Ligand and metal-centred reactivity in 2,6-bis(imino)-1,4-dihydropyridinate Zn(II) alkyls: the dual behaviour of an intriguing type of complex.

Dihydropyridines, either free or metal-coordinated, are organic hydride transfer reductants that perform on the same premises as the natural redox cofactor NAD(P)+/NAD(P)H. 1-Bn and 1-Me are alkylzinc complexes containing dihydropyridinate-based pincer ligands that have been synthesized through different routes involving the addition of ZnR2 (R = Bn, Me) to the 2,6-bis(imino)-pyridine and 2,6-bis(imino)-4-Bn-dihydropyridine (iPrBIP and 4-BniPrBIPH2) ligands, respectively. The alkyls complexes 1-R react with fluorinated alcohols RFOH (RF = C6F5 or t-C4F9) yielding isolable fluoroalkoxides 2-F5 and 2-F9, in which the reactive 1,4-dihydropyridinate ligand remains unchanged. The crystal structure of 2-F5 shows the shortest Zn⋯F-C interaction reported so far, involving one of the o-F atoms of the C6F5 group. However, the mechanism of the alcoholysis reactions is not straightforward, as NMR monitoring revealed that acidic RFOH first protonates the dihydropyridine nitrogen, releasing the dihydropyridine base 4-BniPrBIPH2 and a highly reactive Zn(R)(ORF) species that re-captures the dihydropyridine in a subsequent step, eliminating the corresponding alkane (R-H). Depending on the mixing conditions, the pincer dihydropyridinate ligand may undergo aromatization to produce the new Zn(II) dialkoxides 3-F5 and 3-F9 stabilised by a neutral iPrBIP ligand [(4R-iPrBIP)Zn(ORF)2]. These protonation and hydride transfer reactions illustrate the dual reactivity of the pincer 1,4-dihydropyridinate zinc entity.

Association between adiposity levels and cognitive impairment in the Chilean older adult population.

Although both obesity and ageing are risk factors for cognitive impairment, there is no evidence in Chile on how obesity levels are associated with cognitive function. Therefore, the aim of the present study was to investigate the association between adiposity levels and cognitive impairment in older Chilean adults. This cross-sectional study includes 1384 participants, over 60 years of age, from the Chilean National Health Survey 2009-2010. Cognitive impairment was evaluated using the Mini-Mental State Examination. BMI and waist circumference (WC) were used as measures of adiposity. Compared with people with a normal BMI, the odds of cognitive impairment were higher in participants who were underweight (OR 4·44; 95 % CI 2·43, 6·45; P < 0·0001), overweight (OR 1·86; 95 % CI 1·06, 2·66; P = 0·031) and obese (OR 2·26; 95 % CI 1·31, 3·21; P = 0·003). The associations were robust after adjustment for confounding variables. Similar results were observed for WC. Low and high levels of adiposity are associated with an increased likelihood of cognitive impairment in older adults in Chile.

Asymmetrical size and functionality of the pampas deer (Ozotoceros bezoarticus) testes: Right testis is bigger but left testis is more efficient in spermatogenesis.

Information about gonadal asymmetries in ruminants is very scarce. In this work, we performed three complementary studies to compare characteristics of both testes: (i) weight and size of offspring and adult dead males; (ii) the tissue:fluid relationship determined by ultrasound scanning; and (iii) the spermatogenic status using fine needle aspiration cytology. The right testis was heavier than the left one in both offspring and adult animals and had greater width and volume in adult males than the left one. The ultrasound pixel intensity was similar in both testes. The right testis tended to have more spermatogonia (p = .06) and had a greater percentage of early spermatids (p = .004) than the left testis. On the other hand, the left testis had a greater percentage of spermatozoa (p = .05). The left testis had a greater spermatozoa/spermatogonia ratio (p = .02) and tended to have more spermatozoa/Sertoli cells ratio (p = .07). The spermatogenic index tended to be greater in the left than in the right testis (p = .06). Overall, we concluded that the right testis of pampas deer males is bigger but according to the cytology, it seems to be less spermatogenically effective than the left one, but these differences are not explained by different tissue:fluid ratio in each testis. Although differences were greater in adults than in offspring, asymmetry was observed even in just born offspring.

