The novel FAAH inhibitor, MCH1, reduces the infarction area in the motor cortex-related region but does not affect the sensorimotor function or memory and spatial learning in rats exposed to transient middle cerebral artery occlusion.

Macamides, amides of fatty acids first isolated from maca (Lepidium meyenii) are potentially responsible for the reduction of ischemic injury in the stroke animal model followed by maca extract administration. This deduction comes from its ability to inhibit the fatty acid amide hydrolase activity, an enzyme related to the endocannabinoid anandamide hydrolysis. However, no study about the effects of isolated macamides on in-vivo models has been published yet. Our objective was to evaluate the effect of a 10-day 30 mg/kg i.p. MCH1 administration, the macamide with the higher FAAH inhibition capability, on the neurological recovery and brain infarction area of Sprague-Dawley rats exposed to the transient middle cerebral artery occlusion (MCAO) model. Our results showed that the group receiving MCH1 for 10 days did not improve Garcia's neurological score compared to receiving the vehicle only. Likewise, the MCH1 group did not improve their sensorimotor dysfunction as indicated by the latency to detect and remove the tape from the contralateral forepaw in the adhesive removal test, and a similar number of errors with the contralateral forepaw in the foot fault test compared to the vehicle group at the 10th day. Evaluation of the spatial memory and learning using the Barnes test showed longer latency to reach the escape box in the Vehicle and MCH1 groups compared to the control group (no MCAO) only in the retrieval test, while no effect of MCAO procedure or MCH1 administration was observed in the reversal learning test. Despite the lack of behavioral effect of MCH1, analysis of the infarcted areas in the brain using the 2, 3, 5-Triphenyltetrazolium chloride (TTC) staining method in the seven consecutive coronal sections revealed that the infarcted area in the first (bregma + 4.2 mm) and fifth (bregma -3.8 mm) coronal sections of the MCAO + MCH1 group remained similar to the Control group. These results provide evidence that MCH1 can limit damage from ischemic stroke, although it is not reflected in neurological or sensorimotor behavior and spatial learning and memory.

Efficacy and Safety of Tranexamic Acid for the Control of Surgical Bleeding in Patients Under Liposuction.

Liposuction remains one of the most frequently performed cosmetic surgical procedures and its popularity is increasing every year. However, since its inception, justified concerns regarding patient safety have placed limits on the volume of fat that can be aspirated, influenced by hemodynamic fluctuations and blood loss during liposuction. Tranexamic acid (TXA) is an antifibrinolytic agent that competitively inhibits the conversion of plasminogen to plasmin, thus preventing the binding and degradation of fibrin. Despite the existence of evidence of the effectiveness of TXA in orthopedic and cardiac surgeries, there is little evidence of its use in liposuction. The objective of this study was to evaluate the efficacy and safety of tranexamic acid in the control of surgical bleeding in patients undergoing liposuction, through a prospective, open, randomized and controlled clinical trial. Two groups of 25 participants each were formed to whom the application of TXA in a tumescent solution prior to liposuction or liposuction with the traditional technique was randomly assigned. The results showed a decrease in blood loss reflected by the differences in the final hematocrit values, as well as decrease in the same per aspirated volume (p = 0.003). No adverse events were found related with the TXA application and no blood transfusions were required in this group, in contrast to the control group where the need for blood transfusion was present in 20% of the intervened participants. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Hepatocarcinoma fibrolamelar. Revisión de sus características diferenciales a partir de nuestra serie / Fibrolamellar hepatocellular carcinoma. Differencial characteristics based on our own case series

