Percutaneous treatment of an iatrogenic femoral arteriovenous fistula from an accessory arterial branch: a case report and review of the literature.

Vascular access-related complications are an important consideration in patients undergoing cardiac catheterisation. Patients with CHD are increasingly undergoing percutaneous treatment for suitable procedures as an alternative, less invasive option to surgical intervention. As such, recognition and treatment of these complications are becoming increasingly important. We present a case of a patient with repaired Tetralogy of Fallot who developed a femoral arteriovenous fistula and femoral artery pseudoaneurysm arising from an accessory arterial branch following percutaneous Harmony valve implantation, both of which were treated endovascularly with placement of a stent.

Stability of individualized neonatal parenteral nutrition admixtures with fish oil and high calcium content.

Introduction: Introduction: the stability of total parenteral nutrition admixtures for neonates (TPNAn) has been questioned in relation to the interaction between calcium and fish oil emulsions. Aim: the aim of this study was to check the stability (particle size < 1 µm) of different individualized TPNAn prepared with fish-oil emulsion and containing calcium at concentrations ranging from 10 to 20 mmol/L. Methods: admixtures analyzed: twelve different formulations with SMOFlipid® 20 % (conserved for 24 h and for 96 h), three formulations with Lipoplus® 20 % (conserved for 96 h) and three formulations with SMOFlipid® 20 % with Multi-12K1® Pediatric (conserved for 96 h). Two bags were compounded for each formulation and conservation period. Measurements on each admixture bag: particle standardized diameter by laser diffraction technique and pH by a calibrated pH-meter. Data analysis with mixed linear regression models. Results: maximum particle size was < 0.8 µm for all investigated admixtures. Lipid concentration of 5 g/L and sodium and potassium concentration of 100 mmol/L slightly increased the proportion of particles > 0.6 µm. Ninety six hours storage also increased the percentage of particles > 0.6 µm (+0.143 ± 0.07; p = 0.038) but did not influence other parameters. No association with calcium composition was observed. Amino acid content was inversely correlated with pH (-0.83; p < 0.0001). Conclusions: the studied individualized parenteral nutrition admixtures for newborns that contain fish oil emulsions and meet cation requirements are stable for at least 96 hours.

Introducción: Introducción: existe controversia sobre la estabilidad de las mezclas de nutrición parenteral total para recién nacidos (TPNAn) con emulsiones de omega-3 y alto contenido en calcio. Objetivo: estudiar la estabilidad (tamaño de partículas < 1 µm) de diferentes TPNAn individualizadas preparados con una emulsión lipídica que contiene w3 y concentraciones de calcio entre 10 y 20 mmol/L. Métodos: se analizaron doce formulaciones diferentes con SMOFlipid® 20 % (conservadas durante 24 h y por 96 h), tres formulaciones con Lipoplus® 20 % (conservadas durante 96 h) y tres formulaciones con SMOFlipid® 20 % con Multi-12K1® Pediatric (conservadas durante 96 h). Se prepararon dos bolsas por cada formulación y período de conservación. Se midieron el diámetro de partícula estandarizado mediante técnica de difracción láser y el pH con un pH-metro calibrado. Análisis de datos con modelos de regresión lineal mixta. Resultados: el tamaño máximo de partícula fue < 0,8 µm para todas las mezclas investigadas. La concentración de lípidos de 5 g/L y la concentración de sodio y potasio de 100 mmol/L aumentaron ligeramente la proporción de partículas > 0,6 µm. El almacenamiento de noventa y seis horas también aumentó el porcentaje de partículas > 0,6 µm (+0,143 ± 0,07; p = 0,038) pero no influyó en otros parámetros. No se observó asociación con la concentración de calcio. El contenido de aminoácidos se correlacionó inversamente con el pH (-0,83; p < 0,0001). Conclusiones: las TPNAn individualizadas estudiadas con emulsiones de omega-3 que incluyen los requerimientos de cationes son estables durante al menos 96 horas.

Improvement of Disability in Neurogenic Thoracic Outlet Syndrome by Robotic First Rib Resection.

