A New BODIPY-Based Receptor for the Fluorescent Sensing of Catecholamines.

The human body synthesizes catecholamine neurotransmitters, such as dopamine and noradrenaline. Monitoring the levels of these molecules is crucial for the prevention of important diseases, such as Alzheimer's, schizophrenia, Parkinson's, Huntington's, attention-deficit hyperactivity disorder, and paragangliomas. Here, we have synthesized, characterized, and functionalized the BODIPY core with picolylamine (BDPy-pico) in order to create a sensor capable of detecting these biomarkers. The sensing properties of the BDPy-pico probe in solution were studied using fluorescence titrations and supported by DFT studies. Catecholamine sensing was also performed in the solid state by a simple strip test, using an optical fiber as the detector of emissions. In addition, the selectivity and recovery of the sensor were assessed, suggesting the possibility of using this receptor to detect dopamine and norepinephrine in human saliva.

Cardiomiopatía de Tako-Tsubo inducida por feocromocitoma / Tako-Tsubo cardiomyopathy induced by pheochromocytoma

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Miocardiopatía de Tako-Tsubo: una manifestación inusual de feocromocitoma / Takotsubo cardiomyopathy: rare manifestation of pheochromocytoma

Takotsubo cardiomyopathy (MTT) is an acute ventricular dysfunction and reversible in absence of coronary disease. It is a rare presentation of pheochromocytoma and paraganglioma (FPGL). It was described for the first time in 1990 by Sato et al, the physiopathology is not clear yet. It is associated with high levels of catecholamines, vasospasm in the micro vascularization, rupture of atheromatous plaque and myiocarditis. The clinical presentation is similar to an acute myocardial infarction because of that the FPGL must be considered in patients without obstructive coronary lesions. We present a case of a 50 years old women with history of Arterial Hypertension, active smoking and Neurofibromatosis, who is admitted to emergency room with an acute myocardial pain.

Interacción farmacológica de venlafaxina en el diagnóstico de feocromocitoma / Venlafaxine drug interaction in the diagnosis of pheochromocytoma

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Revisión sistemática del efecto del propranolol sobre el hipermetabolismo del quemado / Systematic review of the effect of propanolol on hypermetabilism in burn injuries

Antecedentes El uso de propranolol se ha propuesto para atenuar la respuesta hipermetabólica del paciente quemado. Objetivos Revisar los estudios publicados hasta diciembre de 2013 que analizan los efectos del propranolol en el paciente quemado. Métodos Se aplicaron los términos «burns», «thermal injury», «betablocker» y «propranolol», con los filtros «human» y «English» y «Spanish» en el buscador Pubmed. Se identificaron 42 artículos de los que 15 eran ensayos clínicos aleatorizados. Se resumen los resultados principales de estos artículos. Resultados principales El propranolol ajustado para lograr una frecuencia cardiaca un 20% menor a la basal (4-6mg/kg/día por vía enteral) disminuye la termogénesis suprafisiológica, el trabajo cardiaco, el gasto energético en reposo y la lipólisis periférica. Aumenta la eficiencia de la síntesis proteica muscular y disminuye la acreción de masa central. La mayor parte de estudios han sido realizados en niños. Conclusiones El propranolol atenúa la respuesta hipermetabólica del paciente quemado pediátrico. Son necesarios más estudios sobre su efecto en la población adulta (AU)

Background The use of propranolol has been proposed to reduce the hypermetabolic response of patients with burn injuries. Objectives To review the studies published up to December 2013 on the effects of propranolol in burn patients. Methods A PubMed search was conducted using the terms «burns», «thermal injury», «beta-blocker» and «propranolol», with the filters «human» and «English» and «Spanish». A total of 42 citations were retrieved, 15 of which were randomized clinical trials. The main results are summarized. Main results Propranolol at doses adjusted to decrease the heart rate by 20% of the baseline value (4-6mg/kg/day p.o.) reduces supraphysiological thermogenesis, cardiac work, resting energy expenditure and peripheral lipolysis. It likewise increases the efficiency of muscular protein synthesis and reduces central mass accretion. Most studies have been conducted in pediatric burn patients. Conclusions Propranolol reduces the hypermetabolic response in pediatric burn patients. More studies on its effects in adult burn patients are needed (AU)

Taquicardia ventricular catecolaminérgica polimórfica: una entidad de diagnóstico difícil / Complex Diagnosis of Catecholaminergic Polymorphic Ventricular Tachycardia

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Serie de feocromocitomas durante 15 años en Navarra / Analysis of a series pheochromocytoma cases over 15 years

