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We report on a 10-year-old female who rapidly developed a left atrial (LA) mass two months after orthotopic heart transplant. Nine days prior to detection of the mass, she received high-dose corticosteroids for acute cellular rejection (grade 2). Despite negative echocardiogram five days prior to detection, a large echogenic mass was noted in the LA (18 x 12 x 24 mm); it was surgically resected after unsuccessful anticoagulation treatment. Pathogenesis of this LA thrombus remains uncertain, but immunosuppression, acute rejection, and high-dose steroid therapy may have contributed. Surgical thrombectomy is a safe and effective treatment option for LA thrombus.

Resumen Objetivo La interconsulta medica es una labor asistencial generalmente poco valorada y estudiada. El principal objetivo ha sido describir y analizar las interconsultas solicitadas a Dermatologia y los aspectos que inciden en su resolucion. Pacientes y metodos Estudio observacional retrospectivo en el que se recogieron las interconsultas de los pacientes ingresados durante 36 meses. Se analizaron variables con relacion al manejo de los pacientes y a la calidad asistencial. Resultados Se incluyo a 750 pacientes, con una edad media de 64,85 ± 20,23 anos. Los servicios medicos fueron los mas solicitantes y, principalmente, Medicina Interna (37,9%). Destacaron las dermatosis inflamatorias (36,2%). El diagnostico individual mas frecuente correspondio al exantema medicamentoso (8,1%). Conclusiones La actividad consultora conlleva un importante impacto en el manejo de los pacientes ingresados, implica una mejora en la calidad asistencial y una reduccion del coste sanitario, y conforma un valor formativo para los medicos residentes.

Objective Medical interconsultations are a healthcare task that is generally undervalued and understudied. The main objective of this study was to describe and analyse the interconsultations requested of dermatology departments and the aspects that are involve in resolving the interconsultations. Patients and methods We conducted an observational retrospective study that collected the interconsultations for patients hospitalised over a period of 36 months. We analysed variables related to the management of patients and the quality of the care. Results The study included 750 patients with a mean age of 64.85 (±20.23) years. The medical departments requested the most consultations, mainly internal medicine departments (37.9 %). The most common topic for the consultations was inflammatory dermatoses (36.2 %). The most common individual diagnosis was drug rash (8.1 %). Conclusions Consultation activities have a significant impact on the management of hospitalised patients, resulting in improved quality of care and reduced healthcare costs. These activities are also of training value for resident physicians.

Ectropion, or eyelid eversion, is the most common form of eyelid malposition. By impairing the eyelid's protective function, ectropion can cause epiphora, lagophthalmos, keratinization, chronic irritation, pain, and ulceration. There are 5 types of ectropion, each with a different cause: congenital, paralytic, involutional, cicatricial, and mechanical. The most common presentation in dermatology is involutional eversion with a mechanical or tractional element. Several options exist for the surgical repair of ectropion and choice of technique will depend on the main pathogenic component. We review the basic anatomy of the eyelid and describe examination techniques for assessing risk and preventing ectropion and for identifying the main pathogenic component in order to select the most suitable repair technique.

In this project, a descriptive research was carried out in order to analyze, evaluate and detail the behavior of buildings between 4 and 18 floors of residential use in the City of San José de Cúcuta, Colombia, at the moment they are subjected to forces produced by earthquakes. For this purpose, a sample of 40 buildings framed in the above-mentioned characteristics was used by means of the SAP 2000 software. The seismic analysis of each building was made and the displacements of these were obtained when they are submitted before an earthquake. With this information, it was possible to calculate the drifts and evaluate them based on the requirements that determine the stiffness conditions present in the buildings. Finally, a document was drawn up identifying those buildings that are susceptible to significant damage in the event of a seismic movement and recommendations, due to the fact that they represent a social risk.

Traditionally a limb that has suffered a fracture, rupture or dislocation is immobilized with plaster, a procedure that generates discomfort in the patient to take a shower, besides producing excessive itching and sweating, stimulating the growth of the bacteria and leading to an odorous form, unhygienic and difficult to keep clean of treatment. On the other hand, if the plaster remains for a long period, it can cause injuries in joints and ligaments. This project describes a methodology of manufacturing a prototype of orthosis for upper limb printed in 3D, through additive manufacturing and reverse engineering, technology that is presented as an excellent alternative to solve the problems of traditional plaster molds. The model of the orthosis is obtained through the Meshmixer software and the structural viability of the design is studied using methods of finite element analysis and biomimetics, to guarantee the best possible mechanical properties. The realization of this work provides a custom-made prototype orthosis, a more comfortable, hygienic and aesthetically pleasing solution, which in turn allows the reduction of the time of use of the plaster molds.

