Usefulness of intravenous lacosamide in status epilepticus.

Lacosamide (LCM) is a treatment option for status epilepticus (SE) described in several series. We therefore proposed to describe its use in status epilepticus patients in our hospital. All patients admitted to our hospital for SE from September 2010 to April 2012 were evaluated. We collected related variables including the type of SE, etiology, antiepileptic drugs (AEDs) used, loading dose of AEDs, cessation of SE after AEDs, ICU admission and mortality. In those patients receiving LCM, we reviewed the infusion rate and time to response. We compared patients receiving LCM with patients in whom it was not used. This was a retrospective and uncontrolled study. A total of 92 patients were included; 67.7 % of SE patients who received LCM responded to treatment. The vast majority of the patients presented non-convulsive and motor focal SE. When we selected patients to receive four or more AEDs, the LCM efficacy was 55.6 %, a very similar result compared to when it was not used. Subsequently, we analyzed the sample regarding the AED administered as the second or third line of treatment, and the responder rate was significantly higher when LCM was used (84.6 vs. 47.8 %, p 0.041). After an adjusted regression analysis, the use of LCM was independently associated with cessation of SE. The total percentage of undesirable effects was very low (12 %), and they were all mild. No relationship was found between a specific etiology and better response. LCM is a useful drug that represents an alternative in the treatment of non-convulsive or focal motor SE. Its efficacy might be more important when it is administered as a second or third option after benzodiazepines. A randomized trial is required to confirm these results.

Fibroma ovárico en mujer joven: reporte de un caso / Ovarian fibroma in a young woman: a case report

El presente caso ocurre en una mujer joven, inicialmente sin síntomas, a la que únicamente le llamó la atención algo de estreñimiento y el aumento del perímetro abdominal, a expensas de protrusión predominantemente desde la fosa y el flanco derechos. Vale destacar la percepción del crecimiento rápido de esta masa. Sin embargo, luego de ser evaluada exhaustivamente, se estima la probabilidad de que se trate de un tumor benigno. Por lo que se practica laparotomía simple...

Epithelial-to-mesenchymal transition of mesothelial cells is an early event during peritoneal dialysis and is associated with high peritoneal transport.

Ultrafiltration (UF) failure is a consequence of long-term peritoneal dialysis (PD). Fibrosis, angiogenesis, and vasculopathy are causes of this functional disorder after 3-8 years on PD. Epithelial-to-mesenchymal transition (EMT) of mesothelial cell (MC) is a key process leading to peritoneal fibrosis with functional deterioration. Our purpose was to study the peritoneal anatomical changes during the first months on PD, and to correlate them with peritoneal functional parameters. We studied 35 stable PD patients for up to 2 years on PD, with a mean age of 45.3+/-14.5 years. Seventy-four percent of patients presented loss of the mesothelial layer, 46% fibrosis (>150 microm) and 17% in situ evidence of EMT (submesothelial cytokeratin staining), which increased over time. All patients with EMT showed myofibroblasts, while only 36% of patients without EMT had myofibroblasts. The number of peritoneal vessels did not vary when we compared different times on PD. Vasculopathy was present in 17% of the samples. Functional studies were used to define the peritoneal transport status. Patients in the highest quartile of mass transfer area coefficient of creatinine (Cr-MTAC) (>11.8 ml min(-1)) showed significantly higher EMT prevalence (P=0.016) but similar number of peritoneal vessels. In the multivariate analysis, the highest quartile of Cr-MTAC remained as an independent factor predicting the presence of EMT (odds ratio 12.4; confidence interval: 1.6-92; P=0.013) after adjusting for fibrosis (P=0.018). We concluded that, during the first 2 PD years, EMT of MCs is a frequent morphological change in the peritoneal membrane. High solute transport status is associated with its presence but not with increased number of peritoneal vessels.

[Intravenous immunoglobulin: another therapeutic application]. / Inmunoglobulina intravenosa: una nueva aplicación terapéutica.

Intravenous immunoglobulin (IVIG) has immunoregulatory functions. In renal transplant, IVIG has been used as an immunosupressor agent only during short period of time and frequently associated to others immunosupressor drugs. In renal transplant IVIG has been used to treat refractory rejection but not as maintenance immunosupressor treatment. We report a case in which IVIG was used as principal immunosupressor agent close to low doses of iv methylprednisolone. The patient could not receive anything by oral way during three months, so she only could be treated by intravenous way. It is the first time that IVIG is used as maintenance immunosupressortreatment for a long time (three months) without secondary effects.

[Orthotopic renal transplant: our experience]. / Revision del trasplante renal ortotópico en nuestro centro.

UNLABELLED: Orthotopic renal transplant (ORT) is useful in cases of severe atherosclerosis, heterotopic bilateral transplant, unsuitable pelvic vessels and in aortic thrombosis, but it is not available in all the institutions and it is only realized of exceptional form. AIM: To review the indication, surgical technique and outcome of the ORT at our hospital. MATERIAL AND METHODS: The studied included five cases between January 1990 and December 2005. We analyzed several variables: demographic characteristics, characteristics of the donor, ischemia times, evolution of renal function and morbi-mortality associated. RESULTS: Left ORT was performed in three men and two women. Mean patient age was 52+/-5 years, all the patients received kidneys from cadaveric donors. Mean creatinine and urea one month postoperative were 2.2+/-0.72 mg/dl and 103+/-17.2 mg/dl and at 6 months postoperative were 1.8+/-0.59 mg/dl and 78+/-14 mg/dl respectively. Immediately all patients received prophylaxis with low molecular weight heparin but it was indicated antiaggregation to two patients when they left the hospital, anticoagulation to two patients and to one of them was decided to anticoagulation nor antiagregation for history of bled digestive. A patient died for bleeding episode at level of the renal graft six months after the transplant, she was in treatment with dicumarinics, they were indicated by venous deep thrombosis in right leg. The survival a year is 80 % of the graft and the patient. Only two patients returned to hospital later, one of them for presenting an episode of diverticulitis and the other one for renal obstructive failure that needed laying of catheter pig-tail. Four patients presented stenosis of renal native vassels detected in control magnetic nuclear resonance, not symptomatic. There are two patients who take more than three years transplanted with renal stable function (creatinina 1.3 mg/dl and 1.4 mg/dl respectively). CONCLUSION: ORT is an excellent option in patients with co-morbidity increased for atherosclerosis and that cannot be placed in the iliac fossaes.

[Endometriosis in the episiotomy scar: a case report and review of the literature]. / Endometriosis en cicatriz de episiotomía: presentación de un caso y revisión de la literatura.

We hereby present a case of perineal endometriosis at the site of an episiotomy scar. Several considerations are made about its incidence, medical and surgical treatment and risks of this very rare complication in episiotomy scar by revision of the medical literature.

Endometriosis en cicatriz de episiotomía: presentación de un caso y revisión de la literatura / Endometriosis in the episiotomy scar: a case report and review of the literature

We hereby present a case of perineal endometriosis at the site of an episiotomy scar. Several considerations are made about its incidence, medical and surgical treatment and risks of this very rare complication in episiotomy scar by revision of the medical literature