Changes in inundation drive carbon dioxide and methane fluxes in a temperate wetland.

Wetlands cycle carbon by being net sinks for carbon dioxide (CO2) and net sources of methane (CH4). Daily and seasonal temporal patterns, dissolved oxygen (DO) availability, inundation status (flooded or dry/partially flooded), water depth, and vegetation can affect the magnitude of carbon uptake or emissions, but the extent and interactive effects of these variables on carbon gas fluxes are poorly understood. We characterized the linkages between carbon fluxes and these environmental and temporal drivers at the Old Woman Creek National Estuarine Research Reserve (OWC), OH. We measured diurnal gas flux patterns in an upstream side channel (called the cove) using chamber measurements at six sites (three vegetated and three non-vegetated). We sampled hourly from 7 AM to 7 PM and monthly from July to October 2022. DO concentrations and water levels were measured monthly. Water inundation status had the most influential effect on carbon fluxes with flooded conditions supporting higher CH4 fluxes (0.39 µmol CH4 m-2 s-1; -1.23 µmol CO2 m-2 s-1) and drier conditions supporting higher CO2 fluxes (0.03 µmol CH4 m-2 s-1; 0.86 µmol CO2 m-2 s-1). When flooded, the wetland was a net CO2 sink; however, it became a source for both CH4 and CO2 when water levels were low. We compared chamber-based gas fluxes from the cove in flooded (July) and dry (August) months to fluxes measured with an eddy covariance tower whose footprint covers flooded portions of the wetland. The diurnal pattern of carbon fluxes at the tower did not vary with changing water levels but remained a CO2 sink and a CH4 source even when the cove where we performed the chamber measurements dried out. These results emphasize the role of inundation status on wetland carbon cycling and highlight the importance of fluctuating hydrologic patterns, especially hydrologic drawdowns, under changing climatic conditions.

Vertical Hydrologic Exchange Flows Control Methane Emissions from Riverbed Sediments.

CH4 emissions from inland waters are highly uncertain in the current global CH4 budget, especially for streams, rivers, and other lotic systems. Previous studies have attributed the strong spatiotemporal heterogeneity of riverine CH4 to environmental factors such as sediment type, water level, temperature, or particulate organic carbon abundance through correlation analysis. However, a mechanistic understanding of the basis for such heterogeneity is lacking. Here, we combine sediment CH4 data from the Hanford reach of the Columbia River with a biogeochemical-transport model to show that vertical hydrologic exchange flows (VHEFs), driven by the difference between river stage and groundwater level, determine CH4 flux at the sediment-water interface. CH4 fluxes show a nonlinear relationship with the magnitude of VHEFs, where high VHEFs introduce O2 into riverbed sediments, which inhibit CH4 production and induce CH4 oxidation, and low VHEFs cause transient reduction in CH4 flux (relative to production) due to reduced advective CH4 transport. In addition, VHEFs lead to the hysteresis of temperature rise and CH4 emissions because high river discharge caused by snowmelt in spring leads to strong downwelling flow that offsets increasing CH4 production with temperature rise. Our findings reveal how the interplay between in-stream hydrologic flux besides fluvial-wetland connectivity and microbial metabolic pathways that compete with methanogenic pathways can produce complex patterns in CH4 production and emission in riverbed alluvial sediments.

Water level changes in Lake Erie drive 21st century CO2 and CH4 fluxes from a coastal temperate wetland.

Wetland water depth influences microbial and plant communities, which can alter the above- and below-ground carbon cycling of a wetland. Wetland water depths are likely to change due to shifting precipitation patterns, which will affect projections of greenhouse gas emissions; however, these effects are rarely incorporated into wetland greenhouse gas models. Seeking to address this gap, we used a mechanistic model, ecosys, to simulate a range of water depth scenarios in a temperate wetland, and analyzed simulated predictions of carbon dioxide (CO2) and methane (CH4) fluxes over the 21st century. We tested our model using eddy covariance measurements of CO2 and CH4 fluxes collected at the Old Woman Creek National Estuarine Research Reserve (OWC) during 2015 and 2016. OWC is a lacustrine, estuarine, freshwater, mineral-soil marsh. An empirical model found that the wetland water depth is highly dependent on the water depth of the nearby Lake Erie. Future wetland surface water depths were modeled based on projection of Lake Erie's water depth using four separate NOAA projections, resulting in four wetland water-depth scenarios. Two of the four 21st century projections for Lake Erie water depths used in this study indicated that the water depth of the wetland would remain nearly steady; however, the other two indicated decreases in the wetland water depth. In our scenario where the wetland dries out, we project the wetland's climatological warming effect will decrease due to smaller CH4 fluxes to the atmosphere and larger CO2 uptake by the wetland. We also found that increased water level can lower emissions by shifting the site towards more open water areas, which have lower CH4 emissions. We found that decreased water depths would cause more widespread colonization of the wetland by macrophyte vegetation. Using an empirical relationship, we also found that further drying could result in other, non-wetland vegetation to emerge, dramatically altering soil carbon cycling. In three of our four projections, we found that in general the magnitude of CO2 and CH4 fluxes steadily increase over the next 100 years in response to higher temperatures. However, in our driest simulations, we projected a different response due to increased oxidation of soil carbon, with CH4 emissions decreasing substantially from an annual cumulative peak of 224.6 to a minimum of 104.7 gC m-2 year-1. In that same simulation, net cumulative flux of CO2 changed from being a sink of 56.5 gC m-2 year-1 to a source of 369.6 gC m-2 year-1 over the same period, despite a temperature increase from 13.7 °C to 14.2 °C. This temperature shift in our other three cases with greater water depths increased the source strength of CH4 and the sink strength of CO2. We conclude that the magnitude of wetland greenhouse-gas fluxes depended on the water depth primarily as it affected the areal percentage of the wetland available for plant colonization, but dramatic decreases in water depths could cause significant reductions in the wetland CH4 fluxes, while simultaneously altering the wetland vegetation.

