Adaptación cultural, lingüística y validación del cuestionario Dry Eye Questionnaire 5 en una población chilena / Adaptation culturally and linguistically to the Chilean population and validation the Dry Eye Questionnaire 5

Antecedentes y objetivo Existen distintos métodos de evaluación de la enfermedad de ojo seco (EOS), entre ellos cuestionarios que analizan distintos aspectos de su sintomatología, los que son importantes para su mejor comprensión y manejo terapéutico. El Dry Eye Questionnaire 5 (DEQ-5) es único en su tipo, pues además de su simplicidad, mide sintomatología en cuatro dimensiones. El objetivo de este estudio fue adaptar cultural, lingüísticamente y validar, este cuestionario para una población chilena. Materiales y métodos Para la adaptación, se realizó la traducción y retrotraducción de la versión original, su análisis lingüístico, una prueba piloto y el examen de expertos, que incorporó una especialista en lingüística. Para la validación se realizó el análisis psicométrico de fiabilidad y validez de constructo. La muestra en la que se validó quedó constituida por 205 personas con EOS. Resultados De los encuestados, 141 (69%) fueron mujeres, la media de edad fue de 48 años ± 16,7 y la mediana del puntaje total DEQ-5 fue de 13 puntos (R.I 8-15 puntos). La versión adaptada resultó con un alfa de Cronbach de 0,8085, puntaje que la clasificó como buena. Discusión El cuestionario DEQ-5 adaptado y validado resultó un buen instrumento para ser usado en poblaciones con características similares a las del estudio. Además, el análisis factorial enriqueció la comprensión de la manera en que las personas con EOS relacionan sus síntomas y qué preguntas se corresponden más entre ellas, representando de mejor manera los aspectos evaluados de la sintomatología de esta enfermedad (AU)

Background and objective There are different methods for evaluating dry eye disease (DID), including questionnaires that analyze different aspects of its symptoms, which are important for its better understanding and therapeutic management. The Dry Eye Questionnaire 5 (DEQ-5), is unique in its kind, because in addition to its simplicity, it measures symptoms in four dimensions. The aim of this study is to adapt culturally and linguistically and validate this instrument to the Chilean population. Material and methods For the adaptation, the translation and retro-translation of the original version was carried out, its linguistic analysis, the pilot test and the expert panel review (which included a linguistics specialist) were used. For the validation, a psychometric analysis of reliability and validity of the construct was incorporated. The sample in which it was validated was constituted by 205 people with dry eye disease. Results One hundred and forty-one (69%) of the respondents were women, the mean of age was 48 years ± 16.7, and the median of the total score DEQ-5 was 13 points (R.I 8–15 points). The adapted version resulted in a Cronbach alpha of 0.8085, scoring that classified it as good. Discussion The questionnaire DEQ-5, which was adapted and validated, was a good instrument to be used in populations with similar characteristics of those in the study. More so, the factor analysis enriched comprehension of the way in which people with dry eye disease relate their symptoms and which questions relate more between them, representing in a better way the aspects evaluated of the symptomatology of this disease (AU)

Chemical-analytical characterization and leaching of heavy metals associated with nanoparticles and microplastics from commercial face masks and the abundance of personal protective equipment (PPE) waste in three metropolitan cities of South America.

In this study, we surveyed the presence of personal protective equipment (PPE) waste on the streets of Bogotá-Colombia, Lima-Perú, and Mar del Plata-Argentina. Furthermore, this work is also focused on the release capacity of Ag, Cu, and Zn metals associated with nanoparticles, and microplastics (MPs) from textile face masks (TFMs) and disposable face masks. According to our results, an association between low-income areas and PPE waste was found, which may be related to the periodicity of waste collection and economic activity. Polymers, like polypropylene, cotton-polyester, and additives, such as CaCO3, MgO, and Ag/Cu as nanoparticles, were identified. TFMs released high levels of Cu (35,900-60,200 µg·L-1), Zn (2340-2380 µg·L-1), and MPs (4528-10,640 particles/piece). Metals associated with nanoparticles leached by face masks did not present any antimicrobial activity against P. aeruginosa. Our study suggests that TFMs may leach large amounts of polluting nano/micromaterials in aquatic environments with potential toxicological effects on organisms.

