Detection of Salmonella enterica in Magellanic penguins (Spheniscus magellanicus) of Chilean Patagonia: evidences of inter-species transmission.

Patagonia in southern South America is among the few world regions where direct human impact is still limited but progressively increasing, mainly represented by tourism, farming, fishing and mining activities. The sanitary condition of Patagonian wildlife is unknown, in spite of being critical for the assessment of anthropogenic effects there. The aim of this study was the characterization of Salmonella enterica strains isolated from wild colonies of Magellanic penguins (Spheniscus magellanicus) located in Magdalena Island and Otway Sound, in Chilean Patagonia. Eight isolates of Salmonella were found, belonging to Agona and Enteritidis serotypes, with an infection rate of 0·38%. Resistance to ampicillin, cefotaxime, ceftiofur and tetracycline antimicrobials were detected, and some of these strains showed genotypic similarity with Salmonella strains isolated from humans and gulls, suggesting inter-species transmission cycles and strengthening the role of penguins as sanitary sentinels in the Patagonian ecosystem.

Multidrug-Resistant Outbreak-Associated Salmonella Strains in Irrigation Water from the Metropolitan Region, Chile.

Salmonella enterica (S. enterica) is the main cause of foodborne diseases in the Chilean population. With the aim of characterizing the presence of S. enterica in bodies of water, samples from 40 sources were obtained, including rivers and irrigation canals used by agricultural farms in the most populated regions of Chile. As result, 35 S. enterica isolates belonging to several serotypes were detected, with the highest frequency represented by Typhimurium and Enteritidis. All strains showed phenotypic antimicrobial resistance, and most of them were multiresistant to critically important antimicrobials. In addition, the pulse-field gel electrophoresis analysis using XbaI and BlnI endonucleases showed that seven Salmonella isolates belonging to serotypes Typhimurium, Enteritidis and Infantis had identical pulsotypes to outbreak-associated clinical isolates detected in the Chilean population, suggesting a public health risk of water pollution in this region. Among sampling sites, the higher detection rates were observed in rural than urban and peri-urban areas, suggesting that the animal husbandry might contribute for environmental dispersion of this pathogen. Future efforts should address the characterization of cause-and-effect relationship between water contamination and foodborne disease, including the implementation of surveillance programmes to tackle potential risks for both human and animal populations.

Papillomatous digital dermatitis in Chilean dairies and evaluation of a screening method.

Outbreaks of papillomatous digital dermatitis (PDD) have been reported from many countries, but there is little information on prevalence and geographic distribution of the disease. Our objectives were to describe prevalence of PDD on dairies belonging to the two main dairy-producer associations in Chile, and to evaluate a milking-parlor screening method for detection of PDD in dairy cows. First, a self-administered questionnaire was sent to all 214 association dairy managers. Seventy percent of the 119 respondents had observed PDD on their dairies. About 83% of the 63 responding managers had first seen PDD during the previous 10 years. Subsequently, a random sample of 43 dairies stratified by association was selected from the total 214 for PDD screening. During milking, we inspected cows' feet for PDD lesions; 91% of dairies had cows affected by PDD; median PDD prevalence for milking cows in dairies was 6.1%. Finally, in one dairy, PDD screening at the parlor was compared to PDD diagnosis by inspecting restrained cows in a chute. The screening method had a sensitivity of 0.72, and a specificity of 0.99. This study demonstrated that PDD was widespread on study dairies in Chile. The screening test presented can be used as a cost efficient method to estimate prevalence of PDD either on individual dairies or in large-scale surveys.

Farm- and host-level risk factors for papillomatous digital dermatitis in Chilean dairy cattle.

