[Recurrence of cervical intraepithelial neoplasia pre-conization with diathermic handle]. / Recidiva de lesión intraepitelial cervical en pacientes postresección de cono con asa diatérmica.

BACKGROUND: Cervical cancer is a major public health problem worldwide. In Mexico there are an estimated 50 cases per 100,000 women. Cervical intraepithelial neoplasia (CIN) is a precursor of inva- sive cancer. Early detection and treatment of this condition lead to a cure rate close to 100%. OBJECTIVES: To know the percentage of patients who, following a loop diathermy conization, present premalignant lesion recurrence within a cyto-colpo-histological follow-up period of one year; to identify risk factors for patients with persistent lesions. METHODS: A descriptive, retrospective, observational and analytical study of cases and controls conducted at the Hospital General Dr. Miguel Silva in Morelia, Mexico from January 2012 to June 2014. The subjects were patients who had undergone diathermy loop conization due to intraepithelial lesions. RESULTS: The population was comprised of 251 patients, of whom 53 (21.1%) presented recurrence within a one-year follow-up period. The average period between the conization procedure and the diagnosis of a persistent lesion was 8.92 ± 3.2 months. The average patient age was 36.1 ± 7.49 in the group that presented post-procedure recurrence, while that of patients without recurrence was 39.1 ± 7.58, with a p value of 0.025. The only risk factor that showed a statistically significant differ- ence was the persistence of oncogenic hybrids, with an odds ratio of 17.568 (8.33-37.02); p = 0.0001. CONCLUSIONS: Despite the high effectiveness of loop diathermy conization, cyto-colpo-histological follow-up is necessary owing to the high risk of persistent lesions.

Manejo anestésico en la extirpación de una tumoración intrarraquídea cervical con monitorización neurofisiológica intraoperatoria en una paciente gestante de 29 semanas / Anaesthetic management of excision of a cervical intraspinal tumor with intraoperative neurophysiologic monitoring in a pregnant woman at 29 weeks

La monitorización neurofisiológica intraoperatoria se emplea para vigilar la función nerviosa, evitando lesiones neurológicas durante la cirugía y disminuyendo la morbilidad; esto la ha convertido en imprescindible para algunas intervenciones de neurocirugía. La baja incidencia de procedimientos neuroquirúrgicos en mujeres gestantes hace que la experiencia de la monitorización neurofisiológica intraoperatoria esté limitada a algún caso clínico. Se presenta el caso de una gestante de 29 semanas con un tumor intrarraquídeo cervical con evolución aguda que precisó cirugía. La participación de un equipo multidisciplinar compuesto por anestesiólogos, neurocirujanos, neurofisiólogos y obstetras, la monitorización fetal continua, la monitorización neurofisiológica intraoperatoria y el mantenimiento de las variables neurofisiológicas y uteroplacentarias fueron clave para el buen desarrollo de la cirugía. Bajo nuestra experiencia, así como en la escasa literatura publicada, no observamos efectos perjudiciales de esta técnica a nivel maternofetal, aportando importantes beneficios durante la cirugía y en su resultado final (AU)

The intraoperative neurophysiological monitoring is a technique used to test and monitor nervous function. This technique has become essential in some neurosurgery interventions, since it avoids neurological injuries during surgery and reduces morbidity. The experience of intraoperative neurophysiological monitoring is limited in some clinical cases due to the low incidence of pregnant women undergoing a surgical procedure. A case is presented of a 29-weeks pregnant woman suffering from a cervical intraspinal tumour with intense pain, which required surgery. The collaboration of a multidisciplinary team composed of anaesthesiologists, neurosurgeons, neurophysiologists and obstetricians, the continuous monitoring of the foetus, the intraoperative neurophysiological monitoring, and maintaining the neurophysiological and utero-placental variables were crucial for the proper development of the surgery. According to our experience and the limited publications in the literature, no damaging effects of this technique were detected at maternal-foetal level. On the contrary, it brings important benefits during the surgery and for the final result (AU)

[Anaesthetic management of excision of a cervical intraspinal tumor with intraoperative neurophysiologic monitoring in a pregnant woman at 29 weeks]. / Manejo anestésico en la extirpación de una tumoración intrarraquídea cervical con monitorización neurofisiológica intraoperatoria en una paciente gestante de 29 semanas.

