Flower morphology evolution in Jaborosa (Solanaceae): shape and size variation associated with contrasting pollination modes.

Flower morphology is considered an important factor in species diversification because it may influence the efficiency of pollination in different ways (e.g. attraction and mechanical fit with different groups of pollinators). In the present study, we quantified the variation in flower morphology (i.e. shape and size) of the diverse South American genus Jaborosa Juss. (Solanaceae) in relation to contrasting pollination modes: rewarding pollination either by moths or by generalist small insects versus brood-site deceptive pollination by saprophilous flies. We examined variations of flower morphology in frontal (pollinator attraction) and sagittal (functional fit with pollinators) views in 12 Jaborosa species using geometric morphometric methods and comparative approaches to infer whether flower shape evolution, not attributable to flower allometry or phylogenetic relationship, is associated with shifts in pollination modes. We found remarkable variation in flower morphology among both Jaborosa species and pollination modes, largely in sagittal view. Evolutionary trends in shape of fly-pollinated flowers were mainly attributable to changes in developmental trajectories. Variation in flower architecture facilitated differential pollen placement - on the proboscis of moths, and either on the back or ventral region of saprophilous flies - promoting diversification of the genus. Diversification of shape, independent of size, in most of the studied Jaborosa species would indicate adaptation to contrasting pollination modes.

Microplastic ingestion by common terns (Sterna hirundo) and their prey during the non-breeding season.

Current evidence demonstrates the presence and persistence of microplastics in the marine food web. Seabirds are predators in marine ecosystems and are highly exposed to marine plastic debris through the food. The aim of this work was to examine the presence of microplastics in a long-distance migratory seabird, the Common tern (Sterna hirundo) (n = 10), and in their prey (n = 53) during the non-breeding season. The study was conducted in Punta Rasa, Bahía Samborombón, province of Buenos Aires, which is an important resting and feeding location for migratory seabirds and shorebirds in South America. Microplastics were found in all the birds examined. The occurrence of microplastics in the gastrointestinal tract (GIT) of Common terns (n = 82) was higher than in regurgitated prey (RP) (n = 28), which is likely reflecting trophic transfer process. Almost all microplastics found were fibers and only 3 were fragments. Microplastics were sorted by color; transparent, black and blue-colored fibers were the most abundant plastic types. Characterization of the polymer type by Fourier Transform Infrared Spectrometry (FTIR) revealed that cellulose ester plastics, polyethylene terephtalate, polyacrylonitrile and polypropylene were the most abundant types found in both the gastrointestinal tract and prey. Our results highlight the high levels of ingested microplastics in Common terns and in their prey, and reflect a concern in this important location for migratory seabirds.

The role of executive functions, social cognition and intelligence in predicting social adaptation of vulnerable populations.

This study sought to evaluate the roles of and interactions between cognitive processes that have been shown to exhibit impact from socioeconomic status (SES) and living conditions in predicting social adaptation (SA) in a population of adults living in socially vulnerable conditions. Participants included 226 people between the ages of 18 and 60 who have been living in vulnerable contexts throughout life in Santiago, Chile. Data was collected through a battery of psychological assessments. A structural equation model (SEM) was implemented to examine the interrelationships among cognitive and social variables. Results indicate a significant relationship between executive function (EF) and SA through both social cognition (SC) and intelligence. Theory of Mind (ToM), a component of SC, was shown to exhibit a significant relationship with affective empathy; interestingly, this was negatively related to SA. Moreover, fluid intelligence (FI) was found to exhibit a positive, indirect relationship with SA through crystallized intelligence (CI). Evaluation of these results in the context of research on the impacts of SES and vulnerable living conditions on psychological function may allow for the development of more effective clinical, political, and social interventions to support psychosocial health among socially vulnerable populations.

