Abordaje transesternal transpericárdico para cierre de fístula del muñón bronquial post neumonectomía / Trans-sternal, trans-pericardial approach for closure of post-pneumonectomy bronchial stump de hiscence

La fistula del muñón bronquial es una seria complicación de la neumonectomía, por su complejidad tanto en los cambios anatomofisiológicos que el paciente experimenta, como en la diversidad de recursos para su resolución. El objetivo de este estudio es la presentación de este primer caso en la historia quirúrgica del país de abordaje transesternal, transpericárdico para el cierre de la fístula del muñón bronquial post neumonectomía en el Hospital San Vicente en Guatemala. Método: Se presenta el caso de una paciente de sexo femenino a quien se le realizó neumonectomía derecha por tuberculosis pulmonar y que presentó dehiscencia del muñón bronquial por lo que se procedió a realizar abordaje transesternal transpericárdico para el cierre del muñón bronquial a nivel de la Carina. Resultados: Se da seguimiento a la paciente por 8 años tras los cuales el problema se considera resuelto. Conclusión: la utilización del abordaje transesternal, transpericárdico para el cierre de la fístula del muñón bronquial postneumonectomía permite alcanzar el bronquio en un ambiente no contaminado debiendo considerarse como un procedimiento adecuado para resolver este tipo de complicación.

Background: Bronchial stump fstula is a serious complicaton of pneumonectomy. The aim of this case report is to document the frst surgical patenttreated with trans-sternal, trans-pericardial approach for bronchial stump fstula closing afer pneumonectomy at San Vicente Hospital in Guatemala.Methods: A female patent who underwent right pneumonectomy for pulmonary tuberculosis with postoperatve bronchial stump dehiscence.Trans-sternal trans-pericardial approach was performed for closing the bronchial stump fstula at the carina.Results: Afer 8 years of follow up, the problem in the patent had completely resolved.Conclusion: Trans-pericardial trans-sternal approach for bronchial stump fstula closing allows bronchium access in a non-contaminated space andshould be considered to resolve this kind of complicaton.

Evaluación de la técnica en microplaca de 3-(4-5- dimetiletiazol-2-II)-2-5-difenilbromuro de tetrazolio (Mtt) como marcador de la susceptibilidad micobacteriana en el laboratorio del Hospital Roosevelt / Evaluation of technical microplate 3-(4-5- dimetiletiazol-2-II) -2-5-difenilbromuro tetrazolium (MTT) as a marker of mycobacterial susceptibility in laboratory Roosevelt Hospital

El método de referencia utilizado actualmente para evaluar la susceptibilidad de la M. tuberculosis a los antibióticos en uso es el método de proporciones de Canetti (MPC), el cual es muy costoso, requiere de personal capacitado y el tiempo de obtención de los resultados es muy prolongado (42 días). Por ello se evaluó la técnica en microplaca con MTT (3-(4-5-dimetiletiazol-2-il)-2,5-difenibromuro de tetrazolio) en base a sensiblidad, especifidad, tiempo costo y se comparó con la técnica de proporciones de Canetti...

Dialysis-associated morbidity, ultrafiltration, and cardiovascular variables in children with HIV infection.

UNLABELLED: Children infected with HIV on maintenance hemodialysis (HD) have increased mortality with adequate single pool Kt/V, as compared to non-HIV children on HD. It is unclear if HIV subjects on HD have similar dialysis-associated morbidity (DAM) and blood volume changes (dBV) as non-HIV subjects. It is also unclear how those variables are related to left ventricular mass index (LVMI), shortening fraction (SF), pre- and postdialysis blood pressure and mortality. METHODS: We investigated the relationship between LVMI, SF and dBV and DAM using noninvasive monitoring of hematocrit in HIV vs. non-HIV subjects and their association with mortality. We used a cross-sectional study design and analyzed 18 pediatric subjects (9 had vertically transmitted HIV) on HD over a 17-month period. HIV subjects tolerated fluid removal during HD treatments as well as non-HIV subjects. RESULTS: In our study we confirmed an association of LVMI with DAM in subjects on HD. We found that HIV subjects who did not survive had a significantly lower SF and similar viral load as compared to subjects who survived. CONCLUSIONS: Noninvasive monitoring of hematocrit in HIV subjects with compromised heart function allows effective ultrafiltration. Routine echocardiography should be periodically performed in all HIV-infected children on renal replacement therapy because subclinical abnormalities, i.e. increased LVMI or reduced SF in this population can be predictors of mortality.