Ebullition dominates methane fluxes from the water surface across different ecohydrological patches in a temperate freshwater marsh at the end of the growing season.

Measurements of the spatial heterogeneity of methane fluxes in wetlands are critical to better understand and predict methane emissions at the ecosystem scale. However, the within-wetland spatial heterogeneity of fluxes is rarely assessed. Here, we use a spatially balanced rapid chamber-based survey of methane at different ecohydrological patches within a temperate freshwater marsh. We measured fluxes exclusively from the water surface without including vegetation. We further used the data from chamber measurements to partition diffusive and ebullitive fluxes. Three ecohydrological patches were distinguishable in the marsh, defined by the type and presence/absence of vegetation. These patches were emergent vegetation, floating-leaved, and open water. Net methane fluxes from the water surface (diffusion plus ebullition) in emergent vegetation patches were larger than in the floating-leaved vegetation and open water patches (p < 0.05). Diffusive fluxes, representing a sizable smaller fraction of net fluxes, were larger in vegetated than in unvegetated patches (p < 0.05), while ebullitive fluxes mirrored the magnitude and differences observed in the net fluxes. Moreover, pooled net and ebullitive fluxes across patches (but not diffusive fluxes) were negatively correlated with water levels, the primary variable affecting patch distribution. Altogether, our results indicate that the differences among ecohydrological patches are driven by ebullition, ultimately highlighting challenges faced by scientists and practitioners in the field and modelers seeking to improve the predictability and resolution of wetland biogeochemical models.

Methane and nitrous oxide porewater concentrations and surface fluxes of a regulated river.

Greenhouse gas (GHG) emissions from rivers are a critical missing component of current global GHG models. Their exclusion is mainly due to a lack of in-situ measurements and a poor understanding of the spatiotemporal dynamics of GHG production and emissions, which prevents optimal model parametrization. We combined simultaneous observations of porewater concentrations along different beach positions and depths, and surface fluxes of methane and nitrous oxide at a plot scale in a large regulated river during three water stages: rising, falling, and low. Our goal was to gain insights into the interactions between hydrological exchanges and GHG emissions and elucidate possible hypotheses that could guide future research on the mechanisms of GHG production, consumption, and transport in the hyporheic zone (HZ). Results indicate that the site functioned as a net source of methane. Surface fluxes of methane during river water stages at three beach positions (shallow, intermediate and deep) correlated with porewater concentrations of methane. However, fluxes were significantly higher in the intermediate position during the low water stage, suggesting that low residence time increased methane emissions. Vertical profiles of methane peaked at different depths, indicating an influence of the magnitude and direction of the hyporheic mixing during the different river water stages on methane production and consumption. The site acted as either a sink or a source of nitrous oxide depending on the elevation of the water column. Nitrous oxide porewater concentrations peaked at the upper layers of the sediment throughout the different water stages. River hydrological stages significantly influenced porewater concentrations and fluxes of GHG, probably by influencing heterotrophic respiration (production and consumption processes) and transport to and from the HZ. Our results highlight the importance of including dynamic hydrological exchanges when studying and modeling GHG production and consumption in the HZ of large rivers.

An Amplifier-Less Acquisition Chain for Power Measurements in Series Resonant Inverters.

Successive approximation register (SAR) analog-to-digital converter (ADC) manufacturers recommend the use of a driver amplifier to achieve the best performance. When a driver amplifier is not used, the conversion speed is severely penalized because of the need to meet the settling time constraint. This paper proposes a simple digital correction method to raise the performance (conversion speed and/or accuracy) when the acquisition chain lacks a driver amplifier. It is intended to reduce the cost, size and power consumption of the conditioning circuit while maintaining acceptable performance. The method is applied to the measurement of the output power delivered by a series resonant inverter for domestic induction heating.

