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OBJECTIVE: To analyze the 3-dimensional relationships of the inferior fronto-occipital fasciculus (IFOF) within the temporal stem using anatomic dissection and to study the surgical application. METHODS: Ten postmortem human hemispheres (5 right, 5 left) were dissected using the Klingler fiber dissection technique. The 3-dimensional relationships of the IFOF with different landmarks of the temporal stem, insula, and temporal lobe were analyzed and measured. RESULTS: An average distance of 10.9 mm (range, 8-15 mm) was observed between the limen insulae and the anterior edge of the IFOF under the inferior limiting sulcus of the insula. This anterior one-third of the temporal stem is crossed by the uncinate fasciculus. The IFOF crosses the posterior two-thirds of the temporal stem, in the space between the posterior limit of the uncinate fasciculus and the lateral geniculate body. The average superoinferior distance between the IFOF and the inferior limiting sulcus was 3.8 mm. The auditory radiations and the claustro-opercular and insulo-opercular fibers of the external and extreme capsules pass through the temporal stem above the IFOF, whereas the optic radiations pass below. CONCLUSION: In the transsylvian approach to the mesiotemporal structures in the left dominant hemisphere, an incision within the posterior 8 mm from the limen insulae is less likely to damage the IFOF than more posterior incisions along the inferior limiting sulcus. In the temporal transopercular approach to left temporo-insular gliomas, the IFOF constitutes the deep functional limit of the resection within the temporal stem.


Martino J.,Hospital Universitario Marques Of Valdecilla | De Lucas E.M.,Universitario Marques Of Valdecilla
Clinical Anatomy | Year: 2014

Precise knowledge of the connectivities of the different white matter bundles is of great value for neuroscience research. Our knowledge of subcortical anatomy has improved exponentially during recent decades owing to the development of magnetic resonance diffusion tensor imaging tractography (DTI). Although DTI tractography has led to important progress in understanding white matter anatomy, the precise trajectory and cortical connections of the subcortical bundles remain poorly determined. The recent literature was extensively reviewed in order to analyze the trajectories and cortical terminations of the lateral association fibers of the brain.The anatomy of the following tracts is reviewed: superior longitudinal fasciculus, middle longitudinal fasciculus, inferior longitudinal fasciculus, inferior fronto-occipital fasciculus, uncinate fasciculus, frontal aslant tract, and vertical occipital fasciculus. The functional role of a tract can be inferred from its topography within the brain. Knowing the functional roles of the cortical areas connected by a certain bundle, it is possible to develop new insights into the putative functional properties of such connections. © 2014 Wiley Periodicals, Inc.


Ortiz J.S.,Hospital Universitario Marques Of Valdecilla
Clinical and Translational Oncology | Year: 2012

Aim The aim of this study is to analyze the use of CT in terminal stage cancer and the percentage of patients who received UCPD in 2009 and 2010 on the Medical Oncology and Palliative Home Care integrated service (UCPD) ward of the Marqués de Valdecilla University Hospital. Method Retrospective analysis of death rate registered on the Medical Oncology ward for 2009 and 2010 and the recorded date of the last CT given. The data are analyzed using the SPSS version 15.0 statistic package. Data were obtained from the Database Minimum Set for oncology admissions. Results The death rate on the Medical Oncology ward is 22-24 %. Total number of cases studied is 303. 47 % of patients are aged 60 or younger. 81.8 % (248) received active cancer treatment; of these, 138 (55.6 %) in the last month, and 84 (33.8 %) in the last 2 weeks. Only 66 patients out of those who died on the ward (21 %) were previously sent to the UCPD. Conclusions Even when it is known that the majority of cancer patients become resistant to CT at the end of their lives, it is often given to patients of all ages. The request for palliative care is rare and often late. © 2012 Federación de Sociedades Españolas de Oncología (FESEO).


Learning disorders are very frequent among children with epilepsy. The etiology is multifactorial, being affected by the type of epileptic syndrome, the cause of epilepsy, a high frequency of epileptic seizures, a previous history of status epilepticus, the age of onset of epilepsy, the antiepileptic treatment being selected, and the role of interictal epileptiform discharges. Several studies have sought to analyze to what extent cognitive impairment can be attributed to interictal epileptiform discharges among the other epilepsy factors. To review the existing evidence on the cognitive impact of interictal epileptiform discharges in children. The disruptive effect of interictal epileptiform discharges on cognition is supported by a wide range of factors, such as the concept of transient cognitive impairment, the definition of epileptic encephalopathy, the natural course of epileptic syndromes with continuous spike and wave activity during slow sleep, the concept of autistic regression related to epileptiform activity, the cognitive profile of benign rolandic epilepsy, and the cognitive impact of non convulsive status epilepticus. According to this information it has been suggested that treatment of interictal epileptiform discharges with antiepileptic drugs could improve cognition and behaviour in these children. Interictal epileptiform discharges are associated with neuropsychological disorders like cognitive impairment and behavioral problems even in absence of clinical epilepsy. Uncontrolled reports and three preliminary randomised controlled trials of antiepileptic treatment of interictal epileptiform discharges have suggested that suppression of discharges is associated with significant improvement in psychosocial function. However, a greater number of controlled studies are required to be carried out, in order to confirm this hypothesis.


Martin-Millan M.,Hospital Universitario Marques Of Valdecilla | Castaneda S.,Hospital Universitario Of La Princesa
Joint Bone Spine | Year: 2013

Estrogens participate in several biological processes through different molecular mechanisms. Their final actions consist of a combination of both direct and indirect effects on different organ and tissues. Estrogen may have pro- and anti-inflammatory properties depending on the situation and the involved tissue. In general, acute loss of estrogens increases the levels of reactive oxygen species and activates nuclear factor-κB and pro-inflammatory cytokine production, indicating their predominant anti-inflammatory properties. Furthermore, pro-inflammatory cytokine expression has been shown to be attenuated by estrogen replacement. Osteoarthritis and cardiovascular disease are two of the more prevalent diseases once menopause is established, which has suggested the link between estrogens and both processes. In addition, deletion of estrogen receptors in female mice results in cartilage damage, osteophytosis and changes in the subchondral bone of the joints suggesting that estrogens have a protective role on the maintenance of joint homeostasis. Furthermore, in spite of the negative effect of estrogen replacement reported in 2002 by the Women's Health Initiative study, several works published afterwards have explored the potential protective effect of estrogen supplementation in animal models and have postulated that these actions may justify a beneficial role of estrogens in different diseases where inflammation is the major feature. In this review, we will analyze the effects of estrogens on certain pathological situations such as osteoarthritis, some autoimmune diseases and coronary heart disease, especially in postmenopausal women. © 2013.

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