Simultaneous removal of fluoride and arsenic from well water by electrocoagulation.

The co-occurrence of fluoride and arsenic in groundwater presents a problem in many, mostly arid, regions of Latin America and the world. These pollutants cause significant health problems and are difficult to remove simultaneously from drinking water. In this study, the electrocoagulation process for the simultaneous removal of fluoride and arsenic was evaluated in well from the state of Durango, Mexico, in order to both solve the local problem and determine how to apply the method generally. Tests were carried out with different times, concentrations, initial pH values, and electric current densities, with iron and aluminum as electrode materials. The removal efficiencies in simultaneous presence were 85.68% for fluoride and approximately 100% for arsenic. The final concentrations for both pollutants were below the drinking water limits established by the World Health Organization (WHO) and Mexican regulations. The optimum conditions of the electrocoagulation process found were a current density of 4.5 mA/cm2, an initial pH of 5, and a treatment time of 15 min, considering initial fluoride and arsenic concentrations of 5 mg/L and 80 µg/L, respectively.

Programa multicéntrico para la atención integral del recién nacido con agresión hipóxico-isquémica perinatal (ARAHIP) / Multicenter program for the integrated care of newborns with perinatal hypoxic-ischemic insult (ARAHIP)

INTRODUCCIÓN: El recién nacido con indicadores de potencial evento hipóxico-isquémico perinatal precisa de una atención integral que detecte precozmente si necesita tratamiento con hipotermia y el control de los factores agravantes del da˜no cerebral en las primeras 6 h de vida. PACIENTES Y MÉTODOS: Aplicación de un programa prospectivo de ámbito poblacional que ordena y sistematiza la atención durante las primeras 6 h de vida en los ≥ 35 semanas nacidos con indicadores de agresión hipóxico-isquémica perinatal. El programa involucra 12 hospitales (91.217 m2), 7 de nivel asistencial i-ii y 5 de nivel III. Se establecen 4 protocolos: a) detección del recién nacido con potencial agresión hipóxico-isquémica; b) vigilancia de la repercusión neurológica y en otros órganos; c) control y tratamiento de complicaciones, y d) vigilancia y acciones durante el transporte. RESULTADOS: Entre junio del 2011 y junio del 2013, de 32.325 recién nacidos ≥ 35 semanas, 213 cumplieron criterios de potencial agresión hipóxico-isquémica perinatal (7,4 por 1.000). El 92% siguió la monitorización establecida en el programa; 33 recién nacidos tuvieron encefalopatía hipóxico-isquémica moderada-grave (1 por 1.000) y 31/33 (94%) recibieron tratamiento con hipotermia. CONCLUSIONES: El programa Atención integral al Recién nacido con Agresión Hipóxico-Isquémica Perinatal ha permitido ofrecer atención integral al recién nacido con indicadores de agresión hipóxico-isquémica perinatal. Se han controlado factores comórbidos agravantes de la lesión cerebral y se han detectado aquellos con encefalopatía hipóxico-isquémica moderadagrave, permitiendo iniciar la hipotermia dentro de las primeras 6 h de vida. Programas de ámbito poblacional son cruciales para disminuir la morbimortalidad asociada a la encefalopatía hipóxico-isquémica

INTRODUCTION: Newborns with perinatal indicators of a potential hypoxic-ischemic event require an integrated care in order to control the aggravating factors of brain damage, and the early identification of candidates for hypothermia treatment. PATIENTS AND METHODS: The application of a prospective, populational program that organizes and systematizes medical care during the first 6 hours of life to all newborns over 35 weeks gestational age born with indicators of a perinatal hypoxic-ischemic insult. The program includes 12 hospitals (91,217 m2); two level I centers, five level II centers, and five level III hospitals. The program establishes four protocols: a) detection of the newborn with a potential hypoxic-ischemic insult, b) surveillance of the neurological repercussions and other organ involvement, c) control and treatment of complications, d) procedures and monitoring during transport. RESULTS: From June 2011 to June 2013, 213 of 32325 newborns above 35 weeks gestational age met the criteria of a potential hypoxic-ischemic insult (7.4/1000), with 92% of them being cared for following the program specifications. Moderate-severe hypoxic-ischemic encephalopathy was diagnosed in 33 cases (1/1,000), and 31 out of the 33 received treatment with hypothermia (94%). CONCLUSIONS: The program for the Integrated Care of Newborns with Perinatal Hypoxic-Ischemic Insult has led to providing a comprehensive care to the newborns with a suspected perinatal hypoxic-ischemic insult. Aggravators of brain damage have been controlled, and cases of moderate-severe hypoxic-ischemic encephalopathy have been detected, allowing the start of hypothermia treatment within the first six hours of life. Populational programs are fundamental to reducing the mortality and morbidity of hypoxic-ischemic encephalopathy

[Multicenter program for the integrated care of newborns with perinatal hypoxic-ischemic insult (ARAHIP)]. / Programa multicéntrico para la atención integral del recién nacido con agresión hipóxico-isquémica perinatal (ARAHIP).

