Mixoma de ovario / Ovarian myxoma

El mixoma de ovario es un tipo de tumor ovárico muy poco frecuente; sólo se han encontrado 16 casos con este diagnóstico en la bibliografía revisada. Se presenta como una masa unilateral en mujeres en edad reproductiva y normalmente es asintomático. Presentamos el caso de una paciente de 24 años, sin antecedentes familiares ni personales de interés, a la que se le detectó una tumoración anexial derecha mediante ecografía de control rutinario. Ante el diagnóstico de tumoración compleja de ovario derecho se decidió realizar una laparotomía exploradora en la que se visualizó una tumoración irregular de aspecto mucinoso de 10 3 10 cm, dependiente del ovario derecho y pediculada. Se procedió a su extirpación y se remitió la pieza como biopsia intraoperatoria, que informó de ausencia de evidencia de malignidad. En el microscopio presentaba una estroma mixomatosa, edematosa, de coloración azulada con la tinción de Pas-azul alcián, y positiva para la tinción de hierro coloidal. Se observaban células fusiformes y estrelladas sin atipias nucleares ni mitosis y no se apreciaba parénquima ovárico conservado. Se identificaban abundantes vasos con finas paredes. El análisis inmunohistoquímico fue positivo para actina, débilmente para desmina y negativo para citoqueratinas. La paciente se encuentra asintomática y sin evidencias de recurrencia tras 9 meses de seguimiento. El mixoma de ovario es poco frecuente y debe distinguirse de entidades como el edema masivo de ovario, los sarcomas mixoides y el rabdomiosarcoma ebrionario (AU)

Ovarian myxoma is a rare ovarian tumor. We identified only 16 cases in the literature reviewed. This neoplasm presents as a unilateral mass in women of reproductive age and is usually asymptomatic. We report the case of a 24-year-old woman, with an unremarkable personal and familial history, in whom a right adnexal tumor was detected on routine ultrasound examination. A right ovarian complex mass was diagnosed and exploratory laparotomy was performed, showing a 10 3 10 irregular mucinous pediculated tumor of the right ovary. The mass was excised and an intraoperative biopsy specimen showed no signs of malignancy. Microscopic examination revealed edematous, myxomatous stroma positive for PAS-Alcian blue and colloidal iron staining. Fusiform and stellate cells without nuclear atypia or mitosis were observed, with no findings of conserved ovarian parenchyma. Abundant thin-walled vessels were identified. Immunohistochemical analysis was positive for actin, weakly positive for desmin and negative for cytokeratin. The patient is currently asymptomatic, with no evidence of recurrence after 9 months of follow-up. Ovarian myxoma is uncommon and should be distinguished from other entities such as massive ovarian edema, myxoid sarcoma and embryonic rhabdomyosarcoma (AU)

Unexpected similarity of intestinal sugar absorption by SGLT1 and apical GLUT2 in an insect (Aphidius ervi, Hymenoptera) and mammals.

Sugars are critical substrates for insect metabolism, but little is known about the transporters and epithelial routes that ensure their constant supply from dietary resources. We have characterized glucose and fructose uptakes across the apical and basolateral membranes of the isolated larval midgut of the aphid parasitoid Aphidius ervi. The uptake of radiolabeled glucose at the basal side of the epithelium was almost suppressed by 200 microM cytochalasin B, uninhibited by phlorizin, and showed the following decreasing rank of specificity for the tested substrates: glucose > glucosamine > fructose, with no recognition of galactose. These functional properties well agree with the expression of GLUT2-like transporters in this membrane. When the apical surface of the epithelium was also exposed to the labeled medium, a cation-dependent glucose uptake, inhibited by 10 microM phlorizin and by an excess of galactose, was detected suggesting the presence in the apical membrane of a cation-dependent cotransporter. Radiolabeled fructose uptakes were only partially inhibited by cytochalasin B. SGLT1-like and GLUT5-like transporters were detected in the apical membranes of the epithelial cell by immunocytochemical experiments. These results, along with the presence of GLUT2-like transporters both in the apical and basolateral cell membranes of the midgut, as we recently demonstrated, allow us to conclude that the model for sugar transepithelial transport in A. ervi midgut appears to be unexpectedly similar to that recently proposed for sugar intestinal absorption in mammals.

