Intoxicación por harina de altramuz: nuevas perspectivas a través de un caso clínico / Lupine flour intoxication: new insights through a case report

El altramuz es un fruto de la familia de las leguminosas que se consume ampliamente como un aperitivo en zonas del Mediterráneo, norte de África, Asia y América Latina. Contiene dos alcaloides que aportan un sabor muy amargo al fruto y tienen efecto anticolinérgico: la esparteína y la lupanina; éstos se eliminan del fruto tras someterlo a un proceso de lavado y remojado. Presentamos un caso de intoxicación por consumo de harina de altramuz: mujer de 41 años que consultó en urgencias por un cuadro agudo de malestar general, sequedad de boca, distensión abdominal, náuseas y midriasis bilateral. Los síntomas se iniciaron una hora después de haber consumido un pan casero elaborado con harina de altramuz seco. Tras instaurar tratamiento sintomático e hidratación, los síntomas desaparecieron en las siguientes horas. La intoxicación por altramuz es un cuadro clínico infrecuente y probablemente infradiagnosticado considerando lo extendido de su consumo, en particular la intoxicación por consumo de harina del mismo. Es probable que en el futuro aumente el consumo de altramuz con objeto de beneficiarse de sus propiedades saludables (mayor contenido proteico, en fibras y proteínas, mayor saciedad). Se precisan un alto índice de sospecha clínica para identificar y tratar correctamente el cuadro, y una información completa a la población general sobre la manera correcta de preparación del altramuz, alertando y concienciando de los riesgos que conlleva su consumo en estado no procesado. (AU)

Lupin is a plant member of the Leguminosae family, widely consumed as a snack in Mediterranean countries, north of Africa, Asia and Latin America. Lupine seeds may cause poisoning due to the presence of two alkaloids, sparteine and lupanine, which can cause anticholinergic effects and have a bitter taste. These substances can be eliminated from the plant after a process of washing and rinsing. A clinical case is presented. A female patient aged 41 was admitted to the Emergency Room with general malaise, mouth dryness, abdominal distension, nausea and bilateral mydriasis, all of acute onset. Symptoms started one hour after consuming a homemade bread elaborated with dry lupine seeds. Symptomatic treatment and intravenous hydration were started and the symptoms disappeared within a few hours. Lupine seed intoxication is infrequent and probably underdiagnosed, considering how widely consumed the seeds are. Lupine flour intoxication is a particularly elusive diagnosis. Lupin consumption is likely to rise in the future due to increased interest in achieving its health benefits (high protein and fiber content). A high degree of clinical suspicion is needed to correctly identify and treat the intoxication. General population should be informed about how to correctly prepare lupine seeds, alerting about the potential risks of consumption in its unprocessed state. (AU)

[Nursemaid's elbow: diagnosis and treatment in emergency department]. / Pronación dolorosa: diagnóstico y manejo de urgencia.

INTRODUCTION: Painful pronation (PD), also known as "nursemaid's elbow", is a common injury caused by abrupt longitudinal traction of the hand while the forearm is pronated and the elbow extended. OBJECTIVE: to describe a sample of patients diagnosed with painful pronation and the different reduction tech niques used for this pathology. PATIENTS AND METHOD: retrospective study of patients who visited the emergency department of a referral hospital, from January 2018 to September 2019. Patients under 7 years of age consulting due to a condition compatible with PD were included. We recorded demogra phic data, sex, and age, number of previous episodes (defining recurrent as three or more episodes), affected extremity, mechanism of injury, diagnostic images, reduction maneuver used, and success obtained measured through the presence of "click" and decrease in pain. Patients who presented any sign of trauma or fractures were excluded from the study. RESULTS: 172 patients were included, 57.6% were female, and a median age of 25.5 months. The most affected side was the left one and the main mechanism was traction of the extremity, followed by a same-level fall. The hyperpronation method was effective in 66% of the cases, and the remaining 34% required a supination maneuver. CONCLUSIONS: PD is a frequent reason for consultation in pediatric patients around the age of 2 years. The hyperpronation method was the most commonly used for its management. It is important to be aware of this pathology in the context of emergency care.

