ABSTRACT
Walking provides numerous benefits to older persons, but its practice is hindered by social factors and the built environment. This article aims to understand the factors that encourage or discourage older people's walking behaviors, as well as the policies influencing those factors in Chile. It does so by reporting the analysis of twenty-five semi-structured interviews with Chilean policymakers and local leaders. The experts consistently represented walking as a beneficial activity for older persons that, nonetheless, occurs in adverse built environments. They asserted that the absence of older people in the public discussion and a top-down policy-making structure hamper its promotion.
Subject(s)
Environment Design , Pedestrians , Humans , Aged , Aged, 80 and over , Chile , Walking , Built EnvironmentABSTRACT
In the present study total phenolic content (TPC), total flavonoid content (TFC), antioxidant activity and antimicrobial properties of grape (Vitis vinifera var. Red Globe) stem extract is reported. Also, the identification of main phenolic compounds was carried out by UPLC-PAD analysis. TPC and TFC of extract were 37.25 g GAE kg-1 and 98.07 g QE kg-1, respectively. Extract showed an antioxidant capacity of 132.60 and 317 g TE kg-1 for DPPH and ABTS radical scavenging capacity, respectively. The main phenolic compounds identified were rutin, gallic acid, chlorogenic acid, caffeic acid, catechin and ferulic acid. Extract inhibited the growth of Listeria monocytogenes, Staphylococcus aureus, Salmonella enterica subsp. enterica serovar Typhimurium, and Escherichia coli O157: H7 at MIC range 16-18 g L-1. Extract affected the different phases of bacterial growth. In addition, application of Extract (25 g L-1) as a sanitizer was effective to reduce the populations of all bacteria inoculated in lettuce (0.859-1.884 log reduction) and spinach (0.843-2.605 log reduction). This study emphasizes the potential of grape processing byproducts as an emergent and attractive source of bioactive compounds with antioxidant properties and antimicrobial activity against important foodborne pathogens. The study demonstrated that stem extract could be used to control the presence of human pathogenic bacteria in fresh leafy vegetables.
ABSTRACT
BACKGROUND: The severe burden imposed by frailty and disability in old age is a major challenge for healthcare systems in low- and middle-income countries alike. The current study aimed to provide estimates of the prevalence of frailty and disability in older adult populations and to examine their relationship with socioeconomic factors in six countries. METHODS: Focusing on adults aged 50+ years, a frailty index was constructed as the proportion of deficits in 40 variables, and disability was assessed using the World Health Organization Disability Assessment Schedule (WHODAS 2.0), as part of the Study on global AGEing and adult health (SAGE) Wave 1 in China, Ghana, India, Mexico, Russia and South Africa. RESULTS: This study included a total of 34,123 respondents. China had the lowest percentages of older adults with frailty (13.1%) and with disability (69.6%), whereas India had the highest percentages (55.5% and 93.3%, respectively). Both frailty and disability increased with age for all countries, and were more frequent in women, although the sex gap varied across countries. Lower levels of both frailty and disability were observed at higher levels of education and wealth. Both education and income were protective factors for frailty and disability in China, India and Russia, whereas only income was protective in Mexico, and only education in South Africa. CONCLUSIONS: Age-related frailty and disability are increasing concerns for older adult populations in low- and middle-income countries. The results indicate that lower levels of frailty and disability can be achieved for older people, and the study highlights the need for targeted preventive approaches and support programs.
Subject(s)
Chronic Disease/epidemiology , Disabled Persons/statistics & numerical data , Aged , Aged, 80 and over , Developing Countries , Disability Evaluation , Female , Global Health , Health Services for the Aged , Humans , Male , Middle Aged , Prevalence , Risk Factors , Socioeconomic Factors , World Health OrganizationABSTRACT
The peritrophic matrix is a chitin-protein structure that envelops the food bolus in the midgut of the majority of insects, but is absent in some groups which have, instead, an unusual extra-cellular lipoprotein membrane named the perimicrovillar membrane. The presence of the perimicrovillar membrane (PMM) allows these insects to exploit restricted ecological niches during all life stages. It is found only in some members of the superorder Paraneoptera and many of these species are of medical and economic importance. In this review we present an overview of the midgut and the digestive system of insects with an emphasis on the order Paraneoptera and differences found across phylogenetic groups. We discuss the importance of the PMM in Hemiptera and the apparent conservation of this structure among hemipteran groups, suggesting that the basic mechanism of PMM production is the same for different hemipteran species. We propose that the PMM is intimately involved in the interaction with parasites and as such should be a target for biological and chemical control of hemipteran insects of economic and medical importance.
