[Percutaneous versus open technique transpedicular fixation in patients with thoracolumbares type A fractures]. / Fijación transpedicular percutánea versus técnica abierta en pacientes con fracturas toracolumbares tipo A.

INTRODUCTION: Percutaneous transpedicular fixation techniques are an emerging tool in the treatment of spinal trauma, however, their use is not fully accepted. OBJECTIVE: Compare results in patients with traumatic vertebral fracture, treated with percutaneous transpedicular fixation surgery versus open transpedicular fixation. MATERIAL AND METHODS: From January to December 2016, 15 patients with traumatic vertebral fracture were randomly divided into 2 groups, group A were six treated with percutaneous transpedicular fixation, group B were treated with open technique transpedicular fixation, three patients were eliminated. Transoperative bleeding, postoperative pain with the 24-hour and two-week postoperative visual scale, the six-week Oswestry lumbar pain disability index, and three, six, 12 and 24 months of postoperative control were evaluated. RESULTS: The follow-up was 24 months. Statistically significant differences in transoperative bleeding (p 2.43E-05), EVA on the first day (p 0.0003), EVA at two weeks (p = 0.01) were reported in the Oswestry lumbar pain disability questionnaire at six weeks (p = 0.0007), three months (p = 0.005), six months (p = 0.005), 12 months (p = 0.01) and 24 months (p = 0.004), no significant differences were observed with respect to operating time (p = 0.12). DISCUSSION: In our work we find that transoperative bleeding, postoperative pain and functional disability are significantly minor in the percutaneous transpedicular fixation group.

INTRODUCCIÓN: Las técnicas de fijación transpedicular percutánea son una herramienta emergente en el tratamiento del trauma espinal, sin embargo, su uso no es totalmente aceptado. OBJETIVO: Comparar resultados en pacientes con fractura vertebral traumática que fueron tratados con cirugía de fijación transpedicular percutánea versus fijación transpedicular abierta. MATERIAL Y MÉTODOS: De Enero a Diciembre de 2016, 15 pacientes con fractura vertebral traumática fueron divididos aleatoriamente en dos grupos: el grupo A fue de seis pacientes tratados con fijación transpedicular percutánea y el grupo B fue de seis pacientes tratados con fijación transpedicular con técnica abierta; tres pacientes fueron eliminados. Se evaluó el sangrado transoperatorio, el dolor postoperatorio con la escala visual análoga a las 24 horas y a las dos semanas del postoperatorio; también se evaluó el índice de discapacidad de dolor lumbar Oswestry a seis semanas, además de tres, seis, 12 y 24 meses del postoperatorio. RESULTADO: El seguimiento fue de 24 meses. Se reportaron diferencias estadísticamente significativas en el sangrado transoperatorio (p 2.43E-05), EVA al primer día (p 0.0003), EVA a las dos semanas (p = 0.01); también en el cuestionario de discapacidad de dolor lumbar Oswestry a las seis semanas (p = 0.0007), tres meses (p = 0.005), seis meses (p = 0.005), 12 meses (p = 0.01) y 24 meses (p = 0.004). No se observaron diferencias significativas con respecto al tiempo operatorio (p = 0.12). DISCUSIÓN: En nuestro trabajo encontramos que el sangrado transoperatorio, dolor postoperatorio y discapacidad funcional son significativamente menores en el grupo de fijación transpedicular percutánea.

[Impact of vaccination against Haemophilus influenzae type b in Cuba]. / Impacto de la vacunación contra Haemophilus influenzae tipo b en Cuba.

OBJECTIVE: To assess the effectiveness of mass vaccination in Cuba of children under 2 years of age against Haemophilus influenzae type b (Hib), the most common causative pathogen of bacterial meningitis. METHODS: The availability of effective Hib conjugate vaccines led to a nationwide vaccination program in 1999 targeting all children under 2 years of age, with a 97% coverage rate achieved. To assess the program's impact, data from 1998 and 1999 from the National Bacterial Meningitis Reporting System were used. RESULTS: Vaccination efficacy was estimated at 99%. The overall incidence of Hib meningitis declined 46.1%, from 1.3 to 0.6 cases per 100,000 population. The greatest overall reduction, of 56.1%, occurred among children under 5 years of age. Among children under 1 year of age, the reduction was 70.5%, and among the rest of the age groups of children under 5, incidence decreased between 25.9% and 49.6%. In the group targeted for vaccination, incidence decreased 61.1%. Among children in the target group who contracted Hib meningitis, only 8 cases (24.2%) had been vaccinated, most with a single dose applied 1 month before becoming ill. CONCLUSIONS: Hib vaccination of all children under 2 years of age in Cuba greatly reduced the incidence of Hib meningitis, as measured by the National Bacterial Meningitis Reporting System.

