Crystalloid volume versus catecholamines for management of hemorrhagic shock during esophagectomy - assessment of microcirculatory tissue oxygenation of the gastric conduit in a porcine model using hyperspectral imaging - an experimental study.

INTRODUCTION: Oncologic esophagectomy is a two-cavity procedure with considerable morbidity and mortality. Complex anatomy and the proximity to major vessels constitute a risk for massive intraoperative hemorrhage. Currently, there is no conclusive consensus on the ideal anesthesiologic countermeasure in case of such immense blood loss. The objective of this work was to identify the most promising anesthesiologic management in case of intraoperative hemorrhage with regards to tissue perfusion of the gastric conduit during esophagectomy using hyperspectral imaging (HSI). MATERIAL AND METHODS: An established live porcine model (n=32) for esophagectomy was used with gastric conduit formation and simulation of a linear stapled side-to-side esophagogastrostomy. After a standardized procedure of controlled blood loss of about 1 L per pig, the four experimental groups (n=8 each) differed in anesthesiologic intervention i.e. (I) permissive hypotension, (II) catecholamine therapy using noradrenaline, (III) crystalloid volume supplementation and (IV) combined crystalloid volume supplementation with noradrenaline therapy. HSI tissue oxygenation (StO2) of the gastric conduit was evaluated and correlated with systemic perfusion parameters. Measurements were conducted before (T0) and after (T1) laparotomy, after hemorrhage (T2) and 60 minutes (T3) and 120 minutes (T4) after anesthesiologic intervention. RESULTS: StO2 values of the gastric conduit showed significantly different results between the four experimental groups with 63.3% (±7.6%) after permissive hypotension (I), 45.9% (±6.4%) after catecholamine therapy (II), 70.5% (±6.1%) after crystalloid volume supplementation (III) and 69.0% (±3.7%) after combined therapy (IV). StO2 values correlated strongly with systemic lactate values (r=-0.67; CI -0.77 to -0.54), which is an established prognostic factor. CONCLUSION: Crystalloid volume supplementation (III) yields the highest StO2 values and lowest systemic lactate values and therefore appears to be the superior primary treatment strategy after hemorrhage during esophagectomy with regards to microcirculatory tissue oxygenation of the gastric conduit.

Graft conditioning with fluticasone propionate reduces graft-versus-host disease upon allogeneic hematopoietic cell transplantation in mice.

Hematopoietic cell transplantation (HCT) treats many blood conditions but remains underused due to complications such as graft-versus-host disease (GvHD). In GvHD, donor immune cells attack the patient, requiring powerful immunosuppressive drugs like glucocorticoids (GCs) to prevent death. In this study, we tested the hypothesis that donor cell conditioning with the glucocorticoid fluticasone propionate (FLU) prior to transplantation could increase hematopoietic stem cell (HSC) engraftment and reduce GvHD. Murine HSCs treated with FLU had increased HSC engraftment and reduced severity and incidence of GvHD after transplantation into allogeneic hosts. While most T cells died upon FLU treatment, donor T cells repopulated in the hosts and appeared less inflammatory and alloreactive. Regulatory T cells (Tregs) are immunomodulatory and survived FLU treatment, resulting in an increased ratio of Tregs to conventional T cells. Our results implicate an important role for Tregs in maintaining allogeneic tolerance in FLU-treated grafts and suggest a therapeutic strategy of pre-treating donor cells (and not the patients directly) with GCs to simultaneously enhance engraftment and reduce GvHD upon allogeneic HCT.

Optimization of anastomotic technique and gastric conduit perfusion with hyperspectral imaging and machine learning in an experimental model for minimally invasive esophagectomy.