Subject(s)
Insect Vectors/anatomy & histology , Insect Vectors/physiology , Reduviidae/anatomy & histology , Reduviidae/physiology , Animals , Biological Evolution , Chagas Disease/transmission , Gastrointestinal Tract/anatomy & histology , Gastrointestinal Tract/physiology , Hemiptera/anatomy & histology , Hemiptera/physiology , Microvilli/physiology , Microvilli/ultrastructureABSTRACT
Food consumers and industries urged the need of natural alternatives to assure food safety and quality. As a response, the use of natural compounds from herbs and spices is an alternative to synthetic additives associated with toxic problems. This review discusses the antimicrobial and antioxidant activity of oregano essential oil (OEO) and its potential as a food additive. Oregano is a plant that has been used as a food seasoning since ancient times. The common name of oregano is given to several species: Origanum (family: Lamiaceae) and Lippia (family: Verbenaceae), amongst others. The main compounds identified in the different OEOs are carvacrol and thymol, which are responsible for the characteristic odor, antimicrobial, and antioxidant activity; however, their content may vary according to the species, harvesting season, and geographical sources. These substances as antibacterial agents make the cell membrane permeable due to its impregnation in the hydrophobic domains, this effect is higher against gram positive bacteria. In addition, the OEO has antioxidant properties effective in retarding the process of lipid peroxidation in fatty foods, and scavenging free radicals. In this perspective, the present review analyzes and discusses the state of the art about the actual and potential uses of OEO as an antimicrobial and antioxidant food additives.
Subject(s)
Anti-Infective Agents/analysis , Antioxidants/analysis , Oils, Volatile/analysis , Origanum/chemistry , Plant Oils/analysis , Food Additives/analysis , Food Analysis , Food Contamination/analysis , Food Microbiology , Food Preservation , Gram-Negative Bacteria/drug effects , Gram-Positive Bacteria/drug effects , Odorants/analysis , TasteABSTRACT
Association of type 2 diabetes (T2D) with common variants in HHEX, HNF4α, KCNJ11, PPARγ, CDKN2A/2B, SLC30A8, CDC123/CAMK1D, TCF7L2, ABCA1 and SLC16A11 genes have been reported, mainly in populations of European and Asian ancestry and to a lesser extent in Latin Americans. Thus, we aimed to investigate the contribution of rs1111875 (HHEX), rs1800961 (HNF4α), rs5219 (KCNJ11), rs1801282 (PPARγ), rs10811661 (CDKN2A/2B), rs13266634 (SLC30A8), rs12779790 (CDC123/CAMK1D), rs7903146 (TCF7L2), rs9282541 (ABCA1) and rs13342692 (SLC16A11) polymorphisms in the genetic background of Maya population to associate their susceptibility to develop T2D. This is one of the first studies designed specifically to investigate the inherited component of T2D in the indigenous population of Mexico. SNPs were genotyped by allelic discrimination method in 575 unrelated Maya individuals. Two SNPs rs10811661 and rs928254 were significantly associated with T2D after adjusting for BMI; rs10811661 in a recessive and rs9282541 in a dominant model. Additionally, we found phenotypical alterations associated with genetic variants: HDL to rs9282541 and insulin to rs13342692. In conclusion, these findings support an association of genetic polymorphisms to develop T2D in Maya population.
Subject(s)
ATP Binding Cassette Transporter 1/genetics , Cyclin-Dependent Kinase Inhibitor p15/genetics , Cyclin-Dependent Kinase Inhibitor p16/genetics , Diabetes Mellitus, Type 2/genetics , Indians, North American/genetics , Monocarboxylic Acid Transporters/genetics , Adult , Body Mass Index , Diabetes Mellitus, Type 2/ethnology , Female , Genetic Association Studies , Genetic Predisposition to Disease , Humans , Indians, North American/ethnology , Male , Mexico/ethnology , Middle Aged , Polymorphism, Single NucleotideABSTRACT
This article pretends to be a guide for the teacher who has the responsibility of elaborating a course program in a competence based curriculum like the one our Faculty of Medicine has adopted as part of the process of curricular innovation.