Fundamento. El feocromocitoma es un tumor productor de catecolaminas que procede de las células cromafines del sistema nervioso simpático. El 80-85% se localiza en la médula adrenal. El diagnóstico se confirma con la determinación de catecolaminas y metanefrinas en plasma y orina. El diagnóstico de localización debe realizarse una vez confirmado el diagnóstico bioquímico, preferentemente mediante tomografía computarizada y/o resonancia magnética. El tratamiento de elección es la cirugía vía laparoscópica. Material y métodos. Revisión de las historias clínicas de los pacientes con diagnóstico anatomo-patológico de feocromocitoma en los servicios de Anatomía Patológica del Complejo Hospitalario de Navarra entre los años 1996 y 2010. Se realiza el análisis descriptivo de los resultados mediante el programa estadístico SPSS. Resultados. Esta serie está formada por 43 pacientes con diagnóstico anatomo-patológico de feocromocitoma durante los últimos 15 años. La edad media de presentación es de 47 años. Entre los más jóvenes hay condensación de pacientes con determinados síndromes genéticos. El método de imagen más empleado ha sido la tomografía computarizada. Encontramos resultados contradictorios en cuanto al empleo de medicación preoperatoria. El comportamiento en todos los casos ha sido benigno. Conclusiones. Creemos conveniente realizar estudio genético en pacientes menores de 20 años de edad. Los parámetros con mayor sensibilidad para el diagnóstico han sido normetanefrina y metanefrina en orina. El único tratamiento curativo es la cirugía, que debería realizarse preferentemente vía laparoscópica(AU)

Background. The pheochromocytoma is a catecholamine secreting tumour derived from chromaffin cells of the sympathetic nervous system. Eighty to eighty-five percent of these tumours are localized in the adrenal medulla. When pheocromocytomas are found outside the adrenal gland they are referred to as extra-adrenal pheochromocytomas or paragangliomas. The diagnosis is confirmed by elevation of catecholamines and the metanephrinesin blood plasma and urine. Localization of the tumour should be done following biochemical diagnosis by means of CT scan and/or MRI. The treatment of choice is tumour resection by laparoscopic surgery. Material and methods. A review was made of all patient medical histories diagnosed with pheochromocytoma confirmed by the pathology reports of Pathologicalanatomy of the Navarre hospital Complex (Anatomía patológica del Complejo hospitalario de Navarra A y B)between 1996 to 2010. Descriptive analysis was made using the IBM SPSS statistics program. Results. Our series consists of 43 patients diagnosed with pheochromocytoma over a span of 15 years. The average age on presentation was 47 years. Among the younger patients specific genetic syndromes were found. Computerized tomography was the most widely used method of localization. Contradictory results were found regarding perioperative medical management protocols. All pheocromocytoma tumours in this series were benign. Conclusions. It is advisable to carry out a genetic study on patients under twenty. The biochemical indicators with the greatest diagnostic sensitivity were the levels of normetanephrine and metanephrine in urine. Surgery was the only treatment option(AU)

Conhecimento dos pais, etiologia e eficácia da Melissa officinalis em associação ou não com a Phytolacca decandra no tratamento do possível bruxismo do sono em crianças / Parent/Guardian knowledge, etiology and efficiency of Melissa officinalis in association or not with Phytolacca decandra in the treatment of the possible sleep bruxism in children

Este trabalho foi composto por 4 estudos. Objetivou-se avaliar:1- os conhecimentos de pais/responsáveis (PR) sobre bruxismo do sono (BS) em crianças e adolescentes (A), por meio de um estudo transversal;2- identificar as evidências científicas sobre diferenças entre os níveis de catecolaminas nos fluídos orgânicos de pacientes com e sem BS, a partir de uma revisão sistemática da literatura; BS;3- relatar o sucesso do uso de medicamento homeopático para tratamento de BN em uma criança acompanhada clinicamente por dois anos;4- investigar a eficácia do uso da Melissa officinalis (MO) em associação ou não com Phytolacca decandra (PD) no tratamento BS através de um estudo clínico controlado e randomizado (ECCR). Crianças de 3 a 12 anos, saudáveis, sem presença de cárie e má-oclusão (n=52) foram selecionadas através do relato de PR sobre a presença de BS. Os pacientes foram numerados de 1-52 e randomicamente alocados de acordo com o tratamento proposto: Placebo (P), Melissa officinalis 12c (MO), Phytolacca decandra 12c (PD), Melissa officinalis 12c + Phytolacca decandra 12c (MO+PD). Os medicamentos foram preparados e organizados em frascos ambar de 15ml (3-6 anos) e 30 ml (6-12anos) e rotulados.Cada tratamento foi realizado por 30 dias com 15 dias de período de descanso. As crianças/pais, o investigador principal e o avaliador que analisou os dados foram mascarados ao tratamento. O desfecho principal foi o efeito da medicação homeopática na redução do BS através de uma Escala Visual Analógica (VAS), analisada pela ANOVA de medidas repetidas com LSD Post-Hoc, assim como os escores traço de ansiedade (TAS) antes e após cada tratamento. A maioria dos PR (73,9%) não tem opinião formada e alguns acreditam que o BN está ligado ao estresse emocional (13,4%) e ao misticismo/religiosidade (3,7%), à saúde (3,7%). Para os PR de crianças sem BN, 81,9% não tinham conhecimento das causas, contra 18,1% daqueles com BN (p=0,011). Os estudos incluídos demonstraram um aumento do nível de catecolaminas na urina de indivíduos com BN. Após terapia homeopática combinada de PD e MO observou-se que o BS e sintomas associados desapareceram no caso relatado. No ECCR houve redução significativa da média dos valores da VAS após as quatro fases de tratamento (p=0,023), sendo P= -1,72±0,29; MO= -2,36 ±0,36; PD= -1,44±0,28; MO+PD= -2,21±0,30. Nenhuma das substâncias testadas provocou efeitos adversos físicos. As leituras do sono (p>0,05), EMG (p>0,05) e ETA (p=0,646) não foram influenciadas por nenhum tratamento. Concluiu-se que a maior parte PR desconhecem as causas e consequências do BS. Além disso, níveis urinários aumentados de catecolaminas foram encontrados em pacientes com BS. Embora no caso clínico o uso de MO e PD tenha sido eficaz, no ECCR, apenas a MO mostrou-se capaz de reduzir o BN, sem efeitos colaterais, enquanto a associação de MO+PD demonstrou efeito antagonista. (AU)

