Concordance of the vestibular bone thickness at the level of point a between teleradiography and cone beam computed tomography / Concordancia del espesor óseo vestibular a nivel del punto a entre telerradiografía y tomografía computarizada de haz cónico

Objective: The aim of this study was to determine the concordance of the vestibular bone thickness measured at the level of point A between Teleradiography and Cone Beam Computed Tomography (CBCT). Materials and Methods: This study consisted of a cross-sectional analytical design of concordance that evaluated the teleradiographies and CBCTs of 32 patients. The measurements were performed by three evaluators, specialists in orthodontics. Two of them measured the CBCTs and one evaluated the teleradiographs. The concordance of both tests was determined using the Concordance Correlation Coefficient. Results: When evaluating the value of the vestibular bone thickness at the level of point A between the CBCT and the teleradiography, it was observed that the mean value of the absolute difference between the two was 0.95±0.74, 95%CI [0.68­1.22], being statistically significant (p=0.0027). When the concordance between both tests was analyzed, it was observed that it was poor (CCC=0.204 95%CI [0.014­0.394]), although statistically significant (p<0.00001). Conclusions: It was possible to conclude that there is no concordance in the measurement of the vestibular bone thickness at the level of Point A between the Teleradiography and the CBCT.

Objetivo: El objetivo de este estudio fue determinar la concordancia del espesor óseo vestibular medido a nivel del punto A entre la Telerradiografía y la Tomografía computarizada de haz cónico (CBCT). Materiales y Métodos: Esta investigación presentó un diseño analítico transversal de concordancia en el que se evaluaron las telerradiografías y CBCT de 32 pacientes. Las mediciones fueron realizadas por tres evaluadores especialistas en ortodoncia, dos de ellos midieron los CBCT y uno las telerradiografías. La concordancia de ambos exámenes fue medida mediante Coeficiente de Correlación de Concordancia. Resultados: Al evaluar el valor del grosor óseo vestibular a nivel del punto A entre el CBCT y la telerradiografía, se observó que el valor promedio de diferencia absoluta entre ambos fue de 0,95±0,74 IC95% [0,68­1,22], siendo estadísticamente significativas (p=0,0027). Cuando se analizó la concordancia entre ambos exámenes se observó que esta fue pobre (CCC=0,204 IC95 % [0,014­0,394]), aunque estadísticamente significativa (p<0,00001). Conclusión: Se pudo concluir que no existe concordancia en la medición del espesor óseo vestibular medido a nivel del Punto A entre la Telerradiografía y el CBCT.

Supervivencia global y libre de enfermedad en mujeres con sobrepeso/obesidad al diagnóstico de cáncer de mama: Un estudio observa-cional de centro único / Overall and disease-free survival in women being over-weight/obesityat the diagnosis of breast cancer. A single-center observationalstudy

Introducción:El objetivo del presente estudio fue evaluar las características clínicas, patológi-cas e histológicas tumorales y su asociación con la recurrencia, metástasis y pronóstico en términos de supervivencia global y libre de enfermedad, de las pacientes que padecen sobre-peso u obesidad al momento del diagnóstico de cáncer de mama.Materiales y métodos:Se condujo un estudio descriptivo,longitudinal,retrospectivo, en un centro oncológico de referencia de Medellín. Se recolectó información de pacientes mayores de 18 años, con cáncer de mama infiltrante temprano y avanzado, entre los años 2012 ­2017, quienes presentaran IMC ≥ 25 kg/m2 al momento del diagnóstico. Las medianas de supervi-vencia se calcularon a través de curvas de Kaplan Meier y las diferencias mediante Log Rank Test.Resultados:Se analizó información de 1.349 pacientes. La mortalidad por todas las causas fue de 13.6% y aumentó proporcionalmente con el IMC (HR = 1.03, IC 1.0-1.05). Se identifica-ron 12.6% de recurrencias y el riesgo con el aumento de IMC no fue estadísticamente signifi-cativo (HR =1.02, IC 0.99 -1.05). Características como mala diferenciación tumoral, invasión linfovascular y estadio tumoral se asociaron de forma univariada con mayor mortalidad.Conclusión:Se demostró una asociación positiva e independiente entre el IMC elevado, la mortalidad y el riesgo de recurrencia en pacientes con cáncer de mama. Así como una aso-ciación con fenotipos tumorales agresivos y características de peor pronóstico. Se sugiere considerar modificaciones en el estilo de vida y un manejo multidisciplinario, como estrate-gias que posiblemente impacten en estos desenlaces

