Experimental design and field deployment of an artificial bio-reef produced by mollusk shell recycling.

Shellfish farming is considered a highly sustainable form of aquaculture that has developed rapidly worldwide. Unfortunately, today biological and chemical pollution of the oceans and marine waters is widespread and has multiple negative impacts on marine ecosystems, which are exacerbated by global climate changes. In addition, such impacts on fisheries and aquaculture are significant in inducing socio-economic losses. Therefore, it is necessary to develop innovative solutions to improve productivity and environmental performance in line with the blue sustainable economy (European Green Deal). However, one upcoming problem associated with shellfish consumption is shell waste and its disposal. In addition, the percentage of wasted shells destined for reuse is much lower than the one accumulated in landfills or in more or less well-managed sites. This represents a weakness of the shellfish farming sector that can only be mitigated through a project of shellfish waste recycling moving towards the circular economy, with undoubted environmental and economic advantages. In the present study, we present a possible solution for recycling clam shells coming from the waste of the fishing industry (circular economy). Indeed, three eco-friendly bio-reefs for the stabilization and implementation of marine biodiversity (blue economy) were realized using additive manufacturing technology (3D printing) for large dimensions (technological innovation). Furthermore, before deploying the reefs on the sea bottom, they were colonized with oysters to promote repopulation.

An intelligent clustering method for devising the geochemical fingerprint of underground aquifers.

Geochemical fingerprinting is a rapidly expanding discipline in the earth and environmental sciences, anchored in the recognition that geological processes leave behind physical, chemical and sometimes also isotopic patterns in the samples. Furthermore, the geochemical fingerprinting of natural cycles (water, carbon, soil and biota fingerprinting) are influenced by the anthropogenic impact and by the climate change. So, their monitoring is a tool of resilience and adaptation. In recent years, computational statistics and artificial intelligence methods have started to be used to help the process of geochemical fingerprinting. In this paper we consider data from 57 wells located in the province of Ferrara (Italy), all belonging to the same geological group and separated into 4 different aquifers. The aquifer from which each well extracts its water is known only in 18 of the 57 cases, while in other 39 cases it can be only hypothesized based on geological considerations. We devise a novel technique for geochemical fingerprinting of groundwater by means of which we are able to identify the exact aquifer from which a sample is extracted with a sufficiently high accuracy. Then, we experimentally prove that out method is sensibly more accurate than typical statistical approaches, such as principal component analysis, for this particular problem.

Curva de aprendizaje para el diagnóstico ecográfico específico de masas anexiales / Learning curve for the specific ultrasound diagnosis of adnexal masses

OBJETIVO: Determinar el tiempo que requiere una curva de aprendizaje para diagnóstico ecográfico específico histopatológico en masas anexiales basándonos en cálculos estadísticos no influidos por la prevalencia según diferentes grados de experiencia. MÉTODOS: Estudio observacional, descriptivo, transversal. Se estudiaron imágenes de 108 masas anexiales. La prueba estándar de oro fue el reporte histopatológico definitivo. Se comparó el rendimiento diagnóstico de 4 examinadores con la siguiente experiencia en diagnóstico ecográfico de patología anexial: A > 20 años, B ≤ 20 hasta > 10 años, C ≤ 10 hasta > 5 años y D ≤ 5 años, analizando solo imágenes y sin datos clínicos de las pacientes, para emitir un diagnóstico específico a libre escritura. RESULTADOS: Prevalencia de masas malignas 17,2 % (15/87). Nivel de confianza en los examinadores se consideró según falta de respuesta diagnóstica: alto (<6 %) con experiencia de más de 10 años y moderado a bajo ≤ 10 años. Examinadores con más de 5 años siempre mostraron likelihood ratio positivo mayor a 10, exactitud diagnóstica mayor a 90 % y Odds ratio diagnóstica mayor a 46, no así para examinador con menor tiempo de experiencia, quién presentó resultados con mala utilidad clínica. El cambio de probabilidad de acierto específico pre-test a post-test mejoró consistentemente con los años de experiencia. CONCLUSIÓN: Se necesitarían más de 10 años de experiencia con especial dedicación a ecografía ginecológica avanzada para un rendimiento diagnóstico específico deseado junto con alta confianza en ecografía de masas anexiales.

