Identificación de parámetros pronósticos relativos a la técnica quirúrgica en pacientes tratados mediante prostatectomía radical robótica / Identifying prognostic parameters related to surgical technique in patients treated by robotic radical prostatectomy

Introducción y objetivo Los factores más estudiados en pacientes tratados mediante prostatectomía radical robótica son antígeno prostático específico (PSA) y las características patológicas de la biopsia y la pieza de prostatectomía. Los factores asociados a la técnica quirúrgica han sido poco estudiados y con resultados controvertidos. El objetivo es identificar todos los factores posibles de la cirugía y su relación con la supervivencia libre de enfermedad (SLE) y de metástasis. Pacientes y métodos Estudio prospectivo aprobado por el Comité de Ética, en pacientes intervenidos de prostatectomía radical robótica desde enero del 2009 con seguimiento mínimo de cinco años. Analizamos como posibles factores pronósticos: el cirujano, el tiempo quirúrgico, la pérdida sanguínea, el acceso fascial, las técnicas de continencia, la preservación de la fascia, las bandeletas neurovasculares, el cuello vesical, la uretra, la curva de aprendizaje y las complicaciones quirúrgicas. Realizamos comparaciones univariables y emparejadas de supervivencia mediante la estimación de Kaplan-Meier y long-rank tests. El nivel de significancia para comparaciones múltiples se estableció con ajuste False Discovery Rate (p ajustada [padj]). Resultados Cohorte de 667 pacientes con mediana de seguimiento de 69 meses. En el análisis univariante, el cirujano (padj = 0,018), la conservación de ligamentos puboprostáticos (padj = 0,02), la preservación de fascia endopélvica (padj = 0,001) y realizar suspensión parauretral (padj < 0,001) son factores de mal pronóstico para la SLE. La preservación de la fascia también afecta negativamente a la supervivencia libre de metástasis (SLM) (padj = 0,04). Las cirugías previas abdominales, la próstata, el tiempo de intervención, el sangrado, el tipo de uretra residual, el lóbulo medio, el acceso fascial, la conservación de bandeletas o cuello vesical, no tienen significancia estadística (AU)

Introduction and objective The most frequently studied factors in patients treated by robotic radical prostatectomy are PSA and pathological features of the biopsy and prostatectomy specimen. Studies on the factors associated with the surgical technique are scarce and with controversial results. The objective is to identify all possible surgical factors and their relationship with disease-free and metastasis-free survival. Patients and Method Prospective study approved by the Ethics Committee, including patients who underwent robotic radical prostatectomy since January 2009 with a minimum follow-up of 5 years. Surgeon, surgical time, blood loss, fascial access, continence techniques, preservation of the fascia, neurovascular bundles, bladder neck, urethra, learning curve and surgical complications, were analyzed as possible prognostic factors. We performed univariate and matched comparisons of survival using Kaplan-Meier estimation and long-rank tests. The significance level for multiple comparisons was established with False Discovery Rate-adjustment (adjusted p). Results Cohort of 667 patients with a median follow-up of 69 months. In univariate analysis, surgeon (adjp = 0.018), preservation of puboprostatic ligaments (adjp = 0.02), preservation of endopelvic fascia (adjp = 0.001) and performing periurethral suspension (adjp < 0.001) are poor prognostic factors for disease-free survival. Fascia preservation also negatively affects metastasis-free survival (adjp = 0.04). Previous abdominal surgeries, prostate, surgical time, blood loss, type of residual urethra, middle lobe, fascial access, fascia or bladder neck preservation, have no statistical significance. Conclusions The surgeon and specific aspects of the surgical technique are determining factors in disease-free survival. Preservation of the fascia is the only factor that negatively affects metastasis-free survival (AU)

Identifying prognostic parameters related to surgical technique in patients treated by robotic radical prostatectomy.

