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Resumen Introduccion El «sindrome del empujador» es un sindrome poco conocido que aparece tras sufrir un accidente cerebrovascular (entre el 10 y el 35% de los casos). Su presencia dificulta la recuperacion ya que el paciente considera su cuerpo vertical cuando esta inclinado unos 20° hacia el lado plejico. Antecedentes y objetivo Se trata de exponer el caso de una mujer, residente en un centro de personas mayores, que presenta dicho sindrome tras un accidente isquemico de la arteria cerebral media derecha. Descripcion del caso Mujer de 81 anos, diestra, autonoma para la marcha previamente a la lesion. Tras la lesion, se enfrenta a una situacion de dependencia, con graves alteraciones posturales. Intervencion Despues conocer el sindrome que presenta, se comienza un tratamiento de fisioterapia, en el que se tienen en cuenta las caracteristicas del sindrome. Se trabaja el alineamiento corporal y la carga de peso en el hemicuerpo derecho, a traves de actividades significativas para ella. Resultados Se evidencia eficacia del tratamiento, utilizando 3 escalas que miden la gravedad del sindrome. Discusion Se concluye que hacen falta mas estudios para la comprension profunda de los mecanismos lesionales y la adaptacion del tratamiento. Conclusion Se evidencia la importancia del conocimiento de las caracteristicas del sindrome por parte del fisioterapeuta y del equipo de atencion directa, asi como de la familia, para realizar un tratamiento eficaz.

Most teratomas involving the thyroid gland are benign and occur in children. However, the adult cases reported are mostly malignant. Many of the cases previously described in the medical literature have fatal outcome because of spread of the tumor refractory to treatment. We report a case of primary malignant teratoma of the thyroid in a 38-year-old pregnant black woman. She was treated with a combination of surgery, and postoperative chemotherapy with good initial response.

Resumen Objetivo Estabilizar el saco aneurismatico y evitar la formacion de fugas tipo II en el tratamiento endovascular de los aneurismas de aorta abdominal (AAA), creando experimentalmente un modelo animal y tratandolo mediante la colocacion de endoprotesis y la ocupacion del saco aneurismatico. Material y metodos Se crearon AAA de forma experimental en cerdos y en ovejas. Se trataron con protesis endovasculares y se estabilizaron, en el mismo procedimiento, introduciendo ethibloc y onix a traves de un cateter vascular situado dentro del saco aneurismatico. En todos se realizaron controles con aortografia y, de forma aleatoria, con angiorresonancia magnetica y tomografia computarizada abdominal. Se efectuaron estudios macroscopicos e histopatologicos. Se analizaron 2 ovejas 1 ano despues. Se valoraron las caracteristicas de los materiales empleados, su difusion en las arterias colaterales y su eficacia para rellenar el saco del aneurisma. Resultados En todos los animales se consiguio, con exito, la realizacion del procedimiento. La supervivencia de los cerdos fue del 100 %, mientras que de una mayor labilidad de las ovejas para la anestesia, resulto una mortalidad perioperatoria del 50 %. De los materiales empleados, tanto ethibloc como onix son faciles de utilizar y resultan estables con el paso del tiempo. Conclusion Es posible rellenar el saco de un AAA tratado con endoprotesis y sus colaterales, en el mismo procedimiento, con materiales introducidos a traves de un cateter.

Colorectal adenocarcinoma is the second cause of cancer mortality in developed countries. Rac1 is a member of the family of Rho GTPases that regulates many intracellular signaling pathways, including those involved in tumorigenesis, invasion, and metastasis. We have investigated the role of Rac1 in colorectal tumor progression by genetic modification of the human colorectal adenocarcinoma cell line SW620 to either overexpress Rac1 or lack Rac1 expression. Tumor behavior was studied by orthotopic injection of stably modified cell lines into the cecal wall of athymic nude mice, a model that replicates the histopathological appearance and clinical behavior of human colorectal adenocarcinoma in humans. While overexpression of Rac1 resulted in an accelerated tumorigenic process, inducing a faster mortality rate, inhibition of Rac1 completely suppressed tumor formation. These results suggest that Rac1 plays a major role in colorectal adenocarcinoma progression. Finally, interference with Rac1 function may provide an important tool to block the malignant phenotype of colorectal adenocarcinoma cells.

