Desempeño del método de suma de discos comparado con el método bidimensional en la estimación cuantitativa del derrame pericárdico / Performance of the method of disks compared to the bidimensional method in the quantitative estimation of pericardial effusion

Resumen Introducción: La ecocardiografía bidimensional es la técnica más efectiva para el diagnóstico del derrame pericárdico, gracias a sus altas sensibilidad y especificidad. Objetivo: Analizar la superioridad del método de suma de discos comparado con el método bidimensional en la estimación del derrame pericárdico por medio de ecocardiografía, tomando como referencia el volumen de líquido pericárdico extraído por pericardiocentesis o cirugía abierta. Método: Estudio retrospectivo de seguimiento de una cohorte basado en registros médicos y archivos de ecocardiografía. Se empleó un diseño pareado en el que cada imagen fue leída por el método bidimensional y por el método de suma de discos. Se incluyeron derrames pericárdicos graves, definidos clínicamente o por parámetros ecocardiográficos, que requirieran drenaje. El desempeño de los métodos de estimación bidimensional y de suma de discos, tomando como referencia la extracción por intervención, se cuantificó mediante áreas bajo la curva operador-receptor (auROC). Resultados: Se analizaron 40 registros, tomando como referencia el volumen obtenido por extracción; con un auROC de 0.81 (intervalo de confianza del 95% [IC95%]: 0.73-0.89), el desempeño diagnóstico del método de suma de discos fue significativamente mayor (p = 0.0335) que el del método bidimensional (auROC: 0.73; IC95%: 0.63-0.83). La estimación realizada por el método de suma de discos subestimó en promedio 51.3 ml (IC95%: −156.2-53.5). Conclusiones: En pacientes con derrame pericárdico e indicación de drenaje o taponamiento cardíaco, el método de suma de discos es superior en comparación con el método bidimensional en el estudio ecocardiográfico para la estimación cuantitativa del derrame pericárdico, ya que discrimina mejor respecto al método bidimensional.

Abstract Introduction: Two-dimensional echocardiography is the most effective technique for diagnosing pericardial effusion due to its high sensitivity and specificity. Objective: The superiority of the method of disks was compared with the bidimensional method in the estimation of pericardial effusion by echocardiography, taking as reference the volume of pericardial fluid removed by pericardiocentesis or open surgery. Method: Retrospective follow-up study of a cohort, based on medical records and echocardiography files. A paired design was used, each image was read by the bidimensional method and by the method of disks. Severe pericardial effusions defined clinically or by echocardiographic parameters, that required drainage were included. The performance of the bidimensional and disks estimation methods, taking the volume removed as a reference, was quantified using areas under the receiver operating characteristic curve (auROC). Results: 40 records were analyzed, taking as a reference the volume obtained by extraction, with an auROC of 0.81 (95% CI: 0.73-0.89) the diagnostic performance of the disks method was significantly higher (p = 0.0335) than the bidimensional method (auROC 0.73, 95% CI: 0.63-0.83). The estimate made by the disks method underestimated an average of 51.3 ml (95% CI: -156.2-53.5). Conclusions: In patients with pericardial effusion with indication of cardiac drainage or tamponade, the disks method is superior in comparison with the bidimensional method in the echocardiographic study of the quantitative estimation of pericardial effusion, discriminating better than the bidimensional method.

Endoscopic closure of gastrointestinal perforations and fistulas using the Ovesco Over-The-Scope Clip system at a tertiary care hospital center. / Cierre endoscópico de perforaciones y fístulas del tracto digestivo mediante el sistema «Over-the scope clip¼ (Ovesco), en un centro terciario.

