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The purpose was to compare the outcomes of patients with ST-elevation myocardial infarction and multivessel coronary artery disease undergoing one-time multivessel revascularization (OTMVR) versus in-hospital staged complete revascularization with percutaneous coronary intervention.This was a single-center, retrospective, observational, and cohort study, including data from January 2013 to April 2019. A total of 634 patients were included in the study. Comparisons were made between patients who underwent in-hospital staged complete revascularization versus OTMVR. The primary endpoint was all-cause in-hospital mortality, secondary endpoints included cardiovascular complications, all-cause new hospitalization, and mortality evaluated at 30 days and 1 year. In addition, we constructed a logistic regression model for determining the risk factors that predicted mortality.Of the 634 patients, 328 were treated with staged revascularization and 306 with OTMVR. About 76.7% were men, with a mean age of 63.3 years. Less complex coronary lesions and a higher proportion of the left anterior descending artery as the culprit vessel were found in the OTMVR group. Compared with staged revascularization, the primary and secondary endpoints occurred less frequently with OTMVR strategy.OTMVR did not generate more complications and demonstrate better clinical outcomes than in-hospital staged revascularization.El propósito fue comparar resultados de pacientes con infarto agudo de miocardio con elevación del segmento ST y enfermedad coronaria multivaso sometidos a revascularización completa de un solo momento frente a revascularización completa por etapas mediante intervención coronaria percutánea.Estudio cohorte observacional, retrospectivo, unicéntrico, con datos de enero de 2013 a abril de 2019, incluyendo 634 pacientes. Se compararon resultados entre pacientes sometidos a revascularización completa por etapas frente a revascularización completa en un solo momento. El objetivo primario fue valorar mortalidad intrahospitalaria por cualquier causa y como objetivos secundarios se evaluaron a 30 días y 1 año las complicaciones cardiovasculares, hospitalizaciones y mortalidad. Se construyó un modelo de regresión logística para determinar los factores de riesgo que predijeron mortalidad.De 634 pacientes, 328 fueron tratados con revascularización por etapas y 306 con revascularización en una intervención. El 76.7% fueron hombres, con una media de edad de 63.3 años. En el grupo de revascularización de un solo tiempo se encontraron lesiones coronarias menos complejas y una mayor proporción de la arteria descendente anterior como vaso culpable. Comparado con el grupo de revascularización por etapas, los objetivos primarios y secundarios ocurrieron con menos frecuencia en el grupo de revascularización en un solo tiempo.Comparada con la revascularización intrahospitalaria por etapas, la revascularización en una intervención lleva a mejores desenlaces clínicos sin generar más complicaciones.

This paper presents a methodological approach for the study of the early historical buildings constructed in reinforced concrete at the beginning of the 20th century. These buildings were conceived...

El párpado es una estructura crítica para la protección y función del globo ocular, y parte primordial en la estética facial. Su reconstrucción está determinada por la extensión de la lesión y el compromiso de las diferentes capas. Siempre se preferirán tejidos loco-regionales debido a su mayor similitud y disposición. Los métodos de reanimación palpebral se pueden dividir en estáticos y dinámicos, considerando a estos últimos como el único medio para restaurar el parpadeo. Presentamos un caso de celulitis orbitaria preseptal con lesión de espesor total del párpado superior y su reconstrucción miofuncional utilizando un colgajo frontal. Este colgajo frontal miocutáneo logró la restauración funcional del párpado comprometido mediante la adición de fibras musculares y permitiendo el fenómeno de reinervación.

This paper describes the inspection for cavity detection in an urban area in Torrente (Valencia, Spain). A shallow cave was found during the excavation work for a new sewerage project. Digging activities were stopped immediately and a GPR survey (400 MHz antenna) was required to reorganise the sewerage planning. The 3D GPR-mapping pinpointed most of the detected cavities on one side of the street. As a result, the sewerage system layout was moved to the side of the street where less evidence of cavities was detected. Therefore, GPR technique is a helpful tool for minimizing costs, time, work safety risks and inconveniences to people living in the neighbourhood during civil engineering works, especially in urbanised areas.

