Cirugía del sueño: Definición de una especialidad emergente, propuesta de una clasificación anatomofuncional integral e indicaciones

Resumen Los trastornos respiratorios del sueño (ronquido primario y síndrome de apnea-hipopnea obstructiva del sueño) han sido tratados mediante múltiples modalidades a lo largo de la historia. Sin embargo, la cirugía de la vía aérea superior siempre ha estado presente, dando cabida a la aparición de múltiples técnicas para este fin. El estudio adecuado de los sitios anatómicos de estrechez o colapso de la vía aérea superior y sus contribuyentes (bajo el concepto de topodiagnóstico) y el mejor entendimiento de los mecanismos de acción de los diferentes procedimientos descritos, ha permitido el nacimiento de una nueva disciplina, dedicada al manejo quirúrgico planificado de este grupo de patologías: la cirugía del sueño.

Abstract Sleep-related breathing disorders (primary snoring and obstructive sleep apnea-hypopnea syndrome) have been treated with multiple modalities throughout history. However, upper airway surgery has always been present, giving appearance of multiple techniques for this purpose. The adequate study of the anatomical sites of upper airway narrowness or collapse and its contributors (under the concept of topodiagnosis) and a better understanding of the different procedures, has allowed the birth of a new discipline, dedicated to a planned surgical management for this group of pathologies: sleep surgery.

Tumores primarios de sacro: análisis de resultados y complicaciones / Primary sacral tumors: analysis of results and complications

Resumen: Introducción: Los tumores primarios de sacro son poco frecuentes, el tratamiento en la mayoría de los casos es quirúrgico con o sin radioterapia adyuvante; los resultados oncológicos y funcionales suelen ser adversos con una tasa alta de complicaciones. Material y métodos: Se realizó un estudio retrospectivo, analítico y observacional que incluye 22 casos tratados entre el 2000 y 2017, se analizaron sus características demográficas, el tipo de tratamiento en la recidiva y el resultado oncológico y funcional; asimismo, se analizó la tasa de complicaciones. Resultados: 22 pacientes fueron sometidos a sacrectomía, con abordaje posterior por cordoma (13 pacientes), tumor de células gigantes (tres pacientes) y otros (seis pacientes). Se realizaron tres sacrectomías totales, 13 sacrectomías parciales, dos hemisacrectomías y cuatro sacrectomías ampliadas. La media de duración quirúrgica fue de 229 minutos, con un sangrado promedio de 2,100 cm3, el tamaño tumoral promedio fue de 13.8 cm (6-30 cm); presentaron complicaciones 10 pacientes, ocho por infección de sitio quirúrgico, uno por hernia sacra y uno por osteomielitis. La supervivencia global fue de 44.4 meses. Discusión: El tratamiento de los tumores sacros es complejo y requiere un equipo multidisciplinario; el resultado oncológico es adecuado cuando se consiguen márgenes libres de neoplasia, los resultados funcionales estarán determinados por el tipo de resección y la tasa de complicaciones es alta; sin embargo, es la mejor alternativa de curación.

Abstract: Introduction: Primary sacral tumors are rare, treatment in most cases is surgical with or without adjuvant radiotherapy; oncology and functional results are usually adverse with a high rate of complications. Material and methods: We conducted a retrospective, analytical and observational studies that includes 22 cases treated between 2000 and 2017, analyzed their characteristics demographic, the type of treatment received, and the oncological, functional results and the rate of complications were analized. Results: 22 patients were subjected to sacrectomy with posterior approah because of cordoma (13 patients), giant cell tumour (three patients) and other (six patients). Three total sacrectomies, 13 partial sacrectomies, two hemisacrectomies and four sacrectomies enlarged were performed. The mean surgical time was 229 minutes, with an average bleeding of 2,100 cm3, the average tumour size was 13.8 cm (6-30cm); 10 patients were presented with complications, eight by surgical site infection, one sacral hernia and one osteomyelitis. Overall survival was 44.4 months. Conclusions: Treatment of sacral tumors is complex, requires a multidisciplinary team; the oncological result is adequate when you get free margins of neoplasia, the functional results will be determined by the type of resection, and the rate of complications is high however is the best alternative healing in our hospital.

