División ganglionar posquirúrgica y su efecto en el recuento ganglionar y la estadificación en pacientes con cáncer gástrico / Postoperative lymph node division and its effect on lymph node count and staging in patients with gastric cancer

Introducción. La gastrectomía y disección ganglionar es el estándar de manejo para los pacientes con cáncer gástrico. Factores como la identificación de ganglios por el patólogo, pueden tener un impacto negativo en la estadificación y el tratamiento. El objetivo de este estudio fue comparar el recuento ganglionar de un espécimen quirúrgico después de una gastrectomía completa (grupo A) y de un espécimen con un fraccionamiento por grupos ganglionares (grupo B). Métodos. Estudio de una base de datos retrospectiva de pacientes sometidos a gastrectomía D2 en el Servicio de Cirugía gastrointestinal de la Liga Contra el Cáncer seccional Risaralda, Pereira, Colombia. Se comparó el recuento ganglionar en especímenes quirúrgicos con y sin división ganglionar por regiones anatómicas previo a su envío a patología. Resultados. De los 94 pacientes intervenidos, 65 pertenecían al grupo A y 29 pacientes al grupo B. El promedio de ganglios fue de 24,4±8,6 y 32,4±14,4 respectivamente (p=0,004). El porcentaje de pacientes con más de 15 y de 25 ganglios fue menor en el grupo A que en el grupo B (27 vs 57, p=0,432 y 19 vs 24, p=0,014). El promedio de pacientes con una relación ganglionar menor 0,2 fue mayor en el grupo B (72,4 % vs 55,4 %, p=0,119). Conclusiones. Los resultados de nuestro estudio mostraron que una división por grupos ganglionares previo a la valoración del espécimen por el servicio de patología incrementa el recuento ganglionar y permite establecer de manera certera el pronóstico de los pacientes, teniendo un impacto positivo en su estadificación, para evitar el sobretratamiento

Introduction. A gastrectomy and lymph node dissection is the standard of management for patients with gastric cancer. Factors such as the identification of nodes by the pathologist can have a negative impact on staging and treatment. The objective of this study was to compare the lymph node count of a surgical specimen after a complete gastrectomy (group A) and of a specimen with lymph node by groups (group B). Methods. Study of a retrospective database of patients undergoing D2 gastrectomy in the Risaralda section of the Liga Contra el Cancer Gastrointestinal surgical service, Pereira, Colombia. The lymph node count was compared in surgical specimens with and without lymph node division by anatomical regions, prior to sending them to pathology. Results. Of the 94 patients who underwent surgery, 65 were from group A and 29 patients were from group B. The average number of nodes was 24.4±8.6 and 32.4±14.4, respectively (p=0.004). The percentage of patients with more than 15 and 25 nodes was lower in group A than in group B (27 vs 57, p=0.432 and 19 vs 24, p=0.014). The average number of patients with a nodal ratio less than 0.2 was higher in group B (72.4% vs 55.4%, p=0.119). Conclusions. The results of our study showed that a division by lymph node groups prior to the evaluation of the specimen by the pathology service increases the lymph node count and allows the prognosis of patients to be accurately established, having a positive impact on their staging, to avoid overtreatment.

The Transbrachial Venous Approach for Pelvic Congestion Syndrome Embolization: An Easy Way to Outpatient Procedure.

BACKGROUND: Pelvic congestion syndrome (PCS) is a frequent finding in adult women and transcatheter embolization of dilated and refluxing veins is the treatment of choice. The procedure can be performed through different venous accesses such as the transfemoral, transjugular, and the transbrachial access. The aim of this study was to demonstrate the feasibility and safety of the transbrachial approach for transcatheter embolization in this pathology in 201 women. Advantages and disadvantages of this access were discussed. METHODS: Between January 2007 and October 2020, female patients who underwent transcatheter embolization for PCS were selected. Embolization procedural details such as venous access sites and embolized veins were collected. RESULTS: Two hundred and one patients were selected for pelvic vein embolization due to PCS. The basilic vein was punctured in 103 patients (51.2%), the cephalic vein was chosen in 76 patients (37.8%) and deep brachial veins in 19 (9.6%). Technical success was observed in 198 (98.5%) cases. Only one major adverse effect was registered; one patient presented with hematoma of the arm that could be managed conservatively. CONCLUSION: The transbrachial venous approach for PCS embolization is safe, effective and minimal invasive. It provides a significant patient comfort, has a low complication rate and can be performed on an outpatient basis.

