Peritoneal Lavage in Complicated Acute Diverticulitis: Back to the Future.

PURPOSE: The aim of this study was to assess laparoscopic lavage in patients with acute diverticulitis. BACKGROUND: In recent times, laparoscopic peritoneal lavage has been considered a therapeutic alternative to standard resection procedures. In Hinchey III diverticulitis there is the possibility of avoiding ostomies or resection procedures. STUDY: This retrospective study was conducted in a single-care institution. RESULTS: Patients requiring emergency surgery for perforated diverticulitis and generalized peritonitis between March 2011 and May 2014 were identified from a prospective database. Seventy-two patients underwent surgery for diverticulitis. Forty-three patients presented with generalized peritonitis (Hinchey III) and 29 with gross fecal contamination (Hinchey IV). From the Hinchey III group, 17 patients (39.5%), with a median age of 56.8 years, were selected to undergo peritoneal lavage.Postoperative length of stay was 4.2 days, the rate of minor complications was 35%, that of major complications was 0%, and mortality rate was 0%. Over a median follow-up of 24.6 months none required reoperation. CONCLUSIONS: The number of patients selected for laparoscopic lavage in the management of perforated diverticulitis is increasing as it provides an alternative to Hartmann's procedure in emergency cases. This approach should be considered suitable for patients without important comorbidities, and only in centers experienced in laparoscopic surgery. It reduces the length of hospital stay. Morbidity and mortality are lower than in those in whom resection was considered necessary. Longer follow-up and results of other trials will be necessary to draw an adequate conclusion.

Patterns of cryptic host specificity in duck lice based on molecular data.

Documenting patterns of host specificity in parasites relies on the adequate definition of parasite species. In many cases, parasites have simplified morphology, making species delimitation based on traditional morphological characters difficult. Molecular data can help in assessing whether widespread parasites harbour cryptic species and, alternatively, in guiding further taxonomic revision in cases in which there is morphological variation. The duck louse genus Anaticola (Phthiraptera: Philopteridae), based on current taxonomy, contains both host-specific and widespread species. Mitochondrial and nuclear DNA sequences of samples from this genus were used to document patterns of host specificity. The comparison of these patterns with morphological variations in Anaticola revealed a general correspondence between the groups identified by DNA sequences and morphology, respectively. These results suggest that a more thorough taxonomic review of this genus is needed. In general, the groups identified on the basis of molecular data were associated with particular groups of waterfowl (e.g. dabbling ducks, sea ducks, geese) or specific biogeographic regions (e.g. North America, South America, Australia, Eurasia).

Isolation of arsenite-oxidizing bacteria from a natural biofilm associated to volcanic rocks of Atacama Desert, Chile.

Arsenic is naturally present in rocks, soil, water, and air. It is released to the environment by natural processes such as volcanic eruptions, and rock erosion. In this study, two arsenite-oxidizing strains were isolated from volcanic rocks obtained from the Camarones Valley, Atacama Desert, Chile. Strains were isolated from biofilms and identified by 16s ARNr sequences analysis. aox genes were detected by RT-PCR. The arsenic oxidation ability was assayed with silver nitrate and HPLC-HG-AAS. Four arsenite-resistant strains were isolated (8 mM). RT-PCR analysis showed the presence of aox genes in UC-2 and UC-6 strains. In addition, UC-2 and UC-6 strains were able to oxidize 90 and 95% arsenite present in the medium to arsenate, at a rate of 9.3 and 9.8 microg ml(-1) h(-1 )respectively. Bicarbonate (HCO(3) (-)) was used as unique carbon source. Finally, the significative oxidation capacity shown by both strains opens the way to further studies aimed at implementing biological systems to treat arsenic rich wastewater.

Arsenic resistant bacteria isolated from arsenic contaminated river in the Atacama Desert (Chile).

In this study, arsenic resistant bacteria were isolated from sediments of an arsenic contaminated river. Arsenic tolerance of bacteria isolated was carried out by serial dilution on agar plate. Redox abilities were investigated using KMnO4. arsC and aox genes were detected by PCR and RT-PCR, respectively. Bacterial populations were identified by RapID system. Forty nine bacterial strains were isolated, of these, 55 % corresponded to the reducing bacteria, 4% to oxidizing bacteria, 8% presented both activities and in 33% of the bacteria none activity was detected. arsC gene was detected in 11 strains and aox genes were not detected. The activity of arsenic transforming microorganisms in river sediment has significant implications for the behavior of the metalloid.

