Failure of talc seromadesis for the treatment of subcutaneous chronic seromas after incisional hernia surgery.

BACKGROUND AND AIM: Talc poudrage has been used since many years for sclerosing chronic pleural effusion. Several reports have shown good results managing chronic seromas after breast, vascular, and incisional hernia surgeries. The purpose of this study is to determine the utility of talc seromadesis for the management of chronic seromas after incisional hernia surgery. MATERIALS AND METHODS: Multicentric prospective observational study including patients diagnosed of chronic seromas after incisional hernia surgery. Under local anesthesia and ultrasonographic control, two percutaneous trocars were placed in the seroma, washing the seroma cavity with 0.9% saline solution and aspirating the remaining liquid. A sample of 4 g of talcum powder was introduced in the seroma cavity, and a 15-F drain was left in place. Patients were followed each week during at least 4 weeks after drainage removal. RESULTS: Between January 2013 and December 2016, a total of six patients were enrolled in the study. Talc poudrage was performed without any complications. Drains were pulled out in a mean time of 3 (range: 2-4) weeks. One case of the chronic seromas was efficiently sclerosed with talc without recurrence in time. In three cases, the seroma recurred, and the final solution was surgical decortication of the seroma. In the other two cases, seroma also recurred and were managed with instillation of ethanol and iodine povidone. CONCLUSION: In our experience, the management of chronic seromas after incisional hernia repair with talc seromadesis is ineffective and is associated with a high rate of seroma recurrence.

Rendimiento de la escala CardShock en pacientes con shock cardiogénico profundo tratados con membrana de oxigenación extracorpórea venoarterial / Predictive ability of the CardShock score in patients with profound cardiogenic shock undergoing venoarterial extracorporeal membrane oxygenation support

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Combining anterior and posterior component separation for extreme cases of abdominal wall reconstruction.

PURPOSE: The closure of midline in abdominal wall incisional hernias is an essential principle. In some exceptional circumstances, despite adequate component separation techniques, this midline closure cannot be achieved. This study aims to review the results of using both anterior and component separation in these exceptional cases. METHODS: We reviewed our experience using the combination of both anterior and posterior component separation in the attempt to close the midline. Our first step was to perform a TAR and a complete extensive dissection of the retromuscular preperitoneal plane developed laterally as far as the posterior axillary line. When the closure of midline was not possible, an external oblique release was made. A retromuscular preperitoneal reinforcement was made with the combination of an absorbable mesh and a 50 × 50 polypropylene mesh. RESULTS: Twelve patients underwent anterior and posterior component separation. The mean hernia width was 23.5 ± 5. The majority were classified as severe complex incisional hernia and had previous attempts of repair. After a mean follow-up of 27 months (range 8-45), no case of recurrence was registered. Only one patient (8.33%) presented with an asymptomatic bulging in the follow-up. European Hernia Society's quality of life scores showed a significant improvement at 2 years postoperatively in the three domains: pain (p = 0.01), restrictions (p = 0.04) and cosmetic (p = 0.01). CONCLUSIONS: The combination of posterior and anterior component separation can effectively treat massive and challenging cases of abdominal wall reconstruction in which the primary midline closure is impossible to achieve despite appropriate optimization of surgery.

Long-term outcomes after prophylactic use of onlay mesh in midline laparotomy.

