Manejo de la Diverticulitis Apendicular: una patología poco común

La diverticulitis apendicular es una enfermedad poco frecuente, con una incidencia aproximada de 1%. Se define por la presencia de divertículos verdaderos o falsos en la pared del apéndice cecal. Durante la fase aguda posee una clínica indistinguible a la apendicitis, sin embargo en ocasiones presenta características clínicas particulares que la distinguen de la apendicitis aguda, tales como la presencia de dolor abdominal insidioso o intermitente y/o ausencia de sintomatología gastrointestinal (náuseas, vómitos o anorexia). En la diverticulitis apendicular las técnicas imagenológicas son de utilidad limitada al otorgar información inespecífica, por lo que el diagnóstico tiende a realizarse mediante el estudio anatomopatológico del apéndice posterior a una intervención quirúrgica en paciente con cuadro clínico compatible con apendicitis aguda. El tratamiento de elección corresponde a la apendicectomía, lo que permite evitar complicaciones futuras como por ejemplo perforación apendicular, neoplasias, entre otros. Se obtuvieron los datos de fuentes como Pubmed y Scielo. Específicamente la búsqueda de artículos originales y de revisiones sistemáticas, preferentemente menores a 15 años de publicación en revistas científicas de alto índice de impacto, con las palabras "diverticulitis apendicular", "diverticulosis" y "complicaciones diverticulares".

Appendiceal diverticulitis is a rare disease with an incidence of approximately 1%. It is defined by the presence of true or false diverticula in the wall of the cecal appendix. During the acute phase, it has symptoms that are indistinguishable from appendicitis, however, it sometimes presents particular clinical characteristics that distinguish it from acute appendicitis, such as the presence of insidious or intermittent abdominal pain and/or the absence of gastrointestinal symptoms (nausea, vomiting, or anorexia). In appendiceal diverticulitis, imaging techniques are of limited utility as they provide non-specific information, so the diagnosis tends to be made through the pathology study of the treatment after surgery in a patient with a clinical picture compatible with acute appendicitis. The treatment of choice corresponds to appendectomy, which allows avoiding future complications such as appendiceal perforation, neoplasms, among others. Data were obtained from sources such as Pubmed and Scielo, specifically searching for original articles and systematic reviews with the words "apendicular diverticulitis", "diverticulosis" and "diverticular complications". The criteria used were articles mainly under 5 years of publication in high-impact scientific journals.

Diagnostic Accuracy of Arterial Spin-Labeling, Dynamic Contrast-Enhanced, and DSC Perfusion Imaging in the Diagnosis of Recurrent High-Grade Gliomas: A Prospective Study.

BACKGROUND AND PURPOSE: For patients with high-grade gliomas, the appearance of a new, enhancing lesion after surgery and chemoradiation represents a diagnostic dilemma. We hypothesized that MR perfusion without and with contrast can differentiate tumor recurrence from radiation necrosis. MATERIALS AND METHODS: In this prospective study, we performed 3 MR perfusion methods: arterial spin-labeling, DSC, and dynamic contrast enhancement. For each lesion, we measured CBF from arterial spin-labeling, uncorrected relative CBV, and leakage-corrected relative CBV from DSC imaging. The volume transfer constant and plasma volume were obtained from dynamic contrast-enhanced imaging without and with T1 mapping using modified Look-Locker inversion recovery (MOLLI). The diagnosis of tumor recurrence or radiation necrosis was determined by either histopathology for patients who underwent re-resection or radiologic follow-up for patients who did not have re-resection. RESULTS: There were 26 patients with 32 lesions, 19 lesions with tumor recurrence and 13 lesions with radiation necrosis. Compared with radiation necrosis, lesions with tumor recurrence had higher CBF (P = .033), leakage-corrected relative CBV (P = .048), and plasma volume using MOLLI T1 mapping (P = .012). For differentiating tumor recurrence from radiation necrosis, the areas under the curve were 0.81 for CBF, 0.80 for plasma volume using MOLLI T1 mapping, and 0.71 for leakage-corrected relative CBV. A correlation was found between CBF and leakage-corrected relative CBV (r s = 0.54), volume transfer constant, and plasma volume (0.50 < r s< 0.77) but not with uncorrected relative CBV (r s = 0.20, P = .29). CONCLUSIONS: In the differentiation of tumor recurrence from radiation necrosis in a newly enhancing lesion, the diagnostic value of arterial spin-labeling-derived CBF is similar to that of DSC and dynamic contrast-enhancement-derived blood volume.

