Uso de imágenes KV CBCT del acelerador lineal Halcyon para la planificación de tratamientos de metástasis óseas con intensión paliativa / Use of KV CBCT images from the Halcyon linear accelerator for treatment planning of bone metastases with palliative intent

Las nuevas tecnologías para el tratamiento del cáncer con radiación ionizante tienen especial interés en mejorar la calidad de las imágenes para el posicionamiento adecuado del paciente con sistemas de radioterapia guiada por imagen IGRT. El sistema Halcyon cuenta con imágenes de tomografía computarizada de haz de cono CBCT. Estas imágenes podrían ser una opción para escenarios donde no se cuente con una Tomografía Computarizada CT o el equipo se encuentre en reparación o mantenimiento especialmente para escenarios de intensión paliativa. La diferencia en la distribución de dosis en imágenes CT y CBCT fue analizada en este estudio. Los resultados mostraron diferencias en las unidades Hounsfield UH, aunque no fueron estadísticamente significativas, el volumen irradiado mostro diferencias máximas de 3,92% que no supera el 4% permitido para tratamientos de intensión paliativa. En cuanto a las dosis dispersas al tejido sano la diferencia tampoco supera el 4%. Nuestro estudio mostro que las imágenes CBCT pueden ser una alternativa para el tratamiento de metástasis óseas, sin embargo, estas imágenes todavía no pueden remplazar las imágenes CT utilizadas para el cálculo de dosis en radioterapia

New technologies for the treatment of cancer with ionizing radiation are of particular interest in improving image quality for proper patient positioning with image-guided radiation therapy IGRT systems. IGRT image-guided radiation therapy systems. The Halcyon system features cone beam computed tomography CBCT imaging. These images could be an option for scenarios where a CT scan is not available or the equipment is under repair or maintenance especially for is under repair or maintenance, especially for palliative scenarios. The difference in the The difference in dose distribution in CT and CBCT images was analyzed in this study. The results showed differences in Hounsfield UH units, although not statistically significant, the irradiated volume showed maximum differences of 3.92%, which is the maximum difference of 3.92%. Differences of 3.92%, which does not exceed the 4% allowed for palliative treatments. As for the doses dispersed to healthy tissue the difference does not exceed the 4% allowed for palliative treatments. Our study showed that CBCT imaging can be an alternative for the treatment of metastases. an alternative for the treatment of bone metastases, however, these images cannot yet replace the CT images used for dose calculation. CT images used for dose calculation in radiotherapy

Effect of the Lacticaseibacillus paracasei JLM Strain Against Brucella abortus Strains in Ripened Cheese.

This study evaluated the antagonistic effect of the Lacticaseibacillus paracasei JLM strain isolated from aguamiel, against Brucella abortus RB51, S19, and 2308 strains, during the manufacture of soft-ripened cheese. First, the tolerance of Lc. paracasei JLM was tested with pH values and bile salt concentrations for 3 h to simulate digestive tract conditions. The antagonistic effect against B. abortus strains was evaluated through double-layer diffusion and agar well diffusion assays. In addition, the stability of the cell-free supernatant (CFS) was tested with the agar well diffusion method under different conditions of temperature, pH, and treatment with digestive enzymes. Finally, the antagonistic effect against B. abortus strains was observed during the manufacture of ripened cheese for 31 days at 4°C and 25°C using the Lc. paracasei JLM strain as starter culture. The results showed that the Lc. paracasei JLM strain remains viable after exposure to different pH values (from 3.00 to 7.00) and concentrations of bile salts (from 0.5% to 7%). Moreover, the results demonstrate that the growth of the three B. abortus strains was inhibited in both antagonism tests and that CFS maintained 86% activity after heat treatment at 100°C, 121°C, or enzymatic digestion (proteinase K, trypsin, chymotrypsin), but it was inactivated at pH levels above 6. Finally, Lc. paracasei JLM completely inhibited the growth of B. abortus in ripened cheese at 25°C from day 17 and showed greater inhibition on the B. abortus RB51 strain in the ripened cheese at 4°C, showing statistical differences for the B. abortus S19 and B. abortus 2308 strains. The current research concluded that the Lc. paracasei JLM strain has an antagonistic effect on B. abortus, enhancing the potential of its use in the future as a probiotic.