Summary Background Adequate prognostic markers to predict outcome of patients with lung cancer are still needed. The aim of this study was to assess whether choline kinase alpha (ChoKα) gene expression could identify patients with different prognoses. ChoKα is an enzyme involved in cell metabolism and proliferation and has a role in oncogene-mediated transformation in several human tumours, including lung cancer. Methods 60 patients with non-small-cell lung cancer (NSCLC) who had undergone surgical resection in a single centre were enrolled into the study as the training group. We used real-time reverse-transcriptase PCR (RT-PCR) to measure ChoKα gene expression and analyse the association between ChoKα expression and survival in evaluable patients. Additionally, a second group of 120 patients with NSCLC from a different hospital were enrolled into the study as the validation group. We did an overall analysis of all 167 patients who had available tissue to confirm the cut-off point for future studies. The primary endpoints were lung-cancer-specific survival and relapse-free survival. Findings Seven of the 60 patients in the training group were not evaluable due to insufficient tissue. In the 53 evaluable patients, the cut-off for those with ChoKα overexpression was defined by receiver operator under the curve (ROC) methodology. 4-year lung-cancer-specific survival was 54·43% (95% CI 28·24–80·61) for 25 patients with ChoKα expression above the ROC-defined cut-off compared with 88·27% (75·79–100) for 28 patients with concentrations of the enzyme below this cut-off (hazard ratio [HR] 3·14 [0·83–11·88], p=0·07). In the validation group, six of the 120 enrolled patients were not evaluable due to insufficient tissue. For the other 114 patients, 4-year lung-cancer-specific survival was 46·66% (32·67–59·65) for those with ChoKα expression above the ROC-defined cut-off compared with 67·01% (50·92–81·11) for patients with concentrations of ChoKα below the cut-off (HR 1·87 [1·01–3·46], p=0·04). A global analysis of all 167 patients further confirmed the association between ChoKα overexpression and worse clinical outcome of patients with NSCLC: 4-year lung-cancer-specific survival for ChoKα expression above the ROC-defined cut-off was 49·00% (36·61–60·38) compared with 70·52% (59·80–76·75) for those with concentrations of ChoKα below the cut-off (HR 1·98 [1·14–3·45], p=0·01). The overall analysis confirmed the cut-off for ChoKα expression should be 1·91-times higher than concentrations noted in healthy tissues when ChoKα is used as an independent predictive factor of relapse-free and lung-cancer-specific survival in patients with early-stage NSCLC. Interpretation ChoKα expression is a new prognostic factor that could be used to help identify patients with early-stage NSCLC who might be at high risk of recurrence, and to identify patients with favourable prognosis who could receive less aggressive treatment options or avoid adjuvant systemic treatment. New treatments that inhibit ChoKα expression or activity in patients with lung cancer should be studied further.

El macroorquidismo es una entidad poco frecuente en niños y que suele aparecer formando parte del síndrome X frágil. Otras posibles etiologías son el hipotiroidismo primario de larga evolución, los restos adrenales en la hiperplasia suprarrenal congénita, los macroadenomas secretores de hormona foliculoestimulante (FSH), los tumores locales, los linfomas o el déficit de aromatasa. En adultos el macroorquidismo bilateral puede constituir una variante de la normalidad. Presentamos el caso de un niño de 11,5 años remitido a nuestro hospital por haber presentado en los últimos meses un llamativo aumento bilateral del tamaño testicular. En la exploración física se objetivó un volumen testicular mayor de 30 ml. Las pruebas complementarias realizadas permitieron descartar las entidades hasta ahora descritas como causantes de macroorquidismo. Por tanto, se estableció el diagnóstico de macroorquidismo idiopático. La hiperplasia de células de Sertoli hallada en la biopsia testicular, sin existir concentraciones plasmáticas elevadas de FSH, induce a especular sobre una hipotética hiperfunción del receptor de la FSH como responsable del exagerado crecimiento testicular que este paciente presentaba. : Macroorchidism is a rare condition in children and is usually associated with fragile X syndrome. Other possible etiologies of macroorchidism are long-standing primary hypothyroidism, adrenal remnants in congenital adrenal hyperplasia, follicle stimulating hormone (FSH)-secreting pituitary macroadenomas, local tumors, lymphomas, and aromatase deficiency. Bilateral macroorchidism can be a normal variant in adult men. We report the case of an 11.5-year-old boy who was referred to our hospital for evaluation of marked bilateral testicular enlargement in the previous few months. Physical examination revealed a testicular volume larger than 30 ml. Complementary investigations allowed us to rule out all hitherto reported etiologies of bilateral macroorchidism and therefore a diagnosis of idiopathic macroorchidism was established. The increased number of Sertoli cells found on biopsy, without elevated plasma FSH levels, prompted us to speculate about a hypothetical FSH receptor hyperfunction as a possible cause of the exaggerated testicular enlargement in this patient.