INTRODUCTION: Newborns with perinatal indicators of a potential hypoxic-ischemic event require an integrated care in order to control the aggravating factors of brain damage, and the early identification of candidates for hypothermia treatment. PATIENTS AND METHODS: The application of a prospective, populational program that organizes and systematizes medical care during the first 6 hours of life to all newborns over 35 weeks gestational age born with indicators of a perinatal hypoxic-ischemic insult. The program includes 12 hospitals (91,217 m(2)); two level i centers, five level ii centers, and five level iii hospitals. The program establishes four protocols: a) detection of the newborn with a potential hypoxic-ischemic insult, b) surveillance of the neurological repercussions and other organ involvement, c) control and treatment of complications, d) procedures and monitoring during transport. RESULTS: From June 2011 to June 2013, 213 of 32325 newborns above 35 weeks gestational age met the criteria of a potential hypoxic-ischemic insult (7.4/1000), with 92% of them being cared for following the program specifications. Moderate-severe hypoxic-ischemic encephalopathy was diagnosed in 33 cases (1/1,000), and 31 out of the 33 received treatment with hypothermia (94%). CONCLUSIONS: The program for the Integrated Care of Newborns with Perinatal Hypoxic-Ischemic Insult has led to providing a comprehensive care to the newborns with a suspected perinatal hypoxic-ischemic insult. Aggravators of brain damage have been controlled, and cases of moderate-severe hypoxic-ischemic encephalopathy have been detected, allowing the start of hypothermia treatment within the first six hours of life. Populational programs are fundamental to reducing the mortality and morbidity of hypoxic-ischemic encephalopathy.

Taller de educación para la salud sobre prevención de osteoporosis en mujeres. Efectividad de una intervenciónenfermera en atención primaria / Workshop on health education on prevention of osteoporosis in women. Effectiveness of an intervention in primary care nurse

Los autocuidados son fundamentales para cualquier persona, sana o enferma, tanto en el tratamiento como en la prevención de enfermedades. Un aumento del nivel de autocuidados es deseable en enfermedades crónicas y de elevada prevalencia como la osteoporosis. El objetivo fue proporcionar conocimientos y promover estilos de vida saludables orientados a mejorar la calidad de vida y el autocuidado en mujeres que reciben educación sanitaria sobre la osteoporosis. El diseño del estudio es de intervención comunitaria, abierto, de un solo centro, prospectivo y de 8 meses de duración, desarrollado en el Centro de Salud de Morarzarzal. La muestra fue de 140 mujeres de edades comprendidas entre 40 y 70 años. Todas las participantes rellenaron un test inicial para evaluar su nivel de conocimientos sobre la osteoporosis y estilos de vida. Efectuamos la valoración de enfermería por patrones funcionales de Salud de Marjory Gordon e identificamos, entre otros, problemas relacionados con el manejo adecuado del régimen terapéutico, su conocimiento y ejecución, estableciendo un diagnóstico enfermero. Con el apoyo de la taxonomía NANDA, la NOC y NIC determinamos los objetivos e intervenciones de enfermería. Las mujeres recibieron 4 sesiones de educación sanitaria grupal sobre menopausia y osteoporosis, dieta equilibrada y adecuada orientada hacia la prevención de la enfermedad, ejercicio físico recomendado, corrección postural y manejo de cargas, hábitos tóxicos y de estilos de vida que afectan a la salud ósea. Tras la intervención educativa, las mujeres volvieron a hacer el test de conocimientos y de estilos de vida. A los 8 meses de finalizar los talleres educativos valoramos los resultados el Plan de Cuidados. El estudio estadístico consistió en comparar los valores de las variables seleccionadas antes y después de la intervención educativa. Las variables cuantitativas se analizaron con test paramétricos (t de Student para datos apareados) y con no paramétricos (test U de Mann Whitney). La potencia escogida para los test fue del 80% y el nivel de significación p<0,05. Al estudiar las diferencias entre los resultados se pretendía averiguar si la intervención educativa grupal y el posterior seguimiento del plan de cuidados en consulta de enfermería fueron efectivos para mejorar los autocuidados y la calidad de vida de las mujeres participantes en el estudio. Obtuvimos los resultados esperados del Plan de Cuidados (AU)

