Spectrochemical analysis of sycamore (Acer pseudoplatanus) leaves for environmental health monitoring

Terrestrial plants are ideal sentinels of environmental pollution, due to their sedentary nature, abundance and sensitivity to atmospheric changes. However, reliable and sensitive biomarkers of exposure have hitherto been difficult to characterise. Biospectroscopy offers a novel approach to the derivation of biomarkers in the form of discrete molecular alterations detectable within a biochemical fingerprint. We investigated the application of this approach for the identification of biomarkers for pollution exposure using the common sycamore (Acer pseudoplatanus) as a sentinel species. Attenuated total reflection Fourier-transform infrared (ATR-FTIR) spectroscopy was used to interrogate leaf tissue collected from three sites exposed to different levels of vehicle exhaust emissions. Following multivariate analysis of acquired spectra, significant biochemical alterations were detected between comparable leaves from different sites that may constitute putative biomarkers for pollution-induced stress. These included differences in carbohydrate and nucleic acid conformations, which may be indicative of sub-lethal exposure effects. We also observed several corresponding spectral alterations in both the leaves of A. pseudoplatanus exposed to ozone pollution under controlled environmental conditions and in leaves infected with the fungal pathogen Rhytisma acerinum, indicating that some stress-induced changes are conserved between different stress signatures. These similarities may be indicative of stress-induced reactive oxygen species (ROS) generation, although further work is needed to verify the precise identity of infrared biomarkers and to identify those that are specific to pollution exposure. Taken together, our data clearly demonstrate that biospectroscopy presents an effective toolkit for the utilisation of higher plants, such as A. pseudoplatanus, as sentinels of environmental pollution

Natural History of MYH7-Related Dilated Cardiomyopathy

BACKGROUND: Variants in myosin heavy chain 7 (MYH7) are responsible for disease in 1% to 5% of patients with dilated cardiomyopathy (DCM); however, the clinical characteristics and natural history of MYH7-related DCM are poorly described. OBJECTIVE: We sought to determine the phenotype and prognosis of MYH7-related DCM. We also evaluated the influence of variant location on phenotypic expression. METHODS: We studied clinical data from 147 individuals with DCM-causing MYH7 variants (47.6% female; 35.6 ± 19.2 years) recruited from 29 international centers. RESULTS: At initial evaluation, 106 (72.1%) patients had DCM (left ventricular ejection fraction: 34.5% ± 11.7%). Median follow-up was 4.5 years (IQR: 1.7-8.0 years), and 23.7% of carriers who were initially phenotype-negative developed DCM. Phenotypic expression by 40 and 60 years was 46% and 88%, respectively, with 18 patients (16%) first diagnosed at <18 years of age. Thirty-six percent of patients with DCM met imaging criteria for LV noncompaction. During follow-up, 28% showed left ventricular reverse remodeling. Incidence of adverse cardiac events among patients with DCM at 5 years was 11.6%, with 5 (4.6%) deaths caused by end-stage heart failure (ESHF) and 5 patients (4.6%) requiring heart transplantation. The major ventricular arrhythmia rate was low (1.0% and 2.1% at 5 years in patients with DCM and in those with LVEF of ≤35%, respectively). ESHF and major ventricular arrhythmia were significantly lower compared with LMNA-related DCM and similar to DCM caused by TTN truncating variants. CONCLUSIONS: MYH7-related DCM is characterized by early age of onset, high phenotypic expression, low left ventricular reverse remodeling, and frequent progression to ESHF. Heart failure complications predominate over ventricular arrhythmias, which are rare

Composition, potential emissions and agricultural value of pig slurry from Spanish commercial farms

