Indications of microsurgery in soft tissue sarcomas.

UNLABELLED: Sarcomas are uncommon tumors and free-margin surgical resection remains the single most important treatment in the curative therapy of soft tissue sarcomas. Refinements in surgical techniques have led to increased function preservation and limb salvage. PATIENTS AND METHODS: The records of patients (n = 41) who underwent microsurgical soft tissue reconstruction subsequent to resection of soft tissue sarcoma during the period 1998 to 2010 were reviewed and compared with a general nonmicrosurgery group (n = 188) in relation to clinicopathological characteristics, surgical procedures, postoperative complications, time until start of adjuvant radiation, functional outcome (Toronto Extremity Salvage Score, TESS), local recurrence, free survival, and disease-specific survival. RESULTS: Forty-one patients (age range: 23 to 95 years) received a total of 42 free flaps. When compared with the general nonmicrosurgery group, these patients presented significant differences with regard to location, histological grade, and neoadjuvant treatments. Complications were encountered in 10 cases, including 3 patients with complete flap loss and 1 patient with partial flap loss; other complications were cervical fistulae, knee arthritis, nonconsolidation, and wound infection. Extremity salvage was achieved in 90% (19/21) of limb sarcomas, with these patients showing adequate postoperative ambulation (TESS 77 ± 16) and adequate use of the upper extremity (TESS 66 ± 26). Two patients underwent amputation after recurrence. Disease-specific survival rates at 5 and 10 years were 79.49% and 76.93%, respectively. CONCLUSION: The microsurgical repair of sarcoma defects is a reliable option that, though not free of complications, is necessary in selected cases such as patients receiving neoadjuvant treatments and those with head and neck location and high-grade tumors. The procedure enables both adequate oncosurgical resection and function preservation. Our microsurgical sarcoma reconstruction data, based on an observation period of 12 years and presenting the results of 42 free tissue transfers in 41 patients, adds further evidence to the previously published smaller series.

[Helicobacter pylori in children in Hospital Nacional de Niños, San José de Costa Rica]. / Helicobacter pylori en niños atendidos en el Hospital Nacional de Niños, San José de Costa Rica.

Infection with Helicobacter pylori is more prevalent in developing than in developed countries. Several publications from Costa Rica associate this agent with almost 70% of the adults suffering gastritis; however, there are not data about its prevalence in children. In order to address that gap in the epidemiology of Helicobacter pylori in Costa Rica, we study 264 children (3 months to 17 years old) remitted to upper endoscopy due to dyspeptic disorders. From each case at least two biopsies were taken; one for Helicobacter isolation and the others for histopathological study. 96 of the children showed any grade of gastritis and in 73 of them was identified H. pylori; also, this agent was associated with 11 of the children without alteration in their gastric mucosa. In total, H. pylori was identified in the 31.8% of the studied cases. The two younger patients infected were a 1 and 2 years-old boys; the former had normal mucosa and the other had gastritis. These data confirm the importance of investigate Helicobacter in young children with gastric discomfort, mainly in developing countries.

Helicobacter pylori en niños atendidos en el Hospital Nacional de Niños, San José de Costa Rica. / [Helicobacter pylori in children in Hospital Nacional de Niños, San José de Costa Rica]

Infection with Helicobacter pylori is more prevalent in developing than in developed countries. Several publications from Costa Rica associate this agent with almost 70

of the adults suffering gastritis; however, there are not data about its prevalence in children. In order to address that gap in the epidemiology of Helicobacter pylori in Costa Rica, we study 264 children (3 months to 17 years old) remitted to upper endoscopy due to dyspeptic disorders. From each case at least two biopsies were taken; one for Helicobacter isolation and the others for histopathological study. 96 of the children showed any grade of gastritis and in 73 of them was identified H. pylori; also, this agent was associated with 11 of the children without alteration in their gastric mucosa. In total, H. pylori was identified in the 31.8

of the studied cases. The two younger patients infected were a 1 and 2 years-old boys; the former had normal mucosa and the other had gastritis. These data confirm the importance of investigate Helicobacter in young children with gastric discomfort, mainly in developing countries.

A simple modification of the Baermann method for diagnosis of strongyloidiasis.

