[Prevalence of asthma and associated risk factors in schoolchildren from an area of indigenous population]. / Prevalencia de asma y factores de riesgo asociados en escolares provenientes de una zona de pueblos indígenas.

INTRODUCTION: The prevalence of asthma in Chile ranges from 10.2 to 14.9%. In previous studies, the Araucanía Region has not been included. OBJECTIVE: To determine the prevalence of asthma in the school po pulation of the Araucanía Region. SUBJECTS AND METHOD: The ISAAC questionnaires were used for asthma symptoms in addition to a questionnaire for recording sociodemographic data, belonging to the Mapuche ethnicity, type of heating, exposure to indoor air pollution, and family history. The Binomial Regression Model was used to evaluate the effect of each of the different variables of inter est, adjusting by age groups (6-7 and 13-14 years). The model also evaluated the additive interaction between these variables and age. RESULTS: 823 surveys were applied, where the prevalence of asthma was 14.2% and 23.2% in the 6-7 year old group and the 13-14 year old group, respectively. 43.7% de clare to be Mapuche, 32.9% live in rural areas, and 81.4% use firewood as a heating method. Through binomial regression model analysis, where for the study group, living in the coastal commune was significantly associated with a lower prevalence of asthma (-13.2% [CI: -17.7 to -8.6]. The history of an asthmatic mother was significantly associated with a higher prevalence of asthma (17.9% [CI: 2.7 to 33.1]. Living in a rural area, to be Mapuche or the type of heating used, showed differences statistically significant (p 0.18, p 0.609 and p 0.480, respectively) Conclusion: 13-14 year-olds school children in the Araucanía Region presented a higher prevalence of asthma. There was an association with asthma in the mother where this increase is not associated with living in a rural area, to be Ma puche or type of heating.

Distance Dependence of Single-Molecule Energy Transfer to Graphene Measured with DNA Origami Nanopositioners.

Despite the thorough investigation of graphene since 2004, altering its surface chemistry and reproducible functionalization remain challenging. This hinders fabrication of more complex hybrid materials with controlled architectures, and as a consequence the development of sensitive and reliable sensors and biological assays. In this contribution, we introduce DNA origami structures as nanopositioners for placing single dye molecules at controlled distances from graphene. The measurements of fluorescence intensity and lifetime of single emitters carried out for distances ranging from 3 to 58 nm confirmed the d-4 dependence of the excitation energy transfer to graphene. Moreover, we determined the characteristic distance for 50% efficiency of the energy transfer from single dyes to graphene to be 17.7 nm. Using pyrene molecules as a glue to immobilize DNA origami nanostructures of various shape on graphene opens new possibilities to develop graphene-based biophysics and biosensing.

Plasmon-assisted Förster resonance energy transfer at the single-molecule level in the moderate quenching regime.

Metallic nanoparticles were shown to affect Förster energy transfer between fluorophore pairs. However, to date, the net plasmonic effect on FRET is still under dispute, with experiments showing efficiency enhancement and reduction. This controversy is due to the challenges involved in the precise positioning of FRET pairs in the near field of a metallic nanostructure, as well as in the accurate characterization of the plasmonic impact on the FRET mechanism. Here, we use the DNA origami technique to place a FRET pair 10 nm away from the surface of gold nanoparticles with sizes ranging from 5 to 20 nm. In this configuration, the fluorophores experience only moderate plasmonic quenching. We use the acceptor bleaching approach to extract the FRET rate constant and efficiency on immobilized single FRET pairs based solely on the donor lifetime. This technique does not require a posteriori correction factors neither a priori knowledge of the acceptor quantum yield, and importantly, it is performed in a single spectral channel. Our results allow us to conclude that, despite the plasmon-assisted Purcell enhancement experienced by donor and acceptor partners, the gold nanoparticles in our samples have a negligible effect on the FRET rate, which in turns yields a reduction of the transfer efficiency.