Antler velvet is thicker in adult than in yearling pampas deer (Ozotoceros bezoarticus): a histological study.

BACKGROUND: Antlers are lined by soft velvet tissue during antler growth. Later, the velvet is shed before rut onset. There are no detailed histological descriptions of the growing velvet, nor whether the velvet changes according to stag age. Our aims were to: 1) describe the basic histology of pampas deer antler velvet from adult and yearling males; and 2) determine the influence of age and time of antler growth on velvet's tissues morphometry. MATERIALS AND METHODS: Samples were collected from 10 stags allocated in two groups, either adult (3-5 years old, n = 5) or yearling males (2 years old, n = 5). The day of antler cast was recorded for each animal. In spring, the stags were anaesthetised and velvet samples were collected from the third tine's distal end. Samples were described qualitatively and a restricted morphometrical analysis of the antler velvet was performed. RESULTS: The number of keratinocyte layers and the thicknesses of: total epidermis, corneum, intermediate and basale epidermal strata, total dermis, superficial and deep dermis were determined. Age and days after antler casting positively influenced in conjunction epidermal thickness (p = 0.037), and tended to influence both stratum intermedium (p = 0.076) and stratum corneum (p = 0.1) thicknesses. Age influenced stratum corneum thickness (p = 0.04). The pampas deer antler velvet lacked both sweat glands and arrector pili muscles. CONCLUSIONS: The deep dermis was densely irrigated but displayed abundant and well developed collagen bundles. Both total epidermal and stratum corneum thicknesses related positively to the age of the animals but were not to the time since antler cast.

Species From the Heliothinae Complex (Lepidoptera: Noctuidae) in Tucumán, Argentina, an Update of Geographical Distribution of Helicoverpa armigera.

The Heliothinae complex in Argentina encompasses Helicoverpa gelotopoeon (Dyar), Helicoverpa zea (Boddie), Helicoverpa armigera (Hübner), and Chloridea virescens (Fabricius). In Tucumán, the native species H. gelotopoeon is one of the most voracious soybean pests and also affects cotton and chickpea, even more in soybean-chickpea succession cropping systems. Differentiation of the Heliothinae complex in the egg, larva, and pupa stages is difficult. Therefore, the observation of the adult wing pattern design and male genitalia is useful to differentiate species. The objective of this study was to identify the species of the Heliothinae complex, determine population fluctuations of the Heliothinae complex in soybean and chickpea crops using male moths collected in pheromone traps in Tucuman province, and update the geographical distribution of H. armigera in Argentina. The species found were H. gelotopoeon, H. armigera, H. zea, and C. virescens. Regardless of province, county, crop, and year, the predominant species was H. gelotopoeon Considering the population dynamics of H. gelotopoeon and H. armigera in chickpea and soybean crops, H. gelotopoeon was the most abundant species in both crops, in all years sampled, and the differences registered were significant. On the other hand, according to the Sistema Nacional Argentino de Vigilancia y Monitoreo de Plagas (SINAVIMO) database and our collections, H. armigera was recorded in eight provinces and 20 counties of Argentina, and its larvae were found on soybean, chickpea, sunflower crops and spiny plumeless thistle (Carduus acanthoides). This is the first report of H. armigera in sunflower and spiny plumeless thistle in Argentina.

Biological parameters of interbreeding subspecies of Meccus phyllosomus (Hemiptera: Reduviidae: Triatominae) in western Mexico.

Understanding the biological parameters of some triatomine subspecies of Meccus phyllosomus (Burmeister) is a crucial first step in estimating the epidemiological importance of this group. Biological parameters related to egg eclosion, egg-to-adult development time, number of blood meals to moult, percentage of females at the end of the cycle, number of laid eggs, and the accumulative mortality for each instar of three M. phyllosomus subspecies [Meccus phyllosomus pallidipennis (Stål), Meccus phyllosomus longipennis (Usinger), and Meccus phyllosomus picturatus (Usinger)] as well as their laboratory hybrids were evaluated and compared. No significant differences (P > 0.05) were recorded among the experimental hybrids (M. p. longipennis × M. p. pallidipennis, M. p. longipennis × M. p. picturatus, M. p. pallidipennis × M. p. picturatus) and reciprocal cohorts. In five of the six studied parameters (egg eclosion, egg-to-adult development time, number of blood meals to moult, number of laid eggs and accumulative mortality), with the exception of the non-significant percentage of females obtained among all the studied cohorts, at least one of the parental cohorts in each set of crosses exhibited better fitness results than by those of their hybrid descendants. The lack of hybrid fitness in our study indicates the maintenance of reproductive isolation of parental genotypes. Moreover, the results lead us to propose that an incipient speciation process by distance is currently developing among the three studied subspecies, increasing the differences between them that modify the transmission efficiency of Trypanosoma cruzi to human beings in Mexico.

