Gluteoplastia de aumento con implantes intramusculares para el mejoramiento del contorno corporal / Augmentation gluteoplasty with intramuscular implants to improve the physical measurement i:en

Introducción: La región glútea ha sido considerada una de las zonas más observadas tanto en mujeres como en hombres y constituye un ícono representativo de belleza corporal. En los últimos años se ha incrementado el deseo de las féminas de aumentar esta región anatómica con implantes. Objetivo: Determinar los resultados estéticos de la gluteoplastia de aumento con implantes intramusculares. Métodos: Se realizó un estudio prospectivo, longitudinal y descriptivo de 25 mujeres que acudieron a la consulta externa del Servicio de Cirugía Plástica del Hospital Clínico-Quirúrgico Hermanos Ameijeiras, desde agosto de 2016 hasta febrero de 2019, para solicitar el aumento de su región glútea con implantes. Resultados: En la serie predominaron el grupo etario de 31 a 40 años (36,0 %) y el fototipo de piel III (88,0 %); asimismo, solo 6 pacientes presentaron complicaciones (24,0 %), entre las cuales sobresalieron el seroma (20,8 %), la asimetría (12,5 %) y la dehiscencia de la sutura (8,3 %). Se observó un aumento significativo de la proyección glútea después de la intervención (α=0,05) y los resultados fueron buenos en la mayoría de las integrantes de la muestra (84,0 %). Conclusiones: La gluteoplastia de aumento con implantes intramusculares es un procedimiento seguro y ofrece resultados estéticos favorables.

Introduction: Gluteal region has been considered one of the most observed areas either in women as in men and constitutes a representative icon of corporal beauty. In the last years the desire of women to increase this anatomical region with implants has been increased. Objective: To determine the aesthetic results of the augmentation gluteoplasty with intramuscular implants. Methods: A prospective, longitudinal and descriptive study of 25 women that went to the Plastic Surgery Service outpatient consultation of Hermanos Ameijeiras Clinical Surgical Hospital was carried out from August, 2016 to February, 2019, to request the increase of the gluteal region with implants. Results: In the series there was a prevalence of the 31 to 40 age group (36.0%) and the skin phototype III (88.0%); also only 6 patients presented complications (24.0%), among which seroma (20.8%), asymmetry (12.5%) and anastomotic dehiscence (8.3%) were notable. A significant increase of the gluteal projection after the intervention was observed (α =0.05) and the results were good in most of the members of the sample (84.0%). Conclusions: The augmentation gluteoplasty with intramuscular implants is a safe procedure and offers favorable aesthetic results.

Experiencia con el uso de toxina botulínica en niños con vejiga hiperactiva neurogénica: Una serie de casos / Experience with Botulinum Toxin in Children with Neurogenic Overactive Bladder: A Case Series

Objetivo Describir la experiencia con la administración de inyección de toxina botulínica en niños con vejiga hiperactiva neurogénica refractaria a manejo de primera línea. Materiales y Métodos Estudio observacional descriptivo (serie de casos) que incluyó a 14 niños con diagnóstico de vejiga hiperactiva neurogénica refractarios a tratamiento de primera línea sometidos a administración intravesical de toxina botulínica entre 2015 y 2021; se realizó el seguimiento teniendo en cuenta las variables clínicas, con evaluación de la respuesta y de los eventos adversos. Se reportaron frecuencias absolutas y porcentajes para las variables cualitativas; para las variables cuantitativas, se reportaron medidas de tendencia central y dispersión. Resultados Se incluyeron 6 niños y 8 niñas, con una media de edad 10,1 (desviación estándar [DE]: ± 4,4) años. Todos los pacientes fueron tratados previamente con anticolinérgico y cateterismos limpios intermitentes, con una media de uso de 2,8 (DE: ± 1.0) pañales al día; 11 (78,5%) pacientes tenían antecedente de infección urinaria, 13 (92,8%), estreñimiento, y 2 (15,3%), incontinencia fecal. En la ecografía, 7 (50,0%) pacientes presentaban engrosamiento de las paredes vesicales, y 6 (42,8%), hidronefrosis. Tras el procedimiento, 1 paciente presentó infección urinaria como complicación, 6 presentaron una respuesta completa, 7, respuesta parcial, y 1 paciente no obtuvo respuesta con la primera inyección, con un tiempo promedio efectivo de la terapia 8 (DE: ± 6,3) meses. Una segunda inyección fue necesaria en 6 (42.8%) pacientes, y, de estos, 3 (50%) requirieron una tercera inyección. Conclusión La inyección de toxina botulinica intravesical como terapia de segunda línea de manejo para vejiga hiperactiva neurogénica tiene buenos resultados, con bajas tasas de complicaciones.