Mortalidad quirúrgica durante pandemia de coronavirus en un centro universitario / Surgical mortality during a coronavirus pandemic in a university center

Resumen Introducción: La pandemia de coronavirus, iniciada en Wuhan el año 2019, ha trastocado al mundo y afectado profundamente a la actividad quirúrgica al restringir el número de intervenciones en forma dramática, después de los reportes iniciales de mortalidad posoperatoria sobre el 20% en pacientes operados portadores de COVID. El objetivo del presente estudio fue evaluar las cifras de mortalidad quirúrgica, en pacientes intervenidos quirúrgicamente durante la pandemia del COVID-19. Materiales y Método: Cohorte retrospectiva de pacientes operados entre el 15 de marzo de 2020 y el 31 de julio de 2020 en un centro universitario. Se evaluó variables clínicas asociadas a la intervención quirúrgica y coinfección por SARS-CoV-2. Resultados: Se analizaron 344 pacientes quienes presentaron una mortalidad global de 6,1%. Se realizó examen de PCR para COVID a 153 pacientes. Presentaron un riesgo de mortalidad significativo los pacientes: PCR COVID(+) (22,7%), p = 0,01, portadores de hipertensión arterial (11,6%) p = 0,03 y mayores de 60 años (12,4%) p < 0,001. No fueron factores estadísticamente significativos de mayor riesgo de mortalidad, las siguientes variables: género, obesidad, diabetes mellitus, patología oncológica, cirugía de urgencia y clasificación de ASA. Al analizar dos subgrupos se observó que los pacientes menores de 60 años COVID negativo presentaron una cifra de mortalidad de 1,26% versus 36,3% en los mayores de 60 años, COVID positivos (p = 0,01). Discusión: Los resultados del presente estudio sugieren que se deben realizar los mayores esfuerzos para descartar la infección por SARS-CoV-2 en la evaluación preoperatoria para disminuir los riesgos de mortalidad posoperatoria.

Background: The coronavirus pandemic, started in the city of Wuhan in 2019, has disrupted the world and deeply affected surgical activity. Restricting the number of interventions dramatically, after initial reports of postoperative mortality over 20% in patients with COVID. The purpose of this study is to evaluate the figures for surgical mortality, during the coronavirus pandemic. Materials and Method: Retrospective cohort of patients operated between March 15, 2020 and July 31, 2020 at a university center. Clinical variables associated with surgical intervention and coinfection by SARS-CoV-2 were evaluated. Results: 344 patients with an overall mortality of 6.1% were analyzed. PCR testing for COVID was performed on 153 patients. Only from the ninth week of the pandemic did routine preoperative testing begin. Patients who presented a higher risk of mortality were: PCR COVID(+) (22.7%), arterial hypertension (11.6%) and age over 60 years (12.4%). In the present series, the following variables were not statistically significant risk factors for mortality: gender, obesity, diabetes mellitus, oncological pathology, emergency surgery and ASA classification. When analyzing two subgroups, we observed that COVID negative patients under 60 had a mortality rate of 1.26%, versus 36.36% in those over 60 years of age, COVID positive. Discussion: The results of the present study lead us to make every effort to rule out COVID infection preoperatively to reduce the risks of postoperative mortality. Although this is a series of cases and the extrapolation of its results should be cautious, having national figures can be a useful element to make decisions in this stage of reactivation of surgical activity.

The influence of the correlation-covariance structure of measurement errors over uncertainties propagation in online monitoring: application to environmental indicators in SUDS.

