¿Desempeña un papel decisivo la excitabilidad corticoespinal ipsilateral en el efecto cruzado provocado por el entrenamiento de fuerza unilateral? Una revisión sistemática / Does ipsilateral corticospinal excitability play a decisive role in the cross-education effect caused by unilateral resistance training? A systematic review

Introducción: El entrenamiento de fuerza unilateral ha demostrado provocar aumentos de fuerza tanto en la extremidad entrenada como en la no entrenada. Una de las teorías actuales más aceptadas defiende que el origen de dicho aumento de rendimiento se encuentra en adaptaciones en el sistema nervioso, concretamente en la corteza motora primaria, siendo los aumentos en la excitabilidad corticoespinal (EC) medida con estimulación magnética transcraneal una de las principales adaptaciones observadas tras periodos crónicos de entrenamiento. Por ello, el principal objetivo es hacer un análisis de la literatura actual para determinar el grado de adaptación que se da en la EC y su posible relación funcional con el aumento de fuerza de la extremidad no entrenada.DesarrolloSe llevó a cabo una búsqueda sistemática en la literatura existente entre enero de 1970 hasta diciembre de 2016 en las bases de datos online Medline (vía PubMed), Ovid, Web of Science y Science Direct con la siguiente estrategia de búsqueda: (Transcranial magnetic stimulation OR excitability) Y (strength training OR resistance training or force) Y (cross transfer OR contralateral limb OR cross education). Finalmente se incluyeron un total de 10 artículos.ConclusionesExiste cierta inconsistencia en los resultados referentes al aumento de la EC. Aunque no se puede descartar que dicha inconsistencia se deba a aspectos metodológicos, los resultados parecen indicar que el aumento de fuerza y el incremento en la EC podrían no estar funcionalmente relacionados. (AU)

Introduction: Unilateral resistance training has been shown to improve muscle strength in both the trained and the untrained limb. One of the most widely accepted theories is that this improved performance is due to nervous system adaptations, specifically in the primary motor cortex. According to this hypothesis, increased corticospinal excitability (CSE), measured with transcranial magnetic stimulation, is one of the main adaptations observed following prolonged periods of training. The principal aim of this review is to determine the degree of adaptation of CSE and its possible functional association with increased strength in the untrained limb.DevelopmentWe performed a systematic literature review of studies published between January 1970 and December 2016, extracted from Medline (via PubMed), Ovid, Web of Science, and Science Direct online databases. The search terms were as follows: (transcranial magnetic stimulation OR excitability) AND (strength training OR resistance training OR force) AND (cross transfer OR contralateral limb OR cross education). A total of 10 articles were found.ConclusionResults regarding increased CSE were inconsistent. Although the possibility that the methodology had a role in this inconsistency cannot be ruled out, the results appear to suggest that there may not be a functional association between increases in muscle strength and in CSE. (AU)

Does ipsilateral corticospinal excitability play a decisive role in the cross-education effect caused by unilateral resistance training? A systematic review. / ¿Desempeña un papel decisivo la excitabilidad corticoespinal ipsilateral en el efecto cruzado provocado por el entrenamiento de fuerza unilateral? Una revisión sistemática.

INTRODUCTION: Unilateral resistance training has been shown to improve muscle strength in both the trained and the untrained limb. One of the most widely accepted theories is that this improved performance is due to nervous system adaptations, specifically in the primary motor cortex. According to this hypothesis, increased corticospinal excitability (CSE), measured with transcranial magnetic stimulation, is one of the main adaptations observed following prolonged periods of training. The principal aim of this review is to determine the degree of adaptation of CSE and its possible functional association with increased strength in the untrained limb. DEVELOPMENT: We performed a systematic literature review of studies published between January 1970 and December 2016, extracted from Medline (via PubMed), Ovid, Web of Science, and Science Direct online databases. The search terms were as follows: (transcranial magnetic stimulation OR excitability) AND (strength training OR resistance training OR force) AND (cross transfer OR contralateral limb OR cross education). A total of 10 articles were found. CONCLUSION: Results regarding increased CSE were inconsistent. Although the possibility that the methodology had a role in this inconsistency cannot be ruled out, the results appear to suggest that there may not be a functional association between increases in muscle strength and in CSE.

Effects of acute and chronic unilateral resistance training variables on ipsilateral motor cortical excitability and cross-education: A systematic review.