Introduction:The objective of the present study was to evaluate the clinical, pathological, and histological characteristics of tumors and their associations with recurrence, metastasis,and prognosis in terms of overall and disease-free survival inoverweight or obese patients at the time of diagnosis.Materials and methods: A descriptive, longitudinal, retrospective study was conducted at a reference cancer center in Medellin. Information was collected from patients older than 18 years of age with early or advanced infiltrating breast cancer between 2012 and 2017 who had a BMI ≥ 25 kg/m2 at the time of diagnosis. Median survival rates were calculated using Kaplan­Meier curves, and differences were determined using the log-rank test.Results: Information from 1,349 patients was analyzed. All-cause mortality was 13.6% and increased proportionally with BMI (HR = 1.03, CI 1.0-1.05). A total of 12.6% of the recurrences were identified,and the risk with increasing BMI was not significantly different(HR =1.02, CI 0.99 -1.05). Patient characteristicssuch as poor tumor differentiation, lymphovascular inva-sion, and tumor stage were univariately associated with increasedmortality.Conclusion: Positiveand independent associations weredemonstrated between high BMI and mortality and between high BMI and the risk of recurrence in patients with breast cancer. In addition, there wasan association betweenaggressive tumor phenotypes and worse prog-nostic characteristics. Lifestylemodifications and multidisciplinary management should be considered strategies for impactingthese outcomes

La encefalitis letárgica de von Economo y la pandemia de la gripe española en Bogotá y Medellín: reseña histórica cien años después

La encefalitis letárgica de von Economo es un trastorno neuropsiquiátrico de posible origen autoinmunitario, en el cual se afectan los ganglios basales. Esta reacción puede ocurrir luego de una infección aguda por diversos agentes virales o bacterianos. Dado que aparece cuando ya se ha resuelto el cuadro agudo, se ha propuesto el mecanismo del mimetismo molecular para explicar la lesión autoinmunitaria. Se han reportado diversos casos a lo largo del tiempo, pero fue con la pandemia de influenza de 1918, conocida como la gripe española, que la encefalitis letárgica alcanzó niveles de epidemia, con casos reportados hasta 1923 en diversos países. La pandemia de la gripe española se extendió a Colombia durante los últimos meses de 1918 y afectó varias ciudades, principalmente Bogotá, donde se reportó el mayor número de enfermos y muertos. Con este trabajo se busca rememorar, cien años después, el ingreso de la gripe española a nuestro país y sus principales complicaciones, entre las que se describieron algunos casos de encefalitis letárgica.

Von Economo's encephalitis is a neuropsychiatric disorder of possible autoimmune origin, which affects basal ganglia. This reaction may occur secondary to infection by different viral or bacterial agents. Given that it appears after the acute episode has disappeared, molecular mimetism has been proposed to explain the autoimmune lesion. Several cases have been reported through time, but it was with the 1918 flu pandemic, known as the Spanish flu, that lethargic encephalitis reached epidemic levels with cases reported until 1923 in various countries. The Spanish flu pandemic appeared in Colombia at the end of 1918 in several cities but it affected especially Bogotá where the highest number of patients and deaths was reported. Our purpose with the present work was to commemorate the arrival of the Spanish flu to our country after one hundred years, as well as to reflect on its main complications, which included some lethargic encepahilitis cases.