INTRODUCTION AND OBJECTIVE: The most frequently studied factors in patients treated by robotic radical prostatectomy are PSA and pathological features of the biopsy and prostatectomy specimen. Studies on the factors associated with the surgical technique are scarce and with controversial results. The objective is to identify all possible surgical factors and their relationship with disease-free and metastasis-free survival. PATIENTS AND METHOD: Prospective study approved by the Ethics Committee, including patients who underwent robotic radical prostatectomy since January 2009 with a minimum follow-up of 5 years. Surgeon, surgical time, blood loss, fascial access, continence techniques, preservation of the fascia, neurovascular bundles, bladder neck, urethra, learning curve and surgical complications, were analyzed as possible prognostic factors. We performed univariate and matched comparisons of survival using Kaplan-Meier estimation and long-rank tests. The significance level for multiple comparisons was established with False Discovery Rate-adjustment (adjusted p). RESULTS: Cohort of 667 patients with a median follow-up of 69 months. In univariate analysis, surgeon (adjp=0.018), preservation of puboprostatic ligaments (adjp=0.02), preservation of endopelvic fascia (adjp=0.001) and performing periurethral suspension (adjp<0.001) are poor prognostic factors for disease-free survival. Fascia preservation also negatively affects metastasis-free survival (adjp=0.04). Previous abdominal surgeries, prostate, surgical time, blood loss, type of residual urethra, middle lobe, fascial access, fascia or bladder neck preservation, have no statistical significance. CONCLUSIONS: The surgeon and specific aspects of the surgical technique are determining factors in disease-free survival. Preservation of the fascia is the only factor that negatively affects metastasis-free survival.

Ganglio centinela en la metástasis ganglionar por cáncer papilar de tiroides: validez diagnóstica y aplicación en la práctica clínica / Sentinel lymph node biopsy in papillary thyroid cancer: Accuracy and application in clinical practice

Introducción La biopsia selectiva del ganglio centinela (BSGC) puede completar el estudio preoperatorio detectando adenopatías no visibles ecográficamente. De este modo, se puede estadificar a los pacientes y estratificar el riesgo de recidiva de forma más precisa y, por tanto, ayudar a definir el tipo de tratamiento tanto quirúrgico como con 131I que debemos realizar. El objetivo fue validar la BSGC para su utilización en el diagnóstico de la metástasis ganglionar por cáncer papilar de tiroides. Métodos Estudio observacional prospectivo de cohortes que incluye a 55 pacientes intervenidos por cáncer papilar de tiroides sin sospecha de afectación ganglionar clínica o radiológica, desde febrero de 2012 hasta febrero de 2015, con un seguimiento de entre 6 y 8 años. Se utilizó 99Tc con nanocoloide intratumoral y una sonda portátil de la gammacámara para la detección de los ganglios centinelas. Variables: edad, género, histológicas, analíticas y estadificación preoperatoria y postoperatoria. Se calculó la sensibilidad, la especificidad y los valores predictivos de la técnica. La validación se determinó calculando la detectabilidad y los falsos negativos de la prueba. Resultados En 53 de los 55 (96,36%) pacientes hubo detección del ganglio centinela. Los falsos negativos fueron 4 (7,5%) pacientes. Del resto, tras aplicar la BSGC, 24 (48,9%) se mantuvieron como N0, 14 (28,5%) pasaron a ser N1a y 11 (22,4%) se clasificaron como N1b. Las diferencias observadas en el estudio fueron significativas (p<0,05). La sensibilidad fue del 86,21%, la especificidad del 100%, el VPP del 100% y el VPN del 85,71%. La precisión diagnóstica fue del 92,45%. Conclusiones La BSGC es una técnica válida para su utilización en los pacientes afectos de cáncer papilar de tiroides, con una alta precisión diagnóstica (AU)