BACKGROUND: The prevalence of incisional hernias (IHs) is still high after midline laparotomy (ML). There is an increasing body of evidence that prophylactic mesh placement (PMP) can be safe and efficient in the short-term outcomes, but there still are some concerns about the potential long-term complications of these meshes. This study describes our long-term PMP experience. METHODS: Observational and prospective study including all patients undergoing the use of prophylactic onlay large-pore polypropylene meshes for the closure of ML since 2008 to 2014. Outcome measures included demographics, perioperative details, wound complications, recurrences, reoperations and chronic complications. RESULTS: A cohort of 172 patients was analysed: 75% elective surgery, 25% emergency cases. Mean age was 68 years with mean body mass index (BMI) of 28.6 kg/m2. Wound classification: 6.4% clean; 85% clean-contaminated; 1.2% contaminated and 8.1% dirty. Follow-up of patients was up to 8 years (mean: 5 ± 1.6). Two meshes were removed due to chronic infection in first six postoperative months. Of the 13 patients (9.02%) who developed IH, 5 of them have been reoperated for IH repair without any difficulty related to previous mesh. During follow-up, 8 patients have been reoperated for other reasons and the integrity of abdominal wall was also checked. After the comparative study, higher BMI and emergency surgery were still risk factors for IH despite PMP. CONCLUSIONS: In our setting, the use of polypropylene prophylactic meshes in MLs is safe, efficient and durable.

Temporal and spatial variation of trace elements in atmospheric deposition around the industrial area of Puchuncaví-Ventanas (Chile) and its influence on exceedances of lead and cadmium critical loads in soils.

Fractionation of elemental contents in atmospheric samples is useful to evaluate pollution levels for risk assessment and pollution sources assignment. We present here the main results of long-term characterization of atmospheric deposition by using a recently developed atmospheric elemental fractionation sampler (AEFS) for major and trace elements monitoring around an important industrial complex located in Puchuncaví region (Chile). Atmospheric deposition samples were collected during two sampling campaigns (2010 and 2011) at four sampling locations: La Greda (LG), Los Maitenes (LM), Puchuncaví (PU) and Valle Alegre (VA). Sample digestion and ICP-MS gave elements deposition values (Al, As, Ba, Cd, Co, Cu, Fe, K, Mn, Pb, Sb, Ti, V and Zn) in the insoluble fraction of the total atmospheric deposition. Results showed that LG location, the closest location to the industrial complex, was the more polluted sampling site having the highest values for the analyzed elements. PU and LM were the next more polluted and, finally, the lowest elements concentrations were registered at VA. The application of Principal Component Analysis and Cluster Analysis identified industrial, traffic and mineral-crustal factors. We found critical loads exceedances for Pb at all sampling locations in the area affected by the industrial emissions, more significant in LG close to the industrial complex, with a trend to decrease in 2011, whereas no exceedances due to atmospheric deposition were detected for Cd.

Eficacia y seguridad del alprostadil intrauretral en pacientes con disfunción eréctil refractarios al tratamiento mediante inhibidores de la 5-fosfodiesterasa / Safety and efficacy of intraurethral alprostadil in patients with erectile dysfunction refractory to treatment using phosphodiesterase-5 inhibitors

Introducción: Los inhibidores de la 5-fosfodiesterasa (IPDE5) son de primera elección para el tratamiento de la disfunción eréctil (DE), pero no siempre son efectivos. El objetivo es presentar nuestra experiencia en el tratamiento de pacientes con DE, refractaria al tratamiento con IPDE5, mediante alprostadil intrauretral. Material y métodos: Revisión de 82 pacientes con DE, sin respuesta a IPDE5, desde marzo de 2013 hasta octubre de 2014. De ellos, 47 (57%) presentaban hipertensión (HTA), 24 (29%) diabetes (DM), y 20 (24%) HTA y DM. Además, 19 (23%) habían sido tratados mediante cirugía radical prostática (PR). Fueron evaluados en la consulta tras la aplicación del tratamiento y a las 4 semanas mediante los cuestionarios validados: International Index of Erectile Function (IIEF-5/SHIM), Global Assessment Questionnaire (GAQ), Sexual Encounter Profile (SEP) y Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS). Resultados: La edad media fue de 60,5 años (40-80), con seguimiento medio de 11,3 meses (1-20). El 68% de los pacientes tratados respondieron a MUSE® (74% en el grupo de HTA, 65% en el de HTA + DM, 62,5% en el de DM y 58% en el de PR). La media del IIEF-5 era de 11,7 ± 4,7, y ascendió hasta 18,6 ± 4,9 tras MUSE®(p = 0,027). La media de la puntuación del EDITS a las 4 semanas fue de 61,6 (6-81,9). El efecto adverso más frecuente fue el escozor uretral, que ocurrió en 24 pacientes (29%). No se observó ningún caso de infección del tracto urinario, síncope ni priapismo. Conclusiones: El alprostadil intrauretral es un tratamiento efectivo y con un amplio perfil de seguridad para tratar a aquellos pacientes con disfunción eréctil refractaria al tratamiento oral con IPDE5

