THERAPEUTIC APPROACH OF COMPLICATED HYDATID DISEASE: ROLE OF ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY IN CHOLANGIOHYDATIDOSIS.

BACKGROUND: Hydatid disease, a parasitic infestation caused by Echinococcus granulosus larvae, is an infectious disease endemic in different areas, such as India, Australia, and South America. The liver is well known as the organ most commonly affected by hydatid disease and may present a wide variety of complications such as hepatothoracic hydatid transit, cyst superinfection, intra-abdominal dissemination, and communication of the biliary cyst with extravasation of parasitic material into the bile duct, also called cholangiohydatidosis. Humans are considered an intermediate host, exposed to these larvae by hand-to-mouth contamination of the feces of infected dogs. AIM: This study aimed to highlight the role of endoscopic retrograde cholangiopancreatography in patients with acute cholangitis secondary to cholangiohydatidosis. METHODS: Considering the imaging findings in a 36-year-old female patient with computed tomography and magnetic resonance imaging showing a complex cystic lesion in liver segment VI, with multiple internal vesicles and a wall defect cyst that communicates with the intrahepatic biliary tree, endoscopic biliary drainage was performed by endoscopic retrograde cholangiopancreatography with papillotomy, leading to the discharge of multiple obstructive cysts and hydatid sand from the main bile duct. RESULTS: Clinical and laboratory findings improved after drainage, with hospital discharge under oral antiparasitic treatment before complete surgical resection of the hepatic hydatid cyst. CONCLUSIONS: Endoscopic retrograde cholangiopancreatography is a safe and useful method for the treatment of biliary complications of hepatic hydatid disease and should be considered the first-line procedure for biliary drainage in cases of cholangiohydatid disease involving secondary acute cholangitis.

[Perception of the educational environment in residents of medical specialties in Chilean universities]. / Percepción del ambiente educacional de postgrado en residentes de especialidades médicas de universidades chilenas.

BACKGROUND: The Learning Environment (LE) influences the performance of students, learning, social life, mental health, and the future of work. AIM: To assess the learning environment (LE) among medical residents of 64 specialties. MATERIAL AND METHODS: Two validated instruments "Postgraduate Hospital Education Environment Measure" (PHEEM) and "Ambulatory Care Learning Educational Environment" (ACLEEM), and open questions were answered online by 1259 residents from 15 universities. A descriptive and analytical statistical analysis and semantic deductive-inductive analyses of open questions were performed. RESULTS: LE was positive rather than negative (PHEEM of 100.5 points (79-116) and ACLEEM of 138.5 points (120-157)). An age over 32 years, male sex, studying in a private university, being in first year of residence and being in a non-surgical specialty were associated with a better PHEEM score (p < 0.05). For ACLEEM, the first year of specialty, a non-surgical specialty and studying in a private university were associated with better scores (p < 0.05). Two programs had excellent LE (Pathological Anatomy and Ophthalmology) and no specialty had a very poor performance or many problems. Aspects of teaching, clinical activities, and teachers were strengths reported by students. Aspects to improve were teaching, protected times and clinical activities. CONCLUSIONS: LE among medical specialties had more positive than negative features, but with areas that should be improved.

Percepción del ambiente educacional de postgrado en residentes de especialidades médicas de universidades chilenas / Perception of the educational environment in residents of medical specialties in Chilean universities

BACKGROUND: The Learning Environment (LE) influences the performance of students, learning, social life, mental health, and the future of work. Aim: To assess the learning environment (LE) among medical residents of 64 specialties. MATERIAL AND METHODS: Two validated instruments "Postgraduate Hospital Education Environment Measure" (PHEEM) and "Ambulatory Care Learning Educational Environment" (ACLEEM), and open questions were answered online by 1259 residents from 15 universities. A descriptive and analytical statistical analysis and semantic deductive-inductive analyses of open questions were performed. Results: LE was positive rather than negative (PHEEM of 100.5 points (79-116) and ACLEEM of 138.5 points (120-157)). An age over 32 years, male sex, studying in a private university, being in first year of residence and being in a non-surgical specialty were associated with a better PHEEM score (p < 0.05). For ACLEEM, the first year of specialty, a non-surgical specialty and studying in a private university were associated with better scores (p < 0.05). Two programs had excellent LE (Pathological Anatomy and Ophthalmology) and no specialty had a very poor performance or many problems. Aspects of teaching, clinical activities, and teachers were strengths reported by students. Aspects to improve were teaching, protected times and clinical activities. CONCLUSIONS: LE among medical specialties had more positive than negative features, but with areas that should be improved.

