[Neurological complications associated with extracorporeal membrane oxygenation (ECMO) therapy in adult patients. A study of a case series]. / Complicaciones neurológicas asociadas al tratamiento con oxigenación por membrana extracorpórea (ECMO) en pacientes adultos. Estudio de una serie de casos.

INTRODUCTION: ECMO is an advanced technique of ventilatory and circulatory support. However, it can be associated with neurological complications. The proposal is to describe the clinical characteristics and neurological complications profile in patients under ECMO support. PATIENTS AND METHODS: To descriptive a case series study. A descriptive and retrospective analysis and a bivariate analysis were performed in order to compare the main clinical variables of interest. RESULTS: 136 adults undergoing ECMO with an average age of 51 years (17-78) were evaluated. Neurological complications were observed in 51 patients (37.5%), corresponding to stroke 22 (16.17%), hypoxic encephalopathy 13 (9.5 %), cerebral hemorrhage (HIC) in 12 (8.8%) and subarachnoid hemorrhage (HSA) in 4 patients (2.9%). Seven (13.7%) of patients with neurological complications had seizures. Neurological complications occurred in 23.53% in venovenous ECMO and in 76.47% with veno-arterial ECMO (p = 0.86). The overall mortality was 51.47% (70/136) for all patients in ECMO and 64.7% (33/51) for the population with neurological complications. The mortality in stroke was 54.5% (12/22), 91.6% (11/12) in HIC and 100% (4) in HSA (p = 0.03). Mortality was higher in veno-arterial ECMO (77.14%) versus venous-venous ECMO (22.86% of total), (p = 0.015). CONCLUSIONS: ECMO is a useful therapeutic tool in cases of high clinical severity. In our study, we identified a high rate of neurological complications that contribute to associated morbidity and mortality. Early neuroimaging studies in these cases could allow early detection of these complications.

TITLE: Complicaciones neurológicas asociadas al tratamiento con oxigenación por membrana extracorpórea (ECMO) en pacientes adultos. Estudio de una serie de casos.Introducción. La ECMO es una técnica avanzada de soporte ventilatorio y circulatorio. Sin embargo, puede asociarse a complicaciones neurológicas. Se propone describir las características clínicas y el perfil de las complicaciones neurológicas en pacientes sometidos a ECMO. Pacientes y métodos. Estudio descriptivo retrospectivo de una serie de casos. Se realizó un análisis descriptivo y un análisis bivariado con la finalidad de comparar las principales variables clínicas de interés. Resultados. Se evaluó a 136 adultos sometidos a ECMO con edad promedio de 51 años (17-78). Las complicaciones neurológicas se presentaron en 51 pacientes (37,5%), de los cuales correspondieron a ictus 22 (16,17%); a encefalopatía hipóxica, 13 (9,5%); a hemorragia intracerebral (HIC), 12 (8,8%), y a hemorragia subaracnoidea (HSA), cuatro (2,9%). Siete (13,7%) de los pacientes con complicaciones neurológicas presentaron crisis epilépticas. Las complicaciones neurológicas se presentaron en 12 pacientes (23,53%) con la ECMO venovenosa y en 39 (76,47%) con la ECMO venoarterial (p = 0,86). La mortalidad global fue del 51,47% (70/136 pacientes) y del 64,7% (33/51) para la población con complicaciones neurológicas. La mortalidad en el ictus fue del 54,5% (12/22), del 91,6% (11/12) en la HIC y del 100% (4/4) en la HSA (p = 0,03). La mortalidad en la ECMO venoarterial fue del 77,14%, frente al 22,86% de la de la ECMO venovenosa (p = 0,015). Conclusiones. La ECMO es una herramienta terapéutica útil en casos de elevada gravedad clínica. En nuestro estudio, identificamos una elevada tasa de complicaciones neurológicas que contribuyen a la morbimortalidad asociada. La realización temprana de estudios de neuroimagen en estos casos podría permitir una detección temprana de estas complicaciones.