Factores de riesgo del parto pretérmino / Risk factors for preterm birth

Objetivo: Determinar cuáles son, en nuestro medio, los factores de riesgo de los partos pretérmino espontáneos y por rotura prematura de membranas. Pacientes y método: Realizamos un estudio retrospectivo, de casos y controles, en el Complejo Hospitalario Universitario de Albacete, en el que se comparó a 315 gestantes con partos pretérmino espontáneos o por rotura prematura de membranas y un grupo control de 315 gestantes con partos a término. Las variables se clasificaron en sociobiológicas, antecedentes obstétricos y características de la gestación actual. Resultados: El antecedente de parto pretérmino (odds ratio [OR] = 3,4; intervalo de confianza [IC] del 95%, 1,7-6,7), los abortos previos (p = 0,002), la gestación múltiple (OR = 28,1; IC del 95%, 6,7-116,8), las técnicas de reproducción asistida (OR = 5,8; IC del 95%, 2,3-14,1), los episodios de ingreso hospitalario con necesidad de tocólisis (OR = 10,8; IC del 95%, 4,2-27,7) y el cerclaje (OR = 5,6; IC del 95%, 1,2-25,7) son más frecuentes entre los casos; sin embargo, ajustando por otras variables, el riesgo desaparece para el cerclaje (ORa = 2,8; IC del 95%, 0,5-14). Conclusiones: Encontramos que los antecedentes de parto pretérmino y abortos previos, la gestación múltiple, las técnicas de reproducción asistida y la hospitalización con necesidad de tocólisis son los factores de riesgo de parto pretérmino en nuestra población

Objective: To determine the risk factors for preterm births occurring spontaneously or due to premature rupture of membranes in our environment. Patients and method: We performed a retrospective case-control study at the Complejo Hospitalario Universitario de Albacete (Spain) that compared 315 pregnant women with preterm labor occurring spontaneously or due to premature rupture of membranes with 315 women selected as controls who delivered at term. The variables were grouped into sociobiological parameters, obstetric history, and characteristics of the current pregnancy. Results: Previous preterm birth (OR = 3.4; 95% CI, 1.7-6.7), prior abortions (p = 0.002), multiple gestation (OR = 28.1; 95% CI, 6.7-116.8), assisted reproductive technology (ART) (OR = 5.8; 95% CI, 2.3-14.1), hospitalization and tocolytic therapy (OR = 10.8; 95% CI, 4.2-27.7), and cerclage (OR = 5.6; 95% CI, 1.2-25.7) were more frequent in cases. However, when OR were adjusted (aOR) by other variables, the risk for cerclage disappeared (aOR = 2.8; 95% CI, 0.5-14). Conclusions: Risk factors for preterm birth in our population were a history of preterm birth and abortions, multiple gestation, ART, and hospitalization with tocolytic therapy

Síndrome de Meigs y seudo-Meigs / Meigs’ and pseudo-Meigs’ syndrome

El síndrome de Meigs consiste en la asociación de tumor benigno de ovario «tipo fibroma» con ascitis e hidrotórax, que se resuelven tras la extirpación del tumor. A veces cursa con elevación del CA 125, que también se normaliza tras la intervención. Las mismas características, pero junto con otro tipo de tumores, benignos o malignos, constituyen el falso síndrome de Meigs. Este síndrome es conocido desde hace muchos años, pero su fisiopatología no parece estar del todo clara. En el presente artículo hemos tratado de realizar una amplia recopilación de lo publicado con respecto al tema, aprovechando la comunicación de 2 casos clínicos, un verdadero y un falso síndrome de Meigs asociados respectivamente a fibroma celular de ovario y carcinoma mucinoso de ovario y endometrio (AU)

