Joint estimation of survival and dispersal effectively corrects the permanent emigration bias in mark-recapture analyses.

Robust and reliable estimates of demographic parameters are essential to understand population dynamics. Natal dispersal is a common process in monitored populations and can cause underestimations of survival and dispersal due to permanent emigration. Here, we present a multistate Bayesian capture-mark-recapture approach based on a joint estimation of natal dispersal kernel and detection probabilities to address biases in survival, dispersal, and related demographic parameters when dispersal information is limited. We implement this approach to long-term data of a threatened population: the Bonelli's eagle in Catalonia (SW Europe). To assess the method's performance, we compare demographic estimates structured by sex, age, and breeding status in cases of limited versus large data scales, with those of classical models where dispersal and detection probabilities are estimated separately. Results show substantial corrections of demographic estimates. Natal dispersal and permanent emigration probabilities were larger in females, and consequently, female non-breeder survival showed larger differences between separate and joint estimation models. Moreover, our results suggest that estimates are sensitive to the choice of the dispersal kernel, fat-tailed kernels providing larger values in cases of data limitation. This study provides a general multistate framework to model demographic parameters while correcting permanent emigration biases caused by natal dispersal.

Tratamiento quirúrgico de aneurismas cerebrales en pacientes en la 8va y 9na década de vida / Surgical treatment of cerebral aneurysms in patients in the 8th and 9th years of life

La hemorragia subarcnoidea por sangrado de aneurismas sigue siendo una enfermedad con una elevada mortalidad y morbilidad. Los avances en microcirugía y en terapia endovascular, no han logrado abatir los altos porcentajes de mala evolución. Por su parte, el tratamiento de los aneurismas no rotos se vuelve cada vez más rutinario, dados los buenos resultados. Un capítulo aparte es el tratamiento o no de aneurismas cerebrales con o sin hemorragia subaracnoidea en pacientes añosos (mayores de 70 años). Hay publicaciones al respecto. Los autores hacen una revisión retrospectiva de 179 pacientes mayores de 70 años portadores de aneurismas cerebrales, con o sin sangrado subaracnoideo. Todos fueron sometidos a cirugía. Se analizan los resultados, los que muestran que la morbimortalidad en este grupo etario no difiere sustancialmente de los que se dan en menores de 70 años.

Subarachnoid haemorrhage due to bleeding of cerebral aneurysms remains a disease with high mortality and morbidity. Advances in microsurgery and endovascular therapy have failed to reduce the high percentages of poor outcome. The treatment of unruptured aneurysms, on the other hand, becomes more and more routinary, given the good results. A separate chapter is the treatment or not of cerebral aneurysms with or without subarachnoid hemorrhage in elderly patients (older than 70 years). There are several publications about it. The authors make a retrospective review of 179 patients older than 70 years with cerebral aneurysms, with or without subarachnoid bleeding.All were submitted to surgery. We analyze the results, which show that morbidity and mortality in this age group do not differ substantially from those occurring under 70 years of age.

Tratamiento quirúrgico en malformación de chiari I en la edad pediátrica: estudio y resultados en serie de 57 casos / Surgical treatment in chiari I malformation in the pediatric age: study and results in a series of 57 cases

