More than seventy years from a milestone in fractal geometry: Moran's theorem.

In this paper, we re-explore in detail the techniques employed in P. A. P. Moran's original proof for a key result in fractal geometry allowing the calculation of the Hausdorff dimension of attractors of iterated function systems constructed by similitudes.

El virus de hepatitis E en los animales domésticos: Una revisión / Hepatitis E virus in domestic animals: A review

El virus de la Hepatitis E (VHE) es un patógeno emergente, fue originalmente identificado como el agente de transmisión de hepatitis entérica No-A, No-B, e identificado en cerdos y en humanos. La infección por el virus de la hepatitis E (VHE), está ganando la atención mundial, debido a la creciente car ga de la enfermedad en los países de baja endemicidad, en términos de morbilidad y mortalidad, sino también debido a los avances recientes en la virología molecular y la epidemiología de esta emergente patógeno. La propagación del VHE infección puede ser descrita como la evolución de una zoonosis hacia una infección humana establecida. Como se sabe por otros virus, tales como el virus de la inmunodeficiencia hu mana o de los virus de influenza, que cruzan las barreras de las especies de animales a los seres humanos, es un fenómeno recurrente. Aunque lenta al principio, una vez que el virus se ha adaptado a los humanos, la propagación de persona a persona puede proceder muy rápidamente. Las cepas del VHE aisladas en humanos tienen una estrecha relación genética con cepas halladas en cerdos, ratas y pollos. Se han determinado anticuerpos anti-VHE en bovinos, caninos, felinos, primates y roedores. El virus de Hepatitis E es de gran importancia desde el punto de vista de la salud pública. Los animales domésticos y otras especies se pueden comportar como reservorios potencialmente infeccioso. El riesgo de infección para el humano es inminente ya sea por consumo de alimentos de origen animal contaminado, aguas contaminadas y transmisión directa oral-oral, oral-fecal. Alimentos de origen animal sin la inspección sanitaria que garanticen la calidad e inocuidad deben ser considerados como un elemento infeccioso potencial a nivel de mataderos industriales y sobre toda la cadena de comercialización.

Hepatitis E virus (HEV) is an emerging pathogen, was originally identified as the agent of transmission of enteric hepatitis Non-A, Non-B, identified in pigs and humans. Hepatitis E virus (HEV), Infection is gaining worldwide attention because of the increasing burden of disease in low endemic countries in terms of morbidity and mortality, but also because of recent advances in the molecular virology and epidemiology of this emerging pathogen. The spread of HEV infection can be described as the evolution of a zoonosis to established human infection. As known from other viruses such as human immunodeficiency virus or influenza virus crossing the species barrier from animals to humans is a recurring phenomenon. Although slow at first, once the virus has adapted to humans, spread from person to person can come very quickly. HEV strains iso lated in humans are closely related genetically to strains found in pigs, rats and chickens. Have been gi - ven an ti-HEV antibodies in cattle, dogs, cats, primates and rodents. Hepatitis E virus is of great importance from the standpoint of public health, the impact on the liver and pregnancy. Pets and other species can behave as re - servoirs potentially infectious. The risk of infection for humans is im mi nent either through consumption of con - taminated food of ani mal origin, contaminated water and direct oral-oral trans mission, fecal-oral. Animal foods without health inspections to ensure quality and safety must be considered as a potential infectious element-level slaughterhouses and the entire supply chain.

Carcinoma epidermoide tímico y linfoma intravascular de células B grandes diseminado. Una asociación no informada / Concurrent thymic squamous cell carcinoma and disseminated intravascular large B-cell lymphoma. A previously unreported association

