Monoclonal Gammopathy of Renal Significance with Progression to Multiple Myeloma in a Patient with ASIA-MO Syndrome.

Background: Autoimmune/inflammatory syndrome induced by adjuvants is a disease associated with an unregulated hyperactivity of the immune system and may also be associated with a high frequency of hematologic malignancies. Report. This is a case of a female with ASIA-MO syndrome secondary to infiltration of mineral oil for aesthetic purposes and presented with multiple episodes of urolithiasis resulting in renal impairment of her left kidney confirmed by scintigraphy and ending in unilateral nephrectomy. Retrospective renal piece analysis confirmed tubulointerstitial infiltration with light chains and plasma cells. Paraffin fixation prevented subsequent immunofluorescence analysis for better follow-up of the patient. Conclusion: The presence of positive immunofixation kappa chains explained the sudden deterioration of renal function with monoclonal gammopathy of renal significance which concluded in an association between diseases, such as multiple light chain myeloma, as a final diagnosis.

Nueva técnica para control de contaminación de fístulas entero atmosféricas en abdomen abierto Björck 4. Método de Capilaridad (MECA) / New technique to control enterocutaneous fistulas contamination in open abdomen Björck 4. Capillarity method (MECA)

Introducción. La fístula enteroatmosférica es una patología compleja que puede ser el resultado de múltiples intervenciones quirúrgicas de la cavidad abdominal. Describimos una nueva técnica para el control de la contaminación en pacientes con fístulas enteroatmosféricas en abdomen abierto Björck 4.Métodos. Se realizó un análisis retrospectivo de cuatro pacientes con fístulas enteroatmosféricas desarrolladas como complicación de procedimientos quirúrgicos abdominales. Se trataron integralmente por un grupo multidisciplinario de Cuidados Intensivos, Cirugía general, Soporte nutricional y Cuidado de heridas y ostomías. Se utilizó una novedosa técnica quirúrgica basada en el principio de capilaridad para mantener limpios los tejidos periostomales. Resultados. Con esta técnica se logró el control de la contaminación abdominal en todos los pacientes y una evo-lución clínica satisfactoria. Posteriormente se programaron para cierre quirúrgico definitivo con éxito. Conclusiones. El manejo de la fístula enteroatmosférica representa un reto para el cirujano y el grupo multidisciplinario que trata al paciente. Esta nueva técnica utilizada en pacientes con fístula enteroatmosférica con abdomen abierto Björck 4 se basa en el principio de capilaridad, y es eficaz en el control de la contaminación, infección y de la sepsis asociada.

Introduction. Enterocutaneous fistula is a complex pathology that can be the result of multiple surgical interventions of the abdominal cavity. We describe a new technique for the control of contamination in patients with enterocutaneous fistulas in the open abdomen Björck 4. Methods. A retrospective analysis of four patients with enterocutaneous fistulas developed as a complication of abdominal surgical procedures was performed. They were treated by a multidisciplinary team of Intensive Care, General Surgery, Nutritional support and Wound and ostomy care. A novel surgical technique based on the capillarity principle was used to keep the periostomies tissues clean. Results. With this technique, control of abdominal contamination was achieved in all patients and a satisfactory clinical evolution. Later they were scheduled for definitive surgical closure with total success. Conclusions. The management of an enterocutaneous fistula represents a challenge for the surgeon and the multidisciplinary group that treats these patients. This new technique used in patients with an enterocutaneous fistula with open abdomen Björck 4 is based on the principle of capillarity action, and is effective in controlling contamination, infection, and associated sepsis.

