LGBTQ+ Identity and Ophthalmologist Burnout.

PURPOSE: To evaluate lesbian, gay, bisexual, transgender, questioning, and other sexual/gender minority (LGBTQ+) orientation as a burnout risk factor among an international ophthalmologist cohort. METHODS: An anonymous, cross-sectional electronic survey was distributed via an Internet platform to characterize the relationship among demographic factors, including LGBTQ+ orientation, and burnout as measured by the Copenhagen Burnout Inventory (CBI). Univariable data analysis (linear) by sexual orientation was performed and variables with an association with a P value of <0.15 in univariable analysis were included in the multiple linear regression modeling. RESULTS: A total of 403 ophthalmologists participated in the survey. The majority self-identified as "White" (69.2%), were from North America (72.0% United States, 18.6% Canada) and were evenly distributed between age of 30 and 65 years. Overall, 13.2% of participants identified as LGBTQ+ and 98.2% as cisgender. Approximately 12% had witnessed or experienced LGBTQ+-related workplace discrimination or harassment. The personal and work-related burnout scores and confidence limits of persons identified as LGBTQ+ were higher and nonoverlapping compared with those reported as non-LGBTQ+. Multivariable analysis identified significant risk factors for higher personal and work-related burnout scores: LGBTQ+ (11.8 and 11.1, P = .0005 and .0023), female gender (5.36 and 4.83, P = .0153 and .0434), older age (19.1 and 19.2, P = .0173 and .0273). and caretaker stress (6.42 and 5.97, P = .0085 and .0239). CONCLUSIONS: LGBTQ+ orientation is a burnout risk factor among ophthalmologists, and LGBTQ+ workplace discrimination may be a contributing factor. Support from ophthalmology organizations to address LGBTQ+-, gender-, and age-related workplace discrimination may decrease burnout. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

Infección por bartonella henselae en pacientes pediátricos. Lesión pseudotumoral de calota. Reporte de caso

Los tumores de calota en pacientes pediátricos poseen múltiples etiologías. Dentro de las causas pseudotumorales, las infecciones juegan un rol importante, siendo la osteomielitis por Bartonella henselae (Enfermedad por Arañazo de Gato) una posibilidad diagnóstica rara, pero que debe ser estudiada y descartada. Se presenta el caso de una lactante de 1 año, con lesión expansiva de calota, a nivel frontal derecho, hipervascularizada e infiltrativa. Se realizó estudio con ultrasonido, tomografía cerebral y cintigrama óseo. Se realizó resección quirúrgica completa de la lesión, con preservación de la duramadre y zona fontanelar, además de un cuidadoso trato con el seno sagital superior. Evolucionó sin complicaciones perioperatorias. El resultado de la biopsia fue compatible con proceso inflamatorio crónico, osteomielitis supurada. Tinción de Warthin Starry positiva sugerente de Bartonella henselae. Se descartó etiología tuberculosa y fúngica. Serología positiva para Bartonella henselae. La paciente completó antibioticoterapia, azitromicina y cotrimoxazol, con evolución clínica favorable.

Calvarial tumors in pediatric patients have multiple etiologies. Among the pseudotumoral causes, infections play an important role, being Bartonella henselae osteomyelitis (Cat Scratch Disease) a rare diagnostic possibility, but it should be studied and ruled out. We present the case of a 1 year old infant, with an expansive lesion of the calvaria, at right frontal level, hypervascularized and infiltrative. Ultrasound, brain tomography and bone scintigram were performed. Complete surgical resection of the lesion was performed, with preservation of the dura mater and fontanel area, in addition to a careful treatment with the superior sagittal sinus. The patient evolved without perioperative complications. The biopsy result was compatible with a chronic inflammatory process, suppurative osteomyelitis. Positive Warthin Starry stain suggestive of Bartonella henselae. Tuberculous and fungal etiology was ruled out. Positive serology for Bartonella henselae. The patient completed antibiotic therapy, azithromycin and cotrimoxazole, with favorable clinical evolution.

A Triplet Label Extends Two-Dimensional Infrared Spectroscopy from Pico- to Microseconds.

