Rabdomiosarcoma laríngeo en un adulto, descripción de un caso y revisión de la literatura / Adult laryngeal rhabdomyosarcoma. Case report and literature review

Resumen El rabdomiosarcoma laríngeo es un cáncer infrecuente en cabeza y cuello, y aún más en adultos. Describimos el caso de un varón de 55 años con un rabdomiosarcoma del músculo cricoaritenoideo posterior izquierdo tratado mediante laringectomía total y linfadenectomía funcional bilateral.

Abstract Laryngeal rhabdomyosarcoma is an uncommon cancer in head and neck, especially in adults. We report a 55 years old male with a rhabdomyosarcoma from the left posterior cricoarytenoid muscle treated with a total laryngectomy and double functional cervical lymphadenectomy.

Schwannoma septal, una causa infrecuente de obstrucción nasal / Septal schwannoma, an uncommon cause of nasal obstruction

Resumen Los schwannomas son neoplasias derivadas de las células de Schwann de la cubierta de los nervios periféricos. Su desarrollo en la región nasosinusal es poco frecuente, especialmente a nivel septal. Su diagnóstico diferencial es variado y debe establecerse con otras causas más habituales de masa nasal unilateral. Su tratamiento es quirúrgico. Describimos el caso de un varón de 47 años con una masa nasal derecha intervenida mediante cirugía endoscópica nasosinusal y con diagnóstico anatomopatológico de schwannoma septal.

Abstract Schwannomas are tumors that proceed from Schwann cells in the cover of peripheral nerves. It is uncommon in the sinonasal area, especially in the nasal septum. The differential diagnosis is extensive and requires contemplating other more frequent causes of unilateral nasal mass. The current treatment of septal schwannoma is surgical. We report a 47-year-old male with a right nasal mass operated by endoscopic sinonasal surgery with an anatomopathological diagnosis of a nasal septal schwannoma.

Encefalocele en paciente con síndrome de Hurler: descripción y revisión de alternativas terapéuticas / Encephalocele in a patient with Hurler syndrome: description and therapeutic alternatives review

Introducción: el síndrome de Hurler es la forma más grave de la mucopolisacaridosis I. El depósito de heparán y dermatán sulfato en las meninges favorece el desarrollo de hidrocefalia y, a su vez, de meningoencefaloceles. Caso clínico: se describe el caso de una paciente de 23 años con este síndrome y un encefalocele nasosinusal intervenido mediante cirugía endoscópica nasosinusal y posterior refuerzo mediante un colgajo pericraneal. Discusión: el abordaje endoscópico de los meningoencefaloceles nasales ha crecido notablemente en los últimos años debido a una tasa de éxito elevada tanto para la eliminación de dicha lesión, como para el adecuado control de la fístula de líquido cefalorraquídeo consecuente. Conclusiones: actualmente, la cirugía endoscópica nasosinusal es una herramienta muy útil para el tratamiento de patologías de base de cráneo y reduce la morbilidad causada por el abordaje transcraneal.

Introduction: Hurler syndrome is the most severe version of mucopolysaccharidosis I. The storage of dermatan and heparin sulfate in meninges allows the development of hydrocephalus and meningoencephaloceles. Case report: We report a 23-year-old female with this syndrome and a sinonasal encephalocele operated by endoscopic sinonasal surgery and subsequent pericranial flap as support. Discussion: Endoscopic sinonasal surgery has grown in last years in relation with treatment of sinonasal meningoencephaloceles due to a high rate of success removing the lesion and closing the subsequent cerebrospinal fluid fistula. Conclusion: Currently, the endoscopic sinonasal surgery has become a useful tool in the management of skull base pathologies, and reduces the morbidity due to a transcranial approach.

Queratoquistes odontogénicos maxilares en paciente con síndrome de Gorlin. Descripción de un caso y revisión de la literatura / Maxillary odontogenic keratocysts in a Gorlin síndrome patient: Case report and literatura review

Los queratoquistes maxilares son frecuentes en pacientes con síndrome de Gorlin. Su tratamiento es debatido por su alta tendencia a la recidiva. En los últimos años la cirugía endoscópica nasosinusal ha adquirido importancia en el manejo de esta patología. Exponemos en caso de un varón de 16 años afecto de este síndrome con queratoquistes maxilares donde se realiza un abordaje combinado, endonasal y transoral.

Maxillary keratocysts are frequent in Gorlin Syndrome patients. Its treatment is discussed due to the high tendency to recurrence. In the last years the sinonasal endoscopic surgery has become an important tool in the management of this pathology. We report a 16 years old boy with Gorlin Syndrome and maxillary keratocysts treated with a trans-nasal endoscopic and intra-oral combined approach.

