The expression pattern of calcium signaling-related genes during smoltification of Salmo salar in productive conditions.

Variations in the mRNA expression of hepatic and muscle genes that are related to calcium signaling were analyzed by real-time qPCR in farmed Atlantic salmon (Salmo salar L. 1758) to determine changes in expression between parr and smolt stages. These organs were selected due to their close relationship with calcium signaling and metabolism (e.g., glycolysis, oxidative phosphorylation, muscle contraction). Differential expression between smolt and parr specimens and between organs was observed. Compared to parr specimens, smolts exhibited upregulated expression of the calcitonin receptor precursor, calcitonin receptor, calcitonin isoform, parathyroid hormone, and calmodulin in the liver. This pattern was inverse in muscle, with the exception of calmodulin, which was significantly upregulated in smolts compared to parr. Additionally, plasma calcium was decreased in the smolt condition. This study is the first to characterize the expression pattern of calcium signaling-related genes in the liver and muscle of parr and smolt S. salar. However, further functional studies are required to obtain a wider understanding about the physiological changes that accompany the productive conditions during smoltification.

Spatial Inhibition of Return promotes changes in response-related mu and beta oscillatory patterns.

The possible role that response processes play in Inhibition of Return (IOR), traditionally associated with reduced or inhibited attentional processing of spatially cued target stimuli presented at cue-target intervals longer than 300 ms, is still under debate. Previous psychophysiological studies on response-related Electroencephalographic (EEG) activity and IOR have found divergent results. Considering that the ability to optimize our behavior not only resides in our capacity to inhibit the focus of attention from irrelevant information but also to inhibit or reduce motor activation associated with responses to that information, it is conceivable that response processes are also affected by IOR. In the present study, time-frequency (T-F) analyses were performed on EEG oscillatory activity between 2 and 40 Hz to check whether spatial IOR affects response preparation and execution during a visuospatial attention task. To avoid possible spatial stimulus-response compatibility effects and their interaction with the IOR effects, the stimuli were presented along the vertical meridian of the visual field. The results differed between lower and upper visual fields. In the lower visual field spatial IOR was related to a synchronization in the pre-movement mu band at bilateral precentral and central electrodes, and in the post-movement beta band at contralateral precentral and central electrodes, which may be associated with an attention-driven reduction of somatomotor processing prior to the execution of responses to relevant stimuli presented at previously cued locations followed by a post-movement deactivation of motor areas. In the upper visual field, spatial IOR was associated with a decrease in desynchronization around response execution in the beta band at contralateral postcentral electrodes that might indicate a late (last moment) reduction of motor activation when responding to spatially cued targets. The present results suggest that different response processes are affected by spatial IOR depending on the visual field where the target is presented.

[Multimodal neuromonitoring in traumatic brain injury: contribution of PTiO2]. / Neuromonitorización multimodal en el TCE: aportación de la PTiO2.

The main goal of exhaustively monitoring neurocritical patients is to avoid secondary injury. In the last few years we have witnessed an increase in brain monitoring tools, beyond the checking of intracranial and brain perfusion pressures. These widely used systems offer valuable but possibly insufficient information. Awareness and correction of brain hypoxia is a useful and interesting measure, not only for diagnostic purposes but also when deciding treatment, and to predict an outcome. In this context, it would be of great interest to use all the information gathered from brain oxygenation monitoring systems in conjunction with other available multimodal monitoring devices, in order to offer individualized treatment for each patient.

Efecto del tiempo en lista de espera quirúrgica en la valoración de la cirugía por parte del paciente / Effect of the waiting time on patients’ surgery evaluation