The moisture content variations in wood have a significant influence in wood’s physicochemical properties, as well as in its electromagnetic properties and to specific effects upon waves’ characteristics. In particular, this paper focuses on the analysis of the Ground-penetrating Radar’s (GPR) using an antenna of 1.6GHz central frequency capacity to register the velocity and the amplitude of the electromagnetic waves’ variation during the drying process of Pinus pinaster Ait timber joists. The results showed that when timber MC descends, the propagation velocity and amplitude of both the direct and the reflected wave increased. The high correlation found between the variables studied demonstrates GPR efficiency and the innovative application of this technique as a non-destructive evaluation tool for timber structures, particularly when studying its moisture content.

This work presents the results of a ground-penetrating radar (GPR) survey of the Sagrado Corazon de Jesus Church (seventeenth century AD). The church belongs to the artistic heritage of the Society of Jesus and is located in the old part of the city of Valencia (Spain). The GPR survey had two main objectives: discovering subfloor features and determining the causes of structural failure, particularly cracks and fractures detected in the building. For the fieldwork, 200 MHz and 400 MHz centre frequency antennae were used and a total of 53 profiles were acquired. The analysis of the reflection profiles and amplitude time-slices showed the presence of a sloping substrate below part of the church. The slope of this substrate and the fact that the church had been built near the old Arab wall of the city (eleventh century AD) suggests that the church was built on top of a moat (ditch). The variable thickness and differential compaction of the subfloor layers probably caused differential settlings in the building and therefore be the origin of some of the structural failures observed in the church. There was also a reflection hyperbola in the profiles of the east transept of the church that was hypothesized to be the reflection from the ceiling of an undocumented crypt due to its shape, size and location. That reflection feature was tested using a boroscope and found to be a brick barrel-vault crypt. Copyright © 2008 John Wiley & Sons, Ltd.

Ground-penetrating radar (GPR) is a non-destructive geophysical technique that is used to analyse soils and structures by providing continuous images of the interior of the media being analysed. In this paper, we present the methodology and results of a study of the reinforced concrete base of a large block of flats, where flow water and flooding are common in the wet and dry seasons. There are also a large number of cracks and fissures in the soil under the base. The damaged building is located in Valencia (Spain). The measurements were taken during two different seasons to include a period when flooding occurred and a period without flooding. The aim of the study was to determine whether the base would remain watertight in future and to analyse the depth of the damage observed on the surface. The results provided us with a detailed map of the damage and the zones that require more detailed analysis. Such damage affects the whole concrete slab. In addition to this analysis, several measurements were carried out to determine the possible causes of the inundations by locating potential wet areas and zones with high water content. A water table and a well were detected, which could be the cause of the humidity damage.

Resumen Introduccion Dentro del diagnostico diferencial de la hematuria en pacientes receptores de un trasplante de medula osea (T.M.O.) debemos considerar la cistitis hemorragica por poliomavirus BK y JC. Algunos han implicado al virus BK como el principal agente en su desarrollo. La viruria por BK tambien se ha asociado a estenosis ureteral en pacientes sometidos a trasplante renal. Las infecciones urinarias virales, excepcionales cuando existe indemnidad del sistema inmune, pueden aparecer con frecuencia en situaciones de inmunocom-promiso. Material y metodos Estudio retrospectivo de 123 pacientes consecutivos sometidos a trasplante de medula osea (1995-2000), analizando los casos en que se presento cistitis hemorragica con aislamiento de poliomavirus BK y JC en orina. Se estudian: caracteristicas poblacionales, enfermedad de base, manifestaciones clinicas y radiologicas, metodos diagnosticos y medidas terapeuticas. Realizamos una revision de los principales aspectos de estos “desconocidos huespedes del aparato urinario”. Resultados Se presento cistitis hemorragica asociada a poliomavirus en 7 casos (5,7% de los TMO), 6 por BK y 1 por JC. Corresponden a 3 varones y 4 mujeres, con una edad media de 29 anos (14-45). Todos los pacientes con urocultivos bacteriologicos, micoticos y parasitologicos negativos. Presentacion clinica como hematuria macroscopica en todos los casos (aparicion entre los dias +30 y +132 post-trasplante), cuya duracion oscilo entre 3 y 30 dias. En 6 casos existian criterios de Enfermedad de Injerto Contra Huesped. Ecograficamente, en 5 pacientes se evidencio un engrosamiento difuso de la pared vesical. En todos se instauro tratamiento mediante hiperhidratacion, sondaje vesical y extraccion de coagulos, lavado endovesical continuo, alcalinizacion urinaria y antivirales sistemicos. No fueron necesarias actuaciones mas agresivas. Como complicacion, un caso de insuficiencia renal leve, reversible. Comentarios La cistitis hemorragica por poliomavirus es una entidad que considerar en pacientes que han recibido un T.M.O., debiendo realizar diagnostico diferencial ante toda hematuria que se presente en estos casos. Es necesario un adecuado manejo urologico de la hematuria, que puede llegar a comprometer la vida del paciente.

