Cannabis Seeds Authentication by Chloroplast and Nuclear DNA Analysis Coupled with High-Resolution Melting Method for Quality Control Purposes.

Background: Cannabis plants and their seed have been used in many cultures as a source of medicine and feeding during history. Today, there is an increasing demand for cannabis seeds for medical use. Moreover, a seed sales market with no legal regulations has also grown. This may pose some issues if a quality control is not set in place. Identification of cannabis strains is important for quality control purposes in a nonregulated growing market and in cases of illegal traffic and medical use. Owing to the high price as a pharmacological drug, commercial products of cannabis plants and seeds for medical users are often subjected to adulterations, either when packing or distributing certified seeds in the market. Materials and Methods: Cannabis commercial seeds and cannabis seeds for medical use were analyzed with high-resolution melting (HRM) analysis using barcoding markers. Humulus lupulus L. plants from a local market were used as outgroup control. DNA barcoding uses specific regions of the genome to identify differences in the genetic sequence of conserved regions such as internal transcribed spacer (ITS) and rbcL. DNA barcoding data can be generated with real-time polymerase chain reaction combined with HRM analysis to distinguish specific conserved DNA regions of closely related species. HRM analysis is the method of choice for rapid analysis of sequence variation. Results: The melting temperature (Tm) of homogeneous packages was consistent with single genotypes. However, packages containing contaminating seeds showed Tm differences of 0.2°C on average. Conclusions: An effective, rapid, and low-cost method based on ITS nuclear DNA and on chloroplast rbcL regions for screening and detection of contamination in commercial cannabis seeds was developed and applied for the analysis of different samples. This approach can be used as a quality control tool for cannabis seeds or other plant material.

Colecistogastrostomía guiada por ultrasonografía endoscópica en un paciente con cáncer pancreático: primer caso en Colombia (con video) / Endoscopic ultrasonography-guided cholecystogastrostomy in a patient with pancreatic cancer: the first case in Colombia (with video)

Resumen El tratamiento actual para la obstrucción biliar maligna es la derivación biliar no quirúrgica con propósito paliativo. La cirugía tiene indicaciones específicas en pacientes con patología maligna con propósito curativo. Sin embargo, la obstrucción duodenal y del conducto biliar intra o extrahepático no dilatado hace que esta cirugía y el procedimiento endoscópico guiado por ultrasonografía endoscópica (USE) sean difíciles de realizar. Presentamos nuestra experiencia con el primer caso en Colombia, un país latinoamericano del tercer mundo. Consistió en una colecistogastrostomía guiada por USE, a partir de la utilización de una endoprótesis luminal (Lumen-apposing metal stents, LAMS) (HOT AXIOS stent, Xlumena Inc.; Mountain View, CA, Estados Unidos) de 15 mm × 10 mm, en un paciente masculino con cáncer pancreático inoperable e invasión duodenal con conducto colédoco dilatado. La colecistogastrostomía guiada por USE podría ser considerada como una opción de más importancia para la descompresión biliar que el drenaje percutáneo, ya que es superior en términos de viabilidad técnica, seguridad y eficacia en casos específicos de estenosis ampular e invasión duodenal. Además, puede ser realizada en países del tercer mundo, cuando se cuenta con el entrenamiento y los instrumentos adecuados. La endoprótesis metálica totalmente recubierta, aplicada a luz (HOT AXIOS stent, Xlumena Inc.; Mountain View, CA, Estados Unidos), es ideal para la colecistogastrostomía guiada por USE, a fin de minimizar complicaciones como fugas biliares. Se necesitan estudios comparativos adicionales para validar los beneficios de esta técnica.

Abstract The current treatment of malignant biliary obstruction is non-surgical biliary diversion with palliative intent. The surgery having specific indications in patients with malignant pathology with curative intent. However, duodenal obstruction and non-dilated intra- or extrahepatic bile duct make these surgical and endoscopic procedures guided by EUS difficult. We present our experience with the first case in Colombia, a third-world country in Latin America, of a cholecystogastrostomy guided by endoscopic ultrasound (EUS) in a patient with unresectable pancreatic cancer and duodenal invasion with dilated common bile duct using a luminal stent (LAMS) (HOT AXIOS stent, Xlumena Inc.; Mountain View, CA, USA) 15 mm × 10 mm. EUS-guided cholecystogastrostomy should be considered as an option for biliary decompression of greater importance than percutaneous drainage since it is superior in terms of technical feasibility, safety and efficacy in specific cases of ampullary stenosis and duodenal invasion. In addition, it can be done in third world countries when it has the appropriate training and implements. The fully covered metal stent applied to light (HOT AXIOS stent, Xlumena Inc.; Mountain View, CA, USA) is ideal for EUS guided cholecystogastrostomy to minimize complications such as bile leakage. Additional comparative studies are needed to validate the benefits of this technique.