Stabilizing Technique for Bridging Stent Placement in Branched Endovascular Aortic Repair.

PURPOSE: To present a bailout technique for bridging covered stent placement during branched endovascular aortic repair (BEVAR) in complex anatomy. TECHNIQUE: BEVAR is an alternative technique for the treatment of thoracoabdominal aortic aneurysms (TAAAs). Visceral and renal vessels must be preserved by bridging covered stent placement through downward-oriented branches of the main stent graft device. Challenging anatomy such as kinking and elongation of the aorta, or type III aortic arch configuration may impede successful catheterization of these branches due to reduced steerability and pushability of the endovascular material. Different alternative techniques have been described to overcome these anatomic barriers. This technical note adds another endovascular solution to complex cases using the guiding sheath stabilizing technique. It is based on a standard "through-and-through" technique. An attached snare is inserted via femoral approach, providing a stable position for branch catheterization and bridging covered stent deployment. CONCLUSION: The stabilizing technique is safe and easy to perform and provides a stable position of the guiding sheath when antegrade branch catheterization is challenging. This technique is an additional tool for handling challenging cases.

Índice de qualidade de efluente tratado em rampas de escoamento superficial / Quality index of wastewater treated in overland flow systems

RESUMO Com o objetivo de avaliar a qualidade do efluente doméstico tratado utilizando a técnica do escoamento superficial em rampas cultivadas com forrageiras, por meio da proposta de um índice de qualidade (IQ) adaptado para fertirrigação, e agrupar os efluentes quanto à similaridade das características químicas utilizando estatística multivariada, foi realizado um experimento montado em um delineamento inteiramente casualizado e no esquema de parcela subdividida 3 × 2 com 5 repetições. As parcelas foram compostas de três espécies de forrageiras: aveia preta, azevém e centeio e as subparcelas formadas por duas taxas de efluente aplicadas no tempo: 50 e 100 kg.ha-1.dia-1 de demanda bioquímica de oxigênio (DBO). O IQ foi desenvolvido utilizando a análise de componentes principais (ACP), que proporcionou a redução das 25 características analisadas nos efluentes em duas componentes que explicaram 90,54% da variância total. O IQ para os efluentes tratados apresentou de alta a baixa restrição ao uso na fertirrigação e o efluente bruto demonstrou restrição severa, já a análise de agrupamento formou três grupos distintos de qualidade, que diferiram quanto à taxa de aplicação de efluente utilizada no sistema de tratamento.

ABSTRACT The objective of this study was to evaluate the quality of treated domestic effluent using the surface runoff technique in slopes cultivated with forages. A quality index was adapted for fertigation and to group effluents that were similar in chemical characteristics using multivariate statistics. The experiment consists of a completely randomized design with a 3x2 subdivided plot scheme with 5 replicates. The plots had three forage species: black oat, ryegrass and rye and the subplots had two effluent rates applied in time: 50 and 100 kg ha-1 day-1 of BOD. The quality index was developed using the main components analysis, which provided a reduction of the 25 characteristics analyzed in the effluents in two components that explained 90.54% of the total variance. The quality index for the treated effluents presented high to low restriction in the fertigation and the raw effluent presented severe restriction. The cluster analysis formed three distinct groups of quality, which differed in the effluent application rate used in the treatment system.

Qualidade da água de nascentes do Assentamento Paraíso / Quality of the water from the springs of the Paraíso settlement

RESUMO Este estudo teve por objetivo avaliar a influência de diferentes usos do solo no entorno de nascentes sobre alguns parâmetros de qualidade das águas de oito nascentes localizadas no Assentamento Paraíso, Alegre, Espírito Santo. As nascentes avaliadas consistiram em uma em meio à floresta remanescente de Mata Atlântica; seis cercadas e em diferentes estágios de recomposição florestal; e uma sem cerca e com acesso livre dos animais de criação. Três amostras de água foram coletadas em cada nascente entre 2011 e 2012, sendo analisados 17 parâmetros. Os valores determinados foram comparados com os padrões normativos para qualidade da água e correlacionados linearmente por meio do coeficiente de correlação. As águas das nascentes se mostraram aptas para o consumo, desde que previamente tratadas, e, quanto maior foram os trabalhos de proteção às nascentes, melhores foram os valores de qualidade de água.