In conventional two-dimensional infrared (2D-IR) spectroscopy, the inherently short vibrational lifetimes limit the time window to observe molecular dynamics typically to tens of picoseconds. The rather complex dynamics of organized molecular systems (e.g., glass formers, polymers, membranes, proteins), however, span a wide range of timescales from femto- to microseconds and beyond. Vibrationally Promoted Electronic Resonance (VIPER) 2D-IR negates the limitations of 2D-IR spectroscopy, for its signal decays with the electronic lifetime. Here, we present 2-Isopropylthioxanthone as the first VIPER 2D-IR probe to exploit intersystem crossing, thereby covering even the microsecond timescale. We achieved the required signal-to-noise ratio and resolution by introducing the Fourier-transform approach to the VIPER 2D-IR pulse sequence. Now, we are in a position to monitor dynamics via spectral diffusion several orders of magnitude beyond the vibrational lifetime of 2D-IR labels.

Cerebral phaeohyphomycosis caused by Alternaria spp.: A case report.

Phaeohyphomycosis is a group of infections caused by pigmented, black, dematiaceous fungi and is responsible for cutaneous, superficial and deep mycoses, disseminated infection and brain abscesses. The primary agents involved include Alternaria spp., Exophiala spp. and Cladophialophora spp. Invasive systemic presentation is rare and in most cases is associated with immunosuppression; for this reason, reported cases of Alternaria spp. infection are scarce. This report describes the case of a 66-year-old man with a history of renal transplantation from a cadaveric donor 1 year ago, which was considered as the primary risk factor. The characteristics of the infection, procedures performed, microbiological findings and treatment provided are described.

Tratamiento de la estenosis traqueobronquial con prótesis: factores de buena respuesta / Treatment of tracheobronchial stenosis with stents: good response factors

OBJETIVO: Determinar predictores de buena respuesta con el uso de prótesis en la estenosis traqueobronquial. MATERIALES Y MÉTODO: Estudio retrospectivo descriptivo de una serie de casos entre junio de 2014 y junio de 2016. Se revisaron registros clínicos, protocolos operatorios, estudios histopatológicos y de imagen. Se consignaron antecedentes demográficos y clínicos al ingreso y luego del procedimiento, etiología de la estenosis traqueal, necesidad de oxígeno en litros, estadía hospitalaria, morbilidad asociada al procedimiento, indicación de terapia complementaria posterior y sobrevida. Se analizaron los datos con estadística descriptiva y analítica. RESULTADOS: Se realizaron 68 procedimientos, en 44 pacientes, 24 mujeres, el diagnóstico principal fue estenosis traqueal con 40 casos. La etiología neoplásica fue el 88% de los casos. El Performance status (PS) de ingreso fue mayor o igual a 2 en el 68% y posterior al procedimiento disminuyó a 22% p < 0,05. En 36 casos los pacientes requerían al menos 1 L de oxígeno lo que disminuyó en 13 casos posterior a la intervención p < 0,05. El tiempo de hospitalización promedio fue 6,2 días (1-60). En 13 pacientes con patología neoplásica se indicó terapia paliativa complementaria. La morbilidad asociada al procedimiento fue de 2,9% dado por prótesis desplazada y lesión iatrogénica. La sobrevida fue de 27% a un año. CONCLUSIONES: La etiología benigna, el PS previo a la intervención menor o igual a 3, requerimiento de oxígeno de 1 litro y obstrucción tumoral menor al 70% del lumen fueron elementos de buena respuesta.

AIM: Determine good response predictors in use of stent in benign and malignant tracheobronchial stenosis. MATERIAL AND METHODS: We retrospectively reviewed medical records of patients submitted to the procedure in the period 2014 to 2016. Clinical records, operative protocols, and histopathological and imaging studies were reviewed. Demographic and clinical data, performance status (PS) at admission and after the procedure, etiology of tracheal stenosis, need for oxygen in liters (L) Post-intervention, hospital stay, procedure-related morbidity, indication of therapy (Chemotherapy and/or Radiotherapy) and survival. Data were analyzed with descriptive and analytics statistics. RESULTS: A total of 68 procedures were performed in 44 patients, 24 women. Tracheal stenosis 40 cases were diagnosed. The malignant etiology was 88%. The admission PS was greater than or equal to 2 in 68% and 22% after the procedure. The oxygen requirements prior to the procedure were at least 1 L in 36 cases and decreased in 13 cases after the procedure. The average hospitalization period was 6.2 days (1-60). Complementary therapy was indicated in 13 patients; the morbidity associated with the procedure was 2.9%, displaced installation and iatrogenic injury. The one year survival was 27%. CONCLUSIONS: Benign etiology, el PS minor than or equal to 3, oxygen requirements prior to the procedure of 1 L and tumoral obstruction less than 75% were good response predictors in our study.

