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lunes, 28 de abril de 2014

Verdaderas hemorragias de placer

La cefalea coital o postcoital se define como un dolor de cabeza de inicio agudo relacionado con la práctica del coito y es una entidad conocida desde antiguo pues al parecer ya hizo Hipócrates las primeras descripciones aunque no se le comenzó a prestar demasiada atención hasta la década de los 70.

Se estima su prevalencia en un 1% de la población y suele aparecer por primera vez al final de la cuarta década de la vida, aunque algunos pacientes la padecen de forma mas temprana, en las cercanías de los 30 años. Se ha descrito en los dos sexos y como una cefalea bilateral de inicio agudo durante la excitación sexual que bruscamente se vuelve muy intensa en el momento del orgasmo. Puede aparecer tanto durante el coito como durante la masturbación. Aparecen en forma de brotes durante semanas o meses y desaparecen de forma espontánea igual que apareció. Durante los brotes puede haber uno o múltiples episodios de cafelea postcoital. La duración de los episodios de cefalea va de unos pocos minutos a las 24 horas. Los dolores graves suelen durar por lo general menos de 4 horas.

A menudo se ha dividido esta cefalea en dos subtipos dependiendo del momento de aparición de la misma en relación con la práctica del sexo: Cefalea preorgásmica y cefalea orgásmica. Esto es de interés porque las causas, los síntomas y la gravedad de ambos tipos suele ser diferente. 


Estadísticamente hablando, las cefaleas preorgásmicas han demostrado deberse a causas benignas y suelen ser cefaleas tensionales o musculoesqueléticas aunque en las ocasiones en que se muestran rebeldes al tratamiento y no ceden deberían hacerse estudios en mayor profundidad.Muy a menudo el diagnóstico de cefalea postcoital benigna es un diagnóstico de exclusión. Estas cefaleas son mas frecuentes en el sexo masculino (proporción de 3/1) y aparecen entre los 20 y 60 años de edad, con dos picos uno a los 20-24 años y otro a los 35-44 años.- La mayoría son una variante de migrañas o cefaleas tensionales que aparecen en pacientes con historia familiar de cefaleas. En el 2004 y 2007 se presentaron sendas publicaciones en las que se mostraba una elevada co-incidencia entre estas cefaleas postcoitales benignas, las migrañas (25%), las cefaleas benignas por ejercicio (29%) y las cefaleas tensionales (45%)

Sin embargo las cefaleas orgásmicas comienzan de forma explosiva en el momento del climax (lo que los anglosajones llaman un dolor de cabeza fulgurante o Thunderclap headache) y tienen en ocasiones patología grave subyacente con mayor morbimortalidad por lo que estan indicadas pruebas de diagnóstico mas caras y agresivas de manera inmediata. Lo mas frecuente son las causas vasculares entre las que se han descrito la disección de arteria basilar, la disección de arteria carótida, las estenosis y los aneurismas, las hemorragias intracraneales, las hemorragias suaracnoideas y los infartos cerebrales isquémicos.


En el año 2004 se publicó en la revista Headache un interesante caso de una paciente de 44 años con cefalea postcoital debida a vasoespasmos cerebrales


y dos años después en Archvos de Neurologia un caso de una mujer de 33 años con ictus isquemicos recurrentes hemiparéticos y disartria por infartos capsulares durante los orgasmos.



En el 2007 se publica otro interesante caso con una disección de la arteria basilar



Ya se habían descrito casos de infartos isquemicos subcorticales en cefaleas postcoitales de tipo Thunderclap prebiamente, postulándose como posibles mecanismos un foramen oval permeable (una publicación en 2004 en Archivos de Neurología), migrañas (una publicación en 1993 en la revista Cephalalgia) y disección de la arteria vertebral (un caso en 1996 en la revista American Familian Physician), pero lo interesante de este caso descrito en el 2006 es que se debían a una disección aislada de la arteria cerebral media que produjo infartos isquemicos por afectación de la arteria estriatocpsular durante los orgasmos.

En el año 2008 se publica en el European Journal of Neurology una carta al editor escrita desde el Departamento de Neurologia de la Universidad Católica de Corea en Seul el caso de una mujer de 52 años de edad con episodios de paresia del brazo izquierdo y disartria durante el coito y que no se debian a ningún mecanismo de vasoespasmo arterial ni emboilia a través de foramen oval permeable, sino a la hiperventilación durante el coito que producía un descenso del flujo sanguineo de un 50% e isquemia cerebral transitoria.


