A computed tomography study of the fibula: morphology, morphometry, intramedullary anatomy, application prospects on intramedullary nailing.

PURPOSE: The intramedullary percutaneous pinning in fractures of the lateral malleolus is a technique of osteosynthesis that can reduce complications of ORIF. Our study describes the morphology and the morphometry of the fibula, in particular intramedullary, so as to specify the best fibular nail features. METHODS: We conducted a retrospective study on CT acquisitions of fibulae in vivo. We studied total length, and the distal malleolar angle. Regarding intramedullary morphology, six axial study levels were defined. Each level was assigned a morphometric classification (oval, triangular, quadrangular or irregular), and a measure of the diameter of the cavity. The distance between the smaller diameter and the malleolar tip was investigated. RESULTS: We included 50 patients for 97 fibulae. The average age was 66.5 years. The irregular morphology type was the most frequently found. The average length was 370.5 mm (SD = 18.1; CI 95% [366.9; 374.1]), the average distal malleolar angle was 163.5° (SD = 3.7; CI 95% [162.7; 164.2]). The average minimal intramedullary diameter at malleolus level was 3.2 mm (SD = 1.2; CI 95% [3.0; 3.5]), with a minimum size reaching 95.8 mm (SD = 13.8; CI 95% [93.0; 98.5]) of the malleolar tip. CONCLUSIONS: The analysis of morphological parameters of the fibula, in particular the lateral malleolus and intramedullary morphology is necessary for the design of a morpho-adapted nail. Interpersonal variability must be taken into account by the implant industry to offer nails of suited lengths and diameters.

[Progressive Brown-Sequard syndrome secondary to idiopathic spinal cord herniation: clinico-radiological and surgical correlations]. / Síndrome de Brown-Séquard progresivo secundario a hernia medular idiopática: correlación clinicorradiológica y quirúrgica.

INTRODUCTION: Idiopathic medullary herniation is an infrequent disease, which shows up in clinical form as a progressive mielopathy, most commonly known as the Brown-Sequard syndrome. Its anatomical base is a dural defect where a portion of anterior spinal cord gets progressively incarcerated. The MRI and myelo-CT scan show a bending of the spinal cord in the form of a «bell tent¼ towards the anterior dural sheath at the mid-dorsal portion mainly. CASE REPORT: A 37 year old male, who was diagnosed of idiopathic medullary herniation and surgically treated by our own developed technique, reporting its neuroradiological, anatomo-surgical and clinical correlation. CONCLUSION: Treatment should be individualized, as no standard surgical technique has been established up to the present.

TITLE: Síndrome de Brown-Séquard progresivo secundario a hernia medular idiopática: correlación clinicorradiológica y quirúrgica.Introducción. La hernia medular idiopática es una patología infrecuente que cursa clínicamente con una mielopatía progresiva, la mayoría de las ocasiones en forma de síndrome de Brown-Séquard. Su base anatómica es un defecto dural por el que se incarcera progresivamente una porción del cordón medular anterior. La resonancia magnética y la mielotomografía demuestran un acodamiento medular en «tienda de campaña¼ hacia la cara anterior del estuche dural, a nivel dorsal medio fundamentalmente. Caso clínico. Varón de 37 años, diagnosticado de hernia medular idiopática e intervenido quirúrgicamente mediante una técnica propia; se demuestra su correlación neurorradiológica, anatomoquirúrgica y evolutiva. Conclusión. El tratamiento debe ser individualizado, pues no existe una técnica quirúrgica universalmente establecida.

Indirect costs associated with glioblastoma: Experience at one hospital. / Costes indirectos asociados al glioblastoma. Experiencia en un centro.

