Poster Session : PS 0470 ; Nephrology ; Acute Toluene Intoxication: Prospective Observational Study

( Rene Rodriguez Gutierrez ),( Roberto Monreal Robles ),( Carlos R Camara Lemarroy ),( Jose G Gonzalez Gonzalez ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Toluene is one of the most widely abused inhaled drugs and dangerous metabolic abnormalities are associated to its acute intoxication. It has been previously reported that rhabdomyolysis and acute hepatorenal injury could be hallmarks of the disease, and could constitute risk factors for poor outcomes. The objective was to describe the clinical presentation, to characterize the renal and liver abnormalities, the management and prognosis associated to acute toluene intoxication. Methods: We prospectively assessed 20 patients that were admitted to a single center`s emergency department from 2007-2014 with clinical and metabolic alterations due to acute toluene intoxication. Results: Patients were severely acidotic on admission (mean pH: 7.14 ± 0.09) with a mean anion gap of 16 ± 6.9 mmol/L and mean potassium level of 2.19 mmol/L ± 1.32. The main clinical presentation consisted of weakness associated to severe hypokalemia and acidosis. Renal glomerular injury (proteinuria) was ubiquitous. Serum creatine-phosphokinase levels were elevated in 16 cases, with a mean elevation of 6 times the upper normal limit (1,544 ± 1,864 U/L). Liver function tests were normal, except for ALP, which was elevated in 15 patients. Gamma-glutamyl transpeptidase was elevated in all patients, with a mean of 103.9 ± 66.9. Rhabdomyolysis occurred in 80% of patients, probably due to hypokalemia and hypophosphatemia. There were three deaths, all associated with altered mental status, severe acidosis, hypokalemia and acute oliguric renal failure. The causes of death were cardiac rhythm abnormalities. Conclusions: The hallmarks of acute toluene intoxication are hypokalemic paralysis and metabolic acidosis. Liver injury and rhabdomyolysis are common. Altered mental state on admission, renal failure, severe acidemia and female gender could be associated with a poor outcome, and patients with these characteristics should be treated in an intensive care unit.

Poster Session:PS 0197 ; Endocrinology : Severe Hypercalcemia: Chronic Tophaceous Gout the Responsible Cause?

( Rene Rodriguez Gutierrez ),( Roberto Monreal Robles ),( Maria Azucena Zapata Rivera ),( Karla V Rodriguez Velver ),( Fernando Jj Lavallegonzalez ),( Jose Gerardo Gonzalez Gonzalez ),( Jesus Zacarias 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background and Description: The association of chronic tophaceous gout with severe hypercalcemia is extremely rare and has been usually associated with calcitriol secretion. PTHrP has never been described as the responsible cause. A 42-year old man with a long stand history of chronic gout initiated a week before admission with polyuria, polypsia and progressive altered mental status. Neurological examination revealed only lethargy. Characteristic, multiple, non-tender tophi were obvious at inspection (Figures 1-3). Initial laboratory work up revealed a uric acid of 14.0 mg/dl, calcium of 14.5 mg/dl, phosphorous of 6.3 mg/dl, creatinine of 5.4 mg/dl, blood nitrogen urea of 56, a MDRD GFR of 16 ml/min. Diagnostic and Therapeutic Approach: PTH was suppressed (< 3.0 pg/ml), 25-dihydroxyvitamin D was normal, PTHrP was elevated 45.0 pg/ml, and calcitriol normal (19.6 pg/ml). Radiographs revealed bone erosions (Figure 1-3). Bone scan and a PET-CT were negative for metastasis and malignancy. Treatment was initiated with calcitonin, hydration and prednisone. PTH, 25-dihydroxyvitamin D, PTHrP, and calcitriol returned to normal values. At 6 months follow-up he referred no pain, tophi had improved and calcium levels were within normal range. Discussion and Conclusion: A systemic research on PubMed, Medline, Embase and MedConsult with the search criteria: “Tophaceous gout”, hypercalcemia”, “calcitriol”, “PTHrP”, was made. The proposed mechanism has being an enhanced 1a-hydroxylation of vitamin D in a proliferative chronic synovitis. In this case calcitriol levels were normal. PTHrP had never been, until now, described as the responsible cause of hypercalcemia in gout. In our case baseline PTHrP and calcium values were elevated and after medical treatment both returned to normal values. Immobilization is another well-known cause of mild calcium elevations. It is likely that in this case this was an exacerbating rather than the primary factor.

