New-onset cardiac mass due to left atrial appendage inversion during cardiac surgery.

Cardiac mass assessment is challenging in the intraoperative scenario. We present the case of a 22-year-old woman with a new-onset left atrial mass during cardiopulmonary bypass following closure of a ventricular septal defect. We discuss the role of intraoperative echocardiographic examination, the differential diagnosis, and raise awareness of the left atrial appendage as a rare etiology of an acute left atrial mass.

Robotic Cardiac Surgery in Colombia: Overcoming the Challenges of a Middle-income Setting.

In developing countries, limited resources and low health budgets result in slow developments in the field of cardiac surgery. As a consequence, advances in surgery become a challenging process. In Colombia, most institutions do not have the capacity or infrastructure for minimally invasive and video-assisted cardiac surgery, let alone robotic assisted cardiac surgery (RACS). Despite the challenges, efforts to overcome these hurdles are critical for the future of cardiac surgery in low-income settings. Here we describe the first cases of robotic cardiac surgeries performed in Colombia.

Robotic cardiac surgery in Colombia: overcoming the challenges of a middle-income setting

Abstract In developing countries, limited resources and low health budgets result in slow developments in the field of cardiac surgery. As a consequence, advances in surgery become a challenging process. In Colombia, most institutions do not have the capacity or infrastructure for minimally invasive and video-assisted cardiac surgery, let alone robotic assisted cardiac surgery (RACS). Despite the challenges, efforts to overcome these hurdles are critical for the future of cardiac surgery in low-income settings. Here we describe the first cases of robotic cardiac surgeries performed in Colombia.

Surgical removal of intravascular leiomyomas with intracardiac extension: A two-case report.

Leiomyomatosis is a uterine condition that can rarely present with extrauterine involvement. Intravenous and intracardiac extensions are extremely rare presentations and, in these cases, the intra-cardiac mass may be confused with a cardiac myxoma and can be associated with pulmonary embolism. Here we report two cases of successful surgically removed intracardiac leiomyomas under cardiopulmonary bypass.

Aneurisma de la arteria coronaria derecha: Revisión de la literatura y reporte de casos / Aneurysm of the right coronary artery: Literature review and cases report

El aneurisma de la arteria coronaria derecha es una entidad rara, que se presenta principalmente en mujeres. Las causas más frecuentes de muerte por aneurisma son en su orden: ruptura, trombosis, isquemia. La enfermedad aterosclerótica es la causa más frecuente de aneurisma espontáneo. La mayoría de los pacientes son asintomáticos, y presentan soplo continuo o moderada cardiomegalia, y plétora en la radiografía de tórax. En etapas avanzadas produce cardiopatía isquémica. Para su diagnóstico es necesario un juicio clínico adecuado y exámenes de rutina para enfermedad coronaria. Se exponen dos casos tratados en la Fundación Clìnica A. Shaio, con base en los cuales se analiza el diagnóstico, las complicaciones y el tratamiento realizado.

The aneurysm of the right coronary artery is a rare entity, which occurs primarily in women. The most frequent causes of death in these aneurysms are in its order: rupture, thrombosis and ischemia. Atherosclerotic disease is the most frequent cause of spontaneous aneurysm. Most patients are asymptomatic and have a continuous murmur or moderate cardiomegaly and plethora on chest X-ray. In advanced stages it causes ischemic heart disease. Its diagnosis requires an adequate clinical judgment and routine tests for coronary artery disease.

Anomalía del retorno venoso sistémico. Drenaje anómalo de la vena cava superior derecha a la aurícula izquierda: revisión de la literatura y reporte de caso / Anomalous systemic venous return. Anomalous drainage of the right superior vena cava into the left atrium: review of literature and case report

La anomalía total del retorno venoso sistémico tiene gran variedad de presentaciones; sin embargo, la patología de más baja frecuencia es el drenaje de vena cava superior derecha a la aurícula izquierda, hecho de peso para que en el mundo se reporten pocos casos. En la Fundación Clínica Abood Shaio se trató el caso de una paciente de seis años de edad con drenaje venoso total de cava superior derecha a la aurícula izquierda, mediante la técnica de movilización de cava superior y anastomosis cavo-atrial, y se obtuvieron buenos resultados. El caso es mención corresponde al número 21 en la literatura mundial.

