Continuous aqueous phase reforming of a synthetic brewery wastewater with Pt/C and PtRe/C catalysts for biohydrogen production.

This work investigates H2 production through aqueous phase reforming (APR) of synthetic brewery wastewater in a continuous fixed bed reactor with Pt and PtRe (3 wt %) catalysts supported on activated carbon. The influence of weight hourly space velocity (WHSV) and superficial Ar gas flow velocity (VAr) was assessed for the sake of optimisation, while reaction temperature and pressure were maintained at 225 °C and 28 bar, respectively. H2 production was found to be higher using the PtRe catalyst at the lowest WHSV (0.03 h-1) and highest VAr (0.8 cm s-1). The comparison of the maximum H2 production obtained in this work (27.9 µmol min-1) with other treatment processes shows the potential of the application of APR process for H2 production from brewery wastewater. Despite the different reaction conditions tested, the catalysts showed deactivation with time on stream, which was related to the formation of solid deposits on the surface of the catalysts. Therefore, future research should be related to the development of more stable catalysts, strategies that avoid deactivation by coking and regeneration processes.

Espina de pescado alojada en la glándula tiroides / Fishbone lodged in the thyroid gland

Los cuerpos extraños alojados en la vía aéreodigestiva superior son un motivo de consulta frecuente para el otorrinolaringólogo. Uno de los más frecuentes son las espinas de pescado. En raras ocasiones, éstas migran hacia tejidos adyacentes y generan complicaciones importantes. Presentamos el caso de una paciente que tras la ingesta de pescado manifiesta sensación de cuerpo extraño faríngeo, odinofagia y dolor látero cervical derecho. Dada la ausencia de hallazgos a la exploración física y laringoscópica se realiza una tomografia computarizada cervical, visualizando un cuerpo extraño alojado en la glándula tiroidea. Se interviene mediante cervicotomía media, realizando la extracción de la espina sin complicaciones. El diagnóstico precoz y manejo adecuado es determinante para prevenir complicaciones en estos casos.

Foreign bodies in the aerodigestive tract are commonly confronted in otolaryngology practice. The most frequent are the fish bones. In rare cases they can move and cause numerous complications. We report the case of a patient that manifest the sensation of pharyngeal foreign body, after fish ingestion. She also referred odynophagia and right cervical pain. Physical and laryngoscopic examination were normal. A cervical CT was performed, where a foreign body lodged in the thyroid gland was visualized, median cervicotomy was done and the foreign body was extracted. Early diagnosis and adequate management are crucial to prevent complications in these cases.

GC-MS Metabolite Profile and Identification of Unusual Homologous Cannabinoids in High Potency Cannabis sativa.

Phytochemical investigation of the lipids extracted from seeds of Cannabis sativa by GC-MS showed 43 cannabinoids, 16 of which are new. The extract is dominated by Δ9-tetrahydrocannabinolic acid (A) and its neutral derivative trans-Δ9-tetrahydrocannabinol-C5 (THC) Cis and trans-Δ9-tetrahydrocannabinol-C7 isomers with an ethyl-pentyl branched chain together with minor amounts of trans-Δ9-tetrahydrocannabinol with a methyl-pentyl C6 branched side chain were identified as new natural compounds. Four cannabichromene isomers with a C5 side chain are postulated to be derived from the double bond migration at the terminal isoprenyl unit. C7 cannabichromene together with the neutral and acidic forms of cannabinol-C7 were also detected. The mass spectrum of these homologues as trimethylsilyl (TMS) derivatives are presented, and the fragmentation patterns are discussed.

Role of major resection in pulmonary metastasectomy for colorectal cancer in the Spanish prospective multicenter study (GECMP-CCR).