The increase of self-care is crucial for any person, healthy or ill, during his treatment or for preventing any illness. This is applicable to osteoporosis, a chronic illness with a high prevalence. Objective: To increase knowledge and promote healthy life styles to improve live quality and self-care for women receiving health education on osteoporosis. Design: Open community intervention trial, prospective during 8 months, developed in a single center: Moralzarzal Health Center. The sample included 140 women aged between 40 and 70. All participants completed an initial test to assess their level of knowledge about osteoporosis and lifestyles. We performed nursing assessment by Marjory Gordon’s Health functional patterns and we identified, among others, problems related to proper management of therapeutic regimen, its knowledge and its execution, establishing a nursing diagnosis. We determined the goals and nursing interventions with the support of taxonomy NANDA, NOC and NIC. The women received four sessions of group health education about menopause and osteoporosis, balanced and adequate diet oriented to disease prevention, recommended physical activity, postural correction and load management, bad habits and lifestyles that affect bone health. After the educational intervention, the women completed again the test of knowledge and lifestyles, and 8 months after the educational workshops’ end, we valued the Care Plan results. The statistical study was to compare the values of selected variables before and after the educational intervention. Quantitative variables were analyzed using parametric tests (Student t test for paired data) or nonparametric (Mann Whitney U test). The power chosen for the test was 80% and significance level p <0.05. By studying the differences in results we wanted to determine if the educational intervention and subsequent monitoring of the care plan in nursing consultations were effective in improving self-care and quality of life of women participating in the study. We obtained the expected results of the Plan of Care (AU)

Factors associated with allergic rhinitis in children from northern Mexico City.

BACKGROUND: The International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire allows users to find factors associated with allergic diseases, but thus far most of the studies on risk factors for allergic diseases have been devoted to asthma and not to rhinitis. OBJECTIVE: To determine the main factors associated with symptoms of allergic rhinitis and rhinoconjunctivitis in school children and adolescents in northern Mexico City. PATIENTS AND METHODS: A cross sectional, multicenter survey was conducted in northern Mexico City, in children aged 6-7 and 13-14 years. The survey instrument was the Phase Three B ISAAC questionnaire, which was validated and standardized in Spanish. RESULTS: There were 4106 6-7-year-olds and 6576 13-14-year-olds. The total prevalence of diagnosis of allergic rhinitis was 4.6%. The prevalence of cumulative and current symptoms of rhinitis was considered high (>29%), but the prevalence of the diagnosis of allergic rhinitis was considered low (ranging from 3.4% to 5.6%). The prevalence of symptoms of rhinitis with conjunctivitis had intermediate values (ranging from 20.3% to 30.2%). Cumulative symptoms of allergic rhinitis, current symptoms of allergic rhinitis, and rhinoconjunctivitis were related to symptoms of current or cumulative asthma, symptoms of current or cumulative atopic eczema, and current use of paracetamol (odds ratio > 1, P < .05). CONCLUSION: The present results support the concept of rhinitis and asthma as common chronic respiratory diseases, and this study also found a relation between paracetamol use and rhinitis in children.

[Evidence for autosomal dominant inheritance through the maternal line in a case of primary ciliary diskinesia]. / Evidencia de transmisión autos6mica dominante a través de la linea materna en un caso de discinesia ciliar primaria.

An atypical case of primary ciliary dyskinesia is presented in which the inheritance, rather than the classical autosomal recessive, appears to be transmitted as an autosomal dominant trait through the maternal line. The case involves two brothers of 29 and 30 years of age, married without children, with a history of infertility, frequent episodes of sinusitis, and recurrent pulmonary infections. Their mother and sister have chronic bronchopathy of unknown etiology. Their father is healthy without pulmonary problems or sinusitis. At physical exam, both brothers, sister and mother presented with bronchial rhonchi at lung auscultation. Blood analysis and pulmonary function, liver and renal tests were all normal. The ultraestructual study of the sperm flagellum by electron microscopy revealed that both brothers have the same anomaly. Namely, in the majority of the cross-sections, both dynein arms are missing. The nexin filament was present, as well as the radial spokes and the central pair of microtubules. In some sperm, besides the absence of dynein arms, there was also absence of the central pair of microtubules. Neither anomalies of the fibrous sheath nor of the dense fibers were found. In approximately 50% of the spermatozoa, the midpiece had a decreased number of mitochondria and extra non-aligned mitochondria. Other findings included extra peripheral microtubules in the axoneme.

