Assessment of Kidney Graft Function Evolution Measured by Creatinine and Cystatin C.

INTRODUCTION: The 2013 Kidney Disease Outcomes Quality Initiative Clinical Practice Guideline suggests measuring cystatin C (sCys) in adults with glomerular filtration rate (GFR) based on creatinine (sCr) between 45 and 59 mL/min/1.73 m2 if confirmation of chronic kidney disease (CKD) is required. There is not enough evidence to recommend the use of sCys or sCr to estimate GFR in kidney transplant recipients. OBJECTIVES: Our aims were to describe the evolution of sCr, sCys, and GFR in a group of kidney transplant patients and to determine their association with some markers of morbidity at 1 year. METHODS: A total of 54 patients were included. Analytical and clinical data were recorded. Renal function was analyzed using the CKD Epidemiology Collaboration (EPI) sCr equation and CKD-EPI sCys equation. RESULTS: sCys-estimated GFR was higher than estimated from sCr by CKD-EPI. The values of sCys have more variability than those of sCr. The agreement between the stages of CKD by sCr or sCys-estimated GFR measured by Cohen's kappa coefficient was only fair. One-year CKD-associated variables correlated differently with sCr and sCys-estimated GFR. Hemoglobin, uric acid, calcium, and phosphorus related to sCr-estimated GFR, whereas serum albumin was associated with sCys-estimated GFR. CONCLUSIONS: sCys values have a higher variability than sCr in kidney transplant recipients. sCys- or sCr-based GFRs have a nonsimilar behavior in these patients with weak agreement to stratify CKD stages and a different relationship to CKD-related comorbid conditions.

[Analysis of small areas of pediatric cancer in the municipality of Murcia (Spain)]. / Análisis en áreas pequeñas del cáncer pediátrico en el municipio de Murcia.

INTRODUCTION: Occasionally, primary care pediatricians notice the presence of small clusters of pediatric cancer (PC), but are often frustrated by the findings after statistical analysis. The study of small areas in spatial epidemiology has led to advances in identifying clusters and the environmental risk factors involved. The purpose of this study was to describe the PC incidence and the spatial distribution at the minimum level of disaggregation possible in Murcia, presenting the first urban municipality map of PC in Spain. MATERIALS AND METHODS: A population-based descriptive study was conducted on the PC cases diagnosed in children younger than 15 years, between 1998 and 2013 in the municipality of Murcia. Cases were classified by sex, age group, and tumor type. Coordinates of home addresses at the time of diagnosis were assigned to each case, and spatial and spatio-temporal analyses were carried out at the level of census tracts, using FleXScan and SatScan. RESULTS: A total of 155 cases of PC were diagnosed during this period. The overall incidence of PC (138/10(6) of children under the age of 15) and the incidence for individual tumor types were within the expected ranges for Europe. A spatio-temporal cluster of Hodgkin lymphoma was identified. CONCLUSIONS: Small area analysis of PC cases may be a useful tool for the identification of PC clusters, which would allow for the generation of hypotheses regarding disease etiology, as well as developing urban models for environmental surveillance of PC.

[Long-term follow up of childhood cancer survivors in the Murcia Region: preferences and attitudes of Primary Care professionals]. / Programa de largo seguimiento de supervivientes de cáncer pediátrico en la Región de Murcia: preferencias y actitudes de los profesionales de Atención Primaria.

OBJECTIVE: To assess attitudes, beliefs and knowledge of primary medical care professionals as regards the follow-up of Childhood Cancer Survivors (CCS) and the introduction of a Long-Term Follow-Up Program for Childhood Cancer Survivors in the Region of Murcia (PLASESCAP-MUR). MATERIAL AND METHODS: Descriptive cross-sectional study using a structured, self-administered questionnaire. These questionnaires were sent to all primary medical care professionals in Murcia Health District 1. RESULTS: Response rate of 58% (100/172), with 71% and 22% being family physicians and pediatricians, respectively, of whom 49% provided medical care to a CCS in the last 5 years, with 84% reporting that they never or rarely received a detailed report of overall assessment of the survivor. More than 75% found that access to detailed follow-up information was quite or very useful; 95% prefer to consult experts when providing medical care to survivors, and 80% believe that improving the quality of the environment may decrease the morbidity and mortality of the survivors. A statistically significant relationship was found between the length of practicing medicine and the perception of the importance of environmental factors. CONCLUSIONS: It seems to be important to increase the training of primary care professionals for the long-term follow-up of CCS, as well as having the detailed information through a personalized long-term follow-up of each survivor. PLASESCAP-MUR offers an integrated follow-up to CCS in a model of shared care between Long Term Monitoring Units and Primary Care Units.

[The association of adherence to a Mediterranean diet during early pregnancy and the risk of gastroschisis in the offspring]. / Asociación de la adherencia a la dieta mediterránea al inicio del embarazo y riesgo de gastrosquisis en la descendencia: un estudio de casos-controles.