Characterization of inflammatory bowel disease in Colombia: Results of a national register. / Caracterización de la enfermedad inflamatoria intestinal en Colombia: resultados de un registro nacional.

AIM: To determine the clinical, sociodemographic, and treatment characteristics of inflammatory bowel disease (IBD) in a Colombian population register. METHODS: A descriptive, analytic, observational, cross-sectional, multicenter study on patients with IBD from 17 hospital centers in 9 Colombian cities was conducted. RESULTS: A total of 2,291 patients with IBD were documented, 1,813 (79.1%) of whom presented with ulcerative colitis (UC), 456 (19.9%) with Crohn's disease (CD), and 22 with IBD unclassified (0.9%). The UC/CD ratio was 3.9:1. A total of 18.5% of the patients with UC and 47.3% with CD received biologic therapy. Patients with extensive UC had greater biologic therapy use (OR = 2.78, 95% CI: 2.10-3.65, p = 0.000), a higher surgery rate (OR = 5.4, 95% CI: 3.5-8.3, p = 0.000), and greater frequency of hospitalization (OR = 4.34, 95% CI: 3.47-5.44, p = 0.000). Patients with severe UC had greater biologic therapy use (OR = 5.04, 95% CI: 3.75-6.78, p = 0.000), a higher surgery rate (OR = 8.64, 95% CI: 5.4-13.78, p = 0.000), and greater frequency of hospitalization (OR = 28.45, 95% CI: 19.9-40.7, p = 0.000). CD patients with inflammatory disease behavior (B1) presented with a lower frequency of hospitalization (OR = 0.12, 95% CI: 0.07-0.19, p = 0.000), a lower surgery rate (OR = 0.08, 95% CI: 0.043-0.15, p = 0.000), and less biologic therapy use (OR = 0.26, 95% CI: 0.17-0.41, p = 0.000). CONCLUSION: In Colombia, there is a predominance of UC over CD (3.9:1), as occurs in other Latin American countries. Patients with extensive UC, severe UC, or CD with noninflammatory disease behavior (B2, B3) have a worse prognosis.

Hallazgos Histopatológicos del Tejido Pericoronario de Terceros Molares Incluidos Sanos / Histopathological Findings of Pericoronary Tissue in Healthy Third Molars

RESUMEN: Este estudio se realizó para evaluar la presentación de cambios histopatológicos tempranos en sacos pericoronarios de terceros molares incluidos sanos. Sesenta y un tejidos pericoronarios de terceros molares incluidos, clínicamente asintomáticos y sin evidencia radiográfica de anomalía del saco pericoronario, se extrajeron por diferentes razones. Las muestras se fijaron y procesaron de forma rutinaria y se tiñeron con hematoxilina-eosina antes de la evaluación. Se estandarizaron los diagnósticos concluyendo que toda muestra que presente metaplasia escamosa del epitelio reducido del órgano del esmalte (EEE) se considerará cambio quístico temprano. De las muestras presentadas, el 28 % mostró metaplasia escamosa sugerente de cambio quístico temprano. Esta variación histológica del tejido pericoronario fue significativamente mayor en los pacientes menores de 20 años de edad, sexo femenino, terceros molares mandibulares, en inclusión ósea y en pacientes que no informaron sintomatología local previa (P = 0,05). Estos hallazgos sugieren que la ausencia de semiología clínica y radiográfica en terceros molares incluidos no necesariamente indica ausencia de alteraciones en el tejido pericoronario de los mismos.

ABSTRACT: This study was performed to evaluate the presentation of early histopathological changes in pericoronal healthy third molars. Sixty-one pericororonitis tissues third molars, without radiographic evidence of abnormality in pericoronary sack, extracted for various reasons. The samples were fixed and processed routinely and stained with hematoxylin-eosin before evaluation. Diagnostic standardized concluding that all this shows that squamous metaplasia of the reduced enamel organ (EEE) is considered cystic epithelium were early change. Of the samples submitted, 28 % showed squamous metaplasia early suggestive of cystic change. This histological tissue pericoronary variation was significantly higher in patients under 20 years of age, female gender, mandibular third molars, including in bone and in patients who reported no previous local symptoms (P = 0.05). These findings suggest that the absence of clinical and radiographic semiology third molars does not necessarily indicate the absence of alterations in tissue pericoronary thereof.