Evidencia de transmisión autosómica dominante a través de la línea materna en un caso de discinesia ciliar primaria / Evidence for autosomal dominant inheritance through the maternal line in a case of primary ciliary diskinesia

Se presenta evidencia de un caso atípico de discinesia ciliar primaria en el que la transmisión genética, en lugar de la clásica autosómica recesiva, parece ser de tipo autosómico dominante transmitida a través de la línea materna. Se trata de un caso de dos hermanos de 29 y 30 años de edad casados y sin hijos, con historia de infertilidad, sinusitis frecuentes e infecciones respiratorias recurrentes. Madre y hermana presentan broncopatía crónica no filiada. Padre sano sin afectación pulmonar o sinusal. En el examen físico, en ambos hermanos, la hermana, y la madre, sólo destaca la presencia de roncus en la auscultación pulmonar. Bioquímica ordinaria normal, incluyendo pruebas de función pulmonar, hepática y renal. El estudio ultraestructural del flagelo espermático por microscopía electrónica indica que los dos hermanos tienen la misma anomalía. En la mayoría de las secciones transversales se encuentra ausencia de ambos brazos de dineína. El filamento de nexina está presente, así como las fibras radiales y el par central. En espermatozoides aislados, coincidiendo con la ausencia de los brazos de dineína, hay también pérdida del par central. No se encontraron anomalías en la vaina fibrosa, ni pérdida de las fibras densas. La pieza intermedia en aproximadamente el 50% de los espermatozoides mostraba una disminución en el número de mitocondrias y de mitocondrias extras no alineadas. Otros hallazgos fueron la presencia de microtúbulos extra periféricos al axonema

An atypical case of primary ciliary dyskinesia is presented in which the inheritance, rather than the classical autosomal recessive, appears to be transmitted as an autosomal dominant trait through the maternal line. The case involves two brothers of 29 and 30 years of age, married without children, with a history of infertility, frequent episodes of sinusitis, and recurrent pulmonary infections. Their mother and sister have chronic bronchopathy of unknown etiology. Their father is healthy without pulmonary problems or sinusitis. At physical exam, both brothers, sister and mother presented with bronchial rhonchi at lung auscultation. Blood analysis and pulmonary function, liver and renal tests were all normal. The ultraestructual study of the sperm flagellum by electron microscopy revealed that both brothers have the same anomaly. Namely, in the majority of the cross-sections, both dynein arms are missing. The nexin filament was present, as well as the radial spokes and the central pair of microtubules. In some sperm, besides the absence of dynein arms, there was also absence of the central pair of microtubules. Neither anomalies of the fibrous sheath nor of the dense fibers were found. In approximately 50% of the spermatozoa, the midpiece had a decreased number of mitochondria and extra non- aligned mitochondria. Other findings included extra peripheral microtubules in the axoneme

Parasitic mycelial forms of coccidioides species in Mexican patients.

Of 26 cases of coccidioidomycosis reported here, 15 showed hyphae, atypical parasitic structures of Coccidioides spp. in fresh cytologic and/or histologic specimen preparations. The finding of this morphology could have implications which should be considered, especially when the disease affects areas of nonendemicity.

Formoterol vs. albuterol administered via Turbuhaler system in the emergency treatment of acute asthma in children.

BACKGROUND: Formoterol is a new beta 2 agonist with a duration of 8-12 hours. Albuterol is a beta 2-agonist with rapid onset of action and a duration of approximately 6 hours. OBJECTIVE: The aim of the present study was to compare the onset of action between formoterol and albuterol, both administered through a Turbohaler. MATERIAL AND METHOD: In a double-blind, parallel-group study design 36 patients were randomly allocated to receive either formoterol 12 microg or salbutamol 200 microg. The two drugs were administered through a Turbohaler system. Response (% forced expiratory volume in one second [FEV1]) was evaluated 3, 30 and 60 minutes after drug administration. RESULTS: The %FEV1 values at 3, 30 and 60 minutes were similar in both groups: 82 15.0 for formoterol and 82 14.4 for albuterol at 60 minutes (p > 0.05). CONCLUSIONS: Formoterol 12 microg has a similar onset of action and potency to albuterol 200 microg when administered via a Turbuhaler in children with a mild acute asthma crisis.