Introduction: Phosphodiesterase-5 inhibitors (PDE5i) are the first choice for treating erectile dysfunction (ED) but are not always effective. The aim of this study was to present our experience in treating patients with ED, refractory to treatment with PDE5i, using intraurethral alprostadil (MUSE). Material and methods: We conducted a review of 82 patients with ED and no response to PDE5i, from March 2013 to October 2014. Forty-seven patients (57%) had hypertension (AHT), 24 (29%) had diabetes (DM) and 20 (24%) had AHT and DM. Additionally, 19 (23%) had undergone radical prostatic (RP) surgery. The patients were evaluated after the treatment was applied and at 4 weeks using the following validated questionnaires: International Index of Erectile Function (IIEF-5/SHIM), Global Assessment Questionnaire (GAQ), Sexual Encounter Profile (SEP) and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS). Results: The mean patient age was 60.5 years (40-80), and the mean follow-up was 11.3 months (1-20). Sixty-eight percent of the treated patients responded to MUSE® (74% in the AHT group, 65% in the AHT + DM group, 62.5% in the DM group and 58% in the RP group). The mean IIEF-5 score was 11.7 ± 4.7, which increased to 18.6 ± 4.9 after MUSE was administered (P=.027). The mean EDITS score at 4 weeks was 61.6 (6-81.9). The most common adverse effect was urethral burning, which occurred in 24 patients (29%). There were no cases of urinary tract infection, syncope or priapism. Conclusions: Intraurethral alprostadil is an effective treatment and has a broad safety profile for treating patients with erectile dysfunction refractory to oral treatment with PDE5i

Safety and efficacy of intraurethral alprostadil in patients with erectile dysfunction refractory to treatment using phosphodiesterase-5 inhibitors.

INTRODUCTION: Phosphodiesterase-5 inhibitors (PDE5i) are the first choice for treating erectile dysfunction (ED) but are not always effective. The aim of this study was to present our experience in treating patients with ED, refractory to treatment with PDE5i, using intraurethral alprostadil (MUSE). MATERIAL AND METHODS: We conducted a review of 82 patients with ED and no response to PDE5i, from March 2013 to October 2014. Forty-seven patients (57%) had hypertension (AHT), 24 (29%) had diabetes (DM) and 20 (24%) had AHT and DM. Additionally, 19 (23%) had undergone radical prostatic (RP) surgery. The patients were evaluated after the treatment was applied and at 4 weeks using the following validated questionnaires: International Index of Erectile Function (IIEF-5/SHIM), Global Assessment Questionnaire (GAQ), Sexual Encounter Profile (SEP) and Erectile Dysfunction Inventory of Treatment Satisfaction (EDITS). RESULTS: The mean patient age was 60.5 years (40-80), and the mean follow-up was 11.3 months (1-20). Sixty-eight percent of the treated patients responded to MUSE(®) (74% in the AHT group, 65% in the AHT+DM group, 62.5% in the DM group and 58% in the RP group). The mean IIEF-5 score was 11.7±4.7, which increased to 18.6±4.9 after MUSE was administered (P=.027). The mean EDITS score at 4 weeks was 61.6 (6-81.9). The most common adverse effect was urethral burning, which occurred in 24 patients (29%). There were no cases of urinary tract infection, syncope or priapism. CONCLUSIONS: Intraurethral alprostadil is an effective treatment and has a broad safety profile for treating patients with erectile dysfunction refractory to oral treatment with PDE5i.