Introducción: Las malformaciones de Chiari constituyen un grupo heterogéneo de patologías que ocasionan la herniación descendente de estructuras de la fosa posterior. La malformación de Chiari tipo I (MCI) se define como la herniación amigdalina de al menos 3 a 5 mm por debajo del nivel del foramen magno. La resonancia magnética ha aumentado el número de casos diagnosticados, inclusive en la edad pediátrica. Este trabajo tiene por objetivo presentar los resultados en cuanto a hallazgos clínicos y evolución postoperatoria en una serie pediátrica y se realiza una revisión del tema. Pacientes y métodos: Se efectuó un análisis retrospectivo de cohorte única de 57 pacientes operados a lo largo de 20 años por el mismo equipo neuroquirúrgico. Se revisaron los registros de uno de los autores (ES) para obtener datos sobre presentación clínica, diagnóstico, tratamiento y evolución postoperatoria, con un seguimiento de al menos 6 meses en cada paciente. Resultados: Se operaron 57 pacientes de entre 3 a 13 años de edad. El 100% de las malformaciones de Chiari I operadas eran sintomáticas. El síntoma más frecuente fue la cefalea (90%). En todos los casos se efectuó descompresión de la fosa posterior con duroplastia. El 100% de los pacientes presentaron mejoría clínica postoperatoria que se mantuvo a los 6 meses de seguimiento. Se registraron 3 casos de pseudomeningocele y un solo caso de fístula externa de LCR (7%). Conclusiones: La descompresión de fosa posterior con duroplastia es una opción quirúrgica muy efectiva y con baja tasa de complicaciones.

Introduction: Chiari malformations constitute a heterogeneous group of disorders characterized by a maldevelopment of the hindbrain and posterior cranial fossa that determines downward herniation of the cerebellar tonsils. Chiari malformation type I is defined as a 3 to 5 mm tonsillar herniation below the level of the foramen magnum. MRI has increased the number of cases diagnosed even in the pediatric age. Hence, the aim of this article is to present our results concerning clinical findings and outcomes on an exclusively pediatric series and to perform a review of the subject.Patients and methods:this is a retrospective, single-cohort study involving 57 patients operated in a 20-year period by the same neurosurgical team. Clinical records of one of the authors (ES) were reviewed in order to obtain data about symptoms, diagnosis, treatment and postoperative outcome at 6-month follow up.Results: 57 patients between 3 and 13 years of age were operated on. All of the patients were symptomatic at the time of diagnosis. The most frequent symptom was headache (90. All of the patients underwent posterior fossa decompression with duroplasty. 100% of the patients experienced sustained clinical improvement even at 6 month-follow up. Three cases of pseudomeningocele and only one case of external CSF leak were observed (7%).Conclusions:according to our findings and international literature, posterior fossa decompression with duroplasty is an effective surgical treatment with a low rate of complications.

[Developmental outcome of extremely low birth weight infants (<1,000 g) during the first three years of life]. / Seguimiento de recién nacidos de peso menor o igual a 1.000 g durante los tres primeros años de vida.

INTRODUCTION: Obstetrics and Perinatal Care has improved in the last few years. As a result there has been a significant increase in preterm babies and longer survival. The risk of abnormalities in their development is high; they need follow up, prompt action and prevention from the neonatal period. MATERIAL AND METHODS: We evaluated 116 preterm babies, birth weight less than or equal to 1,000 grams, admitted to our Unit over 5 years. Seventy five neonates survived after the neonatal period (64.7 %). We studied the development during the first three years of life. RESULTS: The number of admissions of extremely low birth weigh infants has increased by 100 % in the last five years and the survival has increased by 15 %. Failure to thrive was the most frequent problem; in the first 2 years of life neonatal growth retardation was present in more than 50 % of cases (58 % 1st year, 57 % 2nd year, 40 % 3rd year). Catch-up growth occurred except in infants who had intrauterine growth retardation. Motor function disorders were the most serious; minor alterations in this system were the most frequent but usually did not compromise the life of the patient. Cerebral palsy was present in 14 % in the 1st year of life, 17,4 % 2nd year and 19 % 3rd year. Retinopathy of prematurity was very high in our group (74 %), but ophthalmic sequela were infrequent (3.2 % 1st year, 3.9 % 2nd year, and 3.4 % 3rd year); similarly with hearing function (deafness 2.0 %). Only some mild or moderate language development delay was present and psychomotor development was normal in the majority of cases and those who were retarded improved with time. CONCLUSIONS: Nowadays there is a significant increase in the incidence and survival of extremely low birth weigh infants. They have a higher risk of abnormal development. The most frequent problem is failure to thrive and the most serious is cerebral palsy. Major ophthalmic and hearing sequela are rare. Psychomotor and language development is normal in the majority of these patients.

