Variation in Susceptibility to Downy Mildew Infection in Spanish Minority Vine Varieties.

Downy mildew is one of the most destructive diseases affecting grapevines (Vitis vinifera L.). Caused by the oomycete Plasmopara viticola (Berk. and Curt.) Berl. and de Toni, it can appear anywhere where vines are cultivated. It is habitually controlled by the application of phytosanitary agents (copper-based or systemic) at different stages of the vine growth cycle. This, however, is costly, can lead to reduced yields, has a considerable environmental impact, and its overuse close to harvest can cause fermentation problems. All grapevines are susceptible to this disease, although the degree of susceptibility differs between varieties. Market demands and European legislation on viticulture and the use of phytosanitary agents (art. 14 of Directive 128/2009/EC) now make it important to know the sensitivity of all available varieties, including minority varieties. Such knowledge allows for a more appropriate use of phytosanitary agents, fosters the commercial use of these varieties and thus increases the offer of wines associated with different terroirs, and helps identify material for use in crop improvement programmes via crossing or genetic transformation, etc. Over 2020-2021, the susceptibility to P. viticola of 63 minority vine varieties from different regions of Spain was examined in the laboratory using the leaf disc technique. Some 87% of these varieties were highly susceptible and 11% moderately susceptible; just 2% showed low susceptibility. The least susceptible of all was the variety Morate (Madrid, IMIDRA). Those showing intermediate susceptibility included the varieties Sanguina (Castilla la Mancha, IVICAM), Planta Mula (Comunidad Valenciana, ITVE), Rayada Melonera (Madrid, IMIDRA), Zamarrica (Galicia, EVEGA), Cariñena Roja (Cataluña, INCAVI), Mandrègue (Aragón, DGA) and Bastardo Blanco (Extremadura, CICYTEX). The highly susceptible varieties could be differentiated into three subgroups depending on sporulation severity and density.

Ataxia and focal dystonia in Kallmann syndrome.

A case of Kallmann syndrome (KS) associated with rare neurological manifestations is presented. Cerebellar ataxia probably caused by a small posterior fossa and a focal dystonia affecting the left lower limb expand the spectrum of neurological manifestations occurring in KS. Further studies are needed to better understand these manifestations.

Validation of a structured intensive laparoscopic course for basic and advanced gynecologic skills training.

OBJECTIVE: To describe and validate a gynecologic laparoscopic-surgery training model. METHODS: The present prospective observational study was conducted at the Minimally Invasive Surgery Centre Jesús Usón, Cáceres, Spain, between January 2011 and June 2013. Novice gynecologists attended a 3-day course including simulation and animal training. Participants' were assessed before and after training using a virtual reality simulator; during training, gynecologists were timed and assessed using an Objective and Structured Assessment of Technical Skills score. The virtual reality simulator-assessed skills were eye-hand coordination, hand-hand coordination, and transference of objects. Participants were asked to rate various elements of the training program using a five-point scale. RESULTS: The study enrolled 21 gynecologists. Participants performed all tasks faster (P<0.001), using fewer movements (P<0.05 for left and right instruments), after receiving training. During participants' final animal and simulator training sessions, completion times were reduced (P<0.001) and assessment scores (P<0.001) increased for all techniques and tasks. Participants considered suturing to be the most useful aspect of the basic-skills training (4.95±0.22); animal training received a higher rating than simulator training for practicing new techniques (4.81±0.40 vs 4.05±0.86) and maintaining skills (4.76±0.54 vs 3.95±0.97). CONCLUSION: Combining proficiency-based physical simulation and animal training models under expert guidance is an efficient model for improving basic and advanced laparoscopic skills. Suturing and animal models were the preferred training components.