Subject(s)
Curriculum , Education, Medical , Teaching/methods , Learning , CurriculumABSTRACT
It is has been shown that the majority of T. cruzi strains isolated from Mexico belong to the T. cruzi I (TCI). The immune response produced in response to Mexican T. cruzi I strains has not been well characterized. In this study, two Mexican T. cruzi I strains were used to infect Balb/c mice. The Queretaro (TBAR/MX/0000/Queretaro)(Qro) strain resulted in 100% mortality. In contrast, no mortality was observed in mice infected with the Ninoa (MHOM/MX/1994/Ninoa) strain. Both strains produced extended lymphocyte infiltrates in cardiac tissue. Ninoa infection induced a diverse humoral response with a higher variety of immunoglobulin isotypes than were found in Qro-infected mice. Also, a stronger inflammatory TH1 response, represented by IL-12p40, IFNgamma, RANTES, MIG, MIP-1beta, and MCP-1 production was observed in Qro-infected mice when compared with Ninoa-infected mice. We propose that an exacerbated TH1 immune response is a likely cause of pathological damage observed in cardiac tissue and the primary cause of death in Qro-infected mice.
Subject(s)
Chagas Disease/immunology , Chagas Disease/microbiology , Trypanosoma cruzi/pathogenicity , Animals , CD4-Positive T-Lymphocytes/immunology , CD8-Positive T-Lymphocytes/immunology , Cytokines/biosynthesis , Cytokines/genetics , Cytokines/immunology , Disease Models, Animal , Female , Heart/parasitology , Histocytochemistry , Immunoglobulin Isotypes/blood , Immunoglobulin Isotypes/immunology , Mice , Mice, Inbred BALB C , Spleen/pathology , Th1 Cells/immunology , Trypanosoma cruzi/immunologyABSTRACT
Clinical and epidemiological aspects of shigatoxin producing E. coli (STEC) infections and hemolytic uremic syndrome (HUS) are reviewed. Surveillance results from 14 sentinel centers during 2000-2002 showed a mean incidence rate of 3.4 HUS cases per 100.000 children, with the highest incidence in the 6 to 28 month age group. Disease is endemic with summer peaks. Between 1988 and 2002 we obtained the clinical characteristics of a group of 119 HUS children with the following results: mean age 16 months, bloody diarrhea 57.8 percent, no previous diarrhea 9 percent, 60 percent received antibiotics, 72 percent had oligoanuria, 53 percent required dialysis, 15 percent had seizures and 31 percent had dizziness; mortality was 3 percent. Four foodborne outbreaks have been detected in Santiago, two outbreaks occurred in household settings, one in a Day Care Center and one in a Neonatal Unit. Recommendations for diagnosis, treatment and prevention of STEC infections, including potential vaccines are discussed.
Se revisan y actualizan aspectos clínicos y epidemiológicos de las infecciones por Escherichia coli productora de shigatoxina (STEC), y el síndrome hemolítico urémico (SHU). Se incluyen resultados de una vigilancia de SHU en 14 centros centinelas (2000-2002), que mostró una incidencia promedio de 3,4 casos por 100.000 niños, 78 por ciento) en el grupo de 6 a 48 meses. Esta vigilancia reflejó una situación endémica, con aumento en verano. Se analiza la observación clínica protocolizada de 119 pacientes con SHU hospitalizados en la Región Metropolitana (RM) (1988 y 2002). Edad promedio: 16 meses. El 578 por ciento> tenía diarrea con sangre, 9 por ciento> no tenía diarrea previa, 60 por ciento> recibió antibacterianos, 72 por ciento> presentó oligoanuria y 53 por ciento> necesitó diálisis. El 31 por cientoo tuvo compromiso de conciencia y 15 por cientoo presentó convulsiones. Letalidad 3 por ciento. Se analizan brotes de STEC asociados a alimentos ocurridos en la RM en el hogar (2), un jardín infantil (1) y en un servicio de neonatología (1). Finalmente, se entregar recomendaciones para el manejo clínico y prevención, se revisan los criterios diagnósticos, nuevas estrategias terapéuticas y progresos en el desarrollo de vacunas.