ABSTRACT The objective of this study was to evaluate the influence of land use in the surrounding of the springs on some of the parameters of water quality in eight springs located in the Paraíso settlement in the city of Alegre, Espírito Santo, Brazil. The springs evaluated were: one in the Atlantic forest remnant; six fenced ones and in different stages of forest recovery; and one without a fence and with free livestock access. Three samples of water were collected in each spring in 2011 and 2012, and 17 parameters were analyzed. The determined values were compared to the normative standards for water quality and linearly correlated through the correlation coefficient. Water from the springs showed to be consumable, if previously treated, and the more protected the springs, the better the water quality values.

Wet bulb and Conilon coffee root distribution under drip irrigation / Bulbo molhado e sistema radicular do cafeeiro Conilon sob irrigação localizada

ABSTRACT Knowledge of the wet bulb and the root system of the Conilon coffee plant is highly important for the correct management of irrigation. Therefore, the aim of this work was to characterize the wet bulb and Conilon coffee root distribution under drip irrigation. The experiment was conducted in the city of São Mateus, ES, Brazil with five replications of a completely randomized design of a 4 x 6 split-plot scheme, which represents four points located according to plant location and six depths. Two points were located in the plant line and two points between lines. For row spacing, we used a split-plot scheme 5 x 6 with five points in relation with plant location and six depths with five replications. The coffee roots were analysed by volume, superficial area, length and diameter. The wet bulb was measured with tubes located in six points near the plants with two points in the plant row (between two plants) and five points between rows. The measurements were conducted at four depth ranges with three replications. The wet bulb reached a depth of between 0.40 and 0.50 m, providing an excess of water in depth, evidencing the importance of this characterization for the irrigation management of drip-irrigated Conilon coffee. The depth of the radicular system for better irrigation management efficiency of drip-irrigated coffee is 0.30 m, exhibiting 67.4% of root volume and 68.0% of surface area.

RESUMO O conhecimento do bulbo molhado e do sistema radicular do cafeeiro Conilon é de suma importância para o manejo correto da irrigação. Diante disso, objetivou-se caracterizar o bulbo molhado e o sistema radicular do cafeeiro Conilon sob irrigação localizada. O experimento foi realizado em São Mateus-ES, em um delineamento inteiramente casualizado em parcela subdividida 4 x 6, sendo quatro pontos em relação à planta e seis faixas de profundidade, com cinco repetições. Sendo dois na linha e sete na entre linha com distância entre si de 0,20 m. E na entre linha do cafeeiro em parcela subdividida 5 x 6, sendo cinco pontos em relação à planta e seis faixas de profundidade, com cinco repetições. Foram avaliados volume, área superficial, comprimento e diâmetro de raiz. O bulbo molhado foi determinado usando tubos dispostos em seis pontos em relação à planta, sendo um ponto na linha de plantio do cafeeiro entre duas plantas, e em cinco pontos na entre linha, sendo as medições realizadas em quatro faixas de profundidades, com três repetições. O bulbo molhado atingiu profundidade entre 0,40 a 0,50 m, proporcionando excesso de água em profundidade, evidenciando a importância dessa caracterização para o manejo da irrigação do cafeeiro Conilon irrigado por gotejamento. A profundidade do sistema radicular para melhor eficiência do manejo da irrigação do café Conilon irrigado por gotejamento é de 0,30 m, tendo apresentaram está profundidade 67,4% do volume de raiz e 68,0% de área superficial.

