Hidatidosis musculoesquelética: una localización atípica / Musculoskeletal hydatidosis: an unusual location

La hidatidosis es una zoonosis con una elevada prevalencia aún en nuestro medio. Generalmente afecta a hígado y pulmón, debiendo considerarse la afectación músculo-esquelética una localización atípica de la enfermedad. Presentamos el caso de un paciente con lesiones en cresta iliaca y glúteo medio izquierdos, con fistulización espontánea a través de la piel. Se realizó tratamiento combinado con un ciclo de albendazol previo a la intervención y exéresis quirúrgica de la lesión. En el postoperatorio se completaron dos ciclos más de tratamiento con albendazol en un intento de disminuir el riesgo de recurrencia de la enfermedad. El paciente se encuentra asintomático y no ha presentado ninguna complicación hasta la fecha

Hydatidosis is a zoonosis with a continuing high prevalence in our environment. The most commonly affected organs are the lungs and the liver, with the musculoskeletal location being considered an unusual one. We comment the case of a patient who presented a series of lesions in his left iliac crest and middle left buttock with spontaneous fistulization to the skin surface. In this case a combined treatment was given; prior to the surgical operation we administered a cycle of albendazol. Following removal of the lesion, the patient was given two further cycles of albendazol in order to minimize the risk of a recurrence of the illness. This patient is currently free of any symptoms relating to this illness

Perforación intramural espontánea del esófago / Spontaneous intramural dissection of the esophagus

La perforación intramural espontánea del esófago (PIEE) es un trastorno esofágico raro. Es una enfermedad benigna, que a pesar del aspecto endoscópico tan alarmante, tiene una buena respuesta al tratamiento conservador y un pronóstico excelente. Sin embargo, algunas situaciones requieren un tratamiento quirúrgico urgente: perforación con mediastinitis, sangrado masivo o absceso entre otras. La gastroscopia es una prueba fundamental para el diagnóstico, una vez garantizada la indemnidad del esófago mediante pruebas radiológicas (esofagograma con contraste hidrosoluble, tomografía computarizada, resonancia magnética). Exponemos el caso de una mujer de 42 años de edad, con dolor torácico agudo, disfagia y odinofagia, que sometemos a estudio radiológico y endoscópico. Ante la persistencia de la clínica y la duda diagnóstica (perforación esofágica transmural frente a quiste de duplicación esofágico complicado), se decide intervenir quirúrgicamente. El diagnóstico final fue de PIEE

Spontaneous intramural dissection of the esophagus (SIDE) is an unusual clinical entity. It is a benign disease that, despite its alarming endoscopic appearance, usually responds well to conservative management and has an excellent prognosis. Nevertheless, some situations require emergency surgical treatment. These situations include esophageal perforation with mediastinitis, massive bleeding, and abscess, among others. Upper gastrointestinal endoscopy is a useful diagnostic test when radiological examinations (hydrosoluble contrast esophagogram, computed tomography, or magnetic resonance imaging) have excluded perforation. We present the case of a 42-year-old woman who was admitted to our hospital complaining of acute chest pain, dysphagia, and odynophagia. Because of the persistence of symptoms and diagnostic uncertainty (SIDE versus complicated esophageal duplication cyst) surgery was performed. The definitive diagnosis was SIDE

Tabaquismo en pacientes hospitalizados / Smoking of in-patients

Objetivo: Este estudio investiga los conocimientos y las actitudes respecto al hábito de fumar en pacientes hospitalizados. Se pretende así identificar aquellas actuaciones sanitarias que podrían ayudarnos a reducir la prevalencia del hábito tabáquico. Material y métodos: Estudio transversal de una muestra aleatoria simple de 395 pacientes, del Hospital Universitario Virgen Macarena de Sevilla, de los que 345 (89 por ciento) aceptaron participar en esta investigación. El cuestionario sobre hábito tabáquico, administrado por un sólo encuestador, se complementó con información sobre características epidemiológicas y clínicas de los pacientes Resultados: Un 60 por ciento de pacientes son fumadores actuales ò ex-fumadores, con diferencias estadísticamente significativas en la distribución del hábito de fumar según edad, género, educación, nivel socioeconómico y diagnóstico de ingreso. Más del 90 por ciento de los pacientes conoce la relación causal entre tabaco y cáncer de pulmón o enfermedad pulmonar obstructiva crónica, pero esta proporción es menor para las localizaciones oncológicas de laringe (86 por ciento), esófago (86 por ciento) y cavidad oral (81 por ciento), cardiopatía coronaria (82 por ciento) y recién nacidos de bajo peso (78 por ciento) sin que existan diferencias significativas entre fumadores, ex fumadores y no fumadores. El 45 por ciento de los fumadores actuales tenían menos de 15 años cuando comenzaron a fumar y un 40 por ciento adicional entre 15 y 19 años. El 46 por ciento de los fumadores han intentado, sin éxito, dejar este hábito, a pesar de recibir recomendaciones, en este sentido, del personal sanitario (61 por ciento), familiares y amigos (60 por ciento). Conclusiones: La actuaciones sanitarias contra el tabaquismo deben contemplar, el apoyo farmacológico y psicoterapéutico a los fumadores actuales ya que una proporción importante de los mismos aunque desean abandonar el tabaquismo, no lo consiguen (AU)