Esta noche, cuando entre de guardia me pasaron el caso de un paciente de 83 años, hipertenso y dislipémico a tratamiento medicamentoso para su hipertensión que ingresó en nuestro servicio por un cuadro confusional, apraxia y déficit visual pero que refería que en los 15 días prebios había comenzado con una cefalea postcoital brusca que trató con escaso resultado con paracetamol.

El TAC mostró lo siguiente:


Área hiperdensa de aprox 4,7 x 2,7 x 3 cm en lóbulo occipital izquierdo compatible con hemorragia intraparenquimatosa, con ligera hipodensidad adyacente en relación con edema.Hiperdensidad en surco frontoparietal ipsilateral compatible con componente de hemorragia subaracnoidea.Áreas hipodensas (similar al LCR) frontal derecha y parietooccipital ipsilateral compatibles con áreas de gliosis por patología remota.Línea media centrada.Tamaño ventricular acorde con su atrofia córtico-subcortical.

¡En este caso llama la atención no solo la tremenda hemorragia cerebral, sino  la edad del paciente!

lunes, 7 de abril de 2014

Wellcomeimage awards 2014

Los ganadores del  decimotercer Wellcome Image Awards se conocieron el 11 de marzo de 2014.

Los ganadores del concurso los elije un jurado. El siguiente video es una grabación de como este jurado escogió a los ganadores el año 2011.



Como resultado de una colaboración iniciada el año 2011, este año los Premios Wellcome Image cuentan con una fotografía del Koch Institute for Integrative Cancer Research del Massachusetts Institute of Technology. Además, por primera vez este año las imágenes ganadoras están disponibles para ver en exposiciones públicas simultáneas en cuatro grandes centros de ciencia en el Reino Unido, así como en un escaparate en la sede de la Wellcome Trust en Londres y en la Galería Ruskin en Cambridge durante el  Festival de la Ciencia deCambridge.

Los centros son:

  • Glasgow Science Centre

  • Museo de Ciencia e Industria (MOSI) en Manchester

  • Techniquest en Cardiff

  • W5 en Belfast


Acerca de Wellcome Images

Wellcome Images es el principal recurso mundial para imágenes médicas, abarcando temas que van desde la historia médica y social a la atención sanitaria moderna, la ciencia biomédica y la medicina clínica. Más de 200 000 imágenes entre los que se incluyen manuscritos, libros raros, archivos y pinturas a los rayos X, la fotografía clínica y micrografías electrónicas de barrido, están todas disponibles en el sitio web de Wellcome Images.

Cualquier persona puede apuntarse a su e-boletín por correo electrónico en images@wellcome.ac.uk

Todas las imágenes están disponibles gratuitamente para uso no comercial. Esto incluye el estudio privado, la investigación no comercial, el uso de una sola copia para la crítica y la revisión, el uso en los exámenes y tesis, y el uso personaln e individual. Los derechos de reproducción comercial y editorial se ofrecen a precios competitivos. Para obtener más información o para solicitar imágenes de alta resolución, comuníquese Wellcome Images.


Cualquier investigador científico, fotógrafo clínico o ilustrador puede colaborar con WellcomeImages. Todos los contribuyentes reciben comisión y todo el crédito por los usos de la imagen, conservando su material original y los derechos de autor.

Para saber más visite wellcomeimages.org o contacte con Sabrina Taner:

T +44 (0) 20 7611 8360
E s.taner @ wellcome.ac.uk


Y ahora los premios Wellcome Image del 2014



Plant reproductive parts
STEFAN EBERHARD

Scanning electron micrograph of part of a thale cress flower, showing the male and female reproductive organs. The female part of the flower, the pistil (the blue feathery structure on an olive green stalk), is at the centre of the image and contains egg cells (ovules) housed in an ovary. It is surrounded by the male parts, the stamens, which have their anthers coloured light green and their filaments brown. Some of the anthers are open, revealing pollen grains ready for dispersal (the light green/yellow spherical structures, for example in the anther in the top-left of the image). The pollen grains contain the male sperm cells. After an egg cell is fertilised by a sperm cell it develops into a seed. The petals are coloured purple. Thale cress, or Arabidopsis thaliana, was the first plant to have its entire genome sequenced, and is widely used as a model organism in molecular and plant biology research. The width of the image is 1200 micrometres (1.2 mm).



