Massive digestive bleeding as a result of gastric heterotopy: a case report. / Sangrado digestivo masivo por heterotopia gástrica. Reporte de un caso.

INTRODUCTION: Gastric heterotopy is a rare entity in the pediatric population. It occurs in the gastrointestinal tract, leading to digestive bleeding. CLINICAL CASE: This is the case of a 10-year-old boy with gastric tissue in the proximal jejunum, which caused two massive digestive bleeding episodes. Diagnostic techniques included endoscopic capsule, enteroscopy, and biopsy. The patient was scheduled for laparotomy and resection. After one year of follow-up, he remained asymptomatic. DISCUSSION: Gastric heterotopy approach represents a diagnostic challenge. Owing to how rare it is, there is no global consensus in terms of treatment. However, surgery is the definitive therapy. In this case, decision was made not to perform intestinal resection and anastomosis, but resection of the compromised intestinal wall. No malignity was reported in the literature reviewed.

INTRODUCCION: La heterotopia gástrica es una entidad infrecuente en la población pediátrica. Se presenta en el tracto gastrointestinal llevando a cuadros clínicos de sangrado digestivo. CASO CLINICO: Se reporta el caso de un escolar de 10 años, el cual presentó tejido gástrico en el yeyuno proximal, originando sangrado digestivo masivo en dos ocasiones. La secuencia de apoyos diagnósticos requirió cápsula endoscópica, enteroscopia y biopsia. Fue llevado a laparotomía y resección de la lesión. En el seguimiento al año se mantuvo asintomático. DISCUSION: Su abordaje genera un reto diagnóstico. Debido a su infrecuente presentación no hay un consenso global para el tratamiento, sin embargo, la intervención quirúrgica es la terapia definitiva. En este caso no se hizo resección intestinal y anastomosis sino resección de la pared intestinal comprometida. No se reportó malignidad en la literatura revisada.

Sangrado digestivo masivo por heterotopia gástrica. Reporte de un caso / Massive digestive bleeding as a result of gastric heterotopy: a case repor

Introducción: La heterotopia gástrica es una entidad infrecuente enla población pediátrica. Se presenta en el tracto gastrointestinal llevandoa cuadros clínicos de sangrado digestivo. Caso clínico: Se reporta el caso de un escolar de 10 años, el cualpresentó tejido gástrico en el yeyuno proximal, originando sangradodigestivo masivo en dos ocasiones. La secuencia de apoyos diagnósti-cos requirió cápsula endoscópica, enteroscopia y biopsia. Fue llevadoa laparotomía y resección de la lesión. En el seguimiento al año semantuvo asintomático. Discusión: Su abordaje genera un reto diagnóstico. Debido a suinfrecuente presentación no hay un consenso global para el tratamien-to, sin embargo, la intervención quirúrgica es la terapia definitiva. Eneste caso no se hizo resección intestinal y anastomosis sino resecciónde la pared intestinal comprometida. No se reportó malignidad en laliteratura revisada.(AU)

Introduction: Gastric heterotopy is a rare entity in the pediatricpopulation. It occurs in the gastrointestinal tract, leading to digestivebleeding. Clinical case: This is the case of a 10-year-old boy with gastrictissue in the proximal jejunum, which caused two massive digestivebleeding episodes. Diagnostic techniques included endoscopic capsule,enteroscopy, and biopsy. The patient was scheduled for laparotomyand resection. After one year of follow-up, he remained asymptomatic. Discussion: Gastric heterotopy approach represents a diagnosticchallenge. Owing to how rare it is, there is no global consensus in termsof treatment. However, surgery is the definitive therapy. In this case,decision was made not to perform intestinal resection and anastomosis,but resection of the compromised intestinal wall. No malignity wasreported in the literature reviewed.(AU)

[Calcifying fibrous pseudotumor of the mesentery: an unusual case in a 9-year-old girl]. / Pseudotumor fibroso calcificado del mesenterio: un caso inusual en una niña de 9 años.