This work is composed of 4 studies. Its main objectives were to evaluate: (1) parent's/guardian's (PG) knowledge about sleep bruxism (SB) in children and adolescents (A), by a transversal study; (2) identify the scientific evidences of different levels of catecholamine in the organic fluids of patients who do not suffer from SB, from a systematic revision of literature; (3) report the success of the use of homeopathic medicine for SB treatment in a child accompanied clinically for two years; (4) investigate the usefulness of Melissa officinalis (MO) in association or not with Phytolacca decandra (PD) in the treatment for SB in a controlled randomized and clinical study (CRCS). Healthy children, aged 3-12 years old and without tooth decay and malocclusion (n=52) were selected in accordance to the PG's statements related to SB. The patients were numbered from 1-52 and randomly allocated in accordance with the proposed treatment: Placebo (P), Melissa officinalis (MO), Phytolacca decandra (PD), Melissa officinalis 12c + Phytolacca decandra 12c (MO + PD). The medication was prepared in amber bottles of 15ml (3-6 years old), 30ml (6-12 years old) and labelled. Each treatment was realized in periods of 30 days with 15 days of rest. The children/parents, principal investigator and the data analyzer were all masked for the treatment. The principal outcome was the effect of the homeopathic medicine in the reduction of SB from an Analog Visual Scale (AVS) and analyzed by ANOVA from repeated metrics with LSD Post-Hoc, as with the scores from the Anxiety Traits (AT) from before and after the treatment. Most of the PG do not have a formed opinion on the matter (73.9%), while others believe that SB is associated with emotional stress (13.4%), mysticism/religion (3.7%) or health (3.7%). The PG of the children without SB (81.9%) had no knowledge of the possible causes versus those with SB (18.1%) (p=0.011). The studies demonstrate an increase in the level of catecholamine in the urine for those who have SB. After the homeopathic treatment combined with PD and MO, it was noted that the symptoms disappeared in the reported cases. In the CRCS there was a large reduction in the mean values for AVS after the 4 stages of treatment (p=0.023), with P= -1.72±0.29; MO= -2.36±0.36; PD= -1.44±0.28; MO+PD= -2.21±0.30. None of the tested substances provoked adverse physical reactions. The sleep readings (p>0.05), EMG (p>0.05) and ETA (p=0.646) were not influenced by any treatment. It was concluded that most PG have no knowledge of the causes and consequences of SB. Also, increased levels of catecholamine were found in the urine samples for patients with SB. Even though in the clinical case the use of MO and PD proved to be efficient, in CRCS only MO proved to be capable of reducing SB without any collateral effects, while the combination of MO + PD demonstrated an antagonist effect. (AU)

Este trabajo se compone de cuatro estudios. Su objetivo es evaluar:1- los conocimientos de padres/responsables (PR) sobre bruxismo del sueño (BS) en niños y adolescentes (A), por medio de un estudio transversal;2- identificar las evidencias científicas sobre diferencias entre los niveles de catecolaminas en los fluidos orgánicos de pacientes con y sin BS, a partir de una revisión sistemática de la literatura; BS;3- relatar el éxito del uso de medicamento homeopático para tratamiento de BS en un niño acompañado clínicamente durante dos años;4- investigar la eficacia del uso de Melissa officinalis (MO) asociado o no a Phytolacca decandra (PD) en el tratamiento BS a través de un estudio clínico controlado y randomizado (ECCR). Niños de 3 a 12 años, sanos, sin presencia de carie ni mala-oclusión (n=52) se seleccionaron por el relato de PR sobre la presencia de BS. Los pacientes se numeraron de 1-52 y de manera aleatoria ubicados de acuerdo al tratamiento propuesto: Placebo (P), Melissa officinalis 12c (MO), Phytolacca decandra 12c (PD), Melissa officinalis 12c + Phytolacca decandra 12c (MO+PD). Los medicamentos fueron preparados y organizados en frascos ámbar de 15ml (3-6 años) y 30 ml (6-12años) y rotulados. Cada tratamiento se llevó a cabo durante 30 días con 15 días como período de descanso. Los niños/padres, el investigador principal y el evaluador que analizó los datos acudieron mascarados al tratamiento. El desenlace principal fue el efecto de la medicación homeopática en la reducción del BS a través de una Escala Visual Analógica (VAS), analizada por la ANOVA de medidas repetidas con LSD Post-Hoc, como los scores de rastro de ansiedad (TAS) antes y después de cada tratamiento. La mayoría de los PR (73,9%) no tiene opinión formada y algunos creen que el BS está ligado al estrés emocional (13,4%) y al misticismo/religiosidad (3,7%), a la salud (3,7%). Para los PR de niños sin BS, 81,9% no tenían conocimiento de las causas, contra 18,1% de aquellos con BS (p=0,011). Los estudios incluidos demostraron un aumento del nivel de catecolaminas en la orina de individuos con BS. Tras terapia homeopática combinada de PD y MO se observó que el BS y síntomas asociados desaparecieron en el caso relatado. No ECCR hubo reducción significativa del promedio de los valores de la VAS después de las cuatro fases de tratamiento (p=0,023), siendo P= -1,72±0,29; MO= -2,36±0,36; PD= -1,44±0,28; MO+PD= - 2,21±0,30. Ninguna de las sustancias experimentadas provocó efectos adversos físicos. Las lecturas del sueño (p>0,05), EMG (p>0,05) y ETA (p=0,646) no fueron influenciadas por ningún tratamiento. Se concluyó que la mayor parte PR desconoce las causas y consecuencias del BS. Además, niveles urinarios aumentados de catecolaminas fueron encontrados en pacientes con BS. Aunque en el caso clínico el uso de MO y PD haya sido eficaz, en el ECCR, apenas la MO se mostró capaz de reducir el BS, sin efectos colaterales, mientras que la asociación de MO+PD demostró efecto antagonista. (AU)