Valoración geriátrica integral en cuidados paliativos: revisión bibliográfica / Comprehensive geriatric assessment in palliative care: a literature review

El progresivo envejecimiento de la población es explicado por el avance en el cuidado de la salud, y las transiciones demográficas y epidemiológicas presentes en el plano mundial. Este fenómeno implica cambios en el campo social y económico, en los sistemas de educación y salud y en la seguridad social. En consecuencia, es característico encontrar adultos mayores con multimorbilidad que presentan enfermedades crónicas con diferentes trayectorias al final de la vida y que van a requerir atención en el modelo de cuidados paliativos. La valoración geriátrica integral (VGI) es la tecnología disponible en la actualidad para abordar la compleja situación de los adultos mayores, en particular los que necesitan atención por cuidados paliativos. El proceso de la VGI ofrece un enfoque integral que se fundamenta en el modelo biopsicosocial y se operativiza mediante la actuación de un equipo interdisciplinario, quien brinda evaluación y cuidado paliativo de forma individualizada y continua, y adaptado a lo largo de la trayectoria de la enfermedad, ayudando a determinar un pronóstico y calidad de vida potencial en cada adulto mayor. En la VGI dentro de los cuidados paliativos, la planificación anticipada de cuidados y la toma de decisiones compartida son de especial importancia, desde el momento en el que los adultos mayores tienen indicación de ser atendidos hasta el final de sus vidas, y después de la muerte, dando soporte a sus familiares y cuidadores. (AU)

The progressive aging of the population may be explained by advances in health care, and by the demographic and epidemiological transitions present on a worldwide level. This phenomenon implies changes in the social and economic settings, in the education and health care systems, and in social security. As a consequence, older adults with multiple morbidities are typically encountered who develop chronic diseases with different trajectories at the end of life, and who will require care within the palliative model. Comprehensive geriatric assessment (CGA) is the technology currently available to address the complex situation of older adults, particularly of those who need palliative care. The CGA process offers a comprehensive approach that is based on the biopsychosocial model and made operational through the efforts of an interdisciplinary team that provides assessment and palliative care in an individualized, continuous, adaptive way throughout the course of the disease, helping to establish the prognosis and potential quality of life of each older adult. To implement CGA within the palliative care setting, advance care planning and shared decisionmaking are of special importance from the time palliative care is indicated to the end of life, as is providing support to relatives and caregivers after the patient’s demise.

First histopathological study in kidneys of rodents naturally infected with Leptospira pathogenic species from Yucatan, Mexico.

OBJECTIVE: To report the renal histological lesions in synanthropic rodents, Mus musculus and Rattus rattus, naturally infected with Leptospira spp., captured in a rural community in Yucatan, Mexico. METHODS: Kidney samples of synanthropic rodents were collected from a rural community in Yucatan, Mexico. Polymerase chain reaction was used to detect Leptospira spp. infection. Tissue kidney was fixed in 10% buffered formalin, processed according to the usual techniques for paraffin inclusion, cut and stained with hematoxylin and eosin, and examined using a conventional electronic microscope. RESULTS: A total of 187 rodents were captured. Nine individuals (4.8%) were positive for Leptospira spp. in the molecular analysis. All renal lesions observed in the histopathological study had been reported previously for Leptospira spp. infection. CONCLUSIONS: The histopathological lesions are present in the kidneys, plus the results of the polymerase chain reaction confirm that these rodents are true carriers of Leptospira spp.

Parasitic Zoonoses in Humans and Their Dogs from a Rural Community of Tropical Mexico.

A cross-sectional study was made on 89 inhabitants and their dogs from a rural community of Yucatan, Mexico, to determine the serological prevalence of some zoonotic parasitic agents. Samples were taken to monitor the presence and intensity of infection with gastrointestinal parasites in dogs. In humans, the serological prevalence of T. canis, T. gondii, and T. spiralis was 29.2%, 91.0%, and 6.7%, respectively. No associations were found between positive cases and studied variables. From the total of blood samples taken from dogs, 87 (97.6%) were seropositive to T. gondii; only 52 viable fecal samples were collected from dogs of which 46.2% had the presence of gastrointestinal parasites with low to moderate intensity; from those, 12% had the presence of T. canis. This study demonstrates the presence of the studied zoonotic agents in the area particularly T. gondii which suggest a common source of infection in dogs and humans and a high number of oocyts present in the environment. Preventive measures must be designed towards good prophylactic practices in domestic and backyard animals (T. canis and T. spiralis). Contaminated sources with T. gondii (food and water) should be further investigated in order to design effective control measures.

An epidemiological study of intestinal parasites of dogs from Yucatan, Mexico, and their risk to public health.

