Ultrasonido realizado por el otorrinolaringólogo-cirujano de cabeza y cuello: revisión de la literatura

Resumen El ultrasonido realizado por el otorrinolaringólogo-cirujano de cabeza y cuello permite realizar evaluaciones y diagnósticos en tiempo real, tomar decisiones en un menor tiempo y realizar intervenciones, lo que aumenta la eficiencia de una consulta. A pesar del profundo conocimiento de la anatomía de cabeza y cuello del otorrinolaringólogo, esta técnica aún no es muy difundida en nuestro país. Se recomienda la acreditación en un curso impartido por una entidad conocida y realizar una evaluación en informe estructurado. El ultrasonido realizado por el otorrinolaringólogo-cirujano de cabeza y cuello ha demostrado excelentes resultados para diferenciar masas cervicales benignas de aquellas malignas, y muy importantemente para tomar muestras de punción con agua fina o biopsias core. Se presenta una revisión de la literatura sobre el ultrasonido realizado por el cirujano, sus indicaciones, utilidad y recomendaciones al momento de realizarla.

Abstract Head and neck surgeon-performed ultrasound allows evaluations and diagnoses in real time, make faster decisions and carry out interventions, which increases the efficiency of the medical appointment. Despite otolaryngologists have a deep knowledge about head and neck anatomy, this technique is still not widespread in Chile. It is recommended to take an accreditation program given by a well-known entity and to perform structured evaluations and reports. Head and neck surgeon-performed ultrasound has shown excellent results to differentiate benign from certain malignant cervical masses, as well as to perform fine needle aspiration biopsies and core biopsies. We present a literature review on surgeon-performed ultrasound, its indications, efficacy and recommendations at the time of performing it.

The impact of major league baseball on the incidence of operative hand and facial trauma at a level 1 trauma center

BACKGROUND: Professional affiliation between medical centers and professional sports teams can be mutually beneficial in the provision of healthcare and marketing strategy. Anecdotal evidence suggests a link between trauma volume and sporting events; however, there is limited data. This study aims to characterize the incidence of operative hand and facial trauma during professional baseball home games. METHODS: A retrospective review of surgical cases for traumatic hand or facial injuries at a level 1 center between 1999 and 2012 was performed. Demographic information including date of injury, admission status, and operative repair were collected. Patients were grouped based on whether their trauma occurred on the date of a home game. RESULTS: Operative hand and facial trauma occurred at a rate of 33.4 injuries per 100 days with home games, compared to 22.2 injuries per 100 days (incidence rate ratios, 1.50; 95% confidence interval, 1.34–1.69). When home games were played, patients were more likely to present as a result of motorcycle accidents (3.1% vs. 1.5%; P=0.04) or bicycle accidents (5.0% vs. 2.6%; P=0.01). Other mechanisms of trauma were not statistically different. There was an increase incidence of injuries during home games in August; weekly variability showed an increased incidence during the weekends. CONCLUSIONS: There was an increased rate of operative hand and facial injuries on dates with professional home games. The incidence of injuries during home games was higher in the late summer and on the weekends. Further analysis may allow improved resource allocation and strategies for injury prevention and treatment.

High-risk behaviors and experiences with traffic law among night drivers in Curitiba, Brazil

Objective: To explore high-risk behaviors and experiences with traffic law among night drivers in Curitiba, Brazil. Method: Data from 398 drivers on sociodemographic parameters, high-risk behaviors, experiences with traffic law, and traffic law violations were collected through interviews conducted at sobriety checkpoints. Exploratory-descriptive and analytical statistics were used. Results: The mean age of the participants was 32.6±11.2 years (range, 18 to 75 years). Half of the drivers reported having driven after drinking in the last year, predominantly single men aged 18 to 29 years who drive cars and drink alcohol frequently. Only 55% of the drivers who had driven after drinking in the last year self-reported some concern about being detected in a police operation. Conclusions: A significant association was found between sociodemographic variables and behavior, which can help tailor public interventions to a specific group of drivers: young men who exhibit high-risk behaviors in traffic, such as driving after drinking alcohol, some of whom report heavy alcohol consumption. This group represents a challenge for educational and enforcement interventions, particularly because they admit to violating current laws and have a low perception of punishment due to the low risk of being detected by the police.

