Post-thyroidectomy bilateral cervical plexus block relieves pain: a systematic review.

PURPOSE: To assess the effectiveness of bilateral superficial cervical plexus block (BSCPB) in treating post-thyroidectomy pain. METHODS: MEDLINE, Embase, Google Scholar, LILACS, and the Cochrane Central Register of Controlled Trials, were extensively searched. The search period extended from 1968 until December 2022. Randomized controlled trials comparing BSCPB to placebo, no block in patients with thyroidectomy for benign or malignant thyroid disease were included. Outcomes were pain in the first 24 h after surgery. Analgesic rescue, period before the first rescue dosage, and 24-h opioid usage were secondary outcomes. The RoB 2 instrument was used to evaluate the risk of bias. RESULTS: 34 of 354 studies were eligible. There were 2,519 patients. BSCPB reduced the intensity of pain postoperatively [SMD: - 1.17 (95% CI: - 1.54 to - 0.81)] and in the first 24 h [- 0.62 (95%: 0.91 to 0.33)]. A considerable delay for the first opioid dose, rescue analgesics, and postoperative opioid usage was also found. CONCLUSION: BSCPB's 24-h analgesic efficacy minimizes the requirement for rescue analgesia, postoperative opioid intake, and rescue analgesia start time. The choice of anesthetic and different application methods might affect its effectiveness.

Post-thyroidectomy pain relief is enhanced by wound infiltration. A systematic review of randomized controlled trials.

INTRODUCTION: Thyroidectomy is a common surgical procedure. Traditional options for pain management, such as analgesics and nonsteroidal anti-inflammatory medications (NSAIDs), are limited by their side effects. Surgical wound infiltration with local anesthetics has the potential to reduce the need for analgesics in a number of surgical procedures. This systematic review and meta-analysis wanted to resolve these concerns and assess the efficacy of WI in the management of postoperative pain after thyroidectomy. MATERIAL AND METHODS: The review adhered to Cochrane Collaboration and PRISMA standards. RCTs comparing WI with no infiltration or placebo were included. Patients with benign or malignant thyroid disease who underwent open thyroidectomy were eligible. Postoperative pain was assessed using a visual analogue scale (VAS) as the primary outcome. Time to first rescue dose, the need for analgesic rescue in the first 24 h, and total opioid analgesic consumption were secondary outcomes. Standardized mean difference (SMD) and odds ratio (OR) were used to analyze the data. RESULTS: 16 randomized controlled trials involving 1202 patients were included. At 6 and 8 h postoperatively, WI exhibited a statistically significant impact on pain management. In the WI group, the need for analgesic rescue was significantly reduced. At 4 h postoperatively, non-anesthetic medications demonstrated a significant analgesic effect. CONCLUSIONS: This systematic review and meta-analysis support the use of WI with local anesthetics for postoperative pain management after thyroidectomy. These findings have significant implications for improving perioperative care, especially in ambulatory settings where effective pain management is essential.

Conformity: the hidden actor in surgical decisions.

Conformity in decision making has a relevant impact in surgical environments. This manuscript reveals how group-based opinions can distort the surgeon's individual judgment, even in critical situations. Two key phenomena are analysed: communication cascades and group polarisation, which amplify conformity and lead to extreme and sometimes harmful decisions. It is important to highlight the importance of evidence-based education, critical thinking, and diversification of information sources to counteract the negative effects of conformity. Self-identifying conformist tendencies, encouraging open debate, and implementing constructive dissent strategies can help mitigate the effects of conformity in decision-making. Reviewing authority models and promoting diversity in surgical settings may improve decision-making and the quality of patient care.

Cellular N-myristoyl transferases Are Required for Mammarenavirus Multiplication.

The mammarenavirus matrix Z protein plays critical roles in virus assembly and cell egress, whereas heterotrimer complexes of a stable signal peptide (SSP) together with glycoprotein subunits GP1 and GP2, generated via co-and post-translational processing of the surface glycoprotein precursor GPC, form the spikes that decorate the virion surface and mediate virus cell entry via receptor-mediated endocytosis. The Z protein and SSP undergo N-terminal myristoylation by host cell N-myristoyltransferases (NMT1 and NMT2), and G2A mutations that prevent myristoylation of Z or SSP have been shown to affect Z mediated virus budding and GP2 mediated fusion activity required to complete the virus cell entry process. In the present work, we present evidence that the validated on-target specific pan NMT inhibitor DDD85464 exerts a potent antiviral activity against the prototypic mammarenavirus lymphocytic choriomeningitis virus (LCMV) that correlated with reduced Z budding activity and GP2 mediated fusion activity, as well as proteasome mediated degradation of the Z protein. The potent anti-mammarenaviral activity of DDD85646 was also observed with the hemorrhagic fever causing mammarenaviruses Junin (JUNV) and Lassa (LASV) viruses. Our results support exploration of NMT inhibition as a broad-spectrum antiviral against human pathogenic mammarenaviruses.

