Neurochemistry and circuit organization of the lateral spiriform nucleus of birds: A uniquely nonmammalian direct pathway component of the basal ganglia.

We used diverse methods to characterize the role of avian lateral spiriform nucleus (SpL) in basal ganglia motor function. Connectivity analysis showed that SpL receives input from globus pallidus (GP), and the intrapeduncular nucleus (INP) located ventromedial to GP, whose neurons express numerous striatal markers. SpL-projecting GP neurons were large and aspiny, while SpL-projecting INP neurons were medium sized and spiny. Connectivity analysis further showed that SpL receives inputs from subthalamic nucleus (STN) and substantia nigra pars reticulata (SNr), and that the SNr also receives inputs from GP, INP, and STN. Neurochemical analysis showed that SpL neurons express ENK, GAD, and a variety of pallidal neuron markers, and receive GABAergic terminals, some of which also contain DARPP32, consistent with GP pallidal and INP striatal inputs. Connectivity and neurochemical analysis showed that the SpL input to tectum prominently ends on GABAA receptor-enriched tectobulbar neurons. Behavioral studies showed that lesions of SpL impair visuomotor behaviors involving tracking and pecking moving targets. Our results suggest that SpL modulates brainstem-projecting tectobulbar neurons in a manner comparable to the demonstrated influence of GP internus on motor thalamus and of SNr on tectobulbar neurons in mammals. Given published data in amphibians and reptiles, it seems likely the SpL circuit represents a major direct pathway-type circuit by which the basal ganglia exerts its motor influence in nonmammalian tetrapods. The present studies also show that avian striatum is divided into three spatially segregated territories with differing connectivity, a medial striato-nigral territory, a dorsolateral striato-GP territory, and the ventrolateral INP motor territory.

Subpopulations of corticotropin-releasing factor containing neurons and internal circuits in the chicken central extended amygdala.

In mammals, the central extended amygdala is critical for the regulation of the stress response. This regulation is extremely complex, involving multiple subpopulations of GABAergic neurons and complex networks of internal and external connections. Two neuron subpopulations expressing corticotropin-releasing factor (CRF), located in the central amygdala and the lateral bed nucleus of the stria terminalis (BSTL), play a key role in the long-term component of fear learning and in sustained fear responses akin to anxiety. Very little is known about the regulation of stress by the amygdala in nonmammals, hindering efforts for trying to improve animal welfare. In birds, one of the major problems relates to the high evolutionary divergence of the telencephalon, where the amygdala is located. In the present study, we aimed to investigate the presence of CRF neurons of the central extended amygdala in chicken and the local connections within this region. We found two major subpopulations of CRF cells in BSTL and the medial capsular central amygdala of chicken. Based on multiple labeling of CRF mRNA with different developmental transcription factors, all CRF neurons seem to originate within the telencephalon since they express Foxg1, and there are two subtypes with different embryonic origins that express Islet1 or Pax6. In addition, we demonstrated direct projections from Pax6 cells of the capsular central amygdala to BSTL and the oval central amygdala. We also found projections from Islet1 cells of the oval central amygdala to BSTL, which may constitute an indirect pathway for the regulation of BSTL output cells. Part of these projections may be mediated by CRF cells, in agreement with the expression of CRF receptors in both Ceov and BSTL. Our results show a complex organization of the central extended amygdala in chicken and open new venues for studying how different cells and circuits regulate stress in these animals.

Mapping of corticotropin-releasing factor, receptors, and binding protein mRNA in the chicken telencephalon throughout development.

