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Las cirugías de cabeza y cuello presentan un alto riesgo de sangrado que puede significar el uso de transfusiones sanguíneas. Existen casos en las que éstas son rechazadas, como sucede con los Testigos de Jehová. Se expone el caso de una paciente Testigo de Jehová con un tumor rinosinusal con alto riesgo de sangrado que consultó por epistaxis recurrente. Se evidencia un tumor ocluyendo la fosa nasal derecha de aspecto vascular a la rinoscopía y la tomografía computarizada. Múltiples aferencias de la arteria esfenopalatina y etmoidales se observaron en una angiografía cerebral. Previo a la resección, se embolizó la arteria maxilar. Durante la cirugía, se contó con un sistema de recuperación de sangre autóloga, hemodilución e infusión de ácido tranexámico. Se ligó la arteria etmoidal anterior derecha vía externa con apoyo endoscópico y luego se resecó el tumor vía endoscópica. La biopsia reveló un carcinoma sinonasal escamoso. Existen alternativas terapéuticas en pacientes que rechacen el uso de hemoderivados. Destacan medidas preoperatorias como la embolización endovascular, intraoperatorias como el uso de agentes hemostáticos, técnicas quirúrgicas y anestésicas. Es importante analizar todas las opciones disponibles de forma multidisciplinara y junto con el paciente, para determinar la conducta más adecuada a seguir.

Head and neck surgeries have a high risk of bleeding, and therefore could require the use of blood transfusions. There are cases for which blood transfusions are not an acceptable option, as is the case for Jehovah's Witnesses. We present the case of a Jehovah's Witness with a sinonasal tumor with a high risk of bleeding, who presented with recurrent epistaxis. Rhinoscopy and computed tomography revealed a vascular-like tumor occluding the right nasal cavity. Cerebral angiography showed afferents of the sphenopalatine and ethmoidal arteries leading to the tumor. Prior to the resection, the maxillary artery was embolized. During surgery, we relied on an autologous blood recovery system, hemodilution and tranexamic acid. Right anterior ethmoidal artery ligation was performed by an endoscopic assisted external approach. The tumor was resected endoscopically The biopsy revealed a squamous sinonasal carcinoma. There are therapeutic alternatives for patients who cannot receive blood products. There are preoperative measures such as endovascular embolization, intraoperative measures such as the use of hemostatic agents and specific surgical or anesthetic techniques. It's important to analyze all of the available options in a multidisciplinary team approach, and to take into consideration the patient's preferences, in order to determine the best surgical conduct.

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BACKGROUND: Retinal diseases associated with the dysfunction or death of photoreceptors are a major cause of blindness around the world, improvements in genetics tools, like next generation sequencing (NGS) allows the discovery of genes and genetic changes that lead to many of those retinal diseases. Though, there very few databases that explores a wide spectrum of retinal diseases, phenotypes, genes, and proteins, thus creating the need for a more comprehensive database, that groups all these parameters. METHODS: Multiple open access databases were compiled into a new comprehensive database. A biological network was then crated, and organized using Cytoscape. The network was scrutinized for presence of hubs, measuring the concentration of grouped nodes. Finally, a trace back analysis was performed in areas were the power law reports a high r-squared value near one, that indicates high nodes density. RESULTS: This work leads to creation of a retinal database that includes 324 diseases, 803 genes, 463 phenotypes, and 2461 proteins. Four biological networks (1) a disease and gene network connected by common phenotypes, (2) a disease and phenotype network connected by common genes, (3) a disease and gene network with shared disease or gene as the cause of an edge, and (4) a protein and disease network. The resulting networks will allow users to have easier searching for retinal diseases, phenotypes, genes, and proteins and their interrelationships. CONCLUSIONS: These networks have a broader range of information than previously available ones, helping clinicians in the comprehension of this complex group of diseases.

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The telencephalic subpallium is the source of various GABAergic interneuron cohorts that invade the pallium via tangential migration. Based on genoarchitectonic studies, the subpallium has been subdivided into four major domains: striatum, pallidum, diagonal area and preoptic area (Puelles et al. 2013; Allen Developing Mouse Brain Atlas), and a larger set of molecularly distinct progenitor areas (Flames et al. 2007). Fate mapping, genetic lineage-tracing studies, and other approaches have suggested that each subpallial subdivision produces specific sorts of inhibitory interneurons, distinguished by differential peptidic content, which are distributed tangentially to pallial and subpallial target territories (e.g., olfactory bulb, isocortex, hippocampus, pallial and subpallial amygdala, striatum, pallidum, septum). In this report, we map descriptively the early differentiation and apparent migratory dispersion of mouse subpallial somatostatin-expressing (Sst) cells from E10.5 onward, comparing their topography with the expression patterns of the genes Dlx5, Gbx2, Lhx7-8, Nkx2.1, Nkx5.1 (Hmx3), and Shh, which variously label parts of the subpallium. Whereas some experimental results suggest that Sst cells are pallidal, our data reveal that many, if not most, telencephalic Sst cells derive from de diagonal area (Dg). Sst-positive cells initially only present at the embryonic Dg selectively populate radially the medial part of the bed nucleus striae terminalis (from paraseptal to amygdaloid regions) and part of the central amygdala; they also invade tangentially the striatum, while eschewing the globus pallidum and the preoptic area, and integrate within most cortical and nuclear pallial areas between E10.5 and E16.5.