Breast cancer treatment
KHULOUD T AL-JAMAL AND IZZAT SUFFIAN

Scanning electron micrograph of a cluster of breast cancer cells (coloured blue). The cells have been treated with nanometre-sized particles (nanocarriers) carrying the anticancer drug doxorubicin. This is causing some of the cells to die (coloured purple) through a process known as programmed cell death, or apoptosis, which is where cells effectively commit suicide in a controlled, predictable way. Being able to specifically turn on this pathway in cancer cells will reduce a tumour's size and hopefully limit its growth. Doxorubicin does not discriminate between normal, healthy cells and cancer cells and can affect both. To overcome this the nanocarrier can be chemically modified to recognise some tumour cells and deliver the drug to the intended target. The diameter of the cell cluster is approximately 250 micrometres (0.25 mm). The nanocarriers used to treat these cells are approximately 6 nanometres (0.000006 mm) in size.


Zebrafish embryo
ANNIE CAVANAGH AND DAVID MCCARTHY

Scanning electron micrograph of a four-day-old zebrafish embryo. To capture this image, the zebrafish was physically attached to a stub (specimen holder) by its tail and tilted to 65 degrees. As zebrafish embryos are approximately 1 cm in length, making the whole embryo too big to be captured in a single image, three separate images had to be taken along its length and then stitched together digitally. Colour was then added to the black-and-white image using tones and shading to try and represent the reflectiveness of fish scales. The zebrafish is a small, tropical, freshwater fish that originally comes from Asia. It is commonly used as a model organism to study developmental biology and neurodegeneration (the deterioration or death of nerve cells) in vertebrates.




Miniature marine organism
SPIKE WALKER

Light micrograph of a miniature organism found in the sea, part of a group called Foraminifera (pronounced for-am-in-if-er-ra). This organism is approximately 1.4 mm long and has an outer shell made of calcium carbonate called a test. When the organism dies, its test is eventually turned into rock such as chalk or limestone on the seabed. This specimen came from the South China Sea and has a narrow neck with an external corkscrew-like thread.




Vitamin C crystals
SPIKE WALKER

Light micrograph of crystals of oxidised vitamin C (L-ascorbic acid). To make vitamin C crystals, vitamin C powder that had begun to oxidise was dissolved in water and a drop spread onto a microscope slide. This was warmed until enough water had evaporated to leave a thin film of solution packed full of vitamin C, which was then scratched with a needle to initiate crystal growth. As the crystals are colourless and more or less transparent, they were imaged using polarised light microscopy with crossed polars to enhance the contrast and colour of the image. The crystals are needle-shaped, but at low magnifications you can only see the final form their groupings take. Our bodies cannot make vitamin C, so we have to obtain it from food and drink. Vitamin C is used to make collagen, a protein found in many different tissues in the body. Too little vitamin C means that not enough collagen can be made, which causes skin, cartilage, bone and blood vessels to start to break down. This rare disease is called scurvy. The width of the image is 8 mm.




Lily flower bud
SPIKE WALKER

Light micrograph of a stained slice of a lily flower bud showing the male and female reproductive organs. At the centre of the image is the pistil, the female part of the flower, which contains six egg cells (ovules) housed in an ovary. This is surrounded by six male anthers (the white material) each containing four pollen sacs (the red circles), which are filled with pollen grains. Pollen grains contain the male sperm cells. After an egg cell is fertilised by a sperm cell it develops into a seed. Around the outside of the bud are three petals (small, circular in shape) and three sepals (large, triangular in shape). The width of the image is 10 mm.




Solar panel
EBERHARDT JOSUÉ FRIEDRICH KERNAHAN AND ENRIQUE RODRÍGUEZ CAÑAS

Scanning electron micrograph of a crystal of copper indium gallium diselenide, or Cu(In,Ga)Se2 (commonly abbreviated to CIGSe or CIGS). CIGS is a semiconductor used to make thin-film solar panels, as it converts sunlight (solar energy) into electricity very efficiently. Thin-film solar cells and modules based on CIGS are also very durable outdoors. Solar energy is one of the most abundant and cleanest renewable energy sources currently available. Using renewable energy sources reduces dependence on fossil fuels and helps to protect the environment. This image has been digitally coloured. The width of the image is 320 micrometres (0.32 mm).