[Spinal subacute combined degeneration after intrathecal chemotherapy. Report of two cases]. / Síndrome de degeneración combinada de la médula espinal y radiculopatía en dos pacientes por quimioterapia intratecal con metrotrexato y citarabina. Casos clínicos.

Intrathecal chemotherapy may be complicated with the development of myelopathies or toxic radiculopathies. This myeloradicular involvement, of toxic character, is unpredictable, since these patients have repeatedly received Intrathecal chemotherapy with the same drugs without apparent injury. The toxic effect should be mainly attributed to Cytarabine and not to methotrexate, since the central nervous system lacks Cytidine deaminase, the enzyme that degrades Cytarabine. We report two patients, an 18-year-old woman and a 16 years old male, who received systemic and intrathecal chemotherapy (methotrexate, cytarabine) for the treatment of an acute lymphoblastic leukemia and developed, in relation to this procedure, a spinal subacute combined degeneration. They had a proprioceptive and motor alteration of the lower extremities and neuroimaging showed selective rear and side spinal cord hyper intensity produced by central axonopathy. Two weeks later the woman developed a quadriplegia and the young man a flaccid paraplegia due to added root involvement.

Síndrome de degeneración combinada de la médula espinal y radiculopatía en dos pacientes por quimioterapia intratecal con metrotrexato y citarabina: casos clínicos / Spinal subacute combined degeneration after intrathecal chemotherapy: report of two cases

Intrathecal chemotherapy may be complicated with the development of myelopathies or toxic radiculopathies. This myeloradicular involvement, of toxic character, is unpredictable, since these patients have repeatedly received Intrathecal chemotherapy with the same drugs without apparent injury. The toxic effect should be mainly attributed to Cytarabine and not to methotrexate, since the central nervous system lacks Cytidine deaminase, the enzyme that degrades Cytarabine. We report two patients, an 18-year-old woman and a 16 years old male, who received systemic and intrathecal chemotherapy (methotrexate, cytarabine) for the treatment of an acute lymphoblastic leukemia and developed, in relation to this procedure, a spinal subacute combined degeneration. They had a proprioceptive and motor alteration of the lower extremities and neuroimaging showed selective rear and side spinal cord hyper intensity produced by central axonopathy. Two weeks later the woman developed a quadriplegia and the young man a flaccid paraplegia due to added root involvement.

Influencia de la Actividad Física en la Sintomatología del Síndrome Premenstrual en universitarias / Influence of Physical Activity on Symptoms of the Syndrome Premenstrual in college girls

RESUMEN Objetivo: Determinar la influencia de la actividad física en la sintomatología del síndrome premenstrual en un grupo de mujeres de la Facultad de Medicina de la Universidad de Concepción. Métodos: Estudio observacional, descriptivo, transversal, realizado en 340 mujeres escogidas al azar de edades entre 18 a 27 años, estudiantes de la Facultad de Medicina de la Universidad de Concepción. Se utilizaron instrumentos validados para población chilena, como los criterios para el diagnóstico del trastorno disfórico premenstrual DSM-IV-TR, la Escala Visual Análoga (EVA) para la medición del dolor y el Cuestionario Internacional de Actividad Física (IPAQ) para la intensidad de esta. Los datos se obtuvieron por medio de encuestas autoadministradas y los resultados se analizaron mediante pruebas estadísticas. Resultados: Un 55,9% (n=190) presenta Síndrome premenstrual según los criterios utilizados. Los principales síntomas manifestados fueron: fatiga y falta de energía en un 64,7% (n=220), hipersensibilidad mamaria, cefalea e hinchazón en un 62,9% (n=214) y ansiedad, tensión, agobio y colapso en un 60,9% (n=207). Del total de encuestadas, el mayor porcentaje (42,6%) (n=145) realiza actividad física moderada. Al cruzar las variables de actividad física y la sintomatología del síndrome premenstrual se estableció que no existía relación entre ellas (valor p=0,605). Conclusiones: la actividad física no tiene influencia sobre la disminución de la sintomatología del síndrome premenstrual en la población estudiada.