The intraoperative neurophysiological monitoring is a technique used to test and monitor nervous function. This technique has become essential in some neurosurgery interventions, since it avoids neurological injuries during surgery and reduces morbidity. The experience of intraoperative neurophysiological monitoring is limited in some clinical cases due to the low incidence of pregnant women undergoing a surgical procedure. A case is presented of a 29-weeks pregnant woman suffering from a cervical intraspinal tumour with intense pain, which required surgery. The collaboration of a multidisciplinary team composed of anaesthesiologists, neurosurgeons, neurophysiologists and obstetricians, the continuous monitoring of the foetus, the intraoperative neurophysiological monitoring, and maintaining the neurophysiological and utero-placental variables were crucial for the proper development of the surgery. According to our experience and the limited publications in the literature, no damaging effects of this technique were detected at maternal-foetal level. On the contrary, it brings important benefits during the surgery and for the final result.

Consideraciones perioperatorias para la realización de una biopsia cerebral en un paciente con enfermedad de Creutzfeldt-Jakob esporádica subtipo VV2 / Perioperative considerations for performing a brain biopsy on a patient with subtype VV2 sporadic Creutzfeldt-Jakob disease

La enfermedad de Creutzfeldt-Jakob (ECJ) es la encefalopatía espongiforme transmisible más común. Consiste en una afección neurológica infecciosa, progresiva y degenerativa, con un periodo de incubación presumiblemente prolongado, pero un curso rápidamente fatal. La ECJ es transmitada por un agente infeccioso proteico o «prion». Dado que los priones son difíciles de erradicar y son resistentes a los métodos de esterilización actualmente empleados, se deben tomar precauciones especiales con los instrumentos quirúrgicos. Se recomiendan equipos de un solo uso, destrucción del equipo contaminado, descontaminación de los instrumentos reutilizables, uso de ropa de protección, y almacenamiento y puesta en cuarentena de los instrumentos quirúrgicos. El equipo de un solo uso y algunos tejidos y fluidos corporales del paciente con ECJ son altamente infecciosos y deben ser incinerados. Se presenta un caso de un paciente al que se le realizó una biopsia cerebral por la sospecha de ECJ, siendo confirmada una ECJ esporádica. Para ello llevamos a cabo unas medidas preventivas específicas para reducir el riesgo de contagio al personal sanitario (AU)

Creutzfeldt-Jakob disease (CJD) is the most common transmissible spongiform encephalopathy. It is an infectious, progressive, degenerative neurological disorder, with a presumably long incubation period, but a rapid fatal course. CJD is transmitted by a proteinaceous infectious agent, or «prion». Because the prions are difficult to eradicate and are resistant to the currently used sterilization methods, special precautions must be taken with all surgical instruments. It is recommended the single-use equipment, destruction of contaminated equipment, decontamination of reusable instruments, use of protective clothing, and storing and quarantining surgical instruments. The single-use equipment and some tissues and body fluids from the patient with CJD are highly infectious and must be incinerated. We report a case of a patient who had undergone brain biopsy for suspected of CJD, being confirmed to have sporadic CJD. Specific preventive measures were taken to reduce the risk of transmission to healthcare workers (AU)

[Perioperative considerations for performing a brain biopsy on a patient with subtype VV2 sporadic Creutzfeldt-Jakob disease]. / Consideraciones perioperatorias para la realización de una biopsia cerebral en un paciente con enfermedad de Creutzfeldt-Jakob esporádica subtipo VV2.