Condrosarcoma del hueso hioides: a propósito de un caso

Resumen Los condrosarcomas son cánceres realmente infrecuentes en cabeza y cuello, y más aún en el hueso hioides. Por lo general, son neoplasias que debutan como una masa cervical sin otra sintomatología. Su diagnóstico requiere de estudios de imagen y su tratamiento es fundamentalmente quirúrgico. Comentamos el caso de un paciente de 57 años, desde el diagnóstico de la lesión hasta su tratamiento y seguimiento, y una revisión bibliográfica de esta patología.

Abstract Chondrosarcomas are a rare type of head and neck cancer, especially in the hyoid bone. They usually make their debut through a cervical mass, without other symptoms. The diagnosis requires image studies, and the treatment is fundamentally surgical. We report the case of a 57 years old patient, from the lesion diagnosis, its treatment and follow up, and a bibliographic review of this pathology.

Milk yield and composition in dairy cows with post-partum disorders / [Produção e composição do leite em vacas com desordens no pós-parto]

This study aimed to determine the impact of different post-partum disorders on milk yield and composition. One hundred and fifteen Holstein cows from a commercial dairy farm located in the state of Rio Grande do Sul in southern Brazil were monitored up to 62 days post-partum. During this period, body condition score evaluation and animal clinical examination were conducted. Percentages of fat, protein, and lactose, as well as somatic cells score, were determined in milk samples. The AST activity and concentrations of NEFA, calcium, and BHBA, were analyzed in blood samples. The occurrence of clinical disorders was identified in 30 (26%) cows. Subclinical disorders were identified in 64 (56%) cows. Only 21 (18%) cows did not suffer any kind of disorder within the studied period. In this study, no significant differences were found in milk production, protein, and somatic cell count in clinical, subclinical, and healthy cows. Milk fat and the fat: protein quotient (F:P) were higher in cows with clinical disorders and the 6 to 21 days in milk, and lactose were lower in cows with clinical disorders and the 22 to 42 days in milk (P<0.05).(AU)

O objetivo deste estudo foi determinar o impacto de diferentes distúrbios após o parto na produção de leite e em sua composição. Cento e quinze vacas Holandesas de uma fazenda de gado leiteiro, localizada em estado da região Sul do Brasil, foram monitoradas até 62 dias após o parto. Durante esse período, foram realizadas avaliações do escore de condição corporal e exame clínico nos animais. As porcentagens de gordura, proteína e lactose, bem como o escore de células somáticas, foram determinadas nas amostras de leite. A atividade do AST e as concentrações de NEFA, cálcio e BHBA foram analisadas em amostras de sangue. A ocorrência de distúrbios clínicos foi identificada em 30 (26%) vacas, os distúrbios subclínicos foram identificados em 64 (56%) vacas. Apenas 21 (18%) vacas não sofreram nenhum tipo de distúrbio ao longo do período estudado. Neste estudo, não foram encontradas diferenças significativas na produção do leite, proteína e na contagem de células somáticas em vacas com doenças clínicas, subclínicas e saudáveis. No leite, a gordura e o quociente gordura e proteína (G:P) foram maiores em vacas com doença clínica no período de seis a 21 dias de lactação, e a lactose foi menor em vacas com doença clínica no período de 22 a 42 dias de lactação (P<0,05).(AU)

Metabolic profile of female lambs on annual ryegrass pasture managed under different grazing intensities and methods / [Perfil metabólico de cordeiros fêmeas em pastagem de azevém manejada sob diferentes intensidades e métodos de pastejo]

The aim of this study was to evaluate the effect of grazing methods and intensities on the metabolic profile of lambs grazing ryegrass. This study was performed in Eldorado do Sul (RS). The treatments consisted of two grazing intensities with rotational and continuous stocking methods: moderate and low. The experimental design was a randomized block arranged in a factorial scheme with four replicates. To evaluate the metabolic and nutritional conditions of the lambs, blood samples were collected to evaluate phosphorus, albumin, glucose, magnesium, globulin, cortisol, urea and total proteins. The highest blood urea value was observed in the month of September in lambs kept in continuous method grazing. There was no statistical difference between the grazing intensities and grazing methods for albumin, glucose, magnesium, globulin, cortisol and total protein levels in profile lambs. The cortisol values suggested that the animals were not subjected to high stress levels. In conclusion, rearing female lambs on ryegrass, irrespective of grazing methods or intensities, allowed the maintenance of body homeostasis and did not cause any metabolic unbalances, nutritional unbalances or stress.(AU)