OBJECTIVE: The increase in voluntary force of an untrained limb (i.e. Cross-education) after unilateral resistance training (RT) is believed to be a consequence of cortical adaptations. However, studies measuring neurophysiological adaptations with transcranial magnetic stimulation (TMS) found inconsistent results. One unexamined factor contributing to the conflicting data is the variation in the type and intensity of muscle contractions, fatigue, and the strategies of pacing the movement. Therefore, the purpose was to analyse how those unilateral RT variables affect the adaptations in ipsilateral M1 (iM1) and cross-education. METHODS: We performed a systematic literature review, with the following search terms with Boolean conjunctions: "Transcranial magnetic stimulation" AND "Ipsilateral cortex" AND "Resistance training". RESULTS: The 11 acute and 12 chronic studies included partially support the idea of increased cortical excitability and reduced intracortical inhibition in iM1, but the inconsistency between studies was high. CONCLUSIONS: Differences in type and intensity of contraction, fatigue, and strategies of pacing the movement contributed to the inconsistencies. The tentative conclusion is that high intensity eccentric or externally paced contractions are effective to increase iM1 excitability but cross-education can occur in the absence of such changes. Thus, the mechanism of the cross-education examined with TMS remains unclear.

Catarata congénita en un paciente con aneuploidía cromosómica 47, XYY / Cataract in a patient with 47, XYY sex chromosome aneuploidy

CASO CLÍNICO: Paciente masculino de 16 años de edad con antecedente de miopía alta y catarata congénita unilateral, talla alta, dismorfias faciales, hiperlaxitud de falanges y alteraciones de la conducta. La madre tenía antecedente de 3 pérdidas gestacionales. Se realizó cariotipo en sangre periférica reportando 47,XYY. Discusión: Los pacientes con aneuploidía 47,XYY tienen mayor riesgo de malformaciones congénitas, las alteraciones oftalmológicas no son frecuentes. La evaluación de pacientes con talla alta y alteraciones de la conducta debe incluir cariotipo como parte del abordaje diagnóstico

CASE REPORT: The case concerns a 16 year-old boy with a history of high myopia and unilateral congenital cataract, tall stature for age, facial dysmorphism, hypermobile metacarpal-phalangeal joints, as well as behavioural problems. The mother had a history of recurrent pregnancy loss. Chromosomal analysis of the peripheral blood lymphocytes reported 47,XYY. DISCUSSION: Patients with sex chromosome aneuploidy 47,XYY have higher risk of congenital malformations, although ophthalmological anomalies are unusual. Evaluation of patients with tall stature and behavioural problems should include a chromosomal analysis in order to determine the aetiology

Concurrencia de fatiga y potenciación tras una contracción voluntaria máxima sostenida / Concurrence of fatigue and potentiation after a sustained maximal voluntary contraction

El objetivo del presente estudio fue analizar la concurrencia e interacción existente entre diferentes factores que afectan al rendimiento, tales como son la fatiga central, la fatiga periférica y la potenciación post-activación (PPA) tras la realización de una contracción máxima voluntaria (CMV) sostenida hasta la pérdida del 50% en los valores de fuerza iniciales. Con el objetivo de valorar los efectos de la fatiga central, fatiga periférica y la PPA se utilizó la técnica de interpolación de descargas. Los resultados han revelado pérdidas en los valores de durante aproximadamente 3'30'' y que la fatiga dependió tanto de factores centrales como periféricos. También se produjo una inhibición de la PPA tras la realización de la CMV sostenida, durante un breve periodo de tiempo (entre 30'' y 1'30''). Además, se observó la coexistencia de los distintos fenómenos estudiados, que sin embargo, demostraron tener una curva de recuperación temporal diferente (AU)

The aim of the present study was to analyze the concurrence and interaction between different factors affecting the performance, such as central fatigue, peripheral fatigue and post-activation potentiation (PAP) after the performance of a maximal voluntary contraction (MVC) sustained until the loss of the 50% of the initial torque value. In order to assess the effects of central fatigue, peripheral fatigue and the PAP on the performance of the MVC, the twitch interpolation technique was used. Our findings revealed a loss of the force capability during at least 3'30'' and that the recorded fatigue had central and peripheral contributions. Moreover, it has been observed an inhibition of the PAP after the completion of the sustained MVC during a brief interval (between 30'' and 1'30''). Furthermore, it has been observed the coexistence of the different studied phenomena, however, they showed different time course of the recovery (AU)

Cataract in a patient with 47,XYY sex chromosome aneuploidy. / Catarata congénita en un paciente con aneuploidía cromosómica 47,XYY.