Understanding the neural mechanisms that regulate the stress response is critical to know how animals adapt to a changing world and is one of the key factors to be considered for improving animal welfare. Corticotropin-releasing factor (CRF) is crucial for regulating physiological and endocrine responses, triggering the activation of the sympathetic nervous system and the hypothalamo-pituitary-adrenal axis (HPA) during stress. In mammals, several telencephalic areas, such as the amygdala and the hippocampus, regulate the autonomic system and the HPA responses. These centers include subpopulations of CRF containing neurons that, by way of CRF receptors, play modulatory roles in the emotional and cognitive aspects of stress. CRF binding protein also plays a role, buffering extracellular CRF and regulating its availability. CRF role in activation of the HPA is evolutionary conserved in vertebrates, highlighting the relevance of this system to help animals cope with adversity. However, knowledge on CRF systems in the avian telencephalon is very limited, and no information exists on detailed expression of CRF receptors and binding protein. Knowing that the stress response changes with age, with important variations during the first week posthatching, the aim of this study was to analyze mRNA expression of CRF, CRF receptors 1 and 2, and CRF binding protein in chicken telencephalon throughout embryonic and early posthatching development, using in situ hybridization. Our results demonstrate an early expression of CRF and its receptors in pallial areas regulating sensory processing, sensorimotor integration and cognition, and a late expression in subpallial areas regulating the stress response. However, CRF buffering system develops earlier in the subpallium than in the pallium. These results help to understand the mechanisms underlying the negative effects of noise and light during prehatching stages in chicken, and suggest that stress regulation becomes more sophisticated with age.

Evolution and Development of Amygdala Subdivisions: Pallial, Subpallial, and Beyond.

The amygdala is a central node in functional networks regulating emotions, social behavior, and social cognition. It develops in the telencephalon and includes pallial and subpallial parts, but these are extremely complex with multiple subdivisions, cell types, and connections. The homology of the amygdala in nonmammals is highly controversial, especially for the pallial part, and we are still far from understanding general principles on its organization that are common to different groups. Here, we review data on the adult functional architecture and developmental genoarchitecture of the amygdala in different amniotes (mammals and sauropsids), which are helping to disentangle and to better understand this complex structure. The use of an evolutionary developmental biology (evo-devo) approach has helped distinguish three major divisions in the amygdala, derived from the pallium, the subpallium, and from a newly identified division called telencephalon-opto-hypothalamic domain (TOH). This approach has also helped identify homologous cell populations with identical embryonic origins and molecular profiles in the amygdala of different amniotes. While subpallial cells produce different subtypes of GABAergic neurons, the pallium and TOH are major sources of glutamatergic cells. Available data point to a development-based molecular code that contributes to shape distinct functional subsystems in the amygdala, and comparative genoarchitecture is helping to delineate the cells involved in same subsystems in non-mammals. Thus, the evodevo approach can provide crucial information to understand common organizing principles of the amygdala cells and networks that control behavior, emotions, and cognition in amniotes.

Distinct Subdivisions in the Transition Between Telencephalon and Hypothalamus Produce Otp and Sim1 Cells for the Extended Amygdala in Sauropsids.

Based on the coexpression of the transcription factors Foxg1 and Otp, we recently identified in the mouse a new radial embryonic division named the telencephalon-opto-hypothalamic (TOH) domain that produces the vast majority of glutamatergic neurons found in the medial extended amygdala. To know whether a similar division exists in other amniotes, we carried out double labeling of Foxg1 and Otp in embryonic brain sections of two species of sauropsids, the domestic chicken (Gallus gallus domesticus), and the long-tailed lacertid lizard (Psammodromus algirus). Since in mice Otp overlaps with the transcription factor Sim1, we also analyzed the coexpression of Foxg1 and Sim1 and compared it to the glutamatergic cell marker VGLUT2. Our results showed that the TOH domain is also present in sauropsids and produces subpopulations of Otp/Foxg1 and Sim1/Foxg1 cells for the medial extended amygdala. In addition, we found Sim1/Foxg1 cells that invade the central extended amygdala, and other Otp and Sim1 cells not coexpressing Foxg1 that invade the extended and the pallial amygdala. These different Otp and Sim1 cell subpopulations, with or without Foxg1, are likely glutamatergic. Our results highlight the complex divisional organization of telencephalon-hypothalamic transition, which contributes to the heterogeneity of amygdalar cells. In addition, our results open new venues to study further the amygdalar cells derived from different divisions around this transition zone and their relationship to other cells derived from the pallium or the subpallium.

