Querión de Celso, aspectos diagnósticos y terapéuticos: Presentación de un caso / Kerion Celsi, diagnostic and therapeutic aspects: a case report

RESUMEN La tiña capitis es una enfermedad que afecta con mayor frecuencia a la población pediátrica; es ocasionada por hongos dermatofitos y es el querión su forma inflamatoria severa. Su diagnóstico e intervención temprana evita posibles secuelas estéticas y psicológicas en quienes lo padecen. Se presenta caso de paciente masculino de 4 años quien consultó al servicio de dermatología por cuadro de 4 meses de placa eritemato-descamativa con pústulas que progresó a única placa de predominio alopécica y adenopatías cervicales. El reporte microbiológico confirmó su diagnóstico, y el ultrasonido contribuyó al pronóstico y conducta terapéutica.

ABSTRACT Tinea capitis is a disease that most frequently affects the pediatric population caused by dermatophyte fungi, of which kerion is the severe inflammatory form of it. Its early diagnosis and intervention avoids possible aesthetic and psychological consequences in those who suffer from it. The case of a 4-year-old male patient is presented, who attend the dermatology service for 4 months of erythematous-desquamative plaque with pustules that evolved to a single plaque of predominantly alopecia and cervical lymphadenopathy. Microbiological report confirmed its diagnosis, and ultrasound contributed to the prognosis and therapeutic behavior.

Safety profile of the 9-valent human papillomavirus vaccine: assessment in prior quadrivalent HPV vaccine recipients and in men 16 to 26 years of age.

A 9-valent HPV (9vHPV) vaccine has been developed to protect against HPV type 6/11/16/18/31/33/45/52/58-related infection and disease. Previous safety analyses from 7 clinical trials conducted in 9vHPV vaccine recipients 9-26 years of age, including comparisons of 9vHPV and quadrivalent HPV (qHPV) vaccines in girls and women 16-26 years of age, showed that the 9vHPV vaccine was generally well tolerated. Additional safety analyses were conducted to include the results of new clinical studies. The safety profile of the 9vHPV vaccine in prior qHPV vaccine recipients (n = 3756 from 1 randomized controlled trial and 2 open-label extension studies) and young men (n = 248 9vHPV and n = 248 qHPV vaccine recipients from 1 randomized controlled trial) was evaluated. Vaccine was administered as a 3-dose regimen (at Day 1 and Months 2 and 6), and adverse events (AEs) were monitored. The most common AEs were injection-site events (91.1% and 79.0% in prior qHPV vaccine recipients and young men, respectively), the majority of which were mild. Discontinuations due to an AE were rare (0.2% and 0.0% among prior qHPV vaccine recipients and young men, respectively). In young men, the AE profile of the 9vHPV vaccine was generally similar to that of the qHPV vaccine. Overall, the 9vHPV vaccine was generally well tolerated in prior qHPV vaccine recipients and in young men, with an AE profile generally consistent with that previously reported with the broader clinical program.

PARKIN overexpression in human mesenchymal stromal cells from Wharton's jelly suppresses 6-hydroxydopamine-induced apoptosis: Potential therapeutic strategy in Parkinson's disease.