BACKGROUND: Robotic transthoracic first rib resection (R-FRR) has advantages over traditional approaches; however, its impact on postoperative neurogenic thoracic outlet syndrome (nTOS) outcomes is unknown. Our primary objective was to determine improvement of patient-reported outcome measures (PROMs) of pain and disability after R-FRR in nTOS. Our secondary objective was to compare improvement of patient-reported pain between R-FRR and supraclavicular FRR (SC-FRR) in nTOS. METHODS: We queried a prospectively maintained, single-surgeon, single-institution database for patients with nTOS undergoing R-FRR or SC-FRR with available preoperative and postoperative PROMs. PROMs included the Disability of the Arm, Hand, and Shoulder (DASH) questionnaire and visual analog scale (VAS) for pain. RESULTS: Cohort 1 included 37 patients (32 women) undergoing 40 R-FRRs, with an average age of 36 years. Preoperative VAS and DASH (6.0 and 64.2, respectively) improved significantly at the first (2.8 and 35.0; P < .001 for both) and second postoperative visits (1.4 and 30.2; P < .01 for both) which occurred at 2.6 and 15.3 weeks, respectively. Cohort 2 included 57 R-FRRs performed in 53 patients and 35 SC-FRRs performed in 34 patients. The R-FRR and SC-FRR groups did not significantly differ in sex, age, hand dominance, TOS laterality, or preoperative VAS. At the first postoperative visit (2.4 weeks), R-FRR was associated with lower VAS scores (P = .023) and greater VAS improvement than SC-FRR (53% and 27% decrease, respectively; P = .008). CONCLUSIONS: R-FRR results in significant improvement in disability and pain in nTOS and may have a greater impact on patient-reported pain than SC-FRR in the early postoperative period.

Safety of robotic first rib resection for thoracic outlet syndrome.

OBJECTIVES: Robotic first rib resection (R-FRR) is an emerging approach in the field of thoracic outlet syndrome (TOS) that has technical advantages over traditional open approaches, including superior exposure of the first rib and freedom from retracting neurovascular structures. We set out to define the safety of R-FRR and compare it with that of the conventional supraclavicular approach (SC-FRR). METHODS: We queried a prospectively maintained, single-surgeon, single-institution database for all FRR operations performed for neurogenic TOS and venous TOS. Preoperative, intraoperative, and complications were compared between approaches. RESULTS: Seventy-two R-FRRs and 51 SC-FRRs were performed in 66 and 50 patients, respectively. These groups were not significantly different in age, body mass index, sex, type of TOS, or preoperative use of opioids. Length of procedure and hospital stay were not different between groups. Postoperative inpatient self-reported pain (visual analog scale score 4.7 vs 5.2; P = .049) and administered morphine milligram equivalents (37.5 vs 81.1 MME, P < .001) were significantly lower in R-FRR than SC-FRR. Brachial plexus palsy was less frequent after R-FRR than SC-FRR (1% vs 18%, P = .002) and resolved by 4 months in call cases. All cases were sensory palsies with the exception of 2 motor palsies, which were both in the SC-FRR group. In multivariable analyses, R-FRR was independently associated with less frequent total complications than SC-FRR (P = .002; odds ratio, 0.08; 95% confidence interval, 0.02-0.39). CONCLUSIONS: R-FRR provides outstanding exposure of the first rib and eliminates retraction of the brachial plexus and its consequences.

Rivaroxaban and selective serotonin reuptake inhibitors: Bleeding risk resulting from their concomitant use.

OBJECTIVE: The combination of selective serotonin reuptake inhibitors with  rivaroxaban may result in a dual interaction (pharmacokinetic and pharmacodynamic) depending on the type of selective serotonin reuptake inhibitor employed (CYP3A4-inhibiting vs. non-CYP3A4 inhibiting).  The purpose of this study was to use real world data to determine if the type of  selective serotonin reuptake inhibitor used plays a role in the risk and severity of bleeding in patients receiving rivaroxaban. Method: This was a single-center retrospective longitudinal observational study carried out between January 2016 and February 2020 in patients aged 18 years or older treated concurrently with rivaroxaban (prescribed for treatments) and a selective serotonin reuptake  nhibitor. Patients were divided into two groups according to the selective  serotonin reuptake inhibitor they received, i.e., a CYP3A4 inhibitor (group 1):  sertraline, fluoxetine and paroxetine, or a non-CYP3A4 inhibitor (group 2): citalopram and escitalopram. We analyzed the bleeding events and  everity, the daily dose of rivaroxaban used and the medication administered concomitantly. RESULTS: A total of 146 patients were included (89 in group 1 and 57 in group  2) and 35 bleeding events (24% of patients) were identified, of  which 12 were  major and 23 were minor. The bleeding rate was higher in group 1  (25.8% vs 21.0%) but there were no differences in major bleeding (10.1% vs  5.3%; p = 0.235) or minor bleeding (13.5% vs 15.8%; p = 0.496). The  bleeding rate with a daily rivaroxaban dose of 20 mg was 9% (8/89) in group 1  and 14% (8/57) in group 2 (p = 0.2137), as compared with 16.9% (15/89)  in group 1 versus 7% (4/57) in group 2 (p = 0.042) for a daily 15 mg dose. CONCLUSIONS: Although the type of selective serotonin reuptake inhibitor used  concurrently with rivaroxaban was not found to influence the patients' bleeding  risk, a significant increase in the risk of bleeding was  bserved based on the dose of rivaroxaban used.