Formoterol vs. Albuterol administered via Turbuhaler System in the emergency treatment of acute asthma in children

Background: Formoterol is a new β2-agonist with a duration of 8-12 hours. Albuterol is a β2-agonist with rapid onset of action and a duration of approximately 6 hours.Objective: The aim of the present study was to compare the onset of action between formoterol and albuterol, both administered through a Turbohaler®. Material and method: In a double-blind, parallel-group study design 36 patients were randomly allocated to receive either formoterol 12 μg or salbutamol 200 μg. The two drugs were administered through a Turbohaler® system. Response (% forced expiratory volume in one second [FEV1]) was evaluated 3, 30 and 60 minutes after drug administration. Results: The %FEV1 values at 3, 30 and 60 minutes were similar in both groups: 82 ± 15.0 for formoterol and 82 ± 14.4 for albuterol at 60 minutes (p > 0.05). Conclusions: Formoterol 12 μg has a similar onset of action and potency to albuterol 200 μg when administered via a Turbuhaler® in children with a mild acute asthma crisis (AU)

Información básica: Formoterol es un nuevo Beta2-agonista con un efecto de 8-12 horas. Salbutamol es un Beta2-agonista con una acción de comienzo rápido que dura aproximadamente 6 horas. Objetivo: El objetivo del presente estudio era comparar el inicio de la acción entre formoterol y salbutamol, ambos administrados mediante Turbohaler. Material y método: En un estudio doble ciego y de grupos paralelos se distribuyó aleatoriamente a 36 pacientes para recibir formoterol 12 mg o salbutamol 200mg. Los dos fármacos se administraron por medio de un sistema Turbohaler. Se evaluó la respuesta ( por cientoFEV1) 3, 30 y 60 minutos después de la administración del fármaco. Resultados: Los valores de por cientoFEV1 a los 3, 30 y 60 minutos fueron semejantes entre los grupos (p > 0,05), p. ej., 82 ñ 15,0 con formoterol y 82 ñ 14,4 con salbutamol a los 60 min. Conclusiones: Formoterol 12mg tuvo un inicio de acción y una potencia similares a las de salbutamol 200mg cuando se administraron a través de Turbuhaler a niños con crisis asmáticas agudas leves (AU)

Use of OM-85 BV in children suffering from recurrent respiratory tract infections and subnormal IgG subclass levels.

BACKGROUND: Recurrent acute respiratory tract infections (RARTIs) in children are related to IgG subclass deficiencies. The aim of the trial was to evaluate the effect of OM-85 BV in the number of RARTIs as well as in the IgG subclass levels. METHODS: This was a randomized, double-blind, placebo-controlled clinical trial. Patients of ages three to six years, having three or more documented ARTIs during the last six months with subnormal IgG subclass levels were included. Patients took either one capsule of OM-85 BV (3.5 mg) or placebo orally every day for ten consecutive days per month during three consecutive months. Patients were followed three further months without drug intake. IgG subclass levels were determined before and after treatment. RESULTS: IgG4 levels diminished after the OM-85 BV treatment (-3 [-8.0, -1.0] median difference [95 % CI] p < 0.05 by Wilcoxon test). No other significant changes in IgG subclasses were observed. After six months the patients in the OM-85 BV group (n = 20) experienced 2.8 1.4 (mean SD) ARTIs, while the patients in the placebo group (n = 20) suffered 5.2 1.5 ARTIs (-2.4 [3.3, -1.5] mean difference [95 % CI] p < 0.001 by Student's t test). Three patients with OM-85 BV had gastrointestinal events related to drug administration, as well as three placebo patients. CONCLUSION: This study demonstrated the clinical benefit of OM-85 BV in patients suffering from RARTIs and subnormal levels of IgG subclasses. This trial opens new perspectives in the research of the mechanism of action of OM-85 BV.