BACKGROUND AIMS: Stem cell transplantation is an excellent option for regenerative or replacement therapy. However, deleterious microenvironmental and endogenous factors (e.g., oxidative stress) compromise ongoing graft survival and longevity. Therefore, (transient or stable) genetically modified cells may be reasonably thought to resist oxidative stress-induced damage. Genetic engineering of mesenchymal stromal cells (MSCs) obtained from Wharton's jelly tissue may offer some therapeutic potential. PARKIN is a multifunctional ubiquitin ligase able to protect dopaminergic cells against stress-related signaling. We, therefore, evaluated the effect of the neurotoxicant 6-hydroxydopamine (6-OHDA) on regulated cell death signaling in MSCs and investigated whether overexpression of PARKIN in MSCs was capable of modulating the effect of 6-OHDA. METHODS: We transiently transfected Wharton's jelly-derived MSCs with an mCherry-PARKIN vector using the Lipofectamine LTX method. Naïve MSCs and MSCs overexpressing PARKIN were exposed to increasing concentrations of 6-OHDA. We used light and fluorescence microscopy, flow cytometry, immunocytochemistry staining, in-cell Western and Western blot analysis. RESULTS: After 12-24 h of 6-OHDA exposure, we detected dichlorofluorescein (DCF)-positive cells (80%) indicative of reactive oxygen species (H2O2) production, reduced cell viability (40-50%), decreased mitochondrial membrane potential (ΔΨm, ~35-45%), DNA fragmentation (18-30%), and G1-arrested cell cycle in the MSCs. 6-OHDA exposure increased the expression of the transcription factor c-JUN, increased the expression of the mitochondria maintenance Phosphatase and tensin homologue-induced putative kinase 1 (PINK1) protein and increased the expression of pro-apoptotic PUMA, caspase-3 and apoptosis-inducing factor (AIF). 6-OHDA exposure also significantly augmented the oxidation of the oxidative stress sensor, DJ-1. Overexpression of PARKIN in MSCs not only significantly reduced the expression of cell death and oxidative stress markers but also significantly reduced DCF-positive cells (~50% reduction). DISCUSSION: 6-OHDA induced apoptosis in MSCs via generation of H2O2, activation of c-JUN and PUMA, mitochondrial depolarization and nuclei fragmentation. Our findings suggest that PARKIN protects MSCs against 6-OHDA toxicity by partly interacting with H2O2, reducing the expression of c-JUN, PUMA, AIF and caspase-3, and maintaining the mitochondrial ΔΨm.

Skewed Invariant Natural Killer T (iNKT) Cells, Impaired iNKT:B Cell Help and Decreased SAP Expression in Blood Lymphocytes from Patients with Common Variable Immunodeficiency.

Common variable immunodeficiency (CVID) is a syndrome with predominantly defective B cell function. However, abnormalities in the number and function of other lymphocyte subpopulations in peripheral blood (PB) have been described in most patients. We have analysed the distribution of iNKT cell subpopulations in the PB of CVID patients and the ability of these cells to provide in vitro cognate B cell help. The total of iNKT cells was reduced in the PB of CVID patients, especially CD4+, CD4-/CD8- and CCR5+/CXCR3+. These findings were associated with an enrichment of memory-like and a tendency towards a reduction in TNF-α-expressing effector iNKT cells in the peripheral blood mononuclear cells (PBMC) of CVID patients. Moreover, an accumulation of follicular helper iNKT cells in the PB of CVID patients was demonstrated. CVID αGalCer-pulsed iNKT cells are not able to induce autologous B cell proliferation although they do induce proliferation to healthy donor B cells. Interestingly, autologous and heterologous co-cultures did not differ in the amount of immunoglobulin secreted by B cells in vitro. Finally, reduced intracellular SAP expression in iNKT cells and other lymphocytes in the blood from CVID patients was observed. These results provide further insights into the immunological mechanisms underlying the iNKT cell defects and the potential targets to improve B cell help in CVID.

[A phenotypic description of 26 patients with Ritscher-Schinzel syndrome (cranio-cerebello-cardiac dysplasia or 3C syndrome)]. / Descripcion fenotipica de 26 pacientes con sindrome de Ritscher-Schinzel (displasia craneo-cerebelo-cardiaca o sindrome 3C).

INTRODUCTION: Ritscher-Schinzel syndrome (also known as cranio-cerebello-cardiac dysplasia or 3C syndrome) is a rare genetic syndrome that is mainly characterised by the association of cardiac and craniofacial anomalies together with others affecting the posterior fossa. PATIENTS AND METHODS: We report on 26 patients with Ritscher-Schinzel syndrome at a hospital in Medellin, in the Department of Antioquia, Colombia. RESULTS: Males account for 69% of this cohort. The mean age of the cohort was 30 months, and 42% were under the age of one year at the time of diagnosis. All of them presented ocular disorders, and megalocornea was the most frequent ocular manifestation (69%), whereas low-set ears (80.7%) and septal heart defects (68.7%) were the most common facial and cardiac malformations, respectively. The most frequent malformations of the posterior fossa were megacisterna magna (31.8%) and Dandy-Walker malformation (27%). 84% of the cases had delayed neurodevelopment or intellectual disability. Skeletal manifestations were frequent: the group consisting of camptodactyly, single palmar crease, overlapping fingers, vertical talus and nail hypoplasia were found in hands and feet in 96% of the cases. CONCLUSIONS: Ritscher-Schinzel syndrome is a heterogeneous syndrome from the genetic and clinical point of view. These results suggest that the skeletal and ocular abnormalities that were observed can facilitate the phenotypic diagnosis. However, it is necessary to conduct further studies that allow us to gain a deeper knowledge of its prevalence and help identify other genes involved in this syndrome.