Tissue distribution and tumor uptake of folate receptor-targeted epothilone folate conjugate, BMS-753493, in CD2F1 mice after systemic administration

To assess targeting of an epothilone folate conjugate (BMS-753493) to the folate receptor (FR)-overexpressed tumor in mice bearing both FR+ and FR- tumors, a series of experiments were conducted by quantitative whole-body autoradiography (QWBA) and LC-MS/MS following i.v. administration of BMS-753493 or its active moiety, BMS-748285 in mice bearing FR+ (98M109) and FR- (M109) tumors. QWBA showed [H]BMS-753493-derived radioactivity was extensively distributed to various tissues. The FR over-expressing 98M109 tumors showed consistently higher level of radioactivity than FR-negative tumors (., M109 tumors) up to 48 h post dose of [H]BMS-753493, despite the magnitude of difference between the tumors is relatively small (generally 3~5-fold). The radioactivity level in 98M109 tumors was 2~12-fold of normal tissues except intestine/content at 48 h post dose. No selective radioactivity uptake into 98M109 tumors over M109 or normal tissues was observed after i.v. administration of the active epothilone, [H]BMS-748285. LC-MS/MS measurements demonstrated that the concentrations of BMS-748285, presumably from hydrolysis of the folate conjugate, in 98M109 tumors were greater than those in M109 tumors after i.v. administration of BMS-753493 (2-3-fold) whereas no differential uptake in the tumors following BMS-748285 administration. Those data were consistent with radioactivity determinations. Those results demonstrated that the folate conjugation in BMS-753493 enabled moderately preferential distribution of the active epothilone to FR over-expressing 98M109 tumors, thereby supporting targeted delivery of cytotoxics through the folate receptor.

Targeting the Phosphatidylinositol-3-kinase Pathway in Gastric Cancer: Can Omics Improve Outcomes? / 대한배뇨장애요실금학회지

Phosphatidylinositol-3-kinase (PI3K) pathway signaling is an established oncogenic signal transduction pathway implicated in multiple malignancies. Therapeutic targeting of PI3K pathway components has improved outcomes in chronic lymphocytic leukemia, kidney cancer, breast cancer, and neuroendocrine tumors. Gastric cancers harbor some of the highest rates of oncogenic alterations in PI3K but attempts to translate this genomic observation have met with limited clinical success and novel approaches are needed. In the following review we discuss PI3K signaling, previous preclinical and clinical investigations in gastric cancer, and discuss future strategies aimed at overcoming resistance and improving efficacy. Identification and refinement of molecular tumor subtypes, development of predictive biomarkers along, and rational drug combination strategies are key to capitalizing on the therapeutic potential of PI3K pathway directed therapies in gastric cancers.

Targeting the Phosphatidylinositol-3-kinase Pathway in Gastric Cancer: Can Omics Improve Outcomes? / 대한배뇨장애요실금학회지

Phosphatidylinositol-3-kinase (PI3K) pathway signaling is an established oncogenic signal transduction pathway implicated in multiple malignancies. Therapeutic targeting of PI3K pathway components has improved outcomes in chronic lymphocytic leukemia, kidney cancer, breast cancer, and neuroendocrine tumors. Gastric cancers harbor some of the highest rates of oncogenic alterations in PI3K but attempts to translate this genomic observation have met with limited clinical success and novel approaches are needed. In the following review we discuss PI3K signaling, previous preclinical and clinical investigations in gastric cancer, and discuss future strategies aimed at overcoming resistance and improving efficacy. Identification and refinement of molecular tumor subtypes, development of predictive biomarkers along, and rational drug combination strategies are key to capitalizing on the therapeutic potential of PI3K pathway directed therapies in gastric cancers.