ITS barcoding using high resolution melting analysis of Cannabis sativa drug seizures in Chile: A forensic application.

Cannabis sativa L. is a plant cultivated worldwide as a source of fiber, medicine, and intoxicant. Traditionally, C. sativa is divided into two main types: fiber type (hemp) and drug type. Drug-type C. sativa differs from hemp by the presence of a high quantity of the psychoactive drug, Δ9-tetrahydrocannabinol (Δ9 THC). Cannabis sativa is the most commonly used used illicit controlled substance in Chile. Chile is the third greatest consumer of Cannabis in South America. The objective of this study was to determine the genetic composition of ten drug seizures of Cannabis spp. in the south of Chile using a high resolution melting (HRM) strategy combined with a barcoding marker, ITS. C. sativa samples were selected from previously processed more than a thousand crime cases at the, Araucania region crime lab, National Dept. of Health. Ten cases were selected. Sample collection was based on the following: a) dry and fresh samples with no evidence of decomposition or degradation, b) defined plant fragments such as flowers and leaves from individual plants and, c) samples with different content of THC, CBN and CBD. Five sub samples were randomly selected from each case (N=50). The commercial Silver Haze strain was used as a control. Two real-time PCR and HRM analyses were conducted. The first analysis was performed with a representative sample of each of the 10 cases studied. Then a second assay was performed with all subsamples of cases 1, 5 and 8. Results showed that real-time PCR combined with HRM analysis using ITS allowed to determine the genetic composition of cannabis in all cases studied. The derivative of melting and the analysis of the shape of the curve and the peak of Tm, showed that three groups can be clearly distinguished. A first group exhibited a peak of Tm close to 87.4°C and includes cases 7 and 8. A second group had a peak of Tm close to 87.6°C and includes case 5. A third group displayed a peak of Tm close to 87.9°C and includes case 1, 6 and Silver Haze strain. A second experiment was performed using subsamples of cases 1, 5 and 8. Case 1 displayed a unique composition of the drug suggesting that this seizure contained cannabis clonally propagated. In case 5, two genotypes were present, therefore this could be associated with two strain or two different origin. Case 8, was composed of a mixture of cannabis strains indicating the presence of various crop type and/or different biogeographic origin. In general, our results suggested genetically homogeneous seizures from Araucanía Region. The high latitude (37° 35' and 39° 37' South latitude) and the natural geographic borders that surround southern Chile helps the control of cannabis traffic into the country. Finally, HRM analysis coupled with the barcode ITS demonstrated to be a rapid and low-cost screening method.

Use of Eucalyptus DNA profiling in a case of illegal logging.

Eucalyptus is grown world-wide for paper pulp, solid wood, and other industries. Theft or illegal cutting of the trees causes hardship to owners of plantations and countries whose economies rely on the sale and export of eucalyptus products. Unfortunately, many of these crimes go unpunished due to lack of forensic evidence. Over 1200 short tandem repeat (STR) markers have been identified in the genomes of genus Eucalyptus and related species. However, their importance and utility in aiding forensic investigations of wood theft have not been explored. This study evaluated nine STRs for diversity and applied them to a case involving suspected wood theft. As expected, three dinucleotide STR markers showed greater variability but resulted in harder to interpret profiles. Four STR tetranucleotide markers evaluated in this study were found to contain additional repeat structures (dinucleotide or trinucleotide) that enhanced their variability but resulted in profiles with peaks at multiple stutter positions and heterozygote peak imbalance. The most promising STR markers were EGM37 and EMBRA 1374. Though less variable, they yielded robust and reproducible DNA profiles. All nine STR markers were applied to a case involving suspected wood theft. Samples were collected from seized wood and from remaining stumps in a plantation. No DNA match was found, thus eliminating the evidence samples as having originated from the forest. Dendrochronology analysis also resulted in an exclusion. This case study represents the first report using STR markers in any eucalyptus species to provide DNA evidence in a case of suspected wood theft.

Endoscopic ultrasound (EUS) guided choledocoduodenostomy in a patient with irresecable pancreas cancer and biliar obstruction using a luminal apposing metal stent (LAMS).