Seguimiento de recién nacidos de peso menor o igual a 1.000 g durante los tres primeros años de vida / Developmental outcome of extremely low birth weight infants (<1.000 g) during the first three years of life

Introducción: Debido a los avances en obstetricia y neonatología nos encontramos actualmente con un aumento importante de recién nacidos prematuros y una mayor supervivencia de éstos. Son niños con mayor riesgo de alteraciones en su desarrollo, por lo que es necesario un seguimiento y una actuación precoces, además de una prevención desde el período neonatal. Material y métodos. Se evalúan 116 prematuros de peso menor o igual a 1.000 g que ingresaron en nuestra unidad durante 5 años. Sobrevivieron al período neonatal 75 (64,7 %) y se hizo un seguimiento de su desarrollo durante los primeros 3 años de vida. Resultados: En esos 5 años aumentó el 100 % el número de ingresos de recién nacidos de bajo peso extremado y la supervivencia subió el 15 %. La secuela más frecuente fue el retraso ponderal; más de la mitad no seguían una curva normal en sus primeros 2 años de vida (el 58 % el primer año, el 57 % el segundo año y el 40 % el tercer año) aunque tendían progresivamente a la normalidad, salvo aquéllos nacidos con retraso del crecimiento intrauterino, que tuvieron peor pronóstico. En cuanto al desarrollo neurológico, las secuelas motoras fueron las más graves; lo más frecuente fueron mínimas alteraciones en la motricidad que no comprometían la vida normal del niño, pero el 14 % presentaba signos de parálisis cerebral el primer año de vida, el 17,4 % el segundo año y el 19 % el tercer año. Aunque el porcentaje de retinopatía de la prematuridad en nuestro grupo fue alto (74 %), las secuelas oftalmológicas fueron escasas (el 3,2 % el primer año, el 3,9 el segundo año y el 2,4 % el tercer año), así como las auditivas (sordera, 2,0 %). El desarrollo del lenguaje y el psicomotor fue normal en la mayoría de los niños y los que presentaron algún retraso fue leve o moderado. Conclusiones: Nos encontramos ante un aumento importante de la incidencia y supervivencia de recién nacidos de bajo peso extremo, con mayor riesgo de presentar secuelas en su desarrollo. La más frecuente es el retraso en la curva ponderal y la más grave, la parálisis cerebral; las alteraciones oftalmológicas y auditivas graves son poco frecuentes y el desarrollo psicomotor y del lenguaje es normal en la mayoría de estos niños (AU)

Introduction: Obstetrics and Perinatal Care has improved in the last few years. As a result there has been a significant increase in preterm babies and longer survival. The risk of abnormalities in their development is high; they need follow up, prompt action and prevention from the neonatal period. Material and methods: We evaluated 116 preterm babies, birth weight less than or equal to 1,000 grams, admitted to our Unit over 5 years. Seventy five neonates survived after the neonatal period (64.7 %). We studied the development during the first three years of life. Results: The number of admissions of extremely low birth weigh infants has increased by 100 % in the last five years and the survival has increased by 15 %. Failure to thrive was the most frequent problem; in the first 2 years of life neonatal growth retardation was present in more than 50 % of cases (58 % 1st year, 57 % 2nd year, 40 % 3rd year). Catch-up growth occurred except in infants who had intrauterine growth retardation. Motor function disorders were the most serious; minor alterations in this system were the most frequent but usually did not compromise the life of the patient. Cerebral palsy was present in 14 % in the 1st year of life, 17,4 % 2nd year and 19 % 3rd year. Retinopathy of prematurity was very high in our group (74 %), but ophthalmic sequela were infrequent (3.2 % 1st year, 3.9 % 2nd year, and 3.4 % 3rd year); similarly with hearing function (deafness 2.0 %). Only some mild or moderate language development delay was present and psychomotor development was normal in the majority of cases and those who were retarded improved with time. Conclusions: Nowadays there is a significant increase in the incidence and survival of extremely low birth weigh infants. They have a higher risk of abnormal development. The most frequent problem is failure to thrive and the most serious is cerebral palsy. Major ophthalmic and hearing sequela are rare. Psychomotor and language development is normal in the majority of these patients (AU)

[Early percutaneous revascularization in patients with unstable angina. Current results and comparison with conservative medical treatment]. / Revascularización precoz percutánea en los pacientes con angina inestable. Resultados actuales y comparación con el tratamiento médico conservador.

