Tratamiento reconstructivo de bajo costo tras resección de tumor de células gigantes de radio distal / Low-cost reconstructive treatment after resection of distal radius giant cell tumor

Resumen: Introducción: El tumor de células gigantes (TCG) es un tumor óseo intramedular benigno que surge con frecuencia en los extremos de los huesos largos. Después del fémur distal y la tibia proximal, el radio distal es el tercer sitio más afectado con tumores, particularmente agresivos. Nuestro objetivo es la presentación del caso clínico de una paciente con diagnóstico de TCG de radio distal clasificada en grado III de Campanacci que recibió un tratamiento ajustado a sus posibilidades económicas. Reporte de caso: Paciente femenino de 47 años, sin solvencia económica y sin ningún servicio médico. El tratamiento incluyó resección en bloque, reconstrucción con autoinjerto de peroné distal y artrodesis radiocarpiana con placa de compresión bloqueada. Dieciocho meses después, la paciente presentaba una buena fuerza de prensión (80% respecto al lado sano) y tenía una función motora fina en la mano. La muñeca presentó estabilidad con pronación de 85o, supinación de 80o, flexión-extensión de 0o y una puntuación de 6.7 en el cuestionario de evaluación de resultados funcionales DASH. Su evolución radiológica a cinco años después de su cirugía continuó sin datos de recidiva local y afectación pulmonar. Conclusión: El resultado en esta paciente, junto con los datos publicados, indican que la técnica de resección tumoral en bloque, más el autoinjerto de peroné distal y la artrodesis con placa de compresión bloqueada proporcionan un resultado óptimo de funcionalidad para el tumor radial distal grado III a bajo costo.

Abstract: Introduction: Giant cell tumor (GCT) is a benign intramedullary bone tumor that frequently arises at the ends of long bones. After the distal femur and proximal tibia, the distal radius is the third most affected site with particularly aggressive tumors. Our objective is the presentation of the clinical case of a patient diagnosed with distal radius GCT classified in grade III of Campanacci who received a treatment adjusted to her economic possibilities. Case report: A 47-year-old female, without economic solvency and with some medical service. Treatment included block resection, reconstruction with distal fibula autograft, and radiocarpal fusion with blocked compression plate. Eighteen months later, the patient had good grip strength (80% on the healthy side) and had fine motor function in the hand. The wrist presented stability with pronation of 85o, supination of 80o, flexion-extension of 0o and a score of 6.7 in the DASH functional outcomes assessment questionnaire. His radiological evaluation five years after his surgery continued with no evidence of local recurrence and pulmonary involvement. Conclusion: The result in this patient, together with the published data, indicate that the block tumor resection technique, plus distal fibula autograft and arthrodesis with blocked compression plate provide an optimal result of functionality for the grade III distal radial tumor at low cost.

Sustentabilidad hospitalaria, calidad y seguridad del paciente en el Hospital Clínico Universidad de Chile / Hospital sustainability, quality and patient safety in Hospital Clínico Universidad de Chile

The sustainability of the Universidad de Chile Clinical Hospital must be understood comprehensively; providing higher quality and safety for our patients, ensuring highest standards of medical care. The quality of care must be understood not only in complying with the minimum standards to accredit and grant GES benefits, establish agreements with health insurers and be financially competitive; It must be incorporated into its management the dimensions of quality - effectiveness, efficiency, accessibility, safety, equity and patient-centered care- minimizing the costs of non-quality work. Our Clinical Hospital, as our country's main training center in healthcare professions, must include training at the undergraduate students' curriculum in quality and patient safety issues. (AU)

Desempenho produtivo e econômica de surubins (pseudoplatystoma sp) alimentados com níveis de proteína e estocados em tanque-rede / Growth performance and economic of pseudoplatystoma sp fed with protein levels reared in net cages