Trastorno bipolar en la infancia de causa orgánica / Childhood Bipolar Disorder due to organic causes

La búsqueda de las bases orgánicas de las enfermedades mentales es uno de los objetivos históricos de la psiquiatría. Frente a otros supuestos etiológicos de difícil verificación, la constatación de bases orgánicas acerca a la psiquiatría al resto de las especialidades médicas. Dicha disfunción puede ser primaria (si afecta al cerebro de manera directa o selectiva) o secundaria (si la disfunción afecta a diversos órganos o sistemas, entre ellos el cerebro). La comunicación de Casos Clínicos en los que se evidencia la conexión entre el substrato lesional y la expresión psicopatológica puede resultar ilustrativa y, en ocasiones, orientar futuras investigaciones. Presentamos dos Casos Clínicos de sintomatología sugerente de Trastorno Bipolar en la infancia, secundarios ambos a causa orgánica

The search for organic bases of mental illnesses is one of the central goals of psychiatry. Unlike other etiological hypotheses hard to verify, the search for organic bases brings psychiatry closer to other medical specialities. Such dysfunction may be primary (if it affects the brain directly or selectively) or secondary (if the dysfunction concerns various organs or systems including the brain). Reporting clinical cases in which there are clear connections between substrate damage and psychopathological expression can be illuminating, and occasionally a guide for future research. Two cases are presented with symptoms suggestive of childhood bipolar disorder, both due to organic causes

[Serum creatinine and creatinine clearance to estimate renal function in essential hypertension]. / Creatinina sérica y aclaramiento de creatinina para la valoración de la función renal en hipertensos esenciales.

The shortcoming of serum creatinine (SCr) as an index of renal function is well known, patients can have significantly decreased glomerular filtration rates (GFR) with normal range SCr values, making the recognition of renal dysfunction more difficult. This study was designed to estimate renal function and the prevalence of renal dysfunction in essential hypertensive patients, comparing SCr and 4 formulas used to measure the creatinine clearance (CrCl) (the urinary CrCl formula, Cockcroft-Gault, MDRD and body surface formula) The study included 721 essential hypertensive patients, 319 men (44.2%), 402 women (55.8%), mean age 56.3 +/- 13.9 (53.7 +/- 14.4 vs 58.3 +/- 13.3). In all subjects SCr was measured and 24-h urine sample was collected to evaluate CrCl. Creatinine clereance was calculated by 4 formulas. Patients were grouped according to age (< 40, 41-65, 65-75 and > 76) and renal function was classified as normal when SCr < 1.4 in women and 1.5 mg/dl in men and CrCl (> 60 ml/m, respectively) within the above written formulas. SCr increases with age (1.01 +/- 0.36 vs 1.3 +/- 1.15) and CrCl decreases according to the 4 formulas (107.6; 92.8; 74.7 and 57.3 for the urinary SCr formula); (117.7; 87.7; 65.9 and 49.5 for the CC formula); (87.4, 74.9, 66.5 and 61 for the MDRD formula) and (97, 85.3, 71.9 and 57.3 for the body suface formula). The 4 formulas are comparable markers of renal function in the overall population. With any formula the percentage of patients with impaired renal function was much higher than indicated by the plasma creatinine alone (4% for SCr) vs 18.3-25.3% (CrCl < 60 ml/m) according to the 4 formulas. This study documents the substantial prevalence of abnormal renal function in essential hypertension. Estimation of GFR may help to facilitate the early identification of patients with renal impairment.

