Case series of gallstone ileus: only enterolitotomy, one stage or two stage surgery?

Biliary ileus is a rare disease and an infrequent cause of intestinal obstruction, occasionally occurs in frail elderly patients and has a certain predilection for the female sex. The diagnosis is complex and requires a high clinical suspicion and complementary examinations such as abdominal radiography and contrasted abdominal tomography. Treatment should be individualized according to the clinical characteristics of each patient, with the alternatives being resolution only by enterolithotomy, one stage surgery and two stage surgery. We report 3 cases of biliary ileus, each one managed with a different surgical procedure. The decision was aimed at resolving the intestinal obstruction by enterolithotomy, and the definitive management was performed according to the clinical characteristics of each patient; however, there is no consensus or algorithm that recommends the ideal surgical technique. The recommended surgical procedure for the resolution of biliary ileus will be discussed.

Early-stage intestinal-type gastric adenocarcinoma as an incidental finding: case report and review of literature

Gastric cancer is the malignant neoplasm in which gastric resection is the only viable strategy for long-term survival. Gastric carcinoma typically does not produce symptoms, therefore presenting as either advance or metastatic disease at the time of diagnosis. The most common early symptoms tend to be abdominal pain and weight loss. Adequate surgical resection is the only curative therapeutic option in patients with resectable gastric cancer. We present the case of a 66-year-old male patient who initially presented with abdominal pain and one episode of gastrointestinal bleeding, for which an endoscopic biopsy was conducted which reported intestinal-type gastric adenocarcinoma. Subtotal gastrectomy with Billroth II anastomosis was then performed without reported complications. Patient remains asymptomatic 3 months following the surgical intervention in surveillance with ambulatory care.

Early-stage intestinal-type gastric adenocarcinoma as an incidental finding: case report and review of literature

Gastric cancer is the malignant neoplasm in which gastric resection is the only viable strategy for long-term survival. Gastric carcinoma typically does not produce symptoms, therefore presenting as either advance or metastatic disease at the time of diagnosis. The most common early symptoms tend to be abdominal pain and weight loss. Adequate surgical resection is the only curative therapeutic option in patients with resectable gastric cancer. We present the case of a 66-year-old male patient who initially presented with abdominal pain and one episode of gastrointestinal bleeding, for which an endoscopic biopsy was conducted which reported intestinal-type gastric adenocarcinoma. Subtotal gastrectomy with Billroth II anastomosis was then performed without reported complications. Patient remains asymptomatic 3 months following the surgical intervention in surveillance with ambulatory care.

Mortalidad por cáncer de próstata en Chile: tendencias del período 1955-2019 / Prostate cancer mortality trends in Chile (1955-2019)

BACKGROUND: Prostate cancer is the tumor with the highest incidence among men and one of Chile's leading causes of death. AIM: To analyze temporal trends in prostate cancer mortality in Chile. MATERIAL AND METHODS: Mortality rates in Chile for the period between 1955 and 2019 were calculated. The number of deaths was obtained from the national demographic yearbooks and the Ministery of Health mortality registries. Population estimates from the demographic center of the Economic Commission for Latin America and the Caribbean of the United Nations were used. Chilean census population of 2017 was used as reference to calculate adjusted rates. Trends were analyzed using a join point regression. RESULTS: Crude mortality rates of prostatic cancer increased between 1995 and 2012 in three different phases, namely between 1955 and 1989 with a 2.7% annual increase, between 1989 and 1996 at a 6.8% annual rate, and between 1996 to 2012 with a 2.8% annual increase. From 2012 the rate remained stable. Adjusted mortality rates increased slowly at a 1.7% rate from 1955 to 1993, accelerating between 1993 and 1996, when they increased 12.1% per year. From 1996 onwards there was a significant decrease in mortality at a 1.2% annual rate. This decrease was significant and observed within all age groups but more importantly at older ages. CONCLUSIONS: Prostate cancer mortality in Chile has decreased significantly during the last two decades, like that observed in developed nations.

Relación entre obesidad y enfermedades crónicas no transmisibles e infecciosas / Relationship between obesity and chronic non-communicable and infectious diseases

Introducción: la obesidad aumenta el riesgo a padecer de enfermedades crónicas no transmisibles (ECNT) y afecta el curso de enfermedades de origen infeccioso. Objetivo: examinar la literatura sobre cómo influye la obesidad en la gravedad del cuadro clínico de algunas de las enfermedades no transmisibles y transmisibles de mayor impacto en el Perú. Métodos: investigación documental. Se hace un análisis de contenidos de artículos y documentos de estudios desarrollados en diversos contextos asociados a la presencia de obesidad junto con infecciones o ECNT y en base de datos. Resultados: la condición de obesidad alcanzada por malos hábitos de consumo y baja actividad física, es la principal responsable del elevado índice de las ECNT y por consecuente de las tasas de mortalidad. Conclusiones: el exceso de peso afecta al sistema inmunológico, contribuyendo específicamente en los fenómenos exacerbados de respuesta inflamatoria sistémica, determinada por el aumento de secreción de adipocitoquinas, que predispone al organismo a desarrollar y contraer ECNT y enfermedades infecciosas. (AU)