CASE REPORT: The case concerns a 16 year-old boy with a history of high myopia and unilateral congenital cataract, tall stature for age, facial dysmorphism, hypermobile metacarpal-phalangeal joints, as well as behavioural problems. The mother had a history of recurrent pregnancy loss. Chromosomal analysis of the peripheral blood lymphocytes reported 47,XYY. DISCUSSION: Patients with sex chromosome aneuploidy 47,XYY have higher risk of congenital malformations, although ophthalmological anomalies are unusual. Evaluation of patients with tall stature and behavioural problems should include a chromosomal analysis in order to determine the aetiology.

Neural adaptations after short-term wingate-based high-intensity interval training.

OBJECTIVES: This study examined the neural adaptations associated with a low-volume Wingate-based High Intensity Interval Training (HIIT). METHODS: Fourteen recreationally trained males were divided into an experimental (HIIT) and a control group to determine whether a short-term (4 weeks) Wingate-based HIIT program could alter the Hoffmann (H-) reflex, volitional (V-) wave and maximum voluntary contraction (MVC) of the plantar-flexor muscles, and the peak power achieved during a Wingate test. RESULTS: Absolute and relative peak power increased in the HIIT group (ABS_Ppeak: +14.7%, P=0.001; and REL_Ppeak: +15.0%, P=0.001), but not in the control group (ABS_Ppeak: P=0.466; and REL_Ppeak: P=0.493). However, no significant changes were found in the MVC (P>0.05 for both groups). There was a significant increase in H-reflex size after HIIT (+24.5%, P=0.004), while it remained unchanged in the control group (P=0.134). No significant changes were observed either in the V-wave or in the Vwave/Mwave ratio (P>0.05 for both groups). CONCLUSION: The Wingate-based training led to an increased peak power together with a higher spinal excitability. However, no changes were found either in the volitional wave or in the MVC, indicating a lack of adaptation in the central motor drive.

Efecto inmediato de infusiones de consumo habitual en las propiedades salivales / Immediate effect of commonly consumed infusions in the salivary properties

Gran cantidad de población consume cotidianamente infusiones, como el Té, Manzanilla y Yerba Mate. Diferentes estudios han determinado sus efectos benéficos en los seres humanos, razón por la cual, para este estudio se han seleccionado aquellas infusiones de uso habitual con el fin de caracterizar sus efectos inmediatos sobre las propiedades de la saliva. Con grupos de 37 sujetos sanos, entre 18-23 años, de bajo riesgo cariogénico se obtuvieron 3 muestras de saliva no estimulada: Basal; Post-ingesta de Agua Destilada (Placebo) y Post-ingesta Infusión (Té Negro, Té Verde, Mate, Manzanilla y Manzanilla con Endulzante), respectivamente. Todas las pruebas fueron realizadas bajo condiciones estándar. Se determinó el flujo salival (ml/min), pH mediante pH-metro (PL-600, GOnDO Electronics Co, TW) y capacidad buffer mediante método de Ericsson. Todos los datos se procesaron mediante la prueba ANOVA con el programa Origin 6.0. El promedio de Flujo Salival Basal (0,51 ml/min) tiende a aumentar destacando el efecto de la Manzanilla con Endulzante (0,63 ml/min); el pH basal (7,25) se mantuvo relativamente constante, y la Capacidad Buffer (4,38) también tiende a aumentar destacando la Manzanilla (5,01). El efecto de algunas infusiones es positivo sobre las propiedades salivales, destacando la Infusión de Manzanilla, Manzanilla con Endulzante y Yerba Mate las cuales aumentan significativamente el flujo y la capacidad buffer salival, lo cual sugiere un efecto benéfico en la prevención de caries.