ABSTRACT Objectives: Determine the influence of physical activity on the symptoms of premenstrual syndrome in females students of the Faculty of Medicine, Universidad de Concepción, Concepción Campus in 2014 Methods: A cross sectional study was applied to 340 randomly selected women aged between 18-27 years old belonging to the Faculty of Medicine of the Universidad de Concepción. Data were obtained through self-administered surveys and the results were analyzed by the respective statistical techniques. Results: Of the sample (n = 340), 55.9% (n = 190) had premenstrual syndrome according to the canon used. The main symptoms manifested were fatigue and lack of energy in 64.7% (n = 220), breast tenderness, headache and swelling in 62.9% (n = 214) and anxiety, stress, overwhelm and collapse into a 60.9% (n = 207). Of the total of the participants, the highest percentage (42.6%) (n = 145) performs moderate physical activity. When the variables of physical activity and premenstrual syndrome were crossed, was established that it did not exist relationship between them (p value = 0.605). Conclusions: With the obtaining and analyzing of the results, it seems that physical activity does not have major influence on the symptoms of premenstrual syndrome in the population studied.

The STIM1 inhibitor ML9 disrupts basal autophagy in cardiomyocytes by decreasing lysosome content.

Stromal-interaction molecule 1 (STIM1)-mediated store-operated Ca2+ entry (SOCE) plays a key role in mediating cardiomyocyte hypertrophy, both in vitro and in vivo. Moreover, there is growing support for the contribution of SOCE to the Ca2+ overload associated with ischemia/reperfusion injury. Therefore, STIM1 inhibition is proposed as a novel target for controlling both hypertrophy and ischemia/reperfusion-induced Ca2+ overload. Our aim was to evaluate the effect of ML9, a STIM1 inhibitor, on cardiomyocyte viability. ML9 was found to induce cell death in cultured neonatal rat cardiomyocytes. Caspase-3 activation, apoptotic index and release of the necrosis marker lactate dehydrogenase to the extracellular medium were evaluated. ML9-induced cardiomyocyte death was not associated with increased intracellular ROS or decreased ATP levels. Moreover, treatment with ML9 significantly increased levels of the autophagy marker LC3-II, without altering Beclin1 or p62 protein levels. However, treatment with ML9 followed by bafilomycin-A1 did not produce further increases in LC3-II content. Furthermore, treatment with ML9 resulted in decreased LysoTracker® Green staining. Collectively, these data suggest that ML9-induced cardiomyocyte death is triggered by a ML9-dependent disruption of autophagic flux due to lysosomal dysfunction.

Chile Crece Contigo: Implementation, results, and scaling-up lessons.

BACKGROUND: Chile Crece Contigo (ChCC) is defined as a comprehensive, intersectoral, and multicomponent policy that aims to help all children reach their full potential for development, regardless of their socio-economic status. METHODS: This case study was developed on the basis of grey literature review and key informants' interviews. RESULTS: ChCC behaves as a complex adaptive system that combines universal and targeted benefits for the more vulnerable starting since gestation and until the children are 4 years old. Three key ministries are involved in ChCC management: health, education, and social development. Studies show adequate programme implementation and positive effects of ChCC on child development. In addition, it was found that the more families use ChCC benefits and the longer the subsystem has been operating in the commune, the greater the positive effects. CONCLUSIONS: Strong political support based on principles of equity and child rights combined with strong evidence and funding commitment from government has been central to emergence, scaling up, and sustainability of ChCC. Further sustainability of ChCC will rely on firmly establishing a well-trained and compensated cadre of early child development professionals and paraprofessionals as well as an improved management and evaluation decentralized system.