Poster Session:PS 0198 ; Endocrinology : Giant Cystic Prolactinoma in a Woman: Do Not Forget the Hook Effect

( Rene Rodriguez Gutierrez ),( Karla V Rodriguez Velver ),( Maria Azucena Zapata Rivera ),( Roberto Monreal Robles ),( Fernando J Lavalle Gonzalez ),( Jose G Gonzalez Gonzalezz ),( Jesus Zacarias Vill 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background and Case Presentation: Cystic prolactinomas correspond to = 1% of all prolactinomas and its association with a giant pituitary macroadenoma in a woman has been seldom reported. A 43-year old woman was evaluated for a suprasellar tumor. She had absence of menses since 2 years. Three months before she started to have progressive headache. She also referred asthenia, adynamia, fatigue, dry hairiness, decreased libido, vaginal atrophy, and chronic constipation. Hair in armpits and pubic area was insignificant and osteotendinous reflex relaxation phase was slow. Galactorrhea was absent and presented bitemporal hemianopsia. Diagnostic and Therapeutic Approach: MRI scan revealed a 5 x 3.5 cm suprasellar mass and a 8.1 x 3.6 cm cystic component (Figures 1-3). Cortisol level 2.2 mg/dl, FSH and LH were low, estradiol < 0.05 pg/mL, IGF-1 normal and a serum prolactin of 125 ng/mL. Serial dilutions 1:10 and 1:100 were made. Diluted prolactine was 12,500 ng/mL (hook effect). Treatment with cabergoline, prednisone and levothyroxine were initiated. At two months follow-up prolactin serum levels decreased to 32.1 ng/mL. Discussion and Conclusion: A systemic research on PubMed, Medline, Embase and MedConsult with the search criteria: “Giant Cystic Prolactinoma”, “prolactin”, “prolactioma and “hook effect” was made. Due to the clinical signs of hypogonadism, the image in the MRI and the low/moderate high serum prolactin levels serial dilutions of prolactin were made. Serum prolactin assays can greatly underestimate extremely high levels of hormone, the so called “hook effect”. In present case, a high level of suspicion along with low/moderate prolactin levels and the MRI image consistent with a pituitary adenoma made us ask for diluted prolactin samples. If missed, this would have delayed the diagnosis and consequently would have changed the treatment plan and prognosis of the patient.

An alternative approach to extruding a vertically impacted lower third molar using an orthodontic miniscrew: A case report with cone-beam CT follow-up

Arthur Rodriguez Gonzalez Cortes,Juliana No-Cortes,Marcelo Gusmão Paraíso Cavalcanti,Emiko Saito Arita 대한영상치의학회 2014 Imaging Science in Dentistry Vol.44 No.2

One of the most common oral surgical procedures is the extraction of the lower third molar (LTM). Postoperative complications such as paresthesia due to inferior alveolar nerve (IAN) injury are commonly observed in cases of horizontal and vertical impaction. The present report discusses a case of a vertically impacted LTM associated with a dentigerous cyst. An intimate contact between the LTM roots and the mandibular canal was observed on a panoramic radiograph and confirmed with cone-beam computed tomographic (CBCT) cross-sectional cuts. An orthodontic miniscrew was then used to extrude the LTM prior to its surgical removal in order to avoid the risk of inferior alveolar nerve injury. CBCT imaging follow-up confirmed the success of the LTM orthodontic extrusion.

Perinatal/Postnatal Study of D-003, a Mixture of Long-Chain Fatty Acids, in Rats

M.D. Rodriguez,J.E. Gonzalez,E.F. Leon,A. Gutierrez,G. Marrero,R. Gamez,H Garcia,,E Goicochea,Y. Rodriguez,A. Gomez 한국식품영양과학회 2006 Journal of medicinal food Vol.9 No.2

