Caracterización clínica y angiográfica según sexo de pacientes con síndrome coronario agudo sin supradesnivel del segmento ST / Clinical and angiographic characterization according to sex of patients with acute coronary syndrome without ST segment elevation

Ischemic Heart Disease is the leading cause of death and of potential years of life lost in Chile. The most frequent acute presentation of this group of pathologies is the Acute Coronary Syndrome (ACS) without ST segment elevation. According to the literature, there is a proportion of patients with non-ST elevated ACS in which coronary angiography reveals a mild coronary lesion or even shows no detectable lesion at all. This scenario is more common in women than in men. Compared with men, women with non-ST elevated ACS are older than men and more frequently have hypertension. Furthermore, women are less likely to have previous cardiac diseases, and are less common to present serum troponin rise at admission. In Chile, there are no previous studies about the differences between sexes in this disease. The objective of this study is to determine if there are major differences between sexes in aspects like clinical and angiographic findings in patients with non-ST elevated ACS. The study used a database of 1900 consecutive patients who were submitted for coronary angiography and had been previously diagnosticated with non-ST elevated ACS, between the years 2001-2017. Clinical assessment, laboratory and angiographic results were collected and analyzed to establish major differences considering p<0,05. 69% of patients were men. When comparing, the proportion of smokers was greater in men, who also more frequently had progressive worsening of angina or treatment-resistant chest pain as clinical presentations. Furthermore, previous coronary bypass surgery, previous percutaneous coronary intervention and previous myocardial infarction were more common in men. As to women, they were older and more frequently had hypertension and/or hypothyroidism. Unstable angina as a clinical presentation was more usual than in men and electrocardiographic findings as a negative T-wave in the anterior wall, evolutive segment changes and left branch bundle block were also more common. In addition, serum troponin rise was more frequent than in men. There was no difference in risk stratification with TIMI score. When comparing angiographic findings, women had more frequently mild lesions or no lesions at all (44% in women versus 27% in men). In conclusion, clinical aspects are different in between sexes as to presence of comorbidities, cardiovascular risk factors and previous cardiovascular disease. Clinical presentation is also different, as to symptoms and as to electrocardiographic findings and laboratory exams. At last, and as evidence suggests, there is a greater proportion of women with mild coronary lesions or without lesions than in men when comparing angiographic findings. (AU)

Adenoma hipofisario ectópico del seno esfenoidal persistente tras cirugía manejado con tratamiento conservador / Ectopic pituitary adenoma in the sphenoid sinus persistent after surgery managed with conservative treatment

Los adenomas hipofisarios ectópicos (EPA) constituyen un reto diagnóstico, dada su escasa prevalencia y variada presentación en la que puede incluirse un síndrome de hipersecreción de hormonas hipofisarias. La clínica suele ser larvada e inespecífica, no presentan ninguna característica radiológica diferencial y el diagnóstico habitualmente es anatomopatológico. Sin embargo, a pesar de ser tumores benignos, pueden presentar un comportamiento agresivo, con invasión ósea y difícil resección completa, por lo que un diagnóstico de sospecha precoz podría resultar en un tratamiento más eficaz y con un menor número de complicaciones. Presentamos el caso de una paciente con un adenoma hipofisario ectópico silente en el seno esfenoidal con inmunohistoquímica positiva para Hormona de crecimiento (GH) y prolactina que presentaba restos tumorales tras la intervención quirúrgica y ha sido manejada con tratamiento médico conservado, con buenos resultados.

Ectopic pituitary adenomas constitute a diagnostic challenge, given their low prevalence and varied presentation in which a pituitary hormone hypersecretion syndrome may be included. Clinical symptoms are usually latent and nonspecific, they have no differential radiological characteristics and the diagnosis is usually anatomopathological. However, despite being benign tumors, they can exhibit aggressive behavior, with bone invasion and difficult complete resection, so a diagnosis of early suspicion could result in more effective treatment and fewer complications. We present the case of a patient with a silent ectopic pituitary adenoma in the sphenoid sinus with positive immunohistochemistry for Growth Hormone (GH) and prolactin who had tumor remnants after surgery and was managed with conservative medical treatment, with good results.

La relación de ayuda enfermera ­ paciente en servicios de pediatría: el relato biográfico de Isabel / The nurse-patient relationship in pediatric services: Isabel biographical account

INTRODUCCIÓN: Los relatos biográficos (RB) son historias vividas por las personas, este estudio analiza el RB de Isabel, una enfermera pediátrica. OBJETIVO: Este artículo tiene como propósito describir los principales aspectos éticos de la relación de ayuda que se establece entre profesionales de enfermería y pacientes pediátricos. METODOLOGÍA: Se utiliza metodología cualitativa con relato biográfico (RB), la información se obtuvo a partir de una entrevista consentida, abierta y en profundidad. La visión del informante permite poner en contexto las principales categorías que se relacionan con el cuidado de niños/as. RESULTADOS: Se identificaron cinco categorías asociadas a la relación de ayuda del profesional de enfermería y pacientes pediátricos; empatía y sensibilidad ética, disimilitudes entre los intereses institucionales y la gestión del cuidado, auto percepción de los profesionales de enfermería, autocuidado y afrontamiento de eventos críticos. DISCUSIÓN: Las emociones son una fuente importante de visión moral de las enfermeras pediátricas CONCLUSIÓN: Las categorías contribuyen a la reflexión sobre el conocimiento ético, y releva la sensibilidad emocional, para valorar la empatía y compasión en los servicios pediátricos.

