[Spine cord descompresion and instrumentation in a case of solid aneurysmal bone cyst in the lumbar spine]. / Descompresión medular e instrumentación en un caso de variante sólida de quiste óseo aneurismático en raquis lumbar.

We report a 8-year-old boy with two month history of pain and stiffness in his left lower extremity. On x-ray, MRI and scintigraphy examinations a lytic lesion affecting the body and posterior arc of his third lumbar vertebral become evident. The tumour was excised through a double, anterior and posterior approach; spinal fusion with posterior transpedicular instrumentation was also performed in the same procedure; in order to achieve solid fusion tricortical liofilized graft was also inserted. Histological studies evidenced finding compatible with aneurysmal bone cyst solid variant. Five years after surgery the patient is pain free and no recurrence is evident under diagnostic images tools. For the treatment of aneurysmal bone cyst of the spine we recommend complete excision of the tumour in a combined anterior and posterior one staged procedure, together with hardware instrumentation and bone graft, no recurrence or instability is seen after five years followup.

Inhibition of ornithine decarboxylase by the isomers of 1,4-dimethylputrescine.

1,4-Dimethylputrescine (2,5-hexanediamine) was separated into its racemic and meso isomers by fractional crystallization of its dibenzoyl derivative. The racemic form was resolved into its (+)- and (-)-isomers with (+)- and (-)-dibenzoyltartaric acids. None of the three isomers (meso, +, and -) inhibited ornithine decarboxylase (ODC) activity in vitro, while all the three were strongly inhibitory of ODC when assayed in vivo in rats or in H-35 hepatoma cells. In rat liver the three isomers also decreased the putrescine pool while only the (+)-isomer decreased spermidine content. In the H-35 cells the (-)- and (+)-isomers decreased the spermidine and spermine content. When ODC was induced in the latter by insulin it was found that the (-)-isomer strongly inhibited protein and ODC synthesis, while the (+)-isomer and the meso isomer were less inhibitory. The meso isomer was a good inducer of ODC antizyme in rat liver, while the (+)- and (-)-isomers were poor inducers of the former.

Esplenectomía laparoscópica en pacientes con púrpura trombocitopénica idiopática: primera experiencia en el Hospital Regional de Arica / Laparoscopic splenectomy in patients with idiopathic thrombocytopenic purpura: first experience at the Regional Hospital of Arica

Introducción: La púrpura trombocitopénica idiopática (PTI) es una de las trombocitopenias más frecuentes en adultos. La esplenectomía corresponde a uno de sus tratamientos de segunda línea en pacientes refractarios a otras terapias médicas. Objetivo: Presentar nuestra primera experiencia en esplenectomía laparoscópica en el servicio de cirugía del Hospital Regional de Arica. Materiales y métodos: Se realizó una revisión transversal retrospectiva de pacientes con PTI a quienes se les indicó esplenectomía por falla en el tratamiento médico. Se tabularon los exámenes preoperatorios, plaquetas 24 h pre y posquirúrgicas, plaquetas al inicio del estudio (3 meses preoperatorios) y al mes del postoperatorio, complicaciones quirúrgicas y características histopatológicas. Resultados: Se realizaron 5 esplenectomías. El 100% de los pacientes presentaron mejoría a las 24 h de postoperados. Al cabo de un mes, sólo 3 de 5 pacientes tuvieron una mejoría de su trombocitopenia. No hubo complicaciones mayores como hemoperitoneo o fístulas pancreáticas. Un paciente presentó equimosis en un puerto. Conclusiones: La esplenectomía laparoscópica es una técnica factible de realizar en nuestro centro, con una tasa de complicaciones y resultados comparables con centros de mayor volumen.

