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Aim To evaluate the effects of photodynamic therapy (PDT) in the nonsurgical treatment of chronic periodontitis. Materials and methods A randomized, single-blind, controlled, parallel-group clinical trial was performed. Sixty patients were enrolled: 20 healthy controls and 40 patients with periodontitis. The 40 patients were randomized for scaling and root planing (SRP) or SRP+PDT. Periodontal (plaque index, probing depth, clinical recession, clinical attachment level, bleeding on probing, and gingival crevicular fluid volume, corresponding to 381 vs 428 critical sites), microbiological (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, Prevotella intermedia and Campylobacter rectus presence, 18 vs 19 samples) and biochemical (interleukin (IL)-1β, IL-6 and tumour necrosis factor (TNF)-α, receptor activator of nuclear factor-kappaB ligand (RANK-L) and osteoprotegerin (OPG) levels, 18 vs 19 samples) parameters were recorded. Results Within each group, significant improvements were found for clinical parameters, though without significant differences between groups. RANK-L was significantly decreased at week 13 in the SRP+PDT group compared with the SRP group. SRP+PDT, but not SRP alone, significantly reduced the abundance of A. actinomycetemcomitans. Conclusions Except for a significant decrease in the pathogenic burden of A. actinomycetemcomitans, coadjuvant PDT resulted in no additional improvement compared with SRP alone in patients diagnosed with moderate to advanced chronic periodontitis. This article is protected by copyright. All rights reserved.

OBJECTIVES Ranolazine improves vascular function in animal models. We evaluate the effects of ranolazine on vascular function and adrenergic response in human saphenous vein. METHODS Rings from 53 patients undergoing coronary artery bypass grafting were mounted in organ baths. Concentration–response curves to ranolazine were constructed in rings precontracted with phenylephrine, endothelin-1, vasopressin, KCl and the thromboxane A2 analogue U-46619. In rings precontracted with phenylephrine, relaxation to ranolazine was tested in the absence and presence of endothelial factors inhibitors, K+ channel blockers and verapamil. The effects of ranolazine on frequency–response and concentration–response curves to phenylephrine were performed in the absence and presence of endothelial factors inhibitors and K+ channel blockers. Endothelial nitric oxide synthase, α1 adrenergic receptor and large conductance Ca2+-activated K+ channel protein expressions were measured by Western blotting. RESULTS Ranolazine (10−9–10−4 M) produced a concentration-dependent relaxation only in rings precontracted with phenylephrine that was reduced by endothelial denudation, NG-nitro-l-arginine methyl ester (10−4 M), charybdotoxin (10−7 M) and verapamil (10−6 M). Ranolazine diminished adrenergic contractions induced by electrical field stimulation (2–4 Hz) and phenylephrine (10−9–10−5 M) that were prevented by tetraethylammonium (10−3 M) and charybdotoxin (10−7 M). Ranolazine significantly decreased α1 adrenergic receptor and increased large conductance Ca2+-activated K+ channel protein expression in the saphenous vein. CONCLUSIONS Ranolazine diminishes the adrenergic vasoconstriction, acting as α1 antagonist, and by increasing large conductance Ca2+-activated K+ channel involvement. The relaxant effects of ranolazine are partially mediated by endothelial nitric oxide, large conductance Ca2+-activated K+ channels and the blockade of voltage-dependent Ca2+ channels.

To evaluate the obstetric management and neonatal outcomes in twin pregnancies with delayed delivery of the second twin, including follow-up.This study is a review of four cases of delayed delivery of the second twin in our hospital from 2009 to 2012. The obstetric management of the cases from the expulsion of the first twin to the delivery of the second twin is analyzed. The neonatal outcomes including follow-up for 2 years were reviewed.The first twins were delivered between 15 and 25 weeks (average 21 weeks) and the second twins were delivered between 25 and 31 weeks (average 27 weeks). One first twin (25 %) survived, while three (75 %) second twins survived. Two out of the three second twins delivered after 28 weeks were in satisfactory condition.The delayed delivery of the second twins which occurred in the third trimester is associated with favorable outcome, however, the risks should not be ignored.

A 17-year-old nulligravida woman presented to the emergency department complaining of a six months’ history of severe dysmenorrhea. The patient underwent a laparoscopic excision of a right ovarian endometrioma in another hospital one year ago, 24 months after menarche at 14 years of age. Transvaginal ultrasonography, magnetic resonance imaging, hysteroscopy as well as laparo- scopy revealed a unicornuate uterus with a noncommunicating right rudimentary horn, a dilated right fallopian tube and a novel 40 mm right ovarian endometrioma. An excision of the right fallopian tube, the rudimentary horn and the endometrioma was performed. Since endometriosis may be originated by retrograde menstruation, an obstructive mullerian malformation should be ruled out at the diagnosis of endometriosis, particularly in adolescents. It may lead clinicians to provide an initial definitive treatment for avoidingrapid recurrent endometriosis.