Risk factors for severe postoperative complications after gastrectomy for gastric and esophagogastric junction cancers / Fatores de risco para complicações pós-operatórias graves após gastrectomia por câncer do estômago e junção esofagogástrica

ABSTRACT Background: Gastrectomy is the main treatment for gastric and Siewert type II-III esophagogastric junction (EGJ) cancer. This surgery is associated with significant morbidity. Total morbidity rates vary across different studies and few have evaluated postoperative morbidity according to complication severity. Aim: To identify the predictors of severe postoperative morbidity. Methods: This was a retrospective cohort study from a prospective database. We included patients treated with gastrectomy for gastric or EGJ cancers between January 2012 and December 2016 at a single center. Severe morbidity was defined as Clavien-Dindo score ≥3. A multivariate analysis was performed to identify predictors of severe morbidity. Results: Two hundred and eighty-nine gastrectomies were performed (67% males, median age: 65 years). Tumor location was EGJ in 14%, upper third of the stomach in 30%, middle third in 26%, and lower third in 28%. In 196 (67%), a total gastrectomy was performed with a D2 lymph node dissection in 85%. Two hundred and eleven patients (79%) underwent an open gastrectomy. T status was T1 in 23% and T3/T4 in 68%. Postoperative mortality was 2.4% and morbidity rate was 41%. Severe morbidity was 11% and was mainly represented by esophagojejunostomy leak (2.4%), duodenal stump leak (2.1%), and respiratory complications (2%). On multivariate analysis, EGJ location and T3/T4 tumors were associated with a higher rate of severe postoperative morbidity. Conclusion: Severe postoperative morbidity after gastrectomy was 11%. Esophagogastric junction tumor location and T3/T4 status are risk factors for severe postoperative morbidity.

RESUMO Raciona l: A gastrectomia é o tratamento principal para o câncer de junção esofagogástrica (EGJ) e Siewert tipo II-III. Ela está associada à morbidade significativa. As taxas de morbidade total variam entre os diferentes estudos e poucos avaliaram a morbidade pós-operatória de acordo com a gravidade da complicação. Objetivo: Identificar os preditores de morbidade pós-operatória grave. Métodos: Este foi um estudo de coorte retrospectivo de um banco de dados prospectivo. Foram incluídos pacientes tratados com gastrectomia para câncer gástrico ou EGJ em um único centro. A morbidade severa foi definida como escore de Clavien-Dindo ≥3. Análise multivariada foi realizada para identificar preditores de morbidade grave. Resultados: Duzentos e oitenta e nove gastrectomias foram realizadas (67% homens, mediana de idade: 65 anos). A localização do tumor foi EGJ em 14%, o terço superior do estômago em 30%, o terço médio em 26% e o terço inferior em 28%. Em 196 (67%), foi realizada gastrectomia total com dissecção de linfonodos D2 em 85%. Duzentos e onze pacientes (79%) foram submetidos à gastrectomia aberta. O estado T foi T1 em 23% e T3/T4 em 68%. A mortalidade pós-operatória foi de 2,4% e a taxa de morbidade foi de 41%. A morbidade severa foi de 11% e foi representada principalmente por fístula esofagojejunal (2,4%), fístula duodenal (2,1%) e complicações respiratórias (2%). Na análise multivariada, a localização do EGJ e os tumores T3/T4 foram associados com maior morbidade pós-operatória grave. Conclusão: Morbidade pós-operatória severa após gastrectomia foi de 11%. A localização do tumor na junção esofagogástrica e o estado T3/T4 são fatores de risco para a morbidade pós-operatória grave.

Survival and perioperative morbidity of totally laparoscopic versus open gastrectomy for early gastric cancer: analysis from a single latin american centre / Comparação da sobrevida e morbidade perioperatória da gastrectomia totalmente laparoscópica vs. laparotômica para tratamento do câncer gástrico precoce em um centro latino-americano

ABSTRACT Background: Laparoscopic gastrectomy has numerous perioperative advantages, but the long-term survival of patients after this procedure has been less studied. Aim: To compare survival, oncologic and perioperative outcomes between completely laparoscopic vs. open gastrectomy for early gastric cancer. Methods: This study was retrospective, and our main outcomes were the overall and disease-specific 5-year survival, lymph node count and R0 resection rate. Our secondary outcome was postoperative morbidity. Results: Were included 116 patients (59% men, age 68 years, comorbidities 73%, BMI 25) who underwent 50 laparoscopic gastrectomies and 66 open gastrectomies. The demographic characteristics, tumour location, type of surgery, extent of lymph node dissection and stage did not significantly differ between groups. The overall complication rate was similar in both groups (40% vs. 28%, p=ns), and complications graded at least Clavien 2 (36% vs. 18%, p=0.03), respiratory (9% vs. 0%, p=0.03) and wound-abdominal wall complications (12% vs. 0%, p=0.009) were significantly lower after laparoscopic gastrectomy. The lymph node count (21 vs. 23 nodes; p=ns) and R0 resection rate (100% vs. 96%; p=ns) did not significantly differ between groups. The 5-year overall survival (84% vs. 87%, p=0.31) and disease-specific survival (93% vs. 98%, p=0.20) did not significantly differ between the laparoscopic and open gastrectomy groups. Conclusion: The results of this study support similar oncologic outcome and long-term survival for patients with early gastric cancer after laparoscopic gastrectomy and open gastrectomy. In addition, the laparoscopic approach is associated with less severe morbidity and a lower occurrence of respiratory and wound-abdominal wall complications.