EVIDENCE FOR AUTOSOMAL DOMINANT INHERITANCE THROUGH THE MATERNAL LINE IN A CASE OF PRIMARY CILIARY DISKINESIA. An atypical case of primary ciliary dyskinesia is presented in which the inheritance, rather than the classical autosomal recessive, appears to be transmitted as an autosomal dominant trait through the maternal line. The case involves two brothers of 29 and 30 years of age, married without children, with a history of infertility, frequent episodes of sinusitis, and recurrent pulmonary infections. Their mother and sister have chronic bronchopathy of unknown etiology. Their father is healthy without pulmonary problems or sinusitis. At physical exam, both brothers, sister and mother presented with bronchial rhonchi at lung auscultation. Blood analysis and pulmonary function, liver and renal tests were all normal. The ultraestructual study of the sperm flagellum by electron microscopy revealed that both brothers have the same anomaly. Namely, in the majority of the cross-sections, both dynein arms are missing. The nexin filament was present, as well as the radial spokes and the central pair of microtubules. In some sperm, besides the absence of dynein arms, there was also absence of the central pair of microtubules. Neither anomalies of the fibrous sheath nor of the dense fibers were found. In approximately 50% of the spermatozoa, the midpiece had a decreased number of mitochondria and extra non- aligned mitochondria. Other findings included extra peripheral microtubules in the axoneme.

La granulomatosis broncocentrica es una reaccion granulomatosa necrosante centrada alrededor de los bronquios y bronquiolos. En pacientes asmaticos, se considera que la granulomatosis broncocentrica representa una reaccion de hipersensibilidad frente a antigenos fungicos intrabronquiales. Sin embargo, en pacientes sin asma todavia no se ha identificado el posible agente etiologico de esta lesion en el tracto respiratorio Presentamos el caso de una mujer de 46 anos con granulomatosis broncocentrica asociada a hidatidosis pulmonar. Los posibles mecanismos inmunopatogenicos desencadenantes de las lesiones bronquiales en este caso se discuten brevemente

Trabajo presentado al 21th Meeting of the European Association for Cancer Research celebrado en Bruselas (Belgica) del 25 de Junio al 30 de Junio de 2010.

Background Human spermatogenesis is regulated by activation of the nuclear androgen receptor (AR) of Sertoli cells. Aim AR expression has been examined in three congenital diseases with severely damaged testis and cryptorchidism (17 cases), androgen insensibility syndrome (AIS) (6 cases) and Klinefelter syndrome (9 cases). Methods Morphologic, immunohistochemical and morpho-metric evaluation, as well as PCR detection of the CAG-triplet of AR. Results In complete spermatogenesis most Sertoli cells show intense nuclear AR expression, with intensity variable from cell to cell, depending on the maturation stage of spermatogenesis, and it is completely absent in germ cells. In azoospermic human testis, AR expression in Sertoli cells is higher in number and intensity in Sertoli cell-only pattern than in those with spermatogenesis arrest, or as compared with normal testis (control group). In cryptorchidia, the tubules with disgenetic or immature Sertoli cells had no anti-AR antibody reactivity. These results suggest a direct correlation between AR expression decrease and severity of the cryptorchidic disgenetic lesions. Sertoli cells are highly disgenetic in Klinefelter syndrome and their nuclei show a variable AR-immunoexpression spectrum from moderately positive to completely negative nuclei. Conclusions AR-expression is not substantially modified in hypospermatogenic or in atrophic areas of seminiferous tubules. Testicular lesions in cryptorchidic patients, in AIS testis and in testicular biopsies of patients with Klinefelter syndrome are associated with AR immunoexpression alterations, although apparently these alterations are not due to AR important mutations, as we have not found abnormal bands of CAG-triplet of AR in cryptorchidism and AIS.

In the present report the effects of postpuberal gonadectomy on vomeronasal organ (VO) morphology were studied. Postpuberal gonadectomy induced in both male and female rats a decrement in the height of the epithelium and in the nuclear size of the bipolar neurons. These results show that the maintenance of neurosensorial normal morphology depend upon the activational effects of sex steroids.