A cross-sectional study was conducted in southern Chile between January and March, 1996, to identify risk factors for papillomatous digital dermatitis (PDD) in lactating dairy and dual-purpose cows. A total of 3,265 cows from 22 farms were examined in the milking parlor for PDD lesions. Additional information was collected from dairies' computerized records and by direct interview of managers. Data were analyzed using logistic and logistic-binomial regression (with dairy as a random-effect term). German Red-Pied (dual-purpose) cows were significantly (P < 0.05) less likely (odds ratio (OR) = 0.3) to have PDD lesions than German Black-Pied and Holstein crossbreds. First-parity cows had the highest odds of PDD, and odds diminished, in a dose-effect manner, as parity increased. Odds of PDD increased with increasing days in lactation. Cows that calved during winter were more likely to have PDD (OR = 1.4) than those calving at any other season. Cows on farms that bought heifers in the past 10 years had a 3-fold increase in the odds of PDD compared to those on farms that never bought heifers. Loose-housed cows had a higher risk of PDD (OR = 7), followed by cows in free stalls or in open corrals (OR = 2.8 and 1.3, respectively), compared to cows on pasture all year. Cows on dairies that used a footbath during 1996 were less likely (OR = 0.3) to have PDD than those in dairies not using one. Parlor type was associated with PDD, but this was likely an effect of parlor design on ease of inspection of cows' feet. A policy of trimming all cows' vs. only lame cows' feet and a policy about buying adult cows did not have significant effects on PDD risk.

[Tuberculosis: a re-emerging zoonosis?]. / Tuberculosis: una zoonosis re-emergente?

Tuberculosis is an infectious disease that is found throughout the world and which can have a dramatic impact on the economy and on human and animal health. In humans, the principal cause of infection is Mycobacterium tuberculosis, but the animal-specific pathogen, M. bovis, is arguablythe most important zoonotic agent in human history. Despite the fact that several countries have implemented control programmes for M. bovis infection in animals, which has resulted in a reduction in the number of human cases as well, recent years have witnessed a re-emergence of tuberculosis. This is due to the appearance of strains that are resistant to the main antibiotics used to treat the infection in humans, the spread of the human immunodeficiency virus, the maintenance of wild reservoirs and the persistence of the infection in livestock, particularly in developing regions. Coordinated efforts by human and animal health services, the improvement of diagnostic techniques and the development of more effective vaccines to prevent the infection are the main strategies for controlling this disease.

Occurrence of suicide and seasonal variation.

OBJECTIVE: To review the estimated suicide rates for the Region Metropolitan, the main socio-political center in Chile, for the period 1979-1994, and to determine whether they follow a seasonal pattern. METHOD: Data available for the period 1979-94 at the Forensic Services in Chile was analyzed using Analyses of variance. RESULTS: It was register 5,386 suicides. While the "warm" months (October, November, December & January) concentrated 39.0% of cases, the so called "cold" months reported 28.7%. This contrast is made even clearer by the month-to-month analysis, showing the highest suicide rate in December (10.6%) against the lowest rate in June (7.0%). Further statistical analysis revealed these differences to be significant. CONCLUSION: The study shows that in Chile, representing as it does the Southern Hemisphere, the suicide rates tend to present a seasonal variation as has elsewhere been determined for in the North Hemisphere.

[Pulmonary lymphangioleiomyomatosis: report of one case]. / Linfangioleiomiomatosis pulmonar: Caso clínico.

Lymphangioleiomyomatosis (LAM) is a rare interstitial lung disease, of unknown etiology, affecting almost exclusively women. Microscopically LAM consists of a diffuse proliferation of smooth muscle cells. LAM can occur without evidence of other diseases (sporadic LAM) or in conjunction with tuberous sclerosis complex (TSC). It presents with progressive breathlessness or with recurrent pneumothorax or chylothorax. We report a 33 year-old woman with a history of recurrent pneumothorax. Computed tomography (CT) scans showed numerous thin-walled cysts throughout the lungs, a characteristic finding in LAM. A pulmonary biopsy was compatible with the diagnosis and HMB-45 monoclonal antibodies were positive. Treatment with Sirolimus was started).

Inervación y localización biométrica de los puntos motores del músculo tríceps sural / Innervation and localization of the motor points of triceps surae muscle