A great number of the population consumes daily a variety of infusions such as Tea, Chamomile and Mate Herb. Different studies have determined their favorable effects in human beings, for this reason those infusions habitually used have been selected for this study, in order to characterize their immediate effects on the saliva properties. We studied groups of 37 healthy subjects, between 18-23 years of age, with low caries risk, and obtained 3 samples of non-stimulated saliva: Basal; Post-ingestion of Distilled Water (Placebo); Post-ingestion of Infusion (Black Tea, Green Tea, Mate Herb, Chamomile and Chamomile with Sucralose). All the tests were realized under standard conditions. We measured, salivary flow (ml/min); pH with pH-meter (PL-600, GOnDO Electronics Co, TW) and buffer capacity with Ericsson's method. All the information was processed with Anova Test in Origin 6.0. Our results showed the average of Salivary Basal Flow (0.51 ml/min) tends to increase standing out the effect of Chamomile with Sucralose (0.63 ml/min), the basal pH (7.25) was maintained relatively constant, and finally the Buffer Capacity (4.38) also tends to increase, emphasizing Chamomile (5.01). The effect of some infusions is positive on the salivary properties, emphasizing the Infusion of Chamomile, Chamomile with Sucralose and Mate Herb, which increase significantly the flow and the salivary buffer capacity. This suggests a favorable effect in the prevention of caries.

Effects of a balanced energy and high protein formula diet(Vegestart complet®) vs. low-calorie regular diet in morbid obese patientsprior to bariatric surgery (laparoscopic single anastomosis gastric bypass): A prospective, double-blind randomized study / Efectos de una dieta-formula normocalórica e hiperproteica (Vegestart complet®) vs dieta normal baja en calorias en pacientes con obesidad morbida como preparacion a cirugía bariátrica (bypass gástrico laparoscópico de una anastomosis): estudio prospectivo doble ciego aleatorizado

Objective: Bariatric surgery is considered the only therapeutic alternative for morbid obesity and its comorbidities. High risks factors are usually linked with this kind of surgery. In order to reduce it, we consider that losing at least 10% of overweight in Morbid Obese (MO) and a minimum of 20% in Super- Obese patients (SO) before surgery, may reduce the morbidity of the procedure. The aim of our study is to demonstrate the effectiveness and tolerance of a balanced energy formula diet at the preoperative stage, comparing it against a low calorie regular diet. Method: We studied 120 patients divided into two groups of 60 each, group A was treated 20 days prior to bariatric surgery with a balanced energy formula diet, based on 200Kcal every 6 hours for 12 days and group B was treated with a low calorie regular diet with no carbs or fat. The last eight days prior to surgery both groups took only clear liquids. We studied the evolution of weight loss, the BMI, as well as behavior of co-morbidities as systolic blood pressure, diastolic blood pressure, glucose controls and tolerance at the protocol. Results: The study shows that patients undergoing a balanced energy formula diet improved their comorbidities statistically significant in terms of decrease in weight and BMI loss, blood pressure and glucose, compared to the group that was treated before surgery with a low calorie regular diet. Nevertheless both groups improving the weight loss and co-morbidities with better surgical results and facilities. Conclusion: A correct preparation of the Morbid Obese patients prior of surgery can reduce the operative risks improving the results. Our study show that the preoperative treatment with a balanced energy formula diet as were included in our protocol in patients undergoing bariatric surgery improves statistical better their overall conditions, lowers cardiovascular risk and metabolic diseases that the patients with regular diet alone (AU)

Objetivos: La cirugía bariátrica es considerada la única alternativa terapéutica para el control de la obesidad mórbida y sus co-morbilidades. Dada la complejidad, gravedad y dificultades de estos pacientes, todo lo que hagamos para disminuir los riesgos peri-operatorios debe ser considerado como muy beneficioso para ellos. De este modo consideramos que una disminución como mínimo del 10% en el exceso de peso en los Obesos Mórbidos (OM) y un 20% en los Super-Obesos (SO), antes de la cirugía, puede mejorar los resultados y disminuir la morbimortalidad del procedimiento. El objetivo de nuestro estudio es demostrar la eficiencia y tolerancia de una dieta-fórmula hiperproteica y normocalórica como preparación preoperatoria, comparándola con una dieta hipocalórica de comida habitual. Métodos: De forma prospectiva y aleatorizada, se estudiaron 120 pacientes divididos en dos grupos de 60 cada uno. Las dietas se administraron 20 días previos a la cirugía. Al primer grupo (A), se le aplicó una dieta-fórmula hiperproteica y normocalórica en bricks, conteniendo 200 kcal cada 6 horas durante los primeros 12 días y al segundo grupo (B), una dieta hiperproteica normal sin carbohidratos o grasas. Los últimos 8 días previos a la cirugía se dieron solamente líquidos claros en ambos grupos. El análisis se efectuó sobre la evolución del peso, del IMC, de la presión arterial y de los niveles de glucemia, así como de la tolerancia al procedimiento. Resultados: El estudio demostró que los pacientes pertenecientes al grupo A, mejoraron de forma estadísticamente significativa tanto en la pérdida de peso y del IMC, como de las co-morbilidades estudiadas, frente a los pacientes que integraron el grupo B. Aunque en todo el conjunto, ambos grupos obtuvieron pérdida de peso preoperatoria y mejoría en sus co-morbilidades. Conclusiones: Una preparación adecuada para los pacientes que vayan a ser sometidos a cirugía bariátrica, puede mejorar los resultados y minimizar los posibles efectos indeseables de la misma. Una dieta-fórmula del tipo de la ensayada en nuestro estudio, alcanza los objetivos de pérdida de peso y reducción o control de las co-morbilidades en mejor proporción que las dietas hipocalóricas habituales, mejorando el riesgo cardiovascular y facilitando todo el proceso quirúrgico (AU)