La incidencia de tumores malignos extratímicos en pacientes con timoma es significantivamente más alta que en la población general. El linfoma no Hodgkin es la neoplasia más comúnmente asociada. En esta revisión, informamos la concurrencia de un carcinoma epidermoide tímico y un linfoma intravascular de células B grandes diseminado, caracterizado por presentación clínica rápidamente progresiva y fatal, en un hombre de 78 a˜nos. Este caso constituye la primera asociación informada entre ambas neoplasias. Debido a su rareza y a la multiplicidad de presentaciones, es muy difícil diagnosticar este tipo de linfoma antemortem, por lo que debería ser incluido en el diagnóstico diferencial de todo paciente que presente enfermedad sistémica y elevación marcada de la deshidrogenada láctica sérica. En el presente caso pensamos que el linfoma pudiera haberse desarrollado como resultado de un defecto en la vigilancia inmunológica o una alteración de la inmunorregulación causada por el carcinoma tímico. En casos como el actual la autopsia es el único método de diagnostico seguro(AU)

The incidence of extrathymic malignancies in patients with thymoma is significantly higher than in the general population. Non-Hodgkin lymphoma represents the most commonly associated tumor type. We report the concurrence of primary thymic squamous cell carcinoma and disseminated intravascular large B-cell lymphoma (IVL) in a 78-year-old man characterized by a rapidly fatal clinical course. To our knowledge, this is the first time that such an association is reported. Due to its rarity and the multiplicity of presentations, it is very difficult to diagnose this type of extranodal lymphoma antemortem. The intravascular lymphoma should be included in the differential diagnosis when a patient presents signs of a systemic disease and marked elevation of serum LDH. In this case the lymphoma may have been developed as a result of defective immunologic surveillance or impaired immunoregulation caused by the thymic carcinoma. In our case as in some other cases of IVL, diagnosis could only be conclusively confirmed on autopsy(AU)

Laryngeal granuloma in a thorougbread horse: a multidisciplinary study / Granuloma laríngeo en un caballo pura sangre: un estudio multidisciplinario / Granuloma de laringe em um cavalo puro-sangue: um estudo multidisciplinar

A two year-old racing thoroughbred mare presented with loud respiratory stertor, that was auscultated in thetracheal and laryngeal regions. Upon palpitation of the larynx, no changes were noted. The upper respiratory tractwas examined via a fiberoptic endoscopy where the nasal passages were observed to be unchanged and the scope passed with normal resistance. The guttural pouches and their openings were normal. The right arytenoid cartilage appeared thickened throughout its length and failed to retract during inspiration. In the right, dorsal cricoarytenoidcartilage a gross mass was observed projecting from the right wall. The mass was surgically removed from thelarynx and samples were collected for histopathologic and bacterial study. Histopathologic study of the cricoidcartilage revealed extensive proliferation of fibrous connective tissue, well vascularized granulation tissue with diffuse infiltration of lymphocytes, plasma cells and a few giant cells. Bacterial cultures provided isolation of Pseudomonas aeruginosa, whose antibiogram demonstrated sensitivities to ampicillin, ceftazidime, ciprofloxacin, cefepime, gentamicin, imipinem, meropenem, piperacillin, piperacillin/tazobactam and resistance to trimethoprim. In conclusion, a laryngeal granuloma was detected in a racing thoroughbred mare by a multidisciplinary, clinical study involving endoscopy, as well as histopathologic and microbiologic studies.

Una yegua de dos años de edad Pura Sangre de Carreras presentó estertor respiratorio fuerte que se auscultaen las regiones de la tráquea y la laringe. En la palpación de la laringe no se detectaron cambios. Las víasrespiratorias superiores fueron examinadas con un endoscopio de fibra óptica en los pasajes nasales no seobservaron cambios la resistencia fue normal. Las bolsas guturales y sus aberturas fueron normales, el cartílagoaritenoideo derecho apareció engrosado en toda su longitud y no se retrae durante la inspiración. En el cartílagocricoaritenoideo dorsal derecho se observó una masa que sobresale de la pared derecha. La masa fue removidamediante cirugía de la laringe y las muestras fueron colectadas para un estudio histopatológico y bacteriano. Elestudio histopatológico del cartílago cricoides evidenció una gran proliferación de tejido conectivo fibroso, tejido de granulación bien vascularizado con infiltrado difuso de linfocitos, células plasmáticas y células gigantes. Elcultivo bacteriano permitió el aislamiento de Pseudomonas aeruginosa, el antibiograma mostró una sensibilidadde la ampicilina, ceftazidima, ciprofloxacina, cefepima, gentamicina, imipenem, meropenem, piperacilina,piperacilina / tazobactam y la resistencia a el trimetoprim. En conclusión, se detecto un granuloma laríngeo en un Pura Sangre de Carrera mediante un estudio multidisciplinario clínico, endoscopio, histopatológico ymicrobiológico.

