Articles publicats en revistes (Cirurgia i Especialitats Medicoquirúrgiques)

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Type 2 and Non-type 2 Inflammation in the Upper Airways: Cellular and Molecular Alterations in Olfactory Neuroepithelium Cell Populations
(Springer Science + Business Media, 2024-04-01) Marin, Concepció; Alobid, Isam; López Chacón, Mauricio; Rodriguez-Van Strahlen, Camilo; Mullol i Miret, Joaquim
Purpose of review: Neurogenesis occurring in the olfactory epithelium is critical to continuously replace olfactory neurons to maintain olfactory function, but is impaired during chronic type 2 and non-type 2 inflammation of the upper airways. In this review, we describe the neurobiology of olfaction and the olfactory alterations in chronic rhinosinusitis with nasal polyps (type 2 inflammation) and post-viral acute rhinosinusitis (non-type 2 inflammation), highlighting the role of immune response attenuating olfactory neurogenesis as a possibly mechanism for the loss of smell in these diseases. Recent findings: Several studies have provided relevant insights into the role of basal stem cells as direct participants in the progression of chronic inflammation identifying a functional switch away from a neuro-regenerative phenotype to one contributing to immune defense, a process that induces a deficient replacement of olfactory neurons. The interaction between olfactory stem cells and immune system might critically underlie ongoing loss of smell in type 2 and non-type 2 inflammatory upper airway diseases. In this review, we describe the neurobiology of olfaction and the olfactory alterations in type 2 and non-type 2 inflammatory upper airway diseases, highlighting the role of immune response attenuating olfactory neurogenesis, as a possibly mechanism for the lack of loss of smell recovery.
Standard or Fin SIGN® nail? which option is better for the treatment of femoral fractures in low and middle-income countries?
(Springer Verlag, 2024-08-01) Perdomo Lizarraga, Juan Carlos; Andrade Arellano, Dennys J.; Necchi, Marco; Zavatta, Marcello; Ryan Coker, Marcella F. D.; Dixon Cole, Richmond; Muñoz Mahamud, Ernesto; Combalía Aleu, Andrés
Purpose Femoral fractures are common in low and middle-income countries (LMIC), predominantly caused by high-energy trauma. The surgical implant generation network (SIGN®) program offers two different intramedullary nails in LMIC which are designed to be used without image intensifier free of charge for the patients: the SIGN standard nail (SSN®) and the SIGN Fin nail (SFN®). This study aimed to compare the results of the SSN® and the SFN® for the treatment of middle and distal shaft femoral fractures through a retrograde approach. Material and Methods This was a retrospective, descriptive, and non-experimental study including all consecutive patients who underwent surgical management of middle or distal shaft femoral fracture between January 2017 and May 2022 in an NGO hospital located in Freetown, Sierra Leone. The duration of surgery, type of reduction, complications like screw loosening, implant migration, anterior knee pain and non-union rate at six months of follow up were evaluated. Results A total of 122 patients were included in the study. Group A: 60 patients were managed with SSN® and Group B: 62 patients with SFN®. The mean operative time was 104 min with SSN® and 78 with SFN® (p < 0.001). Open reduction of the fracture was necessary in ten (16.7%) patients with SSN® and 12 (19.4%) patients treated with SFN® (p = 0.69). Non-union was observed in one (1.7%) patient with SSN® and two (3.2%) patients with SFN® (p = 0.57). Conclusions Both options seem equally effective in treating midshaft and distal femoral shaft fractures. The SFN® reduces the surgical time, due to this fact, in polytraumatized patients, patients with bilateral femur fracture or patients with ipsilateral tibia fracture, it can be considered as the best option to be used. There was no statistical difference in the complications presented by the two groups.