OBJECTIVE: To determine the time required for a learning curve of histopathological specific ultrasound diagnosis in adnexal masses based on statistical calculations not influenced by prevalence according to different degrees of experience. METHODS: Observational, descriptive, cross-sectional study. Images of 108 adnexal masses were studied. The gold standard test was the definitive histopathological report. The diagnostic performance of 4 examiners with the following experience in ultrasound diagnosis of adnexal pathology: A > 20 years, B ≤ 20 to > 10 years, C ≤ 10 to > 5 years and D ≤ 5 years was compared, analyzing only images and blinded of clinical data of the patients, to issue a specific diagnosis with free writing. RESULTS: Prevalence of malignant masses 17.2% (15/87). The level of confidence in the examiners was considered according to the lack of diagnostic response: high (<6%) with experience of more than 10 years and moderate to low ≤ 10 years. The examiners with more than 5 years always showed likelihood ratio positive greater than 10, diagnostic accuracy greater than 90% and diagnostic Odds ratio greater than 46, not so for the examiner with less experience time who presented results with little clinical utility. The change in specific probability from pre-test to post-test improved consistently with years of experience. CONCLUSION: More than 10 years of experience with special dedication to advanced gynecological ultrasound are probably needed for a desired specific diagnostic performance coupled with high confidence in adnexal mass ultrasound.

GIRADS: método de clasificación de masas anexiales, revisión sistemática y metanálisis. 10 años de experiencia / GIRADS: adnexal masses classification method, systematic review and metanalysis. 10 years of experience

OBJETIVO: evaluar la experiencia en la utilización del método GIRADS para clasificar masas anexiales a diez años de su primera publicación. MÉTODO: Se realizó búsqueda de estudios que utilizan el sistema GIRADS: Medline (Pubmed), Google Scholar y Web of Science, desde enero de 2009 hasta diciembre de 2019. Se calculó la sensibilidad y especificidad agrupada, Likelihood ratio (LR) (+) y LR (-) y Odds ratio de diagnóstico (DOR). La calidad de los estudios se evaluó con QUADAS-2. RESULTADOS: Se identificaron 15 estudios y se incluyeron 13 de ellos con 4473 masas, 878 de ellas malignas. La prevalencia media de malignidad ovárica fue del 23 % y la agrupada de 19.6%. El riesgo de sesgo fue alto en cuatro estudios para el dominio "selección de pacientes" y fue bajo en todos en todos los estudios para los dominios "prueba índice" y "prueba de referencia". La sensibilidad, especificidad, LR (+) y LR (-) agrupadas y el DOR del sistema GIRADS para clasificar las masas anexiales fueron: 96.8% (intervalo de confianza [IC] 95% = 94% - 98%), 91.2 % (IC 95 % = 85% - 94%), 11.0 (IC 95% = 6.9 -13.4) y 0.035 (IC 95% = 0.02- 0.09), y 209 (IC 95% = 99-444), respectivamente. La heterogeneidad fue alta para la sensibilidad y especificidad. De acuerdo a la metaregresión, la heterogeneidad entre los estudios se explica por la prevalencia de malignidad, múltiples observadores y la ausencia de diagnóstico histopatológico para todos los casos incluidos en un determinado estudio. CONCLUSIÓN: el sistema GIRADS tiene un buen rendimiento diagnóstico para clasificar masas anexiales.

OBJECTIVE: to evaluate the experience of using GIRADS method to classify adnexal masses ten years after its publication. METHOD: A search was carried out for studies reporting on the use of the GIRADS system in the Medline (Pubmed), Google Scholar and Web of Science databases, from January 2009 to December 2019. Pooled sensitivity and specificity, Likelihood ratio (LR) (+) and LR (-) and Diagnostic Odds ratio (DOR) were calculated. The quality of the studies was assessed by QUADAS-2. RESULTS: 15 studies were identified, and 13 of them were included with 4473 masses, of which 878 were malignant. The mean prevalence of ovarian malignancy was 23% and the prevalence pooled. of 19.6%. The risk of bias was high in four studies for the domain 'patient selection' and low for all studies for the domains 'index test' and 'reference test'. The sensitivity, specificity, pooled LR (+) and LR (-) and the DOR of the GIRADS system to classify adnexal masses were 96.8% (95% confidence interval [CI] = 94% -98%), 91.2 % (95% CI = 85% -94%), 11.0 (95% CI = 6.9-13.4) and 0.035 (95% CI = 0.02-0.09), and 209 (95% CI = 99-444), respectively. Heterogeneity was high for both sensitivity and specificity. According to meta-regression, this heterogeneity was explained by the prevalence of malignancy, the use of multiple observers, and the absence of histopathological diagnosis for all cases included in a given study. CONCLUSION: the GIRADS system has a good diagnostic performance to classify adnexal masses.

