Rehabilitación olfatoria en pacientes laringectomizados: maniobra de inducción del flujo aéreo nasal / Olfactory rehabilitation in laryngectomized patients: nasal airflow inducing maneuver

Resumen Introducción: La laringectomía total (LT) tiene como secuela la perdida de la voz, pero otra consecuencia no estudiada es la pérdida del olfato. Objetivo: Demostrar que la "maniobra de inducción del flujo aéreo nasal" (MIFAN) rehabilita el olfato en pacientes con LT. Material y Método: Estudio cuasiexperimental antes-después en pacientes laringectomizados por cáncer de laringe del Servicio de Otorrinolaringología del Hospital Barros Luco Trudeau (HBLT) de Santiago de Chile. Evaluación a través de encuesta, examen físico, nasofibroscopía y test olfatométrico. Pacientes con alteración del olfato por transmisión serán enrolados y se enseñará la MIFAN. Resultados: Se estudiaron 12 pacientes: 10 hombres, 2 mujeres. Edad promedio 66,3 años, todos autovalentes. 66,6% presentó anosmia y 33,3% hiposmia. Todos lograron realizar la maniobra. Posrehabilitación el 100% presentó presencia de olfato valorada por olfatometría. Población intervenida similar a otras series en cuanto a sexo y edad. La erigmofonación facilita la rehabilitación con MIFAN. La rehabilitación del olfato se logró en todos y paralelamente mejoró el sentido del gusto. Conclusión: La MIFAN es una técnica sencilla, barata y asequible para lograr rehabilitar el sentido del olfato en pacientes laringectomizados.

Abstract Introduction: Total laryngectomy (TL) has as a consequence the loss of voice, but another not studied consequence is the loss of smell. Aim: To demonstrate that the "nasal airflow inducing maneuver" (NAIM) rehabilitates smell in patients with TL. Material and Method: A quasi-experimental before-after study in laryngectomized patients for laryngeal cancer from the Otorhinolaryngology Service (ENT) of the Barros Luco Trudeau Hospital (BLTH) at Santiago, Chile. Evaluation through survey, physical examination, nasofibroscopy and olfactory test. Patients with transmission impairment of smell were enrolled and NAIM was performed. Results: 12 patients were studied: 10 men, 2 women. Average age 66.3 years. All self-supporting. 66.6% presented anosmia and 33.3% hyposmia. They all managed to perform the maneuver. Post-rehabilitation, 100% presented the presence of smell assessed by olfactometry. Intervened population similar to other series in terms of sex and age. Esophageal speech facilitates NAIM rehabilitation. Rehabilitation of smell was achieved in all of them and in parallel, the sense of taste improved. Conclusion: NAIM is a simple, cheap and affordable technique to rehabilitate the sense of smell in laryngectomized patients.

Prevalencia de comorbilidad depresiva en la enfermedad de Ménière

Resumen Introducción: Existe relación entre la enfermedad de Ménière (EM) y los trastornos psiquiátricos. Objetivo: Evaluar si los pacientes con EM presentan mayor prevalencia de comorbilidad depresiva en comparación a lo descrito para la población general nacional. Material y Método: Estudio analítico transversal entre los años 2009-2016, en pacientes del Servicio de Otorrinolaringología del Hospital Barros Luco Trudeau con diagnóstico de EM definitivo. Se aplicó la escala del nivel funcional para EM, tinnitus handicap inventory, test de tamizaje de depresión de Goldberg y una evaluación por psiquiatra. Resultados: Se evaluaron 64 pacientes. Promedio de edad fue 52,5 años. La prevalencia de trastorno depresivo fue 71,8%. De éstos, el 71,7% fue diagnosticado antes del estudio y el 28,3% restante durante el estudio. Conclusión: La prevalencia de comorbilidad depresiva en la EM es mayor que la descrita para la población general nacional. Determinar si la EM es la causante de esta prevalencia, o cada uno de sus síntomas por separado, requerirá de nuevos estudios.

