Comparison of procedural success between two radial sheaths : Comparison of the 6-Fr Glidesheath Slender to 6-Fr standard sheath.

BACKGROUND: The most common cause of procedural failure in cardiac catheterization using the transradial approach is radial artery spasm. The aim of this study was to compare the procedural success rate of the 6­Fr Glidesheath Slender with the 6­Fr standard sheath in transradial coronary angiography and intervention. METHODS: Patients who underwent percutaneous coronary angiography via the transradial approach through placement of a 6-Fr Glidesheath Slender or a 6-Fr standard sheath for primary radial access were prospectively enrolled in the study. RESULTS: The study included 200 cases: 76 patients undergoing percutaneous coronary angiography with the Glidesheath Slender and 124 patients with the standard sheath. Failed procedures were recorded for 19 patients (9.5%), defined as inability to complete the procedure via the primary access. There was no difference in the percentage of failed cases between the Glidesheath Slender and standard sheath groups (10.5% vs. 8.9%, OR = 1.21, p = 0.8). More cases of spasm were observed in the Glidesheath Slender group compared with the standard sheath group, which was not statistically significant (7.9% vs. 5.7%, OR = 1.43, p = 0.56). Smoking, hyperlipidemia, and age influenced the procedural outcome in the Glidesheath Slender group, while body mass index, sex, and smoking impacted the procedural outcome in the standard sheath group. CONCLUSION: There is no difference in procedural success rates, as defined by the ability to complete the procedure via primary radial access, between the 6­Fr Glidesheath Slender and the 6­Fr standard sheath. Our study suggests that the patient characteristics that elevate the risk of procedural failure for Glidesheath Slender may differ from those for the standard sheath.

[Ureteral triplication]. / Triplicidad ureteral.

INTRODUCTION: Ureteral triplication is considered a rare anomaly and its association with ectopic ureterocele, is unusual. CLINICAL CASE: We report a male with a history of recurrent urinary tract infections, who showed left vesicoureteral reflux associated with apparent ureteral duplication in multiple test performed, and only during the vesicostomy was discovered a third ureter ending in a ectopic ureterocele corresponding with the upper pole ectopic kidney. CONCLUSIONS: Being a very unusual and complex pathology, and despite all the tests made, it is very difficult to make an accurate presurgical diagnosis, therefore the diagnosis sometimes is only performed during the surgical treatment, which must be individualized according to fthe unctional stage of each renal portion and the termination of each ureter.

Determination of biofilm production by Candida tropicalis isolated from hospitalized patients and its relation to cellular surface hydrophobicity, plastic adherence and filamentation ability.

Candida tropicalis is an emerging virulent species. The aim of this study is to determine the biofilm-forming ability of 29 strains of C. tropicalis isolated from inpatients, and to examine its relation with other virulence factors such as cellular surface hydrophobicity (CSH), immediate (15 min, IA) and late (24 h, LA) plastic adherence and filamentation ability. The study was performed in parallel using two incubation temperatures - 37 and 22 °C - to determine the effect of growth temperature variations on these pathogenic attributes of C. tropicalis. Biofilm formation (BF) was measured by optical density (OD) and by XTT reduction (XTT); Slime index (SI), which includes growth as a correction factor in BF, was calculated in both methods. All strains were hydrophobic and adherent - at 15 min and 24 h - at both temperatures, with higher values for 22 °C; the adhered basal yeast layer appears to be necessary to achieve subsequent development of biofilm. Filamentation ability varied from 76.2% of strains at 37 °C to 26.6% at 22 °C. All C. tropicalis strains were biofilm producers, with similar results obtained using OD determination and XTT measurement to evaluation methods; SI is useful when good growth is not presented. BF at 37 °C was similar at 24 h and 96 h incubation; conversely, at 22 °C, the highest number of biofilm-producing strains was detected at 96 h. CSH is an important pathogenic factor which is involved in adherence, is influenced by the filamentation of yeast, and plays a critical role in BF.