This paper presents a methodology to assess the influence of the correlation-covariance structure of measurement errors in online monitoring over the propagation of uncertainties, applied to wet-weather environmental indicators in sustainable urban drainage systems (SUDSs). The effect of auto-correlated and heteroskedastic errors in measured time-series over the estimated probability density function (PDF) of different environmental indicators is analyzed for a wide variety of possible error structures in the data. For this purpose, multiple correlation-covariance structures are randomly generated from exploring the parametric space of a linear exponent autoregressive (LEAR) model, employing a Bayesian-based Markov Chain Monte Carlo sampling technique. Significant differences tests are proposed to identify the most correlated parameters of the correlation-covariance error model with statistics of the environmental indicator PDFs. The method is applied to total suspended solids (TSS) and chemical oxygen demand (COD) time-series recorded during 13 rainfall events at the inlet and outlet of a SUDS train (stormwater settling tank-horizontal constructed wetland). In this case, results showed that the total error in the estimation of the analyzed environmental indicators is mostly explained by standard uncertainties (flattening of the PDFs) rather than bias contributions (displacement of the PDFs). The correlation-covariance model parameters related to the temporal delimitation of hydrographs/pollutographs and the intensity of the autocorrelation showed to have the strongest influence in the propagation of measurement errors (flattening/displacement of the PDFs).

Hernia útero inguinal derecha atascada en mujer en edad fértil: reporte de un caso / Incarcerated right utero inguinal hernia in a woman of reproductive age: case report

Resumen Introducción: La hernia de pared abdominal es una patología habitual; la presentación más frecuente es de tipo inguinal, cercano a un 70% del total. La incidencia de un saco herniario inguinal conteniendo ovarios y trompas de Falopio, es un hecho reportado en 2,9% de los casos. Caso clínico: Se presenta una paciente, sexo femenino, de 42 años de edad, con historia de hernia inguinal derecha de larga data, ingresa por aumento de volumen doloroso e irreductible, en región inguinal derecha, no impresiona estrangulada; ingresa a pabellón de urgencia. Dentro de los hallazgos quirúrgicos destacan saco herniario que contiene útero y ambos ovarios, sin compromiso vascular. Paciente evoluciona de forma favorable egresando 2 días posterior a la cirugía.

Introduction: Abdominal wall hernia is a frequent pathology, the most frequent hernia are the inguinal type, closed to 70% of all. Although the incidence of inguinal hernial sac containing ovary and Fallopian tubes are reported on a 2.9% of the cases. Case Report: Female patient 42 years old, with a long-term history of right inguinal hernia, with sudden pain and irreducible increase of volume in the correspondent inguinal zone that doesn't look strangled; she was admitted to the emergency operating room. Among surgical findings hernia's sac content was uterus and both ovaries with no signs of vascular compromise. The patient's favorable evolved let her to be discharged from the hospital after 2 days from post operative care

On the stability of Cu x Te polytypes: phase transitions, vibrational and electronic properties.

Based on the experimental structures reported for the Cu x Te (1 ⩽ x ⩽ 2) system, a theoretical study on stability and phase transitions has been performed. Three theoretical structures derived from rickardite (Cu1.5Te) were considered to represent different Cu/Te ratios (1, 1.5 and 2). The structural, electronic, and vibrational properties were calculated by density functional theory and compared to the experimental data available to date. This analysis showed that the proposed CuTe and Cu1.5Te structures are energetically and dynamically stable (unlike Cu2Te), and that their vibrational modes may play an important role in the reported Raman spectra for Cu x Te films. As well, it was found that being vulcanite the most stable phase for x = 1, the addition of Cu atoms to this structure induces a gradual flattening of the Cu planes, producing significant changes in the electronic band structure. A thorough review of the experimental reports on the electrical properties of the system was carried out. The experimental data showed that, in agreement with the calculations, the electrical conductivity is higher for phases with x ⩽ 1.5, decreasing as x gets closer to 2. Hence, the low-copper concentration phases are the best choice for solar cell applications due to their electrical properties and stability.

Tratamiento quirúrgico de la endometriosis pélvica profunda con compromiso colorrectal / Surgical treatment of deep pelvic endometriosis with colorectal involvement