Uma égua de corrida puro-sangue de dois anos apresentou estertor respiratório forte que foi auscultado nasregiões da traquéia e da laringe. Na palpação da laringe não foram detectadas alterações. As vias respiratórias foram examinados com um endoscópio de fibra ótica onde nas fossas nasais não foram observados trocas e a resistência era normal. As bolsas guturais e as suas aberturas foram normais. A cartilagem aritenóide direita apareceu espessada em todo seu comprimento e não se retrai durante a inspiração. Na cartilagem cricoaritenóidedorsal direita mostrou uma massa que se projeta da parede direita. A massa foi removida através de cirurgia dalaringe e as amostras foram coletadas para um estudo histopatológico e bacteriano. O estudo histopatológico dacartilagem cricóide evidenciou uma proliferação grande de tecido conector fibroso, tecido de granulação bemvascularizado com infiltrado difuso de linfócitos, células plasmáticas e células gigantes. A cultura bacterianapermitiu o isolamento de Pseudomonas aeruginosa e o antibiograma mostrou sensibilidade de ampicilina,ceftazidima, ciprofloxacina, cefepima, gentamicina, imipenem, meropeném, piperacilina/tazobactama, eresistência a trimetoprim. Em conclusão, um granuloma de laringe foi detectado em uma égua de corridapuro-sangue através de um estudo clínico multidisciplinar, envolvendo endoscopia, avaliação histopatológicae microbiológica.

El género Helicobacter en los animales domésticos: una revisión / Helicobacter genus in domestic animals: a review

El género Helicobacter ha sido ampliamente estudiado por su importancia en el desarrollo de esofagitis, gastritis, ulceras y neoplasias gástricas en humanos. Existen especies específicas tal es el caso del canino, suino, aves de corral y el equino siendo utilizados ampliamente como modelos animales experimentales para el estudio de la patogenia de estas bacterias. En equinos ha sido detectada la presencia de ADN en mucosa gástrica y sero conversión pero identificada como Helicobacter equorum; fue aislada recientemente. En aves de corral Helicobacter pullorum fue aislada de un intestino lesionado y el hígado de pollos de engorde y gallinas ponedoras. Recientemente fue aislada de estómagos de cerdos, caracterizada y propuesta una nueva especie de Helicobacter, H. suis sp.nov y H. pylori en infecciones crónicas puede inducir enfermedad gastrointestinal en suinos. H. pylori en perros y gatos, así como H. felis, H. bizzozeroni, H. salomonis, Fle xispira rappini (H. rappini) y H. heilmannii. En caninos esta relacionada con gastritis, ulceraciones gastroduodenales y procesos neoplásicos gástricos. En rumiantes y pequeños rumiantes ha sido re portada la presencia de ADN de Helicobacter pylori y se considera como un potencial patógeno para el humano. El género Helicobacter es de gran importancia desde el punto de vista de la salud pública, por el impacto que tiene sobre el esófago, mucosa gástrica, mucosa intestinal, sobre el hígado y potencial inductor de carcinogenesis gástrica. El riesgo de infección para el humano es inminente ya sea por consumo de alimentos de origen animal contaminado, aguas contaminadas y transmisión directa oral-oral, oral-fecal.