Non-invasive meningitis screening in neonates and infants: multicentre international study
(Nature Publishing Group, 2025-07-23) Ajanovic, Sara ; Petrone, Paula; Sial, Hassan; Muñoz, David; Agut, Thais; Salas, Barbara; Carreras, Nuria; Alarcón Allen, Ana; Iriondo Sanz, Martín; Luaces Cubells, Carles; Arias, Sara; Bassat Orellana, Quique; The UNITED study group
BACKGROUND AND OBJECTIVES: Meningitis diagnosis requires a lumbar puncture (LP) to obtain cerebrospinal fluid (CSF) for a laboratory-based analysis. In high-income settings, LPs are part of the systematic approach to screen for meningitis, and most yield negative results. In low- and middle-income settings, LPs are seldom performed, and suspected cases are often treated empirically. The aim of this study was to validate a non-invasive transfontanellar white blood cell (WBC) counter in CSF to screen for meningitis. METHODS:: We conducted a prospective study across three Spanish hospitals, one Mozambican and one Moroccan hospital (2020–2023). We included patients under 24 months with suspected meningitis, an open fontanelle, and a LP performed within 24 h from recruitment. High-resolution-ultrasound (HRUS) images of the CSF were obtained using a customized probe. A deeplearning model was trained to classify CSF patterns based on LPs WBC counts, using a 30cells/mm3 threshold. RESULTS:: The algorithm was applied to 3782 images from 76 patients. It correctly classified 17/18 CSFs with 30 WBC, and 55/58 controls (sensitivity 94.4%, specificity 94.8%). The only false negative was paired to a traumatic LP with 40 corrected WBC/mm3. CONCLUSIONS:: This non-invasive device could be an accurate tool for screening meningitis in neonates and young infants, modulating LP indications. Pediatric Research (2026) 99:1040–1050; https://doi.org/10.1038/s41390-025-04179-7 IMPACT: ● Our non-invasive, high-resolution ultrasound device achieved 94% accuracy in detecting elevated leukocyte counts in neonates and infants with suspected meningitis, compared to the gold standard (lumbar punctures and laboratory analysis). ● This first-in-class screening device introduces the first non-invasive method for neonatal and infant meningitis screening, potentially modulating lumbar puncture indications. ● This technology could substantially reduce lumbar punctures in low-suspicion cases and provides a viable alternative critically ill patients worldwide or in settings where lumbar punctures are unfeasible, especially in low-income countries).
Management of deceased and living kidney donor with lithiasis: a multicenter retrospective study on behalf of the renal transplant group of the Spanish urological association
(Springer Verlag, 2024-06-22) Sierra, Alba; Etcheverry, Begoña; Álvarez-Maestro, Mario; López Martínez, Juan Manuel; Fiol Riera, Maria; Torrecilla, Carlos; Vigués i Julià, Francesc; Martínez, Carmen; Carbonell Vayá, Enrique J.; Martínez-Pérez, Salvador; Alcaraz Asensio, Antonio; Luque Gálvez, Ma. Pilar; Musquera i Felip, Mireia
Background: To maximize the availability of suitable grafts and ensure effective management, several reports have demonstrated successful outcomes when using kidney grafts with urolithiasis. This multicenter study reports on the management and long-term outcomes of kidney transplantation using renal grafts with lithiasis. Methods: Retrospective data from three Spanish hospitals were analyzed for kidney transplants involving grafts with nephrolithiasis performed between December 2009 and August 2023. The study included adult patients, excluding those with incomplete records. It evaluated stone characteristics, complications, and outcomes in recipients and in living kidney donors. Results: Out of 38 analyzed kidney transplants, 57.9% were cadaveric and 42.1% were from living kidney donors. Most diagnoses were incidental during donor evaluation, with an average stone size of 7.06 mm. After follow-up (median 26 months), all recipients but one had functioning grafts, and there were no stone recurrences in both recipients and living kidney donors. Conservative management was adopted in 28 cases, while 10 cases required ex-vivo flexible ureterorenoscopy for stone removal. Following conservative management, 5 patients needed additional treatments for stone-related events. Conclusions: Kidneys with lithiasis can be considered for transplantation in selected cases, resulting in good functional outcomes with no stone recurrence in recipients or living donors.
Systematic Review of Long Term Sinonasal Outcomes in CRSwNP after Endoscopic Sinus Surgery: A call for Unified and Standardized Criteria and Terms
(Springer Science + Business Media, 2024-06-24) Rodriguez-Van Strahlen, Camilo; Arancibia Verdugo, Claudio; Calvo Henriquez, Christian; Mullol i Miret, Joaquim; Alobid, Isam
Purpose of review: To present current evidence in long-term (> 5 years) results after endoscopic sinus surgery (ESS) focusing on Patients Reported Outcome Measures (PROMs) and other sinonasal outcomes while assessing the role of ESS in the treatment of CRSwNP, and identifying outcomes which affect the results of ESS and defining recommendations for future studies. Recent findings: Long-term results of ESS in CRSwNP can be branched in PROMs and other objective measurements. Despite the heterogeneity of reported outcomes make it difficult to perform comparisons and meta-analysis, ESS improves PROMs, including symptoms, QOL and olfaction. Objectives outcomes such as NPS, LMS, type of surgery, or recurrence and revision surgery don't have a clear role in long-term results. Clustering patients suggest asthma, N-ERD, allergy, eosinophil count and IL-5 could have a role in predicting recurrence and severe disease. Long-term studies of CRSwNP treated with ESS are scarce. There is a significant need to standardize the report of results. The use of tools as SNOT-22, NPS, validated smell tests, defined criteria for disease recurrence and control and ESS extension in a unified systematic way could allow better comparisons between treatments in the new era of biologics.