Absceso de Brodie, una patología de difícil diagnóstico / Brodie's abscess, a pathology difficult to diagnose

INTRODUCCIÓN: Las infecciones osteoarticulares agudas pediátricas constituyen patologías poco frecuentes, siendo de suma importancia realizar un diagnóstico precoz y tratamiento adecuado para evitar las compli caciones agudas o a largo plazo. El absceso de Brodie (AB) es una forma de osteomielitis subaguda de baja incidencia y de difícil diagnóstico, por lo que es imprescindible la sospecha clínica. OBJETIVO: Presentar un caso de AB y describir las características etiológicas y clínicas de esta patología. CASO CLÍNICO: Paciente 14 años, evaluado por dolor de muslo derecho de un mes de evolución, afebril y sin antecedente de trauma. Al examen físico no presentaba aumento de volumen, el rango de movimiento (ROM) de cadera derecha era doloroso y la sensibilidad estaba aumentada a la palpación su perficial de banda iliotibial (BIT) derecha. Estudio radiológico sin alteraciones. Por persistir síntomas se solicitó ecografía de muslo que mostró irregularidad ósea cortical. Resonancia Magnética (RM) evidenció lesión en diáfisis de fémur derecho de probable origen tumoral o infeccioso. Parámetros inflamatorios sin alteraciones. Se realizó toma de biopsia y cultivos, aislando Staphylococcus aureus multisensible. Se procedió a aseo quirúrgico y terapia antibiótica endovenosa, evolucionando favo rablemente. CONCLUSIONES: La presentación clínica y laboratorio en AB pueden ser inespecíficas. El clínico no especialista debe tener un alto índice de sospecha de esta patología como posible diagnós tico diferencial en pacientes que persisten con dolor y presentan una alteración radiológica, incluso ante la ausencia de otros síntomas y parámetros inflamatorios normales. Es importante realizar una biopsia ósea para el diagnóstico diferencial de patologías tumorales.

INTRODUCTION: Acute osteoarticular infections in children are rare pathologies, therefore early diagnosis and prompt treatment are crucial to avoid acute and long-term complications. Brodie's abscess (BA) is an un common type of subacute osteomyelitis, difficult to diagnose, so clinical suspicion is essential. OBJECTIVE: To describe a case of Brodie's abscess and its etiological and clinical features. CLINICAL CASE: A 14-year-old patient was seen at our clinic, who reported a one-month pain in the right thigh, with no history of fever or trauma. Physical examination revealed no volume increase, painful right hip range of motion, and increased sensitivity on superficial palpation of the right iliotibial band. X-rays where normal. Because of the pain persistence, an ultrasound was requested which showed a cortical irregularity. Magnetic resonance imaging (MRI) was performed and revealed a right femoral diaphysis, due to a possible bone tumor or an infectious process. Lab tests were normal. Biopsy and cultures were collected, identifying multi-sensitive Staphylococcus aureus. He was managed with debridement and intravenous antibiotics, responding positively. CONCLUSIONS: The BA's clinical features and lab tests are unspecific, therefore the non-specialist physician should strongly suspect this pathology as a possible differential diagnosis in patients who persist with pain and present imaging alterations, even when there are no other symptoms or normal inflammatory parameters. A bone biopsy is essential for the differential diagnosis of tumor pathologies.

[Brodie's abscess, a pathology difficult to diagnose]. / Absceso de Brodie, una patología de difícil diagnóstico.

INTRODUCTION: Acute osteoarticular infections in children are rare pathologies, therefore early diagnosis and prompt treatment are crucial to avoid acute and long-term complications. Brodie's abscess (BA) is an un common type of subacute osteomyelitis, difficult to diagnose, so clinical suspicion is essential. Ob jective: To describe a case of Brodie's abscess and its etiological and clinical features. CLINICAL CASE: A 14-year-old patient was seen at our clinic, who reported a one-month pain in the right thigh, with no history of fever or trauma. Physical examination revealed no volume increase, painful right hip range of motion, and increased sensitivity on superficial palpation of the right iliotibial band. X-rays where normal. Because of the pain persistence, an ultrasound was requested which showed a cortical irregularity. Magnetic resonance imaging (MRI) was performed and revealed a right femoral diaphysis, due to a possible bone tumor or an infectious process. Lab tests were normal. Biopsy and cultures were collected, identifying multi-sensitive Staphylococcus aureus. He was managed with debridement and intravenous antibiotics, responding positively. CONCLUSIONS: The BA's clinical features and lab tests are unspecific, therefore the non-specialist physician should strongly suspect this pathology as a possible differential diagnosis in patients who persist with pain and present imaging alterations, even when there are no other symptoms or normal inflammatory parameters. A bone biopsy is essential for the differential diagnosis of tumor pathologies.