[EN] Pig slurry is a valuable fertilizer for crop production but at the same time its management may pose environmental risks. Slurry samples were collected from 77 commercial farms of four animal categories (gestating and lactating sows, nursery piglets and growing pigs) and analyzed for macronutrients, micronutrients, heavy metals and volatile fatty acids. Emissions of ammonia (NH3) and biochemical methane potential (BMP) were quantified. Slurry electrical conductivity, pH, dry matter content and ash content were also determined. Data analysis included an analysis of correlations among variables, the development of predictionmodels for gaseousemissions and the analysis of nutritional content of slurries for crop production. Descriptive information is provided in this work and shows a wide range of variability in all studied variables. Animal category affected some physicochemical parameters, probably as a consequence of different slurry management and use of cleaning water. Slurries from gestating sows and growing pigs tended to be more concentrated in nutrients, whereas the slurry from lactating sows and nursery piglets tended to be more diluted. Relevant relationships were found among slurry characteristics expressed in fresh basis and gas emissions. Predictivemodels using on-farmmeasurable parameterswere obtained forNH3 (R2 = 0.51) andCH4 (R2 = 0.76), which suggests that BMP may be estimated in commercial farms from easily determined slurry characteristics. Finally, slurry nutrient composition was highly variable. Therefore, complete analyses of slurries should be performed for an effective and environmental friendly land application.This project was funded by the Spanish Ministry of Science and Innovation (AGL2011-30023) and the Valencian Government (ACOMP/2013/118). We thank the BABEL Project, Building Academic Bonds between Europe and Latin America. Erasmus Mundus Programme Action 2 for PhD fellowships. The translation of this paper was funded by the Universitat Politecnica de Valencia, Spain.Antezana-Julian, WO.; Blas, CD.; García-Rebollar, P.; Rodríguez, C.; Beccaccia, A.; Ferrer Riera, P.; Cerisuelo, A.... (2016). Composition, potential emissions and agricultural value of pig slurry from Spanish commercial farms. Nutrient Cycling in Agroecosystems. 104(2):159-173. https://doi.org/10.1007/s10705-016-9764-3S1591731042Aarnink AJA, Verstegen MWA (2007) Nutrition, key factor to reduce environmental load from pig production. Livest Sci 109(1–3):194–203Abubaker J, Risberg K, Jönsson E, Dahlin A S, Cederlund H, Pell M (2015) Short-term effects of biogas digestates and pig slurry application on soil microbial activity. Appl Environ Soil Sci. Article ID 658542: 1–15Adekunle KF, Okolie JA (2015) A review of biochemical process of anaerobic digestion. Adv Biosci Biotechnol 6:205–212Angelidaki I, Alves M, Bolzonella D, Borzacconi L, Campos JL, Guwy J, Kalyuzhnyi S, Jenicek P, Van Lier JB (2009) Defining the biomethane potential (BMP) of solid organic wastes and energy crops: a proposed protocol for batch assays. Water Sci Technol 59(5):927–934Antezana W, Calvet S, Beccaccia A, Ferrer P, De Blas C, García-Rebollar P, Cerisuelo A (2015) Effects of nutrition on digestion efficiency and gaseous emissions from slurry in growing pigs: III. Influence of varying the dietary level of calcium soap of palm fatty acids distillate with or without orange pulp supplementation. Anim Feed Sci Technol 209:128–136APHA (2005) Standard methods for the examination of water and wastewater. Centennial, BaltimoreBai ZH, Qin W, Chen Q, Oenema O, Zhang FS (2014) Changes in pig production in china and their effects on nitrogen and phosphorus use and losses. Environ Sci Technol 48:12742–12749Beccaccia A, Ferrer P, Ibáñez MA, Estellés F, Rodríguez C, Moset V, De Blas C, Calvet S, García-rebollar P (2015) Relationships among slurry characteristics and gaseous emissions at different types of commercial spanish pig farms. Span J Agric Res 13(1):1–15Conn KL, Topp E, Lazarovits G (2007) Factors influencing the concentration of volatile fatty acids, ammonia, and other nutrients in stored liquid pig manure. J Environ Qual 36(2):440–447Diacono M, Montemurro F (2010) Long-term effects of organic amendments on soil fertility. A review. Agron Sustain Dev 30:401–422. doi: 10.1051/agro/2009040Díez JA, Hernaiz P, Muñoz MJ, Torre A, Vallejo A (2006) Impact of pig slurry on soil properties, water salinization, nitrate leaching and crop yield in a four-year experiment in Central Spain. Soil Use Manag 20(4):444–450Dourmad J-Y, Jondreville C (2007) Impact of nutrition on nitrogen, phosphorus, Cu and Zn in pig manure, and on emissions of ammonia and