Risk of catecholamine crisis in patients undergoing resection of unsuspected pheochromocytoma

PURPOSE: To report the risk of catecholamine crisis in patients undergoing resection of unsuspected pheochromocytoma. MATERIALS AND METHODS: Over a four-year period, we retrospectively identified four patients who underwent resection of adrenal pheochromocytoma in whom the diagnosis was unsuspected based on preoperative clinical, biochemical, and imaging evaluation. RESULTS: None of the patients exhibited preoperative clinical features of catecholamine excess. Preoperative biochemical screening in two patients was normal. CT scan performed in all patients demonstrated a nonspecific enhancing adrenal mass. During surgical resection of the adrenal mass, hemodynamic instability was observed in two of four patients, and one of these two patients also suffered a myocardial infarct. CONCLUSION: Both surgeons and radiologists should maintain a high index of suspicion for pheochromocytoma, as the tumor can be asymptomatic, biochemically negative, and have nonspecific imaging features. Resection of such unsuspected pheochromocytomas carries a substantial risk of intraoperative hemodynamic instability.

Feocromocitoma: más de una década de experiencia. Revisión de la literatura / Pheochromocytoma: More than a decade of experience. Review of the literature

Objetivos: Presentamos 18 pacientes diagnosticados de feocromocitoma en los últimos 12 años. Material y métodos: Es un estudio retrospectivo observacional valorando los aspectos clínicos, analíticos y patológicos más importantes. Resultados: La edad media fue de 53,5 años con predominio masculino y un seguimiento de 5 años; siendo la consulta más frecuente el hallazgo incidental (29%). Cuatro pacientes padecían un síndrome familiar hereditario. Los tumores se distribuyeron por igual con un caso bilateral. Para el estudio clínico se solicitaron catecolaminas y metanefrinas plasmáticas y en orina de 24h, siendo sometidos a control de la tensión arterial antes de la cirugía con alfabloqueantes y betabloqueantes. Hasta la introducción de la cirugía laparoscópica en nuestro servicio en el 2003, el tratamiento de elección era la cirugía abierta. El acceso transabdominal subcostal fue el más utilizado (47%) y la duración media de 207min.Ninguno presentó tumores metacrónicos y dos pacientes desarrollaron metástasis a distancia con fallecimiento en corto espacio de tiempo. Conclusiones: El feocromocitoma en una enfermedad amenazante por su morbilidad cardiovascular, que precisa realizar un estudio analítico y funcional. El tratamiento quirúrgico, por vía abierta o laparoscópica, dependiendo de las características del tumor y del paciente, tiene resultados satisfactorios y comparables (AU)

Objectives: We present 18 patients with pheochromocytoma in the past 12 years. Material and methods: It is a retrospective observational study evaluating the clinical, biochemical and pathological most important. Results: The mean age was 53.5 years with male predominance and monitoring of five years, being the most frequent incidental findings (29%). Four patients had a familial syndrome hereditary. The tumors were equally distributed with a bilateral case. For the clinical study was made and plasma catecholamines and metanephrines in urine for 24h and subjected to control blood pressure before surgery and beta blockers. Until the introduction of laparoscopic surgery in our department in 2003, the treatment of choice was open surgery. Transabdominal subcostal access was more frequent (47%) and average duration of 207min.No patients showed metachronous tumors and two patients developed distant metastases to death in short time. Conclusions: Pheochromocytoma in a threatening disease by cardiovascular disease, which needs to perform an analytical and functional. Surgical treatment, by open or laparoscopic surgery, depending on the characteristics of the tumor and the patient, is satisfactory and comparable results (AU)

Pheochromocytoma: a long-term follow-up of 24 patients undergoing laparoscopic adrenalectomy