Evolución de la cirugía bariátrica en Chile y el mundo / Bariatric Surgery's History in Chile and the World

Resumen La obesidad es reconocida como "la gran epidemia" del siglo XXI. Los primeros tratamientos fueron enfocados en el manejo médico, sin lograr los resultados esperados, por lo cual surge la cirugía bariátrica (CB) como la mejor alternativa. Inicialmente la obesidad se concibe como una figura de poder en el imperio egipcio, luego como enfermedad por Galeno e Hipócrates, reapareciendo más tarde como símbolo de fecundidad en Europa. Las primeras técnicas fueron el bypass yeyuno-colónico por Payne y De Wind modificado luego por Scopinaro, consolidándose más tarde como el bypass actual por Mason, Wittgrove e Higa. Por su parte, la gastrectomía en manga fue concebida por Gagner como puente de la derivación biliopancreática, pero dado sus excelentes resultados se consolida como técnica por sí sola. A su vez, la CB evidencia efectos metabólicos inesperados, posicionándose en la actualidad como el mejor tratamiento tanto para la obesidad como para el síndrome metabólico. En Chile la CB se inicia en 1986 con González del Hospital Van Buren con la experiencia en bypass yeyuno-ileal, continuando con Awad y Loehnert del Hospital San Juan de Dios. Luego se consolida con el desarrollo de la CB moderna tanto en la Universidad Católica como en la Universidad de Chile, llegando en la actualidad a ser un procedimiento ampliamente difundido en todo el país. El objetivo principal de la siguiente revisión es analizar el concepto de obesidad en la historia y la evolución de la CB en Chile y el mundo, rememorando sus inicios y destacando su constante desarrollo.

Obesity is recognized as "the great epidemic" of the 21st century. The first treatments were focused on medical management, failing to achieve the expected results, which is why bariatric surgery (BC) emerges as the best alternative. Obesity was initially conceived as a power figure in the Egyptian empire, later as a disease by Galen and Hippocrates, later reappearing as a symbol of fertility in Europe. The first techniques were the jejuno-colonic bypass by Payne and De Wind, later modified by Scopinaro, to finally consolidate as the current bypass by Mason, Wittgrove and Higa. For its part, sleeve gastrectomy was conceived by Gagner as a bridge for biliopancreatic diversion, but given its excellent results, it is consolidated as a technique by itself. In turn, BC shows unexpected metabolic effects, currently positioning itself as the best treatment for both obesity and metabolic syndrome. In Chile, BC started in 1986 with González at the Van Buren Hospital with his experience in jejuno-ileal bypass, continuing with Awad and Loehnert at the San Juan de Dios Hospital. Later, it was consolidated with the development of modern BC both at the Catholic University and at the University of Chile, currently becoming a widely disseminated procedure throughout the country. The main objective of the following review is to analyze the concept of obesity in history and the evolution of BC in Chile and the world, recalling its beginnings and highlighting its continuous development.

Prognostic factors and survival in Ewing's sarcoma treated by limb salvage surgery.

PURPOSE: Survival in Ewing's sarcoma (ES) has increased with the use of chemotherapy. Surgical techniques such as limb salvage (LS) have been developed. Survival and adverse events have been widely studied in general series of ES, but there are few specific series of ES cases treated by LS, despite this being the most commonly used (surgical) approach. The aim of this study was to determine survival and prognostic factors in ES patients undergoing LS. PATIENTS AND METHODS: We analysed all ES patients treated between January 1984 and May 2008 and selected all those treated by systemic multimodal therapy and LS. We assessed the influence of patient characteristics, tumour parameters and therapeutic results in event-free survival (EFS). RESULTS: Ninety patients were included. Fifty of them were treated by systemic multimodal therapy and locally by LS. ean age was 20 years. Overall survival (OS) was 68.8% and EFS was 60.6% at years. In the univariate analysis, pelvic location, age and response to chemotherapy were associated with poor prognosis. After multivariate analysis, poor response to treatment, pelvis location and age between 12 and 17 years were found to be independent prognostic factors. Dissemination at diagnosis was not a prognostic factor. CONCLUSIONS: OS and EFS in ES treated by LS were similar to findings in previous ES studies. factors are no different, except for the presence of metastasis at diagnosis.

