ABSTRACT
Resumen El dolor crónico es una condición cada vez más prevalente, que afecta aproximadamente a un 32% de la población nacional. Estos pacientes poseen características particulares que complejizan un óptimo cuidado perioperatorio, sobre todo en términos de analgesia, efectos adversos de los distintos fármacos y complicaciones postquirúrgicas. El objetivo de esta revisión es exponer el creciente problema que involucra el manejo de los pacientes con dolor crónico no oncológico sometidos a una cirugía, y destacar algunas consideraciones que se deben tener en su cuidado. Dentro de los aspectos más relevantes están una adecuada caracterización del dolor y un buen esquema analgésico a ser utilizado en el perioperatorio, prefiriendo un enfoque multimodal ajustado acorde a las necesidades del paciente. Se debe tener especial consideración en pacientes usuarios crónicos de opioides, aquellos con dolor neuropático y aquellos con fibromialgia. Un adecuado seguimiento de estos grupos permitirá ajustar los esquemas de acuerdo con sus necesidades y lograr un mejor manejo analgésico perioperatorio.
Chronic pain is an increasingly prevalent condition, estimated in approximately 32% of the Chilean population. These patients have characteristics that make optimal perioperative care more complex, especially in terms of analgesia, adverse effects of the different drugs, and post-surgical complications. The aim of this publication is to expose the growing problem involved in the management of patients with chronic pain undergoing surgery, and to highlight some considerations that must be taken. Among the most relevant aspects are an adequate characterization of pain and a good analgesic scheme to be used in the perioperative period, preferring a multimodal analgesia approach adjusted according to the patient's needs. Special consideration should be given to patients with chronic opioids use, those with neuropathic pain and those with fibromyalgia. An adequate follow-up of these groups will allow adjusting the schemes according to their needs and achieve a better perioperative analgesic management.
Subject(s)
Humans , Perioperative Care/methods , Chronic Pain/prevention & control , Surgical Procedures, Operative/adverse effects , Perioperative Care/standards , Chronic Pain/drug therapy , Analgesics/administration & dosageABSTRACT
Ataxias are one of the most frequent complaints in Neurogenetics units worldwide. Currently, more than 50 subtypes of spinocerebellar ataxias and more than 60 recessive ataxias are recognized. We conducted an 11-year prospective, observational, analytical study in order to estimate the frequency of pediatric and adult genetic ataxias in Argentina, to describe the phenotypes of this cohort and evaluate the diagnostic yield of the algorithm used in our unit. We included 334 ataxic patients. Our diagnostic approach was successful in one-third of the cohort. A final molecular diagnosis was reached in 113 subjects. This rate is significantly higher in the subgroup of patients with a positive family history, where the diagnostic yield increased to 55%. The most prevalent dominant and recessive ataxias in Argentina were SCA-2 (36% of dominant ataxias) and FA (62% of recessive ataxias), respectively. Next generation sequencing-based assays were diagnostic in the 65% of the patients requiring these tests. These results provide relevant epidemiological information, bringing a comprehensive knowledge of the most prevalent subtypes of genetic ataxias and their phenotypes in our territory and laying the groundwork for rationally implementing genetic diagnostic programs for these disorders in our country.
Subject(s)
Algorithms , Cerebellar Ataxia/genetics , Genetic Heterogeneity , Molecular Diagnostic Techniques/methods , Adolescent , Adult , Age of Onset , Aged , Aged, 80 and over , Argentina/epidemiology , Cerebellar Ataxia/classification , Cerebellar Ataxia/diagnosis , Cerebellar Ataxia/epidemiology , Child , Child, Preschool , Chronic Disease , Disease Progression , Genes, Dominant , Genes, Recessive , High-Throughput Nucleotide Sequencing , Humans , Middle Aged , Nystagmus, Pathologic/genetics , Prospective Studies , Young AdultABSTRACT
Resumen Introducción Los cambios en la práctica profesional han transformado la intención de los estudiantes de medicina de optar por una carrera en cirugía. Objetivo Evaluar los factores asociados con esta intención en un contexto de acelerada dinámica educativa y sanitaria. Materiales y Método Evaluamos la intención de los estudiantes de diez facultades de medicina en Colombia, y los factores asociados, mediante un cuestionario (escala de Likert) desarrollado a partir de la revisión de la literatura. Identificamos la asociación entre los factores y la intención mediante un análisis de regresión lineal. Los resultados de la regresión se presentan mediante coeficientes β (p < 0,05). Resultados Un total de 252 estudiantes (65,87% mujeres) fueron incluidos en el análisis. El promedio de la intención fue 3,15 ± 1,34 (1-5). Los factores significativamente asociados fueron: identificación con el estilo de vida quirúrgico (β = 0,25); identificación con modelos (β = 0,18); atributos personales (β = 0,25) e identificación con la práctica profesional del cirujano (β = 0,16). No encontramos asociación significativa con el género (mujeres en la especialidad), prestigio, dinámica del posgrado ni recompensa futura. Conclusión Existe una intención moderada de elegir una carrera de cirugía entre estudiantes de medicina colombianos. Optar por esta carrera requiere atributos personales, modelos e identificación con el estilo de vida y práctica profesional del cirujano. Se requieren estudios cualitativos que exploren en profundidad estos resultados e intervenciones focalizadas a estimular esta intención entre los estudiantes.
