Ictus isquémico en niño como complicación de adenoamigdalectomía / Ischemic stroke in childhood. A complication of tonsillectomy

Dentro de la edad pediátrica, la amigdalectomía es una de las cirugías otorrinolaringológicas más realizadas. Las complicaciones postoperatorias se clasifican en: primarias o inmediatas, de aparición generalmente en las primeras 24 h; y secundarias o tardías, a partir de las 48 h. Presentamos el caso de un infarto cerebral en un niño de 3 años, tras la realización de una amigdalectomía, que fue diagnosticado en el postoperatorio inmediato. En la eco-doppler y la angio-TC cerebral se visualizó un trombo intraluminal en la arteria carótida interna izquierda de etiología traumática directa, probablemente secundario a la ligadura arterial durante los procedimientos de hemostasia (AU)

Tonsillectomy is one of the most frecuently performed otorhinolaryngological procedures on children. The postoperative complications are classified into primary or intermediate, which generally appear within 24 h, and as secondary or delayed, after 48 h. We present the case of an ischemic stroke after performing a tonsillectomy on a 3 year-old boy, which was diagnosed in the immediate postoperative period. Using brain echo-doppler and angio-CT, an intraluminal clot was observed in the left internal carotid artery, probably as a result of direct vessel injury during arterial ligature for hemostasis (AU)

[Ischemic stroke in childhood. A complication of tonsillectomy]. / Ictus isquémico en niño como complicación de adenoamigdalectomía.

Tonsillectomy is one of the most frequently performed otorhinolaryngological procedures on children. The postoperative complications are classified into primary or intermediate, which generally appear within 24h, and as secondary or delayed, after 48 h. We present the case of an ischemic stroke after performing a tonsillectomy on a 3 year-old boy, which was diagnosed in the immediate postoperative period. Using brain echo-doppler and angio-CT, an intraluminal clot was observed in the left internal carotid artery, probably as a result of direct vessel injury during arterial ligature for hemostasis.

Gas-phase synthesis of the silaisocyanoethylene molecule (C2H3NSi).

The gas-phase reaction between the silicon nitride radical (SiN) and the prototypical olefin--ethylene--is investigated experimentally and theoretically for the first time. Silicon nitride (SiN) and the cyano radical (CN) are isoelectronic; however, their chemical reactivities and structures are drastically different from each other. Through the use of the cross molecular beam technique, we were able to study the notoriously refractory silicon nitride radical in reaction with ethylene under single-collision conditions. We investigated the similarities and also the distinct differences with the cyano radical-ethylene system. We find that the silicon nitride radical bonds by the nitrogen atom to the double bond of ethylene; in comparison, the cyano radical adds via its carbon atom. The silicon nitride addition is barrierless, forming a long-lived SiNCH(2)CH(2) collision complex, which is also able to isomerize via a hydrogen shift to the SiNCHCH(3) intermediate. Both isomers can emit a hydrogen atom via tight transition states to form the silaisocyanoethylene (SiNC(2)H(3)) molecule in an overall exoergic reaction. This presents the very first experiment in which the silaisocyanoethylene molecule--a member of the silaisocyanide family--has been formed via a directed synthesis under gas-phase single-collision conditions. In comparison with the isoelectronic cyano-ethylene system, the cyanoethylene (C(2)H(3)CN) isomer is formed. Therefore, the replacement of a single carbon atom by an isovalent silicon atom, i.e. shifting from the cyano (CN) to the silicon nitride (SiN) radical, has a dramatic influence not only on the reactivity with ethylene (carbon atom versus nitrogen atom addition) but also on the final reaction products. In the reactions of ethylene with silicon nitride and the cyano radical, the silaisonitrile over the silanitrile and the nitrile over the isonitrile reaction products are favored, respectively. This reaction provides rare experimental data for investigating the chemistry of bimolecular reactions of silicon nitride diatomics in chemical vapor deposition techniques and interstellar environments.

[Comparison of clinical arterial pressure, home-arterial pressure measurement, and ambulatory arterial pressure monitoring in patients with type II diabetes mellitus and diabetic nephropathy]. / Comparación de presión arterial clínica, automedida domiciliaria de presión arterial y monitorización ambulatoria de presión arterial en el paciente con diabetes mellitus tipo 2 y nefropatía diabética.