[Increase of newborns with anorectal malformation in 2011. Is it just by chance?]. / Acumulación de neonatos con malformación anorrectal en 2011. Solo azar?

OBJECTIVE: In 2011 we have diagnosed 9 anorectal malformations (MAR). This means 13.3 cases/10.000 NB versusu the estimated incidence of 2 cases/10.000 NB. This accumulation of defects can not be due to chance, so we have decided to focus on its research. MATERIAL AND METHODS: The study included all the patients with anorrectal malformations born in 2011. In all of them we analyzed: geographic area, age and health status of parents, pregnancy, exposure to teratogens, especially lorazepam intake, sex, gestational age, weight at birth, exploration of the abdomen and perineum, birth defects associated, imaging studies performed, treatment and current situation. RESULTS: All patients came from our province, and maternal age is under 20 years in 2 patientes and older than 30 in 7; male-dominated (8/1); low forms in 4 of 9 patients. 100% of newborns have some type of associated malformation, in genitals, urinary system or costovertebral. Clinical assessment and imaging study provided the right diagnosis in all the cases. It must be noted the absence of difficulties in the surgery treatment and a favorable outcome in all children. CONCLUSIONS: To this accumulation of cases with anorrectal malformation cases it is added a male predominanced, and a high incidence of associatedmalformations and high defects. We have not found an epidemiological explanation for this concentration of patients with anorrectal malformations. This forces us to continue our investigation if detected for some reason, currently not known.

[Ectopic testicular parenchyma in albugineal tunic]. / Parénquima testicular ectópico en la túnica albugínea.

We introduce a male patient with bilateral chryptorchidism submitted to surgery; during the intervention, macroscopically round macules were seen in the outer surface of both testes. In the round macules histological study, groups of seminiferous tubules were observed, including stroma and Leydig's intestitial cells surrounded of tunica albuginea, isolated from the rest of testicular parenchymal tissue; the diagnosis "Ectopic testicular parenchyma tissue" was confirmed by histopathological study. Due to the seminiferous tubules are surrounded by the tunica albuginea, with no apparent connection to the rest of the testicular parenchyma, a long-term assessment is required, both during puberty as well as in adulthood; owing to that can mislead and make unnecessary laparotomies and orchiectomies in the future.

[Gastroesophageal reflux disease. Evaluation and indication for surgical treatment by esophageal phmetry]. / Enfermedad por reflujo gastroesofágico, Valoración e indicación de tratamiento quirúrgico mediante pHmetría esofágica.

INTRODUCTION: Oesophageal pH monitoring is considered the best procedure to assess the severity of gastroesophageal reflux disease (GERD), conditioning its treatment. The indication for surgery is becoming less common. We intend to meet this test to what extent it has influenced. MATERIAL AND METHODS: We recruit patients treated in our Centre since the introduction of pH monitoring. We compare the number of times before and after its use. We value clinical manifestations, usual pH metric values versus non-operated patients with pathological test, associated pathology. SAMPLE: 91 patients, 151 pH metric studies (98 preoperative). Number of interventions prior to introduction of pH monitoring: 20/year, post: 3.79/year. SYMPTOMS: gastrointestinal 60.2%, respiratory 10.2%, mixed 24.5%. 495 non-operated patients, 692 pathological studies. PH metric values operated/not operated: No. reflux 116.91 +/- 125.46/101.69 +/- 83.39 (p < 0.001), No. reflux >5 minutes 8.49 +/- 8.28/4.43 +/- 4.85 (p = 0.001), longest reflux 60.21 +/- 95.93/31.16 +/- 80.09 (p < 0.001), clearance 1.27 +/- 1.44/0.86 +/- 1.05 (p = 0.04), DeMeester 52.74 +/- 56.21/29.49 +/- 23.57 (p < 0.001). 14 of 98 preoperative pH monitoring were normal. Associated pathology operated/not operated: 13.26%/ 7.47%. CONCLUSIONS: The pH metric control of patients with GERD and the progress of medical treatment have led to a decrease in surgical procedures. In our experience, the intensity of GERD is a valuable parameter in deciding on the surgery. We attach particular value parameters measuring oesophageal clearance and indices that integrate several of them. However, in some patients without pathological pH monitoring, we have indicated the operation. The prevalence of associated pathology in the operated makes us value them more demanding.