INTRODUCTION: Esophagectomy is the mainstay of esophageal cancer treatment, but anastomotic insufficiency related morbidity and mortality remain challenging for patient outcome. Therefore, the objective of this work was to optimize anastomotic technique and gastric conduit perfusion with hyperspectral imaging (HSI) for total minimally invasive esophagectomy (MIE) with linear stapled anastomosis. MATERIAL AND METHODS: A live porcine model (n = 58) for MIE was used with gastric conduit formation and simulation of linear stapled side-to-side esophagogastrostomy. Four main experimental groups differed in stapling length (3 vs. 6 cm) and simulation of anastomotic position on the conduit (cranial vs. caudal). Tissue oxygenation around the anastomotic simulation site was evaluated using HSI and was validated with histopathology. RESULTS: The tissue oxygenation (ΔStO2) after the anastomotic simulation remained constant only for the short stapler in caudal position (-0.4 ± 4.4%, n.s.) while it was impaired markedly in the other groups (short-cranial: -15.6 ± 11.5%, p = 0.0002; long-cranial: -20.4 ± 7.6%, p = 0.0126; long-caudal: -16.1 ± 9.4%, p < 0.0001). Tissue samples from avascular stomach as measured by HSI showed correspondent eosinophilic pre-necrotic changes in 35.7 ± 9.7% of the surface area. CONCLUSION: Tissue oxygenation at the site of anastomotic simulation of the gastric conduit during MIE is influenced by stapling technique. Optimal oxygenation was achieved with a short stapler (3 cm) and sufficient distance of the simulated anastomosis to the cranial end of the gastric conduit. HSI tissue deoxygenation corresponded to histopathologic necrotic tissue changes. The experimental model with HSI and ML allow for systematic optimization of gastric conduit perfusion and anastomotic technique while clinical translation will have to be proven.

[Surgery 4.0-are we ready?] / Wie weit ist Chirugie 4.0?

The increasing networking of data systems in medicine is not only leading to modern interdisciplinarity in the sense of cooperation between different medical departments, but also poses new challenges regarding the building and room infrastructure. The surgical operating room of the future expands or augments its reality, away from the pure building characteristics, towards an intelligent and communicative space platform. The building infrastructure (operating theatre) serves as sensor and actuator. Thus, it is possible to inform about missing diagnostics as well as to register them directly in the contextualization of the planned surgical intervention or to integrate them into the processes. Integrated operating theatres represent a comprehensive computer platform based on a corresponding system architecture with software-based protocols. An underlying modular system consisting of various modules for image acquisition and analysis, interaction and visualization supports the integration and merging of heterogeneous data that are generated in a hospital operation. Integral building data (e.g., air conditioning, lighting control, device registration) are merged with patient-related data (age, type of illness, concomitant diseases, existing diagnostic CT and MRI images). New systems coming onto the market, as well as already existing systems will have to be measured by the extent to which they will be able to guarantee this integration of information-similar to the development from mobile phone to smartphone. Cost reduction should not be the only legitimizing argument for the market launch, but the vision of a new quality of surgical perception and action.

[Argentinean consensus guidelines on the use of monoclonal antibodies in patients with migraine]. / Consenso sobre el uso de anticuerpos monoclonales en la migraña en Argentina.

INTRODUCTION: Migraine is a very prevalent disorder that is estimated to affect about 15% of adult subjects. Recently, the efficacy and safety of monoclonal antibodies that act on the calcitonin gene-related peptide pathway (MA-CGRP) has been evaluated in migraine. Several groups around the world have developed consensus guidelines about the use of monoclonal antibodies, however, in some regions is difficult to extrapolate the recommendations. AIM: To provide recommendations for the use of MA-CGRP in migraine in Argentina. DEVELOPMENT: A group of neurology experts from Argentina, by using the online surveys methodology as well as face to face meetings developed the intended consensus for the use of MA-CGRP in migraine in Argentina. Recommendations were established based on published evidence and the expert opinion. Recommendations focused on how, when, treatment duration and patients follow up. CONCLUSION: The recommendations of this consensus guidelines attempt to optimize the use of MA-CGRP in migraine in Argentina.