Objective To describe the experience with the administration of botulinum toxin injection in children with neurogenic overactive bladder who were refractory to the first-line management. Materials and Methods A descriptive observational study (case series) which included 14 children with a diagnosis of neurogenic overactive bladder who were refractory to the first-line treatment and were aubmitted to the intravesical administration of botulinum toxin between 2015 and 2021. Follow-up was performed taking into account the clinical variables, wth an evaluation of the response and the adverse events. Absolute frequencies and percentages were reported for the qualitative variables; for the quantitative variables, measures of central tendency and dispersion were reported. Results We included 6 boys and 8 girls with a mean age of 10.1 (standard deviation [SD]: ± 4.4) years. All patients were previously treated with anticholinergics and clean intermittent catheterizations, with a mean use of 2.8 (SD: ± 1.0) diapers per day; 11 (78.5%) had a history of urinary tract infection, 13 (92.8%), constipation, and 2 (15.3%), fecal incontinence. On ultrasound, 7 (50.0%) patients presented bladder wall thickening, and 6 (42.8%), hydronephrosis. After the procedure, 1 patient presented urinary tract infection as a complication, 6 presented complete response, 7, partial response, and 1 patient did not obtain a response with the first injection, with an effective mean time of therapy of 8 (SD: ± 6.3) months. A second injection was required by 6 (42.8%) patients, and of these, 3 (50%) required a third injection. Conclusion Intravesical botulinum toxin injection as a second-line management therapy for neurogenic overactive bladder yileds good results, with low rates of complications.

Evaluación de un nuevo indice de riesgo de malignidad (IRM H2M) para predecir malignidad de los tumores anexiales. Hospital Nacional Dos de Mayo: enero 2008 - diciembre 2010 / Evaluation of a new index of risk of malignancy (IRM H2M) to predict malignancy in adnexal tumors. National Hospital Dos de Mayo: January 2008-December 2010

Objetivo: Determinar la utilidad del IRM H2M en predecir malignidad de tumores anexiales en pacientes atendidas en el Hospital Nacional Dos de Mayo (HNDM), período 2008-2010. Estudio: Observacional, Analítico, Transversal, Retrospectivo. Lugar: Servicio Oncología Ginecológica-HNDM. Población: pacientes con diagnóstico preoperatorio de tumoración anexial, período 2008-2010. Metodología: El IRM H2M se calculó con el producto del puntaje ultrasonográfico derivado de Sassone (U), estado menopáusico (M), Ca 125 (U/mL), y diámetro tumoral mayor (D). La prueba X2 fue usada para probar diferencias en el M, U y D. Se calculó la sensibilidad y especificidad del Ca 125 y el lRM H2M, asimismo se construyó curvas ROC para determinar su validez (IC 95 por ciento). Resultados: 105 pacientes fueron incluidos en el trabajo. Hubo diferencia significativa entre las edades del grupo de tumores benignos (N=85) y malignos (N=20) (42.16 ± 13.43 vs 50.70 ± 12.59 años; p<0.05). La neoplasia maligna más frecuente fue el cístoadenocarcínoma seroso (7.6 por ciento) y benigna cistoadenoma seroso (32.4 por ciento). Hubo buena correlación entre malignidad con "U", "M" y Ca 125. El "D" no mostró relación con la malignidad de los tumores. El área bajo la curva ROC del IRM H2M fue significativamente mayor que todos sus parámetros individuales; el mejor punto corte fue 346,5 con una sensibilidad de 90.0 por ciento y especificidad de 90.6 por ciento. Conclusión: El IRM H2M discrimina confiablemente los tumores anexiales en benignos y malignos.