Trauma, disociación y verguenza. Un tratamiento de adicción / Trauma, dissociation and shame. An addiction treatment

El proceso de recuperación de una adicción requiere transitar por un profundo cambio de la manera en que una persona se relaciona consigo mismo y con los demás. En este trabajo se describe parte de un proceso terapéutico que muestra la manera en que se ponen en juego la subjetividad del paciente y su terapeuta. Se trata de un paciente de 35 años, dependiente a cocaína. En el contexto de su rehabilitación, se descubrió que el paciente había engañado en forma sistemática a su familia y al equipo terapéutico. En realidad, no había estado abstinente, sino que mantenía un constante consumo. Por diversas razones, el sistema de tratamiento falló en cumplir con los exámenes de orina propios de una rehabilitación. Luego del destape de la verdad, el paciente reacciona con indiferencia y agresividad. El terapeuta se molesta con la conducta del paciente, lo confronta y se produce un impasse entre ambos. El eje de análisis del caso son los sentimientos de vergüenza del paciente y su terapeuta. Se relaciona la vergüenza con el trauma relacional del paciente. Se discute acerca de dos enactments, relacionándolos con la vergüenza disociada. Se analiza el caso en el contexto de la alta exigencia impuesta en los tratamientos de adicciones.

The addiction recovery process needs to go through a qualitative change in the way a patient relates to others and himself.In this report, a therapeutic process is described, showing the way both patient´s and therapist´s subjectivity interact. The case is about a 35 years old man, addicted to cocaine. The patient kept assisting to treatment sessions, in the context of an addiction program. A collaborative relationship with his individual therapist was developed, validating its contribution and mutual understanding. Nevertheless, things changed when it was discovered that the patient had lied during 3 months. Despite the fact he had asserted he had been abstinent, he had been consuming cocaine 3-4 times a week. Due to different reasons, the treatment system failed at practicing weekly urine screening. After the hidden consumption was opened, Joseph reacts both indifferently and aggressively. The therapist feels annoyed and confronts the patient. A therapeutic impasse is generated.The center of this case analysis is both patient´s and therapist´s shame. This feeling is related to patient´s relational trauma. Two enactments are discussed, understanding them as signs of dissociated shame, addict/patient dissociation and validated/cared self dissociation. A context of high therapeutic expectation amongst addiction treatments is also considered.

Técnica combinada de LEC con ureteroscopía flexible en cálculo de gran tamaño en cáliz inferior / ESWL technique combined with Flexible ureteroscopy in big lower calyx stones

El tratamiento del cálculo del caliz inferior es controversial. Los resultados del tratamiento de los cálculos caliciarios mayores de 1 cm especialmente en el cáliz inferior son no óptimos con la Litotripsia extracorpórea . Debido al avance en los ureteroscopios flexibles es que iniciamos una experiencia para obtener pacientes libres de cálculos residuales. Se presentan 15 pacientes con cálculos mayores de 1 cm. que fueron operados en una sola sesión aplicando primero Litotripsia extracorpórea hasta fragmentar el cálculo y luego extraer los fragmentos residuales con ureteroscopio flexible. En 14 de 15 pacientes el control demostró ausencia de caculos residuales. Esta experiencia demuestra la eficacia de la combinación de ambos métodos sin complicaciones. Debe evaluarse la relación costo beneficio de esta técnica en el objetivo de dejar a los pacientes libres de cálculos.

Treatment of lower caliz’ Stone is controversial. Greater than 1 cm and especially in the low caliz witht he extracorporeal lithotripsy is bad. Because of advances in flexible ureteroscopes is to begin an experience for patients with big stones in the low caliz. We present 15 patients with stones larger than 1 cm who were operated in a single session using extracorporeal lithotripsy to fragment first calculating and then extract the residual fragments with ureteroscoip flexible. In 14 of 15 patients showed Stone free. This report demonstrates the effectiveness of the combination of both methods without complications. Must evaluate the cost benefit of this technique in order to make patients stone free.

Fluorescence enhancement at docking sites of DNA-directed self-assembled nanoantennas.