Therapeutic approach of complicated hydatid disease: role of endoscopic retrograde cholangiopancreatography in cholangiohydatidosis / Abordagem terapêutica da doença hidática complicada: papel da colangiopancreatografia retrógrada endoscópica na colangiohidatidose

ABSTRACT BACKGROUND: Hydatid disease, a parasitic infestation caused by Echinococcus granulosus larvae, is an infectious disease endemic in different areas, such as India, Australia, and South America. The liver is well known as the organ most commonly affected by hydatid disease and may present a wide variety of complications such as hepatothoracic hydatid transit, cyst superinfection, intra-abdominal dissemination, and communication of the biliary cyst with extravasation of parasitic material into the bile duct, also called cholangiohydatidosis. Humans are considered an intermediate host, exposed to these larvae by hand-to-mouth contamination of the feces of infected dogs. AIM: This study aimed to highlight the role of endoscopic retrograde cholangiopancreatography in patients with acute cholangitis secondary to cholangiohydatidosis. METHODS: Considering the imaging findings in a 36-year-old female patient with computed tomography and magnetic resonance imaging showing a complex cystic lesion in liver segment VI, with multiple internal vesicles and a wall defect cyst that communicates with the intrahepatic biliary tree, endoscopic biliary drainage was performed by endoscopic retrograde cholangiopancreatography with papillotomy, leading to the discharge of multiple obstructive cysts and hydatid sand from the main bile duct. RESULTS: Clinical and laboratory findings improved after drainage, with hospital discharge under oral antiparasitic treatment before complete surgical resection of the hepatic hydatid cyst. CONCLUSIONS: Endoscopic retrograde cholangiopancreatography is a safe and useful method for the treatment of biliary complications of hepatic hydatid disease and should be considered the first-line procedure for biliary drainage in cases of cholangiohydatid disease involving secondary acute cholangitis.

RESUMO RACIONAL: A doença hidática, uma infestação parasitária causada pelas larvas de Echinococcus granulosus, é uma doença infecciosa endêmica em diferentes áreas como Índia, Austrália e América do Sul. O fígado é conhecido como o órgão mais comumente afetado pela hidatidose, podendo apresentar uma grande variedade de complicações como trânsito hidático hepato-torácico, superinfecção do cisto, disseminação intra-abdominal e comunicação do cisto biliar com extravasamento de material parasitário para o ducto biliar ou também chamada de colangio-hidatidose O ser humano é considerado um hospedeiro intermediário, exposto a essas larvas pela contaminação mão-boca das fezes de cães infectados. OBJETIVO: Destacar o papel da endoscópica por colangiopancreatografia retrógrada em pacientes com colangite aguda secundária à colangio-hidatidose. MÉTODOS: Considerando os achados de imagem, em paciente feminina de 36 anos de idade, com imagens de tomografia computadorizada e ressonância magnética mostrando uma lesão cística complexa no segmento hepático VI, com múltiplas vesículas internas e um defeito de parede cística que se comunica com a árvore biliar intra-hepática foi realizada drenagem biliar endoscópica por colangiopancreatografia retrógrada com papilotomia, levando à descarga de múltiplos cistos obstrutivos e areia hidática da via biliar principal. RESULTADOS: Os achados clínicos e laboratoriais melhoraram após a drenagem, com alta hospitalar sob tratamento antiparasitário oral antes da ressecção cirúrgica completa do cisto hidático hepático. CONCLUSÕES: A endoscópica por colangiopancreatografia retrógrada é um método seguro e útil para o tratamento das complicações biliares da hidatidose hepática, devendo ser considerado o procedimento de primeira linha para drenagem biliar nos casos de colangio-hidatidose que envolve colangite aguda secundária.

Leukocyte and Platelet-Rich Fibrin Have Same Effect as Blood Clot in the 3-Dimensional Alveolar Ridge Preservation. A Split-Mouth Randomized Clinical Trial.