Cellular N-Myristoyl Transferases Are Required for Mammarenavirus Multiplication.

The mammarenavirus matrix Z protein plays critical roles in virus assembly and cell egress. Meanwhile, heterotrimer complexes of a stable signal peptide (SSP) together with glycoprotein subunits GP1 and GP2, generated via co-and post-translational processing of the surface glycoprotein precursor GPC, form the spikes that decorate the virion surface and mediate virus cell entry via receptor-mediated endocytosis. The Z protein and the SSP undergo N-terminal myristoylation by host cell N-myristoyltransferases (NMT1 and NMT2), and G2A mutations that prevent myristoylation of Z or SSP have been shown to affect the Z-mediated virus budding and GP2-mediated fusion activity that is required to complete the virus cell entry process. In the present work, we present evidence that the validated on-target specific pan-NMT inhibitor DDD85646 exerts a potent antiviral activity against the prototypic mammarenavirus lymphocytic choriomeningitis virus (LCMV) that correlates with reduced Z budding activity and GP2-mediated fusion activity as well as with proteasome-mediated degradation of the Z protein. The potent anti-mammarenaviral activity of DDD85646 was also observed with the hemorrhagic-fever-causing Junin (JUNV) and Lassa (LASV) mammarenaviruses. Our results support the exploration of NMT inhibition as a broad-spectrum antiviral against human pathogenic mammarenaviruses.

Locoregional strategies to decrease postoperative pain and neck discomfort after open thyroidectomy: A scoping review.

Adequate pain control enhances patients' quality of life and allows a quick return to normal activities. Current pain management practices may contribute to the crisis of opioid addiction. We summarize the evidence that evaluates locoregional interventions to decrease pain and neck discomfort after thyroidectomy. We designed a scoping review. The search strategy was made in the Pubmed/MEDLINE and EMBASE database. We included only systematic reviews and RCTs that compared two or more strategies. Forty-nine publications including 5045 patients fulfilled criteria. Sore throat frequency is higher for endotracheal intubation and topical administration of anesthetic before intubation decreases this. Pre-incisional infiltration of the surgical wound decreases postoperative pain. Bilateral superficial plexus nerve block decreases analgesic requirements during and after thyroidectomy. Wound massage and neck exercises decrease postoperative discomfort. Locoregional interventions significantly impact postoperative pain and may reduce opioid use and improve patient outcomes.

Evaluation of the level of high density lipoproteins as a predictor of severity in abdominal sepsis.

Background: Alterations in the lipid profile are part of the acute phase response, this corresponds to the so-called lipemia of sepsis. Objective: To determine if the serum level of high density lipoprotein (HDL) is related to severity and mortality. Method: Retrospective, descriptive, cross-sectional study of patients diagnosed with abdominal sepsis. During the period from April 2016 to February 2017. The severity was determined by APACHE II, SOFA, Mannheim, CONUT, the presence of organic faults and mortality. Results: We included 154 cases, 59 female and 95 male; The main organ causing abdominal sepsis was the appendix 41.6%. The overall mortality was 14.3%. The presence of organic faults was 35.1%. The mean HDL level was 37.64 mg/dl (SD ± 16.16). The findings, subjected to statistical verification by Student's t-test, showed significance among the cases with SOFA > 4 (p = 0.01) and Mannheim > 26 (p = 0.001), CONUT > 6 (p = 0.001), presence of organic failures (p = 0.001), and mortality (p = 0.003). Conclusions: HDL levels are related to severity, with the development of organic failures and mortality in sepsis.