[EN] Rubrics are scoring guides that, when done right, offer teachers some advantages while qualifying. Our experience consisted in elaborate a rubric to evaluate the group work and analyze the qualifications obtained, broken down by sections and compare them with weight given to each section within the rubric. The aim of our study was to analyze whether the rubric used was discriminatory, as well as, to detect strengths and weaknesses in the designed rubric. The results showed a wide range of qualifications once evaluated with our rubric. 80% of rubric featured well-defined descriptors and of the remaining 20%, 10% was evaluated by students and the other 10% was too subjective because evaluation criteria were not well-defined. In conclusion, our rubric was discriminatory and therefore suitable to evaluate the goup work of our students. Sections with fewer descriptors were less discriminatory than those with defined criteria. Generally a wide range of qualifications demonstrate the suitability of the rubric used., [ES] Las rúbricas de evaluación son guías de puntuación que bien elaboradas ofrecen al profesorado unas ventajas a la hora de calificar. En nuestra experiencia hemos diseñado una rúbrica para evaluar trabajos en grupo y hemos analizado las calificaciones obtenidas, desglosadas por apartados y comparándolas con el peso otorgado a cada apartado dentro de la rúbrica. La finalidad de este estudio era analizar si la rúbrica diseñada era discriminatoria, así como detectar los puntos débiles de la misma para reflexionar sobre las mejoras que se le podrían practicar. Los resultados mostraron un amplio abanico de calificaciones evaluando con la rúbrica diseñada. El 80% de la rúbrica contó con descriptores bien definidos y del 20% restante, un 10% fue evaluado por los alumnos y el otro 10% resultó demasiado subjetivo por no tener bien definidos los criterios de evaluación, considerándose éste un punto débil de la misma y susceptible de mejora. En términos generales, la rúbrica utilizada ofreció notas discriminatorias entre grupos demostrando la idoneidad de su diseño.

[EN] Usually, students tend to divide tasks unequally when they have to work in groups, everyone prepares a part of the manuscript and later they bind all parts together and deliver it. In this way, learning is fragmented and the desired goal is not achieved: to work cooperatively. In our experience we proposed students to work as a group of scientists. From a brief background they had to write an introduction, design a protocol using the indicated experimental technique and finally they had to speculate and discuss on the expected results. The activity should have raised the cooperation among all group members, because the correct understanding of a section required of the understanding of the preceding sections. The results showed that our students have problems working as a team, because only students with high motivation for the subject showed an improvement in learning by this method. This is probably due to an education system that qualifies students based on their individual effort. However, the activity encouraged many positive aspects such as doubts clarification, discussion of ideas among them, the correct search for information and also offered quality manuscripts., [ES] Habitualmente cuando se plantea una actividad en grupo los alumnos tienden a dividir de forma desigual las tareas, reúnen lo realizado individualmente y lo entregan. De esta manera, el aprendizaje se fragmenta y no se consigue el objetivo deseado: trabajar cooperativamente. Nuestra experiencia consistió en proponer a los estudiantes que trabajasen como un grupo de científicos. A partir de unos breves antecedentes se les pedía que escribieran una introducción, elaborasen un protocolo experimental usando la técnica indicada y por último que especulasen y discutiesen sobre los resultados esperados según el protocolo diseñado. La actividad planteada debía fomentar la cooperación de todos los integrantes del grupo, pues el correcto entendimiento de un apartado del trabajo requería de la comprensión de los apartados anteriores. Los resultados evidenciaron que el aprendizaje de los conceptos trabajados en grupo mejoró en aquellos alumnos que tenían mayor motivación por la asignatura. En general, trabajar en equipo entraña dificultad para nuestros estudiantes, habituados a un sistema educativo que califica en base al esfuerzo individual. Sin embargo la actividad fomentó diversos aspectos positivos como la resolución de dudas, el debate de ideas entre iguales, la búsqueda correcta de la información y además ofreció manuscritos de calidad.