PURPOSE: Leukocyte- and platelet-rich fibrin (L-PRF) has been used for alveolar ridge preservation (ARP) in postextraction tooth sockets. However, current reports have measured its effectiveness in linear measurements of 3-dimensional ridge preservation. The purpose of this study was to determine the effectiveness of the use of L-PRF filling versus natural clot blood healing in ARP according to the clinical, radiographic, and volumetric measurements of postextraction tooth sockets. MATERIALS AND METHODS: A split-mouth randomized clinical trial was designed. Healthy patients who needed bilateral extraction of upper third molars were selected. After the tooth extraction, the socket was filled and distributed randomly with L-PRF and the contralateral socket only with the blood clot. The dimensional change of soft tissue healing around the sockets, and the length, depth, and difference of bone formation were examined using standardized periapical radiographs. Volumetric measurement variation of the sockets was evaluated by 3-dimensional scanning of dental casts. Changes of all measures were analyzed at 7 days (initial) and 3 months (final) after the tooth extraction and compared between both groups (t test; P < .05). RESULTS: Sixteen patients (aged 24.75 ± 3.53 years; 56.25% women) participated. Measurements of wound healing and the length, depth, and difference of bone formation were similar for both study groups at initial and final times. The calculation of initial-final volumetric socket variation was 15.45 ± 13.12 µL using L-PRF and 14.12 ± 11.23 µL using blood clot (P = .78). CONCLUSIONS: L-PRF filling showed the same dimensional and volumetric behavior as normal blood clot healing in the ARP of postextraction tooth sockets. Future investigations will have to analyze the use of surgical models and digital instruments in ARP techniques.

Knobloch syndrome in a patient from Chile.

Knobloch Syndrome (KS) is a rare autosomal recessive hereditary disease. Despite its clinical heterogeneity, it is characterized by vitreoretinal degeneration and high myopia, with or without occipital skull defects. It is caused by mutations in the COL18A1 gene, which codifies for collagen XVIII, present in retina and vascular endothelium. Since the first description of the disease by doctors Knobloch and Layer in 1972, over 100 cases and 20 pathogenic or likely pathogenic mutations have been reported. We present the case of a child born from a consanguineous couple in Chile with congenital high myopia and dysmorphisms without an occipital skull defect. Whole exome sequencing analysis revealed an inherited homozygous variant in COL18A1, c.4224_4225delinsC, p.Pro1411Leufs*35.

Melanoma anorrectal: a propósito de un caso / Anorectal melanoma: a case report

Introducción: El melanoma anorrectal es una neoplasia poco frecuente, que posee mal pronóstico debido a lo avanzado de la enfermedad al momento del diagnóstico, con una sobrevida a los cinco años menor al 10%. A diferencia del melanoma cutáneo, hasta el 87% de los melanomas anorrectales pueden ser amelanocíticos. Suele presentarse con sintomatología inespecífica, principalmente con rectorragia o como hallazgo incidental en colonoscopías. Caso clínico: Paciente sexo femenino de 63 años que presenta rectorragia de 4 meses de evolución. El diagnóstico fue confirmado con biopsia rectal e inmunohistoquímica con marcadores HBM 45 y S100 positivos. Estudio de diseminación resultó negativo. El tratamiento de elección fue la resección abdominoperineal. Conclusiones: Actualmente, no existe una diferencia significativa en la sobrevida en aquellos pacientes que se someten a resección abdominoperineal (Operación de Miles) en relación a aquellos que se les realiza resección local más radioterapia. Es necesario obtener siempre un margen quirúrgico adecuado, sin comprometer severamente la funcionalidad del esfínter anal. (AU)

Introduction: Anorectal melanoma is a rare, highly mlignant tumor due to its lack of early diagnosis, with a poor poor 5-year survival of 10%. About 87% of anorectal melanomas are amelanotic. Patients often present with non-specific symptoms, mainly with rectal bleeding. Case report: The following is a reported case from Felix Bulnes Hospital. A 63-year-old female patient who presented 4-month rectal bleeding. The diagnosis was confirmed with rectal biopsy and immunohistochemistry with expression of HBM 45 and S100 protein. Abdominoperineal resection was the treatment of choice. Conclusion: Patients undergoing radical surgery have no significant survival difference compared to those undergoing local excision with radiation therapy. (AU)

Cultured autologous bone marrow stem cells inhibit bony fusion in a rabbit model of posterolateral lumbar fusion with autologous bone graft.

