Spatio-temporal flowering patterns in Mediterranean Poaceae. A community study in SW Spain.

This study focused on phenological timing and spatial patterns in 30 Poaceae species flowering in spring in different types of plant cover (scrub, riverbank and pasture). Grass community composition was studied, and the influence of species and plant cover on the start date and duration of flowering was assessed from March to June in both 2014 and 2015. Twenty-nine sampling sites were selected for phenological monitoring using the BBCH scale. Data were subjected to GLMM analyses. Binary discriminant analysis revealed differences in grass community composition as a function of plant cover type; scrub cover comprised a considerably larger number of species than those in riverbank and pasture. Moreover, more species diversity was observed in 2014 than in 2015 with a drier and stressed pre-flowering period. Differences on phenology were also recorded between plant cover types and study years. Species in pasture and riverbank flowered before (113.4 days; 116.1 days) than species in scrub (120.9 days), being these species with shorter flowering length because they are more exposed to the characteristic of the Mediterranean region during the summer. In general, flowering onset occurred later in 2014 (118.2 days) than in 2015 (115.8 days), probably attributable to precipitation occurring during March. On the other hand, spatial autocorrelation within some cover types has been observed, showing spatial patterns exist at a smaller scale. The findings of this study contribute to a better understanding of grass phenology in different environments.

Phylogeography of the invasive weed Hypochaeris radicata (Asteraceae): from Moroccan origin to worldwide introduced populations.

In an attempt to delineate the area of origin and migratory expansion of the highly successful invasive weedy species Hypochaeris radicata, we analysed amplified fragment length polymorphisms from samples taken from 44 populations. Population sampling focused on the central and western Mediterranean area, but also included sites from Northern Spain, Western and Central Europe, Southeast Asia and South America. The six primer combinations applied to 213 individuals generated a total of 517 fragments of which 513 (99.2%) were polymorphic. The neighbour-joining tree presented five clusters and these divisions were supported by the results of Bayesian analyses: plants in the Moroccan, Betic Sierras (Southern Spain), and central Mediterranean clusters are all heterocarpic. The north and central Spanish, southwestern Sierra Morena, and Central European, Asian and South American cluster contain both heterocarpic (southwestern Sierra Morena) and homocarpic populations (all other populations). The Doñana cluster includes two homocarpic populations. Analyses of fragment parameters indicate that the oldest populations of H. radicata are located in Morocco and that the species expanded from this area in the Late Quaternary via at least three migratory routes, the earliest of which seems to have been to the southwestern Iberian Peninsula, with subsequent colonizations to the central Mediterranean area and the Betic Sierras. Homocarpic populations originated in the southwestern Iberian Peninsula and subsequently spread across north and central Spain, Central Europe and worldwide, where they became a highly successful weed.

Gastric pouch carcinoma after gastric bypass for morbid obesity.

The relationship between bariatric surgery and gastric cancer is conjectural. We present a 52-year-old woman with BMI 45 operated initially by a Lap-Band procedure complicated by gastric wall erosion of the band 9 months later. She was re-operated and the band was removed. She subsequently underwent a Roux-en-Y gastric bypass. 5 years after, gastric carcinoma was discovered in the gastric pouch. Because of varied symptoms following bariatric surgery, patients may not present promptly with symptoms related to a gastric carcinoma.

[Complications of intestinal transporting of cocaine packets. Study of 215 cases]. / Complicaciones en transportadores intestinales de paquetes con cocaína. Estudio de 215 casos.

BACKGROUND: To analyse clinical manifestations, diagnosis and management in the "body packer syndrome". MATERIAL AND METHODS: We collected 215 patients who had ingested packets of cocaine. RESULTS: Bowel obstruction, haemorrhagic complications and seizures were observed in 5.1, 4.2 and 2.3%, respectively. Toxic manifestations of cocaine occurred in 4 patients. CONCLUSIONS: Radiographs of abdomen are necessary for diagnosis and follow-up. Close surveillance in necessary to identify intestinal obstruction or acute intoxication by cocaine.

