Anthropomorphic Polydimethylsiloxane silicone-based phantom for Diffuse Optical Imaging.

This work presents a method for constructing phantoms suitable for diffuse optical mammography. They are based on Polydimethylsiloxane silicones, with the characteristic of being anthropomorphic, and having similar mechanical and optical properties as a real breast. These phantoms are useful for testing the performance of diffuse optical imaging devices in the near infrared, both in transmittance and reflectance geometries, since they can be constructed containing inclusions, to simulate breast tumors. An alternative component to be used as scattering agent, that is easier to handle than traditional scattering agents, is also studied. The optical properties of the phantoms were tested varying the concentration of scattering and absorbing agents, while their mechanical properties were modified by adding a silicone fluid to the basic mixture. Finally, the phantoms were tested by Diffuse Optical Imaging experiments, and these images were compared to the ones obtained by conventional ultrasound techniques. Results show that the constructed anthropomorphic phantoms properly reproduce the optical and mechanical characteristics of human breasts, and are suitable to be used in Diffuse Optical Imaging.

Advantages and Short-Term Outcomes of Laparoscopic-Assisted Renal Surgery in Elderly Patients

Objective: To compare the perioperative results of adult and elderly patients undergoing laparoscopic renal surgery. Methodology: Retrospective, analytical study. 448 who underwent kidney surgery for benign or malignant pathologies between 2011-2019 were included in the General Hospital of Mexico “Dr. Eduardo Liceaga”. They were categorized into two groups: Group 1 <60 years and Group 2 >60 years. Descriptive statistics and bivariate analysis were performed, the calculations were performed with 95% reliability and a value of p (<0.05). Results: In the group over 60 years of age, the following was found: Age: 67.1 years (60-83). IMC 28.3 kg/m2 (19-48.7). Intra and postsurgical outcomes: intraoperative bleeding = 184.4cc (5-1700). Surgical Time = 112.6min (30-240). Days of hospital stay = 2 (1-7). Complications in 2.6% (Clavien-Dindo: I = 2; II = 1), no conversion was required in any patient. There were no statistically significant differences with group 1, an exception for intraoperative bleeding. Conclusions: Our study is a pioneer in Latin America in the evaluation of the geriatric population and outcomes with laparoscopic surgery and we recommend that renal procedures with a laparoscopic approach should be considered as the best strategy in the management of benign or malignant renal pathology in geriatric patients (AU)

Objetivo: Comparar los resultados perioperatorios depacientes adultos y adultos mayores sometidos a cirugía renal laparoscópica.Material y Métodos: Estudio retrospectivo,analítico. Se incluyeron 448 sometidos a cirugías renalespor patologías benignas o malignas entre 2011-2019 en elHospital General de México “Dr. Eduardo Liceaga”. Secategorizaron en dos grupos: Grupo 1 <60 años y Grupo2 >60 años. Se realizó estadística descriptiva y análisisbivariado, los cálculos se realizaron con confiabilidad del95% y un valor de p (< 0.05).Resultados: En el grupo de mayores de 60 años, seencontró lo siguiente: Edad promedio: 67.1 años (60-83).IMC 28.3 kg/m2(19-48.7). Desenlaces trans y postquirúrgicos: sangrado transoperatorio (STO) = 184.4cc (5-1700).Tiempo Quirúrgico = 112.6 min (30-240). Días de estanciaintrahospitalaria = 2 (1-7). Complicaciones en el 2.6%(Clavien-Dindo: I = 2; II = 1), no se requirió conversiónen ningún paciente. No existieron diferencias estadísticamente significativas con el grupo 1, a excepción del STO.Conclusiones: Nuestro estudio es pionero enIberoamérica en la evaluación de la población geriátricay desenlaces con cirugía laparoscópica y recomendamosque los procedimientos renales con abordaje laparoscópicodeben considerarse como la mejor estrategia en el manejode patología renal benigna o maligna en los pacientes geriátricos (AU)

One-Year Outcomes of a Piscine Soft Tissue Alternative Used in Mucogingival Procedures: A Clinical Case Series.