Adaptation culturally and linguistically to the Chilean population and validation the Dry Eye Questionnaire 5.

BACKGROUND AND OBJECTIVE: There are different methods for evaluating dry eye disease (DID), including questionnaires that analyze different aspects of its symptoms, which are important for its better understanding and therapeutic management. The Dry Eye Questionnaire 5 (DEQ-5), is unique in its kind, because in addition to its simplicity, it measures symptoms in 4 dimensions. The aim of this study is to adapt culturally and linguistically and validate this instrument to the Chilean population. MATERIAL AND METHODS: For the adaptation, the translation and retro-translation of the original version was carried out, its linguistic analysis, the pilot test and the expert panel review (which included a linguistics specialist) were used. For the validation, a psychometric analysis of reliability and validity of the construct was incorporated. The sample in which it was validated was constituted by 205 people with dry eye disease. RESULTS: 141 (69%) of the respondents were women, the mean of age was 48 years ±16,7, and the median of the total score DEQ-5 was 13 points (R.I 8-15 points). The adapted version resulted in a Cronbach alpha of 0.8085, scoring that classified it as good. DISCUSSION: The questionnaire DEQ-5, which was adapted and validated, was a good instrument to be used in populations with similar characteristics of those in the study. More so, the factor analysis enriched comprehension of the way in which people with dry eye disease relate their symptoms and which questions relate more between them, representing in a better way the aspects evaluated of the symptomatology of this disease.

Production of bacterial cellulose tubes for biomedical applications: Analysis of the effect of fermentation time on selected properties.

Biosynthesis of bacterial cellulose (BC) in cylindrical oxygen permeable molds allows the production of hollow tubular structures of increasing interest for biomedical applications (artificial blood vessels, ureters, urethra, trachea, esophagus, etc.). In the current contribution a simple set-up is used to obtain BC tubes of predefined dimensions; and the effects of fermentation time on the water holding capacity, nanofibrils network architecture, specific surface area, chemical purity, thermal stability, mechanical properties, and cell adhesion, proliferation and migration of BC tubes are systematically analysed for the first time. The results reported highlight the role of culture time on key properties of the BC tubes produced, with significant differences arising from the denser and more compact fibril arrangements generated at longer fermentation intervals.

El ojo seco está relacionado con un aumento intrasujeto de la variabilidad de osmolaridad lagrimal confirmado por tecnología de aprendizaje de máquinas / Dry eye is matched by increased intrasubject variability in tear osmolarity as confirmed by machine learning approach

Objetivo: La medición de la osmolaridad lagrimal en pacientes con ojo seco ha sido cuestionada debido a su alta variabilidad. El entendimiento del origen de dicha variabilidad ayudaría a la interpretación clínica de los valores obtenidos. Esta investigación evalúa la medición de la variabilidad lagrimal en la práctica clínica. Material y métodos: Veinte pacientes con ojo seco y 20 controles fueron evaluados. Fueron realizadas 3 mediciones consecutivas de osmolaridad a intervalos de 5min. La variabilidad fue definida como la diferencia entre las mediciones más extremas obtenidas en cada ojo. Se utilizaron técnicas de aprendizaje de máquinas para evaluar la capacidad discriminadora de la osmolaridad lagrimal. Resultados: La osmolaridad promedio en el grupo control y ojo seco fueron 295,1 ± 7,3 mOsm/L y 300,6 ± 11,2 mOsm/L, respectivamente (p = 0,004). La variabilidad de la osmolaridad lagrimal fue 7,5 ± 3,6 mOsm/L en el grupo control y 16,7 ± 11,9 mOsm/L en los pacientes con ojo seco (p < 0,001). Basado en la osmolaridad, un clasificador logístico obtuvo un 85% de precisión. Conclusiones: La osmolaridad promedio y la variabilidad fueron significativamente más altas en pacientes con ojo seco. Por otra parte, las técnicas de aprendizaje de máquina demostraron buena precisión para clasificar a los pacientes. Por tanto, la alta variabilidad parece ser característica propia de la enfermedad de ojo seco