Land-use changes and precipitation cycles to understand hydrodynamic responses in semiarid Mediterranean karstic watersheds.

Non-planned agricultural land abandonment is affecting natural hydrological processes. This is especially relevant in vulnerable arid karstic watersheds, where water resources are scarce but vital for sustaining natural ecosystems and human settlements. However, studies assessing the spatiotemporal evolution of the hydrological responses considering land-use changes and precipitation cycles for long periods are rare in karstic environments. In this research, we selected a representative karstic watershed in a Mediterranean semiarid domain, since in this belt, karst environments are prone to land degradation processes due to human impacts. Geographic Information Systems-based tools and hydrological modeling considering daily time steps were combined with temporal analysis of climate variables (wavelet analysis) to demonstrate possible interactions and vulnerable responses. Observed daily flow data were used to calibrate/validate these hydrological models by applying statistic indicators such as the NSE efficiency and a self-developed index (the ANSE index). This new index could enhance goodness-of-fit measurements obtained with traditional statistics during the model optimization. We hypothesize that this is key to adding new inputs to this research line. Our results revealed that: i) changes in the type of sclerophyllous vegetation (Quercus calliprinos, ilex, rotundifolia, suber, etc.) from 81.5% during the initial stage (1990) to natural grasslands by 81.6% (2018); and, ii) decreases in agricultural areas (crops) by approximately 60% and their transformation into coniferous forests, rock outcrops, sparsely natural grasslands, etc. in the same period. Consequently, increases in the curve number (CN) rates were identified as a result of land abandonment. As a result, an increase in peak flow events jointly with a relevant decrease of the average flow rates (water scarcity) in the watershed was predicted by the HEC-HMS model and verified through the observed data. This research provides useful information about the effects of anthropogenic changes in the hydrodynamic behaviour of karstic watersheds and water resource impacts, especially key in water-scarce areas that depict important hazards for the water supply of related populations and natural ecosystems.

Evolving Views on the Pallium.

The pallium is the largest part of the telencephalon in amniotes, and comparison of its subdivisions across species has been extremely difficult and controversial due to its high divergence. Comparative embryonic genoarchitecture studies have greatly contributed to propose models of pallial fundamental divisions, which can be compared across species and be used to extract general organizing principles as well as to ask more focused and insightful research questions. The use of these models is crucial to discern between conservation, convergence or divergence in the neural populations and networks found in the pallium. Here we provide a critical review of the models proposed using this approach, including tetrapartite, hexapartite and double-ring models, and compare them to other models. While recognizing the power of these models for understanding brain architecture, development and evolution, we also highlight limitations and comment on aspects that require attention for improvement. We also discuss on the use of transcriptomic data for understanding pallial evolution and advise for better contextualization of these data by discerning between gene regulatory networks involved in the generation of specific units and cell populations versus genes expressed later, many of which are activity dependent and their expression is more likely subjected to convergent evolution.

Corrigendum: Genetic Identification of the Central Nucleus and Other Components of the Central Extended Amygdala in Chicken During Development.

[This corrects the article DOI: 10.3389/fnana.2014.00090.].

Remote thermal detection of exfoliation sheet deformation.