American Society of Hematology, ABHH, ACHO, Grupo CAHT, Grupo CLAHT, SAH, SBHH, SHU, SOCHIHEM, SOMETH, Sociedad Panamena de Hematología, Sociedad Peruana de Hematología, and SVH 2023 guidelines for diagnosis of venous thromboembolism and for its management in special populations in Latin America.

Implementation of international guidelines in Latin American settings requires additional considerations (ie, values and preferences, resources, accessibility, feasibility, and impact on health equity). The purpose of this guideline is to provide evidence-based recommendations about the diagnosis of venous thromboembolism (VTE) and its management in children and during pregnancy. We used the GRADE ADOLOPMENT method to adapt recommendations from 3 American Society of Hematology (ASH) VTE guidelines (diagnosis of VTE, VTE in pregnancy, and VTE in the pediatric population). ASH and 12 local hematology societies formed a guideline panel comprising medical professionals from 10 countries in Latin America. Panelists prioritized 10 questions about the diagnosis of VTE and 18 questions about its management in special populations that were relevant for the Latin American context. A knowledge synthesis team updated evidence reviews of health effects conducted for the original ASH guidelines and summarized information about factors specific to the Latin American context. In comparison with the original guideline, there were significant changes in 2 of 10 diagnostic recommendations (changes in the diagnostic algorithms) and in 9 of 18 management recommendations (4 changed direction and 5 changed strength). This guideline ADOLOPMENT project highlighted the importance of contextualizing recommendations in other settings based on differences in values, resources, feasibility, and health equity impact.

American Society of Hematology, ABHH, ACHO, Grupo CAHT, Grupo CLAHT, SAH, SBHH, SHU, SOCHIHEM, SOMETH, Sociedad Panamena de Hematología, Sociedad Peruana de Hematología, and SVH 2023 guidelines for diagnosis of venous thromboembolism and for its management in special populations in Latin America

Implementation of international guidelines in Latin American settings requires additional considerations (ie, values and preferences, resources, accessibility, feasibility, and impact on health equity). The purpose of this guideline is to provide evidence-based recommendations about the diagnosis of venous thromboembolism (VTE) and its management in children and during pregnancy. We used the GRADE ADOLOPMENT method to adapt recommendations from 3 American Society of Hematology (ASH) VTE guidelines (diagnosis of VTE, VTE in pregnancy, and VTE in the pediatric population). ASH and 12 local hematology societies formed a guideline panel comprising medical professionals from 10 countries in Latin America. Panelists prioritized 10 questions about the diagnosis of VTE and 18 questions about its management in special populations that were relevant for the Latin American context. A knowledge synthesis team updated evidence reviews of health effects conducted for the original ASH guidelines and summarized information about factors specific to the Latin American context. In comparison with the original guideline, there were significant changes in 2 of 10 diagnostic recommendations (changes in the diagnostic algorithms) and in 9 of 18 management recommendations (4 changed direction and 5 changed strength). This guideline ADOLOPMENT project highlighted the importance of contextualizing recommendations in other settings based on differences in values, resources, feasibility, and health equity impact.

Survival of Brucella abortus RB51 and S19 Vaccine Strains in Fresh and Ripened Cheeses.

Brucellosis is a zoonotic infection caused by the consumption of contaminated raw milk and dairy products. This study aims to compare survival rates of Brucella abortus RB51 and S19 vaccine strains to that of virulent B. abortus 2308 strain during the manufacture of fresh and ripened cheeses. To do this, we inoculated fresh pasteurized milk with B. abortus RB51, S19, or 2308 at a 6 × 108 colony-forming unit per milliliter concentration during the cheese making process. Cheese was manufactured at room temperature, then, fresh cheeses were conserved at either 4°C or 25°C for 7 days, while ripened cheeses were conserved for 31 days at the same temperatures. We measured B. abortus survival and pH values during different stages of the process. Our results confirm that all three strains can maintain viable cells in both types of cheeses throughout the process. Survival of B. abortus RB51 was 10 times lower than was the survival of the B. abortus S19 and B. abortus 2308 strains in both fresh and ripened cheeses. Our results also suggest that both temperature and pH can condition Brucella survival. In conclusion, B. abortus RB51 and S19 vaccine strains can survive throughout the manufacture and conservation processes of both fresh and ripened cheeses. In turn, this implies a potential health risk if cheeses contaminated with these strains were to be consumed.