The free gingival graft (FGG) has been used predictably for gingival procedures aimed to increase the width of keratinized tissue (KT). Several soft tissue alternatives, such as xenografts and allografts, have been studied and proven to be successful with varying degrees. This pilot clinical case series evaluated the efficacy, safety, and initial clinical outcomes (measuring KT width) of a piscine xenograft material (Omega3 Wound, Kerecis) compared to the FGG (harvested from the patient palate) in correcting mucogingival deformities around teeth. A convenience sample of six subjects with unilateral or bilateral lack of KT were enrolled in the study. The primary objective of this pilot study was to determine the gain in width of KT. Secondary objectives included investigating the probing depth, recession depth, bleeding on probing, and inflammation score. There were three FGG sites and six xenograft sites. In bilateral-site treatments, FGG or piscine xenograft were randomly assigned. For unilateral sites, the piscine xenograft was used. Postoperatively, the patients returned for follow-up at 1, 2, 4, 12, 24, 48, and 52 weeks. All six subjects completed the 12-month study and reported uneventful healing. On average, the xenograft sites had a 3.25-mm gain in KT width, and the FGG had an average gain of 3.67 mm. This pilot clinical series showed the piscine xenograft to be safe and efficacious during healing and to increase the width of KT. Future studies may include a more robust study design with a greater number of subjects.

Resource recovery assessment at a pulp mill wastewater treatment plant in Uruguay.

Using a mathematical model, a resource recovery assessment was carried out at a pulp mill activated sludge wastewater treatment plant (WWTP) located in Uruguay. Through the evaluation of different scenarios, the potential production of methane from secondary sludge, with its inherent energy savings, and the recovery of phosphorus (P) as struvite were estimated. Considering the current WWTP configuration with a sludge retention time (SRT) of 32 days, and according to the model, which is a simplification of reality, the assessment indicates that the implementation of an anaerobic digester (AD) to treat the excess sludge can lead to a methane production of approximately 1736 m3 CH4 d-1, being a promising alternative to increase the WWTP treatment performance. Furthermore, the model predictions suggest that by shortening the SRT from 32 to 5 days, the methane production could increase by up to 5568 m3 CH4 d-1. If the methane produced is used to generate electrical energy to operate the WWTP, energy savings of about 88% can be achieved. Regarding the potential recovery of P as struvite, the addition of a struvite reactor could be an efficient option to recover approximately 1611 mg L-1 of struvite (corresponding to a load of about 433 kg d-1). By optimizing the process performance, these findings highlight the potential recovery of resources in pulp mill WWTP, while complying with stringent effluent discharge standards. In addition, further research activities such as pilot-test or detailed laboratory studies may be needed to validate the previous recommendations for industrial scale application.

Decision support system for the provision of emergency sanitation.

Proper provision of sanitation in emergencies is considered a life-saving intervention. Without access to sanitation, refugees at emergency camps are at a high risk of contracting diseases. Even the most knowledgeable relief agencies have experienced difficulties providing sanitation alternatives in such challenging scenarios. This study developed a computer-based decision support system (DSS) to plan a sanitation response in emergencies. The sanitation alternatives suggested by the DSS are based on a sanitation chain concept that considers different steps in the faecal sludge management, from the toilet or latrine to the safe disposal of faecal matters. The DSS first screens individual sanitation technologies using the user's given input. Remaining sanitation options are then built into a feasible sanitation chain. Subsequently, each technology in the chain is evaluated on a scoring system. Different sanitation chains can later be ranked based on the total evaluation scores. The DSS addresses several deficiencies encountered in the provision of sanitation in emergencies including: the application of standard practices and intuition, the omission of site specific conditions, the limited knowledge exhibited by emergency planners, and the provision of sanitation focused exclusively on the collection step (i.e., just the provision of toilets).

Diffuse reflectance optical topography: location of inclusions in 3D and detectability limits.

In the present contribution we investigate the images of CW diffusely reflected light for a point-like source, registered by a CCD camera imaging a turbid medium containing an absorbing lesion. We show that detection of µa variations (absorption anomalies) is achieved if images are normalized to background intensity. A theoretical analysis based on the diffusion approximation is presented to investigate the sensitivity and the limitations of our proposal and a novel procedure to find the location of the inclusions in 3D is given and tested. An analysis of the noise and its influence on the detection capabilities of our proposal is provided. Experimental results on phantoms are also given, supporting the proposed approach.

High mortality and lesions of the central nervous system in trypanosomosis by Trypanosoma vivax in Brazilian hair sheep.