Mesenchymal stem cells (MSCs) have been isolated from various tissues and expanded in culture. MSCs add osteogenic potential to ceramic scaffolds when used together. A spinal fusion rabbit model was used to evaluate whether a pellet of cultured, autologous bone marrow MSCs (BMSCs) with osteogenic differentiation could increase the fusion rate when co-grafted with an autologous bone graft compared to autograft alone. Thirty rabbits were randomly assigned to two groups. Group 1 received bone autograft alone and Group 2 received bone autograft plus a pellet of cultured and differentiated BMSCs. Group 2 rabbits had a bone marrow puncture, after which the BMSC were cultured and osteoblastic differentiation was induced. BMSC cultures were obtained from 12 of 15 rabbits. The 27 rabbits underwent a bilateral, L4-L5 intertransverse fusion with an autograft and in Group 2 rabbits a pellet of differentiated BMSCs was added to the autograft. In Group 1, the fusion rate was 53% (8 of 15 rabbits) and in Group 2 the fusion rate was 0% (p<0.05). Adding differentiated BMSCs in a pellet without a scaffold not only failed to increase fusion rate, but completely inhibited bony growth.

Autograft versus allograft with or without demineralized bone matrix in posterolateral lumbar fusion in rabbits. Laboratory investigation.

OBJECT: Posterolateral spinal fusions are performed to treat different spinal disorders. Autograft continues to be the gold standard; it is, however, associated with donor site morbidity and limited sources. Allograft has been used, but has been reported to result in lower fusion rates. Demineralized bone matrix (DBM) has also been used and reportedly increases the fusion rate in a variety of critical defect models. Different forms of DBM are available, not all have been independently studied. To evaluate the effect of a xenogenic DBM added to allograft on the fusion rate of posterolateral lumbar spine arthrodesis the authors designed an experimental study comparing posterolateral fusion rate using autograft, allograft, and allograft plus a xenogenic DBM in a validated animal model. METHODS: A bilateral, 1-level (L4-5) intertransverse process fusion was performed in 45 male New Zealand rabbits. Iliac crest bone graft was harvested bilaterally from each rabbit. The rabbits were randomly assigned to 3 groups: Group I, Autograft, 15 rabbits; Group II, Allograft, 15 rabbits; and Group III, Allograft plus DBM in a paste form (Dynagraft). The animals were killed 8 weeks after surgery. Fusion was assessed radiographically and by manual palpation by 2 independent observers. The results were analyzed using the Fisher exact test and chi-square test. RESULTS: The fusion rate was 46.6% (7 of 15 rabbits) in the autograft group, 33.3% (5 of 15 rabbits) in the allograft group, and 33.3% (5 of 15 rabbits) in the allograft plus DBM group (p > 0.05). CONCLUSIONS: Autograft produced a higher fusion rate than allograft in this spinal fusion rabbit model, but the difference was not statistically significant. Allograft plus xenogenic DBM showed the same fusion rate as allograft alone.

Iron deficiency anemia in infancy: long-lasting effects on auditory and visual system functioning.

Evoked potentials provide noninvasive measures of nerve transmission and CNS functioning. Auditory brainstem responses (ABR) and visual evoked potentials (VEP) show dramatic changes in infancy, largely as a result of progressive myelination. Because iron is required for normal myelination, pathway transmission in these sensory systems might be affected by early iron deficiency. We previously reported evidence to that effect: infants with iron-deficiency anemia (IDA) had slower transmission through the auditory brainstem pathway, uncorrected by iron therapy. To determine long-term effects, ABR and/or VEP of healthy Chilean children who were treated for IDA or were nonanemic in infancy were compared at approximately 4 y of age. Absolute latencies for all ABR waves and interpeak latencies (except I-III interval) were significantly longer in former IDA children. Longer latency was also observed for the P100 wave on VEP. The magnitude of differences was large-about 1 SD. These findings, with differences in latencies but not amplitudes, further support the hypothesis that IDA in infancy alters myelination and provide evidence that effects on transmission through the auditory and visual systems can be long lasting. Subtle changes in sensory pathway transmission might be an underlying mechanism for the derailment of other developmental aspects in early IDA.