Introduction The changes in the professional practice have transformed the intention of medical students to choose a surgical career. Aim Evaluate the factors associated with this intention in a context of accelerated educational and health dynamics. Materials and Method We evaluated the intention of the students of ten medical schools in Colombia, and the associated factors, through a questionnaire (Likert scale) settled from a literature review. We identify the association between the factors and the intention by using linear regression analysis. The results of the regression are presented by β coefficients (p < 0.05). Results A total of 252 students (65.87% women) were included in the analysis. The average of the intention was 3.15 ± 1.34 (1-5). The factors significantly associated were: identification with the surgical lifestyle (β = 0.25); identification with models (β = 0.18); personal attributes (β = 0.25) and identification with the professional practice of the surgeon (β = 0.16). We did not find significant associations with gender (women in the specialty), prestige, postgraduate dynamics and future rewards. Conclusion There is a moderate intention to choose a career in surgery among Colombian medical undergraduates. Choosing this career requires personal attributes, models and identification with the lifestyle and professional practice of the surgeon. Further qualitative studies are necessary to explore these results in depth, as well as interventions to stimulate this intention among students.
Subject(s)
Humans , Students, Medical/psychology , Surgeons/psychology , Surveys and Questionnaires , Colombia , Surgeons/educationABSTRACT
Resumen Objetivo: Determinar los factores asociados al ataque cerebrovascular isquémico en el servicio de urgencias de la Clínica Especializada Los Andes, de la ciudad de Tunja, entre los años 2013 a 2016. Pacientes y métodos: Estudio de casos y controles; los casos correspondieron a 97 pacientes con ataque cerebrovascular isquémico (infarto cerebral isquémico y accidente isquémico transitorio) y los controles a 291 pacientes sin ataque cerebrovascular isquémico que ingresaron a urgencias entre los años 2013 a 2016. Resultados: El sexo femenino correspondió al 56,7% (55) de los casos y al 54,6% de los controles (154) (p = 0,069). La media de edad en el grupo caso fue de 73,7 años ENT#091;DE: 10,5 añosENT#093; y en los controles de 64,5 años ENT#091;DE: 11,3 añosENT#093;. Los factores asociados al ataque cerebrovascular isquémico fueron: antecedente de ataque cerebrovascular isquémico ENT#091;OR 7,7 IC 95% 3,2; 18 p= 0,000ENT#093;, tabaquismo ENT#091;OR 4,4 IC 95% 1,1; 18 p= 0,022ENT#093;, dislipidemia ENT#091;OR 3 IC 95% 1,2; 7,5 p= 0,017ENT#093;, edad igual o mayor a 70 años ENT#091;OR 2,3 IC 95% 1,3; 4,1 p= 0,002ENT#093; e hipertensión arterial ENT#091;OR 1,8 IC 95% 1,06; 3,3 p= 0,029ENT#093;. Conclusiones: Los factores asociados al ataque cerebrovascular isquémico fueron, en orden de importancia, antecedente de ataque cerebrovascular isquémico, tabaquismo, dislipidemia, edad igual o mayor a 70 años E hipertensión arterial.
Abstract Objective: To determine the factors associated with ischaemic cerebrovascular accidents (ICVA) in the Emergency Department of the Andes Specialist Clinic of the city of Tunja, between the years 2013 and 2016. Patients and methods: A case-control study was conducted in which the cases consisted of 97 patients with ICVA (ischaemic cerebral infarction and transient ischaemic accident), and the controls were 291 patients with no ICVA, who were admitted to the Emergency Department between the years 2013 and 2016. Results: There were 56.7% (55) females in the cases, and 54.6% (154) in the controls (P=.069). The mean age of the cases was 73.7 years ENT#091;SD: 10.5 yearsENT#093;, and 64.5 years ENT#091;SD: 11.3 yearsENT#093; in the controls. The factors associated with ICVA were: a history of ICVA ENT#091;OR; 7.7, 95% CI; 3.2-18, P=.000ENT#093;, smoking ENT#091;OR; 4.4, 95% CI; 1.1-18, P=.022ENT#093;, dyslipidaemia ENT#091;OR; 3, 95% CI; 1.2-7.5, P=.017ENT#093;, age equal to or greater than 70 years ENT#091;OR; 2.3, 95% CI; 1.3-4.1, P=.002ENT#093;, and arterial hypertension ENT#091;OR; 1.8, 95% CI; 1.06-3.3, P=.029ENT#093;. Conclusions: The factors associated with ischaemic cerebrovascular accident were, in order of importance, a history of ischaemic cerebrovascular accident, smoking, dyslipidaemia, age equal to or greater than 70 years, and arterial hypertension.