RESUMO Racional: A gastrectomia laparoscópica tem numerosas vantagens perioperatórias, mas a sobrevivência em longo prazo após este procedimento tem sido menos estudada. Objetivo: Comparar resultados de sobrevivência, oncológica e perioperatória entre a gastrectomia completamente laparoscópica vs. aberta para câncer gástrico precoce. Método: Este estudo foi retrospectivo e os principais resultados foram a sobrevivência global e específica de cinco anos, contagem de linfonodos e taxa de ressecção R0. Resultado secundário foi a morbidade pós-operatória. Resultados: Foram incluídos 116 pacientes (59% homens, idade 68 anos, comorbidades 73%, IMC 25) que foram submetidos a 50 gastrectomias laparoscópicas e 66 gastrectomias abertas. As características demográficas, a localização do tumor, o tipo de operação, a extensão da dissecção dos linfonodos e do estágio não diferiram significativamente entre os grupos. A taxa geral de complicações foi semelhante em ambos os grupos (40% vs. 28%, p=ns) e complicações classificadas Clavien 2 (36% vs. 18%, p=0,03), respiratórias (9% vs. 0%, p=0,03) e as da parede abdominal (12% vs. 0%, p=0,009) foram significativamente menores após a gastrectomia laparoscópica. A contagem de linfonodos (21 contra 23, p=ns) e a taxa de ressecção R0 (100% vs. 96%; p=ns) não diferiram significativamente entre os grupos. A sobrevida global de cinco anos (84% vs. 87%, p=0,31) e a sobrevida específica (93% vs. 98%, p=0,20) não diferiram significativamente entre os grupos de gastrectomia laparoscópica e aberta. Conclusão: Estes resultados suportam resultados oncológicos similares e sobrevida em longo prazo para pacientes com câncer gástrico precoce após gastrectomia laparoscópica e gastrectomia aberta. Além disso, a abordagem laparoscópica está associada com morbidade menos grave e menor ocorrência de complicações respiratórias e da parede abdominal.

Limitación del esfuerzo terapéutico: experiencias de enfermeras en una unidad de cuidados intensivos / Limitation of therapeutic effort: Experiences of nurses in an intensive care unit

El propósito de este estudio fue comprender cómo es la experiencia de las enfermeras en cuanto a vivenciar la limitación del esfuerzo terapéutico (LET) en unidades de paciente crítico de un hospital público de la región de Valparaíso. Se opta por un estudio de tipo cualitativo, de trayectoria fenomenológica, se realizó entrevista en profundidad a 3 enfermeras, con la pregunta orientadora ¿Qué experiencia tiene usted como enfermera de Unidad de Cuidados Intensivos (UCI) con respecto a la LET? Los discursos fueron interpretados bajo el referencial de Fenómeno Situado de Joel Martins. En los relatos se evidencia el uso de las palabras "manejo proporcional" como sinónimo, el rol de enfermería es confuso en la toma de decisión respecto a la LET pero se releva al momento del cuidado al final de la vida. Se concluye que las enfermeras son quienes deben asumir un rol más protagónico en el cuidado de la persona en esta situación, participando activamente en la toma de decisiones del binomio familia-paciente. Se recomienda la creación de protocolos para la LET, detallando la definición de la LET junto con el rol de enfermería y del equipo de salud, con el objetivo de no prolongar la vida innecesariamente, no aumentar la esperanza familiar y asegurar el cuidado al final de la vida.