Impacto del índice de masa corporal en la presión arterial medida con esfigmomanómetro de mercurio en niños y adolescentes con diabetes mellitus tipo 1 / The impact of body mass index on blood pressure measured with mercury sphygmomanometer in children and adolescents with type 1 diabetes mellitus

Resumen Introducción Los pacientes con diabetes mellitus tipo 1 (DM1) y sobrepeso tienen más riesgo de desarrollar cambios en la presión arterial (PA), y esto incrementa su morbilidad y mortalidad cardiovascular. En este estudio se determinó la relación entre la PA y el índice de masa corporal (IMC) y el promedio de las tres últimas mediciones de hemoglobina glucosilada (HbA1c) de pacientes con DM1. Métodos Estudio transversal analítico en niños y adolescentes con DM1 con más de un año de evolución. Las variables dependientes fueron la PA sistólica y diastólica medidas con esfigmomanómetro y las variables independientes, IMC y promedio de las últimas tres mediciones de la HbA1c. Se utilizó regresión lineal múltiple con intervalo de confianza del 95%. Resultados Se estudiaron 75 pacientes con DM1. La mediana del tiempo de evolución de la DM1 fue de 3.5 años (mínimo 1 año-máximo 14.8 años), el IMC 19.5 ± 3.1 kg/cm2 y la HbA1c 8.3 ± 2.4%. De los 75 pacientes, 66 presentaron PA < percentil 90 y 9 PA ≥ percentil 90 (12%). Se construyeron dos modelos de regresión lineal múltiple, con PA sistólica y diastólica como variables dependientes. Las posibles variables predictoras fueron sugeridas por el contexto teórico y el análisis estadístico. El IMC expresado en puntuación zeta (zIMC) fue predictor para PA sistólica/diastólica. Los modelos sugirieron que a cada incremento de unidad del zIMC corresponde un aumento de 5.1 y 3.6 mmHg de PA sistólica y diastólica, respectivamente. Conclusiones Se observó una correlación positiva de la PA sistólica y la diastólica con el zIMC.

Abstract Background Patients with type 1 diabetes mellitus (T1DM) and overweight have more risk to develop changes in blood pressure that increase cardiovascular morbidity and mortality. In this study, the relationship between blood pressure (BP) with the body mass index (BMI) and the average of the last three measurements of glycated hemoglobin (HbA1c) in patients with T1DM was determined. Methods A cross-sectional analytical study was conducted in children and adolescents with T1DM with over a year since diagnosis. The dependent variables were systolic and diastolic BP, measured with a mercury sphygmomanometer. The independent variables were BMI and average of the last three measurements of HbA1. A linear regression with a 95% confidence interval was used. Results Seventy-five patients with T1DM were studied. The median of disease duration was 3.5 years (min 1-max 14.8 years), BMI 19.5 ± 3.1 kg/cm2 and HbA1c 8.3 ± 2.4%. Sixty-six patients showed BP < percentile 90 and 9 BP ≥ percentile 90 (12%). Two models of linear regression were constructed, with systolic and diastolic BP as dependent variables. The possible predictor variables were suggested by theoretical context and statistical analysis. The predictive variable of high BP was zBMI (body mass index expressed in z-score) for systolic and diastolic BP. Also, the models suggested that for an increase of one unit of zBMI, corresponded a rise of 5.1 and 3.6 mmHg in systolic and diastolic BP, respectively. Conclusions A positive correlation between systolic and diastolic BP with zBMI was observed.

The impact of body mass index on blood pressure measured with mercury sphygmomanometer in children and adolescents with type 1 diabetes mellitus.

Background: Patients with type 1 diabetes mellitus (T1DM) and overweight have more risk to develop changes in blood pressure that increase cardiovascular morbidity and mortality. In this study, the relationship between blood pressure (BP) with the body mass index (BMI) and the average of the last three measurements of glycated hemoglobin (HbA1c) in patients with T1DM was determined. Methods: A cross-sectional analytical study was conducted in children and adolescents with T1DM with over a year since diagnosis. The dependent variables were systolic and diastolic BP, measured with a mercury sphygmomanometer. The independent variables were BMI and average of the last three measurements of HbA1. A linear regression with a 95% confidence interval was used. Results: Seventy-five patients with T1DM were studied. The median of disease duration was 3.5 years (min 1-max 14.8 years), BMI 19.5 ± 3.1 kg/cm2 and HbA1c 8.3 ± 2.4%. Sixty-six patients showed BP < percentile 90 and 9 BP ≥ percentile 90 (12%). Two models of linear regression were constructed, with systolic and diastolic BP as dependent variables. The possible predictor variables were suggested by theoretical context and statistical analysis. The predictive variable of high BP was zBMI (body mass index expressed in z-score) for systolic and diastolic BP. Also, the models suggested that for an increase of one unit of zBMI, corresponded a rise of 5.1 and 3.6 mmHg in systolic and diastolic BP, respectively. Conclusions: A positive correlation between systolic and diastolic BP with zBMI was observed.