Antecedentes: Las alteraciones en el perfil de lípidos son parte de la respuesta de fase aguda, lo que corresponde a la denominada lipemia de la sepsis. Objetivo: Determinar si la concentración sérica de lipoproteínas de alta densidad (HDL) se relaciona con la gravedad y la mortalidad. Método: Estudio retrospectivo, descriptivo, transversal, de pacientes con diagnóstico de sepsis abdominal, durante el periodo de abril de 2016 a febrero de 2017. Se determinó la gravedad mediante APACHE II, SOFA, Mannheim, CONUT, la presencia de fallas orgánicas y la mortalidad. Resultados: Se incluyeron 154 casos, 59 mujeres y 95 hombres. El principal órgano causante de sepsis abdominal fue el apéndice (41.6%). La mortalidad global fue del 14.3%. La presencia de fallas orgánicas fue del 35.1%. El valor medio de HDL se situó en 37.64 mg/dl (desviación estándar: ± 16.16). Los hallazgos, sometidos a verificación estadística mediante la prueba t de Student, mostraron significancia entre los casos con SOFA > 4 (p = 0.01) y Mannheim > 26 (p = 0.001), CONUT > 6 (p = 0.001), presencia de fallas orgánicas (p = 0.001) y mortalidad (p = 0.003). Conclusión: Los valores de HDL se relacionan con la gravedad, con el desarrollo de fallas orgánicas y con la mortalidad en la sepsis.

Resultados posquirúrgicos con el uso del sistema de sellado de vasos ultrasónico en cirugía de sarcomas de tejidos blandos en las extremidades. Estudio de cohorte longitudinal / Post-surgical results with the use of the ultrasonic vessel sealing system in surgery for soft tissue sarcomas resection in the limbs. A longitudinal cohort study

Introducción Los sarcomas de Tejidos blandos en los miembros tienen una incidencia de 4.7 casos por 100.000 habitantes y su manejo quirúrgico tiene una alta tasa de morbilidad y mortalidad por sangrado para lo cual se requiere utilizar el sellado ultrasónico de vasos. El objetivo del estudio es determinar los resultados intraoperatorios y postoperatorios con el uso los sistemas de sellado de vasos ultrasónico en la resección de sarcomas de tejidos blandos. Materiales & Métodos Se realizó una cohorte longitudinal entre mayo de 2017 y diciembre de 2018 incluyendo a todos los pacientes sometidos a resección de sarcomas de tejidos blandos usando la tecnología de sellado ultrasónico de vasos que presentaron complicaciones intraoperatorias y postoperatorias. Se registraron las variables de edad, sexo, municipio, barrio, ocupación, hemoglobina prequirúrgica, sangrado intraoperatorio, drenaje por hemovac, hemoglobina postquirúrgica, seroma, hematoma, necesidad de transfusión sanguínea, y complicaciones mayores. Los datos se analizaron mediante Shapiro Wilk o Kolmogorov Smirnov para la estadística descriptiva. Las pruebas de hipótesis para comparar la ocurrencia de ciertas características por estadio o severidad de la patología tumoral se realizó por prueba Chi2 o test de Fisher en variables cualitativas mientras que las cuantitativas con t Student o Mann Whitney, un valor de p<0,05 fue considerado como estadísticamente significativo. Resultados Se incluyeron 32 pacientes en el estudio: 13 mujeres y 19 hombres; los principales tipos de sarcomas encontrados fueron el sarcoma fusocelular en 11 casos y el liposarcoma en 5 casos. Se encontró una mediana de diferencia de hemoglobina de -1.85 gr/dL. El uso del sistema ultrasónico de sellado de vasos bipolares presentó un éxito de las cirugías en un 71%; se presentaron complicaciones en 12% de los pacientes Discusión El sistema de sellado ultrasónico de vasos se presenta como una alternativa que puede brindar el beneficio de realización de cirugías de menor duración con una hemostasia más segura, es menester dar profundidad a la materia de estudio de este trabajo mediante la aplicación de estudios aleatorizados y controlados.