Resumen Objetivo Revisar la evolucion y las opciones terapeuticas en las gestaciones con diagnostico intrauterino de taquicardia fetal. Materiales y metodos Estudio observacional retrospectivo en 23 pacientes con diagnostico de taquicardia fetal y seguimiento gestacional en el Servicio de Obstetricia del Hospital Universitario La Fe de Valencia entre los anos 2002 y 2010. Los datos de las gestaciones incluidas en el estudio fueron recogidos mediante revision de las historias clinicas de las pacientes. Resultados La edad gestacional media de deteccion de la taquicardia fetal fue 30,2 semanas. De los 23 fetos, 18 (78,26%) presentaron taquicardia supraventricular, 2 (8,69%) flutter auricular y 3 (13,04%) taquicardia no filiada. Seis fetos desarrollaron hidrops (26,08%). En 13 casos (56,52%) se prescribio inicialmente tratamiento con digoxina en monoterapia, en uno (4,34%) con digoxina y amiodarona, en 2 (8,69%) con digoxina y flecainida y en otro (4,34%) unicamente con flecainida, debiendo modificarse el tratamiento inicial en 15 casos (65,21%). La taquicardia fue revertida en 9 fetos. Finalizaron mediante parto vaginal 11 gestaciones (47,82%), mientras que en las 12 restantes se realizo cesarea (52,17%). Conclusion Nuestros resultados apoyan la evidencia actual, considerando que una proporcion significativa de taquicardias fetales pueden ser tratadas exitosamente mediante administracion transplacentaria de antiarritmicos, siendo la digoxina el farmaco de primera eleccion. Con el tratamiento y el seguimiento adecuados el pronostico fetal de esta afeccion es favorable, resolviendose el ritmo cardiaco anormal en un alto porcentaje de casos durante la gestacion.

Objective To investigate the effect of antiangiogenic treatment on experimental endometriotic lesion nerve fibers. Design Heterologous mouse model of endometriosis. Setting University Institute IVI, University Hospital La Fe. Animal(s) Ovariectomized nude mice (n = 16) receiving human endometrial fragments from oocyte donors (n = 4). Intervention(s) Endometrium fragments stuck in the peritoneum of 5-week-old female nude mice treated with vehicle (n = 8) and antiangiogenic agent cabergoline (n = 8; Cb 2, 0.05 mg/kg/day) for 14 days. Main Outcome Measure(s) Immunofluorescence analysis of von-Willebrand factor (vWF) and vascular smooth muscle cells (αSMA) for evaluating the number of immature blood vessels (IBV) and microvascular density (MVD); immunochemical analysis of protein-gene product 9.5 (PGP 9.5) to assess nerve fibers density (NFD), and blue toluidine staining to confirm presence of mast cells and macrophages in endometriotic lesions. Result(s) All the results were quantified by morphometric techniques. The IBV, NFD, and number of macrophages and mast cells were statistically significantly decreased in the Cb2-treated group when compared with controls. Conclusion(s) Antiangiogenic treatment statistically significantly diminishes new blood vessel formation after macrophage, mast cell, and nerve fiber reduction, providing a rationale to test antiangiogenic agents as a novel therapeutic approach to severe pelvic pain associated with human peritoneal endometriosis.

Los fibroadenomas son las lesiones mamarias mas frecuentes durante la adolescencia. Se habla de «fibroadenoma gigante» cuando alcanza un tamano mayor de 5cm o un peso superior a 500g. Su tratamiento consiste en la tumorectomia, siendo necesaria excepcionalmente la mastectomia. En ocasiones resulta complicada su diferenciacion histologica con el tumor filodes, lesion mamaria benigna muy recidivante que raramente evoluciona como maligna. Presentamos el caso de una paciente diagnosticada de fibroadenoma gigante a los 17 anos y sometida a cinco intervenciones por sucesivas recidivas tumorales, con resultado final de la realizacion de una mastectomia. En dos ocasiones la lesion fue catalogada como tumor filodes borderline. Consideramos de interes su presentacion por su excepcional evolucion y como ejemplo de la dificultad de las indicaciones quirurgicas en determinadas lesiones mamarias benignas de dificil diagnostico anatomopatologico.

Introduccion La colecistectomia laparoscopica (CL) ambulatoria no se ha generalizado por temor del cirujano a las potenciales complicaciones postoperatorias y preferencia del paciente a la hospitalizacion. El establecimiento de criterios selectivos estrictos y la hospitalizacion a domicilio podrian cambiar esta predisposicion. Los objetivos de este estudio son averiguar que porcentaje de nuestra poblacion con colelitiasis cumple dichos criterios, confirmar su validez y descubrir si debe mejorarse el proceso quirurgico antes de implementarse. Material y metodo Se analizan prospectivamente los primeros 200 casos de CL electiva desde enero de 2006. Los criterios de exclusion son: preoperatorios (causas sociales, edad ≥ 70 anos, ASA III inestable o ASA IV, enfermedad concomitante que precisa control hospitalario, ingreso previo por afeccion biliopancreatica), intraoperatorios (conversion a laparotomia, tiempo quirurgico ≥ 90 min, sin identificacion o sangrado de la arteria cistica, aplicacion de material hemostatico, hemorragia en puertas de entrada, vertido de bilis intraabdominal, drenajes, extraccion dificultosa de vesicula, complicaciones anestesicas y/o quirurgicas) y postoperatorios (inestabilidad hemodinamica, dolor excesivo, nauseas y/o vomitos en la sala de reanimacion). Resultados Cumplieron criterios 53 (26,5%) pacientes. El sexo femenino y la menor edad favorecen el proceso ambulatorio. Se presentaron incidencias postoperatorias en el 9,4% que podrian asumirse por el equipo de hospitalizacion a domicilio. Conclusiones La CL en regimen ambulatorio es segura. La edad avanzada y la enfermedad concomitante limitan la inclusion. La hospitalizacion a domicilio puede solucionar las posibles complicaciones y facilitar el alta precoz de los pacientes sin criterios de CL ambulatoria.