Objective: To ascertain the usefulness of the IRM H2M in predicting malignancy in adnexal tumors in patients treated at HNDM between 2008 and 2010. Study: Observational, retrospective and transversal. Location: Oncologic Gynecology Service from HNDM. Population: Patients with preoperative diagnosis of adnexal tumor, between 2008 and 2010. Methods: IRM H2M index was calculated by multiplying the Sassone derived ultrasonographic score (U), menopausal status (M), ea 125 (U/mL) and the larger diameter of the tumor (D). The X2 test was used to prove differences in M, U and D. Sensitivity and specificity of the IRM H2M index was calculated and ROC curves were generated to determine its validity (Cl 95 per cent). Results: 105 patients were included in the study. There was a significant difference between the age of the patients with benign tumors (N=85) and those with malign ones (N=20) (42.16 ± 13.43 vs 50.70 ± 12.59 years; p<0.05). The most common malign tumor was the serous cystadenocarcinoma (7.6 per cent) and the most common benign tumor was the serous cystadenoma (32.4 per cent). There was a strong correlation between malignancy and "U", "M" and Ca-125. "D" did not show any relation with malignancy. The area under the ROC curve for the IRM H2M was significantly higher than every one of its individual components; the best cut off point was 346.5, with a sensitivity of 90.0 per cent and a specificity of 90.6 per cent. Conclusion: The IRM H2M index distinguishes reliably the adnexal benign tumors from the malign adnexal tumors.

Sistema de grupo sanguíneo ABO: [revisión] / ABO blood group system: [review]

el descubrimiento del grupo sanguíneo ABO en el año 1900 por el científico austríaco Karl Landsteiner, causó gran entusiasmo en la comunidad científica de la época. Hasta entonces, toda la sangre se consideraba igual en todas las personas, y no se entendían las consecuencias a menudo trágicas de las transfusiones de sangre. Con los descubrimientos realizados en el grupo sanguíneo ABO, no sólo la transfusión de sangre en el mundo se hizo mßs segura, sino que permitió el estudio de una de las primeras características hereditarias humanas descubiertas más importantes en medicina...

Sobrecarga asociada con el cuidado de ancianos dependientes / Caregiver burden in dependent elderly

Objetivo: Determinar la frecuencia y los factores asociados con la presencia de sobrecarga para el cuidador en ancianos dependientes. Diseño: Estudio piloto comparativo y observaciones de corte transversal. Pacientes y métodos: Se evaluaron 35 pacientes ancianos (>60 años) residentes en la comunidad de la ciudad de Buenaventura (Valle del Cauca, Colombia), que tuvieran un puntaje en el índice de Barthel <85 puntos y cuidador, entre marzo y mayo de 2006. Se evaluaron las variables socio-demográficas en el anciano y en el cuidador, así como las variables biomédicas. Para evaluar la esfera mental se aplicó la prueba de Minimental y para la depresión la escala de Depresión Geriátrica de Yesavage. En la valoración social se empleó la escala de APGAR familiar, para determinar la carga del cuidado la escala de Zarit y para la valoración funcional se utilizó el índice de Barthel. Resultados: El promedio de edad y la desviación estándar (DE) del grupo de pacientes fue 78.9±10 años. Se observó una mayor proporción de mujeres (68.5%). En los cuidadores, el promedio de edad y la DE fue 49.4±18.8 años, 91% eran mujeres. Se encontró que en 54.2% de los cuidadores no había sobrecarga, 40% presentaban una sobrecarga leve y el resto presentaba una sobrecarga intensa. Al realizar análisis bivariado entre la presencia de sobrecarga para el cuidador con número de enfermedades crónicas, puntajes en las escalas de la prueba de Minimental, depresión geriátrica y APGAR familiar se observaron asociaciones estadísticas (p<0.02). Se observó asociación significativa entre el grado de dependencia en las actividades básicas cotidianas (ABC) en el aspecto físico con la presencia de sobrecarga para el cuidador (p<0.001).

