Capecitabine Plus Aromatase Inhibitor as First Line Therapy for Hormone Receptor Positive, HER2 Negative Metastatic Breast Cancer.

(1) Background: recent evidence suggests that long low-dose capecitabine regimens have a synergistic effect with endocrine therapy as aromatase inhibitors (AIs), and might increase overall survival for hormone-receptor-positive, HER2-negative, metastatic breast cancer compared to both treatments. We performed a retrospective study to confirm the efficacy and expand the safety data for capecitabine plus AI (a combination henceforth named XELIA) for this indication. (2) We conducted a single-center retrospective cohort study of 163 hormone receptor-positive metastatic breast cancer patients who received either the XELIA regimen, capecitabine, or an aromatase inhibitor (AI) as single agents in first-line treatment. The primary endpoint was progression-free survival, and the secondary endpoints were overall survival, best objective response, and toxicity incidence. (3) Results: the median progression-free survival for patients receiving XELIA, AI, and capecitabine was 29.37 months (20.91 to 37.84; 95% CI), 20.04 months (7.29 to 32.80; 95% CI) and 10.48 (8.69 to 12.28; 95% CI), respectively. The overall response rate was higher in the XELIA group (29.5%) than in the AI (14.3%) and capecitabine (9.1%) groups. However, the differences in overall survival were not statistically significant. Apart from hand-foot syndrome, there were no statistically significant differences in adverse events between the groups. (4) Conclusions: this retrospective study suggests that progression-free survival and overall response rates improved with the XELIA regimen compared to use of aromatase inhibitors and capecitabine alone. Combined use demonstrated an adequate safety profile and might represent an advantageous treatment in places where CDK 4/6 is not available. Larger studies and randomized clinical trials are required to confirm the effects shown in our study.

International interlaboratory validation of a nested PCR for molecular detection of Babesia bovis and Babesia bigemina, causative agents of bovine babesiosis.

Babesia bovis and B. bigemina are tick-transmitted parasites causing bovine babesiosis, characterized by significant morbidity and mortality leading to economic losses to the livestock industry in tropical and subtropical regions worldwide. Animals that recover from acute infection remain carriers with low parasitemia acting as a source of transmission, and often escape detection. An improved diagnosis of a B. bovis and/or B. bigemina infection of carrier animals is enabled by the availability of detection methods with high sensitivity. To this end, two nested PCR assays targeting the cytochrome b (cytb) genes of B. bovis and B. bigemina (cytb-nPCR), have been recently developed and an increased sensitivity with respect to reference protocols has been shown (Romero-Salas et al., 2016). In this study, the specificity against a panel of hemoparasites that potentially co-occur with B. bovis and B. bigemina was demonstrated to ensure applicability of the cytb-nPCR assays in a wide range of regions where bovine babesiosis is endemic. Furthermore, we compared both reported cytb-nPCR assays with reference nPCR and qPCR protocols for (i) their capability to detect carrier animals in the field, and (ii) their reproducibility when performed in different laboratories by independent operators. We show that, in a panel of bovine field samples (n = 100), the cytb-nPCR assays detected a considerably higher number of 25% B. bovis and 61% B. bigemina-positive animals compared to 7% and 20% B. bovis and 55% and 49% B. bigemina-positive animals when tested by reference nPCR and qPCR protocols, respectively. Cytb-nPCRs were also found superior in the detection of carrier animals when field samples from Africa were analyzed. In addition, both the B. bovis and B. bigemina cytb-nPCR assays were independently validated in a single blinded study in three laboratories. Importantly, no significant differences in the number/percentage of infected animals was observed using cytb-nPCR assays. In summary, the cytb-nPCR assays detected a considerably higher number of chronically infected B. bovis and B. bigemina carrier animals compared to reference nPCR and qPCR protocols, when applied in different epidemiological field situations. Furthermore, a high reproducibility between laboratories could be demonstrated.

Unraveling the Complexity of the Rhomboid Serine Protease 4 Family of Babesia bovis Using Bioinformatics and Experimental Studies.