Validación de un modelo de formación intensiva en cirugía digestiva laparoscópica / Validation of a model of intensive training in digestive laparoscopic surgery

INTRODUCCIÓN: Nuestro objetivo fue validar un modelo de formación en cirugía laparoscópica para residentes de cirugía general. MÉTODOS: Doce residentes de cirugía general realizaron un programa formativo, consistente en una sesión teórica (una hora) y una sesión práctica en simulador (7 h) y modelo animal (13 h). En la primera y última repetición de los ejercicios y la funduplicatura de Nissen, se registró el tiempo y la puntuación de la escala de puntuación global objective structured assessment of technical skills (OSATS). Antes y después del curso, los participantes realizaron 4 ejercicios en el simulador virtual LAPMentor(TM): 1) coordinación ojo-mano, 2) coordinación mano-mano, 3) transferencia de objetos y 4) ejercicio de colecistectomía, registrándose las métricas de tiempo y movimiento. Además, rellenaron un cuestionario sobre los elementos formativos en una escala del 1 al 5. RESULTADOS: La última repetición de los ejercicios y de la funduplicatura de Nissen se realizaron más rápido y con mejor puntuación OSATS. Tras el curso, los participantes realizaron todos los ejercicios en LAPMentor(TM) más rápido, aumentando la velocidad de movimientos en todos ellos. El número de movimientos disminuyó en los ejercicios 2, 3 y 4, así como la distancia recorrida en los ejercicios 2 y 4. Los elementos del programa fueron valorados positivamente. El ejercicio de sutura fue el aspecto mejor valorado (4,90 ± 0,32). CONCLUSIONES: Este modelo de formación en cirugía laparoscópica ha demostrado ser válido para la mejora de habilidades básicas y avanzadas de médicos residentes de cirugía general. La sutura intracorpórea y el modelo animal fueron los elementos formativos mejor valorados

INTRODUCTION: Our objective was to assess a laparoscopic training model for general surgery residents. METHODS: Twelve general surgery residents carried out a training program, consisting of a theoretical session (one hour) and a hands-on session on simulator (7 h) and on animal model (13 h). For the first and last repetitions of simulator tasks and the Nissen fundoplication technique, time and scores from the global rating scale objective structured assessment of technical skills (OSATS) were registered. Before and after the course, participants performed 4 tasks on the virtual reality simulator LAPMentor(TM): 1) hand-eye coordination, 2) hand-hand coordination, 3) transference of objects and 4) cholecystectomy task, registering time and movement metrics. Moreover, the residents completed a questionnaire related to the training components on a 5-point rating scale. RESULTS: The last repetition of the tasks and the Nissen fundoplication technique were performed faster and with a higher OSATS score. After the course, the participants performed all LAPMentor(TM) tasks faster, increasing the speed of movements in all tasks. Number of movements decreased in tasks 2, 3 and 4; as well as path length in tasks 2 and 4. Training components were positively rated by residents, being the suture task the aspect best rated (4.90 ± 0.32). CONCLUSIONS: This training model in digestive laparoscopic surgery has demonstrated to be valid for the improvement of basic and advanced skills of general surgery residents. Intracorporeal suturing and the animal model were the best rated training elements

Validation of a model of intensive training in digestive laparoscopic surgery.

INTRODUCTION: Our objective was to assess a laparoscopic training model for general surgery residents. METHODS: Twelve general surgery residents carried out a training program, consisting of a theoretical session (one hour) and a hands-on session on simulator (7 h) and on animal model (13 h). For the first and last repetitions of simulator tasks and the Nissen fundoplication technique, time and scores from the global rating scale objective structured assessment of technical skills (OSATS) were registered. Before and after the course, participants performed 4 tasks on the virtual reality simulator LAPMentor™: 1) hand-eye coordination, 2) hand-hand coordination, 3) transference of objects and 4) cholecystectomy task, registering time and movement metrics. Moreover, the residents completed a questionnaire related to the training components on a 5-point rating scale. RESULTS: The last repetition of the tasks and the Nissen fundoplication technique were performed faster and with a higher OSATS score. After the course, the participants performed all LAPMentor™ tasks faster, increasing the speed of movements in all tasks. Number of movements decreased in tasks 2, 3 and 4; as well as path length in tasks 2 and 4. Training components were positively rated by residents, being the suture task the aspect best rated (4.90 ± 0.32). CONCLUSIONS: This training model in digestive laparoscopic surgery has demonstrated to be valid for the improvement of basic and advanced skills of general surgery residents. Intracorporeal suturing and the animal model were the best rated training elements.