Allergic reaction to undeclared lupin in a chocolate

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Fractionation of trace elements in total atmospheric deposition by filtrating-bulk passive sampling.

We have developed and validated a new simple and effective methodology for fractionation of soluble and insoluble forms of trace elements in total atmospheric deposition. The proposed methodology is based on the modification of a standard total deposition passive sampler by integrating a quartz fiber filter that retains the insoluble material, allowing the soluble fraction to pass through and flow to a receiving bottle. The quartz filter containing the insoluble fraction and the liquid containing the soluble fraction are then separately assayed by standardized ICP-MS protocols. The proposed atmospheric elemental fractionation sampler (AEFS) was validated by analyzing a Coal Fly Ash reference material with proper recoveries, and tested for field fractionation of a set of 10 key trace elements in total atmospheric deposition at the industrial area of Puchuncaví-Ventanas, Chile. The AEFS was proven useful for pollution assessment and also to identify variability of the soluble and insoluble fractions of the selected elements within the study area, improving the analytical information attainable by standard passive samplers for total deposition without the need of using sophisticated and high cost wet-only/dry only collectors.

U1 snRNP control of 3'-end processing and the therapeutic application of U1 inhibition combined with RNA interference.

U1 snRNP (U1 small nuclear ribonucleoprotein) is a well-characterized splicing factor. Besides, when U1 snRNP binds close to a putative polyadenylation site, mostly located in introns, it prevents premature cleavage and polyadenylation and controls the length of most cellular mRNAs. On the other hand, U1 snRNP binding close to the 3'-end of some mRNAs, inhibits polyadenylation and, therefore, gene expression. The inhibition of polyadenylation by U1 snRNP is the basis of U1i (U1 snRNP-based inhibition), a technique used to inhibit gene expression. U1i consists of the expression of a U1 snRNP modified to interact with a target mRNA and inhibit target gene expression. U1i has been used to inhibit the expression of reporter or endogenous genes both in tissue culture and in animal models. Furthermore, combination of U1i and RNA interference (RNAi) results in synergistic increased inhibitions which allow the dose of inhibitors to be decreased whilst at the same time obtaining good inhibitions with fewer unwanted secondary effects. The combination of RNAi and U1i is of special interest for antiviral therapy, as a functional decrease of the expression of replicative viral RNAs may require high inhibition and the combination of two or more inhibitors should decrease the possibility of escape mutants resistant to treatment. In fact, a therapy with U1i combined with RNAi is currently being developed for the treatment of HBV infections. We believe that this review will clarify the hallmarks of U1i technology and will encourage many laboratories to use U1i for functional studies and therapeutic applications.

Miniaturized voltammetric stripping on screen printed gold electrodes for field determination of copper in atmospheric deposition.

The applicability of commercial screen-printed gold electrodes (SPGEs) connected to a portable potentiostat and a laptop has been explored to optimize a new square wave anodic stripping voltammetric method for on-site determination of soluble Cu(II) in atmospheric deposition samples taken around an industrial complex. Electrode conditioning procedures, chemical and instrumental variables have been optimized to develop a reliable method capable of measuring dissolved copper with a detection limit of 3.7 ng mL(-1), useful for pollution monitoring or screening purposes. The proposed method was tested with the SLRS-5 River Water for Trace Metals (recoveries 109.9-113.1%) and the SPS-SW2 Batch 121 Elements in Surface Waters (recoveries 93.2-97.6%). The method was applied to soluble Cu(II) measurement in liquid samples taken by a total atmospheric deposition collector modified with a quartz filter for soluble and insoluble elemental speciation. The voltammetric measurements on field samples were tested in the lab by a reference ICP-MS method, with good agreement. The proposed method proved capability for field operation during a two weeks monitoring campaign.

Somatic mosaicism in a case of apparently sporadic Creutzfeldt-Jakob disease carrying a de novo D178N mutation in the PRNP gene.