[Primary sacral tumors: analysis of results and complications]. / Tumores primarios de sacro: análisis de resultados y complicaciones.

INTRODUCTION: Primary sacral tumors are rare, treatment in most cases is surgical with or without adjuvant radiotherapy; oncology and functional results are usually adverse with a high rate of complications. MATERIAL AND METHODS: We conducted a retrospective, analytical and observational studies that includes 22 cases treated between 2000 and 2017, analyzed their characteristics demographic, the type of treatment received, and the oncological, functional results and the rate of complications were analized. RESULTS: 22 patients were subjected to sacrectomy with posterior approah because of cordoma (13 patients), giant cell tumour (three patients) and other (six patients). Three total sacrectomies, 13 partial sacrectomies, two hemisacrectomies and four sacrectomies enlarged were performed. The mean surgical time was 229 minutes, with an average bleeding of 2,100 cm3, the average tumour size was 13.8 cm (6-30cm); 10 patients were presented with complications, eight by surgical site infection, one sacral hernia and one osteomyelitis. Overall survival was 44.4 months. CONCLUSIONS: Treatment of sacral tumors is complex, requires a multidisciplinary team; the oncological result is adequate when you get free margins of neoplasia, the functional results will be determined by the type of resection, and the rate of complications is high however is the best alternative healing in our hospital.

INTRODUCCIÓN: Los tumores primarios de sacro son poco frecuentes, el tratamiento en la mayoría de los casos es quirúrgico con o sin radioterapia adyuvante; los resultados oncológicos y funcionales suelen ser adversos con una tasa alta de complicaciones. MATERIAL Y MÉTODOS: Se realizó un estudio retrospectivo, analítico y observacional que incluye 22 casos tratados entre el 2000 y 2017, se analizaron sus características demográficas, el tipo de tratamiento en la recidiva y el resultado oncológico y funcional; asimismo, se analizó la tasa de complicaciones. RESULTADOS: 22 pacientes fueron sometidos a sacrectomía, con abordaje posterior por cordoma (13 pacientes), tumor de células gigantes (tres pacientes) y otros (seis pacientes). Se realizaron tres sacrectomías totales, 13 sacrectomías parciales, dos hemisacrectomías y cuatro sacrectomías ampliadas. La media de duración quirúrgica fue de 229 minutos, con un sangrado promedio de 2,100 cm3, el tamaño tumoral promedio fue de 13.8 cm (6-30 cm); presentaron complicaciones 10 pacientes, ocho por infección de sitio quirúrgico, uno por hernia sacra y uno por osteomielitis. La supervivencia global fue de 44.4 meses. DISCUSIÓN: El tratamiento de los tumores sacros es complejo y requiere un equipo multidisciplinario; el resultado oncológico es adecuado cuando se consiguen márgenes libres de neoplasia, los resultados funcionales estarán determinados por el tipo de resección y la tasa de complicaciones es alta; sin embargo, es la mejor alternativa de curación.

Sistema electrónico para reeducación postural estática en tiempo real / Electronic system for Static Postural Re-education in Real Time

Resumen: En este trabajo se presenta un sistema electrónico, basado en la medición de la distribución del peso en los pies, cuyo objetivo es coadyuvar en la evaluación postural. La evaluación postural utilizada por los fisioterapeutas para corregir problemas musculo-esqueléticos derivados por la edad, accidentes, enfermedades, etc. El sistema electrónico construido se validó preliminarmente utilizando videocámaras para corroborar la postura en un sujeto. Con los datos obtenidos se pudo confirmar que el sistema propuesto es capaz de ayudar en la corrección de la postura en tiempo real. La limitación principal de este trabajo es el reducido número de pruebas, por lo que sólo se presentan resultados preliminares. La originalidad de este trabajo reside principalmente en la solución propuesta para evaluar y corregir la postura por medio de un sistema electrónico, novedoso por el método empleado y su portabilidad. Derivado de los resultados presentados se puede concluir que sistema propuesto es capaz de ayudar a corregir la postura en tiempo real.