Introduction: Idiopathic thrombocytopenic purpura (ITP) is one of the most common acquired thrombocytopenia in adults. Splenectomy is as second line treatment in medical refractory patients. Aim: The aim of this study is to present our first initial experience in laparoscopic splenectomy of the surgical department of Arica's local hospital. Materials and methods: This is a transversal prospective review of patients with ITP which splenectomy was performed due medical treatment failure. Preoperative blood test: platelet count at the beginning of the study, 24 h pre op, 24 h post op and a month post surgery were tabulated. Postoperative complications and histopathology characteristics were reported. Results: We performed 5 splenectomies, 100% of the patients presented a recovery platelet count at 24 h postop. In the first month only 3 patients had an improvement of their thrombocytopenia. There were no major complications, like hemoperitoneum or pancreatic leaks, only one patient presented port site ecchymosis. Conclusions: Laparoscopic splenectomy is a feasible technique in our center with a complication rate and outcomes comparable to high volume center.

[Arthroscopic removal of an intraarticular projectile from the knee]. / Extracción de proyectil intraarticular en rodilla mediante artroscopía.

OBJECTIVE: We present the case of a patient who sustained a gunshot wound; the projectile was located in the knee and was arthroscopically removed. CLINICAL CASE: A 31 year-old patient sustained a gunshot wound in the right thigh, right hand and left knee. X-rays revealed the presence of a projectile in the knee, thigh and hand. The projectile was arthroscopically removed. DISCUSSION: Traumas causing articular wounds of the knee are infrequent. Excluding the most frequent causes of articular wounds, a small percentage of them are due to gunshot wounds. There is consensus around arthroscopy as a technique useful to remove articular foreign bodies; it has advantages over open surgery. This procedure minimizes surgical morbidity, reduces the risk of septic arthritis, synovitis, arthropathy or systemic lead toxicity, and it also hastens the patient's functional recovery. Knee arthroscopy allows physicians to provide a definitive treatment of these injuries, explore the joint, diagnose associated injuries and perform debridement and articular lavage. CONCLUSION: Arthroscopy is an effective tool for the extraction of articular projectiles; it also allows diagnosing and treating associated lesions.

Prevención de la aparición de fibrosis epidural post-laminectomía con el empleo de rapamicina y barrera colágeno. Estudio experimental en Conejos / Prevention of post-laminectomy peridural fibrosis with sirolimus and barrier collagen. An experimental rabbit study

Objetivo: La fibrosis epidural resulta una complicación de aparición frecuente tras practicar laminectomía. No disponemos en la actualidad de mecanismos que eviten su formación. Rapamicina posee la capacidad de inhibir la respuesta inflamatoria y fibroblástica, asi como el colageno presenta propiedad hemostática. Este trabajo, pretende valorar la capacidad de ambos agentes utilizados de forma conjunta, en evitar la aparicion de fibrosis epidural tras laminectomía. Material y método: Practicamos laminectomía del espacio intervertebral L4-L5 en 32 conejos, distribuidos en 4 grupos, que se sacrificaron a las 8 semanas. En el espacio epidural creado tras laminectomia en el grupo de casos se instilo 5 ml de rapamicina y se posicionó membrana de colágeno, en el segundo grupo se posiciono membrana de colageno, el tercer grupo recibio instilacion de 5 ml de rapamicina y en el grupo de control lavado con 5 ml de suero fisiologico tras finalizar laminectomía. Las preparaciones histológicas fueron estudiadas mediante microscopía óptica. Se cuantificaron las poblaciones celulares presentes en la reacción inflamatoria, el grosor de la membrana fibrosa y grado de adherencia dural. Resultados: La medida de la superficie fibrosa, el grado de adherencia dural y la celularidad inflamatoria fue siempre menor en los conejos del grupo tratado con rapamicina y membrana de colageno que el resto (p<0.05). Conclusiones: Rapamicina en presencia de colágeno reduce la formación fibrosis y la extensión de adherencia peridural, disminuye la presencia de células inflamatorias y fibroblasticas