O objetivo deste estudo foi avaliar o efeito dos métodos e das intensidades de pastejo no perfil metabólico de cordeiros. Este estudo foi realizado em Eldorado do Sul (RS). Os tratamentos consistiram em duas intensidades de pastejo (moderada e baixa), com métodos lotação rotativa e lotação contínua. O delineamento experimental foi em blocos ao acaso, em esquema fatorial com quatro repetições. Para avaliar as condições metabólicas e nutricionais dos cordeiros, foram coletadas amostras de sangue para avaliar fósforo, albumina, glicose, magnésio, globulina, cortisol, ureia e proteínas totais. O maior valor de ureia no sangue foi observado no mês de setembro nos cordeiros mantidos em pastejo contínuo. Não houve diferença estatística entre as intensidades de pastejo e os métodos de pastejo para albumina, glicose, magnésio, globulina, cortisol e níveis de proteína total nos cordeiros perfilados. Os valores de cortisol sugeriram que os animais não foram submetidos a altos níveis de estresse. Concluindo, a criação de cordeiros em azevém, independentemente dos métodos ou das intensidades de pastejo, permitiu a manutenção da homeostase corporal e não causou desequilíbrios metabólicos, desequilíbrios nutricionais ou estresse.(AU)

Hipertrigliceridemia severa refractaria a tratamiento médico y pancreatitis aguda recurrente: uso de plasmaféresis crónica ambulatoria en el Hospital San Pablo de Coquimbo. Reporte de un caso

Severe Hypertriglyceridemia (HTG) is associated with complications such as acute pancreatitis (AP) with high morbidity and mortality rates. We report a 42 years-old man with refractory HTG diagnosed at 19 years of age, and multiple episodes of AP, admitted with the suspicion of a new AP episode. Serum triglycerides were over 2000 mg/dl. His body mass index was 18 kg/m2, there was no evidence of xanthomas or xanthelasmas, but lipemia retinalis was found. Management included heparin and insulin, added to his usual treatment with fibrates, statins, omega-3 fatty acids, and orlistat. Due to lack of response, apheresis was started. After five sessions, triglycerides decreased to 588 mg/dl (82% reduction) and levels remained below 1000 mg/dl with daily apheresis. The patient continued with weekly sessions as outpatient with a sustained good response.

Onicomicosis en pediatría: actualización y tratamiento / Pediatric onychomycosis: update and management

Resumen: La onicomicosis (OM) es una infección fúngica de las uñas, cuyo principal agente causal es el Tricophytum rubrum. Si bien es una patología infrecuente en niños, se ha observado un aumento en la prevalencia en el último tiempo. Hasta la fecha, existen diversos estudios y guías clínicas de OM en adultos. Sin embargo, la literatura en edad pediátrica es escasa, lo que dificulta el tratamiento en pediatría. En el presente articulo se revisa la literatura actual, los métodos diagnosticos de OM, datos epidemiológicos locales y globales, y se presentan las opciones de tratamiento disponibles conside rando su eficacia y perfil de seguridad en población pediátrica.

Abstract: Onychomycosis (OM) is a fungal infection of the nails, whose main etiologic agent is Trichophytum rubrum. Although, it is an unusual pathology in children, in the last years an increase in its preva lence has been observed. To date, there are several studies and clinical guidelines for OM in adults. However, literature in children is scarce, which makes pediatric treatment difficult. The objective of this publication was to review the current literature in order to establish diagnostic methods for OM, national and international epidemiological data, and to provide treatment options taking into account their efficiency and safety profile in the pediatric population.

Caracterización de las consultas realizadas a un Centro de Información Toxicológica por productos de aseo y productos cosméticos en niños / Characterization of the phone-calls made to a poison center related to household and cosmetics products exposition in pediatrics

INTRODUCCIÓN: Los productos de aseo y cosméticos son necesarios en el diario vivir y ampliamente utilizados por la población. Sin embargo, su uso puede no estar exento de riesgos, especialmente cuando no se utilizan o almacenan según lo recomendado. Es importante caracterizar las exposiciones, ya que eso es útil para implementar estrategias para reducir la morbilidad, mortalidad y costos asociados, especialmente en la población infantil. OBJETIVO: Caracterizar los reportes asociados a exposiciones a productos de aseo y productos cosméticos en pacientes menores de 12 años reportados al Centro de Información Toxicológica de la Universidad Católica de Chile (CITUC). PACIENTES Y MÉTODO: Estudio descriptivo transversal de llamados telefónicos reportados a CITUC durante el año 2016. Se analizaron las variables: edad, sexo, agente, interlocutor, localización del interlocutor e inciden te, circunstancia de exposición, vía(s) de exposición, sintomatología, y severidad, mediante fichas de registro manual y desde el software de registro electrónico denominado "INTOX Data Manage ment System" de la OMS. RESULTADOS: Cumplieron criterios de inclusión 3.415 casos. Los menores de 5 años representaron el 91% de las exposiciones y el 58,5% correspondió al sexo masculino. Un 99,4% correspondió a exposiciones accidentales y el 98,6% ocurrieron en el hogar. El 68,3% no presentó síntomas, tras la exposición. Las llamadas fueron realizadas por familiares (57%) y personal de salud (42%). Los 4 agentes con mayor incidencia fueron cloro doméstico (27,6%), limpiadores y lustres de pisos (13,1%), lavalozas (7,9%) y perfumes/colonias (5,8%). La principal vía de exposición fue digestiva (89,4%). CONCLUSIONES: Los productos de aseo y cosméticos son causas comunes de exposiciones especialmente en menores de 5 años. Si bien son productos de baja mortalidad y morbilidad, es importante educar a la población para prevenir posibles intoxicaciones en la población infantil.