Mebiolgel, a thermoreversible polymer as a scaffold for three dimensional culture of Huh7 cell line with improved hepatocyte differentiation marker expression and HCV replication.

Purpose: A novel three dimensional (3D) culture system purely synthesised from co‑polymer which is free from biological contamination for Huh7 cell cultivation and hepatitis C virus (HCV) replication has been attempted. Materials and Methods: Mebiolgel, a thermo‑reversible gelation polymer was used as a 3D scaffold for culturing Huh7, a liver carcinoma cell line used in our study. The 3D culture of the cells were infected with cell culture derived HCV. Result: The scaffold supported the cell growth as 3D spheroids for up to 63 days. Moreover mebiolgel was found to be improving the hepatocyte differentiation of Huh7 cells at the transcript level. Three dimensional culture was susceptible for HCV infection, and this was confirmed by detecting the HCV replication intermediate viral core antigen. Conclusion: Mebiolgel based culture system was proven to be suited for 3D culture of Huh7 cells by improvising liver specific genotypic expression and was susceptible for HCV replication. Since mebiolgel based Huh 7 express better hepatocyte differentiation markers genotypically, this can be implemented as an alternate for primary hepatocytes in studies such as viral isolation from patient serum.

Successful transportation of human corneal endothelial tissues without cool preservation in varying Indian tropical climatic conditions and in vitro cell expansion using a novel polymer.

Background: Though the transplantation of human corneal endothelial tissue (CET) separated from cadaver cornea is in practice, its transportation has not been reported. We report the successful transportation of CET in varying Indian climatic conditions without cool preservation and the in vitro expansion of Human Corneal Endothelial Precursor Cells (HCEPCs) using a novel Thermo‑reversible gelation polymer (TGP). Materials and Methods: CET from cadaver corneas (n = 67), unsuitable for transplantation, were used. In phase I, CET was transported in Basal Culture Medium (Group I) and TGP (Group II) and in Phase II, in TGP cocktail alone, from three hospitals 250‑2500 km away, to a central laboratory. The transportation time ranged from 6 h to 72 h and the outdoor temperature between 20°C and 41°C. On arrival, CET were processed, cells were expanded upto 30 days in basal culture medium (Group A) and TGP scaffold (Group B). Cell viability and morphology were documented and Reverse transcription polymerase chain reaction (RT‑PCR) characterization undertaken. Results: In Phase I, TGP yielded more viable cells (0.11 × 106 cells) than Group I (0.04 × 106 cells). In Phase II, the average cell count was 5.44 × 104 cells. During expansion, viability of HCEPCs spheres in TGP was maintained for a longer duration. The cells from both the groups tested positive for B‑3 tubulin and negative for cytokeratins K3 and K12, thereby proving them to be HCEPCs. Conclusion: TGP preserves the CET during transportation without cool preservation and supports in vitro expansion, with a higher yield of HCEPCs, similar to that reported in clinical studies.

Combining Autologous Peripheral Blood Mononuclear Cells with Fibroblast Growth Factor Therapy Along with Stringent Infection Control Leading to Successful Limb Salvage in Diabetic Patient with Chronic Renal Failure and Severe Toe Gangrene

Peripheral arterial disease (PAD) is a common complication of Diabetes Mellitus (DM) and often culminates in amputation of the affected foot. Pseudomonas aeruginosa infections associated with PAD are difficult to treat due to their multi-drug resistance. Herein we report a 38 year old male who reported with DM, chronic kidney disease (CKD) and rest pain of the right second toe in October 2011. He underwent percutaneous transluminal angioplasty (PTA) which was unsuccessful. The gangrene of the toes worsened and amputation of the right second toe was done. Bacteriological examination showed presence of P. aeruginosa which during the course of antibiotic therapy became multi-drug resistant. Gangrene and abscess of the foot worsened and amputation of the right third toe was performed. Then autologous peripheral blood mononuclear cell (PBMNC) therapy was performed but as infection control could not still be achieved, the fourth toe was amputated. A protocol of foot bath using carbonic water, local usage of antibiotics (Polymyxin-B), and basic fibroblast growth factor (b-FGF) spray was then employed after which the infection could be controlled and improvement in vascularity of the right foot could be observed in angiography. This combined approach after proper validation could be considered for similar cases.