odours. Livest Sci 112(3):192–198EUROSTAT (2015) Pig farming sector—statistical portrait. Pig Farming in the European Union: considerable variations from one member state to another. Statistics in Focus 15/2014. Author: Pol Marquer, Teresa Rabade, Roberta Forti ISSN:2314-9647, Catalogue number: KS-SF-14-015-EN-NFangueiro D, Lopes C, Surgy S, Vasconcelos E (2012a) Effect of the pig slurry separation techniques on the characteristics and potential availability of N to plants in the resulting liquid and solid fractions. Biosyst Eng 113(2):187–194Fangueiro D, Ribeiro H, Vasconcelos E, Coutinho J, Cabral F (2012b) Influence of animal slurries composition and relative particle size fractions on the C and N mineralization following soil incorporation. Biomass Bioenergy 47:50–51Ferrer P, Cambra-López M, Cerisuelo A, Peñaranda D, Moset V (2014) The use of agricultural substrates to improve methane yield in anaerobic co-digestion with pig slurry: effect of substrate type and inclusion level. Waste Manag 34:196–203Galassi G, Colombini S, Malagutti L, Crovetto GM, Rapetti L (2010) Effects of high fibre and low protein diets on performance, digestibility, nitrogen excretion and ammonia emission in the heavy pig. Anim Feed Sci Technol 161:3–4Gopalan P, Jensen PD, Batstone DJ (2013) Anaerobic digestion of swine effluent: impact of production stages. Biomass Bioenergy 48:121–129Hernández D, Fernández JM, Plaza C, Polo A (2007) Water-soluble organic matter and biological activity of a degraded soil amended with pig slurry. Sci Total Environ 378:101–103Hernández D, Polo A, Plaza C (2013) Long-term effects of pig slurry on barley yield and N use efficiency under semiarid mediterranean conditions. Eur J Agron 44:47–86Hristov AN, Oh J, Lee C, Meinen R, Montes F, Ott T, Firkins J, Rotz A, Dell C, Adesogan A, Yang W, Tricarico J, Kebreab E, Waghorn G, Dijkstra J, Oosting S (2013) Mitigation of greenhouse gas emissions in livestock production—A review of technical options for non-CO2 emissions. In: Gerber PJ, Henderson B, Makkar HPS (eds) FAO Animal Production and Health Paper No. 177. FAO, RomeIguácel F, Yagüe MR, Betrán J, Orús F (2011) Ensayos de Fertilización Con Purín Porcino, En Cereales de Invierno de Secano, Dirección General de Desarrollo Rural, Centro de Transferencia Agroalimentaria, Gobierno de Aragón. Informe Técnico 226:15Jarret G, Cerisuelo A, Peu P, Martinez J, Dourmad JY (2012) Impact of pig diets with different fibre contents on the composition of excreta and their gaseous emissions and anaerobic digestion. Agric Ecosyst Environ 160:51–58Jouany JP (1982) Volatile fatty acid and alcohol determination in digestive contents, silage juices, bacterial cultures and anaerobic fermentor contents. Sci Alimen 2:131–144Krupa SV (2003) Effects of atmospheric ammonia (NH3) on terrestrial vegetation: a review. Environ Pollut 124(2):179–221Mantovi P, Fumagalli L, Beretta GP, Guermandi M (2006) Nitrate leaching through the unsaturated zone following pig slurry applications. J Hydrol 316:1–4Martínez-Suller L, Azzellino A, Provolo G (2008) Analysis of livestock slurries from farms across Northern Italy: relationship between indicators and nutrient content. Biosyst Eng 99(4):540–552Moral R, Moreno-Caselles J, Perez-Murcia MD, Perez-Espinosa A, Rufete B, Paredes C (2005a) Characterisation of the organic matter pool in manures. Bioresour Technol 96(2):153–158Moral R, Perez-Murcia MD, Perez-Espinosa A, Moreno-Caselles J, Paredes C (2005b) Estimation of nutrient values of pig slurries in Southeast Spain using easily determined properties. Waste Manag 25(7):719–725Moral R, Perez-Murcia MD, Perez-Espinosa A, Moreno-Caselles J, Paredes C, Rufete B (2008) Salinity, organic content, micronutrients and heavy metals in pig slurries from South-Eastern Spain. Waste Manag 28(2):367–371Morazán H, Alvarez-Rodriguez J, Seradj AR, Balcells J, Babot D (2015) Trade-offs among growth performance, nutrient digestion and carcass traits when feeding low protein and/or high neutral-detergent fiber diets to growing-finishing pigs. Anim Feed Sci Technol 207:168–180Moset V, Cambra-López M, Estellés F, Torres AG, Cerisuelo A (2012) Evolution of chemical composition and gas emissions from aged pig slurry during outdoor storage with and without prior solid separation. Biosyst Eng 111(1):2–10Ndegwa PM, Vaddella VK, Hristov N, Joo HS (2009) Measuring concentrations of ammonia in ambient air or exhaust air stream using acid traps.  