ABSTRACT
In Spain organ transplantation constitutes one of the greatest challenges and teamwork of hospital centres. It is estimated that in the year 2020 Spain contributed 19% of all donors to the European Union. The confirmatory support diagnosis recommends by law some complementary techniques in certain cases, including neurophysiological techniques, especially the use of electroencephalogram and evoked potentials. These cases require the clinical neurophysiologist to make the right clinical and technical decisions for the correct performance and interpretation of the same. To date, there is no national consensus on the performance of these techniques. Updated bibliographic review on neurophysiological techniques (electroencephalogram and evoked potentials). Analysis by Delphi method and expert judgment of the working group of the Clinical Neurophysiology Society of the Communities of Valencia and Murcia. Neurophysiological techniques can be a support in the diagnosis of encephalic death, both confirmatory and to shorten observation times. In order to perform them, minimum technical standards are required to allow optimal performance of the studies, especially taking into account medication, hemodynamic situation, absence of hypothermia, and age group. We present the first guide in Spanish elaborated by the Society of Neurophysiology of the Communities of Valencia and Murcia for the performance in our hospitals of neurophysiological techniques in the diagnosis of brain death.
TITLE: Recomendaciones para el empleo de técnicas neurofisiológicas en el diagnóstico de muerte encefálica de la Sociedad de Neurofisiología Clínica de las Comunidades de Valencia y Murcia.En España, el trasplante de órganos constituye uno de los mayores retos y trabajo en equipo de los centros hospitalarios. Se estima que en 2020 España aportó a la Unión Europea el 19% de la totalidad de los donantes. El diagnóstico de apoyo confirmatorio recomienda por ley algunas técnicas complementarias en determinados casos, entre ellas las técnicas neurofisiológicas, en especial el uso del electroencefalograma y los potenciales evocados. Estos casos plantean al neurofisiólogo clínico la toma acertada de decisiones tanto clínicas como técnicas para su correcta realización e interpretación. Hasta ahora no existe a nivel nacional un consenso de realización de estas técnicas. Es una revisión bibliográfica actualizada sobre las técnicas neurofisiológicas (electroencefalograma y potenciales evocados), con análisis mediante método Delphi y juicio de expertos del grupo de trabajo de la Sociedad de Neurofisiología Clínica de las Comunidades de Valencia y Murcia. Las técnicas neurofisiológicas permiten ser un apoyo en el diagnóstico de muerte encefálica, tanto de forma confirmatoria como para acortar tiempos de observación. Para su realización se precisan unos mínimos estándares técnicos que permitan realizar de forma óptima los estudios. Especialmente hay que tener en cuenta la medicación, la situación hemodinámica, la ausencia de hipotermia y el grupo de edad. Presentamos la primera guía en castellano elaborada por la Sociedad de Neurofisiología de las Comunidades de Valencia y Murcia para la realización en nuestros hospitales de las técnicas neurofisiológicas en el diagnóstico de muerte encefálica.
Subject(s)
Brain Death , Neurophysiology , Brain , Brain Death/diagnosis , Electroencephalography , Evoked Potentials , HumansABSTRACT
BACKGROUND: Asthma is a common chronic lung disease characterized by airflow obstruction, airway hyperresponsiveness (AHR), and airway inflammation. IGFs have been reported to play a role in asthma, but little is known about how the insulin-like growth factor 1 receptor (IGF1R) affects asthma pathobiology. METHODS: Female Igf1r-deficient and control mice were intranasally challenged with house dust mite (HDM) extract or PBS five days per week for four weeks. Lung function measurements, and bronchoalveolar lavage fluid (BALF), serum, and lungs were collected on day 28 for further cellular, histological, and molecular analysis. RESULTS: Following HDM exposure, the control mice responded with a marked AHR and airway inflammation. The Igf1r-deficient mice exhibited an increased expression of the IGF system and surfactant genes, which were decreased in a similar manner for control and Igf1r-deficient mice after HDM exposure. On the other hand, the Igf1r-deficient mice exhibited no AHR, and a selective decrease in blood and BALF eosinophils, lung Il13 levels, collagen, and smooth muscle, as well as a significant depletion of goblet cell metaplasia and mucus secretion markers after HDM exposure. The Igf1r-deficient mice displayed a distinctly thinner epithelial layer than control mice, but this was not altered by HDM. CONCLUSIONS: Herein, we demonstrate by the first time that the Igf1r plays an important role in murine asthma, mediating both AHR and mucus secretion after HDM exposure. Thus, our study identifies IGF1R as a potential therapeutic target, not only for asthma but also for hypersecretory airway diseases.