Abstract: This paper presents an electronic system aimed to assist on the postural evaluation by measuring the weight distribution on the feet. Postural evaluation is commonly used by physiotherapists in order to correct muscle-skeletal problems such as those derived from ageing, accidents, diseases, etc. The developed electronic system was validated preliminary using video cameras to confirm the correct postures of the subject under test. With the obtained data it is possible to corroborate that the proposed system is capable to assist on the correction of the postural position in real time. The main limitation of this work is the reduced number of tests, due to this only preliminary results are presented. The main novelty of this work is the proposed solution to evaluate and help to correct the posture by using a portable electronic device based on force sensors. Derived from the presented results it can be concluded that the proposed system is capable to assist on the evaluation and correction of postural position in real time.

Biliary Complications After Liver Transplantation: Incidence, Risk Factors and Impact on Patient and Graft Survival.

INTRODUCTION: Biliary complications (BC) are one of the most frequent surgical complications after liver transplantation. They include biliary stenosis, leaks, choledocolitiasis and sphincter of Oddi dysfunction. These complications can cause graft dysfunction, retrasplantation, or even death. The purpose of this study was to identify factors related to BC. MATERIALS AND METHODS: The medical records of all adult patients who underwent their first liver transplantation in our institution from 2005 to 2013 were reviewed, and any BC that required management was recorded. Cumulative incidence of BC was estimated using Kaplan-Meier. Patient and graft survival was compared using the log-rank test. The Cox regression model was used to establish associated factors. RESULTS: Of the 236 patients who underwent liver transplantation, 41 patients (17.8%) developed BC. Cumulative incidence was 12.9%, 17.2%, and 20%, after 1, 3 and 5 years of the transplantation, respectively. Twenty-six cases of biliary stenosis, 11 of leaks, and 4 of choledocolitiasis were identified. Most patients were managed endoscopically (82.9%). There were no differences in patient or graft survival. DISCUSSION: Biliary stenosis is the most frequent BC. Patients with higher risk of BC were of blood type AB (P < .001), had viral hepatitis (P = .049), or had alcoholic cirrhosis (P = .036). The success with the endoscopic treatment reduced the need for surgical interventions. CONCLUSIONS: The incidence of BC in our institution is comparable with the incidence reported in other institutions. Further prospective studies with larger series of patients are warranted to identify other factors associated with development of BC.

Drug-resistant epilepsy: definition and treatment alternatives.

INTRODUCTION: Drug-resistant epilepsy affects 25% of all epileptic patients, and quality of life decreases in these patients due to their seizures. Early detection is crucial in order to establish potential treatment alternatives and determine if the patient is a surgical candidate. DEVELOPMENT: PubMed search for articles, recommendations published by major medical societies, and clinical practice guidelines for drug-resistant epilepsy and its medical and surgical treatment options. Evidence and recommendations are classified according to the criteria of the Oxford Centre for Evidence-Based Medicine (2001) and the European Federation of Neurological Societies (2004) for therapeutic actions. CONCLUSIONS: Identifying patients with drug-resistant epilepsy is important for optimising drug therapy. Experts recommend rational polytherapy with antiepileptic drugs to find more effective combinations with fewer adverse effects. When adequate seizure control is not achieved, a presurgical evaluation in an epilepsy referral centre is recommended. These evaluations explore how to resect the epileptogenic zone without causing functional deficits in cases in which this is feasible. If resective surgery is not achievable, palliative surgery or neurostimulation systems (including vagus nerve, trigeminal nerve, or deep brain stimulation) may be an option. Other treatment alternatives such as ketogenic diet may also be considered in selected patients.