Introduction The presence of lymph nodes metastasis in papillary thyroid cancer modifies the type of surgical resection as well as the indication of the treatment with 131I in the postoperative period. This therapeutic approach is based on the results of the diagnostic tests, like the cervical ultrasonography. Currently other methods of diagnostic are tested as selective sentinel lymph node biopsy (SLNB). It can complement to the ultrasound results. The aim was to validate the SLNB for use in the diagnosis of lymph node metastasis by papillary thyroid cancer. Methods Observational prospective cohort study of 55 patients who underwent papillary thyroid cancer without suspicion of lymph node involvement clinical or radiological, since February 2012 through February 2015, with a follow-up between 6 and 8 years. It was used 99Tc with intratumoral nanocoloid and a portable tube of the gamma camera for the detection of the sentinel node. Variables: age, gender, histological, analytical and preoperative and postoperative staging. The sensitivity, specificity and predictive values of technique was calculated. The validation was determined by calculating the detectability and the false negative results of the test. Results In 53 of the 55 patients (96.36%) there was the sentinel node detection. The false negative were 4 patients (7.5%). Of the rest, after applying the SLNB, 24 (48.9%) were kept as N0, 14 (28.5%) became N1a and 11 (22.4%) were classified as N1b. The differences observed in the study were significant (P<.05). The sensitivity was 86.21%, the specificity of 100%, the PPV was 100% and the NPV of 85.71%. The diagnostic accuracy was 92.45%. Conclusions The SLNB is a valid technique for use in patients suffering from papillary thyroid cancer with a high diagnostic accuracy (AU)

[Importance of the forensic autopsy in the diagnosis of septic shock: a case report]. / Importancia de la autopsia forense en el diagnóstico del shock séptico: a propósito de un caso.

Septic shock sometimes starts with unspecific symptoms that hamper the clinical diagnosis and, therefore an appropriate treatment. When the septic shock follows a fulminating course with a fatal outcome, the etiological diagnosis has to be conducted post-mortem. Sudden unexpected deaths in children and young adults are frequently the object of medico-legal autopsies. Some sudden unexpected deaths have an infectious origin, which requires further analyses, including microbiology, to establish the cause of death. Here, the case of a fatal septic shock in a 19-month old male infant is presented. After a mild foot injury, an infection by Streptococcus pyogenes progressed to septic shock with a fatal outcome as post-mortem studies demonstrated.

Shock séptico por Streptococcus pyogenes en un niño. ¿Es posible el diagnóstico en patología forense? / Septic shock by Streptococcus pyogenes in a child. Is diagnosis possible in forensic pathology?

El shock séptico es el final de numerosos procesos infecciosos que ponen en peligro la vida y que son catalogados como muertes súbitas, de mayor repercusión legal en niños y adultos jóvenes, por lo que son objeto de autopsias forenses. Normalmente son consecuencia de patógenos que en general producen enfermedades leves, pero que en determinadas circunstancias pueden evolucionar a cuadros graves que terminan en el fallecimiento y pueden plantear problemas médico-legales, sobre todo en su detección y diagnóstico. Presentamos el caso de un varón de 20 meses de edad que, tras un cuadro banal de herida en el pie, evolucionó hasta shock séptico y fallecimiento a consecuencia de sepsis por Streptococcus pyogenes, como se evidenció en estudios complementarios especiales post mortem con los que no está familiarizado el patólogo forense

Septic shock is the final common route of numerous life-threatening infectious processes, which are classified as sudden deaths of major legal repercussion in children and young adults and are the subject of forensic autopsies. They are usually the result of pathogens that usually have mild and banal diseases, but in certain circumstances can evolve into severe conditions that end in death and can pose medical problems, especially in detection and diagnosis. We present the case of a 20-month-old male who, after a common foot injury, evolved to septic shock and death as a consequence of streptococcus pyogenes sepsis, as evidenced in special postmortem studies with which the forensic pathologist is unfamiliar

Neumoconiosis por aglomerados de cuarzo: hallazgo de autopsia en un suicidio / Pneumoconiosis quartz agglomerates: autopsy finding of suicide