Biological characteristics of geographically isolated populations of Meccus mazzottii (Hemiptera: Reduviidae) in southern Mexico.

Chagas disease, caused by Trypanosoma cruzi Chagas, is one of the most epidemiologically important vector-borne zoonoses in Mexico. Among the 32 reported triatomine species from Mexico, Meccus mazzottii (Usinger) (Hemiptera: Reduviidae) is one of the most important vectors of T. cruzi in the southern part of the country. Variability among populations of triatomines has been recorded for several species (Meccus longipennis (Usinger) and Meccus pallidipennis (Stal)) that are closely related to M. mazzottii, showing an apparent influence of local environmental conditions on the biology of each population, which could modify the impact of vector control measurements. Therefore, this study sought to compare the biological features of populations of M. mazzottii from two geographically far apart areas that have similar environmental characteristics and to compare populations from close geographical areas that have different environmental characteristics. The mean longevity, percentages of mortality of nymphs, the total mean number of bloodmeals to molt (considered instar by instar), the mean number of eggs laid by females, and the percentage of hatched eggs were similar between the two localities that are geographically far apart but have similar environmental characteristics. On the other hand, important differences were noticed when a comparison was carried out on the two localities with similar environmental conditions with respect to that locality with different conditions, independent of geographic distance. Most of the studied parameters led us to conclude that the three studied populations are very highly influenced by local environmental conditions. The results of this study indicate the importance of studying the biological characteristics of local populations of triatomines to carry out specific control measurements, instead of using standard ones that could fail if they are not adapted to the target population.

Permanent contact with females increases testosterone and improves fresh semen traits in pampas deer (Ozotoceros bezoarticus) males.

Socio-sexual signals can stimulate neuroendocrinal control of reproduction. The aim of this work was to test the hypothesis that permanent and close contact with females stimulates testosterone production and enhances fresh seminal characteristics of pampas deer males. Five adult males (group CF) were established in a paddock in five breeding groups each comprising one stag and between five and ten hinds. Six adult males (group IS) were held in another paddock without any direct contact with females. Fecal testosterone concentrations were determined for each male, weekly, from October to May. Semen was collected by electro-ejaculation and evaluated before and after the addition of diluents [November: Fructose-Tris-Glycine with 20% egg yolk (FTG); April: Andromed]. Males in contact with females from mid-December to February exhibited significantly (P=0.04) greater concentrations of testosterone than those without. In November, CF males ejaculated semen of significantly (P=0.03) higher quality, with a significantly (P=0.02) greater proportion of progressive motile spermatozoa than IS males. After dilution with FTG, semen from the CF males had greater quality (P=0.04), a greater percentage of motile spermatozoa (P=0.04), spermatozoa with progressive motility (P=0.01), and spermatozoa with intact acrosomes (P=0.03). Semen from CF males also had lower fractions of spermatozoa with damaged acrosomes (P=0.04). In April, there were no significant differences in semen properties between the two groups. After the addition of extender, semen from CF males had a greater percentage of spermatozoa with damaged acrosomes (P=0.04). It is concluded that contact with females stimulates reproductive patterns of male pampas deer, resulting in better fresh semen characteristics before rutting and higher testosterone concentrations during the rut.

Export of commercial Hass avocados from Argentina poses negligible risk of Ceratitis capitata (Diptera: Tephritidae) infestation.