Here, we report an outbreak of Trypanosoma vivax-induced trypanosomosis in Brazilian hair sheep on a farm in Paraíba state, a non-endemic region in northeastern Brazilian. Of 306 total sheep, 240 showed clinical signs and 216 died. Clinical signs included anorexia, lethargy, anemia, rough hair coat, weight loss, submandibular edema, abortion, and in some cases, neurological signs such as head pressing, lateral recumbence, paddling movements and muscle tremors. T. vivax was identified by blood smear analysis and polymerase chain reaction (PCR). At necropsy, animals exhibited watery blood, pale tissue coloring, and the presence of liquid in the peritoneal cavity and pericardial sac. Histologically, nonsuppurative myocarditis and meningoencephalitis with areas of malacia were observed. After treatment, no parasites were detected by blood smear analysis or PCR. Cattle and buffalo that remained in the same pasture were also infected but presented with asymptomatic infections. Epidemiological data suggest that T. vivax was introduced to the farm and the susceptible flock by buffalos that were asymptomatic carriers of the infection; T. vivax was most likely transmitted by Tabanus spp. bites and also iatrogenically.

Laparoscopic radical hysterectomy with the use of a modified uterine manipulator for the management of stage IB1 cervix cancer.

We prospectively collected data on all patients with stage IB1 cervical cancer, who underwent total laparoscopic radical hysterectomy with the use of a modified uterine manipulator. From January 2000 to December 2005, 54 patients met the study criteria. The mean age was 41.8 +/- 7.47 years. Average BMI (kg/m(2)) was 27.38 +/- 3.13. Squamous carcinoma and adenocarcinoma were found in 88.88% and 11.11% of the cases, respectively. The average surgical time was 265 +/- 70.8 min. The mean estimated blood loss was 276.11 +/- 123.03 ml. The average patient lymph node count was 19.64 +/- 5.08. Positive malignant lymph nodes were identified in 11.11% of the cases. Surgical margins were free of disease in all patients. The mean hospital stay was 1.5 +/- 1 days. There was no mortality. Total laparoscopic radical hysterectomy can be considered a safe alternative to laparotomy. The use of a uterine manipulator does not pose an increased surgical risk and allows for a simpler and more feasible procedure.

Characterization of spliced leader genes of Trypanosoma ( Megatrypanum) theileri: phylogeographical analysis of Brazilian isolates from cattle supports spatial clustering of genotypes and parity with ribosomal markers.

Trypanosoma (Megatrypanum) theileri from cattle and trypanosomes of other artiodactyls form a clade of closely related species in analyses using ribosomal sequences. Analysis of polymorphic sequences of a larger number of trypanosomes from broader geographical origins is required to evaluate the clustering of isolates as suggested by previous studies. Here, we determined the sequences of the spliced leader (SL) genes of 21 isolates from cattle and 2 from water buffalo from distant regions of Brazil. Analysis of SL gene repeats revealed that the 5S rRNA gene is inserted within the intergenic region. Phylogeographical patterns inferred using SL sequences showed at least 5 major genotypes of T. theileri distributed in 2 strongly divergent lineages. Lineage TthI comprises genotypes IA and IB from buffalo and cattle, respectively, from the Southeast and Central regions, whereas genotype IC is restricted to cattle from the Southern region. Lineage TthII includes cattle genotypes IIA, which is restricted to the North and Northeast, and IIB, found in the Centre, West, North and Northeast. PCR-RFLP of SL genes revealed valuable markers for genotyping T. theileri. The results of this study emphasize the genetic complexity and corroborate the geographical structuring of T. theileri genotypes found in cattle.

Diminazene aceturate in the control of Trypanosoma evansi infection in cats.

The aim of this study was to investigate the efficacy of diminazene aceturate in the control of the infection by Trypanosoma evansi in cats. Fourteen animals were infected with 10(8) trypomastigote forms each and six were used as negative control (group A). Seven of the infected cats were used as positive control (group B) and seven were treated with diminazene aceturate (3.5 mg kg(-1)) for 5 consecutive days (group C). Biochemical and hematological parameters were evaluated during the experiment. Blood with anticoagulant was collected at day 49 post-inoculation and preserved in ethanol for DNA extraction. Samples were analyzed using PCR T. evansi-specific to assess the effectiveness of treatment. The treatment with diminazene aceturate had an efficacy of 85.7%. Alanine aminotransferase, gamma-glutamyltransferase, urea, and creatinine values remained within the normal physiological range in the treated cats. Hemogram was normalized in all the cured animals. Therefore, the therapy used is effective in controlling T. evansi in cats.

