Pleura, peritoneo y pericardio: estudio morfológico post mortem cualitativo y cuantitativo enfocado hacia su aplicación a patologías, diagnósticos y tratamientos que los involucran

We have not found work in the literature related to values of total area of the peritoneal cavity uneviscerated bodies, pleura and pericardium. The evisceration deforms the structures, especially the sheet, causing inaccurate results. Values surface of each space of the peritoneal cavity can be useful in dialysis and in the treatment of infectious or tumoral processes. It began by determining the area of the spaces that make up the peritoneal cavity and their respective parietal and visceral portions. In 10 female cadavers (mean age 75.88 ± 2.99 ± ES years) without abdominal pathology, fixedin formaldehyde without evisceration, the peritoneal surface of the spaces by a method developed in our laboratory (measured Medicine 66: 165- 66, 2006). The values are expressed as mean ± ES. Total peritoneal surface was 14323.62 ± 824.37 cm2. Of each space and its contribution to the total was: Visceral or retro epiploic (RE) 7767.82 ± 646.70 cm2 and 53.70 ± 1.65%; Previsceral or pre epiploic (PE) 1637.05 ± 110.24 cm2 and 11.45 ± 0.54%;right subphrenic (SFD) 1078.32 ± 68.85 cm2 and 7.67 ± 0.57%; left subhepatic (SHIZ) 1009.01 ±50.51 ± 7.12 cm2 and 0.30%; Left subphrenic (SFIZ) 828.58 ± 48.22 cm2 and 5.87 ± 0.37%; rightsubhepatic (SHD) 790.69 ± 37.92 cm2 and 5.64 ± 0.36%; Transcavity (TC) 780.85 ± 48.90 cm2 and 5.49 ± 0.27%; Pelvic (P) 431.30 ± 41.62 cm2 and 3.06 ± 0.3%.The percentage contributions visceral and parietal peritoneum total were 78.76 ± 1.06 and 21.24± 1.06 and each space: RE 64.77 ± 1.62 and 12.25 ± 1.14; PE 8.66 ± 0.45 and 21.76 ± 1.38; SFD 4.86 ± 0.42 and 18.08 ± 1.07; SHIZ 6.54 ± 0.37 and 9.41 ± 0.61; SFIZ 3.15 ± 0.31 and 16.12 ± 1.12; SHD 2.78 ± 0.26 and 16.26 ± 0.54; TC 6.31 ± 0.27 and 2.59 ± 0.55; P 2.93 ± 0.33 and 3.53 ± 0.42. The study provides the values of surface peritoneal spaces. One of the eight, the Visceral or retro epiploic, with almost 2/3 of visceral surface comprising loops of small intestine, accounts forover 50% of total peritoneal surface, while about 60% of the total parietal peritoneum provide and subhepatic and subphrenic spaces. We are currently processing pleuras using the same methodology used in the peritoneum.No hemos hallado en la bibliografía trabajos de otros autores relacionados a valores de superficie total de la cavidad peritoneal en cadáveres no eviscerados ni de la pleura y del pericardio. Las evisceraciones deforman las estructuras, en especial las laminares, haciendo inexactos los resultados. Valores de superficie de cada espacio de la cavidad peritoneal pueden ser de utilidad en la diálisis y en el tratamiento de procesos infecciosos o tumorales. Se comenzó por determinar la superficie de los espacios que componen la cavidad peritoneal y sus respectivas porciones visceral y parietal. En diez cadáveres femeninos (edad media ± ES 75.88 ± 2.99 años) sin patología abdominal, fijados en formaldehído y sin evisceración, se midió la superficie peritoneal de los espacios por un método desarrollado en nuestro laboratorio (Medicina 66:165-66, 2006). Los valores se expresan como media ± ES. La superficie peritoneal total fue de 14323.62±824.37cm2. La superficie de cada espacio y su contribución al total fue: visceral o retroepiploico (RE) 7767.82±646.70 cm2 y 53.70±1.65%; previsceral o preepiploico (PE) 1637.05±110.24 cm2 y 11.45±0.54%; subfrénico derecho (SFD) 1078.32±68.85 cm2 y 7.67±0.57%; subhepático izquierdo (SHIZ) 1009.01±50.51 cm2 y 7.12±0.30%; subfrénico izquierdo (SFIZ) 828.58±48.22 cm2 y 5.87±0.37%; subhepático derecho (SHD) 790.69±37.92 cm2 y 5.64±0.36%; transcavidad (TC) 780.85±48.90 cm2 y 5.49±0.27%; pelviano (P) 431.30±41.62 cm2 y 3.06±0.3 %. Los aportes porcentuales visceral y parietal al peritoneo total fueron: 78.76±1.06 y 21.24±1.06 y la de cada espacio: RE 64.77±1.62 y 12.25±1.14; PE 8.66±0.45 y 21.76±1.38; SFD 4.86±0.42 y 18.08±1.07; SHIZ 6.54±0.37 y 9.41±0.61; SFIZ 3.15±0.31 y 16.12±1.12; SHD 2.78±0.26 y 16.26±0.54; TC 6.31±0.27 y 2.59±0.55; P 2.93± 0.33 y 3.53±0.42. El trabajo aporta los valores de superficie de los espacios peritoneales. Uno de los ocho, el visceralo retroepiploico, con casi 2/3 de superficie visceral, que contiene las asas del intestino delgado, representa más del 50 % de la superficie peritoneal total, mientras que cerca del 60 % de peritoneo parietal total lo aportan los espacios subfrénicos y subhepáticos. Actualmente procesamos pleura utilizando la misma metodología