[Small left colon syndrome: a review of our experience]. / Síndrome del colon izquierdo pequeño: revisión de nuestra experiencia.

OBJECTIVE: The object is to present our experience with the small left colon syndrome (SLCS) and to investigate the usefulness of the anorrectal manometry in the study of these patients. MATERIAL AND METHODS: This was a retrospective review of the clinical histories of 10 patients treated in our Hospital for SLCS. The following variables are valued: sex, mother precedents, type of childbirth, gestational age, birth weight, clinical presentation (low colonic obstruction), delayed meconium passage, contrast enema with gastrografin, anorrectal manometry and treatment (Nursing, days of digestive rest, time of parenteral nutrition). RESULTS: During the study period, 10 patient were identified (5 are men). SLCS is reported in 2 sets of twins; in one set both twins are affected and in the other set 1 twin is affected. Maternal diabetes was identified in 6 patients. The mean gestational age was 36.6 + 2.11 weeks, and the weight 3001 +/- 689.72 g. 2 patient presented anomalies associated: fetopatía diabetic, hemivértebras D11-L2. All 10 infants presented abdominal distention and vomiting at 48.73 +/- 45.39 hours of life. Only 2 presented meconium passage in the first 24 hours. The contrast enema with gastrografin performed show typical findings of this syndrome in all cases. The anorrectal manometry carries out in 8 patients and demonstrates presence of the recto-anal inhibitory reflex (RAIR) in 5 and absence in 3. In these 3 patients with no RAIR, the study was repeated weekly until the presence being observed (normally between 2a and 3a week of life). In 1 newborn was necessary colostomy; the suction rectal biopsy showed immaturity of ganglionars cells and the manometric control previously at the close of the colostomy (9 months) showed presence of the RAIR. Conservative treatment (nursing and digestive rest) was successful in all cases with a mean of duration the 6.40 +/- 5.10 days. 6 patient needed parenteral nutrition during 7.30 +/- 8.49 days. The mean of discharge was 17.78 +/- 13.28 days. The clinical development was favourable in all the cases. CONCLUSIONS: The contrast enema with gastrografin is diagnostic and therapeutic and together with the nursing, has allowed solve the distal intestinal obstruction in 9 cases (90%). In the newborns with absence of RIAR, the anomanometric controls have allowed to know the moment of the maturation of the anorectal function.

[Surgical closure of ductus arteriosus in the extreme or very extreme preterm infant]. / Cierre quirúrgico del conducto arterioso en el pretérmino extremo o muy extremo.

OBJECTIVES: The surgical close of patent ductus arteriosus in the extreme or very extreme premature presents difficulties, because of its anaesthesia, surgical intervention and the clinical circumstances that usually accompany this pathology. We reviewed our experience in order to understand the factors that have contributed to the obtained results. METHODS: In all the reviewed patients we evalue: gestational age, birth weight, drug treatment, surgical close, incidence of bronchopulmonary dysplasia, necrotizing enterocolitis and renal failure, time of hospitalization, mortality and its causes. RESULTS: The sample is constituted of 26 prematures whose average gestational age is 26.24 weeks and average weight 885 g. 22 were treated with indomethacin, at an average age of 7 days, and all of them underwent surgical close, at an average age of 19 days (0-50). 10 patients suffered bronchopulmonary dysplasia, operated when they were 28 days of life. 7 suffered renal failure, 5 of them after drug treatment. 6 suffered necrotizing enterocolitis. 7 died (27%), 3 of them because of prematurity and preoperative severe pathology, 2 because of heart disease, and 2 because of severe necrotizing enterocolitis. CONCLUSIONS: Surgical ligation of patent ductus arteriosus in these patients is well tolerated, especially if the attention to prevent bronchopulmonary dysplasia, necrotizing enterocolitis and renal failure is optimized. Mortality in our series is not very different from that provided for the total of prematures with similar gestational age and birth weight, regardless of their pathology.