OBJETIVO: La combinación de rivaroxabán e inhibidores selectivos de la recaptación de serotonina presenta un riesgo de interacción  farmacodinámica y farmacocinética que depende del tipo de inhibidor selectivo  de la recaptación de serotonina empleado, ya que algunos son inhibidores del  citocromo p450, mientras que otros no lo son. El objetivo del presente estudio  fue evaluar con datos de vida real si el tipo de inhibidor selectivo de la  recaptación de serotonina utilizado influye en la frecuencia y en la gravedad de  sangrado en pacientes anticoagulados con rivaroxabán. Método: Estudio observacional, longitudinal, retrospectivo y unicéntrico, realizado entre enero de 2016 y febrero de 2020 en pacientes ≥  18 años que recibían rivaroxabán, en indicaciones autorizadas y financiadas, y  que estaban siendo tratados concomitantemente con inhibidores selectivos de  la recaptación de serotonina. Se establecieron dos cohortes en función del  inhibidor selectivo de la recaptación de serotonina coadministrado: inhibidores  del CYP3A4 (grupo 1) ­sertralina, fluoxetina y paroxetina­, y no inhibidores  del CYP3A4 (grupo 2) ­citalopram y escitalopram­. Se analizaron los eventos  hemorrágicos, la gravedad del sangrado, la dosis diaria de rivaroxabán y la  medicación concomitante que pudiese influir en el riesgo de sangrado. RESULTADOS: Se incluyeron 146 pacientes (89 en el grupo 1 y 57 en el grupo  2) y se identificaron un total de 35 eventos hemorrágicos (24% de los  pacientes), de los que 12 fueron eventos mayores y 23 menores. La frecuencia  de sangrado fue ligeramente mayor en el grupo 1 que en el 2 (25,8% versus 21%), pero no se encontraron diferencias significativas entre  ambos grupos, ni tampoco en la frecuencia de sangrados mayores  (10,1% versus 5,3%; p = 0,235) o menores (13,5% versus 15,8%; p =  0,496). La frecuencia de eventos hemorrágicos con la dosis de 20 mg fue del  9% (8/89) en el grupo 1 y del 14% (8/57) en el grupo 2 (p = 0,2137), mientras que con una dosis de 15 mg la frecuencia de eventos fue del 16,9% (15/89) en el grupo 1 y del 7% (4/57) en el grupo 2 (p = 0,042). CONCLUSIONES: No se han hallado diferencias significativas en el riesgo de  sangrado según el tipo de inhibidor selectivo de la recaptación de serotonina  que se administre de forma concomitante al rivaroxabán. Sí se han observado  diferencias significativas en función de la dosis de rivaroxabán utilizada.

Interaction between valproic acid and meropenem or ertapenem in patients with epilepsy: clinical relevance and results from pharmaceutical intervention.

OBJECTIVE: The literature has described the interaction between valproic acid  and carbapenems. This interaction leads to decreases in plasma concentrations  of valproic acid. The main objectives of this study were  to assess its relevance in clinical practice, to identify variables associated with  increased seizure episode rates, and to analyse the impact of pharmaceutical intervention on avoiding the effects of this interaction. METHOD: An observational retrospective study of inpatients with epilepsy  admitted between 2016 and 2020. Their pharmacological treatment throughout  admission was recorded, and the presence of other interactions  leading to decreased plasma concentrations of valproic acid was reviewed. The  seizure rate during the year prior to admission was compared to that during  the interaction period. For every episode in which the interaction was detected, an intervention was conducted by providing the prescriber with information on  the interaction and suggesting a change of antibiotherapy as well as the  pharmacokinetic monitoring of valproic acid. RESULTS: 37 episodes were included. 58.1% of the patients were male and  median age was 70 years. In total, 56.8% of the patients received meropenem  and 43.2% received ertapenem. The median duration of  concomitant treatment with valproic acid and carbapenem was 4 days. The  incidence rate ratio was 2.60 (95% confidence interval: 1.61-4.21). Thus, this  interaction was associated with a higher seizure rate. A statistically significant  association was found between higher seizure rates and patients treated with  more than one anti-epileptic drug. Hospital pharmacists detected 24 episodes  (64.9%). In total, 17 interventions (70.8%) were accepted and 13  combinations were discontinued. Pharmacokinetic monitoring was conducted in  13 episodes (35.1%) and infratherapeutic levels were found in all of them. CONCLUSIONS: The interaction between valproic acid and meropenem or ertapenem is clinically relevant. It is recommended that this combination should be avoided provided that a viable alternative is available.  Pharmaceutical intervention may contribute to preventing seizures associated with this combination.