Objectives: To determine the frequency and the associated factors with the presence of care burden imposed by dependent elderly of Buenaventura, Valle; Colombia. Design: A pilot cross-sectional study. Patients and methods: Between March and May of 2006, data were collected on 35 over 60 years old patients who live in the community of Buenaventura, with a score in the Barthel index <85 and their caregiver. Socio-demographic variables were evaluated in the elderly and the caregiver. Medical variables were evaluated. For mental appraisal, the scale of the minimental test was applied and for the elderly depression the scale of geriatric depression of Yesavage was used. For the social evaluation, the family APGAR scale was applied, the care giver’s burden was determined by the Zarit scale, and the functional valuation by the Barthel index. Results: The mean age and the standard deviation of the patient group was 78.9±10 years. There was a larger proportion of women (68.5%). In the care givers, the regular age and the standard deviation was 49.4±18.8 years, where 91% were women. It was found that for 54.2% of the caregivers there was no burden at all, 40% of them had a minimum burden and the others a greater burden. Bivariate analysis between the care giver’s burden and the number of chronic disease, the score on the minimental test, elderly depression and the family APGAR, resulted in statistic association (p<0.02). Significant association was found between level of dependency in the basic common day activities related with physical aspects and the presence of care giver’s burden (p<0.001).

Análisis del llanto en niños hipoacúsicos y normoyentes de 0 a 2 años de edad

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Abstract: Infant crying is a complex phenomenon that implies several functions: breathing, action of laryngeal and supralaryngeal muscles under the control of the neurovegetative systems of the brainstem, and the limbic system, and the association of cortical areas and the cerebellum. Although it is a communication system different to babbling and language, it is related with the future development of phonation. Cry analysis provides information about the neuro-physiologic and psychological states of newborns and the identification of perinatal abnormalities. It is necessary to discuss the subject extensively because there are new data on situations such as laringomalacia, congenital hypothyroidism, deafness and sleep apnea that seem to be associated to infantile crying behaviors. Infant cries can be analyzed as behavioral conditions (hunger, anger and pain cries) allows knowing of mother-child relationship or the effect under diverse cultural conditions, such as stress, emo-tional deprivation or illness. A spectrographic analysis of the cries may identify several characteristics: threshold, latency, duration of phonation, maximum and minimum of the fundamental frequency (F0), occurrence and maximum pitch of shift, gliding, melody, biphonation, bifurcation, noise concentration, quality of the voice, double harmonic break, glottal plosives, vibratos, melody types, F0 stability and inspiratory stridor. To date, it has not been possible to establish alteration patterns. The best studied variables are F0, its harmonics and the duration of each emission; it is accepted that F0 varies between 400 and 600 Hz, during 1.4 ± 0.6s. Under such approaches, diverse alterations and risk factors have been studied: congenital alterations, malnutrition, sudden death, maternal exposition to drugs, prematurely born babies or perinatal asphyxia and disturbances of the central nervous system. Authors have reported F0 equal or less than 300 Hz in cases of sudden death or with high frequencies, near the 1000 Hz in the Cri du chat syndrome, perinatal asphyxia and other cases who died suddenly. During the cry, there is an increase of intra-abdominal pressure, heart rate and blood pressure, reduction of oxygen saturation, increase of the intra cranial-pressure, beginning of stress reactions, depletion of the energy anf oxygen reserves, such as the found in the Valsalva's maneuver. Every event of prolonged cries implies alteration of the breathing control like a Hering-Breuer reflex. Considering that some authors have proposed early vocalizations are a good predictor of deafness, in a previous paper we reported the characteristics of the cry of 20 deaf neonates. However, we were not able to demonstrate differences when comparing them with normal hearing neonates and infants, using only parametric methods. Still, we decided to go further and investgate the quality of infant cries of deaf neonates and infants. Material and methods. Twenty zero-to two-year old cases were studied; they were deaf children of both sexes; all cases were included in a follow-up program on the Human Communication Department of the National Institute of Perinatology of Mexico and were compared with 20 normal hearing children. We re-corded Brain Stem Evoked Auditory Responses (BEAR) and cry recording using a digital Sony recorder during the physical exploration. We analyzed the frequency (Hz) and duration of the espiratory cries, the duration of inspiration between two cry emissions and the characteristics of the spectrogram. Quantitative analysis. The usual