The purpose of this study was to understand the experience of nurses in terms of experiencing limitation of therapeutic effort (LET) in critical patient units of a public hospital in Valparaíso. We opted for a qualitative study, a phenomenological trajectory, an in-depthinterview with 3 nurses, with the guiding question. What experience do you have as an Intensive Care Unit (ICU) nurse regarding LET? The speeches were interpreted under the referential of Located Phenomenon of Joel Martins. In the stories the use of the words "proportional management" is evidenced as synonymous, the nursing role is confusing in the decision making regarding the LET but it is relieved at the moment of care at the end of life. It is concluded that nurses are the ones who must assume a more protagonic role in the care of the person in this situation, participating actively in the decision making of the family-patient binomial. It is recommended the creation of protocols for the LET, detailing the definition of the LET along with the role of nursing and the health team, with the aim of not prolonging life unnecessarily, not increasing family hope and ensuring care at the end of life.

Síndrome de corea hiperglicemia y ganglios básales / Chorea hyperglicemia basal ganglia síndrome

Resumen La diabetes mellitus es una enfermedad de alta prevalência, así como también lo son sus complicaciones agudas. Una de ellas es el estado hiperosmolar no cetósico que raramente se asocia con alteraciones involuntarias del movimiento. Sin embargo, existe una condición que asocia alteraciones glucémicas con desórdenes del movimiento, denominado síndrome de corea hiperglicemia y ganglios basales, de la cual presentamos un caso y hacemos revisión de la literatura.

Abstract Diabetes mellitus is a disease of high prevalence, as well as its acute complications. One of them is the nonketotic hyperosmolar state that is rarely associated with involuntary changes in movement. However, there is a condition that associates glycemic alterations with movement disorders, called chorea hyperglycemia basal ganglia syndrome, of which we present a case and review the literature.

Experiencia inicial con esofagectomia mínimamente invasiva transtorácica en posición semiprono por cáncer esofágico / Initial experience with minimally invasive transtoraxic esophagectomy in semiprone position for esophageal cancer

Resumen Introducción El tratamiento quirúrgico del cáncer esofágico se asocia a una alta morbimortalidad. El abordaje mínimamente invasivo se ha introducido con el objetivo de disminuir la morbilidad postoperatoria. Objetivo Describir la técnica y los resultados de la esofagectomía mínimamente invasiva (EMI) transtorácica en posición semiprono. Métodos Estudio de cohorte descriptivo. Se incluyeron pacientes con una EMI electiva por cáncer entre abril de 2013 y mayo de 2017. Se registraron variables demográficas, perioperatorias, anatomía patológica y la sobrevida. Resultados Incluimos 33 pacientes (24 hombres, edad 69 años, 91% con comorbilidades). La ubicación predominante del tumor fue en los tercios medio e inferior del esófago (90%). Quince (45%) pacientes recibieron neoadyuvancia. No existieron casos de conversión a toracotomías. La reconstrucción se realizó con estómago en un 93%. Se realizó anastomosis cervical en 66% y torácica en 30%. El tiempo operatorio fue de 420 (330-570) minutos y el sangrado de 200 (20-700) cc. La mortalidad a 90 días fue de 0%. La morbilidad global fue de 78%, se registró un 15% de neumonía y un 9% requirió una reoperación. La estadía hospitalaria fue de 23 (11-81) días. La histología fue carcinoma escamoso en 51% y adenocarcinoma en 45%. Los márgenes fueron RO en 87%. El recuento ganglionar alcanzó 30 (9-45) ganglios. La sobrevida global a 2 años es 68%. Conclusión Los resultados preliminares de esta técnica son favorables; sin ningún caso de mortalidad postoperatoria. Los resultados oncológicos demuestran un alto porcentaje de cirugía RO y adecuado recuento ganglionar.