Objetivo: La interacción entre ácido valproico y carbapenems está descrita en  la literatura y conlleva una disminución de los niveles plasmáticos de ácido  valproico. Los objetivos son evaluar su relevancia en la práctica clínica, conocer  las variables que se asocian a un incremento de crisis epilépticas y  analizar el impacto de la intervención farmacéutica para evitar las  consecuencias de dicha interacción.Método: En este estudio observacional retrospectivo se estudiaron pacientes  con epilepsia hospitalizados entre 2016 y 2020. Se registró el tratamiento  farmacológico prescrito en el ingreso y se revisó la presencia de otras  interacciones que redujeran la concentración plasmática de ácido valproico. La  frecuencia de crisis epilépticas durante el año previo al ingreso se comparó con  la correspondiente al periodo de interacción. Se realizó una intervención  en todos los episodios con la interacción detectada informando al prescriptor  sobre la interacción y proponiendo sustitución de la antibioterapia, así como  monitorización farmacocinética de ácido valproico.Resultados: Se incluyeron 37 episodios. El 58,1% eran varones y la mediana  de edad fue de 70 años. El 56,8% de los pacientes recibió meropenem y el  43,2% restante, ertapenem. Para la duración del tratamiento concomitante  entre ácido valproico y el carbapenem prescrito  se obtuvo una mediana de 4  días. Se halló una razón de tasas de incidencia de 2,60 (intervalo de confianza  del 95%: 1,61-4,21), por lo que esta interacción se asocia a una mayor  frecuencia de crisis epilépticas. Se asoció una mayor frecuencia de crisis  estadísticamente significativa en los pacientes tratados con más de un fármaco  antiepiléptico. Los farmacéuticos hospitalarios detectaron 24  episodios (64,9%). Se aceptaron 17 intervenciones farmacéuticas (70,8%) y  se suprimieron 13 combinaciones. Se realizó monitorización farmacocinética en  13 episodios (35,1%) y en todos se hallaron niveles infraterapéuticos. Conclusiones: La interacción entre ácido valproico y meropenem o ertapenem  es clínicamente relevante y se recomienda evitarla siempre que  existan alternativas viables. La intervención farmacéutica puede contribuir a  prevenir las crisis epilépticas favorecidas por esta combinación.

Patients with less than three episodes of diverticulitis may benefit from elective laparoscopic sigmoidectomy.

BACKGROUND: This study was designed to asses the predictive factors of postoperative complications in patients who underwent a laparoscopic elective approach for recurrent diverticulitis and to determine the relationship between the number of acute episodes and surgical morbidity. METHODS: A retrospective analysis was performed on patients with colonic diverticular disease treated by an elective laparoscopic approach between July 2000 and November 2007. The variables studied were age, sex, BMI, ASA, number of previous acute episodes, local severity, abdominal surgery history, comorbidity, and laparoscopic training of the surgeon. Logistic regression analysis was used to establish significant results. RESULTS: A total of 137 patients were analyzed; 87 (63.5%) were men with a mean age of 56.7 (range, 27-89) years. Intraoperative and postoperative complications occurred in 2.9% (n = 4) and 12.4% (n = 17) of the patients respectively. Conversion rate was 9.4% (n = 13). Local severity (odds ratio (OR), 16.34; 95% confidence interval (CI), 4.1-64.5, p = 0.00007), history of abdominal surgery (OR, 3.02; 95% CI, 0.8-11.5; p = 0.02), and the training of the operating surgeon (OR, 4.8; 95% CI, 1.02-22.7; p = 0.001) were significant risk factors related to surgery conversion. A history of three or more acute episodes was significantly associated with a high severity of local process and was a risk factor related to conversion (OR, 2.6; 95% CI, 0.5-12.3; p = 0.22). The severity of the local process seems to be a risk factor for perioperative complications. A significant association (chi2, 4.45; p = 0.03) between conversion and postoperative complications also was observed (OR: 3.79, 95% CI, 1.02-14.07; p = 0.04). CONCLUSIONS: A history of three or more acute episodes of diverticulitis with conservative treatment is associated with a high severity of the local process during laparoscopic sigmoidectomy and increases the rate of conversion and perioperative complications.