Introducción. El hepatocarcinoma fibrolamelar (CHCFL) es un tumor infrecuente, de aparición en adultos jóvenes y sobre hígado sano. Clásicamente considerado una variante del carcinoma hepatocelular (CHC), difieren en tantos aspectos, que debieranconceptuarse como entidades diferentes. El objetivo de este trabajo es refrescar sus características, haciendo hincapié en las diferenciales, para ser tenido en consideración ante lesiones hepáticas sólidas ocupantes de espacio en pacientes jóvenes. Material ymétodo.Estudio descriptivo retrospectivo de las características de 5 casos de CHCFL intervenidos en la unidad de cirugía hepatobiliopancreática un hospital de tercer nivel. Resultados. Cinco casos, edad media 31.8 años, mujer/hombre 4/1. Todos ellos sobrehígado sano, con clínica inespecífica. Radiológicamente e histopatológicamente cumplen las características típicas de este tumor.Sometidos en todos los casos a resecciones quirúrgicas amplias, y reintervenidos, por recidiva, 2 casos, uno de ellos en forma detrasplante hepático. La tabla 1 recoge todas las características epidemiológicas y clínicas, datos operatorios y supervivencia globaly libre de enfermedad de los pacientes incluidos en el estudio. Discusión. De curso clínico insidioso y silente en muchas ocasiones,el diagnóstico suele ser tardío, con grandes masas tumorales en las pruebas de imagen. Actualmente el tratamiento quirúrgico esel único potencialmente curativo. Pese a una supervivencia prolongada, la tasa de recidiva es muy elevada, precisando en muchoscasos intervenciones reiteradas. Los resultados en nuestra serie son acordes con la literatura y podrían calificarse como paradigmade las características anatomoclínicas, terapéuticas y pronósticas de este tipo de tumor. (AU)

Introduction. Fibrolamellar hepatocellular carcinoma is an infrequent tumour, which appears in young adults and on healthy liver.It has been classically considered a subtype of hepatocellular carcinoma, but they differ in such many aspects they could be considered separately. The objective of this review is to refresh its differential characteristics in order to take into account in the differentialdiagnosis of hepatic solid lessions in young adults. Material and methods. Descriptive retrospective study of the principles characteristics of the five fibrolamellar hepatocellular carcinoma operated patients by the hepatobilliary surgery team of our hospital.Results. Five cases, medium age 31.8 years, women/men 4/1. All of them in healthy liver with inespecific symptoms and radiollogicaland hystopathological typical characteristics. All of them having enlarged hepatic ressections and reoperated two of them becauseof recurrence, in one case in form of hepatic transplantation. Table 1 collect all the epidemiological and clinical characteristics, operation reports, global and recurrence free survival of all patientes included in the study. Discussion. Having insidious and silentdevelopment in many cases, diagnosis can be delayed, appearing big tumoral masses on the imaging tests. Nowadays, surgery is the only curative treatment. Despite long survival periods, the recurrence rate is very high, needing sometimes being reoperated. Our results are in the line of the literature results and could be classified as the paradigm of anatomoclinic, therapeutic and prognostic characteristics of this type of tumour. (AU)

Gaseous benzene degradation by photocatalysis using ZnO + Zn2TiO4 thin films obtained by sol-gel process.

The benzene pollutant in gaseous phase was successfully degraded by using ZnO + Zn2TiO4 multicomponent oxide thin films as photocatalysts. The films were obtained with different Ti/Zn ratios (0, 0.20, 0.40, 0.45, 0.50, 0.67, 0.84, and 1) by the sol-gel route. The initial level of benzene concentration was 110 ± 10 ppm. The process was carried out under different conditions of relative humidity (RH): 25, 50, and 80 % in a batch-type reactor, at room temperature. The results show benzene degradation near to 95 % at t = 240 min, where the multicomponent oxide semiconductor has a Ti/Zn ratio of 0.67. Meanwhile, with the TiO2 thin films, only a degradation of 70 % was reached at the same measurement conditions. This synergistic effect on the photocatalytic activity is a result of the coupling of both semiconductor oxides. An adverse effect on the photocatalytic activity was observed as the relative humidity increases.

[Sub-tenon block for ocular globe anesthesia: a review]. / Anestesia subtenoniana en cirugia del globo ocular: revision.

Sub-Tenon anesthesia is an effective, well-tolerated technique for surgery in the anterior or posterior compartments of the eye. The advantages of this block are comparable to those of peribulbar and retrobulbar anesthesia and complications are minimal. Sub-Tenon anesthesia provides better analgesia than akinesia. Most studies suggest that sub-Tenon anesthesia is a good technique to choose, given that potential adverse effects are fewer than for other regional blocks and analgesia and akinesia are superior.