TITLE: Consenso sobre el uso de anticuerpos monoclonales en la migraña en Argentina.Introducción. La migraña es un trastorno muy prevalente que se estima que afecta a alrededor del 15% de los sujetos adultos. Durante los últimos años, se ha evaluado la eficacia y la seguridad de los anticuerpos monoclonales que actúan sobre la vía del péptido relacionado con el gen de la calcitonina (AM-PRGC) en la migraña. Diversos grupos de trabajo internacionales han intentado clarificar y normatizar el uso de estos medicamentos en la migraña. Sin embargo, en muchas ocasiones se extrapolan datos de otras regiones que no contemplan la realidad de cada lugar o son difíciles de implementar. Objetivo. Proveer recomendaciones sobre el uso de AM-PRGC en pacientes con migraña en Argentina. Desarrollo. Un grupo de expertos de Argentina conformado por neurólogos, mediante metodología de ronda de encuestas en la distancia y reuniones presenciales, llevó adelante la elaboración del consenso pretendido para el uso de AM-PRGC en pacientes con migraña en Argentina. Se establecieron las recomendaciones basadas en la evidencia publicada y en el criterio de los expertos que participaron. Las recomendaciones se enfocaron en el momento de usar los AM-PRGC en la migraña tanto crónica como episódica, la duración, los cuidados y el entorno para hacerlo. Conclusión. Las recomendaciones establecidas en el presente consenso permitirán optimizar el manejo de los AM-PRGC en pacientes con migraña en Argentina.

Autoimmune associations in a Mexican cohort with primary biliary cholangitis. / Asociaciones autoinmunes en una cohorte mexicana con colangitis biliar primaria.

INTRODUCTION: Several groups have reported associations of primary biliary cholangitis with other autoimmune entities, particularly Sjögren's syndrome and hypothyroidism. Its prevalence and characteristics in Mexican patients is unknown. AIM: To determine the frequency and characteristics of autoimmune diseases in a Mexican cohort of patients with primary biliary cholangitis. MATERIALS AND METHODS: The medical records of patients that presented with primary biliary cholangitis within the time frame of 2005 and 2012 were reviewed and assessed for other autoimmune diseases. RESULTS: Seventy-eight patients, 75 women and 3 men, were included. Their mean age was 55.8 years. Seventy-three cases had positive antimitochondrial antibodies (94.8%) and disease was confirmed in 5 through liver biopsy. Five patients (8%) had anti-smooth muscle antibodies and 55/78 (70.5%) had antinuclear antibodies by indirect immunofluorescence. Forty-nine patients (62.8%) were positive for an autoimmune disease other than primary biliary cholangitis. Among those, 20 patients had one associated disease, 14 had 2, and 15 patients had 3 concomitant diseases. They included: Sjögren's syndrome in 23/78 patients (29.5%), dysthyroidism in 21/78 cases (26.9%), Raynaud syndrome in 11/78 (14.1%), CREST syndrome in 9/78 patients (11.4%), rheumatoid arthritis in 6/78 patients (7.7%), vitiligo in 5/78 (6.4%), scleroderma in 4/78 patients (5.1%), and other diseases in 8 patients. In 12/78 patients (15.4%), there was a documented family background of autoimmune disease. CONCLUSIONS: The presence of autoimmune associations in our cohort was frequent, and similar in characteristics to the information reported by other groups. The clinical implications of those findings remain to be determined.

Reconstrucción con colgajo de músculo temporal en defecto del tercio medio de la región facial. Nuestra experiencia en un hospital de mediana complejidad / TEMPORALIS MUSCLE FLAP RECONSTRUCTION IN FACIAL REGION DEFECTS. OUR EXPERIENCE IN MEDIUM COMPLEXITY HOSPITAL