We introduce self-assembled nanoantennas to enhance the fluorescence intensity in a plasmonic hotspot of zeptoliter volume. The nanoantennas are prepared by attaching one or two gold nanoparticles (NPs) to DNA origami structures, which also incorporated docking sites for a single fluorescent dye next to one NP or in the gap between two NPs. We measured the dependence of the fluorescence enhancement on NP size and number and compare it to numerical simulations. A maximum of 117-fold fluorescence enhancement was obtained for a dye molecule positioned in the 23-nanometer gap between 100-nanometer gold NPs. Direct visualization of the binding and unbinding of short DNA strands, as well as the conformational dynamics of a DNA Holliday junction in the hotspot of the nanoantenna, show the compatibility with single-molecule assays.

Cristaluria en una población pediátrica del estado carabobo, venezuela / Cristaluria in a pediatric population of carabobo state, venezuela

En la orina la presencia de cristales tiene poco significado clínico, aunque su correcta identificación es de utilidad en pediatría pues, proporciona información para el diagnóstico de padecimientos sistémicos, enfermedades de las vías urinarias y posibles errores congénitos del metabolismo. A fin de evaluar la influencia del género, grupo etario, condición socioeconómica y el estado nutricional antropométrico sobre la prevalencia de cristaluria, se evaluaron 381 niños aparentemente sanos, edad 1 a 18 años, atendidos en tres de los ambulatorios del Municipio Guacara, Estado Carabobo. Se determinó estado nutricional antropométrico mediante peso/edad, talla/edad, peso/talla, área grasa y área muscular en lactantes, preescolares y escolares; índice de masa corporal para adolescentes; nivel socioeconómico medido por Graffar modificado. Análisis de orina al microscopio óptico (aumento 400x) Estadístico SPSS versión 10.0 significancia p<0,05. Del total de la población estudiada 49,1% presentó cristaluria, con prevalencia en preescolares y adolescentes (33,2% y 26,2% respectivamente), con predominio estadísticamente significativo en varones (57,8%). El cristal prevalerte fue el oxalato de calcio en 66,8%, con una relación estadísticamente significativa entre tipo de cristal, grupo etario y estrato socioeconómico. En el estado nutricional antropométrico se encontró 16,6% de desnutrición, predominio del estrato socioeconómico IV en todos los grupos etarios. Se concluye que la cristaluria encontrada en esta población pediátrica de nivel socioeconómico bajo, es independiente del estado nutricional antropométrico, aunque asociado a otros factores como grupo etario, género y estrato socioeconómico(AU)

In the urine the crystal presence has little clinical meaning; although its correct identification is of utility in pediatric, due to it provide information for the diagnosis of systemic sufferings, diseases of the urinary routes and possible congenital errors of the metabolism. In order to evaluate the influence of the gender, etario group, socioeconomic condition and the anthropometric nutritional state on the prevalence of cristaluria, 381 apparently healthy children were evaluated; age 1 to 18 years, taken care in three of the ambulatory of the Guacara Municipality, Carabobo State. Was determined anthropometric nutritional state by means of weight/age, carves/age, weight/ carves, greasy area and muscular area in suckling babies, preschool and school students; corporal mass index for adolescents; socioeconomic level measured by modified Graffar. Analysis of urine by optical microscope (400x). Statistical SPSS version 10.1 significance p<0.05. Of the total of studied population 49.1% presented cristaluria, with prevalence in preschool and adolescents (33.2% and 26.2% respectively), with statistically significant predominance in boys (57.8%). The crystal prevalent was the oxalate of calcium in 66.8%, with a statistically significant relation between type of crystal, etario group and socioeconomic layer. In the anthropometric nutritional state was 16,6% of undernourishment. Predominance of socioeconomic layer IV in all the etarios groups. We concludes that cristaluria found in this pediatric population of low socioeconomic level, is independent of the anthropometric nutritional state, although other factors like etario group, gender and socioeconomic level are associated(AU)

