Unveiling the tartrazine binding mode with ds-DNA by UV-visible spectroscopy, electrochemical, and QM/MM methods.

Here, we studied the interaction between the food colorant tartrazine (TZ) and double stranded DNA (dsDNA), using spectroscopic, electrochemical, and computational methods such as QM/MM combined with TD-DFT. Despite the UV-vis spectroscopy is widely used to study the interaction between molecules, for the case of TZ there are discrepancies in the analyses presented in the literature available, presenting both hyperchromic and hypochromic effects and consequently different rationalizations for their results. Herein we propose the combination of UV-vis experiments with the design of high-level computational models capable of reproducing the experimental behavior to finally define the proper binding mode at the molecular scale together with the rationalization of the experimental optical response due to the complex formation. To complement the UV-vis experiments, we propose the use of electrochemical measurements, to support the results obtained through UV-vis spectroscopy, as it has been successfully used for the determination of interaction modes between small molecules and biomolecules in any condition. Our UV-vis spectroscopy experiments showed only a hypochromic effect of the absorption spectra of TZ after interaction with DNA, indicative of TZ being deeply buried in the DNA structure. The effect of ionic strength in the experimental procedures led to the dissociation of TZ, thus indicating that the interaction mode was groove binding. On the other hand, the electrochemical studies showed an irreversible reduction peak of TZ, which after the interaction with DNA exhibited a positive shift in potential that can be attributed to groove binding. The binding constant for TZ-DNA was calculated as 4.45x104M-1 (UV-vis) and 5.75x104M-1 (electrochemistry), in line with other groove binder azo dyes. Finally, through the QM/MM calculations we found that the minor-groove binding mode interacting in zones rich in adenine and thymine was the model best suited to reproduce the experimental UV-vis response.

Responses of monogenean species to variations in abiotic parameters in tilapiculture.

Fish farming is becoming an increasingly popular agricultural activity, and water quality in these environments is a major concern. Fish parasites, such as monogeneans, respond to changes in abiotic conditions, either with an increase or decrease in population. This study aimed to identify gill monogeneans and analyse their relationships with abiotic factors during the ontogenetic development of Nile tilapia over the fish culture cycle in Mato Grosso do Sul, Brazil. Fish were sampled monthly for eight months, and a total of 200 fish were collected. The physical and chemical water parameters were measured and correlated with the abundance of each monogenean species. Over the fish culture cycle, the physical and chemical parameters fluctuated, and the water quality decreased. The parasites found included Cichlidogyrus tilapiae, Cichlidogyrus thurstonae, Cichlidogyrus sclerosus, Cichlidogyrus halli and Scutogyrus longicornis. The abundances of all species showed significant differences during ontogenetic development (body size) and C. tilapiae, C. sclerosus, C. thurstonae and S. longicornis were correlated with changes in abiotic conditions. However, C. halli was not significantly correlated with any of the evaluated physical or chemical parameters. Understanding how different monogenean species respond to changes in the physical and chemical parameters of water during a production cycle can prevent peaks in abundance and subsequent sanitary problems.

Thermoluminescence emission on lead oxychloroborate glasses under UV exposure.

Glassy materials were prepared using two different systems: 50B2 O3 - (50 - x)PbO - xPbCl2, with x = 0, 2 and 5 in mol % (System BPCl-I) and 50BO1.5 - (50 - x)PbO - xPbCl2 with x = 0, 2, 5 and 7 in cationic % (System BPCl-II). Structural and optical characterization showed that PbCl when substituted for PbO changed the structure of the glass network by replacing nonbridging oxygens for chlorine ions. This substitution also caused a change in the number of defects responsible for thermoluminescence (TL) emission (electrons and hole trap centres). Thermoluminescence emissions were observed for the first time in lead oxychloroborate glasses after exposure to UV radiation. Sample BPCl-I-2 (x = 2 from System I) demonstrated better TL emission compared with other glass samples. One intense peak in the glow curve, centred at ~122°C followed by a shoulder at ~180°C, was highly sensitive to UV radiation. There were also good linear responses at dose range ~0.4 to ~2 J/cm2 for the first peak (low temperature) and ~0.4 to ~4 J/cm2 for the second peak (high temperature).

Predictors of short- and long-term recurrence of suicidal behavior in borderline personality disorder.

OBJECTIVE: To evaluate the incidence of suicidal outcomes and risk factors for short- and long-term recurrence of suicidal behavior (SB) among high-risk borderline personality disorder (BPD) patients during a 24-month prospective follow-up period. METHODS: A multicenter prospective cohort study was designed to compare data obtained from 136 patients admitted to the emergency department for current suicidal ideation (SI) or a recent suicide attempt (SA). Subjects were clinically evaluated and monitored for a new SA or suicide. RESULTS: The incidence of a new SA was 25.63 events/100 persons-year, and one patient died by suicide. Child sexual abuse (CSA) was the only significant predictor throughout the complete follow-up period. The absence of prior psychiatric treatment predicts the recurrence of SB in the first 6 months of follow-up. Patient age, poor psychosocial functioning before hospitalization, age at first SA, and having multiple suicide attempts increased risk of SB recurrence at the long-term period (24th months). In addition, there was an interaction between CSA and poor psychosocial functioning that increased risk of SB. CONCLUSION: The risk of recurrence was higher during the first 6 months. Risk factors at 6 and 24 months vary. These findings are important for implementing suicide strategies.