American Society of Hematology, ABHH, ACHO, Grupo CAHT, Grupo CLAHT, SAH, SBHH, SHU, SOCHIHEM, SOMETH, Sociedad Panameña de Hematología, Sociedad Peruana de Hematología, and SVH 2022 guidelines for prevention of venous thromboembolism in surgical and medical patients and long-distance travelers in Latin America.

BACKGROUND: Venous thromboembolism (VTE) is a common disease in Latin American settings. Implementation of international guidelines in Latin American settings requires additional considerations. OBJECTIVE: To provide evidence-based guidelines about VTE prevention for Latin American patients, clinicians, and decision makers. METHODS: We used the GRADE ADOLOPMENT method to adapt recommendations from 2 American Society of Hematology (ASH) VTE guidelines (Prevention of VTE in Surgical Patients and Prophylaxis for Medical Patients). ASH and 12 local hematology societies formed a guideline panel composed of medical professionals from 10 countries in Latin America. Panelists prioritized 20 questions relevant to the Latin American context. A knowledge synthesis team updated evidence reviews of health effects conducted for the original ASH guidelines and summarized information about factors specific to the Latin American context, that is, values and preferences, resources, accessibility, feasibility, and impact on health equity. RESULTS: The panel agreed on 21 recommendations. In comparison with the original guideline, 6 recommendations changed direction and 4 recommendations changed strength. CONCLUSIONS: This guideline ADOLOPMENT project highlighted the importance of contextualization of recommendations in other settings, based on differences in values, resources, feasibility, and health equity impact.

Effect of laser photocoagulation, antiangiogenic therapy or a combined treatment on refractive outcomes of newborns with ROP.

PURPOSE: To determine the refractive outcome after treatment with laser photocoagulation, intravitreal antiangiogenic injection or both, for the treatment of type 1 ROP and/or aggressive posterior ROP using defocus equivalent terms. These results will be compared with the spherical equivalent (SE) notation in an initial refraction (during the first 3 years after treatment) and in a final evaluation (three years after treatment). METHODS: Clinical charts review of preterm patients who developed type 1 ROP and/or aggressive posterior ROP who were treated with laser photocoagulation, intravitreal antiangiogenic injection, or both, between January 2007 and December 2014 at Fundación Oftalmológica de Santander were reviewed. Refractive error was evaluated at two different time points in three different treatment groups. RESULTS: Seventy-seven eyes (56 patients) with ROP diagnosis treated with laser, antiangiogenics or in a combined scheme were included. Median gestational age was 29 weeks (IQR = 3), median birth weight was 1100 (IQR = 335) and mean corrected age at the time of treatment was 37.3 weeks (SD 2.2). Refractive outcomes in SE terms for the first refraction had a median of -0.50 diopters and in defocus terms, 4.00 diopters (D). For the second refraction, -3.00 diopters and 4.00 diopters (D), respectively. Pearson correlation test result for the first measurement was 93% (p = 0.000) and for the second evaluation was 99% (p = 0.000). CONCLUSIONS: Low birth weight had a statistically significant association to the increase of the refractive outcome. The high correlation between SE and DE for refractive errors allows us to confirm that DE is an appropriate metric to report refractive outcomes in this group of patients due to the presence of combined refractive ametropias.

Methodology for adaptation of the ASH Guidelines for Management of Venous Thromboembolism for the Latin American context.