TITLE: Descripcion fenotipica de 26 pacientes con sindrome de Ritscher-Schinzel (displasia craneo-cerebelo-cardiaca o sindrome 3C).Introduccion. El sindrome de Ritscher-Schinzel (tambien conocido como displasia craneo-cerebelo-cardiaca o sindrome 3C) es un sindrome genetico raro que se caracteriza principalmente por la asociacion de anomalias cardiacas, craneofaciales y de la fosa posterior. Pacientes y metodos. Se describen 26 pacientes con sindrome de Ritscher-Schinzel pertenecientes a un hospital de Medellin en el departamento de Antioquia, Colombia. Resultados. La presente cohorte esta compuesta en un 69% por hombres. La mediana de edad de la cohorte fue de 30 meses y el 42% tenia menos de 1 año de edad en el momento del diagnostico. Todos presentaban afectacion ocular, y la megalocornea fue la manifestacion ocular mas frecuente (69%), mientras que las orejas de implantacion baja (80,7%) y los defectos cardiacos septales (68,7%) fueron las malformaciones faciales y cardiacas mas comunes, respectivamente. Las malformaciones de la fosa posterior mas frecuentes fueron megacisterna magna (31,8%) y malformacion de Dandy-Walker (27%). El 84% tenia retraso del neurodesarrollo o discapacidad intelectual. Las manifestaciones esqueleticas fueron frecuentes: el conjunto de camptodactilia, pliegue palmar unico, dedos sobrelapados, astragalo vertical e hipoplasia ungueal en las manos y los pies se hallo en el 96% de los casos. Conclusiones. El sindrome de Ritscher-Schinzel es heterogeneo desde el punto de vista genetico y clinico. Estos resultados sugieren que las anormalidades esqueleticas y oculares observadas pueden facilitar el diagnostico fenotipico. No obstante, es necesario realizar estudios adicionales que permitan conocer mejor su prevalencia y facilitar la identificacion de otros genes implicados en este sindrome.

Estenosis esofágica por Histoplasma: manejo con prótesis metálica autoexpandible / Management of Esophageal Stenosis Due to Histoplasma with Self-expanding Metal Stents

Las estenosis esofágicas benignas son una causa común de consulta en los servicios de endoscopia y gastroenterología. Usualmente, dada su naturaleza no neoplásica, estas se han manejado con dilataciones endoscópicas a repetición, incómodas y costosas para el paciente, dada su constante repetición; además de tener siempre el riesgo de perforación esofágica en cada sesión. El uso de prótesis esofágicas para manejo de las estenosis esofágicas benignas viene en progresivo aumento con resultados prometedores para varias de las etiologías de este tipo de obstrucciones. Presentamos el caso de una estenosis esofágica benigna secundaria a infección por Histoplasma capsulatum, manejada con una prótesis metálica totalmente cubierta con resolución completa de la obstrucción.

Benign esophageal strictures are a common cause of medical consultation and gastroenterological endoscopy. Usually, given their non-neoplastic nature, they have been managed with recurrent endoscopic dilation which is uncomfortable for the patient and which generates high costs due repetition. In addition, there is always the risk of esophageal perforation at every session. The use of esophageal stents for management of benign esophageal strictures is becoming increasingly more common and is promising for various etiologies. We present a case of a benign esophageal stricture secondary to infection with histoplasma capsulatum which was managed entirely with a completely covered metal stent. This led to complete resolution of the obstruction.

Use of the gluteus maximus muscle as the neosphincter for restoration of anal function after abdominoperineal resection.