La inervación de los músculos es descrita de forma general, faltando datos biométricos sobre el lugar donde penetran los nervios en el vientre muscular. Con el propósito de conocer la inervación y los puntos motores de los componentes del músculo tríceps sural en la población chilena, estudiamos 18 miembros inferiores de individuos, adultos, fijados en formaldehido al 10 por ciento. Se realizó disección por planos, identificando los nervios dirigidos a las cabezas lateral y medial del músculo gastrocnemio y al músculo sóleo, esquematizando y fotografiando los hallazgos. Se identificó el origen de los ramos, respecto a una línea trazada entre las partes más prominentes de los epicóndilos femorales (LBEC), así como también, los puntos de ingreso en el vientre muscular, clasificando estos ramos como principales (R) y secundarios (RS). En todas las muestras la inervación provino del nervio tibial. La cabeza medial del músculo gastrocnemio recibió un ramo (R1) en 15 casos y dos (R1 y R2) en 3 casos. El origen de R1 se localizó en promedio a 23,6 +/- 11,5 mm distal a la LBEC; en 15 casos el R1 se dividió hasta en 4RS. Los puntos donde ingresaron estos últimos respecto a LBEC fueron en promedio 40,4 +/- 11,1 mm el RS1 y 46,9 +/- 9,1 mm el RS2. La cabeza lateral recibió un ramo en 17 casos y dos en 1 caso; el origen de R1 se localizó en promedio a 35,6 +/- 11,8 mm distal a la LBEC; en 12 casos el R1 se dividió hasta en 4RS. Los puntos donde ingresaron estos últimos respecto a LBEC fueron 49,4 +/- 9,3 mm el RS1 y 52,4 +/- 10,6 mm el RS2. El músculo sóleo recibió su ramo de un tronco común con la cabeza lateral del gastrocnemio en 7 casos y un ramo directo R1 en 6 casos y dos ramos (R1 y R2) en 5 casos, de los cuales, en 3 de ellos, recibió un ramo anterior y uno posterior; el origen de R1 se localizó a 40,4 +/- 14,4 mm de LBEC; el origen del tronco común se ubicó a 20,2 mm de esta línea. El R1 se dividió hasta en 7 RS. Estos resultados son un aporte a la anatomía...

The knowledge of innervation of muscles is generally described, but we can complement the point where the nerves penetrate the muscle belly, from the biometric standpoint. In order to know the innervation and motor points in the components of the triceps surae muscle, 18 formolized lower limbs of adult Chilean individuals were studied. Planes dissection was performed by identifying the point nerve of the lateral and medial head of gastrocnemius muscle and soleus muscle. All specimens were schematized and photographed. We identified the source of the branches, about a line drawn between the most prominent parts of the femoral epicondyles (BECL), as well as the points of entry into the muscle belly, classifying these branches as principal (BR) and secondary ( SBR). In all samples the innervations came from the tibial nerve. The medial head of the gastrocnemius muscle received one branch (BR1) in 15 cases and two (BR1 and BR2) in 3 cases. The BR1 origin is located on average 23.6 +/- 11.5 mm distal to the BECL, in 15 cases the BR1 split up into four SBR. The points where these latter entered in muscular belly regarding BECL were on average: 40.4 + 11.1 mm (SBR1) distal to this line and 46.9 +/- 9.1 mm (SBR2). The lateral head received one branch in 17 cases and two in 1 case; the origin of BR1 was found on average to 35.6 +/- 11,8 mm distal to the BECL; in 12 cases the BR1 was divided up in four SBR. Regarding to BECL the SBR entered in muscle belly distal to this line, 49.4 +/- 9.3 mm (SBR1) and 52.4 +/- 10.6 mm (SBR2). The soleus muscle received his branch from a common trunk with the lateral head of the gastrocnemius in 7 cases and one direct branch BR1 in 6 cases and two branches (BR1 and BR2) in 5 cases, of which 3 of them received one anterior branch and posterior branch; the origin of BR1 was located 40.4 ± 14.4 mm distal to the BECL; the common trunk origin was located at 20.2 mm distal from this line...

Variaciones del Nervio Isquiático en Relación al Músculo Piriforme / Variations of the Sciatic Nerve in Relation to the Piriformis Muscle

El nervio isquiático nace del plexo sacro y sale de la pelvis a través del foramen isquiático mayor por debajo del musculo piriforme como un tronco común. En ocasiones, este nervio puede emerger dividido en sus dos componentes: el nervio fibular común y nervio tibial, encontrándose, variaciones que podrían dar origen a una condición de compresión nerviosa. En este trabajo se exponen dos variaciones del nervio isquiático en un mismo individuo, donde en la primera el nervio fibular común atraviesa el músculo piriforme y luego desciende junto al nervio tibial y la segunda, donde el nervio fibular común se forma a partir de un ramo superior que perfora el músculo piriforme y el otro inferior que pasa debajo de él, para unirse luego en el margen inferior de éste músculo y formar el nervio fibular común, que desciende junto al nervio tibial. Las variaciones del nervio isquiático en relación al músculo piriforme podrían explicar el síndrome del músculo piriforme.