The prevalence of intestinal parasites in dogs and factors associated were studied in a rural community of Yucatan (southern Mexico), with special attention to those gastrointestinal parasites potentially transmitted to man. One hundred thirty dogs from 91 households were studied. Fecal samples were processed by the centrifugation-flotation and the McMaster techniques. To determine factors associated with zoonotic parasites in dogs, univariate analysis was performed, using sex, age, and body condition as independent variables. Variables with p < 0.2 were analyzed by a logistic regression. Of 130 dogs, 104 were positive for the presence of intestinal parasites, representing a prevalence of 80%. Eggs of four species of helminths (Ancylostoma caninum, Thichuris vulpis, Toxocara canis, and Dipylidium caninum) and coccidian oocysts were detected. A. caninum was the most prevalent parasite (73.8%), followed by T. vulpis (25.4%), T. canis (6.2%), D. caninum (2.3%), and coccidian oocysts (2.3%). The majority of dogs were infected by only one species of parasite (70/130, 53.8%). Mixed infection caused by two or three zoonotic parasites were discovered in 21.3% (30/130) and 3.1% (4/130), respectively. A. caninum showed the highest egg output (42.3% of dogs had ≥ 500 eggs per gram). Factors associated with zoonotic parasites were age (<2 years old; odds ratio = 5.30, p = 0.029) and body condition (poor body condition; odds ratio = 6.69, p = 0.026). In conclusion, young dogs from rural Yucatan, Mexico, with poor body condition had a higher prevalence of intestinal zoonotic parasites as these factors were associated with a higher risk of becoming infected.

Neuronavegacion: Experiencia en biopsia intracraneana / Neuronavegation: the experience with brain biopsies in neurosurgycal service in Bogota

Introducción. La continua evolución de las aplicaciones tecnológica permite ofrecer a los pacientes procedimientos, cada vez menos cruentos, más seguros y de mejor costo-efectividad. Tal sucede con la cirugía guiada por imágenes TAC; RM; angiografia etc., también denominada neuronavegación. Objetivo: Presentar la experiencia del servicio de neurocirugía del Hospital Central de la Policía (HOCEN) de Bogotá en la obtención de biopsias cerebrales por neuronavegación. Material y Métodos. Se utilizó el sistema Vectorvisión, en el cual se cargan los estudios previo del paciente (TAC, RM;angiografia efe) para obtener mediante neuronavegación biopsias cerebrales que permitieron concretar el diagnóstico de diversas lesiones del sistema nervioso central. Se comparó el rendimiento del sistema de neuronavegación mediante el Vectorvisión, con el de biopsia estereotáctica (guiada por TAC} realizado en el mismo servicio. Resultados. De 125 procedimientos guiados por imágenes 64 fueron biopsias, 15 de las cuales se realizaron con el Vectorvison; la duración promedio de este procedimiento fue de 100 minutos (DS 27,22) menor que la requerida para una biopsia estereotáctica. Se hizo diagnóstico hispatopatológico en todos los casos, con una baja tasa de complicaciones (4,7 por ciento).

[Endoscopic dilatation of benign colon and rectum stenosis]. / Dilatación endoscópica de las estenosis benignas de colon y recto.

AIM: To determine the usefulness of endoscopic dilatation in dealing with benign stenosis of the anus, rectum and colon. PATIENTS AND METHODS USED: Thirty six (36) patients with stenosis, anus (8), rectum (22) and colon (6) were given endoscopic treatment using hydroneumatic balloons, electro incision (radiated cuts) or a combination of both. Rigid equipment (metal) was used for distal stenosis. Age ranged between 30 and 82 years. Twelve (12) patients were male and 24 female. The diameter of the stenosis was less than 13 mm in 18 of the patients and 11 patients carried colostomy. RESULTS: All 36 patients were subjected to a total of 113 dilatation sessions. The average number of sessions per patient for patients with anal stenosis was 2.5 and for patients with colorectal stenosis, 3.32. One patient with rectal stenosis required 21 sessions to achieve final objective. The result achieved was good in 31 patients, less than satisfactory in 3 patients and bad in one patient, who presented a stenosis which was over 5 cm long. We lost track of a patient in the follow up stage. Success in closing the colostomy was achieved in 9 patients, while one presented a complication due to the procedure (cervical emphysema) which remitted with medical attention. CONCLUSIONS: Endoscopic dilatation offers, through its different techniques, a safe and efficient method for the treatment of benign stenosis of the anus, rectum and colon and must be considered as a first class tool for the treatment of this kind of pathologies.