Identification of bacterial and fungal species in human cadavers used in anatomy teaching / Identificación de especies bacterianas y fúngicas en cadáveres humanos utilizados en la enseñanza de la anatomía

Within the framework of undergraduate and postgraduate medical education, cadavers have been used to teach anatomy by dissection or by using prosected specimens. To accomplish this, an appropriated preservation process must guarantee that the cadaver is kept safe for harm, destruction, and decomposition. Embalming fluid contains fixatives, disinfectants, surfactants, buffers, salt, and water, making the cadaver safe for teaching anatomy. However, it remains unclear if there is any risk of dissemination of microorganisms during anatomy teaching, research, and dissection procedures on fixed cadavers. The purpose of this study is to identify bacterial and fungal species in fixed cadaveric material used in anatomy teaching. Samples of cadavers and anatomical sections were cultured and biochemical tests and molecular identification by polymerase chain reaction (PCR) were performed to identify the microorganisms. The results indicate that fixed cadaveric material has viable bacteria on its surfaces and almost all these correspond to gram-negative bacilli of the Enterobacteriaceae family. In conclusion, fixed cadavers could be a reservoir of bacteria. This study underscores the importance of generating safe manipulation protocols to avoid eventual contamination and disease.

Dentro del curriculum de los programas de postgrado y pregrado de las carreras de la salud, los cadáveres han sido utilizados para la enseñanza de la anatomía mediante la disección o utilizando preparados anatómicos. Para poder llevar a cabo esto, el cadáver debe pasar por un adecuado proceso de preservación; en el que se utilizan fluidos que contienen fijadores, desinfectantes, surfactantes, buffers, sal y agua, los cuales lo protegen del deterioro y la descomposición. Las soluciones fijadoras y conservadoras contienen desinfectantes, surfactantes, fijadores, buffers, sal y agua, que hacen que el cadáver sea seguro para la enseñanza de la anatomía. Sin embargo, no está claro si existe algún riesgo de diseminación de microorganismos durante la enseñanza, investigación y/o disección en estos cadáveres. El propósito del estudio es identificar especies bacterianas y/o fúngicas en material cadavérico previamente fijado, usado en la enseñanza de la anatomía. Se realizaron cultivos y técnicas de identificación molecular mediante reacción en cadena de polimerasa de muestras tomadas desde material cadavérico para identificar los microorganismos encontrados. Los resultados indican que el material cadavérico previamente fijado posee bacterias en sus superficies, la mayoría corresponde a bacilos gram negativos de la familia de las Enterobacteriaceae. En conclusión, los cadáveres previamente fijados pueden ser reservorio de bacterias. Este estudio destaca la importancia de generar protocolos de manipulación con el fin de evitar una posible contaminación y enfermedad.

Aneurisma de la vena de Galeno: diagnóstico prenatal y manejo / Vein of Galen aneurysm: prenatal diagnosis and management

RESUMEN Las malformaciones vasculares cerebrales son infrecuentes, dentro de ellas, el aneurisma de la vena de Galeno (AVG) tiene una incidencia de 1 en 25.000 recién nacidos. El ultrasonido obstétrico de rutina ha permitido el diagnóstico prenatal de dicha alteración, permitiendo establecer el pronóstico del recién nacido. En la exploración mediante ultrasonido del cerebro fetal, la presencia de una imagen quística supratentorial con flujo turbulento al Doppler color permite establecer el diagnóstico. La asociación con signos de insuficiencia cardiaca ha mostrado altas tasas de mortalidad neonatal. Se presenta el caso de un feto al que se realiza el diagnóstico prenatal mediante ultrasonido y su confirmación por neuroimagenes al nacimiento.

ABSTRACT Cerebral vascular abnormalities are rare. The vein of Galen aneurysmal malformation (VGAM) has an incidence of 1 in 25,000 newborns. The routine obstetric ultrasound has allowed the prenatal diagnosis and establish the prognosis of the newborn. In the ultrasound examination of the fetal brain, the presence of a supratentorial cystic image with turbulent flow to the color Doppler makes the diagnosis. The association with signs of heart failure have shown high neonatal mortality. We present a case of a fetus with prenatal diagnosis of VGAM by 2D ultrasound and confirmation by neuroimaging at birth.