Total anomalous systemic venous return has a variety of presentations, being the drainage of right superior vena cava into the left atrium a low frequency condition. There are few reported cases in the world. In Shaio Clinic Foundation we have handled a case of total venous drainage of the right superior vena cava into the left atrium in a 6-year old girl, using the superior vena cava mobilization technique and cavo-atrial anastomosis, with good results. This case is reported as case number 21 in the world.

Stray dogs as reservoirs of the zoonotic agents Leptospira interrogans, Trypanosoma cruzi, and Aspergillus spp. in an urban area of Chiapas in southern Mexico.

This investigation determined the presence and prevalence of the zoonotic agents Leptospira interrogans, Trypanosoma cruzi, and Aspergillus spp. in the stray dog population (a total of 224 stray dogs) in an urban area of Southern Mexico. Blood serum samples were taken from all dogs, and root hair samples were taken from dogs with skin lesions and partial alopecia. IgG antibodies for L. interrogans from 10 serovars were detected using the microscopic agglutination test. Immunofluorescence antibody test and Western blot assay were used for serologic diagnosis of T. cruzi. The Sabouraud medium was used to isolate Aspergillus spp. Prevalence of L. interrogans was 4.9%, which was determined by identifying only serovars Pyrogenes, which accounted for 3.6%, and Tarassovi, which constituted 1.3%, with titers from 1:100 to 1:800. Additionally, T. cruzi antibodies were detected in 4.5% of the dogs. Skin lesions were found in 43% of the dogs (98/224), and 35 cultures were positive for Aspergillus spp. (35.7%, p < 0.05, 95% confidence interval 2.45-3.67), identified as A. niger (82.8%), A. flavus (14.3%), and A. terreus (2.9%). This study demonstrates the presence of certain zoonotic agents (bacteria, protozoa, and fungi) in stray dogs living within the studied area. Dogs play an important role in the transmission of diseases that are potentially harmful to humans. Although the prevalence of canine leptospirosis and trypanosomiasis is not high in Southern Mexico compared with other tropical regions of Mexico, the presence of these zoonotic agents in the stray dog population demonstrates that the stray dog population in this region is a significant reservoir and potential source of infection in humans. Special care should be taken when handling stray dogs that exhibit skin lesions with partial alopecia, since a pathological Aspergillus sp. fungus may be present.

Susceptibility of colorectal cancer cells to Sindbis virus infection.

Sindbis virus (SIN), a member of the Togaviridae family, infects a broad range of cells and has been shown to be an effective anti-tumor agent. The infection efficiency of the virus, however, varies greatly among target cells. In this report, we compared the ability of SIN to infect colorectal cancer cells and cells of other cancer origin. While tumor cells from breast, leukemia, and prostate cancers were largely resistant to SIN infection, nine of the ten colorectal cancer cell lines tested were sensitive to SIN infection. Moreover, SIN susceptibility correlated with the metastatic potential of the colorectal cancer cells. Two highly aggressive and invasive cell lines, SW620 and COLO-320DM were the most sensitive to SIN infection. Similarly, SIN preferentially targeted metastatic tumor cells in a mouse xenograft model for colon cancer progression. The higher infection rate was not due to increased expression of the 67kD laminin receptor, a specific receptor for SIN infection, although viral attachment and entry were markedly enhanced in SW620 cells. These results suggest that SIN may employ a novel cell attachment/entry mechanism during infection, allowing selective targeting of colorectal cancer cells.

Clinical and functional characterization of a human ORNT1 mutation (T32R) in the hyperornithinemia-hyperammonemia-homocitrullinuria (HHH) syndrome.