Use of OM-85 BV in children suffering from recurrent respiratory tract infections and subnormal IgG subclass levels

Background: Recurrent acute respiratory tract infections (RARTIs) in children are related to IgG subclass deficiencies. The aim of the trial was to evaluate the effect of OM-85 BV in the number of RARTIs as well as in the IgG subclass levels. Methods: This was a randomized, double-blind, placebo-controlled clinical trial. Patients of ages three to six years, having three or more documented ARTIs during the last six months with subnormal IgG subclass levels were included. Patients took either one capsule of OM-85 BV (3.5 mg) or placebo orally every day for ten consecutive days per month during three consecutive months. Patients were followed three further months without drug intake. IgG subclass levels were determined before and after treatment. Results: IgG4 levels diminished after the OM-85 BV treatment (-3 [-8.0, -1.0] median difference [95 % CI] p < 0.05 by Wilcoxon test). No other significant changes in IgG subclasses were observed. After six months the patients in the OM-85 BV group (n = 20) experienced 2.8 ± 1.4 (mean ± SD) ARTIs, while the patients in the placebo group (n = 20) suffered 5.2 ± 1.5 ARTIs (-2.4 [­3.3, -1.5] mean difference [95 % CI] p < 0.001 by Student's t test). Three patients with OM-85 BV had gastrointestinal events related to drug administration, as well as three placebo patients. Conclusion: This study demonstrated the clinical benefit of OM-85 BV in patients suffering from RARTIs and subnormal levels of IgG subclasses. This trial opens new perspectives in the research of the mechanism of action of OM-85 BV (AU)

Antecedentes: Las infecciones agudas del tracto respiratorio recurrentes (RARTI) en los niños se relacionan con deficiencias de subclases de IgG. El propósito del estudio fue evaluar el efecto de OM-85 BV en el número de RARTI así como en los niveles de subclases de IgG. Métodos: Este fue un estudio clínico aleatorizado, doble ciego, controlado con placebo. Fueron incluidos pacientes de edades de 3 a 6 años, con tres o más ARTI documentadas durante los últimos 6 meses y con niveles subnormales de subclases de IgG. Los pacientes tomaron una cápsula de OM-85 BV (3,5 mg) o placebo por vía oral todos los días por 10 días consecutivos por mes durante 3 meses consecutivos. Los pacientes fueron seguidos por 3 meses más sin tomar medicamento. Los niveles de subclases de IgG fueron determinados antes y después del tratamiento. Resultados: Los niveles de IgG4 diminuyeron después del tratamiento con OM-85 BV (-3 [-8,0, -1,0] diferencia mediana [IC 95 per cent] p < 0,05 por la prueba de Wilcoxon). Ningún otro cambio significativo en las subclases de IgG fue observado. Después de 6 meses los pacientes en el grupo de OM-85 BV (n = 20) experimentó 2,8 ñ 1,4 (media ñ DE) ARTI, mientras que los pacientes en el grupo del placebo (n = 20) sufrieron 5,2 ñ 1,5 ARTI (-2,4 [-3,3, -1,5] diferencia media [IC 95 per cent] p < 0,001 por t de Student). Tres pacientes con OM-85 BV tuvieron trastornos gastrointestinales relacionados a la administración del medicamento, así como tres pacientes con placebo. Conclusión: Este estudio demostró el beneficio clínico de OM-85 BV en los pacientes que sufren de RARTI y de niveles subnormales de subclases de IgG. Este estudio abre nuevas perspectivas en la búsqueda del mecanismo de acción de OM-85 BV (AU)

Adenoma metanéfrico renal típico. Cirugía conservadora / Tipical metanephric renal adenoma. Conservative surgery

El Adenoma Metanéfrico es un infrecuente tumor renal clasificado dentro del grupo complejo de los tumores embrionarios renales o nefroblásticos. Afecta generalmente a mujeres jóvenes y tiene un buen pronóstico en la mayoría de los casos. Debe diferenciarse fundamentalmente de variantes de carácter maligno como el carcinoma papilar de células renales, del adenosarcoma metanéfrico y del tumor de Wilms del adulto. La sospecha del mismo junto con un análisis intraoperatorio del tumor puede facilitar el empleo de cirugía renal conservadora como tratamiento evitando una cirugía radical agresiva e innecesaria. Existen casos de Adenoma Metanéfrico metastásico, con lo que el carácter totalmente benigno de esta patología y su potencial maligno no se encuentran aún totalmente esclarecidos. (AU)

[Typical renal metanephric adenoma. Conservative surgery]. / Adenoma metanéfrico renal típico. Cirugía conservadora.

Metanephric Adenoma is uncommon renal tumor included in the complex group of the embryologics or nefroblastics renal tumors. Generally occurs in young females and usually has excellent prognosis. It's important to differentiate of malignant variants, particularly renal cell papillary carcinoma, metanephric adenosarcoma and adult Wilms tumor. The suspicion and intraoperative analysis of the tumor can to facilitate the use of conservative renal surgery in order to avoid unnecessary radical and aggressive surgery. To exist cases of metastatic metanephric adenoma, and the totally benign characteristic of the metanephric adenoma and the malignant potential isn't totally clarify.