Long-term outcome of subthalamic nucleus DBS in Parkinson's disease: from the advanced phase towards the late stage of the disease?

Deep Brain Stimulation of the Subthalamic Nucleus (STN-DBS) is an effective treatment for Parkinson's disease (PD), but only few studies investigated its long-term efficacy. Furthermore, little is known about the role of PD-subtype on STN-DBS long-term outcome

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Registro, clasificación y estudio de imágenes digitalizadas de resonancia magnética del cerebro humano (...) como complemento al estudio de modificaciones cerebrales relacionadas a la edad, el sexo y/o patología

Los valores de ángulos medidos en imágenes, entre ellas las de resonancia magnética del cerebro, son independientes del tamaño de la imagen. Esta propiedad permitiría determinar, en ambos sexos, variaciones con la edad y, eventualmente, la patología de zonas del cerebro involucradas. Cuando un ángulo varía significativamente en alguna de las condiciones anteriormente citadas sugiere que la modificación compromete la forma. Debido a que cada ángulo se traza entre reparos anatómicos confiables, perfectamente identificables en cada imagen, una variación significativa en la medida del ángulo es indicativa de variación de la posición de los reparos anatómicos en la superficie imagen del cerebro y, por lo tanto, de la zona cerebral que los incluye. Consecuentemente, una significativa variación de los ángulos con relación a límites de normalidad según sexo y edad podría aportar un dato de relevancia para el diagnóstico de patologías. Uno de los objetivos de este proyecto fue determinar el valor de dos ángulos correspondientes a la imagen del lóbulo parietal de los dos hemisferios en el mismo rango de edad en ambos sexos. Utilizando el programa Scion Image for Windows en imágenes parasagitales de resonancia magnética de 65 sujetos sin patología psiquiátrica ni neurológica, de ambos sexos y entre 41 y 60 años, se trazaron en cada hemisferio dos ángulos adyacentes sobre la superficie del lóbulo parietal, entre reparos anatómicos confiables. El vértice de los ángulos coincidía con el punto de intersección del borde dorsal del cuerpo calloso con la recta que pasa por los puntos más distantes del borde ventral del cuerpo calloso. Los lados de los ángulos cortaban a la imagen del borde del cerebro a nivel del límite del lóbulo frontal con el parietal y de este con el occipital. Para el procesamiento de datos se utilizó análisis de varianza (ANOVA). Los resultados mostraron que los ángulos homólogos no difieren significativamente entre sexos. Sin embargo, mediciones de longitud y de superficie de la zona indican que son mayores en el sexomasculino.Es necesario incrementar el número de casos para obtener valores controles confiables y compararlos con casos patológicos. Se concluye que la forma de la región estudiada en el rango de edades considerado es semejante en ambos sexos. Las variaciones de valores de los ángulos, independientemente del sexo, podrían ser de utilidad clínica en la búsqueda de señales de patología psiquiátrica y/ o neurológica.Angle values measured in images, including magnetic resonance imaging of the brain, are independent of image size. This property would determine, in both sexes, changes with age and eventually the pathology of brain areas involved. When an angle varies significantly in any of the above conditions suggests that compromises the form modification .Because each angle is plotted between reliable anatomic landmarks, identifiable in eachimage, a significant variation in the angle measure is indicative of variation of the position of the anatomic landmarks in the brain imaging surface and, therefore, the brain area that includes them. Consequently, a significant variation of angles relative to normal limits by sex and age could provide relevant information for diagnosis of diseases. One objective of this project was to determine the value of two angles corresponding to the image of the parietal lobe of both hemispheres at the same age in both sexes. Using the program Scion Image for Windows in parasagittal MRIs of 65 subjects without psychiatric or neurological disease, of both sexes and between 41 and 60 years, they were drawn in each hemisphere two adjacent angles on the surface of the parietal lobe between reliable anatomic landmarks. The apex angles coincide with the intersection point of the dorsal edge of the corpus callosum with the line passing through the most distant points of the ventral edge of the corpus callosum, the sides of the angles cut to the image edge brain level limit the frontal lobe with parietal and occipital it. For data processing analysis of variance (ANOVA) was used.The results showed that the homologous angles did not differ significantly between the sexes. However measurements of length and surface area indicate that are higher in males. It needs to increase the number of cases to obtain reliable values compared with controls and pathological cases. It is concluded that the shape of the region studied in the age range considered, it is similar in both sexes. Variations angle values, regardless of sex, could be clinically useful in the search for signs of psychiatric and / or neurological disorders