Physicochemical and microbiological stability of two news oral liquid formulations of clonidine hydrochloride for pediatric patients.

Pediatric patients present changing physiological features. Because of the lack of land suitable for commercial management, pediatric specialties very often need to prepare extemporaneous formulations to improve the dosage and administration of drugs for children. Oral liquid formulations are the most suitable for pediatric patients. Clonidine is widely used in the pediatric population for opioid withdrawal, hypertensive crisis, attention deficit disorders and hyperactivity syndrome, and as an analgesic in neuropathic cancer pain. The objective was to study the physicochemical and microbiological stability and determine the shelf life of an oral solution containing 20 µg/mL clonidine hydrochloride in different storage conditions (5 ± 3 °C, 25 ± 3 °C, and 40 ± 2 °C). Using raw material with excipients safe for all pediatric age groups, two oral liquid formulations of clonidine hydrochloride were designed (with and without preservatives). Solutions stored at 5 ± 3 °C (with and without preservatives) were physically and microbiologically stable for at least 90 days in closed containers and for 42 days after opening. Two oral solutions of clonidine hydrochloride 20 µg/mL were developed for pediatric use from raw materials that are readily available and easy to process, containing safe excipients that are stable over a long period of time.

Micosis pulmonar por Paracoccidioides brasiliensis: confusión peligrosa con sarcoidosis / Pulmonary mycosis caused by Paracoccidioides brasiliensis: dangerous confusion with sarcoidosis

Se presenta el caso de un paciente de origen sudamericano con una enfermedad pulmonar diagnosticada inicialmente de sarcoidosis y tratado con corticoides. A pesar de una mejora inicial, el paciente fue empeorando hasta que por fin el cuadro se atribuyó a una paracoccidioidomicosis. Esta micosis sistémica tiene rasgos comunes con la sarcoidosis, pero el tratamiento difiere hasta el punto de que los corticoides pueden poner en peligro la vida del paciente (AU)

We present the case of a patient from South America with a lung disease that was initially diagnosed as sarcoidosis and treated with corticoids. Despite an initial improvement, the patient worsened gradually until his condition was finally attributed to paracoccidioidomycosis. This systemic mycosis has features in common with sarcoidosis, but the treatment differs drastically because corticoids can place the patient's life at risk (AU)

Cirugía bariátrica con técnica de Santoro II: resultados metabólicos a 3 meses y 1 año / Bariatric surgery with Santoro II technique: metabolic results after 3 months and 1 year

Introducción: La obesidad tiene una alta prevalencia mundial, 25,1 por ciento de los chilenos la padece. La técnica de Santoro II (TS), como cirugía bariátrica, ha demostrado ser beneficiosa en el tratamiento de la obesidad y comorbilidades. Objetivo: Determinar variabilidad de índice de masa corporal (IMC) y parámetros metabólicos con TS en el Hospital Hernán Henríquez Aravena - Temuco (HHHA) y Clínica Alemana Temuco (CAT). Hipótesis: Los pacientes sometidos a cirugía bariátrica con TS disminuyen significativamente su IMC y parámetros metabólicos. Material y Método: Se realizó un estudio de corte transversal, muestreo intencional no probabilístico, revisando fichas de pacientes operados con TS entre los años 2005 y 2010 en el HHHA y CAT. Las variables analizadas fueron IMC, glicemia, presión arterial sistólica (PAS) y diastólica (PAD), y perfil lipídico. Los datos fueron analizados con t de Student, X2 y prueba de Fisher según correspondió. Resultados: N=26. Del total, 73 por ciento (19) fueron mujeres, con una edad promedio de 40,16 años (DE 12,07). A los 3 meses se observó una tendencia a la disminución de las variables analizadas, siendo estadísticamente significativas, con excepción de PAD. Un año después, la diferencia de estos valores con los de precirugía fueron mayores, pero la disminución de la PAD tampoco fue estadísticamente significativa. Discusión: En pacientes obesos, la TS es un procedimiento efectivo en el control metabólico, con resultados que se mantienen hasta el año de seguimiento. Nuestros resultados concuerdan según la literatura, pero faltan nuevas investigaciones para respaldar que estos son independientes a la baja de peso.