Objective: Because of high variability, tear film osmolarity measures have been questioned in dry eye assessment. Understanding the origin of such variability would aid data interpretation. This study aims to evaluate osmolarity variability in a clinical setting. Material and methods: Twenty dry eyes and 20 control patients were evaluated. Three consecutive osmolarity measurements per eye at 5min intervals were obtained. Variability was represented by the difference between both extreme readings per eye. Machine learning techniques were used to quantify discrimination capacity of tear osmolarity for dry eye. Results: Mean osmolarities in the control and dry eye groups were 295.1 ± 7.3 mOsm/L and 300.6 ± 11.2 mOsm/L, respectively (P=.004). Osmolarity variabilities were 7.5 ± 3.6 mOsm/L and 16.7 ± 11.9 mOsm/L, for the control and dry eye groups, respectively (P < .001). Based on osmolarity, a logistic classifier showed an 85% classification accuracy. Conclusions: In the clinical setting, both mean osmolarity and osmolarity variability in the dry eye group were significantly higher than in the control group. Machine learning techniques showed good classification accuracy. It is concluded that higher variability of tear osmolarity is a dry eye feature

Dry eye is matched by increased intrasubject variability in tear osmolarity as confirmed by machine learning approach. / El ojo seco está relacionado con un aumento intrasujeto de la variabilidad de osmolaridad lagrimal confirmado por tecnología de aprendizaje de máquinas.

OBJECTIVE: Because of high variability, tear film osmolarity measures have been questioned in dry eye assessment. Understanding the origin of such variability would aid data interpretation. This study aims to evaluate osmolarity variability in a clinical setting. MATERIAL AND METHODS: Twenty dry eyes and 20 control patients were evaluated. Three consecutive osmolarity measurements per eye at 5min intervals were obtained. Variability was represented by the difference between both extreme readings per eye. Machine learning techniques were used to quantify discrimination capacity of tear osmolarity for dry eye. RESULTS: Mean osmolarities in the control and dry eye groups were 295.1±7.3mOsm/L and 300.6±11.2mOsm/L, respectively (P=.004). Osmolarity variabilities were 7.5±3.6mOsm/L and 16.7±11.9mOsm/L, for the control and dry eye groups, respectively (P<.001). Based on osmolarity, a logistic classifier showed an 85% classification accuracy. CONCLUSIONS: In the clinical setting, both mean osmolarity and osmolarity variability in the dry eye group were significantly higher than in the control group. Machine learning techniques showed good classification accuracy. It is concluded that higher variability of tear osmolarity is a dry eye feature.

2-D assembly of supramolecular nanoarchitectures on Mg(0001).

In this work, a Mg(0001) single crystal is used as a novel template to grow 2D supramolecular nano-architectures. By using scanning tunnelling microscopy (STM) and high-resolution X-ray photoemission spectroscopy (HR-XPS), the formation of either a homo-molecular or metal-organic network is reported for carboxylic or amino functionalized molecules, respectively.

Sorption of Cr(III) and Cr(VI) to K2Mn4O9 nanomaterial a Study of the effect of pH, time, temperature and interferences.