Development of a closed chest model of chronic myocardial infarction in Swine: magnetic resonance imaging and pathological evaluation.

Our aim was to develop an easy-to-induce, reproducible, and low mortality clinically relevant closed-chest model of chronic myocardial infarction in swine using intracoronary ethanol and characterize its evolution using MRI and pathology. We injected 3-4 mL of 100% ethanol into the mid-LAD of anesthetized swine. Heart function and infarct size were assessed serially using MRI. Pigs were euthanized on days 7, 30, and 90 (n = 5 at each timepoint). Postoperative MRI revealed compromised contractility and decreased ejection fraction, from 53.8% ± 6.32% to 43.79% ± 7.72% (P = 0.001). These values remained lower than baseline thorough the followup (46.54% ± 11.12%, 44.48% ± 7.77%, and 40.48% ± 6.40%, resp., P < 0.05). Progressive remodeling was seen in all animals. Infarcted myocardium decreased on the first 30 days (from 18.09% ± 7.26% to 9.9% ± 5.68%) and then stabilized (10.2% ± 4.21%). Pathology revealed increasing collagen content and fibrous organization over time, with a rim of preserved endocardial cells. In conclusion, intracoronary ethanol administration in swine consistently results in infarction. The sustained compromise in heart function and myocardial thinning over time indicate that the model may be useful for the preclinical evaluation of and training in therapeutic approaches to heart failure.

Evaluation in an animal model of a hybrid covered metallic ureteral stent: a new design.

OBJECTIVE: To evaluate a new design for a hybrid, dynamic, metallic ureteral stent that might avoid the formation of urothelial hyperplasia after ureteral metallic stenting in an experimental study. MATERIALS AND METHODS: A total of 30 healthy female pigs were included in the present study, and an experimental obstructive uropathy in the right lumbar ureter was created in each pig. Obstruction was confirmed using percutaneous ultrasonography and retrograde ureteral pyelography and endoluminal ultrasonography 6 weeks after obstructive uropathy model creation. Then, the pigs were randomly distributed into 2 groups. Group 1 underwent standard metallic ureteral self-expanding internally covered stent deployment. Group 2 received a new hybrid metallic ureteral self-expanding internally covered stent. The follow-up period was 6 months. RESULTS: The hybrid metallic ureteral self-expanding internally covered stent group had a lower rate of urothelial hyperplasia (21% vs 70%), reduced stent migration (6.6% vs 33.3%), and a greater success rate after 6 months of follow-up (86.6% vs 47%) compared with the standard metallic ureteral self-expanding internally covered stent deployment group, with statically significant differences between the 2 groups. CONCLUSION: Our experimental results have indicated that the use of the hybrid metallic ureteral self-expanding internally covered stent in ureteral strictures is feasible, safe, and effective and reduces the formation of urothelial hyperplasia without secondary interventions to maintain ureteral patency.

Chronic intrapericardial catheterization for repeated drug delivery: technical feasibility study in the Göttingen minipig.

BACKGROUND: A minimally invasive pericardial access and chronic catheterization may enhance the therapeutic effects of intrapericardial drug delivery. We aimed to evaluate the technical feasibility of percutaneous intrapericardial implantation of a drug port system for chronic local drug delivery. METHODS AND RESULTS: Under fluoroscopic guidance, a percutaneous subxiphoid access to the pericardial space was obtained with fine needle and micropuncture set in 6 Göttingen minipigs. A 6.4 Fr silicone tube and its drug port were implanted into the pericardial space and a subcutaneous pocket. One animal was euthanized immediately after procedure for acute macroscopic study. The other 5 animals were followed monthly for 2 months and then euthanized for chronic macroscopic study. Technical success was obtained in all animals. The mean procedure duration was 55.3 ± 9.6 minutes and the mean radiation exposure time was 7.9 ± 1.9 minutes. Acute macroscopic study showed no pericardial laceration at the entry site and no gross injury to the nearby epicardium. Follow-ups demonstrated that the pericardial space was intact and silicone catheters kept patent in all cases. No migration of the catheter tip out of the pericardial space or leakage of contrast was observed. All the catheters were easily removed at the end of study. Infection of the subcutaneous tunnel as a major complication was found in 1 pig. Small scattered adhesions of the pericardial space were observed in 2 pigs at chronic macroscopic study. CONCLUSIONS: Percutaneous intrapericardial catheterization for chronic local drug delivery is technically feasible and of potential for clinical trial.