OBJECTIVES: The aim of this study was to study the association of adherence to the Mediterranean diet in early pregnancy maternal and the offspring's risk of gastroschisis. METHODS: Case-control study. We describe 11 cases of gastroschisis in the region of Murcia from 2007 to 2012 and 34 concurrent controls. At the time of diagnosis each of the cases completed a validated Food Frequency Questionnaire (FFQ) consisting of 98 items on the periconceptional diet. Confounding factors: smoking, exposure to cannabis / marihuana, age of the parents, BMI, income and educational level. We conducted a descriptive and multivariate logistic regression statistical analysis. RESULTS: Mothers of children with gastroschisis were younger (20.8 years, 95% CI 17.3 to 24.2) and their diet consisted of less caloric intake, saturated fat and monounsaturated fats and proteins than controls. The Odds Ratio (OR) in the multivariate model controlling for confounding factors: maternal age (year) 0.70 (95% CI 0.51 to 0.96), monounsaturated fatty acids (oleic acid, g) 0.79 (95% CI 0.65 to 0, 97) and vegetable intake (rations/week) 0.70 (95% CI 0.48 to 1.00). CONCLUSION: A maternal diet rich in oleic acid and vegetable products may prevent vascular risk of onphalomesenteric arteries reducing the risk of gastroschisis.

La exposición crónica al uranio, un riesgo potencial de nefrotoxicidad / Uranium is a naturally occurring element widely distributed in the crust

El uranio es un elemento natural que se encuentra ampliamente distribuido en la corteza terrestre. Cierta cantidad de este metal se encuentra presente en los alimentos, en el aire, en el suelo y en el agua, por lo que el ser humano se encuentra expuesto al mismo de forma natural. Pero también puede ser objeto de una sobreexposición patológica como consecuencia de la deposición de uranio natural desde la atmósfera o debido a actividades industriales humanas que vierten productos de desecho directamente sobre el terreno. Actualmente la exposición debida a la actividad industrial se ha incrementado debido a que el uranio representa una de las pocas fuentes energéticas que cumplen con el “Protocolo de Kyoto”, sumándole la ventaja de que es muy económico. España, es uno de los países Europeos con más contenido de uranio en su suelo y por ello, susceptible de exposición natural, pero también industrial, ya que dada la demanda energética se están reabriendo algunas de sus minas. La nefrotoxicidad es el principal efecto observado tras exposición aguda a uranio. Este efecto se ha descrito en múltiples estudios realizados en animales de experimentación y en algunos casos de humanos expuestos a dosis elevadas de uranio de forma accidental. Sin embargo, la producción de daño renal por exposición crónica está poco documentada. Existen escasos estudios experimentales en los que se administren bajas dosis de uranio durante largos periodos de tiempo y los referidos en humanos son muy heterogéneos en cuanto a la vía de exposición, la dosis, el tipo de uranio etc, por lo que resulta muy difícil extraer conclusiones sobre los efectos renales por sobreexposición crónica. En esta revisión se pretende hacer una recopilación y discusión de gran parte de estudios epidemiológicos y de experimentación, a fin de obtener una idea de la nefrotoxicidad real que supone la exposición crónica a este metal para el ser humano (AU)

Certain amount of this metal is present in food, air, soil and water, for that humans are exposed to it naturally. But it can also be pathological overexposure as a result of natural uranium deposition from the atmosphere or due to human industrial activities that discharge waste products directly on the ground. Currently exposure due to industrial activity has increased because the uranium is one of the few sources of energy that meet the "Kyoto Protocol", adding the advantage that it is very economical. Spain is one of most European countries with uranium content in soil and thus susceptible to natural exposure, but also industrial, as given energy demand are reopening some of its mines. Nephrotoxicity is the main effect observed after acute exposure to uranium. This effect has been described in multiple studies in experimental animals and in some cases of humans accidentally exposed to high doses of uranium. However, the production of kidney damage from chronic exposure is poorly documented. There are few experimental studies in which low doses are administered uranium for long periods of time. Moreover, data in humans are very heterogeneous regarding the route of exposure, dose, type of uranium etc, so it is very difficult to draw findings on chronic renal effects of overexposure. In this review we tried to make a compilation and discussion of several epidemiological and experimental studies in order to get an idea of the real nephrotoxicity involving chronic exposure to this metal to humans (AU)

[Environment and paediatric cancer in the Region of Murcia (Spain): integrating clinical and environmental history in a geographic information system]. / Medio ambiente y cáncer pediátrico en la Región de Murcia (España): integrando la historia clínica medioambiental en un sistema de información geográfica.