In patients with ongoing angina, despite optimal medical therapy, the best therapeutic alternative is coronary angiography followed by emergency coronary revascularization with surgery or angioplasty. However, whether or not all patients should have early angiography and revascularization is a matter of debate. This paper reviews the advantages of modern medical therapy in this setting and the problems associated with early coronary revascularization. In particular, it analyses the data from the main clinical trials that have specifically compared an early invasive procedure with a conservative strategy in unstable coronary syndromes. Finally, it assesses the impact of the new antithrombotic agents, such as glycoprotein IIb/IIIa receptor blockers, particularly during coronary percutaneous interventions. The data reviewed suggest that early invasive intervention should be reconsidered, and that patients should be controlled (if possible) under medical treatment until non invasive stratification tests allow the identification of those patients who would benefit most from revascularization.

[An assessment of myocardial ischemia in women with the exercise test validated by coronary angiography]. / Evaluación de la isquemia miocárdica en mujeres con la prueba de esfuerzo validada mediante coronariografía.

Ischemic heart disease has been studied in men and women only as a group. We studied the sensitivity and specificity of the exercise stress testing in women. The exercise stress testing (EST) was validated with the coronary arteriography. We studied 72 women and 129 men, the mean age was 55 years for women and 51 years for men. We found in women 83.2% of estimated maximal heart rate; the rate pressure product was 2.4, no different from the values recorded in men (p greater than 0.06). The blood pressure response to exercise was higher in women, and the maximal work capacity was more elevated in men (p less than 0.006). We found normal coronary arteries in 41 women, 70.7% with a positive (EST) compared with a 87.07% in men. The sensitivity and specificity of the exercise stress testing for the diagnosis of ischemic heart disease is smaller in women.

[Dynamic intracavitary echoes studied by transthoracic and transesophageal echocardiography]. / Ecos dinámicos intracavitarios estudiados con ecocardiografía transtorácica y transesofágica.

One hundred consecutive echocardiograms performed on adults using transthoracic and transesophageal (TEE) transducers were analyzed in order to determine the prevalence of spontaneous contrast (SC) and the factors associated with it. Indications for study included complex congenital cardiopathy, evaluation of valve lesions or prosthetic valves, dissecting aortic aneurysm, cardiac masses and evaluation of ventricular function. SC was observed only with TEE and appeared in 25% of cases, most frequently in left atrium. Factors associated with contrast included mitral valve disease and replacement, ventricular dysfunction, left atrial dilatation and atrial fibrillation. An important relationship existed between SC and presence of thrombi. Atrioventricular valvular regurgitation was not associated with SC. Results are compared with those of previous series.

[The clinical features of myocardial infarct via "normal" coronary angiography. The experience of the Instituto Nacional de Cardiología]. / Rasgos clínicos del infarto del miocardio con coronariografía "normal". Experiencia del Instituto Nacional de Cardiología.

The end-point of our study was to find clinical differences between patients with myocardial infarction and evident obstructions in coronary angiography, and patients without coronary obstructions. In a 10 years follow-up period, 48 patients with diagnosis of myocardial infarction and normal coronary arteries by angiography (group A) where admitted al hospital. We compared this group with 80 patients (group B), randomly selected from all patients with myocardial infarction and evident obstructions in coronarography. Patient age at the ischemic event, familiar history of ischemic heart disease or sudden death, obesity, drug habits, contraception drugs use, and history of migraine and Raynaud's phenomenon were pointed out. Thirty patients from group A were admitted with acute myocardial infarction, and we also analysed in these patients prodromal symptoms, precipitating factors, AMI localisation, serum enzymatic levels, rhythm and/or conduction disturbances, clinical condition, treatment and new ischemic events. Group A patients showed lower age-average, smoking habit, prodromal symptoms and serum CPK levels. They have better ventricular performance parameters and a greater incidence of women. The only different risk factor for ischemic heart disease between both groups was smoking.