Purpose: Pheochromocytomas are tumors derived from chromaffin cells that often secrete catecholamines and cause hypertension. The clinical diagnosis of pheochromocytoma depends on the presence of excessive production of catecholamines. Conventional imaging modalities that have been used in the preoperative evaluation include CT, MRI, and 131I-MIBG scintigraphy. Surgical resection is the definitive treatment for patients with pheochromocytoma. The goal of this study was to evaluate the long-term follow-up of 24 patients undergoing laparoscopic adrenalectomy for pheochromocytoma. Materials and Methods: From January 1995 to September 2006, 24 patients underwent laparoscopic adrenalectomy for adrenal pheochromocytoma. Twenty (83.3 percent) patients had arterial hypertension. The inclusion criteria of patients in this retrospective study were laparoscopic approach, unilateral or bilateral adrenal tumor, pathological diagnosis of pheochromocytoma and a minimum follow-up of 18 months. Results: Intra-operative complications occurred in 4 (16.7 percent) patients. Two (8.3 percent) patients had postoperative complications. Two patients (8.3 percent) had blood transfusion. The mean postoperative hospital stay was 3.8 days (range 1 to 11). Eighteen (90 percent) of the twenty patients who had symptomatic hypertension, returned to normal blood pressure immediately after surgery, during the hospital stay. In one patient, the high blood pressure levels remained unchanged. Another patient persisted with mild hypertension, well controlled by a single antihypertensive drug. Conclusions: Our results confirmed that laparoscopic adrenalectomy for pheochromocytoma is a safe and effective procedure, providing the benefits of a minimally invasive approach. In our study, the initial positive results obtained in the treatment of 24 patients were confirmed after a mean follow-up of 74 months.

Efectos inmediatos de las tecnicas de thrust de C3 en cervicalgias y su relación con los niveles de serotonina y catecolaminas / The immediate effects of using thrust techniques on C3 to treat neck pain and the consequent changes in the levels of serotonin and catecholamines in the blood

Introducción: El dolor cervical crónico, suele localizarse en la zona posterior del cuello (nuca-zona interescapular) con más de 12 semanas de duración y mayor incidencia en el sexo femenino, puediendo asociarse a períodos de reagudización invalidante, con una frecuencia y duración variables. Objetivos: Determinar el efecto de la manipulación de la tercera vértebra cervical (C3) en el Umbral de Dolor a la Presión (UDP) del punto gatillo (PG1) de los músculos trapecios superiores, en pacientes con cervicalgias mecánicas crónicas, así como los cambios en los niveles de serotonina y catecolaminas en la sangre. Material y Métodos: Estudio experimental, aleatorizado, a doble ciego, con mediciones pre y post intervención en el grupo control y experimental, con una muestra de 60 pacientes (n=60). Se utilizó un dinamómeto digital para medir el UDP del PG1 de trapecio superior. Así mismo, se midió la amplitud articular cervical en todos sus componentes, incluyendo la Escala Visual Analógica (EVA) de dolor. También se analizaron los niveles de serotonina y catecolaminas en la sangre. Resultados: Encontramos una reducción significativa (p=0,013) en el UDP del PG1 del trapecio derecho. También se detectó una mejoría significativa (p=0,028) en el balance articular a la flexión cervical y en la escala EVA (p=0,007). No se encontraron cambios significativos entre los grupos control y experimental en los niveles de serotonina (F=1,121; p=0,294), noradrenalina (F= 1,129; p=0,292), adrenalina (F=1,194; p=0,279) y dopamina (F=1,213; p=0,275). No obstante, se observa una tendencia a un incremento en los niveles de serotonina y catecolaminas. Conclusiones: La manipulación de C3, provoca cambios en el PG1 del trapecio derecho, aumenta el balance articular a la flexión cervical y mejora el dolor percibido por la escala EVA ante dicha flexión. La manipulación de C3, no provoca cambios en los niveles de serotonina y catecolaminas en sangre. La confirmación de una posible tendencia al incremento en los niveles de serotonina y catecolaminas, requiere ser estudiada en futuras investigaciones (AU)

Introduction: Chronic neck pain tends to occur in the posterior region of the neck (neck-interscapular area), lasting 12 weeks or more and is more common in women. It can be associated with debilitating flare-ups of varying frequency and duration. Objective: To determine the effect of manipulating the third cervical vertebra (C3) on the Pressure Pain Threshold (PPT) of the trigger point (TP1) of the upper trapezius muscles in patients with chronic mechanical neck pain and the resulting changes to levels of serotonin and catecholamines in the blood. Material and methods: Experimental, randomized, double-blinded study, with pre and post-intervention measurements from a control group and an experimental group with a sample of 60 patients (n=60). A digital dynamometer was used to measure the PPT of TP1 of the upper trapezius muscle. We measured all parameters of range of motion in the cervical spine, using the Visual Analogue Scale (VAS) to record pain perception. We also measured the levels of serotonin and catecholamines in the blood. Results: We found a significant reduction (p=0.013) in the PPT of TP1 of the right trapezius muscle. We also saw a significant improvement (p=0.028) in joint balance on cervical flexion and in VAS results (p=0.007). We did not find any significant statistical differences in the levels of serotonin (F=1.121; p=0.294), noradrenaline (norepinephrine) (F=1.129; p=0.292), adrenaline (F=1.194; p=0.279) or dopamine (F=1.213; p=0.275) in the control group and the experimental group. However, we did observe a tendency for the levels of serotonin and catecholamines to increase. Conclusions: Manipulating C3 produces changes in TP1 of the right trapezius muscle, increases joint balance on cervical flexion and decreases the level of pain perceived, measured using the VAS scale. Manipulating C3 did not produce any changes in the levels of serotonin and catecholamines in the blood. Levels of serotonin and catecholamines should be analyzed in future studies to confirm a tendency to increase (AU)