[The Budd-Chiari syndrome as the first manifestation of polycythemia vera]. / Síndrome de Budd-Chiari como primera manifestación de policitemia vera.

The case of a 57-year-old male diagnosed as having Budd-Chiari syndrome secondary to a polycythemia vera, which produced a thrombosis of the suprahepatic veins as a first manifestation, is presented. The rarity of this clinical case and the rapidly lethal evolution of the patient, confirms the bad prognosis of this association.

[Cardiovascular complications due to cocaine]. / Complicaciones cardiovasculares por cocaína.

The increase of cocaine consumption is a common new item in the medical literature and in the national press and, hence, it does not surprises us any more. However, we are seeing every day the appearance of unknown or forgotten complications. In this paper, we review the cardiovascular complications due to the consumption of this drug, stressing the physiopathological mechanisms and the therapeutical aspects. In addition, we describe our experience with the management of these patients.

[Impact of arterial hypertension on the central nervous system]. / Repercusión de la hipertensión arterial sobre el sistema nervioso central.

Cerebrovascular diseases (CVD) entail high costs associated to therapies, hospitalizations and disabilities. Arterial hypertension (AHT) is the major modifiable risk factor for the development of all types of CVDs (cerebrovascular accidents, vascular dementias, etc.). The increase of arterial pressure causes functional and anatomical changes in the cerebral circulation which facilitate the development of CVDs. The time of evolution and the severity of the AHT, as well as the associated vascular risk factors, will determine its impact on the central nervous system.

[Thrombotic thrombocytopenic purpura: the need of an early treatment]. / Púpura trombocitopénica trombótica: necesidad de un tratamiento precoz.

Two patients affected by thrombotic thrombocytopenic purpura (TTP) are treated with plasmapheresis, fresh frozen plasma infusion, steroid and inhibitors of platelet aggregation with an impaired final stage: the first patient died during a plasmapheresis session and the other had a good evolution, obtaining complete recovery, maintained a year later. We discuss the clinical features and highlight the needs for early treatment with all the latest therapies.

[Alcohol withdrawal syndrome: clinical and analytical manifestations and treatment]. / Síndrome de abstinencia alcohólica: manifestaciones clínicas, analíticas y tratamiento.

BACKGROUND: The aim of this study was to analyze clinical manifestations and treatment aspects of alcohol withdrawal syndrome. MATERIAL AND METHODS: A retrospective study of 212 clinical records. RESULTS: The commonest withdrawal effects were tremulousness (68.7%) 7 agitation (67.3%) and hallucinations (46%). Most patients were male. The 64% recognize a period of relative or absolute abstinence less than two days, and a 67.8% have been previous incident of withdrawal syndrome. The commonest complications during hospital stay were rhabdomyolysis (26%). Time of symptoms were three days and mean of hospitalization were 14 days. The treatment used was the correction of fluid and electrolyte imbalance (93%) and B vitamins (98%). In relation to the use of drugs, in 84% of our patients we used benzodiazepines with longer-acting, and clomethiazole in 50% of cases. Mortality were 0.9%. CONCLUSIONS: Patient with alcohol withdrawal syndrome was a male, previously drinker, with a period of abstinence less than two days. In addition to tremulousness and agitation, in our series, we wish to emphasize higher frequency of hallucinations, and the incidence of complications as rhabdomyolysis, despite of such response of treatment is good and mortality is low.

[Rhabdomyolysis and cocaine consumption: presentation of 13 cases]. / Rabdomiolisis y consumo de cocaína: presentación de 13 casos.

We present 13 cases taken care at the Emergency Service, whose diagnosis was acute rhabdomyolysis related to consumption of illicit drugs. In all cases, the presence of cocaine in the urine was detected. Clinical features, other associated factors and complications are described, stressing the etiopathogenic mechanism of presentation of cocaine-related rhabdomyolysis.

[Intraparenchymal cerebral hemorrhage and cocaine]. / Hemorragia intraparenquimatosa cerebral y cocaína.