Benquerencia (La Serena - Spain) rock art: An integrated spectroscopy analysis with FTIR and Raman.

La Serena region is a large plateau with open landscapes bounded in the south by a mountain chain formed by the Benquerencia, Tiros and La Rinconada Sierras. There are more than 300 painted and engraved sites in the region. Cueva Grande, Cueva de En medio and Cueva Pequeña are three Schematic rock art shelters located in the municipality of Benquerencia de la Serena, Badajoz, Spain. Over their panels have been documented more than a hundred of painted schematic figures (anthropomorphic figures, eye-shape figures and symbols) (Neolithic - Copper Age). Paintings are monochromatic with red or black coloration. A total of 13 samples (10 red and 3 black samples) from different panels were collected and analyzed using micro-Raman spectroscopy and ATR-FTIR. Micro-Raman spectroscopy was able to characterize the main mineral component, respectively hematite for the red figures and charcoal for the black paintings. ATR-FTIR was useful to possible ochre and possible organic identification. These latest results are particularly important for understanding manufacturing processes and addressing conservation problems.

Stroke units in Italy: engaging the public in optimizing existing resources.

BACKGROUND AND PURPOSE: The lack of a wide implementation of stroke units (SU)s in Italy appears to accompany the underuse of the operating units. Community awareness of acute stroke care options may affect stroke resource use. Our aim was to determine the level of knowledge about SUs and tissue-plasminogen activator (t-PA) treatment amongst Italian adults and investigate its relationship to local stroke services implementation. METHODS: A nation-based telephone survey was carried out in a sample of 1000 residents aged >18 years in May-June 2010. The questionnaire included close-ended questions regarding knowledge of SUs and t-PA treatment. Number and location of both SUs and t-PA treatments were provided by a concurrent national hospital-based survey. The prevalence and distribution of acute stroke care awareness in the community was examined and multivariate analyses were generated. RESULTS: Amongst the 1000 participants (474 men, mean age 48.8 ± 17.2), only 26.2% reported knowing about the availability of t-PA treatment and only 15% were aware of the existence of SUs. Awareness of both SUs and t-PA was significantly associated only with education. These associations remained significant in the multivariate analyses. The degree of stroke services implementation (in terms of SUs/inhabitant rates and number of t-PA treatments) was not associated with SU and t-PA awareness. CONCLUSIONS: This is the first European study that explored public knowledge about t-PA treatment and SUs. Italian adults proved insufficiently educated about SUs and t-PA; there is no higher awareness in areas with a greater supply of stroke services. This might partially explain the underuse of Italian SUs.

Validation of automatic contour propagation for 4D treatment planning using multiple metrics.

The aim of this work is to provide insights into multiple metrics clinical validation of deformable image registration and contour propagation methods in 4D lung radiotherapy planning. The following indices were analyzed and compared: Volume Difference (VD), Dice Similarity Coefficient (DSC), Positive Predictive Value (PPV) and Surface Distances (SD). The analysis was performed on three patient datasets, using as reference a ground-truth volume generated by means of Simultaneous Truth And Performance Level Estimation (STAPLE) algorithm from the outlines of five experts. Significant discrepancies in the quality assessment provided by the different metrics in all the examined cases were found. Metrics sensitivity was more evident in presence of image artifacts and particularly for tubular anatomical structures, such as esophagus or spinal cord. Volume Differences did not account for position and DSC exhibited criticalities due to its intrinsic symmetry (i.e. over- and under-estimation of the reference contours cannot be discriminated) and dependency on the total volume of the structure. PPV analysis showed more robust performance, as each voxel concurs to the classification of the propagation, but was not able to detect inclusion of propagated and ground-truth volumes. Mesh distances could interpret the actual shape of the structures, but might report higher mismatches in case of large local differences in the contour surfaces. According to our study, the combination of VD and SD for the validation of contour propagation algorithms in 4D could provide the necessary failure detection accuracy.