Gastrointestinal Symptoms and Elevated Levels of Anti-Saccharomyces cerevisiae Antibodies Are Associated with Higher Disease Activity in Colombian Patients with Spondyloarthritis.

BACKGROUND: Spondyloarthritis (SpA) is a group of articular inflammatory rheumatic diseases that their gastrointestinal manifestations are around 10% of their extra-articular symptoms, supporting that the inflammatory response of the intestinal mucosa could be associated with the clinical status. OBJECTIVES: To investigate the association between gastrointestinal symptoms and autoantibodies and disease activity between SpA patients, healthy subjects (HS), and patients with inflammatory bowel disease (IBD). METHODS: 102 SpA patients, 29 IBD patients, and 117 HS were included. Autoantibodies as ASCA, ANCA, anti-tTG, anti-DGP, ANA, and IgA were measured. The patients were assessed to evaluate clinical and gastrointestinal symptoms. An association analysis was performed using Chi square test and a logistic regression. RESULTS: Significant differences were found for ASCA levels in SpA (28.2%) compared to IBD (14.2%) and HS (6.0%) (p = 0.029), as well as for ANAS in SpA (49.5%) and IBD (37.9%) (p < 0.001) and abdominal pain (p = 0.012) between SpA (54.3%) and IBD (27.5%). Significant associations were found between BASDAI > 4 and gastrointestinal symptoms (p < 0.05) and IgA (p = 0.007). The association for abdominal bloating was maintained (OR: 3.93, CI-95%, 1.14-13.56; p = 0.030). CONCLUSIONS: Gastrointestinal symptoms, ASCA, ANAS, and IgA levels were associated with high disease activity in SpA compared with IBD and HS.

Absceso de pared duodenal secundario a palillo de dientes enclavado en duodeno como causa inusual de dolor abdominal crónico / Duodenal Wall Abscess Secondary to a Toothpick in the Duodenum is an Unusual Cause of Chronic Abdominal Pain

Resumen Los cuerpos extraños (CE) constituyen una de las urgencias más frecuentes en gastroenterología. Aunque la mayoría de estos pasan de forma espontánea, en algunos casos pueden causar perforaciones. Presentamos el caso de un paciente masculino de 32 años quien consultó de forma ambulatoria por un cuadro de dolor abdominal de 4 meses de evolución. Dentro de los estudios solicitados se realizó una endoscopia de vías digestivas altas (EVDA) cuyo principal hallazgo fue la presencia de un cuerpo extraño (palillo de dientes) enclavado en el duodeno, que fue extraído sin complicaciones.

Abstract Foreign bodies are one of the most frequent emergencies in gastroenterology. Although most of these pass spontaneously, in some cases they can cause perforations. We present the case of a 32-year-old male patient who came to the outpatient clinic after four months of abdominal pain. An endoscopy of the upper digestive tract found a toothpick embedded in the duodenum. It was extracted without complications.

Presentación atípica de esofagitis herpética / Atypical Herpes Esophagitis

La infección esofágica por virus del herpes es una entidad rara que se ha reportado con mayor frecuencia en pacientes inmunocomprometidos. Esta infección afecta principalmente a pacientes con virus de la inmunodeficiencia humana (VIH) y a pacientes que reciben terapia inmunosupresora o quimioterapia. La severidad de los síntomas está relacionada con el grado de afectación esofágica, siendo la odinofagia la presentación clínica más frecuente. Por otro lado, el hallazgo endoscópico más común es la presencia de úlceras múltiples bien circunscritas que se presentan típicamente en el tercio distal del esófago. El tratamiento estándar descrito es el aciclovir oral por 1 a 2 semanas.