Introducción: El colgajo pediculado realizado con músculo temporal es una opción terapéutica válida para la reconstrucción de defectos de la región facial posterior a una resección quirúrgica, es una alternativa aceptable a los colgajos libres cuando estos no pueden ser utilizados ya sea por el performance status o patología de base de los pacientes a tratar o por no contar con cirujano microvascular. Objetivo: Describir nuestra experiencia en el uso de este colgajo para la reconstrucción de 7 pacientes con defectos de órbita, paladar y mucosa yugal tras la cirugía ablativa de diversas patologías. Materiales y métodos: Revisión retrospectiva de los pacientes del Servicio de Cirugía General del Hospital José Ramon Vidal, Corrientes-Argentina operados en el periodo comprendido desde enero del 2019 hasta enero del 2021.En este lapso, 7 pacientes fueron sometidos a cirugía reconstructiva inmediata con colgajo de músculo temporal en defectos del tercio medio de la región facial. Resultados: Un total de siete pacientes, (4 masculino- 3 femenino), sometidos a cirugía ablativa por presentar patología maligna (6) y patología benigna (1), con una edad media de 60 años. Dos colgajos se utilizaron para defectos de región orbitaria y partes blandas, seis para defectos en la cavidadoral­ en un paciente se emplearon los 2 músculos temporales-. El colgajo fue exitoso en todos los casos, se presentaron complicaciones menores como: dolor postoperatorio, hematoma, trismus, depresión de la zona dadora. Se obtuvo márgenes libres en el total de los procedimientos. Discusión: La cirugía reconstructiva con colgajo pediculado de musculo temporal es una excelente alternativa de colgajo regional con buenos resultados, posee alta tasa de éxito justificada por su buena vascularización. Además, la proximidad del músculo temporal con la región maxilofacial y su inserción contribuyen a obtener un arco de rotación hasta 180° sin comprometersu vitalidad. Es útil para la reconstrucción en un acto quirúrgico, acortando el tiempo intraoperatorio y sin cambios posicionales. Conclusiones: El colgajo de músculo temporal resulta una opción válida a los colgajos libres osteo-mio-cutáneos para defectos mixtos (óseos y de partes blandas) del tercio medio facial luego de la cirugía ablativa, cuando estos últimos no pueden ser implementados teniendo en cuenta varios aspectos como performance estatus de los pacientes, patología de base y necesidad de contar con un cirujano microvascular

Introduction: temporalis muscle vascularized flaps is a valid therapeutic option for reconstruction of defects in facial region after surgical resections. It is an acceptable alternative to free transfer flaps when these cannot be used because of the patient's performance state and base pathologies. Or because of the lack of a microvascular surgeon. Objectives: To describe on experience applying this kind of flaps for the reconstruction or 7 patients, with defects in palate orbit and yugal mucose after resective surgeries for various pathologies. Materials and methods: retrospective revision of patients in the general department, of Jose R Vidal Hospital (Corrientes - Argentina) into underwent surgery during the period between January 2019 ad January 2021. A total of 7 patients underwent immediate reconstructive surgery using a temporalis muscle flap. Results: 7 patients (4 males y 3 female) underwent resective surgery for different malignant (6) and benign (1) with a median age of 60. Two flaps were used for defects of the orbitary region and soft tissue, six for defects of the oral cavity (in one patient both temporalis muscle were used. Te procedure was successful in all cases, and minor complication were present, (post operatory pain, hematoma, trismus, excavation of the donor region) all procedures resulted un surgical margins of lesion of malignancy. Discussion: reconstructive surgery using a vascularized flap of temporalis muscle is an excellent alternative for regional flaps with good results and a high success justified because of its a good irrigation. Besides the proximity between temporalis muscle and the maxillofacial region, possibilities a flap rotation of up to 180 grades without compromising its vitality it is also useful for reconstruction in a single surgery shortening intra-operatory time while avoiding repositioning of the patients during the procedure. Conclusions: Temporalis muscle flaps are valid option to free osteo- mayo- cutaneal flaps for mixed defects (involving bone and soft tissue) of the medium third of facial region after resective surgeries when the latter cannot be carried and because of various aspects little performance status base pathologies and lack of microvascular margin.