INTRODUCTION AND AIM: Enteric perforations and fistulas are difficult to manage due to comorbidities, poor nutritional status, and anatomic challenges related to multiple interventions in those patients. The use of endoscopic methods as a nonsurgical approach is increasing. The aim of the present study was to describe the clinical experience with the use of the Ovesco Over-The-Scope Clip system in the closure of perforations, fistulas, and other indications in the digestive tract at a tertiary care hospital center. MATERIALS AND METHODS: A case series was carried out on patients that underwent lesion closure with the Ovesco clip, within the time frame of January 2015 to December 2017. RESULTS: The Ovesco clip was used for closure in 14 patients ranging in age from 21-90 years, with different indications: iatrogenic perforations; anastomotic leaks and fistulas; tracheoesophageal fistulas; and esophagogastric perforation. Technical success was achieved in 100% of the patients and clinical success in 78.57%. No complications were reported. CONCLUSIONS: The Ovesco Over-The-Scope Clip system is a safe and effective method for managing gastrointestinal acute perforations and fistulas.

Perspectives on cervical cancer screening and prevention: challenges faced by providers and patients along the Texas-Mexico border.

BACKGROUND: The Rio Grande Valley (RGV) and Laredo regions located along the Texas-Mexico border consist of seven counties with a population of approximately 1.5 million people and a high uninsured rate (33.5%). Cervical cancer mortality in these border counties is approximately 30% higher than the rest of Texas. The RGV and Laredo areas were studied to better understand the state of access to cervical cancer prevention services along the Texas-Mexico border. METHODS: Data on the population served and the services provided were analyzed to determine the gap between cervical cancer screenings recommended versus those received. Through interviews, we gathered the perspectives of 16 local stakeholders regarding cervical cancer screening for underserved individuals in the region. FINDINGS: It is estimated that 69,139 uninsured women aged 21-64 years in the RGV/Laredo per year are recommended to undergo cervical cancer screening with Papanicolaou (Pap) and/or human papillomavirus (HPV) testing, but only 8941 (12.9%) Pap tests are being performed by the Federally Qualified Health Center (FQHC) serving uninsured women in these regions. Systemic barriers identified include insufficient provider clinical capacity, the high cost of healthcare, and uncertainty about government funding sources. Patient barriers identified include inadequate knowledge on navigating the local healthcare system, low health literacy, lack of money and childcare, an inability to miss work, limited transportation, and fear of deportation. CONCLUSION: Decreasing the disparity between cervical cancer screening services provided and those recommended requires addressing the barriers, identified by local experts, which prevent uninsured women from accessing care. These challenges are being addressed through ongoing programs and collaborations.

Diversity of Anopheles spp. (Diptera: Culicidae) in an Amazonian Urban Area.

The genus Anopheles encompasses several species considered as vectors of human infecting Plasmodium. Environmental changes are responsible for behavior changes in these vectors and therefore the pattern of malaria transmission. To better understand the dynamics of malaria transmission, this study aimed at identify the species of adult anophelines found in a malaria endemic urban area of the Amazon region, Mâncio Lima, located in the Acre State Brazil. Using Shannon-type light traps installed at 11 collection points near fish ponds, a total of 116 anophelines were collected belonging to nine species. Anopheles darlingi Root 1926 and An. albitarsis s.l. Lynch-Arribalzaga 1878 were the most abundant and predominant species. Despite the low number of captured adult anophelines, the occurrence of An. darlingi throughout all urban area and the presence of secondary vectors reinforce the need of a permanent and continuous entomological surveillance.

Oncocercosis: de lo básico a lo clínico / Onchocerciasis: From basics to clinical / Oncocercose: do básico ao clínico

La oncocercosis es una de las enfermedades tropicales desatendidas, producida por el nemátodo filárico Onchocerca volvulus y transmitida por la picadura de la mosca negra del género Simulium. Es considerada la segunda causa mundial de ceguera prevenible y está presente en 35 naciones de tres continentes: África, América y Asia. Existen tres países declarados libres de oncocercosis: Colombia, Ecuador y México. Las principales manifestaciones clínicas son dermatológicas y oculares; sin embargo, también se han descrito alteraciones linfáticas y neurológicas. El diagnóstico se realiza por identificación de microfilarias en biopsia de piel o esclerocorneal, nodulectomía para buscar gusanos adultos o con lámpara de hendidura y observar el parásito en el ojo. Existe tratamiento farmacológico con ivermectina o quirúrgico con extracción directa de los nemátodos adultos de los oncocercomas. Los programas mundiales se basan en control vectorial y farmacoterapia. Con los conocimientos actuales y esfuerzos mundiales, la oncocercosis continúa siendo un grave problema de salud pública y causa de discapacidad. Por estas razones, se hace necesario una actualización en el tema.

