Transcervical drainage of abdominal-pelvic abscess after laparoscopic sacrocolpopexy.

INTRODUCTION AND HYPOTHESIS: Abdominopelvic abscess is a serious, but infrequent, postoperative complication of sacrocolpopexy, which a priori requires a second surgery to debride the affected tissue and dry out the infected mesh in addition to a prolonged broad-spectrum antibiotic therapy. METHODS: We present two cases of post-surgical abdominopelvic abscesses, treated with conservative management using ultrasound-guided transcervical drainage and prolonged antibiotic therapy. Both patients underwent a favorable evolution without needing the removal of the mesh. CONCLUSIONS: Because of the search for new alternatives to avoid mesh removal and the comorbidity associated with a second surgery, transcervical drainage is a treatment to be considered in selected cases.

Alliance and Treatment Outcome in Family-Involved Treatment for Youth Problems: A Three-Level Meta-analysis.

Alliance has been shown to predict treatment outcome in family-involved treatment for youth problems in several studies. However, meta-analytic research on alliance in family-involved treatment is scarce, and to date, no meta-analytic study on the alliance-outcome association in this field has paid attention to moderating variables. We included 28 studies reporting on the alliance-outcome association in 21 independent study samples of families receiving family-involved treatment for youth problems (N = 2126 families, M age youth ranging from 10.6 to 16.1). We performed three multilevel meta-analyses of the associations between three types of alliance processes and treatment outcome, and of several moderator variables. The quality of the alliance was significantly associated with treatment outcome (r = .183, p < .001). Correlations were significantly stronger when alliance scores of different measurement moments were averaged or added, when families were help-seeking rather than receiving mandated care and when studies included younger children. The correlation between alliance improvement and treatment outcome just failed to reached significance (r = .281, p = .067), and no significant correlation was found between split alliances and treatment outcome (r = .106, p = .343). However, the number of included studies reporting on alliance change scores or split alliances was small. Our findings demonstrate that alliance plays a small but significant role in the effectiveness of family-involved treatment. Future research should focus on investigating the more complex systemic aspects of alliance to gain fuller understanding of the dynamic role of alliance in working with families.

Diagnóstico prenatal de trombohematoma subcoriónico masivo (mola de Breus) / Prenatal diagnosis of massive subchorionic thrombohematoma (Breus mole)

El trombohematoma subcoriónico masivo o Mola de Breus, por ser éste el autor que lo describió por primera vez en abortos, es un hematoma subcorial de al menos 1 cm de grosor que ocupa al menos, el 50% de la superficie fetal. Suele asociar una alta morbimortalidad fetal y perinatal, en forma de abortos, retraso del crecimiento intrauterino, muerte intrauterina, desprendimiento de placenta normalmente inserta y recién nacidos de bajo peso, generalmente pretérminos. Esta entidad debe diferenciarse de otros procesos que pueden asentar bajo la placa corial, hacia la superficie fetal como: corioangioma, depósitos de fibrina y trombosis del espacio intervelloso. Se han intentado postular mecanismos que pudieran causar dicha circunstancia, sin que por el momento podamos definir factores de riesgo médicos que claramente predispongan a padecer esta entidad. El objetivo de describir estos dos casos clínicos diagnosticados en 2013 es resaltar que, gracias a la sospecha ecográfica de un trombohematoma subcoriónico masivo, podemos estudiar la pieza de placenta y membranas tras la finalización de la gestación, con lo que obtendríamos así la confirmación anátomo-patológica, de otra manera esta información podría perderse.

The massive subchorionictrombo hematoma or Breus's Mola, this was the author who first described it in miscarriages, is a subchorionic hematoma at least 1 cm in thickness which occupies at least 50% of the fetal surface. Usually associated with high fetal and perinatal morbidity and mortality, as miscarriages, intrau-terine growth retardation, stillbirth, placental abruption and low birth weight, preterm generally. This entity should be distinguished from other processes that can seat under the chorionic plate to the fetal surface as chorioangioma, fibrin deposition and thrombosis intervillous space. They have tried to apply mechanisms that could cause such a circumstance, but for now we don't define medical risk factors that predispose clearly suffer from this entity. In order to describe these two cases diagnosed in 2013 is to emphasize that thanks to the sonographic suspicion of a massive subchorionic trombohematoma, can study the piece of placenta and membranes after the end of pregnancy, so it would provide pathologic confirmation, otherwise this information could be lost.