Dermatofibrosarcoma protuberans vulvar: tres casos clínicos de localización inusual / Dermatofibrosarcoma protuberans vulvar: three clinical cases of localization unusual

RESUMEN El dermatofibrosarcoma protuberans (DFSP) es un sarcoma fusocelular de grado intermedio de malignidad con máxima incidencia en adultos entre 20 y 40 años y de localización habitualmente troncular (cabeza, cuello extremidades superiores). Se presentan tres casos de DFSP de localización excepcional a nivel vulvar. Las pacientes fueron tratadas con vulvectomía respetando márgenes de seguridad pero, debido a la idiosincrasia del tumor, presentaron recidivas locales que precisaron de una nueva cirugía. En su posterior seguimiento no presentaron recaídas y se encuentran libres de enfermedad.

ABSTRACT Dermatofibrosarcoma protuberans (DFSP) is an intermediate grade spindle-cell sarcoma with a highest incidence in adults between 20 and 40 years old and a trunk location (head, neck and arms). We introduce three case reports of vulvar DFSP considered unusual because of their location. The patients were conducted a free-margin vulvectomy but, due to the nature of the tumor, local reappearances required a second surgery. In the subsequent follow-up they did not suffer from any tumor relapse and they are currently disease-free.

Desarrollo moral de los estudiantes de un programa de enfermería / Moral development of the students of a nursing program

Resumen Objetivo: Determinar el nivel de desarrollo moral de los estudiantes del programa de Enfermería de la Universidad Industrial de Santander. Materiales y métodos: Estudio de corte transversal que utilizó el Cuestionario de Opinión sobre Problemas Sociales (COPS) fundamentado en la clasificación propuesta por Kohlberg y reestructurado por Rest. La población blanco correspondió a 187 estudiantes de enfermería de la Universidad Industrial de Santander, matriculados en los núcleos temáticos de cuidado. Resultados: Se pudo establecer el desarrollo de la competencia moral en cada uno de sus niveles: pre convencional, convencional y pos convencional, evidenciándose una correspondencia del 42.9% para el desarrollo moral convencional, seguida del 39.4% para el post convencional, y del 9.5% para el pre convencional. Conclusiones: La mayoría de los estudiantes de enfermería se encontraban en el nivel convencional de su desarrollo moral, aspecto que permite inferir que no existen diferencias entre los niveles académicos, excepto en los estudiantes del tercer nivel, quienes obtuvieron un mayor desarrollo moral post convencional, lo cual puede obedecer a la coincidencia entre la finalización de la asignatura de ética en enfermería, propia del plan curricular, y el momento en que se llevó a cabo la investigación.

Abstract Objective: To determine the level of moral development of the students of the Nursing program of the Universidad Industrial de Santander. Materials and methods: Cross-sectional study using the Opinion Questionnaire on Social Problems (COPS) based on the classification proposed by Kohlberg and restructured by Rest. The target population corresponded of 187 nursing students from the Universidad Industrial de Santander, enrolled in the thematic nuclei of carefulness. Results: It was possible to establish the development of moral competence in each of its levels: pre-conventional, conventional and post conventional, evidencing a correspondence of 42.9% for conventional moral development, followed by 39.4% for the conventional post, and 9.5 % for the pre-conventional. Conclusions: The majority of nursing students were at the conventional level of moral development, aspect that allows to infer that there are no differences between academic levels. Except in the third level students, whom obtained a greater post-conventional moral development, which can obey of the coincidence between the completion of the subject of ethics in nursing, contained in the curricular plan, and the time when the research was carried out.

The inner world of overactive monitoring: neural markers of interoception in obsessive-compulsive disorder.