We studied two related families (HHH013 and HHH015) with the hyperornithinemia-hyperammonemia-homocitrullinuria (HHH) syndrome, a disorder of the urea cycle and ornithine degradation pathway, who have the same novel ornithine transporter (ORNT1) genotype (T32R) but a variable phenotype. Both HHH015 patients are doing well in school and are clinically stable; conversely, the three affected HHH013 siblings had academic difficulties and one suffered recurrent episodes of hyperammonemia and ultimately died. Overexpression studies revealed that the product of the ORNT1-T32R allele has residual function. Ornithine transport studies in HHH015 fibroblasts, however, showed basal activity similar to fibroblasts carrying nonfunctional ORNT1 alleles. We also examined two potential modifying factors, the ORNT2 gene and the mitochondrial DNA lineage (haplogroup). Haplogroups, associated with specific diseases, are hypothesized to influence mitochondrial function. Results demonstrated that both HHH015 patients are heterozygous for an ORNT2 gain of function polymorphism and belong to haplogroup A whereas the HHH013 siblings carry the wild-type ORNT2 and are haplogroup H. These observations suggest that the ORNT1 genotype cannot predict the phenotype of HHH patients. The reason for the phenotypic variability is unknown, but factors such as redundant transporters and mitochondrial lineage may contribute to the neuropathophysiology of HHH patients.

Parásitos del tapir centroamericano Tapirus bairdii (Perissodactyla: Tapiridae) en Chiapas, México / Parasites of the Central American tapir Tapirus bairdii (Perissodactyla: Tapiridae) in Chiapas, Mexico

We analyzed 19 samples of Baird's tapir feces from La Sepultura Biosphere Reserve, collected between March and July 1999. We also took samples directly from a male tapir captured at the Montes Azules Biosphere Reserve. Both reserves are in Chiapas, Mexico. We used five techniques: flotation, MacMaster, micrometric, Ritchie's sedimentation and Ferreira's quantitative. In addition, we collected ectoparasites from animals captured in both reserves and from a captive couple from Tuxtla Gutierrez, Chiapas. These nematodes and protozoans were found: Agriostomun sp., Lacandoria sp., Neomurshidia sp., Trichostrongylus sp., Strongylus sp., Brachylumus sp, and an unidentified species of ancilostomaide. We also found Eimeria sp. and Balantidium coli, as well as the mites Dermacentor halli, Dermacentor latus, Amblyomma cajannense, Amblyomma coelebs, Amblyomma ovale, Anocentor nitens and Ixodes bicornis.

Se recolectaron 19 muestras de excretas del tapir centroamericano (Tapirus bairdii) en la Reserva “La Sepultura” (marzo a julio de 1999), así como un muestreo directo a un tapir macho de la Reserva “Montes Azules” (Chiapas, México). Se analizaron con cinco técnicas (flotación, MacMaster, micrometría, sedimentación de Ritchie y cuantitativa de Ferreira). Además se recolectaron muestras en piel de animales capturados en en las dos reservas y en una pareja de zoológico proveniente de Tuxtla Gutiérrez, Chiapas. Se hallaron nematodos y protozoarios: Agriostomun sp., Lacandoria sp., Neomurshidia sp., Trichostrongylus sp., Strongylus sp., Brachylumus sp., y un ancilostomaideo aun por identificar. Además se informa la presencia de Eimeria sp., y Balantidium coli. Los ácaros hallados fueron; Dermacentor halli, Dermacentor latus, Amblyomma cajannense, Amblyomma coelebs, Amblyomma ovale, Anocentor nitens e Ixodes bicornis.

[Parasites of the Central American tapir Tapirus bairdii (Perissodactyla: Tapiridae) in Chiapas, Mexico]. / Parásitos del tapir centroamericano Tapirus bairdii (Perissodactyla: Tapiridae) en Chiapas, México.

We analyzed 19 samples of Baird's tapir feces from La Sepultura Biosphere Reserve, collected between March and July 1999. We also took samples directly from a male tapir captured at the Montes Azules Biosphere Reserve. Both reserves are in Chiapas, Mexico. We used five techniques: flotation, MacMaster, micrometric, Ritchie's sedimentation and Ferreira's quantitative. In addition, we collected ectoparasites from animals captured in both reserves and from a captive couple from Tuxtla Gutierrez, Chiapas. These nematodes and protozoans were found: Agriostomun sp., Lacandoria sp., Neomurshidia sp., Trichostrongylus sp., Strongylus sp., Brachylumus sp, and an unidentified species of ancilostomaide. We also found Eimeria sp. and Balantidium coli, as well as the mites Dermacentor halli, Dermacentor latus, Amblyomma cajannense, Amblyomma coelebs, Amblyomma ovale, Anocentor nitens and Ixodes bicornis.

Cloning and characterization of human ORNT2: a second mitochondrial ornithine transporter that can rescue a defective ORNT1 in patients with the hyperornithinemia-hyperammonemia-homocitrullinuria syndrome, a urea cycle disorder.