Introducción: Los pacientes con diabetes mellitus tipo 1 (DM1) y sobrepeso tienen más riesgo de desarrollar cambios en la presión arterial (PA), y esto incrementa su morbilidad y mortalidad cardiovascular. En este estudio se determinó la relación entre la PA y el índice de masa corporal (IMC) y el promedio de las tres últimas mediciones de hemoglobina glucosilada (HbA1c) de pacientes con DM1. Métodos: Estudio transversal analítico en niños y adolescentes con DM1 con más de un año de evolución. Las variables dependientes fueron la PA sistólica y diastólica medidas con esfigmomanómetro y las variables independientes, IMC y promedio de las últimas tres mediciones de la HbA1c. Se utilizó regresión lineal múltiple con intervalo de confianza del 95%. Resultados: Se estudiaron 75 pacientes con DM1. La mediana del tiempo de evolución de la DM1 fue de 3.5 años (mínimo 1 año-máximo 14.8 años), el IMC 19.5 ± 3.1 kg/cm2 y la HbA1c 8.3 ± 2.4%. De los 75 pacientes, 66 presentaron PA < percentil 90 y 9 PA ≥ percentil 90 (12%). Se construyeron dos modelos de regresión lineal múltiple, con PA sistólica y diastólica como variables dependientes. Las posibles variables predictoras fueron sugeridas por el contexto teórico y el análisis estadístico. El IMC expresado en puntuación zeta (zIMC) fue predictor para PA sistólica/diastólica. Los modelos sugirieron que a cada incremento de unidad del zIMC corresponde un aumento de 5.1 y 3.6 mmHg de PA sistólica y diastólica, respectivamente. Conclusiones: Se observó una correlación positiva de la PA sistólica y la diastólica con el zIMC.

Management and outcome of obstructive ureteral stones in the emergency department: Emphasis on urine tests and antibiotics usage.

BACKGROUND: Kidney stone related complaints in the Emergency Department (ED) are common. Current guidelines recommend antibiotic therapy for infected obstructive stones and stone removal in a timely fashion, but there is no clear recommendation for prophylactic antibiotic use for bacteriuria or pyuria in the setting of obstructive ureteral stones. OBJECTIVES: The aim of this study is to evaluate the current management of patients with obstructive ureteral stones in a single ED with emphasis on urine tests and antibiotics use. METHODS: The picture archiving and communication system (PACS) was used to filter the list of patients who received a computed tomography (CT) scan of the abdomen and pelvis that positively identified obstructive ureteral stones. Demographics and clinical data were also recorded and analyzed. RESULTS: Of the patients discharged, 278 patients did not receive antibiotics in the ED or a prescription. Of these, 8 patients had positive culture, 4 patients followed up, and one developed and was treated for a urinary-tract infection. One hundred ninety two patients were not given antibiotics in the ED but received an antibiotics prescription, and 4 patients had positive cultures grow. Two followed up and had no infection-related complications. Fourteen patients were discharged without a prescription after receiving a single dose of antibiotics in the ED, with no positive urine cultures and 9 patients following up without complication. CONCLUSION: Antibiotics were given at the discretion of the provider without clear pattern. A high rate of infectious complication did not occur in the followed up patient group.

Carbon sequestration and methane emissions along a microtopographic gradient in a tropical Andean peatland.

Tropical alpine peatlands are among the least studied wetlands types on earth. Their important ecosystem services at local and regional scope are currently threatened by climate and land use changes. Recent studies in these ecosystems suggest their importance to the provision of climate regulation services, prompting a better understanding of the underlying functions and their variability at ecosystem scales. The objective of this study is to determine the variability of methane (CH4) fluxes and carbon (C) sequestration within a tropical alpine peatland in three locations along a microtopographic gradient and its associated plant diversity. These locations accounted for: 1) hummocks, found mostly near the edge of the peat with a water table below the soil surface, 2) lawns, in the transition zone, with a water-table near the soil surface, and 3) hollows, permanently flooded with a water table above the soil surface, composed of small patches of open water intermingled with unconsolidated hummocks that surface the water level. Results indicate that CH4 flux is lowest in the lawns, while C sequestration is highest. Conversely, the hummock and hollow have higher CH4 flux and lower C sequestration. In addition, plant diversity in the lawns is higher than in the hummock and hollow location. Dryer conditions brought by current climate change in the northern Andes are expected to lower the water tables in the peatland. This change is expected to drive a change in CH4 flux and C sequestration at the lawns, currently dominating the peatland, towards values more similar to those measured in the hummocks. This decrease may also represent a change towards the lower plant diversity that characterized the hummock. Such changes will reduce the ratio of C sequestration:CH4 flux signifying the reduction of resilience and increment of vulnerability of the climate-regulating service to further perturbations.