Guía práctica para el manejo y tratamiento ante la cistitis radical / Practical treatment approach of radiation induced cystitis

Objetivo: Establecer una pauta de actuación y un algoritmo terapéutico ante la aparición de hematuria en pacientes con antecedentes de radioterapia pélvica, revisando para ello las diferentes opciones de tratamiento reflejadas en la literatura médica. Material y métodos: A través de PubMed se realiza una revisión bibliográfica de artículos relacionados con la cistitis rádica, incluyendo términos de búsqueda referidos a las diferentes opciones de tratamiento: ácido hialurónico endovesical; estrógenos conjugados, pentosan polisulfato, ácido aminocaproico oral, factor VIIa recombinante, cámara hiperbárica, embolización, aluminio endovesical, balón Helmstein y formolización. Se limita la búsqueda a publicaciones en castellano e inglés y se excluyen aquellas referidas a la experimentación animal. Resultados: Se expone cada una de las opciones citadas, haciendo referencia al mecanismo de acción, pauta y dosis de administración, efectos secundarios y prevención de los mismos si es posible así como eficacia del tratamiento. Tras conseguir estabilizar hemodinamicamente al paciente y descartar la presencia de lesiones neoformativas vesicales y/o hematurias originadas en tramo urinario superior, se debe iniciar un tratamiento escalonado. Conclusiones: El conocer diferentes opciones de tratamiento y sus pautas de administración permitirá al urólogo obtener una mayor tasa de éxitos en el difícil manejo de esta patología (AU)

Objective: Establish a pattern of behavior and treatment algorithm at the onset of hematuria in patients with a previous history of pelvic radiation, checking for this different treatment options reflected in the literature. Material and methods: Through performing a PubMed literature review of articles related to IC lies, searching items includes the different treatment options: intravesical hyaluronic acid, conjugated estrogens, pentosan polysulfate, oral aminocaproic acid, recombinant factor VIIa, hyperbaric chamber, embolization, aluminum intravesical, Helmstein ball and formalin. Limits the search to english or spanish publications and excluding those related to animal experimentation. Results: Every option is exposed, referring to the physiopathology, dosage regimen and administration, side effects and treatment efficacy. Conclusions: Once patient hemodynamic stabilization is achieved, and after rule out bladder tumors injuries and /or haemathuria originating from the upper urinary tract, treatment should start rolling. To know different treatment options and patterns of administration will allow the urologist to obtain a higher rate of success in the difficult management of this condition (AU)

[Practical treatment approach of radiation induced cystitis]. / Guía práctica para el manejo y tratamiento ante la cistitis radical.

OBJECTIVE: Establish a pattern of behavior and treatment algorithm at the onset of hematuria in patients with a previous history of pelvic radiation, checking for this different treatment options reflected in the literature. MATERIAL AND METHODS: Through performing a PubMed literature review of articles related to IC lies, searching items includes the different treatment options: intravesical hyaluronic acid, conjugated estrogens, pentosan polysulfate, oral aminocaproic acid, recombinant factor VIIa, hyperbaric chamber, embolization, aluminum intravesical, Helmstein ball and formalin. Limits the search to english or spanish publications and excluding those related to animal experimentation. RESULTS: Every option is exposed, referring to the physiopathology, dosage regimen and administration, side effects and treatment efficacy. CONCLUSIONS: Once patient hemodynamic stabilization is achieved, and after rule out bladder tumors injuries and /or haemathuria originating from the upper urinary tract, treatment should start rolling. To know different treatment options and patterns of administration will allow the urologist to obtain a higher rate of success in the difficult management of this condition.