Introduction: Obesity increases the risk of chronic non-communicable diseases (NCDs) and affects the course of diseases of infectious origin. Objective: Reviewing the literature on how obesity influences the severity of the clinical picture of some of the non-communicable and communicable diseases of greatest impact in Peru. Methods:Documentary research, from studies developed in various contexts associated with the presence of obesity along with infections or NCDs. Results: The condition of obesity reached by bad consumption habits and low physical activity is the main responsible for the high rate of NCDs, consequently, mortality. Conclusions: Excess weight affects the immune system, contributing specifically to exacerbated phenomena of a systemic inflammatory response, determined by increased secretion of adipocytokines, which predisposes the body to develop and contract NCDs and infectious diseases. (AU)

Biomechanical Evaluation of Hemiarthroplasty in the First Proximal Phalanx. A Finite Element Study

ABSTRACT Hallux rigidus produces a decrease in the dorsiflexion of the first metatarsophalangeal joint and is usually associated with the appearance of osteophytes. Hemiarthroplasty in the first proximal phalanx is a recommended surgical procedure in patients with advanced grade of hallux rigidus. Finite element analysis allows us to understand the biomechanical behavior of the foot. The objective of this work is to evaluate the biomechanical effects of an hemi implant placed in first proximal phalanx. Two models of finite elements are going to be compared, one free of pathologies and the other with a hemiarthroplasty in the first ray of the foot. We detected after inserting the prosthesis in the model that passive windlass mechanism is lost, and the lesser toes become overloaded, which leads to a loss of efficiency in gait as well as being able to cause postsurgical medical complications.

Evaluación de comorbilidades y pronóstico de la neumonía por COVID-19: revisión de la literatura

La infección por COVID-19 presenta una elevada mortalidad respecto a otros virus respiratorios. En este artículo buscamos definir las comorbilidades que están asociadas a la elevada mortalidad o a las complicaciones que requieren mayor soporte ventilatorio en unidades de cuidados intensivos. Se ha diseñado una búsqueda bibliográfica con respecto a las comorbilidades y/o alteraciones en los exámenes de laboratorio y los estudios radiológicos que se han asociado a la presencia de mortalidad, especialmente en los casos descritos en China.

Mortality due to SARS-CoV-2 is high compared to that caused by other respiratory viruses. This article aims to define the comorbidities associated with high mortality rates or complications that require ventilatory support in intensive care units. A bibliographic search has been performed with respect to comorbidities and/or alterations in laboratory tests and radiographic exams that have been associated with mortality, especially those described in China.

The ERBB2 gene polymorphisms rs2643194, rs2934971, and rs1058808 are associated with increased risk of gastric cancer

Gastric cancer (GC) is the third most lethal type of cancer worldwide. Single nucleotide polymorphisms (SNPs) in regulatory sites or coding regions can modify the expression of genes involved in gastric carcinogenesis, as ERBB2, which encodes for the tyrosine-kinase receptor HER-2. The aim of this work was to analyze the association of the polymorphisms: rs2643194, rs2517951, rs2643195, rs2934971, and rs1058808 with GC, as they have not yet been analyzed in GC patients, as well as to report their frequency in the general Mexican population (GMP). We studied genomic DNA from subjects with GC (n=74), gastric inflammatory diseases (GID, n=76 control subjects), and GMP (n=102). Genotypes were obtained by means of real-time PCR and DNA-sequencing. The risks for GC were estimated through odds ratio (OR) using the Cochran-Armitage trend test and multinomial logistic regression. Increased risk for GC was observed under the dominant inheritance model for the rs2643194 TT or CT genotypes with an OR of 2.75 (95%CI 1.12−6.75, P=0.023); the rs2934971 TT or GT genotypes with an OR of 2.41 (95%CI 1.01−5.76, P=0.043), and the rs1058808 GG or CG genotypes with an OR of 2.21 (95%CI 1.00−4.87, P=0.046). The SNPs rs2643194, rs2934971, and rs1058808 of the ERBB2 gene were associated with increased risk for GC.

El ser, la base del cuidado humanístico / Being, the basis of humanistic care

La profesión del cuidado una disciplina práctica, considerando desde su génesis, a la enfermería contemporánea una profesión por antonomasia humanística, se ha observado en los planes de estudios universitarios un vacío en humanidades y ciencias sociales, donde emerge la necesidad de indagar aspectos y sustentos filosóficos que permitan reducir brechas del conocimiento con el sujeto y objeto del cuidado. Pregunta de investigación: ¿Cómo recuperamos y reposicionamos al ser como base del cuidado humanístico? Objetivo General: Identificar al ser como base del cuidado humanístico. Objetivos específicos: Ordenar temporalmente sistemas filosóficos que permitan a la profesión, formar sus andamiajes para que, desde el cuidado humanístico, sea alienable a la naturaleza del ser. Cosechar literatura con saberes que aporten al humanismo de la enfermería Metodología: La génesis del escrito con orientación filosófica es poco común en un sistema clínico con bases positivistas a una enfermería tambaleante en reconocimiento de sus paradigmas por tener elementos filosóficos epistemológicos escasos, y justificar la investigación documental para el análisis de textos, es necesario aportar una orientación filosófica a este estudio, desde otros horizontes, para los caudales del saber de la enfermería, que permitan fortalecer dicha disciplina, apoyada desde el método de la mayéutica, el descubrimiento de la verdad que parte del supuesto de que todos ya conocemos todo. Resultados: El ser es base del cuidado humanístico, porque en él no existen barreras que lo marginen de la totalidad de lo que es, ya que se encuentra sedimentado en los pilares del auto reconocimiento existencial de la persona que en su expresión impregna verdad con los sentidos comunicantes. Del documento se espera que en un futuro permita atribuir nuevos proyectos de investigación en enfermería, porque abona desde el pensamiento filosófico para estimular a enfermería.

