which progressed in the months before death. Spinal cord biopsy performed in life did not provide diagnostic findings because the vessels showed no neoplastic involvement. Immunohistochemical findings demonstrated large B-cell lymphoma. A review of the neurological features described in previously published cases of IVL is provided.

Plasma modulation of harmonic emission spectra from laser-plasma interactions.

We report results from particle-in-cell simulations of the interaction of intense laser light with overdense plasma designed to examine the effects of plasma waves generated by pulses of fast electrons on high-order harmonic emission from the plasma. We show that the emission spectrum is modulated at the plasma frequency and identify combinations of parameters and circumstances favorable for modulation. In particular, the observed modulation is shown to depend not only on the chosen plasma electron density and intensity of the incident light but on the density profile and pulse shape.

[Differential effect of left and right temporal lobectomy on emotional recognition and experience in patients with epilepsy]. / Efecto diferencial de la lobectomía temporal izquierda y derecha sobre el reconocimiento y la experiencia emocional en pacientes con epilepsia.

INTRODUCTION: Temporal lobe and amygdala are structures that participate in emotional processing. The purpose of this study was to determine the differential effect of left (LTL) and right (RTL) temporal lobectomy on emotional recognition and experience as well as mood in treatment resistant epileptics who were evaluated pre and post-surgically. PATIENTS AND METHODS: Five temporal lobe epileptic patients participated in the study (two from the right and three from the left hemisphere) who were evaluated before and after three months of the surgery. Emotional and prosodic recognition were evaluated, inside and outside of a social context, with and without time limit. Besides, subjective emotional experience while seeing movie fragments was evaluated as well as positive and negative emotional states, anxiety and depression. RESULTS: After the surgery, patients with RTL had lower number of correct responses in fear facial and prosodic recognition, while patients with LTL did not show deterioration or they even improved. There were not differences as a function of the intervened hemisphere neither in the intensity of emotions perceived in the scenes, nor in the emotional experience, however, both groups experienced a decrease of negative emotions and anxiety. CONCLUSIONS: The results suggest that RTL had a greater effect on emotional recognition outside of a context and with limited time than LTL, while in the emotional experience there were not differences between groups. Lobectomy induced an improvement on affective states.

Efecto diferencial de la lobectomía temporal izquierda y derecha sobre el reconocimiento y la experiencia emocional en pacientes con epilepsia / Differential effect of left and right temporal lobectomy on emotional recognition and experience in patients with epilepsy

Introducción. El lóbulo temporal y la amígdala son estructuras que participan en el procesamiento emocional. La finalidad del presente estudio fue determinar el efecto diferencial de la lobectomía temporal izquierda (LTI) y derecha (LTD) en el reconocimiento y la experiencia emocional, así como en los estados afectivos en pacientes epilépticos refractarios al tratamiento evaluados pre y posquirúrgicamente. Pacientes y métodos. Participaron cinco pacientes con epilepsia del lóbulo temporal (dos del hemisferio derecho y tres del izquierdo) a los que se evaluó antes y después de tres meses de la cirugía. Se estudió el reconocimiento emocional facial y prosódico dentro y fuera de un contexto social, con y sin tiempo límite. Además, se valoró la experiencia emocional subjetiva ante fragmentos de películas y los estados emocionales positivos y negativos, la ansiedad y la depresión. Resultados. Posquirúrgicamente, los pacientes con LTD tuvieron menos aciertos en el reconocimiento de la expresión de miedo con tiempo límite y de la prosodia, mientras que los pacientes con LTI no mostraron deterioro o incluso mejoraron. No hubo diferencias en función del hemisferio intervenido ni en la intensidad con que percibieron las emociones en las escenas, ni en la experiencia emocional, aunque ambos grupos experimentaron una disminución de las emociones negativas y la ansiedad. Conclusiones. Los resultados sugieren que la LTD tuvo un mayor efecto sobre el reconocimiento emocional fuera de un contexto y con tiempo límite que la LTI, mientras que en la experiencia emocional no se observaron diferencias entre grupos. La lobectomía indujo una mejoría en los estados afectivos (AU)