A growing body of research indicates that rock slope failures, particularly from exfoliating cliffs, are promoted by rock deformations induced by daily temperature cycles. Although previous research has described how these deformations occur, full three-dimensional monitoring of both the deformations and the associated temperature changes has not yet been performed. Here we use integrated terrestrial laser scanning (TLS) and infrared thermography (IRT) techniques to monitor daily deformations of two granitic exfoliating cliffs in Yosemite National Park (CA, USA). At one cliff, we employed TLS and IRT in conjunction with in situ instrumentation to confirm previously documented behavior of an exfoliated rock sheet, which experiences daily closing and opening of the exfoliation fracture during rock cooling and heating, respectively, with a few hours delay from the minimum and maximum temperatures. The most deformed portion of the sheet coincides with the area where both the fracture aperture and the temperature variations are greatest. With the general deformation and temperature relations established, we then employed IRT at a second cliff, where we remotely detected and identified 11 exfoliation sheets that displayed those general thermal relations. TLS measurements then subsequently confirmed the deformation patterns of these sheets showing that sheets with larger apertures are more likely to display larger thermal-related deformations. Our high-frequency monitoring shows how coupled TLS and IRT allows for remote detection of thermally induced deformations and, importantly, how IRT could potentially be used on its own to identify partially detached exfoliation sheets capable of large-scale deformation. These results offer a new and efficient approach for investigating potential rockfall sources on exfoliating cliffs.

A novel telencephalon-opto-hypothalamic morphogenetic domain coexpressing Foxg1 and Otp produces most of the glutamatergic neurons of the medial extended amygdala.

Deficits in social cognition and behavior are a hallmark of many psychiatric disorders. The medial extended amygdala, including the medial amygdala and the medial bed nucleus of the stria terminalis, is a key component of functional networks involved in sociality. However, this nuclear complex is highly heterogeneous and contains numerous GABAergic and glutamatergic neuron subpopulations. Deciphering the connections of different neurons is essential in order to understand how this structure regulates different aspects of sociality, and it is necessary to evaluate their differential implication in distinct mental disorders. Developmental studies in different vertebrates are offering new venues to understand neuronal diversity of the medial extended amygdala and are helping to establish a relation between the embryonic origin and molecular signature of distinct neurons with the functional subcircuits in which they are engaged. These studies have provided many details on the distinct GABAergic neurons of the medial extended amygdala, but information on the glutamatergic neurons is still scarce. Using an Otp-eGFP transgenic mouse and multiple fluorescent labeling, we show that most glutamatergic neurons of the medial extended amygdala originate in a distinct telencephalon-opto-hypothalamic embryonic domain (TOH), located at the transition between telencephalon and hypothalamus, which produces Otp-lineage neurons expressing the telencephalic marker Foxg1 but not Nkx2.1 during development. These glutamatergic cells include a subpopulation of projection neurons of the medial amygdala, which activation has been previously shown to promote autistic-like behavior. Our data open new venues for studying the implication of this neuron subtype in neurodevelopmental disorders producing social deficits.

The effects of socioeconomic conditions on old-age mortality within shared disability pathways.

OBJECTIVE: How disability manifests itself in an individual is a highly complex process influenced by a wide range of individual and environmental factors. Its complexity makes the search for generalizable characteristics of the disablement process a challenging task. Consequentially, little is known about how the effect on other health outcomes such as life expectancy are modified after the onset of chronic ailments. In this paper we posit an alternative approach to generalize health trajectories of older people with disability and then analyze how socioeconomic conditions affect the longevity within these trajectory groups. METHODS: Individual level information about the first three successive onsets of chronic disability after age 50 is transformed into state-sequences. We extract trajectory groups based on onset time and the time spent in a certain state. Mortality hazards are then estimated with a Gompertz proportional hazards model to compare effects of different socioeconomic measures within the trajectory groups. RESULTS: Three distinct trajectory groups are identified, the mild (1), the early severe (2), and late severe (3) pathway. Estimates of the mortality analysis suggest that social inequalities in longevity are less pronounced after onset of old-age disability. We found a consistent survival prolonging effect for individuals who engage in daily activities (such as meeting with friends, walking) that ranged between 33.2% and 77.3%. The importance of other variables varies between trajectory groups. DISCUSSION: This study shows how health trajectories of individuals with disability can be generalized when information on the onset and severity of single conditions is available. Such an approach may help us to better predict health and care expenditures and help families and individuals with their personal care planning. The findings from the subsequent survival analysis suggest a substantial reduction of socioeconomic mortality differences after onset of old-age disability, which appears to be independent of its nature.