A Rancieite type material (K2Mn4O9) nanomaterial was synthesized and tested for the removal of chromium (III) and chromium (VI) from aqueous solutions. The synthesized nanomaterial was characterized using powder XRD and SEM. XRD showed weak diffraction peaks at only at the angles associated with K2Mn4O9. The SEM corroborated that the nanoparticles were present; however, the nanoparticles were clustered into larger aggregates. Batch studies were performed to determine the optimum pH, capacity, time dependency, interferences, and the thermodynamics of the binding. The optimum pH for the binding of Cr(III) and Cr(VI) were determined to be pH 5 and pH 2, respectively. Isotherm studies were performed at temperatures of 4 , 25 , and 45 for Cr(III) and Cr(VI) and showed binding capacities of 21.7 mg/g, 36.5 mg/g, 41.8 mg/g for Cr(III). The Cr(VI) binding capacities were 4.22 mg/g, 4.08 mg/g, and 3.25 mg/g at the respective temperatures. The thermodynamic studies showed that the binding processes for the reactions were spontaneous and endothermic, with a ΔH was 17.54 kJ/mol for Cr(III) and 6.05 kJ/mol for Cr(VI). The of sorption for Cr(III) were determined to be -3.88 kJ/mol, -5.83 kJ/mol and -7.03 kJ/mol at the aforementioned temperatures. The ΔG values for the Cr(VI) sorption were determined to be -4.89 kJ/mol, -5.64 kJ/mol, and -6.05 kJ/mol. In addition, the ΔS values for Cr(III) and Cr(VI) were determined to be 77.92 J/mol and 39.49 J/mol, respectively. The thermodynamics indicate that the binding of Cr(III) and Cr(VI) is spontaneous and endothermic.

TH17 cells express ST2 and are controlled by the alarmin IL-33 in the small intestine.

TH17 cells are major drivers of inflammation and involved in several autoimmune diseases. Tissue inflammation is a beneficial host response to infection, but it can also contribute to autoimmunity. The crosstalk between a tissue and the immune system during an inflammatory response is key for preserving tissue integrity and restoring physiological processes. However, how the inflamed tissue regulates the magnitude of an immune response by controlling pro-inflammatory T cells is not well characterized so far. Here we show that TH17 cells accumulating in the small intestine upon inflammation express the IL-33 receptor (ST2) and intestinal epithelial cells (IEC) are the main source of the alarmin interleukin-33 (IL-33). We show that pro-inflammatory TH17 cells acquire a regulatory phenotype with immunosuppressive properties in response to IL-33. Absence of ST2 signaling promotes the secretion of pro-inflammatory cytokines by TH17 cells and dampens the secretion of IL-10. Our results provide new insights into the mechanisms by which IEC, via IL-33/ST2 axis, may control pro-inflammatory TH17 cells in the small intestine to sustain homeostasis.

The Porphyromonas gingivalis O antigen is required for inhibition of apoptosis in gingival epithelial cells following bacterial infection.

BACKGROUND AND OBJECTIVE: Porphyromonas gingivalis infection induces apoptosis inhibition in gingival epithelial cells; however, it is not fully understood which bacterial effectors are involved in this process. The aim of this study is to evaluate whether the P. gingivalis lipopolysaccharide (LPS), specifically the O-antigen region, affects adherence, invasion, viability and apoptosis of gingival epithelial cells. MATERIAL AND METHODS: Gingival epithelial cells (OKF6/TERT2 line) were infected by different freshly prepared P. gingivalis clinical isolates, obtained from subjects with chronic periodontitis (CP3 and CP4) and healthy individuals (H1 and H3). Periodontitis and healthy isolates show differences in O-antigen production, as healthy isolates lack the O-antigen region. In addition, cells were infected by a site-specific mutant lacking the O-antigen portion. After 24 h postinfection, cell proliferation, viability and apoptosis were evaluated by Trypan blue, MTS and annexin V assays, respectively. Bacterial invasion, adhesion and proliferation were measured by gentamicin/metronidazole protection assays. Finally, toll-like receptor (TLR)2 and TLR4 mRNA expression was evaluated by quantitative reverse transcription-polymerase chain reaction. Statistical analysis was performed using ANOVA, Tukey's or Dunnett's tests (p < 0.05). RESULTS: At 24 h postinfection, strains lacking the O-antigen region (healthy isolates and O-antigen ligase-deficient strain) were unable to increase proliferation and viability, or decrease apoptosis as compared with strains producing intact LPS (periodontitis isolates and reference strain). However, the presence of the O-antigen neither contributed to changes in the ability of the bacteria to adhere to or invade cells, nor to intracellular survival. The presence of O-antigen also increased the expression of TLR4 (nearly sixfold), which correlated with inhibition of apoptosis. CONCLUSION: The O-antigen region of P. gingivalis LPS is required to increase gingival epithelial cell viability upon infection by bacteria and this increase is attributable to a reduction in apoptosis. Moreover, although bacterial internalization is required, the effects observed are not due to alterations in P. gingivalis adherence, invasion or intracellular survival. Interestingly, inhibition of apoptosis correlates with increased TLR4 expression, suggesting a role for TLR4 in this process.

