Elevación transitoria del segmento st en paciente victima de trauma eléctrico en el Hospital San Rafael de Alajuela / Transient ST-segment elevation victim of electric trauma patient in the hospital alajuela

El trauma eléctrico ocurre cuando un organismo vivo participa de un circuito eléctrico. Esto produce un síndrome traumático que involucra daño térmico y alteraciones eléctricas en el cuerpo. Para entenderlo mejor es necesario conocer la física de la electricidad. En este articulo se revisara un caso que se presento en el hospital San Rafael en el cual fue posible observar anormalidades electrocardiografícas en un paciente expuesto a traumas eléctrico leve.

Electrical injuries happen when a living organism takes part in an electrical circuit through the tissues of that organism.Because of this, the result is trauma syndrome that involves termal damage an electrical disturbances into the body.For a better understanding, is necessary to know about the physics of electricity.We`ll rewiew a clinical case happened in Hospital San Rafael, in which was possible to see electrocardiograma anormalities in pacient exposed to low electrical trauma.

Tumores intraventriculares supratentoriales de origen glial / Supratentorial intraventricular tumors of glial origin

Los tumores gliales intraventriculares representan un gran reto de acceso neuroquirúrgico debido a su localización profunda, asociación intima con numerosas estructuras vasculares de áreas críticas cerebrales y su relación circunferencial a múltiples tractos subcorticales. Debido a todo esto, el acceso quirúrgico a estas regiones, debe incluir una serie de consideraciones minuciosas anatómicas para minimizar el riesgo de lesión a estructuras de considerable importancia y funcionabilidad y lograr una resección máxima posible. Presentamos una reseña de 4 casos los cuales fueron ingresados y atendidos por el servicio de neurocirugía del Hospital México, los cuales ingresaron en un intervalo de 8 meses entre agosto del 2012 y febrero del 2013.

Intraventricular tumor represent a big neurosurgical approach challenge because of thier deep localization, intimal association with critical arterial vessels, and circunferential relations with withe matter tracts. It is why, surgical access to these regions must include anatomical issues to minimize injuries to structures of vital importance and functionability. We present a resume of 4 cases which where admitted to Neusurgical Service of Hospital Mexico between august 2012 and february 2013.

Rabdomioma intracardiaco fetal como causa de trasplante cardiaco en recién nacido: a propósito de un caso / Fetal cardiac rhabdomyoma as a cause of cardiac transplantation in a newborn: a case report

El rabdomioma es el tumor cardiaco más común en la vida fetal, muchas veces asociado a esclerosis tuberosa, y generalmente diagnosticado en el tercer trimestre de la gestación. Presentamos el caso de un rabdomioma cardiaco que ocupa la totalidad del ventrículo izquierdo del feto, como causa de trasplante cardiaco en la infancia (AU)

Rhabdomyoma is the most common cardiac tumor in fetuses. This entity is often associated with tuberous sclerosis and is usually diagnosed in the third trimester of pregnancy. We report a case of cardiac rhabdomyoma occupying the entire left ventricle of the fetus and leading to cardiac transplantation in infancy (AU)

Espacio retrocarotídeo lateral: espacio retrocarotídeo medial: hacia la bifurcación basilar / I spread retrocarotideo laterally. I spread retrocarotideo medially: towards the basilary bifurcation

Los aneurismas de la bifurcación basilar son tributarios hoy en día de ser manejados o mediante terapia endovascular o en forma directa, con técnicas microquirúrgicas; aquellas lesiones grandes o gigantes y con cuellos anchos o las que integran en su cuello a la arteria cerebral posterior o perforantes talámicas, sobre todo, las mamilotalámicas, no son tributarias de ser manejadas con terapia endovascular. Para el cirujano de aneurismas es de capital importancia el conocimiento adecuado de los espacios retrocarotídeo lateral y medial.