Detection of patients with functional dyspepsia using wavelet transform applied to their electrogastrogram

The aim of the present study was to develop a classifier able to discriminate between healthy controls and dyspeptic patients by analysis of their electrogastrograms. Fifty-six electrogastrograms were analyzed, corresponding to 42 dyspeptic patients and 14 healthy controls. The original signals were subsampled, filtered and divided into the pre-, post-, and prandial stages. A time-frequency transformation based on wavelets was used to extract the signal characteristics, and a special selection procedure based on correlation was used to reduce their number. The analysis was carried out by evaluating different neural network structures to classify the wavelet coefficients into two groups (healthy subjects and dyspeptic patients). The optimization process of the classifier led to a linear model. A dimension reduction that resulted in only 25 percent of uncorrelated electrogastrogram characteristics gave 24 inputs for the classifier. The prandial stage gave the most significant results. Under these conditions, the classifier achieved 78.6 percent sensitivity, 92.9 percent specificity, and an error of 17.9 ± 6 percent (with a 95 percent confidence level). These data show that it is possible to establish significant differences between patients and normal controls when time-frequency characteristics are extracted from an electrogastrogram, with an adequate component reduction, outperforming the results obtained with classical Fourier analysis. These findings can contribute to increasing our understanding of the pathophysiological mechanisms involved in functional dyspepsia and perhaps to improving the pharmacological treatment of functional dyspeptic patients.

Detection of patients with functional dyspepsia using wavelet transform applied to their electrogastrogram.

The aim of the present study was to develop a classifier able to discriminate between healthy controls and dyspeptic patients by analysis of their electrogastrograms. Fifty-six electrogastrograms were analyzed, corresponding to 42 dyspeptic patients and 14 healthy controls. The original signals were subsampled, filtered and divided into the pre-, post-, and prandial stages. A time-frequency transformation based on wavelets was used to extract the signal characteristics, and a special selection procedure based on correlation was used to reduce their number. The analysis was carried out by evaluating different neural network structures to classify the wavelet coefficients into two groups (healthy subjects and dyspeptic patients). The optimization process of the classifier led to a linear model. A dimension reduction that resulted in only 25% of uncorrelated electrogastrogram characteristics gave 24 inputs for the classifier. The prandial stage gave the most significant results. Under these conditions, the classifier achieved 78.6% sensitivity, 92.9% specificity, and an error of 17.9 +/- 6% (with a 95% confidence level). These data show that it is possible to establish significant differences between patients and normal controls when time-frequency characteristics are extracted from an electrogastrogram, with an adequate component reduction, outperforming the results obtained with classical Fourier analysis. These findings can contribute to increasing our understanding of the pathophysiological mechanisms involved in functional dyspepsia and perhaps to improving the pharmacological treatment of functional dyspeptic patients.

Situación socieconómica: diagnóstico nutricional antropométrico y dietario en niños y adolescentes de Valencia-Venezuela / Socioeconomic status: anthropometric nutritional diagnosis and dietary adequacy in children and adolescents of an area of Valencia-Venezuela

La capacidad de compra de alimentos derivada del nivel socioeconómico influye en calidad y cantidad de la dieta, pudiendo originar alteraciones nutricionales. Se planteó evaluar la asociación de indicadores socioeconómicos y antropométricos con la adecuación dietaria en niños de una zona de pobreza. Se estudiaron 257 niños menores de 18 años, de una Parroquia de Valencia, 2004. Se determinó estrato socioeconómico (ESE)(Graffar-Méndez), adecuación dietaria (recordatorios 24h, n=97) e indicadores antropométricos: P/E, T/E, P/T, circunferencia brazo, área grasa y muscular, pliegue tricipital e Índice de Masa Corporal). Análisis estadístico por distribución de frecuencia, Chi cuadrado y Pearson. Predominaron varones, escolares, estratos IV y V y una familia por vivienda. Hubo 36,6% de déficit, normalidad en 54,8% y 8,6% de exceso nutricional. Las adecuaciones calórica y proteica fueron aceptables, pero excesiva para fibra, 41,2% de déficit calórico y 45,3% en proteínas, 58,3% de los normales y en exceso tenían aporte calórico deficiente, y los desnutridos 46,5%. El exceso en consumo de fibra (49%) fue independiente del estrato y estado nutricional. La adecuación de fibra se relacionó con ingesta calórica y proteica, edad, talla y área muscular pero no hubo entre adecuación calórica y proteínas con ESE. Se concluye que hubo asociación importante entre el consumo dietario y estado nutricional pero la asociación es menor con el ESE. La evidencia no relacionó las alteraciones encontradas con la situación de pobreza. La evaluación del consumo de alimentos fue útil para complementar la información antropométrica y sociodemográfica; considerando la sub o sobreestimación del dato dietario.