TRIM3, a tumor suppressor linked to regulation of p21(Waf1/Cip1.).

The TRIM family of genes is largely studied because of their roles in development, differentiation and host cell antiviral defenses; however, roles in cancer biology are emerging. Loss of heterozygosity of the TRIM3 locus in ∼20% of human glioblastomas raised the possibility that this NHL-domain containing member of the TRIM gene family might be a mammalian tumor suppressor. Consistent with this, reducing TRIM3 expression increased the incidence of and accelerated the development of platelet-derived growth factor -induced glioma in mice. Furthermore, TRIM3 can bind to the cdk inhibitor p21(WAF1/CIP1). Thus, we conclude that TRIM3 is a tumor suppressor mapping to chromosome 11p15.5 and that it might block tumor growth by sequestering p21 and preventing it from facilitating the accumulation of cyclin D1-cdk4.

Calidad percibida de la atención de enfermería por usuarios hospitalizados, Tunja, 2011 / Perceived quality of nursing care hospital by users, Tunja 2011

Objetivo: evaluar la calidad percibida de los usuarios en servicios de hospitalización respecto a la atención de enfermería recibida. Metodología: estudio cuantitativo, descriptivo de corte transversal. Análisis univariado y bivariado. La muestra n=183 fue recolectada en un Hospital de Tunja en los servicios de Medicina Interna y Quirúrgicas, a través del instrumento servqhos-e. Resultados: la medición de la calidad objetiva, subjetiva y el nivel de satisfacción de los usuarios de los servicios del hospital, reportó puntuaciones con medias de 4,08 para amabilidad y 3,98 para preparación del personal de enfermería y un nivel de satisfacción global del 92,9%. Discusión: la medición de la calidad percibida por los usuarios mediante el instrumento servqhos-e, permite evaluar desde la percepción de los usuarios, la calidad de la atención brindada por profesionales de enfermería en aspectos objetivos y subjetivos, los cuales son predictores de la satisfacción; los aspectos mejor evaluados corresponden a variables subjetivas, sin embargo, las expectativas de los usuarios no se superan...

Objective: to evaluate the usersÆ perception regarding the quality of the nursing care received. Methodology: a quantitative, cross-sectional descriptive study with univariate and bivariate analyses. The sample (n = 183) was collected from the Internal Medicine and Surgery units of the Tunja Hospital using the servqhos-e instrument. Results: the measurement of the objective and subjective quality, as well as the measurement of the usersÆ satisfaction level regarding hospital services had scores with a mean of 4.08 for kindness, and 3.98 for nursing staff training. In addition, the overall satisfaction level was 92.9%. Discussion: using the instrument servqhos-e to measure the quality perceived by the users made it possible to assess the quality of the care provided by nursing professionals. This measurement was conducted from the userÆs own point of view and focused on the objective and subjective aspects, which are predictors of satisfaction. Additionally, the highest scores belonged to subjective variables, but the usersÆ expectations were not met...

[Peri-ictal SPECT in temporal lobe epilepsy: post-surgical evaluation]. / SPECT periictal en la epilepsia del lóbulo temporal: valoración tras cirugía.