INTRODUCTION: Calcifying fibrous pseudotumor is a rare benign lesion with few peritoneal and mesenteric cases in pediatric population described. Its course is mainly asymptomatic, which is why diagnosis corresponds mostly to incidental findings. CLINICAL CASE: Authors present the case of a 9-year-old patient with abdominal pain, and intra-abdominal mass finding in abdominal tomography. The histopathological study realized established diagnosis of calcifying fibrous pseudotumor, which is why programmed resection of the mass was performed by laparotomy. Follow-up was performed during one year, without evidence of recurrences through ecography. COMMENTS: Authors discuss the diagnostic and therapeutic approach in this patient compared to that described in the literature.

INTRODUCCION: El pseudotumor fibroso calcificado es una lesión benigna, con pocos casos de localización peritoneal y mesentérica descritos en la población pediátrica. Su curso es principalmente asintomático, por lo cual el diagnóstico corresponde en su mayoría a hallazgos incidentales. CASO CLINICO: Se presenta el caso de una paciente de 9 años con dolor abdominal y hallazgo de masa entra-abdominal en tomografía de abdomen. El estudio histopatológico realizado estableció el diagnóstico de pseudotumor fibroso calcificado, por lo que se llevó a resección programada de la masa mediante laparotomía. El seguimiento de la paciente fue durante un año, sin evidencia de recurrencias en ecografía. COMENTARIOS: Se discute la aproximación diagnóstica y terapéutica en esta paciente comparado con lo descrito en la literatura.

Pseudotumor fibroso calcificado del mesenterio: un caso inusual en una niña de 9 años / Calcifying fibrous pseudotumor of the mesentery: an unusual case in a 9-year-old girl

Introducción: El pseudotumor fibroso calcificado es una lesión benigna, con pocos casos de localización peritoneal y mesentérica descritos en la población pediátrica. Su curso es principalmente asintomático, por lo cual el diagnóstico corresponde en su mayoría a hallazgos incidentales. Caso clínico: Se presenta el caso de una paciente de 9 años con dolor abdominal y hallazgo de masa entra-abdominal en tomografía de abdomen. El estudio histopatológico realizado estableció el diagnóstico de pseudotumor fibroso calcificado, por lo que se llevó a resección programada de la masa mediante laparotomía. El seguimiento de la paciente fue durante un año, sin evidencia de recurrencias en ecografía. Comentarios: Se discute la aproximación diagnóstica y terapéutica en esta paciente comparado con lo descrito en la literatura

Introduction: Calcifying fibrous pseudotumor is a rare benign lesion with few peritoneal and mesenteric cases in pediatric population described. Its course is mainly asymptomatic, which is why diagnosis corresponds mostly to incidental findings. Clinical case: Authors present the case of a 9-year-old patient with abdominal pain, and intra-abdominal mass finding in abdominal tomography. The histopathological study realized established diagnosis of calcifying fibrous pseudotumor, which is why programmed resection of the mass was performed by laparotomy. Follow-up was performed during one year, without evidence of recurrences through ecography. Comments: Authors discuss the diagnostic and therapeutic approach in this patient compared to that described in the literature

Extracellular matrix influence in Streptococcus mutans gene expression in a cariogenic biofilm.

Caries etiology is biofilm-diet-dependent. Biofilms are highly dynamic and structured microbial communities enmeshed in a three-dimensional extracellular matrix. The study evaluated the expression dynamics of Streptococcus mutans genes associated with exopolysaccharides (EPS) (gtfBCD, gbpB, dexA), lipoteichoic acids (LTA) (dltABCD, SMU_775c) and extracellular DNA (eDNA) (lytST, lrgAB, ccpA) during matrix development within a mixed-species biofilm of S. mutans, Actinomyces naeslundii and Streptococcus gordonii. Mixed-species biofilms using S. mutans strains UA159 or ΔgtfB formed on saliva-coated hydroxyapatite discs were submitted to a nutritional challenge (providing an abundance of sucrose and starch). Biofilms were removed at eight developmental stages for gene expression analysis by quantitative polymerase chain reaction. The pH of spent culture media remained acidic throughout the experimental periods, being lower after sucrose and starch exposure. All genes were expressed at all biofilm developmental phases. EPS- and LTA-associated genes had a similar expression profile for both biofilms, presenting lower levels of expression at 67, 91 and 115 hours and a peak of expression at 55 hours, but having distinct expression magnitudes, with lower values for ΔgtfB (eg, fold-difference of ~382 for gtfC and ~16 for dltB at 43 hours). The eDNA-associated genes presented different dynamics of expression between both strains. In UA159 biofilms lrgA and lrgB genes were highly expressed at 29 hours (which were ~13 and ~5.4 times vs ΔgtfB, respectively), whereas in ΔgtfB biofilms an inverse relationship between lytS and lrgA and lrgB expression was detected. Therefore, the deletion of gtfB influences dynamics and magnitude of expression of genes associated with matrix main components.