Introducción: Analizar el efecto del tiempo en lista de espera quirúrgica en el grado de satisfacción de los pacientes de cirugía mayor ambulatoria (CMA).Material y métodos: Estudio descriptivo basado en encuestas enviadas por correo. Estudio realizado en un hospital general de la Comunidad de Madrid. Se empleó una versión adaptada de SERVQHOS. Tamaño muestral calculado a partir de la actividad quirúrgica anual considerando un error del 2 %, p = q = 0,50, nivel de confianza del 95 % y una esperanza de respuesta del 40 %.Resultados: Se analizaron 431 encuestas (tasa de respuesta del 37,2 %). El Alpha de Cronbach de SERVQHOS-CMA fue de 0,92 (IC95 % 0,90-0,93). 226 pacientes (52,4 %) informaron estar en lista de espera menos de 1 mes; solo 35 (7,4 %) esperaron más de 3 meses. 177 (41,1 %) se declararon muy satisfechos y otros 137 (31,8 %) satisfechos con la CMA. No existieron diferencias en la satisfacción en función de sexo (p = 0,09) o actividad profesional (p = 0,56). A mayor edad, mayor satisfacción (p = 0,04). La satisfacción global con la cirugía (p = 0,02) y con aspectos concretos como: resultado de la cirugía (p = 0,02), trato (p = 0,007), información (p = 0,006), atenciones de enfermería (p = 0,013), competencia de los profesionales (p = 0,001) o información una vez en casa (p = 0,002), fue menor cuando el tiempo en lista de espera fue superior a 3 meses. Conclusiones: Conforme aumenta el tiempo de permanencia en la lista de espera quirúrgica disminuye la satisfacción del paciente (AU)

Objective: To analyze the effect of time on waiting list for surgery in the satisfaction of ambulatory surgical patients. Methods: Descriptive study based on mailed surveys. Setting: general hospital in the Community of Madrid. Instrument: an adapted version of SERVQHOS. Sample size calculated from the annual surgical activity considering an error of 2 %, p = q = 0.50, confidence level of 95 % and expectancy of response of 40 %.Results: 431 responses (response rate 37.2 %) were analyzed. The Cronbach’s Alpha SERVQHOS-CMA was 0.92 (95 % CI 0.90 to 0.93). 226 patients (52.4 %) reported being on the waiting list within 1 month, only 35 patients (7.4 %) waited more than 3 months. 177 patients (41. 1%) declared themselves very satisfied and another 137 patients (31.8 %) satisfied with the CMA. No significant differences in satisfaction based on sex (p = 0.09) or occupation (p = 0.56) were found. The older patient showed more satisfaction (p = 0.04). Overall satisfaction with surgery (p = 0.02) and specific aspects as a result of surgery (p = 0.02), treatment (p = 0.007), information (p = 0.006), nursing care (p = 0.013), professionals´ competence (p = 0.001) or information once at home (0.002) was lower when the time on the waiting list was over 3 months. Conclusions: As the time that patient remains on surgical waiting list increases further satisfaction once intervened decreases (AU)

Carcinoma basoescamoso mutilante en región facial / Facial mutilant basosquamous carcinoma

El carcinoma basoescamoso constituye una neoplasia epithelial maligna poco frecuente, que comparte características clínicas y biológicas con el carcinoma basocelular y espinocelular. Esta neoplasia ha sido considerada durante años una variedad de carcinoma basocelular, aunque en la actualidad se acepta plenamente su entidad propia. Presentamos el caso de un varón de 59 años de edad, indigente, que presentaba lesión tumoral ulcerada, de cuatro años de evolución, localizada en región malar izquierda, orbitaria y pirámide nasal, con importante destrucción de estas estructuras y extensión a la base del cráneo a través del nervio óptico. La importancia del carcinoma basoescamoso radica en su gran agresividad local, tendencia a la recidiva y capacidad de producir metástasis a distancia, por lo que el tratamiento más efectivo es la detección precoz y extirpación completa del mismo; hecho, que como ocurre en el caso que presentamos, no es siempre posible

Basosquamous carcinoma is a rare epithelial malignant neoplasm with clinical and biological features of both basal and squamous cell carcinoma. This neoplasm has been characterized for years as a variant of basal cell carcinoma, although now it is widely accepted as a clinical entity. We report a 59-year-old male patient, homeless, who presented an ulcerated tumoral lesion from four years ago, located in left malar region, orbit and nasal pyramid. It caused an important destruction of these anatomic structures and spred out the skull base through optic nerve. The most important features of basosquamous carcinoma are its great local aggressiveness, high frequency of recurrences and its metastatic potential. Because of that, the most effective therapeutic measure is the early detection and complete removement of these tumours; although, as the case we report, it is not always possible

[Schwannomas of the lingual nerve]. / Schwanoma del nervio lingual.