INTRODUCTION: Biographical accounts (RB) are stories lived by people, this study analyzes the RB of Isabel, a pediatric nurse. OBJECTIVE: The purpose of this article is to describe the main ethical aspects of the support relationship established between nursing professionals and pediatric patients. METHODOLOGY: Qualitative methodology with biographical account (RB) is used, the information was obtained from a consented, open and in-depth interview. The informant's vision allows us to put into context the main categories related to childcare. RESULTS: Five categories associated with the relationship of help of the nursing professional and pediatric patients were identified; empathy and ethical sensitivity, dissimilarities between institutional interests and care management, self perception of nursing professionals, self-care and coping with critical events. DISCUSSION: Emotions are an important source of moral vision for pediatric nurses. CONCLUSION:The categories contribute to reflection on ethical knowledge, and relieves emotional sensitivity, to have empathy and compassion in pediatric services.

Factores pronósticos de morbimortalidad cardiovascular en pacientes egresados con infarto agudo al miocardio seguidos por un año / Prognostic factors of cardiovascular morbidity and mortality in patients with acute myocardial infarction followed for one year

Acute myocardial infarction is one of the main causes of death in the world, this occurs in the in-hospital period as well as in the follow-up. It has been much studied what occurs in the in-hospital period, but much less what occurs in the follow-up of patients with this pathology. The objective of this study was to follow patients discharged after myocardial infarction for 1 year and analyze predictors of cardiovascular events. 1174 patients were followed for 1 year, of which 17% presented some serious cardiovascular event, associated with the presence of male sex, older age, arterial hypertension, previous history of angina, hospital treatment only pharmacological, inclusion of positive inotropes in the initial treatment and use of calcium channel blockers, factors already shown by international literature but less analyzed in our country, and furthermore, the demonstration that invasive management with coronary angioplasty or bypass surgery are protective factors of the occurrence of events in this period, which reinforces the idea of a more intensive and invasive management in patients with this pathology. (AU)

Requirements and energy efficiency of Pelibuey and Katahdin non pregnant, non lactating ewes in Yucatan, Mexico / Requerimientos y eficiencia energética de ovejas Pelibuey y Katahdin no gestantes, no lactantes en Yucatán, México

Abstract Objective. To estimate metabolizable energy requirements for maintenance (MEm), energy efficiency of weight gain (EEWG) and fat thickness, in Pelibuey and Katahdin ewes in Yucatan, Mexico. Material and method. Eight non pregnant, non lactating, multiparous ewes, were feed at three intake levels with a diet containing 2.0 Mcal/Kg-1 of ME and 11 % of CP. Feed intake was measured daily, ewes weight and thickness of subcutaneous fat (SF) were determined every 14 days. The EMm was estimated by regressing values of live weight against metabolizable energy intake (MEI), EEWG was estimate as gram of weight gain per Mcal of MEI. Results. There were no differences between breeds in MEm (97±4 and 110±4 kcal/Kg0.75, for Pelibuey and Katahdin) and EEWG (58±8 and 63±8 g/Mcal of MEI, for Pelibuey and Katahdin); differences were found in SF (6.1±0.2 and 4.9±0.2 mm, for Pelibuey and Katahdin). Conclusions. The energy requirements for maintenance were similar in Pelibuey and Katahdin ewes in Yucatan, Mexico.

Resumen Objetivo. Estimar los requerimientos de energía metabolizable para el mantenimiento (MEm), le eficiencia energética del incremento de peso (EEWG) y el grosor de grasa, en ovejas Pelibuey y Katahdin en Yucatán, México. Materiales y método. Ocho ovejas multíparas no gestantes, no lactantes, fueron alimentadas a tres niveles de consumo con una dieta que contenía 2.0 Mcal/kg-1 de EM y 11% de PC. El consumo de alimento fue medido diariamente, el peso de ovejas y el grosor de grasa subcutánea (SF) se determinó cada 14 días. La MEm fue estimada por regresión de los valores de peso vivo contra el consumo de EM (MEI), la EEWG fue estimada como los gramos de ganancia de peso por Mcal de MEI. Resultados. No existieron diferencias entre razas en EMm (97±4 y 110±4 kcal/Kg0.75, para Pelibuey y Katahdin respectivamente) y EEWG (58±8 y 63±8 g/Mcal de MEI, para Pelibuey y Katahdin respectivamente); se encontraron diferencias en SF (6.1±0.2 y 4.9±0.2 mm, para Pelibuey y Katahdin respectivamente). Conclusiones. Los requerimientos de energía para mantenimiento fueron similares en las ovejas Pelibuey y Katahdin en Yucatán, México.

