Supervivencia de pacientes con metástasis cervical de primario desconocido en el Instituto Nacional de Oncología y Radiobiología. 2007-2012

Resumen Introducción: Las metástasis cervicales con primario oculto representan el 5% de los tumores de cabeza y cuello. Su diagnóstico y tratamiento han sufrido modificaciones con los años según las diferentes investigaciones, con vistas a mayores tasas de supervivencia. Objetivo: Determinar la supervivencia global y según diferentes variables. Material y Método: Investigación retrospectiva, descriptiva y longitudinal de 96 pacientes diagnosticados en el Instituto Nacional de Oncología y Radiobiología (INOR) en el periodo 2007-2012, manteniéndose el seguimiento hasta el 31 de diciembre de 2017. Resultados: De los pacientes estudiados, 65 eran hombres (67,7%) y 31 mujeres (32,3%), para una razón de 2,1:1, con una media de edad de 61,4 años. El tabaquismo estuvo presente en el 64,6% de la población. El nivel ganglionar más afectado fue el II y 41 pacientes (42,7%) presentaron una enfermedad N1 al diagnóstico. En 42 pacientes (43,8%) estuvo presente el grado histológico poco diferenciado. Al 70,9% se les practicó cirugía con adyuvancia o sin ella y el 86,5% tuvo respuesta completa. El tumor primario apareció en el 13,5% de los casos, más frecuente en amígdala. La supervivencia global a los 5 años fue del 74% y resultaron variables determinantes de supervivencia el estado ganglionar y la extensión extraganglionar. Los resultados coinciden con la literatura revisada. Conclusión: La supervivencia global a los 5 años de los pacientes con metástasis cervical de primario oculto es elevada, tiene tendencia a mejorar con el paso de los años y está determinada por el estado ganglionar y la extensión extracapsular de forma inversamente proporcional.

Abstract Introduction: Cervical metastases with occult primary represent 5% of head and neck tumors. Its diagnosis and treatment have been modified over the years according to different investigations, with a view to higher survival rates. Aim: To determine the overall survival and according to different variables. Material and Method: A retrospective, descriptive and longitudinal investigation of 96 patients diagnosed at INOR in the period 2007-2012 was carried out, with follow-up until December 31, 2017. Results: Of the patients studied, 65 were men (67.7%) and 31 women (32.3%), for a ratio of 2.1: 1, with a mean age of 61.4 years. Smoking was present in the 64.6% of the population. The most affected lymph node level was level II and 42 patients (43.8%) presented N1 disease at diagnosis. Poorly differentiated histological grade was present in 42 patients (43.8%). 70.9% underwent surgery with or without adjuvant surgery and 86.5% had a complete response. The primary tumor appeared in 13.5% of cases, more frequent in the amygdala. Overall survival at 5 years was 74%, and survival variables were lymph node status and extranodal extension. The results coincide with the reviewed literature. Conclusion: The overall 5-year survival of patients with occult primary cervical metastasis is high, tends to improve over the years, and is determined by lymph node status and extracapsular extension in an inversely proportional manner.

Sponges as sentinels: patterns of spatial and intra-individual variation in trace metal concentration.

If sponges are to be effective biomonitors we require a better understanding of the spatial scales over which metals vary in these organisms. We determined how concentration of Cd, Zn, Cu, Pb, Hg and Se varied over four spatial scales for two common estuarine sponge species in the Sydney region. We examined variability with a fully nested sampling design; between coastal lakes, within coastal lakes, between sponges and within sponges. Calculation of variance components confirmed that 'within-sponge' variation in Cd, Zn, Cu, Pb and Se concentrations were low (1-14%) relative to the two largest spatial scales (49-98%) examined. In contrast, Hg concentrations exhibited marked variability 'between-sponges' and were below detection at one location. There was little evidence that sponge size was a good predictor of metal concentration. Taken together, these outcomes confirm that fragments of these sponges could be successfully transplanted and therefore show promise as biomonitors of metal contamination.