Correção estética de queloide gengival devido a sequela cirúrgica / Aesthetic correction of gingival keloid due to surgical sequels

O enxerto gengival livre obtido do palato carrega as características genotípicas daquela região. Desta maneira, quando realizado em áreas de exposição gengival pode representar uma queixa estética. A correção desta sequela costuma não ter sucesso quando se elimina superficialmente o tecido gengival, ocorrendo recidiva. Apresentamos um caso em que obtivemos êxito estético por meio de um enxerto pediculado de mucosa alveolar na área correspondente ao enxerto gengival com aparência de queloide. Métodos: paciente do gênero feminino, 32 anos, relata ter extraído o segundo pré-molar esquerdo há dois anos, com perda da tábua óssea vestibular e que, posteriormente, foi realizado um enxerto ósseo e gengival livre, resultando em cicatriz com aspecto de queloide. Realizada inicialmente uma gengivoplastia, houve pouca alteração na aparência do queloide. Idealizou-se, então, uma técnica que poderíamos denominar de enxerto pediculado de mucosa alveolar, onde foi possível a correção estética. Resultado: foi possível a correção da aparência queloide do enxerto gengival livre, pela substituição por enxerto pediculado de mucosa alveolar sobre a área previamente operada. Conclusão: deve-se evitar enxerto gengival livre em áreas estéticas. É possível corrigir a sequela estética por meio de enxerto pediculado de mucosa alveolar.

Manejo de la pancreatitis aguda: guía de práctica clínica basada en la mejor información disponible / Management of acute pancreatitis: clinical practice guideline based on the best vailable evidence

El tratamiento de la pancreatitis aguda ha variado en el transcurso de los últimos años. La mayoría de los pacientes que cursan con pancreatitis aguda leve, sobrevive sin mayores complicaciones; por el contrario, aquellos con pancreatitis aguda grave presentan un curso incierto y, con respecto a su morbimortalidad, la infección pancreática es el factor de riesgo más importante. Los avances en el diagnóstico por imágenes y el desarrollo de la radiología intervencionista, han revolucionado el tratamiento quirúrgico.

The management of acute pancreatitis has evolved significantly over the last few years. Currently, most patients with acute pancreatitis survive without complications. Severe acute pancreatitis show bizarre evolution and the most important risk factor for morbidity and mortality is infection of the pancreatic necrosis. Advances in diagnostic imaging and minimally invasive techniques in surgery and radiology have revolutionized the surgical management of this disease.

Hazardous alcohol use in rural southern India: Nature, prevalence and risk factors.

Background. There is a dearth of data on the hazardous use of alcohol in rural India. Methods. We examined the nature, prevalence and factors associated with hazardous use of alcohol among men in a rural community in southern India. We used stratified sampling to select subjects from the Kaniyambadi block and employed ‘AUDIT’, a standard instrument, to assess the use of alcohol. Results. The prevalence of life-time use, use in the past year and hazardous use of alcohol was 46.7%, 34.8% and 14.2%, respectively. Using Indian made foreign liquor (OR 20.51; 95% CI 8.81–47.75) and living in a village which brewed illicit alcohol (OR 2.82; 95% CI 1.39–5.72) were risk factors for hazardous use while education (OR 0.39; 95% CI 0.21–0.72) was protective. These factors remained significantly associated with hazardous use after adjusting for age and education using logistic regression. Conclusion. The relationship between the availability of illicit and commercial alcohol and its hazardous use suggests the need for an alcohol policy which takes into account health and economic issues and also implements the law to prevent the negative impact of problem drinking.