Resumen Presentamos el seguimiento de un caso clinico de pentalogia de Cantrell detectado en la ecografia del primer trimestre. Se trata de una paciente de 33 anos, G2C1, sin antecedentes medicos de interes. Acude en su semana 13 + 2 para ecografia del primer trimestre. La ecografia se informo como feto unico con una longitud cefalo-nalga de 50,1 mm y una translucencia nucal de 7,5 mm. Se observa masa cardiopulmonar extracorporea, diagnosticandose de ectopia cordis, megavejiga, afectacion renal bilateral y pies zambos, etiquetandose al feto como portador de la pentologia de Cantrell. La paciente solicito interrupcion voluntaria del embarazo. La anatomia patologica describio feto con peso y talla adecuados a edad gestacional, que presentaba por la cara anterior extrofia visceral, identificandose tanto corazon como paquete intestinal y vejiga. Por tanto, el uso de la ecografia del primer trimestre no solo permite el diagnostico de la viabilidad fetal y la datacion de la edad gestacional, sino que hoy en dia permite tambien el diagnostico de patologia malfomativa estructural sin necesidad de esperar a la ecografia de la semana 20 para la toma de decisiones. Con este trabajo pretendemos describir la utilidad de la ecografia de primer trimestre en el diagnostico de patologia morfologica, tratando en nuestro caso la pentalogia de Cantrell.

Resumen El sindrome de Ehlers-Danlos (SED) es un grupo de enfermedades del tejido conectivo caracterizado principalmente por fragilidad tisular e hiperlaxitud articular. Es poco frecuente su asociacion con el embarazo y algunos tipos cursan con complicaciones severas maternas. Presentamos nuestra experiencia con una paciente de 35 anos afectada de SED tipo clasico, que presento un embarazo sin complicaciones, que alcanzo las 38 semanas y, un aborto espontaneo en el primer trimestre de una gestacion gemelar.

Objectives: Plasma levels of endogenous guanidino-substituted analogues of L -arginine are increased in various pathologic conditions. In the present study we determined the effects of some of these compounds on basal and stimulated release of nitric oxide in human internal thoracic and radial arteries. Methods: Rings of human internal thoracic and radial arteries were obtained from 16 multiorgan donors. The rings were suspended in organ baths for isometric recording of tension. Results: N G -monomethyl L -arginine (10 –6 to 10 –3 mol/L) and N G ,N G -dimethyl L -arginine (10 –6 to 10 –3 mol/L) caused concentration- and endothelium-dependent contractions. Maximal force of contractions for N G -monomethyl L -arginine and N G ,N G -dimethyl L -arginine in the internal thoracic artery were 18.0% ± 4.3% and 17.8% ± 3.8%, respectively, of the contraction to 100 mmol/L KCl, and those found in the radial artery were 9.6% ± 2.5% and 9.1% ± 2.4%, respectively. Aminoguanidine (10 –5 to 3 × 10 –3 mol/L) and methylguanidine (10 –5 to 3 × 10 –3 mol/L) produced endothelium-independent contractions. L -Arginine (10 –3 mol/L) prevented the contractions by N G -monomethyl L -arginine and N G ,N G -dimethyl L -arginine but did not change contractions induced by aminoguanidine and methylguanidine. N G -monomethyl L -arginine and N G ,N G -dimethyl L -arginine inhibited, in a concentration-dependent manner, the endothelium-dependent relaxation to acetylcholine in the internal thoracic artery and had little attenuating effect in the radial artery; aminoguanidine and methylguanidine were without effect. Conclusions: The results suggest that the contractions induced by N G -monomethyl L -arginine and N G ,N G -dimethyl L -arginine are due to inhibition of both basal and stimulated nitric oxide production, whereas aminoguanidine and methylguanidine do not affect the synthesis of nitric oxide. An increase in the plasma concentration of N G -monomethyl L -arginine and N G ,N G -dimethyl L -arginine is likely to represent a risk factor for abnormal vasomotor tone in conduit arteries used as coronary grafts. (J Thorac Cardiovasc Surg 2000;120:729-36)