Abstract Introduction: There is a relationship between Ménière's disease (MD) and psychiatric disorders. Aim: To assess whether MD patients have a higher prevalence of depressive comorbidity compared to that described for the national general population. Material and Method: Cross-sectional analytical study between 2009-2016, for patients seen at the Department of Otolaryngology at the Barros Luco Trudeau Hospital with a definitive MD diagnosis. The functional level scale was applied for MD, tinnitus handicap inventory, Goldberg screening for depression, and an evaluation by a psychiatrist. Results: 64 patients were evaluated. Average age was 52.5 years. The prevalence of depressive disorder was 71.8%. Of these, 71.7% were diagnosed before the study and the remaining 28.3% during the study. Conclusion: The prevalence of depressive comorbidity in MD is higher than that described for the national general population. Determine if MD or each symptom separately is the cause of this prevalence requires other studies.

Effects of Agave Fructans, Inulin, and Starch on Metabolic Syndrome Aspects in Healthy Wistar Rats.

Healthy Wistar rats were supplemented during 20 weeks with commercial inulin (I) and Agave tequilana fructans (CAT), experimental fructans from A. tequilana (EAT) and A. salmiana (AS) mature stems, rice starch 10% (RS), and standard feed for rodents (C). Feed intake was kept steady, but with I, body weight and abdominal adipose tissue (6.01 g) decreased at the end. Glucose (mg/dL) (C, 120.52; I, 110.69; CAT, 105.75; EAT, 115.48; AS, 101.63; and RS, 121.82), total cholesterol (C, 89.89; I, 64.48; CAT, 68.04; EAT, 68.74; AS, 68.04; and RS, 82), and triglycerides (C, 84.03; I, 59.52; CAT, 68.56; EAT, 59.08; AS, 75.27; and RS, 81.8) kept being normal and without differences between fructans. At the end, there was a significant increase in lactic acid bacteria when the I and AS groups were compared to the C group (C, 9.18; I, 10.64; CAT, 10.34; EAT, 10.36; AS, 10.49; and RS, 9.62 log 10 CFU/g of feces). In addition, with fructans, there was an accelerated process in feces emptiness, Lieberkühn crypts kept their morphology, and there was an increment of goblet cells.

Temporal Response of Foragers and Guards of Two Stingless Bee Species to Cephalic Compounds of the Robber Bee Lestrimelitta niitkib (Ayala) (Hymenoptera, Apidae).

Lestrimelitta spp. are stingless bees that steal food and nesting materials from other highly social bees to survive. Though most of their victim species respond, either aggressively or submissively, to cephalic components of Lestrimelitta, little is known about if such response changes at some point during extended periods of exposure. Moreover, potential synergistic effects due to a mixture of victim's alarm/defense pheromones and Lestrimelitta mandibular pheromones, like in an actual attack, have not been examined so far. In this paper, we investigated the response of two species of non-robber stingless bees, Scaptotrigona mexicana (Guérin) and Tetragonisca angustula (Latreille), to (a) cephalic compounds from crushed heads of nestmates, (b) cephalic compounds of Lestrimelitta niitkib (Ayala), and (c) a mixture of (a) and (b). We found that even though T. angustula did not react to nestmates' crushed head, its response towards L. niitkib cephalic compounds was stronger and lasted longer than that of S. mexicana. Interestingly, the addition of crushed heads of the non-robber species to L. niitkib crushed heads caused no significant increase in the alarm response of both species. It may be that the absence of an alarm pheromone in T. angustula made this species more receptive to extraneous odors, which is not the case for S. mexicana; however, more species must be studied to elucidate any pattern regarding the absence/presence of alarm pheromones and the corresponding response to intruders' pheromones.

Dolor abdominal agudo / Acute abdominal pain

Acute abdominal pain is one of the most frequent causes of medical consultation in emergency urgent care centers. ER doctors must be capable of recognizing those cases requiring medical treatment and those requiring emergency surgery. Clinical history and physical examination are still the basis for diagnosis, and will guide decisions regarding lab tests and more safe and specific imaging. There are diagnosis such as abdominal pain of unknown origin, gastritis and constipation proven to be associated to error, therefore a stricter follow-up is recommended for these cases. Appendicitis still poses a challenge for diagnosis and if there is clinical suspicion, particularly in young patients and/or women in reproductive age, the recommended approach is ultrasound followed by CT scan (pelvis and abdomen), in case the former is not conclusive. There are special conditions for pregnant and elderly patients regarding imaging tests. During pregnancy, ultrasound and MRI are preferred, whereas CT scan is preferred in case of the elderly, except when biliary disease is suspected, in this case ultrasound is the preferred approach.