Feasibility and dissemination of a computerized home-based treatment for Generalized Anxiety Disorder: A randomized clinical trial.

Generalized Anxiety Disorder (GAD) is a prevalent, impairing, and undertreated psychiatric disorder. We examined if a home-based computerized treatment program can feasibly be delivered and successfully treat GAD symptoms. Using a randomized control trial, we compared three active groups receiving computerized sequenced Attention Bias Modification (ABM) followed by Applied Relaxation psychoeducation (AR-pe), the reversed sequence of AR-pe and ABM, and a simultaneous ABM and AR-pe group to an assessment only control group. The participants comprised 169 adults with a diagnosis of GAD. We asked participants to complete as many as twenty-four 30-min sessions of an at-home computerized treatment program over 12 weeks. The control group received 24 brief assessment questionnaires as well as assessments of attention bias. Results from intent-to-treat analyses show faster rate of improvement for symptoms of anxiety as measured by the Hamilton Anxiety Rating Scale (HAM-A) over time in groups that received active training in contrast to the clinical monitoring (CM) control group. Follow-up analyses revealed that both sequenced groups improved in anxiety when compared to the control group, while the simultaneous group did not outperform the control group. Results suggest that sequenced delivery of ABM and AR, may be a viable home-based treatment option for individuals with GAD who have limited access to resources or are otherwise unable to seek available treatments that require engagement outside of the home. TRIAL REGISTRATION: clinicaltrial. gov Identifier: NCT00602563.

Una presentación inusual de fístula carótido-cavernosa secundaria a trauma craneoencefálico leve: reporte de caso / An unusual presentation of carotid-cavernosa fistula secondary to mild craneoenephalic trauma: a case report

Resumen La fístula carótido-cavernosa es cualquier comunicación anómala entre la arteria carótida y el seno cavernoso que genera un shunt arteriovenoso patológico, se manifiesta en forma anterógrada a la órbita, causa ceguera y oftalmoparesia. Su asociación con trauma craneoencefálico leve es escasa y poco reportada, por lo que se desconoce su prevalencia. Se reporta un paciente masculino de 54 años proveniente de Cali, Colombia, con antecedente de trauma craneoencefálico leve 2 meses antes del ingreso, quien presenta cuadro de cefalea holocraneal y alteraciones visuales. Al examen físico presentó oftalmoparesia, con ptosis palpebral bilateral asimétrica y proptosis pulsátil izquierda; se realizó resonancia magnética cerebral simple y angioresonancia, con hallazgos sugestivos de fístula carótido-cavernosa. El paciente fue llevado a arteriografía más embolización, logrando un resultado favorable. La presencia de cefalea con banderas rojas, alteraciones visuales, proptosis pulsátil y el antecedente de trauma craneoencefálico, sin importar su grado, pueden hacer sospechar la presencia de esta entidad.

Abstract The carotid-cavernous fistula is any abnormal communication between the carotid artery and the cavernous sinus, generating a pathological arteriovenous shunt manifesting anterograde to the orbit, causing blindness and ophthalmoparesis. Its association with mild head trauma is scarce and underreported, its prevalence being unknown. A 54-year-old male patient from Cali - Colombia is reported, with a history of mild cranioencephalic trauma 2 months ago, who consulted for a holocranial headache and visual disturbances. On physical examination he presented ophthalmoparesis, with bilateral asymmetric palpebral ptosis with left pulsatile proptosis. A simple brain magnetic resonance and angio-MRI was performed, with findings suggestive of a carotid-cavernous fistula. The patient was taken to arteriography plus embolization, achieving a favorable result. The presence of headache with red flags, visual disturbances, pulsatile proptosis, and a history of head trauma, regardless of its degree, can lead to suspect the presence of this entity.

Frameshift mutation events in beta-glucosidases.