INTRODUCCIÓN: En la endometriosis el compromiso intestinal afecta hasta al 12% de las pacientes, comprometiendo al recto y a la unión rectosigmoidea en el 90% de los casos. OBJETIVO: Describir la experiencia del equipo de Coloproctología y Ginecología de Clínica Alemana de Santiago en el tratamiento quirúrgico de la endometriosis pélvica profunda con compromiso colorrectal. MATERIAL Y MÉTODOS: Estudio retrospectivo a partir de la base de datos de pacientes con endometriosis tratados entre enero del año 2015 y abril de 2018. Los criterios de inclusión fueron pacientes con clínica de endometriosis pélvica profunda, que tuviesen compromiso colorrectal y hayan sido tratados con shaving rectal, resección discoide o resección segmentaria. Se revisaron fichas clínicas electrónicas, protocolos operatorios y biopsias definitivas. RESULTADOS: Se reclutaron 25 pacientes con una mediana de edad de 35 años. El síntoma principal de consulta fue dismenorrea y el síntoma digestivo más frecuente fue disquecia. En 8 pacientes se realizó un shaving rectal, en 7 una sigmoidectomía, en 9 una resección discoide y en 1 paciente una tiflectomía. La complicación posoperatoria reportada fue la hemorragia digestiva baja en 4 pacientes (Clavien-Dindo I y IIIa). Con una mediana de seguimiento de 13 meses, a la fecha 3 pacientes se les ha diagnosticado algún tipo de recidiva. CONCLUSIÓN: Es importante que la cirugía a realizar, garantice una morbilidad y recurrencia baja. Los resultados en nuestro centro son alentadores, lo que nos hace creer que el tratamiento quirúrgico podría ser una buena alternativa en la endometriosis pélvica profunda con compromiso colorrectal.

INTRODUCTION: In endometriosis, intestinal involvement affects up to 12% of patients, compromising the rectum and the rectosigmoid junction in 90% of cases. AIM: Describe the experience of the Coloproctolgy and Gynecology Team of the Clínica Alemana de Santiago in the surgical treatment of deep pelvic endometriosis with colorectal involvement. MATERIAL AND METHODS: Retrospective study based on the database of patients with endometriosis treated between January 2015 and April 2018. The inclusion criteria were patients with deep pelvic endometriosis clinic, who had colorectal involvement and who had been treated with rectal shaving, discoid resection or segmental resection. Electronic clinical records, operative protocols and definitive biopsies were reviewed. RESULTS: Twenty-five patients with a median age of 35 years were recruited. The main symptom of consultation was dysmenorrhoea and the most frequent digestive symptom was dyschezia. In 8 patients a rectal shaving was performed, in 7 a sigmoidectomy, in 9 a discoid resection and in 1 patient a tiflectomy. The only reported post-operative complication was low gastrointestinal bleeding in 4 of the 25 patients (Clavien-Dindo I and IIIa). A median follow-up of 13 months was achieved, to date 3 patients have been diagnosed with some type of recurrence. CONCLUSION: It is important that the surgery to be performed guarantees low morbidity and recurrence. The results in our center are encouraging, which makes us believe that surgical treatment could be a good alternative in deep pelvic endometriosis with colorectal involvement.

Synthesis of biochar from chili seeds and its application to remove ibuprofen from water. Equilibrium and 3D modeling.

In this work chili seeds (Capsicum annuum) were used as raw material in the synthesis of biochar at temperatures between 400 and 600 °C. The samples were chemically, texturally and morphologically characterized and their properties were correlated with the calcination temperature. The adsorption mechanism of IBP was elucidated by analyzing the effect of solution pH, ionic strength and temperature, whereas that, the intraparticle diffusion mechanism was clarified through the application of a 3D diffusional model. The results evidenced that raising the pyrolysis temperature promotes a greater content of disordered graphitic carbon (51.6-85.02%) with small surface area (0.52-0.18 m2/g) and low quantity of functional groups. The adsorption study demonstrated that the biochar synthesized at 600 °C (C600) enhances the adsorption capacity >50 folds compared with chili seeds. Moreover, at pH = 7 the adsorption mechanism is governed by π-acceptor and attractive electrostatic interactions, whereas at basic pH the main adsorption mechanism is π-acceptor. Additionally, hydrophobic interactions become important by increasing the presence of NaCl. The application of 3D diffusional model based on surface diffusion interpreted clearly the kinetic curves obtaining values of Ds ranging from 2.31 × 10-8-2.51 × 10-8 cm2 s-1. Besides, it was determined that intraparticle mass flux is larger along the shortest axis of the seed, and always directed toward the particle center. The maximum mass flux takes place in the center of particle, and it advances like a moving front as time was increased.

Vibrational and electrical properties of Cu2-xTe films: experimental data and first principle calculations.