Introduction. Temporal lobe and amygdala are structures that participate in emotional processing. The purpose of this study was to determine the differential effect of left (LTL) and right (RTL) temporal lobectomy on emotional recognition and experience as well as mood in treatment resistant epileptics who were evaluated pre and post-surgically. Patients and methods. Five temporal lobe epileptic patients participated in the study (two from the right and three from the left hemisphere) who were evaluated before and after three months of the surgery. Emotional and prosodic recognition were evaluated, inside and outside of a social context, with and without time limit. Besides, subjective emotional experience while seeing movie fragments was evaluated as well as positive and negative emotional states, anxiety and depression. Results. After the surgery, patients with RTL had lower number of correct responses in fear facial and prosodic recognition, while patients with LTL did not show deterioration or they even improved. There were not differences as a function of the intervened hemisphere neither inthe intensity of emotions perceived in the scenes, nor in the emotional experience, however, both groups experienced a decrease of negative emotions and anxiety. Conclusions. The results suggest that RTL had a greater effect on emotional recognition outside of a context and with limited time than LTL, while in the emotional experience there were not differences between groups. Lobectomy induced an improvement on affective states (AU)

Interrupción del embarazo. Estudio comparativo entre diferentes pautas de inducción médica / Pregnancy termination. Comparative study among distinct medical induction regimens

Objetivo: Comparar la eficacia entre diferentes pautas de inducción médica empleadas para la interrupción del embarazo de segundo trimestre. Material y métodos: Análisis retrospectivo de 145 gestantes de 13 a 22 semanas que se expusieron a una interrupción mediante 4 métodos: 1) prostaglandina F2α intraamniótica y E2 endocervical; 2) prostaglandina E2 endocervical; 3) prostaglandina E1 vaginal y oral, y 4) prostaglandina E1 vaginal. Todos ellos seguidos de oxitocina. Resultados: La duración media de expulsión fue de 20,2 ± 7,6; 17,5 ± 8,2; 16,8 ± 8,7 y 12,6 ± 4,2 h, respectivamente. Las diferencias son estadísticamente significativas cuando se analiza la duración media de manera global (p = 0,02, ANOVA) y en no primigestas (p = 0,02, ANOVA). El porcentaje de expulsiones espontáneas antes de las 12 h fue del 5,5, el 31, el 32,5 y el 50%, respectivamente (p = 0,002, χ2). Únicamente aparecen fracasos y efectos secundarios graves (1 caso de coagulación intravascular diseminada) con la prostaglandina E2 endocervical. Conclusiones: La administración vaginal de prostaglandina E1 presenta una menor duración media de expulsión y una mayor tasa de expulsión espontánea a las 12 h

Objective: To compare the effectiveness of distinct medical induction regimens used for second trimester abortions. Materials and methods: We performed a retrospective review of 145 pregnancies between 13 and 22 weeks that underwent an induced abortion using four different methods: 1) intra-amniotic prostaglandin F2α and endocervical E2; 2) endocervical prostaglandin E2; 3) intravaginal and oral prostaglandin E1; and 4) intravaginal prostaglandin E1. All these methods were followed by oxytocin infusion. Results: The mean induction to abortion interval was 20.2 ± 7.6 h; 17.5 ± 8.2 h; 16.8 ± 8.7 h, and 12.6 ± 4.2 h, respectively. The differences were statistically significant when the mean interval was analyzed globally (p = 0.02, ANOVA) and in non-primigravidas (p = 0.02, ANOVA). The rate of successful abortions within 12 hours was 5.5%, 31%, 32.5% and 50%, respectively (p = 0.002 χ2 test). Surgical abortion and serious side effects (one case of disseminated intravascular coagulation) occurred only with prostaglandin E2. Conclusions: Vaginal administration of prostaglandin E1 resulted in a shorter mean induction to abortion interval and a higher rate of successful abortions within 12 hours

[Idiopathic generalised epilepsy. The value of semiology and EEG scanning in its classification]. / Epilepsia generalizada idiopática. Utilidad de la semiología y del electroencefalograma para su clasificación.