Perfluorocarbon-perfused vitrectomy: a new method for vitrectomy--a safety and feasibility study.

PURPOSE: To evaluate the safety and feasibility of perfluorocarbon-perfused vitrectomy (PCPV) as a technique during vitrectomy for proliferative diabetic retinopathy (PDR) and rhegmatogenous retinal detachment (RRD). METHODS: In an experimental, prospective, noncomparative and interventional study, 28 eyes of 28 patients were submitted to vitrectomy with the PCPV technique, 18 eyes with PDR and 10 with RRD. In this technique we replaced the traditional balanced saline solution (BSS) in the infusion line (conventional vitrectomy) by perfluorocarbon liquids (PCL). Some patients with PDR were treated with oxygenated PCL. Clinical evaluation, electroretinography (ERG), and endothelial cell count (ECC) were used to assess the safety of this procedure. An arbitrary grading system (grades 0-5) was used to classify the surgery and maneuvers to assess feasibility. RESULTS: No eyes had a significant decrease in ECC, and the patients in whom we could obtain ERG postoperatively showed no significant differences from preoperative ERG. In the PDR group (using oxygenated and nonoxygenated PCL), 77.8% were graded 5/5; in the RRD group 90% were 5/5. PCPV allowed better visualization of vitreous and intraocular structures, rapid retinal reattachment, less blood in the vitreous cavity, subretinal fluid resolution, blood confinement, retinal stabilization, and easier dissection of epiretinal membranes. In all cases at least one surgical step was eliminated. CONCLUSIONS: PCPV in humans is a safe and feasible technique. Probably in selected cases the use of PCL offers several advantages over BSS, because of their properties (gravitational forces, immiscibility with bodily fluids, and ability to transport oxygen). Prospective and comparative studies are necessary to establish formal indications and possible contraindications.

Nitrogen conservation in a tropical rain forest.

A series of plots in an Amazonian Rain Forest were trenched and treated with calcium to determine the effects of perturbation on numbers and activity of nitrifying bacteria. Although treatment resulted in between 2 and 26% of the nitrogen being lost from the humus layer, virtually all of it was in the NH 4+ form. Numbers of nitrifying bacteria in the plots were relatively low. The low numbers and low activity of nitrifying bacteria is attributed to the low pH and high concentration of tannins in the root mat. It is hypothesized that the suppression of nitrifying bacteria results in nitrogen conservation in the rain forest.

[Ligation of the hypogastric arteries. Analysis of 4000 cases]. / Ligadura de arterias hipogástricas. Análisis de 400 casos.

Experience of 10 years is presented on hypogastric artery ligation as a secondary resource for the hemorrhage control on a selected group of 400 patients; those who have had a previous multiple management to the procedure. The pathology type is shown, risk groups and the problems that conditioned the indication. Surgical technique is analyzed, its complications and secueles; with a follow up of 2 years to 63.5%. Depurated mortality was of 1%. It is concluded that the procedure efficacy depends on it's prompt realization, adequate indication and good technique.

Choque cardiogénico: historia, fisiopatología e implicaciones terapeúticas: parte II / Cardiogenic shock: history, pathophysiology and therapeutical implications. Part II

El choque cardiogénico es la principal causa de muerte entre los pacientes que presentan un síndrome coronario agudo. Después de la revisión histórica y de los conceptos fisiológicos y fisiopatológicos de esta condición clínica expuesta en la primera parte, se revisa su abordaje terapéutico, principalmente la revascularización de emergencia con angioplastía o cirugía.

Transillumination to evaluate spermatogenesis: effect of testosterone enanthate in adult male rats.

The present study has been designed to determine which stages of seminiferous cycle were modified by in vivo intramuscular administration of one or two doses of 25 mg of testosterone enanthate. Testicular weight was significantly reduced after treatment with two doses of testosterone enanthate (p < .05). Assessment of total lengths of stages per 100 mm of seminiferous tubules scored by transillumination showed that testosterone enanthate increased significantly the length of stages VI-VII, but it reduced total lengths of stages I, XII, and XIII-XIV. A dose-dependent reduction in the absolute and relative frequency of stage I was observed with testosterone enanthate treatment, whereas stages VI-VII were significantly increased. Analysis of relative frequencies of stages showed that stages XIII-XIV and stages I-V were significantly below the control value (1), whereas stages VI-VIII were over 1. In summary, results of the present study showed that transillumination is an adequate technique to assess the effect of drugs on spermatogenesis, and that testosterone enanthate modifies the pattern of the stages of the seminiferous epithelium cycle, before testicular weight is affected.