Vibrational and electrical properties of sputtered films of the copper telluride system are presented. Despite of its technological importance in photovoltaics, the fundamental properties of copper tellurides are poorly understood. Films were deposited at 200 °C by rf sputtering from targets containing mixtures of copper and tellurium powders at nominal concentrations of Cu1.25Te, Cu1.5Te, Cu1.75Te and Cu2Te. Remarkably for the copper telluride system, it was possible to obtain single-phase vulcanite (CuTe) from the Cu1.25Te target. Two-phase mixtures of rickardite (Cu7Te5) and weissite (Cu2-xTe) were achieved for other cases. Raman spectra were obtained using two laser lines: 633 and 488 nm. Density functional theory was employed to calculate the phonon dispersion curves and density of states for vulcanite. The Raman bands were in good correspondence with the calculated frequencies. In general, the Raman spectra consisted of high-intensity totally symmetric modes superimposed on monotonically decaying signals. These were explained in terms of three contributing phenomena: convolution of vibrational normal modes, phonon-coupled charge density fluctuations and time-varying local-field contributions to the electric susceptibility. Studies on the conductivity, mobility and carrier concentration were carried out by the Van der Pauw method. Micro/nano scale surface potential studies were performed through Kelvin probe force microscopy mapping.

Mesenchymal stem cell-derived exosomes from different sources selectively promote neuritic outgrowth.

Mesenchymal stem cells (MSCs) obtained from bone marrow (BM) have been shown to promote neuronal growth and survival. However, the comparative effects of MSCs of different sources, including menstrual MSCs (MenSCs), BM, umbilical cord and chorion stem cells on neurite outgrowth have not yet been explored. Moreover, the modulatory effects of MSCs may be mediated by paracrine mechanisms, i.e. by molecules contained in the MSC secretome that includes soluble factors and extracellular vesicles such as microvesicles and/or exosomes. The biogenesis of microvesicles, characterized by a vesicle diameter of 50 to 1000 nm, involves membrane shedding while exosomes, of 30 to 100 nm in diameter, originate in the multivesicular bodies within cells. Both vesicle types, which can be harvested from the conditioned media of cell cultures by differential centrifugation steps, regulate the function of target cells due to their molecular content of microRNA, mRNA, proteins and lipids. Here, we compared the effect of human menstrual MSCs (MenSCs) mediated by cell-cell contact, by their total secretome or by secretome-derived extracellular vesicles on neuritic outgrowth in primary neuronal cultures. The contact of MenSCs with cortical neurons inhibited neurite outgrowth while their total secretome enhanced it. The extracellular vesicle fractions showed a distinctive effect: while the exosome-enriched fraction enhanced neurite outgrowth, the microvesicle-enriched fraction displayed an inhibitory effect. When we compared exosome fractions of different human MSC sources, MenSC exosomes showed superior effects on the growth of the longest neurite in cortical neurons and had a comparable effect to BM-SC exosomes on neurite outgrowth in dorsal root ganglia neurons. Thus, the growth-stimulating effects of exosomes derived from MenSCs as well as the opposing effects of both extracellular vesicle fractions provide important information regarding the potential use of MenSCs as therapeutic conveyors in neurodegenerative pathologies.

Integral multidisciplinary approach in a patient with chronic complete spinal cord injury and hip disarticulation.

STUDY DESIGN: Case report. OBJECTIVES: To highlight the importance of the integral multidisciplinary management of a patient with complete chronic spinal cord injury and hip disarticulation secondary to pressure ulcers (PU). SETTING: Mexico City. METHODS: The case of a 40-year-old male violinist with a spinal cord injury, American Spinal Injury Association Impairment Scale A and neurological level T4, is reported. The patient initiated with bilateral ischiatic, left trochanteric and sacral PU. The ulcers were complicated with infection with sluggish evolution. Thus, it was decided a multidisciplinary management by means of left hip disarticulation and elaboration of a cosmetic prosthesis and the manufacture of a viscous elastic foam cushion for the prevention of new PU. The patient was quickly included in his professional and social activities. CONCLUSION: This study proves that multidisciplinary management of patients with spinal cord injury with complications such as the presence of PU that are resistant to noninvasive treatment can be the solution for the patient's reintegration into their normal life with adequate quality of life.

Self-assembled Targeting of Cancer Cells by Iron(III)-doped, Silica Nanoparticles.