J Environ Qual 38(2):647–653Nicholson FA, Chambers BJ, Williams JR, Unwin RJ (1999) Heavy metal contents of livestock feeds and animal manures in England and Wales. Bioresour Technol 70(1):23–31Olusegun OS (2014) Influence of NPK 15-15-15 Fertilizer and Pig Manure on Nutrient Dynamics and Production of Cowpea, Vigna unguiculata L. Walp. Am J Agric For 2(6):267Parera i Pous J, Olivé D, Mallol Nabot C, Torrijos NC (2010) Adaptación Del Uso de La Conductividad Eléctrica (CE) Para Determinar de Forma Rápida El Contenido En Nutrientes Del Purín Porcino En Catalunya. International Workshop on Anaerobic Digestion of Slaughterhouse Waste, pp 67–76Patience JF, Gould SA, Koehler D, Corrigan B, Elsbernd A, Holloway CL (2015) Super-dosed phytase improves rate and efficiency of gain in nursery pigs. Anim Ind Rep AS 661:98Penha HG, Menezes JF, Silva CA, Lopes G, Carvalho CA, Ramos SJ, Guilherme LRG (2015) Nutrient accumulation and availability and crop yields following long-term application of pig slurry in a Brazilian Cerrado soil. Nutr Cycl Agroecosyst 101(2):259–269Popovic O, Jensen LS (2012) Storage temperature affects distribution of carbon, VFA, ammonia, phosphorus, copper and zinc in raw pig slurry and its separated liquid fraction. Water Res 46(12):3849–3858Provolo G, Martínez-Suller L (2007) In situ determination of slurry nutrient content by electrical conductivity. Bioresour Technol 98(17):3235–3242Sánchez M, González JL (2005) The fertilizer value of pig slurry. I. Values depending on the type of operation. Bioresour Technol 96(10):1117–1123SAS Institute (2008) SAS/STAT User´s guide, v 9.3. SAS Institute Inc., CarySchoumans OF, Chardon WJ, Bechmann ME, Gascuel-Odoux C, Hofman G, Kronvang B, Rubæk HG, Ulén B, Dorioz JM (2014) Mitigation options to reduce phosphorus losses from the agricultural sector and improve surface water quality: a review. Sci Total Environ 468–469:1255–1266Schröder JJ, Cordell D, Smit AL, Rosemarin A (2010) Sustainable use of phosphorus. Plant Research International Wageningen UR. Report 357Scotford IM, Cumby TR, White RP, Carton OT, Lorenz F, Hatterman U, Provolo G (1998) Estimation of the nutrient value of agricultural slurries by measurement of physical and chemical properties. J Agric Eng Res 71(3):291–305Snoek DJW, Johannes DS, Ogink NWM, Koerkamp PWGG (2014) Sensitivity analysis of mechanistic models for estimating ammonia emission from dairy cow urine puddles. Biosyst Eng 121:12–24Suresh A, Choi HL, Oh DI, Moon OK (2009) Prediction of the nutrients value and biochemical characteristics of swine slurry by measurement of EC—electrical conductivity. Bioresour Technol 100:4683–4689Thygesen O, Triolo JM, Sommer SG (2012) Indicators of physical properties and plant nutrient content of animal slurry and separated slurry. Biol Eng Trans 5(3):123–135Triolo JM, Sommer SG, Møller HB, Weisbjerg MR, Jiang XY (2011) A new algorithm to characterize biodegradability of biomass during anaerobic digestion: influence of lignin concentration on methane production potential. Bioresour Technol 102:9395–9402Van Duivenbooden N, de Wit CT, Van Keulen H (1996) Nitrogen, phosphorus and potassium relations in five major cereals reviewed in respect to fertilizer recommendations using simulation modelling. Fertil Res Wagening 44:37–49Viguria M, Sanz-Cobeña A, López DM, Arriaga H, Merino P (2015) Ammonia and greenhouse gases emission from impermeable covered storage and land application of cattle slurry to bare soil. Agric Ecosyst Environ 199:261–271Villamar CA, Canuta T, Belmonte M, Vidal G (2012) Characterization of swine wastewater by toxicity identification evaluation methodology (TIE). Water Air Soil Pollut 223(1):363–369Villamar CA, Rodríguez DC, López D, Peñuela G, Vidal G (2013) Effect of the generation and physical–chemical characterization of swine and dairy cattle slurries on treatment technologies. Waste Manage Res 31(8):820–828Villar MC, Petrikova V, Díaz-Raviña M, Carballas T (2004) Recycling of organic wastes in burnt soils: combined application of poultry manure and plant cultivation. Waste Manage 24(4):365–370Webb J, Menzi H, Pain BF, Misselbrook TH, Dämmgen U, Hendriks H, Döhler H (2005) Managing ammonia emissions from livestock production in Europe. Environ Pollut 135:399–406Webb J, Broomfield M, Jones S, Donovan B (2014) Ammonia and odour emissions from UK pig farms and nitrogen leaching from outdoor pig production. Sci Total Environ 470:865–875Weiland P (2010) Biogas production: current state and perspectives. Appl Microbiol Biotechnol 85:849–860Yagüe MR, Bosch-Serra AD, Boixadera J (2012) Measurement and estimation of the fertiliser value of pig slurry by physicochemical models: usefulness and constraints. Biosyst Eng 111(2):206–216Zhang W, Wei Q, Wu S, Qi D, Li W, Zuo Z, Dong R (2014) Batch anaerobic co-digestion of pig manure with dewatered sewage sludge under mesophilic conditions. Appl Energy 128:175–18