Author Correction: Nitrogen-rich organic soils under warm well-drained conditions are global nitrous oxide emission hotspots.

The original version of this Article contained an error in the first sentence of the Acknowledgements section, which incorrectly referred to the Estonian Research Council grant identifier as "PUTJD618". The correct version replaces the grant identifier with "PUTJD619". This has been corrected in both the PDF and HTML versions of the Article.

Nitrogen-rich organic soils under warm well-drained conditions are global nitrous oxide emission hotspots.

Nitrous oxide (N2O) is a powerful greenhouse gas and the main driver of stratospheric ozone depletion. Since soils are the largest source of N2O, predicting soil response to changes in climate or land use is central to understanding and managing N2O. Here we find that N2O flux can be predicted by models incorporating soil nitrate concentration (NO3-), water content and temperature using a global field survey of N2O emissions and potential driving factors across a wide range of organic soils. N2O emissions increase with NO3- and follow a bell-shaped distribution with water content. Combining the two functions explains 72% of N2O emission from all organic soils. Above 5 mg NO3--N kg-1, either draining wet soils or irrigating well-drained soils increases N2O emission by orders of magnitude. As soil temperature together with NO3- explains 69% of N2O emission, tropical wetlands should be a priority for N2O management.

Espiroadenocarcinoma localizado en pabellón auricular y cuero cabelludo: reporte de un caso de localización inusual / Spiroadenocarcinoma located on ear auricle and scalp: a case report of unusual location

Introducción: El espiradenocarcinoma es una neoplasia maligna inusual que suele surgir de un espiradenoma benigno solitario preexistente. La mayoría de las lesiones aparecen en tronco y extremidades, pero casos extremadamente raros se han reportado en la región del cuero cabelludo y pabellón auricular. Objetivo: Describir el caso de un paciente en quien se diagnosticó espiradenocarcinoma. Diseño: Reporte de caso. Materiales y métodos: Se presenta el caso de un paciente adulto mayor con masa en región auricular y cuero cabelludo, de crecimiento progresivo. Resultados: Los estudios imagenológicos e histopatológicos mostraron una lesión tumoral maligna derivada de los anexos cutáneos complicada con infección y miasis. Se le informa la importancia de resección quirúrgica, pero los familiares se negaron a dicho procedimiento. Por lo cual se le ofrecen medidas paliativas. Conclusión: Describimos un caso extremadamente raro de un espiroadenocarcinoma en cuero cabelludo cerca del pabellón auricular; siendo el primer caso descrito en Colombia.

Introduction: Spiradenocarcinomas an extremely rare malignant neoplasm. Most often arises from a preexisting solitary benign spiroadenoma. Most of the lesions often appear on the trunk, limbs and unusually, on the region of the scalp near the pinna. Objective: To describe a case of a patient who was diagnosed with spiroadenoma. Design: Case report. Methods: We present the case of an elderly patient with a progressive growth mass on the scalp near the pinna. Results: Imaging studies in conjunction with histopathology allowed to evidence a malignant tumor lesion derived from skin annexes and complicated with an infection process and secondary myiasis. We told him the importance of performing surgery but the family refused this procedure. Conclusion: We report an extremely rare case of a spiroadenocarcinoma of the scalp near the pinna; this is the first case reported in Colombia

Identificación de las causas de muerte fetal en una institución hospitalaria de atención materna de Cartagena, Colombia, 2012-2014 / Identification of the causes of foetal demise in a maternal care institution in Cartagena, Colombia, 2012-2014

Objetivo: determinar las causas de las muertes fetales registradas en una institución pública de referencia en Cartagena, Colombia, durante los años 2012-2014. Materiales y métodos: serie de casos. Se incluyeron los óbitos fetales que fueron sometidos a autopsia en la Clínica Maternidad Rafael Calvo de Cartagena, institución pública de segundo nivel de complejidad, que atiende a pacientes afiliadas al régimen subsidiado por el Estado. Se realizó muestreo consecutivo. Se evaluaron la edad gestacional, el sexo y la causa clínica de la muerte mediante el sistema ReCoDe que permite clasificar la muerte fetal mediante nueve categorías. Los resultados se presentan mediante estadística descriptiva. Resultados: se evaluaron 458 fetos con reporte de autopsia. Se estableció la causa de la muerte de manera probable o posible en 440 casos (97 %). Las principales condiciones asociadas a la muerte fetal fueron la insuficiencia placentaria (44,7 %), seguidas de las alteraciones relacionadas con el líquido amniótico (18,6 %), la causa materna (12,8 %), y las causas fetales (12 %). El 2,8 % de los casos fueron clasificados como inexplicados. Conclusiones: el sistema de clasificación ReCoDe permitió la adecuada clasificación de la causa de muerte en el 97 % de los óbitos fetales sometidos a autopsia.