The endoscopic retrograde cholangiopancreatography (ERCP) is the election treatment of biliary obstruction. EUS-guided biliary drainage (EUS-BD) has emerged as an alternative to PTBD with a high technical and clinical success rate, low risk of complications and a better quality of life for the patient. Case presentation we present the first case in Colombia of EUS-guided biliary drainage using luminal apposing metal stent (LAMS) in a patient with unresectable pancreatic adenocarcinoma with biliary obstruction in who ERCP was failed due to neoplastic invasion of the Vater papilla. Discussion Transhepatic biliary drainage has been the most common procedure for treatment of malignant biliary obstruction in cases which ERCP fails due to tumor infiltration of the duodenum or the Vater papilla. During the last decade the development of endoscopic ultrasound (EUS) has implied an alternative for biliary drainage in cases of failed ERCP, demonstrating advantages over Trans hepatic biliary drainage Conclusion Considering that EUS-CD is a safe procedure, with a high rate of technical and clinical success, low risk of complications.

Non surgical management for massive gastric lipomatosis.

BACKGROUND: Gastric lipomatosis (GL) is defined as a lipomatous lesion with diffuse infiltration of the submucosal layer by adipose tissue with multiple lesions and must be differentiated from gastrointestinal lipomas, which are solitary submucosal masses composed of well-differentiated adipose tissue surrounded by a fibrous capsule. GL are uncommon, represents 5 % of gastrointestinal tract lipomas and less than 1∼3 % of all gastric tumors. CASE PRESENTATION: A 65-year-old woman, who underwent non-operatively approach by Gastric lipomatosis. Non-specific gastrointestinal symptoms and endoscopic examination ruled out the possibility of mucosal ulceration or bleeding. Endoscopic ultrasonography and abdominal CT that confirmed gastric lipomatosis. DISCUSSION: Gastric lipomas are usually small, solitary and asymptomatic, and are hence often detected incidentally, surgical management in asymptomatic patients still be a in debate. CONCLUSION: Non operative management in massive gastic lipomatosis is appropiate when the patient is asymptomatic without mucosal ulceration, regardless of the amount of gastric lipomas. Avoiding patient the morbidity of a total gastrectomy.

Endoscopic trans gastric assisted surgery for gastric tumors: Case report and description of a new surgical technique.

BACKGROUND: Minimally invasive intragastric surgery [IGS] was first described by Ohashi in 1995 for early gastric cancer, with 3 trocars placed in the gastric lumen. Prior abdominal surgery is not a contraindication to IGS while the abdominal cavity is not explored, always that exist transilumination. But conversion to laparoscopic and open surgery can be challenging owing to the insufflated stomach and/or small bowel, although gas can be easily released via the gastrostomy. CASE PRESENTATION: A 53-year-old female patient, presented with a sub epithelial gastric antrum lesion confirmed by endoscopic ultrasonography managed with surgical endoscopic percutaneous assisted transgastric technique [EPATS] using a gastrostomy tube and the endoscope. DISCUSSION: We have been developing this operation since 2018. Nevertheless, we think EPATS is worthy to master, as PEIGS can salvage the entire stomach of patients with sub epithelial lesions in the lesser curve and in the esophagogastric junction, who otherwise would have to undergo total or proximal gastrectomy. CONCLUSION: We need to perform more cases for future comparative studies with percutaneous endoscopic intragastric surgery [PEIGS] in terms of parameters as pain, inflammation, complications, stenosis, oncological results and cosmesis.

High-resolution melting of the cytochrome B gene in fecal DNA: A powerful approach for fox species identification of the Lycalopex genus in Chile.

Easy, economic, precise species authentication is currently necessary in many areas of research and diagnosis in molecular biology applied to conservation studies of endangered species. Here, we present a new method for the identification of three fox species of the Lycalopex genus in Chile. We developed an assay based on high-resolution melt analysis of the mitochondrial cytochrome B gene, allowing a simple, low cost, fast, and accurate species determination. To validate the assay applicability for noninvasive samples, we collected fecal samples in the Atacama Desert, finding unexpectedly one species outside of its known distribution range. We conclude that the assay has a potential to become a valuable tool for a standardized genetic monitoring of the Lycalopex species in Chile.

Hybrid identification in Nothofagus subgenus using high resolution melting with ITS and trnL approach.