estimates of means and standard variation were obtained and they were compared with one way analysis of variance. We organized typologies of frequency by means of cluster techniques (Ward method). The distribution of the duration of the periods of crying and silence was explored with a contingency tables. Qualitative analysis. Two standardized observers visually analyzed all the cries to determine any variation of F0 and of harmonic frequencies. Whenever a variation of F0 was observed, we obtained maximum and minimum frequencies, as well as average duration of each cry emission. The procedure was validated by means of the graphic comparison with a Fouries analysis. Results. Mean duration of cries in the deaf group was 0.5845 ± 0.6150 s (range 0.08-5.2 s), while in the group of normal hearing cases was 0.5387 ± 0.2631 (range 0.06-1.75 s). From the deaf group, five cases had very prolonged duration of cries, without statistical significance. The mean duration of the inspiration was 0.3962 ± 0.2326, with a range of 0.06 to 1.75 in the deaf group and of 0.4083 ± 0.1854, with a range of 0.21 at 0.96, in the controls, without difference among groups. There was no correlation between the time of espiratory cry and that of the inspiration. Three cry topologies were organized: one of shorter duration (mean 0.30 s), with 111 spectrograms, an intermediate one (mean 0.73) with 85 spectrograms and one of prolonged duration (mean 4.5 s) with spectrograms of three cases. Three topologies of the inspiratory period were obtained: one of short periods (mean 0.33 s), with 171 spectrograms, one of intermediate duration (mean 0.80 s) with 18 spectrograms and one of prolonged duration (mean 1.60 s) with three cases. There were no statistical differences of tipologies between the deaf groups and normal hearing cases. On the qualitative analysis of cries, we came across several variations which are interpreted as abnormalities: vibratos, poor melodic control, loss of fundamental frequencies, harmonic limited production, plosives, gliding, bi phonation, and a loss of intensity at end of cry emissions. These changes were also observed on the control cases, but only in a very limited number. Discussion. Cry spectrogram analysis are non invasive indicators of the neonate's neurophysiologic organization. Although cry duration varies in healthy newborns, the accepted variation for a normal range is 1.1 to 2.8 s, with standard deviations around 0.6 s. Consistent differences have not been demonstrated between risk and control groups. However, abnormal cases such as Down syndrome or severe asphyxia have very short cries, whereas on the Cri du chat syndrome the duration of cries is prolonged. Extended cries imply cardiac and respiratory risks which have been associated with later outcomes as development retardation and sudden death. There are also some questions to solve, such as the regulation and control of cry, starting from breathing mechanisms or from a sensorial afferent, mediated by hearing. The deaf infants are constituted in a study model, considering that the auditory afference is suppressed and the control of the cry is restricted to the breathing environment. In the studied spectrograms, the duration of the cry was within reported normal limits by other authors, inasmuch in the normal hearing control cases as in the deaf, except the dissident cases, but without these reaching statistical significance. Further research of brainstem function is needed for the abnormal cases with prolonged cry periods, since such cries are interpreted as an alteration of the breathing reflexes of Hering-Breuer, which might have a pathological meaning in the sense of the sob's spasm or even more severe risk factors as sleep apnea and even sudden death. The qualitative analysis in the deaf individuals demonstrated a poor quality and unstable character of melodic control, with a smaller number of harmonics. The deaf cases lost the relationship between the fundamental frequencies and their harmonics, mainly because of the participation of supraglottic structures that modulate pitch and due to the poorness of melodic control, either for monotony or due to the impossibility of returning to a normal pattern, following variations such as vibrato, plosives or noise concentration. In the cases of prolonged cries, starting from the third second, the sound intensity tends to diminish and the harmonics are lost, perhaps due to a decrease of the subglottal pressure of phonation. This finding supports the auditory control of crying related to breathing mechanisms. Conclusions. In preliminary terms, by means of the melodic analysis of the spectrograms, differences are demonstrated be-tween the cries of the deaf and of the normal hearing cases. The increase of the complexity of the melody of the cry, or their poverty, are indicative of the neuromuscular function and they may support the evaluation of phonation before language development. The study of the spectrograms of deaf individuals does not constitute an element for the detection or for diagnosis since, to date, estimators of sensibility or of specificity have not been established, but they constitute a support for its integral evaluation, with the possibility of evaluating and of improving therapeutic rehabilitation.