Ecuadorian Migration in Amsterdam and Madrid: The Structural Contexts

AbstractThe scope of this chapter is to outline the main characteristics of the two contexts that were the scenario of the phenomenon that is the object of this book. The analysis will centre on those structural features of the cities of Amsterdam and Madrid and, more in general, of the Netherlands and Spain, that may have had an influence on the experience of Ecuadorian irregular migrants

Association of follow-up infarct volume with functional outcome in acute ischemic stroke: a pooled analysis of seven randomized trials.

BACKGROUND: Follow-up infarct volume (FIV) has been recommended as an early indicator of treatment efficacy in patients with acute ischemic stroke. Questions remain about the optimal imaging approach for FIV measurement. OBJECTIVE: To examine the association of FIV with 90-day modified Rankin Scale (mRS) score and investigate its dependency on acquisition time and modality. METHODS: Data of seven trials were pooled. FIV was assessed on follow-up (12 hours to 2 weeks) CT or MRI. Infarct location was defined as laterality and involvement of the Alberta Stroke Program Early CT Score regions. Relative quality and strength of multivariable regression models of the association between FIV and functional outcome were assessed. Dependency of imaging modality and acquisition time (≤48 hours vs >48 hours) was evaluated. RESULTS: Of 1665 included patients, 83% were imaged with CT. Median FIV was 41 mL (IQR 14-120). A large FIV was associated with worse functional outcome (OR=0.88(95% CI 0.87 to 0.89) per 10 mL) in adjusted analysis. A model including FIV, location, and hemorrhage type best predicted mRS score. FIV of ≥133 mL was highly specific for unfavorable outcome. FIV was equally strongly associated with mRS score for assessment on CT and MRI, even though large differences in volume were present (48 mL (IQR 15-131) vs 22 mL (IQR 8-71), respectively). Associations of both early and late FIV assessments with outcome were similar in strength (ρ=0.60(95% CI 0.56 to 0.64) and ρ=0.55(95% CI 0.50 to 0.60), respectively). CONCLUSIONS: In patients with an acute ischemic stroke due to a proximal intracranial occlusion of the anterior circulation, FIV is a strong independent predictor of functional outcome and can be assessed before 48 hours, oneither CT or MRI