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Werner's syndrome (WS) is a rare autosomal recessive disorder, characterised by skin changes prematurely during adolescence. An unusual case of WS was found in a 27-year-old pregnant woman who presented to the hospital with a history of uncontrolled hypertension at 32 weeks of gestation. All clinical features corresponding to WS (early aging of skin, hair loss, blurred vision and diabetes type 2) appeared to match with the prospective diagnosis, which was confirmed later with genetic testing. The pregnancy became complicated due to oligohydramnios and therefore a caesarean section was carried out in order to preserve the fetus. Despite all implemented efforts, the patient died intraoperative as a result of cardiac arrest and its complications. Successfully, the newborn survived and it was further investigated to exclude this condition.

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A 47-year-old woman was admitted to the emergency department with a history of asthenia, periorbital and lower limbs oedema, associated with hypokalaemia and increased blood pressure levels. Metabolic and renal causes were initially investigated as thyroid disease, Cushing syndrome and tubulopathies were excluded during the first week of admission. However, further questioning of the patient, revealed that she had been consuming several sachets of raw liquorice lollies (ignored amount) obtained from a herbalist a month ago. Based on the history and clinical findings, liquorice poisoning was highly suspected; an apparent mineralocorticoid excess secondary to ingestion of liquorice. Afterwards, levels of aldosterone and plasma renin activity were measured and found low 3 weeks later; therefore, our clinical suspicion was established. During the patient's stay at the hospital, liquorice was stopped and potassium supplements were started. Subsequently, a week after, the patient fully recovered without any significant sequelae.

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An 18-year-old girl presented with a headache and behavioural changes. She was found to have a frontal mass. Neuroimaging revealed an intra-axial mass, located at the left frontal cortical/subcortical region approximately 6×7, 5×7, 5 cm (TxApxL), having a heterogeneous density with cysts and calcification. She had total gross excision of the neoplasm. Histopathological examination revealed an anaplastic ependymoma. Fluorescence in situ hybridisation, a molecular cytogenetic test, reported deletion of 1p without deletion of 19q. The patient had a good postoperative improvement.

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Haemobilia, defined as bleeding into the biliary tree is a rare condition. We describe a case report of a patient who presented it as a complication of iatrogenic portobiliary fistula, followed after an open cholecystectomy. The patient presented to the emergency department with late onset symptoms of haematemesis and melena a month after surgery. Findings were confirmed by Doppler ultrasound that showed the appearance of intragallbladder mass with high echogenicity representing a blood clot. Also, next to the portal vein and the biliary duct a lesion with mixed blood flow was detected confirming a portobiliary fistula. This case was successfully managed by angiography and selective embolisation.

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The production of electricity in coal-fired power plants (CFPP) is considered a NORM (Naturally Occurring Radioactive Materials) activity because the coals they burn can present relatively high contents of the naturally occurring radionuclides. In this study, the main radiological impact pathways into the surrounding environments of the four largest coal-fired power plants in Spain were analyzed. These pathways are, first, atmospheric evacuations and wind resuspension and, second, effluent evacuations to nearby rivers or directly to the sea. The atmospheric releases of radionuclides were evaluated by the analyses of soil profiles in the vicinities of the CFPPs. No significant enhancement of radionuclides in the surface soil was observed at the points of maximum deposition of combustion gases, located from 4.3 to 13 km away depending on the considered CFPP. However, an increase of (40)K, (226)Ra, and (232)Th in the surface soils was observed in the first kilometre from the chimney for two CFPPs. This suggested that these radionuclides were released in particulate form. There was also a net influence of the climate in which the CFPPs were located. This was observed in the two CFPPs that were in dry environments, while no increase was observed in the other two, located in more humid environments. The liquid effluents released usually presented an enhancement of dissolved chemical species regarding the initial intake water. Enrichments of the (234,238)U and (226)Ra contents in the water used in the plants' routine procedures were observed, and of (210)Po in the wastewater of just one of the plants. In any case, this enhancement was below the parametric value for the Total Indicative Dose for the hypothetical human consumption of the released waters. As a consequence of these releases of radionuclides, local products destined for human consumption produced in the vicinity of the facilities might incorporate natural radionuclides by these pathways, finding no significant enhancement of the natural radionuclide contents due to the CFPPs.