Argentina has to meet quarantine restrictions because of the Mediterranean fruit fly, Ceratitis capitata (Wiedemann) (Diptera: Tephritidae), to export 'Hass' avocados, Persea americana Miller, to certain countries. Hass avocado at the hard, mature green stage is potentially a conditional nonhost for C. capitata and could open export markets without the need for a quarantine treatment. Trapping data from 1998 to 2006 showed that C. capitata was present in avocado orchards, particularly early in the harvest season. The host status of hard, mature green Hass avocado to C. capitata was evaluated using laboratory and field cage tests under no-choice conditions and by assessing natural levels of infestation in commercially harvested fruit from the main avocado production area. In total, 2,250 hard, mature green avocado fruit were exposed to 11,250 gravid females for 24 or 48 h after harvest in laboratory or field cages, and no infestations were found. During 11 seasons, 5,949 fruit in total were sampled from the trees and 992 fruit were collected from the ground, and in none of them were any live or dead fruit fly larvae found. Inspection of >198,000 commercial fruit at the packinghouse from 1998 to 2011 showed no symptoms of fruit fly infestation. These data exceed the published standards for determination of nonhost status, as well as the Probit 9 standard for development of quarantine treatments. Hass avocado harvested at the hard, mature green stage was not infested by C. capitata and seems to pose a negligible quarantine risk. As a consequence, no postharvest treatment or other quarantine actions should be required by importing countries.

Physiological and biochemical parameters in response to electroejaculation in adult and yearling anesthetized pampas deer (Ozotoceros bezoarticus) males.

The aim of this study was to characterize changes in physiological and biochemical parameters during electroejaculation (EE) under general anaesthesia in adult and yearling pampas deer males (Ozotoceros bezoarticus). The relation between heart rate, pulse rate, respiratory rate and oximetry with EE voltages was studied. The changes in cortisol, alkaline phosphatase, creatine kinase, aspartate aminotransferase and rectal temperature were determined before and after electroejaculation (BEE and AEE). Heart rate and pulse rate values increased during EE, with a greater increase in heart rate in adults (p < 0.01). Respiratory rate and SpO(2) were not affected by EE or category. The rectal temperature decreased in adults and yearlings during EE (p = 0.0001). Alkaline phosphatase, creatine kinase and aspartate aminotransferase concentrations increased AEE (p < 0.001, p < 0.01 and p < 0.05, respectively). Alkaline phosphatase and creatine kinase concentrations were greater in young than in adult males (p < 0.05). In conclusion, the EE under general anaesthesia in the pampas deer provoked increases in heart and pulse rates, as well as in creatine kinase, aspartate aminotransferase and alkaline phosphatase concentrations, and a decrease in rectal temperature in both categories. Oximetry values were especially low during the procedure. Heart rate increase was greater in adult males, and alkaline phosphatase and creatine kinase concentrations were greater in yearlings.

Renal Replacement Therapy in Acute Kidney Failure due to Rhabdomyolysis.

Rhabdomyolysis is a syndrome caused by skeletal muscle cells destruction which can occur for many reasons, including prolonged immobilization. The main complication of the syndrome is the development of acute renal failure. Rhabdomyolysis and myoglobinuria are responsible for approximately 5% of all causes of acute renal failure in the USA. The cause of rhabdomyolysis is often multifactorial, and approximately 8-20% of such patients develop myoglobinuric acute renal failure.

Seroprevalence to Trypanosoma cruzi in rural communities of the state of Querétaro (Mexico): statistical evaluation of tests.

OBJECTIVES: The detection of anti-Trypanosoma cruzi antibodies has become one of the priorities of the clinical establishments in the health sector, due both to the increase in positive cases found in transfusion centres as well as to the appearance of patients with characteristic Chagas cardiopathies that seek emergency treatment in the main hospitals of Querétaro (Mexico). DESIGN AND METHODS: The present study seeks to establish for the first time the infection level of Trypanosoma cruzi, in the rural communities of this state and implement the preventive measures necessary to control and/or eradicate this infection. A transversal study was conducted, examining seriologically 1029 blood samples of the inhabitants of rural areas of the state of Querétaro, to detect anti-Trypanosoma cruzi antibodies. RESULTS: The indirect serological diagnostic tests were indirect hemagglutination, enzymo-immunoenzymatic absorbent, recombinant ELISA, and indirect immunofluorescence. For the diagnostic evaluation of serological tests used, ELISA was considered the control test. CONCLUSIONS: The first conclusion was that the two tests with the greatest serological reactivity were ELISA and recombinant ELISA, followed by IFA and IHA, respectively, with the final percentage of positives being 6.6%, far above the national mean of seroprevalence in Mexico (1.6%). On the other hand, the sensitivity, specificity, VP+, VP-, percentage of concordance and Kappa index of the recombinant ELISA tests, IFA, and IHA were determined against the control ELISA. It was found that ELISA and recombinant ELISA presented a greater sensitivity level, as well as the highest values for the different parameters studied.