Introduction: Obesity has high prevalence worldwide, 25.1 percent of chileans suffers from it, with comorbilities associated with cardiovascular risk. The technique of Santoro II (TS) as bariatric surgery, has demonstrated to be beneficial in the treatment of the obesity and comorbidities. Objectives: Determine variability of body mass index (BMI) and metabolic parameters with TS in Hernán Henríquez Aravena Hospital - Temuco (HHHA) and Clínica Alemana Temuco (CAT). Hypothesis: Patients submitted to bariatric surgery with TS significantly decrease their body mass index (BMI), and their metabolic parameters. Material and Method: Cross-sectional study, intentional non-probabilistic sampling, reviewing records of patients operated with TS between 2005 and 2010 in HHHA and CAT. The variables analyzed were BMI, blood sugar, arterial systolic pressure(PAS) and diastolic (PAD), and lipidic profile. The data were analyzed using Student’s t-test, X2 and Fisher’s test, when it was correspond. Results: N=26. The 73 percent were women, with an average age of 40.16 years (SD 12.07). A normalization of the variables analyzed was observed 3 months after surgery, being statistically significant, with the exception of PAD. One year later the surgery, the difference of these values, with those presurgeries, was higher but the decrease of the PAD was not statistically significant either Discussion: In obese patients, the TS is an effective procedure in the metabolic control with results that maintain in a year of follow up. Our results are consistent according to the literature, but further research is needed to support that these are independent of the weight loss.

[Pulmonary mycosis caused by Paracoccidioides brasiliensis: dangerous confusion with sarcoidosis]. / Micosis pulmonar por Paracoccidioides brasiliensis: confusión peligrosa con sarcoidosis.

We present the case of a patient from South America with a lung disease that was initially diagnosed as sarcoidosis and treated with corticoids. Despite an initial improvement, the patient worsened gradually until his condition was finally attributed to paracoccidioidomycosis. This systemic mycosis has features in common with sarcoidosis, but the treatment differs drastically because corticoids can place the patient's life at risk.

Valoración de la tendencia secular de la pubertad en niños y niñas / Assessment of the secular trend in puberty in boys and girls

Objetivo: El objetivo de este estudio es analizar la secuencia de la pubertad en los niños y las niñas de nuestra área sanitaria. Métodología: Trescientos diez niños y niñas sanos de raza caucásica participaron en este estudio prospectivo. Se recogieron las siguientes variables: peso de recién nacido (PRN), peso (kg), talla (cm) e índice de masa corporal (IMC) (%) en los diferentes estadios puberales, edad ósea al inicio y final de la pubertad el tiempo de duración de la pubertad y el crecimiento durante el mismo. Resultados: Media (DE): la pubertad se inicia en los niños a los 12,4 años (1,5) con edad ósea de 11,9 años (1,3) y se alcanza el Tanner V a los 15,6 años (1,5) con edad ósea de 14,5 años. En las niñas la pubertad empieza a los 10,1 años (1,4) con edad ósea de 10,3 años (1,1), y la menarquia a los 12,0 años (1,3) con edad ósea: de 13,2 años (0,9). El tiempo de crecimiento hasta el Tanner V en los niños es de 3 años (1,2) con un crecimiento total de 19,5cm (7,6) En las niñas el tiempo de pubertad hasta la menarquia es de 2,5 años (1,1) con un crecimiento total de 15,7cm (5,0). Los niños que comenzaron la pubertad antes de los 11 años mostraron un crecimiento mayor durante la misma 27,3cm (7,9) que los que lo iniciaron después 17,4cm (5,9) (p<0,0001) y crecieron durante más tiempo 3,9 años (1,2) versus 2,7 (1,1) (p<0,001). De igual forma las niñas que comenzaron la pubertad antes de los 9 años crecieron más 19,7cm (4,3) que las que lo hicieron después 14,4cm (4,5) (p<0,0001) y más tiempo 3,1 años (0,8) versus 2,3(0,9) (p<0,0001). Conclusión: Los niños inician la pubertad a edades similares que otras poblaciones españolas, sin embargo en las niñas se adelanta, así como la menarquia. La edad ósea es acorde a la edad cronológica en ambos sexos al inicio de la pubertad pero no al final, adelantándose en las niñas. La duración de la pubertad y el crecimiento durante la misma es mayor en aquellos que inician la pubertad antes, para ambos sexos. No se encontró ninguna relación entre el IMC y el PRN con el inicio de la pubertad (AU)

