[ECMO support in a child with cardiogenic shock due to Kingella Kingae endocarditis]. / ECMO en un lactante con shock cardiogénico secundario a endocarditis por Kingella Kingae.

INTRODUCTION: Endocarditis is a rare disease in children, especially in those without previous heart disease, and Kingella Kingae (KK) is rarely identified as the cause. Extracorporeal membrane oxyge nation (ECMO) is a support for both heart and respiratory failure. OBJECTIVE: To report the first case of infectious endocarditis (IE) due to KK which required ECMO support secondary to refractory cardiogenic shock. CLINICAL CASE: 19-months-old previously healthy female patient, with a 2-day his tory of fever, and diagnosed with hand-foot-and-mouth disease. The patient developed refractory cardiogenic shock, multiorgan failure, acute respiratory distress syndrome, and deep hemodynamic compromise that required veno-arterial ECMO support. The echography showed an image compa tible with mitral valve vegetation, confirming IE with transthoracic echocardiography. Blood culture was positive for KK. She had an ischemic stroke and required two heart surgeries, the first one for the mass resection and the second one for mitral valve repair, which had a posterior ring pseudoa neurysm. The patient had a favorable evolution and was discharged 73 days after admission. At one year of follow-up, she had no cardiological symptoms, but a mild right brachial-crural hemiparesis persisted. CONCLUSION: This is the first reported case of IE due to KK that required extracorporeal life support. KK endocarditis is an uncommon pathology that can cause multiorgan failure, which can be successfully supported with ECMO.

ECMO en un lactante con shock cardiogénico secundario a endocarditis por Kingella Kingae / ECMO support in a child with cardiogenic shock due to Kingella Kingae endocarditis

Resumen: Introducción: La endocarditis es una enfermedad poco frecuente en niños, especialmente en los sin patología cardiaca previa, y de manera extraordinaria se identifica a Kingella Kingae (KK) como la causa. La oxigenación por membrana extracorpórea (ECMO) es una forma de soporte tanto para fa lla cardiaca como respiratoria. Objetivo: Reportar el primer caso de endocarditis infecciosa (EI) por KK que requiere soporte con ECMO por shock cardiogénico refractario. Caso clínico: Lactante de 19 meses, previamente sana, que consultó por cuadro de 2 días de fiebre, diagnosticándose síndrome pie mano boca. Evolucionó con shock, falla multiorgánica, síndrome de distress respiratorio agudo y compromiso hemodinámico profundo, por lo que se le dio soporte con ECMO veno arterial. La ecoscopía mostró imagen compatible con vegetación en válvula mitral, confirmando EI con ecocardiografía transtorácica. El hemocultivo fue positivo a KK. Presentó accidente cerebrovascular isquémico. Requirió dos cardiocirugías -la primera para resección de la masa y la segunda para la reparación de la válvula mitral, que había quedado con un pseudoaneurisma del anillo- velo posterior. La paciente tuvo una evolución favorable, siendo dada de alta a los 73 días desde el ingreso. Al año de seguimien to se encontraba asintomática cardiaca, pero persistía una hemiparesia braquiocrural derecha leve. Conclusión: Este es el primer caso reportado de EI por KK que requirió soporte vital extracorpóreo. La EI por KK es una patología infrecuente, que puede provocar falla orgánica múltiple, la que puede ser soportada exitosamente con ECMO.

Abstract: Introduction: Endocarditis is a rare disease in children, especially in those without previous heart disease, and Kingella Kingae (KK) is rarely identified as the cause. Extracorporeal membrane oxyge nation (ECMO) is a support for both heart and respiratory failure. Objective: To report the first case of infectious endocarditis (IE) due to KK which required ECMO support secondary to refractory cardiogenic shock. Clinical case: 19-months-old previously healthy female patient, with a 2-day his tory of fever, and diagnosed with hand-foot-and-mouth disease. The patient developed refractory cardiogenic shock, multiorgan failure, acute respiratory distress syndrome, and deep hemodynamic compromise that required veno-arterial ECMO support. The echography showed an image compa tible with mitral valve vegetation, confirming IE with transthoracic echocardiography. Blood culture was positive for KK. She had an ischemic stroke and required two heart surgeries, the first one for the mass resection and the second one for mitral valve repair, which had a posterior ring pseudoa neurysm. The patient had a favorable evolution and was discharged 73 days after admission. At one year of follow-up, she had no cardiological symptoms, but a mild right brachial-crural hemiparesis persisted. Conclusion: This is the first reported case of IE due to KK that required extracorporeal life support. KK endocarditis is an uncommon pathology that can cause multiorgan failure, which can be successfully supported with ECMO.