BACKGROUND: From 2017 to 2020, the American Society of Hematology (ASH) collaborated with 12 hematology societies in Latin America to adapt the ASH guidelines on venous thromboembolism (VTE). OBJECTIVE: To describe the methods used to adapt the ASH guidelines on venous thromboembolism. METHODS: Each society nominated 1 individual to serve on the guideline panel. The work of the panel was facilitated by the 2 methodologists. The methods team selected 4 of the original VTE guidelines for a first round. To select the most relevant questions, a 2-step prioritization process was conducted through an on-line survey and then through in-person discussion. During an in-person meeting in Rio de Janeiro, Brazil, from 23 April through 26 April 2018, the panel developed recommendations using the ADOLOPMENT approach. Evidence about health effects from the original guidelines was reused, but important data about resource use, accessibility, feasibility, and impact in health equity were added. RESULTS: In the guideline accompanying this paper, Latin American panelists selected 17 questions from an original pool of 49. Of the 17 questions addressed, substantial changes were introduced for 5 recommendations, and remarks were added or modified for 12 recommendations. CONCLUSIONS: By using the evidence from an international guideline, a significant amount of work and time were saved; by adding regional evidence, the final recommendations were tailored to the Latin American context. This experience offers an alternative to develop guidelines relevant to local contexts through a global collaboration.

ASH, ABHH, ACHO, Grupo CAHT, Grupo  CLAHT, SAH, SBHH, SHU, SOCHIHEM, SOMETH, Sociedad Panameña de Hematología, SPH, and SVH 2021 guidelines for management of venous thromboembolism in Latin America.

BACKGROUND: Venous thromboembolism (VTE) is a common disease in Latin American settings. Implementing international guidelinn Aes in Latimerican settings requires additional considerations. OBJECTIVE: The purpose of our study was to provide evidence-based guidelines about managing VTE for Latin American patients, clinicians, and decision makers. METHODS: We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE)-ADOLOPMENT method to adapt recommendations from 2 American Society of Hematology (ASH) VTE guidelines (Treatment of VTE and Anticoagulation Therapy). ASH and local hematology societies formed a guideline panel comprised of medical professionals from 10 countries in Latin America. Panelists prioritized 18 questions relevant for the Latin American context. A knowledge synthesis team updated evidence reviews of health effects conducted for the original ASH guidelines and summarized information about factors specific to the Latin American context (ie, values and preferences, resources, accessibility, feasibility, and impact on health equity). RESULTS: The panel agreed on 17 recommendations. Compared with the original guideline, 4 recommendations changed direction and 1 changed strength. CONCLUSIONS: This guideline adolopment project highlighted the importance of contextualization of recommendations suggested by the changes to the original recommendations. The panel also identified 2 implementation priorities for the region: expanding the availability of home treatment and increasing the availability of direct oral anticoagulants (DOACs). The guideline panel made a conditional recommendation in favor of home treatment for individuals with deep venous thrombosis and a conditional recommendation for either home or hospital treatment for individuals with pulmonary embolism. In addition, a conditional recommendation was made in favor of DOACs over vitamin K antagonists for several populations.

Flow cytometry "Ogata score" for the diagnosis of myelodysplastic syndromes in a real-life setting. A Latin American experience.

INTRODUCTION: Flow cytometry (FC) is a helpful tool for the diagnosis of myelodysplastic syndrome (MDS). Different FC score systems have been developed. The "Ogata score" is a simple diagnostic score that has been validated having a sensitivity of 69% and a specificity of 92% in low-risk MDS. We aimed to study the feasibility and the utility of the "Ogata score" for the diagnosis of MDS among Latin America (LA) Laboratories. METHODS: This is a case and control study conducted in LA institutions members of Grupo Latinoamericano de Mielodisplasia (GLAM). A total of 146 MDS patients and 57 control patients were included. "Ogata score" was calculated. RESULTS: The sensitivity of "Ogata score" was 75.6% (95% CI, 66.8-81.3), specificity was 91.2% (95% CI, 79.7-96.7), PPV was 95.6% (95% CI, 88.5-98.3), and NPV was 65.4% (95% CI, 49.1-71.9). In low/intermediate-1 IPSS patients group, the sensitivity was 70.1% (95% CI, 60.2-78.2), specificity was 91.2% (CI-95%, 79.7-96.7), PPV was 94.2% (95% CI, 86.4-97.8), and NPV was 62.1% (95% CI, 53.0-78.7). In the group of patients "without MDS specific markers" (patients without ring sideroblasts, blast excess, or chromosomal abnormalities), the sensitivity was 66.7% (CI-95%, 55.8-76.0), specificity was 91.2% (95% CI, 79.7-96.7), PPV was 92.3% (95% CI, 82.2-97.1), and NPV was 63.5% (95% CI, 51.9-73.5). CONCLUSIONS: The diagnostic power found in this study was similar to the reported by Della-Porta et al. Also in LA, the analysis was made in modern equipment with acquisition of at least 100 000 events which permits a good reproducibility of the results.