Biological response of laser macrostructured and oxidized titanium alloy: an in vitro and in vivo study.

PURPOSE: To assess both the in vitro and in vivo biological response of a laser modified surface in an integrated manner. A combined innovative approach applies lasers to macrostructure as well as to oxidize the surface of titanium alloy implants. MATERIALS AND METHODS: A Nd:YAG marking and ArF excimer lasers were used for macrostructuring and UV-oxidizing the surface of Ti6Al4V discs, respectively. Human fetal osteoblastic cell culture and a sheep tibia model were used to assess the cell response and the osseogeneration capability of as-machined, laser macrostructured and laser macrostructured and oxidized surfaces. RESULTS: In vitro: Laser macrostructuration alone did not promote cell response. Cellular proliferation was enhanced by the additional UV laser oxidation. In vivo: A greater significant percentage of bone-implant contact was obtained for both laser treated surfaces compared to machine-turned control samples, three months after implantation, in spite of the low cellular response for macrostructured samples. The use of sheep model for six months appears to be less adequate for a comparison because of the high level of bone integration in all samples. In spite of the often reported positive effect of titanium oxidation on the triggering of faster osseointegration, in this experiment the additional UV laser oxidation did not lead to a significant in vivo improvement. CONCLUSIONS: Laser macrostructuration of titanium alloy surfaces appears to promote bone apposition and may therefore constitute a promising surface modification strategy. In animal models, the natural process of titanium surface oxidation, because of physiologic fluids, alters properties observed in vitro with cells.

Evaluation of wedged arterial injection as a new technique for delivery of experimental therapeutic substances into the porcine pancreas.

OBJECTIVES: To prospectively evaluate the technical feasibility and efficacy of wedged arterial injection (WAI) as a potential route for experimental selective therapy to the pancreas of healthy pigs. MATERIALS AND METHODS: Selective angiographies were completed in ten pigs under general anaesthesia. By superselective angiography, the catheter was inserted and wedged into the major pancreatic artery, blocking the blood flow. In order to evaluate the efficacy of the WAI method, a DNA-specific fluorescent dye (Hoechst 33258) was used. RESULTS: Histological study revealed a uniform distribution of the fluorescent dye within the nuclei of the endocrine and exocrine pancreatic cells. Pancreatic and liver enzymes as well as histopathology of the pancreas were normal. CONCLUSION: WAI is a highly effective minimally invasive methodology to target the porcine pancreas. The findings suggest that WAI may contribute to developing preclinical assays of pancreas gene or cell-transfer therapies in swine model.

Transarterial prostatic embolization: initial experience in a canine model.

OBJECTIVE: The purpose of this study was to prospectively evaluate pathologic responses to transarterial prostatic embolization and its technical safety in a canine model. MATERIALS AND METHODS: Ten adult male beagle dogs were surgically castrated and given hormonal therapy for 4 months to induce prostatic hyperplasia. After three months of hormonal therapy, the dogs were randomly assigned to a transarterial prostatic embolization group (n = 7) or a control group (n = 3). Dogs in the transarterial prostatic embolization group were subjected to embolization with microspheres 300-500 µm in diameter. Four months after the study was begun, all dogs were sacrificed for pathologic study. Transrectal ultrasound and MRI were performed to evaluate pathologic responses. The data on prostate size acquired with transrectal ultrasound were processed for statistical analysis by paired Student t test. RESULTS: The canine prostatic hyperplasia model was successfully established in 10 dogs. The increase in mean prostate size being as great as 572% after 3 months of hormonal therapy. An intraprostatic cavity was detected 1 month after transarterial prostatic embolization in all seven dogs. Four dogs had significant shrinkage of the prostate, and the other three had an increase in prostate size. Imaging examinations and necropsy revealed a huge cavity occupying almost the entire prostate in the three dogs with increased prostate size. No complications associated with transarterial prostatic embolization were encountered. CONCLUSION: Transarterial prostatic embolization is a safe procedure that can induce prostatic infarction and ablate the prostate. The findings suggest the procedure has potential clinical applications in the care of patients with benign prostatic hyperplasia.