Schwanomas in extracranial head and neck region are an uncommon tumour, but when refered to its origin in the parasympathetic nerve fibers are extremely rare. We describe a case of schwanoma of the right submandibular gland originating from the parasympathetic branch of the lingual nerve, and we discuss about the clinical, diagnostic and therapeutic aspects of this rare tumour and a literature review of the recent cases.

Schwannoma del nervio lingual / Schwannomas of the lingual nerve

Los schwannomas de cabeza y cuello extracraneales constituyen una variedad tumoral relativamente infrecuente, pero cuando hablamos de su origen en las fibras parasimpáticas del nervio lingual se convierten en algo excepcional. Presentamos un caso de schwanoma de la región submandibular derecha originado en las ramas parasimpáticas que el nervio lingual proporciona a la glándula submaxilar, realizando una discusión acerca de los aspectos clínicos, diagnósticos y terapéuticos de esta variedad tumoral y una revisión de los casos descritos en la literatura médica reciente

Schwanomas in extracranial head and neck region are an uncommon tumour, but when refered to its origin in the parasympathetic nerve fibers are extremely rare. We describe a case of schwanoma of the right submandibular gland originating from the parasympathetic branch of the lingual nerve, and we discuss about the clinical, diagnostic and therapeutic aspects of this rare tumour and a literature review of the recent cases

[Nasoalveolar cyst. Five new cases]. / Quistes nasoalveolares. Presentación de 5 nuevos casos.

Nasoalverolar cyst are nonodontogenic maxillary cysts, rare and benign, which are more common in females and blacks. Their diagnosis can be established mainly on the clinical presentation, being usually asymptomatic during several years until they are large enough to cause cosmetic deformities and/or nasal obstruction, with asymmetrical alar flare. The treatment of choice is the complete surgical excision via a sublabial approach. Five cases diagnosed and treated at the Santa Maria del Rosell Hospital are reported, describing the most relevant clinican and pathological findings, so the diagnostic ant therapeutic methods.

[Sleep apnea-hypopnea syndrome and cardiovascular diseases]. / Síndrome de apnea-hipopnea del sueño y enfermedad cardiovascular.

Sleep apnea-hypopnea syndrome is characterised by daytime sleepiness, cognitive-behavioural, respiratory, cardiac, metabolic or inflammatory disorders, secondary to repeated obstruction of the upper airway during sleep. Numerous studies have shown that SAHS is associated with the presence of arterial hypertension and the development of cardiovascular diseases. Similarly, there is an excess of mortality associated with SAHS. An increase in the activity of the sympathetic nervous system and endothelial dysfunction are considered as mediating mechanisms, together with phenomena of oxidative stress, platelet aggregation and thrombosis.

Quistes nasoalveolares. Presentación de 5 nuevos casos / Nasoalveolar cyst. Five new cases

Inverted papilloma is a benign sinonasal tumour with a high recurrence rate and its treatment must be surgery, using endonasal surgery or external aproach. We present a retrospective study of 23 cases treated in our center from 1988 to 2003. There 15 males and 8 females with a mean follow-up of 6 years. The recurrence rate was 40,9%. Patients who underwent endonasal surgery had a recurrence rate of 36,6% and those who underwent external approach surgery had a recurrence rate of 45,5%. There was a 4,5% of association with carcinoma. Endonasal surgery might be a valid surgery approach for the treatement of inverted papilloma in select cases

Nasoalveolar cyst are nonodontogenic maxillary cysts, rare and benign, which are more common in females and blacks. Their diagnosis can be established mainly on the clinical presentation, being usually asymptomatic during several years until they are large enough to cause cosmetic deformities and/or nasal obstruction, with asummetrical alarflare. The treatment of choice is the complete surgical excision via a sublabial approach. Five cases diagnosed an treated at the Santa María del Rosell Hospital are reported, describing the most relevant clinican and pathological findings, so the diagnostic and therapeutic methods

[Facial mutilant basosquamous carcinoma]. / Carcinoma basoescamoso mutilante en región facial.