Effects of the contraceptive skin patch and subdermal contraceptive implant on markers of endothelial cell activation and inflammation.

Changes in blood coagulation factors may partially explain the association between hormonal contraceptives and thrombosis. Therefore, the likely effects of the contraceptive skin patch and subdermal contraceptive implant on levels of inflammatory markers and endothelial activation were analyzed. This was an observational, prospective, longitudinal, nonrandomized study composed of 80 women between 18 and 35 years of age who made the decision to use the contraceptive skin patch or subdermal contraceptive implant. vascular cell adhesion molecule-1 (VCAM-1), endothelial cell leukocyte adhesion molecule-1 (ELAM-1), von Willebrand factor (VWF), and plasminogen activator inhibitor type 1(PAI-1) as well as high-sensitivity C-reactive protein (hsCRP) were assayed before and after 4 months of use of the contraceptive method. VCAM-1, VWF, and PAI-1 remained unchanged in the contraceptive skin patch group; however, a significant increase in hsCRP (0.29-0.50 mg/dL; P =.012) and a significant decrease in ELAM-1 (44-25 ng/mL; P =.022) were observed. A significant diminution in VCAM-1 (463-362 ng/mL; P =.022) was also found in the subdermal contraceptive implant group. Our results strongly suggest that these contraceptive methods do not induce endothelial activation after 4 months of use. Increase in hsCRP levels was unrelated to changes in markers of endothelial activation.

Adenoflemón cervical en la tercera edad. Presentación de un caso / Cervical adenophlegmon in old age. A case report

Se presenta el caso de una paciente de 70 años de edad, raza negra, del sexo femenino, con antecedentes de padecer de diabetes mellitus e hipertensión arterial. Se valoró en la consulta externa del Policlínico Universitario Ernesto Guevara de la Serna de Sandino, de Pinar del Río. Fue evaluado en conjunto por un grupo de especialistas, al presentar un cuadro caracterizado por el aumento de volumen superficial de la región lateral izquierda del cuello, por debajo de la rama horizontal de la mandíbula, a nivel del músculo esternocleidomastoideo, cerca y debajo del pabellón auricular y la parótida, de aproximadamente 5 cm. de diámetro, móvil, doloroso, de superficie lisa y consistencia renitente, sin cambios en la coloración de la piel. Al examen físico otorrinolaringológico no se encontraron otras alteraciones. Se le hizo un ultrasonido en la región afectada y valoró en conjunto el caso efectuado el tratamiento médico, al establecerse el diagnóstico clínico e imaginológico de adenoflemón cervical. Se procedió además a la realización de una BAAF. Los autores presentan las experiencias derivadas de la atención del caso, no frecuente a esta edad y revisan la literatura médica sobre el tema, con especial referencia al diagnóstico y tratamiento.

A 70 year-old, black race, female patient, suffering from diabetes mellitus and hypertension attended to the consultation. The case was analyzed at "Ernesto Guevara de la Serna" outpatient clinic in Sandino, Pinar del Rio. A group of specialists assessed the case that presented a chart characterized by an increase of superficial volume in left lateral region of the neck, below the horizontal branch of the mandible to the level of sternocleidomastoid muscle, near and below outer ear and the parotid, around 5cm of diameter, movable, painful of smooth surface and renitent consistency, without changes in skin color. No other alterations were found at physical examination or ENT specialist examination while imaging studies in the affected region were as well conducted, the case was assessed considering all these procedures to order medical treatment, clinical and imaging diagnosis established a cervical adenophlegmon. A fine needle aspiration biopsy was also performed. The authors presented the experience derived from the medical care of the case, which is not frequent in this age and reviewed the medical literature about the topic, with special emphasis on diagnosis and treatment.