Cobertura con colgajo escrotal en desforramiento peneano: a propósito de dos casos / Scrotal fasciocutaneous flap coverage in degloving lesión of penis, report of two cases

Restablecer la cobertura cutánea en lesiones de urgencia es un desafío para el cirujano, más aún si se trata del pene, ya sea por desforramiento accidental o secundario a procesos sépticos de la región perineal. Se presentan 2 casos. El primero por lesión accidental en un menor de 9 años, quien pierde la totalidad de la piel peneana. El segundo caso en un paciente de 65 años, diabético e hipertenso que presentó un episodio de fasceítis necrotizante. En ambos casos se realiza una cobertura cutánea del defecto utilizando 2 colgajos fasciocutßneos de las bolsas escrotales. En el caso del ni±o, el defecto de cobertura creado en éstas se cubre con colgajo fasciocutáneo de la cara anterior del muslo, y éste último con un injerto dermoepidérmico de la extremidad contralateral, utilizando la misma técnica descrita para el menor. La técnica utilizada cumplió plenamente con los objetivos de realizar una cobertura adecuada, semejante a la piel original, sin interferir con el desarrollo sexual normal del menor y minimizando el trauma psicológico. En el paciente adulto los resultados funcionales y estéticos son adecuados. En la literatura revisada hay muy pocos casos clínicos con utilización de ésta técnica.

To restore the cutaneous coverage in urgency injuries is a challenge for the surgeon, even more if it is a question of cutaneous coverage of the penis, by accidental degloving or secondary to septic processes of perineal región. We present two cases. The first one is a 9 years oíd minor, who lost the totality of his penis skin by accidental injury. The second case is a diabetic and hypertense, 65 years oíd patient, who had an episode of necrotizing fasciitis. In both cases the defect was covered with 2 fasciocutaneous flaps from the scrotal bags. In the child case the defect created in this area was repaired by an antero-internal thigh fasciocutaneous flap and finally the thigh defect was covered by split-skin grafts taken from the contralateral lower limb. The used technique fulfilled the objectives to make a suitable cover and similar to original skin, without interfering with the normal sexual development of the minor and to attenuate the psychological trauma. In the adult patient the functional and aesthetic results are satisfactory. In reviewed Hterature, there are just a few cases of this surgical technique.

Embarazo y parto vaginal en primigesta posterior a reconstrucción mamaria con colgajo TRAM / Pregnancy and vaginal delivery after transverse rectus abdominis musculocutaneous flap for breast reconstruction: report of one case

Introducción: La reconstrucción mamaria con colgajo miocutáneo transverso de recto anterior del abdomen (TRAM), es un recurso disponible en la rehabilitación del cáncer mamario. Existe poca literatura respecto de los cambios que experimenta la pared abdominal previamente debilitada con una gestación. Nuestro objetivo es divulgar nuestra experiencia en una paciente nuligesta, reconstruida con colgajo TRAM y que presentó embarazo de término por parto vaginal, sin incidentes. Material y Método: Análisis retrospectivo de ficha clínica. Paciente de 29 años sometida a radioterapia preoperatoria y mastectomía derecha simple extendida por cáncer mamario. Se realizó reconstrucción mamaria al año, con colgajo TRAM; se utilizó músculo recto unilateral, sin malla protésica, a los tres meses se reconstruyó pezón con injerto de piel perineal con técnica Skate-Flap. Se embarazó sin planificación en el postoperatorio inmediato de la reconstrucción de pezón. Inicia controles en unidad de alto riesgo obstétrico al quinto mes de gestación. Desarrolló un embarazo sin complicaciones, teniendo un parto vaginal de término con recién nacido masculino vivo de 2720 grs. El último control se realizó a los seis años, libre de enfermedad y no encontrándose hernia de la pared abdominal. Conclusiones: Los cambios que experimentó el abdomen, durante la gestación no afectaron la pared debilitada por la ausencia de uno de los músculos rectos abdominales. Se cumplió el objetivo de la reconstrucción mamaria respecto de recuperar la feminidad alterada por una mastectomía. El caso advierte al equipo médico respecto de tomar las precauciones ante la fertilidad en una mujer sexualmente activa.