Linfoma anaplásico de columna cervical: doble reto diagnóstico para el otorrinolaringólogo / Cervical spine anaplastic lymphoma: double diagnostic challenge for the otorhinolaryngologist

RESUMEN Las metástasis de la columna vertebral cervical no se ven comúnmente en el área otorrinolaringológica, y por lo tanto corren el riesgo de pasar por alto durante la evaluación del paciente. Presentamos un caso inusual evaluado debido a las metástasis de la columna cervical de un tumor primario desconocido. Después de extensos procedimientos de estudio que no eran diagnósticos, se obtuvo una biopsia mediante un abordaje cervical extendido. El paciente fue diagnosticado con un linfoma anaplásico, una enfermedad muy rara en la región de cabeza y cuello. Discutimos los hallazgos histológicos y la presentación clínica de esta condición.

ABSTRACT Cervical spine metastases are not commonly seen in the otolaryngology clinic and therefore run the risk of being overlooked during patient evaluation. We report an unusual case evaluated due to cervical spine metastases from an unknown primary tumor. After extensive workup procedures that were non-diagnostic, a biopsy was obtained through an extended cervical approach. The patient was diagnosed with an anaplastic lymphoma, a very rare disease in the head and neck region. We discuss the histologic findings and clinical presentation of this condition.

Presentación de un caso clínico de mucopolisacaridosis Tipo IV, síndrome de Morquio / Presentation of a clinical case of mucopolysaccharidosis type IV, Morquio syndrome

Se presenta el caso de un paciente de 16 años de edad, con el diagnostico de mucopolisacaridosis (MPS) tipo IV-A, con una breve revisión teórica del curso y progresión crónica de esta enfermedad multi-sistémica, que se manifiesta con amplia signo sintomatología, hallazgos de laboratorio y anomalías radiológicas. El objetivo es documentar el caso y difundir a la comunidad médica boliviana, la importancia de los errores innatos del metabolismo, consideradas enfermedades "raras", que a criterio nuestro, sufren un sub-diagnóstico debido a las pocas publicaciones científicas sobre el tema en el medio.

We report the case of a patient 16 years old with a diagnosis of mucopolysaccharidosis (MPS) type IV- A, with a brief theoretical review of chronic course and progression of this multisystem disease, which manifests with extensive signs symptoms, findings are presented, with laboratory and radiological reported abnormalities. The aim is to document the event and communicated to Bolivian medical community, the importance of inborn errors of metabolism, considered "rare" diseases, which in our opinion; suffer a sub- diagnosis because of the few Bolivian scientific publications on the topic.

Percepción del nivel cognoscitivo sobre manejo postural continuo en cuidadores de pacientes en silla de ruedas / Perception of cognition level about continuous postural management in caregivers of patients in wheelchairs

Introducción: Los pacientes con alteraciones neurológicas severas dependen del cuidado de terceros, muchas veces son las familias quienes asumen este rol, pero se desconoce cuánto logran integrar del manejo postural continuo. Objetivo: Determinar la percepción del nivel cognoscitivo de los cuidadores, en relación al manejo postural continuo, de pacientes en silla de ruedas, que asisten al Instituto Teletón Concepción, durante el año 2011. Pacientes y Métodos: Se realizó un estudio cualitativo fenomenológico con muestra de casos tipos en 8 cuidadores, que permitió profundizar en las experiencias individuales de estos, a través de entrevistas semi-estructuradas. Se realizó análisis semántico estructural sobre el discurso de los cuidadores. Resultados: Se estableció los códigos principales bajo los cuales los cuidadores comprenden el manejo postural continuo, el cual se entendió por el concepto de alineación corporal, la condición muscular del paciente y las expectativas de rehabilitación. Hay un mayor reconocimiento de los padres a la información entregada por sus pares, dándole mayor valor emocional. Las experiencias particulares de cada cuidador pueden ser una fuente positiva de refuerzo del programa de manejo postural continuo. Conclusiones: Los cuidadores refieren poseer amplios conocimientos del manejo postural continuo, pero no son capaces de detallar los aspectos básicos del mismo, evidenciando una falta de integración del conocimiento en esta área.