Bat
CHRIS THORN

X-ray projection of a brown long-eared bat hunted and killed by a domestic cat. The brown long-eared bat has relatively large ears and is common in the UK and across Europe. These bats are nocturnal, sleeping during the day in roosts, and hibernate from October/November to March/April. They tend to fly at low altitude close to vegetation where they hunt their prey - insects taken directly from leaves or the ground. Some bats carry diseases, such as the virus that causes rabies, that can be passed to humans if saliva from an infected animal enters the body, for example through a bite or scratch. The rabies virus travels up the nerves and infects the brain and central nervous system. This is almost always fatal unless treated quickly. The actual height of the bat is approximately 5 cm.




Tick sucking blood from human leg
ASHLEY PRYTHERCH

Photograph of a tick burrowing its feeding parts into the skin of the photographer's own leg. Ticks are related to mites and spiders, and at least 20 species live across the UK. They like humid conditions and can be found in wooded areas, tall grasses, urban parks, fields and at the edges of lawns or meadows. Ticks feed on the blood of other animals. If a tick picks up an infection from the blood of an animal it is feeding on, it can pass that infection on to the next animal or human it bites. Examples of diseases spread to humans in this way include Lyme disease, babesiosis, ehrlichiosis and Rocky Mountain spotted fever. This tick is approximately 2.5 mm long.




Seal head
ANDERS PERSSON

Computed tomography (CT) scan of the head of a seal. Virtual 'slices' were taken of the seal using X-rays. These were then used to create a 3D digital model that can be rotated, sliced and magnified as required to obtain a desired view. Different colours and degrees of transparency can also be applied to the various tissues. In the upper image, the skin has been made opaque to reveal surface details such as skin texture and whiskers, which are visible on the face of the animal. In the lower image, the skeleton has been made opaque and different layers of skin and fat tissue have been made partly see-through to reveal the bone of the skull underneath. This technique is extremely useful for noninvasively investigating and diagnosing medical conditions and for performing virtual autopsies.




Agricultural sludge
EBERHARDT JOSUÉ FRIEDRICH KERNAHAN AND ENRIQUE RODRÍGUEZ CAÑAS

Scanning electron micrograph of waste (sludge) from an industrial farming process, after having been burned. In the foreground, silver oxide structures (coloured pink, purple and green) and structures rich in calcium carbonate (coloured brown) can be seen. The background (coloured blue) shows the surface of a zirconia crucible (a container that can withstand very high temperatures), which was used to hold the sample as it burned. The sludge was burned to measure how much carbon, hydrogen, nitrogen and sulphur it contained. A wide range of organic and inorganic samples can be analysed in this way, including soils, sludge, water, fuels, polymers, cosmetics and pharmaceuticals. This technique can also be used in environmental studies to verify the quality or contamination of fuels and soils. The width of the image is 155 micrometres (0.155 mm).



Mechanical heart pump
ANDERS PERSSON

Dual-energy computed tomography (DECT, or dual-energy CT) scan of a patient who received a mechanical heart pump (coloured blue) while waiting for a heart transplant. Virtual 'slices' were taken of the patient's chest using X-rays (with this type of scan, the dose of radiation received by the patient is extremely low). The images were then used to create a 3D digital model that can be rotated, sliced and magnified as required. Different colours and degrees of transparency can also be applied to the various tissues. In this image, the patient's arms are raised up near their head. The heart pump, breastbone (complete with L-shaped metal sutures), collarbone and bones of the ribcage have been made opaque. Other layers of tissue have been made see-through so that the connections between the heart and the pump can be checked. The pump is wired to the left side of the diseased heart and to the aorta (the major artery supplying oxygenated blood from the heart to the rest of the body). The pump's connection to the heart is faultless. This technique is extremely useful for noninvasively investigating and diagnosing medical conditions and for performing virtual autopsies.