The genus Nothofagus is the main component of southern South American temperate forests. The 40 Nothofagus species, evergreen and deciduous, and some natural hybrids are spread among Central and Southern Chile, Argentina, New Zealand, Australia, New Guinea and New Caledonia. Nothofagus nervosa, Nothofagus obliqua and Nothofagus dombeyi are potentially very important timber producers due to their high wood quality and relative fast growth; however, indiscriminate logging has degraded vast areas the Chilean forest causing a serious state of deterioration of their genetic resource. The South of Chile has a large area covered by secondary forests of Nothofagus dombeyi. These forests have a high diversity of species, large amount of biomass and high silvicultural potential. This work shows a case of hybrid identification in Nothofagus subgenus in different secondary forests of Chile, using high resolution melting. Unknown samples of Nothofagus subgenus are genetically distinguishable with the ITS region of Nothofagus antarctica, Nothofagus nitida and N. obliqua species. It was not possible to distinguish between unknown samples of Andean versus coastal origin. Melting curves with ITS approach of unknown material are genetically similar, positioned between N. dombeyi and N. antarctica and distant from N. nitida. The unknown samples are genetically very close to Nothofagus dombeyi. This suggests the presence of hybrid individuality between species (N. dombeyi × N. antarctica) with the possibility of introgression towards the gene pool of N. antarctica, producing the deciduous foliage that is both present. The trnL locus has no distinction between the N. dombeyi and N. antarctica species, since a similar melting curve is present and equal Tm (80.00 °C). The trnL locus cannot be genetically distinguished from one unknown sample of Nothofagus to another, as highlighted in this study.

Tension pneumoperitoneum: Case report of a rare form of acute abdominal compartment syndrome.

INTRODUCTION: Tension pneumoperitoneum is a severe and rare form of pneumoperitoneum with concomitant hemodynamic instability and respiratory failure. It is a variant of abdominal compartment syndrome (ACS) causing an abrupt increase in intra-abdominal pressure. PRESENTATION OF CASE: We present a case of pneumoperitoneum, after an endoscopic mucosal resection with the development of ACS. The patient was successfully treated with percutaneous decompression. DISCUSSION: Decompressive laparotomy is the first treatment option for both most forms of pneumoperitoneum and ACS; nevertheless, this issue is controversial. Recent reports have shown that some patients may be candidates for a minimally invasive catheter decompression avoiding major decompressive surgery. Identifying these patients is vital to avoiding unnecessary surgeries. CONCLUSIONS: Tension pneumoperitoneum is a life-threatening event, early detection and intervention is critical in order to provide prompt and optimal treatment approaches.

Psychedelic fungus (Psilocybe sp.) authentication in a case of illegal drug traffic: sporological, molecular analysis and identification of the psychoactive substance.

In nature, there are >200 species of fungi with hallucinogenic properties. These fungi are classified as Psilocybe, Gymnopilus, and Panaeolus which contain active principles with hallucinogenic properties such as ibotenic acid, psilocybin, psilocin, or baeocystin. In Chile, fungi seizures are mainly of mature specimens or spores. However, clandestine laboratories have been found that process fungus samples at the mycelium stage. In this transient stage of growth (mycelium), traditional taxonomic identification is not feasible, making it necessary to develop a new method of study. Currently, DNA analysis is the only reliable method that can be used as an identification tool for the purposes of supporting evidence, due to the high variability of DNA between species. One way to identify the species of a distinctive DNA fragment is to study PCR products analyzed by real time PCR and sequencing. One of the most popular sequencing methods of forensic interest at the generic and intra-generic levels in plants is internal transcribed spacer (ITS). With real time PCR it is possible to distinguish PCR products by differential analysis of their melting temperature (Tm) curves. This paper describes morphological, chemical, and genetic analysis of mycelia of psychedelic fungi collected from a clandestine laboratory. The fungus species were identified using scanning electron microscopy (SEM), mass spectrometry, HRM analysis, and ITS sequencing. The sporological studies showed a generally smooth surface and oval shape, with maximum length 10.1 µm and width 6.4 µm. The alkaloid Psilocyn was identified by mass spectrometry, while HRM analysis and ITS sequencing identified the species as Psilocybe cubensis. A genetic match was confirmed between the HRM curves obtained from the mycelia (evidence) and biological tissue extracted from the fruiting bodies. Mycelia recovered from the evidence and fruiting bodies (control) were genetically indistinguishable.

Metabolic diversity in tuber tissues of native Chiloé potatoes and commercial cultivars of Solanum tuberosum ssp. tuberosum L.