Introduction: Patients with severe neurological disorders depend on a third party for their care. Usually it is within their own families, that someone takes over that role, however, it is unknown to what extent they are able to integrate “continuous postural management”. Objective: To determine caregivers’ cognitive perception level with regards to “continuous postural management”, of patients who use wheelchairs and who attended Teletón Institute at Concepción, Chile, during the year 2011. Patients and Method: A phenomenological qualitative research using type cases samples in 8 caregivers was carried out. This made possible to go in depth with their individual experiences by conducting semi-structured interviews. A structural semantic analysis about the caregivers’ speech was done. Outcomes: Main codes under which caregivers understand “continuous postural management” were established. This was understood as the concept of body or corporal alignment, patients’ muscular condition and rehabilitation expectancies. There is greater acknowledgment from parents regarding information provided by their peers, which adds greater emotional value. Therefore, each caregiver’s individual experience may become a constructive strengthening source for the “continuous postural management” program. Conclusions: Caregivers reported having broad knowledge regarding “continuous posture management”, however they were unable to provide details about its basic characteristics, thus showing lack of knowledge integration in this area.

Experiencia de diez años en resecciones hepáticas / Ten years experience in hepatic resections

Revisamos experiencia reciente y resultados obtenidos con resecciones hepáticas mayores en pacientes referidos a nuestra institución. Revisión retrospectiva de historias clínicas de pacientes entre agosto de 1998 y agosto de 2008, con el objetivo de precisar el tipo de cirugía efectuada, indicaciones principales, complicaciones y morbimortalidad operatoria. 22 pacientes cuyas historias estuvieron disponibles para revisión. La principal indicación de cirugía fueron neoplasias malignas 86,4% de los casos, las metástasis de carcinoma colorrectal (7) la primera indicación seguida de hepatocarcinoma (4). Otras indicaciones incluyeron: colangiocarcinomas perifericos (2), metástasis de tumores neuroendocrinos (2), diversas lesiones benignas (3) otros tumores (4). La hepatectomía derecha y segmentectomías anatómicas fueron los más frecuentes con un 27,3 % cada uno, seguidos de segmentectomía lateral izquierda (II y III) en 19%. El tiempo operatorio promedio fue 270,4 min (rango: 180-560 min). El promedio de estancia hospitalaria fue 7,7 días (rango:4-30). El 8% de nuestros pacientes no requirió estancia posoperatoria inmediata en UTI. La tasa de complicaciones fue 44,5% siendo el derrame pleural reactivo y el sangrado posoperatorio más frecuentes. La tasa de reintervención fue 18,2%. La mortalidad global fue 9% (2/22), y la inherente al procedimiento quirúrgico 4,5% (1/22). Las resecciones hepáticas mayores son un procedimiento relevante en el armamento del cirujano oncólogo dedicado al tratamiento de neoplasias digestivas, la morbimortalidad operatoria en nuestra institución es similar a otros centros de mayor volumen a nivel internacional.

Review the recent experience and results of major hepatic resections of patients treated at our institution. Retrospective review of clinical records patients submitted to major hepatic resection inten years, between August 1998 to August 2008, with descriptive statistics of type of surgery, indications, complications and surgical related morbimortality. Twenty two patients with complete clinical records for review were included. The main indication for surgery were malignant neoplasms in 86,4% of the cases,being colorectal liver metastasis (7) the first one followed by hepatocarcinomas (4). Other indications included:The periferic colanghiocarcinomas (2), metastasis from neuroendocrine tumors (2), varied beningn lesions (3)and other tumors (4). Right hepatectomy and anatomical segmentectomies were the most frequent procedures 27.3% each, followed by left lateral segmentectomy (II - III) in19% of the cases. Medium operative time was 270.4 min (range: 180-560 min). Mean hospital stay was 7.7 days (range: 4-30). 8% of the patients did not required post operative ICU care. Complications rate was 44.5% being reactive pleural effusion and postoperative bleedingthe most frecuent ones. Reintervention rate was 18.2%, global mortality 9% (2/22), and surgical related mortality was 4.5% (1/22). Major hepatic resections are a relevant procedure in the armament of surgical oncologists dedicated to treatment of digestive neoplasms, the number of such procedures done at public institutions are limited. Operative morbimortality in our institution is similar to other major volume centers.

