Outcomes in patients managed with endovascular stent for malignant superior vena cava syndrome.

Background: Malignant Superior Vena Cava Syndrome (SVCS) corresponds to the clinical manifestations due to the restriction of venous return to the right atrium secondary to obstruction of the superior vena cava and/or its main tributaries for a tumor. Endovascular management has proven to be safe, effective and cause a fast symptomatic relief in patients with SVCS. There is limited evidence in factors associated with outcomes in malignant setting for this procedure. Materials and methods: An analytical retrospective study was conducted and included patients that underwent endovascular management for malignant SVCS at the National Cancer Institute of Colombia between May 2016 and May 2021. Clinical and technical variables were analyzed to found associations with outcomes in these patients. Results: 54 patients were analyzed. Successful procedure rate was 94.4 %. At 10 months, the OS of the entire cohort of patients was 25 %. Patients with breast or lung cancer (P = 0.031), unsuccessful procedure (P = 0.011), and also with short time of symptoms to the date of the endovascular procedure (P = 0.027) had worse OS. Multivariate analysis showed that lung cancer [HR = 2.55, 95%IC:(1.21-5.36)] and left internal jugular vein or left Innominate vein distal stent attachment [HR = 3.27, 95%IC:(1.31-8.15)] were independent factors for worst OS. Conclusions: Based in the high success rate of the endovascular management and the better outcome in patients with early and successful procedure, this procedure should be considered as part of the multimodal treatment in patients with SVCS independent of the clinical scenario and the oncological diagnosis.

Studies of the transition between amplified spontaneous emission and optical lasing in ultrahigh-Q polymeric micro-pedestals.

In this work, we demonstrate the properties of Rhodamine B-doped polymeric cylindrical microlasers to perform either as gain amplification devices through amplified spontaneous emission (ASE) or as optical lasing gain devices. A study based on different %wt concentrations of microcavity families with distinct geometrical features demonstrates the characteristic dependence on either gain amplification phenomena. Principal component analysis (PCA) discriminates the relationship between the main ASE and lasing properties and the geometrical aspects of the cavity families. ASE and optical lasing thresholds were found, respectively, as low as 0.2 µJcm-2 and 0.1 µJcm-2 passing the best-reported microlaser performances in literature for cylindrical cavities, even in comparison with those based on 2D patterns. Moreover, our microlasers showed ultrahigh Q-factor of ∼3 × 106, and for the first time, to the best of our knowledge, a visible emission comb constituted by above a hundred peaks at 40 µJcm-2 with a registered free spectral range (FSR) of 0.25 nm corroborated through the whispery gallery mode (WGM) theory.

Design and fabrication of Mach-Zehnder interferometers in soda-lime glass for temperature sensing applications.

High sensitivity represents one of the main goals that sensing devices need to satisfy for their applications. This work presents to the best of our knowledge the first integrated Mach-Zehnder interferometer (MZI) embedded in soda-lime glass with comparable sensitivity to silicon-on-insulator (SOI) devices. We manufactured the MZIs by the femtosecond direct laser writing (FDLW) technique and characterized them with temperature. Four buried MZIs were manufactured by slightly increasing the optical path due to separation between the arms of the interferometer (Δ s). We achieved a fringe shift of ∼8n m for an increase of 0.18 µm. We have characterized one of these devices with temperature from 30°C to 70°C obtaining a sensitivity of ∼28p m/ ∘ C. We improved the sensitivity of the device to ∼54p m/ ∘ C due to the advantage of the unique three-dimensional (3D) capabilities that FDLW provides, overcoming the characteristically low thermo-optic coefficient of soda-lime glass just by rotating the MZI structure 11°.

Red fluorescent benzothiadiazole derivative loaded in different nanoformulations: Optical properties and their use in bio-imaging.