INTRODUCTION: Environment and Paediatric Cancer (PC) in the Region of Murcia (RM) is an on-going research project that has the following aims: to collect a careful paediatric environmental history (PEH) and to use geographical information systems (GIS) to map the incidence and analyze the geographic distribution of the PC incidence in the RM. The objectives are to present the methodology used for the collection and processing of data and disseminate initial results on the spatial and temporal incidence of PC in the RM (Spain). MATERIAL AND METHODS: A descriptive and georeference study of all PC cases under 15 years, diagnosed from 1 January 1998 to December 31, 2009. Three postal addresses were assigned to each case, residence during pregnancy, postnatal, and at the time of diagnosis. Other variables such as sex, date of birth, date of diagnosis, and histopathology classification were collected. RESULTS: No increase was observed in the trend of incidence of PC. The crude annual incidence rate was 14.3 cases per 100,000 children under 15 years. The standardised incidence ratio was higher in the north-west of the RM. Before diagnosis, 30% of cases had a different postal address than during the pregnancy. CONCLUSIONS: Integrating the spatial and temporal information through the PEH in a GIS should allow the identification and study of space-time clusters through an environmental monitoring system in order to know the importance of associated risk factors.

Apoptotic volume decrease as a geometric determinant for cell dismantling into apoptotic bodies.

Apoptosis is a mode of cell death through which cells are dismantled and cell remains are packed into small, membrane-bound, sealed vesicles called apoptotic bodies, which are easy to erase by phagocytosis by neighbouring and immune system cells. The end point of the process is to cleanly eliminate damaged or unnecessary cells without disrupting the surrounding tissue or eliciting an inflammatory response. The apoptotic process involves a series of specific events including deoxyribonucleic acid and nuclear fragmentation, protease-driven cleavage of specific substrates, which inhibits key survival functions and reorganizes the cell's structure, externalization of molecules involved in phagocytosis, membrane blebbing and cell shrinkage. Apoptotic volume decrease (AVD) leading to cell shrinkage is a core event in the course of apoptosis, the biological meaning of which has not been clearly ascertained. In this article we argue that volume loss is a geometrical requisite for cell dismantling into apoptotic bodies. This is derived from the cell's volume-to-surface ratio. Indeed, package of the original cell volume into smaller membrane-sealed vesicles requires that either cell membrane surface increase or cell volume decrease. In this sense, AVD provides a reservoir of membrane surface for apoptotic body formation. The strategic situation of AVD in the time course of apoptosis is also discussed in the context of apoptotic body formation.

[Bidimensional-ultrasound guided-craniotomy in the excision of supratentorial brain tumours]. / Craneotomía guiada por ultrasonografía bidimensional para exéresis de tumor cerebral supratentorial.

OBJECTIVES: With this 1-year retrospective study we aimed to analyze our experience on the utilization of real-time bidimensional (2-D) ultrasonography as an aid for the localization of deep-seated supratentorial brain tumours. MATERIAL AND METHODS: During the year 2006 we performed 2-D ultrasonographic localization studies in patients undergoing excision of subcortical supratentorial brain tumours whose nature was pathologically proven. The ultrasound machines utilized were 2410 A ultrasounds HP and Phillips HDI 3500 ATL. To check gross anatomical structures we used a 3 MHz probe and then a 5 MHz sound to define the brain tumour characteristics. Coronal and sagittal cuts were obtained during parietal or temporal craniotomies, and axial and sagittal slices in the case of frontal masses. After brain tumour removal and after a thorough irrigation with saline, new image acquisitions were performed to confirm the completeness of tumour excision. The amount of removed tumour was also verified by a post-contrast computerized tomography (CT) scan performed after the surgery. RESULTS: The study group was composed by 30 patients with ages comprised between 28 and 82 years. The time required for tumour localization was 17.5 (+/- 1.9) min. The lesions were approached though 8 temporal, 7 parieto-occipital, 8 parietal, 2 fronto-parietal and 5 temporo-parietal craniotomies. Mean depth of the lesions was 5.3 (+/- 1.6) cm. The histopathologic diagnosis was 17 high-grade gliomas, 3 low-grade astrocytomas, 8 metastatic lesions and 2 oligo-astrocytomas. High-grade gliomas were more echogenic than low-grade tumours and than oedema. No residual tumour was detected at the end of the surgery except in two cases in which a tumoral rest was left due to the proximity of the lesion to eloquent cerebral areas. Postoperative CT scans confirmed the completeness of tumour removal in the patients of the study as assessed by intraoperative ultrasounds. CONCLUSIONS: Real-time 2-D ultrasonography affords an adequate image quality for performing guided-craniotomy in supratentorial brain tumours, as it allows for a safe and accurate localization of the lesions. Its use is mainly indicated in the removal of tumours located in, or close to, important anatomical and functional brain areas and to depict the presence of tumour rests after surgical removal of cerebral neoplasms.