Aspectos técnicos en la infiltración caudal guiada por tomografía computarizada

Introduction: Caudal epidural infiltration is currently one of the most used regional analgesia techniques for control of chronic low pack pain. Our primary objective in this presentation is to highlight a new technique for performing this intervention which is simpler and less aggressive for the patient than that classically used. Material and methods: This new technique has been used on 13 patients (2 males and 11 females) between 33 and 84 years. All patients had chronic lumbar pain. A General Electric Light Speed 16 CT scanner, a 22G lumbar puncture needle and appropriate sterile measures, were used to perform the technique. The CT scanner is a tool that makes it much easier to visualise the sacrococcygeal ligament. After the needle is introduced, and checked using CT, into the caudal spinal canal, the bevel is turned in the cranial direction in order that the medication administered comes out of the needle orifice towards the neural canal. Discussion: The most common technique for performing caudal epidural infiltration is usually done in the prone position with the head turned to one side using an X-ray arch. Using this technique we show that the puncture is less aggressive, quicker and with fewer possibilities of complications. The risk of perforating the dural sac is practically non-existent. There is also less risk of producing haematomas or infections, due to there being much less manipulation of the needle and only involves a direct puncture. In the 100% of cases on which our technique has been performed, the diffusion of the administered medication has been made in the cranial direction, which has been verified using contrast added to the pharmacological mixture.Introducción: La infiltración epidural caudal constituye en la actualidad una de las técnicas de analgesia regional que se utiliza con más frecuencia para el dolor crónico lumbar. Nuestro objetivo principal a alcanzar en esta exposición es poner de relieve una nueva técnica para realizar esta intervención que resulta más sencilla y menos agresiva para el paciente que la utilizada clásicamente. Material y métodos: Esta técnica se ha realizado en 13 pacientes (2 varones y 11 mujeres), con edades comprendidas entre los 33 y los 84 años. Todos los pacientes tenían dolor lumbar crónico. Para realizarla se ha utilizado un equipo de tomografía computarizada (TC) General Electric Light Speed 16, una aguja de punción lumbar de 22G y las medidas estériles adecuadas. La TC es una herramienta que facilita enormemente la visualización del ligamento sacrocoxígeo. Una vez introducida la aguja y comprobado mediante TC que se encuentre en el interior del canal raquídeo caudal, se procede a girar el bisel en dirección craneal con el objetivo de que el fármaco administrada salga por el orificio de la aguja hacia el canal neural. Discusión: La técnica más frecuente en la práctica de la infiltración epidural caudal se realiza habitualmente con el paciente en decúbito prono, con la cabeza girada sobre un lado utilizando un arco de rayos X. Mediante la técnica que mostramos, la punción es menos agresiva, más rápida y hay menos posibilidades de complicaciones. El riesgo de perforar el saco dural es prácticamente inexistente, así como de producir hematomas o infecciones, debido a que la manipulación con la aguja es mucho menor y se ciñe únicamente a una punción directa. En el 100% de los casos en que se ha practicado nuestra técnica, la difusión de la medicación administrada se ha realizado en dirección craneal, lo cual se ha verificado debido al contraste que se ha añadido a la mezcla farmacológica

Alternative Microstructural Measures to Complement Diffusion Tensor Imaging in Migraine Studies with Standard MRI Acquisition

The white matter state in migraine has been investigated using diffusion tensor imaging (DTI) measures, but results using this technique are conflicting. To overcome DTI measures, we employed ensemble average diffusion propagator measures obtained with apparent measures using reduced acquisitions (AMURA). The AMURA measures were return-to-axis (RTAP), return-to-origin (RTOP) and return-to-plane probabilities (RTPP). Tract-based spatial statistics was used to compare fractional anisotropy, mean diffusivity, axial diffusivity and radial diffusivity from DTI, and RTAP, RTOP and RTPP, between healthy controls, episodic migraine and chronic migraine patients. Fifty healthy controls, 54 patients with episodic migraine and 56 with chronic migraine were assessed. Significant differences were found between both types of migraine, with lower axial diffusivity values in 38 white matter regions and higher RTOP values in the middle cerebellar peduncle in patients with a chronic migraine (p &lt; 0.05 family-wise error corrected). Significantly lower RTPP values were found in episodic migraine patients compared to healthy controls in 24 white matter regions (p &lt; 0.05 family-wise error corrected), finding no significant differences using DTI measures. The white matter microstructure is altered in a migraine, and in chronic compared to episodic migraine. AMURA can provide additional results with respect to DTI to uncover white matter alterations in migraine