BACKGROUND: Our aim was to evaluate complications and long-term functional outcome in patients who had sphincter reconstruction using the gluteus maximus muscle as the neosphincter after abdominoperineal resection for rectal cancer treatment. METHODS: Seven patients underwent reconstruction from 2000 to 2010. First, the sigmoid colon was brought down to the perineum as a perineal colostomy, with the procedure protected by a loop ileostomy. Reconstruction of the sphincter mechanism using the gluteus maximus took place 3 months later, and after another 8-12 weeks, the loop ileostomy was closed. We studied the functional outcome of these interventions with follow-up interviews of patients and objectively assessed anorectal function using manometry and the Cleveland Clinic Florida (Jorge-Wexner) fecal incontinence score. RESULTS: The mean follow-up was 56 months (median 47; range 10-123 months). One patient had a perianal wound infection and another had fibrotic stricture in the colocutaneous anastomosis that required several digital dilatations. Anorectal manometry at 3-month follow-up showed resting pressures from 10 to 18 mm Hg and voluntary contraction pressures from 68 to 187 mm Hg. Four patients had excellent sphincter function (Jorge-Wexner scores ≤5). CONCLUSIONS: Our preliminary results show that sphincter reconstruction by means of gluteus maximus transposition can be effective in restoring gastrointestinal continuity and recovering fecal continence in patients who have undergone APR with permanent colostomy for rectal cancer. Furthermore, the reconstruction procedure can be performed 2-4 years after the APR.

[The ureters: findings at multidetector computed tomography]. / Uréter: hallazgos en tomografía computarizada multidetector.

Multidetector computed tomography (MDCT) and advances in CT urography techniques have enabled vast improvements in the depiction of the ureter. Studies of the ureter can find a wide variety of conditions including congenital defects and anatomic variants (anomalies in the origin, distribution, and distal insertion of the ureter) as well as all benign and malignant causes of focal and diffuse wall thickening (inflammatory and infectious processes, and neoplasms, as well as iatrogenic thickening and postsurgical changes). Other benign processes like ureteral kinking and stenosis due to extrinsic compression of the iliac vessels are also well characterized by MDCT. The aim of this article is to show the spectrum of ureteral variants and disease apart from common entities related to stones.

Iron, zinc, and protein bioavailability proxy measures of meals prepared with nutritionally enhanced beans and maize.

Nutritionally enhanced beans (NEB) with more Fe and Zn than conventional beans (CB) and nutritionally enhanced maize (NEM) with more tryptophan and lysine than conventional maize (CM) were developed as part of a crop-biofortification strategy to improve human nutrition. Proxy measures were used to assess Fe and Zn bioavailability and protein digestibility of a bean recipe (fríjol sancochado) and a maize-milk recipe (mazamorra) prepared with enhanced or conventional crops in Colombia. Fe concentration was similar in the cooked NEB and CB and in NEM and CM (P> or = 0.05); in vitro Fe dialyzability was similar in cooked NEB (9.52%) and CB (9.72%) and greater for NEM (37.01%) than CM (32.24%). Zn concentration was higher in the uncooked and cooked NEB than in the CB (P < 0.05); phytate: Zn molar ratios were high in cooked NEB (36: 1) and CB (47: 1), suggesting low Zn bioavailability, and not different from each other (P = 0.07). There were no differences in Zn concentration or phytate: Zn molar ratio in the maize recipes. Nitrogen, tryptophan, and lysine concentrations were higher in the cooked NEM than CM; nitrogen was higher in the cooked NEB than CB (P < 0.05). In vitro protein digestibility was comparable (82% to 83%) for NEM and CM and higher for NEB (84%) than for CB (82%). The higher nutrient concentrations + similar bioavailability (protein in NEM, Zn in NEB), same nutrient concentrations + higher bioavailability (Fe in NEM) or higher nutrient concentrations + higher bioavailability (protein in NEB) can translate into more nutrients absorbed and utilized by the body.