Aneurisma de la arteria ciática persistente con isquemia secundaria de la extremidad, revisión de la literatura y reporte de un caso / Aneurysm of persistent sciatic artery with secondary ischemia of the lower extremity, literature review and case presentation

La arteria ciática persistente es una anomalía congénita poco frecuente que puede cursar asintomática o manifestarse como una masa pulsátil en el glúteo, una isquemia aguda de la extremidad o un dolor ciático. Frecuentemente, presenta degeneración aneurismática y complicaciones relacionadas con el aneurisma, como en el caso que se presenta. No hay consenso sobre el mejor tratamiento; sin embargo, la mayoría de los autores recomienda el tratamiento quirúrgico, conservando la arteria, debido a que en el 40 % de los casos es el vaso principal de la extremidad. Se presenta el caso de una paciente con un aneurisma de la arteria ciática persistente, que consultó por isquemia aguda de la extremidad y fue tratada en forma exitosa con un abordaje combinado, endovascular y quirúrgico

The persistent sciatic artery (PCA) is a rare congenital anomaly that may present asymptomatic or as a pulsating mass in the buttock, acute limb ischemia or sciatic pain. It often presents aneurysmatic degeneration and aneurysmrelated complications, like in the case hereby presented. There is no consensus on the best management, but most authors recommend surgical treatment, preserving the artery because in 40% of cases it is the main vessel of the limb. We had a patient who consulted with an aneurysm of the PCA and acute limb ischemia and who was treated as a combined successful endovascular and surgical approach

Massa seca e extração de nutrientes por duas forrageiras fertirrigadas com esgoto doméstico tratado / Dry mass and nutrient extraction of two forage fertigated with domestic sewage treated

Devido à pouca informação sobre a capacidade de extração de nutrientes do solo por forrageiras fertirrigadas com efluentes, o presente trabalho teve como objetivo avaliar a capacidade de extração de macronutrientes e sódio do solo pelas forrageiras Tifton 85 (Cynodon spp) e Capim Marandú (Brachiaria brizantha) fertirrigadas com esgoto doméstico tratado em três ciclos de produção, em condições de casa de vegetação. Os experimentos foram montados num delineamento inteiramente casualizado, sendo um para cada espécie, ambos no esquema em parcelas subdivididas 4x3 com 5 repetições, sendo quatro ratamentos fertirrigados com esgoto doméstico tratado nas dosagens de 20, 40, 60 e 80 kg ha-1 de nitrogênio nas parcelas e nas subparcelas, três ciclos de produção onde foram realizados cortes no material vegetal das forrageiras, sempre aos 30 dias após o término da aplicação do esgoto doméstico tratado. Após cada corte, os tratamentos foram novamente aplicados e no material vegetal cortado foram quantificados os teores foliares dos macronutrientes e sódio extraídos do solo pelas forrageiras. Os resultados obtidos demonstraram que a aplicação de nitrogênio por meio do esgoto doméstico tratado e os ciclos de produção (cortes) afetaram positivamente a produção de massa seca e a extração dos macronutrientes e sódio pelas plantas de Tifton 85 e de Capim Marandú.

Due to limited information on the ability to extract nutrients from the soil by forage fertigated with effluent, the present study aimed to evaluate the extraction capacity of soil macronutrients and sodium by fodder Tifton 85 (Cynodon spp) and Marandu Grass (Brachiaria brizantha) fertigated with treated domestic sewage on three production cycles in greenhouse conditions. The experiments were performed in a completely randomized design, one for each species, both in split plot layout 4x3 with 5 repetitions, four fertigation with treated domestic sewage at dosages of 20, 40, 60 and 80 kg ha-1 nitrogen in plots and subplots, three production cycles where cuts were made in the forage plant material, always 30 days after the completion of the application of treated domestic sewage. After each cut, the treatments were applied again and cut plant material were quantified foliar levels and sodium extracted from the soil by forage. The results showed that the application of nitrogen through the treated domestic sewage and production cycles (cuts) positively affected the dry matter production and extraction of macronutrients and sodium by plants and Tifton 85 on the Marandú Grass.