Babesia bovis, a tick-transmitted apicomplexan protozoon, infects cattle in tropical and subtropical regions around the world. In the apicomplexans Toxoplasma gondii and Plasmodium falciparum, rhomboid serine protease 4 (ROM4) fulfills an essential role in host cell invasion. We thus investigated B. bovis ROM4 coding genes; their genomic organization; their expression in in vitro cultured asexual (AS) and sexual stages (SS); and strain polymorphisms. B. bovis contains five rom4 paralogous genes in chromosome 2, which we have named rom4.1, 4.2, 4.3, 4.4 and 4.5. There are moderate degrees of sequence identity between them, except for rom4.3 and 4.4, which are almost identical. RT-qPCR analysis showed that rom4.1 and rom4.3/4.4, respectively, display 18-fold and 218-fold significantly higher (p < 0.01) levels of transcription in SS than in AS, suggesting a role in gametogenesis-related processes. In contrast, transcription of rom4.4 and 4.5 differed non-significantly between the stages. ROM4 polymorphisms among geographic isolates were essentially restricted to the number of tandem repeats of a 29-amino acid sequence in ROM4.5. This sequence repeat is highly conserved and predicted as antigenic. B. bovis ROMs likely participate in relevant host−pathogen interactions and are possibly useful targets for the development of new control strategies against this pathogen.

Prognosis of breast cancer diagnosed during pregnancy and early postpartum according to immunohistochemical subtype: A matched case-control study.

PURPOSE: Pregnancy-associated breast cancer (PABC) poses a clinical challenge and its prognosis remains controversial. During the pregnancy and postpartum periods, the breast undergoes biological events that may uniquely influence disease behavior and treatment response. This study aimed to assess if a PABC diagnosis influences survival compared to non-PABC. METHODS: A single-center record review was performed to identify PABC patients diagnosed from January 2007 through June 2018. Two controls were matched to each PABC case by stage, immunohistochemical (IHC) subtype, age (± 3) and year of diagnosis (± 2). Disease-free survival (DFS) and overall survival (OS) were estimated with the Kaplan-Meier method and compared with the log-rank test. Multivariate analysis was used to assess the impact of PABC on outcomes. RESULTS: 125 PABC patients (pregnant: 62; postpartum: 63) and 250 controls were included. Median follow-up was 67.7 and 73.4 months, respectively. 4-year DFS was 62% in pregnant vs 78% in controls (p = 0.010), and 63% in postpartum vs 83% in controls (p = 0.034). Subanalysis by IHC subtype revealed a significantly inferior DFS in PABC with hormone receptor-positive/HER2-negative (p = 0.032) and HER2-positive disease (p = 0.005) compared to corresponding non-PABC patients. 4-year OS was similar between case groups and controls. Multivariate analysis supported the independent impact of pregnant and postpartum status on DFS (p < 0.05). CONCLUSION: Patients diagnosed during pregnancy and early postpartum are at high risk of recurrence. Further research is warranted to better characterize PABC tumor biology and enable the identification of novel therapeutic interventions to improve treatment outcomes.

Highly sensitive nested PCR and rapid immunochromatographic detection of Babesia bovis and Babesia bigemina infection in a cattle herd with acute clinical and fatal cases in Argentina.