Rivaroxaban para el tratamiento de la trombocitopenia inducida por heparina: caso clínico / Treatment of heparin-induced thrombocytopenia with rivaroxaban: case report

Heparin-induced thrombocytopenia (HIT) is immune-mediated. It occurs more frequently with unfractionated heparin (UFH) than with low molecular weight heparins (LMWH). It is associated with thromboembolic rather than hemorrhagic events, as opposed to thrombocytopenia of other etiologies. The key in therapy is the cessation of heparin and the start of another anticoagulant. We report a 58 years old female with HIT secondary to the use of Enoxaparin who was successfully managed with Rivaroxaban. Our goal is to report a novel therapy and provide the evidence that supports its use.

Ileo biliar, reporte de caso clínico / Biliary Ileus, clinical case report

El Íleo biliar es la obstrucción intestinal mecánica secundaria al impacto intraluminal de un lito; considerada como una complicación de la colelitiasis que fistuliza al tubo digestivo, permitiendo la migración del lito, en ocasiones ocurre por paso natural a través de la vía biliar debido a alteraciones del esfínter de Oddi, sobre todo tras la ampliación quirúrgica del mismo.Patología rara que se presenta más en ancianos, la ma-yoría de las series internacionales indican que el promedio de edad en la que se presenta es entre los 60 y 84 años. Afecta principalmente al sexo femenino, con una rela-ción hombre: mujer que va de 1:3 a 1:6, atribuyéndose a la mayor frecuencia de patología biliar en dicho sexo. Esta condición se precede de un cuadro de colecistitis aguda o crónica (75% de los casos). REPORTE DEL CASO Se presenta el caso de un paciente masculino de 83 años, quien acude al servicio de emergencia por pre-sentar dolor más distensión abdominal, nausea y vómito, al examen físico se puede observar un abdomen distendido, con ruidos hidroaéreos abolidos, timpánico a la percusión, doloroso a la palpación profusa. Se le realizan exámenes de laboratorio los cuales indican fórmula leucocitaria incrementada, PCR incrementado mínimamente sobre el límite superior, los exámenes de imagen específicamente la TAC nos indica la existencia de gas en vía biliar y una imagen hiperdensa a nivel de intestino delgado. Cuadro doloroso abdominal se exacerba, persiste distensión abdominal y los ruidos hi-droaereos se mantienen abolidos por lo cual se proyecta una laparotomía exploratoria.

Biliary ileus is the secondary mechanical intestinal obstruction to the intraluminal impact of a litho; it is consi-dered as a complication of cholelithiasis that provokes a fistula in the digestive tract, allowing the migration of the stones. Sometimes occurs by natural passage throu-gh the biliary tract due to alterations of the sphincter of Oddi, especially after the surgical extension of the same.It is a rare pathology that is more common in the elderly, the most international series report an average age be-tween 60 and 84 years.It mainly affects the female sex, with a male relation: female ratio ranging from 1: 3 to 1: 6, attributed to the higher frequency in that sex biliary disease. This condi-tion is preceded by acute or chronic cholecystitis (75% of cases). CASE REPORT It is a case of a man, he is 83-year-old and he goes to emergency service presenting pain and bloating, nausea and vomit, in the physical examination it was observed a distended abdomen with abolished bowel sounds, tympanic to percussion, painful to profuse pal-pation. Laboratory tests are performed and indicate an increased leukocyte count, CRP increased minimally over the upper limit, imaging examinations CT specifi-cally indicates the existence of gas in bile duct and a hyper dense image at the level of the small intestine. The patient still presents pain, for this reason it is projec-ted an exploratory laparotomy.

An appraisal of the phylogenetic relationships of Hypoptopomatini cascudinhos with description of two new genera and three new species (Siluriformes: Loricariidae)

The discovery of three new taxa of Hypoptotopomatini with ambiguous generic assignment prompted a reanalysis of the phylogenetic relationships of the tribe. The analysis focused on a data matrix of 56 terminals and 107 morphological characters comprising the three new taxa, most species of Hypoptopoma and Otocinclus, and all other species of the tribe. The 162 maximally parsimonious trees of 382 steps, consistency index of 0.41, and retention index of 0.83 were then summarized in a strict consensus tree. The results confirm the monophyly of the Hypoptopomatini, recover four genera as monophyletic (Acestridium, Hypoptopoma, Niobichthys, and Otocinclus), revealed Hypoptopoma and Oxyropsis to be non-monophyletic; and revealed two new genera within Hypoptopomatini. Additionally, Otocinclus was found to be sister to a group with all remaining genera of the tribe; Acestridium and Niobichthys were found to be sister to each other and that clade sister to a group formed by ((Leptotocinclus + Hypoptopoma [part]) + (Nannoxyropsis (Oxyropsis + Hypoptopoma [part]))). Based on this framework, changes to the classification and the taxonomy of the Hypoptopomatini are suggested and the new taxa are described.(AU)