The diagnosis of Strongyloides stercoralis infections is routinely made by microscopic observation of larvae in stool samples, a low sensitivity method, or by other, most effective methods, such as the Baermann or agar culture plate methods. We propose in this paper a practical modification of Baermann method. One hundred and six stool samples from alcoholic patients were analyzed using the direct smear test, agar culture plate method, the standard Baermann method, and its proposed modification. For this modification the funnel used in the original version of the method is substituted by a test tube with a rubber stopper, perforated to allow insertion of a pipette tip. The tube with a fecal suspension is inverted over another tube containing 6 ml of saline solution and incubated at 37 degrees C for at least 2 h. The saline solution from the second tube is centrifuged and the pellet is observed microscopically. Larva of S. stercoralis were detected in six samples (5.7%) by the two versions of the Baermann method. Five samples were positive using the agar culture plate method, and only in two samples the larva were observed using direct microscopic observation of fecal smears. Cysts of Endolimax nana and Entamoeba histolytica/dyspar were also detected in the modification of Baermann method. Data obtained by the modified Baermann method suggest that this methodology may helps concentrate larvae of S. stercoralis as efficiently as the original method.

Rapid contrasting of ultrathin sections using microwave irradiation with heat dissipation.

The use of microwave irradiation (MWI) to accelerate fixation, dehydration and contrasting (staining) for electron microscopy has been applied to the development of rapid methods to process biological samples in electron microscopy. A simple explanation is that the reduced time in those procedures is due to heating. In this paper we propose a contrasting method for thin sections that avoids the thermal effects of MWI. Grids with thin sections of mouse kidney, the dinoflagellate Alexandrium monilatum, spermatophores of the fly Archicepsis diversiformis, the bacteria Acinetobacter calcoaceticum and Enterobacter cloacae were placed into Beem capsules and stained with uranyl acetate and lead citrate, while immersed in an ice-water bath, and irradiated for periods ranging from 30 s to 2 min. After each contrasting procedure, the Beem capsule was filled with distilled water to wash the grids under MWI with the same irradiation time as used to contrast. Good results were obtained on irradiating for 1 min and the temperature of the Beem capsule was maintained around 5 degrees C.

Analysis of 'clean' air samples by scanning and transmission electron microscopy and X-ray probe micro-analysis.

Air samples taken from the clean air over Bristol were examined using scanning, transmission and X-ray probe micro-analysis. A diversity of material was identified demonstrating the importance of man-made pollutants which have the potential to produce lung damage in addition to pollen moulds.

Treatment of the asthmatic child.

At the end of 1983 the outpatient clinic at the National Children's Hospital in San José, Costa Rica, adopted a new program for treating children with asthmatic crises. Use of adrenaline was discontinued, and administration of salbutamol in aerosol and short courses of corticosteroids was introduced; also, a special outpatient room was set aside for treating pediatric asthma cases. Between 1984 and 1986 this program's marked superiority was demonstrated by many developments--including reduction of both initial hospitalizations and readmissions for pediatric asthma by nearly 70%.

[Fibro-epithelial polyps of the urinary tract. Apropos of 2 new cases (of the ureter and bladder)]. / Pólipos fibro-epiteliales del tracto urinario. A propósito de dos nuevos casos (ureteral y vesical).

Fibroepithelial polyps are benign mesodermal tumors that may be localized at any level of the urinary tract. However, the ureter and urethra are uncommon sites and these are rarely found in the bladder. Two cases are described involving the middle ureteral third and the bladder. We discuss the different hypotheses regarding its etiology and describe the clinical features, diagnostic methods and treatment. We underscore its benign natural history, treatment by conservative surgery and non-recurrence.

[Treatment of asthma in the emergency clinic of a pediatric hospital]. / Tratamiento del asma en la consulta externa de urgencias de un hospital pediátrico.

At the end of 1983 a change was made in the treatment of children presenting with acute asthmatic attacks in the emergency clinic at a pediatric hospital in Costa Rica. The use of epinephrine was abandoned in favor of salbutamol in spray form and short-term treatment with glucocorticoids. This new regime, compared with the previous one, reduced hospitalizations and readmissions for asthma by nearly 70%, as well as the average hospital stay (3.5 days vs. 5 days).

[Rosette-forming lymphocytes in the peripheral blood of normal children]. / Linfocitos formadores de rosetas en sangre periférica de niños normales.

The study included 180 healthy children distributted into age groups from newborns to 16 years of age. The subpopulations of early E and EAC (T and B) rosette forming lymphocytes were determined. It was found that the main difference is placed in percentual mean values of the newborn where the value of T lymphocytes is less than for the rest of the ages studied, remaining stable beginning at the age of one year. In newborns, the values of B lymphocytes are greater; later, they drop but remain stable also since the age of one.

[T and B lymphocytes in the peripheral blood of the in-utero malnourished new born infant]. / Linfocitos T y B en sangre periférica del recién nacido desnutrido in utero

The per centum distribution of T and B lymphocytes was determined in 30 full term newborns showing adequate development for their gestational age and in 42 full term newborns showing in utero malnutrition. A significant decrease (p less than 0.001) of both lymphocytic subpopulations was found in the in utero malnutrition group. The possibility of a decreased efficiency of the immune response in this group of patients is discussed.