ECMO: Comentario del ensayo EOLIA sobre el uso de la membrana de oxigenación extracorpórea en el síndrome de distrés respiratorio agudo / ECMO: Commentary of the EOLIA trial on the use of Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome

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Comparación de métodos de escalamiento de actividades de la vida diaria en personas mayores / Comparison of scaling methods for activities of daily living in older people

Objetivo: Comparar las propiedades psicométricas de escalas de medición de las actividades de la vida diaria según distintos métodos y comprobar si los más complejos tienen más capacidad discriminatoria. Método: Muestra de personas mayores de la Encuesta sobre discapacidad, autonomía personal y situaciones de dependencia. Se utilizaron 14 ítems que medían actividades de la vida diaria. Cinco métodos de escalamiento: Suma y Rasch (los dos con ítems en forma dicotómica o politómica) y Guttman (forma dicotómica). Se evaluaron su capacidad discriminatoria (precisión relativa [PR]) y el área bajo la curva (AUC). Resultados: Todos los métodos mostraron altas correlaciones de Pearson entre ellos (0,765-0,993). Tenían similar poder discriminatorio al comparar categorías extremas de individuos no limitados respecto a gravemente limitados (PR: 0,93-1,00). El procedimiento Suma politómico mostró la mayor AUC (0,934; intervalo de confianza del 95% [IC95%]: 0,928-0,939) y el Guttman la menor (0,853; IC95%: 0,845-0,861). Conclusiones: Se observa una mayor fiabilidad en ítems politómicos que dicotómicos. Los métodos sencillos (Suma) y los complejos (Rasch) son opciones igualmente válidas. El método Guttman presentó peor capacidad discriminatoria

Objective: To compare the psychometric properties of scales top measure activities of daily living, constructed with different scaling methods, and to check whether the most complex scales have higher discriminatory capacity. Method: Sample of elderly people from the Spanish Survey on Disability, Personal Autonomy and Dependency We used 14 items that measured activities of daily living. Five scaling methods were applied: Sum and Rasch (both for dichotomous and polytomous items) and Guttman (dichotomous). We evaluated the discriminatory capacity (relative precision [RP]) and area under the curve (AUC). Results: All methods showed high Pearson correlations among them (0.765-0.993). They had similar discriminatory power when comparing extreme categories of individuals with no disability with severely limited (RP: 0.93-1.00). The polytomous Sum procedure showed the highest AUC (0.934; 95% confidence interval [95%CI]: 0.928-0.939) and Guttman the lowest (0.853; 95%CI: 0.845-0.861). Conclusions: Polytomous items have greater reliability than the dichotomous ones. Simplest methods (Sum) and most complex (Rasch) are equally valid. Guttman method presented worse discriminatory capacity

Evolution of Pallial Areas and Networks Involved in Sociality: Comparison Between Mammals and Sauropsids.

Birds are extremely interesting animals for studying the neurobiological basis of cognition and its evolution. They include species that are highly social and show high cognitive capabilities. Moreover, birds rely more on visual and auditory cues than on olfaction for social behavior and cognition, just like primates. In primates, there are two major brain networks associated to sociality: (1) one related to perception and decision-making, involving the pallial amygdala (with the basolateral complex as a major component), the temporal and temporoparietal neocortex, and the orbitofrontal cortex; (2) another one related to affiliation, including the medial extended amygdala, the ventromedial prefrontal and anterior cingulate cortices, the ventromedial striatum (largely nucleus accumbens), and the ventromedial hypothalamus. In this account, we used an evolutionary developmental neurobiology approach, in combination with published comparative connectivity and functional data, to identify areas and functional networks in the sauropsidian brain comparable to those of mammals that are related to decision-making and affiliation. Both in mammals and sauropsids, there is an important interaction between these networks by way of cross projections between areas of both systems.

Impact of land use changes on flash flood prediction using a sub-daily SWAT model in five Mediterranean ungauged watersheds (SE Spain).