Objective: To determine the causes of foetal demise documented in a public referral institution in Cartagena, Colombia between 2012-2014. Materials and methods: Case series including foetal demises taken to autopsy at the Rafael Calvo Maternal Clinic in Cartagena, a level II public institution that sees patients affiliated to the State subsidised healthcare regime. A consecutive sampling was used. Gestational age, sex and the clinical cause of death were analysed using the ReCoDe system in which 9 categories are used to classify foetal demise. Descriptive statistics are used to present the results. Results: Overall, 458 foetuses with an autopsy report were assessed. Possible or probable cause of death was established in 440 cases (97 %). The main conditions associated with foetal death were placental insufficiency (44.7 %), followed by amniotic fluid abnormalities (18.6 %), maternal causes (12.8 %), and foetal causes (12 %). Of all the cases, 2.8 % were classified as unexplained. Conclusions: The ReCoDe classification system was useful for classifying the cause of death in 97 % of foetal demises taken to autopsy.

Amiloidosis primaria localizada en amígdalas palatinas: presentación de caso infrecuente / Primary localized amyloidosis in both palatine tonsils: an infrequent case

La amiloidosis es una enfermedad poco frecuente, caracterizada por la presencia de depósitos extracelulares de agregados fibrilares de amiloide en órganos vitales, causando cambios estructurales y funcionales del tejido, puede ser primaria o secundaria, localizada o generalizada. En cabeza y cuello es una entidad muy rara y casi siempre se presenta en su forma localizada; siendo la laringe, el sitio más frecuente de presentación. Objetivo: Presentar el caso de una paciente femenina de 62 años con historia de disfonía, en quien se diagnosticó amiloidosis en amígdalas y realizar una breve revisión de esta enfermedad. Diseño: Reporte de caso. Materiales y métodos: Se presenta el caso de una paciente de 62 años con historia de disfonía, el examen físico reveló amígdalas aumentadas de tamaño y dolorosas. Se le realizó amigdalectomía bilateral. Se diagnosticó amiloidosis en amígdalas mediante estudio histopatológico con tinción de Rojo Congo e inmunohistoquímica. Resultados: Se descartó amiloidosis sistémica, dado que todos los estudios realizados para ésta resultaron negativos, los niveles séricos de inmunoglobulinas, paraproteinas, estudios hematológicos y seguimiento clínico hasta la fecha fueron normales, confirmando el diagnóstico de amiloidosis localizada en las amígdalas. Conclusiones: Es importante el estudio histopatológico e inmunohistoquímico para la realización del diagnóstico definitivo de esta patología. Además a todos los pacientes con diagnóstico de amiloidosis localizada en las amígdalas es indispensable realizar estudios hematológicos, detección de proteínas y seguimiento de los órganos blanco para descartar compromiso sistémico e impactar tempranamente en el pronóstico de los pacientes con esta enfermedad...

Amyloidosis is a rare disease characterized by the presence of extracellular deposits of fibrillar aggregates of amyloid in vital organs, causing tissue structural and functional changes; it may be primary or secondary, localized or generalized. In head and neck amyloidosis is a rare entity and almost always occurs in its localized form; being the larynx, the most common site of presentation. Objective: To describe the case of a 62 years old female patient with a history of dysphonia, in whom localized amyloidosis in the tonsil was diagnosed and to do a brief review of the disease. Design: Case report. Materials and methods: The case of a 62-year woman with history of dysphonia is presented, physical examination revealed enlarged and painful tonsils. A bilateral tonsillectomy was performed. Amyloidosis in tonsils was diagnosed by histopathology with Congo Red staining and immunohistochemistry. Results: Systemic amyloidosis was discarded, since all studies for this were negative, serum immunoglobulin levels, paraprotein, hematological and clinical monitoring to date were normal, confirming the diagnosis of amyloidosis localized in the tonsils. Conclusions: Histopathological and immunohistochemical study is highly important for diagnosing this pathology. Additionally, patients who are diagnosed with localized amyloidosis of the tonsils should be evaluated periodically for hematological studies, protein detection and tracking of the target organs in order to rule out systemic involvement and to impact early in the prognosis of patients with this disease...