La silicosis sigue siendo un problema de salud actual renovado por al aumento en la demanda del uso en el hogar de encimeras de aglomerados de cuarzo en nuestro país. Dichas encimeras contienen cuarzo (sílice cristalina), provocando que dicho polvo inorgánico dé lugar a su depósito en el intersticio pulmonar de los trabajadores que no realicen las medidas de protección adecuadas en el ámbito laboral. Es trabajo de las empresas encargadas de la prevención de riesgos laborales la información de la problemática futura en la salud de aquellos que no opten por utilizar los medios de prevención, así como responsabilidad directa de los encargados de dichas empresas facilitar el material y los medios adecuados para llevarlas a cabo. Presentamos el caso de un varón cuya autopsia reveló el hallazgo casual de neumoconiosis por sílice, confirmándose con posterioridad en la entrevista con la familia que desempeñaba su trabajo en una empresa de mármol artificial y la producción de una enfermedad profesional (AU)

Silicosis is still a current health problem by the renewed increase in demand for use in the home countertops quartz agglomerates in Spain. These countertops contain quartz (crystalline silica), causing said inorganic powder from place to deposit in the lung interstitium of workers not performing the appropriate protection measures in the workplace. It is a work of the companies in charge of the prevention of labor risks the information of the future problematics in the health of those that they do not choose to use the means of prevention as well as direct responsibility of the managers of the above mentioned companies of facilitating the material and the means adapted to carry out them. We report the case of a man whose autopsy revealed the incidental finding of pneumoconiosis silica, confirming later in the interview with the family who held his job at a company producing artificial marble and an occupational disease (AU)

Autopsia por silico-asbestosis. Revisión a propósito de un caso forense / Autopsy by silico-asbestosis. A review of a forensic case

Se presenta el caso de un varón de 72 años de edad, ex fumador desde hace años, diagnosticado de silicosis y carcinoma epidermoide de pulmón derecho, solicitándose por parte de la familia autopsia judicial por la sospecha de padecimiento de asbestosis y tras su confirmación reclamación como enfermedad profesional. La exposición de este suceso nos permite realizar una revisión de una enfermedad profesional que suele pasar como desconocida en las salas de autopsia, a pesar de su repercusión judicial. La asbestosis es un tipo de neumoconiosis reconocida como enfermedad profesional producida por la inhalación de fibras de asbesto. Su inhalación provoca fibrosis pulmonar. Presenta un tiempo de latencia clínica inversamente proporcional al nivel de exposición. Además de fibrosis pulmonar pueden producirse derrames pleurales, placas fibrosas pleurales, mesoteliomas, carcinomas pleurales y carcinoma de laringe. La silicosis es la neumoconiosis producida por inhalación de partículas de sílice, entendiendo por neumoconiosis la enfermedad ocasionada por el depósito de polvo en los pulmones con una reacción patológica frente a este, en especialde tipo fibroso. La silicosis es una enfermedad fibrótica-pulmonar de carácter irreversible y considerada enfermedad profesional incapacitante en muchos países, una de cuyas variantes más raras es la silico-asbestosis, la cual requiere exposición al sílice y al amianto (AU)

The case is presented the case of a 72-year-old ex-smoker for years, diagnosed with silicosis and squamous cell carcinoma of the right lung, being requested by the judicial autopsy family suspected of suffering from asbestosis and after confirmation complaint as an occupational disease. The exposure of this event allows us to conduct a review of an occupational disease usually happens as unknown in autopsy rooms despite its legal repercussions. Asbestosis is a type of pneumoconiosis recognized as an occupational disease caused by inhaling asbestos fibers. Inhalation causes pulmonary fibrosis in the lung presenting a time inversely proportional to the exposure level clinical latency. Besides pulmonary fibrosis may occur pleural effusions, pleural fibrous plaques, mesothelioma, pleural carcinomas and laryngeal carcinoma. Silicosis is produced by inhalation pneumoconiosis silica particles, meaning the disease caused by pneumoconiosis dust deposit in the lungs with a pathological reaction to the same, especially fibrous. Silicosis is a fibrotic lung disease-and considered irreversible disabling occupational disease in many countries one of which is the more rare variants silico asbestosis, which requires exposure to silica and asbestos (AU)