INTRODUCTION: our aim was to evaluate the usefulness of peri-ictal SPECT in localising the epileptogenic region (ER) in candidates for temporal lobectomy to treat medically refractory complex partial seizures (CPS). Interictal and ictal SPECT, MRI and video-EEG results were compared and the positive predictive value (PPV) was calculated in those patients with good surgical outcome. MATERIALS AND METHODS: 37 patients who had a minimum of 3 years follow-up after surgery were studied retrospectively. Pre-surgical evaluation had included video-EEG monitoring, MRI and interictal and ictal SPECT. These results were compared to the surgically treated ER and successful outcome confirmed by post-surgical clinical follow-up. 29/37 patients remained seizure-free in the post-surgical follow-up. Interictal and peri-ictal SPECT were performed using 740 MBq of 99mTc-HMPAO. Peri-ictal SPECT was ictal in 25 patients and postictal in 12. RESULTS: ER concordance with video-EEG and peri-ictal SPECT was 86% (32/37 patients). It was 84% (31/37) for MRI and 54% (20/37 patients) for interictal SPECT. Peri-ictal SPECT localised the ER in 8/11 patients with discordant MRI and video-EEG results. Ictal SPECT localised the ER in the correct temporal lobe in 23/25 patients (92% concordance). In the 29 patients with a good surgical outcome, the PPV of video-EEG was 95% (27/29) and it was 90% (26/29) for both MRI and peri-ictal SPECT. CONCLUSIONS: peri-ictal brain SPECT is well able to localize ER in patients with temporal lobe epilepsy. Periictal SPECT concordance with ER was as good as video-EEG and MRI and its PPV was as good as that of MRI. We strongly recommend its use in the pre-surgical evaluation of temporal lobe epilepsy, especially when MRI and EEG are discordant.

Adenovirus-mediated expression of caveolin-1 in mouse liver increases plasma high-density lipoprotein levels.

Caveolae are 50-100 nm plasma membrane invaginations, which function in cell signaling and transcytosis, as well as in regulating cellular cholesterol homeostasis. These subcompartments of the plasma membrane are characterized by the presence of caveolin proteins. Recent studies have indicated that caveolae may be involved in the regulation of cellular cholesterol efflux to HDL, as well as selective uptake mediated by SR-BI. In the present study, we have determined the effect of caveolin-1 overexpression in mouse liver on plasma lipoprotein metabolism. We evaluated this effect using an adenovirus-mediated gene delivery system. C57BL/6J mice were injected with adenoviruses encoding either caveolin-1 (Adcav-1) or green fluorescent protein (AdGFP) together with a transactivator adenovirus (AdtTA). We found that, after adenovirus injection, caveolin-1 was overexpressed in hepatocytes. Moreover, the recombinant protein was localized to the plasma membrane. We also found that caveolin-1 overexpression induced a marked change in the lipoprotein profile of injected animals. In caveolin-1 overexpressing animals, plasma HDL-cholesterol levels were found to be approximately 2-fold elevated, as compared with control animals. To determine the effect of caveolin-1 on SR-BI-mediated selective uptake, we infected murine hepatocytes in culture with an adenoviral vector carrying the caveolin-1 cDNA or GFP as a control protein. We show that, in primary cultures of hepatocytes, caveolin-1 inhibits DiI-HDL uptake mediated by SR-BI. This result would mechanistically explain the increased plasma HDL-cholesterol levels we observed in caveolin-1 adenovirus-injected animals. In addition, caveolin-1 expression increased the secretion of apolipoprotein A-I in cultured hepatocytes and increased apolipoprotein A-I plasma levels in mice. Our study therefore demonstrates an important role for caveolin-1 in regulating HDL metabolism.

Mammalian cell expression of dimeric small immune proteins (SIP).

We have designed and expressed bivalent small immune proteins (SIP) based on scFv fragments connected through a short linker of four amino acids to the CH3 domain of the human immunoglobulin gamma 1 H-chain. Three different versions have been designed and expressed in mammalian cells. In one construct a cysteine residue was included in the last amino acid of the flexible 15-amino acid long linker connecting the V(L) and V(H) domains, thus creating a disulphide bond stabilized molecule. A version with a shorter (five amino acids) V(L)/V(H) linker was also produced and shown to be efficiently assembled and secreted. All three SIPs form dimers retaining their antigenic specificity in Western blotting and having a comparable functional affinity (avidity) as determined by ELISA.