Meigs' syndrome consists of a benign ovarian «fibroma type» tumor in association with ascites and hydrothorax that disappear after tumoral resection. CA 125 levels are sometimes elevated but return to normal after surgery. The same characteristics but with other types of tumors, whether benign or malignant, constitute pseudo-Meigs' syndrome. This syndrome has been known for many years, but its pathophysiology is unclear. The present article aims to provide an up-to-date review of the literature published on the topic. We also report two cases, one of Meigs' syndrome associated with ovarian cellular fibroma and another of pseudo-Meigs' syndrome associated with mucinous carcinoma of the ovary and endometrium (AU)

To what extent are the effects of diet on coronary heart disease lipid-mediated?

BACKGROUND: Cohort and case-control studies support the effect of diet on coronary heart disease. The objective of this study was to analyze the strength of the influence of dietary fat subtypes and other nutrients on serum lipids levels in patients with a first acute myocardial infarction. METHODS: We studied 139 patients with a first myocardial infarction and no previous history of vascular disease. Serum lipids were determined, and nutrient intake was analyzed using a validated 118-food item questionnaire. RESULTS: Multiple regression models found weak but significant associations between the intake of different fatty acids and total to HDL cholesterol ratio (atherogenic index) when we adjusted for age, gender and body mass index (BMI). Positive associations with serum HDL cholesterol concentration were observed for energy-adjusted intake of red wine, alcohol intake, and omega-3 fatty acids intake. However, these nutrients explained less than 12% of the variability in the atherogenic index, and less than 17% in the variability of HDL. CONCLUSIONS: Our results suggest only a modest contribution of the investigated nutrients on serum lipids (atherogenic index and HDL cholesterol) in coronary patients. Alternative mechanisms of dietary factors not directly related with serum lipids or, more likely, a global effect of diet on inflammatory and antioxidant parameters should be studied in order to better understand the nature of dietary habits' influence on cardiovascular disease.

Optimization of air protection expenditures on municipal scale.

The application of air protection methods and technologies involves considerable investment and maintenance costs. Thus, to reduce overall expenditures an economic calculation of air pollution control, should be applied. This problem is connected in special way with areas of great population of inhabitants with spatially uneven density, where energetic, technological and domestic emission sources are located. Such calculations are preferred to be used on the town and municipal scale. The maximized ecological effect might be calculated from aggregate mean annual ambient concentration and population density distribution. Aggregate concentration reflects concentrations of all emitted pollutants, being taken into account. As an example, the optimization for Bytom--an industrial town regarded as one of the most heavily polluted in Europe--was carried out due to its energy production facilities. Alternative fuels were taken into consideration. It demonstrates that expenditures of a relatively small percentage of overall energy production costs can make a substantial improvement to the ambient air condition.

Type of alcoholic beverage and first acute myocardial infarction: a case-control study in a Mediterranean country.

BACKGROUND: Although international comparisons have consistently found an inverse association between wine and coronary heart disease, few epidemiologic studies are available in Southern Europe. We assessed the association of wine, red wine, and the pattern of drinking wine during meals with the risk of myocardial infarction. HYPOTHESIS: We specifically evaluated three hypotheses: (1) Is the protection against incidence of nonfatal myocardial infarction stronger for wine than for other alcoholic beverages? (2) Does the wine consumed during meals represent a more beneficial pattern of alcohol consumption? (3) Is red wine more advantageous than other types of wine? METHODS: A case-control study (171 cases, 171 matched controls) was conducted in Spain. Multiple dietary and nondietary potential confounders were assessed. RESULTS: Exposure to wine, red wine, and wine during meals was associated with risk reductions similar to those of other alcoholic beverages (point estimates of the odds ratio for low and high intake were 0.48 and 0.38 for wine; 0.42 and 0.55 for other beverages). However, after controlling for total alcohol intake, wine consumption (g/day) improved the prediction of a myocardial infarction. CONCLUSIONS: Our data showed that red wine or drinking wine during meals was similar to alcohol from other sources for reducing coronary risk. However, an additional benefit of wine, keeping constant overall alcohol intake, deserves further research.

