The Prediction of Shunt Response in Idiopathic Normal-Pressure Hydrocephalus Based on Intracranial Pressure Monitoring and Lumbar Infusion.

BACKGROUND: Intracranial pressure (ICP) monitoring and infusion studies have long been used in the preoperative workup of patients with suspected idiopathic normal-pressure hydrocephalus (iNPH). We have analysed the predictive values of different measures derived from both investigations, emphasising the differences between responders and nonresponders. MATERIALS AND METHODS: ICP monitoring and lumbar infusion studies were routinely performed during a 6-year period. Shunting was proposed when the resistance to cerebrospinal fluid outflow (ROUT) >12 mmHg/ml/min and/or a minimum 15 % of slow waves were detected. The outcome was evaluated 6 months after surgery. Recorded data from ICP monitoring were mean pressure and pulse amplitude, the total percentage of slow waves and the presence of different types of slow waves following the classification proposed by Raftopoulos et al. Recorded data from lumbar infusion studies were mean values of pressure and pulse amplitude during three epochs (basal, early infusion and plateau), ROUT and the pulsatility response to the increase in mean pressure during the infusion. This response was quantified by two pulse amplitude indexes: the pulse amplitude index during the early infusion stage (A1) and the pulse amplitude index during the plateau stage (A2). RESULTS: Thirty shunted patients were evaluated at the end of the follow-up and 23 (76.7 %) of them improved. Differences in the percentage of slow waves, ROUT and both pulsatility indexes were not statistically significant. The proportion of patients with great symmetrical waves and pulse amplitude during the early infusion stage were higher in responders (p < 0.05). The predictive analysis yielded the highest accuracy, with ROUT and A1 as a logical "OR" combination. CONCLUSION: The combined use of ICP monitoring and lumbar infusion to forecast the response to shunting in patients with suspected iNPH did not improve the accuracy provided by any of them alone.

Tumor borderline de ovario en adolescente / A borderline ovarian tumour in an adolescent

El cáncer de ovario es la causa de más de 140.000 muertes en el mundo. La edad, la nuliparidad y la historia familiar de cáncer ovárico se han asociado con mayor riesgo. Los tumores borderline de ovario se caracterizan por presentar un curso clínico y un pronóstico claramente más favorables que el cáncer ovárico invasivo. El uso de marcadores tumorales no ha mostrado utilidad en la detección temprana de la enfermedad, por lo que un alto grado de sospecha, junto con la exploración física y estudios de imagen, es clave para su diagnóstico. Presentamos el caso de una adolescente con tumor borderline de ovario sin clínica previa que se detectó en la exploración ecográfica realizada en el centro de salud (AU)

Ovarian cancer is responsible for over 140,000 deaths worldwide. Age, nulliparity and family history of ovarian cancer have been associated with increased risk. Borderline ovarian tumours are characterised by a clearly more favourable clinical course and prognosis than invasive ovarian cancer. The use of tumour markers has not proved useful in the early detection of disease, so a high level of suspicion, along with physical examination and imaging studies are the key to diagnosis. We present the case of an adolescent with a borderline ovarian tumor without previous clinical symptoms which was detected on ultrasound performed in the clinic (AU)

Estudio de las características antropométricas y nutricionales de los adolescentes del núcleo urbano de Valladolid / Study of the anthropometric and nutritional characteristics of adolescents in the city of Valladolid

Objetivos: Descripción de las características antropométricas de una muestra de adolescentes de Valladolid junto al análisis de ingesta dietética del grupo de población. Material y métodos: Estudio de campo observacional descriptivo transversal, de una muestra de 557 adolescentes (14 - 18 años), seleccionada por muestreo probabilística de entre 6 institutos públicos y privados, de distintos barrios de Valladolid. Se realizó un cuestionario de frecuencia de consumo junto a la medición antropométrica. La clasificación de los individuos se realizó mediante el cálculo del Z-score del Índice de Masa Corporal (IMC),los puntos de corte para el IMC de Cole y criterios de la International Diabetes Federation (IDF). El análisis nutricional se realizó mediante un enfoque probabilístico y el índice de adecuación nutricional. Resultados: El exceso de peso es similar en ambos sexos(17%), sin emabargo existe un 15,2% de prevalencia de bajo peso entre las mujeres estudiadas, frente al 4,5% en varones(p<0,005). El 1,3% presentan riesgo de padecer síndrome metabólico. El consumo energético se distribuye: 30-32% lípidos, 45% hidratos de carbono y 16-17% proteínas. La valoración nutricional refleja probable déficit de consumo en yodo, zinc, vitaminas A y E. Conclusiones: La prevalencia de obesos está próxima ala de otras series, pero la prevalencia de sobrepeso es inferior. Es muy importante el porcentaje de mujeres con IMC por debajo de lo normal para su edad y sexo. Existe un exceso de aporte proteico, de grasas saturadas y de colesterol, con un déficit en el consumo de hidratos de carbono, yodo, zinc y vitaminas A y E (AU)