The care profession discipline practice, whereas since its genesis, to the contemporary nursing a profession quintessential humanistic, it has been observed in university curricula a vacuum in the humanities and social sciences, where it emerges the need of investigating aspects and philosophical livelihoods that will reduce the knowledge gaps with the subject and object of care. Investigation question: How we recover and repositioned to be as the basis of humanistic care? General Objetive: Identify the self as the basis of humanistic care Specifics Objetives: Order temporarily philosophical systems that allow the profession, to form its scaffolding so that, from the humanistic care, be alienable to the nature of being. Harvest literature with knowledge that contribute to the humanism of the nursing Methodology: The genesis of the writing with philosophical orientation is rare in a positivist bases to a wobbly nursing clinical system in recognition of their paradigms for having few epistemological philosophical elements, and justify the research documentary for the analysis of texts, is necessary to provide a philosophical orientation to this study from other horizons, for the flow of knowledge nursing, which enable the strengthening of this discipline, supported from the method of maieutics, the discovery of the truth is that part of the course that we all already know everything. Results: Being is based on the humanistic care, because in it there are no barriers that marginalize of the totality of what is since it is settled on the pillars of the auto existential recognition of person who in his expression permeates truth with the senses connecting. The document is expected to allow in the future be attributed to new projects of research in nursing, because you pay from the philosophical thought to stimulate to the infirmary.

Heminefrectomía en pacientes con doble sistema renal. Experiencia en el Hospital Garrahan / Heminephrectomy in patients with a duplex kidney. Experience at the Garrahan Hospital

La heminefrectomía puede constituir el tratamiento definitivo en el 85% de los pacientes con diagnóstico de doble sistema con uno de los mismos no funcionante. Actualmente el abordaje laparoscópico es de elección tanto por sus resultados estéticos como evolución postoperatoria. Materiales y métodos: se efectuó una revisión y análisis retrospectivo de todos los pacientes operados de heminefrectomía desde el año 2000 a 2014. Resultados: 44 pacientes fueron operados de forma convencional durante el período 2000-2010 y 30 de forma laparoscópica transperitoneal durante el período 2010-2014. La media de duración del procedimiento fue menor para el grupo convencional (89,6 vs 128 min, p = 0,000) mientras que la media de estadía hospitalaria fue menor para el grupo laparoscópico (4,2 vs 5,1, p = 0,19). La tasa de reoperación fue mayor en el grupo convencional (20,4% vs 6,7%, p = 0,18) y la principal causa fue por la presencia un muñón ureteral sintomático. En los controles por centellograma DMSA (en 19 pacientes del segundo grupo) no se objetivó la pérdida de función de la unidad remanente en ningún individuo. Conclusiones: La heminefrectomía es un procedimiento seguro con baja tasa de complicaciones cuya tendencia actual es realizar la cirugía de forma laparoscópica obteniendo resultados similares y menor tasa de complicaciones que en la forma convencional (AU)

Heminephrectomy may be the definitive treatment in 85% of patients diagnosed with a duplex kidney system of which one is not working. Currently, a laparoscopic approach is the treatment of choice because of both esthetic results and postoperative outcome. Material and methods: A retrospective analysis of all patients who underwent heminephrectomy between 2000 and 2014 was conducted. Results: 44 patients underwent conventional surgery in the period 2000-2010 and 30 underwent transperitoneal laparoscopy in the period 2010-2014. Mean duration of the procedure was less in the conventional group (89.6 vs 128 min, p = 0.000), while the mean hospital stay was less in the laparoscopic group (4.2 vs 5.1, p = 0.19). Reoperation rate was higher in the conventional group (20.4% vs 6.7%, p = 0.18) and the main cause was presence of a symptomatic ureteral stump. On DMSA whole body scan controls (in 19 patients in the second group) no loss of function of the remaining unit was observed in any of the patients. Conclusions: Heminephrectomy is a safe procedure with a low complication rate and a current trend to be performed using laparoscopy with similar results and a lower complication rate than in conventional surgery (AU)

Tratamiento de la litiasis renal con nefrolitotomía percutánea con láser en la población pediátrica: experiencia inicial / Treatment of kidney stones using percutaneous nephrolithotomy with laser in a pediatric population: an initial experience