Phylogenetic analysis of Trypanosoma vivax supports the separation of South American/West African from East African isolates and a new T. vivax-like genotype infecting a nyala antelope from Mozambique.

In this study, we addressed the phylogenetic and taxonomic relationships of Trypanosoma vivax and related trypanosomes nested in the subgenus Duttonella through combined morphological and phylogeographical analyses. We previously demonstrated that the clade T. vivax harbours a homogeneous clade comprising West African/South American isolates and the heterogeneous East African isolates. Herein we characterized a trypanosome isolated from a nyala antelope (Tragelaphus angasi) wild-caught in Mozambique (East Africa) and diagnosed as T. vivax-like based on biological, morphological and molecular data. Phylogenetic relationships, phylogeographical patterns and estimates of genetic divergence were based on SSU and ITS rDNA sequences of T. vivax from Brazil and Venezuela (South America), Nigeria (West Africa), and from T. vivax-like trypanosomes from Mozambique, Kenya and Tanzania (East Africa). Despite being well-supported within the T. vivax clade, the nyala trypanosome was highly divergent from all other T. vivax and T. vivax-like trypanosomes, even those from East Africa. Considering its host origin, morphological features, behaviour in experimentally infected goats, phylogenetic placement, and genetic divergence this isolate represents a new genotype of trypanosome closely phylogenetically related to T. vivax. This study corroborated the high complexity and the existence of distinct genotypes yet undescribed within the subgenus Duttonella.

Cirugía de control de daños: análisis fisiopatológico e implicancias / Demage control surgery: phisio-pathologic analysis and involves

Antecedentes: La cirugía "por etapas" o "de control de daños" ha cambiado conceptualmente el manejo de pacientes en estado "in tremis". estos pueden tener una patología de base traumática, ginecoobstétrica o bien de cualquier otro origen que descompese su sistema cardiovascular o metabólico. Si bien es un concepto fisiopatológico moderno, el origen se remonta a los primeros años del siglo XX. Objetivos: Evaluar la experiencia de nuestro hospital en el manejo de pacientes sometidos a la táctica del "control de daño". Diseño: Estudio de evaluación retrospectiva. Población: pacientes que ingresaron con traumatismos en abdomen y que fueron declarados "in extremis" ante el estado metabólico y/o cardiovascular. Método: Se evaluaron 41 pacientes de los cuales veinte eran traumatismos hepáticos, siete traumatismos pelvianos, cinco traumatismos de hipocondrio izquierdo, otros cinco con traumatismos retroperitoneales en zona ll y otros cuatro con traumatismo duodenopancreático. Resultados: Con una mortalidad global de 18 casos (43,9 por ciento), los que presentaron mayor mortalidad grupal fueron los de hipocondrio izquierdo (60 por ciento) y los retroperitoneales (60 por ciento), finalmente los pelvianos con 57,1 por ciento y los duodenopancreáticos con 50 por ciento. Los traumatismos hepáticos presentaron una mortalidad del 30 por ciento. Conclusiones: Es una táctica clinicoquirúrgica para un grupo reducido de pacientes cuyo estado hemodinámico y/o metabólico presenta alta mortalidad. La indicación de la incorporación del paciente a la sistemática del control del daño es del cirujano. Los resultados obtenidos dependen además de la calidad profesional y técnica de los Servicios de Terapia Intensiva, Anestesia y Hemoterapia. El control del daño mantiene elevada aún la mortalidad. El hecho está relacionado con la condición de extrema gravedad de cada uno de los pacientes. Debe tenerse presente que sólo entre un 5 y un 9 por ciento de los traumatizados graves reúne criterios de aplicación de esta terapéutica (AU)

Cirugía de control de daños: análisis fisiopatológico e implicancias / Demage control surgery: phisio-pathologic analysis and involves