We recently characterized the mitochondrial ornithine transporter (ORNT1), the gene defective in the hyperornithinemia-hyperammonemia-homocitrullinuria (HHH) syndrome, a urea cycle disorder. Despite the apparent functional ablation of ORNT1 in 10 French-Canadian probands with the ORNT1-F188 Delta allele, these patients are mildly affected when compared to patients with other urea cycle disorders such as deficiency of ornithine transcarbamylase. Given that the inner mitochondrial membrane is impermeable to solutes, we hypothesize that other unidentified carriers have some degree of functional redundancy with ORNT1. Using conserved sequences of mammalian and fungal mitochondrial ornithine transporters, we screened the Expressed Sequence Tag database for additional transporters belonging to the ORNT subfamily. Here we identify a new intronless gene, ORNT2, located on chromosome 5. The gene product of ORNT2 is 88% identical to ORNT1, targets to the mitochondria and is expressed in human liver, pancreas, kidney, and cultured fibroblasts from control and HHH patients. When ORNT2 is overexpressed transiently in cultured fibroblasts from HHH patients, it rescues the deficient ornithine metabolism in these cells. Our results suggest that ORNT2 may in part be responsible for the milder phenotype in HHH patients secondary to a gene redundancy effect. We believe ORNT2 arose from a retrotransposition event. To our knowledge, this is the first report of a functional retroposon (ORNT2) that can rescue the disease phenotype of the gene it arose from, ORNT1. As such, ORNT2 may eventually become a candidate for pharmacological-based approaches to correct a urea cycle disorder.

Identification of t(15;17) and a segmental duplication of chromosome 11q23 in a patient with acute myeloblastic leukemia M2.

A 32-year-old man was newly diagnosed with acute myelocytic leukemia, classified as acute myeloblastic leukemia with maturation (AML-M2) according to the French-American-British classification system. Conventional chromosome analysis before chemotherapy treatment revealed an abnormal karyotype: a possible segmental duplication of 11q23, plus a translocation between chromosomes 15 and 17 [t(15;17) (q22;q21.1)] in the majority of cells analyzed. Fluorescence in situ hybridization analysis using commercially available probes confirmed the cytogenetic findings. To our knowledge, this is the first report of a combination of t(15;17) and a segmental duplication of 11q23 in a patient with AML-M2.

Leucemia linfoblástica aguda del adulto: experiencia del Instituto Nacional de Cancerología de 1983-1987 / Adult acute lymphoblastic leukemia: experience at the Instituto Nacional de cancerología, 1983 - 1987

De enero 1983 a diciembre de 1987 se diagnosticaron en el INCan, 40 casos nuevos de leucemia linfoblástica aguda. Correspondieron a 20 hombres y 20 mujeres con edad media de 20.5 años (extremos 13-41 años). Seis pacientes se excluyeron del análisis, tres pacientes fallecieron sin recibir tratamiento y tres murieron en las primeras 96 horas de la inducción. Veintiocho recibieron tratamiento de inducción con esquema HOP: doxorrubicina, vincristina, prednisona y seis recibieron el esquema LSA2L2: ciclofosfamida, vincristina, adriamicina y prednisona, La profilaxis al SNC fue irregular. Se administró un tratamiento de mantenimiento convencional por dos ó tres años con pulsos mensuales de vincristina, prednisona, metotrexato semanal y 6-mercapturina diariamente. En los pacientes que recibieron LSA2L2, se intensificó con ciclos mensuales y alternos de Ara-C, ciclofosfamida y adriamicina. En 34 casos evaluables, 19 (56 por ciento) alcanzaron respuesta completa, seis (16.5 por ciento) respuesta parcial y nueve (26.5 por ciento) fallecieron durante la inducción. La respuesta completa en 9/19 pacientes, se alcanzó en las primeras cuatro semanas con una mediana de seguimiento de 319 días (141-1736+). Sólo dos pacientes continúan vivos en primera respuesta completa. Un paciente, falleció por causa no relacionada con la LLA y otro está perdido para seguimiento, ambos con respuesta completa. Se analizan las causas de muerte durante la inducción y el bajo porcentaje de sobrevivientes libres de enfermedad a largo plazo