Diagnóstico de rabdomioma fetal ecográfico / Ultrasonographic diagnosis of fetal rhabdomyoma

El rabdomioma es una tumoración rara detectada, en la mayor parte de las ocasiones, por ecografía y representa aproximadamente un 1% del total de las anomalías cardíacas halladas intraútero. La evolución intrauterina y su repercusión hemodinámica dependen del crecimiento del tumor. Grandes masas pueden ser causa de obstrucciones y posteriormente de hidropesía y taquiarritmias. A estas complicaciones se añade su asociación a la esclerosis tuberosa, la cual ocupa un lugar importante en el consejo prenatal a los padres, ya que su herencia es autosómica dominante. La frecuencia de la asociación es del 50-70% en las distintas series (AU)

Rhabdomyoma is a rare tumor usually detected by ultrasonography. This neoplasm represents approximately 1% of all intrauterine cardiac abnormalities. Development inside the uterus and the hemodynamic repercussions of this entity depend on tumoral growth. Large masses can cause obstructions and subsequently hydrops and tachyarrhythmias. In addition to these complications, rhabdomyoma is associated with tuberous sclerosis, which occupies an importance place in prenatal counseling since inheritance is autosomal dominant. The frequency of this association is between 50% and 70% in distinct series (AU)

Pancreatitis aguda tras anestesia con propofol en un adolescente tratado con anfotericina B liposomal / Acute pancreatitis after anesthesia with propofol in teenage boy treated with liposomal amphotericin B

No disponible

Infarto cerebeloso durante el primer trimestre de gestación / Cerebellar infarction during the first trimester of pregnancy

El infarto cerebral que acontece en mujeres jóvenes no por tener una baja incidencia deja de resultar de extremada gravedad, ya que presenta tasas de mortalidad cercanas al 20 por ciento. En el caso de que la mujer se encuentre gestante, se originará un importante menoscabo de salud durante un período de máximo desarrollo personal y familiar. Aunque teóricamente la apoplejía cerebral responde a muy variadas causas etiopatogénicas, son muchos los casos en mujeres jóvenes en que no se logra establecer con certeza la razón principal. La exploración clínica neurológica necesita apoyarse en técnicas de diagnóstico radiológico para discriminar inicialmente entre factores con una patogenia isquémica o hemorrágica. La tomografía craneal debe indicarse con los mismos criterios que en otras pacientes no embarazadas, sin que por ello resulte dañada la viabilidad embrionaria o fetal. La dosis de radiación emitida no supone poner en peligro el bienestar fetal y sí puede aportar datos que nos ayuden a intentar predecir un pronóstico materno y establecer la terapéutica más apropiada (AU)

Distribution of human virus contamination in shellfish from different growing areas in Greece, Spain, Sweden, and the United Kingdom.

Viral pollution in shellfish has been analyzed simultaneously across a wide range of geographical regions, with emphasis on the concomitant variations in physicochemical characteristics and social features. The methods for sample treatment and for the detection of human enteric viruses were optimized by the participating laboratories. The second part of this study involves the selection of a protocol for virus detection, which was validated by analyzing the distribution and concentration of human viral pathogens under diverse conditions during an 18-month period in four European countries. Shellfish-growing areas from diverse countries in the north and south of Europe were defined and studied, and the microbiological quality of the shellfish was analyzed. Human adenovirus, Norwalk-like virus, and enterovirus were identified as contaminants of shellfish in all the participating countries. Hepatitis A virus was also isolated in all areas except Sweden. The seasonal distribution of viral contamination was also described. Norwalk-like virus appeared to be the only group of viruses that demonstrated seasonal variation, with lower concentrations occurring during warm months. The depuration treatments currently applied were shown to be adequate for reducing Escherichia coli levels but ineffective for the elimination of viral particles. The human adenoviruses detected by PCR correlate with the presence of other human viruses and could be useful as a molecular index of viral contamination in shellfish.

Depuration dynamics of viruses in shellfish.