Blue laser for the exclusive endoscopic transcanal approach to middle ear paraganglioma
(Springer Verlag, 2024-02-09) Quer Castells, Mireia; Sandoval Puig, Marta; Larrosa Diaz, Francisco de Asis
Background: The management of glomus tympanicum tumours can be challenging. Blue laser coagulation may improve bleeding control thus facilitating an endoscopic transcanal excision. The objective of this presentation is to illustrate the authors' experience using this novel tool. Methods: Case report of a patient that underwent exclusive endoscopic transcanal blue laser surgery of a class A2 glomus tympanicum tumour in a tertiary referral center. Conclusion: The present study provides evidence of the safety and efficacy of endoscopic blue laser surgery, for the minimally invasive treatment of early-stage glomus tympanicum tumours.
In Vitro Activity of Ampicillin Plus Ceftriaxone Against Non-faecalis and Non-faecium Enterococcal Isolates With/Without VanC Phenotype: Clinical Implications for Infective Endocarditis.
(MDPI, 2024-12-05) García González, Javier; Cañas, María Alexandra; Cuervo Requena, Guillermo; Hernández Meneses, Marta; Verdejo, Miguel Ángel; Bodro, Marta; Díez de los Ríos, Javier; Gasch, Oriol; Ribera, Alba; Falces Salvador, Carles; Perissinotti, Andrés; Vidal, Bàrbara; Quintana, Eduard; Moreno Camacho, Ma. Asunción; Piquet, Maria; Roca Subirà, Ignasi; Fernández Pittol, Mariana José; San José Villar, Sol María; García de la Mària, Cristina; Miró Meda, José M. (José María), 1956- ; Hospital Clínic Endocarditis Study Group
1) Background: Alternative antibiotics are needed to treat infective endocarditis (IE) caused by non-faecalis/non-faecium enterococci; we aimed to assess the in vitro activity of ampicillin plus ceftriaxone (AMP + CTR) against these enterococci and to describe its clinical efficacy in IE cases. (2) Methods: Time–kill curves with standard (ISI) and high (IHI) inocula were performed to test VanC isolates [3 E. casseliflavus (ECAS) and 1 E. gallinarum (EGALL)] and non-VanC isolates [1 E. durans (EDUR), 1 E. hirae (EHIR) and 1 E. raffinosus (ERAF)]. The narrative literature review of IE cases treated with AMP + CTR was analyzed alongside three study cases. Clinical outcomes were relapse and death. (3) Results: Ampicillin plus gentamicin (AMP + GEN) showed synergistic and bactericidal activity against most isolates. AMP + CTR was synergistic at ISI for EGALL, EDUR, and EHIR and bactericidal against EHIR. At IHI, indifferent activity was observed for all isolates. In IE cases treated with AMP + CTR, it was only effective for EDUR and EHIR. Clinical information for EGALL IE is lacking. For IE caused by ECAS and ERAF, AMP + CTR seems suboptimal or ineffective, respectively. (4) AMP + CTR cannot be recommended for treating IE due to ECAS/ERAF. In contrast, this combination was effective in IE caused by EDUR/EHIR and could be recommended.
A 25-year scoping review of the organ donation system in Malaysia: past, present, and future
(The Korean Society for Transplantation, 2024-09-30) Khoo, Lay See; Ballesté, Chloë
Organ donation and transplantation are integral components of modern medicine. This scoping review thoroughly explores the historical evolution, current status, and future prospects of organ donation and transplantation in Malaysia. Historically, Malaysia faced significant challenges in establishing a robust organ transplantation system, with various factors hindering organ donation efforts. Currently, Malaysia continues to struggle with stagnant donation rates despite collaborative efforts from various sectors. There is an urgent need to amend the 50-year-old Human Tissue Act to strengthen the legal framework for organ donation and address ethical concerns. Looking to the future, Malaysia could adopt a soft opt-out system and prioritize advancements in organ preservation techniques by exploring new sources of organs through the donation after circulatory death program. Continued efforts are necessary to enhance education programs for professionals and the public, dispelling myths about organ donation and effectively educating on the concepts of brain death. Malaysia strives to create a more accessible future for organ transplantation, aligning with the Sustainable Development Goals to reduce the burden of organ failure and improve the population’s health and well-being.
Gestational age assessment by ultrasound cerebellar measurements in fetal and perinatal deaths.