Las plantas medicinales en el control de nemátodos gastrointestinales en cabras: potencial de las plantas que crecen en la región de Coquimbo, Chile / Medicinal plants in the control of gastrointestinal nematodes in goats: the potential of the plants which grow at the Coquimbo region, Chile

RESUMO O objetivo deste estudo foi determinar o potencial de plantas que crecem na região de Coquimbo, no controle de nematódeos gastrintestinais em caprinos. Nós usamos uma abordagem não-experimental para validar a eficácia potencial das plantas medicinais como anti-helmínticos. Esta validação foi realizada com base em uma revisão da extensa literatura consultada a respeito de plantas medicinais. Determinou-se o um potencial de eficácia das plantas, da consistência das informações sobre o uso tradicional, os compostos presentes e farmacologia. Analisamos também os dados dos potenciais efeitos adversos que impedem seu uso em animais. Antecedentes apoiam a um alto potencial da eficácia como anti-helmíntico para se três espécies de plantas que crescem na região de Coquimbo: Allium sativum L., Artemisia absinthium L. e Chenopodium ambrosioides L. Os possíveis efeitos secundários do consumo de plantas medicinais ou seus derivados devem ser avaliadas em testes de campo antes de serem utilizados nas em escala produtiva.

ABSTRACT The aim of this study was to determine the potential of the plants which grow at the Coquimbo region in the control of gastrointestinal nematodes in goats. We used a non-experimental approach to evaluate the potential efficacy of medicinal plants as anthelmintics. This research was conducted with exhaustive bibliography referred to the medicinal use of plants in the international literature. We determined the potential of effectiveness of the plants, the consistency of the information about the traditional use, the present compounds and the pharmacology. We also performed an analysis about the potential adverse effects of the plants" application in animals. The collected data support the efficacy of these three species of plants growing at the Coquimbo region as efficient anthelmintic ones: the Allium sativum L., the Artemisia absinthium L. and the Chenopodium ambrosioides L. The possible side effects of the consumption of medicinal plants or their derivatives must be evaluated in field trials before they start being used in a productive scale.

Dose equivalence between continuous erythropoietin receptor activator (CERA), Darbepoetin and Epoetin in patients with advanced chronic kidney disease.

BACKGROUND: Anemia is a prevalent situation in patients with chronic kidney disease (CKD) and can be well managed with erythropoiesis-stimulating agents (ESAs). Continuous erythropoietin receptor activator (CERA) has a long half-life that allows to be administered once monthly. The lowest recommended dose for patients with non dialysis CKD is 120 µg per month. The objectives were to assess the efficacy of subcutaneous monthly dosing of CERA in CKD stages 4 and 5 not on dialysis, and to determine the equivalent dose to epoetin ß and darbepoetin α. METHODS: This is a cohort study. A 30-patient group that ESAs was changed to CERA (µg/month) was used as treatment group. We used the following clinically-based equivalent dosing: epoetin ß (IU/week) and darbepoetin α (µg/week): 3000/15= 50; 4000/20=75; 6000/30=100; 8000/40=150. Another group of 30 patients with similar characteristics was used as control group and received the same epoetin ß and darbepoetin α doses. RESULTS: The mean CERA initial dose and at 6 months was 81.9 ± 35.2 and 82.0 ± 37.82 µg/month (p=0.37). The mean erythropoietin resistance index (ERI) and hemoglobin at baseline and at 6 months in the CERA group and in the control group were not statistically significant. CONCLUSION: Monthly dosing treatment with CERA is safe and effective. A dose of 75-100 µg/month is enough to maintain stable levels of hemoglobin. Hippokratia 2014; 18 (4): 315-318.