The sciatic nerve arises from the sacral plexus and exits the pelvis through the greater sciatic foramen below the piriformis muscle as a common trunk. Sometimes this nerve can emerge divided into two components: the common fibular nerve and tibial nerve, finding variations that could give rise to a condition of nerve compression. In this paper we describe two variations of the sciatic nerve in the same individual, where in the first common fibular nerve passes through the piriformis and then descends along the tibial nerve and the second, where the common fibular nerve is formed from a higher branch that pierce to piriform muscle and a lower branch passing under him, then join at the inferior margin of this muscle and form the common fibular nerve, which descends with the tibial nerve. Variations of the sciatic nerve in relation to the piriformis muscle could explain the piriformis syndrome.

División Alta del Nervio Fibular Superficial: Origen Precoz de los Nervios Cutáneos Dorsales del Pie / High Division of Superficial Fibular Nerve: Early Origin of the Dorsal Cutaneous Nerves of the Foot

Los nervios cutáneos dorsales del pie se originan a partir del nervio fibular superficial (NFS), después que éste pasa desde el compartimiento lateral de la pierna a través de la fascia profunda, para luego distribuirse superficialmente en el dorso del pie. A veces, el nervio fibular superficial se divide precozmente, por lo que estos nervios se originan profundamente y con una disposición diferente. Con el propósito de dar a conocer en estos casos, los niveles de origen de los nervios cutáneos dorsales del pie y el punto de penetración en la fascia profunda de la pierna, se estudiaron 16 muestras de individuos, chilenos, adultos, fijadas en formaldehido al 10 por ciento. En 2 de ellas, su origen se observó a un nivel alto, cerca de la parte proximal de la fíbula. En el primer caso, el nervio cutáneo dorsal intermedio se originó directamente de la división posterior del NFS; la división anterior del NFS se subdividió en dos ramos, los que después de un corto trayecto se unieron y formaron el nervio cutáneo dorsal medial. En el segundo caso, los nervios cutáneos dorsales intermedio y medial se originaron directamente del NFS, que después de un corto trayecto se dividió en estos dos nervios. El origen de los nervios cutáneos dorsales del pie se registró en relación al epicóndilo lateral del fémur y el paso de éstos a través de la fascia profunda de la pierna hacia su distribución cutánea fue relacionado al maléolo lateral. Aunque el origen de los nervios cutáneos dorsales del pie ocurra a un nivel próximo a la cabeza de la fíbula, perforan la fascia mencionada, en su tercio distal. Un conocimiento detallado del NFS y de sus ramos y variaciones anatómicas puede reducir lesiones iatrogénicas en éstos durante los procedimientos quirúrgicos realizados en el compartimiento lateral de la pierna.

The dorsal cutaneous nerves of the foot originate from the superficial fibular nerve (SFN), then pass from the lateral compartment of the leg piercing the deep fascia, thus distributed superficially in the dorsum of the foot. Sometimes SFN splits early, so these nerves originate deeply and with a different arrangement. The objective of this research was to study in these cases, the origin of the dorsal cutaneous nerves of the foot and pierce point level in the deep fascia of the leg. We studied 16 formolized samples of Chilean adult individuals. In two of them its origin was observed at a high level, near the proximal epiphysis of the fibula. In the first case the intermediate dorsal cutaneous nerve arose directly from the posterior division of SFN, of short course; the anterior division of SFN was subdivided into two branches, which after a short course, both branches joined to form the medial dorsal cutaneous nerve. In the second case the medial and intermediate dorsal cutaneous nerves originated directly from the SFN, which after a short course, it divided in these two nerves. The origin level was recorded in relation to the lateral epicondyle of the femur and the passage of these nerves through the deep fascia of the leg for its skin distribution was located in relation to the lateral malleolus. Although the origin of the dorsal cutaneous nerves of the foot occur very close to the proximal epiphysis of the fibula, passing through the mentioned fascia in its distal third. A detailed knowledge of the branches of the SFN and variations can reduce injuries in these nerves during surgical procedures in the lateral compartment of the leg.