El dolor abdominal agudo es una de las causas más frecuentes de consulta a los servicios de urgencia. Los médicos de urgencia deben tener presente su amplio diagnóstico diferencial, y ser capaces de distinguir aquellos casos que requieren un manejo médico o quirúrgico de urgencia. La historia clínica y examen físico siguen siendo las armas fundamentales para el diagnóstico, que guiarán el estudio de laboratorio y la selección de imágenes más segura y de mejor sensibilidad y especificidad. Existen diagnósticos como el dolor abdominal no precisado, gastritis y constipación, que han demostrado estar asociados a error, por lo que se sugiere un seguimiento más estricto en estos casos. La apendicitis sigue siendo un desafío diagnóstico y frente a sospecha clínica, especialmente en jóvenes y/o mujeres en edad fértil, el enfrentamiento diagnóstico con imágenes recomendado es el ultrasonido, seguido de la tomografía computarizada (TC) de abdomen y pelvis, si el primero es no concluyente o negativo. La embarazada y el adulto mayor tienen condiciones especiales, y en cuanto a imágenes, se prefiere el ultrasonido y la resonancia magnética en la primera y la TC precoz en el adulto mayor, excepto cuando hay sospecha de patología biliar donde siempre es de elección el ultrasonido.

Intraoperative cystography pre- and post-endoscopic treatment for vesicoureteral reflux: guaranteed success?

OBJECTIVE: This study was designed to investigate whether post-endoscopic treatment (ET) intraoperative cystography is predictive of treatment outcome. PATIENTS AND METHODS: Patients diagnosed with vesicoureteral reflux (VUR) and treated endoscopically with polyacrylate/polyalcohol copolymer or dextranomer hyaluronic acid were studied prospectively between August 2009 and April 2011. Slow infusion pre-ET cystography was performed under anesthesia. Post-ET cystography was performed only if the intraoperative pre-ET results demonstrated VUR. RESULTS: Over a period of 20 months, 23 patients were studied (18 girls, five boys), with an average age of 41.9 months (range 13 months-11 years). Thirty-two renal units with reflux were treated: nine bilateral cases, seven right, and seven left. The distribution of reflux grades was as follows: two grade I, 10 grade II, 11 grade III, nine grade IV. All injected ureters demonstrated grade 0 hydrodistention after the procedure. Twelve of 23 of the pre-ET cystography results were negative for VUR, indicating that the sensitivity of this test is 47% compared with the preoperative voiding cystourethrography (VCUG) or nuclear cystogram. There were no procedure complications. CONCLUSION: Of all patients (n = 23), nearly 60% did not demonstrate pre-ET VUR on intraoperative cystography. If a postoperative VCUG had been performed on all patients, more than half would have received unnecessary radiation. Therefore, this study demonstrates that post-ET cystography does not predict the success of ET of VUR intraoperative. Pre-ET cystography under general anesthesia before ureteral injection, has very low sensitivity, creating false-negatives that may complicate the interpretation of post-ET cystography. We suggest that intraoperative cystography before and after ET fails to show clinical utility and should not be used to predict the outcome of endoscopic VUR treatment.

Colangiopancreatografía retrograda endoscópica (CPRE) precoz y pancreatitis aguda biliar (PAB) / Early endoscopic retrograde cholangiopancreatography (ERCP) and acute biliary pancreatitis (ABP)

For over 20 years we have discussed the indication of early endoscopic retrograde cholangiopancreatography (ERCP) (72 h before the onset of symptoms) in acute biliary pancreatitis (ABP), seeking to stop the inflammatory process, reducing complications and mortality, taking into account that ERCP can cause pancreatitis and other complications such as perforation and hemorrhage. To elucidate this problem, there have been multiple meta-analyses based on the same 3 or 5 randomized controlled trials of early ERCP versus conventional treatment (including elective ERCP) in ABP, which have produced conflicting results. There is agreement regarding that it is not indicated in mild ABP, and it is indicated in ABP associated with cholangitis and persistent obstruction of the ampulla of Vater. There is controversy in severe presentation of ABP, since current evidence does not definitely show the usefulness of early ERCP. No more complications related to ERCP have been reported in this situation.