[DIAGNOSTIC AND THERAPEUTIC COLONOSCOPY IN PEDIATRICS] / Colonoscopía diagnótica y terapéutica en pediatría.

Gastrointestinal bleeding in childhood is an uncommon problem, althought when it happens it maybe an emergency. Upper bleeding predominates, and when we consider lower bleeding, the principal cause are polyps. Recent evidence points out that polyps are responsible for bleeding in 77% of cases.We decided to study the clinical course, histologic characteristics and treatment in children with lower gastrointestinal bleeding. This investigation was held at Edgardo Rebagliati National Hospital during 1990 to 1996. Inclusion criteria were: younger than 14 years, gastrointestinal bleeding, and colonoscopy exam.100 colonoscopies were done in 74 children. Polyps were the cause for gastrointestinal bleeding in 71.6% of cases. In 14 children more than one colonoscopy was done. More than one polyp in 16 children were found. Ulcerative colitis was diagnosed in two cases, and intestinal tuberculosis in other two cases. Average age was 8.8 years, and 100% presented rectorragia and anemia.Polyps were located principally in rectum and sigmoid. Polipectomy was done in 94.34% of the cases, and it was technically succesful. We had only one complication (snare wire was trapped) but with no morbidity.Histological examination demonstrated that juvenile polyp was the most frequent type (56.66%), followed by tubular adenoma (11.32%), and Peutz-Jegher polyp in 3.77%. Treatment was polipectomy in all cases. Eleven procedures were done in the surgical room, and 19 in the endoscopy unit, with no complications in any of the cases.CONCLUSION: In children the main cause for lower gastrointestinal bleeding are polyps. All cases present with rectorragia or anemia, and juvenile polyps are the most frequent type. Colonoscopy is a safe method for diagnosis and treatment, which can be done in the endoscopy unit with mild sedation and with an anesthesist or pediatrician as assistants.

Caracterización antigénica de un virus de la bronquitis infecciosa, aislado en pollos de traspatio en Yucatán, México / Antigenic characterization of an infectious bronchitis virus isolated in backyard chicken in the state of Yucatan, Mexico

La producción animal de traspatio es una actividad tradicional en México, cuya finalidad es solucionar algunos problemas de la difícil situación económica de los campesinos. Los pollo son la especie más común en dicho sistema en Yucatán y son alimentados con subproductos, En estudios previos se encontró que las enfermedades respiratorias constituyen las más importantes en estos animales. En el presente estudio se obtuvo un aislamiento del virus de la bronquitis infecciosa en pollos de engorda introducidos al traspatio del poblado Sinanché, Yucatán, México; aquél se denominó SIN6. La caracterización antigénica de este aislamiento se realizó mediante la prueba de inhibición de la hemaglutinación, utilizando antígeno hemaglutinante producido a partir de 11 serotipos de referencia del virus de la bronquitis infecciosa (Massachusetts 41, Arkansas, Connecticut, Holte, CVL/9, 793/B, Holandés 274, Holandés 1466, Australiano "T", italiano 624, y Chileno 368), y antisueros contra estos serotipos y el Iowa 97; de este último no se logró obtener antígeno a pesar de repetidos intentos. El aislamiento SIN6 tuvo una relación antigénica baja con todos los serotipos de referencia, lo que indica que probablemente es un serotipo nuevo, aunque estudios de secuencia genética son necesarios para confirmarlo. El serotipo CVL/9 presentó una fuerte relación antigénica con todos los demás, esta circunstancia lo hace un candidato para la producción de una vacuna universal contra la bronquitis infecciosa

Identificación de granjas seropositivas a Mycoplasma hyopneumonie y exploración de potenciales factores de riesgo relacionados a su presentación en 33 granjas porcinas del estado de Yucatan, México / To identify forms seropositive to mycoplasma hyopneumonie and to investigate the potential risk factors on its presentation in 33 pig farms in the state of Yucatan, Mexico