Food purchase capacity is related to socioeconomic level, and it influences dietary quality and quantity. Changes on diet may cause alterations of nutritional status. In order to evaluate the association between socioeconomic and anthropometrics indicators to dietary adequacy in children from a poverty area, 257 children and adolescents randomly selected, from Valencia, Venezuela (2004) were assessed. Socioeconomic status was determined(SES, Graffar-Méndez), dietary adequacy (24h recalls, n=97) and anthropometrical indicators (W/A, H/A, W/H, arm circumference, fat and muscular area, tricipital skinfold and BMI) were measured. Statistical Analysis by frequency distribution, Chi² test and Pearson correlation was performed. Boys, school children; families in poverty(IV and V stratum) and one family/home were highly prevalent. Nutritional diagnosis consisted of: 36.6% of deficit, 54.8% of normality and 8.6% of excess. Mean caloric and protein intake and adequacy were acceptable, but fiber adequacy was excessive. 41.2% of subjects had inadequate energy intake and 45.3% inadequate protein intake. Energy intake was deficient in 58.3% of normal subjects and also in those in excess, and in 46.5% of undernourished children, 52.1% of the undernourished children had excessive adequacy for fiber. There was association between fiber adequacy to energy and protein intake, age; height and muscular area, but not between energy and protein intake to socioeconomic condition. It is concluded that there was an important association between dietary intake and nutritional status but only a weak relation to SES. Evaluation of dietary intake and adequacy is useful to complement anthropometric and socioeconomic information; but care has to be taken for the possibility of under or overestimation of data reported by the interviewed.

Asociación entre pobreza e infestación parasitaria intestinal en preescolares, escolares y adolescentes del sur de Valencia estado Carabobo-Venezuela / Association between poverty and intestinal parasitism in pre-school, elementary school children and adolescents from south of Valencia state of Carabobo Venezuela

Condiciones de vida deficientes, contaminación fecal de agua, de alimentos y del suelo favorecen la transmisión de parásitos intestinales. Para establecer asociación entre pobreza e infestación parasitaria se evaluaron aspectos socio-sanitarios (composición familiar, estrato social, vivienda), ambientales (agua, excretas) y coproparasitológicos (examen directo y kato) en 257 sujetos (2 a 18 años), de Valencia Estado Carabobo. Se encontró: Predominio de escolares en estrato IV, de estructura monofamiliar y de 5 personas por grupo; 48,2 por ciento de infestación, alta prevalencia en escolares (mono (57,3 por ciento) y poliparasitismo (52,6 por ciento). Los protozoarios fueron más prevalentes en el estrato IV (63,9 por ciento) y los helmintos en el estrato V (64,3 por ciento). No se encontró asociación estadísticamente significativa entre estrato socioeconómico por el método de Graffar- Méndez Castellano y parasitosis, pero sí entre parasitosis y ausencia de cloacas, agua no tratada, baño intradomiciliario, ausencia de piso y número de personas por familia. Predominio de protozoarios en familias de hasta 5 personas (56,6 por ciento) y helmintos en familias con mas de de cinco personas (78,6 por ciento). Asociación significativa entre Blastocystis hominis, Entamoeba coli y Ascaris lumbricoides y familias de más de 5 personas. Hubo estrecha aociación entre parasitosis y condiciones socio-sanitarias, ambientales y conductuales, lo que favorece la morbilidad en este grupo poblacional, perpetuando el ciclo de pobreza e infestación parasitaria.