Anestesia subtenoniana en cirugía del globo ocular: revisión / Sub-Tenon block for ocular globe anesthesia: a review

La anestesia subtenoniana es una técnica efectiva y bien tolerada que permite realizar intervenciones de la cámara anterior y posterior del ojo. Ofrece similares ventajas que la anestesia peribulbar y retrobulbar al tiempo que minimiza sus complicaciones. La anestesia subtenoniana proporciona mejor analgesia que aquinesia. Frente a las anestesias tópica e intracamerular, la mayoría de estudios aboga por la anestesia subtenoniana como la técnica de elección, ya que disminuye los potenciales efectos adversos de las otras técnicas regionales y proporciona mejor analgesia y aquinesia(AU)

Sub-Tenon anesthesia is an effective, well-tolerated technique for surgery in the anterior or posterior compartments of the eye. The advantages of this block are comparable to those of peribulbar and retrobulbar anesthesia and complications are minimal. Sub-Tenon anesthesia provides better analgesia than akinesia. Most studies suggest that sub-Tenon anesthesia is a good technique to choose, given that potential adverse effects are fewer than for other regional blocks and analgesia and akinesia are superior(AU)

[Acute paraplegia secondary to painless aortic dissection]. / Paraplejía aguda secundaria a la disección indolora de la aorta.

INTRODUCTION: Acute aortic dissection (AAD) is a serious and uncommon event. The clinical presentation generally includes thoracic or back pain. Painless aortic dissection is an extremely rare occurrence. Acute paraplegia is one of the neurological complications secondary to AAD. Although painful paraplegia is seen in 2% to 3% of AAD cases, painless paraplegia is a very rare event. CASE REPORT: A 51-year-old man with a long term history of hypertension, presented with acute paralysis of the lower extremities, with no chest or back pain. CONCLUSION: In presence of acute neurologic events, must always be investigated a vascular cause and, in these group of disease, the aortic dissection may be researched, although the pain wasn't present on occasion of the diagnosis.

Un caso de meningitis por virus Toscana en Murcia / A case of meningitis due to Toscana virus in Murcia

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Evaluation of renal and hepatic functions in dogs naturally infected by visceral leishmaniasis submitted to treatment with meglumine antimoniate.

The present study aimed to evaluate the renal and hepatic responses in eight dogs with visceral leishmaniasis submitted to treatment with meglumine antimoniate and to verify the occurrence of possible side effects. Urinalysis, hepatic and renal function tests were carried out in all animals at up to seven moments. After the end of a six-month observation period, all dogs were euthanized. Before the beginning of the experiment urinary and biochemical alterations were observed in four dogs due to the changes caused by the parasite itself. These alterations included the presence of renal cells, cylindruria, proteinuria, azotemia, hyperproteinemia and hypoalbuminemia. One dog died on the third day after treatment because an aggravation of the clinical picture, probably due to the medication. During the course of the study, an increase in hepatic enzymes was verified in two animals. Sixty days after the beginning of the treatment four dogs showed remission of clinical signs. The other three were asymptomatic with persistent biochemical alterations. From these, two presented recurrence of clinical signs about 150 days after the beginning of the treatment while in the other, hyperproteinemia persisted. Meglumine antimoniate was not efficient to treat dogs with severe renal dysfunction and the side effects observed were pain at the site of injection and the probable transient hepatotoxicity, evidenced by biochemical examinations, but without the presence of clinical signs.

[Paraneoplastic cerebellar degeneration as initial presentation of a pancreatic small-cell carcinoma]. / Degeneración cerebelosa paraneoplásica como inicio de un carcinoma indiferenciado de células pequeñas de páncreas.

INTRODUCTION: Oat (small) cell carcinoma is the type of tumour most frequently associated to neurologic paraneoplastic syndromes. It is usually located in the lungs although it has been described in some other locations. Cerebellar symptoms may appear alone, associated to anti Yo antibodies ( Breast and gynaecologic carcinomas), or as manifestation of a more generalized paraneoplastic encephalopathy, associated to signs and symptoms of some other neurologic systems affected. CASE REPORT: A 52 year old patient consulted due to a pancerebellar clinical picture, which started about two months before, and later associated to polineuropathy. Abdominal CT showed a 4 cm mass in the head of the pancreas. Pathologic evaluation demonstrated a poorly differentiated small cell pancreatic tumour. Anti Hu antibodies in high titres were found both in serum and cerebrospinal fluid. DISCUSSION: The association of anti Hu immunity and paraneoplastic encephalomyelitis has been observed in patients with neuroblastoma, seminomas, colorectal, breast and prostate carcinomas and some types of sarcoma. Only about 1% of pancreatic malignancies correspond to small cell type. We have not found any previous report about the association between a paraneoplastic syndrome and pancreatic poorly differentiated small cell carcinoma.

