[Seizures in the emergency service: the clinical and therapeutic characteristics of 122 patients]. / Crisis en urgencias: una vista a las características clínicas y terapéuticas a través de 122 pacientes.

INTRODUCTION: Epileptic seizures are a common cause of admission in emergency services at hospitals. Performing the correct diagnosis can be difficult, and deciding when and which anti-seizure medication (ASM) to prescribe is critical. Our objective is to detail the characteristics of patients treated in a medium-sized hospital for this reason. PATIENTS AND METHODS: A retrospective observational study was performed, including all the adult patients treated by the emergency service of the Lucus Augusti University Hospital between January 2022 and January 2023 with a diagnosis of epileptic seizure on discharge. The study recorded their demographic variables, history, whether it was their first seizure, the number of seizures, whether an anti-seizure medication was administered and which one, the diagnosis, the tests performed, and whether the patient was referred to the neurology service. RESULTS: A total of 122 patients were diagnosed with epileptic seizures in the emergency service. 50.8% of the patients were women. The mean age was 69.8 years. Neurological assessment was requested for 47.6%. 50.8% presented their first seizure. No diagnosis was performed in 46% of the cases, of which only 10 were evaluated by the neurology service. The most common etiology was vascular. An electroencephalogram was performed on 41.8%. Levetiracetam was practically the only drug administered when the neurology department was not consulted. CONCLUSIONS: Early evaluation of patients with their first seizure in the emergency service by a neurological specialist is crucial for the diagnosis of epilepsy. The same anti-seizure medication is almost always prescribed when no cross-consultation takes place.

TITLE: Crisis en urgencias: una vista a las características clínicas y terapéuticas a través de 122 pacientes.Introducción. Las crisis epilépticas son un motivo frecuente de consulta en los servicios de urgencias hospitalarias. Llegar al diagnóstico correcto puede ser complejo, y es fundamental decidir cuándo y qué medicamento anticrisis (MAC) pautar. Nuestro objetivo es detallar las características de los pacientes que consultaron por este motivo en un hospital mediano. Pacientes y métodos. Estudio observacional retrospectivo de todos los pacientes mayores de edad que consultaron en el servicio de urgencias del Hospital Universitario Lucus Augusti entre enero de 2022 y enero de 2023 con diagnóstico al alta de crisis epiléptica. Se registraron variables demográficas, los antecedentes, si era una primera crisis, el número de éstas, si se inició un MAC y cuál, el diagnóstico, qué pruebas se realizaron y si se interconsultó con la guardia de neurología. Resultados. Se diagnosticó a 122 pacientes de crisis epilépticas en urgencias. El 50,8% eran mujeres. La media de edad fue de 69,8 años. Se solicitó valoración por neurología en un 47,6%. El 50,8% presentó una primera crisis. No se llegó al diagnóstico en un 46% de los casos, de los cuales sólo 10 fueron valorados por neurología. La etiología más frecuente fue la vascular. Se realizó un electroencefalograma en un 41,8%. El levetiracetam fue prácticamente el único fármaco utilizado cuando no se consultó con neurología. Conclusiones. La valoración precoz de los pacientes con una primera crisis en urgencias por un especialista en neurología es determinante para el diagnóstico de epilepsia. Cuando no se interconsulta, casi siempre se pauta el mismo MAC.

Low density Porcicoll separates spermatozoa from bacteria and retains sperm quality.