PTI y embarazo: una experiencia con rituximab / ITP and pregnancy: an experience with rituximab

El Púrpura Trombocitopénico Idiopático (PTI) es una patología asociada a una de cada 500 a 1000 gestantes. Su reconocimiento oportuno y adecuado manejo durante el embarazo, permite reducir la morbimortalidad tanto materna como fetal. Los corticoides como tratamiento de primera línea para PTI en embarazadas, es igual que en población general, con respuestas observadas entre el 5° y 7° día, alcanzando un 50 - 60% de éxito. El caso que presentamos se trata de una gestante en el 2° trimestre tardío con PTI refractario al tratamiento con corticoides, con muy bajos niveles de plaquetas y alto riesgo de hemorragia, por lo cual se decide el uso de Rituximab, un anticuerpo monoclonal (categoría C de la FDA) con escasa prescripción en el embarazo. Exponemos nuestra experiencia en este caso.

Idiopathic thrombocytopenic purpura ( ITP) is a condition associated with each 500-1000 pregnancies . Its early recognition and proper management during pregnancy, can reduce both maternal and fetal morbidity and mortality. Corticosteroids as first-line treatment for ITP in pregnant women is the same as in the general population, with responses observed between the 5th and 7th day, approximately 50-60 % of patients respond favorably. The case presented is a pregnant patient in the 2th trimester with refractory ITP treatment with corticosteroids, very low levels of platelets and high risk of bleeding so the use of Rituximab is decided, a monoclonal antibody (category C FDA) with little prescription in pregnancy. We describe our experience in this case.

Differences between female suicidal patients with family history of suicide attempt and family history of completed suicide.

BACKGROUND: Family history of suicidal behavior and suicide are both risk factors for suicide. However, the effects of family history of suicide versus suicide attempts on patient suicidal behavior remain unclear. The aim of the present study was to understand if family history of suicide as compared to family history of suicide attempts or no family history of suicidal behavior evidences different associations with suicidal behavior among psychiatric patients. METHOD: Participants included 157 female patients between the ages of 18 and 65years admitted at the Dr. Braulio A. Moyano Neuropsychiatric Women's Hospital. RESULTS: Seventy-nine patients (50.3%) reported no family history of suicidal behavior (NFHSB), while 78 patients (49.7%) reported a family history of suicidal behavior. Specifically, 41 patients (26.1%) reported a family history of suicide attempt (FHSA) and 37 patients (23.6%) reported a family history of suicide (FHS). These groups showed significant differences between family history of psychopathology and number of previous suicide attempts. Patients with an FHSA were more likely to present with a greater number of previous suicide attempts as compared to patients with NFHSB and FHS. CONCLUSION: There is an association between the number of suicide attempts and family history of suicide attempts in female patients hospitalized for suicidal behavior.

Kinesiología en pacientes con fibrosis quística en atención primaria de salud / Physioterapy for cystic fibrosis patients in primary health care

Physiotherapy is a mainstay treatment of cystic fibrosis (CF) patients. It has been adapted to the greater survival of patients and is partly responsible for this achievement. The scope of the physiotherapist in this condition should not focus only on “bronchial hygiene”, because as CF is a systemic disease. It must consider the individual as a whole, and therefore include: education and use of aerosol therapy, encouragement and advice in general physical activity and sports, posture and mobility, noninvasive ventilatory assistance, rehabilitation and transplantation. The physiotherapist must be highly trained, have deep knowledge of the disease and the ability to integrate a multidisciplinary team to determine the best therapeutic actions required by each patient. This article shows the physiotherapist’s main actions, as part of a multidisciplinary team to treat CF patients. However, no reference is made to post transplant physiotherapy, situation that requires a particular approach that is beyond the scope of this manuscript.

La kinesiología respiratoria se ha constituido un pilar fundamental del tratamiento y manejo de la enfermedad, la cual se ha adaptado a los cambios que ha implicado la mayor sobrevida de los pacientes con fibrosis quística (FQ) y en parte es responsable de este logro. El campo de acción del kinesiólogo en esta patología no sólo debe estar enfocando en la “higiene bronquial”, ya que como se trata de una patología sistémica debe considerar al individuo en su totalidad, por lo el enfoque debe incluir también: educación y uso de la aerosol terapia, incentivo y asesoramiento de en la actividad física general y deportes, postura y movilidad, asistencia ventilatoria no invasiva, rehabilitación y trasplante. El kinesiólogo que trate paciente con fibrosis quística, debe ser un profesional altamente capacitado, con conocimientos profundos de la enfermedad con la capacidad de integrar un equipo multidisciplinario que determine las mejores actuaciones terapéuticas requeridas por cada paciente en forma particular. En este artículo se han abordado las principales actuaciones del profesional Kinesiólogo integrante de un equipo multidisciplinario requerido para el tratamiento de los paciente con FQ, sin embargo no se ha abordado el manejo kinésico en paciente trasplantado que requiere un enfoque particular que escapa a la intención de esta publicación.