Introducción. Dentro de los problema infecciosos más graves que afectan a la porcicultura intensiva en todo el mundo se encuentran los respiratorios, los cuales producen efectos adversos sobre la ganancia de peso, la eficiencia alimenticia y la mortalidad. El objetivo del estudio fue detectar la presencia de anticuerpos contra Mycoplasma hyopneumonie (M. hyopneumonie) en cerdos de engorda del estado de Yucatán, México. Material y métodos. Se realizó un estudio transversal en 33 granjas porcinas del estado de Yucatán. En cada granja se recolectó 14 muestras de sueros procedentes de cerdos de engorda (= 5 meses de edad) de líneas comerciales. Para la detección de anticuerpos contra M. hyopneumonie, se utilizó una prueba comercial de ELISA indirecta. En cada granja se aplicó un cuestionario para conocer potenciales factores que pudieran estar relacionados a la seropositividad. La seroprevalencia de M. hyopneumoie se estratificó en dos categorías (ó 30 por ciento) y (> 30 por ciento) y se utilizó la prueba de Ji cuadrada para explorar la asociación con variables contenidas en aspectos generales, de instalaciones y equipo, medidas zoosanitarias y manejo. Resultados. De las 33 granjas muestreadas, 31 (93.9 por ciento) tuvieron al menos un animal seropositivo a M. hyopneumonie. De los 462 sueros evaluados, 168 (36.4 por ciento) resultaron seropositivos. No se encontró asociación (p>0.05) entre las variables analizadas como potenciales factores de riesgo y las seroprevalencias a M. hyopneumonie. Conclusioens. La seropositividad a M. hyopneumonie se encuentra presente y ampliamente distribuida en las granjas porcinas estudiadas y que éstas realizan práctica de manejo que pueden favorecer la presencia o incremento de la seroprevalencia a M. hyopneumonie

Mesenteric cyst of lymphatic origin: a radiopathological correlation and case report

Mesenteric cysts are uncommon abdominal masses in children. They occur most frequently in the small bowel mesentery and often contain chylous fluid. These cysts may be multilocular, grow to huge proportions and are believed to be caused by obstructed, malformed, ectopic lymphatic tissue. The patients' clinical presentations is dependent on cyst size, location and related complications such as partial or complete bowel obstruction, perforation, peritonitis, volvulus and malignant degeneration. Surgical resection is the treatment of choice. Ultrasound and CT are the most valuable modalities for evaluating mesenteric cysts

Colorectal carcinoma: a pathologic and immunopathologic study

Lewis-related blood group antigens are carbohydrate determinants carried on surface glycoproteins and glycolipids of erythrocytes and some epithelial cells. Their expressions in colorectal mucosa has been considered either as a marker of differentiation antigens or of tumor associated antigens. We prospectively studied Lewis-related blood group antigens in patients undergoing colectomy for colonic adenocarcinoma. Immunohematological studies were performed on preoperative blood samples and ABO and Lewis blood groups were determined. Tissue samples were obtained from the adenocarcinoma and from the adjacent non-neoplastic mucosa. The degree of tumor differentiation (grade of the tumor) was analyzed on hematoxylin and eosin stained slides. Immunoperoxidase staining was performed using antibodies against A, B, Le(a), Le(b), Le(x), and Le(y) antigens. The staining results of the colonic carcinoma were compared with those of the non-neoplastic mucosa and with the patient's red blood cell Lewis phenotype. A total of 22 patients were studied, 12 males and 10 females, with an average age of 64 +/- 12 years. There were 12 modified Dukes B and 10 modified Dukes C carcinomas. Le(a), a marker of differentiation antigens, was expressed in the non-neoplastic mucosa of 82 per cent of the specimens. Le(y), a marker of tumor associated antigens, was detected in 77 per cent of the carcinomas while expressed only in 18 per cent of the adjacent non-neoplastic mucosa. Le(x), supposedly a marker for tumor aggressiveness, was found in 55 per cent of the carcinomas. However, it was virtually absent in the five carcinomas which did not invade the pericolic tissues