[Familial adenomatous polyposis: a follow-up of the extracolonic manifestations]. / Poliposis adenomatosa familiar: seguimiento de las manifestaciones extracolónicas.

INTRODUCTION: Total colectomy is the only effective treatment for prophylaxis against colon cancer in patients with familial adenomatous polyposis (FAP). We present our experience with 4 children colectomized for FAP, with a particular focus on the long-term surveillance to detect extracolonic manifestations. PATIENTS AND METHODS: We review the clinical histories of 4 patients from 10 to 16-years-old, with family histories of FAP. Performed for each patient were: genetic testing, colonoscopy, double contrast enema, gastro-oesophageal duodenoscopy, thyroid and abdominal ultrasound, fundus oculi, and tumour markers (CEA, CA 19.9). They underwent total colectomy with ileoanal anastomosis and anorectal mucosectomy with an ileal J-pouch. During follow-up, they were monitored regularly with imaging techniques (including a video capsule in one patient) and endoscopy. Also evaluated were faecal continence, food intake, and height-weight development. RESULTS: All had multiple polyps in the colon, and mutation of the APC gene. Hypertrophy of the retinal pigment epithelium was observed in three. Immediately postoperative, there were abundant diarrhoeic stools, two presented an episode of "pouchitis", and one moderate undernourishment. One patient had an intraperitoneal haemorrhage that was resolved by blood transfusion. All 4 have normal faecal continence. During the first months postoperative, two patients showed considerable weight loss. In the follow-up (> 3 years), moderate undernourishment was observed in one patient. Duodenal polyps were found in two patients--in one by duodenoscopy, and in the other with the video capsule. CONCLUSIONS: After colectomy, FAP patients may develop extracolonic clinical manifestations, some of which may be malignant such as thyroid and periampullary cancer. Careful surveillance of these patients is therefore very important, with annual checks using gastroduodenoscopy and thyroid and abdominal ultrasound.

[Intrakidney-catheter. Post pyelo-plasty complication]. / Catéter intrarrenal. Complicación post-pieloplastia.

One of the more severe urology complications are the forgetfulness of surgical instruments or materials (compress, gauzes...), with different types of complications. We present a male, operated of left hydronephosis. The post surgical catheter was retired five days after the anterograde urography, being all normal. But, in the new urography, practised six month after, a little fragment of catheter was discover, being necessary to do a new lobotomy and extraction. After revised the paediatric-urology bibliography, we note the very few articles about surgical complications, which is not the case of the adult's urologist. And this is very negative to the resident training, and also to our patients.

Effect of geraniol on rat cardiomyocytes and its potential use as a cardioprotective natural compound.

AIMS: Reactive oxygen species (ROS) are generated in the ischaemic myocardium especially during early reperfusion and affect myocardial function and viability. Monoterpenes have been proposed to play beneficial roles in diverse physiological systems; however, the mechanisms of action remain largely unknown. This study aims to assess the effect of monoterpene geraniol (GOH) on neonatal rat ventricular cardiomyocytes (NRVCs) subjected to oxidative stress. MAIN METHODS: We used an in vitro model of hypoxia-reoxygenation. Cardioprotective (AMPK) and cardiotoxic (ERK1/2, ROS) signaling indicators were measured. Assays were performed by fluorogenic probes, MTT assays and Western-blots. KEY FINDINGS: We determined that the addition of GOH (5-200µM) to cultured normoxic and hypoxic-NRVCs diminished the endogenous production of ROS in stressed cardiomyocytes. We observed that GOH treatment increased pAMPK levels and decreased pERK1/2 levels in cultured NRVCs. SIGNIFICANCE: This report suggests that GOH is a candidate cardioprotective natural compound that operates by blunting the oxidative stress signaling that is normally induced by hypoxia-reoxygenation.