The present study was designed to characterize the response of human penile dorsal artery and deep dorsal vein to dilator drugs used in the diagnosis and treatment of erectile dysfunction with special emphasis on the effects on sympathetic neurotransmission. Ring segments of penile dorsal artery and deep dorsal vein were obtained from 20 multi-organ donors during procurement of organs for transplantation. The rings (3 ;mm long) were suspended in organ bath chambers for isometric recording of tension. We then studied the relaxant responses to prostaglandin E1 (PGE1), vasoactive intestinal peptide (VIP), papaverine (PV), sodium nitroprusside (SNP) and linsidomine chlorhydrate (SIN-1), and analysed the effects of these drugs on contractions induced by stimulation of perivascular sympathetic nerves. In artery and vein rings contracted by noradrenaline, all the drugs tested caused concentration-dependent relaxation. The order of potencies in terms of IC50 values (concentration of agonist causing 50% of the maximal relaxation) was PGE1 = VIP > SNP > SIN-1 = PV. Both arteries and veins contracted to electrical field stimulation (15 ;V, 0.5–2 ;Hz, 0.2 ;ms duration for 15 ;s) in a frequency-dependent manner. All relaxant drugs caused concentration-dependent inhibition of neurogenic contractions; the relative order of potencies was PGE1 > VIP > SNP > SIN-1 = PV. It is concluded that inhibition of sympathetic activity constitutes an effective relaxing mechanism in penile dorsal artery and vein. Modulation of sympathetic activity together with the direct effects on smooth muscle should be considered to evaluate adequately the efficacy of relaxant drugs to increase human penile blood supply.

1. The aim of the present study was to investigate in rat mesenteric artery rings whether low concentrations of vasopressin could modify the contractile responses to noradrenaline and electrical stimulation of perivascular nerves. 2. Vasopressin (10[10]-10[-7] M) caused concentration-dependent contractions (pD2 = 8.36+/-0.09). The V1-receptor antagonist d(CH2)5Tyr(Me)AVP (10[-9]-10[-8] M) produced parallel rightward shifts of the control curve for vasopressin. Schild analysis yielded a pA2 value of 9.83 with a slope of 1.10+/-0.14. 3. Vasopressin (3 x 10[-10] and 10[-9] M) caused concentration-dependent potentiation of the contractions elicited by electrical stimulation (2-8 Hz; 0.2 ms duration for 30 s) and produced leftward shifts of the concentration-response curve for noradrenaline. The V1-receptor antagonist induced concentration-dependent inhibitions of potentiation induced by vasopressin. The selective V1-receptor agonist [Phe2, Orn8]-vasotocin (3 x 10[10] and 10[-9] M) induced potentiation of electrical stimulation-evoked responses which was also inhibited in the presence of the V1 antagonist (10[-8] M). In contrast, the V2-receptor agonist deamino-8-D-arginine vasopressin (desmopressin 10[-8]-10[-7] M) did not modify the electrical stimulation-induced responses and the V2-receptor antagonist [d(CH2)5, D-Ile2, Ile4, Arg8]-vasopressin (10[-8]-10[-7] M) did not affect the potentiation evoked by vasopressin. 4. In artery rings contracted by 10(-6) M noradrenaline in the presence of 10(-6) M guanethidine and 10(-6) M atropine, electrical stimulation (2, 4 and 8 Hz) produced frequency-dependent relaxations which were unaffected by 10(-9) M vasopressin but abolished by 10(-6) M tetrodotoxin. 5. Vasopressin also potentiated contractions elicited by KCl and contractions induced by addition of CaCl2 to KCl depolarized vessels. The augmenting effects were inhibited by the V1 antagonist. 6. In the presence of the calcium antagonist nifedipine (10[-6] M), vasopressin failed to enhance the contractile responses to electrical stimulation, noradrenaline and KCl. 7. The results demonstrate that low concentrations of vasopressin strongly potentiate the contractions to adrenergic stimulation and KCl depolarization. This effect appears to be mediated by V1 receptor stimulation which brings about an increase in calcium entry through dihydropyridine-sensitive calcium channels.

Morbid obesity is a chronic multifunctional disease characterized by an accumulation of fat. Epidemiological studies have shown that obesity is associated with cardiovascular and metabolic disorders. Endothelial dysfunction, as defined by an imbalance between relaxing and contractile endothelial factors, plays a central role in the pathogenesis of these cardiometabolic diseases. Diminished bioavailability of nitric oxide (NO) contributes to endothelial dysfunction and impairs endothelium- dependent vasodilatation. But this is not the only mechanism that drives to endothelial dysfunction. Obesity has been associated with a chronic inflammatory process, atherosclerosis, and oxidative stress. Moreover levels of asymmetrical dimethyl-L-arginine (ADMA), an endogenous inhibitor of endothelial nitric oxide synthase (eNOS), are elevated in obesity. On the other hand, increasing prostanoid-dependent vasoconstriction and decreasing vasodilator prostanoids also lead to endothelial dysfunction in obesity. Other mechanisms related to endothelin-1 (ET-1) or endothelium derived hyperpolarizing factor (EDHF) have been proposed. Bariatric surgery (BS) is a safe and effective means to achieve significant weight loss, but its use is limited only to patients with severe obesity including morbid obesity. BS also proved efficient in endothelial dysfunction reduction improving cardiovascular and metabolic comorbidities associated with morbid obesity such as diabetes, coronary artery disease, nonalcoholic fatty liver disease and cancer. This review will provide a brief overview of the mechanisms that link obesity with endothelial dysfunction, and how weight loss is a cornerstone treatment for cardiovascular comorbidities obesity-related. A better understanding of the mechanisms of obesity-induced endothelial dysfunction may help develop new therapeutic strategies to reduce cardiovascular morbidity and mortality.