Fluorophores with optimized nonlinear optical properties have become prominent as contrast labels in laser scanning microscopy (LSM). The purpose of this work is to report on a novel benzothiadiazole derivative, namely 4,7-bis(5-((9,9-dioctyl-9H-fluoren-2-yl)ethynyl)thiophen-2-yl)benzo[c][1,2,5]thiadiazole (EFBT) and its optical performance when it is loaded into organic nanostructures intended as labels for LSM. Four different nanostructured labels were prepared: i) EFBT-loaded silica nanoparticles (SiNPs); ii) folate-bioconjugated SiNPs (SiNPs-FA); iii) EFBT-loaded PEGylated nanoparticles (NPs-PEG); and iv) EFBT-loaded folate-terminated PEGylated nanoparticles (NPs-PEG-FA). All these nanostructures are reported through a comparative study of their linear and nonlinear optical properties, including their performance as exogenous label agents in the cervical cancer cell line HeLa. This assessment of the performance of a specific fluorophore loaded into different nanostructured matrices (labels), and fairly compared under the same characterization conditions, including the LSM settings, is less common while previous reports had focused in comparing silica and PEGylated nanoparticles but loaded with different fluorophores. The results show that the internal molecular organization into each type of organic nanostructure impacted differently the properties of EFBT, where the silica matrix tend to preserve the optical performance of the fluorophore by preventing intermolecular interactions; in contrast, PEGylated nanoparticles favored molecular interactions and introduced non-radiative decay channels that degrades drastically the optical performance. Nevertheless, the use of functionalized ends entities produced a better cellular label uptake with PEGylated that with silica nanoparticles. In overall, the NPs-PEG-FA label produced the best HeLa imaging.

Low-cost fabrication of microlasers based on polymeric micropedestals.

Our current work exploits direct laser writing (DLW) and low one-photon absorption (LOPA) in a low-cost three-dimensional optical fabrication system designed to print micrometric polymeric structures. Micropedestals were obtained by focusing a laser beam on a photoresist layer deposited on a silica glass substrate. Subsequent coating with rhodamine 6G dye allows these pedestals to function as microlasers upon optical excitation at 532 nm. Our microlasers, with a diameter of ∼53µm and a height of ∼40µm, exhibit a broad fluorescence peak in the spectral range 540-600 nm, in addition to narrow lasing peaks, exhibiting quality factors Q exceeding 2000 and a lasing threshold of ∼5µJcm-2. The observed free spectral range associated with the lasing peaks of ∼1.3nm is consistent with simulations, which we include in this paper. In addition, we present simulations for the longitudinal shift of the patterning laser spot, which occurs particularly for relatively thick photoresist layers, coupled with a large index contrast at the photoresist top surface. Such a shift could introduce errors in the resulting microfabricated structures if left unaccounted for. We hope that our work will contribute to the development of microlasers for various photonic applications, particularly if dimensions can be reduced, for on-chip optical communications and data processing.

PIFA-mediated ethoxyiodination of enamides with potassium iodide.

The regioselective ethoxyiodination of enamides was developed using PIFA in combination with potassium iodide in ethanol. The reaction proceeds regioselectively with excellent yields and diastereoselectivities, providing valuable synthons for further functionalisations. Control experiments were conducted, indicating that the transformation occurs through an ionic manifold involving an in situ generated hypoiodite species.

Mycotoxin-contaminated diets and deactivating compound in laying hens: 1. effects on performance characteristics and relative organ weight.