INTRODUCTION: Glioblastoma is the most common primary brain tumour. Despite advances in treatment, its prognosis remains dismal, with a mean survival time of about 14 months. Many articles have addressed direct costs, those associated with the diagnosis and treatment of the disease. Indirect costs, those associated with loss of productivity due to the disease, have seldom been described. MATERIAL AND METHOD: We conducted a retrospective study in patients diagnosed with glioblastoma at Hospital Universitario Donostia between January 1, 2010 and December 31, 2013. We collected demographics, data regarding the treatment received, and survival times. We calculated the indirect costs with the human capital approach, adjusting the mean salaries of comparable individuals by sex and age and obtaining mortality data for the general population from the Spanish National Statistics Institute. Past salaries were updated to 2015 euros according to the annual inflation rate and we applied a discount of 3.5% compounded yearly to future salaries. RESULTS: We reviewed the records of 99 patients: 46 women (mean age 63.53) and 53 men (mean age 59.94); 29 patients underwent a biopsy and the remaining 70 underwent excisional surgery. Mean survival was 18.092 months for the whole series. The total indirect cost for the series was €11 080 762 (2015). Mean indirect cost per patient was €111 926 (2015). DISCUSSION: Although glioblastoma is a relatively uncommon type of tumour, accounting for only 4% of all cancers, its poor prognosis and potential sequelae generate disproportionately large morbidity and mortality rates which translate to high indirect costs. Clinicians should be aware of the societal impact of glioblastoma and indirect costs should be taken into account when cost effectiveness studies are performed to better illustrate the overall consequences of this disease.

Abrogation of Junin virus encephalitis by critical cyclophosphamide timing and dosage.

Junin virus-induced encephalitis in suckling mouse is a delayed-type hypersensitivity reaction, whose immunopathologic nature has been proven by suppressing the thymus-dependent response. Cyclophosphamide (CY) given at day +6 post-infection (p.i.) has been shown to modulate infection, presumably by TDTH lymphocyte inactivation. To determine critical timing and i.p. drug dose, brain histology and survival were studied in 3-day-old Balb/c mice, inoculated i.c. with Junin virus. Optimal protection was achieved with a non-toxic, 50 mg/kg CY dose at day 6 p.i. (+6): no brain tissue damage was detected in animals killed at day +12, when the necropsied controls exhibited widespread lesions. Other timings (day +3, +4, +5) proved less effective. As regards alternative dosage at day +6, 30 mg was useless, and severe leptomeningitis was evident, whereas 40 mg significantly lowered mortality, and lesions were much milder and less constant. It seems that the 50 mg/kg CY dose must be administered at a critical time p.i. to inactivate sensitized TDTH lymphocytes and to reduce mortality and CNS pathology significantly.

[Variations of the delayed hypersensitivity reaction in mice inoculated with different lots of sheep red blood cells]. / Variaciones de la reacción de hipersensibilidad retardada en ratones inoculados con diferentes lotes de glóbulos rojos de carnero.

Delayed-type-hypersensitivity (DTH) response "in vivo" is commonly evaluated by the footpad swelling test (FPST). High doses of Sheep Red Blood Cells (SRBC) are known to produce negligible DTH, while low doses lead to optimal sensitization. As expected FPST values obtained in Balb/c mice using 10(6) or 10(8) SRBC as sensitizing doses, showed that in 9 out of 10 batches from individual rams, the former dose resulted in higher values than the latter. However, only 3 out of the above 9 exhibited statistically significant differences between immunizing doses (Table 1). Therefore, in our hands, the accuracy of FPST is highly dependent on the SRBC source. We suggest the need of testing individual SRBC batches at both dilutions before use.

[Pulmonary lymphomatoid granulomatosis associated with AIDS. Report of a case and review of the literature]. / Granulomatosis linfomatoide pulmonar asociada a SIDA. A propósito de un caso y revisión de la literatura.

We present an AIDs patient who was admitted to our hospital because of dry cough, pleuritic chest pain, fever and bilateral lung nodules on the chest X-ray. An open lung biopsy was diagnostic for Lymphomatoid Granulomatosis (GL). We review the literature of the clinical manifestations, anatomopathological and pathogenetic features, roentgenographic and laboratory findings, as well as treatment strategies of these patients. The GL has been described in association with AIDS, although in spite of the high prevalence of AIDS in our days, the association between these two entities is not frequent according to the few references in the literature.

[Diffuse T-cell lymphoma of the cervix uteri: an unusual localization of an infrequent tumor]. / Linfoma difuso de células T de cérvix uterino: una localización inusual de un tumor poco frecuente.