Utilidad del score predictivo de Cameron para la realización de traqueostomía electiva después de cirugía tumoral oral / Usefulness of the Cameron tracheostomy scoring system after oral tumor surgery

Objetivos. Analizar la aplicación del score predictivo (SP) de Cameron para la traqueostomía reglada (TR) en cirugía tumoral oral. Material y métodos. Estudio retrospectivo y descriptivo de pacientes intervenidos de cirugía tumoral oral consecutivamente entre enero de 2010 y diciembre de 2012. Se recogieron los ítems del SP: la reconstrucción y el tipo de injerto, la maxilectomía inferior, la disección bilateral cervical y la localización tumoral. Se agruparon los pacientes según el manejo de la vía aérea al final de la cirugía en 4 grupos: extubados, intubados, TR y traqueostomía urgente. Se consideró un punto de corte ≥ 5 puntos del SP para la realización de TR. Resultados. Se registraron un total de 90 pacientes. La distribución por grupos fue: extubados = 27,8% de los casos, intubados = 17,8%, TR = 53,3% y un caso (1,1%) de traqueostomía urgente. Los 3 pacientes en los que se efectuó una traqueostomía no reglada tenían un SP ≥ 5 puntos. Usando el valor del SP ≥ 5 puntos se obtuvo un valor de sensibilidad diagnóstica de 0,7 para un intervalo de confianza (IC) del 95% de 0,57-0,82 y un valor de especificidad diagnóstica de 0,9 (IC del 95% 0,79-0,99). El VPP fue de 0,9 (IC del 95% 0,81-0,99) y el VPN de 0,67 (IC del 95% 0,54-0,8). El ABC dio un valor de 0,87 (error estándar 0,36). El cociente de probabilidad positivo fue 6,48. Conclusión. La decisión de realizar una TR durante la cirugía tumoral oral puede reforzarse utilizando el SP de Cameron basándose en datos objetivos (AU)

Objectives. The aim of this study was to analyze the results of applying the predictive score (PS) of Cameron to perform elective tracheostomy (ET) in oral tumor surgery. Material and methods. A retrospective and descriptive study was conducted on consecutive patients undergoing oral tumor surgery between January 2010 and December 2012. Items of the PS were collected: reconstruction and type of graft, mandibulectomy, bilateral neck dissection, and tumor location. Patients were grouped according to the management of the airway at the end of surgery into 4 groups: extubated, intubated, ET, and urgent tracheostomy. A cutoff of ≥ 5 points PS was considered for conducting ET. Results. A total of 90 patients were included. Group distribution was: extubated = 27.8%, intubated = 17.8%, ET = 53.3%, and one case (1.1%) of urgent tracheostomy. Using the cutoff value of PS ≥ 5 points yielded a diagnostic sensitivity value of 0.7 for a 95% confidence interval (CI) (0.57 to 0.82), and a diagnostic specificity value of 0.9 (95% CI 0.79 to 0.99). The PPV was 0.9 (95% CI 0.81 to 0.99) and the NPV was 0.67 (95% CI 0.54 to 0.8). The AUC gave a value of 0.87 (standard error 0.36). The likelihood ratio was 6.48. Conclusion. The decision to perform an ET for oral tumor surgery can be enhanced using the PS of Cameron based on objective data (AU)

[Usefulness of the Cameron tracheostomy scoring system after oral tumor surgery]. / Utilidad del score predictivo de Cameron para la realización de traqueostomía electiva después de cirugía tumoral oral.