Creutzfeldt-Jakob disease (CJD) is the most common transmissible spongiform encephalopathy. It is an infectious, progressive, degenerative neurological disorder, with a presumably long incubation period, but a rapid fatal course. CJD is transmitted by a proteinaceous infectious agent, or «prion¼. Because the prions are difficult to eradicate and are resistant to the currently used sterilization methods, special precautions must be taken with all surgical instruments. It is recommended the single-use equipment, destruction of contaminated equipment, decontamination of reusable instruments, use of protective clothing, and storing and quarantining surgical instruments. The single-use equipment and some tissues and body fluids from the patient with CJD are highly infectious and must be incinerated. We report a case of a patient who had undergone brain biopsy for suspected of CJD, being confirmed to have sporadic CJD. Specific preventive measures were taken to reduce the risk of transmission to healthcare workers.

Low-dose amphotericin B and murine dialyzable spleen extracts protect against systemic candida infection in mice.

Candida albicans causes opportunistic systemic infections with high mortality (30%-50%). Despite significant nephrotoxicity, amphotericin (AmB) is still used for the treatment of this serious fungal infection. Therefore, alternative treatments are urgently needed. Dialyzable leukocyte extracts have been used successfully to treat patients with mucocutaneous candidiasis, but their effectiveness in systemic candidiasis has not been evaluated. In this study, low-dose AmB (0.1 mg/kg) plus 10 pg of murine dialyzable spleen extracts (mDSE) were tested in a systemic candidiasis mouse model. Survival, tissue fungal burden, kidney damage, kidney cytokines, and serum levels of IL-6 and hepcidin were evaluated. Our results showed that the combined treatment of low-dose AmB plus mDSE improved survival and reduced kidney fungal burden and histopathology; these effects correlated with increased kidney concentration of IFN- γ and TGF- ß 1, decreased levels of TNF- α , IL-6, and IL-10, as well as high levels of systemic IL-6 and hepcidin. Low-dose AmB and mDSE synergized to clear the infectious agent and reduced tissue damage, confirming the efficacy of a low dose of AmB, which might decrease the risk of drug toxicity. Further studies are necessary to explore these findings and its implications in future therapeutic approaches.

Effectiveness of intranasal vaccination against Angiostrongylus costaricensis using a serine/threonine phosphatase 2 A synthetic peptide and recombinant antigens.

Intranasal immunization was assayed in C57BL/6 mice against Angiostrongylus costaricensis using a synthetic and a recombinant peptide belonging to the catalytic region of the serine/threonine phosphatase 2 A (PP2A) of the parasite. Immunization was carried out with the synthetic peptide (SP) polymerized either with itself or with the beta fraction of the cholera toxin (CTB) and then enclosed in nanocapsules of phosphatidyl choline, cholesterol and Quil A (ISCOM). Another group of mice was immunized with recombinant peptide. Immunization consisted of two intranasal inoculations at two-week intervals, and the challenge with L3 larvae was made one month after the last vaccination. The effectiveness of immunization was evaluated 30 days after infection by analysis of the number of parasites in the arteries of the immunized mice, as well as by measuring spleen sizes in the experimental groups. The response induced was determined by identifying the isotypes of IgG as well as the IgE and IgA specific antigen response. The interleukins produced by the splenocyte culture of the different groups were assessed after exposing them to the peptide used in the immunization. From our results, 60%, 80%, and 100% protection against the A. costaricensis challenge was achieved in mice immunized with polymerized synthetic peptide in ISCOM, synthetic peptide polymerized with the CTB in ISCOM and inclusion bodies respectively. Splenomegaly was found to be less evident in the immunized mice than in the controls. A significant increase in IFN gamma and IL-17 levels was observed in the group with 100% protection. The results showed that vaccination through the nasal mucosa may constitute a useful method of immunization and result in a protective immune response against A. costaricensis.

Using national health weeks to deliver deworming to children: lessons from Mexico.