Simulación de anisocoria postraumática / Posttraumatic anisocoria simulation

En la práctica forense es relativamente frecuente encontrar individuos que elaboran o exageran síntomas de enfermedades, de manera consciente, con la intención de obtener una ganancia; en otras ocasiones atribuyen malformaciones o patologías previas a un nuevo evento traumático. Por ello es preciso ser minuciosos a la hora de establecer el nexo causal. Se presenta el caso de un individuo que pretende atribuir la secuela de anisocoria traumática a una agresión. El médico forense, con la colaboración de la Policía Científica, pudo demostrar que el origen de la lesión era previo, no pudiéndose establecer el nexo causal (AU)

In forensic practice is relatively common to find individuals who produce or exaggerate symptoms of disease, consciously, with the intention of making a profit. Sometimes, malformations or previous pathologies attributed to a new traumatic event. It is therefore necessary to be careful when establishing causation. Today we bring, the case of an individual who seeks to attribute the traumatic aftermath of an attack anisocoria. The Forensic Physician, with the collaboration of the Scientific Police, was able to demonstrate that the origin of the injury was before, not being able to establish a causal link (AU)

Rotura de bazo en dos tiempos / Two-Stages Splenic Rupture

El caso que traemos hoy a colación es el de un varón de 45 años de edad, que es encontrado muerto en su domicilio, refiriendo los vecinos que había sufrido una agresión 3 días antes. La inspección reveló algunas lesiones leves en la cabeza y los miembros, no mostrando el abdomen signos de violencia. La elasticidad de las paredes abdominales permite que la fuerza de un traumatismo se transmita rápidamente a los órganos internos. Esta misma laxitud sería la causa de la coexistencia de graves daños internos en ausencia de lesiones externas. En el caso de que haya cierto grado de anticipación pueden contraerse los músculos abdominales, con lo que se atenúan las lesiones. Las contusiones abdominales pueden ocasionar daños en los órganos internos de distinta índole. Destacan por su frecuencia las roturas hepáticas y en segundo lugar las esplénicas. Las lesiones abdominales en los traumatismos cerrados (sin comunicación entre la cavidad peritoneal y el exterior) pueden permanecer latentes varias horas, e incluso días, apareciendo de forma diferida los síntomas de irritación peritoneal (AU)

The case showed in this article is a forty five years old man who was founded dead at home suffering an aggression three days before, from what his neighbors told to police. Forensic inspection showed several head and limbs slight injuries without violence abdominal signs. Abdomen walls elasticity causes a fast traumatic force transmission to internal organs. This elasticity also explains serious internal injuries without external lesions. In case there exist certain anticipation, abdominal musculature contraction could lessen these injuries. Abdominal contusions could cause several damages types to internal organs. The most important are hepatic ruptures, and on the second place there are splenic ruptures. Abdominal injuries caused by closed traumatisms (without any connection between the peritoneal cavity andthe outside), could stay latent for many hours, even days, appearing peritoneal irritation delayed symptoms (AU)

Isolation of prebiotic carbohydrates by supercritical fluid extraction. Scaling-up and economical feasibility.

Production of prebiotic carbohydrates at competitive prices is a challenge nowadays since the well-established production processes involve many purification steps which are labour intensive and require important amounts of reagents and products thus increasing prebiotic's price. Several processes have been studied in our laboratory involving the use of Supercritical Fluid Technology to fractionate and purify carbohydrate solid mixtures. Research carried out at laboratory scale using theoretical mixtures (lactose/lactulose and galactose/tagatose), commercially available carbohydrate mixtures and carbohydrate mixtures produced by enzymatic transglycosylation and isomerized with complexating reagents demonstrated that purification of prebiotic carbohydrates was technically possible by supercritical fluid extraction. In the present work, the process optimized at laboratory scale to fractionate carbohydrate mixtures produced by enzymatic transglycosylation has been scaled-up to an industrial level and its economic feasibility has been simulated employing AspenONE(®) V7.3 software to obtain consistent data supporting the interest of a potential investment for prebiotics production at large scale using supercritical fluids.