Subject(s)
Humans , Cerebrovascular Circulation , Cerebrum , Risk FactorsABSTRACT
BACKGROUND/PURPOSE: Facial lipoatrophy in HIV patients, secondary to antiretroviral therapy (ART) with thymidine analogs, has been related to important psychosocial alterations and poor adherence to treatment. Polyacrylamide gel (PAAG) is a filler that has been used for treating facial lipoatrophy in HIV patients. The aim was to assess the clinical and sonographic anatomical changes after injection of PAAG in HIV patients with facial lipoatrophy secondary to ART. METHODS: HIV patients receiving ART and suffering from severe facial lipoatrophy were recruited and underwent clinical and color Doppler ultrasound evaluation prior to PAAG application (AQUAMID® ) and sonographically monitored at 18 months and clinically followed up for 36 months after the procedure. Adverse effects were recorded based on occurrence and complexity. RESULTS: A total of 33 patients were evaluated, 30 men (91%) and 3 women (9%) with an average age of 49.6 years (±8.4). Clinical improvement assessed by a dermatologist had an average score of 5.9 (±0.7) on a scale of 1-7. On color Doppler ultrasound there was a significant increase of the thickness of the subcutaneous tissue (SCT) in both nasofold lines when comparing before and after PAAG injection (P < 0.01) and no signs of inflammation (hypervascularity). User satisfaction was qualified as excellent or good in all cases. Only two patients experienced adverse effects (hematoma and puncture site infection), which was successfully managed without consequences. CONCLUSION: Treatment of facial lipoatrophy with PAAG seems to be effective in HIV patients and no signs of complications were observed in the monitoring at 36 months after injection. Color Doppler ultrasound can identify the filler deposits and the anatomical changes of the SCT non-invasively.
Subject(s)
Acrylic Resins/administration & dosage , Anti-Retroviral Agents/adverse effects , Facial Dermatoses/diagnostic imaging , Facial Dermatoses/therapy , HIV-Associated Lipodystrophy Syndrome/diagnostic imaging , HIV-Associated Lipodystrophy Syndrome/therapy , Ultrasonography, Doppler, Color/methods , Adult , Dermal Fillers/administration & dosage , Facial Dermatoses/chemically induced , Female , HIV-Associated Lipodystrophy Syndrome/chemically induced , Humans , Male , Treatment OutcomeABSTRACT
Plastic surgeries are becoming more popular, being performed on a varied type of population and often as office-based procedures. Despite being highly elective procedures, they have risks and complications, which should be reported to patients by the health personnel. The most frequently performed procedures are breast augmentation and body liposuction. The most relevant complications associated with plastic surgery are pulmonary embolism and deep vein thrombosis, which is the leading cause of mortality in this type of surgery. Other complications are local anesthetics intoxication secondary to the use of tumescent solution in body liposuction, inadequate management of perioperative intravenous fluids, mild hypothermia and severe pain after surgery caused by poor postoperative analgesia. It is essential to prevent the described complications, which significantly increase morbidity, mortality and hospital stay. The perioperative measures that have demonstrated effectiveness in reducing perioperative risk are thromboprophylaxis, depending on the thrombotic risk categorization of each patient and the use of adequate concentrations of lidocaine and vasoconstrictor in the tumescent solution. Appropriate temperature monitorization and use of conservation measures in patients with exposure of large body surfaces is also an important issue, as is diligence in intraoperative fluid balance and administration of intravenous multimodal analgesia, adjusted to the magnitude of the surgery. In order to achieve this, proper communication between the surgical team, anesthesiologists and nurses is vital, as it permits implementation of specific measures that permit adequate monitorization, prevention of complications and analgesic management described above.