BACKGROUND: Hypertension is common in type 2 diabetes with diabetic nephropathy, and increases the risk of cardiovascular complications and renal chronic insufficiency. The aim of our evaluation in these patients was: a) to study the correlation between office blood pressure (BP), self-monitored (SMBP) and 24-hour ambulatory blood pressure monitoring (ABPM). b) To study the correlation between these methods and cardiovascular and renal complications. METHODS: We studied 60 patients (mean age 66.7 +/- 9 years, mean duration of diabetes 11.3 +/- 7 years) with arterial hypertension, type 2 diabetes and diabetic nephropathy. Macroangiopathy and echocardiography were recorded. We measured, SMBP and ABPM without modifying the antihypertensive treatment. The white coat phenomenon (WCP) was determined and patients were classified as dippers or non dippers according to their blood pressure diurnal rhythm. RESULTS: Mean glycated haemoglobin was 7.8% and mean serum creatinine 1.2 +/- 0.5 mg/dl, 30% of patients had proteinuria and 70% microalbuminuria The mean number of antihypertensive drugs was 2.2 +/- 1. The mean BP was: Office BP: 158.2 +/- 24/85.3 +/- 9 mmHg, pulse pressure (PP) 72.9 +/- 21 mmHg; SMBP: 145.4 +/- 18/77.5 +/- 7 mmHg, PP 67.9 +/- 18 mmHg and BP in the early morning 150.2 +/- 20/79.9 +/- 9 mmHg; ABPM: diurnal mean 138.9 +/- 15/74.1 +/- 6 mmHg, PP 64.8 +/- 15 mmHg and BP in the early morning 146.5 +/- 16/78.5 +/- 7 mmHg. The three techniques showed a good correlation and WCP was detected in 46.7% of patients with SMBP and in 56.7% with ABPM. We found no correlation between BP and macroangiopathy, but an increase of systolic BP in SMBP and ABPM in proteinuric patients were found and correlation between mass left ventricular index (MLVI) and PP in office and systolic BP and PP in SMBP and ABPM was significant. 70% of patients were non dippers, with a higher MLVI. CONCLUSIONS: Decreases in BP in type 2 diabetes with diabetic nephropathy are difficult of maintain despite combinations of different antihypertensive drugs. These patients present an important WCP and worse prognosis data, such as elevation of systolic BP, increased PP, poor night BP fall and a BP rise in the early morning. Also, we can't reduced the BP during 24 hours in an important number of patients. These characteristics can be detected by combining the office BP measurement, SMBP and ABPM. The alternative possibility would be lifestyle modification, appropriate drug combinations and to start treatment at lower levels than those currently used as thresholds (the guidelines for antihypertensive treatment have been drastically shifted in this direction over the past years).

Comparación de presión arterial clínica, automedida domiciliaria de presión arterial y monitorización ambulatoria de presión arterial en el paciente con diabetes mellitus tipo 2 y nefropatía diabética / Comparison of office blood pressure, self-monitored blood pressure and ambulatory blood pressure in type 2 diabetes with diabetic nephropathy