Background Limbs soft tissue sarcomas have an incidence of 4.7 cases per 100,000 inhabitants and their surgical management has a high rate of morbidity and mortality due to bleeding. Use of ultrasonic vessel sealing is a novel technique often required. The aim of the study is to determine whether the intraoperative and postoperative results can be improve with the use of ultrasonic vessel sealing systems when surgeons are performing resection surgery of soft tissue sarcomas. Methods A longitudinal cohort was conducted between May 2017 and December 2018, including all patients undergoing resection of soft tissue sarcomas using ultrasonic vessel sealing technology that presented intraoperative and postoperative complications. The variables of age, sex, municipality, neighborhood, occupation, preoperative hemoglobin, intraoperative bleeding, hemovac drainage, postsurgical hemoglobin, seroma, hematoma, need for blood transfusion, and major complications were recorded. Data were analyzed using Shapiro Wilk or Kolmogorov Smirnov for descriptive statistics. Hypothesis tests to compare the occurrence of certain characteristics by stage or severity of the tumor pathology were performed using the Chi2 test or Fisher's test in qualitative variables, while the quantitative ones with t Student or Mann Whitney, a value of p<0.05 it was considered statistically significant. Results 32 patients were included in the study: 13 women and 19 men; the main types of sarcomas found were spindle cell sarcoma in 11 cases and liposarcoma in 5 cases. A median hemoglobin difference of −1.85g/dL was found. The use of the ultrasonic bipolar vessel sealing system showed a 71% success rate for surgeries; complications occurred in 12% of patients. Discussion Ultrasonic vessel sealing system is a valid alternative that benefits limbs soft tissue sarcomas resection patient surgery by reducing surgery time and improving safer hemostasis. Further randomized controlled studies should be preformed.

Carcinoma urotelial del tracto urinario superior: a propósito de un caso y revisión de la literatura / Upper urinary tract urothelial carcinoma: case report and review of the literature

El carcinoma urotelial (CU) del tracto urinario superior es infrecuente y representa solo del 5%-10% de todos los CU. Estas neoplasias crecen a partir del urotelio de los cálices renales hasta el tercio distal del uréter. Se reporta el caso de un paciente masculino de 68 años de edad quien presenta enfermedad actual de 3 meses de evolución caracterizada por dolor lumbar izquierdo, tipo cólico, de leve a moderada intensidad, el cual atenúa parcialmente con el uso de AINES, asociado a hematuria visible total de predominio nocturno. El uroanálisis mostró hematuria macroscópica y la citología urinaria evidenció atipias sugerentes de carcinoma. La TAC abdomino-pélvica contrastada evidenció un defecto de llenado en relación al cáliz inferior de riñón izquierdo y plastrón ganglionar paraaórtico izquierdo. Se practicó nefroureterectomía radical izquierda evidenciando tumor de 3 x 3 x 1 cm en relación a pelvis renal extensiva a cáliz inferior invadiendo parénquima renal. El estudio histopatológico mostró un carcinoma urotelial papilar infiltrativo de alto grado con márgenes sin lesiones y ganglios linfáticos con metástasis. El paciente evoluciona satisfactoriamente durante el período postoperatorio y actualmente recibe terapia adyuvante. A pesar de ser una patología poco frecuente, puede presentarse y el urólogo debe estar en capacidad para poder enfrentarla(AU)

Upper urinary tract urothelial carcinoma (UC) is infrequent and represents only 5%-10% of all UCs. These neoplasms grow from the urothelium of renal calyces to the distal third of the ureter. A case of UC of the upper urinary tract is reported in a 68-year-old male patient with a 3-month history of left lumbar mild to moderate pain, which partially mitigates with the use of NSAIDs associated with visible total predominantly nocturnal hematuria. Macroscopic hematuria was evident and urinary cytology reported carcinoma suggestive atypias. Contrasted CT of abdomen and pelvis showed filling defect in relation to lower calyx of the left kidney and left para-aortic ganglion plastron. Radical left nephroureterectomy was performed showing a 3 x 3 x 1 cm tumor in relation to the renal pelvis extending to the lower cavity and invading renal parenchyma. Histopathology showed high grade infiltrative papillary CU with margins without lesions and lymph nodes with metastasis. Patient evolves satisfactorily in the postoperative period and is currently in adjuvant therapy. Although this pathology is rare, it can occur and the urologist must be able to face it(AU)

Osteocondroma de patela. Reporte de caso / Patellar osteochondroma. Case report

Los osteocondromas son tumores benignos frecuentes en la niñez, usualmente localizados en la metáfisis de los huesos y se van alejando de la fisis a medida que se da el crecimiento. Los osteocondromas de patela son poco comunes, refiriéndonos a su ubicación. El objetivo es informar un raro caso de un paciente escolar quien presento este tumor en su rótula derecha.

Osteochondromas are frequent benign tumors in childhood, usually located in bone metaphysis from where they recede from the physis as growth occurs. Osteochondromas of the patella are rare as this location is unfrequent. The objective is to report a rare case of a school patient who presented this tumor in his right patella.