Onchocerciasis is one of the neglected tropical diseases; it is produced by the filarial nematode Onchocerca volvulus and is transmitted through the bites of infected black flies of the Simulium genus. It is considered the second leading cause of preventable blindness and is present in 35 countries on three continents: Africa, America, and Asia. The following three countries have been declared free from onchocerciasis: Colombia, Ecuador, and Mexico. The main clinical manifestations are dermatological and ocular; however, lymphatic and neurological alterations have also been described. Diagnosis is made by identification of microfilariae in skin or sclerocorneal biopsy, by nodulectomy in search of adult worms, or by using a slit lamp to observe the parasite in the eye. There is pharmacological treatment through the use of ivermectin or surgical treatment by direct removal of adult nematodes from the onchocercomas. World programs are based on vector control and drug therapy. Despite current knowledge and global efforts, onchocerciasis remains a serious public health issue and an important cause of disability. Thus, an update on the topic is warranted.

A oncocercose é uma das doenças tropicais desatendidas, produzida pelo nemátodo filárico Onchocerca volvulus e transmitida pela picada da mosca negra do gênero Simulium. É considerada a segunda causa mundial de cegueira evitáveis e está presente em 35 nações de três continentes: África, América e Ásia. Existem três países declarados livres de oncocercose: Colômbia, Equador e México. As principais manifestações clínicas são dermatológicas e oculares; apesar disso, também se há descrito alterações linfáticas e neurológicas. O diagnóstico se realiza por identificação de microfilárias em biopsia da pele ou esclerocorneano, nodulectomia para buscar larva adultas ou com lâmpada de fenda e observar o parasita no olho. Existe tratamento farmacológico com ivermectina ou cirúrgico com extração direta dos nemátodos adultos dos oncocercomas. Os programas mundiais se baseiam no controle vectorial e farmacoterapia. Com os conhecimentos atuais e esforços mundiais, a oncocercose continua sendo um grave problema de saúde pública e causa de deficiência. Por estas razões, se faz necessário uma atualização no assunto.

Caracterización de una población con discapacidad visual (baja visión y ceguera) atendida en dos instituciones prestadoras de salud de Medellín / Characterization of a population with visual disabilities (low vision and blindness) attended in two health institutions from Medellín / Caracterização de uma população com incapacidade visual (baixa visão e cegueira) atendida em duas instituições prestadoras de saúde de Medellín

Objetivo: caracterizar, en los ámbitos clínico y sociodemográfico, una población de pacientes con discapacidad visual atendidos en dos instituciones de salud de la ciudad de Medellín (departamento de Antioquia/Colombia), con énfasis en la etiología del déficit visual irreversible. Metodología: estudio observacional descriptivo. Estudio macro sobre deficiencias visuales unilaterales y bilaterales en 1 742 registros de historias clínicas para identificar pacientes con baja visión o ceguera. Aplicación de un formato de investigación orientado a validar los pacientes con discapacidad visual y se seleccionaron 107 historias clínicas. Resultados: el 56.6% presenta discapacidad visual tipo baja visión y el 43.4% discapacidad visual tipo ceguera. El déficit visual responsable de la discapacidad visual fue del 39% por causas oftalmológicas, 20% por alteraciones neuro-oftalmológicas y 17% por trastornos neurológicos de cortezas visuales. Además de la agudeza visual, se encontraron otras deficiencias de la función visual: atrofia óptica, alteración electrofisiológica de la conducción visual y encefalomalacia en cortezas visuales. El 82% de los pacientes tiene al menos una comorbilidad no oftalmológica. Conclusiones: es fundamental un adecuado registro de las características biológicas, sociales, psicológicas y de las actividades de rehabilitación de los pacientes con baja visión y ceguera, para entender en forma integral no sólo la discapacidad sino el impacto que produce.

