Apendicitis aguda en gestante: Un Reporte de Caso / Acute Appendicitis In Pregnant Women: A Case Report

La apendicitis aguda es una patología de abdomen agudo quirúrgico frecuente en el embarazo, siendo de difícil diagnóstico debido a los cambios fisiológicos del embarazo que ocasionan cuadros clínicos confusos. Reportamos el caso de una gran multigesta de 27 años de 22 semanas 3/7 en el cual se diagnosticó clínicamente apendicitis aguda, siendo intervenida quirúrgicamente sin complicaciones, encontrándose un apéndice necrosado corroborado posteriormente con anatomía patológica. Es importante enfatizar el rol de la anamnesis dirigida aunado al examen clínico orientado por los cambios fisiológicos del embarazo. Un diagnóstico oportuno junto al manejo interdisciplinario permitirá reducir significativamente los riesgos materno y fetales relacionados a esta patología, y tanto la extirpación del apéndice como la continuación del embarazo.

Acute appendicitis is the most common pathology from acute abdomen during pregnancy, which has a difficult diagnosis because of the physiological changes during pregnancy which results in confusing clinical presentations. We reported the case of a multiparous woman of 27 years with 22 3/7 weeks diagnosed with acute appendicitis, undergoing surgery without complications and with a necrosed appendix that was evidenced through pathological examination. It is important to emphasis the role of the anamnesis with the physical examination guided by the physiological pregnancy changes related to the appendix. A timely diagnosis and treatment with an interdisciplinary approach would significantly reduce the maternal-fetal risks related to this pathology, the appendix removal and the continuation of the pregnancy.

Poliposis hamartomatosa gastrointestinal con intususcepción intestinal, en paciente con Síndrome de PeutzJeghers: Presentación de un caso / Gastrointestinal Hamartomatous Polyposis with Intestinal Intususception in a Patient with Peutz-Jeghers Síndrome: A Case Report

Se trata del caso de una paciente de 17 años de edad, quien consulta por dolor abdominal posterior a un procedimiento endoscópico de resección de pólipo intestinal. La paciente tiene diagnóstico conocido de síndrome de Peutz Jeghers (SPJ), el cual se manifiesta por poliposis intestinal de tipo hamartomatoso e hiperpigmentación mucocutánea. En esta revisión se describen los principales hallazgos del SPJ en tomografía multicorte del abdomen, incluyendo la intususcepción que es una de las complicaciones más frecuentes de estos pacientes.

This article presents the case of a 17-year-old female patient with abdominal pain following an endoscopic procedure (polypectomy). The patient has a known diagnosis of Peutz-Jeghers syndrome (PJS), which is manifested by hamartomatous intestinal polyposis and mucocutaneous hyperpigmentation. This review presents the tomographic characterization of multiple gastric and intestinal polyps, including intussusception, which is one of the main complications in these patients.

Lyophilized allografts without pre-treatment with glutaraldehyde are more suitable than cryopreserved allografts for pulmonary artery reconstruction

Various methods are available for preservation of vascular grafts for pulmonary artery (PA) replacement. Lyophilization and cryopreservation reduce antigenicity and prevent thrombosis and calcification in vascular grafts, so both methods can be used to obtain vascular bioprostheses. We evaluated the hemodynamic, gasometric, imaging, and macroscopic and microscopic findings produced by PA reconstruction with lyophilized (LyoPA) grafts and cryopreserved (CryoPA) grafts in dogs. Eighteen healthy crossbred adult dogs of both sexes weighing between 18 and 20 kg were used and divided into three groups of six: group I, PA section and reanastomosis; group II, PA resection and reconstruction with LyoPA allograft; group III, PA resection and reconstruction with CryoPA allograft. Dogs were evaluated 4 weeks after surgery, and the status of the graft and vascular anastomosis were examined macroscopically and microscopically. No clinical, radiologic, or blood-gas abnormalities were observed during the study. The mean pulmonary artery pressure (MPAP) in group III increased significantly at the end of the study compared with baseline (P=0.02) and final [P=0.007, two-way repeat-measures analysis of variance (RM ANOVA)] values. Pulmonary vascular resistance of groups II and III increased immediately after reperfusion and also at the end of the study compared to baseline. The increase shown by group III vs group I was significant only if compared with after surgery and study end (P=0.016 and P=0.005, respectively, two-way RM ANOVA). Microscopically, permeability was reduced by ≤75% in group III. In conclusion, substitution of PAs with LyoPA grafts is technically feasible and clinically promising.