Determination of personal care products -benzophenones and parabens- in human menstrual blood.

Benzophenones and parabens are synthetic chemicals used in many personal care products, foods and pharmaceuticals. Benzophenones are used to protect the skin and materials from the adverse effects of UV-radiation, and parabens are used as preservatives. Despite their widespread occurrence and proven endocrine disrupting activity, relatively little is known about human exposure to these compounds. In the present work, an analytical method based on sample treatment using dispersive liquid-liquid microextraction (DLLME) for the extraction of six benzophenones (benzophenone-1, -2, -3, -6, -8 and 4-hydroxybenzophenone) and four parabens (methyl-, ethyl-, propyl- and butyl- paraben) from human menstrual blood samples, followed by ultrahigh performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS) analysis, is proposed and validated. The method was validated using matrix-matched standard calibration followed by a recovery assay with spiked samples. The limits of detection ranged from 0.1 to 0.3ngmL-1, with recoveries of 93.8% to 108.9%, and precision (evaluated as relative standard deviation) lower than 14% for all selected compounds. This method was successfully applied for the determination of the target compounds in 25 samples of human menstrual blood. Methylparaben and benzophenone-3 were the most frequently detected compounds (96%).

Serum and adipose tissue as matrices for assessment of exposure to persistent organic pollutants in breast cancer patients.

The aim of this study was to assess differences between two biological matrices (serum and breast adipose tissue) in the evaluation of persistent organic pollutant (POP) exposure in breast cancer patients. The study population consisted of 103 women undergoing surgery for newly diagnosed breast carcinoma in a public hospital in Granada, Southern Spain. Independent variables were gathered from questionnaires and clinical records. POP concentrations were quantified in breast adipose tissue and serum samples. Spearman correlation tests were performed between pairs of POP concentrations and stepwise multivariable linear regression analyses were conducted to assess predictors of concentrations in the two matrices. p,p'- Dichlorodiphenyldichloroethylene (p,p'-DDE) showed the the highest median concentration in both matrices (194.34 and 173.84 ng/g lipid in adipose tissue and serum, respectively). Median wet-basis adipose tissue:serum ratios ranged from 109.34 to 651.62, while lipid-basis ratios ranged from 0.88 to 4.34. In general, we found significant positive correlation coefficients between pairs of POPs in adipose tissue and in serum, which were always higher in adipose tissue. We found positive and statistically significant correlations between serum and adipose tissue concentrations of p,p'-DDE and hexachlorobenzene (HCB) but not of polychlorinated biphenyls (PCBs). Age was positively associated with most POPs in adipose tissue and serum, while the body mass index was positively associated with adipose tissue HCB concentrations and negatively associated with serum PCB-153 and PCB-138 concentrations. Recent weight loss was inversely associated with POP residues in adipose tissue and positively associated with POP residues in serum. Serum HCB and PCB-180 concentrations were lower in patients who had received preoperative chemotherapy. According to our results, serum and adipose tissue POP concentrations in breast cancer patients may be differentially affected by external predictors. Taken together, these findings indicate the need to take account of the individual POP(s) under study and the biological matrix used when relating internal POP exposure to breast cancer disease and to make a careful selection of covariates for adjusting the model.

Phytoremediation of Landfill Leachate with Colocasia esculenta, Gynerum sagittatum and Heliconia psittacorum in Constructed Wetlands.