Carcinosarcoma uterino con extensión pélvica: presentación de un caso y revisión de la literatura / Uterine carcinosarcoma with extension to the pelvis: Case presentation and review of the literature

Objetivo: se presenta un caso de carcinosarcoma uterino para hacer una revisión de la literatura publicada acerca de la epidemiologia, el diagnóstico, tratamiento y pronóstico de esta neoplasia. Materiales y métodos: se presenta el caso de una paciente de 73 años de edad, quien consultó a un centro de referencia para atención ginecoobstétrica en Cartagena (Colombia), por sangrado vaginal, pérdida de peso y masa pélvica. El análisis microscópico reveló un carcinosarcoma endometrial/ tumor mülleriano mixto maligno. Se realizó una búsqueda sistemática en las bases de datos Medline vía PubMed, Hinari, Imbiomed, ScienceDirect y EBSCO, utilizando los términos "Carcinosarcoma", "Neoplasias uterinas", "Útero". Se buscaron estudios tipo reporte de casos, revisiones de temas u otros estudios publicados en los últimos diez años, en inglés o español. Resultados: se encontraron 350 títulos de los cuales un total de 20 artículos estaban relacionados directamente con el tema, de estos se seleccionaron 18 que correspondieron a ocho reportes de casos, siete revisiones de temas, dos cohortes retrospectivas y un ensayo clínico. El carcinosarcoma uterino es una neoplasia poco frecuente que afecta especialmente a mujeres posmenopáusicas. Histopatológicamente se observa una combinación de cambios carcinomatosos y sarcomatosos; el tratamiento estándar es quirúrgico. La profundidad de la invasión miometrial ha sido sugerida como factor pronóstico muy importante, y en un 50 % de los casos presenta extensión extrauterina que se asocia con una supervivencia general muy pobre. Conclusiones: el carcinosarcoma es una neoplasia de baja frecuencia caracterizada por su población celular bifásica y mal pronóstico.

Objective: Presentation of a case of uterine carcinosarcoma and review of the literature on the epidemiology, diagnosis, treatment and prognosis of this neoplasm. Materials and methods: A 73 year-old female patient presenting with vaginal bleeding, weight loss and a pelvic mass to a referral centre for gynaecological and obstetrical care in Cartagena, Colombia. The microscopic examination revealed a mixed malignant endometrial carcinosarcoma/ müllerian tumor. A systematic search was conducted in the Medline via PubMed, Hinari, Imbiomed, ScienceDirect and Ebsco databases, using the terms "carcinosarcoma", "uterine neoplasms", "uterus". The search included case reports, topic reviews or other studies published within the past 10 years, both in English and Spanish. Results: Overall, 350 titles were found, 20 of which were directly related to the topic. Of these, 18 were selected, including 8 case reports, 7 topic reviews, 2 retrospective cohorts, and 1 clinical trial. Uterine carcinosarcoma is an infrequent neoplasm affecting post-menopausal women in particular. The histopathology shows a combination of carcinomatous and sarcomatous changes. The standard treatment is surgery. It has been suggested that the depth of invasion into de myometrium is a very important prognostic factor, and extra-uterine extension is found in 50% of cases. It is generally associated with very poor survival. Conclusions: Carcinosarcoma is an infrequent neoplasm characterized by biphasic cell population and poor prognosis.

Ascariasis hepática: reporte de un caso y revisión de la literatura / Hepatic ascariasis: report of a case and review of the literature

El absceso hepático causado por áscaris es una presentación muy rara; constituye el 1 % de todos los casos y puede estar compuesto por huevos y/o gusanos adultos. Se presenta caso de mujer de 70 años, admitida por urgencias, con dolor tipo cólico en hemiabdomen superior, vómito, fiebre y sensación de masa; trae reporte de ecografía con colelitiasis, áscaris en el colédoco y aumento del tamaño pancreático. La TAC muestra imagen con aspecto de colección en hígado y parte anterior del páncreas. La biopsia hepática reporta infiltrado inflamatorio crónico mixto de predominio eosinofílico con células gigantes multinucleadas y necrosis, asociado a estructuras circulares compatible con ascariasis. Se realiza tratamiento con antibióticos y antihelmínticos, con evolución satisfactoria. En la literatura consultada son raros los casos reportados de ascariasis hepática, por lo cual es pertinente el reporte del caso.

Liver abscess caused by Ascaris is a very rare presentation, constituting about the 1 % of all cases and can consist on eggs and adult worms. There is a case of a 70 years woman admitted in emergency room due to colicky pain in the upper abdomen, vomiting, fever and abdominal mass sensation, the report of abdominal ultrasound shows cholelithiasis, Ascaris in the common bile duct and pancreatic enlarge-ment. Computed tomography showed an image reflecting collection in liver and in the front of the pancreas. The liver biopsy reported chronic mixed inflammatory infíltrate of predominantly eosinophilic multinucleated with giant cells and dead tissue, associated to circular structures that are compatible with ascariasis. Antibiotic and anthelmintics treat-ment is performed with satisfactory evolution. In the consulted literature are rare reported cases of hepatic ascariasis, what is relevant for the report of the case.