Agencia de autocuidado en pacientes hipertensos del Hospital Erasmo Meoz / Self care agency in patients with hypertension of the Erasmo Meoz Hospital / Administração de autocuidado em pacientes com hipertensão do Hospital Erasmo Meoz

El propósito del estudio fue determinar la capacidad de agencia de autocuidado de los hipertensos usuarios del servicio de \r\nconsulta externa del Hospital Universitario Erasmo Meoz en San José de Cúcuta (Colombia). Se realizó un estudio descriptivo, \r\ntransversal con abordaje cuantitativo durante el primer semestre del 2012. Mediante muestreo no probabilístico fueron seleccio\r\n-\r\nnados 200 hipertensos a quienes se les aplicó el cuestionario de evaluación de la capacidad de agencia de autocuidado en el \r\npaciente hipertenso.\r\nA nivel global se encontró que un porcentaje representativo de los encuestados (62,5%) presentó mediana capacidad de agencia \r\nde autocuidado; el 37,0% alta capacidad y baja un 0,5%. Estos resultados guardan correspondencia con el comportamiento de las \r\nrespuestas dadas por los participantes a la gran mayoría de los ítems que componen el instrumento. Además plantean un impor\r\n-\r\ntante desafío para la enfermería en la definición de estrategias de intervención asistencial y educativa que motiven y apoyen a las \r\npersonas hipertensas, para que sean autosuficientes frente a su propio cuidado, con capacidad de tomar sus propias decisiones y \r\nde solventar de manera autónoma sus necesidades en el manejo de su enfermedad.

The purpose of this study was to determine the capacity for \r\nself-care agency of hypertensive patients of the Hospital \r\nUniversitario Erasmo Meoz outpatient service in San José de \r\nCúcuta (Colombia). A descriptive, cross-sectional study with a \r\nqualitative approach was performed during the first semester \r\nof 2012. In a non-probabilistic sample a questionnaire was \r\nadministered to 200 hypertensive patients to evaluate the \r\nability of self-care agency in hypertensive patients.\r\nGlobally, it was found that a representative percent of the \r\nrespondents (62.5%) had a medium capacity for auto-care \r\nagency; 37% high capacity and 0.5% had low. These results are \r\nin line with the results of the answers given by the participants \r\nin the great majority of the items that make up the instru\r\n-\r\nment. In addition, the results represented a major challenge for \r\nnursing in defining of intervention strategies for assistance and \r\neducational intervention that encourage and supports people \r\nwith hypertension, to become auto sufficient in their own care, \r\nwith capacity to make their own decisions and to solve in an \r\nautonomous way their needs in the handling of their illness.

O propósito do estudo foi determinar a capacidade da admi\r\n-\r\nnistração de autocuidado dos pacientes hipertensos do \r\nserviço de consulta externa do Hospital Universitário Erasmo \r\nMeoz, em San José de Cúcuta (Colômbia). Foi realizado um \r\nestudo descritivo, transversal com abordagem quantitativa \r\ndurante o primeiro semestre de 2012. Por meio de amos\r\n-\r\ntragem não probabilística foram selecionados 200 hipertensos, \r\nque receberam o questionário de avaliação da capacidade de \r\nadministração de autocuidado no paciente hipertenso.\r\nA nível global descobriu-se que uma percentagem represen\r\n-\r\ntativa dos respondentes, 62,5%, apresentou capacidade média \r\nda agência de autocuidado, 37,0%, capacidade alta e 0,5%, \r\nbaixa. Estes resultados correspondem ao comportamento das \r\nrespostas dadas pelos participantes para a maioria dos itens \r\nque compõem o instrumento. Além disso, expõem um impor\r\n-\r\ntante desafio para a enfermagem na definição de estratégias \r\nde intervenção assistencial e educativa que motivem e apoiem \r\nas pessoas hipertensas, para que sejam autossuficientes \r\nquanto ao seu próprio cuidado, capazes de tomar suas próprias \r\ndecisões e resolver de forma autônoma suas necessidades na \r\ngestão de sua doença.

Satisfacción de pacientes con cicatrices atróficas de acné tratados con láser ablativo y/o técnicas quirúrgicas / Satisfaction of patients with atrophic acne scars treated with ablative laser and / or surgical techniques

Las cicatrices atróficas constituyen una complicación frecuente del acné vulgar. Existen múltiples tratamientos quirúrgicos, aunque ninguno ha demostrado ser satisfactorio. Se realizó un estudio transversal retrospectivo de 47 pacientes con cicatrices atróficas de acné intervenidos mediante Cirugía Punch (CP) y/o Láser CO2 10.600 nm (LCO), a quienes se aplicó un cuestionario validado entre Abril y Septiembre de 2014. El 63,8 por ciento recibió tratamiento solo con LCO, el 10,6 por ciento solo con CP y el 25,6 por ciento recibió ambos tratamientos. Respecto al grado de satisfacción, el 9 por ciento refirió un puntaje de 10 luego del procedimiento, el 32 por ciento entre 7-9, el 43 por ciento entre 4-6 y un 17 por ciento entre 0-3. El 66 por ciento de los pacientes refirió que los efectos se mantienen en el tiempo y el 21 por ciento reportó efectos adversos. El tratamiento quirúrgico de las cicatrices atróficas de acné con técnicas como CP y/o LCO consigue grados de satisfacción moderados, con efectos mantenidos a largo plazo y escasos efectos adversos.