Subject(s)
Insulin-Like Growth Factor I/physiology , Mucus/metabolism , Pyroglyphidae/immunology , Respiratory Hypersensitivity/metabolism , Animals , Asthma/etiology , Eosinophils/immunology , Female , Insulin-Like Growth Factor I/deficiency , Insulin-Like Growth Factor I/metabolism , MiceABSTRACT
La estenosis uretral, después de la fístula, es la complicación más frecuente que presentan los pacientes intervenidos de hipospadias. Su incidencia oscila entre un 4 por ciento-12 por ciento dependiendo de la técnica quirúrgica empleada. Su trata-miento en la mayoría de las ocasiones es sencillo, siendo suficiente la dilatación de la zona estenosada en una o varias sesiones. Sin embargo en otros casos, sobre todo en los pacientes con hipospadias graves en los que ha sido preciso la disección y resección amplia de los tejidos fibrosos para corregir la incurvación y en los multitratados, la dilatación de la zona estenosada es difícil. Presentamos 3 pacientes afectos de hipospadias graves (escrotales y perineales) multioperados, que presentaron como complicación en el post-operatorio estenosis uretral a distinto nivel. Sometidos a programa de dilataciones periódicas durante varios meses no se consiguió solucionar la estenosis. Se intervinieron para intentar ampliar la zona estenosada. En dos la ampliación se hizo con un injerto libre de mucosa oral y en el tercero se utilizó un colgajo local. Al poco tiempo de la ampliación, se estenosaron de nuevo, no respondiendo de nuevo al programa de dilataciones. Ante la persistencia de la sintomatología y la dureza de las cicatrices de la zona estenosada, se inyectó Triamcinolona D.C.I. acetónido (Trigon Depot) corticoesteroide de acción prolongada, sobre la zona de máxima fibrosis uretral, con la idea de reproducir el efecto reblandecedor que tiene sobre las cicatrices cutáneas hipertróficas y queloideas. Los tres pacientes fueron tratados con inyecciones repetidas de triamcinolona con un intervalo entre ellas de 2 a 3 meses. El periodo de seguimiento de estos pacientes oscila entre 5 y 20 meses, encontrándose todos libres de sintomatología y con un buen chorro miccional (AU)
Subject(s)
Adolescent , Male , Humans , Child , Triamcinolone Acetonide , Postoperative Complications , Urethral Stricture , Glucocorticoids , Delayed-Action Preparations , Hypospadias , Severity of Illness IndexABSTRACT
Urethral stenosis is, after the fistula, the most frequent complication in patients undergoing hypospadias repair. Incidence ranges between 6% and 10% depending on the surgical technique. Treatment of this complication with simple dilation of the narrowed segment is enough in most cases. However, dilation of the stricture may be difficult in patients with severe hypospadias that required wide dissection and excision of fibrotic tissue to repair a large deviation and also in patients who had previously multiple operations. We report 3 patients with severe hypospadias (scrotal and perineal) with history of multiple operations for that condition and postoperative urethral stenosis at different sites. All patients had periodical dilations for several months without any improvement. Surgical treatment was indicated to enlarge the stenotic segment. Enlargement was performed using oral mucosa graft in two cases and a local flap in the third one. Urethral stricture recurred in all cases very soon after the plasty and repeated dilations did not improve the symptoms. In the presence of hard scar tissue it was decided to inject triamcinolone DCI acetoide (Trigon depot), a long acting steroid, into the segment where the fibrotic narrowing was more severe, in an effort to obtain the same results reported in the treatment of hypertrophic scars and keloids. All the patients had repeated triamcinolone injections of hypertrophic scars and keloids. All the patients had repeated triamcinolone injections every 2-3 months. Follow-up ranges between 5 and 20 months and all of them are free of symptoms.
Subject(s)
Glucocorticoids/therapeutic use , Hypospadias/surgery , Postoperative Complications/drug therapy , Triamcinolone Acetonide/therapeutic use , Urethral Stricture/drug therapy , Adolescent , Child , Delayed-Action Preparations , Humans , Male , Severity of Illness IndexABSTRACT
OBJECTIVE: To find what vital events middle-aged women in our society most often experience and their influence as stress factors on physical health and subjective psychological well-being. DESIGN: A multivariant transversal study. SETTING: 5 primary care centres in Valencia and Alicante. PARTICIPANTS: 306 women chosen at random among those seen at these health centres. MEASUREMENTS AND MAIN RESULTS: Frequency analysis of vital events. Correlation analysis with questionnaires on physical symptoms and diseases, psychological well-being, work situation, emotional behaviour, sexuality and relationships with their partner. ANOVA: dividing the sample into 2 groups based on mean adaptive effort. The most common events numbered 23. The ANOVA showed a significant association between greater adaptive effort and negative emotional behaviour, personal control, material well-being, relationship with the partner, and physical and psychological symptoms. CONCLUSIONS: The relevance of daily events as generators of stress was confirmed, as was the impact of these and major events on these women's physical and psychological health. The importance of attending women at this stage of their lives from an integrated and interdisciplinary perspective, which tackles the physiological, psychological and cultural features together, was shown.