Reportar nuestra experiencia inicial de nefrolitotomía percutánea (NLPC) con láser Holmium para el tratamiento de litiasis renal en la población pediátrica. Material y métodos: Estudio retrospectivo descriptivo de pacientes menores de 16 años con litiasis renal que fueron tratados con nefrolitotomía percutánea en el servicio de Urología del Hospital Garrahan en el período comprendido entre agosto de 2013 y marzo de 2015. Resultados: 19 procedimientos en 16 pacientes con un número de 17 unidades renales (UR) con una edad media de 7 años y un rango de 2 a 15 (Tabla 2). Los tipos de litiasis tratadas fueron: litiasis coraliforme en 6 pacientes (37,5%), coraliforme incompleto en 3 pacientes (18,7%), litiasis piélicas mayores de 2 cm en 4 pacientes (25%), litiasis piélicas menores de 2 cm en 2 pacientes (12,5%) y múltiples mayores de 2 cm en 1 paciente (6,25%). Se realizó acceso único en 15 pacientes, en sólo uno se configuró un segundo acceso y se reingresó o se realizó cirugía en dos tiempos en 3 pacientes (todos con litiasis coraliforme completa). La tasa de litiasis residual total fue del 21,1 %, todas ellas en litiasis coraliformes completas. Las complicaciones se observaron en 3 casos (18,7%) y fueron clasificadas como tipo III B en dos pacientes y del tipo I en uno. En los dos primeros se requirió conversión a vía abierta y en el último paciente solo se dejó colocada nefrostomía por 7 días. La internación promedio fue de 2,8 días con un rango de 1 a 15 días. El seguimiento medio fue de 7 meses con un rango de 4 a 13 meses. Conclusiones: La nefrolitotomía percutánea en pediatría es un método con baja morbilidad, que requiere una curva de aprendizaje prolongada y es determinante contar con todo el material necesario para "liberar" al riñón de litiasis urinaria (AU)

The aim of the study was to report our initial experience with percutaneous nephrolithotomy (PCNL) with holmium laser for the treatment of kidney stones in children. Material and methods: A descriptive retrospective analysis was conducted in patients younger than 16 years with kidney stones treated with PCNL at the department of urology of Garrahan Hospital between August 2013 and March 2015. Results: 19 procedures were performed in 16 patients with a number of 17 renal units (RU) and a mean age of 7 years, ranging from 2 to 15 years (Table 2). Types of kidney stones were: Staghorn kidney stones 6 patients (37.5%), partial staghorn kidney stones in 3 patients (18.7%), renal pelvis kidney stones larger than 2 cm in 4 patients (25%), renal pelvis kidney stones smaller than 2 cm in 2 patients (12.5%), and multiple kidney stones larger than 2 cm in 1 patient (6.25%). A single tract was performed in 15 patients, a second tract in only one, and re-entry or a two-step surgery was performed in 3 patients (all with complete staghorn kidney stones). The rate of residual stones was 21.1 %, all of them were complete staghorn stones. Complications occurred in 3 cases (18.7%) and were classified as type III B in two patients and type I in one. In the first two patients conversion to open surgery was necessary and in the remaining patient the nephrostomy was left in place for 7 days. Mean hospital stay was 2.8 days with a range of 1 to 15 days. Mean follow-up time was 7 months with a range of 4 to 13 months. Conclusions: In children PCNL is a procedure with low morbidity requiring a long learning curve. Availability of all the necessary materials is essential to be able to "release" the kidney from the stones (AU)

Rol de onabotulinumtoxin A en el tratamiento de niños con vejiga neurogénica / The rol of Onabotulinumtoxin A in the treatment of children with a neurogenic bladder

Introducción: Onabotulinumtoxina es una alternativa terapéutica de segunda línea en pacientes sin respuesta a los anticolinérgicos. Objetivo: Evaluar los efectos de repetidas inyecciones de onabotulinumtoxina en vejigas neurogénicas refractarias al tratamiento clásico. Pacientes y métodos: Se evaluaron 82 pacientes menores de 18 años con vejiga neurogénica, en su mayoría por disrafia espinal. Todos fueron refractarios a oxibutinina oral. Si luego del tercer mes de la primer inyección en el detrusor se constataba mejoría clínica y/o urodinámica; se reinyectaban entre los 9 y 12 meses, nuevamente. De lo contrario, se indicaba cistoplastia de aumento. En algunos casos se utilizaron otros procedimientos endoscópicos - quirúrgicos accesorios. Resultados: Se reinyectaron con Onabotulinumtoxina, dos, tres, cuatro y cinco veces: 20 casos, 7, 4 y un caso, respectivamente. En el 51% promedio se logró continencia urinaria total (score cero-seco). En la primera y segunda inyección hubo incremento significativo en la media de capacidad cistométrica: de 254 a 331 ml (p: 0.007) y de 257 a 367 ml (p: 0.014); respectivamente. En algunos casos, luego de la primer inyección mejoró significativamente la compliance: de 6,9 a 11,4 ml/cmH2O (p: 0.05). La media de presión del detrusor al final del llenado disminuyó en promedio de 37 a 34,4 cmH2O. La sobreactividad del detrusor (n:22) se atenuó en el 54,4% luego de la primer inyección. No se registraron efectos adversos mayores con las reinyecciones. En 15 pacientes refractarios a OnabotulinumtoxinA se realizó ampliación vesical. Conclusión: Luego del tratamiento con onabotulinumtoxina, la continencia urinaria alcanzada fue del 50% promedio. La capacidad cistometrica se incrementó significativamente con las dos primeras inyecciones; aunque no se acompañó paralelamente de un importante descenso de presiones endovesicales. El uso de onabotulinumtoxina ha logrado suprimir o retrasar la clásica indicación de cistoplastia de aumento en niños refractarios a los anticolinérgicos (AU)