Resultado de un estudio de casos múltiples con niños ciegos de edad temprana de la provincia Ciego de Ávila / Result of a study of multiple cases with blind children of early age from Ciego de Avila province

El juego es la actividad más importante del niño, porque propicia la estimulación de diversos procesos y cualidades psíquicas, tales como: la discriminación perceptual, la concentración de la atención, la generalización de relaciones, el razonamiento, las destrezas motrices, la sensibilidad táctil activa, la actividad motora gruesa, los movimientos finos de la mano y la percepción de la forma, lo que permite conocer el objeto, sus particularidades y propiedades; elementos esenciales a desarrollar en los invidentes. Es por eso que en el proceso de estimulación se requiere tener en cuenta la concepción del desarrollo físico y psíquico de este; y las potencialidades para alcanzarlo, a partir de las vivencias personales y del juego. Los resultados que emergieron del estudio de caso realizado permitieron corroborar la factibilidad de la estimulación temprana para el desarrollo armónico de los recursos compensatorio de los niños ciegos. Se apreciaron elocuentes logros en el desarrollo físico y psíquico de los mismos, también se logró una transformación en el modo de pensar y actuar de los adultos relacionados con el proceso de estimulación, se tornó más enternecedora la relación afectiva del adulto con el niño ciego, del niño ciego con el adulto y del niño ciego con otros niños (AU)

Game is the most important activity of a boy, because causes the psychic stimulation of diverse processes and qualities, such as: perceptual discrimination, concentration of attention, generalization of relations, reasoning, motor skills, active tactile sensitivity, gross motor activity, fine movements of the hand and the perception of the form, what allows to know the object, its particularitities and properties; essential elements to develop in blind persons. That is why in the stimulation process it is required to consider the conception of the physical and psychic development; and the potentialities to reach it, from personal experiences and the game. The results that emerged from the study of carried out case allowed to corroborate the feasibility of the early stimulation for the harmonic development of the compensatory resources of blind children. Eloquent profits in the physical and psychic development were appraised, also managed a transformation in the way of thinking and acting of adults related to the stimulation process, becoming more moving the affective relation of the adult with the blind child, the blind child with the adult and the blind child with other children (AU)

Dr Enrique A González Corona, paradigma de la docencia médica en Santiago de Cub / Dr Enrique A González Corona, paradigm of the medical teaching in Santiago de Cuba

Este trabajo constituye un acercamiento a una figura representativa de la docencia médica santiaguera, que ha dedicado su vida a esta noble misión y hoy como profesor consultante e investigador lo sigue haciendo, se dan a conocer los elementos más importantes de su vida familiar, estudiantil y profesional tanto en la docencia como fundador de la primera Escuela de Medicina fuera de la capital, como en la asistencia como fundador del Servicio Médico Rural, su trabajo destacado como pediatra en diferentes instituciones santiaguera, colaborando con en el inicio de este servicio en otras provincias y su ayuda solidaria en Guyana. Se valoran algunos elementos de su personalidad como un profesional sencillo, afable, responsable, patriota, exigente y reflexivo que lo convierten en un educador que constituye ejemplo para la formación de la nueva generación de profesionales de la salud. Es un trabajo original porque la propia personalidad que se estudia participa activamente en la investigación dándole mayor objetividad y puede sentar pautas para posteriores investigaciones de este corte(AU)

Registro único de bacteriología clínica (RUBAC)

Este registro pretende ser una ayuda en el trabajo que desarrollan los laboratorios de bacteriología del país de manera que la información pueda ser almacenada más allá de contar probablemente con sistemas electrónicos-para luego ser aprovechada en todos aquellos aspectos que fueran pertinentes, por ejemplo en la análisis retrospectivo de lo hecho, en brindar información sistemátizada para fines de vigilancia epidemiológica, en la proyeccción del trabajo futuro, etc. En todo caso esta herramienta, por su carácter dinámico buscará su continua actualización y adaptación a las necesidades de la Red nacional de Bacteriología del país

Prevalence of human papillomavirus infection in rural villages of the Bolivian Amazon.