OBJECTIVES: The aim of this study was to analyze the results of applying the predictive score (PS) of Cameron to perform elective tracheostomy (ET) in oral tumor surgery. MATERIAL AND METHODS: A retrospective and descriptive study was conducted on consecutive patients undergoing oral tumor surgery between January 2010 and December 2012. Items of the PS were collected: reconstruction and type of graft, mandibulectomy, bilateral neck dissection, and tumor location. Patients were grouped according to the management of the airway at the end of surgery into 4 groups: extubated, intubated, ET, and urgent tracheostomy. A cutoff of≥5 points PS was considered for conducting ET. RESULTS: A total of 90 patients were included. Group distribution was: extubated=27.8%, intubated=17.8%, ET=53.3%, and one case (1.1%) of urgent tracheostomy. Using the cutoff value of PS≥5 points yielded a diagnostic sensitivity value of 0.7 for a 95% confidence interval (CI) (0.57 to 0.82), and a diagnostic specificity value of 0.9 (95% CI 0.79 to 0.99). The PPV was 0.9 (95% CI 0.81 to 0.99) and the NPV was 0.67 (95% CI 0.54 to 0.8). The AUC gave a value of 0.87 (standard error 0.36). The likelihood ratio was 6.48. CONCLUSION: The decision to perform an ET for oral tumor surgery can be enhanced using the PS of Cameron based on objective data.

Trends in World Dental Research: an overview of the last three decades using the Web of Science.

OBJECTIVE: The objective of this paper is to analyse the scientific activity of dental sciences over the last 30 years. MATERIALS AND METHODS: Dental-research output was identified by retrieving all citable dental documents in the Web of Science (WoS) database in the periods 1986-1988, 1996-1998, and 2006-2008. For this, a two-phase search strategy was designed: firstly, output in Dentistry, Oral Surgery, and Medicine (DOSM) Journal Citation Reports (JCR) category journals were compiled; secondly, for journal documents of other JCR categories but related to Dentistry (Non-DOSM), an innovative search strategy was designed based on a double criterion, thematic and institutional. RESULTS: The results showed that DOSM production increased in absolute but decreased in relative terms over the last 30 years. The JCR categories where dental researchers publish also varied. Surprisingly, the geographic distribution of the production shows a growing concentration of the steadily fewer countries, a previously undescribed phenomenon, while the thematic analysis reveals that this production continued to form four broad thematic areas encompassing the remaining specialties: Dental Materials Prosthodontics, Orthodontics, and General Dentistry. CONCLUSIONS: Scientific production in dentistry has changed in the past three decades both quantitatively and qualitatively, as well as their geographical distribution despite being structured around the same specialties. CLINICAL RELEVANCE: In this study, along with some key messages about the key shifts in publication trends, in terms of subject, where published and by whom, we propose a new methodology which could be useful to professionals as well as researchers, in which the exhaustivity and precision rates for scientific information retrieval improve.

[Urethroplasty with lateral pedunculated flap for complicated hypospadias]. / Uretroplastia con colgajo lateral pediculado para las hipospadias complicadas.

UNLABELLED: With the modern techniques, we can resolve almost the totallity of hypospadias. But there are patients with recurrent fistulas associated to uretral stenosis that can finish all the surgical possibilities. MATERIAL AND METHODS: Retrospective review. Lateral based flap uretroplasty consists in the exposition of the uretra, to reconstruct in one-stage the original neourethra with the lateral skin of the penis. RESULTS: From 2008, we have correct 5 patients with a mean age of 12,1 years (9-15) and a weight of 55,34 kg (22-98 kg). All of them were previously corrected 3 to 7 times, with recurrent fistulas. At the office, stenosis urethral was verified. Surgical correction was made in 90-110 minutes and results were positive in all patients, correcting the stenosis after a follow-up of more than a year. Only the oldest two patients had present minimally glans fistula. CONCLUSIONS: Lateral based flap urethroplasty is a useful technique for the correction of the complicated fistulas, allowing the correction of the fistulas and the stenosis of the urethra.