Las cirugías plásticas son cada vez más frecuentes, abarcando todo tipo de población y realizándose incluso en la consulta médica. Las cirugías estéticas más frecuentemente realizadas son aumento mamario y liposucción corporal. Son procedimientos quirúrgicos sumamente electivos, pero poseen riesgos y complicaciones asociados, los cuales deben ser debidamente informados a los pacientes. La complicación más relevante es el tromboembolismo pulmonar, generalmente asociado a trombosis venosa profunda, el cual es la primera causa de mortalidad en este tipo de cirugías. Otras complicaciones destacadas son intoxicación por anestésicos locales secundaria al uso de solución tumescente para liposucción corporal, inadecuado manejo de fluidos endovenosos perioperatorios, hipotermia inadvertida y dolor intenso por deficiente analgesia postoperatoria. Estas complicaciones aumentan significativamente la morbimortalidad y estadía hospitalaria, por lo que su prevención es fundamental. Las medidas que han demostrado disminución significativa de los riesgos y complicaciones perioperatorios en cirugía plástica son tromboprofilaxis según categorización del riesgo trombótico de cada paciente, revisar que la solución tumescente administrada para liposucciones tenga concentraciones adecuadas de lidocaína (idealmente utilizando vasoconstrictores coadyuvantes), utilizar medidas adecuadas de monitorización y conservación de temperatura en pacientes con gran superficie corporal expuesta, ser acuciosos en el balance intraoperatorio de fluidos endovenosos y administrar analgesia postoperatoria multimodal, balanceada y acorde a la magnitud del dolor. Es vital una adecuada comunicación entre el equipo de cirujanos, anestesiólogos, enfermeros e instrumentadores quirúrgicos con el objetivo de conocer las particularidades de las distintas cirugías plásticas e implementar las medidas de monitorización, prevención de complicaciones y manejo analgésico antes descritas.
Subject(s)
Humans , Surgery, Plastic/adverse effects , Intraoperative Complications/epidemiology , Anesthetics/adverse effects , Surgery, Plastic/mortality , Pulmonary Embolism/etiology , Hypothermia/etiology , Lipectomy/adverse effects , Risk FactorsABSTRACT
Delirium (acute confusional state) is a common and disabling complication among surgical older people. It is often underdiagnosed and undertreated. Its incidence varies by type of intervention and it is associated with several complications such as functional impairment, cognitive dysfunction, prolonged hospitalization and institutionalization. These increase hospitalization costs and the risk of death. There are precipitating and predisposing risk factors, which increase the susceptibility for postoperative delirium. This condition should be considered as a syndrome of epidemiological importance, which needs to be prevented or treated in a timely manner through a multidisciplinary intervention. The perioperative care of elderly patients involves different medical specialties and is a subject of general knowledge.
Subject(s)
Delirium/etiology , Postoperative Complications , Aged , Delirium/diagnosis , Delirium/drug therapy , Humans , Postoperative Complications/diagnosis , Postoperative Complications/drug therapy , Risk FactorsABSTRACT
Delirium (acute confusional state) is a common and disabling complication among surgical older people. It is often underdiagnosed and undertreated. Its incidence varies by type of intervention and it is associated with several complications such as functional impairment, cognitive dysfunction, prolonged hospitalization and institutionalization. These increase hospitalization costs and the risk of death. There are precipitating and predisposing risk factors, which increase the susceptibility for postoperative delirium. This condition should be considered as a syndrome of epidemiological importance, which needs to be prevented or treated in a timely manner through a multidisciplinary intervention. The perioperative care of elderly patients involves different medical specialties and is a subject of general knowledge.
Subject(s)
Aged , Humans , Delirium/etiology , Postoperative Complications , Delirium/diagnosis , Delirium/drug therapy , Postoperative Complications/diagnosis , Postoperative Complications/drug therapy , Risk FactorsABSTRACT
We report the case of a patient with a cerebral aneurysm, located in the left middle cerebral artery. During the clipping of this aneurysm, the bispectral index (BIS) increased for no apparent reason. This was then interpreted as intraoperative non-convulsive status epilepticus. This clinical condition may have negative impact in the prognosis of the patient, so it is very important to be able to detect this conditions as early as possible. Measuring the BIS while the patient is anaesthetised could be useful in this situation, considering that an increase in values greater than 60, associated with acidosis and without any other peri-anaesthetic explanation, may provide evidence of a convulsive equivalent state, allowing appropriate action to be taken.