[Acute peritonitis and small bowel diverticula in a patient with mitochondrial neurogastrointestinal encephalomyopathy]. / Peritonitis agudas y divertículos del intestino delgado en una paciente con encefalomiopatía neurogastrointestinal mitocondrial.

INTRODUCTION: Jejunal and ileal diverticula are acquired lesions that are often associated with intestinal motility disturbances like those occurring in myopathies and neuropathies with visceral affection. Mitochondrial neurogastrointestinal encephalomyopathy is characterized by gastrointestinal dysmotility, cachexia, ptosis with external ophthalmoparesis, neuropathy, leukoencephalopathy and laboratory evidence of mitochondrial alteration. CLINICAL CASE: A female patient that since 9 months age presented digestive symptoms: diarrhea, nauseous, vomits, slow digestions and abdominal pain. She had myopia. At the age of 20, in a seven months period, she precised urgent abdominal surgical intervention in three occasions for acute diffuse peritonitis related to jejunal and ileal diverticula. She presented cachexia, mild palpebral ptosis, external ophthalmoparesis, hypertrophic major auricular nerves, scoliosis, pes cavus, distal weakness and hypoesthesia in extremities, bilateral neurosensorial hypoacusia and lactic acidosis. The electroneurographic study was compatible with severe chronic demyelinating sensitive motor polyneuropathy. In the cerebral MR leukoencephalopathy was detected. In muscular tissue it was seen alteration in all fibers type I with numerous lipid vacuoles and an increase of mitochondrial number in the form of thick grains and subsarcolemmal mitochondrial bags. There was no ragged red fibers nor ultrastructural mitochondrial alterations. There was chain respiratory complex III deficiency. CONCLUSIONS: In patients with intestinal dysmotility manifestations and jejunal and ileal diverticula neuropathies and myopathies with visceral affection must be suspected, among them MNGIE syndrome.

Peritonitis agudas y divertículos del intestino delgado en unapaciente con encefalomiopatía neurogastrointestinal mitocondrial / Acute peritonitis and small bowel diverticula in a patient with mitochondrial neurogastrointestinal encephalomyopathy

Introducción. Los divertículos del yeyuno y del íleon son lesiones adquiridas que se suelen asociar a trastornos de la motilidad intestinal, como las que ocurren en las miopatías y neuropatías con afectación visceral. La encefalomiopatía neurogastrointestinal mitocondrial (síndrome MNGIE) se caracteriza por dismotilidad gastrointestinal, caquexia, ptosis con oftalmoparesia externa, neuropatía, leucoencefalopatía y evidencia de laboratorio de alteración mitocondrial. Caso clínico. Mujer que desde los 9 meses de edad padecía síntomas digestivos: diarrea, náuseas, vómitos, digestiones lentas y dolor abdominal. Tenía miopía. A los 20 años de edad, en un periodo de siete meses, precisó cirugía abdominal urgente en tres ocasiones por peritonitis aguda difusa relacionada con divertículos en el yeyuno y el íleon. Tenía caquexia, ptosis parpebral ligera, oftalmoparesia externa, nervios auriculares mayores hipertróficos, escoliosis, pies cavos, debilidad e hipoestesia distales en extremidades, hipoacusia neurosensorial bilateral y acidosis láctica. El estudio electroneurográfico era compatible con una polineuropatía sensitivomotora desmielinizante crónica severa. En la RM cerebral se vio leucoencefalopatía. En el tejido muscular se apreció alteración de todas las fibras tipo I con abundantes vacuolas de lípidos y aumento del número de mitocondrias en forma de granos gruesos y de las bolsas mitocondriales subsarcolemales. No se observaron fibras rojo-rotas ni alteraciones ultraestructurales de las mitocondrias. Se detectó un déficit del complejo III de la cadena respiratoria. Conclusión. En pacientes con manifestaciones de dismotilidad intestinal y divertículos de yeyuno e íleon se debe sospechar de neuropatías y miopatías con afectación visceral, entre ellas el síndrome MNGIE (AU)

The Filshie clip for laparoscopic adnexal surgery.