Video-based assistance system for training in minimally invasive surgery.

In this paper, the development of an assisting system for laparoscopic surgical training is presented. With this system, we expect to facilitate the training process at the first stages of training in laparoscopic surgery and to contribute to an objective evaluation of surgical skills. To achieve this, we propose the insertion of multimedia contents and outlines of work adapted to the level of experience of trainees and the detection of the movements of the laparoscopic instrument into the monitored image. A module to track the instrument is implemented focusing on the tip of the laparoscopic tool. This tracking method does not need the presence of artificial marks or special colours to distinguish the instruments. Similarly, the system has another method based on visual tracking to localize support multimedia content in a stable position of the field of vision. Therefore, this position of the support content is adapted to the movements of the camera or the working area. Experimental results are presented to show the feasibility of the proposed system for assisting in laparoscopic surgical training.

Ureteral double-J wire stent effectiveness after endopyelotomy: an animal model study.

OBJECTIVES: The aim of this experimental study was to assess the possibility of decreasing the size of the ureteral stents used after an endopyelotomy. To this end, an experimental study was performed which compared a ureteral double-J wire stent versus a standard 7F ureteral stent after endopyelotomy. METHODS: Twenty healthy female pigs were randomly divided into 2 groups: group I (double pigtail ureteral stent 7F) and group II (lumenless ureteral double-J wire stent, Zebrastent™, 0.035 inches in diameter). Percutaneous, endoluminal ultrasonographic and fluoroscopic studies were analyzed during the 3 different phases of the study. The first phase included premodel documentation of normal urinary tracts and laparoscopic ureteropelvic junction (UPJ) obstruction induction. During the second phase, 6 weeks later, diagnosis and endopyelotomy were carried out. Sixteen weeks after the obstruction treatment, follow-up imaging studies and postmortem evaluations of all animals were performed. RESULTS: After the sonographic and fluoroscopic assessments, we determined the success rate for each group: 80% for group I and 90% for group II. No significant statistical differences were evident in the evolution of the diameter of the UPJ between groups. Better healing of the UPJ and a lower level of retroperitoneal repercussions were seen in group II. CONCLUSIONS: The ureteral double-J wire stent (Zebrastent) has been shown to be highly effective after endopyelotomy. This means that it is possible to reduce the size of ureteral stents after endopyelotomy with the advantages that this entails. Double-J ureteral stents probably act as a scaffold rather than a mold.

Effectiveness of three-dimensional fluoroscopy in percutaneous nephrostomy: an animal model study.

OBJECTIVES: To present, in an experimental study, an assessment of innovative digital fluoroscopy systems with three-dimensional (3D) reconstruction for use in endourologic applications. METHODS: The experiment was performed in a pig model. We used 5 pigs. An obstructive uropathy model was created in the right kidney to dilate the urinary tract for group 1. Group 2 consisted of the nondilated left kidney. After selecting the tract on the 3D image, the lower caliceal group was punctured in the 2 kidneys under fluoroscopic control, to assess the efficiency of the 3D reconstruction when selecting the renal calix to be punctured. RESULTS: The 3D reconstruction system allowed us to obtain reconstruct the pelvis in three dimensions, isolated as the pelvis and renal parenchyma, as well as the adjacent bony relationships. In this study, the success rate was 100% for locating the selected renal calix. CONCLUSIONS: With this 3D reconstruction system, we were able to obtain a series of images that allowed for the study of the volume of the kidney, perfectly determining its renal calix distribution in the operating room. This enabled us to determine the precise delineation of the target calix. We, therefore, consider this new urologic application of fluoroscopy very useful in surgical planning for antegrade access of the upper urinary tract.