Subject(s)
Intracranial Aneurysm/surgery , Intraoperative Complications/diagnosis , Intraoperative Neurophysiological Monitoring , Seizures/diagnosis , Consciousness Monitors , Female , Humans , Intraoperative Neurophysiological Monitoring/instrumentation , Middle Aged , Risk AssessmentABSTRACT
El Laboratorio de Plastinación de la Universidad de los Andes ha trabajado hasta hoy, exclusivamente la técnica en Silicona para preservar el material cadavérico mediante este tipo de conservación. Sin embargo, este método tiene algunas desventajas en cortes anatómicos finos. Se desarrolló un método de plastinación en resina poliéster, en base a la técnica ya protocolizada, adaptándolas a nuestro laboratorio, con el fin de obtener muestras con mayor resistencia y calidad, sin alterar las estructuras. Se utilizaron cortes anatómicos de segmentos distales de miembro inferior humano fijados en acetona a - 17 C y otros de encéfalo de vacuno fijados con formalina acuosa al 10 por ciento a 4 C, de un grosor que varía entre 0,4 y 0,8 cm. Se procedió a deshidratar las muestras en acetona a -17 C para luego seleccionar piezas que fueron impregnadas y plastinadas con resina P-4 sin catalizador y otras con catalizador en proporciones 2:1. El proceso de polimerización fue común para ambas con luz ultravioleta. Se obtienen muestras sólidas y rígidas, con cierta transparencia, especialmente en los cortes más finos. No se observaron alteraciones de forma y tamaño. Los mejores resultados en cuanto a transparencia, se obtuvieron con la Resina sin catalizador. Se logró estandarizar una técnica con Resina poliéster P-4, obteniendo cortes anatómicos de buena calidad y con una resistencia mucho mayor que la obtenida para este tipo de muestras en la plastinación con Silicona...
The plastination laboratory at Universidad de los Andes has always worked exclusively silicone as a technique to preserve cadaveric material. However, this method has disadvantages in thin anatomical pieces. A plastination method has been developed using polyester resin P-4, using an already protocolized technique and adapting it to our laboratory to obtain better quality and resistant pieces, without altering the anatomical structures. Anatomical pieces of human lower extremities were used, which were fixated in acetone at -17 C and bovine encephalous pieces, fixated with 10 percent aquoeus formalyn at 4 C, with a variable width of 0.4 to 0.8 cm. The pieces were then dehydrated in acetone at -17 C; among these pieces, some were selected, impregnated and plastinated with P-4 resin, using in some of them a catalyst in a ratio of 2:1. The polymerization process was the same for all pieces with ultraviolet light. Solid and rigid pieces were obtained, with a partial transparency, especially on the thinnest cuts. No alterations in size and shape were observed. The best results in transparency were obtained with the technique without the use of catalyst. An adapted standardized protocol for polyester resin P-4 technique was achieved, obtaining good quality anatomical pieces with a higher resistance compared to pieces plastinated using the silicone technique...
Subject(s)
Humans , Animals , Tissue Preservation/methods , Plastic Embedding , Resins , Anatomy/methods , Dissection , Polyesters , Organ Preservation/methodsABSTRACT
The aim of this study was to perform a descriptive study of the morphology, anatomical variations and morphometry of medial talocrural (or deltoid) ligament. We dissected 27 lower limbs obtained from amputations without histories of age, sex or disease. The measurements were made with a caliper, compass and ruler, expressing the results in millimeters. We described the superficial layer morphology of the medial ligament, measuring the size and ligament's thickness. For the deep layer we described and measured the length (l), width (w) and thickness (t). Results: Superficial layer: trapezoid form=66.7 percent (anterior margin=30.5 mm; posterior margin=27.6 mm; top margin=22.6 mm; bottom margin=50.5 mm), rectangular form=19 percent (anterior margin=19.3 mm; posterior margin=27.2 mm; top margin=24.4 mm; bottom margin=29.8 mm), triangular form=14.3 percent (anterior margin=37 mm; posterior margin=37.8 mm; bottom margin=48.3 mm). The average thickness of the superficial layer was 3.6 mm. Deep layer of the medial ligament: l=6.9 mm, w=11 mm, t=5.7 mm; presented rectangular form in 100 percent. In 76.2 percent of the specimens, the deep layer was covered completely by the superficial layer; however, in 23.8 percent the coverage is incomplete, showing the deep layer by posterior angle. The literature is contradictory regarding the anatomy and variations of the medial ligament of the ankle. There are important differences in morphology, attachments, subdivisions and relationships between the two layers of the deltoid ligament. Conclusions: We found significant anatomical variations in the morphology and the relationship between the superficial and deep layers of the deltoid ligament.