A descoberta de três novos táxons pertencentes à Hypoptopomatini com designações genéricas incertas, levaram a uma nova análise das relações filogenéticas da tribo. A análise focou em uma matriz de dados formada por 56 terminais e 107 caracteres morfológicos incluindo os três novos táxons, a maioria das espécies de Hypoptopoma e Otocinclus, e todas as demais espécies da tribo. As 162 árvores maximamente parcimoniosas com 382 passos, índice de consistência 0.41 e índice de retenção 0.83 foram sumarizadas em um consenso estrito. O resultado obtido corrobora o monofiletismo de Hypoptopomatini, recupera quatro gêneros como grupos monofiléticos (Acestridium, Hypoptopoma, Niobichthys, e Otocinclus), aponta Hypoptopoma e Oxyropsis como grupos não-monofiléticos e revela dois novos gêneros pertencentes à Hypoptopomatini. Adicionalmente, Otocinclus foi encontrado como sendo grupo-irmão de um clado formado por todos os demais gêneros da tribo e Acestridium e Niobichthys formam um grupo-irmão mais relacionado a um clado formado por dois grupos monofiléticos ((Leptotocinclus + Hypoptopoma [parte]) + (Nannoxyropsis (Oxyropsis + Hypoptopoma [parte]))). Com base neste cenário, sugere-se mudanças na classificação e na taxonomia de Hypoptopomatini e os novos táxons são descritos.(AU)

Modo de Vida de un grupo de trabajadores informales, Bogotá D.C., 2014 / Mode of Life of an informal group of workers, Bogotá D.C., 2014 / Sustento de um grupo de trabalhadores informais, Bogotá D.C., 2014

Objetivo: Comprender el Modo de vida de un grupo de trabajadores informales vendedores de productos agrícolas en carreta, en el territorio de Corabastos, Bogotá D.C., como aproximación al Perfil Epidemiológico del grupo. Metodología: Estudio cualitativo, descriptivo, participaron 29 trabajadores informales, la recolección de la información se realizó por medio de cuatro técnicas cualitativas y fue analizada por medio del método de análisis de contenido temático. Resultados: El MV se describió a partir del reconocimiento del territorio, las condiciones grupales de trabajo, la calidad y disfrute de bienes de consumo del grupo, capacidad para crear y reproducir valores culturales e identidad, capacidad para empoderamiento, organización y soporte en beneficios del grupo y calidad de las relacionesecológicas de estos trabajadores informales Discusión y conclusiones: El concepto de MV que se describió es amplio y recoge categorías que no han sido evaluadas en otras investigaciones, específicamente en relación a los trabajadores informales y la inserción en un espacio social, un espacio ambiental, en la relación con instituciones estatales, valores culturales y su capacidad organizativa.

Objective: To understand the mode of life of a group of informal work sellers of agricultural products, who use, as a working tool, a wooden cart. The place for this economical activity is a place named Corabastos, a gathering place of agricultural products. It is located in Bogotá D.C. This is an approximation to the epidemiological profile of the group. Methodology: Qualitative, 29 informal workers participated, Data collection was conducted through four qualitative techniques and it was analyzed using the method of analysis of thematic content. Results:The mode of life of this group, was described taking a as a starting point some specific aspects: The recognition of the territory (Corabastos), the group working conditions, the quality and enjoyment of consumer goods in the group, the ability to create and reproduce cultural values and identity, the ability to empowerment, organization and support in order to benefit the group Finally, the ecological relationships of the group were also taken into account. Discussion and conclusions: The concept was described MV is broad and includes categories that have not been evaluated in other investigations, specifically in relation to informal workers and insertion in a social space, environmental space, in the relationship with state institutions, cultural values and its organizational capacity.

Objetivo: compreender o modo de vida de um grupo de trabalhadores vendedores informais de produtos agrícolas no carro no território de Corabastos, Bogotá DC, como um perfil epidemiológico aproximação do grupo. Metodologia: estudo qualitativo envolvendo 29 trabalhadores informais. A recolha de dados foi realizada por quatro métodos qualitativos e foi analisada pelo método de análise de conteúdo. Resultados: A MV é descrito com base no reconhecimento do território, o grupo de condições de trabalho, qualidade e satisfação do grupo de bens de consumo, a capacidade de criar e reproduzir valores culturais e de identidade, capacidade de capacitação, organização e benefícios de suporte grupo ea qualidade das relações ecológicas desses trabalhadores informais. Discussão econclusões: o conceito foi descrito MV é amplo e inclui categorias que ainda não foram avaliados em outros estudos, especificamente em relação aos trabalhadores informais e inserção em um espaço social , um espaço ambiental, em relação às instituições do estado, valores culturais e capacidade organizacional.

Redescription of the endangered hypoptopomatine catfish Parotocinclus spilurus (Fowler, 1941) (Siluriformes: Loricariidae) from the upper rio Jaguaribe basin, northeastern Brazil

Abstract Parotocinclus spilurus (Fowler) was originally described as a species of Plecostomus based on six specimens collected in the rio Salgado, Icó Municipality, Ceará State, northeastern Brazil. Because the original description of P. spilurus is brief and uninformative, a detailed redescription of this endangered species based on the type series and on freshly collected topotypes was made. Data on osteology, intraspecific variation, sexual dimorphism and color pattern in life are presented for the first time, aiming at providing the necessary characters to differentiate the species from its congeners, as well as providing data on the distribution, habitat and conservation.