Restauraciones cerámicas en molares jóvenes con endodoncia / Ceramics restorations in young molars with endodontic

Objetivo: Efectuar restauraciones cerámicas Cerec (feldespática y de dióxido de circonio) en molares jóvenes con endodoncia, para prevenir complicaciones en el aparato estomatognático por la pérdida de estos dientes. Material y métodos: Se describe la confección de restauraciones cerámicas a nivel de la zona molar mandibular derecha de un paciente del género femenino de 18 años de edad, a quien se le realizó radiografía periapical, por presentar dolor espontáneo en el lado derecho mandibular. Se diagnosticó una pulpitis irreversible en el primer y segundo molar que fue tratada en odónticamente. Las restauraciones cerámicas de ambos molares fueron confeccionadas con los sistemas CAD/CAM Cerec y evaluadas clínicamente a los 6 y 12 meses, de acuerdo a los criterios establecidos por el Servicio de Salud Pública de los Estados Unidos (USPHS).Resultados: La evaluación clínica evidenció que las estructuras de cerámica feldespática y de dióxido de circonio ofrecen en el lapso evaluado, adecuada forma anatómica, adaptación marginal, estabilidad en el color, ausencia de caries recidiva a nivel de dientes del sector posterior con tratamiento endodóntico y aceptación del paciente (AU)

Material and methods: It describes the making of ceramic restorations in the right mandibular molar area to a female patient of 18 years old, to whom it was made a periapical radiography, for presenting spontaneous pain on the mandibular right side. It was diagnosed as an irreversible pulpitis at the first and second molar, that were treated endodontically. The ceramic restorations of both molars were made with the Cerec CAD/CA Msystem and were examined after 6 and 12 months in accordance with the US Public Health Service (USPHS)criteria at baseline. Results: The clinical evaluation showed that the structures of feldspathic ceramic and zirconium dioxide in the offer period evaluated presented, proper anatomical shape, marginal adaptation, color stability, absence of recurrence cavities in the posterior teeth with endodontic treatment and acceptance of the patient (AU)

Effects on cell viability of three zebrafish testicular cell or tissue cryopreservation methods.

In this work, three cryopreservation procedures were tested in order to obtain efficiently viable testicular cells after cryopreservation. Testicular cells of Wild type zebrafish males were frozen using an equilibrium protocol and testicular tissue fragments were cryopreserved with equilibrium freezing and vitrification procedures. Results showed that vitrification was significantly more efficient than freezing in terms of final cell survival (cell freezing: 14.4%, tissue freezing: 77.4%-85.5%, tissue vitrification: 94%). It must be noted that, in live cells, the presence of pseudopodia was frequently observed, which indicated their spermatogonial nature. Based on these results, the authors suggest that vitrification, with the subsequent elimination of connective tissue after warming, offers the best combination to rescue live testicular cells as a genetic conservation procedure in zebrafish.

[Myocardial bridging and coronary spasm on effort]. / Pont myocardique et spasme coronaire à l'effort.

The discovery of myocardial bridging during coronary angiographies is common. Yet these bridges are rarely the origin of acute coronary syndrome. We report the case of an active 45 year old man with no cardiovascular risk factors who had acute coronary syndrome. Emergency coronary angiography just revealed two myocardial bridges on the anterior interventricular artery which did not explain this acute episode. A subsequent second angiogram together with endocoronary echography demonstrated that there was no atheroma and a methergin test set off diffuse coronary spasm. The association of myocardial bridging and coronary spasm has only rarely been reported in the literature. We describe the clinical, therapeutic and prognostic characteristics.