BACKGROUND: Patients with pulmonary metastases from colorectal cancer (CRC) may benefit from aggressive surgical therapy. The objective of this study was to determine the role of major anatomic resection for pulmonary metastasectomy to improve survival when compared with limited pulmonary resection. PATIENTS AND METHODS: Data of 522 patients (64.2% men, mean age 64.5 years) who underwent pulmonary resections with curative intent for CRC metastases over a 2-year period were reviewed. All patients were followed for a minimum of 3 years. Disease-specific survival (DSS) and disease-free survival (DFS) were assessed with the Kaplan-Meier method. Factors associated with DSS and DFS were analyzed using a Cox proportional hazards regression model. RESULTS: A total of 394 (75.6%) patients underwent wedge resection, 19 (3.6%) anatomic segmentectomy, 5 (0.9%) lesser resections not described, 100 (19.3%) lobectomy, and 4 (0.8%) pneumonectomy. Accordingly, 104 (19.9%) patients were treated with major anatomic resection and 418 (80.1%) with lesser resection. Operations were carried out with video-assisted thoracoscopic surgery (VATS) in 93 patients. The overall DSS and DFS were 55 and 28.3 months, respectively. Significant differences in DSS and DFS in favor of major resection versus lesser resection (DSS median not reached versus 52.2 months, P = 0.03; DFS median not reached versus 23.9 months, P < 0.001) were found. In the multivariate analysis, major resection appeared to be a protective factor in DSS [hazard ratio (HR) 0.6, 95% confidence interval (CI) 0.41-0.96, P = 0.031] and DFS (HR 0.5, 95% CI 0.36-0.75, P < 0.001). The surgical approach (VATS versus open surgical resection) had no effect on outcome. CONCLUSION: Major anatomic resection with lymphadenectomy for pulmonary metastasectomy can be considered in selected CRC patient with sufficient functional reserve to improve the DSS and DFS. Further prospective randomized studies are needed to confirm the present results.

Álbum clínico de dermatología de Jerónimo Pérez Ortiz (1886) / Jerónimo Pérez Ortiz's 1886 Album of Clinical Dermatology

No disponible

Comparison of two HIV testing strategies in primary care centres: indicator-condition-guided testing vs. testing of those with non-indicator conditions.

OBJECTIVES: The aim of the study was to compare prospectively indicator-condition (IC)-guided testing versus testing of those with non-indicator conditions (NICs) in four primary care centres (PCCs) in Barcelona, Spain. METHODS: From October 2009 to February 2011, patients aged from 18 to 65 years old who attended a PCC for a new herpes zoster infection, seborrhoeic eczema, mononucleosis syndrome or leucopenia/thrombopenia were included in the IC group, and one in every 10 randomly selected patients consulting for other reasons were included in the NIC group. A proportion of patients in each group were offered an HIV test; those who agreed to be tested were given a rapid finger-stick HIV test (€6 per test). Epidemiological and clinical data were collected and analysed. RESULTS: During the study period, 775 patients attended with one of the four selected ICs, while 66,043 patients presented with an NIC. HIV screening was offered to 89 patients with ICs (offer rate 11.5%), of whom 85 agreed to and completed testing (94.4 and 100% acceptance and completion rates, respectively). In the NIC group, an HIV test was offered to 344 persons (offer rate 5.2%), of whom 313 accepted (90.9%) and 304 completed (97.1%) testing. HIV tests were positive in four persons [prevalence 4.7%; 95% confidence interval (CI) 1.3-11.6%] in the IC group and in one person in the NIC group (prevalence 0.3%; 95% CI 0.01-1.82%; P < 0.009). If every eligible person had taken an HIV test, we would have spent €4650 in the IC group and €396,258 in the NIC group, and an estimated 36 (95% CI 25-49) and 198 persons (95% CI 171-227), respectively, would have been diagnosed with HIV infection. The estimated cost per new HIV diagnosis would have been €129 (95% CI €107-153) in the IC group and €2001 (95% CI €1913-2088) in the NIC group. CONCLUSIONS: Although the number of patients included in the study was small and the results should be treated with caution, IC-guided HIV testing, based on four selected ICs, in PCCs seems to be a more feasible and less expensive strategy to improve diagnosis of HIV infection in Spain than a nontargeted HIV testing strategy.