Craneotomía guiada por ultrasonografía bidimensional para exéresis de tumorcerebral supratentorial / Bidimensional-ultrasound guided-craniotomy in the excision of supratentorial brain tumours

Objetivos: El objetivo de este estudio descriptivo es presentar nuestra experiencia clínica durante un año sobre la utilización de la ultrasonografía bidimensional (2-D) en tiempo-real para la exéresis de tumor supratentorial de localización cerebral profunda. Material y métodos: Durante el año 2006 realizamos craneotomía guiada por ultrasonografía 2-D en pacientes sometidos a cirugía para exéresis de tumor supratentorial, confirmado por anatomía patológica y de localización subcortical. Para la realización de la ultrasonografía se utilizaron los modelos de ultrasonidos M 2410 A ultrasounds HP y Phillips HDI 3500 ATL. Se utilizó en primer lugar un transductor de 3Mhz para localizar estructuras anatómicas, seguido de un transductor de 5MHz para la identificación del tumor cerebral. Se consiguieron cortes en el plano sagital y coronal durante la craneotomía parietal o temporal y en el plano axial y sagital en la craneotomía frontal. Tras la exéresis del tumor, se realizó una nueva ultrasonografía tras irrigar la cavidad con suero salino para la visualización de remanentes tumorales. Se realizó una tomografía computarizada (TC) craneal postoperatoria para verificar la exéresis total del tumor. Resultados: Se incluyeron en el estudio 30 pacientes de edades comprendidas entre 28 y 82 años. El tiempo requerido para la localización de la lesión fue de 17,5 (±1,9) min. Se realizaron 8 craneotomías temporales, 7 parietooccipitales, 8 parietales, 2 frontoparietales y 5 parietotemporales. La lesión fue localizada a una profundidad media de 5,3 (±1,6) cm. El estudio histológico reveló 17 gliomas de alto grado, 3 gliomas de bajo grado, 8 lesiones metastásicas y 2 oligoastrocitomas. Los gliomas de alto grado mostraron mayor ecogenidad que los gliomas de bajo grado y el edema cerebral. No se detectaron restos del tumor al final de la cirugía, excepto en dos pacientes debido a la proximidad a áreas elocuentes del cerebro. La TC craneal postoperatoria confirmó la exéresis total del tumor en los pacientes incluidos en el estudio. Conclusiones: La ultrasonografía 2-D en tiempo-real proporciona una imagen de calidad aceptable para la realización de craneotomía guiada para exéresis de tumores supratentoriales, ya que permite su localización de manera fiable y segura, sobre todo de tumores localizados en zonas del cerebro con gran importancia anatómica y funcional, así como identificar restos de tumor una vez finalizada la cirugía (AU)

Objectives: With this 1-year retrospective study we aimed to analyze our experience on the utilization of real-time bidimensional (2-D) ultrasonography as an aid for the localization of deep-seated supratentorial brain tumours. Material and methods: During the year 2006 we performed 2-D ultrasonographic localization studies in patients undergoing excision of subcortical supratentorial brain tumours whose nature was pathologically proven. The ultrasound machines utilized were 2410 A ultrasounds HP and Phillips HDI 3500 ATL. To check gross anatomical structures we used a 3MHz probe and then a 5MHz sound to define the brain tumour characteristics. Coronal and sagittal cuts were obtained during parietal or temporal craniotomies, and axial and sagittal slices in the case of frontal masses. After brain tumour removal and after a thorough irrigation with saline, new image acquisitions were performed to confirm the completeness of tumour excision. The amount of removed tumour was also verified by a post-contrast computerized tomography (CT) scan performed after the surgery. Results: The study group was composed by 30 patients with ages comprised between 28 and 82 years. The time required for tumour localization was 17.5 (±1.9)min. The lesions were approached though 8 temporal, 7 parieto-occipital, 8 parietal, 2 fronto-parietal and 5 temporo-parietal craniotomies. Mean depth of the lesions was 5.3 (±1.6)cm. The histopathologic diagnosis was 17 high-grade gliomas, 3 low-grade astrocitomas, 8 metastatic lesions and 2 oligo-astrocytomas. Highgrade gliomas were more echogenic than low-grade tumours and than oedema. No residual tumour was detected at the end of the surgery except in two cases in which a tumoral rest was left due to the proximity of the lesion to eloquent cerebral areas. Postoperative CT scans confirmed the completeness of tumour removal in the patients of the study as assessed by intraoperative ultrasounds. Conclusions: Real-time 2-D ultrasonography affords an adequate image quality for performing guided-craniotomy in supratentorial brain tumours, as it allows for a safe and accurate localization of the lesions. Its use is mainly indicated in the removal of tumours located in, or close to, important anatomical and functional brain areas and to depict the presence of tumour rests after surgical removal of cerebral neoplasms (AU)

[Postoperative delirium in patient neurosurgical: evaluation by means of the Abbreviated Mental Test]. / Delirio postoperatorio en pacientes neuroquirúrgicos: evaluación mediante el Test Mental Abreviado.