Subject(s)
Child, Preschool , Female , Humans , Infant , Male , Escherichia coli Infections/microbiology , Hemolytic-Uremic Syndrome/microbiology , Shiga-Toxigenic Escherichia coli/isolation & purification , Chile/epidemiology , Escherichia coli Infections/diagnosis , Escherichia coli Infections/epidemiology , Hemolytic-Uremic Syndrome/diagnosis , Hemolytic-Uremic Syndrome/epidemiology , Incidence , Population SurveillanceABSTRACT
Background: Hemolytic-uremic syndrome (HUS) is characterized by acute renal failure, microangiopathic hemolytic anemia and thrombocytopenia. Aim: To describe the characteñstics ofpatients with the diagnosis ofHUS in Chile, and to identify the most reliable early predictors oímorbidity and moñality. Material and methods: The clinical records ofpatients with HUS aged less than 15 years, attended between January 1990 and December 2003 in 15 hospitals, were reviewed. Demographic, clinical, biochemical, hematological parameters, morbidity and mortality were analyzed. Results: A cohort of 587 patients aged 2 to 8 years, 48 percent males, was analyzed. Ninety two percent had diarrhea. At the moment of diagnosis, anuria was observed in 39 percent of the patients, hypertension in 45 percent and seizures in 17 percent. Forty two percent required renal replacement therapy (RRT) and perítoneal dialysis was used in the majoríty of cases (78 percent). The most frequently isolated etiological agentwas Escherichia coli. Mortality rate was 2.9 percent in the acute phase of the disease and there was a positive correlation between mortality and anuria, seizures, white blood cell count (WCC) >20.000/mm³ and requirements of renal replacement therapy (p <0.05). Twelve percent of patients evolved to chronic renal failure and the risk factors during the acute phase were the need for renal replacement therapy, anuria, WCC >20.000/mm³, seizures and hypertension. Conclusions: The present study emphasizes important clinical and epidemiological aspeets ofHUSin a Chilean pediatricpopulation.
Subject(s)
Child , Child, Preschool , Female , Humans , Infant , Male , Acute Kidney Injury , Anuria/etiology , Hemolytic-Uremic Syndrome/complications , Acute Kidney Injury , Anuria/epidemiology , Anuria/therapy , Child Health Services/statistics & numerical data , Chile/epidemiology , Follow-Up Studies , Hemolytic-Uremic Syndrome/mortality , Hemolytic-Uremic Syndrome/therapy , Hospitalization , Logistic Models , Prognosis , Renal Dialysis , Retrospective Studies , Risk FactorsABSTRACT
BACKGROUND: Hemolytic-uremic syndrome (HUS) is characterized by acute renal failure, microangiopathic hemolytic anemia and thrombocytopenia. AIM: To describe the characteristics of patients with the diagnosis of HUS in Chile, and to identify the most reliable early predictors of morbidity and mortality. MATERIAL AND METHODS: The clinical records of patients with HUS aged less than 15 years, attended between January 1990 and December 2003 in 15 hospitals, were reviewed. Demographic, clinical, biochemical, hematological parameters, morbidity and mortality were analyzed. RESULTS: A cohort of 587 patients aged 2 to 8 years, 48% males, was analyzed. Ninety two percent had diarrhea. At the moment of diagnosis, anuria was observed in 39% of the patients, hypertension in 45% and seizures in 17%. Forty two percent required renal replacement therapy (RRT) and peritoneal dialysis was used in the majority of cases (78%). The most frequently isolated etiological agent was Escherichia coli. Mortality rate was 2.9% in the acute phase of the disease and there was a positive correlation between mortality and anuria, seizures, white blood cell count (WCC)>20.000/mm3 and requirements of renal replacement therapy (p<0.05). Twelve percent of patients evolved to chronic renal failure and the risk factors during the acute phase were the need for renal replacement therapy, anuria, WCC>20.000/mm3, seizures and hypertension. CONCLUSIONS: The present study emphasizes important clinical and epidemiological aspects of HUS in a Chilean pediatric population.
Subject(s)
Acute Kidney Injury/etiology , Anuria/etiology , Hemolytic-Uremic Syndrome/complications , Acute Kidney Injury/mortality , Acute Kidney Injury/therapy , Anuria/epidemiology , Anuria/therapy , Child , Child Health Services/statistics & numerical data , Child, Preschool , Chile/epidemiology , Female , Follow-Up Studies , Hemolytic-Uremic Syndrome/mortality , Hemolytic-Uremic Syndrome/therapy , Hospitalization , Humans , Infant , Logistic Models , Male , Prognosis , Renal Dialysis , Retrospective Studies , Risk FactorsABSTRACT
Se presentan los hallazgos intracardíacos en CT de coronarias realizados en Clínica Alemana de Santiago entre noviembre 2003 - agosto 2006. La tomografía computada cardíaca es utilizada para la evaluación de las arterias coronarias, pero también puede ser útil para la evaluación de otras estructuras cardíacas. En estas estructuras podemos encontrar patología asociada como aneurismas auriculares o ventriculares, secuelas de infartos entre otros. Nosotros describimos nuestro protocolo y revisamos los principales hallazgos no coronarios.