INTRODUCTION: The different syndromes included in the idiopathic generalized epilepsies present an important overlapping of their electroclinical characteristics. AIM: To compare the two actual classifications (International classification of epileptic syndromes: ILAE of 1989 and of 2001) in a sample of patients with idiopathic generalised epilepsy (IGE) and to evaluate which electro-clinical factors were more useful in order to classify a patient into a syndrome. PATIENTS AND METHODS: 70 patients (44 women/26 men). Neurological examination and neuro-radiological examination were normal in all cases. The EEG (standard or sleep deprived) showed generalised epileptiform discharges in all patients. Clinical findings included a median age of onset 12.3 years. Most frequent first type of seizure was tonic-clonic (71%). Seizures during awakening were the most frequent (37%) and lack of sleep was the most important precipitating factor (44.7%). Generalized epileptiform discharges were present in 62.9% of the basal sleep deprived EEG, on the other hand, only 22.3% of the basal standard EEG showed epileptiform discharges, p = 0.048. 28% of patients were unclassifiable according to the 1989 ILAE classification, 7% were unclassifiable according to the 2001 ILAE classification. EEG during intermittent photic stimulation (p = 0.007), at awakening (p = 0.015) and the timetable of the seizures (seizures generalised at awakening) (p = 0.053) differentiated between idiopathic generalised syndromes of adolescence. CONCLUSION: The 2001 ILAE classification is more useful in order to classify patients with IGE because includes patients previously considered unclassifiable in the syndrome of generalised epilepsy with different phenotypes.

Epilepsia generalizada idiopática. Utilidad de la semiología y del electroencefalograma para su clasificación / Idiopathic generalised epilepsy. The value of semiology and EEG scanning in its classification

Introducción. Los síndromes que conforman las epilepsias generalizadas idiopáticas (EGI) presentan un importante solapamiento de características electroclínicas. Objetivo. Valorar la capacidad diagnóstica para la EGI de la clasificación de la Liga Internacional contra la Epilepsia (ILAE) de 1989 y la del 2001, y determinar qué características clínicas y electroencefalográficas (EEG) permiten discriminar entre los síndromes. Pacientes y métodos. Participaron 70 pacientes (44 mujeres y 26 hombres). Todos presentaban descargas epileptiformes generalizadas en el EEG estándar o de privación de sueño (PS). Se aplicaron las clasificaciones de la ILAE de 1989 y del 2001. Resultados. Edad media de la primera crisis: 12,3 años; primera crisis más frecuente: tonicoclónica generalizada (71 por ciento); horario más frecuente de presentación de crisis: al despertar (37 por ciento); factor desencadenante más frecuente: privación de sueño (44,7 por ciento). Se observaron descargas generalizadas paroxísticas en el 62,9 por ciento de los EEG de PS basales, respecto a un 22,3 por ciento de los EEG estándares basales (p = 0,048). El 28 por ciento de los pacientes era inclasificable, según la clasificación de 1989, frente a sólo el 7 por ciento según la clasificación del 2001. Tanto las características del EEG (aparición de paroxismos durante la EGI, p = 0,007, y EEG en el momento del despertar, p = 0,015) como las clínicas (horario de las crisis, p = 0,053) diferenciaban los síndromes que conforman las EGI de la adolescencia. Conclusión. La clasificación de la ILAE del 2001 tiene un mayor porcentaje de pacientes, debido a que los pacientes considerados inclasificables en la clasificación del 1989 se incluyen dentro del síndrome de epilepsia generalizada con fenotipos variables (AU)

Introduction. The different syndromes included in the idiopathic generalized epilepsies present an important overlapping of their electroclinical characteristics. Aim. To compare the two actual classifications (International classification of epileptic syndromes: ILAE of 1989 and of 2001) in a sample of patients with idiopathic generalised epilepsy (IGE) and to evaluate which electro-clinical factors were more useful in order to classify a patient into a syndrome. Patients and methods. 70 patients (44 women/26 men). Neurological examination and neuro-radiological examination were normal in all cases. The EEG (standard or sleep deprived) showed generalised epileptiform discharges in all patients. Clinical findings included a median age of onset 12.3 years. Most frequent first type of seizure was tonic-clonic (71%). Seizures during awakening were the most frequent (37%) and lack of sleep was the most important precipitating factor (44.7%). Generalized epileptiform discharges were present in 62.9% of the basal sleep deprived EEG, on the other hand, only 22.3% of the basal standard EEG showed epileptiform discharges, p = 0.048. 28% of patients were unclassifiable according to the 1989 ILAE classification, 7% were unclassifiable according to the 2001 ILAE classification. EEG during intermittent photic stimulation (p = 0.007), at awakening (p = 0.015) and the timetable of the seizures (seizures generalised at awakening) (p = 0.053) differentiated between idiopathic generalised syndromes of adolescence. Conclusion. The 2001 ILAE classification is more useful in order to classify patients with IGE because includes patients previously considered unclassifiable in the syndrome of generalised epilepsy with different phenotypes (AU)

Maternal soluble tumour necrosis factor receptor type 2 (sTNFR2) and adiponectin are both related to blood pressure during gestation and infant's birthweight.