Desde hace más de 20 años se discute la indicación de la colangiopancreatografía retrógrada endoscópica (CPRE) precoz (antes de 72 h del inicio de los síntomas) en la pancreatitis aguda biliar (PAB), buscando detener el proceso inflamatorio, disminuyendo sus complicaciones y su mortalidad, tomando en cuenta que la CPRE puede ser causa de pancreatitis y otras complicaciones como perforación y hemorragia. Para dilucidar este problema se han realizado múltiples meta-análisis basados en los mismos 3 ó 5 estudios aleatorizados y controlados de CPRE precoz versus el tratamiento convencional (que incluye CPRE electiva) en PAB, los cuales han dado resultados discordantes. En lo que hay acuerdo es en que no está indicada en la PAB leve y sí está indicada en la PAB asociada a colangitis y a obstrucción persistente de la ampolla de Vater. En la PAB de presentación grave hay controversia; la evidencia actual no demuestra en forma definitiva la utilidad de una CPRE precoz. No se ha reportado mayor número de complicaciones relacionadas a la CPRE en esta situación.

Land-sea interface features of four estuaries on the South America Atlantic coast.

The Brazilian coastal zone extends from 4º N to 34º S latitude and because of its long extension, the interface zone from continent to ocean includes a high diversity of geomorphologic and oceanographic characteristics. The rivers from the Northeast and East regions are marked by a typical unimodal seasonal flux patterns but with different amplitudes. As the climate indicates, the rivers from the Northeast are subject to an accentuated seasonal variability with an elevated input and flood pulses during the rainy season and low to negligible fluxes during the dry season. Small-scale rivers usually present typical torrential behaviour. In the humid eastern region, the unimodal seasonal cycle is dampened with a more constant input supply. Recently, some studies have shown that the material supply from rivers along the Northeast and Eastern coasts is diluted by surface tropical waters of oceanic currents and that the estuarine plume dispersal is restricted to a narrow coastal belt. However, human impacts of course mask or even override both natural hydrological cycles and CO2 emissions from terrestrial biomes, or depending on the nature of the human impact, can even increase extreme events. Henceforth this contribution addresses the typological, hydrological and biome diversity of the four estuarine systems fed and affected by the respective Amazon, São Francisco, Paraíba do Sul and Plata watersheds.

Protocolo prospectivo de pieloplastia laparoscópia pediátrica; del estrés a la tranquilidad / Prospective protocol for laparoscopic pyeloplasty in pediatrics; from stress to tranquility

La resolución quirúrgica de una obstrucción pieloureteral (OPU), con mayor frecuencia se realiza de forma laparoscópica. Siendo un procedimiento difícil per-se, consideramos que para optimizar tiempos, materiales y esfuerzo es necesario involucrar a todo el equipo quirúrgico. Se evalúa protocolo quirúrgico prospectivo, con ajuste de protocolo a mitad del estudio en post de mejorar los tiempos quirúrgicos. Método: Estudio prospectivo de 12 casos de pacientes >5kg con OPU y MA G3 con dificultad de vaciamiento; en quienes se aplicó el protocolo quirúrgico para pieloplastia laparoscópica (pasos quirúrgicos, características de suturas, pig-tail y material quirúrgico). Todos los casos fueron operados por 2 cirujanos con experiencia laparoscópica urológica avanzada (>5 años); un mismo ayudante y dos instrumentistas. Después de los primeros 6 pacientes (grupo A) se analizó y perfeccionó el protocolo quirúrgico, comparando posteriormente resultados y en especial tiempo quirúrgico con los siguientes 6 (grupo B). Resultados: La serie incluyó 9 hombres. La mediana para edad fue de 9.3 meses. El peso promedio fue 16. 7 kg (20.4 vs 13.1 kg respectivamente). En grupo A se realizaron 4 derechas y 2 izquierdas, y el grupo B fue inverso (4 izquierdas). Tres de doce pacientes presentaban OPU secundaria a vasos aberrantes. El tiempo quirúrgico promedio por grupo fue de 171.2 (120-200 min) vs 141.7 (90-210 min) respectivamente. El seguimiento promedio fue 19.6 meses (13-24 meses), todos los pacientes tuvieron buena evolución, con MA G-3 sin obstrucción al vaciamiento y disminución de la hidronefrosis. Conclusiones: Consideramos que la disminución del tiempo quirúrgico en el segundo grupo se debió tanto a la integración del equipo como al perfeccionamiento del protocolo quirúrgico: en la técnica, colocación de un cuarto trocar, forma de colocar pig-tail, tipo y tamaño de suturas, preparación...