INTRODUCTION: The native potatoes (Solanum tuberosum ssp. tuberosum L.) cultivated on Chiloé Island in southern Chile have great variability in terms of tuber shape, size, color and flavor. These traits have been preserved throughout generations due to the geographical position of Chiloé, as well as the different uses given by local farmers. OBJECTIVES: The present study aimed to investigate the diversity of metabolites in skin and pulp tissues of eleven native accessions of potatoes from Chile, and evaluate the metabolite associations between tuber tissues. METHODS: For a deeper characterization of these accessions, we performed a comprehensive metabolic study in skin and pulp tissues of tubers, 3 months after harvesting. Specific targeted quantification of metabolites using 96 well microplates, and high-performance liquid chromatography combined with non-targeted metabolite profiling by gas chromatography time-of-flight mass spectrometry were used in this study. RESULTS: We observed differential levels of antioxidant activity and phenolic compounds between skin and pulp compared to a common commercial cultivar (Desireé). In addition, we uncovered considerable metabolite variability between different tuber tissues and between native potatoes. Network correlation analysis revealed different metabolite associations among tuber tissues that indicate distinct associations between primary metabolite and anthocyanin levels, and antioxidant activity in skin and pulp tissues. Moreover, multivariate analysis lead to the grouping of native and commercial cultivars based on metabolites from both skin and pulp tissues. CONCLUSIONS: As well as providing important information to potato producers and breeding programs on the levels of health relevant phytochemicals and other abundant metabolites such as starch, proteins and amino acids, this study highlights the associations of different metabolites in tuber skins and pulp, indicating the need for distinct strategies for metabolic engineering in these tissues. Furthermore, this study shows that native Chilean potato accessions have great potential as a natural source of phytochemicals.

[IgG4-related disease: a case report]. / Enfermedad asociada a IgG4: reporte de un caso.

IgG4-related disease is an inflammatory condition characterized by high levels of IgG4. It affects salivary and lacrimal glands, pancreas, lymph nodes, lungs or kidney. The diagnosis is based on identifying a histological pattern with a dense lymphocyte and plasmacyte infiltration, focal fibrosis or phlebitis, finding more than 10 IgG4 positive cells per high power field and/or IgG4/IgG ratio in plasma higher than 40%. We present a patient with Mikulicz's disease who meets histological findings required for the diagnosis of IgG4 related disease.

La enfermedad relacionada con IgG4 es una condición fibroinflamatoria en la que existe elevación de IgG4, afección a nivel de glándulas salivares, lacrimales, páncreas, ganglios linfáticos y pulmón. Para su diagnóstico se requiere la identificación de un patrón histológico sugestivo que muestre infiltrado linfoplasmocitario denso, fibrosis focal o flebitis a nivel de una glándula, más de 10 células positivas para IgG4 por campo de gran aumento y relación de IgG4/IgG arriba de 40% en plasma. Describimos el caso de una paciente que presentó enfermedad de Mikulicz y cumplió con los datos histológicos para diagnóstico de enfermedad relacionada con IgG4.

Correlación entre el grado de neoplasia intraepitelial cervical y la expresión dual de p16 Y ki67, en biopsia de cuello uterino en el Hospital Santa Rosa de Lima-Perú año 2016 / Correlation between the degree of cervical intraepitelial neoplasis (nic) and the dual expression of p16 and ki67, in uterine neck biopsy in Santa Rosa Hospital of Lima-Peru year 2016

Objetivo: Determinar la frecuencia de coexpresión dual del p16 (INK4a) y ki67 en los diferentes grados de las neoplasias intraepiteliales cervicales (NIC) y su contribución molecular para diagnóstico y pronóstico. Material y Metodos: El diseño es descriptivo, prospectivo transversal. Se revisaron 20 biopsias de cérvix embebidas en parafina, que se encontraban en el archivo de Anatomía Patológica de un Hospital tercer nivel de Perú entre Enero y Diciembre del 2016, cuyas láminas portaobjeto fueron coloreadas con hematoxilina-eosina y reportadas como neoplasia intraepitelial (NIC) I, II, III. Se realizaron nuevos cortes histológicos de 3 micras para estudios complementarios usando la técnica de inmunohistoquímica dual. Las células con positividad para p16 mostraron tinción citoplasmática y/o nuclear de color rojizo y aquellas con positividad para ki67 mostraron coloración nuclear marrón. Resultados: Los 20 casos de neoplasia intraepitelial se dividen en: 06 casos de NIC I; 11 casos de NIC II y 03 casos de NIC III. La tinción dual para el Ki67 y p16 se realizó a los 20 casos, esto mostró una coexpresión en el 85% y ausencia de expresión dual en 15%. Se observó tinción en los diversos grados de NIC predominando el grado 1+ en un 50%. En el grado 2+ y 3+ la expresión fuerte en NIC II y NIC III respectivamente. La expresión del Ki67 se dio en todos los diferentes grados de NIC. Conclusiones: La coexpresión del Ki67 y p16 es de 85% en los diversos grados de NIC, siendo frecuente en el grupo de NIC II. (AU)