Tendencia de la mortalidad por ictus isquémico (2000-2009) y factores pronósticos. Estudio ICTUS-Extremadura / Ischemic stroke mortality tendency (2000-2009) and prognostic factors. ICTUS Study-Extremadura (Spain)

Antecedentes y objetivos. La mortalidad por ictus isquémico es elevada en nuestro entorno, aunque desconocemos su magnitud y evolución en una década reciente. Por ello hemos analizado la mortalidad global hospitalaria y al cabo de un año de los enfermos con ictus isquémico atendidos en un hospital comarcal y sus factores pronósticos. Pacientes y métodos. Estudio de cohorte histórica, con seguimiento de un año, de los pacientes ingresados en el Hospital Don Benito-Villanueva de la Serena (Badajoz) con el diagnóstico de ictus isquémico (1 de enero 2000 al 31 de diciembre 2009). Se recogieron datos epidemiológicos y clínicos, y los fallecimientos por cualquier causa. Resultados. Se incluyeron 2.228 pacientes (50,8% varones), con una edad media de 71 (DE: 10) años. La mortalidad hospitalaria fue del 15,3% y al cabo de un año del 16,9%, sin cambios relevantes en los 10 años del estudio. Los factores asociados a una mayor mortalidad hospitalaria fueron: edad, insuficiencia cardiaca y renal, y la no realización de pruebas diagnósticas, y al año fueron: edad, demencia, enfermedad pulmonar obstructiva crónica, infarto de miocardio, fibrilación auricular y la no realización de pruebas diagnósticas. Durante el estudio se incrementaron la realización de pruebas diagnósticas y el tratamiento al alta con estatinas, heparina y antihipertensivos. Conclusiones. Los pacientes ingresados por ictus isquémico en un hospital comarcal presentaron una mortalidad global al cabo de un año del 29,6%. No asistimos a una mejoría en esta tendencia durante 10 años. La mortalidad se asoció a la mayor edad, comorbilidades y no realización de pruebas diagnósticas(AU)

Background and objectives. Mortality due to stroke is high in our setting. However, we do not know its magnitude and course in a recent decade. Thus, we have assessed the global inhospital mortality and that at 1 year of stroke in patients seen in a regional hospital as well as its prognostic factors. Material and methods. A one-year follow-up historical cohort study was performed of patients admitted at Don Benito-Villanueva de la Serena Regional Hospital (Badajoz) with diagnosis of ischemic stroke (1 January 2000 to 31 December 2009). Epidemiological, clinical data all cause death information were collected. Results. A total of 2.228 patients (50.8% male), mean age 71 (SD 10) years were recruited. In-hospital mortality rate was 15.3% and mortality rate at 1 year was 16.9%, with no significant changes during the 10-year study period. Risk factors for greater in-hospital mortality were age, previous renal and heart failure and not performing diagnostic tests. Factors associated with 1-year all-cause mortality were age, dementia, chronic obstructive pulmonary disease, myocardial infarction, atrial fibrillation and also not performing diagnostic tests. During the study, use of diagnostic tests and treatment with statin, heparin and antihypertensive medication on discharge increased. Conclusions. Patients admitted due to ischemic stroke, in a regional hospital presented a 1 year mortality rate of 29.6%. This tendency did not improve during the 10-year study period. Mortality was associated to greater age, comorbidities and not performing diagnostic tests(AU)

Ischemic stroke mortality tendency (2000-2009) and prognostic factors. ICTUS Study-Extremadura (Spain).

BACKGROUND AND OBJECTIVES: Mortality due to stroke is high in our setting. However, we do not know its magnitude and course in a recent decade. Thus, we have assessed the global inhospital mortality and that at 1 year of stroke in patients seen in a regional hospital as well as its prognostic factors. MATERIAL AND METHODS: A one-year follow-up historical cohort study was performed of patients admitted at Don Benito-Villanueva de la Serena Regional Hospital (Badajoz) with diagnosis of ischemic stroke (1 January 2000 to 31 December 2009). Epidemiological, clinical data all cause death information were collected. RESULTS: A total of 2.228 patients (50.8% male), mean age 71 (SD 10) years were recruited. In-hospital mortality rate was 15.3% and mortality rate at 1 year was 16.9%, with no significant changes during the 10-year study period. Risk factors for greater in-hospital mortality were age, previous renal and heart failure and not performing diagnostic tests. Factors associated with 1-year all-cause mortality were age, dementia, chronic obstructive pulmonary disease, myocardial infarction, atrial fibrillation and also not performing diagnostic tests. During the study, use of diagnostic tests and treatment with statin, heparin and antihypertensive medication on discharge increased. CONCLUSIONS: Patients admitted due to ischemic stroke, in a regional hospital presented a 1 year mortality rate of 29.6%. This tendency did not improve during the 10-year study period. Mortality was associated to greater age, comorbidities and not performing diagnostic tests.