The MSH2 c.388_389del mutation shows a founder effect in Portuguese Lynch syndrome families.

The MSH2 c.388_389del mutation has occasionally been described in Lynch families worldwide. At the Portuguese Oncology Institute in Porto, Portugal, we have identified 16 seemingly unrelated families with this germline mutation. To evaluate if this alteration is a founder or a recurrent mutation we performed haplotype analysis in the 16 Portuguese index cases and 55 relatives, as well as in four index cases and 13 relatives reported from Germany, Scotland, England, and Argentina. In the Portuguese families we observed a shared haplotype of approximately 10 Mb and all were originated from the north of Portugal. These results suggest that this alteration is a founder mutation in Portugal with a relatively recent origin. In the reported families outside Portugal with this mutation different haplotype backgrounds were observed, supporting the hypothesis that it occurred de novo on multiple occasions. We also conclude that the high proportion of families with the MSH2 c.388_389del mutation indicates that screening for this alteration as a first step may be cost-effective in the genetic testing of Lynch syndrome suspects of Portuguese ancestry, especially those originating from the north of Portugal.

Diagnóstico ecográfico de la disfunción del eje hipotálamo-hipófisis-ovario-útero: propuesta de estudio / Dysfunction of the hypothalamic-pituitary-ovarian-uterus axis: ultrasound diagnosis

Transvaginal ultrasound is the gold standard for the evaluation of the structural gynecological pathology both benign and malignant, with optimal performance. Currently the functional gynecological pathology is, usually not considered in the routine ultrasound study. This leads to a sub diagnosis of frequent pathologies, for example metrorrhagia or amenorrhea. It is feasible, after discarding the organic possibilities, and relating sonographic markers specific to the clinical status, to achieve an orientation about the origin of the dysfunction of the hypothalamic-pituitary-ovarian-uterus axis.

La ecografía transvaginal es el gold standard para la evaluación de la patología ginecológica estructural tanto benigna como maligna con óptimo rendimiento. Actualmente, la patología ginecológica funcional habitualmente no forma parte del estudio ultrasonográfico de rutina lo que lleva a un subdiagnóstico de patologías frecuentes como por ejemplo metrorragias o amenorreas. Es factible, descartando los cuadros orgánicos y relacionando marcadores ecográficos específicos con el cuadro clínico, lograr una orientación sobre el origen de la disfunción del eje hipotálamo-hipófisis-ovario-útero.

Resonancia magnética nuclear con difusión: una nueva alternativa para valorar la respuesta patológica a la neoadyuvancia por cáncer de recto

Antecedentes: En la re-estadificación post-neoadyuvancia del cáncer de recto existen discrepancias clínico-patológicas y actualmente no existen métodos complementarios útiles para diferenciar la presencia o ausencia de tumor viable. Objetivo: Determinar el valor de la resonancia nuclear magnética con técnica de difusión en la identificación de la respuesta patológica completa luego de la neoadyuvancia y determinar su relación con el grado de respuesta clínica. Lugar de aplicación: Hospital Privado de la Comunidad. Diseño: Retrospectivo Población: 24 pacientes (10 mujeres), mediana de edad: 61 años, operados por cáncer de recto entre junio 2009 y enero 2011. Medidas de evaluación: De acuerdo a la respuesta clínica, fueron agrupados en Respondedores y No Respondedores. Todo valor de coeficiente de difusión aparente mayor a 1.2 x 10-3 mm²/seg fue considerado como respuesta patológica completa. Resultados: La mediana del coeficiente de difusión aparente fue de 1.1 (rango 0.7-2). En 4 casos (17%) se obtuvieron valores de coeficiente de difusión aparente mayores a 1.2 y fueron considerados como respuesta patológica completa. La mediana de coeficiente de difusión aparente en los casos con respuesta patológica completa fue significativamente mayor que la de los casos sin respuesta patológica completa (1.45 vs 1.01 respectivamente, p = 0.0002). De los 24 pacientes, 5 (21%) correspondieron al grupo de respuesta clínica. De ellos, 4 tuvieron una respuesta patológica completa. La resonancia nuclear magnética con técnica de difusión logró identificar estos 4 casos. En el paciente de este grupo que presentaba persistencia tumoral, el valor de coeficiente de difusión aparente fue de 1.1. De esta manera la resonancia nuclear magnética con técnica de difusión logró identificar al único caso en que se justificaría una cirugía radical. De los 19 pacientes que fueron considerados no respondedores, ninguno tuvo respuesta patológica completa. En todos estos casos los índices de coeficiente de difusión aparente fueron menores a 1.2 x 10-3 mm²/seg y en consecuencia no hubo ningún caso de falso negativo. Conclusiones: La resonancia nuclear magnética con técnica de difusión es una herramienta útil para la reestadificación post-neoayuvancia en cáncer de recto.