(Elsevier, 2025-06-01) Peñuelas, Núria; Saco, Adela; Marimon, Lorena; Díez Ahijado, Laia; Nadal Serra, Alfons; Sisuashvili, Lia; Darecka, Katarzyna; Gratacós Solsona, Eduard; Crispi Brillas, Fàtima; Monterde, Elena; García Otero, Laura; Arca Díaz, Gemma; Bassat Orellana, Quique; González Álvarez, Raquel; Menéndez, Clara; Ordi i Majà, Jaume; Rakislova, Natalia
Background: Perinatal mortality remains high in low- and middle-income countries. Accurate assessment of fetal gestational age is crucial to distinguish between prematurity and intrauterine growth restriction, 2 conditions commonly associated with perinatal mortality that require different preventive strategies and management. Ultrasound measurements of the cerebellum have been shown to be accurate in assessing gestational age during pregnancy, but their postmortem performance has not yet been evaluated. Objective: We aimed to explore the feasibility and validity of gestational age estimation in fetal and perinatal deaths by ultrasound measurements of the cerebellum. Study design: This is an observational cross-sectional study. Between August 2020 and November 2022 postmortem cerebellar ultrasound measurements were conducted in a tertiary referral hospital in Barcelona, Spain. Extrauterine assessment included transcerebellar diameter, cerebellar vermis height, and cerebellar vermis length. Moreover, intrauterine ultrasound and autopsy direct cerebellar assessments were undertaken in a subset of cases. A total of 137 fetal and perinatal deaths [63 (46.0%) fetal deaths, 69 (50.4%) stillbirths, and 5 (3.6%) neonates] were included. First, we correlated different types of transcerebellar diameter measurements between them (intrauterine, extrauterine, and autopsy-based). Then, we evaluated the relationship between the extrauterine cerebellar ultrasound measurements and gestational age, and their performance across trimesters of gestation and in different central nervous system abnormalities. Results: Gestational age ranged from 15.2 to 40.6 weeks. High correlation was observed between extrauterine, intrauterine, and autopsy transcerebellar measurements (P<.001) and between all extrauterine cerebellar measurements and gestational age (P<.001). Extrauterine transcerebellar diameter was identified as the strongest predictor of gestational age (coefficient of determination=0.88; P<.001), and its accuracy was not affected by the trimester of gestation, intrauterine growth restriction, or central nervous system alterations. Conclusion: This study shows the feasibility and accuracy of postmortem gestational age evaluation by extrauterine ultrasound measurements of the cerebellum, especially of transcerebellar diameter. Implementation of this method as part of postmortem assessment could improve cause of death attribution, especially in resource-constrained settings.
Role of Reserve Cells in Metaplasia and the Development of Human Papillomavirus-Associated High-Grade Squamous Intraepithelial Lesions at the Cervical Transformation Zone.
(United States and Canadian Academy of Pathology, 2025-07-01) Aiyenuro, Ademola; Griffin, Heather; Schichl, Konstanze; Omar, Tanvier; Ordi i Majà, Jaume; Kelly, Helen A.; Walker, Caroline; Pino Saladrigues, Marta del; Desai, Kanan T.; Sanjosé Llongueras, Silvia de; Schiffman, Mark; Doorbar, John
Squamous cervical cancers generally arise as a result of persistent infection with high-risk human papillomaviruses (hrHPVs) and occur near the squamocolumnar junction (SCJ) and within the transformation zone (TZ). The susceptibility of the TZ to HPV-related carcinogenesis appears linked to epithelial cell plasticity, with squamous metaplasia originating from a specialized stem cell population at this site. Two alternative cell populations have been implicated: keratin (K)7+ve cuboidal cells located at the SCJ vs a more broadly distributed K17+ve cervical reserve cell population. To distinguish between the hypotheses, we utilized multiplex immunofluorescence and large-scale digital imaging to map cell populations at the TZ of 165 women with and without hrHPV infections. Our results did not reveal a distinct population of K7+ cuboidal cells at the SCJ but found instead that the cuboidal and columnar cells of the TZ express K7 and K8 throughout and lack the p63 transcription factor required for epithelial stratification. Squamous metaplasia and reserve cells, which are defined by their subcolumnar location and pattern of biomarker expression (K5/K17/P63), were conspicuous at cervical crypt entrances within the TZ extending proximally toward the endocervix. In HPV-infected tissue, crypt-entrance regions with thin high-grade squamous intraepithelial lesion pathology showed prominent expression of hrHPV E6/E7 mRNA, as detected by fluorescence in situ hybridization, and p16/MCM expression, with infection also apparent in neighboring reserve cells. In some instances, normal/uninfected reserve cells (E6/E7 mRNA-ve) and squamous metaplasia were not only seen close to these regions of hrHPV infection but also extended well beyond the infected area both laterally and by depth. Our results confirm that the reserve cells underneath the columnar epithelia at TZ have the potential to undergo malignant squamous transformation via reserve cell proliferation, in agreement with previous histopathological studies. These translational findings highlight the importance of understanding the molecular biology of the epithelial sites where HPV cancers develop and suggest that in high-risk individuals, treatment strategies should target a wider area than previously thought.