Propofol en perfusión continua en niños en estado crítico / Continuous propofol perfusion in critically ill children

Objetivo: Describir la sedación con perfusión continua de propofol en niños en estado crítico. Diseño: Estudio observacional descriptivo retrospectivo. Ámbito: Unidad de cuidados intensivos pediátricos. Pacientes: Pacientes que requirieron sedoanalgesia entre el 1 de octubre de 2009 y el 30 de septiembre de 2010.Intervenciones: Ninguna. Variables recogidas: Demográficas, clínicas, de laboratorio, diagnóstico, tratamiento, complicaciones y evolución de cada paciente. Se analizaron los posibles efectos adversos asociados a la administración de propofol, comparando el grupo de pacientes a los que se les administró con el resto de los niños críticos. Resultados: Recibieron propofol en perfusión continua 71 de los 222 pacientes recogidos (32%). Los fármacos sedoanalgésicos más utilizados fueron el midazolam, seguido del fentanilo y del propofol. La dosis media de propofol fue de 2,1mg/kg/h [desviación estándar (DE) 1,3, rango: 0,5-6)] y la duración media de 6,7 días (DE 8,5; rango: 0,5-40). La edad media fue de 45,8 meses (mediana 24; rango intercuartil: 7-65), siendo el 52% varones. Ningún paciente presentó síndrome de infusión por propofol ni otros efectos adversos graves. Los pacientes tratados con propofol presentaron con mayor frecuencia algunas alteraciones analíticas que el resto, pero no se demostró relación causa efecto con la administración del fármaco. No existieron diferencias significativas en los niveles de lactato ni en la incidencia de infecciones entre ambos grupos. Conclusión: el propofol a una dosis de 1 a 4mg/kg/h puede utilizarse como un fármaco alternativo para la sedación de mantenimiento en los niños críticamente enfermos. Sin embargo son necesarios más estudios que valoren su eficacia y seguridad (AU)

Objective To describe sedation with continuous perfusion of propofol in critically ill children. Design A retrospective, descriptive observational study was carried out. Setting A pediatric intensive care unit. Patients Pediatric patients requiring sedoanalgesia between October 1, 2009 and September 30, 2010. Interventions None. Data collected Demographic, clinical and laboratory test variables, diagnosis, treatment, complications and evolution in each patient. In addition, the potential adverse effects associated with propofol administration were analyzed. Results: Midazolam, fentanyl and propofol were the most commonly used sedative and analgesic drugs. Seventy-one out of 222 patients (32%) received propofol in continuous infusion. The average dose was 2.1mg/kg/h (SD 1.3, range: 0.5 to 6), and the average duration of treatment was of 6.7 days (SD 8.5 range 0.5-40). Fifty-two percent were males, and the mean patient age was 45.8 months (median: 24; interquartile range: 7-65). No patient developed propofol infusion syndrome or other serious drug-related adverse effects. Patients treated with propofol showed more abnormal laboratory test findings, although no relationship to drug administration could be demonstrated. There were no significant differences in lactate level or in the incidence of infection in either group. Conclusions: Propofol at a dose of 1 to 4mg/kg/h is a safe alternative for sustained sedation in critically ill children. However, further studies are needed to assess its effects and safety profile (AU)

[Continuous propofol perfusion in critically ill children]. / Propofol en perfusión continua en niños en estado crítico.

OBJECTIVE: To describe sedation with continuous perfusion of propofol in critically ill children. DESIGN: A retrospective, descriptive observational study was carried out. SETTING: A pediatric intensive care unit. PATIENTS: Pediatric patients requiring sedoanalgesia between October 1, 2009 and September 30, 2010. INTERVENTIONS: None. DATA COLLECTED: Demographic, clinical and laboratory test variables, diagnosis, treatment, complications and evolution in each patient. In addition, the potential adverse effects associated with propofol administration were analyzed. RESULTS: Midazolam, fentanyl and propofol were the most commonly used sedative and analgesic drugs. Seventy-one out of 222 patients (32%) received propofol in continuous infusion. The average dose was 2.1 mg/kg/h (SD 1.3, range: 0.5 to 6), and the average duration of treatment was of 6.7 days (SD 8.5 range 0.5-40). Fifty-two percent were males, and the mean patient age was 45.8 months (median: 24; interquartile range: 7-65). No patient developed propofol infusion syndrome or other serious drug-related adverse effects. Patients treated with propofol showed more abnormal laboratory test findings, although no relationship to drug administration could be demonstrated. There were no significant differences in lactate level or in the incidence of infection in either group. CONCLUSIONS: Propofol at a dose of 1 to 4 mg/kg/h is a safe alternative for sustained sedation in critically ill children. However, further studies are needed to assess its effects and safety profile.