Iron(III)-doped silica nanoshells are shown to possess an in vitro cell-receptor mediated targeting functionality for endocytosis. Compared to plain silica nanoparticles, iron enriched ones are shown to be target-specific, a property that makes them potentially better vehicles for applications, such as drug delivery and tumor imaging, by making them more selective and thereby reducing the nanoparticle dose. Iron(III) in the nanoshells can interact with endogenous transferrin, a serum protein found in mammalian cell culture media, which subsequently promotes transport of the nanoshells into cells by the transferrin receptor-mediated endocytosis pathway. The enhanced uptake of the iron(III)-doped nanoshells relative to undoped silica nanoshells by a transferrin receptor-mediated pathway was established using fluorescence and confocal microscopy in an epithelial breast cancer cell line. This process was also confirmed using fluorescence activated cell sorting (FACS) measurements that show competitive blocking of nanoparticle uptake by added holo-transferrin.

The evaluation of rainfall influence on combined sewer overflows characteristics: the Berlin case study.

The present study aims to explore the relationship between rainfall variables and water quality/quantity characteristics of combined sewer overflows (CSOs), by the use of multivariate statistical methods and online measurements at a principal CSO outlet in Berlin (Germany). Canonical correlation results showed that the maximum and average rainfall intensities are the most influential variables to describe CSO water quantity and pollutant loads whereas the duration of the rainfall event and the rain depth seem to be the most influential variables to describe CSO pollutant concentrations. The analysis of partial least squares (PLS) regression models confirms the findings of the canonical correlation and highlights three main influences of rainfall on CSO characteristics: (i) CSO water quantity characteristics are mainly influenced by the maximal rainfall intensities, (ii) CSO pollutant concentrations were found to be mostly associated with duration of the rainfall and (iii) pollutant loads seemed to be principally influenced by dry weather duration before the rainfall event. The prediction quality of PLS models is rather low (R² < 0.6) but results can be useful to explore qualitatively the influence of rainfall on CSO characteristics.

Effects of vasectomy on seminal plasma alkaline phosphatase in male alpacas (Vicugña pacos).

Azoospermia is a common finding in male alpacas which present for infertility. The challenge is to differentiate azoospermia of testicular origin from non-testicular origin. In several species, alkaline phosphatase (AP) concentrations in seminal plasma have been used as a diagnostic marker of contributions of the testis and epididymis to the ejaculate. The purpose of this study was to determine whether AP assay could differentiate testicular from non-testicular azoospermia in male alpacas. An experimental model of bilateral outflow obstruction (pre-scrotal vasectomy) was used in 22 male alpacas, aged 2-9 years. No reproductive history was available. Animals were submitted for electroejaculation (EE) under general anaesthesia and vasectomy performed. Five weeks later, animals were submitted for EE. Vasectomy was not successful in one animal, which was removed from analysis. AP levels were compared in seminal plasma in the pre- and post-vasectomy samples. The mean ± SEM concentration of AP in pre-vasectomy seminal plasma was 504.29 ± 166.45 U/l (range 10-2910); the post-vasectomy levels were 252.48 ± 81.77 U/l (range 0-1640; p = 0.06). In 71.4% of animals, AP levels decreased, varying from 18% to 100% reduction. Results of this study suggest that AP is not produced exclusively by the testis and epididymis in alpacas and that AP assay is not a valid diagnostic test for determination of origin of azoospermia; the gold standard for diagnosis of origin of azoospermia remains testicular biopsy.

Hepatocarcinoma en hígado no cirrótico / Hepatocellular carcinoma in a non cirrhotic liver

Background: The appearance of hepatocellular carcinoma in non-cirrhotic livers is uncommon. Material and Method: We report a 62 years old woman presenting with a liver mass that was subjected to a left hepatectomy. Results: The pathology report disclosed a poorly to moderately differentiated hepatocellular carcinoma. The surrounding liver tissue was normal. Immunohistochemistry identified intracytoplasmic a-1 antitrypsin granules, confirming the suspicion of a-1 antitrypsin deficiency.