Background: There exist clinical-pathological discrepancies at the staging after neoadyuvant therapy of rectal cancer, and there are currently no additional useful methods to distinguish the presence or absence of viable tumor. Objective: To determine the value of magnetic resonance diffusion imaging technique in the identification of the pathological complete response after the neoadyuvant therapy and to determine its relationship with the degree of clinical response. Setting: Private Community Hospital. Design: Retrospective Population: 24 patients (10 women), median age: 61, operated on for rectal cancer from June 2009 to January 2011. Outcome measures: According to the clinical response, patients grouped in responders and non-responders. All apparent diffusion coefficient value greater than 1.2 x 10-3 mm²/seg was regarded as pathological response. Results: Median of apparent diffusion coefficient was 1.1 (0.7 and 2 range). In 4 cases (17 per cent) the apparent diffusion coefficient was greater than 1.2 x 10-3 mm², and were regarded as pathological complete. The medianm of apparent diffusion coefficien in cases with complete pathological response was significantly higher than the cases without pathological complete response (1.45 vs 1.01 respectively, p = 0.0002). Five out of 24 patients (21%) corresponded to the group in clinical response. Of these, 4 were n pathological compete response. The magnetic resonance imaging technique was able to identify these 4 cases. In the patient of this group which featured tumor persistence, the apparent diffusion coefficient value was 1.1. Thus the magnetic resonance diffusion imaging technique was able to identify the only case in which a radical surgery would be justified. Among the19 Patients were considered non-responders, none had pathological complete response. In all these cases apparent diffusion coefficient rates were lower to 1.2 x 10-3 mm²/ sec and therefore there was no case of false negative. Conclusions: The magnetic resonance diffusion technique is a useful tool for the staging after neoayuvant therapy in rectal cancer.

[Health-related quality of life in patients with rheumatoid arthritis: assessment by a Italian version of the Arthritis Impact Measurement Scales, Version 2 (AIMS2)]. / La qualità della vita dei pazienti con artrite reumatoide: valutazione mediante la versione italiana del questionario Arthritis Impact Measurement Scales 2 (AIMS2).

The research carried out by Censis Foundation, in collaboration with SIR (Italian Society of Rheumatology) and ANMAR (National association of rheumatic patients) involved 646 patients, diagnosed with rheumatoid arthritis (RA) by a rheumatologist according to ACR criteria. The patients were recruited through a representative sample of 300 general practitioners (GP). A cross-sectional survey was conducted to study the current status of health-related quality of life (HRQL) of patients using a revised Italian version of a revised version of the Arthritis Impact Measurement Scales 2 (AIMS2). The AIMS2 was administered to the 646 patients with (RA) attending arthritis clinics at various hospitals across the country. Self-report functional disability scores were calculated for all 12 specific scales, summary components, and overall impact measures. The AIMS2 has been validated for the Italian language. Ranging from 0 (perfect health) to 10 (poor health), the mean scores of the AIMS2 showed an important impact of the disease on the 4 components of the health status of these patients: walking and bending, mean score = 5.1; nervous tension = 5.0, arthritis pain = 5.0, and social activity = 4.6. Among other dimensions, the impact of RA was moderate for mood, work, hand and finger function and mobility (mean score: 3.7, 3.7, 3.5 and 3.4, respectively) and low for household tasks, arm function, self-care tasks and family support (3.0, 2.9, 2.5 and 2.1, respectively). There was a tendency for the scores of younger patients to be better than those of olders patients. In conclusion, RA have a clearly detrimental effect on the HRQL in both physical and mental components. Prevention and management of physical disability should be seriously planned in consideration of the changes in these conditions in RA patients. Use of the AIMS2 makes it easier and less costly to collect data and reduces the burden on RA patients.