O surubim (Pseudoplatystoma sp.) é uma das espécie de peixe mais apreciadas para o consumo. Por ser uma espécie carnívora, exige atenção especial no que tange às suas exigências nutricionais. Até o momento, poucos estudos foram realizados para estabelecê-las na fase de engorda, em especial em sistema de cultivo intensivo. O objetivo do presente estudo foi avaliar os desempenhos zootécnico e econômico de surubins (Pseudoplatystoma sp.) na fase final de crescimento, estocados em tanque-rede e alimentados com dietas com diferentes níveis de proteína. Os peixes, com peso de 356,6±40,3g, foram acondicionados em 12 tanques-rede de 18m3, nos quais permaneceram por cinco meses até adquirirem o peso comercial para abate. O tratamento experimental foi constituído por três dietas extrusadas comerciais, com os níveis de proteína bruta (36, 38, 40%PB) sendo substituídos gradativamente por carboidratos. Foram avaliados os parâmetros de crescimento, rendimento de filé, enzimas metabólicas e desempenho econômico. O ganho de peso, o ganho de peso diário, o consumo de dieta, a taxa de eficiência proteica, a sobrevivência e o rendimento de filé não apresentaram diferença significativa. A conversão alimentar foi melhor para os peixes alimentados com a dieta com 38 e 40%PB. Não foram observadas diferenças significativas para os parâmetros de índice hepatossomático e de enzimas hepáticas. Apesar dos maiores gastos com a ração contendo 38%PB em comparação à dieta com 36%PB, esta foi a que apresentou o melhor índice de custo por kg de peixe produzido. Os melhores índices de crescimento e o menor custo de arraçoamento foram obtidos pelos peixes alimentados com a dieta 38%PB, sendo esta, portanto recomendada para o arraçoamento na fase final de surubins em tanque-rede.

The Pseudoplatystoma sp. is one of the most appreciated fish species for consumption. Being a carnivorous species, the painted requires special attention regarding their nutritional requirements. To date, few studies have been conducted to establish them in their stage of fattening especially in intensive cultivation systems. The aim of the present study was to evaluate the growth and economic performance of Pseudoplatystoma sp fed with protein levels reared in net cages. The fish weighing from 356.6 ± 40.3g were packed in twelve net cages in 18 m3 in which they remained for five months until acquiring the commercial weight for slaughter. The experimental treatment was constituted by three commercial extruded diets with different crude protein levels (36, 38, 40% CP) gradually being replaced with carbohydrate. Growth parameters, metabolic enzymes, fillet yield and economic performance were evaluated. The gain in weight, daily weight gain, diet consumption, protein efficiency rate, survival and fillet yield did not show significant difference. The feed conversion was best for fish fed a diet with 38 and 40% CP. No significant differences were observed for the hepatossomatic index parameters and liver enzymes. There were larger expenditures on rations containing 38% PB compared to the diet with 36% CP, this presented the best index of cost per kg of fish produced. The best growth rates and lower cost of feeding were obtained by fish fed with a 38% CP diet, which is, therefore, recommended for feeding in the final phase of surubins monitored via net cages.

Atresia Folicular en Ovarios de Prochilodus lineatus / Follicular Atresia in Ovaries of Prochilodus lineatus

Durante el período reproductivo, en el ovario de los teleósteos se forman cíclicamente folículos primarios, los que maduran y son liberados en el momento de la ovulación. Sin embargo, algunos de ellos desarrollan un proceso de atresia con degeneración y reabsorción, el que para ser considerado un evento fisiológico debería predominar al final del ciclo reproductivo. Las características morfológicas de ovarios de Prochilodus lineatus fueron analizadas para identificar la presencia de folículos atrésicos como indicadores de posibles modificaciones de su biología reproductiva que afecte la repoblación de la especie. En los ovarios de P. lineatus predominaron los cambios morfológicos que se corresponden con la denominada atresia tipo I, y los folículos atrésicos fueron observados en peces con índice gonadosomático bajo que se encontraban al final del ciclo reproductivo. La atresia folicular hallada no pudo vincularse con algún proceso patológico que provoque una disminución de la especie en el ecosistema del río Paraná.

During the reproductive period, primary follicles are formed cyclically in the ovary of teleost, which mature and are released at the ovulation time. However, some of them develop a process of atresia with degeneration and resorption, which to be considered a physiological event should prevail at the end of the reproductive cycle. Morphological characteristics of ovaries of Prochilodus lineatus were analyzed for the presence of atresic follicles as indicators of possible changes in their reproductive biology affecting the repopulation of the species. In the ovaries of P. lineatus dominated the morphological changes that correspond to the so-called type I atresia, and atresic follicles were observed in fish with low gonadosomatic index who were at the end of the reproductive cycle. Detected follicular atresia could not be linked to a pathological process that causes a decline of the species in the Paraná river ecosystem.