Tratamiento de lesiones hepáticas tumorales con RENIO188- LIPIODOL. Experiencia en Colombia / Treatment of liver cancer injuries with RENIO188- LIPIODOL. Experience in Colombia

Objetivo: Evaluar pacientes con lesiones tumorales hepáticas, no quirúrgicas, a quienes se les administro Renio 188 -Lipiodol vía transarterial, como alternativa terapéutica.Método: Once pacientes con cáncer de hígado no operable se trataron con dosis entre 170 y 4181 MBq de Renio 188 Lipiodol a través de la arteria hepática. Los pacientes fueron evaluados clínicamente, con test hematológicos, de función hepática y TAC hepático periódicamente.Resultados: El tratamiento con Renio 188 Lipiodol fue bien tolerado . Tres pacientes desarrollaron fiebre leve y un paciente Neumonitis Intersticial que resolvió completamente. En el TAC de control siete pacientes evidenciaron reducción significativa del tamaño de la lesión , 1 sin cambios, 1 progresión y 2 no se han evaluado.Conclusiones: Renio 188 Lipiodol es un tratamiento seguro, la técnica de preparación fácilmente reproducible y se constituye en una alternativa terapéutica para este tipo de pacientes.

C455R notch3 mutation in a Colombian CADASIL kindred with early onset of stroke.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is caused by mutations in the notch3 epidermal growth factor-like repeats. A Colombian kindred carries a novel C455R mutation located in the predicted ligand-binding domain. Stroke occurred in the patients at an unusually early age (median age: 31 years) in comparison to the more frequent onset in the fourth decade of life in other CADASIL populations, including a second Colombian kindred with an R1031C mutation.

Ligaduras de hemorroides internas con bandas elásticas / Elastic band ligature of internal hemorrhoids

En 1964 uno de nosotros (J.E.R.) inicio el uso de ligaduras con bandas elasticas para el tratamiento de hemorroides internas. En esta oportunidad revisamos una muestra de 439 ligaduras realizadas en 114 pacientes desde 1992 a 1997 (3,8 ligaduras por paciente). La edad promedio fue de 50 años, y 60 por ciento de los pacientes eran hombres. La indicacion fundamental fue sangrado indoloro y ano humedo. Todos los procedimientos fueron realizados en forma ambulatoria. En 16 casos seleccionados se practicó) mas de una ligadura por sesion. Hubo 9 complicaciones, siendo la mas frecuente la trombosis de hemorroides externas. Concluimos que las ligaduras de hemorroides internas con bandas elasticas son una alternativa valida en el tratamiento de esta entidad. Este procedimiento tiene baja morbilidad y costo, con alta efectividad y satisfaccion del paciente; prolongada, ocasiona complicaciones y secuelas importantes y el costo es alto. Las consideraciones anteriores han estimulado el desarrollo de alternativas, una de las cuales es la ligadura con bandas elasticas. Este procedimiento fue introducido por BLAISDELL (1958) y mejorado y popularizado por BARRON (1963). Es una alternativa ambulatoria para el tratamiento de todos los grados de hemorroides internas. Se han publicado multiples trabajos que demuestran las enormes ventajas de esta tecnica. Es de anotar que la hemorroidectomía quirurgica sigue siendo la conducta de eleccion para algunos casos. En agosto de 1997 presentamos en el XXIV Congreso Nacional de Cirugia un informe preliminar, el cual queremos ahora complementar.

Reconstrucción de la hipofaringe y el esófago cervical mediante autotrasplante del yeyuno / Reconstruction of the hypophaynx and cervical esophagus with jejunal autotransplantation