Objective: to characterize the clinical and socio-demographical characteristics of a population of patients with visual impairment attended at two health institutions in Medellín (Antioquia, Colombia), with an emphasis on the etiology of irreversible vision loss. Methodology: Observational, descriptive study of unilateral and bilateral visual impairment in 1 742 medical records to identify patients with low vision or blindness. A research form was used to validate patients with visual impairment, and 107 medical records were selected. Results: 56.6% presented low vision and 43.4% presented blindness. Vision loss was due to ophthalmic causes in 39% of cases, 20% were caused by neuro-ophthalmic alterations and 17% by neurological disorders of the visual cortex. In addition to visual acuity, other visual impairments were found, such as optic atrophy, electrophysiological alteration of the visual pathway, and encephalomalacia in visual cortices. 82% of patients had at least one nonophthalmic comorbidity. Conclusions: Adequate registration of rehabilitation activity, biological, social, and psychological characteristics of patients with low vision and blindness is essential in order to fully understand both the impairment and its impact.

Objetivo: caracterizar, nos âmbitos clínico e sócio-demográfico, uma população de pacientes com incapacidade visual atendidos em duas instituições de saúde da cidade de Medellín (departamento de Antioquia/Colômbia), com énfase na etiologia do déficit visual irreversível. Metodologia: estudo observacional descritivo. Estudo macro sobre deficiências visuais unilaterais e bilaterais em 1 742 registros de histórias clínicas para identificar pacientes com baixa visão ou cegueira. Aplicação de um formato de investigação orientado a validar os pacientes com incapacidade visual e se selecionaram 107 histórias clínicas. Resultados: 56.6% apresenta incapacidade visual tipo baixa visão e 43.4% incapacidade visual tipo cegueira. O déficit visual responsável da incapacidade visual foi de 39% por causas oftalmológicas, 20% por alterações neuro-oftalmológicas e 17% por transtornos neurológicos de córtex visual. Ademais da agudeza visual, se encontraram outras deficiências da função visual: atrofia óptica, alteração eletrofisiológica da condução visual e encefalomalácia em córtex visual. 82% dos pacientes têm pelo menos uma comorbilidade não oftalmológica. Conclusões: é fundamental um adequado registro das características biológicas, sociais, psicológicas e das atividades de reabilitação dos pacientes com baixa visão e cegueira, para entender em forma integral não só a incapacidade senão o impacto que produz.

Endothelial eNOS/arginase imbalance contributes to vascular dysfunction in IUGR umbilical and placental vessels.

Placental vascular tone is critically influenced by nitric oxide (NO) derived from endothelial NO synthase (eNOS) activity. Placental vessels from pregnancies complicated with intrauterine growth restriction present altered NOS-dependent vasodilation. Arginase-2 competes with eNOS for l-arginine and counteracts the NOS-dependent relaxation in umbilical vessels from normal pregnancies. However there is no data regarding the contribution of arginase activity on the impaired endothelial function in IUGR placenta. We studied whether arginase-2 participates in IUGR-related placental vascular dysfunction counteracting eNOS-dependent relaxation, and the regulation of arginase-2 and eNOS expression in endothelial cells from IUGR umbilical arteries (HUAEC) and veins (HUVEC). In IUGR-derived umbilical arteries (UA) and veins (UV), and chorionic arteries (CA), NOS-dependent vasoactive response in the presence and absence of BEC (arginase inhibitor) was studied. Protein levels of eNOS (total and Ser(1177)-P-eNOS), arginase-2 and arginase activity were determined in IUGR HUAEC and HUVEC. In IUGR vessels eNOS-dependent relaxation was reduced, being improved by BEC. This effect was higher in arteries than veins, and in chorionic compared with umbilical vessels. In cultured IUGR endothelial cells, arginase-2 protein expression and activity were increased in HUVEC, without changes in HUAEC. In IUGR-derived endothelium there was a generalized reduction in the in vitro eNOS activation (Ser(1177)-P-eNOS/eNOS), and therefore a decreased eNOS/arginase activity ratio. Here we provide ex vivo and in vitro evidence for a vascular role of arginase throughout placental vasculature, negatively controlling NOS activity. This effect seems to be crucial in the pathophysiology of endothelial dysfunction present in IUGR feto-placental vessels.