INTRODUCTION: Household cleaning products and cosmetics are necessary for daily life and widely used by the population. However, their use may not be risk-free, especially when they are not used or stored as recommended. It is important to characterize exposures, as this is useful for developing stra tegies to reduce morbidity, mortality, and health costs associated, especially in the child population. OBJECTIVE: To describe reports associated with household cleaning products and cosmetics exposure in patients under the age of 12, reported to the Poison Information Center of the Catholic University of Chile (CITUC). PATIENTS AND METHOD: Descriptive cross-sectional study of phone calls to CITUC during 2016. The analyzed variables were age, sex, product, caller, caller and incident location, ex posure circumstances, exposure route(s), symptoms, and severity from manual records and from the WHO's electronic record software 'INTOX Data Management System'. RESULTS: 3,415 cases met the inclusion criteria. Children under the age of five represented 91% of the exposures, and 58.5% were male. 99.4% were accidental exposures, and 98.6% occurred at home. Family members (57%) and health personnel (42%) made the calls. 68.3% of the patients had no symptoms after exposure. The four products with the highest incidence were household bleach (27.6%), floor cleaners and polishers (13.1%), dish soap (7.9%), and perfume/cologne (5.8%). The main exposure route was by ingestion (89.4%). CONCLUSIONS: Household cleaning products and cosmetics are common causes of exposures especially in children under the age of five. Although these products have a low morbidity and mortality rate, it is important to educate the population to prevent possible poisonings in the child population.

Enfrentamiento de la ingesta de cuerpo extraño en un Hospital Regional del sur de Chile / Management of foreign body ingestion at a Regional Hospital in southern Chile

Introducción: La ingesta de cuerpos extraños (ICE) es frecuente en pediatría y puede llevar a complicaciones. Nuestro objetivo es revisar la experiencia de nuestro centro en el manejo de estos pacientes y proponer un protocolo de tratamiento. Material y Método: Estudio transversal retrospectivo, observacional y descriptivo, en el cual se revisaron los informes endoscópicos y fichas de pacientes con diagnóstico de ICE manejados por la Unidad de Endoscopia Pediátrica del Hospital Clínico Regional de Concepción entre enero de 2013 y junio de 2017 (53 meses), totalizando 40 casos. El registro y análisis de los datos se realizó con Microsoft® Excel 2016® para MacOS®. Resultados: El promedio de edad fue de 3,96 ± 3,24 años. La moda estadística fue de 2 años. A todos los pacientes se les realizó una endoscopia digestiva alta. El CE más frecuente fue la moneda (61,9%). En 6 casos (14,2%) fue una pila de botón. La retención de CE fue en tercio proximal del esófago (30,9%), el cuerpo gástrico (26,2%) y el tercio distal del esófago (14,2%), extrayéndose principalmente con pinza de cuerpo extraño (90,4%). El 57,5% evidenció alguna lesión relacionada a la ubicación del CE, siendo la más grave la producida por pila de botón. Conclusión: La ICE en niños es una entidad potencialmente peligrosa, por lo que se hace necesario disponer de una unidad de endoscopia pediátrica y protocolos de manejo para evitar complicaciones, sobre todo con objetos de alto riesgo.