Basosquamous carcinoma is a rare epithelial malignant neoplasm with clinical and biological features of both basal and squamous cell carcinoma. This neoplasm has been characterized for years as a variant of basal cell carcinoma, although now it is widely accepted as a clinical entity. We report a 59-year-old male patient, homeless, who presented an ulcerated tumoral lesion from four years ago, located in left malar region, orbit and nasal pyramid. It caused an important destruction of these anatomic structures and spred out the skull base through optic nerve. The most important features of basosquamous carcinoma are its great local aggressiveness, high frequency of recurrences and its metastatic potential. Because of that, the most effective therapeutic measure is the early detection and complete removement of these tumours; although, as the case we report, it is not always possible.

Síndrome de apnea-hipopnea del sueño y enfermedad cardiovascular / Sleep apnea-hypopnea syndrome and cardiovascular diseases

El síndrome de apnea-hipopnea del sueño se caracteriza por un cuadro de somnolencia diurna excesiva, trastornos cognitivos-conductuales, respiratorios, cardíacos, metabólicos o inflamatorios secundarios a episodios repetidos de obstrucción de la vía aérea superior durante el sueño. Numerosos estudios han demostrado que el SAHS se asocia a la presencia de hipertensión arterial y al desarrollo de enfermedades cardiovasculares. Asimismo se acepta un exceso de mortalidad asociado con el SAHS. Como mecanismos mediadores se consideran un aumento de actividad del sistema nervioso simpático, una disfunción endotelial, junto con fenómenos de estrés oxidativo, agregación plaquetaria y trombosis

Sleep apnea-hypopnea syndrome is characterised by daytime sleepiness, cognitive-behavioural, respiratory, cardiac, metabolic or inflammatory disorders, secondary to repeated obstruction of the upper airway during sleep. Numerous studies have shown that SAHS is associated with the presence of arterial hypertension and the development of cardiovascular diseases. Similarly, there is an excess of mortality associated with SAHS. An increase in the activity of the sympathetic nervous system and endothelial dysfunction are considered as mediating mechanisms, together with phenomena of oxidative stress, platelet aggregation and thrombosis

[Evolution of the epidemiological characteristics of tuberculosis in Navarra (1994-2003)]. / Evolución en las características epidemiológicas de la tuberculosis en Navarra (1994-2003).

AIM: To describe the changes in the incidence and the epidemiological profile of tuberculosis in Navarra. METHODS: The cases of tuberculosis in the 1994-2003 period were analysed. Cases reported to the system of obligatory notifiable diseases, completed with the microbiological diagnoses and the cases collected in other health registers. RESULTS: The incidence of tuberculosis fell from 21 per 100,000 inhabitants in the five-year period 1994-1998 to 16 per 100,000 in 1999-2003. In both periods the number of cases in men doubled that in women, and the maximum incidence occurred in the age groups from 25 to 44 and over 65 years of age. The diagnoses of tuberculosis in persons with HIV infection fell from 15.1% to 6.6% and those in immigrants rose from 2.2% to 21.3%. Somewhat over 3% of the cases had received prior anti-tuberculosis treatment and about 6% showed resistance to some medicine, without significant differences between periods. The proportion of potentially transmissible tuberculosis (73%) underwent no significant changes, nor did that of those with positive sputum bacilloscopy. The number of outbreaks (groupings of two or more cases) rose from 18 to 26 and the percentage of cases secondary to another recent case rose from 3.6% to 10.1% (p<0,001). In the 1999-2003 period, pulmonary localisation occurred in isolated form in 67.7% of the patients, and in combination with other localisations in another 5.1%. The isolated pleural form appeared in 9.9% and the meningeal form in 1.5%. CONCLUSION: There has been an advance in the control of tuberculosis although its incidence is still high with respect to other European countries. Control of imported cases is one of the challenges to be faced in coming years, without neglecting control measures in the autochthonous population.