Metazoan parasite communities of rock cod Eleginops maclovinus along southern Chilean coast and their use as biological tags at a local spatial scale.

The composition of the metazoan parasite fauna of the rock cod Eleginops maclovinus from three locations in southern Chile was compared to assess the local spatial variation of the community component of their parasitic faunas. A total of 13 108 metazoan parasites (5267 endoparasites and 7841 ectoparasites) belonging to 34 taxa were collected from 268 specimens of E. maclovinus between October 2008 and March 2009. The populations and community quantitative descriptors were estimated. Altogether, 97.4% of the fish were infected with at least one parasite taxon. The most prevalent species were Hypoechinorhynchus magellanicus (Acanthocephala), Caligus rogercresseyi, Lepeophtheirus mugiloides, Clavella adunca (Copepoda) and Similascarophis sp. (Nematoda). Five species are new records for this host: Argulus araucanus, Hirudinea gen. sp1., Hirudinea gen. sp2., Benedenia sp. and Camallanidae gen. sp. A linear discriminant analysis (LDA) showed that the metazoan parasite fauna of E. maclovinus varied qualitatively and quantitatively among three locations, with 89.7% of fish being correctly assigned to their respective locations. This suggested that parasites could be a reliable tool to discriminate individual fish from geographically close locations. There was a weak relationship between the parasite fauna and fish size and there were no accumulations of parasites in the host over time, which could be associated with ontogenetic changes of diet associated with habitat use.

Temporización inmediata de implantes unitarios en la maxila posterior / Immediate temporization of posterior maxilla single tooth implant

Propósito: El presente artículo es un estudio prospectivo de las tasas de éxito implantaria y de las complicaciones mecánicas y biológicas en el tratamiento rehabilitador implanto-asistido del sector posterior de la maxila, mediante provisionalización inmediata. Material y Método: El estudio clínico observó a 21 sujetos desdentados parciales unitarios del sector posterior maxilar, con reborde cicatrizado y antagonista dentario natural, por un período de 6 meses, en los que se insertaron implantes cónicos roscados de conexión interna, con tratamiento de superficie, temporizados inmediatamente después de insertados en el hueso maxilar, mediante la confección de una corona de resina acrílica sobre un pilar temporal de titanio atornillada directa al implante, dejados sin contactos dentarios durante la máxima intercuspidación (MIC) y movimientos excéntricos mandibulares. Todas las restauraciones fueron observadas durante un período de 6 meses, evaluando tasa de éxito implantario, complicaciones biológicas y mecánicas. Resultados: Se insertaron 25 implantes en 21 pacientes, obteniéndose un valor promedio de inserción de torque quirúrgico de 45.6 Nt. Durante el período de observación clínico se presentó un 100 por ciento de éxito de sobrevida implantario, no se detectaron complicaciones biológicas, pero sí se presentaron complicaciones mecánicas por fractura de una cúspide vestibular de una restauración provisional acrílica y dos aflojamientos de tornillos. Conclusiones: La temporización unitaria mediante provisorio atornillado es un protocolo predecible y confiable que permite el proceso de oseointegración y la coexistencia en salud de tejido periimplantario y su sistema protésico.