Preliminary results with a training program for thoracoscopic atrial fibrillation therapy.

BACKGROUND: Novel devices have been designed for the treatment of atrial fibrillation (AF) using minimally invasive approaches. This study aimed to determine the usefulness of a sheep model for training in cardiac surgical ablation using a minimally invasive approach in an experimental hands-on training course. METHODS: After initial training using a laparoscopic pelvic trainer, 15 sheep were subjected to surgery by six thoracic surgeons attending a hands-on thoracoscopic course. Dissection to the posterior wall of the pulmonary veins was followed by insertion of a microwave device around both the caudal cava vein and the pulmonary veins. The complications were recorded, and the effectiveness of the surgery was evaluated by complete deployment of the microwave device. The animals were killed after completion of the procedure. RESULTS: Isolation of the cava vein and the pulmonary veins and placement of the microwave probe were performed successfully for 10 animals using a complete thoracoscopic approach. Two animals died during the procedure. The main complications of the procedure were hemorrhage and difficulty isolating the blood vessels using a minimally invasive procedure. After the training period, the thoracoscopic surgical maneuvers were accurate and reliable. CONCLUSION: The technical feasibility of performing safe and efficient thoracoscopic placement of a microwave device in a sheep model was demonstrated in this study, suggesting that the results of this study are a useful contribution to the development of an animal model for surgical training and experimental cardiac surgeries.

Technical feasibility of totally natural orifice cholecystectomy in a swine model.

The goal of this study was to evaluate the feasibility of totally NOTES performing a cholecystectomy without laparoscopic assistance. A gastroscope was used through a transvaginal access in five acute female pigs. An incision of 2 cm was created in the vagina and pneumoperitoneum was obtained with a Veress needle. The gallbladder was located in the abdominal cavity using endoscopic transillumination for spatial orientation. After the abdominal suspension of the gallbladder the cholecystectomy was completed with the NOTES technique in four animals without complications. In one animal we had technical problems and the procedure was stopped. The mean operative time was 110 minutes. The transvaginal approach provides complete abdominal exploration and both the cystic duct and artery were identified, clipped, and transected. After dissection the gallbladder was removed through the vagina. Our results showed that completely transvaginal NOTES cholecystectomy is a feasible technique performed only with a flexible endoscope.

Maxillary sinus-floor elevation: an animal model.

OBJECTIVES: To find an animal model for modified Caldwell-Luc procedure training. The animal model should have (1) a proper cortical thickness in the lateral wall; (2) a similar morphology and resistance of the Schneiderian membrane in humans; and, finally, (3) an oral approach. MATERIALS AND METHODS: Twelve fresh heads (four Merino sheep, four Murciano-Granadina goats and four Large-White pigs). Two skulls from each of these species were also used. Several three-dimensional imagings from the skulls of each species were acquired using a C-arm. Two fresh heads of each species were used to perform the modified Caldwell-Luc procedure. Two fresh heads of each species were firstly frozen at -30 degrees C for 48 h and then sawed in blocks containing only the target region of the maxillary sinus. RESULTS: The average thickness was 2.03 mm in goat and sheep and 2.80 in pig. Releasing and elevation of the Schneiderian membrane from the sinus floor were easy in the three species. The approach of the maxillary sinus in sheep, goat and pig from the buccal vestibule required a previous surgical enlargement of the buccal vestibule. CONCLUSIONS: In conclusion, the cortical bone thickness and Schneider membrane characteristics in Merina sheep and Murciano-Granadina goat allow a perfect training for the modified Caldwell-Luc procedure. However, the approach from the oral cavity needs, in these species, a previous enlargement of the buccal vestibule. The excessive thickness of the cortical bone restricts the use of pigs for this technique.