Poor living conditions, fecal contamination of food, water and soil are factors that contribute to intestinal parasites transmission. In order to stablish association between poverty and parasitary infectation, socio-sanitary (family structure, social stratum, housing), environmental (water and excreta disposition) and coproparasitological (direct and kato examination) aspects were evaluated, in 257 subjects (2-18 years old), from Valencia, Carabobo State. Findings were: High prevalence of school children, of stratum IV, of monofamiliar structure, with five persons per group. Parasite infestation was found in 48.2 percent of children, more prevalent in school children, with mono (53.7 percent) and poliparasitism (52.6 percent). Protozoa forms were more prevalent in stratum IV (63.9 percent) and helminthes forms in stratum V (64.3 percent). There was not statistically significant association between socioeconomic strata assessed by Graffar-M‚ndez Castellano method and parasitic infestation, but between parasitic infestation and sociosanitary conditions (absence of sewers, non-treated water, intradomiciliary bath, absence of floor and number of people by family), statistically significant association was present. Predominance of protozoa in subjects from small families groups (less than five persons) was 56.6 percent while in children from large families groups (higher than five persons), prevalence of helminthes was 78.6 percent. Significant association was found between Blastocystis hominis, Entamoeba coli and Ascaris lumbricoides and large families groups. It is concluded that a strong and significant association was found between parasite infestations and socio-sanitary, environmental and cultural conditions, situation that favours a high morbidity rate, which perpetuates the interactions cycle of poverty and parasite infestations.

Surface plasmons in terahertz metamaterials.

We characterize terahertz metamaterials by applying apertureless near-field microscopy with a bandwidth that covers the entire spectral response of the structures. The observations agree with the interpretation of the fundamental mode of the metamaterial. But the high frequency resonance shows properties that deviate from the common interpretation. We show that the high frequency response is governed by surface Plasmon excitations, which have a comparable oscillator strength as the fundamental mode.

Shear force control for a terahertz near field microscope.

We report on the advancement of apertureless terahertz microscopy by active shear force control of the scanning probe. Extreme subwavelength spatial resolution and a maximized image contrast are achieved by maintaining a tip-surface distance of about 20 nm. The constant distance between scanning tip and surface results in terahertz images that mirror the dielectric permittivity of the surface.

Millimeter wave probing of the acoustic phase for concealed object detection.

We developed a far infrared technique for detecting objects that are concealed behind a barrier, which is opaque for visible light. The technique makes use of the fact that mechanically coupled objects can be distinguished by their acoustic phase during a driven vibration. The pattern of the acoustic phase is imaged using 70 GHz radiation. The experimental data demonstrate that virtually all objects can be sensed, which includes metals as well as dielectric materials.

Infecciones por candida en neonatología / Candida infections in neonatology

Introducción: La infecciones nosocomiales por hongos han aumentado significativamente en los últimos veinte años, y entre estas, las infecciones por Candida constituyen una causa emergente en unidades de neonatología. Objetivos: Caracterizar el perfil clínico-microbiológico de los recién nacidos ingresados a una unidad de neonatología que desarrollaron una infección por Candida. Pacientes y Método: Estudio retrospectivo tipo caso control en un período de 10 años (1994 a 2004). Por cada caso se seleccionaron dos controles de similar edad gestacional que no hayan presentado infección a Candida. Resultados: Se identificaron 14 casos con infecciones por Candida. Comparados con los controles (n = 28) los recién nacidos con infecciones por Candida tuvieron significativamente (p < 0,05) mayor: estadía hospitalaria, proporción de ventilación mecánica, uso de alimentación parenteral - antibióticos, intervenciones quirúrgicas y mortalidad. En el grupo con infecciones por Candida; nueve se presentaron en recién nacidos a término o cerca del término, la especie más frecuentemente aislada fue Candida albicans en ocho casos y en seis casos Candida no albicans siendo el principal sitio de aislamiento el territorio sanguíneo. La mortalidad en esta serie fue de 28% (4/14). Conclusiones: En nuestra unidad, las Infecciones por Candida predominaron en recién nacidos a término y se confirma la emergencia de Candida no albicans como causantes de infecciones nosocomiales por hongos. Se requiere optimalizar el diagnóstico precoz y la búsqueda de la diseminación a distancia de estas infecciones.