Purpose: This article is a prospective study of implant success rates and of mechanical and biological complications in the assisted-implant rehabilitation treatment of the posterior maxilla by immediate temporization. Material and Methods: The clinical study observed 21 partially edentulous subjects with lip scar and antagonistic natural teeth in the posterior maxilla for a period of 6 months in which conical threaded internal implant connections were inserted with a surface treatment and timed immediately after being inserted into the jawbone by producing an acrylic resin crown on a temporary titanium abutment screwed directly into the implant and left without tooth contacts during the Maximal Intercuspal (MIC) and mandibular eccentric movements. All restorations were observed over a period of 6 months evaluating implant success rate and biological and mechanical complications. Results: 25 implants were inserted into 21 patients yielding an average surgical insertion torque of 45.6 Nt. During the clinical observation there was 100 percent success of implant survival. No biological complications were detected, but there were mechanical complications - a buccal cusp fracture of an acrylic provisional restoration and two screws loosening. Conclusions: The unit temporization by temporary screwing is a predictable and reliable protocol that allows osseointegration and the coexistence in the health of peri-implant tissue and its prosthetic system.

Experiencia y significado del proceso de edentulismo de adultos mayores, atendidos en un consultorio del servicio público chileno / Experience and significance of the edentulous process of older adults who attended a chilean public service office

En Santiago de Chile la prevalencia de desdentados totales en individuos mayores de 65 años es de 33.84 por ciento, es decir uno de cada tres santiaguinos de la 3° edad, es portador de prótesis totales. Prevalencia similar a la encontrada en países desarrollados. A partir de esta investigación se pretende comprender cual es la experiencia, significados y valoración del proceso de edentulismo de adultos mayores, tratados en un servicio de salud público, y sus familiares más cercanos; para entender cuales son sus vivencias y padecimientos; para poder entregarle una atención más completa, significativa y eficiente, orientada a lo que las personas perciben como importante. Tipo de estudio: El presente trabajo de investigación se desarrolló dentro de un paradigma naturalista cualitativo, por cuanto está interesado en conocer el fenómeno desde el propio marco de referencia del actor social; fundamentado en la realidad, de carácter exploratorio y enfoque fenomenológico. Selección de participantes: Se seleccionó a 11 hombres y 9 mujeres; adultos mayores, desdentados totales del Centro de Salud Familiar Garín, y a un familiar directo. Se consideró para esta investigación la aplicación de entrevistas semi estructuradas y grupo focal. Resultados: El presente estudio de investigación cualitativa, entregó relevante información, en la forma como piensa siente y vivencia el problema del edentulismo el propio actor social; la que pude ser considerada en la elaboración de nuevos proyectos y programas desarrollados especialmente para esta población; así como también, en el campo educacional.

In Santiago, Chile the prevalence of Edentulous in individuals over 65 years of age is 33.84 percent; this is to say that one third of Santiago s senior citizens wear dentures. Prevalence similar to this can be found in developed countries. From this research, the aim is to understand the experience, significance and assessment of the Edentulous process of senior citizens that are treated in public health service and to also understand the experiences and sufferings of their immediate families; To be able to give fuller, meaningful, and efficient attention by focusing on what people perceive as important. Type of study: This research work was developed within a qualitative naturalistic paradigm, to know the phenomenon from the interest point of the framework itself, the social actor; based on reality, exploratory and phenomenological approach. Selection of participants: 11 men and 9 women were selected; Elderly, all edentulous patients (and their immediate families) from the Garín Family Health Center. The application of semi-structured interviews and focus groups were considered for this research. Results: The qualitative research study delivered relevant information in the way that the Edentulous social actor himself thinks, feels and experiences the problem. This could be considered in the development of new projects and programs developed specifically for this population. As well as in the educational field.