Uso de bloqueo paravertebral torácico bilateral en cirugía cardiaca para extubación postoperatoria inmediata: serie de casos clínicos / Use of paravertebral block thoracic bilateral in cardiac surgery to extubation Immediate postoperative: clinical case series

El desarrollo de protocolos de extubación precoz en cirugía cardiaca se basa en el uso de técnicas anestésicas que persiguen el objetivo de tener un paciente con un estado de vigilia adecuado y una vía aérea segura durante el período de emergencia de la anestesia. Se diseñó un estudio prospectivo y descriptivo con el objetivo de evaluar si el uso de bloqueo paravertebral torácico bilateral (BPVTB) previo a una cirugía cardiaca en adultos disminuye los requerimientos intraoperatorios (IO) de opioides, y aumentando con ello la posibilidad de extubación segura en el pabellón y, además, evaluar la calidad analgésica postoperatoria (PO). Material y Método: Los pacientes deben ser adultos sometidos a una cirugía cardiaca por esternotomía. Los criterios de exclusión fueron: cirugía larga y compleja, paro circulatorio, hipotermia profunda, insuficiencia cardiaca, hipertensión pulmonar severa, obesidad > grado II, enfermedad pulmonar severa y coagulopatía. Los pacientes seleccionados fueron sometidos a un BPVTB, y luego se indujo anestesia general no estandarizada. Tras realizar la cirugía prevista, al inicio del cierre de la piel se suspende el agente anestésico inhalatorio, se realiza prueba de ventilación espontánea y se extuba en pabellón si cumple criterios establecidos. Posteriormente se evaluó PaO2 y PaCO2(ingreso UCI), se aplicó escala visual análoga (EVA) para medir intensidad del dolor (6 h del PO) y al finalizar el primer día de PO se consignó el consumo de opioides, la incidencia de náuseas y vómitos y la necesidad de usar ventilación mecánica invasiva (VMI) o no invasiva (VMNI)...

The development of early extubation protocols in cardiac surgery are based on anesthesic techniques able to have the appropriate anesthesia depth and a secured airway during the emergence of anesthesia. A prospective study was design in adults subjected to cardiac surgery in order to evaluate the effectiveness of preoperative bilateral paravertebral thoracic block (BPVTB) in decreasing intraoperative opiods doses and allow a safe extubation in the operating room (OR) and, even more, give a good quality postoperative (PO) analgesia. Material and Methods: Patients subjected to a cardiac surgery with sternotomy. Exclusion criteria were: long and complex surgery, circulatory arrest, deep hypothermia, cardiac failure, severe pulmonary hypertension, obesity grade II or greater, severe lung disease and coagulophaty. A cohort of patients were subjected to a BPVTB, then general anesthesia was induced (no standarized technique). After cardiac surgery, at the beginning of skin suture, inhaled anesthetics were discontinued and after successful spontaneous breathing test, the patient was extubated in the operating room. PaO2 y PaCO2 was evaluated at the arrival to the ICU. Visual analogue scale (VAS) was applied every 6 hours to measure pain level. At the end of the first day opiod dose, PONV and ventilation support (invasive and noinvasive) was registered...(AU)

Autotrasplante cardiaco en el tratamiento quirúrgico de tumores cardiacos primarios: Caso clínico / Heart autotrasplantation for the treatment of a rhabdomyosarcoma of the left ventricle: Report of one case

Background: Heart autotrasplantation is an exceptional surgical technique used in the treatment of uncontrolled cardiac arrhythmias and primary unresectable cardiac tumors. We report a 28-year-old male with a rhabdomyosarcoma of the left ventricle, localized in the lateral and posterior wall, which involved the mitral valve and circumflex artery. After a complete study ruling out dissemination of the tumor, the patient was operated. Surgical exploration determined the unresectabilility of the tumor with the heart in situ. Therefore, the heart was explanted, preserving the right atrium and coronary sinus for re-implantation. Fifty percent of the mitral valve and the circumflex artery from its origin, were resected due to tumor infiltration. The heart was reconstructed with bovine pericardium and a mechanical valve was implanted in the mitral position. Afterward, the heart was implanted again following the same sequence as in bicaval transplantation, followed by a double bypass grafting to the distal circumflex territory. The patient had no significant complications and after nine months of follow up, there was no evidence of local recurrence. In the fourth postoperative month, a subcutaneous mass in the left thigh that was considered a metastasis without histological confirmation appeared. The lesion disappeared with radio and chemotherapy.