This study assessed the accumulation of Cd (II), Hg (II), Cr (VI) and Pb (II) in Gynerium sagittatum (Gs), Colocasia esculenta (Ce) and Heliconia psittacorum (He) planted in constructed wetlands treating synthetic landfill leachate. Sixteen bioreactors were operated in two experimental blocks. Metal concentrations in the influent and effluent; root, stem, branch and leaves of plants were analysed, as well as COD, N-NH4+, TKN, T, pH, ORP, DO, and EC. Average removal efficiencies of COD, TKN and NH4+-N were 66, 67 and 72%, respectively and heavy metal removal ranged from 92 to 98% in all units. Cr (VI) was not detected in any effluent sample. The bioconcentration factors (BCF) were 10(0) -10(2). The BCF of Cr (VI) was the lowest: 0.59 and 2.5 (L kg(-1)) for Gs and He respectively; whilst Cd (II) had the highest (130-135 L kg(-1)) for Gs. Roots showed a higher metal content than shoots. Translocation factors (TF) were lower, He was the plant exhibiting TFs>1 for Pb (II), Cr (T) and Hg (II) and 0.4-0.9 for Cd (II) and Cr (VI). The evaluated plants demonstrate their suitability for phytoremediation of landfill leachate and all of them can be categorized as metals accumulators.

Lesiones intestinales por imanes. Serie de casos / Magnet intestinal lesions. Case series

La ingesta de cuerpos extraños es una entidad frecuente en la población pediátrica; la mayoría de los casos ocurren entre los 6 meses y los 3 años. En general, la gran mayoría de los cuerpos extraños no se asocian con morbi-mortalidad. La ingestión de 2 o más imanes puede llevar a obstrucción, formación de fístulas, ulceración, perforación y volvulación del intestino. En esta serie se presentan 4 casos de pacientes con ingesta de múltiples imanes y quienes, dadas las características del cuerpo extraño ingerido y el cuadro clínico, requirieron tratamiento quirúrgico(AU)

The ingestion of foreign bodies is a common trouble in the pediatric population, and most of cases occur between 6 months and 3 years. In general the vast majority of foreign bodies are not associated with morbidity or mortality. Ingestion of two or more magnets can lead to obstruction, fistulas, ulceration, perforation and bowel volvulus. In this series we present 4 cases of patients ingesting multiple magnets and who due to the ingested foreign body characteristics and clinical profile required surgical treatment (AU)

[Magnet intestinal lesions. Case series]. / Lesiones intestinales por imanes. Serie de casos.

The ingestion of foreign bodies is a common trouble in the pediatric population, and most of cases occur between 6 months and 3 years. In general the vast majority of foreign bodies are not associated with morbidity or mortality. Ingestion of two or more magnets can lead to obstruction, fistulas, ulceration, perforation and bowel volvulus. In this series we present 4 cases of patients ingesting multiple magnets and who due to the ingested foreign body characteristics and clinical profile required surgical treatment.

[Haloperidol or droperidol with dexamethasone for antiemetic prophylaxis in laparoscopic cholecystectomy]. / Haloperidol o droperidol asociados a dexametasona como profilaxis antiemética en colecistectomías laparoscópicas.

OBJECTIVES: To compare haloperidol to droperidol, both with dexamethasone, for antiemetic prophylaxis in elective laparoscopic cholecystectomy. MATERIAL AND METHODS: Prospective, randomized double-blind trial enrolling 75 ASA 1-2 patients who received anesthesia with propofol and remifentanil. After induction, 8 mg of intravenous dexamethasone was administered. After surgery, depending on group assignment, patients received 10 microg x kg(-1) of intravenous haloperidol (n = 25), 10 microg x kg(-1) of droperidol (n = 25), or physiologic saline solution (n = 25). Outcomes recorded were episodes of nausea or vomiting in the postoperative period (first 6 hours and/or 6-24 hours), requirement for antiemetic agents, morphine consumption, pain assessed on a visual analog scale, level of sedation, and adverse effects. RESULTS: Five patients in the haloperidol group, 6 in the droperidol group, and 13 in the control group experienced an episode of nausea or vomiting in the 24-hour postoperative period (P < .05 between the active treatment groups and the control group). One patient in the haloperidol group, 6 in the droperidol group, and 8 in the control group reported nausea in the first 6 hours (P < .05). Three patients in the haloperidol group, 1 in the droperidol group, and 8 in the control group reported nausea in the later postoperative period (6-24 hours) (P < .05, droperidol vs control). Three patients in the haloperidol group, 1 in the droperidol group, and 7 in the control group experienced late vomiting (P < .05, droperidol vs control). CONCLUSIONS: Either haloperidol or droperidol in combination with dexamethasone is more effective than dexamethasone alone for antiemetic prophylaxis after laparoscopic cholecystectomy.