Effects of a balanced energy and high protein formula diet (Vegestart complet®) vs. low-calorie regular diet in morbid obese patients prior to bariatric surgery (laparoscopic single anastomosis gastric bypass): a prospective, double-blind randomized study.

OBJECTIVE: Bariatric surgery is considered the only therapeutic alternative for morbid obesity and its comorbidities. High risks factors are usually linked with this kind of surgery. In order to reduce it, we consider that losing at least 10% of overweight in Morbid Obese (MO) and a minimum of 20% in Super- Obese patients (SO) before surgery, may reduce the morbidity of the procedure. The aim of our study is to demonstrate the effectiveness and tolerance of a balanced energy formula diet at the preoperative stage, comparing it against a low calorie regular diet. METHOD: We studied 120 patients divided into two groups of 60 each, group A was treated 20 days prior to bariatric surgery with a balanced energy formula diet, based on 200 Kcal every 6 hours for 12 days and group B was treated with a low calorie regular diet with no carbs or fat. The last eight days prior to surgery both groups took only clear liquids. We studied the evolution of weight loss, the BMI, as well as behavior of co-morbidities as systolic blood pressure, diastolic blood pressure, glucose controls and tolerance at the protocol. RESULTS: The study shows that patients undergoing a balanced energy formula diet improved their comorbidities statistically significant in terms of decrease in weight and BMI loss, blood pressure and glucose, compared to the group that was treated before surgery with a low calorie regular diet. Nevertheless both groups improving the weight loss and co-morbidities with better surgical results and facilities. CONCLUSION: A correct preparation of the Morbid Obese patients prior of surgery can reduce the operative risks improving the results. Our study show that the preoperative treatment with a balanced energy formula diet as were included in our protocol in patients undergoing bariatric surgery improves statistical better their overall conditions, lowers cardiovascular risk and metabolic diseases that the patients with regular diet alone.

Curva de potencia en jugadores de baloncesto de liga EBA / No disponible

En baloncesto, la habilidad de generar altos niveles de fuerza en cortos periodos de tiempo (potencia muscular) es un factor determinante para mejorar el rendimiento deportivo (Hedrick, 1993). Así los métodos de entrenamiento con pesas, el entrenamiento pliométrico y la combinación de ambos, parecen ser los más efectivos para la mejora de la potencia muscular (Santos & Janeira, 2008), siempre que se conozca la intensidad óptima con la que trabajar para el desarrollo de la máxima potencia. Sin embargo, no se ha encontrado ningún estudio que la defina en baloncesto. Por lo tanto, el objetivo del presente trabajo fue definir la curva potencia-fuerza (P-F) en jugadores de baloncesto de élite pertenecientes a un equipo de Liga EBA (AU)

[Arteriovenous fistula of the renal stump after nephrectomy]. / Fistula arteriovenosa renal secundaria a la ligadura en bloque del pedículo renal.

An arteriovenous fistula of the renal pedicle is a rare complication after nephrectomy. Most of cases we identify it time along after surgery. We present a case of an arteriovenous fistula of the right renal pedicle after nephrectomy done for pyonephrosis 40 years before. We comment the clinical features, treatment and evolution of the patient. We also review the actual literature.

Fístula arteriovenosa renal secundaria a la ligadura en bloque del pedículo renal / Arteriovenous fistula of the renal stump after nephrectomy

La fístula o aneurisma arteriovenoso del pedículo renal después de la nefrectomía es una complicación poco frecuente. La mayoría de las veces se diagnostica muchos años después de la cirugía. Presentamos un caso de fístula arteriovenosa del pedículo renal derecho después de una nefrectomía realizada, por pionefrosis litiásica derecha, 40 años antes. Comentamos el cuadro clínico inicial, el tratamiento y la evolución del paciente. Se revisa la literatura actual

An arteriovenous fistula of the renal pedicle is a rare complication after nephrectomy. Most of cases we identify it time along after surgery. We present a case of an arteriovenous fistula of the right renal pedicle after nephrectomy done for pyonephrosis 40 years before. We comment the clinical features, treatment and evolution of the patient. We also review the actual literature