Vaginal stones are rare. We can classify them as primary or secondary, depending on the presence or the absencse of a foreign body nidus. Various cases can led to stone formation. Most of them developed in women with a vesicovaginal or urethrovaginal fistula, as well as in patients with congenital anomalies of the genitourinary tract, previous pelvic radiotherapy, neuropathic bladder and other different causes of vaginal outlet obstruction. Secondary vaginal stones, formed around foreign bodies, are not so frequent. Radiological examination and urethro-vaginoscopy make easy the right diagnosis. Sometimes the stone may be fragmented by lithotripsy before the extraction. The associated etiology should be treated concomitantly in order to prevent recurrence. We report a case of primary vaginal stone associated with an urethrovaginal fistula in a 25 years old women and a review of the related literature.

Simultaneous measurements of surface temperatures in the equatorial and polar regions of gyrating hailstones, growing in a closed circuit wind tunnel, were performed using two infrared microscopes. Results indicate that a temperature difference as high as 5.9°C existed between these regions, with maximum differences occurring in the liquid water content range of 1.5 to 6.4 g m−3. Under such conditions growth was generally characterized by a dry, cold regime at the poles and a wet, warmer regime at the equator. Thus, contrary to standard assumptions, the surface temperature of growing hailstones cannot be considered homogeneous. A comparison of the hailstone growth results from the present study, performed at laboratory pressure, with those of Garcia-Garcia and List (1992), who varied air pressure with temperature according to the Denver soundings (Beckwith, 1960), indicates that the mass growth rate is enhanced at lower pressures due to the combination of increased terminal velocity and collection efficiency. Smaller ice fractions in deposits were measured at lower air pressures for comparable air temperatures and liquid water contents. This investigation demonstrates the difficulty of extrapolating from laboratory pressure to hail growth regions at lower pressure. An examination of the governing equations shows that such a simulation is physically impossible.

The extramedular hematopoyesis is the result of the bown marrow sever chronical hipofunction, being the genitourinary afection very unusual. We are presenting a singular case by its own clinicopathology consecuences and exceptional incidence in context of a upper tract urothelial tumor.

The dielectric response of timber to electrical fields is influenced by many factors, one of the most important being the internal structure of the wood. Thus the anisotropy of the wood should be taken into account when the ground-penetrating radar (GPR) technique is used to explore the properties of timber. The work carried out analyzes, by means of a GPR with a 1.6 GHz antenna, the dielectric behavior of Maritime Pine timber according to the direction of the electrical field with respect to the grain. After the acquisition process, the propagation velocities, amplitudes, and spectra variations were compared for all the studied grain directions. Significant differences were found between these parameters when the field was propagated in a parallel direction compared with perpendicular to the grain. However, when the field was propagated in various perpendicular directions to the grain (radial & tangential) the studied parameters were not found to differ greatly.

Se estudió el impacto de la fragmentación del hábitat sobre la variabilidad genética en dos poblaciones de Crassostrea rhizophorae Guilding 1828 del sistema estuarino de la laguna de Términos, Campeche, México, mediante la expresión de isoenzimas de 10 sistemas enzimáticos y proteína total. Se utilizó el programa TFPGA 1.3 para analizar las frecuencias génicas de las poblaciones en estudio. Muestras de músculo de 50 organismos de cada población se utilizaron para caracterizar la expresión genotípica. Los parámetros determinados fueron estadística descriptiva, estadística F, distancia genética, equilibrio Hardy-Weinberg, UPGMA y el número de migrantes como indicador del flujo de genes. Los valores de polimorfismo proteico fueron 36.35% (p95) y 90.90% (p99). Los datos de heterocigosis se ubicaron entre 0.2491 para Idh1 hasta 0.01 en Pt1, el valor de heterocigocidad media fue He = 0.1044. Los promedios de Fis = 0.1574 y Fit = 0.1727 indicaron deficiencia de heterocigotos. La media de Fst = 0.0181 indicó que las diferencias genéticas correspondieron a variación interpoblacional con endogamia moderada. El número de migrantes obtenido por la ecuación de Slatkin resultó de 13.5621 por generación, indicativo de cierto grado de variabilidad entre las poblaciones, es consistente con valores de distancia genética de Nei. Se concluye que las dos poblaciones reflejan sensibilidad a los procesos adaptativos interpoblacionales producidos por la discontinuidad del medio geográfico sin detrimento de su variabilidad genética y no reflejan fragilidad que las exponga a proceso de formación de metapoblaciones.