Esophageal herpes viral infections are rare condition that have been reported most frequently in immunocompromised patients. This infection primarily affects patients with human immunodeficiency virus (HIV) and patients receiving immunosuppressants or chemotherapy. The severity of symptoms is related to the degree of esophageal involvement. Odynophagia is the most common clinical presentation while the most common endoscopic finding is multiple well-circumscribed ulcers. These typically occur in the distal third of the esophagus. Standard treatment is oral acyclovir for one to two weeks.

[Ventricular dysfunction and acute pulmonary edema related to intraoperative hypertensive crisis: a case report of clinical and echocardiographic assessment]. / Disfunción ventricular y edema agudo de pulmón asociado a crisis hipertensiva intraoperatoria. Evaluación clínica y ecocardiográfica.

A 39-year-old obese woman underwent surgery to open an obstructed tear duct under general anesthesia. After reversal of the neuromuscular block, the patient had a sudden, severe increase in blood pressure related to nonsustained monomorphic ventricular tachycardia. Acute pulmonary edema and cardiogenic shock developed minutes after treatment with propranolol, labetalol, and nitroglycerin. Intraoperative transesophageal echocardiography showed severe diffuse left ventricular hypokinesis with an ejection fraction under 15%. Hemodynamic stability was achieved with inotropic infusions. Angiography ruled out coronary artery injury and echocardiographic follow-up revealed progressive improvement of ventricular function. We analyze diagnostic possibilities and describe the benefits of echocardiography in the diagnosis and treatment of intraoperative acute heart failure.

An inositol 1,4,5-triphosphate (IP3)-IP3 receptor pathway is required for insulin-stimulated glucose transporter 4 translocation and glucose uptake in cardiomyocytes.

Intracellular calcium levels ([Ca2+]i) and glucose uptake are central to cardiomyocyte physiology, yet connections between them have not been studied. We investigated whether insulin regulates [Ca2+]i in cultured cardiomyocytes, the participating mechanisms, and their influence on glucose uptake via SLC2 family of facilitative glucose transporter 4 (GLUT4). Primary neonatal rat cardiomyocytes were preloaded with the Ca2+ fluorescent dye fluo3-acetoxymethyl ester compound (AM) and visualized by confocal microscopy. Ca2+ transport pathways were selectively targeted by chemical and molecular inhibition. Glucose uptake was assessed using [3H]2-deoxyglucose, and surface GLUT4 levels were quantified in nonpermeabilized cardiomyocytes transfected with GLUT4-myc-enhanced green fluorescent protein. Insulin elicited a fast, two-component, transient increase in [Ca2+]i. Nifedipine and ryanodine prevented only the first component. The second one was reduced by inositol-1,4,5-trisphosphate (IP3)-receptor-selective inhibitors (xestospongin C, 2 amino-ethoxydiphenylborate), by type 2 IP3 receptor knockdown via small interfering RNA or by transfected Gßγ peptidic inhibitor ßARKct. Insulin-stimulated glucose uptake was prevented by bis(2-aminophenoxy)ethane-N,N,N',N'-tetra-acetic acid-AM, 2-amino-ethoxydiphenylborate, and ßARK-ct but not by nifedipine or ryanodine. Similarly, insulin-dependent exofacial exposure of GLUT4-myc-enhanced green fluorescent protein was inhibited by bis(2-aminophenoxy)ethane-N,N,N',N'-tetra-acetic acid-AM and xestospongin C but not by nifedipine. Phosphatidylinositol 3-kinase and Akt were also required for the second phase of Ca2+ release and GLUT4 translocation. Transfected dominant-negative phosphatidylinositol 3-kinase γ inhibited the latter. In conclusion, in primary neonatal cardiomyocytes, insulin induces an important component of Ca2+ release via IP3 receptor. This component signals to glucose uptake via GLUT4, revealing a so-far unrealized contribution of IP3-sensitive Ca2+ stores to insulin action. This pathway may influence cardiac metabolism in conditions yet to be explored in adult myocardium.