Haloperidol o droperidol asociados a dexametasona como profilaxis antiemética en colecistectomías laparoscópicas / Haloperidol or droperidol with dexamethasone for antiemetic prophylaxis in laparoscopic cholecystectomy

OBJETIVOS: Comparar haloperidol y droperidol asociados a dexametasona como profilaxis antiemética en colecistectomías laparoscópicas electivas. MATERIALES Y MÉTODOS: Estudio prospectivo, randomizado, doble-ciego sobre 75 pacientes ASA I-III que recibieron anestesia con propofol y remifentanilo. Tras la inducción, se administraron 8 mg de dexametasona iv y al finalizar la intervención, según el grupo estudiado: 10 μg kg-1 de haloperidol iv (grupo H; n = 25), 10 μg kg-1 de droperidol (grupo D; n = 25) o suero fisiológico (grupo control; C; n = 25). Se registraron las náuseas y vómitos en el postoperatorio (6 primeras horas y 6-24 horas), necesidades de antieméticos, consumo de morfina, la escala visual analógica para dolor, el grado de sedación y efectos adversos. RESULTADOS: Cinco pacientes en el grupo haloperidol, seis en el grupo droperidol y trece en el grupo control presentaron algún episodio de náusea o vómito en las 24 horas (p < 0,05 grupos H y D versus C). Un paciente en el grupo H, 6 en el grupo D y 8 en el grupo C tuvieron náuseas en las primeras 6 horas (p < 0,05 grupo H versus grupo C). Tres pacientes en el grupo H, uno en el grupo D y ocho en el grupo C presentaron náuseas en el postoperatorio tardío (6-24 h) (p < 0,05 grupo D vs grupo C). 3 pacientes en el grupo H, 1 en el grupo D y 7 en el grupo C presentaron vómitos tardíos (p < 0,05 grupo D vs C). CONCLUSIONES: Haloperidol o droperidol en combinación con dexametasona son superiores a dexametasona sola como profilaxis antiemética en colecistectomías laparoscópicas

OBJECTIVES: To compare haloperidol to droperidol, both with dexamethasone, for antiemetic prophylaxis in elective laparoscopic cholecystectomy. MATERIAL AND METHODS: Prospective, randomized double-blind trial enrolling 75 ASA 1-2 patients who received anesthesia with propofol and remifentanil. After induction, 8 mg of intravenous dexamethasone was administered. After surgery, depending on group assignment, patients received 10 μg· kg-1 of intravenous haloperidol (n = 25), 10 μg·kg-1 of droperidol (n = 25), or physiologic saline solution (n = 25). Outcomes recorded were episodes of nausea or vomiting in the postoperative period (first 6 hours and/or 6-24 hours), requirement for antiemetic agents, morphine consumption, pain assessed on a visual analog scale, level of sedation, and adverse effects. RESULTS: Five patients in the haloperidol group, 6 in the droperidol group, and 13 in the control group experienced an episode of nausea or vomiting in the 24-hour postoperative period (P <.05 between the active treatment groups and the control group). One patient in the haloperidol group, 6 in the droperidol group, and 8 in the control group reported nausea in the first 6 hours (P <.05). Three patients in the haloperidol group, 1 in the droperidol group, and 8 in the control group reported nausea in the later postoperative period (6-24 hours) (P <.05, droperidol vs control). Three patients in the haloperidol group, 1 in the droperidol group, and 7 in the control group experienced late vomiting (P <.05, droperidol vs control). CONCLUSIONS: Either haloperidol or droperidol in combination with dexamethasone is more effective than dexamethasone alone for antiemetic prophylaxis after laparoscopic cholecystectomy

Adición de bicarbonato de sodio y/o clonidina a la mepivacaína. Influencia sobre las características del bloqueo de plexo braquial por vía axilar / Addition of sodium bicarbonate and/or clonidine to mepivacaine: influence on axillary brachial plexus block characteristics