Protocolo protésico - quirúrgico en temporización inmediata de dientes unitarios, utilizando una cubeta multifuncional desmontable / Prosthetic protocol - surgery in the immediate temporization of a single tooth using a multifunctional removable tray

Propósito: El presente reporte clínico es la descripción de un protocolo protésico - quirúrgico que permite la visualización directa del sitio operatorio y el correcto posicionamiento protésico - implantario de una corona temporal atornillada, construida inmediatamente de insertado el implante. Material y métodos: Se seleccionaron 10 pacientes del programa de especialización en implantologia bucomaxilofacial de la Universidad de Chile, cuyo criterio de inclusión principal fue ser desdentado parcial unitario posterior, con antagonista dentario natural. Como protocolo diagnóstico se solicitaron exámenes de laboratorio, exámenes radiograficos y se registraron sus arcos dentarios con impresiones de estudio a fin de obtener modelos de yeso, los que fueron posicionados en un articulador semiajustable tipo Whip Mix, donde se confeccionó un encerado diagnóstico del diente a reemplazar, libre de contacto oclusal en máxima intercuspidación (MIC) y en los movimientos excursivos mandibulares. Basado en el encerado de diagnóstico se diseño una cubeta multifuncional desmontable (U. de Chile) cuya característica fundamental es que fusiona una guía quirúrgica y una guía de montaje protésico, para una correcta temporización inmediata. El procedimiento se inicia mediante un colgajo de espesor total, posicionamiento en boca de la guía multifuncional en fase quirúrgica, para permitir el fresado del lecho implantario y la inserción implantaria. El lecho quirúrgico es suturado mediante una seda negra trensada y se confecciona en forma inmediata una corona temporal atornillada utilizando la guía multifuncional en fase de carga protésica. Resultados: Se instalaron un total de 12 implantes Renova Tapered (Lifecore) utilizando la cubeta multifuncional la cual facilitó la direción del fresado y la contrucción de sus respectivas coronas temporales de resina acrilica, no segmentadas atornilladas. Conclusiones: Con las limitaciones de este estudio, la fusión de ambos procedimientos brinda...

Purpose: This clinical report is the description of a prosthetic protocol - surgery which allows direct visualization of the operative site and the correct positioning of the prosthetic-implantation of a screw retained temporary crown constructed immediately following the insertion of the implant. Methods: 10 patients, whose main inclusion criterion was having a partially edentulous posterior unit with an opposing natural tooth, were selected from the specialized program of Maxillofacial Implantology at the University of Chile. As diagnostic protocol was requested, laboratory tests, radiographic examinations and impressions of dental arches were recorded in order to obtain plaster models for the study and which were positioned in a semi-adjustable articulator type Whip Mix, which produced a diagnostic wax-up tooth replacement, free of occlusal contact in the maximal intercuspal (MIC) and mandibular excursions. Based on the diagnostic wax-up one can design a multi-functional removable tray (U. de Chile), whose key feature is that it merges a surgical guide and a prosthetic assembly guide for the correct immediate temporization. The procedure starts with a full thickness flap positioned in the mouth of the multi-functional guide of the surgical phase to allow the implant site drilling and implant insertion. The surgical site is sutured with black braided silk and you immediately draw up the screw retained temporary crown using the multi-functional guide in the prosthetic loading phase. Results: A total of 12 Renova Tapered implants (Lifecore) were installed using the multi-functional tray which provided the direction of the drilling and construction of its acrylic- resin temporary crowns without segmented screws. Conclusions: With the limitations of this study, the merging of both procedures provide a predictable safe alternative treatment that is quick and easy to implement for the clinician allowing the immediate temporization of the implant. Technical Report.

Lipophilic but not hydrophilic statins selectively induce cell death in gynaecological cancers expressing high levels of HMGCoA reductase.