Cervical cancer constitutes a major health problem in developing countries like Bolivia. The roles of certain genotypes of human papillomaviruses (HPVs) in the pathogenesis of cervical cancer is well established. The prevalence of HPV infection among sexually active women varies greatly. Information regarding HPV infection in Bolivia is very much scarce, specially in regions like the Amazonian lowland. We studied 135 healthy women living in four rural localities of the Bolivian Amazon. Presence of HPV in DNA extracted from cervical swabs was analyzed using a reverse line hybridization assay. The estimated overall HPV infection prevalence among the studied rural localities was 5.9% (ranging from 0-16.6%). These values were unexpectedly low considering Bolivia has a high incidence of cervical cancer. The fact that Amazonian people seem to be less exposed to HPV, makes it likely that some other risk factors including host lifestyle behaviors and genetic background may be involved in the development of cervical cancer in this population.

Prevalence of human papillomavirus infection in rural villages of the Bolivian Amazon

Cervical cancer constitutes a major health problem in developing countries like Bolivia. The roles of certain genotypes of human papillomaviruses (HPVs) in the pathogenesis of cervical cancer is well established. The prevalence of HPV infection among sexually active women varies greatly. Information regarding HPV infection in Bolivia is very much scarce, specially in regions like the Amazonian lowland. We studied 135 healthy women living in four rural localities of the Bolivian Amazon. Presence of HPV in DNA extracted from cervical swabs was analyzed using a reverse line hybridization assay. The estimated overall HPV infection prevalence among the studied rural localities was 5.9 percent (ranging from 0-16.6 percent). These values were unexpectedly low considering Bolivia has a high incidence of cervical cancer. The fact that Amazonian people seem to be less exposed to HPV, makes it likely that some other risk factors including host lifestyle behaviors and genetic background may be involved in the development of cervical cancer in this population

Endovascular treatment of complicated type-B aortic dissection with stent-grafts:: midterm results.

PURPOSE: To report the midterm results of the endovascular treatment of complicated type-B aortic dissection with use of stent-grafts. MATERIALS AND METHODS: Ten patients with acute (n = 4) or chronic (n = 6) complicated type-B dissection were treated with custom-made stent-grafts. Indications for treatment included uncontrollable hypertension with dissection extension (n = 3), renal ischemia (n = 1), and false lumen aneurysm (n = 6). Stainless-steel Z-stents covered with polyester grafts were placed in the initial six patients. Nitinol stents covered with ultrathin polytetrafluoroethylene were used in the remaining four patients. The patients were followed-up with helical computed tomography for a maximum of 30 months (mean, 20 mo). RESULTS: There was one technical failure related to the access site. Early complications included deep venous thrombosis (n = 1) and embolic stroke (n = 1). Complete thrombosis of the thoracic false lumen was achieved in six patients and partial thrombosis was achieved in three. Aneurysms developed at the ends of the stainless-steel stents in two patients, requiring additional stent-graft placement. Despite successful remodeling of the thoracic aorta, three of four patients with distal reentry into the abdominal aorta experienced progressive abdominal aortic aneurysm (AAA). AAA rupture developed in two patients; one rupture was fatal and the other was treated with emergency surgery. CONCLUSIONS: Endovascular treatment of complicated type-B aortic dissection is technically feasible and effective. Closely monitoring the treated aorta is essential to detect early aneurysm formation at the ends of rigid stents. Despite adequate sealing of the tears in the thoracic aorta, dissection with distal reentry phenomenon into the abdominal aorta may evolve into AAA with late rupture.

¿Es la extremidad superior más tolerante al síndrome compartimental? / ¿Is the upper extremity more tolerant to the compartment syndrome?

El trauma vascular es causa comun de consulta en los grandes centros de trauma del mundo y la lesión vascular es la razón más frecuente de sindrome compartimental que tratan los cirujanos. Durante muchos años la fasciotomía ha sido la herramienta terapéutica mas aceptada para el manejo del sindrome compartimental y en múltiples esutdios se han demostrado sus bondades. No obstante su utilidad se convierte en la puerta de entrada para la infección en áreas musculares previamene afectadas por la isquemia. Mucho se ha escrito acerca de la fasciotomia como una herramienta terapéutica en cualquier extremidad, pero se acepta que esta muestra sus mejores resultados en la extremidad superior, teóricamente con base en la mayor tolerancia de la extremidad superior a los efectos del síndrome compartimental; las series muestran desproporción en el porcentaje de fasciotomías en pacientes con trauma vascular de las extremidades superiores en comparación con las inferiores. Esta mejor tolerancia a la isquemia determinaria una mejor evolución clínica de las extremidades superiores que han requerido fasciotomía, con respecto a las extremidades inferiores. El objetivo del presente trabajo fue comparar las características clínicas y complicaciones de los pacientes con trauma vascular de las extremidades superiores que requirieron fasciotomía con respecto a las infereiores, para detectar si existe diferencia en el pronóstico e identificar qué factores pueden explicar esta diferencia.