Antecedentes: La cirugía "por etapas" o "de control de daños" ha cambiado conceptualmente el manejo de pacientes en estado "in tremis". estos pueden tener una patología de base traumática, ginecoobstétrica o bien de cualquier otro origen que descompese su sistema cardiovascular o metabólico. Si bien es un concepto fisiopatológico moderno, el origen se remonta a los primeros años del siglo XX. Objetivos: Evaluar la experiencia de nuestro hospital en el manejo de pacientes sometidos a la táctica del "control de daño". Diseño: Estudio de evaluación retrospectiva. Población: pacientes que ingresaron con traumatismos en abdomen y que fueron declarados "in extremis" ante el estado metabólico y/o cardiovascular. Método: Se evaluaron 41 pacientes de los cuales veinte eran traumatismos hepáticos, siete traumatismos pelvianos, cinco traumatismos de hipocondrio izquierdo, otros cinco con traumatismos retroperitoneales en zona ll y otros cuatro con traumatismo duodenopancreático. Resultados: Con una mortalidad global de 18 casos (43,9 por ciento), los que presentaron mayor mortalidad grupal fueron los de hipocondrio izquierdo (60 por ciento) y los retroperitoneales (60 por ciento), finalmente los pelvianos con 57,1 por ciento y los duodenopancreáticos con 50 por ciento. Los traumatismos hepáticos presentaron una mortalidad del 30 por ciento. Conclusiones: Es una táctica clinicoquirúrgica para un grupo reducido de pacientes cuyo estado hemodinámico y/o metabólico presenta alta mortalidad. La indicación de la incorporación del paciente a la sistemática del control del daño es del cirujano. Los resultados obtenidos dependen además de la calidad profesional y técnica de los Servicios de Terapia Intensiva, Anestesia y Hemoterapia. El control del daño mantiene elevada aún la mortalidad. El hecho está relacionado con la condición de extrema gravedad de cada uno de los pacientes. Debe tenerse presente que sólo entre un 5 y un 9 por ciento de los traumatizados graves reúne criterios de aplicación de esta terapéutica

Clinicopathologic characteristics of head and neck squamous cell carcinoma in Puerto Ricans

OBJECTIVE: The purpose of this study is to characterize head and neck squamous cell carcinoma (HNSCC) in the Puerto Rican population. This is a follow-up to our initial published report on the first 134 patients. Specifically, demographic characteristics, stage at presentation, initial treatment given, and rate of recurrence were studied. METHODS: Relevant data was obtained from 445 histologically confirmed HNSCC cases identified through the University of Puerto Rico School of Medicine Otolaryngology Department Head and Neck Cancer Clinics between August 1993 and January 2003. Data collected after informed consent included demographic factors (sex, age, areas of residence, income); risk factors (occupation, alcohol intake, cigarette usage); and pathological variables (tumor location, histopathology, stage at presentation, current disease status, tumor recurrence). RESULTS: The average age at diagnosis was 64.0 years (range 18-98); 84.5 per cent of the patients were male, 16 per cent were females. The most frequent anatomical sites of the primary tumor were the larynx (36.4 per cent) and the oral cavity (29.9 per cent). The majority of patients (61.1 per cent) presented with advanced stage (III-IV) disease at the time of diagnosis and over half (55.5 per cent) had moderately-differentiated tumors. Most patients had less than 12 years of formal education (81.2 per cent). Prolonged use of tobacco and alcohol identified in 88.1 per cent and 79.8 per cent of patients, respectively. The most frequent therapeutic modality used was radiation therapy followed by the combination of radiation and surgery. Twenty five percent of the cases experienced a recurrence of disease during the follow-up period. CONCLUSIONS: These findings emphasize the need for early detection programs for HNSCC in Puerto Rican patients given the high rate of advanced-stage disease at time of diagnosis. The key role of heavy alcohol intake and tobacco use as risk factors in the development of HNSCC is once again highlighted.