Laparoscopic surgical resolution for an ureteropelvic junction obstruction (UPJO) is being widely used around the world. lt is considered as a hard and difficult procedure per-se, we considered for time, materials and effort Optimization; to involve every single member of the surgical team. A surgical protocol was developed and revised, with some adjustments in the middle looking forward to reduce surgical time. Method: Prospective study including 12 patients <5kg weight with UPJO and difficult emptying MA G-3; to whom a surgical protocol for laparoscopic pyeloplasty was applied (surgical steps, suture characteristics, stent and surgical material). All cases were operated by 2 advanced skilled laparoscopic surgeons (>5 year experience); same assistant surgeon and two different surgical assistants. After the first 6 cases (group A) the protocol was revised and improved, comparing results especially surgical time with group B (n=6). Results: The series included 9 male, median ages was 9.3 months. Average weight was 16. 7 kg (20.4 vs 13.1 kg for each group). Four right-sided pyeloplasties and 2 left-sided were performed in group A, and opposite in group B (4 left-side). Three of twelve patients had UPJO secondary to polar vessels. The mean surgical time was 171.2 ( 120-200 min) vs 141. 7 (90-210 min) respective/y. Mean follow-up was 19.6 months (13-24 mo), all patients had good outcome, without obstruction in the MA G-3 study and regression of the hydronephrosis...

Catéteres de hemodiálisis en el paciente <15 Kg: rompiendo paradigmas / Hemodyalisis catheters in patients under 15 Kg: braking paradigma

La instalación de catéteres venosos centrales (CVC) para hemodiálisis es parte de la práctica habitual en los servicios de nefrourologia pediátrica. Sin embargo, aún no existen suficientes reportes sobre resultados exitosos con los catéteres de hemodiálisis (HD) en < 15 kg. Nuestro objetivo es reportar la sobrevida y el desarrollo de complicaciones de los CVC insertados en niños <15 kg y evaluar si su uso es seguro en pediatría. Método: Se realizó un seguimiento prospectivo de los pacientes con enfermedad renal crónica terminal (ERC T), con peso < 15 kg, en quienes se instaló un CVC de hemodiálisis tunelizado por punción, entre julio 2006 y junio 2011. Se analizaron variables como: género, enfermedad de base, edad y peso al inicio de HD, resultado de la HD, sitio de inserción, número de catéteres por paciente, motivo de retiro y tiempo de sobrevida del catéter. Resultados: Durante un periodo de 60 meses, se instalaron 31 CVC en 11 pacientes < 15 kg, 8 hombres y 3 mujeres. La principal causa de ERCT es displasia renal. Al inicio de la HD, la edad promedio de los pacientes fue de 27 meses (5-6om) y la media de peso de 10 kg (4. 5-13 kg). El principal sitio de inserción fue la vena yugular interna (90 por ciento). La duración media de HD fue de 312 días (26-840 días).En promedio se requirieron 2.5 catéteres por paciente (rango 1-5). Los factores mecánicos (trombosis, desplazamiento o acodadura), fueron la principal causa de retiro del catéter (39 por ciento), seguidos por las infecciones (13 por ciento). La sobrevida promedio fue de 110 días/catéter (0 a 586)...

Placement of central venous catheters (C VC) for hemodialysis is part of the usual practice of the pediatric nephron urology services. However, there are few data in the literature documenting successful results with the catheters of hemodialysis (HD) in patients weighing less than 15 kg. Our aim is to report the survival and complications of CVC insertion in children weighing less than 15 kg and to assess whether their use is suitable and safe in low-weight pediatric patients. Methods: Prospective follow-up of patients with end-stage renal disease (ESRD), weighing less than 15 kg, in whom a tunneled hemodialysis CVC was inserted, between July 2006 and June 2011. The following data is gathered: gender, underlying cause of chronic kidney disease, age and weight at the beginning of hemodialysis, catheter location, and duration of HD and reason for discontinuing it, number of catheters used per patient, reasons for removal, and catheter survival. Results: During a period of 60 months, 11 CVC were placed in 31 patients weighing less than 15 kg (8 boys and 3 girls). The main cause of ESRD was renal dysplasia. Mean age at start of dialysis was 27 months (5-60 m) and mean weight was 10 kg (4.5-13 kg). The main catheter location was the internal jugular vein (90 percent). The mean duration of HD was 312 days (26-840 days). An average of 2.5 catheters was required per patient (range 1-5). Mechanical factors (thrombosis, displacement or Layering) were the most common cause of central-line removal (39 percent), followed by infections (13 percent). Mean catheter survival was 110 days/ catheter (range 0-586)...