Antibiotics are added to semen extenders to control the growth of bacteria contaminating semen during collection but may contribute to the development of antibiotic resistance. An alternative would be physical separation of spermatozoa from bacteria. The objective of the present study was to evaluate two low densities of Porcicoll for removal of bacteria, and for their effect on sperm recovery and sperm quality. Semen was collected from boars at a commercial station. Aliquots of 8 extended ejaculates were subjected to colloid centrifugation through 20% Porcicoll (P20) and 30% Porcicoll (P30) in 500 mL tubes and then stored at 17 °C. Microbiological examination and sperm quality evaluation (computer assisted sperm analysis and flow cytometry) were carried out on controls and all colloid-selected samples immediately after preparation and again after storage for 3 and 7 days. The microorganisms found were mainly bacteria from the environment, gut or skin. There was a considerable reduction or complete removal of some bacteria by both colloids. Recovery rates were 86% for P20 and 81% for P30. Sperm quality was not adversely affected by colloid centrifugation on day 0, and thereafter showed a more gradual deterioration in colloid centrifuged samples than in controls, possibly due to lower bacterial contamination. There were no differences in sperm quality between the two colloid treatments. Thus, these results show that contaminating bacteria in semen can be controlled by centrifugation through low density colloids.

Carta del presidente de la SEACV a la editorial «MENTOR. Un programa innovador de reclutamiento de residentes» / Letter from the Chairman of the SEACV on the editorial, «MENTOR: a novel program for recruiting residents»

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Endovascular treatment of splenic and renal aneurysms.

Four cases (three women and one man) of embolization of visceral artery aneurysms are presented, of which two affected the splenic artery and two the renal artery. The two renal aneurysms were related to hypertension; one of the splenic aneurysms was diagnosed in the context of hypertension, and the other affected a woman of a fertile age. Microguides, microcatheters, and Guglielmi platinum coils, liberated by electrolysis, with different lengths and characteristics, were used. Also, one of the renal aneurysm cases was related to the placing of a stent due to the existence of a stenosis of the renal artery adjacent to the aneurysmatic neck. Immediate occlusion of the aneurysm was achieved in the four cases. Evaluation with nuclear magnetic resonance angiography carried out 3 months later confirmed the sealing of the aneurysm and the patency of the native artery. Currently available devices provide a good therapeutic option for the embolization of visceral aneurysms with low morbidity and mortality rates.

Encuesta epidemiológica sobre la insuficiencia venosa crónica en España: estudio DETECT-IVC 2006 / An epidemiological survey on chronic venous insufficiency in Spain: the DETECT-IVC 2006 study

Introducción. Se ha desarrollado el estudio DETECT-IVC 2006, con los objetivos de verificar los elevados datosde prevalencia de insuficiencia venosa crónica (IVC) obtenidos en la encuesta DETECT-IVC del año 2000 y comprobar si seha modificado el patrón del tratamiento de esta patología entre los médicos de atención primaria (AP). Sujetos y métodos.Se ha realizado una encuesta con fines epidemiológicos, de tipo transversal, que debía incluir 16.770 sujetos que acudíanpor cualquier motivo a una consulta de AP. Participaron como investigadores 1.118 médicos de AP, con 37 coordinadores especialistasen Angiología y Cirugía Vascular. Se ha seguido con cada paciente el protocolo del estudio. Resultados. El 71%refería algún síntoma o signo dependiente de la IVC, especialmente la pesadez de piernas y las varículas. Un 62% de los encuestadospresentaban algún tipo de signo de IVC en el examen físico. Se identificaron úlceras cutáneas en un 2% de los examinados.Un 38% de los sujetos se encontraba dentro de los grupos del 2 al 6 de la clasificación CEAP, y un 88% de sujetossalían de la cita con tratamiento. Conclusión. Los resultados de la encuesta confirmaron la elevada prevalencia de la IVC enEspaña, muy superior a las cifras comunicadas por los estudios referenciales. En los seis años transcurridos entre uno y otroestudio ha variado el patrón de tratamiento de la IVC por los médicos de AP, que han incrementado las recomendaciones delas diversas terapias, adecuándolas a los estadios evolutivos de la enfermedad