Uso de la comprensión externa como tratamiento inicial del onfalocele gigante / External comprenssion for the initial treatment of giant omphalocele

Se presenta un recién nacido con Pentalogía de Cantrell y onfalocele gigante tratado inicialmente con apósitos secos y compresión externa con faja de Velcro (método propuesto De Luca) con excelente resultado. La experiencia en este caso complejo por las malformaciones asociadas, nos permite adherir al concepto que la comprensión externa de un onfalocele gigante usando un apósito seco estéril efectivo, económico y de bajo riesgo para el tratamiento inicial del onfalocele gigante y debe ser tenido en cuenta en todos los casos de onfaloceles gigantes

Evaluación de la eficacia terapéutica de cefixime en el tratamiento de la fase aguda de la sinusitis en adultos / Evaluation of the therapeutic efficacy of cefixime in the treatment of acute phase sinusitis in adults

Se estudiaron 40 pacientes adultos con cuadro clinico compatible con sinusitis aguda, confirmada por serie radiografica. Fueron evaluables 36, se trataron con una dosis unica diaria de cefixime, 400 mg por via oral, durante diez dias. Los germenes aislados del material purulento de rinofaringe y meato medio fueron Staphylococcus aureus (39.4 por ciento) y Moraxella catarrhalis (12.1 por ciento), erradicándose el 70 por ciento al terminar el tratamiento. El sitio de la toma de la muestra de germenes no representativos del proceso infeccioso. El 94 por ciento de los pacientes mejoraron clinica y radiologicamente con el tratamiento; en uno fue ineficaz. La mejoria clinica fue significativa estadisticamente desde el quinto dia de tratamiento. El medicamento fue bien tolerado en el 94 por ciento de los casos, presentándose en dos pacientes leves trastornos gastrointestinales como nauseas y dolor abdominal

Evaluación de un programa de pesquisa de hipoacusia en recien nacidos / Evaluation of the program of research on hypoacusia in newborn infants

Un equipo multidisciplinario desarrolló el Programa de Pesquisa de Niños Sordos (PROPENSO) en dos maternidades de la ciudad de Buenos Aires, una pública, R. Sardá (RS) y la otra privada del Sanatorio Otamendi y Miroli (SOM). El tamizado sistemático de 5489 recién nacidos desde mayo a diciembre de 1984 reveló 267 (4,8 por ciento) que reunían factores de "alto riesgo" para hipoacusia. La evaluación diagnóstica posterior, realizada en su mayoría en el centro del CEIDHI se completó en 155 (58 por ciento) niños de la cohorte de riesgo: 112 (52,6 por ciento) de los 213 pesquisados en RS y 43 (79,6 por ciento) de los 54 del SOM. En esta etapa se analizó la validez de una prueba subjetiva (audiometría conductual) en relación a un barrido de alta intensidad con potenciales evocados audiométricos de tronco (PEAT) observando una sensibilidad de 46 por ciento y una especificidad de 94 por ciento. Se detectaron finalmente 4 lactantes con hipoacusia severa bilateral persistente y 5 con sordera unilateral y se inició en ellos tempranamente la orientación y tratamiento. Debe contemplarse, para mejorar la eficiencia de futuras estrategias de pesquisa de hipoacusia infantil, que: a) el uso de un listado para identificar factores de riesgo en recién nacidos es un procedimiento efectivo, b) es difícil lograr el seguimiento ambulatorio, especialmente para familias de bajos ingresos, y c) la audiometría conductal parece ser un método suficientemente confiable para el reconocimiento inicial de hipoacusia severa (pero no en los primeros meses de vida).

Clonación y expresión del ADNc para el activador tisular del plasminógeno en cèlulas de animales / Cloning and expresion of human tissue-type plasminogen activator cDNA in eukararyotic cells

Una alta expresión de tPA humana recombinante en células de hamster chino (CHO), fue obtenida usando el sistema de coamplificación del gen de la dehidrofolato reductasa (DHFR). La proteina fue secretada activa al medio de cultivo. En varios clones se mantuvo la producción estable, aun en ausencia de presión selectiva. No obstante, cuando el mismo ADN complementario fue clonado en un vector de expresión de baculovirus, sólo fue posible detectar niveles muy bajos de actividad tPA