Aplicabilidad del sistema de puntuación PREVENT III en cirugía de derivación vascular infragenicular con injerto compuesto o sintético / Applicability of PREVENT-III score in below-knee bypass surgery with composite or synthetic graft

INTRODUCCIÓN: El tratamiento de la isquemia crítica de la extremidad involucra un bypass o terapia endovascular. Ya se han desarrollado herramientas para predecir la sobrevida libre de amputación, como PREVENT-III, que ha demostrado su utilidad únicamente en injertos autógenos. OBJETIVO: Demostrar la aplicabilidad de PREVENT-III con injerto no autógeno. MATERIAL Y MÉTODOS: Se revisaron 87 expedientes de pacientes tratados mediante bypass infragenicular entre marzo de 2011 y marzo de 2013. Un total de 40 pacientes reunieron los criterios de inclusión; se calculó su puntuación PREVENT-III, se anotó el tipo de injerto utilizado, comorbilidades y su sobrevida libre de amputación a 12 meses. RESULTADOS: Se incluyó a 40 pacientes, con media de edad de 68,4 ± 9 años (47-90), 19 mujeres y 21 hombres. Las comorbilidades fueron diabetes mellitus (n = 28; 70%), tabaquismo suspendido (n = 24), hipertensión arterial sistémica (n = 19), tabaquismo activo (n = 11), angina o infarto cardiaco previo (n = 8), tabaquismo negado (n = 5), hipercolesterolemia (n = 4), dislipidemia mixta (n = 4), y ningún paciente tuvo enfermedad renal crónica. Se utilizó injerto sintético (n = 27; 67,5%) e injertos compuestos (n = 13). Fueron tratados mediante amputación mayor 7 pacientes (3 sintéticos + 4 compuestos) con riesgo bajo, y 8 (6 sintéticos + 2 compuestos) con riesgo moderado (p = 0,062). Al subdividir los grupos, 9 (3 riesgo bajo + 6 moderado) con injerto sintético fueron amputados (p = 0,034), y 6 con compuesto (4 riesgo bajo + 2 moderado) (p = 0,0657). CONCLUSIONES: La escala PREVENT-III es aplicable con injerto sintético, sin embargo, el comportamiento en presencia de injerto compuesto es errático

INTRODUCTION: Treating critical limb ischemia involves a bypass or endovascular therapy. Tools, such as PREVENT-III have been developed to predict amputation-free survival, but their usefulness has only been demonstrated in autologous grafts. OBJECTIVE: To demonstrate the applicability of PREVENT-III with non-autologous grafts. MATERIAL AND METHODS: A study was conducted on 87 cases of patients who underwent below-knee bypass between March 2011 and March 2013. Of the 40 patients that met the inclusion criteria, the PREVENT-III score, the type of graft used, comorbidity, and survival free of amputation at 12 months, were recorded. RESULTS: The 40 patients included had a mean age of 68.4 ± 9 years (47-90), and there were 19 women and 21 men. Comorbidities were diabetes mellitus (n = 28; 70%), ex-smoker (n = 24), systemic hypertension (n = 19), active smoking (n = 11), angina or history of myocardial infarction (n = 8), non-smokers (n = 5), hypercholesterolemia (n = 4), hypercholesterolemia + hypertriglyceridemia (n = 4), and with no patients with end stage renal disease. Synthetic grafts were used in (n = 27; 67.5%) and composite grafts in (n = 13). Major amputation was performed on 7 low risk patients (3 synthetic + 4 composite), and 8 moderate risk patients (6 synthetic + 2 composite) (P=.062). By dividing into sub-groups, 9 (3 moderate + 6 low risk) with synthetic graft were amputees (P = .034), and 6 with composite (4 moderate + 2 low risk) (P = .0657). CONCLUSIONS: The PREVENT-III can be applied to synthetic grafts; however, the behavior in the presence of composite graft is erratic

Dendritic morphology changes in neurons from the prefrontal cortex, hippocampus and nucleus accumbens in rats after lesion of the thalamic reticular nucleus.