Medical problems related to cocaine consumption are not rare in our environment; however, to this respect, descriptions in the spanish literature are scarce. We present three cases of intracerebral hemorrhage which occurred after cocaine consumption (intranasal route in two cases and intravenous route in one case). In the three cases, another associated risk factor was observed (alcohol in one case, hypertension in other case, arteriovenous malformation in the third case). We comment on the pathophysiological theories of the cause of bleeding, high-lighting the routine search of this association.

[Cocaine-induced neurological complications]. / Complicaciones neurológicas por cocaína.

Cocaine intake growth is a well-known fact, and that involves the appearance of unknown or forgotten complications. We have wanted to make a checking of neurologic complications due to the intake of this drug, make a special point of the physiopathological mechanisms and stopping at those related to treatment. We also want to contribute with our experience with regard to these processes.

[Rhabdomyolysis in acute intoxications]. / Rabdomiolisis en intoxicaciones agudas.

The development of rhabdomyolysis is a complications of acute intoxications, although its actual incidences is unknown. We had studied the frequency and differential characteristics of the patients with such complications. A prospective study was conducted with 200 patients admitted to a General Hospital from an urban area due to acute intoxication, recording the etiology of the intoxication, motivation and analytical characteristics of the patients with rhabdomyolysis compared to their patients without rhabdomyolysis. The incidence of rhabdomyolysis was 7.7%. Among the patients with rhabdomyolysis, ludic motivation (59%) and etiology associated to drug abuse (heroin 30%, cocaine 24%) were more frequent compared to the patients without rhabdomyolysis. Twenty per cent of the patients consuming cocaine and 17% of the patients consuming heroin developed rhabdomyolysis. Acute rhabdomyolysis was, thus, a significant complication of acute intoxications, associated to the consumption of illegal drugs and, at least in our cases, with a good evolution regarding the renal function.

[Community-acquired pneumonia in the aged: prognostic factors]. / Neumonía comunitaria en el anciano: factores pronósticos.

We studied the clinical characteristics and the initial supplementary test available in the emergency service, in aged patients with community-acquired pneumonia, as well as their mortality prognosis value. We assessed 190 patients attended consecutively during one year. Clinical, analytical and radiological data were registered. The parameters associated to a higher mortality were: age, absence of thoracic pain, reduction in the level of consciousness, leukocytosis, increased urea levels, aminotransferases, lactate dehydrogenase and reduction in prothrombin activity and pH. The data associated to a greater relative risk were: age above 80 years, absence of thoracic pain, prothrombin activity lower than 70% and ALT < 40 U/l. The presence of three to four of these variables had a sensitivity of 62% and a specificity of 94% in the prediction of mortality. In the multivariable analysis, the following variables remained significative: age, obnubilation and decrease of prothrombin. We stress the relevance of a high clinical suspicion, given the frequency of these cases with little symptomatology, in order to allow for an early treatment and the identification of right risk patients at the initial assessment.

[Progressive external ophthalmoplegia]. / Oftalmoplejia externa progresiva.

Progressive external ophthalmoplegia is a myopathic alteration of slow progression which affects the extrinsic ocular muscles; ptosis of the eyelid being the most characteristic sign. Nowadays, it is included as type of muscular dystrophy. Even though mitochondrial changes have been described, they are not specific to this disease. 2 cases are described in this paper, commenting on clinical, electromyographic and pathological aspects.

[Anesthetic management of a hydatid cyst adhering to the inferior vena cava]. / Tratamiento anestésico de un quiste hidatídico adosado a la vena cava inferior.

A patient with a hepatic hydatid cyst with fistula formation to inferior vena cava is reported. To carry out the resection, the cyst was isolated from systemic circulation by means of cardiopulmonary bypass. Inferior vena cava was cannulated through the right atrium until the implantation area of the cyst (above the hepatic veins) was surpassed. Bypass was carried out in 25 minutes by means of cannulation of the ascending aorta, without clamping the aorta, myocardial protection or hypothermia. Postoperative analgesia was achieved with a lumbar epidural catheter. Measures to prevent anaphylactic shock are recommended, an anesthetic technique based on the prevention of hypersensitivity reactions and a careful surgical technique to prevent hydatid dissemination.