Role of fibre and fruit in the Mediterranean diet to protect against myocardial infarction: a case-control study in Spain.

OBJECTIVE: To assess the association between a first acute myocardial infarction and the consumption of fibre and fruit. DESIGN: Hospital-based case-control study with incident cases. A validated semi-quantitative food frequency questionnaire (136 items) was used to assess food intake. SETTING: Three third-level university hospitals in Pamplona (Spain). SUBJECTS: Cases were subjects aged under 80, newly diagnosed with acute myocardial infarction. Each case patient (n=171) was matched to a control subject of the same gender and age (5 y bands) admitted to the same hospital. RESULTS: An inverse association was apparent for the three upper quintiles of fibre intake. After adjustment for non-dietary and dietary confounders, an inverse linear trend was clearly significant, showing the highest relative reduction of risk (86%) for the fifth quintile (OR=0.14, 95% confidence interval: 0.03-0.67). An inverse association was also apparent for fruit intake, but not for vegetables or legumes. CONCLUSIONS: Our data suggest that a substantial part of the postulated benefits of the Mediterranean diet on coronary risk might be attributed to a high intake of fibre and fruit.

Risk of first non-fatal myocardial infarction negatively associated with olive oil consumption: a case-control study in Spain.

BACKGROUND: Olive oil is the main source of dietary lipids in most Mediterranean countries where mortality and incidence rates for coronary heart disease (CHD) are the lowest in Europe. Although international comparisons and mechanistic reasons support the hypothesis that a high olive oil intake may prevent CHD, limited data from studies of individuals are available. METHODS: A hospital-based case-control study was conducted in Pamplona (Spain) recruiting 171 patients (81% males, age <80 years) who suffered their first acute myocardial infarction and 171 age-, gender- and hospital-matched controls (admitted to minor surgery, trauma or urology wards). A validated semi-quantitative food frequency questionnaire (136 items) was used to appraise previous long-term dietary exposures. The same physician conducted the face-to-face interview for each case patient and his/her matched control. Conditional logistic regression modelling was used to take into account potential dietary and non-dietary confounders. RESULTS: The exposure to the upper quintile of energy-adjusted olive oil (median intake: 54 g/day) was associated with a statistically significant 82% relative reduction in the risk of a first myocardial infarction (OR = 0.18; 95% CI : 0.06-0.63) after adjustment for dietary and non-dietary confounders. CONCLUSIONS: Our data suggest that olive oil may reduce the risk of coronary disease. These findings require confirmation in further observational studies and trials.

Trastorno de pánico: perspectivas psicológicas actuales sobre su génesis y tratamiento / Panic disorder: present psychological perspectives concerning its origin and treatment

En los últimos años, las investigaciones sobre el trastorno de pánico -panic disorder- han ocupado buena parte de los estudios en psicopatología, siendo abordado el síndrome desde perspectivas tanto psiquiátrico-biologicistas como cognitivo-conductuales. En la actualidad, el trastorno de pánico es definido por la aparición de ataques de pánico inesperados o con cierta predisposición situacional, teniendo como macanismos precipitantes básicos, las sensaciones corporales de signo catastrofista, que actuarían como disparadoras de los mismos, junto con una sensibilidad a la ansiedad, elevada. Conocer los mecanismos psicológicos intrínsecos que operan en la génesis y desarrollo del trastomo, significa un paso importante para encarar la terapia (AU)

[Differences between young and elderly patients in a protocol for the diagnosis and follow-up of arterial hypertension] . / Diferencias entre pacientes jóvenes y ancianos en un protocolo de diagnóstico y seguimiento de hipertensión arterial.