Morfología de la Piel y Producción de Lana en Cruzamiento Absorbente con Merino Multipropósito / Skin Morphology and Wool Production on Merino Multipurpose from Absorbent Crosses

Las tendencias del mercado de fibras textiles muestran que las lanas finas son las que se adaptan a las preferencias de la industria textil. En Argentina, la producción de lanas finas es insignificante y esto representa una limitante para el crecimiento lanero del país. La necesidad de desarrollar una alternativa de producción ovina lleva a considerar al Merino Multipropósito como una opción interesante. En la provincia de Corrientes, se iniciaron cruzamientos con estos animales, pero existen inquietudes con respecto a lograr una disminución en el diámetro de la fibra y que repercuta en el peso del vellón. El objetivo del trabajo fue evaluar el efecto del cruzamiento de ovejas Corriedale con machos MPM, sobre las características de la piel y la producción y calidad de lana. Los parámetros evaluados fueron diámetro de fibra, densidad de folículos y relación S/P. Para el recuento de folículos primarios y secundarios se realizaron biopsias de piel con auxilio de un sacabocado. Las características en relación con la producción y calidad de lana se consideraron entre borregas contemporáneas. La comparación realizada en este trabajo permitiría atribuir la disminución del diámetro de fibra, al cruzamiento con MPM. La densidad de folículos en las madres Corriedale, en las borregas Corriedale y en la F1 (Corriedale x MPM) fueron diferente significativamente. La relación S/P fue 9,08 ± 2,32, 9,46 ± 1,57, y 11,93± 2,18, respectivamente. El peso del vellón en borregas de la F1 (Corriedale x MPM) fue inferior y significativamente diferente de sus contemporáneas Corriedale. El rinde al lavado en las borregas Corriedale fue superior al de las borregas nacidas del cruzamiento con MPM. Las diferencias fueron significativas en el largo de mecha entre borregas Corriedale y Corriedale x MPM. En las condiciones realizadas no se pudo comprobar todas las expectativas esperadas con el cruzamiento. Nuevas experiencias serán necesarias para respaldar morfológica y productivamente la posible inversión.

Textile market trends show that fine wools are more suitable to reach the preferences of textile industry. Production of fine wool in Argentina are insignificant, which is a limitation on the development of the country. The need to develop new alternatives of production leads us consider the Multipurpose Merinos as an option. Crossbreeding with these animals began at Corrientes state in order to achieve a reduction in the diameter of fiber and an impact on the weight of the fleece. These crossbreedings with Corriedale sheep were carried out with the objective of analyzing changes on wool production, quality and skin characteristics. Evaluation parameters were fiber diameter, density of follicles and Secondary/Primary relation. Follicle count primary and secondary were made from skin biopsies and were performed with the aid of a punch. Features regarding the production and quality of wool from sheep were considered in contemporary animals, evaluating fleece weight and clean dirty, length of strands, washing yields, coefficient variation of fiber and W / D3. The comparison made in this paper would attribute the decrease in fiber diameter to the crossing with MPM. The follicle density on Corriedale ewes, Corriedale ewe lambs in and the F1 (Corriedale x MPM) were significantly different. The S / P was 9,08 ± 2,32 ; 9.46 ± 1.57 and 11,93 ± 2,18 respectively. The fleece weight in the F1 ewe lambs (Corriedale x MPM) was lower and significantly different from its Corriedale contemporaries. The yield on wash fleece at Corriedale ewe lambs was higher than ewe lambs crossbred with MPM. The differences were significant in length of strands between Corriedale and Corriedale sheep x MPM. Expected results from the crossbreeding could not be substantiated under the conditions realized. Additional studies will be needed to support possible morphological and productive investment.

Apendicitis aguda asociada a masa palpable en fosa iliaca derecha / Acute appendicitis associated with palpable mass in the right lower quadrant

La apendicitis aguda es la primera causa de cirugía en pediatría. Su manejo es de urgencia. Como complicación del proceso inflamatorio local se puede producir un plastrón apendicular, siendo este la principal causa de masa en fosa iliaca derecha asociada a cuadro clínico compatible; sin embargo, se debe considerar la ocurrencia de otras causas de masa local. El abordaje quirúrgico inmediato prima en el estudio de una masa en fosa iliaca derecha asociada a dolor local cuando se requiere llegar al diagnóstico con precisión, prefiriéndose antes que el abordaje diferido o conservador, usados con frecuencia cuando la sospecha principal es masa de origen apendicular.

The acute appendicitis is the first cause of surgery in pediatric care. Its management is urgent. As a complication of the local inflammatory process, it can develops an appendicular abscess, being this the principal cause of right fossa iliac’s mass associated to clinic; nevertheless, it has to be considered other causes of local mass. The surgical approach goes first in the study of the right fossa iliac’s mass associated to local pain when it is required to have a diagnosis with accuracy, preferring this before the interval appendicectomy or conservative management, frequently used when the principal hypothesis is an appendiceal mass.