Objective: Changes in the onset of puberty have been reported in the last few years. The aim of this study is to determine pubertal trends in boys and girls. Method: Longitudinal study was conducted on 310 caucasian children. We analysed birth weight (BW), weight (kg), height (cm) and body mass index (BMI) (%), bone age, duration of puberty growth and pubertal height spurt. Results: For boys the mean age at stage 2 was 12.4 (1.5) years with a bone age of 11.9 (1.3) years, and stage 5: 15.6 (1.5) with a bone age of 14.5. Mean age (years) (SD) for girls stage 2 was 10.1 (1.4), with a bone age of 10.3 (1.1). Age at menarche was 12.0 (1.3), with a bone age of 13.2 (0.9). Duration of puberty growth for boys was 3 years (1.2), and for girls 2.5 years (1.1). Pubertal height spurt in boys was 19.5cm (7.6) and for girls was 15.7cm (5.0). Girls with puberty onset<9 years of age show a greater pubertal height gain (19.7cm (4.3)) than girls >9 years of age [14.4 (4.5) (P<0.0001)] and a longer period of pubertal growth 3.1 years (0.8) versus 2.3 (0.9) (P<0.0001). Boys with puberty onset <11 years of age had a greater pubertal height gain [27.3cm (7.9)] than boys > 11 years of age [17.4 (5.9) (P<0.0001)] and a longer period of puberty growth of 3.9 years (1.2) versus 2.7 (1.1) (P<0.001). Conclusions: Boys presented secondary sex characteristics at the same age as other studies, but the girls reached puberty and menarche at a younger age than previous studies in the Mediterranean area. Bone age correlates with chronological age for both sexes at the beginning of puberty but not at the end. Early onset of puberty was associated with a greater pubertal height gain and a longer period of pubertal growth. There was no correlation between BW or BMI with onset of puberty (AU)

[Assessment of the secular trend in puberty in boys and girls]. / Valoración de la tendencia secular de la pubertad en niños y niñas.

OBJECTIVE: Changes in the onset of puberty have been reported in the last few years. The aim of this study is to determine pubertal trends in boys and girls. METHOD: Longitudinal study was conducted on 310 caucasian children. We analysed birth weight (BW), weight (kg), height (cm) and body mass index (BMI) (%), bone age, duration of puberty growth and pubertal height spurt. RESULTS: For boys the mean age at stage 2 was 12.4 (1.5) years with a bone age of 11.9 (1.3) years, and stage 5: 15.6 (1.5) with a bone age of 14.5. Mean age (years) (SD) for girls stage 2 was 10.1 (1.4), with a bone age of 10.3 (1.1). Age at menarche was 12.0 (1.3), with a bone age of 13.2 (0.9). Duration of puberty growth for boys was 3 years (1.2), and for girls 2.5 years (1.1). Pubertal height spurt in boys was 19.5cm (7.6) and for girls was 15.7cm (5.0). Girls with puberty onset<9 years of age show a greater pubertal height gain (19.7cm (4.3)) than girls >9 years of age [14.4 (4.5) (P<0.0001)] and a longer period of pubertal growth 3.1 years (0.8) versus 2.3 (0.9) (P<0.0001). Boys with puberty onset <11 years of age had a greater pubertal height gain [27.3cm (7.9)] than boys > 11 years of age [17.4 (5.9) (P<0.0001)] and a longer period of puberty growth of 3.9 years (1.2) versus 2.7 (1.1) (P<0.001). CONCLUSIONS: Boys presented secondary sex characteristics at the same age as other studies, but the girls reached puberty and menarche at a younger age than previous studies in the Mediterranean area. Bone age correlates with chronological age for both sexes at the beginning of puberty but not at the end. Early onset of puberty was associated with a greater pubertal height gain and a longer period of pubertal growth. There was no correlation between BW or BMI with onset of puberty.