OBJECTIVES: To assess the incidence and characteristics of postoperative changes in the higher cerebral functions after elective intracranial surgery under general anesthesia. PATIENTS AND METHODS: This is a prospective study of 60 patients, aged 18-81 years, submitted to neurosurgical operations, allocated into two groups of 30 patients each: intracranial surgery group, patients submitted to craniotomy, and extracranial surgery group or control group, patients submitted to spinal procedures. All patients were given the Abbreviated Mental Test (AMT) on the day before to the operation, and then 2 and 24 hours after the end of the procedure. All individuals were managed with the same anesthetic technique. RESULTS: No differences in regard to demographics, duration of the operation, ASA physical state, and habits were found between the two groups. No differences in the pre-surgical and post-surgical AMT mean score were encountered between patients submitted to intracranial 9.87 +/- 0.35 or to spinal surgeries 9.80 +/- 0.41. Similarly, there were no significant differences between the two groups in the results of the AMT performed at 2 and 24 hours after the end of the surgeries. Only two subjects undergoing spinal procedures had a score of < or = 8 in the AMT performed 2-hours after the operation, while none showed a decrease in the 24-hour test score. CONCLUSIONS: Patients submitted to intracranial surgery did not show any changes in cognitive or attention functions during the first postoperative 24 hours as assessed by the AMT.

Delirio postoperatorio en pacientes neuroquirúrgicos: evaluación mediante el Test Mental Abreviado / Postoperative delirium in patient neurosurgical: evaluation by means of the Abbreviated Mental Test

Objetivo. Evaluar la incidencia y características de la alteración postoperatoria de las funciones cerebrales superiores en los pacientes sometidos a cirugía intracraneal electiva bajo anestesia general. Pacientes y método. Estudio prospectivo de 60pacientes ASA I-III, de edades comprendidas entre los 18 y 81 años, intervenidos quirúrgicamente por el Servicio de Neurocirugía de nuestro Hospital, distribuidos en dos grupos de 30 pacientes cada uno: grupo cirugía intracraneal, pacientes sometidos a cirugía por procesos intracraneales, y grupo cirugía extracraneal o grupo control, pacientes intervenidos de columna cervical o lumbar. Se registraron los datos demográficos de edad, sexo, peso, talla, así como hábitos, enfermedades coexistentes y medicación habitual. A todos los pacientes se les realizó el test mental abreviado (AMT) el día previo a la intervención quirúrgica y a las 2 y 24horas del periodo postoperatorio. Todos los pacientes fueron sometidos a la misma técnica anestésica. Fueron excluidos los pacientes que presentaron un AMT preoperatorio ≤ 8.Resultados. No hubo diferencias en los datos demográficos, duración de la cirugía, estado físico ASA y consumo de alcohol y tabaco. No se hallaron diferencias significativas entre grupos en la puntuación media obtenida en el AMT realizado el día antes de la cirugía, que fue de 9,87 ± 0,35 para los pacientes sometidos a cirugía intracraneal y de 9,80 ± 0.41 para los pacientes intervenidos de columna. Así mismo, no se observaron diferencias significativas entre los dos grupos en el AMT realizado a la 2 y 24 horas del postoperatorio: 4 de los pacientes sometidos a cirugía intracraneal presentaron una puntuación en el AMT ≤ 8 a las 2 horas de finalizada la cirugía, y 3 pacientes del mismo grupo, a las 24horas del postoperatorio; tan solo 2 pacientes intervenidos de columna presentaron una puntuación en el AMT≤ 8 a las 2 horas de finalizada la cirugía y ninguno a las 24 horas del postoperatorio. Conclusiones. Según los resultados obtenidos en este estudio podemos concluir que los pacientes sometidos a cirugía intracraneal no sufren alteraciones de la función cognitiva ni de la atención durante las primeras 24horas del postoperatorio, evaluados mediante el AMT

Objectives. To assess the incidence and characteristics of postoperative changes in the higher cerebral functions after elective intracranial surgery under general anesthesia. Patients and methods. This is a prospective study of60 patients, aged 18-81 years, submitted to neurosurgical operations, allocated into two groups of 30 patient seach: intracranial surgery group, patients submitted to craniotomy, and extracranial surgery group or control group, patients submitted to spinal procedures. All patients were given the Abbreviated Mental Test (AMT)on the day before to the operation, and then 2 and 24hours after the end of the procedure. All individuals were managed with the same anesthetic technique. Results. No differences in regard to demographics, duration of the operation, ASA physical state, and habits were found between the two groups. No differences in the pre-surgical and post-surgical AMT mean score were encountered between patients submitted to intracranial 9.87 ± 0.35 or to spinal surgeries 9.80 ±0.41. Similarly, there were no significant differences between the two groups in the results of the AMT performed at 2 and 24 hours after the end of the surgeries. Only two subjects undergoing spinal procedures had as core of ≤ 8 in the AMT performed 2-hours after the operation, while none showed a decrease in the 24-hourtest score. Conclusions. Patients submitted to intracranial surgery did not show any changes in cognitive or attention functions during the first postoperative 24 hours as assessed by the AMT

[Comparison of anesthetic maintenance and recovery with propofol versus sevoflurane combined with remifentanil in craniotomy for supratentorial neoplasm]. / Estudio comparativo de remifentanilo combinado con propofol o sevofluorano para el mantenimiento y recuperación de la anestesia en craneotomía por neoplasia supratentorial.