Objetive: To determine the frequency of dual coexpression of p16 (INK4a) and ki67 in the different degrees of cervical intraepithelial neoplasia (CIN) and its molecular contribution for diagnosis and prognosis. Material And Methods: the design is descriptive, prospective and cross-sectional. 20 cervix biopsies embedded in paraffin have been reviewed. These slides gathered from January 2016 to December 2016 were located in the records of Anatomical Pathology Department of a third level Hospital in Peru. The slides were stained with hematoxylin-eosin and reported as intraepithelial neoplasia (CIN) I, II, III. New histological sections of 3 microns were made for complementary studies by using dual immunohistochemistry technique. The cells with positivity for p16 showed cytoplasmic and / or nuclear reddish staining and those with positivity for ki67 showed brown nuclear coloration. Results: The 20 cases of intraepithelial neoplasia are divided into: 06 cases of CIN I; 11 cases of CIN II and 03 cases of CIN III. Dual staining for Ki67 and p16 was performed in all 20 cases. This showed coexpression in 85% and absence of dual expression in 15%. Staining was observed in the different grades of CIN, with predominance in grade 1+ ( 50%). In grade 2+ and 3+ the expression was strong in CIN II and CIN III respectively. The expression of Ki67 occurred in all the different grades of NIC. Conclusions: The coexpression of Ki67 and p16 is 85% in the different grades of CIN, being frequent in the group of CIN II. (AU)

Manejo actual del adenoma de la ampolla de Vater / Current management of adenomas of the ampulla of Vater

A lo largo de la historia, el manejo de los tumores periampulares, malignos o benignos, ha sido la cirugía radical. Sin embargo, la gran complejidad de estos procedimientos, sus complicaciones y su alto índice de mortalidad hicieron impulsar el desarrollo de nuevas técnicas quirúrgicas mínimamente invasivas. Se presenta el caso clínico de una paciente de 55 años, con hallazgo incidental de un adenoma de la ampolla de Vater en una endoscopia de vías digestivas altas, T1N0M0, manejado con papilectomía endoscópica, sin complicaciones y con márgenes negativos en el estudio histopatológico de la pieza quirúrgica. La papilectomía endoscópica, fue reportada por primera vez por Ponchon, et al., en 1989. La presentación clínica del adenoma de la ampolla de Vater es asintomática y su diagnóstico es incidental en la endoscopia de vías digestivas altas. El diagnóstico de este tipo de neoplasia se hace teniendo en cuenta la apariencia endoscópica y la histología; por lo tanto, es vital la utilización de un duodenoscopio lateral para poder tener una evaluación completa de la papila. Es importante practicar una ultrasonografía endoscópica biliopancreática, ya que esta determina la profundidad de la lesión y, además, permite descartar adenomegalias locales o regionales. La papilectomía endoscópica es un procedimiento que requiere de manos experimentadas para disminuir el riesgo de complicaciones.

Introduction: Historically, the management of periampullary tumors, malignant or benign, has been radical surgery, starting with Alessandro Codivilla, who in 1898 described the surgical technique for the performance of pancreaticoduodenectomy. Later, in 1899, William Halsted performed the first transduodenal ampullectomy. The complexity of these procedures, the associated complications and high mortality stimulated the development of novel minimally invasive surgical techniques. Case report: Fifty five year old female with incidental finding of an adenoma of the ampulla of Vater at endoscopy of the upper digestive tract, T1N0M0, managed by endoscopic papillectomy, without complications; surgical pathology reported negative margins. Discussion: Endoscopic papillectomy was first reported by Ponchon et al in 1989. The presence of an adenoma of the ampulla of Vater remains asymptomatic and the diagnosis is an incidental finding during upper digestive tract endoscopy. The diagnosis of this neoplasm is made by the endoscopic appearance and histopathology. It is imperative to use a lateral duodenoscope in order to have full assessment of the papilla. It is also important performing pancreatic biliary endosonography, as this determines the depth of the lesion and also rules out local or regional lymphadenopathy. Endoscopic papillectomy is a procedure that requires experienced hands, to avoid complications such as perforation, cholangitis, papillary stenosis, bleeding and pancreatitis, the last two being the most common with an incidence up to 25-30%. Conclusions: Randomized clinical trials are required to substantiate the benefit of endoscopic papillectomy in malignant pathology, and also there is need to develop management guidelines.