Helicobacter genus have been reported for important in de velopment of esophagitis, gastritis, ulcer and neoplastic in human. In domestic animal have described specific species in the dog, swine, poultry and equine and is very common used in experimental animal model with study of pathogenic of this bacteria’s. In equine have been detected DNA, seroconversion and were isolated Helicobacter equorum recently. In poultry were isolated of damage intestinal and liver Helicobacter pullorum. Recently were isolate of gastric mucosa Helicobacter suis sp. nov. and H. pylori associated a gastrointestinal. In ruminants and small ruminants have been reported H. pylori potential pathogens by human. H. pylori, H. felis, H. bizzozeroni, H. salomonis, Fle xis pira rappini (H. rappini) y H. heilmannii is re ationl with gastritis, ulcer, neoplastic gastric in dogs and cats. Helico bacter genus is very important in point of public health with impact above of esophagea, gastric mucosa, in testinal mu cosa, liver and powerful inducted of gastric car cinogenesis. Human risk of infection is imminent by ingest of food animal and water contamination and direct transmitted oral-oral and oral-faecal.

Enfermedad tromboembólica en el paciente oncológico avanzado: revisión y propuesta terapéutica / No disponible

Objetivos: ofrecer información sobre el estado actual de la enfermedad tromboembólica en el paciente oncológico, la evidencia existente en situación avanzada de enfermedad y proponer un protocolo de tromboprofilaxis primaria en caso de hospitalización. Material y métodos: revisión de la literatura hasta marzo 2009 utilizando las palabras clave: neoplasia, heparina de bajo peso molecular, embolismo pulmonar, cuidados paliativos y tromboembolismo venoso. Asimismo se identificaron posibles fuentes bibliográficas suministradas en las referencias de los artículos obtenidos e información específica reciente conocida por los autores. Resultados: la enfermedad tromboembólica (ETE) es una grave complicación en el paciente oncológico. La morbilidad previa, presencia de mutaciones, tipo de neoplasia, enfermedad diseminada, uso de catéteres centrales, cirugía, hospitalización, tratamiento con quimioterapia (Qt) son algunos de los factores que elevan el riesgo de ETE. A pesar de ello la tromboprofilaxis primaria durante la hospitalización del paciente oncológico es baja, la del paciente paliativo aún lo es más y la mayoría de las unidades carecen de protocolo específico. Conclusiones: en base a la ausencia de recomendaciones específicas sobre tromboprofilaxis primaria en el paciente paliativo durante la hospitalización, proponemos un algoritmo de profilaxis basado en la situación pronóstica y existencia de factores de riesgo (AU)

Objectives: to provide information on the current status of deep vein thrombosis in cancer patients, and the existing evidence, and to propose a protocol for primary thromboprophylaxis in hospitalized palliative patients. Material and methods: a review till March 2009 using the key words: neoplasm, low molecular weight heparin, pulmonary embolism, palliative care, and venous thromboembolism. Potential sources provided by bibliographic references in reviewed articles were also identified, as well as recent and specific information known by the authors. Results: thromboembolic disease (TED) is a serious complication in cancer patients. It is a multifactorial disease associated with endothelial injury, blood stasis, and hypercoagulability. Pre-existing morbidity, presence of mutations, type of cancer, disease extension, use of a central venous access, surgery, hospitalization, and treatment with chemotherapy are some of the factors that increase TED risk. Despite this, primary thromboprophylaxis during hospitalization of cancer patients is low, which is more frequent in the case of palliative patients, and most palliative care units do not have a specific protocol. Conclusions: based on the absence of specific recommendations for primary thromboprophylaxis in palliative patients during hospitalization, we propose an algorithm for prophylaxis based on the existence of prognostic risk factors (AU)

Prescription of antibiotics in intensive care units in Latin America: an observational study.