We present the retrospective review of incidental intracardiac findings in coronary CTA performed at Clínica Alemana Santiago between november2003 until august 2006. Cardiac CT is frequently used in clinical practice for evaluation coronary arteries, but can be useful for evaluation of other cardiac structures. In these structures we can find associated pathology as auricular and ventricular aneurysms, damage of heart infarcts, among others. We describe our study protocol and review principal findings.
Subject(s)
Humans , Male , Adult , Aged, 80 and over , Female , Middle Aged , Coronary Angiography/statistics & numerical data , Heart , Tomography, X-Ray Computed , Heart Septum , Chile/epidemiology , Retrospective Studies , Sex DistributionABSTRACT
Se presenta una revisión de los casos de angioedema asociado al uso de Inhibidores de la Enzima Convertidora de Angiotensina de nuestro hospital. El objetivo es dar a conocer esta patología a la comunidad médica. La edad promedio de presentación fue de 67,8 años. Los pacientes tomaron el medicamento por entre 1 y 96 meses, antes de la aparición de los síntomas. La cantidad de episodios de angioedema antes del diagnóstico fue entre l y 7,el seguimiento después del tratamiento, entre 8 y 18 meses. El síntoma más frecuente fue edema lingual, aunque una paciente requirió tratamiento en la Unidad de Cuidados Intensivos con intubación orotraqueal. Se presenta una revisión de la literatura, con énfasis en la epidemiología, diagnóstico, mecanismo fisiopatológico y tratamiento de la enfermedad.
Subject(s)
Humans , Male , Female , Middle Aged , Angioedema , Enalapril/adverse effects , Angioedema , Epidemiology, Descriptive , Retrospective Studies , Follow-Up Studies , Time Factors , Angiotensin-Converting Enzyme Inhibitors/adverse effectsABSTRACT
The purpose of this work was to clarify the taxonomy and phylogenetic relationship of the Phyllosoma complex and other important vectors in Mexico. The internal transcribed spacer 2 (ITS-2) of rDNA and the cytochrome B gene of mtDNA (mtCytB) were analyzed for the following species of triatomine: Triatoma bassolsae, T. longipennis, T. mazzottii, T. mexicana, T. pallidipennis, T. picturata, and T. phyllosoma belonging to the Phyllosoma complex, as well as T. dimidiata, T. rubida, T. infestans, and Rhodnius prolixus. The results obtained with the analysis of the ITS-2 sequences showed that the Phyllosoma complex species could not be phylogenetically separated, since T. bassolsae and T. pallidipennis, as well as T. phyllosoma and T. mazzottii were indistinguishable. In contrast, the mtCytB gene separates each one of these triatomine species. The results support the proximity of all seven species currently included in the Phyllosoma complex as well as the exclusion of T. dimidiata. For the first time T. lecticularia and T. rubida were analyzed and were also shown to be related to the Phyllosoma complex.
Subject(s)
Insect Vectors/genetics , Triatoma/classification , Triatoma/genetics , Animals , Base Sequence , Cytochromes b/genetics , DNA, Mitochondrial/genetics , DNA, Ribosomal/genetics , DNA, Ribosomal Spacer , Mexico , Microsatellite Repeats , Phylogeny , Rhodnius/classification , Rhodnius/genetics , Sequence Alignment , United StatesABSTRACT
Objetivo: Descripción de las indicaciones y resultados del tratamiento quirúrgico de las fracturas de columna cervical superior, durante el periodo entre enero de 1989 y diciembre de 1998. Pacientes y métodos: Estudio retrospectivo de 17 casos, 15 hombres (88,2 por ciento) y 2 mujeres (11,8 por ciento), con una edad promedio de 32,7 años y un seguimiento promedio de 56.4 meses. Los casos correspondieron a 1 fractura del atlas (5,9 por ciento), 12 fracturas de apófisis odontoides (70,5 por ciento), 2 fracturas de los pedículos del axis (11,8 por ciento) y 2 fracturas del atlas y axis (11,8 por ciento). Dos casos presentaron compromiso radicular asociado (11,8 por ciento). Resultados: La consolidación se obtuvo en promedio a las 12 semanas en la fractura del atlas, a las 9.8 semanas en las fracturas del odontoides, a las 10 semanas en las fracturas de los pedículos del axis y a las 16 semanas en las fracturas de atlas y axis. Se presentó dehiscencia parcial de herida en 1 caso. Los casos con compromiso radicular se recuperaron completamente. Conclusión: El manejo de las fracturas de columna cervical superior es generalmente conservador y el tratamiento quirúrgico se encuentra reservado para las lesiones inestables y las complicaciones de la consolidación.