Identification case of evidence in timber tracing of Pinus radiate, using high-resolution melting (HRM) analysis.

Fast, accurate detection of plant species and their hybrids using molecular tools will facilitate assessment and monitoring of timber tracing evidence. In this study the origin of unknown pine samples is determined for a case of timber theft in the region of Araucania southern Chile. We evaluate the utility of the trnL marker region for species identification applied to pine wood based on High Resolution Melting. This efficient tracing methods can be incorporated into forestry applications such as certification of origin. The object of this work was genotype identification using high-resolution melting (HRM) and trnL approaches for Pinus radiata (Don) in timber tracing evidence. Our results indicate that trnL is a very sensitive marker for delimiting species and HRM analysis was used successfully for genotyping Pinus samples for timber tracing purposes. Genotyping samples by HRM analysis with the trnL1 approach allowed us to differentiate two wood samples from the Pinaceae family: Pinus radiata (Don) and Pseudotsuga menziesii (Mirb.) Franco. The same approach with Pinus trnL wood was not able to discriminate between samples of Pinus radiata, indicating that the samples were genetically indistinguishable, possibly because they have the same genotype at this locus. Timber tracing with HRM analysis is expected to contribute to future forest certification schemes, control of illegal trading, and molecular traceability of Pinus spp.

Manejo de un sangrado por úlcera posligadura de várices esofágicas mediante prótesis metálica autoexpandible: reporte de un caso y revisión de la literatura / Management of a Bleeding Ulcer by Post-esophageal Ligation of Varices with Self Expanding metal Stents: Case Report and Literature Review

Los inicios del manejo del sangrado variceal con compresión directa datan de 1930 por Westphal y colaboradores. Después, en 1950, se desarrolló el balón de Sengstaken-Blakemore, definido por Panes y colaboradores como la primera línea de terapia; en 1980, a nivel de várices esofágicas y en várices gástricas, se empleaba el balón de Linton-Nachlass (1, 2). Se presenta el caso clínico de un paciente con cirrosis hepática por hepatitis C, Child B, con várices esofágicas, a las cuales se les realizó ligadura en dos ocasiones por sangrado y en la segunda ocasión por inminencia de ruptura, esta última llevada a cabo dos semanas antes del evento. El paciente muestra un cuadro clínico compatible con hemorragia de vías digestivas altas masiva, con evidencia endoscópica de úlcera esofágica sangrante que no mejora con terlipresina, ni escleroterapia con adrenalina, ni compresión local con balón de acalasia. En consecuencia, como terapia de rescate se decide colocar un stent esofágico metálico autoexpandible parcialmente recubierto (por no contar con totalmente recubierto en el momento), con control parcial del sangrado. Es recomendable el uso del stent como terapia de rescate para el sangrado por várices esofágicas refractarias. Debe emplearse el diseñado especialmente para esta indicación (SX-Ella Danis), como un puente para poder estabilizar al paciente y realizar una terapia definitiva como la TIPS, tal cual como se procedió en un nuestro paciente.

Early treatment of bleeding varices with direct compression dates from the work by Westphal et al. in 1930. Later in 1950, Sengstaken-Blakemore developed their balloon which Panes and collaborators defined as the first line of therapy for esophageal varices in 1980 while they used the Linton-Nachlass balloon for gastric varices (1, 2). This study presents the clinical case of a patient with liver cirrhosis due to hepatitis C, (Child B) with esophageal varices which were ligated on two different occasions because of bleeding. On the second occasion a rupture was imminent and ligation occurred two weeks prior to the event. The patient presented a clinical picture compatible with massive upper gastrointestinal bleeding with endoscopic evidence of a bleeding esophageal ulcer that did not improve with terlipressin, sclerotherapy with adrenaline, or balloon dilatation. Consequently, it was to use a partially covered self-expanding metal esophageal stent for salvage therapy since a completely covered stent was not available at that time. Stenting achieved partial control of bleeding. We recommend the use of stenting with a stent specifically designed for this indication (SX-Ella Danis) as salvage therapy for refractory bleeding from esophageal varices. The stent can be used as a bridge to stabilize the patient in order to perform TIPS as the definitive treatment, as in the case of our patient.

