Perineural Invasion of Cranial Nerves in Cutaneous Squamous Cell Carcinoma: Unraveling Its Complexities, Diagnostic Challenges, and Multifaceted Treatment Approaches.

Cutaneous squamous cell carcinoma is the second most common neoplasm among non-melanoma skin cancers. When associated with perineural invasion of the cranial nerves, with clinical features often observed in trigeminal and facial nerves due to their cutaneous extension, it may lead to a worse prognosis. This paper introduces a rare case of an 81-year-old male, with a history of a moderately differentiated invasive carcinoma of the left frontal region with perineural invasion on the left trigeminal cranial nerve. The case underscores the aggressive nature of the intraneural infiltration by squamous cell carcinoma and the challenges in managing such advanced malignancies.

Mecanismos neuroprotectores de los canabinoides en la isquemia cerebral y las enfermedades neurodegenerativas / Neuroprotective mechanisms of cannabinoids in brain ischemia and neurodegenerative disorders

Una de las causas más importantes de morbilidad y mortalidad es la disfunción neurológica; su alta incidencia ha estimulado una intensa búsqueda de mecanismos para proteger al sistema nervioso central de situaciones que producen hipoxia e isquemia. El mayor reto es interrumpir los eventos bioquímicos que involucra y que llevan a la muerte neuronal. Esto puede conseguirse a través de la neuroprotección que tiene por objeto frenar las cascadas inmunológica y metabólica que aparecen después de un daño neurológico agudo. Cuando esto sucede, se producen eventos fisiopatológicos que incluyen la producción de citocinas, el estrés oxidante y la excitotoxicidad. Respecto a todos esos mecanismos, se han reportado efectos protectores de los endocanabinoides, los cuales parecen ser neuroprotectores en modelos animales de isquemia cerebral, excitotoxicidad, trauma cerebral y en enfermedades neurodegenerativas. Algunos análogos de canabinoides se encuentran actualmente en evaluación (fases clínicas I-III) para el tratamiento de enfermedades agudas que involucran a la muerte neuronal (isquemia y trauma cerebrales). El estudio del sistema canabinoide podría generar agentes neuroprotectores efectivos de amplio espectro de acción para el tratamiento de afecciones neurológicas en un futuro cercano.

One of the most important causes of morbidity and mortality is neurologic dysfunction; its high incidence has led to an intense research of the mechanisms that protect the central nervous system from hypoxia and ischemia. The mayor challenge is to block the biochemical events leading to neuronal death. This may be achieved by neuroprotective mechanisms that avoid the metabolic and immunologic cascades that follow a neurological damage. When it occurs, several pathophysiological events develop including cytokine release, oxidative stress and excitotoxicity. Neuroprotective effects of cannabinoids to all those mechanisms have been reported in animal models of brain ischemia, excitotoxicity, brain trauma and neurodegenerative disorders. Some endocannabinoid analogs are being tested in clinical studies (I-III phase) for acute disorders involving neuronal death (brain trauma and ischemia). The study of the cannabinoid system may allow the discovery of effective neuroprotective drugs for the treatment of neurological disorders.

[Early analgesia does not block labor in first pregnancies]. / La aplicación temprana de analgesia no detiene el trabajo de parto en mujeres primigestas.

Pain during labor alters the well-being of the mother and fetus. Peridural analgesia may prevent pain, but some physicians prefer to administrate this until labor has progressed in order to avoid blocking labor so a cesarean surgery would be required. In this case, the mother suffers pain until labor has progressed enough to apply analgesia. Thus, the mother suffers pain while labor has progressed enough. Cesarean surgery increases maternal morbidity, thus it is important to evaluate labor progression when analgesia is applied at an early or advanced stage of labor. This study evaluated the effect of early analgesia on labor progression. First pregnancies at a latent or active stage of labor were included. Ropivacaine peridural analgesia was applied. All the patients completed labor (latent labor: final dilation 10 cm (10-10 cm); active labor: final dilation 10 cm (10-10 cm); p = 0.812). The proportion of patients undergoing cesarean surgery was not different between the groups (four in latent labor (7%), eight in active labor (12%); p = 0.545). Our results suggest that early analgesia may be applied without compromising labor progression.