Introduction: OnabotulinumtoxinA is a second-line alternative therapy for patients who do not respond to anticholinergics. Aim: To evaluate the impact of repeated injections of OnabotulinumtoxinA in neurogenic bladders refractory to conventional treatment. Patients and methods: 82 patients younger than 18 years with a neurogenic bladder, in the majority due to spinal dysraphism, were evaluated. All were refractory to oral oxybutynin. If in the third month after the first injection in the detrusor clinical and/or urodynamic improvement was observed, between 9 and 12 months later a second injection was given. If not, augmentation cystoplasty was indicated. In some cases other endoscopic/surgical procedures were used. Results: Twenty, seven, four, and one case were reinjected with OnabotulinumtoxinA, two, three, four, and five times, respectively. In a mean of 51% of the patients total urinary continence was achieved (score zero - completely dry). On the first and second injection a significant increase of the maximum cystometric capacity was observed: from 254 to 331 ml (p: 0.007) and from 257 to 367 ml (p: 0.014), respectively. In some cases, after the first injection compliance improved significantly: from 6.9 to 11.4 ml/cmH2O (p: 0.05). Mean end filling detrusor pressure diminished from 37 to 34.4 cmH2O. Detrusor overactivity (n: 22) attenuated in 54.4% after the first injection. No major adverse effects were recorded after the reinjections. In 15 patients that were refractory to OnabotulinumtoxinA augmentation cystoplasty was performed. Conclusion: After OnabotulinumtoxinA treatment, 50% urinary continence was achieved. Cystometric capacity increased significantly after the first two injections; however, it was not associated with an important decrease of intravesical pressure. The use of OnabotulinumtoxinA may avoid or delay the classical indication of augmentation cystoplasty in anticholinergicrefractory children (AU)

Sobrevida de pacientes e injerto en niños con trasplante renal: experiencia del Hospital Garrahan en dos períodos / Patient and graft survival in children with a kidney transplant: The experience at Garrahan Hospital over two periods

En adultos y niños con trasplante renal (TxR) la sobrevida de paciente e injerto ha mejorado. En Argentina no existen datos de sobrevida en niños con TxR en diferentes décadas. El objeto de este trabajo fue valorar en niños con TxR sobrevida de paciente e injerto y analizar causas de muerte, perdida de injerto y factores de riesgo de pérdida. Dado que desde el año 2001 se unificaron prácticas de diagnóstico y tratamiento, se compararon dos periodos: 1988-2000 y 2001-2015. Se incluyeron 773 niños. A 1, 3, 5, 7 y 10 años, En TxR de DV (n=327), la sobrevida del paciente fue de 99%, 99%, 98%, 95%, 95% vs 100% y 96%, 96%, 96% y 96% (p=0.74); la del injerto de 97%, 91%, 85%, 78% y 67% vs 95%, 88%, 85%, 81% y 76% (p=0.81). En TxR de DC (n=446) la sobrevida de paciente fue de 97%, 93%, 90%, 89% y 87% en el 1er. periodo vs. 100%, 99% y 98% 98% y 98% en el 2do (p<0.001); la del injerto de 83%, 75%, 68%, 64% y 52% vs. 95%, 87%, 83%, 76% y 61% respectivamente (p<0. 001). El Rechazo Crónico fue la 1er causa de perdida (61% vs 62%); la 2da la muerte del paciente con injerto funcionante. La sepsis bacteriana fue la 1era causa de muerte (56% vs 67%). Ningún niño falleció por neoplasia entre el 2001 y 2015. En DV, fueron predictores de perdida de injerto: DGF (HR: 4.8; p<0.001), edad al TxR > 12 años (HR: 2.7; p=0.002) y RA tardío (HR: 2.1; p=0.009). En DC la necesidad de diálisis en la 1er semana post TxR (DGF): (HR: 4.4; p<0.001), el rechazo agudo (RA) tardío (HR: 3.7; p<0.001), GSFS como causa de IRC (HR: 2.5; p=0.01), y RA temprano (HR: 2.2; p=0.02). Conclusión: En el 2do periodo la sobrevida de paciente e injerto los TxR con DC mejoro, y en los TxR con DV no tuvo cambios. El rechazo crónico continúa siendo la 1era causa de perdida. Ningún paciente tuvo neoplasia (AU)

Patient and graft survival in kidney transplantation (KTx) has improved. In Argentina there are no data comparing transplant outcomes in children over different eras. The aim of this study was to evaluate patient and graft survival in children with KTx and to analyze cause of death, graft loss, and risk factors of graft loss. As diagnostic and treatment practices were unified in 2001, two periods were compared: 1988-2000 and 2001-2015. Overall, 773 children were included. Survival at 1, 3, 5, 7, and 10 years after a living-related donor (LRD) KTx was 99%, 99%, 98%, 95%, 95% vs 100% y 96%, 96%, 96% and 96% (p=0.74); graft survival was 97%, 91%, 85%, 78% y 67% vs 95%, 88%, 85%, 81%, and 76% (p=0.81). Patient survival after deceased donor (DD) KTx (n=446) was 97%, 93%, 90%, 89%, and 87% in the 1st period vs. 100%, 99% y 98% 98%, and 98% in the 2nd (p<0.001); graft survival was 83%, 75%, 68%, 64%, and 52% vs. 95%, 87%, 83%, 76%, and 61%, respectively (p<0. 001). Chronic rejection was the first cause of graft loss (61% vs 62%); the second was death of the patient with a functioning graft. Bacterial sepsis was the first cause of death (56% vs 67%). None of the patients died because of malignancies between 2001 and 2015. Among LRD transplants predicting factors of graft loss were: DGF (HR: 4.8; p<0.001), age at KTx >12 years (HR: 2.7; p=0.002), and late acute rejection (AR) (HR: 2.1; p=0.009). Among DD need for dialysis in the first week post-KTx (DGF): (HR: 4.4; p<0.001), late AR (HR: 3.7; p<0.001), FSGS-related CFR (HR: 2.5; p=0.01), and early AR (HR: 2.2; p=0.02). Conclusion: In the second period patient and graft survival after DD improved, while that of KTx with LRD remained unchanged. Chronic rejection continues being the first cause of graft loss. None of the patients developed malignancies.