Several studies in rodents have shown that dysfunctions of the thalamic reticular nucleus (TRN) result in deficits of sensory gating and attentional processes, two core features of schizophrenia. TRN receives inputs from the prefrontal cortex (PFC) and hippocampal formation, two structures which send excitatory projections to the nucleus accumbens (NAcc) and are interconnected with the basolateral amygdala (BLA). Here we determined whether (and which) changes occurred four weeks after a TRN lesion in the dendritic morphology of pyramidal neurons of layers 3 and 5 of the PFC, neurons of ventral and dorsal hippocampus, BLA, and the medium spiny neurons of the NAcc. Dendritic morphology and characteristics were measured by using Golgi-Cox procedure followed by Sholl analysis. We also evaluated the effects of TRN lesion on exploratory behavior assessed by hole-board test and locomotor activity induced by a novel environment. We found that TRN damage induced a reduction in the exploratory behavior measured by hole-board test with neuronal hypotrophy in PFC (layer 5), CA1 ventral hippocampus and NAcc neurons. Taken together, these data suggest that the behavioral and morphological effects of TRN lesion are, at least partially, mediated by limbic subregions with possible consequences for schizophrenia-related behaviors.

Female sexual offenders in the educational system: a brief overview.

Female sexual offenders comprise the minority of sexual offenders in the criminal justice system. However, empirical research reveals that sexual offenses against adolescents by females are a bigger problem than previously thought, particularly in the educational system. The authors review some of the data in the criminal justice system as well as in empirical research studies about female sexual offenders, with a specific focus on females who commit sexual crimes against students who are minors.

Bocavirus humano: Estudios en la literatura médica y en Chile / Human bocavirus: Studies in the literature and in Chile

The human bocavirus (HBoV), virus of the Parvoviridae family, discovered by molecular methods in 2005,has been reported in respiratory samples, stool, urine and blood, both in children and adults. Prevalence ratesrange from 0.8% in fecal samples of individuals with acute diarrhea, up to 19% in respiratory samples and blood.HBoV has been detected in up to 43% of nasopharyngeal samples in asymptomatic children. In Chile, HBoV wasdetected in 24.2% of nasopharyngeal swabs in children under 5 years of age with respiratory symptoms of which74% had coinfection with other viruses. In asymptomatic children under 5 years of age, 37.5% of NP sampleswere positive for HBoV. We discuss the role of HBoV as a causal agent of respiratory and/or enteric disease inlight of the high rates of coinfection and asymptomatic infections.

[Septo-optic dysplasia (Morsier's syndrome): a case report]. / Displasia septóptica (síndrome de Morsier): a propósito de un caso.

CASE REPORT: We report the case of an infant with septo-optic dysplasia, or Morsier's syndrome, which is a condition affecting the central nervous system that can only be confirmed by means of neuroimaging. This syndrome involves hypoplasia of one or both optic nerves, absence of septum pellucidum, agenesis of the corpus callosum, cerebellar atrophy, ventricular dilatation and brain cysts, together with ectopic, aplastic or hypoplastic neurohypophysis. CONCLUSIONS: It is an infrequent disease and its causation is uncertain, although the predominant hypothesis suggests a genetic foundation. The mechanism by which it is transmitted by inheritance is unknown. The age of the mother is characteristically low; it is known that over half the children affected by this condition were born to mothers below the age of 20. It may be accompanied by liver damage and it is essential to establish a diagnosis and treatment as early as possible. Prognosis is general favourable.

Displasia septóptica (síndrome de Morsier): a propósito de un caso / Septo-optic dysplasia (Mosier’s syndrome): A case report

Caso clínico. Se presenta el caso de una lactante con displasia septóptica o síndrome de Morsier, una entidad del sistema nervioso central que sólo puede confirmarse por medio de neuroimágenes. Este síndrome consiste en la hipoplasia de uno o ambos nervios ópticos, ausencia de septo pelúcido, agenesia de cuerpo calloso, atrofia cerebelosa, dilatación ventricular y quistes cerebrales, junto con neurohipófisis ectópica, aplásica o hipoplásica. Conclusiones. Se trata de una enfermedad infrecuente y de etiología poco clara, en la que predomina la hipótesis genética. No se conoce el mecanismo de transmisión hereditaria. De forma característica, la edad materna suele ser baja; es conocido que en más de la mitad de los niños afectados eran hijos de madres con edad inferior a 20 años. Puede acompañarse de daño hepático y es de gran importancia su diagnósticotemprano e instauración de tratamiento. El pronóstico en general es bueno