Carcinoma renal de células claras: a propósito de un caso y revisión de la literatura / Renal clear cell carcinoma: case report and review of the literature

El carcinoma de células renales (CCR) es la lesión sólida más frecuente en el riñón y representa aproximadamente el 90% de los tumores renales malignos. Hay un predominio 1,5:1 de varones sobre las mujeres y su incidencia máxima tiene lugar entre los 60 y 70 años de edad. Este tipo de cáncer representa el 2%-3% de todos los cánceres y su incidencia máxima ocurre en los países occidentales. Se reporta un caso poco frecuente de CCR en una paciente femenina de 35 años de edad con una hematuria total, sin dolor, de 2 días de duración. El TAC abdomino-pélvico reveló una lesión ocupante de espacio de 15 x 12 x 10 cm aproximadamente, de aspecto neoproliferativo, con características heterogéneas de hipo e hiperdensidad, de 40 uH, neovascularización y realce al contraste, que compromete cáliz medio e inferior de riñón izquierdo, extensivo hasta pelvis renal. Se practicó nefrectomía radical izquierda. El estudio histopatológico reporta un carcinoma de células claras bien diferenciado de bajo grado, con márgenes libres y ganglios linfáticos sin MT. Paciente quien evoluciona satisfactoriamente en planificación de terapia adyuvante. Por el hecho de ser una presentación en un adulto joven, lo ideal es que el urólogo este en la capacidad de realizar el diagnóstico a la brevedad posible(AU)

Renal cell cancer (RCC) is the most common solid lesion in the kidney and accounts for approximately 90% of malignant renal tumors. There is a 1.5:1 male predominance and the highest incidence occurs between 60 and 70 years of age. RCC represents 2%-3% of all cancers and its highest incidence occurs in western countries. We report a rare case of a female patient of 35 years of age who has had pain free hematuria for two days. A contrasted abdominal/pelvic CT revealed a lesion of approximately 15 x 12 x 10 cm with neoproliferative appearance and heterogeneous features of hypo and hyperdensity of 40 uH, with neovascularization and contrast enhancement, compromising the middle and lower calyx of the left kidney extensive to renal pelvis. A left radical nephrectomy was performed. Histopathological study revealed a well-differentiated low grade clear cell carcinoma, with free margins and lymph nodes without metastasis. The patient has a satisfactory evolution and is awaiting adjuvant treatment. Due to the fact that the patient is a young adult, the urologist should be able to make the diagnosis as soon as possible(AU)

Modification of the negative pressure therapy technique for treatment of wound infection after spinal surgery / Modificação da técnica de terapia de pressão negativa para tratamento de infecção de ferida depois de cirurgia de coluna / Modificación de la técnica de terapia de presión negativa para tratamiento de infección de la herida después de cirugía de columna

ABSTRACT Objective To describe the indications and contraindications of negative pressure assisted wound therapy as well as a modification to the negative pressure technique that has been shown to shorten the number of changes of dressings and hospital stay with the early closure of the wound. Methods A review of the existing literature in the databases OVID, PubMed, Cochrane and Medigraphic was carried out in relation to the pressure-assisted closure of wounds. This is a non-invasive and active healing system that uses localized and controlled negative pressure, which consists of a specialized dressing that includes reticulated foam that removes the exudates through a tube to an airtight container. This set forms microdeformations in the wound bed, which are known to cause an important increase in fibroblastic migration and consequently of higher quality tissue, granulation tissue formation and angiogenesis. Results It was found that this method shortens the number of days of hospital stay. The technique describes the primary closure of the wound after intense cleansing and debridement of the non-viable tissue and signs of infection. Conclusions Negative pressure wound therapy is effective for the treatment of deep infections in postsurgical spinal wound, with average time of use of 1 to 4 weeks in the most severe cases. Level of evidence IV; Case Series.