Recent reports have suggested that statins induce cell death in certain epithelial cancers and that patients taking statins to reduce cholesterol levels possess lower cancer incidence. However, little is known about the mechanisms of action of different statins or the effects of these statins in gynaecological malignancies. The apoptotic potential of two lipophilic statins (lovastatin and simvastatin) and one hydrophilic statin (pravastatin) was assessed in cancer cell lines (ovarian, endometrial and cervical) and primary cultured cancerous and normal tissues. Cell viability was studied by MTS assays and apoptosis was confirmed by Western blotting of PARP and flow cytometry. The expressions of key apoptotic cascade proteins were analysed. Our results demonstrate that both lovastatin and simvastatin, but not pravastatin, selectively induced cell death in dose- and time-dependent manner in ovarian, endometrial and cervical cancers. Little or no toxicity was observed with any statin on normal cells. Lipophilic statins induced activation of caspase-8 and -9; BID cleavage, cytochrome C release and PARP cleavage. Statin-sensitive cancers expressed high levels of HMG-CoA reductase compared with resistant cultures. The effect of lipophilic statins was dependent on inhibition of enzymatic activity of HMG-CoA reductase since mevalonate pre-incubation almost completely abrogated the apoptotic effect. Moreover, the apoptotic effect involved the inhibition of synthesis of geranylgeranyl pyrophosphate rather than farnesyl pyrophosphate. In conclusion, lipophilic but not hydrophilic statins induce cell death through activation of extrinsic and intrinsic apoptotic cascades in cancerous cells from the human female genital tract, which express high levels of HMG-CoA reductase. These results promote further investigation in the use of lipophilic statins as anticancer agents in gynaecological malignancies.

Kidney graft survival in patients with hepatitis C: a single center experience.

Hepatitis C virus (HCV) infection is highly prevalent in renal transplant candidates; however, its effect on the transplant outcome is still controversial. The aim of the present study was to determine the effect of HCV infection in the outcome of kidney transplantation in a single transplant center. The study population 144 HCV- randomized selected patients and 64 HCV+ patients transplanted from 1973 to 2000, followed for up to 60 months post-transplantation. This retrospective study included the following variables: type of dialysis, time on renal replacement therapy, number of transfusions before and after transplantation, number of transplants, type of donor, immunosuppression, and rejection episodes. The Kaplan-Meier method was used to estimate graft and patient survival. Log-rank test was used to assess the difference in survival between HCV+ and HCV-. A multivariate Cox proportional hazards model was used to analyze the relation between graft and patient survival. HCV+ and HCV- patients had similar demographic and clinical characteristics; however, a higher number of HCV+ patients received blood transfusions after transplantation. Patient survival was not significantly different in 39 HCV+ and 96 HCV- patients transplanted with living-related donors (71% and 77% at five yr, respectively). Similarly, there was not significant difference in 25 HCV+ and 48 HCV- patients transplanted with kidneys from deceased donors, although there was a tendency to better outcome in HCV- patients (55% and 72% at five yr respectively). Regarding graft survival, there was also no differences in HCV+ and HCV- recipients of living-related grafts (61% and 66% at five yr post-transplant, respectively) and recipients of kidneys from deceased donors (44% and 41%, respectively). The results show that HCV+ patients can be transplanted with the same success than HCV- patients.

Detection of amastigotes of Trypanosoma cruzi in a kidney graft with acute dysfunction.

We described a case of allograft kidney dysfunction associated with renal parenchymal infection with amastigotes of Trypanosoma cruzi. The patient was diagnosed as being chronically infected prior to transplantation. The infection was probably acquired by blood transfusion. He could not complete antiparasitic treatment due to drug toxicity. He was transplanted from a cadaver who showed a negative test for Chagas' disease. One year after transplantation the serum creatinine progressively increased. Histological examination of renal biopsy revealed intracytoplasmic amastigotes of T cruzi. No evidence of other specific alterations in the graft was detected. It was unknown whether graft dysfunction was only due to parasitic infection. The present case confirmed that T cruzi can infect kidney grafts and that immunosuppression in kidney transplantation is potentially a cause of dissemination of Chagas' disease.

Tumor fibroso solitario de la orbita / Solitary fibrous tumor of the orbit

El tumor fibroso solitario se localiza principalmente en la pleura. Su localización extrapleural es rara, en cabeza y cuello se han encontrado pocos casos, principalmente en los senos paranasales y rinofaringe. De igual manera es de presentación infrecuente la localización en los tejidos blandos de la órbita, la cual ha sido descrita recientemente. El objetivo de este informe es la presentación clínica patológica y por imágenes de un caso tratado en la Fundación Santa Fe de Bogotá, en conjunto con la Clínica Barraquer