The consumption of shellfish has been associated with viral infections even in cases where shellfish complied with the current regulation, which is based on bacterial analysis. In this study, depuration rates of potential indicators and human viruses have been analysed in order to study the use of complementary parameters for evaluating the microbiological quality of depurated shellfish. Depuration of naturally highly polluted mussels has been evaluated and analyses for Escherichia coli, Clostridium perfringens, somatic coliphages, F-RNA phages and bacteriophages infecting Bacteroides fragilis RYC2056 and HSP40, human adenovirus, enterovirus have been done. Seawater of the depuration tank was disinfected by UV irradiation, ozone and passed through a skimmer and a biological filter. The correct functioning of the depuration tank was monitored by the quantification of total organic carbon (TOC), NH4+ and total aerobic bacteria in the seawater. To study the relation between the bacteriophages and the human viruses analysed, a logistic regression model was applied. F-RNA phages are significantly related to human adenoviruses and enteroviruses. Thus, they can be used as a complementary parameter for evaluating the efficiency of the depuration treatment. Somatic coliphages are also significantly associated with enteroviruses. Bacteriophages infecting B. fragilis HSP40 were analysed by the double-agar-layer (DAL) method, which quantifies infectious viruses, and by nested PCR, which detects the presence of the genome of these phages. The highest sensitivity of the molecular techniques was demonstrated and the results obtained are an indicator of a close relation between positive results by PCR and the presence of infectious viral particles in shellfish. All shellfish samples were negative for human viruses by PCR after 5 days of depuration treatment and the results obtained applying a regression model also showed negative results or nearly for F-RNA phages and bacteriophages infecting B. fragilis RYC2056. Thus, in this specific depuration treatment, 5 days may be necessary to assess the sanitary quality of shellfish.

Maternal inheritance of manic depression in hemizygotes for the G6PD-Mediterranean mutation. Indirect evidence for Xq28 transmission in Sardinia.

Both X-linkage and a parent-of-origin effect have been hypothesized in manic-depressive disorder. We have previously shown an allelic association between X-linked G6PD deficiency and manic depression in Mediterranean populations. To test both X-linkage and a parent-of-origin effect in manic depression further, we have studied 274 Sardinian manic-depressive probands and their parents. Excess of maternal transmission (P = 0.005) of major affective disorder was found in male probands carrying the G6PD-Mediterranean mutation. Our results provide indirect molecular support for an association between manic depression and the Xq28 chromosome region in Sardinia. Further studies on Xq28 using tests of allelic association and transmission disequilibrium with multiple DNA markers are required, to clarify the nature of the association we have found. Our study cannot implicate or exclude a direct role for G6PD deficiency in the aetiology of manic depression.

[Streptococcal gangrene and so-called "flesh-eating bacteria disease". A rare and devastating disease]. / La gangrena estreptocócica y la así llamada "enfermedad de las bacterias devoradoras de carne". Una infección rara y devastadora.

Streptococcal gangrene, an unusual form of necrotizing fasciitis with fatal outcome, has been recently rediscovered and has gained popularity with the name "disease of flesh eating bacteria". The incidence of this and other severe diseases caused by Streptococcus pneumoniae has been suggested to be increasing. Only three patients with this disease have been studied at our institution in the last 12 years and in a review of a bacteremic infections caused by beta-hemolytic streptococci a significant increase of these infections was not observed. We report here the clinical and pathological characteristics of streptococcal gangrene as well as a review of the more recent literature.

Suicidal behavior on and off lithium prophylaxis in a group of patients with prior suicide attempts.

One hundred patients who had attempted suicide before commencing lithium prophylaxis were followed up. Outcome was analyzed in terms of attempted or completed suicide after a mean of 10 years since admission to the lithium clinics. Of 10 patients who committed suicide, 9 had discontinued adequate lithium prophylaxis for a period ranging from 2 weeks to 7 years before death. Having discontinued lithium therapy was associated with suicide also in the subgroup of patients for whom lithium had not completely prevented episodes during lithium treatment. Suicide risk was 24 times as high during periods off compared with periods on adequate lithium prophylaxis. Incidence of attempting suicide was similar during the periods before receiving or after discontinuing lithium treatment, whereas it was 5 to 6 times lower during prophylaxis. Continuous and adequate lithium prophylaxis should be considered in the presence of high suicide risk, even if the prophylactic effect on the underlying mood disorder may be incomplete.