Adenoflemón cervical en la tercera edad: presentación de un caso / Cervical adenophlegmon in old age: a case report

Se presenta el caso de una paciente de 70 años de edad, raza negra, del sexo femenino, con antecedentes de padecer de diabetes mellitus e hipertensión arterial. Se valoró en la consulta externa del Policlínico Universitario Ernesto Guevara de la Serna de Sandino, de Pinar del Río. Fue evaluado en conjunto por un grupo de especialistas, al presentar un cuadro caracterizado por el aumento de volumen superficial de la región lateral izquierda del cuello, por debajo de la rama horizontal de la mandíbula, a nivel del músculo esternocleidomastoideo, cerca y debajo del pabellón auricular y la parótida, de aproximadamente 5 cm de diámetro, móvil, doloroso, de superficie lisa y consistencia renitente, sin cambios en la coloración de la piel. Al examen físico otorrinolaringológico no se encontraron otras alteraciones. Se le hizo un ultrasonido en la región afectada y valoró en conjunto el caso efectuado el tratamiento médico, al establecerse el diagnóstico clínico e imaginológico de adenoflemón cervical. Se procedió además a la realización de una BAAF. Los autores presentan las experiencias derivadas de la atención del caso, no frecuente a esta edad y revisan la literatura médica sobre el tema, con especial referencia al diagnóstico y tratamiento(AU)

A 70 year-old, black race, female patient, suffering from diabetes mellitus and hypertension attended to the consultation. The case was analyzed at Ernesto Guevara de la Serna outpatient clinic in Sandino, Pinar del Rio. A group of specialists assessed the case that presented a chart characterized by an increase of superficial volume in left lateral region of the neck, below the horizontal branch of the mandible to the level of sternocleidomastoid muscle, near and below outer ear and the parotid, around 5cm of diameter, movable, painful of smooth surface and renitent consistency, without changes in skin color. No other alterations were found at physical examination or ENT specialist examination while imaging studies in the affected region were as well conducted, the case was assessed considering all these procedures to order medical treatment, clinical and imaging diagnosis established a cervical adenophlegmon. A fine needle aspiration biopsy was also performed. The authors presented the experience derived from the medical care of the case, which is not frequent in this age and reviewed the medical literature about the topic, with special emphasis on diagnosis and treatment(AU)

[Lupus membranous nephropathy]. / Nefropatía lúpica membranosa.

The systemic lupus erythematosus associated renal hystopathological complexity and its clinical translation, are still a diagnostic challenge with therapeutical implications which, however, include new options in the last few years within the immunosupression compass. The new insights elicited by research work attempt to give some light on renal biopsy performance, its relationship with the arrogated clinical spectrum, its prognosis and on the lupus nephropathy new treatments currently under ongoing clinical trials, some of them showing encouraging results. The lupus membranous nephropathy, recognized as an anatomopathological entity more than 4 decades ago, means a specific pattern in the whole renal lupus histologycal range and, in many aspects, an etiopathogenic enigma.

Nefropatía lúpica membranosa / Lupus membranous nephropathy

Tanto la complejidad histopatológica renal asociada al desarrollo del lupus eritematoso sistémico como la traducción clínica derivada de aquélla siguen representando un reto diagnóstico con implicaciones terapéuticas, a las que cada vez se ofrece un mayor número de opciones dentro del campo de la inmunodepresión. Los nuevos hallazgos obtenidos por la investigación intentan arrojar nueva luz sobre la interpretación de la biopsia renal, su correlación con el espectro clínico atribuido y su pronóstico, y sobre los nuevos tratamientos de la nefropatía lúpica, algunos de los cuales se encuentran actualmente en fases intermedias de ensayo clínico y ofrecen resultados esperanzadores. La nefropatía lúpica membranosa, reconocida como entidad anatomopatológica hace ya más de 40 años, representa a su vez una especificidad morfológica en el conjunto del material histológico acumulado y un enigma todavía en muchos aspectos de su etiopatogenia

The systemic lupus erythematosus associated renal hystopathological complexity and its clinical translation, are still a diagnostic challenge with therapeutical implications which, however, include new options in the last few years within the immunosupression compass. The new insights elicited by research work attempt to give some light on renal biopsy performance, its relationship with the arrogated clinical spectrum, its prognosis and on the lupus nephropathy new treatments currently under ongoing clinical trials, some of them showing encouraging results. The lupus membranous nephropathy, recognized as an anatomopathological entity more than 4 decades ago, means a specific pattern in the whole renal lupus histologycal range and, in many aspects, an etiopathogenic enigma