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In several Naturally Occurring Radioactive Material (NORM) industries, relatively high temperatures are used as part of their industrial processes. In coal combustion, as occur in other high temperature processes, an increase of the activity concentration of every natural radioisotope is produced both, in residues and by-products. An additional increase can be observed in the activity concentration of radionuclides of elements with low boiling point. This work is centred in the increase of polonium, more precisely in its radioisotope Po-210, present in the natural chains, and with a half-life long enough to be considered for radiation protection purposes. This additional increase appears mainly in the residual particles that are suspended in the flue gases: the fly-ashes. Besides, scales, with a high concentration of this radioisotope, were observed. These scales are produced on surfaces with a temperature lower than the boiling point of the chemical element. Both, the accumulation in particles and the production of scales are attributed to condensation effects. When effective doses for the public and the workers are evaluated, taking into account these increases in activity concentrations, the use of theoretical models is necessary. In this work a theoretical description of those effects is presented. Moreover, a verification of the predictions of the model was performed by comparing them with measurements carried on in coal-fired power plants. The same description here presented is applicable in general to the behaviour of Po-210 in other NORM industries where high temperature processes involving raw materials are used, as can be ceramic, cement production, tiles production or steel processing.

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This paper presents results from an international exercise undertaken to test model predictions against an independent data set for the transfer of radioactivity to fruit. Six models with various structures and complexity participated in this exercise. Predictions from these models were compared against independent experimental measurements on the transfer of 134Cs and 85Sr via leaf-to-fruit and soil-to-fruit in strawberry plants after an acute release. Foliar contamination was carried out through wet deposition on the plant at two different growing stages, anthesis and ripening, while soil contamination was effected at anthesis only. In the case of foliar contamination, predicted values are within the same order of magnitude as the measured values for both radionuclides, while in the case of soil contamination models tend to under-predict by up to three orders of magnitude for 134Cs, while differences for 85Sr are lower. Performance of models against experimental data is discussed together with the lessons learned from this exercise.

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Modeling is widely used to predict radionuclide distribution following accidental radionuclide releases. Modeling is crucial in emergency response planning and risk communication, and understanding model uncertainty is important not only in conducting analysis consistent with current regulatory guidance, but also in gaining stakeholder and decision-maker trust in the process and confidence in the results. However, while methods for dealing with parameter uncertainty are fairly well developed, an adequate representation of uncertainties associated with models remains rare. This paper addresses uncertainty about a model's structure (i.e., the relevance of simplifying assumptions and mathematical equations) that is seldom addressed in practical applications of environmental modeling. The use of several alternative models to derive a range of model outputs or risks is probably the only available technique to assess consistency in model prediction. Since each independent model requires significant resources for development and calibration, multiple models are not generally applied to the same problem. This study uses results from one such model intercomparison conducted by the Fruits Working Group, which was created under the International Atomic Energy Agency (IAEA) BIOMASS (BIOsphere Modelling and ASSessment) Program. Model-model intercomparisons presented in this study were conducted by the working group for two different scenarios (acute or continuous deposition), one radionuclide ((137)Cs), and three fruit-bearing crops (strawberries, apples, and blackcurrants). The differences between models were as great as five orders of magnitude for short-term predictions following acute radionuclide deposition. For long-term predictions and for the continuous deposition scenario, the differences between models were about two orders of magnitude. The difference between strawberry, apple, and blackcurrant contamination predicted by one model is far less than the difference in prediction of contamination for a single plant species given by different models. This study illustrates the importance of problem formulation and implementation of an analytic-deliberative process in risk characterization.

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Although fruit is an important component of the diet, the extent to which it contributes to radiological exposure remains unclear, partially as a consequence of uncertainties in models and data used to assess transfer of radionuclides in the food chain. A Fruits Working Group operated as part of the IAEA BIOMASS (BIOsphere Modelling and ASSessment) programme from 1997 to 2000, with the aim of improving the robustness of the models that are used for radiological assessment. The Group completed a number of modelling and experimental activities including: (i) a review of experimental, field and modelling information on the transfer of radionuclides to fruit; (ii) discussion of recently completed or ongoing experimental studies; (iii) development of a database on the transfer of radionuclides to fruit; (iv) development of a conceptual model for fruit and (v) two model intercomparison studies and a model validation study. The Group achieved significant advances in understanding the processes involved in transfer of radionuclides to fruit. The work demonstrated that further experimental and modelling studies are required to ensure that the current generation of models can be applied to a wide range of scenarios.