Mammary reconstruction using Transverse Rectus Abdominis Musculocutaneos Flap (TRAM) is successfully used for mammary reconstruction after breast cancer surgery. The absence of the anterior rectus muscle modifies the functional properties of the abdominal wall. There is little knowledge about what occurs with a debilitated abdominal wall during pregnancy after mammary reconstruction using a TRAM flap. We report a 29 years old patient, who was treated for breast cancer with preoperative radiotherapy and a right side mastectomy with lymphadenectomy. TRAM flap was done one year later; a single rectus abdominis was used and the abdominal wall was not reinforced with a mesh. After three months, the nipple was reconstructed with the skate flap technique. Although it was not planned, she got pregnant and did not search for obstetric assessment until the fifth month. She was followed at the high risk obstetric unit and no complications were observed in her abdominal wall. She had a vaginal delivery of a healthy full term male newborn weighing 2720 grams. Six years later, there was no evidence of abdominal wall complications. Therefore, abdominal stress during pregnancy did not affect the debilitated abdominal wall after rotation of the rectus abdominis muscle.

[Septic shock due to community-acquired complicated intra-abdominal infection treated with ertapenem: outcome in 25 cases]. / Resultados en 25 pacientes con shock séptico por infección intraabdominal complicada adquirida en la comunidad tratados con ertapenem.

OBJECTIVES: To assess the effectiveness of ertapenem in patients admitted to a surgical intensive care unit with septic shock due to community-acquired complicated intra-abdominal infection. PATIENTS AND METHODS: Patients undergoing emergency surgery for community-acquired complicated intra-abdominal infection were enrolled prospectively. All patients were given intravenous ertapenem at a rate of 1 g/24 h and the guidelines of the Surviving Sepsis Campaign were applied. Outcome measures were duration of antibiotic therapy, mean length of stay in the surgical intensive care unit (ICU), antibiotic failure, and death while in the surgical ICU. RESULTS: Twenty-five patients with a mean (SD) age of 74 (14) years were enrolled. The origin of infection was the colon in 56% of the cases; most patients (76%) had generalized peritonitis. The mean stay in the surgical ICU was 10 (7) days. The mean duration of antibiotic therapy was 5.8 (1.26) days. Antibiotic failure occurred in 12%. Mortality in the surgical ICU was 28%. CONCLUSIONS: Our findings suggest that patients with community-acquired intra-abdominal infection and septic shock have a good chance of survival when treated according to the guidelines of the Surviving Sepsis Campaign. Ertapenem seems to give good results when used in this setting.

Cirugía menor en un hospital de baja complejidad / Minor surgery in a low-complexity hospital

El objetivo del presente trabajo es describir los resultados derivados de realizar una cirugía menor (CM) por el médico general y analizar la correlación diagnóstico prequirúrgico y diagnóstico histopatológico. El tipo de diseño de este trabajo es descriptivo, retrospectivo. Se analizarán las intervenciones realizadas durante dos años por médicos generales, en el Hospital de Parral. Las mediciones y resultados principales que se analizaron son variables descriptivas (edad y sexo, localización, diagnóstico de la lesión, motivo de la CM, tipo de intervención, tiempo de espera y resultados histológicos) de todas las intervenciones. Se compara el diagnóstico previo respecto al histopatológico. Se practicaron 425 intervenciones. Se obtuvieron datos completos en 404 pacientes (229 hombres y 105 mujeres; edad media de 42 años). El motivo más habitual de la CM fue el estético, el dolor local seguido del miedo a la malignidad de la lesión. Las técnicas quirúrgicas más frecuentes fueron la exéresis quirúrgica 45,7 por ciento y extirpación con electrobisturí 19,2 por ciento. Las lesiones tratadas fueron principalmente quiste epidérmico, 43 casos, verrugas, 77 casos, y patología ungueal, 46 casos. Se remitieron al Servicio de Anatomía Patológica 220 casos y el acuerdo diagnóstico con su informe histopatológico fue del 66,2 por ciento. El tiempo medio de espera del resultado del informe fue de 12 días.