BACKGROUND: Obsessive-compulsive disorder (OCD) patients typically overmonitor their own behavior, as shown by symptoms of excessive doubt and checking. Although this is well established for the patients' relationship with external stimuli in the environment, no study has explored their monitoring of internal body signals, a process known to be affected in anxiety-related syndromes. Here, we explored this issue through a cardiac interoception task that measures sensing of heartbeats. Our aim was to explore key behavioral and electrophysiological aspects of internal-cue monitoring in OCD, while examining their potential distinctiveness in this condition. METHOD: We administered a heartbeat detection (HBD) task (with related interoceptive confidence and awareness measures) to three matched groups (OCD patients, panic disorder patients, healthy controls) and recorded ongoing modulations of two task-relevant electrophysiological markers: the heart evoked potential (HEP) and the motor potential (MP). RESULTS: Behaviorally, OCD patients outperformed controls and panic patients in the HBD task. Moreover, they exhibited greater amplitude modulation of both the HEP and the MP during cardiac interoception. However, they evinced poorer confidence and awareness of their interoceptive skills. CONCLUSIONS: Convergent behavioral and electrophysiological data showed that overactive monitoring in OCD extends to the sensing of internal bodily signals. Moreover, this pattern discriminated OCD from panic patients, suggesting a condition-distinctive alteration. Our results highlight the potential of exploring interoceptive processes in the OCD spectrum to better characterize the population's cognitive profile. Finally, these findings may lay new bridges between somatic theories of emotion and cognitive models of OCD.

Pénfigo vulgar: dificultad en el diagnóstico de un tipo de dermatosis vulvar poco frecuente. Reporte de un caso / Vulgar pemphigus: Difficulty in diagnosis of a infrequent vulvar dermatoses. A case report

Resumen ANTECEDENTES: las alteraciones cutáneas de la vulva suponen un motivo frecuente de consulta a ginecólogos y dermatólogos. Los síntomas suelen ser imprecisos, con prurito y ardor, por lo que las pacientes tardan en acudir a consultar al médico. OBJETIVO: exponer un caso poco frecuente de pénfigo vulgar vulvar; además, revisar la incidencia, manifestaciones clínicas, diagnóstico y estrategias de tratamiento. CASO CLÍNICO: paciente de 86 años de edad que acudió a consulta por la aparición de lesiones vulvares ulceradas y ardorosas de dos meses de evolución. Se obtuvo una biopsia para el estudio histológico, cuyo resultado fue acantólisis y formación de una vesícula intraepidérmica suprabasal, sin evidencia de disqueratosis o necrosis. Se prescribieron corticoesteroides por vía tópica y oral durante un mes. Después de ese lapso se realizó un estudio de control, esta vez de una lesión más reciente, que evidenció infiltrado inflamatorio linfoplasmocitario con aislados eosinófilos, sin permeación del epitelio. La inmunofluorescencia directa reportó depósitos intercelulares de IgG en todo el espesor de la epidermis y de C3 en los estratos suprabasales, con lo que se confirmó el diagnóstico de pénfigo vulgar. CONCLUSIONES: para establecer el diagnóstico de las dermatosis vulvares poco frecuentes es importante efectuar una correcta correlación clínico-patológica, pues la mayor parte de estas enfermedades se manifiestan casi de forma idéntica.

Abstract BACKGROUND: The skin diseases of the vulva are a frequent reason for consultation with both gynecologists and dermatologists. The clinical symptoms are usually vague as pruritus or stinging and patients usually consult later. OBJECTIVE: To document a case of vulgaris vulvar pemphigus, and review the incidence, clinical presentation, diagnostic strategies and treatment. CLINCAL CASE: An 86-year-old patient who came to medical service for ulcerated and burning vulvar lesions of two months of progression. A biopsy was obtained for the histological study, which resulted in acantholysis and suprabasal intraepidermal vesicle, without evidence of dyskeratosis or necrosis. We prescribe topical and oral corticosteroids during a month. Posteriorly, a control study was performed of the most recent lesion that evidenced lymphoplasmacytic inflammatory infiltrate with eosinophilic isolates, without epithelial permeation. Direct immunofluorescence test reported intercellular deposits, IgG throughout the thickness of the epidermis, and C3 in the suprabasal stratum, thus confirming the diagnosis of pemphigus vulgaris. CONCLUSIONS: For correct diagnosis it is essential the clinic-pathological correlation, because many of these diseases manifest themselves almost identically.