We report the case of an infant with septo-optic dysplasia, or Morsier’s syndrome, which is a conditionaffecting the central nervous system that can only be confirmed by means of neuroimaging. This syndrome involves hypoplasia of one or both optic nerves, absence of septum pellucidum, agenesis of the corpus callosum, cerebellar atrophy, ventricular dilatation and brain cysts, together with ectopic, aplastic or hypoplastic neurohypophysis. Conclusions. It is an infrequent disease and its causation is uncertain, although the predominant hypothesis suggests a genetic foundation. The mechanism by which it is transmitted by inheritance is unknown. The age of the mother is characteristically low; it is known that over half the children affected by this condition were born to mothers below the age of 20. It may be accompanied by liver damage and it is essentialto establish a diagnosis and treatment as early as possible. Prognosis is general favourable

Técnica inhalatoria en lactantes hospitalizados / Evaluation of the inhalatory technique in hospitalized infants

Background: The quality of the inhalatory technique (IT) is a factor on which its therapeutic success relies. Objective: Evaluate the quality of the IT performed by mothers of hospitalized infants due to acute respiratory infections, identifying possible mistakes. Method: 10 steps of an optimal IT were evaluated through a numerical scale previously designed, each step qualified with score 0 or 1 according to its accomplishment (maximum 10 points). The IT of each mother was evaluated and the correct accomplishment percentage of each step was calculated. Results: Mothers' IT scores presented a range of 4 to 10 points, where 12.5 percent reached the maximum score. The steps with the least accomplishment percentages were: appropriate waiting time between 2 inhalations (17.2 percent), performance of a second inhalation (83.6 percent) and holding the mouth and nose inside the inhalatory chamber for 10 seconds or 10 respiratory cycles once the inhalation had been administrated (89.1 percent). Conclusion: Although the majority of mothers had received IT instruction and are familiarized with it, certain steps are still performed in a deficient way, compromising the therapy success.

La calidad con que se realiza la técnica inhalatoria (TI) es un factor condicionante de su éxito terapéutico. Objetivo: Evaluar la calidad de la TI realizada por madres de lactantes hospitalizados por infecciones respiratorias agudas, identificando posibles errores. Pacientes y Métodos: Mediante una escala numérica previamente diseñada que incluyó 10 pasos de una TI óptima (calificada con puntaje 0 ó 1 según cumplimiento, puntaje máximo 10), se evaluó la TI de cada madre y el porcentaje de cumplimiento de cada paso. Resultados: El rango de calificaciones de las madres fue 4 a 10 puntos, obteniendo 12,5 por ciento el puntaje máximo. Los pasos que obtuvieron los menores porcentajes de cumplimiento fueron: tiempo de espera entre dos ciclos inhalatorios (17,2 por ciento), realización de un segundo ciclo inhalatorio (83,6 por ciento) y mantenimiento por 10 segundos o 10 respiraciones de la boca y nariz del lactante dentro de la aerocámara una vez administrada la inhalación (89,1 por ciento). Conclusión: A pesar de que la mayoría de las madres ha recibido instrucción y están familiarizadas con el uso de inhaladores, algunos pasos son realizados en forma deficiente por un elevado número de ellas, comprometiendo el éxito de la terapia.

Adherencia a las inmunizaciones en niños con necesidades de cuidado médico especial / Adherence to immunization among children with special health care needs

Los niños con necesidades de cuidado médico especial (NECMES) son una población creciente en pediatría y su riesgo de complicaciones asociadas a enfermedades infecciosas es alto. Objetivo. En niños con NECMES, describir la adherencia al Programa Nacional de Inmunizaciones (PNI) y al uso de vacunas adicionales recomendadas. Pacientes y Métodos. En forma retrospectiva se registró en niños con NECMES, hospitalizados: vacunas PNI administradas, retrasos y causas de éstos, prescripción y administración de vacunas adicionales. Resultados. Se analizaron 70 niños: 30 presentaron al menos un atraso en las vacunas PNI, 40,0 por ciento por hospitalizaciones previas, 26,7 por ciento por morbilidad menor y 20 por ciento por otras causas no justificadas. Se prescribió vacunas adicionales al PNI a 49 niños (70 por ciento) pero sólo 25 las recibieron. Conclusiones. Esta población presentó baja adherencia al esquema de vacunación PNI y extra PNI. Cualquier contacto con el personal de salud, incluyendo la hospitalización, debe constituir una oportunidad para actualizar las inmunizaciones.