Comparison of cartilage histopathology assessment systems on human knee joints at all stages of osteoarthritis development.

OBJECTIVE: To compare the MANKIN and OARSI cartilage histopathology assessment systems using human articular cartilage from a large number of donors across the adult age spectrum representing all levels of cartilage degradation. DESIGN: Human knees (n=125 from 65 donors; age range 23-92) were obtained from tissue banks. All cartilage surfaces were macroscopically graded. Osteochondral slabs representing the entire central regions of both femoral condyles, tibial plateaus, and the patella were processed for histology and Safranin O - Fast Green staining. Slides representing normal, aged, and osteoarthritis (OA) tissue were scanned and electronic images were scored online by five observers. Statistical analysis was performed for inter- and intra-observer variability, reproducibility and reliability. RESULTS: The inter-observer variability among five observers for the MANKIN system showed a similar good Intra-class correlation coefficient (ICC>0.81) as for the OARSI system (ICC>0.78). Repeat scoring by three of the five readers showed very good agreement (ICC>0.94). Both systems showed a high reproducibility among four of the five readers as indicated by the Spearman's rho value. For the MANKIN system, the surface represented by lesion depth was the parameter where all readers showed an excellent agreement. Other parameters such as cellularity, Safranin O staining intensity and tidemark had greater inter-reader disagreement. CONCLUSION: Both scoring systems were reliable but appeared too complex and time consuming for assessment of lesion severity, the major parameter determined in standardized scoring systems. To rapidly and reproducibly assess severity of cartilage degradation, we propose to develop a simplified system for lesion volume.

Osteosarcomas de la región de cabeza y cuello / Osteosarcoma of the head and neck area: analysis of 12 patients

Background: Less than 10 percent of osteosarcomas are located the head and neck region, mainly affecting the mandible and maxillary region. Aim: To analyze the therapeutic modality, types of reconstruction, surgical complications and survival of patients treated for osteosarcoma of the head and neck. Material and Methods: Review of medical records of 12 patients aged 17 to 34 years (6 women) treated for osteosarcoma of the head and neck between September 1998 and may 2009. Results: The localization of the tumor was maxillary in eight, mandibular three and ethmoidal in one patient. According to histologic grade, seven tumors were grade 1, four were grade 2 and one was grade 3. Adjuvant and neoadjuvant chemotherapy were administered to all and seven patients, respectively. The surgical treatment for maxillary tumors was maxillectomy. A reconstruction with rectum abdomini free flap was done in four patients and with dermoepidermic graft and an obturator prosthesis in three. In one patient, the defect was covered with a dental prosthesis. Treatment for mandibular tumors was mandibular excision. A reconstruction with peroneal free flap was performed in two patients and with an iliac crest graft in one. The ethmoidal tumor was resected and covered with local flaps. There were four complications. Two patients had a cutaneous fistula, one patient had a free flap partial atrophy and one patient had surgical site infection. Two patients who had positive margins died from local recurrence. Of the 10 patients with negative margins, seven are alive without recurrence, one died due to the disease, one has disseminated disease and one died from another cause. Conclusions: Our results in the treatment of head and neck osteosarcomas are consistent with published data.

Objetivos: Analizar la modalidad terapéutica, tipos de reconstrucción, complicaciones quirúrgicas y sobrevida de un grupo de pacientes tratados por esta patología. Métodos: Revisión de fichas clínicas de 12 pacientes portadores de osteosarcoma de cabeza y cuello entre septiembre de 1998 y mayo de 2009. Resultados: Edad promedio 30 años (17-34), 6 mujeres y 6 hombres. Localización fue 8 maxilar, 3 mandibular y 1 etmoidales. 7 tumores G1, 4 G2 y 1 G3. Siete pacientes recibieron quimioterapia neoadyuvante y todos adyuvante. El tratamiento de tumores maxilares fueron maxilectomías reconstruidas 4 con colgajo libre de recto abdominal, 3 con injerto dermoepidérmico más prótesis obturadora y una con prótesis dentaria. Se realizó mandibulectomía a los tumores mandibulares, 2 reconstruidos con colgajo libre de peroné y uno con injerto de cresta ilíaca. El tratamiento del tumor etmoidal fue resección craneofacial y se reparó con colgajos locales. Hubo 4 complicaciones; 2 fístulas cutáneas, una atrofia parcial de colgajo libre y una infección de herida operatoria. Dos pacientes tuvieron bordes comprometidos, quienes murieron por recidiva local. De los 10 pacientes con bordes libres, 7 se encuentran sin evidencia de recidiva, uno con enfermedad diseminada, uno fallecido por la enfermedad y uno fallecido por otra causa. Conclusiones: Nuestros resultados son consistentes con la literatura.