Cardiomiopatia de takotsubo como causa de disfunção ventricular transitória / Takotsubo cardiomyopathy causing transitory ventricular dysfunction

Relato do caso de mulher de 74 anos, com hipertensão arterial sistêmica e insuficiência vascular periférica, que apresentou sintomas de síndrome coronariana aguda. A angiografia coronariana demonstrou artérias sem obstruções significativas. A ventriculografia e a ecocardiografia demonstraram acinesia dos segmentos médios e apicais, e hipercinesia dos segmentos basais do ventrículo esquerdo. A paciente evoluiu com recuperação completa da função global e motilidade segmentar em ecocardiografia realizada duas semanas após o início dos sintomas. Esse padrão incomum e reversível de disfunção sistólica e comprometimento segmentar dando ao ventrículo esquerdo forma semelhante a um takotsubo é hoje conhecido como cardiomiopatia do estresse.

This is the report of a 74-year-old female patient with a history of systemic hypertension and peripheral vascular disease who presented acute coronary syndrome symptoms. Coronary angiography showed coronary arteries with no significant obstructions. Ventriculography and echocardiography showed akinesia in mid and apical segments; and hyperkinesia of left ventricle basal segments. Two weeks after the onset of symptoms, a new echocardiogram demonstrated normal global and regional systolic function. The uncommon, reversible pattern for systolic dysfunction and segmental compromising that gives left ventricle a takostubo-like shape is known today as stress cardiomyopathy.

Crisis miasténica y síndrome de takotsubo: una relación no casual / Myasthenic crisis and Takotsubo syndrome: a non-chance relationship

Introducción. El síndrome de takotsubo (STT) es una rara entidad que simula un infarto agudo de miocardio. Asocia dolor precordial, elevación del segmento ST, ausencia de oclusión coronaria y deformación reversible ventricular izquierda por discinesia anteroapical que recuerda a un arte japonés de pescar pulpos (tako-tsubo). Se relaciona con estrés emocional y físico, y se piensa que está mediado por una liberación catecolaminérgica aguda. Caso clínico. Mujer de 83 años, hipertensa. Ingresó en la unidad coronaria con sospecha de síndrome coronario agudo e insuficiencia respiratoria, por lo que requirió ventilación mecánica. El ecocardiograma mostró disfunción ventricular grave con discinesia apical. El cateterismo cardíaco descartó enfermedad coronaria. La ventriculografía reveló una deformación ampulosa sistólica de los segmentos anterior y apical (STT). Se intentó retirar la ventilación sin éxito y se consultó con neurología. La anamnesis dirigida reveló un cuadro de meses de evolución de debilidad generalizada, disfagia y disnea progresivas. Un test de edrofonio fue positivo. El electromiograma de fibra aislada mostró jitter patológico. Los anticuerpos antirreceptor de acetilcolina fueron positivos. La paciente fue tratada con inmunoglobulinas, corticoides y piridostigmina. El ecocardiograma de control objetivó resolución del STT. Conclusiones. El STT debe contemplarse dentro de las complicaciones extraneurológicas de la crisis miasténica. El neurólogo debe tenerlo presente ante cualquier síntoma o signo de potencial origen cardíaco en la crisis miasténica y otros padecimientos neurocríticos (AU)

Introduction. Takotsubo syndrome (TTS) is a rare condition that mimics an acute myocardial infarction. It is associated with precordial pain, ST segment elevation, absence of coronary occlusion and reversible deformation of the left ventricle due to anteroapical dyskinesia that is reminiscent of a Japanese art of fishing octopuses (tako-tsubo). It is related with emotional and physical stress, and is thought to be mediated by an acute release of catecholamines. Case report. An 83-year-old woman with hypertension. She was admitted to the heart unit with a suspected acute coronary syndrome and respiratory failure, and thus required mechanical ventilation. An echocardiography scan showed severe ventricular dysfunction with apical dyskinesia. Cardiac catheterisation ruled out heart disease and a ventriculography scan revealed a bloated systolic deformation of the anterior and apical segments (TTS). Attempts to withdraw ventilation were unsuccessful and the neurology department was consulted. A directed medical history revealed that the patient had been suffering from generalised weakness, and progressive dysphagia and dyspnoea for several months. Results of an edrophonium test were positive. Single-fibre electromyography showed a pathological jitter and acetylcholine antireceptor antibodies were positive. The patient was treated with immunoglobulins, corticoids and pyridostigmine. A control echocardiogram showed resolution of the TTS. Conclusions. TTS must be considered within the extra-neurological complications arising from myasthenic crisis. The neurologist must take this into account when faced with any symptom or sign of a potentially cardiac origin in myasthenic crisis and other neurocritical conditions (AU)

Mínimas alterações hormonais em paciente com grande feocromocitoma / Slight hormonal alterations in a patient with a large pheochromocytoma

