Percutaneous retrieval of fractured intravascular catheters in premature infants.

BACKGROUND: Premature infants often require long-term indwelling intravascular catheters. Occasionally, catheters fracture and migrate into cardiovascular structures, risking perforation, infection, thrombosis, and interference with cardiac and valve function. This case series describes our experience with percutaneous retrieval of broken intravascular catheters. METHODS: A gooseneck micro-snare was used to retrieve fractured catheters in four premature infants, weighing between 840 and 1930 grams. RESULTS: All procedures were successful without complications. CONCLUSIONS: Gooseneck-snare retrieval of broken indwelling intravascular catheters can be performed safely and successfully in premature infants even those that weigh less than 1000 grams.

Enlarged left vitelline vein remnant as a cause of cyanosis after the Fontan procedure: resolution with an Amplatzer vascular plug.

A 6-year-old girl with heterotaxy and a functional single ventricle had persistent cyanosis 4 years after a fenestrated Fontan procedure. Cardiac catheterization revealed a large venous fistula from a left-sided hepatic vein to the coronary sinus, resulting in desaturation. The anomalous vein was occluded with an Amplatzer vascular plug.

Knot security in laparoscopic surgery. A comparative study with conventional knots.

BACKGROUND: Few comparative studies have evaluated conventional and laparoscopic knots. The objective of this study was to evaluate laparoscopic knot reliability and identify which type of knot is most secure. METHODS: Seven types of knots were compared; each one was conventionally tied with four and six throws and similarly by laparoscopy. Dinsmore nomenclature for knots was used. A tension meter was used to evaluate knot reliability, using the loop method, and percentage of failure by slipping and tensile strength was calculated for each group. RESULTS: When S=S=S=S and S=S=S=S=S=S geometry are excluded, there was no difference between laparoscopic and conventional knot. A significant difference between four- and six-throw knots was shown. Excluding S=S=S=S=S=S geometry, all knots in the conventional six-throw group were secure. Intracorporeal 2X1X1X1X1 and 1X1X1X1X1X1 and extracorporeal SXS#SXS#SXS six-throw laparoscopic group knots were secure. CONCLUSIONS: Laparoscopic knots are as secure as conventional knots. All knots must be made with six throws because security is maximized.

La fracción del aceite de oliva (FG-30), disminuye el área de la quemadura con costra hipotrófica, escasa secreción y analgesia en ratas con quemaduras de tercer grado / Olive oil (FG-30), dimenish of area of the burn with hypotroprics scab, in rats with burns of grade thrid

El aceite de oliva ha sido utilizado desde tiempos inmemoriales como agente cicatrizante. La separación química de sus constituyentes nos ha permitido aislar una fracción que hemos denominado FG-30, con potente efecto cicatrizante que en el presente estudio fue comparado con la Sulfadiacina de plata con respecto a la evolución y el porcentaje de disminución del área de quemadura de tercer grado en ratas. Para ello se estudiaron 22 ratas Sprague-Dawley, con pesos entre 225-250 g. con quemaduras de tercer grado, las cuales fueron divididas en tres grupos, uno control, sin tratamiento; uno experimental que recibió tratamiento tópico con FG-30, y otro experimental que recibió tratamiento tópico con Sulfadiacina. A los tres grupos se le midió el área de quemadura los días 1, 10, 20 y 35 luego de iniciado el tratamiento, además se procedió a la observación de los cambios macroscópicos de la lesión y comportamiento de las ratas. El tratamiento con FG-30 y con sulfadiacina produjo una mejoría significativa en el porcentaje de disminución del área de la quemadura a los 20 y 35 días. En cuanto a la observación clínica del grupo FG-30 se apreció poca secreción, costra hipotrófica y uniforme así como analgesia; el grupo Sulfadiacina presentó abundante secreción, costra hipertrófica, deforme, fétida, blanquecina, y dolor durante 35 días, todo esto comparado con el grupo control que no recibió ningún tipo de tratamiento. Las mejorías producidas por el FG-30 con respecto al porcentaje de disminución de la quemadura y la observación macroscópica, lo ubica como una alternativa potencial como cicatrizante en quemadura