Excessive daytime sleepiness in multiple system atrophy (SLEEMSA study)

\u3cp\u3eBACKGROUND: Sleep disorders are common in multiple system atrophy (MSA), but the prevalence of excessive daytime sleepiness (EDS) is not well known.\u3c/p\u3e\u3cp\u3eOBJECTIVE: To assess the frequency and associations of EDS in MSA.\u3c/p\u3e\u3cp\u3eDESIGN: Survey of EDS in consecutive patients with MSA and comparison with patients with Parkinson disease (PD) and individuals without known neurologic disease.\u3c/p\u3e\u3cp\u3eSETTING: Twelve tertiary referral centers.\u3c/p\u3e\u3cp\u3ePARTICIPANTS: Eighty-six consecutive patients with MSA; 86 patients with PD matched for age, sex, and Hoehn and Yahr stage; and 86 healthy subject individuals matched for age and sex.\u3c/p\u3e\u3cp\u3eMAIN OUTCOME MEASURES: Epworth Sleepiness Scale (ESS), modified ESS, Sudden Onset of Sleep Scale, Tandberg Sleepiness Scale, Pittsburgh Sleep Quality Index, disease severity, dopaminergic treatment amount, and presence of restless legs syndrome.\u3c/p\u3e\u3cp\u3eRESULTS: Mean (SD) ESS scores were comparable in MSA (7.72 [5.05]) and PD (8.23 [4.62]) but were higher than in healthy subjects (4.52 [2.98]) (P < .001). Excessive daytime sleepiness (ESS score >10) was present in 28% of patients with MSA, 29% of patients with PD, and 2% of healthy subjects (P < .001). In MSA, in contrast to PD, the amount of dopaminergic treatment was not correlated with EDS. Disease severity was weakly correlated with EDS in MSA and PD. Restless legs syndrome occurred in 28% of patients with MSA, 14% of patients with PD, and 7% of healthy subjects (P < .001). Multiple regression analysis (with 95% confidence intervals obtained using nonparametric bootstrapping) showed that sleep-disordered breathing and sleep efficiency predicted EDS in MSA and amount of dopaminergic treatment and presence of restless legs syndrome in PD.\u3c/p\u3e\u3cp\u3eCONCLUSIONS: More than one-quarter of patients with MSA experience EDS, a frequency similar to that encountered in PD. In these 2 conditions, EDS seems to be associated with different causes.\u3c/p\u3

Retrospective evaluation of the dose equivalence of Botox and Dysport in the management of blepharospasm and hemifacial spasm: a novel paradigm for a never ending story

Botox(\uae) and Dysport(\uae) are the preparations of botulinum neurotoxin most widely used for therapeutic purposes. Several studies have addressed the topic of the equivalency ratio (D/B ratio) to be used in clinical practice and whether a reliable value exists is still a matter of debate. To this purpose, we ideated a novel paradigm by retrospectively examining the patients affected by hemifacial spasm and blepharospasm. We compared the pairs of treatments with a switch from one brand to the other undergone by the same patient in consecutive sessions with overlapping clinical outcome. Out of 2006 treatments, we found 51 treatment pairs. D/B ratio was extremely variable (range 1.2-13.3) and in most cases (65%) it was between 1:3 and 1:5. In conclusion, even if the 1:4 ratio might be reliable for clinical purpose, a true bioequivalence between Dysport(\uae) and Botox(\uae) might not exist due to the intrinsic difference in their pharmacokinetic properties