Rupture of the thoracic esophagus by compressed air

A case of rupture of the oesophagus due to the accidental passage of compressed air through the mouth is reported. Two longitudinal lacerations were present in the thoracic oesophagus; they were treated by radical oesophagectomy cervical oesophagostomy and gastrostomy for feeding. Reconstruction was made by retrosternal coloplasty. The course of the patient was uneventful.     

苦红菇化学成分的研究

从野生真菌苦红菇(Russula rosacea(Bull)Grrayem,Fr.)子实体酸性部分得到两个新的四环三萜酸化合物,经光谱(IR,¹HNMR,¹³CNMR,MS)、尤其是二维核磁共振(¹³C-¹HCOSY,COLOC,NOEDIFF)谱解析,确定其结构分别如Ⅰ和Ⅱ所示,Ⅰ命名为苦红菇酸A(rosaceaacidA),Ⅱ为苦红菇酸B(rosaceaacidB)。     

Organ Donors With Exceptional Medical Conditions Also Count!

All organ donors, even those who have died under exceptional conditions, can provide at least one valid organ for transplantation. It is thus necessary to evaluate the outcomes of donors with unusual diseases. We reviewed 909 organ donors at six hospitals over the last 15 years. Of these, 29 (3.19%) were considered to be exceptional either because of prior disease, the circumstance of death, or complications arising during admission. Among the 53 organs transplanted from all these donors (except two), the mean number of valid organs per donor was 1.88 rather than 2.36 for standard donors. One patient who received a liver transplant died due to the same infection as that diagnosed in the donor. The remaining recipients experienced no primary graft failure or transmission of problems present in the donor.     

Increased Organ Donations From People Born Outside Spain

Organs donated from persons born outside Spain are becoming increasingly numerous. These persons now account for 26.1% of all donors in the “Malaga sector,” an area of tourism with a high percentage of immigrants. Acceptance to donation among persons from Europe and South America is similar to that of Spanish persons but lower among those born in Africa. We must recognize the great help that cultural mediators provided not only by assistance with the language barrier but also by generating confidence among families and understanding their emotions, feelings, and traditions, mainly during interviews with families from different social and cultural miliere. To be efficient, the interpreters or cultural mediators need to have received specific training in the organ donation process and to be involved and convinced that organ donation and transplantation is the best solution for severe health problems.     

Local anesthesia of the knee for arthroscopic surgery. Our experience in 1,000 cases]

We performed local anesthesia of the knee for arthroscopic surgery in 1,000 patients who were diagnosed of meniscopathy, chondropathy, or block of the knee. We established two anesthetic times. The first consisted of an intraarticular administration of 40 ml of a mixture containing bupivacaine 0.5%, lidocaine 0.5% or prilocaine 1%, and adrenaline 1:200,000. The second was extraarticular and consisted of a local infiltration at the sites of entrance of the arthroscope or instrumental material with lidocaine 0.5% or prilocaine 1%, with adrenaline 1:100,000. We kept a latency period of 10 to 15 min, time required for setting up the arthroscopic procedure. Ischemia was systematically avoided. With this technique the following surgical treatments were performed: meniscectomy, curettage of articular cartilage, synovectomy, plica sections, and extraction of free bodies. Tolerance to surgery was excellent in 32.3% cases, good in 46.5%, regular in 16%, and bad in 5.2%. In no cases more complex anesthetic techniques were undertaken. We conclude that the anesthetic technique used in this study is appropriate for arthroscopic surgery of the knee and allows to perform ambulatory surgery. The procedure is not useful in cases of ligament reconstruction, regional infection, and rupture of the articular capsula. Although the anesthetic technique is easy some factors should be considered before indication of the procedure such as a careful selection of the patient, skillfulness of the surgeon in performing the arthroscopy, and the accuracy of the preoperative diagnosis.     