The proportion of children with special health care needs (CSHCN) due to chronic illness is increasing. They have a high risk of complications due to infectious diseases. Objective. To describe adherence to the Expanded Program of Immunization (EPI) and administration of other expert recommended vaccines in CSHCN. Patients and methods. In a retrospective manner information on chronic disease, EPI vaccines administration, reasons for delays, prescription and administration of additionally recommended vaccines was registered in a cohort of hospitalized CSHCN. Results. Seventy children were analyzed. Thirty (42.9 percent) had at least one delay in EPI immunization schedule; 40 percent due to previous hospitalizations, 26.7 percent due to minor morbidity and 20 percent due to other unjustified reasons. Forty-nine (70.0 percent) received prescriptions for additional vaccines, but only 25 actually received them. Conclusions. CSHCN showed low adherence to EPI and received few additionally recommended vaccines. Every contact with these patients, including hospitalization should be used to update immunizations.

Age at onset of major depression in inner-city adults with asthma.

Depression generally begins before Type II diabetes and coronary artery disease; however, no data are available on whether asthma or major depressive disorder (MDD) have an earlier onset. The age at onset of asthma and depression were collected from 85 adult asthma patients with current MDD. The mean ages at onset of asthma and MDD were 21.0 years and 28.8 years, respectively. Asthma preceded MDD in 62% of cases; MDD preceded asthma onset in 24% of cases; and asthma and MDD had a concurrent onset in 14% of the cases. In asthma patients, unlike patients with Type II diabetes and coronary artery disease, depression appears generally to occur after the onset of asthma.

Test de estimulación intraarterial selectiva con calcio en el diagnóstico de localización de insulinomas: Casos clínicos / Selective intra arterial calcium stimulation for the localization of insulinomas: Report of two cases

Insulinoma is the most common neuroendocrine tumor. Its clinical manifestations are frequently confounded with neuropsychiatric symptoms, and definitive diagnosis can be delayed for a long time. These tumors are usually small, of less than 2 cm. Thus, their preoperative localization is difficult. We report two patients with a clinical diagnosis of insulinoma, in whom the preoperative imaging study was negative. Both fulfilled diagnostic criteria, with high serum insulin levels in the presence of a blood glucose of less than 45 mg/dl. The imaging study, including abdominal computed tomography and pancreatic endoscopic ultrasonography did not disclose the location of the tumor. A pancreatic angiography with selective stimulation with intra arterial calcium and venous sampling for insulin measurements, was performed in both patients. This test allowed the exact localization of the tumors and their successful excision. A review of other localization diagnostic tests is done (Rev Méd Chile 2004; 132: 71-5).

Remisión parcial del hipercortisolismo en una enfermedad de Cushing posterior a una apoplejia hipofisiaria: caso clínico / Partial remission of Cushing disease after pituitary apoplexy: report of 1 case

ACTH secreting macroadenomas and pituitary apoplexy are unusual in Cushing disease. In the few cases reported in the literature, they have been found in long term hypercortisolism. We communicate a 43 yr old woman with a 4 year evolution Cushing syndrome, who developed sudden cephalea and oftalmoplejia. A Computed Tomography of the pituitary fossa disclosed a macroadenoma with intracapsular hemorrhage and suprasellar expansion. In the functional tests, serum cortisol was suppressed with dexamethasone in a dose of 1 and 8 mg and responded to the desmopressin stimulus. Nevertheless, cortisol levels were lower than those observed in Cushing syndrome of similar magnitude. The tumor was resected by transphenoidal surgery and immunohistochemistry to ACTH was positive. In this case, the laboratory results suggest a partial remission of the hypercortisolism after pituitary apoplexy

Endocarditis infecciosa: factores pronósticos de mortalidad en 131 casos / Infectious endocarditis: prognostic factors of mortality in 131 cases