Penile Squamous Cell Carcinomas in Sub-Saharan Africa and Europe: Differential Etiopathogenesis
(MDPI, 2022-10-27) Manzotti, Carolina; Chulo, Laurina; López del Campo, Ricardo; Trias, Isabel; Pino Saladrigues, Marta del; Saude, Ofelia; Basílio, Iracema; Tchamo, Nelson; Lovane, Lucilia; Lorenzoni, Cesaltina; Fernandes, Fabiola; Saco, Adela; Rodrigo Calvo, María Teresa; Marimon, Lorena; Ismail, Mamudo R.; Carrilho, Carla; Ribera-Cortada, Inmaculada; Ordi i Majà, Jaume; Rakislova, Natalia
Penile squamous cell carcinomas (PSCC) are classified by the World Health Organization into two categories based on their relationship with the human papillomavirus (HPV): HPV-associated and HPV-independent. We compared a cohort of PSCC from Mozambique, a sub-Saharan country in southeast Africa with a high prevalence of HPV and HIV infection, and Spain, a country in southwestern Europe with a low prevalence of HPV and HIV, to study the distribution of the etiopathogenic categories of these tumors in both sites. A total of 79 PSCC were included in the study (28 from Mozambique and 51 from Spain). All cases underwent HPV-DNA polymerase chain reaction (PCR) testing, genotyping, and immunohistochemistry for p16 and p53. Any PSCC showing either p16 overexpression or HPV-DNA in PCR analysis was considered HPV-associated. Overall, 40/79 (50.6%) tumors were classified as HPV-associated and 39 (49.4%) as HPV-independent. The two sites showed marked differences: 25/28 (89.3%) tumors from Mozambique and only 15/51 (29.4%) from Spain were HPV-associated (p < 0.001). HPV16 was the most frequent HPV type identified in 64.0% (16/25) of the HPV-associated tumors from Mozambique, and 60.0% (9/15) from Spain (p = 0.8). On average, patients from Mozambique were almost two decades younger than those from Spain (mean age 50.9 ± 14.9 and 69.2 ± 13.3, respectively [p < 0.001]). In conclusion, significant etiopathogenic differences between PSCC in Mozambique and Spain were observed, with a remarkably high prevalence of HPV-associated tumors in Mozambique and a relatively low prevalence in Spain. These data may have important consequences for primary prevention of PSCC worldwide.
Selection of the Most Suitable Culture Medium for Patient-Derived Lung Cancer Organoids
(Karger, 2024-09-05) Acosta Plasencia, Melissa; He, Yangyi; Martínez Hernández, Daniel; Orozco, Juan Pablo; Carrasco, Antonio; Altuna Coy, Antonio; Yang, Tianmiao; Díaz Sánchez, Tania; Molins López-Rodó, Laureano; Ramos Izquierdo, Ricard; Marrades Sicart, Ramon Ma.; Navarro Ponz, Alfons
Introduction: Patient-derived organoids have emerged as a promising in vitro model for precision medicine, particularly in cancer, but also in noncancer-related diseases. However, the optimal culture medium for culturing patient-derived lung organoids has not yet been agreed upon. This study aimed to shed light on the optimal selection of a culture media for developing studies using patient-derived lung organoids. Methods: Tumor and normal paired tissue from 71 resected non-small cell lung cancer patients were processed for organoid culture. Lung cancer organoids (LCOs) were derived from tumor tissue and normal lung organoids (LNOs) from nonneoplastic lung tissue. Three different culture media were compared: permissive culture medium (PCM), limited culture medium (LCM), and minimum basal medium (MBM). We assessed their effectiveness in establishing organoid cultures, promoting organoid growth and viability, and compared their differential phenotypic characteristics. Results: While PCM was associated with the highest success rate and useful for long-term expansion, MBM was the best option to avoid normal organoid overgrowth in the organoid culture. The density, size, and viability of LNOs were reduced using LCM and severely affected with MBM. LNOs cultured in PCM tend to differentiate to bronchospheres, while alveolosphere differentiation can be observed in those cultured with LCM. The morphological phenotype of LCO was influenced by the culture media of election. Mesenchymal cell overgrowth was observed when LCM was used. Conclusion: This work highlights the importance of considering the research objectives when selecting the most suitable culture medium for growing patient-derived lung organoids.