Parallel activation of Ca(2+)-induced survival and death pathways in cardiomyocytes by sorbitol-induced hyperosmotic stress.

Hyperosmotic stress promotes rapid and pronounced apoptosis in cultured cardiomyocytes. Here, we investigated if Ca(2+) signals contribute to this response. Exposure of cardiomyocytes to sorbitol [600 mosmol (kg water)(-1)] elicited large and oscillatory intracellular Ca(2+) concentration increases. These Ca(2+) signals were inhibited by nifedipine, Cd(2+), U73122, xestospongin C and ryanodine, suggesting contributions from both Ca(2+) influx through voltage dependent L-type Ca(2+) channels plus Ca(2+) release from intracellular stores mediated by IP(3) receptors and ryanodine receptors. Hyperosmotic stress also increased mitochondrial Ca(2+) levels, promoted mitochondrial depolarization, reduced intracellular ATP content, and activated the transcriptional factor cyclic AMP responsive element binding protein (CREB), determined by increased CREB phosphorylation and electrophoretic mobility shift assays. Incubation with 1 mM EGTA to decrease extracellular [Ca(2+)] prevented cardiomyocyte apoptosis induced by hyperosmotic stress, while overexpression of an adenoviral dominant negative form of CREB abolished the cardioprotection provided by 1 mM EGTA. These results suggest that hyperosmotic stress induced by sorbitol, by increasing Ca(2+) influx and raising intracellular Ca(2+) concentration, activates Ca(2+) release from stores and causes cell death through mitochondrial function collapse. In addition, the present results suggest that the Ca(2+) increase induced by hyperosmotic stress promotes cell survival by recruiting CREB-mediated signaling. Thus, the fate of cardiomyocytes under hyperosmotic stress will depend on the balance between Ca(2+)-induced survival and death pathways.

Síndrome del niño sacudido en Chile: una forma más de maltrato infantil / Shaken baby syndrome in Chile: another form of child abuse

Introduction: The shaken baby syndrome is the most common cause of death and severe neurological damage in abused children. Characterized by acute encephalopathy with sub dural and retinal hemorrhages, which occur in inappropriate situations or an inconsistent story The lesions are due to the increased size of the child's head, weak neck musculature and the abundance of non-myelinated brain tissue that allows excessive stretching of blood vessels associated with the mechanism of injury that involves application of rotational forces of acceleration slowdown. Our goal is to present the clinical features of children admitted to four hospitals in Chile in order to alert the clinician to the suspicion and search box. Methods: Clinical and imaging analysis of six patients with clinical criteria for shaken baby syndrome, as defined by the presence of intracranial or intraocular injury as a result of shocks, in the context of physical abuse in children under two years. Results: Six cases, four children, two girls. Ages 3 months to 16 months. The first symptom in one child was ophthalmoparesis, four with seizures, one of which was admitted in severe coma until he died. All had retinal hemorrhages. Brain Magnetic Resonance showed subdural collections in all of them with different data. The coagulation study was negative in all. Conclusion: The shaken baby syndrome is a reality in Chile and its high morbidity and mortality should place emphasis on prevention at all levels of health care.