Resumen Los tumores renales neuroendocrinos son de presentacion extremadamente rara. Presentamos un caso clinico y revisamos la literatura sobre esta patologia

The dielectric behaviour of timber in an electrical field depends on many factors, and one of the most important is the direction of the fiber. This work analyses the wave parameter variations of the dielectric response of timber according to the direction of an electrical field applied by ground penetrating radar (GPR) with a 1.6 GHz antenna. Two types of tests were performed on samples of maritime pine timber (Pinus pinaster Ait.). After the acquisition process the propagation velocities, amplitudes, and spectra variations were compared for the studied fiber directions. Interesting differences were found between these parameters when the field was propagated in a parallel direction or perpendicularly to the fiber.

The moisture content (MC) is a critical parameter for most physical and chemical pathologies of timber and, in the case of structural wood, a MC > 20% can be dangerous for any load-bearing construction. The complexity of evaluating MC while timber is in use by means of the current methods (oven-drying and resistance wood meter) led us to test non-destructive techniques to evaluate this parameter on site. With this in mind, measurements with two non-destructive techniques, ground-penetrating radar (GPR) and ultrasound, were carried out on joists of Pinus pinaster Ait. from their initial green state until the point of hygroscopic equilibrium moisture content. In particular, the analysis presented in this paper focuses on the capacity of each technique to register the velocity variations of their waves during the timber drying process. Prior to the GPR analysis, it was necessary to distinguish between differences in the propagation velocity of electromagnetic waves (vEM) attributable to the wood anisotropy and those due to variations in MC. The propagation velocity of the electromagnetic waves was always found to be lower when the electrical field was parallel to the grain of the wood than when it was perpendicular to it. However, when the field was perpendicular, its direction whether radial or tangential, did not significantly affect the vEM. The direct measurements illustrate the ability of the GPR technique to characterize the MC of timber as a clear decrease in the MC resulted in an increase in the vEM. A strong correlation was obtained between the two parameters with coefficients of determination, R2 > 90%. Longitudinal elastic wave velocities (vP) were assessed by means of a ultrasound technique during the timber drying process. Despite the fact that the vP increased with the decreasing MC of each joist, the determination coefficient between these two variables was very low. The analysis presented in this paper is a successful application of the GPR technique to the study of wood s physical properties and has a promising future for the non-destructive, on-site analysis of timber MC., Financial support for this research was provided by the Spanish Ministry of Science and Innovation under the 2009-2012 national research and development plan through a project entitled: 'Integration of advanced and non-destructive evaluation techniques for structural timber and the restoration and conservation of heritage buildings (BIA2008-00342)'. We would like to thank our colleagues at the materials laboratory of the Escuela Tecnica Superior de Gestion de la Edificacion at the Universidad Politecnica de Valencia, Spain. The translation of this paper was funded by the Universidad Politecnica de Valencia.

The moisture content (MC) has a significant influence in wood’s physicochemical properties and therefore in most types of wood pathologies. The MC variation leads to modifications of its electromagnetic properties and to specific effects upon waves’ characteristics. Given the advantages of the direct electromagnetic wave (DW) observation, the aim of this work is to asses the ability of this wave to provide access to timber MC characterization. For this purpose, GPR measurements were carried out on timber joists (1.6 GHz central frequency). The dielectric behaviour of wood varies according to the direction of the fiber. Therefore, it is necessary to distinguish between differences attributable to the wood anisotropy and those due to variations in MC. With this aim, prior to the MC analysis, assays were carried out in different directions regarding the fiber. The results of this study show very satisfactory correlations between DW amplitudes and MC in all fiber directions. These results showed, in agreement with theory, that a decrease of MC results in an increase of the DW amplitude. These results demonstrates the GPR efficiency and the innovative application of this technique as a non-destructive evaluation tool for the rapid sounding of timber structures.