Prevalence and Clinical Correlators of Undiagnosed Significant Depressive Symptoms Among Individuals with Type 2 Diabetes In A Mediterranean Population.

Objective: To determine the frequency and clinical parameters, of clinically significant depressive symptoms among a type 2 diabetes (T2DM) sample from a Mediterranean area without an established diagnosis of depressive disorder (DD). Methods: 320 subjects with T2DM were recruited randomly from Primary-Care settings and the Endocrine Department from a tertiary center in Mallorca (Spain). 91 healthy individuals matched by age, gender and BMI were used as controls. All participating patients graded by the presence of DD by using the "Beck Depression Inventory" (BDI), considering pathological a cut-off score equal or greater than 16. Results: 27.2% T2DM subjects had significant symptoms of DD compared with 12.1% in the control group (p<0.01). BDI score was higher among T2DM when compared with controls (12±9.6 vs. 7.4±5, p<0.0001). The proportion of females (68% vs. 37%, p<0.0001), subjects without an active job (68% vs. 45%, p=0.01) and singles (38% vs. 18%, p=0.007) was greater among T2DM with a BDI≥16. Subjects with criteria for DD had a higher BMI (31.99±5.96 vs. 30.53±5.62, p=0.03). Fasting plasma glucose was higher among T2DM with a BDI≥16 (162±70 vs. 147±45 mg/dl, p=0.02) as well as HbA1c levels (7.9±1.8% vs. 7.4±1.4%, p=0.01), triglycerides (203±183 vs. 161±103 mg/dl; p=0.03) and LDL-cholesterol (112±31 vs. 104±35 mg/dl; p=0.03). Gender, marital status, BMI and triglycerides were independently related to the presence of DD after a logistic regression model. Conclusions: Relevant depressive symptoms are more prevalent among Mediterranean T2DM subjects than in general population. Main clinical correlators of significant depressive symptoms are gender, marital status and BMI.

Tailored synthesis of nanostructures by laser irradiation of a precursor microdroplet stream in open-air.

A method to synthesize multicomponent nanostructures in open-air is presented. A microdroplet precursor target is irradiated with a nanosecond laser pulse to induce plasma. At low droplet dispensing rates, the precursor and solvent are fully atomized without debris to produce nanoparticles and nanofilaments during plasma cooling. More complex structures like nanolayers or nanofoams can be synthetised at kilohertz droplet dispensing rates as additional droplets in the vicinity of the target droplet are subjected to the laser-induced plasma and its associated shockwave. Examples of both low- and fast-rate mechanisms are presented for Mn-Fe bi-metal oxide nanoparticles and zinc oxide nanoparticles, nanofilaments and nanofoams. Real-time diagnostics were carried out with time-resolved imaging, atomic emission spectroscopy, light scattering and shadowgraphy. In addition to overcoming some of the difficulties associated with pulsed-laser deposition (PLD), the use of a liquid precursor whose composition can be tailored on a droplet-to-droplet basis opens a number of possibilities.

Is there loss of protective muscarinic receptor mechanism in asthma?

We investigated the hypothesis that prior airway muscarinic receptor stimulation (with aerosolized methacholine) would modify the bronchoconstrictor response to histamine, which is, in part, vagally mediated. On four different experiment days, the following combinations of methacholine and histamine inhalation challenges were performed in 15 subjects (nine normal and six asthmatic) in a random fashion: methacholine-histamine, histamine-methacholine; methacholine-methacholine and histamine-histamine. Cumulative provocative dose of each agonist which caused a 50 percent decrease in SGaw was estimated (PD50). The second challenge was performed approximately 1 hour after the first challenge, when SGaw had returned to baseline. In normal subjects, prior muscarinic stimulation with methacholine suppressed the subsequent bronchoconstrictor response to histamine (mean +/- SE PD50 histamine increased from 13.7 +/- 3.1 to 28.4 +/- 7.2 breath units), without modifying the bronchoconstrictor response to methacholine. In asthmatic subjects, prior methacholine exposure failed to modify the bronchoconstrictor responses to histamine and methacholine. In contrast, prior challenge with histamine did not modify the subsequent bronchoconstrictor responses to histamine and methacholine in both normal and asthmatic subjects. Pretreatment with ipratropium bromide attenuated the histamine-induced bronchoconstriction, suggesting that airway effects of histamine, in part, are vagally mediated. These data suggest that prior muscarinic stimulation has a protective effect on histamine-induced bronchoconstriction in normal subjects and the absence of this inhibitory effect in asthmatic patients may represent loss of a protective muscarinic receptor mechanism.