El objetivo fue realizar un estudio descriptivo de la morfología, variaciones anatómicas y la morfometría del ligamento talocrural medial (o deltoídeo). Se disecaron 27 miembros inferiores obtenidos de amputaciones sin antecedentes de edad, sexo, ni morbilidad. Las mediciones se realizaron con un pie de metro, regla y compás, expresando los resultados en milímetros. Se describió la morfología del ligamento medial en su capa superficial, midiendo el tamaño y grosor del ligamento. Para la capa profunda se describió y midió la longitud (l), ancho (a) y espesor (e). Resultados: En la capa superficial se observó: forma trapezoidal = 66,7 por ciento (margen anterior = 30,5 mm; margen posterior = 27,6 mm; margen superior = 22,6 mm; margen inferior = 50,5 mm), forma rectangular= 19 por ciento (margen anterior = 19,3 mm; margen posterior = 27,2 mm, margen superior = 24,4 mm; margen inferior = 29,8 mm), forma triangular = 14,3 por ciento (margen anterior=37 mm, margen posterior = 37,8 mm; margen inferior = 48,3 mm). El espesor promedio de la capa superficial fue de 3,6 mm. La capa profunda del ligamento medial: l = 6.9 mm, a = 11 mm, e = 5,7 mm, presentó forma rectangular en el 100 por ciento de los casos. En el 76,2 por ciento de las muestras, la capa profunda estaba completamente cubierta por la capa superficial, sin embargo, en 23,8 por ciento la cobertura fue incompleta, mostrando la capa profunda por el ángulo posterior. La literatura es contradictoria respecto a la anatomía y variaciones del ligamento medial del tobillo. Existen importantes diferencias en su morfología, inserciones, subdivisiones y las relaciones entre las dos capas del ligamento deltoídeo. Conclusiones: Se encontraron importantes variaciones anatómicas en la morfología y la relación entre las capas superficial y profunda del ligamento deltoídeo.
Subject(s)
Humans , Lateral Ligament, Ankle/anatomy & histology , Lateral Ligament, Ankle/innervation , Lateral Ligament, Ankle/blood supply , Ligaments/anatomy & histology , Ligaments/innervation , Deltoid Muscle/anatomy & histologyABSTRACT
Las lesiones del ligamento talofibular lateral son un problema común en traumatología. Éstas corresponden a la mayoría de los esguinces de tobillo, siendo el ligamento talofibular anterior el de mayor frecuencia, seguido del calcáneo fibular. Mediante nuestro estudio intentaremos describir la anatomía de estos ligamentos, teniendo así una herramienta para su enfrentamiento quirúrgico. Se realizó un estudio descriptivo morfométrico sobre los ligamentos talocrurales laterales, obteniéndose un promedio de sus medidas y frecuencia de variaciones anatómicas. Se disecaron 27 miembros inferiores obtenidos de amputaciones sin antecedentes de edad, sexo y morbilidad. Los ligamentos fueron medidos con un pie de metro, compás de puntas secas y regla milimetrada, expresando los resultados en milímetros. Se midió el largo(l), ancho(a), espesor(e), área de origen(ao) y área de inserción(ai). Se describieron las variaciones anatómicas que presentaron estos ligamentos. Los resultados fueron: Lig. calcáneo fibular (l=30,3mm; a=5,46mm; e=2,4mm; ao=46,17mm²; ai=66,59mm²). No presentó variaciones anatómicas. Lig. talofibular posterior (l=25,74mm; a=6,37mm; e=4,35mm; ao=40,1mm²; ai=80,19mm²). En 22,2 por ciento se describe una proyección de fibras accesorias (fascículo ascendente o tibial) que nacen del origen del ligamento, dirigiéndose hacia superior para insertarse en la caraarticular de la tibia. Lig. talofibular anterior (l=20,01mm; a=10,2mm; e=2,3mm; ao=60,03mm²; ai=66,96mm²). En 57 por ciento de los casos fue único, en 43 por ciento bifurcado y 0 por ciento trifurcado. Un 46,15 por ciento posee fibras arciformes que unen los orígenes de los ligamentos fibulotalar anterior y fibulocalcáneo. En conclusión se encontraron importantes variaciones anatómicas que no son aisladas, sino forman distintos grupos anatómicos de cada ligamento.
The lateral talofibular ligament injuries are a common problem in trauma. These correspond to the majority of ankle sprains, anterior talofibular ligament being the most frequent, followed by the calcaneal fibular. Through our study we will try to describe the anatomy of these ligaments, thus having a surgical tool for confrontation. A descriptive study was conducted on the morphometric lateral talocrural ligaments, resulting in an average of their measurements and frequency of anatomical variations. Were dissected 27 limbs from amputation with no history of age, sex and morbidity. The ligaments were measured with a tube foot, dry dividers and millimeter ruler, expressing the results in millimeters. We measured the length (l), width (a), thickness (e), area of origin (o) and insertion site (i). Described the anatomic variations presented these ligaments. The results were: fibulocalcaneal ligaments (l = 30.3 mm, a = 5.46 mm, e = 2.4 mm, ao = 46.17 mm²; ai = 66.59 mm²). No anatomic variations presented. Posterior talofibular ligament (l = 25.74 mm, a = 6.37 mm, e = 4.35 mm, ao = 40.1 mm²; ai = 80.19 mm²). In 22.2 percent described a projection accessory fiber (fascicle up or fibular) arising from the origin of the ligament, superior heading to attach to the articular surface of the fibula. Anterior talofibular ligament (l = 20.01 mm, a = 10.2 mm, e = 2.3 mm, ao = 60.03 mm²; ai = 66.96 mm²). In 57 percent of cases was unique, bifurcated in 43 percent and 0 percent triple-barbed. A 46.15 percent have arcuate fibers connecting the origins of the anterior fibulotalar and fibulocalcaneal ligaments. In conclusion important anatomical variations were found are not isolated, but form distinct anatomical groups each ligament.