Estudio prospectivo comparativo entre el clavo gamma trocantérico y el clavo femoral proximal AO (PFN) en el tratamiento de las fracturas trocantéricas inestables / Prospective comparative study of the intertrochanteric Gamma nail and AO proximal femoral nail in the treatment of unstable intertrochanteric fractures

Objetivo. Estudio prospectivo randomizado comparativo entre dos técnicas endomedulares de última generación (clavo femoral proximal AO [PFN] frente a gamma trocantérico) en el tratamiento quirúrgico de las fracturas inestables trocantéricas. Material y método. Se estudian 156 pacientes, a 79 de ellos se les implantó un clavo AO PFN y a 77 un clavo gamma trocantérico en fracturas tipo 3-1-A2 y 3-1-A3 de la clasificación AO, con edades medias de 82,3 y 81,8 años, respectivamente. Se analizan los tiempos operatorios, de amplificador de imágenes, requerimientos transfusionales, complicaciones médicas y mecánicas, y el resultado clínico al año de seguimiento. Resultados. No se observaron diferencias significativas en las características generales de ambos grupos. En los pacientes tratados con clavo gamma trocantérico se observó mayor número de transfusiones, y mayor frecuencia e intensidad de dolor en el muslo. No se observaron diferencias significativas en las complicaciones mecánicas, ni en el resultado funcional clínico al año. Conclusiones. El comportamiento de ambos implantes fue similar, con resultados excelentes en la estabilización de las fracturas inestables trocantéricas con similares escasas complicaciones mecánicas; si bien los pacientes a los que se colocó un clavo gamma fueron transfundidos con mayor frecuencia y presentaron mayor dolor en el muslo de forma significativa

Objective. Randomized prospective comparative study of two late-generation intramedullary techniques (the AO proximal femoral nail [PFN] versus the Gamma nail) in the surgical management of unstable intertrochanteric fractures. Materials and methods. In a study of 156 patients, the AO PFN was implanted in 79 and the Gamma nail in 77 patients with AO fractures type 3-1-A2 and type 3-1-A3. The mean age of patients was 82.3 years in the PFN group and 81.8 years in the Gamma group. Operating times, imaging, transfusion requirements, medical and mechanical complications, and clinical outcome after one year of follow-up were analyzed. Results. No significant differences were observed in the general characteristics of the two groups. Patients treated with a Gamma nail received more transfusions and had more frequent and more intense pain in the thigh. No significant differences were observed in the mechanical complications or functional results at one year. Conclusions. The performance of the two implants was similar, both producing excellent results in the stabilization of unstable intertrochanteric fractures and few mechanical complications; patients implanted the Gamma nail had significantly more frequent transfusions and pain in the thigh

[Erythropoietin alone or as an adjuvant for the autologous blood donation program in major orthopedic surgery]. / Eritropoyetina sola o como coadyuvante del programa de donación de sangre autóloga en cirugía ortopédica mayor.

BACKGROUND: Patients with anemia undergoing elective joint replacement are often excluded from preoperative autologous donation (PAD). The purpose of this study was to compare the efficacy of preoperative erythropoietin (epoetin alpha) as an adjuvant treatment to PAD versus preoperative erythropoietin alfa alone in patients with mild anemia undergoing major orthopedic surgery. PATIENTS AND METHODS: The study enrolled 75 patients scheduled for total joint arthropalsty of the hip or knee or spinal surgery and with a hemoglobin (Hb) concentration between 10 and 13 g/dL. Group 1 patients were assigned to receive weekly doses of subcutaneous epoetin alpha (40,000 IU) 21, 14, and 7 days before surgery and to participate in the PAD program; group 2 patients were excluded from the PAD program and received 2 doses of epoetin alpha every week over the same period. RESULTS: Group 1 (n = 39) and group 2 (n = 36) were similar with respect to patient characteristics, biological parameters, and surgical procedures, In group 1, mean preoperative Hb rose fom 12.5 g/dL to 12.8 g/dL, patients received a mean 5.1 doses of epoetin alpha, and they gave a mean 1.9 units of autologus blood and 1 received allogenic blood. In group 30.7% received transfusions of autologous blood and 1 received allogenic blood. In group 2, preoperative Hb increased from 11.7 g/dL to 13.5 g/dL, patients received 3.8 doses of epoetin alpha, and 3 were transfused with allogenic blood (P > 0.05). CONCLUSION: Epoetin alpha alone and erythropoietin as a adjuvant to a PAD program are equally effective in reducing allogenic transfusion during hip and knee arthroplasty and spinal column surgery of up to 3 spaces.