Atrophic scars are a common complication of acne vulgaris. There are multiple surgical treatments, but none have proved satisfactory. A retrospective cross-sectional study of 47 patients with atrophic acne scars surgery was performed by Punch Surgery (CP) and / or CO2 Laser 10,600 nm (LCO), a validated questionnaire between April and September 2014 was applied. 63.8 percent received only LCO treatment, only 10.6 percent CP and 25.6 percent received both treatments. Regarding the degree of satisfaction, 9 percent reported a score of 10 after the procedure, 32 percent between 7-9, 43 percent between 4-6 and 17 percent 0-3. 66 percent of patients reported that the effects are maintained over time, and 21 percent reported adverse effects. Surgical treatment of atrophic acne scars with techniques such as CP and / or LCO achieved moderate degree of satisfaction with maintained long-term effects and few adverse effects.

Relación entre el valor del ratio elastográfico y la clasificación citológica de Bethesda en la patología tiroidea / Relationship between the value of elastography ratio and the cytological classification of Bethesda in thyroid pathology

Objetivo: Presentar nuestra experiencia en la categorización de la patología tiroidea, a través de la utilización de parámetros ecográficos de malignidad y elastografía con medición del ratio de la deformación tisular, y la correlación de los hallazgos obtenidos con la clasificación citológica de Bethesda. Materiales y métodos: Se llevó a cabo un estudio prospectivo y observacional, entre septiembre de 2012 y abril de 2013, que incluyó 137 nódulos tiroideos. Se excluyeron 10 casos Bethesda III-IV. Se realizó ecografía, power Doppler, visualización de micropartículas (Micropure) y elastografía con medición del ratio elastográfico, así como también punción aspirativa con aguja fina guiada por ecografía (con el citólogo presente), utilizando la clasificación Bethesda. Los estudios fueron hechos por el mismo operador con un ecógrafo Toshiba Aplio 400 y los datos estadísticos se evaluaron con el programa IBM SPSS Statistics 20. Resultados: Se estudiaron 127 nódulos en pacientes con una edad promedio de 59±16 anos. El 82% de los casos ocurrió en mujeres. Ciento veinte nódulos (94%) fueron clasificados como Bethesda II. La media elastográfica para Bethesda I-II fue de 1,94±2,12 vs. 7,07±5,46 para V-VI (p: 0,048). El punto de corte elastográfico ≤ 2 (87 de 127) presentó una sensibilidad del 85,7% y una especificidad del 81,7% para predecir Bethesda asociada a patología benigna, con un valor predictivo negativo (VPN) del 99% y un valor predictivo positivo del 15%. Conclusiones: El ratio elastográfico permitió descartar la patología tiroidea maligna con valores ≤ 2 y un VPN del 99%, mejorando la selección de los pacientes a punzar. El incremento del ratio elastográfico se asoció a una mayor probabilidad de patología maligna, aunque no se pudo establecer un valor de corte debido al bajo número de casos con Bethesda V-VI.

Objectives: We present our experience in the categorization of thyroid pathology using the sonographic parameters of malignancy and elastography with measurement elastography strain ratio, to evaluate the relationship between the results found and the Bethesda classification. Materials and methods: Prospective observational study, included 137 thyroid nodules studied between September 2012- April 2013. We excluded 10 cases with Bethesda categories III-IV. Ultrasonography, Doppler, Micropure, elastogrphy strain ratio between the lesion and the normal tissue, fine needle aspiration cytology (FNAC),were the diagnosis methods used. The pathologist was always present and the cytological classi fication of Bethesda was used. All study was made by the same physician used Toshiba Aplio 400 ultrasound unit. Results were analyzed with IBM SPSS Statistics 20. Results: We studied 127 nodules in patients 59±16 years old, 82% were female; 120 were Bethesda II (94%). The average strain ratio for nodules Bethesda I-II was 1.94±2.12 vs. 7.07±5.46 for those nodules Bethesda V-VI (p:0,048). This means that an elastography strain ratio ≤ 2 (87 of 127 nodules) has a sensibility of 85.7% and a specificity of 81.7% of predicting Bethesda associated with benign pathology with a negative predictive value (NPV) of 99% and a positive predictive value of 15%. Conclusion: The elastography strain ratio allowed to discard malignant nodules with strain ratio ≤ 2 with a NPV of 99% improves the selection of patients for FNAC. The increment in the elastography strain ratio was associated to a higher possibility of malignant thyroid pathology, being unable to determine a limit value due to the low amount of cases with nodules Bethesda V-VI.