The aim of this study was to analyze whether tyrosine phosphorylation in tumoral arteries may modulate their vascular response. To do this, mesenteric arteries supplying blood flow to colorectal tumors or to normal intestine were obtained during surgery and prepared for isometric tension recording in an organ bath. Increasing tyrosine phosphorylation with the phosphatase inhibitor, sodium orthovanadate produced arterial contraction which was lower in tumoral than in control arteries, whereas it reduced the contraction to noradrenaline in tumoral but not in control arteries and reduced the relaxation to bradykinin in control but not in tumoral arteries. Protein expression of VEGF-A and of the VEGF receptor FLT1 was similar in control and tumoral arteries, but expression of the VEGF receptor KDR was increased in tumoral compared with control arteries. This suggests that tyrosine phosphorylation may produce inhibition of the contraction in tumoral mesenteric arteries, which may increase blood flow to the tumor when tyrosine phosphorylation is increased by stimulation of VEGF receptors, This work was financed by Fondo de Investigaciones Sanitarias (PS09/00394) and Fundaci´on Mutua Madrileña (AP57242009)

Twin reverse arterial perfusion (TRAP) sequence is a rare complication that occurs exclusively in monochorionic multiple gestations (Wong and Sepulveda 2005). It consists in a normal twin, who acts...

The effects of vasopressin were studied in isolated rings from branches (2-3 mm in external diameter) of human renal arteries obtained from 18 patients undergoing nephrectomy for non-obstructive neoplasia. In arterial rings under resting tension, vasopressin produced concentration-dependent and endothelium-independent contractions with an EC 50 of 9.1 x 10 -10 mol L -1 . The vasopressin V 1 receptor antagonist d(CH 2 ) 5 Tyr(Me)AVP (10 -6 mol L -1 ) displaced the control curve to vasopressin 564-fold to the right in a parallel manner. In precontracted arterial rings and previously treated with the V 1 antagonist (10 -6 mol L -1 ) vasopressin caused endothelium-independent relaxation. The relaxation to vasopressin was reduced significantly by indomethacin (10 -6 mol L -1 ) and unaffected by the V 1 /V 2 receptor antagonist desGly d(CH 2 ) 5 -D-Tyr(Et)ValAVP (10 -6 mol L -1 ) or by N G -nitro-L-arginine methyl ester (10 -4 mol L -1 ). These observations indicate that vasopressin is primarily a constrictor of human renal arteries by V 1 -receptor stimulation. Vasopressin causes prostaglandin-mediated dilatation of human renal arteries only if V 1 -receptor blockade is present. The effects of vasopressin on human renal arteries may be relevant in those clinical situations characterized by increased plasma vasopressin levels.

We studied the effects of vasopressin on isolated rings of human deferential artery and vas deferens (prostatic portion) obtained from patients undergoing radical cystectomy (n = 11) or prostatectomy (n = 10). Ring segments of artery or vas deferens were studied in organ bath experiments at optimal resting tension. In artery rings, vasopressin produced concentration-dependent, endothelium-independent contractions with an EC50 of 4.5 x 10(-10) M. The presence of NG-nitro-L-arginine methyl ester hydrochloride (10(-4) M), an inhibitor of nitric oxide synthase, did not change significantly (P > 0.05) the vasopressin-induced contraction. In ring preparations of the prostatic part of the vas deferens, vasopressin induced phasic contractions with an EC50 of 7.0 x 10(-9) M. The vasopressin V1 receptor antagonist, d(CH2)5Tyr(Me)AVP (10(-8) and 10(-6)), displaced to the right in parallel the control curve to vasopressin in artery and vas deferens rings. These results indicate that vasopressin exerts a powerful constrictor action on human deferential artery and vas deferens by direct stimulation of V1 receptors. It is concluded that the deferential artery may dampen the passage of blood to the vas deferens in circumstances characterized by increased plasma vasopressin levels.