Compensated frameshift mutation is a modification of the reading frame of a gene that takes place by way of various molecular events. It appears to be a widespread event that is only observed when homologous amino acid and nucleodotide sequences are compared. To identify these mutation events, the sequence analysis rationale was based on the search for short regions that would have much lower degrees of conservation in protein, but not in DNA, in well-conserved beta-glucosidase families. We have restricted our study to a seed set of sequences of O-glycoside hydrolase families 1 and 3. We found compensated frameshift mutation in the family of 1 beta-glucosidases for the Erwinia herbicola, Cellulomonas fimi, and (non-cyanogenic) Trifolium repens gene sequences, and in the family of 3 beta-glucosidases for the Clostridium thermocellum and Clostridium stercorarium gene sequences. By computational treatment, the observed mutation events in the gene frameshifting sub-sequence have been neutralised. Each nucleotide insertion must be eliminated and each nucleotide deletion must be substituted by the symbol N (any nucleotide). When the frameshifting fragments of the amino acid sequences were substituted by the computationally neutralised subsequences, the beta-glucosidase alignments were improved. We also discuss the structural implications of the compensated frameshift mutations events.

Resección rectal por vía perineal mediante engrapadora lineal: experiencia inicial de una nueva técnica para el tratamiento del rectocele anterior / Rectal resection perineally via a linear stapler: initial experience of a new technique for the treatment of the anterior rectocele

Introducción: Analizar los resultados a corto y mediano plazo del tratamiento del rectocele anterior mediante la resección rectal transperineal con engrapadora lineal y refuerzo del tabique rectovaginal con malla. Prospectivo de casos consecutivos. Pacientes y método: Entre 01 de abril de 2008 y 31 de Marzo de 2010, 12 pacientes fueron tratados en nuestra institución por presentar diagnóstico de Rectocele Anterior. Los pacientes fueron evaluados por cirujanos entrenados; sometidos a manometría anorrectal y estudios imagenológicos dinámicos. Se realizó una técnica de Resección Rectal por vía perineal con engrapadora lineal y la aplicación de malla. Se aplicaron distintos scores para evaluar los resultados. Resultados: El 100% fueron sexo femenino, edad promedio 44,6 años. El tiempo promedio de cirugía fue 164 minutos (r: 135-180). No hubo complicaciones intraoperatorias. La estadía media hospitalaria fue 2,6 días. La morbilidad fue del 16,6% (2) y no hubo mortalidad relacionada al procedimiento. La evaluación basal del score ODS mostró un promedio de 19.16, mientras el promedio determinado al 7 y 21 día postoperatorio fue 0,5 y 0,16 respectivamente (P = 0,001). La evaluación del estreñimiento usando el score PAC-SYM mostró un resultado basal promedio de 17,08, mientras que al 7 y 21 día postoperatorio fue 3,25 y 1,32 respectivamente (P = 0,002). El cuestionario de Satisfacción a los 6 meses mostró mejoría significativa respecto al valor basal (p = 0,001). Conclusión: Esta nueva técnica permite restaurar el tabique rectovaginal resecando el defecto rectal. Los resultados funcionales obtenidos son favorables, con baja morbilidad y pocas complicaciones relacionadas al uso de mallas. (AU)

Objective: To analyze short and mid-term results of anterior rectocele treatment by trans perineal rectal resection with linear stapler and rectovaginal septum reinforcement with mesh. Patients and methods: Between 01April 2008 and 31 March 2010, 12 patients were treated at our institution with diagnosis of Anterior Rectocele. Patients were evaluated by trained surgeons, underwent anorectal manometry and dynamic images studies. We performed a novel technique called "Stapled Perineal Rectocele resection". Different scores were applied to evaluate the results. Results: 100% were female, average age 44.6 years. The mean surgical time was 164 minutes (r: 135-180). There were no intraoperative complications. The average hospital stay was 2.6 days. The morbidity was 16.6% (2) and there was no procedure-related mortality. Baseline of ODS showed an average score of 19.16, while the average determined at 7 and 21 days postoperatively was 0.5 and 0.16 respectively (P = 0.001). The assessment of constipation using the PAC-SYM score showed a mean baseline of 17.08 results, while at 7 and 21 days after surgery was 3.25 and 1.32 respectively (P = 0.002). The patient satisfaction score after six months showed significant improvement from baseline (p = 0.001). Conclusion: The novel technique restores rectovaginal septum and extirpates the rectal defect. The functional results are favorable, with low morbidity and few complications related to the use of mesh. (AU)

A first-stage approximation to identify new imprinted genes through sequence analysis of its coding regions.