The current experiment was conducted to determine the effect of mycotoxin-contaminated diets with aflatoxin (AFLA) and deoxynivalenol (DON) and dietary inclusion of deactivation compound on layer hen performance during a 10-wk trial. The experimental design consisted of a 4 × 2 factorial with 4 toxin levels: control, low (0.5 mg/kg AFLA + 1.0 mg/kg DON), medium (1.5 mg/kg AFLA + 1.5 mg/kg DON), and high (2.0 mg/kg AFLA + 2.0 mg/kg DON) with or without the inclusion of deactivation compound. Three hundred eighty-four 25-wk-old laying hens were randomly assigned to 1 of the 8 treatment groups. Birds were fed contaminated diets for a 6-wk phase of toxin administration followed by a 4-wk recovery phase, when all birds were fed mycotoxin-free diets. Twelve hens from each treatment were subjected to necropsy following each phase. Relative liver and kidney weights were increased (P < 0.05) at the medium and high toxin levels following the toxin phase, but the deactivation compound reduced (P < 0.05) relative liver and kidney weights following the recovery period. The high toxin level decreased (P < 0.05) feed consumption and egg production during the toxin period, whereas the deactivation compound increased (P < 0.05) egg production during the first 2 wk of the toxin phase. Egg weights were reduced (P < 0.05) in hens fed medium and high levels of toxin. An interaction existed between toxin level and deactivation compound inclusion with regard to feed conversion (g of feed/g of egg). High inclusion level of toxins increased feed conversion compared with the control diet, whereas deactivation compound inclusion reduced feed conversion to a level comparable with the control. These data indicate that deactivation compound can reduce or eliminate adverse effects of mycotoxicoses in peak-performing laying hens.

Effects of mycotoxin-contaminated diets and deactivating compound in laying hens: 2. effects on white shell egg quality and characteristics.

An experiment was conducted to determine the effect of dietary inclusion of Mycofix Select (Biomin GmbH, Herzogenburg, Austria) on discrete egg parameters and quality characteristics of hens fed mycotoxin-contaminated diets (aflatoxin; AFLA) and deoxynivalenol (DON)) during a 10-wk trial. A 4 × 2 factorial design was used with 4 contamination levels: control, low (0.5 mg/kg of AFLA + 1.0 mg/kg of DON), medium (1.5 mg/kg of AFLA + 1.5 mg/kg of DON), and high (2.0 mg/kg of AFLA + 2.0 mg/kg of DON) with or without the inclusion of mycotoxin deactivating compound. Three hundred and eighty-four 25-wk-old laying hens were housed 3 per cage. Birds were fed contaminated diets for a 6-wk phase of toxin administration followed by a 4-wk recovery phase, when all birds were fed mycotoxin-free diets. Parameters evaluated included egg weight, Haugh unit value, specific gravity, eggshell thickness, egg shape index, and relative albumen and yolk weights. Albumen height and Haugh unit value were depressed (P < 0.05) at the high mycotoxin level 2 wk postinclusion. Egg weight was significantly reduced (P < 0.05) with the high toxins level by the third week of toxin administration and remained throughout the study during toxin administration. Egg shape index indicated a variation (P < 0.05) in shape with all toxin levels compared with the control. Relative yolk weight was decreased (P < 0.05) by the high toxin level. An interaction existed between the deactivating compound inclusion and toxins level with regard to specific gravity. Following the toxin phase, the deactivating compound inclusion increased (P < 0.05) egg specific gravity in the control and low toxin groups whereas a decrease (P < 0.05) was observed at the high toxin level. These data indicate that mycotoxins present in feed can reduce egg quality, size, yolk weight, and alter egg shape and that inclusion of a mycotoxin deactivating compound can ameliorate some of the negative effects of mycotoxin consumption.

[Postural orthostatic tachycardia syndrome (POTS): report of 15 cases]. / Taquicardia postural ortostática en 15 pacientes: disautonomía compleja.