Management of a hypertensive ulcer with an epidermal growth factor-based formulation.

This rare ulcer was treated with a human recombinant epidermal growth factor-based formulation and antihypertensive drugs. Full granulation was achieved in 49 days and complete wound closure in 79 days. No adverse events were reported.

Triple aneurisma aórtico, rara presentación / In case infrequent of triple aortic aneurysm

Introducción. Se presenta un raro caso de triple aneurisma aórtico, dos de tipo arteriosclerótico en la aorta torácica y otro de tipo disecante antiguo y reentrado en la aorta abdominal. Propósito del estudio. Dar a conocer una rara presentación y combinación de aneurismas. Material y método. Se presenta un paciente que ingresa en el hospital provincial Dr. Antonio Luaces por presentar dolor toráxico y tener al examen físico y complementario un aneurisma torácico, lo que lo lleva al fallecimiento. Resultados. Después de fallecer el paciente se realiza la necropsia y se encuentra doble aneurisma aórtico toráxico arteriosclerótico y un aneurisma aórtico abdominal disecante antiguo con reentrada. Conclusiones. Se presenta un raro caso y una rara combinación de aneurismas torácicoabdominal, arteriosclerótico y disecante, se presentan fotos (AU)

Introduction. A strange case of triple aortic aneurysm, two of type atherosclerotic in the thoracic aorta is presented and another of type old dissection and reenter in the abdominal aorta. urpose of the study. To give to know a strange presentation of aneurysms combination. Material and method. A patient is presented that enters in the provincial hospital Dr. Antonio Luaces to present thoracic pain and to have to the physical and complementary exam an thoracic aneurysm, what takes it to the death. Results. After dying the patient she is carried out the autopsy and it is double thoracic aneurysm aortic atherosclerotic and an aortic aneurysm abdominal with old dissection with reenter Conclusions. It is presented a strange case and a strange combination of thoracic, abdominal aneurysms abdominal, atherosclerotic and dissection, pictures are presented (AU)

[Evaluation of auditory hallucinations: the PSYRATS scale]. / La evaluación de las alucinaciones auditivas: la escala PSYRATS.

INTRODUCTION: Translate and adapt the PSYRATS scale for evaluation of auditory hallucinations to Spanish and study the psychometric behavior. METHOD: After being translated into Spanish, the scale was applied to a sample of 80 patients. All had a history of auditory hallucinations, 71 with Schizophrenia and 9 with schizoaffective disorder according to DSM-IV diagnostic criteria. Demographic and clinical data were collected by a semi-structured interview, tape recording the sessions for every patient. For the reliability study, 27 patients of the sample were evaluated independently by the first four auhors of this paper. For the study of concurrent validity the results of this scale were compared with those of the Krawiecka scale in 60 patients of the sample. RESULTS: In the Spanish version, the 11 items were conserved with slight modifications in two of them. The scale showed high reliability with coefficients in the 11 items higher than 0.85. The concurrent validity showed high association between the hallucination item of the Krawiecka scale and the PSYRATS. In the factorial analysis four factors that explained 62% of the variance were obtained. CONCLUSIONS: The Spanish version of the PSYRATS (for hallucinations) is, to our knowledge, the first scale adapted to Spanish for the study of auditory hallucinations, showing excellent psychometric properties.

