Prosthetic devices: challenges and implications of robotic implants and biological interfaces.

Although among designs of prosthetics there have been some successes in the design of functional robotic implants, there remain many issues and challenges concerned with the failure to meet the 'ideal' requirements of a satisfactory prosthetic. These 'ideals' require the device to be easy to control, comfortable to wear, and cosmetically pleasing. Because the literature on prosthetics and robotic implants are voluminous, this review focuses on four topics to determine key challenges and opportunities underlying these interdisciplinary research areas: firstly, an artificial hand as a biomimetic; secondly, prosthetic implants (electromyography signals and control); thirdly, prosthetic implants and tissue reactions to the material(s) of implants; fourthly, how inflammatory responses of cells and tissues surrounding implanted sensors interfere with the signal transmission of such sensors. This review also notes the importance of the biological interfaces that robotic implants and other prosthetic devices are in contact with and how an improved knowledge of pathophysiological changes at such biological interfaces will lead to improved and more biocompatible designs of prosthetics. This review concludes with the vision that, to develop a design that satisfies the above 'ideals', an interdisciplinary team of biomedical and tissue engineers, and biomaterial and biomedical scientists is needed to work together holistically and synergistically.

Trombosis venosa subclavia y tromboembolismo pulmonar como manifestación de trombopenia inducida por heparina tipo II / Subclavian thrombosis and pulmonary thromboembolism as manifestation of type II heparin-induced thrombocytopenia

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[Cerebral venous sinus thrombosis and ulcerative colitis]. / Trombosis de senos venosos cerebrales y colitis ulcerosa.

Hypercoagulability is a extraintestinal manifestation of inflammatory bowel disease, which could provoke thromboembolic phenomena. Central nervous system venous thrombosis is a rare complication and could be unnoticed. We report on a patient with ulcerative colitis who presented cerebral venous sinus thrombosis as the first manifestation of a hypercoagulable state. We review the literature and discuss about the pathogenic mechanisms of such complication.

Trombosis de senos venosos cerebrales y colitis ulcerosa / Cerebral venous sinus thrombosis and ulcerative colitis

La EEI se acompaña de múltiples manifestaciones extraintestinales, entre ellas un estado de hipercoagulabilidad que puede dar lugar a fenómenos tromboembólicos. Entre estos últimos están las trombosis venosas cerebrales (TVC) que son raras y pueden dar lugar a un cuadro poco llamativo, pasando desapercibidas. Describimos el caso de un paciente diagnosticado previamente de colitis ulcerosa que presentó TVC como primera manifestación de un síndrome de hipercoagulabilidad. Se revisa la literatura y se comentan los mecanismos patogénicos (AU)

[Hyperprolactinemia associated with acute intermittent porphyria]. / Hiperprolactinemia asociada a porfiria aguda intermitente.

Galactorrhea as the result of hyperprolactinemia has been described in very rare cases associated to acute outbreaks of intermittent acute porphyria (IAP). In our country, any of such cases have been published or analytically documented. We present the case of a patient admitted in our hospital for the study of abdominal pain and galactorrhea, with latter diagnosis of IAP, supported by the assessment of the activity of the enzyme showing a deficit in the red blood cells.

[Right endocarditis caused by Staphylococcus aureus in parenteral drug addicts: evaluation of a combined therapeutic scheme for 2 weeks versus conventional treatment]. / Endocarditis derecha por Staphylococcus aureus en adictos a drogas por vía parenteral: valoración de un régimen terapéutico combinado de 2 semanas frente al tratamiento convencional.

BACKGROUND: Intravenous drug addicts (IVDA) are a group of patients in whom it is difficult to complete standard treatment of infectious endocarditis due to frequent antisocial behavior and in whom, once clinical improvement is achieved, voluntary discharge is frequently requested. This is why the evaluation of new treatment schedules tending to decrease the length of the same is of great interest. This non randomized study has the aim of knowing the efficacy of a short treatment with cloxacillin or vancomycin associated to gentamicin in right-sided endocarditis by methicillin-sensitive Staphylococcus aureus, comparing this with the standard schedule of 28 days. METHODS: This series was made up of IVDA patients diagnosed of right endocarditis by S. aureus. Inclusion criteria were the presence of intravenous drug addiction, isolation of methicillin-sensitive S. aureus in 2 or more blood cultures and achievement of the diagnostic criteria of right-sided endocarditis. Two schedules were used: a) standard: cloxacillin or vancomycin for 4 weeks, associating aminoglucoside in the first 3-5 days; b) short; cloxacillin or vancomycin associated to gentamicin for 2 weeks with no ulterior treatment. The study was not randomized and the treatment of 2 weeks was compared with historic controls treated for 4 weeks. The criteria evaluated were those of clinical cure, relapse, appearance of complications during treatment and mortality. RESULTS: Both the standard treatment and the combination of cloxacillin or vancomycin with gentamicin for 2 weeks cured 100% of the episodes of right endocarditis by S. aureus. There were no relapses and mortality was nul. Neither were there any differences between the two groups with regard to appearance of complications. CONCLUSIONS: In intravenous drug addict patients with right-sided endocarditis by methicillin S. aureus, the association of cloxacillin and gentamicin for 2 weeks is an effective alternative to long (4 week) treatments with only one antibiotic. The low number of cases treated with vancomycin does not allow conclusions to be drawn on its efficacy.