Endourologic techniques for ureteropelvic junction obstruction therapy. Comparative animal study.

PURPOSE: The aim of this work is to compare 3 endourologic techniques for treating a ureteropelvic junction (UPJ) obstruction. To accomplish this, we performed a study in a porcine animal specimen, in which we compared laparoscopic pyeloplasty that emerges as the future gold standard technique, with 2 endopyelotomy techniques. MATERIAL AND METHODS: Twenty-four healthy large white female pigs were randomly divided in 3 groups-group I (laparoscopic pyeloplasty), group II (endopyelotomy-Acucise, Applied Medical, Rancho Margarita, CA), and group III (endoballoon rupture endopyelotomy). Percutaneous and endoluminal ultrasonographic and fluoroscopic studies were analyzed during the different phases of the study. The study was divided in 3 phases. First one included premodel documentation of normal urinary tract and laparoscopic UPJ obstruction induction. During second phase at 6 weeks later, diagnosis and endourologic treatment were carried out. Fifteen weeks after obstruction treatment, follow-up imaging studies and postmortem evaluation of all animals were performed. RESULTS: After the sonographic and fluoroscopic assessment, we determined the percentage of success rate for each technique-with an 87.5% for groups I and II and 75% for group III. Significant statistical differences were found between the 2 pyelotomy groups and the pyeloplasty group regarding the duration of the intervention. Significant statistical differences are evident in the evolution of the UPJ's diameter between groups I and III. CONCLUSIONS: Laparoscopic pyeloplasty is the technique that produces fewer side effects in the reconstructed area, as well as a wider dilation of the UPJ. Nevertheless, as we show in this study, we found similar results between endopyelotomy in selected patients than pyeloplasty, and it is simpler and less invasive than the latter.

Tratamiento con levotiroxina e imatinib / Levothyroxine therapy and imatinib

Los requerimientos de levotiroxina de los pacientes con hipotiroidismo suelen ser estables y por ello se recomienda control de la función tiroidea1 o 2 veces al año. Las dosis de levotiroxina ocasionalmente pueden variar por interacciones farmacológicas. Presentamos el caso de una paciente que requirió ajuste de la dosis del evotiroxina al iniciar el tratamiento con imatinib. Mujer de 59 años en tratamiento con levotiroxina por hipotiroidismo secundario atiroidectomía subtotal con buen control clínico y analítico. Tras ser diagnosticada de leucemia mieloide crónica y ser tratada con imatinib,presentó clínica y bioquímica compatible con hipotiroidismo, que precisó un aumento de la dosis de levotiroxina para mantener la función tiroideanormal. Recientemente se ha descrito algún caso de hipotiroidismo al añadir imatinib a pacientes en tratamiento sustitutivo con levotiroxina. Este nuevo caso avala la interacción de ambos fármacos. Por lo tanto, c omentamos los posible mecanismos fisiopatológicos que contribuyen a que el imatinib induzca el hipotiroidismo en pacientes en tratamiento sustitutivo con hormona tiroidea (AU)

Levothyroxine requirements in patients with hypothyroidism are usually stable. Consequently, thyroid function is usually monitored once or twice yearly. Occasionally, the dose of levothyroxine can be changed by pharmacologicalreactions. We report the case of a 59-year-old woman who was under levothyroxine therapy for hypothyroidism secondary to subtotal thyroidectomy, with clinical and biochemical euthyroidism, who required an increased dose of levothyroxine after starting imatinib therapy. The patient was diagnosed with chronic myeloid leukemia and imatinib therapy was started. Subsequently, we observed clinical and biochemical hypothyroidism, requiring an increase in levothyroxine dose. Some cases of hypothyroidism after initiation of imatinib therapy in patients with levothyroxine replacement therapy have recently been published. Our case provides further evidence of a reaction between the two drugs. Therefore, wediscuss the most likely physiopathological mechanisms contributing to imatinibinduced hypothyroidism in patients underlevothyroxine replacement therapy (AU)