Cuerno cutáneo y carcinoma sebáceo: diagnóstico diferencial a propósito de un caso / Cutaneous horn and sebaceous carcinoma: differential diagnosis of a case report

El cuerno cutáneo es un concepto semiológico. Se define como una lesión tumoral hiperqueratósica de aspecto cónico y tamaño variable, que puede tener como base una lesión de origen benigno, premaligno o maligno. El tratamiento consiste en la resección completa de la lesión, seguido de un estudio histopatológico para precisar el diagnóstico. El carcinoma sebáceo, neoplasia maligna derivada del epitelioanexial de las glándulas sebáceas, se ha descrito como una etiología poco frecuente de cuerno cutáneo. Su diagnóstico es difícil, ya que carece de elementos clínicos característicos y su histología puede ser similar al carcinoma espinocelular o basocelular, pero importante ya que constituye una neoplasia agresiva, con riesgo de recurrencia local y metástasis. A continuación, presentamos el caso de un hombre de 68 años con diagnóstico clínico de cuerno cutáneo palpebral y diagnóstico histopatológico de carcinoma sebáceo.

The cutaneous horn is a semiological concept. It is defined as an hyperkeratotic tumor of conical appearance and variable size, which may be based on benign, premalignant or malignant lesion. The treatment is the complete resection followed by an histopathology study to clarify the diagnosis. Sebaceous carcinoma, malignant neoplasm derived from adnexal epithelium of sebaceous glands, has been described as a rare etiology of cutaneous horn. Diagnosis is difficult because it doesn’t have characteristic clinical features and histology may be similar to squamous or basal cell carcinoma, but it is important because is an aggressive neoplasm with risk of local recurrence and metastasis. We present a case of a 68-year-old man, with a clinical diagnosis of eyelid cutaneous horn and histopathological diagnosis of sebaceous carcinoma.

Evaluación del olfato en pacientes con patología tumoral en la región selar, intervenidos mediante abordaje endoscópico transesfenoidal transnasal / Assessment of smell in patients with tumor pathology in the sellar region, operated by transnasal transsphenoidal endoscopic approach

Introducción: Para acceder a la región selar, podemos utilizar las técnicas transcraneal, transeptal, o transnasal endoscópica, pudiendo provocar diferentes grados de hiposmia. Se ha descrito menor morbilidad al utilizar la técnica endoscópica, pero faltan estudios dirigidos a los resultados olfatorios. Objetivo: Determinar la presencia de deterioro olfatorio en los pacientes sometidos a un abordaje transnasal endoscópico. Material y método: Se reclutaron 12 pacientes con tumores en la región selar durante 8 meses. Se les realizó un test de olfato preoperatorio, fueron intervenidos mediante abordaje transnasal endoscópico y controlados al mes posoperatorio. Resultados: Se logró seguimiento a 10 pacientes. Seis (60%) presentaron un test de olfato preoperatorio normal. Al mes posoperatorio, se constató mejoría olfatoria en 1 (10%) paciente, 8 (80%) se mantuvieron en la misma categoría y 1 (10%) presentó deterioro olfatorio. En suma, 9 de 10 pacientes (90%) mantienen o mejoran su olfato al mes posoperatorio. Conclusión: Nuestros resultados sugieren que el abordaje transnasal endoscópico utilizado en este estudio no produce deterioro olfatorio. Dado que además es una técnica de abordaje efectiva y relativamente segura, consideramos que constituye una alternativa factible para utilizar en pacientes con patología tumoral en la región selar.

Introduction: To access the sellar region we can use the transcranial, transeptal, or transnasal endoscopic approaches, which may cause different degrees of hyposmia. It has described less morbidity to use the endocopic technique, however, there are few studies directed at olfactory outcomes. Aim: To determine the presence of olfactory impairment secondary to endoscopic transnasal approach. Material and method: 12 patients with tumors in the sellar region were enrolled during 8 months. They were underwent a smell test preoperatively, operated by endoscopic transnasal approach, and controlled with postoperative retesting, after one month. Results: Follow-up was achieved to 10 patients. 6 (60%) presented a normal preoperative smell test. Within one postoperative month, olfactory improvement was found in 1 (10%) patient, 8 (80%) remained in the same category and 1 (10%) had olfactory impairment. In all, 9 out of 10 patients (90%) maintain or improve their sense of smell after surgery. Conclusions: Our results suggest that the transnasal endoscopic approach used in this study, doesn't produce olfactory impairment. Given that is also an effective and relatively safe approach, we believe that is a feasible alternative for use in patients with tumor pathology in the sellar region.