[Expression of epidermal growth factor receptor and p53 protein in superficial cancer of the urinary bladder]. / Expresión del receptor del factor de crecimiento epidérmico y de la proteína p53 en el cáncer superficial de vejiga urinaria.

OBJECTIVE: To determine the relationship of the immunohistochemical expression of p53 and EGF-r (epidermal growth factor receptor) and the recurrence rate and disease-free interval in superficial bladder cancer. METHODS: 144 patients with superficial transitional cell carcinoma of the bladder were studied over a period of three years. Direct dilution anti-EGF-r monoclonal antibody (Biogenex, San Ramon, CA 94583, USA) was utilized for EGF-r determination. Anti-p53 mouse monoclonal antibody (DO7, Novocastra, Newcastle, 24 Claremont Place, UK) at a concentration of 1:100 was utilized for protein p53 determination and was considered negative if less than 10% of the tumor cells were stained and positive if 10% to 100% of the cells stained. EGF-r was determined only as either positive or negative regardless of percent of expression. RESULTS: 55 patients (38%) showed EGF-r and 14 (9.7%) showed p53 expression. The disease free survival was 54.08 months in the patients that showed EGF-r expression vs 30 months for those that did not, the difference being statistically significant (p = 0.027). However, no differences were found in this regard for p53 expression. Tumors that expressed EGF-r recurred in the same site as that of the primary tumor. By contrast, those that did not express EGF-r recurred in another or in multiple sites. CONCLUSIONS: The risk of recurrence is lower in bladder tumors that express EGF-r than those that do not, and when they recur, this generally occurs in the same site as the primary tumor. However, determination of p53 expression was not useful in determining the risk of recurrence or progression of superficial bladder tumors.

[Desensitization to human recombinant DNA insulin in an adolescent with insulin-dependent diabetes mellitus]. / Desensibilización a insulina DNA recombinante humana en una adolescente con diabetes mellitus insulinodependiente.

BACKGROUND: Adverse reactions to drugs have increased in the last years, about 15% of all side effects are thought to be immune mediated according to the Coombs and Gell classification they can be type I (immediate) hypersensitivity, type II (cytotoxic) type III (immune complex mediated) or type IV (delay). Allergy to insulin is defined as an immunological response type I, and type II or III to exogenous insulin solutions occurring the 0.1% and 0.2% of the patients. PATIENTS: A 13 year old female with a 4-year history of insulin-dependent diabetes mellitus who presented hypersensitivity against recombinant DNA (rDNA) insulin manifested with urticaria and itching. We used a premedication therapy without good response and impossibility to use alternative therapy for her metabolic control, so she needed desensitization with insulin. METHODS: Skin prick testing with rapid insulin preparations 1:10 W/V dilution were positive. IgE antibodies to insulin weren't presented. IgE serum values were normal. We began the desensitization with a rapid 1:1000 UI insulin solution by intradermal route, than by subcutaneous route until reaching the accumulated doses necessary per day. During the process it appeared a papular rash and itching which were treated with an intravenous antihistaminic without troubles. RESULTS: The patient tolerated the desensitization procedure very well. For the past 14 months she has been treated uneventfully by subcutaneous administration of rDNA insulin. DISCUSSION: The desensitization against drugs is not a frequently process it only has to be used when it is impossible to substitute the treatment. Our patient showed probably hypersensitivity type 1 to insulin. However, we have to take into account the cytotoxic reaction caused by IgG or IgM antibodies or by immune complex. The desensitization finally was tolerated, 14 months after our patient accepts correctly her daily dose of human recombinant insulin.

[Procedure for bronchodynamic tests with inhaled allergens]. / Procedimiento para realizar pruebas broncodinámicas con alergenos inhalados.

The asthma is one of the most frequent chronic illnesses in the children. It is characterized by hyperreactivity from the air roads to inspecific stimuli (metacholin and histamin) and specific (allergens). The broncodynamics tests determines the broncolability asthmatic boy's and they help to settle down the I diagnose functional. They should be carried out with antigenic extracts of high quality, lyophilized watery and standardized; you can use an open or closed circuit and a dosimeter, the initial dose of the allergen it is lower than with the one that the positive cutaneous reactivity was obtained, carrying out successive increments until the VEF-1 descend 15% or more. The patient's security is fundamental, they should be carried out for specialized personnel.

