Bloqueo erector de la espina y sedación con dexmedetomidina en nivats (non intubated video-assisted thoracoscopic surgery) / Erector spinae block and sedation with dexmedetomidine in nivats (non intubated video-assisted thoracoscopic surgery)

La vía aérea difícil (VAD) es una de las principales causas de morbimortalidad en anestesia. La posibilidad de realizar una cirugía toracoscopica en ventilación espontánea con el uso de fármacos como la dexmedetomidina y remifentanilo, proporcionandoademás, analgesia con un bloqueo ecoguiado del erector de la espina han facilitado y/o posibilitado la realización de cirugía toracoscopica sin necesidad de intubación endotraqueal disminuyendo por tanto la necesidad de manipular la vía aérea, siendo una gran alternativa ante una VAD. (AU)

Difficult airway (DAV) is one of the main causes of morbidity and mortality in anesthesia. The possibility of performing spontaneously ventilated thoracoscopic surgery with the use of drugs such as dexmedetomidine and remifentanil, also providing analgesiawith an ultrasound-guided erector spinae block, has favoured and / or made possible thoracoscopic surgery without the need forendotracheal intubation, thus reducing the need to manipulate the airway, being a great alternative to VAD. (AU)

La reacción en cadena de la polimerasa en el diagnóstico de la enfermedad meningocócica invasiva / The use of polymerase chain reaction in the diagnosis of invasive meningococcal disease

INTRODUCCIÓN OBJETIVOS: La enfermedad meningocócica invasiva (EMI) constituye un grave problema de salud pública. A pesar de que el cultivo es la técnica de referencia para su diagnóstico, la administración previa de antibiótico altera su sensibilidad. Los objetivos de este estudio son el análisis epidemiológico de la EMI en nuestro medio, evaluar la utilidad de la reacción en cadena de la polimerasa (PCR) para incrementar el diagnóstico de confirmación de la EMI y valorar la asociación de la administración de antibiótico con el resultado negativo del cultivo. Pacientes y métodos: Estudio retrospectivo de los pacientes menores de 16 a˜nos diagnosticados de EMI mediante cultivo, PCR o ambos, que ingresaron en nuestro centro en el periodo 2004- 2012. Resultados: Se incluyó a 75 pacientes, de los cuales el 52% presentó sepsis, el 30,7% meningitis y el 17,3% sepsis con meningitis. La PCR fue positiva en todas las muestras de sangre y líquido cefalorraquídeo analizadas, mientras que el cultivo tuvo una positividad muy inferior (50,7%). Recibieron antibiótico antes de la extracción de las muestras 40 pacientes (53,3%) y el 40% de ellos fueron confirmados por la PCR. Conclusiones: Gracias a la PCR se obtuvo un diagnóstico de confirmación de EMI en el 38,7% de los casos y del serogrupo, hecho relevante para la vigilancia epidemiológica y el estudio de la efectividad vacunal

INTRODUCTION AND OBJECTIVES AND AIMS: Invasive meningococcal disease (IMD) remains a serious public health problem. Although culture is the gold standard, previous antibiotic therapy reduces its sensibility. The aim of this study is the epidemiological analysis of IMD in our area, to assess the usefulness of polymerase chain reaction (PCR) to increase its diagnostic accuracy,and to show the association of antibiotic administration with the negative result of the culture. Patients and methods: A retrospective study was conducted on all children younger than 16 years with microbiologically (positive culture and/or PCR) confirmed IMD, admitted to our hospital between 2004-2012. Results: Seventy-five patients were included, of whom 52% had sepsis, 30.7% meningitis, and 17.3% with both of them. PCR was positive in all samples, whereas a positive was seen 50.7% of the cultures. Previously administered antibiotic was documented in 40 patients (53.3%), and 40% of them were confirmed by PCR only. Conclusions: PCR was the only test providing evidence for IMD diagnosis and serogroup determination in almost 39% of cases

[The use of polymerase chain reaction in the diagnosis of invasive meningococcal disease]. / La reacción en cadena de la polimerasa en el diagnóstico de la enfermedad meningocócica invasiva.

INTRODUCTION AND OBJECTIVES AND AIMS: Invasive meningococcal disease (IMD) remains a serious public health problem. Although culture is the gold standard, previous antibiotic therapy reduces its sensibility. The aim of this study is the epidemiological analysis of IMD in our area, to assess the usefulness of polymerase chain reaction (PCR) to increase its diagnostic accuracy,and to show the association of antibiotic administration with the negative result of the culture. PATIENTS AND METHODS: A retrospective study was conducted on all children younger than 16 years with microbiologically (positive culture and/or PCR) confirmed IMD, admitted to our hospital between 2004-2012. RESULTS: Seventy-five patients were included, of whom 52% had sepsis, 30.7% meningitis, and 17.3% with both of them. PCR was positive in all samples, whereas a positive was seen 50.7% of the cultures. Previously administered antibiotic was documented in 40 patients (53.3%), and 40% of them were confirmed by PCR only. CONCLUSIONS: PCR was the only test providing evidence for IMD diagnosis and serogroup determination in almost 39% of cases.