Purpose: Epidural fibrosis is a common complication for the patients who underwent laminectomy. No mechanical procedure is known that can prevent its appearance. Sirolimus has been shown to exert its anti-inflammatory, antifibrotic, and antiproliferative multifaceted properties and collagen has hemostatic properties. The object of this study was to investigate the effects of sirolimus and collagen-barrier on the prevention of postlaminectomy epidural fibrosis formation in laminectomy rabbits. Material and methods: We performed a laminectomy in the L4-L5 space in 32 rabbits, distributed into 4 groups, which were put down at 8 weeks. The study group received a 5 ml dose of sirolimus and collagen-barrier, second group a collagenbarrier, third group 5 ml of sirolimus and rabbits in the control groups were injected saline solution. Histologic preparations were studied by means of imaging techniques. The cell populations present in the inflammatory reaction were quantified as well as the thickness of the fibrous membrane and epidural scar adhesion. Results: The mean of the fibrous area, epidural scar adhesion and inflammatory cells was always less in the rabbits of the sirolimus and collagen barrier group compared to the other groups (p<0.05). Conclusions: Sirolimus and collagen-barrier is able to prevent epidural scar adhesion, inhibits the presence of inflammatory cells in the fibrous scar and reduces the extent of its adhesiveness and fibroblast proliferation

Descompresión medular e instrumentación en un caso de variante sólida de quisteóseo aneurismático en raquis lumbar / Spine cord descompresion and instrumentation in a case of solid aneurysmal bone cyst in the lumbar spine

Se discute el caso de un paciente varón de ochoaños de edad que refería dolor y limitación funcionalen extremidad inferior izquierda. Tras estudios complementariosmediante radiografías, tomografía axialcomputarizada, resonancia magnética y gammagrafíase evidenció la presencia de una lesión osteolítica encuerpo y arco posterior de la tercera vértebra lumbar.La tumoración fue resecada a través de doble abordaje(anterior retroperitoneal y posterior) e instrumentaciónpedicular posterior con aporte estructural de huesotricortical liofilizado en un solo tiempo. El diagnósticohistológico reveló la presencia de variante sólida de unquiste óseo aneurismático. Cinco años tras la cirugía elpaciente no presentó dolor lumbar ni recurrencia de laenfermedad. La resección completa del tumor junto coninstrumentación pedicular previno recidivas y desarrollode inestabilidad (AU)

We report a 8-year-old boy with two month historyof pain and stiffness in his left lower extremity. On xray,MRI and scintigraphy examinations a lytic lesionaffecting the body and posterior arc of his third lumbarvertebral become evident. The tumour was excisedthrough a double, anterior and posterior approach;spinal fusion with posterior transpedicular instrumentationwas also performed in the same procedure; inorder to achieve solid fusion tricortical liofilized graftwas also inserted. Histological studies evidenced findingcompatible with aneurismal bone cyst solid variant.Five years after surgery the patient is pain free and norecurrence is evident under diagnostic images tools. Forthe treatment of aneurismal bone cyst of the spine werecommend complete excision of the tumour in a combinedanterior and posterior one staged procedure, togetherwith hardware instrumentation and bone graft, norecurrence or instability is seen after five years followup (AU)

Sarcoma de kaposi extratorácico: evidencias de una enfermedad multisistémica / Extra-thoracic kaposi's sarcoma: evidence of a multisystemic involvement

Kaposi's sarcoma is a low-grade vascular neoplasm that typically manifests as one of four variants, being the epidemic (or AIDS-related) the best known of them. The pulmonary involvement of this disease is well described and is expressed mainly by bilateral parenchymal nodules of characteristic morphology; however, this tumor produces a multisystemic compromise that is not widely known. Due to the increasing incidence and survival rates of patients with HIV, and the fact that Kaposi's sarcoma is one of its frequent complications, we sought to describe its staging and major imaging findings in computed tomography, given the importance of timely recognition of this neoplasm for a proper prognosis and management of the disease.

El sarco made Kaposies un tumor vascular de bajo grado, que manifesta típicamente cuatro formas diferentes, siendo la epidémica (o relacionada con el SIDA) la más conocida de ellas. El compromiso pulmonar de esta enfermedad está bien descrito y se manifiesta principalmente por nódulos parenquimatosos bilateral es de morfología característica ; sin embargo, esta neoplasia produce un compromiso multisistémico que no es ampliamente conocido. Debido a la creciente incidencia y sobrevida de los pacientes con VIH y el hecho de que el sarcoma de Kaposi es una de sus complicaciones frecuentes, decidimos describir su estadificación y los principales hallazgos imaginológicos en tomografía computada, por la importancia de su conocimiento para el adecuado pronóstico y manejo de esta enfermedad.