Signaling pathways in early onset sporadic breast cancer of patients in Indonesia.

AIM: to determine signaling pathways in breast cancers from patients aged 35 years old or younger and patients aged more than 35 years old. METHODS: this was a cross-sectional, comparative study of female breast cancer patients who were recruited and divided into two age groups, i.e. 35 years or younger and more than 35 years old. Specimens were obtained by biopsy or surgical removal of the tumors and were confirmed by histopathological examination. The expression of ER, IGF-1R, Her-2, MAPK, and cyclin D1 were measured using immunohistochemistry. RESULTS: ninety-three patients were recruited from September 2004 to December 2005. Forty-three patients were 35 years or younger. More than 90% of the patients within the two groups showed invasive ductal carcinomas and more than half of these tumors were grade 2. Immunohistochemical staining was successfully done in 90 patients. ER-alpha expression was negative in 33 breast cancers (78.6%) from patients less than 35 years old and 32 cancers (66.7%) of older patients. The expressions of IGF-1R, Her-2, MAPK, and cyclin D1 were positive, respectively in 17 (40.5%), 11 (26.2%), 28 (66.7%), and 7 (16.7%) cancers within the group of patients 35 years old or younger, and, respectively in 18 (37.5%), 11 (22.9%), 37 (77.1%), and 9 (18.8%) of cancers from patients more than 35 years old. CONCLUSION: there were no statistically significant differences in the expression of any of the biomarkers between the two groups. In all patients, ER was negative in 72.2% cases and MAPK was positive in 76.7% cases. Patients aged 35 years or younger showed similar ER, IGF-1R, Her-2, MAPK, and cyclin D1 expressions compared to cancers from patients more than 35 years old. These were predominantly ER-negative, suggesting that estrogen does not play a dominant role in their growth. The frequent expression of MAPK in these cancers raises the possibility that growth factors play a dominant role in their growth.

Primary Sjö-gren's syndrome presenting with distal, renal tubular acidosis and rhabdomyolysis.

Primary Sjögren's syndrome (PSS) is rare in India. Clinically manifest renal disease in PSS is uncommon and is usually an autoimmune tubulointerstitial nephritis presenting with distal renal tubular acidosis (dRTA) or a urinary concentrating defect. Hypokalemic paralysis due to dRTA in PSS is rare but well documented in medical literature. Rhabdomyolysis as a consequence of hypokalemia in PSS is exceptional. We report a case of PSS with dRTA and rhabdomyolysis causing prolonged respiratory failure and quadriparesis.

Comparison of acute toxicities of two chemotherapy schedules for head and neck cancers.

BACKGROUND: Chemo-radiotherapy has become the standard of care for loco-regionally advanced head and neck cancers. Platinum based regimens are the most effective. Although benefits are proven with chemo-radiation, acute toxicities are markedly increased. The dose and delivery schedules of Cisplatin have ranged from intermittent higher dose [100 mg/m2] every 3 weeks to low dose [6 mg/m2] daily administration. At present there is no data indicating which regimen is superior. PURPOSE: To compare acute toxicities of two chemotherapy schedules for head and neck cancers. MATERIALS AND METHODS: A total of 83 head and neck cancer patients treated with two schedules of concurrent chemo RT were analyzed, retrospectively, for treatment toxicity. In group A [51 patients], chemotherapy [CT] was administered on week 1, 4 and 7 [cisplatin 100 mg/m2] over a period of 2-3 days. In group B [32 patients], CT was delivered weekly [cisplatin 40 mg/m2]. Radiotherapy dose was 7000 cGy in 35 fractions for definitive concurrent chemo-radiation and 6600 cGy in 33 fractions for adjuvant treatment. RESULTS: Group B patients had increased grade III skin and hematological toxicity, where as patients in group A had more pharyngeal toxicity. Treatment interruptions and percentage of weight loss were higher in group B. Weekly CT schedule had higher rate of severe mucositis, which was statistically significant on both univariate [P = 0.005] and multivariate [P = 0.007] analysis. CONCLUSIONS: Three weekly CT is less toxic than weekly. Weekly CT can be made more acceptable by reducing the dose and using feeding tubes for nutrition.