Resumo Parotocinclus spilurus (Fowler)foi descrita originalmente como uma espécie do gênero Plecostomus combase em seis espécimes coletados no rio Salgado, Município de Icó, Estado do Ceará. Devido à descrição original de P. spilurus ser breve e pouco informativa, uma redescrição detalhada desta espécieameaçada combase na série tipo e em topótipos recentemente coletados foi feita. Dados de osteologia, variação ontogenética, dimorfismo sexual e padrão de coloração em vida são apresentados pela primeira vez, com o objetivo de fornecer caracteres necessários para distinguir a espécie das suas demais congêneres, assim como fornecer dados de distribuição, habitat e conservação.

Colposacropexia abdominal abierta con malla mixta en el prolapso de cúpula vaginal: experiencia en el Hospital de Quilpué, Chile / Open abdominal colposacropexy with mixed mesh in vaginal vault prolapse: experience in the Hospital of Quilpué, Chile

INTRODUCCIÓN: La colposacropexia por vía abdominal abierta (CSPA) es el gold standard para el tratamiento del prolapso de la cúpula vaginal (PCV). OBJETIVO: Mostrar nuestra experiencia, en un Hospital de mediana complejidad, en los primeros siete casos sometidos a un CSPA, reportando las complicaciones intra y post operatorias. MÉTODO: Se realizó un estudio prospectivo descriptivo en nuestras siete primeras pacientes portadoras de un prolapso de cúpula vaginal estadio III o IV (POP-Q) sintomáticas, sin incontinencia urinaria y sometidas a una CSPA, con una malla mixta en el Servicio de Obstetricia y Ginecología del Hospital de Quilpué. RESULTADOS: Se reclutaron 7 pacientes. Ninguna de ellas presentaba complicaciones con riesgo vital peri-operatorio, en un período de seguimiento de 33 meses. En el 100% de las pacientes se logró cura objetiva definida como un POP-Q estadio 0 o I, y buena calidad de vida según el Cuestionario de Impacto del Piso Pélvico (PFIQ-7, versión validada en español). Durante el seguimiento, sólo una paciente presentó exposición asintomática de 5 mm de la malla, resuelta con su resección por vía vaginal. Ninguna paciente requirió de una cirugía por prolapso de órganos pélvicos después de la CSPA. CONCLUSIÓN: Los resultados obtenidos concuerdan con la literatura. La CSPA sigue siendo el gold standard para el tratamiento del PCV, no siendo superada por el momento, por ninguna otra técnica, incluso la colposacropexia laparoscópica. Estimamos que el uso de mallas parcialmente reabsorbibles pueden disminuir la exposición de mallas, sin embargo se requieren de más estudios.

INTRODUCTION: The abdominal sacral-colpopexy is currently considered the gold standard for the management of (CSPA) vaginal vault prolapse (PCV). OBJECTIVE: To report our surgical experience at a county hospital with our first seven abdominal sacral-colpopexy cases. Reporting intra and post-operative complications. METHODS: We conducted a prospective descriptive study involving our first seven cases of patients with symptomatic vaginal vault prolapse stage III or IV (POP-Q) without urinary incontinence. All patients were undergoing CSPA with a partially absorbable mesh in the Obstetrics and Gynecology Department at the Quilpué Hospital. RESULTS: Seven patients were recruited. None of them presented a life threatening complication during a mean follow up period of 33 months. A hundred percent of patients achieved objetive cure defined as POP-Q stage 0 or I and subjective cure defined as a significant improvement in a validated questionnaire (PFIQ-7 spanish version). During patients follow up, only one patient had an asymptomatic 5 mm mesh exposure, resolved with a vaginal resection. None of the patients required surgery for pelvic organ prolapse after the CSPA. CONCLUSION: These results are in agreement with the international literature. The CSPA continues to be the gold standard for the PCV treatment of vaginal vault prolapse and has not been surpassed by either vaginal technique or the laparoscopic sacral-colpopexy. We believe that the use of partially reabsorbable meshes can decrease the rate of mesh exposure, however further studies are required.

A new species of the armored catfish Parotocinclus (Loricariidae: Hypoptopomatinae), from the Amazon basin in Colombia

A new species of hypoptopomatine cascudinho is described from a creek tributary to the Amazon River in Leticia, Amazonas Departament, Colombia. The new species of Parotocinclus is distinguished from congeners from northeastern to southeastern Brazilian rivers in having the cheek canal plate elongated posteriorly on the ventral surface of head and contacting the cleithrum. It is diagnosed from P. collinsae (Essequibo River basin, Guiana) and P. halbothi (rio Trombetas basin, Brazil and Marowijne River, Suriname), by having a triangular patch of dark pigmentation on the anterior portion of the dorsal-fin membrane, by the absence of unicuspid accessory teeth on both the premaxilla and dentary, and by having a Y-shaped light mark on the snout. The new species of Parotocinclus is distinguished from all remaining congeners by having a pigmentation pattern consisting of conspicuous dark dots smaller than a pupil diameter, broadly distributed dorsally and ventrally.