Creatinina sérica y aclaramiento de creatinina para la valoración de la función renal en hipertensos esenciales / Serum creatinine and creatinine clearance for renal function evaluation

La creatinina plasmática puede subestimar el filtrado glomerular. Los pacientespueden tener una disminución significativa del filtrado glomerular conun valor de creatinina plasmática dentro de la normalidad, haciendo difícil ladetección precoz del deterioro de la función renal. En este trabajo se estimala función renal así como la prevalencia de la disfunción renal en pacientescon hipertensión arterial esencial, mediante la determinación de creatinina sérica,comparándolo con la medida del aclaramiento de creatinina, medida por4 fórmulas distintas; la fórmula habitual con recogida orina de 24 h, la fórmulade Cockcroft-Gault, MDRD abreviada y la fórmula habitual corregida porla superficie corporal. El estudio incluye 721 hipertensos esenciales, 319 hombres(44,2%), 402 mujeres (55,8%), con edad media 56,3 ± 13,9 (53,7 ±14,4 vs 58,3 ± 13,3). En todos ellos se determina la creatinina plasmática asícomo el aclaramiento de creatinina por las 4 fórmulas señaladas. Los pacientesfueron agrupados en función de la edad, en 4 grupos ( 76 años), la función renal fue calificado como normal cuando la creatininasérica es 60 ml/m en las cuatro fórmulas.La creatinina plasmática aumenta con la edad (1,01 ± 0,36 vs 1,3 ± 1,15en aquellos con edad menor de 40 y mayor de 70 años y el aclaramiento decreatinina disminuye con la edad según las 4 fórmulas (107,6; 92,8; 74,7,57,3 para la fórmula habitual); (117,7; 87,7; 65,9; 49,5 para la fórmula deCockroft-Gault); (87,4, 74,9, 66,5 y 61 para la fórmula MDRD abreviada) y(97, 85,3, 71,9; 57,3 para la fórmula de superficie corporal). Las 4 fórmulasson comparables para la medición de la función renal, con cualquiera deellas, el porcentaje de deterioro de la función renal fue mucho mayor (18,3-25,3% (CrCl < 60 ml/m) que el obtenido cuando se utiliza la creatinina plasmática(4%). Este estudio, demuestra la importancia de la determinación delaclaramiento de creatinina en hipertensos esenciales a la hora de valorar elfiltrado glomerular, detectando más precozmente el deterioro de la funciónrenal que cuando se utiliza la creatinina sérica

The shortcoming of serum creatinine (SCr) as an index of renal function is wellknown, patients can have significantly decreased glomerular filtration rates (GFR)with normal range SCr values, making the recognition of renal dysfunction moredifficult. This study was designed to estimate renal function and the prevalence ofrenal dysfunction in essential hypertensive patients, comparing SCr and 4 formulasused to measure the creatinine clearance (CrCl) (the urinary CrCl formula,Cockcroft-Gault, MDRD and body surface formula)The study included 721 essential hypertensive patients, 319 men (44.2%), 402women (55.8%), mean age 56.3 ± 13.9 (53.7 ± 14.4 vs 58.3 ± 13.3). In all subjectsSCr was measured and 24-h urine sample was collected to evaluate CrCl.Creatinine clereance was calculated by 4 formulas. Patients were grouped accordingto age ( 76) and renal function was classified asnormal when SCr 60 ml/m,respectively) within the above written formulas.SCr increases with age (1.01 ± 0.36 vs 1.3 ± 1.15) and CrCl decreases accordingto the 4 formulas (107,6; 92,8; 74,7 and 57,3 for the urinary SCr formula);(117,7; 87,7; 65,9 and 49,5 for the CG formula); (87,4, 74,9, 66,5 and 61 forthe MDRD formula) and (97, 85,3, 71,9 and 57,3 for the body suface formula).The 4 formulas are comparable markers of renal function in the overall population.With any formula the percentage of patients with impaired renal function wasmuch higher than indicated by the plasma creatinine alone (4% for SCr) vs 18,3-25,3% (CrCl < 60 ml/m) according to the 4 formulas. This study documents thesubstantial prevalence of abnormal renal function in essential hypertension. Estimationof GFR may help to facilitate the early identification of patients with renalimpairment