[Nocardia nova brain abscess]. / Absceso cerebral por Nocardia nova.

Nocardia nova is an uncommon pathogen for human beings. We describe an immunocompetent patient who acquired multiple cerebral abscesses. A surgical drainage yielded a sulpha-trimethoprim susceptible N. nova strain. The patient recovered uneventfully after a prolonged treatment with sulpha-trimethoprim.

[Heart autotransplantation for the treatment of a rhabdomyosarcoma of the left ventricle. Report of one case]. / Autotrasplante cardiaco en el tratamiento quirúrgico de tumores cardiacos primarios. Caso clínico.

Heart autotransplantation is an exceptional surgical technique used in the treatment of uncontrolled cardiac arrhythmias and primary unresectable cardiac tumors. We report a 28-year-old male with a rhabdomyosarcoma of the left ventricle, localized in the lateral and posterior wall, which involved the mitral valve and circumflex artery. After a complete study ruling out dissemination of the tumor, the patient was operated. Surgical exploration determined the unresectability of the tumor with the heart in situ. Therefore, the heart was explanted, preserving the right atrium and coronary sinus for re-implantation. Fifty percent of the mitral valve and the circumflex artery from its origin, were resected due to tumor infiltration. The heart was reconstructed with bovine pericardium and a mechanical valve was implanted in the mitral position. Afterward, the heart was implanted again following the same sequence as in bicaval transplantation, followed by a double bypass grafting to the distal circumflex territory. The patient had no significant complications and after nine months of follow up, there was no evidence of local recurrence. In the fourth postoperative month, a subcutaneous mass in the left thigh that was considered a metastasis without histological confirmation appeared. The lesion disappeared with radio and chemotherapy.

[Surgical results among 100 patients with type A aortic dissection: retrospective review]. / Disección aórtica tipo A: Resultados operatorios y seguimiento a mediano plazo.

BACKGROUND: Tipe A aortic dissection involves the ascending aorta and has high mortality rates without surgical treatment. AIM: To report the results of surgical treatment of type A aortic dissection. MATERIAL AND METHODS: Retrospective review of medical records of 100 patients aged 17 to 78 years (73% males) operated between January 2000 and August 2008, for type A aortic dissection. Follow up was performed with telephone interviews and review of national death records. RESULTS: Eighty three percent of patients had an acute dissection. Operative mortality was 27 and 20% for patients with acute and chronic dissection, respectively. Mortality was 50% among patients aged 70 years or more, compared with 21% among their younger counterparts, The most common complication was bleeding that required a new surgical procedure in 18% of patients. Actuarial survival was 70% at five years. Cardiovascular problems caused the death of two of the nine patients that died during follow up. CONCLUSIONS: Surgical mortality among patients with type A aortic dissection was higher among patients with acute episodes and those aged 70 years or more.

Disección aórtica tipo A: Resultados operatorios y seguimiento a mediano plazo / Surgical results among 100 patients with type A aortic dissection: Retrospective review

Background: Tipe A aortic dissection involves the ascending aorta and has high mortality rates without surgical treatment. Aim: To report the results of surgical treatment of type A aortic dissection. Material and Methods: Retrospective review of medical records of 100 patients aged 17 to 78 years (73 percent males) operated between January 2000 and August 2008, for type A aortic dissection. Follow up was performed with telephone interviews and review of national death records. Results: Eighty three percent of patients had an acute dissection. Operative mortality was 27 and 20 percent for patients with acute and chronic dissection, respectively. Mortality was 50 percent among patients aged 70 years or more, compared with 21 percent among their younger counterparts, The most common complication was bleeding that required a new surgical procedure in 18 percent of patients. Actuarial survival was 70 percent at five years. Cardiovascular problems caused the death of two of the nine patients that died during follow up. Conclusions: Surgical mortality among patients with type A aortic dissection was higher among patients with acute episodes and those aged 70 years or more.