Factores sociodemográficos y gestacionales asociados a la concentración de hemoglobina en embarazadas de la red hospitalaria pública de medellín / Sociodemographic and pregnancy aspects associated with hemoglobin concentration in pregnant women from public hospitals in medellín

Objective: To explore associations of sociodemographic and gestational factors with blood hemoglobin concentration. Methodology: Randomized sample of 336 pregnant women medical records from the Public Hospital Network in Medellín. Hemoglobin concentration, sociodemographic, and pregnancy data analyzed by Student T test, ANOVA and Pearsons correlation. Results: Average age of pregnant women was 24±6; 3.3%; 67.6% of them were high school graduates; 62.2% had permanent partners. Number of attendance to prenatal appointments was 6+1. Pregestacional weight was 54.4+8.2 kg; average hemoglobin concentration on the first trimester was 13.0±1.0 g/dl, 11.9±1.1 g/dl on the second, and 12.2±1.1 g/dl on the third. There was a significant difference in hemoglobin concentration based on pregestacional body mass index (BMI) (p=0,035), a significant correlation between first trimester hemoglobin concentration and pregestacional BMI (r=0.178, p=0.028), and also with third trimester hemoglobin concentration (r=0.356 andp=0.000). Conclusion: Pregestacional BMI was associated with hemoglobin concentration at the beginning and at the end of pregnancy.

Objetivo: Explorar la asociación de factores socio-demográficos y gestacionales con la concentración de hemoglobina. Metodología: Estudio descriptivo transversal en 336 embarazadas de la Red Hospitalaria Pública de Medellín, 2007; se obtuvieron datos socio-demográficos, gestacionales y hemoglobina. Para el análisis se utilizó T de Student, ANOVA y correlación de Pearson. Resultados: el promedio de edad fue 24±6 años, 67,6% había cursado secundaria, 62,2% tenía un compañero estable, la asistencia a los controles prenatales fue 6±1, peso pre-gestational: 54,4±8,2kg, hemoglobina: 13,0±1,0g/dL en el primer trimestre, 11,9±1,1 g/dL en segundo y 12,2±1,1 g/dL en tercero. Se encontró una diferencia significativa entre la hemoglobina por IMC pregestacional (p=0,035). La hemoglobina del primer trimestre correlacionó con el IMC pregestacional (r=0,178 y p=0,028) y con la hemoglobina del tercer trimestre (r=0,356 y p=0,000). Conclusión: El IMC pregestacional, se asoció con la concentración de hemoglobina del primer trimestre y correlacionó con la hemoglobina final de la gestación.

Cytomegalovirus infection renal transplant recipients: risk factors and outcome.

OBJECTIVE: Cytomegalovirus (CMV) is the most common viral infection after allotransplantation; it can be a major cause of morbidity and mortality. Our aim was to analyze the main risk factors that lead to development of CMV infection and disease. PATIENTS AND METHODS: We retrospectively analyzed 207 patients who received a renal allograft from May 2003 to December 2007. Three patients (D-/R-) were excluded. CMV infection was defined by the detection of 2 or more positive tests for pp65 antigenemia and CMV disease by evidence of attributable symptoms in need of antiviral treatment. RESULTS: Thirty-two patients (15.7%) presented active CMV infections and another 35 (17.2%), CMV disease. The mean follow-up was 27.8 +/- 17 months. Prior to transplantation, 9.2% of patients were seronegative (D+/R-) and 77.9% seropositive (D+/R+). Compared with noninfected patients, those with CMV infection/disease were older and received an allograft from an older donor. Upon logistic regression analysis, recipient age older than 55 years, induction therapy with Thymoglobulin, and maintenance immunosuppression with cyclosporine were the major risk factors to develop CMV disease. An early acute rejection episode was more frequent and renal function measured by serum creatinine poorer until 18 months posttransplantation among CMV-infected versus noninfected patients. CONCLUSIONS: Our data showed that CMV infection is a common complication after kidney transplantation associated with older age, induction treatment with antilymphocyte globulin, worse renal function, and increased patient morbidity.