Enfermedad invasora por Neisseria meningitidis serogrupo 29E y deficiencia de C5 / Invasive disease due to Neisseria meningitidis serogroup 29E and C5 deficiency

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Lumbociática como forma de presentación de una malformación vascular: síndrome de Foix-Alajouanine / Sciatica as a presentation form of a vascular malformation: Foix-Alajouanine syndrome

La lumbociática y la lumbalgia son el motivo más frecuente de consulta de origen musculoesquelético en atención primaria y especializada. Las malformaciones vasculares medulares y entre ellas las fístulas arteriovenosas son una rara entidad, pero una causa tratable de tetraplejía progresiva. Los síntomas de aparición pueden ser dolor radicular y lumbar, debilidad y alteración de esfínteres entre otros. La fisiopatología de estas malformaciones explica mediante las variaciones de presión venosa la forma de aparición relacionada con los esfuerzos y la clínica tan variable. Es imprescindible un diagnóstico diferencial con otras afecciones con sintomatología neurológica. El diagnóstico y tratamiento precoz puede evitar la progresión. Presentamos el caso de un varón de 40 años diagnosticado inicialmente de lumbociática, que evolucionó de manera aguda a una paraparesia y cuyo diagnóstico resultó ser una fístula arteriovenosa medular. Describimos los tipos de malformaciones arteriovenosas y su fisiopatología (AU)

Sciatica and low back pain are the most frequent reasons for skeletal muscle consultation in primary and specialized care. Spinal cord vascular malformations, among them arteriovenous fistulae, are a rare but a treatable condition of progressive paraplegia and tetraplegia. The initial symptoms may be radicular and lumbar pain, weakness and sphincters disorders, among others. The pathophysiology of these malformations explains the presentation form related to efforts and such variable clinical symptoms according to the variation of venous pressure. A differential diagnosis must be made in regards to other diseases that have neurological symptoms. Early diagnosis and treatment can prevent the disease-progression. We report the case of a 40-year old man initially diagnosed of sciatica that evolved to acute paraparesia. Finally, he was diagnosed of spinal arteriovenous fistula. We describe the different types of arteriovenous malformations and their pathophysiology (AU)

Enfermedad invasora por meningococo del serogrupo 29E / Invasive meningitis due to serogroup 29E meningococci

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Critical COPD respiratory illness is linked to increased transcriptomic activity of neutrophil proteases genes.

BACKGROUND: Gene expression profiling (GEP) in cells obtained from peripheral blood has shown that this is a very useful approach for biomarker discovery and for studying molecular pathogenesis of prevalent diseases. While there is limited literature available on gene expression markers associated with Chronic Obstructive Pulmonary Disease (COPD), the transcriptomic picture associated with critical respiratory illness in this disease is not known at the present moment. FINDINGS: By using Agilent microarray chips, we have profiled gene expression signatures in the whole blood of 28 COPD patients hospitalized with different degrees of respiratory compromise.12 of them needed of admission to the ICU, whilst 16 were admitted to the Respiratory Medicine Service. GeneSpring GX 11.0 software was used for performing statistical comparisons of transcript levels between ICU and non-ICU patients. Ingenuity pathway analysis 8.5 (IPA) and the Kyoto Encyclopedia of Genes and Genomes (KEGG) were used to select, annotate and visualize genes by function and pathway (gene ontology). T-test showed evidence of 1501 genes differentially expressed between ICU and non-ICU patients. IPA and KEGG analysis of the most representative biological functions revealed that ICU patients had increased levels of neutrophil gene transcripts, being [cathepsin G (CTSG)], [elastase, neutrophil expressed (ELANE)], [proteinase 3 (PRTN3)], [myeloperoxidase (MPO)], [cathepsin D (CTSD)], [defensin, alpha 3, neutrophil-specific (DEFA3)], azurocidin 1 (AZU1)], and [bactericidal/permeability-increasing protein (BPI)] the most representative ones. Proteins codified by these genes form part of the azurophilic granules of neutrophils and are involved in both antimicrobial defence and tissue damage. This "neutrophil signature" was paralleled by the necessity of advanced respiratory and vital support, and the presence of bacterial infection. CONCLUSION: Study of transcriptomic signatures in blood suggests an essential role of neutrophil proteases in COPD patients with critical respiratory illness. Measurement and modulation of the expression of these genes could present an option for clinical monitoring and treatment of severe COPD exacerbations.

Minimizing creatine kinase variability in rats for neuromuscular research purposes.