Objectives: A description of the anthropometric characteristics of a sample of adolescents from Valladolid and the analysis of dietary intake of the population. Materials and methods: Observational study of descriptive cross-field of a sample of 557 adolescents (14 - 18years) by probabilistic sampling from 6 public and private, in different districts of Valladolid. We carried out a food frequency questionnaire with anthropometric measurements. The classification of individuals was by calculating the Z-score of body mass index (BMI), the Cole`s cut off points for BMI and criteria of the International Diabetes Federation (IDF). Nutritional analysis: probabilistic approach and the nutrient adequacyratio. Results: Excess weight is similar in both sexes (17%),but there is a 15.2% prevalence of underweight among the women studied, compared to 4.5% in males (p<0.005). 1.3% risk of having metabolic syndrome. Energy consumption is distributed: 30-32% fat, 45% carbohydrates and 16-17% protein. The nutritional deficiency likely reflects consumption in iodine, zinc, vitamins A and E. Conclusions: The prevalence of obesity is close to that of other series, but the prevalence of overweight is lower. It is very important percentage of women with a BMI below normal for their age and sex. There is an excess of protein intake of saturated fat and cholesterol, with a deficit in the consumption of carbohydrates, iodine, zinc and vitamins A and E (AU)

[Study of the anthropometric and nutritional characteristics of adolescents in the city of Valladolid]. / Estudio de las características antropométricas y nutricionales de los adolescentes del núcleo urbano de Valladolid.

OBJECTIVES: A description of the anthropometric characteristics of a sample of adolescents from Valladolid and the analysis of dietary intake of the population. MATERIALS AND METHODS: Observational study of descriptive cross-field of a sample of 557 adolescents (14-18 years) by probabilistic sampling from 6 public and private, in different districts of Valladolid. We carried out a food frequency questionnaire with anthropometric measurements. The classification of individuals was by calculating the Z-score of body mass index (BMI), the Cole´s cutoff points for BMI and criteria of the International Diabetes Federation (IDF). Nutritional analysis: probabilistic approach and the nutrient adequacy ratio. RESULTS: Excess weight is similar in both sexes (17%), but there is a 15.2% prevalence of underweight among the women studied, compared to 4.5% in males (p<0.005). 1.3% risk of having metabolic syndrome. Energy consumption is distributed: 30-32% fat, 45% carbohydrates and 16-17% protein. The nutritional deficiency likely reflects consumption in iodine, zinc, vitamins A and E. CONCLUSIONS: The prevalence of obesity is close to that of other series, but the prevalence of overweight is lower. It is very important percentage of women with a BMI below normal for their age and sex. There is an excess of protein intake of saturated fat and cholesterol, with a deficit in the consumption of carbohydrates, iodine, zinc and vitamins A and E.

Análisis de complicaciones e indicadores de calidad en una unidad de CMA / No disponible

Objetivos: Evaluar en una unidad de cirugía ambulatoria los indicadores de calidad básicos en relación con periodos anteriores de la misma unidad, y con los de otras unidades de cirugía ambulatoria. Material y métodos: Estudio prospectivo de los pacientes intervenidos en régimen ambulatorio en el periodo del 1 de enero de 2005 al 31 de diciembre de 2005. Se recogen para ello el número y tipo de complicaciones y los indicadores de calidad básicos de este tipo de cirugía (índice de suspensión, índice de ingresos e índice de sustitución). Resultados: Las complicaciones registradas en el periodo señalado fueron un total de 49 (0,98%) en los 4.966 procedimientos realizados en régimen de cirugía sin ingreso. De ellas, el 65,3% (32 casos) fueron complicaciones menores, frente a un 34,7% de complicaciones mayores. La complicación más frecuente fue la hemorragia del campo quirúrgico, siguiendo en importancia el dolor de herida quirúrgica y con menor incidencia los problemas infecciosos. El índice de sustitución fue de un 58,2%, el de suspensión del 6,95%, y el de ingresos de un 4,03%. Conclusiones: En nuestro estudio hemos podido observar una mejoría progresiva de los indicadores de la unidad de cirugía ambulatoria. Sin embargo, todavía es necesario continuar avanzando para ofrecer condiciones óptimas a los pacientes para la resolución de sus patologías, haciendo especial hincapié en una selección eficaz por parte de cirujano y anestesiólogo, y una evaluación preoperatoria cuidadosa (AU)