D-003 is a mixture of long-chain fatty acids isolated and purified from sugar cane wax with cholesterol-low-ering and antiplatelet effects. In order to further characterize the developmental toxicity during the treatment period from lategestation up to weaning of the offspring, pregnant females received 0 (control), 500, and 1,000 mg/kg/day D-003 daily byoral gavage beginning at day 15 of pregnancy and through gestation until day 21 postpartum. Maternal clinical signs, bodyweight, and food intake were measured at regular intervals during gestation and lactation. Live pups were weighed, sexed,and examined for developmental signs. One female and male of each litter were randomly selected to evaluate the reproduc-tive potential. There were no spontaneous or dose-related maternal deaths during the course of this study. The general healthand behavioral condition of offspring was good in all groups. No significant differences among groups were found in com-parisons of litter size, survival through the weaning period, sex ratio, and male and female weights. This peri- and postnatalstudy conducted with D-003 in rats indicated that treatment of the dam during late gestation and lactation did not show ad-versely effects on reproductive performance or fetal development over two generations.

An alternative approach to extruding a vertically impacted lower third molar using an orthodontic miniscrew: A case report with cone-beam CT follow-up

Cortes, Arthur Rodriguez Gonzalez,No-Cortes, Juliana,Cavalcanti, Marcelo Gusmao Paraiso,Arita, Emiko Saito Korean Academy of Oral and Maxillofacial Radiology 2014 Imaging Science in Dentistry Vol.44 No.2

One of the most common oral surgical procedures is the extraction of the lower third molar (LTM). Postoperative complications such as paresthesia due to inferior alveolar nerve (IAN) injury are commonly observed in cases of horizontal and vertical impaction. The present report discusses a case of a vertically impacted LTM associated with a dentigerous cyst. An intimate contact between the LTM roots and the mandibular canal was observed on a panoramic radiograph and confirmed with cone-beam computed tomographic (CBCT) cross-sectional cuts. An orthodontic miniscrew was then used to extrude the LTM prior to its surgical removal in order to avoid the risk of inferior alveolar nerve injury. CBCT imaging follow-up confirmed the success of the LTM orthodontic extrusion.

A Polymorphism in the Matrix Metalloproteinase-2 (MMP-2-1306T>C) Gene Promoter is Associated with High Risk of Ischemic Stroke in Hypertensive Patients

Nelida A. Gonzalez Hernandez,Rebeca O. Millan Guerrero,Gabriel Ceja Espiritu,Luz M. Baltazar Rodriguez,Rafael Rodriguez Salazar,Bertha A. Olmedo Buenrostro,Irma G. Enriquez Maldonado,Valery Melnikov,J 한국유전학회 2008 Genes & Genomics Vol.30 No.6

The action of matrix metalloproteinases (MMPs) can weaken the arterial wall, contributing to the destabilizing and rupture of atheromatous plaque. Within the MMPs, type 2 stands out due to its action on basement membrane constituents. Previous studies have revealed elevated levels of MMP-2 in the acute phase of ischemic stroke (IS). An MMP-2 single nucleotide polymorphism, -1306T>C (rs243865), displayed strikingly high promoter activity with the C allele. Our study analyzed whether or not the MMP-2-1306T>C polymorphism contributed to the development of IS in a Mexican population. Ninety-eight patients with IS and 213 control subjects were analyzed. Genomic DNA isolation, polymerase chain reaction (PCR), and polymorphism detection by restriction enzyme digestion were performed to detect MMP-2-1306T>C polymorphism. An increased probability of IS associated with the MMP-2 CC genotype (OR, 1.70; 95% CI, 1.02-2.85) was found. IS risk associated with the CC genotype was more pronounced in hypertensive subjects (OR, 2.81; 95% CI, 1.4-5.5). The CC genotype was not associated with the development of primary hypertension. The data suggest that MMP-2-1306T>C polymorphism greatly contributes to IS development in the population studied, principally in hypertensive subjects. This case-control study lends support to the association of MMP-2 with stroke at the genetic level, an association consistent with MMP-2 participation in IS physiopathology.

Intraneural Venous Malformations of the Median Nerve

Porto, Sara Alicia Gonzalez,Rodriguez, Alba Gonzalez,Miguez, Jose Midon Korean Society of Plastic and Reconstructive Surge 2016 Archives of Plastic Surgery Vol.43 No.4

Venous malformations arising from the peripheral nerve are a rare type of vascular malformation. We present the first case of an intraneural venous malformation of the median nerve to be reported in a child and review the previous two cases of median nerve compression due to a venous malformation that have been reported. These cases presented with painless masses in the volar aspect of the wrist or with symptoms suggestive of carpal tunnel syndrome. Clinical suspicion should lead to the use of Doppler ultrasonography as the first-line diagnostic tool. Magnetic resonance imaging and histopathology can confirm the diagnosis, as phleboliths are pathognomonic of venous malformations. Surgical treatment appears to be the only modality capable of successfully controlling the growth of an intraneural malformation. Sclerotherapy and radiotherapy have never been used to treat this type of malformation.