Bendopnea is a recently described symptom of advanced heart failure. Its prevalence and prognostic utility in other cardiac conditions are unknown. METHODS: We prospectively enrolled 108 consecutive patients (75 ± 3 years, 68% men) with severe symptomatic aortic stenosis referred for surgical aortic valve replacement (SAVR). Preoperatively, patients were tested for bendopnea, which was considered to be present when dyspnoea occurred within 30 s of bending forward. Univariable and stepwise multivariable analyses tested the association of bendopnea with preoperative echocardiographic parameters and postoperative clinical outcomes. RESULTS: Bendopnea was present in 46 of 108 (42%) patients. The mean time of onset was 10.5 ± 3.4 s. Bendopnea was associated with higher estimated pulmonary artery systolic pressures [51 (11) mmHg vs 40 (11) mmHg), P

Resumen El plano quirurgico es el plano de diseccion por el que podemos realizar la exeresis del tumor respetando la mayoria de las estructuras anatomicas neurovasculares. La mayoria de los tumores cutaneos se localizan en la cabeza y el cuello. Por tanto, es importante para el cirujano dermatologico tener un profundo conocimiento de la anatomia quirurgica de esta area. El temor a danar estructuras importantes puede llevarnos a no ser suficientemente eficaces en el tratamiento quirurgico, con el consiguiente riesgo de persistencia o recidiva tumoral. El conocimiento del sistema musculoaponeurotico superficial y sus relaciones con los puntos clave neurovasculares nos permitira planificar la ejecucion de la intervencion, guiarnos en la localizacion del plano adecuado y minimizar las complicaciones posquirurgicas. El objetivo de este articulo es revisar las caracteristicas anatomicas claves para el conocimiento de los planos de diseccion adecuados en la cabeza y el cuello, y con ello, asegurar la supervivencia de los colgajos e injertos.

The surgical plane is a plane of dissection that can be used to excise a tumor while preserving most of the neurovascular structures. The majority of skin tumors are situated on the head and neck, and dermatologic surgeons should therefore have detailed knowledge of the surgical anatomy of this region. Fear of damaging important structures may result in insufficient efficacy of the surgical treatment, with consequent risk of persistence or recurrence of the tumor. Knowledge of the superficial musculoaponeurotic system and its relationship to key neurovascular structures enables the operation to be planned and will help us to locate the appropriate plane and minimize postoperative complications. The objective of this article is to review the key anatomical features defining suitable planes of dissection in the head and neck, the use of which will ensure survival of flaps and grafts.

Given that highly active antiretroviral therapy (HAART) has been demonstrated useful to restore immune competence in type-1 human immunodeficiency virus (HIV-1)-infected subjects, we evaluated the specific antibody response to influenza vaccine in a cohort of HIV-1-infected children on HAART so as to analyze the quality of this immune response in patients under antiretroviral therapy. Sixteen HIV-1-infected children and 10 HIV-1 seronegative controls were immunized with a commercially available trivalent inactivated influenza vaccine containing the strains A/H1N1, A/H3N2, and B. Serum hemagglutinin inhibition (HI) antibody titers were determined for the three viral strains at the time of vaccination and 1 month later. Immunization induced a significantly increased humoral response against the three influenza virus strains in controls, and only against A/H3N2 in HIV-1-infected children. The comparison of post-vaccination HI titers between HIV-1+ patients and HIV-1 negative controls showed significantly higher HI titers against the three strains in controls. In addition, post vaccination protective HI titers (defined as equal to or higher than 1:40) against the strains A/H3N2 and B were observed in a lower proportion of HIV-1+ children than in controls, while a similar proportion of individuals from each group achieved protective HI titers against the A/H1N1 strain. The CD4+ T cell count, CD4/CD8 T cells ratio, and serum viral load were not affected by influenza virus vaccination when pre- vs post-vaccination values were compared. These findings suggest that despite the fact that HAART is efficient in controlling HIV-1 replication and in increasing CD4+ T cell count in HIV-1-infected children, restoration of immune competence and response to cognate antigens remain incomplete, indicating that additional therapeutic strategies are required to achieve a full reconstitution of immune functions. COL0008639 COL0058784 COL0012444

Budd-Chiari syndrome is a rare disease characterized by hepatic outflow obstruction due to different causes. Hepatic nodules in patients with Budd-Chiari syndrome are rare and can be due to hepatocellular carcinoma and benign regenerative nodules. Imaging descriptions of regenerative nodules in cirrhotic livers are numerous, but the imaging findings of benign regenerative nodules associated with Budd-Chiari syndrome have only recently been reported. We present the computed tomographic and magnetic resonance features of benign regenerative hepatic nodules with copper accumulation in a patient with chronic Budd-Chiari syndrome.