Embarazo ectópico tubárico tras programa FIV y embarazo ectópico abdominal / Tubal ectopic pregnancy after IVF and abdominal ectopic pregnancy

El tratamiento de la gestación extrauterina depende del diagnóstico precoz que se realice, conjuntamente con métodos de diagnóstico como determinaciones de valores de -HCG, sonografía transvaginal y culdocentesis previa a una intervención quirúrgica, laparoscópica o laparotomía y actitud expectante. El embarazo ectópico tiene una incidencia del 0,942,6 por ciento de gestaciones. Entre el 4 al 8 por ciento de embarazos ectópicos se producen tras el tratamiento por estimulación ovárica, y dentro de la reproducción asistida programa FIV, su incidencia está entre el 2,1 y el 9,4 por ciento, frecuencia muy superior a la observada en la población general fértil. El pronóstico de embarazo ectópico es responsable del 2 al 5 por ciento de las muertes maternas por complicaciones, como shock hemorrágico (AU)

Tacrolimus-Basiliximab versus Cyclosporine-Basiliximab in renal transplantation "de novo": acute rejection and complications.

BACKGROUND: Optimal immunosuppression is essential to maintain kidney allograft viability but minimizing toxicity is also fundamental. OBJECTIVE: This article compares immunosuppressants, corticosteroids, cyclosporine, tacrolimus, and basiliximab, which are used in the treatment regimens for renal transplantation. The analyses evaluated their effectiveness to prevent acute rejection episodes and to reduce the appearance of other complications, mainly infectious disease complications. METHODS: Ninety-five patients were analysed during the first year after primary renal transplantation. These patients were included in a random way in 3 different groups according to the immunosuppressant drug therapy: Group I (35 patients) received corticosteroids + CsA; Group II (35 patients) received corticosteroids + CsA + Basiliximab; Group III (25 patients) received corticosteroids + Tacrolimus + Basiliximab. RESULTS: Among the 95 patients, 9 presented with an acute rejection episode in Group I. None in Group II, and one in group III. With reference to the infectious disease complications, the incidence of oral herpes was one case in Group I, 4 cases in Group II, and 2 cases in group III. CONCLUSIONS: Treatment with Basiliximab produced a significantly lower incidence of acute rejection cases and an increase in infectious disease complications, such as lip herpes.

[Susceptibility of Streptococcus pyogenes isolates from pharyngeal exudates in Cordoba (Spain)]. / Sensibilidad de aislamientos faríngeos de Streptococcus pyogenes en la provincia de Córdoba (España).

Streptococcus pyogenes is an important human pathogen. Betalactams are still the drug of choice for the treatment of infections caused by this microorganism. In recent years an increase in the use of macrolides for initial treatment in respiratory infections has been observed; consequently, the number of macrolide-resistant isolates has also increased. We investigated the susceptibility of S. pyogenes to penicillin, erythromycin, clarithromycin and clindamycin in Cordoba during 2000, 2001 and the first 6 months of 2002. We obtained 100 isolates of S. pyogenes from 1232 pharyngeal exudates, all of which were susceptible to penicillin and 39 of which were resistant to erythromycin and clarithromycin. Twenty-six of these 39 isolates were susceptible to clindamycin.

Sensibilidad de aislamientos faríngeosde Streptococcus pyogenesen la provincia de Córdoba (España) / Susceptibility of Streptococcus pyogenes isolates from pharyngeal exudates in Cordoba (Spain)

Streptococcus pyogenes es un importante patógeno humano. Su tratamiento de elección lo constituyen los betalactámicos, pero en los últimos años se ha observado un incremento en el uso de macrólidos como tratamiento inicial de las infecciones respiratorias, con lo que también se ha visto aumentado el número de cepas resistentes a estos antimicrobianos. En este trabajo se investigó el perfil de sensibilidad en nuestra zona de S. pyogenes a la penicilina, la eritromicina, la claritromicina y la clindamicina en los años 2000, 2001 y primer semestre del año 2002. De un total de 1232 frotis faríngeos se obtuvieron 100 S. pyogenes, todos ellos sensibles a la penicilina y 39 resistentes a la eritromicina y la claritromicina (39 por ciento). De estas 39 cepas, 26 fueron sensibles a la clindamicina (67 por ciento) (AU)

Synergic effect of vicinal stereocenters in [3 + 2] cycloadditions of carbohydrate azadipolarophiles and mesoionic dipoles: origin of diastereofacial selectivity.