BACKGROUND: Gynecologic endoscopic procedures are increasingly common and require the ability to control large vascular structures. METHOD: The Filshie clip is a silicone-lined, titanium occlusive device, originally designed and Food and Drug Administration (FDA) approved for surgical contraception. This device also has the potential for occluding vascular structures during laparoscopic surgery. EXPERIENCE AND RESULTS: We describe a salpingectomy, an excision of bilateral hydrosalpinges, and a salpingo-oopherectomy. We performed all procedures laparoscopically using this device as the primary modality for assuring hemostasis. CONCLUSION: The Filshie clip is a useful and economical device for assuring hemostasis during gynecologic endoscopic surgery.

Nuclear chromatin patterns in normal, hyperplastic and atypical endometrium.

OBJECTIVE: To characterize the nuclei of endometrial lesions for the diagnostic categories of normal glandular tissue, simple hyperplasia, atypical hyperplasia and adenocarcinoma of the endometrium, with the specific goal of probing for heterogeneity. STUDY DESIGN: For each diagnostic category the images of 360 nuclei were recorded on a high-resolution video microphotometer. Features descriptive of the statistical and spatial distribution of nuclear chromatin were computed for each nucleus. A nonsupervised learning algorithm, P-index, was employed to establish subsets of nuclei within each diagnostic category and to determine whether these subsets were statistically significantly different in the nuclear chromatin pattern. RESULTS: Lesions from cases of hyperplasia, atypical hyperplasia and adenocarcinoma of the endometrium each contained several subsets of nuclei with statistically significantly different chromatin patterns. For one such subset from each diagnostic category, a clear trend of progression toward adenocarcinoma could be demonstrated. CONCLUSION: The nuclei in endometrial lesions represent a highly heterogeneous set. Any measure of lesion progression or regression due to chemopreventive intervention, in an individual case, will have to examine the proportion of nuclei in each of these subsets as well as measures of deviation from normal for each subset.

Progression curves for endometrial lesions.

OBJECTIVE: To derive a numeric measure for the progression of endometrial lesions as a baseline study for an eventual assessment of chemopreventive intervention efficacy. STUDY DESIGN: Tissue sections from normal endometrium at the proliferative and secretory phase, simple hyperplasia, atypical hyperplasia from cases free of concomitant adenocarcinoma and adenocarcinoma of the endometrium were recorded at high spatial resolution. Six cases from each diagnostic category were chosen as "typical," and 60 epithelial nuclei were randomly selected for measurement for each case. Discriminant analyses were carried out to derive a direction of progressive change in feature space and to correct the progression curve for the presence of cells not expressing progressive change among the random sample of nuclei. RESULTS: A well-conditioned progression curve was derived based on the mean discriminant function scores for each diagnostic category and the mean nuclear abnormality of the nuclei in each category, as expressed by their deviation in feature values from normal reference nuclei. The lesion signatures showed a clear trend toward extension into the range of higher nuclear abnormalities with increasing progression. There was an indication that abnormal endometrial lesions may comprise cases with distinctly different degrees of nuclear abnormality. CONCLUSION: A numeric assessment of lesion progression for endometrial lesions, based on karyometric measurements, is possible. The data suggest that additional analysis may provide further characterizing information for individual lesions.

Effect of academic affiliation and obstetric volume on clinical outcome and cost of childbirth.

OBJECTIVE: To determine whether the academic affiliation and obstetric volume of the delivering hospital has an impact on clinical and economic outcomes. METHODS: We performed a cross-sectional analysis of data for all births in the State of Maryland during 1996. Acute hospital discharge data were obtained from the publicly available Maryland Health Services Cost Review Commission database. Institutions were classified as community hospitals, community teaching hospitals, and academic medical centers. Principal outcome variables included cesarean birth and complication rates, total hospital charges, and length of stay. RESULTS: A total of 63,143 cases were identified for analysis. The cesarean delivery rate was lower among academic medical centers, compared with community teaching hospitals and community hospitals (18.4% compared with 24.3% and 21.2%, respectively). After adjustment for patient case-mix, the adjusted odds ratio (OR) for cesarean birth was 0.66 at academic medical centers and 1.23 at community teaching hospitals compared with community hospitals (P <.01). Rates of episiotomy and serious complications were lower at academic medical centers compared with community hospitals. Adjusted total hospital charges were lower and length of stay was shorter for community hospitals compared with academic medical centers ($2937 compared with $3564 and 2.2 days compared with 2.5 days, respectively). CONCLUSION: Hospital academic affiliation was an important predictor of clinical outcomes. Better clinical outcomes were found primarily among patients at academic medical centers, although these institutions demonstrated moderately higher resource utilization, compared with community hospitals.