OBJECTIVE: To compare the effectiveness of propofol versus sevoflurane associated with remifentanil on the maintenance of anesthesia and on recovery in patients undergoing elective supratentorial craniotomy. PATIENTS AND METHODS: Prospective randomized trial enrolling 90 patients scheduled for excision of a brain neoplasm. All received an infusion of remifentanil at a dose of 0.5 microg x Kg(-1) x min(-1) until tracheal intubation and then 0.25 microg x Kg(-1) x min(-1) during surgery. Induction was achieved with propofol and anesthesia was maintained with either sevoflurane at a maximum alveolar concentration of 0.4 (45 patients) or propofol by target controlled infusion at a concentration of 2.5 microg x mL(-1) (45 patients, group P). Variables assessed were hemodynamic stability during anesthesia and times and quality of recovery from anesthesia (eye opening, initiation of spontaneous ventilation, extubation, cough reflex, and temporal and spacial orientation 3 minutes after extubation. During the first 24 hours after surgery, pain intensity was evaluated on a verbal visual analog scale (VAS) and the incidence of nausea and vomiting was recorded. RESULTS: Times until eye opening upon request and until extubation were significantly shorter in the sevoflurane group than in the propofol group: 3.7 (SD, 1.2) minutes vs 5 (3.1) minutes, respectively, for eye opening and 6.6 (1.2) minutes vs 8.1 (3.3) minutes for extubation (P<0.01). The incidence of nausea and vomiting was significantly higher in the sevoflurane group (40% vs 13%, respectively, P<0.01). CONCLUSIONS: Combining remifentanil with propofol or with sevoflurane provides satisfactory anesthesia during elective supratentorial craniotomy to remove a brain neoplasm. Hemodynamic stability is appropriate and recovery from anesthesia is rapid.

Estudio comparativo de remifentanilo combinado con propofol o sevofluorano para el mantenimiento y recuperación de la anestesia en craneotomía por neoplasia supratentorial / Comparison of anesthetic maintenance and recovery with propofol versus sevoflurane combined with remifentanil in craniotomy for supratentorial neoplasm

OBJETIVO. Comparar el uso de propofol o sevofluoranoasociados a remifentanilo para el mantenimiento yrecuperación de la anestesia en pacientes sometidos acraneotomía supratentorial electiva.PACIENTES Y MÉTODOS. Estudio prospectivo y aleatoriosobre 90 pacientes programados para exéresis deneoplasia cerebral. Todos recibieron remifentanilo a 0,5µg Kg-1 min-1 hasta la intubación traqueal seguido de0,25 µg Kg-1 min-1 durante la cirugía. Inducción con propofoly mantenimiento con sevoflurano 0,4 CAM (45pacientes, grupo S) o propofol con TCI (target controlinfusion) a 2,5 µg mL-1 (45 pacientes, grupo P). Se valoróla estabilidad hemodinámica durante la anestesia, lostiempos y calidad de la recuperación tras la anestesia:apertura de los ojos, inicio de la ventilación, extubación,capacidad para toser y orientación temporoespacial a los3 minutos de la extubación. Durante las primeras 24horas del postoperatorio se evaluó la intensidad deldolor mediante la escala de valoración verbal (EVS) y seregistró la incidencia de náuseas y vómitos (NVPO).RESULTADOS. Los tiempos de apertura de los ojos pororden y de extubación fueron significativamente menoresen el grupo S (3,7 ± 1,2 min frente 5 ± 3,1 min y 6,6± 1,2 min frente 8,1 ± 3,3 min (p<0,01 respectivamente).La incidencia de NVPO fue significativamente superioren el grupo S (40% frente 13%, p<0,01).CONCLUSIONES. La combinación de remifentanilo conpropofol o con sevoflurano proporcionan una anestesiasatisfactoria durante la craneotomía supratentorial electivapor neoplasia cerebral, consiguiendo la estabilidadhemodinámica apropiada y la recuperación rápida de laanestesia

OBJECTIVE: To compare the effectiveness of propofolversus sevoflurane associated with remifentanil on themaintenance of anesthesia and on recovery in patientsundergoing elective supratentorial craniotomy.PATIENTS AND METHODS: Prospective randomized trialenrolling 90 patients scheduled for excision of a brainneoplasm. All received an infusion of remifentanil at adose of 0.5 µg·Kg-1·min-1 until tracheal intubation andthen 0.25 µg·Kg-1·min-1 during surgery. Induction wasachieved with propofol and anesthesia was maintainedwith either sevoflurane at a maximum alveolar concentrationof 0.4 (45 patients) or propofol by target controlledinfusion at a concentration of 2.5 µg·mL-1 (45patients, group P). Variables assessed were hemodynamicstability during anesthesia and times and qualityof recovery from anesthesia (eye opening, initiation ofspontaneous ventilation, extubation, cough reflex, andtemporal and spacial orientation 3 minutes after extubation.During the first 24 hours after surgery, pain intensitywas evaluated on a verbal visual analog scale (VAS)and the incidence of nausea and vomiting was recorded.RESULTS: Times until eye opening upon request anduntil extubation were significantly shorter in the sevofluranegroup than in the propofol group: 3.7 (SD, 1.2)minutes vs 5 (3.1) minutes, respectively, for eye openingand 6.6 (1.2) minutes vs 8.1 (3.3) minutes for extubation(P<0.01). The incidence of nausea and vomiting was significantlyhigher in the sevoflurane group (40% vs 13%,respectively, P<0.01).CONCLUSIONS: Combining remifentanil with propofolor with sevoflurane provides satisfactory anesthesiaduring elective supratentorial craniotomy to remove abrain neoplasm. Hemodynamic stability is appropriateand recovery from anesthesia is rapid