Formación del nervio sural en individuos chilenos / Sural nerve formation in Chilean individuals

La inervación cutánea de la región posterior de la pierna esta dada por el nervio cutáneo sural medial (NCSM), el nervio cutáneo sural lateral (NCSL), el nervio sural (NS) y el nervio safeno. Estos ramos son variables pudiendo los dos primeros, ser independientes o estar unidos y formar el nervio sural. Con el propósito de determinar la formación del nervio sural y los niveles de origen de los nervios NCSM y NCSDL, disecamos 12 piernas formolizadas, 7 izquierdas y 5 derechas, de individuos chilenos, adultos. El punto de origen y unión de los nervios NCSM y NCSL se localizó en relación a una línea transversal trazada entre los puntos más prominentes de los cóndilos femorales (LBE), así como una línea trazada entre los dos maléolos (LBM). La distancia entre ambas líneas fue en promedio 31,8 cm.; el punto de origen del NCSL se situó en promedio a 3,75 cm proximal a la LBE y el del NCSM a 2,23 cm proximal a la misma línea. En 7 muestras (58,3 por ciento) observamos unión de los dos ramos formando el NS ( en dos de ellas a través de un ramo comunicante fibular) y en las restantes se mantuvieron independientes. El punto de unión de los nervios referidos fue localizado proximal a la LBM. Los resultados obtenidos complementarán el conocimiento anatómico de la inervación sensitiva de la pierna.

The skin of the posterior region of the leg is supplied by the medial sural cutaneous (MSCN), lateral sural cutaneous (LSCN), sural (SN) and the safenous nerves. These nerves present variations where the first and second nerves can be independents or both join to form the sural nerve. The objective of this research was to determine the sural nerve formation and the origin level of the MSCN and LSCN. We dissected 12 legs fixed in formaldehyde 10 percent (7 of the left side and 5 of the right side), from of adult Chilean individuals. The origin and join points of the MSCN and LSCN nerves were localized in relation to horizontal line between the prominent points of the femoral condyles (BCL), so as a horizontal line between the two malleolus (BML), respectively. The distance between both lines was average 31.8 cm; the origin point of the LSCN was 3.75 cm proximal to BCL and the origin point of the MSCN was 2.23 cm proximal to this line. In 7 cases we observed both nerves forming the sural nerve (in two of them, by a fibular communicant branch) and in rest cases were independents. The joint point of the referred nerves was localized proximal to BML. These results are a contribution to the anatomic knowledge of the sensitive innervation of the leg.

Inervación de los músculos fibulares largo y corto en individuos chilenos: estudio anatómico y biométrico / Innervation of the fibularis longus and brevis muscles in chilean individuals: anatomic and biometric study

La inervación de los músculos del compartimiento lateral de la pierna es conocida desde un punto de vista general y su dependencia del nervio fibular superficial (NFS) es descrita en la mayoría de los textos clásicos. Sin embargo, detalles del número de ramos nerviosos que reciben los músculos y a que nivel se encuentran sus puntos motores es poco conocido, sobretodo en nuestra población. Basado en lo anterior y con el propósito de aportar datos respecto a las variables mencionadas y determinar niveles de origen y localización de los puntos motores de los músculos fibulares largo y corto, se realizó un estudio anatómico y biométrico en 16 piernas formolizadas de individuos adultos, chilenos. Se realizó disección por planos, identificando en la parte proximal de la pierna el nervio fibular común (NFC) y su punto de división en nn. fibular superficial (NFS) y fibular profundo (NFP), localizando los ramos primarios (R1,R2,R3 o más) dirigidos a los músculos en estudio. Para determinar su punto de origen y punto de penetración en éstos, se identificó la parte más prominente del epicóndilo lateral del fémur, desde el cual se registró la distancia entre este punto de referencia y las variables mencionadas. Cuando hubo subdivisiones en ramos secundarios (RS), se registró también su punto de origen y punto de penetración en el vientre muscular. En el m. fibular largo se observó en los 16 casos R1 y R2; 13 casos con R1, R2 y R3; 5 casos con R1, R2, R3 y R4 y 1 presentó 5R. El R1 provino del NFC en 6 casos (37,5 por ciento), del NFS en 9 (56,3 por ciento) y del nervio cutáneo dorsal medial (división precoz de NFS) en 1 (6,3 por ciento); el R2 se originó en el NFC en 2 casos (12,5 por ciento), del NFS en 13 (81,3 por ciento) y del nervio cutáneo dorsal medial en 1(6,3 por ciento); el R3 fue emitido por el NFS en 11 casos y por el nervio cutáneo dorsal intermedio (división precoz NFS) en 2 casos. Los ramos primarios se subdividieron hasta en 5 RS. El m. fibular corto...