Relatamos caso clínico no qual o paciente apresentou sintomas sugestivos de feocromocitoma, grande tumor (maior que 50 g) e mínima alteração laboratorial, exemplificando uma armadilha diagnóstica. Um homem de 31 anos apresentou dois episódios de abdômen agudo, sendo o último acompanhado por cefaléia, hipertensão arterial, rubor facial, sudorese e palidez cutânea. Em outra internação, o paciente apresentava hipertensão arterial sustentada e arritmia cardíaca. Em relação aos testes laboratoriais, apenas o ácido vanil-mandélico foi levemente alterado. Cintilografia com MIBG foi realizada e sugeriu a presença de grande massa adrenal compatível com feocromocitoma. Uma amostra histopatológica da peça foi obtida após cirurgia e confirmou esta hipótese. Esse caso sugere que em pacientes que possuem sintomas sugestivos de feocromocitoma, mesmo com valores normais de catecolaminas plasmáticas e metanefrinas urinárias, devemos considerar as possibilidades de um grande tumor metabolizando catecolaminas em seu interior ou que sofreu necrose hemorrágica.

Síndrome de apnea del sueño, catecolaminas y alteración lipídica / Sleep adnea syndrome, catecholamines and lipid desorder

Objetivos: determinar si el síndrome de apneas-hipopneas del sueño (SAHS) incrementa las cifras de catecolaminas y a través de este mecanismo puede alterar el perfil lipídico. Pacientes y métodos: estudio prospectivo, grupo control y muestreo consecutivo de sujetos con sospecha de SAHS. Fueron excluidos aquellos con enfermedad grave de órgano o ingesta de fármacos con efecto sobre la actividad simpática y/o perfil lipídico. Según el índice de apneas-hipopneas (IAH) obtenido en la polisomnografía, los sujetos se asignaron al grupo clínico (IAH >5) o al grupo control (IAH <5). En ambos se compararon las cifras de colesterol total, HDL-c, triglicéridos y noradrenalina urinaria. Resultados: Fueron incluidos 33 en el grupo clínico y 16 en el control sin existir diferencias en edad, género e índice de masa corporal (IMC). En el grupo clínico, la noradrenalina en orina y colesterol total se elevaron significativamente mientras que disminuyeron las del HDL-colesterol. Se observó una correlación significativa entre los valores de la saturación periférica de O2 (SapO2) y la noradrenalina urinaria, aunque la variabilidad de ésta sólo se asoció independientemente con el índice de desaturación y el IMC. También se detectó correlación significativa entre la noradrenalina urinaria y colesterol total, HDL-c y triglicéridos, sin embargo esta correlación desapareció al ajustar por edad, género e IMC. Conclusiones: el SAHS aumenta la actividad simpática nocturna y el índice de desaturación es el factor de mayor influencia. En los pacientes con SAHS se incrementan significativamente las cifras séricas de colesterol total mientras descienden las del HDL-c, aunque estos resultados no fueron explicados de forma independiente por el aumento en la actividad simpática (AU)

Objectives: To determine whether the syndrome sleep apnea-hypopnea syndrome (SAHS) increases catechilamine value and throught this mechanism may alter the lipid profile. (..) (AU)

Cardiac Catecholamines in Rabbits: Seasonal Changes and Norepinephrine Effect

In an attempt to determine whether myocardial catecholamines vary from season to season, their concentration in rabbits was measured throughout the whole year by the spectrophotofluorometric method. The highest concentration of cardiac catecholamine was observed in summer. Measurement of the atrial response to norepinephrine revealed no significant alteration during the entire period of the experiment.

Incidentaloma adrenal e hipertensión arterial / Adrenal incidentaloma and high blood pressure

El incidentaloma adrenal se define como el hallazgo casual de una lesión adrenal evidenciada durante un estudio de imagen abdominal y su incidencia en la población general es del 4-6 %. Entre las etiologías posibles se incluyen lesiones benignas o malignas que pueden ser hormonalmente activas o inactivas. Datos recientes sugieren que la incidencia de hiperaldosteronismo primario (HAP) en pacientes hipertensos puede alcanzar hasta un 10 %, representando una de las causas más frecuentes de hipertensión arterial secundaria. En la mayoría de los casos el HAP es causado por un adenoma adrenal productor de aldosterona (APA) o hiperplasia bilateral idiopática. Evidencias recientes sugieren que la aldosterona ejerce un efecto deletéreo directo sobre el sistema cardiovascular incrementando la incidencia de eventos cardiovasculares y cerebrovasculares. Se expone el caso clínico de una mujer de 38 años con hipertensión arterial secundaria a un APA que se presentó como una masa adrenal incidentalmente descubierta

Adrenal incidentaloma is defined as the casual finding of an adrenal lesion seen during an abdominal imaging study and its incidence in the general population is 4-6 %. Benign or malignant lesions, that may be hormonally active or inactive, are found among the possible etiologies. Recent data suggest that the incidence of primary hyperaldosteronism (PHA) in hypertense patients may reach up to 10 %, thus representing one of the most frequent causes of secondary high blood pressure. In most of the cases, PHA is caused by an adrenal aldosterone producing adenoma (APA) or bilateral idiopathic hyperplasia. Recent evidence suggests that aldosterone has a direct harmful effect on the cardiovascular system, increasing the incidence of cardiovascular and cerebrovascular events. The clinical case of a 38-year old woman with HBP secondary to APA that presented as an incidentally discovered adrenal mass is presented

