[Changes in the international recommendations on neonatal resuscitation, 2010: comments]. / Adaptación de las recomendaciones internacionales sobre reanimación neonatal 2010: comentarios.

Since previous publication in 2005, the most significant changes that have been addressed in the 2010 International Liaison Committee on Resuscitation (ILCOR) recommendations are as follows: (i) use of 2 vital characteristics (heart rate and breathing) to initially evaluate progression to the following step in resuscitation; (ii) oximetry monitoring for the evaluation of oxygenation (assessment of color is unreliable); (iii) for babies born at term it is better to start resuscitation with air rather than 100% oxygen; (iv) administration of supplementary oxygen should be regulated by blending oxygen and air; (v) controversy about endotraqueal suctioning of depressed infants born through meconium-stained amniotic fluid; (vi) chest compression-ventilation ratio should remain at 3/1 for neonates unless the arrest is known to be of cardiac etiology, in which case a higher ratio should be considered; (vii) use of therapeutic hypothermia for infants born at term or near term evolving to moderate or severe hypoxic-ischemic encephalopathy, with protocol and follow-up coordinated through a regional perinatal system (post-resuscitation management); (viii) cord clamping delay for at least 1 minute in babies who do not require resuscitation (there is insufficient evidence to recommend a time for clamping in those who require resuscitation) and, (ix) it is appropriate to consider discontinuing resuscitation if there has been no detectable heart rate for 10 minutes, although many factors contribute to the decision to continue beyond 10 minutes. Under certain circumstances, non-initiation of resuscitation could be proposed taking into consideration general recommendations, own results and parents' opinion.

Hemiagénesis tiroidea de lóbulo derecho: comunicación de un caso / Right thyroid hemiagenesis and microcarcinoma of the left lobe: report of one case

In congenital thyroid hemiagenesis, one of the thyroid lobes, usually the left one, does not develop. This condition is generally asymptomatic. We report a 47 years old female with a diffuse left goiter. An ultrasound detected the right lobe hemiagenesis. She was subjected to a subtotal thyroidectomy. The pathological study of the surgical piece disclosed the presence of an encapsulated papillary carcinoma, follicular variant with a diameter of 2 mm.

La hemiagénesis tiroidea es una anormalidad congénita inhabitual en la cual uno de los lóbulos de la tiroides no se desarrolla. Su prevalencia es desconocida, debido a que generalmente es asintomática. Damos cuenta del caso de una mujer de 47 años, con bocio difuso de predominio izquierdo, operada, con presencia de microcarcinoma papilar en el lóbulo remanente. La detección de la hemiagénesis tiroidea es usualmente casual durante el examen de la glándula tiroides por otras causas. Es más frecuente en mujeres que en hombres (3:1), y el lóbulo izquierdo suele estar más comprometido que el derecho. Este caso muestra la inhabitual hemiagénesis tiroidea derecha con presencia de microcarcinoma papilar latente.

[Immunohistochemical expression of Ki-67 as a marker of proliferation in gallbladder mucosa samples with or without cancer]. / Proliferación celular en la mucosa de la vesícula biliar no tumoral en colecistitis crónicas litiásicas. Expresión de Ki-67 en matrices de tejidos.

BACKGROUND: There is paucity of knowledge on the proliferative features of normal or chronically inflamed gallbladder and the mechanisms of development of gallbladder cancer. AIM: To study the proliferation features of non tumoral gallbladder mucosa through the expression of Ki-67 antigen in tissue micro array analysis. MATERIAL AND METHODS: The immunohystochemical expression of Ki-67 in tissue micro array was studied in 96 samples of non tumoral gallbladder mucosa (coming from 74 females aged 45+/-16 years and 22 males aged 53+/-16 years) and 102 samples of gallbladder cancer (coming from 84 females aged 62+/- 14 years and 18 males aged 70+/- 13 years). RESULTS: The staining index of Ki-67 expression was 19+/-25% (range 096-8996) in samples of non tumoral mucosa and 46+/-29% (range 396-9896) in gallbladder cancer (p <0.01). Ki-67 was expressed in less than 10% of epithelial cells in 55% of non tumoral mucosa samples and 6% of gallbladder cancer samples. Seventy five percent of gallbladder cancer samples had a staining index of more than 20%. An expression of Ki-67 over 20% or 50% was observed in 25% and 15% of non tumoral mucosa samples, respectively. CONCLUSIONS: Non tumoral gallbladder mucosa samples have a high proliferation index, measured using Ki-67 immunohystochemical expression. There is a group of samples with cellular hyper-proliferation that maybe related to the pathogenesis of gallbladder cancer.