Mexico established national health weeks (NHWs) in the early 1980s to promote childhood vaccinations. Because of the cumulative worldwide peer-reviewed scientific evidence, the recommendations of the World Health Organization and other international organisations, the political will of the Mexican government and the infrastructure provided by the NHWs, deworming was added to the NHWs in 1993. In addition to the Ministry of Health, several other government organisations participated in administering the deworming component. Tens of millions of school-age and preschool children between the ages of 2 years and 14 years now receive deworming (a single 400 mg dose of albendazole) approximately every 8 months. Between 1993 and 1998 evaluations were carried out in over 90,000 children to determine the effect of NHWs on the prevalence of geohelminth infections. In 1993, the overall prevalence of Ascaris was 20% and that of Trichuris was 15%. Prevalences decreased significantly over time (p <0.001). Treatment efficacy for Ascaris ranged from 91.6% to 85.3%, and for Trichuris, from 97.9% to 42.6%. In 1998, after conducting 12 NHWs with deworming, the respective prevalences were Ascaris 8% and Trichuris 11%. The experience of Mexico in integrating albendazole into its NHWs shows how deworming can be delivered to large numbers of at-risk children using an existing infrastructure. The NHW approach may be generalisable in other countries with successful national vaccination campaigns. The challenge remaining is to sustain the deworming programme until other longer-term behavioural, environmental and socioeconomic changes can be implemented.

Screening of antifungal activity of plants from the northeast of Mexico.

Screening of the antifungal activity of plants from the northeast of Mexico against some of the main etiological agents inducing pulmonary mycoses, Candida albicans, Aspergillus fumigatus, Histoplasma capsulatum, and Coccidioides immitis, was conducted in vitro. We used the M27-A2 and M38-A methods from the National Committee for Clinical Laboratory Standards to screen the antifungal activity. Ten hydroalcoholic extracts from the 15 plants evaluated showed antifungal activity against at least one of these fungi. Following this, a differential extraction was conducted with solvents of different polarities, and 16 extracts showed activity ranging from 16 to 125microg/mL against the different fungi. Toxicity of the extracts was evaluated by means of the test of lethality to Artemia salina, two of which were shown to have toxicity.

Effects of pentoxifylline on the urinary protein excretion profile of type 2 diabetic patients with microproteinuria: a double-blind, placebo-controlled randomized trial.

AIMS: The purpose of this study was to identify the effect of pentoxifylline on the urinary protein excretion profile in type 2 diabetic patients. METHODS: 40 type 2 nonhypertensive diabetic patients were randomly allocated to receive either pentoxifylline 400 mg t.i.d. or placebo daily for 16 weeks. Eligible subjects were those with urinary albumin excretion between 20 and 200 microg/min. Subjects receiving angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), calcium antagonists, and diuretics as well as those with reduced renal function, pregnancy, urinary tract infection, and smoking were not included. A 6-month pretreatment stabilization phase aimed to reduce and stabilize fasting serum glucose levels was carried out. Urinary proteins were identified by electrophoresis, and immunodetection was identified by Western blot. Electrophoretic analysis was performed using molecular weight markers of 150, 132, 77, and 66 kDa to identify high-weight proteins, and 54, 41, 36, 27, 21, 14.3, and 12 kDa to identify low-weight proteins. RESULTS: At baseline, subjects in both groups who showed a glomerular tubular pattern did not differ in their urinary excretion profile. The urinary proteins identified were immunoglobulin G, ceruloplasmin, transferrin, and albumin (glomerular pattern) as well as alpha1-antitrypsin, alpha1-acid glycoprotein, collagenase inhibitor, alpha1-microglobulin, trypsin inhibitor, lysozyme, and beta2-microglobulin (tubular pattern). Subjects who received pentoxifylline had reduced urinary excretion of high- and low-molecular weight proteins. CONCLUSIONS: Urinary protein excretion in type 2 diabetic subjects shows a mixed, glomerular and tubular, pattern. Pentoxifylline reduces the excretion of both high and low molecular-weight urinary proteins.

[Anesthetic management of a boy with sialidosis]. / Manejo anestésico de un paciente con sialidosis.