Caracterización de una población con discapacidad visual (baja visión y ceguera) atendida en dos instituciones prestadoras de salud de Medellín / Characterization of a population with visual disabilities (low vision and blindness) attended in two health institutions from Medellín / Caracterização de uma população com incapacidade visual (baixa visão e cegueira) atendida em duas instituições prestadoras de saúde de Medellín

Objetivo: caracterizar, en los ámbitos clínico y sociodemográfico, una población de pacientes con discapacidad visual atendidos en dos instituciones de salud de la ciudad de Medellín (departamento de Antioquia/Colombia), con énfasis en la etiología del déficit visual irreversible. Metodología: estudio observacional descriptivo. Estudio macro sobre deficiencias visuales unilaterales y bilaterales en 1 742 registros de historias clínicas para identificar pacientes con baja visión o ceguera. Aplicación de un formato de investigación orientado a validar los pacientes con discapacidad visual y se seleccionaron 107 historias clínicas. Resultados: el 56.6% presenta discapacidad visual tipo baja visión y el 43.4% discapacidad visual tipo ceguera. El déficit visual responsable de la discapacidad visual fue del 39% por causas oftalmológicas, 20% por alteraciones neuro-oftalmológicas y 17% por trastornos neurológicos de cortezas visuales. Además de la agudeza visual, se encontraron otras deficiencias de la función visual: atrofia óptica, alteración electrofisiológica de la conducción visual y encefalomalacia en cortezas visuales. El 82% de los pacientes tiene al menos una comorbilidad no oftalmológica. Conclusiones: es fundamental un adecuado registro de las características biológicas, sociales, psicológicas y de las actividades de rehabilitación de los pacientes con baja visión y ceguera, para entender en forma integral no sólo la discapacidad sino el impacto que produce.

Objective: to characterize the clinical and socio-demographical characteristics of a population of patients with visual impairment attended at two health institutions in Medellín (Antioquia, Colombia), with an emphasis on the etiology of irreversible vision loss. Methodology: Observational, descriptive study of unilateral and bilateral visual impairment in 1 742 medical records to identify patients with low vision or blindness. A research form was used to validate patients with visual impairment, and 107 medical records were selected. Results: 56.6% presented low vision and 43.4% presented blindness. Vision loss was due to ophthalmic causes in 39% of cases, 20% were caused by neuro-ophthalmic alterations and 17% by neurological disorders of the visual cortex. In addition to visual acuity, other visual impairments were found, such as optic atrophy, electrophysiological alteration of the visual pathway, and encephalomalacia in visual cortices. 82% of patients had at least one nonophthalmic comorbidity. Conclusions: Adequate registration of rehabilitation activity, biological, social, and psychological characteristics of patients with low vision and blindness is essential in order to fully understand both the impairment and its impact.

Objetivo: caracterizar, nos âmbitos clínico e sócio-demográfico, uma população de pacientes com incapacidade visual atendidos em duas instituições de saúde da cidade de Medellín (departamento de Antioquia/Colômbia), com énfase na etiologia do déficit visual irreversível. Metodologia: estudo observacional descritivo. Estudo macro sobre deficiências visuais unilaterais e bilaterais em 1 742 registros de histórias clínicas para identificar pacientes com baixa visão ou cegueira. Aplicação de um formato de investigação orientado a validar os pacientes com incapacidade visual e se selecionaram 107 histórias clínicas. Resultados: 56.6% apresenta incapacidade visual tipo baixa visão e 43.4% incapacidade visual tipo cegueira. O déficit visual responsável da incapacidade visual foi de 39% por causas oftalmológicas, 20% por alterações neuro-oftalmológicas e 17% por transtornos neurológicos de córtex visual. Ademais da agudeza visual, se encontraram outras deficiências da função visual: atrofia óptica, alteração eletrofisiológica da condução visual e encefalomalácia em córtex visual. 82% dos pacientes têm pelo menos uma comorbilidade não oftalmológica. Conclusões: é fundamental um adequado registro das características biológicas, sociais, psicológicas e das atividades de reabilitação dos pacientes com baixa visão e cegueira, para entender em forma integral não só a incapacidade senão o impacto que produz.

Fascitis eosinofílica: a propósito de un caso / Eosinophilic fasciitis: an account of a case

Eosinophilic fasciitis is a rare entity characterized by induration of skin and peripheral eosinophilia. The pathogenesis is still not well known, but is known association with hematological, autoimmune or neoplastic diseases. The complex and not well standardized treatment. For a patient of 66 years presented with a history of morphea...

La Fascitis Eosinofílica (FE) es una entidad muy infrecuente, caracterizada por induración de piel y eosinofilia periférica. La patogenia aún no es bien conocida, pero es sabida la asociación con enfermedades hematológicas, autoinmunes o neoplásicas. El tratamiento es complejo y no bien estandarizado. Se presenta el caso de una paciente de 66 años, con antecedentes de morfea...