We followed during their hospital stay, 129 patients aged 14 to 74 years old, who had 131 episodes of infective endocarditis. Clinical assessment, echocardiography and microbiological study was done to all patients. Surgical indications were those derived from complications. Thirty three patients died during hospital stay (25.2 percent). There were no differences between survivors and deceased patients in the lapse between onset of symptoms and hospital admission, presence of fever, dyspnea or heart murmurs. Skin and mucosal septic manifestations occured with higher frequency in deceased patients (57.1 and 24.3 percent respectively). Blood cultures were positive in 55 percent in survivors and 48 percent in those who died. The most frequent infecting organisms were staphilococci and streptococci. Vegetations were found with greater frequency in aortic position in both groups of patients. Deceased patients had a higher frequency of cardiac failure (84 and 65 percent respectively) and embolic episodes (77 and 46 percent respectively) than survivors. Antimicrobial treatment was successfull in 94 percent of survivors and 15 percent of those who died. Forty percent of survivors and 54 percent of deceased patients were subjected to surgical procedures. The most important predictor of hospital mortality in this series of patients with infective endocarditis was antimicrobial treatment failure

Dietary fish oil reduces microthrombi over atherosclerotic lesions in hyperlipidemic swine even in the absence of plasma cholesterol reduction.

We have investigated in swine the effect of fish oil additives to a butter-cholesterol hyperlipidemic diet (BT) on atherogenesis and thrombogenesis when average plasma cholesterol levels were kept similar in fish oil-treated and untreated BT groups. The studies included evaluation of lesion sizes and cell numbers, counts of adherent monocytes over lesions, and counts of platelet clumps (microthrombi) over lesions either attached directly to endothelium or to adherent monocytes. Anatomic sites studied for lesion development were the left anterior descending coronary artery (LAD), the distal 1/5 of the abdominal aorta, and a proximal portion of the thoracic aorta. Counts of attached monocytes and platelet clumps were made by scanning electron microscopy only for the LAD and expressed per mm2 of surface. The most striking new result was in regard to the platelet clumps. These were reduced by the fish oil from 996 +/- 295/mm2 in the untreated BT group to 313 +/- 59 and 364 +/- 105 in BT+cod liver oil and BT+menhaden oil groups, respectively. Most of the platelet clumps were adherent to attached monocytes in all groups and the number of attached monocytes were greatly reduced by the fish oil additive. Thus there were close relationships among platelet clumps, monocytes, and lesion endothelium. Numbers of attachments over nonlesion endothelium were much less than those over lesions in all dietary groups. The most surprising result was the lack of retardation of lesion growth by the fish oil additives in spite of the reduction in attached monocytes and platelet clumps. In previous studies where the high plasma cholesterol levels in the BT swine had been modestly reduced (about 25%) there had been a marked retardation of lesion growth. The current result suggests that plasma cholesterol is the major factor controlling lesion growth in this model through under milder conditions and longer observation periods other factors might become apparent.

Primary gastric adenosarcoma.

We describe the first case, to our knowledge, of a primary gastric adenosarcoma surgically resected from a 46-year-old white man. This biphasic neoplasm, well described in the female genital tract, was composed of cytologically benign tubular and cystic glands widely dispersed within a sarcomatous stromal component. Immunohistochemically, the epithelial elements were positive for cytokeratin, while the stromal elements were positive for vimentin and desmin. The clinical and pathologic features of pelvic adenosarcomas are described and compared with the tumor of the stomach. Although accurate prediction of the biologic behavior of this gastric neoplasm is difficult, the high mitotic rate in the sarcomatous component and the infiltration of the gastric serosal surface by the tumor were considered to be ominous prognostic features.

DNA ploidy of oncocytic-granular renal cell carcinomas and renal oncocytomas by image analysis.

DNA ploidy analysis of five renal oncocytomas, six pure oncocytic-granular renal cell carcinomas, 15 pure clear cell renal carcinomas, and two cases of mixed oncocytic-granular and clear cell heterogenous renal cell carcinomas were determined on Feulgen-stained paraffin sections using the (CAS-200 image Analyzer). All five renal oncocytomas were diploid, as were six oncocytic-granular renal cell carcinomas. Three of the 15 clear renal cell carcinomas were aneuploid. In one heterogeneous renal cell carcinoma, the oncocytic-granular foci were diploid and the clear cell focus was aneuploid. The other heterogeneous renal cell carcinoma was uniformly diploid. In 21 renal cell carcinomas, one of 14 stage I tumors was aneuploid, all four stages II and III tumors were diploid, and two of three stage IV cases were aneuploid. All stages I, II, and III patients were free of disease 3 to 48 months after surgery. All three stage IV cases were dead of their disease within 36 months of surgery. We conclude that DNA analysis by image cytometry best identifies the heterogeneity of ploidy patterns in mixed cell type carcinomas, generally correlates with the stage of disease, and may be of value in predicting overall prognosis of renal epithelial neoplasms. DNA analysis by image cytometry, however, did not reveal significant differences between oncocytic granular cell carcinoma and oncocytoma, since both lesions were generally diploid. The distinction between the two tumors is best made on morphologic grounds.