Increased serum malondialdehyde and decreased nitric oxide within 24 hours of thrombotic stroke onset

Ischaemia/reperfusion generates free oxygen radicals, that react with the unsaturated lipids of biomenbranes resulting in the generation of products such as malondialdehyde (MDA). MDA could be a sensor for tissue damage and reperfusion. Nitric oxide (NO), released due to the early arrival of leukocytes to the brain parenchyma, could be a sensor for non-flow phenomenon. Thereby, the purpose of this research was to evaluate the behavior of MDA and NO within the first 24 hours after the stroke onset. Fifteen patients aged between 49 and 87 years, admitted to the emergency of University Hospital and Chiquinquirá hospitalin Maracaibo, Venezuela, were examined by a neurologist and underwent 12-lead ECG and brain CT scan for the diagnosis of thrombotic stroke. Serum MDA and NO were measured as thiobarbituric acid adducts and total nitrites. Data were collected within the first 24 hours after the stroke onset. MDA for patients with stroke had a significant increase (p<0.001) when compared with heallthy controls (47.9ñ7.1 vs 1.7ñ0.2µmol/L). Conversely, serum NO for patients with stroke had a significant decrease (p<0.001), when compared with the group control (14.5ñ1,4 vs. 41,3ñ3,7µmol/L. The lowest values of MDA and the highest values of NO were observed in two patients, who died. MDA increases and NO diminishes within the first 24 hour after the thombotic stroke onset. This suggests that the MDA could be used as a potential reliable and sensitive sensor for reperfusión, whereas NO could acts as a potential biochemical sensor for non-reflow phenomenon

Papel de la laparoscopia en el tratamiento del síndrome de Peutz Jeghers: revisión de la literatura / Role of laparoscopy in the treatment of Peutz Jeghers Syndrome

La enteroscopia en combinacion con la laparoscopia son un metodo seguro y efectivo en el tratamiento de los polipos en el sindrome de Peutz Jeghers, eliminando las multiples laparotomias que estos pacientes requieren y las complicaciones derivadas de ellas, más las ventajas de la cirugia videoasistida ya conocidas por todos. Se reporta nuestra experiencia con un paciente joven con diagnostico previo de sindrome de Peutz Jeghers, con cuadro de dolor abdominal asociado a sindrome anemico; se le realiza acceso combinado de laparoscopia y enteroscopia intraoperatoria videoasistida con polipectomia y reseccion de polipos. Se realiza una breve revision de la literatura y la descripcion de la tecnica operatoria.

DNA damage and repair in cells of lead exposed people.

BACKGROUND: One of the main sources of occupational exposure to lead in Colombia is in workers of battery industries and lead smelters. Genotoxic studies in human populations exposed to this metal have had conflicting results; this type of study has not been reported in Colombia. METHODS: Genotoxic effects of lead were studied in blood cell samples from workers of electric battery factories exposed to lead compounds. Single strand breaks and interference with DNA repair processes after an in vitro exposure of x-rays (300 cGy) were analyzed using the Comet Assay. The battery workers (n = 43) and 13 people not occupationally exposed to lead compounds who were selected as a control group, were classified into four categories according to their blood lead level. RESULTS: A significant difference was observed in DNA damage before the x-rays exposure (basal) between the lowest and highest categories of lead (mean DNA migration 55.6 micro and 85.9 micro, respectively). Additionally, a significant difference in DNA migration was also found immediately after irradiation between the lowest and highest lead categories (mean DNA migration: 199.8 micro and 317.8 micro respectively). The DNA migrations at different times after irradiation did not show a significant difference among the different lead levels. CONCLUSIONS: We concluded that although the single strand breaks following irradiation were not affected by blood lead concentration, the metal seems to sensitize the cells to damage induced by other genotoxicants.