In the present study, a positive training set of 30 known human imprinted gene coding regions are compared with a set of 72 randomly sampled human nonimprinted gene coding regions (negative training set) to identify genomic features common to human imprinted genes. The most important feature of the present work is its ability to use multivariate analysis to look at variation, at coding region DNA level, among imprinted and non-imprinted genes. There is a force affecting genomic parameters that appears through the use of the appropriate multivariate methods (principle components analysis (PCA) and quadratic discriminant analysis (QDA)) to analyse quantitative genomic data. We show that variables, such as CG content, [bp]% CpG islands, [bp]% Large Tandem Repeats, and [bp]% Simple Repeats, are able to distinguish coding regions of human imprinted genes.

Specific gene hypomethylation and cancer: new insights into coding region feature trends.

Giving coding region structural features a role in the hypomethylation of specific genes, the occurrence of G+C content, CpG islands, repeat and retrotransposable elements in demethylated genes related to cancer has been evaluated. A comparative analysis among different cancer types has also been performed. In this work, the inter-cancer coding region features comparative analysis carried out, show insights into what structural trends/patterns are present in the studied cancers.

Simultaneous horizontal gene transfer of a gene coding for ribosomal protein l27 and operational genes in Arthrobacter sp.

Phylogenetic analysis of bacterial L27 ribosomal proteins showed that, against taxonomy, the L27 protein from the Actinobacteria Arthrobacter sp. clusters with protein sequences from the Bacillus group. The L27 gene clusters in the Arthrobacter sp. genome with six genes responsible for creatinine and sarcosine degradation. Phylogenetic analyses of orthologue proteins encoded by three of these genes also showed a phylogenetic relationship with Bacillus species. Comparisons between the synonymous codon usage of the Arthrobacter sp. genes and those from complete genomes showed that Arthrobacter genes encoding the L27 ribosomal protein and the proteins responsible for the degradation of creatinine and sarcosine have a codon usage that is more similar to that of Bacillus species than that of Arthrobacter. We suggest that the Arthrobacter sp. genes encoding the L27 ribosomal protein and the proteins responsible for the degradation of creatinine and sarcosine were acquired simultaneously through horizontal gene transfer from an unknown Bacillus species.

Análisis de variables clínico patológicas relacionadas con la presencia de metástasis ganglionar en la resección electiva del cáncer de colon / Analysis of clinic and pathological variables associated with lymph nodes metastases in elective colon cancer surgery

Objetivo: Analizar los factores clínico patológicos relacionados a la presencia de ganglios metastáticos en pacientes intervenidos electivamente con diagnóstico de cáncer de colon. Pacientes y Métodos: Entre Enero de 2001 y Diciembre de 2006 se realizaron 189 cirugías electivas por cáncer de colon en el Sector de Coloproctología de nuestro hospital; 141 pacientes se analizan en este trabajo, 54 por ciento de sexo masculino, con una edad promedio de 67,2 (28-87) años. Las variables estudiadas fueron edad, sexo, localización, grado de diferenciación celular, penetración tumoral, carácter mucinoso, crecimiento y estadío tumoral. Dichos factores se compararon entre pacientes con ganglios metastásicos y sin metástasis ganglionares. La técnica quirúrgica se realizó según las normativas actuales. Las piezas fueron analizadas por el mismo equipo de anatomopatólogos. Resultados: Los pacientes con metástasis ganglionares representaron el 42,5 por ciento (60). La asociación de distintas variables con la presencia de metástasis ganglionares fue significativa para la presencia de componente mucinoso (p=0,002), bajo grado de diferenciación celular (p=0,000) y mayor penetración tumoral (p=0,0004). El análisis de regresión mostró para los tumores mucinosos OR=3.7 (IC 95 per cent: 1,53-8,9), con mayor profundidad de penetración OR=4.69 (IC 95 per cent: 1,9-11) y bajo grado de diferenciación OR=8.18 (IC 95 per cent: 2,8-23,3). Conclusión: La presencia de componente mucinoso, bajo grado de diferenciación celular y la mayor penetración tumoral demostraron ser factores de riesgo asociados a la presencia de ganglios positivos en la pieza.