Rat serum or plasma creatine kinase (CK) activity is widely used to evaluate myopathic processes, to test the myotoxicity of different drugs, or to analyse the benefits of emerging gene therapies in some neuromuscular disorders. However, great variability is found in this determination. The aim of this study has been to control some factors of variation in order to reduce variability and increase the reproducibility of analytical data. 8-10-week-old Wistar-Han rats were used. The study consisted of four sequential phases. Phase I aimed to analyse the effect of ether and isoflurane as anaesthetic drugs. The objective of Phase II was to evaluate bleeding rats via retro-orbital sinus vs. tail vein. Phases III and IV were designed as two separate, repeated measure experiments on two factors: habituation to laboratory handling procedures in Phase III and gender in Phase IV. The repeated factor was the storage temperature of blood sample prior to centrifugation. Ether did not significantly increased the CK value. Using isoflurane, getting rats accustomed to laboratory handling procedures and whole blood refrigeration prior to centrifugation and serum separation resulted in statistically significant reduction in CK value and variability. Male rats showed significantly higher values than female rats. In the light of our findings, CK value and variability in rats may be minimized by choosing tail vein as site of bleeding, getting rats accustomed to laboratory handling procedures and maintaining whole blood refrigerated until centrifugation and serum separation.

[Developmental cysts in the presacral space in adults]. / Quistes del desarrollo en el espacio presacro en el adulto.

Localization of primitive neoplasms the retrorectal or presacral space is rare in adults as most of these tumors are congenital. Developmental cysts are included within the group of retrorectal congenital cystic neoplasms and are slowly-progressive cystic neoplasms. Because of their localization, their manifestation is delayed, despite their congenital nature. Their form of presentation is varied and is caused by compression of the surrounding organs or infectious complications of the cyst.We describe two cases of presacral developmental cysts (one epidermoid cyst and one dermoid cyst) that presented in adulthood. Special attention is paid to the classification, and diagnostic and therapeutic problems of these tumors.

Shock e isquemia miocárdica por reacción disulfiram-alcohol / Shock and myocardial ischaemia because disulfiram-alcohol reaction

Los síntomas de la reacción disulfiram-alcohol, aunque intensos y desagradables, suelen ser transitorios. La persistencia de las alteraciones hemodinámicas graves o con signos de disfunción orgánica se han descrito de forma excepcional, constituyendo en la actualidad una rareza por la escasa utilización del fármaco. Presentamos el caso de un paciente atendido por un cuadro de shock y síndrome coronario agudo, sus particularidades clínicas, dificultad diagnóstica y de tratamiento, que resultó ser consecuencia de una reacción disulfiram-alcohol inicialmente no advertida (AU)

Idiopathic megacolon associated with oesophageal achalasia.

We report a rare case of achalasia coexistent with megacolon. The patient, a 25-year-old woman, presented at our hospital with a history of abdominal pain with distension, and was finally operated on for a megacolon. Five months later she presented symptoms of progressive dysphagia and heartburn. Oesophageal manometry of the upper and lower oesophageal sphincter and X-ray studies showed images compatible with achalasia. Oesophagomyotomy of the oesophagogastric junction (Heller procedure with Dor haemifundoplication technique) was performed. In the specimens taken for biopsy, neither pathology of the myenteric plexuses, nor atrophy of the muscle fibres was evident. Chagas' disease serological diagnosis for Trypanosoma cruzii, neurological disease, diabetes and all the pathological events related with neuromuscular disorders of the gastrointestinal tract proved negative. We believe that the pathological findings are related to a dysfunction of the physiological mediators of the upper and lower digestive tract motility. The present case is extraordinary and, to our knowledge, extremely rare. The association of the two pathological diseases is questionable, and the literature is reviewed.

Reproductive status of mothers affects sex-biased parental investment in humans.

An analysis of the sexual differences in birth weights of 381 children showed that boys are heavier than girls for multiparous mothers but not for primiparous ones. The results support the current hypotheses that predict sex biases in parental investment, with higher costs of producing male offspring in some mammals.

The mitogen-activated protein kinase homolog HOG1 gene controls glycerol accumulation in the pathogenic fungus Candida albicans.

The Candida albicans HOG1 gene (HOG1CA) was cloned by functional complementation of the osmosensitive phenotype associated with Saccharomyces cerevisiae hog1 delta mutants. HOG1CA codes for a 377-amino-acid protein, 78% identical to S. cerevisiae Hog1p. A C. albicans hog1 null mutant was found to be sensitive to osmotic stress and failed to accumulate glycerol on high-osmolarity media.

[Insulinoma. Apropos of a new case]. / El insulinoma. A propósito de un nuevo caso.

Insulinomas are rare tumors whose difficult diagnosis is usually delayed with respect to appearance of the first symptoms. The Whipple triad (symptoms of hypoglycemia, low blood glucose and rapid alleviation of symptoms after glucose administration) associated with an increase in plasma immunoreactive insulin (IRI) and low blood glucose levels constitute the diagnostic basis of insulinoma as the cause of organic hypoglycemia. Curative treatment entails surgery and its success will depend on the location of the tumor. Selective arteriography and, more recently, percutaneous transhepatic insulin determination (IRI) in the splenoportal axis have a diagnostic rate of 90%. Nevertheless, none of these topographic diagnostic methods replaces meticulous intraoperative exploration of the pancreas, which in our case was definitive for cure.