The accretional growth of gyrating hailstones was studied in a pressure- and temperature-controlled icing wind tunnel, starting with oblate ice spheroids, under cloud conditions and at free-fall speeds. Measured parameters were hailstone surface temperature (with infrared radiometric microscope), net collection efficiency, ice fraction, surface roughness, and final shape of the particle. Surface temperatures of water skins covering growing deposits were found to be supercooled up to −2.5°C, depending on experimental conditions. Over the range of variables covered, the transition from solid to spongy ice deposits occurred at surface temperatures below 0°C. This revised Schumann-Ludlam limit is approximated by a linear liquid water content-air temperature relationship. The final shape of the hailstones varied with icing conditions, and different surface roughness characteristics appeared depending on the gyration rates. Other main findings are that spongy deposits grow while millimeter-sized drops ...

Since 1987, Spain has been continuously developing several scientific projects, mainly based on Earth Sciences, in Geodesy, Geochemistry, Geology or Volcanology. The need of a geodetic reference frame when doing hydrographic and topographic mapping meant the organization of the earlier campaigns with the main goals of updating the existing cartography and of making new maps of the area. During this period of time, new techniques arose in Space Geodesy improving the classical methodology and making possible its applications to other different fields such as tectonic or volcanism. Spanish Antarctic Geodetic activities from the 1987–1988 to 2006–2007 campaigns are described as well as a geodetic and a levelling network are presented. The first network, RGAE, was designed and established to define a reference frame in the region formed by the South Shetlands Islands, the Bransfield Sea and the Antarctic Peninsula whereas the second one, REGID, was planned to control the volcanic activity in Deception Island. Finally, the horizontal and vertical deformation models are described too, as well as the strategy which has been followed when computing an experimental geoid.

This work analyzes the efficiency of the ground penetrating radar (GPR) technique for the evaluation of strength grading of structural sawn timber. For this end, tests were performed on pinus radiata timber samples using GPR and other common evaluation techniques: visual grading and ultrasound-based evaluation. In order to determine the level of reliability of the different grading methods for timber structures, the results obtained with each method are compared to the results obtained from experimental bending-strength tests undertaken in accordance with standard EN408. Finally, the level of reliability of the GPR technique is compared to that of the other methods analyzed in this paper. The results obtained in this work show that GPR can be a valuable tool for the evaluation of structural timber, since it is a non-destructive technique, fast and easy to use, and what is more important, more reliable than other current evaluation methods used for timber grading.

We report a case of neoplasm of the urinary bladder with pseudosarcomatous stromal differentiation. Heterologous carcinosarcomas are extremely rare malignant neoplasms (seventy-eight cases have been previously described). This is a case of carcinoma containing numerous osteoclast type giant cells that stained for vinmentin and acid phosphatase and were negative for cytokeratin and lysozyme.

Presentamos un caso de tumor vesical con diferenciación pseudosarcomatosa del estroma. Son extremadamente raros (sólo se había descrito 78 casos en el mundo hasta el año 2001). También son llamados carcinosarcomas heterólogos, dentro de los cuales se encuentran los llamados carcinosarcomas con células gigantes tipo osteoclasto, que se caracterizan por ser positivos para vimentina y fosfatasa ácida y negativos para marcadores epiteliales (citoqueratinas de bajo peso y lisozima).