La enuresis. Una manifestación de la regresión en la infancia / Euneresis. A manifestation of regression in infancy

Este artículo refleja el trabajo de un grupo de estudio sobre la relación entre enuresis y regresión. Se considera a la enuresis como síntoma privilegiado que expresa la regresión o el estancamiento en el desarrollo psicosexual del niño y surge la cuestión de cuándo la enuresis puede ser entendida como síntoma de un conflicto y cuándo como un trastorno. Tres viñetas clínicas ilustran tres posibles interpretaciones, no excluyentes, de este síntoma: expresión de hostilidad hacia las figuras parentales, emergente de un conflicto en la relación con los padres y manifestación regresiva (AU)

This article reflects the work of a study group concerning the relationship between enuresis and regression. Enuresis is considered as a privileged symptom which expresses the regression or the stagnation in the sexual development of the individual and the question arises as to what extent enuresis can be understood as conflict or as a disorder. Three clinical vignettes illustrate three possible interpretations not naturally excluded in this symptoms: expression of hostility towards parents, conflict with the relationship with parents and regressive manifestation (AU)

Contractura axilar por quemadura tratada con Integra® / Axillary burn contracture treated with Integra®

Introduction: Severe axillary burn is an unusual accident that frequently evolves to contracture generating important cosmetic and functional deficiencies. Contracture scars in this region are difficult to treat because of the anatomic characteristics of the area that has multiple power vectors. Functional restoration has to be one of the main goals in the management of burns in the axilla and flaps have shown high rate of morbidity. Integra® provides satisfactory elasticity and dermal resistance which results in positive functional results. Objective: Analyze the results of the use of Integra® in axillary burn contracture scars at a specialized Burns Center. Materials and Methods: There were 4 patients who underwent reconstructive surgery using Integra® for axillary burn contractures between January 2002 and March 2006. Follow-up was divided into perioperative and late. Early follow-up checked general post-operative evolution and late follow-up was focused on functionality and patient independence evaluated using Barthel's index of daily living activities. Results: There were 3 males and 1 female, average age 27 (18-41) with a minimum follow up of 9 months. There were no perioperative complications and good or very good range of motion results. Conclusions: Our results are similar to artificial skin substitutes used in other anatomical regions.

Las quemaduras axilares severas son un accidente infrecuente que evolucionan a la retracción generando deficiencias cosméticas y funcionales. Estas cicatrices son difíciles de tratar por las características anatómicas del área, donde la corrección de un vector de movimiento puede alterar otro. Objetivo: Mostrar nuestros resultados utilizando el sustituto cutáneo Integra® en el tratamiento de cicatrices retráctiles axilares por quemadura. Pacientes y Métodos: Se recolectaron antecedentes médicos y fotográficos de pacientes portadores de cicatrices retráctiles axilares por quemadura entre enero de 2002 y marzo de 2006 en el Hospital del Trabajador de Santiago. Se evaluó pre y postoperatoriamente a los pacientes en forma subjetiva por fisiatra y con el Test de Barthel. Resultados: Se incluyeron 4 pacientes en el estudio (3 mujeres y 1 hombre), edad media 27 años (18-41). Todas las quemaduras fueron producidas por fuego. Índice de Barthel preoperatorio fue de 87,5 (levemente dependiente para las actividades de la vida diaria) y rango de movimiento moderadamente afectado. En el postoperatorio los pacientes fueron catalogados como independientes según el Test de Barthel y el rango de movimiento fue descrito como bueno o muy bueno por el fisiatra. No hubo complicaciones peri operatorias, Integra® prendió adecuadamente en todos los casos. Los pacientes fueron seguidos en promedio 16 meses (9-22). Conclusiones: Los sustitutos dérmicos han sido usados para la corrección de cicatrices de quemaduras con buenos resultados, pero no hay reportes en la axila. El pequeño número de pacientes que presentamos tienen un excelente resultado funcional, lo que nos estimula a seguir trabajando en este rumbo.