A one-day point prevalence study to investigate the patterns of antibiotic use was undertaken in 43 latin American (LA) intensive care units. Of 510 patients admitted, 231 received antibiotic treatment on the day of the study (45%); in 125 cases (54%) due to nosocomial-acquired infections. The most frequent infection reported was nosocomial pneumonia (43%). Only in 122 patients (53%) were cultures performed before starting antibiotic treatment. 33% of the isolated microorganisms were enterobacteriaceae (40% extended-spectrum beta-lactamase-producing), 23% methicillin-resistant Staphylococcus aureus and 17% carbapenems-resistant non-fermentative Gram-negatives. The antibiotics most frequently prescribed were carbapenems (99/231, 43%); alone (60/99, 60%) or in combination with vancomycin (39/99, 40%). "Restricted" antibiotics (carbapenems, vancomycin, piperacillin-tazobactam, broad-spectrum cephalosporins, tigecycline, polymixins and linezolid) were most frequently indicated in severely ill patients (APACHE II score at admission >15, p=0.0007 and, SOFA score at the beginning of the antibiotic treatment >3, p=0.0000). Only 36% of antibiotic treatments were cultured-directed.Our findings help explain the high rates of multidrug-resistant pathogens in LA settings (i.e. ESBL-producing Gram-negatives) and the severity of the registered patients illnesses.

Cirugía fetal en la hernia diafragmática congénita / Fetal surgery in congenital diaphragmatic hernia

La hernia diafragmática congénita, se cree es resultado de la fusión incompleta de la membrana pleuroperitoneal y el paso del contenido abdominal al interior del tórax. Realizamos una revisión de la literatura sobre la etiología y del tratamiento de esta patología

Congenital diaphragmatic hernia is believed to result from incomplete pleuroperitoneal membrane fusion and passage of abdominal contents into the chest. We carry out a literature review regarding the etiology and treatment of this pathology

Evolución y resultados de la consulta externa de Cuidados Paliativos en el Institut Català d’Oncologia: 2001-2005 / No disponible

Objetivo: describir el proceso de citación en la consulta externa y sus principales resultados clínicos del Servicio de Cuidados Paliativos del Institut Català d’Oncologia, para el periodo 2001-2005. Pacientes y métodos: pacientes consecutivos por los que se consultó y se visitaron en las consultas externas durante el periodo de estudio. Cada paciente por el que se consultó fue evaluado y programado para visita siguiendo un protocolo claramente definido. En cada visita se registraron variables demográficas y clínicas y se evaluaron el dolor, anorexia, estreñimiento, insomnio, debilidad, ansiedad y depresión. La eficacia en el control sintomático se analizó para aquellos pacientes que fueron capaces de hacer tres visitas consecutivas. Resultados: referente al proceso de citación fueron evaluables 2.385 pacientes. El 80% de los pacientes programados vinieron a visita y la mediana de tiempo entre la demanda y la visita fue de 10 días. La evaluación del control sintomático fue posible para 553 pacientes, mostrando un significativo buen control de todos los síntomas con excepción de la astenia. El 55% de los pacientes requirieron opioides para el dolor, observándose un cambio en el patrón pasando de morfina a fentanilo TTS. Conclusiones: la carga asistencial, en nuestro centro, en la consulta externa de cuidados paliativos es alta. Los resultados del proceso de citación muestran un alto cumplimiento con un mínimo tiempo de espera entre la petición y la visita. Los resultados clínicos muestran un buen control global de los síntomas con excepción de la astenia. También se observa un cambio en el patrón de la prescripción de opioides. Este estudio ha de ser considerado como la línea basal para futuros estudios en nuestro centro o en otros de características similares (AU)

Objective: to describe the appointment scheduling process in the outpatient clinic, and the main clinical results of the palliative care service at Institut Català d’Oncologia for the period 2001-2005. Patients and methods: patients consecutively visited in the outpatient clinic during the study period. Each patient was evaluated and scheduled following a clearly defined appointment protocol. Demographic and clinical variables, and symptom control for pain, anorexia, constipation, insomnia, weakness, anxiety, and depression were recorded for each visit. Symptom control efficacy was analyzed for patients able to pay three consecutive visits. Results: regarding the appointment process, 2,385 patients were evaluable. Eigthy percent of patients scheduled were able to attend the visit, and the median time between request and visit was 10 days. Symptom control was evaluable for 553 patients, with a significantly good control for all symptoms but weakness. Opioids for pain were used by 55% of patients, with a progressive change in the pattern of prescription from morphine to fentanil-TTS. Conclusion: in our center palliative care outpatient activity has a high workload. The results of our appointment process show high compliance with a minimum delay between request and visit. Overall, clinical outcomes demonstrate a good control for a set of paradigmatic symptoms in advanced cancer patients, except fort weakness. Also, a change was found in the pattern of opioid prescription. This study should be considered a baseline report that may be of help for further analyses, both in our Institute and other cancer centers (AU)

[Editorial situation of seven Latin American journals on respiratory diseases]. / Estudio situacional de siete revistas latinoamericanas de Neumología.