[Benchmarking in patient identification: An opportunity to learn]. / Benchmarking en la identificación de pacientes: una oportunidad para aprender.

OBJECTIVE: To perform a benchmarking on the safe identification of hospital patients involved in "Club de las tres C" (Calidez, Calidad y Cuidados) in order to prepare a common procedure for this process. MATERIAL AND METHODS: A descriptive study was conducted on the patient identification process in palliative care and stroke units in 5medium-stay hospitals. The following steps were carried out: Data collection from each hospital; organisation and data analysis, and preparation of a common procedure for this process. RESULTS: The data obtained for the safe identification of all stroke patients were: hospital 1 (93%), hospital 2 (93.1%), hospital 3 (100%), and hospital 5 (93.4%), and for the palliative care process: hospital 1 (93%), hospital 2 (92.3%), hospital 3 (92%), hospital 4 (98.3%), and hospital 5 (85.2%). CONCLUSIONS: The aim of the study has been accomplished successfully. Benchmarking activities have been developed and knowledge on the patient identification process has been shared. All hospitals had good results. The hospital 3 was best in the ictus identification process. The benchmarking identification is difficult, but, a useful common procedure that collects the best practices has been identified among the 5 hospitals.

Encephalitozoon microsporidia modulates p53-mediated apoptosis in infected cells.

Microsporidia are intracellular obligate parasites which have recently been found to be related to fungi. They have a unique extrusion apparatus that is able to inject the sporoplasm directly into the target cell without using receptors. Encephalitozoon microsporidia are a source of morbidity and mortality in humans. It has been suggested that microsporidia may modulate the host cell cycle and apoptosis. We report here that caspase-3 cleavage is inhibited at different times of Vero cell infection by Encephalitozoon microsporidia and that the phosphorylation and translocation of p53 to the nucleus, previous steps for the activation of this protein, do not occur after infection of Vero cells. Consequently, the transcriptional function of p53 is impaired during the infection cycle as demonstrated by luciferase reporter assays. Thus, to our knowledge, for the first time it is shown that an intracellular parasite may be able to multiply in the host cell without activating the p53 apoptotic pathway of that cell. However, changes in the expression of Bcl-2 or Bax levels were not observed.

[Familial adenomatous polyposis: Gardner's syndrome]. / Poliposis adenomatosa familiar: síndrome de Gardner.

Familial adenomatous polyposis (PAF) associated to soft tissue tumors or osteomas constitutes the Gardner's syndrome of autosomal dominant inheritance. The risk of colorectal cancer in these patients is 100%. We present a patient with Gardner's syndrome who was had colectomy at early age. An eleven years old boy he was evaluated due to a family history of PAF and subcutaneous tumors (occipital and left thigh). Genetic profile shows a mutation in gene APC and the colonoscopy confirms the polyposis; the biopsy also suggested moderate dysplasia. When the patient reached the age of twelve, a total colectomy with colorectal mucosectomy was performed. Cystic subcutaneous lesions (epidermoid cysts) were also excised. In the postoperative period there were no complications. The prophylactic colectomy, is the only effective treatment to prevent the colorectal cancer. Gardner's syndrome patients requires periodic controls to rule out the appearance of new tumors or anomalies in the retine. The duodenoscopy is essential in the follow up of these patients because of the frequency of duodenal affectation.

"Raking-in Technique:" Removal Of Brachiocephalic Vein Thrombus Using AngioVac® Device Within A Stented Venous Segment.