Propagación in vitro de Renealmia alpinia (Rottb. ), planta con actividad antiofídica / In vitro propagation of Renealmia alpinia (Rottb), plant against snakebite

La Renealmia alpinia (matandrea o achira de monte) es una planta que por sus efectos antiedematizantes, antihemorrágicos y neutralizantes del veneno de la serpiente Bothrops asper (mapaná equis), se constituye en una potencial alternativa de atención primaria en accidentes ofídicos, o en una fuente de moléculas con importancia farmacéutica. A pesar de ello, no existen estudios previos encaminados a la propagación vegetativa, la desdiferenciación tisular o la producción in vitro de sus metabolitos. En este trabajo se evaluan bajo condiciones in vitro algunas variables como la altura, el número de brotes y raíces en la propagación de R. alpinia, así como la tasa de velocidad de multiplicación y la inducción de tejido indiferenciado en explantes foliares. La adición de 6- Bencilaminopurina (3 mg/L) promueve la propagación de esta especie vegetal, con una tasa de velocidad de multiplicación (TVM) de 1.39 brotes/semana, mientras que la inducción de tejido indiferenciado se ve favorecida por la exposición de los explantes foliares a la combinación de 2,4-D (2 mg/L) y BA (1mg/L). Adicionalmente, se detecta en el tejido foliar (de plantas crecidas in vitro y ex vitro) la presencia de cumarinas, metabolitos encontrados en algunas plantas con conocida actividad antiofídica, abriendo así la posibilidad de estudios encaminados a la producción y evaluación in vitro, de estos y otros metabolitos con potencial interés farmacéutico

Coexistent congenital aortic defects, aneurysm of sinus of valsalva, atrial septal defect and infective endocarditis: a case report

Coarctation of the Aorta is frequently associated with bicuspid aortic valve. This is a risk factor for infective endocarditis. Aneurysm of a sinus of Valsalva is a rare defect with a prevalence of 0.09. They are associated in 10of cases with a bicuspid aortic valve and less frequently with coarctation of the aorta and atrial septal defect. It is extremely rare the association of coarctation of the aorta with an atrial septal defect. This is one of the first cases reported in Puerto Rico of an adult patient with coarctation of the aorta in association with a bicuspid aortic valve, a ruptured aneurysm of a sinus of Valsalva and an atrial septal defect. The patient is a 22 year old male with coarctation of the aorta diagnosed since childhood who was admitted at the Cardiovascular Center of Puerto Rico with signs of heart failure due to infective endocarditis secondary to a teeth infection. Upon evaluation with transthoracic and transesophageal echos, he was found to have a coarctation at the aortic isthmus, aortic root dilatation, bicuspid aortic valve with vegetation, severe aortic and tricuspid regurgitation, aneurysm of the non coronary sinus of Valsalva with perforation to the right atrium, biatrial enlargement and a dilated right ventricle. Successful antibiotic treatment of endocarditis was achieved followed by surgical replacement of the aortic valve and ascending aorta with closure of the non coronary sinus of Valsalva was done. An secundum atrial septal defect was found and was also closed. Surgical correction of the coarctation of the aorta was postponed for a future time. The patient had a successful postsurgical recovery and was discharged home with anticoagulation treatment.

Heart transplantation in females: the experience in Puerto Rico

BACKGROUND: Heart transplantation is the procedure of choice for a selected group of patients with end stage heart disease. Gender related differences have been observed in the heart transplant field: less women than men are recipients of heart transplants, more risk of rejection in female recipients, and a perception toward reduced survival in women. We report our experience of heart transplantation in females in Puerto Rico. METHODS: We studied the data bank of 69 heart transplant recipients in the Puerto Rico Heart Transplant Program from June 1999 to June 2005. Gender related differences in the number of recipients: males or females, incidence of rejection, survival, and other outcomes were analyzed. RESULTS: 69 patients received an orthotopic heart transplant from June 1999 to June 2005, in a single center in Puerto Rico. The mean age of the patients was 47 (11-62) years. Fifty patients (72%) were men, and 19 patients (28%), were women. Survival in the female group at 3 months, 1, 2, 3, 4, and 5 years was 100%, 100%, 100%, 100%, 90%, and 90% respectively. The survival in the male group at 3 months, 1, 2, 3, 4 and 5 years was 97%, 97%, 97%, 94%, 86 and 79% respectively. There was an early, higher incidence of rejection in women during the first three months post transplant; 1.5 vs. 0.75, (P=0.04) episodes per patient in the female, and male group respectively. After the third month post transplant there was no significant difference in rejection incidence. The incidence of infectious episodes was significantly more frequent in female than in male recipients, 2.8 vs. 1 (P=0.02) per patient respectively. CONCLUSIONS: There were more male than female heart transplant recipients at a ratio of 3:1, without a significant gender difference in survival. The risk of rejection was higher in females in the early period post transplantation, but thereafter this risk showed no signinificant statistical difference. The incidence of infection was more frequent in female...