Evolución en las características epidemiológicas de la tuberculosis en Navarra (1994-2003) / Evolution of the epidemiological characteristics of tuberculosis in Navarra (1994-2003)

Objetivo. Describir los cambios en la incidencia y en el perfil epidemiológico de la tuberculosis en Navarra. Métodos. Se analizaron los casos de tuberculosis del período 1994-2003 según el sistema de enfermedades de declaración obligatoria, completado con los diagnósticos microbiológicos y con los casos captados por otros registros sanitarios.Resultados. La incidencia de tuberculosis disminuyó desde 21 por 100.000 habitantes en el quinquenio 1994-1998 hasta 16 por 100.000 en 1999-2003. En ambos períodos los casos en hombres duplicaron a los de mujeres, y la máxima incidencia se produjo en los grupos de 25 a 44 y mayores de 65 años. Los diagnósticos de tuberculosis en personas con infección por el VIH disminuyeron del 15,1 al 6,6% y los realizados en personas inmigrantes aumentaron del 2,2 al 21,3%. Algo más del 3% de los casos había recibido tratamiento antituberculoso previo y en torno al 6% presentaban resistencia a algún fármaco, sin diferencias significativas entre periodos. La proporción de tuberculosis potencialmente transmisibles (73%) no experimentó cambios significativos, ni la de aquellas con baciloscopia de esputo positiva (53%). El número de brotes (agrupaciones de dos o más casos) pasó de 18 a 26 y el porcentaje de casos secundarios a otro reciente aumentó desde 3,6 a 10,1% (p<0,001). En el período 1999-2003, la localización pulmonar se presentó de forma aislada en el 67,7% y combinada con otras localizaciones en otro 5,1%. La forma pleural aislada apareció en el 9,9% y la meníngea en el 1,5% de los pacientes.Conclusión. Se ha avanzado en el control de la tuberculosis aunque todavía la incidencia es alta respecto a otros países europeos. El control de los casos importados es uno de los retos para los próximos años, sin descuidar las medidas de control en la población autóctona

Aim. To describe the changes in the incidence and the epidemiological profile of tuberculosis in Navarra. Methods. The cases of tuberculosis in the 1994-2003 period were analysed. Cases reported to the system of obligatory notifiable diseases, completed with the microbiological diagnoses and the cases collected in other health registers. Results. The incidence of tuberculosis fell from 21 per 100,000 inhabitants in the five-year period 1994-1998 to 16 per 100,000 in 1999-2003. In both periods the number of cases in men doubled that in women, and the maximum incidence occurred in the age groups from 25 to 44 and over 65 years of age. The diagnoses of tuberculosis in persons with HIV infection fell from 15.1% to 6.6% and those in immigrants rose from 2.2% to 21.3%. Somewhat over 3% of the cases had received prior anti-tuberculosis treatment and about 6% showed resistance to some medicine, without significant differences between periods. The proportion of potentially transmissible tuberculosis (73%) underwent no significant changes, nor did that of those with positive sputum bacilloscopy. The number of outbreaks (groupings of two or more cases) rose from 18 to 26 and the percentage of cases secondary to another recent case rose from 3.6% to 10.1% (p<0,001). In the 1999-2003 period, pulmonary localisation occurred in isolated form in 67.7% of the patients, and in combination with other localisations in another 5.1%. The isolated pleural form appeared in 9.9% and the meningeal form in 1.5%. Conclusion. There has been an advance in the control of tuberculosis although its incidence is still high with respect to other European countries. Control of imported cases is one of the challenges to be faced in coming years, without neglecting control measures in the autochthonous population

Epidemiology of urticaria in Spain.