Hallazgos histológicos y seguimiento clínico de pacientes con mEn 2 tras tiroidectomía profiláctica / Clinical follow up and histological findings of patients With men2 treated With prophylactic thyroidectomy

Objetivo. Presentar nuestra experiencia en el manejo profiláctico mediante tiroidectomía del carcinoma medular tiroideo, revisando la correlación entre los hallazgos clínicos, analíticos, histopatológicos y genéticos en sujetos con síndrome de neoplasia endocrina múltiple tipo 2A (MEN 2A) y carcinoma medular familiar de tiroides (CMFT).materiales y métodos. Estudio retrospectivo mediante revisión de historias clínicas de pacientes con diagnóstico de MEN 2A o CMFT, derivados a nuestra consulta tras consejo genético desde 1997 hasta 2011. Se analizaron las variables sexo, edad al diagnóstico y a la cirugía, valores pre y postoperatorios de calcitonina (y metanefrinas en pacientes con MEN 2A), hallazgos histopatológicos, seguimiento y supervivencia. Resultados. Se identificaron 13 pacientes con antecedentes familiares de CMT, 9 mujeres y 4 varones, 11 portadores de mutación en protooncogén RET para MEN 2A y 2 no portadores (CMFT). La edad media al diagnóstico fue 4,2 años (rango: 1,8-8,2). Todos los pacientes fueron tratados mediante tiroidectomía total con una edad media de 6 años (rango: 4,1-8,5). Los hallazgos histopatológicos demostraron 7 casos de hiperplasia nodular de células C, 2 microcarcinomas, 1 carcinoma multicéntrico, 1 tiroiditis linfocitaria y 2 sin evidencia de enfermedad. La calcitonina preoperatoria estaba elevada en 3 casos, coincidiendo en uno con histopatología de microcarcinoma. Todos los pacientes se encuentran libres de enfermedad.Conclusiones. La tiroidectomía profiláctica precoz es la única herramienta preventiva y curativa para el CMT en pacientes susceptibles genéticamente de padecerlo. Es imprescindible la creación de equipos multidisciplinarios (Endocrinología, Genética Clínica y Cirugía Pediátrica) para el estudio, manejo y seguimiento de los pacientes con MEN 2A y sus familias (AU)

Objective. To present our experience in the prophylactic management of the medullary thyroid carcinoma (MTC), reviewing the correlation between clinical, analytical, histopathological, and genetic findings on subjects with type 2A multiple endocrine neoplasia (MEN 2A) and familial MTC.material and methods. A retrospective study was done by reviewing the medical records of patients diagnosed with MEN 2A or familial MTC, between 1997 and 2011. The variables studied were sex, age at the time of diagnosis, age at the time of surgery, pre and post operative Calcitonin levels, pre and post op Metanephrine levels in patients with MEN 2A, histopathological findings, follow up and overall survival.Results. Thirteen patients were identified with family history of MTC, 9 females and 4 males. Eleven carriers of mutation on RET proto-oncongene for MEN 2A and no carriers for Familial MTC. The median age at the time of diagnosis was 4.2 years (range: 1.8 to 8.2). All patients were treated with total thyroidectomy, with a median age of 6 years (range: 4.08 to 8.5). The histopathological findings demonstrated 7 cases of C-Cells nodular hyperplasia, 2 micro-carcinomas, 1 multicentric carcinoma, 1 lymphocytic thyroiditis and 2 without evidence of disease. Elevated pre operative Calcitonin levels were found in 3 cases, correlated with one histopathological finding of micro-carcinoma. All patients are disease free.Conclusion. In patients with genetic predisposition to suffer the disease, early prophylactic thyroidectomy is the only current available approach to prevent and cure MTC.The creation of a multidisciplinary team (Endocrinology, clinical genetics, and pediatric surgery), is necessary to study, manage and follow up patients with MEN 2A and their families (AU)

Uretroplastia con colgajo lateral pediculado para las hipospadias complicadas / Urethroplasty with lateral pedunculated flap for complicated hypospadias