[Socio-demographic aspects and therapeutic pathways in patients with rheumatoid arthritis in Italy]. / Aspetti socio-demografici e modalità di accesso alle terapie farmacologiche in pazienti con artrite reumatoide in Italia.

The research carried out by Censis Foundation, in collaboration with SIR (Italian Society of Rheumatology) and ANMAR (National Association of Rheumatic patients), with the sponsorship of Roche S.p.A., involved more than 600 patients, diagnosed with arthritis by a rheumatologist according to ACR criteria. The patients were recruited through a representative sample of 300 general practitioners. A number of different research and survey tools were used to collect data, helping to identify several of the problems that affect Italian patients: a survey form to be filled by the GPs, in order to verify the diagnosis and the comorbidity level; a questionnaire for the self-assessment of the disease activity, Rheumatoid Arthritis Disease Activity Index (RADAI), and a sociological questionnaire set up for the analysis of the main aspects of the patients' path. Among the most serious criticalities found, the difficulties and the time needed for the patients to get a clear AR diagnosis, the problems in interacting with health structures, and the differences in accessing pharmaceutical therapies (only a slight majority of patients use DMARDs drugs, a small amount takes biological drugs, while a large number of patients is treated exclusively with symptomatic drugs) stand out. The differences in patients' condition appear then to be exaggerated, regarding the chances to get an early diagnosis, the access path to specialised centres, and in receiving the most appropriate treatments. Moreover, these differences appear to be strongly dependent on both the social characteristics of the patients and the supply arrangement in their area.

Cirugía colorrectal laparoscópica: Resultados a corto plazo en una serie de 300 pacientes / Laparoscópica recto colonic surgery: Short term results in a series of 300 patients

Antecedentes: La cirugía laparoscópica ha modificado el manejo de la patología colorrectal. Objetivo: Analizar los resultados a corto plazo obtenidos con el abordaje laparoscópico de la patología colorrectal. Lugar de aplicación: Sección de coloproctología, Hospital Privado. Diseño: Cohorte, retrospectivo. Población: 300 pacientes (mediana de edad 62 años, 51,4% de mujeres) tratados mediante abordaje laparoscópico entre marzo de 2003 y abril 2007. Método: Análisis de una base de datos prospectiva. Conversión, readmisión hospitalaria y complicaciones posoperatorias fueron analizadas en base a las características demográficas, tipo de procedimiento efectuado y curva de aprendizaje. Se realizó un análisis multivariado para detectar factores asociados a conversión. Resultados: Conversión global: 15%. La resección anterior mostró un índice de conversión significativamente mayor al del resto de los procedimientos (29%, p=2.02). No observamos diferencias a lo largo de nuestra curva de aprendizaje, a excepción de una disminución del tiempo operatorio. Estadía hospitalaria: 3 días. Morbilida global: 19,6%. Las complicaciones postoperatorias más frecuentes fueron el íleo (9%), la infección de herida (2,3%) y la fístula anastomótica (1,3%). Mortalidad: 0.6%. Los hombres se convirtieron del doble que las mujeres (p=0.01) y se complicaron más (p=0.006). El sexo, el IMC y el tipo de procedimiento resultaron ser actores asociados a conversión. Conclusiones: La cirugía laparoscópica ha logrado trasladar los beneficios del abordaje nininvasivo al manejo de la patología colorrectal. Distintos factores pueden modificar sus resultados a corto plazo, especialmente en términos de conversión. El conocimiento de éstos puede contribuir a una adecuada selección de los casos.

Cirugía colorrectal laparoscópica: Resultados a corto plazo en una serie de 300 pacientes / Laparoscópica recto colonic surgery: Short term results in a series of 300 patients