Subject(s)
Humans , Male , Adult , Female , Axis, Cervical Vertebra/surgery , Axis, Cervical Vertebra/injuries , Cervical Atlas/surgery , Cervical Atlas/injuries , Spinal Fractures/surgery , Odontoid Process , Retrospective Studies , Spinal FusionABSTRACT
Objetivo: Evaluación del manejo y resultados de los casos de pseudoartrosis de diáfisis húmeral tratados quirúrgicamente entre febrero de 1992 y diciembre de 2001. Pacientes y Métodos: Estudio restrospectivo de 18 casos, 15 hombres (83,3 por ciento) y 3 mujeres (16,7 por ciento), con una edad promedio de 39,6 años y un seguimiento promedio de 68,3 meses. Siete casos presentaron una pseudoartrosis atrófica (38,9 por ciento) y en 6 casos fue hipertrófica (33,3 por ciento) y en 5 casos hipotrófica (27,8 por ciento). Todos los casos fueron tratados quirúrgicamente, empleando fijación interna con placa en 12 casos (66,7 por ciento) y enclavado endomedular en 6 casos (33,3 por ciento). En 12 casos se efectuó aporte de injerto óseo (66,7 por ciento). Resultados: La consolidación se obtuvo en promedio a las 12,7 semanas luego del tratamiento quirúrgico de la pseudoartrosis, con un rango entre 8 y 24 semanas. La valoración funcional fue buena en pseudoartrosis, con una rango entre 8 y 24 semanas. La valoración funcional fue buena en 17 casos (94,4 por ciento) y defieciente en 1 caso (5,6 por ciento). Hubo dos complicaciones que fueron 1 caso de hematoma de herida operatoria y 1 caso de infección superficial en la cresta ilíaca donante (11,1 por ciento). Conclusión: La pseudoartrosis de la diáfisis humeral requiere habitualmente de tratamiento quirúrgico, siendo la fijación más aporte de injerto óseo el método de elección para las lesiones atróficas e hipotróficas y la correcta estabilización en el tratamiento de las lesiones hipertróficas.
Subject(s)
Humans , Male , Adult , Female , Bone Transplantation , Fracture Fixation, Internal , Humeral Fractures/surgery , Pseudarthrosis/surgery , Retrospective StudiesABSTRACT
Un porcentaje considerable de pacientes que requieren cirugía vesical con intestino corresponden a mujeres en edad fértil. El embarazo y parto en este grupo de pacientes sólo ha sido reportado de forma ocasional. El objetivo del presente trabajo es describir una serie clínica de mujeres que consiguieron gestación y parto, posterior a cirugía de ampliación o derivación vesical con intestino. Revisión retrospectiva de fichas clínicas de 6 mujeres que cursaron con una gestación exitosa, posterior a cirugía de enterocistoplastía. Se consideró: diagnóstico pre operatorio, cirugía realizada, embarazo, tipo de parto y complicaciones. Desde el año 1988 a la fecha, se ha realizado cirugía vesical con intestino en 37 mujeres en edad fértil. Seis de ellas han conseguido embarazo, con siete gestaciones reportadas. Los diagnósticos pre operatorios fueron: tres cistopatías intersticiales, dos vejigas neurogénicas y una hiperactividad idiopática del Detrusor. El tipo de cirugía fue ampliación vesical con intestino detubulizado en cuatro casos y ampliación con cierre de cuello y ostomía continente en dos. Los embarazos fueron: feto único en cinco pacientes y gemelar en una. Las complicaciones más significativas fueron infección del tracto urinario y parto prematuro. El parto correspondió a cesárea en cinco mujeres y parto vaginal en una. Posterior al parto, una paciente requirió revisión de la ostomía por prolapso e incontinencia. Las mujeres en edad fértil que han requerido cirugía vesical con intestino, pueden conseguir un embarazo y parto exitoso con baja incidencia de complicaciones.
Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Pregnancy Complications , Urinary Diversion/adverse effects , Urinary Bladder/surgery , Retrospective Studies , Urinary Tract Infections/complicationsABSTRACT
Objetivo: Evaluación de los resultados del tratamiento con reducción abierta y fijación interna de las fracturas desplazadas de acetábulo, intervenidas quirúrgicamente entre enero de 1989 y diciembre de 1998. Material y Método: Estudio retrospectivo de 57 pacientes con una edad promedio de 34, 6 años y un tiempo medio de seguimiento de 66,3 meses. El mecanismo lesional correspondió en 45 casos a accidentes de tráfico (78,9 por ciento) y en 12 casos a aplastamientos (21,1 por ciento). De acuerdo con la clasificación de Judet y Letournel hubo 24 fracturas simples (42,1 por ciento) y 33 fracturas complejas (57,9 por ciento). La fijación interna se realizó con placa y tornillo en 35 casos (61,4 por ciento) y con tornillos en 22 casos (38,6 por ciento). Resultados: La reducción postoperatoria fue anatómica en 27 casos (47,3 por ciento), satisfactoria en 16 casos (28,1 por ciento) y deficiente en 14 casos (24,6 por ciento). Los resultados funcionales fueron excelentes en 22 casos (38,6 por ciento), buenos en 18 casos (31,6 por ciento), regulares en 6 casos (10,5 por ciento) y malos en 11 casos (19,3 por ciento). Las complicaciones precoces fueron redesplazamiento de la fractura en 3 casos (5,3 por ciento), hematoma postoperatoria en 2 casos (3,5 por ciento), parálisis del nervio ciático en 2 casos (3,5 por ciento), trombosis venosa profunda en un caso (1,8 por ciento) infección profunda en un caso (1,8 por ciento) e infección superficial en un caso (1,8 por ciento). Las complicaciones tardías fueron osificación heterotópica en 7 casos (12,3 por ciento), artrosis postraumática en 6 casos (10,5 por ciento) y necrosis avascular de la cabeza femoral en 4 casos (7,0 por ciento). Conclusión: La reducción abierta y fijación interna es un método eficaz para el tratamiento de las fracturas desplazadas de acetábulo, pues permite reconstruir la articulación coxofemoral, consiguiendo buenos resultados clínicos en el largo plazo.
Subject(s)
Humans , Male , Adolescent , Adult , Female , Middle Aged , Acetabulum/surgery , Acetabulum/injuries , Acetabulum , Fracture Fixation, Internal , Fractures, Bone/surgery , Bone Plates , Bone Screws , Follow-Up Studies , Retrospective Studies , Treatment OutcomeABSTRACT
La litotripsia extracorpórea por ondas de choque (LEC), ha ganado su espacio en el tratamiento de los cálculos de la vía urinaria. Una de las indicaciones más ccontrovertidas para la LEC son los grandes cálculos renales y los de uréter distal. El objetivo de nuestro trabajo es evaluar la efectividad de la litotripsia extracorpórea (LEC) en cálculos de uréter distal. Se realizó una revisión retrospectiva de 70 pacientes sometidos a LEC por cálculo de uréter distal en nuestro hospital, durante el período diciembre 1996 a mayo del 2002. Se utilizó el litotriptor electrohidráulico Direx Tripter Compact. De nuestros 70 pacientes, el 68,6 porciento era de sexo masculino y el 31,4 porciento femenino, con un promedio de edad de 41,9 años. Tres de estos pacientes presentaban cálculos dobles, lo que da un total de 73 unidades de litiasis. El 53,4 porciento son derechos y 46,6 porciento izquierdos. El tamaño promedio de los cálculos fue de 8,5 mm y el promedio de ondas de choque aplicadas fue de 3211. El 19,2 porciento de los cálculos no se fragmentó o lo hizo en sólo 2 fragmentos, produciéndose fragmentación y posterior eliminación en el 80,8 porciento. En 14 pacientes (20 porciento) se requirió tratamiento complementario (9 ureterolitectomías : 8 endoscópicas yuna vía abierta, y 5 LEC adicionales).