Resumen Los meningiomas multiples intracraneales son procesos raros, generalmente benignos y con entidad propia. Suelen provocar escasos sintomas clinicos, resultando el diagnostico muchas veces casual y el tratamiento tardio. Presentamos tres casos de meningiomas multiples con diferente localizacion intracraneal, incluida la forma intraventricular. En uno de los pacientes los meningiomas estaban asociados a un schwannoma gigante del acustico. Revisamos la literatura para establecer un protocolo que contribuya a favorecer el diagnostico, pronostico tratamiento precoz de estos procesos.

Producción Científica, The aim of the study was to assess patterns of the use of medicines by the general population older than 0 years. The study was based on the information contained in the computerized database from the 1993 Spanish Household Health Survey. A representative sample of the population older than 0 was identi- ®ed, and a survey of 26,334 persons was carried out. Of the population 45.3% had taken some medicine in the last 2 weeks prior to the carrying out of the survey. The proportion was greater for women (50.6%) than for men (39.6%). With increasing age, the frequency and amount of medication use increased. A little over 20% of the medicines used were not prescribed by a doctor (self-medication). Data show the frequency of the use of medicines by the Spanish population. # 1997 by John Wiley & Sons, Ltd.

A 5-month-old girl presented with symptoms of malnutrition and severe urinary tract infection, with signs of sepsis and acute renal failure: serum creatinine, 1.4 mg/dl. Both blood and urine cultures were positive for Escherichia coli, and antibiotic therapy was started. Severe, almost symmetrical, bilateral nephromegaly was evident on computed tomography (Figure 1). Voiding cystourethrography showed no urinary tract abnormalities. Bilateral renal biopsies were performed and bilateral malakoplakia was diagnosed. Malakoplakia is the result of a defect in macrophage function, causing impairment of bactericidal activity. The large macrophages that are present at sites of infection (von Hansemann cells) exhibit numerous secondary lysosomes containing partially digested organisms. Calcification of these lysosomes results in the formation of intracytoplasmic bodies called Michaelis–Gutmann bodies (Figure 2), considered pathognomonic of the disease. Renal parenchymal involvement may produce varying degrees of renal enlargement. Other relatively frequent described causes of massive bilateral non-cystic nephromegaly include renal infiltration by hematolymphoid diseases, nephroblastomatosis, megalocystic interstitial nephritis, xanthogranulomatous pyelonephritis, and other infections. At 6 months after diagnosis, the patient is well, but nephromegaly continues and her serum creatinine level is 0.7 mg/dl (creatinine clearance 33 ml/min). Prognosis of renal malakoplakia in children is variable: some patients recover completely, others develop end-stage renal disease, and others may die.

The concept of shear wave elasticity imaging is applied to arteries. The goal of this study is to demonstrate the potential of this technique for precisely and non-invasively quantifying the elasticity of the arterial wall. Experiments are performed in arterial phantoms composed of elastic cylindrical shells that have an elastic modulus in the range of human arteries stiffness. The feasibility of imaging the shear wave propagation in real-time and measuring the frequency dispersion over a large bandwidth (100-1500 Hz) is demonstrated with good accuracy. Experimental dispersion curves are in good agreement with the theoretical curves computed for each phantom. Based on the dispersion measurement, a simple method is developed to derive the elastic modulus of the arterial wall. Finally, the feasibility of quantifying non-invasively the elastic modulus of the arterial wall is demonstrated in vivo on healthy volunteers.