Bovine babesiosis is a tick-transmitted haemoparasitic disease caused by Babesia bovis and B. bigemina affecting cattle of tropical and subtropical regions around the world. Pathogens are transmitted by the tick vector Rhipicephalus microplus displaying a widespread distribution in northeastern Argentina. The disease is characterized by significant animal morbidity and mortality resulting in considerable economic loss. In this study, B. bovis and B. bigemina infection was investigated in a cattle herd of 150 adult bovines of pure Braford breed raised in a tick-hyperendemic field using molecular and serum antibody tests. A highly sensitive nested polymerase chain reaction (nPCR) assay targeting a species-specific region of the apocytochrome b gene resulted in direct B. bovis and B. bigemina detection in 27.3% and 54.7% of bovines, respectively. A recently developed immunochromatographic strip test (ICT) based on recombinant forms of spherical body protein 4 and the C-terminal region of rhoptry-associated protein 1 showed that 71.3% and 89.3% of bovines were seropositive for B. bovis and B. bigemina, respectively. The mixed infection rate as observed by direct (19.3%) and indirect detection (65.3%) coincided with those expected, respectively. Importantly, four months after sampling, nine bovines of the studied herd showed clinical signs of bovine babesiosis of which six animals eventually died. Microscopic detection of infected erythrocytes in Giemsa-stained blood smears confirmed B. bovis infection. Our study demonstrates that although animals showed a relatively high and very high rate of immunity against infection with B. bovis (71.3%) and B. bigemina (89.3%) parasites, respectively, clinical cases and fatalities due to the infection with B. bovis were observed. It is proposed that the most adequate control measure in the studied epidemiological situation is to vaccinate animals to prevent losses and/or an outbreak of bovine babesiosis.

Defining trajectories of acute pain in surgical patients short title: acute pain follow-up.

INTRODUCTION: Assessment of acute postoperative pain is mandatory for effective treatments. Pain trajectories may help professionals improve treatments. It has been suggested that uncontrolled pain in the immediate postoperative period generates higher pain intensities on the following days of hospital stay. OBJECTIVE: To determine the relationship between pain during the first postoperative hour and the first 24 postoperative hours. METHODS: Setting: a general university hospital. Study design: a prospective observational, analytical study of patients undergoing surgical procedures under general anesthesia and hospitalized for at least 24 hours. Five assessments of pain were carried out during the first hour in the recovery room followed by three assessments during the first 24 hours. The slopes of pain trajectories were calculated, and the relationship between them was analyzed. RESULTS: 234 patients were recruited, 31.3% had uncontrolled pain on arrival at the recovery room; at the end of the first 24 hours after surgery, 5.5% of the patients had uncontrolled pain. The first pain intensity score in the recovery room correlated negatively with the slope for the first hour (P1): rS = -0.657 (p = 0.000). Similarly, the first pain intensity score had a negative association with the pain trajectory slope during the hospital stay (P2): rS = -0.141 (p = 0.032). When comparing the two slopes, a nonsignificant negative correlation was found: rS = -0.126. CONCLUSIONS: the trajectory of pain during the first hour does not predict the behavior of the trajectory during the first day after surgery.

Defining trajectories of acute pain in surgical patients short title: acute pain follow-up

SUMMARY INTRODUCTION: Assessment of acute postoperative pain is mandatory for effective treatments. Pain trajectories may help professionals improve treatments. It has been suggested that uncontrolled pain in the immediate postoperative period generates higher pain intensities on the following days of hospital stay. OBJECTIVE: To determine the relationship between pain during the first postoperative hour and the first 24 postoperative hours. METHODS: Setting: a general university hospital. Study design: a prospective observational, analytical study of patients undergoing surgical procedures under general anesthesia and hospitalized for at least 24 hours. Five assessments of pain were carried out during the first hour in the recovery room followed by three assessments during the first 24 hours. The slopes of pain trajectories were calculated, and the relationship between them was analyzed. RESULTS: 234 patients were recruited, 31.3% had uncontrolled pain on arrival at the recovery room; at the end of the first 24 hours after surgery, 5.5% of the patients had uncontrolled pain. The first pain intensity score in the recovery room correlated negatively with the slope for the first hour (P1): rS = −0.657 (p = 0.000). Similarly, the first pain intensity score had a negative association with the pain trajectory slope during the hospital stay (P2): rS = −0.141 (p = 0.032). When comparing the two slopes, a nonsignificant negative correlation was found: rS = −0.126. CONCLUSIONS: the trajectory of pain during the first hour does not predict the behavior of the trajectory during the first day after surgery.