Malignant melanoma with zosteriform metastases

Melanoma is a tumor that has a high tendency to metastasize to the skin. Zosteriform metastases are a rare form of metastasizing melanoma. We describe a 79-year-old man with melanoma presenting with a dermatomal distribution and no visceral metastases.     

Theoretical aspects of the neurobiological integration of memory

Whenever a peripheral structure like the visual system captures information, the input signal reverberates in circuits of neurons, which send it thereafter towards: (a) the motor system, triggering a specific response, evoked by a short-term memory mechanism; and (b) the hippocampus, to produce long-term potentiation or depression. Two different processes regulate short-term memory: (1) Homosynaptic depression that inhibits neurotransmitter release by means of a decrease in Ca++ inflow, and an increase in calmodulin affinity for synaptic vesicles; and (2) Heterosynaptic facilitation that triggers neurotransmitter release, whenever serotonin activates a proteinkinase A. Besides carrying out a brief review on the matter, we support two different physiological explanations with regard to: (a) ion exchange process and the interstitial pH during habituation; and (b) the possibility of a sensitive presynaptic neuron interaction within the habituated reverberant circuit, to trigger dishabituation. We also propose the term 'time-mediated stimulatory action dependent' to name those serotonin receptors that may lead to a rapid or a delayed postsynaptic onset responses.     

接受激素替代疗法的绝经后亚洲妇女的干眼症

目的:比较接受和不接受激素替代疗法的绝经后妇女干眼症的发生情况。方法:采用横断面研究方法比较对照组和接受激素替代疗法的绝经后妇女干眼症的发生。对所有的受试者行泪液分泌实验,泪膜破裂时间和玫瑰红孟加拉染色检查。结果:总共54例妇女被纳入研究,其中接受激素替代疗法(第2组)30例(55.6%),对照组24例(44.4%)没有进行任何激素治疗(第1组)。在第2组中,11例服用雌激素(2A组),其余19例同时服用雌激素和孕酮(2B组)。在第1组组中有29.2%发生了干眼症,第2组为70.0%(P=0.003),进一步分析发现2B组(84.2%)较2A组(45.5%)更多发生了干眼症(P=0.042)。结论:本研究发现在绝经后服用激素的妇女中干眼症比较常见,它否定了先前激素替代疗法具有防止干眼症发生的假设。     

Split for two adults: what is the real feasibility?

INTRODUCTION: A split liver for two adults is a good theoretical option but the number of cases is low. We have tried to assess the feasibility of this technique. MATERIALS AND METHODS: From April 2002 to April 2004, we evaluated 81 donors of which only 59 (72.8%) were used for transplantation of which 10 were grafted in other centers (pediatric or emergency code). Among the 49 donors the criteria for splitting were: ages >14 and <50 years, weight >70 and <100 kg, less than 3 days in the intensive care unit (ICU), hemodynamic stability, Na(+) < 160 mg/L, liver enzymes elevated no more than twofold, no macroscopic steatosis, and procurement in our hospital. RESULTS: The mean donor age was 50.7 years (range: 16 to 77) of whom 25 were men (51%). The mean weight was 65.7 kg (range: 50 to 100) and days of ICU stay, 3 (range: 1 to 23). Six grafts (12%) were split. The reasons for not splitting were: age (n = 26 [53%]), weight (n = 17 [34.7%]), UCI >3 days (n = 9 [18.3%]), Na(+) > 160 (n = 1 [2%]), blood liver test elevated (n = 5 [10.2%]), steatosis (n = 6 [12.2%]), and procurement outside our center (n = 20 [40.8%]). The donors not suitable for splitting had: only one criteria (n = 12 [24.4%]; 2 (n = 23 [46.9%], 3 (n = 6 [12.2%]) or 4 (n = 2 [4.1%]). If we had had two suitable recipients, we could performed six more liver transplantations (12.2% increase). CONCLUSIONS: The theoretical feasibility of a split liver for two adults is 12.2%, but the actual probability is lower because of lack of two adequate candidates.