Se presenta la experiencia de los autores con el autotrasplante de yeyuno en cuatro pacientes con lesiones severas de la hipofaringe y el esofago cervical secundarios a lesiones por arma de fuego, arma cortopunzante, accidente de tránsito y lesion iatrogenica despues de cirugia de tiroides por cancer papilar. Se hace un recuento historico de la cirugia reconstructiva del esofago cervical, se presentan los aspectos anatomicos y fisiologicos del mecanismo de la deglucion y la descripcion de los principales detalles tecnicos del procedimiento quirurgico. Todos los pacientes desarrollaron en el posoperatorio algun grado de disfagia que fue cediendo gradualmente. Un paciente alimentado durante cinco años por sonda de gastrostomia, presento una neumonía grave por broncoaspiracion en el dia veinte posoperatorio, la cual cedió con tratamiento medico. Un paciente con fistula externa a nivel de la anastomosis superior en las primeras 72 horas, en el septimo dia luego de la operacion habia cerrado la fistula. En un paciente fue necesario repetir dos veces la anastomosis venosa por trombosis sucesiva de esta. Durante el acto operatorio se evaluo la permeabilidad de las anastomosis microvasculares y la viabilidad del asa mediante observacion del color, secrecion y peristaltismo durante un periodo de 30 minutos. En dos pacientes se exteriorizo un segmento del asa trasplantada para vigilancia de la viabilidad del asa yeyunal, que posteriormente fue resecada. La via oral se inicio en todos los pacientes a los ocho dias despues de practicarse un esofagogrania. A los cuatro pacientes se les dio de alta tolerando dieta licuada y con la sonda de gastrostomia cerrada. Por su pediculo vascular y su diámetro, el yeyuno es el injerto ideal para remplazos de hasta 20 cm de esofago cervical, y aunque funciona como un conducto pasivo, presenta una adaptacion adecuada a la deglucion si no hay compromiso neuromuscular importante en la hipofaringe. El ascenso gástrico sigue siendo el metodo de eleccion cuando se practica una esofaguectomia total. El uso del colon se reserva para los casos que por cirugia previa o por quemadura extensa no se puede utilizar el estomago. El manejo de estos pacientes debe ser multidisciplinario y debe incluir un cirujano con experiencia en microcirugia vascular.

Laparoscopic ultrasonography: a training model.

PURPOSE: The purpose of this study was to develop a surgical training program and to test the accuracy of laparoscopic ultrasound in detecting injected lesions in pig livers. METHODS: Pig livers were divided into eight segments and injected with Surgilube "malignant" and silicone "benign" lesions. All were examined by laparoscopic ultrasound followed by liver explantation to confirm results. First, a pilot study was conducted on six swine by injecting Surgilube lesions and performing laparoscopic ultrasound through 3 different ports (left upper quadrant (I), umbilicus (II), and right lower quadrant (III)) to determine per-segment accuracy and to optimize port placement. Second, blinded injection of Surgilube and silicone implants was done on 18 pigs with laparoscopic ultrasound conducted through the two most accurate ports from the pilot study. This model was then tested during a resident training workshop. RESULTS: In the pilot study, per-lesion and per-segment sensitivity was 96 percent, with no difference among the three ports used. Ports I and II were chosen for the blinded study for their convenience in performing laparoscopic colectomy. In the blinded study, per-segment sensitivity, specificity, and accuracy were 97 percent, 94 percent, and 96 percent and 99 percent, 94 percent, and 97 percent for ports I and II, respectively. At the conclusion of a pilot workshop, trainee per-segment sensitivity, specificity, and accuracy were 60 percent, 80 percent, and 70 percent, respectively. The major difficulty was differentiating benign from malignant lesions. CONCLUSIONS: A useful liver laparoscopic ultrasound training model for surgeons was developed with good preliminary results. It is anticipated that further training will enhance laparoscopic ultrasound accuracy rates before application of this modality in humans.

Experiencia inicial con el stent esofagico de song para el tratamiento paliativo de la disfagia maligna benigna y fistula esofagotraqueal / Initial experience with esophageal stent, song type fot palliative treatment of bening and malignat dysphagia and tracheoesophageal fistula

Se evaluaron los resultados clínicos de la colocación de stents esofágicos autoexpandibles recubiertos tipo Song de fabricación local en el tratamiento paliativo de la disfagia tumoral, por estenosis benigna y en casos de fístula esofagotraqueal. Entre Agosto de 1998 y Mayo de 1999 se colocaron 27 stents en 24 pacientes, 20 pacientes con estenosis malignas del esófago y 4 pacientes con estenosis benignas. El stent se construyó localmente con alambre de acero inoxidable en Z, cubierto de una membrana de poliuretano. Todos los pacientes presentaban disfagia severa a líquidos o comidas blandas y se consideraron inoperables o malos candidatos quirúrgicos. La colocación del stent fue técnicamente posible en 23 pacientes. En un paciente el stent migró superiormente. Dos pacientes requirieron 2 stents cada uno. Mejoría significativa de la disfagia se observó en 23 pacientes. Las complicaciones tempranas fueron dolor severo (n=3) y sangrado que requirió transfusión (n= 1). Complicaciones tardías incluyeron migración (n = 1) y obstrucción por comida (n = 1). Síntomas de reflujo gastroesofágico severo se observaron en 3 pacientes. Stents con válvulas antirreflujos se utilizaron en 4 pacientes sin presencia de reflujo significativo ni obstrucción por comida. Los stents esofágicos autoexpandibles recubiertos ofrecen una paliación efectiva de la disfagia de origen tumoral y es el tratamiento de elección en las fístulas traqueoesofágicas en pacientes que no sean candidatos quirúrgicos. En un grupo seleccionado de pacientes con estenosis esofágicas benignas, la colocación de stents en forma temporal o permanente ofrece una alternativa al manejo no quirúrgico de la disfagia