Objective: To analyze the association between clinic and pathologic variables with the presence of positive lymph nodes in patients operated of colon cancer. Patients and Methods: From January 2001 to December 2006, 189 elective surgeries for colon cancer were done at our institution; 141 patients were analyzed in this study, 54 per cent males, average age was 67,2 (28-87) years. The variables included were age, sex, localization, cytologic degree, tumor penetration, mucinous component, type of growth and tumor stage. Those variables were compared between patients with lymph nodes metastases and without it. Surgery procedure was accorded to actual guidelines. Tumour specimens were studied by the same group of pathologiest. Results: Patients with lymph nodes metastases represents 42,5 per cent (60). The variables association with the presence of positive lymph nodes in the specimen showed statistic significance for mucinous component (p=0,002), low cytologic differentiation (p=0,000) and deepest wall penetration (p=0,0004). Unilogistic regression demonstrated an OR=3.7 (IC 95 per cent: 1,53-8,9) for mucinous tumours, OR=4.69 (IC 95 per cent: 1,9-11) for deepest wall penetration and OR=8.18 (IC 95 per cent: 2,8-23,3) for low cytologic degree of differentiation. Conclusion: The presence of extensive mucinous component, low cytologic degree of differentiation and deepest wall penetration represents risk factors for positive lymph nodes in the tumour specimen.

Tratamiento de hemorroides sintomáticas grado III y IV mediante macroligadura elástica como práctica de consultorio / Office treatment of advanced symptomatic hemorrhoidal disease using macro banding technique

Introducción: La enfermedad hemorroidal es frecuente en nuestro medio. Existen diversos métodos para controlar sus síntomas, incluyendo la colocación de bandas elásticas que se reserva para hemorroides grado II y III poco voluminosas sangrantes. En hemorroides grado III-IV la resolución suele ser quirúrgica requiriendo anestesia, internación y habitualmente poco confortable para el paciente. Objetivo: Determinar la factibilidad del tratamiento ambulatorio de hemorroides grado III y IV mediante la aplicación de macroligaduras elásticas. Pacientes y Métodos: Entre Febrero y Junio de 2008 se evaluaron 82 pacientes tratados en consultorio mediante macroligadura de hemorroides sintomáticas avanzadas. El procedimiento se realizó en consultorio, bajo anestesia local, hasta 3 bandas en forma simultánea y los controles a las 72 horas, 7º, 14º, y 21º días. Resultados: Se trataron dos y tres paquetes en el 50 y 17 por ciento de casos. La tolerancia al procedimiento fue buena en el 83 por ciento. El tiempo promedio fue 12.7 minutos. 34 por ciento refirió dolor leve en las 72 horas asociado a hipertonía esfinteriana (p<0.000) y paquetes mayores o iguales a 2 cm3 (p=0.04). 25.6 por ciento de los pacientes refirieron sangrado escaso en las primeras 72 horas. No se registraron complicaciones sépticas. El tiempo promedio de reinserción laboral fue 2,24 (r= 0.5-6) días. Conclusiones: El tratamiento ambulatorio de la enfermedad hemorroidal avanzada mediante macroligadura elástica en consultorio es seguro, confortable y permite una rápida reinserción laboral.

Background: Hemorrhoidal disease is very frequent. For the control of symptoms, diverse methods have been developed including hemorrhoids banding in grade II-III not voluminous and with bleeding as principal symptom. Usually, in advanced (grade III and IV) disease surgical resolution is necessary, with the need of anesthesia, hospitalization, and not much comfortable for the patient. Aim: To determinate the feasibility of office ambulatory macro banding in the treatment of advanced hemorrhoidal disease (grade III-IV). Patients and methods: Eighty two patients treated with macro banding for advanced hemorrhoidal disease were evaluated between February and June from 2008. The procedure was done in the office, under local anesthesia, with simultaneous banding if necessary and with controls at 72 hours, 7º, 14º and 21º day post procedure. Results: Two and three banding was done in 50 and 17 per cent respectively. Eighty three percent referred good tolerance for the procedure. Mean time of the procedure was 12.7 minutes. In 34 per cent of patients light pain sensation was referred in the first 72 hours associated with esphinteric hypertonic (p <0.000) and the treatment of hemorrhoids bigger than 2cm3 (p 0.04). In 25.6 per cent of patients minimal bleeding was observed in to the first 72 hours. No septic complications were observed. Mean time for labor return was 2.24 (range: 0.5-6) days. Conclusion: Office ambulatory treatment of advanced hemorrhoidal disease using macro banding technique is safe, comfortable and allows a faster recover for working.