[Study of the seroprevalence of toxocariasis in an infantile population in the City of Havana]. / Estudio de seroprevalencia de toxocariasis en una población infantil de Ciudad de La Habana.

A serological study to detect antibodies to Toxocara canis in a group of 156 healthy children from City of Havana is reported for the first time in Cuba. An ELISA method was employed using excretion/secretion antigens obtained in our laboratory. Data on epidemiological factors surveyed in this group are presented. Positivity percentage was of 5.2%. Results are discussed.

[ Exsanguination, extreme hemodilution and autologous retransfusion in cardiopulmonary bypass]. / exsanguinación, hemodilución extrema y retransfusión autológa en derivación cardiopulmonar

In ten dogs and seven patients undergoing open heart surgery, 94% of circulatory volume was replaced by electrolitic solutions; extracted blood was stored temporarily at 5degreesC. Usage of blood was avoided for replacement of extracorporeal fluid circuit and blood lost during surgery. After cardiopulmonar bypass, storage blood was transfused. In both experimental and clinical conditions neither renal, electrolitic nor blood alterations were observed.

Choque cardiogénico: historia, fisiopatología e implicaciones terapeúticas. Parte I / Cardiogenic shock: history, pathophysiology and therapeutic implications. Part I

El choque cardiogénico es la principal causa de muerte entre los pacientes que presentan un sindrome coronario agudo. Se presenta una revisión histórica y conceptos fisiológicos y fisiopatológicos de esta condición clínica que son la base para su abordaje terapéutico, principalmente la revasculrización de emergencia con angioplastia o cirugía.

Frequency of the thermolabile variant C677T in the MTHFR gene and lack of association with neural tube defects in the State of Yucatan, Mexico.

The C677T variant in the MTHFR gene is considered to be an associated risk factor for neural tube defects. However, the association has not been found in some ethnic groups. In order to assess the association between neural tube defects and the C677T variant, we determined the frequency of this variant in the MTHFR gene in the State of Yucatan, Mexico, where neural tube defects are highly prevalent. The study was performed on 65 subjects with spine bifida, 60 of their mothers and 110 control subjects. The presence of the C677T variant was determined by amplification and digestion with HinF1 of each subject's DNA. Genotypic and allelic frequencies were calculated for all groups. We did not observe any statistically significant difference in the genotypic or allelic frequencies between cases and controls for any of the groups studied (p > 0.05), suggesting that the thermolabile variant C677T is not an associated risk factor neither for the development of neural tube defects nor for mothers to have affected offspring in the population from Yucatan. Interestingly, the frequency of the C677T variant (54%) obtained in the Yucatan population is one of the highest reported (p < 0.01) and confirmed the high frequency of this allele throughout Mexico.

Enteroparasitosis y estado nutricional en niños menores de 4 años de wawa-wasi de Pamplona Alta San Juan de Miraflores Lima - Perú - 2006 / Enteroparasities and nutritional status in children younger than 4 years old from daycare centers of pamplona Alta San Juan de Miraflores, Lima, Peru, 2006

Se realizó un estudio prospectivo transversal de 112 niños entre 1 a 4 años de tres wawa wasi del área de Pamplona Alta en el distrito de San Juan de Miraflores con la finalidad de estudiar la prevalencia de enteroparasitosis y su relación con el estado nutricional. Para determinar la prevalencia de parasitosis intestinal se utilizó la Técnica de Burrows (PAF), para el diagnóstico de Enterobius vermicularis se utilizaron el método de la cinta engomada o Test de Grahan. Para determinar el estado nutricional se clasificó a los participantes en 4 categorías según el indice de Waterlow: eutrófico, desnutrido agudo, desnutrido crónico compensado y desnutrido crónico reagudizado, se emplearon los indicadores Antropométricos: peso/edad, talla/edad, peso/talla, para lo cual se utilizaron tablas antropométricas de la National Center for Health Stadistics del 2004. En cuanto a la prevalencia de parasitosis fueron positivas en el 82 por ciento de la población 18 por ciento de las muestras resultaron negativas. Se encontró que Enterobirus vermicularis fue el parásito más frecuente con 66 por ciento de los casos, seguido por Giardia Lamblia 17 por ciento. Se encontró que el 55 por ciento de la población fueron eutróficos, 7 por ciento desnutridos agudos y 38 por ciento desnutridos crónicos compensados. De los niños eutróficos el 73 por ciento estaban parasitados, mientras que el 91 por ciento de los 100 por ciento de los desnutridos agudos tenían parásitos. Con estos resultados nutricional y la frecuencia de enteroparasitosis en la población estudiada.