Nit on human hair
KEVIN MACKENZIE

Scanning electron micrograph of a nit or head louse egg (coloured green) attached to a strand of human hair(coloured brown). Head lice feed on human blood and live in close proximity to the scalp. Female lice layeggs in sacs that attach firmly to individual strands of hair near the base of the hair shaft. Most willhatch within seven to ten days, and the newly emerged immature louse (nymph) will then need to feed onblood to survive. The width of the image is 1.5 mm.




Kidney stone
KEVIN MACKENZIE

Scanning electron micrograph of a kidney stone removed from Kevin Mackenzie, the creator of the image.Kidney stones form when salts, minerals and chemicals in the urine (for example calcium oxalate and uricacid) clump together and solidify. Kidney stones vary in size. Small kidney stones are often passednaturally, but larger stones sometimes get stuck in the kidney or in the tubes that carry urine out of thebody. Kidney stones can cause a lot of discomfort and pain, and in some cases can lead to infection. If astone cannot be passed naturally it may need to be surgically removed or broken up. The size of the stonein this image is 2 mm.




Hardening of heart tissue
SERGIO BERTAZZO


Scanning electron micrograph of the surface of human heart valve (aortic valve) tissue. Clumps of calciumsalts (the spherical structures coloured orange) are building up on the heart valve through a processcalled calcification. Over time this hardens the soft tissue and can eventually stop the valve from workingproperly, leading to heart disease. This image was produced using a technique called density-dependentcolour scanning electron microscopy, which takes into account the physical surface features of the materialas well as its density. In this image the orange colour identifies denser, calcified material, whilestructures that appear in green are less dense. The width of the image is 64 micrometres (0.064 mm).




Medieval jawbone
KEVIN MACKENZIE

Bird's-eye view of a micro-computed tomography (micro-CT) scan of a medieval human lower jawbone. X-rayswere used to take 4800 virtual 'slices' of the jaw, which were made into a digital model. Colours andtextures were then added to highlight the teeth (coloured blue) and bone (coloured brown). As the realjawbone is a precious sample, the digital model was subsequently cut and its teeth extracted virtually; thedifferent levels of mineralisation present in each tooth could then be visualised and colour-coded withoutcausing any physical damage to the real specimen. The lower jawbone, or mandible, is a horseshoe-shapedbone that holds the lower teeth. It is the strongest, largest bone in the face.



Wiring of the human brain
ZEYNEP M SAYGIN

Bird's-eye view of nerve fibres in a normal, healthy adult human brain. The back of the brain is on the left of the image and the left side of the brain is at the top of the image. Brain cells communicate witheach other through these nerve fibres, which have been visualised by diffusion-weighted magnetic resonanceimaging (DWI MRI). Diffusion-weighted imaging is a specialised type of MRI scan; here it is measuring the movement of water in many directions in order to reconstruct the orientation of the nerve fibres. As thisis a 3D image the direction of the nerve fibres has been colour-coded. Fibres travelling up and down(between the top of the head and neck) are coloured blue, fibres travelling forwards and backwards (betweenthe face and back of the head) are coloured green, and fibres travelling left and right (between the ears)are coloured red. These patterns of connectivity in the brain are being used to better understand brainfunction and how this changes in people as they develop or in those with dyslexia. This image appears as aresult of our MIT partnership.




Astrantia flowers
DR HENRY OAKELEY

Photograph of flowers from the plant Astrantia major. This particular variety is called Hadspen Blood, and is also known as Masterwort, Gentleman's Melancholy, Hattie's Pincushion, Mountain Sanicle or Black-rootSanicle. It is an herbaceous perennial native to central and eastern Europe. Astrantia blooms from June to August and produces star-shaped flowers that look like pincushions. It was once used to treat many different conditions, including cramps, heart failure, ulcers, infected wounds, bad breath and toothache -but it is not used anymore as it has a strong laxative effect and may also induce abortion. It is in thefamily Apiaceae along with Hemlock and Giant Hogweed, which are both toxic. This image was taken in the Medicinal Garden of the Royal College of Physicians in London.

NOTA: 

QUIERO DAR PÚBLICAMENTE LAS GRACIAS A MI PADRE QUE ME DIÓ A CONOCER ESTOS PREMIOS DE FOTOGRAFÍA Y SU PÁGINA WEB. ¡Siempre me estás mandando cosas geniales por el email!