Tratamiento no operatorio en el traumatismo abdominal cerrado: análisis preliminar / Non operative management for blunt solid organ abdominal trauma

Antecedentes: Es controvertido el tratamiento no operatorio en el traumatismo abdominal cerrado. Establecida la causa mecánica, los cirujanos tuvieron históricamente tendencia a la exploración quirúrgica en los traumatismos moderados y graves. Objetivo: Analizar una secuencia de tratamiento no operatorio en el traumatismo abdominal cerrado tipos I, II y III (de acuerdo a la clasificación AAST). Lugar de aplicación: Departamento de Cirugía General, Complejo Médico-Hospitalario de Fuerzas de Seguridad. Diseño: Estudio prospectivo observacional. Material y métodos: 39 pacientes con traumatismo abdominal cerrado con criterios de inclusión para análisis secuencial de tratamiento no operatorio: 12 hepáticos, 15 renales y 12 esplénicos. Resultados: Se encontró 0 por ciento de mortalidad con 4 fallas terapéuticos (10,2 por ciento) una hepática y 3 esplénicas. No hubo fallas con trauma renal. Internación hospitalaria prolongada en lesiones esplénicas. Conclusiones: Sólo en centros asistenciales con dedicación al trauma con disponibilidad de diagnósticos imagenológicos las 24 hs del día con protocolos de inclusión y exclusión de pacientes pueden realizar tratamiento no operatorio. Deben involucrarse en ésto autoridades y cirujanos actuantes debido al costo de internaciones prolongadas. Desventajas incluyen el retardo en la decisión quirúrgica. La principal ventaja es la disminución de laparotomías innecesarias

Tratamiento no operatorio en el traumatismo abdominal cerrado: análisis preliminar / Non operative management for blunt solid organ abdominal trauma

Antecedentes: Es controvertido el tratamiento no operatorio en el traumatismo abdominal cerrado. Establecida la causa mecánica, los cirujanos tuvieron históricamente tendencia a la exploración quirúrgica en los traumatismos moderados y graves. Objetivo: Analizar una secuencia de tratamiento no operatorio en el traumatismo abdominal cerrado tipos I, II y III (de acuerdo a la clasificación AAST). Lugar de aplicación: Departamento de Cirugía General, Complejo Médico-Hospitalario de Fuerzas de Seguridad. Diseño: Estudio prospectivo observacional. Material y métodos: 39 pacientes con traumatismo abdominal cerrado con criterios de inclusión para análisis secuencial de tratamiento no operatorio: 12 hepáticos, 15 renales y 12 esplénicos. Resultados: Se encontró 0 por ciento de mortalidad con 4 fallas terapéuticos (10,2 por ciento) una hepática y 3 esplénicas. No hubo fallas con trauma renal. Internación hospitalaria prolongada en lesiones esplénicas. Conclusiones: Sólo en centros asistenciales con dedicación al trauma con disponibilidad de diagnósticos imagenológicos las 24 hs del día con protocolos de inclusión y exclusión de pacientes pueden realizar tratamiento no operatorio. Deben involucrarse en ésto autoridades y cirujanos actuantes debido al costo de internaciones prolongadas. Desventajas incluyen el retardo en la decisión quirúrgica. La principal ventaja es la disminución de laparotomías innecesarias (AU)

Lesiones inadvertidas en el trauma penetrante abdominal / Unnoticed lesions in abdominal trauma

Antecedentes: Los traumatismos en general y los abdominales en particular están aumentando en todas las sociedades. Las lesiones inadvertidas son una realidad con independencia de la sistemática que se utiliza, tanto en el estudio como en el tratamiento. Objetivos: Analizar la frecuencia y las causas de las lesiones no percibidas tanto en el pre como en el intraoperatorio. Lugar de aplicación: Servicio de Cirugía General, Complejo Hospitalario. Diseño: Estudio retrospectivo. Material y métodos: En una serie de 600 pacientes heridos de bala en abdomen tratados entre diciembre de 1984 y diciembre del 2000 se hallaron 16 lesiones inadvertidas. Las formas clínicas de presentación fueron: hemorragia y shock hipovolémico en cinco casos, peritonitis en cuatro casos, sepsis cuatro casos, salida de orina por los drenajes 2 casos y disartria con tendencia al coma un caso. Resultados: De su análisis se desprende que los errores fueron cometidos tanto en la evaluación preoperatoria (4 casos con un paciente fallecido), como en la exploración intraoperatoria (12 casos con dos fallecidos). En 15 casos inadvertidas aun dentro del área corporal en la cual se produjo la injuria. En un caso la lesión se halló fuera del área corporal de mayor foco de atención. Conclusiones: En nuestra serie las lesiones no percibidas se observaron en el 2,5 por ciento. La frecuencia de aparición en la literatura mundial consultada se halla entre un 3 y un 12 por ciento. En las mismas relatan alta morbimortalidad, la cual en la presente serie fue del 18,7 por ciento. A nuestro entender hay ciertas regiones del abdomen particularmente proclives a presentar este tipo de lesiones