We present a case of a twin pregnancy in which one fetus developed a rapidly growing unilateral intrathoracic tumor. While a cystic adenomatoid malformation was suspected in the ultrasound scan, the magnetic resonance scan suggested a pulmonary blastoma or a bronchioalveolar carcinoma. Postnatal chest radiography and contrast-enhanced computed tomography of the affected newborn were performed, and it was ruled out the possibility of malignant origin. Finally, the anatomopathologic exam revealed the presence of a mesenchymal hamartoma in the chest wall. Nevertheless, parents refused any treatment for the newborn.

Arthrogryposis multiplex congenital is a rare condition defined as contractures in multiple joints at birth due to disorders starting in fetal life. Its etiology is associated with many different conditions and in many instances remains unknown. The final common pathway to all of them is decreased fetal movement (fetal akinesia) due to an abnormal intrauterine environment. Causes of decreased fetal movements may be neuropathic abnormalities, abnormalities of connective tissue or muscle, intrauterine vascular compromise, maternal diseases, and space limitations within the uterus. When the cause of arthrogryposis is space limitations in uterus, the most common etiology is oligohydramnios. The same can result from intrauterine tumours as fibroids, although to our knowledge there are only two papers reporting cases of fetal deformities related to uterine leiomyomas. We describe a well-documented exceptional case of arthrogryposis associated with the presence of a large uterine fibroid. It could illustrate the importance of a careful and appropriate assessment of uterine fibroids before and in the course of a pregnancy considering that they can cause both serious maternal and fetal complications.

La endometriosis ureteral es una infrecuente localizacion de endometriosis profunda, que puede condicionar una grave disminucion de la funcion renal de forma silenciosa. Se presenta el caso de una paciente con fibrosis peritoneal secundaria a endometriosis profunda, cuya inespecifica sintomatologia conllevo un retraso diagnostico, permitiendo el desarrollo de hidronefrosis. Es necesario descartar la presencia de endometriosis profunda en mujeres en edad fertil con hidronefrosis de etiologia desconocida.

Outpatient laparoscopic cholecystectomy (CL) has not been generalised due to the fear of complications by the surgeon and preference of patients for hospitalisation. This situation could be changed by setting up strict selection criteria and providing hospital home care. The aims of this study are to find out what percentage of our population fulfil these criteria, confirm their validity and find out if the surgical process should be improved before being introduced.A retrospective analysis was carried out on the first 200 elective CL cases dating from January 2006. The exclusion criteria were as follows: pre-operative criteria (social causes, age $ 70 years, unstable ASA III or ASA IV, an associated pathology or admission due to biliopancreatic patho-logy), intra-operative criteria (conversion, surgical time lasting longer than 90 minutes, non-identification or bleeding of the cystic artery, application of haemostatic material, haemorrhaging in the entrance ports, intra-abdominal bile spillage, drainage, difficulties in removing the gallbladder, anaesthetic and/or surgical complications) and post-operative (haemodynamic instability, excessive pain, nausea, and /or vomiting).Out of the 200 cases, 53 (26.5%) patients fulfilled the criteria. The outpatient system was preferred predominantly by females and by those younger in age. Post-operative incidents occurred in 9.4% of the cases and these were dealt with by the hospital home care team.Ambulatory CL procedure is safe. Patients of advanced age or with associated pathologies limit the inclusion. Hospital home care can solve any possible complications and contribute to the speedy discharge in those patients without criteria.

Previous studies have shown that asymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA) and nitric oxide (NO) play a prominent role in liver dysfunction. The objective of this study was to determine whether plasma levels of ADMA, SDMA and NO are altered in patients with chronic hepatitis C.Plasma levels of ADMA, SDMA and NO (nitrite plus nitrate) were measured in 22 patients with chronic hepatitis C and 24 patients with sustained virologic response after treatment with peginterferon plus ribavirin. Seven healthy volunteers served as controls.Plasma levels of ADMA, SDMA and NO were not significantly different between groups: chronic hepatitis C, ADMA 0.55+/-0.06, SDMA 0.22+/-0.03, NO 36.3+/-5.9 micromol/l; treated patients, ADMA 0.60+/-0.15, SDMA 0.31+/-0.05, NO 36.1+/-5.5 micromol/l; controls, ADMA 0.65+/-0.08, SDMA 0.28+/-0.05, NO 40.7+/-8.9 micromol/l).Our results show that plasma NO, ADMA and SDMA concentrations are not changed in patients with chronic hepatitis C without superimposed signs of acute inflammatory activity. Furthermore, no significant differences in plasma values of NO and dimethylarginines were observed between the group of untreated patients and the group of patients treated with interferon plus ribavirin.