Treatment of renal transplant failure.

INTRODUCTION: Among graft failures beyond months, we performed progressive reduction and complete withdrawal of immunosuppressive drugs and steroids over a period of 6 months. PATIENTS AND METHODS: We analyzed the treatment and complications associated with all late allograft failures in 34 patients (8.19%) out of 415 patients transplanted from November 1996 to November 2006. RESULTS: In 21 patients (61.8%), the progressive reduction of immunosuppressive treatment was effective and well tolerated; however, in 13 patients (38.2%) there was rejection of the allograft at 10.74 +/- 8.95 months (0.77-34.80) after the failure. With the reintroduction of these drugs, the rejection was controlled in seven patients, but in the other six we had to embolize the allograft, which had to be repeated in one case. Embolization was well tolerated, but in one case there was migration of one coil to the femoral artery. One patient treated with drug withdrawal experienced emphysematous pyelonephritis after repeated urinary infections, requiring a nephrectomy. Thirteen (38.2%) of the patients with late failures have been admitted for a second transplant; five of them showed HLA sensitization. CONCLUSIONS: Conservative treatment with progressive withdrawal of immunosuppression was effective and well tolerated in two-thirds of the patients with late renal allograft failure, but one-third of the patients rejected the graft and needed allograft embolization. Infection of the graft and HLA sensitization can complicate the course of these patients.

[A dose-response study of the chronic effect of ketoconazole on androgen and cortisol secretion in women with hyperandrogenism]. / Estudio dosis-respuesta de la acción crónica del cetoconazol sobre la secreción androgénica y de cortisol en mujeres con hiperandrogenismo.

We have previously shown that ketoconazole may inhibit the androgen synthesis, but the risk to induce a blockade in the cortisol synthesis and/or hepatic abnormalities makes it mandatory to look for the least dose that is able to inhibit androgen production without inducing other abnormalities. To this end, we studied the levels of 17-alpha-hydroxyprogesterone (17, alpha-OH-P), dehydroepiandrosterone sulphate (DHEA-S), delta 4-androstenedione (delta 4-A), total (tT) and free (fT) testosterone, and the cortisol response to ACTH in 13 women with hyperandrogenism, before and after ketoconazole therapy at dosages of 400, 600, and 800 mg/day. Although with the 400 mg regimen a reduction in the levels of androstenedione and free and total testosterone was already observed, it was of small amount and it was not until the 600 mg regimen that androgen levels became normal. Thus, DHEAS-S was reduced from 3.672 +/- 1.013 to 2.216 +/- 756 ng/ml (p less than 0.05); delta 4-A was reduced from 392 +/- 80 to 283 +/- 79 ng/ml (p less than 0.01); tT was reduced from 1.5 +/- 0.78 to 0.7 +/- 0.1 ng/ml (p less than 0.05), and fT from 5.5 +/- 1.0 to 2.7 +/- 1.3 pg/ml (p less than 0.001). By contrast, 17 alpha-OH-P increased from 1.7 +/- 1.3 to 4.7 +/- 1.3 ng/ml (p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

[Familial incidence of bilateral anorchia. Study of three siblings (author's transl)]. / Incidencia familial de anorquismo bilateral. Estudio de tres hermanos.

Three siblings consulted because of hypogonadism. Physical examination revealed absence of secondary sexual characteristics and infantile genitalia. Increased serum concentrations of LH and FSH were found with abnormal high response to the stimulus with 100 Ug LH-RH. Plasma testosterone concentrations were 0.7, 0.5, and 0.3 ng/ml, respectively; no change in these values was observed after administering 5.000 UI HCG per day during 1 week. Patients underwent a laparotomy but no testicular tissue remnants were found. Whether vascular anomalies, trauma, infectious processes or other factors are responsible is not known. The possibility that genetic abnormalities could be involved in the pathogenesis of this entity is suggested.