Sialidosis is an autosomal recessive disease caused by neuraminidase deficiency, which causes material rich in sialic acid to accumulate in various tissues and organs, leading to morphological and functional changes. Mainly the osteoarticular, cardiorespiratory, and central nervous systems are affected. We report the case of a 14-year-old boy diagnosed with sialidosis type 2 who was proposed for spinal column arthrodesis to treat severe thoracolumbar scoliosis. Physical examination revealed pectus carinatum; facial deformity and macroglossia; hypertelorism and frontal bossing; short neck; atlantoaxial subluxation; severe arthrogryposis of elbows, knees and wrists, coxa valga, and club foot. Relevant medical history included moderately severe aortic valve insufficiency and myoclonic epilepsy. Surgery was performed under balanced anesthesia. Awakening was delayed and the patient was transferred to the intensive care unit under mechanical ventilation. Anesthetic problems that can present in patients with such deformities include difficult airway, complicated management of associated cardiopathy, and difficult weaning from mechanical ventilation.

153 SM-EDTMP (Samario) como tratamiento del dolor óseo de origen metastático / 153 SM-EDTMP (SAMARIO) For the treatment of metastatic bone pain

Introducción: 153 Sm-EDTMP es un agente radioactivo que puede ser usado para el diagnóstico así como el tratamiento de algunas enfermedades. El objetivo de este estudio es evaluar la eficacia de 153 Sm-EDTMP en el tratamiento del dolor crónico debido a metástasis óseas en el cáncer de próstata. Material y métodos: Se realiza un estudio prospectivo dónde se incluyen siete pacientes con dolor crónico, en relación con metástasis óseas por cáncer prostático, a los que se les administra de forma intravenosa 153 Sm-EDTMP para controlar el dolor. La eficacia de este agente fue evaluada según los cambios obtenidos en la escala visual-analgésica de (EVA), tiempo en el que se alcanzó la respuesta terapéutica, efectos adversos y cambios en el consumo diario de analgésicos. Resultados: 2 de 7 pacientes (28.5%) tuvieron remisión completa del dolor, 4 de 7 (37.2%) remisión parcial (EVA ≥1 y ≤3) y 1 de 7 (14.3%) no mostraron mejoría. La respuesta terapéutica ocurrió a los 10-30 días después de la administración del fármaco en 83.3% de los pacientes, 16.6% requirieron más tiempo. No se observaron efectos adversos mayores; 20% sintieron nauseas, 5% vómitos y 0% toxicidad hematológica. 5 de 7 pacientes (71.4%) redujeron el consumo de analgésicos. Conclusiones: 153 Sm-EDTMP es seguro y eficaz para la paliación rápida del dolor ocasionado por metástasis óseas, aunque aún quedan importantes cuestiones que resolver, fundamentalmente sobre los factores que influyen en la respuesta terapéutica a este radiofármaco (AU)

Introduction: 153 Sm-EDTMP is a radioactive agent used for both the diagnosis and treatment of some diseases. The aim of this study is to evaluate the efficacy of 153 Sm-EDTMP for the treatment of chronic pain due to bone metastasis in prostate cancer. Material and methods: Prospective study including seven patients suffering chronic pain due to bone metastasis in prostate cancer to whom intravenous 153 Sm-EDTMP for pain control was administered. The efficacy of this agent was evaluated through Visual Analog Scale (VAS) changes, time needed for therapeutic response and variations in the daily analgesic demands. Results: 2 in 7 patients (28.5%) obtained full pain relief, 4 in 7 (37.2%) partial relief (VAS ≥1 and ≤3) and 1 in 7 (14.3%) did not show any improvement. In 83.3% of patients, therapeutic response took place 10-30 days after the administration of the drug; 16.6% required a longer period of time. No main adverse events were observed; 20% suffered nausea, 5% vomiting and 0% hematologic toxicity. 5 in 7 patients (71.4%) reduced their analgesic requirements. Conclusions: Although a number of questions still remain unanswered, mainly about factors conditioning the therapeutic response to this drug, 153 Sm-EDTMP is safe and effective for the prompt relief of pain due to bone metastasis (AU)

Manejo anestésico de un paciente con sialidosis / Anesthetic management of a boy with sialidosis