Estudio del control metabólico en pacientes diabéticos en hemodiálisis crónica: hemoglobina glicosilada, fructosamina y glicemias capilares / Study of metabolic control in diabetic patients on chronic hemodialysis: glycated hemoglobin, fructosamine and capillary glycemia

Background: In conditions that may change red blood cell survival, such as hemodialysis, the accuracy of A1c glycosylated hemoglobin (HbA1c) to assess metabolic control can be hampered. Other glycosylated proteins such as fructosamine, could accomplish the role of HbA1c. Aim: To assess if HbA1c is a good metabolic control parameter in diabetic patients on chronic hemodialysis. To compare fructosamine, HbA1c and serial capillary glucose levels in the same patients. Material and Methods: Patients on hemodialysis three times per week were studied. Twenty one subjects with diabetes mellitus and 10 non-diabetic patients were included (70 percent were male). During a period of 14 days, fasting and post prandial capillary glucose levels were measured. Venous glucose, HbA1c and fructosamine were measured at the onset and completion of the monitoring period. Results: Diabetic patients were older than their non-diabetic counterparts (65 and 47 years respectively, p < 0.04). In diabetic and non-diabetic patients respectively, capillary blood glucose levels were 161 +/- 22 and 104 +/- 51 mg/dl, HbA1c levels were 6.8 +/- 1.2 and 5.4 +/- 0.4 percent and fructosamine levels were 282.0 +/- 126.6 and 154.6 +/- 73 umol/L. In all patients there was a positive correlation between blood glucose, HbA1c (r = 0.78 p < 0.01) and fructosamine (r = 0.52, p 0.02). There was a positive correlation between mean capillary glucose, HbA1c (r = 0.77, p < 0.01) and fructosamine (r = 0.69, p < 0.02). Among diabetic patients, the correlation coefficients between mean capillary glucose levels, HbA1c and fructosamine levels were 0.67 (p < 0.01) and 0.51 (NS), respectively. Conclusions: Among diabetic patients on hemodialysis fructosamine levels are not a better indicator of metabolic control than HbA1c.

Estudio retrospectivo de pacientes con alopecia fibrosante frontal / Retrospective study of patients with frontal fibrosing alopecia

Introducción: La alopecia fibrosante frontal, considerada por algunos autores como un subtipo de liquen plano pilaris, corresponde a una alopecia cicatricial primaria, que se presenta en mujeres adultas y se caracteriza por el retroceso simétrico de la línea de implantación fronto temporal. Se presenta un estudio descriptivo de pacientes con Alopecía fibrosante frontal atendidos en este centro. Objetivos: Evaluar características clínicas, dermatoscópicas e histopatológicas de pacientes con alopecia fibrosante frontal. Materiales y métodos: Estudio retrospectivo de pacientes con diagnóstico clínico-histopatológico de alopecia fibrosante frontal atendidos en nuestro centro desde Julio 2010 a Octubre 2012. Resultados: Se encontraron 57 casos con diagnóstico histológico de alopecia cicatricial, de los cuales 8 (14 por ciento) se diagnosticaron como Alopecia Fibrosante Frontal. El 100 por ciento correspondieron a mujeres, el promedio de edad fue de 45 años. Sólo la mitad de los casos comenzó con la alopecia luego del climaterio. El hallazgo clínico más frecuentemente encontrado fue el retroceso de la línea de implantación frontotemporal (87,5 por ciento); y en segundo lugar la disminución difusa de densidad capilar (37,5 por ciento) y alopecia de la cola de las cejas (50 por ciento). No se reportó ningún caso asociado a liquen plano cutáneo o de mucosas. Los hallazgos más relevantes a la dermatoscopía fueron: eritema perifolicular (50 por ciento) e hiperqueratosis folicular (25 por ciento). A la histopatología, los principales hallazgos fueron el infiltrado inflamatorio linfocitario perifolicular (50 por ciento) y fibrosis concéntrica perifolicular (100 por ciento). Discusión: La Alopecia fibrosante frontalrepresenta el 14 por ciento de las alopecias cicatriciales primarias en nuestra serie. La edad al diagnóstico fue inferior a lo reportado en la literatura. El principal hallazgo clínico fue el retroceso de la línea de implantación frontotemporal...