Non-Hodgkin lymphomas are frequent tumors. However, extraglandulary forms are very unusual, and the location in the uterine cervix is also extraordinary. A case of an elderly woman with symptoms not related with the tumor, in whom the diagnosis was made from the incidental finding of a distended obstructive bladder is presented. Pelvic mass is one of the forms of presentation of primary malignant lymphomas of the uterine cervix. Diagnosis was made in this case by transvaginal biopsy under general anesthesia. Biopsy showed a diffuse T-cell lymphoma, a very rare finding considering that most of published cases are B-cell type. The importance of distinguishing malignant lymphoma from undifferentiated carcinoma or sarcoma is emphasized since cervical malignant lymphoma can be successfully treated with irradiation.

[Caudal epidural anesthesia in pyloromyotomy in infants: our experience]. / Anestesia epidural caudal en la piloromiotomía del lactante: nuestra experiencia.

The aim of this work is to introduce an alternative to ordinary anaesthetic with tracheal intubation for the surgery of pyloric stenosis. We argue in favour of this alternative that it can be achieved with relative ease if the technique of caudal epidural is well known, a better control of peri and post-operative analgesia without the need of opiates, and that this technique obviates orotracheal intubation and intermittent positive pressure ventilation. Based on our experience with 18 patients, we introduce the anaesthetic technique, the monitoring systems and the obtained results. Our conclusion is that this technique is a good alternative to general anaesthetic for the surgical treatment of pyloric stenosis.

[Falls in a psychiatric unit]. / Caídas en una unidad de psiquiatría.

This paper analyses the falls suffered by patients admitted in the Psychiatric Unit of the "Virgen del Camino" Hospital in the period between April 1998 and October 1999, corresponding to a total of 713 persons aged between 15 and 96 years. The aim of this paper, besides that of registering the falls, is to seek a possible relation between the fall and diverse factors such as diagnosis, treatment, age, time of day when the fall took place, the surroundings where it occurred, the autonomy of the patient and its consequences. A total of 59 falls were registered, corresponding to 36 patients who suffered falls, and it was found after analysing the different factors influencing the fall that a clear profile of the patient involved could not be established, since no clear relation was found between these factors and the fall.

Costes indirectos asociados al glioblastoma. Experiencia en un centro / Indirect costs associated with glioblastoma: Experience at one hospital

Introducción: El glioblastoma es el tumor cerebral más frecuente. A pesar de los avances en su tratamiento, el pronóstico sigue siendo pobre, con una supervivencia media en torno a los 14 meses. Los costes directos, aquellos asociados al diagnóstico y el tratamiento de la enfermedad, han sido descritos ampliamente. Los costes indirectos, aquellos derivados de la pérdida de productividad debido a la enfermedad, han sido descritos en escasas ocasiones. Material y método: Realizamos un estudio retrospectivo, incluyendo a los pacientes diagnosticados entre el 1 de enero del 2010 y el 31 de diciembre del 2013 de glioblastoma en el Hospital Universitario Donostia. Recogimos datos demográficos, relativos al tratamiento ofertado y la supervivencia. Calculamos los costes indirectos a través del método del capital humano, obteniendo datos de sujetos comparables según sexo y edad, y de mortalidad de la población general a través del Instituto Nacional de Estadística. Los salarios pasados fueron actualizados a euros de 2015 según la tasa de inflación interanual y los salarios futuros fueron descontados en un 3,5% anual en forma de interés compuesto. Resultados: Revisamos a 99 pacientes, 46 mujeres (edad media 63,53 años) y 53 hombres (edad media 59,94 años). En 29 pacientes se realizó una biopsia y en los 70 restantes se realizó una cirugía resectiva. La supervivencia global media fue de 18,092 meses. Los costes indirectos totales fueron de 11.080.762 Euros (2015). El coste indirecto medio por paciente fue de 111.926 Euros (2015). Discusión: A pesar de que el glioblastoma es un tipo relativamente poco frecuente de tumor, que supone el 4% de todos los tipos de cáncer, su mal pronóstico y sus posibles secuelas generan una mortalidad y morbilidad desproporcionadamente altas. Esto se traduce en unos costes indirectos muy elevados. El clínico debe ser consciente del impacto del glioblastoma en la sociedad y los costes indirectos deben ser tenidos en cuenta en los estudios de coste-efectividad para conocer las consecuencias globales de esta enfermedad (AU)