Valoración oftalmológica de los pacientes pediátricos con diagnóstico de leucemia / Ophthalmological evaluation of pediatric patients with leukemia

El contacto que tiene el oftalmólogo con el niño con leucemia puede limitarse a aquel que presenta proptosis o una masa orbitaria evidente. Se busca en el artículo revisar algunos conceptos básicos sobre la Leucemia, resaltar la importancia del compromiso ocular en la misma y proponer un protocolo para el examen oftalmológico en pacientes menores de 15 años una vez hecho el diagnóstico de Leucemia y en los diferentes estadíos actualmente reconocidos de la enfermedad y el tratamiento. Se presentan argumentos que justifican la valoración oftalmológica de esta población

Síndrome angiodisplásico de Klippel-Trenaunay-Weber / Klipplel-Trenaunay-Weber angyodisplasic syndrome

El síndrome de Klippel-Trenaunay-Weber es una entidad congénita rara que puede presentar los siguientes signos clínicos: Manchas de "vino de Oporto" o "manchas de nacimiento" (malformaciones capilares venosas), hipertrofia ósea o de tejidos blandos, malformaciones venosas y anomaías capilares. Pueden presentarse complicaciones como glaucoma, sangrado, celulitis, trombosis venosas o embolismo pulmonar; otras anomalías asociadas pueden darse en otros sistemas, como gigantismo de los artejos, manos o pies, linfoedema, o compromiso de los órganos pélvicos o abdominales. Este síndrome se limita a una sola extremidad, pero puede comprometer más de una, la cabeza o el tronco; cada caso es único y puede exhibir diferente grado de compromiso. Su etiología es por herencia esporádica, probablemente localizada en una alteración en 5q13.3 o 11q13. una teoría aceptada es que este síndrome puede ser producido por anomalías mesodérmicas durante el desarrollo fetal; otra sugiere que la causa puede ser el resultado de una mutación secundaria de un gen somático. El tratamiento más efectivo es el manejo conservador de los síntomas: la terapia láser puede reducir o eliminar las lesiones cutáneas. Tanto la Tomografía Axial Computarizada como la esonancia Nuclear Magnética y los estudios doppler a color son útiles en determinar la extensión del síndrome y para determinar la mejor manera de tratarlo

Estudio retrospectivo de la utilización del balón de contrapulsación intraórtico en la Clínica Shaio / Applications of intra-aortic balloon pump

Se realizó un estudio restrospectivo en 87 aplicaciones del Balón de Contrapulsación Intraórtico (B.C.I.A.), en la Fundación Clínica Shaio de Santafé de Bogotá, para describir sus indicaciones, utilidades, resultados, complicaciones y cambios hemodinámicos. Se utilizó con un promedio de 2,77 aplicaciones por mes, en una edad promedio de 58,1 años, en 66 (75 por ciento) de hombres y 21 (24 por ciento) mujeres; 95 por ciento presentaban cualquier manifestación de enfermedad coronaria y 5 por ciento tenían cardiopatía valvular. Fué encontrando como condición clínica el shock cardiogénico en 76 por ciento de los casos, como patología principal al infarto agudo del miocardio en 32 por ciento y como mayor situación clínica al soporte para la salida de circulación extracorporea en 26 por ciento de las aplicaciones. El 74 por ciento (47 casos) fue utilizado en situaciones clínicas relacionadas con la cirugía cardíaca y el 51 por ciento (44 casos) del total de los casos fueron posteriores a procedimientos invasivos. Los resultados mostraron 62 por ciento de éxito con el soporte mecánico, sobrevida intrahospitalaria de 57 por ciento, 18 por ciento de complicaciones y 1 por ciento de muerte causada directamente por el B.C.I.A.. Se observó un beneficio mayor para las aplicaciones preventivas que como manejo agresivo. Este estudio mostró muy bajo beneficio en los pacientes mayores de 75 años y tambien en los que presentaban cardiopatía valvular. Se diseñó un esquema de clasificación y tabulación para las diversas indicaciones de soporte mecánico externo, que será de mucha utilidad en estudios posteriores