INTRODUCTION: A case is reported of left brachiocephalic vein thrombus removal using the Angiovac device within a stented venous segment via a through-and-through access technique. REPORT: This novel technique involves obtaining through-and-through access from the left basilic vein to the right femoral vein, which then facilitates the advancement of the Angiovac device to successfully remove in a stepwise fashion the thrombus present within a stented region of the left brachiocephalic vein. DISCUSSION: The Angiovac device has been shown to be very useful and effective at removing large amounts of thrombus, tumor, and foreign bodies within arterial and venous systems successfully. This novel technique uses the through-and-through venous access approach to allow for this device to remain close to the targeted area of thrombus burden and prevent damage of the already existing stents in this region.

[Congenital colonic atresia. Surgery correction in one or two stages?]. / Atresia de sigma cierre quirúrgico primario o secundario?

Sigmoid atresia is rare, the recognzed prevalence is 1 per 15.000 to 60.000 live born. We present a 30 hours old boy with vomiting, abdominal distension and failure to pass meconium. Physical examination showed severe abdominal distension. An enema was performed and a gray mucus plug taken out. The abdominal plain XR showed bowel obstruction and in a barium enema only 5-7 cm of microcolon was seen. With the diagnosis of sigmoid atresia the patient underwent surgery, observing one atresia type I, with dilated proximal loop and distal microcolon. A colostomy was performed and few days later one end-to-end anastomosis was made.

Increase in nuclear calcium in smooth muscle cells exposed to oxidized low density lipoprotein.

Vascular smooth muscle cells respond with an increase in intracellular Ca2+ within seconds after exposure to oxidized low density lipoprotein (oxLDL). This has been suggested to represent a signaling response that may have implications for gene expression. If so, oxLDL may induce increases in nuclear Ca2+ in smooth muscle cells in response to oxLDL. Aortic smooth muscle cells were exposed to 100 microg/ml oxLDL. Large, rapid increases in [Ca2+]i were observed using fluo-3 as an indicator dye to detect intracellular Ca2+ on the stage of a confocal microscope. This was also confirmed using ratiometric imaging of indo signals. These elevations appeared to be localized to the nuclear region of the cell. DNA staining of the cells confirmed its localization to the nuclear/perinuclear region of the cell. Our data demonstrate that oxLDL induces a nuclear localized elevation in Ca2+i that may have important implications for nuclear function.

Triglyceride and cholesterol content in bile, blood, and gallbladder wall.

Cholesterol gallstone disease is frequent in Chile compared with other countries, as is cholesterolosis of the gallbladder. The purpose of this study was to determine any differences in bile composition and cholesterol content in the gallbladder wall and serum of patients compared with findings in patients with gallstones and control subjects. In control subjects, cholesterol content of the gallbladder wall was determined in autopsy material. Patients with cholesterolosis had bile composition similar to that of patients with gallstones, with supersaturation of cholesterol in the bile. Also, these patients had increased levels of cholesterol in the gallbladder wall but normal serum cholesterol levels. These findings suggest that altered bile composition occurs in patients with cholesterolosis and gallstones.

Phagocytic activity of polymorphonuclear leukocytes on Escherichia coli previously exposed to metronidazole.

A study was made of the action of different concentrations of metronidazole of the viability of Escherichia coli under aerobic and anaerobic conditions. The viability of E. coli was reduced by 60 to 99% after 24 hours of anaerobic incubation, according to the concentration of metronidazole tested. In addition, there were significant morphological changes in the bacteria. Exposure of antibiotic-induced filaments of E. coli LP 136 to phagocytosis caused the cfu/ml value to drop by 60% after 120 minutes. Under identical conditions, using the mutant strain E. coli RYC 819, which did not become filamented by metronidazole although it did present similar ultrastructural changes, this reduction reached 83%. These results may explain the therapeutic success of metronidazole in polymicrobial infections.