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INTRODUCTION: The diagnosis of patients with cognitive deterioration or dementia requires a global approach in which the neuropsychological examination is a key piece. As part of the GERMCIDE study (Group for the Study and Multicenter Registry of Incident Cases of Dementia in Spain), a protocol was designed that included an assessment of the different cognitive functions that are most frequently altered in dementias (memory, orientation, speech, praxis, abstraction capacity and executive function). METHODS: In order to obtain data in normal subjects, this neuropsychological protocol was applied to a group of persons over 50 years without cognitive deterioration or dementia. RESULTS: A total of 103 subjects whose ages ranged from 50 to 95 years (mean: 73.5; SD: 9.3 years); 39 (37.9%) men and 64 (62.1%) women were studied. The mean score on the Mini-Mental State Examination (MMSE) was 27/30 (SD: 2.0). In the speech and praxis tests, 90% of the subjects obtained the maximum value, while performances were more unequal in memory, reasoning and programming. Mean score, standard deviation and distribution in percentages for each subtest are presented. CONCLUSIONS: The values obtained in this sample of normal subjects and their distribution in percentages may be very helpful to facilitate the interpretation of the findings of the neuropsychological examination with the GERMCIDE protocol in the general neurology clinic visits and also in the specialized visits in dementia.

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Introducción. El diagnóstico de los pacientes con deterioro cognitivo o demencia exige un enfoque global en el que la exploración neuropsicológica es una pieza clave. Como parte del estudio GERMCIDE (Grupo para el Estudio y Registro Multicéntrico de Casos Incidentes de Demencia en España) se diseñó un protocolo que incluye una valoración de las diferentes funciones cognitivas que con mayor frecuencia se alteran en las demencias (memoria, orientación, lenguaje, praxias, capacidad de abstracción y función ejecutiva). Métodos. Con el objetivo de obtener datos en sujetos normales este protocolo neuropsicológico se aplicó a un grupo de personas mayores de 50 años sin deterioro cognitivo ni demencia. Resultados. Se estudiaron 103 sujetos con edades comprendidas entre 50 y 95 años (media: 73,5; desviación estándar [DE]: '9,3 años); 39 (37,90J0) hombres y 64 (62,1 %) mujeres. La puntuación media en el Mini-Mental State Examination (MMSE) fue de 27/30 (DE: 2,0). En las pruebas de lenguaje y praxias el 900J0 de los sujetos obtuvieron el valor máximo, mientras que en memoria, razonamiento y programación los rendimientos fueron más dispares. Se presenta la puntuación media, DE y distribución en percentiles para cada subtest. Conclusiones. Los valores obtenidos en esta muestra de sujetos normales y su distribución en percentiles pueden ser de gran ayuda para facilitar la interpretación de los hallazgos de la exploración neuropsicológica con el protocolo GERMCIDE en las consultas de neurología general y también en las consultas especializadas en demencia

Introduction. The diagnosis of patients with cognitive deterioration or dementia requires a global approach in which the neuropsychological examination is a key piece. As part of the GERMCIDE study (Group for the Study and Multicenter Registry of Incident Cases of Dementia in Spain), a protocol was designed that included an assessment of the different cognitive functions that are most frequently altered in dementias (memory, orientation, speech, praxis, abstraction capacity and executive function). Methods. In order to obtain data in normal subjects, this neuropsychological protocol was applied to a group of persons over 50 years without cognitive deterioration or dementia. Results. A total of 103 subjects whose ages ranged from 50 to 95 years (mean: 73.5; SD: 9.3 years); 39 (37.9%) men and 64 (62.1%) women were studied. The mean score on the Mini-Mental State Examination (MMSE) was 27/30 (SD: 2.0). In the speech and praxis tests, 90% of the subjects obtained the maximum value, while performances were more unequal in memory, reasoning and programming. Mean score, standard deviation and distribution in percentages for each subtest are presented. Conclusions. The values obtained in this sample of normal subjects and their distribution in percentages may be very helpful to facilitate the interpretation of the findings of the neuropsychological examination with the GERMCIDE protocol in the general neurology clinic visits and also in the specialized visits in dementia

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En el número anterior aprendimos a manejar Pubmed. Ahora vamos a limitar mejor nuestra búsqueda, usando la base de datos de palabras clave y las preguntas clínicas; también aprenderemos cómo buscar artículos en unas determinadas revistas, así como los recursos de Pubmed para conseguir el artículo completo online (AU)

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