Introduction: Foreign body ingestion (FBI) is common in pediatrics and can lead to complications. The aim of the present study is to review the experience of our center in the management of these patients and to propose a treatment protocol. Material and Method: Retrospective, observational and descriptive cross-sectional study, in which the endoscopic reports and records of patients diagnosed with IFB managed by the Pediatric Endoscopy Unit of the Regional Clinical Hospital of Concepción between January 2013 and June 2017 (53 months) were reviewed, with a total of 40 cases. Data recording and analysis was performed with Microsoft® Excel 2016® for MacOS®. Results: The average age was 3,96 ± 3,24 years. The statistical fashion was 2 years. All patients underwent a upper gastrointestinal endoscopy. The most frequent FB was the coin (61,9%). In 6 opportunities (14,2%) was a button batery. FB retention was in the proximal third of the esophagus (30,9%), the gastric body (26,2%) and the distal third of the esophagus (14,2%), being extracted mainly with foreign body clamp (90,4%). The 57,5% showed some injury related to the location of the FB, being the most serious the produced by button batery. Conclusion: FBI in children is a potentially dangerous entity, so it becomes necessary to have a pediatric endoscopy unit and treatment protocols to avoid complications, especially with high-risk objects.

Validación del instrumento: Competencias del personal de enfermería en Salud Pública, en el contexto mexicano / Validation of instrument: Competencies among nursing personnel of public health in the Mexican context / Validação do instrumento: Competências do pessoal de enfermagem em Saúde Pública, no contexto mexicano

Introducción Cuando se utilicen cuestionarios desarrollados en otros países e idiomas en estudios científicos, además de traducirlos, es necesario su adaptación cultural y validación, el objetivo de esta investigación es contar con un instrumento válido y confiable para evaluar las competencias del personal de enfermería en salud pública, para aplicarlo en el contexto mexicano. Metodología El estudio fue de tipo descriptivo-transversal, multietápico, la población se integró en 3 grupos para las 3 diferentes etapas, en la primera, por un grupo de 10 expertos en investigación de la Facultad de Enfermería de Tampico, de la Universidad Autónoma de Tamaulipas, México y 17 profesionales que laboran en el primer nivel de atención; en la segunda, 30 profesionales de enfermería y en la tercera 177 profesionales que trabajan en el campo de la salud pública, todos ellos de tres jurisdicciones del Sur de Tamaulipas, México, el muestreo fue por conveniencia. Resultados En cuanto a los tres procesos que se realizaron para la validación del instrumento, se mostraron resultados adecuados y satisfactorios para su aplicación, ya que en la prueba de V-Aiken se obtuvo un resultado cercano a 1, en el proceso semántico sólo se realizó modificación a una palabra; a través de la prueba piloto se obtuvo un resultado de 0.97 en el Alfa de Cronbach. Conclusiones El instrumento se considera válido para iniciar con la evaluación de las mencionadas competencias, para contar con un diagnóstico inicial de las áreas de oportunidad para personal de enfermería.

Introduction When using questionnaires developed in other countries and languages for scientific studies, besides the translation, it is necessary their cultural adaptation and validation. The objective of this work was to assure the use of an instrument which is valid and reliable while assessing the competencies among nursing personnel of public health in the Mexican context. Methodology This is a descriptive-transversal and multi-step study. The population was represented by 3 groups for 3 different stages. The first group was integrated by 10 experts in research from the Nursing Faculty of the University of Tamaulipas, Tampico, and 17 professionals working in the first level of attention. The second group was integrated by 30 professionals of nursing. The third group was integrated by 177 professionals working in the field of public health. All professionals were from three jurisdictions in the south of Tamaulipas, Mexico. The sampling process was by convenience. Results The three validation processes showed satisfactory results for the adaptation of the instrument. The V-Aiken test score was close to 1. Regarding the semantics, only one word was modified. The pilot test had a final Cronbach Alpha of 0.97. Conclusions The instrument was considered valid for the assessment of the herein referenced competencies.

Introdução Quando se utilizem questionários desenvolvidos em outros países e idiomas em estudos científicos, além de traduzi-los, é necessário sua adaptação cultural e validação, o objetivo desta pesquisa é contar com um instrumento válido e confiável para avaliar as competências do pessoal de enfermagem em saúde pública, para aplicá-lo no contexto mexicano. Metodologia O estudo foi de tipo descritivo-transversal, multietápico, a população integrou-se em 3 grupos para as 3 diferentes etapas, na primeira, por um grupo de 10 experientes na pesquisa da Faculdade de Enfermagem de Tampico, da Universidad Autónoma de Tamaulipas, México e 17 profissionais que laboram no primeiro nível de atenção; na segunda, 30 profissionais de enfermagem e na terceira 177 profissionais que trabalham no campo da saúde pública, todos eles de três jurisdições do Sul de Tamaulipas, México, a amostra foi por conveniência. Resultados Em referência aos três processos que se realizaram para a validação do instrumento, mostraram-se resultados adequados e satisfatórios para sua aplicação, já que na prova de V-Aiken obteve-se um resultado próximo a 1, no processo semântico só se realizou modificação a una palavra; a través da prova piloto obteve-se um resultado de 0.97 na alfa de cronbach. Conclusões O instrumento considera-se válido para iniciar com a avaliação das mencionadas competências, para contar com um diagnóstico inicial das áreas de oportunidade para pessoal de enfermagem.