Proliferación celular en la mucosa de la vesícula biliar no tumoral en colecistitis crónicas litiásicas. Expresión de Ki-67 en matrices de tejidos / Immunohistochemical expression of Ki-67 as a marker of proliferation in gallbladder mucosa samples with or without cancer

Background: There is paucity of knowledge on the proliferative features of normal or chronically inflamed gallbladder and the mechanisms of development of gallbladder cancer. Aim: To study the proliferation features of non tumoral gallbladder mucosa through the expression of Ki-67 antigen in tissue micro array analysis. Material and methods: The immunohystochemical expression of Ki-67 in tissue micro array was studied in 96 samples of non tumoral gallbladder mucosa (coming from 74 females aged 45±16 years and 22 males aged 53±16 years) and 102 samples of gallbladder cancer (coming from 84 females aged 62± 14 years and 18 males aged 70± 13 years). Results: The staining index of Ki-67 expression was 19±25 percent (range 096-8996) in samples of non tumoral mucosa and 46±29 percent (range 396-9896) in gallbladder cancer (p <0.01). Ki-67 was expressed in less than 10 percent of epithelial cells in 55 percent of non tumoral mucosa samples and 6 percent of gallbladder cancer samples. Seventy five percent of gallbladder cancer samples had a staining index of more than 20 percent. An expression of Ki-67 over 20 percent or 50 percent was observed in 25 percent and 15 percent of non tumoral mucosa samples, respectively Conclusions: Non tumoral gallbladder mucosa samples have a high proliferation index, measured using Ki-67 immunohystochemical expression. There is a group of samples with cellular hyper-proliferation that maybe related to the pathogenesis of gallbladder cancer.

Duplicación de la vesícula biliar: vesícula doble de tipo Y operada: reporte de un caso / Gallbladder duplication: report of one case

The duplication of the gallbladder is a rare malformation, seen in one every 3.000 necropsies. It is detected preoperatively by abdominal ultrasound. We report a 28 years old female consulting for abdominal pain. An abdominal ultrasound showed the presence of cholelithiasis and a complete septum in the gallbladder lumen. During surgery, a distended and inflamed gallbladder was found with a septum that divided it in two parts, and one biliary stone. There was also a double cystic duct. The pathological study confirmed the gallbladder duplication with inflammation.

La patología de la vesícula biliar (VB) ocupa un lugar importante en nuestro país. Las anomalías congénitas más frecuentes incluyen alteraciones en los conductos biliares, arteria cística e infrecuentemente duplicaciones de la VB, con una incidencia de 1 en 3.000-4.000 autopsias. Esta anomalía congénita puede ser detectada preoperatoriamente por estudios imagenológicos, principalmente ecotomografía, siendo en el pasado un hallazgo quirúrgico. El diagnóstico diferencial de la duplicación vesicular incluye la vesícula con fondo plegado o gorro frigio, divertículos vesiculares, quistes de las vías biliares extra-hepáticas y la vesícula bilobulada o septada. Comunicamos el caso de una duplicación vesicular de tipo Y, en una mujer con diagnóstico ecotomográfico, la cual fue operada de forma clásica.

[Morbility and mortality associated with prosthetic patch in congenital diaphragmatic hernia]. / Morbimortalidad en pacientes con parche protésico para el cierre de la hernia diafragmática congénita.

AIM: To analyze morbility, mortality and neonatal intensive care management in CDH patients who required a prosthetic patch to close the diaphragmatic defects, and to compare these results with those who were made a primary closure. MATERIAL AND METHODS: We reviewed the clinical charts of CDH patients managed at our institution between January 1994 and December 2006, including demographic data, clinical management, treatment options, complications and mortality. Appropriate statistical tests were used to evaluate the data: mortality, need of high frequency oscillatory ventilation (HFOV), days of intubation, days of total parenteral nutrition (TPN), days of admission, reherniation, need of Nissen funduplication and intestinal obstruction; a p value less than 0.05 was considered statistically significant. RESULTS: Eighty-seven CDH patients were reviewed, 68 right, 17 left and 2 bilateral defects. Seventeen died before surgery (19.5%). Among the 70 operated patients, 21 (24.1%) required a prosthetic patch, 18 in the left and 3 in the right side. Overall mortality, need of HFOV, intubation days, need of TPN, days of admission, reherniation rate and need of Nissen funduplication were all significantly worse in the group who required a patch. Rate of intestinal obstruction was similar in both groups. CONCLUSIONS: Patients who required a prosthetic patch to close the diaphragmatic defect suffered from higher morbidity and presented a higher mortality than those who did not required the patch.