Úlcera marginal perforada post bypass gástrico laparoscópico / Perforated marginal ulcer after laparoscopic gastric bypass

Introduction: Perforated marginal ulcer is a serious event that usually requires reoperation and is associated with morbidity and mortality. Characterization and management of these patients is still debated. Objective: To describe a series of patients subjected to a laparoscopic gastric bypass (LGBP) that evolved with a perforated marginal ulcer. Material and Methods: Records of patients undergoing a LGBP the last 10 years and evolved with a perforated marginal ulcer were retrospectively reviewed. Clinical features, treatment and perioperative morbidity and mortality were analyzed. Results: During this period 2,095 patients were subjected to a LGBP, 12 of them presented a perforated marginal ulcer, corresponding to 10 women and 2 men. Mean age was 39 (21-60) and mean body mass index at the time of initial surgery was 34 (29.3 to 38.6). Ten patients were smoker at the moment of perforation. The occurrence of this happened at a mean of 27 months (range 3-54, median 23.5) after surgery. Eleven cases had a surgical resolution, with a laparoscopic approach in 9 of them and laparotomy on 2. In all cases, a perforated ulcer in the jejunal side of the gastro-jejunal anastomosis was found. There was no mortality or morbidity associated with surgery. Conclusions: In our experience the occurrence of perforated marginal ulcer after a LGBP develops in a small percentage of patients. The laparoscopic approach is of choice, presenting a low morbidity and mortality. Smoking was present in most patients.

Introducción: La perforación de una úlcera marginal es un evento grave que suele requerir una reoperación y se asocia a morbimortalidad. El manejo de estos pacientes es debatido y complejo. Objetivo: Describir una serie de pacientes operados de bypass gástrico laparoscópico (BPGLP) que evolucionaron con una úlcera marginal perforada. Material y Método: Se revisaron retrospectivamente las fichas de pacientes operados de BPGL los últimos 10 años y que evolucionaron con una úlcera marginal perforada. Se analizaron las características clínicas, de tratamiento y morbimortalidad perioperatoria. Resultados: Durante este período se operaron 2.095 pacientes de BPGLP, 12 de los cuales presentaron una úlcera marginal perforada, correspondientes a 10 mujeres y 2 hombres. El promedio de edad fue 39 años (21-60) y el índice de masa corporal (IMC) promedio al momento de la primera cirugía fue 34 (29,3-38,6). Diez pacientes tenían hábito tabáquico activo al momento de la perforación. La ocurrencia de esta sucedió en promedio a los 27 meses (rango 3-54, mediana 23,5) de la cirugía. En 11 casos la resolución fue quirúrgica, mediante abordaje laparoscópico en 9 y laparotomía en 2. En todos los casos se encontró una úlcera perforada en la vertiente yeyunal de la gastro-yeyuno anastomosis. No hubo mortalidad ni morbilidad asociada a la cirugía. Conclusiones: En nuestra experiencia la ocurrencia de úlcera marginal perforada post BPGLP se desarrolla en un bajo porcentaje de pacientes. El abordaje laparoscópico es de elección, presentando una baja morbimortalidad. El hábito tabáquico estuvo presente en la mayoría de los pacientes.

Institutional development of freshwater fish stocking in Mexico.

By using freshwater fish stocking information from the Mexican government, this work described the current situation of the national stocking and its associated fishery policy. There is a lack of effective freshwater stocking programmes as a result of limited fisheries management, unharmonized fisheries regulations and institutional performance. The fry production has decreased from 140 to 20 million in the past 11 years.