Introduction Surgical treatment of esophageal cancer is associated with high morbidity and mortality. The minimally invasive approach has been introduced with the aim of reducing postoperative morbidity. Aim To describe the surgical technique and the results of transthoracic minimally invasive esophagectomy (MIE) in semiprone position. Material and Methods Descriptive cohort study. Patients with an elective MIE for cancer were included between April 2013 and May 2017. Demographic, perioperative, pathology and survival variables were recorded. Results We included 33 patients (24 men, age 69 years, 91% with comorbidities). The predominant location of the tumor was in the middle and lower thirds of the esophagus (90%). Fifteen (45%) patients received neoadjuvant treatment. There were no cases of conversion to thoracotomy. The reconstruction was performed with stomach in 93%. Cervical anastomosis was performed in 66% and thoracic anastomosis in 30%. The operative time was 420 (330-570) minutes and bleeding 200 (20-700) cc. The 90-day mortality rate was 0%. Overall morbidity was 78%, there was a 15% occurrence of pneumonia and 9% required a reoperation. The hospital stay was 23 (11-81) days. The histology was squamous carcinoma in 51% and adenocarcinoma in 45%. Margins were RO at 87%. The lymph node count reached 30 (9-45) lymph nodes. Overall 2-year survival is 68%. Conclusion The preliminary results of this technique are favorable, without any case of postoperative mortality. The oncological results demonstrate a high percentage of RO surgery and adequate lymph node count.

Gastrectomía totalmente laparoscópica por neoplasias gástricas: Experiencia en un centro público / Totally laparoscopic gastrectomy for the treatment of gastric tumors

Background: The laparoscopic approach for the treatment of gastric tumors has many advantages. Aim: To evaluate the results of a laparoscopic gastrectomy program developed in a public hospital. Patients and Methods: Retrospective review of epidemiological, perioperative and follow-up data of patients who were treated with a laparoscopic gastrectomy due to gastric tumors between 2006 and 2013. A totally laparoscopic technique was used for all cases. Complications were evaluated according to the Clavien-Dindo classification. Results: Fifty one patients, aged 65 (36-85) years, underwent a laparoscopic gastrectomy. In 22 patients a total gastrectomy was performed. Conversion rate to open surgery was 8%. Operative time was 330 (90-500) min and bleeding was 200 (20-500) ml. Median hospital stay was 7 (3-37) days. Postoperative morbidity was present in 17 (33%) patients, 3 (6%) patients had complications grade 3 or higher and one patient died (1.9%). Tumor pathology was adenocarcinoma in 39 patients. A complete resection was achieved in 97%. Twenty nine patients (74%) with gastric adenocarcinoma had early gastric cancer and 84% of patients were in stage one. Median lymph node count was 24. Median follow-up was 26 (1-91) months. There was no cancer related mortality among patients subjected to a curative resection. Overall survival for patients with adenocarcinoma was 92% at 3 years. Conclusions: This study supports the feasibility and safety of a laparoscopic gastrectomy program in a public hospital; with low morbidity, adequate lymph node dissection and long-term survival. This approach must be considered an option for selected patients with gastric cancer.

Propiedades psicométricas del Inventario de Depresión de Beck-II en adolescentes chilenos / Psychometric properties of Beck's Depression Inventory II

En la presente investigación se estudian las propiedades psicométricas de la más reciente versión del Inventario de Depresión de Beck (BDI-II, Beck, Steer & Brown, 1996) en adolescentes chilenos. Una muestra de adolescentes consultantes a servicios de salud mental fue comparada con dos tipos de muestras controles. El inventario mostró un alto grado de consistencia interna (alfa=0,91) y apropiada correlación test-retest (t=0,66), así como capacidad para identificar adolescentes consultantes en servicios de salud mental. El BDI-II y la escala de afecto depresivo del MACI mostró una correlación de 7=0,82. Tanto una estructura unifactorial como bifactorial mostraron una adecuada bondad de ajuste en el análisis factorial confirmatorio. Los resultados indican que el BDI-II es un instrumento adecuado para evaluar sintomatología depresiva en adolescentes chilenos.

The psychometric properties of the most recent version of Beck's Depression Inventory (BDI-II, Beck, Steer & Brown, 1996) in Chilean adolescents is evaluated in the current research. A sample of adolescents from the mental health services was compared with two kind of control samples. The inventory showed high internal reliability (alpha=0,91) and proper test-retest correlation (r=0,66), as well as the ability to identify adolescents consulting in mental health services. The BDI-II and the MACI depression affection scale show a correlation of r=0,82. Both unifactorial and bifactorial structure show a suitable goodness-of-fit in the confirmatory factor analysis. The results indicate that BDI-II is an adequate instrument to assess depressive symptoms in Chilean adolescents.