BACKGROUND: In spite of the frequency of chronic urticaria there are very few epidemiological studies of its prevalence and distribution. OBJECTIVE: We wanted to approach the real prevalence of chronic urticaria in a population-based study and to depict demographic distribution and personal perception of the disease. We also wanted to describe the frequency of acute urticaria episodes in the population studied. METHODS: We conducted a population-based study among adults in Spain. We questioned 5003 individuals after calculating a sample size for a maximum variability (conservative approach p=q=0.5). RESULTS: We found a 0.6% (95% CI: 0.4-0.8) prevalence of chronic urticaria. The prevalence is significantly higher in women than in men with a OR=3.82 (95%CI 1.56-9.37). Chronic urticaria is a self-limited disease, yet in 8.7% of cases chronic urticaria lasts from one to 5 years and in 11.3%, for more than 5 years. The average age of onset is 40 years. CONCLUSIONS: We offer large epidemiology study data on the prevalence of chronic urticaria. The prevalence of chronic urticaria has not yet been defined in an adult population-based study. With this work we offer such data to describe the prevalence and features of this disease.

Prevalencia de alergia en la población adulta española / Allergy prevalence in adult spanish population

Introduccián: En lo últimos decenios se está registrando un aumento de las enfermedades alérgicas en todo el mundo. Sin embargo hay pocos estudios de prevalencia de alergia en la población general española. Objetivos: Establecer la prevalencia de enfermedades alérgicas en una muestra de población general adulta del estado español. Así como establecer las causas y las manifestaciones de esta alergia. Material y métodos: Se realizó un estudio observacional de tipo tranversal. El tamaño de la muestra. suponiendo un nivel máximo de indeterminación prevalencia = 50%) y aceptando un error del 1.4% y un nivel de confianza del 95%. Fue de 5.003 sujeto . La muestra e seleccionó de forma aleatoria y automática del listín de teléfono, aplicando el control de cuotas de zona. el número de habitantes, el sexo y la edad. La recogida 1:1e datos se efectuó mediante encuesta telefónica siguiendo la técnica CATI (Computer-assisted Telephone Interview technique) con oporte Omnibus Phonebus de Taylor Ne/son Sofres Market Research. Resultados: De los 4.949 sujetos incluidos en el análisis. un 21,6% (IC 95% 20,4- 22,7%) refirieron ser alérgicos. La prevalencia fue mayor en mujeres (24,6%), en el grupo de 18 a 24 años de edad (26.9%) y en poblaciones de más de 500.000 habitantes (24,3%). mientras que fue menor en los varones (18,3%), en la región norte-centro ( 17 ,8%) y en poblaciones con menos de 10.000 habitantes ( 18.7% ). o hubo diferencia significativa en relación al nivel socioeconómico. La rinoconjuntivitis fue la manifestación alérgica más frecuente (45,4%) seguida del asma bronquial (24.9% ), la urticaria (24.6% ), la dermatitis (21,5%) y el angioederna (6% ). Las tres causas más frecuente de alergia fueron con diferencia los pólenes (31,5%). los medicamento (29,4%) y los ácaros del polvo domé tico (25.3%). Mucho menos frecuentes fueron los animales (6,8%). los metales (4.9%). los alimentos (4.8%), los hongos (3%), las picadura de insecto (2.5%), la exposición al sol (1,9%) y el látex (0,8%). Conclusiones: La prevalencia de alergia en la población adulta española es del 21,6%, y es más frecuente en las mujeres y en los núcleos urbanos de más de 500.000 habitantes. La manifestación más frecuente es la rinoconjuntivitis. Las manifestaciones cutáneas de la alergia no son despreciables. Las causas más frecuentes de alergia con los aeroalérgeno (pólenes y ácaros) y lo medicamentos (AU)

Background: In spite of the worldwide increase in allergic diseases over the recent years, few epidemiological studies have been conducted in Spain. Objective: We wanted to establish the real prevalence of allergy in a sample of adult general population. We then wanted to describe the profile. the causes and the type of caused disease. Methods: We conducted a population-based study among adults in Spain. We questioned 5003 individuals after calculating a simple size for a máximum undetermination level of (p = 50%). assuming a 1.4 error for global results and a 95% confidence interval (95% CI) l. Five thousands and three individual: were randomly selected from the telephone directory and matched according to sex, age and area. The phone survey was performed with each individual employing the Computer-assisted Telephone lnterview technique supported by Taylor elson Phonebus Company (Barcelona, Spain). Results: We found a 21.6% (95% CI: 20.4-22, 7%) prevalence of allergy. The prevalence was higher in wornen (24.6%) than in men (18.3%). Allergy condition was higher from 18 to 24 years old (26.9%). As it was expected. the prevalence was also higher in urban cities > 500.000 habitants (24.3%) than in rural cities with less than 10.000 habitants ( 18. 7% ). We did not find differences among economical status. The most cornrnon manifestation of allergic disease was rhinoconjunctivitis (45..+%) followed by bronchial asthrna (24.99'c), urticaria (24.6%). Dermatitis (21.5% ), and angioedema (6

Sinus venosus syndrome: atrial septal defect or anomalous venous connection? A multiplane transoesophageal approach.