Neumoencéfalo a tensión tras cirugía intracraneal en posición supina / Tension pneumocephalus after intracraneal surgery in the supine position

El neumoencéfalo a tensión es una complicación grave, poco frecuente, que aparece tras cirugía de la fosa posterior con pacientes en posición sentada. Esta complicación puede amenazar la vida del paciente y requerir tratamiento inmediato. Sin embargo, el neumoencéfalo a tensión tras cirugía intracraneal en posición supina se ha publicado en raras ocasiones. Presentamos un caso de neumoencéfalo a tensión tras una craneotomía para la exéresis de un proceso expansivo frontotemporal izquierdo realizada en posición supina (AU)

Tension pneumocephalus is a rare and severe com¬plication appearing after posterior fossa procedures in the sitting position. This complication may endanger the pacientes life and require immediate treatment. However, tension pneumocephalus after neurosurgical procedure in the supine position have been scarcely reported. We report such a complication occurring in a 14-year-old girl submitted to a frontotemporal cra¬niotomy for removal of an astrocytome performed with the patient supine. We discuss ethiopathogenesis and management of this complication (AU)

[Tension pneumocephalus after intracranial surgery in the supine position]. / Neumoencéfalo a tensión tras cirugía intracraneal en posición supina.

Tension pneumocephalus is a rare and severe complication appearing after posterior fossa procedures in the sitting position. This complication may endanger the patient's life and require immediate treatment. However, tension pneumocephalus after neurosurgical procedure in the supine position have been scarcely reported. We report such a complication occurring in a 14-year-old girl submitted to a frontotemporal craniotomy for removal of an astrocytome performed with the patient supine. We discuss ethiopathogenesis and management of this complication.

Retinoid-related molecules require caspase 9 for the effective release of Smac and the rapid induction of apoptosis.

Certain retinoid-related molecules (RRMs) with agonist or antagonist activities have been described to induce apoptosis in a variety of cancer cell lines and show promise for the treatment of cancer. Similar to other chemotherapeutic drugs, these retinoid analogs have been suggested to induce apoptosis through the intrinsic pathway, which requires the release of cytochrome c from the mitochondria for the effective activation of caspase 9. Expression of a catalytically inactive form of caspase 9, which functions as a dominant negative mutant, inhibits the induction of DEVDase activity and nuclear fragmentation by selective RRMs. Whereas the RRMs could induce the release of cytochrome c in the absence of caspase 9 activity, the later is necessary for the effective release of Smac/Diablo from the mitochondria. Furthermore, overexpression of Bcl-2 or Bcl-X(L) also inhibits RRM-induced apoptosis. We demonstrate that activation of caspase 2 by the agonist MX2870-1 requires caspase 9 activity and is inhibited by Bcl-2 overexpression. In contrast, the antagonist MX781 induces cleavage of procaspase 2 upstream of mitochondria and independently of caspase 9. Thus, two retinoid analogs with unique characteristics activate two distinct apical caspases (2 or 9) to initiate apoptosis. In addition to caspase-mediated cell death, sustained exposure to the RRMs can also lead to loss of cell viability in cells lacking caspase 9 activity or in cells stimulated in the presence of the caspase inhibitor Z-VAD-fmk. Moreover, MX2870-1 and MX781 produce cell cycle arrest independently of caspase activity and the retinoid receptors.

[Cerebral activation during Stroop's test in a case of early focal brain injury]. / Activación cerebral durante el test de Stroop en un caso de lesión cerebral focal temprana.

INTRODUCTION: Functional magnetic resonance imaging (fMRI) offers an important advantage over other functional neuroimaging techniques used with children because of its harmlessness. Previous studies conducted with adults with alexia suggested two ways the brain can reorganise reading after a brain injury affecting the left hemisphere, one contralateral and the other ipsilateral. CASE REPORT: We describe a study carried out using fMRI of a 10 year old girl with an injury to the left hemisphere caused by a fishing harpoon when she was 6 years old. As a result of the accident the girl presented a right hemiparesia. The girl s parents and teachers also reported difficulties in the acquisition of reading writing and arithmetic, as well as a certain degree of attentional deficit. An fMRI exploration was performed while the girl was doing the Stroop test. The structural MR images showed left hemisphere cortical lesions in the orbital and angular gyrus regions, in addition to the caudate and putamen nuclei, and in the inferior longitudinal bundle. The fRMI revealed a strong overactivation of the right dorsolateral frontal cortex, in the evaluation of interference, and activations of the right angular and bilateral supramarginal gyri, in the evaluation of word reading. CONCLUSION: The functional study suggests the existence of a reorganisation of reading that is both intra and inter hemispheric.