BACKGROUND: Patients with postural orthostatic tachycardia syndrome (POTS) report dizziness, lightheadedness, weakness, blurred vision, and fatigue upon standing. The diagnosis of the syndrome is made when an orthostatic intolerance and tachycardia appear in the standing position. AIM: To report 15 patients with POTS. MATERIAL AND METHODS: Review of Tilt test reports in a period of 15 years. Those reports in which orthostatic postural tachycardia and symptoms compatible with POTS appeared, were selected for analysis. RESULTS: We identified 15 patients (3.1% of all positive Tilt test reports) with compatible signs and symptoms. There was a lag of 8 -10 years between the onset of symptoms and the time of diagnosis. Most patients complained of orthostatic intolerance, dizziness and frequent fainting. Orthostatic tachycardia and symptoms occurred on average after 2.9 and 6.1 minutes, respectively,of staying in the standing position. These patients had a high frequency of family history of syncope orpresyncope (66% frequency) and hyper mobility syndrome (53% prevalence). Only 33% of the patients reported relief of their symptoms after being treated (most of them with fludrocortisone). Most patients that reported little or no relief, did not use medications or were treated for a short period. CONCLUSIONS: POTS syndrome is uncommon but disturbs quality of life of those who suffer it. Its association with hyper mobility syndromes must be investigated.

Evaluation of probiotic administration on the immune response of coccidiosis-vaccinated broilers.

Probiotics are nonpathogenic bacteria that can promote bird health by reducing pathogen colonization. Researchers have previously demonstrated that the avian immune response can be modulated with probiotics, which may provide a mechanism for the reported reductions in pathogens. We examined phagocyte oxidative burst and cell proliferation of vaccinated broilers administered probiotics. We hypothesized that the combination of probiotic bacteria and a vaccine would affect immune function. Two studies were conducted to evaluate this interaction in broilers. Treatments consisted of a negative control, probiotic, vaccine, or a probiotic + vaccine. Peripheral blood was collected on d 7, 14, and 21 of age. Heterophils and monocytes were evaluated for oxidative burst and lymphocytes were assayed for proliferation. In study 1, heterophil oxidative burst was higher (P ≤ 0.05) in each treatment that received probiotic on d 14 when compared with the negative control. On d 21, an enhanced (P ≤ 0.05) heterophil oxidative burst was observed in the probiotic treatment when compared with the other treatments. On d 14, monocyte oxidative burst was greater (P ≤ 0.05) in the probiotic + vaccine treatment when compared with all other treatments. An increase (P ≤ 0.05) in lymphocyte proliferation was observed among all treatments on d 7 when compared with the negative control. Both vaccine treatments had significant lymphocyte proliferation on d 14 when compared with the negative control. In study 2, the probiotic treatment was associated with greater levels in heterophil oxidative burst on d 7 when compared with all other treatments. On d 21, an increase (P ≤ 0.05) in heterophil oxidative burst was seen in the vaccine treatment when compared with the negative control. On d 7, increased (P ≤ 0.05) monocyte oxidative burst was observed in the vaccine treatment when compared with the negative control. No significant differences were observed in lymphocyte proliferation in any of the treatment groups. These data suggest that probiotics can modulate the immune response and may play a role in vaccination.

[Effect of the populations of Alabama argillacea (Hübner) (Lepidoptera: Noctuidae) on cotton crop at two sowing distances]. / Efecto de las poblaciones de Alabama argillacea (Hübner) (Lepidoptera: Noctuidae) en cultivos de algodón a dos distanciamientos.

The objective of this research was to evaluate the incidence of damage by the leafworm Alabama argillacea (Hübner) on yields of cotton grown under rows spaced 0.38 m and 0.76 m at the irrigation area of Santiago del Estero, Argentina. The period evaluated was extended from first flower to first open boll. Treatments were T1 - without control of larvae, T2 - with control of larvae, T3 - control since first flower to the end of effective blooming, and T4 - with larval control since the end of effective blooming to first open boll. The effect of injuries on the crop was evaluated trough boll cotton yield. Larvae were sampled in a weekly basis and insects were present from the first flower until harvest. Populations of A. argillacea decreased crop yields in the two distances tested, by decreasing the weight or number of open bolls.

Pitfalls in measuring high-density lipoprotein cholesterol concentrations in HIV-infected patients.