INTRODUCCIÓN: El bloqueo del plexo braquial (BPB)por vía axilar es un procedimiento anestésico habitual.La adición de variados fármacos coadyuvantes se hamostrado efectiva en la mejoría de los resultados conesta técnica. Este estudio evalúa la incorporación debicarbonato de sodio y/o clonidina al BPB con mepivacaína.MATERIAL Y MÉTODO: Se realizó un estudio controladorandomizado de 60 pacientes, entre 18 y 70 años, ASA 1a 3 estables, que recibieron anestesia con técnica deBPB. Se dividieron en 4 grupos de 15 pacientes: GrupoI (control) recibió 40 mL de mepivacaína (MEP) 1% conadrenalina (A) + 5 mL de suero fisiológico (SF); el GrupoII, 40 mL MEP 1% con A + 4 mL NaHCO3 + 1 mLSF; el Grupo III, 40 mL MEP 1% con A + 150 µg clonidina+ 4 mL SF y el Grupo IV, 40 mL MEP 1% con A +4 mL NaHCO3 + 150 µg de clonidina.RESULTADOS: El tiempo de instalación del BPB fue significativamentemenor en los grupos II y IV. La duracióndel BPB fue mayor en el grupo III, la analgesia obtenidaen el grupo 3 fue significativamente mayor.CONCLUSIONES: La adición de bicarbonato de sodio ala mepivacaína disminuye el tiempo de latencia del BPBpor vía axilar, la incorporación de clonidina prolonga laduración de la anestesia y analgesia, la adición conjuntade bicarbonato de sodio y clonidina reduce el tiempo delatencia pero no incrementa la duración de la anestesiay analgesia

BACKGROUND AND OBJECTIVE: The axillary brachialplexus block is a frequently performed anesthetic technique.Adding a variety of coadjuvant drugs has beenshown to improve results. This study evaluated the additionof sodium bicarbonate (NaHCO3) and/or clonidineto mepivacaine for performing the block.MATERIAL AND METHODS: Sixty patients between 18and 70 years old, ASA 1-3 in stable condition receivedaxillary brachial plexus blocks in a randomized controlledstudy. Four groups of 15 patients each were formed:group I (control group) received 40 mL of 1% mepivacainewith adrenaline plus 5 mL of saline; group II, 40mL of 1% mepivacaine with adrenaline plus 4 mL ofNaHCO3 and 1 mL of saline; group III, 40 mL of 1%mepivacaine with 150 µg of clonidine plus 4mL of saline;and group IV, 40 mL of 1% mepivacaine with adrenalineplus 4 mL of NaHCO3 and 150 µg of clonidine.RESULTS: The onset time was significantly shorter ingroups 2 and 4. The duration of the block was longer ingroup 3 and the analgesic effect was significantlybetter.CONCLUSIONS: Adding NaHCO3 to mepivacaine shortensthe time of onset of an axillary brachial plexus block.Including clonidine prolongs the duration of anesthesiaand analgesia. The addition of both NaHCO3 and clonidineshortens time to onset but does not prolong durationof anesthesia or analgesia

[Addition of sodium bicarbonate and/or clonidine to mepivacaine: influence on axillary brachial plexus block characteristics]. / Adición de bicarbonato de sodio y/o clonidina a la mepivacaína. Influencia sobre las características del bloqueo de plexo braquial por vía axilar.

BACKGROUND AND OBJECTIVE: The axillary brachial plexus block is a frequently performed anesthetic technique. Adding a variety of coadjuvant drugs has been shown to improve results. This study evaluated the addition of sodium bicarbonate (NaHCO3) and/or clonidine to mepivacaine for performing the block. MATERIAL AND METHODS: Sixty patients between 18 and 70 years old, ASA 1-3 in stable condition received axillary brachial plexus blocks in a randomized controlled study. Four groups of 15 patients each were formed: group I (control group) received 40 mL of 1% mepivacaine with adrenaline plus 5 mL of saline; group II, 40 mL of 1% mepivacaine with adrenaline plus 4 mL of NaHCO3 and 1 mL of saline; group III, 40 mL of 1% mepivacaine with 150 microg of clonidine plus 4mL of saline; and group IV, 40 mL of 1% mepivacaine with adrenaline plus 4 mL of NaHCO3 and 150 microg of clonidine. RESULTS: The onset time was significantly shorter in groups 2 and 4. The duration of the block was longer in group 3 and the analgesic effect was significantly better. CONCLUSIONS: Adding NaHCO3 to mepivacaine shortens the time of onset of an axillary brachial plexus block. Including clonidine prolongs the duration of anesthesia and analgesia. The addition of both NaHCO3 and clonidine shortens time to onset but does not prolong duration of anesthesia or analgesia.