Pleistocene refugia and recolonization routes in the southern Andes: insights from Hypochaeris palustris (Asteraceae, Lactuceae).

Hypochaeris palustris (Phil.) De Wild. is a species growing in the southern Andean chain. To elucidate potential Pleistocene refugia and recolonization routes in the southern Andes, we analysed amplified fragment length polymorphisms (AFLPs) in 206 individuals in 21 populations of H. palustris from the coastal Cordillera, the central, northern, and eastern ranges of the southern Andes, and Patagonia. Populations from the coastal Cordillera harboured more private AFLP fragments, and exhibited a higher frequency of polymorphic fragments as well as higher Shannon diversity than all other areas investigated. The comparison among pooled AFLP profiles of each region revealed that the central Andean ranges shared most fragments with populations from the margins of the distributional area in the Andes, in the N, E, and S (Patagonia). Phenetic analysis indicated close relationships among populations of the central ranges. Populations of the coastal Cordillera were shown to be highly differentiated from the Andean populations. It is very likely therefore that (1) H. palustris recolonized the central ranges of the southern Andes from nearby refugia, possibly unglaciated areas N, E, and/or S of its present distributional area; (2) the postglacial spread of H. palustris in the central ranges of the southern Andes occurred rapidly; and (3) the coastal Cordillera served as a refugium for H. palustris, but these populations did not contribute to the recolonization of the central Andean ranges.

Removal of EDTA by UV-C/hydrogen peroxide.

Mineralization of a 5 mM EDTA solution at pH 3 was evaluated via TOC removal under UV-C irradiation in the presence of H2O2 at various conditions. The highest TOC removal (78%) was obtained using a 40:1 H2O2/EDTA molar ratio, after 540 min irradiation. However, a 20:1 ratio gave slightly lower results, being economically more attractive. Best results of TOC removal were obtained under pH controlled conditions. Addition of TiO2 (1 g l(-1)) was detrimental, even in the presence of H2O2, indicating that at this concentration, TiO2 inhibits the mineralization, probably by scattering or by screening of the light.

Genetics of colonization in Hypochaeris tenuifolia (Asteraceae, Lactuceae) on Volcán Lonquimay, Chile.

Understanding the genetics of colonizing populations has been, and continues to remain, an important focus in evolutionary biology. Different theoretical models predict varying levels of genetic variation in colonizing populations depending upon strength of founder effect, gene flow and rate of population growth and immigration following colonization. We analyse overall genetic variation using amplified fragment length polymorphism markers in colonizing populations of Hypochaeris tenuifolia (Asteraceae) in the southern Andes. Volcán Lonquimay newly erupted on 25 December 1988, producing a side cone, La Navidad, and sent lava and ash into surrounding areas. Many domesticated animals (estimated at 10 000) and many natural plant populations were destroyed. Into this new open habitat have come immigrant populations of several angiosperm species, most conspicuously H. tenuifolia that forms leaf rosettes with flowering scapes to 15 cm and orange-yellow heads 1-2 cm in diameter. Genetic diversity in five founder populations in the eruption zone is compared with that from five nearby survivor populations, as well as with eight isolated northern and four southern populations from throughout the entire range of the species in Chile. Results from 477 individuals representing 447 different multilocus phenotypes, yielded 170 DNA fragments of which 144 (85%) were polymorphic. Genetic diversity within founder populations is neither lower than in survivor populations nor in isolated populations throughout the range of the species, but it is lower among founder populations than among other populations immediately and distantly outside the zone of disturbance. Closest genetic similarity occurs between founders and nearby survivor populations as well as those in adjacent southern regions.

Allozyme diversity in endemic flowering plant species of the Juan Fernandez Archipelago, Chile: ecological and historical factors with implications for conservation.