Prevención de la recurrencia peritoneal en el tratamiento quirúrgico del cáncer gástrico / Prevention of peritoneal recurrence of gastric cancer

The peritoneal cavity is the main site of gastric cancer recurrence after curative surgery. When this recurrence occurs, patients may experience bowel obstruction, dehydration and multiple hospital admissions. The therapeutic options that may decrease the rate of peritoneal recurrence and increase five years survival are intraoperative hyperthermic chemotherapy, extensive intraoperative peritoneal lavage and routine bursectomy. We herein review the oncological results of curative surgery for gastric cancer, its failure patterns and the risk factors for peritoneal recurrence. We also review the studies aiming to prevent peritoneal carcinomatosis.

La recurrencia peritoneal en el cáncer gástrico avanzado, luego de una cirugía con intención curativa es un problema que debe ser considerado una prioridad en nuestro país, debido a la alta proporción de pacientes con compromiso de la serosa gástrica al momento del diagnóstico, siendo el peritoneo el principal sitio de recurrencia luego de una cirugía con intención curativa en este grupo. Luego de la recurrencia peritoneal, los pacientes presentan un deterioro importante de la calidad de vida, principalmente por episodios de obstrucción intestinal, deshidratación y rehospitalizaciones. Se han realizado múltiples estudios en el extranjero de potenciales medidas que se pueden realizar durante la cirugía inicial con intención curativa que previenen la recurrencia. Algunas de estas medidas han disminuido la recurrencia peritoneal y aumentado la sobrevida a 5 años, como son la quimioterapia hipertérmica intraoperatoria, el lavado peritoneal extensivo y la bursectomía rutinaria, en pacientes seleccionados. El objetivo de la presente revisión es mostrar los resultados oncológicos de la cirugía curativa, los patrones de falla luego de una cirugía curativa, los factores de riesgo para una recurrencia peritoneal y los estudios que se han realizado en relación a la prevención de la carcinomatosis peritoneal.

Cáncer de vejiga: ¿estamos llegando a músculo? / Bladder cancer: are we reaching muscle?

Introducción: El cáncer vesical es el noveno cáncer más común a nivel mundial. La finalidad de la RTUv en los tumores Ta y T1 es hacer un diagnóstico completo y correcto, y una resección terapéutica. Objetivo: Determinar el porcentaje de muestras con tejido muscular de las RTUv. Materiales y métodos: Estudio retrospectivo, longitudinal y descriptivo. Incluidos todos los informes del Servicio de Anatomía Patológica del HPSB desde el 2001 hasta Julio de 2012, informados como muestra de vejiga o cáncer vesical. Resultados: 122 casos cumplieron todos los criterios. 87.7 por ciento presentaban tejido muscular. De las muestras con diagnóstico de cáncer, 28.6 por ciento presentaban in¬ ltración, 32.4 por ciento eran de alto grado y 67.6 por ciento de bajo grado. Conclusión: cerca del 88 por ciento de las RTUv que se han realizado en los últimos 10 años en nuestra unidad y que están indicadas por el diagnóstico o sospecha de cáncer vesical, tienen tejido muscular y por lo tanto están correctamente realizadas.

Introduction: Bladder cancer is the ninth most common cancer worldwide. The purpose of TURB in Ta and T1 stage tumors is to make a complete and accurate diagnosis, and therapeutic resection. Objective: To determine the percentage of samples with muscle tissue of TURB. Materials and Methods: Retrospective, longitudinal and descriptive study. Including all Service reports HPSB Pathology from 2001 until July 2012, reported as a bladder sample or bladder cancer. Results: 122 cases met all the criteria. 87.7 percent had muscle tissue. Of the samples with cancer diagnosis, 28.6 percent had infiltration, 32.4 percent were high grade and 67.6 percent low grade. Conclusion: About 88 percent of the TURB that have been made in the last 10 years in our unit and are indicated by the diagnosis or suspected bladder cancer have muscle tissue and therefore were made correctly.