[Postoperative course of prosthetic valve replacement]. / Evolución postoperatoria en el recambio valvular protésico.

In order to know the post-operative outcome of patients with valvular replacement due to prosthetic dysfunction, we reviewed the clinical charts of 94 patients operated at the Instituto Nacional de Cardiología "Ignacio Chávez" between January 1986 and December 1988. Eighty four cases were replaced by the first time the remaining 10 by a second time. Diagnosis of prosthetic dysfunction was made by clinical, radiological, echocardiographic and haemodynamic parameters. The most frequent causes of dysfunction were the rupture of prosthetic leaflets, stenosis with calcific deposition and paravalvular leaks. The global mortality rate was 19.15%, higher than the native valve replacement group. The most important predictors of surgical mortality were: 1) poor ventricular function (functional classes III and IV), 2) aortic clamping period, 3) the need of a second prosthetic replacement and 4) the time of prosthetic dysfunction. Thus, we conclude that it is of great importance the early recognition of prosthetic valve dysfunction. The need of special surgical procedures in these cases should be evaluated in order to reduce morbidity and mortality.

[Partial pericardial tamponade immediately after cardiac surgery]. / Taponamiento pericárdio parcial en el postoperatorio inmediato de cirugía cardíaca.

Partial pericardial tamponade is a critical situation frequently misdiagnosed. We describe five patients with this entity during an urgent surgical reintervention performed few hours after the initial one. We found clots compressing cardiac cavities in all, usually in the right atrium. In one of them we found also a clot compressing the left atrium. None of the patients studied had the classical clinical features of cardiac tamponade (Kussmaul's sign: pulsus paradoxus) and we found no difference in blood pressure, quantity of bleeding or pulmonary capillary pressure, considering the reinterventional moment in comparison to the values taken immediately after the initial surgery and the ones registered during the surgical reintervention. There was significative increase in the central venous pressure value, decreased urine output and drop in the cardiac index. Based on this observation, we believe it is possible to have a presumptive diagnosis of partial pericardial tamponade by bidimensional echocardiographic studies just before the surgical reintervention.

[Myocardial infarct immediately after a normal exercise test]. / Infarto de miocardio inmediatamente después de una prueba de esfuerzo normal.

Two cases of myocardial infarction immediately following a normal stress testing, are described. The incidence and possible pathophysiological mechanisms are discussed. In one of the patients it was difficult to establish the pathophysiological mechanism which was the cause of the ischemic event. In the other, the coronary arteriography revealed only minimal obstructive disease. Therefore, coronary vasospasm with thrombus formation as a cause of the infarction ia an interesting speculative possibility in view of the angiographic findings. Acute myocardial infarction after a normal electrocardiographic response to maximal exercise testing is extremely rare, and the precise pathophysiologic mechanism that leads to his complication is not clear.

[Cardiovascular abnormalities in Ehlers-Danlos syndrome. Report of a case]. / Anormalidades cardiovasculares en el síndrome de Ehlers-Danlos. Informe de un caso.

This is the case of a 34-year-old woman with Ehlers-Danlos syndrome whose cardiopulmonary manifestations are the following: Prolapse of mitral and tricuspid valves. Aneurysmal dilatation of main arteries without aortic or pulmonary insufficiency. Disturbances in pulmonary function tests and pulmonary arterial hypertension. The diagnosis was verified by skin biopsy and an electron microscopic study. Due to the clinical and histopathological characteristics, we have considered this case to be a non-specified type of the 10 varieties described up to now, and have decided to report it also because of the interesting findings in the hemodynamic and pulmonary function tests.