Eritropoyetina sola o como coadyuvante del programa de donación de sangre autóloga en cirugía ortopédica mayor / Erythropoietin alone and as an adjuvant to autologous blood donation in major orthopedic surgery

La anemia es el principal factor de riesgo de transfusión y causa de exclusión del programa de donación autóloga preoperatoria (DAP). Nuestro objetivo fue comparar la eritropoyetina recombinante humana (epoetina alfa) sola o como coadyuvante del programa DAP en pacientes con anemia moderada programados para cirugía ortopédica mayor. MATERIAL Y MÉTODOS: Estudiamos 75 pacientes intervenidos de artroplastia de cadera, rodilla o cirugía de columna, con hemoglobina (Hb) basal entre 10-13 g/dl. En el grupo 1 se incluyeron los pacientes asignados al programa de DAP y recibieron dos dosis semanales de 40.000 UI de epoetina alfa subcutánea las semanas -3,-2,-1 y en el grupo 2, los excluidos del programa de DAP y recibieron una dosis las semanas -3,-2,-1 y el día previo a la cirugía. RESULTADOS: 39 pacientes fueron incluidos en el grupo 1 y 36 en el grupo 2. Ambos grupos fueron similares en características demográficas, biológicas y quirúrgicas. En el grupo 1 la Hb basal aumentó de 12,5 g/dl a 12,8 g/dl en el preoperatorio, se obtuvieron una media de 1,9 unidades de sangre autóloga por paciente y recibieron 5,1 dosis de epoetina alfa.En este grupo el 30,7 por ciento de los pacientes fue transfundido con sangre autóloga y 1 recibió sangre alogénica. En el grupo 2 la Hb aumentó de 11,7 g/dl a 13,5 g/dl en el preoperatorio, recibieron 3,8 dosis de epoetina alfa y 3 pacientes fueron transfundidos con sangre alogénica (p>0,05). CONCLUSIONES: En la artroplastia de cadera, rodilla o cirugía de columna de hasta 3 espacios, la epoetina alfa como coadyuvante del programa DAP resulta igual de eficaz en reducir la transfusión alogénica (AU)

Antinociceptive effect of clomipramine in monoarthritic rats as revealed by the paw pressure test and the C-fiber-evoked reflex.

The antinociceptive effect of clomipramine was studied in monoarthritic rats by using the paw pressure test and the C-fiber-evoked reflex. Monoarthritis was produced by intra-articular injection of complete Freund's adjuvant into the tibio-tarsal joint. Joint circumference as well as vocalization threshold to graded paw pressure were evaluated weekly during a 14-week period after the intra-articular injection. At week 8, monoarthritic and vehicle-injected control rats were given either clomipramine or saline and both the paw pressure threshold and inhibition of the C-fiber-evoked reflex response were evaluated. Results showed that (i) 1.5, 3.0, and 6.0 mg/kg, i.v. of clomipramine induced significantly greater dose-dependent antinociception to paw pressure testing in the monoarthritic group, as compared to the control one; and (ii) 0.75, 1.5, 3.0, and 6.0 mg/kg, i.v. of clomipramine exerted significantly higher dose-dependent inhibition of the C-reflex activity in monoarthritic rats than in controls. Results suggest that the higher sensitivity to clomipramine in monoarthritic rats could be related to adaptive changes occurring in monoamine metabolism or in other neurotransmitter systems during chronic pain.

Intrathecally administered gabapentin inhibits formalin-evoked nociception and the expression of Fos-like immunoreactivity in the spinal cord of the rat.