Introduction. The DETECT-IVC 2006 study was developed with the aim of verifying the high figures for theprevalence of chronic venous insufficiency (CVI) that were obtained in the DETECT-IVC survey carried out in the year2000 and to determine whether any modifications have been made to the pattern of treatment of this condition employedby primary care (PC) physicians. Subjects and methods. A cross-sectional epidemiological survey was carried outinvolving 16,770 subjects who visited a PC clinic, regardless of the reason for doing so. The researchers who took partin the survey were 1,118 PC physicians, with 37 coordinators who were specialised in Angiology and Vascular Surgery.The study protocol was followed in the case of each patient. Results. Seventy-one per cent reported some CVI-relatedsymptom or sign, the most frequent being heaviness in the legs and variculae. In the physical examination 62% of therespondents presented some sign of CVI. Skin ulcers were identified in 2% of those submitted to examination. Thirtyeightper cent of the subjects belonged to groups 2 to 6 in the CEAP classification and 88% of the subjects left the visitwith some kind of treatment. Conclusions. The results of the survey confirm the elevated prevalence of CVI in Spain,which is much higher than the figures reported in the reference studies. In the six years separating the two studies,changes have taken place in the pattern of treatment of CVI by PC physicians, who have increased the recommendationsof the different therapies in order to adapt them to the different stages of the progression of the disease

Controversias en las úlceras de las extremidades inferiores / Controversial issues regarding lower extremity ulcers

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Comparison of the in vitro and in vivo neurotoxicity of three new sources of kainic acid.

Historically, all commercially available kainic acid has been derived from a single biological source using a consistent method of extraction and purification. That source became unavailable in 1995. Recently, three new commercial suppliers of kainic acid have made the product available, but the source of the material and the purification processes used differ. Our objective was to systematically compare the response produced by each of these new sources of kainic acid using three established neurobiological techniques: neuronal cell culture, hippocampal slice electrophysiology, and whole animal behavioural toxicity. Results in all three systems indicated no overall differences between the three formulations, although studies in both cerebellar neuron cultures and whole animal toxicity testing in mice, revealed some significant differences that may imply subtle differences in receptor selectivity and/or potency. We conclude that all three sources of kainic acid are viable alternatives to traditional kainate but they may not be identical. Until further information becomes available researchers may want to avoid using the three formulations interchangeably, and take note of the source of kainic acid when evaluating literature describing results from other laboratories.

Búsqueda de neoplasia oculta asociada a trombosis venosa profunda idiopática / Screening of hidden neoplasm in idiophatic deep venous thrombosis

Introducción. La dificultad de cualquier programa de detección de patología oculta estriba en encontrar una prueba diagnóstica sensible, específica, inocua y barata. Objetivo. Evaluar la eficacia diagnóstica de un protocolo diagnóstico (concreto) de cáncer oculto en pacientes ingresados por trombosis venosa profunda (TVP) idiopática. Pacientes y métodos. Estudio prospectivo sobre 209 pacientes consecutivos, con edad igual o menor a 80 años, diagnosticados de TVP idiopática mediante técnicas de imagen, entre enero 1995 y diciembre 1999. La distribución por sexos fue: 128 varones y 81 mujeres. Realizamos una búsqueda de neoplasia oculta ampliando el protocolo básico (historia clínica y pruebas diagnósticas básicas) mediante ecografía abdominopélvica y marcadores biológicos tumorales. El seguimiento clínico (repitiendo pruebas diagnósticas si era necesario) se llevó a cabo a los 3, 6, 12 y 24 meses (media: 21,2 meses), se produjeron 11 pérdidas de seguimiento (5,6 por ciento). Resultados. Se encontraron 14 neoplasias ocultas (6,7 por ciento). Seis presentaban algún síntoma o signo clínico de sospecha. El primer signo de alarma fue: ecografía en 6 casos, marcadores tumorales positivos en 6 ( 3 prostáticos, 2 CEA, Ca 195 y uno Ca 19,9, Ca 125) y radiografía de tórax en 2. Ocho de 14 (57,14 por ciento) con enfermedad metastásica al diagnóstico. Falsos positivos: 3 ecografías y 12 marcadores tumorales sin tumor en investigación posterior o seguimiento. En el seguimiento, solo un tumor no fue detectado inicialmente. Conclusiones. El porcentaje de tumores detectados (6,7 por ciento) y de tumores en estadio temprano (43,8 por ciento) justifica el protocolo diagnóstico establecido de cáncer oculto. La sensibilidad del protocolo diagnóstico fue del 93,33 por ciento (14/15). Casuísticas más amplias podrían acotar la sistemática futura en la investigación de tumores ocultos asociados a TVP idiopática (AU)