OBJECTIVES: HIV infection and its treatment are associated with dyslipidaemia and increased risk of cardiovascular disease. Accurate high-density lipoprotein (HDL) cholesterol values are necessary for the management of these abnormalities, but current methods have not been properly assessed in these patients. The aim of this study was to assess in HIV-infected patients the consistency and accuracy of a synthetic polymer/detergent homogeneous assay used to measure HDL cholesterol concentrations and to evaluate the impact of storage. METHODS: HDL cholesterol was measured using a synthetic polymer/detergent homogeneous method in samples from HIV-infected patients and healthy subjects for each of the storage regimens: baseline, after 1 week at 4 degrees C, and after 12 months at -80 degrees C. The ultracentrifugation and precipitation assays were used for comparison. RESULTS: Three out of every 20 samples from HIV-infected patients had discrepant HDL cholesterol values with respect to the ultracentrifugation method. Overestimation was associated with high C-reactive protein concentrations and underestimation with plasma gamma-globulin concentrations, an effect that was amplified by any of the storage conditions tested. CONCLUSIONS: Caution is needed when using the synthetic polymer/detergent homogeneous method for direct measurement of HDL cholesterol concentrations in HIV-infected patients. This assay is of limited use in clinical trials in which frozen samples are analysed.

Nonconcordance between subclinical atherosclerosis and the calculated Framingham risk score in HIV-infected patients: relationships with serum markers of oxidation and inflammation.

OBJECTIVES: HIV-infected patients show an increased cardiovascular disease (CVD) risk resulting, essentially, from metabolic disturbances related to chronic infection and antiretroviral treatments. The aims of this study were: (1) to evaluate the agreement between the CVD risk estimated using the Framingham risk score (FRS) and the observed presence of subclinical atherosclerosis in HIV-infected patients; (2) to investigate the relationships between CVD and plasma biomarkers of oxidation and inflammation. METHODS: Atherosclerosis was evaluated in 187 HIV-infected patients by measuring the carotid intima-media thickness (CIMT). CVD risk was estimated using the FRS. We also measured the circulating levels of interleukin-6, monocyte chemoattractant protein-1 (MCP-1) and oxidized low-density lipoprotein (LDL), and paraoxonase-1 activity and concentration. RESULTS: There was a weak, albeit statistically significant, agreement between FRS and CIMT (kappa=0.229, P<0.001). A high proportion of patients with an estimated low risk had subclinical atherosclerosis (n=66; 56.4%). In a multivariate analysis, the presence of subclinical atherosclerosis in this subgroup of patients was associated with age [odds ratio (OR) 1.285; 95% confidence interval (CI) 1.084-1.524; P=0.004], body mass index (OR 0.799; 95% CI 0.642-0.994; P=0.044), MCP-1 (OR 1.027; 95% CI 1.004-1.050; P=0.020) and oxidized LDL (OR 1.026; 95% CI 1.001-1.051; P=0.041). CONCLUSION: FRS underestimated the presence of subclinical atherosclerosis in HIV-infected patients. The increased CVD risk was related, in part, to the chronic oxidative stress and inflammatory status associated with this patient population.

Determination of bixin and norbixin in meat using liquid chromatography and photodiode array detection.

The development of an analytical method that enables routine analysis of annatto dye, specifically bixin and norbixin, in meat tissue is described. Liquid-solid extraction was carried out using acetonitrile. Analysis was by HPLC with photodiode array detection using two fixed wavelengths (458 and 486 nm). The possibilities of ion trap mass spectrometry (MS) were also assessed. Method performance characteristics, according to Commission Decision 2002/657/EC, were determined, with recoveries between 99 and 102% and calibration curves being linear in the 0.5-10 mg kg(-1) range. The limit of quantification was 0.5 mg kg(-1).