[Effect of heating on FEV-1 in children with asthma challenged with exercise]. / Efecto del calentamiento sobre el VEF-1 en niños con asma sometidos a reto por ejercicio.

AIMS: The exercise-induced bronchoespasm, also called asthma for exercise, it corresponds to a frequent clinical entity that commonly accompanies the asthmatic patient. Their frequency is of around the 80 to 90% for the patients with asthma; it is presented among 40 to 50% of the children with allergic rhinitis, in the athletes 14% and in the population's 12% in general. OBJECTIVE: To determine the effectiveness of a heating routine like preventive agent of the exercise-induced bronchoespasm. METHOD: 30 patients were included of between 10 and 16 years of age, asthmatic and with exercise-induced bronchoespasm by diagnosed by means of challenge test to the exercise. All the patients carried out an exercise routine with duration of 20 minutes during which movements of elasticity, calisthenics and light activity were made directed to the exercise to develop, taking as objective parameter 60% of the frequency heart submax. Did all the patients carry out challenge at once, again to the exercise, in which a band numberless was used, with speeds that were increased progressively from 1 to 8 km/h and with inclination of 0? 10 0. The spirometrics registrations was made before the challenge and at the 2, 5, 10, 15, 20, 25, 30 and 60 minutes after the same one. RESULTS: The average of the patient's age was of 12.8 +/- 2 years with size of 157 +/- 10 cm. CONCLUSION: The heating in children with broncoespasmo induced by exercise acts as a protective agent against the decrement of the VEF-1. Although the heating can be a good control method in the asthmatic patient, it is necessary to keep in mind that not all the patients have a benefit of this protection. This can only be used in patient with programmed physical activity, since in the preschoolers it is not possible to implant a heating routine for the characteristics characteristic of their activity.

[Determination of immediate hypersensitivity to pollen in allergic patients in the Federal District]. / Determinación de hipersensibilidad inmediata a pólenes en pacientes alérgicos del Distrito Federal.

AIMS: The immediate hypersensibility immediate mediated by IgE represents the damage mechanism type 1 according to the original classification of Gell & Coombs. MATERIAL AND METHOD: Observational study, descriptive, transverse in the one which were checked the files of 1250 patient of the Allergy Service of the Hospital Infantil de Mexico Federico Gomez with diagnostic of rhinitis allergic; asthma; asthma and rhinitis allergic. RESULTS: 1250 patient studied 468 were of the feminine sex (37.44%) and 782 (62.58%) of the masculine with a mean age in either case of 7.9 +/- 3.5 SD. With respect to result of cutaneous test 154 (12.32%) were negative and 1096 (87.68%) were positive to one or more antigens. CONCLUSIONS: The obtained results indicate the importance of accomplishing greater number of studies that relate not only the percentages of positive in the determination of immediate hypersensitive, but also to the frequency of pollens in the means to the one which is unfolded the patient, together with the stages of pollination throughout the Mexican Republic, in pediatric population as well as in adult, to effect cutaneous tests selects according to the zone and to stablish a specific treatment and adapted for each patient.

[Air flow measurement in children with mite allergies before and after skin prick test]. / Medición de la flujimetría en niños alérgicos a ácaros antes y después del reto con pruebas por prick.

OBJECTIVE: To determine the obstruction of the air flow by flujimetry subsequent to the application of tests cutaneous specific (Dermatophagoides pteronisinnus) in sensitive children. MATERIAL AND METHODS: They were studied 44 patient of one and other sex with diagnostic of asthma and antecedent of sensibility to the mite Dermatophagoides pteronisinnus through tests cutaneous for prick, with an average age of 6 to 16 years, captured of the external consult of the allergy service of the Hospital Infantil de Mexico Federico Gómez. It is a longitudinal study, prospective, blind, cross, in the one which previously was made a challenge test with antigen standardized of Dermatophagoides pteronisinnus or glycerine, previous reading of flujimetry. RESULTS: Of the patients challenged with antigen in 23 there was decrease of the respiratory maximum flow, with a p < 0.05, but without clinical meaning. When they were challenged with placebo only it reduced in patient seven the respiratory maximum flow, also significative statistically, but without clinic relevancy. CONCLUSION: The cutaneous tests are a useful tool in allergy and sure, since almost they do not produce serious systemic reactions.