In the present study, we investigated the effects of intrathecal gabapentin on nociceptive behaviors and the numbers of spinal Fos-like immunoreactive (Fos-LI) neurons evoked by injection of 0.25 to 2.5% formalin in the hindpaw of the rat. Pretreatment with gabapentin dose dependently decreased flinches and weighted pain scores in phase 2, but not phase 1, at each concentration of formalin. The highest dose of gabapentin (100 microgram) shifted the EC(50) values of formalin for both flinches and weighted pain scores to the right by 2.5-fold, suggesting that formalin was perceived to be significantly less noxious. Gabapentin also decreased phase 2 behaviors when administered after formalin but was only one third as potent. Unlike its inhibition of formalin-evoked nociceptive behaviors, the effect of gabapentin on the expression of Fos-like immunoreactivity in the spinal cord was highly dependent on the concentration of formalin. Intrathecal pretreatment with 100 microgram of gabapentin did not decrease the numbers of Fos-LI neurons evoked by 0.5% formalin, yet this dose decreased the numbers of Fos-LI neurons in laminae I-II and VII-X of rats that received 1.25% formalin and uniformly decreased by 50% the numbers of Fos-LI neurons in all laminae of rats that received 2.5% formalin. These latter findings suggest that gabapentin neither nonselectively decreases the excitability of spinal cord neurons nor uniformly inhibits the release of all neurotransmitters from primary afferent terminals. Rather, its effects may be preferential for those neurotransmitters released by higher, more noxious concentrations of formalin and for conditions in which there is a greater induction of central sensitization.

[Hypertension. New French recommendations]. / Hypertension artérielle. Les nouvelles recommandations françaises.

The field of hypertensive medicine is constantly and rapidly changing, especially with regards to treatment. In view of its high incidence and its complications, it is a major public health concern. This explains the periodic publication of national or international recommendations with the object of informing practitioners of the latest publications in a form applicable to clinical medicine. In France, the "Agence Nationale d'Accréditation et d'Evaluation en Santé" (ANAES) has recently published its recommendations for the management of hypertension. The dominant issues are the recognition of validated electronic sphygmomanometers for measuring the blood pressure in the out-patient setting, the evaluation of individual cardiovascular risk for treatment choice, the value of non-pharmacological interventions, the tailoring of antihypertensive treatment and the abandon of the concept of equal benefit of comparable blood pressure lowering irrespective of the molecule used.

Semantic features and semantic categories: differences in rapid activation of the lexicon.

Robust priming was shown in a semantic categorization task for prime-target pairs which shared semantic features (e.g., pumpkin-squash). Priming facilitation for these pairs was demonstrated at extremely rapid prime exposures (28 and 43 ms) and increased with prime duration. The onset and amount of facilitation differed significantly for these semantic, nonassociative pairs and for associative-semantic prime-target pairs (e.g., cow-bull). The latter pairs produced facilitation, but later (at prime-target SOAs of 70 and 200 ms) and of lesser magnitude. These results are discussed in relation to three current models of semantic memory: spreading activation, compound cue, and distributed models.

[The importance of lipoprotein(a) as a predictive factor of coronary atherosclerosis]. / Importance de la lipoprotéine(a) comme facteur prédictif de l'athérosclérose coronarienne.

OBJECTIVE: The predictive value of lipoprotein(a), Lp(a), for coronary artery disease, is strongly suspected, though unproven. The normal serum level is 0.3 g/l. We searched for correlations between serum Lp(a) levels and coronary artery disease in a population of patients hospitalized in a general cardiology unit. METHOD: Serum Lp(a) was assayed in all patients consecutively hospitalized during 1994 in the Valence hospital cardiology unit. Two groups were distinguished: patients with coronary artery disease (n = 444) and those presumed free of coronary artery disease (n = 555). Coronography were performed when required. Serum Lp(a) levels were compared for the following variables: age, sex, smoking habits, blood pressure, total cholesterol, HDL and LDL-cholesterol, triglycerides and apolipoproteins A1 and A2. Univariate, then multivariate analysis were performed first patients of all ages, then for those aged more and less than 60 years. RESULTS: Univariate analysis demonstrated that Lp(a) > 0.3 g/l was associated with coronary heart disease (OR = 1.33; p = 0.03), although this correlation was no longer significant after adjustment for other known risk factors (OR = 1.28; p = 0.07), except in the subgroup of patients over 60 years of age (OR = 1.37; p = 0.04). CONCLUSION: There was a non-significant trend favoring an association between serum Lp(a) level > 0.3 g/l and the development of coronary artery disease.