espanolObjetivo: Realizar una revision y actualizacion acerca de los actuales enfoques diagnosticos, terapeuticos y fisiopatologicos de la orbitopatia tiroidea y plantear un abordaje clinico sencillo, precoz y practico, basado en el conocimiento de la enfermedad. Metodos: Revision de la literatura publicada referente a la orbitopatia tiroidea y exposicion de nuestra experiencia, casuistica y manera actual de enfocar esta patologia. Resultados: La orbitopatia tiroidea es una enfermedad inflamatoria orbitaria con un posible origen autoinmune y que suele asociarse a trastornos metabolicos de la glandula tiroidea. Su presentacion clinica es muy variada y puede causar alteraciones significativas de la vision y de la arquitectura orbitaria, lo que se traduce en una disminucion importante de la calidad de vida de los pacientes y muchas veces provoca una severa afectacion de la personalidad. Fisiopatologicamente su mecanismo sigue siendo incierto, pero se cree que existe un autoantigeno comun entre la glandula tiroides y los fibroblastos preadipociticos de la orbita. Afecta mayormente a mujeres y esta negativamente influenciada por factores como el tabaquismo, la edad, el sexo y la raza. Conclusiones: El conocimiento clinico es esencial para el diagnostico precoz de la enfermedad, el cual sera el mejor elemento para su adecuado tratamiento. El tratamiento medico debe ser precoz, agresivo y acorde a la fase en que se presente el paciente con el fin de evitar las graves consecuencias de la orbitopatia tiroidea. El tratamiento quirurgico debera ser logico y ordenado, pero a su vez rapido, con el fin de devolver al paciente al entorno laboral, social y familiar. EnglishPurpose: To review and to update the current diagnostic and therapeutic approaches and the pathogenesis of thyroid orbitopathy. To propose a practical, basic and precocious approach based in the knowledge of the disorder. Methods: Literature review and exposition of our experience in the management of thyroid orbitopathy. Results: Thyroid orbitopathy is an inflammatory orbital disease that probably has an autoimmune origin and most of the time is related to systemic disorders of the thyroid gland. The disease has a variable clinical presentation and it may cause severe damage in vision and orbital architecture, therefore, producing a decrease in the patient’s quality of life and may also alter significantly the personal behavior. Pathogenesis of the disease is not yet fully understood, but it is widely held that there is a common autoantigen shared between the thyroid gland and the orbital adipogenic fibroblasts. Women are more likely to develop thyroid orbitopathy, and the disease is clearly affected by several factors such as smoking, age, sex and race. Conclusions: Clinical knowledge is essential for the early diagnosis of this disorder, and it is the most important factor for the proper management of the disease. The medical treatment must be initiated promptly and should be aggressive and based in the current phase of the disease, in order to avoid the severe damage that follows thyroid orbitopathy. The surgical approach must be logical and sequential, but, on the other hand, must be rapid and aggressive in order to return the patient to his/her labour, social and familiar environment.

Producción Científica, In this study, we analyzed patterns of combined benzodiazepines and alcohol use among the Spanish general population over the age of 16 years. The study was based on information from the 1997 Spanish National Household Health Survey. A total of 6,396 persons over 16 years of age, a representative sample of noninstitutionalized Spaniards, were surveyed. One percent of the population are consumers of benzodiazepines and daily drinkers of alcohol; fundamentally, these consumers are men, of whom 15.4% drink alcohol at a high level ( > 50 units/week). Findings show the frequency of concurrent use of benzodiazepines and alcohol by the Spanish population

CO RR EC TE D PR OO F physician is required in disregarding another pathology and to adjust treatment.We collected epidemiological data, associated comorbidities, days of delay to surgery, presence of another complications, length of stay, evolution (discharge or death) and readmissions within 30 days after discharge. Results: The study included 131 patients with hip fracture in this period; the mean age was 81.15 +/− 10.19 years and 107 (81.7%) were women. A total of 24 (18.3%) patients developed delirium. There was no differences in gender (p= 0.12), but thosewith deliriumwere older (84.9 vs 80.2, p = 0.04) and had a higher length of stay (25.2 vs 17.3, p = 0.03). The mean Barthel index was lower in those with delirium (65 vs 78, p = 0.14). Previous diagnosis of dementia is associated with the presence of this complication (41.7% vs 22.4%, p = 0.04). There were no differences between those who were operated before or after 72 h (p= .87). The presence of another complications (heart failure, arrhythmia, renal failure, pneumonia, diabetic ketoacidosis, urinary tract infections, pressure ulcers, and hypertension) was similar in both groups. In evolution, the development of delirium did not provide a higher mortality (4.2% vs 8.4%, p = 0.42) but was associated with a higher rate of readmissions within 30 days (20.8% vs. 7.5%, p = 0.04), especially for medical reasons and higher mortality rate in the readmission (80% vs 12.5%, p = 0.03). The healthcare cost of a patient with delirium is 19% greater than in a patient without delirium (1.121.15€). Conclusion: In our series, the presence of acute deliriumhas been associatedwith increased age, prior history of dementia and a lower score on the Barthel Index. Surgical delay does not affect the development of this syndrome. There is no increased mortality during hospitalization, however, these patients have a higher length of stay, readmission rate and mortality within 30 days, with a consequent increase in healthcare costs. Measures to reduce the incidence of this syndrome, would lead to significant economic savings.

In this paper an analysis is made of beverage preferences and their effect on alcohol consumption patterns. For this purpose we have used the 1993 Spanish National Household Health Survey conducted on members of the population aged 16 or over. Beer and spirits are consumed more frequently by young people and wine by older people. The most consumed daily drink is wine and beer on a weekly basis. Men always drank more frequently and consumed a greater number of drinks per occasion than women for the three types of drink analyzed. The study shows that beverage preference is an important factor in the characterization of alcohol use patterns.