Expression of Thinopyrum intermedium-Derived Barley yellow dwarf virus Resistance in Elite Bread Wheat Backgrounds.

ABSTRACT Resistance to Barley yellow dwarf virus (BYDV) is not found in wheat but is available in a Thinopyrum intermedium translocation (Ti) carried on chromosome 7DL of bread wheat recombinant lines. We used one of those lines (TC14/2*Spear) to introgress the Ti into bread wheat cultivars and to determine the influence of wheat backgrounds, with and without known tolerance to BYDV, on the expression of resistance. Two single and three backcross populations, segregating for the presence of the alien fragment, were tested under field conditions and artificial inoculation with BYDV isolates MAV-Mex and PAV-Mex. Lines containing the fragment were identified using the microsatellite marker gwm37. Tillering, biomass, grain yield, thousand-kernel weight, and seed quality were evaluated in inoculated and noninoculated plots. Resistance was assessed by enzyme-linked immunosorbent assay. In early generations, the alien fragment followed expected Mendelian segregation, whereas in the advanced ones a slight bias against its transmission was observed. No positive nor negative effects of Ti on agronomic performance and quality were found. A significant optical density reduction in individuals carrying the fragment was observed after PAV infection in crosses with lines Anza and Baviacora but not with Milan. In addition, the fragment was associated with a lower frequency of infected plants for both PAV and MAV isolates. The reduced yield loss associated with the presence of the translocation was due largely to the lower infection rate.

Evaluation of different drugs in two models of immediate hypersensitivity.

The effect of the calcium antagonists, verapamil, nicardipine and diltiazem, the two cromones, disodium cromoglycate and SM-857 (11-oxo-11H-pyrido[2,1-b]quinazoline-2-carboxylic acid), and the anthelmintic, diethylcarbamazine citrate, have been compared on the ovalbumin (OA)-induced contraction of the isolated trachea and longitudinal muscle-myenteric plexus (LM-MP) from sensitized guinea-pigs. The calcium antagonists prevented the OA-induced contractions in LM-MP and to a lesser degree the OA-induced contractions in trachea. Similar doses of SM-857 protected both tissues but neither cromoglycate (10(-5)M) nor diethylcarbamazine (10(-5)M) affected these contractions. The OA-induced contraction in trachea had a tonic phase that was not present in the LM-MP response. Only the calcium antagonists succeeded in relaxing this OA tonic component, diltiazem being the more potent. These results unmask different mechanisms of drug action on immediate hypersensitivity and specific sensibilities, depending on the kind of tissue.

Electrophysiological effects of penticainide in the anaesthetized dog.

The cardiac electrophysiological effects of Penticainide, a new antiarrhythmic agent, were studied by means of intracardiac electrodes in the anaesthetized dog. Intravenous administration of 5 mg/kg of Penticainide reduced the sinus rate and prolonged the sinus node recovery time. Atrial refractory periods increased. Anterograde intranodal conduction slowed and nodal refractoriness increased. Conduction time in the His-Purkinje tissue and ventricle increased, as did the ventricular refractory periods. Monophasic action potential duration was not altered by the drug in the atrium or the ventricle. The mechanism of action of Penticainide as an antiarrhythmic drug seems to be correlated to its membrane effects: inhibition of the fast-inward current, responsible for the marked effects on His-Purkinje and ventricular tissues; and inhibition of the slow-inward current, suggested by its effects on sinus node and atrio-ventricular node.