The intermolecular [3 + 2] cycloaddition of carbohydrate-derived 1,2-diaza-1,3-butadienes and 1,3-thiazolium-4-olates provides a conceptual basis for the problem of diastereofacial preference in the acyclic series of unsaturated sugars. Experimental results employing a side chain of D-arabino configuration have shown the stereodifferentiation exerted by the first stereogenic center that renders the Re,Re face of the acyclic sugar-chain azadiene eligible for cycloaddition (J. Org. Chem. 2000, 65, 5089). The results of the present work, now utilizing an alternative framework of D-lyxo configuration, evidence the discriminating power of the second stereogenic carbon, which induces the preferential approach to the Re,Si face of the heterocyclic dipole. This scheme of face selectivity is also grounded in theoretical calculations at a semiempirical level. In addition to dihydrothiophenes, which are the expected products of the [3 + 2] cycloaddition, bicyclic systems based on dihydrothieno[2,3-c]piperidine skeleton can also be obtained.

The first density functional study on the

The hetero-Diels-Alder reactions of 1,2-diaza-1,3-butadiene with ethylene, methyl vinyl ether, and methyl acrylate have been investigated theoretically with the aid of density functional theory using the Becke3LYP/6-31G(d) computational level. In the reactions with substituted alkenes, the transition states are concerted but asynchronous; the shortest bond-forming distance involves the nonsubstituted carbon of the alkene. In agreement with the experimental results, the reaction with methyl vinyl ether proceeds with high endo stereoselectivity and with complete regioselectivity to form the 6-methoxy cycloadduct. The conformational study of the transition states shows a sharp s-trans preference. In contrast, the [4 + 2]-cycloaddition of 1,2-diaza-1,3-butadiene with methyl acrylate have been found to occur with low regio- and stereoselectivity but with a s-cis preference in the transition structures.

Diastereoselective cycloadditions of 1,3-thiazolium-4-olates with chiral 1,2-diaza-1,3-butadienes

A series of 2-(N-methyl)benzylamino-1,3-thiazolium-4-olates (2-aminothioisomunchnones) react with chiral 1,2-diaza-1,3-butadienes derived from carbohydrates to afford a diastereomeric mixture of (4R,5S)- and (4R,5R)-4,5-dihydrothiophenes. These substrate-controlled cycloadditions are chemoselective, regiospecific, and proceed with a high facial diastereoselection. A theoretical rationale at semiempirical level does justify the stereochemical outcome observed in the experiments.

[Preoperative radiotherapy in stage I endometrial cancer. I. 5-year survival]. / Radioterapia preoperatoria en cáncer de endometrio estadío I. Supervivencia a cinco años.

The results of treatments applied to 25 patients with stage I adenocarcinoma of the endometrium, are presented. The patients were attended between 1979 to 1984 at the Oncology Service of the Hospital 20 de Noviembre in Mexico City. Three successive methods of treatments were used: preoperative external radiation to the pelvis with telecobalt, using a dose of 5000 cGy in 6-7 weeks. Subsequently, one apparatus containing two capsules of radium of 20 or 15 mg within intravaginal applicator made of flexible plastic inserted in a vaginal acrylic cylinder; the dose given was 5000 cGy at vaginal mucosa. Finally, total abdominal hysterectomy and bilateral salpingo-oophorectomy. The following results were obtained from the five years control period: 92 per cent of the patients were cured and without incidence of intrapelvic tumoral recidivation.