Uma espécie nova de cascudinho hypoptopomatíneo é descrita de um igarapé afluente do rio Amazonas em Leticia, Departamento Amazonas, Colômbia. A espécie nova de Parotocinclus é diagnosticada de suas congêneres do nordeste e sudeste do Brasil por ter a placa com canal da bochecha alongada posteriormente na superfície ventral da cabeça e em contato com o cleitro. A espécie nova é diagnosticada de P. collinsae (bacia do rio Essequibo, Guiana) e P. halbothi (bacia do rio Trombetas, Brasil e rio Marowijne, Suriname), por possuir uma mancha de pigmentação escura triangular na porção anterior da membrana da nadadeira dorsal, pela falta de dentes acessórios unicúspides na pré-maxila e no dentário, e por possuir uma mancha clara em forma de Y no focinho. A espécie nova de Parotocinclus se distingue das demais congêneres por possuir um padrão de pigmentação do corpo consistindo de conspícuos pontos escuros menores do que um diâmetro da pupila, amplamente distribuídos dorsal e ventralmente.

Neoplasia mucinosa gigante de páncreas: presentación de caso clínico y revisión de la literatura / Giant mucinous neoplasm of the pancreas: presentation of a case and review of the literature

Female, 34 year-old patient with diffuse abdominal pain, bloating, and early satiety. Results from a study performed show a complex cystic mass in the pancreas with positive pancreatic mucinous cystadenoma histology. Cystadenoma/Mucinous cystadenocarcinoma represent 10 percent of cystic tumors within the pancreas, which occurr almost exclusively in women. Grossly they are uni or multilocular and contain dense, rich in mucinous matter. Histologically they exhibit columnar epithelium with presence of ovarian stroma. They vary in size, with a 10 cm average. Given their malignancy risk, surgical resection is recommended. Ultrasonography (US) helps to identify these lesions, however fails to provide a definitive diagnosis. Computed tomography (CT) and Magnetic resonance imaging (MRI) have higher accuracy, helping to identify aggressive nature in 75-90 percent. MRI is the test of choice for its resolution capacity. Endoscopic US allows for better characterization and for conducting fine-needle aspiration (FNA) for biochemical and cytological analysis of the liquid, achieving a significant increase in the diagnosis specificity. The differential diagnosis must be performed with other cystic lesions, considering that the final diagnosis is histological. The American College of Radiology suggests the use of surgical resection of mucinous neoplasms of the pancreas, Intraductal papillary or mucinous tumors the IPMT main duct and branch (if symptomatic, growing progressively, > 3 cm, have solid component and/or main duct dilation associated)...

Paciente 34 años, femenino, con dolor abdominal difuso, meteorismo y saciedad precoz. Se realiza estudio con imágenes que demuestran una gran masa quística compleja del páncreas cuya histología fue positiva para cistoadenoma mucinoso de páncreas. Los cistoadenomas/cistoadenocarcinomas mucinosos representan el 10 por ciento de los tumores quísticos del páncreas y se presentan casi exclusivamente en mujeres. Macroscópicamente son uni o multicavitados y contienen material denso, rico en mucina. Histológicamente presentan epitelio cilíndrico con presencia de estroma ovárico. Su tamaño es variable con promedio de 10 cm. Dado el riesgo de malignización se prefiere resección quirúrgica. La ultrasonografía (US) identifica estas lesiones, sin embargo, no llega a diagnóstico definitivo. La tomografía computarizada (TC) y la resonancia magnética (RM), presentan una precisión mayor, ayudando a diferenciar el carácter agresivo en 75-90 por ciento. La RM es el examen de elección por su capacidad de resolución. La US endoscópica permite una mejor caracterización y la realización de punción-aspiración con aguja fina (PAAF) para el estudio bioquímico y citológico del líquido, consiguiendo aumentar considerablemente la especificidad del diagnóstico. El diagnóstico diferencial debe realizarse con otras lesiones quísticas, teniendo en cuenta que el diagnóstico definitivo es histológico. El American College of Radiology sugiere resección quirúrgica de las neoplasias mucinosas de páncreas, y de los tumores papilares mucinosos intraductales (TPMI) de ducto principal y de rama (si son sintomáticos, crecen en forma progresiva, presentan un diámetro > 3 cm, presentan componente sólido y/o se asocian dilatación del conducto principal)...

Feocromocitoma maligno: comunicación de 2 casos tratados con cirugía de mínima invasión / Malignant pheochromocytoma treated with minimally invasive surgery

Introducción: El Feocromocitoma es un tumor de células cromafines productor de catecolaminas. Su variedad maligna es muy poco frecuente. Objetivo: Describir 2 casos de Feocromocitoma maligno tratados con cirugía mínimamente invasiva. Casos clínicos: Presentamos 2 pacientes de sexo femenino, de 31 y 51 años respectivamente. La primera con historia de hipertensión arterial de larga data y uso de múltiples fármacos. La segunda paciente debuta con dolor abdominal. En ambos casos los estudios radiológicos y metabólicos confirmaron el diagnóstico de Feocromocitoma. A la primera paciente se le realizó un procedimiento laparoscópico puro, mientras que a la segunda paciente se le realizó un procedimiento laparoscópico asistido por robot. En ambos casos fue necesario realizar adrenalectomía en bloque con el riñón, por compromiso del hilio renal. No hubo complicaciones severas intra ni post-operatorias, como tampoco conversión a cirugía abierta. La histopatología confirmó el diagnóstico de Feocromocitoma maligno con metástasis ganglionares regionales y márgenes quirúrgicos negativos. Ambas se mantienen en control, sin evidencia de recurrencia. Conclusión: El Feocromocitoma maligno puede ser manejado de forma mínimamente invasiva, con morbilidad y resultados oncológicos comparables a cirugía abierta.