Differential diagnosis of hematuria after bone marrow transplantation (B.M.T.) may include polyomavirus (BK and JC)-associated haemorrhagic cystitis. Many reports have implied BK virus as the major pathogen in the development of hemorrhagic cystitis after BMT. BK viruria is also associated with ureteric stenosis in renal allografts recipients. Viral urinary tract infections are uncommon in healthy individuals, but we can find them frequently in patients under immunosuppressive conditions.Retrospective study of 123 consecutive B.M.T. recipients in the period from 1995 to 2000, evaluating those with polyomavirus-associated hemorrhagic cystitis. We present patient's characteristics, primary disease, clinical features, diagnosis aspects and treatment of these "hidden hosts of urinary tract".7 patients (5.7% of B.M.T.) developed BK or JC virus-associated hemorrhagic cystitis; 3 men and 4 women; median patient age was 29 years (range 14 to 45 years). Bacterial, mycobacterial and parasitic urine cultivates had negative results in all of them. The clinical course was characterized by a late onset of haemorrhagic cystitis (days +30 to +132 after BMT). All 7 patients developed macroscopic haematuria (duration 3 to 30 days). In 6 cases Graft Versus Host Disease (G.V.H.D.) criteria were found. Ultrasonographic studies revealed diffuse thickening of bladder wall in 5 patients. Hematuria was managed by hyperhydratation, blood transfusions, transurethral catheter and evacuation of blood clots, continuous bladder irrigation, urine alkalinization and antiviral therapy. No other more aggressive measures were required to stop the bleeding. Only 1 case of transient elevated creatinine.Polyomavirus-associated haemorrhagic cystitis must be considered in differential diagnosis of hematuria in bone marrow transplantation recipients. Urological management, according with the severity and duration of hematuria, is frequently required.

The extramodular hematopoiesis is the result of the bone marrow sever chronical hypofunction, being the genitourinary affection very unusual. We are presenting a singular case by its own clinicopathology consequences and exceptional incidence in context of a upper tract urothelial tumor.

One of the basic characteristics of urothelial carcinoma is its tendency to synchronous or metachronous multifocality. Thus the need to explore the entire urinary tract of patients with urothelial neoformations. The aim of this article is to study the tumors of the upper urinary tract that appear synchronously with infiltrating carcinoma of the bladder. The clinicopathological characteristics and the morbidity and mortality of en bloc surgery of both tumors are analyzed.A retrospective study was carried out on 170 radical cystectomies for infiltrating bladder tumor performed in our department over a 13-year period. Patient history, clinicopathological characteristics, complementary tests, type of surgery performed, postoperative complications and follow-up were analyzed.Tumor of the upper urinary tract appeared in 14 (1 bilateral) of these patients and were synchronous in 10 cases. All patients were male; mean age 63 years. Three were localized in the pelvis, 2 in the proximal ureter and 6 in the distal third. Diagnosis was made by IVP in 6 patients and by US and antegrade pyelography in the other 4 patients. Nephroureterectomy and radical cystectomy were performed en bloc in 8 cases; 6 had a Bricker procedure and 2 ileal substitution. Salvage radical cystectomy + distal ureterectomy were performed in the other two patients. Two patients submitted to en bloc surgery had postoperative complications; one presented prolonged ileua and the other required surgery for retroperitoneal hemorrhage. The two patients submitted to palliative surgery died of and sepsis during the postoperative period. At 33 months' mean follow-up, 3 patients have shown tumor progression.There is a high proportion of synchronous tumor of the upper urinary tract in our series of patients with infiltrating carcinoma of the bladder undergoing radical cystectomy, therefore we consider it necessary to explore the entire urinary system. Surgical removal of both tumors en bloc does not increase the morbidity and mortality.

To present an additional case of mucinous adenocarcinoma of the prostate gland. The histochemical and immunohistochemical findings demonstrating its prostatic origin are presented and the literature is reviewed.A 53-year-old male with no previous symptoms or signs presented for a prostatic examination. DRE was normal and PSA was 35 ng/ml. A prostate biopsy demonstrated adenocarcinoma of the prostate with a Gleason score of 3 + 3. Complementary studies were negative. The patient was submitted to radical prostatectomy. Anatomopathological analysis of the surgical specimen demonstrated a prostatic mucinous adenocarcinoma. At one-year follow-up, the patient is alive and disease-free and PSA values have returned to normal.Mucinous adenocarcinoma of the prostate is a rare anatomopathological variant whose natural history and prognosis are not well-known. This tumor type generally does not respond to any treatment and is hormone-resistant.

The neuroendocrine renal tumors are of extremely strange presentation. We present a review of the literature published on this pathology.

Vaginal stones are rare. We can classify them as primary or secondary, depending on the presence or the absencse of a foreign body nidus. Various cases can led to stone formation. Most of them developed in women with a vesicovaginal or urethrovaginal fistula, as well as in patients with congenital anomalies of the genitourinary tract, previous pelvic radiotherapy, neuropathic bladder and other different causes of vaginal outlet obstruction. Secondary vaginal stones, formed around foreign bodies, are not so frequent. Radiological examination and urethro-vaginoscopy make easy the right diagnosis. Sometimes the stone may be fragmented by lithotripsy before the extraction. The associated etiology should be treated concomitantly in order to prevent recurrence. We report a case of primary vaginal stone associated with an urethrovaginal fistula in a 25 years old women and a review of the related literature.