Bioamplificador multicanal para la adquisición de la señal ECGAR, del prototipo DIGICARDIAC / Multichannel bioamplifier for ECGAR signal acquisition, DIGICARDIAC prototype

El prototipo DIGICARDIAC es un instrumento de uso médico que permite la adquisición simultánea de las doce derivaciones del electrocardiograma (ECG) estándar, con características de alta resolución (ECGAR). El presente trabajo reporta el desarrollo de la etapa de amplificación multicanal implementada en el hardware de este prototipo. Esta etapa consta de 8 amplificadores diferenciales en configuraciones especiales, con un elevado rechazo al ruido en modo común (CMRR). Los filtros utilizados permiten la corrección automática de la línea de base y la eliminación de señales de ruido por encima de los 300Hz. Adicionalmente se incorporaron los circuitos de protección correspondientes a un equipo médico. En las pruebas de funcionamiento se comprobó la eficiencia del dispositivo. Los resultados demostraron la superioridad del instrumento desarrollado en comparación con los electrocardiógrafos comerciales.

The prototype DIGICARDIAC is a medical instrument that allows the simultaneous acquisition the twelve lead of standard electrocardiogram (ECG), with high resolution features (ECGAR ). This paper reports the development the multichannel amplifier implemented in the hardware of this prototype. This section consists of 8 differential amplifiers in special configurations, with a high common mode rejection ratio (CMRR). The filters used allow automatic correction of baseline and eliminating noise signals above 300Hz. Additionally were incorporated protective circuits corresponding to a medical team. In the device operation testing efficiency was checked. The results demonstrated the superiority of the instrument developed in comparison with commercial electrocardiographs.

Inserción laparoscópica de catéter de diálisis peritoneal: experiencia de 3 años / Laparoscopic placement of peritoneal dialysis catheters: experience in 81 patients

Background: Laparoscopic placement of peritoneal dialysis catheters is associated with a lower rate of complications. Aim: To report the experience in laparoscopic placement of peritoneal dialysis catheters. Material and Methods: Review of medical records of 81 patients aged 15 to 90 years (42 males) subjected to the procedure between 2010 and 2013. Results: A three port plus omentopexy technique was used. Surgical time was 51 minutes. Other simultaneous surgical procedures were performed in four patients. No patient died, had a bowel perforation or required conversion to open surgery. Ninety eight percent of patients were discharged less than 24 hours after the procedure, using standard analgesics. Four patients required a new surgical procedure due to minor complications. All installed catheters were functional until the moment of his review. Conclusions: Laparoscopic placement of peritoneal dialysis catheters is a safe and effective procedure...

Objetivo: Describir la técnica quirúrgica usada en Hospital Regional de Talca (HRT) para la inserción laparoscópica de catéter de diálisis peritoneal y analizar sus resultados. Material y Método: Se realizó un estudio retrospectivo, descriptivo, mediante la revisión de fichas clínicas del total de pacientes sometidos a inserción laparoscópica de catéter de peritoneodiálisis en el HRT entre marzo de 2010 y abril de 2013. Se recopiló información sobre los pacientes, la técnica quirúrgica y complicaciones postoperatorias. Resultados: Total 81 pacientes, sin exclusiones, sometidos a cirugía bajo técnica laparoscópica de 3 puertos más omentopexia. Tiempo quirúrgico medio 50,9 min. Se realizó otro procedimiento quirúrgico simultáneo en 4 pacientes. No se reportaron perforación de víscera hueca ni conversión a cirugía abierta. No hubo mortalidad asociada al acto quirúrgico. El 97,5 por ciento tuvo alta quirúrgica antes de las 24 h postoperatorias, con requerimientos analgésicos estándar. Sólo 4 pacientes requirieron reintervención quirúrgica por complicaciones menores y en 4 se realizó laparoscopia diagnóstica tardía por dolor. El 100 por ciento de los catéteres instalados bajo esta técnica permanecen funcionales hasta el momento del corte de la serie. Conclusión: Nuestra experiencia es comparable con otras series a nivel mundial, siendo un procedimiento reproducible de manera segura y costo-efectiva...

Theoretical insights into the adsorption of neutral, radical and anionic thiophenols on gold(111).

The interaction of thiol and thiolate containing molecules with gold (S-Au) has gained increasing interest because of its applications in molecular electronic devices and catalysis. In this context, the enhanced conductivity of thiophenol compared to alkanethiol represents an opportunity to develop more sensitive and selective gold-based devices by incorporating molecules with the aryl-thiol moiety into their structures. As has been proposed earlier, the thiol moiety is deprotonated after binding to gold, hence, we present here a comparative study of the S-Au bond strength between several neutral and deprotonated aromatic-sulfur systems in their anionic and radical forms with a detailed description of the nature of this interaction. The study was performed by means of computational chemistry methods, using a cluster of 42 Au atoms as a model of the Au(111) surface that allowed us to provide new chemical insights to control the S-Au interface interaction strength. Our results revealed that the thiophenols-gold interaction is mainly dispersive where the interaction energies range between 31 and 43 kcal mol(-1). The radical and anionic thiophenolates-gold interaction increases due to a strong charge transfer character, depicting interaction energies in the range of 50 to 55 kcal mol(-1) and 62 to 92 kcal mol(-1), respectively. These results suggest that for the anionic thiophenolate the binding strength can be tailored according to the electron-donor capabilities of the ligand which in turn can be finely tuned by several substituents. Our results are of possible impact for the design of new devices.