A survey was conducted in a meeting sponsored by ALAT (Latin American Association of Thoracic Diseases). Each of the seven editors reported about their journal and answered a questionnaire. The improvement in knowledge divulgation is the main motivation of respiratory societies to edit their own journals. To disseminate medical knowledge and report experiences, are the main motivations of authors to submit papers. The most common deficiency of submitted manuscripts is a bad compliance with journal requirements. An improvement in the relationship between author-editor-reviewer should be the best strategy to enhance the quality of the manuscripts. Suggestions to improve the Latin American journals included to professionalize editorial work, to increase the meticulousness of manuscripts reviewers and to reinforce international norms for editing medical journals. Some major problems reported were a lack of a regular and adequate periodicity in publishing the issues, lack of original papers submitted that mean a "milestone" for the specialty a low percentage of submitted papers rejection and a high and frequent turnover of editors. Although several journals are available in electronic indices, they should be maintained in their printed form. Each journal should have printed its subscription fee, even considering that its subscription is included in the annual society membership fee. The feasibility to generate a multinational Latin American Journal on Respiratory Diseases should be explored.

Estudio situacional de siete revistas latinoamericanas de Neumología / Editorial situation of seven Latin American journals on respiratory diseases

A survey was conducted in a meeting sponsored by ALAT (Latin American Association of Thoracic Diseases). Each of the seven editors reported about their journal and answered a questionnaire. The improvement in knowledge divulgation is the main motivation of respiratory societies to edit their own journals. To disseminate medical knowledge and report experiences, are the main motivations of authors to submit papers. The most common deficiency of submitted manuscripts is a bad compliance with journal requirements. An improvement in the relationship between author-editor-reviewer should be the best strategy to enhance the quality of the manuscripts. Suggestions to improve the Latin American journals included to professionalize editorial work, to increase the meticulousness of manuscripts reviewers and to reinforce international norms for editing medical journals. Some major problems reported were a lack of a regular and adequate periodicity in publishing the issues, lack of original papers submitted that mean a "milestone" for the specialty a low percentage of submitted papers rejection and a high and frequent turnover of editors. Although several journals are available in electronic indices, they should be maintained in their printed form. Each journal should have printed its subscription fee, even considering that its subscription is included in the annual society membership fee. The feasibility to generate a multinational Latin American Journal on Respiratory Diseases should be explored.

Lesiones gástricas asociadas a la presencia de bacterias del género helicobacter en caninos / Gastric lesions associated with the presence of bacteria of the helicobacter genusin canine

Las lesiones digestivas se presentan dependiendo del agente causal, su duración y del grado de exposición. La spirocercosis compromete los sistemas digestivo, circulatorio y óseo, y la helicobacteriosis, es relacionada a gastritis, ulceraciones gastroduodenales y procesos neoplásicos estomacales, reportando a el H. pylori en perros y gatos, como posibilidad zoonótica. Este estudio se realizó en la Sección de Caninos del Bioterio de FCV-UCV, en 43 perros caracterizados por antecedentes callejeros y variados manejos alimenticios, médicos y sanitarios. Sus objetivos, registrar patologías en estómago y determinar, presencia de bacterias del género Helicobacter en lesiones gástricas asociadas a esta bacteria. Las técnicas diagnosticas registraron 16,3% de nódulos por S. lupi, y 13,9% de lesiones inflamatorias y úlceras gastroduodenales; 100% de positividad a ureasa. La histopatología, 58,14% de gastritis aguda superficial, 20,93% de gastritis crónica superficial y 6,98% de gastritis crónica atrófica; la histoquímica evidenció bacterias espiraladas en mucosa gástrica y, se detectó anticuerpos contra H. pylori a 4,7%. No hubo crecimiento bacteriano en cultivos de biopsia. La prueba no paramétrica de Friedman reveló que no hay significancia entre la relación sexo (0,0833) y lesiones esófago-gástricas (0,1561), pero sí, para el sexo (0,0455) en relación con lesiones gástricas (0,1196). El manejo de la población en estudio, tuvo influencia en la aparición de spirocercosis y en la colonización de Helicobacter spp. además, fueron propensos a la infección con H. pylori siendo el perro entonces una alternativa como modelo para el estudio de la helicobacteriosis.