Activación cerebral durante el test de Stroop en un caso de lesión cerebral focal temprana / Cerebral activation during Stroop's test in a case of early focal brain injury

Introducción. La resonancia magnética funcional (RMf) presenta una gran ventaja frente a otras técnicas en estudios de neuroimagen funcional con niños debido a su inocuidad. Estudios previos de adultos con alexia sugieren dos vías de reorganización cerebral de la lectura tras una lesión cerebral del hemisferio izquierdo, una contralateral y la otra ipsilateral. Caso clínico. Describimos un estudio mediante RMf de una niña de 10 años con una lesión del hemisferio izquierdo causada por un arpón de pesca, lesión ocurrida a los 6 años de edad. Como consecuencia del accidente la niña presenta hemiparesia derecha. Los padres y profesores informaron también de dificultades en la adquisición de la lectoescritura y el cálculo, así como cierto déficit atencional. Se realizó una exploración mediante RMf mientras la niña ejecutaba la prueba de Stroop. Las imágenes de RM estructural demostraron lesiones corticales del hemisferio izquierdo en la región orbital y el giro angular, así como en los núcleos caudado y putamen y en el fascículo longitudinal inferior. La RMf reveló una fuerte sobreactivación del córtex frontal dorsolateral derecho, en la evaluación de la interferencia, y activaciones del giro angular derecho y supramarginal bilateral, en la evaluación de la lectura de palabras. Conclusión. El estudio funcional sugiere la existencia de una reorganización intra e interhemisférica de la lectura (AU)

Introduction. Functional magnetic resonance imaging (fMRI) offers an important advantage over other functional neuroimaging techniques used with children because of its harmlessness. Previous studies conducted with adults with alexia suggested two ways the brain can reorganise reading after a brain injury affecting the left hemisphere, one contralateral and the other ipsilateral. Case report. We describe a study carried out using fMRI of a 10-year-old girl with an injury to the left hemisphere caused by a fishing harpoon when she was 6 years old. As a result of the accident the girl presented a right hemiparesia. The girl’s parents and teachers also reported difficulties in the acquisition of reading-writing and arithmetic, as well as a certain degree of attentional deficit. An fMRI exploration was performed while the girl was doing the Stroop test. The structural MR images showed left hemisphere cortical lesions in the orbital and angular gyrus regions, in addition to the caudate and putamen nuclei, and in the inferior longitudinal bundle. The fRMI revealed a strong overactivation of the right dorsolateral frontal cortex, in the evaluation of interference, and activations of the right angular and bilateral supramarginal gyri, in the evaluation of word reading. Conclusion. The functional study suggests the existence of a reorganisation of reading that is both intra- and interhemispheric (AU)

Retinoid-related molecules induce cytochrome c release and apoptosis through activation of c-Jun NH(2)-terminal kinase/p38 mitogen-activated protein kinases.

Retinoid-related molecules have been described that induce apoptosis in a variety of cancer cell lines. Of particular interest is the apoptotic activity of the all-trans-retinoic acid receptor gamma-selective molecules MX2870-1 and MX3350-1. These compounds have been shown to be effective in vivo against lung cancer and could therefore serve as important leads for novel anticancer drugs. We analyzed the death signaling pathways activated by these molecules. We observed that apoptotic retinoid-related molecules (RRMs) cause the release of cytochrome c from the mitochondria and subsequent activation of caspases 9 and 3. This was preceded by a strong and sustained activation of c-Jun NH(2)-terminal kinase as well as p38 kinase, which was independent of caspase activity. Inhibition of p38 kinase activity by the specific inhibitor SB203580 did not affect the induction of apoptosis by MX2870-1. However, interference with the activation of c-Jun NH(2)-terminal kinase and p38 stress kinases by PD169316 completely blocked all signs of apoptosis, including caspase activity, DNA fragmentation, and phosphatidylserine externalization. PD169316 also prevented the cleavage of Bid and the release of cytochrome c induced by this class of RRMs. Furthermore, processing and activation of different caspases by MX2870-1 was completely inhibited by increasing concentrations of PD169316. Thus, the investigated RRMs induce a death pathway, which is independent of Fas ligand, that is also activated by UV radiation and other agents. Our findings open the possibility for the future use of this class of RRMs in combination therapies with other anticancer drugs.

[Spontaneous rhinorrhea due to basal encephalocele]. / Rinorrea espontánea por encefalocele basal.

We report the case of a 4-year-old girl who presented spontaneous watery discharge through the left nostril due to a basal encephalocele. Two infrequent operative findings were the presence of an excavation of the cribriform plate, and not of a true osseous defect, and the absence of the left olfactory bulb.