RESUMO INTRODUÇÃO: A avaliação da dor pós-operatória aguda é obrigatória para tratamentos eficientes. As trajetórias da dor podem ajudar os profissionais a melhorar os tratamentos. Tem sido sugerido que a falta de controle da dor no período pós-operatório imediato vai gerar maior intensidade dessa dor durante os dias seguintes de estadia no hospital. OBJETIVO: Determinar o relacionamento entre a dor durante a primeira hora pós-operatória e as 24 horas após a mesma. MÉTODOS: Lugar da pesquisa: Hospital universitário geral. Desenho do estudo: Foi feito um estudo analítico prospectivo operacional com pacientes submetidos a procedimentos cirúrgicos sob anestesia geral e que foram hospitalizados pelo menos 24 horas antes. Cinco avaliações de dor foram feitas na primeira hora na sala de recuperação, seguidas de três avaliações durante as primeiras 24 horas. Os declives das trajetórias da dor foram calculados e seu relacionamento entre elas foi analisado. RESULTADOS: Duzentos e trinta e quatro pacientes foram recrutados, 31,3% apresentaram dor não controlada no ingresso à sala de recuperação; no final das primeiras 24 horas após a cirurgia, 5,5% dos pacientes apresentaram dor não controlada. O score da primeira intensidade de dor na sala de recuperação teve uma correlação negativa com o declive da primeira hora (P1): rS = −0,657 (p=0,000). De maneira similar, o score na primeira intensidade de dor teve uma associação negativa com o declive da trajetória da dor durante a permanência no hospital (P2): rS = −0,141 (p=0,032). Quando comparados os dois declives, não foi encontrada uma correlação significativa: rS = −0,126. CONCLUSÃO: A trajetória da dor durante a primeira hora não prediz o comportamento da trajetória durante o primeiro dia após a cirurgia.

Mitigated clinical disease in water buffaloes experimentally infected with Babesia bovis.

Water buffaloes (Bubalus bubalis) are raised in tropical and subtropical regions of the world, and act as hosts of Babesia bovis parasites and the tick vector Rhipicephalus microplus. As no clinical cases of B. bovis-infection have been reported, we hypothesized that, unlike bovines, water buffaloes respond asymptomatically to an acute infection. To test this hypothesis, we inoculated two groups of 24-month-old Mediterranean breed water buffaloes with 108 erythrocytes infected with two Argentine B. bovis isolates: BboM2P (n = 5) or BboS2P (n = 5). These strains displayed mild (BboM2P) or high (BboS2P) pathogenicity in Bos taurus calves of the same age (n = 5 and n = 1, respectively), when tested in parallel. In water buffaloes, no changes in body temperature were observed with both strains, and no hematocrit changes were detected in BboM2P-inoculated animals. In contrast, in the BboS2P-inoculated water buffalo group significant but relatively minor reductions in haematocrit values were noted compared to the infected bovine. The parasitemia attained in water buffaloes was considerably lower than in bovines and could only be detected by nested PCR, or indirectly via serology, whereas in most bovines, it could also be detected in Giemsa-stained smears under the light microscope. Our results show that water buffaloes present no or significantly mitigated clinical symptoms to B. bovis infections and suggest that they are able to substantially reduce and/or eliminate B. bovis parasites from circulation by an efficient innate immune mechanism.

Efficacy of a new device to optimize positive pressure ventilation via face mask in edentulous patients: a randomized trial.

BACKGROUND: Mask ventilation is routinely performed during anesthesia. Under some circumstances, it might be difficult to perform, such as in edentulous patients, due to inadequate mask seal. We developed a new device called NIPARA and studied its use For ventilation optimization in edentulous patients. METHODS: This randomized controlled trial included edentulous adults who had no other predictors of difficult airway, scheduled to undergo general anesthesia. Patients were assigned either to the NIPARA device group or to the control group (oral airway only). The primary outcomes were peak inspiratory pressure and tidal volume values of the first 14 breaths. The secondary outcome was the incidence of complications. RESULTS: Data from 37 patients were collected during a one-year period (twenty in the NIPARA device group and 17 in the control group). The difference in mean PIP was not statistically significant. The tidal volume was 1.5 times greater in the NIPARA group than in the control group. One patient from the intervention group had minimal oral trauma. CONCLUSION: In the administration of face mask ventilation, NIPARA is an effective device that significantly improves the tidal volume administered in edentulous patients.