Minimally Invasive versus Open Surgery for Spinal Metastasis: A Systematic Review and Meta-Analysis

Hinojosa-Gonzalez David Eugenio,Roblesgil-Medrano Andres,Villarreal-Espinosa Juan Bernardo,Tellez-Garcia Eduardo,Bueno-Gutierrez Luis Carlos,Rodriguez-Barreda Jose Ramon,Flores-Villalba Eduardo,Martin 대한척추외과학회 2022 Asian Spine Journal Vol.16 No.4

Bones are the third most common location for solid tumor metastasis affecting up to 10% of patients with solid tumors. When the spine is involved, thoracic and lumbar vertebrae are frequently affected. Access to spinal lesions can be through minimally invasive surgery (MIS) or traditional open surgery (OS). This study aims to determine which method provides an advantage. Following the PRISMA (Preferred Inventory for Systematic Reviews and Meta-Analysis) guidelines, a systematic review was conducted to identify studies that compare MIS with OS in patients with spinal metastatic disease. Data were analyzed using Review Manager ver. 5.3 (RevMan; Cochrane, London, UK). Ten studies were included. Operative time was similar among groups at -35.23 minutes (95% confidence interval [CI], -73.36 to 2.91 minutes; <i>p</i>=0.07). Intraoperative bleeding was lower in MIS at -562.59 mL (95% CI, -776.97 to -348.20 mL; <i>p</i><0.00001). OS procedures had higher odds of requiring blood transfusions at 0.26 (95% CI, 0.15 to 0.45; <i>p</i><0.00001). Both approaches instrumented similar numbers of levels at -0.05 levels (95% CI, -0.75 to 0.66 levels; <i>p</i>=0.89). We observed a decreased need for postoperative bed rest at -1.60 days (95% CI, -2.46 to -0.74 days; <i>p</i>=0.0003), a shorter length of stay at -3.08 days (95% CI, -4.50 to -1.66 days; <i>p</i>=0.001), and decreased odds of complications at 0.60 (95% CI, 0.37 to 0.96; <i>p</i>=0.03) in the MIS group. Both approaches revealed similar reintervention rates at 0.65 (95% CI, 0.15 to 2.84; <i>p</i>=0.57), effective rates of reducing metastasis-related pain at -0.74 (95% CI, -2.41 to 0.94; <i>p</i>=0.39), and comparable scores of the Tokuhashi scale at -0.52 (95% CI, -2.08 to 1.05; <i>p</i>=0.41), Frankel scale at 1.00 (95% CI, 0.60 to 1.68; <i>p</i>=1.0), and American Spinal Injury Association Scale at 0.53 (95% CI, 0.21 to 1.37; <i>p</i>=0.19). MIS appears to provide advantages over OS. Larger and prospective studies should fully detail the role of MIS as a treatment for spine metastasis.

Caffeine as a source for nitrogen doped graphene, and its functionalization with silver nanowires in-situ

Ramirez-Gonzalez, Daniel,Cruz-Rivera, Jose de J.,Tiznado, Hugo,Rodriguez, Angel G.,Guillen-Escamilla, Ivan,Zamudio-Ojeda, Adalberto Techno-Press 2020 Advances in nano research Vol.9 No.1

In this work, we report the use of caffeine as an alternative source of nitrogen to successfully dope graphene (quaternary 400.6 eV and pyridinic at 398 eV according XPS), as well as the growth of silver nanowires (in-situ) in the surface of nitrogen doped graphene (NG) sheets. We used the improved graphene oxide method (IGO), chemical reduction of graphene oxide (GOx), and impregnation with caffeine as source of nitrogen for doping and subsequently, silver nanowires (NW) grow in the surface by the reduction of silver salts in the presence of NG, achieving a numerous of growth of NW in the graphene sheets. As supporting experimental evidence, the samples were analyzed using conventional characterization techniques: SEM-EDX, XRD, FT-IR, micro RAMAN, TEM, and XPS.