Diversity, equity, and inclusion in transplantation
(Frontiers Media, 2024-10-09) Bellini, Maria Irene; Ballesté, Chloë; Martins, Paulo N.; Ulasi, Ifeoma; Valantine, Hannah A; Potena, Luciano
Diversity, equity, and inclusion in transplantation
Editorial: Equity in Transplantation: A Commitment for Progress in Troubled Times
(Frontiers Media, 2022-08-24) Berney, Thierry; Ulasi, Ifeoma; Ballesté, Chloë; Martins, Paulo N.; Bellini, Maria Irene; Valantine, Hannah A; Potena, Luciano
Transplantation is a therapeutic strategy founded on an altruistic gift. In this troublesome context we, who are involved in transplantation, have more than ever an urgent and specific duty to safeguard the value of this gift by acting to ensure equity in the delivery of care, preserve the value of diversity and inclusion, and remove the biases that limit access to transplantation.
Explorando la sexualidad de las mujeres: el erotismo de la lactancia materna
(Selene, 2024-06-01) Zayas Ros, María; Castelo-Branco Flores, Camil
Objetivo: El abordaje de la sexualidad durante la lactancia materna es mínimo y se desconoce mucho al respecto, en especial porque nos centramos en la parte nutriz. El propósito de este estudio es indagar en aspectos concretos de la sexualidad y erótica en pareja durante la lactancia materna y explorar el papel de los pechos durante los juegos eróticos en esta etapa. Diseño: se trata de un estudio cualitativo descriptivo con enfoque fenomenológico. Emplazamiento: se llevó a cabo en grupos de crianza y lactancia materna de diferentes barrios de Barcelona. Participantes: la muestra se obtuvo por propósito y debían ser madres que estuvieran amamantando con una experiencia positiva de la lactancia materna y que su perfil se ajustara a los criterios de inclusión y exclusión. Se consiguió una muestra de 18 participantes. Mediciones principales: la recogida de datos se hizo mediante entrevistas individuales y privadas que posteriormente se analizaron con la metodología de Giorgi. Resultados: sólo una minoría de las entrevistadas confirma que el pecho siga teniendo función erótica durante las relaciones sexuales en este período. La mayor parte de las mujeres rechaza, ha disminuido o modificado los juegos eróticos con el pecho y recalcan desligarlos de contenido sexual durante esta etapa. Conclusiones: los cambios sensitivos y de significado de los pechos en esta etapa influirán y modificarán los encuentros sexuales y dinámicas de pareja que previamente se tenían establecidas. Se requiere de investigaciones más focalizadas y concretas para abordar y comprender los juegos eróticos de lactancia.
Endoscopic endonasal surgery to treat intrinsic brainstem lesions: correlation between anatomy and surgery
(International Rhinologic Society, 2021-04-01) Topczewski, Thomaz E.; Di Somma, Alberto; Culebras, Diego; Reyes, Luis; Torales, Jorge; Tercero Uribe, Ana; Langdon Montero, Cristobal; Alobid, Isam; Torné, Ramón; Roldán Ramos, Pedro; Prats Galino, Alberto; Enseñat Nora, Joaquim
OBJECTIVE: The endoscopic endonasal approach (EEA) has been proposed as an alternative in the surgical removal of ventral brainstem lesions. However, the feasibility and limitations of this approach to treat such pathologies are still poorly understood. This study aimed to report our experience in five consecutive cases of intrinsic brainstem lesions that were managed via an EEA, as well as the specific anatomy of each case. METHODS: All patients were treated in a single center by a multidisciplinary surgical team between 2015 and 2019. Before surgery, a dedicated anatomical analysis of the brainstem safe entry zone was performed, and proper surgical planning was carried out. Neurophysiological monitoring was used in all cases. Anatomical dissections were performed in three human cadaveric heads using 0° and 30° endoscopes, and specific 3D reconstructions were executed using Amira 3D software. RESULTS: All lesions were located at the level of the ventral brainstem. Specifically, one mesencephalic cavernoma, two pontine ca- vernomas, one pontine gliomas, and one medullary diffuse midline glioma were reported. Cerebrospinal fluid leak was the major complication that occurred in one case (medullary diffuse midline glioma). From an anatomical standpoint, three main safe entry zones were used, namely the anterior mesencephalic zone (AMZ), the peritrigeminal zone (PTZ, used in two cases), and the olivar zone (OZ). Reviewing the literature, 17 cases of various brainstem lesions treated using an EEA were found. CONCLUSIONS: To our knowledge, this was the first preliminary clinical series of intrinsic brainstem lesions treated via an EEA presented in the literature. The EEA can be considered a valid surgical alternative to traditional transcranial approaches to treat selected intra-axial brainstem lesions located at the level of the ventral brainstem. To achieve good results, surgery must involve comprehensive anatomical knowledge, meticulous preoperative surgical planning, and intraoperative neurophysiological moni- toring.
