[Neuropsychological aspects of nicotine craving]. / Aspectos neuropsicológicos del craving por la nicotina.

Craving has been defined as the motivation to self-administer a substance previously consumed. It has been hypothesized that craving contributes significantly to compulsive drug use and relapse after a period of abstinence in humans. Neuropsychological and brain-imaging studies have identified numerous brain regions that may be involved in craving. In this paper, the neuropsychological mechanisms of craving for nicotine are reviewed, focusing on three systems that appear to be involved in craving states. First of all, the reward system, responsible for the development of dependence and craving. Secondly, the emotional and associative system, which is related to conditioned craving. And third, the system involved in the neural basis of cognitive and decision making processes. The most influential theoretical models on craving are also reviewed, including those based on conditioning mechanisms, on cognitive mechanisms and on cognitive-behavioral mechanisms, as well as the neurobiological model. Factors related to the evaluation and treatment of craving are also discussed, with particular emphasis on clinical aspects. Finally, we stress the importance of a multidisciplinary approach for achieving a common model on craving and improving the diagnostic tools and treatment strategies.

Aspectos neuropsicológicos del craving por la nicotina / Neuropsychological aspects of nicotine craving

El craving se ha definido como la motivación de autoadministrarse una sustancia que previamente ha sido consumida. Se considera que el craving es responsable del consumo compulsivo de una sustancia, así como del alto nivel de recaídas después de periodos de abstinencia. Los estudios neuropsicológicos y de imagen cerebral han identificado numerosas regiones cerebrales implicadas en el craving. En este artículo se revisan los mecanismos neuropsicológicos implicados en el craving por la nicotina, centrándose en los tres sistemas involucrados en el craving. Primero, el sistema de recompensa, responsable del desarrollo de la dependencia y del craving. Segundo, el sistema emocional y asociativo que se relaciona con el craving condicionado. Tercero, el sistema implicado en la toma de decisiones y procesos cognitivos. Además, se revisa los modelos teóricos más influyentes, como los Modelos basados en el Condicionamiento, Modelos Cognitivo-Conductuales, Modelos Cognitivos y Modelo Neurobiológico. También se discuten otros aspectos relacionados con la evaluación y tratamiento del craving, haciendo énfasis en los aspectos clínicos. Como conclusión, se acentúa la importancia de un enfoque multidisciplinar para lograr un modelo común del craving, así como para mejorar las herramientas diagnósticas y las estrategias de tratamiento (AU)

Craving has been defined as the motivation to self-administer a substance previously consumed. It has been hypothesized that craving contributes significantly to compulsive drug use and relapse after a period of abstinence in humans. Neuropsychological and brain-imaging studies have identified numerous brain regions that may be involved in craving. In this paper, the neuropsychological mechanisms of craving for nicotine are reviewed, focusing on three systems that appear to be involved in craving states. First of all, the reward system, responsible for the development of dependence and craving. Secondly, the emotional and associative system, which is related to conditioned craving. And third, the system involved in the neural basis of cognitive and decision making processes. The most influential theoretical models on craving are also reviewed, including those based on conditioning mechanisms, on cognitive mechanisms and on cognitive-behavioral mechanisms, as well as the neurobiological model. Factors related to the evaluation and treatment of craving are also discussed, with particular emphasis on clinical aspects. Finally, we stress the importance of a multidisciplinary approach for achieving a common model on craving and improving the diagnostic tools and treatment strategies (AU)

Manejo obstétrico de la gastrosquisis en una gestación de 26 semanas / Obstetric management of gastroschisis in a 26-week pregnancy

La gastrosquisis fetal es la malformación congénita de la pared abdominal más común. Esta anomalía es susceptible de una corrección quirúrgica posnatal mediante cierre primario de la fascia o diferido mediante una técnica de silo. Presentamos el caso de una gestante que inicia su primer control de gestación en la 26 semana, con hallazgo ecográfico de gastrosquisis fetal (AU)

Fetal gastroschisis is the most common congenital malformation of the abdominal wall. This anomaly can be corrected by postnatal surgery, either through primary closure of the fascia or delayed closure by means of a silo technique. We present the case of a woman who attended her first prenatal visit in week 26 of pregnancy, with an ultrasonographic finding of fetal gastroschisis (AU)

Gestación ectópica del segundo trimestre / Second trimester ectopic pregnancy

La incidencia global del embarazo ectópico es del 1-2% de las gestaciones. Es infrecuente su diagnostico en el segundo trimestre, ya que por lo general los síntomas aparecen durante el primer trimestre. Presentamos el caso de una mujer que acude a urgencias con dolor en la fosa ilíaca de varios días de evolución y mediante la ecografía se le diagnostica embarazo tubárico derecho, con feto de biometría concordante con las 13 semanas de amenorrea de la paciente (AU)

The global incidence of ectopic pregnancy is around 1-2%. Its diagnosis is rare in the second trimester as symptoms usually appear during the first trimester. We present the case of a woman who was seen in the emergency room with a right lower quadrant pain of a few days duration. A transvaginal ultrasound confirmed an ectopic right pregnancy with a 13-week embryo (AU)