Prevalence and histopathology of Neoechinorhynchus curemai Noronha, 1973 (Acanthocephala: Neoechinorhynchidae) in Prochilodus lineatus Valenciennes, 1836 from Volta Grande Reservoir, MG, Brazil

The present work studied the prevalence and histopathology of Neoechinorhynchus curemai Noronha, 1973 (Acanthocephala: Neoechinorhynchidae) from curimbatá, Prochilodus lineatus Valenciennes, 1836. Eighteen fishes with averages of 46.7 + 1.1 cm length and 1,674.8 + 75.6 g weight were collected with net, bimonthly from December 1995 thru December 1996 in the hydroelectric power station of Volta Grande Reservoir (Cemig), Minas Gerais, Brazil. From analysed fishes, 15 were infected with acanthocephalans in the intestine (prevalence 83.3%). The greatest mean intensity occurred in August 1996 with 66.5 (16 to 208) parasites. Histopathological analysis showed complete desquamation of the intestinal epithelium with severe hyperplasia and hypertrofia of the goblet cells. Severe inflammatory reaction at the submucosa, displacement of their sheaf, associated with oedema and mononuclear and eosinophilic infiltration were observed.

O presente trabalho estudou a prevalência e a histopatologia de Neoechinorhynchus curemai Noronha, 1973 (Acanthocephala: Neoechinorhynchidae) em curimbatá, Prochilodus lineatus Valenciennes, 1836. Dezoito peixes com comprimento total médio de 46,7 + 1,1 cm e peso médio de 1.674,8 + 75,6 g foram coletados com rede, bimestralmente, de dezembro de 1995 a dezembro de 1996 na usina hidrelétrica do Reservatório de Volta Grande (Cemig), Minas Gerais, Brasil. Dos peixes analisados, 15 estavam infectados com acantocéfalos no intestino (prevalência de 83,3%). A maior intensidade média ocorreu em agosto de 1996, com 66,5 (16 a 208) parasitos. A análise histopatológica revelou completa descamação do epitélio intestinal com severa hiperplasia e hipertrofia das células caliciformes. Observou-se, ainda, forte reação inflamatória na submucosa, deslocamento de feixes, associado a edemas, bem como infiltração mononuclear e eosinofílica.

Prevalence and histopathology of Neoechinorhynchus curemai Noronha, 1973 (Acanthocephala: Neoechinorhynchidae) in Prochilodus lineatus Valenciennes, 1836 from Volta Grande Reservoir, MG, Brazil

The present work studied the prevalence and histopathology of Neoechinorhynchus curemai Noronha, 1973 (Acanthocephala: Neoechinorhynchidae) from curimbatá, Prochilodus lineatus Valenciennes, 1836. Eighteen fishes with averages of 46.7 + 1.1 cm length and 1,674.8 + 75.6 g weight were collected with net, bimonthly from December 1995 thru December 1996 in the hydroelectric power station of Volta Grande Reservoir (Cemig), Minas Gerais, Brazil. From analysed fishes, 15 were infected with acanthocephalans in the intestine (prevalence 83.3 percent). The greatest mean intensity occurred in August 1996 with 66.5 (16 to 208) parasites. Histopathological analysis showed complete desquamation of the intestinal epithelium with severe hyperplasia and hypertrofia of the goblet cells. Severe inflammatory reaction at the submucosa, displacement of their sheaf, associated with oedema and mononuclear and eosinophilic infiltration were observed

Modificaciones al modelo experimental de trasplante hepático ortotópico / Modifications to the experimental model of orthotopic liver transplantation

Se presenta nueva técnica en trasplantes hepáticos experimentales en perros. Utilizando, como variantes del modelo clásico de Starzl, dos by-pass, uno portoyugular y otro endocavo, logramos reducir el tiempo total de clampeo y de las cavas, con las consiguientes menores alteraciones cardiovasculares, electrolíticas y riesgo de sangramiento

Otras alternativas técnicas en el transplante hepático heterotópico experimental / Other technical alternatives in the experimental heterotopic hepatic transplantation

Presentamos nuestra técnica en el transplante hepático heterotópico en perros. Antes de anastomosar las cavas a nivel infrahepático, colocamos un by-pass endocavo multifenestado, para evitar problemas de drenaje venoso del hígado. Este catéter intracavo permite maniobrar dirigidas a obviar los riesgos de sangramiento y alteraciones electrolíticas y cardiovasculares