Introduction: Frontal fibrosing alopecia, considered by some authors as a subtype of lichen planopilaris, is a scarring alopecia that usually involves adult women and is characterized by the symmetric recession of fronto-temporal hairline. Objectives: Characterize the clinical, dermoscopic and histological features of frontal fibrosing alopecia. Materials and Methods: We conducted a retrospective study of patients with clinical and histological diagnosis of Frontal Fibrosing Alopecia treated in our institution from July 2010 to October2012. Results: 8 out of 57 cases with histological diagnosis of scarring alopecia, had diagnosis of frontal fibrosing alopecia (14 percent). 100 percent were women, with mean age of 45 years. 50 percent of patients began with alopecia in the post-climacteric period. Recession of frontotemporal hair-line was the most common finding (87.5 percent), associated with reduced capillary density (37.5 percent) and loss of eyebrows (50 percent). In our study, none of the patients had other signs of lichen planus. At dermoscopy, most common finding were perifollicular erythema (50 percent) and follicular hyperkeratosis (25 percent). Most common histological findings were a perifollicular lymphocytic inflammatory infiltrate (50 percent) and perifollicular concentric fibrosis (100 percent). Discussion: Frontal fibrosing alopecia represents 14 percent of scarring alopecia in our series. Age at diagnosis was lower than reported in the literature, and only 50 percent of women presented alopecia in the postmenopausal period. The main clinical finding was the recession of frontotemporal hairline...

Diagnóstico diferencial y manejo del escroto agudo en niños / Differential diagnosis and management of the acute scrotum in children

Acute scrotum is a common entity found in pediatric emergency rooms all over the world. This is a syndrome in which fast and accurate diagnosis is vital to perform an effective treatment of the underlying disease. Testicular torsion is the first diagnosis that has to be discarded. Torsion of appendix testis and epididymitis or orchitis must also be considered. If clinical signs are compatible with testicular torsion, and especially if the condition has not passed the six hours threshold, surgical exploration has to be perform at once. Radiological tests cannot delaysurgical exploration. Detorsion must be achieved as soon as possible to prevent irreversible ischemia and necrosis of the testicle that could lead to an orchiectomy. Once the torsion is relieved, the testicle must be placed in warm, moist sponges to test for adequate perfusion. If the testicle has acceptable blood supply, both testicles have to be fixed to prevent similar events in the future. If health providers are familiarized with the clinical presentation of these conditions, testicular torsion and other causes of acute scrotum could be diagnosed and treated rapidly and therefore important complications, such as fertility impairment, could be prevented.

Tracheal cryopreservation: caspase-3 immunoreactivity in tracheal epithelium and in mixed glands

Cryopreservation has an immunomodulating effect on tracheal tissue as a result of class II antigen depletion due to epithelium exfoliation. However, not all epithelium is detached. We evaluated the role of apoptosis in the remaining epithelium of 30 cryopreserved tracheal grafts. Caspase-3 immunoreactivity of tracheal epithelium was studied in canine tracheal segments cryopreserved with F12K medium, with or without subsequent storage in liquid nitrogen at -196°C for 15 days. Loss of structural integrity of tracheal mixed glands was observed in all cryopreserved tracheal segments. Caspase-3 immunoreactivity in tracheal mucosa and in mixed glands was significantly decreased, in contrast to the control group and to cryopreserved tracheal segments in which it remained high, due to the effect of storage in liquid nitrogen (P < 0.05, ANOVA and Tukey test). We conclude that apoptosis can be triggered in epithelial cells during tracheal graft harvesting even prior to cryopreservation, and although the epithelial caspase-3 immunoreactivity is reduced in tracheal cryopreservation, this could be explained by increased cell death. Apoptosis cannot be stopped during tracheal cryopreservation.

Aproximación a la depresión infantil por parte de psicólogos que trabajan en COSAM de la Región Metropolitana / Approach of Psychologists Working for COSAM, Región Metropolitana, to Childhood Depression

Se analiza cómo se aproximan a la depresión infantil, psicólogos clínicos que trabajan en Salud Pública en la Región Metropolitana. Chile. Es un estudio descriptivo, de diseño no experimental, transversal y de muestra intencionada. Participan 19 psicólogos de Centros Comunitarios de Salud Mental y Familiar. Se recaba la información a través de entrevistas semiestructuradas, las cuales se analizan mediante la técnica de Análisis de Contenido. Los resultados señalan que: a.- Los psicólogos tienen una comprensión teórica parcial del fenómeno, b.- Relacionan el trastorno fundamentalmente con disfunciones familiares y contextos poco contenedores, haciendo poca alusión a etiología biológica, c- Realizan el tratamiento principalmente de manera individual, con inclusión ocasional de la familia. Se discute el fortalecimiento de la aproximación realizada por los profesionales.

The research analyzes how clinical psychologists working for the Public Health Service, Región Metropolitana, Chile, approach childhood depression. It is a descriptive research, of non-experimental cross-sectional design and with a delibérate sarnple. 19 psychologists of Centros Comunitarios de Salud Mental y Familiar (Community Centers for Mental and Family Health) took part in the research. The information was collected through semi-structured interviews, which were analyzed by means of the Content Analysis technique. The results show that these psychologists have a partial theoretical understanding of the phenomenon. They relate this disorder mainly to family dysfunctions and not very containing contexts, making little mention of biological etiology. They mostly give treatment on an individual basis, including the family occasionally. The strengthening of these professional's approach is discussed.