Total hip replacement in Gaucher's disease: effects of enzyme replacement therapy.

Total hip replacement in patients with Gaucher's disease with symptomatic osteonecrosis of the femoral head is controversial because of the high early failure rates. We describe four patients who had an uncemented total hip replacement following enzyme replacement therapy for a median of two years and one month (1 to 9.8 years) prior to surgery, and who remained on treatment. At operation, the bone had a normal appearance and consistency. Histopathological examination showed that, compared with previous biopsies of untreated Gaucher's disease, the Gaucher cell infiltrate had decreased progressively with therapy, being replaced by normal adipose tissue. The surfaces of viable bone beyond the osteonecrotic areas showed osteoblasts, indicating remodelling. In one case acetabular revision was carried out after 11 years and eight months. The three remaining patients had a mean follow-up of six years and four months (3.3 to 12 years). We recommend initiating enzyme replacement therapy at least one to two years prior to total hip replacement to facilitate bone remodelling and to allow implantation of uncemented components in these young patients.

Tracheal chondrosarcoma--a rare complication in Maffucci syndrome.

Maffucci syndrome is a rare congenital non-hereditary disease characterised by subcutaneous haemangiomata and multiple enchondromata. We present a case of an intermediate grade myxoid chondrosarcoma of the tracheal cartilage in a 34-year-old man with a history of Maffucci syndrome. Chondrosarcoma of the trachea are extremely rare tumours. A review of the radiological literature reveals approximately 15 previously published cases. No case was found with a history of Maffucci syndrome.

Colgajo miocutáneo de gastrocnemius medial con isla triangular de piel y cierre en V-Y / Gastrocnemius muscle myocutaneous flap with a triangular skin isle and V-Y closure: report of five patients

A gastrocnemius muscle myocutaneous flap with a triangular skin isle and V-Y closure can be used to correct cutaneous defects with exposure of the proximal part of the tibia. The advantages of this technique are an excellent irrigation and the cutaneous closure using a flap in a zone that is exposed to multiple trauma. The presence of a arteriovenous perforating vessel previously located with color Doppler, ensures the vitality of the flap. We report five males patients aged 20 to 70 years, in whom this technique as used to correct traumatic defects of a mean diameter of 11 cm. All flaps remained viable.

Para corregir defectos cutáneos con exposición de fractura de tibia a nivel del tercio proximal, una buena alternativa es el colgajo miocutáneo de gastrocnemius medial con isla triangular de piel con cierre en V-Y. Las ventajas estriban en la excelente irrigación del colgajo, y en proporcionar un cierre cutáneo con colgajo, en una zona expuesta a múltiples traumatismos. El hecho de tener una perforante arterio venosa previamente ubicada con doppler color, asegura la vitalidad del colgajo. Se presenta la experiencia del Servicio de Cirugía Plástica del Hospital del Trabajador de Santiago consistente en 5 pacientes masculinos en los que se realiza un colgajo de perforante de gastrocnemius medial, con edad entre 20 y 70 años. La etiología del defecto fue traumática. El defecto a corregir fue en promedio de 11 cms de diámetro. Todos los colgajos fueron viables. Se destaca que este es un colgajo inédito, descrito por primera vez por el autor principal en el año 2006.

El legado de José Eugenio Olavide en los Estados Unidos / The Legacy of José Eugenio Olavide in the United States

No disponible

No disponible