Adrenalectomía por laparoscopia / Laparoscopic adrenalectomy

La cirugia laparoscopica de las glandulas suprarrenales ya se está practicando en los centros quirurgicos. En el Hospital Pablo Tobon Uribe de Medellin se realizo este procedimiento en un paciente de 32 años de edad con hipertension arterial avanzada e irreversible, como componente de un sindrome de Conn o hiperaldosteronismo primario, con resultados satisfactorios.Se describe la tecnica operatoria y se revisa brevemente el tema desde el doble punto de vista clinico y quirurgico.

Esplenectomía laparoscópica / Laparoscopic splenectomy

Se presenta la experiencia de los autores en esplenectomia laparoscopica a partir de 1994, en la que se describe por primera vez en el pais la práctica de 29 casos en pacientes con purpura trombocitopenica idiopatica, esferocitosis hereditaria y anemia hemolitica autoinmune. Se discuten las indicaciones y contraindicaciones, se describe la tecnica quirurgica y las variaciones que hemos implementado, comparándolas con las de otros autores, con el fin de disminuir costos. Se presentan los resultados y se concluye que es un procedimiento seguro, eficaz, con las ventajas para el paciente de la cirugia minimamente invasora, y que es posible realizarlo a costos razonables.

Cirugía antirreflujo por laparoscopia / Laparoscopic antireflux surgery

El reflujo gastroesofagico (RGE) constituye el 75 por ciento de la patologia benigna del esofago. La cirugia antirreflujo se convierte en el unico metodo capaz de producir un efecto sostenido para evitar las diferentes complicaciones secundarias al paso del contenido ácido del estomago por el esofago. Se presenta la experiencia inicial de 200 casos tratados con el procedimiento de Nissen por videolaparoscopia, con un tiempo quirurgico de 60 min., frecuencia de conversion del 1 por ciento, complicaciones intraoperatorias del 5.5 por ciento, disfagia del 11 por ciento, y la aparicion de sintomas como flatulencia y sensacion de plenitud. El 97.5 por ciento de los pacientes quedaron libres de sintomas por RGE. El procedimiento de Nissen por videolaparoscopia, se convierte en el metodo ideal para los pacientes con RGE, por su alta seguridad y eficacia ya demostrada en nivel mundial.

Cirugía endoscópica en el tratamiento de la acalasia esofágica / Endoscopic surgery for achalasia of the esophagus

Se presenta la experiencia de los autores en el manejo endoscopico del paciente con acalasia esofágica. De 1992 a 1997, se practicaron 53 procedimientos quirurgicos. De 1992 a 1994, 23 casos de esofagomiotomia por via torácica. De 1994 a 1997, 30 casos de esofagomiotomia por via laparoscopica. Se describen las vias de acceso al torax y al abdomen. La respuesta de los pacientes en el 96 por ciento y 99 por ciento, respectivamente, ha sido la mejoria clinica y la de los parámetros manometricos; no fue necesaria ninguna conversion y solo se presento la ruptura de la mucosa esofágica en 1 caso. En el tratamiento del paciente con acalasia esofágica, se consideran estos como los pilares del procedimiento quirurgico por su seguridad y efectividad.

Healthy Municipios in Latin America.

PIP: This article describes the Healthy Municipios movement in Latin America and gives examples of some PAHO projects that could become demonstration projects. The Healthy Municipios movement was established in the early 1990s. The movement aims to promote healthy municipalities according to objectives set forth in the 1987 Ottawa Charter on Health Promotion, the 1992 Declaration of Bogota, and the 1993 Caribbean Health Promotion Charter. The movement is a joint effort of government, the health sector, and the community in promoting health locally. Key features of the movement are its creativity, variety, political strength, and adaptation to local conditions. Technical cooperation serves the purpose of facilitating information exchange and promotes the use of modern techniques of analysis and scientific and technical information. All projects shared the following common features: initiation by the local community with strong political commitment, intersectoral organizational structure, widespread community mobilization and participation, problem solving activities, and a recognizable leader. Pioneering projects include the Comprehensive Project for Cienfuegos, Cuba; the Health Manizales, Colombia; the Network in Mexico; Baruta and El Hatillo, Venezuela; Valdivia, Chile; and San Carlos Canton, Costa Rica. It is concluded that these projects and most others aim to assure equity. These efforts are important for placing health on the political agenda and implementing healthy policies. The Valdivia project, for example, serves a population of about 120,000 in the urban city of Valdivia, the semi-urban area, and rural areas. The project was officially sanctioned by the President of Chile on World Health Day in 1993. Progress was reported in mass communication and school-based programs. Attention was directed also to prevention of risk factors for noncommunicable diseases and to the problem of traffic accidents.^ieng