Introduction: Glioblastoma is the most common primary brain tumour. Despite advances in treatment, its prognosis remains dismal, with a mean survival time of about 14 months. Many articles have addressed direct costs, those associated with the diagnosis and treatment of the disease. Indirect costs, those associated with loss of productivity due to the disease, have seldom been described. Material and method: We conducted a retrospective study in patients diagnosed with glioblastoma at Hospital Universitario Donostia between January 1, 2010 and December 31, 2013. We collected demographics, data regarding the treatment received, and survival times. We calculated the indirect costs with the human capital approach, adjusting the mean salaries of comparable individuals by sex and age and obtaining mortality data for the general population from the Spanish National Statistics Institute. Past salaries were updated to 2015 euros according to the annual inflation rate and we applied a discount of 3.5% compounded yearly to future salaries. Results: We reviewed the records of 99 patients: 46 women (mean age 63.53) and 53 men (mean age 59.94); 29 patients underwent a biopsy and the remaining 70 underwent excisional surgery. Mean survival was 18.092 months for the whole series. The total indirect cost for the series was Euros11 080 762 (2015). Mean indirect cost per patient was Euros 111 926 (2015). Discussion: Although glioblastoma is a relatively uncommon type of tumour, accounting for only 4% of all cancers, its poor prognosis and potential sequelae generate disproportionately large morbidity and mortality rates which translate to high indirect costs. Clinicians should be aware of the societal impact of glioblastoma and indirect costs should be taken into account when cost effectiveness studies are performed to better illustrate the overall consequences of this disease (AU)

Mathematical model for the homeostasis of alpha-macroglobulins in the rat.

Alpha-macroglobulins (AM) are proteins that inactivate proteinases. Sodium monofluorophosphate (MFP) binds to AM and transiently changes AM plasma levels. As a consequence MFP is useful to modify AM homeostasis. A mathematical model to study the homeostasis of AM is proposed in this paper. The model describes changes in plasma concentration of AM, MFP concentration in the gastrointestinal tract, MFP plasma concentration, plasma concentration of AMMFP and includes rate constants of the processes involved in AM homeostasis. Estimation of the rate constants values was achieved using experimental and mathematical resources. The homeostasis of AM after an oral dose of 80 µmol of MFP was analyzed with a simulation tool. Experimental conditions that modify the homeostasis of AM had been simulated and validated using specific drugs that change some parameter of the system. The mathematical model describes accurately the behavior of the biological model. The results allow concluding that the simplifications made did not underestimate the main processes involved in the homeostasis and, also that the assumptions made were correct.

Valoración del dolor en los pacientes en hemodiálisis / No disponible

No disponible

Biophysical properties of gap junctions between freshly dispersed pairs of mouse pancreatic beta cells.

Coupling between beta cells through gap junctions has been postulated as a principal mechanism of electrical synchronization of glucose-induced activity throughout the islet of Langerhans. We characterized junctional conductance between isolated pairs of mouse pancreatic beta cells by whole-cell recording with two independent patch-clamp circuits. Most pairs were coupled (67%, n = 155), although the mean junctional conductance (gj) (215 +/- 110 pS) was lower than reported in other tissues. Coupling could be recorded for long periods, up to 40 min. Voltage imposed across the junctional or nonjunctional membranes had no effect on gj. Up to several hours of treatment to increase intracellular cAMP levels did not affect gj. Electrically coupled pairs did not show transfer of the dye Lucifer yellow. Octanol (2 mM) reversibly decreased gj. Lower concentrations of octanol (0.5 mM) and heptanol (0.5 mM) than required to uncouple beta cells decreased voltage-dependent K+ and Ca2+ currents in nonjunctional membranes. Although gj recorded in these experiments would be expected to be provided by current flowing through only a few channels of the unitary conductance previously reported for other gap junctions, no unitary junctional currents were observed even during reversible suppression of gj by octanol. This result suggests either that the single channel conductance of gap junction channels between beta cells is smaller than in other tissues (less than 20 pS) or that the small mean conductance is due to transitions between open and closed states that are too rapid or too slow to be resolved.