Subject(s)
Humans , Lateral Ligament, Ankle/anatomy & histologyABSTRACT
A study was conducted in 2006 to determine the prevalence of Salmonella on three cantaloupe farms in Matamoros, Coahuila, Mexico, and on one farm that cultivates chile peppers var. Bell in Culiacán, Sinaloa, Mexico. Samples from cantaloupe farms consisted of cantaloupe rinses, irrigation water, water from furrows in the field, and workers' hands. Samples from the chile pepper farm consisted of rinses of chile peppers obtained at the field, pepper rinses obtained at the packing house, and irrigation water from the field. A total of 55 samples were obtained from both production systems. Twelve and 10 samples from the cantaloupe and chile pepper production systems, respectively, tested positive for Salmonella according to a traditional culture method. The difference between the proportion of Salmonella-positive samples from the cantaloupe production system (12 of 28 = 0.43) and the chile pepper production system (10 of 27 = 0.37) was not statistically significant (P > 0.05). A PCR-restriction fragment length polymorphism (RFLP) method based on the fliC gene was used to determine the serotype of the isolates. Salmonella Typhimurium was the only serotype found associated with the cantaloupe production system, whereas both Salmonella Typhimurium and Enteritidis serotypes were found associated with the chile pepper production system. Results showed that 91% (20 of 22) and 9% (2 of 22) of the isolates from both agricultural systems matched with the Salmonella Typhimurium and Salmonella Enteritidis reference strain restriction profiles, respectively. This study demonstrates the utility of the PCR-RFLP technique for determining the serotypes of Salmonella isolates obtained from cantaloupe and chile pepper production systems.
Subject(s)
Capsicum/microbiology , Cucumis melo/microbiology , DNA, Bacterial/analysis , Food Contamination/analysis , Polymorphism, Restriction Fragment Length , Salmonella/isolation & purification , Bacterial Typing Techniques , Colony Count, Microbial , Consumer Product Safety , Food Handling/methods , Food Microbiology , Food Packaging/methods , Mexico , Polymerase Chain Reaction/methods , Salmonella/classification , Salmonella/genetics , Salmonella enteritidis/classification , Salmonella enteritidis/genetics , Salmonella enteritidis/isolation & purification , Salmonella typhimurium/classification , Salmonella typhimurium/genetics , Salmonella typhimurium/isolation & purification , Sensitivity and Specificity , Serotyping , Water MicrobiologyABSTRACT
We underwent a project aimed to define the clinical and immunological characteristics of type 1 diabetes (T1D) in a Colombian population. This was a multicenter and cross-sectional study. Patients were systematically interviewed and their medical records reviewed, using a questionnaire that sought information about demographic, clinical and immunological characteristics. Glutamic acid decarboxylase antibodies (GADA), tyrosine phosphatase antibodies (IA-2A) and insulin antibodies (IAA) were examined by radioimmunoassay. There were 107 patients with T1D. Male:female ratio was 1:1. Half of the patients developed diabetes ketoacidosis at onset. GADA, IA-2A, and IAA were detected in 45%, 40%, and 69% of the cases, respectively. GADA positive patients were older and had a less duration of disease than patients without these autoantibodies (p<0.01). Association between breast feeding with the presence of antibodies or clinical characteristics was not observed. The results highlight some differences of T1D expression according to geographic location and ethnicity. Differences in age at onset and clinical variables may point to an environmental factor or deficient access to health care system. Genetic studies underway will provide important information in this population. These results might help to define public health policies in our population to improve T1D diagnosis, patients' quality of life and their outcome.