Stent vs. tutor ureteral en el trasplante renal pediátrico / Ureteral stent vs. reimplantation in pediatric kidney transplantation

Antecedentes y Objetivos: La práctica de la colocación de stent en la anastomosis ureteral en trasplante es controvertido. Los beneficios del stent incluyen: descompresión continua del uréter con menor tensión anastomótica y alineamiento ureteral que protege de la obstrucción. Las desventajas: infección urinaria, obstrucción a largo plazo de la unión ureterovesical, hematuria por erosión mucosa y el retiro del mismo bajo sedación por vía endoscópica. Es nuestro objetivo investigar la incidencia de complicaciones con la utilización de stent ureteral vs. tutor ureteral en el trasplante renal pediátrico. Material y Métodos: Valoración retrospectiva de pacientes trasplantados renales en nuestra institución con técnica de Lich-Gregoir en el implante ureteral en el período febrero 2008 a marzo 2014. Dos grupos de pacientes para investigar complicaciones: aquellos con tutor ureteral por período de 5 dias vs. los pacientes en los que se utilizó catéter doble jota (stent) por período de 30 días. Se identificaron los pacientes con uropatía y nefropatía como causa de insuficiencia renal crónica terminal (IRCT) y se asociaron a las complicaciones que fueron divididas en no infecciosas (urológicas) y en infecciosas (infección urinaria). Resultados: Se evaluaron 183 pacientes. En el grupo con tutor ureteral (n=68) se presentaron complicaciones urológicas en 8 pacientes (11.76%), 2 urópatas y 6 nefrópatas y las complicaciones infecciosas se observaron en 15 pacientes (22.06%). En el grupo stent (n=115) se presentaron complicaciones urológicas en 3 casos (2,61%), 2 urópatas y un nefrópata y las complicaciones infecciosas se observaron en 43 pacientes (37.39%). Conclusiones: La asociación de la técnica de Lich Gregoir con stent mejora la morbilidad evitando complicaciones no infecciosas, pero aumenta la incidencia de complicaciones infecciosas independiente del origen de la causa de la IRCT (AU)

Background and aims: Stent placement in ureteral anastomosis is controversial. Benefits of the stent include: continuous decompression of the ureter with less anastomotic tension and ureteral alignment with better protection from ureteral narrowing. Disadvantages: urinary infection, long-term stricture of the vesicoureteral junction, hematuria due to mucosal erosion and its endoscopic removal under sedation. Our aim was to assess the incidence of complications of the use of a ureteral stent vs. ureteral splint in pediatric kidney transplantation. Material and methods: Retrospective assessment of kidney transplant patients in whom the Lich-Gregoir technique was used for ureteral implantation between February 2008 and March 2014. Two groups of patients were selected to assess complications: Patients with a ureteral splint for 5 days vs. patients in whom a double J catheter (stent) was used for 30 days. Patients with uropathy and nephropathy due to end-stage chronic renal failure (ESRD) were identified and associated complications were divided into non-infectious (urological) and infectious (urinary infection) complications. Results: 183 patients were evaluated. In the ureteral splint group (n=68), urological complications were observed in 8 patients (11.76%), 2 uropathic and 6 nephropathic, and infectious complications were observed in 15 patients (22.06%). In the stent group (n=115), urological complications were observed in 3 cases (2.61%), 2 uropathic and 1 nephropathic, and infectious complications were seen in 43 patients (37.39%). Conclusions: The association of the Lich Gregoir technique with stent placement improves morbidity avoiding non-infectious complications, but increases the incidence of infectious complications regardless of the cause of ESRD (AU)

Seudoaneurisma postraumático de arteria tibial anterior secundario a fractura diafisiaria de tibia. Reporte de caso / Post-traumatic pseudoaneurysm of the anterior tibial artery secondary to tibial shaft fracture. Case report

Resumen: El seudoaneurisma arterial en la extremidad inferior es una entidad poco frecuente, en particular en el segmento infrapoplíteo. Comúnmente se le asocia a reparaciones vasculares o secundario a una lesión arterial localizada, posterior a fractura o a un evento quirúrgico. En México poco se ha documentado sobre esta entidad que afecta la arteria tibial anterior secundaria a proceso traumático y osteosíntesis. El sangrado súbito debido a una ruptura del seudoaneurisma es un posible desenlace catastrófico para la viabilidad del segmento, por lo cual es de suma importancia detectarla y diagnosticarla a tiempo. Las indicaciones en cuanto al tratamiento siguen siendo controvertidas en las publicaciones internacionales. Las opciones resolutivas pueden ser quirúrgicas o endovasculares. Según reportes actuales, la mejor opción terapéutica es el injerto autólogo de vena safena que mantiene el flujo sanguíneo y minimiza el riesgo de isquemia periférica. El objetivo de este trabajo es exponer el caso de un paciente que presentó la complicación descrita previamente y de la misma forma, realizar una revisión de la bibliografía consultada. Es importante indagar más sobre este tema, que bien puede pasar inadvertido en un gran número de casos por su sintomatología silente.