RESUMO Objetivo Descrever as indicações e contraindicações da terapia de cicatrização assistida pela pressão negativa, assim como uma modificação nessa técnica, que demonstrou diminuir o número de recargas de curativos e de internação hospitalar, por meio da manipulação do fechamento precoce de feridas. Métodos Foi realizada uma revisão da literatura, em bases de dados da OVID, PubMed, Cochrane e Medigraphic, sobre a terapia de cicatrização assistida pela pressão negativa. Este é um sistema ativo de cura não invasivo utilizando pressão negativa controlada e localizada, que consiste em um curativo especializado, com a inclusão de uma espuma reticulada que conduz, através de um tubo de exsudado, a um recipiente hermético, formando micro deformações no leito da ferida. A técnica tem provado ser uma importante causa do aumento da migração fibroblástica e, consequentemente, de tecido de qualidade mais elevada, junto com a formação de tecido de granulação e angiogénese. Resultados Em relação à técnica, descreve-se as etapas como forma de fechamento primário da ferida após limpeza intensa, desbridamento da área não viável e das características infecciosas. Além disso, o uso da técnica demonstrou diminuir o número de dias de internação hospitalar. Conclusão Este método de pressão negativa é eficaz para o tratamento de infecções pós-cirúrgicas profundas da coluna vertebral, sendo usado, em média, de um a quatro semanas nos casos mais graves. Nível de evidência IV; Série de Casos.

RESUMEN Objetivo Describir las indicaciones y contraindicaciones de la terapia de cicatrización de heridas asistida por presión negativa, así como una modificación a la técnica de presión negativa que ha demostrado acortar el número de recambio de apósitos y la estancia hospitalaria con el cierre temprano de la herida. Métodos Se realizó una revisión de la literatura existente en las bases de datos OVID, PubMed, Cochrane y Medigraphic en relación a la terapia de cicatrización de heridas asistida por presión negativa. Es un sistema de cicatrización no invasivo y activo que utiliza presión negativa localizada y controlada, que consiste de un apósito especializado que incluye esponja reticulada que elimina los exudados a través de un tubo a un recipiente hermético. Este conjunto forma micro deformaciones en el lecho de la herida, que se sabe que causan aumento importante de la migración fibroblástica y, por consiguiente, tejido de mayor calidad, formación de tejido de granulación y angiogénesis. Resultados Se constató que este método acorta el número de días de estancia hospitalaria. La técnica describe el cierre primario de la herida después de limpieza intensa y desbridamiento del tejido no viable y de los signos de infección. Conclusiones La terapia de heridas por presión negativa es eficaz para el tratamiento de las infecciones profundas de heridas en el postoperatorio de la columna vertebral, con un tiempo promedio de uso de 1 a 4 semanas en los casos más severos. Nivel de evidencia IV, Serie de Casos.

Modulation of the activities of catalase, cu-zn, mn superoxide dismutase, and glutathione peroxidase in adipocyte from ovariectomised female rats with metabolic syndrome.

The aim of this study was to evaluate the association between estrogen removal, antioxidant enzymes, and oxidative stress generated by obesity in a MS female rat model. Thirty two female Wistar rats were divided into 4 groups: Control (C), MS, MS ovariectomized (Ovx), and MS Ovx plus estradiol (E2). MS was induced by administering 30% sucrose to drinking water for 24 weeks. After sacrifice, intra-abdominal fat was dissected; adipocytes were isolated and lipid peroxidation, non-enzymatic antioxidant capacity, and the activities of Cu-Zn and Mn superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) were determined. There were no significant differences in the activities of Cu-Zn, Mn SOD, CAT, and GPx between the C and MS groups, but in the MS Ovx group there was a statistically significant decrease in the activities of these enzymes when compared to MS and MS Ovx+E2. The increased lipid peroxidation and nonenzymatic antioxidant capacity found in MS Ovx was significantly decreased when compared to MS and MS Ovx+E2. In conclusion, the removal of E2 by ovariectomy decreases the activity of the antioxidant enzymes in the intra-abdominal tissue of MS female rats; this is reflected by increased lipid peroxidation and decreased nonenzymatic antioxidant capacity.

Multiple extrauterine pregnancy with early and near full-term mummified fetuses in a New Zealand white rabbit (Oryctolagus cuniculus).

Extrauterine pregnancy (EP) is infrequent in mammalian species and occurs when fertilized ova implant and develop outside the uterus. A common outcome is abdominal pregnancy resulting in mummified fetuses (lithopedia). Here we describe an unusual case of abdominal pregnancy with early and near full-term lithopedia. Macroscopic findings supported the diagnosis of lithopedia with distinct age differences and facilitated further characterization of primary ectopia and risk factors leading to this occurrence.