Nosocomial fungal infections have significantly increased over the past 2 decades. Candida species are recognized as leading nosocomial pathogens in neonatal intensive care unit. Objective: To describe the clinical and microbiological profile of Candida infections in a neonatal intensive care unit. Method: Retrospective case-control study in a period of 10 years (1994-2004), performed in all newborns admitted to our unit. Each case was compared with 2 control neonates who did not have fungal infection. Results: 14 cases of Candida infections were identified. Compared with match controls (n = 28), newborns with Candida infections had significantly (p < 0,05) longer hospitalizations and duration of mechanical ventilation, use of parenteral nutrition and broad spectrum antibiotics, along with surgical interventions and mortality. In the group with fungal infections, 9 were term or near-term newborns, mean age at onset was 21 days and Candida albicans was recovered from 8 of 14 cases. Blood was the main source for positive cultures (8/14), fungal dissemination was rare and 28% died (4/14). Conclusions: Candida infections predominate in term and near-term newborns and Candida no albicans have become common agents of nosocomial fungal infections in our unit. Improvement of diagnosis and multiple organ evaluation are further required.

Prótesis testicular en pacientes orquiectomizados por cáncer testicular. ¿se justifica como insumo del plan nacional de salud Auge Ges? / Testicular prostheses in patient after orchidectomy for testicular cancer: justified as devices of the AUGE-GES’s health national law?

La pérdida de un testículo es un trauma físico y psicológico, en particular si la causa es por cáncer. En Chile desde julio de 2005 rige la Ley Nº 19.966, AUGE GES en Salud, y el cáncer testicular del adulto está incluido, pero no contempla la prótesis testicular. Fue esta la motivación para realizar este trabajo y objetivar si es un punto importante del tratamiento del cáncer de testículo. Material y Métodos: Se realizó una entrevista personal a 60 pacientes orquiectomizados por cáncer testicular, entregándoles un cuestionario dividido en preguntas antes y después de la orquiectomía ampliada, y si aceptan o rechazan la prótesis testicular y sus razones. Las respuestas se tabularon en una base de datos Microsoft Access. Se aplicó análisis estadístico con método de Fisher' Irving. Resultados: La mediana de edad fue 31 años (17-57). El 66,7 por ciento refirió no tener problemas de ser monórquicos; el 28,3 por ciento relató complejo de mostrarse desnudo y el 5 por ciento indicó incomodidad física. El 58,3 por ciento se operaría nuevamente para instalar la prótesis testicular y de éstos el 88,5 por ciento lo haría por estética. El 93,3 por ciento hubiese aceptado la instalación de prótesis al momento de la orquiectomía. No existió diferencia al comparar grupo de solteros y casados, ni grupo etario. Discusión: La repercusión psicológica es algo muy difícil de objetivar, sobre todo en una sociedad machista. Al momento de preguntar si se operarían varios de los pacientes cambian su respuesta y muestran su malestar de ser monórquicos. Es muy importante el hecho de contar con la prótesis al momento de la orquiectomía para optimizar los tiempos y disminuir los costos físicos y psicológicos de una nueva cirugía. Conclusiones: Dado que la Ley 19.966 de Salud, establece las prestaciones de carácter promocional, preventivo, curativo, de rehabilitación y paliativo, y que en el caso del cáncer testicular no cuenta con la prótesis dentro del Listado de Prestaciones Específicas, no se estaría cumpliendo con el carácter de rehabilitación garantizado por la Ley mencionada. Es por esta razón, y en base a los resultados obtenidos en este estudio, que se justifica plenamente que la prótesis testicular fuese parte del Plan AUGE GES.