Vasopressin not only acts directly on blood vessels through V1-receptor stimulation but also may modulate adrenergic-mediated responses in animal experiments in vitro and in vivo. The aim of the present study was to investigate whether subpressor concentrations of vasopressin could modify the constrictor responses to norepinephrine and electrical stimulation of the perivascular nerves in human mesenteric arteries. Human mesenteric artery rings (3-3.5 mm long, 0.8-1.2 mm OD) were obtained from 38 patients undergoing abdominal operations. The arterial rings were suspended in organ bath chambers for isometric recording of tension. Vasopressin (3 x 10(-11) M) enhanced the contractions elicited by electrical stimulation at 2, 4, and 8 Hz (by 100, 100, and 72%, respectively) and produced a leftward shift of the concentration-response curves to norepinephrine (half-maximal effective concentration decreased from 2.2 x 10(-6) to 5.0 x 10(-7) M; P < 0.05) without any alteration in maximal contractions. Vasopressin also potentiated KCl- and calcium-induced contractions. The V1-receptor antagonist 1-[beta-mercapto-beta,beta-cyclopentamethylenepropionic acid-2-O-methyl-tyrosine, 8-arginine]vasopressin (10(-6) M) prevented the potentiation evoked by vasopressin in all cases. The calcium antagonist nifedipine (10(-6) M) did not affect the potentiation of electrical stimulation and norepinephrine induced by vasopressin but abolished KCl-induced contractions. The results suggest that vasopressin, in addition to its direct vasoconstrictor effect, strongly potentiates the responses to adrenergic stimulation and KCl depolarization. Both the direct and indirect effects of vasopressin appear to be mediated by V1-receptor stimulation. The amplifying effect of vasopressin on constrictor responses may be relevant in those clinical situations characterized by increased plasma vasopressin levels.

The present study was designed to investigate the contribution of the endothelium and that of the L-arginine pathway on the contractile responses of isolated human pulmonary arteries to electrical field stimulation (EFS) and noradrenaline. Isometric tension was measured in artery rings obtained from portions of human lung after thoracic surgery for removal of lung carcinoma (18 patients). Electrical field stimulation (EFS) induced frequency-dependent contractions of isolated human pulmonary arteries which were abolished by tetrodotoxin, guanethidine and prazosin (all at 10(-6) M). The increases in tension were of greater magnitude in arteries denuded of endothelium. NG-nitro-L-arginine methyl ester (L-NAME) (10(-4) M) potentiated the contractile response to EFS in artery rings with endothelium but not in endothelium-denuded arteries. The potentiation induced by L-NAME was completely reversed by L-arginine (10(-4) M) but not by D-arginine (10(-4) M). Indomethacin (3 x 10(-6) M) had no significant effect on the contractile response to EFS. Contractile responses to noradrenaline were similar in arteries with and without endothelium. Our results suggest that electrical field stimulation releases endothelium-derived nitric oxide, which inhibits the contractile responses of human pulmonary arteries. Although adrenergic nerves seem to be responsible for the contraction, the transmitter involved in the release of nitric oxide does not appear to be noradrenaline.

1. The effects of vasopressin and deamino-8-D-arginine vasopressin (DDAVP, desmopressin) were studied in artery rings (0.8-1 mm in external diameter) obtained from portions of human omentum during the course of abdominal operations (27 patients). 2. In arterial rings under resting tension, vasopressin produced concentration-dependent, endothelium-independent contractions with an EC50 of 0.59 +/- 0.12 nM. The V1 antagonist d(CH2)5Tyr(Me)AVP (1 microM) and the mixed V1-V2 antagonist desGly-d(CH2)5D-Tyr(Et)ValAVP (0.01 microM) displaced the control curve to vasopressin to the right in a parallel manner without differences in the maximal responses. In the presence of indomethacin (1 microM) the contractile response to vasopressin was significantly increased (P < 0.01). 3. In precontracted arterial rings, previously treated with the V1 antagonist, d(CH2)5Tyr(Me)AVP (1 microM), vasopressin produced endothelium-dependent relaxation. This relaxation was reduced significantly (P < 0.05) by indomethacin (1 microM) and unaffected by the V1-V2 receptor antagonist desGly-d(CH2)5D-Tyr(Et)ValAVP (1 microM) or by NG-nitro-L-arginine methyl ester (L-NAME, 0.1 mM). 4. The selective V2 receptor agonist, DDAVP, caused endothelium-independent, concentration-dependent relaxations in precontracted arterial rings that were inhibited by the mixed V1-V2 receptor antagonist, but not by the V1 receptor antagonist or by pretreatment with indomethacin or L-NAME. 5. Results from this study suggest that vasopressin is primarily a constrictor of human mesenteric arteries by V1 receptor stimulation; vasopressin causes dilatation only during V1 receptor blockade. The relaxation appears to be mediated by the release of vasodilator prostaglandins from the endothelial cell layer and is independent of V2 receptor stimulation or release of nitric oxide. In contrast, the relaxation induced by DDAVP is largely dependent on stimulation of V2 receptors.