Thermo-optical characteristics and concentration quenching effects in Nd3+ doped yttrium calcium borate glasses.

In this work we present a comprehensive study of the spectroscopic and thermo-optical properties of a set of samples with composition xNd(2)O(3)-(5-x)Y(2)O(3-)40CaO-55B(2)O(3) (0 ≤ x ≤ 1.0 mol%). Their fluorescence quantum efficiency (η) values were determined using the thermal lens technique and the dependence on the ionic concentration was analyzed in terms of energy transfer processes, based on the Förster-Dexter model of multipolar ion-ion interactions. A maximum η = 0.54 was found to be substantially higher than for yttrium aluminoborate crystals and glasses with comparable Nd(3+) content. As for the thermo-optical properties of yttrium calcium borate, they are comparable to other well-known laser glasses. The obtained energy transfer microparameters and the weak dependence of η on the Nd(3+) concentration with a high optimum Nd(3+) concentration put this system as a strong candidate for photonics applications.

First record of Mugil hospes in the Gulf of Mexico and its identification from Mugil curema using ctenii.

This study gives the first record of Mugil hospes distributed in the Gulf of Mexico. This species previously has been confused with its congener Mugil curema and can be easily differentiated by the shape of the ctenii on their scales.

Necrosectomía laparoscópica en pancreatitis aguda / Laparoscopic necrosectomy in severe pancreatitis: retrospective analysis of 11 patients

Background: Laparoscopic surgery can be used in the treatment of severe acute pancreatitis. Aim: To report the experience with laparoscopic necrosectomy and abscess drainage in severe acute pancreatitis. Material and Methods: Retrospective analysis of medical records of 11 patients aged 13 to 78 years (10 males), with severe pancreatitis, subjected to laparoscopic necrosectomy or abscess drainage between 2006 and 2009. Results: Operative time ranged from 110 to 205 min. In all cases, a satisfactory necrosectomy and collection drainage were performed. No complications were recorded and no patient required to be converted to open surgery. Five patients were reoperated. In three of these, the laparoscopic approach was used again. Conclusions: Laparoscopic necrosectomy is safe and useful for patients with severe pancreatitis.

Introducción: La pancreatitis aguda grave, asociada a necrosis pancreática infectada, tiene una elevada mortalidad. En la mayoría de los casos, el tratamiento es quirúrgico, sin embargo, este se asocia a una alta morbilidad. El desarrollo de la cirugía mínimamente invasiva ha permitido incorporar la técnica laparoscópica al tratamiento de esta enfermedad. Objetivo: Presentar nuestra experiencia en necrosectomía y drenaje de abscesos por vía laparoscópica en pacientes con pancreatitis aguda grave. Pacientes y Métodos: Análisis retrospectivo de todos los pacientes con diagnóstico de pancreatitis aguda grave con necrosis infectada y/o abscesos sometidos a necrosectomía y drenaje de abscesos por vía laparoscópica. Se describen los datos demográficos, etiología de la pancreatitis aguda, imágenes pre y post-operatorias, así como los detalles de cada cirugía, la indicación quirúrgica, complicaciones, necesidad de re-operaciones y evolución tardía. Resultados: La serie está compuesta por 11 pacientes, todos con diagnóstico de pancreatitis aguda grave, operados entre abril de 2006 y junio de 2009. El tiempo operatorio promedio fue 138 min (110-205 min). En todos los casos, se realizó una necrosectomía satisfactoria y drenaje de colecciones. No hubo complicaciones derivadas de la técnica laparoscópica ni conversión a cirugía abierta en ningún paciente durante la primera cirugía. Cinco pacientes fueron re-operados, 3 de ellos por vía laparoscópica. Conclusiones: La necrosectomía laparoscópica es una alternativa válida y disponible en nuestro centro, con resultados comparables y probablemente superiores a la cirugía abierta, y con resultados satisfactorios en cuanto a morbilidad, protección de la pared abdominal y mortalidad postoperatoria.