Subcoracoid dislocation of the distal end of the clavicle. A case report.

Subcoracoid dislocation of the outer end of the clavicle in association with an acromial fracture is a rare injury usually produced by high energy trauma that moves the clavicle posterior to the conjoined tendon and inferior to the coracoid process. To restore the acromioclavicular joint, open reduction is needed. After the reduction is accomplished, the clavicle has to be stabilized with a coracoclavicular screw. The acromial fracture can be reduced and held with nonabsorbable sutures placed through the bone. To avoid osteolysis of the distal end of the clavicle and to be able to repair the torn ligaments, treatment should not be delayed.

Effects of clomipramine and desipramine on a C-fiber reflex in rats.

A C-fiber nociceptive reflex evoked by electrical stimulation within the territory of the sural nerve, was recorded from the ipsilateral biceps femoris muscle in urethane anesthetized rats. Intravenously administered clomipramine and desipramine produced a dose-dependent depression of the C-fiber reflex. High doses of intrathecal desipramine also inhibited the C-fiber reflex, while similar intrathecal doses of clomipramine produced only a modest inhibition of the response. Intracerebroventricular administration of clomipramine decreased dose-dependently the C-fiber reflex whereas intracerebroventricular desipramine increased this reflex. These findings suggest that tricyclic antidepressants with noradrenergic selectivity, as desipramine, inhibit the spinal processing of C inputs by acting directly at the spinal cord level, while those with serotonergic spectra, as clomipramine, depress the C-fiber-evoked spinal reflex by acting at a supraspinal modulatory site.

Finding the locus of semantic satiation: an electrophysiological attempt.

The present study examined the effect of massed repetition of an initial category name upon the subsequent semantic categorization of a target word by means of an electrophysiological measure of semantic processing: the N400. Results showed the classic N400 effect, whereby evoked potentials were more negative for targets that were not members of the repeated category than for member targets. Moreover, repetition of the category name led to an increased and sustained positivity. The N400 effect was not modified, however, by repetition. Hence, insomuch as the N400 reflects meaning integration processes, these results do not support the hypothesis that massed repetition exerts its influence at the level of meaning integration.

Idiopathic normal pressure hydrocephalus: analysis of factors related to cerebrospinal fluid dynamics determining functional prognosis.

This investigation has been undertaken to analyze the findings with both the cerebrospinal fluid (CSF) pressure (Pcsf) and CSF pulse pressure (PP) in order to predict the outcome of patients with the syndrome of idiopathic normal pressure hydrocephalus (NPH). Accordingly, a prospective clinical study was planned in which two groups of patients with NPH, having analogous prevalence of several matched clinical and radiological parameters, were separated on the basis of their positive or negative response to shunting. Both the resting Pcsf and CSF PP profiles were compared in these two groups, and between them and normal controls. CSF PP amplitude and CSF PP latency correlated directly in conditions associated with either normal or high compliance (controls and patients with Alzheimer-like disorders), whereas this correlation was inverse in states of low compliance (NPH). On the other hand, shunt-responders showed a resting Pcsf significantly higher than both non-responders and controls. The following conclusions were obtained: 1) CSF PP is a high-amplitude and relative low-latency wave in NPH when compared with controls: 2) CSF PP amplitude and latency correlate directly in normal subjects and in those with primary cerebral atrophy; 3) a non-reversible stage of NPH could be conceived in contradistinction to the reversible one, in both of which an inverse correlation between the amplitude and the latency takes place, the main difference between them being the resting Pcsf, which is significantly lower in the former than in the latter, depending on the degree of atrophic changes developed.