La sialidosis es una enfermedad autosómica recesivacausada por el déficit del enzima neuraminidasa. Dichodéficit provoca un acúmulo de material rico en ácido siálicoen diversos tejidos y órganos de la economía, ocasionandoalteraciones morfológicas y funcionales en losmismos. Afecta principalmente al sistema osteoarticular,cardiorrespiratorio y sistema nervioso central (SNC).Presentamos el caso clínico de un varón de 14 añosdiagnosticado de sialidosis tipo II, propuesto para artrodesisde columna vertebral por escoliosis toracolumbarsevera. A la exploración física presentaba deformidadtorácica en quilla, facies dismórfica con macroglosia,hipertelorismo y frente olímpica, cuello corto, subluxaciónatloaxoidea y artrogriposis severa con flexo decodos, rodillas, muñecas, coxa valga y pies equinos.Como antecedentes personales destacaba la existencia deinsuficiencia aórtica moderada y epilepsia mioclónica.Fue intervenido bajo anestesia general balanceada presentandoretraso en el despertar y precisando traslado ala unidad de cuidados intensivos con ventilación mecánica.Los problemas anestésicos que pueden presentar estospacientes comprenden la existencia de una vía aérea difícil,el manejo de las cardiopatías asociadas y las dificultadesen la desconexión de la ventilación mecánica

Sialidosis is an autosomal recessive disease caused byneuraminidase deficiency, which causes material rich insialic acid to accumulate in various tissues and organs,leading to morphological and functional changes.Mainly the osteoarticular, cardiorespiratory, and centralnervous systems are affected.We report the case of a 14-year-old boy diagnosed withsialidosis type 2 who was proposed for spinal columnarthrodesis to treat severe thoracolumbar scoliosis. Physicalexamination revealed pectus carinatum; facial deformityand macroglossia; hypertelorism and frontal bossing;short neck; atlantoaxial subluxation; severe arthrogryposisof elbows, knees and wrists, coxa valga, andclub foot. Relevant medical history included moderatelysevere aortic valve insufficiency and myoclonic epilepsy.Surgery was performed under balanced anesthesia. Awakeningwas delayed and the patient was transferred to theintensive care unit under mechanical ventilation.Anesthetic problems that can present in patients withsuch deformities include difficult airway, complicatedmanagement of associated cardiopathy, and difficultweaning from mechanical ventilation

Eclampsia en una gestante adicta a drogas / Eclampsia in a pregnant drug addict

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Profilaxis antihemorrágica en cirugía de bajo riesgo en el síndrome de Bernard-Soulier / Antihemorrhagic prophylaxis in low risk surgery in Bernard-Soulier syndrome

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[Complications and morbidity and mortality rates in a postanesthetic intensive care unit]. / Patología y morbimortalidad en una Unidad de Reanimación Obstétrica.

OBJECTIVES: To describe the complications leading to admission of obstetric patients to intensive care or intensive postanesthetic care units. To describe the morbidity and mortality rates in such patients. MATERIAL AND METHODS: We carried out a descriptive study based on patient records of 23,246 births at the Hospital Materno Infantil belonging to the University Hospitals Virgen del Rocio in Sevilla, Spain, over a 3-year period (2001-2003). RESULTS: In the 23,246 births reviewed, 746 women (3%) required admission to the obstetric postoperative intensive care unit. The most common reasons were pre-eclampsia in 146 cases (19%), ectopic pregnancy in 97 cases (13%), and postpartum bleeding in 75 cases (10%). Among the 146 cases of preeclampsia treated in the unit, there were 8 cases of eclampsia and 7 of acute pulmonary edema. Two deaths (0.3%) occurred, due to eclampsia in 1 case and to pulmonary thromboembolism in the other. CONCLUSIONS: Obstetric patients are at risk of serious complications that require admission to intensive care or intensive postanesthetic care units, and we therefore emphasize the need to create such units at tertiary care hospitals.

Resolución de dificultad de vía aérea en una cesárea urgente con fastrach / Fastrach mask to resolve a difficult airway during emergency cesarean section

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