Endoscopia y esófago de Barrett: ¿en qué fallamos? / Endoscopy and Barrett's esophagus: where did we fail?

Introducción. El esófago de Barrett es una metaplasia intestinal especializada, cuyo diagnóstico se basa en la identificación de la mucosa de color salmón en el esófago, la apropiada ejecución de las biopsias y la confirmación histológica. Objetivos. Determinar la eficacia de la inspección endoscópica en comparación con los resultados de histopatología y la precisión de la descripción visual del esófago de Barrett en Colombia en comparación con otros países. Materiales y métodos. Se trata de un estudio internacional multicéntrico, con revisión prospectiva de bases de datos. Se evaluaron los hallazgos endoscópicos de 347 pacientes con sospecha de esófago de Barrett y se compararon con los reportes de histopatología. Además, se determinó la frecuencia de la adecuada descripción de los hallazgos endoscópicos y el apropiado protocolo de biopsias en tres países. Resultados. La presencia de esófago de Barrett se confirmó en 133 de 347 pacientes (38 %). Hubo metaplasia intestinal en 118 de 133 pacientes (89 %) y, displasia de bajo grado, en 15 (11 %). La morfología del esófago de Barrett se describió en 262 de 347 pacientes (76 %) y, la longitud, en 205 de ellos (59 %). La media de biopsias fue de 3,6±2,2. Conclusiones. Según los resultados, la inspección visual para el diagnóstico del esófago de Barrett es poco eficaz y se hizo una adecuada descripción de los hallazgos endoscópicos en cerca de la mitad de los pacientes con sospecha de esófago de Barrett en Colombia. Este estudio sugiere la necesidad de hacerle seguimiento a las guías de la American Gastroenterological Association para optimizar el diagnóstico del esófago de Barrett.

Background: Barrett esophagus is a specialized intestinal metaplasia. The diagnosis is based on visualization of a salmon colored mucosa, the properly executed biopsies and the pathology confirmation. Aims: The aims of this study were to determine the efficacy of the endoscopic inspection as compared with the histopathology report and the precision of the visual description of the Barrett's esophagus in Colombia in comparison with other nations. Methods: This is an international multicentric study with prospective review of the data bases. We evaluated the endoscopic findings of 347 patients in whom the endoscopist thought that Barrett´s esophagus was present, and compared them to the pathology results. In addition, we assessed the frequency of an adequate description of the endoscopic findings and the observance of a due biopsy protocol in three countries. Results: The presence of Barrett's esophagus was confirmed in 133 of the 347 patients (38%). Metaplasia was present in 118 of the 133 patients (89%) and low grade dysplasia in 15 patients (11%). The morphology of Barrett´s esophagus was described in 262 of the 347 patients (76%), and the length was reported in 205 of these patients (59%). An average of 3.6±2.2 biopsies were taken. Conclusions: According to our results, visual inspection for the diagnosis of Barrett's esophagus has a low efficacy, and a precise description of the Barretts esophagus was not done in around a half of the patients in Colombia. This study suggests the need for more strict observation of the American Gastroenterological Association and the American College of Gastroenterology guidelines by physicians in order to optimize the diagnosis of Barretts esophagus.

Genetic diversity among native varieties and commercial cultivars of Solanum tuberosum ssp. tuberosum L. present in Chile

Background: The object of this work was to determine the genetic and allelic diversity of Solanum species present in Chile, assessing allelic distribution among native varieties and commercial cultivars of Solanum tuberosum ssp. tuberosum L., using microsatellite markers. Results: A high level of allelic richness was found in the potatoes studied. The seven microsatellite markers used presented a total of 64 allelic variants among native varieties and commercial cultivars of Solanum tuberosum ssp. tuberosum. The SSR loci generated an average of 9.16 alleles/locus. The group with the highest PIC was that of native varieties collected in the Chiloe archipelago. The high PIC values found indicate that the native varieties from Chiloe have a low level of interrelation, representing wide genetic diversity. Conclusions: The markers with the highest number of alleles in native varieties corresponded to loci STG 0016 and LEMALX. Commercial cultivars do not present the same genetic variability as native varieties, and the allelic richness of commercial cultivars is lower than that of native varieties of S. tuberosum ssp. tuberosum. Most of the native varieties were clustered in accordance with their geographical location, while commercial cultivars, were clustered in accordance with their breeding programs in Chile and Europe, with the exception of Shepody.