Introduction: Pheochromocytoma is a tumor derived from chromaffin cells that produces cathecolamines. Malignant pheochromocytomas are extremely rare. Aim: To describe 2 cases of malignant Pheochromocytoma treated with pure laparoscopic and robot assisted surgery. Clinical cases: Two female patients, 31 and 51 years of age, presented with a history of high blood pressure and abdominal pain. Radiologic and metabolic studies confirmed the diagnosis of Pheochromocytoma in both patients. A pure laparoscopic approach was performed in the first patient while a robotic assisted laparoscopy was done in the second patient. In both cases, adrenalectomy with in bloc nephrectomy was performed due to compromise of the renal sinus. There were no complications or conversion to open surgery. Histopathology confirmed the diagnosis of malignant Pheochromocytoma with metastasis to regional nodes and negative surgical margins. At follow-up, there is no evidence of recurrence. Conclusion: Malignant Pheochromocytoma can be treated with minimally invasive surgery, with morbidity and oncological outcomes similar to open approach.

Efectos de la injuria renal isquémica aguda en la disfunción extrarenal: estudio experimental aleatorizado / Acute kidney injury and extrarenal organ dysfunction: a randomized experimental study

Introducción: La insuficiencia renal aguda (IRA) es una enfermedad grave y causante de disfunciones de órganos distantes que incrementan su mortalidad. Objetivo: Identificar disfunción hemodinámica y respiratoria gatillada por IRA en un modelo pediátrico animal de isquemia-reperfusión renal. Método: Doce cerdos anestesiados (11,9 +/- 1,0 kg). En seis animales se indujo lesión renal bilateral por isquemia-reperfusión: 45 min de isquemia y 240 min de reperfusión, mientras que los seis animales restantes fueron grupo control. En condiciones basales y posterior a lesión renal se realizó monitorización hemodinámica convencional y termodilución transpulmonar. Paralelamente se midió gasometría arterial y análisis de mecánica pulmonar. Resultados: Hubo un incremento de la precarga volumétrica en 29 por ciento (221 +/- 22 ml/m² vs 286 +/- 16 ml/m², p = 0,04) y de la presión arterial media en 58 por ciento (71 +/- 6 mmHg vs 112 +/- 17 mmHg, p = 0,04) respecto a controles, sin cambios en frecuencia cardíaca, presión venosa central ni gasto cardíaco. Además ocurrió un aumento del agua extravascular pulmonar en 86 por ciento (7,6 +/- 0,6 ml/kg vs 14,1 +/- 1,4 ml/kg, p = 0,02), sin cambios en intercambio gaseoso ni mecánica pulmonar. Simultáneamente hubo un leve deterioro de la creatinina sérica (1,12 +/- 0,07 mg/dL vs 1,45 +/- 0,10 mg/dL, p = 0,03). Discusión: En este modelo experimental se pudo apreciar el desarrollo temprano de disfunción hemodinámica y pulmonar. Se evidenció un aumento de la precarga volumétrica y de la presión arterial, asociado a un incremento substancial del agua extravascular pulmonar. Creemos que es fundamental monitorizar de forma seriada la función hemodinámica y respiratoria en sujetos con una lesión renal aguda, aún sin una IRA urémica.

Background: Acute kidney injury (AKI) is a serious disease that can cause distant organ injuries and is associated with high mortality rates. Objective: To identify the hemodynamic and respiratory dysfunction triggered by AKI, in an animal model of renal ischemia-reperfusion. Method: Twelve anesthetized juvenile pigs (11.9 +/- 1.0 kg). Six animals underwent ischemia/reperfusion-induced AKI: 45 min of ischemia and 240 minutes of reperfusion, while the remaining six animals were the control group. In basal conditions and after AKI, a conventional hemodynamic monitoring and transpulmonary thermodilution were performed. At the same time, arterial blood gases and lung mechanics were measured. Results: There was a 29 percent increase in volumetric preload (221 +/- 22 ml/m² vs 286 +/- 16 ml/m², p = 0.04) and a 58 percent mean arterial pressure increase (71 +/- 6 mmHg vs 112 +/- 17 mmHg, p = 0.04) compared to controls, without changes in heart rate, central venous pressure and cardiac output. In addition, an increase of 86 percent in extravascular lung water (7.6 +/- 0.6 ml/kg vs 14.1 +/- 1.4 ml/ kg, p = 0.02) was reported, without changes in gas exchange and lung mechanics. Simultaneously, a slight increase in serum creatinine (1.12 +/- 0.07 mg/dl vs 1.45 +/- 0.10 mg/dl, p = 0.03) was described. Discussion: An early development of hemodynamic and pulmonary dysfunction was observed in this experimental reperfusion model. An increase in volumetric preload and blood pressure associated with a substantial increase in the extravascular lung water were also reported. It is essential serially monitor the hemodynamic and respiratory functions in AKI, including nonuremic subjects.