Antecedentes: La cirugía laparoscópica ha modificado el manejo de la patología colorrectal. Objetivo: Analizar los resultados a corto plazo obtenidos con el abordaje laparoscópico de la patología colorrectal. Lugar de aplicación: Sección de coloproctología, Hospital Privado. Diseño: Cohorte, retrospectivo. Población: 300 pacientes (mediana de edad 62 años, 51,4% de mujeres) tratados mediante abordaje laparoscópico entre marzo de 2003 y abril 2007. Método: Análisis de una base de datos prospectiva. Conversión, readmisión hospitalaria y complicaciones posoperatorias fueron analizadas en base a las características demográficas, tipo de procedimiento efectuado y curva de aprendizaje. Se realizó un análisis multivariado para detectar factores asociados a conversión. Resultados: Conversión global: 15%. La resección anterior mostró un índice de conversión significativamente mayor al del resto de los procedimientos (29%, p=2.02). No observamos diferencias a lo largo de nuestra curva de aprendizaje, a excepción de una disminución del tiempo operatorio. Estadía hospitalaria: 3 días. Morbilida global: 19,6%. Las complicaciones postoperatorias más frecuentes fueron el íleo (9%), la infección de herida (2,3%) y la fístula anastomótica (1,3%). Mortalidad: 0.6%. Los hombres se convirtieron del doble que las mujeres (p=0.01) y se complicaron más (p=0.006). El sexo, el IMC y el tipo de procedimiento resultaron ser actores asociados a conversión. Conclusiones: La cirugía laparoscópica ha logrado trasladar los beneficios del abordaje nininvasivo al manejo de la patología colorrectal. Distintos factores pueden modificar sus resultados a corto plazo, especialmente en términos de conversión. El conocimiento de éstos puede contribuir a una adecuada selección de los casos.(AU)

Diagnóstico muy precoz de siameses: caso clínico y revisión de la literatura / Early diagnosis of conjoined twins: clinical case and literature review

We report a clinical case in which an early ultrasound diagnosis of retained abortion of thoracoomphalopagus siamese twins is performed by embryonic biometry at 9.5 weeks of gestation. 2D and 3D images clearly illustrate the condition and the accuracy of prompt diagnosis of a disease with such a low prevalence among the world population.

Se reporta caso clínico en el cual se realiza el diagnóstico ecográfico precoz de aborto retenido de siameses tóraco onfalópagos de 9 1/2 semanas por biometría embrionaria. Destacables son las imágenes 2D y 3D que ilustran claramente la condición y la precocidad del diagnóstico de una patología tanpoco prevalente en la población mundial.

Carcinomatosis peritoneal: resultados quirúrgicos de la cirugía de citorreducción y quimioterapia / Peritoneal carcinomatosis: results of surgical cytoreduction surgery and chemotherapy

Objetivo: Presentar la experiencia preliminar en el tratamiento de la carcinomatosis peritoneal de origen gastrointestinal y ginecológico. Métodos: El estudio incluye 11 pacientes portadores de carcinomatosis, tratados por medio de citorreducción y quimioterapia hipertérmica intraoperatoria y operados entre enero del 2005 y enero del 2008. Resultados: La mediana de edad de los pacientes fue de 50 años (rango = 22-56) y pertenecieron al sexo masculino el 54.5%. La mediana de duración del procedimiento citorreductivo fue de 630 min (rango 205-840). La citorreducción completa fue obtenida en el 54,6% (6/11) de los pacientes. La mediana de órganos resecados por paciente fue 4 (rango = 2 - 5) y la mediana de peritonectomia por paciente fue de 3 (rango = 0-6). Las drogas utilizadas para el baño hipertérmico fueron la Mitomicina C en las carcinomatosis por cancer de colon y del apéndice y el Cisplatino en carcinomatosis por cáncer de ovario. El tiempo d irrigación fue de 90 min y la mediana de la temperatura alcanzada fue de 41º C (39ºC - 43ºC). La mortalidad posoperatoria fue del 9,1% (1/11) y la morbilidad del 63,6% (7/11). La mediana de internación fue de 10 días (4-67), en los pacientes complicados la media de internación fue de 44 días para las severas y de 9 días para las leves. La supervivencia libre de tumor fue del 30% (mediana de seguimiento de 8,3 meses).

Rol actual de la ultrasonografía en el diagnóstico del embarazo ectópico / Current role of ultrasonography in ectopic pregnancy diagnosis

We analyze the use of transvaginal bidimensional ultrasound technique in ectopic pregnancy diagnosis and its expected results, provided that current ultrasonic criteria, in association with the beta-HCG, are properly applied.

Se analiza el uso de la ultrasonografía bidimensional transvaginal en el diagnóstico del embarazo ectópico y los resultados esperables si se aplican correctamente los criterios ultrasónicos actuales, en asociación con la bHCG.