Prospective study of 112 children cross between 1 and 4 years of three wawa wasi Pamplona Alta area in the district of San Juan de Miraflores with the aim of studying the prevalence of enteroparasitosis and its relationship with the state nutritional. To determine the prevalence of intestinal parasitosis used the technique Burrows (PAF) for the diagnosis of Enterobius vermicularis is the method used tape or rubberized test Graham. To determine the nutritional status was classified the participants into 4 categories according to the index Waterlow: eutrófico, acute undernourished, underfed and malnourished chronic harmonious chronic reagudización, were used anthropometric indicators: weight/age, height/age, weight / height for which were used anthropometric tables of the National Center for Health Stadistics 2004. As for the prevalence of parasites were positive for 82 per cent of the population 18 per cent of samples were negative. It was that Enterobirus vermicularis was the most frequent parasitie with 66 per cent of cases, followed by Giardia lamblia 17 per cent. It was found that 55 per cent of the population were eutrophic, 7 per cent acute malnutrition amd 38 per cent chronically malnourished compensated. Of the children eutróficos 73 per cent were infected, while 91 per cent of chronically malnourished offset were infested, and 100 per cent of acute had parasities. We conclude that there is a strong link between nutritional status and frequency of enteroparasitosis in the population studied.

Misoprostol intracervical vs. vaginal: características clínicas en la inducción del parto / Misoprostol intracervical or vaginal. Clinics characteristics in delivery induction

Misoprostol (Cytotec, Searle de México, S. A.), una prostaglandina sintética (PG) análoga de la E, fue administrada a 100 mujeres embarazadas durante el tercer trimestre (edad gestacional media de 39,4 semanas), en dosis de 100 mcg para la inducción del parto. La vía de administración fue vaginal (n=68) o intracervical (n=32), con una distribución aleatoria. Después de unas pocas horas, tras una aplicación única del medicamento, 95 pacientes iniciaron una labor activa de parto, otras 4 pacientes la iniciaron posterior a una segunda aplicación, 24 horas después. No se encontró alguna diferencia estadísticamente significativa con respecto al resultado del embarazo o la madurez cervical, clasificada según el puntaje de Bishop, al comparar las dos vías de administración. La edad y paridez tampoco mostraron diferencias estadísticamente significativas como factores que modularan la respuesta al medicamento. Ochenta y tres pacientes tuvieron un parto vaginal dentro de las primeras 18 horas posterior a una única aplicación del medicamento. De las 4 pacientes que recibieron una segunda dosis vaginal (n=2) o intracervical (n=2), tres tuvieron partos vaginales. La tasa global de cesáreas fue del 12 por ciento . En 4 pacientes se observaron efectos colaterales sistématicos maternos mínimos, relacionados con el medicamento. Hubo taquisistolia en 11 casos, en uno de los cuales se detectó sufrimiento agudo que se resolvió con tratamiento tocolítico. La administración local de misoprostol logró la maduración cervical y la labor de parto activa

Colitis amibiana fulminante y ameboma en un mismo paciente / Fulminant amebiac colitis and ameboma in a some patient

La colitis amibiana fulminante es una complicación infrecuente de la amibiasis la cual está asociada a una alta tasa de mortalidad. La existencia deuna masa tumora (ameboma) en recto o colon es de hecho muy rara pero cuando se presenta puede causar dificultades diagnósticas. Reportamos el caso en una paciente embarazada de 27 años de edad, quien fue intervenida de emergencia presentando esta rara aosciación

Complicaciones con el uso del tubo en T / Complications with rise of the T tube

Fueron revisados las Historias Clínicas de 744 pacientes sometidos a cirugía biliar entre los años 1975 y 1985 por el Servicio de Cirugía del Hospital Militar "Dr. Carlos Arvelo", con el objeto de analizar las complicaciones surgidas con la utilización del tubo en T. 82 pacientes reunieron criterios para la colocación del tubo en T; de estos se colocaron en 79 pacientes y solo 11 presentaron complicaciones (13.9%): siendo la más frecuente la fistula biliar (6,3%). La utilización del tubo en T disminuido con el transcurso de los años lo que se explica por el avance existente en procedimientos endoscópicos y sonograficos que le proporcionan al cirujano un diagnóstico preoperatorio más preciso. Consideramos que la utilización del tubo en T tiene plena vigencia siempre y cuando se cumpla con los criterios para su colocación y que la misma sea hecha correctamente