OBJECTIVE: To determine possible differences between the control of hypertension in elderly patients and in young patients. DESIGN: Retrospective observation study of the differences between initial and final systolic and diastolic blood pressure, of their relationship to inclusion in medical treatment, and of the control obtained with different kinds of, and changes in, treatment, of drug association, periodic check-ups, vascular disease and risk factors. SETTING: The urban Azpilagaña Health District in Pamplona. PATIENTS: 389 hypertense patients were studied retrospectively: 196 of 70 or over and 193 between 45 and 60. MAIN RESULTS: More older patients were treated medically (91.8% vs 84.5%, p = 0.024), and received combined two-drug treatment (30.1% vs 19.7%, p < 0.001), although the young people received more than two hypertension drugs more often (11.4% vs 2.5%, p < 0.001). Final control (< 140/90) was achieved more often among young people (39.9% vs 26.5%, p = 0.005). In the older patients group initial higher diastolic pressure was related to final pressure control. More older patients had periodic check-ups at the health centre (73.3% vs 63.7%, p < 0.001), but this practice only improved relative control (< or = 140/90) in young people (p = 0.001). Older patients used more diuretics (p < 0.001) and less beta-blockers (p < 0.001), with no differences for other hypertension drugs. CONCLUSIONS: There are differences based on age in treatment and control of hypertension patients. Older patients with diastolic hypertension are controlled more easily. Altogether and in both groups analysed, the percentage of people with normal pressure after treatment was higher than in other studies.

Diferencias entre pacientes jóvenes y ancianos en un protocolo de diagnóstico y seguimiento de hipertensión arterial / Differences between young and elderly patients in a protocol for diagnosis and follow-up of hypertension

Objetivo. Determinar la posible existencia de diferencias en el control de la hipertensión en sujetos ancianos en comparación con hipertensos jóvenes. Diseño. Estudio observacional retrospectivo de las diferencias entre las tensiones arteriales sistólica (TAS) y diastólica (TAD) iniciales y finales, y su relación con la inclusión en tratamiento farmacológico, así como el control obtenido según tipo y cambios de tratamiento, asociación farmacológica, revisiones periódicas, enfermedad vascular o factores de riesgo. Emplazamiento. Zona Básica de Salud de Azpilagaña en Pamplona, con características urbanas. Pacientes. Se estudiaron retrospectivamente 389 hipertensos: 196 de 70 o más años y 193 de 45-60 años. Resultados principales. Más pacientes mayores fueron tratados con fármacos (91,8 frente a 84,5 por ciento, p = 0,024) y recibían tratamiento combinado con 2 fármacos (30,1 frente a 19,7 por ciento, p < 0,001), aunque son los jóvenes los que con mayor frecuencia reciben más de 2 antihipertensivos (11,4 frente a 2,5 por ciento, p < 0,001). El control final (< 140/90) se consiguió con más frecuencia entre los jóvenes (39,9 frente a 26,5 por ciento, p = 0,005). En el grupo de pacientes mayores la mayor tensión diastólica inicial se relacionó con el control tensional final. Más pacientes mayores siguieron las revisiones periódicas en el centro de salud (73,3 frente a 63,7 por ciento, p < 0,001), pero esta práctica sólo mejoró el control relativo (ó 140/90) en los jóvenes (p = 0,001). En pacientes mayores se emplearon más diuréticos (p < 0,001) y menos bloqueadores beta (p < 0,001), sin diferencias en otros antihipertensivos. Conclusiones. Hay diferencias en el tratamiento y control de los pacientes hipertensos en relación a su edad. Los pacientes mayores con hipertensión diastólica se controlan más fácilmente. En conjunto, y en ambos grupos analizados, el porcentaje de sujetos normotensos tras tratamiento es superior al reseñado en otros estudios (AU)