Evaluación preparticipativa cardiovascular pediátrica: declaración de posición de la Sociedad Chilena de Pediatría (SOCHIPE), Sociedad Chilena de Medicina del Deporte (SOCHMEDEP) y Sociedad Chilena de Cardiología y Cirugía Cardiovascular (SOCHICAR) / Cardiovascular preparticipation screening of young population: position statement of Chilean Scientific Societies

La Evaluación Preparticipativa (EPP) definida como "la supervisión de salud de individuos, previo a la práctica de la actividad física y/o deporte, que busca optimizar su participación deportiva segura y brindar una oportunidad para identificar los riesgos actuales y futuros de su salud y su calidad de vida" contempla la EPP Cardiovascular (EPPC), que tiene por objetivo la pesquiza de patologías cardio vasculares con riesgo de agravarse o presentar muerte súbita durante la práctica de ejercicio. Si bien existe amplio consenso internacional respecto a que la realización de la EPPC en jovenes deportistas es de utilidad, no existe consenso respecto a si esta debe ser realizada a toda la población pediátrica ni tampoco sobre cuál es la mejor estrategia a aplicar. En el presente trabajo se presenta la posición de las sociedades cientificas relacionadas al deporte, actividad fisica y salud infantil sobre la Evaluación Preparticipativa Cardiovascular Pediátrica.

The Preparticipation Physical Evaluation (PPE), defined as "the health supervision of individuals, prior to the practice of physical activity and/or sports, which seeks to optimize their safe participation in sports and provide an opportunity to identify current and future risks to their health and quality of life", inclu des the Cardiovascular assessment, which aims to screen cardiovascular pathologies with the risk of worsening or sudden death during exercise. Although there is broad international consensus that the use of Pediatric Cardiovascular PPE in young athletes is useful, there is no consensus on whether this should be used in the entire pediatric population or on which is the best strategy to apply. This article presents the position of the scientific societies related to sport, physical activity and child health on the Pediatric Cardiovascular PPE.

Eyelid Kaposi Sarcoma in an HIV-negative Patient

Kaposi sarcoma (KS) is a low-grade, multicentric vascular neoplasm. Most commonly, it involves the skin, but it can occur at any site on the body. The cutaneous lesions are often located on the lower legs, genitalia, oral mucosa, and face. KS is categorized in four different types: classic, endemic, epidemic or AIDS associated, and transplantation associated. We report a case of HIV-negative, classic KS located on the eyelid. The eyelid lesion was completely excised, and after a 1-year follow-up, no recurrences were observed. Ocular involvement by KS in a patient who is serologically negative for HIV is extremely rare.

Resonancia magnética cardíaca en el seguimiento alejado de pacientes con tetralogía de Fallot / Cardiac Magnetic Resonance in long term follow-up of Tetralogy of Fallot

INTRODUCCIÓN: La tetralogía de Fallot (TF) es la cardiopatía congénita cianótica más frecuente. La insuficiencia pulmonar (IP) y dilatación del ventrículo derecho (VD) son las complicaciones más frecuentes a largo plazo. La resonancia magnética cardiaca (RMC) es el "gold standard" para la evaluación del VD. OBJETIVO: Analizar la información obtenida de las RMC en el seguimiento de pacientes con TF. PACIENTES Y MÉTODO: Se incluyeron RMC realizadas entre 2007 y 2012 a pacientes con TF, reparados con parche transanular (PTA) o ampliación infundibular (AInf) y sin recambio valvular pulmonar (RVP). La fracción de regurgitación pulmonar (FRP), el volumen y función ventricular fueron evaluados. RESULTADOS: Se realizaron 122 RMC a 114 pacientes. Edad promedio al examen 15,4 ± 7,4 años. 53,3% presentó IP severa (> 40%). La media del volumen de fin de diástole del VD (VFDVD) fue 157,3 ± 38,6 ml/m2, fin de sístole (VFSVD) de 85,3 ± 27 ml/m2 y fracción de eyección (FEVD) 46,4 ± 7,1%. 48,4% presentaba un VFDVD mayor de 150 ml/m2 y el 32,8% mayor a 170 ml/ m2. El PTA se relacionó con mayores volúmenes de VD que la AInf. VFDVD mayor a 170 ml/m2 mostraron peor FEVD (FEVD 47,9 ± 7% vs 43,2 ± 6,4%, p < 0,01). DISCUSIÓN: Casi la mitad mostró una significativa dilatación del VD demostrando que la indicación de RMC es tardía en el seguimiento. El PTA se asoció con mayores VFDVD y VFSVD pero no a peor FEVD.

