[Review of the post-intubation tracheal stenosis: a case report]. / Revisión de las estenosis traqueales tras intubación: a propósito de un caso.

Postintubation tracheal stenosis is a very important clinical situation. It is estimated to occur in approximately 5% to 20% of intubated or tracheostomized patients. However, 1% also suffers severe respiratory dysfunction. We report the case of a 45-year old patient who required surgery under general anesthesia (first intubation experience) after suffering severe coronary disease. The patient was admitted to the intensive care unit, connected to maintained mechanical ventilation for 9 days when he was weaned and extubated. He then suffered a picture of respiratory failure requiring reintubation (for a second time) and reconnection to the mechanical ventilator. He evolved favorably, and it was possible to wean him again with final extubation on the 12th day. At 28 days, he presented a picture of dyspnea, stridor, tachypnea and a bronchoscope examination show tracheal stenosis in the subglotic region. He was treated with laser and silicone tracheal stent, with good evolution.

Is TEE useful in patients with small subcortical strokes?

Although the role of transesophageal echocardiography (TEE) in the investigation of stroke mechanism is well established, the value of this test in patients with lacunar presentation is unclear. Review of 214 patients with acute cerebral ischemia referred for TEE to exclude cardioaortic sources of embolism after non-diagnostic basic work-up including carotid ultrasound and transthoracic echocardiography. TEE was considered positive when it showed large or complex aortic arch plaques, left atrial thrombus, mitral or aortic valve vegetations, or patent foramen ovale with atrial septal aneurysm. Multivariate regression analysis was performed to assess the value of lacunar syndrome and radiological small subcortical infarctions in predicting TEE result. Predictive values and likelihood ratios for these variables were calculated. Fifty-two patients (24%) had positive TEE. The most common embolic source was large or complex aortic plaques in 19% of patients. Neither clinical presentation with lacunar syndrome nor the presence of small subcortical infarction on CT scan predicted a negative TEE result on univariate or multivariate analysis. However, the combination of lacunar syndrome with radiological small subcortical infarction was uniformly associated with negative TEE (P=0.01; negative predictive value 100%). The combination of lacunar syndrome with small subcortical radiological infarct predicts the absence of cardioaortic sources of embolism on TEE in patients with acute cerebral ischemia.

Distribution and function of potassium channels in the electrosensory lateral line lobe of weakly electric apteronotid fish.

Potassium channels are one of the fundamental requirements for the generation of action potentials in the nervous system, and their characteristics shape the output of neurons in response to synaptic input. We review here the distribution and function of a high-threshold potassium channel (Kv3.3) in the electrosensory lateral line lobe of the weakly electric fish Apteronotus leptorhynchus, with particular focus on the pyramidal cells in this brain structure. These cells contain both high-threshold Kv3.3 channels, as well as low-threshold potassium channels of unknown molecular identity. Kv3.3 potassium channels regulate burst discharge in pyramidal cells and enable sustained high frequency firing through their ability to reduce an accumulation of low-threshold potassium current.

[Hepatic alterations in a model of alcoholism in the rat]. / Alteraciones hepáticas en un modelo de alcoholismo en ratas.

Today, there are a great number of investigations about alcoholism. The effects of alcohol had been studied in Medicine, Psychology, Biology, Biochemistry, Physiology or Pharmacology. Many investigations are carried out with humans, however, in most experiments is necessary to use animal models. Many experimental models of alcoholism in animals are usually used in the laboratories and they present several differences among them. In our investigation we have studied the hepatic alterations in an experimental model of alcoholism in the rat because the liver is a very sensitive organ which suffers the effects of alcohol and its metabolites. We try to demonstrate that there are hepatic lesions which allows the use of this experimental in the study of the behavioral and neural parameters in the rat. The experimental model of alcoholism that we propose has been considered appropriate to study the behavioral effects of alcohol, not only because the animals show the characteristic hepatic lesions, but also because they do not suffer manipulations that could alter them and as a consequence bias the behavioral data.

[Diffuse lung hemorrhage and necrotizing glomerulonephritis in a case of Wegener's granulomatosis. Diagnostic and therapeutic approach]. / Hemorragia pulmonar difusa y glomerulonefritis necrotizante en un caso de granulomatosis de Wegener. Actitud diagnóstica y terapéutica.

We present the case of a 59 years old male with Wegener's Granulomatosis with uncommon manifestations such as diffuse pulmonary hemorrhage and acute renal failure due to necrotizing glomerulonephritis. Neutrophil anticytoplasmic antibodies determination was negative. Conventional and high resolution thoracic computed tomography showed cavitated lung nodules with small peripheral vessels. These lesions, that are characteristic of this type of vasculitis, were not appreciated on the routine chest roetgenogram. Definitive diagnosis was made by the histological study of open lung and renal biopsies. Favourable response to corticosteroids, immunosuppressive drugs and hemodialysis was obtained. Diffuse pulmonary hemorrhage is an uncommon manifestation of Wegener's Granulomatosis, and must be considered as a vital emergency that justify the use of aggressive diagnostic and therapeutic methods.

[Pulmonary lymphangiomatosis associated with renal angiomyolipoma. Presentation of a case and review of the literature]. / Linfangiomiomatosis pulmonar asociada con angiomiolipoma renal. Presentación de un caso y revisión de la literatura.

The case concerned is one of lymphangiomyomatosis (LAM) in a woman aged 39, that after a episode of spontaneous pneumothorax was subject to medical research for progressive dyspnea of medium efforts and bloodstained sputum. High resolution CT showed numerous thin-walled cystic airspaces of varying sizes distributed diffusely throughout the lungs. The abdominal CT and ultrasound developed multiple right renal angiomyolipomas. The histopathological study of the sample obtained by open lung biopsy was conclusive of LAM. The main feature of this rare disease, which occurs almost exclusively in women of reproductive age, is the abnormal proliferation of immature smooth muscle at the level of the distal airway, small blood vessels and lung lymphatic system, including sometimes the mediastinal and retroperitoneal lymphatic system. The clinical, functional, radiological and differential diagnostic aspects with entities histopathologically similarities are discussed and the therapeutic possibilities are reviewed.

[Trimethoprim-sulfamethoxazole++ in the treatment of a case of localized Wegener's granulomatosis]. / Trimetoprim-sulfametoxazol en el tratamiento de un caso de granulomatosis de Wegener localizada.

A 50 year old man, affected by a Wegener's granulomatosis limited to lung, is presented. The indirect immunofluorescence test for "Anticytoplasmic Antibodies" (ACPA) was negative and we got the definitive diagnostic by the histological study from thoracotomy and biopsy samples. We started treatment with trimethoprim-sulfamethoxazole and a good evolution with an adequate clinical control, x-ray study and blood test was obtained. Some aspects of the value of the ACPA as diagnostic and activity markers of the disease and also the use of an antimicrobial agent on the treatment of this nosological entity are discussed.

Canine primary hyperparathyroidism and its association with urolithiasis.

Primary hyperparathyroidism results from autonomous secretion of parathyroid hormone by a single or multiple parathyroid glands. Clinical signs result from various combinations of hypercalcemia, hypercalcemic nephropathy, urolithiasis, or mobilization of calcium and phosphorus from bone. Following parathyroidectomy, the prognosis for dogs with primary hyperparathyroidism is good if the disorder is diagnosed before renal disease is advanced.