Hernia incisional en el Hospital de Lota / Incisional hernia in the Lota Hospital

El presente trabajo es un estudio retrospectivo que tiene como objetivo verificar los factores predisponentes más importantes en 61 pacientes con hernia incisional que ingresaron al servicio de cirugía del Hospital de Lota y fueron sometidos a intervención quirúrgica entre abril del año 2002 y abril del 2004. Como resultado, la incidencia en cuanto al sexo mostró una proporción de 4 a 1 entre mujeres y hombres; es decir, un 80,3 por ciento de mujeres y un 19,6 por ciento de hombres. En cuanto a la distribución por edad, la mayor incidencia fue para el grupo etáreo comprendido entre 41 a 60 años, con un 62,2 por ciento. Dentro de los factores predisponentes más importantes, tenemos: la obesidad (con un índice de masa corporal promedio de 31,2), las cirugías previas y, dentro de éstas, las cirugías ginecológicas (54 por ciento), la colecistectomía abierta (32,7 por ciento), la apendicectomía (3,2 por ciento) y otras (9,8 por ciento). No hubo mortalidad y morbilidad (3,2 por ciento) se debió principalmente a la reacción al material de sutura.

Uso del remifentanilo: caso clínico / Remifentanil use: clinical case

El correcto tratamiento del dolor postoperatorio constituye una prioridad dentro de los objetivos del anestesiólogo. En pacientes con patología vascular severa quirúrgica, el tratamiento analgésico efectivo se suele realizar mediante bloqueo continuo epidural. Sin embargo, la administración de analgésicos, tanto opiáceos como no opiáceos, por vía intravenosa, es una alternativa a la vía epidural cuando esta es desestimada. El clorhidrato de remifentanilo es un opioide de acción ultracorta con elevada potencia analgésica. Debido a sus propiedades farmacocinéticas es un fármaco predecible en el inicio de acción y en la desaparición de sus efectos, independientemente de la infusión o la dosis total administrada. Dada la ausencia de efecto analgésico residual tras anestesia general con este fármaco, es preciso establecer un adecuado plan analgésico postoperatorio. Remifentanilo a dosis inferiores a 0,2µg.kg-¹.min­-¹ permite optimizar la analgesia y confort de los pacientes en la URPA, siendo una alternativa al uso del bloqueo central epidural para control del dolor postoperatorio en cirugía vascular de urgencias.

Hidatidosis muscular: 2 casos clínicos / Muscle hydatidosis: two clinical cases

La hidatidosis por equinococcus granolossus es una parasitosis que afecta principalmente a hígado y pulmón y que en una mínima proporción implica de forma primaria al músculo. Presentamos 2 casos de pacientes intervenidos por una masa quística muscular que tras llegar al diagnóstico de hidatidosis fue tratada con antihelmínticos. Se practicó intervención radical resecando en bloque la periquística. en el seguimiento postoperatorio no se apreciaron imágenes quísticas no siendo necesarias nuevas intervenciones. El tratamiento de elección de la hidatidosis en cualquier localización es la resección quirúrgica radical (quistoperiquistectomía), lo que requiere un diagnóstico previo adecuado. Ante una masa quística muscular no se debe olvidar esta lozalización de la hidatidosis, ya que el primer tratamiento que se realice determinará la evolución de una patología benigna que, como en nuestro caso, puede evolucionar con recurrencias múltiples, muy invalidantes y de difícil resolución. La rareza de un caso de hidatosis muscular primaria, incluso en un país endémico como el nuestro, junto con la evolución peculiar, que puede recordar ciertas premisas básicas en el tratamiento de la enfermedad hidatídica, sea cual sea su localización, han motivado la comunicación de estos casos.