Intramedullary sarcoidosis presenting as incomplete paraplegia: case report and literature review.

Sarcoidosis is a chronic, multisystem noncaseating granulomatous disease of unknown etiology. Sarcoidosis typically presents clinically in individuals between the ages of 20 and 40 years. Although sarcoidosis most commonly affects the respiratory system, nearly any organ system can be involved. Spinal cord involvement by sarcoidosis is a rare event, occurring in less than 1% of patients with systemic disease. The case presented is that of a 29-year-old black male with benign past medical history who presented with a 6-week history of progressive incomplete paraplegia and bowel dysfunction. Magnetic resonance imaging revealed an intramedullary mass at the T-4-T-5 levels. The patient underwent thoracic laminectomy and debulking of the mass. The pathology was consistent with granulomatous disease. Postoperatively, the patient was placed on prednisone. He subsequently received comprehensive inpatient and outpatient rehabilitation and at present is bowel and bladder continent and ambulating at community levels with a rolling walker. The diagnosis of sarcoidosis; potential treatment options, including debulking and long-term steroid use; and prognosis will be discussed.

Intercomparison of absorbed dose to water measurements for 60Co gamma rays using Fricke, alanine and radiochromic dye film dosimetry.

Measurements of absorbed dose at 5 cm depth in a 30 x 30 x 30 cm3 water phantom have been performed using three independent dosimetric techniques: Fricke, alanine and radiochromic dye film (GafChromic HD-810). The measurements were carried out in the secondary standard dosimetry laboratory at ININ Mexico using a collimated 60Co gamma source with a radiation field of 10 x 10 cm2 at the phantom front surface. The source to phantom distance was set at 100 cm. The reference absorbed dose at 5 cm depth in the water phantom was obtained using a 0.6 cm3 ionisation chamber. The absorbed dose to water for the test dosimetry techniques was around 100 Gy. The deviations of the dose obtained from these dosimetry techniques were within 4%. The reasons for these deviations are discussed.

[South American blastomycosis. Diagnosis by colonoscopy]. / Blastomicosis sud-Americana. Diagnóstico mediante colonoscopia.

Two cases of South American Blastomycosis are presented; the disease is not frequent in our country; the cases are a segmentary and difuse type primitive localized in the colon. In both of them the colonoscopy was a very important aid in the diagnosis.

[Cases of gastroenteritis associated to Vibrio cholerae no 01 in Oran, Salta]. / Casos de gastroenteritis asociados a Vibrio cholerae no O1 en Orán, Salta.

Forty-one sporadic cases of non-O group 1 Vibrio cholerae gastroenteritis were detected in Orán, Salta, between February 1992 and February 1995. The frequency of isolation was 0.9% of the diarrhea cases. Out of 41 patients, 21 (51.2%) were older than 15 years and 25 (60.9%) were male. All the patients had diarrhea, 24 (58.5%) had watery stools and 6 (14.6%) cholera-like diarrhea; 10 (24.4%) presented vomiting and 12 (29%) mild dehydration. Six malnourished children who suffered from diarrhea with moderate dehydration for more than a week, were hospitalized. V. cholerae non O1 and Shigella flexneri were isolated from one patient, during the first outbreak and V. cholerae non O1 and Salmonella IV 50:b:- were recovered simultaneously from another patient during the fourth outbreak. A 72 year old woman died during the second cholera outbreak. The symptoms were: watery diarrhea, vomiting, fever and mild dehydration. A strain of V. cholerae O5, that did not produce cholera toxin, heat-stable enterotoxin, Kanagawa-like hemolysin or verocitotoxin was detected. It was positive for El Tor hemolysin and D-mannose and L-fucose resistant cells-associated hemagglutinins. Among the 41 isolates studied, all were oxidase and indole positive, fermented glucose, saccharose and mannitol. They were all motile, produced lysine and ornithine decarboxylases but not arginine dihydrolase or hydrogen sulfide. They were sensitive to O129 vibriostatic compound. None of them belonged to O1 or O139 serogroup and they did not produce cholera troxin. Among the V. cholerae non O1 strains isolated, 9.5% were resistant to ampicillin and 4.9% to trimethoprim-sulfamethoxazole. Active surveillance had shown that V. cholerae non-O1 is not an important agent of diarrhea in Orán, Salta.