Flash floods cause severe natural disasters over the world generating property and infrastructures damages, poverty and loss of human life, among others. Mediterranean coastal watersheds are specially sensible to flash floods effects due to their typical drainage basin features (steep slopes, short concentration times, complex orography, etc.) and the high rainfall intensity typical of convective systems. In the present study, the temporal evolution of the hydrological answer in five Mediterranean (SE Spain) ravine basins with sizes from 10.2 km2 to 200.9 km2 were analysed. A sub-daily SWAT model was used at watershed scale to capture the complex hydrological dynamics. Five land use scenarios corresponding to no-urbanization (baseline), 1990, 2000, 2006 and 2012 were evaluated using GIS-based tools. Additionally, statistical significant differences among the studied scenarios were checked employing the Kruskal-Wallis and post-hoc tests based on Mann-Whitney test with BH correction. Our results show that flash flood risks have increased in the studied catchments due to changes in land uses, particularly affected by a large urban growth. Observed changes in soil uses have been important since the sixties of the last century, because of a high demographic and touristic pressure and specially the urban area has enhanced considerably during the last 22 years. Currently, some of these catchments present around 70% of their surface occupied by urban land uses with high population density producing curve number surpasses 85 and 90 levels. The hydrological response of the studied basins changed to higher flow rate peaks and shorter concentration times. Some discharges increased significantly from the baseline land use scenario (≈50 m3/s, 190 m3/s, 380 m3/s) to the most urbanised scenario (≈235 m3/s, 385 m3/s, 940 m3/s), respectively. These findings provide to urban planning policy makers very useful information in the face of flash flood effects, which have cost even human lifes in the studied ravine basins during last years.

[Comparison of scaling methods for activities of daily living in older people]. / Comparación de métodos de escalamiento de actividades de la vida diaria en personas mayores.

OBJECTIVE: To compare the psychometric properties of scales top measure activities of daily living, constructed with different scaling methods, and to check whether the most complex scales have higher discriminatory capacity. METHOD: Sample of elderly people from the Spanish Survey on Disability, Personal Autonomy and Dependency We used 14 items that measured activities of daily living. Five scaling methods were applied: Sum and Rasch (both for dichotomous and polytomous items) and Guttman (dichotomous). We evaluated the discriminatory capacity (relative precision [RP]) and area under the curve (AUC). RESULTS: All methods showed high Pearson correlations among them (0.765-0.993). They had similar discriminatory power when comparing extreme categories of individuals with no disability with severely limited (RP: 0.93-1.00). The polytomous Sum procedure showed the highest AUC (0.934; 95% confidence interval [95%CI]: 0.928-0.939) and Guttman the lowest (0.853; 95%CI: 0.845-0.861). CONCLUSIONS: Polytomous items have greater reliability than the dichotomous ones. Simplest methods (Sum) and most complex (Rasch) are equally valid. Guttman method presented worse discriminatory capacity.

Cirugía mayor ambulatoria de la glándula tiroides y paratiroides: resultados tras 6 años de experiencia / Major outpatient surgery of the thyroid and parathyroid glands: results after 6 years experience