INTRODUCCIÓN: Tetralogy of Fallot (TOF) is the most frequent cyanotic congenital heart disease. Pulmonary regurgitation (PR) and right ventricle (RV) enlargement and dysfunction are the most common long-term complications. Cardiac magnetic resonance (CMR) is the gold standard for RV evaluation. OBJECTIVE: To analyze CMR results in the follow-up of TOF patients. PATIENTS AND METHOD: All CMR performed between 2007 and 2012 in TOF patients with transannular patch (TAP) repair or infundibular widening, and without pulmonary valve replacement (PVR) were included. Pulmonary regurgitant fraction (PRF), ventricular end-diastolic (EDV) and end-systolic volume (ESV), and ejection fraction (EF) were examined. RESULTS: 122 CMR were performed in 114 patients. Average age at CMR was 15.4±7.4 years. 53.3% of them presented severe PR (> 40%). RVEDV was 157.3 ± 38.6 ml/m2, RVESV was 85.3 ± 27 ml/m2 and RVEF was 46.4 ± 7.1%. RVEDV was > 150 ml/ m2 in 48.4% and > 170 ml/m2 in 32.8% of patients. Patients with TAP showed larger RV volumes compared with those with infundibular widening. RVEDV > 170 ml/m2 showed worse RVEF that those with lower RVEDV (47.9 ± 7% vs 43.2 ± 6.4%, p < 0.01). CONCLUSION: Almost half of the pa tients showed significant RV enlargement, demonstrating that the indication of CMR is late in their follow-up. TAP was associated with higher RVEDV and RVESV, but no worse RVEF.

¿Es efectivo el aciclovir en el tratamiento de la varicela en niños y adolescentes? / Is acyclovir effective for the treatment of varicella in children and adolescents?

Resumen INTRODUCCIÓN: La varicela es una enfermedad infecciosa frecuente y altamente contagiosa, producida por el virus Varicella Zoster. Tradicionalmente se ha recomendado tratarla en forma sintomática, ya que existe controversia en relación a la utilidad del tratamiento antiviral, en especial en niños y adolescentes. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos tres revisiones sistemáticas, que en conjunto incluyen tres estudios primarios, todos correspondientes a ensayos aleatorizados. Concluimos que el uso de aciclovir podría no disminuir las complicaciones asociadas, y no está claro si disminuye las lesiones o el prurito porque la certeza de la evidencia es muy baja.

Abstract INTRODUCTION: Varicella (chickenpox) is a frequent and highly contagious infectious disease, caused by the Varicella zoster virus. Traditionally, it has been recommended to focus on the management of symptoms, since there is controversy about the role of antivirals, particularly in children and adolescents. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified three systematic reviews including three studies overall, all of them corresponding to randomized trials. We concluded the use of acyclovir might not decrease the associated complications, and it is not clear whether it reduces lesions or itching because the certainty of the evidence is very low.

Tratamiento de Flegmasía Cerúlea Dolens con Trombólisis: Reporte de caso / Treatment of Phlegmasia Cerulea Dolens with Thrombolysis: Case report

La Flegmasía Cerúlea Dolens es una complicación rara y severa de la trombosis venosa profunda, que se manifiesta clínicamente con edema profuso, dolor y cianosis del miembro inferior afectado. La obstrucción masiva del sistema venoso determina un aumento de la presión de los compartimentos de la extremidad, que finalmente compromete la circulación arterial. Su tratamiento debe ser agresivo para evitar la gangrena y/o la muerte. Presentamos el caso de una paciente atendida en la Clínica La Sagrada Familia, Armenia ­ Colombia, quien consultó por cuadro clínico de edema progresivo en miembro inferior izquierdo, encontrando cambios isquémicos en falanges distales y edema grado III en miembro inferior izquierdo, con reporte de dúplex venoso con trombosis venosa profunda iliofemoral extensa izquierda y dúplex arterial con reducción de los flujos arteriales secundario a edema severo de tejidos blandos, se indica flebografía con trombólisis venosa por catéter regional en miembro inferior izquierdo con infusión continua de trombolítico. Con respectivos controles angiográficos a las 24 y 48 horas con recanalización del 80% de las venas iliaca, femoral y poplítea, se suspendió infusión y se retiró catéter, continuó anticoagulación con heparina no fraccionada hasta lograr paso a anticoagulación oral con posterior egreso hospitalario dado su evolución satisfactoria.