Deconstrucción y construcción en la elaboración del duelo / Deconstruction and construction in the elaboration of the mourning

Freud (1976), entre 1914 y 1916, escribió un conjunto de textos metapsicológicos que componen todo un marco teórico del psicoanálisis. Entre dichos textos es de resaltar aquel que tiene por nombre "duelo y melancolía", en el que se hace una importante distinción entre ambos términos, y a su vez nos permite alcanzar un gran acercamiento a la comprensión del duelo, tema del que es motivo este ensayo. Para ello se realiza un análisis hermenéutico entre los diferentes textos de dicho autor para resaltar los elementos claves que permitan abordar el tema propuesto.

Between 1914 and 1916 Freud (1976) wrote a set of texts of metapsychology that make up a theoretical framework of psychoanalysis. In those texts is the famous "mourning and melancholia", in the texts appear a distinction between the word "mourning" and the word "melancholia" and this will allow us to understand the first word. The author makes a hermeneutical analysis between the texts of Freud to highlight the keywords on the theme.

¿Es la psicología una ciencia? / ¿The psychology is science?

La psicología es considerada hoy en día como parte de las ciencias sociales y humanas. Este título ha sido posible gracias a los esfuerzos que ha hecho dicha disciplina por demostrar su carácter científico. No obstante, mediante el análisis riguroso, es posible dar cuenta de que los planteamientos que propone la ciencia no se corresponden en su totalidad con los que propone la psicología, poniendo, en este sentido, una ambigüedad con relación a si la psicología es ciencia, motivo de este ensayo. Para ello se realiza el análisis hermenéutico con los textos que se proponen de base para la discusión, resaltando los principales argumentos y derivar de allí una conclusión.

The psychology has been considered today how part of social and humans sciences.It has been posible thanks to the efforts of this discipline for show his scientific character. Nevertheless is posible realize a anlysis of their approaches and say that it is not related to science, showing the ambiguity of psychology, reason for this text. An analysis is made hermeneutic whit the proposed texts for discussion.

Quiste óseo aneurismático de la patela: reporte de caso / Aneurysmal bone cyst of the patella: case report

Los tumores en la patela son poco frecuentes. En este trabajo se presenta el caso de un paciente que consultó por dolor en la cara anterior de la rodilla derecha, sensación de masa y limitación a la flexoextensión de la misma. La tomografía axial computada mostró una lesión de aspecto tumoral con septos o tabiques que abarcaba la mayor parte de la rótula.

Desarrollo de un modelo canino de hipertensión ventricular derecha crónica progresiva / DEvelopment of a canine model to produce chronic, progressive right ventricular hypertension

Introducción: En modelos animales se ha producido hipertensión ventricular derecha ocluyendo la arteria pulmonar con bandas hechas de silastic, lino, tygón, o teflón. Estos procedimientos no permiten una oclusión gradual y progresiva que remede lo observado en la condición clínica de hipertensión arterial pulmonar e hipertensión ventricular derecha crónica. El objetivo del presente estudio es crear un modelo donde la obstrucción progresiva sea factible. Material y métodos: Diseñamos tanto un programa de adquisición de datos hemodinámicos como un dispositivo oclusor hidráulico (DOH) del tronco de la arteria pulmonar que permite un control externo de la presión ventricular deseada. Estudiamos durante 6 meses, a 12 perros mestizos sanos de 18 a 28 kg de peso. Realizamos mediciones hemodinámicas cada 2 meses, en condición basal, a 40 mmHg y a 60 mmHg de presión sistólica del ventrículo derecho (PSVD), respectivamente. Resultados: El programa facilitó el análisis instantáneo de múltiples variables hemodinámicas. A 60 mmHg de PSVD, la presión diastólica final del ventrículo derecho incrementó de 4.2 ñ 0.4 mmHg a 13.2 ñ 1.1 mmHg, p < 0.000, el gasto cardiaco ajustado al peso del perro disminuyó de 0.16 ñ 0.03 L/min/kg hasta 0.09 ñ 0.01 L/min/kg, p < 0.000 y la presión diastólica final del ventrículo izquierdo, incrementó de 7.4 ñ 0.8 mmHg a 16.3 ñ 2.8 mmHg, p < 0.000. El dispositivo mantuvo en el tiempo la PSVD requerida. La confiabilidad por coeficiente de correlación intraclase fue de 0.83, P < 0.005. Conclusiones: El modelo de hipertensión ventricular derecha crónica está creado. El programa de captura hemodinámica permite un análisis versátil. El DOH es confiable para mantener la PSVD en el tiempo.