Prognostic value of microvascular density in dukes a and B (t1-t4, n0, m0) colorectal carcinomas.

BACKGROUND: Aproximatelly 30% of patients operated on for colorectal cancer (CRC), with an expectedly favourable prognosis (Dukes A-B/T1-T4, N0, M0) suffer recurrence and/or die. METHOD: In order to determine if tumor microvascular density (MVD) is a prognostic factor in CRC, samples from tumors of 104 Dukes A-B CRC patients were retrospectively studied. Immunohistochemistry was performed for anti-CD34 antibody to visualize tumor vascularisation. MVD was expressed as the total number of vessels and as the percentage of microvascular area. We calculated MVD with a morphometry program and performed descriptive, bivariate, and survival statistics. RESULTS: The mean number of vessels was 37.37/200x field, and the mean vascular area was the 3.972%. 30% of the patients with < 37 vessels/field, and 21% of the patients with > 37 vessels/field, experienced recurrence/death. The 35% of patients with < 4% of vascular area died following recurrence, compared with 14% of patients with > or =4% of vascular area. These differences in % of vascular area were statistically significant. CONCLUSION: MVD expressed as the total number of vessels had no a statistically significant influence on the evolution of CRC. However, neoplasias with a greater % of vascular were associated to a better outcome.

Índices parasitarios y descripción morfológica de Contracaecum sp. (nematoda: anisakidae) en blanquillo sorubim cuspicaudus (pimelodidae) del río Sinú / Parasitics index and morfological description of contracaeum sp. (nematoda: anisakidae) in transandean shovelnose catfish sorubim cuspicaudus (pimelodidae) from sinú river basin

Objetivo. Determinar la presencia de parásitos en el blanquillo Sorubim cuspicaudus. Materiales y métodos. Se utilizaron 33 peces recolectados entre abril y diciembre de 2007, posteriormente llevados al laboratorio para reconocimiento externo e interno, y disección e inspección de la cavidad visceral. Los nemátodos encontrados fueron preservados en glicerina formalada al 5%, posteriormente fueron aclarados, visualizándose las estructuras internas para la merística e identificación con base en claves morfométricas. Para la microscopía de barrido (JEOL JSM-5910LV a un voltaje de aceleración de 15 kV) los parásitos fueron transferidos a formaldehído al 4% y luego fijados en tetraóxido de osmio, deshidratados con series de etanol y cubiertos con una película de oro (6-8nm) por electrodeposición (Denton Vacuum Desk II). Resultados. Los nemátodos fueron hallados solamente en la cavidad visceral e identificados como Contracaecum sp., en estado larval III, de color blanquecino, dos labios en el extremo anterior, un diente cuticular cónico y ligeramente romo. El extremo posterior es cónico, con dos glándulas anexas, ano y mucrón; la cola post-anal larga y sin espina terminal. La prevalencia de este parásito fue del 96.9% y en todos los casos la infestación fue leve. Del total de ejemplares analizados; los machos (n=9) presentaron intensidad parasitaria de 24.88±18.70 parásitos/pez; mientras que las hembras (n=24) presentaron una intensidad parasitaria de 69.52±22.77 parásitos/pez. Conclusiones. Contracaecum sp. se encuentra en cavidad visceral de blanquillo en estado larval III.

[Acute type A aortic dissection in pregnant patient with Marfan syndrome. Report of one case]. / Disección aórtica y síndrome de Marfán en el embarazo. A propósito de un caso clínico.

Aortic dissection is a life-threatening disease that requires immediate surgical intervention. Marfan syndrome is a hereditary disease with an autosomal dominant transmission, which affects the connective tissue, with skeletal, cardiovascular and ocular involvement. It is one of the most prevalent connective tissue disorders, presenting a risk of aortic dissection of approximately 1% even without dilatation of the aorta. When dissection occurs during pregnancy and requires surgical intervention (type A dissection), maternal mortality is high (2096-30%). We report a 38 year-old woman with Marfan syndrome that had an acute type A aortic dissection and severe aortic regurgitation at 37 weeks of gestation. The patient underwent a cesarean section and delivered a healthy baby. Afterwards, aortic valve repair and ascending aortic replacement was successfully performed under circulatory arrest with deep hypothermia. Additionally mitral valve repair for degenerative disease with posterior, autologous pericardium mitral valve ring was performed.