Fibrobroncoscopia, intubación bronquial selectiva ybloqueadores bronquiales / No disponible

La intubación bronquial selectiva y las técnicas de bloqueo bronquial selectivo son un apartado fundamental de la Anestesiología moderna aplicada a la cirugía torácica. Sin ellas no se podrían dar las condiciones óptimas para realizar la mayoría de los procedimientos quirúrgicos torácicos. Como ocurre en otras facetas de la anestesia, la práctica del aislamiento pulmonar se basa en una formación adecuada del anestesiólogo, particularmente en las técnicas fibrobroncoscópicas, y no está exenta de riesgos. En este artículo revisamos los fundamentos, indicaciones, complicaciones, y modalidades técnicas para la consecución del adecuado aislamiento pulmonar (AU)

Endobronchial tube placement and techniques for achieving selective bronchial blockade are fundamental issues in modern Anesthesiology practice applied to thoracic surgery. The optimal conditions for the great majority of thoracic surgical procedures are achieved only when they are used. As in other aspects of anesthesia, the practice of pulmonary isolation is based on the appropriate training of the anesthesiologist, particularly in the use of the flexible fiber optic bronchoscope, as it is not risk-free. In this article we review the fundamentals, indications, complications, and technical modalities to achieve lung isolation (AU)

Ethnic differences in HLA antigens in Chilean donors and recipients: data from the National Renal Transplantation Program.

To describe HLA antigen distribution, looking for possible markers of renal disease in Mapuche and non-Mapuche people in the renal transplantation program, we reviewed data from 1297 histocompatibility studies of the Chilean national renal transplantation program (421 donors and 876 recipients), performed between 2000 and 2005. Mapuche people were classified according to their family surnames. The most frequent antigens found among the total Chilean population were A2 (48%), A19 (33%), B16 (33%), B35 (26%), DR4 (38%), and DR6 (28%), without significant differences between donors and recipients. Among the 114 individuals (9%) classified as Mapuche, the most frequent antigens were A28 (49%), A2 (44%), B16 (63%), B35 (24%), DR4 (48%), and DR8 (30%), with A28/B16/DR4 as the most common haplotype. In contrast, A28, B16, DR4, and DR8 were significantly more frequent in Mapuche compared with non-Mapuche people. B8 was significantly more frequent in Mapuche recipients than in non-Mapuche recipients and Mapuche donors. The higher frequency of some HLA antigens in Mapuche people was confirmed, possibly corresponding to ethnic markers. The special concentration of B8 among Mapuche recipients might represent a genetic factor predisposing to chronic renal disease in this human group.

Renal transplantation in Mapuche people.

Previous studies have demonstrated higher concentrations of some histocompatibility antigens in Mapuche people compared with non-Mapuche Chileans in the renal transplantation program. With the aim of evaluating whether those antigenic differences might induce differences in the outcomes of renal transplantation among patients belonging to that ethnic group, we reviewed HLA studies and at least 6 months follow-up of all patients with a first kidney transplant between 1980 and 2006. The 248 patients had a mean age of 37.6 years, 40% were females, and 48% had living related donors. The mean kidney follow-up was 90 months and patient follow-up was 106 months. Thirty-nine patients (16%) were classified as Mapuche, according to their surnames, including 16 women with overall mean age of 34.5 years, and 14 had been transplanted from a living related donor. Mapuche patients received organs with better HLA matching expressed as number of identities (3.4 +/- 0.1 versus 2.8 +/- 0.1 among non-Mapuche; P < .05), and the proportion receiving organs with > or = 3 compatibilities was significantly higher (Mapuche 38% versus non-Mapuche 22%; P < .05). Kaplan-Meier survival curves showed nonsignificant differences in kidney survival: 86% at 5 years and 68% at 10 years in Mapuche; and 83% and 65%, respectively, for non-Mapuche. Patient survival rates were 97% at 5 years and 86% at 10 years in the Mapuche group versus 91% and 79%, respectively, in the non-Mapuche group; both results were not significantly different. Our results showed similar outcomes of kidney and patient survivals among Mapuche people even when they received organs with better HLA matches.