Signo de la cimitarra / Scimitar sign

The scimitar sign refers to the image resembling a short, curved Turkish sword called scimitar, created by an anomalous pulmonary vein. It can be seen in chest radiography, computed tomography and magnetic resonance. It forms part of the scimitar syndrome, characterized by partial or total anomalous pulmonary venous drainage, associated with hypoplasia of the right lung and dextrocardia. Depending on the magnitude of the right-to-left shunt, it may present in children with pulmonary hypertension and right cardiac failure, or as asymptomatic imaging findings in adults.

El signo de la cimitarra es la imagen creada por una vena pulmonar anómala similar a una espada turca, corta y curva llamada cimitarra. Se puede ver en radiografía de tórax, tomografía computada y resonancia magnética. Forma parte del síndrome de la cimitarra, caracterizado por un drenaje pulmonar anómalo, parcial o total, asociado a hipoplasia del pulmón derecho y dextrocardia. Dependiendo de la magnitud del shunt de derecha a izquierda producido, se puede presentar en edades infantiles con hipertensión pulmonar y falla cardiaca derecha, o en adultos, de manera asintomática, como hallazgo imagenológico.

Resultados del tratamiento con revascularización distal y ligadura intermedia, de la isquemia de mano después de acceso vascular para hemodiálisis / Distal revascularization-interval ligation for ischemic steal syndrome after hemodialysis access: experience in 23 patients

Background: The creation of vascular accesses for hemodialysis can cause distal ischemia and steal syndromes. Aim: To assess the effectiveness of the technique of distal revascularization-interval ligation to alleviate distal ischemia and preserve vascular access. Material and Methods: Retrospective review of medical records, identifying 23 patients (13 women, aged between 24 and 79 years), with distal ischemia secondary to a vascular access for hemodialysis, that were treated with distal revascularization-interval liga-tion. Patient characteristics and outcome of the surgical procedure were recorded. Results: Fourteen patients were diabetic and 15 had high blood pressure. All had the vascular access in the elbow, 20 were done with vein and three were prosthetic. Steal appeared in a lapse ranging from hours to six years after performing the procedure. In 14 patients it appeared before 12 months. Revascularization was performed between 1 day and three months after the appearance of the steal syndrome. Seventeen patients (74 percent) had a substantial relief of ischemic symptoms, with healing of ulcers and digital amputations. Three patients died soon after the procedure (13 percent). In two the pain persisted, requiring a banding of the access, that finally became thrombosed. One patient required a distal forearm amputation. Thirteen patients (56 percent) had a late death after the procedure. After revascularization, the vascular accesses were used for a mean of two years. Conclusions: Revascularization-interval ligation relieves distal ischemia and maintains the patency of the vascular access for hemodialysis. Patients with steal syndrome secondary to vascular access are of high risk.

Objetivo: Investigar la efectividad de la técnica de revascularización distal y ligadura intermedia (RDLI) en aliviar la isquemia y preservar el acceso arteriovenoso. Material y Métodos: Una revisión retrospectiva de fichas clínicas (1990-2010), identificó 26 pacientes con robo. Se excluyen 3, que se sometieron a ligadura del acceso; 23 fueron tratados con RDLI. Se obtuvo información demográfica, comorbilidades, antecedentes del acceso, morbimortalidad y respuesta al tratamiento. Resultados: De los 23 pacientes, 13 eran mujeres y 10 hombres, con edad promedio de 59 años (24-79 años). Catorce (61 por ciento) eran diabéticos y quince (65 por ciento) hipertensos. Todos con acceso en pliegue del codo, 20 con vena y 3 protésicos. La latencia en aparición del robo ocurrió antes de 12 meses, en 14 pacientes (78 por ciento); con rango desde horas a 6,5 años. La revascularización se realizó en tiempo variable entre 1 día y 13 meses; sólo 8 pacientes antes de los 30 días. El 74 por ciento de los pacientes (17), tuvo mejoría sustancial o completa de manifestaciones isquémicas, cicatrizando úlceras y amputaciones digitales. Tres fallecieron precozmente; en 2 pacientes, persistió el dolor, requiriendo banding del acceso, que finalmente se trombosó; un paciente debió ser amputado del antebrazo distal, pese a revascularización, al no ceder cuadro infeccioso. La mortalidad operatoria fue de 13 por ciento, correspondiendo a 3 pacientes muy deteriorados con isquemia severa. La mortalidad tardía fue de 56,5 por ciento (13 pacientes). El tiempo promedio de uso del acceso fue de 2 años, post revascularización. Conclusión: La RDLI es el procedimiento de elección en el tratamiento del robo, ya que elimina efectivamente la isquemia y mantiene en uso el acceso. Los pacientes con robo, especialmente diabéticos, representan un grupo de alto riesgo y mortalidad.