Transmissible spongiform encephalopathies (TSEs) are a group of rare fatal neurodegenerative disorders. Creutzfeldt-Jakob disease (CJD) represents the most common form of TSE and can be classified into sporadic, genetic, iatrogenic and variant forms. Genetic cases are related to prion protein gene mutations but they only account for 10-20% of cases. Here we report an apparently sporadic CJD case with negative family history carrying a mutation at codon 178 of prion protein gene. This mutation is a de novo mutation as the parents of the case do not show it. Furthermore the presence of three different alleles (wild type 129M-178D and 129V-178D and mutated 129V-178N), confirmed by different methods, indicates that this de novo mutation is a post-zygotic mutation that produces somatic mosaicism. The proportion of mutated cells in peripheral blood cells and in brain tissue was similar and was estimated at approximately 97%, suggesting that the mutation occurred at an early stage of embryogenesis. Neuropathological examination disclosed spongiform change mainly involving the caudate and putamen, and the cerebral cortex, together with proteinase K-resistant PrP globular deposits in the cerebrum and cerebellum. PrP typing was characterized by a lower band of 21 kDa. This is the first case of mosaicism described in prion diseases and illustrates a potential etiology for apparently sporadic neurodegenerative diseases. In light of this case, genetic counseling for inherited and sporadic forms of transmissible encephalopathies should take into account this possibility for genetic screening procedures.

Los chicles de nicotina no son una golosina / Nicotine gum is not a sweet

Objetivo: Resaltar la peligrosidad de la posible ingesta accidental de chicles de nicotina en niños, debido a su forma de presentación, similar a la de sus golosinas. Material y Métodos: Estudio observacional retrospectivo de cuatro casos de ingesta accidental de 1-2 chicles de nicotina de 2 mg en niñas, registrados en el Hospital General de Segovia durante el año 2007 con edades comprendidas entre los 4 y los 7 años. Resultados: En los cuatro casos apareció sintomatología tras la ingesta del chicle, que ocurrió 20-30 minutos después de estar masticándolo. Los síntomas predominantes, en el 75% de los casos fueron náuseas, vómitos y mareo. En dos casos, 30 minutos tras la ingesta, se administró en el Servicio de Urgencias carbón activado, a los otros dos por haber pasado 4 horas tras la ingesta no se les administró. Tras permanecer 12 horas en observación y estando asintomáticas fueron dadas de alta. Discusión: La ingesta accidental de chicles de nicotina puede producir importantes efectos adversos, los cuales aparecen más rápidamente en niños que en adultos. Debe considerarse como primera medida, y más aún en la primera hora tras la ingesta la administración de carbón activado. Puesto que los niños los pueden confundir fácilmente e ingerir de forma accidental, debería tenerse en cuenta la modificación en su forma de presentación por parte de la industria farmacéutica, así como, un mayor cuidado por parte de los padres para evitar que los niños los tengan a su alcance y los ingieran (AU)

Objective: Stress the dangerousness of the possible accidental intake of nicotine gums in children due to their presentation form that is similar to that of sweets. Material and Methods: Observational, retrospective study of 4 cases in girls whose ages ranged from 4 to 7 years of accident intake of 1-2 nicotine gums of 2 mg recorded in the Hospital General of Segovia during the year 2007.Results: In the four cases, symptoms appeared after the intake of the gum, this occurring 20-30 minutes after they were chewed. The predominant symptoms in 75% of the cases were nausea, vomiting and dizziness. At 30 minutes of the intake, two cases were administered activated carbon in the Emergency Department, and there maining two were not administered it because 4 hours had passed since the intake. After remaining in observation for 12 hours and being asymptomatic, they were discharged. Discussion: Accidental intake of nicotine gum may cause important adverse effects, these appearing faster in children than in adults. Administration of activated carbon should be considered as the first measure, and even more so during the first hours after its intake. Since children can easily confuse it and accidentally consume it, the pharmaceutical industry should consider changing its presentation form. Furthermore, parents should be more careful so as to prevent their children from having access to it and consuming it (AU)