Melanized and non-melanized multicellular form mutants of Wangiella dermatitidis in mice: mortality and histopathology studies.

One melanized (Mc3) and one non-melanized (Mc3W) multicellular form mutant of W. dermatitidis were compared with parental wild type in NYLAR mice. Each mutant grows as multicellular (muriform-like) forms in vitro at 37 degrees C and as yeasts at less than or equal to 30 degrees C. Yeast cells of all three strains were injected intravenously at concentrations of 1 x 10(4), 1 x 10(6), 1 x 10(7), 3 x 10(7) and 1 x 10(8) cells/mouse in groups of 10 mice. There was no virulence difference between wild type and Mc3, with 100% mortality obtained with each strain at greater than or equal to 1 x 10(7) cells/mouse. In contrast, Mc3W was less virulent, with mortality being obtained only at 1 x 10(8) cells/mouse. Histopathological study of brains, lungs, livers and spleens of moribund mice revealed that both Mc3 and Mc3W persisted in tissue as muriform cells, and in some cases as yeast, pseudohyphal and hyphal forms. There was no major difference between Mc3 and Mc3W in terms of histopathological response. These data support the association between melanin and virulence in W. dermatitidis and provide a model for the study of muriform cells in vivo.

Primary hepatic leiomyosarcoma in a child with the acquired immunodeficiency syndrome.

We report the first case of acquired immunodeficiency syndrome (AIDS)-related primary hepatic leiomyosarcoma in a 9-year-old girl. The pathologic diagnosis was made on a partial hepatectomy specimen and was confirmed by immunohistochemistry and electron microscopy. No human immunodeficiency virus-related nucleic acid was identified in tumor cells by in situ hybridization. Review of the AIDS-related literature reveals a rising incidence of tumors of smooth muscle origin in human immunodeficiency virus-infected patients. This case study details the eighth pediatric AIDS patient with a tumor of smooth muscle origin and represents the 20th and the youngest patient with primary hepatic leiomyosarcoma to be reported in the world literature.

Image analysis quantitation of immunoreactive retinoblastoma protein in human thyroid neoplasms with a streptavidin-biotin-peroxidase staining technique.

Studies investigating the molecular pathogenesis of common thyroid neoplasms have shown altered expression and/or structure of proto-oncogenes, G-proteins, and growth factors. Growth suppressor genes, genomic DNA segments that code for proteins believed to function as growth suppressors, have not been evaluated for a potential role in the pathogenesis of thyroid neoplasms. The retinoblastoma gene (RB1) maps to chromosome 13q14 and encodes a 110 kilodalton variably phosphorylated nuclear protein (Rb) that functions as a growth suppressor in a wide variety of human tissues. The frequent association of Rb protein loss with multiple neoplasms has prompted the authors to apply a specific and rapid immunohistochemical technique using streptavidin-biotin-peroxidase technology evaluated by image analysis that can be used to quantitate the level of immunoreactive Rb protein (iRb) in thyroid neoplasms. In utilizing streptavidin-biotin technology for nuclear iRb detection, artifacts that can be associated with the use of avidin such as nonspecific binding at physiologic pH and nonspecific complex formation with cellular components including chromatin are avoided. By this method, positive nuclear staining for iRb in the follicular cells of three follicular adenomas and in CV-1 control cells known to express Rb was demonstrated. Two papillary carcinomas, two medullary carcinomas and a SAOS-2 cell line known to produce a defective form of Rb stained at significantly lower levels (P less than .001). The authors conclude that the streptavidin-biotin-peroxidase staining technique evaluated by image analysis is a sensitive and specific detection system for nuclear iRb studies; has significant advantages over previously used techniques; and that thyroid neoplasms may variably express iRb which may, in part, reflect their variable pathogenesis.