Adenoma papilar del conducto cístico: una afección infrecuente: reporte de un caso / Case report: papillary adenoma of the cystic duct: an uncommon condition

Papillary adenoma of the biliary ducts is a rare benign tumor, that often present as obstructive jaundice and abdominal pain. Most of the tumors are localized in the distal main bile duct and very uncommonly are observed in the cystic duct. These tumors has been associated to chronic inflammation and genetic disorders progressing from adenoma to carcinoma. We report a case of a 88 years old woman presenting epigastric and right upper quadrant abdominal pain. Endoscopic retrograde cholangiopancreatography showed a polypoid lesion arising from the cystic duct and extending into the common bile duct. A partial resection was performed and samples of the tumor tissue were obtained during this procedure. Histology confirmed a papillary adenoma of the biliary duct. A review of literature is presented.

El adenoma papilar de la vía biliar es un tumor benigno infrecuente que se presenta habitualmente como un cuadro de ictericia obstructiva y dolor abdominal. La mayoría se localiza en la vía biliar distal común y en raras ocasiones en el conducto cístico. Es probablemente el resultado de un proceso de inflamación crónica y de cambios genéticos que puede progresar desde adenoma a adenocarcinoma. Se reporta un caso de una paciente de 88 años que presentó dolor abdominal epigástrico y de hipocondrio derecho. La colangiopancreatografía endoscópica retrógrada demostró una lesión polipoidea originada en el conducto cístico con extensión a colédoco. Se realizó resección parcial y biopsia. El estudio anatomopatológico diferido confirmó un adenoma papilar de la vía biliar. Se presentó una revisión de la literatura.

[Results of the treatment of congenital diaphagmatic hernia with conventional terapeutics modalities]. / Resultados en el tratamiento de la hernia diafragmáitica con terapias convencionales.

AIM: In this study, we analyze our results in the treatment of congenital diaphragmatic hernia (CDH) using conventional ventilatory therapy without ECMO. PATIENTS AND METHODS: fifty one CDH patients (27 males and 24 females) treated at our institution between 1997 and 2004 were reviewed. Data referred to obstetrics, prenatal diagnosis, newborn care, type of hernia and surgical treatment were analyzed. We recorded ventilatory treatment modalities and the outcome of the patients. We also compared the survival of our series with those expected using the formula proposed by the CDH study group in 2001. We finally analized separately those patients with early clinical presentation and who fulfilled ECMO criteria. Data from necropsies were also recovered when available. RESULTS: Prenatal diagnosis was made in 58% of the patients. Fifty nine percent were born by c-section. The diaphragmatic defect was left-sided in 42 patients, right in 8 and bilateral in 1. Ten patients needed a prosthetic patch to close the defect. Eighteen out of the 51 patients (35%) died, 11 of them without surgical treatment. Early presentation of clinical picture was evident in 44 patients; among them 46% required high frequency ventilation and 53% nitric oxide therapy. Medium age at operation was 56+/-49 hours. The 7 children with late clinical presentation are alive. Among the 44 remaining patients, 26 are also alive (59,09%), data similar to those expected by the formula (62.39%, p>0.05). Fifteen patients had oxigenation index (IO) over 40, with a stimated survival rate of 48%, a statistically significant lower rate when compared to patients with IO<40. None of the patients with IO>40 survived; in 4 out of the 7 available necropsy studies, a severe lung hypoplasia was found (index lung weight/body weight <0.006). Among the remaining 27 children with IO<40, 24 (90%) are alive. CONCLUSIONS: A survival rate over 90% can be achieved by conventional ventilatory measures in patients with IO<40. In our experience, children with IO>40 are rarely candidates to ECMO therapy because of the associated severe lung hypoplasia confirmed by necropsy studies.

Comparative study of three diagnostic approaches (FISH, STRs and MLPA) in 30 patients with 22q11.2 deletion syndrome.

The 22q11.2 deletion syndrome is commonly diagnosed using fluorescence in situ hybridization (FISH) with commercial probes. The chromosomal breakpoints and deletion size are subsequently characterized by short tandem repeat (STR) segregation tests or by further FISH probes. Recently, a multiplex ligation-dependent probe amplification (MLPA) single tube assay was developed to detect deletions of the 22q11.2 region and other chromosomal regions associated with DiGeorge/velocardiofacial syndrome. We have compared the results of these three techniques in a group of 30 patients affected with 22q11.2 deletion syndrome. MLPA correctly called all patients who had been previously diagnosed by FISH. The MLPA results were concordant in all patients with the STR analysis in respect to deletion size. Furthermore, this novel technique resolved seven cases that were undetermined by STR analysis. These results confirm the efficiency of MLPA as a rapid, reliable, economical, high-throughput method for the diagnosis of 22q11.2 deletion syndrome.

Complejo pared abdominal-miembro inferior: reporte de dos casos / Limb body wall complex: report of 2 cases

Se presentan dos casos clínicos del complejo pared abdominal-miembro inferior resueltos en la maternidad del Hospital Regional Temuco. El diagnóstico fue presuntivo en ambos casos por las evidentes y múltiples anomalías estructurales descritas en el examen ultrasonográfico. Son discutidas las características y patogénesis del complejo malformativo