Effect of glycation on sodium caseinate-stabilized emulsions obtained by ultrasound.

This work explores the potential of high-intensity ultrasound to produce fine-dispersion, long-time-stable, oil-in-water emulsions prepared with native and glycated bovine sodium caseinate (SC). Regardless the ultrasound amplitude and time assayed, the sonicated emulsions of native SC at 0.5 mg/mL had much higher emulsifying activity indexes compared with those emulsions formed by Ultra-Turrax (IKA Werke GmbH & Co., Staufen, Germany) homogenization. Nevertheless, the native SC emulsions were very unstable despite the optimization of parameters such as protein concentration, amplitude of ultrasound wave, and sonication time by using a Box-Behnken design. Early glycation of SC with either galactose, lactose, or 10 kDa dextran substantially improved both emulsifying activity and the stability, whereas at advanced stages of glycation, SC emulsions showed notably reduced emulsifying properties, likely because extensive glycation of SC promoted its polymerization mainly through covalent cross-linking, as was demonstrated by particle size measurements. The increase in particle diameter of glycoconjugates likely affected the diffusion of SC from bulk to the oil-water interface and slowed the reorientation process of the protein at the interface. These findings show that the combined effect of early-stage glycation of SC and high-intensity ultrasound as an emergent technique to form emulsions has the potential to provide improved emulsions that could be used in several food applications.

Herida inciso-punzante y escápula alata: a propósito de un caso / Sharp injury and winged scapula: about a case

La peligrosidad de las heridas inciso-punzantes viene determinada por su situación y por la existencia de estructuras vitales subyacentes; alcanzando una mayor gravedad, las localizadas en tórax y cuello. Las lesiones cervicales adquieren un peor pronóstico vital cuando se afectan los grandes vasos o la vía aérea, pudiendo quedar secuelas incapacitantes por lesión de los nervios que discurren por la zona. En el siguiente artículo exponemos un caso de herida inciso-punzante laterocervical izquierda, con lesión (neurotmesis) del nervio accesorio o espinal (XI par craneal), que determina la aparición de una escápula alada, signo característico de esta lesión (AU)

The danger of incised wounds is determined by their position and the underlying vital structures, and the ones localized in the torax are more serius. Cervical lesions get worse vital pronostic when they affect great vessels and the airway. This could result in the disability of the nerves which flow in this area. In the next article, we present one left lateral-cervical incised wound case, with an accesory nerve (spinal accesory nerve or XI C.N.) disorder (neurotmesis), which determine the appearance of a winged scapula. The winged scapula is the characteristic sign of this lesion (AU)

Asfixia autoerótica: La escena de la muerte / Autoerotic asphyxia. The scene of the death

En números anteriores de nuestra revista se han tratado, con profusión de imágenes, las asfixias mecánicas; tanto en su aspecto macroscópico, como microscópico. Hoy mostramos una ahorcadura, atípica hasta hace escaso tiempo en nuestro medio, la "asfixia autoerótica". El diagnóstico de la naturaleza de la muerte (accidental, suicida e incluso homicida) ha sido muy discutido, teniendo un papel fundamental en su aclaración, la Diligencia de Levantamiento de Cadáver. Un examen meticuloso del lugar de los hechos nos va a orientar de manera definitiva sobre la naturaleza del óbito (AU)

In previous numbers of our magazine one has treated, with profusion of images, the asphyxiations mechanics; so much in their macroscopic aspect, as microscopic. Today we show a hanging, atypical up to scanty time ago in our way, the "autoerotic asphyxiation". The diagnosis of the nature of the death (accidental, suicidal and enclosed killer) has been very controversial, having a fundamental role in his explanation the scene of the death. A meticulous examination of the place of the facts is going to orientate us in a definitive way on the nature of the death (AU)

Purification of lactulose from mixtures with lactose using pressurized liquid extraction with ethanol-water at different temperatures.