Juvenile gangrenous vasculitis of the scrotum is a peculiar form of scrotal gangrene of undetermined etiology, with clinical and pathological features of its own, described in 1973 by Piñol et al. We report a new case, considering this entity as part of the differential diagnosis of scrotal gangrene, and a review of relative literature.

Four additional cases of malignant priapism or priapism secondary to penile metastasis from urogenital tumors are presented and the literature is reviewed.Chest and abdominal radiological evaluation, cavernosal and abdominal US, abdominal and pelvic CT and MRI, and cavernosal biopsy were performed for the localization and staging of the primary tumor.Conservative palliative management achieved a survival of only a few months in three of the patients with tumor dissemination to adjacent vital organs. Radical surgery was performed in one patient with tumor localized to the genital area. Currently, this patient has no clinical symptoms, although the follow-up is only 4 months.Malignant priapism is rare and usually secondary to GU tumors. The prognosis is poor since it generally indicates the presence of multiorgan metastasis. However, the prognosis is better for single metastasis, which is an indication for radical surgery.

The health condition and some clinical aspects configure a group of senior citizens in need of further care who could benefit from specialized geriatric care, although no consensus exists as to how to identify these patients. The aim of this study is to describe the profile of those patients over 64 years of age who are hospitalized in a geriatric unit and to compare this profile to the senior citizens hospitalized in general medical and surgical units.A cohort representative of the population over age 64 in the Judicial District of Toledo (n = 3214) was studied over an eighteen-month period for the purpose of identifying the income and length of stays at the public hospitals in the health care district in question. The health condition-related variables were gathered by means of personal interviews, and the income and the different aspects thereof by way of hospital admissions department data.A total of 410 individuals were admitted (12.8%), 168 patients (30.7%) in geriatrics, 204 (37.3%) in medical units and 174 (32.0%) in surgical units. In geriatrics, the average age was significantly higher (age 77.4), there being no differences in the average length of stay (12.8 days; CI 95%) 10.6-14.0), 44 patients (8.1%) having died, 26 (59.1%) hospitalized in geriatrics. More females, younger patients having minor vision and hearing impairments were admitted to the surgical units. In geriatrics, as compared to the medical units, more patients over 80 years of age, living in senior citizen living facilities, having no spouse, moderate-to-severe functional dependence, impaired cognitive function, depression, poor quality of life and scanty social resources.No differences were found to exist between the health conditions of those over age 64 who were hospitalized in non-surgical and surgical units. In geriatrics, as compared to the other groups of units, the patients were older, in worse condition, had a higher death rate and similar average length of stay.

To present three illustrative cases of pyeloureteritis cystica and review the literature.Three illustrative cases diagnosed at our department are described. Patient history, clinical features, diagnostic procedures and treatment are analyzed and the literature is reviewed.Our patients had no specific symptoms. All three patients had urinary tract infection with pyeloureteral involvement, which was bilateral in two cases. One of these patients had a long-indwelling catheter.Pyeloureteritis cystica is a benign and uncommon condition whose etiology is not well-known. It is generally associated with chronic infection and inflammation, and may be difficult to distinguish from other filling defects of the urinary tract. Due to its benign nature, treatment must always be conservative and close follow-up is recommended.

A case of gaseous gangrene by Clostridium septicum associated with colorectal cancer is presented. The patient evolved rapidly towards septic shock and death. Autopsy showed occult neoplasm and pelvic and retroperitoneal myonecrosis. An exceptional finding was that of myocarditis in which thick gram-positive bacilli were identified. A review of the literature was carried out regarding the pathogenesis and clinical manifestations of this disease. The association of colonic neoplasm and Clostridium septicum may be related with the sensitivity of the cells of this neoplasm to the toxins of the microorganisms. The usefulness of this cytotoxicity is being tested in the therapeutic reduction of tumoral mass. With respect to clinical attitude, all the authors agree on the need for clinical suspicion as to the possible existence of occult colon neoplasm in individuals with septic shock by gaseous gangrene with no obvious entry site. Diagnosis is performed by imaging techniques with barium enema and if this is normal colonoscopy is carried out. Emergency treatment consists in laparotomy with resection of the neoplasm and debridement of the area accompanied by hyperbaric oxygen and antibiotics.