[Management of bleeding esophageal varices in public and private institutions in Chile]. / Diagnóstico y tratamiento de las várices esófago gástricas en Chile: Realidad nacional.

BACKGROUND: The better treatment modalities for bleeding esophageal varices have improved the prognosis of cirrhosis. AIM: To inquire about diagnostic and treatment modalities for esophageal bleeding in Chile. MATERIAL AND METHODS: An enquiry about diagnosis and treatment of esophageal bleeding was designed and electronically sent to public and private health institutions that could admit patients and were located in cities with more than 100,000 inhabitants. RESULTS: The enquiry was answered by 31 of 35 public and 17 of 19 private health institutions that were consulted. Emergency endoscopy was available in 6 of 27 public and in the 16 private institutions that had an emergency room. Rubber band was available in 16 public (52%) and in all private institutions. Cyanoacrylate injections were done in 10 public (32%) and 11 (65%) private institutions. No public institution installed transjugular intrahepatic portosystemic shunts, but 8 had occasional access to this technique. This procedure was done in 7 (41%) private institutions and all had access to it. Surgical treatment was feasible in 20 public (65%) and all private institutions. Primary prophylaxis was done in 18 public (58%) and 14 private (82%) institutions. Secondary prophylaxis was carried out in 26 public (84%) and 16 private (94%) institutions. CONCLUSIONS: Public health institutions have poor access to adequate diagnostic and treatment methods for esophageal bleeding. The primary and secondary prophylaxis of esophageal varices must be improved in both types of institutions.

Diagnóstico y tratamiento de las várices esófago gástricas en Chile: realidad nacional / Management of bleeding esophageal varices in public and private institutions in Chile

Background: The better treatment modalities for bleeding esophageal varices have improved the prognosis of cirrhosis. Aim: To inquire about diagnostic and treatment modalities for esophageal bleeding in Chile. Material and methods: An enquiry about diagnosis and treatment of esophageal bleeding was designed and electronically sent to public and private health institutions that could admit patients and were located in cides with more than 100,000 inhabitants. Results: The enquiry was answered by 31 of 35 public and 17 of 19 private health institutionis that were consulted. Emergency endoscopy was available in 6 of 27 public and in the 16 private institutionis that had an emergency room. Rubber band ligation was available in 16 public (52 percent) and in all private institutions. Cyanoacrylate injections were done in 10 public (32 percent) and 11 (65 percent) private institutions. No public institution installed transjugular intrahepatic portosystemic shunts, but 8 had occasional access to this technique. This procedure was done in 7 (41 percent) private institutions and all had access to it. Surgical treatment was feasible in 20 public (65 percent) and all private institutions. Primary prophylaxis was done in 18 public (58 percent) and 14 private (82 percent) institutions. Secondary prophylaxis was carried out in 26 public (84 percent) and 16 private (94 percent) institutions. Conclusions: Public health institutions have poor access to adequate diagnostic and treatment methods for esophageal bleeding. The primary and secondary prophylaxis of esophageal varices must be improved in both types of institutions.

Dial organic carbon fluctuations in a mangrove tidal creek in Sepetiba bay, Southeast Brazil

The carbon (C) concentration and flux, as dissolved organic carbon (DOC), particulate organic carbon (POC) and macrodetritus (MD), were quantified through 4 tidal cycles in a mangrove tidal creek in Southeastern Brazil. DOC was the major fraction of the total C concentration, accounting for 68 and 61 percent of the total C concentration during ebb and flood periods respectively. Concentrations of DOC (Ebb = 3,41 ± 0,57 mgC.L-1 and Flood = 3,55 ± 0,76 mgC.L-1) and POC (Ebb = 1,73 ± 0,99 mgC.L-1 and Flood = 1,28 ± 0,45 mgC.L-1) were relatively similar during the four tidal cycles. Macrodetritus presented a wide variation with concentration peaks probably related to external forces, such as winds, which enrich the ebb flow with leaf litter. DOC and POC fluxes depended primarily on tidal and net water fluxes, whereas MD fluxes were not. The magnitude of the DOC and POC fluxes varied with the area flooded at high tide, but not the MD fluxes. DOC was the major form of carbon export to Sepetiba Bay. During the four tidal cycles, the forest exported a total of 1,2 kg of organic carbon per ha, mostly as DOC (60 percent), followed by POC (22 percent) and MD (18 percent).