Postanesthesia evaluation of emotional and psychological satisfaction in a Hispanic population.

BACKGROUND: Patient satisfaction has a positive impact on clinical care. Different strategies, such as questionnaires, have been developed to evaluate and improve patient satisfaction. A validated pediatric anesthesia questionnaire previously showed the importance of perioperative care built upon a relationship of trust between healthcare providers and children and parents, and a comfortable environment in which satisfactory answers are provided. However, the questionnaire was validated in English, and no research exists on the use of satisfaction questionnaires in Spanish. Given that there are 559 million Spanish speakers in the world, of which 53 million live in the United States, we intended to validate a Spanish version of this questionnaire to measure parental and pediatric satisfaction after anesthesia, and facilitate the provision and quality management of anesthesia care in Hispanic populations. METHODS: A questionnaire validated in English was translated to Spanish. Subsequently, it was administered to children who had undergone surgery and their parents to determine reliability, validity, acceptability, and reproducibility. RESULTS: Of the 228 recruited parents, a total of 221 agreed to participate, and 77 questionnaires were filled out completely by both parents and children. Overall response rates of 97% for parents and 90% for children were achieved. The reliability, test-retest reliability, and internal consistency were examined, and a McNemar coefficient of 0.97 and a Cronbach's alpha coefficient of 0.82 were obtained. Construct validity was obtained through comparisons of the following items: the child's perception of serenity imparted by the medical staff with the parent's satisfaction with conversations between the anesthesiologist and child, the nurse's ability to make the child feel better with the parent's satisfaction with the nurse's professionalism, and the nurse's kindness toward the child with the parent's perception of the care provided. CONCLUSION: This questionnaire proved to be simple and easy to understand within the literate Spanish-speaking population. It had adequate content validity and high reliability, acceptability, reproducibility, and construct validity. We believe that this Spanish questionnaire can be used with success among Hispanic populations resulting in improved care for those undergoing anesthesia, and therefore, patient satisfaction.

A comparison of King Vision video laryngoscopy and direct laryngoscopy as performed by residents: a randomized controlled trial.

STUDY OBJECTIVE: For more than 40 years, direct laryngoscopy (DL) has been used to assure the airway during endotracheal intubation. The King Vision video laryngoscope is one of the latest devices introduced for endotracheal intubation. We hypothesize that, relative to direct laryngoscopy, it improves the intubation success rate with fewer intubation attempts and no difference in intubation time or complications. DESIGN: This randomized controlled clinical trial included. SETTING: The operating room and postanesthesia care unit of an academic hospital. PATIENTS: Eighty-eight patients with American Society of Anesthesiologists status I to II and aged ≥18 years who were scheduled for elective surgery under general anesthesia and had no predictors of difficult airway. Patients were randomized (44 per group) to undergo intubation using either DL or King Vision video laryngoscopy (KVVL) performed by first year residents in anesthesia and intensive care. MEASUREMENTS: During endotracheal intubation by residents, measurements were success rate, number of attempts, time to intubation, visualization of the glottis, and presence of complications. MAIN RESULTS: Both groups had a 100% success rate. A greater frequency of grade 1 laryngoscopy was reported with KVVL (86.4%) relative to DL (59.1%) (P < .05). There were no differences in time to intubation or the number of attempts between the groups (P = .75 and P = .91, respectively). Complications after intubation were low and included oral trauma, esophageal intubation, and sore throat. CONCLUSIONS: The use of KVVL by residents with less than 1 year of training (considered nonexperts) significantly improves visualization of the glottis in patients without predictors of difficult airway. The incidence of complications was too low to draw conclusions.