The digestive injuries appear depending on the causal agent, his duration and on the degree of exhibition. The spirocercosis compromises the digestive, circulatory and osseous systems, and the helicobacteriosis, is related to gastritis, gastroduodenal ulcerations and stomach neoplasics processes, reporting to H. pylori in dogs and cats, as zoonótic possibility. This study was realized in the Canine Section of FCV-UCV’s Bioterio, in 43 dogs characterized by street antecedents and varied nourishing, medical and sanitary managings. Its objectives were to register pathologies in stomach and to determine the presence of bacteria of the Helicobacter genus in gastric injuries associated with this bacterium. The diagnostic techniques showed 16.3% of nodules for S. lupi, and 13.9% of inflammatory injuries and sores gastroduodenals; 100% of positivity to ureasa. The histopathology revealed 58.14% of acute superficial gastritis, 20.93% of chronic superficial gastritis and 6.98% of chronic atrophic gastritis; the histochemist demonstrated espiral bacterias in gastric mucous, also, antibodies were detected against H. pylori to 4.7%. There was no bacterial growth in cultures of biopsy. The non paramétric test of Friedman revealed no significance between the sex relation (0.0833) and esophagus gastric injure (0.1561), but if, for the sex (0.0455) in relation with gastric injuries (0.1196). The managing of the population in study had influence in the appearance of spirocercosis, and the colonization of Helicobacter spp., in addition, they were inclined to the infection with H. pylori, being the dog then an alternative as model for the study of the helicobacteriosis.

Tumor filodes benigno de la mama: a propósito de un caso / Filodes benign tumor of the breast: a purpose of a case

El tumor filodes es una patología poco frecuente. Aunque por lo general es benigno histológicamente, puede presentar un comportamiento maligno con alta tasa de mortalidad. Muy similar al fibroadenoma, crece sustancialmente más rápido y puede alcanzar dimensiones de hasta 20 centimetros. Se presenta el caso de una paciente femenina de 44 años quien 1 año antes se le diagnóstico un tumor filodes de mama derecha de poco diámetro que progreso hasta alcanzar aproximadamente los 20 cms de diámetro acompaño de infección de piel y partes blandas. Al mejorar condiciones se resolvió con una mastectomía total y permanece asintomática al presente. Considerando la poca incidencia y la alta tasa de confusión con fibroadenomas se reviso la literatura que avalara las técnicas diagnósticas terapéuticas empleadas actualmente en el manejo de estos pacientes.

Relationship between ambulatory blood pressure monitoring and response of blood pressure in male hypertensive adolescents to exercise.