Struma ovarii: presentación de caso y revisión de la literatura / Struma ovarii: Case presentation and literature review

Objetivo: presentar un caso de teratoma especializado del ovario y hacer una revisión de la literatura publicada en relación con la epidemiología y las características diagnósticas con énfasis en el diagnóstico histopatológico.Materiales y métodos: se presenta el caso de una paciente de 50 años de edad, con masa pélvica, que consulta a la ESE Clínica Maternidad Rafael Calvo, centro de referencia del departamento de Bolívar, institución de segundo nivel de complejidad, que atiende a pacientes de estratos socioeconómicos bajos y población rural. La ecografía y la tomografía axial computarizada muestran teratoma ovárico bilateral. Se realizó histerectomía más salpingooferectomía bilateral. El examen histopatológico del tumor derecho mostró múltiples estructuras foliculares tiroideas, con contenido coloide; se diagnostica struma ovarii. Se realizó una búsqueda de la literatura en Medline vía PubMed de 1966 a la fecha; además se buscó en Hinari, Imbiomed y Ebsco usando los términos: “Struma Ovarii”, “Ovario”, “Estruma”, “Teratoma monodérmico”, “Teratoma bilateral”, publicados en inglés o español que trataran sobre la epidemiología y el diagnóstico histopatológico.Resultados: se encontraron 450 artículos publicados, de los cuales se revisó un total de 27 relacionados con struma ovarii y teratomas bilaterales, de estos se seleccionaron 11 que correspondieron a reportes de casos y revisiones de tema.Conclusiones: el struma ovarii es una variante especializada de los teratomas ováricos, los signos y síntomas de hipertiroidismo y la aparición asociada de masa pélvica pueden sugerir el diagnóstico. El ultrasonido y la tomografía axial pueden ser útiles en el diagnóstico diferencial. Los criterios histopatológicos juegan un papel crucial en el diagnóstico definitivo.

Objective: To present a case of specialized ovarian teratoma and a review of the published literature on the epidemiology and the diagnostic characteristics of this tumor, emphasizing the histopathological diagnosis.Materials and methods: A 50 year-old female patient who was seen because a pelvic mass at the ESE Clínica Maternidad Rafael Calvo, level II referral center in the Department of Bolívar that serves patients of the rural areas and low socioeconomic levels. Ultrasound and computerized axial tomography revealed bilateral ovarian teratomas. Hysterectomy plus bilateral salpyngo-oophorectomy was performed. The histopathology of the right-sided tumor showed multiple follicular thyroid structures with colloid content, resulting in a diagnosis of Struma Ovarii. A search of the literature was conducted in Medline via Pubmend, from 1996 to this date. Additional searches were conducted in Hinari, Imbiomed, and Ebsco using the terms “Struma Ovarii”, “Ovary”, “Struma”, “Monodermal teratoma”, “Bilateral teratoma”, published in English or Spanish and dealing with the epidemiology and the histopathological diagnosis.Results: Overall, 450 published articles were found and, of those, 27 relating to struma ovarii and bilateral teratomas were reviewed. Of those, 11 case reports and reviews of the subject were selected.Conclusions: Struma ovarii is a specialized variant of ovarian teratomas, and signs and symptoms such as hyperthyroidism and the associated presence of a pelvic mass may suggest the diagnosis. Diagnostic tests include ultrasound and axial tomography, which may help with differentiation and diagnosis. Histopathological criteria play a crucial role in the final diagnosis. Histopathological criteria play a crucial role in the final diagnosis.

Coloboma ocular como hallazgo incidental. Reporte de caso / Ocular coloboma as incidental finding. A case report

El coloboma ocular es una entidad infrecuente provocada por el cierre incompleto de la fisura embrionaria entre la quinta y la séptima semana de gestación. Se presenta el caso de una paciente de 6 años admitida por urgencias por presentar trauma contundente en el ojo derecho, es valorada por oftalmología, que encuentra en la ecografía ocular bilateral, compromiso de ojo derecho con ectasia y herniación secundaria del humor vítreo hacia la pared posterior del globo ocular y desarrollo anormal de la retina, coroides y esclera. Se decide realizar procedimiento quirúrgico que se lleva a cabo sin complicaciones. Patología reporta, cambios de metaplasia del contenido "Uveo-retiniano", formando cartílago, musculo y tejido adiposo, que se dispone de forma desordenada en un estroma fibroso, realizando diagnóstico de Coloboma Uveal.

Ocular coloboma is an uncommon condition caused by an incomplete closure of the embryonic fissure between the fifth and the seventh week of gestation. We reported a case of a 6 year old patient who was evaluated by ophthalmology service at emergency room after blunt trauma in the right eye. Patient was evalutated bilaterally with ocular ultrasound which showed, commitment ectasia right eye and vitreous herniation secondary to posterior wall eyeball and abnormal development of the retina, choroid and sclera. Was decided to perform a surgical procedure is performed without complications. Pathology reports, content metaplastic changes "uveo-retinal" forming cartilage, muscle and adipose tissue, which is arranged in a disorderly manner in a fibrous stroma, making diagnosis of Uveal Coloboma.