Objetivo: Se estudian las características de la hipertención arterial en el paciente con diabetes mellitus (DM) tipo 2 y nefropatía diabética con el objetivo de analizar la concordancia entre la presión arterial en consulta (PAC), la automedida domiciliaria de PA (AMPA) y la monitorización ambulatoria de PA (MAPA) y el grado de asociación de las tres técnicas con la afectación cardiovascular y renal.Material y método: Los criterios de inclusión en el estudio fueron la existencia de DM tipo 2, hipertensión arterial y nefropatía diabética. Se recogen las determinaciones bioquímicas, la afectación macrovascular y se realiza ecocardiograma. Sin modificar el tratamiento antihipertensivo se determinan las cifras de PA mediante tres técnicas: PAC, AMPA y MAPA.Resultados: Se estudian 60 pacientes con una edad media de 66,7 ñ 9 años y una duración de la diabetes de 11,3 ñ 7 años. La hemoglobina glicada fue de 7,8 por ciento, la creatinina plasmática de 1,2 ñ 0,5 mg/dl, el 70 por ciento presentaban microalbuminuira y el 30 por ciento proteinuria. La media de fármacos antihipertensivos administrados fue de 2,2 ñ 1. Las cifras de PA fueron: PAC: 158,2 ñ 24 / 85,3 ñ 9 mmHg, con presión del pulso (PP) 72,9 ñ 21 mmHg; AMPA: media diurna 145,4 ñ 18 / 77,5 ñ 7 mmHg, PP 67,9 ñ 18 mmHg y toma matutina 150,2 ñ 20 / 79,9 ñ 9 mmHg; MAPA: media diurna 138,9 ñ 15 / 74,1 ñ 6 mmHg, PP 64,8 ñ 15 mmHg y media en las 2 primeras horas de la mañana 146,5 ñ 16 / 78,5 ñ 7 mmHg. Las tres técnicas mostraron buena correlación entre sí y el fenómeno de bata blanca (FBB) se detectó en un 46,7 por ciento según AMPA y en un 56,7 por ciento según MAPA. No se encuentra correlación entre las cifras de PA y la macroangiopatía, y sí mayor elevación de PAS en AMPA y MAPA en los pacientes con proteinuria NEFROLOGÍA. Vol. XXII. Número 2. 2002 y correlación significativa del índice de masa ventricular izquierda (IMVI) con la PP en consulta y con la PA sistólica y la PP en AMPA y MAPA. El 70 por ciento fue non dipper, con un mayor IMVI.Conclusiones: La hipertensión arterial en la DM tipo 2 con nefropatía diabética es difícil de controlar a pesar de la combinación de distintos fármacos antihipertensivos, presenta un importante FBB y datos de mayor agresividad como la elevación a expensas principalmente de la PA sistólica, una presión del pulso aumentada, un pobre descenso nocturno y una cifras elevadas enlas primeras horas de la mañana. Estas características suponen una dificultad añadida en su manejo y pueden ser detectadas combinando las tomas en consulta con la AMPA y la MAPA. En su control, se debe considerar la modificación del estilo de vida, una adecuada combinación de fármacos y un inicio precoz del tratamiento con umbrales de PA más bajos de los habitualmente utilizados, orientación que han tomado las guías de tratamiento antihipertensivo en los últimos años. a pesar de ello, en un número importante de pacientes no se consigue controlar de forma adecuada la PA durante las 24 horas (AU)

Transvaginal sonography in endometrial carcinoma: preoperative assessment of the depth of myometrial invasion in 50 cases.

OBJECTIVE: A prospective study was designed for patients previously diagnosed of endometrial carcinoma to evaluate the accuracy of transvaginal sonography (TVS) in determining both the presence and the depth of myometrial invasion. Patients with advanced stage disease (III and IV) were specifically excluded from the analysis. SUBJECTS AND METHODS: Sixty patients with endometrial carcinoma underwent transvaginal ultrasonography. Ten of these patients were ruled out due to various reasons. In the remaining 50 cases, TVS findings were compared with those obtained after total abdominal hysterectomy and bilateral salpingo-oophorectomy (AHT). RESULTS: The sensitivity of TVS in detecting deep invasion, i.e. more than 50% of the myometrial thickness was 94.1%, while the specificity was 84.8% and the overall accuracy was 88%. Following the classification of the International Federation of Obstetrics and Gynecology, stage I, which divides myometrial invasion into three categories (none, superficial involvement and deep invasion) sensitivity was 66.2%, specificity was 83.1% and overall accuracy was 77.2%. CONCLUSION: These findings are consistent with those reported in literature with regard to overall accuracy of TVS. Results are similar to those obtained with magnetic resonance imaging (MRI) without contrast and slightly lower than MRI plus contrast.

[Usefulness of IgG and IgM detection against antigen 60 in the diagnosis of thoracic tuberculosis]. / Utilidad de la determinación de IgG e IgM frente al antígeno 60 para el diagnóstico de la tuberculosis torácica.

We conducted a prospective study in order to assess the use of the "ELISA" method (Anda-Tb) for the detection of antibodies IgG and IgM against antigen 60 in mycobacterias for the initial diagnosis of thoracic tuberculosis. 215 serum samples from 44 patients with tuberculosis and 171 control cases were studied. The threshold value for IgG in our environment is 200 U, resulting in a specificity of 98% and a sensitivity of 34%. The IgM test has a low sensitivity, although when combined with the IgG, the sensitivity of the test increases while its specificity is reduced. This method is not useful in patients with HIV infection and immunodepression (AIDS). We have not observed any relationship between the serology and the response to PPD intradermorreaction. We conclude that this method could be used in our environment as a supplementary test, but in any case as a substitute of the traditional microbiological diagnosis.