Cánceres sólo detectados en la ultrasonografía mamaria / Cancers detected only in the breast ultrasound

Objetivos: Para evaluar la utilidad del ultrasonido mamario en nuestro medio, nos propusimos determinar el porcentaje de cánceres no detectables en mamografía, diagnosticados sólo en ultrasonido y determinar los factores que dificultan su diagnóstico mamográfico. Material y métodos: En el período comprendido entre enero de 2003 y diciembre de 2007, se realizó la revisión retrospectiva de los 441 cánceres estudiados en nuestro servicio. Se analizaron las características clínicas, mamográficos, ecográficas y anatomopatológicas de todos aquellos casos en que la mamografía no aportó signos sospechosos y la ultrasonografía detectó la lesión. Resultados: Ochenta y cuatro cánceres fueron detectados por ultrasonografía con mamografía negativa en 80 pacientes, edad media: 52.7 años (rango= 20-86). EI 98.8 por ciento fueron nódulos. Ninguno de ellos presentó microcalcificaciones. Tamaño lesional promedio: 15.8mm (rango= 5-60 mm). Veinte tumores eran clínicamente palpables, por 10 que los cánceres detectables exclusivamente en ultrasonido corresponde a un 14.5 por ciento. Se encontraron mamas densas (tipo ACR 3 Y4) en eI 82.5 por ciento. La histopatología reveló cánceres infiltrantes en 78 (93 por ciento). Conclusiones: E114.5 por ciento de los cánceres clínica y mamográficamente ocultos fueron detectables exclusivamente en ultrasonido. La gran mayoría de estos correspondía a pequeños cánceres invasores en mujeres de edad productiva. Los factores que influyeron negativamente en el diagnóstico mamográficos fueron: alta densidad del parenquima, ausencia de microcalcificaciones, mínima reacción estromal y pequeño tamaño tumoral. Por lo anterior, el uso del ultrasonido se recomienda como complemento indispensable a la mamografía especial mente en mamas densas.

Purpouse: To asses the utility of breast ultrasound (US) in our local area, we propose to determinate the percent of cancer in negative mammograms only detected by US and which factors make mammographically occult the malignancy. Materials and methods: From January 2003 through December 2007 we found 441 breast cancers, we reviewed the clinics, mammographies, ultrasounds and histopathologies findings in all the cases when the mammogram was negative and only the US detected. Results: Eighty four cancers were found only in US with negative mammogram in 80 patients, mean aged: 52.7 (range =20-86). The 98.8 percent were nodes. None of them had microcalcifications. Mean size was 15.8 mm (range= 5-60 mm). Twenty tumors were clinically palpable, so the cancers only detected by US corresponded to 14.5 percent. The 82.5 percent presented high density (type ACR 3 and 4). The histopathologies findings revealed invasive carcinoma in 78 (93 percent). Conclusions: The 14.5 percent of the non palpable and occult mamographically cancers were detected only detected by US. The most of them corresponded to small invasive carcinomas in women under 60 years old. The factors than influyed negatively in the diagnostic were: the high density of breast tissue, the ausence of microcalcifications, the minimal estromal reaction and small tumor size. We recommended the US like indispensable complement to mammograms, especially in women with dense breast.

Rotavirus and coronavirus outbreak: etiology of annual diarrhea in Costa Rican children

In Costa Rica, an annual outbreak of infant diarrheal disease (December and January) was reported since 1976, and rotavirus was incriminated later as the main etiological agent (1976-1981). Apparently the disease has not been systematically studied in Costa Rica after 1981. For that reason the occurrence of the outbreak was retrospectively documented for 1993-1995 and etiology was studied in 48 children treated for diarrhea at the Nacional Children Hospital (capital city of San Jose) during December, 1994 and January, 1995. Rotavirus (33percent) and coronavirus (27percent) were the main agents. To our knowledge, this is the first time that these viruses are incriminated in an outbreak of diarrhea