Tratamiento mediante punción guiada por TC de un meningocele intrasacro oculto doloroso: Caso clínico y revisión de la literatura

Case reports: We report a 43-year old patient with a history of disabling pain sacrum 8/10 on the VAS of 8 months. No sensory disturbances were noted or loss of bowel control. Consultation conducted in multiple hospitals. She underwent a computed tomography (CT) lumbar that highlighted a hemangioma in L5, a magnetic resonance imaging (MRI) of the pelvis which showed muscle breakdown grade I of the left maximus gluteus, and a cystic lesion in the sacrum, which was interpreted as a Tarlov cyst. She received analgesic and anti-inflammatory treatment with no improvement. She also goes through two facet blocks and even a lock in the left piriformis, all without results. In our center we practised a lumbosacral MRI which highlighted a cystic lesion localized in central and right lateral sacral spinal canal at the level of S2-S3 transition. It was high signal on T2 and low signal on T1. Discussion: According to Nabors classification, this lesion corresponds to a hidden intrasacro meningocele. The hidden intrasacro meningocele (extradural meningeal cyst type classification LB Nabors) is a rare entity that usually develops between the third and fourth decade of life, as an insidious clinical lower extremity pain, with or without radicular symptoms, bowel dysfunction and sensory disturbances. The usual treatment of these lesions is surgical intervention. In our case puncture and evacuation guided by CT of the sacral cyst was performed, yielding about 2 cc of a sero-hematic fluid. The postoperative course was a remarkable improvement, and the sacral pain happened to be 3/10 on the VAS. In the literature that we have reviewed, this is the first case in which a hidden painful intrasacro meningocele is evacuated by CT-guided puncture.Casos clínicos: Presentamos una paciente de 43 años con historia clínica de dolor sacro incapacitante 8/10 en la escala de EVA de 8 meses de evolución. No se apreciaban alteraciones sensitivas ni pérdida del control de esfínteres. Realizó consulta en múltiples hospitales. Se le practicaron una tomografía computadorizada (TC) lumbar que puso de relieve un hemangioma en L5, una resonancia magnética (RM) de pelvis en la que se evidenció rotura muscular grado I del glúteo mayor izquierdo y una lesión quística en el sacro que se interpretó como quiste de Tarlov. Recibió tratamiento analgésico y antiinflamatorio sin mejoría. Se le realizaron dos bloqueos facetarios e incluso un bloqueo del músculo piriforme izquierdo, todo ello sin resultados. En nuestro centro se practicó una RM lumbo-sacra que puso de relieve la lesión quística de localización central y lateral derecha en canal espinal sacro a la altura de la transición S2-S3. Era de alta señal en T2 y de baja señal en T1. Según la clasificación de Nabors correspondía a un meningocele intrasacro oculto. Discusión: El meningocele intrasacro oculto (quiste meníngeo extradural tipo lB de la clasificación de Nabors) es una entidad poco frecuente que se presenta generalmente entre la tercera y cuarta década de la vida, como un cuadro clínico insidioso de dolor en extremidades inferiores, con o sin síntomas radiculares, disfunción de esfínteres y alteraciones sensitivas. El tratamiento habitual de este tipo de lesiones es la intervención quirúrgica. En nuestro caso se realizó punción y evacuación del quiste sacro guiado por TC obteniéndose unos 2 cc de un líquido sero-hemático. La evolución posterior fue de mejoría notable del dolor sacro que paso a ser de 3/10 en la escala de EVA. En la revisión de la literatura que hemos efectuado este es el primer caso en que se trata un meningocele intrasacro oculto doloroso mediante punción evacuadora guiada por TC