OBJECTIVE: Tumour necrosis factor alpha (TNF-alpha) and adiponectin are strongly related to insulin sensitivity; insulin resistance of pregnancy is a major determinant of infant's birthweight. We aimed to study the contributions of maternal serum concentrations of soluble TNF-alpha receptors (sTNFR1 and sTNFR2) and adiponectin to infant's birthweight. DESIGN: Cross-sectional, hospital-based study of insulin sensitivity during gestation. PATIENTS: Fifty-one healthy women with uncomplicated pregnancy and delivery (except for elective Caesarian section) and their healthy newborn infants. measurements Maternal blood levels of glucose, insulin, glycosylated haemaglobin (HbA1c), sTNFR1, sTNFR2 and adiponectin at delivery; cord-blood levels of sTNFR1, sTNFR2 and adiponectin. RESULTS: At delivery, maternal sTNFR2 correlated with systolic blood pressure (SBP; r = 0.38, P = 0.005). In multiple regression analyses, SBP and HbA1c were independent predictors of sTNFR2, explaining 18 and 7% of its variance, respectively; insulin resistance index (HOMA-IR), body mass index at delivery and SBP were independent predictors of adiponectin, explaining 15, 8 and 7% of its variance, respectively. Both maternal sTNFR2 and SBP were negatively correlated with infant's birthweight (r = -0.28, P = 0.04 and r = -0.36, P = 0.01 respectively, adjusted for sex and gestational age). In multivariate regression analyses, infant's sex and either maternal sTNFR2 or adiponectin were independent predictors of infant's birthweight, each explaining between 6 and 9% of birthweight variance. Further addition of maternal SBP to these models revealed that this variable was the main predictor of infant's birthweight, explaining 13% of its variance. CONCLUSIONS: Maternal sTNFR2 and adiponectin are independently related to both maternal blood pressure and infant's birthweight in uncomplicated pregnancy. The contributions of the TNF-alpha system and adiponectin to hypertensive disorders of pregnancy and fetal growth merit further studies.

[Acute interstitial nephritis associated with omeprazole therapy]. / Nefritis intersticial aguda por omeprazol.

From 1 to 3% of acute renal failures are due to acute interstitial nephritis (AIN). Most of them are due to drugs. Nonsteroidal antiinflammatory drugs, penicillins and sulfonamides are the most frequently reported. Clinical presentation of drug-induced AIN has changed over time and with the use of new drugs. In fact actually the classic triad of fever, rash and eosinophilia is uncommon. Omeprazole is a drug widely used in the treatment of gastroesophageal reflux disease and peptic ulcer disease. Serious side effects are rare with this drug, but despite of its safety we can see serious adverse effects such as acute renal failure. We describe two cases of acute interstitial nephritis after use of omeprazole and a review of all the cases published in the last years.

Protocolos antienvejecimiento / Antiaging protocols

El autor presenta la necesidad de protocolizar los métodos de diagnóstico y tratamiento con el fin de sistematizar la terapia antienvejecimiento. En relación a los protocolos establecidos, remarca la importancia de valorar, de forma práctica, las distintas pruebas tanto químicas como biológicas: estudio de los componentes sanguíneos, de la composición corporal, el índice de masa corporal o BMl, el índice metabólico basal o BMR, los análisis del colesterol, lipoproteínas, triglicéridos y glucosa y el llamado estado biológico. A continuación expone como Se pueden valorar todos estos datos obtenidos para poder aplicar el correspondiente tratamiento mediante un aporte enzimático (enzimas digestivas, metabólicas y alimentarias), analizando la influencia corporal de los déficits de determinadas enzimas alimentarias (proteasa, amilasa, lipasa, celulasa, etc) así como sus mecanismos y niveles de actuación para finalmente exponer una serie de puntos clave y las diferentes soluciones recomendables para modificar el proceso del envejecimiento con especial énfasis en el ejercicio y sus diversas modalidades (AU)