Introducción: El Carcinoma Hepatocelular (HCC), tumor hepático primario más frecuente, se presenta en general en hígados cirróticos. Un porcentaje menor se desarrolla en pacientes sin cirrosis, en los cuales deben buscarse otras etiologías. Paciente y Método: Se presenta un caso clínico y las características anato-mopatológicas de una paciente con hepatocarcinoma e hígado no cirrótico tratada en nuestro centro. Mujer de 62 años, con historia de dolor abdominal y baja de peso. Estudio por imágenes revela masa hepática de aproximadamente 8 cm de diámetro mayor, en segmentos II, III y IV, sugerente de HCC. Resultados: Se realiza hepatectomía izquierda. Evoluciona de forma satisfactoria en el postoperatorio. La biopsia muestra un HCC moderada a pobremente diferenciado. El tejido no tumoral es normal, con gránulos intracitoplasmáticos Pas y Pas diastasa (+). Inmunohistoquímica identifica gránulos intracitoplasmáticos de antitripsina, con lo que se confirma la sospecha diagnóstica de déficit de a-1 antitripsina.

Prolapso genital: etiopatogenia, diagnóstico y tratamiento / Genital prolapse: etiopathogenesis, diagnosis and treatment

Vaginal prolapse is a very common disorder in the general female population. Because it is so common and often asymptomatically, there is no exact definition of this condition. Additionally its exact prevalence is not known. There are multiple risk factors that cause vaginal prolapse, for example age and vaginal deliveries are the most common, and nevertheless it is considered a multifactorial process. From the surgical point of view the most accepted theory for its production is site-specific tears that would generate the prolapse as they occur. Its diagnosis is clinical and is currently classified into four stages according to the degree of descent that exists with respect to the hymen. There are many different types of treatment, and the most used are pessaries, physiotherapy and surgery. The following is a review that covers various relevant aspects of the vaginal prolapse, his confrontation and treatment.

Prolapso genital: alteraciones del colágeno como factor etiológico / Genital prolapse: alterations of collagen as an etiological factor

The etiological search of pelvic organ prolapse has led to the study of connective tissue that surrounds it directly, called endopelvic fascia. So there have been several studies looking for changes in the main types of collagen existing in this area, trying to describe the changes that they would experience in order to facilitate the prolapse. It has been postulated mainly a decrease in collagen content, thereby reducing the tensile strength of the suspension elements of the pelvic organs and thus descent occurring. However, the literature has been discordant, and published numerous studies that show an increase of collagen in this area, which could be due to a state of pelvic floor repair in patients with various recognized risk factors. Most publications have different biases that preclude a completely valid conclusion. Because of this, still is not clear what changes would experience at the histological level the endopelvic fascia and there is no consensus among different centers. Here is a review of existing literature on this subject with emphasis on different molecular and histological findings of each study and their biases.

Peculiarities of Raman scattering in bioconjugated CdSe/ZnS quantum dots.

The article presents the results of analysis of Raman scattering spectra of non-conjugated and bioconjugated CdSe/ZnS core-shell quantum dots (QDs). Commercial CdSe/ZnS QDs used covered by polymer are characterized by color emission with the maxima at 605-610 nm (2.03-2.05 eV). The bioconjugation process is performed to biomolecules-the antihuman Interleukin 10 (IL10) antibodies (mab). Raman scattering spectra measured at room temperature with excitation by a He-Ne laser line (632.8 nm) demonstrate two groups of peaks: (1) related to the Si substrate at 230-460, 522, 610, 670, 940-1040 cm(-1) and (2) to the PEG polymer on the QD surface in the range of 837-3320 cm(-1). It is revealed that the CdSe/ZnS QD bioconjugation to the antihuman Interleukin 10 antibodies is accompanied with the dramatic changes in the intensity of the Raman lines of both types: the intensity of the Si related line increases six- or ten-fold, but the intensity of the polymer related line decreases ten-fold. The models explaining the mentioned effects in Raman scattering spectra have been discussed.

Neuromodulación en patologías de piso pélvico / Neuromodulation in pelvic floor dysfunctions

Através de la historia la neuromodulación ha demostrado ser una alternativa de tratamiento eficaz en el manejo de diversas disfunciones del piso pélvico. Distintas técnicas intentan conseguir un objetivo común, sin embargo, el éxito terapéutico es disímil dependiendo de la severidad y tipo de patología. Describimos los aspectos clínicos y operacionales relacionados con las diversas técnicas, así como los mecanismos de acción propuestos para la neuromodulación.

Through hystory, neuromodulation have proved to be an effective alternative of management of pelvic floor dysfunctions. Several technical alternatives try to reach a same therapeutic objetive, however, depending on the severity and type of symptom their succes differ. We describe the clinical and technical aspects related to those different technics so as the mechanisms of action that are propose for the neuromodulation.