A new species of the Neoplecostomine catfish Pareiorhaphis (Siluriformes: Loricariidae) from the Coastal basins of Espírito Santo, eastern Brazil

Pareiorhaphis ruschii, new species, is the first neoplecostomine catfish of the genus Pareiorhaphis described based on material from tributaries to the rio Piraquê-Açu and rio Reis Magos, both small coastal drainages in the State of Espírito Santo, eastern Brazil. The new species is promptly diagnosed from all its congeners by features related to the morphology of the lower lip margin, number of preadipose azygous plates, size and shape of the pectoral-fin spine, and caudal-fin skeleton. Additionally, sexual dimorphism of the new species is marked by hypertrophied odontodes on the lateral margins of head slightly directed forward in adult males.

Pareiorhaphis ruschii, espécie nova, é o primeiro cascudo neoplecostomíneo do gênero Pareiorhaphis descrito de afluentes dos rios Piraquê-Açu e Reis Magos, ambos pequenas bacias costeiras do estado do Espírito Santo, leste do Brasil. A espécie nova é prontamente diagnosticada de todas as demais congêneres por caracteres relacionados à morfologia da margem do lábio inferior, número de placas ázigas pré-adiposas, forma e tamanho do raio não ramificado das nadadeiras peitorais e forma do esqueleto da nadadeira caudal. O dimorfismo sexual da espécie nova é marcado pelos odontódeos hipertrofiados na margem lateral da cabeça que são ligeiramente orientados anteriormente em machos adultos.

Posición oficial de la Sociedad Chilena de Climaterio para el manejo clínico de la mujer climatérica / Official position of the Chilean Society of Climacteric on the management of climacteric women

The health of many women is affected in the climacteric period, either by symp-toms that deteriorate their life quality (QL) or by chronic diseases that affect their life expectancy. Therefore, it is mandatory to evaluate these two aspects, having as core objectives for any eventual therapeutic intervention, the improvement of QL and the reduction of cardiovascular risk and fractures. To evaluate QL it is mandatory to follow structured interviews that weigh systematically climacteric symptoms such as the Menopause Rating Scale (MRS). The paradigm of the metabolic syndrome constitutes a suitable frame to evaluate cardiovascular risk. Age, a low body weight, a history of fractures and steroid use are risk factors for fractures. A proper evaluation will allow the detection of patients with a low QL or a high risk for chronic disease, therefore identifying those women who require therapy. The clinical management should include recommendations to improve lifestyles, increase physical activity, avoidance of smoking and to follow a low calorie diet rich in vegetables and fruits. Hormonal therapy is the most effcient treatment to improve the QL and its risk is minimized when it is used in low doses or by the transdermal route. Tibolone is an alternative, especially useful in patients with mood disorders and sexual dysfunction. Vaginal estrogens are also a good option, when urogenital symptoms are the main complaint. Some antidepressants can be an effective therapy in patients with vasomotor symptoms who are not willing or cannot use estrogens. The effectiveness of any alternative therapy for menopausal symptoms has not been demonstrated. Dyslipidemia, hypertension, obesity and insulin resistance should be managed ac-cording to guidelines. Calcium and vitamin D have positive effects on bone density and certain tendency to reduce vertebral fractures. Bisphosphonates decrease the risk of vertebral fractures.

Re-validation of Otocinclus arnoldi Regan and reappraisal of Otocinclus phylogeny (Siluriformes: Loricariidae)

Otocinclus arnoldi from the La Plata basin is resurrected from the synonymy of O. flexilis described from the rio Jacuí drainage, based on three distinguishing features: the possession of five branched pectoral-fin rays, the larger number of enlarged odontodes on the tip of the parieto-supraoccipital posterior process, and having the prootic involved in the contact with the hyomandibular articular condyle. These species are also compared to O. mimulus, a third species described from the Paraná River basin, and the three species are rediagnosed. A reassessment of the phylogenetic relationships of all species of Otocinclus shows a well-supported clade composed of (O. xakriaba ((O. mimulus, O. arnoldi) (O. affinis, O. flexilis))) from the eastern-draining river basins of the Brazilian Shield as sister-group to a clade including all remaining Otocinclus species which are distributed on a wide lowland area of the Amazonas, Paraguay, and Orinoco basins.

Otocinclus arnoldi da bacia do rio da Prata é revalidada da sinonímia de O. flexilis, descrito da bacia do rio Jacuí, baseado em três características distintivas: a presença de cinco raios ramificados na nadadeira peitoral, o maior número de odontódeos hipertrofiados na ponta do processo posterior do parieto-supraoccipital, e por ter o proótico envolvido no contato com o côndilo articular do hiomandibular. Essas espécies são também comparadas com O. mimulus, outra espécie descrita da bacia do rio Paraná, e as três espécies são re-diagnosticadas. Uma nova análise filogenética de todas as espécies de Otocinclus revelou um clado bem suportado composto por (O. xakriaba ((O. mimulus, O. arnoldi)(O. affinis, O. flexilis))) dos rios do escudo Brasileiro que drenam para leste, como grupo-irmão de um clado que inclui todas as demais espécies de Otocinclus que são distribuídas em uma grande área baixa das bacias do Amazonas, Paraguai e Orinoco.