As concentrações e fluxos de carbono orgânico sob forma de carbono orgânico dissolvido (COD), carbono orgânico particulado (COP) e macrodetritos (MD) foram quantificadas durante 4 ciclos de maré em canal de maré na Floresta Experimental de Itacuruçá, Baía de Sepetiba, RJ, litoral sudeste do Brasil. COD foi a fração mais importante para a concentração total de carbono orgânico, contribuindo com 68 e 61 por cento da concentração total de C nos períodos de maré vazante e enchente, respectivamente. As concentrações de COD (vazante = 3.41 ± 0.57 mgC.L-1 e enchente = 3.55 ± 0.76 mgC.L-1) e COP (vazante = 1.73 ± 0.99 mgC.L-1 e enchente = 1.28 ± 0.45 mgC.L-1) foram similares durante os 4 ciclos de maré. A fração macrodetritos apresentou uma ampla variabilidade com máximos de concentração relacionados a fatores externos como ventos, que enriqueceram as águas de vazante com macrodetritos. A magnitude dos fluxos de COD e COP, mas não os de macrodetritos, relacionaram-se com os fluxos de água e a conseqüente área inundada pela maré. A fração COD foi a mais importante forma de exportação de carbono orgânico pelo manguezal. Durante os 4 ciclos monitorados, a floresta exportou um total de 1.2 kg de carbono orgânico, 60 por cento sob forma de COD, seguido pelo COP (22 por cento) e pela fração macrodetritos (18 por cento).

Dial organic carbon fluctuations in a mangrove tidal creek in Sepetiba bay, Southeast Brazil.

The carbon (C) concentration and flux, as dissolved organic carbon (DOC), particulate organic carbon (POC) and macrodetritus (MD), were quantified through 4 tidal cycles in a mangrove tidal creek in Southeastern Brazil. DOC was the major fraction of the total C concentration, accounting for 68 and 61% of the total C concentration during ebb and flood periods respectively. Concentrations of DOC (Ebb = 3.41 +/- 0.57 mgC.L-1 and Flood = 3.55 +/- 0.76 mgC.L-1) and POC (Ebb = 1.73 +/- 0.99 mgC.L-1 and Flood = 1.28 +/- 0.45 mgC.L-1) were relatively similar during the four tidal cycles. Macrodetritus presented a wide variation with concentration peaks probably related to external forces, such as winds, which enrich the ebb flow with leaf litter. DOC and POC fluxes depended primarily on tidal and net water fluxes, whereas MD fluxes were not. The magnitude of the DOC and POC fluxes varied with the area flooded at high tide, but not the MD fluxes. DOC was the major form of carbon export to Sepetiba Bay. During the four tidal cycles, the forest exported a total of 1.2 kg of organic carbon per ha, mostly as DOC (60%), followed by POC (22%) and MD (18%).

Breakthrough pain characteristics and syndromes in patients with cancer pain. An international survey.

Breakthrough pain (BKP) is a transitory flare of pain that occurs on a background of relatively well controlled baseline pain. Previous surveys have found that BKP is highly prevalent among patients with cancer pain and predicts more severe pain, pain-related distress and functional impairment, and relatively poor quality of life. An international group of investigators assembled by a task force of the International Association for the Study of Pain (IASP) evaluated the prevalence and characteristics of BKP as part of a prospective, cross-sectional survey of cancer pain. Fifty-eight clinicians in 24 countries evaluated a total of 1095 patients with cancer pain using patient-rated items from the Brief Pain Inventory (BPI) and observer-rated measures. The observer-rated information included demographic and tumor-related data, the occurrence of BKP, and responses on checklists of pain syndromes and pathophysiologies. The clinicians reported BKP in 64.8% of patients. Physicians from English-speaking countries were significantly more likely to report BKP than other physicians. BKP was associated with higher pain scores and functional interference on the BPI. Multivariate analysis showed an independent association of BKP with the presence of more than one pain, a vertebral pain syndrome, pain due to plexopathy, and English-speaking country. These data confirm the high prevalence of BKP, its association with more severe pain and functional impairment, and its relationship to specific cancer pain syndromes. Further studies are needed to characterize subtypes of BKP. The uneven distribution of BKP reporting across pain specialists from different countries suggests that more standardized methods for diagnosing BKP are needed.