[Aspects of reproduction related to human rights. III. Artificial termination of pregnancy]. / Aspectos de la reproducción relacionados con los derechos humanos. III. Terminación artificial del embarazo.

PIP: Induced abortion is no doubt a public health problem. In Mexico 34.9% of women aged 15-49 return at least once to hospital services for complications of induced abortion. Complications of include infection, hemorrhage, shock, and traumatic lesions; risk of complications in termination of 2nd trimester pregnancy is 3-4 times higher than for 1st trimester termination. Longterm complications include prematurity, spontaneous abortion, placental anomalies, fetal death, and psychological sequelae. The majority of women returning for induced abortions are between 30-40, with high parity, an unstable union, low education, and low income. For many of these women the idea of contraception is much more alien than the idea of abortion. Many people believe that legalization of abortion in Mexico would decrease the number of illegally induced abortions. If this postulation has not been proven right in rich countries such as the U.S. and many European countries, there is no reason it would prove right in Mexico, where the number of woman illegally practicing abortion is large among the lower classes. Moreover, the majority of the population still lack basic medical services, not to mention abortion services, and most medical institutions in rural areas do not have the equipment and personnel to cover the eventual request for abortion. Most importantly, legalization of abortion would decrease the number of contraception users, instead of increasing it. Another important fact to be taken into consideration is the high percentage of complications after legally induced abortion, as demonstrated by U.S. and European statistics.^ieng

[Perinatal medicine. Medico-social implications. I. Technics used in the identification of high risk pregnancy]. / Medicina perinatal. Implicaciones médico-sociales i. técnicas utilizadas en la identificación del embarazo de riesgo elevado.

PIP: The most important advancement in perinatology during the past few years has been the possibility to selectively establish a criterion to judge high risk pregnancies, which still represent the great majority of cases of materno-infant morbimortality. Social, economic, and cultural factors, age, biological antecedents of the mother, previous pregnancies, and medical history, have all a great influence in the evaluation of gestation. Through the years several models have been constructed to evaluate high perinatal risks; excluding complications due to danger of congenital abnormalities only 19% of women are exposed to high risk pregnancy. Among prenatal risk factors the most common are toxemia, chronic hypertension, severe cardiopathy, and diabetes; risk factors that may become more evident during delivery or shortly before it are toxemia again, premature rupture of membranes, meconial amniotic fluid, and abnormal presentation.^ieng

Viral RNAs are unusually compact.

A majority of viruses are composed of long single-stranded genomic RNA molecules encapsulated by protein shells with diameters of just a few tens of nanometers. We examine the extent to which these viral RNAs have evolved to be physically compact molecules to facilitate encapsulation. Measurements of equal-length viral, non-viral, coding and non-coding RNAs show viral RNAs to have among the smallest sizes in solution, i.e., the highest gel-electrophoretic mobilities and the smallest hydrodynamic radii. Using graph-theoretical analyses we demonstrate that their sizes correlate with the compactness of branching patterns in predicted secondary structure ensembles. The density of branching is determined by the number and relative positions of 3-helix junctions, and is highly sensitive to the presence of rare higher-order junctions with 4 or more helices. Compact branching arises from a preponderance of base pairing between nucleotides close to each other in the primary sequence. The density of branching represents a degree of freedom optimized by viral RNA genomes in response to the evolutionary pressure to be packaged reliably. Several families of viruses are analyzed to delineate the effects of capsid geometry, size and charge stabilization on the selective pressure for RNA compactness. Compact branching has important implications for RNA folding and viral assembly.