Efficacy and Safety of Mechanical Thrombectomy in Acute Ischemic Stroke Secondary to Infective Endocarditis
(European Society of Clinical Microbiology and Infectious Diseases, 2025-02-07) Lapeña, Pau; Urra, Xabier; Llopis Pérez, Jaime; Hernández Meneses, Marta; Cuervo Requena, Guillermo; Maisterra, Olga; Escrihuela-Vidal, Francesc ; Prats-Sánchez, Luis; Sáez, Carmen; Olmos, Carmen; Hernández-Fernández, Francisco; Werner, Mariano; Pérez de la Ossa, Natalia; Quintana, Eduard; Moreno Camacho, Ma. Asunción; Chamorro Sánchez, Ángel; Miró Meda, José M. (José María), 1956-; Mechanical Thrombectomy in IE Investigators; Cat-SCR Consortium
Objectives: Acute ischaemic strokes (stroke) are frequent and severe extracardiac complications in infective endocarditis (IE). Because intravenous thrombolysis (i.v.-thrombolysis) is contraindicated, mechanical thrombectomy (thrombectomy) offers potential benefits. We aimed to compare thrombectomy efficacy and safety between IE-related and general stroke cases. Methods: Multicentre study of consecutive IE cases treated with thrombectomy at nine stroke centres in Spain from 2011 to 2022. Using propensity score matching, 50 IE cases were 1:4 matched with patients without IE stroke (n = 200). Efficacy was defined by successful recanalization rates (modified treatment in cerebral ischaemia scale ≥2 b), neurological improvement at 24 hours (decrease of National Institutes of Health Stroke Scale compared with baseline), and good neurological outcome rates at 3 months (modified Rankin scale ≤2). Safety was assessed by intracranial haemorrhage (IC-haemorrhage), symptomatic IC-haemorrhage, crude mortality, and stroke-related mortality. Results: Among 54 IE cases, 50 were matched with 200 controls. Successful recanalization was similarly achieved in both groups (76% vs. 83%). Median National Institutes of Health Stroke Scale at 24 hours was comparable, with analogous rates of neurological improvement (78% vs. 78%), and early dramatic response (48% vs. 46.5%). No differences were seen regarding IC-haemorrhage rates, except for when prior i.v.-thrombolysis was given. Although crude mortality was higher in the IE cohort, no differences were seen in stroke-related mortality (12% vs. 15%). At 3 months, modified Rankin scale scores of the two groups were superimposable. Discussion: Thrombectomy in IE is as effective and safe as in patients without IE, and prior i.v.-thrombolysis could decrease the procedural safety. Clinical practice guidelines may consider including the recommendation to perform thrombectomy alone in IE-related stroke.
Endoscopic transorbital superior eyelid approach: anatomical study from a neurosurgical perspective
(American Association of Neurological Surgeons, 2018-11-01) Di Somma, Alberto; Andaluz, Norberto; Cavallo, Luigi Maria; de Notaris, Matteo; Dallan, Iacopo; Solari, Domenico; Zimmer, Lee A.; Keller, Jeffrey T.; Zuccarello, Mario; Prats Galino, Alberto; Cappabianca, Paolo
OBJECTIVERecent studies have proposed the superior eyelid endoscopic transorbital approach as a new minimally invasive route to access orbital lesions, mostly in otolaryngology and maxillofacial surgeries. The authors undertook this anatomical study in order to contribute a neurosurgical perspective, exploring the anterior and middle cranial fossa areas through this purely endoscopic transorbital trajectory.METHODSAnatomical dissections were performed in 10 human cadaveric heads (20 sides) using 0° and 30° endoscopes. A step-by-step description of the superior eyelid transorbital endoscopic route and surgically oriented classification are provided.RESULTSThe authors' cadaveric prosection of this approach defined 3 modular routes that could be combined. Two corridors using bone removal lateral to the superior and inferior orbital fissures exposed the middle and anterior cranial fossa (lateral orbital corridors to the anterior and middle cranial base) to unveil the temporal pole region, lateral wall of the cavernous sinus, middle cranial fossa floor, and frontobasal area (i.e., orbital and recti gyri of the frontal lobe). Combined, these 2 corridors exposed the lateral aspect of the lesser sphenoid wing with the Sylvian region (combined lateral orbital corridor to the anterior and middle cranial fossa, with lesser sphenoid wing removal). The medial corridor, with extension of bone removal medially to the superior and inferior orbital fissure, afforded exposure of the opticocarotid area (medial orbital corridor to the opticocarotid area).CONCLUSIONSAlong with its minimally invasive nature, the superior eyelid transorbital approach allows good visualization and manipulation of anatomical structures mainly located in the anterior and middle cranial fossae (i.e., lateral to the superior and inferior orbital fissures). The visualization and management of the opticocarotid region medial to the superior orbital fissure are more complex. Further studies are needed to prove clinical applications of this relatively novel surgical pathway.