Detección molecular de coinfección con los virus de la diarrea viral bovina (BVDV) en búfalos de agua (Bubalus bubalis) serológicamente negativos / Molecular analyses detect natural coinfection of water buffaloes (Bubalus bubalis) with bovine viral diarrhea viruses (BVDV) in serologically negative animals

La infección de los búfalos de agua (Bubalus bubalis) con los virus de la diarrea viral bovina (BVDV) ha sido confirmada mediante técnicas serológicas y moleculares en trabajos anteriores. Con el fin de determinar la presencia de animales persistentemente infectados y las especies y subtipos circulantes de BVDV en esta especie animal se realizó un estudio sobre una manada de búfalos de producción mixta con ganado bovino (Bossp.). Nuestros resultados serológicos mostraron un alto nivel de positividad frente a BVDV-1 y BVDV-2 dentro de la manada de búfalos. El análisis molecular sobre muestras de sangre de los animales serológicamente negativos reveló la presencia de ácido nucleico viral, lo que confirma la existencia de búfalos persistentemente infectados. El clonado y la secuenciación de la región 5 'UTR de algunas de las muestras obtenidas de búfalo reveló la presencia de coinfección natural con al menos dos subtipos diferentes de BVDV (1a y 1b) y con las especies virales BVDV-1 y BVDV-2

Infection of water buffaloes (Bubalus bubalis) with bovine viral diarrhea viruses (BVDV) has been confirmed in several studies by serological and molecular techniques. In order to determine the presence of persistently infected animals and circulating species and subtypes of BVDV we conducted this study on a buffalo herd, whose habitat was shared with bovine cattle (Bossp.). Our serological results showed a high level of positivity for BVDV-1 and BVDV-2 within the buffalo herd. The molecular analyses of blood samples in serologically negative animals revealed the presence of viral nucleic acid, confirming the existence of persistent infection in the buffaloes. Cloning and sequencing of the 5' UTR of some of these samples revealed the presence of naturally mix-infected buffaloes with at least two different subtypes (1a and 1b), and also with both BVDV species (BVDV-1 and BVDV-2)

Molecular analyses detect natural coinfection of water buffaloes (Bubalus bubalis) with bovine viral diarrhea viruses (BVDV) in serologically negative animals.

Infection of water buffaloes (Bubalus bubalis) with bovine viral diarrhea viruses (BVDV) has been confirmed in several studies by serological and molecular techniques. In order to determine the presence of persistently infected animals and circulating species and subtypes of BVDV we conducted this study on a buffalo herd, whose habitat was shared with bovine cattle (Bossp.). Our serological results showed a high level of positivity for BVDV-1 and BVDV-2 within the buffalo herd. The molecular analyses of blood samples in serologically negative animals revealed the presence of viral nucleic acid, confirming the existence of persistent infection in the buffaloes. Cloning and sequencing of the 5' UTR of some of these samples revealed the presence of naturally mix-infected buffaloes with at least two different subtypes (1a and 1b), and also with both BVDV species (BVDV-1 and BVDV-2).

[Leptospirosis outbreak in calves from Corrientes Province, Argentina]. / Brote de leptospirosis en terneros en recría en la provincia de Corrientes, Argentina.

Leptospirosis is an infectious disease resulting in significant economic losses in livestock production. This disease causes abortion, embryo death, death of calves within the first few days of life and mastitis. We report a leptospirosis outbreak in calf growing and fattening. Histopathological and hemoparasite studies, immunofluorescence, and bacterial cultures were performed. A strain of Leptospira interrogans serovar Pomona was isolated from samples collected from dead calves.

Water Buffalos as carriers of Babesia bovis in Argentina.

The tick-transmitted hemoprotozoan Babesia bovis is a major causative agent of bovine babesiosis, an often fatal disease of cattle. The disease is widespread in the northeastern region of Argentina, where an increasing part of the livestock is composed of water buffalos. Although clinical cases of buffalo babesiosis have not been reported so far, the pathogen-transmitting tick vector has been occasionally observed by us to be feeding on water buffalos. We therefore set out to examine whether buffalos may constitute a reservoir of the parasite. Competitive enzyme-linked immunosorbent assay (cELISA) detected B. bovis-specific antibodies in 20% of investigated buffalos (21/103), while direct detection of the pathogen by nested PCR was demonstrated in 34% of the animals (35/103). In one field, more than 60% of investigated animals (22/36) tested positive by nested PCR. These results are discussed in the context of buffalo babesiosis reported in other countries and in view of the currently effected control measures against bovine babesiosis in the region.