Clinico-radiological profile of stroke in eastern Nepal: a computed tomographic study.

AIM: Stroke is a frequent cause of death and disability in elderly patients. This study was carried out to establish the pattern of various types of cerebrovascular accident (CVA) in eastern Nepal and to correlate the clinical data and radiological findings in cases of stroke. MATERIALS AND METHODS: All the patients clinically diagnosed as stroke and referred to the radiology department for Computed tomography (CT) of the brain over a period of 1 year were included. RESULTS: There were 150 patients with stroke (104 males and 46 females), aged 7 to 91 years in which infarction (58%) was more common than haemorrhage (42%) in both group of age (< or = 40 years and > 40 years). Smoking was the commonest risk factor noted in 40.66% cases followed by hypertension (40%). Excessive meat consumption (more than 4 times a week) was seen in 69.1% cases. In early Middle Cerebral Artery (MCA) territory infarction presenting within six hours of onset, positive CT findings were seen in 40% cases among which, obscuration of the lentiform nuclei was diagnostic. CONCLUSION: In this part of Nepal, infarction is more common than haemorrhage as the cause of stroke and in contrary to western population; hemorrhagic stroke constitutes a significantly higher proportion of stroke. Smoking is the commonest risk factor followed by hypertension and it is also seen in combination with alcohol in many cases. Excessive meat consumption could be an additional risk factor for stroke in this part of Nepal. In younger age group (< or = 40 years), haemorrhage is more common than infarction and alcohol consumption is the commonest risk factor.

Development of oral health in Africa

Around 80% of African communities can be considered to be materially deprived. The presence of widespread poverty and underdevelopment in Africa means that communities are increasingly exposed to all of the major environmental determinants of oral disease. Previous approaches to oral health in Africa have failed to recognize the epidemiological priorities of the region or identify reliable and appropriate strategies to address them. Efforts have consisted of providing unplanned, ad hoc and spasmodic curative oral health services, which in most cases are poorly distributed and only reach affluent or urban communities. Realizing the limited impact of existing strategies, the World Health Organization Regional Office for Africa [WHO/AFRO] developed a regional oral health strategy to assist African countries and their partners in identifying priorities and planning preventive-oriented programmes, particularly at the district level. The long-term objective is to provide equitable and universal access to cost-effective quality oral healthcare and thereby significantly reduce the incidence of oral diseases in Africa

Prevención de la deficiencia de hierro y la anemia por ésta durante los primeros cinco años de vida / Detection and prevention or iron deficiency and iron deficiency anemia during the first five years of life

La deficiencia de hierro es la deficiencia nutrimental más común en lactantes y preescolares tanto en países industrializados como en menos industrializados. Por ello, es muy importante conocer los requerimientos de hierro tanto en lactantes como en niños de 1 a 5 años de edad. La biodisponibilidad de hierro en los alimentos depende de la forma de hierro (hierro heme o no heme) y la presencia de inhibidores o "facilitadores" de la absorción de éste.Las estrategias para eliminar la deficiencia de hierro deben dirigirse preferentemente a los lactantes que provienen de familias de escasos recursos económicos, a lactantes alimentados con fórmulas no adicionadas con hierro (sin considerar el estado socioeconómico), a quienes son alimentados con leche de vaca o aquellos alimentados con leche materna más allá de los 4 meses.En niños de 1 a 5 años se sugiere: 1. Favorecer el consumo de carnes, aves y pescado si las condiciones económicas lo permiten; 2. Consumir alimentos adicionados con hierro, de preferencia sulfato o fumarato ferroso; y 3. Dar atención especial a la relación temporal entre el consumo de alimentos utilizados como fuentes de hierro y alimentos que contribuyen con mayores inhibidores y "facilitadores" de la absorción de hierro no heme.