Objectives: To evaluate the unit of ambulatory surgery. To analyze and compare the basics quality indicators with previous periods of the same unit and with other centres. Material and methods: Study of the patients operated on program of ambulatory mayor surgery in the period of January, 1st 2005 to December, 31st 2005. In order to accomplish this goal, information is collected such as number and type of complications appeared, major and minor complications, and the basics quality indicators of this type of surgery (suspension index, admission index and substitution index). Results: The complications registered in that period were 49 from 4,966 in all carried procedures (0.98%). From these complications 32 cases, 65.3%, were minor complications, while 34.7% were mayor complications. The complication more frequent is the haemorrhage with 19 cases registered, next in importance is the surgery injure pain and with less incidence infectious problems. The substitution index was 58, 2% in 2005, the suspension index was 6.95% and the admission index was 4.03%. Conclusions: In our study we have noticed a progressive improvement of the indicators of the ambulatory surgery unit. However, it is still necessary to keep advancing in order to offer our patients the optimum conditions for the resolution of their pathologies insisting on an efficient selection by the surgeon and anaesthetist, and a careful presurgery evaluation (AU)

Dermatitis alérgica de contacto por productos de parafarmacia / Allergic contact dermatitis due to parapharmacy products

No disponible

Éxtasis (3,4-metilendioximetanfetamina, MDMA): aspectos farmacológicos, clínicos y criminológicos / Ecstasy (3,4-methylenedioxymethamphetamine, MDMA): pharmacological, clinical, and criminological aspects

Objetivo: El consumo de drogas de síntesis, sobre todo de éxtasis (MDMA, 3,4-metilendioximetanfetamina), se ha incrementado notablemente en los últimos años. Este hecho podría explicarse por la falsa idea de los consumidores de su escasa toxicidad, junto al convencimiento de que su uso mejora la capacidad de relación interpersonal. En la presente revisión se pretende desmitificar estos aspectos y alertar de la peligrosidad de su consumo. Material y métodos: Se revisan aspectos epidemiológicos, farmacológicos (farmacocinética, efectos neuroquímicos tras administración aguda y crónica), toxicológicos y criminológicos, así como las manifestaciones clínicas (subjetivas y físicas) y el abordaje terapéutico de los trastornos inducidos por la MDMA. Resultados: Los efectos psíquicos ocasionados por la MDMA parecen deberse al incremento de las tasas de monoaminas en el sistema nervioso central (SNC). El mecanismo principal de la euforia inducida por la MDMA es el incremento serotoninérgico y dopaminérgico que provoca en el núcleo accumbens, propiedad que comparte con otras drogas de abuso. La administración de MDMA de forma repetitiva da lugar a un proceso de destrucción, en ocasiones de modo definitivo, de axones serotoninérgicos. La morbimortalidad por éxtasis se debe a la hipertermia fulminante, arritmia cardíaca, coagulación intravascular diseminada, rabdomiolisis, insuficiencia renal aguda y toxicidad hepática. Conclusiones: La neurotoxicidad descrita en el animal de experimentación y en el humano, junto con los cuadros psicopatológicos observados en consumidores de éxtasis, sugieren que la MDMA no es una sustancia apta para su uso recreativo. Por este motivo, y dado el incremento del tráfico y empleo de esta droga, su consumo puede convertirse en un auténtico problema sociosanitario (AU)

¿Hipersensibilidad a medicamentos? a propósito de un caso / Drug hypersensitivity? A propos of a case

No disponible

Regeneration of the spinal ventral roots. An experimental study in cats.

From a clinical standpoint recovery of spinal nerve roots is less likely than that of peripheral nerves, despite their identical structures. This may be due to several factors including the length of gap to be bridged, changes in the proximal stump or neuroma, and chromatolysis. In this paper we discuss the roles of some of these factors in relation to the neuronal depopulation in the spinal cord anterior horn area following section of the anterior root. The lack of growth or the successful growth of the axon through the gap in the root influences the degree of depopulation in the anterior horn area.