Fetal ultrasound biometry: normative charts for a Puerto Rican population

PURPOSE: To evaluate fetal growth parameters throughout gestation in Puerto Rican women and compare them to other mixed U.S. populations. METHODS: Cross-sectional study of 548 patients who met inclusion criteria of Puerto Rican ancestry, no history of drug, alcohol or tobacco use, no identifiable fetal anomalies, normal amniotic fluid and certainty of last menstrual period. Standard sonographic biometric data (biparietal diameter, occipito-frontal diameter, head circumference, abdominal circumference, femur length and estimated fetal weight) was obtained for each gestational age between 13 and 38 weeks and the 10th, 50th, and 90th percentile determined for each one. Results were compared to those of other mixed U.S. populations. RESULTS: Biometric data on fetal growth throughout gestation among Puerto Ricans is presented. Comparison with other mixed populations did not show any significant differences in fetal biometric measurements throughout pregnancy. CONCLUSIONS: Different to other ethnic groups, Puerto Ricans show similar fetal growth patterns as those reported from mixed U.S. populations. This information validates the use of these reference values in the evaluation of fetuses in Puerto Rico.

Seasonal variation in the incidence of cleft lip and palate based on the age of conception

BACKGROUND: The purpose of this study is to identify seasonal changes in the incidence of Cleft lip and Palate (CL/P) in our population. METHODS: All cases of isolated CL/P born in Puerto Rico from January 1998 through December 2002 were identified through the Puerto Rican birth defect registry. Conception dates were estimated based on the reported last menstrual period. All deliveries during this same period were recorded and their conception dates estimated in the same manner. The data was separated into 4 groups for each year studied corresponding approximately to the four seasons. RESULTS: 484 cases of CL/P were identified among 308,968 live births (incidence 1.57/1000 live births. The lowest incidence of CL/P was seen during fall and winter (1.24 and 1.38/1000 live births respectively) and the highest during spring and summer (1.77 and 1.97/1000 live births respectively) (p = 0.002). The seasons with the highest incidence correspond to the period when the least number of conceptions are occurring. Estimation of relative risks using winter as a reference point (relative risk of 1.0) showed a decrease in the risk of CL/P in fall to .89 (95th confidence interval 0.88 - 1.57), an increase in the risk to 1.28 (CI 1.16 - 2.03) during spring and 1.42 (CI 1.16 - 2.03) during summer. CONCLUSIONS: The reported seasonal variation in incidence may be secondary to the action of yet to be identified teratogens acting on the population at large, or more likely, changes in activity and diet patterns of the population.

DNA fingerprinting by ERIC-PCR for comparing Listeria spp. strains isolated from different sources in San Luis: Argentina / Caracterización molecular por ERIC-PCR de cepas de Listeria spp. aisladas de diversos orígenes en San Luis: Argentina

In this study, a total of 24 Listeria spp. strains were analyzed. Twenty-two isolates were obtained in San Luis (Argentina) from human, animal, and food samples. Two types of strains, Listeria monocytogenes CLIP 22762 and Listeria innocua CLIP 74915, were included as reference strains. All isolates were biochemically identified and characterized by serotyping, phage typing, and amplification of the flaA gene by polymerase chain reaction (PCR). Repetitive intergenic consensus (ERIC) sequence-based PCR was used to generate DNA fingerprints. On the basis of ERIC-PCR fingerprints, Listeria spp. strains were divided into three major clusters matching origin of isolation. ERIC-PCR fingerprints of human and animal isolates were different from those of food isolates. In addition, groups I and II included ten L. monocytogenes strains, and only one Listeria seeligeri strain. Group III included nine L. innocua strains and four L. monocytogenes strains. Computer evaluation of ERIC-PCR fingerprints allowed discrimination between the tested serotypes 1/2b, 4b, 6a, and 6b within each major cluster. The index of discrimination calculated was 0.94. This study suggests that the ERIC-PCR technique provides an alternative method for the identification of Listeria species and the discrimination of strains within one species.

En este estudio se analizaron 24 cepas de Listeria spp. De ellas, 22 fueron obtenidas en San Luis (Argentina), a partir de muestras humanas, de animales y alimentos. Se incluyeron 2 cepas de referencia Listeria monocytogenes CLIP 22762 y Listeria innocua CLIP 74915. Todos los aislamientos fueron identificados bioquímicamente y caracterizados por serotipificación, fagotipificación y detección del gen flaA por reacción en cadena de la polimerasa (PCR). Se generaron perfiles de bandas de ADN mediante la amplificación de secuencias repetitivas de consenso intergénico de enterobacterias (ERIC-PCR). De acuerdo a los resultados obtenidos por ERIC-PCR, las cepas de Listeria spp. fueron divididas en 3 grupos según su origen. Los perfiles de los aislamientos humanos y animales fueron distintos de los correspondientes a alimentos. Por otra parte, dentro de los grupos I y II se incluyeron 10 cepas de L. monocytogenes y solamente una de Listeria seeligeri. Dentro del grupo III no sólo estuvieron incluidas las 9 cepas de L. innocua sino también 4 de L. monocytogenes. La evaluación de los perfiles de bandas obtenidos por ERIC-PCR permitió la discriminación entre los serotipos ensayados 1/2b, 4b, 6a y 6b dentro de cada grupo. El índice de discriminación calculado para ERIC-PCR fue de 0,94. Los resultados sugieren que la técnica de ERIC-PCR provee un método alternativo válido para la identificación de especies de Listeria y, asimismo, permite la diferenciación de cepas dentro de una misma especie.