OBJECTIVE: To discuss the anatomical features of sinus venosus atrial defect on the basis of a comprehensive transoesophageal echocardiography (TOE) examination and its relation to surgical data. METHODS: 24 patients (13 men, 11 women, mean (SD) age 37 (17) years, range 17-73 years) with a posterior interatrial communication closely related to the entrance of the superior (SVC) or inferior vena cava (IVC) who underwent TOE before surgical repair. Records of these patients were retrospectively reviewed and compared with surgical assessments. RESULTS: In 13 patients, TOE showed a deficiency in the extraseptal wall that normally separates the left atrium and right upper pulmonary vein from the SVC and right atrium. This deficiency unroofed the right upper pulmonary vein, compelling it to drain into the SVC, which overrode the intact atrial septum. In three patients, TOE examination showed a defect in the wall of the IVC, which continued directly into the posterior border of the left atrium. Thus, the intact muscular border of the atrial septum was overridden by the mouth of the IVC, which presented a biatrial connection. In the remaining eight patients, the defect was located in the muscular posterior border of the fossa ovalis. A residuum of atrial septum was visualised in the superior margin of the defect. Neither caval vein overriding nor anomalous pulmonary vein drainage was present. CONCLUSIONS: Sinus venosus syndrome should be regarded as an anomalous venous connection with an interatrial communication outside the confines of the atrial septum, in the unfolding wall that normally separates the left atrium from either caval vein. It results in overriding of the caval veins across the intact atrial septum and partial pulmonary vein anomalous drainage. It should be differentiated from posterior atrial septal defect without overriding or anomalous venous connections.

Left atrial dissection: pathogenesis, clinical course, and transesophageal echocardiographic recognition.

Left atrial dissection is an uncommon entity. It is generally associated with mitral valve replacement, but other predisposing factors should be considered in pathogenesis. We discuss a series of 11 patients with pathologically confirmed left atrial dissection who had been diagnosed previously by transesophageal echocardiography. Predisposing factors and surgical or pathologic findings were reviewed to identify the pathogenic mechanism and to explain the clinical course, hemodynamic disorder, and echocardiographic features. Dissection of the coronary sinus secondary to retrograde cardioplegia, endocarditis, cardiac rupture after myocardial infarction, and blunt chest trauma also could be related to its development. Transesophageal echocardiography identified a mobile intimal flap of the atrial wall that was creating a false chamber and allowed accurate diagnosis of prosthetic mitral valve function, endocarditis complications, and a left ventricular pseudoaneurysm after acute myocardial infarction. Color flow Doppler was particularly useful in identifying complications: communication between the false chamber and true left atria, permitting mitral regurgitation through the periannular route; development of atrial shunts; and severe tricuspid regurgitation caused by disruption of the anterior papillary muscle.

[Solitary pelvic kidney and vaginal agenesia]. / Riñón pelviano solitario y agenesia vaginal.

OBJECTIVE: To present a case of solitary pelvic kidney with congenital absence of the vagina. METHODS: A patient with solitary pelvic kidney and vaginal aplasia is described. Patient evaluation included hematological, hormonal, cytogenetic, laparoscopic and imaging studies. RESULTS: Blood, hormone and cytogenetic studies were normal. Laparoscopy showed absence of the uterus and both tubes and ovaries, which was confirmed by pneumopyelography. IVP showed absence of renal shadows and a solitary pelvic kidney. CONCLUSIONS: Congenital absence of the vagina should be suspected in a patient with a pelvic solitary kidney consulting for primary amenorrhea.