Hemorragia incoercible por trauma maxilofacial: experiencia del Hospital del Trabajador / Management of intractable bleeding facial trauma

Introduction: The aim of this paper is to show our experience in the management of intractable bleeding facial trauma during the past 10 years to determine its impact on our environment and outline the basic principles of treatment. Methods: A retrospective study of all patients with maxillofacial trauma and uncontrollable bleeding from 1999 to 2009. Inclusion criteria were oro-nasal bleeding secondary to maxi-llofacial trauma requiring emergency treatment by a specialist, without other associated lesions that could be a source of bleeding. We obtained demographic information, mechanism of injury, diagnosis of injury, hemodynamic status, type and timing of tamponade, definitive surgical treatment, results and evolution. Results: 21 patients in the study period, a true incidence of 0.002 percent. 7 patients (33.3 percent) with trauma naso-septal; 5 (23.8 percent) with panfacial fractures, and 7 (33.3 percent) with variable involvement of the upper and middle face. Nine patients (42.9 percent) had isolated facial injuries. Only 5 patients (23.8 percent) had hemodynamic compromise. Thirteen patients (61.9 percent) required posterior nasal packing with or without another procedure to control bleeding. Eight patients (38.1 percent) required early reduction and internal fixation as definitive treatment. Conclusions: Maxillofacial trauma uncontrollable bleeding is uncommon and rarely is the primary cause of hypovolemic shock. It should be suspected in patients with facial injuries from hours bleeding. The packing, suturing of wounds and reduce/OTS are the mainstays of early treatment.

Introducción: El objetivo del presente trabajo es mostrar nuestra experiencia en el manejo de la hemorragia incoercible por trauma facial durante los últimos 10 años, para determinar su incidencia y delinear los principios básicos del tratamiento. Material y Método: Estudio retrospectivo de todos los pacientes con hemorragia incoercible por trauma maxilofacial entre 1999 y 2009. Criterios de inclusión fueron hemorragia oro-nasal secundaria a traumatismo maxilofacial, sin otras lesiones asociadas que pudieran ser fuente de hemorragia, que requirió de tratamiento de urgencia por un especialista. Se obtuvo información demográfica, mecanismo de injuria, diagnóstico del traumatismo, estado hemodinámico, tipo y momento del tratamiento especializado, tratamiento quirúrgico definitivo, resultados y evolución. Resultados: 21 pacientes en el período de estudio, con incidencia real de 0,002 por ciento. Destacan 7 pacientes (33,3 por ciento) con trauma nasoseptal, con o sin heridas faciales; 5 (23,8 por ciento) con fracturas panfaciales; 7 (33,3 por ciento) con compromiso variable del tercio superior y medio de la cara. Nueve pacientes (42,9 por ciento) presentaron lesiones faciales aisladas. 5 pacientes (23,8 por ciento) presentaron compromiso hemodinámico. Trece pacientes (61,9 por ciento) necesitaron un taponamiento nasal posterior, asociado o no a otro procedimiento para el control de la hemorragia. Ocho pacientes (38,1 por ciento) necesitaron reducción y osteosíntesis precoz como tratamiento definitivo. Conclusiones: La hemorragia incoercible por trauma maxilofacial es poco frecuente y rara vez es la causa primaria de shock hipovolémi-co. Se la debe sospechar especialmente en pacientes con lesiones faciales que llevan horas con sangrado, aún de poca cuantía, pero persistente. El taponamiento, sutura de heridas y reducción/OTS precoz son los pilares de su tratamiento.

Videotoracoscopía en cáncer de ovario avanzado con sospecha de compromiso torácico / Video-assisted thoracoscopy in advanced ovarian cancer with a probable thoracic involvement

Objetivo: Evaluar la experiencia con videotoracoscopía en pacientes con sospecha de cáncer de ovario avanzado con probable compromiso del tórax. Método: Se analiza las pacientes con sospecha clínica e imagenológica de cáncer de ovario avanzado que presentan derrames pleurales moderado y severo, así como procesos tumorales torácicos para evaluar la posibilidad de citorreducción óptima o completa. Todos los casos sometidos a este procedimiento entre enero de 2009 a Agosto de 2011, son analizados con énfasis en el diagnóstico y en los hallazgos a la videotoracoscopía, así como sus resultados. Resultados: 11 pacientes con clínica y tomografía axial computarizada de tórax sospechoso de compromiso pleural o pulmonar, son sometidas al procedimiento previo al intento de citorreducción abdominopélvica. La edad promedio fue de 62 años y Ca 125 promedio de 1030 U/ml. En 6 pacientes se encontró enfermedad macroscópica pleural, la biopsia fue positiva para adenocarcinoma en 5. Dos de ellas se consideraron no citorreducible en abdomen y se indicó neoadyuvancia. La tercera se citorredujo en forma óptima. En 2 pacientes se indicó neoadyudancia por tener residuo tumoral torácico mayor a 1 cm, consideradas citorreducibles en abdomen. De las 6 pacientes sin enfermedad torácica, 4 se citorredujeron óptimamente, una falleció previo a la cirugía abdominal y otra resultó un tumor ovárico benigno. Conclusión: La videotoracoscopía es útil para evaluar enfermedad torácica y tomar decisiones en relación a la citorreducción abdominal o neoadyuvancia en cáncer avanzado de ovario.