Colgajo pediculado del músculo dorsal ancho: aplicaciones en cirugía reconstructiva oncológica de cabeza y cuello / Latissimus dorsi pedicled flap: applications in head and neck oncological reconstructive surgery

- Introducción: El colgajo miocutáneo del músculo dorsal ancho es el más antiguo de su tipo.Higinio Tanzini publicó en 1906 su experiencia en la reconstrucción mamaria con esta técnica, la cual cayó en el olvido por mucho tiempo. En la década del 70 la idea fue retomada por Olivari y cols. Su uso en cabeza y cuello corresponde a Quillen en 1978 que lo utilizó de forma pediculada por primera vez en el área cérvicofacial. Este colgajo permite la reconstrucción de grandes defectos cutáneos y mucosos y su gran versatilidad le permite un amplio espectro de indicaciones en cavidad bucal, orofaringe, hipofaringe, territorio craneo-orbitario, etc. En nuestro trabajo se ilustra el empleo de esta técnica como un arma más en el arsenal reconstructivo del cirujano de cabeza y cuello. Se muestran los resultados preliminares de los primeros casos operados con esta técnica.- Material y métodos: Se revisan las historias clínicas de 15 pacientes a los cuales se les realizó por diferentes razones la técnica del colgajo dorsal ancho en nuestro Instituto, recolectando datos generales, referentes a su enfermedad, defecto a reconstruir, complicaciones postoperatorias y resultados estéticos y funcionales.- Resultados: Los territorios reconstruidos: fueron 4 defectos grandes de piel y partes blandas del cuello, 5 defectos faringoesofágicos, 2 defectos de cavidad oral, dos defectos combinados de carrillo y piel de la mejilla, un defecto craneo-orbitario y un defecto de la región parotídea. La necrosis total apareció en 2 de los 15 casos, todos con defectos faringoesofágicos. La necrosis parcial en 2 pacientes. En el resto de los casos el colgajo presentó buena vitalidad.- Conclusiones: El colgajo dorsal ancho es un método fiable para la reconstrucciones en cabeza y cuello. Por su pedículo expuesto es muy sensible a la necrosis tras la sepsis y fístula en los casos de reconstrucciones faringoesofágicas (AU)

Bone aluminum uptake in uremic rats receiving intraperitoneal iron.

To assess the effect of concomitant iron and aluminum loads on bone aluminum accumulation and on the response to the deferoxamine test in rats with the same aluminum surcharge, Wistar rats with chronic renal failure were divided into three groups: iron-overloaded rats (N = 6) (intraperitoneal iron); iron-depleted rats (N = 6) (blood withdrawal two to three times per week); control rats (N = 4) (no manipulation). All groups received intraperitoneal aluminum simultaneously. After 6 wk, a deferoxamine challenge test was performed. Thereafter, bone aluminum and iron were measured. The iron-overloaded rats showed higher bone iron content (iron overloaded: 147.7+/-55.4 microg/g; iron depleted: 7.9+/-1.0, and controls 13.3+/-9.9 microg/g, p < 0.010) and lower bone aluminum content (iron overloaded: 14.2+/-4.0 microg/g; iron depleted: 70.9+/-35.1 microg/g; controls: 72.7+/-28.3 microg/g p < 0.005). No differences were found between the iron-depleted and control rats. After the deferoxamine infusion, the iron-depleted rats tended to have higher serum aluminum increments (p = NS) and higher urinary aluminum excretion (p < 0.012, p < 0.020) than control rats despite similar amounts of aluminum in bone of the two groups. Aluminum bone accumulation was minor if iron and aluminum loads were given concomitantly. The iron depletion influenced the results of the deferoxamine challenge test in rats with similar bone aluminum burden.