Resultados de la psicoterapia grupal breve en estudiantes universitarios de la Quinta Región: estudio exploratorio basado en instrumentos proyectivos / Sort-term group psychotherapy outcomes with college students of fifth region: exploratory study based upon projective tests

El presente artículo es una investigación exploratoria del cambio en psicoterapia grupal en relación con algunas dimensiones de funcionamiento psíquico. Se informa sobre los resultados de un tratamiento grupal breve con estudiantes evaluados pre y post-tratamiento por medio del uso de una batería de pruebas proyectivas. Los resultados se organizan en matrices de análisis cuyas significaciones tienden a indicar cambios focales en las dimensiones de función de identidad, mayoritariamente, y en energía disponible y control de impulsos, en menor grado. Se analiza el alcance y las posibles implicancias tanto de los cambios como de los no cambios. Se discute la sensibilidad mostrada por los instrumentos utilizados así como las limitantes impuestas por los defectos metodológicos del estudio.

Derrame pleural como complicación de la alimentación parenteral por vía central en el recién nacido: a propósito de un caso / Pleural effusion as a complication of central parenteral feeding in the newborn: based on one

Presentamos un caso de derrame pleural como complicación de la colocación de un catéter epicutáneo en el recién nacido, por perforación de la arteria pulmonar derecha, discutiendo sobre la forma de presentación y manejo. A pesar de la seguridad con que este tipo de catéteres son utilizados en el neonato, son posibles las complicaciones, sobre todo en forma de perforación vascular, como en nuestro caso (AU)

[Cholangiocarcinoma]. / Colangiocarcinoma.

The cholangiocarcinoma is a low-prevalence neoplasia, but represents a great medical challenge in its diagnosis and treatment because of its insidious clinical manifestations. Its cellular origin has been associated to other hepatic tumors, and to multiple congenital or acquired factors (infections, drugs and other diseases). The most frequent histological type is the adenocarcinoma and the most common localization is the choledochal duct; local metastases are frequently found in autopsies. The usual clinical findings are pruritus, weight loss, anorexia, jaundice and hepatomegaly. The immunohistochemical advances related to oncogenes (ras & C-erb B-1) and tumor markers (Epidermal Growth Factor and Integrin among others) allow to make differential diagnosis with other hepatic cancers and will provide valuable information about its cell biology. The initial approach to patients with this disease is made by ultrasound (US), which can be associate to Doppler; Computed Axial Tomography and Nuclear Magnetic Resonance have similar sensitivity and specificity, so they are preferred to US in the elderly with history of weight loss. It's better to perform Percutaneous Transhepatic Cholangiography than Endoscopic Retrogrado Pancreatocholangiography when its possible because the first permits a comprehensive visualization of the biliary tree. The treatment includes resection and endoprosthesis placement. The combination of surgery, Chemotherapy and Radiotherapy allows to achieve the best survival rates, and opens a door to new strategies related to this malignancy.

[The therapeutic management of the rupture of a kidney graft]. / Actitud terapéutica ante la rotura del injerto renal.

From a consecutive series of 106 renal transplants, we present our experience on spontaneous renal allograft rupture. This complication appeared in 6 patients, which accounts for 5.6% of the overall group: four patients (66.6%) had acute rejection, two (33.3%) developed thrombosis of the renal vein (one of which coincided with rejection), and rupture was attributed to trauma in one patient (16.6%). Rupture was diagnosed within the first two weeks after transplant in five patients and on day 27 in one patient. The therapeutic approach was determined according to the cause of the rupture. In our view, nephrectomy is warranted in those cases with venous thrombosis and in acute rejection correction of hypovolemia and adequate immunosuppression are essential. Drainage of perirenal hematoma is the first step when conservative surgical treatment is required. We use three-dimensional renal corsetage with polyglycolic acid mesh (PAM) for hemostasis and to prevent expansion and fragmentation of the parenchyma. PAM is easy to handle and covers the kidney completely and uniformly. Two nephrectomies were carried out and in both cases thrombosis of the renal vein was diagnosed. PAM was placed in two cases: one with rejection and the other with trauma. The remaining two patients were managed conservatively due to the good response of rejection to immunosuppressor therapy and the patients response to medical treatment. There were no deaths and complications were observed in only one patient (16.6%). All patients with preserved transplant (66.6%) had a good course and renal function was preserved.