Abstract: Arterial pseudoaneurysm of the lower limb is an infrequent entity, particularly in the infrapopliteal segment. It is commonly associated to vascular repairs or follows a localized arterial lesion, a fracture or a surgical procedure. There is little information in Mexico about this entity in cases involving the anterior tibial artery, and secondary to trauma and osteosynthesis. Given that sudden bleeding due to rupture of the pseudoaneurysm is a possible catastrophic outcome for the viability of the segment, it is important to timely detect and diagnose the pseudoaneurysm. Treatment indications contained in the international literature are controversial. Solution-oriented approaches may be either surgical or endovascular. Current reports show that the best treatment option is an autologous saphenous vein graft, which maintains blood flow and minimizes the risk of peripheral ischemia. The purpose of this paper is to report the case of a patient who sustained the above mentioned complication and provide a literature review. This topic should be further investigated, as this condition may go unnoticed in a large number of cases, given that its symptoms are silent.

Tumor recurrence and tumor‑related mortality in endometrial cancer: Analysis in 276 patients.

BACKGROUND: In this manuscript, we assessed tumor recurrence and tumor‑related mortality in a clinical series of endometrial cancer patients. MATERIALS AND METHODS: A retrospective evaluation of 276 patients (mean age 64 years) with histologically confirmed endometrial cancer treated at a single hospital in Madrid (Spain) was conducted. The median follow‑up was estimated using the inverse Kaplan–Meier method. RESULTS: Salient findings were endometrioid carcinoma (84.8% of cases), grade G1 (48.9%) and stages IB (35.1%) and IC (23.2%). Myometrial infiltration >50% was documented in 31.2% of cases and lymphovascular space invasion in 11.9%. After surgery, 52.5% of patients were classified into the low risk group, 21.4% into the intermediate risk group and 26.1% into the high risk group. Tumor recurrence occurred in 14.5% of patients, with an estimated median follow‑up of 45 months (95% confidence interval (CI): 41.2–48.8), locoregional recurrence in 42.5% and distant recurrences in 57.5%. Furthermore, 40% of tumor recurrences developed during the first year after primary treatment and 90% over the first 3 years of follow‑up. The tumor‑related mortality rate was 15.9%. The estimated median follow‑up was 46 months (95% CI: 43.0–49.0). Furthermore, 5.07% of death because of tumor developed during the first year after primary treatment and 13.77% over the first 3 years of follow‑up. CONCLUSION: The rates of tumor‑related death and tumor recurrence in endometrial cancer patients are low, with the highest percentages occurring within 3 years of primary treatment. Most of the recurrences occur outside the pelvis.

Mortalidad evitable en los estados de la frontera del norte de México: posibles implicaciones sociales y para los servicios de salud / Avoidable mortality in the states at the northern border of Mexico: possible social implications for health care services / Mortalidade evitável nos estados da fronteira do norte do México: possíveis implicações sociais e para os serviços de saúde

OBJETIVO: analizar la mortalidad evitable en los estados de la frontera del norte de México entre 1998 y 2007 para indirectamente evaluar la calidad de los servicios de salud en la región. METODOLOGIA: se analizó la información sobre mortalidad del Sistema Nacional de Información en Salud (SINAIS). La unidad de análisis fue la causa básica de la defunción codificada según la décima revisión de la CIE. La mortalidad evitable fue clasificada según el catálogo de causas de muerte propuesto por Gómez. Se hizo un análisis exploratorio de la relación entre la mortalidad evitable y la derechohabiencia y el nivel socioeconómico de los municipios correspondientes a las muertes. RESULTADOS: la tasa de mortalidad evitable global fue de 350.2 muertes por mil habitantes en la región. La mortalidad evitable por diagnóstico y tratamiento médico precoz, violencia y VIH/SIDA tuvo tasas de 223, 60 y 5 por mil habitantes, respectivamente, presentando variaciones de magnitud, sociodemográficas y por derochohabiencia entre estados. DISCUSIÓN Y CONCLUSIONES: las poblaciones de los estados de la frontera norte de México se caracterizan por tener una dinámica sociodemográfica y de los servicios de salud muy intensa. Los resultados sugieren que el sistema de salud está siendo rebasado en su respuesta a una alta frecuencia de enfermedades no transmisibles. En el aspecto social existen condiciones estructurales en México que favorecen la presencia de narcotráfico y su consecuente causa de violencia y consumo de drogas ilegales que podrían estar relacionadas con la frecuencia de muertes violentas y en forma subsidiaria con las causadas por el VIH/SIDA.