Introducción: El síndrome del niño sacudido es la causa más común de muerte y daño neurológico severo en niños maltratados. Caracterizado por encefalopatía aguda con hemorragias subduralesy retinianas, que ocurren en un contexto inadecuado o en una historia inconsistente. Las lesiones se explican por el mayor tamaño de la cabeza del niño, la debilidad de la musculatura cervicaly la abundancia de tejido encefálico no mielinizado que permite un excesivo estiramiento de los vasos sanguíneos asociado al mecanismo de injuria que implica aplicación de fuerzas rotacionales de aceleración-desaceleración. Nuestro objetivo es presentar las características clínicas de niños ingresados a cuatro hospitales de Chile para así alertar al clínico hacia la sospecha y búsqueda del cuadro. Método: Análisis clínico e imagenológico de seis pacientes con criterios clínicos para síndrome del niño sacudido, definido por la presencia de lesiones intracraneales o intraoculares como resultado de sacudidas, en el contexto de maltrato físico, en niños menores de dos a±os. Resultados: Seis casos, cuatro niños, dos niñas. Edades entre 3 meses y 16 meses. Uno debutó con oftalmoparesia, cuatro con crisis convulsivas de los cuales uno ingresó en coma evolucionando grave hasta fallecer. Todos presentaban hemorragias retinianas. La Resonancia Magnética cerebral mostró en todos ellos colecciones subdurales de distinta data. El estudio de coagulopatías fue negativo en todos. Conclusión: El síndrome del niño sacudido es una realidad en Chile y por su alta morbimortalidad se debiera insistir en la prevención de éste a todo nivel de la atención en salud.

Carcinoma de Células escamosas de vulva. Presentación de 28 pacientes / Squamous cell carcinoma of the vulva. Experience in 28 patients

Introducción. El carcinoma de células escamosas de la vulva constituye el 1 al 4 % de los tumores en la mujer, y ocupa el cuarto lugar de las neoplasias del tracto genital femenino. Objetivos. Determinar la incidencia de carcinoma epidermoide de vulva, e identificar el grado de invasión. Material y métodos. Se realizó un estudio retrospectivo, observacional de las pacientes atendidas en el consultorio de patología vulvar durante 4 años y 8 meses. Se estudiaron 28 mujeres con diagnóstico clínico e histopatológico de carcinoma de células escamosas. Resultados. Del total de pacientes evaluadas en el consultorio, 6,17% (28) presentó carcinoma de células escamosas. La edad promedio fue de 62,5 años. De las 28 pacientes, el 64,28% (18) presentó carcinoma de células escamosas invasor y el 35,7% (10) VIN, cuatro desarrollados a partir de liquen escleroso, tres con displasia epitelial (VIN diferenciado) y tres con diagnóstico de papulosis bowenoide (VIN usual). Todas las pacientes refirieron como signo predominante prurito y el tabaquismo se detectó en el 60% de los casos. Conclusiones. Se presentan 28 casos de carcinoma epidermoide vulvar: el 64,2 % fue invasor y el 35,7% neoplasia intraepitelial (VIN). De ésta el 70% correspondió a VIN diferenciado y el 30% restante a VIN usual. Esta casuística nos ha permitido conocer la incidencia de neoplasia epitelial vulvar en nuestro medio además de poder diferenciar los grados de invasión y factores patogénicos.

Introduction. The squamous cell carcinoma of the vulva constitutesbetween 1 and 4% of cancers affecting women, occupying fourthplace among neoplasias of the female genital tract.Objetives. To determine the incidence of squamous cell carcinomaof the vulva and identify grade of invasion.Material and methods. An observational retrospective study wasconducted, in which 28 patients were studied with clinical and pathologicaldiagnosis of squamous cell carcinoma of the vulva.Results. Of the total genital carcinomas in our hospital, the vulvarcarcinomas accounted for 6.17% of the genital tract tumours. Of the28 patients included in the study, 18 invasive carcinomas (64.28%)were detected and 10 vulvar intraepidermal neoplasia (VIN 35.7%).The average age of incidence was 62.5 years. The predominantsymptom was pruritus, and the most significant signs were tumour.In the 10 patients that were diagnosed with VIN, 4 developed froma lichen sclerosus, 3 from epithelial dysplasia and 3 with papulosisbowenoide. 60% of patients were smokers.Conclusions. 28 cases of epidermoide carcinoma of the vulva werestudied resulting in 64.2% invasive and 35.7% VIN. Of the latter, 70%corresponded to differentiated VIN and 30% usual VIN. This casuistryhas permitted us to observe the incidence of squamous cell carcinomain our region, and allowed us to differentiate the grades of invasionand pathogenic factors (Dermatol Argent 2009;15(5):344-349).