[Pulsatile perineal hematoma after transrectal prostatic biopsy]. / Hematoma perineal pulsátil tras biopsia prostática transrectal.

OBJECTIVE: A case of pulsatile perineal hematoma following transrectal biopsy of the prostate is presented. METHODS: A patient who had undergone transrectal biopsy of the prostate a few days earlier complained of a pulsatile sensation in the perineal region caused by a pseudoaneurysm of a left hypogastric artery. Patient evaluation included echo Doppler, pelvioabdominal CT and arteriography. Transcatheter intraarterial embolization with Gianturco-Wallace coils was performed. RESULTS: Excellent results were achieved. Filling of the aneurysm was immediately reduced and symptoms disappeared. CONCLUSION: This technique is gaining importance in the treatment of pelvic hemorrhage because it is relatively simple and carries a low morbidity and mortality.

Overexpression of prothymosin alpha accelerates proliferation and retards differentiation in HL-60 cells.

Prothymosin alpha (ProTalpha) is an acidic nuclear protein the expression of which is related to the proliferation and differentiation processes in mammalian cells. In the present study we have stably transfected HL-60 cells, a biological system that allows the study of both proliferation and differentiation, with recombinant vectors encoding sense and antisense ProTalpha mRNA. In the HL-60 cell clones overexpressing ProTalpha we observed an acceleration in the growth rate, whereas expression of the antisense orientation showed the opposite effect. Moreover, cell-cycle analysis demonstrated that the G1-phase was shortened in the cells expressing the sense construct. Before studying how ProTalpha affects differentiation, we showed that the down-regulation of ProTalpha gene during differentiation occurs in all mammalian cell lines (HL-60, K562, U937, MEL C88, N2A and PC12) analysed. The biological effect evoked by the induction of the ProTalpha sense vector was the retardation of cell differentiation, although expression of the antisense construct showed no effect on differentiation. In conclusion, our findings provide evidence that ProTalpha is directly implicated in cellular proliferation and that the maintenance of high levels of ProTalpha inside HL-60 cells is incompatible with their ability to differentiate.

Differentiation-linked expression of prothymosin alpha gene in human myeloid leukemic cells.

Prothymosin alpha (ProT alpha) is a nuclear protein related to cell proliferation. Its gene is highly activated during postnatal development at stages containing many proliferating but also differentiating cells. In this report, a study on ProT alpha gene expression during differentiation of human myeloid leukemic (HL-60) cells was undertaken to analyze the possible association of ProT alpha to cell differentiation. When HL-60 cells were induced to differentiate to granulocytes (using retinoic acid) or monocyte/macrophages (using 12-O-tetradecanoylphorbol-13-acetate), a marked down-regulation in the levels of ProT alpha transcript was found. When cell division of immature HL-60 cells was interrupted by either treatment with hydroxyurea or serum starvation, ProT alpha gene expression was not significantly altered. These findings suggest that loss of ProT alpha mRNA in induced HL-60 cells is a differentiation-related event. Examination of the stability of ProT alpha mRNA showed that the stabilization of the ProT alpha transcript is differentially regulated in the two HL-60 lineages. Nuclear run-on experiments revealed that during HL-60 differentiation, the transcriptional activity of the ProT alpha gene does not experience significant variations.