Penetrating neck injuries: helical CT angiography for initial evaluation.

PURPOSE: To report an experience with helical computed tomographic (CT) angiography as the initial procedure to rule out arterial lesions caused by penetrating neck injuries. MATERIALS AND METHODS: During 27 months, 175 patients were referred for helical CT angiography of the neck because of clinical suspicion of arterial injuries. The protocol included a 100-mL bolus of nonionic contrast material injected at 4.5 mL/sec, with 11-second scanning delay, 3-mm collimation, and pitch of 1.3-2.0. CT images were interpreted prospectively by the emergency radiologist, and two radiologists retrospectively interpreted studies with consensus. Outcome was determined with examination of patients and their charts. The sensitivity, specificity, and positive and negative predictive values were calculated. RESULTS: Studies in two patients were considered inadequate for diagnosis; these patients were referred for conventional arteriography and had normal findings. In 27 patients (15.6%), arterial lesions were detected. One patient had two arterial injuries. Lesions demonstrated with helical CT angiography were arterial occlusion (n = 14), pseudoaneurysm (n = 8), pseudoaneurysm and arteriovenous fistulae (n = 4), and partial thrombosis (n = 2). The remaining 146 patients had normal arteries. On the basis of these findings, patients were treated with surgery (n = 21), endovascular intervention (n = 7), and observation alone (n = 146). CONCLUSION: Results indicate that helical CT angiography can be used as the initial method for evaluation in patients with possible arterial injuries of the neck.

Human Papillomavirus Infection among Bolivian Amazonian Women.

Cervical cancer is the most common malignancy among women in Latin America. Human papilloma virus infection is known to be an important risk factor. However, HPV infection among Bolivian women has not yet been fully evaluated. The present study aimed to investigate HPV infection among women living in a rural region of the Bolivian Amazon. Cervical swab samples were collected from 151 healthy women in three Amazonian villages. From every woman, two samples were collected by cotton swab; one for cytological examination and the other for ethanol-preservation of cervical epithelial cells for HPV DNA testing. High molecular DNA was extracted from the ethanol-preserved cervical epithelial cells and tested for HPV DNA by a PCR-RFLP protocol. Ethanol-preserved cervical epithelial cells remained suitable for DNA isolation and PCR amplification of human b-globin and HPV E6/E7 genes, 25 days after sample collection in the field. HPV-31, HPV-58 and HPV-6 were detected in the studied population. The overall prevalence of HPV infection among Bolivian Amazonian women was 8.0%. Neither dual nor multiple HPV infections were found in any of the positive samples. This is the first report of HPV prevalence and type distribution among Bolivian Amazonian women. Our new method for preservation of cervical epithelial cells in ethanol may be useful for viro-epidemiological studies in rural areas.

Evaluación de antígenos recombinantes para el diagnóstico de la enfermedad de Chagas / Evaluation of antigenes recombinants for the diagnostic of the chagas disease