[The potentially infected newborn infant]. / El recién nacido potencialmente infectado.

In order to establish relationship between premature rupture of membranes (RPM) and neonatal infection, together with the importance of other factors during this process, 50 newborns with history of RPM were studied. In a control group and in groups of newborns with less than and more than 24 hours of plain RPM, related to clinically healthy and vigorous infants, no case of infection was found. On the other hand, 30% and 60% respectively of infections were found in groups less than and more than 24 hours of RPM, but with the presence of other contaminating factors that impair immunological response of the newborn, such as: acute maternal infection, prolonged delivery, unexpected birth, pediatric reanimation procedures, organic immaturity, fetal suffering, immediatie neonatal depression and intercurrent pathology. There were two deaths: a case with RPM of 5 hours and another one with 38 hours, but both with high rating due to the presence and intensity of "aggravating factors" mentioned having internal action mechanism that apparently of restrains to the perpetuation of the hypoxia-acidosis cycle. A provisional sheet is presented to evaluate such "aggravating factors" considering that an RPM associated to them represents a high risk of neonatal infection. In cases of clinically healthy newborns with plain RPM, we advice only to watch over them for 3--5 day, but no antimicrobial treatment at all.

Caídas en una unidad de psiquiatría / Falls in a psychiatric unit

En el presente trabajo se analizan las caídas ocurridas en los pacientes ingresados en la Unidad de Psiquiatría del Hospital Virgen del Camino en el periodo comprendido entre abril de 1998 y octubre de 1999, correspondiendo a un total de 713 personas, con edades entre 15 y 96 años. El objetivo de este trabajo, además de registrar las caídas es buscar la posible relación entre la caída y diversos factores como el diagnóstico, el tratamiento, la edad, la hora del día en que se produce la caída, el entorno de la misma, la autonomía del paciente y las consecuencias de la misma. Se registraron un total de 59 caídas correspondientes a 36 pacientes caedores y se encontró que tras analizar los diferentes factores que influyen en la caída no se puede establecer un perfil claro de riesgo de la persona que las sufre por no haber encontrado una relación clara entre la variable analizada y la caída. (AU)

Variaciones de la reacción de hipersensibilidad retardada en ratones inoculados con diferentes lotes de glóbulos rojos de carnero. / [Variations of the delayed hypersensitivity reaction in mice inoculated with different lots of sheep red blood cells]

Delayed-type-hypersensitivity (DTH) response [quot ]in vivo[quot ] is commonly evaluated by the footpad swelling test (FPST). High doses of Sheep Red Blood Cells (SRBC) are known to produce negligible DTH, while low doses lead to optimal sensitization. As expected FPST values obtained in Balb/c mice using 10(6) or 10(8) SRBC as sensitizing doses, showed that in 9 out of 10 batches from individual rams, the former dose resulted in higher values than the latter. However, only 3 out of the above 9 exhibited statistically significant differences between immunizing doses (Table 1). Therefore, in our hands, the accuracy of FPST is highly dependent on the SRBC source. We suggest the need of testing individual SRBC batches at both dilutions before use.

Anestesia epidural caudal en la piloromiotomía del lactante: Nuestra experiencia* / Caudal epidural anaesthetic in infants for pyloromyotomy: Our experience

El objetivo de este trabajo es presentar la anestesia epidural caudal como alternativa a la anestesia general convencional con entubación endotraqueal para la cirugía de la estenosis pilórica, aportando como ventajas su relativa sencillez una vez dominada la técnica, un mejor control de la analgesia perioperatoria y postoperatoria sin la necesidad de usar opiáceos, y el evitar la entubación orotraqueal y el manejo ventilatorio. Basándonos en la experiencia con 18 pacientes, presentamos la técnica realizada, los sistemas de monitorización y los resultados obtenidos. Concluímos que esta sistemática es un buen método alternativo a la anestesia general en la corrección quirúrgica de la estenosis de píloro (AU)