La evaluación de las alucinaciones auditivas: la Escala PSYRATS / Evaluation of auditory hallucinations: the PSYRATS scale

Introducción. Traducir, adaptar al castellano y estudiar el comportamiento psicométrico de la Escala PSYRATS para la evaluación de las alucinaciones auditivas. Métodos. Después de adaptar al castellano se aplica dicha escala a una muestra de 80 pacientes. Todos ellos con historia de alucinaciones auditivas, 71 con el diagnóstico de esquizofrenia y nueve con trastorno esquizoafectivo según criterios DSM-IV. Se recogieron datos demográficos y clínicos a través de una entrevista semiestructurada, grabándose a cada paciente en cinta magnetofónica. Para el estudio de la fiabilidad interexaminadores 27 pacientes de la muestra fueron evaluados de forma independiente por los cuatro primeros autores de este artículo. Para el estudio de la validez concurrente se compararon los resultados de esta escala con los de la escala Krawiecka en 60 pacientes de la muestra. Resultados. En la versión castellana se conservaron los 11 ítems con ligeras modificaciones en dos de ellos. La escala mostró una alta fiabilidad interexaminadores con coeficientes de fiabilidad en los 11 ítems mayores de 0,85.La validez concurrente mostró asimismo una alta asociación entre el ítem de alucinaciones de la escala Krawiecka y la PSYRATS. En el análisis factorial se obtuvieron cuatro factores que explicaron el 62 por ciento de la varianza. Conclusiones. La versión castellana de la PSYRATS es la primera escala adaptada al castellano para el estudio de las alucinaciones auditivas, mostrando excelentes propiedades psicométricas (AU)

Partial improvement in pulmonary function after successful percutaneous balloon mitral valvotomy.

STUDY OBJECTIVES: This study was performed to assess the changes in pulmonary function after a successful percutaneous balloon mitral valvotomy (PBMV) in 23 consecutive patients with symptomatic mitral stenosis. METHODS AND RESULTS: Lung function preprocedure and postprocedure were evaluated by spirometric flow, static pulmonary volumes, and diffusion capacity of the lung for carbon monoxide (DLCO). At baseline, a reduction in small airways flow (maximal expiratory flow at 50% of vital capacity, 70 +/- 29% of predicted value; maximal expiratory flow at 25% of vital capacity, 55 +/- 26% of predicted value) and an increase in DLCO (118 +/- 29%) and Krough Index (KCO; 123 +/- 29% of predicted value) were observed. PBMV caused an improvement in hemodynamic parameters with an increase in mitral valve area (from 1.0 +/- 0.3 to 1.9 +/- 0.5 cm(2); p < 0.001) and a decrease in left atrial pressure (from 17 +/- 3 to 12 +/- 5 mm Hg; p < 0.001). These changes were associated with a significant increase in FVC (from 2.8 +/- 0.84 to 2.9 +/- 0.80 L; p < 0.05) and in FEV(1) (from 2.2 +/- 0.72 to 2.3 +/- 0.68 L; p < 0.05). A decrease in DLCO was observed after PBMV (from 26.7 +/- 7 to 22.5 +/- 5.4 mL/min/mm Hg; p < 0.001; and KCO, from 6.2 +/- 1.4 to 5.2 +/- 1.2 mL/min/mm Hg/L; p < 0.001). No significant changes in small airways flow were detected, suggesting only a partial improvement in pulmonary congestion. CONCLUSION: We conclude that the initial impairment of lung function in patients with symptomatic mitral stenosis is only partially ameliorated by PBMV.

Study and modulation of human cortical excitability with transcranial magnetic stimulation.

Transcranial magnetic stimulation (TMS) can be applied in different paradigms to obtain a measure of various aspects of cortical excitability. These different TMS paradigms provide information about different neurotransmitter systems, enhance our understanding about the pathophysiology of neuropsychiatric conditions, and in the future may be helpful as a guide for pharmacological interventions. In addition, repetitive TMS (rTMS) modulates cortical excitability beyond the duration of the rTMS trains themselves. Depending on rTMS parameters, a lasting inhibition or facilitation of cortical excitability can be induced. These effects can be demonstrated neurophysiologically or by combining rTMS with neuroimaging techniques. The effects do not remain limited to the cortical area directly targeted by rTMS, but affect a wider neural network transynaptically. Modulation of cortical excitability by rTMS may in the future be useful not only as a research tool but also as a therapeutic intervention in neurology, psychiatry, and neurorehabilitation.