Comparative Epidemiology of Monosporascus Root Rot and Vine Decline in Muskmelon, Watermelon, and Grafted Watermelon Crops.

Disease progression and soil population dynamics of Monosporascus cannonballus ascospores were studied and compared through the entire growing season in muskmelon, watermelon, and watermelon grafted onto Cucurbita rootstock crops. In muskmelon and watermelon, there was a decrease of ascospore counts in soil from transplanting until first symptoms of vine decline were observed. This decrease probably was related to ascospore germination and subsequent root infection. Later, there was a remarkable increase of ascospore counts in a parallel way to the quick development of vine decline symptoms, which lead to plant death. In these crops, root colonization adjusted to first-order linear equations and vine decline progression best correlated with exponential and logistic models. In contrast, there were no symptoms of vine decline on grafted watermelon. Furthermore, the isolation of M. cannonballus from Cucurbita roots was considerably lower, perithecia were never observed, and ascospore soil populations remained stable. These results suggest that disease control by grafting onto genus Cucurbita seems to be related primarily by the increased resistance of its root system to infection by M. canonballus, and provide further evidence of the use of grafting as a disease management measure for this disease.

Reordenamientos subteloméricos complejos en un síndrome de Wolf-Hirschhorn familiar / Complex subteloremic rearrangements in familial Wolf-Hirschhorn syndrome

Presentamos el caso de una recién nacida, estudiada por un fenotipo peculiar con cariotipo normal. Se realizó un análisis genético de las regiones subteloméricas mediante la técnica MLPA( multiplex ligation-dependent probe amplification) y se confirmaron los hallazgos mediante hibridación in situ fluorescente(FISH). Se detectó un reordenamiento de estas regiones en los cromosomas 4 y 20 de manera que la paciente presentaba una deleción en 4p y una amplificación en 20p, responsable la primera de ellas del síndrome clínico de Wolf-Hirschhorn. En el estudio familiar se encontró un reordenamiento subtelomérico balanceado en el padre de la niña y en la hermana del padre, cuya hija resultó también estar afectada por dicho síndrome

We report the case of a girl who presented a peculiar phenotype at birth, with a normal karyotype. Genetic analysis of the subtelomeric regions was performed using multiplex ligation-dependent probe amplification (MLPA) and the findings were confirmed by fluorescents in situ hybridisation (FISH). A rearrangement of these regions was detected in chromosomes 4 and 20, there being a 4p deletion, which is responsible for Wolf-Hirschhorn syndrome, and an amplification of 20p. In the family study, we found a balanced subtelomeric rearrangement in the girl´s father and in the father´s sister, whose daughter was also found to be affected by the syndrome

Herniación cerebral en oído medio / Middle ear brain herniation

Se presenta un caso de herniación cerebral espontánea en oído medio, destacando la escasa e inespecífica sintomatología al momento de la consulta y su presentación bilateral. A continuación se presenta una breve revisión del tema haciendo mención a las etiologías, formas de presentación y tratamiento. La herniación cerebral en oído medio es una patología poco común, siendo la etiología espontánea o idiopática, como es este caso, aun más infrecuente. La principal etiología es la posquirúrgica. Si se sospecha su presencia, el paciente debe ser estudiado con tomografía computada y resonancia magnética de oídos. Se debe considerar esta patología en los casos que presenten ocupación atical o mastoídea junto a una erosión del tegmen, sobre todo si el paciente ha sido operado previamente o tiene una otitis media crónica. Una vez diagnosticada, se debe realizar una reparación quirúrgica precoz, debido al riesgo que se puedan generar complicaciones neurológicas. Para decidir el tipo de abordaje se deben considerar el tamaño de la herniación y del defecto, su localización y número. El éxito de las distintas técnicas quirúrgicas es alto cuando se elige la técnica correcta.