Objetivo: La cirugía mayor ambulatoria (CMA) y con estancia inferior a 24 horas (overnight stay) se ha consolidado en muchas patologías aunque en cirugía tiroidea y paratiroidea resulta controvertido. El objetivo es valorar nuestros resultados en cirugía del tiroides y paratiroides en régimen de CMA durante un periodo de 6 años. Material y Métodos: Estudio observacional prospectivo de pacientes con indicación de hemitiroidectomía o paratiroidectomía enfocada en régimen CMA entre enero de 2011 y diciembre de 2016. Los pacientes cumplían criterios de CMA. En los primeros años se excluyeron los nodulos tiroideos mayores de 3 cm y los pacientes ASA III. Los pacientes ingresaron la mañana de la intervención, tras el acto quirúrgico pasaron a la Unidad de Recuperación Posquirúrgica y posteriormente a sala de hospitalización. Tras 8 h, si cumplían criterios, fueron dados de alta. Resultados: Se intervinieron 270 pacientes, la tasa de aplicabilidad global fue del 59%, la tasa de aceptabilidad global del 83,6% y el índice de sustitución del 49,2%. El índice de ingresos no deseados fue del 10,4% para la paratiroidectomía y del 17,6% en la cirugía del tiroides. Ningún paciente presentó complicaciones mayores en su domicilio. El grado de satisfacción fue alto o muy alto en el 94% de los pacientes. Conclusiones: La paratiroidectomía enfocada y la hemitiroidectomía realizada por cirujanos expertos en pacientes seleccionados, es segura y efectiva en régimen ambulatorio. Es posible mejorar el índice de sustitución ambulatorio aumentando la tasa de aplicabilidad y aceptabilidad.

Objetive: Ambulatory or overnight stay surgery have been consolidated in many different procedures. However, its use in thyroid and parathyroid surgery is still controversial. The aim of this report is to present the results of 6 years of ambulatory patients undergoing surgery of the thyroid or parathyroid glands. Material and Methods: Prospective observational study of patients who underwent hemithyroidectomy or selective parathyroidectomy in the ambulatory program from January 2011 to December 2016. All patients included met the general criteria of ambulatory surgery. During the first years nodules bigger than 3 cm and patients classified as ASA III were excluded. Patients arrive at hospital the morning of surgery. After the operation, patients pass to the post-anesthesia care unit and then to the hospitalization room. 8 hours after surgery patients are discharged home if they meet the criteria. Results: 270 patients were operated, 159 of them met the inclusion criteria. The overall applicability rate was 59%. The acceptance rate was 83.6% and the substitution index was 49.2%. The unwanted hospital admission was 10.4% for the parathyroidectomy and 17.6% for the hemithyroidectomy. Any patient presented major complications at home. The satisfaction rate was high or very high for 94% of the patients. Conclusion: Selective parathyroidectomy and hemithyroidectomy performed by experienced surgeons in selected patients can be safely and effectively carried out in ambulatory surgery (outpatient). It would be possible to improve the substitution index by increasing the application and acceptability ratios.

Linfangioma quístico retroperitoneal: Un tumor infrecuente en la edad adulta / Retroperitoneal cystic lymphangioma: A rare tumor in adulthood

Los linfangiomas son tumores benignos raros del sistema linfático, más comunes en la población pediátrica. La localización intraabdominal es muy infrecuente: tan solo el 1% de los linfangiomas aparece en el retroperitoneo. Se describe una tumoración quística infrecuente tanto por su localización como por la edad de presentación. Los linfangiomas retroperitoneales son tumores raros y su etiopatogenia es incierta. El diagnóstico se realiza mediante estudios de imagen; las técnicas de elección son la ultrasonografía (USG), la resonancia magnética (RM) o la tomografía computarizada (TC). A pesar de que se trata de tumores de naturaleza benigna, la exéresis quirúrgica completa es el tratamiento de elección para prevenir complicaciones como la sobreinfección, la rotura o el sangrado. Nuestro caso resulta infrecuente tanto por la localización retroperitoneal del tumor como por la tardía edad de presentación.

Background: lymphangiomas are rare benign tumors of the lymphatic system, being more common in the pediatric population. Intra-abdominal localization is very rare; only 1 % of lymphangiomas appear in the retroperitoneum. We report a case of a rare tumor because of its location and the elderly age of presentation. Retroperitoneal lymphangioma is a rare tumor with an unertain pathogenesis. Diagnosis is usually confirmed by imaging studies , e.g., US, MRI or CT. Although they are benign tumors, complete surgical resection is the treatment of choice. With this treatment, complications like infection, perforation or bleeding are prevented. Our case is unusual because of the retroperitoneal location of the tumor and the late age of presentation.