The innervation of the muscles of the lateral compartment of the leg is known from a general point of view and its dependence of the superficial fibular nerve (SFN) is described in the majority of the classic texts. Nevertheless, there is little information regarding detail of the number of nervous branches that muscles receive, or the location of its motor points, principally in our population. The objective of this study was to contribute to anatomic knowledge of the mentioned variables and determine the origin levels of muscular branches and the motor points location in the fibularis longus and fibularis brevis muscles. We carried out an anatomical and biometric study in 16 cadaveric legs fixed in formaldehyde of adult, Chilean individuals. Dissections were made, identifying in the proximal part of the leg the common fibular nerve (CFN) and its division point in superficial (SFN) and deep (DFN) fibularis nerves, locating the primary branches (R1, R2, R3 or more) directed for the muscles in the study.To determine the origin level of muscular branches and motor point, we identified the most prominent part of the lateral epicondyle of femur, from which the distance was recorded between this point of reference and the mentioned variables. When there were subdivisions in secondary branches (SB), also we recorded its point of origin and motor point in the muscular belly. In the fibularis longus muscle we observed R1 and R2 in 16 cases; R1, R2 and R3 in 13 cases; R1, R2, R3 and R4 in 5 cases and 5R in one case. The R1 originated from the CFN in 6 cases (37.5 percent), from the SFN in 9 (56.3 percent) and from the medial dorsal cutaneous nerve (SFN precocious division) in 1 (6.3 percent); The R2 originated in the CFN in 2 cases (12.5 percent), of the SFN in 13 (81.3 percent) and of the medial dorsal cutaneous nerve in 1 (6.3 percent); the R3 was emitted by the SFN in 11 cases and by the intermediate dorsal cutaneous nerve (SFN precocious division) in 2...

[The need for psychiatrists in Chile. A projection for the year 2,000]. / Las necesidades de psiquiatras en Chile. Proyección para el año 2000.

In less than 15 year's time, the number of psychiatrists available should have increased twofold. It is thus calculated that about 500 psychiatrists would be working by 1990. An uneven regional distribution, however still survives with 80% of professionals congregated in the Chilean capital city area--less than 25% professionals working with the Health Services National System (SNSS) which is supposed to cover 75% of nationwide care. Besides, no psychiatric care is available as far as peripheral offices are concerned. By resorting to several parameters (vg. psychiatric needs according to prevalent pathologies, care demands, and ratio), as well as national data, and various author's opinion, it is estimated that about 650 psychiatrists will be needed in the year 2000. Hence, about 220 new psychiatrists should be trained during the 10 years ahead, if population's vegetative growth as well as replacements due to retirement, death, etc. are taken into account.

[Neuroleptic malignant syndrome]. / Síndrome maligno por neurolépticos.

This is a review article on neuroleptic malignant syndrome. Clinical manifestations and differential diagnosis are discussed. Treatment is based on suppression of the drug and administration of bromocriptine and dantrolene. After recovery, neuroleptics should be withheld or a drug with low dopaminergic blocking effect would be selected.

[Antidepressant psychopharmacotherapy]. / Psicofarmacoterapia antidepresiva.

Considering the prevalence of major unipolar depression, the economical costs of its management and the different medications available for its treatment, it is imperative to have a good knowledge of the basic principles used to classify anti depressive medications. A good acquaintance on their mechanisms of action on neurotransmission and receptors, wil allow a better understanding of their therapeutic action and secondary effects. Tricyclics, non selective MAO inhibitors, reversible MAO inhibitors, selective serotonin reuptake inhibitors, dopamine and noradrenalin reuptake inhibitors, 5-HT2 blockers with serotonin reuptake blocking effect, serotonin, noradrenalin and dopamine reuptake inhibitors, alfa 2 receptor blockers and 5-HT/2-3 inhibitors are the eight available types of antidepressants.

[Treatment of bipolar disorder during pregnancy and puerperium period. A case report]. / Tratamiento de la enfermedad bipolar durante el embarazo y puerperio. Caso clínico.

We report a 37 years old woman with a severe bipolar disorder, that became pregnant during treatment with lithium. The patient and her family were informed about the 0.05-0.1% risk of cardiac malformations of the newborn, but decided to maintain her pregnancy and not to discontinue the use of lithium, fearing a relapse of her psychiatric ailment. She continued under medical surveillance and had a normal delivery, but no breast feeding was allowed.