Diversidad de levaduras en canopias y suelos asociados con Bulnesia retama y Larrea divaricata / Yeast diversity in Bulnesia retama and Larrea divaricata canopies and associated soils.

Los ambientes áridos están dominados por vegetación arbustiva, con acumulación de nutrientes bajo la canopia de los arbustos y con suelos relativamente infértiles en los interparches. Los distintos componentes de los vegetales constituyen uno de los hábitat más comunes para las levaduras. Existen numerosos antecedentes acerca de investigaciones sobre levaduras cuyo hábitat lo constituyen árboles y arbustos, sin embargo no existen referencias sobre levaduras asociadas a las Zigofiláceas, una familia de matorrales preponderantes en la Provincia de Monte argentino. El objetivo de este trabajo fue conocer la biodiversidad de levaduras en suelos y canopias asociados con Bulnesia retama y Larrea divaricata, en los Médanos Grandes de Caucete, San Juan, Argentina. Sobre un total de 87 aislamientos de levaduras identificados, se observó una mayor diversidad taxonómica en las asociadas tanto al suelo como a la parte aérea de B. retama, respecto de L. divaricata. A partir de la canopia de B. retama y su suelo asociado se aislaron 9 y 10 especies de levaduras respectivamente, mientras que de la parte aérea y suelo de L. divaricata 4 y 3. Los géneros identificados fueron: Candida, Debaryomyces, Dekkera, Saccharomyces, Torulaspora, Sporidiobolus y Pichia. En total se encontraron 14 especies en todos los microambientes.

Bush like vegetation dominates arid environments, and there is nutrients accumulation under shrub canopies and relatively unfertile soils between vegetal patches areas. Plants are one of the most common habitats for yeasts. There are many reports about yeasts inhabiting different plant components. Nevertheless, there are no reports about yeasts associated with Zigophyllaceae, an important shrub family of the Argentinean Province of Monte. The objective of this work was to analyzed yeast biodiversity of Bulnesia retama and Larrea divaricata canopies and associated soils, at Médanos Grandes of Caucete, San Juan, Argentina. Eighty seven (87) isolated yeasts were identified. From B. retama canopy and associated soil was observed a larger taxonomical diversity respect to L. divaricata. Nine (9) and ten (10) species were isolated from canopy and associated soil of B. retama, respectively. From L. divaricata canopy were 4 species and 3 species from its associated soil isolated. Identified genera were: Candida, Debaryomyces, Dekkera, Saccharomyces, Torulaspora, Sporidiobolus and Pichia. Fourteen (14) species were found at all microenvironments.

Prenatal diagnosis of renal disease

INTRODUCTION: The purpose of this study is to report the range of renal congenital anomalies identified by ultrasonography and to analyze the indications for the ultrasound study that lead to their diagnosis. MATERIALS AND METHODS: All cases of renal malformations diagnosed at our institution from June 2001 through May 2004 were evaluated retrospectively. The indications for sonographic evaluation were reviewed. Cases were divided into those referred for routine ultrasound screening and those referred with other indications. Results were expressed as percents of total. RESULTS: A total of 117 cases of renal congenital anomalies were identified, in 14 cases (11.9), other congenital anomalies were also present. Hydronephrosis was the most common diagnosis detected in 64 cases (54.7). There were 21 lethal renal anomalies identified (17.9). Multicystic dysplastic kidneys were present in 21 cases (17.9). Renal agenesis was identified in 15 cases (12.8). Other detected anomalies were: bladder outlet obstruction 15 (12.8), echogenic kidneys 13 (11.1), ectopic ureteral implantation 2 (1.7), renal cysts 1 (0.8), pelvic kidney 3 (2.6), double collecting system 1 (0.8), and unilateral atrophic kidney 1 (0.8). A total of 94 cases (80.3) had no indications for sonographic evaluation other than routine screening. CONCLUSIONS: Relying on risk factors as indications for ultrasound studies will not detect the majority of congenital anomalies, especially those associated to the urogenital system, a group of conditions that may particularly benefit form prenatal detection.