The Flegmasia Cerulea Dolens is a rare and severe complication of deep venous thrombosis, which manifests clinically with profuse edema, pain and cyanosis of the affected lower limb. The massive obstruction of the venous system is an increase in the pressure of the limb compartments, which compromises the arterial circulation. Your treatment should be aggressive to avoid gangrene and / or death. We present the case of a patient treated at La Sagrada Familia Clinic, Armenia - Colombia, who consulted for clinical picture of progressive edema in left lower limb, finding ischemic changes in distal phalanges and grade III edema in left lower limb, with report of duplex venous with deep left iliofemoral venous thrombosis and arterial duplex with reduction of arterial flow secondary to severe soft tissue edema, phlebography with venous thrombolysis is indicated by regional catheter in left lower limb with continuous thrombolytic infusion. With the respective angiographic controls at 24 and 48 hours with 80% recanalization of the iliac, femoral and popliteal veins, the infusion was interrupted and the catheter was withdrawn, anticoagulation with unfractionated heparin was continued until oral anticoagulation was administered, the hospital discharge was performed given its satisfactory evolution.

ADMINISTRATION OF EARLY POST-PARTUM ORLAN DRENCH IN DAIRY COWS: EFFECT ON METABOLIC PROFILE / ADMINISTRACIÓN ORAL DE DRENCH EN EL POSPARTO TEMPRANO EN VACAS LECHERAS: EFECTO SOBRE EL PERFIL METABÓLICO

Some prophylactic treatments have been proposed in high-yielding dairy cattle in order to minimize the effects of negative energy balance and some disturbances such as hypocalcaemia and ketosis. The objective of this study was to evaluate the effects of two doses of Drench within 24 h after calving on the metabolic profile and prevention of ketosis. A total of 48 cows from a herd in Rio Grande do Sul state (southern Brazil) was used in the study. The animals were randomly selected and treated orally with Drench (N= 32, propylene glycol, electrolytes and choline in 40 L of water) and water (N= 16) used as control. Blood samples were collected by blood coccygeal venipuncture through a vacutainer plain system tubes. Biochemical determinations were performed in serum (albumin, urea, cholesterol, triglycerides, non-esterified fatty acids -NEFA-, calcium, phosphorus, magnesium, aspartate transaminase -AST- and gammaglutamyl-transferase -GGT-) and a cow-side determination of beta-hydroxybutyrate (BHB) was performed using the Abbot blood Precision Xtra system. All cows in the experiment had their milk production controlled. The Drench treatment produces a tendency to a better milk yield (32.5 vs 29.6 L/cow/day) and helps to prevent subclinical ketosis, as indicated by a lesser prevalence of subclinical ketosis (29.7% vs 37.2%) and mean values of BHB (1.19 vs 1.27 mmol/L) as well as a lesser lipolysis as indicated by NEFA values (509 vs 1.560 pmol/L). The other components of the metabolic profile did not have substantial effects between treatments. In short, on the conditions of the present work, the Drench treatment is an effective management tool for prevention of subclinical ketosis and severe lipolysis.

Alguns tratamentos profiláticos têm sido propostos em vacas leiteiras de alta produção a fim de minimizar os efeitos do balanço energético negativo e alguns distúrbios como hipocalcemia e cetose. Os objetivos desse estudo foram avaliar os efeitos da administração de duas doses de Drench em até 24 h depois do parto sobre o perfil metabólico e a prevenção da cetose. Um grupo de 48 vacas de um rebanho no Rio Grande do Sul foi usado no estudo. Os animais foram selecionados aleatoriamente e tratado oralmente com Drench (N= 32, propileno-glicol, eletrólitos e colina em 40 L de água) e água (N= 16) usado como controle. Amostras de sangue foram coletadas por punção venosa coccígea, através do sistema vacutainer, em tubos sem anticoagulante. Foram realizadas determinações bioquímicas no soro (albumina, ureia, colesterol, triglicerídeos, ácidos graxos não esterificados -NEFA-, cálcio, fósforo, magnésio, aspartato aminotransferase -AST- e gama-glutamil-transferase -GGT-), e na propriedade, ao pé da vaca, foi feita a determinação do beta-hidroxibutirato (BHB) no sangue com o sistema Abbot Precision Xtra. Todas as vacas do experimento tiveram sua produção leiteira controlada. O tratamento com Drench causou tendência a uma melhor produção de leite (32.5 vs 29.6 L/vaca/dia) e ajudou a prevenir a cetose subclínica, como indicou a menor prevalência (29.7% vs 37.2%) e menores médias de BHB (1.19 vs 1.27 mmol/L) bem como menor lipólise, indicado pelos valores de NE FA (509 vs 1.560 μmol/L). Os demais componentes do perfil metabólico não tiveram efeitos substanciais entre os tratamentos. Em suma, nas condições do presente trabalho, o tratamento com Drench pode ser considerado eficaz como ferramenta para a prevenção de cetose subclínica e da lipólise severa.