[Endoscopic diagnosis of tumors of Vater's ampulla]. / Diagnóstico endoscópico de los tumores del ámpula de Vater.

The diagnosis of ampulla of Vater tumors is complex due to the proximity of other anatomical structures that are the originating sites of tumors with different natural histories, treatment and prognosis. A retrospective study of 65 consecutive patients with conclusive ampulla of Vater tumor diagnosis from January 1994 to April 1998 was conducted. Icterus was the principal symptom in 92%. In 34/65 patients on whom ultrasound or CT scan were performed, nearly half showed only dilation in the bile ducts, an ampullar tumor was suspected in six, in another six, pancreatic tumor was suspected and then discarded, and seven had no specific findings. Endoscopic imaging discovered the tumor in all of the cases, but the biopsy was diagnostic in only 84.6%: forty-eight carcinomas were discovered in addition to six adenomas (two with carcinoma and one with dysplasia) and one lymphoma. A diagnosis was arrived at in ten patients with negative biopsies through other means. Surgeries uncovered two carcinoids with endoscopic diagnosis of carcinoma. It was concluded that endoscopy is a good diagnostic method that allows palliation; however, it requires a perfecting process such as endoluminal ultrasound, specially if, taking into consideration the elevated morbimortality involved in pancreatoduodenectomies, conservative treatment is sought.

The metabolism of 19-nor contraceptive progestins modulates their biological activity at the neuroendocrine level.

In this communication, a series of studies from our laboratory dealing with the mechanism of action of 17 alpha-ethinyl derivatives of 19-nor testosterone are reviewed. The administration of norethisterone (NET) to long-term castrated female rats induces the nuclear translocation of pituitary estradiol receptors and is followed by some estrogenic-like effects at the hypothalamic-pituitary unit. It is established that an A-ring reduced metabolite of NET, the 3 beta,5 alpha-tetrahydro NET derivative, is responsible for the observed in vivo estrogenic effects of the parent compound. 3 beta,5 alpha-NET binds to the estrogen receptor and is efficient in inducing the pituitary estrogen-dependent progesterone receptor and in increasing the uterine weight in long-term castrated rats. Furthermore, administration of 3 beta,5 alpha-NET and the 5 alpha-reduced metabolite of NET (5 alpha-NET) are able to inhibit the release of gonadotropins in the castrated animal to a greater extent than NET. Moreover, pretreatment with tamoxifen, an estrogen binding site competitor, results in a significant diminution of the antigonadotropic potency of 3 beta,5 alpha-NET but not of the 5 alpha-NET, which is only inhibited by the administration of cyproterone acetate. These findings underline the importance of the metabolic rate of NET for the expression of its biological effects at the hypothalamic-pituitary unit.

Mouse fibroblasts an adequate experimental model to study androgen action at the cellular level.

En el presente trabajo se estudio la biotransformacion de 3H-testosterona por fibroblastos murinos (L-929) matenidos en cultivo. Los fibroblastos murinos fueron incubados en monocapa con medio minimo esencial de Eagle en la presencia de tres diferentes concentraciones de 3H-testosterona (3, 10 y 20 nM). Las incubaciones se realizaron a 37o. grados C. durante 72 horas. La pureza radioquimica de cada uno de los metabolitos aislados se llevo a cabo por doble dilucion isotopica incluyendo diversos sistemas cromatograficos asi como la recristalizacion de cada uno de los metabolitos hasta obtener actividades especificas constantes. Los resultados demostraron la biotransformacion de 3H-testosterona a los siguientes metabolitos: 3 alfa, 5 alfa-androstandiol, 5 alfa-dihidrotestosterona, androstendiona y 5 alfa-androstandiona. La incubacion de 3H-testosterona a una concentracion de 20 nM resulto en el grado maximo de conversion metabolica siendo androstendiona y 5-alfa-dihidrotestosterona, los principales metabolitos formados. Estos resultados permiten la demostracion de la presencia de los siguientes sistemas enzimaticos responsables de la biotransformacion de 3H-testosterona por fibroblastos murinos: 17 beta-hidroxisteroide oxidoreductasa, 5 alfa-reductasa y la 3 alfa-hidroxiesteroide oxidoreductasa. En resumen el presente estudio sugiere que los fibroblastos murinos L-929 representan un modelo adecuado para el estudio del mecanismo de accion intracelular de hormonas esteroides con actividad androgenica