Objective: To asses the knowledge and attitude about smoking habit of in-patients in order to detect the sanitary activities that could help to decrease the prevalence of smoking. Material and methods: Cross-sectional observational study of random sample (n=395) of in-patients of University Hospital Virgen Macarean, Seville, Spain. Participation rate was 89% (n= 350) and the interviewer-administered questionnaire was completed with epidemiological and clinical additional data. Results: Sixty per cent of in-patients were smokers or former smokers. There were statistically significant differences in smoking distribution by age, gender, education, socio-economic level and admission diagnosis. Etiologic relationships between tobacco smoking and lung cancer or chronic lung disease were known by more than 90% of in-patients but other smoking’s health effects were not so well known: larynx (86%), oesophagus (86%) and oral cavity (81%) cancer, coronary heart disease (82%) and low birthweight (78%). Forty-five per cent of smokers began to smoke before the age of 15 and an additional 40% at 15-19 year. Forty-six per cent of smokers tried to leave this habit without success in spite of receiving medical advice of leaving smoking (61%) and the recommendations of family and friends (60%). Conclusions: Preventive campaigns against tobacco smoking must include pharmacological and psicological treatment for current smokers because an important proportion of them try to leave this habit without success (AU)

The first density functional study on the

The hetero-Diels-Alder reactions of 1,2-diaza-1,3-butadiene with ethylene, methyl vinyl ether, and methyl acrylate have been investigated theoretically with the aid of density functional theory using the Becke3LYP/6-31G(d) computational level. In the reactions with substituted alkenes, the transition states are concerted but asynchronous; the shortest bond-forming distance involves the nonsubstituted carbon of the alkene. In agreement with the experimental results, the reaction with methyl vinyl ether proceeds with high endo stereoselectivity and with complete regioselectivity to form the 6-methoxy cycloadduct. The conformational study of the transition states shows a sharp s-trans preference. In contrast, the [4 + 2]-cycloaddition of 1,2-diaza-1,3-butadiene with methyl acrylate have been found to occur with low regio- and stereoselectivity but with a s-cis preference in the transition structures.

Computational studies on the BF3-catalyzed cycloaddition of furan with methyl vinyl ketone: a new look at Lewis acid catalysis

Transition structures for both uncatalyzed and BF3-catalyzed Diels-Alder reactions involving furan and methyl vinyl ketone have been determined at the hybrid DFT (B3LYP/6-31G*) level of theory. The transition structures are predicted to be relatively concerted and highly asynchronous in all cases. A subsequent bond-order analysis has been carried out at the MP2/6-31G*//B3LYP/6-31G*. The role of the Lewis acid and the origin of the endo selectivity have been discussed in terms of the nature and number of interactions present in the four possible transition structures. The partition of the potential energy barrier has also been used to estimate the contributions of the pure deformation energy and the differential interaction between the reaction partners on passing from the ground state to the saddle point. This analysis reveals that the major influence arises from the heterodiene-dienophile interaction instead of that corresponding to a BF3-dienophile interaction.

Diastereoselective cycloadditions of 1,3-thiazolium-4-olates with chiral 1,2-diaza-1,3-butadienes

A series of 2-(N-methyl)benzylamino-1,3-thiazolium-4-olates (2-aminothioisomunchnones) react with chiral 1,2-diaza-1,3-butadienes derived from carbohydrates to afford a diastereomeric mixture of (4R,5S)- and (4R,5R)-4,5-dihydrothiophenes. These substrate-controlled cycloadditions are chemoselective, regiospecific, and proceed with a high facial diastereoselection. A theoretical rationale at semiempirical level does justify the stereochemical outcome observed in the experiments.