Las técnicas habituales de los hipospadias permiten resolver la práctica totalidad de esta patología con resultados muy positivos. Desgraciadamente, existen pacientes que se fistulizan repetidas veces, agotando las posibilidades quirúrgicas. Generalmente se asocian a estenosis uretral. Queremos presentar una técnica que nos ha facilitado la reparación de estos pacientes con resultados esperanzadores . Material y métodos. Revisión retrospectiva de una serie de casos. La técnica del colgajo lateral pediculado consiste en un desmontaje dela uretra y exposición de la misma, para proceder a su reconstrucción en un solo tiempo por medio de la piel lateral de la uretra que se tubulariza sobre la neouretra primitiva. Resultados. Desde 2008 hemos intervenido 5 pacientes con una edad media de 12,1 años (9-15) y un peso de 55,34 kg (22-98 kg).Previamente habían sufrido de 3 a 7 operaciones de corrección de hipospadias, siempre fistulizadas. En consulta se comprobó la estenosis uretral en todos los pacientes. La intervención se realizó en un tiempo de 90-110 minutos y los resultados fueron favorables en todos los pacientes, resolviéndose las estenosis, con un seguimiento medio superior al año. Tan solo los dos pacientes más mayores han presentado mínimas fístulas glanulares. Conclusiones. La uretroplastia con colgajo lateral pediculado es una técnica útil para el tratamiento de los hipospadias complicados permitiendo la resolución de las fístulas y, especialmente, de las estenosis de uretra (AU)

With the modern techniques, we can resolve almost the totallity of hypospadias. But there are patients with recurrent fi stulas associated touretral stenosis that can finish all the surgical possibilities. Material and methods. Retrospective review. Lateral based flapuretroplasty consists in the exposition of the uretra, to reconstruct in one-stage the original neourethra with the lateral skin of the penis. Results. From 2008, we have correct 5 patients with a mean age of 12,1 years (9-15) and a weight of 55,34 kg (22-98 kg). All of them were previously corrected 3 to 7 times, with recurrent fistulas. At the office, stenosis urethral was verified. Surgical correction was made in 90-110 minutes and results were positive in all patients, correcting the stenosis after a follow-up of more than a year. Only the oldest two patients had present minimally glansfistula. Conclusions. Lateral based flap urethroplasty is a useful technique for the correction of the complicated fistulas, allowing the correction of the fistulas and the stenosis of the urethra (AU)

[Clinical follow up and histological findings of patients with MEN2 treated with prophylactic thyroidectomy]. / Hallazgos histológicos y seguimiento clínico de pacientes con MEN 2 tras tiroidectomía profiláctica.

OBJECTIVE: To present our experience in the prophylactic management of the medullary thyroid carcinoma (MTC), reviewing the correlation between clinical, analytical, histopathological, and genetic findings on subjects with type 2A multiple endocrine neoplasia (MEN 2A) and familial MTC. MATERIAL AND METHODS: A retrospective study was done by reviewing the medical records of patients diagnosed with MEN 2A or familial MTC, between 1997 and 2011. The variables studied were sex, age at the time of diagnosis, age at the time of surgery, pre and post operative Calcitonin levels, pre and post op Metanephrine levels in patients with MEN 2A, histopathological findings, follow up and overall survival. RESULTS: Thirteen patients were identified with family history of MTC, 9 females and 4 males. Eleven carriers of mutation on RET proto-oncongene for MEN 2A and no carriers for Familial MTC. The median age at the time of diagnosis was 4.2 years (range: 1.8 to 8.2). All patients were treated with total thyroidectomy, with a median age of 6 years (range: 4.08 to 8.5). The histopathological findings demonstrated 7 cases of C-Cells nodular hyperplasia, 2 micro-carcinomas, 1 multicentric carcinoma, 1 lymphocytic thyroiditis and 2 without evidence of disease. Elevated pre operative Calcitonin levels were found in 3 cases, correlated with one histopathological finding of micro-carcinoma. All patients are disease free. CONCLUSION: In patients with genetic predisposition to suffer the disease, early prophylactic thyroidectomy is the only current available approach to prevent and cure MTC. The creation of a multidisciplinary team (Endocrinology, clinical genetics, and pediatric surgery), is necessary to study, manage and follow up patients with MEN 2A and their families.