The level and apportionment of allozyme diversity were determined for 29 endemic (and 1 native) species from the Juan Fernández Islands, Chile. Mean diversities at the species level (H(es) = 0.065) are low but comparable to those measured for other insular endemics in the Pacific. A high mean proportion (0.338) of species-level diversity resides among populations. Diversity statistics were compared for species in different ecological-life history trait categories and abundance classes. Species occurring in large populations and those present in scattered small populations have higher diversities than species occurring in one or two populations. Although not significant with the conservative statistical test employed, lower diversity was found in highly selfing species as compared to animal- or wind-pollinated species. The apportionment of genetic diversity within and among populations (G(ST) values) is not significantly different for any of the species categories. Of particular interest is the lack of difference between animal- and wind-pollinated species because previous analyses of large data sets showed higher differentiation between populations of animal- than wind-pollinated species. Historical factors, both ecological and phylogenetic in nature, can influence the level and apportionment of diversity within insular endemics, and thus ecological correlates of diversity seen in many continental species may not apply to endemics. The results have several conservation implications. The preservation of large populations or several small populations is important for conserving diversity within species because when species are reduced to one or two populations, allozyme diversity is sharply reduced. High mean G(ST) values for the species examined illustrate the need for conserving as many populations as possible, either in the wild or in the garden, to preserve maximal diversity within species. Effective conservation strategies require empirical knowledge of each species.

El procuramiento de órganos en un servicio de urgencia de la Región Metropolitana / Organ provision at an emergency service, Región Metropolitana

La unidad de emergencia del área occidente tiene una población asignada de 800.000 habitantes y es el centro de derivación de urgencias para adultos. Estadísticas extranjeras establecen que un 2 por ciento de los fallecidos o 45 individuos por millón de habitantes por año deberían ser donantes potenciales. De acuerdo a esto, en nuestra unidad debería ser posible de obtener entre 15 y 20 donantes efectivos por año. En 1992, se inició un programa de procuramiento a nivel local, basado en: educación y motivación, implementación básica y obtención de recursos y evaluación periódica de resultados. El objetivo de esta comunicación fue presentar los resultados y motivar al personal de salud que labora en otros puntos del país para que inicien esta actividad. El número de donantes potenciales aumentó de 2 a 45 por año y el número de donantes efectivos de 1 a 15 por año. El número de órganos procurados fue de 88 riñones, 7 hígados, 11 donantes de válvulas cardíacas, 10 donantes de córneas, 2 donantes cardíacos y 1 donante óseo. El número de riñones entregados al pool nacional supera a los riñones recibidos de otras partes. Desde 1993 se ha incrementado el número de donantes multiorgánicos. La motivación del personal médico y paramédico, el apoyo del neurólogo y el respaldo de la dirección de la unidad, han sido elementos importantes para esta mejoría. Estos resultados demuestran que pese a las limitaciones y deficiencias existentes en los servicios de urgencias públicos en Chile, es posible implementar el procuramiento de órganos como una actividad médica habitual

Mini esternotomía en cirugía valvular / Minimally invasive sternotomy for valvular heart surgery

Antecedentes: desde mediados de la presente década se han propuesto distintos accesos mínimamente invasivos en cirugía cardiovascular, entre ellos la miniesternotomía. Objetivo: presentar nuestra experiencia inicial en cirugía valvular a través de miniesternotomía. Pacientes: entre octubre 1997 y diciembre 1998, se efectuó un reemplazo valvular aórtica y en otra un reemplazo valvular mitral, a través de una miniesternotomía media en "J". Nueve pacientes eran hombres. El promedio de edad fue de 53,6 años (29-73). Todos los pacientes fueron operados con monitorización ecocardiográfica transesofágica. Técnica quirúrgica. Se efectuó una esternotomía media en "J" en el 3º o 4º espacio intercostal derecho con una incisión cutánea menor a 10 cm en todos los casos. Para el retorno arterial se canuló la aorta ascendente y para el drenaje venoso, la orejuela derecha con una cánula única. La protección miocárdica se efectuó con cardioplegia cristaloide infundida en forma anterógrada y/o retrógrada a 4ºC. El drenaje de las cavidades izquierdas se efectuó con un catéter introducido a través de la vena pulmonar superior derecha. Los reemlazos valvulares aórticos se efectuaron a través de una aortotomía oblicua y el reemplazo valvular mitral a través de una auriculotomía izquierda superior...