OBJECTIVE: to analyze avoidable mortality between 1998 and 2007 in the border states of Northern Mexico to evaluate, indirectly, the quality of the region's health care services. METHODOLOGY: the information on mortality provided by the National Health Information System (SINAIS) was analyzed. The unit of analysis was the basic cause of death. The cause was coded in accordance with the ICD-10.Avoidable mortality was classified according to Gomez's death causes catalog. Likewise, an exploratory analysis was conducted which focused on the relationship between avoidable mortality and eligibility and the socioeconomic level of the municipalities in which the deaths took place. RESULTS :The global rate of avoidable mortality was of 350.2 deaths per 1000 inhabitants in the region. the rates of avoidable mortality by early diagnosis and medical treatment, violence, and HIV/AIDS were 223, 60 and 5 per 1000 inhabitants respectively. These causes of avoidable mortality showed variations between states in terms of magnitude, eligibility and socio-demographic characteristics. DISCUSSION AND CONCLUSIONS:The population living in the states located in the northern border of Mexico have a very intense epidemiological and sociodemographical dynamics. The results of this study suggest that the Mexican health system is being overcome by the high frequency of non-communicable diseases in this region. In social terms, Mexico has structural conditions that facilitate the development of illegal drugs traffic through the Northern states of Mexico. This could be related to the frequency of violent avoidable deaths and, in a subsidiary manner, in HIV/AIDS deaths.

OBJETIVO: analisar a mortalidade evitável nos estados da fronteira do norte do México entre 1998 e 2007 a fim de avaliar indiretamente a qualidade dos serviços de saúde na região. METODOLOGIA: foi analisada a informação sobre mortalidade do Sistema Nacional de Informação em Saúde. A unidade de análise foi a causa básica da defunção codificada segundo a décima revisão da CIE.A mortalidade evitável foi classificada de acordo com o catálogo de causas de morte proposto por Gómez. Fez-se uma análise exploratória da relação entre a mortalidade evitável e a herança dos direitos e o nível socioeconômico dos municípios correspondentes às mortes. RESULTADOS: a taxa de mortalidade evitável global foi de 350.2 mortes por mil habitantes na região. A mortalidade evitável por diagnóstico e tratamento médico precoce, violência e HIV/AIDS teve taxas de 223, 60 e 5 por mil habitantes, respectivamente, apresentando variações de magnitude, sociodemográficas e por herança de direitos entre estados. DISCUSSÕES E CONCLUSÕES: as populações dos estados da fronteira norte do México caracterizam-se por terem uma dinâmica sociodemográfica e dos serviços de saúde muito forte.Os resultados sugerem que o sistema de saúde está sendo excedido na sua resposta a uma alta frequência de doenças não transmissíveis.No aspecto social existem condições estruturais no México que favorecem a presença de tráfico de drogas, causante de violência e consumo de drogas ilegais que poderiam estar ligadas à frequência de mortes violentas e em forma subsidiária com as causadas pelo HIV/AIDS.

Aislamiento, cultivo y aplicación clínica de los melanocitos humanos: Los melanocitos como una fuente de terapia celular / Isolation, culture and clinical application of human melanocytes: Melanocytes as a source of cell therapy

El vitiligo es una enfermedad pigmentaria cutánea adquirida e idiopática, debido a múltiples factores causales que ocasionan la destrucción o inactivación funcional del melanocito. Ha habido numerosas alternativas terapéuticas a lo largo de los años como: tratamientos tópicos, PUVA (psoralenos más luz ultravioleta) o fototerapia UVB de banda estrecha; sin embargo, muchos no responden a estos tratamientos médicos. El tratamiento quirúrgico del vitiligo se indica cuando las máculas hipo o amelanóticas, se localizan en zonas mal respondedoras o tras fracaso de los tratamientos convencionales. Se trata de favorecer la re-pigmentación de las lesiones, a través del trasplante de melanocitos desde las áreas pigmentadas normales. El objetivo de esta revisión, es el de analizar el estado actual del tratamiento quirúrgico del vitiligo y en concreto, del trasplante de melanocitos autólogos.

Vitiligo is an idiopathic and acquired disorder that affects the pigmentation of the skin due to several factors that cause the destruction of melanocytes. There are numerous therapeutic alternatives, topical treatments, PUVA or narrowband UVB phototherapy. However, many patients do not respond to these medical treatments. Surgical treatment of vitiligo is indicated when depigmented macules are located in poorly responsive or after failure of conventional treatments. It seeks to encourage repigmentation of lesions by transplantation of melanocytes from normal pigmented areas. The objective of this review is to analyze surgical treatment of vitiligo and especially autologous melanocyte transplantation.

Utilización de sulfato de calcio hemihidratado como material de relleno y barrera en un alveolo post-exodoncia: Una observación clínica, tomográfica e histológica comparativa a 4 meses antes de la colocación de implantes / Use of calcium sulfate hemihydrate as a filler and barrier in a post-extraction alveolus. A clinical, tomographic and histological comparative observation to 4 months before implant placement

Evaluar y comparar de forma clínica, tomográfica e histológica el proceso de reparación ósea y la conservación del reborde alveolar en dos alveolos post-extracción de paredes intactas, con y sin la utilización de un material sustituto óseo regenerativo a base de sulfato de calcio hemihidratado como relleno y barrera, antes de la colocación de implantes a cuatro meses.

To evaluate and compare clinically, tomographic and histological the bone repair process and the preservation of the alveolar walls of two sockets intact, with and without the use of a bone substitute material based regenerative calcium sulfate hemihydrate as a filler and barrier before implant placement to four months.