Manejo del derrame pleural, servicio de cirugía, hospital Doctor Roberto Gilbert Elizalde: Guayaquil – Ecuador: enero de 2001 – diciembre de 2003 / Handling of pleural effusion in Doctor Roberto Gilbert Elizalde hospital, surgery service: Guayaquil – Ecuador: January/2001 – December/2003

Tipo de Estudio: retrospectivo, descriptivo, analítico. Objetivo: demostrar la mayor eficiencia del uso de toracoscopía dentro de los diez primeros días en el manejo del derrame pleural sobre otros métodos. Pacientes y Métodos: Se estudió a todos los pacientes del área de cirugía, comprendidos entre 0 a 15 años de edad del hospital “Dr. Roberto Gilbert Elizalde”, que hayan sido atendidos en el período enero 2001 a diciembre 2003, con diagnóstico de neumopatías complicadas con derrame pleural. Resultados: a nivel masculino, con edades que correspondían entre 0 a 30 meses, presentó mayor porcentaje frente a otras edades con un 21.91. En el grupo femenino, el 32.02 de los pacientes correspondían entre las edades de 0-30 meses, este porcentaje fue mayor frente a otros grupos de edades. La zona urbana presentó un 43.26 de neumopatías con derrame pleural. Entre los gérmenes más cultivados se encuentran en un 57.14 el estafilococo aureus. El método de tratamiento quirúrgico más usado fue la toracotomía mínima en un 98.88, sobre la toracoscopía en 1.12 de casos. Conclusiones: esta patología presentó predominio en el grupo femenino, y en el grupo etario entre 0 a 30meses tanto en femenino como en masculino. De acuerdo al correcto manejo del paciente tras la realización de una toracotomía mínima, podemos determinar que el tiempo de uso de un tubo pleural fue: en el 49.44 de los pacientes, y lo usaron entre 1-7 días.

Study Type: Retrospective, descriptive, analytical. Objective: To prove that using thoracoscopy within the first ten days handling pleural effusion is more efficient than other methods. Patients and methods: All patients between 0 and 15 years old of the surgery area of “Dr. Roberto Gilbert Elizalde” hospital treated between January/2001 and December 2003 with the diagnosis of pneumopathy complicated with pleural effusion, were included in this study. Results: male patients from 0 to 30 moths old were up to a greater percentage compared to other ages: 21.91 . In the female group, 32.02 of patients were between ages of 0 and 30 months; this percentage was greater compared to other age groups. In urban zone the percentage of pneumopathies with pleural effusion was 43.26. Among the most frequently found germs in culture are the staphylococcus aureus (57.14 ). The surgical treatment method most frequently used was minimal thoracotomy (98.88 of cases), over thoracoscopy (1.12 of cases). Conclusions: This pathology showed predominance in female group, and in the 0 to 30 months age group as much in the female group as in the male one. According to the appropriate handling of the patient after minimal thoracotomy was carried out, we can see that the using time of a pleural tube was: 49.44 of patients used it between 1 and 7 days.

[Usefulness of real time 3D echocardiography in assessment of rheumatic mitral stenosis]. / Utilidad de la ecocardiografia tridimensional en tiempo real en la valoración de la estenosis mitral reumática.

To date, the assessment of rheumatic mitral stenosis has been based on Doppler methods, which have a high dependence on the hemodinamic conditions and on the planimetry obtained from 2D echo images. Real Time 3D echocardiography has been implemented in the daily clinical practice. It provides high quality 3D images and the acquisition time is very short. In the present work, we try to show the "state of the art" of Real Time 3D echocardiography in the assessment of rheumatic mitral stenosis. These findings are based on the experience of our "Unidad de Imagen Cardiovascular" at the Hospital Clinico San Carlos de Madrid.