Biliary obstruction: findings at MR cholangiography and cross-sectional MR imaging.

Twenty-two patients with malignant biliary obstruction and 21 patients with suspected obstruction of biliary-enteric anastomoses were evaluated over a 12-month period with magnetic resonance (MR) cholangiography and cross-sectional MR imaging. In patients with malignant obstruction, MR cholangiography helped accurately determine the status of the biliary ductal system by identifying the exact location and extent of the obstruction and the severity of duct dilatation. In so doing, MR cholangiography helped determine whether percutaneous transhepatic cholangiography with antegrade stent placement or retrograde cholangiography with stent placement constituted the more suitable treatment. Cross-sectional MR imaging was necessary to identify the organ of tumor origin, define the tumor margins, and determine the stage of disease. This information helped evaluate the appropriateness of curative surgical therapy versus palliative drainage procedures. In patients with biliary-enteric anastomoses, MR cholangiography clearly depicted the site of the anastomosis and demonstrated the status of the intrahepatic ducts, thereby helping determine which patients would benefit from undergoing antegrade duct cannulation with a drainage procedure or perhaps balloon dilation. In some of these patients, MR cholangiography was sufficient to help plan therapeutic intervention. MR cholangiography also demonstrates the presence and size of biliary stones and associated findings such as intraductal tumor growth. In addition, MR cholangiography may obviate retrograde cholangiography, which can be technically difficult to perform.

Complicaciones de la prostatectomía radical retropúbica: nuestra experiencia en 62 pacientes / Complications of radical retropubic prostatectomy: our experience with 62 patients

El propósito de este trabajo es evaluar los resultados de la prostatetectomía radical por vía retropúbica como tratamiento electivo de pacientes con adenocarcinoma de próstata clínicamente localizado. Material y métodos: Se examinaron 62 prostatectomías radicales realizadas entre febrero de 1989 y marzo de 1998. Resultados: De los 62 pacientes operados, 2 fallecidos (3,33 por ciento).1 dentro de las 48 horas y el otro a los 45 días. La unica complicación intraoperatoria fue la hemorragia, que ascendió al 16,66 por ciento . Se observaron complicaciones postoperatoria tempranas en el 11,66 por ciento de los pacientes (angina de pecho 3,33 por ciento, infarto agudo de miocardio 1,66 por ciento, linfocele pelviano 3,33 por ciento, anemia aguda 1,66 por ciento y tromboembolismo pulmonar 1,66 por ciento). Las complicaciones tardías afectaron al 93,33 por ciento de los pacientes. De éstas, las más importantes fueron impotencia (66,66 por ciento) e incontinencia (20 por ciento más allá de los 6 meses de la intervención: 3,33 por ciento tenía incontinencia total, 3,33 por ciento incontinencia severa y 13,33 incontinencia leve); se observó asimismo estrechez uretral (3,33 por ciento), estenosis de la anastomosis uretrovesical (1,66 por ciento) y litiasis de la anastomosis uretrovesical (1,66 por ciento). Conclusiones: La prostatectomía radical implica una baja mortalidad y resultados aceptables en lo quie resdpecta a la calidad de vida en pacientes seleccionados con adenocarcinoma de próstata localizado y expectativa de vida mayor de 10 años. La incontinencia y la impotencia son las principales complicaciones derivadas de esta intervención