Linfangioleiomiomatosis pulmonar: Caso clínico / Pulmonary lymphangioleiomyomatosis: Report of one case

Lymphangioleiomyomatosis (LAM) is a rare interstitial lung disease, of unknown etiology, affecting almost exclusively women. Microscopically LAM consists of a diffuse proliferation of smooth muscle cells. LAM can occur without evidence of other diseases (sporadic LAM) or in conjunction with tuberous sclerosis complex (TSC). It presents with progressive breathlessness or with recurrent pneumothorax or chylothorax. We report a 33 year-old woman with a history of recurrent pneumothorax. Computed tomography (CT) scans showed numerous thin-walled cysts throughout the lungs, a characteristic finding in LAM. A pulmonary biopsy was compatible with the diagnosis and HMB-45 monoclonal antibodies were positive. Treatment with Sirolimus was started.

Abordaje laparoscópico en el testículo no palpable / Laparoscopic approach in the management of non-palpable testes

Objective: To evaluate our experience in laparoscopic management as the procedure of choice for nonpalpable testes (NPT). Methods: Review of charts of all boys with NPT who underwent laparoscopy (January 2000 December 2005). Demographic data, ultrasound (US) results, surgical details were documented. Results: Sixty-three patients (74 NPT) were identified; 25 left, 26 right and 12 bilateral. Mean age at diagnosis was 3.6y (lm-13y). Thirty-seven cases had a pre-op US; in 29 (78 percent) the testis was not found; 7(22 percent) an intra-canalicular teste was described. All were impalpable at evaluation under anesthesia (EUA). Mean age at surgery was 4.9y (2 m-17 y). Laparoscopic findings were; intra-abdominal teste (n = 24, 33 percent), vanishing teste (n = 12, 16 percent) and vas-vessels entering inguinal ring (n = 38, 51 percent). 16/24 underwent a 2-stage Fowler-Stephens orchyopexy and 8/24 a laparoscopic-assisted single stage orchypexy. When vas-vessels entered inguinal ring, inguinal exploration was performed; 23 cases underwent orchyopexy; 13 had orchydectomy (atrophic-vanishing). After follow-up, 3 testes are atrophic. Conclusions: 36/74 NPT were not in the inguinal canal (24 intraabdominal and 12 vanishing). When vas-vessels entered inguinal ring, 13 were vanishing-atrophic and not identifiable (EUA or US). Hence, in 49 cases (66 percent) laparoscopic exploration was critical in teste location, therefore this approach may be the procedure of choice for NPT.

Objetivo: Revisar nuestra experiencia en el abordaje laparoscópico como primer procedimiento en el estudio de teste no palpable (TNP). Método: Todas las fichas de niños con diagnóstico de TNP sometidos a laparoscopia entre Enero 2000 y Diciembre 2005 fueron revisadas. Se documentó detalles demográficos, ecográficos, laparoscópicos y de la cirugía realizada. Resultados: 63 pacientes con 74 TNP fueron identificados; todos fueron no palpados al examen bajo anestesia (EBA). Bajo visión laparoscópica, en 38/ 74 (51 por ciento) el conducto deferente y los vasos se introducían en el orificio inguinal profundo, realizándose una exploración inguinal abierta; 13/38 eran atrofíeos/evanescentes, en 23 se realizó orquidopexia, en 1 se realizó un primer tiempo de Fowler-Stephens y 1 no fue descrito. De los 36 (49 por ciento) testes intra-abdominales, 12 eran evanescentes, en 8 se realizó una orquidopexia asistida por laparoscopia y los otros 16/36 se sometieron a un primer tiempo de F-S. En el post-operatorio hubo 3 testes atrofíeos; 2 luego de un segundo tiempo de F-S y 1 luego de una orquidopexia en primer tiempo fallida. Conclusiones: De los 74 TNP, 36 no estaban en el canal inguinal (24 intrabdominales y 12 atrofíeos/evanescentes). De los casos en que los vasos y deferente se dirigían al anillo inguinal (n = 38), 13 eran atrofíeos/evanescentes, lo que explicaría por qué no fueron detectados al EBA y/o ecografía. Por lo tanto, en 66 por ciento (49/74) de los niños en esta serie, la exploración laparoscópica fue crítica en determinar la localización testicular, lo que la hace recomendable para el enfrentamiento del TNP.