Infección por virus de inmunodeficiencia humana en la embarazada. Importancia del conocimiento de la infección en el embarazo y factores de riesgo en la transmisión perinatal / Human immunodeficiency virus infection in pregnant women. The importance of recognizing the infection during pregnancy and risk factors for perinatal transmission

BACKGROUND: Using adequate infection control measures, the rate of vertical transmission of human immunodeficiency virus (HIV) during pregnancy, has been reduced to 3 per cent in Chile. AIM: To determine vertical transmission rate and risk factors associated to perinatal infection in pregnant women with known (KI) and unknown HIV infection (UI). PATIENTS AND METHODS: HIV infected pregnant women whose deliveries were attended at the San Borja Arriaran Hospital were included. Antiretroviral therapy (ART) has been used since 1995 (Zidovudine 13 patients, biOtherapy 4 and triple therapy 14 patients). Newborns have received ART since 1995. Premature labor without evident cause, premature rupture of membranes, and rupture of membranes over 4 h before delivery were evaluated. Delivery was by elective cesarean section since 1993. Breast feeding was avoided. Pregnant women with UI (suspected disease after delivery due to child or mother pathology) did not received ART. Delivery and breast feeding were managed with common obstetrical-neonatal criteria. RESULTS: Fifty three HIV infected pregnant women were studied (43 with KI and 10 with UI). Four children (36.4 per cent) from the KI group and seven (63.6 per cent from the UI group became infected. The global rate of vertical transmission among KI group was significantly lower than UI group: 9.5 per cent (4/42) vs 70.0 per cent(7/10) p < 0.001. Using ART, this rate was further reduced to 6.5 per cent (2/31) and with bitherapy or triple therapy to 0 per cent (0/18). Breast feeding, vaginal delivery, premature delivery with no clinical cause, premature rupture of membranes, rupture of membranes longer than 4 h and lack of ART, were significantly more common in the UI group, compared with KI group. CONCLUSIONS: Vertical transmission in pregnant women with KI is significantly lower compared with UI. Risk factors increasing HIV perinatal infection are: breast feeding, lack of ART, vaginal delivery, premature rupture of membranes, rupture of membranes > 4 h and premature labor without a clinical cause.

Antibiotic administration in patients with preterm premature rupture of membranes reduces the rate of histological chorioamnionitis: a prospective, randomized, controlled study.

OBJECTIVE: To determine whether antibiotic administration in patients with preterm premature rupture of membranes is associated with a reduction in the rate of histological chorioamnionitis and funisitis. METHODS: One hundred consecutive patients with preterm premature rupture of membranes and no labor between 24 and 34 weeks were invited to participate in this study. Eligible patients randomly received either clindamycin-gentamicin for 7 days or placebo, and were managed expectantly until 35 weeks unless fetal or maternal indications developed. Microbial invasion of the amniotic cavity was defined as the presence of a positive amniotic fluid culture obtained by transabdominal amniocentesis. Cervicovaginal infection was diagnosed when bacterial vaginosis or a positive culture for cervicovaginal pathogens or facultative bacteria associated with a significant increase in the white blood cell count were found. Histological chorioamnionitis was based on the observation of polymorphonuclear leukocyte infiltration of the chorionic plate or the extraplacental fetal membranes. Funisitis was diagnosed in the presence of polymorphonuclear leukocyte infiltration into the umbilical vessel walls or Wharton jelly. Statistics were performed using contingency tables. RESULTS: Seventy-one patients with available histological study of the placenta were included. Thirty-five women received antibiotics and 36 were given placebo. Patients who received antibiotics had a significantly lower rate of histological chorioamnionitis than patients who received placebo (46% (16/35) vs. 69% (25/36), respectively; p < 0.05). This effect was more pronounced among women with microbial invasion of the amniotic cavity and/or cervicovaginal infection (58% vs. 89%, respectively; p < 0.01). Antibiotic therapy was associated with an increase in the frequency of placentas without histological abnormalities (29% vs. 6%; p < 0.01). The frequency of funisitis was not different between groups. CONCLUSION: Administration of antibiotics in patients with preterm premature rupture of membranes is associated with a significant reduction in the incidence of histological chorioamnionitis but it does not modify the frequency of funisitis.