Subject(s)
Autoantibodies/blood , Diabetes Mellitus, Type 1/immunology , Glutamate Decarboxylase/immunology , Insulin Antibodies/blood , Protein Tyrosine Phosphatases/immunology , Adult , Age of Onset , Colombia , Cross-Sectional Studies , Diabetes Mellitus, Type 1/complications , Diabetic Ketoacidosis/etiology , Female , Humans , Male , Protein Tyrosine Phosphatase, Non-Receptor Type 1Subject(s)
Humans , Male , Aged , Spleen/pathology , Hematopoiesis, Extramedullary , Splenomegaly/etiology , Magnetic Resonance Imaging , UltrasonographyABSTRACT
INTRODUCTION: Psychiatric issues present a challenge in the treatment of patients with multidrug-resistant tuberculosis (MDR-TB). Both baseline psychiatric disorders and development of psychiatric complications related to anti-tuberculosis drugs and psychosocial factors require aggressive management. SETTING: A community-based non-governmental health organization in Lima, Peru. OBJECTIVE: To review the literature for psychiatric complications associated with anti-tuberculosis medications, to describe the incidence and prevalence of depression, anxiety and psychosis among individuals receiving MDR-TB therapy, and to detail the management approach used in this cohort. METHODS: A retrospective case series was performed among the first 75 patients to receive individualized MDR-TB therapy in Lima, Peru, between 1996 and 1999. RESULTS: Baseline depression and baseline anxiety were observed in respectively 52.2% and 8.7% of this cohort. Most individuals with baseline depression experienced improvement of depressive symptoms during the course of TB therapy. The incidence of depression, anxiety and psychosis during MDR-TB treatment was 13.3%, 12.0% and 12.0%, respectively. While the majority of individuals with depression, anxiety and psychosis required psychiatric pharmacotherapy, cycloserine was successfully continued in all but one case. CONCLUSION: Psychiatric comorbidities are not a contra-indication to MDR-TB therapy. Management of psychiatric complications is possible without compromising anti-tuberculosis treatment.
Subject(s)
Antibiotics, Antitubercular/adverse effects , Anxiety/chemically induced , Anxiety/epidemiology , Cycloserine/adverse effects , Depressive Disorder/chemically induced , Depressive Disorder/epidemiology , Psychoses, Substance-Induced/epidemiology , Tuberculosis, Multidrug-Resistant/drug therapy , Adult , Age Distribution , Antibiotics, Antitubercular/therapeutic use , Anxiety/diagnosis , Anxiety/therapy , Cycloserine/therapeutic use , Depressive Disorder/diagnosis , Depressive Disorder/therapy , Female , Humans , Incidence , Interview, Psychological , Male , Medical Records , Middle Aged , Mycobacterium tuberculosis/drug effects , Peru/epidemiology , Psychoses, Substance-Induced/diagnosis , Psychoses, Substance-Induced/therapyABSTRACT
Minimal deviation adenocarcinoma (adenoma malignum) is a rare well-differentiated form of invasive cervical adenocarcinoma. Because of its rarity and cytologic changes are subtle there are only a few reports of this pathology, been necessary the realization of large biopsy of the cervical tissue for it histological diagnosis. We made a review in the period 1994-2000, of the clinical, cytological, histological features, treatments and follow-up of 4 patients in the Gynecologic Oncology Department of the University Hospital Vall d' Hebron, Barcelona, Spain.
Subject(s)
Adenocarcinoma/pathology , Uterine Cervical Neoplasms/pathology , Adult , Female , Humans , Middle AgedABSTRACT
OBJECTIVE: To assess urodynamic studies of children with nonrefluxing pyelonephritis, investigate the possible connection between renal damage (as approximately 40% of children with febrile urinary tract infections and no evidence of vesico-ureteric reflux have irreversible renal cortical scarring) and lower urinary tract dysfunction, to test the hypothesis that bladders with high storage and voiding pressures may be the cause of renal damage in these patients. PATIENTS AND METHODS: The clinical records and urodynamic studies of 52 children (46 girls and six boys, mean age 6.6 years) with febrile urinary infections, no evidence of reflux and photopenic areas on renal scintigraphy were evaluated retrospectively. Each child was evaluated by urinary ultrasonography, a voiding cystogram, 99mTc-dimercaptosuccinic acid (DMSA) scan and urodynamic studies. The storage phase of the urodynamic study was divided into two equal segments to consider the filling variables of each. During the emptying phase, voiding pressures and voiding pressures with reference to peak detrusor contraction were evaluated. RESULTS: Despite no child having reflux, the DMSA scans showed bilateral renal scarring in 39 (75%) and unilateral scarring in the remaining children. Forty-eight (93%) children had abnormal urodynamic values: high filling pressures (34), high-pressure uninhibited contractions (32), high voiding pressures (31) and discoordinated voiding (28). The cystometric bladder capacity was lower than the expected bladder capacity (- 75 mL) in 82% of the patients; in only four patients were the urodynamics considered normal. CONCLUSIONS: Most children with renal scarring and no reflux had lower urinary tract dysfunction. Common findings include high storage and voiding pressures, and discoordinated voiding. These findings suggest that abnormal bladder dynamics play a role in the development of renal scars that occur in the absence of reflux.