The viability of the purification of lactulose from a mixture with lactose [70:30 (w/w)] using pressurized liquid extraction (PLE) at 1500 psi for 30 min was studied. Different temperatures (from 40 to 130 degrees C) and proportions of ethanol:water (70:30, 80:20, 90:10, 95:5, and 100:0) as the extraction solvent were assayed. Lactose and lactulose were measured by gas chromatographic analysis as their trimethylsilyl derivatives. Data were fitted through multiple linear regressions to different quadratic models to describe both the extraction yield (in terms of mg of lactulose) and the purity of the lactulose extracted. The optimum extraction conditions provided by the model were as follows: extraction temperature, 40 degrees C; and solvent composition, 70:30 ethanol:water. PLE extraction under the optimized conditions was also applied to purify lactulose from lactose in a synthesis mixture. To our knowledge, this is the first time that PLE has been tested for extraction and purification of lactulose from its mixture with lactose; this technique showed several advantages over classical methods such as the short extraction time and the low solvent consumption.

Intoxicación por Monóxido de Carbono / Poisoning by carbon monoxide

Numerosos autores recomiendan la realización de análisis toxicológico, prácticamente en todos los casos forenses, especialmente, cuando tras el examen macroscópico no aparece suficientemente aclarada la causa de la muerte. La ausencia de lesiones patognomónicas en la mayoría de las intoxicaciones avalan la recomendación anterior; sin embargo, en algunos casos los hallazgos en la autopsia son indicativos del agente causal. Así vemos como la coloración rojo cereza de las livideces cadavéricas van a ser muy sugestivas de intoxicación por monóxido de carbono o cianuro

Several authors recommend to perform a toxicological analysis in practically every forensic autopsy, specifically when the macroscopical examination does not reveal sufficiently the cause of death. The absence of pathognomonic findings in the majority of poisonings support this recommendation. However; in some cases autopsy findings are indicative of the causative agent. For instance, the red cherry coloration from livor mortis are suggestive of a carbon monoxide or cyanide poisoning

Síndrome de Asfixia Sumersión / Asphyxia Drowning Syndrome

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Contusión figurada en precipitación / Figured bruise from a fall

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Saponificación cadavérica parcial / Partial cadaverous saponification

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Gemcitabine in the treatment of advanced transitional cell carcinoma of the urothelium.

M-VAC (cisplatin, methotrexate, adriamycin, vinblastine) combination chemotherapy has been for long time the standard of care in fit patient with advanced urothelial tumors. Gemcitabine/cisplatin with similar results and an improved toxicity profile has proved to be a new standard alternative. Whether or not we can improve survival with newer triplet regimens will depend upon the results of ongoing phase III trials. In addition to the new active drug combinations and targeted therapies, new approaches are emerging for treatment. Chemotherapy optimization using molecular markers predicting chemosensitivity are being applied. There is an obvious need to incorporate in clinical trials a systematic translational approach to explain both our successes and our failures.

Use of chitosan for selective removal of beta-lactoglobulin from whey.

A method is described for selective removal of undenatured beta-lactoglobulin from cheese whey based on interactions between whey proteins and chitosan. Whey was previously clarified at pH 4.5 with addition of chitosan (25 mg/100 mL), and selective removal of beta-lactoglobulin was studied in the pH interval 4.6 to 6.5. Addition of chitosan caused selective precipitation of beta-lactoglobulin that increased with pH. The content of beta-lactoglobulin in whey decreased as the amount of chitosan added was increased. At pH 6.2, addition of 1.9 to 3.0 mg/mL of chitosan led to complete removal of beta-lactoglobulin, whereas at least 80% of the rest of whey proteins remained in solution. The production of cheese whey without beta-lactoglobulin could help to expand the applications of dairy by-products in food processing, and to isolate hypoallergenic whey protein concentrates.