3D reconstruction of peripheral nerves from optical projection tomography images: A method for studying fascicular interconnections and intraneural plexuses.
(Wiley, 2018-04-01) Prats Galino, Alberto; Čapek, Martin; Reina, Miguel Angel; Cvetko, Erika; Radochova, Barbora; Tubbs, Robert Shane; Damjanovska Marija; Stopar Pintaric, Tatjana
The general microscopic characteristics of nerves are described in several textbooks of histology, but the specific microanatomies of most nerves that can be blocked by anesthesiologists are usually less well known. Our objective was to evaluate the 3D reconstruction of nerve fascicles from optical projection tomography images (OPT) and the ability to undertake an internal navigation exploring the morphology in detail, more specifically the fascicular interconnections. Median and lingual nerve samples were obtained from five euthanized piglets. OPT images of the samples were acquired and 3D reconstruction was performed. The OPT technique revealed the inner structure of the nerves at high resolution, including large and small fascicles, perineurium, interfascicular tissue, and epineurium. The fascicles were loosely packed inside the median nerve and more densely so in the lingual nerve. Analysis of the 3D models demonstrated that the nerve fascicles can show six general spatial patterns. Fascicular interconnections were clearly identified. The 3D reconstruction of nerve fascicles from OPT images opens a new path for research into the microstructure of the inner contents of fascicular nerve groups and their spatial disposition within the nerve including their interconnections. These techniques enable 3D images of partial areas of nerves to be produced and could became an excellent tool for obtaining data concerning the 3D microanatomy of nerves, essential for better interpretation of ultrasound images in clinical practice and thus avoiding possible neurological complications. Clin. Anat. 31:424-431, 2018. © 2017 Wiley Periodicals, Inc.
Defining the lateral limits of the endoscopic endonasal transtuberculum transplanum approach: anatomical study with pertinent quantitative analysis.
(American Association of Neurological Surgeons, 2019-03-28) Di Somma, Alberto; Torales, Jorge; Cavallo, Luigi Maria; Pineda, Jose; Solari, Domenico; Gerardi, Rosa Maria; Frio Federico; Enseñat Nora, Joaquim; Prats Galino, Alberto; Cappabianca, Paolo
OBJECTIVE The extended endoscopic endonasal transtuberculum transplanum approach is currently used for the surgical treatment of selected midline anterior skull base lesions. Nevertheless, the possibility of accessing the lateral aspects of the planum sphenoidale could represent a limitation for such an approach. To the authors’ knowledge, a clear definition of the eventual anatomical boundaries has not been delineated. Hence, the present study aimed to detail and quantify the maximum amount of bone removal over the planum sphenoidale required via the endonasal pathway to achieve the most lateral extension of such a corridor and to evaluate the relative surgical freedom. METHODS Six human cadaveric heads were dissected at the Laboratory of Surgical NeuroAnatomy of the University of Barcelona. The laboratory rehearsals were run as follows: 1) preliminary predissection CT scans, 2) the endoscopic endonasal transtuberculum transplanum approach (lateral limit: medial optocarotid recess) followed by postdissection CT scans, 3) maximum lateral extension of the transtuberculum transplanum approach followed by postdissection CT scans, and 4) bone removal and surgical freedom analysis (a nonpaired Student t-test). A conventional subfrontal bilateral approach was used to evaluate, from above, the bone removal from the planum sphenoidale and the lateral limit of the endonasal route. RESULTS The endoscopic endonasal transtuberculum transplanum approach was extended at its maximum lateral aspect in the lateral portion of the anterior skull base, removing the bone above the optic prominence, that is, the medial portion of the lesser sphenoid wing, including the anterior clinoid process. As expected, a greater bone removal volume was obtained compared with the approach when bone removal is limited to the medial optocarotid recess (average 533.45 vs 296.07 mm2; p < 0.01). The anteroposterior diameter was an average of 8.1 vs 15.78 mm, and the laterolateral diameter was an average of 18.77 vs 44.54 mm (p < 0.01). The neurovascular contents of this area were exposed up to the insular segment of the middle cerebral artery. The surgical freedom analysis revealed a possible increased lateral maneuverability of instruments inserted in the contralateral nostril compared with a midline target (average 384.11 vs 235.31 mm2; p < 0.05). CONCLUSIONS Bone removal from the medial aspect of the lesser sphenoid wing, including the anterior clinoid process, may increase the exposure and surgical freedom of the extended endoscopic endonasal transtuberculum transplanum approach over the lateral segment of the anterior skull base. Although this study represents a preliminary anatomical investigation, it could be useful to refine the indications and limitations of the endoscopic endonasal corridor for the surgical management of skull base lesions involving the lateral portion of the planum sphenoidale.

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