Histologic effects of different suture materials in microsurgical anastomosis of the rat uterine horn.

OBJECTIVE: To evaluate the histologic effects and permeability rate of different suture materials in microsurgical anastomosis of the left uterine horn in Wistar rats. STUDY DESIGN: In this histologic study, 81 female Wistar rats were used. A transverse section and anastomosis were performed using three surgical techniques. The rats were divided into 15 experimental groups based on evaluation of three variations in microsurgical technique: (1) one-layer transmucosal anastomosis, (2) one-layer extramucosal anastomosis, and (3) two-layer transmucosal anastomosis. With each technique, five suture materials were used: 7/0 polyglycolic acid, 6/0 polyglactin, 7/0 polydioxanone, 7/0 silk and 7/0 polypropylene. RESULTS: The permeability rate was 86%. Polydioxanone persisted in 41% of cases at 90 days. Abnormal proliferation of mucosal epithelium was verified in 10% of cases. Polypropylene was responsible for the majority of foreign-body granulomas. Polydioxanone produced the smallest inflammatory reaction. CONCLUSION: The type of suture material did not influence the permeability rate. Use of nonabsorbable suture material altered the histologic structure the most and produced the greatest tissue reaction. The best results were obtained with polydioxanone. Monofilial sutures gave rise to fewer structural alterations than did multifilament sutures.

Patología neurológica del anciano: las alteraciones cognitivas. / Aged neurological patology: The cognitive alterations

Este trabajo revisa los aspectos cognitivos de dos cuadros fundamentales en la neuropatología del anciano: la `confusión mental' o delirio y las demencias. De ambas se examina la psicopatología, la clínica y el diagnóstico diferencial y los factores causales. En el caso de la `confusión mental' se examina las fases de la terapéutica; y en las demencias la fisiopatología y la biología molecular, con especial énfasis en los desarrollos recientes

La neurogenética: pasado, presente y futuro / Neurogenetics: past, present and future

La genética en general y la neurogenética en particular han tenido en los últimos años un espectacular desarrollo, que se expone de manera esquemática. Para ello se divide el artículo en tres fases: el pasado, el presente y el futuro. En la primera se describe la historia de la neurogenética; en la segunda se describe los métodos de la genética molecular que han permitido su actual desarrollo y se resume los hallazgos sobre algunas enfermedades como la enfermedad de Duchenne. La tercera parte trata sobre las implicancias futuras que tendrá la neurogenética

Class, perceptions of 'disordered' behaviour, and suggestions for therapy: a tri-cultural comparison.

This paper presents findings from a tri-cultural study in which we argue that class differences pertain not only to rates of mental illness but also to recognition of symptoms of mental illness and to recommendations concerning what should be done by those exhibiting 'disordered behaviour'. It is hypothesized that regardless of respondent's cultural background, the extent to which a deviant behaviour will be defined as a mental health problem, and professional therapy will be suggested as a source of help for that problem, will be positively related to class. Findings from a sample selected from two small West Texas communities, and samples selected from Durango, Mexico, and Juiz de Fora, Brazil, indicate strong support for the first prediction only among the West Texas sample, whereas the second hypothesis concerning therapy suggestions is strongly supported among respondents in all three cultural settings. We conclude that these class differences in perceptions and suggestions concerning five examples of 'disordered' behaviours read to respondents relate to conditions of lower-class life in general. Particularly, structural support found for our hypothesis leads us to suggest a need for informal, nonbureaucratic mental health care systems created to serve lower-class populations residing in class-oriented societies, regardless of cultural differences which may exist among these societies.