En las últimas décadas, la enfermedad de Chagas ha sido reconocida como un serio problema de salud pública. Se estima que 16 a 18 millones de personas estan infectadas y aproximadamente 90 millones viven en zonas endémicas y estan en riesgo de contraer la infección, 12 millones son habitantes de 6 países del Cono Sur de América Latina. A pesar de los grandes esfuerzos por controlar esta enfermedad, la misma continúa afectando a extensas áreas de América Latina debido a la gran extensión en la cual se distribuyen los vectores que transmiten al agente transmisor de esta enfermedad, llegando a ocupar el primer lugar en las enfermedades tropicales, según lo indica el Banco Mundial (1993). La detección de anticuerpos anti-T. cruzi, por los métodos serológicos, es aún un recurso principal en el diagnóstico de la enfermedad de Chagas. La necesidad de encontrar antígenos mejor definidos en el serodiagnóstico de la enfermedad de Chagas es evidente. Estos últimos años la tecnología del DNA recombinante ha sido utilizada para aislar y caracterizar antígenos de T. cruzi los cuales son inmunodominantes en la infeccion humana. Sus mayores ventajas del uso de estos antígenos es su alta propiedad inmunológica, su fácil producción y costo bajo disminuído. En el presente trabajo hemos evaluado tres antígenos recombinantes de Trypanosoma cruzi (H49, A13 y SAPA), validando de esta manera su potencial diagnóstico frente a los métodos serológicos convencionales IFI y ELISA y sueros de pacientes nativos. Se estudiaron 555 muestras de suero de pacientes provenientes de la ciudad de Cochabamba. De estos sueros se seleccionaron 60 para la evaluación de antígenos recombinantes. Se utilizaron las técnicas de IFI y ELISA. Los resultados mostraron un 7.2 por ciento (40/555) de seropositividad para T. cruzi en el total de pacientes estudiados. Las técnicas IFI y ELISA convencional manifestaron una concordancia del 100 por ciento para los 60 sueros seleccionados. Los tres antígenos recombinantes son 100 por ciento específicos para el diagnóstoco de la enfermedad de chagas, no obstante, en cuanto a la sensibilidad se observan diferentes resultados siendo el antígeno H49 el que ofrece el mejor resultado (100 por ciento), seguido por el antígeno SAPA (93.3 por ciento) y con la mayor sensibilidad el antígeno A13 (70 por ciento)

Serodiagnóstico de la Trypanosomiasis Americana en una población infantil: análisis epidemiológico / Serodiagnostic of the trypanosiomasis american in a poblation childlike, epidemiological analysis

La enfermedad de Chagas, ha sido reconocida como un problema mayor de Salud Pública estos últimos años. En Bolivia, la población infantil presenta un alto riesgo de infección por Trypanosoma cruzi en zonas endémicas. En este estudio, 1479 sueros provenientes de niños de 4 a 10 años de una zona peri-urbana de la ciudad de Cochabamba fueron analizados. Dos pruebas serológicas (IFI) y (ELISA) fueron utilizadas para la detección de anticuerpos anti Trypanosoma cruzi y todos los individuos fueron evaluados por un cuestionario epidemiológico y un examen clínico. Un 5.6 por ciento de seropositividad fue encontrado en el total de individuos estudiados. Esta población comprende dos grupos de niños provenientes de dos estratos sociales diferentes. Esta situación esta correlacionada significativamente con el riesgo de infección por Trypanosoma cruzi. Por otra parte, el análisis estadístico realizado entre las variables clínicas, hematológicas y antropométricas en relación a la infección Trypanosoma cruzi, nos demuestra una dependencia neta entre estas variables, salvo algunos aspectos antoropométricos (talla, peso) y hemáticos (población de segmentados) que presentan una tendencia relativa

Transplante simultaneo de rinon y pancreas con pancreaticoduodenocistostomia / Simultaneous transplant of kidney and pancreas with pancreaticduodenalcystostomy

Se presenta el primer caso de un transplate simultaneo renal y pancreatico realizado en Colombia el 26 de Marzo de 1988 en un paciente de 36 anos, que desde los 17 sufria una diabetes mellitus tipo 1 y quien en los ultimos tiempos tenia una insuficiencia renal terminal por sindrome nefrotico. Habia presentado varios episodios de coma diabetico. Una vez realizado el transplante se observo desde un comienzo como el rinon transplantado no funcionaba, lo que dificulto su tratamiento. Permanecio practicamente insulino independiente por mas de tres semanas. Como el pancreas se coloco en situacion extraperitoneal, se presento necrosis de los musculos de esta zona debido a la formacion de un hematoma y se produjo pancreatitis superficial. Hacia la 4 semana hubo compromiso severo de el estado general e inconciencia, y fue necesario extraerle el pancreas transplatado. Fallecio el 21 de abril de 1988, 26 dias despues de la cirugia.