Discinesia medioventricular izquierda transitoria: aspectos clínicos de una nueva variante / Transient Left midventricular dyskinesia: clinical features of a new variant

Presentamos 5 casos consecutivos de discinesia medioventricular transitoria, una variante recientemente descrita de discinesia apical transitoria. Se trata de un síndrome que presenta similitudes con la anterior en cuanto a características clínicas, pronósticas y probablemente etiopatogénicas. Los pacientes, la mayoría en relación con un episodio física o emocionalmente estresante, acudieron a urgencias con un cuadro compatible con infarto agudo de miocardio que incluía discinesia/acinesia de los segmentos medios en la ventriculografía. Las alteraciones ventriculares se resolvieron de manera temprana y completa. Las arterias coronarias no mostraron alteraciones en ningún caso. Su existencia denota que no sólo las porciones apicales, afectas en el síndrome tako-tsubo, pueden alterarse de manera reversible. La aparición de nuevas variantes abre nuevos interrogantes sobre la relación de sistema nervioso, catecolaminas y lesión miocárdica reversible

We report five consecutive patients with transient midventricular dyskinesia, a recently described variant of transient apical dyskinesia. It is a syndrome that shares a broad clinical, prognostic and, probably, pathogenetic resemblance to the latter. The patients, the majority of whom were experiencing an episode of emotional or physical stress, were all admitted to an emergency department with a clinical presentation compatible with acute myocardial infarction. Evidence of dyskinesia or akinesia in midventricular segments was seen on ventriculography. These ventricular abnormalities resolved completely over a short period of time. No coronary artery abnormality was evident in any patient. The existence of this variant shows that segments other than apical ventricular segments, which are affected in tako-tsubo syndrome, can also undergo reversible change. The occurrence of new variants raises further questions about the relationship between the nervous system, catecholamines and reversible myocardial lesions

Mecanismos inflamatorios/antiinflamatorios en el cerebro tras la exposición a estrés / Inflammatory/anti-inflammatory mechanisms in the brain following exposure to stress

La mayoría de los sistemas biológicos que conforman un organismo se ven afectados por el estrés. Elsistema nervioso central no sólo tiene un papel esencial en la regulación de la respuesta general al estrés, sino que es una de las principales dianas. Las consecuencias pueden ser positivas (por ejemplo, estado de alerta) o negativas (patologías neuropsiquiátricas).Específicamente, la exposición a ciertos estímulos estresantes puede desencadenar un proceso neuroinflamatorio. Desarrollo. Se ha descrito que una respuesta neuroinflamatoria excesiva contribuye decisivamente al daño funcional y estructuralobservado en numerosas enfermedades neurológicas y neuropsiquiátricas relacionadas con el estrés, como el síndrome de estrés postraumático, la depresión y la esquizofrenia. El proceso inflamatorio generado por la exposición a estrés se caracteriza por una compleja liberación en cadena de diferentes mediadores celulares, tales como citocinas, factores de transcripción, prostaglandinas, radicales libres, etc. Paralelamente, se ha demostrado que la vía antiinflamatoria de las deoxiprostaglandinas se activa después de estrés en el sistema nervioso central, activación que podría constituir un mecanismo endógeno reguladordel propio proceso inflamatorio. Conclusiones. En el futuro, el mayor conocimiento y estudio de esta vía endógena podría convertirla en una nueva e interesante estrategia preventiva o neuroprotectora frente a las numerosas patologías que poseen un claro componente inflamatorio perjudicial, tales como la isquemia cerebral, enfermedades de Alzheimer y Parkinson, así comolas citadas anteriormente entre las relacionadas con la exposición a estrés

Most of the biological systems that go to make up an organism can be affected by stress. The centralnervous system not only plays an essential role in regulating the general response to stress, but it is also one of its main targets. The consequences may be positive (for example, a state of alertness) or negative (neuropsychiatric pathologies). More specifically, exposure to certain stressing stimuli can trigger a neuroinflammatory process. Development. Reports haveappeared describing how an excessive neuroinflammatory response makes a decisive contribution to the functional and structural damage that is often observed in stress-related neurological and neuropsychiatric diseases, such as post-traumatic stress syndrome, depression and schizophrenia. The inflammatory process generated by exposure to stress is characterised bya complex release of a chain of different cell mediators, such as cytosines, transcription factors, prostaglandins, free radicals, and so forth. In parallel to this, it has been proved that the anti-inflammatory pathway of deoxyprostaglandins is activatedafter stress in the central nervous system, and this activation could constitute an endogenous mechanism that regulates the inflammatory process itself. Conclusions. In the future, further studies and a deeper understanding of this endogenouspathway could make it into a new, interesting preventive or neuroprotective strategy for use in a number of pathologies that have a clear harmful inflammatory component, such as cerebral ischaemia, Alzheimer’s and Parkinson’s diseases, as well asthose mentioned earlier as being related to exposure to stress