The social impact of aging populations: some major issues.

Demographic trends regarding the issue of aging underscore the fact that both current situations and future trends directly concerns all of us. Aging is the reality for the future world. The pace at which demographic transition develops varies among countries and regions of the world, but most of the developed and developing countries will be challenged by increasing numbers of dependent individuals. This is particularly critical in the less-developed countries where older populations will increase substantially faster. It is expected that by the year 2000, Latin America and the Caribbean will have 41 million elderly, 7.2% of the total population. By 2025 this percentage will increase to 10.8%. The stunning growth of the elderly demands special attention of policy and decision-makers. The total dependency ratio will decrease in the Americas between 1980 and 2025 due to a marked decrease in the fertility rate, whereas old age dependency ratios will show a marked increase in all countries except Haiti and Surinam. Most of the elderly populations, predominantly women, are living in urban centers. This fact is one of the most important characteristic of the socioeconomic picture in Latin American and Caribbean countries: urbanization with poverty. Women are bearing mainly the burden. It is obvious that, from a cultural perspective, the social impact of aging populations is a complex issue. The wide range of possible future programs will be the result of differences and similarities in social values, relationships, and dynamics within each society. It is important to recognize that since modern industrialized societies live in a culture emphasizing competition for economic wealth, that values economic over social productivity, and where inequities based on class, gender, and race are accepted, that these are the issues influencing the parameters of aging populations. Social policy development for the elderly needs to be critically examined in order for society to adapt to aging as well as for older populations to adapt to a charging society. The major political challenge is the need for redistributive policies. Developing countries must add new priorities to their scarce resources, for social programs for elderly, while still having to deal with the problems of their younger populations. Women issues are extremely important in considering social policies for elderly population. Feminization of poverty and ill-health during old age is a result of exacerbated risks for women across the life course. Appropriate care and support for this vulnerable group is a priority.(ABSTRACT TRUNCATED AT 400 WORDS)

Evidence of mitochondrial DNA diversity in South American aboriginals.

The absence in South American aboriginals of an Asian-specific marker, a 9-bp deletion between the genes for the second subunit of cytochrome oxidase II and lysine transfer RNA in region V, has been interpreted as a bottlenecking effect at the Isthmus of Panama during the peopling of the Americas. We screened mitochondrial DNA (mtDNA) for this 9-bp tandem repeat and for polymorphisms in specific regions of the mtDNA in 2 ancient and 31 contemporary samples from South American aboriginals. We found additional (mtDNA) diversity in South American aboriginals in three ways. First, an Asian-specific marker not previously reported in South American aboriginals was identified by a sequencing analysis in both the contemporary Andean and Amazonian aboriginal peoples. Second, two new haplotypes so far unique to South American aboriginals were found. Additionally, we show that South American aboriginals fall into discrete populations. These results suggest that the prehistoric colonization of South America is the outcome of multiple migrations; the data do not support a bottlenecking effect at the Isthmus of Panama.

The restructuring of psychiatric care in Latin America: a new policy for mental health services.

This article discusses the epidemiologic and programmatic bases for action as well as the political, historical and technical background for "The Initiative for Restructuring of Psychiatric Care in Latin America." It discusses also the broad implications of this health policy, the modus operandi of its implementation and monitoring, and the chief obstacles that it has encountered. Lastly, it briefly sketches the results obtained thus far.