Dispositivo endoscópico duodeno yeyunal restrictivo en pacientes obesos mórbidos, experiencia inicial en humanos / Initial human experience with a restrictive, duodenal-jejunal by-pass liner for the treatment of morbid obesity

Background: The EndoBarrierTM Gastrointestinal Liner creates an endoscopic duodenal-jejunal bypass leading to weight loss in morbidly obese patients. Aim: To evaluate the safety and efficacy of the EndoBarri-erTM with a 4 mm restrictor in morbidly obese patients. Material and Methods: Ten obese patients aged 18 to 54 years (eight women) with a body mass index (BMI) ranging from 35.8 to 45 kg/m² were enrolled. Patients were followed for 12 weeks after the placement of the device, when it was removed. Outcomes measured were percent excess weight loss ( percentEWL), minor and major adverse events. Results: The mean implant time was 33 +/- 4 minutes with a mean fluoroscopy time of 14.8 +/- 3 minutes. There were no major adverse events. Periodic episodes of nausea and vomiting lead to the endoscopic dilation of the restrictor hole with a 6 mm balloon between 2nd and 8th weeks in seven patients (70 percent). One subject required a second dilation with a 10 mm balloon. The device was endoscopically removed at the 12th week in all patients. The mean removal time was 47 +/- 53.8 minutes (range 10-155 minutes). At week 12, BMI decreased from 40 +/- 3.9 to 34.5 +/- 3.1 kg/m², and percentEWL was 39.8 percent (range, 21.7 percent - 65.3 percent). The mean total weight loss was 16.7 +/- 4.4 kg. Conclusions: The EndoBarrierTM Gastrointestinal Liner with the addition of a duodenal restrictor is a safe and effective short-term treatment for morbidly obese patients.

Introducción: El dispositivo gastrointestinal endoscópico EndoBarrierTM crea un by-pass duodeno-yeyunal permitiendo la pérdida de peso en pacientes obesos mórbidos. El objetivo del estudio fue evaluar la seguridad y eficacia del EndoBarrierTM con un restrictor de 4 mm en los pacientes obesos mórbidos. Método: Fueron enrolados diez pacientes durante un período de 12 semanas a los que se les implantó el EndoBarrierTM. Se analizó pérdida de exceso de peso ( por cientoEWL) y eventos adversos menores y mayores. Al completar las 12 semanas los dispositivos fueron explantados. Resultados: De los diez pacientes, ocho fueron mujeres. La edad fue 34,9 (rango, 18-54) años, el IMC basal fue 40 kg/m² (rango, 35,8-45 kg/m²). El tiempo promedio de implante fue 33 +/- 4 minutos con un tiempo de fluoroscopía de 14,8 +/- 3 minutos. No hubo eventos adversos mayores. Los episodios periódicos de náuseas y vómitos llevaron a realizar dilatación endoscópica del orificio del restrictor con un balón de 6 mm entre la 2a y 8a semanas en siete (70 por ciento) pacientes. Un paciente requirió una segunda dilatación con un balón de 10 mm. El dispositivo fue removido endoscópicamente a la semana 12 en los diez pacientes. El tiempo de explante fue 47 (rango, 10-155) minutos. A la semana 12 el IMC fue 34,2 kg/m² (p < 0,0012) y el por ciento EWL fue 39,8 por ciento (rango, 21,7-65,3 por ciento). El promedio de pérdida total de peso fue 16,7 +/- 4,4 kg. Conclusión: El dispositivo gastrointestinal EndoBarrierTM con la adición de un restrictor duodenal es seguro y efectivo en el tratamiento a corto plazo en los pacientes obesos mórbidos.