BACKGROUND: High blood pressure in the young has been related to the development of hypertension in adults; hence the importance of identifying adolescents with the risk of developing it.OBJECTIVE: To investigate the relationship between 24 h ambulatory blood pressure monitoring and the response of blood pressure in adolescents to exercise. DESIGN: A prospective and cross-sectional study. METHODS: We classified 101 men aged 13-18 years as obese hypertensive, lean hypertensive, obese normotensive, and lean normotensive. Mean blood pressure and variability were measured with ambulatory blood pressure monitoring, and expressed as 24 h, awake, and sleeping periods. Treadmill tests were also performed. RESULTS: Hypertensives and obese normotensives had higher ambulatory blood pressure monitoring values (P< 0.0001). Systolic blood pressure during sleep in obese subjects was significantly higher than that in lean usbjects (119.9 +/- 9 versus 113.6 +/- 8 mmHg, P < 0.001, obese hypertensives versus lean hypertensives; and 113.6 +/- 2 versus 103.0 +/- 2 mmHg, P < 0.002, obese normotensives versus lean normotensives) and nocturnal drop of systolic blood pressure was lower in obese subjects. We found a significant correlation between systolic blood pressure during ambulatory blood pressure monitoring and systolic blood pressure during moderate and maximal exercise for all periods (P < 0.0001). Blood pressure variability during awake period was higher in subjects with maximum exercise systolic blood pressure >/= 200 mmHg (7.4 +/- 2 versus 6.4 +/- 2%, P < 0.01).CONCLUSION: Systolic blood pressure measured by ambulatory blood pressure monitoring is related to response of systolic blood pressure to exercise and ambulatory blood pressure monitoring can identify groups of subjects at greater than normal risk through their higher blood pressure during sleep. Greater than normal blood pressure variability in adolescents is an indicator of the risk of reaching abnormal exercise values of systolic blood pressure. Higher casual blood pressure than ambulatory blood pressure monitoring values for adolescents should be considered abnormal.

Acute myocardial infarction during pregnancy and puerperium in athletic women. Two case reports.

The authors present 2 cases: 1 of a thirty-two-year-old woman and another of a thirty-eight-year-old woman, both Hispanic and athletic, with no identifiable precipitating or coronary risk factors, such as previous heart disease, hypertension, diabetes mellitus, cigarette smoking, hyperlipoproteinemia, oral contraceptive use, coagulation disorders, thyroid disease, collagen tissue disorder, or family history of premature myocardial infarction, who both developed an acute posteroinferior wall myocardial infarction with normal coronary arteries, one during pregnancy, from which normal twin girls were born, and another, during the postpartum period. After reviewing the literature the authors consider the present cases as unique due to the rare association of pregnancy with intrapartum and postpartum acute myocardial infarction with normal coronary arteries in athletic women.

[The use of sublingual captopril in hypertensive crises]. / Uso del captopril sublingual en crisis hipertensivas.

The purpose of this study was to evaluate the antihypertensive efficacy of captopril (C) and its correlation with body mass index (BMI), age and initial blood pressure (BP) in hypertensive crises. The time of the beginning of the antihypertensive effect of C and its side effects were evaluated. Twenty patients, aged between 22 and 59 years, were included in this investigation. BP was measured after 15 min of rest; age, weight and height were recorded and BMI was calculated using the standard formula (Kg/m2). Patients were not taking antihypertensive medications. After the placebo was given to the patients, BP was measured at 30 and 60 min. Sublingual captopril 25 mg was administered and BP was again measured at 5, 10, 15, 30, 60, 120 y 240 min. There was not statistically significant difference between the values of BP before and after placebo. A significant decrease was observed post C, from 182.6/123.6 to 174.6/117.3 (p:SN/p < 0.02) in 10 min., to 169.9/114.9 (p < 0.04/p < 0.001) in 15 min., to 167.7/112.2 (p < 0.02/p < 0.0001) in 30 min., to 164.3/108.8 (p < 0.002/p < 0.0001) in 60 min., to 156.9/106.5 (p < 0.0001/p < 0.0001) in 120 min., to 161.3/107.0 (p < 0.0002/p < 0.0001) in 240 min. In 15 patients there was a decrease in diastolic BP > or = 5 mmHg, 10 min. post C. No correlation was found between decrease in BP and age, nor with BMI. Pearson r correlation index between the decrease in systolic BP and initial systolic BP was 0.63 (p < 0.003) and between the decrease in diastolic BP and initial diastolic BP, 0.59 (p < 0.005). Secondary effects were mild and well tolerated. In conclusion, C effectively reduced BP in hypertensive crises. Because the efficacy of C, its rapid onset of action and minimal side effects, sublingual Captopril should be considered a first line drug for hypertensive crises.