Objective: To describe the experience with video-assisted thoracic evaluation in patients with suspected advanced ovarian cancer with a probable thoracic involvement. Method: Patients with clinical and imaging suspicion of advanced ovarian cancer who have pleural effusions, and thoracic tumor processes are examined to evaluate the possibility of optimal debulking. All cases that underwent this procedure between January 2009 to August 2011, were studied with emphasis on diagnosis, results and findings at videotho-racoscopy. Results: 11 patients with a suspected thoracic commitment, with clinical and computerized axial tomography scan, undergo the procedure previous to an abdominopelvic cytoreductive surgery attempt. The average age was 62 years and CA 125 of 1030 U/ml average. Macroscopic pleural disease was found in 6 patients, but in 5 of them the biopsy gave positive for adenocarcinoma. Two of them were not considered for a cytoreductive surgery in the abdomen and neoadjuvant therapy was indicated. The third patient of the 5 previously mentioned, underwent an optimal cytoreduction. In 2 patients, neoadjuvant therapy was indicated for having residual tumor in the thorax greater than 1 cm, although they were considered for a cytoreductive surgery in the abdomen. Of the 6 patients without chest involvement, 4 underwent an optimal cytoreductive surgery, and one died before the abdominal surgery and the other had a benign ovarian tumor. Conclusion: Videothoracoscopy is useful for diagnosing thoracic metastasis and making decisions regarding cytoreduction and neoadjuvant therapy in advanced ovarian cancer.

Histerectomía extrafascial en cáncer de cuello uterino IB2 posterior a radio-quimioterapia / Extrafascial hysterectomy in IB2 cervical cancer after radiochemotherapy

Objetivo: Evaluar la sobrevida global y libre de enfermedad en pacientes con tratamiento concomitante de radioquimioterapia más histerectomía extrafascial en cáncer de cuello uterino IB2. Método: 31 pacientes con cáncer cérvico-uterino en etapa IB2 fueron tratadas con radioquimioterapia concomitante más histerectomía extrafascial programada en 4 a 6 semanas. Se efectuó radioterapia pelviana externa e implante de braquiterapia útero-vaginal con dosis preoperatoria entre 70-75 Gy a punto A y quimioterapia con cisplatino. Resultados: La edad promedio de las pacientes fue de 41 +/- 8 años. El 81 por ciento de los casos fue carcinoma escamocelular. La histerectomía extrafascial se realizó 4 a 6 semanas post-radiación en el 85 por ciento de los casos. El 79 por ciento y el 13 por ciento de las pacientes recibieron 5 y 4 ciclos de quimioterapia respectivamente. La mediana de seguimiento fue de 38 meses. La sobrevida global y libre de enfermedad estimada a 5 años fue de 86 por ciento y 79 por ciento respectivamente. Hubo diferencia significativa en la sobrevida global en los subgrupos sin o con enfermedad residual macroscópica en la pieza operatoria (p<0,001). Conclusión: Esta serie muestra resultados de sobrevida similares a las reportadas en otros trabajos con el mismo tratamiento. La enfermedad residual en la pieza operatoria podría constituir un factor de valor pronóstico.

Aim: To evaluate overall and disease free survival in cervical cáncer IB2 patients with concomitant chemo-radiotherapy and posterior extrafascial hysterectomy treatment. Methods: Between July 2005 to December 2009, a total of 31 eligible patients with IB2 cervical cancer were treated with chemoradiotherapy and posterior hysterectomy in the Carlos Van Buren Hospital Oncology Unit. Radiotherapy consisted in external pelvic radiation and a utero-vaginal brachitherapy with low rate doses to get preoperatory doses between 70 and 75 Gy to the A point and a concomitant Cisplatin based chemotherapy. After this treatment, the patients received extrafascial hysterectomy 4 to 6 weeks completed chemoradiotherapy. Results: The mean age was 41 +/- 8 years. 81 percent of the patients had an spinocelular carcinoma. The extrafascial hysterectomy was made between 4 to 6 weeks post-radiation in 85 percent of the patients. 79 percent and 13 percent of the patients received 5 and 4 chemotherapy cycles respectively. The median follow up was 38 months. The 5 years overall survival and disease free survival estimates were 86 percent and 79 percent respectively. There was a significant difference between subgroups of patients with and without macroscopic residual disease in the operatory specimen (p<0.001). Conclusion: Our survival is similar to published results with the same treatment. The presence of macroscopic residual disease in the hysterectomy specimen could be a factor of prognostic value.