Introduction During normal aging several changes in sleep/wake patterns are observed, which include frequent awakenings during sleep and increased daytime naps, among others. Likewise, aging has also been associated with a deterioration of cognitive function, learning and memory, although widespread loss of nerve cells does not occur, the most of age-related structural changes observed in nerve cells are modifications in dendrites, dendritic spines or even axons. Evidence accumulated over the last years indicates that these functional changes observed during sleep loss, aging, or both could be due to modifications in synaptic connectivity and intracellular signaling; for example, excitatory synaptic transmission at the hippocampal CA1 region is affected by sleep deprivation; in the locus coeruleus (involved in both arousal system and cognitive performance) the number of neurons projecting to areas such as the cortex and the hippocampus declines with age. Therefore, it has been hypothesized that sleep deprivation may compromise neurophysiological and behavioral events; however, relatively few studies have investigated links between sleep loss and structural changes in neurons and, despite the seemingly similar effects of age and sleep deprivation on cognition and the prevalence of sleep changes with age, little is known about the impact of sleep loss on cellular morphology in aging neurons. For that reasons, the aim of this study was to evaluate the effects of total sleep deprivation on neuronal morphology in the hippocampus and prefrontal cortex of both young and aged animals. Materials and methods A total of 28 male Wistar rats (14 “young-adult” rats, 3–4 months old; 14 “aged rats”, 22–23 months old; 7 for control and 7 for sleep deprivation for each age) were used in this study. Total sleep deprivation was carried out in both experimental groups (young-adult and aged, n = 7 per group) by gentle handling: once sleep-behaviour was observed or low amplitude waves first appear in sleep recording, rats were softly touched in their tails, whiskers or handling them to prevent falling asleep during 24 h. Immediately after sleep deprivation finished, animals were deeply anesthetized with sodium pentobarbital (75 mg/kg, i.p.) and then perfused intracardially with 0.9% saline solution. Brains were removed and stained by modified Golgi-Cox method. Pyramidal neurons from layer 3 of prefrontal cortex and hippocampus (CA1 area) were selected for study. Five neurons from each region of each brain hemisphere per animal were drawn using a camera lucida. Basal dendrites, including all branches, were reconstructed for each neuron and their dendritic tracings were quantified by Sholl analysis. Results Results showed that total dendritic length of prefrontal cortex and hippocampus was not affected either age or after 24 h of sleep deprivation compared to their corresponding control group. However, after 24 h of sleep deprivation (SD) aged animals had an increase in spine density in prefrontal cortex but not in hippocampus. Conclusion Sleep deprivation could be considered a factor that induces neuronal plasticity, which may depend on age. Acknowledgement This study was supported by CONACYT grant 133178.

The case of a young female diagnosed with an IgG deficit and hepatic granulomas is presented. After 6 years of follow up the patient remains asymptomatic without treatment and with moderate biochemical cholestasis. The tests performed did not lead to a definitive etiologic diagnosis, therefore, according to a review of the literature, we believe that the granulomatous reactions are related with the hypogammaglobulinemia itself.

To identify a population group at social risk and its principal features compared with the general population of Medina del Campo.A crossover observation study.Primary care. Health district.Children under 8 belonging to the marginalized non-gypsy population and children of the same age from the general population.Less weight and height, deficient compliance with healthy child monitoring, an acceptable level of vaccination (over 80%), excess of acute dermatological and neurological pathology (7.6% against 0% in the general population). 45% of pregnancies were unwanted, with a higher average of siblings and other people living in ordinary or poor-quality housing, which belonged to the grandparents in 50% of cases. Young parents with little training and serious problems of unemployment (60%), drug dependency (33%), alcoholism (23.3%) and delinquency (18.5%). The mother looked after the children by herself in 48% of cases.There is little healthy child monitoring and light undernourishment, but the vaccination coverage is acceptable. High prevalence of unwanted pregnancies. Young parents, with little education, unemployed, with high prevalence of drug dependency, alcoholism and delinquency. High prevalence of single-parent families.