Lesiones inadvertidas en el trauma penetrante abdominal / Unnoticed lesions in abdominal trauma

Antecedentes: Los traumatismos en general y los abdominales en particular están aumentando en todas las sociedades. Las lesiones inadvertidas son una realidad con independencia de la sistemática que se utiliza, tanto en el estudio como en el tratamiento. Objetivos: Analizar la frecuencia y las causas de las lesiones no percibidas tanto en el pre como en el intraoperatorio. Lugar de aplicación: Servicio de Cirugía General, Complejo Hospitalario. Diseño: Estudio retrospectivo. Material y métodos: En una serie de 600 pacientes heridos de bala en abdomen tratados entre diciembre de 1984 y diciembre del 2000 se hallaron 16 lesiones inadvertidas. Las formas clínicas de presentación fueron: hemorragia y shock hipovolémico en cinco casos, peritonitis en cuatro casos, sepsis cuatro casos, salida de orina por los drenajes 2 casos y disartria con tendencia al coma un caso. Resultados: De su análisis se desprende que los errores fueron cometidos tanto en la evaluación preoperatoria (4 casos con un paciente fallecido), como en la exploración intraoperatoria (12 casos con dos fallecidos). En 15 casos inadvertidas aun dentro del área corporal en la cual se produjo la injuria. En un caso la lesión se halló fuera del área corporal de mayor foco de atención. Conclusiones: En nuestra serie las lesiones no percibidas se observaron en el 2,5 por ciento. La frecuencia de aparición en la literatura mundial consultada se halla entre un 3 y un 12 por ciento. En las mismas relatan alta morbimortalidad, la cual en la presente serie fue del 18,7 por ciento. A nuestro entender hay ciertas regiones del abdomen particularmente proclives a presentar este tipo de lesiones (AU)

Pancreatitis experimental en el opossum. Rol de la esplacnicectomía previa en la respuesta inflamatoria / Experimental pancreatitis in opossum. Rol of the previus splanicectomy in inflamatory response

BACKGROUND: The role of the Autonomous Nervous System in the immunologic and inflammatory response is still an issue of discussion. Furthermore, the physiopathologic mechanisms involved are still unknown. Acute pancreatitis (AP) does not escape this disconcert. In fact, like in every severe acute inflammatory process, its discontrol could be responsible of the high morbidity and mortality rates. OBJECTIVE: To assess to which degree bilateral splanchnicectomy changes the course of acute inflammatory response in AP. METHOD: Prospective research. RESULTS: The following parameters were evaluated: red blood cell count, white blood cell count, calcium, glucemia, urea, aminase, lypase and liver enzymes. Macroscopy and microscopy views of the pancreas were also obtained. The leucocitary response was abolished, and the calcium levels dropped to a lesser degree. CONCLUSIONS: Bilateral splanchnicectomy prior to unchaining AP had a beneficial effect, Its mechanism of action could have been through the disconnection of the respective reflex arches

Pancreatitis experimental en el opossum. Rol de la esplacnicectomía previa en la respuesta inflamatoria / Experimental pancreatitis in opossum. Rol of the previus splanicectomy in inflamatory response

BACKGROUND: The role of the Autonomous Nervous System in the immunologic and inflammatory response is still an issue of discussion. Furthermore, the physiopathologic mechanisms involved are still unknown. Acute pancreatitis (AP) does not escape this disconcert. In fact, like in every severe acute inflammatory process, its discontrol could be responsible of the high morbidity and mortality rates. OBJECTIVE: To assess to which degree bilateral splanchnicectomy changes the course of acute inflammatory response in AP. METHOD: Prospective research. RESULTS: The following parameters were evaluated: red blood cell count, white blood cell count, calcium, glucemia, urea, aminase, lypase and liver enzymes. Macroscopy and microscopy views of the pancreas were also obtained. The leucocitary response was abolished, and the calcium levels dropped to a lesser degree. CONCLUSIONS: Bilateral splanchnicectomy prior to unchaining AP had a beneficial effect, Its mechanism of action could have been through the disconnection of the respective reflex arches (AU)