Diagnóstico serológico de la estrongiloidiosis humana por la técnica de ensayo inmunoenzimatico Medellín, Marzo 1992 – Septiembre 1993 / Sero-diagnosis of human strongyloidiosis by the enzyme linked immunosorbent essay. Medellín, March 1992 – September 1993

Estudio de tipo descriptivo, prospectivo y transversal en la vereda Piedecuesta del Municipio de Amaga, Antioquia, con en objetivo de estandarizar la técnica de ensayo inmunoenzimático (ELISA) para el diagnostico serológico de la estrogiliodiosis y evaluar la sensibilidad y especificidad de la prueba frente a otros métodos diagnósticos. Se estudiaron 301 personas, a las cuales se les realizó 3 coprológicos seriados más el método de concentración por formol-éter. Se seleccionaron en total 111 personas para la realización de ELISA, agrupados de la siguiente manera: pacientes infectados, 35 sueros de pacientes con infección comprobada parasitológicamente por Strongyloides stercoralizs. Grupo 2: Controles parasitados por nemátodos, 23 sueros de pacientes con nemátodos diferentes a S.stercoralis. Grupo 3: controles parasitados por protozoos, 18 sueros de pacientes por protozoos. Grupo 4: Controles con infectados, 35 sueros de pacientes no infectados por ningún parásito...

Purificación parcial de antígenos de menbrana para la obtención de antisueros que reconocen al melanoma B-16 / Parcial purification of membrane antigens for obtaining anti-sera recornizing melanma B-16

Se obtuvieron antisueros que reconocen selectivamente a melanocitos normales y malignos de ratón mediante 2 formas de inmunización: con cèlulas enteras del melanoma murino B-16 y con una fracción semipurificada de menbrana de dichas células. El reconocimiento de los antisueros fue ensayado por técnicas de ELISA e inmunofluorescencia contra melanoma y otros tejidos. Se concluyó que los antisueros obtenidos por inmunización con la fracción purificada presentaron un reconocimiento más especìfico de los melanocitos

Déficit de células OKT4+ en niños con enfermedad de Hodgkin: informe preliminar / Deficit of OKT4+ cells in children with Hodgkin's disease: preliminary report

Se estudiaron las poblaciones linfoides de sangre periférica en un grupo de niños y un grupo de adultos diagnosticados con enfermedad Hodgkin (HDG). Se cuantificaron las subpoblaciones de linfocitos T Rosetas-E+, OKT3+), linfocitos T "auxiliadores/inductores" (OKT4+), linfocitos T "citotóxicos/supresores" (OKT8+) y los linfocitos B (IgsS+). En el grupo de adultos enfermos, se encontraron niveles significativamente bajos de células Rosetas-E+ (p <0,05). En el grupo de niños enfermos, se encontró una inversión evidente del índice OKT4+/OKT8+ debido a que presentaron valores significativamente bajos de células OKT4+ (p < 0,001). Los resultados sugieren que en los niños con enfermedad de Hodgkin existe un incremento de la actividad supresora de la respuesta inmunológica, la cual podría estar asociada con el mecanismo de patogenia de la enfermedad